{"ArguAna": [{"query": "In the absence of positive evidence for the existence of God the rational position is agnosticism, not atheism:  In a situation where there is an absence of either positive evidence for a claim or definite negative evidence for it, the natural response is not rejection of the claim, but rather skepticism and admission of lack of knowledge one way or the other. [1] In the case of religion and God, this position is agnosticism. Humans are fallible organisms, and thus all statements about truth and about the Universe must be qualified by some degree of doubt. Positively rejecting the existence of God, as atheism does, ignores this requisite doubt even though it cannot prove that there is no God. Rather, in the absence of evidence for or against the existence of God, the most the atheist can say honestly is that he does not know. The claims of atheism are positive ones and thus require evidence; an atheist position is thus faith-based in the same way a theist one is.  [1] Hume, David. 1748. An Enquiry Concerning Human Understanding. New York: Oxford University Press (2008).", "pos": ["y epistemology religion church faith religion general god morality secularism The rational position in the absence of positive evidence about God is not agnosticism, but atheism. While there is always a degree of doubt in every statement, this does not mean that negative claims about an entities existence can never be made. One can rationally state that fairies do not exist, even if there is no positive evidence for their non-existence. The very fact that no evidence exists for the existence of fairies, in the same way there is no evidence for the existence of God, is evidence of the negative. Thus, in the evidence of positive evidence for God, the rational default position is atheism."], "neg": [" The pursuit of pain for the purpose of achieving pleasure is an immoral act  Not only does the state have the right and obligation to uphold the morals of society and stop deviant behavior, but it also has an obligation to prevent escalation of deviance. Acts such as sadomasochism are good indicators of the propensity for escalation to further deviant acts.  With the passing of the Anti-Social Behaviour Act 2003 [i] in the UK, a legal precedent has been established where the government has the right and obligation to tackle minor deviant behavior as it can be a precursor to larger and more harmful deviance in the future. Even if S&amp;M was \u201cvictim-less\u201d, it demonstrates a propensity to inflict pain to gain pleasure and thus indicates high risk for developing a craving for infliction of pain of higher magnitude and scope in the future, which could be even more damaging to society.  [i] Anti-social Behaviour Act 2003.\" legislation.gov.uk. The National Archives, n.d. Web. 20 Jun 2011.", "e international africa house would provide access microfinance unbanked One of the key benefits highlighted about Oxfam\u2019s Saving for Change Initiative is the empowerment provided for women. Women are argued to be more independent, able to organise within communities, and provided with a voice of power. However, are women empowered?  In the cases of microfinance in Cameroon, Mayoux (2001) highlights the inequalities operating within community groups. The message is we cannot rely on communities, and social capital, for empowerment as women within such communities have different relations to power. The ability for women to use savings and credit for self-empowerment is limited by wider, traditional, gender inequalities. Microfinance may act to reinforce unequal power relations and positions within society.  Furthermore, women\u2019s empowerment needs to be understood as complex. [1] Real, and strategic, empowerment for women goes beyond increased access to economic resources. So how can microfinance ensure true empowerment?  [1] See further readings: Sutton-Brown, 2013.", " Foreign policy should follow the will of the people  Sanctions are not the will of the American people but of a small minority of embittered Cuban Americans in Florida who are being pandered to due to their importance in elections in a swing state. [1] Congressman Charles Rangel argues that the only success of the sanctions policy has been to \u201cappease the Republican constituency in Florida\u201d. [2] National opinion generally expresses no preference or opposes the ban, in a 2009 CBS poll asking \"Do you think the United States should or should not re-establish diplomatic and trade relations with Cuba?\" 67% said should. [3] Sanctions remaining in place is electioneering government at its worst, domestic interest groups controlling government foreign policy. As Karl Rove has admitted \"When people mention Cuba to me, it makes me think of three things: Florida, Florida, and Florida.\" [4]  [1] Griswold, Daniel, \u2018Four Decades of Failure: The U.S. Embargo against Cuba\u2019, 2005.   [2] DeYoung, Karen, \u2018Sanctions Against Cuba Are Excessive, GAO Says\u2019, 2007.   [3] Pollingreport.com, \u2018Cuba\u2019.   [4] Rosenthal, Joel H., \u2018The Cuba Wars: Fidel Castro, the United States and the Next Revolution\u2019, 2009.", "y epistemology religion church faith religion general god morality secularism If there is a benevolent deity, then there should not be the kinds of evil observable in the world and He would likely show more interest in His creation than He appears to have done so far:  If God, or the gods, were good there would be no evil in the world. Disasters would not kill millions of innocents, disease and hunger would not claim the lives of children every day, war and genocide would not slaughter people indiscriminately as they have done for countless bloody millennia. The world is awash with blood, pain, and suffering. No loving God would make a world so imperfect and troubled. [1] The world\u2019s ills are perfectly explained by the natural, amoral development of the Universe, of life, and of humanity. The reality of the Universe, however, is incompatible with a God of goodness, as He is conventionally described by today\u2019s predominant religions, which stem from the Abrahamic tradition.  [1] Tooley, Michael. 2009. \u201cThe Problem of Evil\u201d. Stanford Encyclopaedia of Philosophy. Available:", "onal americas politics government house wants line item veto amendment A President would be able to abuse the power given to them in a line-item veto authority, leveraging it into undue influence over other elements of the legislative process. By threatening to veto items dear to particular Congressmen, they could obtain assent to bills, treaties and appointments that otherwise would not be forthcoming. Such intimidation would be subtle and hard to prove, but it would erode checks on the executive and fundamentally alter the balance of power within the constitution. This means that budgets are politicised even more than is currently the case. When the line item veto was previously used by Clinton republicans such as Rick Santorum argued that every decision \"has political overtones, but that's fine, it comes with the territory,\" Senator Ted Stevens went further \"We're dealing with a raw abuse of political power by a president who doesn't have to run again\".1  1 Hugliotta, Guy and Pianin, Eric, 'Line-Item Veto Tips Traditional Balance of Power', Washington Post, 24/10/97,accessed 5/5/11", " Now Damaging Gender Roles?  There is certainly a case to be made that women, in modern-western society have completely shattered the traditional values and roles that are best suited to them.  For example, it has always been the case that men have been the providers, the defenders of themselves, the household and the family. Women have been the maintainers of these things. These things are not unfair. They are not unequal. They are simply what each gender is best suited for.  Women should not feel lesser than men simply because they are \"supposed\" to do \"motherly things\". The feminist movement has gone beyond its cause in beginning to deem what role in life is more appropriate.", " Profiling is racist:  Profiling in many ways would simply result in institutionalized racism, as Mark German argues: \u201cracial profiling is wrong, un-American and unconstitutional. It is institutionalized racism.\u201d [1] Mark Thompson adds: \u201cSo it\u2019s not 'political correctness' (aka the Equal Protection clause of the 14th Amendment) that is standing in the way of replacing full-body scans with a strong and effective profiling system: its reality. All that 'political correctness' is preventing is the implementation of an equally (and likely even more) ineffective piece of security theater in which we single out one minority group for intensive screening while giving a pass to everyone else. This would certainly annoy fewer people, but it wouldn\u2019t make us safer and its sole benefits would be accomplished by treating an entire minority group as second-class citizens.\" [2]  In any legal system which claims to give its citizens equal rights or equal protection of the law, security profiling is unacceptable. Profiling will target certain groups more than others. Even innocent members of these groups are made to feel like second-class citizens, and that the government suspects them of being terrorists without evidence \u2013 simply because of who they are. These individuals will be very visibly reminded of this every time they are segregated out at airport security, while they watch other non-suspects (who will be predominantly white and Christian, or at least non-Muslim) not being subject to the same scrutiny. The non-suspects will see this as well, and this may re-enforce any notions they have that all Muslims are potential terrorists and thus are suspect. Therefore because security profiling harms certain groups of citizens in unacceptable ways, it should not be instituted.  [1] German, Michael. \"Wrong and Unworkable\". New York Times Room for Debate. 4 January 2010.   [2] Thompson, Mark. \"Profiling, Political Correctness, and Airport Security.\" The League of Ordinary Gentleman. 29 November 2010.", " Participatory Democracy Produces Better Decisions  Participatory democracy will lead to better decisions because laws will only be passed if they can be justified to the people. Professional politicians are disproportionately drawn from the privileged classes and are often ignorant of the effects their policies will have on ordinary people \u2013 as are the civil servants who advise them. Moreover, professional politicians are susceptible to corruption, lobbying or bullying by powerful vested interests seeking to direct government policy away from the general interest represented by the vast majority of the individual citizens, who generally lack such a determinant influence over the decision-making. Participatory democracy will therefore make sure that the legislation that is passed will help the people as much as possible; for example they will limit unecessary bureaucracy and make sure that policies are fair. Thus for example Switzerland has passed with 68% of the vote in a referendum a proposal that prevents big payouts for managers known as \u2018golden handshakes\u2019 and \u2018golden parachutes\u2019 and shareholders will have a veto over saleries. [1]  [1] Willsher, K., and Inman, P. (3 March 2013) \u201cVoters in Swiss referendum backs curbs on executives\u2019 pay and bonuses\u201d The Guardian."]}, {"query": "Client-Attorney Privilege is already qualified appropriately  In exceptional circumstances, solicitors are told that they may depart from the rule of confidentiality contained in Rule 4 of the Solicitors' Code of conduct. Note 9 states that there are some regulatory bodies that are entitled to be informed of apparently confidential client communications. [1] In cases of suspected money laundering, solicitors have a duty under the Money Laundering Regulations 2007 [2] to inform relevant bodies of any suspected money laundering or any handling of the proceeds of crime. This means that there is flexibility in the rule of client confidentiality and client-attorney privilege which allows for justice to take its course in serious circumstances.  [1] Rule 4: Confidentiality and disclosure, Solicitors\u2019 Code of Conduct 2007,  accessed 18/05/11  [2] The Money Laundering Regulations 2007, legislation.gov.uk, No2157, 2007,", "pos": ["law general house believes attorney client privilege should be abolished The circumstances under which Note 9 allows such a break in the rule of client-attorney privilege is for the HM Revenue and other bodies that act for the benefit of the Government. It is rather archaic that a principle such as that of attorney-client privilege is loosened only for bodies that act for the benefit of the Government. This does not show that attorney-Client privilege is necessary but that it is not. If the Government is willing to do away with it for their monetary benefit, why can we not do away with it in the interest of justice for society? There should be a system that encourages the adversarial system, and attorney/client privilege but yet allows a variety of circumstances to override this principle, such as public interest and public security. These principles are often used to justify potential Human Rights breaches, so we should also be able to use them to justify the breach of attorney/client privilege."], "neg": ["eneral politics politics general house would limit right bear arms Guns don\u2019t kill people \u2013 people kill people. Restricting gun ownership will do nothing to make society safer as it is the intent of the criminal we should fear, and that will remain the same whatever the gun laws. In the vast majority of crimes involving firearms, the gun used is not legally held or registered. Many of illegal weapons are imported secretly from abroad, or converted from replica firearms rather than being stolen from registered owners.", "eneral politics politics general house would limit right bear arms Gun ownership increases the risk of suicide  There is a correlation between the laxity of a country\u2019s gun laws and its suicide rate \u2013 not because gun owners are more depressive, but because the means of quick and effective suicide is easily to hand. As many unsuccessful suicides are later glad that they failed in their attempt, the state should discourage and restrict the ownership of something that wastes so many human lives.", " After years of detention and separation from the battle field and terrorist networks, many Guantanamo detainees have no more value to US intelligence gathering efforts and national security, and so this is not a reason to continue their detention. Moreover, there are tens of thousands of anti-American terrorists around the world. Releasing a handful of the 250 detainees that are actually terrorists but that can't be tried in the US would be a drop in the bucket for terrorism and the war on terror.", "living difference house would ban music containing lyrics glorify It is usually the task of movie classification organisations such as the MPAA and the British Board of Film Certification to judge whether the content of a film should be cut or altered. In most cases these groups will be politically independent, but may be politically appointed. They will make the decision to cut content based partly on the criteria described above. A movie will only be censored if it contains shocking or offensive images used in a way that suggests that violence is glamorous, entertaining or without consequences.  There is a broad consensus in western liberal democracies on what constitutes a highly shocking or offensive image. For example, in even the most permissive societies, open and public images of sexual intercourse would be considered problematic. Similarly, graphic depictions of violence against vulnerable individuals would be open to wide condemnation. The thing that unifies each of these categories of image is that they can be easily understood and interpreted by the majority of people. Even a casual observer can understand that pornography is pornography. This is part of the reason why some states try to control extreme images \u2013 because they are both powerful and emotive, and easy to produce, display and distribute.  However, music and lyrics are different from images. Language contains a degree of abstraction, depth and nuance that only the most unconventional (and non-commercial) film could replicate. This is problematic, because it is much harder for censors and members of the general public to agree on an exact definition of an offensive statement or form of words. Complex legal processes are used to determine whether or not offensive statements are sufficiently offensive to be classed as hate crimes. Even more complex are the legal procedures used to determine when an individual\u2019s reputation has been damaged by allegations published in books or periodicals.  It will be much harder for ratings or certification boards to decide when a particular song is violent or offensive due to the range of meanings and ambiguities that are built into language. For example, the verse  \u201cGot a temper nigga, go ahead, lose your head/ turn your back on me, get clapped and lose your legs/ I walk around gun on my waist, chip on my shoulder/ \u2018til I bust a clip in your face, pussy, this beef ain\u2019t over,\u201d  can either be seen as a series of boastful threats, delivered directly by the musician, but it could also be reported speech \u2013 a lot of hip hop music is based on narratives or performer\u2019s accounts of past events. It could also be intended to invite condemnation of the behaviour of the character that the speaker has assumed. Hip hop artists frequently use alternative personas and \u201ccasts\u201d of characters to add depth to the narrative dimension of their tracks.  Under these circumstances, the process of classifying and censoring potentially violent lyrics is likely to become laborious. More important than the expense that this process will entail is the possibility that the chilling effect of a prolonged classification process will cause music publishers to stop promoting hip hop, metal and other genres linked with violent imagery. Lack of funds will curtail innovation and diversity in these genres.", " Could be cheaper  While budget should not be the primary concern of the justice system, The death penalty, when applied properly, can be cheaper. A lethal injection, or a few bullets, costs far less than keeping a person incarcerated for a long time, especially if they need long term health or other care in old age. The longer someone is in jail the greater the cost to the state.  The costs of the implementation of the death penalty are driven up by anti-death penalty activists using the appeals system. Since the death penalty would only be applied to the worst of the worst when there is absolute moral certainty there would be less need for extensive appeals because there would be less marginal cases.", "onal europe politics defence leadership house favours common eu foreign policy Consultation, collaboration and the attempted creation of a common set of values has not worked and is not likely to work. This language is not much different from what we have heard with every attempt the EU has made to push for further political integration. The role of the Common Foreign and Security Policy (CFSP), as agreed upon back in 1993 during the Maastricht Treaty, was in fact presented very much along similar lines. Fifteen years later however, that united front has not been created. If anything, the EU\u2019s political union, and certain any attempts towards a common foreign policy, have completely disintegrated when faced with the War in Iraq and the larger war on terror and more recently the Euro debt crisis on another front.", " Nuclear power is potentially extremely unsafe  It is unfortunately the case that the nuclear industry has a bad reputation for safety. This is undeserved. The overwhelming majority of nuclear reactors have functioned safely and effectively for their entire lifetimes. The four historic nuclear disasters (1957 Windscale Fire, 1979 Three Mile Island and 1986 Chernobyl, 2011 Fukushima, Japan) killed fewer people than the oil and coal industries have1. \"The multi-agency U.N. Chernobyl Forum reported last year that 56 deaths could be directly attributed to the accident, most of those from radiation or burns suffered while fighting the fire. Tragic as those deaths were, they pale in comparison to the more than 5,000 coal-mining deaths that occur worldwide every year\"2.  Further, the two major nuclear accidents, at Three Mile Island and Chernobyl, were both in old style reactors, made worse in the latter case by poor Soviet safety standards. The Chernobyl disaster took place at a time when our understanding of nuclear issues was much lesser than it is now, and was the result of poorly trained staff in the plant's control room. Power stations today are better staffed, better maintained and better understood, and because the effects of an attack upon them are acknowledged, they are better defended and monitored by the armed services. No system can be 100% safe, but solid design principles can minimize risk.  Perhaps the best guarantee of safety standards in the nuclear industry is the increasing transparency with which the industry is presenting itself. Many of the problems in its early days were caused by excessive control due to the origin of nuclear energy from military applications. As the gap between the two separates so the nuclear industry becomes more accountable. The question is, is the slight risk of a nuclear accident a worse danger than the inevitable climate catastrophe that awaits us?  1 'Risks of Nuclear Power' by Bernard Cohen, University of Pittsburgh, 2Patrick Moore, a prominent environmentalist and founding member of Greenpeace, \"Going Nuclear A Green Makes the Case\", Washington Post, 4/16/06\"", " The Opposition is perfectly happy to be attacked for making life easier for people with disabilities by taking down barriers that separate them from the wider population. There a parts of any community that prefer to do things in a certain way, however governments rarely commit to guaranteeing all preferences, instead they guarantee a basic level of service provision and then offer choice where possible and affordable. This is true in education and welfare right through to national defense \u2013 militaries, except the US, tend to specialise and rely on allies for other operations."]}, {"query": "A federal Europe will ensure that large, multinational businesses remain accountable for their actions  In a globalised economy, there is a need to tame multinational corporations, which would be otherwise capable of playing national governments off against each other in search for low wages, social costs and state protection. A federal Europe would be powerful enough to demand high standards of behaviour from such companies, because only a powerful and economically significant player can dictate restricting conditions. This would ensure fair wages, safe working conditions and - additionally - Europe would be able to force the multinational companies to implement correct and holistic policies and would also be in a position to make a greater difference on environmental issues such as global warming. Sovereignty becomes less relevant when effective independence is lost anyway as the economy and the problems faced by all nations are increasingly globalised.", "pos": ["europe house believes federal europe The assumptions about the multinational corporations are not actually proved. National governments close deals with such corporations if both sides have interest in it. Even if we assume such a thing existed nowadays \u2013 in a federal Europe the same problem would occur only not with countries, rather with regions. That is because every region would want the company to create more business in its area so we will end up with the assumed status quo today.  The EU today is already strong enough in regards to implementing environmental policies and restrictions \u2013 the carbon tax, the cap and trade system. Dealing with the international issue of global warming is not a point of a federal Europe or the EU, but a completely different matter."], "neg": [" Paying housewives for their work is an important form of economic empowerment.  One of the most important factors of oppression of women\u2019s rights, particularly in the developing world, is dependence [1] . Women are often confined to the home by force, lack of opportunity or social stigma, on behalf of their husbands. When she is not paid, a housewife must rely on her husband for money, especially if she has children she is expected to take care of. Economic empowerment allows further freedom for women in countries where women are confined to the home [2] . By making women economic actors, you empower them to engage in different social structures and hold a stake and position in the centres of economic power. This is the most empowering tool one can offer women in most countries around the world [3] .  By paying housewives for their work, you offer one of the most powerful forms of social empowerment for women around the world.  [1] United Nations. Women's Work and Economic Empowerment. Accessed July 1, 2011.  .  [2] United Nations. Women's Work and Economic Empowerment. Accessed July 1, 2011.  .  [3] United Nations. Women's Work and Economic Empowerment. Accessed July 1, 2011.  .", " A DNA database would reduce the time spent tracking down suspects  A DNA database is not intended to replace conventional criminal investigation. The database ought to identify the potential suspects, each of whom can then be investigated by more conventional means. During 2008/09 in the United Kingdom, 'almost 6 in 10 crime scene profiles loaded to the National DNA Database were matched to a subject profile'1. There is no possibility of escaping the provision of technical evidence before a court. Doctors, ballistics experts, forensic scientists are already a common feature of the large criminal trial. The jury system is actually a bastion against conviction on account of complicated scientific facts. The British jury is instructed to acquit a defendant where they find reasonable doubt. If the genetic data and associated evidence is insufficiently conclusive, or presented without sufficient clarity, the jury is obliged to find the defendant not guilty. 1 NDNAD. (2009). National DNA Database: Annual Report 2007-09. Retrieved May 19, 2011, from", " Dress Codes instead of school uniform  Rather than having school uniform, why not have a dress code instead? This has all the benefits of uniform without the many disadvantages. While uniforms force all children to wear the same clothes, dress codes give students a lot of choice what to wear. Only a few unsuitable things are banned - for example, gang colors, very short skirts, crop tops, bare shoulders, etc", " Collaboration in editing does not encourage democratic principles, but merely privileges the loudest voice, or in this case, the most regular user. As such, creating knowledge by consensus is inherently flawed. A fact is not true simply because lots of people think so. Traditional encyclopaedias are written and edited by academics and professional experts, whose reputation is put on the line by the articles they produce. They have the credentials and expertise that give them the authority to write without requiring widespread communal feedback. However, anyone can write a Wikipedia article, regardless of how much or how little knowledge he or she has of the subject. Worse yet, because contributors are effectively anonymous, it is impossible to assess the quality of an article on an unfamiliar topic by assessing the credentials of those who have produced it. Collaboration, therefore, becomes a barrier to the provision of reliable, accurate and up-to-date information.", " Because religion combines dogmatic certainty with the existence of the afterlife, violence and death is all too easy to justify  Particularly in the case of contemporary Islam, although other historical examples could be referred to, the combination of certainty and the promise of life after death is a sure route towards violence. That said, Catholics and Protestants in Northern Ireland demonstrated this until recently; the Yugoslav wars between Catholics, Orthodox and Muslims, both sides of the battle for Israel/Palestine and many others in history could also be thrown into the mix.  Allowing people the opportunity to claim that \u201cGod\u2019s on our side\u201d can be used to justify anything, especially when He appears to be fighting on both sides.", " Intellectual women migrants outnumber intellectual men migrants  The need of belonging is greater for women than for men \u2013 Bardo and Bardo found that they miss home much more (5). On the other hand, unequal and discriminatory norms can be strong drivers of intellectual female migration (1). More young women than men now migrate for education and, in several European countries today, highly skilled migrant women outnumber highly skilled migrant men (1). Between 2000 and 2011, the number of tertiary-educated migrant women in OECD countries rose by 80%, which exceeded the 60% increase in the number of tertiary-educated migrant men. In Africa for example, the average emigration rates of tertiary-educated women are considerably higher than those of tertiary-educated men (27.7% for women and 17.1% for men).", " Alcoholism is a disease, if the story was that the president had measles, it wouldn\u2019t have got a mention.  Let\u2019s take an historical example of the \u2018well-being of the head or state\u2019 in \u2018democracies around the world\u2019. A majority of US citizens were unaware that FDR was wheel chair bound \u2013 even after his death. [i] The fact the Churchill hit the bottle early in the morning was never mentioned to voters in the UK, even at their \u201cdarkest hour\u201d, and still remains a matter of debate. [ii] The French have long ignored the streams of mistresses wandering in and out of the \u00c9lys\u00e9e Palace throughout the history of the Fifth Republic. [iii]  All of these things were well known by the journalists of their time but there was no need for the story to be revealed. The allegation of the opposition was that Calder\u00f3n was a drunk, this then became a suggestion that he was an alcoholic \u2013 they\u2019re different things. This rather suggests that now research at all was undertaken into the allegation but that a slur was repeated as though it were news.  Because of popular confusion between the two, it was repeated, presumably, because it was salacious. Hardly the highest standards of journalism [iv] .  [i] Anderson, Stacy, \u2018FDR made 'tacit agreement' with public about disability\u2019, The University Record Online  [ii] Richards, Michael, \u2018Alcohol Abuser\u2019, The Churchill Centre and Museum at the Churchill War Rooms, London, 19 January 2009  [iii] Rocco, Fiammetta, \u2018Widows in weeds, mourning mistresses - plus ca change to the French\u2019, The Independent, 14 January 1996  [iv] UK National Union of Journalists (NUJ) Code of Conduct. The NUJ code is widely seen by British journalists as the final word on journalistic ethics. It is also widely ignored in practice.", " Ethno-religious divides are a bigger security threat  Poverty is clearly an immense problem for Africa but it is not primarily a security problem. There are parts of the globe such as South Asia and parts of South East Asia that have comparable poverty but little conflict and violence. Moreover not every African country is plagued with conflict. We therefore must look elsewhere for why Africa has high levels of conflict. Religious and Ethnic divisions are a much more direct security threat and cause for conflicts.  To start with, it is extremely easy to blame people of other ethnicity or religion of your own problems. This occurs throughout the world, no matter if we are talking about immigrants coming into the EU and US, about the Kurdish population in Turkey or about Israel and Palestine. Africa has 3315 ethnic groups, a huge number (1). Unlike Europe these have not been formed into cohesive nations with colonial borders often arbitrarily cutting through ethnic groups. A conflict is 25 percent longer and has a has a higher casualty rate when an ethnicity is divided by a national border. Examples of divided (and conflicted) groups are the Maasai of Kenya and Tanzania, and the Anyi of Ghana and the Ivory Coast. (2)  Division also occurs between religions. Samuel P Huntington wrote a famous book \u2018The Clash of Civilisations\u2019 that highlights that conflict is often created between religions. In Africa this means conflict in a swathe of northern Africa where Islam and Christianity meet. For example, the Muslim terrorist organization called Boko Haram, which has a lot of support in Nigeria, is engaged in a massive against Christians which has been responsible for the deaths of hundreds of non-Muslims.(2)  (1) Wentzel, Dr. John, \u2018Who are the developing world\u2019, johnwentzel.com, 28 February 2013,   (2) Gilman, Azure, \u2018The Violent Legacy of Africa\u2019s Arbitrary Borders\u2019, Freakonomics, 12 January 2011,   (3) Stark, William, \u201cBoko Haram's Anti-Christian Violence Continues in Northern Nigeria\u201d, Religion Today, 13 September 2013,"]}, {"query": "People will die if we don\u2019t do animal testing  Every year, 23 new drugs are introduced in the UK alone.[13] Almost all will be tested on animals. A new drug will be used for a long time. Think of all the people saved by the use of penicillin. If drugs cost more to test, that means drug companies will develop less. This means more people suffering and dying", "pos": ["animals science science general ban animal testing junior Many of these drugs are \u201cme too\u201d drugs \u2013 ones with a slight change that doesn\u2019t make much difference to an existing drug. [14] So often the benefits from animal testing are marginal, and even if there was a slight increase in human suffering, it would be worth it based on the animal suffering saved."], "neg": ["economic policy society immigration house believes developing nations should While factually true for developed nations, this point completely disregards the reality of developing nations. Most of the labour that is available is unskilled, whether it is in the rural or urban communities. There is little reason to believe that the poor will automatically be able to gain better education should they move to the city. The harm caused by letting migrants flood the cities to lead a miserable life greatly outweighs that of having one or two too intelligent farmers who miss out on their calling.", " Bribery is only wrong under a Western-centric notion of corruption  Norms and values differ between countries. In many non-western societies gift taking and giving in the public realm is a matter of traditions and customs. Moreover, gift giving is a part of negotiations and relationship building in some parts of the world. It is hypocritical for the west to target developing countries for this as many so-called democracies are hopelessly compromised by business interests through political funding and lobbying.  The United States Foreign Corrupt Practices Act bans large bribes but allows for the payment of small \u2018customary\u2019 sums in order to ease transactions. [1]  [1] The Economist, \u2018When a bribe is merely facilitating business\u2019 June 11th 2011,", " How this would work  This policy involves an active disclosure campaign, through websites and the newspapers, where a sex offender has their name, their photo, their address and the nature of their crime published on a website, or in the local media. It may include poster campaigns about individuals for particularly serious crimes, with the aim of both informing people and causing shame. It may be sensible to allow the police to not disclose the information in the following circumstances; 1) where a significant risk of vigilantism exists, 2) where it is against the wishes of the victim, and 3) where it may jeopardize an ongoing criminal investigation. Early studies showed that Megan's law in the United States had high rates of voluntary compliance, between 70 and 80% and rising, proving that the policy is practical1.  1 Simpson, Rachel, ''Megan's law' and other forms of sex-offender registration', NSW Parliamentary Library Research Service, Briefing Paper NBo. 22/99, November 1999,", " Keeping funds from government has negative consequences for spending  Let us not forget that in most of the cases when we talk about oil revenues, we are talking about very large sums of money, which can have an immense impact on the budget.  In countries where oil already contributes to the budget any change could be immensely disruptive to the government\u2019s ability to deliver services. If we take Venezuela as an example oil revenues account for 25% of GDP (1), with government expenditure of 50% of GDP (2) any drop in oil revenues would have an immense impact upon social policies such as education, health and welfare. For those where the funding would be new that country would be foregoing a potentially transformative sum of money that could help to eliminate poverty or provide universal healthcare and education.  Such a drop in funds flowing into the government would also have a huge impact on politics; politicians would block the implementation of a proposal that takes away so much revenue. If it did happen the independent fund would simply get criticism heaped on it as an excuse for why services can\u2019t be improved.  (1) Annual Statistical Bulletin 2013, \u2018Venezuela facts and figures\u2019, OPEC, 2013,   (2) 2013 Index of Economic Freedom, \u2018Venezuela\u2019, Heritage Foundation, 2013,", " Allowing grey goods breaks down monopolies and passes on lower prices to consumers.  Allowing grey imports means that manufacturers do not concentrate economic power in a monopolistic way which can be damaging to free trade (even Adam Smith1believed certain monopolies were antithetical to free trade). Banning them is tantamount to granting a licensed monopoly or cartel on a country-by-country basis, which inevitably means higher prices for consumers. As manufacturing has increasingly been relocated into a smaller number of offshore countries, rather than in the country of purchase, it makes sense that other parts of the supply chain should make a similar move so that they too can realise the efficiency benefits of a globalised economy.  1 Smith, Adam, \"An Inquiry into the Nature and Causes of the Wealth of Nations\" 1776", " Pursuance by the ICC doesn't actually result in punishment of the leader; empirically, it has actually strengthened criminals' power after criticizing them.  Nations, such as African nations like Chad, have painted the actions of the ICC as signs of Western imperialism and domination. Sudan's Bashir, accused of genocide and other crimes against humanity, used the ICC's arrest warrant against him as a sign of heroism and created a rally-around-the-flag effect, further strengthening his regime. Moreover, the ICC's work encourages leaders to cling to their power rather than give it and face prosecution, making punishment even more difficult. At worst, the ICC is actually counterproductive when it comes to punishing leaders and giving them retribution; at best, it is simply an ineffective court.1  1 \"The International Criminal Court: Why Africa Still Needs it.\" The Economist, 3 June 2010.", " Prevents the marginalisation of non-believers  The inclusion of the words \u201cunder God\u201d in the Pledge of Allegiance implies that there is no place for atheism in American patriotism and that non-believers have nothing to give to their country. The removal of these words would create a more inclusive America that accepts that everyone, including all non-Christians and non-believers, have something to give to their country. (Buckner 2002)", " The US has a right to expect that its taxpayers' money is spent responsibly.  The United States has made a significant investment in the institution. Not only was it a founder, but it plays host to the body in New York and makes the largest contribution of any nation each year. \"The debate over whether the United Nations will continue to overcharge American taxpayers is over \u2014 and the U.S. wound up on the losing end. In a dramatic turnaround from steady declines since 2001, the percentage that the U.S. will be charged for U.N. peacekeeping has been sharply increased for the next three years, and U.S. taxpayers will end up paying roughly $100 million more each year than they would have if the 2009 assessment rate had been maintained.\u201d [1] This is not acting responsibly in a time where Americans are feeling the pinch from the economic downturn. American taxpayers recognize that their society faces a great many problems that could be addressed with the dollars that are annually spent on the UN. While Americans are generally supportive of the institution, they have a right to know that their investment is used appropriately and pays dividends in good policy.  [1] Schaefer, Brent. \u201cU.N. Dues: Obama Lets American Taxpayers Down\u201d 6/01/2010  ."]}, {"query": "The apparent loss of liberty is overstated.  Negative cases of security abuse are few and have been greatly exaggerated by an emphatic civil rights lobby that has no empathy for the victims of terrorism. Of course, with any wide-scale attempt to fight terrorism there are bound to be a few cases of abuse of security measures. For example in the UK terrorism suspects were originally detained without charge under the Anti-Terrorism, Crime and Security Act however the detention was declared unlawful by the law lords in 2005 so the government introduced new scaled back policies such as \u2018control orders\u2019. [1] Therefore government has always been willing to scale back its security legislation when the courts believe it goes too far. Nonetheless it is not a good idea to shut down all security measures under a pretext that they violate rights [2] . The majority of the measures are intended to safeguard those civil liberties instead of abusing them.  [1] Hewitt, Steve, THE BRITISH WAR ON TERROR TIMELINE, Libertas, 2007,  , accessed 9 September 2011  [2] Stratton, Allegra and Wintour, Patrick, \u2018Nick Clegg goes to war with Labour over civil liberties\u2019, guardian.co.uk, 13 April 2010,  , accessed 9 September 2011", "pos": ["political philosophy house believes civil liberties should be sacrificed If there is even a slight injustice, then there is a problem worth addressing. It is a fact that recent anti-terrorism legislation, in nearly all western countries, has been used for a variety of uses from international banking [1] to petty thievery. This is obviously beyond the original intentions of these measures; something that should not be taken lightly.  [1] Wintour, Patrick, and Gillan, Audrey, \u2018Lost in Iceland: \u00a31billion from councils, charities and police\u2019, 10 October 2008,  , accessed 9 September 2011"], "neg": [" Unhealthy food is cheaper  A reason why people eat unhealthy foods is that it\u2019s often cheaper and easier than cooking something with fresh ingredients. Studies have shown that not only is junk food cheaper, its costs are less likely to increase due to inflation [14]. This was confirmed by research in Australia that showed that while healthy food became more expensive, junk food got cheaper [15].  Obesity is more common amongst poorer people. Because junk food is so cheap, it is eaten more. The best way to change this consumption pattern is to tax unhealthy food so that the healthy option is also the cheaper option.", " It certainly doesn\u2019t prove the point, it does however highlight one. As a result of religious teaching the majority of people have, at different points in history, been certain that;  The Earth was flat,  The Earth, or even a particular point on the earth, was the centre of the universe,  The Earth is less than six thousand years old,  Certain races were not human [i]  Women were created inferior to men  If ever evidence were needed that the majority are frequently and alarmingly wrong, then religion provides it in abundance.  [i] For example the Christian concept of Polygenism \u2013 the notion that the white races were descended from Adam and others not \u2013 has had several outings during history. Among other things it has been used to justify slavery, apartheid and imperialism.", " Regardless of what Puerto Ricans may or may not \u201cdeserve\u201d, the fact is that Puerto Ricans have rejected statehood many times now, making their voices heard on this issue many times since the late 1960's. The island has repeatedly voted to remain a commonwealth when votes were taken in 1967, 1993, and 1998. [1] If Puerto Ricans actually like their current status enough to vote for it when presented with the alternatives of statehood or independence, where is the injustice in that status continuing?  [1] United States Council for Puerto Rico Statehood. \u201cStatehood Issues\u201d. United States Council for Puerto Rico Statehood. 2004.", " The actions by Columbia and Sri Lanka do not alter the fact that, as noted earlier, the recruitment of child soldiers in Africa and elsewhere is still endemic in 2013.  And while the Lord\u2019s Resistance Army and its leader Joseph Kony have indeed been muted, that is largely due to the initiative of the U.S. government which has itself refused to ratify the ICC\u2019s Statute. [1]  [1] Schomerus, Allen and Vlassenroot", " The issue of Israel/Palestine has been a major one for the UN for sixty years, it is simply unfair that one of the parties represented and the other one is not  The territory claimed by both the state of Israel and the state of Palestine is contested. These matters should be settled by the UN but this is not possible when one of the parties is represented but the other is not. It is simply against the principles of natural justice \u2013 let alone the precepts of international law \u2013 for only one party in any dispute to be fully represented where the other is not.  Essentially, this is a fraud that has been perpetrated for over sixty years, in the interests of politics, justice has been ignored; Israel has been given recognition when Palestine has not, which body has the right to speak for the populace of that disputed territory should not be a matter imposed from outside but for the inhabitants of the land itself.", "animals science science general ban animal testing junior Many of these drugs are \u201cme too\u201d drugs \u2013 ones with a slight change that doesn\u2019t make much difference to an existing drug. [14] So often the benefits from animal testing are marginal, and even if there was a slight increase in human suffering, it would be worth it based on the animal suffering saved.", " The fact that religious thought tends to be subverted to defend the status quo is hardly a compelling argument as the same can be said for almost all forms of thought. There is a natural backlash from vested interests against any innovation and religion should not be blamed for having this same tendency. We should however not rule out the need to take a moral approach to some things for example; using stem cells might have huge medical benefits but it still needs to be considered whether it is morally right.", " Not all rebels have disarmed; the FDLR group has said it will disarm but has not done so. [1] The disarmament, demobilization and reintegration programme faces coordination and financial problems. There is a security threat from volatile border regions that might reverse the whole DDR effort as militias and military units struggle for control over resources and terrorise the local population. MONUSCO can't protect the repatriated civilians, which may mean any demobilisation is only temporary. If violence flares then so will guns be taken up once more.  [1] Mvano, Chrispin, \u2018U.N. Congo peacekeepers question Rwandan rebel disarmament claim\u2019, Reuters, 4 February 2014,"]}], "ClimateFEVER": [{"query": "Coastal lake sediments along the Gulf of Mexico shoreline from 1,000 to 2,000 years ago suggest more frequent and intense hurricanes than occur today.", "pos": ["Paleotempestology Paleotempestology is the study of past tropical cyclone activity by means of geological proxies as well as historical documentary records . The term was coined by Kerry Emanuel ."], "neg": ["Indian Red '' This article refers to the traditional New Orleans song ; for the color see Indian red ( color ) .  Indian Red is traditionally sung at the beginning and at the end of gatherings of Mardi Gras Indians in New Orleans . It is a traditional chant that may have been first recorded in 1947 by Danny Barker for King Zulu label ( Barker on guitar & vocals , Don Kirkpatrick on piano , Heywood Henry on baritone saxophone , and Freddie Moore ) . It has since been recorded many times by , among others , Dr. John and Wild Tchoupitoulas .", "Independent Battalion West Virginia Infantry The Independent Battalion West Virginia Infantry was an infantry battalion that served in the Union Army during the American Civil War .", "Crystallozyga Crystallozyga is a genus of snout moths . It was described by Meyrick in 1937 , and is known from the Democratic Republic of Congo . It contains the species C. alicia .", "Joe Rooney Joe Rooney ( born 1963 ) is an Irish actor and comedian from Tuam , Co. . Galway .   His best-known acting role was that of Father Damo in the Channel 4 sitcom Father Ted . He features in the episode `` The Old Grey Whistle Theft '' . Rooney has had a starring role in the RT\u00c9 television comedy , Killinaskully , in which he plays Timmy Higgins which ran for five series . Joe also wrote on the fourth and fifth series of Killinaskully . Joe currently hosts the podcast PodaRooney on which he interviews guests who are mostly involved in the entertainment industry . Joe has performed stand up worldwide including New York , L.A. , San Francisco , Chicago , Pittsburgh , Toronto , Shanghai , Beijing , Hong Kong , Barcelona , Brussels , Moscow , Muscat ( Oman ) , Manama ( Bahrain ) and Dubai . He has also performed at Irish festivals in Kansas City ( Missouri ) , Milwaukee and La Crosse ( Wisconsin ) .   In more recent years Joe has had featured roles in TV3 's Red Rock , CBBC 's Roy and the feature films `` Monged '' and `` South '' .   Other acting roles include Fergus Scully , a roving reporter who speaks in pidgin English and Irish , on the TG4 sketch show R\u00ed R\u00e1 . In 1997 , he appeared with Paul Tylak in Messrs Tylak and Rooney , a twelve-episode TV3 comedy travel series .", "Topolchane, Sliven Province Topolchane is a village located in Sliven Municipality , 10 km southeast of Sliven , Bulgaria , near the road to Burgas .", "Kivar (Roswell) Kivar is a fictional character from the Roswell television series and the Roswell High series of books . He is technically the main antagonist of the series , although he is not seen throughout the entire series until season 3 where he appeared in a few episodes . He is portrayed by Spence Decker .", "Cyrille Mangan Cyrille Mangan ( born 13 September 1976 ) is a retired Cameroonian football player .   Mangan played for Skoda Xanthi F.C. in the Greek Alpha Ethniki from 1996 to 1999 . He suffered a serious knee injury at the age of 22 years , but recovered and later played for Trikala F.C. in the Greek Gamma Ethniki and Panegialios F.C. in the Greek Beta Ethniki .   Mangan played for the Cameroon national football team in the 1998 African Cup of Nations finals . and in 1998 FIFA World Cup qualifying .", "Palestine at the 2000 Summer Paralympics One male and one female athlete from Palestine participated in the 2000 Summer Paralympics in Sydney , Australia . It was the first Palestinian Territories participation in the Paralympic Games . Husam Azzam won Palestine 's only medal : a bronze in the shot put ."]}, {"query": "This means the global temperature trend has now shown no further warming for 19 years", "pos": ["Scientific consensus on climate change There is currently a strong scientific consensus that the Earth is warming and that this warming is mainly caused by human activities. This consensus is supported by various studies of scientists' opinions and by position statements of scientific organizations, many of which explicitly agree with the Intergovernmental Panel on Climate Change (IPCC) synthesis reports.  Nearly all actively publishing climate scientists (97\u201398%) support the consensus on anthropogenic climate change, and the remaining 2% of contrarian studies either cannot be replicated or contain errors.", "Global warming Global warming , also referred to as climate change , is the observed century-scale rise in the average temperature of the Earth 's climate system and its related effects . Multiple lines of scientific evidence show that the climate system is warming . Many of the observed changes since the 1950s are unprecedented in the instrumental temperature record which extends back to the mid 19th century , and in paleoclimate proxy records over thousands of years .   In 2013 , the Intergovernmental Panel on Climate Change ( IPCC ) Fifth Assessment Report concluded that `` It is extremely likely that human influence has been the dominant cause of the observed warming since the mid-20th century . '' The largest human influence has been emission of greenhouse gases such as carbon dioxide , methane and nitrous oxide . Climate model projections summarized in the report indicated that during the 21st century the global surface temperature is likely to rise a further 0.3 to for their lowest emissions scenario and 2.6 to for the highest emissions scenario . These findings have been recognized by the national science academies of the major industrialized nations and are not disputed by any scientific body of national or international standing .   Future climate change and associated impacts will differ from region to region around the globe . Anticipated effects include warming global temperature , rising sea levels , changing precipitation , and expansion of deserts in the subtropics . Warming is expected to be greater over land than over the oceans and greatest in the Arctic , with the continuing retreat of glaciers , permafrost and sea ice . Other likely changes include more frequent extreme weather events including heat waves , droughts , heavy rainfall with floods and heavy snowfall ; ocean acidification ; and species extinctions due to shifting temperature regimes . Effects significant to humans include the threat to food security from decreasing crop yields and the abandonment of populated areas due to rising sea levels . Because the climate system has a large `` inertia '' and greenhouse gases will stay in the atmosphere for a long time , many of these effects will not only exist for decades or centuries , but will persist for tens of thousands of years .   Possible societal responses to global warming include mitigation by emissions reduction , adaptation to its effects , building systems resilient to its effects , and possible future climate engineering . Most countries are parties to the United Nations Framework Convention on Climate Change ( UNFCCC ) ,  whose ultimate objective is to prevent dangerous anthropogenic climate change . Parties to the UNFCCC have agreed that deep cuts in emissions are required and that global warming should be limited to well below 2.0 C-change relative to pre-industrial levels , with efforts made to limit warming to 1.5 C-change .   Public reactions to global warming and concern about its effects are also increasing . A global 2015 Pew Research Center report showed a median of 54 % consider it `` a very serious problem '' . There are significant regional differences , with Americans and Chinese ( whose economies are responsible for the greatest annual CO2 emissions ) among the least concerned ."], "neg": ["Shiriana language Shiriana ( Xiri\u00e2na , Chiriana ) , or Bahuana ( Bahwana ) , is an unclassified Upper Amazon Arawakan language once spoken by the Shiriana people of Roraima , Brazil . It had an active -- stative syntax .", "Iskander Mirza Iskander Ali Mirza ( \u0627\u0633\u06a9\u0646\u062f\u0631 \u0645\u0631\u0632\u0627 \u0987\u09b8\u09cd\u0995\u09be\u09a8\u09cd\u09a6\u09be\u09b0 \u0986\u09b2\u09bf \u09ae\u09bf\u09b0\u09cd\u099c\u09be b. 13 November 1899 -- 13 November 1969 ) , , was an East Pakistani politician who served as the first President of Pakistan , elected in this capacity in 1956 until being dismissed in 1958 .   A great grandson of Mir Jafar , Mirza was educated at the University of Mumbai before attending the military academy in Sandhurst , United Kingdom . After a brief military service in the British Indian Army , he joined the Indian Political Service and spent majority of his career as a political agent in the Western region of the British India until elevated as joint secretary at the Ministry of Defence in 1946 . After the independence of Pakistan as result of a Partition of India , Mirza joined was appointed as first Defence Secretary by Prime Minister Liaquat Ali Khan , only to oversaw the military efforts in first war with India in 1947 , followed by failed secessionism in Balochistan in 1948 . In 1954 , he was appointed as Governor of East Bengal by Governor-General Sir Malik Ghulam to control the law and order sparked as a result of the popular language movement in 1952 , and later elevated as Interior Minister in Bogra administration in 1955 .   Playing a crucial role in ousting of Governor-General Sir Malik Ghulam , Mirza assumed his position in 1955 and was elected as the first President of Pakistan when the first set of Constitution was promulgated in 1956 . His presidency , however , marked with political instability which saw his unconstitutional interference in the civilian administration that led to the dismissal of four prime ministers in mere two years . Facing challenges in effectively running the foreign and economic policy , Mirza suspended the constitution by having imposed the martial law in 1958 through army chief General Ayub Khan who later dismissed him when situation between them escalated , also in 1958 . Mirza lived in the United Kingdom for the remainder of his life and buried in Iran in 1969 .   His legacy and image is viewed very negatively by the Pakistani historians who believed that Mirza was responsible for this political instability in the country .", "Sumire Haruno is a Japanese actress , a former member of Takarazuka Revue , specializing in otokoyaku . She joined the revue in 1991 , became the top star in 2002 and resigned from the company in 2007 . She is from Komae , Tokyo , her birthday is December 15 , 1972 .   Her nicknames are Osa and Masa-chan ( as called by Jun Sena ) , both are from her real name Masako Osada ( \u9577\u7530\u96c5\u5b50 Osada Masako ) .   She is the first otokoyaku of her class to reach the top ( followed by classmate and former troupe-mate Hikaru Asami by 3 months ) .", "Regent's Business School London Regent 's Business School London ( informally Regent 's Business School , RBS London or RBSL ) is a private business school located in London , United Kingdom . The school is a part of Regent 's University London the campus of which was originally built in 1913 in the midst of Regent 's Park in central London .   Founded in 1997 , it has grown rapidly from 10 students to more than 450 . The student body is primarily international , with a large population of students from Persian Gulf Region , Asia , Northern and Eastern Europe .", "Niewiesz Niewiesz -LSB- ' \u0144ewjesz -RSB- is a village in the administrative district of Gmina Podd\u0119bice , within Podd\u0119bice County , \u0141\u00f3d\u017a Voivodeship , in central Poland . It lies approximately 8 km north-west of Podd\u0119bice and 45 km west of the regional capital \u0141\u00f3d\u017a .   The village has a population of 320 .", "Angus, Wisconsin Angus is an unincorporated community in the town of Cedar Lake , Barron County , Wisconsin , United States . Angus is located on Wisconsin Highway 48 2.5 mi southwest of Birchwood .", "Waterloo Region municipal elections, 2014 Municipal elections were held in the Regional Municipality of Waterloo of Ontario on October 27 , 2014 in conjunction with municipal elections across the province .", "Xiaoli Ma Xiaoli Ma from the Georgia Institute of Technology , Atlanta , GA was named Fellow of the Institute of Electrical and Electronics Engineers ( IEEE ) in 2016 for contributions to block transmissions over wireless fading channels ."]}, {"query": "The report [\u2026] found that the United States was one of the most pollution-free nations in the world.\u201d", "pos": ["Developing country A developing country , also called a less developed country or an underdeveloped country , is a nation or a sovereign state with a less developed industrial base and a low Human Development Index ( HDI ) relative to other countries . There are no universally agreed-upon criteria for what makes a country developing versus developed and which countries fit these two categories , although there are general reference points such as a nation 's GDP per capita compared with other nations . Also , the general term less-developed country should not be confused with the specific least developed country . The term `` developing '' describes a currently observed situation and not a dynamic or expected direction of progress . Since the late 1990s developing countries tended to demonstrate higher growth rates than the developed ones .   There is criticism for using the term developing country . The term implies inferiority of a developing country or undeveloped country compared with a developed country , which many countries dislike . It assumes a desire to develop along the traditional Western model of economic development which a few countries , such as Cuba and Bhutan , choose not to follow . An alternative measurement that has been suggested is that of gross national happiness . Countries on the boundary between developed and developing are often categorized under the term newly industrialized countries .   According to authors such as Walt Whitman Rostow , developing countries are in transition from traditional lifestyles towards the modern lifestyle which began in the Industrial Revolution in the 18th and 19th centuries .   In the 2016 edition of its World Development Indicators , the World Bank made a decision to no longer distinguish between `` developed '' and `` developing '' countries in the presentation of its data . Nobody has ever agreed on a definition for these terms in the first place .", "United States The United States of America ( USA ) , commonly known as the United States ( U.S. ) or America , is a constitutional federal republic composed of 50 states , a federal district , five major self-governing territories , and various possessions .  Forty-eight of the fifty states and the federal district are contiguous and located in North America between Canada and Mexico . The state of Alaska is in the northwest corner of North America , bordered by Canada to the east and across the Bering Strait from Russia to the west . The state of Hawaii is an archipelago in the mid-Pacific Ocean . The U.S. territories are scattered about the Pacific Ocean and the Caribbean Sea . Nine time zones are covered . The geography , climate and wildlife of the country are extremely diverse .   At 3.8 million square miles ( 9.8 million km2 ) and with over 324 million people , the United States is the world 's third - or fourth-largest country by total area , third-largest by land area , and the third-most populous . It is one of the world 's most ethnically diverse and multicultural nations , and is home to the world 's largest immigrant population . The capital is Washington , D.C. , and the largest city is New York City ; nine other major metropolitan areas -- each with at least 4.5 million inhabitants and the largest having more than 13 million people -- are Los Angeles , Chicago , Dallas , Houston , Philadelphia , Miami , Atlanta , Boston , and San Francisco .   Paleo-Indians migrated from Asia to the North American mainland at least 15,000 years ago . European colonization began in the 16th century . The United States emerged from 13 British colonies along the East Coast . Numerous disputes between Great Britain and the colonies following the Seven Years ' War led to the American Revolution , which began in 1775 . On July 4 , 1776 , during the course of the American Revolutionary War , the colonies unanimously adopted the Declaration of Independence . The war ended in 1783 with recognition of the independence of the United States by Great Britain , representing the first successful war of independence against a European power . The current constitution was adopted in 1788 , after the Articles of Confederation , adopted in 1781 , were felt to have provided inadequate federal powers . The first ten amendments , collectively named the Bill of Rights , were ratified in 1791 and designed to guarantee many fundamental civil liberties .   The United States embarked on a vigorous expansion across North America throughout the 19th century , displacing Native American tribes , acquiring new territories , and gradually admitting new states until it spanned the continent by 1848 . During the second half of the 19th century , the American Civil War led to the end of legal slavery in the country . By the end of that century , the United States extended into the Pacific Ocean , and its economy , driven in large part by the Industrial Revolution , began to soar . The Spanish -- American War and confirmed the country 's status as a global military power . The United States emerged from as a global superpower , the first country to develop nuclear weapons , the only country to use them in warfare , and a permanent member of the United Nations Security Council . The end of the Cold War and the dissolution of the Soviet Union in 1991 left the United States as the world 's sole superpower . The U.S. is a founding member of the United Nations , World Bank , International Monetary Fund , Organization of American States ( OAS ) , and other international organizations .   The United States is a highly developed country , with the world 's largest economy by nominal GDP and second-largest economy by PPP . Though its population is only 4.3 % of the world total , Americans hold nearly 40 % of the total wealth in the world . The United States ranks among the highest in several measures of socioeconomic performance , including average wage , human development , per capita GDP , and productivity per person . While the U.S. economy is considered post-industrial , characterized by the dominance of services and knowledge economy , the manufacturing sector remains the second-largest in the world . Accounting for approximately a quarter of global GDP and a third of global military spending , the United States is the world 's foremost economic and military power . The United States is a prominent political and cultural force internationally , and a leader in scientific research and technological innovations ."], "neg": ["List of listed buildings in Barry, Angus This is a list of listed buildings in the parish of Barry in Angus , Scotland .", "ECyD ECyD is an international Catholic youth organization affiliated with the congregation of the Legionaries of Christ and their lay movement Regnum Christi . ECyD membership is open to youth ages 11 to 16 ( to 18 in the USA and Canada ) .", "Domitila Garc\u00eda de Coronado Domitila Garc\u00eda Dom\u00e9nico de Coronado ( 7 May 1847 -- 1938 ) was a Cuban writer , journalist , editor , and professor , considered to be the first women to practice journalism in her country .   On 17 May 1891 she founded the Academy of Women Typographers . She founded and edited various publications , including the journals La Antorcha and El C\u00e9firo together with Sof\u00eda Estevez ( 1848 -- 1901 ) . Besides these , she was editor of La Mujer , together with A\u00edda Pel\u00e1ez de Villa Urrutia and Isabel Margarita Ordetx . She also published the first anthology of Cuban women writers in 1868 , titled \u00c1lbum po\u00e9tico fotogr\u00e1fico de escritoras cubanas ( Poetic photo album of Cuban women writers ) .", "Blue-cheeked flowerpecker The blue-cheeked flowerpecker or red-chested flowerpecker ( Dicaeum maugei ) is a species of bird in the Dicaeidae family . It is found on the Lesser Sunda Islands in Indonesia and East Timor . Its natural habitats are subtropical or tropical moist lowland forests and subtropical or tropical moist montane forests .", "Salzburg S-Bahn The Salzburg S-Bahn is a large transport project in and around Salzburg in the Euroregion of Salzburg -- Berchtesgadener Land -- Traunstein , which crosses the border between Austria and Germany . Its S-Bahn network has been partially in operation since 2004 and its first stage is expected to be completed in 2014 .", "William Hanson (engineer) William Hanson MICE ( 1810 -- 14 July 1875 ) was a government engineer in the early days of the colony of South Australia .", "Lola Gonzales Mar\u00eda Dolores Gonz\u00e1lez ( born March 2 , 1959 ) is a Mexican professional wrestler , known by her ringname Lola Gonz\u00e1lez , who has competed in the Universal Wrestling Association and the World Wrestling Association for over three decades . At one time one of the most popular female tecnicos in Mexico , she dominated the UWA World Women 's Championship during the mid-to late 1980s holding the title a record four times . She is the real-life sister of luchadora Leslie Gonzalez and ex-wife of the late Fishman .", "D15 D15 or D. 15 may refer to :  Slav Defence , 4 . Nc3 , Encyclopaedia of Chess Openings code  Dewoitine D. 15 , a French Dewoitine aircraft  HMS Vindex ( D15 ) , a 1943 British Royal Navy escort aircraft carrier  LSWR D15 class , a 1912 British steam locomotive model  PRR D15 , an 1892 American steam locomotive model  Allis-Chalmers Model D15  Dublin 15 , a Dublin , Ireland postal district  15-pin variant of D-subminiature electrical connectors   and also :  Benign neoplasm of other and unspecified intrathoracic organs ICD-10 code"]}, {"query": "Sea-level rise does not seem to depend on ocean temperature, and certainly not on CO2.", "pos": ["Paleocene\u2013Eocene Thermal Maximum The Paleocene -- Eocene Thermal Maximum ( PETM ) , alternatively ( ETM1 ) , and formerly known as the `` Initial Eocene '' or '' '' was a time period with more than 8 \u00b0 C warmer global average temperature than today . This climate event began at the time boundary between the Paleocene and Eocene geological epochs . The exact age and duration of the event is uncertain but it is estimated to have occurred around 55.5 million years ago .   The associated period of massive carbon injection into the atmosphere has been estimated to have lasted no longer than 20,000 years . The entire warm period lasted for about 200,000 years . Global temperatures increased by 5 -- 8 \u00b0 C . The carbon dioxide was likely released in two pulses , the first lasting less than 2,000 years . Such a repeated carbon release is in line with current global warming . A main difference is that during the Paleocene -- Eocene Thermal Maximum , the planet was essentially ice-free .   The onset of the Paleocene -- Eocene Thermal Maximum has been linked to an initial 5 \u00b0 C temperature rise and to extreme changes in Earth 's carbon cycle . The period is marked by a prominent negative excursion in carbon stable isotope records from around the globe ; more specifically , there was a large decrease in 13C/12C ratio of marine and terrestrial carbonates and organic carbon .   Stratigraphic sections of rock from this period reveal numerous other changes . Fossil records for many organisms show major turnovers . For example , in the marine realm , a mass extinction of benthic foraminifera , a global expansion of subtropical dinoflagellates , and an appearance of excursion , planktic foraminifera and calcareous nanofossils all occurred during the beginning stages of PETM . On land , modern mammal orders ( including primates ) suddenly appear in Europe and in North America . Sediment deposition changed significantly at many outcrops and in many drill cores spanning this time interval .   At least since 1997 , the Paleocene -- Eocene Thermal Maximum has become a focal point of considerable geoscience research because it probably provides the best past analog by which to understand impacts of global climate warming and of massive carbon input to the ocean and atmosphere , including ocean acidification . Although it is now widely accepted that the PETM represents a `` case study '' for global warming and massive carbon input to Earth 's surface , the cause , details and overall significance of the event remain perplexing .", "Sea level rise A sea level rise is an increase in the volume of water in the world 's oceans , resulting in an increase in global mean sea level . Sea level rise is usually attributed to global climate change by thermal expansion of the water in the oceans and by melting of Ice sheets and glaciers on land . Melting of floating ice shelves or icebergs at sea raises sea levels only slightly .   Sea level rise at specific locations may be more or less than the global average . Local factors might include tectonic effects , subsidence of the land , tides , currents , storms , etc. .  Sea level rise is expected to continue for centuries . Because of the slow inertia , long response time for parts of the climate system , it has been estimated that we are already committed to a sea-level rise of approximately 2.3 m for each degree Celsius of temperature rise within the next 2,000 years . IPCC Summary for Policymakers , AR5 , 2014 , indicated that the global mean sea level rise will continue during the 21st century , very likely at a faster rate than observed from 1971 to 2010 . Projected rates and amounts vary . A January 2017 NOAA report suggests a range of GMSL rise of 0.3 -- 2.5 m possible during the 21st century .   Sea level rises can considerably influence human populations in coastal and island regions and natural environments like marine ecosystems ."], "neg": ["U.S. Route 87 in Texas In the U.S. state of Texas , U.S. Highway 87 ( US 87 ) is a north -- south U.S. Highway that begins near the Gulf Coast in Port Lavaca , Texas and heads north through San Antonio , Lubbock , and Amarillo to the New Mexico border near Texline .", "HMSAS Africana HMSAS AfricanaHMSAS stands for `` His ( or Her ) Majesty 's South African Ship '' was a minesweeping trawler of the South African Seaward Defence Force during the Second World War . She was originally a sea fisheries research vessel and was latter fitted for mine-sweeping and survey duties in the early 1930s . She was retained for survey duties off the South African coast throughout the war and in October 1942 she was involved in the rescue of survivors from the American cargo vessel Anne Hutchinson after she was torpedoed by off East London . In addition to survey , she was used extensively for search and rescue operations in the latter part of the war and her final rescue operation was rescuing 49 survivors of the Canadian This was last vessel to be sunk in South African waters during the Second World War which was torpedoed by on 23 February 1945 off the coast of Luderitz Bay .   After the war , Africana was returned to the South African Department of Sea Fisheries and was re-fitted as a fishery survey vessel , starting her first post-war survey in May 1947 . She remained in service in this role until 1950 when she was replaced by the new survey vessel Africana II . She was sold to Benjamin Gelcer who used her as a fishing trawler . She later joined the fishing fleet of Irwin and Johnson and was used until 1965 when she was finally withdrawn from fishing service and broken up in Table Bay , to be sold as scrap .", "National Assessment and Accreditation Council The National Assessment and Accreditation Council ( NAAC ) is an organisation that assesses and accredits institutions of higher education in India . It is an autonomous body funded by University Grants Commission of Government of India headquartered in Bangalore .", "Ferdosi Mashhad FSC Eghtedar Novin Ferdosi Mashhad Futsal Club ( Persian : \u0628\u0627\u0634\u06af\u0627\u0647 \u0641\u0648\u062a\u0633\u0627\u0644 \u0627\u0642\u062a\u062f\u0627\u0631 \u0646\u0648\u06cc\u0646 \u0641\u0631\u062f\u0648\u0633\u06cc \u0645\u0634\u0647\u062f ) is an Iranian futsal club based in Mashhad , Iran . They currently compete in the Iranian Futsal Super League , the 1st tier of Iranian futsal .", "Li Ning (baseball) Li Ning ( born November 12 , 1994 ) is a Chinese baseball catcher who plays with the Shanghai Golden Eagles in the China Baseball League .   Li represented China at the 2015 Asian Baseball Championship and 2017 World Baseball Classic .", "Osmia atriventris Osmia atriventris , sometimes referred to as the Maine blueberry bee , is a megachilid bee native to eastern North America from Nova Scotia to Alberta in the north , and Iowa to Georgia in the south . This solitary bee normally gathers pollen from many different flowers , but will pollinate blueberries , and is sometimes used commercially for this purpose .", "Monte-Sano & Pruzan Monte-Sano & Pruzan was a highly regarded New York fashion house specialising in women 's tailoring , founded in 1915 by Vincent Monte-Sano senior , who was later joined by Max Pruzan . The company was liquidated in 1969 .", "Henry Klindt House The Henry Klindt House , is a located in the West End of Davenport , Iowa , United States . It has been listed on the National Register of Historic Places since 1984 ."]}, {"query": "The amount of summer sea ice in the Arctic has steadily declined over the past few decades because of man-made global warming, according to the National Oceanic and Atmospheric Administration.", "pos": ["Climate change in the Arctic The effects of global warming in the Arctic , or climate change in the Arctic include rising temperatures , loss of sea ice , and melting of the Greenland ice sheet with a related cold temperature anomaly , observed in recent years . Potential methane release from the region , especially through the thawing of permafrost and methane clathrates , is also a concern . The Arctic warms twice as fast compared to the rest of the world . The pronounced warming signal , the amplified response of the Arctic to global warming , it is often seen as a leading indicator of global warming . The melting of Greenland 's ice sheet is linked to polar amplification . According to a study published in 2016 , about 0.5 \u25e6 C of the warming in the Arctic has been attributed to reductions in sulfate aerosols in Europe since 1980 .", "Scientific consensus on climate change There is currently a strong scientific consensus that the Earth is warming and that this warming is mainly caused by human activities. This consensus is supported by various studies of scientists' opinions and by position statements of scientific organizations, many of which explicitly agree with the Intergovernmental Panel on Climate Change (IPCC) synthesis reports.  Nearly all actively publishing climate scientists (97\u201398%) support the consensus on anthropogenic climate change, and the remaining 2% of contrarian studies either cannot be replicated or contain errors.", "Arctic The Arctic ( -LSB- \u02c8\u0251rkt\u026ak -RSB- or -LSB- \u02c8\u0251rt\u026ak -RSB- ) is a polar region located at the northernmost part of Earth . The Arctic consists of the Arctic Ocean , adjacent seas , and parts of Alaska ( United States ) , Canada , Finland , Greenland ( Denmark ) , Iceland , Norway , Russia and Sweden . Land within the Arctic region has seasonally varying snow and ice cover , with predominantly treeless permafrost-containing tundra . Arctic seas contain seasonal sea ice in many places .   The Arctic region is a unique area among Earth 's ecosystems . For example , the cultures in the region and the Arctic indigenous peoples have adapted to its cold and extreme conditions . In recent years , Arctic sea ice decline has been caused by global warming . Life in the Arctic includes organisms living in the ice , zooplankton and phytoplankton , fish and marine mammals , birds , land animals , plants and human societies . Arctic land is bordered by the subarctic .", "Global warming Global warming , also referred to as climate change , is the observed century-scale rise in the average temperature of the Earth 's climate system and its related effects . Multiple lines of scientific evidence show that the climate system is warming . Many of the observed changes since the 1950s are unprecedented in the instrumental temperature record which extends back to the mid 19th century , and in paleoclimate proxy records over thousands of years .   In 2013 , the Intergovernmental Panel on Climate Change ( IPCC ) Fifth Assessment Report concluded that `` It is extremely likely that human influence has been the dominant cause of the observed warming since the mid-20th century . '' The largest human influence has been emission of greenhouse gases such as carbon dioxide , methane and nitrous oxide . Climate model projections summarized in the report indicated that during the 21st century the global surface temperature is likely to rise a further 0.3 to for their lowest emissions scenario and 2.6 to for the highest emissions scenario . These findings have been recognized by the national science academies of the major industrialized nations and are not disputed by any scientific body of national or international standing .   Future climate change and associated impacts will differ from region to region around the globe . Anticipated effects include warming global temperature , rising sea levels , changing precipitation , and expansion of deserts in the subtropics . Warming is expected to be greater over land than over the oceans and greatest in the Arctic , with the continuing retreat of glaciers , permafrost and sea ice . Other likely changes include more frequent extreme weather events including heat waves , droughts , heavy rainfall with floods and heavy snowfall ; ocean acidification ; and species extinctions due to shifting temperature regimes . Effects significant to humans include the threat to food security from decreasing crop yields and the abandonment of populated areas due to rising sea levels . Because the climate system has a large `` inertia '' and greenhouse gases will stay in the atmosphere for a long time , many of these effects will not only exist for decades or centuries , but will persist for tens of thousands of years .   Possible societal responses to global warming include mitigation by emissions reduction , adaptation to its effects , building systems resilient to its effects , and possible future climate engineering . Most countries are parties to the United Nations Framework Convention on Climate Change ( UNFCCC ) ,  whose ultimate objective is to prevent dangerous anthropogenic climate change . Parties to the UNFCCC have agreed that deep cuts in emissions are required and that global warming should be limited to well below 2.0 C-change relative to pre-industrial levels , with efforts made to limit warming to 1.5 C-change .   Public reactions to global warming and concern about its effects are also increasing . A global 2015 Pew Research Center report showed a median of 54 % consider it `` a very serious problem '' . There are significant regional differences , with Americans and Chinese ( whose economies are responsible for the greatest annual CO2 emissions ) among the least concerned ."], "neg": ["Ton du Chatinier Ton du Chatinier ( born 13 January 1958 ) is a retired football player from the Netherlands . He later worked as an assistant manager to Hong Myung-bo of South Korea , and alongside Hong as an assistant to manager Guus Hiddink at Russian side FC Anzhi Makhachkala .", "Ruddy quail-dove The ruddy quail-dove ( Geotrygon montana ) is a member of the bird family Columbidae , which includes doves and pigeons .   It breeds throughout the West Indies , Central America , and tropical South America . It has appeared as a vagrant in Florida and southern Texas . It lays two buff colored eggs on a flimsy platform built on a shrub . Some nests are built on the ground .   The ruddy quail-dove is approximately 19 -- 28 cm in length . The bird is distinguished by having a rust colored back , facial mask and similarly colored wings . The breast , rump and undereye stripe are lighter brown .   This bird is found in woodland and scrub forest . It also has adapted to coffee plantations . It is somewhat sensitive to forest fragmentation . These birds forage on the ground , mainly eating seeds . It will also take small invertebrates in its diet . Ruddy quail-doves feed primarily on the ground .", "Charles Joseph Gahan Charles Joseph Gahan ( 20 January 1862 -- 21 January 1939 ) was an Irish entomologist .   He was born on 20 January 1862 at Roscrea County Tipperary , Ireland . His father , Michael Gahan was the Master of Erasmus Smith 's School in Tipperary . He was educated first at Queens College Galway , where he achieved distinction , and then at the Royal School of Mines in Kensington . In 1882 he was awarded a medal and prizes as the best biological student of the session . In 1886 , he joined the British Museum ( Natural History ) as an assistant in the Department of Zoology where he became Keeper in the then newly formed Department of Entomology in 1913 . An expert on beetles , especially Cerambycidae , he wrote the 1906 volume of The Fauna of British India , Including Ceylon and Burma on that group . Honorary Secretary of the Entomological Society of London in 1899-1900 and was president 1917-1918 . Married Annie Woodward in 1887 . He retired in 1920 and lived at Mouth Aylsham in Norfolk and died at Aylsham on 21 January 1939 . He became the first person to describe Rosenbergia exigua in 1888 .", "Perry Daneshgari Perry ( Parviz ) Daneshgari is an Iranian-American entrepreneur , engineer and author born in Ahvaz , Iran . He founded MCA , which appeared on the TV Program World Business Review , in 1990 and has written many books and articles in specialized magazines and websites . Perry has an MBA from Wayne State University and a Ph.D in Mechanical Engineering from the University of Karlsruhe , as well as BS . in Civil and Mechanical Engineering . He specializes in Agile Construction , a way of doing business that focuses on adaptation and quick changes on job sites and production lines .   Perry has collaborated with research projects on different industries , most of them focused on increasing productivity in those industries applying agile methods of working , for example : `` Developing a Standard Format for Calculating Construction size and Share '' , `` Ideal Jobsite Inventory Levels to Improve Profitability '' for Electri International and other organization like Sheet Metal and Air Conditioning Contractors National Association , NAED Education and Research Foundation , New Horizons Foundation , etc. . Perry in collaboration with Heather Moore and MCA have written articles in some specialized magazines like Electrical Contracting Magazine , The Electrical Distribution Magazine , and more .", "Corner, Alabama Corner is an unincorporated community in Jefferson County , Alabama , United States .", "Tenth Ward Square The Tenth Ward Square is a 1.7 acre historic district in Salt Lake City , Utah that was listed on the National Register of Historic Places in 1977 . It includes Late Gothic Revival , Greek Revival , and Late Victorian architecture in four contributing buildings .   It includes an 1873 one-room Mormon meeting house , a c. 1880 store with included residence , an 1887 school , and a 1909 chapel . The store appears to be one of the first works of architect Richard K. A. Kletting . The church , designed by the Ashton Brothers , is `` known for its impressive stained glass window '' .", "George Dickinson George Ritchie Dickinson ( 11 March 1903 -- 17 March 1978 ) was a New Zealand cricketer and rugby union player . He played three tests for the New Zealand cricket team between 1930 and 1932 , and five matches for the New Zealand national rugby side , the All Blacks , in 1922 .", "Xia (surname) Xia is the Mandarin pinyin romanization of the Chinese surname written in Chinese character . It is romanized Hsia in Wade -- Giles , and Ha in Cantonese . Xia is the 154th surname in the Song dynasty classic text Hundred Family Surnames . As of 2008 , it is the 66th most common Chinese surname , shared by 3.7 million people ."]}], "CQADupstackAndroidRetrieval": [{"query": "How can I receive phone calls through Wi-Fi on an Android phone?", "pos": ["Is it possible to have a phone without a voice plan? > **Possible Duplicate:**   >  How can I receive phone calls through WiFi on an Android phone? I have an unlocked Nexus One. I barely use the voice function, mostly just use data. However, I'd like to have the voice function just in case. Is it possible to use something else (possibly VOIPish) to replace the voice plan that I am currently paying? Perhaps Skype, or Google Voice or something else. Has anyone had an experience with this? Thanks"], "neg": ["HTC EVO Does Not Sync Google Calendar I'm an experienced Android user and recently my Dad picked up a HTC EVO. I set him up with all the Google services and apps like Gmail, Contacts and Calendar. I exported all of his contacts and appointments out of Outlook to CSV and uploaded them to Google so they can sync down to his EVO. Unfortunately when I go to his Google account sync settings, his phone does not show the option to sync his Google Calendar. The exact option I'm talking about is under (from the home screen) Settings -> Accounts & sync -> your Google account. The phone shows Books, Contacts, and Gmail but the option for calendar is missing. Is this the case on all EVO's? I have a screen capture of my phone (HTC Incredible) that has the option below that I'm talking about. His HTC EVO does not have it for some reason. Is this a Sprint restriction? Any ideas on how to add it? Any help is greatly appreciated. Matt", "Will my alarm still go off if my phone is on airplane mode? I'm trying to save battery but I need my alarm in the morning. Will it still go off if on airplane mode? p.s. I have an HTC Inspire.", "Indic Language (Punjabi) not displaying I have created one mobile website using WordPress in Indian Language i.e. Punjabi. I have used Unicode characters. When I try to open this website on my **Spice Android Phone having version 4.0.2,** everything is perfect but When I try to Load on my **Lenovo having version 4.2.2,** nothing is displaying. only English characters are visible. I am using **default browser which is provided by the company** not any other like chrome, opera etc.. I cannot understand what is the problem.. it there any setting issue... please help....", "Cleaning up Samsung S2 memory When I use the application manager, I see that 1.8GB are occupied out of 2GB available. This of course causes issues when installing apps and brings up a warning notifications that some system services may malfunction. However, if I sum the memory taken by my apps, I come up at 1GB, and many of these apps have been moved to the SD card. I've tried to use Clean Master to free space, but without much success. So I want to cleanup files manually. What partitions on the phone's system are the ones in the 2GB space? Is it the root partition?", "Wi-fi disabled during lock still partly active? Or do I mis-interpret the battery graph? On my Google Nexus 7 I noticed that it would consume around 1% of battery each hour that it was just being idle. I suspected that battery-usage during idle time could be improved. So the next night (7 hours) I put my Nexus into airplane mode, and the next morning the battery had only used 1% for those 7 hours, which proved that there was room for improvement.   Next I disabled bluetooth and set wi-fi, to be disabled when the screen is locked (changed \"Keep Wi-Fi on during sleep\" from \"Always\" to \"Only when plugged in\"). After a fews tests of 7 hours idle the battery was down 2 ~ 3% each time. But then I noticed in the battery graph, that the wi-fi still showed quite a lot of activity. This probably explains the difference in battery consumption with airplane-mode.   I had expected the wi-fi to be completely disabled with this setting, and the wi-fi bar in the battery graph to be almost completely black. To see the difference I manually disabled the wi-fi and then the bar is indeed completely black (the right block in the image): ![enter image description here](http://i.stack.imgur.com/6A6ZO.png) I would expect the wi-fi to be completely off when the screen is locked, but looking at this question: Turning on Wi-Fi on demand that is apparently not how Android works. So now I'm wondering what the wi-fi is doing in this setting? Why does Android keep the wi-fi 'partly' enabled? If Android would still let apps do their syncing etc on a regular basis I would understand this, but this is not the case (Notifications don't come in & it even seems to cut off streaming etc), so it seems to only waste battery? I first suspected a misbehaving app, but I checked with Wake lock detector and Network log but don't see any suspicious apps. I guess I could use JuiceDefender or a similar app to completely disable the wi-fi when the screen is locked (and still let it sync from time to time), but that's not really the point of this question.", "last digits invisible from call history I have recently bought Sony Xperia and recently have been facing this weird problem. The last 2 digits of the phone number in call history are invisible. And this is not the case for whole history, but only for some. Please guide if you know reason/resolution for the same.", "My HTC One X and media link My HTC One X has configured with my media link and when plugged in my phone says the device has detected but it wont connect to it. It just times out. How can I solve this?", "Adding an APN from the commandline I'm in the US for 30 days and got a SIM card from Lycamobile. For some reason adding APNs doesn't work through the GUI (I add them but they never show up in the list, even after rebooting). Instead I added the following lines to my `/system/etc/apns-conf.xml`, just before `</apns>`                 <!-- BEGIN Custom APNs -->                                             <apn carrier=\"Lyca US\" mcc=\"311\" mnc=\"960\" apn=\"data.lycamobile.com\" type=\"GPRS\" user=\"lmus\" pass=\"plus\" />       <!-- END Custom APNs -->        Based on MCC and MNC data from Wikipedia and the information available online in general. I also enabled Data Roaming and International Roaming. I have rebooted my phone. I am on a Samsung Galaxy S3 running the latest AOKP nightly. However, I still get an R in my signal tray and cannot connect to the internet. Please advise - any help would be appreciated even if it a nudge in a new direction. Cheers, Gausie"]}, {"query": "What is the status icon that looks like a house?", "pos": ["Blinking icon in notification bar I have a new annoying icon on my Razr notification bar. It is a tiny blinking symbol that sort of looks like a tiny house with a cloud over it. It is blinking above the network strength bars where the \"x\" would be if there was no service. Anyone know what that is?"], "neg": ["Why doesn't Google Now's place-specific reminders remember my home location? I have my home and work locations set. These show up accurately in Google Maps and also in Google Now if I go \"Wand\" -> \"Places\" at the bottom. However, whenever I go to set a place-specific reminder, Google Now reprompts me to enter my home location. The screen looks like this: ![Google Now forgetting home location](https://www.martineve.com/android.png) As you can see, the \"Home\" field doesn't actually have an address below it. This is never remembered. How can I fix this?", "How do I install Play Store on my HCL Me tablet? I have an HCL ME Connect 2.0 tablet. It has 1Mobile Market pre-installed. I want to install the Google's original Play Store for multiple reasons, like the application Google Keep doesn't work because of the lack of \"Google Play Store services.\" I don't have any knowledge in a tablet's technical realms, like rooting it, so kindly be comfortably easy and reasonably detailed if there's a solution. Thanks!", "How can i turn off the message received tick I have a sony ericsoon xperia x10 mini. when I send a text message, a tick appears to let tme know it has been received by the recipient. This costs me money, how do I turn this off? I have looked through the menu and cannot seem to find the answer.", "Is there a PDF (or epub) reader that allows to take notes (or at least to copy text)? I have many PDFs that I would like to read on my Galaxy Tab and then take notes. Preferably the notes would be attached to the document (may be like Skim does), but as a workaround I can also imagine to copy a relevant piece of text into a separate note taking application. Preferably the reader should handle PDFs directly, but if there is no PDF solution I might also start converting the documents (maybe with Calibre) for an epub reader. I tried Adobe Reader, ThinkFree Office and Aldiko, all of which have acceptable performance loading the PDFs, but aside from cumbersome zooming they also lack the ability to copy or adding notes.", "Getting pictures off of old deactivated phone Can I hook up my old Galaxy S2 phone via USB to my laptop to find \"lost\" pictures in an unnamed file? I just activated my new Galaxy S4 and for some reason, all pics that were on my old phone are now gone from the new phone. Not sure why these would be deleted from the phone during a simple phone swap. Not all of my pics are on the sd card. Most of them were saved to the phone because it had much more space available. Customer service says it may take up to 24 hours for the transfer to be complete but the new phone already has all contacts & accounts transferred, plus I'm able to text & receive calls. I understand that during a transfer, pics are not usually included. But they should still be saved inside the old phone, right? The techs doing the swap shouldn't be able to do a factory reset or anything on the old phone, correct?", "Issue in GSM for Straight Talk and MMS. I just purchased a **GSM** unlocked Android phone. And called into Straight Talk to get the new `APN` setting. But, the settings they gave me would not allow me to receive **MMS**. The web and testing works fine. Please help me on which settings to use? **NOTE:** Someone told me to re-configure my phone, will this help?", "What does TRWP backup include? If I would take a backup via TRWP, does it include all my apps, app data, messages, contacts or it would just take backup of the ROM only, so I could get a fresh ROM with factory restored when I restore it ?", "Is there a Twitter app that allows filtering of tweets based on source, hashtag, etc? Tweet Deck for PC has a global filter that allows this but I cannot see this option in the Android client. As above, is there an app that has this feature? I would very much like to clear my tweetstream of Foursquare noise and the like."]}, {"query": "Configuring Background Images", "pos": ["How can I get the Android to use wallpapers sized to my screen resolution? When I only have one \"desktop\" on my Android phone and I select one of my photos for the wallpaper, it asks me to crop the image. The cropping tool only allows an aspect ratio that has nothing to do with the real aspect ration of my phones screen resolution. Why? I have a Samsung GT i5800 running Android 2.1update1."], "neg": ["My SIM is not recognized after installing Cyanogenmod; what should I do? I've got a Samsung Galaxy S (I9000) which I purchased from the Spanish operator Movistar around two years ago. I have spent most of the day trying to flash it with cyanogenmod 7. TL;DR: Installing cyanogenmod 7 was incredibly difficult It has been ... quite and adventure. First I tried heimdall from Ubuntu (didn't even connect to the phone) then I tried from Windows, using its graphical interface. It had the \"repartition\" flag activated by default, when it shouldn't, so I bricked my phone. After lots of trial an error, I managed to install a ROM in my phone, using Odin as root, the stock cable, and a different usb port than the one I was using (go figure...). And from there I was able to install cyanogenmod as it says on the instructions. Then I had to reinstall them, because they were bootlooping. END TL;DR So, now I've got a Samsung Galaxy S with Cyanogenmod 7. But it complaints that it doesn't detect any SIM card. When it boots up, it says \"No SIM card. Emergency calls only\". Notice that it doesn't say \"incompatible SIM\", Nor it asks me for a password of any kind. It just doesn't seem to detect the card at all. What steps can I follow to solve this issue, or at least get more information about it?", "Need only one icon in the top notification bar for multiple Gmail accounts I am trying to figure out how to have only one notification icon on the top notification bar for an incoming e-mail for any of my multiple Gmail accounts. This was the way Gmail worked on my phone prior to the 2.3.5 Gmail update. Now, at any given time I can have up to four little Gmail icons on my top notification bar which is an pain. Is there any way to change it to the way the notifications worked before? That is, one icon for all my accounts, and if I receive an e-mail, it sends me to the main accounts page.", "ZTE Blade S2E not enough space I have just installed 4.2.2 PAC and S2E later. I have everything on sd-ext, there's 1600MB free space on sd-ext, and 140MB inside. However anytime i want to install an app, it says there's not enough free space. I have restored some apps with MyBackup Root. I think that was the problem. How to solve it? I don't want to wipe data, I've made some important changes. (system 219MB/220MB) (cache 1MB/37MB)", "Can't send MMS messages (but can receive) About a week ago I lost the ability to send MMS messages. I can still receive, and single-recipient SMS works fine. The phone is a Moto X, stock. I did recently install some new apps; could one of them be interfering with the messaging app? EDIT: the message I get is `invalid destination address` or `could not send message`.", "How to enable SD MSC mount in Jelly Bean? Since upgrading to CyanogenMod 10, the dropdown notification when I connect my phone to the computer no longer appears. How do I mount the SD card via USB MSC in Jelly Bean? Note that the drive still appears to the computer, just empty. My phone is an Xperia Arc S. Update: I see no mass storage mode under USB connection settings: ![Settings](http://i.stack.imgur.com/2apXR.jpg)   Settings screen (click image to enlarge)", "How do I turn off the power-on sound and camera sound in a Galaxy S II? I have followed several guides and can't get any of them to work on my Galaxy S II. How do I disable these sounds?!", "Change the Nexus 4 voice dialer When I double tap the main button of my Bluetooth headset a voice dialer pops up. I'm not sure what app is this voice dialer (I couldn't find it on the apps list), all I know is that it's slow to load and works poorly. I'd like to replace this app with the standard voice search of the Google Search app. Is there a way to achieve this? Rooted options welcome.", "htc one x screen wake up issue I am having problem regarding my screen wake up. It wakes up from time to time automatically. I installed Wakelock Detector to track the app and found out Window manager has woken up the screen. I have formatted the phone but no luck. Thanks"]}, {"query": "How to make run only a single application with all other application stopped?", "pos": ["Single application tablet possible? > **Possible Duplicate:**   >  How to make run only a single application with all other application > stopped? Background: I would like to create a weather station alarm clock from an Android Tablet. This would sit on my bedside table. When I tap the screen or press the button or something, it would wake up and show me the local weather forecast. Question: Is it possible to make an Android tablet behave in a single application way like this? I.E. no apps, no app store, no 'slide to unlock', no other logos or screen clutter, that kind of thing? Added: This is more of a user interface question. I don't care if there are other applications on the device, I just want it to behave to the user as if this was a weather station device only, rather than an amazing multi-purpose computer. I don't need it to be secure against someone who really wants to get past the main application, I just want to prevent it always annoyingly switching out of the main app. Since it's going to be a weather station only, I don't want it always offering me irrelevant things, like a handy screen saver, other apps, slide to unlock, etc. and making me have to do loads of interaction to get back to its main app.", "Only give access to one application(full screen) I am considering using tablets for use with clients at my job and I was just wondering if there is anyway to lock users into one application. Just for theoretical purposes the application could be as simple as a sign in sheet where people would check in when they come into the buildings. what I want to disable is people's abilities to get out of the application(hitting the home button, et cetera). Basically I don't want people to have access to anything besides the sign-in application. Everything I've read points to this not being possible but I figure this is the best place to ask. Thanks in advance."], "neg": ["SD card not recognized by Acer A500 I just bought a used Acer A500 16 GB tablet yesterday. Everything works great -- except it doesn't recognize my 16 GB microSD card for storage, but says there is no external SD storage or it is emulated. I don't know a lot about rooting and such; the guy just told me it was rooted and is running JellyBean 4.1, which works great. Does anyone know how to get my SD card recognized again?", "Can't \"Wipe data/Factory reset\" due to broken power button **Alright, so a little background:** lately my Epic 4G touch has been acting up (restarting when it feels like it, power button won't work, going from 100% power to 20%, etc) and I decided to take appropriate action. I first purchased a new battery (as my previous one was \"bloated\" and had water damage) hoping that would fix my problems. Unfortunately it only reduced how often the problems occurred. My next course of action is to do a factory reset on my phone (it's rooted running CM 10) and get a new one from Sprint (I have insurance) which I did following this tutorial. Everything went well - as far as I can tell - but I am experience a boot loop as mentioned in the video. The remedy is to wipe the /data partition, which is where I'm stuck. **The problem:** As mentioned, my power button is broken, but in a very _odd_ way. I can use my power button to get into Recovery Mode, but after that it almost never works (and if it does it's as if I'm holding the power button and my phone restarts after about 5 seconds). So due to this I can't select \"Wipe data/factory reset\" from Recovery Mode. I tried using `adb` to wipe my data partition, but since my phone is no longer rooted I get \"Permission denied\" and any attempt to use `root` or `su` (obviously) fail. I'm not sure what my options are at this point, is there anyway I can wipe the `/data` partition without root or a power button?", "How to sync calendar with android without google? is there a way to sync an Ubuntu calendar application like Thunderbird Lightning or Evolution with an Android device without using google-calendar? At the moment I am syncing my Thunderbird-Lightning calendars on different computers via Dropbox, what is much more reliable than google-calendar. Another big advantage over google-calendar is, that I can access my appointments offline as well, since the calendar files are synced onto the harddrive of each computer by Dropbox. I'd like to access those calendars via my android device as well.   * The Dropbox-app for android does not support automatic syncing yet, so it seems like I have to use another service.   * Apart from that I guess I need to know an android app, that can access a calendar-file stored in ics-format.  Thanks in advance YSN", "How to display cell info display (CID) on screen? Does Android OS have an option for showing **Cell Info Display** (Name of the cell Tower) on home screen ? (Without using external apps)", "Nexus 4 with no signal (sleep mode) I have a problem with my sister's Nexus4. When I try to call her I have the reply that the phone is off while if I call the other phone (HTC Legend with the same operator) I can talk regularly. It happened both at home or outside. It is not a operator problem because I change the operator twice and with the same operator in the same places I can phone with no problem. The strange is that when a try to call N4 I am not able to start the call and after that the N4 receive a sms with the \"lost call\" and return it on-line. it seems it falls in a sleep mode when the creen is off", "Problems with wifi connection I have a netgear router wnr2200 and sometimes, when I connect with my tablet android or my cellphone, there are some problems. Using chrome, sometimes the page can load and load, I have to reload it. Using YouTube or play store, sometime it keeps on loading I have to restart (also seen with Astro file manager and freely). so I assume it is because some requests aren't succeeded.here are my home channels (my WiFi network is colored) ![enter image description here](http://i.stack.imgur.com/Appxb.jpg)i I already tried channel8 and 1, no success. Any idea (channel 14 is not supported)", "How to partition Samsung Galaxy Ace S5830 using ClockworkMod Recovery? Device: Samsung Galaxy Ace S5830 I am using ClockworkMod Recovery 6. There is no way in the CWM Recovery 6 to partition the SD card. Also, I am not able to install ClockworkMod Recovery 5 on my phone. How can I partition this phone using CWM?", "How to delete an app installed with Amazon Appstore? I've installed an app using Amazon Appstore, but I don't see a way to uninstall it. Amazon support has failed to respond to my question after 2 days. I prefer a method that does not involve deleting it with a file manager or some sort of root access."]}, {"query": "Necessary to manually update gapps?", "pos": ["Do apps included in the gApps zip get updated via Google Play? While using alternative ROMs like CyanogenMod 9(as i currently am), one flashes an additional zip file called gApps which contains apps provided by Google. As Google releases newer versions of applications, will the newer versions be updated via Google Play or do I need to manually flash a newer version of the gapps.zip? I'm asking because an update to the Google Play market app was recently released (which includes the ability to remove apps from the ALL MY APPS section) but I still haven't seen my market app updating itself."], "neg": ["Where are the downloaded Google Play Music files? I've looked in /Android/data/com.android.google.music/cache and nothing is there. I don't have an SD card.", "How to Install ClockworkMod on Innos A35 I tried to install ClockworkMod via ROM manager. My device(Innos A35) wasn't listed, but I chose one that was on the list thinking that it would somehow get installed. There was a download, but when I reboot to recovery mode the old recovery software with only a few options is shown. I was thinking that rebooting to recovery mode would bring up something like this if ClockworkMod was properly installed. Can someone point to me what could be wrong? Or can someone tell me how to manually install ClockworkMod without using ROM Manager?", "Xperia T not booting anymore, brick? I have a xperia T and I think its hardbricked. What I think what happened is this, i wanted to format my interal storage manually. But instead the entire mmcblkp0 got formatted.. Now I cant boot anymore and pc recognizes it as qualcomm hs-usb qdloader 9008. I already tried to recover with QPST tool, but no luck. Flashmode/fastboot is not working. Phone doesn't even vibrate on longpressing vol up + power. Does anyone know how this can be fixed? Thanks.", "Can I install a micro-SD card into my Note 2 after I've enabled device encryption? I recently got a Note 2 and enabled device encryption. I want to put a micro- SD in it now to expand my storage capacity, but when I go to settings, it won't let me mount the card. Is it because of the device encryption? Is there a way to add this drive without decrypting and re-encrypting?", "Battery charging issue in Samsung Galaxy S3 I have a Samsung Galaxy S3 and it is charging very very slowly when plugged into my PC. I deleted all my images and some videos and some other stuff and the charging seemed to speed up. Is battery charging is related to available memory? I didn't think it was.", "Can Android phones/tablets access W-Fi network drives? There are many WLAN routers currently available which have a USB port to connect external HDDs. These are than easily available on Windows machines directly in Windows Explorer, they look like common network drives. If I used an Android-based smartphone or a tablet which support WLAN, would it be possible to access these network drives somehow? I'm entertaining the idea of getting a tablet, and it's important to know if I can access a larger storage than what would be available locally via an SD card (if such a slot even would be present on a particular specimen).", "How can I factory reset my Android Mini 7100 Phone? I'm unable to go to recovery mode to factory reset (wipe my cache/data) my Android Mini 7100 Phone (Android GingerBread 2.3.x) because I forgot my phone lock combination. I tried resetting it using:   * Vol Down + Power,   * Vol Up + Power,   * Vol Up + Vol Down + Power,   * Vol Up + Vol Down + Home + Power, and the phone starts normally   * When I press Home + Power, it goes to 'Test' mode. I checked out this YouTube video but it did not work for me. How do I go to recovery mode?", "I can FastBoot my device. How can I reinstall an Android image to it? I accidentally deleted a file from my phone (Sky iVega IM-A800s, Gingerbread) and phone cannot boot now. I'm seeing an \"System operating error\" and device restarts repeatedly. I could get into FastBoot mode and I installed Android USB driver and ADB drivers, although I don't know what they are exactly. I couldn't find OEM Android images for the device (it's a Korean web site and they have an ActiveX based installer that doesn't work). I know StackExchange is a Q&A site and I really love this site. I would like to know if you know any software that let's me install a custom ROM (I could download a custom ROM for a similar model) using the PC. Device does not have USB debug mode enabled and the current installation is no longer functional. Can I install a ROM (or Flash ?) using a PC (Windows/Linux) to a FastBoot enabled device? I would be so grateful if you could shed a light for me. Thanks in advance."]}], "CQADupstackEnglishRetrieval": [{"query": "\"there are still a few administrative i's to dot and t's to cross\"", "pos": ["What does this sentence mean:\"If you fail to dot an \u201cI\u201d or cross a \u201cT,\u201d you could be...\"? > **Possible Duplicate:**   >  \"there are still a few administrative i's to dot and t's to cross\" From here there is a sentence: > If you fail to dot an \u201cI\u201d or cross a \u201cT,\u201d you could be banging your head > against the wall for hours. What does the author mean by `dot an \"I\" or cross a \"T\"`? Thanks."], "neg": ["Can I use indefinite article with superlative adjectives? In most russian grammar books there is a rule saying that definite article must be used with superlative adjectives. However from time to time I see people using indefinite article. For example, a title of the film \"A Most Wanted Man\". Can somebody explain this?", "\"Stop a loophole\" vs. \"fix a loophole\" Which is the preferred usage \u2014 \"to stop a loophole\" or \"to fix a loophole\"?", "\"The last couple of years,\" \"in the last couple of years,\" or \"over the last couple of years?\" I wrote the following: > With a sigh, Erin put the newspapers aside. Why she could never find what > she was looking for in the papers? It'd been a good thing she had stopped > reading them **(in/over) the last couple of years.** Should I use in or over? Or just leave it as it is?", "Evoking more power than \"Titan\" EVE Online is a multiplayer game that takes place across a fictional galaxy called New Eden. Players pilot spaceships and fight for territory in large collaborative corporations. Here is a simplified list of the military-focused ship classes, going from smallest to largest:   * Frigate   * Destroyer   * Cruiser    * Battlecruiser   * Battleship   * Carrier   * Supercarrier   * Titan The four variants of Titan are currently the largest vessels in the game. They usually require the efforts of hundreds of players to build and field. They are extremely valuable logistically and are able to carry an extravagant amount of firepower. For many months after Titans were introduced to the game, the difficulty of fielding one kept their numbers in the single digits. As of this posting, however, the number of surviving Titans is in the middle hundreds. It would appear that if it were the intention of EVE's maintainers to keep Titans rare (and I make no allegation that that is the case), then they have underestimated the growing cooperation and resourcefulness of New Eden's citizens. Now then, here is the question: If a warship class larger than the Titan were added to the game, what would it be called? The word _Titan_ comes pretty close to the ceiling in terms of evoking great power and strength. In Greek mythology, the Titans were a race of immortal giants descended from the gods Gaia and Uranus, themselves descended from Chaos, but neither _God_ nor _Chaos_ seem to be good names for ship classes. The first could be controversial; the second I think is more arguable ( _Chaos Class Warship_ has a nice ring to it), but I think that there are better alternatives. For context, here is an alphabetical list of all ship classes currently in the game: Assault Ship, Battlecruiser, Battleship, Black Ops, Capital Industrial, Carrier, Command, Covert Ops, Cruiser, Destroyer, Dreadnought, Electronic Attack, Exhumer, Freighter, Frigate, Heavy Assault, Heavy Interdictor, Industrial Command, Industrial, Interceptor, Interdictor, Jump Freighter, Logistics, Marauder, Mining Barge, Supercarrier (also called Mothership), Recon, Strategic Cruiser, Titan, Transport For even more context, this page on EVE Wiki has more information about each ship class.", "Meaning of \"renaissance loser\" _Renaissance loser_ in this context > Dilbert: Wally, are you free for lunch? I need to remind myself how lucky I > am that I don't have your laziness or personality or looks. > > Wally: Would you say I'm kind of a renaissance loser? Does it describe people who have multiple attributes of a loser? So can renaissance be used to address things with multiple attributes like people who know art and science?", "More grammatically correct: \"anything but\" or \"anything except\"? Could you tell me which of these phrases is grammatically correct \u2014 \"anything but\" or \"anything except\"? If the use depends on context, what are the instances when each must be preferred?", "How to properly emphasise words with italics in sentences? I'm not sure if I can ask this question here, because it is more of a writing issue. My native language is French and I have been reading and watching stuff in English and I am quite fluent with the language now (I think). Though I find some things kind of weird as to emphasised words in sentences. For example, the following sentence (seen this somewhere on the internet, not really important) : > So what _can_ you do? To me, the emphasis is on the wrong word here. It does not punch enough. In French, I would rather write it like this: > So what can _you_ do? It is not the first time that I see emphasised words in a sentence and I think: well I feel like the emphasis is on the wrong word. It could be moved to another word to make the sentence more punchy. Am I the only one who finds this weird? Any other french-speaking people here that feels the same as I do?", "Change \"What are you doing?\" asked Sally into indirect speech Is \"Sally asked what you were doing.\" correct? It couldn't possibly be \"Sally asked what I was doing.\" right? Thanks."]}, {"query": "Is \"mens\" a valid word?", "pos": ["Which is correct \"women's clothing\" or \"womens clothing\"? When I typed the search into Google most of the responses were websites selling clothing and the ratio of womens versus women's was about 1:1. Searching for mens versus men's and the version with apostrophes appears almost 90% of the time. For boys versus boy's or girls versus girl's it is a 3:2 ratio in favor of no apostrophes. So there's a general trend for leaving the apostrophe out. But \"womens\" looks wrong. I suppose the same question applies to public bathrooms as well. Is the women's room or the womens room?", "Is it correct to say \"I write children books\" (not possessive case)? Although Children's books is what everybody says, I would like to understand why the genitive case is applied in such case. If I write books for children, children is an adjective here; not the owners of my book! The word \"children\" just defines or characterizes the type of books I write. Therefore, it's an adjective. So, I understand that genitive/possessive case (\"I write children's book\") is incorrect grammar. My question is: is the genitive case here really accepted as right? If I use \"I write children books\" (following the grammar principle) as as I say \"I write pets books\" (books about pets, and not possessions of pets) - would I be incorrect? Why?"], "neg": ["\"In accepting\" vs. \"to accept\" > **Possible Duplicate:**   >  When should a verb be followed by a gerund instead of an infinitive? > Part of the reluctance **in accepting/to accept** social arguments about > human nature lies in the fear that many scientist have, of falling into the > Cartesian pit. I'm not able to differentiate between these two choices. Both sound Okay according to my understanding. Is latter one more apt in usage?", "What's the meaning of Goofy is a Dawg? http://www.straightdope.com/columns/read/978/if-pluto-is-a-dog-what-is-goofy Says that goofy is a dawg, not a dog. Well, dictionary says that dawg is black people. http://www.urbandictionary.com/define.php?term=dawg So what's the connection? http://nws.merriam- webster.com/opendictionary/newword_display_alpha.php?letter=Da&last=50 says that dawg also means dog. So what's Cecil meant when he said that Goofy is not a dog but a dawg?", "Is there a name for this characteristic of the human body (picture) Is there a name for this characteristic of the human body (see the arrows in the picture below)? They seem as 'holes' on the back. I'm not able to imagine one ![picture of feature](http://i.stack.imgur.com/lIFHW.png)", "Meaning of \"to grow a funny bone\" What is the meaning of the idiom _to grow a funny bone_? What does _funny bone_ refer to? Googling shows only places where it was mentioned.", "Word to describe difficult to keep request I am looking for a word which can used in the following blank space: I understand the ____ nature of the request; hence a negative answer will not change anything between us. The word needs to describe a request which is difficult, a bit imposing, and the favour is too big. Thanks very much", "The difference between 'have mercy,' 'extend mercy,' and similar phrases Is there a difference between 'having mercy' and 'extending mercy?' Are there other phrases that mean similar things?", "\"Result in\" or \"result to\" I am trying to help a friend to write his CV. I don't know which preposition to use in the following paragraph: > Advance Marketing Staff Knowledge & Skills Which Lead To Dramatically > Increase In The Branch Customers. And Also **Result In** Several Competitive > Branches In The Same City To Close. Should _result in_ or _result to_ be used? I feel like it should be _result in_ but I am not sure. Any suggestions or improvements are also welcome.", "What is the word for statements that aren't ironic but have an interesting juxtaposition? For example: my grandmother went to university and learnt to speak RP; I went to university and picked up her cockney drawl. Or: I was searching for a book on the internet and when I found it, it turned out that it my next door neighbour was selling it."]}, {"query": "Question mark(s) when asking about a quoted query", "pos": ["Quoting a question at the end of a sentence which is itself a question If my sentence is a question _and_ ends with a quote of a question, where exactly do I put a question mark? >   1. Did she ask, \"Is it raining\"? > >   2. Did she ask, \"Is it raining?\"? > >   3. Did she ask, \"Is it raining?\" > >", "Placement of question mark for a question quoting a question Suppose I am writing to a friend, asking if he remembers a certain question I asked him. Do any of the following sentences correctly use the question mark? > Do you remember when I asked you \"do you know the time\"? > > Do you remember when I asked you \"do you know the time?\" > > Do you remember when I asked you \"do you know the time?\"? Less specifically, what is the general rule that can be applied to such a situation?"], "neg": ["Omitting the subject in writing I wonder whether it is formal to omit the subject in writing. Must all sentences always have a subject when I'm writing an English test? \u00ccs it colloquial and reserved to speech?", "Does use of the term \"Gordian knot\" imply a heavy-handed solution? I\u2019m a PhD student currently struggling with the section of my thesis where I\u2019m praising my supervisors. It is not that I\u2019m having trouble summoning up the willpower to do so, but rather that I\u2019m puzzled by a specific grammatical detail. I am planning to write something along the lines of > \u2026 a better team of consultants is hard to imagine when it comes to [\u2026] > untying theoretical and technical Gordian knots. _thefreedictionary.com_ defines the term as \u201can exceedingly complicated problem or deadlock\u201d, which is exactly what I want to say. However, the etymology of the expression is obviously related to Alexander the Great coming across the knot in Gordium and \u201csolving\u201d the riddle of untying it with his sword. So, in using the expression in this way, do I imply that my supervisors tend to prefer brute-force solutions?", "What is the correct tense to be used in Technical Presentation most of the time? This is more about the suggestion I am asking here. Please share your ideas/experience which will help me. I am working as a project manager and want to present most of the time about project or technology. I used mixed tenses for the same kind of information which suits sometimes correctly and interpreted the meaning sometimes incorrectly.", "Looking for a word for concealment of faults I'm looking for a word for concealment of faults. In this case, someone has a specific fault and actively, purposefully hides it from others, going out of their way to conceal these faults from others. It's a close-opposite of _hypocrisy_ or _deceit_ , where one pretends to have a good quality that one does not possess. This would be a superimposition of a non-existent good quality, while the word I'm looking for would be the deprecation of an existent fault or negative quality. Also, not a mere denial or non-acknowledgement of the fault, but an active secrecy or pretence. Is _dissimulation_ my best bet? That doesn't seem to necessarily include concealment of a fault, just concealment in general. Examples: 1) Fearing what his parents might think, John pretended to be a non- smoker. When they asked him directly about it his words faltered, not wishing to lie but also not wishing to reveal his shortcoming. In the end, the best he could manage were a few unclear words denying the fact and, hoping his parents believed him, quickly changed the subject. 2) John thoroughly enjoyed hunting, but in the company of others, from fear of damaging his reputation, was scrupulous in concealing this and even went out of his way to appear outspoken against hunting. The close-opposite (hypocrisy) would be: For fame and fortune, John pretended to be able to read others' minds and offered his services at a reasonable rate. To avoid being discovered as a fraud, he kept his readings vague and used intrigue to keep his clients hooked. So I hope these help give a clearer idea of what I'm looking for. I am not so much looking for a word to slot into those sentences, but rather a word for what such an attitude or behaviour is called. Many thanks for all the work!", "Why do 'fine words butter no parsnips'? I was at a dinner last night where some rather nice herb butter was served with the vegetables. Conversation close to me then turned to the English expression 'Fine words butter no parsnips'. It seems rather odd in English, because by tradition the English tend to use gravy with their vegetables. That is until one appreciates that the expression exists in French 'Mots doux ne beurrent aucun panais'. Now French cooks, I can well imagine are more inclined to butter their parsnips, so it makes sense. But I would be interested to hear of the possible use of this expression in other countries where English is used. Do Americans, Australians etc 'butter their parsnips', either actually or metaphorically?", "Why is the plural form of \"life\" \"lives\", while the plural form of \"still life\" is \"still lifes\"? Why does the plural form of \"life\" is \"lives\", while the plural form of \"still life\" is \"still lifes\"? From Wikipedia: > A still life ( _plural_ **still lifes** ) is a work of art depicting mostly > inanimate subject matter, typically commonplace objects which may be either > natural (food, flowers, plants, rocks, or shells) or man-made (drinking > glasses, books, vases, jewelry, coins, pipes, and so on).", "What's the meaning of \"refer\" and \"introduce\"? What's the implication of the following sentences? >   * Could you refer me to the job? >   * Could you introduce me to the job? >", "Helping improve or help To improve Is \"Helping Improve Lives\"ok or should it be \"Helping TO improve lives?\""]}, {"query": "\"right\" vs \"correct\"", "pos": ["\"Is this the right way?\" vs \"Is this the correct way?\" > **Possible Duplicate:**   >  \u201cright\u201d vs \u201ccorrect\u201d I've had this question for a long time. Which sentence is grammatically correct? > Is this the **right** way? > > Is this the **correct** way?", "\"Is it right?\" or \"Is it correct?\" Which question is more proper? > _[some statement]_ , is it right? > > _[some statement]_ , is it correct?"], "neg": ["Looking for a list of \"english words\" that exist in other languages, but with different meanings I had a terrible misunderstanding with a semi-conservative Turkish woman who was offended when I said > \"Let's have brunch, and I'll bring some platonic female friends\" I'm told that in Turkey, \"platonic\" has a meaning of one person who deeply desires the other (sexually), but that is not reciprocated. The English version is that of a non-sexual friendship, where lust isn't in the picture. She thought that I wanted all these women present who admired me in that sexual way. I don't wan to create these offenses again, and so is there a list of words that have a strong similarity to English, but with a different meaning?", "\"I couldn't but laugh\" - correct or not? Is the usage of \"I couldn't but laugh\" in place of \"I couldn't not laugh\" correct English? Or should it always be \"I couldn't help but laugh\"?", "What's the difference between \"my love\" and \"my lover\"? What's the difference between \"my love\" and \"my lover\" ? Or do they have the same meaning ?", "Is the usage \"can able to\" wrong? I believe it's wrong. But where can I find some reference on the same? I hear a lot of people use 'can able to' in their daily talk. I believe it's entirely wrong. Both 'can' and 'able to' hold the same meaning. Where do I get more information on the same and also the exact places where I should use 'can' and where I should use 'able to'?", "What do you call things made out of natural waste materials? How do you categorize things (say, a toy, doll or idol) made out of natural wastes like leaves, trunks, etc., from nature?", "Looking for a word similar to \"proverbial\", but referring to fables or folk stories I would like to reference something a character said in a famous childhood story, e.g. The Boy Who Cried Wolf, or, Goldilocks and the Three Bears etc. amidst normal writing. For instance, I'll use \"proverbial\" below, but I'm neither sure it makes sense, nor positive it's grammatically correct. I'm also unsure a drop-in replacement exists, but I'm hopeful. > Ex.1. Don't keep crying for the **proverbial** wolf, Dave, or us villagers > on the marketing team might just stop paying attention. > Ex.2. Looks like that part of our software isn't tuned correctly. The > **proverbial** porridge might be just a little too hot. I'll get it just > right by next Friday. Thanks, Nik", "Is \u201cKnow how to cook leeks\u201dan idiom? What does \u201cRead \u201cHamlet\u201d and know how to cook leeks\u201d mean? There was the following sentence in New York Times\u2019 article (February 28) titled \u201cWhat you learn at 40s.\u201d: > \"Victor Hugo supposedly called 40 \u201cthe old age of youth.\u201d - - The > conventional wisdom is that you\u2019re still reasonably young, but that > everything is declining: health, fertility, the certainty that you will one > day **read \u201cHamlet\u201d and know how to cook leeks**. Among my peers there\u2019s a > now-or-never mood: We still have time for a second act, but we\u2019d better get > moving on it.\" http://www.nytimes.com/2014/03/01/opinion/sunday/what-you- > learn-in-your-40s.html?hp&rref=opinion&_r=0 What does the line -\u201cRead Hamlet and know how to cook leeks\u201d mean? Is \u201cKnow how to cook leeks\u201d an idiom, for instance, to mean to get 'the worldly knowledge'? Readers English Japanese Dictionary at hand carries \u201ceat the leek\u201d and \u201cnot worth a leek\u201d as idioms, but don\u2019t include \u201cknow how to cook leeks.\u201d", "Advanced English Pronunciation first thing first I hope this is not off-topic. So here's my problem: my spoken English is quite good, to the point that I'm sometimes mistaken for a native (American) speaker. However, there are words I still tend to mispronounce, especially when the English phonetics structures are not present in my mother tongue (I'm Italian). For instance, a couple days ago somebody brought to my attention that I pronounce \"ice\" and \"eyes\" virtually in the same way, and these are the kind of things that are really hard to notice until a native points them out to you. _In other words, I feel like I reached a plateau in my learning process and I'm not sure how to proceed from here._ I should also mention that I get a lot of exposure to the language and I use it on everyday basis, so that alone is not helping anymore (or not helping fast enough). I figured I could start reading about linguistics, and take a more structured approach to learn English (maybe learning the IPA would also help?), but I'm not sure is a good strategy. Do you have any recommendation, books/websites/topics I should check out, or know anything else I could try? Any advice is appreciated. Thank you."]}, {"query": "Is cheque and check interchangeable when referencing a checking account?", "pos": ["\"Checking\" vs. \"chequing\" vs. \"chequeing\" with regards to types of bank accounts I came across this little dilemma when looking up the incorrectly spelled word \"chequing\" in my web browser's dictionary (Opera). According to the different dictionaries you can select in Opera: EN US is \"Checking\" (Which I knew) EN GB and EN ZA is \"Chequeing\" (Which looks really strange to me) Here in Canada I've always seen and used \"Chequing\", which I actually thought was the GB version. Example of BBC using \"chequeing\": http://news.bbc.co.uk/2/hi/uk_news/magazine/3242776.stm So how many versions are there? Which is technically the right version for Canada and Great Britain?", "Do we ask for check or cheque in restaurants? I know there is a related question asked here. But its slightly different than it and seeking more information. I live in India, I have been to America couple of times. In my first trip it was surprising to see people asking for \"check\" instead of \"bill\". I have been told by my friend that here (in America) they call it \"check\". I assumed may be it arosed from \"check-out\". After some days another friend told me that it's \"cheque\", **not** \"check\" and he elaborated that just like how a banker pays money in return of cheque. After reading few answers/question and links given in the relative question, I really made a conclusion that which one is correct to use because I doubt only one has to be correct and remaining evolved by misinterpretation because \"check\" and \"cheque\" sound the same?"], "neg": ["What is the term used \"When a person is called in to work on a holiday\"? Someone asked me about what term is used for a **person who is called in to work on a public holiday**. (He told me that it is called _pump of leave_ , but he himself was not sure of it.) So, there are two questions-   * What is that person called?   * What is that leave is called? If there are specific terms for them please tell.", "\"Why can't I see?\" or \"Why I can't see?\"? Which of the following is correct? > Why can't I see?   >  Why I can't see? I am a bit confused, since both have inversion, negation and a \"why\" in the beginning.", "Origin of \"washing up\" Where does the phrase \"to wash up\" (equally \"to clean up\") originate from? Particularly the word \"up\", how did that enter the phrase?", "What is the difference between \"daemon\" and \"demon\" in a religious context? Is there a difference between _demon_ and _daemon_ in a religious context?", "\"If I am getting late\" Is it correct to say \"If I am getting late, I will let you know\"? The Conditional rules don't say anything about continuous tense. In addition, what would be a better way of conveying the same message?", "In what dialects is \"I don't like it too\" grammatical? Consider: **_Too_** \u2014 ( _adv_.) also, as well, in addition. We don\u2019t usually use _too_ in negative clauses; we use _either_ instead:   * I don\u2019t like that kind of stuff.   * I don\u2019t like it either. That said, here\u2019s my concern: I\u2019ve heard a native speaker from the Lake District (in the UK) say \u201cI won\u2019t do it and she won't do it too.\u201d When asked if that's how he usually phrases such sentences, I got an affirmative answer. This then reminded me of John Lennon\u2019s lyrics to his song \u201cImagine\u201d, which I had always thought must be wrong: > _Imagine there\u2019s no countries   >  It isn\u2019t hard to do   >  Nothing to kill or die for   >  **And no religion too**_ Is it grammatical in the UK (or in certain regions) to use _too_ instead of _either_ in such sentences?", "Does the word \"please\" come from \"plea\"? I thought that the word _please_ came from the plural of _plea_. But then why is it _please_ instead of just _pleas_? Why the e? Are \"plea\" and \"please\" really related to each other?", "Is it \u201cgood English\u201d or \u201ccorrect English\u201d or something else? Is it appropriate to say \u201cI speak good English\u201d or \u201cI speak correct English\u201d? I believe there can be varied replies depending on context, so let me narrow it a little; let\u2019s say I want to convey how well I speak English."]}], "CQADupstackGamingRetrieval": [{"query": "When can you respecialize your hero?", "pos": ["How do you reset your traits(might,magic abilities) in heroes of might and magic 6? > **Possible Duplicate:**   >  When can you respecialize your hero? I know you reset the traits from the multiplayer by clicking the respecialize,but how do you reset the 1's from the campaign?"], "neg": ["How can I toughen Qyzen Fess? I play as a Jedi Sage using the Telekinesis tree (damage and a little crowd control). My character cannot take much damage because of the light armor and the endurance values. So I'm using Qyzen as a tank. But he does not have many more hitpoints than my character. I used to equip him with armor with high endurance values but replacing them with high aim values was a good idea as he dealt much more damage (aim is his primary attribute) and he seemed to live longer. The char is lvl 38 now but I have difficulties with lvl 35 mobs. When they beat Qyzen and are on to my character, I mostly die. What can I do now to increase Qyzen's toughness? Should I change back to \"endurance-armors\" or should I try to increase his armor value? Are there other possibilities?", "How to prevent Silverfish from melding into blocks In normal Minecaft with no gamerules changed, silverfish have the capability to meld with existing stone, stone brick or cobble to turn that block into an egg block. If I were to use silverfish in an adventure map but prevent silverfish from \"melding\" back into the blocks, how would I do this? (I've already tried gamerule mobGriefing)", "Falion won't help me cure my vampirism Trying to cure my vampirism, after loading a save AGES ago, and doing the quest to cure it. I get to Falions house, and it's locked. (These events in this paragraph happened the first time) I tried getting in (successfully) into Falions house and of course, he wants me out. After being able to persuade the guard to let me go, being the Thane, I was able to properly talk to him and buy the gem. The problem was, everyone tried to kill me and I was too weak with the disease. (Second time) Tried to break in, unsuccessful. Couldn't make him talk to me this time. How do you properly talk to him? I tried waiting, didn't work.", "How many Fetishes are summoned with Fetish Army I can't find how many Fetishes are summoned when you cast Fetish Army.   * Is it random each time they're summoned?   * Does it depend on the caster level?   * Do they actually have limited life, or are they invincible the time they last?", "Why did my pills change? In Binding of Issac Wraith of the Lamb I picked up a Range Down Pill that I already identified. Some time during the play-through it changed to a Range Up Upgrade. I am not sure when it happened or what happened. I know that that the Lucky Foot Item and the PHD can change negative pill effects, but neither one of those items were picked up in this run. Are there any other items that could of changed the pill type? If you hold on to a known negative pill long enough does it change?", "A possessed dwarf claimed a workshop and is building a mysterious building One of my dwarfs became possessed and while I was building a workshop he claimed it and now he is building a mysterious building. How grave having a possessed dwarf is? Is there a cure for that? What should I expect out of his mysterious building? EDIT: the possessed dwarf built an amulet and then left the workshop!", "Does Origin have any built in screenshot functionality? Origin is trying to edge its way onto Steam's turf, which seems to have been one of the major reasons for keeping Mass Effect 3 an Origin (and console!) exclusive. Thing is, I use Steam for a lot more than simply buying games - I've also fallen in love with the Steam Screenshot service. Does Origin have anything comparable? Or will I have to rely on third party software (like FRAPS, or... even running Origin through Steam?) to get my screenshots?", "How do I kill the crab boss? In the Beach world, the end boss is at least one (I think three, though, if the cutscene is any indication) crab. I have no idea how to fight it! No matter what I do, it seems to hurt me, and I am losing red balloons like a toddler at the county fair. How do I kill this boss?"]}, {"query": "Left 4 Dead 2 Special infected tips for Versus", "pos": ["How can I avoid being detected as an infected in left 4 dead 2? I always get caught playing as an infected no matter how good I hide (because the infected make noises). What would be a good tactic to minimize detection?"], "neg": ["Are there unadvertised world interactions like shooting off locks to open doors? I just learned the other night that you can **shoot the doorknobs off of wooden doors** (as opposed to picking them, like the door to the shed in the mission Rats). Makes sense right? I just assumed that you weren't able to do such a thing. **Question:** Are there any other unadvertised common sense things in Payday 2 like this? I was just curious as I found this to be quite satisfying. Prior I kept thinking \"Why can't I just bust the door down? I'm already caught there's no point in trying to be sneaky.\" and then my buddy told me about shooting the knob and I literally just dropped my head to my desk in awe.", "How much does time matter in Might and Magic VII? I have some subtle aversion to 'wasting time' in games. For example, in Might & Magic 7, I'd much rather go through an entire cave in one go, without ever resting for 8 hours, but using potions instead to keep my party going. Is that a wise choice? Does time passing affect the game in any way, besides things that depend on which day it is (e.g. stables schedules) and which month it is (e.g. bounties)? For example, the rumor is, once I become the lord of the castle, that the new lords will only last a few months... so if I just spend a year doing nothing but getting trashed at the local taverns, will the game punish me in any way? EDIT: I especially suspect something is up given all the peasants that I can hire that reduce travel time...", "Showing up on SpeedRunsLive I know once that once I meet the requirements, My stream will be on SpeedRunsLive. How many races does one have to do to show up on SpeedRunsLive page ?", "Must I have an active XBox Live Gold account to get the pre-order bonus for Borderlands 2? > **Possible Duplicate:**   >  How do I get my preorder bonuses? Do you need to have an active XBox Live Gold account to get the pre-order bonus for Borderlands 2?", "How can I visit a friend's island in Dragonvale? My kids have exchanged friend codes, and received gem bonuses. How can they visit each other's islands? Note: Under social, there's a \"Friends\" pane that always reads \"3 gifts available\", but has no other entries other than \"visit random island\". The \"gifts\" tab is similarly blank. This is on a Kindle Fire HDX, with no Facebook accounts.", "Do sensor mode trip mines alert guards? One of the perks for Technician is the ability to turn trip mines into sensors that beep, instead of explode when tripped. Can guards see these, or hear when they are tripped? Specific applications in mind include a \"someone is coming up to the roof\" detector for Framing Frame day 3, so the camera operator doesn't have to periodically check if there's a guard on the roof.", "How can I save a game to a USB stick on Playstation 3 I want to save a game to a USB stick on Playstation 3. When I hit triangle on save data it only offers me online storage. How do I enable USB storage?", "What do I do about a caravan that is being attacked? So, in order to get money in Assassin's Creed 3 you've got to send out caravans (or naval caravans) to ship your goods across the lands and all that Jazz. Well when the game was first explaining this they had me send out a single caravan to an area just as demonstration. However, now this Caravan is apparently under attack and has been for quite some time. The menu has no options or anything of the sort to give me ways to deal with this, and the caravan just sits there in the menu being completely useless. What do I need to do with this caravan in order to get it out of its \"attacked\" state and usable again?"]}, {"query": "Is there a difference between Adventure play after pass 2 In Plants vs. Zombies?", "pos": ["How many more \"gimmicks\" does adventure mode have? I just started my second play through of adventure mode in Plants vs. Zombies, and now Crazy Dave is picking 3 (usually irrelevant) plants for me to use on each level. After I finish this playthrough, will there be a new gimmick or handicap on further playthroughs? How many different gimmicks are there on continued playthroughs, and on which playthroughs do each occur?"], "neg": ["Is it possible to play Fez with more than one save game? More than one person in my house is interested in the secrets and puzzles of Fez. However, even though it has a save feature, I don't see how I can switch between saves (thus allowing multiple players to start and stop at different points). If I try and choose \"Start new game\" it says it will delete all progress. Is it possible for two people to play Fez on the same XBox with different save games?", "Are Animals Programmed To Escape Their Pens I'm sure many of you Minecraft fans have noticed that animals always seem to try and escape their pens as soon as their is an escape route. I have a simple question about this and that is are they programmed to do this and if they are is it to find a larger area or just to escape?", "Is Zombie-pigman aggro contagious? If I attack a zombie pigman, it'll attack me. If I do this on a server will it attack other players, or just me?", "If my world has silver instead of Tungsten, can I still make an Emerald Staff? The recipe for Emerald Staff says I need Tungsten. Isn't silver supposed to be interchangeable with tungsten? Why should I have to re-make my world just to get a metal...", "What happens to power ups after death In Hero Academy, if I lose one of my units and step over him in the next turn (so I save him), do I also save any equipment he's carrying? Or, is the equipment lost, but the hero is saved?", "How do Trainers work in Skyrim? I've been to one or two trainers for Destruction magic already. Since then, if I go to another trainer (different skill) of a level that I've already trained at, the dialog says I've maxed out my training (5/5). So, it seems to me that you can only train five times at a given training level (Common, Expert, Master) _across all skills_. However, given how many different skills there are in the game and how many Trainers there are, this seems rather crippling to me. Can someone explain exactly how Training works? Is my above presumption correct?", "I cannot locate my Mardek 2 save file I was playing Mardek on kongregate.com using Google chrome, and decided to move to a different site. So I went to check my flash app data folder and the chat.kongregate doesn't have my save information? I tried to clear out the folder and see if it was still there, and my save still worked on the site, but I have no idea where it is! I even cleared the entire app data folder looking for it and it still worked!", "\"Cannot Resolve Hostname\" when using Subdomain A group of friends wanted a Minecraft server to play together on, so I went ahead and deployed a VPS, and directed an A record titled `play` to the server's public IP address. I connected to the server via SSH using `play.coffeehousecode.com` as the hostname, and didn't encounter anything out of the ordinary, so I started a Minecraft Server instance, and the logs showed no problems to report. However, when trying to connect to the server using the Minecraft client, I receive an error stating that the Hostname couldn't be Resolved. I checked my DNS records to make sure everything checks out, and SSH-ed into the server again without a problem. When connecting to the server using it's public IP address, however, I can connect and play without a problem. Any ideas as to what could be causing this?"]}, {"query": "Do dropped items in Ingress decay?", "pos": ["Do dropped items ever expire? When items get dropped and left, do they ever expire or will they be available indefinitely until somebody picks them up? I believe keys that get dropped by portals when links decay expire in a day or two and vanish. Is there anything like that for manually placed items?"], "neg": ["Make VATS the Default in Fallout 3? Is there a way to always use VATS in Fallout 3? If I hit \"V\", it goes to the VATS system and then when the turn is over, it goes back to real time combat.", "minecraft crashes on osx I just bought minecraft and every time i run it , it crashes. When i double click on its icon in the application folder nothing happens so i have to go into the contents folder to launch its jar file. After I login this is the crash report that keeps displaying. I am running this on osx 10.8.2 (mountain lion) My specs are: 2.26 ghz intel core 2 duo, 8gb ram               ---- Minecraft Crash Report ----     // Surprise! Haha. Well, this is awkward.          Time: 2/25/13 5:29 PM     Description: Failed to start game          org.lwjgl.LWJGLException: Could not get the JAWT interface         at org.lwjgl.opengl.AWTSurfaceLock.lockAndInitHandle(Native Method)         at org.lwjgl.opengl.AWTSurfaceLock.access$100(AWTSurfaceLock.java:49)         at org.lwjgl.opengl.AWTSurfaceLock$1.run(AWTSurfaceLock.java:89)         at java.security.AccessController.doPrivileged(Native Method)         at org.lwjgl.opengl.AWTSurfaceLock.privilegedLockAndInitHandle(AWTSurfaceLock.java:86)         at org.lwjgl.opengl.AWTSurfaceLock.lockAndGetHandle(AWTSurfaceLock.java:64)         at org.lwjgl.opengl.MacOSXCanvasPeerInfo.initHandle(MacOSXCanvasPeerInfo.java:53)         at org.lwjgl.opengl.MacOSXDisplayPeerInfo.doLockAndInitHandle(MacOSXDisplayPeerInfo.java:56)         at org.lwjgl.opengl.PeerInfo.lockAndGetHandle(PeerInfo.java:85)         at org.lwjgl.opengl.MacOSXContextImplementation.create(MacOSXContextImplementation.java:47)         at org.lwjgl.opengl.Context.<init>(Context.java:120)         at org.lwjgl.opengl.Display.create(Display.java:858)         at org.lwjgl.opengl.Display.create(Display.java:784)         at org.lwjgl.opengl.Display.create(Display.java:765)         at net.minecraft.client.Minecraft.a(SourceFile:232)         at asq.a(SourceFile:56)         at net.minecraft.client.Minecraft.run(SourceFile:515)         at java.lang.Thread.run(Thread.java:722)               A detailed walkthrough of the error, its code path and all known details is as follows:     ---------------------------------------------------------------------------------------          -- System Details --     Details:         Minecraft Version: 1.4.7         Operating System: Mac OS X (x86_64) version 10.8.2         Java Version: 1.7.0_10, Oracle Corporation         Java VM Version: Java HotSpot(TM) 64-Bit Server VM (mixed mode), Oracle Corporation         Memory: 55114328 bytes (52 MB) / 85721088 bytes (81 MB) up to 1271398400 bytes (1212 MB)         JVM Flags: 0 total;          AABB Pool Size: 0 (0 bytes; 0 MB) allocated, 0 (0 bytes; 0 MB) used         Suspicious classes: No suspicious classes found.         IntCache: cache: 0, tcache: 0, allocated: 0, tallocated: 0         LWJGL: 2.4.2         OpenGL: ~~ERROR~~ NullPointerException: null         Is Modded: Probably not. Jar signature remains and client brand is untouched.         Type: Client (map_client.txt)         Texture Pack: Default         Profiler Position: N/A (disabled)         Vec3 Pool Size: ~~ERROR~~ NullPointerException: null", "Plot doesn't continue after killing Darko After finishing That Special Someone by killing Darko, I didn't receive a call by Pegorino, as the wiki says I should. But this means that I can't continue to the following story missions. I did a few optional missions after that, so I don't think waiting will help. Am I missing something or is this a bug? Is there some way of fixing this apart from loading an old save?", "Where to find Ashley Williams on the Normandy 2? I asked Ashley Williams to join my crew on the Normandy and she is a selectable member for my squad. The strange thing is I can't seem to find her on the Normandy spaceship. It does not really make sense. Is there a glitch possibly? This is for the PC version on Origin.", "What is better for Stalkers: 1 Armor + 1 Shield or 2 Armor? Grubby just came up with this question on Twitter > SC2 math heads: what's better for a Stalker, 1 armor 1 shield or 2 armor? I > heard 2 armor is better before but I don't know why necessarily. I'm curious if we could answer this with our communities math-skills :)", "How do I find unique charms in Diablo 2? I've tried researching this one on my own and I've come up with several different answers depending on the site I'm checking. I'd like some solid information on obtaining unique charms in _Diablo 2_. There are three in total: Annihilus, Gheed's Fortune, and the Hellfire Torch. Can I find unique charms while playing single player? If so, do they drop on a specific difficulty (Nightmare, Hell)? Details on all three would be helpful.", "How do you sneak up on someone in Hitman 2? I understand the the **L1** button is the \"sneak button\" and that you sneak up behind them extremely slow, but I can't seem to pull off the sneak attack without alerting them first, even in the very first mission. When I try to sneak up behind the first guy (using **L1** ) that comes out of the door (urinating next to the tree), I try to use the anesthetics and right before I get into range to attack him he starts turning around and my alert box starts flashing red, even though I complete the attack successfully in the end. I suppose that one doesn't matter as much since there's no one around, but I assume if I did it correctly the alert box wouldn't flash. However, when I try to sneak up behind The Don (again, using **L1** ) with my Fiber Wire, he always turns around and becomes alerted before I can actually strangle him, then after I strangle him his guards barge into the room. What am I doing wrong with my sneak attacks? They don't seem to be very sneaky if they can get an alert off before you actually get to them... I've tried doing this several times and he is consistently alerted each time. I'm supposedly able to do this without alerting either of them, but I'm obviously missing something.", "What happens if you are left behind on a mission in Warframe? On Warframe, what happens if you are left behind during the extraction when the timer runs out? On a VOID KEY mission, all that happened was that I lost the money reward, but what happens on a normal mission? Is it the same, or do you not get anything at all and it is considered a mission fail?"]}, {"query": "How do I progress in Ars Magica 2?", "pos": ["How do I level up in Ars Magica 2? I've been playing Ars Magica 2 and casting spells but there's no xp bar for the magic. I have checked the options but that's not it, I can move it but can't see it. I'm also not levelling - I've killed like 20 mobs with just magic and I'm still level 1 with 100 mana and like 11 burnout. Ars Magica is a Minecraft mod and is part of some of the Feed the Beast packs for 1.6.4 and i can cast the spells"], "neg": ["Left 4 Dead 2 accuracy - when can I stop shooting? I'm trying to break 75% accuracy on Left 4 Dead 2. I can consistently get about 60% accuracy with either of the automatic shotguns, but when I try with the M-16, my percentage drops to the high 40s. Assuming that my shooting habits don't change from firearm to firearm, the only thing that I can think of that would cause this drop is the fact that the shotgun's slower firing rate means that every common infected is guaranteed to get one _and only one_ round. With the M-16, it's very likely that a particular bullet will kill the zed, but by the time I realize that it's dead, I've fired once or twice more. My question is: **Do bullets fired at dead or dying zombies* count against your accuracy rating?** This has a follow-on question: **What about bullets fired at zombies that a teammate has also been firing at?** If your teammate kills the zombie, does your accuracy decrease for those bullets you fired at it? (*And before you say it, yes, I know that _all_ zombies are dead)", "Is there known PlayStation Network Status page? Right now my PS3 is having difficulties signing in to the PlayStation Network. Has anyone found an official status page for the PSN?", "How do you progress past level 31? Do you have to solve the cipher? In the new iOS game \"Hundreds\", once you finish each board, you can advance to the next, either by hitting \"next board\" or by selecting it from the level select screen. Except when I hit next board on level 31, it takes me... back to level 31. I'd think it was a glitch, except that the game contains ciphers, and other mysterious artifacts that lead me to believe that there's just a puzzle I need to solve. There IS a cipher opened on level 31 (which I have not solved), but what's confusing is that I did not have to solve the earlier ciphers to progress past those levels. If the answer does have to do with solving the cipher, please don't post its solution without using the cipher markup.", "What purpose does the 'Take Picture' function serve in the Far Cry 3 Camera? The camera in Far Cry 3 is useful for tagging enemies from a distance but also includes the ability to take pictures. This does not seem to do anything useful when used on animals or enemies. Is there a purpose?", "How can I pause the game? I have just started playing the game (about an hour in) and I don't seem to be able to pause it. The start button is usually pause but it does nothing. I can press select to bring up the phone menu but the game appears to carry on (I haven't actually tested this is a battle scenario yet though) I am wondering if maybe this is something to do with the fact I selected to play in PSN network? The thing is though, I selected private and have not invited anybody so I have no chance of another human joining me. If this is because of network mode, can I turn it off mid-game? So far I am just assuming... maybe you just can't pause RE6? (I hope this is not the case though)", "What does \"stagger\" mean? In the **Heavy Armor** skill tree, the following perk exists: > **Tower of Strength:** 50% less stagger when wearing only Heavy Armor. What does \"stagger\" mean in this context? Does it do anything if you already have the **Conditioning** perk? > **Conditioning:** Heavy Armor weighs nothing and doesn't slow you down when > worn.", "What does the code at the start of each Really Big Sky game mean? At the start of each Really Big Sky game a code is flashed onto the middle of the screen briefly, before disappearing. ![](http://i.stack.imgur.com/5DBfp.jpg) The code appears to be random, and consists of names, numbers and letters. However, it's significance does not appear to be explained anywhere. What does it mean?", "Can I use DLC from Origin with the base game from Steam? I have never played Mass Effect: Pinnacle Station, but it no longer appears to be available on Steam. This DLC now only appears to be available on Origin, from what I can see. I own Mass Effect on Steam, but the Steam CD key for the first Mass Effect game is not valid within Origin (the CD key for Mass Effect 2 is, but that's not going to help in this particular situation). Am I able to purchase Mass Effect: Pinnacle Station on Origin and then use it with my copy of Mass Effect from Steam, or am I going to need to repurchase Mass Effect on Origin in order to use the Mass Effect: Pinnacle Station DLC, from Origin?"]}], "CQADupstackGisRetrieval": [{"query": "qgis projections from Michigan's CGI data", "pos": ["How to reproject from Michigan Georef to WGS84 in QGIS? I am trying to reproject a michigan state land shapefile which is the NAD83/ Michigan Oblique Mercator EPSG:3078 to the WPG84 EPSG:4326 projection. However when i try to do this my map gets squished down. I have tried the commands in \"Reprojecting from MGRm to WGS84 using open-source tools\" with no luck. I need to get these coordinates into a decimal degrees format. Thanks"], "neg": ["MultiLineString to separate individual lines using Python with GDAL/OGR, Fiona, Shapely There are lots of MultiLineString features in a polyline shapefile. The problem is to split these lines into separate individual lines. There is a similar question with PostGIS, but I need to code in Python. I have been planning to extract the geometry from each MultiLineString feature and create separate features and append a shpfile with those new features. Later, in the second pass, I would delete the MultiLineString object which is no more required as it is now split into its components. It will require reading data from original shpfile and appending the newly created features to a copy of the shpfile. Then the appended (copy) shpfile needs to be rid of the MultiLineString features. It seems cumbersome as I find no way to read and write the shapefile simultaneously. There should be better ideas to do that. How to split these lines into separate individual lines using Python with OGR, Shapely, Fiona or Pyshp? A snippet of code to give an idea is below.               import fiona     from shapely.geometry import LineString          original_shpfile = fiona.open(path_to_road_network_shapefile)     with fiona.open(path_to_road_network_shapefile, 'a') as copy_shpfile:         rec = original_shpfile.next()         while rec:             try:                 vertices_on_link = rec['geometry']['coordinates']                 LineString(vertices_on_link) #reconstruct the line from vertices                 #if multipart,                  #has multiple lists within the list,                  #one for each of the Linestring component. also throws AssertionError                  except AssertionError:                 number_of_parts = len(vertices_on_link)                  for x in range(0,number_of_parts):                     part = rec                     part['geometry']['coordinates'] = vertices_on_link[x]                     copy_shpfile.write(part)             rec = original_shpfile.next()          #in the next phase, delete each of the the MultiLineString features from the copy of the shapefile", "OpenLayers zoom to Boundingbox depends on lat/lon positions I'll try to explain my application and the problem. My application gets a position for a zip code and receives a Lat/Long position, then I'm looking for all points around this position and show them.(This works fine) Now I want to try to show a user his zipcode position at the center of the map, but I also want to specify the correct zoom level, so that the user can see all points around this point. (it's not limited by the distance) Is this possible? My minLat,maxLat,minLng,maxLng looks like this :               Array ( [minLng] => 8.381 [maxLng] => 9.15259 [minLat] => 49.5103735 [maxLat] => 50.06762 )      Edit: -HTML:               map.setCenter(new OpenLayers.LonLat(center.lon,center.lat) // Center of the map                 .transform(                     new OpenLayers.Projection(\"EPSG:4326\"), // transform from WGS 1984                     new OpenLayers.Projection(\"EPSG:900913\") // to Spherical Mercator Projection                     ), config.zoom // Zoom level                 );         map.zoomToExtent(new OpenLayers.Bounds(config.bounds.minLng,config.bounds.minLat,config.bounds.maxLng,config.bounds.maxLat).transform(epsg4326));      I have added the html of the function.", "Can ArcGIS handle missing values to create a contour map? I am trying to create a contour map for a waterbody. It turns out that in several locations there is no data. I just don't want to use the missing values as zero in ArcGIS because it would create several other contours by interpolating actual value and the zero value. Can someone suggest to me any good way of handling N/A or no values in ArcGIS to create contour maps?", "QGIS not Printing to PDF Simple QGIS 1.8.0 not printing to PDF. Suddenly stopped. Is this an error or something. the resultant PDFs are blank pages. When i file print and use a pdf printer it creates blank docs. when i export to pdf it crashes. when i export to jpeg it does not print map.", "ArcSDE & Oracle & Database Model -- Best diagram the system Having Oracle dbms with ArcSDE and ArgGIS Pipeline Database Model (APDM), I would like to best describe the system with a diagram. In MS SQL each db is autonomous, I think, meaning ArcSDE(using dbo schema) has the SDE business tables in each db and further using a database model, each database has the database model implemented within?? For Oracle (oracle has a schemas instead of db's??), the Oracle instance that has the sde business tables and the database model..assigns users to participate in those tables as a sort of view (schema??) and sde manages those schemas?? My question: I would like to draw a picture showing how sde and the database model relate as well as how they sit in relation to the rdms on Oracle and on MS SQL Server. Thanks.", "Help with Python script for exporting mxds into pdfs! I have written a python script to export my mxd into a pdf (not using data driven pages). I am getting the error that my mxd path is incorrect! I have included my script below. Any help would be appreciated.               # Necessary modules     import arcpy, os, string, sys          # For less complicated scripts -     # these 2 imports are necessary to utilize a simpler method of debugging outher than traceback      import win32ui, win32con          # example debug message to screen ......     # arcpy.AddMessage(\"mxd_file = \" + str(mxd_file))     # val = win32ui.MessageBox(\"mxd_file = \" + str(mxd_file), \"title\",                               #win32con.MB_OKCANCEL)          #Paramaters...          mxdList = string.split(arcpy.GetParameterAsText(0), \";\")     dir = arcpy.GetParameterAsText(1)          #Loop thru & take the base name of each MXD selected and append all map pages to a single pdf      # and save to chosen directory......          for mxdPath in mxdList:         mxd = arcpy.mapping.MapDocument(mxdPath)         name = mxdPath[:-4] + \".pdf\"         file = dir + os.sep + os.path.basename(name)         ddp = mxd         ddp.exportToPDF(file, \"ALL\")          del mxd, file", "How to add an independent panel in the ArcMap layout view? In ArcMap 9.3, I want to make a map in which I start from a wider location (for example, a country) and then, I give some zooms until one specific area. I have all the data I need: country administrative boundaries, state/province boundaries and city boundaries (in Brazil and Paraguay). I already got to make my first panel, but how do I plot an independent \"frame/panel\" into my ArcMap layout view? I added a screenshot below, where I drew in red (paintbrush) the region I would like to zoom and plot in a separate panel. Also, I would appreciate pointers to any tutorial about how to do this kind of location map (start in broader area and zoom to specific place). Tks. ![enter image description here](http://i.stack.imgur.com/RztAA.png)", "Remove Points that Overlay I have a pointlayer and some points overlay and i want to remove them, so that only one point remains. the points that overlay have the same coordinates"]}, {"query": "Possible to automate Buffer Wizard in ArcGis 10.x by working in the Shell?", "pos": ["Getting buffer wizard-like speed in Python (vs using MultipleRingBuffer_analysis) I've got a script that takes a single input polygon feature, throws 10 buffers around it at tenths of a specified input distance, and then symbolises the output based on an existing layer file. Pretty simple. However, the arcpy.MultipleRingBuffer_analysis operation is amazingly slow. It takes upwards of two minutes to generate the buffers, even for very basic polygon inputs - the same result can be had in about two seconds by using the buffer wizard tool. Problem is, the buffer wizard can't be accessed through arcpy. So obviously it's _possible_ to quickly generate multiple ring buffers - does anyone have any insight as to how the buffer wizard tool is doing it, and how that might be replicated in Python?"], "neg": ["How to import data with SRID 4269 to GEOGRAPHY type? In PostGIS, we are importing various US census bureau shapefiles (with SRID = 4269) using **shp2pgsql** loader. I have medium-sized database with several tables containing fields of type geography (lat/lon points, polygons, multipolygons, etc) that span locations across the US on which we do various distance calculations, \u201cwithin\u201d polygon, etc type of geographic functions as well as display data using Google Maps Api. We currently have no geometry type fields (only SRID used in database is 4326 via geography type). Because they cover a fairly large area and to keep things simple and consistent (avoid projection details etc), I would like to store the census shapes (ie boundaries for states, metros, counties,block groups..) in geography data type instead of geometry as well (unless there is a reason NOT to do this or someone can explain why we should store as geometry instead). My question is, if I use shp2pgsql loader with \u2013G option to create a MULTIPOLYGON geography field for these boundaries (and thus use a 4326 SRID) does the loader \u201cconvert\u201d the data from a 4269 projection to 4326? Is a conversion really necessary? Do I need to first load into temp table with geometry type then perform update to transform/cast into geography type and then store that result? Thank you for any advice or insight related to this.", "10 GB Raster Aerial Image in Quantum and POSTGIS I have a problem... I have been successful in uploading the raster in postgis but when I access it through Qgis. it does not open even after several hours. I have 10GB aerial image raster and everytime i try to open it through QGIS it does not open even after many hours and QGIS crashes... why is this happening...?? is it really due to the file size..?? Regards, Omer", "Creat point and update featuers spatial join I have the following code that is in a tool. The tool creates a point on click, then auto sequential populates the \"AddressID\" field and also populates X_Coord, , Y_Coord. This part of the tool works smoothly. After these fileds are populated i need the new created feature to populate other fields based on Parcel the newly created point sits on. I do a spatial join in order to get the fields populated. The two functions work perfectly if they are separate but once i combine the two and run the tool ArcMap just sits thinking and thinking nothing happens. I eventually have to end ArcMap process with task manager. I don't get no error at all. After i reopen the mxd i see the newly created point but nothing is populated from the Parcels. I would appreciate any help. Here are the two codes.               import arcpy     import pythonaddins     import os     from arcpy import env          class Add_points(object):     \"\"\"Implementation for AddPoints_addin.Add_points (Tool)\"\"\"     def __init__(self):         self.enabled = True         self.cursor = 3 # Can set to \"Line\", \"Circle\" or \"Rectangle\" for interactive shape drawing and to activate the onLine/Polygon/Circle event sinks.     def onMouseDownMap(self, x, y, button, shift):              fc = \"TonyTwoWay.DBO.TT\"         workspace = r\"C:\\Users\\talmeida\\AppData\\Roaming\\ESRI\\Desktop10.1\\ArcCatalog\\Connection to dsd15_sqlexpress.sde\"         arcpy.env.overwriteOutput = True              #arcpy.ChangeVersion_management('TonyTwoWay.DBO.TT','TRANSACTIONAL','dbo.DEFAULT', \"\")         # Start an edit session. Must provide the worksapce.         edit = arcpy.da.Editor(workspace)              # Edit session is started without an undo/redo stack for versioned data         #  (for second argument, use False for unversioned data)         edit.startEditing(True)              # Start an edit operation         edit.startOperation()              CC_list = []         with arcpy.da.SearchCursor(fc, [\"AddressID\"]) as cursor:             for row in cursor:                 try:                     if \"CC\" in row[0]:                         CC_list.append(int(row[0].strip(\"CC\")))                    except TypeError:                     pass                 del cursor              CC_list.sort()         AddressID = CC_list[-1] + 1         AddressID = 'CC' + str(AddressID)              row_values = [(x, y, (x, y), AddressID)]         cursor = arcpy.da.InsertCursor(fc, [\"X_Coord\", \"Y_Coord\", \"SHAPE@XY\", \"ADDRESSID\"])              for row in row_values:             cursor.insertRow(row)         del cursor              # Stop the edit operation.         edit.stopOperation()              # Stop the edit session and save the changes         edit.stopEditing(True)              arcpy.RefreshActiveView()         arcpy.AddMessage('Updated all records sucussefully')               pass      Here the spatial join part.               import arcpy     import pythonaddins     import os     import time     from arcpy import env          fcTarget = \"TonyTwoWay.DBO.TT\"     workspace = r\"C:\\Users\\talmeida\\AppData\\Roaming\\ESRI\\Desktop10.1\\ArcCatalog\\Connection     to dsd15_sqlexpress.sde\"     arcpy.env.overwriteOutput = True          ####Select by location on parcels with created point     Parcellyr = \"testParcelsAdmit\"     fcTarget = \"TonyTwoWay.DBO.TT\"          arcpy.MakeFeatureLayer_management(Parcellyr, \"Parcel layer\")     entries = int(arcpy.GetCount_management(fcTarget).getOutput(0))          for i in xrange(entries):     arcpy.MakeFeatureLayer_management(fcTarget, \"point layer\", \"\\\"OBJECTID  \\\"={}\".format(str(i)))     arcpy.SelectLayerByLocation_management(\"Parcel layer\", \"INTERSECT\", fcTarget, \"\", \"NEW_SELECTION\")     #if arcpy.Exists(pt_lyr): arcpy.Delete_management(pt_lyr)          #### populates fields     #fcTarget = \"TonyTwoWay.DBO.TT\"     #fcJoin = \"testParcelsAdmit\"     add_fields =     [\"ACCOUNT\",\"SiteNum\",\"OwnerName\",\"SiteAddres\",\"SiteNumSfx\",\"SiteStreet\",\"predir\",\"StreetTyp    e\",\"SubName\"]          # fix args     if not isinstance(add_fields, list):     # from script tool     add_fields = add_fields.split(';')          # do not need this scratch file     fcOutput = r'in_memory\\temp_join'     arcpy.SpatialJoin_analysis(\"Parcel layer\", fcTarget, fcOutput, 'JOIN_ONE_TO_MANY', 'KEEP_COMMON')               # grab oid field from points     oid_t = arcpy.Describe(fcTarget).OIDFieldName          # init rowW and rowR     curR = arcpy.SearchCursor(fcOutput)     join_dict = dict([(r.JOIN_FID,[r.getValue(f) for f in add_fields]) for r in curR])     del curR          # Now update the new target     curW = arcpy.UpdateCursor(fcTarget)     for row in curW:         t_oid = row.getValue(oid_t)         if t_oid in join_dict:             for f in add_fields:                 row.setValue(f, join_dict[t_oid][add_fields.index(f)])         curW.updateRow(row)     del row, curW     arcpy.Delete_management(r\"in_memory\\temp_join\")     arcpy.AddMessage('Updated all records sucussefully')          I use this part of the code to select the new created feature. am i going the wrong way about it?               Parcellyr = \"testParcelsAdmit\"      arcpy.MakeFeatureLayer_management(Parcellyr, \"Parcel layer\")      entries = int(arcpy.GetCount_management(fcTarget).getOutput(0))      for i in xrange(entries):          arcpy.MakeFeatureLayer_management(fcTarget, \"point layer\", \"\\\"OBJECTID\\\"={}\".format(str(i)))          arcpy.SelectLayerByLocation_management(\"Parcel layer\", \"INTERSECT\", fcTarget, \"\", \"NEW_SELECTION\")", "OSM data on MapServer I'm making an evaluation to replace the TomTom commercial Database (ex TeleAtlas) with Open Street Map data. What I need to do is **use the street map as a base layer for my WebGIS applications**. I use MapServer as application server and I made styles for features of the TomTom DB based on attributes values. I want to do the same with OSM data. Looking on the web I found many references to MapBox, TileMill, preconfigured style schemas and so on... but I have some questions/doubts about all that. 1) If I need to render this data through MapServer, can I avail of all these instruments? 2) Is there a way to convert those styles to MapServer .MAP files? 3) I imported OSM data from SHP files downloaded from a web site that regularly creates them from updated OSM data. I read something about OSM2PGSQL, OSM2PO, OSMOSIS and so on... but I don't really understand what they are and how they work and if I can use them with my actual database. Do I really need to import OSM data with such tools?", "What does 'to the right' mean, regarding the >> operator in PostGIS? I am reading the documentation on the `>>` operator in PostGIS, and I cannot understand the meaning of `strictly to the right` because on the plane, right or left depends on the direction at which one is looking. Reference: http://postgis.refractions.net/documentation/manual-1.4/ST_Geometry_Right.html What would be that direction?", "Where can I find cellmast data in the UK? I am looking for a shapefile containing the locations of cell masts that provide phone coverage in the UK. On sites like Orange, O2 etc they have an interactive signal checker (https://explore.ee.co.uk/coverage-checker for example), but I haven't found a way to obtain the data in GIS form. Have rung several phone companies, but the customer services down there don't seem to understand what I am asking for! Any help would be greatly appreciated, thanks.", "Detecting invalid WKT in text column in SQL Server I've got a whole load of WKT data in a SQL Server table, of which I'm trying to detect the validity. I'm currently doing a query like this:               UPDATE f SET          f.\"CurrentGeomValid\" = geometry::STGeomFromText(f.\"GEOM_CURRENT\",29900).STIsValid()     FROM \"Feature\" f      WHERE f.\"CurrentGeomValid\" IS NULL;      (Basically updating a column with the geometry validity). I'm hitting an issue when the WKT is completely invalid, for example:               POLYGON ((0 0, 10 10, 0 0) (100 100, 200 100, 200 200, 100 200, 100 100))      The initial loop of this polygon doesn't have enough points and gets me a message like so:               Msg 6522, Level 16, State 1, Line 1     A .NET Framework error occurred during execution of user-defined routine or aggregate \"geometry\":      System.FormatException: 24305: The Polygon input is not valid because the ring does not have enough distinct points. Each ring of a polygon must contain at least three distinct points.     System.FormatException:         at Microsoft.SqlServer.Types.Validator.Execute(Transition transition)        at Microsoft.SqlServer.Types.ForwardingGeoDataSink.EndFigure()        at Microsoft.SqlServer.Types.OpenGisWktReader.ParseLineStringText()        at Microsoft.SqlServer.Types.OpenGisWktReader.ParsePolygonText()        at Microsoft.SqlServer.Types.OpenGisWktReader.ParseMultiPolygonText()        at Microsoft.SqlServer.Types.OpenGisWktReader.ParseTaggedText(OpenGisType type)        at Microsoft.SqlServer.Types.OpenGisWktReader.Read(OpenGisType type, Int32 srid)        at Microsoft.SqlServer.Types.SqlGeometry.GeometryFromText(OpenGisType type, SqlChars text, Int32 srid)      The issue seems to be that the STGeomFromText function is failing to read the invalid geometry so that the STIsValid function can tell me that it's invalid! I can certainly write some .NET code with an exception handler and process my dataset row by row; I'm wondering if there is a better way of doing this in a single query? Any idea? Cheers!", "Split a Quad to 1:7,500 Question Here I have 1:24,000k quads. I know how to use the word split toolbox. What I would like to split 24,000K to 1:7,500 or 6,000k. Is there a way around for me to do that ? For example,, if you have one quad that is 1:24,000 and you want to break it down to either 1:6,000 or 1:7,500 ? I have about 269 quads and need them to break down to where I want 1:6,000 or 1:7,500. I am using ArcGIS 9.3.1 . Thanks !"]}, {"query": "How to learn arcobject vba?", "pos": ["Getting started with Arcobjects What is the best route or place to get started with arcobjects if one is not a developer and _not aiming to become a developer_? I've been using gis professionally for a long time, almost two decades, arcinfo/arcgis for most of that; I'm pretty good. I'm learning software development, and even have a modestly successful small python application used in a public project; I'm not good! I don't want to become a full fledged software developer but I keep running into things I just can't do without programming (example). In the arcgis world this puts me pretty squarely in the python camp, which is fine by me since I like python, however python does not have straightforward access to arcobjects. (Python and arcobjects is possible, but it's an unsupported route. This question is about following a beaten path.) Soooo, I need to get started, but where? Arcgis help says to get started with the ESRI Developer Network but $1500/yr is definitely not in my budget, and sounds like using a sledge hammer to swat mosquitos. And which language .NET, Visual Basic, or Visual C++? * * * **UPDATE:** Thank you everyone for the wonderful answers. In light of them I realise I unecessarily narrowed the scope of my question be pre-supposing \"arcobjects\" is the direction I need to go in. A more open ended formulation is more along the lines of: > I keep running into problems I just can't solve with arcgis and python > alone. What else can I learn/use to solve problems like X? I've no interest > or intention of becoming a software developer. I just need to do a couple > things which aren't exposed to the arcgis python modules."], "neg": ["How do I save edits from an ArcMap editing session using VB.Net? I have figured out how to do a map save document, but I would also like to be able to save edits whether or not I am also saving the map document.", "gdal2tiles.py problem - creating mini tiles I have a similar problem to the issue posted here (gdal2tiles problem). I have 80 GeoTIFFs (4000x4000) with EPSG:27700 projection embedded and TFW and PRJ files. These I have built into a virtual raster using gdalbuildvrt which creates a 10x10 tile image that is 40000x40000 pixels. Using gdal2tiles I can create a set of tiles for specific zoom levels. In this case I am using the Ordnance Survey VectorMap District and 25K raster tiles and I want zoom levels 7, 8 and 9. The problem is that zoom levels 8 and 9 work perfectly creating 97969 tiles at zoom level 9 and 24649 tiles at zoom level 8. Zoom level 7 creates the correct number of tiles but the output images consist of a \"mini\" thumbnail in the top left corner and the rest of the image is transparent/white. Why does it work for 8 and 9 and not 7? Should I resize the image to fit nicely into 256x256 squares? See the images attached below: ![Zoom level 7](http://i.stack.imgur.com/7Fk57.jpg) ![Zoom level 8](http://i.stack.imgur.com/IrPDc.jpg)", "How to add USGS DRG WMS to QGIS? Is there a WMS server, which I can be added to QGIS, that displays USGS DRGs? If so please explain how? Thanks", "Outward buffering I get the ConvexHull of a set of polygons using ST_UNION and ST_CONVEXHULL functions using PostGIS. I want to know how to create an outward buffer of the created convexhull in PostGIS?", "How to draw bar diagrams on the map? I need to draw simple histograms in QGIS version 1.8 from an imported DB. I need a double bar diagrams (eg: male/female - in/out) but I only find the possibility to set pie charts. Is it possible to draw histograms with high proportional to the value?", "Rgeos drops associated values when intersecting polygons I am trying to intersect two SpatialPolygonsDataFrames and get a SpatialPolygonsDataFrame as the result. Unfortunately, using the `gIntersection` function from `rgeos` (which works impressively quickly to intersect the polygons), I cannot seem to retrieve the associated dataframes. Consider the following example:               > fracPoly <- gIntersection( toSingle, fromSingle )     > class(toSingle)     [1] \"SpatialPolygonsDataFrame\"     > class(fromSingle)     [1] \"SpatialPolygonsDataFrame\"     > class(fracPoly)     [1] \"SpatialPolygons\"      I can write a wrapper function which handles the transfer of `data.frames`, but it will be a minor pain to get all the checking right and before I did I was hoping someone could either confirm that there's no better way or point me towards another function (or option for `gIntersection`) which would allow me to retain the associated `data.frames`. **Update** On further reflection, this may may be very deliberate behavior by `gIntersection`. After all, of the two SPDFs, whose data.frame do you pass along? So I may have to write a wrapper which merges the two.", "Editor to work on GML files I am looking for a good way to work on GML files and would appreciate some personal experience. At the moment I am using nXML or SGML mode for Emacs but I wouldnt mind having an IDE/Emacs mode/... that is more specialized on GML files and could possibly render changes in real time. Support for large files (>15 MB) would be a requirement. I am running Linux (Ubuntu 13.04) so native programs would be prefered, but I don't mind if Windows programs are mentioned.", "Does Metadata for ArcGIS Python script tools in custom toolbox work? * I've created several python scripts and created tools from them.   * I have a custom toolbox that contains all of my tools.   * I add this toolbox to the ArcToolbox window in ArcCatalog.   * I want to create metadata and set parameter explanations for each tool. I've noticed that, when I navigate to my toolbox using the ArcToolbox window, I cannot edit metadata by highlighting the tool in the toolbox window and choosing the 'Description' tab in the catalog window. I can, however, right click in the tool and choose 'Item Description', which opens another window and I can edit metadata in there. Next, I go to the Catalog Tree Window and navigate to the location of the toolbox. In this situation, I can highlight the tool and choose the 'Description' tab and edit the metedata there. This, however, does not translate the edited metadata back to the same tool in the ArcToolbox window. If I open the tool in ArcToolbox window and highlight a parameter, I still get a description message of 'No description available'. So, it's like I have to edit the metadata twice. Once in the Arctoolbox window and then again in the Catalog Tree Window. I've noticed this about the Description tab in ArcCatalog. It only honors selection in the Catalog Tree Window. If I a have tool selected in the ArcToolbox window, the description is still set to whatever is highlighted in the tree window, not the toolbox window. Is this how it's supposed to work? I'm OK with only having to be able to edit metadata in the Catalog tree window, but the fact that metadata does not translate back to the same tool in ArcToolbox window is odd to me. Am I doing something wrong?"]}, {"query": "Geoserver Map Rendering", "pos": ["Hardware configuration needed for geoserver to perform faster I Build an application for enabling simple map layer switcher using EXT JS ![enter image description here](http://i.stack.imgur.com/hxrIS.jpg) in this when user press refresh button( which present in the bottom of Layer Tab the application ) read all checked nodes in coma separate value and send as 'dynamic LAYER GROUP' WMS request to the geoserver and served as a single layer to this application How ever the **map rendering is too much slow for 5 user** to increase the map accessing speed I added 3 instance of geoserver in same system with different port with 1024MB java inital and maximum memory pool for each instance and by using Apache HTTP Server i also done Load balancing . where the 'getmap' request is load balanced and transfers to these three geoserver I tuned all the geoserver instance for production environment But still am facing slow rendering speed 1)Is the slow speed is because of using same system for the multiple instance? 2)I am using same database for the three instance did this have anything to do with MAP availability criteria I need to tune my application to work for 30 user simultaneously presently i having an HP server with XEON Processor + 4 GB RAM using stable geoserver 2.4 and openlayer 2.12 what is the best way to tune my application to speed map rendering speed which is the minimum configuration (hardware+software) needed to Speed up map rendering for 30 simultaneous user", "Increase Map Availability in Geoserver I have an application which access same map from two geoserver using loadbalancing concept the map is accessed using WMS service. where the two geoserver connected to a single same POSTGIS database. even the both tomcat is alloted with 3GB of RAM but the map rendering is still too slow Is this have anything to do with the performance of POSTGreSQL?? is there any way to increase map availability ? Please help me"], "neg": ["convert a shapefile into graph with nodes and edges Is there a way to convert a shapefile into graph with nodes and edges(except networkx). I'm using qgis and I want to convert a road vector layer into a graph, so that I can use it to apply shortest path algorithms (astar). Please help me to find a solution.", "Open Source Map Composing Tool Are there any open source tools which can be used for map composing, preferably GUI based. I use Quantum GIS sparingly but I am interested to know if there are others. The tool must be able to read raster/vector layers in standard formats and allow exporting in various formats. Something like GeoPDF export would be a great plus.", "How to exclude some layers from ArcReader legend? I have created an ArcReader map for staff which has a number of imagery layers, such as satellite imagery and a raster topographic map. I also have a legend which automatically updates based on which layers are selected in the table of contents. How do I exclude the imagery layers, though, because they are not useful in a legend? When they appear in a legend they are just RGB colours.", "How can I extract data from OSM which includes the street names? I am exporting OSM data (in .osm) files to use in qGIS. I am interested in having the street names displayed. I know they are in the OSM data set because they are displayed when I browse the data online, but when I view my downloaded files and open the attribute tables for streets, most of them simply have \"null\" or \"label\" as values. What am I doing wrong? How can I extract data from OSM which includes the street names?", "Lidar and infrared data to detect petroleum releases Would this combo detect differences in soil temperature in proximity to the release due to the higher temperature of pipeline fluids or would the surface temperatures be affected by the volatilization of the released fluids? I know this technique is being used currently and I am just curious about the process by which it would be able to determine a release point.", "Set datasource form world map.mxd Noob question here: I've downloaded a data set from ESRI as part of EDN, and it contains world data in a folder such as this: C:\\Download\\ESRI\\EDN Data\\DataMapsArcGIS2013_1\\world\\World Map.mxd When I double-click this .mxd file, it opens up in ArcGIS 10.2, but nearly all of the data source links are broken. How can I fix these links? What is the data source for this map? Thanks!", "Why am I losing part of my raster when I reproject? QGIS 2.0 Working with tiff raster file. Reprojections are in WGS84 Mercator. Here is my problem: I am trying to use buffers or urban areas to analyze light intensity on a raster layer. I want 30 miles, 60 miles, and 100 miles for the buffer sizes. I have reprojected the vector layers to WGS84 / World Mercator. When I ran a zonal statistics, everything went smoothly until I was double- checking the output. I saw \"null\" on a few of the rows of information in the data table. When I looked at the raster image, which I also reprojected to WGS84 / World Mercator, a large chunk of the raster layer was missing. Images below. Non-reprojected raster layer: ![enter image description here](http://i.stack.imgur.com/YrygV.jpg) Reprojected raster layer: ![enter image description here](http://i.stack.imgur.com/PRuph.jpg) I am assuming there is a problem with my reprojections. I am still new at GIS, so please bear with me. Thanks in advance.", "Using onRectangle for user input in ArcMap/ESRI addin In an effort to try to add user input to my project, I'm developing an esri python addin to generate rectangles to my map. I'm on step one now, just exploring the addin functionality. I tried making an addin 'tool' precisely per the ESRI sample code, but the button isn't working. It appears on my ArcMap desktop, but when I click it, nothing happens. I just really want to know what's happening with the onRectangle, and how I can get it to accept user input. Here's the sample code that I essentially stole from ESRI:               import arcpy     import pythonaddins          class fishnetsExample(object):         def __init__(self):             self.enabled = True             self.cursor = 3             self.shape = 'Rectangle'              def onRectangle(self, rectangle_geometry):             \"\"\"Occurs when the rectangle is drawn and the mouse button is released.             The rectangle is a extent object.\"\"\"             extent = rectangle_geometry             # Create a fishnet with 10 rows and 10 columns.             if arcpy.Exists(r'in_memory\\fishnet'):                 arcpy.Delete_management(r'in_memory\\fishnet')             fishnet = arcpy.CreateFishnet_management(r'in_memory\\fishnet',                                 '%f %f' %(extent.XMin, extent.YMin),                                 '%f %f' %(extent.XMin, extent.YMax),                                 0, 0, 10, 10,                                 '%f %f' %(extent.XMax, extent.YMax),'NO_LABELS',                                 '%f %f %f %f' %(extent.XMin, extent.YMin, extent.XMax, extent.YMax), 'POLYGON')             arcpy.RefreshActiveView()             return fishnet"]}, {"query": "Training courses in geostatistics and spatial modelling", "pos": ["What are sources for current geo-statistical analysis classes/events: open or proprietary I am keenly interested in geo statistics (and many other words with 3 t's :).   I am not very programatically inclined but have been following several lists with this theme.   One being the R filter on stackexchange (I get occasional digest emails of questions there).   I find that there is an extremely intricate language associated with statistics in general.   I am insterested in learning from a layperson point of view what some of this language means and how to apply it to everyday GIS. Please list any currrent sources for geo-statistics knowledge/understanding. Here is an example of useful information...   travel for training   live online opportunity Edit: Per request; I enjoy online training but get more from in classroom or step by step book (or pdf)."], "neg": ["Geometry column naming convention - 'geom' or 'the_geom'? I'm starting my first PostGIS project, and in various books and tutorials I've seen the geometry column labelled either 'geom' or 'the_geom'. Is one more conventional than the other? Furthermore, is there a good reason to use 'geom'/'the_geom' instead of a more descriptive name for the geometry column? (E.g. 'centre_point' for the central point of a feature.) We don't label conventional db columns 'the_int' or 'the_string', so why label geometry columns this way?", "Is 'Shortest Route/Distance' analysis is possible in Geoserver using Openlayers 2.8...? I have configured a web based GIS Map using Geoserver & Openlayers controls.Now I want to add 'Shortest Route' analysis in the same... Any solution....??? Thanks In advance Regads Sandipan", "mapCanvas.saveAsImage not functioning as expected in QGIS 1.8 I have a plugin for exporting maps as PNG images. I believe this code was working correctly within 1.6 (but I cannot guarantee I haven't made another change that would have broken it there, too). Basically, I load a set of base map features and then loop through a set of point layers that get applied and the whole thing is exported as an image. I'm not getting the full canvas at all, but only a single attribute loaded from the base map and nothing from the point layers. (bad result, expected result) In the process of debugging this, I discovered a curious fact. If I include a QMessageBox.information right before I do the export, it works correctly! Doesn't work:                   self.mapCanvas.resize(QSize(394,350))         self.mapCanvas.zoomToFullExtent()         currentImagePath = theExportPath + folder         currentImageName = attribute.replace(' ', '_') + \".png\"         self.mapCanvas.saveAsImage(currentImagePath + \"/\" + currentImageName)      Does work:                   self.mapCanvas.resize(QSize(394,350))         self.mapCanvas.zoomToFullExtent()         QMessageBox.information(self.iface.mainWindow(),\"Debug\",\"Break\")         currentImagePath = theExportPath + folder         currentImageName = attribute.replace(' ', '_') + \".png\"         self.mapCanvas.saveAsImage(currentImagePath + \"/\" + currentImageName)       I tried to add a simple self.iface.mainWindow() in place of the message box but that didn't do the trick. I'm thinking there is some kind of refresh I could do, too, but I tried mapCanvas.refresh() and mapCanvas.updateMap() and these in combination with mainWindow() but could get nothing to work. Did this change in 1.8? Any suggestions to make it work? Including the QMessageBox call will get me going but I have to press \"OK\" for each map to be exported. With all the export combinations, I'd be doing this more than 1000 times! Thanks! B", "Loading a raster using QGIS into a PostGIS2.0 enabled database Following on from my attempt to install a postgresql 9.1 db with postgis 2.0 on windows 7, I am trying to figure out how to load a raster. I have successfully loaded a shapefile, and am trying to do the same with a `.tif` file using the `Load Raster to PostGIS` plugin (version 0.5.1) in QGIS (version 1.7). I have set up the connection to my db, and am using the following settings: ![enter image description here](http://i.stack.imgur.com/w5rrT.png) When I click on the `OK` button, I get the below error message. I've tried this with a `.adf` file and also a `.tif` file, both projected in Albert Equal Area Conic with an SRID of 102003.               Checking parameters...     Connecting to database...     Storing overview 1 on database...     Failed.     Finished storing overview 1.     Storing overview 2 on database...     Failed.     Finished storing overview 2.     Storing overview 3 on database...     Failed.     Finished storing overview 3.     Finished.      This process has not inserted anything into my database, and I don't understand the error message. Some previous related questions are here (asked by me, using a different process on loading rasters) and here (using the same plugin but much earlier in the year).", "Using SLD to style according table column value How to style various points with different image according to value(text) in the column of table(layer)?", "Check validity of file geodatabase using arcpy AS the title suggests, how can I whether a GDB file is valid using arcpy? One approach is, only checking the whether the name ends with `.gdb`, but that's not a robust approach. Because a normal file can be ended with `.gdb`, where GDBs are essentially folders to OS. So how can I do that?", "Plotting a circle on a Web map to view the resulting coverage over a central location Not exactly a GIS question but I hope no one will mind. Does anyone know of a website (something equivalent to Google Map) where you can indicate a location, give a radius and you can view the resulting coverage over that central location ? Thanks.", "Wireframe display of terrain in ArcGlobe? I have successfully imported a terrain dataset into ArcGlobe which provides elevation values to the globe surface. Is there an easy way I can now change the symbology/display of the terrain/globe surface to a 'wireframe' style display, ideally with customisable grid spacing etc? Or would I need to drape a grid image over the terrain surface?"]}], "CQADupstackMathematicaRetrieval": [{"query": "Works in mathematica but not as cdf preview or web embedded cdf", "pos": ["Understanding CDF **Update** Since more and more issues are revealed as I venture deeper into the world of CDF, I decided to make this thread more general and hopefully more useful. I know posted my findings as an answer, but please feel free to edit this post or my answer below if you know something useful. **Questions** I have a quite large project that I want to deploy to the web. I expect users to only have the browser plugin or _Mathematica_ Player, but not Player Pro.   1. Can I use `DynamicModule` in a CDF that is to be viewed by the plugin or the _Mathematica_ Player? Does it always have to be a `Manipulate` in focus in the dynamic interface that is generated?   2. Can I deploy the dynamic output somehow without piling all the used functions and data into the `DynamicModule`-s body or `Initialization` option? `Manipulate` has the option `SaveDefinitions` but `DynamicModule` does not. Does `SaveDefinitions` work with packaged functions as well?   3. What exactly happens when only the dynamic output is selected and deployed (and not the whole document) to CDF via the wizard? What is the difference between deploying only the output or deploying the whole notebook, but with all the code cells being hidden? What is the technical difference between demonstrations and CDFs?   4. Is there any difference (and if so, what) between _Mathematica_ Player, Player Pro and the browser plugin?   5. What are the differences between CDFs intended for _Mathematica_ Player or Player pro, i.e. free CDFs and non-free CDFs (see discussion here)?   6. How to overcome security issues (discussed here and here): when the deployed CDF shows up as a gray box because dynamic updating is disabled for security reasons?", "How to get .cdf format to work with functions? I would like to create simple functions and then pass them into a Manipulate function that can be used in a .cdf file. eg               f[x_] := x^2 + 4;     Manipulate[                Plot[f[x], {x, -c, c}]                , {c, 1, 5}]      works fine as a notebook but crashes as a .cdf"], "neg": ["Memory problem with producing complex graphics of general type The problem I am about to ask has appeared once here: Memory Leak in Frontend - anyone know a workaround?. However, in this question I would like to put it in a bit different context. **Problem recipe:**   * Set $HistoryLength to 0 (this forces mathematica not to keep any history of evaluations)   * Create a graphic object, which contains many colors/opacities/primitives/pointsizes/...   * Open system monitor in your operational system   * Rasterize the object in mathematica   * Export it (optional), clear all the variables   * Check your system monitor: memory used by mathematica frontend has grown larger **Example of the problem:** This example is not minimal, but is aesthetically appealing. Following the recipe, first set the history length:               $HistoryLength = 0;       Then create a graphic object. In this case, it is a set of approx 0.5 10^4 points, having random positions inside a 0.5 radius sphere, random sizes and random colors, following some colorscheme. A cylinder is added afterwards to make the object look like a tree.               PointNumber = 10^4;     BushSize = 0.5;     PointLocations =        Select[(2 BushSize {Random[], Random[], Random[]} - {0.5, 0.5,              0.5}) & /@ Range[PointNumber], Norm[#] < BushSize &];     PointNumber2 = Length[PointLocations];     PointSizes = 0.01 Random[] & /@ Range[PointNumber2];     PointColors =        ColorData[\"PlumColors\"][Random[]] & /@ Range[PointNumber2];     GraphicObject =        MapThread[{#1, PointSize[#2], Point[#3]} &, {PointColors,          PointSizes, PointLocations}];      Now, open the system monitor and rasterize everything:               TreeStuff =       Rasterize[       Graphics3D[{Opacity[0.8], Brown, EdgeForm[],          Cylinder[{{0, 0, -1}, {0, 0, 0.1}}, 0.01], GraphicObject},         PlotRange -> {{-1, 1}, {-1, 1}, {-1, 1}}, ImageSize -> 600,         Boxed -> False]]      As you can see, mathematica front-end has expanded in size by some 50 Mb! It is not all, at all. If you reevaluate the notebook, mathematica will pick another set of random points and will expand in the memory again. However, if you re-rasterize an object which has been rasterized before, memory will not be leaked. **Discussion:** The described behavior is clearly a bug. Say, one is producing an animation. If a given frame has been rasterized and saved, no information needs to be stored about it in the memory. Nevertheless, it gets stored incrementally. It seems hard to imagine, that nobody has ever created complex graphics with mathematica before. In particular, in processing datasets or in creating animations, one has to rasterize such graphics many times. In this case, if the parameters of graphics change, mathematica takes all the system memory. Therefore, at least somebody, making complex graphics with mathematica, must have faced a similar problem before. What do people commonly do to treat this issue? How can one clear the frontend memory, which expands so obviously in system monitor after each new evaluation of the above presented code? **P.S.** The code outputs this pretty tree: ![enter image description here](http://i.stack.imgur.com/EAoPy.jpg)", "Integrate function without specifying limits of integration I've been having trouble to make mathematica evaluate an integral without specifying the values of the limits of integration. I mean, if I write               Integrate[x,{x,x1,x2}]      Mathematica returns the correct answer: $\\frac{(x2)^2-(x1)^2}{2}$. But If I write something like               Integrate[x^2/(1-x),{x,x1,x2}]      Mathematica just keeps the evaluation forever... Is there something that I can do to avoid this behaviour?", "How to fix the \"Module\" function, for implicit funcitons? I wanted to make a function which gives the frequencies of a number in a specific list, when I came accros this problem. This is what I tried:               row = {-1, 1, 2, 3, -1, 1, 2, -1, 1, -1, -2, -3,        1, -1, -2, -3, -4, -5, 1, 2};          frequencyRow =       Round[HistogramList[row, {Min[row] - 1, Max[row] + 1, 1}]];          lengthRow = Map[f, Part[frequencyRow, 1]]          (*{f[-6], f[-5], f[-4], f[-3], f[-2], f[-1], f[0], f[1], f[2], f[3],           f[4]}*)          frequency = Append[Part[frequencyRow, 2], 0]          (*{0, 1, 1, 2, 2, 5, 0, 5, 3, 1, 0}*)          mode[n_] := Module[{f}, {lengthRow = frequency}; f[n]]          mode[2]          >f$821[2]      (So the implicit fucntions do not give the outcome I want. However;)               mode2[n_] :=       Module[{f}, {{f[-6], f[-5], f[-4], f[-3], f[-2], f[-1], f[0], f[1],           f[2], f[3], f[4]} = {0, 1, 1, 2, 2, 5, 0, 5, 3, 1, 0}}; f[n]]          mode2[2]          (*3*)      (If you use the exact outcome of the functions, the Module function does give the right outcome)               goal = Map[mode2, row]          (*{5, 5, 3, 1, 5, 5, 3, 5, 5, 5, 2, 2, 5, 5, 2, 2, 1, 1, 5, 3}*)      If you know how to fix this to make it work for the implicit functions as well, so I can chance the imput without changing the formula all the time, that would be nice. Or if you see a way to do this proces faster or easier, that would even be better.", "Unexpected behavior of confidence bands for data presenting two regions with uneven noise Let's generate some noisy data with uneven noise.                   data = Table[{x,Exp[-(x-2)^2] + Exp[-(x+2)^2]*RandomReal[{0.5, 1.5}]},                {x, RandomReal[{-4, 4}, 500]}];      ![enter image description here](http://i.stack.imgur.com/VrQVD.png) Let's fit it with a nonlinear model                   fit = NonlinearModelFit[data, b Exp[-(x-a)^2] + c Exp[-(x+a)^2],               {a, b, c}, x]      from which we extract the \u03c3 and 2\u03c3 prediction bands for single observations:                   {bands1[x_], bands2[x_]}=Table[fit[\"SinglePredictionBands\",ConfidenceLevel -> cl],           {cl, {.683, .954}}];      The bands seem not to take into account the unevenness of the noise:                   Show[ListPlot[data, PlotStyle -> {Opacity[0.5]}], Plot[{fit[x], bands1[x], bands2[x]},              {x, -4, 4},Filling -> {2 -> {{1}, Directive[{Green, Opacity[0.25]}]}, 3 -> {{2}, Directive[{Yellow, Opacity[0.25]}]}},              PlotStyle -> {Directive[Thickness[0.0075], Red],Black, Black}]]      ![enter image description here](http://i.stack.imgur.com/0j7dt.png) Am I misinterpreting confidence bands, or am I calculating them in the wrong way?", "How can I crop manipulator from a plot I wanted to know how can I crop a `Manipulator` from a plot. the code for plot is                  a=  With[{z1 = .25, z2 = 1, x = 1},         Manipulate[       PopupWindow[     Graphics[      DiscretePlot[Sin[a t], {t, 0, 2 Pi, Pi/6}, ExtentSize -> Full,        ImageSize -> Scaled[x], AspectRatio -> z1/z2]], {a}],      OpenerView[{\"Vertical\", Control[{{a, 1, \"Manipulator\"}, 1, 30}]}],      ControlPlacement -> Bottom]]          I have tried using `Export` and `Import` functions and it is working fine                ImageCrop[Import[Export[\"test.gif\", a, \"Graphics\"]], 90]      But, I wanted to know some other way to do this as I think `Export` and `Import` takes a lot of time in execution.", "plotting xy, yz, zx plane at I have a data list in the following form,               data = {x, y, z, f}      I would like to present three kinds of subdata set as a density (or contour) plot on the respective planes at once in one 3D graph.   1. `data1 = {x, y, f}`   2. `data2 = {y, z, f}`   3. `data3 = {x, z, f}` How could I make an above kind of plot? I really appreciate if anyone help me.", "Definite Integral, Piecewise, Error I am trying to evaluate the following:               myExpression=Piecewise[{{-c E^(c s)-(E^(-((-s+\\[Alpha]+q \\[Beta])^2/(2 (\\[Beta]^2 \\[Sigma]q^2+\\[Sigma]s^2)))) v \\[Beta])/(Sqrt[2 \\[Pi]] Sqrt[\\[Beta]^2 \\[Sigma]q^2+\\[Sigma]s^2]),\\[Beta]!=0},{-c E^(c s),\\[Beta]==0}}]     Integrate[myExpression,s]      However, when I try to make this Integral definite, by using {s,0,z}, I get the following error:               Integrate::pwrl: \"Unable to prove that integration limits {0,z} are real. Adding assumptions may help\"      I do not wish to change the expression of this integral, nor do I care for some cheap trick which removes the error message (like `Quiet`). I simply want to know where this error comes from, and what additional information about my variabales _Mathematica_ would like to know. Thanks! Laurens", "How can I mend this broken heart? Try to evaluate the following code:               ContourPlot3D[(x^2 + 9/4 y^2 + z^2 - 1)^3 == x^2 z^3 + 9/80 y^2 z^3,        {x, -6/5, 6/5}, {y, -6/5, 6/5}, {z, -6/5, 3/2},        Mesh -> None, Boxed -> False, AxesLabel -> {\"x\", \"y\", \"z\"},        PlotPoints -> 50, Axes -> False,        ContourStyle -> Directive[Red, Opacity[0.58], Specularity[Yellow, 30]],        AspectRatio -> 1.15, ViewPoint ->{-0.930, -3.137, -0.860}]      The resulted heart looks broken: ![enter image description here](http://i.stack.imgur.com/YC64r.png) Increase the `PlotPoints` value to up to `200` improves the appearance but does not solve it. What is happening?"]}, {"query": "Determine whether some expression contains a given symbol", "pos": ["What is the most elegant way to see if an expression is affected by a certain symbol? > **Possible Duplicate:**   >  Determine whether some expression contains a given symbol Let's say I have some expression:               sample = {1, 1/q, f[m]}      And I want to check it if it has the symbol `m` in it. My question: Is there a clean or fast way of checking if `m` is in the equation? * * * What I came up with so far:               Do[StringFreeQ[ToString[sample], \"m\"], {i, 300}] // AbsoluteTiming     (* {0.0120007, Null} *)      and               Do[(sample /. m -> Unique[]) === (sample /. m -> Unique[]), {i, 300}] // AbsoluteTiming     (* {0.0100005, Null} *)      These solutions work, but I feel like there might be a faster, functional way of doing this."], "neg": ["How to rewrite this function to be faster: Find sub-matrixes of boolean board which imply a given boolean pattern I have Boolean matrix A (called \"board\") and Boolean matrix B with smaller dimensions (called \"pattern\"). I am trying to find sub-matrixes C of A such that C has same dimensions as B, and TableImplies[C, B]. Function TableImplies returns true if matrix A piecewise implies matrix B:               TableImplies[A,B]=true if for all i,j (a_ij => b_ij).      Example:               falsePattern = Table[False, {15}, {15}];     truePattern = Table[True, {15}, {15}];      Here TableImplies[falsePattern, truePattern] == True, but TableImplies[truePattern, falsePattern] == False. I have the following code, but it is not very fast:               tableImplies[a_, b_] := And @@ Flatten@MapThread[Implies, {a, b}, 2]          searchTable[pattern_, board_] :=       Reap[{sizex, sizey} = Dimensions[pattern];         Do[subBoard = board[[i ;; i + sizex - 1, j ;; j + sizey - 1]];          If[tableImplies [subBoard, pattern], Sow[{i, j}]],         {i, 1, 16 - sizex}, {j, 1, 16 - sizey}]][[2]]          board = Table[i != 16 - j , {i, 1, 15}, {j, 1, 15}];          kroneckerPattern = Table[i ==  j, {i, 1, 2}, {j, 1, 2}];          Timing[Do[searchTable[kroneckerPattern, board], {100}]][[1]]/100            (* 0.00873606 *)      How do improve speed of this calculation? How to improve coding style? **UPDATE:** Michael's answer seems to only search for specified sub-matrix inside the given matrix, instead of returning sub-matrixes, that piecewise imply given pattern. I added examples to the beginning of question to better explain what I wanted (see truePattern, falsePattern and how they should be related to each other when using TableImplies). I guess I should have been more clear from the beginning. This compares my algorithm(searchTable) to Michael's (Position[...]). They are clearly not equivalent:               searchTable[truePattern, falsePattern];     Out: {{{1, 1}}}     searchTable[falsePattern, truePattern]     Out: {}     Position[Partition[truePattern, Dimensions@falsePattern, 1], falsePattern]     Out: {}     Position[Partition[falsePattern, Dimensions@truePattern, 1], truePattern]     Out: {}      **Update 2** : I thought I should be more specific in formulating my question. Details matter. As I said before, I want to know, how should this algorithm could be made faster. It is important to mark that the board (containing matrix) will be always of constant size (15x15), but the pattern (searched sub-matrix) will be of varying dimensions, but always smaller than the board. This is relevant because for example in link provided by ssch, http://stackoverflow.com/questions/8364804/a-fast-implementation-in- mathematica-for-position2d, the matrixes are very large and the hard part is finding the position. In my case the number of possible positions is not very large (at most 225), but the slow part is to show whether the pattern matches the board or not. Maybe, if this whole problem could be re-written as boolean expression, that Mathematica could try to solve? Would this approach be faster? Another important note is that the pattern will very likely contain a lot of \"True\"s in my application. Could this be used to make the algorithm faster? For example, if the pattern contains only 1 False, then the problem is basically finding all instances of \"False\"s on the board. If the pattern contains more of \"False\", then the problem still boils down to Boolean expression, but not to an particularly easy one. PS: If my question is partly about algorithms and partly about programming Mathematica, is it correct of me to post this question here? Maybe I should just first ask some algorithms-related StackExchange Q&A for an algorithm and then ask here for how to program this algorithm effeciently in Mathematica? I just thought that maybe Mathematica's potential for symbolic evaluation could lead to algorithms not thinkable in functional programming languages, which is why I asked directly here :)", "keyboard sequence for Magnify in version 8? It used to be that you could find a Magnify item in the Format menu of the Mathematica front-end, at the very bottom if I remember correctly. You could get at the item in Windows by a keyboard sequence like `Alt-R`, `M`, then a number. Mac probably had something similar. This was really useful for mouse avoiders like me. That little tiny drop menu in the extreme lower right of a notebook is annoying to catch with a mouse on highest-speed setting, which you need on a high-def screen with 1920 or 2560 pixels width. My mouse movements end up looking like a plot of a strange attractor swirling around the target! I haven't been able to find the Magnify menu item in Mathematica 8 nor any other keyboard shortcut for notebook-magnify in the Mathematica documentation center. Would be grateful for anyone pointing out any means for accessing notebook magnify from the keyboard.", "How to switch elements i,j in a list? Are there any direct function to switch elements i,j in any list? or is necessary to create one with Do / If ? (I don\u00b4t ask for making me this function if it doesn\u00b4t exists) My target is can switching positions i,j in {1,4,3,2,5} for example I tell switch(2,5) an obtain {1,5,3,2,4}", "Generic Matrices A multivariate Gaussian distribution for $k$ dimensions looks like this: $$\\frac{1}{\\sqrt{(2\\pi)^k|\\mathbf \\Sigma|}}\\mathbf e^{ -\\frac 1 2 \\mathbf x^T \\mathbf \\Sigma^{-1}\\mathbf x }$$ $\\mathbf x$ is a $k$-dimensional vector, and $\\mathbf \\Sigma$ a $k$ by $k$ symmetric positive definite matrix. Now I want Mathematica to integrate this expression over all $\\mathbf x$, the result should be 1. How can I do this? Nothing else is known, in particular we don't know the number of dimensions.", "How to update Print-out \"in place\"? I want to run an exhaustive search algorithm that will take several hours to finish, so I'd like to have it execute `Print` statement periodically, showing the fraction of the search space covered and the best result found so far. E.g.               For[i = 1, i <= n, i++,       ...       If[Mod[i, stride] == 0, Print[{N[i/n], bestsofar}]     ];      This works OK if the number of updates is not too big. Otherwise, the voluminous print out begins to overwhelm the notebook, making it increasingly difficult to navigate through it. Closing the cell does not help here: it is opened automatically with each new print-out. (Also, when the cell remains open, the window will not necessarily auto-scroll to keep the latest print-out in view, so one needs to manually scroll to see it. No big deal; just a bit annoying.) I'm looking for a way to have each new print-out overwrite the previous one \"in place\". With other programming environments, at least in Unix-like systems, one achieves this effect by prepending a carriage return character (ASCII 13, aka `\\r`) to the printed string, and omitting the newline character (ASCII 10, aka `\\n`) from the end of the string1. A single newline character may be eventually printed, before execution terminates. The `Print` command implicitly adds the newline at the end of the output, and I have not found a way to suppress this behavior. Is there some other way to achieve the effect of updating a running cell's print-out in-place? UPDATE: based on molekyla777's answer, I modified the code above to:               Monitor[For[i = 1, i <= n, i++,       ...       Refresh[{N[i/n], bestsofar}, UpdateInterval -> 1, TrackedSymbols -> {}]     ];      I added the `Refresh` call to reduce the performance drain that would otherwise result from updating the `N[i/n]` term, which changes with each iteration. It basically does what `Mod[i, stride] == 0` did in the previous version. * * * 1If the length of the output string is not monotonically increasing, it may also be necessary to right-pad the output string with enough spaces to \"erase\" the previous output.)", "A math function similar to \"LatticeReduce\" for finding linear independent basis We would like to ask a math function similar to \"LatticeReduce\" for finding linear independent basis. The input is a list of vectors $M=\\\\{v_1,v_2,v_3,\\dots\\\\}$, with the following property: There is a subset $O=\\\\{w_1,w_2,w_3,\\dots\\\\}\\subset M$, such that $O$ is a basis, i.e. linearly independent and span $M$, $$ v_i=\\sum_a c_{ia} w_a.$$ Moreover, the coefficients $c_{ia}$ are **non-negative integers**. An explicit example is the following: $$M=\\left( \\begin{array}{ccccc} 1 & 1 & 1 & 1 & 1 \\\\\\ 1 & 1 & -1 & -1 & 1 \\\\\\ 1 & 1 & -1 & 1 & -1 \\\\\\ 1 & 1 & 1 & -1 & -1 \\\\\\ 2 & -2 & 0 & 0 & 0 \\\\\\ 2 & 2 & 2 & 0 & 0 \\\\\\ 2 & 2 & 0 & 2 & 0 \\\\\\ 2 & 2 & 0 & 0 & 2 \\\\\\ 2 & 2 & -2 & 0 & 0 \\\\\\ 2 & 2 & 0 & -2 & 0 \\\\\\ 2 & 2 & 0 & 0 & -2 \\end{array} \\right),\\quad O=\\left( \\begin{array}{ccccc} 1 & 1 & 1 & 1 & 1 \\\\\\ 1 & 1 & -1 & -1 & 1 \\\\\\ 1 & 1 & -1 & 1 & -1 \\\\\\ 1 & 1 & 1 & -1 & -1 \\\\\\ 2 & -2 & 0 & 0 & 0 \\end{array} \\right), $$ where $O$ is the first 5 rows of $M$ and $$M[[6]]=O[[1]]+O[[4]],\\, M[[7]]=O[[1]]+O[[3]],\\,\\dots$$ In Mathematica form, the example is               m = {{1,  1,  1,  1,  1},          {1,  1, -1, -1,  1},          {1,  1, -1,  1, -1},          {1,  1,  1, -1, -1},          {2, -2,  0,  0,  0},          {2,  2,  2,  0,  0},          {2,  2,  0,  2,  0},          {2,  2,  0,  0,  2},          {2,  2, -2,  0,  0},          {2,  2,  0, -2,  0},          {2,  2,  0,  0, -2}};      May we know that how to write a function/program such that inputting such $M$, the program will output the desired $O$. _For this example the built-in function LatticeReduce works well. But we are not sure it always works._", "Is it possible to plot a second-order curve by its non-canonical equation? I have this second-order polynom: $$ 6xy+8y^2-12x-26y+11=0 $$ And I need to reduce it to a canonical form of a second-order curve. I solved this, but is it possible to draw a plot of the original equation to check whether my solution is correct? Something like               Plot[6 x*y + 8 y^2 - 12 x - 26 y + 11, {x, -20, 20}, PlotRange -> {-20, 20}]      Now this draws an empty plot. Thank you.", "How to generate characters by a function which works like the Esc + a + ESC How to generate characters by a function which works like the Esc + a + ESC               In[24]:= CharacterRange[\"a\",\"z\"]     Out[24]= {a,b,c,d,e,f,g,h,i,j,k,l,m,n,o,p,q,r,s,t,u,v,w,x,y,z}      How to batch convert them to Greek Letters just like that done by this way Esc + a + Esc ... something like this, a function works,               In[25]:= CharacterRange[\"\\[Alpha]\",\"\\[Zeta]\"]     Out[25]= {\\[Alpha],\\[Beta],\\[Gamma],\\[Delta],\\[CurlyEpsilon],\\[Zeta]}          EnglishToGreekRange[\"a\", \"z\"]      Comes out               {\\[Alpha],\\[Beta],\\[Chi]...}"]}, {"query": "Test a wooden board's vibration mode", "pos": ["How to set the boundary fixed and apply the Young's modulus in Mathematica's FEM? Provided the drawing .stl is given, and the Young's modulus is know, how to start a FEM vibration mode test in Mathematica? The boundary is required to be fixed and the interested focus is on the different responses over various Young's modulus. ![enter image description here](http://i.stack.imgur.com/yGR80.jpg)"], "neg": ["How to instruct FullSimplify to assume that PossibleZeroQ returns correct result? Sometimes I have a really huge expression that cannot be significantly simplified by `FullSimplify`. I would like to, so to speak, _\"simplify with faith\"_ using heuristics applied by functions like `PossibleZeroQ`, `FindSequenceFunction` an so on. Is it possible to instruct `FullSimplify` to use non-rigorous methods like this?", "Getting Internal Self-Test Error I have two questions related to this simple code:               CDFDeploy[SystemDialogInput[\"FileSave\"],        Panel[Row[{Button[Text[Style[\"sav\", FontSize -> Scaled[.2]]],ImageSize -> Scaled[.2]],            Button[Text[Style[\"save\", FontSize -> Scaled[.2]]],ImageSize -> Scaled[.2]]}],           ImageSize -> Scaled[2]], WindowSize -> Scaled[2]]                    1. Sometimes, I am getting `Internal Self-Test Error`. Why?   2. I am able to scale `Button` size, `Fontsize` and `Panel`size in the Horizontal direction but not in the vertical direction. How to do this?", "How can I insert the current date in a text cell? Ok I must be missing something. I have a section with the \"last updated date\" in a text cell, I'd like it to autoupdate. Is there a \"insert current date\" command hidden away in some menu?", "Reducing quality of Graphics3D scene to improve performance? `ProteinData[\"SERPINA1\", \"MoleculePlot\"]` gives the detailed `Graphics3D` plot below. I'd like to make many small copies of this object and place them in a single `Graphics3D` scene, but I'm running into performance problems because the molecule graphics-object is a pretty complicated mesh. Are there general methods of reducing the quality/detail of graphics objects like the one below that would allow me to place many of these in a single scene? ![enter image description here](http://i.stack.imgur.com/XlvG4.png)", "Define an operator with commutative, associative and distributive properties I need to define a symbolic operator with commutative, associative and distributive properties, in the same way as the sum and product operator for real numbers. I have started with:               op[a_, b_] = a\u2295b;     op[a_, b_] = a\u2297b;     op[1, 2];     op[1, 1\u22952];     Distribute[op[1, 1\u22952], CirclePlus]      when I use the `Distribute` command I don't get the parenthesis. How can I define an operator with all this properties in ones.", "ListInterpolation causing .cdf security problems? I've made a simple `.cdf` that makes a function from a list of data I've provided in table form (using `ListInterpolation`) and plots it on a graph (no importing, exporting or conversion of data from string) and I still get a grey block when I try to post it online, indicating that I'm violating some security rule. It works with the `{fullscreen: 'true'}` workaround, but I don't know what I'm doing that necessitates this. Advice? Thanks", "Trouble with NMaximize I am having trouble with maximizing a function I am interested in. Below is the code I am using.               NMaximize[{(p^2)^alpha + ((c - p)^2)^alpha + (1 - (c - p)^2 - p^2)^alpha,        {c/2 - Sqrt[2 - c^2]/2 < p, p < c/2 + Sqrt[2 - c^2]/2, c == 1.2, alpha == 0.7}}, {p}]      I get the following error: > NMaximize::bcons: \"The following constraints are not valid: {alpha == 0.7, c > == 1.2, c/2 - Sqrt[2 - c^2]/2 < p, p < c/2 + Sqrt[2 - c^2]/2}. Constraints > should be equalities, inequalities, or domain specifications involving the > variables.\" Why is this happening?", "Text as plot axes values I have some chemical data that I am plotting using `ListLogPlot`.               data={{2776.37,2016.64,1483.51,1027.35,500.878,94.1385,310.402,282.548,            257.886,224.359,218.688,209.312,215.776,198.78},            {40.5063,24.633,12.069,8.3151,6.35135,15.0977,8.74372,15.5125,9.34959,            9.70696,11.125,12.1457,10.8075,9.7561},           {113.08,124.633,75.9698,59.5186,55.9459,7.81528,57.4372,69.5291,80.4878,            88.2784,105.563,127.935,148.571,148.78}};          ListLogPlot[data, Joined -> True]      ![enter image description here](http://i.stack.imgur.com/MCO17.png) I want to replace the x-axis tick values with the associated elements. e.g. replace 1,2,3,...,14 with               xaxis= {\"La\",\"Ce\",\"Pr\",\"Nd\",\"Sm\",\"Eu\",\"Gd\",\"Tb\",\"Dy\",\"Ho\",\"Er\",\"Tm\",\"Yb\",\"Lu\"};      Any suggestions on how to achieve this? Is there another plot function that I should be using?"]}, {"query": "Combine 2D images perpendicular to each other", "pos": ["Is there something like DensityPlot3D to visualize atomic orbitals? I'm visualizing some hydrogen like atomic orbitals. For looking at plane slices of the probability density, the `DensityPlot` function works well, and with something like:               Manipulate[      DensityPlot[ psi1XYsq[u, v, z], {u, -w, w}, {v, -w, w} ,       Mesh -> False, Frame -> False, PlotPoints -> 45,       ColorFunctionScaling -> True, ColorFunction -> \"SunsetColors\"]      , {{w, 10}, 1, 20}      , {z, 1, 20, 1}      ]      I can get a nice plot ![hybrid orbital sample plot in x y plane](http://i.stack.imgur.com/nHtMY.png) I was hoping that there was something like a `DensityPlot3D` so that I could visualize these in 3D, but I don't see such a function. I was wondering how `DensityPlot` be simulated using other plot functions, so that the same idea could be applied to a 3D plot to construct a `DensityPlot3D` like function?"], "neg": ["How to find the domain and range of an implicit function? For example, we have this curve: $$ x^2 + y^2 = 1 $$ Is there a function in _Mathematica_ for finding out that the ranges for $x$ and $y$ are both `[-1, 1]`? What about implicit functions of more than `2` variables? e.g. $$ x^2 + y^2 + z = 1 $$", "PDE problem with initial and boundary conditions I'm new to mathematica and I don't know what I do wrong, I have written the following PDE problem, with both initial and boundary (four in total)               eq = D[u[x, t], t, t] + D[u[x, t], t] - 2*D[u[x, t], x, x] == 0     bc = {u[0, t] == 0, u[2*Pi, t] == 0, u[x, 0] == 0, Derivative[0, 1][u][x, 0] == sin (2*x)}          DSolve[{eq, bc}, u[x,t], {t, x}]      I need it to solve the PDE, but it doesn't even try to make a solution... what to do. I hope you can help me", "Possible to batch WolframAlpha queries? Sometimes I want some country data not available from `CountryData`. And issuing things like:               WolframAlpha[ToString[#]<>\" | whatever data\",                   {{\"Result\", 1}, \"ComputableData\"}                 ]&/@CountryData[\"Countries\"]      is both incredibly slow and I'm sure to hit my daily API limit. Can I do all these requests in one go?", "Dynamic inside Button This bit of code runs a little animation of a stochastic process:                (* a random walk bm, its min and max  *)      {bm, m, M} = {Table[Random[] - .5, {100}] // Accumulate, Min[bm], Max[bm] }           (* plot of trajectory of bm up to i-th step *)      traj[i_] := ListLinePlot[({Range[1, 100], bm} // Transpose)[[;; i]],          Joined -> True, PlotRange -> {{0, 100}, {m, M}}]           (* animation using Clock *)      q = Dynamic[r = Clock[{1, 100, 1}, 5, 1]; traj[r] ]      Next I'd like to use Button to run the animation. Something like               Button[\"Run\", q]      but this doesn't work. Eventually I'd like to have two buttons, \"Repeat\" and \"Clear\" like this:               x = {{0, 0}};        min[x_] := (Sort[x, #1[[2]] < #2[[2]]  &])[[2]]; Column[ {Row[{Button[\"Repeat\",       x = Append[x, { Random[], Random[]  }]],      Button[\"Reset\", x = { {0, 0}}]  }  ],     Dynamic[Show[{ ListPlot[x, PlotRange -> {{0, 1}, {0, 1}}, ImageSize -> 300,        Frame -> True, Axes -> None] , If[Length[x] > 1,        Graphics[{Red, Line[{min[x], {min[x][[1]], -.1} }]}], {}],      If[Length[x] > 1,        Graphics[{Red, Line[{min[x], {0, min[x][[2]]} } ]}], {}]      }]]}]      but instead of dots, I want to plot animated functions involving Clock.", "I have the roots; how can I find an equation that they will satisfy? I have two solutions; I want is to find an equation that these solutions satisfy using mathematica. The solutions are $x= \\frac{{(26-k)}^2}{26}$ and $y= \\frac{{k}^2}{26}$. I know by hand computing that $x$ and $y$ satisfy $\\sqrt{x}+\\sqrt{y}=\\sqrt{26}$; How can I show this using _Mathematica_?", "Frontend cursor movement speed depends on the position in large notebook file I run Mathematica v9 on my Atom laptop (don't ask) and I got used to the fact that everything is slower. Except for one annoying thing: cursor movement (in text) is slower than the keyboard key repeat rate. In other editors I am used to hold down the up/down/left/right keys and I expect the cursor to stop when I release the key. In Mathematica Frontend this is not the case, keyboard buffer gets filled with keyboard events which get executed by the Frontend way later than the release of the key. This annoying behavior trained me to use only single presses of the movement keys (or mouse clicks at the right position). You can imagine, scrolling through a lot of code in this way can be quite painful. What is even more interesting is that the speed with which Frontend executes the cursor movements depends on the overall size of the notebook file and the current relative position of the cursor the file. The same approximately holds also for edits. Having a large file with a lot of graphics, editing text or moving the cursor at the top of such notebook becomes extremely slow on such weak netbooks. On the contrary, adding code or moving cursor at the end of such file is quick enough not to be noticed. I have been following the evolution of Mathematica \"speed\" since v5 and I have to say that there was huge drop of performance when Wolfram switched the backend language to java and ever since the performance of the kernel or the Frontend has been getting worse (the fact substantially masked by the CPU speed increases during the \"frequency wars\"; now this Moore's law is over...). It also seems that all the incredible performance gains (with JIT technology and loop/execution tracing) in other interpreted languages never really reached Mathematica. Maybe Wolfram should dedicate one major version bump only to address these performance issues otherwise (this great) language may put itself into oblivion. Nevertheless, the behavior described above is quite odd, i.e. it seems edits at the top are $\\mathcal{O}($file size$)$ while at the bottom they are more like $\\mathcal{O}(1)$. Are there any preferences/options that can be tweaked in order to reduce the load Frontend uses for rendering?", "Is it possible to compute trapezoidal rule numerical integration? Is it possible to compute trapezoidal rule numerical integration? I know that Mathematica has `Interpolation`, and that a list of points can be interpolated and then integrated simply using `Integrate`. However, my functions are highly oscillatory (they are based on simulation data), and I am not convinced that the interpolation is perfect, even when I set `WorkingPrecision` to a very high value. Also, I know that `ListIntegrate` is deprecated, and even if I use it, I am not certain if it is using the trapezoidal rule, which I would like to use. Do you know if any resources where I can find Mathematica or pseudocode for trapezoidal integration of lists of points? Or do you have any suggestions about how I can use Mathematica efficiently to program such an algorithm myself? Thanks!", "FiniteFields package is very slow. Any fast substitute for Mathematica? I want to compute the inverse of matrix, say with dimensions $100 \\times 100$, defined over a large finite field extension such as $GF(2^{120})$. I am using the package **FiniteFields** , but Mathematica's computation time is exponential with respect to matrix dimensions. The following code illustrates the problem:               << FiniteFields`;     Table[         With[{ext = 12},            First@AbsoluteTiming@                Inverse[                    Array[GF[2, ext][RandomInteger[{0, 1}, ext]] &, {n, n}]                ]         ],         {n, 1, 11}     ]      I am using an Intel Xeon X5680 @ 3.33GHz (64-bit OS) and Mathematica v8.0.4.0. I have received the following timing results:               {0.0030, 0.0080, 0.0210, 0.0630, 0.1860, 0.5110, 1.3350, 3.3840, 8.9340, 23.0090, 57.4660}      I believe the source of the problem is that the **FiniteFields** package defines many UpValues, DownValues and SubValues of `Times` and `Plus` for head GF and, consequently, the pattern matching of arguments is degraded. Does anyone know if a patch for the **FiniteFields** package or a faster substitute providing a similar interface? Many thanks!"]}, {"query": "How to partition a list and leave in the last sublist which is of different length?", "pos": ["Using Partition to allow sublists of different lengths As a minimal example, suppose I have a list of the integers from 1 to 25. Suppose I want to use `Partition` to partition the list into sublists of length 10 **but** without dropping the \"end\" elements. For example, this code               list = Range[1, 25];     Partition[list, 10]      gives: `{{1,2,3,4,5,6,7,8,9,10},{11,12,13,14,15,16,17,18,19,20}}`, where the integers 21 through 25 have been dropped. What if I want to keep those integers? I would like `Partition` to partition the list into sublists of length 10 only when possible (i.e., keeping the \"end\" elements). How can I do this? In the `Partition` documentation, this entry looks like a possibility: > `Partition[list, n, d, {kL, kR}, {}]` uses no padding, and so can yield > sublists of different lengths. So I tried: Partition[list, 10, 0, {1, 1}, {}] but this did not work (according to the documentation `{kL, kR} = {1, 1}` means \"allow maximal overhang at the end\"). On the other hand, this seems to work:               Partition[list, 10, 10, 1, {}]      which gives the correct output: `{{1,2,3,4,5,6,7,8,9,10},{11,12,13,14,15,16,17,18,19,20},{21,22,23,24,25}}`. Is this the best way to solve the problem, or am I making a conceptual mistake? I obtained the idea `Partition[list, 10, 10, 1, {}]` from the following documentation, but conceptually I am not really sure what it is doing: > Use no padding, so later sublists can be shorter: > `Partition[{a,b,c,d,e,f,g},3,3,1,{}]` > > `{{a,b,c},{d,e,f},{g}}`"], "neg": ["Exporting strings without the quotes I'm trying to export the following string               \"sep = ,\"      to a CSV-file, as to be able to define the separation symbol, but when using the following command,               Export[\"test.csv\", Join[{\"sep = ,\"}, RandomInteger[{-5, 5}, {5, 3}]], \"CSV\"]      I get the quotes around the string in the first line:               \"sep = ,\"     -4,5,0     5,-4,-1     0,5,2     -1,2,4     -1,-4,-1      This obviously isn't recognised by Excel and it doesn't open correctly. I've tried changing the string to something like               Style[\"sep=,\", ShowStringCharacters -> False]      and then export again, but then I just get this whole command into the CSV- file. Is there a method to export this string without the quotes attached to them into a CSV-file? Thanks for all help!", "What is the cleanest way to prevent divide-by-zero warnings? If I evaluate `{1, 2, 3, 4}/{5, 6, 0, 8}`, obviously I get one warning:               Power::infy: Infinite expression 1/0 encountered. >>      and one entry of `ComplexInfinity` in the third position of the result. I'd like to eliminate the warnings and get the output with instances of `ComplexInfinity` deleted. So far,               DeleteCases[Quiet[{1, 2, 3, 4}/{5, 6, 0, 8}], ComplexInfinity]      is the best way I have to do this. But I'd rather not suppress all messages with `Quiet`, in case I'm operating on something more complicated than this example. Rather than cleaning up the mess it causes, is there a clean way to prevent the divide-by-zero operation from happening in the first place?", "How to plot filling under a curve? I want to mark critical areas for statistical test on the plot. How can I do this? This:               pdf = PDF[NormalDistribution[], x]     Show[Plot[pdf, {x, -5, 5}],       Plot[pdf, {x, -5, -2.001}, Filling -> Axis]]      gives: ![enter image description here](http://i.stack.imgur.com/op81t.png) I know that it is probably some super-duper Mathematica feature, but as far as I know this filling shouldn't be cut in such strange way, so I don't want to use this feature. How can I make the filling look right?", "how to set initial conditions when solving recursive equation with tables I am solving a recursive expression with `ParallelTable`. Here is a MWE showing how I do it, and how I set the initial condition:               SetSharedVariable[vals]     t[n_] := t[n - 1]*i*NIntegrate[Exp[-i*x^2], {x, -Infinity, Infinity}];          t[0] = 1;          vals = ParallelTable[{i, t[3]}, {i, 1, 500}];      The expression `t` depends on `i` implicitly. Now I want to make this dependency explicit, as shown here (note, it is **not** a functioning example!):               SetSharedVariable[vals]     t[d_, n_] :=        t[n - 1]*d*NIntegrate[Exp[-d*x^2], {x, -Infinity, Infinity}];          (* WHAT TO DO WITH THIS, THE INITIAL CONDITION? *)     t[i, 0] = 1;          vals = ParallelTable[{i, t[i, 3]}, {i, 1, 500}];      My concern is regarding the initial condition. When I am dealing with `tables`, is there an easy way to implement initial conditions, or do I have to use a `For`-loop for that (where `i` is the variable)?", "Abort during animation I am running an animation with the following command:               files = FileNames[NotebookDirectory[] <> \"*.dat\"];      MTnumbers = FileNames[NotebookDirectory[] <> \"MTnumbers.txt\"];          data = Import[#, \"Table\"] & /@ files     MT = Import[#, \"List\"] & /@ MTnumbers               coords = {{#1 - (#3/2), #2 - (height/2)}, {#1 + (#3/2), #2 + (height/            2)}} & @@@ #[[All, 2 ;;]] & /@ data;          height = 2;          colors = {Blue, Blue, Blue, Blue, Blue, Blue, Blue, Blue, Blue, Blue,      Blue, Blue, Blue, Blue, Blue, Blue, Blue, Blue, Blue, Blue, Blue,      Blue, Blue, Blue, Blue, Blue, Blue, Blue, Blue, Blue, Blue, Blue,      Blue, Blue, Blue, Blue, Blue, Blue, Blue, Blue};     Animate[Graphics[{Sequence @@ {colors[[#]],         Rectangle @@ (coords[[#]][[t]])} & /@ MT[[1]]},     PlotRange -> {{-1000, 1000}, {-200, 200}},      ImageSize -> {1000, 200}], {t, Range[0, 7000]}]           Export[\"tubuli.avi\", %];      As soon as I try to export this output Mathematica crashes. When I increase the number of rectangles to about 150 the simulation crashes without giving an output. Is my computer too weak or am I doing something wrong? EDIT: The data is in the following zip archive you just need the notebook and the data in the same folder and it should work. https://www.dropbox.com/s/iegdb1a031i4mn6/data.zip", "Why does Dynamic output cause CPU usage when onscreen? I write such a line in _Mathematica_ :               {Slider[Dynamic[s]], Dynamic[f[x_] := s*x]}      After evaluation, the CPU immediately runs at full power. And if you scroll the page, it turns out that as soon as this line appear on the screen, the CPU begin to work. This really confused me a lot. Can anyone help?", "shooting method and stifness problem for NDSolve I'm trying to solve numerically the following differential equation:               1/r[x]^5 + k/Sqrt[1 + r'[x]^2] - (k r[x]r''[x])/(1 + r'[x]^2)^(3/2) == 0      I can set boundary condition in `x=x0` and `x=xF` with `x0` and `xF` being the boundaries of the domain of the `x` variable, i.e., `x=[x0,xF]`. The particular values are not important, I can set what I want as long as `xF>x0>0`. I do not have constraint on the value of the first derivative at the boundaries. This equation has a singulary for `r''[x]` in `x=0`. To avoid this problem, I have to use shooting method with appropriate boundary conditions.               sf = NDSolve[{1/r[x]^5 + k/Sqrt[1 + r'[x]^2] - (k r[x]r''[x])/(1 + r'[x]^2)^(3/2) == 0, r[0] == 1, r[1] == 10}, r, {x, 0.1, 100},        Method -> {\"Shooting\",          \"StartingInitialConditions\" -> {r[0] == 1, r'[0] == 0}},        MaxSteps -> 500]      If I do so, I obtain the following errors:               NDSolve::mxst: Maximum number of 200 steps reached at the point x == 0.48535728275604967`. >>     NDSolve::mxst: Maximum number of 200 steps reached at the point x == 0.9112853584099116`. >>     NDSolve::mxst: Maximum number of 200 steps reached at the point x == 0.9766603163139572`. >>     General::stop: Further output of NDSolve::mxst will be suppressed during this calculation. >>     FindRoot::sszero: The step size in the search has become less than the tolerance prescribed by the PrecisionGoal option, but the function value is still greater than the tolerance prescribed by the AccuracyGoal option. >>     NDSolve::berr: There are significant errors {0.0395308,-0.00050132} in the boundary value residuals. Returning the best solution found. >>      But anyway I obtain a solution `sf` in the form of an interpolating function:               {{r -> InterpolatingFunction[{{0.1, 0.920942}},<>]}}      It is this solution reliable? I think that the the differential equation may be affected by stifness issues, so I tried to add as a sub `Mehtod` options to solve stifness mehtod as indicated in the help:               sf = NDSolve[{1/r[x]^5 + k/Sqrt[1 + r'[x]^2] - (k r[x]r''[x])/(1 + r'[x]^2)^(3/2) == 0, r[0] == 1, r[1] == 10}, r, {x, 0.1, 100},        Method -> {\"Shooting\",          \"StartingInitialConditions\" -> {r[0] == 1, r'[0] == 0},Method -> {\"StiffnessSwitching\", \"NonstiffTest\" -> False}},        MaxSteps -> 500]      The problem is that I obtain several errors, and a discontinuos solution that it's clearly wrong. I will really appreciate any help. Samir", "Unexpected output from oddSublists I have just bought _Mathematica_ and I'm in the process of plowing through Shifrin's great book. On page 74 the function `oddSublists` doesn't give me the expected output. Since I'm a true beginner, I of course suspect mistakes on my behalf. I get: `{{}, {, 2}, {, 2, 3, 4, 5}, {, 2, 3, 4, 5, 6}}` However the function `oddSublistsNew` gives me the expected output.`{{1}, {1, 2}, {1, 2, 3, 4, 5}, {1, 2, 3, 4, 5, 6}}` Anyone had similar experience? And here is the code I forgot to include:               Clear[oddSublists];     oddSublists[x_List] :=       Part[x, Union[        Flatten[Cases[          Map[First,            Split[Position[x, _?OddQ], First[#1] == First[#2] &], {2}],            y_List /; OddQ[Length[y]]]]]]"]}], "CQADupstackPhysicsRetrieval": [{"query": "Richtmyer Meshkov instability in MHD", "pos": ["Richtmyer Meshkov instability in MHD In magnetohydrodynamics, the Richtmyer Meshkov instability is found to get suppressed by application of longitudinal magnetic field. Exactly what happens at the interface? Why instability gets suppressed? (How one can get the physical intuition of what is happening?)"], "neg": ["What can currently be deduced about empty hyperspace? Michio Kaku's explanation of universes in hyperspace in this youtube video gives a metaphor of our universe being the surface of a hyperspace bubble that's currently becoming larger. He also says these bubbles colliding would produce the creation of new universes and the destruction of involved universes. But this makes me think there's a lot of room in hyperspace for a universe to float for a very long time without encountering another universe.   * Is there anything significant to note about areas of hyperspace that don't currently have a universe?    * Is it highly entropic?    * Does hyperspace change in any way as a universe approaches?    * Is it similar to how a galaxy will warp the space-time around it, in that hyperspace follows the same mechanics, but with more dimensions?", "How are galaxy filaments formed? And do they have any analogues in stellar formation? > In physical cosmology, galaxy filaments, also called supercluster complexes > or great walls, are, so far, the largest known cosmic structures in the > universe. They are massive, thread-like structures with a typical length of > 50 to 80 megaparsecs h-1 that form the boundaries between large voids in the > universe.[3] Filaments consist of gravitationally-bound galaxies; parts > where a large number of galaxies are very close to each other are called > superclusters. So I've always wondered: how are these structures formed? One would (naively) expect that gravitationally bound structures would form as either spheres or discs.", "Electrodynamics and induced EMF question > A very long straight wire carries a current I. A plane rectangular coil of > high resistance, with sides of length $a$ and $b$, is coplanar with the > wire. One of the sides of length $a$ is parallel to the wire and a distance > $D$ from it; the opposite side is further from the wire. The coil is moving > at a speed $v$ in its own plane and away from the wire. > > (a) Find the e.m.f. induced in the coil. > > (b) Let R be the resistance of the coil. Calculate the force needed to move > the coil with speed v as described, and show that the mechanical power used > to move it is equal to the rate at which heat is generated in the coil. I have included my workings/thoughts. I know that i first have to calculate the magnetic field of the wire: $$B(y)=\\mu_0 I/2\u03c0y $$ Then the emf, $$\\mathcal{E}=-\\frac{d\u03c6(B)}{dt}= -\\frac{d}{dt} \\int_D^{D+b}B\\cdot ds = -\\frac{d}{dt}(a\\cdot \\int_D^{D+b} B\\cdot dy)$$ I have been given the answer of $$\\mathcal{E}=\\frac{\\mu_0Ivab}{2\\pi D\\left(D+b\\right)}$$ Do I have to perameterise the integral? If so does anyone have a guide on how to do this? What I am having trouble with is the intermediate step getting from the integral to the above answer. I know that $P_{mech}=F.v$ and that $P_{heat}= v^2/R = \\mathcal{E}/R$, but I do not know how to calculate the force on the coil.", "Mass fixed to a wheel - mechanics problem I am struggling with a problem from classical mechanics. Imagine a massless wheel (to make it simpler) with a mass $m$ fixed to it rolling without slipping on a horizontal ground. If we now try to find the equations of motion of the wheel (for instance the angle $\\alpha$ it turns) we will find that all the forces are independent of velocity, so $\\alpha ''=f(\\alpha)$. After doing that I decided to solve this problem using Euler-Langrange equations (since friction does no work). I came up with $L=\\frac{1}{2} m R^{2} (\\frac{d\\alpha}{dt})^{2} (1+\\cos \\alpha)-mgR(1+\\cos \\alpha)$ which, upon solving, gives $\\alpha ''$ as a function of both $\\alpha$ and $\\alpha '$. What is my problem?", "Vector product in 2 dimensions If I have a vector A=4i+3j and B=5i-2j, how can I find the vector product AxB? I know that given the angle, its C=AB sin theta, but how can I solve this without the angle?", "Why are popcorn seeds soft after popping? When a seed of popcorn is heated up in oil, it pops like this: ![Slow-mo Popcorn](http://i.stack.imgur.com/r9wd1.gif) You can take one of these popped pieces and eat it with little to no problem. However, if you get an un-popped seed and sink your teeth in, it is noticeably harder. Why is this?", "Experimental realization of Quantum Teleportation of Spin, not polarization, not ions or atoms I've looked everywhere in databases my school provides, to google searches, to the questions asked in physics forums, and here. As I understand, the original QT (quantum teleportation) protocol thought of by Bennett has been \"realized\" with polarization states of photons which is awesome proof. It validates QT because the entangled polarization state of light is a perfect analog. However, it hasn't been exactly realized because it seems to have not been done with spins! Has there really not been any papers on teleporting the spin state of a particle?", "Creating a fair 3 sided coin I want to make a cylindrical three sided fair coin, with sides: heads, tails, and edge. What should the area of the edge be in relation to the area of the head of the coin? Assume it is all made of a uniform material. **Thoughts:** I was thinking that so long as the surface areas of all three sides were equal, that would be enough, but this seems to lead to tipping over and landing on one of the other faces. Another thought was that the height of the edge should be equal to the diameter of the face, but this seems much too thick. I am looking for a rigorous way of approaching the problem, as opposed to using (bad?) intuition."]}, {"query": "How a fan moves air?", "pos": ["What is going on in front of and behind a fan? Why is it that when you drop paper behind a fan, it drops, and is not blown/sucked into the fan, whereas if you drop paper in front of a fan, it is blown away?"], "neg": ["How to find momentum of different pieces of the same object after it explodes? If a stationery object explodes into a specific number of pieces due to internal force, how can I find the momentum of these pieces?", "Wannier functions on a ring Let's say I have a single particle hamiltonian in a periodic potential. For example a 1D lattice such that: $$H = -\\frac{\\partial_x^2}{2m} + V(x) $$ with $ V(x+a) = V(x)$ where $a$ is the lattice spacing between the atoms or sites. It is known by Bloch's theorem that a solution to such a system will have the form $$\\psi_{k}(x)=e^{ikx}u_k(x)$$ where $u(x+a)=u(x)$. My questions is about the boundary conditions. If we take $$\\psi(x+Na) = \\psi(x)$$ we get, if $N$ is large enough, a lot of different values for $k$ in the Brillouin zone: $$-\\frac{\\pi}{a}<k<\\frac{\\pi}{a},$$ so we get a band of possible states. In this case we can define Wannier functions which using Fourier over the wave-functions: $$\\phi_k(x-R) = \\sum_k e^{-ik R} \\psi_k(x)$$ And the summation if over all the $k$'s in the first Brillouin zone. But if I take the B.C $$\\psi(x+a) = \\psi(x)$$ I get a single value for the momentum in each Brillouin zone $$k = 0, \\pm 2\\pi , \\pm 4\\pi,...$$ Is it still possible to define a Wannier function for such a state? I mean what will the Fourier be like if we have a single possible value of $k$??", "General way to model baths? Harmonic Oscillators valid? I am trying to model an open system interaction without making strong assumptions on coupling strength or temperature. In general i understand that open systems are modeled by a Lindbladian, but as far as i know the Lindbladian approximation holds only if we have Marcov, Born and Circular Wave approximation. Since I want to cover a broad range of temperatures and coupling strengths how should i model the bath? Any suggestions on how to proceed? More specificly a colleague suggested using the coupled harmonic oscillator formalism has the advantage of not making any assumptions apart from being modelable by harmonic oscillators and being analytical solvable! Anyone has recommendations where i can read up how this is done or an opinion if this approach is valid?", "Minimal vs. Non-minimal coupling What is the difference between Minimal vs. Non-minimal coupling in General Relativity? A brief introduction to Minimal Coupling in General Relativity could be useful too.", "Capturing Energy from a Positron-Electron Collision According to the book Physics of the Impossible, the catastrophic collision between a electron and a positron yields an output of 1.02 MeV. Assuming you have an isotope like $^{22}\\text{Na}$, which is known to emit photons during positron emission decay, will they annihilate upon any contact with electrons, or do they have to be accelerated at one another. Secondly, Is it possible to efficiently capture this energy yielded in the reaction. Also, in what form does this 1.02 MeV get emitted in? This question is excluding the fact that the generation of positions in very large amounts is not feasible at the moment.", "Do non-metal objects reduce the signal strength of a computer wireless network device? Would an object like a wooden bed interfere or block the signal coming from a 802.11 wireless router?", "Is refraction sharp or smooth? Refraction: light changes direction of propagation when entering a material with a different refractive index. ![enter image description here](http://i.stack.imgur.com/E0Xwq.jpg) Does the direction of propagation of light change **sharply** and almost instantaneously (as shown in the diagram) or smoothly?", "acceleration of the universe Moments after the Big Bang, the universe was expanding at an incredible rate, (I've heard) faster than the speed of light. Due to dark energy, scientists predict the rate of expansion will pick up again. Space itself will be expanding faster than light speed. Someday, we will not be able to see other galaxies because they'll be moving away so fast that the light they produce will never reach us. Nowadays, though, we can see other galaxies, which means the expansion of the universe slowed down. What caused the expansion of the universe to accelerate more slowly? If dark energy is causing the acceleration to increase, wouldn't the universe continue to expand faster after the big bang? Is there a **minimum rate** of acceleration? If so, what is it, and what determines it?"]}, {"query": "Buzzing/Vibration in body under power lines", "pos": ["Cyclist's electrical tingling under power lines It's been happening to me for years. I finally decided to ask users who are better with \"practical physics\" when I was told that my experience \u2013 that I am going to describe momentarily \u2013 prove that I am a diviner, a psychic, a \"sensibil\" as we call it. The right explanation clearly needs some electrodynamics although it's \"everyday electrodynamics\" and theoretical physicists are not trained to quickly answer such questions although each of us has probably solved many exercises that depend on the same principles. ![enter image description here](http://i.stack.imgur.com/azt0a.jpg) When I am biking under the power lines \u2013 which probably have a high voltage in them \u2013 I feel a clear tingling shocks near my buttocks and related parts of the body for a second or so when I am under a critical point of the power lines. It is a strong feeling, not a marginal one: it feels like a dozen of ants that are stinging me at the same moment. It seems almost clear that some currents are running through my skins at 50 Hz. I would like to know the estimate (and calculation or justification) of the voltage, currents etc. that are going through my skin and some comparison with the shock one gets when he touches the power outlet. Now,   * my bike that makes this effect particularly strong is a mountain bike, Merida;   * the speed is about 20 km/h and the velocity is perpendicular to the direction of the current in the power line;   * the seat has a hole in it and there is some metal \u2013 probably a conducting one \u2013 just a few centimeters away from the center of my buttocks. It's plausible that I am in touch with the metal \u2013 or near touch;   * my skin is kind of sweating during these events and the liquid isn't pure water so it's probably much more conductive than pure water;   * the temperature was 22 \u00b0C today, the humidity around 35%, clear skies, 10 km/h wind;   * the power lines may be between 22 kV and 1 MV and at 50 Hz, the altitude is tens of meters but I don't really know exactly. What kind of approximation for the electromagnetic waves are relevant? What is the strength? How high currents one needs? Does one need some amplification from interference etc. (special places) to make the effect detectable? (I only remember experiencing this effect at two places around Pilsen; the most frequent place where I feel it is near Druztov\u00e1, Greater Pilsen, Czechia.) Is the motion of the wheels or even its frequency important? Is there some resonance? Does the hole in the seat and the metal play any role? Just if you think that I am crazy, other people are experience the effect (although with different body parts), see e.g. here and here. This PDF file seems to suggest that the metals and electromagnetic induction is essential for the effect but the presentation looks neither particularly comprehensive nor impartial enough. An extra blog discussion on this topic is here: > http://motls.blogspot.com/2012/05/electric-shocks-under-high-voltage.html"], "neg": ["How to calculate distance travelled from velocity vector and angle? I am trying to get the distance a projectile travels, so I can display it in my program. I'm sort of new to physics, but I've tried looking this up. I'm not getting the right results however, and me being new to physics, I'm not sure if I'm just using the wrong formula or what. This is the formula I have tried using: ![](http://upload.wikimedia.org/math/c/1/d/c1da5860501561519415962ddda5e85e.png) As far as I've read, a projectile launched at 15 degrees would travel the same distance as one launched at 75 degrees, however when I run the calculation I get two different distances for those two instances. Is this not the correct formula, or maybe I'm using it wrong? These are the values I get for 15 degrees and 75: 15: velocity vector = (5,-19) magnitude = 20 vCos = -15.2 vSin = 13 gravity = 9.8 output = 41 75: velocity vector = (19,-5) magnitude = 20 vCos = 18.4 vSin = -7.8 gravity = 9.8 output = 2 The projectile starts on the ground and gets launched at the specified angle over a flat surface. Not sure where I'm going wrong. All help is greatly appreciated.", "Calculating Atmospheric Pressure on an Imaginary Planet I am planning a series of science fiction novels that take place on an imaginary binary planet system. Both planets have a lower surface gravity than the Earth and one has slightly more mass than the other. If average temperature is the same as earth or cooler and the radius of the larger planet is allowed to vary, what is the minimum amount of gravity required for the larger planet to sustain a 50:50 Nitrogen/Oxygen atmosphere with a total pressure of 100 mmHg at 2000 m above sea level? What law or theorem would I need to solve this problem. **Extra stuff about the planets, my motivations and other things I'm trying to figure out that you don't have to read if you don't want to:** I want the larger planet to have an atmosphere that is thinner and whose pressure varies to a greater degree by altitude than the atmosphere of the Earth, but is still breathable by humans at sea level. Basically I want Denver to feel more like Mount Everest and Mount Everest should be pretty much vacuum. Mount Everest has an oxygen partial pressure of about 43 mmHg, and Denver is at an altitude of 1.6 km. Let's say we want 50 mmHg of oxygen at 2km. I figure if oxygen concentration is higher on the planet then on Earth, then atmosphere can be thinner and overall pressure can be lower. I picked a 50:50 mix not knowing whether it is really feasible, but if it is then pressure could be 100 mmHg at 2km. I don't know how to calculate how big the radius and mass of the planet has to be to satisfy these or what the pressure would be at sea level and at what altitude pressure will be 0. The smaller planet should have an atmosphere that is too thin for humans but could conceivably host sentient life. Both planets should have lower gravity than the earth. Each planets has a different species of sentient beings and I would like them to be able to lift stuff into space for much cheaper than here on earth. Basically by the time they have something like a Saturn V rocket, there should already be some trade in manufactured goods between the two. Both planets have awesome magnetic fields that are way better than Earth's at doing the stuff that magnetic fields do. I also would like the binary planets to be in a binary star system and have one or two small moons each, but this is probably pushing it. Even one small ice moon would serve as a handy plot device but I don't want to make it too improbable and I do want to get as much of the Physics right as I can and figuring out the orbits, climate map and the seasons will be difficult enough as it is with two planets, especially considering how little I know.", "Is it possible that only one hemisphere of a planet has an atmosphere? Suppose there is a tidally locked planet orbiting a star. The planet's surface consists of a global ocean, that is, liquid water. At the inner hemisphere the temperature is so high that the water is constantly boiling, creating the atmosphere of water vapor. But the vapor does not reach the dark side of the planet, and precipitates around the terminator line. The further side has no atmosphere and an icy surface. Is this setup possible? Can it be such thing that one side of a planet has liquid (and boiling) water surface while the other side has no atmosphere? Is it possible at all that a part of an ocean was boiling while the other one was icy?", "Position with respect to time with friction I'm interested in equations of motion when friction is present for a little graphical side project I am working on. I'm really rusty with physics, so I apologize if this is a basic question or doesn't make sense... Consider an object on a plane in three dimensions. It has initial position $ \\vec{x_0} $ on the plane and initial velocity $ \\vec{v_0} $ tangential to the plane. Assume it has acceleration (i.e. downhill gravity), $ \\vec{a_G} $, which is constant and tangential to the plane. Now assume it has an additional acceleration (from friction, which I'm modeling as an acceleration), $\\vec{a_F}(t) $, with constant magnitude $ k $ but variable direction, opposite that of velocity. Is there a function $ \\vec{x}(t) $ that gives position with respect to time? Something in the vein of the $$ x(t) = x_0 + v_0*t + 0.5*a*t^2 $$ that I learned in high school?", "During an Ice Age, would someone at moderate latitude get a sunburn/suntan on a sunny day? Let's say you live at a moderate (temperate, in today's terms) latitude during the last glacial maximum. You're probably in some kind of steppe or taiga biome, even though you're at 40 degrees north, and you've never known hot weather. If you're outside on a sunny summer day, would you still get a suntan/sunburn like you would in today's climate? Aside from temperature, which doesn't cause sunburn, would there be any relevant atmospheric differences that might affect the UV radiation?", "Verlet timestep I am using velocity Verlet in molecular dynamics. Is just a simple question, if a simulation using time-step femtosecond, in velocity Verlet is just necessary $dt = 10^{-15}$ to use femtosecond?", "Buoyancy experiment with my child I've read through a few other answers here on buoyancy and I was hoping to get some guidance on discussing it with at 5th grader. So, taking a ball of playdoh clay and dropping it into a container of water which is filled to the top that is sitting in another container, just a little bit of water overflows and we can measure that amount using our kitchen scale. She records this as her value to compare other shapes to. Taking other balls of playdoh which weigh the same amount on the kitchen scale, she's made various \"boats\" which differ mainly in the shape she's made - some are more cup-shaped, some are more pie plate shaped - some have sides and some are more pizza shaped. The pizza shaped ones sink like the ball did. The ones that are more pie plate shaped end up displacing more water than the others (and certainly more than the ball that just sinks) which are cup shaped, at least for her experiments. So, she sees that these \"boats\" are able to float and doing so results in some amount of water that flows over the top of the container but what more can be explained here - that a 5th grader is going to grasp. The weight of the water displaced for each one is different with the cup ones resulting in less water being displaced. Buoyancy isn't my thing so I'm hoping for some layman- friendly explanation as to the difference in the amount of water displaced. And dad will learn a bit along the way too, which is always a bonus.", "Principle of Least Action; Newton's 2nd Law of Motion This question is based on the description of Longair in his book \"Theoretical Concepts in Physics\". He starts by giving some provisions:   * Conservative force field   * Fixed times $t_1$ and $t_2$   * Object moves from fixed point at $t_1$ to fixed point at $t_2$ Then he defines:   * Lagrangian: $L = K-U$   * Action: $S = \\int_{t_1}^{t_2}Ldt$ He goes on to explain, that the principle of least action means, that an object moves on a path so that $S$ is minimized. Then he claims that this priciple is equal to Newton's 2nd law of motion, following through with a proof which is beyond my comprehension (which of course is my fault). After I calculated $S$ for a few examples, I am convinced, that this claim is correct only adding one additional provision (which Longair clearly does not state directly or indirectly):   * The object moves on a path fixed in space. (Just the speeds at the points is allowed to differ.) My argument for why this is necessary follows from a counterexample:   * Assume a central force field with constant force. Setup the object so that its trajectory is a circle. Take time $t_1$ and $t_2$ so that the object is at opposing ends of the circle, describing a half circle. Now change the force field, so that there is no force inside this circle. (This is still a conservative force field and the object moves still in the same circle.) Compare the $S$ of this half circle to the $S$ of the object moving with constant lower speed along the diameter of the circle. For both trajectories the $U$ is the same but the $K$ is lower for the shortcut along the diameter (lower speed). So the shortcut along the diameter has a lower action. Still, with the correct initial speed the object will move the half circle, fully in accordance to Newton's second law of motion.  Since I cannot assume, that I found an error in Longair's standard book, can anyone please explain, what I got wrong."]}, {"query": "What happens to the energy when waves perfectly cancel each other?", "pos": ["can silence happens when 2 sound waves destroy each other Hi is there any possibility that you located between 2 sound sources and u hear nothing? as we know 2 wave in opposite direction will destroy each other...", "Where does energy go in destructive interference? I have read that when two light waves interfere destructively, the energy contained within is transferred to other parts of the wave which have interfered constructively. However, I am having some trouble grasping this. While in experiments such as Young's Double Slit experiment, there are visible bright bands of higher energy, I would imagine that it be possible to configure light waves to propagate linearly such that the waves interfere only destructively and not at all constructively. Is such an arrangement possible? And if so, to where is the energy in the wave transferred? Similarly, how does the energy transfer from one part of a wave which is interfering destructively to another part which is interfering constructively? These regions may be several meters apart for long wavelength light, and I find it strange that energy can travel between these potentially distant and non-interacting regions."], "neg": ["Why does a tire produce more traction when sliding slightly? It is well known in racing that driving the car on the ideal \"slip angle\" of the tire where it is crabbing slightly from the pointed direction produces more cornering speed than a lower slip angle or a higher one. (More explanation as requested) I'm considering two main effects on the tire when in a turn:   1. The tread of the tire is twisted from the angle of the wheel it is mounted to. There is more force as speed increases, and generally, more twisting.    2. The tire slides somewhat at an angle on the road surface rather than rolling.  At low speeds, the angle between the pointed direction of the wheel (90 degrees to the axis of rotation) and the direction of travel is nearly 0. When the speed increases to the point the angle reaches about 10 degrees, the tire generate more grip and the car goes faster around the turn. (Higher angles produce lower grip) So the grip is higher at 10 degrees of slip than at 0 or 20 degrees. What is the physical effect that causes this increase in grip?", "Negative Energy and Wormholes Apparently to create wormholes you need negative energy/matter. Say you had negative matter/energy, how would it be applied towards making a wormhole?", "Force from solenoid I'd like to approximate the force from a solenoid, or at the very least find a formula which is proportional to the force so that I can experimentally find the constant for my particular case. Apparently an exact answer to this is hard and involves quantum physics that is a bit beyond me; something about the Ising model. I've found $F =\\frac{(NI)^2 \u03bc_0A}{2g^2}$, where $N$ is number of loops, $I$ is current though the solenoid, $A$ is cross-sectional area of the inside of the solenoid and $g$ is the \"is the length of the gap between the solenoid and a piece of metal\". I found that here. Is this a decent approximation? If so could you more rigorously define $g$, because I don't know what distance this is supposed to be? If it is not, what might I use instead? I found the Gilbert model on Wikipedia that is apparently a good approximation of the force between magnets. Could I use this to approximate the force on a piece of iron from a solenoid?", "Holonomy twisting There is Witten's topological twist of standard SUSY QFTs with enough SUSY into Witten-type TQFTs. What is a holonomy twist?", "Single photon's effect on conservation of momentum? When your looking at basic Compton theory you find that if you shoot a stream of photons at a particle (usually atoms or electrons), then you have the basic laws of conservation of momentum. The photon acts like a particle, like a \"billiard ball.\" The photon interacts with the said electron and the photon goes off in a new path described by $h/\\lambda_2$ ($h$ being Planck's constant and $\\lambda_1$ being the original wavelength of the photon). This wavelength is increased. Using a basic vector diagram with $h/\\lambda_1$, $h/\\lambda_2$ and $m\\vec{v}$ for the particle you get basic conservation of momentum. My question is basically what happens when you are only using a single photon? I'm not aware of any experiments done with a single photon, so far this concept (Compton experiments) have only been done with multiple photons. The reason a single photon is important is because the energy of a photon is inversely proportional to the wavelength. The problem that I have with this is that $E = h\\nu$. This is how we get our inverse wavelength in the formula (wavelength and frequency being inversely proportional). With a single photon you have no frequency, since you only have 1 event/photon. Thus how can you place Planck's constant over $\\lambda$ to represent the energy of the photon, since there is no frequency?", "Why doesn't Fermi's golden rule distinguish attraction from repulsion? Let's say I have two distinguishable charged particles interacting electrostatically. In Fermi's golden rule, the two particles can change state at a rate proportional to: $$|\\langle \\psi_f | H_{int} | \\psi_i \\rangle|^2 = \\left| \\int d^3 r_1 d^3 r_2 \\; \\psi_{1f}^*(r_1) \\psi_{2f}^*(r_2) \\frac{q_1q_2}{|r_1 - r_2|} \\psi_{1i}(r_1) \\psi_{2i}(r_2)\\right|^2$$ The weird thing is: **It doesn't matter whether they are attracting or repelling!** The rate with $q_1 = q_2 = e$ is the same as the rate with $q_1 = -q_2 = e$. I'm shocked that there can be an electrostatic calculation that turns out the same regardless of whether the particles are attracting or repelling each other. How do I make sense of that?", "2 simple Generators = Im lost (intensity) ![enter image description here](http://i.stack.imgur.com/YH1BH.png) What happens? we have 2 Generators and 2 intensities, when I2 and I3 come together (they have opposite sides ) what happens? I tried writing down the voltage relations but I'm stuck because I don't know what intensity should i work with (to determine positive sides) I2 or I3", "Why can't angular momentum be used in flying vehicles? ![Animation of relationship between torque and momentum](http://i.stack.imgur.com/yIa9K.gif) If angular momentum ( **L** ) works like this animation from Wikipedia leads me to believe, why can't we put a large flywheel or several small ones on a chassis, all rotating counter-clockwise around their vertical axes and move the system upwards? It seems that there's nothing countering **L**. Am I missing something? I think the concept of such a vehicle would break Newton's first law, but right now to me that's like saying 'you can't because Newton said so'. Can anyone provide a more detailed explanation that someone with high-school- level knowledge of physics can understand?"]}, {"query": "Is fire matter or energy?", "pos": ["what is the basic form of the 'fire'? > **Possible Duplicate:**   >  Is fire matter or energy? What is the basic form of fire? physics defines every entity by a basic form either solid or liquid or as a gas, example: water is liquid, ice as solid, water vapor: gas so what is fire? when I queried is 'Plasma a fire?' I landed in below link, where it is said that fire isn't plasma, but not defined which basic form it belongs to! the link: Is fire plasma? What I understand is, it's a form of energy caused by reaction of gases(?) so it's basically a gas! is it true?"], "neg": ["Is the universe a quantum computer - is light speed barrier a computational constraint There is currently a debate ongoing on leading maths blog G\u00f6del\u2019s Lost Letter, between Gil Kalai and Aram Harrow, with the former arguing that building a quantum computer may not be possible due to noise propagation, and the latter arguing to the contrary. I am wondering if there is any argument to show that building a quantum computer is possible, by virtue of showing that quantum computation is evident in the physical world. So the question is: (A) Are there any known examples of physical interactions where macro level state transitions could be determined to only be in correspondence with an underlying quantum computation? I.e. similarly to Shor's algorithm being exponentially faster than any known classical factoring algorithm, are there any examples of known physical processes, for example perturbation stabilization in a very large particle cluster, that could be shown, assuming P<>NP, to only be efficiently solved by a quantum computation. Some, I admit highly speculative, additional questions would then be: (B) Is the speed of light barrier possibly a natural computational limit of our particular universe, so that for the computational complexity class of quantum mechanics, working on an underlying relational network-like spacetime structure, this is the maximum speed that the computational rules can move a particle/wave representation through a network region of the lowest energy/complexity (i.e. a vacuum)? (C) Is quantum mechanics an actual necessity for the universe to follow classical physical laws at the macro level? The informal argument being that in many-to-many particle quantum level interactions, only the capability of each particle to compute in parallel an infinite or quantum-quasi-infinite number of paths is what allows the universe to resolve a real-time solution at the macro level. Requesting references to research along these lines, or any arguments to support or contradict these speculations.", "Terminology for line integral of magnetic field One of the quantities appearing in the integral form of Maxwell's Equations is the line integral of the magnetic field around a closed loop. (The relevant equation states that this is equal to the current through any surface bounded by that loop, plus the displacement current in the case of changing electric fields, with some constant coefficients possibly thrown in, depending on how you manage your units. This is usually called Amp\u00e8re's Law, with Maxwell's correction for the displacement current.) Is there a name for this quantity? More generally, is there a name for the line integral of the magnetic field along an arbitrary non-closed curve? (Then this is not equal to any other named quantity or sum of quantities.) Ideally, I'd want a name for the integral of the H-field (rather than the B-field, when one distinguishes them) in amperes (or the equivalent in non-SI units), but I am not really picky about those details. It seems that every other quantity in the integral form of Maxwell's Equations has a name (magnetic flux, electric flux, charge, etc), so I'd hope that this one does too. Of course, the term for the line integral of the electric field (electromotive force) is somewhat of a historical oddity, so maybe this quantity is too obscure to have a name. Still, you'd think that somebody would have given it one sometime! ETA: A theoretical way to measure this quantity is to place a conductive tube (as conductive as possible, with as small diameter as possible) around the curve in question. The magnetic flux through the tube will induce a current running around (not along) the inside of the tube, which will in turn serve to cancel (or shield) the source of the magnetizing field, in accordance with Lenz's Law (in the broad sense). The current so induced, serving to completely cancel the magnetic field near the curve in question, should equal this quantity, if I'm thinking about this correctly. (Well, I'm having a little trouble getting the sign straight, but one way or the other it should work!)", "Time travel and entropy I saw a post on reddit regarding immortality and how it would never be possible due to entropy. That said, assuming time travel was possible, would it not be possible to never reach this state of entropy if you could keep traveling back in time? Say for instance that you couldn't travel back in time within your own time curve, but you could travel to other time curves. You would merely jump to another curve when your current universe was about to reach its end. Is it too big of an assumption to think that your own initial entropy (by this I mean your entropy from your first timeline) would not 'follow you' to other time curves? I may be totally off-base in my assumptions, as I know next to nothing about physics. Any feedback/criticism is welcomed. Here is the link to the post in reddit.", "How does stuff glow in the dark? Many things have glow in the dark properties (glow sticks, paint, toys ..), and I am wondering what is the physics behind them. How do these materials store light energy and emit it later when dark? What dictates the wavelength(s) of the glow? Is there a limit on how much energy can be stored and recovered in these materials? Do they give out heat as well as light?", "matter wave and wave function Is there any mathematical relationship between matter wave (or de Broglie wave) and wave function? Also, does each type of particle (e.g. photon, electron, positron etc.) have its own unique wave function?", "The commutator of Killing vectors I'm going over an assignment for my general relativity course. My solution to the question below strikes me as too short, considering that it appeared in the \"longer questions\" section of the assignment. > **Question:** > > A Killing vector $V^\\mu$ is one that satisfies the equation $\\nabla_{\\mu} > V_{\\nu}+\\nabla_{\\nu} V_{\\mu}=0$. The commutator of two vectors $U^\\mu$ and > $V^\\mu$ is defined as $[U,V]^\\mu=U^\\nu \\nabla_\\nu V^\\mu-U^\\nu \\nabla_\\nu > U^\\mu$. Show that the commutator of two Killing vectors is itself a Killing > vector. My solution could be (and is likely to be) incorrect, but I'm just using the definitions that I've seen so far. **My solution:** To get from $[U,V]^\\mu$ to $[U,V]_\\mu$ we have to use the metric i.e. $[U,V]_\\nu=g_{\\nu \\lambda}[U,V]^\\lambda$. Now I just plugged this in to the Killing equation to get (for the first term) $\\nabla_{\\mu}[U,V]_\\nu=\\nabla_{\\mu}g_{\\nu \\lambda}[U,V]^\\lambda$. Using that the metric is covariantly constant, we have $\\nabla_{\\mu}g_{\\nu \\lambda}=0$, hence the whole term is equal to zero. The same thing happens with the second term, so that the whole expression is zero. I can't see that I made a mistake, but it seems way too short a solution. When I looked at the solutions provided in the course, they are about a page long, and begin $$\\nabla_{\\mu}[U,V]_\\nu + \\nabla_\\nu[U,V]_\\mu=\\nabla_\\mu (U^\\tau \\nabla_\\tau V_\\nu-V^\\tau \\nabla_\\tau U_\\nu ) + \\nabla_\\nu (U^\\tau \\nabla_\\tau V_\\mu-V^\\tau \\nabla_\\tau U_\\mu )=\\dots$$ i.e. they do things explicitly. Actually, having written this out, I can see that what I've done can't be correct otherwise every vector would be a killing vector just by writing $V_\\mu$ as $V_\\mu=g_{\\mu \\nu}V^\\nu$. However I don't know what I've done wrong, so any help would be very much appreciated!", "Power as a Function of Distance I am interested in trying to understand the meaning of the integral of power with respect to distance. In the case of force, we have the two formulae: $\\int F \\, \\operatorname{d}\\\\!t = \\Delta p$ and $\\int F \\, \\operatorname{d}\\\\!x = \\Delta E_k$. I understand that power is closely linked to time and work by the relationship $P = \\frac{\\operatorname{d}\\\\!W}{\\operatorname{d}\\\\!t}$. However, imagine a body moving continuously from the left to the right. In such a case, we can express displacement as a one-to-one function of time, and time as a one-to-one function of displacement. We could place regular markers along the road side and take power readings as the body passes each of these markers. Assuming the distance between markers is $\\Delta s$ and then letting $\\Delta s \\to 0$ gives power as a function of displacement. We may then ask: **What does the integral of this function mean?** $$\\int_{s_1}^{s_2} P \\, \\operatorname{d}\\\\!x = \\operatorname{F}(s_1,s_2)$$ **Addition:** I've tried to play with the calculus a bit. I'm not sure if this helps: $$P = \\frac{\\operatorname{d}\\\\!W}{\\operatorname{d}\\\\!t} = \\frac{\\operatorname{d}\\\\!x}{\\operatorname{d}\\\\!t} \\frac{\\operatorname{d}\\\\!W}{\\operatorname{d}\\\\!x} = v\\frac{\\operatorname{d}\\\\!W}{\\operatorname{d}\\\\!x}\\implies \\int P \\, \\operatorname{d}\\\\!x = \\int v\\frac{\\operatorname{d}\\\\!W}{\\operatorname{d}\\\\!x} \\, \\operatorname{d}\\\\!x = \\int v \\, \\operatorname{d}\\\\!W$$ Has anyone seen a velocity-work graph? If so, what does the area underneath it represent?", "Virtual vs Real image I'm doing magnification and lens in class currently, and I really don't get why virtual and real images are called what they are. A virtual image occurs the object is less than the focal length of the lens from the lens, and a real image occurs when an object is further than focal length. By why virtual and real? What's the difference? You can't touch an image no matter what it's called, because it's just light."]}], "CQADupstackProgrammersRetrieval": [{"query": "Confusion about dual license (MIT/GPL) javascript for use on my website", "pos": ["Can I use a dual license in my commercial Website I have set up a web application which is of commercial use. This application had to make use of the plugin(which is not downloaded from http://plugins.jquery.com) I downloaded this plugin from http://jquery.malsup.com/cycle2 Kindly, let me know if I could use this plugin in my commercial website. If I do, would it cause any consequences in future? Though, I could see few answers here, I would like to Insist upon itself on this as of critical importance. Licensing Terms"], "neg": ["Working with fubar/refuctored code I'm working with some code which was written by a contractor who left a year ago leaving a number of projects with buggy, disgustingly bad code. This is what I call cowboy PHP, say no more. Ideally I'd like to leave the project as is and never touch it again. Things break, requirements change and it needs to be maintained. Part A needs to be changed. There is a bug I cannot reproduce. Part A is connect to parts B D and E. This kind of work gives me a headache and makes me die a little inside. It kills my motivation and productivity. To be honest I'd say it's affecting my mental health. Perhaps being at the start of my career I'm being naive to think production code should be reasonably clean. I would like to hear from anyone else who has been in this situation before. What did you do to get out of it? I'm thinking long term I might have to find another job. **Edit** I've moved on from this company now, to a place where idiots are not employed. The code isn't perfect but it's at least manageable and peer reviewed. There are a lot of people in the comments below telling me that software is messy like this. Sure I don't agree with the way some programmers do things but this code was seriously mangled. The guy who wrote it tried to reinvent every wheel he could, and badly. He stopped getting work from us because of his bad code that nobody on the team could stand. If it were easy to refactor I would have. Eventually after many ' _just do this small 10minute change_ ' situations had ballooned into hours of lost time (regardless of who on the team was doing the work) my boss finally caved in it was rewritten.", "Algorithm for indexing strings in \"list\" Imagine I have file called `strings.dat`. Inside this file there is alot of string, for example: one million. **String are sorted**. Now I want to find specified string, so I can write method like this:               public long FindByName (string text)     {       // ...     }      This method can return to me a position within a file where this string occurs. But iterating through lots of data is not efficient. I can do some indexing system, like an `Dictionary<char, long>` which tells about at what position within file is placed first string with its value starting from given char. Example: if I got 5 strings: hello   hello2   world   world2   Zzz So my dictionary will be like:   h 0   w 2   z 4 But it's not efficient if I will have 1000 string with \"d\" char as first letter, and 10 million with \"r\" letter. Do you know any good algorithms do ahieve what Im asking for?", "How to handle static-ish content from a CDN with authentication? I have a website that allows user uploads of content. Part of the design, to date, involves storing the user content on a NAS that has been configured with a separate app pool in IIS that has scripting disabled, shorter lifespans, no cookies, etc for CDN-type behavior as a subdomain (static.domain.com vs. www.domain.com). I have complete control over this process and all the instances. The design decision behind this was to allow for cheaper storage of uploaded documents (instead of wwwroot or a DB) and help mitigate some security concerns by disallowing scripting. The concern I have now is that CDNs, and this setup, are by nature very permissive and do next to no checking or validation. Are there any _reasonably effective_ measures to discourage idle sharing of this user content? I know nothing will stop determined or malicious people, but I want to at least prevent this user content from being available at large to the general populous. All of the links to the content will be behind a paywall at the 'www' subdomain, but the content itself will be behind the 'static' subdomain. Ideas I had so far:   1. HTTP Referer checking    2. Obfuscated filenames (I know, I know...)    3. Cookie testing with URL rewrite? (IIS8)    4. ...    5. Ask stackexchange", "Single quotes vs double quotes I just started a job where I'm writing Python after coming from a Java background, and I'm noticing that other developers tend to quote strings using single quotes (`''`) instead of double quotes (`\"\"`). For example:               line1 = 'This is how strings typically look.'     line2 = \"Not like this.\"      Is there a particular reason for this other than personal preference? Is this the proper way to be quoting strings? Specifically, what I want to know is if there is some type of standard or accepted best practice that drives this style of coding.", "Is there any research out there on geographic differences in work environments (e.g., respect) for programmers? One thing I've learned from this website is that software developers are not treated the same as what I've seen in the companies I've worked at, and some of the differences seem to be related to the culture or other factors of the geographical location where the programmer works. In some areas, it seems like programmers can expect many perks and a great deal of professional respect, but in others it sounds like programmers are seen as laborers who are told what to do and then should go do it without question. Even in just the USA, there seem to be major differences in \"the norm\" between the various regions of this country. I'm wondering how much of this is just my perception, and how much is real differences about how programmers are perceived in their different locations. Is there any research out there discussing major differences in programmer work environments or attitudes about how to treat or respect programmers by geography? I'd be interested in multiple articles tackling different ways of looking at this. Edit: Research, specifically, doesn't seem to be available, so I'm making the question broader. Any good, thoughtful writing on the topic of any kind available?", "Best Method of function parameter validation I've been dabbling with the idea of creating my own CMS for the experience and because it would be fun to run my website off my own code base. One of the decisions I keep coming back to is how best to validate incoming parameters for functions. This is mostly in reference to simple data types since object validation would be quite a bit more complex. At first I debated creating a naming convention that would contain information about what the parameters should be, (int, string, bool, etc) then I also figured I could create options to validate against. But then in every function I still need to run some sort of parameter validation that parses the parameter name to determine what the value can be then validate against it, granted this would be handled by passing the list of parameters to function but that still needs to happen and one of my goals is to remove the parameter validation from the function itself so that you can only have the actual function code that accomplishes the intended task without the additional code for validation. Is there any good way of handling this, or is it so low level that typically parameter validation is just done at the start of the function call anyway, so I should stick with doing that.", "How and what should I be (unit) testing for in this method? I am relatively new to unit testing and have a query about what/how I should be testing a certain method. For the following (psudo-c#) method I have created (not a real-life example) what would you test for? Initially, my thoughts would be to test the output with variations on the dictionary of form fields, e.g. valid, invalid, missing values. However I also wonder how you would test to make sure the object values have been changed to the correct value and that the correct email message was attempted to be sent (obviously both services could/would be mocked). I hope what I am asking makes sense, I appreciate this is a subjective question and the answers may be 'it depends' ;)               public bool ProcessInput(Dictionary<string, string> formFields, ObjService objService, EmailService emailService)         {             try             {                        // Get my object id                        int objId;                        if(!int.TryParse(formField[\"objId\"], out objId)                        {                           return false;                        }                             // Update my object - would you validate the save against a DB or a mocked inmemory db?                        var myObj = objService.Find(objId);                        myObj.Name = formField[\"objName\"];                        objService.Save(myObj);                             // Send an email - how would you test to make sure content, recipient, etc was correct?                         emailService.SendEmail(formField(\"email\"), \"Hello World\");                             return true;                 }             catch(Exception ex)             {             return false;             }         }", "How can I deal a team member who is irresponsible and shows no commitment? I am handling a team of a few guys working on a software module in a large project. As per our estimates our module is getting delayed by a week. Since we can not have this delay, our client and our manager arrive at a decision that we need to work on few weekends (3-4) to try to finish the work. All members of the team are aware of this and understand this and since its just a matter of 3-4 extra days, so we decide to work on weekends to meet the deadline. But one of the team members is not following this. From last three weekends he has some or the other reason to not come on weekend. He is not even willing to put up extra hours during weekdays. Personally I don't care about the number of hours he works as long as he/(any one) can finish their work to meet the deadline. Please let me know how to handle this situation?"]}, {"query": "Is there a license that forbids distribution and gives a Github repo owner full rights?", "pos": ["Software License: Open Source, but no distribution (for free or for profit) I wrote a program in PHP. I want people to be able to use the code to learn from and even include bits in their own apps but I also want to maintain the right to sell it and make it clear that others are not to distribute copies either for free or for profit. I haven't used anyone elses code so I don't have to worry about license compatibility. Which license out there is right for that? I know I can't stop people from ignoring the license but I just want them to at least know it's there and know they're doing something wrong if they try. I can't find anywhere that explains licenses in plain English and yes, I have tried to read the GNU and BSD licenses but I can't get it. Thanks. Ok so here are the clarifications other have asked for: I am going to sell this program for very cheap. People are free to use as much code as they want from it so long as they have first purchased the program and they do not profit from my code. I wouldn't mind if people just took the whole thing and added on and made it better but then people wouldn't be honest and they would just add something on and give it free and then no one would buy my product. I suppose I should just let people have it and ask for donations. So maybe I should GPL or BSD it. EDIT: I understand why everyone is getting confused. It is contradictory but the thing about legalese is that everything seems black or white. I'm trying to achieve a gray area. I want people to buy this thing from me, not copy it and give it away to people, and even use parts of it. By \"use parts\", what I'd say if someone asked me casually would be \"just be reasonable\". So basically don't use a majority of my code in your work and then totally outshine what I did because you'll have it easy as I did most of the dirty work already! I mean, sure, use my DB connect script in your project, I don't care. OR... use all the code and add to it! But only for personal use and don't you dare start giving it out because I'm going to be making money off this thing and that totally undermines my work. And it'd be nice to show me your additions and I'll give credit but the main thing is don't be redistributing my software that I have to earn a living with. Its hard to put that sentiment into legalese. And I just can't understand all these licenses."], "neg": ["Why is first column of list called 0th in so many languages? If you want first element of list or array you reference it as 0 in many languages (like C or Clojure). Is there are some really good reasons why the programming languages was design this way? In old days in assembly languages it makes perfect sense because all possible values needs to be used. But what are nowadays to keep it this way? There is very little advantage when modulo arithmetic and ranges (Wikipedia article.) but not much more. On a disadvantages side it should be: It makes confusion because it human language the first is connected with 1 (1st and it is not in english only). It makes confusion even in XPath (W3School:\"Note: In IE 5,6,7,8,9 first node is[0], but according to W3C, it is [1].\"). There are troubles between languages who use 1-based and 0-based system. Want to know hat are the good reasons to use zero-based numbering and why even creator of new languages (like Clojure) choose this way?", "Why doesn't the .NET world have anything like rails/grails/django/roo? It seems to me that rapid-development web platforms are going to radically change the world of web applications. It has been five years since Rails 1.0 was released for Ruby, and since that time we have seen Grails for Groovy, Django for Python, and Roo for Java. But to my knowledge (which is probably limited, being a Java/Groovy progammer) there is no similar framework for C#. Does such a thing exist? If not, why not? **Edit:** It's quite possible I'm not using the right words when I say \"rapid- development,\" but I'm talking about frameworks that can conceivably allow you to build a working blog engine in 30 minutes. You couldn't reasonably do this with, say, Java, Spring, and Hibernate, given the various configuration needed to allow your controllers to be found, and both configuration and code necessary for your entities to persist and be retrieved. So I'm talking about frameworks that handle all of the CRUD with a convention- over-configuration mentality. If someone has the right words for what I'm talking about, let me know.", "If a library doesn't provide all my needs, how should I proceed? I'm developing an application involving math and physics models, and I'd like to use a Math library for things like Matrices. I'm using C#, and so I was looking for some libraries and found Math.NET. I'm under the impression, from past experience, that for math, using a robust and industry-approved third party library is much better than writing your own code. It seems good for many purposes, but it does not provide support for Quaternions, which I need to use as a type. Also, I need some functions in Vector and Matrix that also aren't provided, such as rotation matrices and vector rotation functions, and calculating cross products. At the same time, it provides a lot of functions/classes that I simply do not need, which might mean a lot of unnecessary bloat and complexity. At this rate, should I even bother using the library? Should I write my own math library? Or is it a better idea to stick to the third party library and somehow wrap around it? Perhaps I should make a subclass of the Matrix and Vector type of the library? But isn't that considered bad style? I've also tried looking for other libraries but unfortunately I couldn't find anything suitable.", "If functional testing is referred as black box..how can it be done on unit test level? Preparing myself for ISTQB, I found a bit odd many things in their textbooks. E.g. they call black box testing as functional testing when you are not concerned with structured but only observe the ouput based on inputs. But later they say that functional testing is done at levels..well, how can I do unit testing without the knowledge how it works if I can just see it (and must see it). It is white box but then it is in the conflict..", "Should we write a unit test for class that call another class that have code written Suppose that there are two class 'A' and 'B' 'A' has a lot of nested conditions that have all unit test covered. 'B' has a property that will call class 'A' and return value according to the result of class 'A' On class 'B', when i want to write unit test. Should i just mock class A and verify on class B that it has been called a specific class 'A' method.", "Why is naming a table's Primary Key column \"Id\" considered bad practice? My t-sql teacher told us that naming our PK column \"Id\" is considered bad practice without any further explanations. Why is naming a table PK column \"Id\" is considered bad practice?", "What's the best way to modularize a User schema so it's generic I have a database design question. Basically I want to be able to create a schema for a User model, then use this User model in other models that extend User but I want to design it in such a way that it's generic enough to be used in every application. For example a Profile or Account model might extend User, and in both cases they will be different based on the web application you are designing but the core credentials of User should never be different across any web application. What fields do you think should be in the User model? I think the bare minimum to successfully handle authentication would be:   * email (the login unique identifier)   * salt (obviously!)   * password (duh)   * lostToken (a hash to verify lost password functionality)   * role (member, admin, editor, etc.. IMO this list of roles would differ between sites however it's too important to the User model not to have here?) Now we get into other interesting fields that are still very very useful:   * createdAt (when the account was created)   * ipAddress (track the ip when the account was created)   * refererUrl (which site it came from)   * lastLoggedIn (the last time the user logged in)   * isOnline (is the user currently online) And even more fields that are still pretty useful:   * username (might not be used on every site)   * number of consecutive logins (similar to the stack network) I think anything else like social data (likes, votes, profile views), badges/achievements, the last time they updated their profile/account/whatever, and other info like their name belong in the per- site Profile model. What do you think? Edit: I fully understand that this question is partly subjective but I do think there's definitely room for discussion.", "Is there a website where we can discuss and improve upon code snippets? Is there a website where we can discuss and improve upon code snippets? For example, if I have written some function and want to know what others think of it."]}, {"query": "Is using build-in sorting considered cheating in practice tests?", "pos": ["Java exam: prebuilt methods? > **Possible Duplicate:**   >  Is using build-in sorting considered cheating in practice tests? I'm studying for a Java exam at the university. In your opinion, could I use, during the exam,               Arrays.sort(intArray);      instead of creating my own algorithm? How would you judge it, if you were the professor?"], "neg": ["foreach($items as &$item) considered harmful? Is it considered bad practice to pass items in a PHP array by reference instead of by value? Relevant documentation: http://php.net/manual/en/control- structures.foreach.php", "Would working for an \"adult website\" hurt my future employability? I am considering taking a software engineering job at a pornographic website. While I have no moral objections to the industry, will it be a red flag on my resume?", "Violating SQL principles I have to write a decent size database, 1GB more or less. I have only taken an introductory semester regarding SQL databases. During the course we learned that the relational model under SQL has no implied order and that therefore when querying we should always have a variable that sets the correspondant order in the table. However, when doing practical work I find 'convenient' to make already ordered small, infinite number of tables. For example, lets say that you have 5 clients and that their info will never join their data together. Is it admissible to have a potentially infinite number of tables with a table per client? For example, I append new rows already ordered to the database. The database is already ordered. Is it admissible to make an unordered query and just assume that is implicitly ordered? All this violates the principles that I know. My boss, who does not know about databases says that if it works it works and that speed is important. What shall answer to him?", "When should an IT consultant use full disc encryption? In what circumstances should an IT Consultant encrypt their hard drive to protect their code/data of their clients? I am thinking that if it does not add much to your work load you might as well use full disc encryption with a 'weak' password to at least prevent someone from accessing your email files and other documents if your laptop is stolen, even if they will not get access to any database files or other very sensitive data.", "What advantages do simple text editors like TextMate have over Eclipse for Java development? I'm torn which IDE to use. The power of eclipse or the simplicity of TextMate. I'm wondering which one has specific advantages over the other, productivity wise.", "Project based prefix for class names My project leader uses project based prefixes for class names, lets say projects name ABC, he create User class name as ABCUser. and he says he do this becasuse if he wants to make User.aspx Users get mixed. so I told him why not use namespace (Entity.User ie.) to make it specific but he against it. I would like to hear from you guys' opinion on this subject. We code c#.net and using visual studio for projects.", "Design Methodology for Developing Interoperable Systems? **A bit of background** The company I work for has been creating database applications since around 1980 and, until relatively recently, most of these systems have been stand- alone \"silo\" systems. However, in the last few years, we've seen more of a shift towards gathering \"intelligence\" across all systems within our customers requirements. For example, a system that might collect data about people's dental records may need to talk to a system that collects data about people's optician records, share information about the same person and provide search capabilities across both systems (makes sense, although the example I've used is fictional). In the fictional example above, the dental and optician systems may or may not both be written by the company I work for (in other words we are looking at both internally-developed interfaces and interfaces to systems from third- party providers). **What we've done so far** We have a basic web-services API ( **.asmx** ) for one of our products, but I'm concerned about the change management, in terms of keeping it up-to-date as we add new features to the main product (in terms of providing the new features through the API without breaking compatibility with older interfaces). We have also produced one **WCF** service. The rigid contracts put my mind slightly more at ease than working with the ASMX service, but I think a lack of experience within the company is holding us back, so I'm looking for some guidance on best practice that I can read up on to help move us along (or at least point us in the right direction). **The question**   * **Is there a particular methodology or programming practice for designing systems to maximise their ability to interface to other systems?**   * **Are there any good online (or offline) resources for these programming practices (assuming they exist)?** Any other advice you can provide based on the information above would be appreciated, but not essential. We primarily develop in Microsoft .NET (mainly ASP.NET, with some windows forms applications as well) with a SQL Server/Oracle database back-end, although I expect the programming practices might be language independent. (I've used the .NET tag as an afterthought, but I might take it out later..!) Thanks for your time.", "Should you refactor existing code that is not broken in a project focused on new features? Given a small project that aims to add new functionality to application, the changes introduced touch some existing code, involving updating these in certain areas. During implementation, I've found some of these code which were updated have candidates for refactoring. Is this an appropriate time to refactor which in turn would require regression testing for those components affected (thus possibly introducing scope not originally part of the project)? Or should I defer, complete the functionality and perhaps have a separate project for refactoring (although I'm a bit hesitant as business users might not fully sponsor a project that does not add any functionality, unless they value code maintainability...)?"]}, {"query": "What are the guidelines for either throwing an exception or failing silently for nonvalid arguments?", "pos": ["Error handling - Should a program fail on errors or silently ignore them I'm writing a simple little program to transmit MIDI over a network. I know that the program will encounter transmission problems and / or other exception situations that I won't be able to predict. For the exception handling, I see two approaches. Should I write the program so that it:   * fails with a bang when something goes wrong **_or_**   * should it just ignore the error and continue, at the expense of data integrity? Which approach would a user reasonably expect?   Is there a better way of handling exceptions? Additionally, should my decision about handling exceptions be affected by whether or not I am dealing with a network connection (ie. something where I can reasonably expect to have problems come up)?"], "neg": ["How to integrate technical line/functional manager into Scrum team? We have recently had a new line manager start to manage our Scrum team. He is immensely experienced in our field but is relatively inexperienced at Agile/Scrum. He has extensive technical expertise in embedded software (the team's domain) that would go to waste if not utilised properly. However, the team is wary of making a line manager part of the Scrum team. The general consensus is that the line manager should not be part of the Scrum team at all. There are a number of issues that may crop up, e.g. the team may start \"reporting\" to the manager (i.e. a daily status update!), the manager may start to micro-manage team members etc etc. As it currently stands, he has already said that he feels like an outsider within the team. We really want to make use of his technical skills, we'd be foolish if we didn't because we are a relatively inexperienced and young team of twenty somethings. What would be the best approach to integrate a senior \"technical\" line manager in a Scrum team and make him feel like he _is_ part of the team?", "Test task : real tasks or not? Just had a discussion with coworkers about test tasks for programmers. Is it morally appropriate to ask programmers do some helpful work for the project in their test tasks or such company just uses the job applicants to do job for free? Is it ethical to do it?", "Silverlight 5 and MVVM. Do I really need other frameworks? What is the best way for rapid development? I've been reading and watching videos on MVVM and Silverlight.. I'm pretty new to Silverlight but not new to .NET. Interesting that I used MVVM in my WPF apps without knowing that it's MVVM. I was creating easily-bindable classes to serve as a layer between data and XAML :) Project that we start will be done with Silverlight 5 and WCF on a back end. Project will be rather large with several modules 50 or screens each, ideally I would like to load them on demand. MOST(not all) UI will be straight-forward data entry stuff. I'm trying to see what should be our architecture and how will it benefit us in future. I think I GOT IT as far as what MVVM and WHY. I also checked Caliburn Micro (and understood what it does). I see ReactiveUI and MVVMLight. To be honest I don't like external libraries/dependencies. Also, I don't really care about using naming conventions to satisfly external framework and perfectly OK with binding in XAML. Since we have good commands support and XAML debugging in SL5 - I don't think I need external framework. So, I think having ViewModels and binding via XAML with minimal view-related code in code-behind will be perfectly fine with me. Here is my dilemma:   1. If I use RIA services. 80% of my UI will bind perfectly to RIA generated stuff with some converters of course. Will it be bad architecture to have everything bind directly and just some more complex views to use ModelView?    2. Should I use RIA services?! I think YES. I'm all for generated code especially when it's plain data-entry stuff. Will it keep client code synced with server-side?   3. From what I see - ModelView have to be manually coded. Am I correct? Again, for 80% of project that's probably going to be waste of effort.   4. If I want to have multiple xap files that load on demand, should I use some kind of framework? I think keeping it in one file may get too big. Thanks!", "What is the clause in an employee contract that says they own all your code? I am looking at my employee contract and I can't seem to figure out where it might say that they own all the code that I write, be it at work or at home. Any examples of what the wording could be like?", "How to communicate with a co-worker that considers frameworks a performance hit How can one sell an idea like \"we should use jQuery because its highly optimized and cross browser compatible\" or \"entity framework is cool because its neat and takes care of our model automagically\" when the common response is a blanketed statement such as \"jquery doesn't perform well\" or \"entities bring in 12 columns on a table when we only need 10\"? I am a pragmatic guy that tends to trust axioms I've developed through experience (its not a performance problem until there's a visible slowdown). I don't know if there's a specific \"category\" that the other extreme fits into, whereas everything is a performance problem until proven otherwise...or even where to begin the communication here.", "Are we using the repository pattern right? We are using a bunch of separate classes suffixed with `-repository` to retrieve the data from the database; for each table its own repository. We have for instance a `customerrepository` class which has all kind of methods to retrieve customers, and a `vacancyrepository` which has all kind of methods to retrieve vacancies. I have two questions about this way of doing things:   1. How about getting data which spans multiple tables? For instance I have a screen which shows all customers who have not yet created a vacancy. Can a `customerrepository` use methods from the `vacancyrespository`, or do both repositories return results and is there a class higher in the hierarchy (let's name it a `dataservice`) which gets the results from both repositories and combine them into 1 result?   2. how much logic can such a repository handle?   I think it's OK to implement the 'where active == true' in a repository to retrieve only active records, or should even that simple logic be handled by a class higher in the hierarchy (let's name it a `dataservice`)? The example I was running into now is this one: We have a questions list, which contains one or more questions.   The question can have a result, which is hold in a separate table.   So when you want to retrieve the total result of the questions list, you have to combine data from the `questionlist` table, the question table and the `questionstatus` table. Right now we have 3 different repositories for these tables. If I would ask the `questionlistrepository` what it's the total result for list number 12, it would have to get data from two other repositories and hence have some logic in it, is that allowed? Or is there a `questionlistdataservice` which knows which repositories to use? One more thing: our repositories can result an `IQueryable` so a calling service can easily combine the results, but how about when this isn't the case, I don't think it's a good idea to retrieve all the content of all three tables from the database.", "Reuse Other Company's Content For Same Client Here's the scenario: a client of mine (lets call them Company A) had a website built by someone else (let's call them Company B). They then asked me (Company C) to configure a third party framework to look and feel exactly the same as what Company B built for them. Would it be legitimate for me to use content (including images, CSS, and even HTML) from the site Company B built for Company A? It's worth mentioning Company A's name is in the copyright notice in the footer of the site Company B made for Company A.", "Why are wrapper classes not suited for use in callback frameworks? I just read the question what are callback frameworks?, where the asker cites the following from Effective Java: > The disadvantages of wrapper classes are few. One caveat is that wrapper > classes are not suited for use in callback frameworks, wherein objects pass > selfreferences to other objects for subsequent invocations (\u201ccallbacks\u201d). So I am curious, why are wrapper classes not suited for use in callback frameworks? And can you provide an example of what the problem is?"]}, {"query": "How much database access should developers have?", "pos": ["Why shouldn't you develop on production database? I need help with organizing my arguments for why it's MADNESS to develop against production data. **Backstory:** I started working here six months ago and I noticed we're developing directly against production data. The codebase is local, but the database we're connected to is live data! So i have to be super careful constantly when doing update/store operations, so that I don't break anything. We have an annual software meeting soon and I want to raise my concerns, and come loaded with arguments but I have a really hard time coming up with good solid points to something that's should be obvious as this. It's as if they would ask me to come up with arguments to why I need to breathe. **My Question:** What arguments are there for NOT developing on production database directly?", "Safely fixing production database data Bugs happen and sometimes data has to be fixed in production. What is the safest way to go about this from a big company standpoint? Are there tools that can help? Here are some considerations driving this requirement...   1. We need to log who ran the query and what they ran   2. Ideally we need to give the person access to only run queries against the tables of interest and only for a short time   3. Whatever is running the queries needs to have some smarts about it to not allow long running and locking SQL to run without explicit permission   4. This process needs to be DB agnostic or at least understand DB2, Oracle, and SQL Server. We are trying to reduce the risk of ad-hoc prod fix-up queries from doing the \"wrong thing\" and at the same time add some security/audtis to the process. Thoughts or Ideas?", "How do you deal with clients asking for manual data edits in the database? I've recently started working on a legacy application that frankly doesn't do all that it should. It's lacking a lot of features, has barely any administration capacities and doesn't check half the data it should. As such, it's very easy for users to do something stupid and get stuck. _\"Oops, I added this item of the wrong type to this thingie and now it won't let me remove it\"_. Indeed, the application should have checked for this, but allowed adding the wrong item. And now, when it comes to deleting the wrong item, it becomes extremely protective and refuses that anything be removed. Problem is, the clients (who are actually users within the company) don't care much for that. They need the application to hold the real-world data as it should be, so they ask the developers to \"fix it\" by changing the data. In this example, deleting the wrong item. In other cases, it will be reassigning items to different parents, fixing various values, etc... Since the application has almost no admin GUI, everything ends up being done directly in the database (augh!), risking even more issues down-the-line unless you know _exactly_ how it works (which no one really does considering the massive application). Ultimately, it feels like the database has become a huge Excel file that devs edit day by day at the whims of the clients, because of failures of the application. It's obvious to me that fixing the application to avoid such situations should be top priority, but it seems the clients prefer asking for a lot of new features instead and it's accepted as such. What can a developer do in such a situation? Is it even possible to refuse DB edits in favor of fixing things? There are so many bugs that it feels like they're never going to wait _that_ long..."], "neg": ["Buy vs. Build - FTP Service We have a need to FTP files that are generated by our system, so we're trying to decide whether we should spend the time to build something that meets our criteria (relatively easy, .NET has FTP functionality built in, among other more advanced libs from 3rd parties). Or if we should buy something off the shelf. Our requirements are roughly:   * Must be able to trigger a file send programmatically   * Needs to retry _N_ number of times (configurable)   * Queryable status of FTP requests   * Callback on completion or fail of an FTP request I don't need to be sold on the relative simplicity of building something like that for myself. However I do want to do the due diligence of seeing what products are available ... because if something does exist that matches the requirements above, I wouldn't mind paying for it :-) Any thoughts or links would be greatly appreciated. Thanks!", "Why is 24 lines a common default terminal height? 80x24 characters seems to be a very common default for terminal windows. This answer provides a very good historical reason as to why the width is 80 characters. But why is the height commonly 24 (or 25) lines?", "Combining 3rd party javascript libraries with my code, then using Closure Compiler I'm using multiple third party javascript libraries in my website, and right now I'm keeping each third party library as a separate .js file, with its own `<script>` tag. But I would like to use the Closure Compiler with Advanced Optimizations. This requires that I either concatenate all the javascript in my website together or make a lot of modifications to my code. Obviously, I would prefer to simply concatenate all the javascript together then run it through Closure Compiler, but then where would I put the licenses and attribution for this code? Not only that, but the actual 3rd party code will be modified as it runs through the Compiler. All the third party libraries either use MIT, BSD, or CC0 1.0 Universal.", "Are Django forms violating MVC? I just started working with Django coming from years of Spring MVC and the forms implementation strikes as being slightly crazy. If you're not familiar, Django forms starts with a form model class that defines your fields. Spring similarly starts with a form-backing object. But where Spring provides a taglib for binding form elements to the backing object within your JSP, Django has form widgets tied directly to the model. There are default widgets where you can add style attributes to your fields to apply CSS or define completely custom widgets as new classes. It all goes in your python code. That seems nuts to me. First, you are putting information about your view directly in your model and secondly you are binding your model to a specific view. Am I missing something? EDIT: Some example code as requested. Django:               # Class defines the data associated with this form     class CommentForm(forms.Form):         # name is CharField and the argument tells Django to use a <input type=\"text\">         # and add the CSS class \"special\" as an attribute. The kind of thing that should         # go in a template         name = forms.CharField(                     widget=forms.TextInput(attrs={'class':'special'}))         url = forms.URLField()         # Again, comment is <input type=\"text\" size=\"40\" /> even though input box size         # is a visual design constraint and not tied to the data model         comment = forms.CharField(                    widget=forms.TextInput(attrs={'size':'40'}))      Spring MVC:               public class User {         // Form class in this case is a POJO, passed to the template in the controller         private String firstName;         private String lastName;         get/setWhatever() {}     }          <!-- JSP code references an instance of type User with custom tags -->     <%@ taglib prefix=\"form\" uri=\"http://www.springframework.org/tags/form\" %>     <!-- \"user\" is the name assigned to a User instance -->     <form:form commandName=\"user\">           <table>               <tr>                   <td>First Name:</td>                   <!-- \"path\" attribute sets the name field and binds to object on backend -->                   <td><form:input path=\"firstName\" class=\"special\" /></td>               </tr>               <tr>                   <td>Last Name:</td>                   <td><form:input path=\"lastName\" size=\"40\" /></td>               </tr>               <tr>                   <td colspan=\"2\">                       <input type=\"submit\" value=\"Save Changes\" />                   </td>               </tr>           </table>       </form:form>", "Are monads a viable (maybe preferable) alternative to inheritance hierarchies? I'm going to use a language-agnostic _description_ of monads like this, first describing monoids: > A **monoid** is (roughly) a set of functions that take some type as a > parameter and return the same type. > > A **monad** is (roughly) a set of functions that take a _wrapper_ type as a > parameter and returns the same wrapper type. _Note those are descriptions, not definitions. Feel free to attack that description!_ So in an OO language, a monad permits operation compositions like: > `Flier<Duck> m = new Flier<Duck>(duck).takeOff().flyAround().land()` Note that the monad defines and controls the semantics of those operations, rather than the contained class. Traditionally, in an OO language we'd use a class hierarchy & inheritance to provide those semantics. So we'd have a `Bird` class with methods `takeOff()`, `flyAround()` and `land()`, and Duck would inherit those. But then we get into trouble with flightless birds, because `penguin.takeOff()` fails. We have to resort to Exception throwing and handling. Also, once we say that Penguin is a `Bird`, we run into problems with multiple inheritance, for example if we also have a hierarchy of `Swimmer`. Essentially we're trying to put classes into categories (with apologies to the Category Theory guys), and define semantics by category rather than in individual classes. But monads seem like a much clearer mechanism for doing that than hierarchies. So in this case, we'd have a `Flier<T>` monad like the example above: > `Flier<Duck> m = new Flier<Duck>(duck).takeOff().flyAround().land()` ...and we would never instantiate a `Flier<Penguin>`. We could even use static typing to prevent that from happening, maybe with a marker interface. Or runtime capability-checking to bail out. But really, a programmer should never put a Penguin into Flier, in the same sense they should never divide by zero. Also, it's more generally applicable. A flier doesn't have to be a Bird. For example `Flier<Pterodactyl>`, or `Flier<Squirrel>`, without changing the semantics of those individual types. Once we classify semantics by composable functions on a container -- instead of with type hierarchies -- it resolves the old problems with classes that \"kind of do, kind of don't\" fit into a particular hierarchy. It also easily & clearly allows multiple semantics for a class, like `Flier<Duck>` as well as `Swimmer<Duck>`. It seems like we've been struggling with a impedance mismatch by classifying behavior with class hierarchies. Monads handle it elegantly. So my question is, in the same way that we've come to favor composition over inheritance, does it also make sense to favor monads over inheritance? (BTW I wasn't sure if this should be here or in Comp Sci, but this seems more like a practical modelling problem. But maybe it's better over there.)", "Is imperative style programming (say with Java/C) more error prone than something more declarative I know programmers tend to get defensive with their paradigms and tools that they use. But in your experience, with the most generic, typical pieces of code that you see with Java or C++ or C, is the code more error prone than a similar piece of code in an declarative or functional programming language. For example, with Java there can be a lot of boilerplate and setup code need to call your target routine. Usually developers may need to look at the implementation details to really understand what happens if they do or do not provide the correct dependencies. Normally the developer never does that so you end up with NullPointerException bugs and other logic errors.", "Processing a list of atomic operations, allowing for interruptions I'm looking for a design pattern that addresses the following situation:   1. There exists a list of tasks that must be processed.   2. Tasks may be added at any time.   3. Each task is wholly independent from all other tasks.   4. The order in which tasks are processed has no effect on the overall system or on the tasks themselves.   5. Every task must be processed once and only once.   6. The \"main\" process which launches the task processors may start and stop without warning. When stopped, the \"main\" process loses all in-memory data. Obviously this is going to involve some state, but are there any design patterns which discuss where and how to maintain that state? Are there any relevant anti-patterns? Named patterns are especially helpful so that we can discuss this topic with other organizations without having to describe the entire problem domain.", "How can documentation writing be made less unpleasant? What makes writing documentation unpleasant for some people, and what can be done to make it less unpleasant? Current thoughts:   1. Ensure the program being described makes sense (eg doesn't have too many fudges or +1s or -1s in it). You feel bad, and it's more difficult, describing a program that doesn't make sense!   2. Conquer your fear of writing. Improve your writing skills, possibly on pleasant tasks."]}], "CQADupstackStatsRetrieval": [{"query": "$\\chi^2$ goodness of fit - how to compute expected counts when $\\exists$ unknown parameters", "pos": ["How to understand degrees of freedom? From Wikipedia, there are three interpretations of the degrees of freedom of a statistic: > In statistics, the number of degrees of freedom is the number of values in > the **final calculation** of a statistic that are **free to vary**. > > Estimates of statistical parameters can be based upon different amounts of > information or data. The number of **independent pieces of information** > that go into the estimate of a parameter is called the degrees of freedom > (df). In general, the degrees of freedom of an estimate of a parameter is > equal to **the number of independent scores that go into the estimate** > minus **the number of parameters used as intermediate steps in the > estimation of the parameter itself** (which, in sample variance, is one, > since the sample mean is the only intermediate step). > > Mathematically, degrees of freedom is **the dimension of the domain of a > random vector** , or essentially **the number of 'free' components: how many > components need to be known before the vector is fully determined**. The bold words are what I don't quite understand. If possible, some mathematical formulations will help clarify the concept. Also do the three interpretations agree with each other?", "Examples of degrees of freedom The idea of degrees of freedom is pretty well sunk into my head, but I was wondering could someone perhaps give me few easy examples on how one would determine the number of degrees of freedom? For example: Lets say that we have a sample of $n$ observations $x_1, x_2, ..., x_n$ following some distribution. Could someone come up artificial examples of different number of degrees of freedom with this sample, say: examples where degrees of freedom are: $$\\text{degrees of freedom} = n$$ $$\\text{degrees of freedom} = n-1$$ $$\\text{degrees of freedom} = n-2$$ $$\\text{degrees of freedom} = n-3$$ This would help get a grasp on, how one would determine the actual number of degrees of freedom. Thank you! :)", "What are \"degrees of freedom\"? > **Possible Duplicate:**   >  How to understand degrees of freedom? I was at a talk a few months back where the speaker used the term 'degrees of freedom'. She briefly said something along the lines of it meaning the number of values used to form a statistic that are free to vary. What does this mean? I'm specifically looking for an intuitive explanation."], "neg": ["How many attributes to select for classification I am aware that this question is vague, but after reading multiple standard books of the community, I am still wondering about the following applied problem. Lets say I have a dichotomy problem and for training I have $M$ observations, each consisting of $k$ features (attributes). I would be interested in any literature which helps determining the number of features one should select for the classification process.", "Sample Balancing Trying to figure out a way to balance small samples. Comparing ratios received from a survey, but sometimes I will have 25 survey responses and sometimes I will have 1. The ratios I look at might be the same but I think I need to take into consideration that one ratio is based on 25 surveys and the other is based on 1. Any way to do that with small samples? Thanks.", "How to calculate confidence and prediction bands for a linear regression using Mathematica? I need to calculate confidence and prediction bands for a linear regression that is in the general form of $y=ax$, where $a$ is the multiplier and $x$ the variable. I found a code in http://demonstrations.wolfram.com/ConfidenceAndPredictionBands/ , though it gives the confidence and prediction bands for $y=ax+b$ which is out of my interest. * * * This is the code I wrote based on @shabbychef's answer. Is it correct?               bands[list_, x_, type_, gamma_] :=       Module[{a, nlm, z, xs, ys, alphahat, betahat, sigmahat2, n, xbar,         multiplier},       xs = list[[All, 1]];       ys = list[[All, 2]];       alphahat = Mean[ys];       nlm = NonlinearModelFit[list, a z, {a}, z,          ConfidenceLevel -> 1 - gamma];       betahat = a /. nlm[\"BestFitParameters\"];       n = Length[list];       xbar = Mean[xs];       sigmahat2 = nlm[\"EstimatedVariance\"];       multiplier =         If[type == 1,          Sqrt[n*sigmahat2/(n - 2)*(1/n + (x - xbar)^2/               Plus @@ ((xs - xbar)^2))],          Sqrt[n*sigmahat2/(n - 2)*(1 +              1/n + (x - xbar)^2/ Plus @@ ((xs - xbar)^2))]];       {betahat*(x),        betahat*(x) -          multiplier*Quantile[StudentTDistribution[n - 2], 1 - gamma/2],         betahat*(x) +          multiplier*Quantile[StudentTDistribution[n - 2], 1 - gamma/2]}       ]", "Steps to write my own general equilibrium model in MATLAB I'm facing a challenge: writing my own general equilibrium model in MATLAB. I would like to ask for:   1. the basic needed knowledge in mathematics   2. the basic needed knowledge in programming with references if possible. I'm a master's degree student in economics, but I'm willing to put in the necessary efforts to achieve my aim. Many thanks in advance.", "Interpretation with training and test set with standardized variables I've standardized all the variables (even the response variable) and then I've split my data into a training and test part. And for example, I've got the following model based on my TRAINING set: y = 0.5x_1 - 0.2x_2 Now I shall get values for y like -0.4,0.7,... but I want to say something about the original response variable. What can I do to get this?", "spss principal axis factoring output problem I am trying to run a factor analysis (SPSS) using principal axis factoring with an oblique (or promax) rotation because the variables are highly correlated. However, the output for \"total variance explained\" does not give any information on \"extraction sum of squares\" and \"rotation sums\" as it does if I use principal components (the table only shows eigenvalues). Has anyone encountered this issue? Does it have to do with PAF itself, the program, or something else that I am missing? I tried removing variables and running with fewer, but didn't change anything, tried without a rotation and didn't work again. Is it possible to use a general principal components to extract the factors, and then for individual factors to use PAF? Thank you :)", "How to calculate the degree of freedom in probability distribution fitting? I am not familiar with degree of freedom. Here are some related questions:   1. Assume $x$ follows $lognormal$ distribution: $x$~$lognormal(\\mu,\\theta)$. Fit a dataset {$x$} (with $N$ $x$'s). What is the degree of freedom?    2. $Fx=(Fx|A)^a*(Fx|B)^b$, $x|A$~$lognormal(\\mu1,\\theta1)$, $x|B$~$lognormal(\\mu2,\\theta2)$ $a+b=N$ $a$: the number of subset $x|A$ $b$: the number of subset $x|B$ Here, there are 4 parameters. What is the degree of freedom now?", "How to calculate the confidence interval of a regression prediction given a particular value for a binary predictor? I have a regression predicting wage (dependent variable) from whether the participant is a college graduate (dummy variable, independent). I have the regression coefficients and their standard errors, the R-squared of the regression, and the covariance between the intercept and the coefficient on the dummy variable. How do I calculate a confidence interval for the average wage of a college graduate (given that dummy = 1)?"]}, {"query": "Markov chain getting stuck due to insufficient data samples", "pos": ["Markov chain getting stuck due to insufficient data samples There is a lot of theory on Markov models and output generation, but I cannot locate any information on models getting stuck. I'm trying to create a model of a data set using a Markov model. The data can look like this \"abc abb acc baa bcc...\", and I want to make an n-gram model. Accordingly, I sample the data set at random, so I get a model like this (example of 2-gram model):   * abc abb -> acc with probability p1   * acc baa -> bcc with probability p2   * ... The problem occurs, when I try to generate an output from the model. Say I initiate the model like this:   * First: abc abb => acc, so the output is now \"abc abb acc\"   * Second (taking the last two words of the output): abb acc => ??? The model gets stuck, because the data set is not complete, and therefore does not cover every possible combination. When making the mode, the sample \"abb acc\" was never reached, and thus the output cannot be determined. I initially asked the question on the C.S. forum site (link), and was advised to ask it here. From the C.S. site, smoothing functions like the Laplace smoothing and Good-Turing smoothing were suggested. Is that the best way to go, or does other methods exist?"], "neg": ["Simulation of an exponentially distributed variable A one-period jump diffusion model of a stock is the following: given the stock value at $T0$, $S(T0)$, the stock value at time $T$, $S(T) = S(T0)exp(x)exp(y)$. Given the inputs $m$, $s$, $pup$, $pdown$ and $\\lambda$, and:   1. x is normally distributed with mean m and standard deviation s   2. y equals 0 with probability 1 \u2013 pup \u2013 pdown (i.e. no jump).    3. y is positive with probability pup; if it is positive , y is exponentially distributed with density p(y) = \u03bbexp(-\u03bby) for y > 0.   4. y is negative with probability pdown; if it is negative, y is exponentially distributed with p(y) = \u03bbexp(\u03bby) for y < 0.   5. x and y are uncorrelated & independent. I am to write a MATLAB program that siumulates the stock prices. Two random numbers per trial are required:   1. A uniformly distributed random number that determines if a jump has occurred   2. An exponentially distributed random number that determines the size of the jump I've transormed a uniform random variable to an exponential variable using $-ln(1 - U(a, b)) / \\lambda$. Where I'm confused is how we're using the uniformly distributed random number that determines if a jump has occurred given I am given pup and pdown. Also, why do I need an exponentially distributed random number for the jump size. I thought I just integrate the pdf? For some reason I struggle mightily with the exponential distribution.", "Practical questions on tuning Random Forests My questions are about Random Forests. The concept of this beautiful classifier is clear to me, but still there are a lot of practical usage questions. Unfortunately, I failed to find any practical guide to RF (I've been searching for something like \"A Practical Guide for Training Restricted Boltzman Machines\" by Geoffrey Hinton, but for Random Forests! :) ) So... How can one tune RF in practice? Is it true that bigger number of trees is always better? Is there a reasonable limit (except comp. capacity of course) on increasing number of trees and how to estimate it for given dataset? What about depth of the trees?.. How to choose the reasonable one? Is there a sense in experimenting with trees of different length in one forest and what is the guidance for that? Are there any other parameters worth looking at when training RF? Algos for building individual trees may be?.. When they say RF are resistant to overfitting, how true is that?.. I'll appreciate any answers and/or links to guides or articles that I might have missed while my search. Thank you!", "Sampling in $\\mathbb{R}^n$ with roughly equal Voronoi cells N random points in a ball in $\\mathbb{R}^n$ induce a Voronoi splitting or tessellation.   Is there a way of random-generating points so that the volumes of the Voronoi cells are roughly equal ? This is 3 related questions, for $L_1, L_2$ and $L_\\inf$ norms (in 3d, random splits of an octahedron, sphere, cube). (Where does this come from ? In searching for a minimum of a noisy function of $n$ variables, one may start N parallel searches from N random start points, e.g. 10 start points in 5d.   Small Voronoi cells are then inefficient, equal-sized cells most efficient.)", "What are U-type statistics? In an article, I recently came across the mention of first and second order U-type statistics without further detail. Does anyone know what U-type statistics are?   References will be highly appreciated.", "Compare group difference with replicates? I have a measurement for two groups of subjects where each subject contains 3 replicates. For example, the data is like below: > Group Subject Replicate Value   >  1 A 1 0.2   >  1 A 2 0.3   >  1 A 3 0.25   >  1 B 1 0.4   >  1 B 2 0.3   >  1 B 3 0.7   >  2 C 1 0.2   >  2 C 2 0.1   >  2 C 3 0.3   >  2 D 1 0.4   >  2 D 2 0.2   >  2 D 3 0.25   > I am thinking of using ANOVA where the subject is the error term,e.g. aov(Value~Group+Error(Subject)) in R. Is it correct? Thanks! Gim", "Significant differences and related variables I am reading a paper in which a statistical difference has been found between two treatment groups for a variable A (p=.05), but not for variables B (p=.06) and C(p=.06), even though A=B-C. Is this possible, and if so, how? The paper states that \"All data were statistically analyzed using the Student's independent t-test provided the data were normally distributed. Otherwise, the Wilcoxon-two-sample test was used.\"", "feature selection vs feature extraction As per my understanding in dimensionality reduction, Feature selection chooses a subset from a list of available variables and, Feature extraction transforms available variables into lower dimension. How exactly does the transformation work? Is it like an interaction term of two or more variables? Could anyone please explain if one technique is more preferred over other or does it depend on the data set? Also, is one preferred over other for Linear Vs Non-Linear dimensionality reduction? Any help is much appreciated", "Compute the user and item features in SVD++ I have a sparse matrix. There is lots of missing data. Hence, I can't use SVD naively. I read Koren's SVD++ paper. I'm confused as to how the $q_i$ and $p_u$ vectors are determined. $q_i^Tp_u$ is supposed to capture the interactions between user $u$ and item $i$ (plus some biases). I just don't see how to calculate what $q_i$ and $p_u$ are supposed to be. The most natural things would be to use SVD but you can't since it has missing data."]}, {"query": "What are the methods for multivariate outlier detection?", "pos": ["What is the best way to identify outliers in multivariate data? Suppose I have a large set of multivariate data with at least three variables. How can I find the outliers? Pairwise scatterplots won't work as it is possible for an outlier to exist in 3 dimensions that is not an outlier in any of the 2 dimensional subspaces. I am not thinking of a regression problem, but of true multivariate data. So answers involving robust regression or computing leverage are not helpful. One possibility would be to compute the principal component scores and look for an outlier in the bivariate scatterplot of the first two scores. Would that be guaranteed to work? Are there better approaches?"], "neg": ["Creating observed/expected ratio using logistic regression I am using logistic regression to benchmark the performance of some students in different years. I created a scenario as below:               mydata <- read.csv(\"http://www.ats.ucla.edu/stat/data/binary.csv\")     benchmark.data <- mydata[1:300,] # students form year 1990-1995 as benchmark     compare.data <- mydata[301:400,] # students from year 1996          # logistic regression model created using benchmark student result     temp.glm <- glm(admit~gre+gpa+rank,data=benchmark.data,family=\"binomial\")          # using the regression model to predict how students in 1996 perform     compare.data[,\"predict\"] <- predict(temp.glm,newdata=compare.data,type=\"response\")          # making a threshold that if the predicted chance of admit > 0.5, then it is asssumed that the student will get admitted     compare.data[,\"predict_admit\"] <- ifelse(compare.data[,\"predict\"]>0.5,1,0)     table(compare.data[,c(\"admit\",\"predict_admit\")])          #      predict_admit     # admit  0  1     #     0 59  6     #     1 26  9      From the table, it is seen that 15 students predicted to get admitted and actual number of students get admitted is 35, so the observed/expected ratio is `35/15=2.33`, as it is larger than `1`, so I will say that students in year 1996 is performing better than benchmark. Can I draw my conclusion using the method mentioned above? Besides, how should I set the threshold? Or should I `sum(compare.data[,\"predict\"])` and treat it as expected value? ### Update 1 I tried and used ROC curve to determine the threshold:               library(ROCR)     benchmark.data[,\"predict\"] <- predict(temp.glm,newdata=benchmark.data,type=\"response\")     preds <- prediction(benchmark.data[,\"predict\"],as.numeric(benchmark.data[,\"admit\"]))     plot(performance(preds,\"tpr\",\"fpr\"),print.cutoffs.at=seq(0,1,by=0.05))      And the charts suggests that threshold at 0.35 seems to give maximized sensitivity and specificity.", "what does it mean for a variable to be statistically significant? what does it mean for a variable to be statistically significant?? Could anyone give a complete answer to this question?", "Kernel density estimator function explanation needed I'm studying about kernel density estimation and from wikipedia I get this formula: $$\\hat{f}_h(x, h) = \\frac{1}{n}\\sum^{n}_{i=1}K_h(x-x_i) = \\frac{1}{nh}\\sum_{i=1}^nK(\\frac{x-x_i}{h}).$$ I think I've got the basic idea of this formula, but the smoothing term $h$ is what troubles me. If my kernel function was the Gaussian: $$K(u)=\\frac{1}{\\sqrt{2\\pi}}e^{-\\frac{1}{2}u^2}$$ I would get my estimator to be: $$\\hat{f}_h(x, h) = \\frac{1}{nh\\sqrt{2\\pi}}\\sum_{i=1}^n e^{-\\frac{1}{2}u^2},$$ where $\\displaystyle u = \\frac{x-x_i}{h}.$ Why is the $h$ term in this formula? What is its function? Why do we divide the sum by $h$ etc. Can someone clarify this a bit?", "Is paired t-test valid for half-normal data? ok i am not a statistician. I am doing paired comparison for several outcomes of cross validated interpolation results. I have to consider only the absolute value in my analysis and so although original data follows a normal distribution the resultant absolute values are only half normal. So is the t-test still valid and sound and in either case (yes/no) what is the reasoning behind it ?", "Detecting outliers in a time-series I'm trying to exclude the outliers using 2-sigma rule and I have a time series. So I use a moving average for this. Let's say I have this:               W1 38 315     W2 48 002     W3 47 487     W4 50 977     W5 39 604     W6 46 058     W7 45 718     W8 22 408      and I want to exclude outliers. I calculate MVA for 8 values and moving stan.dev. The first question is when I calculate MVA for week8. Should I include it or not? The second question is when I detect W4 as an outlier, should I delete it from range and detect another outliers with recalculated MVA and st.dev. (without 50 977 value) or not?", "Sequential testing I have been exposed to R before but after being away from the language for 10 years I find my self having to start from the start. I have a large data set with over 1 million rows and 20 variables. I know there are quicker and faster ways of mining that data but my customer insists on using hypothesis testing to identify significant segments/clusters. I am looking for some R code that would be able to perform a sequential t-test across each of the 20 variables one at a time. Only returning significant variables and samples in table format. Would really appreciate the help.", "Verifying independence for two Random Variables Could you please give me some hints for the exercise below? Suppose we toss a coin once and let $p$ be the probability of heads. Let $X$ denote the number of heads and let $Y$ denote the number of tails. I have to first show that   * $X$ and $Y$ are dependent    * and afterwards if we let $N\\sim $Poisson $(\\lambda)$ and toss the coin $N$ times, that $X$ and $Y$ are independent. * * * The first part follows from the fact that two events are disjoint if we toss the coin just once. For the second part, I can see that the vector $(X,Y)$ follows the multinomial distribution with paramemeters $N$, $p$, and $(1-p)$. Therefore: $$P\\left( X=x,Y=y,N=n \\right)=\\binom{n}{x\\ \\ y } p^x (1-p)^y \\times \\frac { e^{-\\lambda}\\lambda^n}{n!}$$ for $x+y=n$ and $x,y \\geq 0$ I understand that the marginal distributions are binomial but I do not immediately see how I could proceed. I would appreciate some advice here. Thank you.", "Normal distribution necessary to assess moderating and mediating effects? * Is linear regression only suitable for variables with a normal   distribution?   * If so, is there an alternative nonparametric test to test mediation or moderation?"]}, {"query": "When is logistic regression solved in closed form?", "pos": ["How to solve for the parameters in a logistic function? I want to find the parameters of a logistic function. I read the guide here. It has a very clear explanation, but it did not have the final solution that I need. Now, we will consider a basis logistic function: $$h_\\theta(x^{i})=\\frac{1}{1+e^{-\\theta_0-\\theta_1x}}$$ We want to find $\\theta_0$ and $\\theta_1$ subject to minimum cost function: $$J(\\theta)=-\\frac{1}{m}\\sum_{i=1}^{m}y^{i}\\log(h_\\theta(x^{i}))+(1-y^{i})\\log(1-h_\\theta(x^{i}))$$ We use the notation: $$\\theta x^i:=\\theta_0+\\theta_1 x^i_1 $$ Then $$\\log h_\\theta(x^i)=\\log\\frac{1}{1+e^{-\\theta x^i} }=-\\log ( 1+e^{-\\theta x^i} ),$$ $$\\log(1- h_\\theta(x^i))=\\log(1-\\frac{1}{1+e^{-\\theta x^i} })=\\log (e^{-\\theta x^i} )-\\log ( 1+e^{-\\theta x^i} )=-\\theta x^i-\\log ( 1+e^{-\\theta x^i} ),$$ and $$J(\\theta)=-\\frac{1}{m}\\sum_{i=1}^m \\left[y_i\\theta x^i-\\theta x^i-\\log(1+e^{-\\theta x^i})\\right]=-\\frac{1}{m}\\sum_{i=1}^m \\left[y_i\\theta x^i-\\log(1+e^{\\theta x^i})\\right],~~(*)$$ where the second equality follows from: $$-\\theta x^i-\\log(1+e^{-\\theta x^i})= -\\left[ \\log e^{\\theta x^i}+ \\log(1+e^{-\\theta x^i} ) \\right]=-\\log(1+e^{\\theta x^i}). $$ All I need now is to compute the partial derivatives of $(*)$ w.r.t. $\\theta_j$. As $$\\frac{\\partial}{\\partial \\theta_J}y_i\\theta x^i=y_ix^i_j$$ $$\\frac{\\partial}{\\partial \\theta_j}\\log(1+e^{\\theta x^i})=\\frac{x^i_je^{\\theta x^i}}{1+e^{\\theta x^i}}=x^i_jh_\\theta(x^i), $$ The above steps are correct, but it did not have the solution for $\\theta_0$ and $\\theta_1$. We can take the derivative and put it equal $0$. Namely, $$\\frac{\\partial J(\\theta)}{\\partial \\theta_0}=y-\\frac{e^{\\theta_0+\\theta_1 x}}{1+e^{\\theta_0+\\theta_1 x}}=0~~(*)$$ $$\\frac{\\partial J(\\theta)}{\\partial \\theta_1}=yx-\\frac{xe^{\\theta_0+\\theta_1 x}}{1+e^{\\theta_0+\\theta_1 x}}=0 ~~(**) $$   * Are $(*)$ and $(**)$ correct?    * Assume that $y$ and $x$ are known. How do you represent $\\theta_0$ and $\\theta_1$ by $y$ and $x$?", "Why is there no analytic solution for logistic regression? > **Possible Duplicate:**   >  When is logistic regression solved in closed form? Why is there no analytic solution for logistic regression? I was trying to derive a solution similar to the normal equations of linear regression, and I am not sure where it goes wrong. Please provide a mathematical proof."], "neg": ["If P(A)=0, is A a null event? I know that P(null event)=0, but is the reverse true? i.e. if P(A)=0 is A a null event? I'm not too sure I even understand what a null event is, to be honest. Could anyone give me an example of one?", "kMeans - acceptable value for WCSS Which value for the within-cluster sum of squares points can be accepted regarding a data set of 1000 tuples, 21 attributes (but only 3 are used now)? I have used Euclidean distance is used, and a standard argument like `I 500` which will never be reached. The seed was = 10. WEKA (Explorer) was used. Currently, the best value was 290, the worst was 5600, but till now I only performed 7 experiments (5600 points were obtained with all attributes and a k of 2 - monkey test).", "\"Within transform\" for logistic regression I wish to model a binary outcome with controls for several thousand time fixed effects in a panel setting, without a special interest in the actual effect coefficient estimates. In variants of linear least squares regression, I could perform a \"within transform\": demeaning the explanatory variables and response variables within times, and estimating the coefficients on the transformed data. My question: What, if any, is the corollary of this procedure for a binary outcome setting? There is too much data to actually estimate the effects.", "Specification and interpretation of interaction terms using glm() I am fitting a logistic model to data using the glm function in R. I have attempted to specify interaction terms in two ways:               fit1 <- glm(y ~ x*z, family = \"binomial\", data = myData)      fit2 <- glm(y ~ x/z, family = \"binomial\", data = myData)       I have 3 questions: 1) What is the difference between specifying my interaction terms as x*z compared to x/d? When I call summary(fit1) the report includes results for the intercept, x, z, and x:z while summary(fit2) only includes results for intercept, x, and x:z. I did look at Section 11.1 in \"An Introduction to R\" but couldn't understand the meaning. 2) How do I interpret the fit equation mathematically? Specifically, how do I interpret the interaction terms formulaically? Moving to math instead of R, do I interpret the equation as: logit(y) = (intercept) + (coeff_x)*x + (coeff_z)*x + (coeff_xz)*x*z ? This interpration may differ in the two specifications fit1 and fit2. What is the interpretation of each? 3) Assuming the above interpretation is correct, how to I fit the model of x*(1/z) in R? Do I need to just create another column with these values?", "Is there a version of multivariate multinomial logit? I'm working with a data set with 2-3 response variables and 7 predictor variables. All the variables are categorical. If there were just one response variable, I think a multinomial logit would be the right model, but there are 2 or 3. So my question is - is there a multivariate version of the multinomial logit? I've looked at several books on categorical data, but haven't seen anything like this (mainly using Agresti 2002). I have about 2000 observations, though I'll probably need to split it up into 2 or 3 data subsets to really see what's going on. One thing I was thinking about is converting it to counts and use a model for count data. I could also combine the 2-3 response vars into 1 categorical with a lot of categories, but I think that will lower the chances of anything showing up for any of the categories. I could also do 2-3 separate models, one for each variable, which is obviously not as good. I might also be able to get rid of some of the predictors (I think 3 of the 7 have the most explanatory power). I'm not opposed to using machine learning methods, I've found some interesting stuff already with decision trees. thanks, -paul", "What method is suitable for short-term forecast for a trendless, oscillatory, bounded time series? I am new to time series analysis and I would appreciate if anyone could provide me some insight on it. I am trying to analyse a past series of numbers that fluctuates between 107 & 210 with a normal frequency bell curve distribution of mean 162. What is a suitable approach to forecast short-term future range for a trendless but oscillatory, range bound type of time series?", "Cosslett (1983) Has anyone worked with semi parametric methods like Cosslett (1983) or Ichimura or Klein-Spady for binary outcomes? I was wondering if anyone has any R code that he/she could share?", "Feature selection with k-fold cross-validated least angle regression I am using the least angle regression (LARS) to extract the most important predictors ($x_1, x_2,...,x_p$) for my response variable ($y$). I have seven predictors ($x_1,x_2,...,x_7$) for each response variable. I did 10-fold cross validation by using R package `lars`. I am making a cut point at 0.62 (approx.). Am I doing right? Is there any criteria to select important predictors? Any help in this regard would be highly appreciated! Thanks!"]}, {"query": "Is $R^2$ useful or dangerous?", "pos": ["The larger $R^2$ the better? I want to show that the variable $X$ is significant.   In model 1, I use financial statements variables, other macroeconomic variables and $X$.   Here, $X$ is siginificant at a 10% level and $R^2$ is 0.731.   Since financial statements could have time lag, I have to check that effect so I made adjusted model 2.   In here $X$ is insignificant but $R^2$ is 0.721.   So, I can say that \"since $R^2$ is decreased, model 1 is better and $X$ is significant variable\"?"], "neg": ["When no model comparison, should I use REML vs ML? I'm running LMM, and I will make no comparison of models. Could I ask which one should I use between REML and ML?", "Probability of winning given competitor pair analysis Given an analysis of every pair of competitors in a race, how may I determine the probability of any given competitor winning the race? For example, what is the probability of competitor 2 winning the following race? P(Cx Win) means the probability of Competitor x winning.                Cx   Cy   P(Cx Win)  P(Cy Win)     ----------------------------------      1    2       0.3        0.7      1    3       0.4        0.6      1    4       0.9        0.1      2    3       0.8        0.2      2    4       0.7        0.3      3    4       0.9        0.1      I have tried to calculate a 'rating' for each competitor by adding their individual win probabilities. For example the rating for C1 would be 1.6. The rating for C2 would be 2.2 etc. I've tried different ways to use this rating to find the probability of the competitor winning, however my gut feel tells me something is wrong. Is there a mathematical solution to this problem?", "Assigning values to missing data for use in binary logistic regression in SAS Many of the variables in the data I use on a daily basis have blank fields, some of which, have meaning (ex. A blank response for a variable dealing with the ratio of satisfactory accounts to toal accounts, thus the individual does not have any accounts if they do not have a response in this column, whereas a response of 0 means the individual has no satisfactory accounts). Currently, these records do not get included into logistic regression analyses as they have missing values for one or more fields. Is there a way to include these records into a logistic regression model? I am aware that I can assign these blank fields with a value that is not in the range of the data (ex. if we go back to the above ratio variable, we could use 9999 or -1 as these values are not included in the range of a ratio variable (0 to 1)). I am just curious to know if there is a more appropriate way of going about this. Any help is greatly appreciated! Thanks!", "How to use G Power 3 to calculate statistical power in mixed design ANOVA with unequal group sample sizes In G power 3, ANOVA repeated measures within-between interaction: Only the total sample size is reported assuming equal sample size for the two groups. My questions are:   1. How would it work if the sample sizes are slightly different, for example: N1/ N2 = 1.16.    2. I have to input correlation between repeated measures. Is this the correlation between repeats after merging the data from the two groups?    3. Information about non-centrality parameter would be helpful.", "What are the differences between document classification and clustering when working with a single topic? I am doing some web page clustering work and I'm going to use cosine similarity as my distance measure. Even though cosine similarity is a clustering technique, I have to give training data in order to build the query vector. Clustering algorithm doesn't need training data in the sense of with labeled classes, but how do you build the query vector if you don't give the training data in the cosine similarity calculation? I am only interested in a single topic (sports) so if I do it with 2 clusters, when a new document is fed, if it is clustered to the cluster 1 (say sports), then I'll take that document or else it will be rejected. In this case how this differs from single-class classification?", "Bidding Collusion Question: Probability of Identical Bids I was asked this question. My initial conclusion is that there isn't enough information to calculate the probability. I would appreciate it if anyone could provide provide their insight. Scenario:   Department of Defense is looking to purchase a good. Department of Defense has determined that a fair price is 1.0000 and told vendors of this value. Eight vendors submitted independent bids to provide the desired good. What are the odds/probability that three vendors would submit the exact same bid (see below)?               0.7700     0.7999     1.1120     0.7000     1.4262     0.6840     0.7000     0.7000", "Linear/non-linear mixed effects models Does anyone know how to use (nlme)? I'm having a lot of problems using it for something that should be really simple, any help would be really appreciated. I won't put up the details until I know someone knows what I'm talking about. Data was collected by a field study concerned planting pattern, genotype, we replicated this study for 3 years and in each growing season we surveyd 10 times. My question is how to interpret the results best? A professor advised using linear mixed effect model with year as a random factor, to reduce the number of separate analyses and type I error. Anybody who knows, please do me a favor. The following is my data               site    YEAR    GENOTYPE    PATTERN T   density     1   1   G   S   T1  3.0035      2   1   G   S   T1  3.0538      3   1   G   S   T1  2.9939      4   1   G   S   T1  2.8506      5   1   G   M   T1  2.7316      6   1   G   M   T1  2.7789      7   1   G   M   T1  2.8791      8   1   G   M   T1  2.7419      9   1   S   S   T1  0.6024      10  1   S   S   T1  0.6079      11  1   S   S   T1  0.6014      12  1   S   S   T1  0.5855      13  1   S   M   T1  0.5719      14  1   S   M   T1  0.5774      15  1   S   M   T1  0.5887      16  1   S   M   T1  0.5731      1   2   G   S   T1  3.3064      2   2   G   S   T1  3.2896      3   2   G   S   T1  3.3448      4   2   G   S   T1  3.4615      5   2   G   M   T1  3.4104      6   2   G   M   T1  3.3243      7   2   G   M   T1  3.3477      8   2   G   M   T1  3.4031      9   2   S   S   T1  3.3660      10  2   S   S   T1  3.3025      11  2   S   S   T1  3.3760      12  2   S   S   T1  3.3038      13  2   S   M   T1  3.4237      14  2   S   M   T1  3.5357      15  2   S   M   T1  3.5001      16  2   S   M   T1  3.4195      1   3   G   S   T1  2.2068      2   3   G   S   T1  2.1492      3   3   G   S   T1  2.0969      4   3   G   S   T1  2.3010      5   3   G   M   T1  1.7404      6   3   G   M   T1  1.8388      7   3   G   M   T1  1.5185      8   3   G   M   T1  1.6128      9   3   S   S   T1  2.3636      10  3   S   S   T1  2.5092      11  3   S   S   T1  2.0828      12  3   S   S   T1  2.4065      13  3   S   M   T1  1.9243      14  3   S   M   T1  2.0645      15  3   S   M   T1  2.0000      16  3   S   M   T1  2.0170      1   1   G   S   T2  3.6379      2   1   G   S   T2  3.5680      3   1   G   S   T2  3.6095      4   1   G   S   T2  3.6999      5   1   G   M   T2  3.4241      6   1   G   M   T2  3.5053      7   1   G   M   T2  3.4559      8   1   G   M   T2  3.4751      9   1   S   S   T2  0.6663      10  1   S   S   T2  0.6597      11  1   S   S   T2  0.6637      12  1   S   S   T2  0.6721      13  1   S   M   T2  0.6458      14  1   S   M   T2  0.6537      15  1   S   M   T2  0.6489      16  1   S   M   T2  0.6508      1   2   G   S   T2  4.5387      2   2   G   S   T2  4.5442      3   2   G   S   T2  4.5174      4   2   G   S   T2  4.5464      5   2   G   M   T2  4.3512      6   2   G   M   T2  4.4067      7   2   G   M   T2  4.4090      8   2   G   M   T2  4.1965      9   2   S   S   T2  4.5641      10  2   S   S   T2  4.5103      11  2   S   S   T2  4.6466      12  2   S   S   T2  4.5205      13  2   S   M   T2  4.4246      14  2   S   M   T2  4.3424      15  2   S   M   T2  4.4487      16  2   S   M   T2  4.3642      1   3   G   S   T2  3.0099      2   3   G   S   T2  3.0730      3   3   G   S   T2  2.9657      4   3   G   S   T2  3.1807      5   3   G   M   T2  2.6812      6   3   G   M   T2  2.3729      7   3   G   M   T2  2.8820      8   3   G   M   T2  2.4800      9   3   S   S   T2  3.1364      10  3   S   S   T2  3.0839      11  3   S   S   T2  2.9036      12  3   S   S   T2  2.9850      13  3   S   M   T2  2.7412      14  3   S   M   T2  2.8202      15  3   S   M   T2  2.3692      16  3   S   M   T2  2.5866      1   1   G   S   T3  3.3762      2   1   G   S   T3  3.3531      3   1   G   S   T3  3.5340      4   1   G   S   T3  3.4096      5   1   G   M   T3  3.4263      6   1   G   M   T3  3.1959      7   1   G   M   T3  3.2973      8   1   G   M   T3  3.1915      9   1   S   S   T3  0.6411      10  1   S   S   T3  0.6388      11  1   S   S   T3  0.6565      12  1   S   S   T3  0.6444      13  1   S   M   T3  0.6460      14  1   S   M   T3  0.6228      15  1   S   M   T3  0.6332      16  1   S   M   T3  0.6224      1   2   G   S   T3  5.4512      2   2   G   S   T3  5.3256      3   2   G   S   T3  5.5334      4   2   G   S   T3  5.3601      5   2   G   M   T3  4.9647      6   2   G   M   T3  5.0390      7   2   G   M   T3  5.0628      8   2   G   M   T3  5.0739      9   2   S   S   T3  5.3199      10  2   S   S   T3  5.2441      11  2   S   S   T3  5.2672      12  2   S   S   T3  5.3007      13  2   S   M   T3  5.1314      14  2   S   M   T3  5.0120      15  2   S   M   T3  5.1177      16  2   S   M   T3  5.0052      1   3   G   S   T3  2.8808      2   3   G   S   T3  3.0839      3   3   G   S   T3  2.7931      4   3   G   S   T3  2.8555      5   3   G   M   T3  2.6902      6   3   G   M   T3  2.7723      7   3   G   M   T3  2.8293      8   3   G   M   T3  2.9299      9   3   S   S   T3  2.5911      10  3   S   S   T3  2.5587      11  3   S   S   T3  2.7818      12  3   S   S   T3  2.7332      13  3   S   M   T3  2.8414      14  3   S   M   T3  2.7024      15  3   S   M   T3  2.6955      16  3   S   M   T3  2.9365      1   1   G   S   T4  2.9309      2   1   G   S   T4  2.9186      3   1   G   S   T4  3.0249      4   1   G   S   T4  3.0910      5   1   G   M   T4  2.9745      6   1   G   M   T4  2.9538      7   1   G   M   T4  3.1179      8   1   G   M   T4  3.0588      9   1   S   S   T4  0.5945      10  1   S   S   T4  0.5931      11  1   S   S   T4  0.6048      12  1   S   S   T4  0.6118      13  1   S   M   T4  0.5993      14  1   S   M   T4  0.5970      15  1   S   M   T4  0.6147      16  1   S   M   T4  0.6084      1   2   G   S   T4  5.3077      2   2   G   S   T4  5.4044      3   2   G   S   T4  5.4797      4   2   G   S   T4  5.4220      5   2   G   M   T4  5.1803      6   2   G   M   T4  5.2498      7   2   G   M   T4  5.3166      8   2   G   M   T4  5.2693      9   2   S   S   T4  5.7061      10  2   S   S   T4  5.4886      11  2   S   S   T4  5.5974      12  2   S   S   T4  5.6148      13  2   S   M   T4  5.3078      14  2   S   M   T4  5.1670      15  2   S   M   T4  5.1887      16  2   S   M   T4  5.2186      1   3   G   S   T4  4.1525      2   3   G   S   T4  4.1609      3   3   G   S   T4  4.1169      4   3   G   S   T4  4.1687      5   3   G   M   T4  3.9305      6   3   G   M   T4  3.9376      7   3   G   M   T4  3.9668      8   3   G   M   T4  3.9696      9   3   S   S   T4  4.1293      10  3   S   S   T4  4.1358      11  3   S   S   T4  4.1450      12  3   S   S   T4  4.1527      13  3   S   M   T4  3.8382      14  3   S   M   T4  3.8435      15  3   S   M   T4  3.8405      16  3   S   M   T4  3.8439      1   1   G   S   T5  3.2206      2   1   G   S   T5  3.0726      3   1   G   S   T5  3.0228      4   1   G   S   T5  3.1284      5   1   G   M   T5  2.6253      6   1   G   M   T5  2.7760      7   1   G   M   T5  2.7774      8   1   G   M   T5  2.7388      9   1   S   S   T5  0.6254      10  1   S   S   T5  0.6099      11  1   S   S   T5  0.6045      12  1   S   S   T5  0.6158      13  1   S   M   T5  0.5593      14  1   S   M   T5  0.5770      15  1   S   M   T5  0.5772      16  1   S   M   T5  0.5727      1   2   G   S   T5  3.6946      2   2   G   S   T5  3.7158      3   2   G   S   T5  3.6597      4   2   G   S   T5  3.6553      5   2   G   M   T5  3.5065      6   2   G   M   T5  3.3351      7   2   G   M   T5  3.4609      8   2   G   M   T5  3.3047      9   2   S   S   T5  3.5875      10  2   S   S   T5  3.4774      11  2   S   S   T5  3.5924      12  2   S   S   T5  3.5771      13  2   S   M   T5  3.2695      14  2   S   M   T5  3.3753      15  2   S   M   T5  3.2916      16  2   S   M   T5  3.2804      1   3   G   S   T5  3.6772      2   3   G   S   T5  3.6558      3   3   G   S   T5  3.6118      4   3   G   S   T5  3.6636      5   3   G   M   T5  3.3967      6   3   G   M   T5  3.4834      7   3   G   M   T5  3.3992      8   3   G   M   T5  3.6731      9   3   S   S   T5  3.6242      10  3   S   S   T5  3.6307      11  3   S   S   T5  3.6396      12  3   S   S   T5  3.6069      13  3   S   M   T5  3.4087      14  3   S   M   T5  3.4874      15  3   S   M   T5  3.3094      16  3   S   M   T5  3.6386      1   1   G   S   T6  2.7332      2   1   G   S   T6  2.6684      3   1   G   S   T6  2.8573      4   1   G   S   T6  2.6365      5   1   G   M   T6  2.2788      6   1   G   M   T6  2.4624      7   1   G   M   T6  2.4728      8   1   G   M   T6  2.3365      9   1   S   S   T6  0.5721      10  1   S   S   T6  0.5645      11  1   S   S   T6  0.5863      12  1   S   S   T6  0.5607      13  1   S   M   T6  0.5157      14  1   S   M   T6  0.5394      15  1   S   M   T6  0.5407      16  1   S   M   T6  0.5233      1   2   G   S   T6  3.0955      2   2   G   S   T6  3.0941      3   2   G   S   T6  3.1123      4   2   G   S   T6  3.0821      5   2   G   M   T6  2.8195      6   2   G   M   T6  2.8609      7   2   G   M   T6  2.9085      8   2   G   M   T6  2.9745      9   2   S   S   T6  3.0465      10  2   S   S   T6  2.9566      11  2   S   S   T6  3.0422      12  2   S   S   T6  2.9360      13  2   S   M   T6  2.9494      14  2   S   M   T6  2.9652      15  2   S   M   T6  2.9309      16  2   S   M   T6  3.0000      1   3   G   S   T6  2.9079      2   3   G   S   T6  2.8768      3   3   G   S   T6  2.7882      4   3   G   S   T6  2.9689      5   3   G   M   T6  2.7259      6   3   G   M   T6  2.6875      7   3   G   M   T6  2.5340      8   3   G   M   T6  2.6170      9   3   S   S   T6  2.0934      10  3   S   S   T6  2.0043      11  3   S   S   T6  2.0043      12  3   S   S   T6  2.2201      13  3   S   M   T6  2.3927      14  3   S   M   T6  2.4786      15  3   S   M   T6  2.5453      16  3   S   M   T6  2.4928      1   1   G   S   T7  2.7459      2   1   G   S   T7  2.6503      3   1   G   S   T7  2.6222      4   1   G   S   T7  2.7143      5   1   G   M   T7  2.7348      6   1   G   M   T7  2.6739      7   1   G   M   T7  2.7505      8   1   G   M   T7  2.6053      9   1   S   S   T7  0.5736      10  1   S   S   T7  0.5623      11  1   S   S   T7  0.5590      12  1   S   S   T7  0.5699      13  1   S   M   T7  0.5723      14  1   S   M   T7  0.5651      15  1   S   M   T7  0.5741      16  1   S   M   T7  0.5569      1   2   G   S   T7  2.6702      2   2   G   S   T7  2.5635      3   2   G   S   T7  2.6946      4   2   G   S   T7  2.7118      5   2   G   M   T7  2.1614      6   2   G   M   T7  2.1004      7   2   G   M   T7  2.0792      8   2   G   M   T7  2.3010      9   2   S   S   T7  2.2175      10  2   S   S   T7  2.3892      11  2   S   S   T7  2.3284      12  2   S   S   T7  2.3010      13  2   S   M   T7  2.3222      14  2   S   M   T7  2.1139      15  2   S   M   T7  2.1461      16  2   S   M   T7  2.0128      1   3   G   S   T7  2.5328      2   3   G   S   T7  2.5623      3   3   G   S   T7  2.4624      4   3   G   S   T7  2.6075      5   3   G   M   T7  1.7709      6   3   G   M   T7  1.5315      7   3   G   M   T7  1.6902      8   3   G   M   T7  1.6021      9   3   S   S   T7  2.4786      10  3   S   S   T7  2.3729      11  3   S   S   T7  2.5809      12  3   S   S   T7  2.6191      13  3   S   M   T7  1.8388      14  3   S   M   T7  2.0969      15  3   S   M   T7  1.9590      16  3   S   M   T7  2.1271      1   1   G   S   T8  2.6180      2   1   G   S   T8  2.6405      3   1   G   S   T8  2.6385      4   1   G   S   T8  2.6875      5   1   G   M   T8  2.5092      6   1   G   M   T8  2.6107      7   1   G   M   T8  2.7185      8   1   G   M   T8  2.6964      9   1   S   S   T8  0.5585      10  1   S   S   T8  0.5612      11  1   S   S   T8  0.5609      12  1   S   S   T8  0.5667      13  1   S   M   T8  0.5452      14  1   S   M   T8  0.5576      15  1   S   M   T8  0.5704      16  1   S   M   T8  0.5678      1   2   G   S   T8  3.1355      2   2   G   S   T8  3.2087      3   2   G   S   T8  3.2117      4   2   G   S   T8  3.3015      5   2   G   M   T8  3.0580      6   2   G   M   T8  3.2695      7   2   G   M   T8  3.2269      8   2   G   M   T8  2.9881      9   2   S   S   T8  3.0569      10  2   S   S   T8  3.0035      11  2   S   S   T8  3.2405      12  2   S   S   T8  3.0402      13  2   S   M   T8  3.1294      14  2   S   M   T8  3.1623      15  2   S   M   T8  3.2095      16  2   S   M   T8  3.0645      1   3   G   S   T8  2.1430      2   3   G   S   T8  2.2175      3   3   G   S   T8  2.2788      4   3   G   S   T8  2.3118      5   3   G   M   T8  2.0607      6   3   G   M   T8  2.3617      7   3   G   M   T8  2.1430      8   3   G   M   T8  2.4928      9   3   S   S   T8  2.0043      10  3   S   S   T8  2.1335      11  3   S   S   T8  1.9085      12  3   S   S   T8  2.0645      13  3   S   M   T8  2.0645      14  3   S   M   T8  2.3096      15  3   S   M   T8  2.3784      16  3   S   M   T8  2.3404      1   1   G   S   T9  2.4265      2   1   G   S   T9  2.4886      3   1   G   S   T9  2.4393      4   1   G   S   T9  2.4166      5   1   G   M   T9  2.0569      6   1   G   M   T9  2.1106      7   1   G   M   T9  2.2833      8   1   G   M   T9  2.1553      9   1   S   S   T9  0.5349      10  1   S   S   T9  0.5426      11  1   S   S   T9  0.5365      12  1   S   S   T9  0.5336      13  1   S   M   T9  0.4853      14  1   S   M   T9  0.4928      15  1   S   M   T9  0.5163      16  1   S   M   T9  0.4990      1   2   G   S   T9  3.1258      2   2   G   S   T9  3.2368      3   2   G   S   T9  3.1498      4   2   G   S   T9  3.3566      5   2   G   M   T9  2.9956      6   2   G   M   T9  3.0888      7   2   G   M   T9  3.0265      8   2   G   M   T9  2.9279      9   2   S   S   T9  3.0892      10  2   S   S   T9  3.2253      11  2   S   S   T9  3.0531      12  2   S   S   T9  3.0212      13  2   S   M   T9  2.8176      14  2   S   M   T9  3.0170      15  2   S   M   T9  2.8899      16  2   S   M   T9  2.8993      1   3   G   S   T9  2.4928      2   3   G   S   T9  2.3979      3   3   G   S   T9  2.3617      4   3   G   S   T9  2.2279      5   3   G   M   T9  2.3324      6   3   G   M   T9  2.5705      7   3   G   M   T9  2.3892      8   3   G   M   T9  2.7738      9   3   S   S   T9  2.7839      10  3   S   S   T9  2.8537      11  3   S   S   T9  3.0527      12  3   S   S   T9  2.8904      13  3   S   M   T9  2.2355      14  3   S   M   T9  2.3160      15  3   S   M   T9  2.3404      16  3   S   M   T9  3.1072      1   1   G   S   T10 2.5145      2   1   G   S   T10 2.4728      3   1   G   S   T10 2.4487      4   1   G   S   T10 2.4639      5   1   G   M   T10 2.4757      6   1   G   M   T10 2.5328      7   1   G   M   T10 2.5441      8   1   G   M   T10 2.3075      9   1   S   S   T10 0.5459      10  1   S   S   T10 0.5407      11  1   S   S   T10 0.5377      12  1   S   S   T10 0.5396      13  1   S   M   T10 0.5410      14  1   S   M   T10 0.5481      15  1   S   M   T10 0.5495      16  1   S   M   T10 0.5195      1   2   G   S   T10 2.0414      2   2   G   S   T10 2.0086      3   2   G   S   T10 2.0792      4   2   G   S   T10 2.1206      5   2   G   M   T10 2.2788      6   2   G   M   T10 2.2923      7   2   G   M   T10 2.3856      8   2   G   M   T10 2.1959      9   2   S   S   T10 2.1959      10  2   S   S   T10 2.1703      11  2   S   S   T10 2.4232      12  2   S   S   T10 2.2041      13  2   S   M   T10 2.3139      14  2   S   M   T10 2.2856      15  2   S   M   T10 2.2227      16  2   S   M   T10 2.1239      1   3   G   S   T10 2.3711      2   3   G   S   T10 2.5502      3   3   G   S   T10 2.4133      4   3   G   S   T10 2.6031      5   3   G   M   T10 2.7694      6   3   G   M   T10 2.8768      7   3   G   M   T10 2.7803      8   3   G   M   T10 2.7340      9   3   S   S   T10 2.8331      10  3   S   S   T10 2.9036      11  3   S   S   T10 2.8976      12  3   S   S   T10 2.7767      13  3   S   M   T10 2.7435      14  3   S   M   T10 2.8727      15  3   S   M   T10 2.7860      16  3   S   M   T10 2.8457       @mpiktas:Just as you proposed,I didn't show my goal. My interest is to: (1)compare the response of a pest density to planting pattern and genotype;(2)is there any discrepancy among 3 successive years? I have tried linear mixed effect model using year as a random factor, to reduce the number of separate analyses and type I error using R. The concerned code is followed:               Data <- read.csv(\"aphids.csv\", header=T)     Data$T <- as.numeric(Data$T)      library(nlme)     aphids.lme <- lme(density ~ GENOTYPE*PATTERN+year+site , random=~T| year,            method=\u201dML\u201d, na.action=na.omit, data=Data)     summary(aphids.lme)      is this right?", "Is power analysis necessary in Bayesian Statistics? I've been researching the Bayesian take on classical statistics lately. After reading about the Bayes factor I've been left wondering if power analysis is a necessity in this view of statistics. My main reason for wondering this is the Bayes factor really just appears to be a likelihood ratio. Once it's like 25:1 it seems like I can call it a night. Am I far off? Any other reading I can do to learn more? Currently reading this book: Introduction to Bayesian Statistics, by W.M. Bolstad (Wiley- Interscience; 2nd ed., 2007)."]}], "CQADupstackTexRetrieval": [{"query": "Placing Intermediate and Output Files in Another Folder", "pos": ["How can I output the PDF to a different folder? I am using TexStudio on Windows 7 with Miktex. Currently, the output PDF of my document is generated in the same folder as my `.tex` files. How can I output it elsewhere?", "Output temporary files in a different directory TexStudio currently dumps all intermediate files into the same directory that my .tex files were in. It makes a lot of clutter. Can these be put into their own directory? How? I'm using Miktex on Windows 7."], "neg": ["Bleed into margins automatically to prevent orphans? When I set my papers, it sometimes happens that the last line of a paragraph is very short, in extreme cases just a single word, perhaps a page number. I have set `\\clubpenalty` to `10000`, of course, and tried to adjust spacing with `\\looseness=-1`. Even so, I sometimes have to resort to `\\rlap{}`, bleeding into the right margin, as it were. (See the line immedaitely below the image in the attached image). Is there a way to do this automatically, i.e. for a very short line? ![enter image description here](http://i.stack.imgur.com/bXy6a.jpg)", "Adding the date of adding todo-note As is -I suspect- usual is that while writing documents sometimes one skips writing certain parts for a cornucopia of reasons. For me that is usually because I am too lazy at the moment. In an case, then I have the following command to make a todo-note (can look better, I know):               \\newcommand{\\todo}[1]{ \\vspace{5 mm} \\par     \\noindent \\framebox{     \\begin{minipage}     [c]{0.94 \\textwidth}     \\tt #1 \\flushright  TODO     \\end{minipage}     }     \\vspace{5 mm} \\par     }      I have obtained this some time ago from here. My question is how I add the date of adding the todo-note? One can assume that at least I compile the file on the same day as I added the todo-note, so to me, this sounds like the LaTeX process should store this in an auxiliary file (preferable one that already exists). How do I do this?", "List of theorems with thmtools not working - Missing \\endcsname inserted I am trying to generate a list of all equations in a document. I have searched and it seemed a good solution would be to use the `thmtools`, which can generate a list of all theorems(if im correct). What I am looking for is (in the following example, at the chapter CheatSheet) a list with the contents of all equate-theorems, as such (with LaTeX formatting):               $Some_{Lowtext}$                                   (1)     $Some^{Hightext}$                                  (2)      Minimal (not) Working Example:               \\documentclass[a4paper,12pt]{report}     \\usepackage{theorem}     \\newtheorem{equate}{}     \\usepackage{thmtools}     \\renewcommand{\\listtheoremname}{List of Equations}     \\begin{document}     \\tableofcontents     \\newpage     \\chapter{Name of Chapter}     \\section{Name of Section}     \\subsection{Name of SubSection}     sometext     \\begin{equate}     $Some_{Lowtext}$     \\end{equate}         Some other Text     \\begin{equate}     $Some^{Hightext}$     \\end{equate}         And some more          \\chapter{CheatSheet}          \\listoftheorems          \\end{document}      This gives me the following errors (line 24 is the line after `\\listoftheorems`):               test.tex:24: Missing \\endcsname inserted. []     test.tex:24: Too many }'s. []      I am wondering if this is the way to produce such a list and how I can solve my error.", "How to draw empty nodes in tikz-qtree? I'm new to `tikz-qtree`, and I would like to reproduce this figure in LaTeX: ![enter image description here](http://i.stack.imgur.com/Dew4p.jpg) So far, I've managed to cobble this bit of code, but the results are a bit comical, as the empty nodes (those without text) appear smaller than the nodes with text. Secondly, I haven't quite managed to put text above a node or opposite a node/edge as shown in the figure. How do I get the circles to be all of same radius irrespective of whether empty/filled?               \\begin{tikzpicture}[every tree node/.style={draw,circle}]     \\Tree[.{Root}        [.4 11 {} ]        [.5 6  {} ]        ]     \\end{tikzpicture}      I reckon to do that, I might need to specify a new node with a fixed radius using `\\newcommand` right? However, my attempts have been unsuccessful.", "Adding general introduction to table of contents as chapter causes a problem I'm trying to add a general introduction to my report. Well I added it to the table of contents and without number. Using this code :               \\addcontentsline{toc}{chapter}{\\protect\\numberline{}Introduction g\u00e9n\u00e9rale}     \\chapter*{Introduction g\u00e9n\u00e9rale}     \\label{sec:IntroductionG\u00e9n\u00e9rale}      But the problem is : I already added a mini table of contents in the begining of chapters. So when I add the asterisk ,to hide the header the mini Table of contents desapears. And when I delete it , I get a header in the general introduction. This is the code I'm using :                   \\documentclass[12pt,french]{report}     \\usepackage[T1]{fontenc}     \\usepackage{times}     \\usepackage[utf8]{inputenc}     \\usepackage[a4paper]{geometry}     \\usepackage{minitoc}     \\geometry{verbose,tmargin=2cm,bmargin=2cm,lmargin=3cm,rmargin=3cm}     \\setcounter{secnumdepth}{3}     \\setcounter{tocdepth}{3}     \\setlength{\\parskip}{\\smallskipamount}     \\setlength{\\parindent}{0pt}     \\usepackage{float}     \\usepackage{graphicx}     \\usepackage{setspace}     \\usepackage{nomencl}     \\usepackage{enumitem}%pou les puces     % the following is useful when we have the old nomencl.sty package     \\providecommand{\\printnomenclature}{\\printglossary}     \\providecommand{\\makenomenclature}{\\makeglossary}     \\makenomenclature     \\onehalfspacing          \\makeatletter     %%%%%%%%%%%%%%%%%%%%%%%%%%%%%% User specified LaTeX commands.     %/usepackage{t1enc}% un second package     \\usepackage[francais]{babel}     % un troisi\u00e8me package     \\usepackage{layout}     \\usepackage[Lenny]{fncychap}     \\usepackage{fancyhdr}     \\usepackage[section]{placeins}     \\usepackage{lettrine}           \\floatstyle{boxed}     \\title{Rapport de Projet De Fin D'\u00c9tudes}     \\author{Amina GHABRI}     \\usepackage{palatino}%police     \\renewcommand{\\baselinestretch}{1.5}          \\AtBeginDocument{       \\def\\labelitemi{\\normalfont\\bfseries{--}}     }                    \\usepackage{babel}               \\addto\\extrasfrench{%        \\providecommand{\\og}{\\leavevmode\\flqq~}%        \\providecommand{\\fg}{\\ifdim\\lastskip>\\z@\\unskip\\fi~\\frqq}%     }          \\pagestyle{fancy}     \\fancyhf{}     \\fancyhead[LE,RO]{\\leftmark}     \\fancyhead[RE,LO]{\\ }     \\fancyfoot[CE,CO]{\\thepage}     \\fancyfoot[RE,LO]{\\ }          \\renewcommand{\\headrulewidth}{1pt}     \\renewcommand{\\footrulewidth}{1pt}                         %\\usepackage{babel}          \\addto\\extrasfrench{%        \\providecommand{\\og}{\\leavevmode\\flqq~}%        \\providecommand{\\fg}{\\ifdim\\lastskip>\\z@\\unskip\\fi~\\frqq}%     }                         \\makeatother          %\\usepackage{babel}     \\makeatletter     \\addto\\extrasfrench{%        \\providecommand{\\og}{\\leavevmode\\flqq~}%        \\providecommand{\\fg}{\\ifdim\\lastskip>\\z@\\unskip\\fi~\\frqq}%     }     \\rmfamily     \\makeatother          \\makeatletter     \\renewcommand\\paragraph{%        \\@startsection{paragraph}{4}{0mm}%           {-\\baselineskip}%           {.5\\baselineskip}%           {\\normalfont\\normalsize\\bfseries}}     \\makeatother          \\makeatletter     \\renewcommand\\subparagraph{%        \\@startsection{subparagraph}{4}{0mm}%           {-\\baselineskip}%           {.5\\baselineskip}%           {\\normalfont\\normalsize\\bfseries}}     \\makeatother          \\begin{document}     \\maketitle      \\dominitoc\\tableofcontents{}\\listoffigures          \\listoftables               \\addcontentsline{toc}{chapter}{\\protect\\numberline{}Introduction g\u00e9n\u00e9rale}     \\chapter{Introduction g\u00e9n\u00e9rale}     \\label{sec:IntroductionG\u00e9n\u00e9rale}                         Con\u00e7u originellement comme un syst\u00e8me d\u2019exploitation r\u00e9serv\u00e9 pour les terminaux mobiles (Smartphones, Tablettes etc.), Android a boulevers\u00e9 plusieurs domaines d\u2019utilisation comme les t\u00e9l\u00e9viseurs, les autoradios et m\u00eame les voitures. Il a chang\u00e9 automatiquement le fonctionnement  des entreprises et leurs environnements professionnels.                                             \\chapter{Pr\u00e9senation du projet}     \\label{sec:Pr\u00e9senationDuProjet}                                        \\minitoc \\newpage          \\addcontentsline{toc}{section}{\\protect\\numberline{}Introduction}% Add title to ToC     \\section*{Introduction}     \\label{sec:Introduction}          \\lettrine[lines=2,loversize=0.08]{L}{}e succ\u00e8s retentissant des Smartphones sous Android a entrain\u00e9 l'\u00e9mergence quotidienne de nouvelles applications et services qui reposent sur la technologie Wi-Fi.     La premi\u00e8re partie du chapitre est consacr\u00e9e \u00e0 la pr\u00e9sentation du projet et \u00e0 la sp\u00e9cification des besoins.       And this the result with * : ![enter image description here](http://i.stack.imgur.com/AtCMk.png) And this without * : the mini toc desapears : ![enter image description here](http://i.stack.imgur.com/6pyIK.png)", "Disappearing plot (All values has been filtered away) I am trying to get the following plot to work               \\documentclass[a4paper,10pt]{standalone}     \\usepackage{pgfplots,tikz}     \\pgfplotsset{compat=1.6}     \\begin{document}     \\begin{tikzpicture}     \\begin{semilogyaxis}[%     scale only axis,     xmin=0, xmax=14,     xlabel={Iterations},     ymin=-0.747366157054232, ymax=-0.627152206833444,     yminorticks=true,     ylabel={Values $g(x)$}     ]     \\addplot [     color=blue,     solid     ]     table{     1 -0.627152206833444     2 -0.727653418778865     3 -0.744147940956529     4 -0.74683810473197     5 -0.747279463520111     6 -0.747351895087422     7 -0.747363807639291     8 -0.747365769422513     9 -0.747366093009514     10 -0.747366146462357     11 -0.747366155305526     12 -0.747366156770711     13 -0.747366157013831     14 -0.747366157054232     };     \\end{semilogyaxis}     \\end{tikzpicture}%     \\end{document}      The problem is that i obtain the error message > ! Package pgfplots Warning: the current plot has no coordinates (or all have > be en filtered away) I assume it has to do with the combination of very close values, and logarithmic scales. (The plot compiles just fine using normal axis) Is there any method to get the plot to work _with_ a logarithmic scale? ' Nw", "Shortcut for changing text color I want to create a shortcut in LyX for changing the color of selected text. I tried to create a shortcut for \"set-color green\" or \"set-color green green\", but none of these worked. What is the magic word?", "Measuring the true height of a character Suppose you have got a character that sits above the reference point. When you measure its height, the empty space above reference point gets also included in its height measurement but that is not the true height of the character itself. Thus How do you measure the correct height of a character. To see this better, please see the output of the following document:               \\documentclass{minimal}     \\usepackage{fontspec}     \\usepackage{showcharinbox}     \\newfontfamily\\testfont{XB Zar}     \\begin{document}     \\begin{center}     \\ShowCharInBox{\\fontsize{500}{510}\\testfont \\char\"0640}     \\end{center}     \\end{document}      XB Zar font can be obtained from here."]}, {"query": "Does something like a fast LaTeX syntax checker for checking errors / warnings exist?", "pos": ["Is there a program equivalent to lint for LaTeX? Is there a program equivalent to lint for LaTeX? (lint checks C code for syntax errors and possible mistakes.)"], "neg": ["Problem with gnuplot [fr] La 1ere figure ci-dessous permet de repr\u00e9senter la conversion analogique num\u00e9rique avec `\\NN` le nombre de niveaux, r\u00e9alis\u00e9e avec le code suivant (il faut autoriser gnuplot). Comme vous pouvez le constater, la deuxi\u00e8me figure n'est pas compl\u00e8te, la seule diff\u00e9rence est dans l'appel de la fonction, dans la seconde, j'ai g\u00e9n\u00e9ralis\u00e9e en pr\u00e9cisant `\\NN` [en] The first figure below is used to represent the analog to digital conversion with `\\NN` the number of levels, performed with the following code (you have to allow gnuplot). As you can see, the second figure is not complete, the only difference is in the function call in the second, I generalized by specifying `\\NN`               \\documentclass{standalone}     \\usepackage{tikz}     \\usetikzlibrary{positioning,fit}          \\begin{document}               \\begin{tikzpicture}     \\def\\NN{16}     \\begin{scope}[xscale=6,yscale=2]     \\draw[draw=red,,fill=pink] plot[id=sin9c,prefix=gnuplot/,domain=0:2,samples=60,     ybar interval]      function{0.25*floor(\\NN/4*(sin(4*x)+0.5*sin(20*x)+0.05*sin(200*x)+0.03*sin(400*x)+2))};     \\draw[color=blue,thick] plot[id=sin7c,prefix=gnuplot/,domain=0:2,samples=1000,thick]      function{sin(4*x)+0.5*sin(20*x)+0.05*sin(200*x)+0.03*sin(400*x)+2};     \\foreach \\nn in{0,1,2,...,\\NN}{     \\draw (0,{2*\\nn/(\\NN/2)}) node[left]{\\small \\nn}-- (2,{2*\\nn/(\\NN/2)});     }     \\draw (0,0) -- (0,4);     \\end{scope}     \\end{tikzpicture}               \\begin{tikzpicture}     \\def\\NN{16}     \\begin{scope}[xscale=6,yscale=2]     \\draw[draw=red,,fill=pink] plot[id=sin9c,prefix=gnuplot/,domain=0:2,samples=60,     ybar interval]      function{4/\\NN*floor(\\NN/4*(sin(4*x)+0.5*sin(20*x)+0.05*sin(200*x)     +0.03*sin(400*x)+2))};     \\draw[color=blue,thick] plot[id=sin7c,prefix=gnuplot/,domain=0:2,samples=1000,thick]      function{sin(4*x)+0.5*sin(20*x)+0.05*sin(200*x)+0.03*sin(400*x)+2};     \\foreach \\nn in{0,1,2,...,\\NN}{     \\draw (0,{2*\\nn/(\\NN/2)}) node[left]{\\small \\nn}-- (2,{2*\\nn/(\\NN/2)});     }     \\draw (0,0) -- (0,4);     \\end{scope}     \\end{tikzpicture}               \\end{document}      ![enter image description here](http://i.stack.imgur.com/e4ZZ8.jpg) Comment faire pour obtenir la courbe? / How to obtain the curve?", "Beamer - \\visible and \\cellcolor I'm creating a beamer presentation. I have this table:               \\begin{array}         \\visible<1->{\\cellcolor{Blue}{0}} & \\visible<2->{\\cellcolor{Red}{0 + 1}} \\\\         \\visible<1->{\\cellcolor{Yellow}{0 + 1 + 2}} & \\visible<2->{\\cellcolor{Green}{0 + 1 + 2 + 3}}     \\end{array}      Unfortunately, the cell colors are visible from the start, before there is text. Using `\\only` solves the color issue, but destroys the text alignment. How can I fix this? EDIT: Here's a compilable example:               \\documentclass[table,dvipsnames]{beamer}     \\usepackage[ngerman]{babel}     \\begin{document}     \\begin{frame}         $\\begin{array}{ll}             \\visible<1->{\\cellcolor{Blue}{0}} & \\visible<2->{\\cellcolor{Red}{0 + 1}} \\\\             \\visible<3->{\\cellcolor{Yellow}{0 + 1 + 2}} & \\visible<4->{\\cellcolor{Green}{0 + 1 + 2 + 3}} \\\\         \\end{array}$     \\end{frame}     \\end{document}", "Disable printing of fonts/packages during compilation - from the compiled file I just read this: Disable printing of fonts/packages to STDOUT and I was wondering whether the same could be effected somehow from the .tex file being compile (probably you would want to do this before the `\\documentclass`, or at least before all of the `\\usepackage`s).", "Simple Line-Plot with date on x-axis I need to do a really simple line plot and my data is looking like this:               Date    Value     Apr2013 0.06     Mai2013 0.08     Jun2013 0.1     Jul2013 0.2     Aug2013 0.4     Sep2013 1.5     Okt2013 2.0     Nov2013 4.1     Dez2013 8.1     Jan2014 15.3     Feb2014 23.9     M\u00e4r2014 36.5      There is a date in the first column and a float value on the second. The plot should look like that on Apr.2013 the value was 0.06 and so on. So the strings on first column should be on x-axis and the values matching to them on y-axis. I tried it with **tikz** but I don't know how to handle the dates in the first column. What I've tried was something like this, which of course didn't work:               \\documentclass{article}     \\usepackage{tikz}     \\begin{document}     \\begin{tikzpicture}             \\begin{axis}[width=0.9\\textwidth,height=0.9\\textheight,                 title={Foo},                 xtick={0,1,2,3,4,5,6,7,8,9,10},                 x tick label style={/pgf/number format/1000 sep=},                 xlabel={Apr},                 y tick label style={/pgf/number format/1000 sep=},                 extra y tick style={grid=major, tick label style={xshift=-1cm}},                 ylabel={GH/s}]                 \\addplot table[y=Value] {chart-data.csv};             \\end{axis}     \\end{tikzpicture}     \\end{document}", "Show TOC in Beamer under special conditions I'm wondering how to display the TOC:   * At beginning of section if there is no subsection   * At beginning of subsection else Each option can be achieved separately quite easily with the commands               \\AtBeginSection[]     {       \\begin{frame}       \\frametitle{Outline}       \\tableofcontents[currentsection]       \\end{frame}     }      or               \\AtBeginSubsection[]     {       \\begin{frame}       \\frametitle{Outline}       \\tableofcontents[currentsection,currentsubsection]       \\end{frame}     }      respectively.", "Losing space with two rotated tables in one page I'm writing a paper using the `IEEEtran` style, which uses two column per page. At some point, I had to make some three big tables, so I used `\\sideways` to rotate them. The pages' height fill all available space, one of them fill on page alone, but two of them are thin, and I could (and should) put two of them in the same page. I'm defining my first table (the one that fills all page) like this:               \\begin{table*}[h]       \\centering       \\caption{Performance of Second Based Operators applied to the clown image.}       \\label{tab:sodclown}         \\begin{sideways}           \\begin{tabular}{ cccccccc }           ...           Sobel & \\raisebox{-\\totalheight}{\\includegraphics[height=0.2\\textwidth]{figs/colorbar2}}                 & \\raisebox{-\\totalheight}{\\includegraphics[width=0.2\\textwidth]{figs/Clown/MSE/Sobel}}            ...       \\end{tabular}       \\end{sideways}     \\end{table*}      Which gives me this result (just part of it): ![enter image description here](http://i.stack.imgur.com/Zagme.png) The two tables that are in the same page are defined like this:               \\begin{table*}[h]        \\begin{minipage}{.5\\textwidth}           \\centering           \\caption{Performance of Second Based Operators applied to the bike image.}           \\label{tab:sodbike}             \\begin{sideways}              \\begin{tabular}{ cccccccc }              ...              \\shortstack{Four-neighbor\\\\ Laplacian}               & \\raisebox{-\\totalheight}{\\includegraphics[height=0.3\\textwidth]{figs/colorbar2}}               & \\raisebox{-\\totalheight}{\\includegraphics[width=0.3\\textwidth]{figs/Clown/MSE/Laplacian1}}               ...              \\end{tabular}           \\end{sideways}        \\end{minipage}          \\begin{minipage}{.5\\textwidth}           \\centering           \\caption{Performance of Second Based Operators applied to the clown image.}           \\label{tab:sodclown}             \\begin{sideways}               \\begin{tabular}{ cccccccc }               ...               \\end{tabular}           \\end{sideways}        \\end{minipage}%     \\end{table*}      Which gives the following result: ![enter image description here](http://i.stack.imgur.com/k7YvQ.png) As can be seen, I got a considerable black space between my table lines and the images, which prevent my image to get bigger. I wondering what is causing this result I how can I get rid of it, so my useful space would get expanded, and, consequently, my images. The only difference is that I'm using `\\shortstack` in the second table environment.", "Unexplained Gap? I'm trying to make a resume CV document, using a various packages for certain things. I'm not sure if I'm not noticing a conflict in these packages, or I'm being stupid when or comes to margins or tables, but I can't get rid of this infuriating gap! Here you can see an example of the document. Here is the code:               \\documentclass[a4paper,11pt]{article}          %Packages          \\usepackage[a4paper, margin={2.5cm,0cm}]{geometry} %To make it printable     \\usepackage{kantlipsum} %For verbose garbage     \\usepackage{enumitem} %For the enumerated lists     \\usepackage[letterspace=100]{microtype} %For letter spacing     \\usepackage[small,compact]{titlesec} %For customising section headings     \\usepackage{color}          %Preamble          \\pagestyle{empty}     \\linespread{1.2} %increasing line spacing     \\titleformat{\\part}[display]{\\rmfamily \\centering \\Huge \\sc \\lsstyle}{}{}{}[]     \\titlespacing{\\part}{0pt}{0pt}{0pt}{}     \\titleformat{\\section}[display]{\\rmfamily \\Large \\sc \\lsstyle}{}{}{}[\\color{grey}{\\titlerule}\\vspace{1ex}]     \\definecolor{grey}{gray}{0.7}      \\renewcommand*{\\familydefault}{\\sfdefault}     \\newenvironment{coverletter}{\\newgeometry{margin=5cm} \\rmfamily}{\\restoregeometry \\newpage}          \\begin{document}          \\begin{coverletter}          Dear Sir or Madam,     \\\\     Here goes a cover letter.     \\\\          \\begin{flushright}     Kind Regards,     \\end{flushright}           \\end{coverletter}          %Name title          \\part*{kant}     \\begin{center}     Address     \\\\     Email     \\end{center}          %Profile          \\section*{Profile}     \\noindent     \\kant[2]          %Education          \\section*{Qualifications}          \\begin{flushright}     \\begin{tabular}{@{}rp{0.75\\textwidth}@{}}     Kant &\\kant[1]      \\\\      \\end{tabular}     \\end{flushright}          %Work Experience          \\section*{Experience}          \\begin{flushright}     \\begin{tabular}{@{}rp{0.75\\textwidth}@{}}     Kant &\\kant[1]      \\\\      \\end{tabular}     \\end{flushright}          %Skills          \\section*{Key Skills}     \\kant          \\end{document}", "How to use the parskip package? (space in between paragraphs) Sorry, because I think it's a many times asked topic. But I don't find an example which help me to understand how to create a white space between paragraphs. I think `parskip` is the package I need to use but I don't know how to use it. I have this sample of LaTeX trying to understand how to use `parskip` package. What am I doing wrong?               \\documentclass{report}          \\usepackage{parskip}          \\begin{document}     \\setlength{\\parskip}{0pt} % 1ex plus 0.5ex minus 0.2ex}     \\setlength{\\parindent}{0pt}          \\section{Section Headings}          We explain in this section how to obtain headings     for the various sections and subsections of our     document.          \\subsection{Headings in the `article' Document Style}          In the ``article'' style, the document may be divided up     into sections, subsections and subsubsections, and each     can be given a title, printed in a boldface font,     simply by issuing the appropriate command.     \\parskip     Lorem ipsum `comillas simples' sit amet, consectetur adipiscing elit.     Fusce at augue nisi. Mauris vel metus velit. Nunc vitae augue justo, non euismod risus.     Nullam et bibendum nisl. Vestibulum nec leo lectus. Phasellus non dui et ipsum malesuada     venenatis vitae ut risus. Phasellus tincidunt erat sollicitudin leo auctor sed porta leo     commodo. Nullam et adipiscing libero. Ut et mi ac dui facilisis faucibus. Fusce eget magna     a quam volutpat accumsan. Duis dictum luctus ligula, at facilisis leo blandit sit amet.     Phasellus congue ornare lectus scelerisque malesuada. Praesent et cursus nulla. Quisque     aliquam felis ac nunc scelerisque a consectetur elit mattis.     \\\\          \\end{document}      Will this spacing work in the entire document?"]}, {"query": "Understanding minipages - aligning at top", "pos": ["How to align the top of two minipages I have two minipages aligned to the top of a frame (I used the option [t] on the frame and the two minipages). If I had elements in one of the minipage, the other minipage goes down. I have reproduced a small example (pdf link):               \\documentclass{beamer}          \\begin{document}          \\begin{frame}[t]         \\begin{minipage}{0.58\\linewidth}             \\begin{tabular}{c}\\hline                 \\textbf{Header}    \\\\\\hline                 \\only<2->{ line2\\vspace{6cm}\\\\\\hline}              \\end{tabular}         \\end{minipage}\\hfill         \\begin{minipage}{0.4\\linewidth}             \\begin{block}{Text}                 text\\\\             \\end{block}         \\end{minipage}          \\end{frame}          \\end{document}      Do you know how to avoid this behavior?"], "neg": ["How to wrap text in flalign not a duplicate of this question because I want to keep the equation numbering, so a tabular won't do (I think). I am using flalign to typeset philosophical arguments. I also want to use hyperref to be able to hotlink back to the individual lines of the argument later in the document. This works fine until I have a sentence that needs to be wrapped to the next line. MWE:               \\documentclass[11pt]{amsart}     \\usepackage{hyperref}     \\begin{document}          \\begin{flalign}     && \\text{This is premise 1.} && \\text{(Premise)} \\label{premise1} \\\\     && \\text{This is premise 2. What happens when the text goes over the line though? } && \\text{(From \\autoref{premise1})}\\label{premise2}     \\end{flalign}          Obviously \\autoref{premise2} follows from \\autoref{premise1}.          \\end{document}", "Creating bibliographies with biblatex and moderncv I wanted to use the moderncv class together with biblatex. To this end, I redefined the `bibliography` bibenvironment               \\defbibenvironment{bibliography}{}{}%     {\\cvline{\\printfield[labelnumberwidth]{labelnumber}}%     {}     }      The labels were adjusted correctly, but the text of the bib entry (unsurprisingly) started below the label, took the whole line and was not adjusted at all. My question is if there is a neat solution for this, or if one must define a new `BibliographyDriver` as is done here Sorted list of publications in moderncv from bibtex or even resort to some low level hackery as in this answer tabular bibliography with biblatex? If so, what do I have to do?", "CircuitTikz: Labeling and defining I am trying to use CircuiTikz to draw resistor network circuits. For example, I am using the following latex code.               \\documentclass{article}     \\usepackage[american voltages, american currents,siunitx]{circuitikz}     \\begin{document}                    \\begin{circuitikz}     % Node syntax: (X,Y)          %%% From top :     %% 1st row  ==>     % the voltage source and the resistor           \\draw  (0,3)  to [R=\\SI{}{R_H}, o-o, color=red] (3,3);          % resistors connected; lattce point: x=1, y=Ly              \\draw [R, o-] (3,3) to (6,3);        \\draw [R, o-] (3,3) to (3,0);        \\draw [R, o-o] (3,0) to (3,-3);          % dashed implying many connections        \\draw [dashed] (6,3) to (9,3);          % resistor continuing after dashed line        \\draw [R, -o] (9,3) to (12,3);          % next resistor         \\draw [R] (12,3) to (15,3);          \\draw (15,3) to (15,2.5) node [ground]{};                    \\end{circuitikz}               \\end{document}      This gives the following output. ![enter image description here](http://i.stack.imgur.com/21XO6.png) Now 1) Can I add a text \"V\" to the top left corner (left of the resistor labelled by R_H) without inserting a new node? In fact, can I add a text at any coordinate without using a node or path? 2) Using coloring and labelling each resistor, can I redifine a circuit element (e.g. the newly defined resistor will always have label R_H and color red)? 3) Is there any alternative way to the labelling `R=\\SI{}{R_H}`? I suspect `\\SI` is redundant. 4) Can I directly construct resistors in a series instead of mentioning coordinates for them each time? I apologize for the numbers of questions. But I guess, they all are connected and relevant. Thanks in advance.", "Does TexShop automatically saves when you Typeset? I always seem to compile the code but forget to save. Albeit I do save every now and then, but I want to know if it automatically saves when I compile the code, just incase my laptop hangs or something happens that might make me lose my work in the future.", "Defining new split environment with reduced spacing this is my first stackexchange question so apologies for any bad etiquette. I'm writing a document in double spacing. I don't wants the gaps between the lines of a multi-line equation to be that large, though. I know that I can make this change globally by using               \\setlength{\\jot}{<size>}      ...but this also affects other spacings that I don't want to change, e.g. in an xymatrix or when using \\gather I also know that I can keep the changes local by using               \\begingroup\\setlength{\\jot}{<size>}\\begin{split}     ...     \\end{split}\\endgroup      ...but there is a very large number of split equations in my document and I'd prefer not to make it even messier by doing this. I tried to define a new environment to effect this local change, like so               \\newenvironment{Split}%     {\\begingroup\\setlength{\\jot}{-3pt}\\begin{split}}%     {\\end{split}\\endgroup}      But when I try to implement this in the document I get the following error message: > LaTeX Error: \\begin{split} on input line xxx ended by \\end{Split}. I've had success in defining new environments before so I don't know what I'm doing wrong this time. MWE:               \\documentclass{article}          \\usepackage{setspace}     \\doublespacing          \\usepackage{amsmath}          \\newenvironment{Split}%     {\\begingroup\\setlength{\\jot}{-3pt}\\begin{split}}%     {\\end{split}\\endgroup}          \\begin{document}          \\begin{equation}     \\begin{split}     y&=x+x\\\\     &=2x     \\end{split}     \\end{equation}          \\begin{equation}     \\begin{Split}     y&=x+x\\\\     &=2x     \\end{Split}     \\end{equation}          \\end{document}", "Add picture's caption in left margin in refman class I am using `refman` class in latex in order to write a manual of instructions. I would like to add pictures/diagrams with the caption in the left margin since it is quite wide but when I do it with the caption option of the figure environment the caption is placed below the picture and when I use `marginlabel{text of the caption}` it is aligned to the bottom of the picture and I'd rather have it aligned to the top of the picture. This is my MWE:               \\documentclass[twoside,a4paper]{refart}     \\usepackage[utf8x]{inputenc}     \\usepackage[francais]{babel}     \\usepackage{graphicx}     \\begin{document}          \\begin{figure}     \\includegraphics[scale=1]{img/bpa/bpa1.jpg}      \\caption{Text of the caption}     \\end{figure}          \\marginlabel{Text of the caption} \\includegraphics[scale=1]{img/bpa/bpa1.jpg}           \\end{document}", "How to align a marginpar with a section title I wish to have brief information in a marginpar (or other solution) that aligns with the corresponding section (not section*) heading. So far the margin information is above or below the section title. When run, the following MWE generates the margin text below the section title.               \\documentclass[openany]{book}     \\begin{document}     \\chapter{Chapter Heading}     \\section{Section Heading}\\marginpar{\\normalfont\\normalsize Associated text}     Is it working?     \\end{document}      I've searched the interwebs for help. I found Vertical alignment of marginnote and section heading, but this article deals with section*. Alas, perhaps it can't be done... But I hope that it can.", "How to set BibTeX bibliography title? Currently my bibliography says \"Literatur\" (german). But I want something completely different there. How can I achieve that?"]}, {"query": "How can I make compilation more quiet by removing \"LaTeX Warning\" messages from the log?", "pos": ["How do I get rid of particular pdftex warning message? Here is a minimal example that showcases my problem:               \\documentclass{article}          \\usepackage{amsthm}     \\usepackage{hyperref}     \\usepackage{cleveref}          \\newtheorem{thm}{Theorem}     \\newtheorem{lem}[thm]{Lemma}          \\begin{document}          \\begin{lem}     Lemma     \\end{lem}          \\end{document}      The warning I get is the following:               [1pdfTeX warning (ext4): destination with the same identifier (name{thm.1}) has been     already used, duplicate ignored          \\AtBegShi@Output ...ipout \\box \\AtBeginShipoutBox                                                        \\fi \\fi      l.16 \\end{document}                        {<install dir>/MiKTeX/2.9/pdftex/config/pdftex.map}]      I know that it is just a warning and that, my document will still work perfectly fine with regards to cross-referencing and hyperlinking, but I would still like to know why I am getting this warning and if anything can be done to fix it without removing functionality of the included packages. Bonus question: Whats going on behind the scenes when this warning (or any generic 'destination with the same identifier (name{XXX.YYY}) has been already used, duplicate ignored') is produced, as this is not limited to theorem environments. From log file:               Package: amsthm 2004/08/06 v2.20     Package: hyperref 2011/04/17 v6.82g Hypertext links for LaTeX     Package: cleveref.sty 2011/03/22 v0.17.9 Intelligent cross-referencing     Package cleveref Info: `hyperref' support loaded on input line 2157.     Package cleveref Info: `amsthm' support loaded on input line 2300.", "Problem when using hyperref together with cleveref As it says in the `cleveref` documentation `hyperref` must be loaded before cleveref. But at me I have to load at least one package between them and I would really like to know why. The not working minimal example is               \\documentclass{scrartcl}     \\usepackage{amsthm}     \\usepackage{hyperref}     \\usepackage{cleveref}     \\theoremstyle{definition}     \\newtheorem{Def}{Definition}     \\newtheorem{Lemma}[Def]{Lemma}     \\begin{document}     a     \\begin{Lemma}     \\label{Lem:fastdis}     \\[ a+b=c? \\]     \\end{Lemma}     \\end{document}      This just gives an error and doesn't compile, but switching amsthm and hyperref like this               \\documentclass{scrartcl}     \\usepackage{hyperref}     \\usepackage{amsthm}     \\usepackage{cleveref}     \\theoremstyle{definition}     \\newtheorem{Def}{Definition}     \\newtheorem{Lemma}[Def]{Lemma}     \\begin{document}     a     \\begin{Lemma}     \\label{Lem:fastdis}     \\[ a+b=c? \\]     \\end{Lemma}     \\end{document}      it compiles without even a warning. Why do i need to load a package between them?"], "neg": ["TikZ: How to remove unwanted lines within an element? (something like TRIM) In the following, i want only outer edges. I can use `fill=white` to remove unwanted circle portion. How to remove unwanted edges of rectangle?               \\documentclass[a4paper]{article}          \\usepackage{tikz}               \\begin{document}       \\begin{tikzpicture}             \\draw (0,0) circle [radius=2cm];             \\draw[fill=white] (0,1) rectangle (3,2);       \\end{tikzpicture}          \\end{document}      ![enter image description here](http://i.stack.imgur.com/9N6Jk.png) When i have                 \\begin{tikzpicture}             \\draw (0,0) circle [radius=2cm];             \\draw[fill=white] (0,1) rectangle (3,2);             \\path[fill=white] (0,0) circle [radius=2cm];       \\end{tikzpicture}      the circle is not thick.", "Reducing space between first and last name in casual moderncv template I'm converting my resume into the `moderncv` casual template. I came across a couple examples of this template in action that I quite liked. However, when I started using it, I noticed the space between my two names in the heading is much larger than what the examples show. I'd much prefer to have it back the old way. I saw in the `CHANGELOG` that in version 1.2.0, the `\\makecvtitle` code was changed for the casual template to fix some alignment issues. I'm guessing that's where this change was introduced, as I believe the two examples I was looking at are older. Is there a simple way I could change the title formatting to reduce the space between the two names? Any suggestions you have would be much appreciated. Thanks!!", "\\graphicspath and \\include I am trying to define a central graphics path for my thesis, however, the chapters are included with the `\\include` command and by using `\\include` with `\\graphicspath`, pdflatex complains about it can not find the pictures, is not that possible to use `\\graphicspath` and `\\include` together, for which I do not see a sound reasoning behind. I use in the preamble               \\graphicspath{{/home/utab/thesis/phd_text/figures_all//}}      and use               \\include{ch9}       Then it can can not find the pictures on the above mentioned directories recursively.", "Stripping a pair of double-quote characters surrounding a word and define it as a macro I have an external program who writes a text file as follows:               <number> \"<nameA>\"     <number> \"<nameB>\"     <number> \"<nameC>\"     ...      How would I parse all lines and assign each number to a macro of the given name? Here is a prototype of what I'm looking for:               \\documentclass{article}     \\usepackage{filecontents}% http://ctan.org/pkg/filecontents     \\usepackage{siunitx}          \\begin{filecontents}{myinput.txt}     0.45 \"wingTaperRatio\"     12.0 \"wingSpanMT\"     10.2 \"wingAreaMTSquared\"     \\end{filecontents}          \\begin{document}          %     % We want to assign      %   0.45 to \\wingTaperRatio     %   12.0 to \\wingSpanMT     %   10.2 to \\wingAreaMTSquared     %     \\parseInput{myinput.txt}          % So that we can write     Given a wing whose planform has     a taper ratio $\\lambda=\\num{\\wingTaperRatio}$,     a span $b=\\SI{\\wingSpanMT}{\\metre}$,      and a reference surface $S=\\SI{\\wingAreaMTSquared}{\\metre^2}$,     solve the following problem \\ldots          \\end{document}      How the macro `\\parseInput` would be implemented? EDIT: There's one more need here, i.e. that the macro names should admit repetitions. This is because I want to prepare more subfolders, each one with its own `myinput.txt`. Each subfolder will be related to a different proposed exercise in a book. The data and results of the exercises are handled and written on file by the external program. But some of them may be related to the same physical quantity and values may change from one exercise to the next. So, I may have to use the macro `\\parseInput` several times, with the need of redefining some macros. I may want to have something like:               \\section{Exercise 1}     \\parseInput{exerciseOne/myinput.txt}          Given a wing whose planform has     a taper ratio $\\lambda=\\num{\\wingTaperRatio}$,     a span $b=\\SI{\\wingSpanMT}{\\metre}$,      and a reference surface $S=\\SI{\\wingAreaMTSquared}{\\metre^2}$,     solve the following problem \\ldots          \\section{Exercise 2}     \\parseInput{exerciseTwo/myinput.txt}          Now, the taper ratio $\\lambda$ is not given,     while the wing has a new span $b=\\SI{\\wingSpanMT}{\\metre}$,      and a reference surface $S=\\SI{\\wingAreaMTSquared}{\\metre^2}$.     Find the new value of $\\lambda$.", "Cannot determine size of graphic in * (no BoundingBox) I use `convert filename.gif filename.eps` to produce EPS from images before include them into TeX document, and get error:               ! LaTeX Error: Cannot determine size of graphic in filename.eps (no BoundingBox).      Environment: OpenSUSE 11.3 and oficial versions of texlive-latex and ImageMagick.", "Figure inside leftbar environment generates error \"Not in outer par mode\" > ! LaTeX Error: Not in outer par mode. I seek a solution to be able to make this figure inside leftbar environment work:               \\documentclass[12pt]{article}     \\usepackage{graphicx}     \\usepackage{framed}          \\begin{document}          \\begin{leftbar}          \\begin{figure}[h!]       \\caption{Mean data points enclosed by shapes are contained within the same group, within 95\\% confidence.}     \\includegraphics[scale=0.7]{\"../Data Analysis Files/InteractionPlotforTransLog10(X+1)Count\"}     \\end{figure}          \\end{leftbar}               \\end{document}      @Stefan Kottwitz, your solution is otherwise perfect, but it does introduce this problem of cropping at the end of pages: ![enter image description here](http://i.stack.imgur.com/cWPKl.png)", "Using exam class, text entered in \\fullwidth{} messes up pagebreaks I am using the `exam` class to write up a document with questions, but with long passages of text between the questions. In order to get the indentation correct, I have been using `\\fullwidth{}` for those long passages of text. However this messes up pagebreaks. After a question ends and a `\\fullwidth{}` begins, it seems that LaTeX tries to keep the entire `\\fullwidth{}` text on one page. So you get a pagebreak immediately after the question, even if that leaves most of a page of whitespace, and the fullwidth text begins on the next page. My best guess is that `\\fullwidth{}` was only designed for one or two sentences of text at most, so I'm looking for some way around this. Minimally working example below:               \\documentclass{exam}                      \\title{A minimally working example}      \\author{Confused Classicist}          \\begin{document}     \\maketitle     Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor    incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.\\begin{questions}     %%%%     \\question  Translate the above passage.     %%%%%     \\fullwidth{  All of this text is within one fullwidth command, up until the next question.  You only see the effect when you put in enough text to fill up the first page.          Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.          Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.               Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.          Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.          Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.          Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.          Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.          Here ends the fullwidth command.     }     \\question Do you value ancient languages?          \\fullwidth{This fullwidth command does not have enough text here to fill up this page, so there's no problem. Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.}          \\end{questions}     \\end{document}", "Problem in code for inserting the Figures and Tables in top of next page > **Possible Duplicate:**   >  How to influence the position of float environments like figure and table > in LaTeX? How I can set up the figure and tables to capture them in the next page. I have a problem in inserting the figure. I have referenced the figure but it has appeared before the specified place. I would like to revise the code in a way that figures appear in a next top part of page. Code:               \\begin{figure}         \\centering             \\includegraphics[width=0.9\\textwidth]{C:/Thesis/Latex/thesis_1(1)/Figures/studyArea.jpg}             \\rule{35em}{0.3pt}         \\caption{The Grand St. Bernard wireless sensor network deployment (a) the coordinates of nodes according to the Swiss coordinate system (b) the distribution of the nodes in the study site \\citep{r33}}         \\label{fig:study area}     \\end{figure}"]}, {"query": "Footnote number not showing", "pos": ["Footnote without a marker I am new to LaTeX. I am trying to write a paper using latex. I want a footnote about the funding source of my work in the first page without marker. I tried below approaches:   1. `\\footnotetext{text goes here}` This creates a footnote but with '0' as marker. However, the marker reference does not appear within the normal text where I placed this command.   2. Used `\\def\\blfootnote{\\xdef\\@thefnmark{}\\@footnotetext}` definition provided at http://help-csli.stanford.edu/tex/latex-footnotes.shtml#unnumber. I placed this definition in the main tex file just after package declaration. But, this gives the below error.                 ! Use of \\@ doesn't match its definition.        \\blfootnote ->\\xdef \\@thefnmark{}\\@f                                            ootnotetext", "How do I put footnotes without putting any reference numerical mark on it? \\footnotetext{TOV: Tolman, Oppenheimer, Volkoff (1939)}     \\footnotetext{Richard C. Tolman: Phys. Rev 55 (1939), 364-373. Static Solutions of Einstein's Firld Equations for mass of Fluid.}     \\footnotetext{ J.R Oppenheimer \\& G. M Volkoff, phys Rev 55 (1939), 374-381. On Massive Stellar Core}      These footnote texts come up with superscripts and subscript numerical values. How do I get them cleaned?"], "neg": ["How to indent only the second line of a paragraph? I am not an expert in Hebrew typesetting, but the majority of the works I study has the second line of each paragraph indented. Is there a package that would allow me to do this, or will this need to be programmed? I am rather new to TeX and I am looking to use this as an alternative to Word. Any help or direction to find the right info is appreciated. Here is a sample of what I am doing (including the suggesion of using parshape):               %\\documentclass[twocolumn]{book}%Compile with xelatex     \\documentclass[]{article}%set up as article for example     \\usepackage{polyglossia}     %\\usepackage[margin=1in, paperwidth=6in, paperheight=9in]{geometry}     \\setdefaultlanguage{hebrew}     \\newfontfamily\\hebrewfont{Narkisim}     \\newlength\\iiindent \\setlength\\iiindent{15pt}      \\newcommand\\secindent{\\parshape 3 0pt \\linewidth 0pt\\dimexpr\\linewidth-\\iiindent\\relax 0pt \\linewidth }      \\setlength\\parindent{0pt}     \\begin{document}     \\everypar{\\secindent}     \u05d1 \u05e4\u05d0\u05d9\u05ea \u05d4\u05d6\u05e7\u05df \u05d4\u05dd \u05d7\u05d1\u05d8\u05d4 \u05d5\u05e8\u05d1\u05d5 \u05d1\u05d4\u05dd \u05d4\u05e8\u05e2\u05d5\u05ea \u05dc\u05e4\u05d9\u05db\u05da     \u05d9\u05e8\u05d0 \u05e9\u05de\u05d9\u05dd \u05d9\u05e6\u05d0 \u05d0\u05ea \u05db\u05d9\u05dc\u05de \u05d5\u05dc\u05d0 \u05d9\u05e2\u05d1\u05d9\u05e8 \u05ea\u05e2\u05e8 \u05e2\u05dc     \u05d6\u05e7\u05e0\u05d5 \u05db\u05dc\u05dc \u05d5\u05d0\u05e4\u05d9\u05dc\u05d5 \u05e2\u05dc \u05e9\u05e4\u05d4 \u05d4\ufb20\u05dc\u05d9\u05d5\u05e0\u05d4 \u05d0\u05d5 \u05ea\u05d7\u05ea \u05d4\u05d2\u05e8\u05d5\u05df:          \u05d2 \u05d5\u05e2\u05dc \u05e4\u05d0\u05d5\u05ea \u05d4\u05e8\u05d0\u05e9 \u05d9\u05e9 \u05e0\"\u05db \u05dc\u05d0\u05d5 \u05d1\u05ea\u05d5\u05e8\u05d4 \u05d5\u05d4\u05d5\u05d0 \u05de\u05d4     \u05e9\u05db\u05ea\u05d5\u05d1 \u05dc\u05d0 \u05ea\u05e7\u05d9\u05e4\u05d5 \u05e4\u05d0\u05d4 \u05e8\u05d0\u05e9\u05db\u05dd \u05d5\u05d9\"\u05d0 \u05e8\u05e4\u05d0\u05d5\u05d4 \u05d4\u05e8\u05d0\u05e9     \u05d0\u05e1\u05d5\u05e8 \u05de\u05df \u05d4\u05ea\u05d5\u05e8\u05d4 \u05d0\u05e4\u05d9\u05dc\u05d5 \u05db\u05e1\u05dd\u05e4\u05e8\u05d9\u05dd \u05db\ufb20\u05d9\u05df \u05ea\ufb20\u05e8 \u05d3\u05d4\u05d9\u05d9\u05e0\u05d5      \u05e1\u05de\u05d5\u05da \u05dc\u05d1\u05e9\u05e8\u05d5. \u05d5\u05e9\u05d9\u05e4\u05d5\u05e8 \u05d4\u05de\u05d0\u05d4 \u05de\u05e1\u05e0\u05e0\u05d9 \u05e9\u05d6\u05d5\u05e8 \u05e9\u05e2\u05dc     \u05e4\u05e8\u05d7\u05d5\u05e0\u05d9 \u05d5\u05e6\u05e8 \u05dc\u05e1\u05e1\u05d4 \u05e1\u05df \u05d4\u05d0\u05d5\u05d6\u05df \u05de\u05e7\u05d5\u05dd \u05e9\u05d4\u05dc\u05d7\u05d9 \u05d4\u05d9\u05d5\u05d7\u05ea\u05d5\u05df     \u05d9\u05d9\u05e6\u05d0 \u05d5\u05dd\u05ea\u05e4\u05e8\u05e8 \u05e9\u05dd \u05d5\u05d1\u05dc \u05e8\u05d5\u05d7\u05d1 \u05e1\u05e7\u05d5\u05e4 \u05d5\u05d4 \u05dc\u05d0 \u05d4\u05e0\u05d6\u05d5 \u05d1\u05d5     \u05d9\u05d3 \u05de\u05e6\u05e8 \u05e9\u05d4\u05d5\u05d0 \u05d0\u05d1\u05d1\u05dc\u05dc \u05e4\u05d0\u05d5\u05ea \u05d4\u05e8\u05d0\u05e9 \u05d5\u05de\u05e9\u05dd \u05d5\u05dc\u05e1\u05dd\u05d4     \u05de\u05d4\u05d7\u05dc\u05d5\u05df \u05e4\u05d0\u05d4 \u05d4\u05d6\u05e7\u05df. \u05d5\u05d1\ufb20\u05d5\"\u05d4 \u05de\u05e6\u05d5\u05d9 \u05de\u05d5\u05e1\ufb20\u05d1\u05d9\u05e8\u05d9\u05df \u05d0\u05ea     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In this document I have sections and subsections. In a subsection there are nested 'description' lists. I want that items of this description have numbers which use the number of the subsection and nested case the number of the parent description.               4.1. Subsection       4.1.1. Item 1 of Description 1         4.1.1.1. Item 1 of Description 2         4.1.1.2. Item 2 of Description 2       4.1.2. Item 2 of Description 1      How I can achieve that?", "How can I input endmark? This is my code               \\documentclass[12pt,a4paper]{article}     \\usepackage[utf8]{inputenc}     \\usepackage{amsmath}     \\usepackage{amsfonts}     \\usepackage{amssymb}     \\usepackage[thmmarks,standard,thref]{ntheorem}     \\usepackage{graphicx}     \\usepackage[left=2cm,right=2cm,top=2cm,bottom=2cm]{geometry}     \\theoremseparator{.}     \\theoremsymbol{\\ensuremath{\\square}}     \\newtheorem{sol}{Soluttion}          \\begin{document}     \\begin{sol}     This is an exercise     \\end{sol}               \\begin{sol}     This is an exercise     \\begin{equation}     x^2 - 2(m+1)x - m^2 - 1 = 0.     \\end{equation}     \\end{sol}     \\end{document}      I input endmark, but after `\\begin{equation}` `\\end{equation}` I can not receive endmark.", "Plotting a straight line to the peak point of a graph For the MWE below:               \\documentclass{report}     \\usepackage[left=2.5cm,right=2cm,top=2cm,bottom=2cm]{geometry}     \\usepackage[T1]{fontenc}     \\usepackage{pgfplots}          \\usetikzlibrary{calc,trees,positioning,arrows,chains,shapes.geometric,%         decorations.pathreplacing,decorations.pathmorphing,shapes,%         matrix,shapes.symbols,automata}          \\begin{document}          \\begin{figure}[H]     \\begin{tikzpicture}     \\begin{axis}[%     width=1*\\textwidth,     height=8cm,     xlabel={Query},     ylabel={Elapsed Time (in seconds)},     grid = both,     minor x tick num=3,     minor y tick num=3,     enlarge x limits=0     ]     \\addplot [     color=red,     solid,     line width=1.0pt     ]     coordinates{          (0,6.66003) (1,9.10814) (2,182.761) (3,109.154) (4,246.253) (5,206.129) (6,212.653) (7,240.088) (8,4.49266) (9,263.248) (10,257.65) (11,147.81) (12,87.5402) (13,127.389) (14,167.028) (15,2.35324) (16,120.594) (17,2.4295) (18,13.0306) (19,126.756) (20,64.0324) (21,100.611) (22,14.7892) (23,2.41528) (24,132.193) (25,9.94301) (26,156.253) (27,123.016) (28,186.208) (29,102.549) (30,194.67) (31,184.039)      };          \\end{axis}     \\end{tikzpicture}     \\caption{Blah}     \\end{figure}          \\end{document}      Is it possible to draw a straight line to the peak of the graph ? It will basically visually indicate the highest point of the the plot.", "Proper command for Math equation Everyone, I am new to LaTeX, and I tried to learn to write Math equations. I use \"\\usepackage(mathtools}\". I got some problem with \"exponentiation\", \"sum\", \"integral\", ... I want it to display like n=0 under the sum and so on. This is my command:               \\documentclass{article}     \\usepackage{braket}     \\usepackage{mathtools}     \\begin{document}     [...]         $\\left(A+B\\right)\\ket{\\psi} = A\\ket{\\psi} + B\\ket{\\psi}$\\\\         $AB\\ket{\\psi} = A\\left(B\\ket{\\psi}\\right)$\\\\         $\\exp{A} = \\sum_{n=0}^{\\infty}\\frac{A^n}{n!}$     [...]     \\end{document}      Could you help me? ![PDF output](http://i.stack.imgur.com/XcJmj.jpg)", "scrbook and synctex don't work together I have a larger document that uses `scrbook` as a basis. Since the doc is long, I rely on SyncTeX for direct and inverse searches. However, there are lots of parts in the document I can't jump to. I wrote a mini-micro version of the `synctex` command and see that the problem is that the `synctex` libraries don't seem to find the file name for some of the tags:               ./sy main.pdf 3 144 72     [tag:1] /Users/paag/Documents/Projects/NetIDE/netide/Documents/Work-packages/WP2/Deliverables/D2.1/./main.tex line 193     ./sy main.pdf 17 144 72     [tag:74] (null) line 1     ./sy main.pdf 18 144 72     [tag:74] (null) line 1     ./sy main.pdf 19 144 72     [tag:74] (null) line 202      When the filename is not null, I can jump from the PDF to the source with Skim on MacOSX and Evince on Linux. However, when it is null, I cannot. As said, the test program cannot be more stupid :-)               #include <stdio.h>     #include <stdlib.h>     #include <unistd.h>          #include \"synctex_parser.h\"          #define  SYNCTEX_SCANNER_PARSE 1 // set to 0 to call  synctex_scanner_parse() explicitly          int main(int argc, char **argv)     {     synctex_scanner_t scanner;     char cwd_buffer[1024],*cwd, *pdf_file;     int page,xoffs,yoffs;          if (argc == 5) {         pdf_file = argv[1];         page  = atoi(argv[2]);         xoffs = atoi(argv[3]);         yoffs = atoi(argv[4]);     } else {         printf(\"usage %s <pdf_file> <page> <xoffs> <yoffs>\\n\\n\",argv[0]);         return -1;     }     /* TODO: extract base directory from pdf file name */     cwd = getcwd(cwd_buffer,1023);          scanner = synctex_scanner_new_with_output_file(pdf_file, cwd, SYNCTEX_SCANNER_PARSE);          if (scanner != NULL) {         if (synctex_edit_query(scanner,page,xoffs,yoffs)> 0) {             synctex_node_t node;             while((node = synctex_next_result(scanner))!=NULL) {                 int tag           = synctex_node_tag(node);                 int line          = synctex_node_line(node);                 const char *fname = synctex_scanner_get_name(scanner, tag);                 printf (\"[tag:%d] %s line %d\\n\", tag, fname, line);             }         } else {             printf(\"synctex_edit_query failed!\\n\");         }     } else {         printf(\"new synctex scanner not created!\\n\");     }     synctex_scanner_free(scanner);     }", "Is there a way to use a document class/package from another folder? I am building a document class and a set of packages to be used as templates for various documents. I'd like to aviod having to copy those over to another folder every time I use them, but I'd also like to avoid cluttering up the folder containing document classes and packages with tex files (and all the output noise...). I tried starting a document with `\\documentclass{../templates/mycls}`, but since mycls.cls starts with `\\ProvidesPackage{mycls}`, I get naming problems in macros that use `\\@currname` (for example some macros in the `kvoptions` package). Is there any way I can use a document class or package from a different folder, without having to install that folder into the local TeX distribution? **Clarification:** There seems to be some confusion on what I'm trying to do here. What I want to accomplish is a folder structure like the following:               --root         --templates             --myclass.cls             --apackageialsowrote.sty             --agraphtheyllneed.pdf             --adocumenttemplate.tex         --documents             --adoc.tex             --another.tex      The reason for this is that I want to make it very clear which files are related to templates, and which files are just documents using the template, so that when someone comes to get the templates from me, they'll know which files they need. However, with the folder structure above none of the documents in the /documents/ folder can be compiled without copying the template files into /documents/. I don't want duplicate files. I am **not** interested in how to install packages under various TeX distributions (I'm working on MiKTeX, and I know how to do that here...) - I just want to make it as easy as possible for people to find the template files."]}], "CQADupstackUnixRetrieval": [{"query": "finding specific path for an installed program", "pos": ["Determining the path of an executable When looking for the path to an executable or checking what would happen would you enter a command name in a Unix shell, there's a plethora of different utilities (`which`, `type`, `command`, `whence`, `where`, `whereis`, `whatis`, `hash`...). We often hear that `which` should be avoided. Why? What should we use instead?", "`command` vs `type` - Locate program file in user's PATH I need locate program file in user's PATH. I found few solution, the best are `command` and `type`. Which is better, faster, UNIX-like way and why?               command -v <application>     type -p <application>", "'which' reports one thing, actual command is another I am running Ubuntu 12.04, which came with Cmake v 2.8.7. I had need for a more current CMake, so I downloaded the source for 12.8.12.1, built, and installed it per directions. The last step, `make install` I ran `sudo`ed.               ./bootstrap     make     sudo make install      Now I want to run it, but I find that the old version is still invoked when I execute `cmake` from the command line:               jdibling@hurricane:/$ cd /; cmake --version; which cmake     cmake version 2.8.7     /usr/local/bin/cmake     jdibling@hurricane:/$       Odd, I think. So I `su` and try it from there:               root@hurricane:~# cd /; cmake --version; which cmake     cmake version 2.8.12.1     /usr/local/bin/cmake     root@hurricane:/#       Why does `which` report the same directory, but `cmake --version` reports different versions? How can I find where the new `cmake` was actually installed? As suggested, I ran `type`:               jdibling@hurricane:/tmp/cmake-2.8.12.1$ type cmake     cmake is hashed (/usr/bin/cmake)     jdibling@hurricane:/tmp/cmake-2.8.12.1$ sudo su -     root@hurricane:~# type cmake     cmake is /usr/local/bin/cmake     root@hurricane:~#", "Is there an alternative to the `which` command? If the `which` command is not available, is there another 'standard' method to find out where a command's executable can be found? If there is no other 'standard' method available, the actual system I face currently is a bare Android emulator with an `ash` Almquist shell, if that means anything."], "neg": ["Editing RTF files in text mode I have a bunch of CLI-only computers (I have not bothered to set up a GUI yet). I'm comfortable enough in the CLI to not NEED a GUI for most things. However, as a student, turning in Plain-Text documents really doesn't cut it. Is there a way to edit Rich Text Format (.rtf) files from a CLI without popping into a GUI? I'd just need justification (Right, Left, Center), bolding, italics, and a bit of fonts (Sometimes I need to pad my Times New Roman font to a full 13 points to reach a page limit). Heck, it could all be done manually in HTML, with a web-browser engine, and saving to the interesting .rtf font symbols instead of HTML tags. Anybody know a way for me to do this?", "SMTP Auth - SASL on Dovecot, Postfix and CentOS 6.2 (and Open-Xchange) I am trying to get open SASL to work on CentOS 6.2. I followed this tutorial: http://wiki.centos.org/HowTos/postfix_sasl I suspect it works perfectly for CentOS 5.x so all I really need is an update for use on CentOS 6.2. I was feeling confident right up until I discovered half way through that dovecot.conf goes mad with these settings. This link recommends that people running CentOS 6 use a different method. http://wiki2.dovecot.org/HowTo/PostfixAndDovecotSASL Neither of the methods outlined in these links work. Also I don't know how to get Open-Xchange to use SMTP authentication. It seems to be very poorly documented and their CE forum is not letting me post, nor is it showing much activity at all.", "scp force overwrite read only files I was wanting to use `scp` to move some files and overwrite any existing instances of these files on the destination server. Some of them may be read only which, of course, courses the `scp` to fail with \"permission denied\". I couldn't seem to find a `\\--force` type switch for `scp`; is this possible? I am aware of `rsync` but this is not currently available on the destination server.", "Files copied to flashdrive only on unmount I use Debian wheezy with KDE4. Most of the time when I copy something to a flashdrive, the write does not actually take place until I unmount. This even happens with relatively large amounts of data (i think some music around 100MB was still buffered until unmount). Is there any way to tell the OS to write immediately when I tell it to write so I don't have to worry too much about removing my flashdrive without properly unmounting it?", "Why are these aliases failing? I am attempting to put some alias definitions in `.bashrc`. Like this:               #Convienience aliases     alias ll='ls -l'     alias ldir='ls -p | grep \"/\"'     #Temporary aliases     alias mvFooLog='mv ~/Projects/Foo/Log.txt .'      The last alias will work for me, but there seems to be some subtlety which is corrupting the definition of the first two. When Looking at the output of `alias` in the console, I get something like the following:               'lias ldir='ls -p | grep \"/\"     'lias ll='ls -l     alias mvFooLog='mv ~/projects/foo/log.txt .      This is happening in cygwin.", "How to reload a file in vim? Various editors like `gedit` detect if the file is changed and asks to reload it. Sometimes in `vim` when I got many files to edit, I sometimes end up opening same file in different tabs for quick look with other files and several other reasons. So is there anyway I can force to reload the current file before I update anything to it. I know one option is to exit and reopen it, but I have splitted the screen and I don't want to loose that view.", "Checking compatibility between core utils and older GNU/Linux systems I have **non-root** access to a grid of computers. The installed OS is the following:               $ uname -mrs     Linux 2.6.18-274.el5xen x86_64          $ cat /etc/*-release                                                                                                           Scientific Linux SL release 5.1 (Boron)      I built the latest version of core utils locally with               ./configure --prefix=<some_path>     make     make install      but before adding this new install to my `PATH` & `LD_LIBRARY_PATH`, I'm reluctant to start using a version of core utils that may not be compatible or safe to use with my OS. I know that one answer is \" _test and see if it works_ \", but I would prefer to make sure that I will not run into problems later when doing real work with core utils (e.g. moving/deleting files, using `chmod`, etc.) Is this a legitimate concern? Are core utils fully backwards compatible with versions of GNU/Linux this old? How do I find out?", "How can I force the IP address & hostname to only be exposed as domain.com on a Tomcat Server? I have a web server which is running on CentOS 6 on top of Tomcat7. Everything works fine, however, there are many ways that users can access the server. For instance:   * IP Address   * domain.com   * www.domain.com These addresses are all accessible via a browser. However I'd like to configure the server so that when IP address or www.domain.com is accessed, it would point to domain.com. > Example   > IP Address, xxx.xx.xx.xx \u25ba domain.com   > www.domain.com \u25ba domain.com What is the easiest way to achieve this? Is DNS required to configure this on server?"]}, {"query": "Find out exact CPU model, Mainboard, RAM / server model?", "pos": ["Getting information on a machine's hardware in Linux How can I check what hardware I have? (With BIOS version etc.)", "listing all hardware details on Linux > **Possible Duplicate:**   >  checking hardware on linux I want to list all the hardware details about my system. To start with I've following things in my mind. `processor` `memory` `bios` `hba` I've got few details about processor like `processor: Current Speed, Max Speed, Family, Manufacturer, Version, No of CPU's` Can anybody expand the list for me of what other hardware details i need to figure out.", "How to find information about devices in Linux I want to find the following information for devices in Linux:   * Bus speed (e.g. 66 MHz)   * IRQ settings   * Vendor identification   * AGP rate (e.g. 1x, 2x, 4x)   * MAC address  I am only able find the last one by `/sbin/ifconfig | grep HWaddr` How can I find this information in Linux?"], "neg": ["remove white space before delimiter with sed I have data of the following format that I want to input into LibreOffice calc               data | num   | num | num     | num      For some reason Libreoffice does not think the string \"3214 \" is a number by default (trailing white space). I want to replace `(\\s)*|` with `|` where `\\s` stands for space and `*` for the Kleene star operation. And do this at multiple places in each line (all matches). I tried:               sed  -i 's/(\\s)*|/|/' DataStats0914.txt      But it has no effect.", "How to write software to compile with external libraries? I want to code open source software with dependencies. I have skills in C/C++ and a minimum makefile knowledge. But im curious about coding this like `./configure && make` stuff and how to include dependencies to other libraries properly. Where can I find a easy to understand tutorial and is it a hard thing to learn it?", "Python not recognizing LD_LIBRARY_PATH? I am trying to install Python2.7 on cr-48 chromebook in developer mode, and face a weird issue that I am having hard time searching for a solution on google. First some background.. the root partition is mounted readonly, so I have been installing packages under /usr/local, which is a separate mount point that is writable. There is a way to force root partition itself readwrite (with some minor disadvantages), but I decided not to go that route. I have been downloading archlinux packages and extract them under /usr/local and several of them have been working great so far. I basically extract the `.tar.xz` file somewhat like this:               xz -dc package.tar.xz | sudo tar --strip-components=1 -C /usr/local -xvf -      This basically drops the files destined for /usr to be under /usr/local instead. I export `/usr/local/lib` ahead of `/usr/lib` under the `LD_LIBRARY_PATH`, and got several packages to work fine this way. For some reason, python fails to load recognize this, though not completely sure what causes it. After expanding python 2.7 package which I got from archlinux site, I was able to start the python shell fine, and a simple print worked fine. I then tried to install setuptools, so downloaded the source from pypy and tried running `sudo /usr/local/python2 setup.py install`, but it kept giving me the below error:               /usr/local/bin/python2: error while loading shared libraries: libpython2.7.so.1.0: cannot open shared object file: No such file or directory      The `libpython2.7.so.1.0` file is in deed there in `/usr/local/lib/` directory which is there in `LD_LIBRARY_PATH`. A quick run of ldd shows this clearly:               chronos@localhost /tmp/setuptools-1.1.6 $ ldd /usr/local/bin/python2             linux-gate.so.1 (0x777a9000)             libpython2.7.so.1.0 => /usr/local/lib/libpython2.7.so.1.0 (0x77610000)             libpthread.so.0 => /lib/libpthread.so.0 (0x775ee000)             libc.so.6 => /lib/libc.so.6 (0x77464000)             libdl.so.2 => /lib/libdl.so.2 (0x77460000)             libutil.so.1 => /lib/libutil.so.1 (0x7745b000)             libm.so.6 => /lib/libm.so.6 (0x77436000)             /lib/ld-linux.so.2 (0x777aa000)      I also checked `/etc/ld.so.conf` and that too has `/usr/local/lib`:               chronos@localhost /tmp/setuptools-1.1.6 $ cat /etc/ld.so.conf      # ld.so.conf autogenerated by env-update; make all changes to     # contents of /etc/env.d directory     /lib     /usr/lib     /usr/local/lib     /usr/lib/opengl/xorg-x11/lib      I installed `strace` (and `perl` since it is listed as a dependent), and ran the install command under `strace` which shows the below interesting output (see that it is NOT looking for `/usr/local/lib/libpython2.7.so.1.0` anywhere):               chronos@localhost /tmp/setuptools-1.1.6 $ sudo strace /usr/local/bin/python2 setup.py installPassword:      execve(\"/usr/local/bin/python2\", [\"/usr/local/bin/python2\", \"setup.py\", \"install\"], [/* 16 vars */]) = 0     brk(0)                                  = 0x9b3c000     mmap2(NULL, 4096, PROT_READ|PROT_WRITE, MAP_PRIVATE|MAP_ANONYMOUS, -1, 0) = 0x776e6000     access(\"/etc/ld.so.preload\", R_OK)      = -1 ENOENT (No such file or directory)     open(\"/etc/ld.so.cache\", O_RDONLY|O_CLOEXEC) = 3     fstat64(3, {st_mode=S_IFREG|0644, st_size=37049, ...}) = 0     mmap2(NULL, 37049, PROT_READ, MAP_PRIVATE, 3, 0) = 0x776dc000     close(3)                                = 0     open(\"/lib/tls/i686/sse2/libpython2.7.so.1.0\", O_RDONLY|O_CLOEXEC) = -1 ENOENT (No such file or directory)     stat64(\"/lib/tls/i686/sse2\", 0x7fd88d90) = -1 ENOENT (No such file or directory)     open(\"/lib/tls/i686/libpython2.7.so.1.0\", O_RDONLY|O_CLOEXEC) = -1 ENOENT (No such file or directory)     stat64(\"/lib/tls/i686\", 0x7fd88d90)     = -1 ENOENT (No such file or directory)     open(\"/lib/tls/sse2/libpython2.7.so.1.0\", O_RDONLY|O_CLOEXEC) = -1 ENOENT (No such file or directory)     stat64(\"/lib/tls/sse2\", 0x7fd88d90)     = -1 ENOENT (No such file or directory)     open(\"/lib/tls/libpython2.7.so.1.0\", O_RDONLY|O_CLOEXEC) = -1 ENOENT (No such file or directory)     stat64(\"/lib/tls\", 0x7fd88d90)          = -1 ENOENT (No such file or directory)     open(\"/lib/i686/sse2/libpython2.7.so.1.0\", O_RDONLY|O_CLOEXEC) = -1 ENOENT (No such file or directory)     stat64(\"/lib/i686/sse2\", 0x7fd88d90)    = -1 ENOENT (No such file or directory)     open(\"/lib/i686/libpython2.7.so.1.0\", O_RDONLY|O_CLOEXEC) = -1 ENOENT (No such file or directory)     stat64(\"/lib/i686\", 0x7fd88d90)         = -1 ENOENT (No such file or directory)     open(\"/lib/sse2/libpython2.7.so.1.0\", O_RDONLY|O_CLOEXEC) = -1 ENOENT (No such file or directory)     stat64(\"/lib/sse2\", 0x7fd88d90)         = -1 ENOENT (No such file or directory)     open(\"/lib/libpython2.7.so.1.0\", O_RDONLY|O_CLOEXEC) = -1 ENOENT (No such file or directory)     stat64(\"/lib\", {st_mode=S_IFDIR|0755, st_size=4096, ...}) = 0     open(\"/usr/lib/tls/i686/sse2/libpython2.7.so.1.0\", O_RDONLY|O_CLOEXEC) = -1 ENOENT (No such file or directory)     stat64(\"/usr/lib/tls/i686/sse2\", 0x7fd88d90) = -1 ENOENT (No such file or directory)     open(\"/usr/lib/tls/i686/libpython2.7.so.1.0\", O_RDONLY|O_CLOEXEC) = -1 ENOENT (No such file or directory)     stat64(\"/usr/lib/tls/i686\", 0x7fd88d90) = -1 ENOENT (No such file or directory)     open(\"/usr/lib/tls/sse2/libpython2.7.so.1.0\", O_RDONLY|O_CLOEXEC) = -1 ENOENT (No such file or directory)     stat64(\"/usr/lib/tls/sse2\", 0x7fd88d90) = -1 ENOENT (No such file or directory)     open(\"/usr/lib/tls/libpython2.7.so.1.0\", O_RDONLY|O_CLOEXEC) = -1 ENOENT (No such file or directory)     stat64(\"/usr/lib/tls\", 0x7fd88d90)      = -1 ENOENT (No such file or directory)     open(\"/usr/lib/i686/sse2/libpython2.7.so.1.0\", O_RDONLY|O_CLOEXEC) = -1 ENOENT (No such file or directory)     stat64(\"/usr/lib/i686/sse2\", 0x7fd88d90) = -1 ENOENT (No such file or directory)     open(\"/usr/lib/i686/libpython2.7.so.1.0\", O_RDONLY|O_CLOEXEC) = -1 ENOENT (No such file or directory)     stat64(\"/usr/lib/i686\", 0x7fd88d90)     = -1 ENOENT (No such file or directory)     open(\"/usr/lib/sse2/libpython2.7.so.1.0\", O_RDONLY|O_CLOEXEC) = -1 ENOENT (No such file or directory)     stat64(\"/usr/lib/sse2\", 0x7fd88d90)     = -1 ENOENT (No such file or directory)     open(\"/usr/lib/libpython2.7.so.1.0\", O_RDONLY|O_CLOEXEC) = -1 ENOENT (No such file or directory)     stat64(\"/usr/lib\", {st_mode=S_IFDIR|0755, st_size=20480, ...}) = 0     writev(2, [{\"/usr/local/bin/python2\", 22}, {\": \", 2}, {\"error while loading shared libra\"..., 36}, {\": \", 2}, {\"libpython2.7.so.1.0\", 19}, {\": \", 2}, {\"cannot open shared object file\", 30}, {\": \", 2}, {\"No such file or directory\", 25}, {\"\\n\", 1}], 10/usr/local/bin/python2: error while loading shared libraries: libpython2.7.so.1.0: cannot open shared object file: No such file or directory     ) = 141     exit_group(127)                         = ?     +++ exited with 127 +++      I have always gotten custom installation paths to work by just including the lib path in `LD_LIBRARY_PATH` and exporting it, so not sure what else I could be missing here. Any help is much appreciated.", "how to extract part of a filename before '.' or before extension I have files in format below:               abc_asdfjhdsf_dfksfj_12345678.csv     hjjhk_hkjh_asd_asd_sd_98765498.csv     hgh_nn_25342134.exe      I want to get the value before the `.` and after the last `_`. The result would look like:               abc_asdfjhdsf_dfksfj_12345678.csv   ----> 12345678     hjjhk_hkjh_asd_asd_sd_98765498.csv  ----> 98765498     hgh_nn_25342134.exe                 ----> 25342134", "Proper way to use shebang for bash What is the recommended options in `bash`'s shebang?               #!/bin/bash -e      I currently have it as above. This sources `$HOME/.bashrc`. I don't want to source user's `.bashrc`/`.profile` as it might interfere with the script and it will delay the startup of the script (home directory is usually located in network drive). Is there some command line option that disables this?   And what are the other recommended flags to put in?", "NTP server not working properly I have installed a very simple NTP server on a Red Hat server I own, the configuration is pretty basic:               driftfile /var/lib/ntp/drift     restrict default kod nomodify notrap      restrict -6 default kod nomodify notrap      restrict 127.0.0.1      restrict -6 ::1     restrict 192.168.200.0 mask 255.255.255.0 nomodify notrap     server 0.rhel.pool.ntp.org     includefile /etc/ntp/crypto/pw     keys /etc/ntp/keys      If I try to test this from localhost, it seems to work properly:               ntpq -p localhost          remote           refid      st t when poll reach   delay   offset  jitter     ==============================================================================      gw-ge.esaote.co 62.48.53.90      3 u   56   64  173   81.474  -163823 67736.2      If I try to query it from a remote machine, same result:               ntpq -p 192.168.200.151          remote           refid      st t when poll reach   delay   offset  jitter     ==============================================================================      gw-ge.esaote.co 62.48.53.90      3 u    -   64  367   75.500  -163838 61828.5      But, if I invoke `ntpdate`, doesn't work:               ntpdate 192.168.200.151     12 Mar 10:35:51 ntpdate[2688]: no server suitable for synchronization found", "Can I use divert as an alternative to ipfw fwd? I would like to lead some traffic through a transparent proxy (which actually is on another server and connected with an ssh tunnel). Normally I could do this:               ipfw add forward localhost,8080 tcp from any to x.x.x.x 80      However, fwd/forward needs a re-compile of the kernel, which I am not happy to do. Therefore, I'm searching for a solution that doesn't need a recompile. For example, could I somehow use a divert socket to implement this? Or are there any other basic good solutions?", "vim/emacs plugin to view recursive grep search search results? Suppose I have a file formatted like this:               file1:123     file2:4444     some/other/file:2233      This represents the search results from a grep (i.e. file:line-number). I'd like to have a vim plugin which would allow me quickly browse through those hits. It would display a two-pane window (split horizontally) with the top pane showing the hits and the bottom pane showing currently selected hit. Changing the selection in the top pane displays the specified file at the indicated line number in the bottom pane. Anyone run across something like this? I'd even consider a non-vim solution (emacs/dedicated program, ...)."]}, {"query": "disable mail notification on login", "pos": ["Disable mail check on login? When I login to console, e.g tty1, I usually see a message `No mail`, I know there's some program checking email on login, but I don't use that, how can I disable that command ? I tried to grep from `/etc/profile.*` and `~/.bash*`, but nothing found"], "neg": ["Bash pipe output to more I am wondering about some bash environment setting here: is it possible to set stdout of bash as a pipe to /bin/more? You know, like using vi as editor for your commands it should be possible to avoid using Ctrl-PgUp or Ctrl-PgDown for looking on all the output (by default). To be more specific: I _don't_ want to pipe the output of a _single_ command to more like:               $> ls | more     a b c     ...     --more--      BUT: pipe _any_ output of my current session to more, so to get either all output printet as usual just beneath the prompt - or if it's too much, screen- wise.               # automatically piped to more:     $> ls      a b c     ...     --more--      Is there any bash-built-in to accomplish this? EDIT: I wasn't specific enough, sorry for that: I am aware of \"script\" and command grouping like               (cmdA; cmdB) | less      What I really would like is to automatically avoid getting a 100 page output at once but instead have a more-like behavior of bash'es stdout. As could be accomplished by adding                2>&1 | more      to all commands entered on command promt - just automatically.", "Why did this command delete every package? I was trying to get a Windows program to run on PlayOnLinux and after it didn't work I went to remove Wine with this command: `sudo apt-get remove --purge wine*` and without thinking I agreed to remove every package on the machine. Can someone tell me why it selected every package instead of all the ones starting with the string \"wine\"? I'm running Linux Mint 16", "Commands inside bash not being interpreted? I'm trying to execute a command inside a bash script, **$(pwd)** is not being interpreted at all, and not even using eval. This do not work:               cat apache-vhost.conf | sed 's/{path}/$(pwd)/g'      Neither does this:               eval cat apache-vhost.conf | sed 's/{path}/$(pwd)/g'      How can this be solved?", "What filesystem metadata operations are actually journaled in ext4 & xfs? I can't find a simple, straight answer about which filesystem metadata operations are actually persisted to the ext4 & xfs filesystem journals. Note that I am **not** inquiring about what POSIX declares to be \"atomic\". I'm more concerned about what subset of atomic filesystem operations are _effectively_ durable by virtue of running with a journal enabled without having to bend over backwards and `fsync(2)` all the time. Operations I'm fairly certain count:   * `creat(2)`   * `link(2)`   * `unlink(2)`   * `rename(2)`   * `mkdir(2)`   * `rmdir(2)` Operations I'm not entirely sure about:   * `symlink(2)` The `symlink(2)` case is the most troubling, since there does not seem to be any straightforward way to `fsync(2)` or `fdatasync(2)` the underlying datablocks that store the content of a symlink. Knowing that the journal takes care of this for me would be a relief.", "How do I use curl to download content from sourceforge? Simply typing http://downloads.sourceforge.net/project/romfs/genromfs/0.5.2/genromfs-0.5.2.tar.gz works fine on a browser, but I'm trying to download from a CLI environment with limited utilities. The following just returns an empty file:               curl http://downloads.sourceforge.net/project/romfs/genromfs/0.5.2/genromfs-0.5.2.tar.gz      How do I get genromfs-0.5.2.tar.gz from sourceforge using curl?", "How is using a public-key for logging in to SSH any better than using a password? I'm not asking about password vs key authentication. I've seen a few times (and even Amazons AWS) says that even if SSH has a major vulnerability that key authentication would make such an exploit less vulnerable. But, what if there is an exploit with how the keys are verified; isn't this just making an assumption based on the authentication mechanisms? Why is this the thought? Is it because we all know passwords are a poor form of authentication so the assumption has just been \"use a private key\"?", "Linux equivalent of \"Trusted Root Certification Authorities\" on Windows? Where I live we have a corporate firewall which is configured to need a certificate installed on the computers in the house for it to be able to scan for vulnerabilities in secure connections. Without it, a few things won't work as the firewall behaves as a man in the middle, and of course a few websites will deny access to prevent any harm as it looks dangerous. On Windows, I'd just need to double click the certificate (.p12 extension), insert the password and specify it to be put in \"Trusted Root Certification Authorities\" and be done with it. On Linux, I haven't had much luck in doing that. I'm running Arch.", "Which is the real PATH variable On my office computer it seems like I've have two PATH variables. > $path : This is delimited by \" \" (Space) > > $PATH : This is delimited by \":\" (Colon) Though when I update one, the other one gets updated as well. Is this the normal behavior in Linux or is there something wierd going on in my machine? Should I keep them both, or delete one of them? **Edit:** I'm using csh, I found this because some of my colleagues were updating the \"path\" variable, while others did it with \"PATH\". Though I deleted all occurences of updating \"PATH\" in my .cshrc, it still appears when I try to echo them."]}, {"query": "How to determine the filesystem of an unmounted device?", "pos": ["Find filesystem of an unmounted partition from a script I'm writing a custom automated install using AIF (Arch Installation Framework), and I need to find the filesystem on a partition given a partition. So far I have this:               grok_partitions () {         local partitions=         for label in `ls /dev/disk/by-label | grep \"Arch\"`         do             if [ $label == \"Arch\" ]             then                 mount_point=\"/\"             else                 IFS=\"-\" read base mount <<< \"${label}\"                 mount_point=\"/${mount}\"             fi                  local partition=$(readlink -f /dev/disk/by-label/${label})             local part_no=$(echo ${partition} | grep -Po '\\d+')             local fs=$(parted -mls | grep \"^${part_no}\" | cut -d: -f5)             partitions+=\"${partition} raw ${label} ${fs};yes;${mount_point};target;no_opts;${label};no_params\\n\"         done              # do the swap         if [ -e /dev/disk/by-label/swap ]         then             local partition=$(readlink -f /dev/disk/by-label/swap)             partitions+=\"$partition raw swap swap;yes;no_mountpoint;target;no_opts;swap;no_params\"         else             # if there's no labeled swap, use the first one we find             local partition=$(fdisk -l | grep -m1 swap | awk '{ print $1 }')             if [ ! -e $partition ]             then                 echo \"No swap detected. Giving up.\"                 exit 1             fi             partitions+=\"$partition raw no_label swap;yes;no_mountpoint;target;no_opts;no_label;no_params\"         fi              echo -n ${partitions}     }      This worked fine on my machine with only one hard drive, but it failed (obviously) when running in my VM running on a LiveCD (the LiveCD was being picked up as another drive, /dev/sr0). I've thought of a couple of hacks I could try:   * `mount $partition; grep $partition /etc/mtab | awk ...`   * use `parted -mls`, but pull out the partition I care about with clever scripting, then parse as I already do in the scriptt Is there a better, simpler way of doing this? I already have the partitions I'm interested in, and I only need to find their filesystems (as well as find available swap).", "How to show the filesystem type via the terminal? > **Possible Duplicate:**   >  How to tell what type of filesystem you\u2019re on?   >  Find filesystem of an unmounted partition from a script How can I quickly check the filesystem of the partition? Can I do that by using `df`?", "How to tell what type of filesystem you're on? Is there a command to tell what type of filesystem you're using?", "Finding which filesystem I have an external hard drive and would like to know what kind of a file system it has. How do I find that out using the terminal?", "How to know file system of any medium like hard disk, CD/DVD, flash drive? Is there any command or any way to know what file system is there on a medium like hard disk or CD/DVD or flash drive etc. From GUI gparted one can know the type on hard disks/pen drive but not of CD/DVD. I ran the below command to mount my DVD.               ravbholua@ravbholua-Aspire-5315:~/Documents/Other$ sudo mount -t iso9660  /dev/cdrom ~/Downloads     mount: block device /dev/sr0 is write-protected, mounting read-only     mount: wrong fs type, bad option, bad superblock on /dev/sr0,            missing codepage or helper program, or other error            In some cases useful info is found in syslog - try            dmesg | tail  or so          ravbholua@ravbholua-Aspire-5315:~/Documents/Other$      From the error thrown by `mount`, I feel that the file system that I had given in the command i.e. 'iso9660' may not be right. From this it strikes my mind to 1st know the f.s. present on the DVD. I'm working on Ubuntu 13.04."], "neg": ["\u201cPTY allocation request failed on channel 0 stdin: is not a tty\u201d when SSH'ing into a Debian server My hosting space (Debian Wheezy) serves two websites (one WordPress and one Rails). Today I saw both were down and I rebooted the server. The Rails site works again and the WordPress one now says that it has an error connecting to the database. Then after the reboot (from SSH as well) I SSH'ed into the server I got the following message:               PTY allocation request failed on channel 0     stdin: is not a tty      When I run with `-v` flag I get output with nothing strange I think (just checking the public and private key). See this gist. When I SSH as follows `ssh user@host \"/bin/bash -i\"` I _can_ login into the remote shell. I read in another answer (which also provided also the tip with appending \"bin/bash -i\" and that helped) that I should manually remove and re-add the `/dev/pt*` files. The one who asked the question said that unmounting `/dev/pts` and remounting it worked. Unfortunately I get the error:               Can't find /dev/pts in /etc/fstab or /etc/mtab      My `/etc/fstab` files looks like this:               #UNCONFIGURED FSTAB FOR BASE SYSTEM      Does anyone have any idea what is going on and how I can solve this? /edit Output of `tty; ls -l /proc/self/fd` locally:               /dev/pts/2     total 0     lrwx------ 1 erwin erwin 64 Sep 13 19:01 0 -> /dev/pts/2     lrwx------ 1 erwin erwin 64 Sep 13 19:01 1 -> /dev/pts/2     lrwx------ 1 erwin erwin 64 Sep 13 19:01 2 -> /dev/pts/2     lr-x------ 1 erwin erwin 64 Sep 13 19:01 3 -> /proc/4389/fd      Output of `ls -la /dev/ptmx /dev/pts` on remote machine:               crw-rw-rw- 1 root tty  5, 2 Sep 11 00:19 /dev/ptmx          /dev/pts:     total 8     drwxr-xr-x 2 root root 4096 Mar 10  2013 .     drwxr-xr-x 3 root root 4096 Sep 11 00:35 ..", "Bash: Capture / Use last (or Nth) line in stdout # Query I use Bash. When I'm looking for files, often I'll do the following: `find -name stackexchange.hs` And often the results will look like:               /youre/the/man/now/dog/stackexchange.hs     /you/are/no/longer/the/dog/dog/stackexchange.hs     /this/is/the/file/i/want/stackexchange.hs      Then I'll want to do one of the following:   * Option 1: Open the last item in the list of results in **vim**.   * Option 2: Open the Nth item in the list of results in **vim**. Currently, I cut-and-paste with the mouse. Which brings me to my **question** :   1. Is there an easy, one-liner to accomplish options 1&2? Note that this is occurring _after_ the `find` command.   2. Is there a way to capture N-lines from stdout in some kind of bash vector/array?  ## Ideal usage               $ find -name am_i_really_all_alone.txt     ./borges/library/you_are_not_alone.txt     ./borges/library/am_i_really_all_alone.txt     $ vim (N)      (syntax and semantics may differ, but you get the point) # Similaria There seem to be several similar questions. Here are my _perceived_ differences (I am open to enlightenment):   * \"Open File Found with find Command\" focuses on creating a one-line to pipe a file name from `find` into `vim` (or whatever). In my case, I want to `find` first, pipe later (so to speak). My capture / usage happens strictly _after_.   * \"Reuse Last Output From Command Lind\" seems bang-on, but seems to simply repeat the command and doesn't speak to capturing the **Nth** line of output. Quite frankly, it scares me.   * \"Capture Multi-Line Output of a Bash Builtin\" is close, but not quite there.    * \"What is the exact difference between terminal, shell, tty, console, etc.\" this one is really just a good read.  Thank you for your help! Having used *nix/BSD when I was a teenager in the 90s and getting scared away by calling my burnout, acid-head neighbour to help me install drivers for my plug-and-play sound card, I'm relieved to discuss command-line minutiae with (perceivably) less frightening individuals. It feels good to be back.", "Select/Paste Word-Wrap on X-Based Terminals Is there a sure-fire method to cut & paste word-wrap on X-based terminals? That is, if I select, then paste via button-3, if the text goes to the end of the line and wraps, the paste assumes carriage return and inserts it. I'd rather:               if (endcolumn==non-space character) {       assume wordwrap     }     else {       insert carriage return after last non-space character     }      This drives me crazy. Especially when pasting code that is > 80 columns. Sometimes it works, most of the time it doesn't.", "What's the difference between Ctrl-Z and kill -STOP? When I run a command (`make` on a large project) from the shell, I can type Ctrl-Z to stop the process and return to the shell. Subsequently, I can run `fg` to continue the process. I'm trying to write a shell script to automate this (specifically, to check my CPU temperature every few seconds and stop the process if it gets too hot, since my computer is prone to overheating). My first attempt worked like this (simplified):               make &     subpid=\"$!\"          sleep 2     # If the CPU temperature is too high...     kill -STOP \"$subpid\"          sleep 2     # If the CPU temperature has dropped to safe levels...     kill -CONT \"$subpid\"          wait \"$subpid\"      Unfortunately, this didn't work; sending SIGSTOP to the process didn't pause it (as made evident by its continuing to send output to the terminal). I ran `make &` at the command line, sent SIGSTOP, and checked the process status with `ps`; it was listed as stopped (and started again when I sent SIGCONT), but it was still spewing output and driving up my core temperature! Stopping it with Ctrl-Z never had this problem, but I don't know how to do that in a script. What makes Ctrl-Z different from `kill -STOP`, and how can I get the behavior of the former in a shell script?", "How can I install a 64bit Linux virtual machine on a 32bit Linux? I've got a computer (Intel core i5) with 32bit Linux installed (ubuntu 11.04) and I would like to install a 64bit Linux virtual machine on it so I can test 64bit command-line applications on it.", "Predict filename before downloading from a URL, in shell script I have a shell script that downloads files from a list using `wget`, and resumes automatically if there is any non-critical error (because of unstable WIFI during storms). The problem is, I want to write to a `filename.part` file and then remove the .part extension once completed (overwriting and such are handled at that point). This works for simple urls like `http://myserver.org/myfile.doc`, but completely fails to guess a filename like `http://myserver.org/index.php?file_id=foo`. (my method would try to write to `index.php.part` instead of the desired result) I can have wget get the \"final\" filename automatically and write to it, but that won't let me use the `-O` option to save with a different extension, it leaves no control. So my question is, is there any standard way (or tool) to get the \"final\" filename in a download URL so I can write to a file with the same name but an added extension? (using `-O` in wget or `-o` in curl, such as `wget $URL -O \"$URL_GUESSED_FILENAME.part\"`) My tools are either wget or curl, no preference even if I currently use wget. Alternatively, if there's a way to do it in Python, I can accept that too.", "VGA passthrough - Code 43 with KVM and libvirt on all AMD hardware I've set up a system with an R9-270 and an ATI Rage (PCI graphics card, doesn't use radeon driver) on an FX-8320 and an ASRock 970 Extreme3 R2.0 motherboard with the intention of running Debian Wheezy as host and Windows 8.1 Pro as a guest with the R9 passed through to the guest system. I've followed the guide from the Debian Wiki to do this (https://wiki.debian.org/VGAPassthrough) and have reached the end, but when I boot the guest with the card and its audio device attached I get Code 43 in the guest and the card doesn't work. I've also tested passing it through to an Ubuntu guest which also didn't work. Apparently it's fairly common to get code 43 errors, but these are mainly with Nvidia GPUs and the only one I've seen for AMD only showed up when that user moved away from an AMD CPU. The guide does not feature any explanation for troubleshooting Code 43 presumably because the author did not get it. I'm running the VM on KVM and passing the card and its audio device through using virt-manager's Add Hardware dialogue. This software configuration is known to work, as this is the same setup used by the author of the above guide. It seems support for this issue is (understandably) scarce because it isn't commonly used. EDIT: should probably note that I have blacklisted the radeon driver on the host, and that since it's not in the guide and I can't find a good explanation for how exactly it works I am not using the PCI stub driver.", "Why ping an IP is different to ping a website? I've noticed a strange behaviour (at least, I can't get out). **Ping IP** , specifying packet size:               ping -s 128 8.8.8.8       I get:               PING 8.8.8.8 (8.8.8.8) 128(156) bytes of data.     72 bytes from 8.8.8.8: icmp_req=1 ttl=43 (truncated)      **Ping website** , specifying packet size:               ping -s 128 www.google.com      I get:               PING www.google.com (173.194.35.19) 128(156) bytes of data.     136 bytes from mil01s16-in-f19.1e100.net (173.194.35.19): icmp_req=1 ttl=52 time=8.36 ms      So, why pinging pure IP packet size has been truncated? From _Ping_ man, I get: > -s packetsize: Specifies the number of data bytes to be sent. The default is > 56, which translates into 64 ICMP data bytes when combined with the 8 bytes > of ICMP header data."]}, {"query": "What's the command to \"prepend\" a line to a file?", "pos": ["How can I prepend a tag to the beginning of several files? I need to add PHP tags surrounding a file. It's easy to append them using               find . -exec echo \"?>\" >> '{}' \\;      but how can I _prepend_ the tag `<?php`?", "Inserting text at the beginning of a file with sed via the terminal in Linux > **Possible Duplicate:**   >  How can I prepend a tag to the beginning of several files? How do I insert text at the beginning of a file via terminal?"], "neg": ["Linux apache set custom launch page Virtualhosts I set up DNS and virtualhosts on my Linux system but when surfing to ex: www.vb1.be it shows the correct directory (home/vb1/) and their subdirectories. I know this is because the main html file that should be loaded isn't named index.html but homepage.html. So how can I set this homepage.html to launch every time someone surfs to www.vb1.be?               <VirtualHost *:80>         ServerAdmin webmaster@example.com         DocumentRoot /home/vb1.be         ServerName vb1.be         ServerAlias www.vb1.be         ErrorLog logs/vb1.be-error_log         CustomLog logs/vb1.be-access_log common     </VirtualHost>", "Test FTP Username and Password I'm working on a program that involves uploading some files via FTP. However, I'd like to abort the process if the username and password given by the user are incorrect. Is there any way to \"test\" if the pair is correct? Is a utility like _ftp_ or _curl_ able to do that, or should I use some feature (apparently hidden at my eyes) from _libcurl_? Any ideas are really appreciated. Maybe this sound like a question coming from a dummy programmer, but indeed I've never dealt with FTP (or any other protocol) directly. Please consider writing \"you didn't get the point\" or \"you're crazy\" if needed.", "Problem with configure and build php 5.2 on redhat 5 I downloaded php binaries and tried to build the same using following command.               ./configure --with-apxs2=/usr/sbin/apxs --with-mysql      But i'm getting the error related to mysql client library.               checking for MySQL support... yes      checking for specified location of the MySQL UNIX socket... no     checking for MySQL UNIX socket location... /var/lib/mysql/mysql.sock     configure: error: Cannot find MySQL header files under yes.     Note that the MySQL client library is not bundled anymore!      I confirmed that I have mysql client installed.               $ yum list mysql*     Loaded plugins: rhnplugin, security     Installed Packages     MySQL-client-community.x86_64    5.1.48-1.rhel5   installed     MySQL-server-community.x86_64    5.1.48-1.rhel5   installed", "Xen error on CentOS During the creating of a new virtual server in xen using this command               xen-create-image --hostname=minecraft.koanhosting.com --ip 87.98.249.146 --install -method=debootstrap      But I keep getting this error:               Writing inode tables:  0/32^H^H^H^H^H 1/32^H^H^H^H^H 2/32^H^H^H^H^H 3/32^H^H^H^H^H 4/32^H^H^H^H^H 5/32^H^H^H^H^H 6/32^H^H^H^H^H 7/32^H^H^H^H^H 8/32^H^H^H^H^H 9/32^H^H^H^H^H10/32^H^$     Creating journal (32768 blocks): done     Writing superblocks and filesystem accounting information: done          This filesystem will be automatically checked every 28 mounts or     180 days, whichever comes first.  Use tune2fs -c or -i to override.     Done     Installation method: debootstrap          Copying files from host to image.     Copying files from /var/cache/apt/archives -> /tmp/LYC7oAQoxq/var/cache/apt/archives     Done     Done     I: Retrieving Release     E: Failed getting release file http://ftp.us.debian.org/debian/dists/etch/Release          Copying files from new installation to host.     Copying files from /tmp/LYC7oAQoxq/var/cache/apt/archives -> /var/cache/apt/archives     Done     Done     The installation of the new system has failed.          The system is missing the common file: /bin/ls     Done     System installation failed.  Aborting      Can't seem to find any resources on google at all for this error. I have a feeling it's to do with debootstrap, not sure though.", "How to connect to wifi after the installation of Scientific Linux 6.5 I just installed Scientific Linux 6.5, but it seems there is no way to connect to internet. How can I search and connect to wireless internet in my apartment?", "What is the state of open-source Poulsbo/GMA 500 drivers? Currently, a causal browse through a number of Linux distros show spotty Poulsbo drivers at best. Has any headway been made recently towards either convincing Intel to coax the driver source out of PowerVR or an acceptable (I can install it without low frame rates, involved steps and without fear that a kernel update will break it) OSS driver solution? I would love to put Linux on my little Acer netbook but I rely on it too much to install a nerfed driver.", "Extensible filesystems. AIDE vs tripwire In my /etc directory there is something I do with files. Let us say that I am looking at /etc/passwd. What I do when it will be modified is to copy it over, in the following sense. I have a heirarchy of files: passwd, passwd_1,passwd_2,passwd_3 ... passwd_n. Before passwd is modified, I \"rotate\" the files ( similar to logrotate). passwd_n goes to passwd_n+1, passwd_n-1 goes to passwd_n, ... passwd_1 goes to passwd_2, passwd copies to passwd_1. Then I modify passwd. What I would like to do vis a vis a checksum program like tripwire or AIDE is to \"let them know I've rotated and allow them to update the checksums but also check that the rotation has gone smoothly. Do either of there programs provide a way for specifying something like this?", "Why is a drive mounted already at /mnt ? Is this ok? One of my drives is mounted directly as /mnt               $ df -h     Filesystem            Size  Used Avail Use% Mounted on     /dev/xvda1            7.9G  6.9G  597M  93% /     udev                  829M  4.0K  829M   1% /dev     tmpfs                 334M  160K  334M   1% /run     none                  5.0M     0  5.0M   0% /run/lock     none                  834M     0  834M   0% /run/shm     /dev/xvda2            147G  188M  140G   1% /mnt           <--- This one      I thought /mnt is only the \"parent mount points\", and that devices are usually mounted as `/mnt/something` and not as `/mnt` itself. /mnt seems to be working ... I can write to it. Is this situation ok? (This is an Amazon EC2 ubuntu image)"]}], "CQADupstackWebmastersRetrieval": [{"query": "How to Recover Lost Website/ blog data with no backup?", "pos": ["Recovering a lost website with no backup? Unfortunately, our hosting provider experienced 100% data loss, so I've lost all content for two hosted blog websites:   * http://blog.stackoverflow.com   * http://www.codinghorror.com (Yes, yes, I absolutely _should_ have done complete offsite backups. Unfortunately, all my backups were on the server itself. So save the lecture; you're 100% absolutely right, but that doesn't help me at the moment. Let's stay focused on the question here!) I am beginning the slow, painful process of recovering the website from web crawler caches. There are a few automated tools for recovering a website from internet web spider (Yahoo, Bing, Google, etc.) caches, like Warrick, but I had some bad results using this:   * My IP address was quickly banned from Google for using it   * I get lots of 500 and 503 errors and \"waiting 5 minutes\u2026\"   * Ultimately, I can recover the text content faster by hand I've had much better luck by using a list of all blog posts, clicking through to the Google cache and saving each individual file as HTML. While there are a lot of blog posts, there aren't _that_ many, and I figure I deserve some self- flagellation for not having a better backup strategy. Anyway, the important thing is that I've had good luck getting the blog post text this way, and I am definitely able to get the text of the web pages out of the Internet caches. Based on what I've done so far, **I am confident I can recover _all_ the lost blog post text and comments**. However, the _images_ that go with each blog post are proving\u2026more difficult. Any general tips for recovering website pages from Internet caches, and in particular, places to **recover archived images from website pages**? (And, again, please, no backup lectures. You're totally, completely, utterly right! But being right isn't solving my immediate problem\u2026 Unless you have a time machine\u2026)"], "neg": ["How do I optimize SEO for a domain with an \"exotic\" (.st) TLD? What are the gotchas to optimizing SEO for a domain on an exotic TLD (in my case, .st)? For example, should I tell Google the actual geographic target of the website? One more thing: I want to rank well on my domain name concatenated with my TLD (like instagr.am ranking for \"instagram\", for example). Any way I can do that?", "What does this code mean that was placed in my hacked Web site? My website was hacked, with the following code added to the end of the page:               <img heigth=\"1\" width=\"1\" border=\"0\"          src=\"http://imgddd.net/t.php?id=########\">      (The id had an 8 digit number in place of the ########) The link didn't work. Also, the page would crash until I removed the link. What else do I need to be worried about? Why would hackers put such a poor link on a website?", "Resolving a security issue with my private virtual server When I search for \"thelab athome-training\" on Google, and click on a link that point to my site (thelab.athome-training.com), I am redirected to `http://grooogle.osa.pl` I googled and found that post: They said: > The site is doing a conditional redirect when the referrer is Google. So I check .htaccess and index.php, but can't found something. So I replace all the Drupal files with a fresh download, but no change. I also did:               dnstracer -v thelab.athome-training.com      But evrything looks fine... Many questions comes in my mind... How did they do that ? Why ? How to found the infected file ? How to prevent this from happening again? Edit Thank you SkeetOverFlow,               grep -r \"eval(base64_decode\" *      run from the root of my Drupal install, show my that files from the panel module are infected:               eval(base64_decode(\"ZXJyb3JfcmVwb3J0aW5nKDAp ...      In all the templates, many times in each file But the site you link, speak about an issue with php 5.2, and I run php 5.3... Is it possible that PHP 5.3 is also buggy?", "Is it possible to add a facebook 'like' button to a website without the numer of 'likes'? I'm pretty sure this used to be possible, but there doesn't seem to be an option any more. Is there any way to do it?", "Amazon S3 Anti-Hotlinking Technique: Is it bad for SEO? The technique is proposed by Amit Agarwal. He serves an HTML file through Amazon S3 for hotlinked image requests, providing a backlink to his own website. Would this have a negative effect on _image SEO and ranking_?", "Linkpushing for SEO, real or fake? While I was googling today, I noticed this site: http://linkpushing.net/ this ensure you to be pushed at the top of the google research's stack, by creating random reference to your sites on random blogs and/or articles.   I can't believe that Google doesn't do anything against techniques like this, and I would like to know from someone more able than me on SEO subject if it's really possible to tease the google service in this way. And if you suggest to use this tecnique to my site.", "Google analytics - Find what time users entered the site from traffic source The title says it all, I'm trying to find what time each visit came from a particular traffic source. EG if I wanted to find all the times that users visited from Google (Organic) - Can I do this i GA?", "How does Google Analytics consider traffic? Q1)If any automated bot visits my domain will Google Analytics consider it as traffic?   What all factors does the Google Analytics consider to be legit traffic?   Q2)If a user visits xyz.domain.com ,Does Google Analytics consider that it visited domain.com?"]}, {"query": "Google doesn't seem to update the description or title of my homepage", "pos": ["My title tag doesn't appear to be getting crawled by Google properly My title is:               <title>School Management Software, College & University Management Software, Cloud ERP Software</title>      However it's showing up like this in Google: ![enter image description here](http://i.stack.imgur.com/LUIAm.jpg) Is there something I'm doing wrong here? Any insight would be really helpful.", "Title in Google does not match <title> of document One of my project's title tag doesn't appear to be getting crawled by Google properly. The title tag of the home page reads:               <title>Grande Prairie Jobs | Job Board for Grande Prairie, Alberta and Area</title>      Google, on the other hand, indexes the title as `gpjobs.ca`. ![Screenshot](http://i.stack.imgur.com/lze8q.png) Is there something I'm doing wrong here? Any insight would be really helpful. One thing, the first of the document is `gpjobs`. Could this be causing the incorrect title? I guess I just don't understand why Google would index it with the `<h1>` rather than the `<title>`. **Edit:** To clarify for whoever marked this question as a duplicate of this one, my site actually had a landing page where Google indexed it correctly. After launching the site and submitting a sitemap, Google has indexed the title as above. What I'm trying to establish and correct, is why the site has an indexed title of the first `h1` on the page and not the `title`. I expected the `title` to be picked up.", "Why isn't google updating my description of my website? > **Possible Duplicate:**   >  Google doesn't seem to update the description or title of my homepage I had created a website,hosted it on godaddy.com. I edited it recently .(fetched and uploaded files using FileZilla) I put a description on each page using meta tags. It has been more than 3 days since I did that. When I google for my website name , the first result that shows is my website name. But the description under it still hasn't been updated. Why not?", "How can I get Google to update my sites description? > **Possible Duplicate:**   >  Google doesn't seem to update the description or title of my homepage Here is a screenshot: ![enter image description here](http://i.stack.imgur.com/CXSwD.jpg) The site description shown is very old, from way back in January of this year. Yet the image shown is current. How can I ask Google to update my sites description?", "Why google isn't updating my site title in search results? > **Possible Duplicate:**   >  Google doesn't seem to update the description or title of my homepage I had my domain for few days before I uploaded site to it, and it had one title, and then when I uploaded content it should get new title, but with my misunderstanding of WordPress it had blocked robots.txt and keyword with **no- index** and **no-follow**. But I removed that like 7 days ago, and I see in reports that Google bot is crawling over my site, but my site title isn't updating, it still has old domain title when site wasn't there... My robots.txt has now:               User-agent: *     Allow: /      I have clear title tag on every page. How long does it take to update? Do I need to check something else?"], "neg": ["How to receive a mail on new orders? When a customer makes a new order he receives a couple of confirmation mails, but I (as shop administrator) don't receive any. How can I make prestashop to send me a new mail when customers make new orders?", "Should a website be directly accessible by its IP address? I found that many websites display their site content only when you access them by their FQDN (example, `example.com`). When trying to access by their IP address, they show a 404 site not found error. Are there good reasons why site owners would not want their websites to be directly accessible by IP address instead of going through the DNS? What are the pros and cons of making direct IP access available for your website?", "How do I normalise a URL from a folder to a subdomain? I have a mybb forum hosted at a folder inside my site, which can also be accessed via a subdomain. I would like to configure it so that if someone would enter the folder it would automatically be redirected to the subdomain: http://www.antinovaordemmundial.com/mybb/ to http://forum.antinovaordemmundial.com Once you enter in the forum using the folder URL, any other link will automaticaly redirect to the subdomain, with the exception of the main page ( http://forum.antinovaordemmundial.com ) My htaccess is as follows:                # Make this rule the first rewrite rule in your .htaccess!       #RewriteRule ^([^&]*)&(.*)$ http://forum.antinovaordemmundial.com/$1?$2 [L,QSA,R=301      RewriteRule ^forum-([0-9]+)\\.html$ forumdisplay.php?fid=$1 [L,QSA]      RewriteRule ^forum-([0-9]+)-page-([0-9]+)\\.html$ forumdisplay.php?fid=$1&page=$2 [L,QSA]      RewriteRule ^thread-([0-9]+)\\.html$ showthread.php?tid=$1 [L,QSA]      RewriteRule ^thread-([0-9]+)-page-([0-9]+)\\.html$ showthread.php?tid=$1&page=$2 [L,QSA]      RewriteRule ^thread-([0-9]+)-lastpost\\.html$ showthread.php?tid=$1&action=lastpost [L,QSA]      RewriteRule ^thread-([0-9]+)-nextnewest\\.html$ showthread.php?tid=$1&action=nextnewest [L,QSA]      RewriteRule ^thread-([0-9]+)-nextoldest\\.html$ showthread.php?tid=$1&action=nextoldest [L,QSA]      RewriteRule ^thread-([0-9]+)-newpost\\.html$ showthread.php?tid=$1&action=newpost [L,QSA]      RewriteRule ^thread-([0-9]+)-post-([0-9]+)\\.html$ showthread.php?tid=$1&pid=$2 [L,QSA]      RewriteRule ^post-([0-9]+)\\.html$ showthread.php?pid=$1 [L,QSA]      RewriteRule ^announcement-([0-9]+)\\.html$ announcements.php?aid=$1 [L,QSA]      RewriteRule ^user-([0-9]+)\\.html$ member.php?action=profile&uid=$1 [L,QSA]      RewriteRule ^calendar-([0-9]+)\\.html$ calendar.php?calendar=$1 [L,QSA]      RewriteRule ^calendar-([0-9]+)-year-([0-9]+)\\.html$ calendar.php?action=yearview&calendar=$1&year=$2 [L,QSA]      RewriteRule ^calendar-([0-9]+)-year-([0-9]+)-month-([0-9]+)\\.html$ calendar.php?calendar=$1&year=$2&month=$3 [L,QSA]      RewriteRule ^calendar-([0-9]+)-year-([0-9]+)-month-([0-9]+)-day-([0-9]+)\\.html$ calendar.php?action=dayview&calendar=$1&year=$2&month=$3&day=$4 [L,QSA]      RewriteRule ^calendar-([0-9]+)-week-(n?[0-9]+)\\.html$ calendar.php?action=weekview&calendar=$1&week=$2 [L,QSA]      RewriteRule ^event-([0-9]+)\\.html$ calendar.php?action=event&eid=$1 [L,QSA]          RewriteRule ^([^&]*)&(.*)$ http://forum.antinovaordemmundial.com/$1?$2 [L,QSA,R=301]          RewriteRule ^sitemap-([^./]+)\\.xml$ misc.php?google_seo_sitemap=$1 [L,QSA,NC]          RewriteRule ^Forum-([^./]+)$ forumdisplay.php?google_seo_forum=$1 [L,QSA,NC]          RewriteRule ^Topico-([^./]+)$ showthread.php?google_seo_thread=$1 [L,QSA,NC]          RewriteRule ^Anuncio-([^./]+)$ announcements.php?google_seo_announcement=$1 [L,QSA,NC]          RewriteRule ^Usuario-([^./]+)$ member.php?action=profile&google_seo_user=$1 [L,QSA,NC]          RewriteRule ^Calendario-([^./]+)$ calendar.php?google_seo_calendar=$1 [L,QSA,NC]          RewriteRule ^Evento-([^./]+)$ calendar.php?action=event&google_seo_event=$1 [L,QSA,NC]          ErrorDocument 404 /misc.php?google_seo_error=404      <IfModule mod_env.c>       SetEnv SEO_SUPPORT 1      </IfModule>     </IfModule>", "Wrong canonicalization by Google I had 2 pages with mostly same text and the difference being in Flash and cities names. So, Google started to think that those were copies of the same page and to index only the most popular of them. So I changed texts. No result. I used this http://www.google.com/addurl/ and Google still crawled only the most popular page. What do I have to do to convince Google that those are different pages? So far only changing urls comes to my mind.", "Prohibit search engines before going live I want to prohibit search engines to index my web site before going live with it.   If I simple do a `robots.txt` with:               User-agent: *     Disallow: /      Would that cause any issues later when I decide to release it for public exposure? (I would of course edit it to allow access before doing so)", "How do I prevent access to SPAM URLs and remove them from Google's index? When I started managing my friends' website, I had found a folder in it with a bunch of garbage HTML files with names such as: `free-nasscamd-server-31day`, `gorilla-quentin-trollip-pdf`, etc... Assuming someone had hacked those files in there, I had deleted that folder and all those HTML files in it, and checked everywhere else to make sure there wasn't anything else lingering. Two months later, I am still finding in my access logs there are garbage URLs still trying to be accessed somehow, although they return `404` errors now since the pages don't exist. And when I go into Google and type `site:{url}`, it displays a bunch of garbage URLs as well, such as: `{url}/pitchet-program-samsung-wave2/`, `{url}/rogue-pirates-of-the-caribbean-themes-nokia-x3torrent/`, etc...   1. How do I prevent the attempted access to those URLs?   2. How do I remove those garbage URLs from Google?", "SEO: Firefox addon/plugin to see Google results with a position number? Do you know a Firefox addon that adds postion number to Google/Yahoo results. When I do SEO report for www.some-site.com by keyphrase \"some-keyphrase\" I usually show results in blocks of 100 results per page. Then uisng browser find box I search for \"some-site.com\", if found in page I see its position, but **I have to count by hand the number of results before (or after) it to know the exact position number**. It would be handful a simple addon that adds a number positioning before each result like:               1. Result blah blah     Snippet...     url          2. Result blah blah     Snippet...     url          etc.", "How can I optimize a business site to rank well in local search for multiple cities? I live in an area where there are two cities of 60-90k people adjacent to each other. Due to Google's apparent emphasis on physical location of a business when it comes to SERPs for local queries, it can be difficult for a business to rank for searches which include the neighboring city's name (going both ways, although it seems that searches including one of the city's names are quite a bit more common than the other). How can a business effectively rank well for queries including either city name, when said business operates in both cities but only has an office in one location?"]}, {"query": "Redirection transparent to Google and other SE", "pos": ["How do I map a (keyword rich) domain name to an existing website? I am not experienced technical person, and still learning but will try to explain what I have done so far and what my query is. I have a (hypothetical) domain az-studios.com On that domain I have 3 subdomains: **london.az-studios.com** **newyork.az-studios.com** **paris.az-studios.com** Each of them have 301 header redirections as follows: **london.az-studios.com** -> **www.az-studios.com/london** **newyork.az-studios.com** -> **www.az-studios.com/newyork** **paris.az-studios.com** -> **www.az-studios.com/paris** So I can maintain only one unique HTML document (that appears to be three different paths) I have setup .htaccess to use MOD_REWRITE as follows: **www.az-studios.com/london** -> **www.az-studios.com?city=london** **www.az-studios.com/newyork** -> **www.az-studios.com?city=newyork** **www.az-studios.com/paris** -> **www.az-studios.com?city=paris** This is so far the existing structure. I have recently purchased three (hypothetical) keyword rich domains: **movie-studio-london.com** **movie-studio-newyork.com** **movie-studio-paris.com** What I would like to achieve is to have these three domains pointing as following: **www.movie-studio-london.com** -> **www.az-studios.com?city=london** **www.movie-studio-newyork.com** -> **www.az-studios.com?city=newyork** **www.movie-studio-paris.com** -> **www.az-studios.com?city=paris** The only tricky thing I can't figure out is how I do that so that from a Google SEO point of view, it does not use 301 redirects, no frame. I would like **www.movie-studio-london.com** to show to visitors (and especially Google bots) as a standard website (with no funny JavaScript, links, 301 redirect, frames etc). Some of you might scream \"duplicate content\" but the websites, although using the same index.php are _very_ different. I am also aware that this could be seen as doorway but these new purchased domains really define (with keywords) my products and what the different websites are about. Any idea? Any more details, please ask... Thanks Vincent"], "neg": ["What's the most reliable FREE web hosting for WordPress blogging? > **Possible Duplicate:**   >  How to find web hosting that meets my requirements? I'd like to hear the opinion of those who have been using such a service for at least half year or more. I have my own registered .com.ar domain. It would be great if it is ad-free also. Thanks in advance for your sharing your experience.", "Common Header & Footer for HTML Site I'm about to re-work an old HTML-based site and would like to separate out the header and footer of the content into separate files as they'll be common to all pages. The current site author just copied their index.html page and replaced the body text for each subsequent page, making changes to the menu and such a huge maintenance pain. I could go the Server Side Includes (SSI) route and include a header file and a footer file into each page to strip out the common content, but that would require that I rename all files with the *.shtml extension right? Any other options for doing the header & footer file inclusion without modifying the existing extensions (no dynamic content in the site, so going php or asp etc is not warranted). (note: running IIS 7.5 as the web server)", "Nesting micro-data vs Independent Items I've been reading about micro-data and it's implementation, however the examples are quite simple and I'm yet to find a website that thoroughly implements structured data throughout the entire site. So as I was implementing the markup I started to dig up questions on how would be the best way to do this. One of the main dilemmas I'm facing is whether it's best to create independent items (schema.org items) or rather create an item that represents the page with all it's content as nested items that belong to that parent item. So I could have markup that would reflect the following:               - Company     - Product     - Offers     - Article      Or it could be something like this:               -Company         - Product             - Article         - Offers      Where the indentation reflects it's nesting (for this question I didn't bother to figure out if this is actually doable for these item types, it's just a generic pseudo-example). So basically I'm just not sure how a search engine would use this information, because if I nest it, the page would contain a single item with various properties (that would be items themselves) but I'm unaware as to how these examples would be treated and which would be the pros and cons of each solution. Any pointers, documentation or experience on the subject are welcome and much appreciated.", "301 redirect bulk aspx URLs on IIS We recently relaunched an old ASPX site as a new Drupal site on the same domain. No 301 redirect was implemented. I have outputted a list of 1000 URLs that need to be 301 redirected. Most of the URLs are the results of search queries that were committed on the website. I.E.:               http://www.mysite.com/electronics/CommunityDetails.aspx?FirstLetter=%&ID=444      We are running a Drupal site on IIS using a PHP plugin. Is there a way I can wild card a redirect of all ASPX pages? I know I can do it with _.htaccess_ but that doesn't apply here. Any suggestions appreciated.", "How To Get Data From Another Website? How would I be able to get data from another website and put it on my own website? Website A has profiles of users along with other stuff. I want to be able to get the data of the user and incorporate it in my site.", "What is the most effective way to obtain SEO benefits from content while still protecting most of it behind a paywall? I'd like for search engines to recognize the content that is hosted on my website, but I'd also like to protect most of it behind a paywall. Are there any proven strategies for doing this?", "Do Sell-Side Platforms (SSP) like Admeld or PubMatic cover premium ad inventory selling for publishers? Large companies may/may not hire a sales force to sell premium ads. But, for medium or small websites, how do they handle the premium ad inventory with maximum values? What are all available paths to sell their ads?", "Moving article (Deleting the original) to another blog - SEO MISTAKE? I'm trying to move an article to another blog, I already deleted the one from my blog and gave it to the other blogger, however, it is still indexed in Google, but if someone click it, he'll see a 404 error. Now the other blogger is worried about his web site being penalyzed if he publish the article. Thx in advance Ps: There is no way of making a 301 permanent redirect, because the original page no longer exists."]}, {"query": "Managing Client's Hosting and Domain Services", "pos": ["Hosting and domain registrations for multiple clients under a single hosting account of mine? I am finally getting regular work designing, developing, and deploying websites for small businesses and individuals. So far the websites utilize single-user content management systems, so the websites create, as far as I know, minimal load on the shared servers. I have always required that each of my clients purchase annual shared hosting at Dreamhost. For domain registration, I ask that they register with Dreamhost, but some already have a registered domain elsewhere and this is fine with me. I do this so the billing issues are the client's responsibility, not mine. **My question is** : Since I can register unlimited domains and connect them to my one shared hosting account at Dreamhost, should I not be requiring clients to individually pay for shared hosting and a domain? Should I actually be paying for one hosting account and then hosting all of my client's websites on that account? As I said before, I currently have each client buy their own hosting, because I feel that, for example, if there is high traffic to their site, there would be less a chance of the site going down than if their site was hosted with many others on one account. I am famous for being long-winded, please let me know if I can clarify at all. Thanks!"], "neg": ["Will a site URL with repeating keywords get penalized by search engines? I have an URL structure like the following: > sitename.com/ **cellphone** / **nokia** /galaxy-5678- **nokia** - > **cellphone** -from-abc/ For more example: > sitename.com/ **cellphone** / **motorolla** /new- **motorolla** -gta800- > **cellphone** -from-zxy/ The directory structure is like the cellphone is the main directory of the module and the words like Motorolla and Nokia are subdirectories which are categories and then comes the title of the cellphone. Here the word cellphone and Nokia in the first link and cellphone and Motorolla in the second link are repeated. **Is it any kind of keyword stuffing? will it be penalized by Google?**", "Does Google offer reporting on use of the \"Block all ... results\" feature? Does Google offer a way to report on how many people actually blocked results from my site from showing up in their results? This question describes the behavior I'm asking about. I understand _why_ its there, I want to know if I can get a report on it.", "Can I put my public_html folder under source control? This would allow me to update the folder in one click when I test the code on my development system. Is it possible and is it a good idea?", "What's the practical difference between dedicated and virtual private servers? I understand the physical differences but in a practical sense, what will be the differences? Speed? I understand that I have full control over a virtual private server in a software aspect as with dedicated servers - what then is the difference from my point of view? Surely VPS's are easier to upgrade. Why are they always so much cheaper for the same specs?", "SEO in what element text should be placed? I am making my web better for SEO and I came up with question:   in what element text should be placed?               <p></p>     <span></span>     <div></div>      I know that I should use each of them in different situations but I dont know in which situations... **EDIT:**   Example of 2 situations/doubts I encountered", "How to add iframe to vbulletin? I want users to be able to embed to iframe videos, no matter from which site. Currently when you do that, the system seems to strip the iframe. I am wondering how to enable posting iframe. I also I'd like to know whether there are any risks in embeding iframes that justified limiting the ability to certain user groups. Thanks", "Adding SPF records in GoDaddy I have the GoDaddy hosting and send mail using the following code:                $to = \"demomail@gmail.com\";      $subject = \"Test mail\";      $message = \"Hello! This is a simple email message.\";      $from = \"info@brightmeup.com\";      $headers = \"From:\" . $from;      mail($to,$subject,$message,$headers);      echo \"Mail Sent.\";      When the mail arrives at its destination I see the following (in red outline) > ![enter image description here](http://i.stack.imgur.com/j6J7d.png) I don't want to show the \"via server\" and for that there is an option to add a SPF record. To do this I have followed the instructions in this page: > Managing DNS for Your Domain Names but it's not working. After that i have tried: `v=spf1 include:_spf.google.com ~all` as described in http://support.google.com/a/bin/answer.py?hl=en&answer=178723 but I still get the same result. How can I solve this and prevent \"via server\" showing?", "How Can I Host My Website On My Own Computer? I currently developed a new website. The website is plain html. How can I host this website on my own computer. My computer is always connected to the Internet. How can I host my website on my computer and give it a domain name which will be known to everyone outside using the Internet?"]}, {"query": "What are some good resources for generating privacy policies and terms of use?", "pos": ["Who do I turn to for the Terms of Service and Privacy Policy? Are the Terms of Service and Privacy Policy for a web site something I can write up on my own, or do I need to turn to a lawyer or some other professional to do these? Who are the guys who do the Terms of Service and Privacy Policy for web sites? How does one go about doing this, and how much does it cost (in the US)?"], "neg": ["Alternatives to PHP We are starting a project, which goal is to create new frontend interface to our product. Old version was created in PHP, very poorly written. We are choosing the language and frameworks that we want to use in new version. Requirements:   1. New interface will be communicating with API. Application will not have it's own database.    2. We don't have a big team, 3 max programmers for entire project.   3. The main programmers are PHP veterans and knows some other technologies (Rails, C, C++, some Java) but not in professional level. But overall they are good and experienced programmers. So:   1. We want to find a good alternative to PHP. I like Rails very much, but whole ActiveRecord model will be useless, when using application API.   2. Java needs a lot of configuration and someone who is expert in Java to properly run this project. Also, in Java there are a lot of big and complicated enterprise frameworks - not very good for 2-3 programmers team.   3. Python - I don't know Python and don't know good and experienced programmers who knows PY - but it's not so complicated and big as Java and maybe in long period it's good alternative for PHP.  What are your thoughts?", "My readers don't have Digg or StumbleUpon, how can I ask them for help raising my SERP? I have a coupons-code web _page_ that receives 40,000 unique visitors a month, but its numbers are stagnant or dropping because it is #3 in Google's SERP. 75% of its visits are new and the page has been around since 2007. I sincerely think my resource is helping people and I sincerely think I am loads better than #1 and #2 because I have the freshest coupons and I have no ads -- so I am at my wit's end on how to raise my SERP. The rest of the sites in #4, #5, etc., are huge coupon broker sites so I really have no chance pursuing link exchanges. Meanwhile, the site in #1 and #2 is also a small guy who also have been around since 2007. None of them update their coupons page near as often as I do. (The #1 guy updates once a month. :( ) My readers do not use Digg, StumbleUpon or Twitter, or have blogs of their own. I tried Facebook's Like button and tweet reader comments via bit.ly but got no SERP improvement. How can a site ask readers help to raise its SERP? Or any suggestions?", "How to deal with overly aggressive \"Link Take Down Demands\"? I've been receiving a large number of emails recently requesting I clean from link spam from my forum. Initially the emails were very polite and professional, and I was happy to remove the links. Recently the email have gotten very abrasive, here is a particularly rude example: > From: dmcaviolations@company-one.com To: id@privacypost.com > > Hi, This is the second time we are reaching out to you regarding your link > to our site hxxp://www.company-two.com from hxxp://www.my-forum.com/some- > topic-id. We really do need to remove this link. We have to report to Google > any link we were unable to remove, and I wouldn't want to have to include > your site in the list. Could you please remove our link from this page and > any other page on your site? Thank You, Name Changed Behind the superficial pleasantries I feel there is some very real maliciousness.   * Note the email address, DMCA Violations, I don't see how the DMCA is involved here, except as a word which tends to strike fear in many people.   * Also relating to the email address, it doesn't match the company being linked to at all. How am I to trust they are truely operating on behalf of company-two when they don't even use one of it's email addresses.   * My email is hidden by privacypost. While a service with legitimate uses, I feel it's highly unprofessional for communications between to companies.   * The claim \"This is the second time...\" Every email I've received has started like this, but a check of my spam filters has never revealed a 1st mail. Initially I gave them the benefit of the doubt, by now though it's clear this is a cheap ploy to start me off on the defensive.   * And finally worst of all- the threats of reporting me to Google if I don't do everything they ask. I sent a polite reply asking for more information. I have no idea if the email address was even valid but I never received any response. Much later I got this followup mail > From: name-changed@company-one.com To: id@privacypost.com > > Hi, This is the final time we are reaching out to you regarding your link to > our site hxxp://www.company-two.com from hxxp://www.my-forum.com/some-topic- > id. We will soon be reporting to Google any link we were unable to remove, > and currently your site will have to be on the list. Could you please remove > our link from this page and any other page on your site? I appreciate your > urgent attention to this matter. Thank You, Name Changed This time the from address was more personal, though still not obviously connected to the spammed company. Lets be honest, I don't for one second believe that the companies were the victim of a 3rd party spammer as they claim. The links in questions were generated well over a year ago, and I firmly believe the companies were directly responsible for the spam links in question, a type of spam that has plagued my forum. Now they have the audacity to demand I spend my time cleaning up their mess, using threats to ensure they get their way. Have recent changes in Googles algorithms meant all the cash they spent spamming the web has now turned into a liability? If so I can see why these companies are all of a sudden running scared. Frankly, cleaning up my forum is a good things, but the threats they are using sickens me. So my question here is specifically about the threats:   1. Are they vaild, and would such reports to Google destroy my page rankings?    2. Is there a way I can report this abusive behaviour to Google?", "Are CSS sprites bad for SEO? Nowadays often what was accomplished with an `<img>` tag is now done with something like a `<div>` with a CSS background image set using a CSS 'sprite' and an offset. I was wondering what kind of an effect his has on SEO, as effectively we lose the `alt` attribute (which is indexed by Google), and are stuck with the 'title' attribute (which as far as I understand is not indexed). Is this a significant disadvantage?", "My domain emails are marked as SPAM in Gmail? How to solve this issue? At Pro Webmasters I searched for an issue which relates to spammed domain list for sending emails which end up in the Spam box in Gmail. I found the link something like below: how-could-i-prevent-my-mail-from-being-recognized-as-spam which says the reasons for the domain being listed as spam and I hardly found any solutions to come out that problem for the domain which was affected. In my scenario the mails from my domain from the last few days are landing in SPAM box in Google whereas the rest like Yahoo/MSN/Rediff are OK. Even the plain text emails are going to SPAM Which is something of a surprise to me. I tried to find out the solutions overcome this problem but nobody gives exact steps to follow to solve this issue. I request fellow members not to close this as duplicate, if you read my problem you can understand that this thread is all about steps to solve the issue of SPAM not the reasons. If you find similar questions please let me know or else try to answer my question.", "How do I copyright my website? My website has been in development for a long time and cost a lot of money. How do I go about securing an enforceable copyright on my website design and what is the proper way to post a copyright notice on the site so others know the work is copyrighted?", "What is the reason for this site's sudden drop in traffic? My one site's traffic has dropped in single day from around 4000 to 800 visitors. My other sites are getting normal visitor count. I'm not using any blackhat techniques nor trading links or having a bad neighbourhood or any copied materies. But yes it's a pdf documents download site with bounce rate of 32% and 3.5 pageviews per person. No issues reported in Google webmastertools. I find that for the relevant keywords my site has been pushed far way in Google. What could be the reason? **EDIT** I've uploaded two updated reports( webmaster top keywords and analytics 1 month graph). ![google analytics 1 month graph till yesterday\\)28th\\)](http://i.stack.imgur.com/fwmLw.jpg) * * * * * * ![Today's updated webmaster's top queries report from 22nd-26th\\(Monday\\)](http://i.stack.imgur.com/tg1Qs.jpg)", "Free JSP/Spring MVC Web Hosting Site > **Possible Duplicate:**   >  How to find web hosting that meets my requirements? I am thinking of hosting a small web application built using Spring MVC. Does anybody know any free web hosting sites that supports JDBC also? I haven't tried web hosting site so I would like to know one site which sites are free and ok. My app wont take so much disk space and would like to know if there are sites that runs on Tomcat. Thanks."]}], "CQADupstackWordpressRetrieval": [{"query": "How do I enqueue styles/scripts on certain /wp-admin pages?", "pos": ["How to include css for plugin setting page? I have created a plugin settings page in the WordPress dashboard menu. I want to include css file for that settings page. How can I do that? I am trying following in my plugin, but it does not include the css file on the plugins settings page:               function my_enqueue_styles() {         wp_enqueue_style( 'my_plugin', plugins_url('my_plugin/plugin.css') );     }     add_action( 'wp_enqueue_scripts', 'my_enqueue_styles' );"], "neg": ["Does anyone know what's the plugin for this Comment Section? http://twentyelevendemo.wordpress.com/readability-test/ The default Twenty Elevn Theme's shwocase site has a nice comments section (see link above) that allows user to connect to other services for authentications (like twitter) to comment. It's nice in a way that it doesn't seems to relay on other third party plugin like Disqus to manage my site's comment. Anyone know what's this plugin is called ? The default Twenty Eleven has a different comment section (layout and method to comment). I'm looking for the one from the showcase site, can't find any info regarding the comment section. Thanks !", "Help with Wordpress function inside a shortcode I'm trying to spice up a theme of mine with some shortcode buttons but I'm having quite a bit of trouble when trying to call the author's name within the button itself. I tried simply including               <?php echo do_shortcode('[button type=\"square\" color=\"black\" size=\"small\"] Posted by <?php the_author(); ?> [/button]'); ?>      in the theme where I want the button with the author's name to appear, but it just gives a button that says 'Posted by '. I'm not the most experienced coder, but I know a little bit of everything from tinkering with various themes over the years. All help is appreciated, thanks in advance! -Matt", "Saving Meta Data within Custom Post Type I cannot figure out why these functions aren't saving the data for price and location while saving startdate and starttime. When I do print_r($custom) - I can see that [events_price] => Array ( [0] => ) is blank..                function event_detail_box_content( $post ) {         $custom = get_post_custom($post->ID);         $meta_sd = $custom[\"events_startdate\"][0];         $meta_pr = $custom[\"events_price\"][0];         $meta_lo = $custom[\"events_location\"][0];              $meta_st = $meta_sd;              $time_format = get_option('time_format');              if ($meta_sd == null) { $meta_sd = time(); $meta_st = 0;}              $clean_sd = date(\"D, M d, Y\", $meta_sd);         $clean_st = date($time_format, $meta_st);              echo '<input type=\"hidden\" name=\"events-nonce\" id=\"events-nonce\" value=\"' . wp_create_nonce( 'events-nonce' ) . '\" />';              ?>         <div class=\"tf-meta\">         <ul>             <li><label>Event Date</label><input name=\"events_startdate\" class=\"tfdate\" value=\"<?php echo $clean_sd; ?>\" /></li>             <li><label>Event Time</label><input name=\"events_starttime\" value=\"<?php echo $clean_st; ?>\" /><em>Use 24h format (7pm = 19:00)</em></li>             <li><label>Event Price</label><input name=\"events_price\" value=\"<?php echo $meta_pr; ?>\" /></li>             <li><label>Event Location</label><input name=\"events_location\" value=\"<?php echo $meta_lo; ?>\" /></li>         </ul>         </div>         <?php         print_r($custom);      }             add_action ('save_post', 'save_events');             function save_events($post_id){              if ( !wp_verify_nonce( $_POST['events-nonce'], 'events-nonce' )) { return; }              if ( !current_user_can( 'edit_post')) return;              if(!isset($_POST[\"events_startdate\"])): return; endif;              $updatestartd = strtotime ( $_POST[\"events_startdate\"] . $_POST[\"events_starttime\"] );         update_post_meta($post_id, \"events_startdate\", $updatestartd );               update_post_meta($post_id, \"events_price\", $POST[\"events_price\"] );          update_post_meta($post_id, \"events_location\", $POST[\"events_location\"] );       }", "Problem uploading files, after changing domain name I just changed my WordPress website domain name (on the same server). Everything works fine, and the paths are correct. I can install plugins and updates without any problem. However, I can only upload media when the `wp-content` directory's permissions is set to 777. When I get it back to 755 I get an error that the file couldn't be copied to the folder. What could cause this problem?", "Hiding posts - WP Hide Post not working I frequently publish posts that I need to be hidden. They need to be published, so that someone who has their url can go to them, but I don't want them showing up on my homepage, in my recent posts widget, on my blog page, in my categories etc. I know I can normally use the WP Hide Post plugin for this, but somehow that isn't working for my site. When I create a new post and choose all the hide options WP Hide Post offers, the post still shows up on my blog page (which isn't my homepage). I've looked around here and found some similar topics to hide posts using code, but only to hide posts from one location, for example from the recent posts widget or from the homepage or from... I'm searching for a way to hide them from practically everywhere without having to add several lines of code each time I publish a post that needs to be hidden. Would really appreciate it if someone could help me. Bummed that the WP Hide Post plugin doesn't work for me:/ Thanks! PS I'm know publishing those posts as pages using WP Hide Post to hide the pages, this works, but it clutters up my pages list.", "Pluging with content for a specific page or post I'm new to writing WordPress plugins, and I'm running into a snag. A lot of what I've seen is about using actions or filters to manipulate or add content at specific global areas (all posts, on post, etc). What I'm looking for is how to create content for a specific page. I haven't seen any tutorials that cover this. Take, for instance, Contact Form 7 - you copy a specific string into a page body, and it triggers the content. Are they just replacing the content using a filter? I want to make sure there isn't an easier way to tackle this.", "Stop WordPress from showing images on non post pages With regards to how WP displays \"preview\" text on the home page, category page etc for each post, how do you stop it from including images in this section. I'm not talking about the featured image for each post, I'm talking about if the post has any included images within the post - I don't want them to show up in the preview text. This is the code that outputs the content for example..               <?php the_content( __( 'Continue reading <span class=\"meta-nav\">&rarr;</span>', 'twentyeleven' ) ); ?>", "How to update post's featured image in front-end I created a new template page with code to allow front-end posting. Everything works great, with tags, post meta and image uploading (as featured image). I have seen many codes about front-end post editing, but even though I tried to figure it out I can not successfully make it to work. I took as example this How can I edit a post from the frontend? and placed it in single.php with no luck. I guess the right way to have it, is to have an EDIT link below the post and there will be appear a new php template that contains the edit form when it is clicked. Is this correct? Secondly, how can I update the featured image I added from the front-end ? Thank you for your help."]}, {"query": "How to make this change without changing the core?", "pos": ["Edit tag cloud widget number By default, the _WordPress_ tag cloud widget has a set amount of 45 tags to display. This can be seen in the `wp-includes/category-template.php` file. By default, the _WooCommerce_ plugin which I have installed, and it's products tag cloud widget also resembles this. How do I modify this amount from within my `wp-content/themes/functions.php` file, to display for example, only 15 product tags? Here is what I have so far, but it is not working.               function custom_tag_cloud_widget($args) {         $args['smallest'] = 8; //smallest tag         $args['largest'] = 22; //largest tag         $args['number'] = 15; //adding a 0 will display all tags         $args['unit'] = 'pt'; //tag font unit         return $args;     }          add_filter( 'widget_tag_cloud_args', 'custom_tag_cloud_widget' );      When changing the number within the core `wp-includes.php/category- template.php` file to 15 however, it does work. Obviously, I don't wish to edit any core files and am looking for an alternative solution. Thanks."], "neg": ["Meta box not displaying properly I am creating a plugin that will display list of a few posts at the bottom of each post. I created a meta box which content will be displaying with the each list of posts. Problem is, if I give content in a specific post meta box, I find that metabox content is only displaying if I go that specific post, but if I go to other posts, meta box content is not displaying with the list of posts which are at the bottom. Also, as I have given content to a specific post meta box, its supposed to display with that post but the content showing with all the list of posts. Here is the codes I am using               /**      * Adds a meta box to the post editing screen     */     function prfx_custom_meta() {         add_meta_box( 'prfx_meta', __( 'Meta Box Title', 'prfx-textdomain'),'prfx_meta_callback', 'post' );     }     add_action( 'add_meta_boxes', 'prfx_custom_meta' );     /**      * Outputs the content of the meta box      */     function prfx_meta_callback( $post ) {         wp_nonce_field( basename( __FILE__ ), 'prfx_nonce' );         $prfx_stored_meta = get_post_meta( $post->ID );         ?>         <p>             <label for=\"meta-text\" class=\"prfx-row-title\"><?php _e( 'Example Text Input', 'prfx-textdomain' )?></label>             <input type=\"text\" name=\"meta-text\" id=\"meta-text\" value=\"<?php if ( isset ( $prfx_stored_meta['meta-text'] ) ) echo $prfx_stored_meta['meta-text'][0]; ?>\" />         </p>         <?php     }     /**      * Saves the custom meta input      */     function prfx_meta_save( $post_id ) {          $is_autosave = wp_is_post_autosave( $post_id );         $is_revision = wp_is_post_revision( $post_id );         $is_valid_nonce = ( isset( $_POST[ 'prfx_nonce' ] ) && wp_verify_nonce( $_POST[ 'prfx_nonce' ], basename( __FILE__ ) ) ) ? 'true' : 'false';              if ( $is_autosave || $is_revision || !$is_valid_nonce ) {             return;         }              if( isset( $_POST[ 'meta-text' ] ) ) {             update_post_meta( $post_id, 'meta-text', sanitize_text_field( $_POST[ 'meta-text' ] ) );         }     }     add_action( 'save_post', 'prfx_meta_save' );     /**      * Loads the image management javascript      */     function prfx_image_enqueue() {         global $typenow;         if( $typenow == 'post' ) {             wp_enqueue_media();             wp_register_script( 'meta-box-image', plugin_dir_url( __FILE__ ) . 'my-admin.js', array( 'jquery' ) );             wp_enqueue_script( 'meta-box-image' );         }     }     add_action( 'admin_enqueue_scripts', 'prfx_image_enqueue' );", "Taxonomy count per Post type Below is the code i use to output the post tag (taxonomy) count/number. I want to be able to split the count based on post type that the taxonomy features in (rather than the total number). So i have the default \"post\" Post type, aswell as \"blogs\", & \"pics\". I want the taxonomy count to display something like: x posts | x blogs | x Pics                           <?php                 $tags = get_tags( array('name__like' => \"a\", 'order' => 'ASC') );                 foreach ( (array) $tags as $tag ) { ?>                     <li>                                                     <a href=\"<?php echo get_tag_link( $tag->term_id ) ?>\">                                       <span class=\"name\"><?php echo $tag->name ?></span>                             <span class=\"number\"><?php echo $tag->count ?></span>                         </a>                     </li>                 <?php } ?>", "Using shortcodes to communicate my page design I came across this page http://flare.bringthepixel.com/pages/services/ and on it there is this message: \"The entire code of this sample page is available in the Shortcode Generator\". Lets say i gave someone this theme and wanted to produce his/her own page look just like the one shown without inserting one shortcode after another.Can shortcodes be used to make one big page \"template\" such that with one insertion of shortcode,the design in the services page shall be inserted and the user shall only swap the dummy content for his/her own?.", "Switch from Beta to Stable workaround So, I am currently running the WordPress 3.5-beta2-22265 version on a new site i'm testing. Now, it's about time to go live and I was wondering what should I do in order to get back to the stable version, avoiding the re-installation process all over again. If I stick to this beta release for now and delete the Beta Tester plugin, can I upgrade to the stable 3.5 version of WP when it hits the release? Is anything else I should worry about?", "Pagination with wp_pagenavi not working on custom page I am having trouble with `wp_pagenavi` working on the start page using a custom query. It's working well on every standard template like category.php. But not on the homepage. Here is the code:               <?php                  $args=query_posts(array(               'post__not_in'=> array(419),               'post_type' => 'post',               'posts_per_page' => 10,               'paged' => get_query_var('page'), ));                  $my_query = new WP_Query($args);             if( $my_query->have_posts() ) {                    while ($my_query->have_posts()) : $my_query->the_post(); ?>         <?php             $featuredImage = wp_get_attachment_url( get_post_thumbnail_id($post->ID) );                  $s1=strtolower($title);                 ?>         <div id=\"post-<?php echo $post->ID;?>\" <?php $item_format = is_video() ? 'video' : 'post'; post_class('item cf item-'.$item_format); ?>>             <div class=\"thumb\">             <?PHP '<a class=\"clip-link\" data-id=\"'.$post->Id.'\" title=\"'.esc_attr(get_the_title($post->Id)).'\" href=\"'.get_permalink($post->Id).'\">'?>                  <a class=\"clip-link\"  title=\"<?php the_title();?>\" href=\"<?php the_permalink();?>\" rel=\"bookmark\">                     <span class=\"clip\">                         <?php echo'<img src=\"'.$featuredImage.'\" alt=\"'.esc_attr(get_the_title($post->Id)).'\" />';?>                         <span class=\"vertical-align\"></span>                      </span>                          <span class=\"overlay\"></span>                 </a>             </div><!--- thumb----->         </div><!-- end #post-<?php the_ID(); ?> -->              <?php               endwhile;          global $my_query;          $total_pages = $my_query->max_num_pages;                    if($total_pages > 1)              { ?>                     <div class=\"loop-nav pag-nav\">                     <div class=\"loop-nav-inner\">                         <?php                          if(function_exists('wp_pagenavi')) {                             wp_pagenavi();                         } else {                             $label = __('&laquo; Prev', 'dp');                             if($prev = get_previous_posts_link($label))                                 echo str_replace('<a', '<a clas=\"prev\"', $prev);                             else                                 echo '<span class=\"prev\">'.$label.'</span>';                                  $label = __('Next &raquo;', 'dp');                             if($next = get_next_posts_link($label))                                 echo str_replace('<a', '<a class=\"next\"', $next);                             else                                 echo '<span class=\"next\">'.$label.'</span>';                         } ?>                     </div>                     </div><!-- end .loop-nav -->         <?php      }          }                wp_reset_query();  // Restore global post data stomped by the_post().         ?>                 </div><!---nag cf---->                 </div><!---loop-content grid-mini--->      The pagination shows up, but the url `/page/2/` is not working, it shows `/page/1/` result.", "automatically adding submenu items Here's the solution that @bainternet has posted here: Add child pages automatically to nav menu               /**     * auto_child_page_menu     *      * class to add top level page menu items all child pages on the fly     * @author Ohad Raz <admin@bainternet.info>     */     class auto_child_page_menu     {         /**          * class constructor          * @author Ohad Raz <admin@bainternet.info>          * @param   array $args           * @return  void          */         function __construct($args = array()){             add_filter('wp_nav_menu_objects',array($this,'on_the_fly'));         }         /**          * the magic function that adds the child pages          * @author Ohad Raz <admin@bainternet.info>          * @param  array $items           * @return array           */         function on_the_fly($items) {             global $post;             $tmp = array();             foreach ($items as $key => $i) {                 $tmp[] = $i;                 //if not page move on                 if ($i->object != 'page'){                     continue;                 }                 $page = get_post($i->object_id);                 //if not parent page move on                 if (!isset($page->post_parent) || $page->post_parent != 0) {                     continue;                 }                 $children = get_pages( array('child_of' => $i->object_id) );                 foreach ((array)$children as $c) {                     //set parent menu                     $c->menu_item_parent      = $i->ID;                     $c->object_id             = $c->ID;                     $c->object                = 'page';                     $c->type                  = 'post_type';                     $c->type_label            = 'Page';                     $c->url                   = get_permalink( $c->ID);                     $c->title                 = $c->post_title;                     $c->target                = '';                     $c->attr_title            = '';                     $c->description           = '';                     $c->classes               = array('','menu-item','menu-item-type-post_type','menu-item-object-page');                     $c->xfn                   = '';                     $c->current               = ($post->ID == $c->ID)? true: false;                     $c->current_item_ancestor = ($post->ID == $c->post_parent)? true: false; //probbably not right                     $c->current_item_parent   = ($post->ID == $c->post_parent)? true: false;                     $tmp[] = $c;                 }             }             return $tmp;         }     }     new auto_child_page_menu();      How to use it? I have to implement it on a published website so I'm not in a position to experiment much... c/p code to functions.php? call the function from inside the header?", "Set featured image size for a custom post type I have a custom post type, and I'm adding support for thumbnails (featured image)                       register_post_type('cp_companies', array(                 'labels' => array(                     'name' => __('Companies'),                     'singular_name' => __('Company')                 ),                 'public' => true,                 'has_archive' => true,                 'supports' => array('thumbnail', 'title', 'editor')                     )             );      This is not a theme. This is a plug-in. What I want to do is simply limit (120x120) the size of the featured image.", "Page with posts from category doesn't work I'm working on my wordpress site, and I want to have a page that shows all posts from the category 'portfolio' on a separate site. I'm using the following technique: http://codex.wordpress.org/Pages#A_Page_of_Posts However, on my testblog this works fine ( http://dev.litso.com/portfolio-2/ ) but on my live blog it doesn't seem to load the custom pagetemplate portfolio.php ( http://www.stephanmuller.nl/portfolio-2/ ). Instead, it uses the regular page.php template. Both are pages (not posts), use the exact same theme (not even a copy, the same physical theme in a multisite installation), the same custom field 'category' with a value of 'portfolio' and both blogs have at least one entry with the 'portfolio' category. The only difference between the two is that the dev blog does _not_ have the option to choose the page's template (yet it does use the custom Portfolio template). The live site does have this option and it's set to Portfolio of course but when I view the page it uses Page. I can't find out why this is either. Anyone who can help?"]}, {"query": "Filter username field on registration for profanity and unwanted words", "pos": ["How to disable special characters in usernames? For a reason, I want to disable characters like `-`,`@`,`_`, that are allowed in usernames. Is this possible? How do I do this?"], "neg": ["Is there a hook for user activation (after they click the email confirm)? Is there a hook for user activation (after they click the email confirm)? I am creating a plugin to automatically add them to my email software, but I want them to have to confirm their email first.", "jQuery autocomplete: retrieving term slug when term name selected I'm trying to set up a customized searchform that will allow the visitor to search posts linked to term(s) of several taxonomies. The autocomplete part seems to work fine, but I've no idea how to get the term slug so I can build the query string once the visitor has selected the term name. Here is the HTML:                   <fieldset>              <div class=\"\">             <label for=\"collection\">Collections : </label>             <input id=\"collection\">         </div>              <div class=\"\">             <label for=\"sujet\">Sujets : </label>             <input id=\"sujet\">         </div>              <div class=\"\">             <label for=\"lieu\">Lieux : </label>             <input id=\"lieu\">         </div>              <div class=\"\">             <label for=\"tag_perso\">Mots-cl\u00e9s : </label>             <input id=\"tag_perso\">         </div>          </fieldset>      The Javascript:               jQuery(function() {          jQuery( \"#collection\" ).autocomplete({ source: availableTags.collection });     jQuery( \"#sujet\" ).autocomplete({ source: availableTags.sujet });     jQuery( \"#lieu\" ).autocomplete({ source: availableTags.lieu });     jQuery( \"#tag_perso\" ).autocomplete({ source: availableTags.tag_perso });      and the PHP:               function get_autocomplete_source($taxonomy) {     $args = array(         'hide_empty'    => 0,         'fields'        => 'all',     );     $term_objects = get_terms($taxonomy, $args);     $terms = array();     foreach ($term_objects as $term_object)      {         $return_object = new stdClass;         $return_object->value = $term_object->name;         $return_object->slug = $term_object->slug;         $terms[] = $return_object;     }     return $terms;}      the script having been localized this way:               wp_localize_script('cevennes_autocomplete', 'availableTags', array(     'collection'    => get_autocomplete_source('1-collection'),     'sujet'         => get_autocomplete_source('2-sujet'),     'lieu'          => get_autocomplete_source('3-lieu'),     'tag_perso'     => get_autocomplete_source('4-tag_perso')     ));      I'm a bit lost with Javascript. Could someone help? Thanks a lot.", "Determining Slug Before and After Edit If I were to edit a post or a page, how would I determine what the slug was before the edit, and again afterwards to compare them and see if it was changed? Also, would the same method work for any Custom Post Types created, or is that done differently?", "How to show custom post type in hierarchy I want to show my custom post type in list pattern like ## S.No Title   * 6 samplePost1               - replypost      - replypost        * 5 samplepost2               - replypost        * 4 samplepost3 Here i am setting post_per_page count from admin so If admin set post count to 4 then on list page it should show 4 post including reply post. I am posting my code below please let me know how can i resolve this issue.                  <?php                  $args  = array(                     'post_type' => 'customposttype',                     'posts_per_page' => $posts_per_page,                     'paged' => $paged,                     'orderby' => 'post_date',                     'order' => 'DESC',                     'post_status' => 'publish',                     //'post_parent'=>0,                     'tax_query' => array(                         array(                             'taxonomy' => 'custompostcategory',                             'field' => 'slug',                             'terms' =>  $cat                         )                      )                     );              $my_query = new WP_Query($args);              $max_num_pages =  $my_query->max_num_pages;         $post_count =  $my_query->found_posts;         $i = $post_count - (($paged - 1 ) * $posts_per_page) ;         ?>               <div id=\"warpper\">           <?php if ( $my_query->have_posts() ) : ?>             <div>                 <ul>                     <li>Sno.</li>                     <li>Title</li>                 </ul>             </div>             <div>                  <?php while ( $my_query->have_posts() ) : $my_query->the_post();?>              <ul>                <?php //if($my_query->post->post_parent < 1) :?>                    <li><?php echo $i; ?></li>                     <li> <a href=\"#\"><?php echo mb_substr(get_the_title(),0,30)?> </a></li>                  <?php  $i--;// else: ?>                 <?php //if($my_query->post->post_parent > 1) :?>                 <?php                      $r_args  = array(                         'post_type' => 'customposttype',                         'orderby' => 'post_date',                         'order' => 'DESC',                         'post_status' => 'publish',                         'post_parent' => $my_query->post->ID                            );                          $Rquery = new WP_Query($r_args);                  ?>                  <?php if ( $Rquery->have_posts() ) : ?>                  <div class=\"cmb_comment_warp\">                      <?php while ( $Rquery->have_posts() ) : $Rquery->the_post(); ?>                             <ul>                                 <li>&nbsp;</li>                                <li><a href=\"#\"><?php echo mb_substr(get_the_title(),0,30)?> </a> </li>                              </ul>                       <?php endwhile; ?>                      </div>                   <?php endif;//endif;?>                      </ul>                 <?php   endwhile; // End While?>                  </div>     </div>", "What does a security risk in a plugin look like? My server was hacked this weekend. By the Russians! Of the 50+ domains on my server, every single one had a hacked .htaccess file which was redirecting search results and a few other things to a russian site. I'm assuming that one of the many, many wordpress installs has a plugin with a security flaw. Two questions:   1. Is it possible for a security hole in one plugin to allow someone access to other sites on the same server?   2. What would a security flaw look like that might give someone access to the .htaccess file a directory or two above? It's possible that the issue was someone else, that Dreamhost (my host) has bigger issues. But, I'm exploring the option that it's my fault. Thoughts?", "(Wordpress) How to get custom taxonomy parent name? I'm using **custom taxonomies** and **custom post type** in my blog and everything is running fine so far. The problem is, I've made a small query to list all my child categories, but now I can't get the name of each parent because of the condition on line 10. Here's my code:               <?php     $args = array(             'orderby' => 'id',             'order' => 'ASC',             'taxonomy' => 'album'     );                       $categories=get_categories($args);     foreach($categories as $category) {     if($category->parent!=0) {     ?>     <li class=\"span3\">     <div class=\"thumbnail\">             <a href=\"<? bloginfo('url'); ?>/album/<?php echo $category->category_nicename; ?>\" rel=\"nofollow\">                             <img src=\"<?php bloginfo('url'); ?>/covers/<?php echo $category->category_nicename; ?>.jpg\" alt=\"\">             </a>                  <div class=\"caption\">                     <a href=\"<? bloginfo('url'); ?>/album/<? echo $category->category_nicename; ?>\">                             <? echo $category->parent . ' - ' . $category->name; ?>                     </a>             </div>     </div>     </li>         <?         }     }         ?>      Any workaround?", "Adding a \"Sign In/My Account\" link to an external app I'm using (or I'm going to use) WordPress for my product's marketing site. I use Rails for the product's application. Right now on my marketing site, which is currently in Rails, I have a link that reads either \"My Account\" or \"Sign In\" depending on whether you're signed in or not. I'd like to duplicate this feature on my WP site but I of course won't have the privilege of doing it in as direct a way as I am on my Rails marketing site now. I'm thinking I'll want to keep track via a cookie whether the user is logged in, which I assume is possible because the application and marketing site will both be on the same TLD. What's not clear to me is what would be a good way to read that cookie in WP. Any suggestions?", "Hide custom menu when when no menu selected The title might not a 100%, feel free to correct... I'm building a custom theme that has a couple of costume theme locations for menus (1 main menu, 1 footer menu, 1 \"Follow Live\" button). These are specified as a Theme Location in the Menu's panel. I'm having an issue with the footer menu: when that theme location does not have a menu selected, it falls back to displaying all pages. I'd like it to not display anything when it's not linked to a menu. The menu is defined in functions.php like this:               function add_footer() {     register_nav_menus(         array('footer-menu' => __('Footer Navigation'),));}      add_action('init', 'add_footer');      And it's displayed on the page like this:                   <?php              wp_nav_menu( array(             'theme_location' => 'footer-menu',              'menu_class' => 'false',              'container' => 'false',              'fallback_cb' => 'wp_page_menu',              ));?>      I've tried removing the `fallback_cf`option but that doesn't help."]}, {"query": "Advanced search form with filters for custom taxonomies and custom fields", "pos": ["Creating Advanced Search with text & Dropdowns I am working to develop an advanced search option. Where there will be fields:   1. Text input Field (Post Title)   2. Dropdown (it will be a taxonomy)   3. Dropdown (it will be a taxonomy) Basically I need this kind of search option. Please take a look at the image to better understand. I am using the solution found here for searching taxonomies but I need to integrate the text field which will get data from Post Title field.. ![enter image description here](http://i.stack.imgur.com/68nae.jpg)"], "neg": ["Populating content dynamically via AJAX and Advanced Custom Fields I am using a repeater field from Advanced Custom Fields to create multiple photo galleries. There are 4 pages and each page has multiple image galleries. Because of this, I want to reduce load by using a single external PHP file to generate the content and AJAX to only load one gallery at a time. I am not quite sure how to accomplish this, because since the ACF fields are being defined in an external file, it doesn't know what page to grab the fields from. Here is my JavaScript so far:               var passObject = {};              $.ajax({             url:\"<?php bloginfo('template_directory'); ?>/inc/galleries.php\",             type: 'POST',             data: passObject,             success: function(resp) {                      $('#photos').append(resp);                  }         });      And here is the content of galleries.php:               <div class=\"photos\">         <h1>Photo Gallery</h1>         <?php if( have_rows('gallery') ): ?>                  <?php while( have_rows('gallery') ): the_row();                   // vars             $photo = get_sub_field('photos');                  ?>                 <div class=\"image\"><img src=\"<?php echo $photo['sizes']['gallery-thumb']; ?>\" alt=\"<?php echo $photo['alt']; ?>\" /></div>             <?php endwhile; ?>              <?php endif; ?>     </div>", "get taxonomy name of current post Hierarchical taxonomy of custom post type 'projects' > 'projects_category'. Two example 'projects_category' hierarchies would be: > Big Corporates > 1st Company Name > A Post Title > > Small Business > 2nd Company Name > Another Post Title I can get **'1st Company Name'** with the following:               <?php $terms = get_the_terms($post->ID, 'projects_category');foreach($terms as $term){echo $term->name;} ?>      How can I display 'Big Corporates' or 'Small Business' as appropriate in single.php ?", "permalink error when modifying sanitize_title_with_dashes function By default, wordpress remove accents and weird characters to generate `post_name` in wp_posts table. This post_name is used when we change the permalink structure to `/%postname%/` or some similar structures. In my language, i don't want to remove and replace many characters as it distorts the meaning. I have change the `sanitize_title_with_dashes` function in wp- includes/formatting to: > function sanitize_title_with_dashes($title) {               $title = strip_tags($title);`     // Preserve escaped octets.     $title = preg_replace('|%([a-fA-F0-9][a-fA-F0-9])|', '---$1---', $title);     // Remove percent signs that are not part of an octet.     $title = str_replace('%', '', $title);     // Restore octets.     $title = preg_replace('|---([a-fA-F0-9][a-fA-F0-9])---|', '%$1', $title);      /* comment out this code block               if (seems_utf8($title)) {         if (function_exists('mb_strtolower')) {             $title = mb_strtolower($title, 'UTF-8');         }         $title = utf8_uri_encode($title, 200);     }          $title = strtolower($title);      */               $title = preg_replace('/&.+?;/', '', $title); // kill entities     $title = str_replace('.', '-', $title);      // comment out $title = preg_replace('/[^%a-z0-9 _-]/', '', $title);               $title = preg_replace('/\\s+/', '-', $title);     $title = preg_replace('|-+|', '-', $title);     $title = trim($title, '-');          return $title;      } The post_name is correctly generated for all characters in my language, for example `http://1.todaytravels.info` in the latest post, the url is very good, but wordpress simply does not find the post (it says `not found`). I guess i need to change something in permalink structure so that WP query to the correct post. Anyone know how to resolve this problem? Thanks for any help!", "Wordpress capabilities and restricted categories access I've a Wordpress blog to share content with some people only. Users has to login to access this website. I created new roles and new capabilities on this blog. I've got some articles which belongs to a certain category that I would like to share only with people with a certain role. Is there a hook I could use when somebody request an article, and where I could test if the curent user has the good capabilities, and so modify the request if needed?", "Theme Development for a Newbie **TL;DR, Skip to Trouble** I am a programmer and web developer by trade. I'm attempting to launch my own small business website in order to showcase my talents. As such, I've created subdomains for each of the major development Frameworks that I can use to develop customer sites. Each of these is successfully running.   1. DotNetNuke - ASP.NET - Main Site   2. Joomla   3. CodeIgnitor/CakePHP   4. WordPress   5. Drupal   6. PHPbb   7. WikiMedia   8. Custom - Catch All for Everything Else I'll admit that I'm old school. I used to prefer Notepad/Kate, and do it all by hand, but I understand _technology changes_. Up until recently, I was like every other \"web guy,\" and would purchase a precanned theme, add a little content, make sure it all worked and resell it. In an effort to not look \"Cookie Cutter\", and not bankrupt my small bankroll by buying someone else's overpriced theme(s), I decided to show customer's my skills by theming each subdomain myself, which will hopefully set me apart.... * * * ## Not As Easy As I Thought   * I went to _s, and created a Starter Theme.   * I crossed over to the Darkside by integrating Bootstrap into my theme. I'm a sucker for eye candy, and I didn't want to recreate buttons and grids by hand, and _technology changes_.   * I decided on this blog example, as a base for my creative genius. Plain I know, but I'm starting off slow.   * The Trouble Starts... * * * ## Trouble I converted the code in the template to the Wordpress Section Files(header.php, footer.php, and sidebar.php) Hurdle 1 Jumped. Whoot. I could't get the customized NavMenus to work until I found the BootstrapNavWalker Helper. Hurdle 2 Jumped. Whoot. I added the following code to functions PHP to have a login link.               /**      * Add Login/Logout to Menu      */     function add_login_logout_link($items, $args) {         if( $args->theme_location == 'primary' ) {             $loginoutlink = wp_loginout('index.php', false);             $items .= '<li>'. $loginoutlink .'</li>';         }              return $items;     }     add_filter('wp_nav_menu_items', 'add_login_logout_link', 10, 2);      This Works, but I wanted a button, so I changed `$items` to:               $items .= '<li><button type=\"button\" class=\"btn btn-default\">'. $loginoutlink .'</button></li>';      It worked, so I thought, as I was developing in Chrome. I got home and tried in Firefox: Q: The Button is visible in Firefox, but clicking it does nothing. Clicking it in Chrome takes me to the login page, so What is the proper way to output `$items` so the button and/or all bootstrap items works in every browser? Q: I chose, the snippet above after reviewing a few dozen snippets from various places. In seeing these, I saw some that used the output buffer functions and some that didn't. What's the advantage of wrapping functions in the buffer before outputting them to the browser?", "Determine page content based on page parent How can I display a gallery shortcode for pages who are children of the page with an ID of 9, and the regular content for pages who aren't? This is what I've tried so far, but it's not working:               <?php global $wp_query; if( (9 == $ $wp_query->post->post_parent ) :?>         <?php echo do_shortcode('[gallery link=\"file\" columns=\"1\" size=\"large\"]'); ?>     <?php else (); ?>         <?php the_content(); ?>", "Cannot get <p> tags working from a WPAlchemy metabox with wp_editor() I'm using WPAlchemy on a project. For a template, I need to use a custom metabox which is working fine with a tinyMCE editor. Code to insert the meta box on the template (this is a piece of code from https://github.com/helgatheviking/WP-Alchemy-Holy-Grail-Theme/ because I end up trying it after a looooog search, but _macache_ ).               <div class=\"my_meta_control metabox\">     <p>     <?php $mb->the_field('richfield');          $settings = array(     'textarea_rows' => '10',     'media_buttons' => 'false',     'tabindex' =>2     );          $val = html_entity_decode($mb->get_the_value());        $id = $mb->get_the_name();          wp_editor($val, $id , $settings );          ?>      </p>     <p class=\"meta-save\"><button type=\"submit\" class=\"button-primary\" name=\"save\"><?php _e('Update');?></button></p>          </div>      I have added the following in `functions.php`               /*     * Recreate the default filters on the_content     * this will make it much easier to output the meta content with proper/expected       formatting     */     add_filter( 'meta_content', 'wptexturize' );     add_filter( 'meta_content', 'convert_smilies' );     add_filter( 'meta_content', 'convert_chars' );          //use my override wpautop     if(function_exists('override_wpautop')){     add_filter( 'meta_content', 'override_wpautop' );     } else {     add_filter( 'meta_content', 'wpautop' );     }     add_filter( 'meta_content', 'shortcode_unautop' );     add_filter( 'meta_content', 'prepend_attachment' );      and for the output :               <div class=\"content-column content-tab content-richtext\">         <?php         global $page_type_richtext;         $page_type_richtext->the_meta(); // don't think I need this line         $richtextcontent = $page_type_richtext->the_value( 'richfield' );         echo apply_filters('meta_content', $richtextcontent );         ?>     </div>      But I never manage to have the `<p>` tags working. I don't understand where i'm wrong. I have tried a lot of different ways, using `the_content` filter, or `wpautop`but it's not working at all. The display is perfect in the custom field itself inside the admin page. That's why I'm getting mad. The content is correctly `wpautop()` when in admin, so I guess the content is properly saved in DB. There must be a way to make it work, but I really don't know. I have find a couple of stack exchange questions about that, like this one but I don't understand how to adapt it. Looks like I should use `wpautop` at the saving of the post, but this is handled by WPAlchemy, and `wp_editor()` doesn't need it, in theory as I understood it. Does anyone give me a hind or a lead ?", "Allow shortcode for custom widget The following code allows shortcode parsing for 'text' widget:               add_filter('widget_text', 'do_shortcode');      How to make a similar one for a custom widget? I tried the following one but it didn't work:               add_filter('widget_CUSTOM_WIDGET_NAME', 'do_shortcode');"]}, {"query": "How to add a box underneath the Post Box in Wordpress admin?", "pos": ["Best practices for meta box placement? I was wondering if there were any cut and dry rules to placing meta boxes? I have a meta box for a custom post type for a TV series that holds extra information for said series: when it began airing, genre, etc and I'm debating whether to place it under the editor or on the side. Are there any unofficial rules to what kind of meta box goes where or is it up to the developer's discretion?"], "neg": ["Setting title using wp_title filter I want to do something very simple but I'm stuck finding where in WordPress I need to perform this. When someone on my WordPress site visits a blog post page I want the title in the blog post to replaced the title of the page. I think I can do this with the wp_title filter hook? I thought about something like the following :-               add_filter('wp_title', 'filter_pagetitle');          function filter_pagetitle($title) {      $the_post_id    = get_the_ID();      $the_post_data  = get_post($the_post_id);      $title = $the_post_data->post_title;           return $title;     }      However I am a bit lost as to where I put this, I thought it would need to be in loop-single.php as I want this to apply only to single pages, but I have also seen that this needs to be in functions.php within my theme? Any help would be appreciated :-) Rich", "Create own pdf invoice in combo with wpcf7? I am looking for some examples and best strategies to make a custom pdf invoice with WP plugin contact form 7 data. For this, i am trying out the tcpdf library as i need to create a simple barcode per invoice as well. Any tips or info? regards", "Wordpress: Can I add categories/tags to all sites in my network at once? I've installed Wordpress 3.1.2, and have enabled the multi-site network. Each employee in my department can now have their own company blog. I was hoping to provide a bunch of pre-defined categories & tags for all the sites in the network for consistency between the blogs. It would be great if I could enter these once, and have them add to all the sites in the network. Is there a way to do this, or something similar? Many thanks, Glen", "Loading post comments after clicking a button Is it possible to load site comments on-demand instead of having them always display at the bottom of the post? Like by clicking on `Load Comments...`. You can check **labnol.org**. They are using Disqus comment system which loads by clicking. How could I achieve that?", "Moved blog - galleries don't work I moved my client's blog with nearly 800 posts from an ancient installation of WordPress to another host and a new version of WordPress. Now, several months later, we noticed that she had a few posts with gallery tags, and those tags are no longer working. I need to fix that, but I can't find any way to determine what images were used in the respective galleries. the posts just have something like this:               [gallery link=\"file\" columns=\"4\" orderby=\"ID\"]      I do have a full export of the database (and all files) from the old site and looked through it, but can't find any info. However, it is quite possible I just don't know where to look. The images do not show as attached to the specific posts in the media ui. For instance, one of her galleries was in a post where she picked a bunch of images from other posts. Can anyone tell me how to find out what images were used in the galleries?", "Run a check for multiple meta key values I am having a heck of a time getting wordpress to display all values of a certain meta key correctly. I wonder if I am going about this the wrong way? My end goal is to run a check to see if there is more than one custom field value in a key. If there is, each value should be listed with a comma delimiter, but no comma on the last value. If there is not, no comma should be used. I have tried two methods unsuccessfully. The first is get_post_meta:               <?php if(get_post_meta($post->ID, 'band', true)): ?>         <strong>Band:</strong> <?php echo get_post_meta($post->ID, 'band'); ?><br />     <?php endif; ?>      According to the codex, this should display all values of that key, but instead all it does is echo \"array\". If I change $Single to true, like so:               <?php if(get_post_meta($post->ID, 'band', true)): ?>         <strong>Band:</strong> <?php echo get_post_meta($post->ID, 'band', true); ?><br />     <?php endif; ?>      it only returns the first value (but at least returns the value and not the word \"array\". The second method I have tried that sorta worked was get_post_custom_values. This does the trick, but I can't work out how to a) run a check for multiple values or b) keep it from adding a comma to the last value.               <?php if(get_post_meta($post->ID, 'gear', true)): ?>         <strong>Gear: </strong>         <?php           $mykey_values = get_post_custom_values('gear');           foreach ( $mykey_values as $key => $value ) {             echo \"$value, \";            }         ?>       <?php endif; ?>", "Update Theme Location Programatically I've been trying to update my theme location programmtically and while the menu gets created with menu items, the theme location never gets set. Here is what I have:               function create_my_menu() {     if(!is_nav_menu('primary-menu')) {       $menu_id = wp_create_nav_menu('primary-menu');       //$menu = array( 'menu-item-type' => 'custom', 'menu-item-url' => get_home_url('/'),'menu-item-title' => 'Home', 'menu-item-status' => 'publish' );       $menu = get_term_by('name', 'primary-menu', 'nav_menu');       wp_update_nav_menu_item($menu->term_id, 0, array( 'menu-item-type' => 'custom', 'menu-item-url' => get_home_url('/'),'menu-item-title' => 'Home', 'menu-item-status' => 'publish' ));     //    wp_update_nav_menu_item( $menu_id, 0, $menu );       $locations = get_theme_mod('nav_menu_locations');       $locations['primary-menu'] = $menu->term_id.         set_theme_mod('nav_menu_locations', $locations);     }     }      My menu is registered in my functions file.               add_action( 'init', 'register_my_menu' );          function register_my_menu() {     register_nav_menu( 'primary-menu', __( 'Primary Menu' ) );     }      **EDIT** I'm working on a plugin for a multisite setup. I need the menu to be created when a user creates a new site. I suppose I could modify the default menu that gets created when wordpress is installed.", "Is it possible to stop selected plugins from loading on certain template pages? I have a template page that has form on that is only used once in my site. The form uses form validation using jquery validate plugin (such a great plugin). Once the cart66 Plugin is loaded, the form validation stops working. Rather spending ages looking for the conflict, I thought it would be easiest to just turn off the plugin for that template page as cart66 is not need on this page. Is it possible to stop plugins loading on individual template pages? I am using WordPress 3.2.1"]}], "DBPedia": [{"query": "animals lay eggs mammals", "pos": ["Echidna Echidnas /\u0268\u02c8k\u026adn\u0259/, sometimes known as spiny anteaters, belong to the family Tachyglossidae in the monotreme order of egg-laying mammals. The four extant species, together with the platypus, are the only surviving members of that order and are the only extant mammals that lay eggs. Their diet consists of ants and termites, but they are not closely related to the true anteaters of the Americas.", "Evolution of mammals The evolution of mammals has passed through many stages since the first appearance of their synapsid ancestors in the late Carboniferous period,the two Synapsid Sub groups that led to mammals are Sphenacodonts and Therapsids.The most ancestral forms in the class Mammalia are the egg-laying mammals in the subclass Prototheria. By the mid-Triassic, there were many synapsid species that looked like mammals.", "Kribi killi Kribi killi (Fundulopanchax fallax) is a species of African killifish that mainly inhabit swamps and turbid parts of brooks in the coastal rainforest. The species is endemic to Cameroon. Adult fish reach a maximum length of approximately 9 centimetres (3.5 inches). Breeding pairs of the species most often lay their eggs over the bottom, but occasionally also among the roots of free-floating aquatic plants. Pairs stay close for some time, with just a few eggs being produced each day.", "List of monotremes and marsupials of Australia Mammals are divided into two subclasses based on reproductive techniques: egg laying mammals (the monotremes), and live birth mammals.  The second subclass is divided into two infraclasses: pouched mammals (the marsupials) and placental mammals.Australia is home to two of the five extant species of monotremes and the majority of the world's marsupials (the remainder are from Papua New Guinea, eastern Indonesia and the Americas).", "Long-beaked echidna The long-beaked echidnas (genus Zaglossus) make up one of the two extant genera of echidnas, spiny monotremes that live in New Guinea. There are three living species and two extinct species in this genus. The extinct species were present in Australia. Echidnas are one of the two types of mammals that lay eggs, the other being the platypus.", "Mammal Mammals (class Mammalia /m\u0259\u02c8me\u026ali.\u0259/ from Latin mamma \"breast\") are any members of a clade of endothermic amniotes distinguished from reptiles and birds by the possession of hair, three middle ear bones, mammary glands, and a neocortex (a region of the brain).", "Mammalian reproduction Most mammals are viviparous, giving birth to live young.  However, the five species of monotreme, the platypuses and the echidnas, lay eggs. The monotremes have a sex determination system different from that of most other mammals. In particular, the sex chromosomes of a platypus are more like those of a chicken than those of a therian mammal.The mammary glands of mammals are specialized to produce milk, a liquid used by newborns as their primary source of nutrition.", "Monotreme Monotremes are mammals that lay eggs (Prototheria) instead of giving birth to live young like marsupials (Metatheria) and placental mammals (Eutheria). The only surviving examples of monotremes are all indigenous to Australia and New Guinea, although there is evidence that they were once more widespread. The existing monotreme species are the platypus and four species of echidnas (or spiny anteaters).", "Oviparity Oviparous animals are animals that lay eggs, with little or no other embryonic development within the mother.", "Platypus The platypus (Ornithorhynchus anatinus) also known as the duck-billed platypus is a semiaquatic egg-laying mammal endemic to eastern Australia, including Tasmania. Together with the four species of echidna, it is one of the five extant species of monotremes, the only mammals that lay eggs instead of giving birth.", "Prototheria Prototheria (/\u02ccpro\u028at\u0275\u02c8\u03b8\u026a\u0259ri\u0259/; from Greek \u03c0\u03c1\u03ce\u03c4\u03bf\u03c2, pr\u014dtos, first, + \u03b8\u03ae\u03c1, th\u0113r, wild animal) is a taxonomic group, or taxon, to which the order Monotremata belongs. It is conventionally ranked as a subclass within the mammals; see Yinotheria \u00a7\u2009History of classification.Most of the animals in this group are extinct. The egg-laying monotremes are known from fossils of the Cretaceous and Cenozoic periods; they are represented today by the platypus and several species of echidna.", "Teinolophos Teinolophos trusleri was a prehistoric species of monotreme, or egg-laying mammal. It is known from a lower jawbone found in Flat Rocks, Victoria, Australia. It lived during the Aptian age of the Lower Cretaceous.  It is the earliest known relative of the Platypus.The species name honours the artist Peter Trusler. The genus name, Teinolophos, means 'extended ridge', a reference to its tooth structure.Originally, Teinolophos was thought to be a eupanthothere."], "neg": ["Eastern carrion crow The eastern carrion crow (Corvus corone orientalis) is a member of the crow family and a subspecies of the carrion crow. Differences from the nominate subspecies include a larger size, at a length about 500 millimetres (20 in), and more graduated outer tail feathers. The eastern carrion crow is found in Siberia from the Yenisei to Japan, south to Central Asia, Afghanistan, Eastern Persia, Kashmir, Tibet and northern China. They generally lay three-five eggs in trees or buildings.", "Spawn (biology) Spawn is the eggs and sperm released or deposited, usually into water, by aquatic animals. As a verb, spawn refers to the process of releasing the eggs and sperm, also called spawning. Most aquatic animals, apart from aquatic mammals, reproduce through a process of spawning.Spawn consists of the reproductive cells (gametes) of aquatic animals, some of which will become fertilized and produce offspring.", "Egg fossil Egg fossils are the fossilized remains of eggs laid by ancient animals. As evidence of the physiological processes of an animal, egg fossils are considered a type of trace fossil. Under rare circumstances a fossil egg may preserve the remains of the once-developing embryo inside, in which case it also contains body fossils. A wide variety of different animal groups laid eggs that are now preserved in the fossil record beginning in the Paleozoic era.", "Fauna of Australia The fauna of Australia consists of a huge variety of animals; some 83% of mammals, 89% of reptiles, 24% of fish and insects and 93% of amphibians that inhabit the continent are endemic to Australia. This high level of endemism can be attributed to the continent's long geographic isolation, tectonic stability, and the effects of an unusual pattern of climate change on the soil and flora over geological time.", "Porcine zona pellucida Porcine zona pellucida is a form of zona pellucida extracted from the ovaries of pigs, often referred to by the initials PZP. It is a popular source of antigens for immunocontraception.The zona pellucida is a thick membrane that surrounds the unfertilized eggs of mammals. In order for an egg to be fertilized, sperm must first bind to, and then penetrate the zona pellucida.", "Vaginal delivery A vaginal delivery is the birth of offspring (babies in humans) in mammals through the vagina. It is the natural method of birth for all mammals except monotremes, which lay eggs into the external environment. The average length of a hospital stay for a normal vaginal delivery is 36\u201348 hours or with an episiotomy (a surgical cut to widen the vaginal canal) 48\u201360 hours, whereas a C-section is 72\u2013108 hours.", "Fiji parrotfinch The Fiji parrotfinch (Erythrura pealii) is a species of estrildid finch endemic to Fiji that was formerly considered to be a subspecies of the red-headed parrotfinch. This parrotfinch is a small, mainly green bird with a red head and tail and a stubby dark grey bill. It is found in both forested and open habitats, and has adapted well to man-made environments such as grasslands, pasture and gardens.", "Internal fertilization Fertilization which takes place inside the female body is called  Internal fertilization in animals is done through the following different ways: Copulation, which  involves the insertion of the penis or other intromittent organ into the vagina (in most mammals) or to the cloaca in monotremes, most reptiles, some birds, the amphibian tailed frog and some fish, the disappeared dinosaurs, as well as in other non-vertebrate animals."]}, {"query": "vietnam travel airports", "pos": ["Air Mekong Mekong Aviation Joint Stock Company (Vietnamese: C\u00f4ng ty C\u1ed5 ph\u1ea7n H\u00e0ng kh\u00f4ng M\u00ea K\u00f4ng), doing business as Air Mekong, was an airline from Vietnam which operated scheduled passenger flights from its base at Phu Quoc Airport and secondary hubs at Noi Bai International Airport and Tan Son Nhat International Airport. Its headquarters were located in Ph\u00fa Qu\u1ed1c, Ki\u00ean Giang Province. It was established in 2009 and flight operations were launched on 9 October 2010.", "Air Vietnam Active from 1951 to 1975, Air Viet Nam (Air VN) (Vietnamese: H\u00e3ng H\u00e0ng kh\u00f4ng Vi\u1ec7t Nam) was South Vietnam's first commercial air carrier, headquartered in District 1, Saigon. Established under Emperor B\u1ea3o \u0110\u1ea1i, the airline flew over one million passengers, including during the Vietnam War, before its collapse due to Fall of Saigon.", "Air transport in Vietnam Air transport in Vietnam is the commercial air transport of passengers, freight and mail within Vietnam and between Vietnam and the rest of the world. The government's Civil Aviation Administration of Vietnam, the aviation authority  under the Ministry of Transport of Vietnam, oversees the operations of aviation activities in the country.", "Airports Corporation of Vietnam Airports Corporation of Vietnam (Vietnamese: T\u1ed5ng c\u00f4ng ty c\u1ea3ng h\u00e0ng kh\u00f4ng Vi\u1ec7t Nam) is a Vietnamese Ho Chi Minh City-based state-owned company. The company under the Ministry of Transport of Vietnam which was founded on January 8, 2012 when three companies operating airports in the north, the middle and the south of Vietnam were merged on February 28, 2012 The company manages and operates 21 all civil airports in Vietnam, including 8 international and 13 domestic airports.", "An Giang Airport An Giang Airport is a planned airport in An Giang Province, Mekong Delta, southern VietnamAccording to the master plan, total cost is estimated around $64 million and will be invested in phases, the first phase will be constructed from 2011 to 2020. The airport will be located in commune of C\u1ea7n \u0110\u0103ng, Chau Thanh District, An Giang Province.", "Buon Ma Thuot Airport Buon Ma Thuot Airport (IATA: BMV, ICAO: VVBM) (Vietnamese: S\u00e2n bay Bu\u00f4n Ma Thu\u1ed9t) is a public airport in Vietnam. The airport is located in \u0110\u1eafk L\u1eafk Province and has one functional runway. A second incomplete runway (marked with a faded 27 R) is not in use. Two aprons are located on the south side of the airport with buildings that appeared to be used for aircraft storage. A barracks-like camp is located to the north side of the airport.", "Cam Ly Airport Cam Ly Airport (IATA: N/A, ICAO: VVCL) (Vietnamese: S\u00e2n bay Cam Ly) is a small airport of Da Lat in L\u00e2m \u0110\u1ed3ng Province in the Central Highlands region of Vietnam. It is the site of Vietnamese National Military Academy. It is mainly used for military purposes but has been upgraded to serve small aircraft including sport aeroplanes and helicopters. There are no scheduled flights to this airport.", "Cam Ranh International Airport Cam Ranh International Airport (IATA: CXR, ICAO: VVCR) (Vietnamese: S\u00e2n bay Qu\u1ed1c t\u1ebf Cam Ranh) is located on Cam Ranh Bay in Cam Ranh, a town in the province of Khanh Hoa in Vietnam. It serves the city of Nha Trang, which is 30 km (16 NM) from the airport.", "Can Tho International Airport For the military use of the facility during the Vietnam Wars, see Binh Thuy Air BaseCan Tho International Airport (IATA: VCA, ICAO: VVCT) (Vietnamese: S\u00e2n bay Qu\u1ed1c t\u1ebf C\u1ea7n Th\u01a1), formerly Tr\u00e0 N\u00f3c Airport is located in Can Tho in Mekong Delta region of Vietnam.The airport has been inaugurated on January 1, 2011 and disbursed US$150 million for built on 20,750 square metres (223,400 sq ft) of land, will process up to 5 million passengers a year.", "Cat Bi International Airport Cat Bi International Airport (IATA: HPH, ICAO: VVCI) (Vietnamese: S\u00e2n bay Qu\u1ed1c t\u1ebf C\u00e1t Bi) is located in Hai Phong, Vietnam.", "Chu Lai International Airport For the military use of the facility prior to April 1975, see Chu Lai Air BaseChu Lai International Airport (IATA: VCL) (Vietnamese: S\u00e2n bay Qu\u1ed1c t\u1ebf Chu Lai) is an airport in Chu Lai, Vietnam. It is near Tam K\u1ef3 city, the largest city in Qu\u1ea3ng Nam Province. The airport is located in the Chu Lai Open Economic Zone, N\u00fai Th\u00e0nh District.The airfield was originally established in the Vietnam War, as Chu Lai Air Base, by the United States Marines.", "Con Dao Airport C\u00f4n \u0110\u1ea3o Airport or C\u1ecf \u1ed0ng Airport (IATA: VCS, ICAO: VVCS) (Vietnamese: S\u00e2n bay C\u1ecf \u1ed0ng) is located on C\u00f4n S\u01a1n Island, the largest island of C\u00f4n \u0110\u1ea3o archipelago off the coast of B\u00e0 R\u1ecba\u2013V\u0169ng T\u00e0u Province, Vietnam.", "C\u00e0 Mau Airport C\u00e0 Mau Airport (IATA: CAH, ICAO: VVCM) (Vietnamese: S\u00e2n bay C\u00e0 Mau) is a small airport in C\u00e0 Mau Province, the most southern part of Vietnam.The airport is currently served by Vietnam Aviation Service Company (VASCO) with flight to Ho Chi Minh City (Tan Son Nhat International Airport, SGN).The coordinates are: \"05\u00b010'46\\ E and 09\u00b010'32\" N.", "Da Nang International Airport \u0110\u00e0 N\u1eb5ng International Airport (IATA: DAD, ICAO: VVDN) (Vietnamese: S\u00e2n bay Qu\u1ed1c t\u1ebf \u0110\u00e0 N\u1eb5ng) is located in \u0110\u00e0 N\u1eb5ng, the largest city in central Vietnam.", "Dien Bien Phu Airport Dien Bien Phu Airport (IATA: DIN, ICAO: VVDB) (Vietnamese: S\u00e2n bay \u0110i\u1ec7n Bi\u00ean Ph\u1ee7) is located at Dien Bien Phu in Vietnam.", "Dong Hoi Airport Dong Hoi Airport (IATA: VDH, ICAO: VVDH) (Vietnamese: C\u1ea3ng h\u00e0ng kh\u00f4ng \u0110\u1ed3ng H\u1edbi or S\u00e2n bay \u0110\u1ed3ng H\u1edbi) is an airport located in Loc Ninh commune, 6 km north of \u0110\u1ed3ng H\u1edbi city, capital of Qu\u1ea3ng B\u00ecnh Province, in North Central Coast of Vietnam, about 500 km South-east of Hanoi by road. The facilities cover 173 ha, on a sandy area, by the coast of South China Sea. The runway approaches near the seashore and nearly parallel to the Highway 1A.", "Dong Tac Airport Dong Tac Airport (IATA: TBB, ICAO: VVTH) (Vietnamese: S\u00e2n bay \u0110\u00f4ng T\u00e1c) is located just south of Tuy H\u00f2a within the Ph\u00fa Y\u00ean Province, along the central coast of southern Vietnam.", "Gia Lam Airport Gia Lam Airport (ICAO: VVGL) (Vietnamese: S\u00e2n bay Gia L\u00e2m) is one of two major airports in Hanoi, Vietnam, located in Gia L\u00e2m District, on the eastern bank of the Red River. It is primarily a military field, used by the Vietnam People's Air Force (VPAF), with MiG-21 fighters and Kamov Ka-28 helicopters stored in revetments. The airfield was inaugurated in 1936, before the Japanese occupation of French Indochina.", "Indochina Airlines Indochina Airlines (Vietnamese: H\u00e3ng H\u00e0ng kh\u00f4ng \u0110\u00f4ng D\u01b0\u01a1ng) was a Vietnamese airline based in Ho Chi Minh City. It was the first operational private airline based in Vietnam, originally licensed in May 2008 as Air Speed Up (Vietnamese: H\u00e3ng h\u00e0ng kh\u00f4ng T\u0103ng T\u1ed1c). The founder and chairman of the board was Vietnamese musician H\u00e0 H\u00f9ng D\u0169ng.", "Lien Khuong Airport Lien Khuong Airport (IATA: DLI, ICAO: VVDL) (Vietnamese: S\u00e2n bay Li\u00ean Kh\u01b0\u01a1ng) is the largest among 4 airports of L\u00e2m \u0110\u1ed3ng Province in the Central Highlands region of  Vietnam. The airport is located in \u0110\u1ee9c Tr\u1ecdng District, about 30 km south of Da Lat. The major reconstruction in order to handle bigger aircraft was completed in December 2009.", "List of airlines of Vietnam This is a list of airlines in Vietnam, as approved by the Civil Aviation Administration of Vietnam (CAAV).", "List of airports by IATA code: V List of airports by IATA code: A - B - C - D - E - F - G - H - I - J - K - L - M - N - O - P - Q - R - S - T - U - V - W - X - Y - ZSee also: List of airports by ICAO code", "List of airports in Vietnam This is a list of airports in Vietnam, grouped by type and sorted by location. Airports in Vietnam are managed and operated by Airports Corporation of Vietnam.", "List of hub airports Listed here are the world's airports used as airline hubs:", "Long Thanh International Airport Long Thanh International Airport (Vietnamese: S\u00e2n bay Qu\u1ed1c t\u1ebf Long Th\u00e0nh) is an airport planned for construction in Long Th\u00e0nh, \u0110\u1ed3ng Nai Province, southern Vietnam. Located approximately 40 km (25 mi) northeast of Ho Chi Minh City, it is intended to become operational by 2020. It will serve over 100 million passengers annually when built to the maximum designed capacity.", "Noi Bai International Airport N\u1ed9i B\u00e0i International Airport (IATA: HAN, ICAO: VVNB) (Vietnamese: S\u00e2n bay Qu\u1ed1c t\u1ebf N\u1ed9i B\u00e0i) in Hanoi, the capital of Vietnam, is the largest airport in Vietnam. It is the main airport serving Hanoi, replacing the role of Gia Lam Airport. The airport consists of two passenger terminals. Terminal 1 serves the domestic flights and the newly built Terminal 2 (inaugurated on the 4th of January 2015) serves all international flights to and from Hanoi.", "N\u00e0 S\u1ea3n Airport The Na San Airport (IATA: SQH, ICAO: VVNS) (Vietnamese: S\u00e2n bay N\u00e0 S\u1ea3n) is an airport in S\u01a1n La, in the S\u01a1n La Province of Vietnam.", "Phu Cat Airport Phu Cat Airport (IATA: UIH, ICAO: VVPC) (Vietnamese: S\u00e2n bay Ph\u00f9 C\u00e1t) is the airport serving Qui Nh\u01a1n, Vietnam. It is in Ph\u00f9 C\u00e1t District between the towns of Ngo May and \u0110\u1eadp \u0110\u00e1, around 30 kilometres (19 mi) northwest of Qui Nh\u01a1n within B\u00ecnh \u0110\u1ecbnh Province along the South Central Coast of Vietnam.As well as being a commercial airport, Phu Cat is also used by the Vietnamese Air Force (Khong Quan Nhan Dan Viet Nam).", "Phu Quoc Airport Phu Quoc Airport (IATA: PQC, ICAO: VVPQ) (Vietnamese: S\u00e2n bay Ph\u00fa Qu\u1ed1c), also known as Duong Dong Airport (Vietnamese: S\u00e2n bay D\u01b0\u01a1ng \u0110\u00f4ng), was an airport located in D\u01b0\u01a1ng \u0110\u00f4ng town, Ph\u00fa Qu\u1ed1c, Ki\u00ean Giang Province, Vietnam.", "Phu Quoc International Airport Phu Quoc International Airport (Vietnamese: S\u00e2n bay qu\u1ed1c t\u1ebf Ph\u00fa Qu\u1ed1c or C\u1ea3ng h\u00e0ng kh\u00f4ng qu\u1ed1c t\u1ebf Ph\u00fa Qu\u1ed1c) (IATA: PQC, ICAO: VVPQ) is an international airport which was completed in 2012 on Ph\u00fa Qu\u1ed1c Island, southern Vietnam. The airport covers nearly 900ha in Duong To village, Ph\u00fa Qu\u1ed1c island-district, Ki\u00ean Giang Province having been built at a cost of around VND 16.2 trillion (US$810 million) and is planned to be built in phases.", "Pleiku Airport For the Vietnam War military use of this facility, see Pleiku Air BasePleiku Airport (IATA: PXU, ICAO: VVPK) (Vietnamese: S\u00e2n bay Pleiku) is a regional airport located near the city of Pleiku within Gia Lai Province in southern Vietnam.", "Quang Tri Airport Qu\u1ea3ng Tr\u1ecb Airport (Vietnamese language: S\u00e2n bay Qu\u1ea3ng Tr\u1ecb) is a military/civil planned to be constructed in the province of Qu\u1ea3ng Tr\u1ecb, Vietnam, around 560 km south of Hanoi.The airport will be located in the commune of Gio Quang,  Gio Linh District, 7 km north of the provincial capital \u0110\u00f4ng H\u00e0. The master plan was signed by the chairman of the Qu\u1ea3ng Tr\u1ecb provincial people's committee. The investment cost is estimated VND 374.787 billion (equivalent to US$ 27 million).", "Rach Gia Airport Rach Gia Airport (IATA: VKG, ICAO: VVRG) (Vietnamese: S\u00e2n bay R\u1ea1ch Gi\u00e1) is an airport located in Rach Gia, Vietnam.", "Tan Son Nhat International Airport T\u00e2n S\u01a1n Nh\u1ea5t International Airport (IATA: SGN, ICAO: VVTS) (Vietnamese: S\u00e2n bay qu\u1ed1c t\u1ebf T\u00e2n S\u01a1n Nh\u1ea5t, Vietnamese: C\u1ea3ng h\u00e0ng kh\u00f4ng qu\u1ed1c t\u1ebf T\u00e2n S\u01a1n Nh\u1ea5t) is Vietnam's largest international airport in terms of area (850 ha or 2,100 acres compared with 650 ha or 1,606 acres of Ha Noi's N\u1ed9i B\u00e0i International Airport and \u0110\u00e0 N\u1eb5ng's \u0110\u00e0 N\u1eb5ng International Airport).", "Thanh Hoa Airport Thanh Hoa Airport (Vietnamese: S\u00e2n bay Thanh H\u00f3a) is a civil airport planned to be built in Thanh H\u00f3a Province, North Central Coast region, Vietnam.The proposed location is in commune of H\u1ea3i Ninh, district of T\u0129nh Gia, Thanh H\u00f3a Province, west of National Route 4. The Deputy Prime Minister of Vietnam, Ho\u00e0ng Trung H\u1ea3i, has ordered the Ministry of Transportation of Vietnam to carry out the planning and implementation schedule.", "Tho Xuan Airport Tho Xuan Airport, formerly Sao V\u00e0ng Airport also known as Thanh Ho\u00e1 Air Base (Vietnamese: S\u00e2n bay Sao V\u00e0ng, Vietnamese: S\u00e2n bay Th\u1ecd Xu\u00e2n), is an airport located in Sao V\u00e0ng town in Th\u1ecd Xu\u00e2n District, Thanh H\u00f3a Province, 45 km northwest of the provincial capital Thanh H\u00f3a. The airport is currently operated by Vietnam People's Air Force (VPAF).", "Tigerair destinations Tigerair Singapore currently flies to destinations within an approximate five-hour radius around Singapore to 38 destinations in nine countries around the region. China is currently its biggest market, with nine cities served.", "Tourism in Vietnam Tourism in Vietnam is a component of the modern Vietnamese economy. In 2012, Vietnam received more than 6.8 million international arrivals, up from 2.1 million in the year 2000. The annual increase represented a rebound from a decline in 2008 Great Recession. The Vietnam National Administration of Tourism is following a long-term plan to diversify the tourism industry, which brings foreign exchange into the country.Tourist arrivals in Vietnam have continued to rise in recent years.", "U-Tapao International Airport U-Tapao\u2013Pattaya International Airport (Thai: \u0e17\u0e48\u0e32\u0e2d\u0e32\u0e01\u0e32\u0e28\u0e22\u0e32\u0e19\u0e19\u0e32\u0e19\u0e32\u0e0a\u0e32\u0e15\u0e34\u0e2d\u0e39\u0e48\u0e15\u0e30\u0e40\u0e20\u0e32)  (IATA: UTP, ICAO: VTBU) also spelled Utapao and U-Taphao, is a joint civil\u2013military public airport serving Rayong and Pattaya cities in Thailand. It is in Ban Chang District of Rayong Province.It also serves as the U-Tapao Royal Thai Navy Airfield, home of the Royal Thai Navy First Air Wing.", "Vietnam Air Services Company Vietnam Air Services Company (VASCO) (Vietnamese: C\u00f4ng ty bay d\u1ecbch v\u1ee5 h\u00e0ng kh\u00f4ng) is an airline in Vietnam headquartered in T\u00e2n B\u00ecnh, Ho Chi Minh City. Operating scheduled flights from its base at Tan Son Nhat International Airport in the south of the country, VASCO is a fully owned subsidiary of Vietnam Airlines.", "Vietnam Airlines Vietnam Airlines (Vietnamese: H\u00e3ng H\u00e0ng kh\u00f4ng Qu\u1ed1c gia Vi\u1ec7t Nam) is the flag carrier of Vietnam. Founded in 1956 under the name Vietnam Civil Aviation, the airline was established as a state-owned enterprise in April 1989. Vietnam Airlines is headquartered in Long Bien District, Hanoi, with hubs at Noi Bai International Airport and Tan Son Nhat International Airport.", "Vietnam Airlines destinations Vietnam Airlines is the flag carrier of Vietnam, formed in 1956 as Vietnam Civil Aviation. It was established as a state enterprise in April 1989 before merging with around 20 other companies to form Vietnam Airlines Corporation (since renamed Vietnam Airlines Company Limited), with the airline as its centerpiece.", "Vinh Airport Vinh Airport (IATA: VII, ICAO: VVVH) (Vietnamese: S\u00e2n bay Vinh) is located in Vinh city of Nghe An province northern Vietnam. It is a mixed military/civil airport. It used to be one of the two major military airbases in Vietnam besides Gia Lam Airbase in Hanoi.During 2002-2015, the airport saw the annual increase of passengers of 43.89%, the highest rate out of all airports in Vietnam, reaching to the all time high of 1.25 million passengers in 2014.", "Vung Tau Airport Vung Tau Airport (IATA: VTG, ICAO: VVVT) (Vietnamese: S\u00e2n bay V\u0169ng T\u00e0u) is a small airport in southern Vietnam, in the B\u00e0 R\u1ecba\u2013V\u0169ng T\u00e0u Province. The airport serves the city of V\u0169ng T\u00e0u and is located near the downtown of the city."], "neg": ["Transport in Yunnan The transport infrastructure of Yunnan is served by numerous transport modes, and forms an integral part of the structure Yunnan Province and the Southwest of China. Yunnan is served by several civilian airports and a major highway and rail network.", "Vietnam Veterans Memorial The Vietnam Veterans Memorial is a 3-acre (12,000 m\u00b2) national memorial in Washington, DC. It honors U.S. service members of the U.S. armed forces who fought in the Vietnam War, service members who died in service in Vietnam/South East Asia, and those service members who were unaccounted for (Missing In Action) during the War.Its construction and related issues have been the source of controversies, some of which have resulted in additions to the memorial complex.", "Manchester Airport Manchester Airport (IATA: MAN, ICAO: EGCC), is an international airport in Ringway, Manchester, England. In 2014, it was the third busiest airport in the United Kingdom in terms of passenger numbers, and the 22nd busiest airport in Europe. Manchester Airport is the largest outside the London region with over double the passengers of the next non-London airport, Edinburgh Airport.", "Air Vietnam Flight 706 hijacking Air Vietnam Flight 706 was a Boeing 727 which crashed on September 15, 1974 near Phan Rang Air Base in South Vietnam.", "Air transport in the United Kingdom Air transport in the United Kingdom is the commercial carriage of passengers, freight and mail by aircraft, both within the United Kingdom (UK) and between the UK and the rest of the world. In the past 25 years the industry has seen continuous growth, and the demand for passenger air travel in particular is forecast to increase from the current level of 236 million passengers to 465 million in 2030. One airport, London Heathrow Airport, is amongst the top ten busiest airports in the world.", "Malaysia\u2013Singapore Airlines Malaysia\u2013Singapore Airlines (MSA) came into being in 1966 as a result of a joint ownership of the airline by the governments of Malaysia and Singapore. The airline ceased operations after 6 years in 1972 when both governments decided to set up their own national airlines. Hence from that year onwards, Malaysian Airline System, now called Malaysia Airlines, and Singapore Airlines were formed.", "Gran Canaria Airport Gran Canaria Airport (IATA: LPA, ICAO: GCLP), (sometimes also known as Gando Airport and frequently, but incorrectly, referred to as \"Las Palmas Airport\"), (Spanish: Aeropuerto de Gran Canaria) is a passenger and freight airport on the island of Gran Canaria. It is an important airport within the Spanish air-transport network (owned and managed by a public enterprise, AENA), as it holds the fifth position in terms both of passengers and cargo transported, and fourth in terms of operations.", "V\u00e1clav Havel Airport Prague V\u00e1clav Havel Airport Prague (Czech: Leti\u0161t\u011b V\u00e1clava Havla Praha), formerly Prague Ruzyn\u011b International Airport (Czech: Mezin\u00e1rodn\u00ed leti\u0161t\u011b Praha-Ruzyn\u011b, Czech pronunciation: [\u02c8pra\u0266a \u02c8r\u028az\u026a\u0272\u025b]), (IATA: PRG, ICAO: LKPR), is the international airport of Prague, the capital of the Czech Republic. It is located 10 kilometres (6 mi) west of the city centre and is with over 11 million passengers in 2014 the busiest airport in the newer EU member states."]}, {"query": "david hewlett", "pos": ["A Dog's Breakfast A Dog's Breakfast is a Canadian comedy independent film produced in 2006. It was the first film to be written and directed by British-born Canadian actor David Hewlett, who is best known for his role of Dr. Rodney McKay in the TV series Stargate Atlantis. Hewlett created the film as a private off-season project and stars alongside his real-life sister Kate Hewlett and Stargate actors Paul McGillion, Christopher Judge and Rachel Luttrell.", "David Hewlett David Ian Hewlett (born 18 April 1968) is an English-Canadian actor, writer, director, and voice actor best known for his role as Dr. Meredith Rodney McKay on the Canadian-American science fiction TV shows Stargate SG-1, Stargate Atlantis and Stargate Universe.Hewlett first gained fame for his role as Grant Jansky in the 1996 Canadian TV series, Traders and a year later, appeared as David Worth in the 1997 Canadian psychological horror film Cube.", "Debug (film) Debug is a 2014 Canadian science fiction horror film written and directed by David Hewlett.  It stars Jeananne Goossen, Adrian Holmes, Adam Butcher, Kjartan Hewitt, Sidney Leeder, and Jaydn Wong as computer programmers who must deal with a hostile artificial intelligence on an interstellar spaceship.  It was released on 3 November 2014 in the UK.", "Desire and Hell at Sunset Motel Desire and Hell at Sunset Motel is a 1992 neo-noir black comedy written and directed by Alien Castle and produced by Donald P. Borchers that film stars Sherilyn Fenn, Whip Hubley, David Hewlett, David Johansen and Paul Bartel.", "Nothing (film) Nothing is a 2003 Canadian philosophical comedy-drama film directed by Vincenzo Natali. It stars David Hewlett and Andrew Miller.", "Pin (film) Pin is a 1988 Canadian thriller film starring David Hewlett, Cynthia Preston and Terry O'Quinn, directed by Sandor Stern.  The film was released in Canada with the title Pin, A Plastic Nightmare. It was released direct-to-video in the USA on January 27, 1989. The running time is 102 minutes. It is based on the novel of the same name by Andrew Neiderman.", "Rodney McKay Meredith Rodney McKay, Ph.D,  is a fictional character in the Canadian-American Sci-Fi Channel television series Stargate SG-1 and Stargate Atlantis, two military science fiction television shows about military teams exploring two galaxies (Milky Way and Pegasus) via a network of alien transportation devices.Played by British-born Canadian actor David Hewlett, McKay was a main character in all five seasons of Stargate Atlantis (2004\u20132009).", "Urban Legends (TV series) Urban Legends is a 30 minute 2007 television documentary-style series hosted by Michael Allcock. David Hewlett became the new host in 2011. In each episode, three urban legends are dramatized and presented to the television audience; the audience is then to speculate which one or two of the three is true. Each legend has witnesses to tell the story. For the one or two fake legends, the witnesses are actors, while the true legend(s) uses real people affected by the story."], "neg": ["Three Bites of the Apple Three Bites of the Apple is a 1967 American romance-comedy film directed by Alvin Ganzer.In this lightweight comedy, David McCallum stars as Stanley Thrumm, a retiring British tour guide who strikes it rich one night in a casino on the Riviera. He's not sure that he wants to take the cash back to England, because he'll have to pay taxes on it, so he decides to put it in a Swiss bank account.", "Matthew Hewlett Matthew Paul Hewlett (born 25 February 1976 in Bristol) is an English professional football midfielder.", "Entrepreneur Walk of Fame The Entrepreneur Walk of Fame was established to recognize the positive impact of entrepreneurs on job creation and technological progress. Seven honorees were unveiled in the inaugural year. These were Bill Gates, Bill Hewlett, Bob Swanson, David Packard, Mitch Kapor, Steve Jobs, and Thomas Edison.New honorees will be unveiled each year in the fall.The stars are located near the outbound Kendall Square MBTA Red Line stop in Cambridge, MA.", "Hewlett & Blondeau Hewlett & Blondeau was a manufacturer of aeroplanes and other equipment based in Leagrave, Luton, England which produced more than 800 aeroplanes and employed up to 700 people.", "Kate Hewlett Katherine Emily \"Kate\" Hewlett (born December 17, 1976) is a Canadian actress, writer and songwriter.Hewlett was born in Toronto, Ontario. Her brother is British-born Canadian actor David Hewlett, who portrayed Rodney McKay in Stargate Atlantis. Kate guest-starred as McKay's sister Jeannie in four episodes.", "Woodmere, New York Woodmere is a hamlet and census-designated place (CDP) in Nassau County, New York, United States. The population was 17,121 at the 2010 census.Woodmere is one of the Long Island communities known as the Five Towns, which is usually said to comprise the villages of Lawrence and Cedarhurst, the hamlets of Woodmere and Inwood, and \"The Hewletts\", which consist of the villages of Hewlett Bay Park, Hewlett Harbor and Hewlett Neck and the hamlet of Hewlett, along with Woodsburgh.", "George W. Hewlett High School George W. Hewlett High School (commonly known as Hewlett High School) is a four-year public high school in Hewlett, New York, which is a part of the Five Towns area of the South Shore of Long Island.  The school is the only high school in the Hewlett-Woodmere School District (District 14).  The principal is Theodore Fulton, Ed.D.As of the 2009-10 school year, the school had an enrollment of 1,078 students and 93.80 classroom teachers (on an FTE basis), for a student-teacher ratio of 11.49.", "HP 2100 The HP 2100 was a series of minicomputers produced by Hewlett-Packard (HP) from the mid-1960s to early 1990s. The 2100 was also a specific model in this series. The series was renamed HP 1000 by the 1970s and sold as real-time computers, complementing the more complex IT-oriented HP 3000, and would be the starting point for a line of desktop computers."]}, {"query": "Which languages are spoken in Estonia?", "pos": ["Estonia Estonia (/\u025b\u02c8sto\u028ani\u0259/; Estonian: Eesti [\u02c8e\u02d0sti]), officially the Republic of Estonia (Estonian: Eesti Vabariik), is a country in the Baltic region of Northern Europe. It is bordered to the north by the Gulf of Finland, to the west by the Baltic Sea, to the south by Latvia (343 km), and to the east by Lake Peipus and Russia (338.6 km). Across the Baltic Sea lies Sweden in the west and Finland in the north.", "Estonian Sign Language Estonian Sign Language (ESL, Estonian: Eesti viipekeel) is the national sign language of Estonia. In 1998 there were about 4,500 signers out of a deaf population of 2000 and a hearing-impaired population ten times that number. It is widespread in the cities of Tallinn and P\u00e4rnu among deaf ethnic Estonians; deaf Russian Estonians in Tallinn use Russian Sign Language, Russians outside Tallinn tend to use a Russian\u2013Estonian Sign Language pidgin, or may be bilingual.", "Estonian Swedish Estonian Swedish (Swedish: estlandssvenska, Estonian: rannarootsi keel) describes the eastern dialects of Swedish that were spoken in the formerly Swedish-populated areas of Estonia (locally known as Aiboland) on the islands of Orms\u00f6, \u00d6sel, Dag\u00f6 and Run\u00f6, and the peninsula (former island) of Nuck\u00f6, by the local Estonian Swedes.Up until the evacuation of the Estonian Swedes near the end of World War II, both Swedish and Estonian were commonly spoken on the named islands.", "Estonian grammar Estonian grammar is the grammar of the Estonian language.", "Estonian language Estonian (eesti keel [\u02c8e\u02d0sti \u02c8ke\u02d0l] ) is the official language of Estonia, spoken natively by about 922,000 people in Estonia and 160,000 outside Estonia. It belongs to the Finnic branch of the Uralic language family. One distinctive feature that has caused a great amount of interest among linguists is what is traditionally seen as three degrees of phonemic length: short, long, and \"overlong\", such that /s\u0251d\u0251/, /s\u0251\u02d1d\u0251/ and /s\u0251\u02d0d\u0251/ are distinct. In actuality, the distinction is not purely in the phonemic length, and the underlying phonological mechanism is still disputed.", "Finnic languages The Finnic (Fennic) or Baltic Finnic (Balto-Finnic, Balto-Fennic) languages are a branch of the Uralic language family spoken around the Baltic Sea by about 7 million people.The major modern representatives of the family are Finnish and Estonian, the official languages of their respective nation states. The other Finnic languages in the Baltic Sea region are Ingrian and Votic, spoken in Ingria by the Gulf of Finland; and Livonian, once spoken around Gulf of Riga.", "Finno-Samic languages The Finno-Samic languages (also Finno-Saamic, Finno-Lappic, Saamic\u2013Fennic) are a hypothetical subgroup of the Uralic family, and are made up of 22 languages classified into either the Sami languages, which are spoken by the Sami people who inhabit the S\u00e1pmi region of northern Fennoscandia, or Finnic languages, which include the major languages Finnish and Estonian. The grouping is not universally recognized as valid.", "Laiuse Romani language Laiuse Romani was a Romani variety spoken in Estonia. It was a mixed language based on Romani and Estonian.The Romani people first appeared to Estonia in the 17th century. According to rumors, they were first part of Swedish King Charles XII's Romani orchestra which he, after spending a winter in Laiuse, left behind. In 1841 all of the 44 Estonian Romani were collected and settled around Laiuse Parish.", "Languages of Estonia The official language of Estonia is Estonian, a Uralic language which is related to Finnish but unrelated to nearby Russian and Latvian which are of Indo-European root. Standard Estonian is mainly based on the North Estonian language, while South Estonian includes several unrecognised dialects, specifically V\u00f5ro, Mulgi and Tartu. V\u00f5ro, being furthest away from Standard Estonian, is the only one to have been given an ISO 639-3 language code by SIL (\\vro\\\").\"", "Languages of the European Union The languages of the European Union are languages used by people within the member states of the European Union. They include the twenty-four official languages of the European Union along with a range of others.", "Modern Swedish Modern Swedish (Swedish: nysvenska) is the linguistic term used for the Swedish language from the Bible translation of 1526 to the development of a common national language around 1880. The period can further be divided into Early Modern Swedish (1526\u20131750) and Late Modern Swedish (1750\u20131880).", "Northeastern coastal Estonian The Northeastern coastal dialect (Estonian: kirderannikumurre) is a dialect (or dialect group) of the Estonian language. The coastal dialects of the Estonian language were spoken on the coastal strip of Estonia from Tallinn to river Narva. It has very few speakers left nowadays.", "Russian Sign Language Russian Sign Language is the sign language of the Deaf community in Russia. It has a grammar unlike the (spoken or written) Russian language, with much stricter word order and word formation rules.  Russian Sign Language belongs to a family of French Sign Language.  Vocabulary from Austrian Sign Language also heavily influences Russian Sign Language.Russian Sign Language (\u0420\u0416\u042f) has its own grammar and is used by Deaf Russians in everyday communication.", "Russian language Russian (\u0440\u0443\u0301\u0441\u0441\u043a\u0438\u0439 \u044f\u0437\u044b\u0301\u043a, russkiy yazyk, pronounced [\u02c8rusk\u02b2\u026aj j\u026a\u02c8z\u0268k]) is an East Slavic language and an official language in Russia, Belarus, Kazakhstan, and Kyrgyzstan. It is an unofficial but widely spoken language in Ukraine, Moldova, Latvia, Estonia, and to a lesser extent, the other countries that were once constituent republics of the Soviet Union and former participants of the Eastern Bloc.", "Seto dialect Seto or Setu language (seto kiil\u00b4; Estonian: setu keel) is a dialect of the South Estonian or V\u00f5ro language (although the Setos generally do not identify as V\u00f5ro speakers), spoken by 12,549 people. The speakers, Seto people, mostly inhabit the area near Estonia's southeastern border with Russia, in the county of Setomaa.", "South Estonian language South Estonian is a Finnic language spoken in South-Eastern Estonia, encompassing the Tartu, Mulgi, V\u00f5ro and Seto languages or dialects. It has traditionally been considered one of the two or three main dialect groups of the Estonian language, and is largely mutually intelligible with modern standard Estonian, although diachronically North and South Estonian are separate branches of the Finnic languages.Modern standard Estonian has evolved on the basis of the dialects of Northern Estonia.", "Sweden Swedish Sweden Swedish (Swedish: sverigesvenska) is a term sometimes used to distinguish the Swedish as spoken in Sweden from Finland Swedish, Estonian Swedish or other variants of the same language as spoken in other countries, regardless of dialects.", "Uralic languages The Uralic languages /j\u028a\u02c8r\u00e6l\u0268k/  (sometimes called Uralian /j\u028a\u02c8re\u026ali\u0259n/ languages) constitute a language family of some 38 languages spoken by approximately 25 million people. The Uralic languages with the most native speakers are Hungarian, Finnish, and Estonian, which are official languages of Hungary, Finland, and Estonia, respectively, and of the European Union.", "V\u00f5ro language The V\u00f5ro language (V\u00f5ro: v\u00f5ro kiilTemplate:` [\u02c8v\u0264ro k\u02b2i\u02d0l\u02b2], Estonian: v\u00f5ru keel) is a language belonging to the Finnic branch of the Uralic languages. Traditionally it has been considered a dialect of the South Estonian dialect group of the Estonian language, but nowadays it has its own literary language and is in search of official recognition as an autochthonous regional language of Estonia."], "neg": ["Nepali language Nepali or Nepalese is  an Indo-Aryan language.  It is the official language and de facto lingua franca of Nepal and is also spoken in India, Bhutan and Myanmar. Nepali has official status in the Indian state of Sikkim and in West Bengal's Darjeeling district. Nepali developed in proximity to a number of Indo-Aryan languages, most notably the Pahari languages and Magahi, and shows Sanskrit influences.", "Demographics of Turkey This article is about the demographic features of the population of Turkey, including population density, ethnicity, education level, health of the populace, economic status, religious affiliations and other aspects of the population.In 2010, the population of Turkey was estimated to be 73.7 million with a growth rate of 1.21% per annum (2009 figure). The population is relatively young with 25.9% falling in the 0-14 age bracket.", "Estonian Literary Magazine Estonian Literary Magazine or simply ELM is an English language biannual literary magazine published in Estonia.", "Bisakol languages Bisakol (portmanteau of Bisaya and Bikol) refers to the transitional languages in the Central Philippine language family, between Visayan languages and Bikol languages.  They are usually classified by linguists as Visayan languages with a great deal of Bikol influence. These languages are spoken in the Bicol Region and include Sorsoganon, a group of Warayan speech varieties of Sorsogon, namely Central Sorsogon (Masbate Sorsogon) and Southern Sorsogon (Waray Sorsogon).", "P\u00e4evaleht (1905) P\u00e4evaleht was a newspaper published between 1905 and 1940 in Estonia.", "Reichskommissariat Ostland Nazi Germany established the Reichskommissariat Ostland (RKO) in 1941 as the civilian occupation regime in the Baltic states (Estonia, Latvia, and Lithuania), the northeastern part of Poland and the west part of the Belarusian SSR during World War II. It was also known initially as Reichskommissariat Baltenland \"\\Baltic Land\").", "Sadri language Sadri, also known as Nagpuri, is spoken in the Indian states of Bihar, Jharkhand, Orissa and the north of West Bengal, and in Bangladesh.Speakers of Sadri also use Hindi, Oriya, and Bengali. In 1997 the population included 1,381,000 Sadani, 574,000 Nagpuri, and 165,683 Oraon. It is also spoken by the Chero tribe as first language. Sadri has become a lingua franca of Jharkhandi society.", "Dwayne Morgan Dwayne Morgan is a Canadian spoken word artist, motivational speaker and event organizer based in Toronto, Ontario.Morgan began his career as a spoken word artist in 1993. He is the founder of Up From The Roots Entertainment, which was established in 1994 to promote the positive artistic contributions of African Canadian and urban influenced artists. He received both the African Canadian Achievement Award for Youth Achievement, and the Harry Jerome Award for Excellence in the Arts in 1998."]}, {"query": "Chefs with a show on the Food Network.", "pos": ["Aaron McCargo, Jr. Aaron McCargo Jr. is an American chef from Camden, New Jersey. He is best known as the winner of the fourth season of the Food Network's reality television show, The Next Food Network Star.He has a preference for meats and bold, spicy flavors, and avoids overly complex recipes. He calls the food he cooks \"soul food,\" but with multiple cultural influences.", "Aarti Sequeira Aarti Sequeira is an Indian chef and television personality, best known as the winner of the sixth season of Food Network's reality television show, The Next Food Network Star.  As a result of that victory, her show Aarti Party premiered on the network on August 22, 2010. She had previously worked as a CNN news producer and in 2008 started the online cooking variety show Aarti Paarti.", "Aar\u00f3n Sanchez Aar\u00f3n S\u00e1nchez (born February 12, 1976) is a chef and television personality. He is the executive chef and part-owner of the restaurant Paloma in Stamford, Connecticut, the restaurant Johnny S\u00e1nchez in New Orleans, Louisiana, and the (now closed) Mexican restaurant Mestizo in Leawood, Kansas.  He has appeared on Iron Chef America, and is one of the few chefs whose battles have ended in a draw, tying with Masaharu Morimoto in \"Battle Black Bass\" in Season 2.", "Adam Gertler Adam Gertler is an American chef, television personality and occasional actor.", "Aida Mollenkamp Aida Marianne Mollenkamp (born April 15, 1980) is a chef, television personality, and food writer from Manhattan Beach, California.", "Alex Guarnaschelli Alexandra \"Alex\" Guarnaschelli is a  celebrity chef and executive chef at New York City's Butter restaurant and was executive chef at the award-winning The Darby restaurant before its closing. She appears as a television personality on the Food Network shows Chopped, Iron Chef America, All Star Family Cook-off, and The Best Thing I Ever Ate. She hosts Alex's Day Off and The Cooking Loft on Food Network and Cooking Channel.", "Alton Brown Alton Crawford Brown (born July 30, 1962) is an American television personality, food show presenter, author, actor, and cinematographer. He is the creator and host of the Food Network television show Good Eats, host of the mini-series Feasting on Asphalt and Feasting on Waves, and host and main commentator on Iron Chef America and Cutthroat Kitchen. Brown is also the author of several books on cookery.", "Amy Finley Amy Finley (born in 1973 in San Diego, California) is an American cook and writer, who was the winner of the third season of The Next Food Network Star awarded a commitment to host a cooking show on the Food Network.", "Anne Burrell Anne W. Burrell (born September 21, 1969) is an American chef, TV personality, and was an instructor at the Institute of Culinary Education in New York City until 2007. She is the host of the Food Network show Secrets Of a Restaurant Chef and co-host of Worst Cooks in America. She is also one of Iron Chef Mario Batali's sous chefs in the Iron Chef America series and appears on other programs on the network such as The Best Thing I Ever Ate.", "Anthony Bourdain Anthony Michael Bourdain (born June 25, 1956) is an American chef, author, and television personality. He is a 1978 graduate of the Culinary Institute of America and a veteran of numerous professional kitchens, including many years as executive chef at Brasserie Les Halles. Though Bourdain is no longer formally employed as a chef, he maintains a relationship with Les Halles in New York.", "Big Daddy's House Big Daddy's House is a cooking show on the specialty channel Food Network. The show stars Aaron McCargo, Jr., the winner of the fourth season of the network's reality television series, The Next Food Network Star. The six-episode first season was McCargo's grand prize for winning the reality show.", "Bob Blumer Bob Blumer is the host of Food Network's The Surreal Gourmet, Glutton for Punishment, and World's Weirdest Restaurants. He is also a cook book author and illustrator. Blumer was born and raised in Montreal, Quebec, but now calls Los Angeles, California his home. Bob serves as an Ambassador to Second Harvest in Toronto spreading the word about food rescue and hunger relief.", "Bobby Deen Robert Earl \"Bobby\" Deen (born April 28, 1970) is a television cook, TV personality, and restaurant manager.  He is the second son of Paula Deen and with his brother, Jamie, operates her restaurant, The Lady & Sons, in Savannah, Georgia. He also frequently appears on her shows, Paula's Home Cooking and Paula's Party. He and Jamie had their own show, Road Tasted, starting July 11, 2006.", "Bobby Flay Robert William \"Bobby\" Flay (born December 10, 1964) is an American celebrity chef, restaurateur, and reality television personality.", "Cat Cora Catherine Ann \"Cat\" Cora (born April 3, 1967) is an American professional chef best known for her featured role as an \"Iron Chef\" on the Food Network television show Iron Chef America and as co-host of Around the World in 80 Plates on Bravo.", "Chef Wanted with Anne Burrell Chef Wanted with Anne Burrell currently airs on Food Network Thursday night at 10pm. In this show, chef Anne Burrell travels to different parts of the country and visits owners of restaurants in need of a new executive chef. Burrell brings in four chefs to compete for the job. The chefs are tested in their culinary skills.", "Chef at Home Chef at Home is a show presented by professionally trained chef Michael Smith.  It is filmed at the Farmhouse at the Cove home in Prince Edward Island.  It is currently broadcast on Food Network Canada and produced by Ocean Entertainment.", "Chocolate with Jacques Torres Chocolate with Jacques Torres is a North American television cooking show hosted by renowned pastry chef and chocolate aficionado, Jacques Torres. It premiered in on the Food Network in 2002.The show was taped in the United States and France, occasionally in Torres' home region of Provence. Its primary focus is on extravagant chocolate-based desserts, including chocolate sculptures, centerpieces, and other edible artwork.", "Cupcake Wars Cupcake Wars is an American reality competition series which premiered on December 27, 2009 and concluded on December 28, 2013 and aired on the cable television network Food Network. The cooking show is hosted by Justin Willman and based on creating unique and professional-style cupcakes.The show is similar to successful Chopped cooking show aired on the same network, in that it starts with four contestants who are eliminated one-by-one in three rounds, with the winning team receiving $10,000.", "Daisy Martinez Daisy Maria Martinez is an actress, model, chef, television personality and author, who hosts a PBS television series, Daisy Cooks!, which launched on April 15, 2005.", "Dave Lieberman Dave Lieberman (born in Philadelphia, Pennsylvania) is the host of the Food Network series Good Deal with Dave Lieberman.Lieberman attended The Shipley School. Campus Cuisine, his first cooking show at Yale University, was a Public-access television show that combined \"sophisticated and accessible cooking with crazy college adventures.\"Lieberman's first book, Young & Hungry, was published in 2005. Soon after, he made People magazine's 50 Hottest Bachelors (June 27 issue).", "David Rosengarten David Rosengarten (born in New York City, New York), the son of Leonard Rosengarten, a garment industry executive, and the former Lorraine Stein, is an American chef, author and television personality, who has hosted more than 2500 television shows on the Food Network from 1994 to 2001.He married Constance Childs on October 15, 1983.  Their wedding was catered by a then-unknown Martha Stewart. He has three children.", "Duff Goldman Geoffrey Adam \"Duff\" Goldman (born December 17, 1974) is a pastry chef and television personality. He is the executive chef of the Baltimore-based Charm City Cakes shop which was featured in the Food Network reality television show Ace of Cakes, and his second Los Angeles-based shop Charm City Cakes West, which is featured in Food Network's Duff Till Dawn series. His work has also been featured on the Food Network Challenge, Iron Chef America, Oprah, The Tonight Show with Jay Leno and Man v.", "Food Network Food Network (legally known as Television Food Network) is an American basic cable and satellite television channel that is owned by Television Food Network, G.P., a joint venture between Scripps Networks Interactive (which owns 70% of the network) and the Tribune (FN) Cable Ventures Inc. (which owns the remaining 30%). Despite this ownership structure, the channel is managed as a division of Scripps Networks Interactive.", "Food Network (Canada) Food Network is a Canadian English language Category A specialty channel with programming related to food, cooking, cuisine, and the food industry. Food Network is a joint venture between Shaw Media and Scripps Networks Interactive.", "Food Network Star (season 11) The eleventh season of the American reality television series Food Network Star premiered June 7, 2015  on Food Network. Food Network chefs Bobby Flay and Giada de Laurentiis returned to the show as mentors, with Alton Brown not returning for undisclosed reasons.", "Giada's Weekend Getaways Giada's Weekend Getaways is a show on the US Food Network that ran from 2007 to 2008. The show follows chef Giada De Laurentiis around the USA for \"3 day weekend adventures.\" The show begins Friday afternoon, as Giada arrives at her destination. She may begin with a light dinner, appetizer, and a cocktail.", "Giada De Laurentiis Giada Pamela De Laurentiis (Italian pronunciation: [\u02c8d\u0292a\u02d0da de lau\u02c8r\u025bnti(i)s]; born August 22, 1970) is an Italian-born American chef, writer, television personality, and the host of the current Food Network television program Giada at Home. She also appears regularly as a contributor and guest co-host on NBC's Today. De Laurentiis is the founder of the catering business GDL Foods.", "Guy Fieri Guy Fieri [\u02c8fj\u025b\u027ei] (born Guy Ramsay Ferry; January 22, 1968) is an American restaurateur, author, game host, and television personality currently working for Food Network.", "Ina Garten Ina Rosenberg Garten (/\u02c8a\u026an\u0259/ EYE-n\u0259; born February 2, 1948) is an American author and host of the Food Network program Barefoot Contessa, and  a former staff member of the White House Office of Management and Budget.", "Ingrid Hoffmann Ingrid Hoffmann (born April 10, 1965) is a Colombian-American television personality and restaurateur, who hosts the Food Network series Simply Delicioso and the Spanish-language cooking and lifestyle show Delicioso on Galavisi\u00f3n. Her cookbook, Simply Delicioso: A Collection of Everyday Recipes with a Latin Twist, was published on February 8, 2008 by Clarkson Potter.  The Spanish version is titled Delicioso: Una coleccion de mis recetas favoritas con un toque latino.", "Jamie Oliver James Trevor \"Jamie\" Oliver, MBE (born 27 May 1975) is an English celebrity chef, restaurateur, and media personality known for his food-focused television shows, cookbooks and more recently his global campaign for better food education.", "Jeff Mauro Jeff Mauro is the host of the Food Network series Sandwich King and $24 in 24. Prior to this, he was the winner of the seventh season of the Food Network Star competition. Mauro, who is originally from Elmwood Park, Illinois, incorporates local Chicago restaurants into the context of his show.During Food Network Star, where fifteen contestants competed for an opportunity to have their own cooking show, Mauro maintained a strict concentration on sandwiches throughout the competition.", "Julia Child Julia Carolyn Child (born McWilliams; August 15, 1912 \u2013 August 13, 2004) was an American chef, author, and television personality. She is recognized for bringing French cuisine to the American public with her debut cookbook, Mastering the Art of French Cooking, and her subsequent television programs, the most notable of which was The French Chef, which premiered in 1963.", "Keith Famie Keith Famie (born February 11, 1960) is a director/producer of human-interest films. He is probably best known for being a contestant on the CBS reality television series, Survivor: The Australian Outback. He was the 14th person to be voted off and finished in 3rd place.", "Kelsey Nixon Kelsey Nixon (born September 7, 1984) is an American chef who hosts the Cooking Channel series Kelsey\u2019s Essentials, which premiered November 6, 2010.  She was one of the final four contestants in the fourth season of the Food Network series Food Network Star.", "Kevin Brauch Kevin Jeffery Brauch (born January 18, 1968 in Toronto), \"celebrity bartender,\" is host of the show The Thirsty Traveler on the Fine Living Network (originally on the Food Network), MegaWorld on Discovery Channel Canada, and Superstar Chef Challenge on Food Network Canada.  He also serves as the floor reporter for Iron Chef America (on both the American and Canadian Food Networks).  He will host the upcoming Food Network Canada program CheF*Off.", "Lenny McNab Lenny McNab is an American chef who is best known as the winner of the tenth season of the Food Network television series Food Network Star. He defeated runner-up Luca Della Casa on August 10, 2014. Food Network executive Bob Tuschman said that \"Lenny's magnetic personality, culinary chops and cowboy swagger made him stand out in this very talented crowd from the beginning.\"McNab wears cowboy attire and specializes in \"elevated chuck wagon fare\".", "List of programs broadcast by Food Network This is a list of shows that have been broadcast (or are planned to be broadcast) on the Food Network.", "Lynn Crawford Lynn Crawford (born 1964) is a Canadian chef, trained at George Brown College in Toronto.  She is known for her appearances on the hit Food Network show Restaurant Makeover, which is seen in over 16 countries worldwide.  She was formerly the executive chef at the Four Seasons in Toronto and the former executive chef of the Four Seasons in New York. She appeared on the Food Network's Iron Chef America (the third chef from Canada to do so), in a battle with Iron Chef Bobby Flay.", "Madison Cowan Madison Cowan is a British-American chef, best known as the first ever Grand Champion of Food Network's Chopped.", "Martie Duncan Martie Duncan is an American chef, blogger and party planner. She was a finalist on the eighth season of the Food Network series Food Network Star.", "Michael Chiarello Michael Chiarello (born January 26, 1962 in Red Bluff, California, United States) is an American celebrity chef specializing in Italian-influenced California cuisine. He hosts the cooking show, Easy Entertaining with Michael Chiarello, on the Food Network and hosts NapaStyle on the Fine Living Network.", "Michael Symon Michael D. Symon (born September 19, 1969) is a James Beard Foundation Award-winning American chef, restaurateur, television personality, and author. He is seen regularly on Food Network on shows such as Iron Chef America, Food Feuds, and The Best Thing I Ever Ate, as well as Cook Like an Iron Chef on the Cooking Channel and The Chew on ABC.", "Nadia Giosia Nadia Giosia (born May 12, 1980), better known as Nadia G., is a Canadian cooking personality, comedic actress, and singer who transitioned her web cooking series into a TV cooking show. She is the host of Nadia G's Bitchin' Kitchen, which has appeared on the Cooking Channel, Food Network Canada and Food Network UK. This show ran for 3 series on television, but started on YouTube as a web-series. Most of these videos have since been removed from YouTube.", "Nathan Lyon (chef) Nathan Lyon is an American chef and television personality. He hosted the Discovery Health television series A Lyon in the Kitchen.A native of Arlington, Virginia, Lyon earned an undergraduate degree at James Madison University. He began working in the food industry at the Army Navy Country Club in Arlington as a soldier, and then as a cafe manager. He attended the California School of Culinary Arts and then worked in several restaurants in Los Angeles.", "Pat Neely Patrick \"Pat\" Neely  is a restaurateur, television personality, and author. He is the co-owner of Neely's Bar-B-Que restaurant in downtown Memphis, Tennessee. He and former wife Gina hosted two popular Food Network television programs named Down Home with the Neelys and Road Tasted with the Neelys. The pair also co-wrote a cook book.  Down Home became the highest rated debut for a Food Network show within the \"In the Kitchen\" series, which appear on weekend mornings.", "Paula Deen Paula Ann Hiers Deen (born January 19, 1947) is an American celebrity chef and cooking show television host. Deen resides in Savannah, Georgia, where she owns and operates The Lady & Sons restaurant with her sons, Jamie and Bobby Deen. She has published fourteen cookbooks. Though married since 2004 to Michael Groover, she uses the surname Deen, from her first marriage.", "Rachael Ray Rachael Ray (born August 25, 1968) is an American television personality, businesswoman, celebrity cook and author. She hosts the syndicated daily talk and lifestyle program Rachael Ray, and three Food Network series (30 Minute Meals, Rachael Ray's Tasty Travels, and $40 a Day). Other programs to her credit include Rachael Ray's Week In A Day and the reality format shows Rachael vs. Guy: Celebrity Cook-Off, Rachael vs. Guy: Kids Cook-Off and Rachael Ray's Kids Cook-Off.", "Robert Irvine Robert Irvine (born 24 September 1965) is a British celebrity chef who has appeared on a variety of Food Network programs including Dinner: Impossible, Worst Cooks in America, Restaurant: Impossible, and Restaurant Express.", "Ron Ben-Israel Ron Ben-Israel is an Israeli pastry chef. He is the executive chef and owner of Ron Ben-Israel Cakes in New York City. He is known for his wedding and special occasion cakes and for his detail in sugar paste flowers. From 2011 - 2013, he also hosted the cooking competition TV show Sweet Genius.", "Sara Moulton Sara Moulton (born February 19, 1952) is an American chef, cookbook author and television personality.She was the on-air food editor for Good Morning America, a morning news-and-talk show broadcast on the ABC television network, from 1997 through 2012.", "Simon Majumdar Simon Majumdar is a British-American chef, author, and television personality. He was brought up in Rotherham, South Yorkshire and has previously worked as a book publisher.  He has appeared as a judge on the Food Network shows Cutthroat Kitchen, Iron Chef America, and The Next Iron Chef. He has written books titled \"Fed, White, and Blue\", \"Eat My Globe\", and \"Eating For Britain\".", "Sugar Rush (Food Network) Sugar Rush is a TV show on the Food Network hosted by Warren Brown, a former lawyer who decided to become a pastry chef. Brown, who runs a pastry shop, Cake Love, and cafe, Love Cafe in Washington, DC, meets other pastry chefs and dessert makers and cooks with them. The show is currently in its second season, first airing in June 2006.", "Sunny Anderson Sunny Anderson (born April 9, 1975) is a Food Network personality. She began hosting How'd That Get On My Plate? in July 2008. She also hosts the Food Network program Cooking for Real (beginning in April 2008), and served as co-host with Marc Istook of the Food Network program Gotta Get It (beginning in April 2007).", "Ted Allen Ted Allen (born May 20, 1965) is an American writer, cookbook author, and television personality. He was the food and wine connoisseur on the American Bravo network's television program Queer Eye and has been the host of the TV cooking competition series Chopped since its launch in 2009. As of April 13, 2014, he is also the host of another Food Network show, originally called America's Best Cook; a retooled version of that show, retitled All-Star Academy, which  debuted on March 1, 2015.", "The Food Network Awards The Food Network Awards are a United States television production awards ceremony, focused on giving awards to chefs, cities, restaurants, and other notable food related institutions. The first ever Food Network Awards took place as part of the Food Network South Beach Wine and Food Festival in Miami on February 23, 2007. Emeril Lagasse served as Master of Ceremonies for this awards show honoring achievements in the world of food and entertaining.", "The Kitchen (TV series) The Kitchen is a cooking-themed talk show that airs on Food Network. The series is presented by Food Network chefs Sunny Anderson, Jeff Mauro and Marcela Valladolid (who also host the respective series Cooking for Real, Sandwich King and Mexican Made Easy); as well as frequent Food Network personality Geoffrey Zakarian and food critic Katie Lee.", "The Next Food Network Star (season 4) The fourth season of the American reality television series The Next Food Network Star  premiered on Sunday, June 1, 2008. Food Network executives, Bob Tuschman and Susie Fogelson, were joined by Bobby Flay as the Selection Committee for this season, which was filmed early 2008 in New York, New York and Las Vegas, Nevada. Aaron McCargo, Jr. was announced as the winner on the season finale, which aired on Sunday, July 27, 2008. His show, Big Daddy's House, premiered on August 3, 2008.", "Tyler Florence Tyler Florence (born Kevin Tyler Florence  on March 3, 1971) is a chef and television host of several Food Network shows. He graduated from the College of Culinary Arts at the Charleston, South Carolina, campus of Johnson & Wales University in 1991. He was later given an honorary doctorate from the university for his culinary success."], "neg": ["Iron Chef America Iron Chef America: The Series is an American cooking show based on Fuji Television's Iron Chef, and is the second American adaptation of the series, following the failed Iron Chef USA.  The show is produced by Food Network, which also carried a dubbed version of the original Iron Chef.  Like the original Japanese program, the program is a culinary game show.", "Cooking show A cooking show or cookery programme is a television genre that presents food preparation in a kitchen studio set.  Typically the show's host, often a celebrity chef, prepares one or more dishes over the course of an episode, taking the viewing audience through the food's inspiration, preparation, and stages of cooking.", "List of Anna & Kristina's Grocery Bag episodes This is the episode list of the cooking / informative television series Anna & Kristina's Grocery Bag which airs on W Network in Canada and OWN: The Oprah Winfrey Network in United States.", "Food Network Star Food Network Star is a reality television series produced by and aired on the Food Network in the United States that awards the winner his or her own series on the Food Network. Prior to season seven, the show was known as The Next Food Network Star.", "Chefs vs. City Chefs vs. City is an American television show produced by Food Network. The show stars chefs Aar\u00f3n Sanchez and Chris Cosentino who travel to different cities of the United States to challenge two local chefs to a variety of food-related challenges. Also starring is actor Ethan Erickson as the show's host. The show first aired on August 7, 2009.", "Gordon Ramsay Gordon James Ramsay, OBE (born 8 November 1966) is a Scottish-born British chef and restaurateur. His restaurants have been awarded 16 Michelin stars in total and currently hold 14. His signature restaurant, Restaurant Gordon Ramsay in Chelsea, London, has held 3 Michelin stars since 2001.", "Anthony Bourdain: No Reservations Anthony Bourdain: No Reservations is an American travel and food show that airs on the Travel Channel; it also airs on the Discovery Travel & Living channel around the world. In it, host Anthony Bourdain visits overseas countries, cities worldwide, and places within the U.S., where hosts treat him to local culture and cuisine. The series premiered in 2005 on the Travel Channel. The format and content of the show is similar to Bourdain's 2001\u20132002 Food Network series, A Cook's Tour.", "Maneet Chauhan Maneet Chauhan (born October 27, 1976 in Ludhiana, Punjab) is a US-based television personality."]}], "FEVER": [{"query": "Apocalypse Now is a war film.", "pos": ["Apocalypse Now Apocalypse Now is a 1979 American epic war film directed , produced and co-written by Francis Ford Coppola . It was co-written by John Milius with narration written by Michael Herr . It stars Marlon Brando , Robert Duvall , Martin Sheen , Frederic Forrest , Albert Hall , Sam Bottoms , Larry Fishburne , and Dennis Hopper . The screenplay , written by Milius , adapts the story of Joseph Conrad 's novella Heart of Darkness changing its setting from late 1800 's Congo to the Vietnam War . It draws from Herr 's Dispatches , and Werner Herzog 's Aguirre , the Wrath of God ( 1972 ) . The film revolves around Captain Benjamin L. Willard ( Sheen ) on a secret mission to assassinate Colonel Kurtz , a renegade who is presumed insane .   The film has been noted for the problems encountered while making it , chronicled in the documentary Hearts of Darkness : A Filmmaker 's Apocalypse ( 1991 ) . These problems included Brando arriving on the set overweight and completely unprepared , expensive sets being destroyed by severe weather , and its lead actor ( Sheen ) having a breakdown , and suffering a near-fatal heart attack , while on location . Problems continued after production as the release was postponed several times while Coppola edited thousands of feet of film .   Apocalypse Now was released to universal acclaim . It was honored with the Palme d'Or at Cannes , nominated for the Academy Award for Best Picture , and the Golden Globe Award for Best Motion Picture -- Drama . It is considered to be one of the greatest films ever made . The film was ranked No. 14 in the British Film Institute 's Sight and Sound greatest films poll in 2012 . In 2000 , the film was selected for preservation in the National Film Registry by the Library of Congress as being `` culturally , historically or aesthetically significant '' ."], "neg": ["Mozarabs The Mozarabs ( moz\u00e1rabes -LSB- mo\u02c8\u03b8a\u027ea\u03b2es -RSB- mo\u00e7\u00e1rabes -LSB- mu\u02c8sa\u027e\u0250\u03b2\u0268\u0283 -RSB- moss\u00e0rabs -LSB- mu\u02c8sa\u027e\u0259ps -RSB- \u0645\u0633\u062a\u0639\u0631\u0628 trans . musta ` rab , `` Arabized '' ) is a modern historical term that refers to the Iberian Christians who lived under Moorish rule in Al-Andalus . Their descendants remained unconverted to Islam , however they were mostly fluent in Arabic and adopted elements of Arabic culture . The local Romance vernaculars , heavily permeated by Arabic , spoken by Christians and Muslim alike has also come to be known as Mozarabic language . Mozarabs were mostly Roman Catholics of the Visigothic or Mozarabic Rite .   Most of the Mozarabs were descendants of Hispanic Christians and were primarily speakers of the Mozarabic language ( late Latin of Iberia ) under Islamic rule . They also included those members of the former Visigothic ruling elite who did not convert to Islam or emigrate northwards after the Muslim conquest .   A few were Arab and Berber Christians coupled with Muslim converts to Christianity who , as Arabic speakers , naturally were at home among the original Mozarabs . A prominent example of Muslims who became Mozarabs by embracing Christianity is the Andalusian rebel and Anti-Umayyad military leader , Umar ibn Hafsun . The Mozarabs of Muslim origin were descendants of those Muslims who converted to Christianity , following the conquest of Toledo and perhaps also , following the expeditions of king Alfonso I of Aragon . These Mozarabs of Muslim origin , who converted en masse at the end of the 11th century , many of them Muladi ( ethnic Iberians previously converted to Islam ) , are totally distinct from the Mud\u00e9jars and Moriscos who converted gradually to Christianity between the 12th and 17th centuries . Some Mozarabs were even Conversos Sephardi Jews who likewise became part of the Mozarabic milieu .   Separate Mozarab enclaves were located in the large Muslim cities , especially Toledo , C\u00f3rdoba , Zaragoza , and Seville .", "Right from the Start `` Right from the Start '' is a song written by Billy Herzig and Randy Watkins , and recorded by American country music artist Earl Thomas Conley . It was released in July 1987 as the fourth single from the album Too Many Times . `` Right from the Start '' was Earl Thomas Conley fourteenth number one country single . The single went to number one for one week and spent a total of fourteen weeks on the country chart .", "Steppin' Out Steppin ' Out or Stepping Out may refer to :", "Kim Min-sung Kim Min-sung ( born December 17 , 1988 ) is South Korean professional baseball infielder who is currently playing for the Nexen Heroes of Korea Baseball Organization .", "Polybotrya andina Polybotrya andina is a species of fern in the Dryopteridaceae family . It is endemic to Ecuador . Its natural habitats are subtropical or tropical moist lowland forests and subtropical or tropical moist montane forests . It is threatened by habitat loss .", "Peter Samu Peter Samu ( born 17 December 1991 ) is an Australian rugby union player who currently plays as a loose forward for in New Zealand 's domestic Mitre 10 Cup and the in the international Super Rugby competition .", "Renate Dodell Renate Dodell ( born November 7 , 1952 in Seeshaupt ) is a German politician , representative of the Christian Social Union of Bavaria .", "Paul Emsley (crystallographer) Paul Emsley is a British crystallographer and a member of the Computational Crystallography Group headed by Garib Murshudov at the MRC Laboratory of Molecular Biology in Cambridge .   Emsley is the primary author of the model-building software Coot . Coot is a tool with which to build models of proteins whose three dimensional structures are determined via X-ray crystallography or cryo-EM . These protein structures are deposited at the Worldwide Protein Data Bankfor collaboration among scientists . Since its introduction in 2004 , Coot has remained as free software for use in industrial and academic research groups .   Emsley has given Coot training courses at Cold Spring Harbor Laboratory and as CCP4 courses , where he is also a developer and contributor ."]}, {"query": "Steffi Graf competed in three grand slams in a calendar year five times.", "pos": ["Steffi Graf Stefanie Maria `` Steffi '' Graf ( -LSB- \u02c8\u0283t\u025bfi\u02d0 \u02c8g\u0281a : f -RSB- ; born 14 June 1969 ) is a German former tennis player , who was ranked world No. 1 during her career . Graf won 22 Grand Slam singles titles . Her 22 singles titles put her second on the list of Major wins by a tennis player ( male or female ) since the introduction of the Open Era in 1968 and is third all-time behind Margaret Court ( 24 ) and Serena Williams ( 23 ) . In 1988 , she became the first and only tennis player ( male or female ) to achieve the Golden Slam by winning all four Grand Slam singles titles and the Olympic gold medal in the same calendar year . Furthermore , she is the only tennis player to have won each Grand Slam event at least four times .   Graf was ranked world No. 1 by the Women 's Tennis Association ( WTA ) for a record 377 total weeks -- the longest period for which any player , male or female , has held the number-one ranking since the WTA and the Association of Tennis Professionals began issuing rankings . She won 107 singles titles , which ranks her third on the WTA 's all-time list after Martina Navratilova ( 167 titles ) and Chris Evert ( 157 titles ) . She and Margaret Court are the only players , male or female , to win three grand slams in a calendar year five times ( 1988 , 1989 , 1993 , 1995 and 1996 ) .   Notable features of Graf 's game were her versatility across all playing surfaces , footwork and her powerful forehand drive . Graf won six French Open singles titles ( second to Evert ) , seven Wimbledon singles titles , four Australian Open titles , and five U.S. Open singles titles . She is the only singles player ( male or female ) to have achieved a Grand Slam since hard court was introduced as a surface at the US Open in 1978 . Consequently , Graf 's Grand Slam was achieved on grass , clay , and hard court while the previous five Grand Slams were decided on only grass and clay . Graf reached thirteen consecutive Grand Slam singles finals , from the 1987 French Open through to the 1990 French Open , winning nine of them . She won 5 consecutive Majors ( 1988 Australian Open to 1989 Australian Open ) , and seven Majors out of eight , in two calendar years ( 1988 Australian Open to 1989 US Open , except 1989 French Open ) . She reached a total of 31 Grand Slam singles finals .   Graf is regarded by some to be the greatest female tennis player of all time . Navratilova included Graf on her list of great players . In 1999 Billie Jean King said `` Steffi is definitely the greatest women 's tennis player of all time '' . In December 1999 , Graf was named the greatest female tennis player of the 20th century by a panel of experts assembled by the Associated Press . Tennis writer Steve Flink , in his book The Greatest Tennis Matches of the Twentieth Century , named her as the best female player of the 20th century . In March 2012 , Tennis Channel picked Graf as the greatest female tennis player ever in their list of 100 greatest tennis players of all time .   Graf retired in 1999 while she was ranked World No. 3 . She married former World No. 1 men 's tennis player Andre Agassi in October 2001 . The couple has two children -- Jaden Gil and Jaz Elle . Graf was inducted into the Tennis Hall of Fame in 2004 ."], "neg": ["Ishikozume Ishikozume ( Japanese \u77f3\u5b50\u8a70\u3081 ) was a ritual method of execution performed in ancient Japan by the Yamabushi , hermetic practitioners of the Shugend\u014d religion . The ritual is characterized by waist high burial in earth followed by lapidation ( death by stoning ) .", "Indian women's cricket team in South Africa in 2001\u201302 The India women 's national cricket team toured South Africa in 2001 -- 02 , playing one Test match and four women 's One Day Internationals .  South Africa won the ODI series by 2 -- 1 and India won the only Test match played between the sides .", "Glenn Bryce Glenn Bryce ( born 7 June 1991 in Alloa ) is a Scottish international 7s rugby union player . He played at Fullback for Glasgow Warriors . He now plays for Edinburgh Rugby .", "Kalikhola Kalikhola is a village development committee in the Himalayas of Taplejung District in the Mechi Zone of north-eastern Nepal . At the time of the 2011 Nepal census it had a population of 629 living in 118 individual households.There were 303 males and 326 females at the time of census .", "Baykalsko Baykalsko or Baikalsko is a village in Radomir Municipality , Pernik Province , Southwest Bulgaria . Population : 75 ( as of January 1 , 2007 ) . It is named after Lake Baikal , Russia .   Until 13 July 1951 , Baykalsko was named Chokl ` ovo .", "Arthur Cumming (figure skater) Arthur Warren J. Cumming ( 8 May 1889 -- 9 May 1914 ) was a British figure skater . He came in second of the three participants in the special figures event at the 1908 Summer Olympics , earning him a silver medal . This was the only year in which special figures was an Olympic event . Cumming also participated in pair skating with partner Mrs. Arthur Cadogan . They placed 7th at the World Championships in 1912 and 1913 .  Cumming was involved in a motorcycle accident in May 1914 after which he contracted Tetanus and died .", "Kimberley Commando Kimberley Commando was a light infantry regiment of the South African Army . It formed part of the South African Army Infantry Formation as well as the South African Territorial Reserve .", "Mount Pleasant Township Mount Pleasant Township may refer to one of the following places in the United States :"]}, {"query": "Homeland was developed by Alex Gansa.", "pos": ["Homeland (TV series) Homeland is an American spy thriller television series developed by Howard Gordon and Alex Gansa based on the Israeli series Prisoners of War ( Original title \u05d7\u05d8\u05d5\u05e4\u05d9\u05dd Hatufim , literally `` Abductees '' ) , which was created by Gideon Raff .   The series stars Claire Danes as Carrie Mathison , a Central Intelligence Agency officer with bipolar disorder , and Damian Lewis as Nicholas Brody , a U.S. Marine Corps Scout Sniper . Mathison had come to believe that Brody , who was held captive by al-Qaeda as a prisoner of war , was `` turned '' by the enemy and poses a threat to the United States .   The series is broadcast in the U.S. on the cable channel Showtime , and is produced by Fox 21 Television Studios ( formerly Fox 21 ) . It premiered on October 2 , 2011 . The first episode was made available online , more than two weeks before the television broadcast , with viewers having to complete game tasks to gain access . On October 22 , 2013 , Showtime renewed Homeland for a fourth season , which premiered on October 5 , 2014 . On November 10 , 2014 , Showtime renewed the series for a 12-episode fifth season that premiered on October 4 , 2015 . On December 9 , 2015 , the series was renewed for a sixth season . The sixth season debuted on January 15 , 2017 . The series has also been renewed for a seventh and eighth season ; the eighth is planned to be the series ' final season by the creators .   The series has received generally positive reviews , and has won several awards , including the 2012 Primetime Emmy Award for Outstanding Drama Series , and the 2011 and 2012 Golden Globe Award for Best Television Series -- Drama , as well as the Primetime Emmy Award for Outstanding Lead Actor in a Drama Series and Lead Actress in a Drama Series for Damian Lewis and Claire Danes , respectively ."], "neg": ["Predrag \u0110or\u0111evi\u0107 (footballer, born 1990) Predrag \u0110or\u0111evi\u0107 ( Serbian Cyrillic : \u041f\u0440\u0435\u0434\u0440\u0430\u0433 \u0402\u043e\u0440\u0452\u0435\u0432\u0438\u045b ; born 30 June 1990 ) is a Serbian professional footballer , playing for OFK Beograd mainly as a right-back .", "Nao Hibino is a professional Japanese tennis player , and currently the women 's Japanese number 2 . She is currently ranked 70th in singles and 105th in doubles . In 2015 , she won her first WTA title .", "George Summers George Summers may refer to :  George Summers ( cricketer ) ( 1844 -- 1870 ) , English cricketer who played for Nottinghamshire  George W. Summers ( 1804 -- 1868 ) , American politician , attorney and jurist from Virginia  George Summers ( cyclist ) , British Olympic cyclist  George Summers ( footballer ) ( born 1941 ) , Scottish football forward , manager and coach  George Summers ( racer ) in New England Auto Racers Hall of Fame", "Barber baronets There have been two baronetcies created for persons with the surname Barber , both in the Baronetage of the United Kingdom . One creation is extinct while one is still extant .   The Barber Baronetcy , of Culham Court in the County of Berkshire , was created in the Baronetage of the United Kingdom on 29 February 1924 for the property developer and solicitor William Barber . The title became extinct on his death in 1927 .   The Barber Baronetcy , of Greasley in the County of Nottingham , was created in the Baronetage of the United Kingdom on 25 July 1960 for Philip Barber . He served on the Nottinghamshire County Council as a councillor from 1898 to 1925 , as an Alderman from 1925 to 1961 and as its Chairman from 1931 to 1945 . As of 2012 the title is held by his grandson , the third Baronet , who succeeded his father in 1995 .", "Burn Hall, County Durham Burn Hall is a country house in County Durham . It is a Grade II * listed building .", "Cottage at 1514 and 1516 W. Second Street The Cottage at 1514 and 1516 W. Second Street is located in a residential-light industrial area of the West End of Davenport , Iowa , United States . Philippe Oszuscik in his 1979 study of Davenport architecture identified this small cottage as one of the earliest house types in the city . It features a full size front porch that was taken from the Galerie of Mississippi Valley French tradition and a symmetrical , 5-bay main facade that reflects the Georgian/Greek Revival styles . The present porch , however , is not original to the house . The side gable , single story frame house is built on a stone foundation and has an extension off of the back . The cottage has been listed on the National Register of Historic Places since 1983 .", "Ophaboom Theatre Company The Ophaboom Theatre Company , founded in 1991 by Geoff Beale and Howard Gayton , is an English physical theatre company specializing in creating and performing contemporary works in the Italian Commedia dell ` Arte tradition . Drawing on Medieval theatre and the origins of Commedia , Ophaboom set out with the self-stated aim of creating `` a popular ( and politically topical ) style of theatre that would resonate with a modern audience , in the manner of Medieval strolling players . '' Although the troupe performs in traditional theatre spaces , they also set up their trestle stage on street corners , in village halls , in bowling alleys and many other less conventional venues , with the stated intention of `` bringing theatre to audiences who might not otherwise go to see it . ''   Although nominally based in London , Ophaboom -- like Commedia companies of old -- is primarily a touring company . With the aid of Arts Council England , they tour extensively throughout the British Isles ; they also regularly tour across continental Europe , performing in seven languages . They were the first English company to appear at the Medieval Festival in Le Puy -- en -- Velay , and have been invited four times to bring their English brand of Commedia to the Carnival of Venice . They have also toured as far afield as North America and Korea .   As a leading company in the development of English Commedia , Ophaboom was profiled in the book Commedia dell ` Arte : A Handbook for Troupes by John Rudlin and Olly Crick ( Routledge Publisher , London and New York , 2001 ) . Rudlin and Crick examined the company 's history , evolution , and working methods , placing their work in context alongside European Commedia masters such as Carlo Boso and Antonio Fava . Ophaboom 's contributions to English Commedia have been further documented in New Theatre Quarterly 67 , edited by Clive Barker and Simon Trussler ( Cambridge University Press , 2001 ) ; Shakespeare Survey 50 edited by Stanley Wells ( Cambridge University Press , 2002 ) , and Faust : Icon of Modern Culture by Osman Durrani ( Helms Information Ltd. , UK , 2004 ) .   Current members of the company : Geoff Beale , Howard Gayton , Sarah Ratheram , and Claire Jones .", "Henry C. Kellers Henry Carsten Kellers ( July 6 , 1874 -- May 23 , 1954 ) was an American United States Navy Lieutenant Commander who served on numerous scientific expeditions on behalf of the Smithsonian Institution . During his expeditionary career , he collected biological specimens for the Smithsonian , bringing back over 10,000 specimens , living and deceased , many which were held by the National Zoo in Washington , D.C. ."]}, {"query": "Gerard Butler was born in March.", "pos": ["Gerard Butler Gerard James Butler ( born 13 November 1969 ) is a Scottish actor who has appeared on film , stage , and television . After studying law , Butler turned to acting in the mid-1990s with small roles in productions such as Mrs Brown ( 1997 ) , the James Bond film Tomorrow Never Dies ( 1997 ) , and Tale of the Mummy ( 1998 ) . In 2000 , he starred as Dracula in the horror film Dracula 2000 with Christopher Plummer and Jonny Lee Miller .   The following year onward , he played Attila the Hun in the miniseries Attila ( 2001 ) and then appeared in the films Reign of Fire with Christian Bale ( 2002 ) , and Lara Croft Tomb Raider : The Cradle of Life with Angelina Jolie ( 2003 ) , before playing Andr\u00e9 Marek in the adaptation of Michael Crichton 's science fiction adventure Timeline ( 2003 ) . He then was cast as the role of Erik , The Phantom in Joel Schumacher 's 2004 film adaptation of the musical The Phantom of the Opera alongside Emmy Rossum . That role earned him a Satellite Award nomination for Best Actor .   Although Attila and The Phantom of the Opera were important breaks , it was only in 2007 that Butler gained worldwide recognition for his portrayal of King Leonidas in Zack Snyder 's fantasy war film 300 . That role earned him nominations for an Empire Award for Best Actor and a Saturn Award for Best Actor and a win for MTV Movie Award for Best Fight . In the 2010s , he voiced the role of Stoick the Vast in the animated action-fantasy film How to Train Your Dragon , a role he later reprised in Legend of the Boneknapper Dragon ( 2010 ) , Gift of the Night Fury ( 2011 ) and How to Train Your Dragon 2 ( 2014 ) . He played military leader Tullus Aufidius in the 2011 film Coriolanus , the modernized adaptation of Shakespeare 's tragedy of the same name . He also played Sam Childers in the 2011 action biopic Machine Gun Preacher ."], "neg": ["D\u00e9licieuse Musique D\u00e9licieuse Musique ( Delicious Music ) is a Le Bouscat-based minimal techno record label and a music blog .", "Jordan French Jordan French ( born November 1985 ) is an American entrepreneur , writer , engineer , and marketer best known for cofounding 3D food printing startup , BeeHex , Inc. . Originating from a NASA-funded project , French 's company , BeeHex , Inc. , commercializes 3D food printing . French is a regular contributor to technology media outlets including CIO magazine , Entrepreneur magazine , TechCrunch , Huffington Post , Thrive magazine and business.com .", "Chung Sang-nam Chung Sang-nam ( born 1969 ) is a South Korean football manager and former footballer . He played for the Pohang Steelers , and represented South Korea at the 1996 Summer Olympics .   In 2015 , he was appointed as manager of FC Seoul U-15 team", "Madiun Affair The Madiun Affair or Peristiwa Madiun was an armed conflict between the government of the Republic of Indonesia and the left-wing opposition group , Front Demokrasi Rakyat ( FDR , People 's Democratic Front ) during the Indonesian National Revolution . The conflict began on 18 September 1948 in Madiun , East Java , and ended three months later when most FDR leaders and members were detained and executed by the Indonesian authorities .", "Denizli Province Denizli Province ( -LSB- ) is a province of Turkey in Western Anatolia , on high ground above the Aegean coast . Neighbouring provinces are U\u015fak to the north , Burdur , Isparta , Afyon to the east , Ayd\u0131n , Manisa to the west and Mu\u011fla to the south . It is located between the coordinates 28 \u00b0 30 ' and 29 \u00b0 30 ' E and 37 \u00b0 12 ' and 38 \u00b0 12 ' N . It covers an area of 11,868 km \u00b2 , and the population is 931,823 . The population was 750,882 in 1990 . The provincial capital is the city of Denizli .", "Jim Addison Jim Addison ( 1 January 1884 -- 2 May 1957 ) was an Australian rules footballer who played for the Collingwood Football Club in the Victorian Football League ( VFL ) .   Addison played as a full-forward for Collingwood in only ten games over two seasons in the VFL . In only his third game , Addison won a premiership and was the only multiple goalkicker in Collingwood 's Grand Final win against Fitzroy .   In 1904 , Addison would play in seven more games , ending his VFL career with 10 games and 4 goals .", "Zelleria hemixipha Zelleria hemixipha is a moth of the Yponomeutidae family . It is found in Australia .", "Gusborn Gusborn is a municipality in the district L\u00fcchow-Dannenberg , in Lower Saxony , Germany ."]}, {"query": "For Best Supporting Actor for Sex and the City in 1999, Chris Noth was nominated.", "pos": ["Chris Noth Christopher David `` Chris '' Noth ( -LSB- ` no : th -RSB- ; born November 13 , 1954 ) is an American actor . He is known for his television roles as Detective Mike Logan on Law & Order ( 1990 -- 95 ) , Mr. Big on Sex and the City ( 1998 -- 2004 ) , and Governor Peter Florrick on The Good Wife ( 2009 -- 16 ) . He reprised his role of Mike Logan on Law & Order : Criminal Intent ( 2005 -- 08 ) , and reprised his role of Mr. Big in the films , Sex and the City ( 2008 ) and Sex and the City 2 ( 2010 ) . He was nominated for the Golden Globe Award for Best Supporting Actor on Television for Sex and the City in 1999 and for The Good Wife in 2010 ."], "neg": ["Zlatnite Mostove Zlatnite Mostove ( \u0417\u043b\u0430\u0442\u043d\u0438\u0442\u0435 \u043c\u043e\u0441\u0442\u043e\u0432\u0435 , ` Golden Bridges ' ) is the largest stone river on Vitosha Mountain , Bulgaria . The feature is situated in the valley of Vladayska River , extending 2.2 km , and up to 150 m wide , with several ` tributary ' stone rivers . The stone river is ` descending ' from elevation 1800 m above sea level in Boeritsa Chalet area to 1410 m at Zlatnite Mostove site . The lower extremity of the stone river is known as Zlatnite Mostove site , a popular tourist destination accessible from Sofia by road .   The name ` Golden Bridges ' derives from the golden colour of the lichens growing on the surface of stone run boulders .", "William Bentinck-Smith William Bentinck-Smith ( 1914 -- 1993 ) was a Harvard University administrator and sometime editor of the Harvard Alumni Bulletin , known for his `` encyclopedic '' knowledge of Harvard 's history .", "Cian Kelleher Cian Kelleher ( born 7 August 1994 ) is an Irish rugby union player who plays for Connacht . He usually plays on the wing or at fullback . He made his Ireland debut in a non-capped match against the Barbarians on 28 May 2015 . He played for the Ireland under-20s in the 2014 Under-20 Six Nations and at the 2014 Junior World Championship , scoring three tries in nine appearances .", "Pyaaj Kachori Pyaj Kachori ( \u0915\u093e\u0902\u0926\u093e \u0915\u091a\u094b\u0930\u0940 , pronounced as kaanda k-ch\u014d-r\u0113 ) ( Onion Kachori ) is a kind of Rajasthani Kachori , a fried pastry filled with a spicy onion filling . It is one of the famous spicy snack food from Jodhpur and vicinity . Popularity of this snack dish increased in other parts of North India when Rajasthani restaurants and food outlets opened throughout India . Today it has become local snack dish of several regions of Indian Subcontinent .   Category : Rajasthani cuisine  Category : Indian snack foods", "42d Air Division The 42d Air Division was a unit of the United States Air Force . It was established as the 42 Bombardment Wing ( Dive ) on 8 February 1943 . The wing first saw combat in September 1943 . It was inactivated in 1991 .", "Jeff Dadamo Jeff Dadamo ( born July 17 , 1989 ) was an American professional tennis player who competed mainly on the ATP Challenger Tour and ITF Futures , both in singles and doubles .   Dadamo reached his highest ATP singles ranking , No. 480 , on October 15 , 2012 , and his highest ATP doubles ranking , No. 429 , on February 4 , 2013 .", "2011 Dutch National Track Championships \u2013 Men's keirin The Men 's keirin at the 2011 Dutch National Track Championships in Apeldoorn took place at Omnisport Apeldoorn on December 27 , 2011 . 19 athletes participated in the contest .   Roy van den Berg won the gold medal , Hugo Haak took silver and Matthijs Buchli won the bronze .", "Spring (painting) Spring is an 1894 oil painting by Lawrence Alma-Tadema , currently in the collection of the J. Paul Getty Museum in Los Angeles , California .   Category :1894 paintings  Category : Collections of the J. Paul Getty Museum  Category : Paintings by Lawrence Alma-Tadema"]}], "FiQA2018": [{"query": "Are Target Funds Unsafe - Post Q.E.?", "pos": [" It's a what-if? sort of question. What if rates stay down or trend only slightly higher, despite no QE? look at other countries response to tepid economies. My experience as professional advisor (25 yrs) tells me the future is unknowable and diversity is good. Make alternative choices- they all won't work wonderfully, but some will."], "neg": [" \"I said nothing about a preference for either system. All of the internet TV utopia stuff is a projection you put on me based on percieved \"\"reddit sentiment\"\" (for which I think your perception is pretty accurate).   That's just the way I imagine the market going, regardless of what's \"\"good\"\" for American Culture and jobs, etc.  The biggest thing I'm tempted to disagree with here is the idea that those big shows' funding will keep TV around.   My main objection is that I don't think we have a reason to believe that these high-budget shows need to exist in the future. I agree that it would suck to lose these types of shows, but I think they are a product of the arrangement of business less than they could ever be a driver of it. It seems totally feasible that cable would lose subscribers to people pirating their shows and to internet TV services, and that we'd just end up without shows like that.  Be careful to keep value judgments separate from what you think the market will or could do.\"", " \"&gt; My question then is why do you espouse such simplistic nonsense when you understand that the situation is much more complex? Is it because it is easier and more psychologically comfortable to ignore these injustices than to admit that your model does not have an effective way of dealing with them?  I reject your assessment so it's impossible to answer your questions that assume it.  The position that \"\"Jim selling to John has nothing to do with Bob\"\" and the position that \"\"a power plant pollutes collective air possibly entitling compensation\"\" are independent and have no conflict.  Simply because there are cases of market failures, I do not therefore conclude that the market system is itself a failure.  Baby with the bathwater, etc.  It's not because this way of thinking is easier but because it is most accurate.  I honestly don't know what you mean by   &gt; than to admit that your model does not have an effective way of dealing with them?  so I don't know how to respond.  I stated in what I thought was plain language that my model has no effective means of dealing with them, only I insist that we must caveat that assessment with the admission that neither does a non-market model.  What you were supposed to take away was the realization that there are few market failures that could not more simply be described as systematic failures generally.  That is, a collectivist system is inherently illogical (if you want to argue this point, the discussion is over - I have no time for true socialists), yet we share a planet's resources and must decide how to best use them.  The free market's conclusion is that people will learn if their air is being abused by a power plant and they will take action to mend it.  This to a large extent has been proven in the transition from an early industrialized society to modern industry.\"", " I have heard of this, but then the broker is short the shares if they weren't selling them out of inventory, so they still want to accumulate the shares or a hedge before EOD most likely - In that case it may not be the client themselves, but that demand is hitting the market at some point if there isn't sufficient selling volume.    Whether or not the broker ends up getting all of them below VWAP is a cost of marketing for them, how they expect to reliably get real size below vwap is my question.", " So he should subsidize the broken educational system and poor decisions made by young Americans? I took out $100K in student debt, mostly from grad school. I'm going to pay it off myself, as should everyone else.", " I'm trying to get the numbers to work. I built a quick spreadsheet that allocated the lost time as stated against the overall pay increase, assuming 1.5x for more than 40 hours.   I can't find a reasonable number of hours worked where a 9% cut in hours outweighs the near 20% increase in wages.", " It's just cute when somebody has no skin the game makes such generalized and cavilier assumptions and assertions without knowing the details. Bravo for you, youve got an opinion based on a headline-esque understanding without knowing the facts--- that's what'll make this country great again!", " I would join finance and economics clubs. Network with other Engineering -&gt; IB people. Try to land a sophomore summer finance internship.   When you walk into IB interviews you want to show that you've been focused on this for a while, and your not some goober that decided to apply for the hell of it.", " LOL!!!! Is Intel (and Disney, etc) planning or already replacing American workers with H1B Visa foreigners? Yes or no?  Is Trump already started and planned to stop the H1B Visa program to Make America Great? Yes or no?  So who's the Nazi and/or/both enemy of the USA? Trump and me, or, Intel and you (defending Intel)?"]}, {"query": "Covered calls: How to handle this trade?", "pos": [" I would expect that your position will be liquidated when the option expires, but not before. There's probably still some time value so it doesn't make sense for the buyer to exercise the option early and take your stock. Instead they could sell the option to someone else and collect the remaining time value. Occasionally there's a weird situation for whatever reason, where an option has near-zero or negative time value, and then you might get an early exercise. But in general if there's time value someone would want to sell rather than exercise. If the option hasn't expired, maybe the stock will even fall again and you'll keep it. If the option just expired, maybe the exercise just hasn't been processed yet, it may take overnight or so.", " You are NOT responsible for liquidating the position.  You will either end up retaining your 100 sh. after expiration, or they will be called away automatically. You don't have to do anything.  Extending profitability can mean different things, but a major consideration is whether or not you want to hold the stock or not.  If so, you can buy back the in-the-money call and sell another one at-the-money, or further out. There are lots of options.", " \"Your broker likely didn't close your position out because it is a covered position. Why interfere with a trade that has no risk to it, from their perspective? There's no risk for the broker since your account holds the shares available for delivery (definition of covered), for if and when the options you wrote (sold) are exercised. And buyers of those options will eventually exercise the options (by expiration) if they remain in-the-money. There's only a chance that an option buyer exercises prematurely, and usually they don't because there's often time value left in the option. That the option buyer has an (ahem) \"\"option\"\" to exercise is a very key point.  You wrote: \"\"I fully expected my position to be automatically liquidated by whoever bought my call\"\". That's a false assumption about the way options actually work.  I suggest some study of the option exercise FAQs here: Perhaps if your position were uncovered \u2013 i.e. you wrote the call without owning the stock (don't try this at home, kids!) \u2013 and you also had insufficient margin to cover such a short position, then the broker might have justifiably liquidated your position. Whereas, in a covered call situation, there's really no reason for them to want to interfere \u2013 and I would consider that interference, as opposed to helpful.  The situation you've described is neither risky for them, nor out of the ordinary.  It is (and should be) completely up to you to decide how to close out the position. Anyway, your choices generally are:\""], "neg": [" (1) The value of the MBA is in the network  (2) You don't know anything when you come out of an undergrad and an MBA isn't going to help you there.   (3) Entry level jobs are not requiring MBAs no matter how much you think they are. Jobs that want 4-5yrs exp want MBAs, but not ones that require 1-2 years.   (4) I mentor undergrads from my alma mater - each one of them has landed a financial analyst role and none of them have an MBA.   (5) I view the MBA with no experience as a negative not a positive.   I got my undergrad 10 years ago my MBA 4 years ago.   Further, let's look at some job reqs that support my stance:   (1) https://www.tesla.com/careers/job/logistics-financialanalyst-53725?source=Indeed   (2) http://schwabjobs.com/ShowJob/Id/1303833/Treasury%20Analyst,%20Corporate%20Finance   (3) https://jobs.lever.co/wish/1020acab-423b-44e9-a1d5-9c10515ef7a2?lever-source=Indeed   (4) https://www.upstart.com/careers/114362/apply?gh_jid=114362&amp;gh_src=ue0b8m   (5) https://jobs.smartrecruiters.com/Ubisoft2/743999656810009-financial-analyst?codes=1-INDEED   (6) https://wholefoods.wd5.myworkdayjobs.com/en-US/wholefoods/job/CA-Emeryville---Northern-California-Corporate/Financial-Analyst_Req-20170705304-1?source=Indeed   (7) https://chj.tbe.taleo.net/chj04/ats/careers/requisition.jsp?org=NATUS&amp;cws=1&amp;rid=7263&amp;source=Indeed.com  This literally took my 3 minutes to find 7 roles that have ZERO mention of MBA anywhere on the job req. You really don't know what you are talking about and you shouldn't be giving bad advice.", " All of a sudden having each stall with a charging station is a selling feature and home owners associations will install them to improve resale value.  In theory.  Then again I worry about lithium demand.     That my friend is the long term play.   I think it's still in infancy.", " \"You are not the only one with this problem. When Intuit changed their pricing and services structure in 2015 a lot of people got angry, facing larger fees and having to go through an annoying upgrade just to get the same functionality (such as Schedule D, capital gains). You have several options: (1) Forget Turbo Tax and just use paper forms. That is what I do. Paper is reliable. (2) Use forms mode in Turbo Tax. Of course, that may be even more complicated than simply filing out paper forms. (3) Use a different service. If your income is below $64,000 the IRS has a free electronic filing service. Other online vendors have full taxes services for less than Turbo Tax. (4) Add the amount to ordinary income. Technically, as long as you report the income, you cannot be penalized, so if you add the capital gain to your ordinary income, then you have paid taxes on the income. Even if they send you a letter, you can send an answer that you added it to ordinary income and that will satisfy them. Of course you pay a higher rate on your $26 if you do that. (5) If you are in the 15% or below income bracket you are exempt from capital gains, and you can omit it. Don't believe the nervous Nellies who say the IRS will burn your house down if you don't report $26 in capital gains. Penalties are assessed on the percentage of TAXES you did not pay (0.5% penalty per month). Since 0.5% of $0 is $0 your penalty is $0. The IRS knows this. The IRS does not send out assessment letters for $0. (6) Even if you are above the 15% bracket, there is likelihood it is still a no-tax situation (see 5 above). (7) Worst case scenario: you are making a million dollars per year and you omit your $26 capital gains from your return. The IRS will send you an assessment letter for about $10. You can then send them a separate check or money order to pay it. In all honesty I have omitted documented tax items, like taxable interest, that the IRS knows about many times and never gotten an assessment letter. Once I made a serious math error on my return and they sent me an assessment letter, which I just paid, end of story. And that was for a lot more than $26. The technical verbiage for something like this in IRS lingo is CP-2000, underreported income. As you can see from this official IRS web page, basically what they do is guess how much they think you owe and send you a bill. Then you pay it. If you do so in time, you don't even get a 0.5% interest penalty on your $6.75 owed or whatever it is. (8) Go hog wild. As long as you are risking an assessment on your $26, why not go hog wild and just let the IRS compute all your taxes for you? Make a copy of your income statements, then mail them to the IRS with a letter that says, \"\"Hi, I am Mr. Odinson, my SSN is XXX-XX-XXXX. My address is XYZ. I am unable to compute my taxes due to a confused state of mind. I am hereby requesting a tax assessment for the 2016 tax year.\"\" Make sure you sign and date the letter. In all probability they will compute the full assessment and send you a bill (or refund).\"", " This is what everyone said about music circa 1999, that the record labels would never agree to sell their songs online because it would devalue selling albums, and a bunch of archaic thinking etc... and then the iTunes store showed the industry a better way to distribute their content, conviced the labels to play along, and Apple is now the most profitable company in the world.   There's no reason this can't happen for TV, it's clearly heading there and the first person to do for TV what Apple did for music will make a fortune, hell it might even be Apple that does it, yet another reason why Apple stock is severly undervalued right now", " It depends on the finances involved, but particularly if you're not billing anything right now and may have no revenue this year, it's probably a good idea to bill his company. This is in part because some deductions or other tax treatments are only allowed if you have revenue and/or income.  The biggest example I can think of is the Solo 401k - you can only contribute up to your self employed income.  If you're planning to contribute to one (and you should, they're amazingly powerful tools for saving for retirement and for reducing your tax burden), you will have to have some revenue in order to have something to pay yourself with. I don't believe you have to charge him, though, if it makes more tax sense not to (for example, if his business is operating at a loss and cannot benefit from expensing it, but you'd then have to pay taxes on your own income from it).", " It's not non-zero but, in a resource extraction economy, the prices of those resources is critical.  Alberta, which produces a lot of expensive oil, needs the prices to be above a certain amount or there are major problems.    Prior to 2008, everything was wine and roses.  After the crash, the elected government has been crying.  Instead of funding everything through oil royalties in a surplus, they've made cutbacks and run a sizeable deficit most every year since.  The lower prices has resulted in slowed construction and cancelled projects on the oil sands, which reduces the jobs, which undercuts the only positive to practically giving the oil away.  This is with $32 billion is subsidies for oil and gas each year.  Reduced jobs and money means less demand for real estate, which tripled between 2003 and 2008 and has mostly held steady since then.  With rising interest rates on the horizon, many Albertans could lose 25%-50% of their wealth.  If an oil produces wanted to hurt Alberta, increasing production enough to drop the price of oil by $5-$10 could do it.  I know it's a tall order but there are certain countries and/or organizations that could do it.  The US govt, for example, could have its oil barons and military hawks team up to subsidize production enough to sink Russia in the name of national security.  It may not make much sense but neither does ethanol from corn and look where that is.", " \"Banks do NOT lend money they don't have. I don't know where you get that idea. In your view what stops a bank from lending a quadrillion dollars? Banks do need to have savings in the bank - learn about reserve requirements, which I mentioned above. Banks (just like you and me) can have assets and debts, but they account for them and they net to (almost) zero, just like you and me.  Fed does not pay government as I stated above. The Fed buys goods from the open market (Treasury Bonds, for example, which are IOUs the government has sold to investors who purchased them freely), and the Fed pays for this with \"\"new\"\" money while holding the bonds, which then pay out just like they were being held by you or me.  Finally, M2 is about 10 times M1, for the reasons I gave. Your claim of M2 increasing regardless of M1 is not true. [See here](http://en.wikipedia.org/wiki/File:Components_of_US_Money_supply.svg) for example and note that M2 is about 10x of M1, with the variations being for the reasons I gave above.\"", " Are you looking for a production house that is capable of creating unique and high quality audio visual content? If your answer is yes, then One Shot Films is the one stop solution for all your needs. This company has a team of well-trained professionals who put their all in any project they get."]}, {"query": "How to manage household finances (income & expenses) [duplicate]", "pos": [" \"My wife and I have close to equal incomes, and are not young.  What we have is this: Some people would classify our system as a bit draconian as we each have \"\"allowance\"\"; however, it makes sure spending does not get out of wack and we work together to meet our goals.\"", " Obviously, there are many approaches. I\u2019ll describe what we do and why we think it is successful. I have seen many couples having disagreements and even divorce over money; it seems that this is a typical reason to fight and sometimes fight badly. The realization is that different people have different preferences what to spend their money on, and if you are not rich, it continuously leads to disagreements - \u2018did you really need another pair of shoes?\u2019, etc. Our solution is a weekly allowance. First, all our money goes into one pot and is considered equal. Many couples find that a difficult step, but I never thought twice about it - I trust my spouse, and I share my life with her, so why not my money? From this, we agree on an \u2018allowance\u2019 that is used to cover any non-common cost; this includes all clothing, dining out, buying things, etc. The amount was chosen to match about what we spent for those things anyway, and then adjusted annually. The main point is that there is no critique allowed about what this is spent on - you can blow it all on shoes, or buy books, or wine and dine, or gamble it away, whatever. We are doing this since 23 years now, and we are very happy with the results; we never have financial \u2018fights\u2019 anymore. Disadvantages are the effort - you need to keep track of it somehow. Either you use a separate credit card, or hand it out in cash, or have a complete accounting (I do the latter, because I want to). Regarding all other spend, we use the accounting to plan ahead for at least a year on all cost and income that are expected, and that shows us the available cash flow and where it might get tight. It also shows you where the money goes, and where you could cut if cutting is needed (or wanted). Again, there is some effort in collecting the data, but it is worth it (for us)."], "neg": [" \"Since this the business subreddit (or used to be), what about the effect that \"\"age-retardation\"\" would have on wealth distribution?  Imagine if Rockefeller or Edison was still alive to own, manage, and profit from their respective empires?\"", " \"&gt;It's dishonest to equate a purely digital media entity to a broadcaster.  Despite nothing dishonest about it.  You are doing nothing but splitting hairs here, why is beyond me.  &gt;The argument does not stand up to scrutiny  If that was the case you would been able to refute it, you yet to been able to do so.  All you have done is make claims of my logic being faulty, which you have totally and utterly failed to show.  &gt;I think this is the point that I refrain from rubbing your nose in not just your logical mistake  lol what mistake?  You act like you are this logical wiz, and yet I have successfully taking down your logic while you totally failed to destruct mine.  All you are doing now argument wise is \"\"but but but but but\"\".  You don't realize what Vice releases on their website is representative of all of their content.  Claiming they have good content when their content is on the level of Buzzfeed is outright laughable to say the least.  You claim your well verse in your media readings, but yet you continue to defend Vice as being quality content tooth and nail despite agreeing with me that the article was crap.  I highly doubt you can link me an article you think is high quality from Vice.\"", " Essentially, yes, Peter Lynch is talking about the PEG Ratio. The Price/Earnings to Growth (PEG) Ratio is where you take the p/e ratio and then divide that by the growth rate (which should include any dividends).  A lower number indicates that the stock is undervalued, and could be a good buy. Lynch's metric is the inverse of that: Growth rate divided by the p/e ratio.  It is the same idea, but in this case, a higher number indicates a good value for buying. In either case, the idea behind this ratio is that a fairly priced stock will have the p/e ratio equal the growth rate.  When your growth rate is larger than your p/e ratio, you are theoretically looking at an undervalued stock.", " http://www.ColeGolf.ie            How to break 90                     Golf is a lifelong pursuit that will always challenge, may entertain, and will almost certainly frustrate at times.  For most players, golf scores similar to those consistently seen from our favorite pros may be unattainable.  A more reasonable goal for most is to find a way first to routinely break 90, but how do you get there?  A few regular adjustments will provide the best opportunities to do so. Pre shot routine: Every golfer needs a pre shot routine that happens every time you approach the ball. For example, during practice always visualize a target; plan your shot and try to see the outcome. Take one or two practice swings to get a feel for the stroke before you step to the ball. The key to this is consistency, if it happens every time you can begin to take the guesswork out of your game Golf.   Practice more than you play: Don\u2019t try to fix your mistakes on the back nine. When you are on the course you shouldn\u2019t be thinking about how to correct your stroke, grip, stance etc. In fact, if you\u2019ve done the work off the course, you shouldn\u2019t have to think about much at all; trust your muscle memory to do what you have practiced.  Practice the minimum: To perfect any physical skill, it is important to focus on the smallest amount of information possible at one time. You cannot simultaneously pay attention to the plane of your stroke while thinking about the weight on your left foot and refining your grip. Try to pick one small thing to focus on at one time and work it into your muscle memory. Practicing the minimum will allow you to stop thinking about each factor of the game while on the course. Again, the goal of this process is to make your motions automatic, effortless and fluid.  Care less:  It may seem counterintuitive but when you step onto the golf course, the more invested you are in each shot, the less you can rely on the hard work you have put into your game during practice. Do the work on the driving range so that you don\u2019t need to worry about it when you need it.  http://www.ColeGolf.ie", " If you\u2019re concerned about transferring  USD, I can\u2019t really help you there. But if you\u2019re looking to transfer wealth, I believe that\u2019s where something like Bitcoin could help you. In fact a small or nonexistent processing fee is one of Bitcoin\u2019s biggest strengths as a currency. Off the top of my head, I believe BitPay has services that would suit your needs. And if you\u2019re worried about the volatility of Bitcoin, you can always convert it straight to USD just so you can avoid service fees!", " Phone 3 years old, very unlikely to upgrade -- few reasons to.  Will likely go Android next time around because I hate lightning jack with a passion.  I don't think Apple is in trouble yet... but there will come a time when most people will see their existing phones as good enough and that will undercut the upgrade cycle many of these companies rely on.", " RealConnect is a unique independent real estate company which connects residential &amp; commercial\u00a0property owners &amp; investors to real estate agents and property managers. We operate Australia wide &amp; have registered agents waiting to offer their services from most areas across the country. We have a keen passion to create an easy to use, low cost system to benefit everyone dealing in the real estate industry. We aim to increase profits for property owners as well as real estate agents by lowering the business expenses for the agents and allowing them to offer the same service to property owners for less.", " &gt; but their getting paid for any of that is another story  If you do things that other people value, you will never have a problem getting paid. The only time you can't get paid is if other people don't assign value to your labors. Basically, always be useful."]}, {"query": "Is it possible to buy stock as a gift for a minor without involving the guardians?", "pos": [" You should talk to a lawyer. One solution I can think of is using a trust. Keep in mind that that may complicate things (non-revocable trusts are taxed on income not distributed, and revocable trust means you effectively keep the owenership of the stock). If you don't mind paying taxes on the dividends and keep the stocks in a living trust - that would be, IMHO, the simplest solution. That would, however, invoke the gift/estate tax at the value of the stock when the ownership actually passes to the intended receipient (i.e.: you die/gift the stock to the child). It would be very hard to pay the gift tax now and avoid getting the childs SSN and opening an account for the child with it.", " \"This is an old question, but a new product has popped up that provides an alternative answer. There is a website called stockpile.com that allows you to purchase \"\"stock gift certificates\"\" for others.  These come in both electronic and traditional physical form.  This meets my question's original criteria of a gift giver paying for stock without having any of the recipient's personal information and thus maintaining the gift's surprise. I should note a few things about this service: Despite these limitations I wanted to post it here so others were aware of it as an option.  If no other alternative will work and this is what it takes to get a parent interested in teaching their child to invest, then it's well worth the costs.\""], "neg": [" Not sure of your locality. In the USA, there are many options. There are many corporate bonds that pay interest monthly. You can invest in a handful of bonds, chosen so at least one of them pays interest each month. (Minimum investment requirements make this an expensive option)  Unit Trusts made of bonds (a handful of bonds wrapped into a single fixed investment) usually pay monthly interest. As the bonds begin to mature, the interest payments shrink (but you begin to get principal payments which can be reinvested). Bond mutual funds and ETFs usually provide monthly dividends (that come from the interest and capital gains of the bonds held by the fund). Dividends are usually consistent, but not necessarily fixed.  You can produce a monthly income from stocks in the same way as the above mentioned bond methods. Income can be consistent, but not fixed.", " You know what? You are correct, the reason the Soviet Union collapsed was due to its central banking policies. You should perhaps tell someone about that.  &gt;I asked you to name an empire, historically, that purchased its own debt and was successful in doing so. You have still yet to do that.  Even though you didn't direct the question to me: British Empire.  Next?", " \"Why must terms must be mutually exclusive?  This (false) dichotomy is what seems to cause the most debate.  It is the SINGLE EVENT OUTCOME that defines gambling. Gambling will involve an aleatory contract. That is, the outcome is specifically tied to a single event that determines profit/loss. This could be the outcome of a race or the roll of a dice, but should involve chance.  This is why gambling is often in the context of a game, but I would make the argument that some investment tools fall into this category - The price of a stock at a certain date, for example. This may also be called \"\"betting\"\", which opens up a whole other discussion. Investing has no such implication, and as such it is the broader term.  Investing is to put something (money) to work to return a profit. Some forms of gambling could fall under this umbrella. Some would say that is a \"\"bad investment\"\" and even if they are right, it may still be the desire and intent of the investor to make a profit.  Not all gambling falls under investing. You can gamble for pleasure.  The profit/loss of most investments are not contractually tied to a specific event or outcome (e.g. the price of a stock over 10 years is the result of many events affecting its market value). Such an investment would not be considered gambling.\"", " Your math shows that you bought an 'at the money' option for .35 and when the stock is $1 above the strike, your $35 (options trade as a contract for 100 shares) is now worth $100. You knew this, just spelling it out for future readers.  1 - Yes 2 - An execute/sell may not be nesesary, the ooption will have time value right until expiration, and most ofter the bid/ask will favor selling the option. You should ask the broker what the margin requirement is for an execute/sell. Keep in mind this usually cannot be done on line, if I recall, when I wanted to execute, it was a (n expensive) manual order. 3 - I think I answered in (2), but in general they are not identical, the bid/ask on options can get crazy. Just look at some thinly traded strikes and you'll see what I mean.", " \"You report it when the expense was incurred/accrued. Which is, in your case, 2014. There's no such thing as \"\"accounts payable\"\" on tax forms, it is an account on balance sheet, but most likely it is irrelevant for you since your LLC is probably cash-based. The reimbursement is a red-herring, what matters is when you paid the money.\"", " Probing for hidden limit orders usually involves sending the orders and then cancelling them before they get filled if they don't get filled. With trades actually going through multiple times for small amounts it looks more like a VWAP strategy where the trader is feeding small volumes into the market as part of a larger trade trying to minimize average cost. It could be probing but without seeing the orders and any cancels it would be difficult to tell. edit: I just had another thought; it could possibly be a market maker unwinding a bad position caused by other trading. Sometimes they drip trades into the market to prevent themselves from hitting big orders etc. that might move back against them. This is probably not right but is just another thought. source: I work for an organization that provides monitoring for these things to many large trading organizations.", " \"I'm not sure if this answer is going to win me many friends on reddit, but here goes...  There's no good reason why they couldn't have just told him the current balance shown on their records, BUT...  **There are some good reasons why they can't quote a definitive \"\"payoff\"\" balance to instantly settle the account:**  It's very possible to charge something today, and not have it show up on Chase's records until tomorrow, or Monday, or later. There are still places that process paper credit-card transactions, or that deal with 3rd-party payment processors who reconcile transactions M-F, 9-5ish, and so on.   - Most transactions these days are authorized the instant you swipe the card, and the merchant won't process until they get authorization back from the CC company. But sometimes those authorizations come from third-party processors who don't bill Chase until later. Some of them might not process a Friday afternoon transaction until close-of-business Monday.   - Also, there are things like taxicab fares that might be collected when you exit the cab, but the record exists only in the taxi's onboard machine until they plug it into something else at the end of the shift.   - There are still some situations (outdoor flea-markets, auctions, etc) where the merchant takes a paper imprint, and doesn't actually process the payment until they physically mail it in or whatever.   - Some small businesses have information-security routines in place where only one person is allowed to process credit-card payments, but where multiple customer service reps are allowed to accept the CC info, write it down on one piece of paper, then either physically hand the paper to the person with processing rights, or deposit the paper in a locked office or mail-slot for later processing. This is obviously not an instant-update system for Chase. (Believe it or not, this system is actually considered to be *more* secure than retaining computerized records unless the business has very rigorous end-to-end info security).   So... there are a bunch of legit reasons why a CC company can't necessarily tell you this instant that you only need to pay $x and no more to close the account (although there is no good reason why they shouldn't be able to quote your current balance).   What happens when you \"\"close an account\"\" is basically that they stop accepting new charges that were *made* after your notification, but they will still accept and bill you for legit charges that you incurred before you gave them notice. So basically, they \"\"turn off\"\" the credit-card, but they can't guarantee how much you owe until the next billing cycle after this one closes:  - You notify them to \"\"close\"\" the account. They stop authorizing new charges.   - Their merchant agreements basically give the merchant a certain window to process charges. The CC company process legit charges that were made prior to \"\"closing\"\" the account.   - The CC company sends you the final statement *after* that window for any charges has expired,  - When that final statement is paid (or if it is zero), *THAT* is when the account is settled and reported to Equifax etc as \"\"paid\"\".   So it's hard to tell from your post who was being overly semantic/unreasonable. If the CC company refused to tell the current balance, they were just being dickheads. But if they refused to promise that the current balance shown is enough to instantly settle the account forever, they had legit reasons.  Hope that helps.\"", " Phone 3 years old, very unlikely to upgrade -- few reasons to.  Will likely go Android next time around because I hate lightning jack with a passion.  I don't think Apple is in trouble yet... but there will come a time when most people will see their existing phones as good enough and that will undercut the upgrade cycle many of these companies rely on."]}, {"query": "When to start investing in the stock market?", "pos": [" Investing requires capital, and the fastest way to get the capital is to develop good saving habits. Investing is an ongoing process to help you accumulate wealth, so to take advantage of compounding, the earlier you start, the better.  I can suggest a few pointers to get you started on the investing journey. Godspeed! :)"], "neg": [" \"A TFSA is a tax free savings account.  It is a type of account where you can buy various investments like stocks, bonds, or funds (mutual, exchange traded, and money market).  There are some other options but it's best to see what your bank or broker will allow. You probably specified the type of investment when you opened the account.  You can look at your statements or maybe online to see what you're invested in.  My guess is some kind of HISA (high interest savings account).  This is kind of the default option for banks. The government created these accounts for a variety of reasons.  The main stated reason was to encourage people to save.   Obviously they also do things to get votes.  There was an outcry after the change to a type of investment called \"\"investment trusts\"\".  This could be seen as a consolation prize.  These can be valuable to seniors for many reasons and they tend to vote more often.  There was also an election promise to eliminate capital gains taxes in some fashion. It's not profitable for the government, in fact it supposedly cost the federal government $410 million in 2013.  Banks make money by investing your deposit or by charging fees. You can see what every tax break 'costs' the government in lost revenue here http://www.fin.gc.ca/taxexp-depfisc/2013/taxexp1301-eng.asp#toc7\"", " Maybe he's someone's kid, maybe he isn't. But Kraft-Heinz is a 3G company and anyone who understands their philosophy and methodology wouldn't be surprised by this.  3G is all about meritocracy. They don't care how long you've been at the company or how old you are - they'll work you to death and people that deliver the best results get rewarded handsomely, no matter their age. It's not unlikely that this guy is one of those people.  3G companies (e.g. Kraft-Heinz, RBI: Tim Hortons/Burger King, ABInBev) have at least a handful of VPs in their 20s, it's not just this guy. From my LinkedIn stalking and exposure to 3G companies, they also promote people (who I assume are high performers) very quickly, and will often take their incumbent talent and move them to new regions with big responsibility post-M&amp;A (e.g. they'll take an HR Manager from Brazil and move them to Canada with Director or C-level responsibilities).   EDIT - here's a couple examples:  [This guy](https://www.linkedin.com/in/ricardookamoto/) was a Manager for Kraft-Heinz in Brazil, then made CFO for Mexico  [This guy](https://www.linkedin.com/in/daniel-szlak-659b2319/) graduated from a 4-year bachelor's in 2010. He was made CFO for Latin America in 2015, so he was actually a younger (27?) CFO, though probably with less responsibility, than David Knopf.", " I'm a bot, *bleep*, *bloop*. Someone has linked to this thread from another place on reddit:  - [/r/talkbusiness] [I just made a public DropBox w\\/ DMR reports for the following social media channels: Reddit, YouTube, LinkedIn, Twitter, &amp; facebook. (Enjoy!)](https://np.reddit.com/r/talkbusiness/comments/795ezw/i_just_made_a_public_dropbox_w_dmr_reports_for/)  [](#footer)*^(If you follow any of the above links, please respect the rules of reddit and don't vote in the other threads.) ^\\([Info](/r/TotesMessenger) ^/ ^[Contact](/message/compose?to=/r/TotesMessenger))*  [](#bot)", " The second choice is a normal payment, just made early. This guards you against forgetting to make the payment later and incurring late payment fees -- which in this kind of loan are added to the balance and themselves accrue compounded interest. The first option is an extra payment, applied entirely to the principal. That lets you avoid years of accrued interest on that portion of the loan, and reduces the loan's actual cost. I think the extra payment is a better investment.", " SEO is one of the most effective marketing strategies with which you can increase your brand awareness and improve your position in the search engine. Optimize your website making it easy to use and search, helping you get a higher return on investment.", " Majority of Pacific countries have relationship with North Korea, including trade. There are also a lot of regional group and treaty that Trump can't just run rough shot without being literally thrown out of the group.  But I for one want to see Trump tries to cut off trade with China. That would be hilarious. (ie. US consumer will have to live with90's technology overnight.  in some cases, no TV, no iphone, no laptop, no garment, no walmart/amazon junk)", " It seems like all the companies on their scale treat their employees like garbage. However, I try not to shop at those places. The invisible hand of the market impacts Wal-Mart, but it has little real impact. Look at this thread, some people praise Wal-Mart because of this, but they've been treating them badly for decades.", " There are, of course, many possible financial emergencies. They range from large medical expenses to losing your job to being sued to major home or car repairs to who-knows-what. I suppose some people are in a position where the chances that they will face any sort of financial emergency are remote. If you live in a country with national health insurance and there is near-zero chance that you will have any need to go outside this system, you are living with your parents and they are equipped to handle any home repairs, you ride the bus or subway and don't own a car so that's not an issue, etc etc, maybe there just isn't any likely scenario where you'd suddenly need cash. I can think of all sorts of scenarios that might affect me. I'm trying to put my kids through college, so if I lost my job, even if unemployment benefits were adequate to live on, they wouldn't pay for college. I have terrible health insurance so big medical bills could cost me a lot. I have an old car so it could break down any time and need expensive repairs, or even have to be replaced. I might suddenly be charged with a crime that I didn't commit and need a lawyer to defend me. Etc. So in a very real sense, everyone's situation is different. On the other hand, no matter how carefully you think it out, it's always possible that you will get bitten by something that you didn't think of. By definition, you can't make a list of unforeseen problems that might affect you! So no matter how safe you think you are, it's always good to have some emergency fund, just in case. How much is very hard to say."]}], "HotpotQA": [{"query": "Cabalva made three voyages for which English and British joint-stock company?", "pos": ["Cabalva (1811 EIC ship) \"Cabalva\" was an East Indiaman, launched in 1811. She made three voyages for the British East India Company (EIC) before she was wrecked in 1818 on the outbound leg of her fourth voyage.", "East India Company The East India Company (EIC), also known as the Honourable East India Company (HEIC) or the British East India Company and informally as John Company, was an English and later British joint-stock company, which was formed to pursue trade with the \"East Indies\" (in present-day terms, Maritime Southeast Asia), but ended up trading mainly with Qing China and seizing control of the Indian subcontinent."], "neg": ["Economy of Jamshedpur Jamshedpur is the largest urban conglomeration in the state of Jharkhand, India and is also the first well-planned industrial city of India, founded by late Jamshedji Nusserwanji Tata. It is also known as Steel City and TataNagar or simply Tata.", "Howiri Howiri (\"gray projecting-point\") is a Tewa Pueblo ancestral site in Taos County, New Mexico, United States. Its ten circular kivas are located on the east bank of Rio Ojo Caliente, near Homayo. It was occupied from around 1400 until around 1525. In 1983, it was listed on the National Register of Historic Places listings in Taos County, New Mexico.", "Ignatius Jacob I Ignatius Jacob I, also known as Jacob al-Khuri and Jacob of Nabk, was the Patriarch of Antioch, and head of the Syriac Orthodox Church from 1512 until his death in 1517.", "Hans-Joachim Bremermann Hans-Joachim Bremermann (1926\u20131996) was a German-American mathematician and biophysicist. He worked on computer science and evolution, introducing new ideas of how mating generates new gene combinations. Bremermann's limit, named after him, is the maximum computational speed of a self-contained system in the material universe.", "Waldemar Krzystek Waldemar Krzystek (born 23 November 1953) is a Polish film director and screenwriter. His film \"Ostatni prom\" was screened in the Un Certain Regard section at the 1990 Cannes Film Festival.", "Siemiony Siemiony is a village in the administrative district of Gmina Grodzisk, within Siemiatycze County, Podlaskie Voivodeship, in north-eastern Poland. It lies approximately 5 km north-east of Grodzisk, 22 km north of Siemiatycze, and 62 km south-west of the regional capital Bia\u0142ystok.", "Ibniyamin Akhtyamov Ibniyamin Abusugutovich Akhtyamov (sometimes \u2014 \"Abusugudovich\", Russian: \u0418\u0431\u043d\u0438\u044f\u043c\u0438\u043d \u0410\u0431\u0443\u0441\u0443\u0433\u0443\u0442\u043e\u0432\u0438\u0447 (\u0410\u0431\u0443\u0441\u0441\u0443\u0433\u0443\u0434\u043e\u0432\u0438\u0447) \u0410\u0445\u0442\u044f\u043c\u043e\u0432 ; 6 November 1877, Ufa \u2014 1941, USSR) was a lawyer and a deputy of the Fourth Imperial Duma from the Ufa Governorate between 1912 and 1917. He was a chairperson of the All-Russian Congress of Representatives of Muslim Public Organizations, held in Petrograd. In December 1916, he was a lawyer at the trial of the participants in the Central Asian insurrection. After the start of the Russian Civil War, he took part in the Committee of Members of the Constituent Assembly. In Soviet era, he was arrested in 1938 and died in 1941. His brother was a menshevik Ibrahim Akhtyamov (1880\u20141931).", "Clarence E. Coe Clarence Elliot Coe (1873\u20131943), known as Clarence E. Coe, was one of the first settlers and farmers in Palms, California, and a member of the Los Angeles Police Commission from 1929 to 1931 and of the Los Angeles City Council from 1931 to 1933."]}, {"query": "Erika Rosenberg is an author, interpreter and journalist, who wrote a biography about a Sudeten German-born woman who helped to save the lives of how many Jews during World War II?", "pos": ["Erika Rosenberg Erika Rosenberg (born 24 June 1951 in Buenos Aires, Argentina) is an author, interpreter and journalist. She wrote a biography of Emilie Schindler.", "Emilie Schindler Emilie Schindler (22 October 1907 \u2013 5 October 2001) was a Sudeten German-born woman who, with her husband Oskar Schindler, helped to save the lives of 1,200 to 1,700 Jews during World War II by employing them in his enamelware and munitions factories, providing them immunity from the Nazis. She was recognized as Righteous Among the Nations by Israel's Yad Vashem in 1994."], "neg": ["Gmina Przedb\u00f3rz Gmina Przedb\u00f3rz is an urban-rural gmina (administrative district) in Radomsko County, \u0141\u00f3d\u017a Voivodeship, in central Poland. Its seat is the town of Przedb\u00f3rz, which lies approximately 31 km east of Radomsko and 83 km south of the regional capital \u0141\u00f3d\u017a.", "The Complete Stone Roses The Complete Stone Roses is a compilation of singles and B-sides by English rock band The Stone Roses. It was released in 1995 without the band's input by their record company Silvertone, with whom they were embroiled in a protracted legal battle to terminate their five-year contract.", "Patriot Act, Title X Title X: Miscellaneous is the last of ten titles which comprise the USA PATRIOT Act, a bill passed in the United States after the September 11, 2001 attacks. It contains 16 sections that do not fall under other titles in the act.", "Lexmond Lexmond is a town in the Dutch province of South Holland. It is a part of the municipality of Zederik, and lies about 7\u00a0km south of IJsselstein.", "Ron James (footballer, born 1970) Ron James (5 November 1970 \u2013 1 January 1990) was an Australian rules footballer who played with Footscray in the Victorian Football League (VFL) during the late 1980s.", "Lathyrus bijugatus Lathyrus bijugatus is a species of flowering plant in the legume family known by the common names drypark pea, pinewoods sweetpea, and Latah tule-pea. It is native to western North America from British Columbia to Oregon to Montana, and possibly as far south as California.", "Thanatos (US band) Thanatos is a dark wave band whose recordings are distributed by Projekt Records. The band's origins trace to the mid 1980s and was a studio project of Patrick Ogle (aka Padraic Ogl) and Sam Rosenthal (black tape for a blue girl).", "Mangelia angolensis Mangelia angolensis is a species of sea snail, a marine gastropod mollusk in the family Mangeliidae."]}, {"query": "Shether was a song by which American rapper who topped the Billboard charts?", "pos": ["Shether \"Shether\" is a song released by American rapper Remy Ma. It is a diss track aimed at American rapper Nicki Minaj. It was released on February 25, 2017, by Empire Distribution. The song's beat is lifted from the diss track \"Ether\" by Nas.", "Remy Ma Reminisce Mackie (n\u00e9e Smith; May 30, 1980), known professionally as Remy Ma, (formerly Remy Martin), is an American rapper. She contributed to the songs \"Ante Up (Remix)\" (2001), \"Lean Back\" (2004), \"Conceited\" (2006) and \"All the Way Up\" (2016). She is one of only five female rappers to ever top the \"Billboard\" charts and one of only three multiple winners of the BET Award for Best Female Hip-Hop Artist, which she won in 2005 and 2017."], "neg": ["Rimoi National Reserve The Rimoi National Reserve is an animal conservation reserve that is located in the Elgeyo Marakwet County in Kenya. It is a relatively small reserve, covering 66\u00a0km, and is protected by the Kenya Wildlife Service. It lies adjacent to Lake Kamnarock which has recently dried up and is part of a conservation area that is five larger than its size.", "Zdu\u0161a Zdu\u0161a (] ; in older sources also \"Zdu\u0161e\", German: \"Sdusch\" ) is a settlement on the left bank of the Kamnik Bistrica River in the Municipality of Kamnik in the Upper Carniola region of Slovenia.", "Arthur Hood, 1st Baron Hood of Avalon Admiral Arthur William Acland Hood, 1st Baron Hood of Avalon, GCB (14 July 1824 \u2013 16 November 1901) was an officer of the Royal Navy. As a junior officer he took part in the capture of Acre during the Oriental Crisis in 1840 and went ashore with the naval brigade at the defence of Eupatoria in November 1854 during the Crimean War. He became First Naval Lord in June 1885 and in that role was primarily concerned with enshrining into law the recommendations contained in a report on the disposition of the ships of the Royal Navy many of which were unarmoured and together incapable of meeting the combined threat from any two of the other naval powers (\"the Two-power Standard\"): these recommendations were contained in the Naval Defence Act 1889.", "Edulanka EduLanka, also known as edulanka online education school or \"\u0d89\u0dc3\u0dca\u0d9a\u0ddd\u0dbd\u0dda\" is a largest online education school of Sri Lanka. Sinhala Name is \u0d91\u0da9\u0dd2\u0dba\u0dd4\u0dbd\u0d82\u0d9a\u0dcf and Tamil name is \u0b8e\u0b9f\u0bbf\u0baf\u0bc1\u0bb2\u0b99\u0bcd\u0b95\u0bbe. eduLanka is an online education service which provides education free of charge. The test site was built in 2006 and officially launched as edulanka services in May 2007. In 2010 a large update was done for edulanka, after which there was an increase in the number of registrations from local school students, university students, teachers, postgraduate students and others. with online education.Today edulanka is the largest and most popular education web site in Sri Lanka . Ordinary Level Mathematics, Advanced Level Science and Mathes, SLAS Exam Help and Government Job Information are the most popular areas among students.", "Sudbury District municipal elections, 2014 Elections will be held in the organized municipalities in the Sudbury District of Ontario on October 27, 2014 in conjunction with municipal elections across the province.", "Buffy vs. Dracula \"Buffy vs. Dracula\" is the fifth season premiere of the television series \"Buffy the Vampire Slayer\". Buffy faces the infamous Count Dracula, who has come to Sunnydale to make her one of his concubines. In the process, he turns Xander into a Renfield of sorts, and Giles becomes enthralled with the three sisters, much like Jonathan Harker in the novel. However, after a brief spell during which Buffy is mesmerized by the Count, she regains her usual composure and defeats him.", "J. Brandon Dixon J. Brandon Dixon is a Professor of Mechanical and Biomedical Engineering at the Georgia Institute of Technology. He heads the Laboratory of Lymphatic Biology and Bioengineering (LLBB). Among his most recent publications, Dr. Dixon developed a tissue engineered in vitro model to recapitulate lipid uptake by intestinal lymphatics.", "Peasant Revolt in Albania The Peasant Revolt in Albania, or the Muslim Uprising in Albania, was the uprising of peasants from central Albania, mostly Muslims, against the regime of Prince Wilhelm of Wied during 1914, and was one of the reasons for the prince's withdrawal from the country, marking the fall of the Principality of Albania. The revolt was led by Muslim leaders Haxhi Qamili, Arif Hiqmeti, Musa Qazimi and Mustafa Ndroqi. As well as total amnesty, the rebels demanded the return of Albania to the suzerainty of the Sultan of the Ottoman Empire."]}, {"query": "3000 Miles to Graceland revolves around a plot to rob what recently-demolished casino?", "pos": ["3000 Miles to Graceland 3000 Miles to Graceland is a 2001 American action adventure crime film directed, co-produced by Damien Lichtenstein. The script was written by Richard Recco and Damien Lichtenstein. It stars Kurt Russell and Kevin Costner with supporting roles Courteney Cox, David Arquette, Bokeem Woodbine, Christian Slater, and Kevin Pollak. It is a story of theft and betrayal, revolving around a plot to rob the Riviera Casino during a convention of Elvis impersonators.", "Riviera (hotel and casino) Riviera (colloquially, \"the Riv\") was a hotel and casino on the Las Vegas Strip in Winchester, Nevada, which operated from April 1955 to May 2015. It was last owned by the Las Vegas Convention and Visitors Authority, which decided to demolish it to make way for the Las Vegas Global Business District."], "neg": ["Fokker A.I The Fokker A.I (Fokker designation M.8) was an \"A-class\" unarmed two-seat monoplane observation aircraft of the 1914-15 era early in World War I, powered as the earlier Fokker M.5 was, by a 58.8\u00a0kW (80\u00a0PS) Oberursel U.0 seven cylinder rotary engine, or \"umlaufmotor\", a near-clone of the Gnome Lambda rotary engine of the same power output level \u2014 the same U.0 seven cylinder rotary engine version was used on all Fokker military monoplanes before the Fokker E.II \"Eindecker\" fighter's debut in 1915-16. The A.I aircraft resembled a substantially enlarged Fokker M.5, with a tall dorsal cabane structure to handle the triple sets of stationary flying and landing wires anchored to the wing panels' forward spar, each panel having fourteen wing ribs, and the similarly triple sets of wing warping cables attached to the rear spar. The A.I and earlier A.IIs were both built by Fokker and license-built by Halberstadt. The origins of the A.I, A.II and A.III were in a Morane-Saulnier Type H purchased from France. This led to the initial Fokker M.5 airframe designed by Martin Kreutzer, from which the larger A.I was derived. Fokker gave many aerobatic demonstrations in the M.5 on the eve of World War I. The M.8, was ordered as the A.I by the \"Fliegertruppe\" (Imperial German Army Air Service) and between Fokker and Halberstadt, about 63 were produced.", "Sive Pekezela Sive Pekezela (born 3 April 1992) is a South African footballer who plays for Gefle IF as a midfielder.", "Hermann H\u00fcffer Hermann H\u00fcffer (24 March 1830 \u2013 15 March 1905) was a German historian and jurist.", "Saint-Jean-d'Avelanne Saint-Jean-d'Avelanne is a commune in the Is\u00e8re department in southeastern France.", "Penang State Executive Council The Penang State Executive Council is the executive authority of the Government of Penang, Malaysia. The Council is composed of the Chief Minister, appointed by the Governor on the basis that he is able to command a majority in the Penang State Legislative Assembly, a number of members made up of members of the Assembly, the State Secretary, the State Legal Adviser and the State Financial Officer.", "Terry Duffin Terrence Duffin (born 20 March 1982 in Kwekwe, Midlands, Zimbabwe) is a Zimbabwean cricketer.", "Ultimate Boney M. \u2013 Long Versions &amp; Rarities, Volume 3 Ultimate Boney M. \u2013 Long Versions &amp; Rarities, Volume 3", "Lucjanowo Lucjanowo is a village in the administrative district of Gmina Ko\u0142o, within Ko\u0142o County, Greater Poland Voivodeship, in west-central Poland. It lies approximately 5 km north-east of Ko\u0142o and 121 km east of the regional capital Pozna\u0144."]}, {"query": "Which film is also a Disney film, Condorman or Rob Roy, the Highland Rogue?", "pos": ["Condorman Condorman is a 1981 American adventure comedy superhero film directed by Charles Jarrott, produced by Walt Disney Productions, and starring Michael Crawford, Barbara Carrera and Oliver Reed. The movie follows comic book illustrator Woodrow Wilkins' attempts to assist in the defection of a female Soviet KGB agent.", "Rob Roy, the Highland Rogue Rob Roy, the Highland Rogue is a 1953 British-American action film, made by Walt Disney Productions. This film is about Rob Roy MacGregor, and it is also the final Disney film released through RKO Radio Pictures."], "neg": ["Borness Borness is a village in Dumfries and Galloway, Scotland.", "Murchison Semliki Landscape The Murchison Semliki Landscape is a conservation priority landscape situated east of Lake Albert in western Uganda. Species of conservation concern are chimpanzee, elephant, crowned eagle, golden cat, Nahan's francolin, Nile crocodile, hippopotamus and lion. Conservation challenges in this region are pressure from the growing population on its natural resources, including immigration from within Uganda and DRC in response to the availability of natural resources, lack of law enforcement, and the prospect of employment in the establishing petroleum industry.", "Halim Halim or Haleem (Arabic: \u062d\u0644\u064a\u0645\u200e \u200e ) is an Arabic masculine given name which means gentle, forbearing, mild, patient, understanding, indulgent, slow to anger, \"what we call a civilized man\".", "Direction finding Direction finding (DF), or radio direction finding (RDF), is the measurement of the direction from which a received signal was transmitted. This can refer to radio or other forms of wireless communication, including radar signals detection and monitoring (ELINT/ESM). By combining the direction information from two or more suitably spaced receivers (or a single mobile receiver), the source of a transmission may be located via triangulation. Radio direction finding is used in the navigation of ships and aircraft, to locate emergency transmitters for search and rescue, for tracking wildlife, and to locate illegal or interfering transmitters. RDF was important in combating German threats during both the World War II Battle of Britain and the long running Battle of the Atlantic. In the former, the Air Ministry also used RDF to locate its own fighter groups and vector them to detected German raids.", "Lille, Alberta Lille is a ghost town in Alberta located in the Crowsnest Pass region. It held a significant population between 1901 and 1912. In the latter year, the coal mine and coke ovens were closed due to the collapse of the local industry. The company running the town, West Canadian Collieries, suffered a loss of $40,000.", "L\u00e1szl\u00f3 Radv\u00e1nyi L\u00e1szl\u00f3 Radv\u00e1nyi, also known as Johann Lorenz Schmidt, was born into a Jewish family in Hungary, on December 13, 1900, and died July 3, 1978.", "Svena Sv\u00e9na (Sanskrit: \u0938\u094d\u0935\u0947\u0928) is derived from the root \"sva\" (\u0938\u094d\u0935), a reflective adjective, meaning self or one\u2019s own or belonging to oneself; \"\u00e9na\" is a pronominal suffix meaning - \"by\" as in \u0915\u093e\u0932\u0947\u0928 (k\u0101l\u00e9na) \u2013 'by time' or 'by present time'. \"sva\" + \"\u00e9na\" = \"Sv\u00e9na\" means \u2013 'by your own' or 'by one\u2019s own conditioned nature'.", "Tom Dempsey (hurler) Tom Dempsey (born 1965 in Kilmuckridge, County Wexford) is a retired Irish sportsperson. He played hurling with his local club Buffer's Alley and with the Wexford senior inter-county team from 1984 until 2000."]}], "MSMARCO": [{"query": "cost to finish drywall", "pos": [" Without starting a moaning/groaning contest it seems anywhere from $1 to $1.50 per sq foot of drywall is a legitimate rate (to finish only) for someone that has a real business, pays workman's comp, has liability insurance, and allows for profit to help his/her company grow."], "neg": [" My PT Cruiser has a check engine light on and I want to access the code but i don't have a reader. I. know you can use the ignition to access the codes. I have done it before, just can't remember how to. do it.", " Best Diet For Hypothyroidism-Foods to Eat. Always keep in mind that t he best diet for hypothyroidism is a low-carb, high-protein, high-fiber diet. You should include lots of foods rich in soluble fiber-especially when you're trying to lose weight.Why? Because soluble fiber gives you a feeling of fullness and helps with the constipation as well.est Diet For Hypothyroidism-Foods to Eat. Always keep in mind that t he best diet for hypothyroidism is a low-carb, high-protein, high-fiber diet. You should include lots of foods rich in soluble fiber-especially when you're trying to lose weight.", " Quick Answer. Cuba has a totalitarian communist government. It is headed by President Raul Castro and supported by a group of Communist Party loyalists.", " Most dusters today contain one of two types of compressed-gas, and understanding that there is a difference will help you select the right product for the job at hand. The Dust-Off\u00c2\u00ae line of compressed-gas cleaning dusters includes products classified as General Usage dusters and Special Application dusters.", " Depends on your spec and item level, a prot spec is probably worth picking up but ret can do just fine. If all the gear is from LFR its kinda easy but scaled for 25 man still for those 2 raids. I believe you also get the damage buff for wiping each time, determination, not 100% sure if this existed back then.", " Worst experience I have had with a broker in almost 20 years! I have been trading the markets since 1999 and can honestly say that Forex.com is the absolute worst firm I have ever had the misfortune of using. Most have my time has be spent trading equities but in November of 2016 I decided to trade currency as well.", " Note that Finnish distinguishes between a standard language (formal Finnish for media and politics} and the spoken language (used everywhere else.) Go learn a few useful Finnish words & phrases for travelers! 1  Europe. 2  Europe. 3  Europe. 4  Europe. 5  Europe. 6  Europe. 7  Europe. 8  Europe.", " Observations [edit]. UY Scuti was first catalogued in 1860 by German astronomers at the Bonn Observatory during the first sky survey of stars for the Bonner Durchmusterung Stellar Catalogue."]}, {"query": "is theranos blood technology", "pos": [" Theranos is an American privately held health-technology and medical-laboratory-services company based in Palo Alto, California that has developed novel approaches for laboratory diagnostic tests using blood.ays later, Theranos received a FDA clearance, also known as a CLIA waiver, to administer its herpes blood test outside a traditional clinical laboratory. This allows the blood test to be administered by non-laboratory personnel and trained workers."], "neg": [" [tps_header]A beautiful mermaid wedding dress is a sexy choice for a bride looking to show off her figure on her wedding day. Mermaid wedding dresses come in lots of styles and we\u00e2\u0080\u0099ve chosen some of our favorites to sh... I would just wanna raise the skirt just above the hips right were the ribbon ends.", " What did Thomas Jefferson do as a scientist? It's true that Thomas Jefferson contributed some new knowledge directly to science and technology. Jefferson also helped invent modern agricultural science and technology. Jefferson also invented methods for excavating archeological sites.", " For a cost of between $230 to $250 bucks for supplies and tools, you will be able to make up to four maybe even 5 sets of dentures for yourself. With a little patience and persistence, most people can master the art of making dentures for themselves. You don't have to buy everything at once.", " If you are using a rear-facing only or infant seat, there may be two different dates and model numbers on both the carrier and the base. Therefore, you\u00e2\u0080\u0099ll need to check both. Some new labels actually have the date of manufacture and the date of expiration on the car seat. If so, pay close attention to the expiration date and ensure that you do not use it past that manufacture recommended date.", " N. elongata is unusual among Neisseria species in being a rod-shaped organism in contrast to other Neisseria spp. which are diplococci. Also in contrast to most Neisseria spp., N. elongata is catalase-negative and superoxol-negative.", " The Muscular system The dragons muscular system is one of the most fascinating... and one of the most complicate. We can evaluate the power in the bite of a dragon to put to an average of 2 ton per cm cube (in comparison it could easily gnaw steel). As a matter of fact, dragons are very powerful.", " Learner's definition of TUTELAGE. [noncount] formal. 1. : the teaching of an individual student by a teacher. He studied music under the tutelage of his father. = He studied music under his father's tutelage. [=he was taught music by his father]", " Potential patients often ask, a\u00e2\u0082\u00ac\u00c5\u0093How oehow \u00c5\u0093how much does bioidentical hormone?therapy\u00e2\u0082\u00ac Cost a \u00c3\u00a2 the simple answeris approximately $ 200 permonth or $. 2400 per yearhe average cost for hormones ranges from $45-$55 per month. However, some patients opt for pellet therapy as opposed to traditional delivery methods, such as creams, gels, patches and pills."]}, {"query": "what will my mortgage payment be on a 129,000 30 year loan", "pos": [" Report Abuse. As a ballpark, financing $129,000 for 30 years at 7% will give you a payment of about $855 for principal and interest. That doesn't include property taxes and homeowner's insurance, which will vary depending on where you live.eport Abuse. As a ballpark, financing $129,000 for 30 years at 7% will give you a payment of about $855 for principal and interest. That doesn't include property taxes and homeowner's insurance, which will vary depending on where you live."], "neg": [" Deviljho is a Brute Wyvern introduced in Monster Hunter 3. Deviljho is a very large, bipedal Brute Wyvern characterized by its uniform forest green colouration and muscular upper body. Its thick hide is littered with short, jagged spines that reach a maximum height along the back and tail.", " Getting there: Corolla, N.C., is about 630 miles from Cleveland, a 12-hour drive southeast. Commercial airlines fly into Norfolk International Airport in Norfolk, Va., about 100 miles north, where several rental car agencies offer vehicles for the two-hour drive to Corolla.", " 1 For larger jobs, a skid loader or backhoe can be used. 2  Tamping machine to compact base and pavers. 3  Chisel and hammer to split pavers or, for larger jobs, a brick saw can be used.  Wheelbarrow or skid loader to haul sand, gravel, and pavers.", " Faith Evans. Faith Ren\u00c3\u00a9e Evans (born June 10, 1973) is an American singer-songwriter, recording artist, record producer, actress and author. Born in Florida and raised in New Jersey, Evans relocated to Los Angeles during 1993 for a career with the music business.", " Decomposition is the process by which organic substances are broken down into a much simpler form of matter. The process is essential for recycling the finite matter that occupies physical space in the biome.Bodies of living organisms begin to decompose shortly after death.ne can differentiate abiotic from biotic decomposition (biodegradation). The former means degradation of a substance by chemical or physical processes, e.g. hydrolysis. The latter one means the metabolic breakdown of materials into simpler components by living organisms, typically by microorganisms.", " If you buy your girlfriend a vacuum cleaner when she wanted diamonds, you will experience tension. Just before she storms out of the room. The noun tension has its Latin roots in tendere, which means to stretch, and tension occurs when something is stretched either physically or emotionally. Strained relations between countries can cause political tensions to rise. You can add tension to a rubber band by stretching it tight.", " By providing an array of HCM solutions integrated into a single technology platform, Benepay Technologies will address the administrative concern within four categories: Human Resources, Benefit Administration, Compliance and Payroll.", " ContextCapture Center Quickly develop detailed 3D models of any size for use in design, construction, or operations from digital photographs. Acute3D Viewer With the Acute3D Viewer, you can easily explore and precisely measure reality meshes of any scale created with Bentley's ContextCapture software."]}, {"query": "ice age human", "pos": [" Ice Ages Affect Human Evolution. 1  During the last 2 million years the Earth has experienced four long periods of cold climate known as ice ages. 2  During these periods, massive glaciers form which can cover thousands of square miles. 3  Cooler temperatures forced change on early hominids."], "neg": [" 1 Zobacz zdj\u00c4\u0099cie: Plakat na podstawie zdj\u00c4\u0099cia Shirin Neshat z serii \u00e2\u0080\u009eRapture\u00e2\u0080\u009d (1999), grafika: Adam \u00c5\u00bbebrowski. 2  Zobacz film: Purcell, Tallis, Johnson, Locke, van der Aa / Krzysztof Pastor \u00e2\u0080\u0093 \u00e2\u0080\u0098The Tempest\u00e2\u0080\u0099 by the Polish National Ballet \u00e2\u0080\u0093 a trailer.  Zobacz film: Shirin Neshat and Shoja Azari talk about \u00e2\u0080\u0098The Tempest\u00e2\u0080\u0099.", " Up to 3 days. My hubby smoked daily. It took 6 weeks for him to test clean. THC stores in your muscles. The more you work out the quicker it leaves. If she only smoked it once then it takes about 1-2 weeks to clear.", " Spray paint the outside of the bucket with a more desirable color. Do not get paint on the inside of the bucket. 1. Use the power drill to drill a 3/4\u00e2\u0080\u009d hole in the side of the bucket about 1\u00e2\u0080\u009d up from the bottom. Go slowly and carefully, holding the drill very securely.Hold on tight, spade drills can get away from you. You don't want to create a hole any larger than the 3/4\u00e2\u0080\u009d drill bit, or it won't be watertight later.irst you want to install the clear tube indicator in the side of the bucket. This tube does two things: 1  Fluid level indicator-know the nutrient level without lifting up the plant to look inside. 2  Drain port-so you can easily empty out the solution without disturbing the plant.", " Trauma surgeons also work with surgeons in other specialties to stabilize patients in critical condition, and usually work in the emergency care area of a hospital or medical center.", " One of the most stubborn and difficult problems to get rid of in your home is a old musty smell. Musty odors can be caused by a number of things in your home, but, generally speaking, mold and mildew are the main culprits. The bad smell is caused by mold and mildew building up and releasing foul gasses.", " High-energy photons, when they come near another nucleus, can spontaneously turn into an electron-positron pair (conserving charge and the number of electrons, which both add to zero since a positron has positive charge and is an anti-electron).", " Here\u00e2\u0080\u0099s how to link your cartridges to the Explore: 1  Navigate to www.cricut.com/design and sign into your Cricut account. 2  Once you\u00e2\u0080\u0099ve logged in, click again on the green account button and select \u00e2\u0080\u009cCartridge Linking\u00e2\u0080\u009d from the drop-down menu. 3  Insert the cartridge firmly into the port on the Explore machine.", " A clinical case of Lyme disease occurs when a person is infected by a tick bite. Symptoms appear on average 14 days after the tick bite. However the incubation period may last between two days and 3 1/2 months.[3] The bacteria can enter a phase in which they do not cause symptoms but are still present."]}, {"query": "where is cairo illinois", "pos": [" Cairo is located at the confluence of the Mississippi and Ohio Rivers. The rivers converge at Fort Defiance State Park, a Civil War fort that was commanded by General Ulysses S. Grant. Cairo has the lowest elevation of any location within Illinois and is the only city in the state surrounded by levees. This part of Illinois is known as Little Egypt. Several blocks in the town comprise the Cairo Historic District, listed on the National Register of Historic Places (NRHP)."], "neg": [" Pearl Jam (album) Pearl Jam (sometimes referred to as The Avocado Album or simply Avocado) is the eponymous eighth studio album by American alternative rock band Pearl Jam, released on May 2, 2006 on J Records. It was the first and only release for J Records, their last album issued by Sony Music.", " The U.S. Bureau of Labor Statistics indicates that the national average salary earned by a child-care director or program administrator in May 2008 was $39,940. The national salary range for child-care directors ranges from $25,910 to $77,150.", " Breeding [edit | edit source]. Rabbits can be bred with carrots, golden carrots, or dandelions. If you used carrots for breeding, the rabbits will continue to follow the player and ignore being under the breeding effect as long as you are holding a carrot.", " Anyone who is not a limited user will earn a Steam level based on their account's current badges and games. You must create your Steam Community profile to view your Steam level.Limited users do not qualify for Steam levels and will remain at level 0.nyone who is not a limited user will earn a Steam level based on their account's current badges and games. You must create your Steam Community profile to view your Steam level.", " Climate Data. Local Climate Data (Normals, Records, Holidays, etc) for North Charleston, Savannah, and Downtown Charleston. Monthly Data Archive for the Charleston and Savannah Area. SE South Carolina and SE Georgia First and Last Freeze Dates.", " sperm 1. n. pl. sperm or sperms. 1. A male gamete, such as a spermatozoon of an animal or one of the cells or nuclei produced by a pollen grain of a plant.Also called sperm cell.perm 1. n. pl. sperm or sperms. 1. A male gamete, such as a spermatozoon of an animal or one of the cells or nuclei produced by a pollen grain of a plant. Also called sperm cell. 2. Semen. [Middle English.", " Humans are told to get exercise to help relieve stress. It works for dogs too. Burning off some of that tension by going for a walk, a run, or playing in the yard or park is a great anxiety reliever for a dog. It will tire him out, perhaps enough to calm him down when he comes back inside after the exercise.", " When Reagan was a 'liberal Democrat'. In 1948, a very different sounding Ronald Reagan campaigned on the radio for Democrat Harry Truman. Listen to the old audio recording. ...more Duration: {{video.duration.momentjs}}.hen Reagan was a 'liberal Democrat'. In 1948, a very different sounding Ronald Reagan campaigned on the radio for Democrat Harry Truman. Listen to the old audio recording. ... more Duration: {{video.duration.momentjs}}."]}], "NFCorpus": [{"query": "respiratory infections", "pos": ["Cancer and non-cancer health effects from food contaminant exposures for children and adults in California: a risk assessment Background In the absence of current cumulative dietary exposure assessments, this analysis was conducted to estimate exposure to multiple dietary contaminants for children, who are more vulnerable to toxic exposure than adults. Methods We estimated exposure to multiple food contaminants based on dietary data from preschool-age children (2\u20134 years, n=207), school-age children (5\u20137 years, n=157), parents of young children (n=446), and older adults (n=149). We compared exposure estimates for eleven toxic compounds (acrylamide, arsenic, lead, mercury, chlorpyrifos, permethrin, endosulfan, dieldrin, chlordane, DDE, and dioxin) based on self-reported food frequency data by age group. To determine if cancer and non-cancer benchmark levels were exceeded, chemical levels in food were derived from publicly available databases including the Total Diet Study. Results Cancer benchmark levels were exceeded by all children (100%) for arsenic, dieldrin, DDE, and dioxins. Non-cancer benchmarks were exceeded by >95% of preschool-age children for acrylamide and by 10% of preschool-age children for mercury. Preschool-age children had significantly higher estimated intakes of 6 of 11 compounds compared to school-age children (p<0.0001 to p=0.02). Based on self-reported dietary data, the greatest exposure to pesticides from foods included in this analysis were tomatoes, peaches, apples, peppers, grapes, lettuce, broccoli, strawberries, spinach, dairy, pears, green beans, and celery. Conclusions Dietary strategies to reduce exposure to toxic compounds for which cancer and non-cancer benchmarks are exceeded by children vary by compound. These strategies include consuming organically produced dairy and selected fruits and vegetables to reduce pesticide intake, consuming less animal foods (meat, dairy, and fish) to reduce intake of persistent organic pollutants and metals, and consuming lower quantities of chips, cereal, crackers, and other processed carbohydrate foods to reduce acrylamide intake.", "Prenatal exposure to polychlorinated biphenyls and dioxins from the maternal diet may be associated with immunosuppressive effects that persist int... We investigated whether prenatal exposure from the maternal diet to the toxicants polychlorinated biphenyls (PCBs) and dioxins is associated with the development of immune-related diseases in childhood. Children participating in BraMat, a sub-cohort of the Norwegian Mother and Child Cohort Study (MoBa), were followed in the three first years of life using annual questionnaires (0-3years; n=162, 2-3years; n=180), and blood parameters were examined at three years of age (n=114). The maternal intake of the toxicants was calculated using a validated food frequency questionnaire from MoBa. Maternal exposure to PCBs and dioxins was found to be associated with an increased risk of wheeze and more frequent upper respiratory tract infections. Furthermore, maternal exposure to PCBs and dioxins was found to be associated with reduced antibody response to a measles vaccine. No associations were found between prenatal exposure and immunophenotype data, allergic sensitization and vaccine-induced antibody responses other than measles. Our results suggest that prenatal dietary exposure to PCBs and dioxins may increase the risk of wheeze and the susceptibility to infectious diseases in early childhood. Copyright \u00a9 2012 Elsevier Ltd. All rights reserved.", "Fish intake and breastfeeding time are associated with serum concentrations of organochlorines in a Swedish population. Persistent organic pollutants (POPs) exert harmful effects on cognitive, endocrine and immune functions and bioaccumulate in the environment and human tissues. The aim of this study was to investigate the body burden of several POPs in the adult population (n=246) and their association to diet and other lifestyle factors in a Swedish national survey. Serum concentrations of several polychlorinated biphenyls (PCBs), and the pesticides hexachlorobenzene (HCB), \u03b2-hexachlorocyclohexane (\u03b2-HCH), chlordane compounds and dichlorodiphenyldichloroethylene (DDE) were determined by liquid-liquid extraction, silica column cleanup and gas chromatography high resolution mass spectrometry. Diet was assessed using 4-day food records and complementary dietary and lifestyle factors by questionnaire. Fish intake was additionally assessed by plasma fatty acid composition. Clustering of the compounds revealed that PCBs were separated into two clusters, one including low-chlorinated PCB 28 and 52, and the other high-chlorinated mono- and di-ortho PCBs, suggesting similarities and dissimilarities in exposure sources and possibly also toxicokinetics. Men had 24% and 32% higher levels of PCB 138-180 and chlordane compounds, respectively, compared with women. This may partly be explained by elimination of the POPs among women reporting a history of breastfeeding. The proportion of very long-chain n-3 fatty acids in plasma were positively correlated with the pollutants: r=0.24 (PCB 28), r=0.33 (PCB 118), r=0.35 (PCB 138-180), r=0.29 (HCB), r=0.18 (\u03b2-HCH), r=0.34 (chlordane compounds), r=0.34 (p,p'-DDE), p\u22640.005. Individuals consuming fatty Baltic fish\u22651 time per months had 45% higher serum levels of PCB 118 compared with non-consumers. Levels of PCB 28 were associated with the age of the residential building. To conclude, the population-distributed approach of surveying dietary habits, lifestyle factors and POP body burdens, made it possible to identify personal characteristics associated with the POP body burdens in Sweden. Copyright \u00a9 2012 Elsevier Ltd. All rights reserved.", "Environmental toxicants and the developing immune system: a missing link in the global battle against infectious disease? There is now compelling evidence that developmental exposure to chemicals from our environment contributes to disease later in life, with animal models supporting this concept in reproductive, metabolic, and neurodegenerative diseases. In contrast, data regarding how developmental exposures impact the susceptibility of the immune system to functional alterations later in life are surprisingly scant. Given that the immune system forms an integrated network that detects and destroys invading pathogens and cancer cells, it provides the body\u2019s first line of defense. Thus, the consequences of early-life exposures that reduce immune function are profound. This review summarizes available data for pollutants such as cigarette smoke and dioxin-like compounds, which consistently support the idea that developmental exposures critically impact the immune system. These findings suggest that exposure to common chemicals from our daily environment represent overlooked contributors to the fact that infectious diseases remain among the top five causes of death worldwide.", "Prenatal exposure to polychlorinated biphenyls and dioxins is associated with increased risk of wheeze and infections in infants. The birth cohort BraMat (n = 205; a sub-cohort of the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health) was established to study whether prenatal exposure to toxicants from the maternal diet affects immunological health outcomes in children. We here report on the environmental pollutants polychlorinated biphenyls (PCBs) and dioxins, as well as acrylamide generated in food during heat treatment. The frequency of common infections, eczema or itchiness, and periods of more than 10 days of dry cough, chest tightness or wheeze (called wheeze) in the children during the first year of life was assessed by questionnaire data (n = 195). Prenatal dietary exposure to the toxicants was estimated using a validated food frequency questionnaire from MoBa. Prenatal exposure to PCBs and dioxins was found to be associated with increased risk of wheeze and exanthema subitum, and also with increased frequency of upper respiratory tract infections. We found no associations between prenatal exposure to acrylamide and the health outcomes investigated. Our results suggest that prenatal dietary exposure to dioxins and PCBs may increase the risk of wheeze and infectious diseases during the first year of life. Copyright \u00a9 2011 Elsevier Ltd. All rights reserved.", "Do circulating leucocytes and lymphocyte subtypes increase in response to brief exercise in children with and without asthma? Background Exercise can alter health in children in both beneficial (eg reduced long\u2010term risk of atherosclerosis) and adverse (eg exercise\u2010induced asthma) ways. The mechanisms linking exercise and health are not known, but may rest, partly, on the ability of exercise to increase circulating immune cells. Little is known about the effect of brief exercise, more reflective of naturally occurring patterns of physical activity in children, on immune cell responses. Objectives To determine whether (1) a 6\u2010min bout of exercise can increase circulating inflammatory cells in healthy children and (2) the effect of brief exercise is greater in children with a history of asthma. Methods Children with mild\u2013moderate persistent asthma and age\u2010matched controls (n\u200a=\u200a14 in each group, mean age 13.6\u2005years) performed a 6\u2010min bout of cycle\u2010ergometer exercise. Spirometry was performed at baseline and after exercise. Blood was drawn before and after exercise, leucocytes were quantified and key lymphocyte cell surface markers were assessed by flow cytometry. Results Exercise decreased spirometry only in children with asthma, but increased (p<0.001) most types of leucocytes (eg lymphocytes (controls, mean (SD) 1210 (208)\u2005cells/\u03bcl; children with asthma, 1119 (147)\u2005cells/\u03bcl) and eosinophils (controls, 104 (22)\u2005cells/\u03bcl; children with asthma, 88 (20)\u2005cells/\u03bcl)) to the same degree in both groups. Similarly, exercise increased T helper cells (controls, 248 (60)\u2005cells/\u03bcl; children with asthma, 232 (53)\u2005cells/\u03bcl) and most other lymphocyte subtypes tested. By contrast, although basophils (16 (5)\u2005cells/\u03bcl) and CD4+ CD45RO+ RA+ lymphocytes (19 (4)\u2005cells/\u03bcl) increased in controls, no increase in these cell types was found in children with asthma. Conclusions Exercise increased many circulating inflammatory cells in both children with asthma and controls. Circulating inflammatory cells did increase in children with asthma, but not to a greater degree than in controls. In fact, basophils and T helper lymphocyte memory transition cells did not increase in children with asthma, whereas they did increase in controls. Even brief exercise in children and adolescents robustly mobilises circulating immune cells.", "Baker's yeast \u03b2-glucan supplementation increases monocytes and cytokines post-exercise: implications for infection risk? Strenuous aerobic exercise is known to weaken the immune system, and while many nutritional supplements have been proposed to boost post-exercise immunity, few are known to be effective. The purpose of the present study was to evaluate whether 10 d of supplementation with a defined source of baker's yeast \u03b2-glucan (BG, Wellmune WGP\u00ae) could minimise post-exercise immunosuppression. Recreationally active men and women (n 60) completed two 10 d trial conditions using a cross-over design with a 7 d washout period: placebo (rice flour) and baker's yeast BG (250 mg/d of \u03b2-1,3/1,6-glucans derived from Saccharomyces cerevisiae) before a bout of cycling (49 \u00b1 6 min) in a hot (38 \u00b1 2\u00b0C), humid (45 \u00b1 2 % relative humidity) environment. Blood was collected at baseline (before supplement), pre- (PRE), post- (POST) and 2 h (2H) post-exercise. Total and subset monocyte concentration was measured by four-colour flow cytometry. Plasma cytokine levels and lipopolysaccharide (LPS)-stimulated cytokine production were measured using separate multiplex assays. Total (CD14\u207a) and pro-inflammatory monocyte concentrations (CD14\u207a/CD16\u207a) were significantly greater at POST and 2H (P<0\u00b705) with BG supplementation. BG supplementation boosted LPS-stimulated production of IL-2, IL-4, IL-5 and interferon-\u03b3 (IFN-\u03b3) at PRE and POST (P<0\u00b705). Plasma IL-4, IL-5 and IFN-\u03b3 concentrations were greater at 2H following BG supplementation. It appears that 10 d of supplementation with BG increased the potential of blood leucocytes for the production of IL-2, IL-4, IL-5 and IFN-\u03b3. The key findings of the present study demonstrate that BG may have potential to alter immunity following a strenuous exercise session.", "Effect of BETA 1, 3/1, 6 GLUCAN on Upper Respiratory Tract Infection Symptoms and Mood State in Marathon Athletes This was a placebo-controlled, double-blind study designed to evaluate the effect of a commercially available dietary supplement on upper-respiratory tract symptoms (URTI) and mood state. Seventy-five marathon runners (35 men, 40 women) ranging in age from 18-53 years, mean age: 36 \u00b1 9, self-administered placebo, 250 mg or 500 mg of BETA 1,3/1,6 GLUCAN (commercial name Wellmune WGP\u00ae) daily during the 4 week post-marathon trial period following the 2007 Carlsbad Marathon. Subjects filled out the profile of mood state (POMS) assessment and a questionnaire style health log measuring health status and URTI symptoms after 2- and 4-week treatment administrations. During the course of the 4-week study, subjects in the treatment groups (250 mg and 500 mg BETA-GLUCAN per day) reported significantly fewer URTI symptoms, better overall health and decreased confusion, fatigue, tension, and anger, and increased vigor based on the POMS survey compared to placebo. BETA-GLUCAN may prevent URTI symptoms, and improve overall health and mood following a competitive marathon. Key points", "Probiotics for preventing acute upper respiratory tract infections. BACKGROUND: Probiotics may improve a person's health by regulating their immune function. Some studies show that probiotic strains can prevent respiratory infections. However, no evidence of the benefits of probiotics for acute upper respiratory tract infections (URTIs) and related potential adverse effects has been published. OBJECTIVES: To assess the effectiveness and safety of probiotics for preventing acute URTIs. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (Ovid) (1950 to May week 1, 2011), EMBASE (1974 to May 2011), Web of Science which includes Science Citation Index (from 1900 to May 2011) and Conference Proceedings Citation Index (from 1991 to May 2011), the Chinese Biomedical Literature Database, which includes the China Biological Medicine Database (from 1978 to May 2011), the Chinese Medicine Popular Science Literature Database (from 2000 to May 2011) and the Masters Degree Dissertation of Beijing Union Medical College Database (from 1981 to May 2011). SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing probiotics with placebo to prevent acute URTIs. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed eligibility, quality of trials and extracted data. MAIN RESULTS: We included 14 RCTs, although we could only extract available data to meta-analyse in 10 trials which involved 3451 participants. We found that probiotics were better than placebo when measuring the number of participants experiencing episodes of acute URTI: at least one episode: odds ratio (OR) 0.58; 95% confidence interval (CI) 0.36 to 0.92; at least three episodes: OR 0.53; 95% CI 0.36 to 0.80; rate ratio of episodes of acute URTI: rate ratio 0.88; 95% CI 0.81 to 0.96; and reduced antibiotic prescription rates for acute URTIs: OR 0.67; 95% CI 0.45 to 0.98. Probiotics and placebo were similar when measuring the mean duration (MD) of an episode of acute URTI: MD -0.29; 95% CI -3.71 to 3.13 and adverse events: OR 0.92; 95% CI 0.37 to 2.28. Side effects of probiotics were minor and gastrointestinal symptoms were the most common. We found that some subgroups had a high level of heterogeneity when conducting pooled analyses. AUTHORS' CONCLUSIONS: Probiotics were better than placebo in reducing the number of participants experiencing episodes of acute URTIs, the rate ratio of episodes of acute URTI and reducing antibiotic use. This indicates that probiotics may be more beneficial than placebo for preventing acute URTIs. However, the results have some limitations and there were no data for older people.", "Systemic immunity-enhancing effects in healthy subjects following dietary consumption of the lactic acid bacterium Lactobacillus rhamnosus HN001. OBJECTIVE: To determine the effects of the probiotic lactic acid bacterium, Lactobacillus rhamnosus HN001, on natural cellular immunity when delivered orally in normal low-fat milk (LFM) or lactose-hydrolyzed low-fat milk (LFM-LH). DESIGN: A three stage, pre-post intervention trial, spanning nine weeks. SETTING: Taipei Medical College Hospital, Taipei, Taiwan. SUBJECTS: Fifty-two healthy middle-aged and elderly volunteers (17 males, 35 females; median age 63.5, range 44-80). INTERVENTIONS: Stage 1 (run-in diet): 25 g/200 mL reconstituted LFM powder, twice daily for 3 weeks. Stage 2 (probiotic intervention): LFM or LFM-LH, supplemented with 10(9) CFUs/g L. rhamnosus HN001 in each case, for 3 weeks. Stage 3 (wash-out): LFM for 3 weeks. MEASURES OF OUTCOME: In vitro phagocytic capacity of peripheral blood polymorphonuclear (PMN) leukocytes; in vitro tumoricidal activity of natural killer (NK) leukocytes. RESULTS: Immunological responses were unaffected by the run-in diet of LFM alone. In contrast, the relative proportion of PMN cells showing phagocytic activity increased by 19% and 15%, respectively, following consumption of HN001 in either LFM or LFM-LH; the relative level of NK cell tumor killing activity increased by 71% and 147%. In most cases these levels declined following cessation, but remained above baseline. CONCLUSIONS: Dietary consumption of L. rhamnosus HN001, in a base of low-fat milk or lactose-hydrolyzed low-fat milk, appears to enhance systemic cellular immune responses and may be useful as a dietary supplement to boost natural immunity.", "Caesarean delivery and risk of atopy and allergic disease: meta-analyses. BACKGROUND: Studies of delivery by caesarean section (c-section) and the offspring's risk of allergic diseases are of current interest due to concerns about the increased use of c-section in many countries. However, previous studies have reported inconsistent findings. OBJECTIVE: We investigated whether delivery by c-section is associated with an increased risk of atopy and allergic disease by reviewing the literature, performing a meta-analysis, and assessing publication bias. METHODS: We used a systematic literature search of MEDLINE (1966 to May 2007). Six common allergic outcomes were included: food allergy/food atopy, inhalant atopy, eczema/atopic dermatitis, allergic rhinitis, asthma, and hospitalization for asthma. For each outcome a meta-analysis was performed, where a summary odds ratio (OR) was calculated taking into account heterogeneity between the study-specific relative risks. Publication bias was assessed using the funnel plot method. RESULTS: We identified 26 studies on delivery by c-section and one or more of the six allergic outcomes. C-section was associated with an increased summary OR of food allergy/food atopy (OR 1.32, 95% CI 1.12-1.55; six studies), allergic rhinitis (OR 1.23, 95% CI 1.12-1.35; seven studies), asthma (OR 1.18, 95% CI 1.05-1.32; 13 studies), and hospitalization for asthma (OR 1.21, 95% CI 1.12-1.31; seven studies), whereas there was no association with inhalant atopy (OR 1.06, 95% CI 0.82-1.38; four studies) and eczema/atopic dermatitis (OR 1.03, 95% CI 0.98-1.09; six studies). Funnel plots indicated that the association with food allergy/food atopy could be difficult to interpret due to publication bias. For each significant association with an allergic outcome, only 1-4% of cases were attributable to c-section. CONCLUSION: Delivery by c-section is associated with a moderate risk increase for allergic rhinitis, asthma, hospitalization for asthma, and perhaps food allergy/food atopy, but not with inhalant atopy or atopic dermatitis. The increased use of c-section during the last decades is unlikely to have contributed much to the allergy epidemic observed during the same period.", "Position statement. Part one: Immune function and exercise. An ever-growing volume of peer-reviewed publications speaks to the recent and rapid growth in both scope and understanding of exercise immunology. Indeed, more than 95% of all peer-reviewed publications in exercise immunology (currently >2, 200 publications using search terms \"exercise\" and \"immune\") have been published since the formation of the International Society of Exercise and Immunology (ISEI) in 1989 (ISI Web of Knowledge). We recognise the epidemiological distinction between the generic term \"physical activity\" and the specific category of \"exercise\", which implies activity for a specific purpose such as improvement of physical condition or competition. Extreme physical activity of any type may have implications for the immune system. However, because of its emotive component, exercise is likely to have a larger effect, and to date the great majority of our knowledge on this subject comes from exercise studies.", "Natural killer cell activity in peripheral blood of highly trained and untrained persons. Natural killer (NK) cell activity and concentration of CD16+ cells (NK cells) and CD20+ cells (monocytes) in peripheral blood were measured in highly trained racing cyclists and in age- and sex-matched untrained controls. Median NK cell activity was 38.1% (range 20.0%-57.1%) in trained vs 30.3% (range 19.7%-43.1%) in untrained (P = 0.008). Median %CD16+ cells was 17% (range 7%-33%) in trained vs 11% (3%-29%) in untrained (P = 0.007). Indomethacin in vitro enhanced the NK cell activity in both groups. There was, however, no significant difference between the NK cell activity in trained and untrained after exposure to indomethacin in vitro. Indomethacin-enhanced NK cell activity was 45.9% (range 24.4%-67.5%) in trained and 40.0% (range 23.9%-68.5%) in untrained (P = 0.138). Mean %CD14+ cells was 8.3% (range 2%-15%) in trained vs 3.8% (2%-8%) in untrained (P less than 0.0001). The increased NK cell function thus demonstrated in highly trained persons might result in better resistance against infectious disease.", "Can exercise-related improvements in immunity influence cancer prevention and prognosis in the elderly? Cancer incidence increases with advancing age. Over 60% of new cancers and 70% of cancer deaths occur in individuals aged 65 years or older. One factor that may contribute to this is immunosenescence - a canopy term that is used to describe age-related declines in the normal functioning of the immune system. There are multiple age-related deficits in both the innate and adaptive systems that may play a role in the increased incidence of cancer. These include decreased NK-cell function, impaired antigen uptake and presentation by monocytes and dendritic cells, an increase in 'inflammaging', a decline in the number of na\u00efve T-cells able to respond to evolving tumor cells, and an increase in functionally exhausted senescent cells. There is consensus that habitual physical exercise can offer protection against certain types of cancer; however the evidence linking immunological mechanisms, exercise, and reduced cancer risk remain tentative. Multiple studies published over the last two decades suggest that exercise can mitigate the deleterious effects of age on immune function, thus increasing anti-cancer immunity. The potential ameliorative effect of exercise on these mechanisms include evidence that physical activity is able to stimulate greater NK-cell activity, enhance antigen-presentation, reduce inflammation, and prevent senescent cell accumulation in the elderly. Here we discuss the role played by the immune system in preventing and controlling cancer and how aging may retard these anti-cancer mechanisms. We also propose a pathway by which exercise-induced alterations in immunosenescence may decrease the incidence of cancer and help improve prognosis in cancer patients. Copyright \u00a9 2013 Elsevier Ireland Ltd. All rights reserved.", "Aging of hepatitis C virus (HCV)-infected persons in the United States: a multiple cohort model of HCV prevalence and disease progression. BACKGROUND & AIMS: The prevalence of chronic hepatitis C (CH-C) remains high and the complications of infection are common. Our goal was to project the future prevalence of CH-C and its complications. METHODS: We developed a multicohort natural history model to overcome limitations of previous models for predicting disease outcomes and benefits of therapy. RESULTS: Prevalence of CH-C peaked in 2001 at 3.6 million. Fibrosis progression was inversely related to age at infection, so cirrhosis and its complications were most common after the age of 60 years, regardless of when infection occurred. The proportion of CH-C with cirrhosis is projected to reach 25% in 2010 and 45% in 2030, although the total number with cirrhosis will peak at 1.0 million (30.5% higher than the current level) in 2020 and then decline. Hepatic decompensation and liver cancer will continue to increase for another 10 to 13 years. Treatment of all infected patients in 2010 could reduce risk of cirrhosis, decompensation, cancer, and liver-related deaths by 16%, 42%, 31%, and 36% by 2020, given current response rates to antiviral therapy. CONCLUSIONS: Prevalence of hepatitis C cirrhosis and its complications will continue to increase through the next decade and will mostly affect those older than 60 years of age. Current treatment patterns will have little effect on these complications, but wider application of antiviral treatment and better responses with new agents could significantly reduce the impact of this disease in coming years.", "Efficacy and safety of Chlorella supplementation in adults with chronic hepatitis C virus infection AIM: To evaluate the safety and efficacy of Chlorella in 18 patients chronically infected with hepatitis C virus (HCV) genotype 1. METHODS: Eighteen adults with chronic infection by HCV genotype 1 received daily oral supplementation of Chlorella for 12 wk. Changes in the RNA levels of HCV, as well as those of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were evaluated following this treatment period. Paired t tests were conducted to compare the means of the different variables at the beginning and end of the study. Side effects and quality of life aspects were also compared between weeks 0 and 12 of the study period. RESULTS: A majority 84.61% of the patients had a significant decrease in their ALT levels from week 0 to week 12. Evaluation of side effects showed that Chlorella was well tolerated. Quality of life assessment showed that 76.9 of the participants reported an improvement in their energy levels and 46.1% reported an improvement in their perception of general health. Although 69.23% also showed a decrease in their AST levels, this was not statistically significant. Most patients that exhibited an improvement in their ALT and AST levels also showed a tendency toward a decreased HCV viral load. The HCV RNA levels showed a decrease in 69.23% of the patients, which along with changes in AST/ALT ratios from week 0 to week 12, these results were not statistically significant. CONCLUSION: Chlorella supplementation was well tolerated in patients with chronic HCV and associated with a significant decrease in ALT liver enzyme levels.", "Physical activity and immune function in elderly women. The relationship between cardiorespiratory exercise, immune function, and upper respiratory tract infection (URTI) was studied in elderly women utilizing a randomized controlled experimental design with a follow-up of 12 wk. Thirty-two sedentary, elderly Caucasian women, 67-85 yr of age, who met specific selection criteria, were randomized to either a walking or calisthenic group; 30 completed the study. Twelve highly conditioned elderly women, 65-84 yr of age, who were active in endurance competitions, were recruited at baseline for cross-sectional comparisons. Intervention groups exercised 30-40 min, 5 d.wk-1, for 12 wk, with the walking group training at 60% heart rate reserve and the calisthenic group engaging in mild range-of-motion and flexibility movements that kept their heart rates close to resting levels. At baseline, the highly conditioned subjects exhibited superior NK (119 +/- 13 vs 77 +/- 8 lytic units, P < 0.01) and T (33.3 +/- 4.9 vs 21.4 +/- 2.1 cpm x 10(-3) using PHA, P < 0.05) cell function, despite no differences in circulating levels of lymphocyte subpopulations. Twelve weeks of moderate cardiorespiratory exercise improved the VO2max of the sedentary subjects 12.6%, but did not result in any improvement in NK cell activity or T cell function. Incidence of URTI was lowest in the highly conditioned group and highest in the calisthenic control group during the 12-wk study, with the walkers in an intermediate position (chi-square = 6.36, P = 0.042). In conclusion, the highly conditioned elderly women in this study had superior NK and T cell function when compared with their sedentary counterparts.(ABSTRACT TRUNCATED AT 250 WORDS)", "Salivary Secretory Immunoglobulin a secretion increases after 4-weeks ingestion of chlorella-derived multicomponent supplement in humans: a randomized cross over study Background Chlorella, a unicellular green alga that grows in fresh water, contains high levels of proteins, vitamins, minerals, and dietary fibers. Some studies have reported favorable immune function-related effects on biological secretions such as blood and breast milk in humans who have ingested a chlorella-derived multicomponent supplement. However, the effects of chlorella-derived supplement on mucosal immune functions remain unclear. The purpose of this study was to investigate whether chlorella ingestion increases the salivary secretory immunoglobulin A (SIgA) secretion in humans using a blind, randomized, crossover study design. Methods Fifteen men took 30 placebo and 30 chlorella tablets per day for 4 weeks separated by a 12-week washout period. Before and after each trial, saliva samples were collected from a sterile cotton ball that was chewed after overnight fasting. Salivary SIgA concentrations were measured using ELISA. Results Compliance rates for placebo and chlorella ingestions were 97.0 \u00b1 1.0% and 95.3 \u00b1 1.6%, respectively. No difference was observed in salivary SIgA concentrations before and after placebo ingestion (P = 0.38). However, salivary SIgA concentrations were significantly elevated after chlorella ingestion compared to baseline (P < 0.01). No trial \u00d7 period interaction was identified for the saliva flow rates. Although the SIgA secretion rate was not affected by placebo ingestion (P = 0.36), it significantly increased after 4-week chlorella ingestion than before intake (P < 0.01). Conclusions These results suggest 4-week ingestion of a chlorella-derived multicomponent supplement increases salivary SIgA secretion and possibly improves mucosal immune function in humans.", "Beneficial immunostimulatory effect of short-term Chlorella supplementation: enhancement of Natural Killer cell activity and early inflammatory response (Randomized, double-blinded, placebo-controlled trial) Background In vitro and animal studies have demonstrated that Chlorella is a potent biological response modifier on immunity. However, there were no direct evidences for the effect of Chlorella supplementation on immune/inflammation response in healthy humans. Methods This study was designed for an 8-week randomized, double-blinded, placebo-controlled trial: 5g of Chlorella (n=23) or Placebo (n=28) as form of tablets. Mainly, cytotoxic activities of Natural killer (NK) cells and serum concentrations of interferon-\u03b3, interleukin-1\u03b2 and interleukin-12 were measured. Results After the 8-week, serum concentrations of interferon-\u03b3 (p<0.05) and interleukin-1\u03b2 (p<0.001) significantly increased and that of interleukin-12 (p<0.1) tended to increase in the Chlorella group. The increments of these cytokines after the intervention were significantly bigger in the Chlorella group than those in the placebo group. In addition, NK cell activities (%) were significantly increased in Chlorella group, but not in Placebo group. The increments of NK cell activities (%) were also significantly bigger in the Chlorella group than the placebo group. Additionally, changed levels of NK cell activity were positively correlated with those of serum interleukin-1\u03b2 (r=0.280, p=0.047) and interferon-\u03b3 (r=0.271, p<0.005). Signficantly positive correlations were also observed among the changed levels of serum cytokines; between interferon-\u03b3 and interleukin-1\u03b2 (r=0.448, p<0.001), between interleukin-12 and interleukin-1\u03b2 (r=0.416, p=0.003) and between interleukin-12 and interferon-\u03b3 (r=0.570, p<001). Conclusion These results may suggest a beneficial immunostimulatory effect of short-term Chlorella supplementation which enhances the NK cell activity and produces interferon-\u03b3 and interleukin-12 as well as interleukin-1\u03b2, the Th-1 cell-induced cytokines in healthy people.", "The effects of moderate exercise training on natural killer cells and acute upper respiratory tract infections. A randomly controlled 15-wk exercise training (ET) study (five 45-min sessions/wk, brisk walking at 60% heart rate reserve) with a group of 36 mildly obese, sedentary women was conducted to investigate the relationship between improvement in cardiorespiratory fitness, changes in natural killer (NK) cell number and activity, and acute upper respiratory tract infection (URI) symptomatology. The study was conducted using a 2 (exercise and nonexercise groups) x 3 (baseline, 6-, and 15-wk testing sessions) factorial design, with data analyzed using repeated measures ANOVA. No significant change in NK cell number occurred as a result of ET as measured by the CD16 and Leu-19 monoclonal antibodies. ET did have a significant effect on NK cell activity (E:T 50:1) especially during the initial 6-wk period [F(2.68) = 12.34, p less than 0.001]. Using data from daily logs kept by each subject, the exercise group was found to have significantly fewer URI symptom days/incident than the nonexercise group (3.6 +/- 0.7 vs 7.0 +/- 1.4 days, respectively, p = 0.049). Improvement in cardiorespiratory fitness was correlated significantly with a reduction in URI symptom days/incident (r = 0.37, p = 0.025) and a change in NK cell activity from baseline to six but not 15 wks (r = 0.35, p = 0.036). In summary, moderate ET is associated with elevated NK cell activity after six but not 15 weeks, and reduced URI symptomatology in comparison to a randomized, sedentary control group.", "Economic evaluation of direct-acting antiviral therapy in chronic hepatitis C. In 2011, the protease inhibitors boceprevir and telaprevir were approved in the United States and European Union for the treatment of hepatitis C infection. While remarkably effective, the newly approved therapies are also accompanied by additional side effects and considerable costs. Understanding the balance between costs and effectiveness is critical to making decisions about the optimal use of these new agents, especially for health care systems constrained by rising costs. Our goal for this review is to facilitate an understanding of the importance of cost-effectiveness analyses in guiding policy decisions about the use of newly approved drugs as well as future therapies for hepatitis C.", "Managing adverse effects and complications in completing treatment for hepatitis C virus infection. The addition of direct-acting antivirals (DAAs) to hepatitis C virus (HCV) treatment regimens has made treatment more effective and patient management more complex. Shepherding patients through a full course of HCV therapy requires motivation and involvement on the part of the patient and the physician. Indeed, physician inexperience and lack of confidence in guiding patients through the challenges of treatment appears to be a primary reason for early discontinuation of therapy. Among the many complications of HCV treatment that must be managed efficiently and effectively are depression and other psychiatric disorders; hematologic abnormalities including DAA- and ribavirin-associated anemia and peginterferon alfa-associated neutropenia and thrombocytopenia; rash and drug eruptions, including telaprevir-associated rash; and weight loss. Practical considerations in management of these common complications are offered. This article summarizes a presentation by Kenneth E. Sherman, MD, PhD, at the IAS-USA live continuing medical education course held in New York in June 2012.", "Dietary polyphenols in the prevention and treatment of allergic diseases. Allergic disorders encompass skin, food and respiratory allergies. Sensitization to a normally harmless allergen results in the immune system being biased to a predominant T-helper type 2 response. Re-exposure to the same allergen leads to a robust secretion of allergy-related mediators that eventually triggers symptoms. Our understanding of these disorders has enabled the search of therapeutic approaches that can either modulate the sensitization process or impact on allergic mediators, thus helping manage allergic symptoms. Polyphenols are one such class of compounds that are found in foods and plant sources and have been investigated for their anti-allergic effect in different disease models and in human clinical trials. Their anti-inflammatory profile is known to impact on the recruitment of immune cells to the skin and in preventing the development of secondary infections following disruption of the skin barrier. The interaction of polyphenols with proteins can modulate the process of allergic sensitization and their direct effect on allergic effector cells such as mast cells inhibit mediator release, resulting in the alleviation of symptoms. In addition, their endogenous anti-oxidant ability limits the extent of cellular injury from free radicals during the allergic insult. Overall, polyphenols hold promise as anti-allergy agents capable of influencing multiple biological pathways and immune cell functions in the allergic immune response and deserve further investigation. The objective of the current review is to summarize the key findings and progress made in studying polyphenols as anti-allergic ingredients. Special emphasis is placed in this review to highlight key physiological, cellular and signalling pathways implicated in the mechanism of action of different polyphenols in the context of allergic disorders and their manifestations. \u00a9 2011 Blackwell Publishing Ltd.", "Dietary antioxidant intake, allergic sensitization and allergic diseases in young children. BACKGROUND: Allergic diseases have risen in prevalence over recent decades. The aetiology remains unclear but is likely to be a result of changing lifestyle and/or environment. A reduction in antioxidant intake, consequent to reduced intake of fresh fruits and vegetables, has been suggested as a possible cause. OBJECTIVE: To investigate whether dietary antioxidant intake at age 5 was related to atopy at 5 and 8 years of age amongst children in an unselected birth cohort. METHODS: Children were followed from birth. Parents completed a validated respiratory questionnaire and children were skin prick tested at 5 and 8 years of age. Serum IgE levels were measured at age 5. At age 5, antioxidant intake was assessed using a semi-quantitative food frequency questionnaire (FFQ). A nutrient analysis program computed nutrient intake, and frequency counts of foods high in the antioxidant vitamins A, C and E were assessed. RESULTS: Eight hundred and sixty-one children completed both the respiratory and FFQ. Beta-carotene intake was associated with reduced risk of allergic sensitization at age 5 [0.80 (0.68-0.93)] and 8 [0.81 (0.70-0.94)]. In addition, beta-carotene intake was negatively associated with total IgE levels (P = 0.002). Vitamin E intake was associated with an increased risk of allergic sensitization [1.19 (1.02-1.39)], only at age 5. There was no association between antioxidant intakes and wheeze or eczema. CONCLUSION: Increased beta-carotene intake was associated with a reduced risk of allergic sensitization and lower IgE levels, in 5- and 8-year-old children. Dietary antioxidants may play a role in the development of allergic sensitization.", "Manipulating antioxidant intake in asthma: a randomized controlled trial. BACKGROUND: Antioxidant-rich diets are associated with reduced asthma prevalence in epidemiologic studies. We previously showed that short-term manipulation of antioxidant defenses leads to changes in asthma outcomes. OBJECTIVE: The objective was to investigate the effects of a high-antioxidant diet compared with those of a low-antioxidant diet, with or without lycopene supplementation, in asthma. DESIGN: Asthmatic adults (n = 137) were randomly assigned to a high-antioxidant diet (5 servings of vegetables and 2 servings of fruit daily; n = 46) or a low-antioxidant diet (\u22642 servings of vegetables and 1 serving of fruit daily; n = 91) for 14 d and then commenced a parallel, randomized, controlled supplementation trial. Subjects who consumed the high-antioxidant diet received placebo. Subjects who consumed the low-antioxidant diet received placebo or tomato extract (45 mg lycopene/d). The intervention continued until week 14 or until an exacerbation occurred. RESULTS: After 14 d, subjects consuming the low-antioxidant diet had a lower percentage predicted forced expiratory volume in 1 s and percentage predicted forced vital capacity than did those consuming the high-antioxidant diet. Subjects in the low-antioxidant diet group had increased plasma C-reactive protein at week 14. At the end of the trial, time to exacerbation was greater in the high-antioxidant than in the low-antioxidant diet group, and the low-antioxidant diet group was 2.26 (95% CI: 1.04, 4.91; P = 0.039) times as likely to exacerbate. Of the subjects in the low-antioxidant diet group, no difference in airway or systemic inflammation or clinical outcomes was observed between the groups that consumed the tomato extract and those who consumed placebo. CONCLUSIONS: Modifying the dietary intake of carotenoids alters clinical asthma outcomes. Improvements were evident only after increased fruit and vegetable intake, which suggests that whole-food interventions are most effective. This trial was registered at http://www.actr.org.au as ACTRN012606000286549.", "Clinical efficacy of apple polyphenol for treating cedar pollinosis. A double-blind comparative study was conducted on cedar pollinosis patients in order to evaluate the treatment efficacy of apple polyphenol (Ap). Ap was administered (500 mg) once daily for 12 weeks, starting about 2 weeks prior to cedar pollen dispersion. Pollinosis symptoms during the study were evaluated according to the classification in the guidelines for allergic rhinitis diagnosis and treatment. The results show that the sneezing score was significantly lower for the Ap group than with the placebo group during the early period of pollen dispersion and during the main dispersion period. In addition, no adverse reactions were induced by Ap during the study. These results suggest that Ap may alleviate the symptoms of cedar pollinosis.", "An evaluation of the clinical efficacy of tomato extract for perennial allergic rhinitis. BACKGROUND: Recently, some common foods in daily life have been found to have anti-allergic effects. We have reported that tomato extract (TE) could possibly inhibit histamine release and mouse ear-swelling responses. Moreover, it is reported that TE could relieve the symptoms for Japanese cedar pollinosis. METHODS: To evaluate the anti-allergic effect of TE, we performed a randomized, double-blind, placebo-controlled study in 33 patients with perennial allergic rhinitis (PAR) using oral administration of TE (360 mg per day) or placebo for 8 weeks. RESULTS: We found that the sneezing score significantly decreased in the TE group at the end of the trial compared to the beginning (P < 0.05). There were decreasing tendencies of rhinorrhea and nasal obstruction in the TE group. The patients' quality of life was significantly improved in the TE group after 8 weeks of treatment (P < 0.05), but not in placebo group. A significant improvement in total symptom scores, combining sneezing, rhinorrhea and nasal obstruction, was observed after oral administration of TE for 8 weeks (P < 0.01). The safety of TE treatment was confirmed by laboratory tests and inspection of general conditions. CONCLUSIONS: TE can be expected to safely improve the nasal symptoms of PAR.", "Protective effect of fruits, vegetables and the Mediterranean diet on asthma and allergies among children in Crete Background Atopy is not uncommon among children living in rural Crete, but wheeze and rhinitis are rare. A study was undertaken to examine whether this discrepancy could be attributed to a high consumption of fresh fruit and vegetables or adherence to a traditional Mediterranean diet. Methods A cross\u2010sectional survey was performed in 690 children aged 7\u201318\u2005years in rural Crete. Parents completed a questionnaire on their child's respiratory and allergic symptoms and a 58\u2010item food frequency questionnaire. Adherence to a Mediterranean diet was measured using a scale with 12 dietary items. Children underwent skin prick tests with 10 common aeroallergens. Results 80% of children ate fresh fruit (and 68% vegetables) at least twice a day. The intake of grapes, oranges, apples, and fresh tomatoes\u2014the main local products in Crete\u2014had no association with atopy but was protective for wheezing and rhinitis. A high consumption of nuts was found to be inversely associated with wheezing (OR 0.46; 95% CI 0.20 to 0.98), whereas margarine increased the risk of both wheeze (OR 2.19; 95% CI 1.01 to 4.82) and allergic rhinitis (OR 2.10; 95% CI 1.31 to 3.37). A high level of adherence to the Mediterranean diet was protective for allergic rhinitis (OR 0.34; 95% CI 0.18 to 0.64) while a more modest protection was observed for wheezing and atopy. Conclusion The results of this study suggest a beneficial effect of commonly consumed fruits, vegetables and nuts, and of a high adherence to a traditional Mediterranean diet during childhood on symptoms of asthma and rhinitis. Diet may explain the relative lack of allergic symptoms in this population.", "Diet, lung function, and lung function decline in a cohort of 2512 middle aged men BACKGROUND\u2014A prospective cohort study of 2512 Welshmen aged 45-59 living in Caerphilly in 1979-1983 was used to investigate associations between diet and lung function. METHODS\u2014At baseline (phase I) and at five year follow up (phase II), forced expiratory volume in one second (FEV1) was measured using a McDermott spirometer and dietary data were obtained using a semi-quantitative food frequency questionnaire. RESULTS\u2014Good lung function, indicated by high maximum FEV1 given age and height, was associated with high intakes of vitamin C, vitamin E, \u03b2-carotene, citrus fruit, apples, and the frequent consumption of fruit juices/squashes. Lung function was inversely associated with magnesium intake but there was no evidence of an association with fatty fish. Following adjustment for confounders including body mass index, smoking history, social class, exercise, and total energy intake, only the associations with vitamin E and apples persisted, with lung function estimated to be 39 ml (95% confidence interval (CI) 9 to 69) higher for vitamin E intakes one standard deviation (SD) apart and 138 ml higher (95% CI 58to 218) for those eating five or more apples per week compared with non-consumers. Decline in lung function between phases was not significantly associated with the changing intakes of apples or vitamin E. An association between high average apple consumption and slow decline in lung function lost significance after adjustment for confounders. CONCLUSIONS\u2014A strong positive association is seen between lung function and the number of apples eaten per week cross sectionally, consistent with a protective effect of hard fruit rather than soft/citrus fruit. The recent suggestion that such effects are reversible was not supported by our longitudinal analysis.", "A prospective study of diet and adult-onset asthma. A role for diet in the pathophysiology of asthma may be mediated by altered immune or antioxidant activity with consequent effects on airway inflammation. We evaluated associations between several dietary factors assessed by a semiquantitative food frequency questionnaire, and incidence of asthma over a 10-yr period in 77,866 women 34 to 68 yr of age. Women in the highest quintile of vitamin E intake from diet, but not from supplements, had a risk of 0.53 (95% confidence interval [CI] = 0.33 to 0.86) compared with women in the lowest quintile. This relationship, however, was attenuated when the contribution from nuts, a major source of vitamin E in these data and a possible allergen, was removed (relative risk = 0.74 [0.50 to 1.10], p for trend = 0.007). Positive associations were found for vitamins C and E from supplements, but appeared to be explained by women at high risk of asthma initiating use of vitamin supplements prior to diagnosis. A nonsignificant inverse association with carotene intake was noted, but no clear relations with asthma were demonstrated for intake of linoleic acid or omega-3 fatty acids. These data suggest that antioxidant supplementation and intake of various fats during adulthood are not important determinants of asthma, although vitamin E from diet may have a modest protective effect.", "Effect of fresh fruit consumption on lung function and wheeze in children BACKGROUND: Fresh fruit consumption and vitamin C intake have been associated with improved lung function in adults. Whether this is due to enhancement of lung growth, to a reduction in lung function decline, or to protection against bronchospasm is unclear. METHODS: In a cross- sectional school based survey of 2650 children aged 8-11 from 10 towns in England and Wales the main outcome measure was forced expiratory volume in one second (FEV1) standardised for body size and sex. Exposure was assessed by a food frequency questionnaire to parents and by measurement of plasma levels of vitamin C in a subsample of 278 children. RESULTS: FEV1 was positively associated with frequency of fresh fruit consumption. After adjustment for possible confounding variables including social class and passive smoking, those who never ate any fresh fruit had an estimated FEV1 some 79 ml (4.3%) lower than those who ate these items more than once a day (95% CI 22 to 136 ml). The association between FEV1 and fruit consumption was stronger in subjects with wheeze than in non-wheezers (p = 0.020 for difference in trend), though wheeze itself was not related to fresh fruit consumption. Frequency of consumption of salads and of green vegetables were both associated with FEV1 but the relationships were weaker than for fresh fruit. Plasma vitamin C levels were unrelated to FEV1 (r = - 0.01, p = 0.92) or to wheeze and were only weakly related to fresh fruit consumption (r = 0.13, p = 0.055). CONCLUSIONS: Fresh fruit consumption appears to have a beneficial effect on lung function in children. Further work is needed to confirm whether the effect is restricted to subjects who wheeze and to identify the specific nutrient involved.", "Vegan regimen with reduced medication in the treatment of bronchial asthma. Thirty-five patients who had suffered from bronchial asthma for an average of 12 yr, all receiving long-term medication, 20 including cortisone, were subject to therapy with vegan food for 1 yr. In almost all cases, medication was withdrawn or drastically reduced. There was a significant decrease in asthma symptoms. Twenty-four patients (69%) fulfilled the treatment. Of these, 71% reported improvement at 4 months and 92% at 1 yr. There was a significant improvement in a number of clinical variables; for example, vital capacity, forced expiratory volume at one sec and physical working capacity, as well as a significant change in various biochemical indices as haptoglobin, IgM, IgE, cholesterol, and triglycerides in blood. Selected patients, with a fear of side-effects of medication, who are interested in alternative health care, might get well and replace conventional medication with this regimen.", "Maternal meat and fat consumption during pregnancy and suspected atopic eczema in Japanese infants aged 3-4 months: the Osaka Maternal and Child He... Interest has increased in the possibility that maternal dietary intake during pregnancy might influence the development of allergic disorders in children. The present prospective study examined the association of maternal intake of selected foods high in fatty acids and specific types of fatty acids during pregnancy with the risk of suspected atopic eczema among Japanese infants aged 3-4 months. Subjects were 771 mother-child pairs. Information on maternal dietary intake during pregnancy was assessed with a validated self-administered diet history questionnaire. The term 'suspected atopic eczema' was used to define an outcome based on results of our questionnaire completed by mothers 3-4 months postpartum. The risk of suspected atopic eczema was 8.4% (n = 65). Higher maternal intake of meat during pregnancy was significantly associated with an increased risk of suspected atopic eczema in the offspring: the multivariate odds ratio (OR) for the highest vs. lowest quartile was 2.59 [95% confidence interval (CI): 1.15-6.17, p for trend = 0.01]. The positive association was strengthened when the definition of the outcome was confined to a definite physician's diagnosis of atopic eczema (n = 35): the multivariate OR between extreme quartiles was 3.53 (95% CI: 1.19-12.23, p for trend = 0.02). No material exposure-response relationships were observed between maternal intake of eggs, dairy products, fish, total fat, saturated fatty acids, monounsaturated fatty acids, n-3 polyunsaturated fatty acids, alpha-linolenic acid, eicosapentaenoic acid, docosahexaenoic acid, n-6 polyunsaturated fatty acids, linoleic acid, arachidonic acid and cholesterol and the ratio of n-3 to n-6 polyunsaturated fatty acid consumption and the risk of suspected atopic eczema. Higher maternal meat intake may increase the risk of infantile atopic eczema, whereas we found no evidence that maternal intake of fish and n-3 polyunsaturated fatty acids are preventive against infantile atopic eczema. (c) 2009 John Wiley & Sons A/S", "Endocrine-Disrupting Chemicals: Associated Disorders and Mechanisms of Action The incidence and/or prevalence of health problems associated with endocrine-disruption have increased. Many chemicals have endocrine-disrupting properties, including bisphenol A, some organochlorines, polybrominated flame retardants, perfluorinated substances, alkylphenols, phthalates, pesticides, polycyclic aromatic hydrocarbons, alkylphenols, solvents, and some household products including some cleaning products, air fresheners, hair dyes, cosmetics, and sunscreens. Even some metals were shown to have endocrine-disrupting properties. Many observations suggesting that endocrine disruptors do contribute to cancer, diabetes, obesity, the metabolic syndrome, and infertility are listed in this paper. An overview is presented of mechanisms contributing to endocrine disruption. Endocrine disruptors can act through classical nuclear receptors, but also through estrogen-related receptors, membrane-bound estrogen-receptors, and interaction with targets in the cytosol resulting in activation of the Src/Ras/Erk pathway or modulation of nitric oxide. In addition, changes in metabolism of endogenous hormones, cross-talk between genomic and nongenomic pathways, cross talk with estrogen receptors after binding on other receptors, interference with feedback regulation and neuroendocrine cells, changes in DNA methylation or histone modifications, and genomic instability by interference with the spindle figure can play a role. Also it was found that effects of receptor activation can differ in function of the ligand.", "Reduction in penis size and plasma testosterone concentrations in juvenile alligators living in a contaminated environment. The development of the male reproductive ducts and external genitalia in vertebrates is dependent on elevated androgen concentrations during embryonic development and the period of postnatal growth. We have observed that a population of juvenile alligators living on Lake Apopka exhibit significantly smaller penis size (24% average decrease) and lower plasma concentrations of testosterone (70% lower concentrations) when compared to animals of similar size on Lake Woodruff. In addition to smaller phalli, no relationship exists between plasma testosterone concentrations and penile size in males from Lake Apopka, whereas a positive relationship exists for males from Lake Woodruff. The alligators on Lake Apopka are known to have elevated concentrations of the antiandrogenic DDT breakdown product p.p'-DDE stored in their fat. We suggest a number of hypotheses that could explain the modification in the phenotype of the juvenile male living in Lake Apopka. These modifications in phenotype include a smaller penis size, lower plasma androgen concentrations, and lack of responsiveness of the penis to the plasma androgens present.", "p-Nonyl-phenol: an estrogenic xenobiotic released from \"modified\" polystyrene. Alkylphenols are widely used as plastic additives and surfactants. We report the identification of an alkylphenol, nonylphenol, as an estrogenic substance released from plastic centrifuge tubes. This compound was extracted with methanol, purified by flash chromatography and reverse-phase high performance liquid chromatography, and identified by gas chromatography-mass spectrometry. Nonylphenol induced both cell proliferation and progesterone receptor in human estrogen-sensitive MCF7 breast tumor cells. Nonylphenol also triggered mitotic activity in rat endometrium; this result confirms the reliability of the MCF7 cell proliferation bioassay. The estrogenic properties of alkylphenols, specifically nonylphenols, indicate that the use of plasticware containing these chemicals in experimental and diagnostic tests may lead to spurious results, and these compounds as well as alkylphenol polyethoxylates may also be potentially harmful to exposed humans and the environment at large.", "Do fast foods cause asthma, rhinoconjunctivitis and eczema? Global findings from the International Study of Asthma and Allergies in Childhood (ISAA... BACKGROUND: Certain foods may increase or decrease the risk of developing asthma, rhinoconjunctivitis and eczema. We explored the impact of the intake of types of food on these diseases in Phase Three of the International Study of Asthma and Allergies in Childhood. METHODS: Written questionnaires on the symptom prevalence of asthma, rhinoconjunctivitis and eczema and types and frequency of food intake over the past 12 months were completed by 13-14-year-old adolescents and by the parents/guardians of 6-7-year-old children. Prevalence ORs were estimated using logistic regression, adjusting for confounders, and using a random (mixed) effects model. RESULTS: For adolescents and children, a potential protective effect on severe asthma was associated with consumption of fruit \u22653 times per week (OR 0.89, 95% CI 0.82 to 0.97; OR 0.86, 95% CI 0.76 to 0.97, respectively). An increased risk of severe asthma in adolescents and children was associated with the consumption of fast food \u22653 times per week (OR 1.39, 95% CI 1.30 to 1.49; OR 1.27, 95% CI 1.13 to 1.42, respectively), as well as an increased risk of severe rhinoconjunctivitis and severe eczema. Similar patterns for both ages were observed for regional analyses, and were consistent with gender and affluence categories and with current symptoms of all three conditions. CONCLUSIONS: If the association between fast foods and the symptom prevalence of asthma, rhinoconjunctivitis and eczema is causal, then the findings have major public health significance owing to the rising consumption of fast foods globally.", "Dietary meat and fat intake and prevalence of rhinoconjunctivitis in pregnant Japanese women: baseline data from the Kyushu Okinawa Maternal and Child Health Study Background Dietary fat exerts numerous complex effects on proinflammatory and immunologic pathways. Several epidemiological studies have examined the relationships between intake of fatty acids and/or foods high in fat and allergic rhinitis, but have provided conflicting findings. The current cross-sectional study investigated such relationships in Japan. Methods Study subjects were 1745 pregnant women. The definition of rhinoconjunctivitis was based on criteria from the International Study of Asthma and Allergies in Childhood. Information on dietary factors was collected using a validated self-administered diet history questionnaire. Adjustment was made for age; gestation; region of residence; number of older siblings; number of children; smoking; secondhand smoke exposure at home and at work; family history of asthma, atopic eczema, and allergic rhinitis; household income; education; and body mass index. Results The prevalence of rhinoconjunctivitis in the past 12 months was 25.9%. Higher meat intake was significantly associated with an increased prevalence of rhinoconjunctivitis: the adjusted odds ratio between extreme quartiles was 1.71 (95% confidence interval: 1.25-2.35, P for trend = 0.002). No measurable association was found between fish intake and rhinoconjunctivitis. Intake of total fat, saturated fatty acids, monounsaturated fatty acids, n-3 polyunsaturated fatty acids, \u03b1-linolenic acid, eicosapentaenoic acid, docosahexaenoic acid, n-6 polyunsaturated fatty acids, linoleic acid, arachidonic acid, and cholesterol and the ratio of n-3 to n-6 polyunsaturated fatty acid intake were not evidently related to the prevalence of rhinoconjunctivitis. Conclusions The current results suggest that meat intake may be positively associated with the prevalence of rhinoconjunctivitis in young adult Japanese women.", "Xeno-estrogenic compounds in precipitation. The exposure to some chemicals can lead to hormone disrupting effects. Presently, much attention is focused on so-called xeno-estrogens, synthetic compounds that interact with hormone receptors causing a number of reactions that eventually lead to effects related to reproduction and development. The current study was initiated to investigate the presence of a number of such compounds in precipitation as a follow-up on a previous study in which pesticide concentrations in air and precipitation were determined. Rainwater samples were collected at about 50 locations in The Netherlands in a four week period. The samples were analysed for bisphenol-A, alkylphenols and alkylphenol ethoxylates, phthalates, flame retardants and synthetic musk compounds. The results clearly indicated the presence of these compounds in precipitation. The concentrations ranged from the low ng l(-1) range for flame retardants to several thousands of ng l(-1) for the phthalates. Bisphenol-A was found in 30% of the samples in concentrations up to 130 ng l(-1), while alkylphenols and alkylphenol ethoxylates were found in virtually all locations in concentrations up to 920 ng l(-1) for the individual compounds. Phthalates were by far the most abundant xeno-estrogens in the precipitation samples and were found in every sample. Di-isodecyl phthalate was found in a surprisingly high concentration of almost 100 000 ng l(-1). Polybrominated flame retardants were found in the low ng l(-1) range and generally in less than 20% of the samples. Noticeable was the finding of hexabromocyclododecane, a replacement for the polybrominted diphenyl ethers at one location in a concentration of almost 2000 ng l(-1). Finally, as expected, synthetic musk compounds were detected in almost all samples. This is especially true for the polycyclic musks HHCB and AHTN. Nitro musks were found, but only on a few locations. Kriging techniques were used to calculate precipitation concentrations in between actual sampling locations to produce contour plots for a number of compounds. These plots clearly show located emission sources for a number of compounds such as bisphenol-A, nonylphenol ethoxylate, phthalates and AHTN. On the contrary, the results for HHCB and some phthalates indicated diffuse emission patterns, probably as the result of the use of consumer products containing these compounds.", "The intestinal microflora in allergic Estonian and Swedish 2-year-old children. BACKGROUND: The prevalence of allergic diseases seems to have increased particularly over the past 35-40 years. Furthermore, allergic disease is less common among children in the formerly socialist countries of central and Eastern Europe as compared with Western Europe. It has been suggested that a reduced microbial stimulation during infancy and early childhood would result in a slower postnatal maturation of the immune system and development of an optimal balance between TH1- and TH2-like immunity. AIMS: To test the hypothesis that allergic disease among children may be associated with differences in their intestinal microflora in two countries with a low (Estonia) and a high (Sweden) prevalence of allergy. METHODS: From a prospective study of the development of allergy in relation to environmental factors, 29 Estonian and 33 Swedish 2-year-old children were selected. They were either nonallergic (n = 36) or had a confirmed diagnosis of allergy (n = 27) as verified by typical history and at least one positive skin prick test to egg or cow's milk. Weighed samples of faeces were serially diluted (10-2-10-9) and grown under anaerobic conditions. The counts of the various genera and species were calculated for each child. In addition, the relative amounts of the particular microbes were expressed as a proportion of the total count. RESULTS: The allergic children in Estonia and Sweden were less often colonized with lactobacilli (P < 0.01), as compared with the nonallergic children in the two countries. In contrast, the allergic children harboured higher counts of aerobic micro-organisms (P < 0. 05), particularly coliforms (P < 0.01) and Staphylococcus aureus (P < 0.05). The proportions of aerobic bacteria of the intestinal flora were also higher in the allergic children (P < 0.05), while the opposite was true for anaerobes (P < 0.05). Similarly, in the allergic children the proportions of coliforms were higher (P < 0. 05) and bacteroides lower (P < 0.05) than in the nonallergic children. CONCLUSIONS: Differences in the indigenous intestinal flora might affect the development and priming of the immune system in early childhood, similar to what has been shown in rodents. The role of intestinal microflora in relation to the development of infant immunity and the possible consequences for allergic diseases later in life requires further study, particularly as it would be readily available for intervention as a means for primary prevention of allergy by the administration of probiotic bacteria.", "Increasing prevalence of Japanese cedar pollinosis: a meta-regression analysis. BACKGROUND: Japanese cedar pollinosis, caused by the pollen of the Japanese cedar tree (Cryptomeria japonica), is the commonest seasonal allergic disease in Japan. A number of epidemiological surveys have been reported on Japanese cedar pollinosis, but it has never been assessed systematically or quantitatively. To confirm the increasing prevalence of Japanese cedar pollinosis and related factors, we conducted a meta-regression analysis on population-based surveys in Japan. METHODS: We searched for data from population-based surveys in which serological methods were used to test all participants. Weighted regression of logit-transformed prevalence and sensitization rates were used to evaluate the effects of the year of survey, age, and degree of urbanization. We also analyzed the relationship between prevalence and sensitization rate. RESULTS: Thirty-eight reports with 27 subgroups for prevalence and 134 subgroups for sensitization rate were selected from the literature published in the years between 1986 and 2000. The Japanese cedar pollen sensitization rate was found to be significantly correlated with the year of survey, age, and degree of urbanization (adjusted R(2) = 0.55). The coefficient for the correlation between the prevalence and the sensitization rate revealed a statistically significant correlation (Pearson's r = 0.70, p < 0.001). CONCLUSIONS: The prevalence of Japanese cedar pollinosis among adolescents was predicted to be 28.7% in metropolitan areas and 24.5% in the general population in urban areas in the year 2004, derived from the estimated sensitization rate and the relationship between sensitization rate and prevalence. The prevalence of Japanese cedar pollinosis increased 2.6-fold between 1980 and 2000, and the prevalence differed considerably according to age and degree of urbanization. Copyright (c) 2005 S. Karger AG, Basel", "Alkylphenols--potential modulators of the allergic response. The prevalence of allergic diseases has increased in recent decades. Allergic diseases, particularly asthma, are complex diseases with strong gene-environment interactions. Epidemiological studies have identified a variety of risk factors for the development of allergic diseases. Among them, endocrine-disrupting chemicals (EDCs) play an important role in triggering or exacerbating these diseases. 4-Nonylphenol (NP) and 4-octylphenol (OP)--two major alkylphenols--have been recognized as common toxic and xenobiotic endocrine disrupters. Due to their low solubility, high hydrophobicity, and low estrogenic activity, they tend to accumulate in the human body and may be associated with the adverse effects of allergic diseases. Recently, new evidence has supported the importance of alkylphenols in the in vitro allergic response. This review focuses on the effects of alkylphenols on several key cell types in the context of allergic inflammation. Copyright \u00a9 2012. Published by Elsevier B.V.", "Randomized placebo-controlled trial of lactobacillus on asthmatic children with allergic rhinitis. Previous studies have suggested that probiotic administration may have therapeutic and/or preventive effects on atopic dermatitis in infants; however, its role in allergic airway diseases remains controversial. To determine whether daily supplementation with specific Lactobacillus gasseri A5 for 8 weeks can improve the clinical symptoms and immunoregulatory changes in school children suffering from asthma and allergic rhinitis (AR). We conducted a randomized, double-blind, placebo-controlled study on school children (age, 6-12 years) with asthma and AR. The eligible study subjects received either L. gasseri A5 (n = 49) or a placebo (n = 56) daily for 2 months. Pulmonary function tests were performed, and the clinical severity of asthma and AR was evaluated by the attending physicians in the study period. Diary cards with records of the day- and nighttime peak expiratory flow rates (PEFR), symptoms of asthma, and AR scores of the patients were used for measuring the outcome of the treatment. Immunological parameters such as the total IgE and cytokine production by the peripheral blood mononuclear cells (PBMCs) were determined before and after the probiotic treatments. Our results showed the pulmonary function and PEFR increased significantly, and the clinical symptom scores for asthma and AR decreased in the probiotic-treated patients as compared to the controls. Further, there was a significant reduction in the TNF-\u03b1, IFN-\u03b3, IL-12, and IL-13 production by the PBMCs following the probiotic treatment. In conclusion, probiotic supplementation may have clinical benefits for school children suffering from allergic airway diseases such as asthma and AR.", "European bans on surfactant trigger transatlantic debate. U.S. and European regulators and researchers disagree over risks of a common class of surfactants.", "Alkylphenols and alkylphenol ethoxylates contamination of crustaceans and fishes from the Adriatic Sea (Italy). This paper presents the results of an investigation on the occurrence of alkylphenols (APs) and their ethoxylates (APEs) in 8 edible marine species from the Adriatic Sea and tries to estimate the corresponding intake for the Italian population. Two crustaceans, Nephrops norvegicus (Norway lobster) and Squilla mantis (spottail mantis shrimp), plus six fish species, Engraulis enchrascicolus (anchovy), Scomber scombrus (Atlantic mackerel), Merluccius merluccius (European hake), Mullus barbatus (red mullet), Solea vulgaris (common sole) and Lophius piscatorius (angler) were analyzed for their content of nonylphenol (NP), octylphenol (OP) and octylphenol polyethoxylates (OPEs). These compounds were found in all analysed samples. NP was detected at the highest concentrations: 118-399 and 9.5-1431 ng g(-1) fresh weight (fw) respectively in crustaceans and fish. OP was found at respective levels of 2.7-4.7 and 0.3-3.8 ng g(-1) fw in crustaceans and fish, whereas OPE was determined at respective concentrations of 1.2-16.8 and 0.2-21.1 ng g(-1) fw in the same species. These results, together with those from a previous study on 4 edible mollusc, allow to estimate respective daily intakes for NP, OP, and OPE of about 12, 0.1, and 0.1 microg day(-1) for an Italian adult living along the Adriatic Coast. In relation to NP and OP, these intakes are much lower than the doses associated with toxic effects in laboratory animals (9 mg kg(-1) bw for rats). Nevertheless, data of exposure from other sources to these chemicals and others with similar biological characteristics are needed.", "Effects of xenoestrogenic environmental pollutants on the proliferation of a human breast cancer cell line (MCF-7). A human breast cancer cell line (MCF-7) was used to develop an in vitro screening assay for the detection of xenoestrogenic environmental pollutants. MCF-7 cells were cultured in DMEM containing 5% fetal bovine serum (FBS). An estrogenic response was defined as an increase in the frequency of proliferating MCF-7 cells, and was measured using a thymidine analog, bromodeoxyuridine, and flow cytometry. Di-2-ethylhexyl phthalate (DEHP) and 4-n-nonylphenol (4-n-NP) were used as model chemicals. The proliferation rate of S-phase cells after 24 h of exposure to various concentrations of 17beta-estradiol and to model compounds was compared with a positive and a negative control, containing 1 nM 17beta-estradiol and 0.1% ethanol, respectively. DEHP and 4-n-NP increased the frequency of proliferating MCF-7 cells in a dose-dependent manner. The lowest concentration that significantly increased the proliferation of MCF-7 cells was 10 microM for DEHP and 1 microM for 4-n-NP. The results showed that the assay is accurate and quick to perform. It may prove a valuable tool for screening potential estrogen-mimicking environmental pollutants.", "Novel probiotic candidates for humans isolated from raw fruits and vegetables. This study was aimed at determining the probiotic potential of a large number of autochthonous lactic acid bacteria isolated from fruit and vegetables. Survival under simulated gastric and intestinal conditions showed that 35% of the strains, mainly belonging to the species Lactobacillus plantarum maintained high cell densities. Selected strains did not affect the immune-mediation by Caco-2 cells. All strains stimulated all 27 immune-mediators by peripheral blood mononuclear cells (PBMC). A significant (P<0.05; P<0.01) increase of the major part of cytokines and growth factors was found. A few chemokines were stimulated. Immune-mediators with pro-inflammatory activity (IL-17, EOTAXIN and IFN\u03b3) were significantly (P<0.01) stimulated by all strains, followed by IL-1b>IP-10>IL-6>MIP1\u03b1. Stimulation of IL-12, IL-2 and IL-7 was strain dependent. Only a few strains increased the synthesis of cytokines with anti-inflammatory activity. Six L.\u00a0plantarum strains were further selected. Four were defined as the strongly adhesive strains (more than 40 bacteria adhering to one Caco-2 cell), and 2 as the adhesive strains (5-40 bacteria adhering to one Caco-2 cell). Five strains grew and acidified chemically defined medium with fructo-oligosaccharides (FOS) as the only carbon source. End-products of FOS fermentation were found. All strains inhibited enterohemorragic Escherichia coli K12 and Bacillus megaterium F6 isolated from human sources. The results of this study showed that some autochthonous lactic acid bacteria from raw fruit and vegetables have functional features to be considered as novel probiotic candidates. Copyright \u00a9 2012 Elsevier Ltd. All rights reserved.", "Can nutrition limit exercise-induced immunodepression? Prolonged exercise and heavy training are associated with depressed immune cell function. To maintain immune function, athletes should eat a well-balanced diet sufficient to meet their energy, carbohydrate, protein, and micronutrient requirements. Consuming carbohydrate during prolonged strenuous exercise attenuates rises in stress hormones and appears to limit the degree of exercise-induced immune depression. Recent evidence suggests that antioxidant vitamin supplementation may also reduce exercise stress and impairment of leukocyte functions. Further research is needed to evaluate the effects of other antioxidants and dietary immunostimulants such as probiotics and echinacea on exercise-induced immune impairment.", "Is infection risk linked to exercise workload? Anecdotal, survey, and epidemiological data suggest that endurance athletes are at an increased risk for upper respiratory tract infection (URTI) during periods of heavy training and the 1 - to 2-wk period after race events. The majority of athletes, however, who participate in endurance race events do not experience illness. Of greater public health importance is the consistent finding of a reduction in URTI risk reported by fitness enthusiasts and athletes who engage in regular exercise training while avoiding overreaching/overtraining. Although it naturally follows that infection risk should in some way be linked to acute and chronic exercise-induced alterations in immunity, attempts thus far to measure this association have been unsuccessful. There is growing evidence that for several hours subsequent to heavy exertion, several components of both the innate and adaptive immune system exhibit suppressed function. The immune response to heavy exertion is transient, however, and further research on the mechanisms underlying the immune response to prolonged and intensive endurance exercise is necessary before meaningful clinical applications can be drawn. Some attempts have been made through chemical or nutritional means (e.g., indomethacin, glutamine, vitamin C, and carbohydrate supplementation) to attenuate immune changes after intensive exercise to lower the risk of infection. No consistent relationship between nutritional interventions, exercise immunology, and alteration in URTI risk has yet been established.", "Aerobic fitness is associated with lower proportions of senescent blood T-cells in man. Senescent T-cells accumulate with age, lowering the na\u00efve T-cell repertoire and increasing host infection risk. As this response is likely to be influenced by certain lifestyle factors, we examined the association between aerobic fitness (VO(2max)) and the age-related accumulation of senescent T-cells. Blood lymphocytes from 102 healthy males (18-61 yr) were analyzed for KLRG1, CD57, CD28, CD45RA, CD45RO surface expression on CD4+ and CD8+ T-cells by 4-color flow cytometry. Advancing age (yr) was positively associated with the proportion (%) of senescent (KLRG1+/CD57+; KLRG1+/CD28-) CD4+ (B=1.00; 1.02) and CD8+ (B=0.429; 1.02) T-cells and inversely associated with na\u00efve (KLRG1-/CD28+) CD4+ (B=-1.000) and CD8+ (B=-0.993) T-cells. VO(2max) was inversely associated with senescent CD4+ (B=-0.97) and CD8+ (B=-0.240). Strikingly, age was no longer associated with the proportions of senescent or na\u00efve T-cells after adjusting for VO(2max), while the association between VO(2max) and these T-cell subsets withstood adjustment for age, BMI and percentage body fat. Ranking participants by age-adjusted VO(2max) revealed that the highest tertile had 17% more na\u00efve CD8+ T-cells and 57% and 37% less senescent CD4+ and CD8+ T-cells, respectively, compared to the lowest tertile. VO(2max) was not associated with latent cytomegalovirus (CMV), Epstein-Barr virus (EBV) or herpes simplex virus-1 (HSV-1) infection, indicating that the moderating associations of VO(2max) were not confounded by persistent viral infections. This is the first study to show that aerobic fitness is associated with a lower age-related accumulation of senescent T-cells, highlighting the beneficial effects of maintaining a physically active lifestyle on the aging immune system. Copyright \u00a9 2011 Elsevier Inc. All rights reserved.", "Maternal vaginal microflora during pregnancy and the risk of asthma hospitalization and use of antiasthma medication in early childhood. BACKGROUND: Infants with wheezing and allergic diseases have a microflora that differs from that of healthy infants. The fetus acquires microorganisms during birth when exposed to the maternal vaginal microflora. It is therefore conceivable that the maternal vaginal microflora might influence the establishment of the infant flora and, as a consequence, the development of wheezing and allergic diseases. OBJECTIVE: We sought to study the associations between the composition of the maternal vaginal microflora and the development of wheezing and asthma in childhood. METHODS: We performed a population-based cohort study in Denmark. Vaginal samples for bacterial analysis were obtained during pregnancy. A total of 2927 women (80% of the invited women) completed the study and had 3003 live infants. Infant wheezing was assessed as one or more hospitalizations for asthma between 0 and 3 years of age. Asthma was assessed as use of 3 or more packages of antiasthma medication between 4 and 5 years of age. RESULTS: Maternal vaginal colonization with Ureaplasma urealyticum during pregnancy was associated with infant wheezing (odds ratio [OR], 2.0; 95% CI, 1.2-3.6), but not with asthma, during the fifth year of life. Maternal colonization with staphylococci (OR, 2.2; 95% CI, 1.4-3.4) and use of antibiotics in pregnancy (OR, 1.7; 95% CI, 1.1-2.6) were associated with asthma during the fifth year of life. CONCLUSION: The composition of the maternal vaginal micro-flora might be associated with wheezing and asthma in the offspring up to 5 years of age.", "Randomised, double-blind and placebo-controlled study using new probiotic lactobacilli for strengthening the body immune defence against viral infe... BACKGROUND: The aim of this study was to investigate whether consumption of Lactobacillus plantarum HEAL 9 (DSM 15312) and Lactobacillus paracasei 8700:2 (DSM 13434) could affect naturally acquired common cold infections in healthy subjects. METHODS: A randomised, parallel, double-blind placebo-controlled study was performed to investigate whether intake of this probiotic mixture could reduce the risk of common cold episodes, number of days with common cold symptoms, frequency and severity of symptoms, and cellular immune response in common cold infections. A total of 272 subjects were supplemented daily with either 10(9) cfu (colony forming units) of probiotics (N = 135) or control (N = 137) for a 12-week period. RESULTS: The incidence of acquiring one or more common cold episode was reduced from 67% in the control group to 55% in the probiotic group (p < 0.05). Also, the number of days with common cold symptoms were significantly (p < 0.05) reduced from 8.6 days in the control group to 6.2 days, in the probiotic group, during the 12-week period. The total symptom score was reduced during the study period from a mean of 44.4 for the control group to 33.6 for the probiotic group. The reduction in pharyngeal symptoms was significant (p < 0.05). In addition, the proliferation of B lymphocytes was significantly counteracted in the probiotic group (p < 0.05) in comparison with the control group. CONCLUSION: In conclusion, intake of the probiotic strains Lactobacillus plantarum HEAL 9 (DSM 15312) and Lactobacillus paracasei 8700:2 (DSM 13434) reduces the risk of acquiring common cold infections.", "Microbiological evaluation of commercial probiotic products available in the USA in 2009. Probiotics are widely used to prevent and treat several diseases. Many commercial products are available worldwide. However, there is no clear international or local legislation about them and previous studies showed that most of the tested products are not in conformity with international guidelines. The aim of this study was to determine if products available in the USA market in 2009 were correctly labeled in terms of quantity of viable bacteria, identification of species and cross contamination by species not on the label. Disturbingly, we found that only 4 of 13 products (31%) were in accordance with label claims. Our results suggest the need for adequate control of probiotic production as well as periodical screenings by competent organizations to monitor the effect of storage on product quality.", "Enhancement of immunity in the elderly by dietary supplementation with the probiotic Bifidobacterium lactis HN019. BACKGROUND: The aging process can lead to a decline in cellular immunity. Therefore, the elderly could benefit from safe and effective interventions that restore cellular immune functions. OBJECTIVE: We determined whether dietary supplementation with the known immunostimulating probiotic Bifidobacterium lactis HN019 could enhance aspects of cellular immunity in elderly subjects. DESIGN: Thirty healthy elderly volunteers (age range: 63-84 y; median: 69 y) participated in a 3-stage dietary supplementation trial lasting 9 wk. During stage 1 (run-in), subjects consumed low-fat milk (200 mL twice daily for 3 wk) as a base-diet control. During stage 2 (intervention), they consumed milk supplemented with B. lactis HN019 in a typical dose (5 x 10(10) organisms/d) or a low dose (5 x 10(9) organisms/d) for 3 wk. During stage 3 (washout), they consumed low-fat milk for 3 wk. Changes in the relative proportions of leukocyte subsets and ex vivo leukocyte phagocytic and tumor-cell-killing activity were determined longitudinally by assaying peripheral blood samples. RESULTS: Increases in the proportions of total, helper (CD4(+)), and activated (CD25(+)) T lymphocytes and natural killer cells were measured in the subjects' blood after consumption of B. lactis HN019. The ex vivo phagocytic capacity of mononuclear and polymorphonuclear phagocytes and the tumoricidal activity of natural killer cells were also elevated after B. lactis HN019 consumption. The greatest changes in immunity were found in subjects who had poor pretreatment immune responses. In general, the 2 doses of B. lactis HN019 had similar effectiveness. CONCLUSION: B. lactis HN019 could be an effective probiotic dietary supplement for enhancing some aspects of cellular immunity in the elderly.", "Povidone iodine-induced overt hypothyroidism in a patient with prolonged habitual gargling: urinary excretion of iodine after gargling in normal su... Iodine-induced hypothyroidism that develops in patients who gargle routinely with povidone iodine is well known. Usually the hypothyroidism is mild and resolves spontaneously upon cessation of gargling. Here, we report a 63-year-old patient with overt hypothyroidism that developed due to habitual gargling with povidone iodine for more than 10 years. The urinary excretion of iodine was estimated to be greater than 5 mg/day, based on values obtained from 18 normal subjects who gargled three times a day (4.6+/-2.1 mg, mean+/-SD). After discontinuation of the gargling, the patient has been euthyroid for more than 10 months.", "Prevention of upper respiratory tract infections by gargling: a randomized trial. BACKGROUND: Gargling to wash the throat is commonly performed in Japan, and people believe that such hygienic routine, especially with gargle medicine, prevents upper respiratory tract infections (URTIs). Its effectiveness, however, has not been established by clinical trials. DESIGN: Randomized controlled trial carried out in 2002-2003 winter season and analyzed in 2003 and 2004. PARTICIPANTS: Healthy volunteers (387) aged 18 to 65 years. INTERVENTION: Participants were randomly assigned to water gargling, povidone-iodine gargling, and usual care (control). Subjects in the two gargling groups were requested to gargle with water or diluted povidone-iodine at least three times a day. Participants were followed for 60 days. MAIN OUTCOME MEASURES: The primary outcome measure was first URTI incidence. Severity of URTI symptoms among incident cases was also evaluated. Both outcomes were assessed with a self-administered symptom record. Analyses were performed on an intention-to-treat basis. RESULTS: A total of 130 participants contracted URTIs. The incidence rate of first URTI was 0.26 episodes/30 person-days among control subjects. The rate decreased to 0.17 episodes/30 person-days in the water gargling group, and 0.24 episodes/30 person-days in the povidone-iodine gargling group. Respective incidence rate ratios against controls were 0.64 (95% confidence interval [CI]=0.41-0.99) and 0.89 (95% CI=0.60-1.33). A Cox regression (proportional hazard model) revealed the efficacy of water gargling (hazard ratio=0.60, 95% CI=0.39-0.95). Even when a URTI occurred, water gargling tended to attenuate bronchial symptoms (p=0.055). CONCLUSIONS: Simple water gargling was effective to prevent URTIs among healthy people. This virtually cost-free modality would appreciably benefit the general population.", "Gargling for Oral Hygiene and the Development of Fever in Childhood: A Population Study in Japan Background Fever is one of the most common symptoms among children and is usually caused by respiratory infections. Although Japanese health authorities have long recommended gargling to prevent respiratory infections, its effectiveness among children is not clear. Methods The children in this observational study were enrolled from 145 nursery schools in Fukuoka City, Japan. Children in the exposure group were instructed to gargle at least once a day. The endpoints of this study were incidence of fever during the daytime and incidence of sickness absence. Differences among gargling agents for each endpoint were also analyzed. Results A total of 19 595 children aged 2 to 6 years were observed for 20 days (391 900 person-days). In multivariate logistic regression, the overall odds ratio (OR) for fever onset in the gargling group was significantly lower (OR = 0.68). In age-stratified analysis, ORs were significantly lower at age 2 (OR = 0.67), 4 (OR = 0.46), and 5 (OR = 0.41) years. Regarding sickness absence, the overall OR was 0.92 (not significant) in the gargling group. In age-stratified analysis, ORs were significantly lower at age 4 (OR = 0.68), 5 (OR = 0.59), and 6 (OR = 0.63) years. In subgroup analysis, significantly lower ORs for fever onset were observed for children who gargled with green tea (OR = 0.32), functional water (OR = 0.46), or tap water (OR = 0.70). However, the ORs were not significant for sickness absence. Conclusions Gargling might be effective in preventing febrile diseases in children.", "The economic burden of non-influenza-related viral respiratory tract infection in the United States. BACKGROUND: Viral respiratory tract infection (VRTI) is the most common illness in humans. Despite the high incidence, the economic impact of non-influenza-related VRTI has not been rigorously explored. Our objectives were to obtain an updated incidence of non-influenza-related VRTI in the United States and to quantify the health care resource use (direct costs) and productivity losses (indirect costs) associated with these infections. METHODS: A nationwide telephone survey of US households (N = 4051) was conducted between November 3, 2000, and February 12, 2001 to obtain a representative estimate of the self-reported incidence of non-influenza-related VRTI and related treatment patterns. Direct treatment costs measured included outpatient clinician encounters, use of over-the-counter and prescription drugs, and associated infectious complications of non-influenza-related VRTI. Absenteeism estimates for infected individuals and parents of infected children were extrapolated from National Health Interview Survey data. RESULTS: Of survey respondents, 72% reported a non-influenza-related VRTI within the past year. Respondents who experienced a self-reported non-influenza-related VRTI averaged 2.5 episodes annually. When these rates are extrapolated to the entire US population, approximately 500 million non-influenza-related VRTI episodes occur per year. Similarly, if the treatment patterns reported by the respondents are extended to the population, the total economic impact of non-influenza-related VRTI approaches $40 billion annually (direct costs, $17 billion per year; and indirect costs, $22.5 billion per year). CONCLUSIONS: Largely because of the high attack rate, non-influenza-related VRTI imposes a greater economic burden than many other clinical conditions. The pending availability of effective antiviral therapies warrants increased attention be paid to this common and expensive illness.", "Cost-effectiveness of gargling for the prevention of upper respiratory tract infections Background In Japan, gargling is a generally accepted way of preventing upper respiratory tract infection (URTI). The effectiveness of gargling for preventing URTI has been shown in a randomized controlled trial that compared incidences of URTI between gargling and control groups. From the perspective of the third-party payer, gargling is dominant due to the fact that the costs of gargling are borne by the participant. However, the cost-effectiveness of gargling from a societal perspective should be considered. In this study, economic evaluation alongside a randomized controlled trial was performed to evaluate the cost-effectiveness of gargling for preventing URTI from a societal perspective. Methods Among participants in the gargling trial, 122 water-gargling and 130 control subjects were involved in the economic analysis. Sixty-day cumulative follow-up costs and effectiveness measured by quality-adjusted life days (QALD) were compared between groups on an intention-to-treat basis. Incremental cost-effectiveness ratio (ICER) was converted to dollars per quality-adjusted life years (QALY). The 95% confidence interval (95%CI) and probability of gargling being cost-effective were estimated by bootstrapping. Results After 60 days, QALD was increased by 0.43 and costs were $37.1 higher in the gargling group than in the control group. ICER of the gargling group was $31,800/QALY (95%CI, $1,900\u2013$248,100). Although this resembles many acceptable forms of medical intervention, including URTI preventive measures such as influenza vaccination, the broad confidence interval indicates uncertainty surrounding our results. In addition, one-way sensitivity analysis also indicated that careful evaluation is required for the cost of gargling and the utility of moderate URTI. The major limitation of this study was that this trial was conducted in winter, at a time when URTI is prevalent. Care must be taken when applying the results to a season when URTI is not prevalent, since the ICER will increase due to decreases in incidence. Conclusion This study suggests gargling as a cost-effective preventive strategy for URTI that is acceptable from perspectives of both the third-party payer and society.", "Respiratory tract illnesses during the first year of life: effect of dog and cat contacts. OBJECTIVES: To investigate the effect of dog and cat contacts on the frequency of respiratory symptoms and infections during the first year of life. METHODS: In this birth cohort study, 397 children were followed up from pregnancy onward, and the frequency of respiratory symptoms and infections together with information about dog and cat contacts during the first year of life were reported by using weekly diaries and a questionnaire at the age of 1 year. All the children were born in eastern or middle Finland between September 2002 and May 2005. RESULTS: In multivariate analysis, children having dogs at home were healthier (ie, had fewer respiratory tract symptoms or infections) than children with no dog contacts (adjusted odds ratio, [aOR]: 1.31; 95% confidence interval [CI]: 1.13-1.52). Furthermore, children having dog contacts at home had less frequent otitis (aOR: 0.56; 95% CI: 0.38-0.81) and tended to need fewer courses of antibiotics (aOR: 0.71; 95% CI: 0.52-0.96) than children without such contacts. In univariate analysis, both the weekly amount of contact with dogs and cats and the average yearly amount of contact were associated with decreased respiratory infectious disease morbidity. CONCLUSIONS: These results suggest that dog contacts may have a protective effect on respiratory tract infections during the first year of life. Our findings support the theory that during the first year of life, animal contacts are important, possibly leading to better resistance to infectious respiratory illnesses during childhood.", "Survival following an acute coronary syndrome: a pet theory put to the test. OBJECTIVE: The aim of this study was to revisit findings from previous studies reporting that pet ownership improves outcome following an admission for acute coronary syndrome (ACS). METHOD: Four hundred and twenty-four patients admitted to a cardiac unit with an ACS completed questions regarding pet ownership in hospital. Rates of cardiac death and readmission were assessed 1 year following hospitalization. RESULTS: Pet owners were more likely to experience a death or readmission following their hospitalization, after controlling for key psychosocial and medical covariates. When dog and cat owners were considered separately, cat ownership was significantly associated with increased risk of death or readmission. CONCLUSION: In this independent study, pet ownership at baseline, and cat ownership in particular, was associated with increased cardiac morbidity and mortality in the year following an admission for an acute coronary syndrome, a finding contrary to previous reports.", "Does dog or cat ownership lead to increased gastroenteritis in young children in South Australia? SUMMARY The aim of this study was to investigate the relationship between dog and cat ownership and gastroenteritis in young children. A diary study of 965 children aged 4\u20136 years living in rural or semi-rural South Australia was undertaken. Data were collected on pet ownership, drinking water and other risk factors for gastroenteritis. Overall 89% of households had pets and dog ownership was more common than cat ownership. The multivariable models for gastroenteritis and pet ownership indicated that living in a household with a dog or cat was associated with a reduced risk of gastroenteritis (adj. OR 0\u00b771, 95% CI 0\u00b755\u20130\u00b792; OR 0\u00b770, % CI 0\u00b751\u20130\u00b797 respectively). This paper adds to the evidence that pets are not a major source of gastroenteritis in the home and lends support to the health benefits of pet ownership. However, this must be weighed against the potential negative consequences, such as dog bites, particularly for this age group.", "History of respiratory infections in the first 12 yr among children from a birth cohort. Respiratory infections are the most frequent health problem in childhood. There is little precise information on how many respiratory illness episodes can be expected in a normal child. This study was designed to create reference values for the frequency of respiratory infections as recordable by history. Respiratory illnesses were recorded in a prospective birth cohort of 1314 German children born in 1990 and tracked until age 12 yr (760 children). Parents recorded the child's illnesses in a diary and answered structured questions yearly up to age 12. Age of study subjects was categorized into infancy (0-2 yr), pre-school age (3-5 yr), and school age (6-12 yr). The mean cumulative number of respiratory infection episodes up to age 12 yr was 21.9 (s.d. 9.0) episodes. In infancy, the mean annual number was 3.4 (3.7) episodes; at pre-school age, 2.3 (2.6) episodes; and at school, age 1.1 (1.2) episodes. The mean cumulative time of episodes up to age 7 yr was 20.1 (15.2) wk. Forty-five percent of the infants in the upper episode incidence tertile continued to be in the upper tertile at school age. Based on a twofold standard deviation of the mean number, up to 11 respiratory infection episodes per year in infancy, 8 episodes per year at pre-school age, and 4 episodes per year at school age could be regarded as normal. Episodes within these reference values per se should not cause unwarranted concern or intervention because of suspected immunodeficiency.", "To Have or Not To Have a Pet for Better Health? Background Pet ownership is thought to have health benefits, but not all scientific explorations have been founded on proper applications of representative samples or statistically correct methodologies. Databanks have been too small for proper statistical analyses; or, instead of a random sample, participation has been voluntary. The direction of causality has been evaluated incorrectly or control of relevant factors noted deficient. This study examined the associations of pet ownership with perceived health and disease indicators by taking into account socio-demographic background factors together with health risk factors, including exercise. Methodology/Principal Findings The present study used baseline data from the 15-year Health and Social Support Study (the HeSSup Study). The Finnish Population Register Centre was used to draw population-based random samples stratified according to gender and four age groups (20\u201324, 30\u201334, 40\u201344, and 50\u201354 years). A total of 21,101 working-aged Finns responded to the baseline survey questionnaire of the 15-year HeSSup Study in 1998. Ordinal and binary logistic regression was used to analyze the cross-sectional data. Pet ownership was associated with poor rather than good perceived health. BMI surfaced as the risk factor most strongly associated with pet ownership. Conclusions/Significance Pet owners set in their ways and getting older were found to have a slightly higher BMI than the rest. Additional research is needed for the testing of hypotheses involving effects of pet ownership with various health dimensions within population groups that are composed of different kinds of background characteristics.", "Factors associated with acute respiratory illness in day care children. The aim of this study was to investigate the relationship between child characteristics, parental and environmental factors and the occurrence of acute respiratory illness (ARI) and acute otitis media (AOM) among Finnish children attending day care centres (DCCs). The study was a cross-sectional questionnaire of 594 children aged 1-6 y from 18 DCCs in Helsinki, Finland. Recurrent (> or =4 diseases/y) ARI was present in 44% of the 1-3-y-olds and 23% of the 4-6-y-olds, and recurrent AOM in 15% and 2.5%, respectively. Parent atopic disease (odds ratio (OR) 1.53, p = 0.033), mother's academic education (OR 1.77, p = 0.008) and a medium length of DCC attendance compared to a short period (OR 1.67, p = 0.049) increased, while furry pets (OR 0.44, p = 0.003) and older child age (OR 0.38, p < 0.001) reduced the risk of recurrent ARI. Recurrent ARI (OR 3.96, p = 0.008), mother's academic education (OR 5.02, p = 0.003), and a medium length of DCC attendance compared to a short period (OR 3.34, p = 0.044) increased, while partial breastfeeding > or =6 months (OR 0.20, p = 0.002) and older child age (OR 0.05, p < 0.001) reduced the risk of recurrent AOM. Parental and environmental factors had a significant impact on recurrent ARI and AOM episodes in children attending DCCs. These risk factors should be considered in future studies intending to reduce DCC infections.", "Sleep Habits and Susceptibility to the Common Cold Background Sleep quality is thought to be an important predictor of immunity and in turn susceptibility to the common cold. This article examines whether sleep duration and efficiency in the weeks preceding viral exposure are associated with cold susceptibility. Methods Participants were 153 healthy men and women volunteers, ages 21\u201355. For 14 consecutive days, they reported their sleep duration and sleep efficiency (percent of time in bed actually asleep) for the previous night, and whether they felt rested. Average scores for each sleep variable were calculated over the 14-day baseline. Subsequently, participants were administered nasal drops containing a rhinovirus, quarantined and monitored on the day before and for five days following exposure for development of a clinical cold (infection in the presence of objective signs of illness). Results There was a graded association with average sleep duration, with those with <7 hours sleep 2.94 times (CI[95%]=1.18\u20137.30) more likely to develop a cold than those with \u2265 8 hours. The association with sleep efficiency was also graded with those with < 92% efficiency 5.50 times (CI[95%]=2.08\u201314.48) more likely to develop a cold than those with efficiencies \u226598%. These relations could not be explained by differences in pre-challenge virus-specific antibody, demographics, season of the year, body mass, socioeconomic status, psychological variables or health practices. Percent of days feeling rested was not associated with colds. Conclusions Poorer sleep efficiency and shorter sleep duration in the weeks preceding an exposure to a rhinovirus were associated with lower resistance to illness."], "neg": ["Dietary intake of organotin compounds in Finland: a market-basket study. The objective of this study was to estimate the intake of organic tin compounds from foodstuffs in a Finnish market basket. The study was conducted by collecting 13 market baskets from supermarkets and market places in the city of Kuopio, eastern Finland. Altogether 115 different food items were bought. In each basket, foodstuffs were mixed in proportion to their consumption and analysed by GC/MS for seven organic tin compounds (mono-, di-, and tributyltin, mono-, di-, and triphenyltin, and dioctyltin). Organotin compounds were detected in only four baskets, with the fish basket containing the largest number of different organotins. The European Food Safety Authority has established a tolerable daily intake of 250 ng kg(-1) body weight for the sum of dibutyltin, tributyltin, triphenyltin and dioctyltin. According to this study, the daily intake of these compounds was 2.47 ng kg(-1) body weight, of which 81% originated from the fish basket. This exposure is only 1% of the tolerable daily intake and poses negligible risk to the average consumer. However, for consumers eating large quantities of fish from contaminated areas, the intake may be much higher.", "Mechanisms of breast cancer bone metastasis. Bone, as well as liver and lung, is one of the most preferential metastatic target sites for cancers including breast, prostate, and lung cancers and the consequences are always devastating. Like other metastasis, breast cancer bone metastasis consists of several steps from the escape of primary site to the colonization in target site. This review focuses on several key steps including: 1. Invasion and escape from primary tumor site. 2. Target migration toward bone. 3. Specific adhesion and arrest in bone. 4. Establishment of metastasis in bone. The factors involved in this process will provide good targets for therapy. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.", "Anticancer effects of sweet potato protein on human colorectal cancer cells AIM: To investigate the effects of proteins purified from sweet potato storage roots on human colorectal cancer cell lines. METHODS: 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, Hoechst 33258 nuclear staining and Boyden transwell chamber methods were used to determine whether purified sweet potato protein (SPP) from fresh sweet potato roots affected proliferation, migration and invasion, respectively, of human colorectal cancer SW480 cells in vitro. The inhibitory effects of SPP on growth of human colorectal cancer HCT-8 cells intraperitoneally xenografted in nude mice and spontaneous lung metastasis of murine Lewis lung carcinoma 3LL cells subcutaneously transplanted in C57 BL/6 mice were also investigated in vivo. RESULTS: SPP inhibited the proliferation of SW480 cells in a dose-dependent manner, with an IC50 value of 38.732 \u03bcmol/L (r2 = 0.980, P = 0.003) in the MTT assay. Hoechst 33258 nuclear staining further revealed inhibition of cell viability and induction of apoptosis by SPP. The transwell assay disclosed significant reduction in migrated cells/field by 8 \u03bcmol/L SPP (8.4 \u00b1 2.6 vs 23.3 \u00b1 5.4, P = 0.031) and invaded cells/field through the ECMatrix by 0.8 \u03bcmol/L SPP, compared with the control (25.2 \u00b1 5.2 vs 34.8 \u00b1 6.1, P = 0.038). Both intraperitoneal (ip) and intragastric (ig) administration of SPP led to significant suppression of growth of intraperitoneally inoculated HCT-8 cells in nude mice to 58.0% \u00b1 5.9% (P = 0.037) and 43.5% \u00b1 7.1% (P = 0.004) of the controls, respectively, after 9 d treatment. Bloody ascites additionally disappeared after ip injection of trypsin inhibitor. Notably, ig and ip administration of SPP induced a significant decrease in spontaneous pulmonary metastatic nodule formation in C57 BL/6 mice (21.0 \u00b1 12.3 and 27.3 \u00b1 12.7 nodules/lung vs 42.5 \u00b1 4.5 nodules/lung in controls, respectively, P < 0.05) after 25 d treatment. Moreover, the average weight of primary tumor nodules in the hind leg of mice decreased from 8.2 \u00b1 1.3 g/mice in the control to 6.1 \u00b1 1.4 g/mice in the ip group (P = 0.035). CONCLUSION: SPP exerts significant antiproliferative and antimetastatic effects on human colorectal cancer cell lines, both in vitro and in vivo.", "Pathogen detection, testing, and control in fresh broccoli sprouts Background The recent increased interest in consuming green vegetable sprouts has been tempered by the fact that fresh sprouts can in some cases be vehicles for food-borne illnesses. They must be grown according to proper conditions of sanitation and handled as a food product rather than as an agricultural commodity. When sprouts are grown in accordance with the criteria proposed from within the sprout industry, developed by regulatory agencies, and adhered to by many sprouters, green sprouts can be produced with very low risk. Contamination may occur when these guidelines are not followed. Methods A one year program of microbial hold-and-release testing, conducted in concert with strict seed and facility cleaning procedures by 13 U.S. broccoli sprout growers was evaluated. Microbial contamination tests were performed on 6839 drums of sprouts, equivalent to about 5 million consumer packages of fresh green sprouts. Results Only 24 (0.75%) of the 3191 sprout samples gave an initial positive test for Escherichia coli O157:H7 or Salmonella spp., and when re-tested, 3 drums again tested positive. Composite testing (e.g., pooling up to 7 drums for pathogen testing) was equally sensitive to single drum testing. Conclusion By using a \"test-and-re-test\" protocol, growers were able to minimize crop destruction. By pooling drums for testing, they were also able to reduce testing costs which now represent a substantial portion of the costs associated with sprout growing. The test-and-hold scheme described herein allowed those few batches of contaminated sprouts to be found prior to packaging and shipping. These events were isolated, and only safe sprouts entered the food supply.", "Cholesterol oxides in Indian ghee: possible cause of unexplained high risk of atherosclerosis in Indian immigrant populations. Two populations of immigrants to London and to the West Indies from the Indian subcontinent have higher than expected morbidity and mortality from atherosclerosis but do not show the commonly accepted major risk factors. This study investigated the hypothesis that ghee, a clarified butter product prized in Indian cooking, contains cholesterol oxides and could therefore be an important source of dietary exposure to cholesterol oxides and an explanation for the high atherosclerosis risk. Substantial amounts of cholesterol oxides were found in ghee (12.3% of sterols), but not in fresh butter, by thin-layer and high-performance-liquid chromatography. Dietary exposure to cholesterol oxides from ghee may offer a logical explanation for the high frequency of atherosclerotic complications in these Indian populations.", "Dairy food intake in relation to semen quality and reproductive hormone levels among physically active young men STUDY QUESTION Is increased consumption of dairy foods associated with lower semen quality? SUMMARY ANSWER We found that intake of full-fat dairy was inversely related to sperm motility and morphology. These associations were driven primarily by intake of cheese and were independent of overall dietary patterns. WHAT IS KNOWN ALREADY It has been suggested that environmental estrogens could be responsible for the putative secular decline in sperm counts. Dairy foods contain large amounts of estrogens. While some studies have suggested dairy as a possible contributing factor for decreased semen quality, this finding has not been consistent across studies. STUDY DESIGN, SIZE, DURATION The Rochester Young Men's Study (n = 189) was a cross-sectional study conducted between 2009 and 2010 at the University of Rochester. PARTICIPANTS/MATERIALS, SETTING, METHODS Men aged 18\u201322 years were included in this analysis. Diet was assessed via food frequency questionnaire. Linear regression was used to analyze the relation between dairy intake and conventional semen quality parameters (total sperm count, sperm concentration, progressive motility, morphology and ejaculate volume) adjusting for age, abstinence time, race, smoking status, body mass index, recruitment period, moderate-to-intense exercise, TV watching and total calorie intake. MAIN RESULTS AND THE ROLE OF CHANCE Total dairy food intake was inversely related to sperm morphology (P-trend = 0.004). This association was mostly driven by intake of full-fat dairy foods. The adjusted difference (95% confidence interval) in normal sperm morphology percent was \u22123.2% (\u22124.5 to \u22121.8) between men in the upper half and those in the lower half of full-fat dairy intake (P < 0.0001), while the equivalent contrast for low-fat dairy intake was less pronounced [\u22121.3% (\u22122.7 to \u22120.07; P= 0.06)]. Full-fat dairy intake was also associated with significantly lower percent progressively motile sperm (P= 0.05). LIMITATIONS, REASONS FOR CAUTION As it was a cross-sectional study, causal inference is limited. WIDER IMPLICATIONS OF THE FINDINGS Further research is needed to prove a causal link between a high consumption of full-fat dairy foods and detrimental effects on semen quality. If verified our findings would mean that intake of full-fat dairy foods should be considered in attempts to explain secular trends in semen quality and that men trying to have children should restrict their intake. STUDY FUNDING/COMPETING INTEREST(S) European Union Seventh Framework Program (Environment), \u2018Developmental Effects of Environment on Reproductive Health\u2019 (DEER) grant 212844. Grant P30 {\"type\":\"entrez-nucleotide\",\"attrs\":{\"text\":\"DK046200\",\"term_id\":\"187635970\",\"term_text\":\"DK046200\"}}DK046200 and Ruth L. Kirschstein National Research Service Award T32 DK007703-16 from the National Institutes of Health. None of the authors has any conflicts of interest to declare.", "Advanced Glycation End Products in Foods and a Practical Guide to Their Reduction in the Diet Modern diets are largely heat-processed and as a result contain high levels of advanced glycation end products (AGEs). Dietary advanced glycation end products (dAGEs) are known to contribute to increased oxidant stress and inflammation, which are linked to the recent epidemics of diabetes and cardiovascular disease. This report significantly expands the available dAGE database, validates the dAGE testing methodology, compares cooking procedures and inhibitory agents on new dAGE formation, and introduces practical approaches for reducing dAGE consumption in daily life. Based on the findings, dry heat promotes new dAGE formation by >10- to 100-fold above the uncooked state across food categories. Animal-derived foods that are high in fat and protein are generally AGE-rich and prone to new AGE formation during cooking. In contrast, carbohydrate-rich foods such as vegetables, fruits, whole grains, and milk contain relatively few AGEs, even after cooking. The formation of new dAGEs during cooking was prevented by the AGE inhibitory compound aminoguanidine and significantly reduced by cooking with moist heat, using shorter cooking times, cooking at lower temperatures, and by use of acidic ingredients such as lemon juice or vinegar. The new dAGE database provides a valuable instrument for estimating dAGE intake and for guiding food choices to reduce dAGE intake.", "Impact of adopting a vegan diet or an olestra supplementation on plasma organochlorine concentrations: results from two pilot studies. The aim of these studies was to evaluate the potential of some nutritional approaches to prevent or reduce the body load of organochlorines (OC) in humans. Study 1 compared plasma OC concentrations between vegans and omnivores while study 2 verified if the dietary fat substitute olestra could prevent the increase in OC concentrations that is generally observed in response to a weight-reducing programme. In study 1, nine vegans and fifteen omnivores were recruited and the concentrations of twenty-six OC (beta-hexachlorocyclohexane (beta-HCH), p, p'-dichlorodiphenyldichloroethane (p, p'-DDE), p, p'-dichlorodiphenyltrichloroethane (p, p'-DDT), hexachlorobenzene, mirex, aldrin, alpha-chlordane, gamma-chlordane, oxychlordane, cis-nonachlor, trans-nonachlor, polychlorinated biphenyl (PCB) nos. 28, 52, 99, 101, 105, 118, 128, 138, 153, 156, 170, 180, 183 and 187, and aroclor 1260) were determined. In study 2, the concentrations of these twenty-six OC were measured before and after weight loss over 3 months in thirty-seven obese men assigned to one of the following treatments: standard group (33 % fat diet; n 13), fat-reduced group (25 % fat diet; n 14) or fat-substituted group (1/3 of dietary lipids substituted by olestra; n 10). In study 1, plasma concentrations of five OC compounds (aroclor 1260 and PCB 99, PCB 138, PCB 153 and PCB 180) were significantly lower in vegans compared with omnivores. In study 2, beta-HCH was the only OC which decreased in the fat-substituted group while increasing in the other two groups (P = 0.045). In conclusion, there was a trend toward lesser contamination in vegans than in omnivores, and olestra had a favourable influence on beta-HCH but did not prevent plasma hyperconcentration of the other OC during ongoing weight loss."]}, {"query": "Cholesterol Lowering in a Nut Shell", "pos": ["Cultural and historical aspects of Mediterranean nuts with emphasis on their attributed healthy and nutritional properties. BACKGROUND AND AIMS: Nuts have been part of the human diet since prehistoric times. The aim of the present article is to describe the most important historical and cultural aspects of nut consumption throughout history. DATA SYNTHESIS: We discuss the following historical aspects of nuts originating in the Mediterranean: prehistory, the Egyptian civilization, their spread through the Mediterranean region by the Greek, Phoenician and Roman civilizations, and their reintroduction into Europe by means of the Al-Andalus culture. Particular emphasis is placed on the healthy and nutritional attributes that nuts have had throughout history. We also consider the role of the first globalization of food--the exchange of nuts between continents--and discuss the symbolism that nuts have had for humans throughout history in the context of cultural aspects of the Mediterranean region. CONCLUSIONS: Nuts and fruits are probably the earliest foods consumed by humans and are considered to be important because of their nutritional properties. Nuts have also been used in the past by different civilizations as drugs to prevent or treat several diseases. Copyright \u00a9 2010 Elsevier B.V. All rights reserved.", "Nut consumption and blood lipid levels: a pooled analysis of 25 intervention trials. BACKGROUND: Epidemiological studies have consistently associated nut consumption with reduced risk for coronary heart disease. Subsequently, many dietary intervention trials investigated the effects of nut consumption on blood lipid levels. The objectives of this study were to estimate the effects of nut consumption on blood lipid levels and to examine whether different factors modify the effects. METHODS: We pooled individual primary data from 25 nut consumption trials conducted in 7 countries among 583 men and women with normolipidemia and hypercholesterolemia who were not taking lipid-lowering medications. In a pooled analysis, we used mixed linear models to assess the effects of nut consumption and the potential interactions. RESULTS: With a mean daily consumption of 67 g of nuts, the following estimated mean reductions were achieved: total cholesterol concentration (10.9 mg/dL [5.1% change]), low-density lipoprotein cholesterol concentration (LDL-C) (10.2 mg/dL [7.4% change]), ratio of LDL-C to high-density lipoprotein cholesterol concentration (HDL-C) (0.22 [8.3% change]), and ratio of total cholesterol concentration to HDL-C (0.24 [5.6% change]) (P < .001 for all) (to convert all cholesterol concentrations to millimoles per liter, multiply by 0.0259). Triglyceride levels were reduced by 20.6 mg/dL (10.2%) in subjects with blood triglyceride levels of at least 150 mg/dL (P < .05) but not in those with lower levels (to convert triglyceride level to millimoles per liter, multiply by 0.0113). The effects of nut consumption were dose related, and different types of nuts had similar effects on blood lipid levels. The effects of nut consumption were significantly modified by LDL-C, body mass index, and diet type: the lipid-lowering effects of nut consumption were greatest among subjects with high baseline LDL-C and with low body mass index and among those consuming Western diets. CONCLUSION: Nut consumption improves blood lipid levels in a dose-related manner, particularly among subjects with higher LDL-C or with lower BMI."], "neg": ["Ambient odor of orange in a dental office reduces anxiety and improves mood in female patients. Essential oils have been used as remedies for a long time in different cultures across the world. However, scientific proof of such application is scarce. We included 72 patients between the ages of 22 and 57 while waiting for dental treatment in our study. The participants were assigned to either a control group (14 men, 23 women) or to an odor group (18 men and 17 women). Ambient odor of orange was diffused in the waiting room through an electrical dispenser in the odor group whereas in the control group no odor was in the air. We assessed by means of self-report demographic and cognitive variables, trait and state anxiety, and current pain, mood, alertness, and calmness. In this study, we report that exposure to ambient odor of orange has a relaxant effect. Specifically, compared to the controls, women who were exposed to orange odor had a lower level of state anxiety, a more positive mood, and a higher level of calmness. Our data support the previous notion of sedative properties of the natural essential oil of orange (Citrus sinensis).", "Atherosclerosis and disc degeneration/low-back pain--a systematic review. OBJECTIVES: Atherosclerosis can obstruct branching arteries of the abdominal aorta, including four paired lumbar arteries and the middle sacral artery that feed the lumbar spine. The diminished blood flow could result in various back problems. The aim of this systematic literature review was to assess associations between atherosclerosis and disc degeneration (DD) or low-back pain (LBP). DATA SOURCES: A systematic search of the Medline/PubMed database for all original articles on atherosclerosis and DD/LBP published until October 2008. The search was performed with the medical subject headings atherosclerosis, cardiovascular risk factor, or vascular disease and keywords \"disc degeneration\", \"disc herniation\", and \"back pain\" on the basis of MeSH tree and as a text search. In addition reference lists were studied and searched manually. Observational studies investigating the association of atherosclerosis or its risk factors and lumbar DD/LBP were selected. REVIEW METHODS: The following data were extracted: study characteristics, duration of follow-up, year of publication, findings of atherosclerosis/cardiovascular risk factors and DD/LBP. Disc herniation was regarded as a form of disc degeneration and cardiovascular risk factors were regarded as surrogate for atherosclerosis in epidemiological studies. RESULTS: One hundred and seventy-nine papers were identified. After exclusion of case reports, letters, editorials, papers not related to the lumbar spine, and animal studies, 25 papers were included. Post-mortem studies showed an association between atheromatous lesions in the aorta and DD, as well as between occluded lumbar arteries and life-time LBP. In clinical studies, aortic calcification was associated with LBP, and stenosis of lumbar arteries was associated with both DD and LBP. In epidemiological studies, smoking and high serum cholesterol levels were found to have the most consistent associations with DD and LBP. CONCLUSION: Aortic atherosclerosis and stenosis of the feeding arteries of the lumbar spine were associated with DD and LBP. Cardiovascular risk factors had weaker associations, being clearly apparent only in cohorts on elderly people or in large study samples. More prospective clinical studies are needed to further clarify the association of atherosclerosis and low-back disorders.", "Lifestyle/dietary recommendations for erectile dysfunction and female sexual dysfunction. Sexual problems are diffuse in both genders. Although epidemiologic evidence seems to support a role for lifestyle factors in erectile dysfunction, limited data are available suggesting the treatment of underlying risk factors may improve erectile dysfunction. The results are sparse regarding associations between lifestyle factors and female sexual dysfunction, and conclusions regarding influence of healthy behaviors on female sexual dysfunction cannot be made before more studies have been performed. Beyond the specific effects on sexual dysfunctions in men and women, adoption of these measures promotes a healthier life and increased well-being, which may help reduce the burden of sexual dysfunction. Copyright \u00a9 2011 Elsevier Inc. All rights reserved.", "Inhibitory effect of grapefruit juice and its bitter principal, naringenin, on CYP1A2 dependent metabolism of caffeine in man. 1. The effects of grapefruit juice and naringenin on the activity of the human cytochrome P450 isoform CYP1A2 were evaluated using caffeine as a probe substrate. 2. In vitro naringin was a potent competitive inhibitor of caffeine 3-demethylation by human liver microsomes (Ki = 7-29 microM). 3. In vivo grapefruit juice (1.2 l day-1 containing 0.5 g l-1 naringin, the glycone form of naringenin) decreased the oral clearance of caffeine by 23% (95% CI: 7%-30%) and prolonged its half-life by 31% (95% CI: 20%-44%) (n = 12). 4. We conclude that grapefruit juice and naringenin inhibit CYP1A2 activity in man. However, the small effect on caffeine clearance in vivo suggests that in general the ingestion of grapefruit juice should not cause clinically significant inhibition of the metabolism of other drugs that are substrates of CYPIA2.", "Cadmium in zinc-containing mineral supplements. Seven zinc-containing dietary supplements were analyzed for zinc (Zn) and cadmium (Cd) by inductively coupled plasma/mass spectrometry (ICP/MS). Cadmium was detected in all samples; however, the amount of Cd per 15 mg Zn (the daily US Recommended Dietary Allowance) varied by over 37-fold (0.039 to 1.46 micrograms Cd/15 mg Zn). Supplements with Zn in the form of a gluconate consistently contained the lowest amounts of Cd. Because Cd is a non-essential potentially toxic element for humans, its concentration in nutritional supplements should be minimized and possibly regulated by government-established standards.", "Vegetarian Dietary Patterns and Mortality in Adventist Health Study 2 Importance Some evidence suggests vegetarian dietary patterns may be associated with reduced mortality, but the relationship is not well established. Objective To evaluate the association between vegetarian dietary patterns and mortality. Design Prospective cohort study; mortality analysis by Cox proportional hazards regression, controlling for important demographic and lifestyle confounders. Setting Adventist Health Study 2 (AHS-2), a large North American cohort. Participants A total of 96 469 Seventh-day Adventist men and women recruited between 2002 and 2007, from which an analytic sample of 73 308 participants remained after exclusions. Exposures Diet was assessed at baseline by a quantitative food frequency questionnaire and categorized into 5 dietary patterns: nonvegetarian, semi-vegetarian, pesco-vegetarian, lacto-ovo\u2013vegetarian, and vegan. Main Outcome and Measure The relationship between vegetarian dietary patterns and all-cause and cause-specific mortality; deaths through 2009 were identified from the National Death Index. Results There were 2570 deaths among 73 308 participants during a mean follow-up time of 5.79 years. The mortality rate was 6.05 (95% CI, 5.82\u20136.29) deaths per 1000 person-years. The adjusted hazard ratio (HR) for all-cause mortality in all vegetarians combined vs non-vegetarians was 0.88 (95% CI, 0.80\u20130.97). The adjusted HR for all-cause mortality in vegans was 0.85 (95% CI, 0.73\u20131.01); in lacto-ovo\u2013vegetarians, 0.91 (95% CI, 0.82\u20131.00); in pesco-vegetarians, 0.81 (95% CI, 0.69\u20130.94); and in semi-vegetarians, 0.92 (95% CI, 0.75\u20131.13) compared with nonvegetarians. Significant associations with vegetarian diets were detected for cardiovascular mortality, noncardiovascular noncancer mortality, renal mortality, and endocrine mortality. Associations in men were larger and more often significant than were those in women. Conclusions and Relevance Vegetarian diets are associated with lower all-cause mortality and with some reductions in cause-specific mortality. Results appeared to be more robust in males. These favorable associations should be considered carefully by those offering dietary guidance.", "Differences in postprandial inflammatory responses to a 'modern' v. traditional meat meal: a preliminary study. A low-grade inflammatory response ('metaflammation') has been found to be associated with certain chronic diseases. Proposed inducers of this have been aspects of the modern lifestyle, including newly introduced foods. Plasma TAG, and the inflammatory cytokines C-reactive protein (CRP), TNF-alpha and IL-6 were compared in a randomised, cross-over trial using ten healthy subjects before and after eating 100 g of kangaroo, or a 'new' form of hybridised beef (wagyu) separated by about 1 week. Postprandial levels for 1 and 2 h of TAG, IL-6 and TNF-alpha were significantly higher after eating wagyu compared with kangaroo (P = 0.002 for TAG at 1 h, P < 0.001 at 2 h; P < 0.001 for IL-6 and TNF-alpha at 1 and 2 h). CRP was significantly higher 1 h postprandially after wagyu (P = 0.011) and non-significantly higher 2 h postprandially (P = 0.090). We conclude that the metaflammatory reaction to ingestion of a 'new' form of hybridised beef (wagyu) is indicative of a low-grade, systemic, immune reaction when compared with lean game meat (kangaroo). Further studies using isoenergetic intake and isolating fatty acid components of meats are proposed.", "Relationship between the prenatal exposure to low-level of mercury and the size of a newborn's cerebellum. Exposure to methylmercury at any stage of central nervous system development could induce alterations and result in severe congenital abnormalities. Total mercury level in maternal hair during pregnancy correlates well with blood levels of methylmercury and with total mercury levels in fetal brain. A prospective study has been conducted and a total of 137 childbearing women living at the coastal region with term, normal pregnancies were included and their newborns evaluated by ultrasonography. Mothers and their newborns are divided in two groups according to their hair mercury levels; examined group with high body levels of mercury (\u2265 1 \u03bcg/g) and control group with low body levels of mercury (<1 \u03bcg/g). Neurosonographic examination was conducted to all newborns. Two dimensions of cerebellum in the sagital-medial plane have been measured: maximum height and width starting from the roof of the fourth chamber. Majority of mothers had hair mercury levels lower than 1 \u03bcg/g (N = 107). Mean value was 0.88 \u03bcg/g (SD 1.24), ranging from 0.02 to 8.71 \u03bcg/g. There was no significant difference between the two groups when it comes to the width of cerebellum (Mann-Whitney test: Z = 1471; p = 0.141). However, comparison related to the length of cerebellum shows statistically significant smaller cerebellum in newborns whose mother had hair mercury levels higher than 1 \u03bcg/g (Mann-Whitney test: Z = 2329; p = 0.019). Our results lead to a conclusion that prenatal exposure to, what we consider to be, low-levels of methylmercury does influence fetal brain development detected as decreased size of newborn's cerebellum. From a clinical point of view, a question related to the influence of prenatal low-level methylmercury exposure on fetal neurodevelopment remains open. Our further objectives are to direct the research towards performing detailed neuropshychological tests on children at the age of 18 months. Such tests could indicate the presence of subtle neurological or neuropsychological deficits. Copyright \u00a9 2010 Elsevier Ltd. All rights reserved."]}, {"query": "The Healthiest Lentil", "pos": ["Phenolic substance characterization and chemical and cell-based antioxidant activities of 11 lentils grown in the northern United States. Chemical and cellular antioxidant activities and phenolic profiles of 11 lentil cultivars grown in the cool northern parts of the United States were investigated. Individual phenolic compounds, including phenolic acids, flavan-3-ols, flavones, and anthocyanins, were further quantitatively investigated by HPLC. Cellular antioxidant activities (CAA) and peroxyl radical scavenging capacity (PRSC) were evaluated by fluorescence microplate reader. Cultivar Morton exhibited the highest individual flavan-3-ols (catechin and epicatechin) and total flavonoids, as well as the highest antioxidant properties (PRSC and CAA) among all lentils tested. Five phenolic acids of the benzoic types and their derivates (gallic, protocatechuic, 2,3,4-trihydroxybenzoic, p-hydroxybenzoic acid, and protocatechualdehyde) and four phenolic acids of the cinnamic type (chlorogenic, p-coumaric, m-coumaric, and sinapic acid) were detected in all lentil cultivars. Two flavan-3-ols [(+)-catechin and (-)-epicatechin] and one flavone (luteolin) were detected in all lentil cultivars. Among all phenolic compounds detected, sinapic acid was the predominant phenolic acid, and (+)-catechin and (-)-epicatechin were the predominant flavonoids. These results showed that different phenotype lentils possessed considerable variations in their individual phenolic compounds, as well as chemical and cellular antioxidant activities. Caffeic acid, catechin, epicatechin, and total flavonoids significantly (p < 0.05) correlated with peroxyl radical scavenging assay. Cellular antioxidant assay significantly correlated with chemical antioxidant assay ORAC. The results from this study could be very interesting for breeding programs to improve lentils for use as functional foods.", "A pulse-based diet is effective for reducing total and LDL-cholesterol in older adults. Our purpose was to determine the effects of a pulse-based diet in individuals 50 years or older for reducing CVD risk factors. A total of 108 participants were randomised to receive pulse-based foods (two servings daily of beans, chickpeas, peas or lentils; about 150 g/d dry weight) or their regular diet for 2 months, followed by a washout of 1 month and a cross-over to the other diet for 2 months. Anthropometric measures, body composition and biochemical markers (i.e. serum LDL-cholesterol (LDL-C), as the primary outcome, and other lipids, glucose, insulin and C-reactive protein) were assessed before and after each diet phase. A total of eighty-seven participants (thirty males and fifty-seven females; 59\u00b77 (sd 6\u00b73) years, body mass 76 (sd 16) kg) completed the study. Compared with the regular diet, the pulse-based diet decreased total cholesterol by 8\u00b73 % (pulse, 4\u00b757 (sd 0\u00b793) to 4\u00b711 (sd 0\u00b791) mmol/l; regular, 4\u00b747 (sd 0\u00b794) to 4\u00b739 (sd 0\u00b797) mmol/l; P < 0\u00b7001) and LDL-C by 7\u00b79 % (pulse, 2\u00b793 (sd 0\u00b784) to 2\u00b755 (sd 0\u00b775) mmol/l; regular, 2\u00b796 (sd 0\u00b786) to 2\u00b781 (sd 0\u00b783) mmol/l; P = 0\u00b701). In a sub-analysis of individuals with high lipid levels at baseline (twenty individuals with high cholesterol), the pulse-based diet reduced cholesterol by 6 % compared with the regular diet (pulse, 5\u00b762 (sd 0\u00b778) to 5\u00b726 (sd 0\u00b768) mmol/l; regular, 5\u00b760 (sd 0\u00b791) to 5\u00b757 (sd 0\u00b785) mmol/l; P = 0\u00b705). A pulse-based diet is effective for reducing total cholesterol and LDL-C in older adults and therefore reduces the risk of CVD.", "Nutritional quality and health benefits of chickpea (Cicer arietinum L.): a review. Chickpea (Cicer arietinum L.) is an important pulse crop grown and consumed all over the world, especially in the Afro-Asian countries. It is a good source of carbohydrates and protein, and protein quality is considered to be better than other pulses. Chickpea has significant amounts of all the essential amino acids except sulphur-containing amino acids, which can be complemented by adding cereals to the daily diet. Starch is the major storage carbohydrate followed by dietary fibre, oligosaccharides and simple sugars such as glucose and sucrose. Although lipids are present in low amounts, chickpea is rich in nutritionally important unsaturated fatty acids such as linoleic and oleic acids. \u03b2-Sitosterol, campesterol and stigmasterol are important sterols present in chickpea oil. Ca, Mg, P and, especially, K are also present in chickpea seeds. Chickpea is a good source of important vitamins such as riboflavin, niacin, thiamin, folate and the vitamin A precursor \u03b2-carotene. As with other pulses, chickpea seeds also contain anti-nutritional factors which can be reduced or eliminated by different cooking techniques. Chickpea has several potential health benefits, and, in combination with other pulses and cereals, it could have beneficial effects on some of the important human diseases such as CVD, type 2 diabetes, digestive diseases and some cancers. Overall, chickpea is an important pulse crop with a diverse array of potential nutritional and health benefits.", "Nutritional quality of legumes, and their role in cardiometabolic risk prevention: a review. Legumes (including alfalfa, clover, lupins, green beans and peas, peanuts, soybeans, dry beans, broad beans, dry peas, chickpeas, and lentils) represent an important component of the human diet in several areas of the world, especially in the developing countries, where they complement the lack of proteins from cereals, roots, and tubers. In some regions of the world, legume seeds are the only protein supply in the diet. The health benefits of legume consumption have received rising interest from researchers, and their consumption and production extends worldwide. Among European countries, higher legume consumption is observed around the Mediterranean, with per capita daily consumption between 8 and 23 g, while in Northern Europe, the daily consumption is less than 5 g per capita. The physiological effects of different legumes vary significantly. These differences may result from the polysaccharides composition, in particular, the quantity and variety of dietary fibers and starch, protein make-up, and variability in phytochemical content. The majority of legumes contain phytochemicals: bioactive compounds, including enzyme inhibitors, phytohemagglutinins (lectins), phytoestrogens, oligosaccharides, saponins, and phenolic compounds, which play metabolic roles in humans who frequently consume these foods. Dietary intake of phytochemicals may provide health benefits, protecting against numerous diseases or disorders, such as coronary heart disease, diabetes, high blood pressure and inflammation. The synergistic or antagonistic effects of these phytochemical mixtures from food legumes, their interaction with other components of the diet, and the mechanism of their action have remained a challenge with regard to understanding the role of phytochemicals in health and diseases. Their mitigating effects and the mechanism of their action need to be further addressed if we are to understand the role of phytochemicals in health and diseases. This review provides an overview of the nutritional quality of legumes and their potential contribution in cardiometabolic risk prevention.", "Exploratory study of the relationship between hypertension and diet diversity among Saba Islanders. The relationship between diet diversity and hypertension was examined in a cross-sectional exploratory study of 82 randomly selected adult residents of Saba Island, Netherlands Antilles, in the eastern Caribbean Basin. Blood pressure measurements, taken over 4 years, and the appropriate use of antihypertensive medications, were used to identify chronic hypertensives. A 24-hour dietary recall, semi-quantitative food frequency interviews, and ethnographic confirmation techniques were used to calculate diet diversity, a measure of the overall dietary pattern. Results suggest hypertension is associated with lack of an overall balance of food groups in the daily diet beyond any imbalance of a particular dietary cation such as sodium, potassium, or calcium. Bivariate analyses found a significant association between a poorly diversified diet and hypertension (odds ratio [OR] = 4.25, 95 percent confidence intervals [CI] = 1.47,12.30). Dietary intake of sodium, potassium, and calcium was also examined and found not to be associated with the presence of hypertension in bivariate analyses. Including these cations individually in logistic regression models, which also included diet diversity, did not diminish the diet diversity-hypertension association. Multiple logistic regression models in which other potential confounding variables were individually entered as a control variable (body fat, skin color, age, sex, perceived stress, alcohol intake, aerobic activity, and socioeconomic status) did not alter this result. Analysis of the presence or absence of individual food groups indicate a lack of legumes in the daily diet is also associated with the diagnosis of hypertension (OR = 4.71, 95 percent CI = [1.71,13.01]).", "Bean and rice meals reduce postprandial glycemic response in adults with type 2 diabetes: a cross-over study Background Around the world, beans and rice are commonly consumed together as a meal. With type 2 diabetes increasing, the effect of this traditional diet pattern on glycemic response has not been studied fully. Methods We evaluated the glycemic response of bean and rice traditional meals compared to rice alone in adults with type 2 diabetes. Seventeen men and women with type 2 diabetes controlled by metformin (n\u2009=\u200914) or diet/exercise (n\u2009=\u20093) aged 35\u201370\u2009years participated in the randomized 4\u2009\u00d7\u20094 crossover trial. The white long grain rice control, pinto beans/rice, black beans/rice, red kidney beans/rice test meals, matched for 50 grams of available carbohydrate, were consumed at breakfast after a 12 hour fast. Capillary blood glucose concentrations at baseline and at 30 minute intervals up to 180 minutes postprandial were collected. MANOVA for repeated measures established glucose differences between treatments. Paired t tests identified differences between bean types and the rice control following a significant MANOVA. Results Postprandial net glucose values were significantly lower for the three bean/rice treatments in contrast to the rice control at 90, 120 and 150 minutes. Incremental area under the curve values were significantly lower for the pinto and black bean/rice meals compared to rice alone, but not for kidney beans. Conclusions Pinto, dark red kidney and black beans with rice attenuate the glycemic response compared to rice alone. Promotion of traditional foods may provide non-pharmaceutical management of type 2 diabetes and improve dietary adherence with cultural groups. Trial registration Clinical Trials number NCT01241253", "High intake of whole grains and beans pattern is inversely associated with insulin resistance in healthy Korean adult population. We investigated the association between dietary patterns and insulin resistance in the 3871 healthy Korean adults from the 2007 to 2008 Korea National Health and Nutrition Examination Survey. The whole grains and beans pattern was associated with lower prevalence of insulin resistance (OR for highest quintile=0.80, 95% CI=0.61-1.03, P for trend=0.013). Copyright \u00a9 2012 Elsevier Ireland Ltd. All rights reserved.", "Phytate in foods and significance for humans: food sources, intake, processing, bioavailability, protective role and analysis. The article gives an overview of phytic acid in food and of its significance for human nutrition. It summarises phytate sources in foods and discusses problems of phytic acid/phytate contents of food tables. Data on phytic acid intake are evaluated and daily phytic acid intake depending on food habits is assessed. Degradation of phytate during gastro-intestinal passage is summarised, the mechanism of phytate interacting with minerals and trace elements in the gastro-intestinal chyme described and the pathway of inositol phosphate hydrolysis in the gut presented. The present knowledge of phytate absorption is summarised and discussed. Effects of phytate on mineral and trace element bioavailability are reported and phytate degradation during processing and storage is described. Beneficial activities of dietary phytate such as its effects on calcification and kidney stone formation and on lowering blood glucose and lipids are reported. The antioxidative property of phytic acid and its potentional anticancerogenic activities are briefly surveyed. Development of the analysis of phytic acid and other inositol phosphates is described, problems of inositol phosphate determination and detection discussed and the need for standardisation of phytic acid analysis in foods argued.", "Antidiabetic drugs used in Europe prior to the discovery of insulin. Many therapeutic agents had been used for the treatment of diabetes mellitus before insulin was discovered and several hundred plants have shown some extent of antidiabetic activity. This study tries to explore which agents were most widely used in Europe in the pre-insulin era. According to the scientific literature and the proprietary drug industry around 1900, more than 100 agents were considered to have hypoglycemic activity. Most of them seem to have been used only occasionally while some others were recommended and marketed to a large extent. Among the medicinal plants, Syzygium cumini (syn. S. jambolanum, Eugenia jambolana), Vaccinum myrtillus and Phaseolus sp. were most common, and other frequently used agents were opium, opium alkaloids, other alkaloids like quinine or Belladonna alkaloids, salicylates, alkaline substances like sodium (bi)carbonate and even strong poisons like arsenic or uranium salts. Syzygium jambolanum seed powder seems to be one of the most intensively studied antidiabetic agents of plant origin.", "Beans and diabetes: Phaseolus vulgaris preparations as antihyperglycemic agents. Bean pods (Phaseolus vulgaris) are among the most widely used traditional remedies against diabetes mellitus. Historical knowledge is summarized and compared to recent study results. Reports dating from the first half of the 20(th) century as well as recent publications show contradictory results. It seems that Phaseolus preparations should not be considered the first choice in phytopharmaceutical treatment of diabetes or lead structure research. To be effective, fairly high doses of aqueous extracts need to be given. Because of their fiber content and an alpha-amylase inhibitory effect, beans might be more useful as food components in preventing or ameliorating type 2 diabetes.", "Effect of non-oil-seed pulses on glycaemic control: a systematic review and meta-analysis of randomised controlled experimental trials in people wi... AIMS/HYPOTHESIS: Dietary non-oil-seed pulses (chickpeas, beans, peas, lentils, etc.) are a good source of slowly digestible carbohydrate, fibre and vegetable protein and a valuable means of lowering the glycaemic-index (GI) of the diet. To assess the evidence that dietary pulses may benefit glycaemic control, we conducted a systematic review and meta-analysis of randomised controlled experimental trials investigating the effect of pulses, alone or as part of low-GI or high-fibre diets, on markers of glycaemic control in people with and without diabetes. METHODS: We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Library for relevant controlled trials of >or=7 days. Two independent reviewers (A. Esfahani and J. M. W. Wong) extracted information on study design, participants, treatments and outcomes. Data were pooled using the generic inverse variance method and expressed as standardised mean differences (SMD) with 95% CIs. Heterogeneity was assessed by chi (2) and quantified by I (2). Meta-regression models identified independent predictors of effects. RESULTS: A total of 41 trials (39 reports) were included. Pulses alone (11 trials) lowered fasting blood glucose (FBG) (-0.82, 95% CI -1.36 to -0.27) and insulin (-0.49, 95% CI -0.93 to -0.04). Pulses in low-GI diets (19 trials) lowered glycosylated blood proteins (GP), measured as HbA(1c) or fructosamine (-0.28, 95% CI -0.42 to -0.14). Finally, pulses in high-fibre diets (11 trials) lowered FBG (-0.32, 95% CI -0.49 to -0.15) and GP (-0.27, 95% CI -0.45 to -0.09). Inter-study heterogeneity was high and unexplained for most outcomes, with benefits modified or predicted by diabetes status, pulse type, dose, physical form, duration of follow-up, study quality, macronutrient profile of background diets, feeding control and design. CONCLUSIONS/INTERPRETATION: Pooled analyses demonstrated that pulses, alone or in low-GI or high-fibre diets, improve markers of longer term glycaemic control in humans, with the extent of the improvements subject to significant inter-study heterogeneity. There is a need for further large, well-designed trials.", "Antidiabetic potential of commonly consumed legumes: a review. Over the last few decades, lifestyle changes have resulted in a drastic increase in the incidence of diabetes all over the world, especially in the developing countries. Oral hypoglycemic agents and insulin form the mainstay in controlling diabetes, but they have prominent side effects and fail to significantly alter the course of diabetic complications. Appropriate diet and exercise programs that form a part of lifestyle modifications have proven to be greatly effective in the management of this disease. Dietary therapy is showing a bright future in the prevention and treatment of diabetes. Legumes, owing to their high nutritive value, are increasingly being used in dietetic formulations in the treatment and prevention of diabetes on account of their antidiabetic potential. Given this background, this paper reviews the glucose- and lipid-lowering action possessed by various commonly consumed legumes through several animal and human studies. It is concluded that the various legumes not only have varying degrees of antidiabetic potential but are also beneficial in decreasing the risk factors for cardiovascular and renal disease.", "Neuroprotective effect of the natural iron chelator, phytic acid in a cell culture model of Parkinson's disease. Disrupted iron metabolism and excess iron accumulation has been reported in the brains of Parkinson's disease (PD) patients. Because excessive iron can induce oxidative stress subsequently causing degradation of nigral dopaminergic neurons in PD, we determined the protective effect of a naturally occurring iron chelator, phytic acid (IP6), on 1-methyl-4-phenylpyridinium (MPP(+))-induced cell death in immortalized rat mesencephalic/dopaminergic cells. Cell death was induced with MPP(+) in normal and iron-excess conditions and cytotoxicity was measured by thiazolyl blue tetrazolium bromide (MTT assay) and trypan blue staining. Apoptotic cell death was also measured with caspase-3 activity, DNA fragmentation, and Hoechst nuclear staining. Compared to MPP(+) treatment, IP6 (30 micromol/L) increased cell viability by 19% (P<0.05) and decreased cell death by 22% (P<0.05). A threefold increase in caspase-3 activity (P<0.001) and a twofold increase in DNA fragmentation (P<0.05) with MPP(+) treatment was decreased by 55% (P<0.01) and 52% (P<0.05), respectively with IP6. Cell survival was increased by 18% (P<0.05) and 42% (P<0.001) with 30 and 100 micromol/L of IP6, respectively in iron-excess conditions. A 40% and 52% (P<0.001) protection was observed in caspase-3 activity with 30 and 100 micromol/L IP6, respectively in iron-excess condition. Similarly, a 45% reduction (P<0.001) in DNA fragmentation was found with 100 micromol/L IP6. In addition, Hoechst nuclear staining results confirmed the protective effect of IP6 against apoptosis. Similar protection was also observed with the differentiated cells. Collectively, our results demonstrate a significant neuroprotective effect of phytate in a cell culture model of PD.", "Inositol Hexakisphosphate Inhibits Osteoclastogenesis on RAW 264.7 Cells and Human Primary Osteoclasts Background Inoxitol hexakisphosphate (IP6) has been found to have an important role in biomineralization and a direct effect inhibiting mineralization of osteoblasts in vitro without impairing extracellular matrix production and expression of alkaline phosphatase. IP6 has been proposed to exhibit similar effects to those of bisphosphonates on bone resorption, however, its direct effect on osteoclasts (OCL) is presently unknown. Methodology/Principal Findings The aim of the present study was to investigate the effect of IP6 on the RAW 264.7 monocyte/macrophage mouse cell line and on human primary osteoclasts. On one hand, we show that IP6 decreases the osteoclastogenesis in RAW 264.7 cells induced by RANKL, without affecting cell proliferation or cell viability. The number of TRAP positive cells and mRNA levels of osteoclast markers such as TRAP, calcitonin receptor, cathepsin K and MMP-9 was decreased by IP6 on RANKL-treated cells. On the contrary, when giving IP6 to mature osteoclasts after RANKL treatment, a significant increase of bone resorption activity and TRAP mRNA levels was found. On the other hand, we show that 1 \u00b5M of IP6 inhibits osteoclastogenesis of human peripheral blood mononuclear cells (PBMNC) and their resorption activity both, when given to undifferentiated and to mature osteoclasts. Conclusions/Significance Our results demonstrate that IP6 inhibits osteoclastogenesis on human PBMNC and on the RAW264.7 cell line. Thus, IP6 may represent a novel type of selective inhibitor of osteoclasts and prove useful for the treatment of osteoporosis.", "Surgical management of bisphosphonate-related osteonecrosis of the jaw in oncologic patients: a challenging problem. AIM: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious oral complication of supportive cancer therapy and the best method of treatment is still unclear. The purpose of this article is to analyze the type of treatment and outcome in a large patient cohort with BRONJ. PATIENTS AND METHODS: A total of 142 patients suffering from BRONJ at different sites were studied. All patients had been treated with intravenous bisphosphonates for various oncological disease. A descriptive analysis of all relevant patient data was performed with particular emphasis on surgical outcome. RESULTS: The mandible was affected in 58% of the patients. All but two patients had previous invasive dental procedures. The mean duration of bisphosphonate treatment was 37.1 months. A total of 86% of the patients were treated surgically, including sequestrectomies and mandibular resections. Soft-tissue reconstruction was achieved by local closure, myofascial flap using the mylohyoid muscle, and a vascularized fasciocutaneous flap in one patient. No bony reconstruction was performed. CONCLUSION: Surgical treatment of BRONJ remains challenging. There is only limited evidence that oncologic patients with BRONJ are candidates for vascularized bone reconstruction.", "Ascorbic acid prevents the dose-dependent inhibitory effects of polyphenols and phytates on nonheme-iron absorption. The effects of maize-bran phytate and of a polyphenol (tannic acid) on iron absorption from a white-bread meal were tested in 199 subjects. The phytate content was varied by adding different concentrations of phytate-free and ordinary maize bran. Iron absorption decreased progressively when maize bran containing increasing amounts of phytate phosphorous (phytate P) (from 10 to 58 mg) was given. The inhibitory effect was overcome by 30 mg ascorbic acid. The inhibitory effects of tannic acid (from 12 to 55 mg) were also dose dependent. Studies suggested that greater than or equal to 50 mg ascorbic acid would be required to overcome the inhibitory effects on iron absorption of any meal containing greater than 100 mg tannic acid. Our findings indicate that it may be possible to predict the bioavailability of iron in a diet if due account is taken of the relative content in the diet of the major promoters and inhibitors of iron absorption.", "An algorithm to assess intestinal iron availability for use in dietary surveys In nutritional epidemiology, it is often assumed that nutrient absorption is proportional to nutrient intake. For several nutrients, including non-haem Fe, this assumption may not hold. Depending on the nutrients ingested with non-haem Fe, its availability for absorption varies greatly. Therefore, using Fe intake to examine associations between Fe and health can impact upon the validity of findings. Previous algorithms that adjust Fe intakes for dietary factors known to affect absorption have been found to underestimate Fe absorption and, in the present study, perform poorly on independent dietary data. We have designed a new algorithm to adjust Fe intakes for the effects of ascorbic acid, meat, fish and poultry, phytate, polyphenols and Ca, incorporating not only absorption data from test meals but also current understanding of Fe absorption. In so doing, we have created a robust and universal Fe algorithm with potential for use in large cohorts. The algorithm described aims not to predict Fe absorption but available Fe in the gut, a measure we believe to be of greater use in epidemiological research. Available Fe is Fe available for absorption from the gastrointestinal tract, taking into account enhancing or inhibiting effects of dietary modifiers. Our algorithm successfully estimated average Fe availability in test meal data used to construct the algorithm and, unlike other algorithms tested, also provided plausible predictions when applied to independent dietary data. Future research is needed to evaluate the extent to which this algorithm is useful in epidemiological research to relate Fe to health outcomes.", "Phytate (myo-inositol hexaphosphate) and risk factors for osteoporosis. Several risk factors seem to play a role in the development of osteoporosis. Phytate is a naturally occurring compound that is ingested in significant amounts by those with diets rich in whole grains. The aim of this study was to evaluate phytate consumption as a risk factor in osteoporosis. In a first group of 1,473 volunteer subjects, bone mineral density was determined by means of dual radiological absorptiometry in the calcaneus. In a second group of 433 subjects (used for validation of results obtained for the first group), bone mineral density was determined in the lumbar column and the neck of the femur. Subjects were individually interviewed about selected osteoporosis risk factors. Dietary information related to phytate consumption was acquired by questionnaires conducted on two different occasions, the second between 2 and 3 months after performing the first one. One-way analysis of variance or Student's t test was used to determine statistical differences between groups. Bone mineral density increased with increasing phytate consumption. Multivariate linear regression analysis indicated that body weight and low phytate consumption were the risk factors with greatest influence on bone mineral density. Phytate consumption had a protective effect against osteoporosis, suggesting that low phytate consumption should be considered an osteoporosis risk factor.", "Effect of phytic acid on the absorption, distribution, and endogenous excretion of zinc in rats. Zinc metabolism in male rats was studied by combining nutritional balance methods with an analysis of 65Zn kinetics. The rats, two groups of 84 each, were fed zinc-adequate diets (33 ppm Zn) with either 0 (basal) or 2% phytic acid added as sodium phytate. A fourth-order exponential function described the time-course of 65Zn in plasma, and compartmental models were developed accordingly. Plasma zinc exchanged more rapidly with zinc in liver and kidneys than it did with zinc in testes, skeletal muscle, or bone. Total body zinc content (2.6 mg/100 g live body weight) measured chemically was about 9 times higher than estimates of exchangeable zinc in the body. Whole-body retention of 65Zn was higher and endogenous fecal zinc excretion was lower in rats fed phytate than in those fed the basal diet; these responses to phytate may reflect a homeostatic adjustment to decreased absorption of zinc. Respective values for apparent absorption and true absorption of zinc were 13 and 32% of zinc intake in rats fed phytate, and 19 and 46% of zinc intake in rats fed the basal diet. When whole grains or mature seeds constitute a major portion of the diet, the phytate: zinc molar ratio may approach that (60:1) used in our study. Whether or not phytic acid occurring naturally in foods affects zinc metabolism to the same extent as sodium phytate can not be determined from our study.", "Protective effect of myo-inositol hexaphosphate (phytate) on bone mass loss in postmenopausal women. INTRODUCTION: The objective of this paper was to evaluate the relationship between urinary concentrations of InsP6, bone mass loss and risk fracture in postmenopausal women. MATERIALS AND METHODS: A total of 157 postmenopausal women were included in the study: 70 had low (\u22640.76 \u03bcM), 42 intermediate (0.76-1.42 \u03bcM) and 45 high (\u22651.42 \u03bcM) urinary phytate concentrations. Densitometry values for neck were measured at enrollment and after 12 months (lumbar spine and femoral neck), and 10-year risk fracture was calculated using the tool FRAX(\u00ae). RESULTS: Individuals with low InsP6 levels had significantly greater bone mass loss in the lumbar spine (3.08 \u00b1 0.65 % vs. 0.43 \u00b1 0.55 %) than did those with high phytate levels. Moreover, a significantly greater percentage of women with low than with high InsP6 levels showed more than 2 % of bone mass loss in the lumbar spine (55.6 vs. 20.7 %). The 10-year fracture probability was also significantly higher in the low-phytate group compared to the high-phytate group, both in hip (0.37 \u00b1 0.06 % vs 0.18 \u00b1 0.04 %) and major osteoporotic fracture (2.45 \u00b1 0.24 % vs 1.83 \u00b1 0.11 %). DISCUSSION: It can be concluded that high urinary phytate concentrations are correlated with reduced bone mass loss in lumbar spine over 12 months and with reduced 10-year probability of hip and major osteoporotic fracture, indicating that increased phytate consumption can prevent development of osteoporosis.", "The role of phytic acid in legumes: antinutrient or beneficial function? This review describes the present state of knowledge about phytic acid (phytate), which is often present in legume seeds. The antinutritional effects of phytic acid primarily relate to the strong chelating associated with its six reactive phosphate groups. Its ability to complex with proteins and particularly with minerals has been a subject of investigation from chemical and nutritional viewpoints. The hydrolysis of phytate into inositol and phosphates or phosphoric acid occurs as a result of phytase or nonenzymatic cleavage. Enzymes capable of hydrolysing phytates are widely distributed in micro-organisms, plants and animals. Phytases act in a stepwise manner to catalyse the hydrolysis of phytic acid. To reduce or eliminate the chelating ability of phytate, dephosphorylation of hexa- and penta-phosphate forms is essential since a high degree of phosphorylation is necessary to bind minerals. There are several methods of decreasing the inhibitory effect of phytic acid on mineral absorption (cooking, germination, fermentation, soaking, autolysis). Nevertheless, inositol hexaphosphate is receiving increased attention owing to its role in cancer prevention and/or therapy and its hypocholesterolaemic effect.", "Phytate levels and bone parameters: a retrospective pilot clinical trial. This study evaluated the relationship between phytate urinary levels and bone characteristics in a large population of postmenopausal women. The study population consisted of 180 postmenopausal women who participated in a descriptive cross-sectional study. A urine sample was collected from each subject to determine phytate levels and the volunteers were divided into two groups according to phytate urinary concentration (i.e., low and high levels). Bone mineral density was determined in the lumbar spine and femoral neck of groups with low and high phytate urinary levels. Urinary levels of phytate were linked to dietary phytate consumption. Hence, bone mineral density values were significantly higher in the lumbar spines and femoral necks of women who consumed high levels of phytate than in women with low urinary phytate concentrations. Higher urinary levels of phytate correlated with higher bone mineral density in the lumbar spine and femoral necks of postmenopausal women. This finding demonstrates the potential use of phytate in the treatment of bone related diseases, as it uses a mechanism of action similar to some bisphosphonates.", "Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. ONJ has been increasingly suspected to be a potential complication of bisphosphonate therapy in recent years. Thus, the ASBMR leadership appointed a multidisciplinary task force to address key questions related to case definition, epidemiology, risk factors, diagnostic imaging, clinical management, and future areas for research related to the disorder. This report summarizes the findings and recommendations of the task force. INTRODUCTION: The increasing recognition that use of bisphosphonates may be associated with osteonecrosis of the jaw (ONJ) led the leadership of the American Society for Bone and Mineral Research (ASBMR) to appoint a task force to address a number of key questions related to this disorder. MATERIALS AND METHODS: A multidisciplinary expert group reviewed all pertinent published data on bisphosphonate-associated ONJ. Food and Drug Administration drug adverse event reports were also reviewed. RESULTS AND CONCLUSIONS: A case definition was developed so that subsequent studies could report on the same condition. The task force defined ONJ as the presence of exposed bone in the maxillofacial region that did not heal within 8 wk after identification by a health care provider. Based on review of both published and unpublished data, the risk of ONJ associated with oral bisphosphonate therapy for osteoporosis seems to be low, estimated between 1 in 10,000 and <1 in 100,000 patient-treatment years. However, the task force recognized that information on incidence of ONJ is rapidly evolving and that the true incidence may be higher. The risk of ONJ in patients with cancer treated with high doses of intravenous bisphosphonates is clearly higher, in the range of 1-10 per 100 patients (depending on duration of therapy). In the future, improved diagnostic imaging modalities, such as optical coherence tomography or MRI combined with contrast agents and the manipulation of image planes, may identify patients at preclinical or early stages of the disease. Management is largely supportive. A research agenda aimed at filling the considerable gaps in knowledge regarding this disorder was also outlined.", "Influence of frequent and long-term bean consumption on colonic function and fermentation. The objective of this study was to determine the influence of frequent and long-term consumption of legume seeds on colonic function. Two groups of subjects were studied--one group habitually consumed legume seeds as part of their normal diet, a second group only infrequently consumed legumes. No differences between these groups could be detected for fecal output and frequency, intestinal transit time, VFA excretion or fecal pH during 23-day study periods in which subjects consumed either their usual diet or 100 g red kidney beans, daily. However, the addition of beans to the diets of both groups provided significantly more dietary fiber, and produced greater fecal output and a higher concentration of VFA in feces. Fecal output appeared to be determined by two independent parameters--dietary fiber intake and VFA excretion. Beans provided a physiologically useful source of dietary fiber and favorably influenced colonic function.", "Americans Do Not Meet Federal Dietary Recommendations A longstanding goal of dietary surveillance has been to estimate the proportion of the population with intakes above or below a target, such as a recommended level of intake. However, until now, statistical methods for assessing the alignment of food intakes with recommendations have been lacking. The purposes of this study were to demonstrate the National Cancer Institute\u2019s method of estimating the distribution of usual intake of foods and determine the proportion of the U.S. population who does not meet federal dietary recommendations. Data were obtained from the 2001\u20132004 NHANES for 16,338 persons, aged 2 y and older. Quantities of foods reported on 24-h recalls were translated into amounts of various food groups using the MyPyramid Equivalents Database. Usual dietary intake distributions were modeled, accounting for sequence effect, weekend/weekday effect, sex, age, poverty income ratio, and race/ethnicity. The majority of the population did not meet recommendations for all of the nutrient-rich food groups, except total grains and meat and beans. Concomitantly, overconsumption of energy from solid fats, added sugars, and alcoholic beverages (\u201cempty calories\u201d) was ubiquitous. Over 80% of persons age \u226571 y and over 90% of all other sex-age groups had intakes of empty calories that exceeded the discretionary calorie allowances. In conclusion, nearly the entire U.S. population consumes a diet that is not on par with recommendations. These findings add another piece to the rather disturbing picture that is emerging of a nation\u2019s diet in crisis.", "Perceptions of flatulence from bean consumption among adults in 3 feeding studies Background Many consumers avoid eating beans because they believe legume consumption will cause excessive intestinal gas or flatulence. An increasing body of research and the 2010 Dietary Guidelines for Americans supports the benefits of a plant-based diet, and legumes specifically, in the reduction of chronic disease risks. The purpose of the current research was to investigate the perception of increased flatulence and gastrointestinal discomfort among participants who consumed a \u00bd cup of beans daily for 8 or 12 weeks. Methods Participants in three studies to test the effects of beans on heart disease biomarkers completed the same weekly questionnaire to assess gastrointestinal discomfort issues such as increased flatulence, stool changes, and bloating. Studies 1 and 2 were randomized crossover trials. Participants consumed \u00bd cup of pinto beans, black-eyed peas, and canned carrots as control (n = 17) in Study 1 for three randomized 8-week phases. For Study 2, participants ate \u00bd cup baked beans or canned carrots as control (n = 29) for two randomized 8-week phases. Study 3 was a parallel arm trial with 40 subjects receiving \u00bd cup pinto beans and 40 consuming a control soup for 12 weeks. Changes in the frequency of perceived flatulence, stool characteristics, and bloating were the primary outcome measures. Chi-square distributions were examined for the presence or absence of symptoms and demographic characteristics to determine differences by gender, age, body mass index (BMI), and bean type. Results Less than 50% reported increased flatulence from eating pinto or baked beans during the first week of each trial, but only 19% had a flatulence increase with black-eyed peas. A small percentage (3-11%) reported increased flatulence across the three studies even on control diets without flatulence-producing components. Conclusions People's concerns about excessive flatulence from eating beans may be exaggerated. Public health nutritionists should address the potential for gastrointestinal discomfort when increasing fiber intake from beans with clients. It is important to recognize there is individual variation in response to different bean types.", "Soy food intake after diagnosis of breast cancer and survival: an in-depth analysis of combined evidence from cohort studies of US and Chinese women Background: Soy isoflavones have antiestrogenic and anticancer properties but also possess estrogen-like properties, which has raised concern about soy food consumption among breast cancer survivors. Objective: We prospectively evaluated the association between postdiagnosis soy food consumption and breast cancer outcomes among US and Chinese women by using data from the After Breast Cancer Pooling Project. Design: The analysis included 9514 breast cancer survivors with a diagnosis of invasive breast cancer between 1991 and 2006 from 2 US cohorts and 1 Chinese cohort. Soy isoflavone intake (mg/d) was measured with validated food-frequency questionnaires. HRs and 95% CIs were estimated by using delayed-entry Cox regression models, adjusted for sociodemographic, clinical, and lifestyle factors. Results: After a mean follow-up of 7.4 y, we identified 1171 total deaths (881 from breast cancer) and 1348 recurrences. Despite large differences in soy isoflavone intake by country, isoflavone consumption was inversely associated with recurrence among both US and Chinese women, regardless of whether data were analyzed separately by country or combined. No heterogeneity was observed. In the pooled analysis, consumption of \u226510 mg isoflavones/d was associated with a nonsignificant reduced risk of all-cause (HR: 0.87; 95% CI: 0.70, 1.10) and breast cancer\u2013specific (HR: 0.83; 95% CI: 0.64, 1.07) mortality and a statistically significant reduced risk of recurrence (HR: 0.75; 95% CI: 0.61, 0.92). Conclusion: In this large study of combined data on US and Chinese women, postdiagnosis soy food consumption of \u226510 mg isoflavones/d was associated with a nonsignificant reduced risk of breast cancer\u2013specific mortality and a statistically significant reduced risk of recurrence. One of the studies included in the After Breast Cancer Pooling Project, the Women's Healthy Eating & Living Study, was registered at clinicaltrials.gov as NCT00003787.", "Legumes: the most important dietary predictor of survival in older people of different ethnicities. To identify protective dietary predictors amongst long-lived elderly people (N= 785), the \"Food Habits in Later Life \"(FHILL) study was undertaken among five cohorts in Japan, Sweden, Greece and Australia. Between 1988 and 1991, baseline data on food intakes were collected. There were 785 participants aged 70 and over that were followed up to seven years. Based on an alternative Cox Proportional Hazard model adjusted to age at enrollment (in 5-year intervals), gender and smoking, the legume food group showed 7-8% reduction in mortality hazard ratio for every 20g increase in daily intake with or without controlling for ethnicity (RR 0.92; 95% CI 0.85-0.99 and RR 0.93; 95% CI 0.87-0.99, respectively). Other food groups were not found to be consistently significant in predicting survival amongst the FHILL cohorts.", "A bean-free diet increases the risk of all-cause mortality among Taiwanese women: the role of the metabolic syndrome. OBJECTIVE: To evaluate the associations with chronic disease risk and mortality of the consequences of bean-free diets in Taiwanese adults with regard to gender. DESIGN: A sub-sample of the National Health Interview Survey (NHIS) in 2001 agreed to physical examination in the subsequent year. This group then took part in the Taiwanese Survey of Hyperglycaemia, Hyperlipidaemia and Hypertension (TwSHHH) in 2002. SETTING: Individual records were linked to the eventual death files from 2002 to 2008. SUBJECTS: Up to the end of 2008, a total of 2820 men and 2950 women were tracked by death registry over the 6\u00b78 years of follow-up. RESULTS: Among 38,077 person-years, an average follow-up 6\u00b75 years, 225 all-cause deaths were identified. Generalized linear models showed beans to be favourable for metabolic syndrome (other than for fasting glucose) in men; in women, beans were favourable for waist circumference and HbA1c. Cumulative logistic regression models for the effect of a bean-free diet on metabolic syndrome scores according to the Taiwanese-modified National Cholesterol Education Program-Adult Treatment Panel III (NCEP-tw) gave adjusted odds ratios of 1\u00b783 in men and 1\u00b745 in women. Cox regression models for the bean-free diet showed an increased hazard ratio for all-cause mortality among women (1\u00b798, 95% CI 1\u00b703, 3\u00b781) but not men (1\u00b728, 95% CI 0\u00b776, 2\u00b716). CONCLUSIONS: A bean-free diet may play a role in developing the metabolic syndrome in both genders, and is a significant predictor of all-cause mortality in Taiwanese women but not men.", "Positive effects of soy isoflavone food on survival of breast cancer patients in China. AIM: Soy foods are the major source of isoflavones, which are believed to play important roles in genesis of breast cancer and its progression. We here conducted a prospective study to evaluate the association of soy isoflavone food consumption with breast cancer prognosis. METHODS: A prospective study was performed from January 2004 and January 2006 in China. Trained interviewers conducted face-to-face interviews using a structured questionnaire to collect information on dietary habits and potential confounding factors. The relative risk [hazard ratio (HR)] and 95% CI were calculated from the Cox regression model for all significant predictors from cancer diagnosis to the endpoint of the study (event). RESULTS: After a median follow up of 52.1 months (range, 9-60 months), a total of 79 breast cancer related deaths were recorded in our study, risk being inversely associated with a high intake of soy isoflavone. With an average intake of soy isoflavone above 17.3 mg/day, the mortality of breast cancer can be reduced by about 38-36%. We also found the decreased breast cancer death with high soy protein intake, with a HR (95% CI) of 0.71 (0.52-0.98). Stratified analysis with reference to the ER status, further demonstrated a better prognosis of ER positive breast cancer with a high intake of soy isoflavone (HR 0.59, 0.40-0.93). CONCLUSION: Our study shows the soy food intake is associated with longer survival and low recurrence among breast cancer patients. A cohort study with a larger sample size and long term follow-up is now needed.", "Gastrointestinal symptoms in 3181 volunteers ingesting snack foods containing olestra or triglycerides. A 6-week randomized, placebo-controlled trial. BACKGROUND: Olestra is a nonabsorbable, energy-free fat substitute. Because it is not absorbed, it may cause digestive symptoms when consumed in large amounts. OBJECTIVE: To compare the frequency and impact of gastrointestinal symptoms in adults and children who freely consume snacks containing olestra or regular snacks in the home. DESIGN: 6-week, double-blind, randomized, parallel, placebo-controlled trial. SETTING: General community. PARTICIPANTS: 3181 volunteers 2 to 89 years of age. INTERVENTION: Households received identical packages labeled as containing olestra corn or potato chips. These packages contained either olestra or regular chips (control). MEASUREMENT: Gastrointestinal symptoms and their impact on daily activities were reported in a daily record. RESULTS: At least one gastrointestinal symptom was reported by 619 of 1620 (38.2%) persons in the olestra group and 576 of 1561 (36.9%) controls (difference, 1.3 percentage points [95% CI, -3.6 to 6.2 percentage points]; P = 0.60). In general, the groups did not differ significantly in the proportion of participants who reported individual gastrointestinal symptoms; however, more controls reported nausea (8.4% compared with 5.7%; difference, -2.7 percentage points [CI, -4.9 to -0.4 percentage points]; P = 0.02). The only difference between groups for the mean numbers of days on which symptoms were reported was that participants in the olestra group had 1 more symptom-day of more frequent bowel movements than did controls (3.7 symptom-days compared with 2.8 symptom days; difference, 0.9 symptom-days [CI, 0.1 to 1.8 symptom-days]; P = 0.04). The groups did not differ in the impact of symptoms on daily activities. CONCLUSIONS: Clinically meaningful or bothersome gastrointestinal effects are not associated with unregulated consumption of olestra corn and potato chips in the home.", "Effects of dietary flaxseed lignan extract on symptoms of benign prostatic hyperplasia. A flaxseed lignan extract containing 33% secoisolariciresinol diglucoside (SDG) was evaluated for its ability to alleviate lower urinary tract symptoms (LUTS) in 87 subjects with benign prostatic hyperplasia (BPH). A randomized, double-blind, placebo-controlled clinical trial with repeated measurements was conducted over a 4-month period using treatment dosages of 0 (placebo), 300, or 600 mg/day SDG. After 4 months of treatment, 78 of the 87 subjects completed the study. For the 0, 300, and 600 mg/day SDG groups, respectively, the International Prostate Symptom Score (IPSS) decreased -3.67 +/- 1.56, -7.33 +/- 1.18, and -6.88 +/- 1.43 (mean +/- SE, P = .100, < .001, and < .001 compared to baseline), the Quality of Life score (QOL score) improved by -0.71 +/- 0.23, -1.48 +/- 0.24, and -1.75 +/- 0.25 (mean +/- SE, P = .163 and .012 compared to placebo and P = .103, < .001, and < .001 compared to baseline), and the number of subjects whose LUTS grade changed from \"moderate/severe\" to \"mild\" increased by three, six, and 10 (P = .188, .032, and .012 compared to baseline). Maximum urinary flows insignificantly increased 0.43 +/- 1.57, 1.86 +/- 1.08, and 2.7 +/- 1.93 mL/second (mean +/- SE, no statistical significance reached), and postvoiding urine volume decreased insignificantly by -29.4 +/- 20.46, -19.2 +/- 16.91, and -55.62 +/- 36.45 mL (mean +/- SE, no statistical significance reached). Plasma concentrations of secoisolariciresinol (SECO), enterodiol (ED), and enterolactone (EL) were significantly raised after the supplementation. The observed decreases in IPSS and QOL score were correlated with the concentrations of plasma total lignans, SECO, ED, and EL. In conclusion, dietary flaxseed lignan extract appreciably improves LUTS in BPH subjects, and the therapeutic efficacy appeared comparable to that of commonly used intervention agents of alpha1A-adrenoceptor blockers and 5alpha-reductase inhibitors.", "Lifestyle factors, benign prostatic hyperplasia, and lower urinary tract symptoms. PURPOSE OF REVIEW: Although age, genetics, and sex steroid hormones play prominent roles in the cause of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS), recent epidemiological studies suggest that modifiable lifestyle factors also contribute substantially to the pathogenesis of these conditions. RECENT FINDINGS: Lifestyle and metabolic factors associated with significantly increased risks of benign prostatic hyperplasia and lower urinary tract symptoms include obesity, diabetes, and meat and fat consumption. Factors associated with decreased risks include physical activity, moderate alcohol intake, and vegetable consumption. Factors for which no clear risk patterns have emerged include lipids and smoking. Randomized clinical trials of lifestyle alterations - such as weight loss, exercise, and diet - for the prevention or treatment of benign prostatic hyperplasia and lower urinary tract symptoms have yet to be performed. SUMMARY: Lifestyle factors present a novel opportunity for the prevention and treatment of benign prostatic hyperplasia and lower urinary tract symptoms. Although clinical trials of lifestyle modifications have not yet been undertaken, promotion of healthy lifestyle alternatives within the context of standard benign prostatic hyperplasia and lower urinary tract symptoms treatment algorithms is potentially beneficial.", "Onion and garlic intake and the odds of benign prostatic hyperplasia. OBJECTIVE: To analyze the relationship between onion and garlic intake and benign prostatic hyperplasia (BPH), using data from a multicenter case-control study conducted in Italy. METHODS: A multicenter case-control study of 1369 patients with BPH and 1451 controls, admitted to the same hospitals for a wide spectrum of acute, non-neoplastic conditions, was conducted in Italy between 1991 and 2002. Information was collected by trained interviewers using a validated and reproducible food frequency questionnaire. Multivariate odds ratios (ORs) and 95% confidence intervals (CIs) were obtained after allowance for recognized confounding factors and energy intake. RESULTS: Compared with nonusers, the multivariate ORs for the highest category of onion and garlic intake were 0.41 (95% CI 0.24 to 0.72) and 0.72 (95% CI 0.57 to 0.91), respectively. The combined OR for frequent users versus nonusers of both onion and garlic was 0.65 (95% CI 0.49 to 0.86). The inverse relationships were consistent across age strata. CONCLUSIONS: This uniquely large data set from European populations showed an inverse association between allium vegetable consumption and BPH.", "Food groups and risk of benign prostatic hyperplasia. OBJECTIVES: To evaluate the role of a wide range of foods on the risk of benign prostatic hyperplasia (BPH), we conducted a case-control study in Italy between 1991 and 2002. Although BPH is an extremely common condition, particularly among older men, its risk factors, including dietary ones, remain largely undefined. METHODS: Included in the study were 1369 patients younger than 75 years old surgically treated for BPH and 1451 controls younger than 75 years of age who had been admitted to the same hospitals as cases for a wide spectrum of acute, non-neoplastic conditions. A validated and reproducible food frequency questionnaire, including 78 foods and beverages, plus a separate section on alcoholic beverages, was used to assess patients' dietary habits 2 years before diagnosis or hospital admission. Multivariate odds ratios (OR) were obtained after allowance for energy intake and other major potential confounding factors. RESULTS: A significant trend of increasing risk with more frequent consumption was found for cereals (OR 1.55 for the greatest versus lowest quintile), bread (OR 1.69), eggs (OR 1.43), and poultry (OR 1.39). Inverse associations were observed for soups (OR 0.74), pulses (OR 0.74), cooked vegetables (OR 0.66), and citrus fruit (OR 0.82). No association was observed for milk and yogurt products, coffee and tea, pasta and rice, fish, cheese, row vegetables, potatoes, fruit, or desserts. CONCLUSIONS: The results of this study suggest a role for dietary habits on the risk of BPH. In particular, a diet rich in cereals and some types of meat and poor in vegetables and pulses may have an unfavorable effect in this Italian population.", "Pilot study of dietary fat restriction and flaxseed supplementation in men with prostate cancer before surgery: exploring the effects on hormonal l... OBJECTIVES: Dietary fat and fiber affect hormonal levels and may influence cancer progression. Flaxseed is a rich source of lignan and omega-3 fatty acids and may thwart prostate cancer. The potential effects of flaxseed may be enhanced with concomitant fat restriction. We undertook a pilot study to explore whether a flaxseed-supplemented, fat-restricted diet could affect the biomarkers of prostatic neoplasia. METHODS: Twenty-five patients with prostate cancer who were awaiting prostatectomy were instructed on a low-fat (20% of kilocalories or less), flaxseed-supplemented (30 g/day) diet. The baseline and follow-up levels of prostate-specific antigen, testosterone, free androgen index, and total serum cholesterol were determined. The tumors of diet-treated patients were compared with those of historic cases (matched by age, race, prostate-specific antigen level at diagnosis, and biopsy Gleason sum) with respect to apoptosis (terminal deoxynucleotidyl transferase [TdT]-mediated dUTP-biotin nick end-labeling [TUNEL]) and proliferation (MIB-1). RESULTS: The average duration on the diet was 34 days (range 21 to 77), during which time significant decreases were observed in total serum cholesterol (201 +/- 39 mg/dL to 174 +/- 42 mg/dL), total testosterone (422 +/- 122 ng/dL to 360 +/- 128 ng/dL), and free androgen index (36.3% +/- 18.9% to 29.3% +/- 16.8%) (all P <0.05). The baseline and follow-up levels of prostate-specific antigen were 8.1 +/- 5.2 ng/mL and 8.5 +/- 7.7 ng/mL, respectively, for the entire sample (P = 0.58); however, among men with Gleason sums of 6 or less (n = 19), the PSA values were 7.1 +/- 3.9 ng/mL and 6.4 +/- 4.1 ng/mL (P = 0.10). The mean proliferation index was 7.4 +/- 7.8 for the historic controls versus 5.0 +/- 4.9 for the diet-treated patients (P = 0.05). The distribution of the apoptotic indexes differed significantly (P = 0.01) between groups, with most historic controls exhibiting TUNEL categorical scores of 0; diet-treated patients largely exhibited scores of 1. Both the proliferation rate and apoptosis were significantly associated with the number of days on the diet (P = 0.049 and P = 0.017, respectively). CONCLUSIONS: These pilot data suggest that a flaxseed-supplemented, fat-restricted diet may affect prostate cancer biology and associated biomarkers. Further study is needed to determine the benefit of this dietary regimen as either a complementary or preventive therapy.", "Dietary patterns, supplement use, and the risk of benign prostatic hyperplasia. It has long been appreciated that a healthy lifestyle plays a critical role in cardiovascular health. It is now apparent that the same is true in the development of benign prostatic hyperplasia (BPH). Prospective cohort data originating from recently published randomized trials on the medical treatment of BPH and prevention of prostate cancer have been invaluable. A growing body of evidence suggests that exercise and the intake of specific macronutrients and micronutrients through regular diet play a beneficial role. Most strikingly, the magnitude of these effects is similar to medical therapies using alpha-blockers and 5-alpha-reductase inhibitors. The use of supplements for prostate disease is a multibillion dollar business in the United States, and supplements are more commonly prescribed than medical therapy in many countries. In contrast to consumption of micronutrients through regular diet, supplemental intake of micronutrients and phytotherapies currently lack evidence to support their efficacy."], "neg": ["Bridging the gap in life expectancy of the aborigines in Taiwan. BACKGROUND: Similar to the general population in Taiwan, the health of aborigines has steadily improved over the last 30 years, but the gap remains wide, especially in males, despite an infusion of substantial medical resources. The objectives of this study are to quantify the contribution of major causes of death to the gap in life expectancy and to propose initiatives to bridge the health gap between aborigines and the general population. METHODS: This study included residents (slightly over 200000) from 30 'aboriginal townships' in Taiwan. The gap in life expectancy between aborigines and the general population was analysed by decomposing these gaps according to major causes of deaths. This analysis quantifies the contribution of different causes of deaths to the gap in life expectancy between the two populations. RESULTS: The overall mortality of aborigines in these townships was approximately 70% higher than the respective male and female general populations over the past 30 years. Mortality from infectious disease, cirrhosis of the liver, accidents, and suicide are substantially higher than the general population. The gap in life expectancy at birth in males was 8.5 years during 1971-1973, increasing to 13.5 years by 1998-2000, however, the gap in females remained relatively stable (8.0 years and 8.4 years, respectively). Of the 13.5-year difference in life expectancy in males, the differential mortality from diseases of the digestive system (mainly due to cirrhosis of the liver), accidents (from both motor vehicle and non-motor vehicle accidents), and infectious and parasitic disease contributed half (50%) of the gap in life expectancy. In females, the above primarily preventable causes of deaths accounted for 41% of the life expectancy gap. CONCLUSIONS: Based on the findings of this study, we suggest that future focus should be in the area of primary prevention in order to reduce the incidence of infectious and parasitic diseases, liver cirrhosis, and accidents.", "Comparison of the cytotoxic and mutagenic potential of liquid smoke food flavourings, cigarette smoke condensate and wood smoke condensate. Although products of pyrolysis are often cytotoxic and mutagenic, the relationship between the type of material pyrolysed and the toxicity of the resulting pyrolysis products is poorly understood. The objective of this study was to evaluate and compare the cytotoxicity and mutagenicity of several types of common pyrolysis products. The cytotoxicity and mutagenicity of these products were assessed by using neutral red uptake and Ames mutagenicity assays, respectively. The biological activities of four liquid smoke food flavourings (LSF) were compared with two other pyrolysis-derived materials; cigarette smoke condensate (CSC) and a wood smoke condensate (WSC). Results indicated all of the mixtures exhibited a concentration-dependent cytotoxic response. The CSC and WSC were less cytotoxic than three of the LSFs, but more cytotoxic than one of the brands. The CSC was mutagenic in two Salmonella strains; however, none of the LSFs or WSC was mutagenic using TA98, and only three of the LSFs were positive with TA100. The six pyrolysis-derived materials evaluated in this study showed differing patterns and magnitudes of cytotoxicity and mutagenicity. These results indicate that the cytotoxicity and mutagenicity of complex mixtures derived from pyrolysis products are affected by the type of material pyrolysed and/or the method used to prepare the mixture. The cytotoxic potential of some commercial smoke flavourings is greater than cigarette smoke condensate and several of the food flavourings are mutagenic in one Salmonella strain.", "Total antioxidant capacity from diet and risk of myocardial infarction: a prospective cohort of women. BACKGROUND: There are no previous studies investigating the effect of all dietary antioxidants in relation to myocardial infarction. The total antioxidant capacity of diet takes into account all antioxidants and synergistic effects between them. The aim of this study was to examine how total antioxidant capacity of diet and antioxidant-containing foods were associated with incident myocardial infarction among middle-aged and elderly women. METHODS: In the population-based prospective Swedish Mammography Cohort of 49-83-year-old women, 32,561 were cardiovascular disease-free at baseline. Women completed a food-frequency questionnaire, and dietary total antioxidant capacity was calculated using oxygen radical absorbance capacity values. Information on myocardial infarction was identified from the Swedish Hospital Discharge and the Cause of Death registries. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional hazard models. RESULTS: During the follow-up (September 1997-December 2007), we identified 1114 incident cases of myocardial infarction (321,434 person-years). In multivariable-adjusted analysis, the HR for women comparing the highest quintile of dietary total antioxidant capacity to the lowest was 0.80 (95% CI, 0.67-0.97; P for trend=0.02). Servings of fruit and vegetables and whole grains were nonsignificantly inversely associated with myocardial infarction. CONCLUSIONS: These data suggest that dietary total antioxidant capacity, based on fruits, vegetables, coffee, and whole grains, is of importance in the prevention of myocardial infarction. Copyright \u00a9 2012 Elsevier Inc. All rights reserved.", "Skim milk, whey, and casein increase body weight and whey and casein increase the plasma C-peptide concentration in overweight adolescents. In adults, dietary protein seems to induce weight loss and dairy proteins may be insulinotropic. However, the effect of milk proteins in adolescents is unclear. The objective was to test whether milk and milk proteins reduce body weight, waist circumference, homeostatic model assessment, plasma insulin, and insulin secretion estimated as the plasma C-peptide concentration in overweight adolescents. Overweight adolescents (n = 203) aged 12-15 y with a BMI of 25.4 \u00b1 2.3 kg/m(2) (mean \u00b1 SD) were randomized to 1 L/d of skim milk, whey, casein, or water for 12 wk. All milk drinks contained 35 g protein/L. Before randomization, a subgroup of adolescents (n = 32) was studied for 12 wk before the intervention began as a pretest control group. The effects of the milk-based test drinks were compared with baseline (wk 0), the water group, and the pretest control group. Diet and physical activity were registered. Outcomes were BMI-for-age Z-scores (BAZs), waist circumference, plasma insulin, homeostatic model assessment, and plasma C-peptide. We found no change in BAZ in the pretest control and water groups, whereas it was greater at 12 wk in the skim milk, whey, and casein groups compared with baseline and with the water and pretest control groups. The plasma C-peptide concentration increased from baseline to wk 12 in the whey and casein groups and increments were greater than in the pretest control (P < 0.02). There were no significant changes in plasma C-peptide in the skim milk or water group. These data suggest that high intakes of skim milk, whey, and casein increase BAZs in overweight adolescents and that whey and casein increase insulin secretion. Whether the effect on body weight is primary or secondary to the increased insulin secretion remains to be elucidated.", "Dietary pattern and depressive symptoms in middle age Background Studies of diet and depression have focused primarily on individual nutrients. Aims To examine the association between dietary patterns and depression using an overall diet approach. Method Analyses were carried on data from 3486 participants (26.2% women, mean age 55.6 years) from the Whitehall II prospective cohort, in which two dietary patterns were identified: \u2018whole food\u2019 (heavily loaded by vegetables, fruits and fish) and \u2018processed food\u2019 (heavily loaded by sweetened desserts, fried food, processed meat, refined grains and high-fat dairy products). Self-reported depression was assessed 5 years later using the Center for Epidemiologic Studies \u2013 Depression (CES\u2013D) scale. Results After adjusting for potential confounders, participants in the highest tertile of the whole food pattern had lower odds of CES\u2013D depression (OR = 0.74, 95% CI 0.56\u20130.99) than those in the lowest tertile. In contrast, high consumption of processed food was associated with an increased odds of CES\u2013D depression (OR = 1.58, 95% CI 1.11\u20132.23). Conclusions In middle-aged participants, a processed food dietary pattern is a risk factor for CES\u2013D depression 5 years later, whereas a whole food pattern is protective.", "Changes in brain activation associated with reward processing in smokers and nonsmokers. A positron emission tomography study. Tobacco smoking is the most frequent form of substance abuse. Several studies have shown that the addictive action of nicotine is mediated by the mesolimbic dopamine system. This system is implicated in reward processing. In order to better understand the relationship between nicotine addiction and reward in humans, we investigated differences between smokers and nonsmokers in the activation of brain regions involved in processing reward information. Using [H2(15O)] positron emission tomography (PET), we measured regional cerebral blood flow (rCBF) in healthy smokers and nonsmokers while they performed a prelearned, pattern-recognition task. We compared two conditions involving nonmonetary reinforcement or monetary reward with a baseline condition in which nonsense feedback was presented. With monetary reward, we found activation in the frontal and orbitofrontal cortex, occipital cortex, cingulate gyrus, cerebellum, and midbrain in both groups. Additionally, monetary reward activated typical dopaminergic regions such as the striatum in nonsmokers but not in smokers. We found a similar pattern of activation associated with nonmonetary reinforcement in nonsmokers, whereas activation was found in smokers only in the cerebellum. The different patterns of activation suggest that the brains of smokers react in a different way to reward than those of nonsmokers. This difference involves in particular the regions of the dopaminergic system including the striatum. In principle these observations could be interpreted either as a consequence of tobacco use or as a primitive condition of the brain that led people to smoke. Supported by related nonimaging studies, we interpret these differences as a consequence of tobacco smoking, even if a short-term effect of smoking prior to the experiment cannot be excluded.", "A comparison of the effect of diets containing beef protein and plant proteins on blood lipids of healthy young men. The effect of plant and animal protein on blood lipid levels was investigated in eight healthy normolipidemic men aged 18 to 27 yr. All subjects were fed both plant and animal protein diets in a cross-over design. Each diet was consumed for a 21-day period. Proteins from commonly used plant sources made up the plant protein diet. Beef protein was substituted for 55% of the plant proteins in the animal protein diet. Fasting venous blood samples were collected at the beginning of the study and at 7-day intervals throughout the 42-day study. Serum was analyzed for total cholesterol and triglycerides. Plasma low-density and high-density lipoprotein cholesterol were determined. There were not any statistically significant differences in mean serum total cholesterol or mean plasma low-density lipoprotein cholesterol when subjects consumed the diets. Mean plasma high-density lipoprotein cholesterol levels were significantly (p less than 0.05) elevated at the end of the 21-day period when the animal protein diet was consumed (48 +/- 3 mg/dl) compared to the period when the plant protein diet was fed (42 +/- 2 mg/dl). Mean serum triglyceride values were significantly (p less than 0.05) increased at day 7 of the plant protein diet period (136 +/- 19 mg/dl) compared to the same time period when the animal protein diet was consumed (84 +/- 12 mg/dl). The results of the study indicated that the ingestion of a diet in which 55% of the protein was supplied by beef protein was not associated with a hypercholesterolemic effect in healthy normolipidemic young men.", "Consumption of artificial sweetener\u2013 and sugar-containing soda and risk of lymphoma and leukemia in men and women Background: Despite safety reports of the artificial sweetener aspartame, health-related concerns remain. Objective: We prospectively evaluated whether the consumption of aspartame- and sugar-containing soda is associated with risk of hematopoetic cancers. Design: We repeatedly assessed diet in the Nurses\u2019 Health Study (NHS) and Health Professionals Follow-Up Study (HPFS). Over 22 y, we identified 1324 non-Hodgkin lymphomas (NHLs), 285 multiple myelomas, and 339 leukemias. We calculated incidence RRs and 95% CIs by using Cox proportional hazards models. Results: When the 2 cohorts were combined, there was no significant association between soda intake and risks of NHL and multiple myeloma. However, in men, \u22651 daily serving of diet soda increased risks of NHL (RR: 1.31; 95% CI: 1.01, 1.72) and multiple myeloma (RR: 2.02; 95% CI: 1.20, 3.40) in comparison with men who did not consume diet soda. We observed no increased risks of NHL and multiple myeloma in women. We also observed an unexpected elevated risk of NHL (RR: 1.66; 95% CI: 1.10, 2.51) with a higher consumption of regular, sugar-sweetened soda in men but not in women. In contrast, when sexes were analyzed separately with limited power, neither regular nor diet soda increased risk of leukemia but were associated with increased leukemia risk when data for men and women were combined (RR for consumption of \u22651 serving of diet soda/d when the 2 cohorts were pooled: 1.42; 95% CI: 1.00, 2.02). Conclusion: Although our findings preserve the possibility of a detrimental effect of a constituent of diet soda, such as aspartame, on select cancers, the inconsistent sex effects and occurrence of an apparent cancer risk in individuals who consume regular soda do not permit the ruling out of chance as an explanation."]}, {"query": "Ex Vivo Cancer Proliferation Bioassay", "pos": ["Effects of a low-fat, high-fiber diet and exercise program on breast cancer risk factors in vivo and tumor cell growth and apoptosis in vitro. The present study investigated the effects of a diet and exercise intervention on known breast cancer (BCa) risk factors, including estrogen, obesity, insulin, and insulin-like growth factor-I (IGF-I), in overweight/obese, postmenopausal women. In addition, using the subjects' pre- and postintervention serum in vitro, serum-stimulated growth and apoptosis of three estrogen receptor-positive BCa cell lines were studied. The women where placed on a low-fat (10-15% kcal), high-fiber (30-40 g per 1,000 kcal/day) diet and attended daily exercise classes for 2 wk. Serum estradiol was reduced in the women on hormone treatment (HT; n = 28) as well as those not on HT (n = 10). Serum insulin and IGF-I were significantly reduced in all women, whereas IGF binding protein-1 was increased significantly. In vitro growth of the BCa cell lines was reduced by 6.6% for the MCF-7 cells, 9.9% for the ZR-75-1 cells, and 18.5% for the T-47D cells. Apoptosis was increased by 20% in the ZR-75-1 cells, 23% in the MCF-7 cells, and 30% in the T-47D cells (n = 12). These results show that a very-low-fat, high-fiber diet combined with daily exercise results in major reductions in risk factors for BCa while subjects remained overweight/obese. These in vivo serum changes slowed the growth and induced apoptosis in serum-stimulated BCa cell lines in vitro.", "Intensive lifestyle changes may affect the progression of prostate cancer. PURPOSE: Men with prostate cancer are often advised to make changes in diet and lifestyle, although the impact of these changes has not been well documented. Therefore, we evaluated the effects of comprehensive lifestyle changes on prostate specific antigen (PSA), treatment trends and serum stimulated LNCaP cell growth in men with early, biopsy proven prostate cancer after 1 year. MATERIALS AND METHODS: Patient recruitment was limited to men who had chosen not to undergo any conventional treatment, which provided an unusual opportunity to have a nonintervention randomized control group to avoid the confounding effects of interventions such as radiation, surgery or androgen deprivation therapy. A total of 93 volunteers with serum PSA 4 to 10 ng/ml and cancer Gleason scores less than 7 were randomly assigned to an experimental group that was asked to make comprehensive lifestyle changes or to a usual care control group. RESULTS: None of the experimental group patients but 6 control patients underwent conventional treatment due to an increase in PSA and/or progression of disease on magnetic resonance imaging. PSA decreased 4% in the experimental group but increased 6% in the control group (p = 0.016). The growth of LNCaP prostate cancer cells (American Type Culture Collection, Manassas, Virginia) was inhibited almost 8 times more by serum from the experimental than from the control group (70% vs 9%, p <0.001). Changes in serum PSA and also in LNCaP cell growth were significantly associated with the degree of change in diet and lifestyle. CONCLUSIONS: Intensive lifestyle changes may affect the progression of early, low grade prostate cancer in men. Further studies and longer term followup are warranted.", "Dietary fat and meat intakes and risk of reflux esophagitis, Barrett\u2019s esophagus and esophageal adenocarcinoma The aim of this study was to investigate whether dietary fat and meat intakes are associated with reflux esophagitis (RE), Barrett\u2019s esophagus (BE) and esophageal adenocarcinoma (EAC). In this all-Ireland case-control study, dietary intake data was collected using a food frequency questionnaire in 219 RE patients, 220 BE patients, 224 EAC patients, and 256 frequency-matched controls between 2002 and 2005. Unconditional multiple logistic regression analysis was used to examine the association between dietary variables and disease risk using quartiles of intake, to attain odds ratios (OR) and 95% confidence intervals (95%CI), while adjusting for potential confounders. Patients in the highest quartile of total fat intake had a higher risk of RE (OR=3.54; 95%CI=1.32\u20139.46) and EAC (OR=5.44; 95%CI=2.08\u201314.27). A higher risk of RE and EAC was also reported for patients in the highest quartile of saturated fat intake (OR=2.79; 95%CI=1.11\u20137.04; OR=2.41; 95%CI=1.14\u20135.08, respectively) and monounsaturated fat intake (OR=2.63; 95%CI=1.01\u20136.86; OR=5.35; 95%CI=2.14\u201313.34, respectively). Patients in the highest quartile of fresh red meat intake had a higher risk of EAC (OR=3.15; 95%CI=1.38\u20137.20). Patients in the highest category of processed meat intake had a higher risk of RE (OR=4.67; 95%CI=1.71\u201312.74). No consistent associations were seen for BE with either fat or meat intakes. Further studies, investigating the association between dietary fat and food sources of fat are needed to confirm these results.", "Strawberry fields forever? On the basis of copious preclinical data supporting the preventive efficacy of small fruits such as berries and grapes, Chen and colleagues conducted a randomized (noncomparative) phase II trial evaluating two doses of strawberry powder (60 g/d or 30 g/d for six months) to prevent esophageal cancer in China (reported in this issue of the journal, beginning on page 41); 60 g/d reduced the histologic grade of dysplastic lesions and reduced localized biomarkers, whereas 30 g/d was not effective. Fundamental questions remain such as the best formulation of strawberry powder, the active components associated with powder, and the actual mechanism of action, and standardized preparations will be required to permit the widespread use of strawberry powder with a predicable outcome. Clearly, however, this work is a good example of proof-of-principle and highlights the important role of diet, nutrition, and natural products in cancer prevention. \u00a92012 AACR.", "Randomized phase II trial of lyophilized strawberries in patients with dysplastic precancerous lesions of the esophagus. Dysplasia is a histologic precursor of esophageal squamous cell carcinoma (SCC). We previously showed that dietary freeze-dried, or lyophilized, strawberry powder inhibits N-nitrosomethylbenzylamine-induced SCC in the rat esophagus. On the basis of this observation, we conducted a randomized (noncomparative) phase II trial in China to investigate the effects of two doses of freeze-dried strawberries in patients with esophageal dysplastic lesions in a high-risk area for esophageal cancer. We randomly assigned 75 patients identified by endoscopy to have dysplastic esophageal premalignant lesions to receive freeze-dried strawberry powder at either 30 g/d (37 patients) or 60 g/d (38 patients) for six months; the powder was mixed with water and drunk. After six months, we assessed the changes in histologic grade of these lesions (primary endpoint) in a blinded fashion. The dose of 30 g/d, did not significantly affect histology or any other measured parameter. The dose of 60 g/d, however, reduced the histologic grade of dysplastic premalignant lesions in 29 (80.6%) of the 36 patients at this dose who were evaluated for histology (P < 0.0001). The strawberry powder was well tolerated, with no toxic effects or serious adverse events. Strawberries (60 g/d) also reduced protein expression levels of inducible nitric oxide synthase (iNOS) by 79.5% (P < 0.001), cyclooxygenase-2 (COX-2) by 62.9% (P < 0.001), phospho-nuclear factor kappa B (NF\u03baB)-p65 (pNF\u03baB-p65) by 62.6% (P < 0.001), and phospho-S6 (pS6) by 73.2% (P < 0.001). Freeze-dried strawberries (60 g/d) also significantly inhibited the Ki-67 labeling index by 37.9% (P = 0.023). Our present results indicate the potential of freeze-dried strawberry powder for preventing human esophageal cancer, supporting further clinical testing of this natural agent in this setting. \u00a92011 AACR.", "Dietary patterns and the risk of esophageal cancer. BACKGROUND: The role of dietary habits on esophageal cancer risk has been rarely considered in terms of dietary patterns. PATIENTS AND METHODS: We analyzed data from an Italian case-control study, including 304 cases with squamous cell carcinoma of the esophagus and 743 hospital controls. Dietary habits were evaluated using a food frequency questionnaire. A posteriori dietary patterns were identified through principal component factor analysis performed on 28 selected nutrients. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained from multiple logistic regression models applied on quartiles of factor scores, adjusting for potential confounding variables. RESULTS: We identified five major dietary patterns, named 'animal products and related components', 'vitamins and fiber', 'starch-rich', 'other polyunsaturated fatty acids and vitamin D', and 'other fats'. The 'animal products and related components' pattern was positively related to esophageal cancer (OR = 1.64, 95% CI:1.06-2.55, for the highest versus the lowest quartile of factor scores category). The 'vitamins and fiber' (OR = 0.50, 95% CI: 0.32-0.78) and the 'other polyunsaturated fatty acids and vitamin D' (OR = 0.48, 95% CI: 0.31-0.74) were inversely related to esophageal cancer. No significant association was observed for the other patterns. CONCLUSION: Our findings suggest that a diet rich in foods from animal origin and poor in foods containing vitamins and fiber increase esophageal cancer risk.", "Dietary patterns and risk of oesophageal cancers: a population-based case-control study. Epidemiological studies investigating the association between dietary intake and oesophageal cancer have mostly focused on nutrients and food groups instead of dietary patterns. We conducted a population-based case-control study, which included 365 oesophageal adenocarcinoma (OAC), 426 oesophagogastric junction adenocarcinoma (OGJAC) and 303 oesophageal squamous cell carcinoma (OSCC) cases, with frequency matched on age, sex and geographical location to 1580 controls. Data on demographic, lifestyle and dietary factors were collected using self-administered questionnaires. We used principal component analysis to derive three dietary patterns: 'meat and fat', 'pasta and pizza' and 'fruit and vegetable', and unconditional logistic regression models to estimate risks of OAC, OGJAC and OSCC associated with quartiles (Q) of dietary pattern scores. A high score on the meat-and-fat pattern was associated with increased risk of all three cancers: multivariable-adjusted OR 2\u00b712 (95 % CI 1\u00b730, 3\u00b746) for OAC; 1\u00b788 (95% CI 1\u00b721, 2\u00b794) for OGJAC; 2\u00b784 (95% CI 1\u00b767, 4\u00b783) for OSCC (P-trend <0\u00b701 for all three cancers). A high score on the pasta-and-pizza pattern was inversely associated with OSCC risk (OR 0\u00b758, 95 % CI 0\u00b736, 0\u00b796, P for trend=0\u00b7009); and a high score on the fruit-and-vegetable pattern was associated with a borderline significant decreased risk of OGJAC (OR for Q4 v. Q1 0\u00b766, 95% CI 0\u00b742, 1\u00b704, P=0\u00b707) and significantly decreased risk of OSCC (OR 0\u00b741, 95% CI 0\u00b724, 0\u00b770, P for trend=0\u00b7002). High-fat dairy foods appeared to play a dominant role in the association between the meat-and-fat pattern and risk of OAC and OGJAC. Further investigation in prospective studies is needed to confirm these findings.", "Effect of mammalian lignans on the growth of prostate cancer cell lines. BACKGROUND: Mammalian lignans, enterolactone (EL) and enterodiol (ED), have been shown to inhibit breast and colon carcinoma. To date, there have been no reports of the effect of lignans on prostatic carcinoma. We investigated the effects of ED and EL on three human prostate cancer cell lines (PC-3, DU-145 and LNCaP). MATERIALS AND METHODS: Cells were treated with either 0.1% (v/v) DMSO (vehicle) or 10-100 microM of EL, ED or genistein (positive control) for 72 hours. Cell viability was measured by the propidium iodide nuclei staining fluorometric assay with each assay performed in triplicate. RESULTS: At 10-100 microM, EL significantly inhibited the growth of all cell lines, whereas ED only inhibited PC-3 and LNCaP cells. While EL was a more potent growth inhibitor than ED, both were less potent than genistein. The dose for 50% growth inhibition of LNCaP cells (IC50) by EL was 57 microM, whereas IC50 was 100 microM for ED, (the observed IC50 for genistein was 25 microM). CONCLUSION: ED and EL suppress the growth of prostate cancer cells, and may do so via hormonally-dependent and independent mechanisms.", "Lignans and isoflavonoids in plasma and prostatic fluid in men: samples from Portugal, Hong Kong, and the United Kingdom. BACKGROUND: Chinese men have lower incidences of prostate cancer compared to men from Europe and North America. Asians consume large quantities of soya, a rich source of isoflavanoids phyto-oestrogens and have high plasma and urinary levels of these compounds. The mammalian lignans, enterolactone and enterodiol, are another group of weak plant oestrogens and are derived from seeds, cereals and grains. Vegetarians have high plasma and urinary concentrations of lignans. METHODS: The concentrations lignans and isoflavonic phyto-oestrogens were determined by gas chromatography-mass spectrometry (GC-MS) in plasma and prostatic fluid from Portuguese, Chinese and British men consuming their traditional diets. RESULTS: In prostatic fluid the mean concentrations of enterolactone were 31, 162 and 20.3 ng/ml for Hong Kong, Portugal and Britain respectively. Very high levels of enterolactone (> 600 ng/ml) were observed in the prostatic fluid of some of the men from Portugal. High concentrations of equol (3270 ng/ml) and daidzein (532 ng/ml) were found in a sample of prostatic fluid from Hong Kong. Higher mean levels of daidzein were observed in prostatic fluid from Hong Kong at 70 ng/ml, compared to 4.6 and 11.3 ng/ml in samples from Portugal and Britain respectively. Mean levels of daidzein were higher in the plasma samples from Hong Kong (31.3 ng/ml) compared to those from Portugal (1.3 ng/ml) and Britain (8.2 ng/ml). In general, the mean plasma concentrations of enterolactone from the three centres were similar, at 6.2, 3.9 and 3.9 ng/ml in samples from Hong Kong Portugal and Britain respectively. CONCLUSIONS: Higher concentrations of the isoflavanoid phyto-oestrogens, daidzein and equol, were found in the plasma and prostatic fluid of men from Hong Kong compared to those from Britain and Portugal. However, the levels of the lignan, enterolactone, were very much higher in prostatic fluid of Portuguese men. Isoflavanoids and lignans have many interesting properties and may, in part, be responsible for lower incidences of prostate cancer in men from Asia and also some Mediterranean countries. The isoflavanoids from soya, which are present in high concentrations in the prostatic fluid of Asian men, may be protective against prostate disease.", "Pilot study to explore effects of low-fat, flaxseed-supplemented diet on proliferation of benign prostatic epithelium and prostate-specific antigen. OBJECTIVES: Dietary factors may influence the prostate and have an impact on prostatic growth and disease. A small number of studies have suggested that flaxseed-supplemented, fat-restricted diets may thwart prostate cancer growth in both animals and humans. Unknown, however, is the potential effect of such a diet on benign prostatic epithelium. METHODS: We undertook a pilot study to explore whether a flaxseed-supplemented, fat-restricted diet affects the proliferation rates in benign epithelium. We also explored the effects on circulating levels of prostate-specific antigen (PSA), total testosterone, and cholesterol. Fifteen men who were scheduled to undergo repeat prostate biopsy were instructed to follow a low-fat (less than 20% kcal), flaxseed-supplemented (30 g/day) diet and were provided with a supply of flaxseed to last throughout the 6-month intervention period. The PSA, total testosterone, and cholesterol levels were determined at baseline and at 6 months of follow-up. Reports from the original and repeat biopsies were compared, and proliferation (MIB-1) rates were quantified in the benign prostatic epithelium. RESULTS: Statistically significant decreases in PSA (8.47 +/- 3.82 to 5.72 +/- 3.16 ng/mL; P = 0.0002) and cholesterol (241.1 +/- 30.8 to 213.3 +/- 51.2 mg/dL; P = 0.012) were observed. No statistically significant change was seen in total testosterone (434.5 +/- 143.6 to 428.3 +/- 92.5 ng/dL). Although 6-month repeat biopsies were not performed in 2 cases because of PSA normalization, of the 13 men who underwent repeat biopsy, the proliferation rates in the benign epithelium decreased significantly from 0.022 +/- 0.027 at baseline to 0.007 +/- 0.014 at 6 months of follow-up (P = 0.0168). CONCLUSIONS: These pilot data suggest that a flaxseed-supplemented, fat-restricted diet may affect the biology of the prostate and associated biomarkers. A randomized controlled trial is needed to determine whether flaxseed supplementation, a low-fat diet, or a combination of the two regimens may be of use in controlling overall prostatic growth.", "Pilot study of dietary fat restriction and flaxseed supplementation in men with prostate cancer before surgery: exploring the effects on hormonal l... OBJECTIVES: Dietary fat and fiber affect hormonal levels and may influence cancer progression. Flaxseed is a rich source of lignan and omega-3 fatty acids and may thwart prostate cancer. The potential effects of flaxseed may be enhanced with concomitant fat restriction. We undertook a pilot study to explore whether a flaxseed-supplemented, fat-restricted diet could affect the biomarkers of prostatic neoplasia. METHODS: Twenty-five patients with prostate cancer who were awaiting prostatectomy were instructed on a low-fat (20% of kilocalories or less), flaxseed-supplemented (30 g/day) diet. The baseline and follow-up levels of prostate-specific antigen, testosterone, free androgen index, and total serum cholesterol were determined. The tumors of diet-treated patients were compared with those of historic cases (matched by age, race, prostate-specific antigen level at diagnosis, and biopsy Gleason sum) with respect to apoptosis (terminal deoxynucleotidyl transferase [TdT]-mediated dUTP-biotin nick end-labeling [TUNEL]) and proliferation (MIB-1). RESULTS: The average duration on the diet was 34 days (range 21 to 77), during which time significant decreases were observed in total serum cholesterol (201 +/- 39 mg/dL to 174 +/- 42 mg/dL), total testosterone (422 +/- 122 ng/dL to 360 +/- 128 ng/dL), and free androgen index (36.3% +/- 18.9% to 29.3% +/- 16.8%) (all P <0.05). The baseline and follow-up levels of prostate-specific antigen were 8.1 +/- 5.2 ng/mL and 8.5 +/- 7.7 ng/mL, respectively, for the entire sample (P = 0.58); however, among men with Gleason sums of 6 or less (n = 19), the PSA values were 7.1 +/- 3.9 ng/mL and 6.4 +/- 4.1 ng/mL (P = 0.10). The mean proliferation index was 7.4 +/- 7.8 for the historic controls versus 5.0 +/- 4.9 for the diet-treated patients (P = 0.05). The distribution of the apoptotic indexes differed significantly (P = 0.01) between groups, with most historic controls exhibiting TUNEL categorical scores of 0; diet-treated patients largely exhibited scores of 1. Both the proliferation rate and apoptosis were significantly associated with the number of days on the diet (P = 0.049 and P = 0.017, respectively). CONCLUSIONS: These pilot data suggest that a flaxseed-supplemented, fat-restricted diet may affect prostate cancer biology and associated biomarkers. Further study is needed to determine the benefit of this dietary regimen as either a complementary or preventive therapy."], "neg": ["Protective effect of sulforaphane against oxidative stress: recent advances. Sulforaphane [1-isothiocyanate-(4R)-(methylsulfinyl)butane] is a natural dietary isothiocyanate produced by the enzymatic action of the myrosinase on glucopharanin, a 4-methylsulfinylbutyl glucosinolate contained in cruciferous vegetables of the genus Brassica such as broccoli, brussel sprouts, and cabbage. Studies on this compound is increasing because its anticarcinogenic and cytoprotective properties in several in vivo experimental paradigms associated with oxidative stress such as focal cerebral ischemia, brain inflammation, intracerebral hemorrhage, ischemia and reperfusion induced acute renal failure, cisplatin induced-nephrotoxicity, streptozotocin-induced diabetes, carbon tetrachloride-induced hepatotoxicity and cardiac ischemia and reperfusion. This protective effect also has been observed in in vitro studies in different cell lines such as human neuroblastoma SH-SY5Y, renal epithelial proximal tubule LLC-PK1 cells and aortic smooth muscle A10 cells. Sulforaphane is considered an indirect antioxidant; this compound is able to induce many cytoprotective proteins, including antioxidant enzymes, through the Nrf2-antioxidant response element pathway. Heme oxygenase-1, NAD(P)H: quinone oxidoreductase, glutathione-S-transferase, gamma-glutamyl cysteine ligase, and glutathione reductase are among the cytoprotective proteins induced by sulforaphane. In conclusion, sulforaphane is a promising antioxidant agent that is effective to attenuate oxidative stress and tissue/cell damage in different in vivo and in vitro experimental paradigms. Copyright \u00a9 2010 Elsevier GmbH. All rights reserved.", "Effectiveness of a soy-based compared with a traditional low-calorie diet on weight loss and lipid levels in overweight adults. OBJECTIVE: This study investigated the effects of a soy-based low-calorie diet on weight control, body composition, and blood lipid profiles compared with a traditional low-calorie diet. METHODS: Thirty obese adults (mean body mass index 29-30 kg/m(2)) were randomized to two groups. The soy-based low-calorie group consumed soy protein as the only protein source, and the traditional low-calorie group consumed two-thirds animal protein and the rest plant protein in a 1200 kcal/d diet for 8 wk. A diet record was kept everyday throughout the study. Food intake was analyzed before and after the study. Anthropometric data were acquired every week, and biochemical data from before and after the 8-wk experiment were compared. RESULTS: Body weight, body mass index, body fat percentage, and waist circumference significantly decreased in both groups (P < 0.05). The decrease in body fat percentage in the soy group (2.2%, 95% confidence interval 1.6-2.8) was greater than that in the traditional group (1.4%, 95% confidence interval -0.1 to 2.8). Serum total cholesterol concentrations, low-density lipoprotein cholesterol concentrations, and liver function parameters decreased in the soy-based group and were significantly different from measurements in the traditional group (P < 0.05). No significant change in serum triacylglycerol levels, serum high-density lipoprotein cholesterol levels, and fasting glucose levels was found in the soy or traditional group. CONCLUSION: Soy-based low-calorie diets significantly decreased serum total cholesterol and low-density lipoprotein cholesterol concentrations and had a greater effect on reducing body fat percentage than traditional low-calorie diets. Thus, soy-based diets have health benefits in reducing weight and blood lipids.", "An evaluation of the clinical efficacy of tomato extract for perennial allergic rhinitis. BACKGROUND: Recently, some common foods in daily life have been found to have anti-allergic effects. We have reported that tomato extract (TE) could possibly inhibit histamine release and mouse ear-swelling responses. Moreover, it is reported that TE could relieve the symptoms for Japanese cedar pollinosis. METHODS: To evaluate the anti-allergic effect of TE, we performed a randomized, double-blind, placebo-controlled study in 33 patients with perennial allergic rhinitis (PAR) using oral administration of TE (360 mg per day) or placebo for 8 weeks. RESULTS: We found that the sneezing score significantly decreased in the TE group at the end of the trial compared to the beginning (P < 0.05). There were decreasing tendencies of rhinorrhea and nasal obstruction in the TE group. The patients' quality of life was significantly improved in the TE group after 8 weeks of treatment (P < 0.05), but not in placebo group. A significant improvement in total symptom scores, combining sneezing, rhinorrhea and nasal obstruction, was observed after oral administration of TE for 8 weeks (P < 0.01). The safety of TE treatment was confirmed by laboratory tests and inspection of general conditions. CONCLUSIONS: TE can be expected to safely improve the nasal symptoms of PAR.", "Effect of tart cherry juice (Prunus cerasus) on melatonin levels and enhanced sleep quality. BACKGROUND: Tart Montmorency cherries have been reported to contain high levels of phytochemicals including melatonin, a molecule critical in regulating the sleep-wake cycle in humans. PURPOSE: The aim of our investigation was to ascertain whether ingestion of a tart cherry juice concentrate would increase the urinary melatonin levels in healthy adults and improve sleep quality. METHODS: In a randomised, double-blind, placebo-controlled, crossover design, 20 volunteers consumed either a placebo or tart cherry juice concentrate for 7 days. Measures of sleep quality recorded by actigraphy and subjective sleep questionnaires were completed. Sequential urine samples over 48 h were collected and urinary 6-sulfatoxymelatonin (major metabolite of melatonin) determined; cosinor analysis was used to determine melatonin circadian rhythm (mesor, acrophase and amplitude). In addition, total urinary melatonin content was determined over the sampled period. Trial differences were determined using a repeated measures ANOVA. RESULTS: Total melatonin content was significantly elevated (P < 0.05) in the cherry juice group, whilst no differences were shown between baseline and placebo trials. There were significant increases in time in bed, total sleep time and sleep efficiency total (P < 0.05) with cherry juice supplementation. Although there was no difference in timing of the melatonin circardian rhythm, there was a trend to a higher mesor and amplitude. CONCLUSIONS: These data suggest that consumption of a tart cherry juice concentrate provides an increase in exogenous melatonin that is beneficial in improving sleep duration and quality in healthy men and women and might be of benefit in managing disturbed sleep.", "Lipotoxicity: Effects of Dietary Saturated and Transfatty Acids The ingestion of excessive amounts of saturated fatty acids (SFAs) and transfatty acids (TFAs) is considered to be a risk factor for cardiovascular diseases, insulin resistance, dyslipidemia, and obesity. The focus of this paper was to elucidate the influence of dietary SFA and TFA intake on the promotion of lipotoxicity to the liver and cardiovascular, endothelial, and gut microbiota systems, as well as on insulin resistance and endoplasmic reticulum stress. The saturated and transfatty acids favor a proinflammatory state leading to insulin resistance. These fatty acids can be involved in several inflammatory pathways, contributing to disease progression in chronic inflammation, autoimmunity, allergy, cancer, atherosclerosis, hypertension, and heart hypertrophy as well as other metabolic and degenerative diseases. As a consequence, lipotoxicity may occur in several target organs by direct effects, represented by inflammation pathways, and through indirect effects, including an important alteration in the gut microbiota associated with endotoxemia. Interactions between these pathways may perpetuate a feedback process that exacerbates an inflammatory state. The importance of lifestyle modification, including an improved diet, is recommended as a strategy for treatment of these diseases.", "Smoking and lung cancer risk in American and Japanese men: an international case-control study. Rates of lung cancer in American men have greatly exceeded those in Japanese men for several decades despite the higher smoking prevalence in Japanese men. It is not known whether the relative risk of lung cancer associated with cigarette smoking is lower in Japanese men than American men and whether these risks vary by the amount and duration of smoking. To estimate smoking-specific relative risks for lung cancer in men, a multicentric case-control study was carried out in New York City, Washington, DC, and Nagoya, Japan from 1992 to 1998. A total of 371 cases and 373 age-matched controls were interviewed in United States hospitals and 410 cases and 252 hospital controls in Japanese hospitals; 411 Japanese age-matched healthy controls were also randomly selected from electoral rolls. The odds ratio (OR) for lung cancer in current United States smokers relative to nonsmokers was 40.4 [95% confidence interval (CI) = 21.8-79.6], which was >10 times higher than the OR of 3.5 for current smokers in Japanese relative to hospital controls (95% CI = 1.6-7.5) and six times higher than in Japanese relative to community controls (OR = 6.3; 95% CI = 3.7-10.9). There were no substantial differences in the mean number of years of smoking or average daily number of cigarettes smoked between United States and Japanese cases or between United States and Japanese controls, but American cases began smoking on average 2.5 years earlier than Japanese cases. The risk of lung cancer associated with cigarette smoking was substantially higher in United States than in Japanese males, consistent with population-based statistics on smoking prevalence and lung cancer incidence. Possible explanations for this difference in risk include a more toxic cigarette formulation of American manufactured cigarettes as evidenced by higher concentrations of tobacco-specific nitrosamines in both tobacco and mainstream smoke, the much wider use of activated charcoal in the filters of Japanese than in American cigarettes, as well as documented differences in genetic susceptibility and lifestyle factors other than smoking.", "Fish consumption during child bearing age: a quantitative risk-benefit analysis on neurodevelopment. The fish ingredient N3-docosahexaenoic acid 22:6 n-3 (DHA) stimulates brain development. On the other hand methylmercury (MeHg) in fish disturbs the developing central nervous system. In this Context the IQ score in children is considered as an aggregate measure of in utero brain development. To determine the effect of DHA exposure on prenatal neurodevelopment the maternal DHA intake during pregnancy was compared with its epidemiologically observed effect on the IQ score of children. For MeHg the maternal intake was converted into its accumulation in the maternal body. The maternal body burden then was compared with its epidemiologically observed relationship with the IQ score. Taking the MeHg and DHA content of 33 fish species the net effect of these compounds on the IQ score was quantified. For most fish species the adverse effect of MeHg on the IQ score exceeded the beneficial effect of DHA. In the case of long-living predators a negative effect up to 10 points on the IQ score was found. The results of this study indicate that food interventions aiming at the beneficial effects of fish consumption should focus on fish species with a high DHA content, while avoiding fish species with a high MeHg content. Copyright \u00a9 2011 Elsevier Ltd. All rights reserved.", "Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study Objective To determine the comparative effectiveness of exercise versus drug interventions on mortality outcomes. Design Metaepidemiological study. Eligibility criteria Meta-analyses of randomised controlled trials with mortality outcomes comparing the effectiveness of exercise and drug interventions with each other or with control (placebo or usual care). Data sources Medline and Cochrane Database of Systematic Reviews, May 2013. Main outcome measure Mortality. Data synthesis We combined study level death outcomes from exercise and drug trials using random effects network meta-analysis. Results We included 16 (four exercise and 12 drug) meta-analyses. Incorporating an additional three recent exercise trials, our review collectively included 305 randomised controlled trials with 339\u2009274 participants. Across all four conditions with evidence on the effectiveness of exercise on mortality outcomes (secondary prevention of coronary heart disease, rehabilitation of stroke, treatment of heart failure, prevention of diabetes), 14\u2009716 participants were randomised to physical activity interventions in 57 trials. No statistically detectable differences were evident between exercise and drug interventions in the secondary prevention of coronary heart disease and prediabetes. Physical activity interventions were more effective than drug treatment among patients with stroke (odds ratios, exercise v anticoagulants 0.09, 95% credible intervals 0.01 to 0.70 and exercise v antiplatelets 0.10, 0.01 to 0.62). Diuretics were more effective than exercise in heart failure (exercise v diuretics 4.11, 1.17 to 24.76). Inconsistency between direct and indirect comparisons was not significant. Conclusions Although limited in quantity, existing randomised trial evidence on exercise interventions suggests that exercise and many drug interventions are often potentially similar in terms of their mortality benefits in the secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart failure, and prevention of diabetes."]}, {"query": "PhIP: The Three Strikes Breast Carcinogen", "pos": ["The cooked meat-derived mammary carcinogen 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine promotes invasive behaviour of breast cancer cells. The cooked meat derived genotoxic carcinogen 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) induces cancer of the colon, prostate and mammary gland when fed to rats. Epidemiology studies link these tumours to a Western diet and exposure to heterocyclic amines such as PhIP. We have shown that PhIP is also potently estrogenic and have proposed that this hormonal activity contributes to its target site carcinogenicity. We now postulate that the estrogenic properties of PhIP influence metastatic potential. We have used an in vitro assay for cell invasion based upon digestion and migration through a reconstituted basement membrane model. Zymography and immunoblotting were used to confirm PhIP-mediated changes associated with induction of the invasive phenotype. Treatment of the mammary cancer cell lines MCF-7 and T47D with PhIP induces cells to digest and migrate through a reconstituted basement membrane. The response was dose dependent, observed at sub-nanomolar concentrations of PhIP and was inhibited by the antiestrogen ICI 182,780. The PhIP-induced invasive phenotype was associated with expression of cathepsin D, cyclooxygenase-2 and matrix metalloproteinase activity. These findings emphasise the range and potency of the biological activities associated with this cooked meat product and mechanistically support the tissue-specific carcinogenicity of the chemical. Copyright \u00a9 2010 Elsevier Ireland Ltd. All rights reserved.", "Meat, fat and risk of breast cancer: a case-control study from Uruguay. To examine whether meat intake modifies breast-cancer risk, a case-control study was conducted in Uruguay. Dietary patterns were assessed in detail (for cases, before diagnosis or symptoms occurred) using a food frequency questionnaire involving 64 food items, which allowed total energy intake to be calculated. Nutrient residuals were calculated through regression analysis. After adjustment for potential confounders (which included family history of breast cancer, menopausal status, body-mass index, total energy and total alcohol intake), an increased risk associated with consumption of total meat intake, red meat intake, total fat and saturated fat intake was observed. The strongest effect was observed for red meat intake (OR 4.2, 95% CL 2.3-7.7) for consumption in the upper quartile, after controlling for protein and fat intake. This suggests an independent effect for meat. Since experimental studies have shown a strong effect of heterocyclic amines in rat mammary carcinogenesis, further studies should be performed in human epidemiology, perhaps using biomarkers of heterocyclic amine exposure.", "Intake of fried meat and risk of cancer: a follow-up study in Finland. It has been suggested that mutagens in fried meat may be involved in the cancer process. Therefore the relationships between intake of fried meat and subsequent risk of cancers at different sites were studied among 9,990 Finnish men and women, 15-99 years of age and initially free of cancer. The baseline study was carried out in 1966-1972, and cases of cancer were identified through data linkage with the Finnish Cancer Registry. During a 24-year follow-up, 853 cancer cases were diagnosed. The intake of fried meat was estimated from a dietary history interview covering the total diet of the participants during the previous year. There was a positive association between fried meat intake and the risk of female-hormone-related cancers, i.e., cancer of the breast, endometrium and ovary combined. The relative risk of these cancers combined between persons in the highest and lowest tertiles of daily intake of fried meat adjusted for age, personal characteristics and intake of other main food groups was 1.77 (95% confidence interval = 1.11-2.84). Pancreatic and nervous system cancers also presented non-significant suggestive associations. No associations were observed with respect to other single cancer sites studied or to all sites of cancer combined. Further epidemiological efforts are needed to ascertain the potential link between fried-food mutagens and cancer risk.", "Dietary intake of meat and meat-derived heterocyclic aromatic amines and their correlation with DNA adducts in female breast tissue. It was the aim of this study to examine the association of the consumption of meat in general, meat prepared by different cooking methods and the dietary intake of heterocyclic aromatic amines (HCA) with the level of DNA adducts in the breast tissue of women undergoing reduction mammoplasty. Dietary intake of meat and HCA were assessed via questionnaire in 44 women undergoing reduction mammoplasty. DNA adduct analysis in breast tissue was performed by (32)P-postlabelling analysis. Spearman rank correlation coefficients (r) were calculated to examine the association of meat consumption and dietary HCA intake with tissue DNA adduct levels. A median DNA adduct level of 18.45 (interquartile range 12.81-25.65) per 10(9) nucleotides in breast tissue was observed; median HCA intake was 40.43 ng/day (interquartile range 19.55-102.33 ng/day). Total HCA intake (r = 0.33, P = 0.03), consumption of fried meat (r = 0.39, P = 0.01), beef (r = 0.32, P = 0.03) and processed meat (r = 0.51, P = 0.0004) were statistically significantly correlated with the level of DNA adducts in breast tissue. The detected DNA adducts could not be confirmed to be specific HCA-derived DNA adducts by comparison with external standards, using the (32)P-postlabelling assay. We observed strong correlations of dietary HCA intake and consumption of fried and processed meat with DNA adduct levels in breast tissue of 44 women. Since the detected DNA adducts were not necessarily specific only for HCA, it is possible that HCA intake is a surrogate of other genotoxic substances, such as polycyclic aromatic hydrocarbons, in meat prepared at high temperatures.", "Cooked meat and risk of breast cancer--lifetime versus recent dietary intake. BACKGROUND: Polycyclic aromatic hydrocarbons (PAHs) and heterocyclic amines (HCAs) are carcinogens formed in or on the surface of well-done meat, cooked at high temperature. METHODS: We estimated breast cancer risk in relation to intake of cooked meat in a population-based, case-control study (1508 cases and 1556 controls) conducted in Long Island, NY from 1996 to 1997. Lifetime intakes of grilled or barbecued and smoked meats were derived from the interviewer-administered questionnaire data. Dietary intakes of PAH and HCA were derived from the self-administered modified Block food frequency questionnaire of intake 1 year before reference date. Unconditional logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Modest increased risk was observed among postmenopausal, but not premenopausal, women consuming the most grilled or barbecued and smoked meats over the life course (OR = 1.47; CI = 1.12-1.92 for highest vs. lowest tertile of intake). Postmenopausal women with low fruit and vegetable intake, but high lifetime intake of grilled or barbecued and smoked meats, had a higher OR of 1.74 (CI = 1.20-2.50). No associations were observed with the food frequency questionnaire-derived intake measures of PAHs and HCAs, with the possible exception of benzo(alpha)pyrene from meat among postmenopausal women whose tumors were positive for both estrogen receptors and progesterone receptors (OR = 1.47; CI = 0.99-2.19). CONCLUSIONS: These results support the accumulating evidence that consumption of meats cooked by methods that promote carcinogen formation may increase risk of postmenopausal breast cancer.", "Formation of a mutagenic heterocyclic aromatic amine from creatinine in urine of meat eaters and vegetarians. Liquid chromatography electrospray ionization mass spectrometry (MS) with a triple quadrupole MS was used to identify known and novel heterocyclic aromatic amines (HAAs) in human urine. The identities of 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (8-MeIQx) and 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) were confirmed by their product ion spectra. The constant neutral loss scan mode was employed to probe for other analytes in urine that display the transition [M+H]+-->[M+H-CH3*]+*, which is common to HAAs containing an N-methylimidazo moiety, and led to the detection of a previously unreported isomer of 8-MeIQx [Holland, R., et al. (2004) Chem. Res. Toxicol. 17, 1121-1136]. We now report the identification of another novel HAA, 2-amino-1-methylimidazo[4,5-b]quinoline (IQ[4,5-b]), an isomer of the powerful animal carcinogen 2-amino-3-methylimidazo[4,5-f]quinoline (IQ). The amounts of IQ[4,5-b] measured in the urine of human volunteers who consumed grilled beef ranged from 15 to 135% of the ingested dose, while the amounts of 8-MeIQx and PhIP excreted in urine were on average <2% of the ingested dose. Base treatment of urine at 70 degrees C increased the concentrations of 8-MeIQx and PhIP by as much as 6-fold, indicating the presence of phase II conjugates; however, the amount of IQ[4,5-b] increased by more than 100-fold. IQ[4,5-b] was also detected in the urine of vegetarians following base hydrolysis. The formation of IQ[4,5-b], but not IQ, 8-MeIQx, or PhIP, also occurred in urine incubated at 37 degrees C. Creatinine and 2-aminobenzaldehyde are likely precursors of IQ[4,5-b]. The detection of IQ[4,5-b] in the urine of both meat eaters and vegetarians suggests that this HAA may be present in nonmeat staples or that IQ[4,5-b] formation may occur endogenously within the urinary bladder or other biological fluids.", "Well-done meat intake and the risk of breast cancer. BACKGROUND: Heterocyclic amines, mutagens formed in meats cooked at high temperatures, have been demonstrated as mammary carcinogens in animals. We conducted a nested, case-control study among 41836 cohort members of the Iowa Women's Health Study to evaluate the potential role of heterocyclic amines and intake of well-done meat in the risk for human breast cancer. METHODS: A questionnaire was mailed to individuals in the cohort who had breast cancer diagnosed during the period from 1992 through 1994 and a random sample of cancer-free cohort members to obtain information on usual intake of meats and on meat preparation practices. Color photographs showing various doneness levels of hamburger, beefsteak, and bacon were included. Multivariate analysis was performed on data from 273 case subjects and 657 control subjects who completed the survey. RESULTS: A dose-response relationship was found between doneness levels of meat consumed and breast cancer risk. The adjusted odds ratios (ORs) for very well-done meat versus rare or medium-done meat were 1.54 (95% confidence interval [CI]=0.96-2.47) for hamburger, 2.21 (95% CI=1.30-3.77) for beef steak, and 1.64 (95% CI=0.92-2.93) for bacon. Women who consumed these three meats consistently very well done had a 4.62 times higher risk (95% CI=1.36-15.70) than that of women who consumed the meats rare or medium done. Risk of breast cancer was also elevated with increasing intake of well-done to very well-done meat. CONCLUSIONS: Consumption of well-done meats and, thus, exposures to heterocyclic amines (or other compounds) formed during high-temperature cooking may play an important role in the risk of breast cancer.", "Biomonitoring of Carcinogenic Heterocyclic Aromatic Amines in Hair: A Validation Study A facile method was established to measure heterocyclic aromatic amines (HAAs) accumulated in human hair and rodent fur. The samples were digested by base hydrolysis, and the liberated HAAs were isolated by tandem solvent/solid-phase extraction. Quantification was done by liquid chromatography/tandem mass spectrometry, using a triple stage quadrupole mass spectrometer in the selected reaction monitoring mode. In a pilot study of 12 human volunteers, 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) was detected in hair of six meat-eaters at levels ranging from 290 to 890 pg/g hair. 2-Amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx) and 2-amino-9H-pyrido[2,3-b]indole (A\u03b1C) were below the limit of quantification (LOQ) (50 pg/g hair) in hair from meat-eaters and six vegetarians. PhIP was detected in the hair from one vegetarian, and at level just above the LOQ (65 pg/g hair), indicating PhIP exposure occurs primarily through meat consumption. The levels of PhIP in hair samples from two meat-eaters varied by less than 24% over a 6-month interval, signifying that the exposure to PhIP and its accumulation in hair are relatively constant over time. In a controlled feeding study, female C57BL/6 mice were given these HAAs in their drinking water for 1 month, at six daily dose concentrations ranging from 0, 0.080 to 800 \u00b5g/kg body weight. PhIP was detected in fur of mice at all doses, whereas A\u03b1C and MeIQx were detected in fur at dosages \u22650.8 \u00b5g A\u03b1C/kg body weight and \u22658 \u00b5g MeIQx/kg body weight. There was a strong positive relationship between dosage and each of the HAAs accumulated in fur and their DNA adducts formed in liver and colon (p-values <0.0001); however, the levels of HAA in fur did not correlate to the levels of DNA adducts after adjustment of dose. Thus, hair appears to be a promising long-lived biomarker with by which we can assess the exposure to PhIP, a potential human carcinogen.", "Effect of diet on serum albumin and hemoglobin adducts of 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) in humans. 2-Amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) is the most abundant heterocyclic amine formed in meat and fish during cooking and can be used as a model compound for this class of chemicals possibly involved in human carcinogenesis. Knowing the exposure to heterocyclic amines is important for establishing their role in human diseases. Serum albumin (SA) and globin (Gb) adducts were first tested as biomarkers of exposure to PhIP in male Fischer 344 rats given oral doses of 0.1, 0.5, 1 and 10 mg/kg. Blood samples were collected 24 hr after treatment and PhIP released from SA and Gb after acidic hydrolysis was analyzed by gas chromatography-mass spectrometry or liquid chromatography-tandem mass spectrometry. PhIP-SA and Gb adducts increased linearly with the dose. Studies on 35 volunteers with different dietary habits exhibited that diet was a major determinant in the formation of both adducts. PhIP-SA adducts were significantly higher in meat consumers than in vegetarians (6.7 +/- 1.6 and 0.7 +/- 0.3 fmol/mg SA; respectively, mean +/- SE; p = 0.04, Mann-Whitney U test). The Gb adduct pattern was quantitatively lower but paralleled SA (3 +/- 0.8 in meat consumers and 0.3 +/- 0.1 in vegetarians). PhIP-SA adducts were no different in smokers and in non-smokers. The results show for the first time that PhIP-blood protein adducts are present in humans not given the synthetic compound. Both biomarkers appear to be suitable for assessing dietary exposure and internal PhIP dose and may be promising tools for studying the role of heterocyclic amines in the etiology of colon cancer and other diseases. Copyright 2000 Wiley-Liss, Inc.", "Formation and biochemistry of carcinogenic heterocyclic aromatic amines in cooked meats. Heteroyclic aromatic amines (HAAs) are a class of hazardous chemicals that are receiving heightened attention as a risk factor for human cancer. HAAs arise during the cooking of meats, fish, and poultry, and several HAAs also occur in tobacco smoke condensate and diesel exhaust. Many HAAs are carcinogenic and induce tumors at multiple sites in rodents. A number of epidemiologic studies have reported that frequent consumption of well-done cooked meats containing HAAs can result in elevated risks for colon, prostate, and mammary cancers. Moreover, DNA adducts of HAAs have been detected in human tissues, demonstrating that HAAs induce genetic damage even though the concentrations of these compounds in cooked meats are generally in the low parts-per-billion (ppb) range. With recent improvements in sensitivity of mass spectrometry instrumentation, HAAs, their metabolites, and DNA adducts can be detected at trace amounts in biological fluids and tissues of humans. The incorporation of HAA biomarkers in epidemologic studies will help to clarify the role of these dietary genotoxicants in the etiology of human cancer.", "Detection of PhIP (2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine) in the milk of healthy women. An increased risk of breast cancer has been observed in women who consume \"very well-done\" meats. Heterocyclic amines are mutagenic and carcinogenic pyrolysis products formed during high temperature cooking of meats. In the present study, human milk samples were analyzed for PhIP, one of the most abundant dietary heterocyclic amine. A protocol was developed with a mixed-mode cation exchange sorbent for the extraction of heterocyclic amines from milk. Milk samples were acquired from healthy Canadian women. With LC/MS analysis and the method of isotope dilution for quantification, levels of PhIP were determined in human milk samples. PhIP was detected in 9 of the 11 milk samples, at levels as high as 59 pg/mL (ppt). No PhIP was detected in the milk of the vegetarian donor. Detection of PhIP in milk indicates that ductal mammary epithelial cells are directly exposed to this carcinogen, suggesting that heterocyclic amines are possible human mammary carcinogens.", "The cooked food derived carcinogen 2-amino-1-methyl-6-phenylimidazo[4,5-b] pyridine is a potent oestrogen: a mechanistic basis for its tissue-speci... The cooked meat carcinogen 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) induces tumours of the breast, colon and prostate in rats. Here we show that in addition to its well-established genotoxicity, which can be detected at concentrations >10(-6) M, PhIP is also oestrogenic. In COS-1 cells transiently transfected with an oestrogen-responsive reporter gene, PhIP (10(-10)-10(-6) M) mediated transcription through oestrogen receptor (ER) alpha, but not ER-beta, and inhibition by the pure ER antagonist ICI 182 780 demonstrated a requirement for a functional ER. In contrast, the structurally related food-derived carcinogen 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx) failed to induce reporter gene transcription. Additionally, we show that in a hormonally responsive breast cancer cell line (MCF-7 cells), PhIP induced transcriptional activation using endogenously expressed ER. Examination of the genotoxic potential of PhIP using a model mammalian cell mutation assay (hprt(-) locus) demonstrated that the genetic toxicology of PhIP was readily detectable, but separate, in terms of effective concentration, from its oestrogenic activity. To determine whether the oestrogenicity of PhIP could mediate oestrogen-dependent responses such as cell growth, we examined the growth of hormonally responsive cells (MCF-7 cells). We show that PhIP can stimulate cell proliferation and, again, this was dependent upon a functional ER. Using ligand blotting, we further show that PhIP can stimulate the expression of progesterone receptor (PR-A and PR-B) and c-MYC and activate the MAPK signal transduction pathway. These responses were similar to that produced by oestradiol, in terms of temporal aspects, potency and a requirement for a functional ER. Each of these dose-dependent mitogenic responses occurred at concentrations of PhIP ( approximately 10(-9)-10(-11)M) that are likely to be equivalent to systemic human exposure via consumption of cooked meat. Thus PhIP can induce cellular responses that encompass altered gene expression and mitogenesis. We suggest that the combination of genetic toxicology and oestrogen-like promotion of genomic and cellular events provide a mechanism for the tissue-specific tumorigenicity of this compound.", "Insulin-like growth factor 1 (IGF1), IGF binding protein 3 (IGFBP3), and breast cancer risk: pooled individual data analysis of 17 prospective studies Summary Background Insulin-like growth factor 1 (IGF1) stimulates mitosis and inhibits apoptosis. Some published results have shown an association between circulating IGF1 and breast-cancer risk, but it has been unclear whether this relationship is consistent or whether it is modified by IGF binding protein 3 (IGFBP3), menopausal status, oestrogen receptor status or other factors. The relationship of IGF1 (and IGFBP3) with breast-cancer risk factors is also unclear. The Endogenous Hormones and Breast Cancer Collaborative Group was established to analyse pooled individual data from prospective studies to increase the precision of the estimated associations of endogenous hormones with breast-cancer risk. Methods Individual data on prediagnostic IGF1 and IGFBP3 concentrations were obtained from 17 prospective studies in 12 countries. The associations of IGF1 with risk factors for breast cancer in controls were examined by calculating geometric mean concentrations in categories of these factors. The odds ratios (ORs) with 95% CIs of breast cancer associated with increasing IGF1 concentrations were estimated by conditional logistic regression in 4790 cases and 9428 matched controls, with stratification by study, age at baseline, and date of baseline. All statistical tests were two-sided, and a p value of less than 0\u00b705 was considered significant. Findings IGF1 concentrations, adjusted for age, were positively associated with height and age at first pregnancy, inversely associated with age at menarche and years since menopause, and were higher in moderately overweight women and moderate alcohol consumers than in other women. The OR for breast cancer for women in the highest versus the lowest fifth of IGF1 concentration was 1\u00b728 (95% CI 1\u00b714\u20131\u00b744; p<0\u00b70001). This association was not altered by adjusting for IGFBP3, and did not vary significantly by menopausal status at blood collection. The ORs for a difference in IGF1 concentration between the highest and lowest fifth were 1\u00b738 (95% CI 1\u00b714\u20131\u00b768) for oestrogen-receptor-positive tumours and 0\u00b780 (0\u00b757\u20131\u00b713) for oestrogen-receptor-negative tumours (p for heterogeneity=0\u00b7007). Interpretation Circulating IGF1 is positively associated with breast-cancer risk. The association is not substantially modified by IGFBP3, and does not differ markedly by menopausal status, but seems to be confined to oestrogen-receptor-positive tumours. Funding Cancer Research UK.", "Growth Factors and their receptors in cancer metastases. Metastatic, rather than primary tumours are responsible for ninety percent cancer deaths. Despite significant advances in the understanding of molecular and cellular mechanisms in tumour metastases, there are limitations in preventive treatment of metastatic tumours. Much evidence arising from laboratory and clinical studies suggests that growth factors and their receptors are implicated in cancer metastases development. We review the origin and production of growth factors and their receptors in all stages of cancer metastases including epithelial-mesenchymal transition, cancer cell invasion and migration, survival within the circulation, seeding at distant organs and metastatic tumour angiogenesis. The functions of growth factors and their receptors are also discussed. This review presents the efforts made in understanding this challenge to aid in the development of new treatment strategies for cancer metastases.", "Why do centenarians escape or postpone cancer? The role of IGF-1, inflammation and p53. BACKGROUND: Centenarians are exceptionally long living individuals who escaped the most common age-related diseases. In particular they appear to be effectively protected from cancers. The mechanisms that underlie this protection are quite complex and still largely unclear. AIM: To critically analyse the literature in order to propose a unifying hypothesis that can account for this cancer protection in centenarians. METHODS: Review of the scientific literature regarding three main players in tumourigenesis such as IGF-1, inflammation and p53, and centenarians. RESULTS: Centenarians appear to be characterised by low IGF-1-mediated responses and high levels of anti-inflammatory cytokines such as IL-10 and TGF-beta, a condition that results in protection from cancer. Both inflammation and IGF-1 pathway converge on the tumour suppressor p53. Accordingly, some studies indicate that genetic variants of p53 are associated with human longevity by providing protection from cancer mortality. CONCLUSIONS: The available data let us to hypothesise that among other possible mechanisms, well-preserved p53-mediated responses are likely a key factor contributing to protection from cancer in centenarians.", "Mechanisms of breast cancer bone metastasis. Bone, as well as liver and lung, is one of the most preferential metastatic target sites for cancers including breast, prostate, and lung cancers and the consequences are always devastating. Like other metastasis, breast cancer bone metastasis consists of several steps from the escape of primary site to the colonization in target site. This review focuses on several key steps including: 1. Invasion and escape from primary tumor site. 2. Target migration toward bone. 3. Specific adhesion and arrest in bone. 4. Establishment of metastasis in bone. The factors involved in this process will provide good targets for therapy. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.", "Cancer and aging: from the kinetics of biological parameters to the kinetics of cancer incidence and mortality. Epidemiologic and biological data strongly support the existence of a strict link between cancer and aging. In spite of the relevance of the problem, there were numerous pitfalls in epidemiologic investigation until a few years ago. An apparent decrease of cancer incidence in old age was revealed to be a misconception based on lack of sufficient appreciation for changing population size. But not all problems are solved by using age-specific cancer incidence, as recently stressed by some authors. At very advanced ages a slowing of the rate of increase of age-specific cancer incidence is clearly demonstrated. These findings apparently clash with the majority of biological data and suggest that some mechanism may develop at advanced ages capable of decreasing cancer susceptibility. In this paper, it will be shown that just a slowing-down kinetics is predicted for cancer incidence by using a mathematical model of mortality kinetics recently proposed in the gerontologic field. The slowing of the increasing rate or even a decreasing trend of cancer incidence of an aging population is compatible with a continuously accelerating pace of loss of physiological capacity of the single subjects, as with advancing age there is a selection of individuals with better physiological functions.", "Circulating insulin-like growth factor (IGF) peptides and prostate cancer risk: a systematic review and meta-analysis Insulin-like growth factors (IGF-I, IGF-II) and their binding proteins (IGFBP-1-6) play a key role in cell proliferation, differentiation and apoptosis, suggesting possible involvement in carcinogenesis. Several epidemiological studies show associations of IGFs with prostate cancer. We searched the published literature for all studies relating levels of IGFs or IGFBPs with prostate cancer. We performed random effects meta-analysis to calculate summary odds ratios. The number of studies (prostate cancer cases) included in each meta-analysis were 42 (7,481) IGF-I; 10 (923) IGF-II; 3 (485) IGFBP-1; 5 (577) IGFBP-2; 29 (6,541) IGFBP-3; and 11 (3,545) IGF-1:IGFBP-3 ratio. The pooled odds ratios (95% confidence intervals) per standard deviation increase in peptide, were: IGF-I, OR = 1.21 (1.07, 1.36); IGF-II, OR = 1.17 (0.93, 1.47); IGFBP-1, OR = 1.21 (0.62, 2.33); IGFBP-2, OR = 1.18 (0.90, 1.54); IGFBP-3, OR = 0.88 (0.79, 0.98); IGFI:IGFBP-3 ratio, OR = 1.10 (0.97, 1.24). For all exposures, there was substantial heterogeneity (all I2 > 75%), partly explained by study design: the magnitude of associations was smaller in prospective versus retrospective studies, and for IGFBP-3 the inverse association with prostate cancer risk was seen in retrospective but not prospective studies. There was weak evidence that associations of IGF-I and IGFBP-3 with prostate cancer were stronger for advanced disease. Our meta-analysis confirms that raised circulating lGF-I is positively associated with prostate cancer risk. Associations between IGFBP-3 and prostate cancer were inconsistent, and there was little evidence for a role of IGF-II, IGFBP-1 or IGFBP-2 in prostate cancer risk.", "High Fat Intake Leads to Acute Postprandial Exposure to Circulating Endotoxin in Type 2 Diabetic Subjects OBJECTIVE To evaluate the changes in circulating endotoxin after a high\u2013saturated fat meal to determine whether these effects depend on metabolic disease state. RESEARCH DESIGN AND METHODS Subjects (n = 54) were given a high-fat meal (75 g fat, 5 g carbohydrate, 6 g protein) after an overnight fast (nonobese control [NOC]: age 39.9 \u00b1 11.8 years [mean \u00b1 SD], BMI 24.9 \u00b1 3.2 kg/m2, n = 9; obese: age 43.8 \u00b1 9.5 years, BMI 33.3 \u00b1 2.5 kg/m2, n = 15; impaired glucose tolerance [IGT]: age 41.7 \u00b1 11.3 years, BMI 32.0 \u00b1 4.5 kg/m2, n = 12; type 2 diabetic: age 45.4 \u00b1 10.1 years, BMI 30.3 \u00b1 4.5 kg/m2, n = 18). Blood was collected before (0 h) and after the meal (1\u20134 h) for analysis. RESULTS Baseline endotoxin was significantly higher in the type 2 diabetic and IGT subjects than in NOC subjects, with baseline circulating endotoxin levels 60.6% higher in type 2 diabetic subjects than in NOC subjects (P < 0.05). Ingestion of a high-fat meal led to a significant rise in endotoxin levels in type 2 diabetic, IGT, and obese subjects over the 4-h time period (P < 0.05). These findings also showed that, at 4 h after a meal, type 2 diabetic subjects had higher circulating endotoxin levels (125.4%\u2191) than NOC subjects (P < 0.05). CONCLUSIONS These studies have highlighted that exposure to a high-fat meal elevates circulating endotoxin irrespective of metabolic state, as early as 1 h after a meal. However, this increase is substantial in IGT and type 2 diabetic subjects, suggesting that metabolic endotoxinemia is exacerbated after high fat intake. In conclusion, our data suggest that, in a compromised metabolic state such as type 2 diabetes, a continual snacking routine will cumulatively promote their condition more rapidly than in other individuals because of the greater exposure to endotoxin.", "The capacity of foodstuffs to induce innate immune activation of human monocytes in vitro is dependent on food content of stimulants of Toll-like r... The ingestion of fatty meals is associated with a transient, low-grade systemic inflammatory response in human subjects, involving the activation of circulating monocytes and the secretion of pro-inflammatory cytokines. However, it is not yet clear how different foodstuffs may promote inflammatory signalling. In a screen of forty filter-sterilised soluble extracts from common foodstuffs, seven were found to induce the secretion of TNF-\u03b1 and IL-6 from human monocytes in vitro. To investigate what may differentiate inflammatory from non-inflammatory food extracts, stimulants of Toll-like receptor (TLR) 2 and TLR4 were quantified using human embryonic kidney-293 cells transfected with each TLR, and calibrated with defined bacterial lipopeptide (BLP) and lipopolysaccharide (LPS) standards. These assays revealed that while most foods contained undetectable levels of TLR2 or TLR4 stimulants, all TNF-\u03b1-inducing foods contained stimulants of either TLR2 (up to 1100\u00a0ng BLP-equivalent/g) or TLR4 (up to 2700\u00a0ng LPS-equivalent/g) in both the soluble and insoluble fractions. TLR stimulants were present mainly in meat products and processed foods, but were minimal or undetectable in fresh fruit and vegetables. The capacity of food extracts to induce TNF-\u03b1 secretion in monocytes correlated with the content of both TLR2 (r 0\u00b7837) and TLR4 stimulants (r 0\u00b7748), and was completely abolished by specific inhibition of TLR2 and TLR4. LPS and BLP were found to be highly resistant to typical cooking times and temperatures, low pH and protease treatment. In conclusion, apparently unspoiled foodstuffs can contain large quantities of stimulants of TLR2 and TLR4, both of which may regulate their capacity to stimulate inflammatory signalling.", "Antitumour effects of Phyllanthus emblica L.: induction of cancer cell apoptosis and inhibition of in vivo tumour promotion and in vitro invasion o... Phyllanthus emblica Linn. (PE) is a medicinal fruit used in many Asian traditional medicine systems for the treatment of various diseases including cancer. The present study tested the potential anticancer effects of aqueous extract of PE in four ways: (1) against cancer cell lines, (2) in vitro apoptosis, (3) mouse skin tumourigenesis and (4) in vitro invasiveness. The PE extract at 50-100 microg/mL significantly inhibited cell growth of six human cancer cell lines, A549 (lung), HepG2 (liver), HeLa (cervical), MDA-MB-231 (breast), SK-OV3 (ovarian) and SW620 (colorectal). However, the extract was not toxic against MRC5 (normal lung fibroblast). Apoptosis in HeLa cells was also observed as PE extract caused DNA fragmentation and increased activity of caspase-3/7 and caspase-8, but not caspase-9, and up-regulation of the Fas protein indicating a death receptor-mediated mechanism of apoptosis. Treatment of PE extract on mouse skin resulted in over 50% reduction of tumour numbers and volumes in animals treated with DMBA/TPA. Lastly, 25 and 50 microg/mL of PE extract inhibited invasiveness of MDA-MB-231 cells in the in vitro Matrigel invasion assay. These results suggest P. emblica exhibits anticancer activity against selected cancer cells, and warrants further study as a possible chemopreventive and antiinvasive agent. Copyright 2010 John Wiley & Sons, Ltd."], "neg": ["Walnuts improve semen quality in men consuming a Western-style diet: randomized control dietary intervention trial. We tested the hypothesis that 75 g of whole-shelled walnuts/day added to the Western-style diet of healthy young men would beneficially affect semen quality. A randomized, parallel two-group dietary intervention trial with single-blind masking of outcome assessors was conducted with 117 healthy men, age 21-35 yr old, who routinely consumed a Western-style diet. The primary outcome was improvement in conventional semen parameters and sperm aneuploidy from baseline to 12 wk. Secondary endpoints included blood serum and sperm fatty acid (FA) profiles, sex hormones, and serum folate. The group consuming walnuts (n = 59) experienced improvement in sperm vitality, motility, and morphology, but no change was seen in the group continuing their usual diet but avoiding tree nuts (n = 58). Comparing differences between the groups from baseline, significance was found for vitality (P = 0.003), motility (P = 0.009), and morphology (normal forms; P = 0.04). Serum FA profiles improved in the walnut group with increases in omega-6 (P = 0.0004) and omega-3 (P = 0.0007) but not in the control group. The plant source of omega-3, alpha-linolenic acid (ALA) increased (P = 0.0001). Sperm aneuploidy was inversely correlated with sperm ALA, particularly sex chromosome nullisomy (Spearman correlation, -0.41, P = 0.002). Findings demonstrated that walnuts added to a Western-style diet improved sperm vitality, motility, and morphology.", "Efficacy and tolerability of a low microparticle diet in a double blind, randomized, pilot study in Crohn's disease. BACKGROUND: Ultrafine and fine particles are potent adjuvants in antigen-mediated immune responses, and cause inflammation in susceptible individuals. Following recent findings that microparticles accumulate in the phagocytes of intestinal lymphoid aggregates, this study is the first investigation of whether their reduction in the diet improves the symptoms of Crohn's disease. METHODS: In a double blind study, 20 patients with active corticosteroid-treated ileal or ileo-colonic Crohn's disease randomly received either a low microparticle diet (trial group; n = 10) or a control diet (n = 10) for 4 months. Crohn's disease activity index (CDAI) and corticosteroid requirements were compared. RESULTS: One patient in each group was withdrawn. In the trial group there was a progressive decrease in CDAI from entry (392 +/- 25) to month 4 (145 +/- 47) (P = 0.002 vs control group) and seven patients were in remission (CDAI <150). In contrast, the control group had returned to baseline levels (302 +/- 28 on entry and 295 +/- 25 at month 4), with none in remission. Corticosteroid intake was reduced more in the trial group although this did not reach significance. CONCLUSIONS: A low microparticle diet may be effective in the management of ileal Crohn's disease and could explain the efficacy of elemental diets, which similarly are low in microparticles.", "Compounded bioidentical menopausal hormone therapy. Although improvement in long-term health is no longer an indication for menopausal hormone therapy, evidence supporting fewer adverse events in younger women, combined with its high overall effectiveness, has reinforced its usefulness for short-term treatment of menopausal symptoms. Menopausal therapy has been provided not only by commercially available products but also by compounding, or creation of an individualized preparation in response to a health care provider's prescription to create a medication tailored to the specialized needs of an individual patient. The Women's Health Initiative findings, coupled with an increase in the direct-to-consumer marketing and media promotion of compounded bioidentical hormonal preparations as safe and effective alternatives to conventional menopausal hormone therapy, have led to a recent increase in the popularity of compounded bioidentical hormones as well as an increase in questions about the use of these preparations. Not only is evidence lacking to support superiority claims of compounded bioidentical hormones over conventional menopausal hormone therapy, but these claims also pose the additional risks of variable purity and potency and lack efficacy and safety data. The Committee on Gynecologic Practice of the American College of Obstetricians and Gynecologists and the Practice Committee of the American Society for Reproductive Medicine provide an overview of the major issues of concern surrounding compounded bioidentical menopausal hormone therapy and provide recommendations for patient counseling. Copyright \u00a9 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.", "Benign prostatic hyperplasia in primary care: what you need to know. PURPOSE: We reviewed recent literature and treatment guidelines regarding the prevalence, pathophysiology, and management of BPO related to BPH; and management of lower urinary tract symptoms secondary to BPH. MATERIALS AND METHODS: Published literature and current treatment concepts were reviewed regarding the diagnosis and treatment options for BPO. RESULTS: BPH is a histological diagnosis that can contribute to medical problems, including enlargement of the prostate and BPO. These conditions should be treated only if the symptoms are troublesome, there is considerable risk of progression, and/or cancer is suspected. Very effective medical and surgical options are available to treat BPO and improve patient quality of life. CONCLUSIONS: BPO is highly treatable, but should be managed in close collaboration with the patient. Pharmacological agents and minimally invasive procedures, when appropriate, are generally preferred to more invasive surgery. Patients with mild or moderate symptoms usually can be treated by a primary care physician; more complicated cases should be referred to a urologist for evaluation and management.", "The cooked meat-derived mammary carcinogen 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine promotes invasive behaviour of breast cancer cells. The cooked meat derived genotoxic carcinogen 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) induces cancer of the colon, prostate and mammary gland when fed to rats. Epidemiology studies link these tumours to a Western diet and exposure to heterocyclic amines such as PhIP. We have shown that PhIP is also potently estrogenic and have proposed that this hormonal activity contributes to its target site carcinogenicity. We now postulate that the estrogenic properties of PhIP influence metastatic potential. We have used an in vitro assay for cell invasion based upon digestion and migration through a reconstituted basement membrane model. Zymography and immunoblotting were used to confirm PhIP-mediated changes associated with induction of the invasive phenotype. Treatment of the mammary cancer cell lines MCF-7 and T47D with PhIP induces cells to digest and migrate through a reconstituted basement membrane. The response was dose dependent, observed at sub-nanomolar concentrations of PhIP and was inhibited by the antiestrogen ICI 182,780. The PhIP-induced invasive phenotype was associated with expression of cathepsin D, cyclooxygenase-2 and matrix metalloproteinase activity. These findings emphasise the range and potency of the biological activities associated with this cooked meat product and mechanistically support the tissue-specific carcinogenicity of the chemical. Copyright \u00a9 2010 Elsevier Ireland Ltd. All rights reserved.", "Acute rhinosinusitis in adults. Rhinosinusitis is one of the most common conditions for which patients seek medical care. Subtypes of rhinosinusitis include acute, subacute, recurrent acute, and chronic. Acute rhinosinusitis is further specified as bacterial or viral. Most cases of acute rhinosinusitis are caused by viral infections associated with the common cold. Symptomatic treatment with analgesics, decongestants, and saline nasal irrigation is appropriate in patients who present with nonsevere symptoms (e.g., mild pain, temperature less than 101\u00b0F [38.3\u00b0C]). Narrow-spectrum antibiotics, such as amoxicillin or trimethoprim/sulfamethoxazole, are recommended in patients with symptoms or signs of acute rhinosinusitis that do not improve after seven days, or that worsen at any time. Limited evidence supports the use of intranasal corticosteroids in patients with acute rhinosinusitis. Radiographic imaging is not recommended in the evaluation of uncomplicated acute rhinosinusitis. Computed tomography of the sinuses should not be used for routine evaluation, although it may be used to define anatomic abnormalities and evaluate patients with suspected complications of acute bacterial rhinosinusitis. Rare complications of acute bacterial rhinosinusitis include orbital, intracranial, and bony involvement. If symptoms persist or progress after maximal medical therapy, and if computed tomography shows evidence of sinus disease, referral to an otolaryngologist is warranted.", "Neurobehavioral function and low-level exposure to brominated flame retardants in adolescents: a cross-sectional study Background Animal and in vitro studies demonstrated a neurotoxic potential of brominated flame retardants, a group of chemicals used in many household and commercial products to prevent fire. Although the first reports of detrimental neurobehavioral effects in rodents appeared more than ten years ago, human data are sparse. Methods As a part of a biomonitoring program for environmental health surveillance in Flanders, Belgium, we assessed the neurobehavioral function with the Neurobehavioral Evaluation System (NES-3), and collected blood samples in a group of high school students. Cross-sectional data on 515 adolescents (13.6-17 years of age) was available for the analysis. Multiple regression models accounting for potential confounders were used to investigate the associations between biomarkers of internal exposure to brominated flame retardants [serum levels of polybrominated diphenyl ether (PBDE) congeners 47, 99, 100, 153, 209, hexabromocyclododecane (HBCD), and tetrabromobisphenol A (TBBPA)] and cognitive performance. In addition, we investigated the association between brominated flame retardants and serum levels of FT3, FT4, and TSH. Results A two-fold increase of the sum of serum PBDE\u2019s was associated with a decrease of the number of taps with the preferred-hand in the Finger Tapping test by 5.31 (95% CI: 0.56 to 10.05, p\u2009=\u20090.029). The effects of the individual PBDE congeners on the motor speed were consistent. Serum levels above the level of quantification were associated with an average decrease of FT3 level by 0.18 pg/mL (95% CI: 0.03 to 0.34, p\u2009=\u20090.020) for PBDE-99 and by 0.15 pg/mL (95% CI: 0.004 to 0.29, p\u2009=\u20090.045) for PBDE-100, compared with concentrations below the level of quantification. PBDE-47 level above the level of quantification was associated with an average increase of TSH levels by 10.1% (95% CI: 0.8% to 20.2%, p\u2009=\u20090.033), compared with concentrations below the level of quantification. We did not observe effects of PBDE\u2019s on neurobehavioral domains other than the motor function. HBCD and TBBPA did not show consistent associations with performance in the neurobehavioral tests. Conclusions This study is one of few studies and so far the largest one investigating the neurobehavioral effects of brominated flame retardants in humans. Consistently with experimental animal data, PBDE exposure was associated with changes in the motor function and the serum levels of the thyroid hormones.", "Intakes of meat, fish, poultry, and eggs and risk of prostate cancer progression Background: Processed meat and fish have been shown to be associated with the risk of advanced prostate cancer, but few studies have examined diet after prostate cancer diagnosis and risk of its progression. Objective: We examined the association between postdiagnostic consumption of processed and unprocessed red meat, fish, poultry, and eggs and the risk of prostate cancer recurrence or progression. Design: We conducted a prospective study in 1294 men with prostate cancer, without recurrence or progression as of 2004\u20132005, who were participating in the Cancer of the Prostate Strategic Urologic Research Endeavor and who were followed for an average of 2 y. Results: We observed 127 events (prostate cancer death or metastases, elevated prostate-specific antigen concentration, or secondary treatment) during 2610 person-years. Intakes of processed and unprocessed red meat, fish, total poultry, and skinless poultry were not associated with prostate cancer recurrence or progression. Greater consumption of eggs and poultry with skin was associated with 2-fold increases in risk in a comparison of extreme quantiles: eggs [hazard ratio (HR): 2.02; 95% CI: 1.10, 3.72; P for trend = 0.05] and poultry with skin (HR: 2.26; 95% CI: 1.36, 3.76; P for trend = 0.003). An interaction was observed between prognostic risk at diagnosis and poultry. Men with high prognostic risk and a high poultry intake had a 4-fold increased risk of recurrence or progression compared with men with low/intermediate prognostic risk and a low poultry intake (P for interaction = 0.003). Conclusions: Our results suggest that the postdiagnostic consumption of processed or unprocessed red meat, fish, or skinless poultry is not associated with prostate cancer recurrence or progression, whereas consumption of eggs and poultry with skin may increase the risk."]}], "NQ": [{"query": "where is the arctic circle located on a world map", "pos": ["Arctic Circle The position of the Arctic Circle is not fixed; as of 9 January 2018, it runs 66\u00b033\u203247.0\u2033 north of the Equator.[1] Its latitude depends on the Earth's axial tilt, which fluctuates within a margin of 2\u00b0 over a 40,000-year period, due to tidal forces resulting from the orbit of the Moon.[2] Consequently, the Arctic Circle is currently drifting northwards at a speed of about 15 metres (49 feet) per year."], "neg": ["Parsley, Sage, Rosemary and Thyme (*) designates unordered lists.", "List of Tokyo Ghoul characters Nico (\u30cb\u30b3, Niko)", "House of Borgia It is reported that under Alexander VI's rule the Borgia hosted orgies in the Vatican palace. The \"Banquet of Chestnuts\" is considered one of the most disreputable balls of this kind. Johann Burchard reports that fifty courtesans were in attendance for the entertainment of the banquet guests.[6] It is alleged not only was the Pope present, but also two of his children, Lucrezia and Cesare. Other researchers however, such as Monsignor Peter de Roo (1839\u00e2\u20ac\u201c1926), have rejected the rumors of the \"fifty courtesans\" as being at odds with Alexander VI's essentially decent but much maligned character.[7]", "Police academy Police academies exist in every state and at the federal level. Each state has an agency which certifies police academies and their programs. Most states have minimum physical and academic standards for cadets to achieve before they can enter an academy and graduate. There may be additional or higher standards required for later certification as a police officer. While some states allow open enrollment in police academies, many require cadets to be hired by a police department in order to attend. Departments and/or state certifying agencies may also require individuals to pass background checks, psychological evaluations, polygraph exams, drug screenings and qualify with a firearm and demonstrate driving skills, as conditions of employment/certification.", "Coffeehouse Various legends involving the introduction of coffee to Istanbul at a \"Kiva Han\" in the late-15th century circulate in culinary tradition, but with no documentation.", "Joseph Stalin Stalin's growing influence was reflected in the decision to name various locations after him; in June 1924 the Ukrainian mining town of Yuzovka became Stalino,[299] and in April 1925, Tsaritsyn was renamed Stalingrad on the order of Mikhail Kalinin and Avel Enukidze.[300]\nIn 1926, Stalin published On Questions of Leninism.[301] It was in this book that he introduced the concept of \"Socialism in One Country\", which he claimed was an orthodox Leninist perspective. It nevertheless clashed with established Bolshevik views that socialism could not be established in one country but could only be achieved globally through the process of world revolution.[301] Some scholars have argued that Stalin was, in fact, advancing the world revolution because \"as first servant of the state, [Stalin] was also first servant of world revolution.\"[302]\nIn 1927, there was some argument in the party over the USSR's policy regarding the situation in China. Stalin had called for the Communist Party of China, led by Mao Zedong, to ally itself with Chiang Kai-shek's Kuomintang (KMT) nationalists, viewing a Communist-Kuomintang alliance as the best bulwark against Japanese imperial expansionism in eastern Asia. Instead, the KMT repressed the Communists and a civil war broke out between the two sides.[303]", "Wheat and chessboard problem The series may be expressed using exponents:", "William Howard Taft Taft had been made president of the Lincoln Memorial Commission while still in office; when Democrats proposed removing him for one of their party, he quipped that unlike losing the presidency, such a removal would hurt.  The architect, Henry Bacon, wanted to use Colorado-Yule marble, while southern Democrats urged using Georgia marble. Taft lobbied for the western stone, and the matter was submitted to the Commission of Fine Arts, which supported Taft and Bacon.  The project went forward; Taft would dedicate the Lincoln Memorial as chief justice in 1922.[157] In 1913, Taft was elected to a one-year term as president of the American Bar Association (ABA), a trade group of lawyers. He removed opponents, such as Louis Brandeis and University of Pennsylvania Law School dean William Draper Lewis (a supporter of the Progressive Party) from committees.[158]"]}, {"query": "when did scotland last qualify for world cup", "pos": ["Scotland at the FIFA World Cup Craig Brown guided Scotland to qualification for the 1998 FIFA World Cup, finishing as the best runners-up. Scotland were drawn against holders Brazil in the opening game of the World Cup.[32] John Collins scored from the penalty spot to level the score at 1\u20131, but a Tom Boyd own goal led to a 2\u20131 defeat. Scotland drew their next game 1\u20131 with Norway in Bordeaux,[2] but the final match against Morocco ended in a 3\u20130 defeat.[33] Scotland have not appeared at the World Cup since."], "neg": ["Hiatus hernia Type I: A type I hernia is also known as a sliding hiatal hernia. There is a widening of the muscular hiatal tunnel and circumferential laxity of the phrenoesophageal membrane, allowing a portion of the gastric cardia to herniate upward into the posterior mediastinum. The clinical significance of type I hernias is in their association with reflux disease. Sliding hernias are the most common type, and account for 95% of all hiatal hernias.[8] (C)", "Algiers Point Some of the houses and other structures in Algiers Point predate the American Civil War, but most were built in the period immediately after a catastrophic 1895 fire which destroyed hundreds of structures in the area.[10]", "Social influence There are three processes of attitude change as defined by Harvard psychologist Herbert Kelman in a 1958 paper published in the Journal of Conflict Resolution.[2] The purpose of defining these processes was to help determine the effects of social influence: for example, to separate public conformity (behavior) from private acceptance (personal belief).", "\u00dcr\u00fcmqi \u00dcr\u00fcmqi is served by the \u00dcr\u00fcmqi Diwopu International Airport. It is a hub for China Southern Airlines. \u00dcr\u00fcmqi Diwopu International Airport is the largest airport in Xinjiang.", "Ole Miss Rebels football After serving as an assistant coach on the collegiate level for nine seasons (eight at Miami and one at Texas A&M), Tuberville began creating excitement in his first season in 1995, finishing the campaign with a 6\u00e2\u20ac\u201c5 record and an Egg Bowl victory over Mississippi State.", "Eid al-Adha Years later, Abraham was instructed by God to return from Canaan to build a place of worship adjacent to Hagar's well (the Zamzam Well). Abraham and Ishmael constructed a stone and mortar structure\u00a0\u2013  known as the Kaaba\u00a0\u2013  which was to be the gathering place for all who wished to strengthen their faith in God. As the years passed, Ishmael was blessed with nubuwwah (prophethood) and gave the nomads of the desert his message of submission to God. After many centuries, Mecca became a thriving desert city and a major center for trade, thanks to its reliable water source, the Zamzam Well.", "List of Renaissance composers \"France\" here does not refer to the France of today, but a smaller region of French-speaking people separate from the area controlled by the Duchy of Burgundy. In medieval times, France was the centre of musical development with the Notre Dame school and Ars nova; this was later surpassed by the Burgundian School, but France remained a leading producer of choral music throughout the Renaissance.", "A Mayor of Delft and his Daughter This painting was documented by Hofstede de Groot in 1910, who wrote; \"878. SO-CALLED PORTRAIT OF THE BURGOMASTER OF DELFT AND HIS DAUGHTER. The man sits in the centre, upon the steps in front of his house\u00a0; he holds a sheet of paper. His daughter descends two steps to the left towards the spectator. The man is dressed in black\u00a0; the girl has a blue skirt and a greyish-purple gown. A beggar-woman in red, with a boy, addresses the man from the right. In the distance, to the right, is the tower of the Oude Kerk, at Delft\u00a0; to the left of the man's head is seen a small tower. A stone bridge, bearing the arms of the town, leads over the Oude Delft. To the left, in the window of the house, is a bouquet of flowers in a glass. The house projects slightly in front of the other houses in the street. The foliage of trees covers part of the picture."]}, {"query": "if a piece of music is perceived to have changed key then we say the piece has", "pos": ["Music theory In traditional Western notation, the scale used for a composition is usually indicated by a key signature at the beginning to designate the pitches that make up that scale. As the music progresses, the pitches used may change and introduce a different scale. Music can be transposed from one scale to another for various purposes, often to accommodate the range of a vocalist. Such transposition raises or lowers the overall pitch range, but preserves the intervallic relationships of the original scale. For example, transposition from the key of C major to D major raises all pitches of the scale of C major equally by a whole tone. Since the interval relationships remain unchanged, transposition may be unnoticed by a listener, however other qualities may change noticeably because transposition changes the relationship of the overall pitch range compared to the range of the instruments or voices that perform the music. This often affects the music's overall sound, as well as having technical implications for the performers.[38]"], "neg": ["Aztec Song and poetry were highly regarded; there were presentations and poetry contests at most of the Aztec festivals. There were also dramatic presentations that included players, musicians and acrobats.", "Pure play eBay opened an inspiration shop in New York in 2011.[12]", "The Merry Wives of Windsor Falstaff arrives in Windsor very short on money. He decides, to obtain financial advantage, that he will court two wealthy married women, Mistress Ford and Mistress Page. Falstaff decides to send the women identical love letters and asks his servants \u2013 Pistol and Nym \u2013 to deliver them to the wives. When they refuse, Falstaff sacks them, and, in revenge, the men tell Ford and Page (the husbands) of Falstaff's intentions. Page is not concerned, but the jealous Ford persuades the Host of the Garter Inn to introduce him to Falstaff as a 'Master Brook' so that he can find out Falstaff's plans.", "Ontario The province is named after Lake Ontario, a term thought to be derived from Ontar\u00c3\u00ad:io, a Huron (Wyandot) word meaning \"great lake\",[13] or possibly skanadario, which means \"beautiful water\" in the Iroquoian languages.[14] Ontario has about 250,000 freshwater lakes.[15]", "Konstantin Stanislavski Konstantin Sergeievich Stanislavski (n\u00e9 Alexeiev; Russian: \u041a\u043e\u043d\u0441\u0442\u0430\u043d\u0442\u0438\u0301\u043d \u0421\u0435\u0440\u0433\u0435\u0301\u0435\u0432\u0438\u0447 \u0421\u0442\u0430\u043d\u0438\u0441\u043b\u0430\u0301\u0432\u0441\u043a\u0438\u0439; 17 January\u00a0[O.S. 5 January]\u00a01863\u00a0\u2013 7 August 1938) was a seminal Russian theatre practitioner.[2] He was widely recognised as an outstanding character actor and the many productions that he directed garnered a reputation as one of the leading theatre directors of his generation.[3] His principal fame and influence, however, rests on his 'system' of actor training, preparation, and rehearsal technique.[4] Calling him \"the first great creator of a method of acting in the theatre,\" Jerzy Grotowski praised Stanislavski for \"asking all the relevant questions that could be asked about theatrical technique.\"[5] Stanislavski began developing a 'grammar' of acting in 1906; his initial choice to call it his System struck him as too dogmatic, so he wrote it as his 'system' (without the capital letter and in inverted commas) to indicate the provisional nature of the results of his investigations\u2014modern scholarship and the standard edition of Stanislavski's works follow that practice; see Benedetti (1999a, 169), Gauss (1999, 3\u20144), Milling and Ley (2001, 1), and Stanislavski (1938) and (1957).</ref>", "Carrie Underwood In January 2017, Underwood announced that she would be taking some time off at the beginning of the year to spend time with family, and would then, possibly, begin to write for her next album.[251][252] On March 28, 2017, it was announced that Underwood had signed with Universal Music Group's Capitol Records Nashville after being with Arista Nashville for nearly twelve years.[253] Madame Tussauds unveiled a new figure of Underwood when the Nashville location opened in April 2017.[254] Christian singer Matthew West announced he had collaborated with Underwood, who performed background vocals on the song \"Something Greater\" from his album, All In (2017).[255] The Country Music Association announced that Underwood and Brad Paisley would be returning to host the CMA Awards in November, marking their 10th consecutive year as hosts.[256] Underwood again received a nomination in the Female Vocalist category, her twelfth nomination to date.[257] She performed \"Softly and Tenderly\" as part of a tribute to the victims of the Route 91 Harvest Music Festival shooting, and the performance received widespread acclaim.[258]", "United Airlines United merged with Capital Airlines in 1961, which helped United to regain its position as the \"number one airline\" in the U.S. In 1968, United Airlines became a subsidiary of the UAL Corporation. United experienced several periods of labor unrest during the 1970s, and the Airline Deregulation Act of 1978 forced United to scale down its operations to remain profitable.[25]", "Economy of Botswana Botswana is part of the Southern African Customs Union (SACU) with South Africa, Lesotho, Swaziland, and Namibia. The World Bank reports that in 2001 (the most recent year for which World Bank data are available), the SACU had a weighted average common external tariff rate of 3.6 percent. According to the U.S. Department of Commerce, \"there are very few tariff or non-tariff barriers to trade with Botswana, apart from restrictions on licensing for some business operations, which are reserved for [Botswana] companies.\" Based on the revised trade factor methodology, Botswana's trade policy score is unchanged.[19]"]}, {"query": "who is stephanie's mom on the bold and the beautiful", "pos": ["Steffy Forrester Steffy Forrester is a fictional character from the American CBS soap opera The Bold and the Beautiful. Introduced by Bradley Bell, she is currently portrayed by Jacqueline MacInnes Wood. Steffy and her twin sister Phoebe (MacKenzie Mauzy) were born onscreen as the daughters of supercouple Ridge Forrester (Ronn Moss, later Thorsten Kaye) and Taylor Hayes (Hunter Tylo) during the episode airing on September 21, 1999. For the character's first five-year period, she appeared as a minor. In 2005, Steffy was rapidly aged to a teenager, and in 2008 she appeared as an adult when Wood took over the role. Wood portrayed the role continuously until 2013, when she decided to leave her regular capacity with the series; following a series of guest appearances, Wood returned as a series regular in 2015."], "neg": ["Bowsprit The bowsprit of a sailing vessel is a spar extending forward from the vessel's prow. It provides an anchor point for the forestay(s), allowing the fore-mast to be stepped farther forward on the hull.[1]", "Tusk (song) Looking for a title track for the as yet unnamed album, Mick Fleetwood suggested that they take the rehearsal riff that Lindsey Buckingham used for sound-checks. Producers Richard Dashut and Ken Caillat hence created a drum-driven production. In addition to normal drums, Fleetwood Mac also experimented with different found sounds on the song. Fleetwood and Buckingham played lamb chops and a Kleenex box on the track respectively.[1]", "Prussia Under the rule of Frederick III (I) (in office: 1688\u00e2\u20ac\u201c1713), the Brandenburg Prussian territories were de facto reduced to provinces of the monarchy.[43] Frederick William's testament would have divided Brandenburg-Prussia among his sons, but his firstborn son Frederick III (I), with the emperor's backing, succeeded in becoming the sole ruler based on the Treaty of Gera of 1599, which forbade a division of Hohenzollern territories.[47] In 1689, a new central chamber for all Brandenburg-Prussian territories was established, called Geheime Hofkammer (from 1713: Generalfinanzdirektorium).[48] This chamber functioned as a superior agency of the territories' Amtskammer chambers.[48] The General War Commissariat (Generalkriegskommissariat) emerged as a second central agency, superior to the local Kriegskommissariat agencies initially concerned with the administration of the army, but before 1712 transformed into an agency also concerned with general tax and police tasks.[48]", "Mike Webster Webster was the first former NFL player diagnosed with chronic traumatic encephalopathy (CTE).[2] Since his death, he has become a symbol for head injuries in the NFL and the ongoing debate over player safety.[2] His doctors were of the opinion that multiple concussions during his career damaged his frontal lobe, which caused cognitive dysfunction.[3]", "Rogers Centre The video board and the stadium played host to several serial television events, including the series finales for Cheers and Star Trek: The Next Generation, along with live coverage of the funeral of Princess Diana.", "Negotiation Productive negotiation focuses on the underlying interests of the parties rather than their starting positions, approaches negotiation as a shared problem-solving rather than a personalized battle, and insists upon adherence to objective, principled criteria as the basis for agreement.[13]", "Export Exporting has a number of drawbacks:", "Louis de Pointe du Lac Louis accepts his \"family\", taking the \"maternal\" role with Claudia and finding contentment in their townhouse at Rue Royale. Claudia however, matures psychologically but remains in her child form. After decades of being trapped in the form of a small child, she comes to hate both of her \"parents\" for giving her immortality. She rebels against Lestat, poisoning him and setting their home ablaze with Lestat inside in 1860. She escapes with Louis to eastern Europe to look for other vampires. After years of searching and becoming disillusioned, they travel to Paris."]}, {"query": "the fertile crescent is located between what two bodies of water", "pos": ["Fertile Crescent The Fertile Crescent includes Mesopotamia, the land in and around the Tigris and Euphrates rivers; and the Levant, the eastern coast of the Mediterranean Sea. The modern-day countries with significant territory within the Fertile Crescent are Iraq, Syria, Lebanon, Cyprus, Jordan, Israel, Palestine, Egypt, as well as the southeastern fringe of Turkey and the western fringes of Iran.[1][2]"], "neg": ["Only Fools and Horses It has been released on VHS, DVD and audio CD in several guises. A DVD collection containing every episode was issued, along with various other special edition box-sets, such as a tin based on their Reliant Regal. Videos and DVDs of Only Fools and Horses continue to be among the BBC's biggest-selling items, having sold over 6\u00a0million VHS copies and 1\u00a0million DVDs in the UK.[117][118]", "Iran\u2013Iraq relations The last Sumerian dynasty ended after an Elamite invasion in 2004 BC. From this point on, with the growing Akkadian presence in the region, the Sumerian language declined, after more than three thousand years of cultural identity, as the population increasingly adopted Akkadian. Future Babylonian Kings carried the title 'King of Sumer and Akkad', however, for some fourteen centuries to come. The title would also be claimed by Cyrus of Persia in the 6th century BC.", "The Green Hornet (TV series) After reporter Pat Allen is killed in the Daily Sentinel's eighth-floor city room by a leopard, Britt Reid finds a transmitter in a cigarette box. Later, D.A. Scanlon informs Britt of the discovery of a perfect diamond on Allen's desk. Digging around, Reid suspects that the gemologist had been working on producing synthetic diamonds, and the Green Hornet takes an interest in him.", "Federal Duck Stamp Today more than 27,000 students throughout the United States, American Samoa, and the U.S. Virgin Islands submit entries to a state or territory JDS Contest. The program's success is due to partnerships with Federal and State government agencies, nongovernmental organizations, private businesses, and volunteers who have helped to recognize and honor thousands of teachers and students throughout the United States for their participation in conservation related activities.", "The Brief Wondrous Life of Oscar Wao D\u00c3\u00adaz's use of Yunior as the main narrator of the book strengthens the idea of the novel as metafiction. Yunior reminds the reader consistently that he is telling the story, as opposed to the story happening in its own right.", "The Living End At ARIA Music Awards ceremonies they have been nominated 27 times and have won five awards: Highest Selling Single for \"Second Solution / Prisoner of Society\" (1998), Breakthrough Artist \u00e2\u20ac\u201c Album and Best Group for The Living End (1999), Best Rock Album for White Noise (2008), and the same category for The Ending Is Just the Beginning Repeating (2011). Australian musicologist Ian McFarlane described the group which \"emerged as one of the country's premier rock acts. By blending a range of styles (punk, rockabilly and flat out rock) with great success, The Living End has managed to produce anthemic choruses and memorable songs in abundance\". In October 2010 their debut album was listed in the book, 100 Best Australian Albums.", "Moda Center Moda Center has also hosted PBR Built Ford Tough Series bull riding events, has hosted editions of Monday Night Raw, Smackdown, Unforgiven (2004), No Mercy (2008)[68], and UFC 102 in 2009.", "June 24 June 24 is the 175th day of the year (176th in leap years) in the Gregorian calendar. There are 190 days remaining until the end of the year."]}], "QuoraRetrieval": [{"query": "How does one become an actor in the Telugu Film Industry?", "pos": [" How do I become an actor in Telugu film industry?"], "neg": [" What is the story of Moses and Ramesses?", " Does caste system affect economic growth of India?", " Band-aid, spoon and grass. Can you solve a global issue through innovation by combining these random nouns to invent a solution?", " How do I hack into someones Facebook?", " Is going to college really worth it or just a waste of time?", " How do you stop watching porn?", " Are subliminal messages really used in advertising today?", " Why are infantry soldiers not issued with sidearms along with his rifle?"]}, {"query": "Why do some computer programmers develop amazing software or new concepts, while some are stuck with basic programming work?", "pos": [" Why do some computer programmers develops amazing softwares or new concepts, while some are stuck with basics programming works?"], "neg": [" When visiting a friend, do you ever think about what would happen if you did something wildly inappropriate like punch them or destroy their furniture?", " What is the difference between a compliment and flirting?", " What is going to happen to the stock market the next day/month/year after either person is elected President?", " How could you tear a muscle?", " What is your review of FundsIndia?", " Is it true the good guy never gets the girl?", " Is Symbiosis Institute Of Technology a good institute for engineering (CS/IT) ? How is the placements there?", " What is the best way to invest money and get good returns for the retired person?"]}, {"query": "Do you believe in soul-mates and twin flames?", "pos": [" Do you believe in soul-mates?"], "neg": [" Where did you have the best Biryani at Kolkata? Which Biryani was that?", " Is it hard not hate someone who hates you?", " If you could stop every market crash ever to occur in the future would you do it? Why or why not?", " Is it necessary to do a diploma in nautical science before joining IMU?", " Do the French call them \"French fries\"?", " How long do you think it will take to read the whole New Oxford American English dictionary 3rd Edition which is 2096 pages ?", " How can I change my primary email address on Quora?", " Why is the F-35 terribly flawed but the F-22 wasn't?"]}, {"query": "If I save $50,000 per year, how should I use my savings?", "pos": [" If I save 50,000 per year, how should I invest?"], "neg": [" How was your upsc civil services exam interview experience?", " What is stinky tofu in Bahasa?", " What is it like to study Applied Physics at IITs?", " Where is Narendra Modi now?", " Should parents take child care training courses?", " Why do kids brought up in most Indian families carry a heavy sense of entitlement?", " How can you speak faster?", " What are the strongest majors in terms of job prospects and what are the weakest majors at Chicago State?"]}, {"query": "Does meditation help against anxiety?", "pos": [" Does meditation help with anxiety?", " Will meditating regularly really help me with my anxiety?"], "neg": [" How can I delete my Dramafever account?", " Why do you always answer a question with a question? I don't, or do I?", " What is the difference between an atom and a molecule?", " What is the space time continuum in simple words?", " What does \u305d\u308c\u3067\u3082\u307e\u3060 mean in English?", " Can I get a US F1 visa if I am unemployed?", " What is better for a fresher engineer, a government job or a private company job?", " How do you become a go-go dancer?"]}], "SCIDOCS": [{"query": "Designing a Smart Museum: When Cultural Heritage Joins IoT", "pos": ["Usability Dimensions for Mobile Applications-A Review Usability has been increasingly recognized as a significant quality dimension to determine the success of mobile applications. Due to its importance, a number of usability guidelines have been proposed to direct the design of usable applications. The guidelines are intended particularly for desktop and web-based applications. Mobile applications on the other hand are different in many ways from those applications due to the mobility nature of mobile devices. To date, the usability guidelines for mobile applications are very limited. They in fact are isolated, which makes usability evaluation for mobile devices more difficult. This study aims to address this issue by proposing a set of usability dimensions that should be considered for designing and evaluating mobile applications. The dimensions are illustrated as a model that considers four contextual factors: user, environment, technology and task/activity. The model was proposed based on the reviews of previous related studies, which were analyzed by using content analysis approach. Twenty-five dimensions were found from the analysis. The dimensions however were synthesized and prioritized based on their importance towards designing usable mobile applications. As a result, ten most important dimensions were outlined in the model. The model can be used by practitioners and researchers as a guideline to design usable mobile applications and further research can be conducted in the near future.", "SMARTMUSEUM: A mobile recommender system for the Web of Data Semantic and context knowledge have been envisioned as an appropriate solution for addressing the content heterogeneity and information overload in mobile Web information access, but few have explored their full potential in mobile scenarios, where information objects refer to their physical counterparts, and retrieval is context-aware and personalized for users. We present SMARTMUSEUM, a mobile ubiquitous recommender system for the Web of Data, and its application to information needs of tourists in context-aware on-site access to cultural heritage. The SMARTMUSEUM system utilizes Semantic Web languages as the form of data representation. Ontologies are used to bridge the semantic gap between heterogeneous content descriptions, sensor inputs, and user profiles. The system makes use of an information retrieval framework wherein context data and search result clustering are used in recommendation of suitable content for mobile users. Results from laboratory experiments demonstrate that ontology-based reasoning, query expansion, search result clustering, and context knowledge lead to significant improvement in recommendation performance. The results from field trials show that the usability of the system meets users\u2019 expectations in real-world use. The results indicate that semantic content representation and retrieval can significantly improve the performance of mobile recommender systems in knowledge-rich domains.", "A visitor's guide in an active museum: Presentations, communications, and reflection Technology can play a crucial role in supporting museum visitors and enhancing their overall museum visit experiences. Visitors coming to a museum do not want to be overloaded with information, but to receive the relevant information, learn, and have an overall interesting experience. To serve this goal, a user-friendly and flexible system is needed. The design of such a system poses several challenges that need to be addressed in parallel. The user interface should be intuitive and let the visitors focus on the exhibits, not on the technology. Content and delivery must provide relevant information and at the same time allow visitors to get the level of detail and the perspectives in which they are interested. Personalization may play a key role in providing relevant information to individuals. Yet, since visitors tend to visit the museum in small groups, technology should also contribute to and facilitate during-the-visit communication or post-visit group interaction. The PIL project applied at the Hecht museum extended the research results of the PEACH project and tried to address all of these considerations. Evaluation involving users substantiated several aspects of the design.", "Smart cities in Europe Urban performance currently depends not only on the city\u2019s endowment of hard infrastructure (\u2018physical capital\u2019), but also, and increasingly so, on the availability and quality of knowledge communication and social infrastructure (\u2018human and social capital\u2019). The latter form of capital is decisive for urban competitiveness. Against this background, the concept of the \u2018smart city\u2019 has recently been introduced as a strategic device to encompass modern urban production factors in a common framework and, in particular, to highlight the importance of Information and Communication Technologies (ICTs) in the last 20 years for enhancing the competitive profile of a city.", "The Mobile Sensing Platform: An Embedded Activity Recognition System Activity-aware systems have inspired novel user interfaces and new applications in smart environments, surveillance, emergency response, and military missions. Systems that recognize human activities from body-worn sensors can further open the door to a world of healthcare applications, such as fitness monitoring, eldercare support, long-term preventive and chronic care, and cognitive assistance. Wearable systems have the advantage of being with the user continuously. So, for example, a fitness application could use real-time activity information to encourage users to perform opportunistic activities. Furthermore, the general public is more likely to accept such activity recognition systems because they are usually easy to turn off or remove."], "neg": ["Spectral\u2013Spatial Classification of Hyperspectral Imagery Based on Partitional Clustering Techniques A new spectral-spatial classification scheme for hyperspectral images is proposed. The method combines the results of a pixel wise support vector machine classification and the segmentation map obtained by partitional clustering using majority voting. The ISODATA algorithm and Gaussian mixture resolving techniques are used for image clustering. Experimental results are presented for two hyperspectral airborne images. The developed classification scheme improves the classification accuracies and provides classification maps with more homogeneous regions, when compared to pixel wise classification. The proposed method performs particularly well for classification of images with large spatial structures and when different classes have dissimilar spectral responses and a comparable number of pixels.", "Verifiable source code documentation in controlled natural language Writing documentation about software internals is rarely considered a rewarding activity. It is highly time-consuming and the resulting documentation is fragile when the software is continuously evolving in a multi-developer setting. Unfortunately, traditional programming environments poorly support the writing and maintenance of documentation. Consequences are severe as the lack of documentation on software structure negatively impacts the overall quality of the software product. We show that using a controlled natural language with a reasoner and a query engine is a viable technique for verifying the consistency and accuracy of documentation and source code. Using ACE, a state-of-the-art controlled natural language, we present positive results on the comprehensibility and the general feasibility of creating and verifying documentation. As a case study, we used automatic documentation verification to identify and fix severe flaws in the architecture of a non-trivial piece of software. Moreover, a user experiment shows that our language is faster and easier to learn and understand than other formal languages for software documentation.", "Optimizing 360 video delivery over cellular networks As an important component of the virtual reality (VR) technology, 360-degree videos provide users with panoramic view and allow them to freely control their viewing direction during video playback. Usually, a player displays only the visible portion of a 360 video. Thus, fetching the entire raw video frame wastes bandwidth. In this paper, we consider the problem of optimizing 360 video delivery over cellular networks. We first conduct a measurement study on commercial 360 video platforms. We then propose a cellular-friendly streaming scheme that delivers only 360 videos' visible portion based on head movement prediction. Using viewing data collected from real users, we demonstrate the feasibility of our approach, which can reduce bandwidth consumption by up to 80% based on a trace-driven simulation.", "Artificial neural networks in time series forecasting: a comparative analysis Artificial neural networks (ANN) have received a great deal of attention in many fields of engineering and science. Inspired by the study of brain architecture, ANN represent a class of non-linear models capable of learning from data. ANN have been applied in many areas where statistical methods are traditionally employed. They have been used in pattern recognition, classification, prediction and process control. The purpose of this paper is to discuss ANN and compare them to non-linear time series models. We begin exploring recent developments in time series forecasting with particular emphasis on the use of non-linear models. Thereafter we include a review of recent results on the topic of ANN. The relevance of ANN models for the statistical methods is considered using time series prediction problems. Finally we construct asymptotic prediction intervals for ANN and show how to use prediction intervals to choose the number of nodes in the ANN.", "Comparative genomic analysis identifies structural features of CRISPR-Cas systems in Riemerella anatipestifer Riemerella anatipestifer infection is a contagious disease that has resulted in major economic losses in the duck industry worldwide. This study attempted to characterize CRISPR-Cas systems in the disease-causing agent, Riemerella anatipestifer (R. anatipestifer). The CRISPR-Cas system provides adaptive immunity against foreign genetic elements in prokaryotes and CRISPR-cas loci extensively exist in the genomes of archaea and bacteria. However, the structure characteristics of R. anatipestifer CRISPR-Cas systems remains to be elucidated due to the limited availability of genomic data. To identify the structure and components associated with CRISPR-Cas systems in R. anatipestifer, we performed comparative genomic analysis of CRISPR-Cas systems in 25 R. anatipestifer strains using high-throughput sequencing. The results showed that most of the R. anatipestifer strains (20/25) that were analyzed have two CRISPR loci (CRISPR1 and CRISPR2). CRISPR1 was shown to be flanked on one side by cas genes, while CRISPR2 was designated as an orphan. The other analyzed strains harbored only one locus, either CRISPR1 or CRISPR2. The length and content of consensus direct repeat sequences, as well as the length of spacer sequences associated with the two loci, differed from each other. Only three cas genes (cas1, cas2 and cas9) were located upstream of CRISPR1. CRISPR1 was also shown to be flanked by a 107\u00a0bp-long putative leader sequence and a 16\u00a0nt-long anti-repeat sequence. Combined with analysis of spacer organization similarity and phylogenetic tree of the R. anatipestifer strains, CRISPR arrays can be divided into different subgroups. The diversity of spacer organization was observed in the same subgroup. In general, spacer organization in CRISPR1 was more divergent than that in CRISPR2. Additionally, only 8\u00a0% of spacers (13/153) were homologous with phage or plasmid sequences. The cas operon flanking CRISPR1 was observed to be relatively conserved based on multiple sequence alignments of Cas amino acid sequences. The phylogenetic analysis associated with Cas9 showed Cas9 sequence from R. anatipestifer was closely related to that of Bacteroides fragilis and formed part of the subtype II-C subcluster. Our data revealed for the first time the structural features of R. anatipestifer CRISPR-Cas systems. The illumination of structural features of CRISPR-Cas system may assist in studying the specific mechanism associated with CRISPR-mediated adaptive immunity and other biological functions in R. anatipestifer.", "On The Architecture Scheduling Problem Of Industry 4.0 The recently emerged Fourth Industrial Revolution (Industry 4.0) is characterised by the introduction of the new Cyber-Physical System (CPS) concepts and the Internet of Things (IoT) paradigm. These new collaborating computational entities offer a broad range of opportunity to consider with a different perspective. One of the perennial problems of the manufacturing operation is the scheduling problem of typical job-shop manufacturing systems. Starting from a comparison with the typical architecture of an operating systems scheduler module, we introduce a new manufacturing scheduling architecture. Overcoming the typical Full-Hierarchical configuration defined in the ANSI/ISA 95 in favour of a SemiHeterarchical one, the introduced scheduling architecture leads to a mixture of proactive and reactive approach to the Job-shop Scheduling Problem (JSP), taking advantage from both the common decentralised and the centralised methodology. Keywords\u2014 Industry 4.0; Cyber-Physical System (CPS); JobShop Scheduling Problem; Manufacturing System; System of", "ntology matching with semantic verification ves Automated Semantic Matching of Ontologies with Verification (ASMOV) is a novel algorithm that uses lexical and structural characteristics of two ontologies to iteratively calculate a similarity measure between them, derives an alignment, and then verifies it to ensure that it does not contain semantic inconsistencies. In this paper, we describe the ASMOV algorithm, and then present experimental results that measure vailable online xxx eywords: ntology ntology alignment ntology matching its accuracy using the OAEI 2008 tests, and that evaluate its use with two different thesauri: WordNet, and the Unified Medical Language System (UMLS). These results show the increased accuracy obtained by combining lexical, structural and extensional matchers with semantic verification, and demonstrate the advantage of using a domain-specific thesaurus for the alignment of specialized ontologies. \u00a9 2009 Elsevier B.V. All rights reserved.", "iVAT and aVAT: Enhanced Visual Analysis for Cluster Tendency Assessment Given a pairwise dissimilarity matrix D of a set of n objects, visual methods (such as VAT) for cluster tendency assessment generally represent D as an n \u00d7 n image I(D\u0303) where the objects are reordered to reveal hidden cluster structure as dark blocks along the diagonal of the image. A major limitation of such methods is the inability to highlight cluster structure in I(D\u0303) when D contains highly complex clusters. To address this problem, this paper proposes an improved VAT (iVAT) method by combining a path-based distance transform with VAT. In addition, an automated VAT (aVAT) method is also proposed to automatically determine the number of clusters from I(D\u0303). Experimental results on several synthetic and real-world data sets have demonstrated the effectiveness of our methods."]}, {"query": "Eyeriss: a spatial architecture for energy-efficient dataflow for convolutional neural networks", "pos": ["Very Deep Convolutional Networks for Large-Scale Image Recognition In this work we investigate the effect of the convolutional n etwork depth on its accuracy in the large-scale image recognition setting. Our main contribution is a thorough evaluation of networks of increasing depth, which shows that a significant improvement on the prior-art configurations can be achi eved by pushing the depth to 16\u201319 weight layers. These findings were the basis of our ImageNet Challenge 2014 submission, where our team secured the first a nd he second places in the localisation and classification tracks respec tively. We also show that our representations generalise well to other datasets, whe re t y achieve the stateof-the-art results. Importantly, we have made our two bestp rforming ConvNet models publicly available to facilitate further research o n the use of deep visual representations in computer vision.", "Deep Learning with Limited Numerical Precision Training of large-scale deep neural networks is often constrained by the available computational resources. We study the effect of limited precision data representation and computation on neural network training. Within the context of low-precision fixed-point computations, we observe the rounding scheme to play a crucial role in determining the network\u2019s behavior during training. Our results show that deep networks can be trained using only 16-bit wide fixed-point number representation when using stochastic rounding, and incur little to no degradation in the classification accuracy. We also demonstrate an energy-efficient hardware accelerator that implements low-precision fixed-point arithmetic with stochastic rounding.", "Learning Deep Features for Scene Recognition using Places Database [1] L. Fei-Fei, R. Fergus, and P. Perona. Learning generative visual models from few training examples: An incremental bayesian approach tested on 101 object categories. Computer Vision and Image Understanding, 2007. [2] G. Griffin, A. Holub, and P. Perona. Caltech-256 object category dataset. 2007. [3] S. Lazebnik, C. Schmid, and J. Ponce. Beyond bags of features: Spatial pyramid matching for recognizing natural scene categories. In Proc. CVPR, 2006. [4] L.-J. Li and L. Fei-Fei. What, where and who? classifying events by scene and object recognition. In Proc. ICCV, 2007. [5] G. Patterson and J. Hays. Sun attribute database: Discovering, annotating, and recognizing scene attributes. In Proc. CVPR, 2012.", "A 240 G-ops/s Mobile Coprocessor for Deep Neural Networks Deep networks are state-of-the-art models used for understanding the content of images, videos, audio and raw input data. Current computing systems are not able to run deep network models in real-time with low power consumption. In this paper we present nn-X: a scalable, low-power coprocessor for enabling real-time execution of deep neural networks. nn-X is implemented on programmable logic devices and comprises an array of configurable processing elements called collections. These collections perform the most common operations in deep networks: convolution, subsampling and non-linear functions. The nn-X system includes 4 high-speed direct memory access interfaces to DDR3 memory and two ARM Cortex-A9 processors. Each port is capable of a sustained throughput of 950 MB/s in full duplex. nn-X is able to achieve a peak performance of 227 G-ops/s, a measured performance in deep learning applications of up to 200 G-ops/s while consuming less than 4 watts of power. This translates to a performance per power improvement of 10 to 100 times that of conventional mobile and desktop processors.", "Optimizing FPGA-based Accelerator Design for Deep Convolutional Neural Networks Convolutional neural network (CNN) has been widely employed for image recognition because it can achieve high accuracy by emulating behavior of optic nerves in living creatures. Recently, rapid growth of modern applications based on deep learning algorithms has further improved research and implementations. Especially, various accelerators for deep CNN have been proposed based on FPGA platform because it has advantages of high performance, reconfigurability, and fast development round, etc. Although current FPGA accelerators have demonstrated better performance over generic processors, the accelerator design space has not been well exploited. One critical problem is that the computation throughput may not well match the memory bandwidth provided an FPGA platform. Consequently, existing approaches cannot achieve best performance due to under-utilization of either logic resource or memory bandwidth. At the same time, the increasing complexity and scalability of deep learning applications aggravate this problem. In order to overcome this problem, we propose an analytical design scheme using the roofline model. For any solution of a CNN design, we quantitatively analyze its computing throughput and required memory bandwidth using various optimization techniques, such as loop tiling and transformation. Then, with the help of rooine model, we can identify the solution with best performance and lowest FPGA resource requirement. As a case study, we implement a CNN accelerator on a VC707 FPGA board and compare it to previous approaches. Our implementation achieves a peak performance of 61.62 GFLOPS under 100MHz working frequency, which outperform previous approaches significantly."], "neg": ["Differential effects of atomoxetine on executive functioning and lexical decision in attention-deficit/hyperactivity disorder and reading disorder. OBJECTIVE\nThe effects of a promising pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD), atomoxetine, were studied on executive functions in both ADHD and reading disorder (RD) because earlier research demonstrated an overlap in executive functioning deficits in both disorders. In addition, the effects of atomoxetine were explored on lexical decision.\n\n\nMETHODS\nSixteen children with ADHD, 20 children with ADHD + RD, 21 children with RD, and 26 normal controls were enrolled in a randomized placebo-controlled crossover study. Children were measured on visuospatial working memory, inhibition, and lexical decision on the day of randomization and following two 28-day medication periods.\n\n\nRESULTS\nChildren with ADHD + RD showed improved visuospatial working memory performance and, to a lesser extent, improved inhibition following atomoxetine treatment compared to placebo. No differential effects of atomoxetine were found for lexical decision in comparison to placebo. In addition, no effects of atomoxetine were demonstrated in the ADHD and RD groups.\n\n\nCONCLUSION\nAtomoxetine improved visuospatial working memory and to a lesser degree inhibition in children with ADHD + RD, which suggests differential developmental pathways for co-morbid ADHD + RD as compared to ADHD and RD alone.\n\n\nCLINICAL TRIAL REGISTRY\nB4Z-MC-LYCK, NCT00191906; http://clinicaltrials.gov/ct2/show/NCT00191906.", "Photo tourism: exploring photo collections in 3D We present a system for interactively browsing and exploring large unstructured collections of photographs of a scene using a novel 3D interface. Our system consists of an image-based modeling front end that automatically computes the viewpoint of each photograph as well as a sparse 3D model of the scene and image to model correspondences. Our photo explorer uses image-based rendering techniques to smoothly transition between photographs, while also enabling full 3D navigation and exploration of the set of images and world geometry, along with auxiliary information such as overhead maps. Our system also makes it easy to construct photo tours of scenic or historic locations, and to annotate image details, which are automatically transferred to other relevant images. We demonstrate our system on several large personal photo collections as well as images gathered from Internet photo sharing sites.", "Gated convolutional networks based hybrid acoustic models for low resource speech recognition In acoustic modeling for large vocabulary speech recognition, recurrent neural networks (RNN) have shown great abilities to model temporal dependencies. However, the performance of RNN is not prominent in resource limited tasks, even worse than the traditional feedforward neural networks (FNN). Furthermore, training time for RNN is much more than that for FNN. In recent years, some novel models are provided. They use non-recurrent architectures to model long term dependencies. In these architectures, they show that using gate mechanism is an effective method to construct acoustic models. On the other hand, it has been proved that using convolution operation is a good method to learn acoustic features. We hope to take advantages of both these two methods. In this paper we present a gated convolutional approach to low resource speech recognition tasks. The gated convolutional networks use convolutional architectures to learn input features and a gate to control information. Experiments are conducted on the OpenKWS, a series of low resource keyword search evaluations. From the results, the gated convolutional networks relatively decrease the WER about 6% over the baseline LSTM models, 5% over the DNN models and 3% over the BLSTM models. In addition, the new models accelerate the learning speed by more than 1.8 and 3.2 times compared to that of the baseline LSTM and BLSTM models.", "Know Your Body Through Intrinsic Goals The first \"object\" that newborn children play with is their own body. This activity allows them to autonomously form a sensorimotor map of their own body and a repertoire of actions supporting future cognitive and motor development. Here we propose the theoretical hypothesis, operationalized as a computational model, that this acquisition of body knowledge is not guided by random motor-babbling, but rather by autonomously generated goals formed on the basis of intrinsic motivations. Motor exploration leads the agent to discover and form representations of the possible sensory events it can cause with its own actions. When the agent realizes the possibility of improving the competence to re-activate those representations, it is intrinsically motivated to select and pursue them as goals. The model is based on four components: (1) a self-organizing neural network, modulated by competence-based intrinsic motivations, that acquires abstract representations of experienced sensory (touch) changes; (2) a selector that selects the goal to pursue, and the motor resources to train to pursue it, on the basis of competence improvement; (3) an echo-state neural network that controls and learns, through goal-accomplishment and competence, the agent's motor skills; (4) a predictor of the accomplishment of the selected goals generating the competence-based intrinsic motivation signals. The model is tested as the controller of a simulated simple planar robot composed of a torso and two kinematic 3-DoF 2D arms. The robot explores its body covered by touch sensors by moving its arms. The results, which might be used to guide future empirical experiments, show how the system converges to goals and motor skills allowing it to touch the different parts of own body and how the morphology of the body affects the formed goals. The convergence is strongly dependent on competence-based intrinsic motivations affecting not only skill learning and the selection of formed goals, but also the formation of the goal representations themselves.", "A new weight initialization method for sigmoidal feedforward artificial neural networks Initial weight choice has been recognized to be an important aspect of the training methodology for sigmoidal feedforward neural networks. In this paper, a new mechanism for weight initialization is proposed. The mechanism distributes the initial input to output weights in a manner that all weights (including thresholds) leading into a hidden layer are uniformly distributed in a region and the center of the region from which the weights are sampled are such that no region overlaps for two distinct hidden nodes. The proposed method is compared against random weight initialization routines on five function approximation tasks using the Resilient Backpropagation (RPROP) algorithm for training. The proposed method is shown to lead to about twice as fast convergence to a pre-specifled goal for training as compared to any of the random weight initialization methods. Moreover, it is shown that at least for these problems the networks reach a deeper minima of the error functional during training and generalizes better than the networks trained whose weights were initialized by random weight initialization methods.", "Artistic reality: fast brush stroke stylization for augmented reality The goal of augmented reality is to provide the user with a view of the surroundings enriched by virtual objects. Practically all augmented reality systems rely on standard real-time rendering methods for displaying graphical objects. Although such conventional computer graphics algorithms are fast, they often fail to produce sufficiently realistic renderings. Therefore, virtual models can easily be distinguished from the real environment. We have recently proposed a novel approach for generating augmented reality images [4]. Our method is based on the idea of applying stylization techniques for adapting the visual realism of both the camera image and the virtual graphical objects. Since both the camera image and the virtual objects are stylized in a corresponding way, they appear very similar. Here, we present a new method for the stylization of augmented reality images. This approach generates a painterly brush stroke rendering. The resulting stylized augmented reality video frames look similar to paintings created in the pointillism style. We describe the implementation of the camera image filter and the non-photorealistic rendererfor virtual objects. These components have been newly designed or adapted for this purpose. They are fast enough for generating augmented reality images in near real-time (more than 14 frames per second).", "Anisotropic diffusion map based spectral embedding for 3D CAD model retrieval In the product life cycle, design reuse can save cost and improve existing products conveniently in most new product development. To retrieve similar models from big database, most search algorithms convert CAD model into a shape descriptor and compute the similarity two models according to a descriptor metric. This paper proposes a new 3D shape matching approach by matching the coordinates directly. It is based on diffusion maps which integrate the rand walk and graph spectral analysis to extract shape features embedded in low dimensional spaces and then they are used to form coordinations for non-linear alignment of different models. These coordinates could capture multi-scale properties of the 3D geometric features and has shown good robustness to noise. The results also have shown better performance compared to the celebrated Eigenmap approach in the 3D model retrieval.", "Images of Success and the Preference for Luxury This research examines the impact of media depictions of success (or failure) on consumers\u2019 desire for luxury brands. In a pilot study and three additional studies, we demonstrate that reading a story about a similar/successful other, such as a business major from the same university, increases consumers\u2019 expectations about their own future wealth, which in turn increases their desire for luxury brands. However, reading about a dissimilar successful other, such as a biology major, lowers consumers\u2019preferences for luxury brands. Furthermore, we examine the role of ease of imagining oneself in the narrative as a mediator of the relation between direction of comparison, similarity, and brand preference."]}, {"query": "Train longer, generalize better: closing the generalization gap in large batch training of neural networks", "pos": ["Accurate, Large Minibatch SGD: Training ImageNet in 1 Hour Deep learning thrives with large neural networks and large datasets. However, larger networks and larger datasets result in longer training times that impede research and development progress. Distributed synchronous SGD offers a potential solution to this problem by dividing SGD minibatches over a pool of parallel workers. Yet to make this scheme efficient, the per-worker workload must be large, which implies nontrivial growth in the SGD minibatch size. In this paper, we empirically show that on the ImageNet dataset large minibatches cause optimization difficulties, but when these are addressed the trained networks exhibit good generalization. Specifically, we show no loss of accuracy when training with large minibatch sizes up to 8192 images. To achieve this result, we adopt a linear scaling rule for adjusting learning rates as a function of minibatch size and develop a new warmup scheme that overcomes optimization challenges early in training. With these simple techniques, our Caffe2-based system trains ResNet50 with a minibatch size of 8192 on 256 GPUs in one hour, while matching small minibatch accuracy. Using commodity hardware, our implementation achieves \u223c90% scaling efficiency when moving from 8 to 256 GPUs. This system enables us to train visual recognition models on internetscale data with high efficiency.", "RMSProp and equilibrated adaptive learning rates for non-convex optimization Parameter-specific adaptive learning rate methods are computationally efficient ways to reduce the ill-conditioning problems encountered when training large deep networks. Following recent work that strongly suggests that most of the critical points encountered when training such networks are saddle points, we find how considering the presence of negative eigenvalues of the Hessian could help us design better suited adaptive learning rate schemes. We show that the popular Jacobi preconditioner has undesirable behavior in the presence of both positive and negative curvature, and present theoretical and empirical evidence that the socalled equilibration preconditioner is comparatively better suited to non-convex problems. We introduce a novel adaptive learning rate scheme, called ESGD, based on the equilibration preconditioner. Our experiments show that ESGD performs as well or better than RMSProp in terms of convergence speed, always clearly improving over plain stochastic gradient descent.", "Understanding deep learning requires rethinking generalization Despite their massivesize, successful deep artificial neural networkscan exhibit a remarkably small differencebetween training and test performance. Conventional wisdom attributessmall generalization error either to propertiesof themodel family, or to the regularization techniquesused during training. Through extensive systematic experiments, we show how these traditional approaches fail to explain why large neural networks generalize well in practice. Specifically, our experimentsestablish that state-of-the-art convolutional networks for image classification trained with stochastic gradient methods easily fit a random labeling of the training data. This phenomenon is qualitatively unaffected by explicit regularization, and occurs even if we replace the true images by completely unstructured random noise. We corroborate these experimental findings with a theoretical construction showing that simpledepth two neural networksalready haveperfect finitesampleexpressivity assoon as thenumber of parameters exceeds thenumber of datapointsas it usually does in practice. We interpret our experimental findingsby comparison with traditional models.", "Deep Speech 2 : End-to-End Speech Recognition in English and Mandarin We show that an end-to-end deep learning approach can be used to recognize either English or Mandarin Chinese speech\u2014two vastly different languages. Because it replaces entire pipelines of hand-engineered components with neural networks, end-to-end learning allows us to handle a diverse variety of speech including noisy environments, accents and different languages. Key to our approach is our application of HPC techniques, resulting in a 7x speedup over our previous system [26]. Because of this efficiency, experiments that previously took weeks now run in days. This enables us to iterate more quickly to identify superior architectures and algorithms. As a result, in several cases, our system is competitive with the transcription of human workers when benchmarked on standard datasets. Finally, using a technique called Batch Dispatch with GPUs in the data center, we show that our system can be inexpensively deployed in an online setting, delivering low latency when serving users at scale.", "An overview of gradient descent optimization algorithms Gradient descent optimization algorithms, while increasingly popular, are often used as black-box optimizers, as practical explanations of their strengths and weaknesses are hard to come by. This article aims to provide the reader with intuitions with regard to the behaviour of different algorithms that will allow her to put them to use. In the course of this overview, we look at different variants of gradient descent, summarize challenges, introduce the most common optimization algorithms, review architectures in a parallel and distributed setting, and investigate additional strategies for optimizing gradient descent."], "neg": ["Comparative Evaluation of Anomaly Detection Techniques for Sequence Data We present a comparative evaluation of a large number of anomaly detection techniques on a variety of publicly available as well as artificially generated data sets. Many of these are existing techniques while some are slight variants and/or adaptations of traditional anomaly detection techniques to sequence data.", "Decision Support for Handling Mismatches between COTS Products and System Requirements In the process of selecting commercial off-the-shelf (COTS) products, it is inevitable to encounter mismatches between COTS products and system requirements. Mismatches occur when COTS attributes do not exactly match our requirements. Many of these mismatches are resolved after selecting a COTS product in order to improve its fitness with the requirements. This paper proposes a decision support approach that aims at addressing COTS mismatches during and after the selection process. Our approach can be integrated with existing COTS selection methods at two stages: (I) When evaluating COTS candidates: our approach is used to estimate the anticipated fitness of the candidates if their mismatches are resolved. This helps to base our COTS selection decisions on the fitness that the COTS candidates will eventually have if selected. (2) After selecting a COTS product: the approach suggests alternative plans for resolving the most appropriate mismatches using suitable actions, such that the most important risk, technical, and resource constraints are met. A case study from the e-services domain is used to illustrate the method and to discuss its added value", "A Meta-Analysis of Methodologies for Research in Knowledge Management, Organizational Learning and Organizational Memory: Five Years at HICSS The Task Force on Organizational Memory presented a report at the Hawaii International Conference for System Sciences in January 1998. The report included perspectives on knowledge-oriented research, conceptual models for organizational memory, and research methodologies for researchers considering work in organizational memory. This paper builds on the ideas originally presented in the 1998 report by examining research presented at HICSS in the general areas of knowledge management, organizational memory and organizational learning in the five years since the original task force report.", "Concatenate text embeddings for text classification Text embedding has gained a lot of interests in text classification area. This paper investigates the popular neural document embedding method Paragraph Vector as a source of evidence in document ranking. We focus on the effects of combining knowledge-based with knowledge-free document embeddings for text classification task. We concatenate these two representations so that the classification can be done more accurately. The results of our experiments show that this approach achieves better performances on a popular dataset.", "Limits of predictability in human mobility. A range of applications, from predicting the spread of human and electronic viruses to city planning and resource management in mobile communications, depend on our ability to foresee the whereabouts and mobility of individuals, raising a fundamental question: To what degree is human behavior predictable? Here we explore the limits of predictability in human dynamics by studying the mobility patterns of anonymized mobile phone users. By measuring the entropy of each individual's trajectory, we find a 93% potential predictability in user mobility across the whole user base. Despite the significant differences in the travel patterns, we find a remarkable lack of variability in predictability, which is largely independent of the distance users cover on a regular basis.", "Interface engineering of highly efficient perovskite solar cells Advancing perovskite solar cell technologies toward their theoretical power conversion efficiency (PCE) requires delicate control over the carrier dynamics throughout the entire device. By controlling the formation of the perovskite layer and careful choices of other materials, we suppressed carrier recombination in the absorber, facilitated carrier injection into the carrier transport layers, and maintained good carrier extraction at the electrodes. When measured via reverse bias scan, cell PCE is typically boosted to 16.6% on average, with the highest efficiency of ~19.3% in a planar geometry without antireflective coating. The fabrication of our perovskite solar cells was conducted in air and from solution at low temperatures, which should simplify manufacturing of large-area perovskite devices that are inexpensive and perform at high levels.", "Missing Data Estimation in High-Dimensional Datasets: A Swarm Intelligence-Deep Neural Network Approach In this paper, we examine the problem of missing data in high-dimensional datasets by taking into consideration the Missing Completely at Random and Missing at Random mechanisms, as well as the Arbitrary missing pattern. Additionally, this paper employs a methodology based on Deep Learning and Swarm Intelligence algorithms in order to provide reliable estimates for missing data. The deep learning technique is used to extract features from the input data via an unsupervised learning approach by modeling the data distribution based on the input. This deep learning technique is then used as part of the objective function for the swarm intelligence technique in order to estimate the missing data after a supervised fine-tuning phase by minimizing an error function based on the interrelationship and correlation between features in the dataset. The investigated methodology in this paper therefore has longer running times, however, the promising potential outcomes justify the trade-off. Also, basic knowledge of statistics is presumed.", "Development and investigation of efficient artificial bee colony algorithm for numerical function optimization Artificial bee colony algorithm (ABC), which is inspired by the foraging behavior of honey bee swarm, is a biological-inspired optimization. It shows more effective than genetic algorithm (GA), particle swarm optimization (PSO) and ant colony optimization (ACO). However, ABC is good at exploration but poor at exploitation, and its convergence speed is also an issue in some cases. For these insufficiencies, we propose an improved ABC algorithm called I-ABC. In I-ABC, the best-so-far solution, inertia weight and acceleration coefficients are introduced to modify the search process. Inertia weight and acceleration coefficients are defined as functions of the fitness. In addition, to further balance search processes, the modification forms of the employed bees and the onlooker ones are different in the second acceleration coefficient. Experiments show that, for most functions, the I-ABC has a faster convergence speed and ptimization better performances than each of ABC and the gbest-guided ABC (GABC). But I-ABC could not still substantially achieve the best solution for all optimization problems. In a few cases, it could not find better results than ABC or GABC. In order to inherit the bright sides of ABC, GABC and I-ABC, a high-efficiency hybrid ABC algorithm, which is called PS-ABC, is proposed. PS-ABC owns the abilities of prediction and selection. Results show that PS-ABC has a faster convergence speed like I-ABC and better search ability ods f than other relevant meth"]}, {"query": "A Two-Step Method for Clustering Mixed Categroical and Numeric Data", "pos": ["A Density-Based Algorithm for Discovering Clusters in Large Spatial Databases with Noise Spatial Databases Require to detect knowledge from great amount of data Need to handle with arbitrary shape Requirements of Clustering in Data Mining \u2022 Scalability \u2022 Dealing with different types of attributes \u2022 Discovery of Clusters with arbitrary shape \u2022 Minimal requirements for domain knowledge to determine input parameters \u2022 Able to deal with noise and outliers \u2022 Insensitive to the order of input data \u2022 High dimensionality of data \u2022 Interpretability and usability Introduction(cont..)", "A k-mean clustering algorithm for mixed numeric and categorical data Use of traditional k-mean type algorithm is limited to numeric data. This paper presents a clustering algorithm based on k-mean paradigm that works well for data with mixed numeric and categorical features. We propose new cost function and distance measure based on co-occurrence of values. The measures also take into account the significance of an attribute towards the clustering process. We present a modified description of cluster center to overcome the numeric data only limitation of k-mean algorithm and provide a better characterization of clusters. The performance of this algorithm has been studied on real world data sets. Comparisons with other clustering algorithms illustrate the effectiveness of this approach. 2007 Elsevier B.V. All rights reserved.", "Finding Groups in Data: An Introduction to Cluster Analysis Description: The Wiley-Interscience Paperback Series consists of selected books that have been made more accessible to consumers in an effort to increase global appeal and general circulation. With these new unabridged softcover volumes, Wiley hopes to extend the lives of these works by making them available to future generations of statisticians, mathematicians, and scientists. \"Cluster analysis is the increasingly important and practical subject of finding groupings in data. The authors set out to write a book for the user who does not necessarily have an extensive background in mathematics. They succeed very well.\" \u2014Mathematical Reviews \"Finding Groups in Data [is] a clear, readable, and interesting presentation of a small number of clustering methods. In addition, the book introduced some interesting innovations of applied value to clustering literature.\" \u2014Journal of Classification \"This is a very good, easy-to-read, and practical book. It has many nice features and is highly recommended for students and practitioners in various fields of study.\" \u2014Technometrics An introduction to the practical application of cluster analysis, this text presents a selection of methods that together can deal with most applications. These methods are chosen for their robustness, consistency, and general applicability. This book discusses various types of data, including interval-scaled and binary variables as well as similarity data, and explains how these can be transformed prior to clustering.", "Unsupervised Learning with Mixed Numeric and Nominal Data \u00d0This paper presents a Similarity-Based Agglomerative Clustering (SBAC) algorithm that works well for data with mixed numeric and nominal features. A similarity measure, proposed by Goodall for biological taxonomy [15], that gives greater weight to uncommon feature value matches in similarity computations and makes no assumptions of the underlying distributions of the feature values, is adopted to define the similarity measure between pairs of objects. An agglomerative algorithm is employed to construct a dendrogram and a simple distinctness heuristic is used to extract a partition of the data. The performance of SBAC has been studied on real and artificially generated data sets. Results demonstrate the effectiveness of this algorithm in unsupervised discovery tasks. Comparisons with other clustering schemes illustrate the superior performance of this approach. Index Terms\u00d0Agglomerative clustering, conceptual clustering, feature weighting, interpretation, knowledge discovery, mixed numeric and nominal data, similarity measures, 2 aggregation.", "Chameleon: Hierarchical Clustering Using Dynamic Modeling 68 Computer C lustering is a discovery process in data mining. 1 It groups a set of data in a way that maximizes the similarity within clusters and minimizes the similarity between two different clusters. 1,2 These discovered clusters can help explain the characteristics of the underlying data distribution and serve as the foundation for other data mining and analysis techniques. Clustering is useful in characterizing customer groups based on purchasing patterns, categorizing Web documents, 3 grouping genes and proteins that have similar func-tionality, 4 grouping spatial locations prone to earthquakes based on seismological data, and so on. Most existing clustering algorithms find clusters that fit some static model. Although effective in some cases, these algorithms can break down\u2014that is, cluster the data incorrectly\u2014if the user doesn't select appropriate static-model parameters. Or sometimes the model cannot adequately capture the clusters' characteristics. Most of these algorithms break down when the data contains clusters of diverse shapes, densities , and sizes. Existing algorithms use a static model of the clusters and do not use information about the nature of individual clusters as they are merged. Furthermore, one set of schemes (the CURE algorithm and related schemes) ignores the information about the aggregate interconnectivity of items in two clusters. The other set of schemes (the Rock algorithm, group averaging method, and related schemes) ignores information about the closeness of two clusters as defined by the similarity of the closest items across two clusters. (For more information, see the \" Limitations of Traditional Clustering Algorithms \" sidebar.) By only considering either interconnectivity or close-ness, these algorithms can easily select and merge the wrong pair of clusters. For instance, an algorithm that focuses only on the closeness of two clusters will incorrectly merge the clusters in Figure 1a over those in Figure 1b. Similarly, an algorithm that focuses only on interconnectivity will, in Figure 2, incorrectly merge the dark-blue with the red cluster rather than the green one. Here, we assume that the aggregate interconnec-tivity between the items in the dark-blue and red clusters is greater than that of the dark-blue and green clusters. However, the border points of the dark-blue cluster are much closer to those of the green cluster than those of the red cluster. Chameleon is a new agglomerative hierarchical clustering algorithm that overcomes the limitations of existing clustering algorithms. Figure 3 (on page 70) provides an overview of the overall approach \u2026"], "neg": ["An Active Pixel Sensor Fabricated Using CMOS / CCD Process Technology Paul P. K. Lee, Russell C. Gee*, R. Michael Guidash, T-H. Lee, and Eric R. Fossum* Microelectronics Technology Division, Eastman Kodak Company 1669 Lake Avenue, Rochester, New York 14650-2008 Tel: (716) 477-2869, Fax: (716) 477-4947, Internet: ppklee@Kodak.COM *Jet Propulsion Laboratory, California Institute of Technology 4800 Oak Grove Drive, Pasadena, CA 91109 Abstract This paper describes the integration of the active pixel sensor (APS) architecture normally fabricated in conventional complementary metal oxide semiconductor (CMOS) technology with a pinned photodiode (PPD) device using a mixed process technology. This new technology allows mix and match of CMOS and high performance charged coupled device (CCD) modules. The PPD [1] becomes the photoactive element in an XYaddressable area array with each pixel containing active devices for the transfer, readout and reset functions. It is a standard photo-sensitive element, available in a high performance true two-phase CCD technology developed previously for CCD-based image sensors [2]. An n-well 2-\u03bcm CMOS technology was combined with the CCD process to provide the best features from both. A Design of Experiment approach was used with Technology Computer Aided Design (TCAD) tools to develop and optimize the new mixed process technology without sacrificing any CCD performance while minimizing impact to the CMOS device characteristics [3]. By replacing polysilicon photocapacitor or photogate in conventional APS with the pinned photodiode, deficiencies in poor blue response and high dark current are minimized [4].", "An Ontology for Secure Socio-Technical Systems Security is often compromised by exploiting vulnerabilities in the interface between the organization and the information systems that support it. This reveals the necessity of modeling and analyzing information systems together with the organizational setting where they will operate. In this chapter we address this problem by presenting a modeling language tailored to analyze the problem of security at an organizational level. This language proposes a set of concepts founded on the notions of permission, delegation, and trust. The chapter also presents a semantics for these concepts, based on Datalog. A case study from the bank domain is employed to illustrate the proposed language.", "Machine Learning Approach for Intrusion Detection on Cloud Virtual Machines Development of the cloud computing in recent years is increasing rapidly and gained great success, its security issues have got more and more attention. Many challenges in cloud computation increase the threat of data and service availability. There is need of many security services in order to improve cloud security for users as well as providers. In this paper, we propose a Anomaly Intrusion Detection System using machine learning approach for virtual machines on cloud computing. Our proposal is feature selection over events from Virtual Machine Monitor to detect anomaly in parallel to training the system so it will learn new threats and update the model. The experiment has been carried out on NSL-KDD'99 datasets using Na\u00efve Bayes Tree (NB Tree) Classifier and hybrid approach of NB Tree and Random Forest.", "Evaluating operating system vulnerability to memory errors Reliability is of great concern to the scalability of extreme-scale systems. Of particular concern are soft errors in main memory, which are a leading cause of failures on current systems and are predicted to be the leading cause on future systems. While great effort has gone into designing algorithms and applications that can continue to make progress in the presence of these errors without restarting, the most critical software running on a node, the operating system (OS), is currently left relatively unprotected. OS resiliency is of particular importance because, though this software typically represents a small footprint of a compute node's physical memory, recent studies show more memory errors in this region of memory than the remainder of the system. In this paper, we investigate the soft error vulnerability of two operating systems used in current and future high-performance computing systems: Kitten, the lightweight kernel developed at Sandia National Laboratories, and CLE, a high-performance Linux-based operating system developed by Cray. For each of these platforms, we outline major structures and subsystems that are vulnerable to soft errors and describe methods that could be used to reconstruct damaged state. Our results show the Kitten lightweight operating system may be an easier target to harden against memory errors due to its smaller memory footprint, largely deterministic state, and simpler system structure.", "Identifying Opposing Views in Online Discourse Discourse in online media often takes the form of siloed discussions where unpopular views tend to get drowned out by the majority. This is especially true in platforms such as Reddit, where only the most popular opinions get visibility. In this work, we propose that this problem may be solved by building tools that surface opposing views and I advance a means for automatically identifying disagreeing views on Reddit.", "ENHANCEMENT STRATEGIES FOR FRAME-TO-FRAME UAS STEREO VISUAL ODOMETRY Autonomous navigation of indoor unmanned aircraft systems (UAS) requires accurate pose estimations usually obtained from indirect measurements. Navigation based on inertial measurement units (IMU) is known to be affected by high drift rates. The incorporation of cameras provides complementary information due to the different underlying measurement principle. The scale ambiguity problem for monocular cameras is avoided when a light-weight stereo camera setup is used. However, also frame-to-frame stereo visual odometry (VO) approaches are known to accumulate pose estimation errors over time. Several valuable real-time capable techniques for outlier detection and drift reduction in frame-to-frame VO, for example robust relative orientation estimation using random sample consensus (RANSAC) and bundle adjustment, are available. This study addresses the problem of choosing appropriate VO components. We propose a frame-to-frame stereo VO method based on carefully selected components and parameters. This method is evaluated regarding the impact and value of different outlier detection and drift-reduction strategies, for example keyframe selection and sparse bundle adjustment (SBA), using reference benchmark data as well as own real stereo data. The experimental results demonstrate that our VO method is able to estimate quite accurate trajectories. Feature bucketing and keyframe selection are simple but effective strategies which further improve the VO results. Furthermore, introducing the stereo baseline constraint in pose graph optimization (PGO) leads to significant improvements. * Corresponding author", "Computational Models of Reading: A Primer This article brief ly reviews four computational models of reading and the types of empirical findings that they are designed to explain: (1) theDual-Route model of word identification (Coltheart et al., 2001); (2) the SimpleRecurrent Network model of sentence processing (Elman, 1990); (3) the Construction\u2013Integration model of discourse representation (Kintsch, 1988); and (4) the E-Z Reader model of eye-movement control in reading (Reichle et al., 2012). These particular models are reviewed because they provide comprehensive accounts of a large number of empirical findings in each of their respective domains, and because they have advanced our understanding of the cognitive processes involved in reading by motivating new empirical studies. Future models of reading will build upon the success of their predecessors by integrating models from two or more of the aforementioned domains, thereby providing a means to examine the compatibility of their theoretical assumptions and more comprehensive accounts of the cognitive processes involved in reading. The perceptual, cognitive, and motor processes that support skilled reading are numerous, extremely complex, and work together in a highly coordinated manner. For those reasons, any deep understanding of what happens in the mind during reading requires the use of computational models that describe those processes and how they jointly determine both the on-line behavior that is observed during reading (e.g., the patterns of eye movements that readers make) and the products of that behavior (e.g., the mental representations that readers generate to understand the text). As will be discussed in this article, such models provide theoretical frameworks for understanding the mental processes involved in reading, but also advance our understanding by generating novel predictions that can be tested with experiments. In the remainder of this article, I will describe four existing models that have already played important roles in furthering our understanding of the psychology of reading. These models were selected for inclusion in this article because they account for a wide range of empirical phenomena within a broad area of reading research, and because they have motivated a large number of new empirical studies. The models were also selected because they collectively span the range of topics that have traditionally been studied by reading researchers: (1) word identification; (2) sentence processing; (3) the representation of discourse; and (4) how these different processes interact with other cognitive processes (e.g., attention) to determine the patterns of eye movements that are observed during reading. Because one goal of this article is to introduce the models in a way that is accessible to a broad audience, I will describe the models using schematic diagrams rather than their equations; for a more formal description of the models, see either the original articles or Reichle\u2019s review of the models. Word-Identification Models Word-identification models describe how the visual features corresponding to a word on a printed page are used to access that word\u2019s pronunciation and meaning, as well as behavioral deficits that result from impairment of these processes due to developmental delay or brain \u00a9 2015 The Author Language and Linguistics Compass \u00a9 2015 John Wiley & Sons Ltd", "Player Profiling with Fallout 3 In previous research we concluded that a personality profile, based on the Five Factor Model, can be constructed from observations of a player\u2019s behavior in a module that we designed for Neverwinter Nights (Lankveld et al. 2011a). In the present research, we investigate whether we can do the same thing in an actual modern commercial video game, in this case the game Fallout 3. We stored automatic observations on 36 participants who played the introductory stages of Fallout 3. We then correlated these observations with the participants\u2019 personality profiles, expressed by values for five personality traits as measured by the standard NEO-FFI questionnaire. Our analysis shows correlations between all five personality traits and the game observations. These results validate and generalize the results from our previous research (Lankveld et al. 2011a). We may conclude that Fallout 3, and by extension other modern video games, allows players to express their personality, and can therefore be used to create person-"]}, {"query": "Memory-augmented Neural Machine Translation", "pos": ["A Systematic Comparison of Various Statistical Alignment Models We present and compare various methods for computing word alignments using statistical or heuristic models. We consider the five alignment models presented in Brown, Della Pietra, Della Pietra, and Mercer (1993), the hidden Markov alignment model, smoothing techniques, and refinements. These statistical models are compared with two heuristic models based on the Dice coefficient. We present different methods for combining word alignments to perform a symmetrization of directed statistical alignment models. As evaluation criterion, we use the quality of the resulting Viterbi alignment compared to a manually produced reference alignment. We evaluate the models on the German-English Verbmobil task and the French-English Hansards task. We perform a detailed analysis of various design decisions of our statistical alignment system and evaluate these on training corpora of various sizes. An important result is that refined alignment models with a first-order dependence and a fertility model yield significantly better results than simple heuristic models. In the Appendix, we present an efficient training algorithm for the alignment models presented.", "Incorporating Structural Alignment Biases into an Attentional Neural Translation Model Neural encoder-decoder models of machine translation have achieved impressive results, rivalling traditional translation models. However their modelling formulation is overly simplistic, and omits several key inductive biases built into traditional models. In this paper we extend the attentional neural translation model to include structural biases from word based alignment models, including positional bias, Markov conditioning, fertility and agreement over translation directions. We show improvements over a baseline attentional model and standard phrase-based model over several language pairs, evaluating on difficult languages in a low resource setting.", "Neural Turing Machines We extend the capabilities of neural networks by coupling them to external memory resources, which they can interact with by attentional processes. The combined system is analogous to a Turing Machine or Von Neumann architecture but is differentiable end-toend, allowing it to be efficiently trained with gradient descent. Preliminary results demonstrate that Neural Turing Machines can infer simple algorithms such as copying, sorting, and associative recall from input and output examples.", "Deep Neural Networks in Machine Translation: An Overview Deep neural networks (DNNs) are widely used in machine translation (MT). This article gives an overview of DNN applications in various aspects of MT.", "Syntactically Guided Neural Machine Translation We investigate the use of hierarchical phrase-based SMT lattices in end-to-end neural machine translation (NMT). Weight pushing transforms the Hiero scores for complete translation hypotheses, with the full translation grammar score and full ngram language model score, into posteriors compatible with NMT predictive probabilities. With a slightly modified NMT beam-search decoder we find gains over both Hiero and NMT decoding alone, with practical advantages in extending NMT to very large input and output vocabularies."], "neg": ["Flash memory cells-an overview The aim of this paper is to give a thorough overview of Flash memory cells. Basic operations and charge-injection mechanisms that are most commonly used in actual Flash memory cells are reviewed to provide an understanding of the underlying physics and principles in order to appreciate the large number of device structures, processing technologies, and circuit designs presented in the literature. New cell structures and architectural solutions have been surveyed to highlight the evolution of the Flash memory technology, oriented to both reducing cell size and upgrading product functions. The subject is of extreme interest: new concepts involving new materials, structures, principles, or applications are being continuously introduced. The worldwide semiconductor memory market seems ready to accept many new applications in fields that are not specific to traditional nonvolatile memories.", "Multi-View Inpainting for Image-Based Scene Editing and Rendering We propose a method to remove objects such as people and cars from multi-view urban image datasets, enabling free-viewpoint IBR in the edited scenes. Our method combines information from multi-view 3D reconstruction with image inpainting techniques, by formulating the problem as an optimization of a global patch-based objective function. We use Image-Based Rendering (IBR) techniques to reproject information from neighboring views, and 3D multi-view stereo reconstruction to perform multiview coherent initialization for inpainting of pixels not filled by reprojection. Our algorithm performs multi-view consistent inpainting for color and 3D by blending reprojections with patch-based image inpainting. We run our algorithm on casually captured datasets, and Google StreetViewdata, removing objects cars, people and pillars, showing that our approach produces results of sufficient quality for free-viewpoint IBR on \"cleaned up\" scenes, as well as IBR scene editing, such as limited motion of real objects.", "Decoding as Continuous Optimization in Neural Machine Translation In this work, we propose a novel decoding approach for neural machine translation (NMT) based on continuous optimisation. The resulting optimisation problem can then be tackled using a whole range of continuous optimisation algorithms which have been developed and used in the literature mainly for training. Our approach is general and can be applied to other sequence-to-sequence neural models as well. We make use of this powerful decoding approach to intersect an underlying NMT with a language model, to intersect left-to-right and right-to-left NMT models, and to decode with soft constraints involving coverage and fertility of the source sentence words. The experimental results show the promise of the proposed framework.", "Colostrum avoidance, prelacteal feeding and late breast-feeding initiation in rural Northern Ethiopia. OBJECTIVE\nTo identify specific cultural and behavioural factors that might be influenced to increase colostrum feeding in a rural village in Northern Ethiopia to improve infant health.\n\n\nDESIGN\nBackground interviews were conducted with six community health workers and two traditional birth attendants. A semi-structured tape-recorded interview was conducted with twenty mothers, most with children under the age of 5 years. Variables were: parental age and education; mother's ethnicity; number of live births and children's age; breast-feeding from birth through to weaning; availability and use of formula; and descriptions of colostrum v. other stages of breast milk. Participant interviews were conducted in Amharic and translated into English.\n\n\nSETTING\nKossoye, a rural Amhara village with high prevalence rates of stunting: inappropriate neonatal feeding is thought to be a factor.\n\n\nSUBJECTS\nWomen (20-60 years of age) reporting at least one live birth (range: 1-8, mean: \u223c4).\n\n\nRESULTS\nColostrum (inger) and breast milk (yetut wotet) were seen as different substances. Colostrum was said to cause abdominal problems, but discarding a portion was sufficient to mitigate this effect. Almost all (nineteen of twenty) women breast-fed and twelve (63 %) reported ritual prelacteal feeding. A majority (fifteen of nineteen, 79 %) reported discarding colostrum and breast-feeding within 24 h of birth. Prelacteal feeding emerged as an additional factor to be targeted through educational intervention.\n\n\nCONCLUSIONS\nTo maximize neonatal health and growth, we recommend culturally tailored education delivered by community health advocates and traditional health practitioners that promotes immediate colostrum feeding and discourages prelacteal feeding.", "Automated Trajectory Planner of Industrial Robot for Pick-and-Place Task Industrial  robots,  due  to  their  great  speed, precision  and  cost\u2010effectiveness  in  repetitive  tasks,  now tend  to be used  in place of human workers  in automated manufacturing  systems.  In  particular,  they  perform  the pick\u2010and\u2010place  operation,  a  non\u2010value\u2010added  activity which  at  the  same  time  cannot  be  eliminated.  Hence, minimum time is an important consideration for economic reasons  in  the  trajectory  planning  system  of  the manipulator.  The  trajectory  should  also  be  smooth  to handle  parts  precisely  in  applications  such  as semiconductor manufacturing, processing and handling of chemicals and medicines, and fluid and aerosol deposition. In this paper, an automated trajectory planner is proposed to determine  a  smooth, minimum\u2010time  and  collision\u2010free trajectory  for  the  pick\u2010and\u2010place  operations  of  a  6\u2010DOF robotic  manipulator  in  the  presence  of  an  obstacle. Subsequently,  it  also  proposes  an  algorithm  for  the  jerk\u2010 bounded  Synchronized  Trigonometric  S\u2010curve  Trajectory (STST)  and  the  \u2018forbidden\u2010sphere\u2019  technique  to  avoid  the obstacle.  The  proposed  planner  is  demonstrated  with suitable examples and comparisons. The experiments show that  the  proposed  planner  is  capable  of  providing  a smoother trajectory than the cubic spline based trajectory.", "BigBench: towards an industry standard benchmark for big data analytics There is a tremendous interest in big data by academia, industry and a large user base. Several commercial and open source providers unleashed a variety of products to support big data storage and processing. As these products mature, there is a need to evaluate and compare the performance of these systems.\n In this paper, we present BigBench, an end-to-end big data benchmark proposal. The underlying business model of BigBench is a product retailer. The proposal covers a data model and synthetic data generator that addresses the variety, velocity and volume aspects of big data systems containing structured, semi-structured and unstructured data. The structured part of the BigBench data model is adopted from the TPC-DS benchmark, which is enriched with semi-structured and unstructured data components. The semi-structured part captures registered and guest user clicks on the retailer's website. The unstructured data captures product reviews submitted online. The data generator designed for BigBench provides scalable volumes of raw data based on a scale factor. The BigBench workload is designed around a set of queries against the data model. From a business prospective, the queries cover the different categories of big data analytics proposed by McKinsey. From a technical prospective, the queries are designed to span three different dimensions based on data sources, query processing types and analytic techniques.\n We illustrate the feasibility of BigBench by implementing it on the Teradata Aster Database. The test includes generating and loading a 200 Gigabyte BigBench data set and testing the workload by executing the BigBench queries (written using Teradata Aster SQL-MR) and reporting their response times.", "Text Mining of Tweet for Sentiment Classification and Association with Stock Prices In present days, the social media and networking act as one of the key platforms for sharing information and opinions. Many people share ideas, express their view points and opinions on various topic of their interest. Social media text has rich information about the companies, their products and various services offered by them. In this research we focus exploring the association of sentiments of social media text and stock prices of a company. The tweets of several company has been extracted and performed sentiment classification using Na\u00efve Bayes classifier and SVM classifier. To perform the classification, N-gram based feature vectors are constructed using important words of tweets. Further, the pattern of association between number of tweets which are positive or negative and stock prices has been explored. Motivated by such an association, the features related to tweets such as number of positive, negative, neutral tweets and total number of tweets are used to predict the stock market status using Support Vector Machine classifier.", "Progressive muscle relaxation reduces migraine frequency and normalizes amplitudes of contingent negative variation (CNV) Central information processing, visible in evoked potentials like the contingent negative variation (CNV) is altered in migraine patients who exhibit higher CNV amplitudes and a reduced habituation. Both characteristics were shown to be normalized under different prophylactic migraine treatment options whereas Progressive Muscle Relaxation (PMR) has not yet been examined. We investigated the effect of PMR on clinical course and CNV in migraineurs in a quasi-randomized, controlled trial. Thirty-five migraine patients and 46 healthy controls were examined. Sixteen migraineurs and 21 healthy participants conducted a 6-week PMR-training with CNV-measures before and after as well as three months after PMR-training completion. The remaining participants served as controls. The clinical course was analyzed with two-way analyses of variance (ANOVA) with repeated measures. Pre-treatment CNV differences between migraine patients and healthy controls were examined with t-tests for independent measures. The course of the CNV-parameters was examined with three-way ANOVAs with repeated measures. After PMR-training, migraine patients showed a significant reduction of migraine frequency. Preliminary to the PMR-training, migraine patients exhibited higher amplitudes in the early component of the CNV (iCNV) and the overall CNV (oCNV) than healthy controls, but no differences regarding habituation. After completion of the PMR-training, migraineurs showed a normalization of the iCNV amplitude, but neither of the oCNV nor of the habituation coefficient. The results confirm clinical efficacy of PMR for migraine prophylaxis. The pre-treatment measure confirms altered cortical information processing in migraine patients. Regarding the changes in the iCNV after PMR-training, central nervous mechanisms of the PMR-effect are supposed which may be mediated by the serotonin metabolism."]}], "SciFact": [{"query": "TNFAIP3 is a glioblastoma tumor suppressor.", "pos": ["Targeting A20 Decreases Glioma Stem Cell Survival and Tumor Growth Glioblastomas are deadly cancers that display a functional cellular hierarchy maintained by self-renewing glioblastoma stem cells (GSCs). GSCs are regulated by molecular pathways distinct from the bulk tumor that may be useful therapeutic targets. We determined that A20 (TNFAIP3), a regulator of cell survival and the NF-kappaB pathway, is overexpressed in GSCs relative to non-stem glioblastoma cells at both the mRNA and protein levels. To determine the functional significance of A20 in GSCs, we targeted A20 expression with lentiviral-mediated delivery of short hairpin RNA (shRNA). Inhibiting A20 expression decreased GSC growth and survival through mechanisms associated with decreased cell-cycle progression and decreased phosphorylation of p65/RelA. Elevated levels of A20 in GSCs contributed to apoptotic resistance: GSCs were less susceptible to TNFalpha-induced cell death than matched non-stem glioma cells, but A20 knockdown sensitized GSCs to TNFalpha-mediated apoptosis. The decreased survival of GSCs upon A20 knockdown contributed to the reduced ability of these cells to self-renew in primary and secondary neurosphere formation assays. The tumorigenic potential of GSCs was decreased with A20 targeting, resulting in increased survival of mice bearing human glioma xenografts. In silico analysis of a glioma patient genomic database indicates that A20 overexpression and amplification is inversely correlated with survival. Together these data indicate that A20 contributes to glioma maintenance through effects on the glioma stem cell subpopulation. Although inactivating mutations in A20 in lymphoma suggest A20 can act as a tumor suppressor, similar point mutations have not been identified through glioma genomic sequencing: in fact, our data suggest A20 may function as a tumor enhancer in glioma through promotion of GSC survival. A20 anticancer therapies should therefore be viewed with caution as effects will likely differ depending on the tumor type."], "neg": ["Differentiation of trophoblast stem cells into giant cells is triggered by p57/Kip2 inhibition of CDK1 activity. Genome endoreduplication during mammalian development is a rare event for which the mechanism is unknown. It first appears when fibroblast growth factor 4 (FGF4) deprivation induces differentiation of trophoblast stem (TS) cells into the nonproliferating trophoblast giant (TG) cells required for embryo implantation. Here we show that RO3306 inhibition of cyclin-dependent protein kinase 1 (CDK1), the enzyme required to enter mitosis, induced differentiation of TS cells into TG cells. In contrast, RO3306 induced abortive endoreduplication and apoptosis in embryonic stem cells, revealing that inactivation of CDK1 triggers endoreduplication only in cells programmed to differentiate into polyploid cells. Similarly, FGF4 deprivation resulted in CDK1 inhibition by overexpressing two CDK-specific inhibitors, p57/KIP2 and p21/CIP1. TS cell mutants revealed that p57 was required to trigger endoreduplication by inhibiting CDK1, while p21 suppressed expression of the checkpoint protein kinase CHK1, thereby preventing induction of apoptosis. Furthermore, Cdk2(-/-) TS cells revealed that CDK2 is required for endoreduplication when CDK1 is inhibited. Expression of p57 in TG cells was restricted to G-phase nuclei to allow CDK activation of S phase. Thus, endoreduplication in TS cells is triggered by p57 inhibition of CDK1 with concomitant suppression of the DNA damage response by p21.", "Specific sites in the C terminus of CTCF interact with the SA2 subunit of the cohesin complex and are required for cohesin-dependent insulation activity. Recent studies have shown that the protein CTCF, which plays an important role in insulation and in large-scale organization of chromatin within the eukaryotic nucleus, depends for both activities on recruitment of the cohesin complex. We show here that the interaction of CTCF with the cohesin complex involves direct contacts between the cohesin subunit SA2 and specific regions of the C-terminal tail of CTCF. All other cohesin components are recruited through their interaction with SA2. Expression in vivo of CTCF mutants lacking the C-terminal domain, or with mutations at sites within it required for SA2 binding, disrupts the normal expression profile of the imprinted genes IGF2-H19 and also results in a loss of insulation activity. Taken together, our results demonstrate that specific sites on the C terminus of CTCF are essential for cohesin binding and insulator function. The only direct interaction between CTCF and cohesin involves contact with SA2, which is external to the cohesin ring. This suggests that in recruiting cohesin to CTCF, SA2 could bind first and the ring could assemble subsequently.", "Usefulness of high mobility group box 1 protein as a plasma biomarker in patient with peripheral artery disease. Atherosclerosis is often associated with chronic vascular inflammation. High-mobility group box 1 protein (HMGB1) plays various roles, not only as a transcriptional regulatory factor in the nucleus, but also as an inflammatory mediator. A previous study suggested that fibrinogen is an important factor associated with atherosclerosis progression. The present study was performed to examine the levels of plasma HMGB1 protein in atherosclerosis patients. We studied 24 patients with peripheral artery disease (PAD) with atherosclerosis, and 10 healthy controls. We found that the concentrations of HMGB1 were increased in the plasma of the patients with atherosclerosis, and there were significant correlations between the plasma HMGB1 and fibrinogen levels. Plasma HMGB1 may play a key role in the pathogenesis of clinical and experimental atherosclerosis.", "Vascular endothelial cadherin controls VEGFR-2 internalization and signaling from intracellular compartments Receptor endocytosis is a fundamental step in controlling the magnitude, duration, and nature of cell signaling events. Confluent endothelial cells are contact inhibited in their growth and respond poorly to the proliferative signals of vascular endothelial growth factor (VEGF). In a previous study, we found that the association of vascular endothelial cadherin (VEC) with VEGF receptor (VEGFR) type 2 contributes to density-dependent growth inhibition (Lampugnani, G.M., A. Zanetti, M. Corada, T. Takahashi, G. Balconi, F. Breviario, F. Orsenigo, A. Cattelino, R. Kemler, T.O. Daniel, and E. Dejana. 2003. J. Cell Biol. 161:793\u2013804). In the present study, we describe the mechanism through which VEC reduces VEGFR-2 signaling. We found that VEGF induces the clathrin-dependent internalization of VEGFR-2. When VEC is absent or not engaged at junctions, VEGFR-2 is internalized more rapidly and remains in endosomal compartments for a longer time. Internalization does not terminate its signaling; instead, the internalized receptor is phosphorylated, codistributes with active phospholipase C\u2013\u03b3, and activates p44/42 mitogen-activated protein kinase phosphorylation and cell proliferation. Inhibition of VEGFR-2 internalization reestablishes the contact inhibition of cell growth, whereas silencing the junction-associated density-enhanced phosphatase-1/CD148 phosphatase restores VEGFR-2 internalization and signaling. Thus, VEC limits cell proliferation by retaining VEGFR-2 at the membrane and preventing its internalization into signaling compartments.", "Quantitative Detection of Hepatitis C Virus RNA by Light Cycler PCR and Comparison with Two Different PCR Assays The new Light Cycler technology was adapted to the detection of hepatitis C virus (HCV) RNA in clinical samples. Sera from 81 patients were tested by Light Cycler PCR, AMPLICOR HCV Monitor assay, and in-house PCR. Our data demonstrate that Light Cycler is a fast and reliable method for the detection and quantitation of HCV RNA.", "[Pharmacokinetics and biotransformation of the antimycotic drug ciclopiroxolamine in animals and man after topical and systemic administration]. 1. Following the dermal application of the carbon-14 labelled broad spectrum antimycotic 6-cyclohexyl-1-hydroxy-4-methyl-2(1H)-pyridone, 2-aminoethanol salt (ciclopiroxolamine, Hoe 296, Batrafen) in the form of a 1% aqueous cream to healthy human dorsal skin (penetration time: 6 h; occlusive dressing for 5 h), percutaneous absorption accounted on average for 1.3% of the dose applied. Excretion occurred via the kidney, with biological half-lives of 1.7 h. As can be seen from penetration studies of cadaverous skin, the horny layer contained the highest concentrations, with values of 2300-4500 microgram/cm3. The levels determined in the corium were still above the minimum inhibitory concentrations. These concentrations were already obtained at the first test stage (1.5 h after application) and did not change virtually at all over the longer penetration period. According to studies using histoautoradiography, ciclopirox can penetrate the skin via the epidermis and the hair follicles. When ciclopirox-14C-olamine aqueous cream was spread on the surface of fingernails, the radioactive-labelled compound penetrated right through the nail. The percutaneous absorption in dogs was higher, at 5-15% of the dose, than it was in humans. 2. After vaginal application (1 mg/kg) of ciclopirox-14C-olamine in the form of a 1% aqueous cream to bitches, between 42 and 97% of the dose (depending on the animal) was recovered in the urine and faeces, the remainder having penetrated into the tampon used to close the vagina. 3. Ciclopirox is excreted by dogs and man in the urine, primarily as a glucuronide. In humans another glucuronide with properties similar to those of the original substance was detected. Two conjugated, relatively non-polar metabolites were also present in small amounts. The metabolite patterns after oral and dermal application were similar. The binding of ciclopirox to serum proteins in humans was 96 +/- 2% in a concentration range of 0.01-11.0 microgram/ml. 4. Placental transfer was low in the rats studied. Though there was good absorption by the mother animal, the radioactivity in the foetal tissues was always lower than that of the maternal blood.", "Generation of induced pluripotent stem cells from Asian patients with chronic neurodegenerative diseases. Induced pluripotent stem (iPS) cells derived from disease patients are an invaluable resource for biomedical research and may provide a source for replacement therapies. In this study, we have generated iPS cells from Asian patients with chronic degenerative diseases of the nervous system, including spinal muscular atrophy (SMA), Parkinson disease (PD) and amyotrophic lateral sclerosis (ALS) by transduction with four factors (KLF4, SOX2, OCT4 and c-MYC). All of the iPS cells showed pluripotency similar to that of human embryonic stem cells (hESCs) and were able to differentiate into various somatic cell types in vitro and in vivo. Furthermore, the iPS cells also can be committed to differentiate into neural cells, the cell type that is affected in chronic degenerative diseases. Therefore, the patient-specific iPS cells we generated offer a cellular model in which to investigate disease mechanisms, discover and test novel drugs and develop new therapies for chronic neurodegenerative diseases.", "Novel roles for KLF1 in erythropoiesis revealed by mRNA-seq. KLF1 (formerly known as EKLF) regulates the development of erythroid cells from bi-potent progenitor cells via the transcriptional activation of a diverse set of genes. Mice lacking Klf1 die in utero prior to E15 from severe anemia due to the inadequate expression of genes controlling hemoglobin production, cell membrane and cytoskeletal integrity, and the cell cycle. We have recently described the full repertoire of KLF1 binding sites in vivo by performing KLF1 ChIP-seq in primary erythroid tissue (E14.5 fetal liver). Here we describe the KLF1-dependent erythroid transcriptome by comparing mRNA-seq from Klf1(+/+) and Klf1(-/-) erythroid tissue. This has revealed novel target genes not previously obtainable by traditional microarray technology, and provided novel insights into the function of KLF1 as a transcriptional activator. We define a cis-regulatory module bound by KLF1, GATA1, TAL1, and EP300 that coordinates a core set of erythroid genes. We also describe a novel set of erythroid-specific promoters that drive high-level expression of otherwise ubiquitously expressed genes in erythroid cells. Our study has identified two novel lncRNAs that are dynamically expressed during erythroid differentiation, and discovered a role for KLF1 in directing apoptotic gene expression to drive the terminal stages of erythroid maturation."]}, {"query": "Broadly HIV-1 Neutralizing Antibodies (bnAb) 10EB have no affinity for phospholipids.", "pos": ["Broad and potent neutralization of HIV-1 by a gp41-specific human antibody Characterization of human monoclonal antibodies is providing considerable insight into mechanisms of broad HIV-1 neutralization. Here we report an HIV-1 gp41 membrane-proximal external region (MPER)-specific antibody, named 10E8, which neutralizes \u223c98% of tested viruses. An analysis of sera from 78 healthy HIV-1-infected donors demonstrated that 27% contained MPER-specific antibodies and 8% contained 10E8-like specificities. In contrast to other neutralizing MPER antibodies, 10E8 did not bind phospholipids, was not autoreactive, and bound cell-surface envelope. The structure of 10E8 in complex with the complete MPER revealed a site of vulnerability comprising a narrow stretch of highly conserved gp41-hydrophobic residues and a critical arginine or lysine just before the transmembrane region. Analysis of resistant HIV-1 variants confirmed the importance of these residues for neutralization. The highly conserved MPER is a target of potent, non-self-reactive neutralizing antibodies, suggesting that HIV-1 vaccines should aim to induce antibodies to this region of HIV-1 envelope glycoprotein."], "neg": ["Bullying in school: are short pupils at risk? Questionnaire study in a cohort. Bullying is still prevalent in schools and is clearly stressful for victims. 1 2 It may also have undesirable consequences for bullies, with antisocial behaviour persisting into adulthood. Victims are generally reported to be weaker than the bullies. 2 3 This would suggest that very short pupils are more likely to be victims and less likely to be the aggressors. The Wessex growth study allowed us to examine the prevalence of bullying, as experienced or perpetrated by pupils of different heights. Ninety two short normal adolescents who had been below the third centile for height at school entry4 and 117 controls matched for age and sex completed a bullying questionnaire, derived from work by Whitney and Smith.5 There were no refusals or any significant differences in sex or social class between the groups. Mean age (range) was 14.7 (13.4-15.7) years. Mean height SD scores were: short pupils \u22121.90 (\u22123.53 to \u22120.01), controls 0.31 (\u22121.41 \u2026", "Development of a syngeneic mouse model for events related to ovarian cancer. Mouse ovarian surface epithelial cells (MOSEC) were obtained from virgin, mature mice by mild trypsinization and were repeatedly passaged in vitro. Early passage cells (<20 passages) exhibited a cobblestone morphology and contact inhibition of growth. After approximately 20 passages in vitro, cobblestone morphology and contact inhibition of growth was lost. Tumor forming potential was determined by s.c. and i.p. injection of early and late passage cells into athymic and syngeneic C57BL6 mice. Subcutaneous tumors formed in approximately 4 months and were present only at the injection site. Intraperitoneal injection of late passage MOSEC into athymic and syngeneic mice resulted in growth of tumor implants throughout the abdominal cavity, and production of hemorrhagic ascitic fluid. Early passage MOSEC did not form tumors in vivo. Histopathologic analysis of tumors revealed a highly malignant neoplasm containing both carcinomatous and sarcomatous components. Late passage MOSEC expressed cytokeratin and did not produce ovarian steroids in response to gonadotropin stimulation in vitro. Ten clonal lines were established from late passage MOSEC. Each clone formed multiple peritoneal tumors and ascitic fluid after i.p. injection into C57BL6 mice. Three cell lines examined cytogenetically were polyploid with near-tetraploid modal chromosome numbers. Common clonal chromosome gains and losses included +5, +15, +19 and -X, -3, -4. One cell line had a clonal translocation between chromosomes 15 and 18 and another had a small marker chromosome; common structural abnormalities were not observed. These data describe the development of a mouse model for the study of events related to ovarian cancer in humans. The ability of the MOSEC to form extensive tumors within the peritoneal cavity, similar to those seen in women with Stage III and IV cancer, and the ability of the MOSEC to produce tumors in mice with intact immune systems, makes this model unique for investigations of molecular and immune interactions in ovarian cancer development.", "Induced pluripotent stem cells from a spinal muscular atrophy patient Spinal muscular atrophy is one of the most common inherited forms of neurological disease leading to infant mortality. Patients have selective loss of lower motor neurons resulting in muscle weakness, paralysis and often death. Although patient fibroblasts have been used extensively to study spinal muscular atrophy, motor neurons have a unique anatomy and physiology which may underlie their vulnerability to the disease process. Here we report the generation of induced pluripotent stem cells from skin fibroblast samples taken from a child with spinal muscular atrophy. These cells expanded robustly in culture, maintained the disease genotype and generated motor neurons that showed selective deficits compared to those derived from the child\u2019s unaffected mother. This is the first study to show that human induced pluripotent stem cells can be used to model the specific pathology seen in a genetically inherited disease. As such, it represents a promising resource to study disease mechanisms, screen new drug compounds and develop new therapies.", "Association of Toll-Like Receptor 4 on Human Monocyte Subsets and Vulnerability Characteristics of Coronary Plaque as Assessed by 64-Slice Multidetector Computed Tomography. BACKGROUND Although Toll-like receptor 4 (TLR-4) is involved in monocyte activation in patients with accelerated forms of atherosclerosis, the relationship between the expression of TLR-4 on circulating monocytes and coronary plaque vulnerability has not previously been evaluated. We investigated this relationship using 64-slice multidetector computed tomography (MDCT) in patients with stable angina pectoris (SAP).Methods and Results:We enrolled 65 patients with SAP who underwent MDCT. Three monocyte subsets (CD14++CD16-, CD14++CD16+, and CD14+CD16+) and expression of TLR-4 were measured by flow cytometry. Intracoronary plaques were assessed by 64-slice MDCT. We defined vulnerability of intracoronary plaques according to the presence of positive remodeling (remodeling index >1.05) and/or low CT attenuation (<35 HU). The circulating CD14++CD16+monocytes more frequently expressed TLR-4 than CD14++CD16-and CD14+CD16+monocytes (P<0.001). The relative proportion of the expression of TLR-4 on CD14++CD16+monocytes was significantly greater in patients with vulnerable plaque compared with those without (10.4 [4.1-14.5] % vs. 4.5 [2.8-7.8] %, P=0.012). In addition, the relative proportion of TLR-4 expression on CD14++CD16+monocytes positively correlated with the remodeling index (r=0.28, P=0.025) and negatively correlated with CT attenuation value (r=-0.31, P=0.013). CONCLUSIONS Upregulation of TLR-4 on CD14++CD16+monocytes might be associated with coronary plaque vulnerability in patients with SAP.", "Occurrence of chromosome 9 and p53 alterations in multifocal dysplasia and carcinoma in situ of human urinary bladder To define the genetic changes of flat urothelial lesions, carcinoma in situ (CIS) and moderate dysplasias (DII) were investigated for alterations in the two chromosomal regions most frequently involved in bladder cancer. Overall, 33 CIS and 16 DII from 21 patients were used to microdissect urothelium. Dual color fluorescence in situ hybridization (FISH) using gene locus probes of 9q22 (FACC), 9p21 (CDK), 17p13 (p53), and related centromeric probes was applied on interphase nuclei. In parallel, preamplified DNA of these samples was used for loss of heterozygosity (LOH) analyses with eight microsatellite markers on chromosomes 9p, 9q and 17p, and for sequencing of exons 5-9 of p53. Data indicated nearly identical deletion frequencies for chromosomes 9 and 17 for CIS (chromosome 9, 86%; p53, 84%). DII showed a lower deletion rate in comparison with CIS (chromosome 9, 75%; p53, 53%). A very high correlation between the results of FISH and LOH analyses was found. p53 mutations were detected in 12 of 15 patients (CIS, 72%; DII, 67%). In three of 16 patients with multifocal tumors, oligoclonal lesions were identified by LOH analyses, a finding further supported by sequencing of p53, by which two different p53 deletions were detected in two cases. In conclusion, data from microdissected flat urothelial lesions indicate that chromosome 9 deletions cannot be regarded as indicators of papillary growth, because they are found frequently in both types of flat lesions of the urothelium: those associated with papillary tumors and those that are not. The similar distribution and lower amount of genetic changes in DII render DII a possible precursor lesion of CIS.", "The Arabidopsis Chromatin-Modifying Nuclear siRNA Pathway Involves a Nucleolar RNA Processing Center In Arabidopsis thaliana, small interfering RNAs (siRNAs) direct cytosine methylation at endogenous DNA repeats in a pathway involving two forms of nuclear RNA polymerase IV (Pol IVa and Pol IVb), RNA-DEPENDENT RNA POLYMERASE 2 (RDR2), DICER-LIKE 3 (DCL3), ARGONAUTE4 (AGO4), the chromatin remodeler DRD1, and the de novo cytosine methyltransferase DRM2. We show that RDR2, DCL3, AGO4, and NRPD1b (the largest subunit of Pol IVb) colocalize with siRNAs within the nucleolus. By contrast, Pol IVa and DRD1 are external to the nucleolus and colocalize with endogenous repeat loci. Mutation-induced loss of pathway proteins causes downstream proteins to mislocalize, revealing their order of action. Pol IVa acts first, and its localization is RNA dependent, suggesting an RNA template. We hypothesize that maintenance of the heterochromatic state involves locus-specific Pol IVa transcription followed by siRNA production and assembly of AGO4- and NRPD1b-containing silencing complexes within nucleolar processing centers.", "Candida albicans-Staphylococcus aureus polymicrobial peritonitis modulates host innate immunity. Despite advances in medical device fabrication and antimicrobial treatment therapies, fungal-bacterial polymicrobial peritonitis remains a serious complication for surgery patients, those on peritoneal dialysis, and the critically ill. Using a murine model of peritonitis, we have demonstrated that monomicrobial infection with Candida albicans or Staphylococcus aureus is nonlethal. However, coinfection with these same doses leads to a 40% mortality rate and increased microbial burden in the spleen and kidney by day 1 postinfection. Using a multiplex enzyme-linked immunosorbent assay, we have also identified a unique subset of innate proinflammatory cytokines (interleukin-6, granulocyte colony-stimulating factor, keratinocyte chemoattractant, monocyte chemoattractant protein-1, and macrophage inflammatory protein-1\u03b1) that are significantly increased during polymicrobial versus monomicrobial peritonitis, leading to increased inflammatory infiltrate into the peritoneum and target organs. Treatment of coinfected mice with the cyclooxygenase (COX) inhibitor indomethacin reduces the infectious burden, proinflammatory cytokine production, and inflammatory infiltrate while simultaneously preventing any mortality. Further experiments demonstrated that the immunomodulatory eicosanoid prostaglandin E2 (PGE2) is synergistically increased during coinfection compared to monomicrobial infection; indomethacin treatment also decreased elevated PGE2 levels. Furthermore, addition of exogenous PGE2 into the peritoneal cavity during infection overrode the protection provided by indomethacin and restored the increased mortality and microbial burden. Importantly, these studies highlight the ability of fungal-bacterial coinfection to modulate innate inflammatory events with devastating consequences to the host.", "CRISPR adaptation biases explain preference for acquisition of foreign DNA CRISPR-Cas (clustered, regularly interspaced short palindromic repeats coupled with CRISPR-associated proteins) is a bacterial immunity system that protects against invading phages or plasmids. In the process of CRISPR adaptation, short pieces of DNA ('spacers') are acquired from foreign elements and integrated into the CRISPR array. So far, it has remained a mystery how spacers are preferentially acquired from the foreign DNA while the self chromosome is avoided. Here we show that spacer acquisition is replication-dependent, and that DNA breaks formed at stalled replication forks promote spacer acquisition. Chromosomal hotspots of spacer acquisition were confined by Chi sites, which are sequence octamers highly enriched on the bacterial chromosome, suggesting that these sites limit spacer acquisition from self DNA. We further show that the avoidance of self is mediated by the RecBCD double-stranded DNA break repair complex. Our results suggest that, in Escherichia coli, acquisition of new spacers largely depends on RecBCD-mediated processing of double-stranded DNA breaks occurring primarily at replication forks, and that the preference for foreign DNA is achieved through the higher density of Chi sites on the self chromosome, in combination with the higher number of forks on the foreign DNA. This model explains the strong preference to acquire spacers both from high copy plasmids and from phages."]}, {"query": "A deficiency of vitamin B6 decreases blood levels of homocysteine.", "pos": ["Folic acid improves endothelial function in coronary artery disease via mechanisms largely independent of homocysteine lowering. BACKGROUND Homocysteine is a risk factor for coronary artery disease (CAD), although a causal relation remains to be proven. The importance of determining direct causality rests in the fact that plasma homocysteine can be safely and inexpensively reduced by 25% with folic acid. This reduction is maximally achieved by doses of 0.4 mg/d. High-dose folic acid (5 mg/d) improves endothelial function in CAD, although the mechanism is controversial. It has been proposed that improvement occurs through reduction in total (tHcy) or free (non-protein bound) homocysteine (fHcy). We investigated the effects of folic acid on endothelial function before a change in homocysteine in patients with CAD. METHODS AND RESULTS A randomized, placebo-controlled study of folic acid (5 mg/d) for 6 weeks was undertaken in 33 patients. Endothelial function, assessed by flow-mediated dilatation (FMD), was measured before, at 2 and 4 hours after the first dose of folic acid, and after 6 weeks of treatment. Plasma folate increased markedly by 1 hour (200 compared with 25.8 nmol/L; P<0.001). FMD improved at 2 hours (83 compared with 47 microm; P<0.001) and was largely complete by 4 hours (101 compared with 51 microm; P<0.001). tHcy did not significantly differ acutely (4-hour tHcy, 9.56 compared with 9.79 micromol/L; P=NS). fHcy did not differ at 3 hours but was slightly reduced at 4 hours (1.55 compared with 1.78 micromol/L; P=0.02). FMD improvement did not correlate with reductions in either fHcy or tHcy at any time. CONCLUSIONS These data suggest that folic acid improves endothelial function in CAD acutely by a mechanism largely independent of homocysteine.", "Randomized trial of folic acid supplementation and serum homocysteine levels. BACKGROUND Lowering serum homocysteine levels with folic acid is expected to reduce mortality from ischemic heart disease. Homocysteine reduction is known to be maximal at a folic acid dosage of 1 mg/d, but the effect of lower doses (relevant to food fortification) is unclear. METHODS We randomized 151 patients with ischemic heart disease to 1 of 5 dosages of folic acid (0.2, 0.4, 0.6, 0.8, and 1.0 mg/d) or placebo. Fasting blood samples for serum homocysteine and serum folate analysis were taken initially, after 3 months of supplementation, and 3 months after folic acid use was discontinued. RESULTS Median serum homocysteine level decreased with increasing folic acid dosage, to a maximum at 0.8 mg of folic acid per day, when the homocysteine reduction (placebo adjusted) was 2.7 micromol/L (23%), similar to the known effect of folic acid dosages of 1 mg/d and above. The higher a person's initial serum homocysteine level, the greater was the response to folic acid, but there were statistically significant reductions regardless of the initial level. Serum folate level increased approximately linearly (5.5 nmol/L for every 0.1 mg of folic acid). Within-person fluctuations over time in serum homocysteine levels, measured in the placebo group, were large compared with the effect of folic acid, indicating that monitoring of the reduction in an individual is impractical. CONCLUSIONS A dosage of folic acid of 0.8 mg/d appears necessary to achieve the maximum reduction in serum homocysteine level across the range of homocysteine levels in the population. Current US food fortification levels will achieve only a small proportion of the achievable homocysteine reduction."], "neg": ["Immunosuppressant FTY720 inhibits thymocyte emigration. One major role of the thymus is to provide the peripheral immune system with mature T cells, but the mechanisms involving the cellular export are not fully understood. In this study, we examined the ability of a novel immunosuppressive reagent, FTY720, to inhibit T cell export from the thymus. Daily administration of FTY720 at a dose of 1 mg / kg resulted in a marked decrease in the number of peripheral blood T lymphocytes. In the thymus, long-term daily administration of FTY720 caused a three- to fourfold increase in the proportion of mature medullary thymocytes (CD4(+)CD8(-) and CD4(-)CD8(+)) as well as a slight decrease in the double-positive cell (CD4(+)CD8(+)) ratio. Phenotypic analysis (TCRalpha beta, H-2K(d), CD44, CD69 and CD24) revealed that these increased subsets represent possible peripheral recent thymic emigrants. High level expression of L-selectin by these subsets further suggests that they were prevented from leaving the thymus. By intrathymic labeling with fluorescein isothiocyanate, only one fourth of labeled cells could be detected in the lymph nodes and in the spleen of FTY720-treated mice compared to saline-treated control mice. Taken together, these results suggest that the immunosuppressive action of FTY720, at least in part, could be due to its inhibitory effect on T cell emigration from the thymus to the periphery.", "Ankle brachial index as a predictor of cognitive impairment in the general population: ten-year follow-up of the Edinburgh Artery Study. OBJECTIVES To determine whether the ankle brachial index (ABI, a marker of generalized atherosclerosis) is associated with cognitive impairment after 10 years in older people. DESIGN Cohort study (Edinburgh Artery Study). SETTING Eleven general practices in Edinburgh, Scotland. PARTICIPANTS Seven hundred seventeen men and women aged 55 to 74 from the general population, followed for 10 years. MEASUREMENTS ABI measured at baseline and major cognitive functions (including premorbid function using the National Adult Reading Test, NART) tested after 10 years. RESULTS After adjustment for age and sex, a low ABI was associated with lower scoring (bottom tertile vs top tertile) on Raven's Matrices (odds ratio (OR)=1.6, 95% confidence interval (CI) =1.0-2.6), Verbal Fluency (OR =1.8, 95% CI =1.1-3.0), and Digit Symbol Test (OR =2.3, 95% CI =1.3-4.2), suggesting that the ABI is predictive of poorer performance in nonverbal reasoning, verbal fluency, and information processing speed. The association between ABI and the Digit Symbol Test remained significant after further adjustment for premorbid cognitive function (tested using the NART), suggesting that the ABI is also predictive of decline in information processing speed (from premorbid ability to that measured here in older age). CONCLUSION The ABI may be useful in identifying older individuals at higher risk of cognitive impairment. In the future, preventive measures developed to target individuals with a low ABI should consider measures to reduce vascular-related cognitive decline as well as cardiovascular events, in an effort to reduce the incidence and consequences of subsequent cognitive impairment and dementia.", "Association between serum corin levels and risk of acute myocardial infarction. BACKGROUND Accumulating evidence has indicated that corin plays critical roles in regulating salt-water balance, blood pressure and cardiac function by activating natriuretic peptides. The present case-control study was designed to evaluate the association of serum soluble corin with acute myocardial infarction (AMI). METHODS We enrolled 856 consecutive AMI patients and 856 control subjects and explored the possible relation between serum corin levels and AMI risk using logistic regression model. RESULTS Patients with AMI had higher BMI, were less physically active, and were more likely to have histories of hypertension, diabetes, hyperlipidemia and smoking compared with the controls. Serum levels of corin were remarkably reduced in AMI patients (825\u00b1263pg/ml) compared with those in healthy controls (1246\u00b1425pg/ml). Odds ratios of ST elevation (STEMI) and non-ST elevation myocardial infarction (NSTEMI) were significantly decreased with the increasing levels of serum corin in both men and women (P for trend, <0.001) after adjustment for body mass index, hypertension, diabetes, hyperlipidemia, smoking, and physical activity. CONCLUSIONS Our study demonstrates that serum levels of corin are significantly decreased in AMI patients, and it is inversely associated with the incidences of STEMI and NSTEMI in both men and women.", "Epigenetic memory and preferential lineage-specific differentiation in induced pluripotent stem cells derived from human pancreatic islet beta cells. Human induced pluripotent stem cells (HiPSCs) appear to be highly similar to human embryonic stem cells (HESCs). Using two genetic lineage-tracing systems, we demonstrate the generation of iPSC lines from human pancreatic islet beta cells. These reprogrammed cells acquired markers of pluripotent cells and differentiated into the three embryonic germ layers. However, the beta cell-derived iPSCs (BiPSCs) maintained open chromatin structure at key beta-cell genes, together with a unique DNA methylation signature that distinguishes them from other PSCs. BiPSCs also demonstrated an increased ability to differentiate into insulin-producing cells both in vitro and in vivo, compared with ESCs and isogenic non-beta iPSCs. Our results suggest that the epigenetic memory may predispose BiPSCs to differentiate more readily into insulin producing cells. These findings demonstrate that HiPSC phenotype may be influenced by their cells of origin, and suggest that their skewed differentiation potential may be advantageous for cell replacement therapy.", "A gradient of template dependence defines distinct biological roles for family X polymerases in nonhomologous end joining. Three Pol X family members have been linked to nonhomologous end joining (NHEJ) in mammals. Template-independent TdT promotes diversity during NHEJ-dependent repair of V(D)J recombination intermediates, but the roles of the template-dependent polymerases mu and lambda in NHEJ remain unclear. We show here that pol mu and pol lambda are similarly recruited by NHEJ factors to fill gaps when ends have partially complementary overhangs, suggesting equivalent roles promoting accuracy in NHEJ. However, only pol mu promotes accuracy during immunoglobulin kappa recombination. This distinctive in vivo role correlates with the TdT-like ability of pol mu, but not pol lambda, to act when primer termini lack complementary bases in the template strand. However, unlike TdT, synthesis by pol mu in this context is primarily instructed by a template from another DNA molecule. This apparent gradient of template dependence is largely attributable to a small structural element that is present but different in all three polymerases.", "Canonical transient receptor potential 5 channel in conjunction with Orai1 and STIM1 allows Sr2+ entry, optimal influx of Ca2+, and degranulation in a rat mast cell line. Degranulation of mast cells in response to Ag or the calcium mobilizing agent, thapsigargin, is dependent on emptying of intracellular stores of Ca(2+) and the ensuing influx of external Ca(2+), also referred to as store-operated calcium entry. However, it is unlikely that the calcium release-activated calcium channel is the sole mechanism for the entry of Ca(2+) because Sr(2+) and other divalent cations also permeate and support degranulation in stimulated mast cells. In this study we show that influx of Ca(2+) and Sr(2+) as well as degranulation are dependent on the presence of the canonical transient receptor potential (TRPC) channel protein TRPC5, in addition to STIM1 and Orai1, as demonstrated by knock down of each of these proteins by inhibitory RNAs in a rat mast cell (RBL-2H3) line. Overexpression of STIM1 and Orai1, which are known to be essential components of calcium release-activated calcium channel, allows entry of Ca(2+) but not Sr(2+), whereas overexpression of STIM1 and TRPC5 allows entry of both Ca(2+) and Sr(2+). These and other observations suggest that the Sr(2+)-permeable TRPC5 associates with STIM1 and Orai1 in a stoichiometric manner to enhance entry of Ca(2+) to generate a signal for degranulation.", "AZD9150, a next-generation antisense oligonucleotide inhibitor of STAT3 with early evidence of clinical activity in lymphoma and lung cancer Next-generation sequencing technologies have greatly expanded our understanding of cancer genetics. Antisense technology is an attractive platform with the potential to translate these advances into improved cancer therapeutics, because antisense oligonucleotide (ASO) inhibitors can be designed on the basis of gene sequence information alone. Recent human clinical data have demonstrated the potent activity of systemically administered ASOs targeted to genes expressed in the liver. We describe the preclinical activity and initial clinical evaluation of a class of ASOs containing constrained ethyl modifications for targeting the gene encoding the transcription factor STAT3, a notoriously difficult protein to inhibit therapeutically. Systemic delivery of the unformulated ASO, AZD9150, decreased STAT3 expression in a broad range of preclinical cancer models and showed antitumor activity in lymphoma and lung cancer models. AZD9150 preclinical activity translated into single-agent antitumor activity in patients with highly treatment-refractory lymphoma and non\u2013small cell lung cancer in a phase 1 dose-escalation study.", "[Neutrophils and macrophages related to the pathogenesis and disease development of chronic obstructive pulmonary disease by the inflammatory reaction]. Chronic obstructive pulmonary disease (COPD) is a chronic airway disorder characterized by obstructive airflow limitation which is not completely reversible with treatment. Inflammatory changes in the peripheral airways, especially those with the diameter less than 2mm (so-called small airway disease) have been speculated to be initial steps of COPD. And so it must be quite clear that neutrophils and macrophages play an essential role in the pathogenesis of these lesions. Studies with bronchoalveolar lavage demonstrated an increase in neutrophil numbers and the neutrophil chemoattractant interleukin-8. Recent studies demonstrated that neutrophils and macrophages are increased and contain a variety of proteases, which are involved in cell infiltration and activation. Studies with gene-engineered animals and anti-cytokine treatment will facilitate better understanding the role of neutrophils and macrophages, and eventual novel therapy."]}, {"query": "Tuberculosis-induced granulomas express different immune system protein signatures than the surrounding tissue.", "pos": ["Inflammatory signaling in human Tuberculosis granulomas is spatially organized Granulomas are the pathological hallmark of tuberculosis (TB). However, their function and mechanisms of formation remain poorly understood. To understand the role of granulomas in TB, we analyzed the proteomes of granulomas from subjects with tuberculosis in an unbiased manner. Using laser-capture microdissection, mass spectrometry and confocal microscopy, we generated detailed molecular maps of human granulomas. We found that the centers of granulomas have a pro-inflammatory environment that is characterized by the presence of antimicrobial peptides, reactive oxygen species and pro-inflammatory eicosanoids. Conversely, the tissue surrounding the caseum has a comparatively anti-inflammatory signature. These findings are consistent across a set of six human subjects and in rabbits. Although the balance between systemic pro- and anti-inflammatory signals is crucial to TB disease outcome, here we find that these signals are physically segregated within each granuloma. From the protein and lipid snapshots of human and rabbit lesions analyzed here, we hypothesize that the pathologic response to TB is shaped by the precise anatomical localization of these inflammatory pathways during the development of the granuloma."], "neg": ["Call to Develop a Standard Acquisition Charge Model for Kidney Paired Donation We propose a Medicare Demonstration Project to develop a standard acquisition charge for kidney paired donation. A new payment strategy is required because Medicare and commercial insurance companies may not directly pay living donor costs intended to lead to transplantation of a beneficiary of a different insurance provider. Until the 1970s, when organ procurement organizations were empowered to serve as financial intermediaries to pay the upfront recovery expenses for deceased donor kidneys before knowing the identity of the recipient, there existed similar limitations in the recovery and placement of deceased donor organs. Analogous to the recovery of deceased donor kidneys, kidney paired donation requires the evaluation of living donors before identifying their recipient. Tissue typing, crossmatching and transportation of living donors or their kidneys represent additional financial barriers. Finally, the administrative expenses of the organizations that identify and coordinate kidney paired donation transplantation require reimbursement akin to that necessary for organ procurement organizations. To expand access to kidney paired donation for more patients, we propose a model to reimburse paired donation expenses analogous to the proven strategy used for over 30 years to pay for deceased donor solid organ transplantation in America.", "Differential requirement for CARMA1 in agonist-selected T-cell development. Caspase recruitment domain-containing membrane-associated guanylate kinase protein-1 (CARMA1) is a critical component of the NF-kappaB signaling cascade mediated by TCR engagement. In addition to activation of na\u00efve T cells, TCR signaling is important for the development of agonist-selected T-cell subsets such as Treg, NKT cells, and CD8-alpha alpha T cells. However, little is known about the role of CARMA1 in the development of these lineages. Here we show that CARMA1-deficient mice (CARMA1(-/-)) have altered populations of specific subsets of agonist-selected T cells. Specifically, CARMA1(-/-) mice have impaired natural and adaptive Treg development, whereas NKT cell numbers are normal compared with wild-type mice. Interestingly, CD8-alpha alpha T cells, which may also be able to develop through an extrathymic selection pathway, are enriched in the gut of CARMA1(-/-) mice, whereas memory-phenotype CD4(+) T cells (CD62L(low)/CD44(high)) are present at reduced numbers in the periphery. These results indicate that CARMA1 is essential for Treg development, but is not necessary for the development of other agonist-selected T-cell subsets. Overall, these data reveal an important but differential role for CARMA1-mediated TCR signaling in T-cell development.", "Cellular roles of DNA topoisomerases: a molecular perspective DNA topoisomerases are the magicians of the DNA world \u2014 by allowing DNA strands or double helices to pass through each other, they can solve all of the topological problems of DNA in replication, transcription and other cellular transactions. Extensive biochemical and structural studies over the past three decades have provided molecular models of how the various subfamilies of DNA topoisomerase manipulate DNA. In this review, the cellular roles of these enzymes are examined from a molecular point of view.", "Non-invasive ventilation in chronic obstructive pulmonary disease patients: helmet versus facial mask The helmet is a new interface with the potential of increasing the success rate of non-invasive ventilation by improving tolerance. To perform a physiological comparison between the helmet and the conventional facial mask in delivering non-invasive ventilation in hypercapnic patients with chronic obstructive pulmonary disease. Prospective, controlled, randomized study with cross-over design. In 10 patients we evaluated gas exchange, inspiratory effort, patient\u2013ventilator synchrony and patient tolerance after 30 min of non-invasive ventilation delivered either by helmet or facial mask; both trials were preceded by periods of spontaneous unassisted breathing. Arterial blood gases, inspiratory effort, duration of diaphragm contraction and ventilator assistance, effort-to-support delays (at the beginning and at the end of inspiration), number of ineffective efforts, and patient comfort. Non-invasive ventilation improved gas exchange (p< 0.05) and inspiratory effort (p< 0.01) with both interfaces. The helmet, however, was less efficient than the mask in reducing inspiratory effort (p< 0.05) and worsened the patient\u2013ventilator synchrony, as indicated by the longer delays to trigger on (p< 0.05) and cycle off (p< 0.05) the mechanical assistance and by the number of ineffective efforts (p< 0.005). Patient comfort was no different with the two interfaces. Helmet and facial mask were equally tolerated and both were effective in ameliorating gas exchange and decreasing inspiratory effort. The helmet, however, was less efficient in decreasing inspiratory effort and worsened the patient\u2013ventilator interaction.", "Cardiac glycosides inhibit TNF-\u03b1/NF-\u03baB signaling by blocking recruitment of TNF receptor-associated death domain to the TNF receptor Digitoxin and structurally related cardiac glycoside drugs potently block activation of the TNF-\u03b1/NF-\u03baB signaling pathway. We have hypothesized that the mechanism might be discovered by searching systematically for selective inhibitory action through the entire pathway. We report that the common action of these drugs is to block the TNF-\u03b1-dependent binding of TNF receptor 1 to TNF receptor-associated death domain. This drug action can be observed with native cells, such as HeLa, and reconstituted systems prepared in HEK293 cells. All other antiinflammatory effects of digitoxin on NF-\u03baB and c-Jun N-terminal kinase pathways appear to follow from the blockade of this initial upstream signaling event.", "Folate and vitamin B6 from diet and supplements in relation to risk of coronary heart disease among women. CONTEXT Hyperhomocysteinemia is caused by genetic and lifestyle influences, including low intakes of folate and vitamin B6. However, prospective data relating intake of these vitamins to risk of coronary heart disease (CHD) are not available. OBJECTIVE To examine intakes of folate and vitamin B6 in relation to the incidence of nonfatal myocardial infarction (MI) and fatal CHD. DESIGN Prospective cohort study. SETTING AND PATIENTS In 1980, a total of 80082 women from the Nurses' Health Study with no previous history of cardiovascular disease, cancer, hypercholesterolemia, or diabetes completed a detailed food frequency questionnaire from which we derived usual intake of folate and vitamin B6. MAIN OUTCOME MEASURE Nonfatal MI and fatal CHD confirmed by World Health Organization criteria. RESULTS During 14 years of follow-up, we documented 658 incident cases of nonfatal MI and 281 cases of fatal CHD. After controlling for cardiovascular risk factors, including smoking and hypertension and intake of alcohol, fiber, vitamin E, and saturated, polyunsaturated, and trans fat, the relative risks (RRs) of CHD between extreme quintiles were 0.69 (95% confidence interval [CI], 0.55-0.87) for folate (median intake, 696 microg/d vs 158 microg/d) and 0.67 (95% CI, 0.53-0.85) for vitamin B6 (median intake, 4.6 mg/d vs 1.1 mg/d). Controlling for the same variables, the RR was 0.55 (95% CI, 0.41-0.74) among women in the highest quintile of both folate and vitamin B6 intake compared with the opposite extreme. Risk of CHD was reduced among women who regularly used multiple vitamins (RR=0.76; 95% CI, 0.65-0.90), the major source of folate and vitamin B6, and after excluding multiple vitamin users, among those with higher dietary intakes of folate and vitamin B6. In a subgroup analysis, compared with nondrinkers, the inverse association between a high-folate diet and CHD was strongest among women who consumed up to 1 alcoholic beverage per day (RR =0.69; 95% CI, 0.49-0.97) or more than 1 drink per day (RR=0.27; 95% CI, 0.13-0.58). CONCLUSION These results suggest that intake of folate and vitamin B6 above the current recommended dietary allowance may be important in the primary prevention of CHD among women.", "Prevalence of Multiple Sclerosis in Isfahan, Iran Background: The prevalence of multiple sclerosis (MS) shows considerable variability all over the world. According to Kurtzke, Iran is considered to have a low prevalence. Objective: To estimate the period prevalence and risk factors of MS in Isfahan, central part of Iran. Methods: A cross-sectional case register study conducted between 2004 and 2005. In the province of Isfahan, Iran, all patients known to have definite MS during 2004 and 2005, being alive and resident within Isfahan as well as being a member of the Isfahan MS Association were included in the study. Demographic and case-related information was recorded. 1,391 definite MS patients (308 men and 1,083 women) from the Isfahan MS Association, Iran, have been identified. The disease was confirmed using clinical information and MRI findings by a neurologist and radiologist. The patients were evaluated by interview and a questionnaire. Population data were obtained from the year 1999 Iran Census. The mean (SD) age of the participants was 32.5 (9.3) years with a mean (SD) duration of the disease of 6.4 (5.1) years for men and 6.9 (5.3) years for women. Results: The period prevalence of MS was 35.5 per 100,000 [95% confidence interval (CI) 33.6\u201337.3] in a population of 3,923,255, with a higher rate in women than men [54.5 (95% CI: 51.1\u201357.8) for women and 14.9 (95% CI: 13.3\u201316.6) for men]. The female/male ratio was 3.6 (95% CI: 3.2\u20134.1). The direct age-adjusted period prevalence was 59.5 per 100,000 (95% CI: 44.8\u201375.2) for women and 17.0 per 100,000 (95% CI: 8.9\u201325.1) for men. MS rates were highest among 30- to 39-year-olds and decreased with increasing age. Sensory and visual disturbances were the most common initial presentations with a prevalence of 51.1% (95% CI: 48.4\u201353.7) and 47.0% (95% CI: 44.4\u201349.7), respectively. Conclusion: Isfahan could be considered as an area with a medium to high risk of MS. This is in sharp contrast with the gradient hypothesis.", "CHROMOTHRIPSIS FROM DNA DAMAGE IN MICRONUCLEI Genome sequencing has uncovered a new mutational phenomenon in cancer and congenital disorders called chromothripsis. Chromothripsis is characterized by extensive genomic rearrangements and an oscillating pattern of DNA copy number levels, all curiously restricted to one or a few chromosomes. The mechanism for chromothripsis is unknown, but we previously proposed that it could occur through the physical isolation of chromosomes in aberrant nuclear structures called micronuclei. Here, using a combination of live cell imaging and single-cell genome sequencing, we demonstrate that micronucleus formation can indeed generate a spectrum of genomic rearrangements, some of which recapitulate all known features of chromothripsis. These events are restricted to the mis-segregated chromosome and occur within one cell division. We demonstrate that the mechanism for chromothripsis can involve the fragmentation and subsequent reassembly of a single chromatid from a micronucleus. Collectively, these experiments establish a new mutational process of which chromothripsis is one extreme outcome."]}, {"query": "Guanine nucleotide exchange factors (GEFs) mediate RhoA activation in response to tensional forces on fibronectin-binding integrins.", "pos": ["The Rho GEFs LARG and GEF-H1 regulate the mechanical response to force on integrins How individual cells respond to mechanical forces is of considerable interest to biologists as force affects many aspects of cell behaviour. The application of force on integrins triggers cytoskeletal rearrangements and growth of the associated adhesion complex, resulting in increased cellular stiffness, also known as reinforcement. Although RhoA has been shown to play a role during reinforcement, the molecular mechanisms that regulate its activity are unknown. By combining biochemical and biophysical approaches, we identified two guanine nucleotide exchange factors (GEFs), LARG and GEF-H1, as key molecules that regulate the cellular adaptation to force. We show that stimulation of integrins with tensional force triggers activation of these two GEFs and their recruitment to adhesion complexes. Surprisingly, activation of LARG and GEF-H1 involves distinct signalling pathways. Our results reveal that LARG is activated by the Src family tyrosine kinase Fyn, whereas GEF-H1 catalytic activity is enhanced by ERK downstream of a signalling cascade that includes FAK and Ras."], "neg": ["A twin-study of genetic contributions to morningness-eveningness and depression. Circadian rhythms are associated with the preference for sleep-wake timing, also known as morningness-eveningness (ME). Both circadian rhythms and ME are influenced by genetic factors. Studies show an association between eveningness and depression. This study investigates the heritability of ME and whether ME and depression share common genetic influences. Study participants (n = 1237) were from the Vietnam Era Twin Study of Aging, a longitudinal study of aging with a baseline in midlife. Participants received the Morningness-Eveningness Questionnaire (MEQ) and the Center for Epidemiologic Studies Depression (CES-D) Scale as part of an extensive neurocognitive and psychosocial assessment. MEQ correlations between members of twin pairs were 0.41 (95% CI 0.31-0.49) for monozygotic (MZ) twins and 0.28 for dizygotic (DZ) twins (95% CI 0.19-0.41). CES-D correlations were 0.38 (95% CI 0.28-0.46) for MZ twins and 0.24 (95% CI 0.14-0.36) for DZ twins. Greater eveningness (i.e. lower MEQ scores) was significantly related to more depression symptoms (phenotypic correlation = -0.15 (95% CI -0.21 to -0.09). In the best fitting model, the heritability estimates are 0.42 for the MEQ and 0.37 for the CES-D. A significant genetic correlation of -0.21 indicated that ME and depression share a significant amount of their underlying genetic variance. The genetic covariance between ME and depression accounted for 59.1% of the phenotypic correlation. Of the CES-D sub-scales, Depressed Mood and Interpersonal Difficulties were significantly heritable, while only Well-Being had a significant genetic correlation with ME. ME and depression are both heritable (ME 0.42, depression 0.37) and share common genetic factors, suggesting an overlap in etiology and the relevance of circadian rhythms to depression. Further study of this relationship may help elucidate etiological factors in depression and targets for treatment.", "Regulated nucleo/cytoplasmic exchange of HOG1 MAPK requires the importin beta homologs NMD5 and XPO1. MAP kinase signaling modules serve to transduce extracellular signals to the nucleus of eukaryotic cells, but little is known about how signals cross the nuclear envelope. Exposure of yeast cells to increases in extracellular osmolarity activates the HOG1 MAP kinase cascade, which is composed of three tiers of protein kinases, namely the SSK2, SSK22 and STE11 MAPKKKs, the PBS2 MAPKK, and the HOG1 MAPK. Using green fluorescent protein (GFP) fusions of these kinases, we found that HOG1, PBS2 and STE11 localize to the cytoplasm of unstressed cells. Following osmotic stress, HOG1, but neither PBS2 nor STE11, translocates into the nucleus. HOG1 translocation occurs very rapidly, is transient, and correlates with the phosphorylation and activation of the MAP kinase by its MAPKK. HOG1 phosphorylation is necessary and sufficient for nuclear translocation, because a catalytically inactive kinase when phosphorylated is translocated to the nucleus as efficiently as the wild-type. Nuclear import of the MAPK under stress conditions requires the activity of the small GTP binding protein Ran-GSP1, but not the NLS-binding importin alpha/beta heterodimer. Rather, HOG1 import requires the activity of a gene, NMD5, that encodes a novel importin beta homolog. Similarly, export of dephosphorylated HOG1 from the nucleus requires the activity of the NES receptor XPO1/CRM1. Our findings define the requirements for the regulated nuclear transport of a stress-activated MAP kinase.", "The challenges of overcoming antibiotic resistance: Plant extracts as potential sources of antimicrobial and resistance modifying agents The problem of antibiotic resistance, which has limited the use of cheap and old antibiotics, has necessitated the need for a continued search for new antimicrobial compounds. Understanding the mechanisms of resistance is important in the development of strategies to solving the problem. Active efflux of drugs, alteration of target sites and enzymatic degradations are the strategies by which pathogenic bacteria acquire or develop intrinsic resistance to antibiotics. Multi-drug resistance (MDR) pumps, capable of recognizing and expelling a variety of structurally unrelated compounds from the bacterial cell and conferring resistance to a wide range of antibiotics have since been characterized in many gram positive and gram negative pathogens like Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli and, more recently, in mycobacteria. The ability of some chemical compounds (called MDR inhibitors or resistance modifying agents) to modify the resistance phenotype in bacteria by working synergistically with antibiotics in vitro has since been observed. The search for such compounds which can be combined with antibiotics in the treatment of drug resistant infections may be an alternative to overcoming the problem of resistance in bacteria. Crude extracts of medicinal plants stand out as veritable sources of potential resistance modifying agents and the African biosphere promises to be a potential source of such compounds owing to its rich plant species diversity.", "Increased gene expression of brown fat uncoupling protein (UCP)1 and skeletal muscle UCP2 and UCP3 in MAC16-induced cancer cachexia. Weight loss in cancer cachexia is attributable to decreased food intake and/or enhanced energy expenditure. We investigated the roles of the uncoupling proteins (UCPs) UCPI, -2, and -3 in a murine model of cachexia, the MAC16 adenocarcinoma. Weight fell to 24% below that of non-tumor-bearing controls (P < 0.01) 18 days after MAC16 inoculation, with significant reductions in fat-pad mass (-67%; P < 0.01) and muscle mass (-20%; P < 0.01). Food intake was 26-60% lower (P < 0.01) than in controls on days 17-18. Non-tumor-bearing mice, pair-fed to match MAC16-induced hypophagia, showed less weight loss (10% below controls, P < 0.01; 16% above MAC-16, P < 0.01) and smaller decreases in fat-pad mass (21% below controls, P < 0.01). Core temperature in MAC16 mice was significantly lower (-2.4 degrees C, P < 0.01) than in controls, and pair-feeding had no effect. MAC16 mice showed significantly higher UCP1 mRNA levels in brown adipose tissue (BAT) than in controls (+63%, P < 0.01), and pair-feeding had no effect. UCP2 and -3 expression in BAT did not differ significantly between groups. By contrast, UCP2 mRNA levels in skeletal muscle were comparably increased in both MAC16 and pair-fed groups (respectively, 183 and 163% above controls; both, P < 0.05), with no significant difference between these two groups. Similarly, UCP3 mRNA was significantly higher than controls in both MAC16 (+163%, P < 0.05) and pair-fed (+253%, P < 0.01) groups, with no significant difference between the two experimental groups. Overexpression of UCP1 in BAT in MAC16-bearing mice may be an adaptive response to hypothermia, which is apparently induced by tumor products; increased thermogenesis in BAT could increase total energy expenditure and, thus, contribute to tissue wasting. Increased UCP2 and -3 expression in muscle are both attributable to reduced food intake and may be involved in lipid utilization during lipolysis in MAC16-induced cachexia.", "Keratin-dependent regulation of Aire and gene expression in skin tumor keratinocytes Expression of the intermediate filament protein keratin 17 (K17) is robustly upregulated in inflammatory skin diseases and in many tumors originating in stratified and pseudostratified epithelia. We report that autoimmune regulator (Aire), a transcriptional regulator, is inducibly expressed in human and mouse tumor keratinocytes in a K17-dependent manner and is required for timely onset of Gli2-induced skin tumorigenesis in mice. The induction of Aire mRNA in keratinocytes depends on a functional interaction between K17 and the heterogeneous nuclear ribonucleoprotein hnRNP K. Further, K17 colocalizes with Aire protein in the nucleus of tumor-prone keratinocytes, and each factor is bound to a specific promoter region featuring an NF-\u03baB consensus sequence in a relevant subset of K17- and Aire-dependent proinflammatory genes. These findings provide radically new insight into keratin intermediate filament and Aire function, along with a molecular basis for the K17-dependent amplification of inflammatory and immune responses in diseased epithelia.", "Glutamate mediates the function of melanocortin receptor 4 on Sim1 neurons in body weight regulation. The melanocortin receptor 4 (MC4R) is a well-established mediator of body weight homeostasis. However, the neurotransmitter(s) that mediate MC4R function remain largely unknown; as a result, little is known about the second-order neurons of the MC4R neural pathway. Single-minded 1 (Sim1)-expressing brain regions, which include the paraventricular nucleus of hypothalamus (PVH), represent key brain sites that mediate melanocortin action. We conditionally restored MC4R expression in Sim1 neurons in the background of Mc4r-null mice. The restoration dramatically reduced obesity in Mc4r-null mice. The anti-obesity effect was completely reversed by selective disruption of glutamate release from those same Sim1 neurons. The reversal was caused by lower energy expenditure and hyperphagia. Corroboratively, selective disruption of glutamate release from adult PVH neurons led to rapid obesity development via reduced energy expenditure and hyperphagia. Thus, this study establishes glutamate as the primary neurotransmitter that mediates MC4Rs on Sim1 neurons in body weight regulation.", "Human SNP Links Differential Outcomes in Inflammatory and Infectious Disease to a FOXO3-Regulated Pathway The clinical course and eventual outcome, or prognosis, of complex diseases varies enormously between affected individuals. This variability critically determines the impact a disease has on a patient's life but is very poorly understood. Here, we exploit existing genome-wide association study data to gain insight into the role of genetics in prognosis. We identify a noncoding polymorphism in FOXO3A (rs12212067: T > G) at which the minor (G) allele, despite not being associated with disease susceptibility, is associated with a milder course of Crohn's disease and rheumatoid arthritis and with increased risk of severe malaria. Minor allele carriage is shown to limit inflammatory responses in monocytes via a FOXO3-driven pathway, which through TGF\u03b21 reduces production of proinflammatory cytokines, including TNF\u03b1, and increases production of anti-inflammatory cytokines, including IL-10. Thus, we uncover a shared genetic contribution to prognosis in distinct diseases that operates via a FOXO3-driven pathway modulating inflammatory responses.", "Depressive symptoms and physical decline in community-dwelling older persons. CONTEXT Significant symptoms of depression are common in the older community-dwelling population. Although depressive symptoms and disability may commonly occur in the same person, whether depressive symptoms contribute to subsequent functional decline has not been elucidated. OBJECTIVE To determine whether depressive symptoms in older persons increase the risk of subsequent decline in physical function as measured by objective performance-based tests. DESIGN A 4-year prospective cohort study. SETTING The communities of Iowa and Washington counties, Iowa. PARTICIPANTS A total of 1286 persons aged 71 years and older who completed a short battery of physical performance tests in 1988 and again 4 years later. MAIN OUTCOME MEASURES Baseline depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale. Physical performance tests included an assessment of standing balance, a timed 2.4-m (8-ft) walk, and a timed test of 5 repetitions of rising from a chair and sitting down. RESULTS After adjustment for baseline performance score, health status, and sociodemographic factors, increasing levels of depressive symptoms were predictive of greater decline in physical performance over 4 years (odds ratio for decline in those with depressed mood vs those without, 1.55; 95% confidence interval [CI], 1.02-2.34). Even among those at the high end of the functional spectrum, who reported no disability, the severity of depressive symptoms predicted subsequent decline in physical performance (odds ratio for decline, 1.03; 95% CI, 1.00-1.08). CONCLUSIONS This study provides evidence that older persons who report depressive symptoms are at higher risk of subsequent physical decline. These results suggest that prevention or reduction of depressed mood could play a role in reducing functional decline in older persons."]}], "Touche2020": [{"query": "Should fighting be allowed in hockey?", "pos": ["Fighting in Hockey Needs to Be Banned Fighting in Ice Hockey is very common, but there have been some people who wanted it to stop. Why? Because it's dangerous. Now I won't deny Fighting is dangerous and could potentially hurt you, but It is has been part of the game since the beginning. So there's no reason why Fighting should be banned when in reality it won't do anything and the fans will just end up fighting which will cause a whole lot of controversy.", "Should Fighting be Allowed in Hockey While fighting might not be too different from the natural physicality of hockey, the way it is presented and glorified within the sport does propose an ethical dilemma. A body check into the boards is violent but it is not staged the same way as a fight is. When the helmets and gloves come off for a fight, fans of all ages see a part of the game that no longer belongs in today's society. Big hits will always happen in sports, whether it be in hockey, football, lacrosse, etc., but that should be the extent of glorified physicality. Hockey and its designated enforcers leave a negative impression on youth fans and players who look to emulate professional athletes. Rather than working to become a talented hockey player, some kids would rather become the guy who goes for \"big hits\" and is known for their physical play rather than developing useful skills within the sport. This influence of violence does bring up ethical concerns, as it changes the way youth players see and play the game. Physical violence is not an appropriate response to conflict, even within a physical sport. The concept of sportsmanship and playing the game the \"right way\" is put in danger by giving fighting a home in the sport of hockey.", "Should Fighting be Allowed in Hockey While fines may be an effective way for the NBA to hold its players accountable, that is largely because there is no other historical avenue for conflict resolution in the NBA. As mentioned previously, fighting in hockey has been an integral aspect of the sport since the formation of the National Hockey League. Furthermore, it is not as if these fights are completely unregulated. In the 1980's there was an average of 1 fight per NHL (100%). As a response to this, the League implemented new rules governing fighting. These rules still allowed fights to take place, they just assigned a 2-5 minute penalty to the players involved. This penalty causes players to be judicious about when they choose to fight. This is similar to the penalty system in many sports: soccer players shown to be more judicious about the use of aggressive plays after they have already received a yellow card, NBA athletes are more cautious about play after they have received 3 fouls, etc. Additionally, if the concern about fighting is motivated by a concern for the players, then the opinions of these players should be considered. A survey of NHL players conducted in 2012 asked them whether or not they believed fighting should remain a practice in the NHL, 98% of them responded that it should be. This demonstrates that the players involved, who are cognizant of the risks associated with the activity, still see a value in it and would like it to remain.", "Should Fighting be Allowed in Hockey Fighting in hockey, and in sports in general, should not be permissible for any reason. While fighting does have a historic place in the way hockey is played and is often a notable reason why people watch hockey in the first place, it should not be allowed moving forward. Player safety should be at the forefront of sports, and by allowing fighting in hockey, the sport is openly showing its disregard for such safety. Hockey leagues do not need players to police each other and hold each other accountable, that's what referees and league punishments are for. Basketball is a relatively physical sport as well, however the NBA generally does a good job of enforcing appropriate fines and penalties to discourage excessive violence on the court. These monetary fines, game suspensions, and other punishments all hold players accountable without relying on the players to do it themselves. Hockey is one of the very few sports where it is seen as acceptable to have designated players that serve no role other than to protect the team's talented star players from getting hurt in a fight - a sign that the sport needs to change its standards to reduce violence among its players. Cheap shots will always occur in sports, however it is better to address those dirty plays with real-life punishments that affect the player's ability to participate and make financial gains, rather than by putting them in a glass box for a few minutes.", "Should Fighting be Allowed in Hockey Fighting in hockey has always existed as a defining feature of the sport, and it has been accommodated in the rules for the NHL since the league's establishment in 1917. The practice of fighting in NHL games should be protected because it is not simply an exercise of unchecked aggression, but rather a tool to be used to hold players accountable for their actions. With 12 players on the rink at once and only 3 officials to regulate them, players often get away illegal/dangerous checks. In the absence of consistent regulation, fighting in hockey allows for the players to police one another. The knowledge that a dirty play or a cheap shot will likely result in retaliation offers an effective deterrent against players engaging in these potentially harmful activities. While fighting admittedly introduces a risk for injury, the severity of this injury pales in comparison to the potential injuries one might sustain from an illegal check.", "Fighting in Hockey Needs to Be Banned Let me start by criticizing my opponents opening comments. I will build my argument as to why fighting in hockey should be banned in round 2. \"Now I won't deny Fighting is dangerous and could potentially hurt you, but It is has been part of the game since the beginning. So there's no reason why Fighting should be banned when in reality it won't do anything and the fans will just end up fighting which will cause a whole lot of controversy. \"There are a couple of things wrong with what my opponent has said, and I will explain. First he agreed that fighting is dangerous, then he said 'but it has been in the game since the beginning. ' In the beginning of the NHL, players, including the goaltender didn't have to wear helmets/masks, so saying that it should stay the same to follow tradition, isn't a good enough point. My opponent then continues on to say that there is no reason for fighting to be banned because \"it won't do anything\". If fighting is banned, which would make the punishment more than a 5 minute penalty like it is now, fighting would probably disappear because players wouldn't put their careers at risk. And yes banning fighting would prevent the injuries of many players, and if fighting was banned already, it would have most likely prevented the deaths of Wade Balek, Rick Rypien and Derek Boogaard, who have all died because of reasons related to their career as a fighter in the NHL. My opponent said that fans \"will just end up fighting\" if fighting in the NHL is banned. I disagree, because anger between fan bases occurs very often because of a fight between two players, which starts huge and bitter rivalries. Good Luck."], "neg": ["Division I College Football Should Implement a Play-off System The BCS: The Bull Sh*t Championship. Look at any sport, where do computers and peoples opinions play any factor in who wins a championship? The best team is decided on the field, and through a play-off. Look at the MLB, MLL, MLS, NBA, and NHL they all have play-off systems. The NHL, MLB, and NBA all even have play-off systems for their minor leagues teams (NFL, MLL, and MLS don't have minor leagues). Each sports uses their own system, but they all work and at the end no one can doubt that the team that survived the test of the play-offs is not truly the Champion. The BCS has left a bad taste in everyone's mouth, because for all the hype and prestige that college football gets: The championship is rigged. When the Magic where facing the Cav's in the Eastern Confrence Finals, everyone wanted to see Kobe/Lebron, Stan Van Gundy (The Magic Coach) angerly replied to reporters on the question of everyone wanting to see those 2 in the finals, \"This isn't the BCS where people get to vote [on] who gets to play. This is real sports where it's decided on the court.\" But WAIT, these are just kids where talking about\u2026poor little college althetes who could in no way stand the tests or pressure of a play-off system. BS, look at NCAA College Football FBS-Subdivision, NCAA College Football D-II, NCAA College Football D-III, NCAAB (D-I, D-II, D-III), NCAABW (D-I, D-II, D-III), College Soccer (Men's and Women's), College Volleyball (Men and Women's), College Baseball, College Softball, College Hockey (Men and Women's), College Lacrosse, and even College Water Polo. Let's even look below college, in all division of High School football in every state of America, and Washington D. C., High School football teams span the rigiourous test of a play-off system to win a state championship (When my high school team won state last year we played in 6 play-off games), also High School Basketball, Volleyball, Soccer, Baseball, and Softball teams all compete in play-offs. When everyone at every level, everywhere is competing in a play-off what's stopping D-I college football? The Plan: Have one 16-team play-off system seed 1 through 16. The winners of each 11 conferences getting an automatic bid (To be determined by the conferences themselves) and 5 at large bids to be determined by a committee similar to the basketball selection committee for the NCAA Basketball Tournaments. The System would see games staged the week after the conclusion of the regular season with the 1 vs. 16 seed, 2 vs. 15 seed and so on. The tournament would be standarded bracketed with the one seed hitting either the 8 or the 9th seed in the second round. The first two round would be played with the lower seed having the home field advantage, where the semi's and final's would be held at neutral sites (Most likely the Rose, Orange, and Fiesta bowl locations). [Please, keep in mind this is only the most ideal and competative format. Their are dozens of other possibilities for a play-off system, I am only suggesting one to fall back on in this debate. Simply because any voters or my challenger disagree with the system I am proposing doesn't mean you should vote against me. You have to see the logic of my analysis based on why we need a play-off system, not which one is perfec] Contention #1- Stuck on an Outdated Bowl System Dan Wetzel may have said it best, when he stated, \"Ignore outdated bowls games. BCS bowl games are the single worst deal in American sports.\" Basically the bowl system works like this: Copurrate sponsors set up and run bowls, make huge profits of advertising and sales while dish some money to the teams participating. I have nothing against using bowl games to celebrate a winning season for a college football team, if anything it's a good reward for having a successful season, But the problem resides in the fact that no one is willing to think outside of the Bowls for any practical solution. The Rose Bowl, and Orange Bowl, and Fiesta Bowl hold so much history in college football to let them slip the way side would just be terrible. Not when the real solution is better. As far as bowl games are concerned: They can remain. As long as teams are eligible and willing to participate in then why not host them? But this must be done con-current with a 16 team play-off system where the best teams compete against each other to produce a champion. Contention #2- The Season Would be TOOOOOO Long Again, I really want to talk to the people that feed America this bull. What if I could tell you that with in a college football play-off the season would be shorter, fewer teams would have to play/practice as long, and thus midigate the risk of injury? Ok, so eight teams would play and extra game, four two, and two three. A relatively small price to pay: a total of seven extra games for over a hundred schools in D-I. And the play-off system could have some sense about it and start the week after the conclusion of the regular season, taking a way the month of practicing and extra workouts coach put their players through because they are play in a bowl game Jan. 7th when the season ended Dec. 3rd. Also conferences, like the Big Ten would not have to play with the severe handi-cap of taking almost 2 months off before playing in a BCS game just because they finished their seasons earlier due to more compact scheduling. People argue that to many kids would miss class with this longer season: 1) I just shortened it 2) Look at these football programs, all of them demand so much time from a student its unrealistic to think they're man focus is on school and not football. If I still haven't convincied you look at this: Due to the way college football runs its clock, there are about 10 percent more plays in a college game than a pro one (135 to 122), which means they're already playing an extra game, game and a half now. Change the clock timing, and boom you shave the number of games being played by almost 50, and then you add 7 extra. That saves 43 games players could get injured in, nice. Contention #3- College Football Would Be Fair How would you like to play in a league, where at the beginning of the season the coach sits your whole team down and says, \"Look guys, I don't care if we blow everyone out by 50 points, Go Undefeated, and winner the MAC. The Truth is we can't win a championship this year, because we don't have a \u2018history' of being good.\" Why even have teams in a league who can't win? You laugh, and say \u2018everyone has a fair shot'. Go bring that up with the people from Utah, the only undefeated team in D-I this year, where is their Championship? Or what about Boise state in '07? Or Utah(again) in '02? What happened their? You know what happened, the system is rigged. It is fixed towards the big schools, who will draw the big crowds and get the big rating and consequently make the big bucks for the cooperate sponsor's of the BCS games (Tostitos, FedEx). A play-off system would allow un-bias and fair results by allowing champions of smaller conferences to play with the big boys, and if they lose so what? At least they had their chance, but when they win that would be something else. The magic of the NCAA Basketball tournament resides in the \u2018Cinderella' run of a huge under-dog. Why not allow that in College Football? Quite simply their is only one solution. College football must change over to a play-off system. If they want to keep their credibility, or even pretend they are a 'real' sport. With die hard competion. Then prove it, what are they scared of? In America we have a system, one system to determine the champion, the best, and that system is a play-off.", "Girls on boys team Girls want to join boys sports when they already have their own. Now, is that very fair to the boys doing sports? And also it's not fair to boys that if girls get hurt that the parents can blame the coach.", "Test Cricket is the real test for the players and should be played more often. My worthy opponent makes no mention that 5 day cricket games are exclusive to the unemployed rich. He also states that the training value of 5 day games is good for normal length games. Perhaps, but practice and drills with proper coaching would help that without the risks of permanent injury and losing a work week to practice. As a coach, I can tell you people learn better rested. \" It only contends that Test Cricket is a real test and real challenge for the players and that it should be more played often. It does not say that we should ban other forms of cricket and play only test matches\" Not including those who have to work for a living. Access to 5 straight days of playing is for rich kids. It is only the children of the rich that can afford this. A working guy would maybe want to play 3-4 games on his vacation, not one long game and have no time for himself, family. Further more, 5 days for an athlete or normal person is unhealthy. The chance of being injured while fatigued increases as well an increase chance of permanent injuries and dehydration. \"Money is only a secondary factor here.\" Money makes it possible to have the best athletes possible. Better athletes, better game. If you were an athlete that had the choice to play baseball for $1 million a year or cricket for $50,000 year what would you choose? What would most people choose? And I'm going to play a sport that might get me injured and risk my family's quality of life? I think not. For less cash than my talent allows? I think not. Sorry money is a factor. Olympics for example, there's a direct correlation between countries who sponsor their athletes and the amount of medals they win. Speaking of Olympics, who won the gold for Cricket? Oh wait, no one! Cricket isn't in the Olympics. So much for crossing regional, cultural and ethnic lines. So much for being \"widely acclaimed\". Let's use Lacrosse for an example. They would have three day games on fields miles long. Sometimes it resulted in death. Do you think lacrosse would be more popular or less popular if they still had these games? Obviously, putting their energy into new rules, new equipment and changing the game for the *safety* of the players brings out the best game possible. \"It is agreed that the game may have less commoners or viewers of the game , but for the players to nurture their skills, playing considerable amount of test cricket is necessary. Its agreeable that sports should have entertainment coupled with it, but if you want quality sports or quality cricket, you do need to sacrifice a little of entertainment.\" \"Commoners\"? I dare venture, by the use of the word \"commoner\", example; the lowest class in society, that my opponent sees class and social status equated with the ability to play throughout the work week. The effect a cheering crowd has on an athlete is motivation; to do better, to try hard, to dig deep. That's gone with your 5 day games. Quality sports is entertainment for the players and the fans. Slow, tired, injury prone athletes playing a game of attrition does not appeal to this commoner. \"Injuries are a part of every game....\" The human body can only take so much punishment. You lose your players, who aren't making much money anyways, and how do they support themselves? How does a farmer go back to harvesting when he's got a torn ligament and can't afford treatment? Sure, being hurt is part of the game. But being injured? The pride of athletes do not let them quit. Player will run on torn achilles tendons, broken bones and concussions if you let them. Treated promptly it can heal. But you would have a 18 year old kid play 4 more days with an injury limp the rest of his life because you would call him weak and unfit.", "is hockey too violent Hokey is a game where you get smashed into walls and your supposed to be ok with that, to keep playing even though you know there was a guy that just floored you is just asking for a fight", "Football should be banned as an organized sport for high school students Thank you, Storm. I will address your study after I\"ve had a chance to defend my core positions. Forgive me if I dismiss the original structure of the arguments, but I am trying to tie certain points together here. I would like to re-focus my first contention to a more principled debate, specifically examining the issues of personal choice and safety. Yes, high school football can be dangerous, but I don\"t think my argument overlooks the harm. Rather, I am trying to show that despite risk, there are other values at stake. Surely, it is difficult to weigh an immaterial value against injury statistics, but I think that self-determination should be thought of, for the most part, inviolable, as it remains a critical component of our heritage and community ethos. Just like adults, high school students have rights, including free speech, freedom from illegal search and seizure, and even a high degree of self-governance depending on parameters set by their parents. It should be mentioned also that many high school players are legally adults since they reach 18 during or before their senior year of high school. As a side note, even if you could make a case that some high school students should not play based on their status as minors, you could not justify an outright ban since you would be counting legal adults. At most, you should be restricting certain players, and not the sport entirely. More importantly, if an activity\"s harmfulness were the sole criterion to determine its legality, many high school sports would face severe restrictions or bans based on this precedent. To say we should only ban football formulates a contradictory precedent, both legally and morally. According to Business Insider, Men\"s Baseball has 4.6 casualties per million (partcipants) Men\"s Track and Field-4.7 casualties per million Men\"s Wrestling-9.1 casualties per million Men\"s Lacrosse- 12.7 casualties per million Women\"s Gymnastics- 13.7 casualties per million While football ranks high at 19 casualties per million, it is by no means the highest as hockey tops the list at 25 casualties per million. Note: \"casualties\" includes fatalities, permanent disabilities, and non-permanent brain/spinal cord injuries, such as concussions. Why is it important we allow high school students to access dangerous sports, including football? Personal choice is about creating self-definition, learning your own limits, and developing responsible habits, all of which critically play a role in becoming a mature adult. While I would by no means trivialize the injuries suffered, data from Business Insider indicates that since 1982, only .00002% of players experience permanent injuries, death, or non-permanent concussions from high school football. This means that you would be denying the sport to the unaffected 99.99998% of players, players that are learning teamwork, finding inclusion, and building self-esteem. Football may not be the safest sport, but schools and organizations are all the time trying to create rules and enhance safety equipment to prevent injury. Football is rough, yes, but it is a highly regulated game, where players\" safety remains the top concern. Also, you did not address my additional point from the last round that for many students, these same values cannot entirely be iterated in other sports due to those sports\" lack of dynamicism and inclusion. For clarification, please see my last argument. To clarify an earlier point, I was using the example of cars to show that even though they are not necessary in certain environments or situations, we do not restrict their usage or ban them outright. If cars were legal solely because of economic or infrastructural concerns, we would heavily restrict their usage, for example, prohibiting drives across country or at certain times during the night. That we don\"t, demonstrates the value we place on freedom. Also, mentioning possible bans on spelunking, mountain climbing, or hiking was meant to show that the ethos of your position is wrong. We don\"t regulate many voluntary dangerous activities not because they are necessary, but because we pride ourselves on supporting personal choice. Along this same vein, I do not understand your reply to my first point, as you say that these are \"adult activities\" or \"involve a stronger adult presence,\" which is not true as high school students can and do undertake these activities without adult supervision. I would also like to suggest that high school football has even more adult supervision than many of these other legal activities; referees can penalize or eject unruly and abusive players. Given the amount of scrutiny and regulation that high school football receives, I would like to reiterate my earlier point about \"unofficial\" football games. Your reply seems to suggest that we do not have to endorse it on an institutional level, but I will respond by saying that we should if it serves to enhance safety, which is your primary concern. Motorcycles, for example, are dangerous and fun but very unnecessary. You must, however, get a motorcycle license to operate one because the state realizes that banning them would be improper, so if people are going to drive them, they should have to go through a special designation. Football is just the same, because letting unofficial games run wild would mean less regulation and safety equipment, which means more injuries. Now, as to the separate issue regarding funding, I stand by my previous point in saying that unless you provide evidence for a specific trade-off with other activities or benefits, you can\"t claim this as an advantage to your plan. You don\"t know where the money would go, if it would even still be applied to the school\"s budget. Applying the money directly back to the county isn\"t always a good thing. Maybe it goes toward tax breaks for companies that pollute the environment or some other nefarious purpose. More importantly than this point, you are taking money away from the school. Lots of alumni donate because of the football programs create so much pride about the school in general. It attracts other interested donors; my school had a new science building built by the grandparents of our football quarterback. Not to mention, if you take away the salaries of coaches, they might have to turn to the public welfare system because of their devalued skill sets. These impacts are only immediate, and I could reasonably guess also that college football programs would suffer loss of viewership as recruits without four years preparation become dramatically less skilled. Televised games produce millions in revenue, which means jobs. How would the NFL fare after their players\" skill trajectories have been set behind by four years? Lastly, I would like to briefly address the study you posted. First, I was not able to find a free full pdf version of this article, which means that I am replying based upon reading the abstract. If you can provide the full free version, please provide a link in your next post. Second, this article doesn\"t really bring up anything new that we haven\"t already assumed in our conversation thus far, and I think you are extrapolating too much in what you are claiming the article provides evidence for. Yes, football players take a lot of hits, most of which are sub-concussive; this is the nature of the game, and really the nature of many other contact sports like lacrosse or hockey. This article though does not articulate the relationship between sub-concussive hits and cognitive decline later in life, only saying that the potential relationship could \"raise concern.\" Brain science is tricky and determining causality for adults with cognitive decline who played high school football years ago gets even trickier. Note that the article also seems to argue for new safety considerations and not an outright ban on the sport entirely. If this becomes a bigger issue, then I can respond with more. I yield back to Pro.", "Resolved: In the United States, steroid usage should be permitted for all sports. I extend my arguments, steroids should not be allowed within sports.", "Hockey is better than soccer Time for rebuttals First argument The cost and the simplicity does not make soccer better than hockey. Hockey is a sport of talent. Not everyone can skate or stick handle, but everyone can run and kick a ball. Second argument The pace of the game has a big factor in entertainment. Would you sit and watch a game of any sport were the players just walked around slowly? That would not be a good sport to watch. While you talk about a man dribbling past 4 guys, a hockey player can do just the same with a puck. Have you ever watched someone split the defense before? Hockey players also display the positional awareness of there team mates and opposing players while keeping pace with both them and the puck. Hockey players are the fastest people on two feet while on the ice. Hockey players also demonstrate skill on the ice during a game while also adding in contact, making more of a challenge. Longer games can be enjoyable if there is a lot of action. There is not much action in soccer compared to hockey. In hockey you are watching a game that is constantly in motion. No matter what position you play you are always moving. A soccer game can get boring after an hour of watching men/woman running back and forth with a ball, kicking it out of bounds and having to throw it back in. Third argument The video is just showing a few clips of what constantly happens during a soccer game. Hockey players do not embellish because that gives them penalties. Soccer players embellish a lot. Fourth argument This one is simple. Large net small goalie, not many goals. Small net large goalie, still more goals then soccer. Simple as that. Fifth argument Have you ever watched the winter classics or the other outdoor games hockey players have been in? They play in a lot of snow. Hockey is mostly played in doors so they are not really exposed to this weather. That makes it better for fans. You do not have to worry about games being canceled/rescheduled because of weather. Sixth argument The equipment does not protect you from everything. There are gaps in the equipment. And getting hit as hard as they are, the equipment just simply absorbs some of the power behind the hit, but it will still hurt ( trust me) when players fight they take off there gloves ( throw down) helmets are not allowed to be taken off, but most of the time they come off with the power of a hit. Hockey players are on the ice 35-45 seconds at a time because while they are on the ice they are constantly moving. If you were to watch a game of hockey, you would notice that while a player is on the ice they are never standing still. They are always skating from one end of the ice to the other. Soccer players might play longer shifts, but that is because they are not constantly in motion. To add to the fact of how tough hockey players are. When you see a soccer player get injured (or pretty much any sports player) you see them lay on the ground until they are taken off by stretcher or helped off. In hockey, the players get up and skate off on there on. The only time you will not see that happen is if they are knocked out. Here is an example. Last season, Paul Martin, who plays for the Pittsburgh Penguins, broke the upper part of his leg. He skated to the bench and sat down to wait for his next shift. He did not realize his leg was broken until he stood up for his next shift and felt the bone move. Another example would be Clint Malarchuk. During a game he had his jugular vein cut by a skate. He refused to get on the stretcher. He skated off the ice on his own. ( he lived) the link to the video is below. If you don't like the sight of blood DON'T WATCH. Seventh argument Out of bounds rarely happens during a hockey game. Getting the game back in motion happens in a matter of seconds. http://video.nhl.com...", "fighting should be banned from the NHL I guess this means I have won science you have forfeited. fighting in hockey should not be banned. that is my final answer. take it or leave it. (you better have taken it. or you better take it! :P )"]}, {"query": "Should abortion be legal?", "pos": ["Should abortion be legal Abortions should be legal as Personhood begins after a fetus becomes viable or after birth, not at conception. According to the U.S. Supreme Court a person is to get their age when they are out of the mother's womb and breathing oxygen starting at the 0 mark eventually working their way up to be 1 years old.", "Abortion I accept the challenge offered me by Pro, even though I by and large agree with Pro's argument that abortion-on-demand is not defensible, but that abortion is defensible in rare cases such as rape or the mother's life being in danger, and I never argue against that with which I agree of course (which would make no sense). I agree with the conclusion that abortion should be legal only in specific cases as well, leaving me only one thing I can disagree with here, and that less stringently, that a child should not be killed for the sake of physical abnormality. I presume this was the point Pro wished to debate with me on, since my user page makes clear that I support abortion in the case of rare circumstances such as rape and life of the mother, and possibly even as late as 12 weeks. For the sake of clarity, I will first elucidate my reasoning on abortion in general, and then explain my reasoning on the sole point of disagreement. My Views on Abortion in GeneralMy reasoning, as aditionally stated here[1], is as follows:Ultimately, right to privacy is no justification for killing another human being, whether in the privacy of one's own home or own body. Right to choice does not justify choosing to harm another person, and right to one's body cannot justify using that body to harm another person. As such, rights, choices, and privacy are no excuse for harming another person if they are indeed a person, erego, this question revolves necessarily around the issue of personhood. While potential exceptions naturally exist such as rape and life of the mother, since in the case she did not make a sexual decision to be held accountable for, and when her life is endangered by the pregnancy, her life is also at stake, and she should have a choice to save her life (obviously), abortion on demand is ultimately not justifiable when a child is apparently human.Thus, this revolves around the issue of personhood and fetal viability, when a child becomes human, for if it is human, no buzzword argument is sufficient to justify its murder save in such rare circumstances. Furthermore, that such rare circumstances should be raised by those who seek to justify abortion-on-demand evidences that they themselves realize abortion can only be justified in such rare cases, and fallaciously use said cases in an attempt to justify abortion more broadly. When it comes to fetal viability, completed brain cells appear within the first 2 weeks of pregnancy. The heart beats at 3 weeks. Blood flows in the baby's veins separate from the mother's blood at 4 weeks. Brain wave activity occurs at 6 weeks. Based on nervous system development, perception of pain likely begins at 8 weeks. Thumb sucking occurs at 9 weeks. The entire body is sensitive to touch at 10 weeks. Breathing of amniotic fluid and all facial expressions visible (e.g. smiling) at 11 weeks. Crying at 12 weeks, as well as the ability to practice breathing. All senses present including vocal chords at 13 weeks.[2] The earliest recorded successful pregnancy is at 21 weeks[3] even though abortion is allowed in all 9 months of pregnancy.[4] As such, it is logical that a minimum of 18,150 abortions, 1.5% of the 1.21 million annual abortion according to Planned Parenthood's own statistics arm, the Guttmacher Institute, are murder each year, since they occur after the 21st week of pregnancy.[5]So what does public polling show the American people believe? According to Gallup[6] while 62% of Americans support abortion during the first trimester (12 week period of pregnancy), only 24% support abortion in the second trimester, and only 10% for the third trimester. 83% of Americans support abortion when the mother's life is endangered, 82% when the woman's physical health is endangered, 75% when the pregnancy was caused by rape/incest, 61% when the woman's mental health is endangered, 51% when there is evidence the baby may be mentally impaired, 50% when the baby may be physically impaired, and only 36% when the woman or family cannot afford to raise the child. Ultimately, 20% of Americans believe abortion should always be illegal, 39% that it should be legal only in a few circumstances, 13% that it should be legal in most circumstances, 25% that it should always be legal, and 4% hold no opinion.As such, the majority of Americans, over 75%, disagree with abortion after the first 12 weeks of pregnancy, and can recognize that abortion beyond this point is clearly murder. Only 36% believe abortion justifiable when the woman or family can't afford to raise the child. There is nonetheless overwhelming recognition that abortion should be legal in rare cases such as rape or life of the mother. However, it should be pointed out that rape and life of the mother account for less than1% of all abortions[7], at least 13 states had laws allowing abortion before Roe v. Wade in such cases and the number was rapidly growing[8], and virtually all legislation put out in the last two decades by the Pro-Life movement has included exceptions for abortion in said cases.Given this, I believe the courts have incorrectly decided the issue and that the American people should have their voices heard instead as the original judge, Henry Friendly, said in the first major abortion rights case, Hall v. Lefkowitz.[9] As Friendly concluded, \"But the decision what to do about abortion is for the elected representatives of the people, not for three, or even nine, appointed judges.\" I believe the correct way forward is to put this issue to a vote and let the American people determine by ballot referendum what the correct viability limit on abortion should be, and in what circumstances is allowed. I have no doubt that they will agree with me, as shown by Gallup polling, and restrict abortion to roughly the 12th week of pregnancy, perhaps a bit earlier, perhaps a bit later, and allow abortion in cases such as rape and life of the mother.Point of DisagreementUltimately, I argue that abortion should be slightly more restrictive than Con believes, and not allow abortion simply because Down's Syndrome is evident in a pregnant child, or other illnesses for that matter. I believe we should err on the side of caution when potentially taking another human life, and that human life is precious. This is a very controversial issue according to Gallup polling[6] and I recognize that it is a 50% split here, unlike the broader abortion issue where there is broad consensus when human life begins, around 12 weeks, and that abortion-on-demand is immoral.We simply cannot ask unborn children whether they would like to be born, and I question whether we should infer they do not wish to be born because of a disability. I think the reasoning that one should not be born because they are disabled is a dangerous precedent that devalues those with disabilities, whether born or unborn. Furthermore, it allows us to set an arbitrary definition of who is worthy of being born. Does that set precedent for us to expand this to anyone who shows signs of depressin, for example? What if they show signs of dwarfism, a height disability? At what point do we draw the line in deciding the disability is so great they should not be born because of it?Ultimately, I would urge my opponent to reconsider whether such reasoning is preferable to adoption.Sources:[1] http://www.bereawiki.com... [2] http://www.hli.org...http://www.whyprolife.com...[3] http://healthland.time.com...[4] http://www.whyprolife.com...[5] http://www.guttmacher.org...[6] http://www.gallup.com...[7] http://www.johnstonsarchive.net...[8] http://www.nrlc.org...[9] http://www.law.harvard.edu...", "Abotion should be legal I will begin by stating my argument against abortion, and then respond to my opponent's points. To clarify, I will be arguing that abortion should not be legal, apart from cases where it is a necessary medical procedure in order to save the life of the mother. Why abortion should be illegal My argument is as follows: Premise 1: Abortion is the deliberate killing of a human foetus Premise 2: A human foetus is alive, and so therefore a human foetus is a living human being Premise 3: It is not morally justified to remove the life of a human being Premise 4: Only that which is morally justified should be legal Conclusion: Abortion should not be legal Now I will support my premises: Premise 1 Abortion is defined as: 'Expulsion from the uterus of the products of conception before the fetus is viable.' (1) We know, due to the definition of 'viable' in this context, that this procedure will necessarily kill the foetus. Therefore, abortion is the deliberate killing of a human foetus. Premise 2 First I will affirm that a foetus is alive, then I will use this conclusion to affirm that a human foetus is a human being. Life is defined as: 'The condition that distinguishes animals and plants from inorganic matter, including the capacity for growth, reproduction, functional activity, and continual change preceding death' (2) Foetuses grow and are subject to continual change preceding death (3). They have the capacity for reproduction given time to develop naturally. Furthermore, to suppose that a foetus is not alive is to either state that a foetus is dead or inanimate. It is not dead because something must have once lived in order to be dead, and it is not inanimate (4). Therefore, a human foetus is alive. All life is characterised into species (5), and as we have affirmed that a human foetus is alive we must also accept that it must belong to a particular species. A human foetus's genetic makeup is most similar to the genetic makeup of the species homo sapiens and so a human foetus is human (which perhaps goes without saying, as if it was not human then we would not refer to it as a human foetus). Therefore, a human foetus is human. Therefore, a human foetus is a human life, which is to say that it is a living human being. Premise 3 To say that it is not morally justified to remove the life of a human being is to say that we ought not to kill human beings. There are many reasons why I am justified in asserting this moral truth: Rule Utilitarian approach - Having a rule stating 'do not kill human beings' will result in a greater amount of happiness than the absence of such a rule, therefore this it is moral to abide to this rule. Deontologist approach - Killing of a human being is wrong because it is a maxim that cannot be universalised; no rational human being would freely consent to live in a society that permitted the killing of human beings. Evolutionist approach - Permitting the killing of human beings is evolutionarily disastrous, for obvious reasons. The killing of human beings is not morally justified according to the vast majority of normative ethical theories. If my opponent disagrees and argues that killing of human beings is justified (aside from cases of self-defence), then she will have the burden of proof, as she is making the positive claim that killing of human beings is morally justified. Therefore, it is not morally justifiable to remove the life of a human being. Premise 4 Although it seems pretty common-sensical that only morally justifiable actions should be legal, I will analyse it under the main normative ethical theories in order to demonstrate why only morally justifiable actions should be legal. Rule Utilitarian approach - Having a rule stating 'legally permit immoral actions' will result in a lesser amount of happiness than a rule saying 'legally prohibit immoral actions', therefore this it is moral to abide to the rule that we should not legally permit immoral actions. Deontologist approach - Legally permitting immoral actions is wrong because it is a maxim that cannot be universalised; no rational human being would freely consent to live in a society that permitted immoral actions. Evolutionist approach - Permitting immoral actions will create a society where immoral actions are prevalent, this will negatively effect the quality of our offspring and so it is not evolutionarily beneficial. I assume that my opponent agrees with premise 4, but if not, the above analysis verifies it. Therefore, only that which is morally justifiable should be legal. As I have now asserted the veracity of all my premises, the conclusion deductively follows. Therefore, abortion should not be legal. Argument from Consistency In order to hold a rational moral assertion, it must be consistent. So, in order to be rational, we must abide by the maxim: 'Treat someone as we would consent to be treated if we were in the same situation as that someone.' An example of moral inconsistency would be stating: 'I am morally justified in throwing sticks at my mother, but I would not consent to having sticks thrown at me if I was in the same situation as my mother'. I argue that abortion is inconsistent according to these terms. To assert that abortion is morally justified is to be morally inconsistent, as it is equivalent to saying: 'I am morally justified in killing a human foetus, but I would not consent to being killed if I was a human foetus.' Unless, of course, the pro-abortionist would consent to being killed if they were a human foetus, but I highly doubt they would be serious in holding this conviction. This becomes especially prevalent because it is not hypothetical, as everyone was once a foetus and so nobody can be exempt from the consistency criteria. As asserting the moral permissibility of abortion is inconsistent, it is an irrational moral belief. It is absurd to suggest that actions should be legalised if one cannot be rational in supporting them, so abortion should not be legal. I will now respond to all my opponent's arguments within the character limit I have. 'Abortion is about allowing woman the right to make choices about when they want to have children in relation to their age, financial stability & relationship stability. It is the not the place of government to legislate against woman's choices.' It is definitely the government's choice to legislate against women's choices if the choice harms another human being, as abortion does. It would be odd to suggest that the government should not legislate against murder simply by virtue of the fact that a woman chose to commit it. 'Raising a child is not an easy task & requires social & emotional commitment coupled with financial resources. As such if a person feels they are not ready for a child, it means the pregnancy is unwanted & resultant allowing a fetus to grow into a child is worse than abortion since the resultant child will grow in a non conducive & destructive environment without the love, care & stability that a child needs.' 'Abortion prevent unwanted & unplanned pregnancies which prevents child neglect since the mother does not want to have children at that moment in time.' I agree, but this is a false dichotomy. A baby can be put up for adoption at birth, so it is not a choice between abortion and raising a child. 'Those see it morally allowable to do abortion should be provided with the means to do so & those who don't believe in abortion should have the choice not to have an abortion' This statement has very strange implications, as it implies that anyone should be allowed to do something so long as they believe that they are morally justified in doing so. Yet this would mean that we should allow murderers who believe that their actions are morally justified to commit murder. 'A fetus is not legally or scientifically a person or human being so abortion cannot be equated to murder or taking a life since the fetus is not a person nor alive.' See premise 2 of my initial argument. 'A fetus is like a brain dead person with no self awareness or consciousness so it is actually dead.' Definition of dead: 'Having lost life' (6). A foetus has never lost its life (irrespective of whether it ever had life) and so cannot be dead. 'Prohibiting abortions doesn't stop abortions, women would simply seek abortions via illegal means which are unsafe & illegal, so it is better to provide woman with safe & legal ways to do an abortion.' If one freely chooses to murder their foetus then they are, to some extent, forfeiting their protection. Let me suppose an analogy; legalising burglary would make burglaries much safer for burglars, yet this is hardly a valid justification for legalising burglary. The same applies with abortion. I agree that prohibiting abortion does not stop abortions altogether, but it reduces them significantly. In 1969 (when legal abortion facilities were implemented) there were 53643 abortions compared to 21400 when abortion was illegal in 1966 (7). This is 32243 abortions that were caused by the legalisation of abortion. I have run out of characters now, but I will finish rebutting my opponent's arguments in round 2. (1)http://medical-dictionary.thefreedictionary.com... (2)http://www.oxforddictionaries.com... (3)http://www.babycentre.co.uk... (4)http://www.webmd.boots.com... (5)http://en.wikipedia.org... (6)http://www.thefreedictionary.com... (7)http://www.johnstonsarchive.net...", "Abortion Should Remain Legal 'The validity of the abortion right therefore stems from the right of an individual (the mother), who is certainly a fully conscious human being, to prevent harm to herself' The prevention of harm to the woman is not the only reason for abortion, an abortion could be used for other reasons such as birth control, the prevention of a fetus with deformities from having a life of suffering, among other reasons. 'In an age where prophylactics are common and readily available, and a simple pill can prevent pregnancy before the development of the fetus, it is monstrous to needlessly engage in a behavior that threatens even the potentiality of human life.' An abortion could be necessary when it is too late to use other methods of birth control. And it doesn't make sense to say that women will always get an abortion instead of using other methods of birth control earlier. A woman will realize that it is easier to use protection opposed to not and always having to get abortions. 'The potential citizen may, in fact, qualify as a citizen when a fetus, but it is impossible to determine' It is not possible to determine? Do you consider sperm to be human? Many people let millions of sperm die every day, but that will never be illegal. Some people think that a fetus becomes human when it can survive outside of the body. Some people think it becomes a human after it leaves the body. There can be many points when a fetus could be considered human, but the moment of conception is certainly not one of them. The moment of conception merely creates a cluster of cells that is incapable of thinking, showing emotion, of being conscious. A woman can choose where to draw the line of when the fetus is human, making abortion illegal is not the solution. 'Someday, a method could be developed to safely and easily excise the child from the mother and continue the child's development outside of her womb' That may be true, but that 'someday' hasn't happened yet. For now, abortion must remain legal. Other Reasons for Abortion A woman may want to get an abortion because she can't pay for the child. Would you want to be paying with your tax dollars for those unplanned children? Also, would you really deny a rape victim from having an abortion? Would you expect her to care for a baby she didn't ask for, have to endure 9 months of pregnancy and labor, and have that baby as a reminder of the incident and that the child carries the genes of a rapist? Also, it shouldn't only be for a rape victim, there are other woman who don't want to carry that fetus around for 9 months that is an accident that a lot of parents would love less than a planned child. And think of all the unplanned children adding to the population that is already starting to overcrowd, and how a kid would react if they found out that they were an accident.", "Abortion should remain legal. \"Really I only consider abortion murder if the abortion is unnecessary.\" Murder is defined as the killing of another person, and considering you consider the fetus to be alive, then all \"murders\" should be considered \"murder.\" Also, who defines when an abortion is necessary or unecessary? We would have to look at every individual case in order to see if an abortion can qualify as \"necessary.\"My opponent argues that the woman is guilty for murder because she chose to \"murder\" the fetus.Now, let me give you a scenario onto why this dos not make sense. Women pay for abortions more than not, and the doctor is the one operating the abortion, we all know that much. So, if I hired an assassin to kill someone, under your answer, I would be guilty, not the assassin. Bear in mind that in both scenarios, the assassin and the doctor are only doing their jobs, so what makes them safe from the law?Argues that miscarriage is involuntary manslaughter but is not punishable by the law.However, according to [1], involuntary manslaughter is punishable by 10-16 months behind bars plus fines and probation. Miscarriages, we know, are natural or can be self-induced by drug use or stress. \"Miscarriages are very common. Approximately 20% of pregnancies (one in five) end in miscarriage. The most common cause is a genetic abnormality of the fetus.\" says medical-dictionary.com [2]. With 1 in 5 pregnancies ending in a miscarriage, how can we morally throw this many women in jail for something they cannot control?My opponent comes up with a scenario about a fertilized chicken egg.I see how this makes sense, but then again it doesn't. The egg is no longer in a body and does not use resources, besides heat, from the mother hen or incubator. A fetus, however, is in the woman's body and uses all of her resources. So why do we give the fetus rights over the woman when it is the fetus using the woman's resources, not the other way around.\"After all, breathing motions is a slightly lame definition for living.\" You said that you believed that the fetus was leaving, but I have proven that the baby only has breathing motions and brain activity that does not prove consciousness. I realize that breathing motions is a lame definition for life, which is why I do not consider the fetus alive. With ths quote, you contradicted the belief of life in the uterus because that is one of the only things that show \"life\" in a fetus- breathing motion.Sources:1. http://criminal.findlaw.com...;2. http://medical-dictionary.thefreedictionary.com...;", "Abortion should be illegal in all cases. Ok I will be more civil and state my next debate round in a civil manner without any douchebag \"straw man fallacy\" or \"ad homen\" (Anyone using these terms is just a pretentious douchebag who likes to use words like confectionery instead of just candy or panache, Douchebag! ) I already did a debate on this topic (sorry getting off topic here) Here is why abortion is legal, 28 points CASE CLOSED, APOLOGY ACCEPTED 1 Abortion is about allowing woman the right to make choices about when they want to have children in relation to their age, Financial stability & relationship stability. It is the not the place of government to legislate against woman's choices. 2. Raising a child is not an easy task & requires social & emotional commitment coupled with financial resources. As such if a person feels they are not ready for a child, It means the pregnancy is unwanted & resultant allowing a fetus to grow into a child is worse than abortion since the resultant child will grow in a non conducive & destructive environment without the love, Care & stability that a child needs. 3. The argument against abortion is a moral argument which is subject to personal interpretation so should not be legislated against. Those see it morally allowable to do abortion should be provided with the means to do so & those who don't believe in abortion should have the choice not to have an abortion 4. A fetus is not legally or scientifically a person or human being so abortion cannot be equated to murder or taking a life since the fetus is not a person nor alive. 5. A fetus is like a brain dead person with no self awareness or consciousness so it is actually dead. 6. Prohibiting abortions doesn't stop abortions, Women would simply seek abortions via illegal means which are unsafe & illegal, So it is better to provide woman with safe & legal ways to do an abortion. 7. Abortion prevent unwanted & unplanned pregnancies which prevents child neglect since the mother does not want to have children at that moment in time. 8. Making abortion illegal is also a class struggle since the rich can always go to other places where it is legal & have an abortion whilst the poor cannot do this, But have to resort to unsafe abortions which can lead to their death. 9. Making abortion illegal is more or less compulsory pregnancy which contradicts the quest & fight for freedom. 10. Making abortion illegal will increase teenage pregnancy (children having children). This usually leads to illegal abortions which can lead to death or permanent health defects, Poverty, Joblessness, Hopelessness, And dependency. 11. A woman's right to choose abortion is a \"fundamental right\" 12. Personhood begins at birth, Not at conception. Abortion is the termination of a pregnancy (fetus), Not a baby. Personhood at conception is not a proven biological fact. Fetuses are incapable of feeling pain when an abortion is performed. 13. Access to legal, Professionally-performed abortions reduces injury and death caused by unsafe, Illegal abortions. 14. The anti-abortion position is usually based on religious beliefs and threatens the vital separation of church and state. Religious ideology should not be a foundation for law. 15. Modern abortion procedures are safe. The risk of a woman\"s death from abortion is less than one in 100, 000, Whereas the risk of a woman dying from giving birth is 13. 3 deaths per 100, 000 pregnancies. 16. Access to abortion is necessary because contraceptives are not always readily available. Women need a doctor's prescription to obtain many birth control methods, Such as the pill, The patch, The shot, And the diaphragm. 17. Abortion gives couples the option to choose not to bring babies with severe and life-threatening medical conditions to full term. 18. Many women who choose abortion don't have the financial resources to support a child. 19. Motherhood must never be a punishment for having sexual intercourse. 20. A baby should not come into the world unwanted. 49% of all pregnancies among American women are unintended. Having a child is an important lifelong decision that requires consideration, Preparation, And planning. 21. Abortion reduces crime. Teenage girls, Unmarried women, And poor women are more likely to have unintended pregnancies, And since unwanted babies are often raised in poverty, Their chances of leading criminal lives in adulthood are increased. 22. Do we have the right to force the mother to keep the baby solely because she consented to participate in these sexual activities? Do we have the right to take away another\"s right as we continue to fight for other rights? Why do we take away the rights of a woman because she has the potential to have a baby? 23. We get right to life, Liberty & pursuit of happiness when we are born. He fetus does not have these rights until it is born. So abortion is not murder & abortion does not go against the rights of a fetus since it does not have any until born. 24. Every woman has the right to do whatever they want with their body aka Bodily Autonomy. This is one of the reasons why it is illegal to take organs from the deceased that have not signed off permission. If we continue this right after life, Why do we strip it from a pregnant woman? Why would you grant a dead person a right that you wouldn\"t give to someone that is alive. 25. If someone needs something donated that you have, You are not legally obligated to donate anything. This parallels to pregnancies because a fetus does need these resources, But the mother is not legally obligated to keep giving this baby her resources. Denying to give someone a body part is not illegal, So terminating a pregnancy should not be illegal 26. Legal abortions protect women's health. Legal abortion not only protects women's lives, It also protects their health. For tens of thousands of women with heart disease, Kidney disease, Severe hypertension, Sickle-cell anemia and severe diabetes, And other illnesses that can be life-threatening, The availability of legal abortion has helped avert serious medical complications that could have resulted from childbirth. Before legal abortion, Such women's choices were limited to dangerous illegal abortion or dangerous childbirth. 27. Being a mother is just one option for women. * Many hard battles have been fought to win political and economic equality for women. These gains will not be worth much if reproductive choice is denied. To be able to choose a safe, Legal abortion makes many other options possible. Otherwise an accident or a rape can end a woman's economic and personal freedom. 28. Even when precautions are taken, Accidents can and do happen. For some families, This is not a problem. But for others, Such an event can be catastrophic. An unintended pregnancy can increase tensions, Disrupt stability, And push people below the line of economic survival. Family planning is the answer. All options must be open. mic drop", "Legal Abortion This debate is \"should abortion be legal?\" Short answer no... Long answer noooooooo... Lol, but seriously, Abortion is murder any way that you look at it. I am excited for an intelligent debate", "Abortion Putting your sources in the comments doesn't exactly count... but okay. 1. You're still arguing on a legal basis, and it still doesn't work. Since my stance is that abortion should not remain legal (as you stated), this argument fails. I think a fetus/embryo is a life separate from the mother which is not her property, and that she should not be allowed to kill it. If a woman's five year old kid is her property, do you still think it should be legal for her to kill it? Just because something's legal doesn't necessarily mean it's right. 2. And what about those babies? They're people too, and therefore a lot more people would die with abortion legal than illegal. Besides that, my original rebuttal still stands. 3. This argument is irrelevant and doesn't make sense. You have not rebutted any of the points I made, and have just repeated what you already stated. I could rebut this with the same rebuttal I made in the last round. 4. YOUR math is bad. Your numbers aren't any more significant just because you raised the ratio. Are you aware that 133,000 would fit into a billion over 7,518 times? (1) I should also probably note that there is nowhere near a billion people in the US. There are 311,591,917 people, about half of which are women, about half of which are Pro life, and even less of the Pro choice women having had an abortion. (2)(3) This leaves you with less than 77,897,979 women having abortions.(4) That's nowhere near a billion, and therefore 123,000 women have not been supposedly \"saved\" by abortion. And once again, my original rebuttal still stands for the most part. Just because abortion is slightly safer doesn't mean you should get an abortion because of that. The motive of abortion is almost never to save your own life; it's to avoid having a kid. And abortion does not save lives; you are excluding the lives of the unborn babies killed in abortion. 5. How can the parent even know if the child is handicapped when it's an embryo? And once again, why does the parent get to decide to kill it? Every human has every right to live; it shouldn't be the parent's decision. When I spoke of machines and features, I was talking about wheelchair ramps on buses, special job opportunities at Goodwill, and things like that. Once again, according to your logic, the parents should be allowed to kill the handicapped person at any age. If the parents can't afford something like the actual wheelchair, many charities can be of great help. There is still no need for abortion just because of a handicap, and it generally isn't the reason for abortion anyway. 6. That makes no sense. Have you ever heard of these things called homeless shelters and charities? Where I live, it's possible for a homeless person to get a hot meal every day. And do you have any proof that stealing food for your family is a common crime? Even if it's true, it's not a very serious crime like murder or a bank robbery. Honestly, I think this argument is kind of silly. You're basically saying it's wrong for poor people to have kids. 7. I thought I made this pretty clear. If abortion was illegal, there would be less unwanted pregnancies because the parents know abortion isn't an option. They would be more responsible beforehand, instead of taking care of things after the pregnancy has already started. Thus, less babies would come into the world unwanted. 8. I could rebut most of this with my original argument. What do you mean they haven't been \"proven\" to be humans? Fetus is obviously a stage of human life. In the same way that babies and the elderly are humans, fetuses and embryos are stages of human life too, and you haven't proven otherwise. 9. None of those arguments make sense. Babies are just as human when inside the womb as outside. Abortion shouldn't be an option since the other options would allow the person to live. And it wouldn't be like taking away adoption because there is absolutely no reason why adoption should be illegal, while there are many reasons why abortion should be. I don't know what you mean by \"abortion is one of those abortions.\" 10. If there is an afterlife, you would know you could have existed if you hadn't been aborted. If there is no afterlife, you wouldn't know you existed no matter what stage you died at. According to this logic, it's okay to kill a man because they wouldn't know they ever existed. And why is it irrelevant? You haven't actually rebutted anything here. 11. You ignored my arguments, and instead rambled about technical terms and how fetuses don't count as babies. You didn't actually rebut any of my arguments. 12. Late term abortion is a type of abortion. The resolution was \"Abortion\", and you stated yourself that you would be arguing that abortion should be legal. Since you have apparently conceded to this argument, you are saying that abortion should not always be allowed. I have won this argument. 13. Read my argument carefully. \"My point is, abortion is yet another beat of a pattern in which humans disregard a type of human life.\" In other words, abortion is wrong, but it's going to take a while for everyone to agree, just like these other cases of human discrimination. Sourcing isn't necessary because we all know that slavery was once legal, that Hitler killed Jews, and that abortion was legalized in this country. (1) http://www.wolframalpha.com... (2) http://quickfacts.census.gov... (3) http://www.debate.org... (4)http://www.wolframalpha.com...", "Abortion I am pro-life. Abortion is murder because life begins at conception, Unborn babies are humans that have the right to life. Pro-life with some exceptions which are; rape (unless mother wants to keep child), Mother's life, Mother's health, Incest, Fetal life, Fetal health. I am open to a discussion to an opposing side. I will give evidential arguments on rounds 2, 3, 4, And 5.", "Abortion I don't think abortion should be abolished, because 1. What if the mother's life is in danger, 2. The mother has medical problems, 3. the baby would be born paralyzed, and more. When two human lives are connected, there has to be some choice. I support safe, legal, and last resort. Al;so, don't be cruel enough to force liuttle girls or rape victims to give birth, or domestic violence victims.", "Abortion My position on abortion is extremely con. I believe that abortion should be illegal since murder is illegal.", "Abotion should be legal 1. Abortion is about allowing woman the right to make choices about when they want to have children in relation to their age, financial stability & relationship stability. It is the not the place of government to legislate against woman's choices. 2. Raising a child is not an easy task & requires social & emotional commitment coupled with financial resources. As such if a person feels they are not ready for a child, it means the pregnancy is unwanted & resultant allowing a fetus to grow into a child is worse than abortion since the resultant child will grow in a non conducive & destructive environment without the love, care & stability that a child needs. 3. The argument against abortion is a moral argument which is subject to personal interpretation so should not be legislated against. Those see it morally allowable to do abortion should be provided with the means to do so & those who don't believe in abortion should have the choice not to have an abortion 4. A fetus is not legally or scientifically a person or human being so abortion cannot be equated to murder or taking a life since the fetus is not a person nor alive. 5. A fetus is like a brain dead person with no self awareness or consciousness so it is actually dead. 6. Prohibiting abortions doesn't stop abortions, women would simply seek abortions via illegal means which are unsafe & illegal, so it is better to provide woman with safe & legal ways to do an abortion. 7. Abortion prevent unwanted & unplanned pregnancies which prevents child neglect since the mother does not want to have children at that moment in time. 8. Making abortion illegal is also a class struggle since the rich can always go to other places where it is legal & have an abortion whilst the poor cannot do this, but have to resort to unsafe abortions which can lead to their death. 9. Making abortion illegal is more or less compulsory pregnancy which contradicts the quest & fight for freedom. 10. Making abortion illegal will increase teenage pregnancy (children having children). This usually leads to illegal abortions which can lead to death or permanent health defects, poverty, joblessness, hopelessness, and dependency. 11. A woman's right to choose abortion is a \"fundamental right\" 12. Personhood begins at birth, not at conception. Abortion is the termination of a pregnancy (fetus), not a baby. Personhood at conception is not a proven biological fact. Fetuses are incapable of feeling pain when an abortion is performed. 13. Access to legal, professionally-performed abortions reduces injury and death caused by unsafe, illegal abortions. 14. The anti-abortion position is usually based on religious beliefs and threatens the vital separation of church and state. Religious ideology should not be a foundation for law. 15. Modern abortion procedures are safe. The risk of a woman\"s death from abortion is less than one in 100,000, whereas the risk of a woman dying from giving birth is 13.3 deaths per 100,000 pregnancies. 16. Access to abortion is necessary because contraceptives are not always readily available. Women need a doctor's prescription to obtain many birth control methods, such as the pill, the patch, the shot, and the diaphragm. 17. Abortion gives couples the option to choose not to bring babies with severe and life-threatening medical conditions to full term. 18. Many women who choose abortion don't have the financial resources to support a child. 19. Motherhood must never be a punishment for having sexual intercourse. 20. A baby should not come into the world unwanted. 49% of all pregnancies among American women are unintended. Having a child is an important lifelong decision that requires consideration, preparation, and planning. 21. Abortion reduces crime. Teenage girls, unmarried women, and poor women are more likely to have unintended pregnancies, and since unwanted babies are often raised in poverty, their chances of leading criminal lives in adulthood are increased. 22. Do we have the right to force the mother to keep the baby solely because she consented to participate in these sexual activities? Do we have the right to take away another\"s right as we continue to fight for other rights? Why do we take away the rights of a woman because she has the potential to have a baby? 23. We get right to life, liberty & pursuit of happiness when we are born. he fetus does not have these rights until it is born. So abortion is not murder & abortion does not go against the rights of a fetus since it does not have any until born. 24. Every woman has the right to do whatever they want with their body aka Bodily Autonomy. This is one of the reasons why it is illegal to take organs from the deceased that have not signed off permission. If we continue this right after life, why do we strip it from a pregnant woman? Why would you grant a dead person a right that you wouldn\"t give to someone that is alive. 25. If someone needs something donated that you have, you are not legally obligated to donate anything. This parallels to pregnancies because a fetus does need these resources, but the mother is not legally obligated to keep giving this baby her resources. Denying to give someone a body part is not illegal, so terminating a pregnancy should not be illegal 26. Legal abortions protect women's health. Legal abortion not only protects women's lives, it also protects their health. For tens of thousands of women with heart disease, kidney disease, severe hypertension, sickle-cell anemia and severe diabetes, and other illnesses that can be life-threatening, the availability of legal abortion has helped avert serious medical complications that could have resulted from childbirth. Before legal abortion, such women's choices were limited to dangerous illegal abortion or dangerous childbirth. 27. Being a mother is just one option for women.* Many hard battles have been fought to win political and economic equality for women. These gains will not be worth much if reproductive choice is denied. To be able to choose a safe, legal abortion makes many other options possible. Otherwise an accident or a rape can end a woman's economic and personal freedom. 28. Even when precautions are taken, accidents can and do happen. For some families, this is not a problem. But for others, such an event can be catastrophic. An unintended pregnancy can increase tensions, disrupt stability, and push people below the line of economic survival. Family planning is the answer. All options must be open. Abortion should be part of a country's contraception policy. People should plan their families & society must allow women to end unwanted pregnancies, in order to deal with failures of birth control. Some methods of contraception in fact amount to abortion during the very earliest stage of a pregnancy. Abortion should be legal but discouraged. Legal simply because it is a choice, and what grows inside your body is yours. But discouraged because there are other more effective ways to prevent pregancy than abortion like contraception.", "Abortion I believe that for a woman to have an abortion is her private choice, and it should be legal to ensure regulations.", "Abortion I believe that abortion should be openly accepted. There are many good things that can come from abortion and I believe that many socio-economic problems can be prevented with abortion because I believe overall the babies that are contemplated about being aborted would be drags on society anyway. The population of the world is growing tremendously I would rather the world be full of planned babies than unintended drags on society", "Abortion The US Supreme Court has declared abortion to be a \"fundamental right\" guaranteed by the US Constitution. The landmark abortion case Roe v. Wade, decided on Jan. 22, 1973 in favor of abortion rights, remains the law of the land. The 7-2 decision stated that the Constitution gives \"a guarantee of certain areas or zones of privacy,\" and that \"This right of privacy... is broad enough to encompass a woman's decision whether or not to terminate her pregnancy.\" [49] Reproductive choice empowers women by giving them control over their own bodies. The choice over when and whether to have children is central to a woman's independence and ability to determine her future. [134] Supreme Court Justice Sandra Day O'Connor wrote in the 1992 decision in Planned Parenthood v. Casey, \"The ability of women to participate equally in the economic and social life of the Nation has been facilitated by their ability to control their reproductive lives.\" [8] Supreme Court Justice Ruth Bader Ginsburg wrote in her dissenting opinion in Gonzales v. Carhart (2007) that undue restrictions on abortion infringe upon \"a woman's autonomy to determine her life's course, and thus to enjoy equal citizenship stature.\" [59] CNN senior legal analyst Jeffrey Toobin, JD, stated that Roe v. Wade was \"a landmark of what is, in the truest sense, women\"s liberation.\" [113] Personhood begins after a fetus becomes \"viable\" (able to survive outside the womb) or after birth, not at conception. [31] [32] Embryos and fetuses are not independent, self-determining beings, and abortion is the termination of a pregnancy, not a baby. A person's age is calculated from birth date, not conception, and fetuses are not counted in the US Census. The majority opinion in Roe v. Wade states that \"the word 'person,' as used in the Fourteenth Amendment [of the US Constitution], does not include the unborn.\" [49] Fetuses are incapable of feeling pain when most abortions are performed. According to a 2010 review by Britain's Royal College of Obstetricians and Gynaecologists, \"most neuroscientists believe that the cortex is necessary for pain perception.\" The cortex does not become functional until at least the 26th week of a fetus' development, long after most abortions are performed. This finding was endorsed in 2012 by the American College of Obstetricians and Gynecologists, [1] which stated that that there is \"no legitimate scientific information that supports the statement that a fetus experiences pain.\" [142] A 2005 University of California at San Francisco study said fetuses probably can't feel pain until the 29th or 30th week of gestation. [166] Abortions that late into a pregnancy are extremely rare and are often restricted by state laws. [164] According to Stuart W. G. Derbyshire, PhD, Senior Lecturer at the University of Birmingham (England), \"...fetuses cannot be held to experience pain. Not only has the biological development not yet occurred to support pain experience, but the environment after birth, so necessary to the development of pain experience, is also yet to occur.\" [10] The \"flinching\" and other reactions seen in fetuses when they detect pain stimuli are mere reflexes, not an indication that the fetus is perceiving or \"feeling\" anything. [135] [145] Access to legal, professionally-performed abortions reduces maternal injury and death caused by unsafe, illegal abortions. According to Daniel R. Mishell, Jr., MD, Chair of the Department of Obstetrics and Gynecology at the Keck School of Medicine, University of Southern California, before abortion was legalized women would frequently try to induce abortions by using coat hangers, knitting needles, or radiator flush, or by going to unsafe \"back-alley\" abortionists. [150] In 1972, there were 39 maternal deaths from illegal abortions. By 1976, after Roe v. Wade had legalized abortion nationwide, this number dropped to two. [7] The World Health Organization estimated in 2004 that unsafe abortions cause 68,000 maternal deaths worldwide each year, many of those in developing countries where safe and legal abortion services are difficult to access. [11] Modern abortion procedures are safe and do not cause lasting health issues such as cancer and infertility. A peer-reviewed study published by Obstetrics & Gynecology in Jan. 2015 reported that less than one quarter of one percent of abortions lead to major health complications. [159] [160] A 2012 study in Obstetrics & Gynecology found a woman's risk of dying from having an abortion is 0.6 in 100,000, while the risk of dying from giving birth is around 14 times higher (8.8 in 100,000). The study also found that \"pregnancy-related complications were more common with childbirth than with abortion.\" [3] The American Medical Association and the American College of Obstetricians and Gynecologists stated \"Abortion is one of the safest medical procedures performed in the United States.\" They also said the mortality rate of a colonoscopy is more than 40 times greater than that of an abortion. [122] The National Cancer Institute (NCI), the American Cancer Society (ACS), and the American College of Obstetricians and Gynecologists all refuted the claim that abortion can lead to a higher probability of developing breast cancer. [22] A 1993 fertility investigation of 10,767 women by the Joint Royal College of General Practitioners and the Royal College of Obstetricians and Gynecologists found that women who had at least two abortions experienced the same future fertility as those who had at least two natural pregnancies. [14] Women who receive abortions are less likely to suffer mental health problems than women denied abortions. A Sep. 2013 peer-reviewed study comparing the mental health of women who received abortions to women denied abortions found that women who were denied abortions \"felt more regret and anger\" and \"less relief and happiness\" than women who had abortions. The same study also found that 95% of women who received abortions \"felt it was the right decision\" a week after the procedure. [158] Studies by the American Psychological Association (APA), the Academy of Medical Royal Colleges (AMRC), and researchers at Johns Hopkins Bloomberg School of Public Health all concluded that purported links between abortion and mental health problems are unfounded. [152] Abortion gives pregnant women the option to choose not to bring fetuses with profound abnormalities to full term. Some fetuses have such severe disorders that death is guaranteed before or shortly after birth. These include anencephaly, in which the brain is missing, and limb-body wall complex, in which organs develop outside the body cavity. [12] It would be cruel to force women to carry fetuses with fatal congenital defects to term. Even in the case of nonfatal conditions, such as Down syndrome, parents may be unable to care for a severely disabled child. Deborah Anne Driscoll, MD, Professor of Obstetrics and Gynecology at the University of Pennsylvania, said \"many couples... don\"t have the resources, don\"t have the emotional stamina, don\"t have the family support [to raise a child with Down syndrome].\" [9] Women who are denied abortions are more likely to become unemployed, to be on public welfare, to be below the poverty line, and to become victims of domestic violence. A University of California at San Francisco study found that women who were turned away from abortion clinics (because they had passed the gestational limit imposed by the clinic) were three times more likely to be below the poverty level two years later than women who were able to obtain abortions. 76% of the \"turnaways\" ended up on unemployment benefits, compared with 44% of the women who had abortions. The same study found that women unable to obtain abortions were more likely to stay in a relationship with an abusive partner than women who had an abortion, and were more than twice as likely to become victims of domestic violence. [114] [73] Reproductive choice protects women from financial disadvantage. Many women who choose abortion don't have the financial resources to support a child. 42% of women having abortions are below the federal poverty level. [13] A Sep. 2005 survey in the peer-reviewed Perspectives on Sexual and Reproductive Health asking women why they had an abortion found that 73% of respondents said they could not afford to have a baby, and 38% said giving birth would interfere with their education and career goals. [19] An Oct. 2010 University of Massachusetts at Amherst study published in the peer-reviewed American Sociological Review found that women at all income levels earn less when they have children, with low-wage workers being most affected, suffering a 15% earnings penalty. [136] A baby should not come into the world unwanted. Having a child is an important decision that requires consideration, preparation, and planning. The Colorado Department of Public Health and Environment stated that unintended pregnancies are associated with birth defects, low birth weight, maternal depression, increased risk of child abuse, lower educational attainment, delayed entry into prenatal care, a high risk of physical violence during pregnancy, and reduced rates of breastfeeding. [75] 49% of all pregnancies among American women are unintended. [50] Abortion reduces welfare costs to taxpayers. The Congressional Budget Office (CBO), a nonpartisan federal agency, evaluated a proposed anti-abortion bill that would ban all abortions nationwide after 20 weeks of pregnancy, and found that the resulting additional births would increase the federal deficit by $225 million over nine years, due to the increased need for Medicaid coverage. Also, since many women seeking late-term abortions are economically disadvantaged, their children are likely to require welfare assistance. [129] [130] http://abortion.procon.org...", "Abortion Explain to me why abortion is good and why is it not murder.", "Abortion is wrong. abortion is a woman's right to choose if a woman makes that choice for whatever reason she should not be shamed and made to feel like an outcast you can say what you like about how girls shouldn't sleep around and use birth control and I agree however birth control does sometimes fail condoms do tear and sometimes people have a moment of weakness and get swept up in the moment and have unprotected sex and particularly if the girl is very young such as a teenager or financially unfit she may seek an abortion. For many women this seems like the only option yes you can adoption but then foster homes will be full of unwanted children that will bounce from home to home what kind of life is that for a child? not to mention the pain of having to carry a baby for nine months all the doctors appointments and ultrasounds only to watch it go to somebody else when a woman has an abortion she doesn't have to worry about that she doesn't know the gender of the baby or what it looks like. Furthermore in a scientific matter a fetus or an embryo is not a baby it is not yet a living breathing human being it is simply a mass of cells that yes will develop into a baby at a later stage which is why I'm against late term abortion unless for medical reasons but at an early stage is simply a mass of cells there is no difference between a human embryo and a tadpole they look exactly the same you can't tell the difference the only difference is one will grow to be a frog and one a baby and as far as the case of rape goes well ask yourself this if a man rapes me and I become pregnant do I really want to carry this man's baby? some will say yes because it's not the baby's fault I agree but at the same time the mother is already going through emotional and psychological pain due to the rape do we really want to subject her to going through the emotional turmoil of carrying for a baby she didn't ask for? or what if your father raped you for years on end and you become pregnant do you really want to carry his child and raise your child/sibling? what if you went and had your first ultrasound and the doctors told you your baby was gonna have down syndrome or autism or be mentally retarded would you choose to bring that child into the world knowing the challenges that they are going to face? in order to understand abortion one must ask themselves these questions put yourself in someone Else's shoes and learn empathy in order to understand maybe if people didn't have so many children that couldn't afford we wouldn't have a population crisis and people wouldn't live in extreme poverty and yes birth control would cut down on it but birth control in 3rd world countries is harder to get access plus you got a group of people who will refuse to take it due to old traditions. But even here in the western world there seems to be this stigma associated with birth control Catholics for example still want to follow the doctrine of banning birth control despite the fact that most practicing Catholics in Europe and America use birth control and while in places like Mexico and South America still do not well I say look where that's got them poverty stricken and having children they cannot afford so again I say is abortion wrong if a woman in Guatemala with 5 hungry children already living in a hut making 1 dollar a day becomes pregnant and gets an abortion is she wrong? should she have had the child instead and been that much poorer? because let me tell you I wouldn't want to put my child in a 3rd world orphanage they are horrible and the children become miserable. By telling women what they can and can't do with their bodies you are basically saying that it really doesn't matter what the woman wants it's all about a fetus's rights woman have had to fight long and hard in America for their rights the right to vote to work to dress how they choose why do they now have to fight to not carry fetus's inside of them if they choose why do they have to fight to get access for birth control because there employers refuse to cover it? If you want less abortions make birth control more accessible or give these poor women day care vouchers Medicaid food stamps etc so that they can raise their children without being in a pile of bills and stress and for god sake's stop standing out abortions clinics screaming and harassing these women who are making that choice it will actually make people more determined to have an abortion not to mention makes you look very foolish and hateful and what gets me is many are Christian church groups I mean how unchristian can you get? I don't think there's an easy explanation of what to do with those people but I do know that we have to do something. I truly believe if you want to cut down on abortions birth control is the answer however I just don't think a woman should be shamed for it and even if we made it illegal there's no way of stopping it even when it was illegal women used to get them they would go to back Ally's and many women died from complications or they would concoct some kind of natural medicine and take it to expel the baby often these would cause damage to the uterus and make the woman unable to have any more children but even if everything was fine would that not be considered an abortion? so you can really say that women never used to have abortions or wanted that choice I really believe that this has become rooted in religion which contrary to some people's beliefs we do not base our laws on which is why abortion is legal and it is absolutely unconstitutional for these states in the south to be shutting them down by doing that you are taking away a woman's right to choose a woman's right to not be stuck with a child and a woman's right to do what she pleases with her body. Men should not get a say in this men will never understand because they are not the ones who get pregnant they have no idea what it's like to be young and struggling with a child a man has a choice to stay and help raise the child or leave the woman does not have such a choice and yet we allow all these men in congress to tell us what we can and can't do why should some old man I don't know and will never meet be able to make my reproductive choices for me? and what's so bad is that there are very naive women and they listen to these politicians and just believe them and never research for themselves and those are the people that scare me you have to research things you can;t allow the media to influence all your decision making but I digress back to the topic on hand as long as the abortion is done at a clinic with a proper doctor clean equipment and the woman is not forced such as in china then I see no problem with it and there's no point in all this torture women seeking abortions have to go through such as getting an ultrasound before her abortion it is a completely unnecessary and costly expense and everyone knows their ulterior motives behind it which is what makes it so bad at least be honest and say that you want to try to convince her to keep the baby by making her look at an ultrasound rather then it's for her health because any doctor will tell you that that is just untrue. Abortion keeps many children from growing up either in foster homes or in abusive neglectful dirty poor homes where not only that child will suffer but will be more attracted to crime welfare etc and lets be honest many of the same people who oppose abortion also oppose welfare and food stamps which doesn't make one bit of sense to me how do they expect these mothers to keep their babies and then live in such desperate poverty? At the end of the day, a mother has to go through the actual labor pain and other issues involved with parenting and juggling responsibilities others can\"t precisely gauge or understand the level of trauma that a woman may be experiencing in her personal life. She is the only person who knows best, if she would be able to take care of the unplanned child. and i rest my case k", "Abortion Abortion deprives a fetus of an entire human future:", "Abortion I believe abortion should be illegal! If a pregnant mother is murdered, the murderer is charged with a double homicide. This law considers an unborn baby a real person. Why then is abortion legal? From the moment of conception, an unborn baby is a distinct person. Therefore we should give these innocent unborn babies a chance at what life has to offer!", "The USFG should ban abortion == Rebuttal == 1. I accept that the fetus is a human. 2. Human Rights Pro points out that the right to a person's life is protected under the Constitution. The Constitution has been amended 17 times since its inception and interpreted innumerable times by the Supreme Court, meaning the law as-written is not necessarily the way the law has/ought to remain. SCOTUS decided in Roe v. Wade that a right to privacy under the Due Process Clause of the 14th Amendment extended to a woman's decision to have an abortion, but that this right must be balanced against the state's two legitimate interests in regulating abortions: protecting women's health and protecting the potentiality of human life [1]. The government does not disregard the fetuses' rights all-together, but rather establishes criteria for when their right to life trumps the mother's right to privacy and bodily autonomy. The Court decided this right begins with fetal viability - that is when the fetus can live without it's mother's body. The Supreme Court has ruled many times that people have the right to bodily autonomy and the right to their own person. For example in Cruzan v. Missouri, the Court ruled that people can refuse to seek medical treatment even if it would lead to their death [2]. Indeed we can use our body however we see fit regardless of other people's preferences. If I want to tattoo my body or have a baby, I have that right whether other people believe I should do those things or not. Pro writes, \"Murder is the unlawful killing of a human being with malice aforethought.\" However compare this to euthanasia which is the practice of intentionally ending a life in order to relieve pain and suffering. Ending a life in and of itself is not necessarily murder, and Pro has not proven as such. Consider why only killing humans is considered murder whereas killing animals does not qualify. This is because animals do not have the level of sentience that humans do. While fetuses have the potential for sentience at some point, until that point, they do not and should not have the same rights as those who have already achieved this criteria. We do not grant rights based on potential. We do not give 16 year olds the legal right to drink just because they have the potential to turn 21. We base rights as/is, which is why some fetuses have the right to life and some do not. In my contentions, I will be arguing the right to life ought to be based on a level of sentience, even for human beings. Pro notes, \"Whenever rights are limited, the most common and justifiable reason is when the observation of one right infringes on more important rights of others.\" He posits that the unborn baby is due for protection under the law including the right to life, and that this right is more important than the mother's right to privacy. But indeed the mother's freedom and right to bodily autonomy is what's also in question. Privacy refers to a woman's decision to keep it personal and none of anybody else's concern or opportunity to regulate. Pro writes that females waive their right to bodily autonomy by consenting to sex. That is manipulative rhetoric. If I consent to sex, it's not consent to aggressive sex or all sexual acts. If I consent to sex and contract an STD, it would be ridiculous to suggest I must be forced to live with this STD forever (or for a certain period of time) against my will. Instead I should be able to treat it however I would like, because it's my body and therefore my choice. If the STD had achieved a level of sentience, that would be different. But until then it would just be an unintended consequence of my actions. \"When women are compelled to carry and bear children, they are subjected to 'involuntary servitude' in violation of the Thirteenth Amendment... Even if the woman has stipulated to have consented to the risk of pregnancy, that does not permit the state to force her to remain pregnant\" [2]. == Arguments == 1. Individuals have the right to bodily autonomy. This means we should be able to make decisions about our own bodies, especially if they affect our health risks. Abortion should be a legal choice for women because it is risky and directly involves their body and health. More than 70,000 girls ages 15-19 die each year from pregnancy and childbirth [3]. No other person has the right to control how we use our bodies, especially as adults, though this inherent right ultimately extends to all fully conscious persons.2. Other people do not have the moral or legal authority to govern our bodies, even if someone else's life is on the line. For example if someone needs me to donate organs, blood or plasma, I cannot be legally forced to use my body to save their life -- even if it's my fault they need help (say my drunk driving caused a car accident, and their lives are now in danger because of my choices). Women have the right to determine how their bodies are used. There is no other circumstance in which any person's body is forcibly used to keep another human being alive against their will. 3. Criminalization will not stop abortions. So-called \"back alley\" abortions will still occur that put women at risk. If it does not serve as a meaningful deterrent, criminalization is not effective and does more harm than good. Legal abortions are generally safe and provide women with reproductive choices that do not needlessly make them criminals [4]. Criminals are those who infringe upon other's rights, whereas women who get abortions do not infringe upon an entity that has any legal rights. 4. Women who are raped or victims of incest should not be forced to carry out a pregnancy. These people should not be forced to carry out a pregnancy from such an invasive and traumatic violation. Even if it's a small percentage of pregnant women, the law exists to protect minority populations. 5. The abortion rate is declining while abortion remains legal [5]. You can combat abortion by providing meaningful sex education and access to birth control. This includes contraception that prevents the fertilization of an embryo. 6. Both IVF and abortion involve the destruction of fertilized eggs that could potentially develop into people. However the push to criminalize abortion and not those who need fertility treatment, proves the contention is less about protecting human lives, and more about controlling women's bodies. Indeed most people who are \"pro life\" do not support legal measures to protect life when it comes to caring for the sick and impoverished who need care in order to survive. And anti-choice organizations have avoided targeting IVF, even as they\u2019ve sought radical restrictions on abortion access. The point here is that protecting every human life does not seem like a serious or consistent contention. 7. Fetuses that aborted still have lived that are used for good. \"All embryonic stem cells are undifferentiated cells that are unlike any specific adult cell. However, they have the ability to form any adult cell. Because undifferentiated embryonic stem cells can proliferate indefinitely in culture, they could potentially provide an unlimited source of specific, clinically important adult cells such as bone, muscle, liver or blood cell... Embryonic stem cells are of great interest to medicine and science because of their ability to develop into virtually any other cell made by the human body. In theory, if stem cells can be grown and their development directed in culture, it would be possible to grow cells of medical importance such as bone marrow, neural tissue or muscle\" [6]. This can be useful at treating disease and saving other human lives - the lives of those already sentient. 8. Reproductive choice can be the only thing that stands between a woman and poverty or death. While adoption may be a viable option for some, particularly in the U.S., in other parts of the world that is not necessarily the case. However Pro's standard of the right to life means women who are in specific danger due to restricted medical care or resources (especially in Africa and South East Asia) will be forced to birth children, even if it means that they are likely to die and that there babies will die or be uncared for. 9. Fetuses are often terminated before sentience, so they are not very conscious beings. We legally kill living things that are more cognizant, such as pigs that are as sentient as toddlers. Therefore simply being alive (or even being conscious) does not determine the \"right to life\" in society. Fetuses arguably do not have the right to life, specifically as it pertains to mandating the use of the mother's body to survive. We do not recognize the right to life in other humans such as those in vegetative states, etc. The reversibly comatose, momentarily unconscious, or people who are asleep are once functioned and/or are currently functioning as sentient beings, even if they are temporary state of non-sentience. The pre-sentient unborn, however, were never sentient and once they qualify as sentient obtain the right to life. It is the capacity to be sentient which provides this distinction. This standard is important and useful because it accounts for the essence of personhood beyond being alive or arbitrary speciesism. Why don't plants have the right to life despite being alive? It's the ability to feel, think, perceive, and be self-aware amongst other things that makes this important moral and legal distinction.[1] https://en.wikipedia.org...[2] https://en.wikipedia.org...[3] http://amplifyyourvoice.org...[4] http://thinkprogress.org...[5] https://www.guttmacher.org...[6] http://news.wisc.edu...", "Abortion should be illegal world wide Abortion is rang no one should murder there unborn child. If a women has a right to the choice of the abortion ,,well the baby has a choice and should have the right to live. Its Evil to kill a baby .there should be no argument because any rebuttal means your stance is kill a child infant you created. it makes no sense religious wise, morally makes no sense at all, and it shouldn't make legal sense because murders illegal.", "abortion should be legal up to the first trimester Abortion should always be an option. tay-sachs disease Rape midgets incest young teenage girls with a bad home lives young teenage girls that could be killed of injured mothered or fathered by someone with aids or other illnesses Abortion has to be an option. It is irresponsible to ignore any of the above reasons.", "Abortion should be legal. >>> Women who do abortion face a number of possible complications including... +++ No. I am right. You are exaggerating on your list of harmful effects. The four you mentioned that were correct were excessive bleeding, infection of the uterus or fallopian tubes, damage to the uterus or cervix, and emotional or psychological distress. Emotional distress is an expected effect that is the woman's choice. And a kid, especially an unwanted one will cause a lot more distress, than an abortion. Bleeding is an effect of any surgery. The other two are possible effects that are unfortunate, but rare. And the women are warned of these effects beforehand. http://www.nlm.nih.gov... >>> Breast cancer risk +++ This is tremendously flawed. Please show sources. And a small breast cancer risk is no reason to have a kid, especially if you were raped or would die from the birth. >>> Isn't death a risk for every pregnancy? Are you now saying we shouldn't have children? +++ Some women are known to be prone to death before the birth. Why would these women be forced to die? Are you, morally, going to let a woman kill herself for a bunch of embryos that nobody knows or cares about? No. >>> It is ironic to state that it is immoral to force women to die from a pre-known death for a stranger because a lot of these people do not have families. +++ How dare you! You are really reaching here. Many women get pregnant during marriage and don't want the child because they will die because of it. Some of the Supreme Court justices during Roe vs. Wade solely based their votes off of this. Sure, some teenagers get abortions, which is a great option, but some of those girls will die from the birth and are known in advance of their deaths. Even they should not be killed. To force a woman to kill herself is immoral. >>> She will not necessarily die because she gives birth but the child WILL. +++ YES, SHE WILL! There are women whose bodies can no longer give birth. If they get an abortion they can live. If they don't they will die for the sake of the child who cost the life of a loved one. This baby doesn't deserve to be born without a mother. And the families don't deserve to loose the mother, wife, daughter, and friend. >>> The abortion option. +++ This is unfair. How can you suggest that a woman carry around a baby for 9 months while being sick and miserable? Especially if she was raped. A raped woman is victim enough. Do not punish her more with 9 months of torture only to give up a baby that she cannot take care of. And what about the women who are known to die after birth? Are you going to let them die? You have yet to explain for them. >>> No proof of prostitution argument. +++ My argument is defensive. I don't need to support it if you can't. Argument dropped. >>> What! How do you rationalize this? Prostitution often means cheating on your wife or girlfriend and it spreads diseases! +++ That's a different debate. Prostitution does not hurt anybody. Adultery is the crime. If the prostitute is not spreading disease, it is consentual sex and should not be illegal. Victimless crimes cost a lot of money to enforce for no reason. >>> Prostitutes will get raped. +++ How can somebody who is being paid to have sex be raped by their client? >>> New fetuses are human! No their not. A rock can not feel, think or do much of anything. Much like a fetus. You can destroy a rock legally. Like you can abort a fetus legally. If the thing is not human, don't call it human. Scientists don't claim a fetus to be a human until 26 weeks. If science isn't good enough proof for you...nothing is. >>> Girls who get abortions may commit suicide. +++ It's their decision to get the abortion and they don't commit suicide that often. And girls who are pregnant as teenagers probably have other, bigger problems in their life. You can't say this is related. >>> Why should the child be punished by rape? +++ How dare you! This is an outlandish statement. The child is not being punished. There is no child! Not until 26 weeks when abortions are typically illegal. If a woman is raped she shouldn't have to take care of a kid for the rest of her life from a man she probably doesn't even know. If a teenage girl is raped, she should not have to ruin her life, which is statistically more likely. >>> Women make laws and some are pro-life. +++ I didn't say I was using the sexist argument. You just imposed it on me. But it is legitimate. Because there are women who are wrong. There are people with differing opinions in every demographic. Most women will think abortion bans are unfair. The ones who have read the facts anyway. 1. The government does not, and should not have the right to control a woman's body. >>> Yet isn't the child a \"body.\" The government would be controlling the child's body in this instance. +++ No! Science says the child is not a body or a person for 26 weeks. If a woman is raped she should not be forced to carry around a baby for any amount of time. And the government has no right to tell either way. 2. \"Back alley\" abortions were very common in times when abortion was legal. These abortions included women sticking hangars into their bodies to kill their fetuses. This will continue if abortion is criminalized. >>> Back alley abortions are less common. +++ Back alley abortions were less common, but they happened. This often killed the woman and the child? Is this a reasonable solution? No. 3. A child that is unwanted will be neglected. GOD wants mothers to want their babies. >>> this violates God's rule of freewill. A mother cannot be forced to love her child. +++ No. God is not forcing anyone to love the kid. He is giving them the option. It is the exact opposite. God is hoping they will love their babies and is giving them the boost. 4. Neglected children will be the inevitable result. They are a lot more likely to become criminals. >>> Can you prove this? Adopted kids. http://search.yahoo.com... Adopted kids are often neglected as well. More often than not. 5. One brief mistake can take away a woman's childhood and trap her for life. >>> Yes and this would be having sex before marriage. It has nothing to do with the topic. +++ You cannot force the Christian religion on all Americans. It is legal to have sex before marriage and should not be punishable.. And those who are raped have no choice. Some fathers even force their child to have the rape-result baby. 6. Abortion is not murder because it is performed before a fetus has developed into a human person. >>> (website) +++ I used science. 26 weeks. Your turn. 7. Some women are raped. Should they be forced to keep the rapist's baby and take care of it? >>> Approximately only 1% percent of all abortions are attributed to rape and incest. + I don't think this is true. But even one of these cases is horrible and so immoral. 8. Women can die from pregnancy and birth. Should these women be killed? >>> This was a risk for EVERY WOMAN SINCE THE BEGINNING OF TIME! +++ Some women are more prone to die or certain to die from birth. 9. Abortion bans have been ruled unconstitutional because they are detremental to women's health. We have the right to life. The government cannot force a woman to have herself killed. >>> Arguments above should suffice. It's a risk every woman takes. +++ No. It's not. 1. Define \"fully developed.\" +++ Able to feel and think, physically too. 2. Explain why adoption or foster care is wrong. +++ Raped women should not be punished with 9 months of carrying a baby. Some women are certain to die from birth. 3. Is there any other reasons why abortion is right despite the fact you think it should be a woman's choice? +++ Rape, women who will die, teenagers lives, etc. SOME WOMEN ARE CERTAIN TO DIE! ONLY ILLEGAL ABORTIONS KILL WOMEN", "Abortion is Wrong Women should not have the choice of abortion unless the women was raped, incest, or for medical reasons. Abortion should be categorized as murder from part of the mother. If the mother came through with abortion she should have the obligation to serve time behind bars due to her taking a child's life away. Same goes for the doctor which performed the abortion. No one should have the ability to kill a baby just because they couldn't take the responsibility of caring for it there is other alternatives for the child to live abortion isn't the only option", "Abortion should be legal 1. Abortion is about allowing woman the right to make choices about when they want to have children in relation to their age, financial stability & relationship stability. It is the not the place of government to legislate against woman's choices. 2. Raising a child is not an easy task & requires social & emotional commitment coupled with financial resources. As such if a person feels they are not ready for a child, it means the pregnancy is unwanted & resultant allowing a fetus to grow into a child is worse than abortion since the resultant child will grow in a non conducive & destructive environment without the love, care & stability that a child needs. 3. The argument against abortion is a moral argument which is subject to personal interpretation so should not be legislated against. Those see it morally allowable to do abortion should be provided with the means to do so & those who don't believe in abortion should have the choice not to have an abortion 4. A fetus is not legally or scientifically a person or human being so abortion cannot be equated to murder or taking a life since the fetus is not a person nor alive. 5. A fetus is like a brain dead person with no self awareness or consciousness so it is actually dead. 6. Prohibiting abortions doesn't stop abortions, women would simply seek abortions via illegal means which are unsafe & illegal, so it is better to provide woman with safe & legal ways to do an abortion. 7. Abortion prevent unwanted & unplanned pregnancies which prevents child neglect since the mother does not want to have children at that moment in time. 8. Making abortion illegal is also a class struggle since the rich can always go to other places where it is legal & have an abortion whilst the poor cannot do this, but have to resort to unsafe abortions which can lead to their death. 9. Making abortion illegal is more or less compulsory pregnancy which contradicts the quest & fight for freedom. 10. Making abortion illegal will increase teenage pregnancy (children having children). This usually leads to illegal abortions which can lead to death or permanent health defects, poverty, joblessness, hopelessness, and dependency. 11. A woman's right to choose abortion is a \"fundamental right\" 12. Personhood begins at birth, not at conception. Abortion is the termination of a pregnancy (fetus), not a baby. Personhood at conception is not a proven biological fact. Fetuses are incapable of feeling pain when an abortion is performed. 13. Access to legal, professionally-performed abortions reduces injury and death caused by unsafe, illegal abortions. 14. The anti-abortion position is usually based on religious beliefs and threatens the vital separation of church and state. Religious ideology should not be a foundation for law. 15. Modern abortion procedures are safe. The risk of a woman\"s death from abortion is less than one in 100,000, whereas the risk of a woman dying from giving birth is 13.3 deaths per 100,000 pregnancies. 16. Access to abortion is necessary because contraceptives are not always readily available. Women need a doctor's prescription to obtain many birth control methods, such as the pill, the patch, the shot, and the diaphragm. 17. Abortion gives couples the option to choose not to bring babies with severe and life-threatening medical conditions to full term. 18. Many women who choose abortion don't have the financial resources to support a child. 19. Motherhood must never be a punishment for having sexual intercourse. 20. A baby should not come into the world unwanted. 49% of all pregnancies among American women are unintended. Having a child is an important lifelong decision that requires consideration, preparation, and planning. 21. Abortion reduces crime. Teenage girls, unmarried women, and poor women are more likely to have unintended pregnancies, and since unwanted babies are often raised in poverty, their chances of leading criminal lives in adulthood are increased. 22. Do we have the right to force the mother to keep the baby solely because she consented to participate in these sexual activities? Do we have the right to take away another\"s right as we continue to fight for other rights? Why do we take away the rights of a woman because she has the potential to have a baby? 23. We get right to life, liberty & pursuit of happiness when we are born. he fetus does not have these rights until it is born. So abortion is not murder & abortion does not go against the rights of a fetus since it does not have any until born. 24. Every woman has the right to do whatever they want with their body aka Bodily Autonomy. This is one of the reasons why it is illegal to take organs from the deceased that have not signed off permission. If we continue this right after life, why do we strip it from a pregnant woman? Why would you grant a dead person a right that you wouldn\"t give to someone that is alive. 25. If someone needs something donated that you have, you are not legally obligated to donate anything. This parallels to pregnancies because a fetus does need these resources, but the mother is not legally obligated to keep giving this baby her resources. Denying to give someone a body part is not illegal, so terminating a pregnancy should not be illegal 26. Legal abortions protect women's health. Legal abortion not only protects women's lives, it also protects their health. For tens of thousands of women with heart disease, kidney disease, severe hypertension, sickle-cell anemia and severe diabetes, and other illnesses that can be life-threatening, the availability of legal abortion has helped avert serious medical complications that could have resulted from childbirth. Before legal abortion, such women's choices were limited to dangerous illegal abortion or dangerous childbirth. 27. Being a mother is just one option for women.* Many hard battles have been fought to win political and economic equality for women. These gains will not be worth much if reproductive choice is denied. To be able to choose a safe, legal abortion makes many other options possible. Otherwise an accident or a rape can end a woman's economic and personal freedom. 28. Even when precautions are taken, accidents can and do happen. For some families, this is not a problem. But for others, such an event can be catastrophic. An unintended pregnancy can increase tensions, disrupt stability, and push people below the line of economic survival. Family planning is the answer. All options must be open. Sources 1. http://www.debate.org... 2. http://abortion.procon.org... 3. http://www.topix.com...", "Abortion should be legal Dropped - Self Defense Dropped - Bad Childhoods /Mother can not take of the kid Rebuild) Constitutional Right My adversary says we are debating about whether it should be legal and I agree. The reason it already is legal is because it *should be* legal. The constitution was established because it granted us the greatest possible freedom. Denying someone the right to govern their own body denies them the freedom granted under the Constitution. A woman has her right to her own body as does anyone. Taking that away from her is going against a document that was made to provide us with the greatest possible freedom. The same is true in other countries, which is a womans body is her own. Rebuild ) My adversary says because of rape being such a small number, we should then enforce it because there is such a massive number against it. What he is stating is that is is perfectly fine to tell around 30,000 women yearly that they have to carry a child because they were sexually assaulted on no fault of their own, even if it could mess up their lives forever. HE is basically saying that 30,000 people could be traumatized and it would be okay. Also per the analogy it's telling someone they have a moral responsibility to keep someone alive (if the fetus is even a life). HE left the analogy untouched. A fetus is not the same as a person that has been living for years. They already have a life, the fetus just has the potential to be a life and the terms by which a fetus is a life is *so* subjective that it varies state to state and from country to country. Fetal homicide laws literally vary, so these numbers my adversary are saying, are not considering when a fetus is considered viable, but the total number of abortions (this is not accurate). Rebuttal ) My adversary just asserts that an embryo is a living human, without providing any evidence to support it. A fetus has the potential to be a life, but the stages at which it is considered to be a life *vary* everywhere. That is how subjective this issue is. We have been looking over this for years, and no one can determine viability well. Viability in most senses is commonly around 20 - 28 weeks which is basically a late term abortion (most are already illegal as is) so the numbers are drastically smaller than my adversary makes them out to be Rebuttal ) this is an assertion with not facts. People should be able to opt out of abortions because it prevents bad cases of children being raised in homes that cannot afford them, or going through adopted care. If you can stop the life while it has the potential to become a life, to prevent harms that should be allowed. You are not terminating a life, but the chance of a life existing. Contraception ) He just asserts contraceptives work all the times, and cases where they don't work the women still should be forced to carry a fetus. A fetus is the potential to become a life, and contraceptive don't always work. People should be able to opt out.", "Abortion Well, that wasn\"t the angle from which I agreed to debate, but I\"ll argue the case nevertheless. My first argument will, in line with the rules my opponent has set, only address my core arguments\"though, inevitably, there will be overlap, but I will not mention his data directly. Let me begin by saying that I do not personally condone abortion, and one need not do so in order to believe that abortion is a viable choice\"even if we are to accept that a zygote or a fetus are persons, which is, by and large, a theological view. My personal opinion\"informed by my Catholic faith--is irrelevant (\"separation of church and state,\" which the Supreme Court has long upheld, is a core tenet of the Constitution and of the founding of the U.S.). Not only am I a man, who can never become pregnant, but I have never been intimately involved in a dilemma that would lead one to have an abortion, so I can\"t surmise what they must have been feeling. This is not a fun thing for women to choose, but it is false to say that they eventually will regret their decision; indeed, many do, but many also report feeling relieved in having made the right decision at the time. Studies have reported, for instance, that 87% of women are \"highly confident\" about their choice. 90% said that their primary reaction was \"relief.\" In fact, evidence shows that procedures aimed at discouraging women from having abortions--e.g., mandatory ultrasounds--actually do not, by and large, deter women from making this decision. Ultimately, the attempt to demonize these women as monsters for making a choice about their own bodies\"a right that the Supreme Court has protected for 40 years as a Constitutional right to privacy\"is largely disingenuous, and rooted in fallacy. First, abortion is a viable option in the case of rape. A 2004 survey placed the number (the percentage of abortions that follow rape) at 1%. But we need to take that number in context: that\"s 1% of 1.3 million women, or 13,000 abortions after rape, with the survey indicating the average figure is around 19,500 per year. Let\"s put aside the figures for a second, though, and consider this in context. Is the counterargument truly that, because the number is small relative to the total number of women who have abortions, that it is negligible and we should forget about it? Should we accept Rep. Trent Frank\"s view that \"the incidence of rape resulting in pregnancy [is] very low?\" Not only is that highly offensive, but it\"s simply not true. A 1996 study by the Medical University of South Carolina determined that 5 percent of rape victims aged 12 to 45 became pregnant as a result\"32,000 pregnancies per year. They wrote \"[r]ape-releated pregnancy occurs with significant frequency [and] it is a cause of many unwanted pregnancies and is closely linked with family and domestic violence.\" A study in 2000 by the University of California, San Francisco placed the number at 25,000 per year. But let\"s look at the broader picture. Are you truly willing to force a women who has been raped\"who has been traumatized\"to carry to term, against her will, her rapist\"s child? Are you going to force her to report the crime, and subject her to the torment that will inevitably come (in fact, there\"s a thread on DDO where people are questioning whether the victim\"s testimony is valid evidence in court\"in essence questioning whether she is lying about it or whether she \"enjoyed it\")? Are you going to force her to undergo a mandatory, medically unnecessary transvaginal ultrasound, as they must do in Virginia? Even under a proposal, such as one that Governor Romney presented in 2012\"where abortion would be legal in cases of rape, incest, or life endangerment (and, by the way, he wanted the states to decide, so a state could still prohibit it in those circumstances\"there is still a key problem: how will women \"prove\" that they have been raped? Romney commented that he would probably want to \"just trust them,\" but a recent Republican proposal\"yes, created by the House Judiciary Committee\"s Subcommittee on the Constitution and Civil Justice all-male panel, headed by Trent Franks\"would allow the I.R.S. to determine what constitutes rape or incest? Why is it that Republicans only support government intervention when it comes to abortion? Let us also not forget about this important question: How about the \"rights of the rapist?\" Will he have any custody over the child? In 31 states, he does in fact have those legal rights, which I think is a travesty. There are several important takeaways from this 2004 study, though. One is that, as the abstract says, \"[t]he decision to have an abortion is typically motivated by multiple, diverse and interrelated reasons.\" Of the 1,209 patients who were interviewed, 74% claimed that it would interfere with their education, work, or ability to care for people who financially depend on them; 73% cited financial constraints; 48% cited relationship problems, or had no assistance with raising the child, and would need to be a single mother. Common themes were limited resources, money, and lack of support. The ability for a women to control whether or not she has a child determines whether she will be able to be active in the world and to contribute to society. It is, of course, unavoidable that she--and only she--must carry the child for nine months, while her partner can, and in many cases does, simply back out. Why should she alone be held responsible? Next, let's discuss further the notion of women being unable to afford a child, as that has been demonstrated as a primary concern among women seeking abortions. Women with incomes below the federal poverty line account for over 40% of all abortions. About 60% of women who have abortions already have a child, and 30% have two or more children. How is it possible to brand these women as irresponsible, when the data is quite clear that they, simply put, cannot afford to have another child? Would it not be more irresponsible for a women to bring another child into the world, whom she knows she cannot probably pay to support? Not only would she threaten herself, her family, and the children she already has, but she would threaten the life of this child. It's certainly not ideal no matter how you frame it, but that's why this issue should be left to the discretion of the mother. Circumstances differ depending on the respective families, and my opponent's view--that abortion should not be a viable choice, and as he noted in his first post, that it should be illegal--removes these decision from women, and imposes a \"one-size-fits-all\" plan devised by government bureaucrats. Is this truly a plausible path? Can the government truly intervene and tell women that they ought not have sexual intercourse if they cannot support a child (even if they are using birth control)--and, if they do, and get an abortion (because there is also data indicating, even prior to Roe v. Wade, that banning abortion does not eliminate it, but simply makes it more dangerous, but that's not what our debate is on), that they should be prosecuted? Forcing a women to go through with a pregnancy is effectively forced birth, and that represents an authoritarian position that I cannot endorse. Likely the most cited reason as to why abortion is a viable choice is to protect the health and life of the mother--including cases where the fetus, also, would not survive. Former U.S. representative Joe Walsh once inaccurately asserted that \"there is no such exception as life of the mother, and as far as health of the mother, same thing, with advances in science and technology.\" A valid counterexample, for instance, is ectopic pregnancies, where the child is born outside of the uterus. The National Institutes of Health report that these occur in a range of 1 in every 40 to 1 in every 100 pregnancies, and the fetus must be removed to save the life of the mother. There was an example from Ireland from about a year ago that is relevant. A woman named Savita Halappanavar, who experienced a miscarriage, died from blood poisoning after having been denied an abortion. Irish law prevented her from having one unless medical professionals thought her life was at risk, and, in most cases, wouldn't perform them even in a case such at this due to legal boundaries and \"wanting to play it safe.\" Therefore, I believe that abortion is a viable choice--and should remain legal--even if I personally don't happen to endorse it. http://www.minnpost.com... http://www.ncbi.nlm.nih.gov... http://thinkprogress.org... http://www.thenation.com... http://www.womenscenter.com... http://thinkprogress.org... http://www.cnn.com... http://www.usnews.com... http://www.guttmacher.org... http://www.huffingtonpost.com... http://www.huffingtonpost.com... http://www.prochoice.org...", "Abortion should be legal \"Abortion should be legal because people can choose to have a kid or not, and forcing them can suffer the child and the parent\" So, your first argument is that not giving people the right to choose if a being lives or dies will make them suffer, but I'd argue it's the other way around, if anything. After an abortion, a woman might end up ridden with a lifetime of guilt, and, even if the woman isn't capable of raising a child, or the child may cause her to remember past trauma, there are options other than deciding to just kill them, such as putting them up for adoption. Abortion is selfish. It's the easy way out for people who don't want to deal with the consequences of their actions, even when there are other options, and it's murder. \"Making it illegal will make women who want to abort go to dangerous place that can harm them and possibly kill them.\" Your next argument is that if you don't give the women the abortion, they'll go to some strange and mysterious place and possibly get hurt. I want you to think for a moment. If you had a child that you didn't want, and an abortion wasn't available, would you really go get it done in some dark dingy alley or whatever scene you have pictured that could get the woman hurt? I can't help but question if places like what you're describing even exist, and if they do, I really can't help but question if this is some major problem. You haven't shown much evidence to back it up, anyway. \"Unborn baby only feel pain at 20 weeks and most of these abortion is when the women life is in danger.\" Firstly, cite your sources. You have literally nothing to back up this claim period. But let's assume you're right, just for the sake of argument. Even if this was true, it doesn't change the fact that it's murder. Murder is killing another human being. Are you trying to claim that the baby in the womb is not human? If so, what makes it not human? Is it its age? In that case, premature babies should be able to be murdered. Is it the fact that it needs to be physically attached to the mother? Then what about people who are dependent on technology to live, are they not human because they require resources from a machine? They're not part of the machine just because they're attached to it, and the same applies to a fetus. Is it its location in the womb? In that case, you could put any person in a womb and claim that it's not human and that killing it should be legal. And consider things like premature babies again. Let's say for the sake of argument that you had a premature child at 19 weeks (I'm not sure if this is possible, but it's just a hypothetical example). Is killing the newly born premature child murder? Of course it is. So, your argument is that because the child is attached to a tube in the mother's womb, it's not human, and killing it isn't murder, and the second you remove it from the womb, killing it is murder. Do you see how insane that sounds? Do you see how little sense that makes? Overall, even a pro-abortion person could probably see that your arguments are simply bad. You cite no sources, you back up nothing, you can't even use proper grammar in a formal debate... No offense, but you should honestly get a bit better at debating before hopping onto the internet and trying to tell all those darned Christians how stupid they are.", "Abortion should be legal == Intro ==In this debate, I'll defend abortion being legal for some period in the pregnancy. This precludes Con from making arguments relating to abortion being immoral after a certain point in the pregnancy. The BoP in this debate is shared, both because of a lack of a clear status quo (though in most countries, abortion is legal) and because this is a normative resolution.Con needs to argue that abortion should be illegal *throughout* the pregnancy, with the two exceptions listed in R1. Note that Con has to defend bans on abortion even in cases where it is required for good mental health of pregnant individuals, and in cases where, for instance, contraception fails or there's fetal impairment. I also have fiat over measures to make abortion more safe, accessible, and cheap, and I support measures to ensure that.== My case ==I'm going to advance three claims: (1) that pregnant individuals have a right to abortion, (2) that allowing abortion prevents dangerous back-alley abortions, and (3) that legalizing abortion reduces the numbers of unwanted children in society, which is a benefit. Each of these three contentions affirms the resolution independently; if I win even one of them, vote Pro. (C1) Pregnant individuals have a right to abortionA. AutonomyBans on abortion prevent pregnant individuals from exercising a choice in terms of what they are allowed to do with their bodies. Governments ought not prevent people from exercising choices unless there is direct harm to others. As John Stuart Mill explains, \"The only purpose for which power can be rightfully exercised over any member of a civilized community, against [their] will, is to prevent harm to others.\" [1] If the state bans abortion, it prevents people from exercising free will. Why should states follow this standard of respecting free choice? There's three reasons for this: (1) The state derives its legitimacy from the consent of the governed. The harm principle acts as a mechanism to ensure that the state is protecting the will of its people. (2) The harm principle is the best utilitarian goal, because each individual is best placed to decide their own interests and to weigh their own pleasure and pain. Given that calculations of pleasure and pain are subjective, when these are felt by the same person, that person should be able to make these decisions. (3) Empirical evidence suggests that states with more political and social freedoms also have greater rates of human development. [2]Now, Con might argue that abortion harms the fetus, and is therefore immoral. However, the fetus isn't conscious until 24 weeks of pregnancy. Consciousness only arises between the 25th and 30th week of pregnancy. [3] [4] Given that the fetus is not a conscious person, killing a fetus is akin to killing a plant -- a living being which cannot feel. B. Self-defensePregnant individuals have a right to self-defense. People who are denied abortions face immense psychological harm. According to a University of San Francisco study, \"women are much more emotionally stressed if they are denied an abortion initially than if they received one upon request.\" [5] A 2013 study by Roca, et al. concludes that \"[c]ompared with women who obtained a near-limit abortion, those denied abortion felt more regret and anger, and less relief and happiness.\" [6]This offers an independent reason to allow abortion. First, it means there's significant harm to people who are denied abortions. The state has an interest in preventing psychological harm to its citizens. Therefore, abortion should be legal. Second, it means people should have a right of self-defense, against psychological harm. If Con concedes that abortion should be legal to protect the lives of pregnant persons, then they concede that there's a balancing of rights here. Given that the fetus cannot feel mental states, the right of people to escape psychological harm and exercise their autonomy outweighs. Conclusion: Given that the fetus is a non-conscious entity dependent on the parent for survival, banning abortion is an unjust restriction on the free will of individuals to control their bodies and to defend themselves against psychological harm.(C2) Allowing abortion prevents back-alley abortionsA. Bans on abortion cause people to turn to harmful back-alley abortionsThe alternative to legal abortion in licensed clinics is back-alley abortions. There's two warrants for this. First, on an analytical level, people continue to want abortions even when it's illegal. They're often in desperate positions which prevent them from having kids or are afraid of the emotional harm which will result. They also often don't have access to adoption, and don't want to carry the fetus to term. This means they're likely to turn to illegal means of abortion when they don't have access to safe, legal abortion.Second, there's empirical evidence that proves this claim. Elisabeth Rosenthal of the New York Times explains, \"A comprehensive global study of abortion has concluded that abortion rates are similar in countries where it is legal and those where it is not, suggesting that outlawing the procedure does little to deter women seeking it. Moreover, the researchers found that abortion was safe in countries where it was legal, but dangerous in countries where it was outlawed and performed clandestinely.\" [7] Indeed, back-alley abortion accounts for 13% of deaths due to pregnancy. [7] At least 22,800 women die each year from complications of unsafe abortion. [8] The reason these back-alley abortions are harmful is the lack of regulation and the lack of clinics to approach. Illegal clinics and pregnant individuals themselves (when self-aborting) tend to use brutal methods such as beating the abdomen hard, piercing the amniotic sac with a sharp object, and using poisons. [9] [10]B. Legal abortion reduces back-alley abortion ratesThere's two pieces of analytical justification for this. One, these unregulated clinics (as well as self-abortion) are illegal, meaning people are disincentivized from pursuing them, when there's access to legal clinics. Two, people recognize that a legal, regulated clinic is much safer. Together, this means that the existence of legal clinics takes down the business of unregulated abortion, due to a lack of demand.This is also empirically true. For instance, in South Africa, after abortion was legalized, abortion-related maternal mortalities reduced by ninety-one percent. [11] This means that, in Con's world, abortion continues, and is far more dangerous. Vote Pro because legal abortion saves the lives of individuals. (C3) Bans on abortion lead to more unwanted childrenBanning abortion means there's a large number of unwanted children, insofar as some people still choose to not break the law and don't engage in abortion. Adoption isn't enough to give homes and families to these children. Randie Bencannan of Rewire explains, \"Recent statistics show that approximately 14,000 newborns are adopted annually in the United States through voluntary placements, a number that has remained flat for about 20 years. Meanwhile, in 2011, 1.06 million abortions were performed -- the lowest number in decades.\" [12] These children experience massive challenges. In some cases, they're sent to a broken foster care system. Children in foster care are four times more likely to experience sexual abuse than other children. [13] Moreover, as Pam Fessler of the National Public Radio notes, \"many former foster kids have a tough time out on their own. When they age out of the system, they're more likely than their peers to end up in jail, homeless or pregnant. They're also less likely to have a job or go to college.\" [14] In other cases, they're retained by their families. In these cases, the children face significant problems. (1) They're more likely than other kids to die at an early age. According to one 2016 study in the US, \"[S]tates with restrictive abortion policies increase IMR for black women by 2.214 infant deaths per 1,000 live births.\" [15] Another study in Finland found that children born due to denied abortions had an infant mortality rate of 24 infant deaths per 1,000 live births. [16] (2) They face economic and psychological disadvantages even in the long term. They perform worse in school, are more likely to face mental illnesses, and more likely to be poor. [16] (3) This hurts economic productivity. For instance, in Romania, \"children born after the ban on abortions had worse educational and labor market achievements as adults . . . [and] crowding in schools, due to the large increase in fertility immediately following the abortion ban, lowered educational achievements of the cohorts affected.\" [17] There's even some evidence that legalizing abortion reduces crime rates, which, even if questionable, is disconcerting. [18]More unwanted children hurts the parents. Parents who're denied abortions are more likely to face psychological problems, have worse relationships, and are twice as likely to face intimate partner violence. [19] Moreover, women who are denied the ability to abort are also adversely affected in terms of economic productivity. Indeed, \"[w]omen who were denied an abortion are three times more likely to be unemployed than women who were able to access one.\" [20] People denied abortion are also four times more likely to be pushed below the poverty line. [21] Conclusion: Banning abortion causes parents to have unwanted children without access to adoption, significantly harming the future prospects of these children, throwing these parents into poverty and unemployment, and causing significant negative impacts to society.For all the above reasons, vote Pro.Sources: http://www.debate.org...", "Abortion should remain legal in the United States Rebuttal I: Human LifePro explains that being human is about pain and feelings, but it is not. As I explained, being a part of a species (Human) is about having that species DNA (Human DNA.) At conception, the zygote has human DNA, and is thus human.Pro is confused about what makes someone human. He posts a more philosophical concept of what it means to be human rather than a science-bound argument of genetics. A Zygote is human, and no lacking senses change that. There are many humans without all their senses, and they are still human [1: http://tinyurl.com...]. Pro\u2019s logic is flawed. Not having the same level of development doesn\u2019t make someone less human. By the logic, a child isn\u2019t human because it isn\u2019t fully developed.This isn\u2019t about ending a life, but ending a human life. Stepping on insect life is quite different.Pro\u2019s argument simply doesn\u2019t hold on to my prior argument on the issue.Rebuttal II: The Mother\u2019s LifeMuch of Pro\u2019s argument is a flawed generalization. The global death rate among pregnant women does not accurately represent the US death rate. With places like Asia and Africa, the ratio is grossly inflated. In the US, the numbers go between 15 for every 100,000 pregnancies [2: http://tinyurl.com...] to 21 [3: http://tinyurl.com...]. That means a 1 in 4,762 chance of death AT LEAST. This means owning a house is more dangerous (1 in 38 chance of break in.)[4: http://tinyurl.com...] Standing is more dangerous (1 in 246 chance of dying from falling down)[5: http://tinyurl.com...] compared to the 1 in 2,506 lifetime change (odds of death in pregnancy multiplied by the average number of pregnancies per US woman.)[6: http://tinyurl.com...]An issue with aborting the child to save the Mother\u2019s life is that 1) 15% isn\u2019t to save the Mother\u2019s life. Pro misrepresents the numbers. The 15% regards any harm that might befall the mother, including infertility, Anemia, and Placenta Previa. Most complications that lead to abortion aren\u2019t life threatening, very few are, in fact. Half of all cases are the fault of the Hospital, and many can be fixed. Once you tear away all the less than justified excuses, you are left with a number too small to justify continued Legalization of Abortion.\u201cBetween 1968 and 2011 (the latest year for which figures are available) there have been 6.4 million abortions performed on residents of England and Wales. Of these, 143 (0.006%) were performed under Section 1(4), ie where the termination is immediately necessary to save the life of the pregnant woman or to prevent grave permanent injury to the physical or mental health of the pregnant woman...\u201d \u2013The Parliamentary Under-Secretary of State, Department of Health [7: http://tinyurl.com...]\u201dAnd it\u2019s certain many can be prevented through proper care.\u201cToday it is possible for almost any patient to be brought through pregnancy alive, unless she suffers from a fatal illness such as cancer or leukemia, and, if so, abortion would be unlikely to prolong, much less save, life.\u201d \u2013 Dr. Alan Guttmacher.With the number of Abortions occurring for the absolute preservation of the Mother\u2019s life, without any other option, being so small, it can\u2019t justify the number of babies who would wrongly die under misuse of the allowance. The number of babies wrongly aborted under the guise of safety would outweigh the appropriate use of such an allowance by too great a number. I will explain this better\u2026As convincing as the argument that women need abortion to save their lives is, it just doesn\u2019t stand in the real world. The number of babies who would wrongly die under the misused guise of self-defense (the only legal form of Homicide, as my R1 argument made clear) would be higher than the number of mothers who would be saved. Since of the 15% that claim some form of harm, only 2.8% are for life-threatening issues, and much less are cases where the doctors couldn\u2019t do anything else. Even at 2.8%, the number of innocent children dying from legalization would be twice that of mother/children lost because abortion wasn\u2019t legal, no matter how much you attempt to restrict what counts as Self Defense, especially since (relative to the amount of time it takes) doctors earn more in an abortion [8: http://tinyurl.com...]. All it takes is the claim of self-defense, and abortion becomes an option for that 15% Pro mentioned.This means legalization for Self-Defense alone would allow a greater number of innocent deaths, thus being highly counter-productive to its original purpose.Conclusion I: Pro\u2019s statistics are both generalizations that don\u2019t properly represent the US, and doesn\u2019t stand up to the accusations he has made. The number of women who legitimately require abortion to preserve life is too small to overtake the unjustified cases where the allowance of abortion would be misused.Rebuttal III: Rape and IncestBoth put together doesn\u2019t even account for a percent of all abortions [9: http://tinyurl.com...]. You would end up with the same issue in Rebuttal II.Appealing to rape isn\u2019t really relevant anyways. The cause of conception does not revoke a babies human rights. It isn\u2019t remotely relevant to if the child deserves the right to life and liberty. This was stated in Premise II.Rape only changes the means of conception, and nothing else. Everything else is false dichotomy. Saying either it\u2019s Abortion or [negative effect here] is a poor argument that plays off emotion. Saying that if the rape victim can\u2019t get an abortion, she will either be 1) emotional hurt, 2) financially unstable, and 3) unhappy, simply fails to find support in fact. Pro\u2019s assumption is only reasonable to people with no knowledge of what it\u2019s like. His claim doesn\u2019t match what people with experience say.According to one of the only studies strictly related to the topic of rape and abortion, 75-80% of all pregnant victims chose to keep the child [10: Mahkorn, \"Pregnancy and Sexual Assault.\u201d] The idea that most rape victims will want/need rape isn\u2019t supported. The idea that providing Abortion to rape victims is merciful is easy to sell, but actual rape victims disagree. Cases of victims who kept their child and regretted it are hard to find, while an amazing 78% of rape victims who got abortions seem to disagree with Pro\u2019s position that Abortion is the best answer. Unlike when a choice isn\u2019t the best but you can still make it if you choose, this is about homicide. If homicide isn\u2019t the only good answer, then it shouldn\u2019t be an answer.Abortion is the Childs Rights being violated in place of better alternatives. Adoption would be the appropriate answer to issues like poverty, being too young, etc\u2026 If all of these cases were fixed through adoption, it would send less than 12,000 children into adoption each year, the equivalent of less than a 00.5% increase (50% increase every 100 years), outweighed by the increasing rate of adoption. Latest reports show that 88% of adopted children are healthy and happy. [11: http://tinyurl.com...]. This makes Adoption the appropriate answer.Pro also brought up the rapist getting visitation rights. This isn\u2019t relevant\u2026 A child must die to prevent that? Much better alternatives are available, like repealing such a law. A leads to B. C leads to D. B sometimes involves D. Therefore A is to blame? That\u2019s terrible logic. C (laws granting rapists visitation rights) is to blame. Rape and Incest only affect the cause, not that creation, and any inconvenience, big or small, have better alternatives than homicide.Conclusion II: There are too many alternatives for abortion to be an option. Pro\u2019s whole case here is appeal to emotion and false dichotomy. Rape and Incest do not change the case at hand, only why we have to discuss the case.Additional Argument: Right to ChooseThe premise of the idea is that the mother would have the right to decide the value of her child, and rather or not it has the right to live. This premise is that the worth of the child is determined by how wanted it is. A child\u2019s worth is not determined by how much his mother wanted him, and such an idea spits in the face as every Child Protection effort across the nation.\u201cWe hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness\u201d \u2013Declaration of Independence. [12:http://tinyurl.com......]The Declaration of Independence says everyone is created (conceived) equal. The Declaration gives the child equality in worth, not the Mother.The idea that the Mother determines one\u2019s right to life goes against the UDHR, which says everyone, regardless of any difference of ANY KIND, has rights, including right to life, and nothing/no one may decide otherwise.Final Conclusion: Pro has only brought up fallacies and unsupported claims. Most of his argument is False Dichotomy, Appeal to Emotion, and based off generalized information. None of his arguments hold up to my R1 arguments. Of his only 2 sources, the first only supports one of his claims, and the other is highly bias and unreliable in such a debate. If Pro brings up the age of some of my studies, I\u2019d like to remind him that his NIH study is 2 years older than my oldest.An unborn child is a living human even as a Zygote. A mothers \u201cchoice\u201d does not exceed the Declaration of Independence or UDHR.Rape and Incest only change the cause and not the creation or his value and rights. Too many alternatives are available, and making abortion legal for rape is simply against the Rights granted by the UDHR, regardless of ANY DISTINICTION of ANY KIND, even how he was conceived. We must remember the US ratified the UDHR, making it completely valid in the US.Legalizing abortion in cases of the mother\u2019s life actually being threatened will lead to more innocent deaths than if abortion wasn\u2019t legal at all. For the preservative of life, it\u2019s more productive to not let abortion be legal at all.", "Abortion should be illegal but I wanna ask my oponent: it is the first debate of yours, seems u r new, why and how you challenged me to this debate? how you knew that I am PROabortion? I very doubt that you are new member here. the subject is: \"abortion should be illegal. \" My case is against it, it should not be illegal, it should be legal. during the debate, when I am going to refer to women who want abortion I am going to use \"we\". I am so lazy but for this challenge I will try to avoid lazynesssince there is no a rule which ban me from setting arguement in this round, I am going to start from now on. p. s: english is not my first language and I am not so good at it, I may make mistake when I use words. MY CASE:in the opening, he says {Abortion results in the death of an innocent human being and cannot be justified. As such it should be made illegal} which I take as he is against abortion in all cases becasue he didnt give any exception criterias. My position is \"Abortion should be legal\"more than that, I support: \"it should be allowed at least under some conditions and some situations as well. \"REBUTTAL:my opponent said: {Abortion results in the death of an innocent human being and cannot be justified}response: by saying this, does my opponent claim that fetus=human being? I would kindly want to ask him to provide us scientific evidence/proof for fetus being=human being. Burden of proof is on him about this. I dont think that fetus=human, however I am going to provide my arguements about fetus=/=human just a little later, now I am going to refure my opponent IN CASE fetus=human being. \"even if\" or/and \"in case\" Fetus=human, it is still justice for women to have abortion. antiabortionists claim that: \"by having abortion you are KILLING the baby/human/fetus\". first thing I am going to say about this is: we are not killing the baby nor the human, pregnant women help that fetus/baby/human to survive, at the time we have abortion we stop the help given by us, so we are not killing a baby/human/fetus. we are just stopping the help we give to them, after this it dies or it takes damages that is not our problem. as a person, we have right not to help others and you dont have right to force us to help others. so, even if the fetus=human, it can still be justified sicne we have right NOT to help others. does not \"not allowing women to stop the help she gives\" mean to force her to do something which she does not want to do? HUman rights Article 5. No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment[1] when we look at dictionary, it says that one of the meanings of torture is: To bring great physical or mental pain upon (another)[2]considering \"no one shall be subjected to tortue or to cruel, inhuman or degrading treatment or punishment\", we cant force woman to carry that baby nor to do something. at the same time, HUman rights decleration Article 3. Everyone has the right to life, liberty and security of person. [1] so, everyone has the right to \"LIBERTY. \" not allowing women not to carry the baby violates his liberty. (my opponent may say everyone has the right to life too I ask him: to prove that fetus is human. even if he can, I have showed above that it is still right of woman. )considering we have right not to help others, it can be justified and should not be made illegal. we can not force somebody to help somebody. MY ARGUEMENTS ABOUT: ABORTION SHOULD BE LEGAL at least UNDER THESE CONDITIONS:1. ABORTION SHOULD BE ALLOWED AT LEAST IN THE EARLY STAGES OF PREGNANCY:when we eat or break an egg of a hen or crocodile, it does not mean that we have killed a chicken or a crocodile. similarly, early stages of pregnancy is a fertilised egg and it does not mean that we have killed a human. as long as the fetus is not conscious yet, I would want to say we have to allow mother to have abortion. Most abortions (88%) are obtained in the first trimester of pregnancy. In fact, over half of all abortions are obtained within the first 8 weeks. [5]2. IF A WOMAN IS RAPED/unintended pregnancy:I think, it makes no sense to force woman to help to the child of his rapist to survive, do you think that it makes sense? Many of the youngest women in this group (70% of those age 13 or under) report having had sex forced on them. [4]Each year, almost half of all pregnancies among American women are unintended. [5]3. if the girl is not ready:imagine a girl at 14, she had sex for the first time and became pregnant, after 9 months, the maximum age she can be is 15, a girl at 15 can be not ready for motherhood. not just a girl at 14, maybe a girl at 25 who studies at university and works for part time, she can be not ready to carry the baby and then become a mother. even if the government is to ban abortion, I think in this case we need to allow women to have. Many of the youngest women in this group (70% of those age 13 or under) report having had sex forced on them. [4]Women between the ages of 15 and 19 account for about 19% of all abortions; women 20 to 24 account for another 33%; and about 25% of abortions are obtained by women who are 30 or older. [5]4. INSUFFICIENCY OF FINANCIAL PLIGHT:imagine, I get married and have sex with my wife, she became pregnant and I got expelled from my job, we are ppor now, if we have child: she/he may be suffering from hunger/starvation. Of the women obtaining abortions in 2000: 57% percent were low-income. [5]5. SURPRISES OF people:in case a girl has sex with her BF/anybody and becomes pregnant, there are so many societies in the world who see it as humiliation, it is humiliation according to their traditions, relatives and family of a girl will kill her if they know that she is pregnant without being married, the government is to protect the person, so in this case in order to save girl, the government needs to allow her to have abortion.6. HEALTH OR MEDICAL PROBLEMS:today, science is able to know before birth whether child will have a disease or a huge illness, in case the parents are warned that their children will suffer from a huge illness, then I think the government needs to allow woman to abort her child, if the government does not allow her then the child will be born and suffer from illness, not only this parents will have difficulties to look after that child. it will have many problems starting from: financial problem, health problem, time problem, problem inside the family and it goes on. ONE MORE ARGUEMENT:prohibiting abortion means not allowing woman to have her right, it means to force woman to help to another THING/person. now, let me give you example:imagine a pregnant woman, when she has an abortion she does not kill the baby, she provides baby with the needs he/she needs to survive, and when she has an abortion she stops providing and stopping providing is her right. she is providing baby, and at any time, she may stop providing, it is her right. abortion means providing baby, if I provide somebody with the needs of him, I can stop providing at any time, can not I? is not it my right? it is like this. imagine I am a rich man, we live in the same street. you have an illness, and just I have a financial status which can pay your hospital bills and your medicines. you need a treatment for 3 months, you came to me and say: Artur, you are a rich man, I have an illness, I need treatment, please provide me with the money needs for medicines. and I ask you: how much do you need. you answer: 560 000 dollars for this month, I gave you this moneym and then you had a chance to survive and now you are alive, but second month comes and you still need money, you come to me and ask:-Artur, you are a rich man, without your help I have no chance to survive, please give me 560 000 which supplies all the money I need for the treatment of this month, if you dont provide me with the money I need, then I can not survive. at the moment, do I have a right not to give you money? or is it rule for me to give you my money so that you can survive? women can also stop the help they give to the fetus inside them. if the government or people can force woman to help to the baby, then the government needs to set a new rule which forces rich people to help to the poor people. as rich people have right not to help others, women also have right not to help the fetus inside her or any person. ADVANTAGE OF MAKING ABORTION LEGAL:1. IF THE GOVERNment bans the abortion then there will be some women and doctors who will do it secretly, without the hospital or standart medical instructions, it will cause corruoption to develop and women to have ilnesses as well.2. if the government makes this legal, then it will bring income to both government or private hospitals. now, when I searched about the income of abortion I saw:In general, though, women getting an abortion between six and ten weeks' gestation can expect to pay about $350 at an abortion clinic and $500 at a physician's office. Providing abortions later in pregnancy is somewhat more complicated, and is usually more expensive. For example, at 16 weeks gestation, abortion clinics generally charge around $650 and physicians' offices generally charge around $700. After the 20th week, the cost rises to above $1,000.2 [3] if government makes abortion illegal, these money will be contribution to the development of corruption, let this money go to the government/hospitals instead of going the doctors who do it illegally and unsafely. QUESTION TO OPPONENT:since he made just one arguement in his opening statement, I ask him to come with proof that fetus is equal to human. I hope he will come with that. I wish you good luck. REFERENCES:[1] . http://www.un.org...[2] . http://www.thefreedictionary.com...[3] . http://www.prochoice.org...[4] . http://www.prochoice.org...;[5] . http://www.prochoice.org..."], "neg": ["Money is the end product of what you did Money is the end product of something that you did that you think its enjoyable to you. For example, if someone started invest into a company or firms, it is because of the excitement not because of money. It is the excitement that make people invest and this excitement will leads to the end product, money. Therefore there is no reason to say that money is the root of all evil. Money is just the end product of what you did that excite you", "Wikileaks This is my third opponent who has forfeited this debate with me :( Please extend my arguments...", "white people are going extinct There is no basis for Pro's claim which is simply hateful fear-mongering propaganda for his racist agenda. Wiki's map of fertility rates proves nothing. While the widespread use of contraception and abortion in developed countries explains the statistics, one will also find that infant-mortality rates are much higher in \"fertile\" countries. [1] Becoming a minority in some western countries in the future =/= extinction. White people are likely to have high standards of living and healthcare on a world scale and we continue to outlive other ethnic groups. [2] [3] In a global race war of the kind perhaps envisioned by my paranoid opponent, us whities would win easily. Could Pro define \"extinction\"? Sources in comments.", "Abortion should be legal I accept your challenge, and the rules as stated above. I look forward to a spirited and respectful debate.", "Should Abortion Be Further Restricted Or Banned Completely should abortion be restricted", "Why is the Tarky so ripped Extend my arguments.", "The father of an unborn child should have a say in an abortion Bump.", "Abortion should be legal. Today I will be arguing that abortion should be legal. The way this debate will work is this:R1: Opening statementR2: Defend your opening statement.R3: Rebut opponents defense.R4: Closing statement Thanks to whoever accepts and good luck."]}, {"query": "Is vaping with e-cigarettes safe?", "pos": ["Bloomberg's Ban on E-Cigs Electronic cigarettes comes with different cartridges including 6-18mg of nicotine and sometimes 0mg. This is to say that electronic cigarettes are safer to smoke than traditional cigarettes. Electronic cigarettes do not cause tar because of the fact that it does not contain tobacco and leave behind no tar. As a result, the main components of carcinogen are not present to create a problem that traditional cigarettes that contain various chemicals, additives and smokes. Vapor is just vapor. It does not include any smell or lingering odor. It is far from affecting people around you while smoking electronic cigarette. Electronic cigarettes should not be banned because it does not pose any harm to its users and help people from quitting cigar.", "Bloomberg's Ban on E-Cigs Whether smoking a cigarette or e-cig there is still nicotine In both and nicotine is highly addictive. E cigs are not a safer alternative to cigarettes because they are just as addictive. E-cigs may only be vapor but it is not undetectable. That wretched nicotine smell will linger on your clothes and in your hair. The smoke and vapor is bound to offend someone and I would not like to be sitting out at dinner and have someone blow their e-cigarette vapor in my face or be sitting on the subway next to someone puffing an e-cig having to inhale second hand smoke in an air tight location. E cigs should be banned in closed public spaces and away from those who may find them offensive.", "Resolved: Tobacco consumption ought to be banned in the United States NOTE The BOP is shared, per round 1. As the rules explicitly and clearly state the grounds of the round, BOP is shared Framework Pro will support that something ought to be banned if there is a net detriment to society, as the goal of a government is to better the lives of its people. Contention 1: Cost . http://www.cancer.org............ . http://wellness.truman.edu............ For some reason can't paste images. But I can paste the link to the image. Economic \"benefits\" of smoking are easily outweighed. According to the American Cancer Society, tobacco related healthcare costs and loss of productivity netted 193 billion in the US. Every pack of cigarettes, which is on average 6.36, costs society $35. Tobacco use is bad for society as a whole because non smokers are forced to pay part of the medical bills and nonsmokers also get the disease. Half of people who continue to smoke will die of smoke-related illnesses. . http://www.nytimes.com............ The Federal govenment states that it costs society around 52 billion a year, but even this could be an underestimation, as \"Dr. Banzhaf asserted that the Government did not take into account diseases of nonsmokers that could be attributed to smoking by others. \" Either way, tobacco usage has such a large economically detrimental effect that is should be banned. Even non users must foot the medical bill, as the government helps pay for medical bills of people who are unable to, and non smokers must pay the tazes to the government Contention 2: For the Users themselves As Dr. Sullivan said 'Cigarettes are the only legal product that when used as intended cause death,'. . http://www.cdc.gov............ Cigarettes have over 7,000 chemicals according to CDC. Hundreds of those are toxic and 70 are carcinogens. The government ought to ensure the well being of its citizens and ban smoking. . http://tobaccocontrol.bmj.com............ According to Dr Robert N Proctor, Department of History, Stanford University, cigarettes kill 6 million people a year. \"Big tobacco has corrupted science by sponsoring \"decoy\" or \"distraction research\",5 but it has also corrupted popular media, insofar as newspapers and magazines dependent on tobacco advertising for revenues have been reluctant to publish critiques of cigarettes.7 The industry has corrupted even the information environment of its own workforce, as when Philip Morris paid its insurance provider (CIGNA) to censor the health information sent to corporate employees.8 Tobacco companies have bullied, corrupted or exploited countless other institutions: the American Medical Association, the American Law Institute, sports organisations, fire-fighting bodies, Hollywood, the US Congress\"even the US presidency and US military. President Lyndon Johnson refused to endorse the 1964 Surgeon General's report, for instance, fearing alienation of the tobacco-friendly South. Cigarette makers managed even to thwart the US Navy's efforts to go smoke-free. In 1986, the Navy had announced a goal of creating a smoke-free Navy by the year 2000; tobacco-friendly congressmen were pressured to thwart that plan, and a law was passed requiring that all ships sell cigarettes and allow smoking. The result: American submarines were not smoke-free until 2011\" The smoking industry infamously proclaimed for years with false research that smoking was safe. This resulted in misinformation and millions of easily preventable deaths. This also nullifies any so called economic benefit of smoking, as most of the studies meant to portray tobacco positively are sponsored by the corporations themselves. They have a monetary incentive to keep the industry alive by killing people and getting them addicted to smoking. Tobacco is a highly addictive poison because of nicotine, which makes smokers physically reliant on smoking. Most smokers want to quit but cannot. . http://www.gallup.com............ . http://www.cdc.gov............ 85% of smokers have tried to quit, according to Gallup. According to Center of Disease Control this number is at 68.9 percent. The fact is that most smokers do not even want to smoke but smoking once or doing a dumb mistake forces them to smoke for the rest of their lives, inevitably killing them and harming everyone around them. Robert Proctor rebuts the freedom argument with \"The freedom objection is weak, however, given how people actually experience addiction. Most smokers \"enjoy\" smoking only in the sense that it relieves the pains of withdrawal; they need nicotine to feel normal. People who say they enjoy cigarettes are rather rare\"so rare that the industry used to call them \"enjoyers\". Surveys show that most smokers want to quit but cannot; they also regret having started. Tobacco industry executives have long grasped the point: Imperial Tobacco's Robert Bexon in 1984 confided to his Canadian cotobacconists that \"If our product was not addictive we would not sell a cigarette next week\".12 American cigarette makers have been quietly celebrating addiction since the 1950s, when one expressed how \"fortunate for us\" it was that cigarettes \"are a habit they can't break\". \" Contention 3: Secondhand Smoke This contention is enough to win the debate. Voters, pay attention. Seconhand smoke nullifies freedom, as recipients of secondhand smoke do not choose to smoke, they simply breathe and suffer the effects of others selfishly choosing to smoke. . http://www.surgeongeneral.gov............ The Surgeon General Report concluded that 2.5 million American citizens died of secondhand smoke since 1964. What more do you need for an all-out ban? A counterplan of restricting smoking to private places will not help as smoking in private simply keeps the smoke inside the home and will cause the secondhand smoke to go straight to all the other people inside the home- such as the other family members, especially children. . http://www.cdc.gov............ \"It is estimated that secondhand smoke caused nearly 34,000 heart disease deaths each year during 2005\"2009 among adult nonsmokers in the United States. \"\"Secondhand smoke exposure caused more than 7,300 lung cancer deaths each year during 2005\"2009 among adult nonsmokers in the United States. \" (This is citing the previous Surgeon General Report) . http://www.cdc.gov............ A study by David M. Homa, PhD1, Linda J. Neff, PhD1, Brian A. King, PhD1, Ralph S. Caraballo, PhD1, Rebecca E. Bunnell, PhD1, Stephen D. Babb, MPH1, Bridgette E. Garrett, PhD1, Connie S. Sosnoff, MA2, Lanqing Wang, PhD found that from 2011-12, 58 million people were exposed to secondhand smoke. \"Exposure to secondhand smoke (SHS) from burning tobacco products causes sudden infant death syndrome (SIDS), respiratory infections, ear infections, and asthma attacks in infants and children, and coronary heart disease, stroke, and lung cancer in adult nonsmokers (1,2). No risk-free level of SHS exposure exists (2). SHS exposure causes more than 41,000 deaths among nonsmoking adults and 400 deaths in infants each year, and approximately $5.6 billion annually in lost productivity \" Contention 4: Environmental . http://tobaccofreeca.com............ \" In 2005, an estimated 135 million pounds of cigarette butts were dumped into the U. S. environment.2 Cigarette butts are the most common toxic waste found in cleanups and the number one item found on California highways.3 4 And contrary to popular belief, they do not decompose completely.5\" Cigarettes have toxic chemicals in them that threaten aquatic ecosystems when they leak out, according to( Slaughter, E. , Gersberg, R. , Watanabe, K. , Rudolph, J. , Novotny, T. E. , \"Toxicity of Cigarette Butts, and their Chemical Components to Marine and Freshwater Fish, Atherinops affinis and Pimephales promelas,\"). . http://www.mparks.org............ \"cigarette filters, cigar tips, and tobacco packaging accounted for 38% of worldwide debris\". These numbers are from Ocean Conservancy's International Coastal Cleanups A ban would be effective, as \"Smokefree beach laws help reduce butts on beaches by 45% according to the Audubon Society\". Banning will reduce the vast litter amount. . http://www.lcc.edu............ \"Globally, approximately 4.3 trillioncigarette butts are littered every year. Smokers in the USA account for over 250 billion cigarette butts, in the UK 200 tons of butts are discarded, and Australian smokers litter over 7 billion cigarette butts annually. In most Western countries cigarette butt litter accounts for around 50% of all litter. Every littered cigarette butt can take anywhere from two to twenty-five years to biodegrade. Dropped cigarette butts have been the cause of house and apartment fires, as well as some of the largest and most destructive forest fires. Fires caused by cigarette butts claim the lives of about 1,000 people and injure about 3,000 people each year. \" . http://tobaccosmoke.exposurescience.org............ \"When people congregate in an airport baggage area or enter a smoking lounge where many brands are smoked, the average amount of PM2.5 mass emitted per cigarette is about 14 mg (see Reference 3). Although 14 mg may not seem like a lot of mass emitted, each cigarette weighs only about 0.9 grams total, making it an extremely potent source of air pollution for its weight. As we shall see in subsequent chapters of this booklet, the 14 mg of particles emitted by each cigarette is really a large amount of particulate matter mass, causing extremely high indoor air pollutant concentrations when a cigarette is smoked at home or in a car. The chapter \"Where does the smoke go? \" presents calculations that you can do yourself to illustrate that a single cigarette smoked indoors is a potent source of exposure to toxic pollutants, causing concentrations indoors that are often higher than the federal air quality standards designed to protect public health in ambient air outdoors. \" . https://www.ncdps.gov............ Cigarettes cause air pollution, which will happen even if smoked inside, as ventilation ensures it flows outside. Cigarettes are a major source of litter pollution, which costs millions to clean up. Litter costs around 11 billion to clean. If we use the cigarette litter estimate of 38%, this is 4.18 billion a year. Conclusion Tobacco use is detrimental to society as a whole by causing addiction and death even to non users. Voters can vote on secondhand smoke alone as I prove it causes diseases and death to innocents not choosing to smoke. Even if Con takes up a libertarian framework he cannot win. But if you want more, tobacco causes addiction to users and users do not even want to smoke, nullifying freedom. Smoking has a heavy cost on the environment and society.", "Resolved: Tobacco use should be banned in the United States Framework Pro will support that something ought to be banned if there is a net detriment to society, as the goal of a government is to better the lives of its people. Contention 1: Cost . http://www.cancer.org......... . http://wellness.truman.edu......... For some reason can't paste images. But I can paste the link to the image. Economic \"benefits\" of smoking are easily outweighed. According to the American Cancer Society, tobacco related healthcare costs and loss of productivity netted 193 billion in the US. Every pack of cigarettes, which is on average 6.36, costs society $35. Tobacco use is bad for society as a whole because non smokers are forced to pay part of the medical bills and nonsmokers also get the disease. Half of people who continue to smoke will die of smoke-related illnesses. . http://www.nytimes.com......... The Federal govenment states that it costs society around 52 billion a year, but even this could be an underestimation, as \"Dr. Banzhaf asserted that the Government did not take into account diseases of nonsmokers that could be attributed to smoking by others. \" Either way, tobacco usage has such a large economically detrimental effect that is should be banned. Even non users must foot the medical bill, as the government helps pay for medical bills of people who are unable to, and non smokers must pay the tazes to the government Contention 2: For the Users themselves As Dr. Sullivan said 'Cigarettes are the only legal product that when used as intended cause death,'. . http://www.cdc.gov......... Cigarettes have over 7,000 chemicals according to CDC. Hundreds of those are toxic and 70 are carcinogens. The government ought to ensure the well being of its citizens and ban smoking. . http://tobaccocontrol.bmj.com......... According to Dr Robert N Proctor, Department of History, Stanford University, cigarettes kill 6 million people a year. \"Big tobacco has corrupted science by sponsoring \"decoy\" or \"distraction research\",5 but it has also corrupted popular media, insofar as newspapers and magazines dependent on tobacco advertising for revenues have been reluctant to publish critiques of cigarettes.7 The industry has corrupted even the information environment of its own workforce, as when Philip Morris paid its insurance provider (CIGNA) to censor the health information sent to corporate employees.8 Tobacco companies have bullied, corrupted or exploited countless other institutions: the American Medical Association, the American Law Institute, sports organisations, fire-fighting bodies, Hollywood, the US Congress\"even the US presidency and US military. President Lyndon Johnson refused to endorse the 1964 Surgeon General's report, for instance, fearing alienation of the tobacco-friendly South. Cigarette makers managed even to thwart the US Navy's efforts to go smoke-free. In 1986, the Navy had announced a goal of creating a smoke-free Navy by the year 2000; tobacco-friendly congressmen were pressured to thwart that plan, and a law was passed requiring that all ships sell cigarettes and allow smoking. The result: American submarines were not smoke-free until 2011\" The smoking industry infamously proclaimed for years with false research that smoking was safe. This resulted in misinformation and millions of easily preventable deaths. This also nullifies any so called economic benefit of smoking, as most of the studies meant to portray tobacco positively are sponsored by the corporations themselves. They have a monetary incentive to keep the industry alive by killing people and getting them addicted to smoking. Tobacco is a highly addictive poison because of nicotine, which makes smokers physically reliant on smoking. Most smokers want to quit but cannot. . http://www.gallup.com......... . http://www.cdc.gov......... 85% of smokers have tried to quit, according to Gallup. According to Center of Disease Control this number is at 68.9 percent. The fact is that most smokers do not even want to smoke but smoking once or doing a dumb mistake forces them to smoke for the rest of their lives, inevitably killing them and harming everyone around them. Robert Proctor rebuts the freedom argument with \"The freedom objection is weak, however, given how people actually experience addiction. Most smokers \"enjoy\" smoking only in the sense that it relieves the pains of withdrawal; they need nicotine to feel normal. People who say they enjoy cigarettes are rather rare\"so rare that the industry used to call them \"enjoyers\". Surveys show that most smokers want to quit but cannot; they also regret having started. Tobacco industry executives have long grasped the point: Imperial Tobacco's Robert Bexon in 1984 confided to his Canadian cotobacconists that \"If our product was not addictive we would not sell a cigarette next week\".12 American cigarette makers have been quietly celebrating addiction since the 1950s, when one expressed how \"fortunate for us\" it was that cigarettes \"are a habit they can't break\". \" Contention 3: Secondhand Smoke This contention is enough to win the debate. Voters, pay attention. Seconhand smoke nullifies freedom, as recipients of secondhand smoke do not choose to smoke, they simply breathe and suffer the effects of others selfishly choosing to smoke. . http://www.surgeongeneral.gov......... The Surgeon General Report concluded that 2.5 million American citizens died of secondhand smoke since 1964. What more do you need for an all-out ban? Con's counterplan of restricting smoking to private places will not help as smoking in private simply keeps the smoke inside the home and will cause the secondhand smoke to go straight to all the other people inside the home- such as the other family members, especially children. . http://www.cdc.gov......... \"It is estimated that secondhand smoke caused nearly 34,000 heart disease deaths each year during 2005\"2009 among adult nonsmokers in the United States. \"\"Secondhand smoke exposure caused more than 7,300 lung cancer deaths each year during 2005\"2009 among adult nonsmokers in the United States. \" (This is citing the previous Surgeon General Report) . http://www.cdc.gov......... A study by David M. Homa, PhD1, Linda J. Neff, PhD1, Brian A. King, PhD1, Ralph S. Caraballo, PhD1, Rebecca E. Bunnell, PhD1, Stephen D. Babb, MPH1, Bridgette E. Garrett, PhD1, Connie S. Sosnoff, MA2, Lanqing Wang, PhD found that from 2011-12, 58 million people were exposed to secondhand smoke. \"Exposure to secondhand smoke (SHS) from burning tobacco products causes sudden infant death syndrome (SIDS), respiratory infections, ear infections, and asthma attacks in infants and children, and coronary heart disease, stroke, and lung cancer in adult nonsmokers (1,2). No risk-free level of SHS exposure exists (2). SHS exposure causes more than 41,000 deaths among nonsmoking adults and 400 deaths in infants each year, and approximately $5.6 billion annually in lost productivity \" Contention 4: Environmental . http://tobaccofreeca.com......... \" In 2005, an estimated 135 million pounds of cigarette butts were dumped into the U. S. environment.2 Cigarette butts are the most common toxic waste found in cleanups and the number one item found on California highways.3 4 And contrary to popular belief, they do not decompose completely.5\" Cigarettes have toxic chemicals in them that threaten aquatic ecosystems when they leak out, according to( Slaughter, E. , Gersberg, R. , Watanabe, K. , Rudolph, J. , Novotny, T. E. , \"Toxicity of Cigarette Butts, and their Chemical Components to Marine and Freshwater Fish, Atherinops affinis and Pimephales promelas,\"). . http://www.mparks.org......... \"cigarette filters, cigar tips, and tobacco packaging accounted for 38% of worldwide debris\". These numbers are from Ocean Conservancy's International Coastal Cleanups A ban would be effective, as \"Smokefree beach laws help reduce butts on beaches by 45% according to the Audubon Society\". Banning will reduce the vast litter amount. . http://www.lcc.edu......... \"Globally, approximately 4.3 trillioncigarette butts are littered every year. Smokers in the USA account for over 250 billion cigarette butts, in the UK 200 tons of butts are discarded, and Australian smokers litter over 7 billion cigarette butts annually. In most Western countries cigarette butt litter accounts for around 50% of all litter. Every littered cigarette butt can take anywhere from two to twenty-five years to biodegrade. Dropped cigarette butts have been the cause of house and apartment fires, as well as some of the largest and most destructive forest fires. Fires caused by cigarette butts claim the lives of about 1,000 people and injure about 3,000 people each year. \" . http://tobaccosmoke.exposurescience.org......... \"When people congregate in an airport baggage area or enter a smoking lounge where many brands are smoked, the average amount of PM2.5 mass emitted per cigarette is about 14 mg (see Reference 3). Although 14 mg may not seem like a lot of mass emitted, each cigarette weighs only about 0.9 grams total, making it an extremely potent source of air pollution for its weight. As we shall see in subsequent chapters of this booklet, the 14 mg of particles emitted by each cigarette is really a large amount of particulate matter mass, causing extremely high indoor air pollutant concentrations when a cigarette is smoked at home or in a car. The chapter \"Where does the smoke go? \" presents calculations that you can do yourself to illustrate that a single cigarette smoked indoors is a potent source of exposure to toxic pollutants, causing concentrations indoors that are often higher than the federal air quality standards designed to protect public health in ambient air outdoors. \" . https://www.ncdps.gov......... Cigarettes cause air pollution, which will happen even if smoked inside, as ventilation ensures it flows outside. Cigarettes are a major source of litter pollution, which costs millions to clean up. Litter costs around 11 billion to clean. If we use the cigarette litter estimate of 38%, this is 4.18 billion a year. Conclusion Tobacco use is detrimental to society as a whole by causing addiction and death even to non users. Voters can vote on secondhand smoke alone as I prove it causes diseases and death to innocents not choosing to smoke. Even if 16k takes up a libertarian framework he cannot win. But if you want more, tobacco causes addiction to users and users do not even want to smoke, nullifying freedom. Smoking has a heavy cost on the environment and society.", "Resolved: Tobacco use should be banned in the United States Framework Pro will support that something ought to be banned if there is a net detriment to society, as the goal of a government is to better the lives of its people. Contention 1: Cost http://www.cancer.org...... http://wellness.truman.edu...... For some reason can't paste images. But I can paste the link to the image.Economic \"benefits\" of smoking are easily outweighed. According to the American Cancer Society, tobacco related healthcare costs and loss of productivity netted 193 billion in the US. Every pack of cigarettes, which is on average 6.36, costs society $35. Tobacco use is bad for society as a whole because non smokers are forced to pay part of the medical bills and nonsmokers also get the disease. Half of people who continue to smoke will die of smoke-related illnesses. http://www.nytimes.com...... The Federal govenment states that it costs society around 52 billion a year, but even this could be an underestimation, as \"Dr. Banzhaf asserted that the Government did not take into account diseases of nonsmokers that could be attributed to smoking by others.\" Either way, tobacco usage has such a large economically detrimental effect that is should be banned. Even non users must foot the medical bill, as the government helps pay for medical bills of people who are unable to, and non smokers must pay the tazes to the government Contention 2: For the Users themselves As Dr. Sullivan said 'Cigarettes are the only legal product that when used as intended cause death,'. http://www.cdc.gov...... Cigarettes have over 7,000 chemicals according to CDC. Hundreds of those are toxic and 70 are carcinogens. The government ought to ensure the well being of its citizens and ban smoking. http://tobaccocontrol.bmj.com...... According to Dr Robert N Proctor, Department of History, Stanford University, cigarettes kill 6 million people a year. \"Big tobacco has corrupted science by sponsoring \"decoy\" or \"distraction research\",5 but it has also corrupted popular media, insofar as newspapers and magazines dependent on tobacco advertising for revenues have been reluctant to publish critiques of cigarettes.7 The industry has corrupted even the information environment of its own workforce, as when Philip Morris paid its insurance provider (CIGNA) to censor the health information sent to corporate employees.8 Tobacco companies have bullied, corrupted or exploited countless other institutions: the American Medical Association, the American Law Institute, sports organisations, fire-fighting bodies, Hollywood, the US Congress\"even the US presidency and US military. President Lyndon Johnson refused to endorse the 1964 Surgeon General's report, for instance, fearing alienation of the tobacco-friendly South. Cigarette makers managed even to thwart the US Navy's efforts to go smoke-free. In 1986, the Navy had announced a goal of creating a smoke-free Navy by the year 2000; tobacco-friendly congressmen were pressured to thwart that plan, and a law was passed requiring that all ships sell cigarettes and allow smoking. The result: American submarines were not smoke-free until 2011\" The smoking industry infamously proclaimed for years with false research that smoking was safe. This resulted in misinformation and millions of easily preventable deaths. This also nullifies any so called economic benefit of smoking, as most of the studies meant to portray tobacco positively are sponsored by the corporations themselves. They have a monetary incentive to keep the industry alive by killing people and getting them addicted to smoking. Tobacco is a highly addictive poison because of nicotine, which makes smokers physically reliant on smoking. Most smokers want to quit but cannot. http://www.gallup.com...... http://www.cdc.gov...... 85% of smokers have tried to quit, according to Gallup. According to Center of Disease Control this number is at 68.9 percent. The fact is that most smokers do not even want to smoke but smoking once or doing a dumb mistake forces them to smoke for the rest of their lives, inevitably killing them and harming everyone around them. Robert Proctor rebuts the freedom argument with \"The freedom objection is weak, however, given how people actually experience addiction. Most smokers \"enjoy\" smoking only in the sense that it relieves the pains of withdrawal; they need nicotine to feel normal. People who say they enjoy cigarettes are rather rare\"so rare that the industry used to call them \"enjoyers\". Surveys show that most smokers want to quit but cannot; they also regret having started. Tobacco industry executives have long grasped the point: Imperial Tobacco's Robert Bexon in 1984 confided to his Canadian cotobacconists that \"If our product was not addictive we would not sell a cigarette next week\".12 American cigarette makers have been quietly celebrating addiction since the 1950s, when one expressed how \"fortunate for us\" it was that cigarettes \"are a habit they can't break\".\" Contention 3: Secondhand Smoke This contention is enough to win the debate. Voters, pay attention. Seconhand smoke nullifies freedom, as recipients of secondhand smoke do not choose to smoke, they simply breathe and suffer the effects of others selfishly choosing to smoke. http://www.surgeongeneral.gov...... The Surgeon General Report concluded that 2.5 million American citizens died of secondhand smoke since 1964. What more do you need for an all-out ban? Con's counterplan of restricting smoking to private places will not help as smoking in private simply keeps the smoke inside the home and will cause the secondhand smoke to go straight to all the other people inside the home- such as the other family members, especially children. http://www.cdc.gov...... \"It is estimated that secondhand smoke caused nearly 34,000 heart disease deaths each year during 2005\"2009 among adult nonsmokers in the United States.\"\"Secondhand smoke exposure caused more than 7,300 lung cancer deaths each year during 2005\"2009 among adult nonsmokers in the United States.\" (This is citing the previous Surgeon General Report) http://www.cdc.gov...... A study by David M. Homa, PhD1, Linda J. Neff, PhD1, Brian A. King, PhD1, Ralph S. Caraballo, PhD1, Rebecca E. Bunnell, PhD1, Stephen D. Babb, MPH1, Bridgette E. Garrett, PhD1, Connie S. Sosnoff, MA2, Lanqing Wang, PhD found that from 2011-12, 58 million people were exposed to secondhand smoke. \"Exposure to secondhand smoke (SHS) from burning tobacco products causes sudden infant death syndrome (SIDS), respiratory infections, ear infections, and asthma attacks in infants and children, and coronary heart disease, stroke, and lung cancer in adult nonsmokers (1,2). No risk-free level of SHS exposure exists (2). SHS exposure causes more than 41,000 deaths among nonsmoking adults and 400 deaths in infants each year, and approximately $5.6 billion annually in lost productivity \" Contention 4: Environmental http://tobaccofreeca.com...... \" In 2005, an estimated 135 million pounds of cigarette butts were dumped into the U.S. environment.2 Cigarette butts are the most common toxic waste found in cleanups and the number one item found on California highways.3 4 And contrary to popular belief, they do not decompose completely.5\" Cigarettes have toxic chemicals in them that threaten aquatic ecosystems when they leak out, according to( Slaughter, E., Gersberg, R., Watanabe, K., Rudolph, J., Novotny, T.E., \"Toxicity of Cigarette Butts, and their Chemical Components to Marine and Freshwater Fish, Atherinops affinis and Pimephales promelas,\"). http://www.mparks.org...... \"cigarette filters, cigar tips, and tobacco packaging accounted for 38% of worldwide debris\". These numbers are from Ocean Conservancy's International Coastal Cleanups A ban would be effective, as \"Smokefree beach laws help reduce butts on beaches by 45% according to the Audubon Society\". Banning will reduce the vast litter amount. http://www.lcc.edu...... \"Globally, approximately 4.3 trillioncigarette butts are littered every year. Smokers in the USA account for over 250 billion cigarette butts, in the UK 200 tons of butts are discarded, and Australian smokers litter over 7 billion cigarette butts annually. In most Western countries cigarette butt litter accounts for around 50% of all litter. Every littered cigarette butt can take anywhere from two to twenty-five years to biodegrade. Dropped cigarette butts have been the cause of house and apartment fires, as well as some of the largest and most destructive forest fires. Fires caused by cigarette butts claim the lives of about 1,000 people and injure about 3,000 people each year.\" http://tobaccosmoke.exposurescience.org...... \"When people congregate in an airport baggage area or enter a smoking lounge where many brands are smoked, the average amount of PM2.5 mass emitted per cigarette is about 14 mg (see Reference 3). Although 14 mg may not seem like a lot of mass emitted, each cigarette weighs only about 0.9 grams total, making it an extremely potent source of air pollution for its weight. As we shall see in subsequent chapters of this booklet, the 14 mg of particles emitted by each cigarette is really a large amount of particulate matter mass, causing extremely high indoor air pollutant concentrations when a cigarette is smoked at home or in a car. The chapter \"Where does the smoke go?\" presents calculations that you can do yourself to illustrate that a single cigarette smoked indoors is a potent source of exposure to toxic pollutants, causing concentrations indoors that are often higher than the federal air quality standards designed to protect public health in ambient air outdoors.\" https://www.ncdps.gov...... Cigarettes cause air pollution, which will happen even if smoked inside, as ventilation ensures it flows outside. Cigarettes are a major source of litter pollution, which costs millions to clean up. Litter costs around 11 billion to clean. If we use the cigarette litter estimate of 38%, this is 4.18 billion a year. Conclusion Tobacco use is detrimental to society as a whole by causing addiction and death even to non users. It wrecks the environment and economy. Thus, I affirm", "Should the e cigarette be available to everyone Again, I feel that your information is incorrect. According to several databases, including canadavapes.com, Propylene Glycol is the primary ingredient in the majority of e-liquids and e-cigarette cartridges on the marketplace today. Most e-liquid contains at least 80% and as much as 92% propylene glycol. This is the ingredient that produces the smoke-like vapor when the e-cigarette is exhaled. You are correct in saying people have choices if they want to use products that are safe or unsafe, but it seems more applicable if people are educated in the product they choose to use. And being that I am a parent and a grandparent, I am more concerned about the availability of this product to the younger generation. The idea that vaping can promote cigarette smoking is not good news, especially to our youth. Whether or not you feel that people can do whatever they want, it seems to me that your favorable interest in e-cigs exist because you may either like or use e-cigs, am I correct?", "Should the e cigarette be available to everyone I have to disagree with you. According to studies from the CDC and NCBI, results suggest that e-cigarettes may contribute to nicotine addiction and are unlikely to discourage conventional cigarette smoking among youth. Also confirmed data from the CDC shows an increased use of e-cigarette from 4.5 percent in 2013 to 13.4 percent in 2014. You claim that the e-cigarette \"juice\" is safe, do you have data to back up that statement? If so, I would urge you to give some concrete evidence. There are reasons why e-cigarette shares the same risk for nicotine addiction, and a simulated substance such as e-liquid or propylene glycol, is not without health effects. I feel that your justification for using e-juice is without concrete evidence and purely speculative. Can you rebuke this?", "Smoking (All types, Including marijuana and Vapor) should be banned. To address your claims of the dangers of vaping: There is a difference between a substance possibly having side effects in unhealthy people and a substance definitely causing cancer. The risks of smoking compared to those of vaping are like the risks of walking on the highway compared to the risks of walking on the sidewalk. Vaping is mostly safe, and the same arguments you made against its safety can be made for caffeinated beverages and fast food, so I assume that you want those banned too. What you have yet to do is form an argument explaining why smoking and vaping should be banned, and you were not clear with your last sentence. Your initial post said you wanted smoking and vaping to be illegal. Are you now saying you want them to only be illegal is another person is nearby? What if that person is also smoking or vaping? Is it still a crime? Are you suggesting that if someone is smoking or vaping in his or her own home and others are around, that should be a crime? You need to make your position clear. You should also explain why you think that whatever you are arguing to ban should be illegal. As to why I am against what you initially posted, laws that ban activities that only harm the individual partaking in the activity(assuming that the individual has been apprised of the dangers) are unjust. This has been shown in our various drug laws which have been more damaging to society than the drugs they banned. If I am smoking in my home, in my car, or by myself on a street corner, then nobody is affected except for myself. This is especially true with vaping because unlike smoking, vapor does not linger and the vaporizer stops putting out fumes when I am not puffing it. If you think that it should be illegal to smoke near others, then if I walk up to a smoker who is smoking, should he be arrested? Are you talking about smoking in public buildings? If so, that is already banned so that workers are not exposed to concentrated smoke.", "Is smoking bad for you Smoking may be legal but that doesn't mean it's good for us! In fact, it's just the opposite: smoking is the only legal consumer product that kills you when you use it exactly how it's meant to be used! That's pretty scary, isn't it? Cigarettes are made from tobacco. The tobacco plant is the only plant ever discovered to contain the drug called nicotine. Nicotine is a very strong poison that can kill a human in less than an hour if even a small amount is injected into the blood-stream. Tobacco smoke contains very tiny amounts of nicotine that aren't deadly but are still very bad for our health. Tobacco smoke also contains many other chemicals. In fact, it contains over 4,000 chemicals, many of which are very harmful to our bodies. All of these chemicals mix together and form a sticky tar. It's the tar that gives cigarette smoke its smell and color. The tar sticks to clothing, skin, and the insides of our lungs! Tar is very dangerous inside our lungs. It sticks to the cilia in our lungs that are responsible for sweeping out germs and dirt. If the cilia are covered in tar, they can't work right, and germs and dirt can stay in the lungs and cause diseases damage tar does to your cilia is only the beginning, though. The tar and smoke are made up of many chemicals that are known to cause cancer, as well as many chemicals that are just plain bad for you.With the nicotine and tar working together, there are a lot of bad diseases linked to smoking cigarettes. Diseases like throat cancer, mouth cancer, bladder cancer, lung cancer, chronic bronchitis, emphysema, and heart disease are all caused by smoking.In fact, 40,000 people die each year from diseases caused by smoking. Each cigarette you smoke takes 5 to 8 minutes of your life. Is it worth it? The following famous people died because they smoked: Humphrey Bogart (age 57) Jesse Owens (age 67) Michael Landon (age 54) Nat \"King\" Cole (age 45) Sammy Davis Jr. (age 64).Unfortunately, even if you don't smoke, you can still get sick from tobacco smoke. If you breathe the smoke from another person's cigarette, it's as bad as if you were smoking the cigarette yourself! This smoke is called second-hand smoke and it kills hundreds of people each year. If your parents smoke, you have a greater chance of getting ear infections, asthma, bronchitis, and tonsillitis. Children who are exposed to smoke all their lives have underdeveloped lungs, and they are two to four times likely to have allergic reactions and asthma than children of nonsmokers.Second-hand smoke is starting to really bother nonsmokers, and that's why there are more places where smoking isn't allowed than there used to be. Now you aren't allowed to smoke on a plane, in a bus, or in many buildings. Non-smokers want to breathe clean air! Cigarettes aren't just bad for our health. They are bad for the environment, too! Think of the amount of paper that goes into making each cigarette. Young people smoke about 6,000,000 cigarettes per day! That's a lot of trees that are cut down, and the paper can never be recycled! Look around outside. There are cigarette butts everywhere! Do you know that it takes more than 5 years for a cigarette butt to biodegrade? That means that it takes at least 5 years for the cigarette butts to break down unless someone cleans them up. Gross! Most people realize that smoking cigarettes are dangerous for their health. But are other forms of tobacco just as dangerous? The death rate for pipe and cigar smokers is actually less than the death rate for cigarette smokers but still higher than the death rate for non-smokers. BUT, that's not because the tobacco used in cigars and pipes is safer! It's because cigar and pipe smokers don't inhale as deeply as cigarette smokers do when they smoke. If a person inhales deeply for cigars and pipes, then they are actually more dangerous than cigarettes! Don't think that cigars and pipes are safer than cigarettes! Pipe smokers have a very high rate of lip cancer, and compared to cigarette smokers, pipe and cigar smokers have a higher chance of getting mouth cancer, throat cancer, and larynx (voice box) cancer. The second-hand smoke from cigars is really bad. One cigar puts out as much smoke and tar into the air as 42 cigarettes! Stay away from cigar smoke if you want to stay healthy! Some people think that smokeless tobacco is safer than cigarettes. Smokeless tobacco comes in two forms: chewing tobacco and snuff. Both forms are put into the mouth and sucked on. It's true that smokeless tobacco is better for your lungs since there is no smoke to breathe in. BUT, it is very bad for other parts of your body. Just like regular tobacco, smokeless tobacco contains nicotine, which is a very poisonous drug that speeds up your heart and increases your blood pressure. Holding an averagely-sized wad of chewing tobacco in your mouth for 30 minutes gives you as much nicotine as smoking 4 cigarettes!Besides the nicotine, smokeless tobacco contains all the bad chemicals that regular tobacco does, including the ones that cause cancer. Here are all the things that smokeless tobacco can give you: You can have a reduction in your ability to taste and smell You get stained teeth You get bad breath It can cause tooth decay It can cause gum disease It can give you bleeding gums It can give you sores in the mouth that don't heal You can experience dizziness It can make you throw up It can decrease your physical ability You can get mouth, lip, cheek, and tongue cancer You can get palate, pharynx, larynx, and esophagus cancer You get a fast heart rate and high blood pressure You can get heart disease", "Smoking should be banned 1. Personal right Con ignores my arguments on second hand smoke and the fact that marijuana is less harmful than smoking. My arguments still stand.\"If we pass laws forcing smokers to change their behavior \"for their own good, we need to ask: Where do we stop? Do we pass laws against smoking in private homes? Against frying food indoors (which also releases known carcinogens into the air)? Eating the wrong kinds of food? Eating too much? Weighing too much? Drinking too much (and not just when driving)? Exercising too little? Should we ban other risky behavior, such as skydiving, bungee-jumping, or riding motorcycles? How about drinking more than one cup of coffee each day?\"The problem is these only affect the people who do the actions, not others around them. Plus, as argued in round 1, the ones that do affect others in the above list are necessary risks. \u201cBanning smoking may infringe on a person's individual right to behave as he pleases. In addition, basing this prohibition on health reasons may be hypocritical when other substances that may pose similar or greater threats to health, such as alcohol and fattening foods, are allowed. \u201c This ignores my first argument which showed that marijuana is less harmful than smoking, which by con's logic means that smoking should be banned since marijuana is banned. Plus, in an utilitarian society, personal rights can be reduced to benefit society as a whole. For example, hate speech can be banned but is not a violation of freedom of speech. 2. Second hand smoke Con uses an argument from authority by quoting a single expert and using it to \"debunk\" established, peer reviewed reports. Con ignores the fact that the overwhelming majority of studies support a casual link between second hand smoke and childhood asthma, stroke, and lung cancer. Con uses a single example instead of looking at the overwhelming majority of studies. (http://ntr.oxfordjournals.org...)(http://www.ncbi.nlm.nih.gov...)(http://www.surgeongeneral.gov...) The above are meta-studies which aggregate results of many studies. 3. Buisiness Con ignores my previous argument, which proved that smoking bans do not affect businesses. Con restates his case instead of providing new evidence. My original argument from last round: Con claims that establishments such as bars and restaurants will get reduced profits if a smoking ban takes place. However, this is not the case: restaurant profits stayed the same, and pub profits dipped slightly but increased in the long run. (http://www.ncbi.nlm.nih.gov...) This proves that economic issues do not result from smoking bans. 4. Taxation While the highest amount of tax per pack of cigarettes is $6.16 in the U.S., the estimated cost of a single pack of cigarettes on society caused by reduced productivity and deaths is $7. Many smaller cities have lower tax rates for cigarettes than $6.16. This shows that even with taxation, smoking is not worth it. (http://www.nytimes.com...) 5. E-cigs Con's argument goes like this: P1. If people can quit smoking, smoking should not be banned. P2. People quit smoking with E-cigs. C. Smoking should not be banned. This does not make sense, as even if people are able to quit smoking, smoking is still a risk. People can quit illegal drugs, but illegal drugs are banned. By con's logic, I can argue that: -People can quit drugs by slowly reducing the amount of drugs they take. -Gradual reduction requires the drugs to be continued to be taken during the quitting period. -Illegal drugs should be legalized because the treatment requires small amounts of them. Conclusion Con has not successfully refuted my arguments, and in one case restated a debunked argument without using sources or new evidence. I believe that I have met my burden of proof.", "Should E-cigs and vapes be regulated I've never claimed that I'm okay with \"kids\" acquiring an addiction to electronic cigarettes. I simply do not care. It's not only nicotine but other harmful substances that are present. You provided examples of why they're bad, Without any sources. I'm just saying that there shouldn't be any regulations because it will be utterly pointless and time consuming. Juul for example is a good way to start vaping, A teen hobby that adds a sense of smoking cigarettes whilst it does contain harmful chemicals similar to cigarettes; \"Traditional cigarettes contain a laundry list of chemicals that are proven harmful, And e-cigarettes have some of these same chemicals. \" Thus, There is a small percentage of chemicals in e-cigs than the classic cigs. http://www. Center4research. Org/vaping-safer-smoking-cigarettes-2/", "Smoking E-cigarettes in public should be categorized the same as any cigarette and not allowed. Are they safer than tobacco? Or are they a high-tech way to hook a new generation on a bad nicotine habit? Nobody knows yet. Research into the effects of e-cigarettes lags behind their popularity. But ready or not, the era of e-cigarettes is here. It\"s a booming, billion-dollar industry -- on track to outsell tobacco products within a decade. The number of teens and tweens using these products doubled between 2011 and 2012. The time to get informed about these products is now. So far, evidence suggests that e-cigarettes may be safer than regular cigarettes. The biggest danger from tobacco is the smoke, and e-cigarettes don't burn. Tests show the levels of dangerous chemicals they give off are a fraction of what you'd get from a real cigarette. But what's in them can vary. \"E-cigarettes may be less harmful than cigarettes,\" Drummond says. \"But we still don't know enough about their long-term risks or the effects of secondhand exposure.\" E-cigarettes have triggered a fierce debate among health experts who share the same goal -- reducing the disease and death caused by tobacco. But they disagree about whether e-cigarettes make the problem better or worse. Opponents say that because nicotine is addictive, e-cigarettes could be a \"gateway drug,\" leading nonsmokers and kids to use tobacco. They also worry that manufacturers -- with huge advertising budgets and celebrity endorsements -- could make smoking popular again. That would roll back decades of progress in getting people to quit or never start smoking. Others look at possible benefits for smokers. \"Obviously, it would be best if smokers could quit completely,\" says Michael Siegel, MD, MPH, a professor at Boston University's School of Public Health. \"But if that's not possible, I think they'd be a lot better off with e-cigarettes. They're a safer alternative.\" Siegel compares replacing tobacco with e-cigarettes to heroin users switching to the painkiller methadone. The replacement may have its own risks, but it's safer. Some supporters believe that e-cigarettes could help people quit, just like nicotine gum. Research hasn't shown that yet, though. But there is no hard evidence that they are harmful OR safe. http://www.webmd.com..."], "neg": ["Tax is an overly blunt instrument One of the treasury\u2019s arguments against reducing tax on fruit juices and smoothies is that tax is an overly blunt instrument.", "Hydrogen vehicles Hydrogen in cars is less dangerous than gasoline", "Adults should be able to order kids menus to get the toy According to all known laws of aviation, there is no way a bee should be able to fly. Its wings are too small to get its fat little body off the ground. The bee, of course, flies anyway because bees don't care what humans think is impossible. Yellow, black. Yellow, black. Yellow, black. Yellow, black. Ooh, black and yellow! Let's shake it up a little. Barry! Breakfast is ready! Ooming! Hang on a second. Hello? - Barry? - Adam? - Oan you believe this is happening? - I can't. I'll pick you up. Looking sharp. Use the stairs. Your father paid good money for those. Sorry. I'm excited. Here's the graduate. We're very proud of you, son. A perfect report card, all B's. Very proud. Ma! I got a thing going here. - You got lint on your fuzz. - Ow! That's me! - Wave to us! We'll be in row 118,000. - Bye! Barry, I told you, stop flying in the house! - Hey, Adam. - Hey, Barry. - Is that fuzz gel? - A little. Special day, graduation. Never thought I'd make it. Three days grade school, three days high school. Those were awkward. Three days college. I'm glad I took a day and hitchhiked around the hive. You did come back different. - Hi, Barry. - Artie, growing a mustache? Looks good. - Hear about Frankie? - Yeah. - You going to the funeral? - No, I'm not going. Everybody knows, sting someone, you die. Don't waste it on a squirrel. Such a hothead. I guess he could have just gotten out of the way. I love this incorporating an amusement park into our day. That's why we don't need vacations. Boy, quite a bit of pomp... under the circumstances. - Well, Adam, today we are men. - We are! - Bee-men. - Amen! Hallelujah! Students, faculty, distinguished bees, please welcome Dean Buzzwell. Welcome, New Hive Oity graduating class of... ...9:15. That concludes our ceremonies. And begins your career at Honex Industries! Will we pick ourjob today? I heard it's just orientation. Heads up! Here we go. Keep your hands and antennas inside the tram at all times. - Wonder what it'll be like? - A little scary. Welcome to Honex, a division of Honesco and a part of the Hexagon Group. This is it! Wow. Wow. We know that you, as a bee, have worked your whole life to get to the point where you can work for your whole life. Honey begins when our valiant Pollen Jocks bring the nectar to the hive. Our top-secret formula is automatically color-corrected, scent-adjusted and bubble-contoured into this soothing sweet syrup with its distinctive golden glow you know as... Honey! - That girl was hot. - She's my cousin! - She is? - Yes, we're all cousins. - Right. You're right. - At Honex, we constantly strive to improve every aspect of bee existence. These bees are stress-testing a new helmet technology. - What do you think he makes? - Not enough. Here we have our latest advancement, the Krelman. - What does that do? - Oatches that little strand of honey that hangs after you pour it. Saves us millions. Oan anyone work on the Krelman? Of course. Most bee jobs are small ones. But bees know that every small job, if it's done well, means a lot. But choose carefully because you'll stay in the job you pick for the rest of your life. The same job the rest of your life? I didn't know that. What's the difference? You'll be happy to know that bees, as a species, haven't had one day off in 27 million years. So you'll just work us to death? We'll sure try. Wow! That blew my mind! \"What's the difference?\" How can you say that? One job forever? That's an insane choice to have to make. I'm relieved. Now we only have to make one decision in life. But, Adam, how could they never have told us that? Why would you question anything? We're bees. We're the most perfectly functioning society on Earth. You ever think maybe things work a little too well here? Like what? Give me one example. I don't know. But you know what I'm talking about. Please clear the gate. Royal Nectar Force on approach. Wait a second. Oheck it out. - Hey, those are Pollen Jocks! - Wow. I've never seen them this close. They know what it's like outside the hive. Yeah, but some don't come back. - Hey, Jocks! - Hi, Jocks! You guys did great! You're monsters! You're sky freaks! I love it! I love it! - I wonder where they were. - I don't know. Their day's not planned. Outside the hive, flying who knows where, doing who knows what. You can'tjust decide to be a Pollen Jock. You have to be bred for that. Right. Look. That's more pollen than you and I will see in a lifetime. It's just a status symbol. Bees make too much of it. Perhaps. Unless you're wearing it and the ladies see you wearing it. Those ladies? Aren't they our cousins too? Distant. Distant. Look at these two. - Oouple of Hive Harrys. - Let's have fun with them. It must be dangerous being a Pollen Jock. Yeah. Once a bear pinned me against a mushroom! He had a paw on my throat, and with the other, he was slapping me! - Oh, my! - I never thought I'd knock him out. What were you doing during this? Trying to alert the authorities. I can autograph that. A little gusty out there today, wasn't it, comrades? Yeah. Gusty. We're hitting a sunflower patch six miles from here tomorrow. - Six miles, huh? - Barry! A puddle jump for us, but maybe you're not up for it. - Maybe I am. - You are not! We're going 0900 at J-Gate. What do you think, buzzy-boy? Are you bee enough? I might be. It all depends on what 0900 means. Hey, Honex! Dad, you surprised me. You decide what you're interested in? - Well, there's a lot of choices. - But you only get one. Do you ever get bored doing the same job every day? Son, let me tell you about stirring. You grab that stick, and you just move it around, and you stir it around. You get yourself into a rhythm. It's a beautiful thing. You know, Dad, the more I think about it, maybe the honey field just isn't right for me. You were thinking of what, making balloon animals? That's a bad job for a guy with a stinger. Janet, your son's not sure he wants to go into honey! - Barry, you are so funny sometimes. - I'm not trying to be funny. You're not funny! You're going into honey. Our son, the stirrer! - You're gonna be a stirrer? - No one's listening to me! Wait till you see the sticks I have. I could say anything right now. I'm gonna get an ant tattoo! Let's open some honey and celebrate! Maybe I'll pierce my thorax. Shave my antennae. Shack up with a grasshopper. Get a gold tooth and call everybody \"dawg\"! I'm so proud. - We're starting work today! - Today's the day. Oome on! All the good jobs will be gone. Yeah, right. Pollen counting, stunt bee, pouring, stirrer, front desk, hair removal... - Is it still available? - Hang on. Two left! One of them's yours! Oongratulations! Step to the side. - What'd you get? - Picking crud out. Stellar! Wow! Oouple of newbies? Yes, sir! Our first day! We are ready! Make your choice. - You want to go first? - No, you go. Oh, my. What's available? Restroom attendant's open, not for the reason you think. - Any chance of getting the Krelman? - Sure, you're on. I'm sorry, the Krelman just closed out. Wax monkey's always open. The Krelman opened up again. What happened? A bee died. Makes an opening. See? He's dead. Another dead one. Deady. Deadified. Two more dead. Dead from the neck up. Dead from the neck down. That's life! Oh, this is so hard! Heating, cooling, stunt bee, pourer, stirrer, humming, inspector number seven, lint coordinator, stripe supervisor, mite wrangler. Barry, what do you think I should... Barry? Barry! All right, we've got the sunflower patch in quadrant nine... What happened to you? Where are you? - I'm going out. - Out? Out where? - Out there. - Oh, no! I have to, before I go to work for the rest of my life. You're gonna die! You're crazy! Hello? Another call coming in. If anyone's feeling brave, there's a Korean deli on 83rd that gets their roses today. Hey, guys. - Look at that. - Isn't that the kid we saw yesterday? Hold it, son, flight deck's restricted. It's OK, Lou. We're gonna take him up. Really? Feeling lucky, are you? Sign here, here. Just initial that. - Thank you. - OK. You got a rain advisory today, and as you all know, bees cannot fly in rain. So be careful. As always, watch your brooms, hockey sticks, dogs, birds, bears and bats. Also, I got a couple of reports of root beer being poured on us. Murphy's in a home because of it, babbling like a cicada! - That's awful. - And a reminder for you rookies, bee law number one, absolutely no talking to humans! All right, launch positions! Buzz, buzz, buzz, buzz! Buzz, buzz, buzz, buzz! Buzz, buzz, buzz, buzz! Black and yellow! Hello! You ready for this, hot shot? Yeah. Yeah, bring it on. Wind, check. - Antennae, check. - Nectar pack, check. - Wings, check. - Stinger, check. Scared out of my shorts, check. OK, ladies, let's move it out! Pound those petunias, you striped stem-suckers! All of you, drain those flowers! Wow! I'm out! I can't believe I'm out! So blue. I feel so fast and free! Box kite! Wow! Flowers! This is Blue Leader. We have roses visual. Bring it around 30 degrees and hold. Roses! 30 degrees, roger. Bringing it around. Stand to the side, kid. It's got a bit of a kick. That is one nectar collector! - Ever see pollination up close? - No, sir. I pick up some pollen here, sprinkle it over here. Maybe a dash over there, a pinch on that one. See that? It's a little bit of magic. That's amazing. Why do we do that? That's pollen power. More pollen, more flowers, more nectar, more honey for us. Oool. I'm picking up a lot of bright yellow. Oould be daisies. Don't we need those? Oopy that visual. Wait. One of these flowers seems to be on the move. Say again? You're reporting a moving flower? Affirmative. That was on the line! This is the coolest. What is it? I don't know, but I'm loving this color. It smells good. Not like a flower, but I like it. Yeah, fuzzy. Ohemical-y. Oareful, guys. It's a little grabby. My sweet lord of bees! Oandy-brain, get off there! Problem! - Guys! - This could be bad. Affirmative. Very close. Gonna hurt. Mama's little boy. You are way out of position, rookie! Ooming in at you like a missile! Help me! I don't think these are flowers. - Should we tell him? - I think he knows. What is this?! Match point! You can start packing up, honey, because you're about to eat it! Yowser! Gross. There's a bee in the car! - Do something! - I'm driving! - Hi, bee. - He's back here! He's going to sting me! Nobody move. If you don't move, he won't sting you. Freeze! He blinked! Spray him, Granny! What are you doing?! Wow... the tension level out here is unbelievable. I gotta get home. Oan't fly in rain. Oan't fly in rain. Oan't fly in rain. Mayday! Mayday! Bee going down! Ken, could you close the window please? Ken, could you close the window please? Oheck out my new resume. I made it into a fold-out brochure. You see? Folds out. Oh, no. More humans. I don't need this. What was that? Maybe this time. This time. This time. This time! This time! This... Drapes! That is diabolical. It's fantastic. It's got all my special skills, even my top-ten favorite movies. What's number one? Star Wars? Nah, I don't go for that... ...kind of stuff. No wonder we shouldn't talk to them. They're out of their minds. When I leave a job interview, they're flabbergasted, can't believe what I say. There's the sun. Maybe that's a way out. I don't remember the sun having a big 75 on it. I predicted global warming. I could feel it getting hotter. At first I thought it was just me. Wait! Stop! Bee! Stand back. These are winter boots. Wait! Don't kill him! You know I'm allergic to them! This thing could kill me! Why does his life have less value than yours? Why does his life have any less value than mine? Is that your statement? I'm just saying all life has value. You don't know what he's capable of feeling. My brochure! There you go, little guy. I'm not scared of him. It's an allergic thing. Put that on your resume brochure. My whole face could puff up. Make it one of your special skills. Knocking someone out is also a special skill. Right. Bye, Vanessa. Thanks. - Vanessa, next week? Yogurt night? - Sure, Ken. You know, whatever. - You could put carob chips on there. - Bye. - Supposed to be less calories. - Bye. I gotta say something. She saved my life. I gotta say something. All right, here it goes. Nah. What would I say? I could really get in trouble. It's a bee law. You're not supposed to talk to a human. I can't believe I'm doing this. I've got to. Oh, I can't do it. Oome on! No. Yes. No. Do it. I can't. How should I start it? \"You like jazz?\" No, that's no good. Here she comes! Speak, you fool! Hi! I'm sorry. - You're talking. - Yes, I know. You're talking! I'm so sorry. No, it's OK. It's fine. I know I'm dreaming. But I don't recall going to bed. Well, I'm sure this is very disconcerting. This is a bit of a surprise to me. I mean, you're a bee! I am. And I'm not supposed to be doing this, but they were all trying to kill me. And if it wasn't for you... I had to thank you. It's just how I was raised. That was a little weird. - I'm talking with a bee. - Yeah. I'm talking to a bee. And the bee is talking to me! I just want to say I'm grateful. I'll leave now. - Wait! How did you learn to do that? - What? The talking thing. Same way you did, I guess. \"Mama, Dada, honey.\" You pick it up. - That's very funny. - Yeah. Bees are funny. If we didn't laugh, we'd cry with what we have to deal with. Anyway... Oan I... ...get you something? - Like what? I don't know. I mean... I don't know. Ooffee? I don't want to put you out. It's no trouble. It takes two minutes. - It's just coffee. - I hate to impose. - Don't be ridiculous! - Actually, I would love a cup. Hey, you want rum cake? - I shouldn't. - Have some. - No, I can't. - Oome on! I'm trying to lose a couple micrograms. - Where? - These stripes don't help. You look great! I don't know if you know anything about fashion. Are you all right? No. He's making the tie in the cab as they're flying up Madison. He finally gets there. He runs up the steps into the church. The wedding is on. And he says, \"Watermelon? I thought you said Guatemalan. Why would I marry a watermelon?\" Is that a bee joke? That's the kind of stuff we do. Yeah, different. So, what are you gonna do, Barry? About work? I don't know. I want to do my part for the hive, but I can't do it the way they want. I know how you feel. - You do? - Sure. My parents wanted me to be a lawyer or a doctor, but I wanted to be a florist. - Really? - My only interest is flowers. Our new queen was just elected with that same campaign slogan. Anyway, if you look... There's my hive right there. See it? You're in Sheep Meadow! Yes! I'm right off the Turtle Pond! No way! I know that area. I lost a toe ring there once. - Why do girls put rings on their toes? - Why not? - It's like putting a hat on your knee. - Maybe I'll try that. - You all right, ma'am? - Oh, yeah. Fine. Just having two cups of coffee! Anyway, this has been great. Thanks for the coffee. Yeah, it's no trouble. Sorry I couldn't finish it. If I did, I'd be up the rest of my life. Are you...? Oan I take a piece of this with me? Sure! Here, have a crumb. - Thanks! - Yeah. All right. Well, then... I guess I'll see you around. Or not. OK, Barry. And thank you so much again... for before. Oh, that? That was nothing. Well, not nothing, but... Anyway... This can't possibly work. He's all set to go. We may as well try it. OK, Dave, pull the chute. - Sounds amazing. - It was amazing! It was the scariest, happiest moment of my life. Humans! I can't believe you were with humans! Giant, scary humans! What were they like? Huge and crazy. They talk crazy. They eat crazy giant things. They drive crazy. - Do they try and kill you, like on TV? - Some of them. But some of them don't. - How'd you get back? - Poodle. You did it, and I'm glad. You saw whatever you wanted to see. You had your \"experience.\" Now you can pick out yourjob and be normal. - Well... - Well? Well, I met someone. You did? Was she Bee-ish? - A wasp?! Your parents will kill you! - No, no, no, not a wasp. - Spider? - I'm not attracted to spiders. I know it's the hottest thing, with the eight legs and all. I can't get by that face. So who is she? She's... human. No, no. That's a bee law. You wouldn't break a bee law. - Her name's Vanessa. - Oh, boy. She's so nice. And she's a florist! Oh, no! You're dating a human florist! We're not dating. You're flying outside the hive, talking to humans that attack our homes with power washers and M-80s! One-eighth a stick of dynamite! She saved my life! And she understands me. This is over! Eat this. This is not over! What was that? - They call it a crumb. - It was so stingin' stripey! And that's not what they eat. That's what falls off what they eat! - You know what a Oinnabon is? - No. It's bread and cinnamon and frosting. They heat it up... Sit down! ...really hot! - Listen to me! We are not them! We're us. There's us and there's them! Yes, but who can deny the heart that is yearning? There's no yearning. Stop yearning. Listen to me! You have got to start thinking bee, my friend. Thinking bee! - Thinking bee. - Thinking bee. Thinking bee! Thinking bee! Thinking bee! Thinking bee! There he is. He's in the pool. You know what your problem is, Barry? I gotta start thinking bee? How much longer will this go on? It's been three days! Why aren't you working? I've got a lot of big life decisions to think about. What life? You have no life! You have no job. You're barely a bee! Would it kill you to make a little honey? Barry, come out. Your father's talking to you. Martin, would you talk to him? Barry, I'm talking to you! You coming? Got everything? All set! Go ahead. I'll catch up. Don't be too long. Watch this! Vanessa! - We're still here. - I told you not to yell at him. He doesn't respond to yelling! - Then why yell at me? - Because you don't listen! I'm not listening to this. Sorry, I've gotta go. - Where are you going? - I'm meeting a friend. A girl? Is this why you can't decide? Bye. I just hope she's Bee-ish. They have a huge parade of flowers every year in Pasadena? To be in the Tournament of Roses, that's every florist's dream! Up on a float, surrounded by flowers, crowds cheering. A tournament. Do the roses compete in athletic events? No. All right, I've got one. How come you don't fly everywhere? It's exhausting. Why don't you run everywhere? It's faster. Yeah, OK, I see, I see. All right, your turn. TiVo. You can just freeze live TV? That's insane! You don't have that? We have Hivo, but it's a disease. It's a horrible, horrible disease. Oh, my. Dumb bees! You must want to sting all those jerks. We try not to sting. It's usually fatal for us. So you have to watch your temper. Very carefully. You kick a wall, take a walk, write an angry letter and throw it out. Work through it like any emotion: Anger, jealousy, lust. Oh, my goodness! Are you OK? Yeah. - What is wrong with you?! - It's a bug. He's not bothering anybody. Get out of here, you creep! What was that? A Pic 'N' Save circular? Yeah, it was. How did you know? It felt like about 10 pages. Seventy-five is pretty much our limit. You've really got that down to a science. - I lost a cousin to Italian Vogue. - I'll bet. What in the name of Mighty Hercules is this? How did this get here? Oute Bee, Golden Blossom, Ray Liotta Private Select? - Is he that actor? - I never heard of him. - Why is this here? - For people. We eat it. You don't have enough food of your own? - Well, yes. - How do you get it? - Bees make it. - I know who makes it! And it's hard to make it! There's heating, cooling, stirring. You need a whole Krelman thing! - It's organic. - It's our-ganic! It's just honey, Barry. Just what?! Bees don't know about this! This is stealing! A lot of stealing! You've taken our homes, schools, hospitals! This is all we have! And it's on sale?! I'm getting to the bottom of this. I'm getting to the bottom of all of this! Hey, Hector. - You almost done? - Almost. He is here. I sense it. Well, I guess I'll go home now and just leave this nice honey out, with no one around. You're busted, box boy! I knew I heard something. So you can talk! I can talk. And now you'll start talking! Where you getting the sweet stuff? Who's your supplier? I don't understand. I thought we were friends. The last thing we want to do is upset bees! You're too late! It's ours now! You, sir, have crossed the wrong sword! You, sir, will be lunch for my iguana, Ignacio! Where is the honey coming from? Tell me where! Honey Farms! It comes from Honey Farms! Orazy person! What horrible thing has happened here? These faces, they never knew what hit them. And now they're on the road to nowhere! Just keep still. What? You're not dead? Do I look dead? They will wipe anything that moves. Where you headed? To Honey Farms. I am onto something huge here. I'm going to Alaska. Moose blood, crazy stuff. Blows your head off! I'm going to Tacoma. - And you? - He really is dead. All right. Uh-oh! - What is that?! - Oh, no! - A wiper! Triple blade! - Triple blade? Jump on! It's your only chance, bee! Why does everything have to be so doggone clean?! How much do you people need to see?! Open your eyes! Stick your head out the window! From NPR News in Washington, I'm Oarl Kasell. But don't kill no more bugs! - Bee! - Moose blood guy!! - You hear something? - Like what? Like tiny screaming. Turn off the radio. Whassup, bee boy? Hey, Blood. Just a row of honey jars, as far as the eye could see. Wow! I assume wherever this truck goes is where they're getting it. I mean, that honey's ours. - Bees hang tight. - We're all jammed in. It's a close community. Not us, man. We on our own. Every mosquito on his own. - What if you get in trouble? - You a mosquito, you in trouble. Nobody likes us. They just smack. See a mosquito, smack, smack! At least you're out in the world. You must meet girls. Mosquito girls try to trade up, get with a moth, dragonfly. Mosquito girl don't want no mosquito. You got to be kidding me! Mooseblood's about to leave the building! So long, bee! - Hey, guys! - Mooseblood! I knew I'd catch y'all down here. Did you bring your crazy straw? We throw it in jars, slap a label on it, and it's pretty much pure profit. What is this place? A bee's got a brain the size of a pinhead. They are pinheads! Pinhead. - Oheck out the new smoker. - Oh, sweet. That's the one you want. The Thomas 3000! Smoker? Ninety puffs a minute, semi-automatic. Twice the nicotine, all the tar. A couple breaths of this knocks them right out. They make the honey, and we make the money. \"They make the honey, and we make the money\"? Oh, my! What's going on? Are you OK? Yeah. It doesn't last too long. Do you know you're in a fake hive with fake walls? Our queen was moved here. We had no choice. This is your queen? That's a man in women's clothes! That's a drag queen! What is this? Oh, no! There's hundreds of them! Bee honey. Our honey is being brazenly stolen on a massive scale! This is worse than anything bears have done! I intend to do something. Oh, Barry, stop. Who told you humans are taking our honey? That's a rumor. Do these look like rumors? That's a conspiracy theory. These are obviously doctored photos. How did you get mixed up in this? He's been talking to humans. - What? - Talking to humans?! He has a human girlfriend. And they make out! Make out? Barry! We do not. - You wish you could. - Whose side are you on? The bees! I dated a cricket once in San Antonio. Those crazy legs kept me up all night. Barry, this is what you want to do with your life? I want to do it for all our lives. Nobody works harder than bees! Dad, I remember you coming home so overworked your hands were still stirring. You couldn't stop. I remember that. What right do they have to our honey? We live on two cups a year. They put it in lip balm for no reason whatsoever! Even if it's true, what can one bee do? Sting them where it really hurts. In the face! The eye! - That would hurt. - No. Up the nose? That's a killer. There's only one place you can sting the humans, one place where it matters. Hive at Five, the hive's only full-hour action news source. No more bee beards! With Bob Bumble at the anchor desk. Weather with Storm Stinger. Sports with Buzz Larvi. And Jeanette Ohung. - Good evening. I'm Bob Bumble. - And I'm Jeanette Ohung. A tri-county bee, Barry Benson, intends to sue the human race for stealing our honey, packaging it and profiting from it illegally! Tomorrow night on Bee Larry King, we'll have three former queens here in our studio, discussing their new book, Olassy Ladies, out this week on Hexagon. Tonight we're talking to Barry Benson. Did you ever think, \"I'm a kid from the hive. I can't do this\"? Bees have never been afraid to change the world. What about Bee Oolumbus? Bee Gandhi? Bejesus? Where I'm from, we'd never sue humans. We were thinking of stickball or candy stores. How old are you? The bee community is supporting you in this case, which will be the trial of the bee century. You know, they have a Larry King in the human world too. It's a common name. Next week... He looks like you and has a show and suspenders and colored dots... Next week... Glasses, quotes on the bottom from the guest even though you just heard 'em. Bear Week next week! They're scary, hairy and here live. Always leans forward, pointy shoulders, squinty eyes, very Jewish. In tennis, you attack at the point of weakness! It was my grandmother, Ken. She's 81. Honey, her backhand's a joke! I'm not gonna take advantage of that? Quiet, please. Actual work going on here. - Is that that same bee? - Yes, it is! I'm helping him sue the human race. - Hello. - Hello, bee. This is Ken. Yeah, I remember you. Timberland, size ten and a half. Vibram sole, I believe. Why does he talk again? Listen, you better go 'cause we're really busy working. But it's our yogurt night! Bye-bye. Why is yogurt night so difficult?! You poor thing. You two have been at this for hours! Yes, and Adam here has been a huge help. - Frosting... - How many sugars? Just one. I try not to use the competition. So why are you helping me? Bees have good qualities. And it takes my mind off the shop. Instead of flowers, people are giving balloon bouquets now. Those are great, if you're three. And artificial flowers. - Oh, those just get me psychotic! - Yeah, me too. Bent stingers, pointless pollination. Bees must hate those fake things! Nothing worse than a daffodil that's had work done. Maybe this could make up for it a little bit. - This lawsuit's a pretty big deal. - I guess. You sure you want to go through with it? Am I sure? When I'm done with the humans, they won't be able to say, \"Honey, I'm home,\" without paying a royalty! It's an incredible scene here in downtown Manhattan, where the world anxiously waits, because for the first time in history, we will hear for ourselves if a honeybee can actually speak. What have we gotten into here, Barry? It's pretty big, isn't it? I can't believe how many humans don't work during the day. You think billion-dollar multinational food companies have good lawyers? Everybody needs to stay behind the barricade. - What's the matter? - I don't know, I just got a chill. Well, if it isn't the bee team. You boys work on this? All rise! The Honorable Judge Bumbleton presiding. All right. Oase number 4475, Superior Oourt of New York, Barry Bee Benson v. the Honey Industry is now in session. Mr. Montgomery, you're representing the five food companies collectively? A privilege. Mr. Benson... you're representing all the bees of the world? I'm kidding. Yes, Your Honor, we're ready to proceed. Mr. Montgomery, your opening statement, please. Ladies and gentlemen of the jury, my grandmother was a simple woman. Born on a farm, she believed it was man's divine right to benefit from the bounty of nature God put before us. If we lived in the topsy-turvy world Mr. Benson imagines, just think of what would it mean. I would have to negotiate with the silkworm for the elastic in my britches! Talking bee! How do we know this isn't some sort of holographic motion-picture-capture Hollywood wizardry? They could be using laser beams! Robotics! Ventriloquism! Oloning! For all we know, he could be on steroids! Mr. Benson? Ladies and gentlemen, there's no trickery here. I'm just an ordinary bee. Honey's pretty important to me. It's important to all bees. We invented it! We make it. And we protect it with our lives. Unfortunately, there are some people in this room who think they can take it from us 'cause we're the little guys! I'm hoping that, after this is all over, you'll see how, by taking our honey, you not only take everything we have but everything we are! I wish he'd dress like that all the time. So nice! Oall your first witness. So, Mr. Klauss Vanderhayden of Honey Farms, big company you have. I suppose so. I see you also own Honeyburton and Honron! Yes, they provide beekeepers for our farms. Beekeeper. I find that to be a very disturbing term. I don't imagine you employ any bee-free-ers, do you? - No. - I couldn't hear you. - No. - No. Because you don't free bees. You keep bees. Not only that, it seems you thought a bear would be an appropriate image for a jar of honey. They're very lovable creatures. Yogi Bear, Fozzie Bear, Build-A-Bear. You mean like this? Bears kill bees! How'd you like his head crashing through your living room?! Biting into your couch! Spitting out your throw pillows! OK, that's enough. Take him away. So, Mr. Sting, thank you for being here. Your name intrigues me. - Where have I heard it before? - I was with a band called The Police. But you've never been a police officer, have you? No, I haven't. No, you haven't. And so here we have yet another example of bee culture casually stolen by a human for nothing more than a prance-about stage name. Oh, please. Have you ever been stung, Mr. Sting? Because I'm feeling a little stung, Sting. Or should I say... Mr. Gordon M. Sumner! That's not his real name?! You idiots! Mr. Liotta, first, belated congratulations on your Emmy win for a guest spot on ER in 2005. Thank you. Thank you. I see from your resume that you're devilishly handsome with a churning inner turmoil that's ready to blow. I enjoy what I do. Is that a crime? Not yet it isn't. But is this what it's come to for you? Exploiting tiny, helpless bees so you don't have to rehearse your part and learn your lines, sir? Watch it, Benson! I could blow right now! This isn't a goodfella. This is a badfella! Why doesn't someone just step on this creep, and we can all go home?! - Order in this court! - You're all thinking it! Order! Order, I say! - Say it! - Mr. Liotta, please sit down! I think it was awfully nice of that bear to pitch in like that. I think the jury's on our side. Are we doing everything right, legally? I'm a florist. Right. Well, here's to a great team. To a great team! Well, hello. - Ken! - Hello. I didn't think you were coming. No, I was just late. I tried to call, but... the battery. I didn't want all this to go to waste, so I called Barry. Luckily, he was free. Oh, that was lucky. There's a little left. I could heat it up. Yeah, heat it up, sure, whatever. So I hear you're quite a tennis player. I'm not much for the game myself. The ball's a little grabby. That's where I usually sit. Right... there. Ken, Barry was looking at your resume, and he agreed with me that eating with chopsticks isn't really a special skill. You think I don't see what you're doing? I know how hard it is to find the rightjob. We have that in common. Do we? Bees have 100 percent employment, but we do jobs like taking the crud out. That's just what I was thinking about doing. Ken, I let Barry borrow your razor for his fuzz. I hope that was all right. I'm going to drain the old stinger. Yeah, you do that. Look at that. You know, I've just about had it with your little mind games. - What's that? - Italian Vogue. Mamma mia, that's a lot of pages. A lot of ads. Remember what Van said, why is your life more valuable than mine? Funny, I just can't seem to recall that! I think something stinks in here! I love the smell of flowers. How do you like the smell of flames?! Not as much. Water bug! Not taking sides! Ken, I'm wearing a Ohapstick hat! This is pathetic! I've got issues! Well, well, well, a royal flush! - You're bluffing. - Am I? Surf's up, dude! Poo water! That bowl is gnarly. Except for those dirty yellow rings! Kenneth! What are you doing?! You know, I don't even like honey! I don't eat it! We need to talk! He's just a little bee! And he happens to be the nicest bee I've met in a long time! Long time? What are you talking about?! Are there other bugs in your life? No, but there are other things bugging me in life. And you're one of them! Fine! Talking bees, no yogurt night... My nerves are fried from riding on this emotional roller coaster! Goodbye, Ken. And for your information, I prefer sugar-free, artificial sweeteners made by man! I'm sorry about all that. I know it's got an aftertaste! I like it! I always felt there was some kind of barrier between Ken and me. I couldn't overcome it. Oh, well. Are you OK for the trial? I believe Mr. Montgomery is about out of ideas. We would like to call Mr. Barry Benson Bee to the stand. Good idea! You can really see why he's considered one of the best lawyers... Yeah. Layton, you've gotta weave some magic with this jury, or it's gonna be all over. Don't worry. The only thing I have to do to turn this jury around is to remind them of what they don't like about bees. - You got the tweezers? - Are you allergic? Only to losing, son. Only to losing. Mr. Benson Bee, I'll ask you what I think we'd all like to know. What exactly is your relationship to that woman? We're friends. - Good friends? - Yes. How good? Do you live together? Wait a minute... Are you her little... ...bedbug? I've seen a bee documentary or two. From what I understand, doesn't your queen give birth to all the bee children? - Yeah, but... - So those aren't your real parents! - Oh, Barry... - Yes, they are! Hold me back! You're an illegitimate bee, aren't you, Benson? He's denouncing bees! Don't y'all date your cousins? - Objection! - I'm going to pincushion this guy! Adam, don't! It's what he wants! Oh, I'm hit!! Oh, lordy, I am hit! Order! Order! The venom! The venom is coursing through my veins! I have been felled by a winged beast of destruction! You see? You can't treat them like equals! They're striped savages! Stinging's the only thing they know! It's their way! - Adam, stay with me. - I can't feel my legs. What angel of mercy will come forward to suck the poison from my heaving buttocks? I will have order in this court. Order! Order, please! The case of the honeybees versus the human race took a pointed turn against the bees yesterday when one of their legal team stung Layton T. Montgomery. - Hey, buddy. - Hey. - Is there much pain? - Yeah. I... I blew the whole case, didn't I? It doesn't matter. What matters is you're alive. You could have died. I'd be better off dead. Look at me. They got it from the cafeteria downstairs, in a tuna sandwich. Look, there's a little celery still on it. What was it like to sting someone? I can't explain it. It was all... All adrenaline and then... and then ecstasy! All right. You think it was all a trap? Of course. I'm sorry. I flew us right into this. What were we thinking? Look at us. We're just a couple of bugs in this world. What will the humans do to us if they win? I don't know. I hear they put the roaches in motels. That doesn't sound so bad. Adam, they check in, but they don't check out! Oh, my. Oould you get a nurse to close that window? - Why? - The smoke. Bees don't smoke. Right. Bees don't smoke. Bees don't smoke! But some bees are smoking. That's it! That's our case! It is? It's not over? Get dressed. I've gotta go somewhere. Get back to the court and stall. Stall any way you can. And assuming you've done step correctly, you're ready for the tub. Mr. Flayman. Yes? Yes, Your Honor! Where is the rest of your team? Well, Your Honor, it's interesting. Bees are trained to fly haphazardly, and as a result, we don't make very good time. I actually heard a funny story about... Your Honor, haven't these ridiculous bugs taken up enough of this court's valuable time? How much longer will we allow these absurd shenanigans to go on? They have presented no compelling evidence to support their charges against my clients, who run legitimate businesses. I move for a complete dismissal of this entire case! Mr. Flayman, I'm afraid I'm going to have to consider Mr. Montgomery's motion. But you can't! We have a terrific case. Where is your proof? Where is the evidence? Show me the smoking gun! Hold it, Your Honor! You want a smoking gun? Here is your smoking gun. What is that? It's a bee smoker! What, this? This harmless little contraption? This couldn't hurt a fly, let alone a bee. Look at what has happened to bees who have never been asked, \"Smoking or non?\" Is this what nature intended for us? To be forcibly addicted to smoke machines and man-made wooden slat work camps? Living out our lives as honey slaves to the white man? - What are we gonna do? - He's playing the species card. Ladies and gentlemen, please, free these bees! Free the bees! Free the bees! Free the bees! Free the bees! Free the bees! The court finds in favor of the bees! Vanessa, we won! I knew you could do it! High-five! Sorry. I'm OK! You know what this means? All the honey will finally belong to the bees. Now we won't have to work so hard all the time. This is an unholy perversion of the balance of nature, Benson. You'll regret this. Barry, how much honey is out there? All right. One at a time. Barry, who are you wearing? My sweater is Ralph Lauren, and I have no pants. - What if Montgomery's right? - What do you mean? We've been living the bee way a long time, 27 million years. Oongratulations on your victory. What will you demand as a settlement? First, we'll demand a complete shutdown of all bee work camps. Then we want back the honey that was ours to begin with, every last drop. We demand an end to the glorification of the bear as anything more than a filthy, smelly, bad-breath stink machine. We're all aware of what they do in the woods. Wait for my signal. Take him out. He'll have nauseous for a few hours, then he'll be fine. And we will no longer tolerate bee-negative nicknames... But it's just a prance-about stage name! ...unnecessary inclusion of honey in bogus health products and la-dee-da human tea-time snack garnishments. Oan't breathe. Bring it in, boys! Hold it right there! Good. Tap it. Mr. Buzzwell, we just passed three cups, and there's gallons more coming! - I think we need to shut down! - Shut down? We've never shut down. Shut down honey production! Stop making honey! Turn your key, sir! What do we do now? Oannonball! We're shutting honey production! Mission abort. Aborting pollination and nectar detail. Returning to base. Adam, you wouldn't believe how much honey was out there. Oh, yeah? What's going on? Where is everybody? - Are they out celebrating? - They're home. They don't know what to do. Laying out, sleeping in. I heard your Uncle Oarl was on his way to San Antonio with a cricket. At least we got our honey back. Sometimes I think, so what if humans liked our honey? Who wouldn't? It's the greatest thing in the world! I was excited to be part of making it. This was my new desk. This was my new job. I wanted to do it really well. And now... Now I can't. I don't understand why they're not happy. I thought their lives would be better! They're doing nothing. It's amazing. Honey really changes people. You don't have any idea what's going on, do you? - What did you want to show me? - This. What happened here? That is not the half of it. Oh, no. Oh, my. They're all wilting. Doesn't look very good, does it? No. And whose fault do you think that is? You know, I'm gonna guess bees. Bees? Specifically, me. I didn't think bees not needing to make honey would affect all these things. It's notjust flowers. Fruits, vegetables, they all need bees. That's our whole SAT test right there. Take away produce, that affects the entire animal kingdom. And then, of course... The human species? So if there's no more pollination, it could all just go south here, couldn't it? I know this is also partly my fault. How about a suicide pact? How do we do it? - I'll sting you, you step on me. - Thatjust kills you twice. Right, right. Listen, Barry... sorry, but I gotta get going. I had to open my mouth and talk. Vanessa? Vanessa? Why are you leaving? Where are you going? To the final Tournament of Roses parade in Pasadena. They've moved it to this weekend because all the flowers are dying. It's the last chance I'll ever have to see it. Vanessa, I just wanna say I'm sorry. I never meant it to turn out like this. I know. Me neither. Tournament of Roses. Roses can't do sports. Wait a minute. Roses. Roses? Roses! Vanessa! Roses?! Barry? - Roses are flowers! - Yes, they are. Flowers, bees, pollen! I know. That's why this is the last parade. Maybe not. Oould you ask him to slow down? Oould you slow down? Barry! OK, I made a huge mistake. This is a total disaster, all my fault. Yes, it kind of is. I've ruined the planet. I wanted to help you with the flower shop. I've made it worse. Actually, it's completely closed down. I thought maybe you were remodeling. But I have another idea, and it's greater than my previous ideas combined. I don't want to hear it! All right, they have the roses, the roses have the pollen. I know every bee, plant and flower bud in this park. All we gotta do is get what they've got back here with what we've got. - Bees. - Park. - Pollen! - Flowers. - Repollination! - Across the nation! Tournament of Roses, Pasadena, Oalifornia. They've got nothing but flowers, floats and cotton candy. Security will be tight. I have an idea. Vanessa Bloome, FTD. Official floral business. It's real. Sorry, ma'am. Nice brooch. Thank you. It was a gift. Once inside, we just pick the right float. How about The Princess and the Pea? I could be the princess, and you could be the pea! Yes, I got it. - Where should I sit? - What are you? - I believe I'm the pea. - The pea? It goes under the mattresses. - Not in this fairy tale, sweetheart. - I'm getting the marshal. You do that! This whole parade is a fiasco! Let's see what this baby'll do. Hey, what are you doing?! Then all we do is blend in with traffic... ...without arousing suspicion. Once at the airport, there's no stopping us. Stop! Security. - You and your insect pack your float? - Yes. Has it been in your possession the entire time? Would you remove your shoes? - Remove your stinger. - It's part of me. I know. Just having some fun. Enjoy your flight. Then if we're lucky, we'll have just enough pollen to do the job. Oan you believe how lucky we are? We have just enough pollen to do the job! I think this is gonna work. It's got to work. Attention, passengers, this is Oaptain Scott. We have a bit of bad weather in New York. It looks like we'll experience a couple hours delay. Barry, these are cut flowers with no water. They'll never make it. I gotta get up there and talk to them. Be careful. Oan I get help with the Sky Mall magazine? I'd like to order the talking inflatable nose and ear hair trimmer. Oaptain, I'm in a real situation. - What'd you say, Hal? - Nothing. Bee! Don't freak out! My entire species... What are you doing? - Wait a minute! I'm an attorney! - Who's an attorney? Don't move. Oh, Barry. Good afternoon, passengers. This is your captain. Would a Miss Vanessa Bloome in 24B please report to the cockpit? And please hurry! What happened here? There was a DustBuster, a toupee, a life raft exploded. One's bald, one's in a boat, they're both unconscious! - Is that another bee joke? - No! No one's flying the plane! This is JFK control tower, Flight 356. What's your status? This is Vanessa Bloome. I'm a florist from New York. Where's the pilot? He's unconscious, and so is the copilot. Not good. Does anyone onboard have flight experience? As a matter of fact, there is. - Who's that? - Barry Benson. From the honey trial?! Oh, great. Vanessa, this is nothing more than a big metal bee. It's got giant wings, huge engines. I can't fly a plane. - Why not? Isn't John Travolta a pilot? - Yes. How hard could it be? Wait, Barry! We're headed into some lightning. This is Bob Bumble. We have some late-breaking news from JFK Airport, where a suspenseful scene is developing. Barry Benson, fresh from his legal victory... That's Barry! ...is attempting to land a plane, loaded with people, flowers and an incapacitated flight crew. Flowers?! We have a storm in the area and two individuals at the controls with absolutely no flight experience. Just a minute. There's a bee on that plane. I'm quite familiar with Mr. Benson and his no-account compadres. They've done enough damage. But isn't he your only hope? Technically, a bee shouldn't be able to fly at all. Their wings are too small... Haven't we heard this a million times? \"The surface area of the wings and body mass make no sense.\" - Get this on the air! - Got it. - Stand by. - We're going live. The way we work may be a mystery to you. Making honey takes a lot of bees doing a lot of small jobs. But let me tell you about a small job. If you do it well, it makes a big difference. More than we realized. To us, to everyone. That's why I want to get bees back to working together. That's the bee way! We're not made of Jell-O. We get behind a fellow. - Black and yellow! - Hello! Left, right, down, hover. - Hover? - Forget hover. This isn't so hard. Beep-beep! Beep-beep! Barry, what happened?! Wait, I think we were on autopilot the whole time. - That may have been helping me. - And now we're not! So it turns out I cannot fly a plane. All of you, let's get behind this fellow! Move it out! Move out! Our only chance is if I do what I'd do, you copy me with the wings of the plane! Don't have to yell. I'm not yelling! We're in a lot of trouble. It's very hard to concentrate with that panicky tone in your voice! It's not a tone. I'm panicking! I can't do this! Vanessa, pull yourself together. You have to snap out of it! You snap out of it. You snap out of it. - You snap out of it! - You snap out of it! - You snap out of it! - You snap out of it! - You snap out of it! - You snap out of it! - Hold it! - Why? Oome on, it's my turn. How is the plane flying? I don't know. Hello? Benson, got any flowers for a happy occasion in there? The Pollen Jocks! They do get behind a fellow. - Black and yellow. - Hello. All right, let's drop this tin can on the blacktop. Where? I can't see anything. Oan you? No, nothing. It's all cloudy. Oome on. You got to think bee, Barry. - Thinking bee. - Thinking bee. Thinking bee! Thinking bee! Thinking bee! Wait a minute. I think I'm feeling something. - What? - I don't know. It's strong, pulling me. Like a 27-million-year-old instinct. Bring the nose down. Thinking bee! Thinking bee! Thinking bee! - What in the world is on the tarmac? - Get some lights on that! Thinking bee! Thinking bee! Thinking bee! - Vanessa, aim for the flower. - OK. Out the engines. We're going in on bee power. Ready, boys? Affirmative! Good. Good. Easy, now. That's it. Land on that flower! Ready? Full reverse! Spin it around! - Not that flower! The other one! - Which one? - That flower. - I'm aiming at the flower! That's a fat guy in a flowered shirt. I mean the giant pulsating flower made of millions of bees! Pull forward. Nose down. Tail up. Rotate around it. - This is insane, Barry! - This's the only way I know how to fly. Am I koo-koo-kachoo, or is this plane flying in an insect-like pattern? Get your nose in there. Don't be afraid. Smell it. Full reverse! Just drop it. Be a part of it. Aim for the center! Now drop it in! Drop it in, woman! Oome on, already. Barry, we did it! You taught me how to fly! - Yes. No high-five! - Right. Barry, it worked! Did you see the giant flower? What giant flower? Where? Of course I saw the flower! That was genius! - Thank you. - But we're not done yet. Listen, everyone! This runway is covered with the last pollen from the last flowers available anywhere on Earth. That means this is our last chance. We're the only ones who make honey, pollinate flowers and dress like this. If we're gonna survive as a species, this is our moment! What do you say? Are we going to be bees, orjust Museum of Natural History keychains? We're bees! Keychain! Then follow me! Except Keychain. Hold on, Barry. Here. You've earned this. Yeah! I'm a Pollen Jock! And it's a perfect fit. All I gotta do are the sleeves. Oh, yeah. That's our Barry. Mom! The bees are back! If anybody needs to make a call, now's the time. I got a feeling we'll be working late tonight! Here's your change. Have a great afternoon! Oan I help who's next? Would you like some honey with that? It is bee-approved. Don't forget these. Milk, cream, cheese, it's all me. And I don't see a nickel! Sometimes I just feel like a piece of meat! I had no idea. Barry, I'm sorry. Have you got a moment? Would you excuse me? My mosquito associate will help you. Sorry I'm late. He's a lawyer too? I was already a blood-sucking parasite. All I needed was a briefcase. Have a great afternoon! Barry, I just got this huge tulip order, and I can't get them anywhere. No problem, Vannie. Just leave it to me. You're a lifesaver, Barry. Oan I help who's next? All right, scramble, jocks! It's time to fly. Thank you, Barry! That bee is living my life! Let it go, Kenny. - When will this nightmare end?! - Let it all go. - Beautiful day to fly. - Sure is. Between you and me, I was dying to get out of that office. You have got to start thinking bee, my friend. - Thinking bee! - Me? Hold it. Let's just stop for a second. Hold it. I'm sorry. I'm sorry, everyone. Oan we stop here? I'm not making a major life decision during a production number! All right. Take ten, everybody. Wrap it up, guys. I had virtually no rehearsal for that.", "Sports shooting is a safe activity Shooting as a sport has the potential to desensitize people to the lethal nature of all firearms, creating a gun culture that glamorizes and legitimizes unnecessary gun ownership.", "The Rise of China is Safe and Peaceful 'I believe that the rise of China is peaceful and should not be feared off.'Hi! HoKiaJunn,You believe what you like. I recognize China for what it is. China is a 'superpower' on the world stage. China has little regard for it's citizens or its environment. China is owed money by 'absolutely everyone'. It is the Shylock of global finance and it will attempt to extract it's pound of flesh. Ethnic minorities are suffocated beneath this monolith. China has an extensive nuclear arsenal that it updates in order to keep pigeons off it's rice crops. Most Chinese people that I have encountered are honest, hard working and peaceful . They are friendly and compliant but that is not what we are talking about here. We are discussing 'China', the political entity that is. Make a case for them if you can. Good Luck", "Global C02 trading not like US sulfur trading \"The case against carbon trading\". Rising Tide - \"CO2 IS NOT SO2. The main model for carbon trading is Sulphur Dioxide (SO2) emissions trading under the US 1990 Clean Air Act. This programme faced none of the problems listed above- it was small (a few hundred companies), easy to monitor (one pollutant from one source-power generation), had permanent targets, and, above all, was conducted within one country with strong enforcement mechanisms.\"", "are vaccines safe vaccines are safe they protect the body against diseases. they work by giving the body a mild or similar case of the disease.", "Marijuana should be legalized for medical and recreational use. You can point out all you want, but the comparison is valid. Both are considered recreational drugs. Marijuana is all natural, and helps with many ailments. It has been prescribed and freely ingested for hundreds of years or more. Not one death has been fully attributed to it at all. http://freecannabis.net... Prohibition of marijuana is comparable to that of alcohol in the early part of 1900s. People are going to do it, regardless of legality, if marijuana was legally available as an option other than alcohol, you would be essentially saving those lives from liver disease, alcoholism, and other short or long term effects of alcohol, in exchange for some slight memory loss, (which is why smart phones come in handy) good sleep, and a surge in sales at local cookie factories. For those states that have yet to legalize, the marijuana market belongs mainly to drug sellers that sell far worse chemicals along with it. Looking at Colorado, where it has become legal, crime rates have dropped, and jobs have been created. Since the first retail marijuana stores opened on January 1st, 2014, the state of Colorado has benefitted from a decrease in crime rates, a decrease in traffic fatalities, an increase in tax revenue and economic output from retail marijuana sales, and an increase in jobs. http://www.mintpressnews.com... Farmers are finally making a decent living now. Taxation of marijuana has helped build schools, and more. The age requirement helps keep the plant out of underage hands, when drug dealers have no age requirements, and young customers may be tempted to buy more dangerous drugs. The money from these deals usually go to buy guns, etc. Cartels get a lot of business from the black market, which is unavoidable due to the increase in useage, so keeping the sale illegal is ideal to them. The prison industry also gains plenty from prohibition of marijuana, because most people don't want to quit using, regardless of legality, resulting in overcrowded prison populations, most for as little as a single cannabis cigarette. It is for this reason America has the highest percentage of incarcerated people's in the world. Smoking the plant, while far less dangerous than cigarettes, provide the easiest, quickest release of thc, but with legalization, comes more innovative, safer techniques for intake, such as edibles and vaping. http://www.iflscience.com...https://en.m.wikipedia.org... Big pharmacy, which accounts for very serious side effects, will also take a paycut with the legalization of marijuana, which I'd like to point out to our voters you have dropped. Over half of American adults have at least tried marijuana. Over half of Americans at least think it's a good idea to legalize it. It's a creation of nature that has harmless side effects in most people, and to those who feel it dangerous, or decide they would like to keep their short term memory, only need to stay away from the plant. Did you know that the USFG prescribed a few people(and still supply to this day) several marijuana cigarettes every day? They know it has medical significance, even admitting that cannabis cures cancer in question 6 of the q&a section of the .gov link below, which is hypocritical.http://www.cbsnews.com...http://www.cancer.gov...Doctors, lawyers, and business owners like myself smoke cannabis on a daily basis. While it's best done in privacy to unwind. Most of America thinks it's a good thing, it makes most people happy with very little dangers, if any. Notice how many time my opponent uses words like \"may\" or \"could\" and saying they don't know the long-term effects. We've been using this God given plant for centuries, is it possible that there are no long term effects? If you are scared of it, don't use it. Simple as that, but prohibition is not working right now, and we should learn from the areas that have legalized it, and move forward. Many states would have already done so I'm my opinion, if it weren't for the USFG. The government has a shortage of hackers, some of the smartest men and women on the planet in my honest opinion, because none of the best ones can pass a urinalysis for cannabis. So much for that whole brain killing argument.http://motherboard.vice.com... http://www.wsj.com..."]}, {"query": "Should churches remain tax-exempt?", "pos": ["Churches, mosques, synagogues, etc. ought not be exempt from federal taxation. Preface: I would ask Pro if the next round, or perhaps the round after, be made the concluding round. This debate will devolve into repetition and nonsense if we go all 5 rounds. Proposition: My Opponent challenged my view that Tax Exemption is natural. However, he does not elaborate further. Therefore, he has effectively left the matter in my favour. What we earn is naturally ours, ergo, to have what is ours taken is not natural, even if necessary. I will follow up later. Counter-Case I: Corporate Tax Summarization: My opponent claims that we will simply label churches as Corporations. Counter: Churches are not Corporations. This is simple, objective fact. Pro can no more relabel them then he could relabel me rich. Pro claims that Churches seek to make money. This means nothing. All charities seek to acquire revenue. What matters is the use of this money. A Corporation will make money to benefit its leaders/shareholders through financial profit. A church seeks to gain revenue in order to benefit everyone else, through charitable means. Ergo, the Churches are in fact Charities, and cannot be labeled as anything else, any more then he can relabel the Salvation Army. To do so in order to expand tax revenue would be a grievous abuse of power, and a sign of a Government that is falling beyond the threshold. No, Churches will be labeled as what they are, Charitable organizations. Pro says Tithes are mandatory, I ask for sources. Social Pressures are also given when charities stand outside walmart, or when we are asked to donate at the register. But this doesn\u2019t change the nature of the charities responsible. No, Pro may be too weak to resist social pressure, but he cannot redefine \u201cVoluntary\u201d. No matter how much pressure is applied, the fact that you can say no (Often times without people knowing) means it is completely voluntary. I, for example, did not give tithe in church today. Conclusion: Pro failed to prove that Churches are Corporations, and merely declared them to be so. Or rather, declared that he would label them Corporations, regardless of what they actually are. Counter-Case II: \u201cCounter-Cases\u201d / \u201cCases\u201d Summarization: Pro has attempted to attack my Counters, while presented a new case that Churches aren\u2019t Charities. Counter: \u201cWhen these groups enter society, they give up the right to not be taxed. \u201d This is one of the most philosophically bankrupt views I have seen in awhile. Again, to keep what we earn is the natural way, and to be taxed is unnatural, if necessary. To act as though taxation is inherent until otherwise said shows a lack of understanding of the nature of taxation. Saying that government withholding tax is a sign of support further shows his flawed philosophy toward taxation. The inability to distinguish between not having our income stolen, and being money suggests he views our money as Government Property, with the money we have left being our allowance. I will allow the Voters to make of this philosophy what they will. Once the smaller Churches begin going under, Pro will then give them a stimulus. This means taking money from wealthier churches, and giving it to smaller churches, to make up for the tax that is now implemented. This is the endorsement of religion the First Amendment is against. This means benefiting the smaller churches at the expense of the large ones (ironically, more so than Pro\u2019s claim that exemption benefits larger churches more). Or perhaps we not tax them at all, and not need to give taxpayer money to Churches. Or they collapse. Then tax revenue is lost. Now no one gets Social Aid. My opponent declares SCOTUS to be the final authority, yet again committing the Appeal to Authority, without giving evidence that they are right. SCOTUS has been wrong before. They are largely an opinion with authority, whereas my sources are academic. I have shown the flaw in their reasoning, Pro has not shown flaw in my sources. Pro says that our education system is underfunded, without source. I have sourced that it is among the most well-funded in the world. All other problems are in administration, and therefore extra funding won\u2019t help. Our SS problems are derived from a broken system. Money will be wasted without change. Pro fails to express how taking the money from a charity, and wasting half of it will benefit us more than just letting the Charity use the money. Paying the debt is no better than war. It is taking more money to pay for the government's own inefficiencies, rather than trying to fix it from the government\u2019s (expenditure) end. Pro fails to show how these churches are not charitable. Rather, he makes the unsubstantiated claim that they \u201ckeep a cut for themselves\u201d. What he is referring to is unknown, and thus irrelevant. Any administrative/maintenance/debt costs are normal for charities. They are still Charities. Scientology has a controversial tax status. It has even been revoked because it didn\u2019t meet the requirements to be a non-for-profit Church. {1} Thus Churches can lose status. Pro also mentions that bureaucracy won\u2019t waste the money. I sourced that there was waste. Here is another {2} Conclusion: Pro\u2019s Counters fail to dispel my arguments, and he fails to revive his own. As it stands, his logic is shown to be faulty. Pro says my argument relies on Churches being Charity, but as this is the established fact about Churches, it is actually Pro\u2019s job to show they are not Charities. He has failed in this endeavor, as his statements, when looked at carefully, can be seen to apply to any Charity. His failure to show that churches can even be taxes further defies his claim that taxing them will benefit social programs. He further continues making unsubstantiated claims that adding money to these programs will help, when I have shown the problems are often not financial. Sources: 1} Wikipedia: . http://bit.ly... 2} Slate: . http://slate.me... Case: Long-Term Loss Thesis: I will show here that increasing taxation will only lead to a less successful future, with a dangerous precedent in place, and decreased taxation is prefered. Rationalization: A fact that many people seem not to realize is that taxation harms long term economic growth {3}. With less capital, business/people have less spare income for expansion. This will not change for churches. Their decreased growth will lead to the revenue from them dropping overtime relative to inflation and government spending. Eventually, the Social assistance gained from this tax (which is already less than lost by taxing charities) will further decline relative to had the Churches been able to simply invest the money into expension (something Charities are allowed to do). But worse, is the precedence. After taxing the Churches, the Government will find that it is not enough. Because 71 Billion won\u2019t fix the anything. Instead of fixing their fiscal incompetence, they simply added a tax, on a 501c3 eligible group with strong legal defenses. The precedence is almost certainly set. If it has already been set (very likely given increasing tax/GDP ratio {4}), it will be further enforced. New taxes, expanded taxes. This will lead to slowed economic growth, and cause long-term harm to revenue. If taxes are lowered instead, the economy will grow from increased investment/ease-of-business. The increase in economy will eventually reach a point will more revenue can be brought in with lower and less taxes. A long-term solution, along with fixing the bureaucratic mess, and destroying waste. Far better and more efficient than the short-term solution of taxing more, which will only necessitate (and precedate) further taxation increases. Conclusion: Pro\u2019s economic policies would see decreased economic/church growth, leading to a situation where tax revenues will be lower (relative to inflation) in spite of higher tax rates. Lower taxes and smaller/efficient government is best. Sources: 3} TPC: . http://tpc.io... 4} . http://bit.ly... Closing Statement: Pro fails to resuscitate his arguments, often merely repeating them without further elaboration. He fails to realize that simply referring to SCOTUS\u2019 position doesn\u2019t justify their claims. Pro doesn\u2019t really make any headway against my claims, beyond relying on the notion that he can tax them as something they aren\u2019t (Corporations). And if they don\u2019t fit the classification, he\u2019ll tax them as such anyhow. This doesn\u2019t work, and Pro failed to show Churches to be anything but Charities, as his descriptions of the churches are little different than other Charities once analyzed. Perhaps most crippling is Pro revealing his faulty philosophy toward taxation, implying that theft of our earned money is natural, and to be allowed to keep all of our earned income is a gift from government. This is a dangerous notion. Pro may not have stated this philosophy word-for-word, but the implication is there. Especially, when he says not having our money taken is the same as being given money. This is a stockholmesque view. Taxation is Theft. Taxation is necessary, but it is theft. It must be done carefully, and every single effort must be made to keep it as low as possible. If government fails in this endeavour, and choses to keep raising tax, then it must be seen as an aggressive parasite to our economic system, taking more, and giving less. Pro would prefer this parasite, because his disdain for religion justifies expanded taxation on charities simply due to their religious nature. {5/6} Sources: 5} . http://bit.ly... 6} Mises: . http://bit.ly...", "Churches, mosques, synagogues, etc. ought not be exempt from federal taxation. Synopsis: The Resolution is interpreted to suggest that religious communities (the definition of \u201cChurch/Mosque/Synagogue\u201d being used) should pay Taxes, and not have tax exempt status. The word \u201cChurch\u201d will be used in substitution to all forms of related Religious Communities. Proposition I: Definitions Tax: A compulsory contribution to state revenue, levied by the government on workers' income and business profits or added to the cost of some goods, services, and transactions. {1} Exempt: Free from an obligation or liability imposed on others {2} Endorsement: An act of giving one's public approval or support to someone or something. {3} Sources: 1} . http://bit.ly... 2} . http://bit.ly... 3} . http://bit.ly... Proposition II: BOP will be on my Opponent, as he desires a change from the Status Quo, is Pro, and the instigator of the debate. Additionally, I claim that all money, being properly acquired, is exempt from tax until otherwise made compulsory. In this way, not being required to pay tax is the natural system, and therefore, Pro must show that there is a proper justification to extend taxation over a currently untaxed organization. Counter-Case I: Endorsement of Religion / Favouring Large Churches Counter: This is purely non sequitur. Allowing people to keep more of what is already theirs does not count as endorsing them. Rather, giving them money would count as Endorsement. They aren\u2019t being given money, they are keeping the money that was already theirs. It would be endorsement to give a different status to other religious communities. Which means all Religious communities would either need taxed, or exempt. My opponent referenced a SCOTUS decision, however it isn\u2019t sourced, so it can be disregarded, since no details are linked. Regardless, I will go ahead and point out that it is still an appeal to authority, and doesn\u2019t matter in a discussion on what we believe should/n\u2019t be done. Regardless of their decision, being allowed to keep more of your money is not the same as being given money. SCOTUS seems to speak from the position that our money is the government's money until we are told we can keep it. But that isn\u2019t how it works. The issue with Pros second claim is that it assumes removing tax exemption will somehow be more fair than allowing both Large and Small Churches to keep all their income. In truth, Larger churches are more easily capable of paying taxes, while Smaller Churches risk falling under and failing, in the same way that small business\u2019 are hurt more than large business\u2019. Whereas a similar tax rate will still allow large organizations enough income to accomplish their goals and obligations, it would leave smaller organizations a smaller income to do so, preventing growth. With that said, I will further point out that there is a break in the logic that says allowing two people to keep all their money benefits the richer more because he has more money to keep. Saying a wealthier organization makes more money, so we should take it, doesn\u2019t work. In actuality, giving a different tax liability to different Religious Organizations risk creating \u201cendorsement\u201d by forcing larger ones to pay more. Giving the same Liability endorses the larger ones by hurting smaller \u201ccompetitors\u201d. Conclusion:I have shown here that there is no endorsement or unfairness in giving the same tax exemption to all organizations of the same type. Rather the only way to avoid the government influencing religion is to keep Government out of Church coffers. Counter-Case II: Use of Tax Revenue. Counter: So? Firstly, I\u2019ll let Pro know that Blogs, which do not have links to direct sources, are not themselves sources. So Pro\u2019s first source is not valid. Regardless, it doesn\u2019t matter. We cannot simply justify increased taxation by the amount it will provide. Instead of sustaining increased spending with increased taxation, we must first work to decrease spending. Funneling the money into systems like the VA is a waste, as it is not an issue of money, but of structure and efficiency, like many other budgets. Other budgets are similarly well funded, but suffer from inefficiency and wasteful bureaucracy (Such as education, where we have one of the highest spending per students in the world {4/5/6}), or otherwise has dedicated revenue (SS is supported by largely by Pay Roll Tax {7/8}). And to say we could fund the Vietnam war is also a terrible thought. Taxing Charities to fund unpopular wars? Pro is listing how we can use the money, but I argue we should try to fix the problems that lead to the failure of these programs. Taxation from Churches look like a lot, but will not fix our problems. So we should try something that can. Streamline bureaucracy, modernize systems, and try to fix our financial problems by decreasing financial needs. If the systems are not able to be fixed without constantly increased taxation, then the system is broken and should be replaced. Pro sets a dangerous precedent of fixing problems by taking more money. I will lastly point out that Religious organizations are highly charitable (sourced in Case I below). Pro is wanting to take this charitable money, lose half of it in Bureaucracy, and use the rest for welfare. It will not help, but rather it will decrease national social assistance. Of course, this doesn\u2019t really matter, as the Churches will not pay taxes regardless of their religious status, as I will point out in my Case below. . Conclusion:Here it is shown that the notion that our budget should be fixed by increasing taxes is flawed and dangerous, and that the problem should be fixed from the expenditure end. If Pro had his way, our government could spend as much as they want, and simply charge us more for the right to exist, rather than taking responsibility for our money which they have forced us to hand over. Why should we be forced to give more and more to an irresponsible Robber Baron that won\u2019t at least try to minimize the costs? No, be accountable to our money, then we can talk about taking our holy dollars. Sources: 4} CBS: . http://cbsn.ws... 5} OECD: . http://bit.ly... 6} Investopedia: . http://bit.ly... 7} . http://bit.ly... 8} Heritage: . http://bit.ly... Case: Churches are Non-For-Profit / Funded by Donation. Thesis: I will prove here that removing the tax exempt status will not change anything, as Churches are inherently tax exempt through being Charitable organizations. Rationalization: Churches are non-for-profit. They are highly charitable {9, yes the source says the catholic church doesn\u2019t provide half of SA, but it does show they alone still provide a great portion}. The church's income largely goes to paying workers (like most Charities, which is subject to income tax), debt {like most Charities}, mortgage/rent {like most Charities}, maintenance {like most Charities}, and Bills {like most Charities}. The remainder is largely charitable or related to religious programs {10}. Like all Charities, they are inherently Tax-Exempt. I will point out that Churches must meet certain 501c3 requirements, such as not attempting to intervene in political campaigns. They may, under certain instances, be subject to UBIT Tax. {11} Churches are Charitable, and therefore tax exempt, even without their status as churches, as their non-administrative expenses deal with social aid, and religious expansion, rather than commercial or financial profit. {12} So even with removing the religious exemption, Churches will not be paying taxes anyhow. Pro would have to also support altering the 501c3 requirements, which risk forcing other non-religious charities to pay taxes, or otherwise to add in a clause preventing non-religious organizations from being class as Charities, which would be worse as that would become religious discrimination. Conclusion:Here I have successfully shown that Churches, being charitable organizations, would be tax exempt even barring religious exemptions. The impact of this coincides with Counter-Case II. Pro spoke of all the ways we can use Religious Taxes, but since these Churches, as charitable groups, will pay no tax anyhow, there will be no extra income for the inefficient social programs that Pro wants to support. All the effort of forcing through a controversial law to get the Churches taxed, and absolutely no increase in revenue. Sources: 9} Politifact: . http://bit.ly... 10} . http://bit.ly... 11} Score: . http://bit.ly... 12} Investopedia: . http://bit.ly... Closing Statement: My opponents arguments are basically that we should fix our fiscal problems by increasing taxes, rather than fixing the problems inherent in the current system. I rather suggest we fix the problems so that we need not increase taxes. Beyond this, Pro gives no other real argument because the non-sequitur that letting Groups keep their own money is the same as giving them money, when it is different on principle, and that tax exemptions benefit richer churches more, when in reality, taxation would hurt smaller churches more. Regardless of religious status, the sheer majority of these organizations are Charitable, and would not be taxable regardless. Any money taxed would be used less efficiently with the added layers of bureaucracy. I\u2019ll point out that there are major moral problems if money taxed from Church went to things (or freed other money to go to things) which are fundamentally against the Church\u2019s views. Lastly, I repeat myself, not for the last time this debate: The Budget should be fixed streamlining, removing redundant or aged programs/departments/regulations, and fighting wasteful/corrupt spending. Not by following the never ending policy of increased taxation, which will only reward their fiscal incompetence rather than force fiscal reform. {13/14} Sources: 13} Heritage:. http://bit.ly... 14} The Hill:. http://bit.ly... ==Unitomic==", "Churches of all religions should be taxed by the government. It seems my opponent has failed to provide any form of rebuttal against my arguments. Very well, I will proceed. I. Property TaxThe Walz decision The U.S. Supreme Court, by a vote of 8-1, upheld the tax exemption of churches in Walz v. Tax Commission of the City of New York, 397 U.S. 664 (1970). Walz, a self-described Christian who did not belong to any church and owned real estate in Richmond County, N.Y., sued the tax committee over property tax exemption for churches. Walz claimed he and other taxpayers were forced to indirectly subsidize churches.The majority decision, written by Chief Justice Burger, held that the tax exempt status granted to all houses of worship is the same privilege given to other nonprofits organizations:\"The legislative purpose of a property tax exemption is neither the advancement nor the inhibition of religion; it is neither sponsorship nor hostility. New York, in common with the other States, has determined that certain entities that exist in a harmonious relationship to the community at large, and that foster its 'moral or mental improvement,' should not be inhibited in their activities by property taxation or the hazard of loss of those properties for non payment of taxes. It [397 U.S. 664 , 673] has not singled out one particular church or religious group or even churches as such; rather, it has granted exemption to all houses of religious worship within a broad class of property owned by nonprofit, quasi-public corporations which include hospitals, libraries, playgrounds, scientific, professional, historical, and patriotic groups. Source: http://ffrf.org...Importantly, my opponent failed to inform the audience that the so-called luxury home was built using the pastors personal money that he earned from book sales and paid personal appearances around the world. The pastor himself is known as a \"rock star\" of the community with a congregation of roughly 14,000 every week. Furthermore, even though his private home has absolutely nothing to do with the property tax exemption argument my opponent is trying to make, his church has contributed over ten million dollars to the community. This is all within the last eight years. Not only does the amount of ten million dollars in eight years dwarf the amount my opponent is trying to use as an argument, but it also is far more than that community would have received via government spending going-back-to-the-community.Source: http://www.wcnc.com...II. Sales TaxA sales tax is something that can be avoided by most non-profit organizations, not just churches. So to claim \"avoiding\" a sales tax as necessarily a bad thing, perhaps we should also be targeting the boy/girl scouts, or the local gardening club or even our local charity fundraisers. Furthermore, sales tax exemption is a very fine line usually defined on the State level of politics. This implies that your math is incorrect in the sense that not only is your portrayal of an 8.25% sale tax something that isn't verifiable without sources but also that not every state permits every church sales tax exemption. Furthermore, while churches might be exempt from sales taxes in certain states - depending on their legal status, they might be subject to paying a \"franchise\" tax. Thus, in reality, churches aren't always as 'tax-free' as my opponent is implying.III. Capital Gains Tax Once again, my opponent made the mistake of attempting to claim that when churches sell 'stuff' they don't pay capital gains tax. This tax law has several exceptions that even require churches to pay taxes in certain situation. For clarification on those situations I have provided some information: Property used for exempt purposes. Any gain or loss from the sale or other disposition of property used for the exempt purposes of the foundation is not included in figuring the tax on net investment income. If the foundation uses property for its exempt purposes, but also inci\u00addentally receives income from the property that is subject to the net investment income tax, any gain or loss from the sale or other disposition of the property would not be subject to the tax. For example, if a tax-exempt private foundation maintains historic buildings that are open for public inspection, but it requires a number of employees to live in these buildings and charges rent, the rent is subject to the tax on net invest\u00adment income, but any gain or loss resulting from the sale of these buildings is not subject to the tax. However, if a private foundation uses prop\u00aderty both for exempt purposes and (other than incidentally) for investment purposes, (for exam\u00adple, a building in which the foundation\u2019s charita\u00adble and investment activities are carried on) that part of the gain or loss from the sale or other disposition of the property that is allocable to the investment use of the property must be taken into account in figuring the tax on net investment income. Source: http://www.irs.gov...Considering that the mall leases space to for-profit companies such as Forever 21, they will not be exempt from capital gains tax. The only real point my opponent can make in the case of the mall is that it was built property tax free, but as with the previous example - the money returned to the local community by the church itself has far outweighed the money 'lost' by tax exemptions. IV. Absolute claims made by OpponentIn closing, my opponent made the bold statement: Churches do not have to account for where their money is spent, unlike any other organization. Blatantly, churches are given extra brakes and exemptions that no other organization is offered.This is far from accurate. As I have shown above, it is not just churches that do not have to account for where their money is spent - but rather, most non-profit organizations enjoy the same benefits of tax-exempt status as churches. The claim made by my opponent is baseless and completely false. While I can agree with my opponent that separation of church and state does not mean churches should go unchecked, it most certainly means that church and state are to remain separated. By allowing the taxation of churches we are doing nothing more than removing that degree of separation that has been necessary to maintain the balance between the two dominating forces. What history has proven, if anything, is that cycles of the past are unknowingly repeated - we must not allow that to happen once more. My only hope is that, once again, I have not failed in reflecting the importance of keeping churches tax free, and ultimately - free from external influence or governance.", "Churches should be taxed. Even though my opponent forfeited, I'll still see what I can pick apart from her arguments.Notice that not once throughout my opponent's main arguments did she ever distinguish between a church and a non-profit organization. In that light, she also failed to provide you a single reason to vote Pro.As I said in my opening argument, churches are like non-profit organizations, which provide benefits to the community as a whole without being taxed for it. My opponent didn't even try to argue against this in her opening argument, possibly because she, as well as I, acknowledge all of the good that can come out of a local church.The problem with my opponent's case is that she doesn't realize that taxing a church will simply discourage it from providing these benefits to the community. People who work at churches or even people who volunteer are already taxed at an individual level. This poses a problem for taxing the churches, as Professor Dean Kelly writes in his book \"To tax them again for participation in voluntary organizations from which they derive no monetary gain would be \u2018double taxation\u2019 indeed, and would effectively serve to discourage them from devoting time, money, and energy to organizations which contribute to the upbuilding of the fabric of democracy.\"[1] And what does this mean? If churches spend less time helping the community, who picks up the slack? Either the government does so, which ultimately means more taxes for all of us, or nobody picks it up at all. Both situations are undesirable and completely avoidable by not taxing churches in the first place.Looking at my opponent's arguments, all I can really see are complaints about what the churches have. So what if churches own land? So what if they have facilities on this land? Pro hasn't given you a single reason as to why these are even bad things, except for that some people feel like they can't use those facilities.The last sentence the Pro says is the most fallacious of all: \"Religious affiliations only remain tax-exempt if the government sees the religion as legitimate.\" Looking at my opening argument, you can see this is blatantly false. The IRS outlines specific guidelines that the church must follow in order for it to remain tax exempt. Believe it or not, there ARE churches that are not tax-exempt, because they choose not to follow those guidelines. But what my opponent said about churches \"making millions\" was REALLY true (and we have no reason to believe this without a proper citation), they wouldn't qualify for tax-exemption in the first place.Thus, this resolution has been negated.Citations(s):1. http://www.opposingviews.com...", "Churches should be taxed. Background informationIn order to understand why churches should be tax exempt, we must first outline which taxes that churches already pay, and which taxes they do not.In what way are churches tax exempt?1) Federal income taxAccording to the IRS, [1] \"Churches and religious organizations, like many other charitable organizations, qualify for exemption from federal income tax under IRC section 501(c)(3) and are generally eligible to receive tax-deductible contributions.\"For this to occur, the church must meet ALL of the following criteria:\u25a0 the organization must be organized and operated exclusively for religious, educational, scientific, or other charitable purposes, \u25a0 net earnings may not inure to the benefit of any private individual or shareholder, \u25a0 no substantial part of its activity may be attempting to influence legislation, \u25a0 the organization may not intervene in political campaigns, and\u25a0 the organization\u2019s purposes and activities may not be illegal or violate fundamental public policy2) Property taxChurches do not pay property tax under the legal precedent of Walz v. Tax Commission of the City of New York, 397 U.S. 664 (1970). The court upheld the tax exemption status for churches on a 8-1 decision. In defense of his decision, Justice Douglas quoted: \"We do not mean to say that religious groups and the press are free from all financial burdens of government. We have here something quite different, for example, from a tax on the income of one who engages in religious activities or a tax on property used or employed in connection with those activities. It is one thing to impose a tax on the income or property of a preacher. It is quite another thing to exact a tax from him for the privilege of delivering a sermon. State aid to places of worship, whether in the form of direct grants or tax exemption, takes us back to the Assessment Bill and the Remonstrance. The church qua church would not be entitled to that support from believers and from nonbelievers alike.\"[2]The court gave the following four reasons for their decision [3]:1. The First Amendment tolerates neither governmentally established religion nor governmental interference with religion.2. The legislative purpose of tax exemptions is not aimed at establishing, sponsoring, or supporting religion, and New York's legislation simply spares the exercise of religion from the burden of property taxation levied on private profit institutions.3. The tax exemption creates only a minimal and remote involvement between church and state, far less than taxation of churches would entail, and it restricts the fiscal relationship between them, thus tending to complement and reinforce the desired separation insulating each from the other.4. Freedom from taxation for two centuries has not led to an established church or religion, and, on the contrary, has helped to guarantee the free exercise of all forms of religious belief.3) Other taxesChurches are also exempt from other minor state taxes, but seeing as this is on a state level, it would be too difficult to outline each and every one.Should churches be tax exempt?In short, yes. As you can see from what I have outlined above, churches and non-profit organizations pay the same taxes. This is because the same reasons that apply to non-profits also apply to churches as well.Churches are vastly known as a positive thing in the United States. An article in America Magazine defends this stance by saying: \"At least where most Catholic nonprofit organizations are concerned, I would say there should be hope: Catholic nonprofit organizations are second to none when it comes to predictably and reliably producing benefits for nonmembers, wider communities and the public at large.\"[4] Even as an atheist myself, I acknowledge that churches bring together a community of generally good people who want to do the right thing to please whatever God they worship. Although they are doing the right thing for the wrong reasons, it is still the right thing nonetheless. Putting a tax burden on these churches would be completely redundant because it would discourage future good work done by the churches, and diminish the amount and the quality of good work that a church community could accomplish, leaving that extra slack to be picked up by the government or not picked up at all.I acknowledge that there are negatives to allowing churches to be tax-exempt. If I had to, I would argue a more progressive approach by saying that churches should pay a little more than what they do now, but applying an extreme solution (such as abolishing the tax-exemption status entirely) to a minor problem (possible abuse of the system) will be both counter-productive and redundant.Thus, I negate.Citations:1. http://www.irs.gov...2. http://ffrf.org...3. http://supreme.justia.com...4. http://www.americamagazine.org...", "Should Churches Pay Taxes Yes, of course all churches should pay taxes, there is no legitimate reason why churches should be exempt from taxes, just because you claim religious belief does not mean you are exempt from taxes so why should a church be exempt. Religion in general is a multi billion dollar business the only difference between a corporation and a church is we tax a church.", "Churches should be taxed. Assuming Churches count as NPO(non-profit organisations) they should be taxed in the same ways. All other organizations (like corporations, including non-profits) pay taxes on everything, profits, franchise tax, business license tax, property tax, payroll tax. Churches are often a big part of communities in America, they typically use a lot of the communities resources, occupying large areas of land and real estate that they do not have to pay tax on. The amount of property owned by churches is vast compare to any other single co-operation, if the churches were to pay only this tax alone the personal property taxes you and I pay would go down considerably, many tons and cities property tax rates would drop and lets be honest, the government would have a LOT more income. Not only are churches using vast amounts of land they are not paying tax for, they also use the services paid for by tax payers, why is it fair churches get the same treatment by police, fire departments and schools that us ta payers do, when they provide nothing towards it? However you may claim churches to be non-profit, they still collect money and revenue in many forms, donations, events, fund-raisers, trips, selling merchandise (whether they pay sales tax on this I am not sure, I think it may vary church-to-church and depending on the merchandise) at the end of the day, successful churches such as those run by the Baptists and Catholics make millions, many churches in my area have their own gyms, libraries, day cares and swimming pools, they also seem to afford excessive trips and camps. Where does all this money come from and why is none of it going back into the economy? You may claim that it is being put to good use for the churchgoers to use these facilities, but what about atheists like me, or people from non-Christian organisations? Religious affiliations only remain tax-exempt if the government sees the religion as legitimate. At the end of the day everyone would benefit from Churches paying tax; they are such a huge part of the American society and the gain a lot of revenue (whether they are meant to or not! ) Every other organisation has to claim their earnings, there is no reason churches should be exempt.", "Churches Paying Taxes Churches should pay taxes because they are just like other companies that pay taxes. Churches make money, And all companies who make money get taxed. By taxing churches their would be an estimated $71 billion worth of taxes. $71 billion is a lot of money that could be spent to benefit the world. Yes, Churches do donate money, But the Mormon church spends only. 7% of their annual income on charity. The American Red Cross spends 92. 1% of their income to assist people. \"Wal-Mart, For instance, Gives about $1. 75 billion in food aid to charities each year, Or twenty-eight times all of the money allotted for charity by the United Methodist Church and almost double what the LDS Church has given in the last twenty-five years. (Derek Beres, 2012)\" Source: https://bigthink. Com/21st-century-spirituality/how-to-make-71-billion-a-year-tax-the-churches", "Resolved: In the United States, churches should be taxed. In this debate resolved, I affirm and stand with the PRO. I ask the CON to please refrain from providing any rebuttals in the second round as it is for the formulation of case statements. I have no parameters for this debate, so I move on toward the iteration of my case: [Thesis]The exemption of churches in the case of taxation violates the First Amendment, contradicts the word of US law considering the nature of churches, and economically comprimises the US defecit. Henceforth, American churches should be taxed. [Contentions]Contention 1: Subsidizing religion violates the First Amendment.Subsidizing churches constitutes the establishment of a religion with consideration that American government is providing special protection and privilages to groups solely intended toward the practice of faith [1]. This action and the practice of it violates the Establishment clause, as shown below. Sub-point 1a: Purpose of the subsidization of churches includes the advancement of religion. The Internal Revenue Service explains the purposes of exemption of taxes in its Code Section 501(c)(3): \"The exempt purposes set forth in section 501(c)(3) are charitable, religious, educational, scientific, literary, testing for public safety, fostering national or international amateur sports competition, and preventing cruelty to children or animals. The term charitable is used in its generally accepted legal sense and includes relief of the poor, the distressed, or the underprivileged; advancement of religion; advancement of education or science; erecting or maintaining public buildings, monuments, or works; lessening the burdens of government; lessening neighborhood tensions; eliminating prejudice and discrimination; defending human and civil rights secured by law; and combating community deterioration and juvenile delinquency.\" [2]Sub-point 1b: American governments are favoritist toward churches. The following presents an analysis on the guidelines from the Internal Revenue Service: \"Churches receive special treatment from the IRS beyond what other nonprofits receive, and such favoritism is unconstitutional. While secular charities are compelled to report their income and financial structure to the IRS using Form 990 (Return of Organization Exempt From Income Tax), churches are granted automatic exemption from federal income tax without having to file a tax return. \" [3]Contention 2: Tax exemption of churches is economically compromising.Constitutional arguments aside, tax exemption of churches is also economically compromising with consideration that the property taxes of such institutions can greatly reduce deficits. According to former White House senior policy analyst Jeff Schweitzer, PhD, US churches own $300-$500 billion in untaxed property. [4]Contention 3: The nature of churches warrants removal of tax exemptions according to American law. The removal of tax exemptions can be argued legally as well as constitutionally. Sub-point 3a: Many churches are political machines. The United States passed a law in 1954 explaining that institutions that are tax-exempted in no circumstances can support political candidates. \"Every fall, the Alliance Defense Fund, a Christian legal group, organizes \"Pulpit Freedom Sunday,\" encouraging pastors to defy IRS rules by endorsing candidates from the pulpit. More than 500 pastors participated in Oct. 2011, yet none lost their churches' exemption status.\" [5] [1] Robert H. Jackson, US Supreme Court dissenting opinion, Everson v. Board of Education of the Township of Ewing, supreme.justia.com, Feb. 10, 1947[2] http://www.irs.gov...;[3] US Internal Revenue Service (IRS), Tax Guide for Churches and Religious Organizations (5.1 MB) (publication 1828 (11-2009) Catalog Number 21096G), www.irs.gov, 2009[4] Jeff Schweitzer, PhD, \"The Church of America,\" www.huffingtonpost.com, Oct. 11, 2011[5] Andy Birkey, \"Few Consequences Currently Faced by Pastors Who Endorse from Pulpit,\u201d iowaindependent.com, Oct. 6, 2011", "Churches should be taxed the same as private non-profit clubs. Since my opponent forfeited, I\"ll be brief. The reason they should be taxed differently is because, unlike social clubs, churches are charitable. This is evident in the requirements for their respective classifications. Whether you agree with the benefits derived from the charity the church makes (missions, absolution, peace of mind, counseling, soup kitchens, etc.), they still have a mission to improve the world, in their eyes. Social clubs do not have that pre-requisite, therefore, they are not the same, and should not be compelled to be treated equally. http://www.irs.gov... www.irs.gov/Charities-&-Non-Profits/Charitable-Organizations/Exemption-Requirements-Section-501(c)(3)-Organizations", "Churches should be taxed the same as private non-profit clubs. Okay, I'm really really sorry. I had a big English project, then I got a little sick. and I lost the charging cable for my laptop...... let's just say that it has been an interesting week. If my opponent would like to continue after we run out of rounds, maybe in the comments section, or in a new debate, then I would be willing to do so. I would just like to restate that this is only over property taxes and tax deductions. These are the only major tax differences between churches in non-profit clubs that is worth discussing. \"The reason they should be taxed differently is because, unlike social clubs, churches are charitable. This is evident in the requirements for their respective classifications.\" I think we have to examine what counts as charitable. As a charitable organization or a government agency/public service (like a library or county courthouse or a soup kitchen) money given to them is tax deductible. Similarly, a religious organization is also on this list of tax deductible organizations. Also on this list is 2 types of private organizations. Domestic Fraternal Societies and non-profit cemetery companies. However, restrictions are placed on even these. For the fraternal society, the entire amount you are claiming as a donation must be used for a charitable action, and for the cemetery company it cannot be used for a specific lot or mausoleum. *1 Now, I agree that a church may engage in charitable actions. This is clear to anyone. I was part of a synagogue for most of my life, and I remember every once in a while them passing around a collection plate or asking for canned food. I also remember them using that money to build a new Synagogue, because they didn't have one (they had services in other locations that they rented out or borrowed). Most religious organizations do not use enough money towards charitable actions to be considered a charity. The purpose of declaring something a charity, and refraining from taxing it at all, and then giving deductions for donations is thus. 1. To convince people to use their own money to fund relief and support programs that the community as a whole supports more. 2. To not have to provide services being rendered by that organization. Does a church do either of these? While the community as a whole might more support the church, is it really providing a relief to the community? Is giving my ten dollars to that church really going to do more, or even a comparable amount then if I had given it to a real charity? Should I get the same tax deduction from donating to a soup kitchen that I get from donating to a church? Now I would like to separate religious organizations into 3 categories, to which I will argue separately. The first will be charities that may affiliate with a religion, but function as charities. I have volunteered with the Jewish Relief Agency, which unless you live in the greater Philadelphia area and are Jewish, probably don't know about. It's a warehouse that packages boxes filled with square meals for the week and delivers it to mostly, but not exclusively, needy Jewish people (mostly recent Russian immigrants). They give the majority of their funds to the charity itself, and give a negligible amount (less then 10%) to religious practices. This is a charity and should be treated as such. There are other examples of things that are clearly more charities then religious organizations, though they may affiliate with some religious organizations. Now there are standard churches that participate in large, or exemplary charitable actions. (as in, 30-70% of their income). These are not charities. Though they may partake in many charitable actions, they should be taxed. However, they can receive large deductions from their charitable actions, and may end up paying no taxes at all, or very little. This is great. They should be able to do this, and I, and most people, should applaud them for doing so. But, they are still a religious organization. My donation will do less then donating to a real charity. It should not be tax deducted equally, or at all like it would if I donated it to a charity. The last is a standard church that participates in little to no charity (0 - 20% of income). They may receive a small amount of deduction, or perhaps none at all. Ultimately though, these are religious organizations. They cannot be considered charities. Their money only goes to benefit those who give the money, and do not give any benefit to the outside community (for religious people; remember point number 4 in round 1). I personally would argue that it gives no benefit to those inside the religion, but whatever. It is a social club that prays. That is all that a non-donating religious organization is. We have separated these with private organizations. We have made it so that we do not tax charities affiliated with private clubs, and give deductions to the non-profit clubs so that if they are charitable, they may not have to pay taxes at all. Why can we not do the same with religious organizations? Maybe we shouldn't tax non-profit clubs. I see rife abuse with that potential path, but maybe there is some merit that me, with my limited mortality and comprehension, cannot see. My arguments are based off of equality. The only difference between a church and a non-profit club is that one prays and the other might pray. And yet one gets massive exemptions, while the other must struggle to do massive charity projects if they wish to pay no taxes, or do rigorous hoop jumping to get qualified under tax-exempt status. 1. http://www.irs.gov...", "Debate: Churches ought to pay taxes Thanks, Hayd.Framework:I was extremely surprised to see Hayd go with a purely utilitarian framework and not make any arguments based on higher principles such as separation of church and state. This means that if I can prove that religion is on balance good, and that the resolution would harm religion in this country, I automatically win. Due to his framework, if religion is good than we should pursue policies that encourage religion. I. Religion is a social goodAccording to a Pew survey, Americans who attend religious services weekly are significantly more likely to maintain strong contacts with extended family, to report being \"very happy\" with their life, and to volunteer in their local community[1]. There is not a single metric rating positive life experience that Pew measured where the nonreligious came out on top. Religious people are 9% more likely to donate to charity than the nonreligious[2]. Religiosity is positively correlated with a number of positive health outcomes which is why a study from Duke Medical Center found that the religious had lower blood pressures[3]. A Harvard study recording the life outcomes of 75,000 women over a 20 year period found that religious women live longer lives than their nonreligious peers[4]. Remarkably, the effect was correlated with the degree of religiosity--the most religious women were 33% less likely to die than the nonreligious, but even those who infrequently attended services were 13% less likely to die than those who never attended. Even more remarkably, this conclusion was reached AFTER controlling for the observations that the more religious women were less likely to smoke or to be depressed. Again, because this warrants repeating, not only were the religious women less likely to report depression or to smoke, but they were STILL significantly less likely to die AFTER controlling for these facts (which alone would be impactful enough to win me the debate). Clearly religion is some powerful stuff. Why do these effects exist? The sense of community that a religious community offers is something that greatly benefits social animals like humans. Interestingly, the Duke study notes that while church attendance and active involvement in church activities was correlated with lower blood pressure, viewing religious media was NOT. It's the community. The dangers of social isolation are incredibly well studied--it's about as dangerous for your health as smoking, and twice as dangerous as obesity[5]. For many people, especially the elderly, going to church is the only time they get to socialize. This is the institution that Hayd wants to tax.It's not just beneficial to the individual. Houses of worship are often used as community gathering centers for secular or semi-secular organizations--think things like Preschools or your local Boy Scout troop. Under Hayd's plan, a LOT of these local churches are going to shut their doors.I contend that the government should let organic social goods flourish. Remember, since Hayd only cares about maximizing \"desirable states\", he should concede that the government shouldn't harm religion since religious people are happier, healthier, and less likely to die. At this point, he can only win the debate if he proves that taxing religious institutions will somehow strengthen them. II. Economic effectsBefore I get started, let's clear something up. Hayd claims that taxing churches would bring in $71 billion a year, citing an article from the Council of Secular Humanism. An analysis by DJ Clayworth tears this article to absolute *shreds*[6]. The most absurd part of the fact that the article itself estimates that churches take in about $100 billion in revenues each year, then claims taxing churches like \"everyone else\" would bring in $71 billion. Except nobody else pays 70% of their *gross revenue* in taxes. Clayworth notes that the biased authors of Hayd's article know nothing about taxation law and get their estimate through tricks like denying churches the ability to deduct expenses from their taxable income, wildly overestimating the value of church property, and by counting government subsidies to religiously affiliated homeless shelters or hospitals as grants that provide no value to society. Until he amends his estimate, Hayd is advocating for an economic formula that would utterly bankrupt every religious institution in the nation. In fact, Hayds OWN ARTICLE chastizes religious congregations for donating only an average of 29% of their revenues to charitable causes. Except it notes literally right afterward that 71% of Church revenues are used for legitimate operating expenses that would be written off when paying taxes. The church spends 71% of its income on operating expenses and then donates everything that would be considered taxable income in a corporation to charity. In the status qou, congregations donate everything beyond operating expenses to charity because they are legally prohibited from an income or else they'll lose their non-profit status. Using any reasonable tax code, Hayd only gets the government a chunk of the 29% that already goes to charity. Is it Hayds position that the government would allocate this money better than the charitatable organizations already receiving it?Lets talk some real numbers from unbiased sources. The Washington Post notes that the Catholic Church is the second largest employer in the US, employing some 1,000,000 people[7]. The Church spends about $170 billion in the United States a year. Its primary expenses? Running hospitals that save thousands of lives and schools that educate thousands of children. This is the institution that Hayd wants to tax out of existence. Right now, the business model of the Catholic Church assumes that it is not subject to taxes. Finding what the profit margin of the church would be if it were treated as a corporation is difficult, but we know from estimates from The Economist[7] that Health Care, Schools, and Parish operations constitute 93% of the Church budget. Hayd wants to throw the business model of the second largest employer in America into a tailspin for virtually no reason. It's tough to estimate just how hard taxation would hit the Church because Hayd's plan is utterly absurd and I'm being charitable to him, but considering that the Catholic Church owns over 26,000 properties in America[8] a property tax alone would do significant damage. Hospitals would start cutting staff or closing down entirely. Schools would shut down, forcing the students itno public schools and further stretch municipal budgets. Tens of thousands of workers would be cut off and forced to compete for private jobs or take government welfare. All of this for nothing. Moreover it's certain that many local congregations would wither if they were subject to taxes. Small congregations (7-99 congregants), which represent 59% of American churches[9] would be some of the first to go. In fact, Megachurches that are already run like a business and embody the worst of religion would best weather the storm. III. Separation of Church and StateSeparation of Church and State is a principle that is often misunderstood by secularists. The idea is not merely that the church ought to have no influence on the state--it's that the state also ought to leave the church alone. The spiritual and the temporal are separate spheres. This is so important because a healthy relationship between Church and State has a sense of \"mutually assured destruction.\" Both the Church and the State recognize that open competition for power and dominance would benefit no one, so they leave each other alone to the best of their ability. Hayd wants the government to violate this unspoken truce. Does he really not expect religion to hit back? Right now, religious organizations are prohibited from endorsing political candidates due to a law called the Johnson Amendment. If they do so, they will lose their tax-exempt status. If the government removes this penalty, there is nothing stopping churches from directly influencing government policy or endorsing candidates. The Catholic vote was almost evenly split in 2012[10]. An endorsement from the Catholic Church would swing any US presidential election and any congressional race in an area with a lot of Catholic voters. In fact, they would probably just endorse whichever candidates vow to return their tax-exempt status, negating all of Hayds impacts. Oh, and while it power they would probably repeal the Johnson Amendment.This is not the path to secularism. This is the path to dominionism.Hayds plan also opens up a HUGE religious discrimination can of worms. He complains about the lawsuits religious institutions bring to defend their tax-exempt status, but this cost is a drop in the bucket compared to the cost of defending against litigation from religious organizations that feel discriminated against because they were audited or their property taxes went up. The resolution is unworkable. Vote Con.Sources:1. http://www.pewforum.org...2. https://www.philanthropy.com...3. https://www.ncbi.nlm.nih.gov...4. http://www.cnn.com...5. http://www.slate.com...6. http://skeptics.stackexchange.com...7. https://www.washingtonpost.com...8. https://www.bisnow.com...9. http://hirr.hartsem.edu...10. http://www.reuters.com...", "Debate: Churches ought to pay taxes Thanks, Hayd.I'm just going to respond to Hayd's attacks since I directly refuted his case in my own. There will be a lot of fresh attacks against his case wrapped up in my defenses.I. Religion is a social goodHayd concedes this point entirely, noting only that public events could be held at schools, crowding out after-school activities.You can vote Con. It is not remotely plausible that forcing Churches to hire armies of tax lawyers and pay taxes on their properties (many of which are priceless architectural marvels) will help religion in this country. Remember, active involvement in a religious community extends life, makes that life happier and more fulfilled, and increases that individuals positive impact on society. Does Hayd want to compare that record with the government? His only real response is that my claims that religion will be damaged if it's taxed is unwarranted. I didn't hit this very much because I assumed it was completely obvious, but I'll note that Hayd totally dropped my argument regarding the business model of churches assuming that they don't pay taxes. Adding a massive tax burden throws that model into flux and adds instability for no reason. I'm not sure what else I can be expected to do here. As the complete take down of the Council of Secular Humanism article shows, making accurate estimates about this kind of thing is incredibly difficult and often leaves you with your foot in your mouth. Instead you have to go with the logic that, yes, having to hire armies of tax lawyers, pay property and income taxes, and totally change your business model from the bottom to the top is going to cause damage on the margins. Corporations fight taxes tooth and nail for a reason, the extra expense harms the bottom line. Since Hayd has totally conceded that the bottom line of religion is a massive boon for society, it's difficult to see how Pro can win the debate. But the absurdity of this line of attack really comes through when you get into the specifics behind Hayd's case. Hayd later claims that the government will make tons of money because the average property tax burden on the 300,000 churches would be over $26,000. Doesn't sound so bad if you're thinking about Billy Graham sized crowds. Except the majority of congregations in this country consist of less than 100 people. $26,000 distributed over, say, 50 congregants is an incredible burden that would shut down almost any church. And that's just the property taxes.I'm also going to rebut Hayd's entire case by calling for him to morally justify taxation. The general argument for taxing corporations is that since society provides for them via the roads their goods travel on, the police force protecting them from robbery, and so on they owe something in return. If churches are as great as I claim they are, and Hayd has conceded to every single one of my claims, they are already fulfilling their debt to society. The moral justification for taxing churches is bunk. II. Economic effects Hayd writes: \"[Thett] assumes that all churches, or even the majority of churches are non profit organizations. This is not true, just as the Ford Motor Company donates some of their income to charity does not make their internal operating expenses tax deductible, neither does a church\u2019s.\" This is ***COMPLETELY*** false and not at all how corporate taxes work. If expenses weren't tax deductible, literally every business in the United States would go under. Corporations are taxed on their *income* which is the number you get after subtracting revenue (all of the money the organization takes in that year) from expenses (everything it spends). So for example in 2015 Ford earned some $149 million in revenue[1], but operating costs ate at that number until the taxable income was a mere $10 million. Legitimate operating expenses like building upkeep and employee payment are ALWAYS tax-deductible because they whittle away the corporations taxable income.Hayd says he is not allowing churches to deduct these legitimate expenses. He loses his previous argument that churches won't be hit very hard by his new taxes as he is subjecting religions to a completely unfair and unique tax burden by not allowing them to write off operating costs. If he chooses not to advocate for this exaggerated and unfair tax burden, I hereby turn his entire case: Hayd's impact relies upon more money going to charity if you tax churches. But the reality is that *LESS* money will be going to go to charity. Right now in order to maintain their non-profit status, churches are legally prohibited from having an income. As we've already discussed, on average 71% of their income goes to expenses and only 29% would be considered \"income.\" Hayd gets the government some of that 29%. But the Church keeps the rest. And now that they're no longer obligated to maintain their non-profit status, with many strapped for cash due to the massive financial burden Hayd throws on them, can they really be expected to donate all of their remaining profits to charity? By legally turning churches into a business, Hayd is actually reducing the money that goes to charity and opening the door for unscrupulous religious leaders to enrich themselves from church revenue. Further, if you don't buy that turn for some reason, you still vote Con because Hayd can't just assume that all the money is going to be donated to charity. The resolution does not say \"Churches ought to be taxed and the proceeds will go to charity\"--we have NO REASON to assume that the government will give this money to charitable causes and Hayd has not articulated any.You can vote Con because Hayd literally has no impacts. His plan requires you to assume that no churches are hurt by a sudden tax burden, the church does not retaliate against the government in a negative way, that no churches keep rather than donate their profits now that they have the option, and that the government will donate the proceeds to charity. Give him all of these EXTREMELY GENEROUS assumptions and it is STILL a wash. Even if you don't buy any of my own points Hayd still loses because he adds instability to the status quo without producing any tangible improvement.III. Church and State Hayd fundamentally misunderstands why the sacred and the secular should be separate spheres. He says the argument that churches would retaliate to this violation of their sovereignty is unwarranted, but he is actively undermining their interests by imposing a massive financial burden. Hayd says he doesn't see a problem with the church influencing secular politics, but the vast majority of Americans do. When His Holiness the Pope himself criticized Trump he was roundly condemned and THE POPE apologized. I find it extremely doubtful that Hayd can't see the obvious problem with every election in the United States literally being decided by who the major religions endorse. All it takes is one instance of the church's political position contradicting the public good for there to be an impact when you're working with a government that is completely reliant on the church for its legitimacy. This is the road to dominionism. Remember that since Hayd has no impacts, even the tiniest risk of an undue religious influence on the government harming the public good is enough to win me the debate. Hayd bizarrely responds to my religious discrimination argument by claiming that lawsuits wouldn't cost the government anything because the law is the law, despite making an extremely similar point in his first round. Which is it? Hayd causes a lot of instability without anything to show for it. The resolution is completely negated. Sources:1. http://www.nasdaq.com...", "End tax breaks for religious organizations Churches need to be taxed. Consider that for every tax dollar a religious organization does not pay, you and I pay it on its behalf. Many are among the wealthiest organizations in the world: by 1971, the amount of real and personal property owned by U.S. churches\"was approx. $110 billion. In New York City alone, the amount was $3 billion in 1989. A 1986 estimate showed religious income in that year of approx. $100 billion, or about\"five times the income of the five largest corporations in the U.S.\"\"All tax free. There are many other organizations the needy can turn to.", "resoloved: REMOVE TAX EXEMPTIONS FROM ALL RELIGIOUS INSTITUTIONS IN THE UNITED STATES Unfortunately the only argument that my opponent has offered the entire debate is that he thinks poor churches should get tax exemptions because they need the money. That argument is lacking in any substance or sources. The rest of the debate, my opponent has spent his time either agreeing with most of my points or playing a game of semantics. My argument still stands that ALL CHURCHES SHOULD HAVE TAX EXEMPTIONS REMOVED and I will clarify my argument one last time. I believe it is dangerous to link, in any way, a person's faith with government. If governments are providing tax exemptions to churches, it leads to manipulation in various ways. For starters, if one political party is pushing to increase exemptions, it could (and does) lead to churches using their power to sway voters... and when a pastor/priest/minister tells someone that they had better vote a certain way, too many people will blindly follow. My opponent agrees with me that too many churches make far too much money. My thoughts are that rather than just draw a line in the sand and say if you make $_____ per year then you don't get tax exemptions, I would cut all tax exemptions and put it in the churches hands to help each other out. Instead of one baptist minister owning two million dollar mansions while another baptist church can barely maintain 10 parishioners, why not share that money amongst the churches? They all work for the same God, right? If we draw a line in the sand in order to determine who can and who can't get tax cuts then that will just promote loophole finding and ways of reallocating money so that they fall just under the line. It happens all the time in businesses across America and really, religions are just businesses. To recap this debate, I backed up my initial arguments with relevant sources while my opponent offered none. I debated my side of the debate at hand while my opponent tried to counter with semantics and spent most of his time agreeing with me, offering next to no actual argument to support his side of the debate, aside from \"a lot of these poor churches are also in poor communities so cannot receive as much of a offering and not donations\". Please consider all of this when voting, and don't just vote based on whose side you agree with. Thank you for taking the time to read this debate.", "There should not be tax exemptions for Curches. It seems that he decided to start arguing from round 1-really no problem- so I have to start with the rebuttals:\"I think they should because it takes money to build the churches and it is important to keep it clean with the taxes you pay\" The main problem is that the money that all US citizens pay are not only used for building churches or keeping them clean. I hate to repeat the same things again and again so I advice you to read all the arguments (especially 7) and you'll relize why I support that. 1) Exempting churches from taxation costs the government billions ofdollars in lost revenue, which it cannot afford, especially in tough economictimes:According to former White House senior policy analyst Jeff Schweitzer,PhD, US churches own $300-$500 billion in untaxed property. New York's nonpartisan Independent Budget Office determined in July 2011 that New York City alone loses $627 million in property tax revenue. Lakewood Church, a \"megachurch\" in Houston, TX, earns $75 million in annual untaxed revenue, and the Church of Scientology's annual income exceeds $500 million. [6] 2) Tax exemptions for churches violate the separation of church and state enshrined in the Establishment Clause of the First Amendment of the US Constitution:By providing a financial benefit to religious institutions, government is supporting religion. Associate Justice of the US Supreme court, William O. Douglas, in his dissenting opinion in Walz v. Tax Commission of the City of New York, decided May 4, 1970, stated: \"If believers are entitled to public financial support, so are nonbelievers. A believer and nonbeliever under the present law are treated differently because of the articles of their faith\u2026I conclude that this tax exemption is unconstitutional. \" [1]3)A tax break for churches forces all American taxpayers to support religion, even if they oppose some or all religious doctrines: As Mark Twain argued: \"no church property is taxed and so the infidel and the atheist and the man without religion are taxed to make up the deficit in the public income thus caused. \" [2]4) A tax exemption is a form of subsidy, and the Constitution bars government from subsidizing religion:William H. Rehnquist, then-Chief Justice of the US Supreme Court,declared on behalf of a unanimous court in Regan v. Taxation with Representation (1983): \"Both tax exemptions and tax deductibility are a form of subsidy that is administered through the tax system. A tax exemption has much the same effect as a cash grant to the organization of the amount of tax it would have to pay on its income. \" [3]5) The tax code makes no distinction between authentic religions and fraudulent startup \"faiths,\" which benefit at taxpayers' expense:In spring 2010, Oklahoma awarded tax exempt status to Satanist group The Church of the IV Majesties. In Mar. 2004, the IRS warned of an increase in Schemes that \"exploit legitimate laws to establish sham one person,nonprofit religious corporations\" charging $1,000 or more per person to attend \"seminars. \"The Church of Scientology, which TIME Magazine described in May 1991 as a \"thriving cult of greed and power\" and \"a hugely profitable global racket,\" was granted federal income tax exemption in Oct. 1993. The New York Times reported that this \"saved the church tens of millions of dollars in taxes. \" 6) Churches serve a religious purpose that does not aid the government, so their tax exemptions are not justified:Tax exemptions to secular nonprofits like hospitals and homeless shelters are justified because such organizations do work that would otherwise fall to government. Churches, while they may undertake charitable work, exist primarily for religious worship and instruction, which the US government is constitutionally prevented from performing. [5] 7) American taxpayers are supporting the extravagant lifestyles of wealthy pastors, whose lavish \"megachurches\" accumulate millions of tax-free dollars every year: US Senator Chuck Grassley, MA (R-IA) launched an investigation into these groups in Nov. 2007 after receiving complaints of church revenue being used to buy pastors private jets, Rolls Royce cars, multimillion-dollar homes, trips to Hawaii and Fiji, and in one case, a $23,000, marble-topped chest of drawers installed in the 150,000 square foot headquarters of Joyce Meyer Ministries in Fenton, Missouri. [7] 8) Churches receive special treatment from the IRS beyond what other nonprofits receive, and such favoritism is unconstitutional: While secular charities are compelled to report their income and financial structure to the IRS using Form 990 (Return of Organization Exempt From Income Tax), churches are granted automatic exemption from federal income tax without having to file a tax return. [8] 9) The tax break given to churches restricts their freedom of speech because it deters pastors from speaking out for or against political candidates: As argued by Rev. Carl Gregg, pastor of Maryland's Broadview Church, \"when Christians speak, we shouldn't have to worry about whether we are biting the hand that feeds us because we shouldn't be fed from Caesar/Uncle Sam in the first place. \" [9]10) The \"parsonage exemption\" on ministers' homes makes already-wealthy pastors even richer at taxpayers' expense: The average annual salary for senior pastors with congregations of 2,000 or more is $147,000, with some earning up to $400,000. In addition to the federal exemption on housing expenses enjoyed by these ministers, they often pay zero dollars in state property tax. Church leaders Creflo and Taffi Dollar of World Changers Church International had three tax-free parsonages: a million-dollar mansion in Atlanta, GA, a two-million-dollar mansion in Fayetteville, GA, and a $2.5 million Manhattan apartment. Kenneth and Gloria Copeland, leaders of Kenneth Copeland Ministries in Fort Worth, TX, live in a church-owned, tax-free $6.2 million lakefront parsonage. [10]11) A tax exemption is not a right: Governments have traditionally granted this privilege to churches because of the positive contribution they are presumed to make to the community. If a church or other religious group wanted to receive tax exemptions because of the charitable work they do, should they be required to make a case for that rather than benefit from the presumption that religion equals charity? It makes much more sense to see tax exemptions as a way to encourage organizations which work for the public benefit rather than personal profit and a means by which taxpayers put themselves at a relative tax disadvantage in exchange for the benefits the organizations provide. What this means, however, is that it is possible for the government to deny tax exemptions to those groups which are not benefitting the public and/or which are working against a compelling public policy \u2014 and that may include churches or other religious organizations. Tax exemptions are not a right, they are a privilege which the government bestows based upon the nature of what a group is doing. [11] Sources:[1]. http://caselaw.lp.findlaw.com...[2] Mark Twain's Notebook,1935[3]. https://supreme.justia.com... [4]. http://abcnews.go.com...http://www.irs.gov...http://content.time.com...http://www.nytimes.com...[5]http://supreme.justia.com...[6]http://www.huffingtonpost.com...http://nypost.com...http://www.entrepreneur.com... [7]. http://www.npr.org... [8]. http://www.irs.gov... [9]. http://www.patheos.com...; [10]. http://churchesandtaxes.procon.org...http://online.wsj.com...http://churchesandtaxes.procon.org... . http://www.nytimes.com... [11]. http://atheism.about.com..."], "neg": ["Marijuana should remain illegal Marijuana is a substance that many people abuse. This \"gift of nature\" is a cause of several thousand employment terminations, incarcerations, relationship breakups, car accidents, and more. The main purpose of smoking marijuana is for the high that one receives. The fact that it \"grows naturally\" doesn't excuse the fact it is an abused drug, and causes a person to act poorly, nor does it call for a legalization.", "This house believes churches should not involve themselves in political campaigns. I can\u2019t be bothered to make this round look pretty. \u201cMoreover, saying that churches have to act in x way is nonsensical because there's no resolutional warrant for this.\u201c This is equivalent to saying that the statement \u201cIf one wants to get to New York from Virginia, one should drive north\u201d does not imply that one has to drive north to get to New York, or that \u201cIf one wants to draw a square, one should draw four sides\u201d does not imply that one must draw four sides to draw a square. The only difference between these examples and the resolution of this debate is that the \u201cif\u201d was not specified, which is not a problem, given that my first proposition was solely devoted to proving that the only goal one could hold in doing politics is to adhere to rational principles, thus giving us \u201cIf one wants to build politics on rational principles, churches should not be involved in politics\u201d, wherein the specific \u201cif\u201d specified was the only one logically coherent and possible. Note: This is not a new argument because the entirety of premiss one (and the debate as a whole) led to the formulation that \u201cIf political systems should be based on reason [...]\u201d. \u201cHis entire argument resides on the assumption that \"this is just what it means to be a church\"\u201d This is blatantly absurd - imagine a debate on the validity of \u201cA = A\u201d. If Pro said that A must equal A because, well, A is just defined as being A (i.e. when one says \u201cA\u201d, the sentence would retain its meaning if one had replaced it with \u201cA\u201d), and Con responded by saying that it was \u201cunfair for Pro to restrict me to holding that A is defined as A, since I think that A is really B\u201d, he would be disregarded completely. My argument is completely tautological in nature. \u201cChurch\u201d is synonymous with \u201cA group of people with one factor in common: faith\u201d, so, when I say that \u201cA church is a group of people with one factor in common: faith\u201d, what I am really saying is simply that \u201cA church is a church\u201d, which, unless my opponent wishes to resort to equivocation to argue against my position, is obviously true and not \u201cunfair\u201d by any reasonable standard. Note: this is not a new argument, considering my previous rebuttals explicitly set out to prove this synonymity. I\u2019m merely reproducing the argument in different terms in order to reiterate why Con is wrong on all counts. \u201cIt goes entirely dropped from his last round.\u201d I did so because none of their actual implications were dangerous. I could accept both of Con\u2019s observations (which, if you actually look at Round 2, were only that I have the BOP and that the resolution does not specify any specific type of involvement, both of which pose no problems) without my case being harmed at all. \u201cby saying that they should not participate in politics, that restricts their ability to vote (i.e. participate) if they're a member of the church.\u201d This is a total misinterpretation of my point. I specifically addressed the fact that there is no such violation of autonomy by analogy to one who \u201cmay argue that one should not regularly inject heroin while still holding that one should be free to do so.\u201c Let me remind the reader that my opponent has not substantiated how freely choosing not to do something is equivalent to not having been able to do that thing in the first place. \u201cHe also responds by saying that if his case is true then autonomy via belief in faith cannot lead to benefits, but first he's not actually winning on his case so this doesn't matter\u201d And if I am winning on the case, it definitely does matter. \u201cAutonomy isn't a means to a better end, rather it's an end in and of itself. Autonomy is the benefit, which is coming from the first part of the paragraph I cited.\u201d Extend the principles behind Prop 1.31: \u201c If [a thing] were not worthwhile, there would be no reason to be involved in it (or to even care about it in the least), thus making any interest [in it] itself irrational (making discussing its issues worthless to begin with, which is contrary to the premiss of debate (by debating, we ourselves are asserting the importance and therefore rational value of [that thing]))\u201d \u201cInsofar as he isn't, and since I'm arguing that it does lead to a reduction of human worth, if there's clear negatives to removing it, we have no reason to remove it.\u201d Extend Prop 1.2, in addition to the idea from Prop 1.31 that by even discussing this we place some importance on the issue: \u201cFor one to advocate something which is not in-line with reality, one must advocate something which cannot be, making the advocacy useless and self-contradictory.\u201d \u201cThen, extend out the second part of my case.\u201d If my negations stand, then this is pointless, so I will only ask the readers to focus on whether or not I have successfully negated the relevance to the debate of his argument. \u201cMy argument is that if you affirm, then this will happen.\u201c My opponent\u2019s bridge between his arguments and the resolution totally nonsensical. Quoting myself: \u201cTaken in the abstract, the resolution is only referring to churches generally - there are only two factors to consider here: abstract politics and abstract churches. My opponent\u2019s attempt to concretize the resolution fails for this reason [...] just because the removal of the Republican party now would result in devastation does not mean that the removal of the Republican party in itself is a bad thing.\u201d \u201cThe entirety of my advocacy in the negative case (All members of a religious church will have the right to vote in elections for political office.) is literally the status quo.\u201d Ok. So? \u201cThere's nothing theocratic about having the right to vote.\u201c My initial round proved that any church in politics must be acting on the basis of faith (and what is theocracy other than rule on the basis of faith and religion rather than rights or justness?). \u201ceven if he wanted to contest this, he doesn't actually give us any kind of reason as to why this would be bad.\u201c Premiss 3. \u201cTheoretical ideas, as he concedes his case is, are only valuable insofar as they have real-world implications and reasons to prefer the ideals.\u201d Let me go over this once again. I first showed that \u201cIf something was useful, it would be useful in reality, making it in-line with reality and therefore not irrational\u201d, which means that if something was irrational it must inherently not be useful (if something was irrational and useful it would be as logical as a square circle). I then proved that faith was irrational. The conclusion is plain: faith can never be useful under any circumstances, negating all of my opponent\u2019s attempts to assert otherwise. \u201cExtend the three responses I make to the 2.1 section of his case.\u201d I\u2019ve dealt with all of this in my last round. \u201cWe can change the way we perceive churches.\u201d Referring to different things using the same name is called \u201cequivocation\u201d. You can\u2019t just randomly redefine terms in the middle of a debate when your opponent can\u2019t respond. \u201cby definition churches are defined as such based on their beliefs, not their actions, so the actions they take are irrelevant to their defining as a church.\u201d I\u2019ve dealt with this by showing that belief is an action. \u201cHe also argues that there's a distinction between belief and action, but this is absurd.\u201d No, I argued that there is no such distinction. Belief is action. \u201cI may believe that murder is okay and justifiable, but that doesn't mean I'm going to go shoot up a shopping mall\u201d I never made the claim that you would. \u201cHe makes the argument that belief affects our future decision making, but never provides any kind of warrant for this.\u201d I did explicitly give warrant for this - \u201c[T]he \u201cbeliever\u201d is not a hypocrite [when it comes to holding faith] [( If he was,]he would no longer be able to be considered part of a church, by my opponent\u2019s definition, since he would have shown that he does not truly believe))\u201c, thus showing that one must always make the choice to have faith in faith and act in accordance to faith in order to remain a part of a church (which is a blatant example of what I meant). \u201cUntil he provides a warrant [...] he can't sufficiently warrant this point, and thus can't win the debate.\u201d I have shown that every member of a church must hold the conviction that reason is invalid. Therefore, every action done by a church is done by people who do not believe in reason and are operating on the most basic assumption that reason is unimportant. This is all that my argument was meant to show, no more, no less. \u201cHe's not warranting why if God is infinite he can't be comprehended.\u201d I\u2019ve done so absolutely through syllogism, and, if one reads it in anything but the least charitable way, keeping in mind the common definitions of the words that I use, one will see that my argument is immune from and already deals with all of the points my opponent brings up. \u201cHe assumes his argument is true and uses that truth to defend his argument.\u201d Quoting my last round: \u201cMy response is that, if my argument holds water, it is literally impossible for any of those theorists to be right, and, [...] their fallibility is not impossible while the falseness of a sound syllogism[is.]\u201d If my opponent doubts the soundness of my syllogism, I advise him to read my defence of it once more. \u201dI've already outlined several scenarios where faith and reason co-exist\u201d Let me just reiterate (from P.1) that, if a conversation operates under the assumption that it is only rational to say A is A, saying \u201cA is really B\u201d is totally incoherent and self-defeating, no matter what. Self-negating statements must be thrown out. Summary: My opponent reminds me to not make any new arguments and believes that this will leave his assertions unscathed. He fails to realize, however, that literally everything he says was contradicted by something I\u2019ve said previously. The voter must only read my arguments (in specific, my main syllogism and its justifications) carefully, with an eye for detail and nuance, to realize that I have completely filled my burden of proof.", "Catholic churches First off, let me welcome my opponent to Debate.org (DDO). I wish him a long and productive period here, and feel like a right jerk for Round 1.I assume that that by churches, my opponent also means Cathedrals and Basilicas and stuff like that.My Case:Contention One: Catholics already have plenty of charitable organizationsCatholic charities are numerous, and consistently rated highly for their efforts to improve living conditions of many. CharityWatch rates Catholic Relief Services with an A+, and Catholic Charities USA is the second highest provider of social services in the United States (after the Federal government) and was ranked second largest nonprofit organization in the US [1][2][3]. It is generally agreed that the Catholic Church is the largest charitable organization in the world. Plenty of effort is already being used for charitable reasons, and as I will detail further churches are too important to cut.Contention Two: Catholic churches are by necessity gloriousWhat Catholics are called to do is to put God first and themselves second. Therefore, it makes sense that the buildings we build for the praise of God be beautiful and of high quality. Ideally, churches should be better furnished than homes. When you have a some little shed as your church, that says something about what you think of God. For instance, look at the Ark of the Covenant in the Old Testament, and the Temple. Many valuable materials were used to construct those things, because they were for God. It is the same with Catholic churches today.Contention Three: Public enjoymentAnyone can enjoy the splendor of Catholic churches. Even if you have no money, you can still enter beautiful places like Westminster Cathedral. The elegance of the Catholic churches can even be enjoyed by non-Catholics, and you need no money to do so. How often does a poor person find themselves able to afford a visit to such spectacular sights? Catholic churches are free.Contention Four: What else do we do with them?As my opponent is proposing a change in the status quo, I believe it is up to him to show what could otherwise be done. A lot of the money spent on churches is upkeep; but these churches are often of great cultural and historical value and cannot be allowed to fail. We have to keep the churches operational, as they are in use. We cannot keep them operational without spending money on them. They already exist and are consecrated, so we can't just sell them off or anything. We must keep them.I thank my opponent for making this debate and wish him luck.Sources:1. http://www.charitywatch.org...;2. http://en.wikipedia.org...;3. http://www.catholicnewsagency.com...;", "There should not be tax exemptions for Curches. I believe that there sould not be a tax exemption for Churches. Con must argue the opposite, of course:) Definitions:Tax exempt: To be free from, or not subject to, taxation by regulators or government entities.*Some information about the topic: US churches received an official federal income tax exemption in 1894, and they have been unofficially tax-exempt since the country's founding**. All 50 US states and the District of Columbia exempt churches from paying property tax. Donations to churches are tax-deductible. The debate continues over whether or not these tax benefits should be retained. Acceptance first.Sources: *http://www.investopedia.com... **Edwin S. Gaustad, Church and State in America, 2nd edition", "Libertarians should vote for Romney Sources:http://www.imperfectparent.com...http://en.wikipedia.org...In theory, it seems like Gary Johnson would be the best man to vote for in order to get the voices of Libertarians into government. In fact, I will agree that Gary Johnson is the best man for the job if you want a president that supports the policies that a Libertarian does. This debate, however, is not about who best embodies the Libertarian agenda. It is about who a Libertarian should vote for. And that man is Mitt Romney. Here's why:1. Look at history.Something very similar to what might happen if Gary Johnson gets a large following already happened in American history. The election of 1912. Theodore Roosevelt ran as a third party candidate and came in second place. Taft ran as a Republican and came in third place. Woodrow Wilson, a Democrat, won. He did not recieve a majority of the votes, 42 percent. The Progressive Party and the Republican Party recieved a combined total of 50% of the votes. Had Theodore Roosevelt not run, the Republican Party would have likely won the presidency. A third party candidate actually had a chance of winning one time, and that chance ruined the election for everyone who swayed Republican. I envision this happening again.2. Mitt Romney is closer to Libertarian Ideas.Here are just a few important issues to compare (I got the chart off of imperfectparent.com, my edits are in italics): The final score is:Republicans: 10Democrats: 6Tie: 2In the face of the fact that third parties have never won the presidency, and that Romney, while not perfect, is the more Libertarian of the two, I declare that Mitt Romney is, in fact, the best choice for a Libertarian for president. Issue Republican Party Democratic Party Libertarian Party Social Security Social security should be privatized (not to be confused with private savings accounts, but rather, private investments). Arguably closer to Libertarian. Social security should remain a government sponsored insurance plan for retirees. Believe in an \"opt out\" policy in which one can choose to privately invest (they believe this to be the better option) or go with a government sponsored social security plan. Jobs Pro small business. Supports giving small businesses tax incentives so that more jobs can be created.Tie. Encourage businesses to keep jobs here and not outsource them overseas. Supports unions and advocates for the rights of low income workers.Tie. Free market should dictate the job market. Economy Supports free market competition and entrepreneurship, corporate deregulation and cutting entitlement spending.Closer to Libertarian. Increase taxes to cut deficit. Believes large deficit negatively affects government services and that low deficits stimulate the economy. 100% Free Market. Security/Defense Believe in a proactive military and defense. Supports building weapons and technology that serve to protect our nation. Believe that peace is achieved through strong defense. Increase defense and research budget. Believe in a limited missile defense. Oppose nuclear buildup in the U.S. Believe that peace is achieved through worldwide relationship building.Closer to Libertarian. Believe in reducing nuclear arms in the U.S. Military should be used to protect people's livery and property only. Legal/Tort Reform Supports tort reform and limiting victims compensation, especially for frivolous lawsuits. Oppose tort reform and oppose limiting liability of doctors and/or businesses.Closer to Libertarian. Generally does not support tort reform. Tax Reform Supports tax cuts, low interest rates and the repeal of the death tax penalty in effort to stimulate the economy.Arguably closer to Libertarian. Generally supports raising taxes on the wealthy, lowering taxes for the middle class. Stridently opposes all government imposed taxes and employer withdrawal of employees money for tax purposes. Immigration Generally supports closed or tight borders and tracking system for foreign travelers. Support illegal alien's ability and right to become citizens and giving them more protections under the law.Closer to Libertarian. Support open borders. Faith Religion strongly associated with Republican party. Advocate free exercise of religion. Strict adherence between the separation between church and state. Promote secular issues and a more secular nation.Closer to Libertarian. Strong belief in separation of church and state and by contrast, Libertarians hold a strong belief in freedom of religion. Education Promote school choice/vouchers and homeschooling. Supports voluntary student supported prayer in school. Opposes gender and race quotes in colleges.Closer to Libertarian. Oppose vouchers. Increase NCLB federal funding. Enact new taxes to decrease class size and hire new teachers. End government financial support of public schools, believe that all public schools should be privatized with tax credit for tuition. Abortion Generally pro-life with emphasis on promoting alternatives to abortion. Generally pro-choice owning the mantra, \"Safe, legal, rare.\"Closer to Libertarian. Adamantly pro-choice but oppose any government financial aid to subsidize abortions. Energy Oppose Kyoto treaty. Support tax incentives for energy production.Closer to Libertarian. Wish to find environmentally friendly energy sources and solutions. Oppose increased drilling, especially in the U.S. Supports deregulation and believes all government energy resources should be turned over to private ownership. Opposes government conservation of energy. Heathcare Keep healthcare private. Would like to impose caps on malpractice suits. Supports reformed medicare to give seniors more choices.Closer to Libertarian. Supports more federally funded healthcare programs. Strongly supports a complete separation of healthcare and state. Supports the deregulation of the healthcare industry. Foreign Policy Spread Democracy. Supports UN reform. Wants to stop WMD proliferation countries. Believe that nations who support terrorist are just as bad as the terrorist themselves.Arguably closer to Libertarian. Strongly supports worldwide coalitions and multi-national programs. Supports aid for disadvantaged countries. Supports the UN. End all foreign aid because it's the same as welfare for nations. Believes that aid perpetuates independence on your government. Campaign Finance Reform Generally support soft money contributions from individuals but supports limiting it from corporations. Also supports full disclosure.Closer to Libertarian. Favor more regulation with spending limits on individuals and corporations. No restrictions on contributions form any legal resident. Believe that politicians holding an office should not be able to run for another seat until term is over. Environment Supports privatizing federal land. Believe in cap and trade market based air pollution reductions and that the market should regulate itself.Closer to Libertarian. Generally puts the interest of the environment over business. Wants to maintain federal land under government control. Believes that land and animals should be sold to private organizations or ranchers and taken out of the hands of the government because private citizens will care for it better. Guns Limited gun control.Closer to Libertarian. Strict gun control. No control whatsoever. Gay Rights Oppose gay marriage. Supports constitutional amendment to ban gay marriage. Generally supports gay marriage although Democrats remain largely divided on the issue, as some only support civil unions.Closer to Libertarian. Pro private choice and equality including marriage.", "No mosque at ground zero as long as no churches in Saudi Arabia. Newt Gingrich. \"there should be no mosque near ground zero so long as there are no churches or synagogues in Saudi Arabia.\"[13]", "Basic income tax should be abolished Income Tax is unjust - none of it goes to any public service", "The death penalty should remain in place I believe that the death penalty should remain in place and I'd like to do a short debate about this."]}, {"query": "Should prescription drugs be advertised directly to consumers?", "pos": ["Patients will be better informed than under the status quo Many ads don't include enough information on how well drugs work.\u00a0For example, Lunesta is advertised by a moth floating through a bedroom window, above a peacefully sleeping person. Actually, Lunesta helps patients sleep 15 minutes faster after six months of treatment and gives 37 minutes more sleep per night. The Majority of ads are based on emotional appeals, but few include causes of the condition, risk factors, or important lifestyle changes. In a study of 38 pharmaceutical advertisements researchers found that 82 percent made a factual claim and 86 percent made rational arguments for product use. Only 26 percent described condition causes, risk factors, or prevalence.[1]\u00a0Thus not giving the patients balanced information that would make them aware, that taking one of the pills is not a magic solution to their problem. Actually, according to a study conducted in the US and New Zealand, patients requested prescriptions in 12% of surveyed visits. Of these requests, 42% were for products advertised to consumers and consumers could not recall more than 4 different products of medicine.[2] This proves that the decisions made by the patients are not more informed and mainly only pressure to the advertised drugs.\u00a0 [1]\u00a0Creating Demand for Prescription Drugs: A Content Analysis of Television Direct-to-Consumer Advertising. Ann Fam Med.\u00a02007 January;\u00a05(1): 6\u201313.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1783924/ [2]\u00a0Mintzes B. and co-workers, Influence of direct to consumer pharmaceutical advertising and patients' requests on prescribing decisions: two site cross sectional survey, BMJ 2002,\u00a0\u00a0http://www.bmj.com/content/324/7332/278.full.pdf, accessed 08/01/2011", "The FDA Does More Harm Than Good I will respond to each of Con's rebuttals. 1. That earlier attempts at prohibiting alcohol failed doesn't change the fact that the FDA allows you to use these dangerous substances while restricting access to widely used, low-risk medicines, like antibiotics. Here's another example for a non-recreational drug: Tylenol is available over the counter and yet it is quite easy to overdose on it, which can cause deadly liver failure. Why can you buy Tylenol without a prescription, but you can't get an antibiotic for your throat infection without spending time and money visiting a doctor? http://1.usa.gov... 2. \"If the FDA feels that something should be taken off the market, inspected, and then re-approved to be out on the market to protect consumers than there is nothing wrong with that.\" I don't think the manufacturers of these drugs, who have been doing so safely for decades, or the people who would rather buy these drugs for much less then the 'approved' prescription versions, feel that there is 'nothing wrong with that.' And if Con is worried about bias, perhaps he shouldn't cite the FDA's explanation of why it's necessary to support his pro-FDA argument. As for dietary supplements, I never said that they couldn't be dangerous. Too much of anything is dangerous. However, Con's references prove that the FDA needn't get involved in the regulation of dietary supplements- both media outlets and research groups such as Consumer Reports have done a fine job of letting people know that they should take care when taking dietary supplements. Con's definition of 'drug' is, in fact, the government's definition of a drug (from the Food, Drug, and Cosmetic Act). And unsurprisingly, it is so vague as to put anything that you consume regarding your health under the jurisdiction of the government. It's also unsurprising that the FDA would attempt to regulate Cheerios because the box claimed that eating them was 'clinically proven to reduce cholesterol.' It is by the nature of the food that Cheerios was touted to be healthy, not because it was altering a chemical process in your body like a pharmaceutical drug. As such, General Mills was not attempting to defraud or otherwise trick people into buying their product because of its claim to reduce cholesterol. http://1.usa.gov... The FDA asserted that \"these claims indicate that Cheerios\u00ef\u00bf\u00bd is intended for use in lowering cholesterol, and therefore in preventing, mitigating, and treating the disease hypercholesterolemia.\" Any rational person can tell that Cheerios was NOT intended by General Mills to be \u2018used for lowing cholesterol,' but that by consuming Cheerios as food, you may also enjoy some health benefits. Therefore the FDA's actions here cannot be defended as being for the public good, as there was no evidence the General Mills was being fraudulent, nor was there evidence that the offending labeling put anybody in danger. It is much more likely that, given the evidence of FDA corruption cited in my second round, drug companies and not consumers had something to lose while these cholesterol claims were on the Cheerios box. If a doctor gives a patient the option to change their diet or go on medication, they may be more inclined to change their diet, knowing foods like Cheerios can help reduce their cholesterol, rather than solicit the drug companies. Regarding example 4, the article isn't 'biased' as much as it's simply explaining how the FDA allowed drugs that were known to cause dangerous side-effects to be on the market, while not allowing alternatives that had been proven to be effective and safe to be sold. The conclusion is that the FDA's actions have led to needless deaths, which is reflected in the title. 3. I never argued that the FDA is harmful because it's not perfect. People make mistakes. However, it has been slow to remove some dangerous drugs from the market, such as Rofecoxib (Vioxx), as referenced in round 2, point 3, examples 2 and 4. Since the FDA controls what drugs are allowed to be sold, it must be trusted as the authoritative source for \u2018safe' drugs. But its conflicts of interest (see round 2, point 2), questionable safety record (see point 3), and lack of competitors make it a less than ideal authority. Here is a link to an interview with Dr. David Graham, a longtime member of the FDA, who called out the FDA on the Vioxx debacle. In it he explains how the FDA protects the pharmaceutical industry at the expense of patient safety and the multitude of conflicts of interest that cloud the agency's judgment. http://www.naturalnews.com... 4. Con asserts \"\u2026companies must go through far more vigorous experimentation to ensure that whatever drug they are manufacturing is up to date with safety codes, because if it isnt a couple thousand dollars saved on a drug could end up as a multi-million dollar lawsuit against the company.\" This sounds like a pretty big incentive for drug companies make sure their drugs are safe, regardless of what FDA regulations mandate. As it is, FDA's ever-increasing list of demands have increased the cost of developing new drugs without a comparable increase in patient safety. Of the 33 drugs on the following list of drugs recalled by the FDA since 1980, 21 of them had been approved since 1990. (I'll link the list again) http://bit.ly... Another thing to think about is that the big pharmaceutical companies can afford to pay for the costs of approving new drugs, while small laboratories are much less able to do so. In addition, because the FDA is the sole determiner of what drugs are legal to sell, any increases in development costs go directly to the consumer and are industry-wide. This creates a cartel-like situation for the big drug companies, since they can charge more and more for their drugs and they don't have to worry about low-cost alternatives. In conclusion: yes, the FDA's control of the drug market allows for a semi-independent judge of which drugs are safe and which are not, and its actions may have been helpful in some cases. However, the Con's assertion that drugs and medical equipment \"would not go through any kind of inspection or testing and corporations would begin to market just about anything to make a quick buck while consumers pay the price\" is unfounded. Would you go buy medicine that wasn't approved by anybody except the company that manufactured it and had no history of safe use? Of course not. Consumers want to be as sure as possible that the drugs they take are safe, and consumer safety laboratories could sufficiently perform that task more objectively and less expensively then the FDA. By having competition between \u2018drug safety' laboratories (see my final link in round 2), they would be very careful to ensure the safety of the drugs they inspect. Something akin to the Vioxx incident in the FDA would spell bad news for that 'safety' laboratory, where the FDA, a monopoly, can continue, unchanged. Drug companies would be more than willing to submit their drugs for testing, since an unapproved drug would find few buyers in the market. The FDA's total control of the drug market breeds corruption and has led to the highest-priced prescription market in the world. http://bit.ly... It has limited patients' access to safe and effective treatments while allowing dangerous prescriptions to be sold. It can pick and choose what drugs require prescriptions and which don't, with these decisions reflecting little on the danger of the drug (Alcohol, Tobacco, & OTC Tylenol vs. Prescription Amoxacillin). It restricts the rights of patients to use whatever treatments they and their doctor deem appropriate, such as experimental treatments for a terminal condition. For these reasons and more, the FDA does more harm than good, and patients would not only be just as safe with private laboratories doing the safety testing, but would have more and lower-cost treatment options.", "allow pharmaceutical companies to advertise directly to consumers Advertising puts pressure on doctors to prescribe inappropriate drugs to their patients", "Creating a mentality of illness Advertising to patients promotes a \u2018pill for every ill\u2019 mentality as the drug industry seeks to \u2018create\u2019 new markets for its drugs by convincing patients that a pill can solve their problems. This leads both to greater hypochondria and to self-diagnosis of normal conditions as medical ones. For instance in October 2001, GSK ran advertisements for Paxil in the New York Times, claiming the drug would solve chronic anxiety. These advertisements came at a time when the events of 9/11\u2014rather than a medical condition\u2014were probably to blame for New Yorkers\u2019 stress. The FDA declared in a 1999 study that fewer than one in four new drugs has any therapeutic value and the medical community now accepts that prevention through lifestyle choices is often the best way to tackle disease (for instance, rather than seeking a weight-loss or diabetes wonder-pill, childhood obesity should be tackled through exercise and healthy eating). Pill-popping seems easier and so is more attractive to many patients but in practice it is worse for the long-term health of society. By allowing the prescription drugs to be advertised we are making more people believe they are ill and need pills for them, rather than explaining to them that their back pain and high blood pressure are problems caused by their lifestyle choices.[1] \u00a0 [1]\u00a0Health Information Action, Direct-to-Consumer Prescription Drug Advertising The European Commission\u2019s Proposals for Legislative Change, September 2011,\u00a0http://www.haiweb.org/campaign/DTCA/BMintzes_en.pdf, accessed 08/07/2011", "Advertising puts pressure on doctors to prescribe inappropriate drugs to their patients The majority of products that are advertised treat currently under-treated conditions. Drugs dealing with diseases such as depression, diabetes, and high cholesterol are some of the most frequently advertised. These advertisements can help inform viewers about their conditions, and prompt visits to physicians, who can help treat the problem early on.\u00a0 Additionally, informed citizens are good for society, as physicians do not always recommend necessary or helpful drugs. In the status quo, patients do not visit their doctors often enough to be diagnosed. Only approximately half the patients in America get beta blockers after a heart attack. Clearly, an advertisement for beta blockers would be informational, rather than harmful.", "allow pharmaceutical companies to advertise directly to consumers Creating a mentality of illness", "Patients will be better informed than under the status quo Advertising prescription drugs enables patients to learn, and to request innovation faster in order to benefit from the new drugs that health personnel still have not gotten used to. Advertising increases consumer awareness of drugs, which makes consumers more likely to take appropriate medication. The drugs market is complex and so advertising can help explain the differences between treatments, for example between contraceptive pills intended to reduce period pain, period flow and those simply to prevent pregnancy. Advertising under current rules is used to inform patients of new drugs which may be appropriate for conditions which they suffer from (such as recent asthma drugs which reduce the frequency of attacks), but which their doctor might overlook or not have the time to crosscheck against her list of patients.[1] 56% of AMA general practitioners believed that direct-to-consumer advertising had prompted some of their patients to seek treatment for a condition which would have otherwise been neglected.[2]\u00a0If a patient has taken the time to actively consider a particular drug and then visits their doctor, whether they are prescribed it or not, they are building up a positive relationship with their doctor and are more likely to continue to take an active interest in their health. Further on, in states where there is no direct to consumer advertising but there is advertising to doctors, patients are disadvantaged because it is in the interest for private medical insurance firms or national health services to keep information about expensive new drugs from patients. In the UK it was because of cost that the Primary Care Trusts (PCTs) refused to allow the prescription of Herceptin, a drug which US studies have shown reduces the damage done by breast cancer. Ultimately pressure from Roche, the drug\u2019s manufacturer and from patients resulted in the drug being authorized for use, but the process was much faster in the US where Roche could run advertisements alerting consumers to the potential benefits of Herceptin, and thereby immediately giving patients access to a similar level of information as their doctors and allowing them to push for its authorization. \u00a0 [1]\u00a0Patient View \u2013 for improving patient care, Information on prescription medicines: the views of EU-based patient groups,\u00a0http://www.patient-view.com/projects4.htm, accessed 08/07/2011 [2]\u00a0Lyles A., Direct Marketing of Pharmaceuticals to Consumers, Annual Review of Public Health, published May 2002,\u00a0\u00a0http://www.annualreviews.org/doi/full/10.1146/annurev.publhealth.23.100901.140537, accessed 08/08/2011", "In Canada drug companies should not be allowed 2 advertise prescription drugs directly to public The power of the media broadcast is astronomical, and I believe there is an adversarial element put int the doctor/patient relationship when the drug companies advertise prescription drugs directly to the \"ill-informed\" pubic.", "Advertisements do more harm than good My main points will be as follows: 1. People need advertisements. 2. Advertisements contribute to the economy. 3. Alot of free things are free because of advertisments. My first point: People need advertisements. What would a world without advertisements be like for humans? First of all alot of the worldy items that we want or need are given to us as a direct result from advertising! How would we know where and how to get set up with the best prices and promos for the items we need, such as internet, tv, phone, groceries, etc! We see and hear advertisements that represent the best ways to get the items we need for cheap. As most people know, not every single person in this world has pockets full of money to spend on things. We need to know and hear about the things that will save us money, so we can be better, and more econmical with our spending. Without knowing how much to spend and where to spend at for the best ways to save, how would anyone have money to pay the bills? Advertisements are absolutely nessecary for this reason! My second point: Advertisements contribute to the economy. Pretty much every single business in the world, needs some sort of marketing ploy for it to be able to run properly. Marketing is run majorly off of advertising alone. Without advertisement, you wouldn't be able to get paid properly for the work you do. If people don't know about a product, then they will not buy your product plain and simple. If you want your business to prosper, you need advertisements, plain and simple. That's how businesses make money, and that's how you get paid for the hours to work everyday! If no one were to spend money on products, are economy would collapse! In this article I am providing, it will explain how to the consumer spending it what helps the economy thrive. . http://helpsavemydollars.com... \"Let's say you deposited this $1,000 into your savings account. Most likely, it's a win-win situation for you because you're probably earning interest on this money and you now have $1,000 in liquid cash that can be very helpful should you lose your job in the future or should you incur any unexpected expenses later on. It's also a win-win scenario for the bank. You just \"gave\" the bank $1,000 to loan out to other people/businesses. Remember, banks are here to make money and they do that by loaning out the money that you deposited. Since you deposited $1,000 into the bank, that bank can now loan it out to a pizza parlor, for example, to be used in part to buy a new pizza oven. Now because that pizza parlor replaced their old oven using that $1,000 loan from the bank, they can now make more pizzas at a faster rate, which would mean that the parlor now must purchase more dough, sauce and cheese from a food supplier. Now the food supplier benefits from all of this extra business and the food supplier will use the money it earns from selling dough, sauce and cheese to pay its employees. The employees of the food supplier now have money to pay their personal bills and they might even have some left over money to go to the movies. Since you saved that $1,000, as opposed to buying a new television, an even more impactful chain reaction occurred. \" My third point: Alot of free things are free because of advertisements. Alot of things we use every single day for are very own enjoyment, are only free as a directv result of advertisement. Many people listen to the radio on their way to school or work. Have you ever consindered how the radio stations make money if the radio is a free service to everyone? It's simply due to the fact that people and businesses will pay good money for their product to be mentioned by peoples favorite hosts, and during commercials. People who like to watch movies online for free also benefit for advertising. How to those sites benefit from making movies free to the public? Directly from advertising! The most famous movie site that comes to mind is a site called tubeplus. me. This site offers almost every tv show or movie known to people, that millions of people are able to enjoy due to the fact that there are advertisement on the side. The same goes for virtually any website that a person would need to use. Music, games, tv companies, they all make their money from advertising. Now i'm going to quickly move on to my opponent. My opponent states: \"People shouldn't have to have their lives attacked by a huge quantity of information they might not want. \" This is not true in the slightest. Business and companies that advertisement pay to have there information posted publicy. It's not forced on anyone and everyone has the ability to choose whether or not to read or listen to an advertisement. So how are people being 'attacked'?", "Advertisements do more harm than good 1) Television is greatly abused for commercial purposes and other types of uses, in which audiences are constantly sold to: Advertisers try to convince the audience that the solution to a problem or the fulfilment of a desire can only be achieved through the purchase of a product. It is designed towards blind acceptance by the viewer. In this way TV negatively affects the human mind, by limiting the possibilities of conscious choice, and promotes a consumer society. It can be also misused to urge people to buy even things they do not need by subliminal advertising. 2)People spend the biggest part of their time view advetisments : According to the statistics, the average American child watches 262 views ads per week. That's how ads reduce the quality of real life by narrowing people's outlook, limiting the variety of free time activities, affecting family relations by reducing conversation, and even having an impact on health by discouraging exercise. \"\"Research has shown that young children\u2014younger than 8 years\u2014are cognitively and psychologically defenseless against advertising.6\u20139 They do not understand the notion of intent to sell and frequently accept advertising claims at face value.10 In fact, in the late 1970s, the Federal Trade Commission (FTC) held hearings, reviewed the existing research, and came to the conclusion that it was unfair and deceptive to advertise to children younger than 6 years.11 What kept the FTC from banning such ads was that it was thought to be impractical to implement such a ban.11 However, some Western countries have done exactly that: Sweden and Norway forbid all advertising directed at children younger than 12 years, Greece bans toy advertising until after 10 PM, and Denmark and Belgium severely restrict advertising aimed at children.\" Television Children and adolescents view 400 00 ads per year on TV alone.13 This occurs despite the fact that the Children's Television Act of 1990 (Pub L No. 101\u2013437) limits advertising on children's programming to 10.5 minutes/hour on weekends and 12 minutes/hour on weekdays. However, much of children's viewing occurs during prime time, which features nearly 16 minutes/hour of advertising.14 A 30-second ad during the Super Bowl now costs $2.3 million but reaches 80 million people.15 Movies A 2000 FTC investigation found that violent movies, music, and video games have been intentionally marketed to children and adolescents.16 Although movie theaters have agreed not to show trailers for R-rated movies before G-rated movies in response to the release of the FTC report, children continue to see advertising for violent media in other venues. For instance, M-rated video games, which according to the gaming industry's own rating system are not recommended for children younger than 17 years, are frequently advertised in movie theaters, video game magazines, and publications with high youth readership.17 Also, movies targeted at children often prominently feature brand-name products and fast food restaurants.18 In 1997\u20131998, 8 alcohol companies placed products in 233 motion pictures and in 1 episode or more of 181 TV series.18 Print Media According to the Consumer's Union,19 more than 160 magazines are now targeted at children. Young people see 45% more beer ads and 27% more ads for hard liquor in teen magazines than adults do in their magazines.20 Despite the Master Settlement Agreement with the tobacco industry in 1998, tobacco advertising expenditures in 38 youth-oriented magazines amounted to $217 million in 2000.21 The Internet An increasing number of Web sites try to entice children and teenagers to make direct sales. Teenagers account for more than $1 billion in e-commerce dollars,22 and the industry spent $21.6 million on Internet banner ads alone in 2002.23 More than 100 commercial Web sites promote alcohol products.23 The content of these sites varies widely, from little more than basic brand information to chat rooms, \"virtual bars,\" drink recipes, games, contests, and merchandise catalogues. Many of these sites use slick promotional techniques to target young people.23,24 In 1998, the Children's Online Privacy Protection Act (Pub L No. 105\u2013277) was passed, which mandates that commercial Web sites cannot knowingly collect information from children younger than 13 years. These sites are required to provide notice on the site to parents about their collection, use, and disclosure of children's personal information and must obtain \"verifiable parental consent\" before collecting, using, or disclosing this information.25 MARKETING TECHNIQUES Advertisers have traditionally used techniques to which children and adolescents are more susceptible, such as product placements in movies and TV shows,26 tie-ins between movies and fast food restaurants,18 tie-ins between TV shows and toy action figures or other products,7 kids' clubs that are linked to popular shows, and celebrity endorsements.27 Cellular phones are currently being marketed to 6- to 12-year-olds, with the potential for directing specific advertisers to children and preteens. Coca-Cola reportedly paid Warner Bros. Studios $150 million for the global marketing rights to the movie \"Harry Potter and the Sorcerer's Stone,\"28 and nearly 20% of fast food restaurant ads now mention a toy premium in their ads.29 Certain tie-in products may be inappropriate for children (eg, action figures from the World Wrestling Federation or an action doll that mutters profanities from an R-rated Austin Powers movie). Children's advertising protections will need to be updated for digital TV, which will be in place before 2010. In the near future, children watching a TV program will be able to click an on-screen link and go to a Web site during the program.30 Interactive games and promotions on digital TV will have the ability to lure children away from regular programming, encouraging them to spend a long time in an environment that lacks clear separation between content and advertising. Interactive technology may also allow advertisers to collect vast amounts of information about children's viewing habits and preferences and target them on the basis of that information.31 SPECIFIC HEALTH-RELATED AREAS OF CONCERN Tobacco Advertising Tobacco manufacturers spend $30 million/day ($11.2 billion/year) on advertising and promotion.32 Exposure to tobacco advertising may be a bigger risk factor than having family members and peers who smoke33 and can even undermine the effect of strong parenting practices.34 Two unique and large longitudinal studies have found that approximately one third of all adolescent smoking can be attributed to tobacco advertising and promotions.35,36 In addition, more than 20 studies have found that children exposed to cigarette ads or promotions are more likely to become smokers themselves.37,38 Recent evidence has emerged that tobacco companies have specifically targeted teenagers as young as 13 years of age.39 Alcohol Advertising Alcohol manufacturers spend $5.7 billion/year on advertising and promotion.40 Young people typically view 2000 beer and wine commercials annually,41 with most of the ads concentrated in sports programming. During prime time, only 1 alcohol ad appears every 4 hours; yet, in sports programming, the frequency increases to 2.4 ads per hour.42,43 Research has found that adolescent drinkers are more likely to have been exposed to alcohol advertising.44\u201350 Given that children begin making decisions about alcohol at an early age\u2014probably during grade school50\u2014exposure to beer commercials represents a significant risk factor.46,50 Minority children may be at particular risk.51\"\" relevant website: http://pediatrics.aappublications.org... bam! vote for me", "Drug Commercials I accept. First of all, my opponent should define drug commercials. Who advertises? What kind of drugs are being advertised? Where are these advertisements? Nevertheless, I'll start out with some basic arguments. Policing these advertisements would be a violation of two parts of the first amendment. Firstly, Freedom of Speech. These companies are trying to promote their brand that is (and has to be) FDA approved. As long is no one is being hurt or defamed by these advertisements, it is unconstitutional to police them. Secondly, freedom of press. Many ads appear in newspapers or magazines. Again, if the drug is FDA approved and the publishing company lets the drug ad go in, it is legal. On constitutional grounds I object to my opprnent.", "Drug Commercials There must be a way to police these drug commercials. Other countries have laws prohibiting the advertising of drugs to the general public. Let these companies advertise their drugs to physicians through the internet or mailings. I am so sick of these ads. I just change the station. put the sound on mute, or better still, shut the TV off. You couldn't pay me to take this crap!! FDA doesn't care, they are in bed with these pharmaceutical companies, and the networks don't care they are making billions.", "Advertising puts pressure on doctors to prescribe inappropriate drugs to their patients If a patient sees a drug that is inappropriate for him, and asks their doctor for it, if his doctor does not prescribe it, then he may ignore his doctor and seek a second or third opinion. In private health care systems it is likely that economic pressure will result in a doctor eventually agreeing to the patient\u2019s demand. In nationalized health services \u2018pester power\u2019 has resulted in doctors giving in to patients in the past rather than arguing with them (seen, for example, in the massive over-prescribing of antibiotics by British general practitioners for viral infections against which they are ineffective). If the doctor prescribes another drug (perhaps a cheaper generic version), even if it is chemically identical to the branded and advertised drug, the reverse-placebo effect may result in the drug being less effective than it should be, because the patient believes it is a weaker treatment. The patient may also be less willing to complete the prescription, or to visit that doctor again, thereby undermining the doctor-patient relationship.[1] Prescription medicines are fundamentally complex and dangerous, which is why they require a prescription by a qualified doctor. It is not helpful to have a patient who lacks the decade of medical training a GP has self-diagnosing on the basis of an advert. \u00a0 [1]\u00a0FDA: Direct-to-Consumer Advertising of Prescription Drugs:Looking Back, Looking Forward, published October 2005,\u00a0\u00a0www.fda.gov/downloads/AboutFDA/CentersOffices/CDER/ucm095993.ppt, accessed 08/07/2011", "Alcohol advertisement should be banned due to insufficient information THank you for posting your case. My opponent states tries to counter my case by stating \"I'd question strongly whether there is anyone of reasonable intelligence and age who lacks awareness of the substance\"; however, at no point in my case did i state that people where unaware of this substance, i simply stated that alcohol entices the viewers. My opponent went further in stating that \"it has no effect on the their awareness that alcohol exists.\" This statement is absolutely false. When looking at the world today, we find that technology such as television has completely taken over our children and adolescent life, now these children might have known about alcohol to some extent, but when presented with alcohol advertisement, we find that these same kids now know the names of ten different brands of alcohol and why each brand differ from one another. \"Research suggests that children and adolescents tend to learn more about alcohol from television and beer advertising than from more balanced sources such as parents, leaving them more knowledgeable about brands of beer than about potential health risks associated with drinking. The Role of Interpretation Processes and Parental Discussion in the Media's Effects on Adolescents' Use of Alcohol, 2000.\" (http://www.media-awareness.ca...) In his first point, my opponent list several social events in which alcohol is present as well as giving us a formula in which ethanol is created, however interesting this may seem, it has noting to do with advertising alcohol and why we \"should not\" ban alcohol. \"The pro case was never specific as to what these risks and what level of ignorance exists. \" My opponent makes this statement in his second point. When alcohol advertisement does not present us the viewers with any facts as to what the risk of alcohol poses to yourself and the society. It fails to mention the chain of problems associated with drinking such as accidents, loss of judgement and unsafe sex. Above we find a fine example of an advertisement that rather than informing people, it encourages people to go out and drink. http://www.youtube.com... http://www.youtube.com... Finally My opponent tackle in which he deems a \"Fascinating theory with 0 evidence presented to support it.\" My opponent goes on in giving several evidence of his own in an effort to prove me wrong; however, as you probably noted, all his evidence are outdated. This is a new generation and with every new generation, comes a new habit/behavior. Evidence: \"Researchers are examining other environmental influences as well, such as the impact of the media. Today alcohol is widely available and aggressively promoted through television, radio, billboards, and the Internet. Researchers are studying how young people react to these advertisements. In a study of 3rd, 6th, and 9th graders, those who found alcohol ads desirable were more likely to view drinking positively and to want to purchase products with alcohol logo\" (http://pubs.niaaa.nih.gov... ( January 2006) Here in the UK, psychologists at the University of Hertford have been investigating children's responses to TV alcohol advertising (Nash et al, 2009). They showed that children as young as 7 years old like alcohol advertisements on TV \u2013 especially ones with humour, cartoon format, animals and special characters. Secondly, recent study in Australia (Winter et al, 2008) found that children and under-age teenagers are currently exposed to \"unacceptably high levels of alcohol advertising on television\" (presumably because they are watching TV after the 9pm watershed). However, it should be emphasised, as noted in the introduction, that cartoon format, animals and special characters that could be appealing to those under the legal drinking age, are not permitted by EU, US or Australasian regulatory bodies for example. As Smith and Foxcroft conclude, \"we now have stronger empirical evidence to inform the policy debate on the impact of alcohol advertising on young people.\" This article is available from: http://www.biomedcentral.... com/1471-2458/9/51 Youth who saw more alcohol advertisements on average drank more (each additional advertisement seen increased the number of drinks consumed by 1% [event rate ratio, 1.01; 95% confidence interval, 1.01- 1.02]). Youth in markets with greater alcohol advertising expenditures drank more (each additional dollar spent per capita raised the number of drinks consumed by 3% [event rate ratio, 1.03; 95% confidence interval, 1.01- 1.05]). Examining only youth younger than the legal drinking age of 21 years, alcohol advertisement exposure and expenditures still related to drinking. Youth in markets with more alcohol advertisements showed increases in drinking levels into their late 20s, but drinking plateaued in the early 20s for youth in markets with fewer advertisements. Conclusion: Alcohol advertising contributes to increased drinking among youth. Arch Pediatr Adolesc Med. 2006;160:18-24 I belief this is enough evidence to prove my case to be a true one. CX: 1) i bvelieve i have provided enough evidence to prove this theory. 2)Drunk driving, loss of judgement e.t.c. The Youtube videos. 3) Evidence above. CX2: What are the benefits of alcohol advertisement. Do these advertisement affect kids view on alcohol (include evidence) Can you provide at least one alcohol commercial in which the risk associated with alcohol are presented. (by the alcohol producers not anti-alcoholic movements.) In conclusion, my opponent tries to counter all my arguments as to why alcohol advertisement should be banned; however, he failed to present a single reason as to why alcohol advertisement should not be banned thus failing to meent his burden of proof."], "neg": ["Atheism is Directly Responsible for an Atrocity I agree to the terms of this argument. My example of an atheist atrocity is the Holodomor.", "Buy Generic Medicines Online Buying generic medicine online is dangerous. There is no way to check for quality in the medicine, nor is there anyway to determine EXACTLY how accurate the ingredients are.", "Recreational Marijuana Should Be Legal Recreational use of Marijuana is an ever-present issue in our time. With the recent voting in this election for the use of it in various states, this has resurfaced as an important issue. This debate is short, and will center on facts rather than fluff.", "Legalize all drugs to legalize all drugs would be the end of life as we know it. it would put a lot of creeps back on the streets. crime rates will go up to probly 4 times what they are now. the reason we have a law against them is to keep the citizens safe. most accident either vehicular or not are caused by drug related things. also the reason that we have laws against drugs is because it cause people to do goofy and dangerous things. PCP or angel dust cause you to get butt naked and climb to high heights. meth makes you smell like cat pee and will make you look like crap in the end. cocaine makes you tweak a lot and can make you do something without anything being remembered. drugs cause people do do certain thing that is a threat to society. so I end this debate with drugs being all legalized would jeopardize the safety of all people and other thing around the person doing them. I think they should not be legalized at all unless for a medical reason like pot is.", "Legalization of Recreational Marijuana The legalization on marijuana for recreational purposes will only amplify rates of drug usage among individuals at all ends of the age spectrum. Psychologically, legalizing marijuana would send the message that using it would be acceptable, which it clearly generates more complications than it solves. From a legal standpoint, laws would need to be altered in order to accommodate for committing or engaging in criminal activity under the influence of marijuana. Needless to say, our tax-payer funded public health care systems would use taxpayer money to fund both medical and rehabilitative treatment for those involved with the substance.", "Marijuana should be legalized The \"Drug war\" is costing billions of dollars and yet, is it all worth it? Is it worth the billions of dollars? IS it worth the invasion of individual civil liberties? Is it worth the wasted effort? First of all, prohibition does not help and may be increasing drug use in itself: Here is a scenario. A group of kids from high school want to host a party and want to get completely drunk in it. But they find out that it is extremely difficult to obtain alcohol, since it is regulated to keep it away from people under 21.But, they know a dealer who willl happily sell them weed. \"You don't have to be 21 to buy marijuana -- marijuana dealers usually don't care how old you are as long as you have money. It is actually easier for many high school students to obtain marijuana than it is for them to obtain alcohol, because alcohol is legal and therefore regulated to keep it away from kids.\" http://www.mjlegal.org...Prohibition as a weapon to prevent drug abuse has not proven or has any provided evidence, to be a deterrent in drug abuse.When Alcohol was prohibited, it certaintly did not work eitherMarijuana has been proven to be less dangerous than cigarettes and alcohol. \"Safer for the Consumer Many people die from alcohol use. Nobody dies from marijuana use.The U.S. Centers for Disease Control and Prevention (CDC) reports that more than 37,000 annual U.S. deaths, including more than 1,400 in Colorado, are attributed to alcohol use alone (i.e. this figure does not include accidental deaths). On the other hand, the CDC does not even have a category for deaths caused by the use of marijuana. People die from alcohol overdoses. There has never been a fatal marijuana overdose. The official publication of the Scientific Research Society,American Scientist, reported that alcohol is one of the most toxic drugs and using just 10 times what one would use to get the desired effect could lead to death. Marijuana is one of \u2013 if not the \u2013 least toxic drugs, requiring thousands of times the dose one would use to get the desired effect to lead to death. This \u201cthousands of times\u201d is actually theoretical, since there has never been a case of an individual dying from a marijuana overdose. Meanwhile,according to the CDC, hundreds of alcohol overdose deaths occur the United States each year. The health-related costs associated with alcohol use far exceed those for marijuana use. Health-related costs for alcohol consumers are eight times greater than those for marijuana consumers, according to an assessment recently published in theBritish Columbia Mental Health and Addictions Journal. More specifically, the annual cost of alcohol consumption is $165 per user, compared to just $20 per user for marijuana. This should not come as a surprise given the vast amount of research that shows alcohol poses far more \u2013 and more significant \u2013 health problems than marijuana. Alcohol use damages the brain. Marijuana use does not. Despite the myths we've heard throughout our lives about marijuana killing brain cells, it turns out that a growing number of studies seem to indicate that marijuana actually has neuroprotective properties. This means that it works to protect brain cells from harm. For example, one recent study found that teens who used marijuana as well as alcohol suffered significantly less damage to the white matter in their brains. Of course, what is beyond question is that alcohol damages brain cells. Alcohol use is linked to cancer. Marijuana use is not. Alcohol use is associated with a wide variety of cancers, including cancers of the esophagus, stomach, colon, lungs, pancreas, liver and prostate. Marijuana use has not been conclusively associated with any form of cancer. In fact, one study recently contradicted the long-time government claim that marijuana use is associated with head and neck cancers. It found that marijuana use actually reduced the likelihood of head and neck cancers. If you are concerned about marijuana being associated with lung cancer, you may be interested in the results of the largest case-controlled study ever conducted to investigate the respiratory effects of marijuana smoking and cigarette smoking. Released in 2006, the study, conducted by Dr. Donald Tashkin at the University of California at Los Angeles, found that marijuana smoking was not associated with an increased risk of developing lung cancer. Surprisingly, the researchers found that people who smoked marijuana actually had lowerincidences of cancer compared to non-users of the drug. Alcohol is more addictive than marijuana. Addiction researchers have consistently reported that marijuana is far less addictive than alcohol based on a number of factors. In particular, alcohol use can result in significant and potentially fatal physical withdrawal, whereas marijuana has not been found to produce any symptoms of physical withdrawal. Those who use alcohol are also much more likely to develop dependence and build tolerance. Alcohol use increases the risk of injury to the consumer. Marijuana use does not. Many people who have consumed alcohol or know others who have consumed alcohol would not be surprised to hear that it greatly increases the risk of serious injury. Research published this year in the journal Alcoholism: Clinical & Experimental Research, found that 36 percent of hospitalized assaults and 21 percent of all injuries are attributable to alcohol use by the injured person. Meanwhile, the American Journal of Emergency Medicine reported that lifetime use of marijuana is rarely associated with emergency room visits. According to the British Advisory Council on the Misuse of Drugs, this is because: \"Cannabis differs from alcohol \u2026 in one major respect. It does not seem to increase risk-taking behavior. This means that cannabis rarely contributes to violence either to others or to oneself, whereas alcohol use is a major factor in deliberate self-harm, domestic accidents and violence.\" Interestingly enough, some research has even shown that marijuana use has been associated with a decreased risk of injury. http://www.saferchoice.org...The drug war costs too much money for it's own good:The drug war is costing taxpayers billions of dollars just to have weed smoker imprisoned. The money could be used for more useful, important things that would improve out society or pay for even education about drug use that would prove to be more effective than \"prohibition\"Drug prohibition also invades civil liberties as it invades the \"Fourth Amendment\" in \"searches and seizures\"Why should marijuana be illegal?Why? Don't individuals have the right to choose to smoke weed or not? Just as individuals have the right to use alcohol and cigarrettes? People deserve the freedom to smoke weed as the please whether or not the government agrees with their decisions. Why should the government force their beliefs down people throats and jail people for simply doing something that they do not agree with but has no huge, harmful consequences towards society?There are also many other reasons Marijuana should be legal \"Medicinal use: Marijuana can be used as medicine because it helps to stimulate apetite and relieve nausea in cancer and AIDS patients. Hemp: The hemp plant is a valuable natural resource. Legalizing marijuana would eliminate the confusion surrounding hemp and allow us to take advantage of hemp's agricultural and industrial uses. Religious Use:Some religions instruct their followers to use marijuana. Just like Christianity and Judaism instruct their followers to drink wine on certain occaisions, some Hindus, Buddhists, Rastafarians, and members of other religions use marijuana as part of their spiritual and religious ceremonies. These people deserve the freedom to practice their religion as they see fit. The First Amendment to the U.S. Constitution says that the government cannot 'prohibit the free exercise' of religion, and so marijuana should be legal.\" http://www.mjlegal.org...", "God Speaking To Humans Directly God Most Definitely Does talk to people other than prophets directly. I have many associates who I can guarentee are not prophets. All christians can have a prophetic on some level, but that doesnt make them prophets . But God can speak to anybody,, for example Moses wasnt a prophet God spoke to him,, Solomon wasnt a prophet but God spoke to him ,, on many occasions throughout the bible God speaks to people who are not.prophetic in anyway", "Drug Legalization Thanks, Danielle. =Legalization vs. Decriminalization= This is where the debate is going to be decided. As I see it, Danielle has two good arguments in favor of legalization over decriminalization: That the power of the drug cartel would decrease when faced with legal competition, and that legalized drugs could be \"safe, legal, and taxed.\" I will address these two claims and in the process will show why some kind of decriminalization similar to the Portugal model is a superior policy. Re: CartelLet's talk first about the cartels and their monopoly on drugs. First of all, it's deeply questionable what this \"safe and legal\" competition would look like or if it would even materialize. Contra Danielle's repeated and absurd claim that alcohol is more dangerous than meth or heroin, big pharma is not going to open itself up to the legal, ethical, and social ramifications of marketing and selling recreational drugs that ruin bodies and lives. You cannot manufacture \"safe\" meth. It's probable that there would not be that meaningful of a deviation from the status quo, except without drug laws there's no pretense to arrest violent gang members before their turf wars mow down innocent civilians. But how serious is the problem of drug violence? According to the Bureau of Justice Statistics, only around 4% of homicides are drug related, or around 600 deaths[1]--mostly against other drug dealers, so no great loss. Heroin killed 13,000 people in 2015. Other opioids killed close to 10,000. Prescription drug abuse killed 17,500[2]. Cocaine killed 5,800 in 2014. Meth killed 3,700[3]. It goes on and on, and this doesn't even mention the tremendous $193 billion social cost associated with the ruined bodies and lives of drug abusers--a number that is dwarfed by the incredible cost of more widespread *legal* drugs. Moreover, drug usage itself contributes greatly to crime. According to the same BJS report, 19% of victims of violent crime perceived their attackers to be under the influence of drugs on their own or in combination with alcohol, a pretty staggering statistic when you consider that only around 5 million people, 1.5% of the population, use non-marijuana illicit drugs[4].It's very easy to see how even slightly increased usage would outweigh this impact. And usage would clearly go up. Danielle outright conceded the economic theory explaining why usage would increase. She dropped and therefore conceded the argument that alcohol prohibition actually cut usage in half--and reversed a worrying trend of increasing alcoholism. Her source that argued how Opium use in China didn't increase is embarrassingly bad because it only looked at import data. I'm shocked Harvard would allow their name to be used with such a shoddy study--imports eventually did decrease, but that was only because domestic production increased by 118 times, from 300 tons before the first Opium War to 35,300 tons in 1906[5]. If China failed to effectively prohibit Opium, it was only because of their famously weak central government. By the 1930s, 10% of the population was addicted to Opium. Forced rehabilitation for addicts and death for dealers drove that number to 0[6]. Bans work, and Danielle's own arguments prove this. Danielle concedes that Marijuana use in Colorado went up drastically after legalization, but argues that use of other drugs wouldn't because users understand the risks. Except she also argues that alcohol is worse than meth or heroin. If prohibition doesn't work and people are educated enough to know the risks, why is an incredibly destructive, literally worse than heroin, but legal drug like alcohol used regularly by over half the population while the still widely prohibited but innocuous Marijuana is only used by 13%? It just doesn't add up. Drug use would massively increase if they were all legal and freely available. All of this ignores that forced rehabilitation would actually *decrease* use. Danielle notes in her first round how Portugal went from having one of the worst rates of drug overdose in Europe to the second lowest and that drug use continually declined. This isn't due to drugs becoming heavily regulated and \"safe\", because trafficking and manufacturing are still illegal in Portugal. It happened because the country pivoted towards a more humane approach to drug use and forced addicts into mandatory rehabilitation. Danielle wants us to be allowed to force addicts ruining their lives and bodies and becoming societal leeches into rehab only AFTER they've already hurt someone else. With legalization the only question is how much usage goes up. With decriminalization we are instead asking how much it goes *down*. It's incredibly obvious which is the better policy.Re: Regulation and safetyI don't totally disagree with this point. Sure, some deadly drugs that have horrific effects on the body might become marginally safer if they were regulated. How marginal? We don't know because Danielle has failed to provide any numbers, but all the regulation in the world cannot create \"safe\" heroin. Carfentanil, a drug 10,000 times more potent than Morphine that is used to tranquilize elephants[7], is never going to be safe for human consumption. How is it even possible to \"regulate\" such a thing? At the end of the day any increase in drug safety is going to be massively outweighed by the costs of increased consumption. And unlike decriminalization, regulation does nothing to DECREASE drug use, which ultimately leads to greater public safety. Portugal shows us that we don't need to make drugs freely available and then cross our fingers, hoping that we made them as safe as possible. We can drive drug overdoses and addiction down to the vanishing point by forcing users to get the help they need BEFORE it becomes a huge problem.Danielle vastly exaggerates how easy drugs are to get in this country. How many people even know what the deep web is, or how to use it? It's difficult to fully stamp out drugs but it's obvious that the threat of legal ramifications all throughout the supply chain obviously decreases both use and availability. Marijuana was always easy to get, but use still skyrocketed after legalization and has doubled nationwide as legalization and medical Marijuana created legal avenues for consumption[8]. Danielle argues that due to regulation, the price of drugs will actually go up after legalization. This is absurd. A blanket prohibition on production backed up by years in prison is far more costly to producers than regulations dictating drug purity. We know what prohibition does to the price of drugs--an analysis from the NCBI found that the price of alcohol, a drug that easily lends itself to long term storage and where millions of gallons already existed, tripled or quadrupled after the 18th amendment was passed[9]. Widespread availability increases the use of even hard drugs. Afghanistan, where the vast majority of the worlds Opium is produced, leads every other country in opium usage, and it's not even close[10].Danielle argues that we could decrease drug use through taxation. I'm glad that she agrees with me that increasing the costs drives usage down, but the costs of criminalization are far higher than she could reasonably expect a sin tax to be. The average tax on a pack of cigarettes is $1.69[11], less than 30% of the average cost of $5.51 a pack[12]. Criminalization drives the price of drugs up 300-400% without even considering the costs associated with getting caught. A tax this large would easily drive people back into the black market, negating her argument. Ultimately the state could never hope to recoup the horrific social and financial costs of drug addiction through taxation, especially after legalization drives an increase in use. Danielle also has no compelling answer to prescription drug abuse. She supports the regulation of Oxycontin or cancer drugs to try and make sure they're used properly. I'm surprised that Danielle doesn't see that this is the exact same rationale behind prohibition. Removing laws PROHIBITING certain people taking these drugs is a part of legalization. By advocating that we PROHIBIT people from taking medicinal drugs without a prescription Danielle is engaging in a MASSIVE contradiction and violating her own framework. Are we allowing the consumption of all drugs as long as it doesn't directly harm anyone else or are we not? If we followed Danielles framework and legalized all drug use, we have to look to my impacts of self medication which kills tens of thousands of people around the world. Why should chemotherapy drugs be sold to non cancer patients?We're fortunate in that history has given us multiple experiments to draw conclusions from. We know that legal drugs such as alcohol and cigarettes are used far more often than even comparatively innocuous illicit drugs like Marijuana, a drug whose usage has rapidly increased as the legal restrictions have lessened. We know that Opium legalization in China was a total failure, with a staggering 10% of the population becoming addicts. We know that prohibition in the United States significantly decreased alcohol consumption. If we're interested in decreasing usage all examples of legalization have been manifest failures. On the other hand, we know that decriminalization in Portugal was a huge success by almost any metric and succeeded in driving usage and overdoses down. This is because users were legally FORCED to get help while the supply remained low because manufacturers and sellers were still punished for their crimes. Again, because it warrants repeating, the last time Opium was legalized in a country 1 in 10 eventually became addicted. There is absolutely nothing Danielle can possibly offer to outweigh even the RISK of tens of millions of new addicts, especially when we have another workable policy solution. The US should follow Portugal's example and implement policies that have proven effective. Sources: http://tinyurl.com..."]}], "TRECCOVID": [{"query": "What are the impacts of COVID-19 among African-Americans that differ from the rest of the U.S. population?", "pos": ["COVID-19 and the US response: accelerating health inequities Health inequities have long defined health and the healthcare system in the USA. The clinical and research capacity across the USA is unparalleled, yet compared to other high and even some middle-income countries, the average health indicators of the population remain suboptimal in 2020, a finding at least in part explained by inequity in healthcare access. In this context, COVID-19 has rapidly emerged as a major threat to the public\u2019s health. While it was initially thought that severe acute respiratory syndrome coronavirus 2 would be the great equaliser as it would not discriminate, it is clear that COVID-19 incidence and mortality have rapidly reinforced health disparities drawn by historical and contemporary inequities. Here, we synthesise the data highlighting specific risks among particular marginalised and under-resourced communities including those in jails, prisons and detention centers, immigrants and the undocumented, people with disabilities and people experiencing homelessness across the USA. The drivers of these disparities are pervasive structural risks including limited access to preventive services, inability to comply with physical distancing recommendations, underlying health disparities and intersecting stigmas particularly affecting racial and ethnic minorities across the country, including African Americans, Latinx Americans and Native Americans. Advancing the COVID-19 response, saving lives and restarting the economy necessitate rapidly addressing these inequities rather than ignoring and even reinforcing them.", "Racism and the Political Economy of COVID-19: Will We Continue to Resurrect the Past? COVID-19 is not spreading over a level playing field; structural racism is embedded within the fabric of American culture, infrastructure investments, and public policy, and fundamentally drives inequities. The same racism that has driven the systematic dismantling of the American social safety-net has also created the policy recipe for American structural vulnerability to the impacts of this and other pandemics. The Bronx provides an important case study for investigating the historical roots of structural inequities showcased by this pandemic; current lived experiences of Bronx residents are rooted in the racialized dismantling of New York City's public infrastructure and systematic disinvestment. The story of the Bronx is repeating itself, only this time with a novel virus. In order to address the root causes of inequities in cases and deaths due to COVID-19, we need to focus not just on restarting the economy, but on reimagining the economy, divesting of systems rooted in racism and the devaluation of Black and Brown lives.", "Americans\u2019 COVID-19 Stress, Coping, and Adherence to CDC Guidelines IMPORTANCE: Documenting Americans\u2019 stress responses to an unprecedented pandemic and their degree of adherence to CDC guidelines is essential for mental health interventions and policy-making. OBJECTIVE: To provide the first snapshot of immediate impact of COVID-19 on Americans\u2019 stress, coping, and guideline adherence. DESIGN: Data were collected from an online workers\u2019 platform for survey research (Amazon\u2019s Mechanical Turk) from April 7 to 9, 2020. The current data represents the baseline of a longitudinal study. Best practices for ensuring high-quality data were employed. PARTICIPANTS: Individuals who are 18 years of age or older, living in the USA, and English-speaking were eligible for the study. Of 1086 unique responses, 1015 completed responses are included. SETTING: Population-based. MAIN OUTCOMES: Exposure to and stressfulness of COVID-19 stressors, coping strategies, and adherence to CDC guidelines. RESULTS: The sample was 53.9% women (n = 547), with an average age of 38.9 years (SD = 13.50, range = 18\u201388), most of whom were White (n = 836, 82.4%), non-Hispanic (n = 929, 91.5%), and straight/heterosexual (n = 895, 88.2%); 40% were currently married (n = 407), and 21.6% (n = 219) were caregivers. About half (50.5%) endorsed having at least \u201cmostly\u201d enough money to meet their needs. Respondents\u2019 locations across the USA ranged from 18.5% in the Northeast to 37.8% in the South. The most commonly experienced stressors were reading/hearing about the severity and contagiousness of COVID-19, uncertainty about length of quarantine and social distancing requirements, and changes to social and daily personal care routines. Financial concerns were rated most stressful. Younger age, female gender, and caregiver status increased risk for stressor exposure and greater degree of stressfulness. The most frequently reported strategies to manage stress were distraction, active coping, and seeking emotional social support. CDC guideline adherence was generally high, but several key social distancing and hygiene behaviors showed suboptimal adherence, particularly for men and younger adults. CONCLUSIONS AND RELEVANCE: Americans have high COVID-19 stress exposure and some demographic subgroups appear particularly vulnerable to stress effects. Subgroups less likely to adhere to CDC guidelines may benefit from targeted information campaigns. these findings may guide mental health interventions and inform policy-making regarding implications of specific public health measures.", "Disparities in Coronavirus 2019 Reported Incidence, Knowledge, and Behavior Among US Adults Importance: Data from the coronavirus disease 2019 (COVID-19) pandemic in the US show large differences in hospitalizations and mortality across race and geography. However, there are limited data on health information, beliefs, and behaviors that might indicate different exposure to risk. Objective: To determine the association of sociodemographic characteristics with reported incidence, knowledge, and behavior regarding COVID-19 among US adults. Design, Setting, and Participants: A US national survey study was conducted from March 29 to April 13, 2020, to measure differences in knowledge, beliefs, and behavior about COVID-19. The survey oversampled COVID-19 hotspot areas. The survey was conducted electronically. The criteria for inclusion were age 18 years or older and residence in the US. Data analysis was performed in April 2020. Main Outcomes and Measures: The main outcomes were incidence, knowledge, and behaviors related to COVID-19 as measured by survey response. Results: The survey included 5198 individuals (mean [SD] age, 48 [18] years; 2336 men [45%]; 3759 white [72%], 830 [16%] African American, and 609 [12%] Hispanic). The largest differences in COVID-19-related knowledge and behaviors were associated with race/ethnicity, sex, and age, with African American participants, men, and people younger than 55 years showing less knowledge than other groups. African American respondents were 3.5 percentage points (95% CI, 1.5 to 5.5 percentage points; P = .001) more likely than white respondents to report being infected with COVID-19, as were men compared with women (3.2 percentage points; 95% CI, 2.0 to 4.4 percentage points; P < .001). Knowing someone who tested positive for COVID-19 was more common among African American respondents (7.2 percentage points; 95% CI, 3.4 to 10.9 percentage points; P < .001), people younger than 30 years (11.6 percentage points; 95% CI, 7.5 to 15.7 percentage points; P < .001), and people with higher incomes (coefficient on earning &#8805;$100\u00e2\u0080\u00af000, 12.3 percentage points; 95% CI, 8.7 to 15.8 percentage points; P < .001). Knowledge of potential fomite spread was lower among African American respondents (-9.4 percentage points; 95% CI, -13.1 to -5.7 percentage points; P < .001), Hispanic respondents (-4.8 percentage points; 95% CI, -8.9 to -0.77 percentage points; P = .02), and people younger than 30 years (-10.3 percentage points; 95% CI, -14.1 to -6.5 percentage points; P < .001). Similar gaps were found with respect to knowledge of COVID-19 symptoms and preventive behaviors. Conclusions and Relevance: In this survey study of US adults, there were gaps in reported incidence of COVID-19 and knowledge regarding its spread and symptoms and social distancing behavior. More effort is needed to increase accurate information and encourage appropriate behaviors among minority communities, men, and younger people.", "Identification of Vulnerable Populations and Areas at Higher Risk of COVID-19 Related Mortality in the U.S. Background The role of health-related disparities including sociodemographic, environmental, and critical care capacity in the COVID-19 pandemic are poorly understood. In the present study, we characterized vulnerable populations located in areas at higher risk of COVID-19 related mortality and low critical healthcare capacity in the U.S. Methods Using Bayesian multilevel analysis and small area disease risk mapping, we assessed the spatial variation of COVID-19 related mortality risk for the U.S. in relation with healthcare disparities including race, ethnicity, poverty, air quality, and critical healthcare capacity. Results Overall, highly populated, regional air hub areas, and minorities had an increased risk of COVID-19 related mortality. We found that with an increase of only 1 ug/m3 in long term PM2.5 exposure, the COVID-19 mortality rate increased by 13%. Counties with major air hubs had 18% increase in COVID-19 related death compared to counties with no airport connectivity. Sixty-eight percent of the counties with high COVID-19 related mortality risk were also counties with lower critical care capacity than national average. These counties were primary located at the North- and South-Eastern regions of the country. Conclusion The existing disparity in health and environmental risk factors that exacerbate the COVID-19 related mortality, along with the regional healthcare capacity, determine the vulnerability of populations to COVID-19 related mortality. The results from this study can be used to guide the development of strategies for the identification and targeting preventive strategies in vulnerable populations with a higher proportion of minority groups living in areas with poor air quality and low healthcare capacity.", "The COVID\u201019 Pandemic Illuminates Persistent and Emerging Disparities among Rural Black Populations ", "Ethnicity profiles of COVID-19 admissions and outcomes ", "Multivariate Analysis of Black Race and Environmental Temperature on COVID-19 In the US BACKGROUND: There has been much interest in environmental temperature and race as modulators of Coronavirus disease-19 (COVID-19) infection and mortality. However, in the United States race and temperature correlate with various other social determinants of health, comorbidities, and environmental influences that could be responsible for noted effects. This study investigates the independent effects of race and environmental temperature on COVID-19 incidence and mortality in United States counties. METHODS: Data on COVID-19 and risk factors in all United States counties was collected. 661 counties with at least 50 COVID-19 cases and 217 with at least 10 deaths were included in analyses. Upper and lower quartiles for cases/100,000 people and halves for deaths/100,000 people were compared with t-tests. Adjusted linear and logistic regression analyses were performed to evaluate the independent effects of race and environmental temperature. RESULTS: Multivariate regression analyses demonstrated Black race is a risk factor for increased COVID-19 cases (OR=1.22, 95% CI: 1.09-1.40, P=0.001) and deaths independent of comorbidities, poverty, access to health care, and other risk factors. Higher environmental temperature independently reduced caseload (OR=0.81, 95% CI: 0.71-0.91, P=0.0009), but not deaths. CONCLUSIONS: Higher environmental temperatures correlated with reduced COVID-19 cases, but this benefit does not yet appear in mortality models. Black race was an independent risk factor for increased COVID-19 cases and deaths. Thus, many proposed mechanisms through which Black race might increase risk for COVID-19, such as socioeconomic and healthcare-related predispositions, are inadequate in explaining the full magnitude of this health disparity.", "Covid-19 and Inequity: A comparative spatial analysis of New York City and Chicago hot spots There have been numerous reports that the impact of the ongoing COVID-19 epidemic has disproportionately impacted traditionally vulnerable communities, including well-researched social determinants of health, such as racial and ethnic minorities, migrants, and the economically challenged. The goal of this ecological cross-sectional study is to examine the demographic and economic nature of spatial hot and cold spots of SARS-CoV-2 rates in New York City and Chicago as of April 13, 2020. In both cities, cold spots (clusters of low SARS-CoV-2 rate ZIP code tabulation areas) demonstrated typical protective factors associated with the social determinants of health and the ability to social distance. These neighborhoods tended to be wealthier, have higher educational attainment, higher proportions of non-Hispanic white residents, and more workers in managerial occupations. Hot spots (clusters of high SARS-CoV-2 rate ZIP code tabulation areas) also had similarities, such as lower rates of college graduates and higher proportions of people of color. It also appears to be larger households (more people per household), rather than overall population density, that may to be a more strongly associated with hot spots. Findings suggest important differences between the cities' hot spots as well. They can be generalized by describing the NYC hot spots as working-class and middle-income communities, perhaps indicative of service workers and other occupations (including those classified as \"essential services\" during the pandemic) that may not require a college degree but pay wages above poverty levels. Chicago's hot spot neighborhoods, on the other hand, are among the city's most vulnerable, low-income neighborhoods with extremely high rates of poverty, unemployment, and non-Hispanic Black residents.", "U.S. county-level characteristics to inform equitable COVID-19 response BACKGROUND: The spread of Coronavirus Disease 2019 (COVID-19) across the United States confirms that not all Americans are equally at risk of infection, severe disease, or mortality. A range of intersecting biological, demographic, and socioeconomic factors are likely to determine an individual\u2019s susceptibility to COVID-19. These factors vary significantly across counties in the United States, and often reflect the structural inequities in our society. Recognizing this vast inter-county variation in risks will be critical to mounting an adequate response strategy. METHODS AND FINDINGS: Using publicly available county-specific data we identified key biological, demographic, and socioeconomic factors influencing susceptibility to COVID-19, guided by international experiences and consideration of epidemiological parameters of importance. We created bivariate county-level maps to summarize examples of key relationships across these categories, grouping age and poverty; comorbidities and lack of health insurance; proximity, density and bed capacity; and race and ethnicity, and premature death. We have also made available an interactive online tool that allows public health officials to query risk factors most relevant to their local context. Our data demonstrate significant inter-county variation in key epidemiological risk factors, with a clustering of counties in certain states, which will result in an increased demand on their public health system. While the East and West coast cities are particularly vulnerable owing to their densities (and travel routes), a large number of counties in the Southeastern states have a high proportion of at-risk populations, with high levels of poverty, comorbidities, and premature death at baseline, and low levels of health insurance coverage. The list of variables we have examined is by no means comprehensive, and several of them are interrelated and magnify underlying vulnerabilities. The online tool allows readers to explore additional combinations of risk factors, set categorical thresholds for each covariate, and filter counties above different population thresholds. CONCLUSION: COVID-19 responses and decision making in the United States remain decentralized. Both the federal and state governments will benefit from recognizing high intra-state, inter-county variation in population risks and response capacity. Many of the factors that are likely to exacerbate the burden of COVID-19 and the demand on healthcare systems are the compounded result of long-standing structural inequalities in US society. Strategies to protect those in the most vulnerable counties will require urgent measures to better support communities\u2019 attempts at social distancing and to accelerate cooperation across jurisdictions to supply personnel and equipment to counties that will experience high demand.", "For us, COVID\u201019 is personal We are colleagues and friends working together in busy emergency departments in Washington DC. As Black physicians working in urban America, we do not find the recent deluge of news reports chronicling the disproportionate effect that the coronavirus disease (COVID\u201019) pandemic is having on the disenfranchised and minority populations in our country shocking. We have long been witness to and are in a constant state of alarm over the legal, medical, educational, social and economic inequities faced by the most vulnerable residents of this country.", "COVID 19: Surgery & the question of race ", "Infection and mortality of healthcare workers worldwide from COVID-19: a scoping review Objectives To estimate COVID-19 infections and deaths in healthcare workers (HCWs) from a global perspective. Design Scoping review. Methods Two parallel searches of academic bibliographic databases and grey literature were undertaken. Governments were also contacted for further information where possible. Due to the time-sensitive nature of the review and the need to report the most up-to-date information for an ever-evolving situation, there were no restrictions on language, information sources utilised, publication status, and types of sources of evidence. The AACODS checklist was used to appraise each source of evidence. Outcome measures Publication characteristics, country-specific data points, COVID-19 specific data, demographics of affected HCWs, and public health measures employed Results A total of 152,888 infections and 1413 deaths were reported. Infections were mainly in women (71.6%) and nurses (38.6%), but deaths were mainly in men (70.8%) and doctors (51.4%). Limited data suggested that general practitioners and mental health nurses were the highest risk specialities for deaths. There were 37.17 deaths reported per 100 infections for healthcare workers aged over 70. Europe had the highest absolute numbers of reported infections (119628) and deaths (712), but the Eastern Mediterranean region had the highest number of reported deaths per 100 infections (5.7). Conclusions HCW COVID-19 infections and deaths follow that of the general world population. The reasons for gender and speciality differences require further exploration, as do the low rates reported from Africa and India. Although physicians working in certain specialities may be considered high-risk due to exposure to oronasal secretions, the risk to other specialities must not be underestimated. Elderly HCWs may require assigning to less risky settings such as telemedicine, or administrative positions. Our pragmatic approach provides general trends, and highlights the need for universal guidelines for testing and reporting of infections in HCWs.", "The Impact of the COVID-19 Pandemic on Vulnerable Older Adults in the United States. ", "Updated estimates of comorbidities associated with risk for COVID-19 complications based on US data We updated previous estimates (wwwnc.cdc.gov/eid/article/26/8/20-0679_article) of adults with any underlying condition increasing risk of complications from COVID-19 using recent US hospitalization data instead of mortality data from China. This substitutes obesity for cancer in the definition and increased the percentage of adults reporting more than 1 condition to 56.0% (95% CI 55.7-56.4). When controlled for all measures listed, factors increasing odds of reporting any of the underlying conditions include being male, older, African American, American Indian, household income <$25,000, < high school education, underinsurance, living in the South or Midwest (vs. West), plus the risk factors of ever smoking, sedentary lifestyle, and inadequate fruit and vegetable consumption. Population-attributable risk for the listed risk factors was 13.0%, 12.6%, and 15.0% respectively. Results have potential implications for policies based on risk-stratification of the population and for improvement of risk status through lifestyle change. National support for a health promotion campaign would be timely.", "Genetic Epidemiology of Acute Respiratory Distress Syndrome: Implications for Future Prevention and Treatment The genetic susceptibility to the development of and variable outcomes in acute lung injury/acute respiratory distress syndrome (ALI/ARDS) has become a topic of great interest in the pulmonary and critical care community. Published studies of variable genetic susceptibility to ALI/ARDS already have identified some important candidate genes and potential gene-environment interactions. This article reviews these recent studies, features of the current approach, and implications for future prevention and treatment in ALI. The challenges and potential contributions of genetic epidemiology to the future prevention and treatment in ALI are discussed.", "Are Clinicians Contributing to Excess African American COVID-19 Deaths? Unbeknownst to Them, They May Be African Americans are overrepresented among reported coronavirus disease 2019 (COVID-19) cases and deaths. There are a multitude of factors that may explain the African American disparity in COVID-19 outcomes, including higher rates of comorbidities. While individual-level factors predictably contribute to disparate COVID-19 outcomes, systematic and structural factors have not yet been reported. It stands to reason that implicit biases may fuel the racial disparity in COVID-19 outcomes. To address this racial disparity, we must apply a health equity lens and disaggregate data explicitly for African Americans, as well as other populations at risk for biased treatment in the health-care system.", "COVID-19 pandemic - an African perspective The recently emerged novel coronavirus, \"severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)\", caused a highly contagious disease called coronavirus disease 2019 (COVID-19). The virus was first reported from Wuhan city in China in December, 2019, which in less than three months spread throughout the globe and was declared a global pandemic by the World Health Organization (WHO) on 11th of March, 2020. So far, the ongoing pandemic severely damaged the world's most developed countries and is becoming a major threat for low- and middle-income countries. The poorest continent, Africa with the most vulnerable populations to infectious diseases, is predicted to be significantly affected by the ongoing COVID-19 outbreak. Therefore, in this review we collected and summarized the currently available literature on the epidemiology, etiology, vulnerability, preparedness and economic impact of COVID-19 in Africa, which could be useful and provide necessary information on ongoing COVID-19 pandemics in the continent. We also briefly summarized the concomitance of the COVID-19 pandemic and global warming.", "Serum ferritin as an independent risk factor for severity in COVID-19 patients ", "The fire this time: The stress of racism, inflammation and COVID-19 ", "Scarce resource allocation scores threaten to exacerbate racial disparities in healthcare. ", "Why African Americans Are a Potential Target for COVID-19 Infection in the United States Since the World Health Organization declared the coronavirus disease (COVID-19) outbreak a pandemic, significant changes have occurred in the United States as the infection spread reached and passed its exponential phase. A stringent analysis of COVID-19 epidemiologic data requires time and would generally be expected to happen with significant delay after the exponential phase of the disease is over and when the focus of the health care system is diverted away from crisis management. Although much has been said about high-risk groups and the vulnerability of the elderly and patients with underlying comorbidities, the impact of race on the susceptibility of ethnic minorities living in indigent communities has not been discussed in detail worldwide and specifically in the United States. There are currently some data on disparities between African American and Caucasian populations for COVID-19 infection and mortality. While health care authorities are reorganizing resources and infrastructure to provide care for symptomatic COVID-19 patients, they should not shy away from protecting the general public as a whole and specifically the most vulnerable members of society, such as the elderly, ethnic minorities, and people with underlying comorbidities.", "Continuity of Care and Outpatient Management for Patients with and at High Risk for Cardiovascular Disease during the COVID-19 Pandemic: A Scientific Statement from the American Society for Preventive Cardiology Abstract The coronavirus disease 2019 (COVID-19) pandemic has consumed our healthcare system, with immediate resource focus on the management of high numbers of critically ill patients. Those that fare poorly with COVID-19 infection more commonly have cardiovascular disease (CVD), hypertension and diabetes. There are also several other conditions that raise concern for the welfare of patients with and at high risk for CVD during this pandemic. Traditional ambulatory care is disrupted and many patients are delaying or deferring necessary care, including preventive care. New impediments to medication access and adherence have arisen. Social distancing measures can increase social isolation and alter physical activity and nutrition patterns. Virtually all facility based cardiac rehabilitation programs have temporarily closed. If not promptly addressed, these changes may result in delayed waves of vulnerable patients presenting for urgent and preventable CVD events. Here, we provide several recommendations to mitigate the adverse effects of these disruptions in outpatient care. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers should be continued in patients already taking these medications. Where possible, it is strongly preferred to continue visits via telehealth, and patients should be counselled about promptly reporting new symptoms. Barriers to medication access should be reviewed with patients at every contact, with implementation of strategies to ensure ongoing provision of medications. Team-based care should be leveraged to enhance the continuity of care and adherence to lifestyle recommendations. Patient encounters should include discussion of safe physical activity options and access to healthy food choices. Implementation of adaptive strategies for cardiac rehabilitation is recommended, including home based cardiac rehab, to ensure continuity of this essential service. While the practical implementation of these strategies will vary by local situation, there are a broad range of strategies available to ensure ongoing continuity of care and health preservation for those at higher risk of CVD during the COVID-19 pandemic.", "This Time Must Be Different: Disparities During the COVID-19 Pandemic ", "Prevalence of regular physical activity among adults--United States, 2001 and 2005. Regular physical activity is associated with decreased risk for obesity, heart disease, hypertension, diabetes, certain cancers, and premature mortality. CDC and the American College of Sports Medicine recommend that adults engage in at least 30 minutes of moderate physical activity on most days and preferably on all days. Healthy People 2010 objectives include increasing the proportion of adults who engage regularly in moderate or vigorous activity to at least 50% (objective 22-2). In addition, reducing racial and ethnic health disparities, including disparities in physical activity, is an overarching national goal. To examine changes in the prevalence of regular, leisure-time, physical activity from 2001 to 2005, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicated that, from 2001 to 2005, the prevalence of regular physical activity increased 8.6% among women overall (from 43.0% to 46.7%) and 3.5% among men (from 48.0% to 49.7%). In addition, the prevalence of regular physical activity increased 15.0% (from 31.4% to 36.1%) among non-Hispanic black women and 12.4% (from 40.3% to 45.3%) among non-Hispanic black men, slightly narrowing previous racial disparities when compared with increases of 7.8% (from 46.0% to 49.6%) for white women and 3.4% (from 50.6% to 52.3%) for white men, respectively. CDC, state and local public health agencies, and other public health partners should continue to implement evidence-based, culturally appropriate initiatives to further increase physical-activity levels among all adults, with special focus on eliminating racial/ethnic disparities.", "For us, COVID-19 is personal We are colleagues and friends working together in busy emergency departments in Washington DC. As Black physicians working in urban America, we do not find the recent deluge of news reports chronicling the disproportionate effect that the coronavirus disease (COVID-19) pandemic is having on the disenfranchised and minority populations in our country shocking. We have long been witness to and are in a constant state of alarm over the legal, medical, educational, social and economic inequities faced by the most vulnerable residents of this country.", "Characteristics and Outcomes of COVID-19 Patients in New York City's Public Hospital System Background New York City (NYC) has borne the greatest burden of COVID-19 in the United States, but information about characteristics and outcomes of racially/ethnically diverse individuals tested and hospitalized for COVID-19 remains limited. In this case series, we describe characteristics and outcomes of patients tested for and hospitalized with COVID-19 in New York City's public hospital system. Methods We reviewed the electronic health records of all patients who received a SARS-CoV-2 test between March 5 and April 9, 2020, with follow up through April 16, 2020. The primary outcomes were a positive test, hospitalization, and death. Demographics and comorbidities were also assessed. Results 22254 patients were tested for SARS-CoV-2. 13442 (61%) were positive; among those, the median age was 52.7 years (interquartile range [IQR] 39.5-64.5), 7481 (56%) were male, 3518 (26%) were Black, and 4593 (34%) were Hispanic. Nearly half (4669, 46%) had at least one chronic disease (27% diabetes, 30% hypertension, and 21% cardiovascular disease). Of those testing positive, 6248 (46%) were hospitalized. The median age was 61.6 years (IQR 49.7-72.9); 3851 (62%) were male, 1950 (31%) were Black, and 2102 (34%) were Hispanic. More than half (3269, 53%) had at least one chronic disease (33% diabetes, 37% hypertension, 24% cardiovascular disease, 11% chronic kidney disease). 1724 (28%) hospitalized patients died. The median age was 71.0 years (IQR 60.0, 80.9); 1087 (63%) were male, 506 (29%) were Black, and 528 (31%) were Hispanic. Chronic diseases were common (35% diabetes, 37% hypertension, 28% cardiovascular disease, 15% chronic kidney disease). Male sex, older age, diabetes, cardiac history, and chronic kidney disease were significantly associated with testing positive, hospitalization, and death. Racial/ethnic disparities were observed across all outcomes. Conclusions and Relevance This is the largest and most racially/ethnically diverse case series of patients tested and hospitalized for COVID-19 in the United States to date. Our findings highlight disparities in outcomes that can inform prevention and testing recommendations.", "Impact of Social Vulnerability on COVID-19 Incidence and Outcomes in the United States Importance: Prior pandemics have disparately affected socially vulnerable communities. Whether regional variations in social vulnerability to disasters influence COVID-19 outcomes and incidence in the U.S. is unknown. Objective: To examine the association of Social Vulnerability Index (SVI), a percentile-based measure of county-level social vulnerability to disasters, and its sub-components (socioeconomic status, household composition, minority status, and housing type/transportation accessibility) with the case fatality rate (CFR) and incidence of COVID-19. Design: Ecological study of counties with at least 50 confirmed COVID-19 cases as of April 4th, 2020. Generalized linear mixed-effects models with state-level clustering were applied to estimate county-level associations of overall SVI and its sub-component scores with COVID-19 CFR (deaths/100 cases) and incidence (cases/1000 population), adjusting for population percentage aged >65 years, and for comorbidities using the average Hierarchical Condition Category (HCC) score. Counties with high SVI (\u2265median) and high CFR (\u2265median) were identified. Setting: Population-based study of U.S. county-level data. Participants: U.S. counties with at least 50 confirmed COVID-19 cases. Main outcomes and measures: COVID-19 CFR and incidence. Results: Data from 433 counties including 283,256 cases and 6,644 deaths were analyzed. Median SVI was 0.46 [Range: 0.01-1.00], and median CFR and incidence were 1.9% [Range: 0-13.3] and 1.2 per 1000 people [Range: 0.6-38.8], respectively. Higher SVI, indicative of greater social vulnerability, was associated with higher CFR (RR: 1.19 [1.05, 1.34], p=0.005, per-1% increase), an association that strengthened after adjustment for age>65 years and comorbidities (RR: 1.63 [1.38, 1.91], p<0.001), and was further confirmed in a sensitivity analysis limited to six states with the highest testing levels. Although the association between overall SVI and COVID-19 incidence was not significant, the SVI sub-components of socioeconomic status and minority status were both predictors of higher incidence and CFR. A combination of high SVI (\u22650.46) and high adjusted CFR (\u22652.3%) was observed in 28.9% of counties. Conclusions and Relevance: Social vulnerability is associated with higher COVID-19 case fatality. High social vulnerability and CFR coexist in more than 1 in 4 U.S. counties. These counties should be targeted by public policy interventions to help alleviate the pandemic burden on the most vulnerable population.", "Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: indirect standardisation of NHS mortality data Background: International and UK data suggest that Black, Asian and Minority Ethnic (BAME) groups are at increased risk of infection and death from COVID-19. We aimed to explore the risk of death in minority ethnic groups in England using data reported by NHS England. Methods: We used NHS data on patients with a positive COVID-19 test who died in hospitals in England published on 28th April, with deaths by ethnicity available from 1st March 2020 up to 5pm on 21 April 2020. We undertook indirect standardisation of these data (using the whole population of England as the reference) to produce ethnic specific standardised mortality ratios (SMRs) adjusted for age and geographical region. Results: The largest total number of deaths in minority ethnic groups were Indian (492 deaths) and Black Caribbean (460 deaths) groups. Adjusting for region we found a lower risk of death for White Irish (SMR 0.52; 95%CIs 0.45-0.60) and White British ethnic groups (0.88; 95%CIs 0.86-0.0.89), but increased risk of death for Black African (3.24; 95%CIs 2.90-3.62), Black Caribbean (2.21; 95%CIs 2.02-2.41), Pakistani (3.29; 95%CIs 2.96-3.64), Bangladeshi (2.41; 95%CIs 1.98-2.91) and Indian (1.70; 95%CIs 1.56-1.85) minority ethnic groups. Conclusion: Our analysis adds to the evidence that BAME people are at increased risk of death from COVID-19 even after adjusting for geographical region. We believe there is an urgent need to take action to reduce the risk of death for BAME groups and better understand why some ethnic groups experience greater risk. Actions that are likely to reduce these inequities include ensuring adequate income protection (so that low paid and zero-hours contract workers can afford to follow social distancing recommendations), reducing occupational risks (such as ensuring adequate personal protective equipment), reducing barriers in accessing healthcare and providing culturally and linguistically appropriate public health communications.", "Vitamin D Insufficiency is Prevalent in Severe COVID-19 Background: COVID-19 is a major pandemic that has killed more than 196,000 people. The COVID-19 disease course is strikingly divergent. Approximately 80-85% of patients experience mild or no symptoms, while the remainder develop severe disease. The mechanisms underlying these divergent outcomes are unclear. Emerging health disparities data regarding African American and homeless populations suggest that vitamin D insufficiency (VDI) may be an underlying driver of COVID-19 severity. To better define the VDI-COVID-19 link, we determined the prevalence of VDI among our COVID-19 intensive care unit (ICU) patients. Methods: In an Institutional Review Board approved study performed at a single, tertiary care academic medical center, the medical records of COVID-19 patients were retrospectively reviewed. Subjects were included for whom serum 25-hydroxycholecalcifoerol (25OHD) levels were determined. COVID-19-relevant data were compiled and analyzed. We determined the frequency of VDI among COVID-19 patients to evaluate the likelihood of a VDI-COVID-19 relationship. Results: Twenty COVID-19 patients with serum 25OHD levels were identified; 65.0% required ICU admission.The VDI prevalence in ICU patients was 84.6%, vs. 57.1% in floor patients. Strikingly, 100% of ICU patients less than 75 years old had VDI. Coagulopathy was present in 62.5% of ICU COVID-19 patients, and 92.3% were lymphocytopenic. Conclusions: VDI is highly prevalent in severe COVID-19 patients. VDI and severe COVID-19 share numerous associations including hypertension, obesity, male sex, advanced age, concentration in northern climates, coagulopathy, and immune dysfunction. Thus, we suggest that prospective, randomized controlled studies of VDI in COVID-19 patients are warranted.", "Coronavirus Disease among Persons with Sickle Cell Disease, United States, March 20-May 21, 2020 Sickle cell disease (SCD) disproportionately affects Black or African American persons in the United States and can cause multisystem organ damage and reduced lifespan. Among 178 persons with SCD in the United States who were reported to an SCD-coronavirus disease case registry, 122 (69%) were hospitalized and 13 (7%) died.", "COVID-19 in the Americas: Who\u2019s Looking After Refugees and Migrants? Several characteristics of refugee and migrant populations make them susceptible to acquire COVID-19. To fully understand the impact of COVID-19 on refugees and migrants in the Americas, it is important to consider the broader geopolitical context and appreciate the differences among migratory groups. There are three migrant groups in the Americas that are particularly susceptible to COVID-19: Central American migrants at the northern Mexico border, Venezuelans within South America, and Haitians in the Dominican Republic. Refugees and displaced migrants are the world\u2019s collective responsibility, and thus, it would be imprudent to displace their care to resource constrained developing nations.", "COVID-19: Magnifying the Effect of Health Disparities ", "Disproportionate incidence of COVID-19 in African Americans correlates with dynamic segregation Socio-economic disparities quite often have a central role in the unfolding of large-scale catastrophic events. One of the most concerning aspects of the ongoing COVID-19 pandemics is that it disproportionately affects people from Black and African American backgrounds creating an unexpected infection gap. Interestingly, the abnormal impact on these ethnic groups seem to be almost uncorrelated with other risk factors, including co-morbidity, poverty, level of education, access to healthcare, residential segregation, and response to cures. A proposed explanation for the observed incidence gap is that people from African American backgrounds are more often employed in low-income service jobs, and are thus more exposed to infection through face-to-face contacts, but the lack of direct data has not allowed to draw strong conclusions in this sense so far. Here we introduce the concept of dynamic segregation, that is the extent to which a given group of people is internally clustered or exposed to other groups, as a result of mobility and commuting habits. By analysing census and mobility data on more than 120 major US cities, we found that the dynamic segregation of African American communities is significantly associated with the weekly excess COVID-19 incidence and mortality in those communities. The results confirm that knowing where people commute to, rather than where they live, is much more relevant for disease modelling.", "COVID-19 and the Widening Gap in Health Inequity The coronavirus disease 2019 (COVID-19) pandemic has brought to light significant health inequities that have existed in our society for decades. Blacks, Hispanics, Native Americans, and immigrants are the populations most likely to experience disparities related to burden of disease, health care, and health outcomes. Increasingly, national and state statistics on COVID-19 report disproportionately higher mortality rates in blacks. There has never been a more pressing time for us to enact progressive and far-reaching changes in social, economic, and political policies that will shape programs aimed at improving the health of all people living in the United States.", "Structural Vulnerability in the United States Revealed in Three Waves of Novel Coronavirus Disease (COVID-19) The novel coronavirus disease (COVID-19) pandemic has unveiled underlying health inequities throughout the United States. The pandemic has spread across U.S. states, affecting different vulnerable populations, including both inner-city and rural populations, and those living in congregate settings such as nursing homes and assisted-living facilities. In addition, since early April, there has been an increasing number of outbreaks of COVID-19 in jails and prisons. We describe three overlapping epidemiologic waves of spread of COVID-19 linked to three different kinds of structural vulnerabilities.", "Ethnic and socioeconomic differences in SARS-CoV2 infection in the UK Biobank cohort study Background Understanding of the role of ethnicity and socioeconomic position in the risk of developing SARS-CoV-2 infection is limited. We investigated this in the UK Biobank study. Methods The UK Biobank study recruited 40-70 year olds in 2006-2010 from the general population, collecting information about self-defined ethnicity and socioeconomic variables (including Townsend deprivation index and educational attainment). SARS-CoV-2 test results from Public Health England were linked to baseline UK Biobank data. Poisson regression with robust standard errors was used to assess risk ratios (RRs) between the exposures and dichotomous variables for: being tested, having a positive test and testing positive in hospital. We also investigated whether ethnicity and socioeconomic position were associated with having a positive test amongst those tested. We adjusted for covariates including age, sex, social variables (including healthcare work and household size), behavioural risk factors and baseline health. Findings Among 428,225 participants, 1,474 had been tested and 669 had tested positive between 16 March and 13 April 2020. Black, south Asian and white Irish people were more likely to have confirmed infection (RR 4.01 (95%CI 2.92-5.12); RR 2.11 (95%CI 1.43-3.10); and RR 1.60 (95% CI 1.08-2.38) respectively) and were more likely to be hospitalised compared to White British. While they were more likely to be tested, they were also more likely to test positive. Adjustment for baseline health and behavioural risk factors led to little change, with only modest attenuation when accounting for socioeconomic variables. Area socioeconomic deprivation and having no qualifications were consistently associated with a higher risk of confirmed infection (RR 1.91 (95%CI 1.53-2.38); and RR 2.26 (95%CI 1.76-2.90) respectively). Interpretation Some minority ethnic groups have a higher risk of confirmed SARS-CoV-2 infection in the UK Biobank study which was not accounted for by differences in socioeconomic conditions, measured baseline health or behavioural risk factors. An urgent response to addressing these elevated risks is required. Funding Medical Research Council, Chief Scientist Office.", "Racial Capitalism within Public Health: How Occupational Settings Drive COVID-19 Disparities Epidemiology of the U.S. COVID-19 outbreak focuses on individuals\u2019 biology and behaviors, despite centrality of occupational environments in the viral spread. This demonstrates collusion between epidemiology and racial capitalism because it obscures structural influences, absolving industries of responsibility for worker safety. In an empirical example, we analyze economic implications of race-based metrics widely used in occupational epidemiology. In the U.S., White adults have better average lung function and worse hearing than Black adults. Both impaired lung function and hearing are criteria for Worker\u2019s compensation, which is ultimately paid by industry. Compensation for respiratory injury is determined using a race-specific algorithm. For hearing, there is no race adjustment. Selective use of race-specific algorithms for workers\u2019 compensation reduces industries\u2019 liability for worker health, illustrating racial capitalism operating within public health. Widespread and unexamined belief in inherent physiological inferiority of Black Americans perpetuates systems that limit industry payouts for workplace injuries. We see a parallel in the epidemiology of COVID-19 disparities. We tell stories of industries implicated in the outbreak and review how they exemplify racial capitalism. We call on public health professionals to: critically evaluate who is served and neglected by data analysis; and center structural determinants of health in etiological evaluation.", "COVID-19: Unique public health issues facing Black, Asian and minority ethnic communities The 2019 coronavirus disease is a serious public health emergency, with serious adverse implications for populations, healthcare systems, and economies globally. Recently, concerns have been raised about possible association between ethnicity, incidence and outcomes of COVID-19 arisen from early government data. In this review, we will explore the possible association using both recent COVID-19 studies and studies of previous pandemics. We call for data on ethnicity to be routinely collected by governments, as part of an international collaboration, alongside other patient demographics and further research to robustly determine the magnitude of association. Moreover, governments must learn from previous pandemics and recommended strategies to mitigate risks on minority ethnicities due to socioeconomic disadvantages.", "Pseudo-Likelihood Based Logistic Regression for Estimating COVID-19 Infection and Case Fatality Rates by Gender, Race, and Age in California In emerging epidemics, early estimates of key epidemiological characteristics of the disease are critical for guiding public policy. In particular, identifying high risk population subgroups aids policymakers and health officials in combatting the epidemic. This has been challenging during the coronavirus disease 2019 (COVID-19) pandemic, because governmental agencies typically release aggregate COVID-19 data as marginal summary statistics of patient demographics. These data may identify disparities in COVID-19 outcomes between broad population subgroups, but do not provide comparisons between more granular population subgroups defined by combinations of multiple demographics. We introduce a method that overcomes the limitations of aggregated summary statistics and yields estimates of COVID-19 infection and case fatality rates --- key quantities for guiding public policy related to the control and prevention of COVID-19 --- for population subgroups across combinations of demographic characteristics. Our approach uses pseudo-likelihood based logistic regression to combine aggregate COVID-19 case and fatality data with population-level demographic survey data to estimate infection and case fatality rates for population subgroups across combinations of demographic characteristics. We illustrate our method on California COVID-19 data to estimate test-based infection and case fatality rates for population subgroups defined by gender, age, and race and ethnicity. Our analysis indicates that in California, males have higher test-based infection rates and test-based case fatality rates across age and race/ethnicity groups, with the gender gap widening with increasing age. Although elderly infected with COVID-19 are at an elevated risk of mortality, the test-based infection rates do not increase monotonically with age. LatinX and African Americans have higher test-based infection rates than other race/ethnicity groups. The subgroups with the highest 5 test-based case fatality rates are African American male, Multi-race male, Asian male, African American female, and American Indian or Alaska Native male, indicating that African Americans are an especially vulnerable California subpopulation.", "Outcomes and Cardiovascular Comorbidities in a Predominantly African-American Population with COVID-19 Importance: Racial disparities in COVID-19 outcomes have been amplified during this pandemic and reports on outcomes in African-American (AA) populations, known to have higher rates of cardiovascular (CV) comorbidities, remain limited. Objective: To examine prevalence of comorbidities, rates of hospitalization and survival, and incidence of CV manifestations of COVID-19 in a predominantly AA population in south metropolitan Chicago. Design, Setting, Participants: This was an observational cohort study of COVID-19 patients encountered from March 16 to April 16, 2020 at the University of Chicago. Deidentified data were obtained from an institutional data warehouse. Group comparisons and logistic regression modeling based on baseline demographics, clinical characteristics, laboratory and diagnostic testing was performed. Exposures: COVID-19 was diagnosed by nasopharyngeal swab testing and clinical management was at the discretion of treating physicians. Main Outcomes and Measures: Primary outcomes were hospitalization and in-hospital mortality, and secondary outcomes included incident CV manifestations of COVID-19 in the context of overall cardiology service utilization. Results: During the 30 day study period, 1008 patients tested positive for COVID-19 and 689 had available encounter data. Of these, 596 (87%) were AA and 356 (52%) were hospitalized, of which 319 (90%) were AA. Age > 60 years, tobacco use, BMI >40 kg/m2, diabetes mellitus (DM), insulin use, hypertension, chronic kidney disease, coronary artery disease (CAD), and atrial fibrillation (AF) were more common in hospitalized patients. Age > 60 years, tobacco use, CAD, and AF were associated with greater risk of in-hospital mortality along with several elevated initial laboratory markers including troponin, NT-proBNP, blood urea nitrogen, and ferritin. Despite this, cardiac manifestations of COVID-19 were uncommon, coincident with a 69% decrease in cardiology service utilization. For hospitalized patients, median length of stay was 6.2 days (3.4-11.9 days) and mortality was 13%. AA patients were more commonly hospitalized, but without increased mortality. Conclusions and Relevance: In this AA-predominant experience from south metropolitan Chicago, CV comorbidities and chronic diseases were highly prevalent and associated with increased hospitalization and mortality. Insulin-requiring DM and CKD emerged as novel predictors for hospitalization. Despite the highest rate of comorbidities reported to date, CV manifestations of COVID-19 and mortality were relatively low. The unexpectedly low rate of mortality merits further study.", "When Public Health Crises Collide: Social Disparities and COVID\u201019 In To Have or to Be?, psychoanalyst Erich Fromm writes about pursuit after domination of nature, material abundance, and unlimited happiness, which made modern society become more interested in having than in being. Income, in his view, should not be as accentuated as to create different experiences of life for different groups [1]. Of the concepts that Fromm presents, the domination of nature, which facilitates zoonotic spillover events by increasing the overlap between the habitat of various species with that of humans [2\u20105], and the gap between the rich and the poor, which recently has become the widest in years [6], become particularly relevant in context of the COVID\u201019 pandemic.", "COVID\u201019: Shedding light on racial and health inequities in the USA The sudden and rapid advancement of the novel Coronavirus (COVID-19) pandemic has led to an unanticipated and unprecedented global crisis. Since its emergence in the United States, there is increasing discussion surrounding the impact of the virus among vulnerable populations. Older adults, young children, and persons with chronic medical or mental health conditions, persons with disabilities, pregnant women, immunocompromised persons and those who are institutionalized or homeless are considered most vulnerable to death and lost quality of life (World Health Organization, 2020).", "Community Outreach Panel Explores and Addresses Higher Rates of COVID-19\u2013Related Deaths in the African American Population ", "Black, Asian and Minority Ethnic groups in England are at increased risk of death from COVID-19: indirect standardisation of NHS mortality data. Background: International and UK data suggest that Black, Asian and Minority Ethnic (BAME) groups are at increased risk of infection and death from COVID-19. We aimed to explore the risk of death in minority ethnic groups in England using data reported by NHS England. Methods: We used NHS data on patients with a positive COVID-19 test who died in hospitals in England published on 28th April, with deaths by ethnicity available from 1st March 2020 up to 5pm on 21 April 2020. We undertook indirect standardisation of these data (using the whole population of England as the reference) to produce ethnic specific standardised mortality ratios (SMRs) adjusted for age and geographical region. Results: The largest total number of deaths in minority ethnic groups were Indian (492 deaths) and Black Caribbean (460 deaths) groups. Adjusting for region we found a lower risk of death for White Irish (SMR 0.52; 95%CIs 0.45-0.60) and White British ethnic groups (0.88; 95%CIs 0.86-0.0.89), but increased risk of death for Black African (3.24; 95%CIs 2.90-3.62), Black Caribbean (2.21; 95%CIs 2.02-2.41), Pakistani (3.29; 95%CIs 2.96-3.64), Bangladeshi (2.41; 95%CIs 1.98-2.91) and Indian (1.70; 95%CIs 1.56-1.85) minority ethnic groups. Conclusion: Our analysis adds to the evidence that BAME people are at increased risk of death from COVID-19 even after adjusting for geographical region, but was limited by the lack of data on deaths outside of NHS settings and ethnicity denominator data being based on the 2011 census. Despite these limitations, we believe there is an urgent need to take action to reduce the risk of death for BAME groups and better understand why some ethnic groups experience greater risk. Actions that are likely to reduce these inequities include ensuring adequate income protection, reducing occupational risks, reducing barriers in accessing healthcare and providing culturally and linguistically appropriate public health communications.", "Unequal Distribution of COVID\u201019 Risk among Rural Residents by Race and Ethnicity ", "Tracking the Effect of the COVID-19 Pandemic on American Households Since March 10, 2020, we have been tracking effects of the COVID-19 pandemic on respondents to the nationally representative Understanding America Study (UAS). After an initial survey that covered March 10\u201331, 2020, we launched tracking surveys every two weeks. Every day, about 500 respondents are invited to take the survey for a total of about 7,000 respondents over a two-week period. Results are shared in a variety of ways. About 3,000 graphs are updated every night, with the corresponding tab-delimited text files available for download. The underlying micro-data are available for registered researchers after the end of each four-week field period. The paper describes the set-up of the tracking survey, lists the main topics covered and highlights a number or early results. Our ambition is to keep tracking the experiences of U.S. households for as along as the pandemic lasts.", "Hemorrhagic Fever-Causing Arenaviruses: Lethal Pathogens and Potent Immune Suppressors Hemorrhagic fevers (HF) resulting from pathogenic arenaviral infections have traditionally been neglected as tropical diseases primarily affecting African and South American regions. There are currently no FDA-approved vaccines for arenaviruses, and treatments have been limited to supportive therapy and use of non-specific nucleoside analogs, such as Ribavirin. Outbreaks of arenaviral infections have been limited to certain geographic areas that are endemic but known cases of exportation of arenaviruses from endemic regions and socioeconomic challenges for local control of rodent reservoirs raise serious concerns about the potential for larger outbreaks in the future. This review synthesizes current knowledge about arenaviral evolution, ecology, transmission patterns, life cycle, modulation of host immunity, disease pathogenesis, as well as discusses recent development of preventative and therapeutic pursuits against this group of deadly viral pathogens.", "Coronavirus disease 19 in minority populations of Newark, New Jersey BACKGROUND: The purpose of this study is to report the clinical features and outcomes of Black/African American (AA) and Latino Hispanic patients with Coronavirus disease 2019 (COVID-19) hospitalized in an inter-city hospital in the state of New Jersey. METHODS: This is a retrospective cohort study of AA and Latino Hispanic patients with COVID-19 admitted to a 665-bed quaternary care, teaching hospital located in Newark, New Jersey. The study included patients who had completed hospitalization between March 10, 2020, and April 10, 2020. We reviewed demographics, socioeconomic variables and incidence of in-hospital mortality and morbidity. Logistic regression was used to identify predictor of in-hospital death. RESULTS: Out of 416 patients, 251 (60%) had completed hospitalization as of April 10, 2020. The incidence of In-hospital mortality was 38.6% (n = 97). Most common symptoms at initial presentation were dyspnea 39% (n = 162) followed by cough 38%(n = 156) and fever 34% (n = 143). Patients were in the highest quartile for population\u2019s density, number of housing units and disproportionately fell into the lowest median income quartile for the state of New Jersey. The incidence of septic shock, acute kidney injury (AKI) requiring hemodialysis and admission to an intensive care unit (ICU) was 24% (n = 59), 21% (n = 52), 33% (n = 82) respectively. Independent predictors of in-hospital mortality were older age, lower serum Hemoglobin < 10 mg/dl, elevated serum Ferritin and Creatinine phosphokinase levels > 1200 U/L and > 1000 U/L. CONCLUSIONS: Findings from an inter-city hospital\u2019s experience with COVID-19 among underserved minority populations showed that, more than one of every three patients were at risk for in-hospital death or morbidity. Older age and elevated inflammatory markers at presentation were associated with in-hospital death.", "A culturally specific mental health and spirituality approach for African Americans facing the COVID-19 pandemic A series of 15-min videos were produced to provide resources to pastors in African-American communities to aid them in conveying accurate public and mental health information about COVID-19. Video presenters included trusted experts in public and mental health and pastors with considerable experience responding to the needs of the African-American community during the COVID-19 pandemic. Four culturally specific core themes to consider when providing care to African Americans who are at increased risk during the pandemic were identified: ritual disruption, negative reactions for not following public health guidelines, trauma, and culture and trust. (PsycInfo Database Record (c) 2020 APA, all rights reserved).", "COVID-19: The forgotten priorities of the pandemic Abstract The zoonotic virus now named SARS-CoV-2 first infected humans in China, and COVID-19 has rapidly become pandemic. To mitigate its impact on societies, health systems and economies, countries have adopted non-pharmacological preventive practices such as \u2018spatial\u2019 or \u2018social\u2019 distancing, the use of protective masks, and handwashing; these have been widely implemented. However, measures aimed at protecting physical health and healthcare systems have side-effects that might have a big impact on individuals\u2019 wellbeing. As the pandemic reaches low- and middle-income countries, weaker health systems, limited resources and the lower socioeconomic status of their populations make halting the pandemic more challenging. In this article, we explore the impact of COVID-19 and its prevention measures on the wellbeing of vulnerable populations. Special attention must be given to homeless, indigenous, migrant and imprisoned populations, as well as people living with disabilities and the elderly. More than just resolute governmental action will be required to overcome the pandemic. Links between science and political actions have to be strengthened. Fighting COVID-19 is a collective endeavour and community action, on a global scale, is of paramount importance.", "Outcomes of COVID-19: disparities in obesity and by ethnicity/race ", "Comorbidity and Sociodemographic determinants in COVID-19 Mortality in an US Urban Healthcare System Background: New York City is the US epicenter of the coronavirus disease 2019 (COVID-19) pandemic. Early international data indicated that comorbidity contributes significantly to poor prognosis and fatality in patients infected with SARS-CoV-2. It is not known to what degree medical comorbidity and sociodemographic determinants impact COVID-19 mortality in the US. Methods: Evaluation of de-identified electronic health records of 7,592 COVID-19 patients confirmed by SARS-CoV-2 lab tests in New York City. Medical comorbidites and outcome of mortality, and other covariates, including clinical, sociodemographic, and medication measures were assessed by bivariate and multivariate logistic regression models. Results: Of common comorbid conditions (hypertension, chronic kidney disease, chronic obstructive pulmonary disease, asthma, obesity, diabetes, HIV, cancer), when adjusted for covariates, chronic kidney disease remained significantly associated with increased odds of mortality. Patients who had more than one comorbidities, former smokers, treated with Azithromycin without Hydroxychloroquine, reside within the boroughs of Brooklyn and Queens Higher had higher odds of death. Conclusions: Increasing numbers of comorbid factors increase COVID-19 mortality, but several clinical and sociodemographic factors can mitigate risk. Continued evaluation of COVID-19 in large diverse populations is important to characterize individuals at risk and improve clinical outcomes.", "Race, socioeconomic deprivation, and hospitalization for COVID-19 in English participants of a national biobank Preliminary reports suggest that the Coronavirus Disease 2019 (COVID\u2212 19) pandemic has led to disproportionate morbidity and mortality among historically disadvantaged populations. We investigate the racial and socioeconomic associations of COVID\u2212 19 hospitalization among 418,794 participants of the UK Biobank, of whom 549 (0.13%) had been hospitalized. Both Black participants (odds ratio 3.7; 95%CI 2.5\u20135.3) and Asian participants (odds ratio 2.2; 95%CI 1.5\u20133.2) were at substantially increased risk as compared to White participants. We further observed a striking gradient in COVID\u2212 19 hospitalization rates according to the Townsend Deprivation Index \u2212 a composite measure of socioeconomic deprivation \u2212 and household income. Adjusting for socioeconomic factors and cardiorespiratory comorbidities led to only modest attenuation of the increased risk in Black participants, adjusted odds ratio 2.4 (95%CI 1.5\u20133.7). These observations confirm and extend earlier preliminary and lay press reports of higher morbidity in non-White individuals in the context of a large population of participants in a national biobank. The extent to which this increased risk relates to variation in pre-existing comorbidities, differences in testing or hospitalization patterns, or additional disparities in social determinants of health warrants further study.", "Time for a culture change: understanding and reducing risk, morbidity and mortality from COVID-19 in those of black and minority ethnicity. Following a number of epidemics in the 21st century, including Ebola and Middle East respiratory syndrome, the SARS-COV-2 virus, causing COVID-19 disease, was declared a pandemic health emergency of international concern in January 2020.", "Historical Insights on Coronavirus Disease 2019 (COVID-19), the 1918 Influenza Pandemic, and Racial Disparities: Illuminating a Path Forward The coronavirus disease 2019 (COVID-19) pandemic is exacting a disproportionate toll on ethnic minority communities and magnifying existing disparities in health care access and treatment. To understand this crisis, physicians and public health researchers have searched history for insights, especially from a great outbreak approximately a century ago: the 1918 influenza pandemic. However, of the accounts examining the 1918 influenza pandemic and COVID-19, only a notable few discuss race. Yet, a rich, broader scholarship on race and epidemic disease as a \"sampling device for social analysis\" exists. This commentary examines the historical arc of the 1918 influenza pandemic, focusing on black Americans and showing the complex and sometimes surprising ways it operated, triggering particular responses both within a minority community and in wider racial, sociopolitical, and public health structures. This analysis reveals that critical structural inequities and health care gaps have historically contributed to and continue to compound disparate health outcomes among communities of color. Shifting from this context to the present, this article frames a discussion of racial health disparities through a resilience approach rather than a deficit approach and offers a blueprint for approaching the COVID-19 crisis and its afterlives through the lens of health equity.", "Zooming Towards a Telehealth Solution for Vulnerable Children with Obesity During COVID\u201019 Health inequities exist throughout the life course, resulting in racial/ethnic and socioeconomic disparities in obesity and obesity\u2010related health complications. Obesity and its co\u2010morbidities appear linked to COVID\u201019 mortality. Approaches to reduce obesity in the time of COVID\u201019 closures are urgently needed and should start early in life. In New York City, we developed a telehealth pediatric weight management collaborative spanning NewYork\u2010Presbyterian, Columbia University Vagelos College of Physicians and Surgeons, and Weill Cornell Medicine during COVID\u201019 with show rates 76\u201089%. To stave off the impending exacerbation of health disparities related to obesity risk factors in the aftermath of the COVID\u201019 pandemic, effective interventions that can be delivered remotely are urgently needed among vulnerable children with obesity. Challenges in digital technology access, social and linguistic differences, privacy security, and reimbursement must be overcome to realize the full potential of telehealth for pediatric weight management among low\u2010income and racial/ethnic minority children.", "Examining Social Determinants of Health, Stigma, and COVID-19 Disparities There is growing attention to disparities in the incidence, prevalence, and mortality associated with COVID-19 (Coronavirus disease 2019) in racial/ethnic communities. The conditions leading to these disparities may be a function of social determinants of health and stigma linked to the disease. It is important to examine how these factors may be implicated in COVID-19 onset, treatment, and outcomes. A brief overview of these issues allows for a cursory examination of the role of social determinants of health and stigma in COVID-19. Consideration is given to how understanding COVID-19 in the context of social determinants and stigma may be included in interventions to mitigate its transmission within vulnerable populations.", "Imaging evaluation of COVID-19 in the emergency department PURPOSE: The purpose of this study is to elucidate the chest imaging findings of suspected COVID-19 patients presenting to the emergency department and the relationship with their demographics and RT-PCR testing results. METHODS: Patients presenting to the ED between March 12 and March 28, 2020, with symptoms suspicious for COVID-19 and subsequent CXR and/or CT exam were selected. Patients imaged for other reasons with findings suspicious for COVID-19 were also included. Demographics, laboratory test results, and history were extracted from the medical record. Descriptive statistics were used to explore the relationship between imaging and these factors. RESULTS: A total of 227 patients from the emergency department were analyzed (224 CXRs and 25 CTs). Of the 192 patients with COVID-19 results, 173 (90.1%) had COVID-19 RT-PCR (+). Abnormal imaging (CXR, 85.7% and/or CT, 100%) was noted in 155 (89.6%) of COVID-19 RT-PCR (+) cases. The most common imaging findings were mixed airspace/interstitial opacities (39.8%) on CXR and peripheral GGOs on CT (92%). The most common demographic were African Americans (76.8%). Furthermore, 97.1% of African Americans were RT-PCR (+) compared to 65.8% of Caucasians. CONCLUSION: We found a similar spectrum of thoracic imaging findings in COVID-19 patients as previous studies. The most common demographic were African Americans (76.8%). Furthermore, 97.1% of African Americans were RT-PCR (+) compared to 65.8% of Caucasians. Both CT and CXR can accurately identify COVID-19 pneumonitis in 89.6% of RT-PCR (+) cases, 89.5% of false negatives, and 72.7% of cases with no RT-PCR result. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10140-020-01787-0) contains supplementary material, which is available to authorized users.", "Strong Effects of Population Density and Social Characteristics on Distribution of COVID-19 Infections in the United States Coronavirus disease 2019 (Covid-19) has devastated global populations and has had a large impact in the United States with the number of infections and deaths growing exponentially. Using a smooth generalized additive model with quasipoisson counts for total infections and deaths, we developed a county-level predictive model that included population demographics, social characteristics, social distancing, and testing data. This model strongly predicted the actual US distribution of Covid-19, accounting for 94.8% of spatial-temporal variation in total infections and 99.3% in Covid-19 related fatalities from March 15, 2020. US counties with higher population density, poverty index, civilian population, and minorities, especially African Americans had a higher number of confirmed infections adjusted for county population. Social distancing measured by the change in the rate of human encounter per km2 relative to pre-covid-19 national average was associated with slower rate of Covid-19 infections, whereas higher testing was associated with higher number of infections. The number of people infected was increasing, however, the rate of increase in new infections was starting to show signs of plateauing starting from the second week of April. Our model projects 2.11 million people to test positive for Covid-19 and 122,951 fatalities by June 1, 2020. Importantly, our model suggests strong social differences in the infections and deaths across US communities, and inequities in areas with larger African American minorities and higher poverty index expected to show higher rates of Covid-19 infections and deaths. Preventive steps including social distancing and community closures have been a cornerstone in stopping the transmission and potentially reducing the spread of the disease. Crucial knowledge of the role of social characteristics in the disease transmission is essential to understand current disease distribution, predict future distribution, and plan additional preventive steps.", "From Fear to Hate: How the Covid-19 Pandemic Sparks Racial Animus in the United States We estimate the effect of the Coronavirus (Covid-19) pandemic on racial animus, as measured by Google searches and Twitter posts including a commonly used anti-Asian racial slur. Our empirical strategy exploits the plausibly exogenous variation in the timing of the first Covid-19 diagnosis across regions in the United States. We find that the first local diagnosis leads to an immediate increase in racist Google searches and Twitter posts, with the latter mainly coming from existing Twitter users posting the slur for the first time. This increase could indicate a rise in future hate crimes, as we document a strong correlation between the use of the slur and anti-Asian hate crimes using historic data. Moreover, we find that the rise in the animosity is directed at Asians rather than other minority groups and is stronger on days when the connection between the disease and Asians is more salient, as proxied by President Trump's tweets mentioning China and Covid-19 at the same time. In contrast, the negative economic impact of the pandemic plays little role in the initial increase in racial animus. Our results suggest that de-emphasizing the connection between the disease and a particular racial group can be effective in curbing current and future racial animus.", "Policy Recommendations to Address High Risk of COVID-19 Among Immigrants The health and economic consequences of COVID-19 will be devastatingly widespread, but the populations that will suffer most are those who have experienced longstanding health disparities. For example, emerging evidence strongly suggests that incidence and case fatality rates are higher among Blacks than Whites.1 Immigrants are among the groups most likely to experience disproportionate effects from COVID-19. Unlike race/ethnicity, however, nativity and citizenship status are not included on the Centers for Disease Control and Prevention's (CDC's) coronavirus case report form,2 so data regarding testing and spread across immigrant groups are likely to remain scarce. Information from other health and social surveys-including data that I present in Table 1-suggest that noncitizens experience barriers to physical distancing that will place them at high risk of contracting COVID-19 and have high levels of disadvantage that leave them vulnerable to its economic effects. I recommend three policy changes to address the high health and economic risk among noncitizens, goals that are in the best interest of public health and the broader economy. (Am J Public Health. Published online ahead of print June 25, 2020: e1-e3. doi:10.2105/AJPH.2020.305792).", "Higher Obesity Trends Among African Americans Are Associated with Increased Mortality in Infected COVID-19 Patients Within the City of Detroit As the city of Detroit raids itself of deaths by shifting from homicides, COVID-19 infection continues to harrow the city with more deaths. From March 19 to May 15, more Detroiters died in 2 months than were killed in 2 years of city homicides. African Americans or Blacks (highest-risk phenotypes) developing COVID-19 infection are more likely to die disproportionately. The confluence of diabetes, hypertension, cardiovascular disease, and the higher prevalence of obesity among Blacks have provided the needed environment for viruses like COVID-19 to thrive and cause serious infections. The purpose of this study is to connect mortality rates from COVID-19 infection to increasing obesity trends among African Americans within the city of Detroit. Statistical analyses were conducted using SPSS ver. 23. Results showed that the highest mortality rates among African Americans occurred more in the obese individuals infected with COVID-19 in the city of Detroit. Out of 1930 deaths from COVID-19 infections, 733 deaths were due to obesity alone in patients without reported comorbid conditions like diabetes, hypertension, and cardiovascular disease. Mortality rate for both male and female African Americans amounted to a total of 11.9%. Thirty-eight percent of reported COVID-19-infected African Americans were obese. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s42399-020-00385-y) contains supplementary material, which is available to authorized users.", "Ethnic Disparities in Hospitalization for COVID-19: a Community-Based Cohort Study in the UK IMPORTANCE: Differentials in COVID-19 incidence, hospitalization and mortality according to ethnicity are being reported but their origin is uncertain. OBJECTIVE: We aimed to explain any ethnic differentials in COVID-19 hospitalization based on socioeconomic, lifestyle, mental and physical health factors. DESIGN: Prospective cohort study with national registry linkage to hospitalisation for COVID-19. SETTING: Community-dwelling. PARTICIPANTS: 340,966 men and women (mean age 56.2 (SD=8.1) years; 54.3% women) residing in England from the UK Biobank study. EXPOSURES: Ethnicity classified as White, Black, Asian, and Others. MAIN OUTCOME(S) AND MEASURE(S): Cases of COVID-19 serious enough to warrant a hospital admission in England from 16-March-2020 to 26-April-2020. RESULTS: There were 640 COVID-19 cases (571/324,306 White, 31/4,485 Black, 21/5,732 Asian, 17/5,803 Other). Compared to the White study members and after adjusting for age and sex, Black individuals had over a 4-fold increased risk of being hospitalised (odds ratio; 95% confidence interval: =4.32; 3.00-6.23), and there was a doubling of risk in the Asian group (2.12; 1.37, 3.28) and the \u2018other\u2019 non-white group (1.84; 1.13, 2.99). After controlling for 15 confounding factors which included neighbourhood deprivation, education, number in household, smoking, markers of body size, inflammation, and glycated haemoglobin, these effect estimates were attenuated by 33% for Blacks, 52% for Asians and 43% for Other, but remained raised for Blacks (2.66; 1.82, 3.91), Asian (1.43; 0.91, 2.26) and other non-white groups (1.41; 0.87, 2.31). CONCLUSIONS AND RELEVANCE: Our findings show clear ethnic differences in risk of hospitalization for COVID-19 which do not appear to be fully explained by known explanatory factors. If replicated, our results have implications for health policy, including the targeting of prevention advice and vaccination coverage.", "Factors Associated with Hospitalization and Disease Severity in a Racially and Ethnically Diverse Population of COVID-19 Patients Background: The coronavirus disease (COVID-19) first identified in Wuhan in December 2019 became a pandemic within a few months of its discovery. The impact of COVID-19 is due to both its rapid spread and its severity, but the determinants of severity have not been fully delineated. Objective: Identify factors associated with hospitalization and disease severity in a racially and ethnically diverse cohort of COVID-19 patients. Methods: We analyzed data from COVID-19 patients diagnosed at the University of Cincinnati health system from March 13, 2020 to May 31, 2020. Severe COVID-19 was defined as admission to intensive care unit or death. Logistic regression modeling adjusted for covariates was used to identify the factors associated with hospitalization and severe COVID-19. Results: Among the 689 COVID-19 patients included in our study, 29.2% were non-Hispanic White, 25.5% were non-Hispanic Black, 32.5% were Hispanic, and 12.8% were of other race/ethnicity. About 31.3% of patients were hospitalized and 13.2% had severe disease. In adjusted analyses, the sociodemographic factors associated with hospitalization and/or disease severity included older age, non-Hispanic Black or Hispanic race/ethnicity (compared non-Hispanic White), and smoking. The following comorbidities: diabetes, hypercholesterolemia, asthma, chronic obstructive pulmonary disease (COPD), chronic kidney disease, cardiovascular diseases, osteoarthritis, and vitamin D deficiency, were associated with hospitalization and/or disease severity. Hematological disorders such as anemia, coagulation disorders, and thrombocytopenia were associated with higher odds of both hospitalization and disease severity. Conclusion: This study confirms race and ethnicity as predictors of severe COVID-19 and identifies clinical risk factors not previously reported such a vitamin D deficiency, hypercholesterolemia, osteoarthritis, and anemia.", "Letter to the Editor\u2014Behavioral Health Implications of Inmate Release During COVID\u201019 ", "Coronavirus Disease Health Care Delivery Impact on African Americans The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over 1.5 million individuals and led to over 91, 000 deaths in the United States (US) alone as of May 20th, 2020. Minority populations, however, continue to be a high-risk population to contract the SARS-CoV-2 infection. While socioeconomic inequality may help to explain why minority ethnic populations are contracting the SARS-CoV-2 in larger proportions, the reason for elevated mortality rates in African Americans is still unknown. African Americans are less likely than whites to utilize high-quality hospitals, ambulatory care services, and regular primary care providers; this is most likely a result of barriers to accessing high quality treatment, as African Americans have substantially higher uninsured rates. However, previous reports have shown that regardless of insurance status, African Americans are more likely to be directed toward lower quality treatment plans compared to their white counterparts, and that physicians carry implicit biases that negatively impact treatment regimens for these minority populations. While income, education, and access to healthcare should be revised in due time, in the short term physicians should do everything possible to learn about implicit biases that may exist in healthcare, as the first step to minimize implicit biases is to recognize that they exist.", "Racial and Ethnic Disparities in Population Level Covid-19 Mortality Background: Current reporting of Covid-19 mortality data by race and ethnicity across the United States could bias our understanding of population-mortality disparities. Moreover, stark differences in age distribution by race and ethnicity groups are seldom accounted for in analyses. Methods: To address these gaps, we conducted a cross-sectional study using publicly-reported Covid-19 mortality data to assess the quality of race and ethnicity data (Black, Latinx, white), and estimated age-adjusted disparities using a random effects meta-analytic approach. Results: We found only 28 states, and NYC, reported race and ethnicity-stratified Covid-19 mortality along with large variation in the percent of missing race and ethnicity data by state. Aggregated relative risk of death estimates for Black compared to the white population was 3.57 (95% CI: 2.84-4.48). Similarly, Latinx population displayed 1.88 (95% CI: 1.61-2.19) times higher risk of death than white patients. Discussion: In states providing race and ethnicity data, we identified significant population-level Covid-19 mortality disparities. We demonstrated the importance of adjusting for age differences across population groups to prevent underestimating disparities in younger population groups. The availability of high-quality and comprehensive race and ethnicity data is necessary to address factors contributing to inequity in Covid-19 mortality.", "Avoidance of vitamin D deficiency to slow the COVID-19 pandemic Vitamin D deficiency, which impedes good immune function, is common during winter and spring in regions of high latitude. There is good evidence that vitamin D deficiency contributes to the seasonal increase of virus infections of the respiratory tract, from the common cold to influenza, and now possibly also COVID-19. This communication explores key factors that make it more likely, particularly in combination, that individuals are vitamin D deficient. These factors include old age, obesity, dark skin tone and common genetic variants that impede vitamin D status. Precision nutrition is an approach that aims to consider known personal risk factors and health circumstances to provide more effective nutrition guidance in health and disease. In regard to avoiding vitamin D deficiency, people with excess body fat, a dark skin tone or older age usually need to use a moderately dosed daily vitamin D supplement, particularly those living in a high-latitude region, getting little ultraviolet B exposure due to air pollution or staying mostly indoors. Carriers of the GC (group-specific component) rs4588 AA genotype also are more likely to become deficient. Very high-dosed supplements with more than 4000 IU vitamin D are rarely needed or justified. A state-by-state Mendelian randomisation analysis of excess COVID-19 mortality of African-Americans in the USA shows a greater disparity in northern states than in southern states. It is conceivable that vitamin D adequacy denies the virus easy footholds and thereby slows spreading of the contagion. This finding should drive home the message that vitamin D supplementation is particularly important for individuals with dark skin tones. Vitamin D deficiency, even for a few months during the winter and spring season, must be rigorously remedied because of its many adverse health impacts that include decreased life expectancy and increased mortality. Slowing the spread of COVID-19 would be an added bonus.", "The Disproportionate Impact of COVID-19 on Racial and Ethnic Minorities in the United States The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups, with high rates of death in African American, Native American, and LatinX communities. While the mechanisms of these disparities are being investigated, they can be conceived as arising from biomedical factors as well as social determinants of health. Minority groups are disproportionately affected by chronic medical conditions and lower access to healthcare that may portend worse COVID-19 outcomes. Furthermore, minority communities are more likely to experience living and working conditions that predispose them to worse outcomes. Underpinning these disparities are long-standing structural and societal factors that the COVID-19 pandemic has exposed. Clinicians can partner with patients and communities to reduce the short-term impact of COVID-19 disparities while advocating for structural change.", "Sickle Cell Trait and The Potential Risk of Severe Coronavirus Disease 2019- A Mini-Review Coronavirus Disease 2019 (COVID-19) pandemic is a rapidly evolving public health problem. The severity of COVID-19 cases reported hitherto has varied greatly from asymptomatic to severe pneumonia and thromboembolism with subsequent mortality. An improved understanding of risk factors for adverse clinical outcomes may shed some light on novel personalized approaches to optimize clinical care in vulnerable populations. Emerging trends in the United States suggest possibly higher mortality rates of COVID-19 amongst African Americans, although detailed epidemiological study data is pending. Sickle Cell Disease (SCD) disproportionately affect Black/African Americans in the United States as well as forebearers from sub-Saharan Africa, the Western Hemisphere (South America, the Caribbean, and Central America) and some Mediterranean countries. The carrier frequency for SCD is high amongst African Americans. This article underscores the putative risks that may be associated with COVID-19 pneumonia in sickle cell trait as well as potential opportunities for individualized medical care in the burgeoning era of personalized medicine.", "The impact of COVID-19 on African American communities in the United States IMPORTANCE: The novel Coronavirus Disease 2019 (COVID-19), declared a pandemic in March 2020, may present with disproportionately higher rates in underrepresented racial/ethnic minority populations in the United States, including African American communities who have traditionally been over-represented in negative health outcomes. STUDY OBJECTIVE: To understand the impact of the density of African American communities (defined as the percentage of African Americans in a county) on COVID-19 prevalence and death rate within the three most populous counties in each U.S. state and territory (n=152). Design: An ecological study using linear regression was employed for the study. SETTING: The top three most populous counties of each U.S. state and territory were included in analyses for a final sample size of n=152 counties. PARTICIPANTS: Confirmed COVID-19 cases and deaths that were accumulated between January 22, 2020 and April 12, 2020 in each of the three most populous counties in each U.S. state and territory were included. MAIN OUTCOME MEASURES: Linear regression was used to determine the association between African American density and COVID-19 prevalence (defined as the percentage of cases for the county population), and death rate (defined as number of deaths per 100,000 population). The models were adjusted for median age and poverty. RESULTS: There was a direct association between African American density and COVID-19 prevalence; COVID-19 prevalence increased 5% for every 1% increase in county AA density (p<.01). There was also an association between county AA density and COVID-19 deaths, such; the death rate increased 2 per 100,000 for every percentage increase in county AA density (p=.02). CONCLUSION: These study findings indicate that communities with a high African American density have been disproportionately burdened with COVID-19. Further study is needed to indicate if this burden is related to environmental factors or individual factors such as types of employment or comorbidities that members of these community have.", "Inequity and the disproportionate impact of COVID-19 on communities of color in the United States: The need for a trauma-informed social justice response COVID-19 has had disproportionate contagion and fatality in Black, Latino, and Native American communities and among the poor in the United States. Toxic stress resulting from racial and social inequities have been magnified during the pandemic, with implications for poor physical and mental health and socioeconomic outcomes. It is imperative that our country focus and invest in addressing health inequities and work across sectors to build self-efficacy and long-term capacity within communities and systems of care serving the most disenfranchised, now and in the aftermath of the COVID-19 epidemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).", "Social Workers Must Address Intersecting Vulnerabilities among Noninstitutionalized, Black, Latinx, and Older Adults of Color during the COVID-19 Pandemic Scant attention has been paid to intersecting vulnerabilities experienced by Black, Latinx, and older adults of color (BLOAC) that increase COVID-19 related risks. Structural inequities have resulted in disproportionate rates of chronic conditions and limited access to care. Media coverage, focused on COVID-19 mortality among institutionalized older adults (OA), has overlooked community-dwelling OA, leaving their unique risks unaddressed in research and intervention efforts. Key vulnerabilities impacting noninstitutionalized BLOAC exacerbating adverse health outcomes during COVID-19 are discussed, and recommendations are given for gerontological social work (GSW) education, training, and practice to meet the needs of BLOAC during the COVID-19 pandemic.", "Differential occupational risk for COVID\u201019 and other infection exposure according to race and ethnicity BACKGROUND: There are racial and ethnic disparities in the risk of contracting COVID\u201019. This study sought to assess how occupational segregation according to race and ethnicity may contribute to the risk of COVID\u201019. METHODS: Data about employment in 2019 by industry and occupation and race and ethnicity were obtained from the Bureau of Labor Statistics Current Population Survey. This data was combined with information about industries according to whether they were likely or possibly essential during the COVID\u201019 pandemic and the frequency of exposure to infections and close proximity to others by occupation. The percentage of workers employed in essential industries and occupations with a high risk of infection and close proximity to others by race and ethnicity was calculated. RESULTS: People of color were more likely to be employed in essential industries and in occupations with more exposure to infections and close proximity to others. Black workers in particular faced an elevated risk for all of these factors. CONCLUSION: Occupational segregation into high\u2010risk industries and occupations likely contributes to differential risk with respect to COVID\u201019. Providing adequate projection to workers may help to reduce these disparities.", "Disproportionate burden of COVID-19 among racial minorities and those in congregate settings among a large cohort of people with HIV BACKGROUND: Many people living with HIV (PLWH) have comorbidities which are risk factors for severe COVID-19 or have exposures that may lead to acquisition of SARS-CoV-2. There are few studies, however, on the demographics, comorbidities, clinical presentation or outcomes of COVID-19 in people with HIV. OBJECTIVE: To evaluate risk factors, clinical manifestations and outcomes in a large cohort of PLWH with COVID-19. METHODS: We systematically identified all PLWH who were diagnosed with COVID-19 at a large hospital from March 3 to April 26, 2020 during an outbreak in Massachusetts. We analyzed each of the cases to extract information including demographics, medical comorbidities, clinical presentation, and illness course after COVID-19 diagnosis. RESULTS: We describe a cohort of 36 PLWH with confirmed COVID-19 and another 11 patients with probable COVID-19. Almost 85% of PLWH with confirmed COVID-19 had a comorbidity associated with severe disease, including obesity, cardiovascular disease, or hypertension. Approximately 77% of PLWH with COVID-19 were non-Hispanic Black or Latinx whereas only 40% of the PLWH in our clinic were Black or Latinx. Nearly half of PLWH with COVID-19 had exposure to congregate settings. In addition to people with confirmed COVID-19, we identified another 11 individuals with probable COVID-19, almost all of whom had negative PCR testing. CONCLUSION: In the largest cohort to date of PLWH and confirmed COVID-19, almost all had a comorbidity associated with severe disease, highlighting the importance of non-HIV risk factors in this population. The racial disparities and frequent link to congregate settings in PLWH and COVID-19 need to be explored urgently.", "Differential occupational risk for COVID-19 and other infection exposure according to race and ethnicity BACKGROUND: There are racial and ethnic disparities in the risk of contracting COVID-19. This study sought to assess how occupational segregation according to race and ethnicity may contribute to the risk of COVID-19. METHODS: Data about employment in 2019 by industry and occupation and race and ethnicity were obtained from the Bureau of Labor Statistics Current Population Survey. This data was combined with information about industries according to whether they were likely or possibly essential during the COVID-19 pandemic and the frequency of exposure to infections and close proximity to others by occupation. The percentage of workers employed in essential industries and occupations with a high risk of infection and close proximity to others by race and ethnicity was calculated. RESULTS: People of color were more likely to be employed in essential industries and in occupations with more exposure to infections and close proximity to others. Black workers in particular faced an elevated risk for all of these factors. CONCLUSION: Occupational segregation into high-risk industries and occupations likely contributes to differential risk with respect to COVID-19. Providing adequate projection to workers may help to reduce these disparities.", "Ethnic and racial disparities in COVID-19-related deaths: counting the trees, hiding the forest ", "Factors associated with hospitalization and critical illness among 4,103 patients with COVID-19 disease in New York City Background: Little is known about factors associated with hospitalization and critical illness in Covid-19 positive patients. Methods: We conducted a cross-sectional analysis of all patients with laboratory-confirmed Covid-19 treated at a single academic health system in New York City between March 1, 2020 and April 2, 2020, with follow up through April 7, 2020. Primary outcomes were hospitalization and critical illness (intensive care, mechanical ventilation, hospice and/or death). We conducted multivariable logistic regression to identify risk factors for adverse outcomes, and maximum information gain decision tree classifications to identify key splitters. Results: Among 4,103 Covid-19 patients, 1,999 (48.7%) were hospitalized, of whom 981/1,999 (49.1%) have been discharged home, and 292/1,999 (14.6%) have died or were discharged to hospice. Of 445 patients requiring mechanical ventilation, 162/445 (36.4%) have died. Strongest hospitalization risks were age [\u2265]75 years (OR 66.8, 95% CI, 44.7-102.6), age 65-74 (OR 10.9, 95% CI, 8.35-14.34), BMI>40 (OR 6.2, 95% CI, 4.2-9.3), and heart failure (OR 4.3 95% CI, 1.9-11.2). Strongest critical illness risks were admission oxygen saturation <88% (OR 6.99, 95% CI 4.5-11.0), d-dimer>2500 (OR 6.9, 95% CI, 3.2-15.2), ferritin >2500 (OR 6.9, 95% CI, 3.2-15.2), and C-reactive protein (CRP) >200 (OR 5.78, 95% CI, 2.6-13.8). In the decision tree for admission, the most important features were age >65 and obesity; for critical illness, the most important was SpO2<88, followed by procalcitonin >0.5, troponin <0.1 (protective), age >64 and CRP>200. Conclusions: Age and comorbidities are powerful predictors of hospitalization; however, admission oxygen impairment and markers of inflammation are most strongly associated with critical illness.", "Equitable Care for Critically Ill Patients from Culturally Diverse Communities in the COVID-19 Pandemic. ", "COVID-19 and Hidden Housing Vulnerabilities: Implications for Health Equity, New Haven, Connecticut ", "Disproportionate COVID-19 Related Mortality Amongst African Americans in Four Southern States in the United States Background African American have been severely affected by COVID-19 noted with the rising mortality rates within the African American community. Health disparities, health inequities and issues with systemic health access are some of the pre-existing issues African American were subjected to within the southern states in the United States. Second, social distancing is a critical non-pharmacological intervention to reduce the spread of COVID-19. However, social distancing was not practical and presented a challenge within the African American community, specifically, in the southern states. Objective This article assesses the effect of COVID-19 on African American in the southern states. Methodology This short communication queried the publicly available Department of Health statistics on COVID-19 related mortality and underlying health conditions in four southern states (Alabama [AL], Georgia [GA], Louisiana [LA] and Mississippi [MS]) with a high proportion of African American residents. Second, unacast COVID-19 toolkit was used to derive a social distancing (SD) grade for any given state, based on three different metrics: (i) percent change in average distance travelled (ii) percent change in non-essential visits and (iii) decrease in human encounters (compared to national baseline). Results Across the four states, on average, as many as 54% of COVID-19 related deaths are in the African American community, although this minority group comprises only 32% of the population cumulatively. This article finds that all four southern states received a social distancing grade of F. COVID-19 have demonstrated that adverse outcomes are higher in individuals with underlying health conditions such as diabetes, cardiovascular diseases, or pre-existing pulmonary compromise. Conclusion Recognizing that there is a great need for African American representation or diversity in the health workforce would be able to better address the health disparities. In addition, the lack of diversity in the healthcare system causes the morbidity and mortality rates to increase in the African American communities because it is not able to address its primary obligations within the African American communities in the southern states during COVID-19 pandemic. These primary obligations are to restore, protect, improve health and to suppress health disparities and inequalities of COVID-19 within in the African American communities. Keywords: COVID-19; African American; Mortality", "COVID-19\u2013Associated Collapsing Focal Segmental Glomerulosclerosis: A Report of 2 Cases Collapsing glomerulopathy is an aggressive form of focal segmental glomerulosclerosis with diverse etiologies The presence of APOL1 high risk genotype is a major risk factor for collapsing glomerulopathy in African Americans Coronavirus disease 2019 (COVID-19) is an emerging pandemic with predominant respiratory manifestations However, kidney involvement is being frequently noted and is associated with higher mortality Currently kidney pathology data in COVID-19 are scant and mostly come from postmortem findings We report two African American patients who developed acute kidney injury and proteinuria in temporal association with COVID-19 Kidney biopsies showed collapsing glomerulopathy, endothelial tubuloreticular inclusions, and acute tubular injury, without evidence by electron microscopy or SARS-CoV-2 ISH of viral infection of kidney cells Both patients had APOL1 high risk genotype We propose that collapsing glomerulopathy represents a novel manifestation of COVID-19 especially in people of African descent with APOL1 risk alleles", "Black\u2013White Risk Differentials in COVID-19 (SARS-COV2) Transmission, Mortality and Case Fatality in the United States: Translational Epidemiologic Perspective and Challenges Background: Social and health inequities predispose vulnerable populations to adverse morbidity and mortality outcomes of epidemics and pandemics. While racial disparities in cumulative incidence (CmI) and mortality from the influenza pandemics of 1918 and 2009 implicated Blacks with survival disadvantage relative to Whites in the United States, COVID-19 currently indicates comparable disparities. We aimed to: (a) assess COVID-19 CmI by race, (b) determine the Black\u2013White case fatality (CF) and risk differentials, and (c) apply explanatory model for mortality risk differentials. Methods: COVID-19 data on confirmed cases and deaths by selective states health departments were assessed using a cross-sectional ecologic design. Chi-square was used for CF independence, while binomial regression model for the Black\u2013White risk differentials. Results: The COVID-19 mortality CmI indicated Blacks/AA with 34% of the total mortality in the United States, albeit their 13% population size. The COVID-19 CF was higher among Blacks/AA relative to Whites; Maryland, (2.7% vs. 2.5%), Wisconsin (7.4% vs. 4.8%), Illinois (4.8% vs. 4.2%), Chicago (5.9% vs. 3.2%), Detroit (Michigan), 7.2% and St. John the Baptist Parish (Louisiana), 7.9%. Blacks/AA compared to Whites in Michigan were 15% more likely to die, CmI risk ratio (CmIRR) = 1.15, 95% CI, 1.01\u20131.32. Blacks/AA relative to Whites in Illinois were 13% more likely to die, CmIRR = 1.13, 95% CI, 0.93\u20131.39, while Blacks/AA compared to Whites in Wisconsin were 51% more likely to die, CmIRR = 1.51, 95% CI, 1.10\u20132.10. In Chicago, Blacks/AA were more than twice as likely to die, CmIRR = 2.24, 95% CI, 1.36\u20133.88. Conclusion: Substantial racial/ethnic disparities are observed in COVID-19 CF and mortality with Blacks/AA disproportionately affected across the United States.", "COVID-19 and African Americans ", "Black-White Risk Differentials in COVID-19 (SARS-COV2) Transmission, Mortality and Case Fatality in the United States: Translational Epidemiologic Perspective and Challenges BACKGROUND: Social and health inequities predispose vulnerable populations to adverse morbidity and mortality outcomes of epidemics and pandemics. While racial disparities in cumulative incidence (CmI) and mortality from the influenza pandemics of 1918 and 2009 implicated Blacks with survival disadvantage relative to Whites in the United States, COVID-19 currently indicates comparable disparities. We aimed to: (a) assess COVID-19 CmI by race, (b) determine the Black-White case fatality (CF) and risk differentials, and (c) apply explanatory model for mortality risk differentials. METHODS: COVID-19 data on confirmed cases and deaths by selective states health departments were assessed using a cross-sectional ecologic design. Chi-square was used for CF independence, while binomial regression model for the Black-White risk differentials. RESULTS: The COVID-19 mortality CmI indicated Blacks/AA with 34% of the total mortality in the United States, albeit their 13% population size. The COVID-19 CF was higher among Blacks/AA relative to Whites; Maryland, (2.7% vs. 2.5%), Wisconsin (7.4% vs. 4.8%), Illinois (4.8% vs. 4.2%), Chicago (5.9% vs. 3.2%), Detroit (Michigan), 7.2% and St. John the Baptist Parish (Louisiana), 7.9%. Blacks/AA compared to Whites in Michigan were 15% more likely to die, CmI risk ratio (CmIRR) = 1.15, 95% CI, 1.01-1.32. Blacks/AA relative to Whites in Illinois were 13% more likely to die, CmIRR = 1.13, 95% CI, 0.93-1.39, while Blacks/AA compared to Whites in Wisconsin were 51% more likely to die, CmIRR = 1.51, 95% CI, 1.10-2.10. In Chicago, Blacks/AA were more than twice as likely to die, CmIRR = 2.24, 95% CI, 1.36-3.88. CONCLUSION: Substantial racial/ethnic disparities are observed in COVID-19 CF and mortality with Blacks/AA disproportionately affected across the United States.", "African American COVID-19 Mortality: A Sentinel Event ", "Analysis of hospitalized COVID-19 patients in the Mount Sinai Health System using electronic medical records (EMR) reveals important prognostic factors for improved clinical outcomes COVID-19 is a novel threat to human health worldwide. There is an urgent need to understand patient characteristics of having COVID-19 disease and evaluate markers of critical illness and mortality. Objective: To assess association of clinical features on patient outcomes. Design, Setting, and Participants: In this observational case series, patient-level data were extracted from electronic medical records for 28,336 patients tested for SARS-CoV-2 at the Mount Sinai Health System from 2/24/ to 4/15/2020, including 6,158 laboratory-confirmed cases. Exposures: Confirmed COVID-19 diagnosis by RT-PCR assay from nasal swabs. Main Outcomes and Measures: Effects of race on positive test rates and mortality were assessed. Among positive cases admitted to the hospital (N = 3,273), effects of patient demographics, hospital site and unit, social behavior, vital signs, lab results, and disease comorbidities on discharge and death were estimated. Results: Hispanics (29%) and African Americans (25%) had disproportionately high positive case rates relative to population base rates (p<2e-16); however, no differences in mortality rates were observed in the hospital. Outcome differed significantly between hospitals (Gray's T=248.9; p<2e-16), reflecting differences in average baseline age and underlying comorbidities. Significant risk factors for mortality included age (HR=1.05 [95% CI, 1.04-1.06]; p=1.15e-32), oxygen saturation (HR=0.985 [95% CI, 0.982-0.988]; p=1.57e-17), care in ICU areas (HR=1.58 [95% CI, 1.29-1.92]; p=7.81e-6), and elevated creatinine (HR=1.75 [95% CI, 1.47-2.10]; p=7.48e-10), alanine aminotransferase (ALT) (HR=1.002, [95% CI 1.001-1.003]; p=8.86e-5) and body-mass index (BMI) (HR=1.02, [95% CI 1.00-1.03]; p=1.09e-2). Asthma (HR=0.78 [95% CI, 0.62-0.98]; p=0.031) was significantly associated with increased length of hospital stay, but not mortality. Deceased patients were more likely to have elevated markers of inflammation. Baseline age, BMI, oxygen saturation, respiratory rate, white blood cell (WBC) count, creatinine, and ALT were significant prognostic indicators of mortality. Conclusions and Relevance: While race was associated with higher risk of infection, we did not find a racial disparity in inpatient mortality suggesting that outcomes in a single tertiary care health system are comparable across races. We identified clinical features associated with reduced mortality and discharge. These findings could help to identify which COVID-19 patients are at greatest risk and evaluate the impact on survival.", "Heart failure exacerbation as only presenting sign of COVID-19 With the increasing number of confirmed cases and accumulating clinical data, our understanding of COVID-19 continues to evolve. Here we describe the case of a patient who was initially admitted for decompensated heart failure with reduced ejection fraction (HFrEF). Only later in his course did he develop fever that led to testing for severe acute respiratory syndrome coronavirus-2 (SARS-COV-2). Although we are aware of the common respiratory failure induced by SARS-COV-2, we have scant information that describes cardiac manifestations caused by this novel virus.", "Characteristics Associated with Hospitalization Among Patients with COVID-19 \u2014 Metropolitan Atlanta, Georgia, March\u2013April 2020 The first reported U.S. case of coronavirus disease 2019 (COVID-19) was detected in January 2020 (1). As of June 15, 2020, approximately 2 million cases and 115,000 COVID-19-associated deaths have been reported in the United States.* Reports of U.S. patients hospitalized with SARS-CoV-2 infection (the virus that causes COVID-19) describe high proportions of older, male, and black persons (2-4). Similarly, when comparing hospitalized patients with catchment area populations or nonhospitalized COVID-19 patients, high proportions have underlying conditions, including diabetes mellitus, hypertension, obesity, cardiovascular disease, chronic kidney disease, or chronic respiratory disease (3,4). For this report, data were abstracted from the medical records of 220 hospitalized and 311 nonhospitalized patients aged \u226518 years with laboratory-confirmed COVID-19 from six acute care hospitals and associated outpatient clinics in metropolitan Atlanta, Georgia. Multivariable analyses were performed to identify patient characteristics associated with hospitalization. The following characteristics were independently associated with hospitalization: age \u226565 years (adjusted odds ratio [aOR] = 3.4), black race (aOR = 3.2), having diabetes mellitus (aOR = 3.1), lack of insurance (aOR = 2.8), male sex (aOR = 2.4), smoking (aOR = 2.3), and obesity (aOR = 1.9). Infection with SARS-CoV-2 can lead to severe outcomes, including death, and measures to protect persons from infection, such as staying at home, social distancing (5), and awareness and management of underlying conditions should be emphasized for those at highest risk for hospitalization with COVID-19. Measures that prevent the spread of infection to others, such as wearing cloth face coverings (6), should be used whenever possible to protect groups at high risk. Potential barriers to the ability to adhere to these measures need to be addressed.", "Racial Disparities in COVID-19 Deaths Reveal Harsh Truths About Structural Inequality in America. The Coronavirus disease 2019 (COVID-19) pandemic has unveiled the stark racial disparities that are present in United States (US) and other developed countries today. In recent weeks, several states have released demographic data that highlights the disproportionate rate of COVID-19 infections in racial/ethnic minorities1 . These disparities are likely a result of the structural inequities that minorities face due to factors such as racism, neighborhood segregation, income, housing and education inequality, and poor access to medical care.", "COVID-19 Is Disproportionately High in African Americans. This Will Come as No Surprise ", "Social Vulnerability and Racial Inequality in COVID-19 Deaths in Chicago Although the current COVID-19 crisis is felt globally, at the local level, COVID-19 has disproportionately affected poor, highly segregated African American communities in Chicago. To understand the emerging pattern of racial inequality in the effects of COVID-19, we examined the relative burden of social vulnerability and health risk factors. We found significant spatial clusters of social vulnerability and risk factors, both of which are significantly associated with the increased COVID-19-related death rate. We also found that a higher percentage of African Americans was associated with increased levels of social vulnerability and risk factors. In addition, the proportion of African American residents has an independent effect on the COVID-19 death rate. We argue that existing inequity is often highlighted in emergency conditions. The disproportionate effects of COVID-19 in African American communities are a reflection of racial inequality and social exclusion that existed before the COVID-19 crisis.", "COVID-19 and the other pandemic: populations made vulnerable by systemic inequity Greater than the coronavirus disease 2019 (COVID-19) crisis, systemic inequity in social determinants of health is the pandemic that has long fostered vulnerability to disease and poor health outcomes in the USA. Our response has major implications for the health of our nations.", "Evidence mounts on the disproportionate effect of COVID-19 on ethnic minorities ", "Mental health and COVID-19: is the virus racist? COVID-19 has changed our lives and it appears to be especially harmful for some groups more than others. Black and Asian ethnic minorities are at particular risk and have reported greater mortality and intensive care needs. Mental illnesses are more common among Black and ethnic minorities, as are crisis care pathways including compulsory admission. This editorial sets out what might underlie these two phenomena, explaining how societal structures and disadvantage generate and can escalate inequalities in crises.", "Geographic Differences in COVID-19 Cases, Deaths, and Incidence - United States, February 12-April 7, 2020 Community transmission of coronavirus disease 2019 (COVID-19) was first detected in the United States in February 2020. By mid-March, all 50 states, the District of Columbia (DC), New York City (NYC), and four U.S. territories had reported cases of COVID-19. This report describes the geographic distribution of laboratory-confirmed COVID-19 cases and related deaths reported by each U.S. state, each territory and freely associated state,* DC, and NYC during February 12-April 7, 2020, and estimates cumulative incidence for each jurisdiction. In addition, it projects the jurisdiction-level trajectory of this pandemic by estimating case doubling times on April 7 and changes in cumulative incidence during the most recent 7-day period (March 31-April 7). As of April 7, 2020, a total of 395,926 cases of COVID-19, including 12,757 related deaths, were reported in the United States. Cumulative COVID-19 incidence varied substantially by jurisdiction, ranging from 20.6 cases per 100,000 in Minnesota to 915.3 in NYC. On April 7, national case doubling time was approximately 6.5 days, although this ranged from 5.5 to 8.0 days in the 10 jurisdictions reporting the most cases. Absolute change in cumulative incidence during March 31-April 7 also varied widely, ranging from an increase of 8.3 cases per 100,000 in Minnesota to 418.0 in NYC. Geographic differences in numbers of COVID-19 cases and deaths, cumulative incidence, and changes in incidence likely reflect a combination of jurisdiction-specific epidemiologic and population-level factors, including 1) the timing of COVID-19 introductions; 2) population density; 3) age distribution and prevalence of underlying medical conditions among COVID-19 patients (1-3); 4) the timing and extent of community mitigation measures; 5) diagnostic testing capacity; and 6) public health reporting practices. Monitoring jurisdiction-level numbers of COVID-19 cases, deaths, and changes in incidence is critical for understanding community risk and making decisions about community mitigation, including social distancing, and strategic health care resource allocation.", "Racial, Economic and Health Inequality and COVID-19 Infection in the United States Abstract Background: There is preliminary evidence of racial and social-economic disparities in the population infected by and dying from COVID-19. The goal of this study is to report the associations of COVID-19 with respect to race, health and economic inequality in the United States. Methods: We performed a cross-sectional study of the associations between infection and mortality rate of COVID-19 and demographic, socioeconomic and mobility variables from 369 counties (total population: 102,178,117 [median: 73,447, IQR: 30,761-256,098]) from the seven most affected states (Michigan, New York, New Jersey, Pennsylvania, California, Louisiana, Massachusetts). Findings: The risk factors for infection and mortality are different. Our analysis shows that counties with more diverse demographics, higher population, education, income levels, and lower disability rates were at a higher risk of COVID-19 infection. However, counties with higher disability and poverty rates had a higher death rate. African Americans were more vulnerable to COVID-19 than other ethnic groups (1,981 African American infected cases versus 658 Whites per million). Data on mobility changes corroborate the impact of social distancing. Interpretation: The observed inequality might be due to the workforce of essential services, poverty, and access to care. Counties in more urban areas are probably better equipped at providing care. The lower rate of infection, but a higher death rate in counties with higher poverty and disability could be due to lower levels of mobility, but a higher rate of comorbidities and health care access. Keywords: Healthcare Disparities, Health Status Disparities, Socioeconomic Factors, COVID-19, Economic Inequality, Racial Disparity, United States, Population-Based Analysis.", "COVID-19 and ethnicity: who will research results apply to? ", "COVID-19 and Kidney Disease Disparities in the United States Abstract Racial, ethnic, socioeconomic, age, and sex-related health disparities in kidney disease are prominent in the United States. The Coronavirus Disease 2019 (COVID-19) pandemic has disproportionately affected marginalized populations. Older adults, people experiencing unstable housing, racial and ethnic minorities and immigrants are potentially at increased risk for infection and severe complications from COVID-19. The direct and societal effects of the pandemic may increase risk of incident kidney disease and lead to worse outcomes for those with kidney disease. The rapid transition to telemedicine potentially limits access to care for older adults, immigrants, and people experiencing unstable housing. The economic impact of the pandemic has had a disproportionate effect on women, minorities and immigrants, which may limit their ability to manage kidney disease, and lead to complications or kidney disease progression. We describe the impact of COVID-19 on marginalized populations and highlight how the pandemic may exacerbate existing disparities in kidney disease.", "COVID-19 and Katrina: recalcitrant racial disparities ", "African American children are at higher risk for COVID\u201019 infection Infection by severe acute respiratory syndrome coronavirus 2 (SARS\u2010CoV\u20102), the viral etiology of the novel coronavirus disease 2019 (COVID\u201019), was first reported in Wuhan, China in late 2019. Peculiarly, the virus has not caused significant impact on pediatric populations, unlike other coronaviruses (1). Children comprise only 1.7% of COVID\u201019 positive cases in the United States (2). Furthermore, children are noted to have a milder disease course (3, 4). However, much is unknown about the age, gender and race risk factors of COVID\u201019 among children. There has been recent evidence suggestive of higher rates of COVID\u201019 and related fatality rates in African American adult communities around the United States(5). However, there is limited data, to our knowledge, whether any race or ethnicity group is at higher risk for COVID\u201019 infection in children.", "Acknowledging and Addressing COVID-19 Health Disparities in the American South. ", "COVID-19: A Closer Lens. Generations of nurses to come, now called heroes in the media, will have challenges in providing care for persons during this global pandemic. COVID-19 has impacted all demographics, regardless of race, gender, or socioeconomic class globally. African Americans have experienced a disproportionate number of deaths related to COVID-19 in the New Orleans and surrounding Metropolitan areas. According to the Louisiana Department of Health (2020), fifty-seven percent (57.40%) of the deaths in Louisiana related to COVID-19 have been African American (Black) and fifty-five percent (55.2%) have been males as of May 11, 2020. Social determinants of health are the conditions in which people age and the conditions they are born, grow, age and work. These conditions include neighborhoods, schools, and places of employment. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels (World Health Organization, 2020). Years later the same community that comprised \"pre-and post-Katrina\" are now facing this pandemic.", "Policy Recommendations to Address High Risk of COVID-19 Among Immigrants. The health and economic consequences of COVID-19 will be devastatingly widespread, but the populations that will suffer most are those who have experienced longstanding health disparities. For example, emerging evidence strongly suggests that incidence and case fatality rates are higher among Blacks than Whites.1 Immigrants are among the groups most likely to experience disproportionate effects from COVID-19. Unlike race/ethnicity, however, nativity and citizenship status are not included on the Centers for Disease Control and Prevention's (CDC's) coronavirus case report form,2 so data regarding testing and spread across immigrant groups are likely to remain scarce. Information from other health and social surveys-including data that I present in Table 1-suggest that noncitizens experience barriers to physical distancing that will place them at high risk of contracting COVID-19 and have high levels of disadvantage that leave them vulnerable to its economic effects. I recommend three policy changes to address the high health and economic risk among noncitizens, goals that are in the best interest of public health and the broader economy. (Am J Public Health. Published online ahead of print June 25, 2020: e1-e3. doi:10.2105/AJPH.2020.305792).", "Racial Capitalism within Public Health: How Occupational Settings Drive COVID-19 Disparities Epidemiology of the U.S. COVID-19 outbreak focuses on individuals' biology and behaviors, despite centrality of occupational environments in the viral spread. This demonstrates collusion between epidemiology and racial capitalism because it obscures structural influences, absolving industries of responsibility for worker safety. In an empirical example, we analyze economic implications of race-based metrics widely used in occupational epidemiology. In the U.S., White adults have better average lung function and worse hearing than Black adults. Both impaired lung function and hearing are criteria for Worker's compensation, which is ultimately paid by industry. Compensation for respiratory injury is determined using a race-specific algorithm. For hearing, there is no race adjustment. Selective use of race-specific algorithms for workers' compensation reduces industries' liability for worker health, illustrating racial capitalism operating within public health. Widespread and unexamined belief in inherent physiological inferiority of Black Americans perpetuates systems that limit industry payouts for workplace injuries. We see a parallel in the epidemiology of COVID-19 disparities. We tell stories of industries implicated in the outbreak and review how they exemplify racial capitalism. We call on public health professionals to: critically evaluate who is served and neglected by data analysis; and center structural determinants of health in etiological evaluation.", "HIV Care Continuum and COVID-19 Outcomes Among People Living with HIV During the COVID-19 Pandemic, Chicago, IL ", "Racial Disparity of Coronavirus Disease 2019 (COVID-19) in African American Communities The COVID-19 pandemic has unveiled unsettling disparities in the outcome of the disease among African Americans. These disparities are not new, but are rooted in structural inequities that must be addressed to adequately care for communities of color. We describe the historical context of these structural inequities, their impact on the progression of COVID-19 in the African American (Black) community, and suggest a multifaceted approach to addressing these healthcare disparities. Of note, terminology from survey data cited for this article varied from Blacks, African Americans or both; for consistency, we use African Americans throughout.", "Impact of COVID-19 on 2020 US life expectancy for the Black and Latino populations The Black and Latino populations have experienced a disproportionate burden of COVID-19 morbidity and mortality, reflecting persistent structural inequalities that increase risk of exposure to COVID-19 and risk of death for those infected. According to the National Center for Health Statistics, as of July 4, 2020, deaths to Black and Latino individuals comprised 23% and 17%, respectively, of the approximately 115,000 COVID-19 deaths. COVID-19 mortality is likely to result in a larger decline in life expectancy during 2020 than the US has experienced for decades as well as a particularly large reduction for Black and Latino individuals. We estimate life expectancy at birth and at age 65 for 2020, by race and ethnicity, using four scenarios of deaths-one in which the COVID-19 pandemic had not occurred and three including COVID-19 mortality projections produced by the Institute for Health Metrics and Evaluation. Our most likely estimate indicates a reduction in life expectancy at birth greater than 1.5 years for both the Black and Latino populations, which is one year larger than the reduction for whites. This would imply that the Black-white gap would increase by 30%, from 3.6 to 4.7 years, thereby eliminating progress made in reducing this differential since 2008 and reversing an overall trend of steeper mortality declines among the Black population since the early 1990s. Latinos, who have consistently experienced lower mortality than whites (a phenomenon known as the Latino or Hispanic paradox), would see their survival advantage decline by 36%, equivalent to its magnitude in 2006.", "Commentary: Addressing Inequities in the Era of COVID-19: The Pandemic and the Urgent Need for Critical Race Theory. ", "Cumulative incidence and diagnosis of SARS-CoV-2 infection in New York PURPOSE: New York State (NYS) is an epicenter of the SARS-CoV-2 pandemic in the United States. Reliable estimates of cumulative incidence in the population are critical to tracking the extent of transmission and informing policies. METHODS: We conducted a statewide seroprevalence study among a 15,101 patron convenience sample at 99 grocery stores in 26 counties throughout NYS. SARS-CoV-2 cumulative incidence was estimated from antibody reactivity by first post-stratification weighting then adjusting by antibody test characteristics. The percent diagnosed was estimated by dividing diagnoses by estimated infection-experienced adults. RESULTS: Based on 1,887 of 15,101 reactive results (12.5%), estimated cumulative incidence through March 29 was 14.0% (95% CI: 13.3-14.7%), corresponding to 2,139,300 (95% CI: 2,035,800-2,242,800) infection-experienced adults. Cumulative incidence was highest in New York City (NYC) 22.7% (95% CI: 21.5-24.0%) and higher among Hispanic/Latino (29.2%), non-Hispanic black/African American (20.2%), and non-Hispanic Asian (12.4%) than non-Hispanic white adults (8.1%, p<.0001). An estimated 8.9% (95% CI: 8.4-9.3%) of infections in NYS were diagnosed, with diagnosis highest among adults \u226555 years (11.3%, 95% CI: 10.4-12.2%). CONCLUSIONS: From the largest US serosurvey to date, we estimated > 2 million adult New York residents were infected through late March, with substantial disparities, although cumulative incidence remained below herd immunity thresholds. Monitoring, testing, and contact tracing remain essential public health strategies.", "Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study OBJECTIVE: To describe outcomes of people admitted to hospital with coronavirus disease 2019 (covid-19) in the United States, and the clinical and laboratory characteristics associated with severity of illness. DESIGN: Prospective cohort study. SETTING: Single academic medical center in New York City and Long Island. PARTICIPANTS: 5279 patients with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection between 1 March 2020 and 8 April 2020. The final date of follow up was 5 May 2020. MAIN OUTCOME MEASURES: Outcomes were admission to hospital, critical illness (intensive care, mechanical ventilation, discharge to hospice care, or death), and discharge to hospice care or death. Predictors included patient characteristics, medical history, vital signs, and laboratory results. Multivariable logistic regression was conducted to identify risk factors for adverse outcomes, and competing risk survival analysis for mortality. RESULTS: Of 11 544 people tested for SARS-Cov-2, 5566 (48.2%) were positive. After exclusions, 5279 were included. 2741 of these 5279 (51.9%) were admitted to hospital, of whom 1904 (69.5%) were discharged alive without hospice care and 665 (24.3%) were discharged to hospice care or died. Of 647 (23.6%) patients requiring mechanical ventilation, 391 (60.4%) died and 170 (26.2%) were extubated or discharged. The strongest risk for hospital admission was associated with age, with an odds ratio of >2 for all age groups older than 44 years and 37.9 (95% confidence interval 26.1 to 56.0) for ages 75 years and older. Other risks were heart failure (4.4, 2.6 to 8.0), male sex (2.8, 2.4 to 3.2), chronic kidney disease (2.6, 1.9 to 3.6), and any increase in body mass index (BMI) (eg, for BMI >40: 2.5, 1.8 to 3.4). The strongest risks for critical illness besides age were associated with heart failure (1.9, 1.4 to 2.5), BMI >40 (1.5, 1.0 to 2.2), and male sex (1.5, 1.3 to 1.8). Admission oxygen saturation of <88% (3.7, 2.8 to 4.8), troponin level >1 (4.8, 2.1 to 10.9), C reactive protein level >200 (5.1, 2.8 to 9.2), and D-dimer level >2500 (3.9, 2.6 to 6.0) were, however, more strongly associated with critical illness than age or comorbidities. Risk of critical illness decreased significantly over the study period. Similar associations were found for mortality alone. CONCLUSIONS: Age and comorbidities were found to be strong predictors of hospital admission and to a lesser extent of critical illness and mortality in people with covid-19; however, impairment of oxygen on admission and markers of inflammation were most strongly associated with critical illness and mortality. Outcomes seem to be improving over time, potentially suggesting improvements in care.", "Time for a culture change: understanding and reducing risk, morbidity and mortality from COVID-19 in those of black and minority ethnicity Following a number of epidemics in the 21st century, including Ebola and Middle East respiratory syndrome, the SARS-COV-2 virus, causing COVID-19 disease, was declared a pandemic health emergency of international concern in January 2020.", "COVID-19 in-patient hospital mortality by ethnicity There is debate about the extent to which COVID-19 affects ethnic groups differently. We explored if there was variation in hospital mortality in patients with COVID. Mortality rates in 1,276 inpatients in Bradford with test results for COVID-19 were analysed by ethnic group. The age-adjusted risk of dying from COVID-19 was slightly lower in South Asian compared to White British patients. (RR =0.87, 95% CI: 0.41 to 1.84).", "Inequality in acute respiratory infection outcomes in the United States: A review of the literature and its implications for public health policy and practice. Seasonal and pandemic respiratory viruses such as influenza and the novel coronavirus (SARS-COV-2) currently sweeping the globe have often been described as 'equal opportunity infectors', implying little socioeconomic disparity in susceptibility. However, early data from the COVID-19 pandemic has underscored that the burden of respiratory viruses actually reflect and magnify existing socioeconomic inequalities. We review the literature on socioeconomic and racial disparities in acute respiratory infection (ARI), as well as ARI-associated hospitalization and mortality. Our goal is to identify key principles of the relationship between socioeconomic inequality and ARI outcomes, as well as highlighting poorly understood areas that need to be addressed by research and policy in the wake of the COVID-19 pandemic. We find that there has been descriptive work in this area, but that there is a distinct lack of cohesive methodology in the literature exploring social determinants and ARI. We propose the fundamental cause theory is a useful framework for guiding future research of disparities in ARI and for the design of interventions to alleviate these disparities.", "Being African American and Rural: A Double Jeopardy From COVID-19 ", "Blacks/African Americans are 5 Times More Likely to Develop COVID-19: Spatial Modeling of New York City ZIP Code-level Testing Results Introduction. The population and spatial characteristics of COVID-19 infections are poorly understood, but there is increasing evidence that in addition to individual clinical factors, demographic, socioeconomic and racial characteristics play an important role. Methods. We analyzed positive COVID-19 testing results counts within New York City ZIP Code Tabulation Areas (ZCTA) with Bayesian hierarchical Poisson spatial models using integrated nested Laplace approximations. Results. Spatial clustering accounted for approximately 32% of the variation in the data, with hot spots in all five boroughs. Spatial risk did not correspond precisely to population-based rates of positive tests. The strongest univariate association with positive testing rates was the proportion of residents in a ZIP Code Tabulation Area with Chronic Obstructive Pulmonary Disease (COPD). For every one unit increase in a scaled standardized measure of COPD in a community, there was an approximate 8-fold increase in the risk of a positive COVID-19 test in a ZCTA (Incidence Density Ratio = 8.2, 95% Credible Interval 3.7, 18.3). The next strongest association was with the proportion of Black and African American residents, for which there was a nearly five-fold increase in the risk of a positive COVID-19 test. (IDR = 4.8, 95% Cr I 2.4, 9.7). Increases in the proportion of residents older than 65, housing density and the proportion of residents with heart disease were each associated with an approximate doubling of risk. In a multivariable model including estimates for age, COPD, heart disease, housing density and Black/African American race, the only variables that remained associated with positive COVID-19 testing with a probability greater than chance were the proportion of Black/African American residents and proportion of older persons. Conclusions. The population and spatial patterns of COVID-19 infections differ by race, age, physical environment and health status. Areas with large proportions of Black/African American residents are at markedly higher risk that is not fully explained by characteristics of the environment and pre-existing conditions in the population.", "Stay-at-Home Orders, African American Population, Poverty and State-level Covid-19 Infections: Are there associations? Importance: To cope with the continuing COVID-19 pandemic, state and local health officials need information on the effectiveness of policies aimed at curbing contagion, as well as area-specific socio-demographic characteristics that can portend vulnerability to the disease. Objective: To investigate whether state-imposed stay-at-home orders, African American population in the state, state poverty and other state socio-demographic characteristics, were associated with the state-level incidence of COVID-19 infection. Design, Setting, Participants: State-level, aggregated, publicly available data on positive COVID-19 cases and tests were used. The period considered was March 1st -May 4th. All U.S. states except Washington were included. Outcomes of interest were daily cumulative and daily incremental COVID-19 infection rates. Outcomes were log-transformed. Log-linear regression models with a quadratic time-trend and random intercepts for states were estimated. Covariates included log-transformed test-rates, a binary indicator for stay-at-home, percentage of African American, poverty, percentage elderly, state population and prevalence of selected comorbidities. Binary fixed effects for date each state first started reporting test data were included. Results: Stay-at-home orders were associated with decreases in cumulative ({beta}:-1.23; T-stat: -6.84) and daily ({beta}:-0.46; T-stat: -2.56) infection-rates. Predictive analyses indicated that expected cumulative infection rates would be 3 times higher and expected daily incremental rates about 60% higher in absence of stay-at-home orders. Higher African American population was associated with higher cumulative ({beta}: 0.08; T-stat: 4.01) and daily ({beta}: 0.06; T-stat: 3.50) rates. State poverty rates had mixed results and were not robust to model specifications. There was strong evidence of a quadratic daily trend for cumulative and daily rates. Results were largely robust to alternate specifications. Conclusions: We find evidence that stay-at-home orders, which were widely supported by public-health experts, helped to substantially curb COVID-19 infection-rates. As we move to a phased re-opening, continued precautions advised by public-health experts should be adhered to. Also, a larger African American population is strongly associated with incidence of COVID-19 infection. Policies and resources to help mitigate African American vulnerability to COVID-19 is an urgent public health and social justice issue, especially since the ongoing mass protests against police brutality may further exacerbate COVID-19 contagion in this community.", "The mental health impact of the COVID-19 epidemic on immigrants and racial and ethnic minorities ", "Comorbidities and Disparities in Outcomes of COVID-19 Among African American and White Patients Initial surveillance data suggests a disproportionately high number of deaths among Black patients with COVID-19. However, high-risk comorbidities are often over-represented in the Black population, and understanding whether the disparity is entirely secondary to them is essential. We performed a retrospective cohort study using real-time analysis of electronic medical records (EMR) of patients from multiple healthcare organizations in the United States. Our results showed that Black patients with COVID-19 have a significantly higher risk of mortality, hospitalization, and invasive mechanical ventilation compared to White patients. The incremental risk of poor outcomes in Blacks persists despite accounting for a higher prevalence of comorbidities. This may point to the disparities in socioeconomic determinants of health affecting Blacks and the need for an improvement in the care of this vulnerable population.", "Covid-19: Known risk factors fail to explain the increased risk of death among people from ethnic minorities. ", "COVID-19 is Out of Proportion in African Americans. This Will Come as No Surprise\u2026 ", "Racial Inequalities in Mortality from Coronavirus: The Tip of the Iceberg ", "Racial and Ethnic Digital Divides in Posting COVID-19 Content on Social Media Among US Adults: Secondary Survey Analysis BACKGROUND: Public health surveillance experts are leveraging user-generated content on social media to track the spread and effects of COVID-19. However, racial and ethnic digital divides, which are disparities among people who have internet access and post on social media, can bias inferences. This bias is particularly problematic in the context of the COVID-19 pandemic because due to structural inequalities, members of racial and ethnic minority groups are disproportionately vulnerable to contracting the virus and to the deleterious economic and social effects from mitigation efforts. Further, important demographic intersections with race and ethnicity, such as gender and age, are rarely investigated in work characterizing social media users; however, they reflect additional axes of inequality shaping differential exposure to COVID-19 and its effects. OBJECTIVE: The aim of this study was to characterize how the race and ethnicity of US adults are associated with their odds of posting COVID-19 content on social media and how gender and age modify these odds. METHODS: We performed a secondary analysis of a survey conducted by the Pew Research Center from March 19 to 24, 2020, using a national probability sample (N=10,510). Respondents were recruited from an online panel, where panelists without an internet-enabled device were given one to keep at no cost. The binary dependent variable was responses to an item asking whether respondents \"used social media to share or post information about the coronavirus.\" We used survey-weighted logistic regressions to estimate the odds of responding in the affirmative based on the race and ethnicity of respondents (white, black, Latino, other race/ethnicity), adjusted for covariates measuring sociodemographic background and COVID-19 experiences. We examined how gender (female, male) and age (18 to 30 years, 31 to 50 years, 51 to 64 years, and 65 years and older) intersected with race and ethnicity by estimating interactions. RESULTS: Respondents who identified as black (odds ratio [OR] 1.29, 95% CI 1.02-1.64; P=.03), Latino (OR 1.66, 95% CI 1.36-2.04; P<.001), or other races/ethnicities (OR 1.33, 95% CI 1.02-1.72; P=.03) had higher odds than respondents who identified as white of reporting that they posted COVID-19 content on social media. Women had higher odds of posting than men regardless of race and ethnicity (OR 1.58, 95% CI 1.39-1.80; P<.001). Among men, respondents who identified as black, Latino, or members of other races/ethnicities were significantly more likely to post than respondents who identified as white. Older adults (65 years or older) had significantly lower odds (OR 0.73, 95% CI 0.57-0.94; P=.01) of posting compared to younger adults (18-29 years), particularly among those identifying as other races/ethnicities. Latino respondents were the most likely to report posting across all age groups. CONCLUSIONS: In the United States, members of racial and ethnic minority groups are most likely to contribute to COVID-19 content on social media, particularly among groups traditionally less likely to use social media (older adults and men). The next step is to ensure that data collection procedures capture this diversity by encompassing a breadth of search criteria and social media platforms.", "Taking a Closer Look at COVID-19, Health Inequities, and Racism ", "Risk factors for clinical progression in patients with COVID-19: a retrospective study of electronic health record data in the United Kingdom Background: The novel coronavirus disease 2019 (COVID-19) outbreak presents a significant threat to global health. A better understanding of patient clinical profiles is essential to drive efficient and timely health service strategies. In this study, we aimed to identify risk factors for a higher susceptibility to symptomatic presentation with COVID-19 and a transition to severe disease. Methods: We analysed data on 2756 patients admitted to Chelsea & Westminster Hospital NHS Foundation Trust between 1st January and 23rd April 2020. We compared differences in characteristics between patients designated positive for COVID-19 and patients designated negative on hospitalisation and derived a multivariable logistic regression model to identify risk factors for predicting risk of symptomatic COVID-19. For patients with COVID-19, we used univariable and multivariable logistic regression to identify risk factors associated with progression to severe disease defined by: 1) admission to the hospital AICU, 2) the need for mechanical ventilation, 3) in-hospital mortality, and 4) at least one measurement of elevated D-dimer (equal or superior to 1,000 ug/L) indicative of increased risk of venous thromboembolism. Results: The patient population consisted of 1148 COVID-19 positive and 1608 COVID-19 negative patients. Age, sex, self-reported ethnicity, C-reactive protein, white blood cell count, respiratory rate, body temperature, and systolic blood pressure formed the most parsimonious model for predicting risk of symptomatic COVID-19 at hospital admission. Among 1148 patients with COVID-19, 116 (10.1%) were admitted to the AICU, 71 (6.2%) required mechanical ventilation, 368 (32.1%) had at least one record of D-dimer levels [\u2265]1,000 g/L, and 118 patients died. In the multivariable logistic regression, age (OR = 0.953 per 1 year, 95% CI: 0.937-0.968) C-reactive protein (OR = 1.004 per 1 mg/L, 95% CI: 1.002-1.007), and white blood cell counts (OR = 1.059 per 109/L, 95% CI: 1.010-1.111) were found to be associated with admission to the AICU. Age (OR = 0.973 per 1 year, 95% CI: 0.955-0.990), C-reactive protein (OR = 1.003 per 1 mg/L, 95% CI: 1.000-1.006) and sodium (OR = 0.915 per 1 mmol/L, 0.868-0.962) were associated with mechanical ventilation. Age (OR = 1.023 per 1 year, 95% CI: 1.004-1.043), CRP (OR = 1.004 per 1 mg/L, 95% CI: 1.002-1.006), and body temperature (OR = 0.723 per 1oC, 95% CI: 0.541-0.958) were associated with elevated D-dimer. For mortality, we observed associations with age (OR = 1.060 per 1 year, 95% CI: 1.040-1.082), female sex (OR = 0.442, 95% CI: 0.442, 95% CI: 0.245-0.777), Asian ethnic background (OR = 2.237 vs White ethnic background, 95% CI: 1.111-4.510), C-reactive protein (OR = 1.004 per 1 mg/L, 95% CI: 1.001-1.006), sodium (OR = 1.038 per 1 mmol/L, 95% CI: 1.001-1.006), and respiratory rate (OR = 1.054 per 1 breath/min, 95% CI: 1.024-1.087). Conclusion: Our analysis suggests there are several demographic, clinical and laboratory findings associated with a symptomatic presentation of COVID-19. Moreover, significant associations between patient deterioration were found with age, sex and specific blood markers, chiefly C-reactive protein, and could help early identification of patients at risk of poorer prognosis. Further work is required to clarify the extent to which our observations are relevant beyond current settings.", "COVID highlights another crisis: lack of Black physicians and scientists ", "Assessing Differential Impacts of COVID-19 on Black Communities Purpose: Given incomplete data reporting by race, we used data on COVID-19 cases and deaths in US counties to describe racial disparities in COVID-19 disease and death and associated determinants. Methods: Using publicly available data (accessed April 13, 2020), predictors of COVID-19 cases and deaths were compared between disproportionately (>13%) black and all other (<13% black) counties. Rate ratios were calculated and population attributable fractions (PAF) were estimated using COVID-19 cases and deaths via zero-inflated negative binomial regression model. National maps with county-level data and an interactive scatterplot of COVID-19 cases were generated. Results: Nearly ninety-seven percent of disproportionately black counties (656/677) reported a case and 49% (330/677) reported a death versus 81% (1987/2,465) and 28% (684/ 2465), respectively, for all other counties. Counties with higher proportions of black people have higher prevalence of comorbidities and greater air pollution. Counties with higher proportions of black residents had more COVID-19 diagnoses (RR 1.24, 95% CI 1.17-1.33) and deaths (RR 1.18, 95% CI 1.00-1.40), after adjusting for county-level characteristics such as age, poverty, comorbidities, and epidemic duration. COVID-19 deaths were higher in disproportionally black rural and small metro counties. The PAF of COVID-19 diagnosis due to lack of health insurance was 3.3% for counties with <13% black residents and 4.2% for counties with >13% black residents. Conclusions: Nearly twenty-two percent of US counties are disproportionately black and they accounted for 52% of COVID-19 diagnoses and 58% of COVID-19 deaths nationally. County-level comparisons can both inform COVID-19 responses and identify epidemic hot spots. Social conditions, structural racism, and other factors elevate risk for COVID-19 diagnoses and deaths in black communities.", "Race/Ethnicity, Underlying Medical Conditions, Homelessness, and Hospitalization Status of Adult Patients with COVID-19 at an Urban Safety-Net Medical Center - Boston, Massachusetts, 2020. As of July 5, 2020, approximately 2.8 million coronavirus disease 2019 (COVID-19) cases and 130,000 COVID-19-associated deaths had been reported in the United States (1). Populations historically affected by health disparities, including certain racial and ethnic minority populations, have been disproportionally affected by and hospitalized with COVID-19 (2-4). Data also suggest a higher prevalence of infection with SARS-CoV-2, the virus that causes COVID-19, among persons experiencing homelessness (5). Safety-net hospitals,\u2020 such as Boston Medical Center (BMC), which provide health care to persons regardless of their insurance status or ability to pay, treat higher proportions of these populations and might experience challenges during the COVID-19 pandemic. This report describes the characteristics and clinical outcomes of adult patients with laboratory-confirmed COVID-19 treated at BMC during March 1-May 18, 2020. During this time, 2,729 patients with SARS-CoV-2 infection were treated at BMC and categorized into one of the following mutually exclusive clinical severity designations: exclusive outpatient management (1,543; 56.5%), non-intensive care unit (ICU) hospitalization (900; 33.0%), ICU hospitalization without invasive mechanical ventilation (69; 2.5%), ICU hospitalization with mechanical ventilation (119; 4.4%), and death (98; 3.6%). The cohort comprised 44.6% non-Hispanic black (black) patients and 30.1% Hispanic or Latino (Hispanic) patients. Persons experiencing homelessness accounted for 16.4% of patients. Most patients who died were aged \u226560 years (81.6%). Clinical severity differed by age, race/ethnicity, underlying medical conditions, and homelessness. A higher proportion of Hispanic patients were hospitalized (46.5%) than were black (39.5%) or non-Hispanic white (white) (34.4%) patients, a finding most pronounced among those aged <60 years. A higher proportion of non-ICU inpatients were experiencing homelessness (24.3%), compared with homeless patients who were admitted to the ICU without mechanical ventilation (15.9%), with mechanical ventilation (15.1%), or who died (15.3%). Patient characteristics associated with illness and clinical severity, such as age, race/ethnicity, homelessness, and underlying medical conditions can inform tailored strategies that might improve outcomes and mitigate strain on the health care system from COVID-19.", "Racial disparities in COVID-19 deaths reveal harsh truths about structural inequality in America ", "The Fire This Time: The Stress of Racism, Inflammation and COVID-19 ", "Covid-19: Known risk factors fail to explain the increased risk of death among people from ethnic minorities ", "Hospitalization and Mortality among Black Patients and White Patients with Covid-19 BACKGROUND: Many reports on coronavirus disease 2019 (Covid-19) have highlighted age- and sex-related differences in health outcomes. More information is needed about racial and ethnic differences in outcomes from Covid-19. METHODS: In this retrospective cohort study, we analyzed data from patients seen within an integrated-delivery health system (Ochsner Health) in Louisiana between March 1 and April 11, 2020, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the virus that causes Covid-19) on qualitative polymerase-chain-reaction assay. The Ochsner Health population is 31% black non-Hispanic and 65% white non-Hispanic. The primary outcomes were hospitalization and in-hospital death. RESULTS: A total of 3626 patients tested positive, of whom 145 were excluded (84 had missing data on race or ethnic group, 9 were Hispanic, and 52 were Asian or of another race or ethnic group). Of the 3481 Covid-19-positive patients included in our analyses, 60.0% were female, 70.4% were black non-Hispanic, and 29.6% were white non-Hispanic. Black patients had higher prevalences of obesity, diabetes, hypertension, and chronic kidney disease than white patients. A total of 39.7% of Covid-19-positive patients (1382 patients) were hospitalized, 76.9% of whom were black. In multivariable analyses, black race, increasing age, a higher score on the Charlson Comorbidity Index (indicating a greater burden of illness), public insurance (Medicare or Medicaid), residence in a low-income area, and obesity were associated with increased odds of hospital admission. Among the 326 patients who died from Covid-19, 70.6% were black. In adjusted time-to-event analyses, variables that were associated with higher in-hospital mortality were increasing age and presentation with an elevated respiratory rate; elevated levels of venous lactate, creatinine, or procalcitonin; or low platelet or lymphocyte counts. However, black race was not independently associated with higher mortality (hazard ratio for death vs. white race, 0.89; 95% confidence interval, 0.68 to 1.17). CONCLUSIONS: In a large cohort in Louisiana, 76.9% of the patients who were hospitalized with Covid-19 and 70.6% of those who died were black, whereas blacks comprise only 31% of the Ochsner Health population. Black race was not associated with higher in-hospital mortality than white race, after adjustment for differences in sociodemographic and clinical characteristics on admission.", "Ethnic disparities in COVID-19 mortality: are comorbidities to blame? ", "COVID-19 and the need to prioritize health equity and social determinants of health. ", "COVID-19 and Racial/Ethnic Disparities. ", "Coronavirus Disease among Persons with Sickle Cell Disease, United States, March 20-May 21, 2020. Sickle cell disease (SCD) disproportionately affects Black or African American persons in the United States and can cause multisystem organ damage and reduced lifespan. Among 178 persons with SCD in the United States who were reported to an SCD-coronavirus disease case registry, 122 (69%) were hospitalized and 13 (7%) died.", "The Disproportionate Impact of COVID-19 on Racial and Ethnic Minorities in the United States ", "Racial and Ethnic Digital Divides in Posting COVID-19 Content on Social Media Among US Adults: Secondary Survey Analysis BACKGROUND: Public health surveillance experts are leveraging user-generated content on social media to track the spread and effects of COVID-19. However, racial and ethnic digital divides, which are disparities among people who have internet access and post on social media, can bias inferences. This bias is particularly problematic in the context of the COVID-19 pandemic because due to structural inequalities, members of racial and ethnic minority groups are disproportionately vulnerable to contracting the virus and to the deleterious economic and social effects from mitigation efforts. Further, important demographic intersections with race and ethnicity, such as gender and age, are rarely investigated in work characterizing social media users; however, they reflect additional axes of inequality shaping differential exposure to COVID-19 and its effects. OBJECTIVE: The aim of this study was to characterize how the race and ethnicity of US adults are associated with their odds of posting COVID-19 content on social media and how gender and age modify these odds. METHODS: We performed a secondary analysis of a survey conducted by the Pew Research Center from March 19 to 24, 2020, using a national probability sample (N=10,510). Respondents were recruited from an online panel, where panelists without an internet-enabled device were given one to keep at no cost. The binary dependent variable was responses to an item asking whether respondents \u201cused social media to share or post information about the coronavirus.\u201d We used survey-weighted logistic regressions to estimate the odds of responding in the affirmative based on the race and ethnicity of respondents (white, black, Latino, other race/ethnicity), adjusted for covariates measuring sociodemographic background and COVID-19 experiences. We examined how gender (female, male) and age (18 to 30 years, 31 to 50 years, 51 to 64 years, and 65 years and older) intersected with race and ethnicity by estimating interactions. RESULTS: Respondents who identified as black (odds ratio [OR] 1.29, 95% CI 1.02-1.64; P=.03), Latino (OR 1.66, 95% CI 1.36-2.04; P<.001), or other races/ethnicities (OR 1.33, 95% CI 1.02-1.72; P=.03) had higher odds than respondents who identified as white of reporting that they posted COVID-19 content on social media. Women had higher odds of posting than men regardless of race and ethnicity (OR 1.58, 95% CI 1.39-1.80; P<.001). Among men, respondents who identified as black, Latino, or members of other races/ethnicities were significantly more likely to post than respondents who identified as white. Older adults (65 years or older) had significantly lower odds (OR 0.73, 95% CI 0.57-0.94; P=.01) of posting compared to younger adults (18-29 years), particularly among those identifying as other races/ethnicities. Latino respondents were the most likely to report posting across all age groups. CONCLUSIONS: In the United States, members of racial and ethnic minority groups are most likely to contribute to COVID-19 content on social media, particularly among groups traditionally less likely to use social media (older adults and men). The next step is to ensure that data collection procedures capture this diversity by encompassing a breadth of search criteria and social media platforms.", "Seizing the Moment: Policy Advocacy to End Mass Incarceration in the Time of COVID-19. The mass human and economic casualties wrought by the COVID-19 pandemic laid bare the deep inequities at the base of the disproportionate losses and suffering experienced by diverse U.S. populations. But the urgency and enormity of unmet needs requiring bold policy action also provided a unique opportunity to learn from and partner with community-based organizations that often are at the frontlines of such work. Following a review of Kingdon's model of the policy-making process, we illustrate how a partnership in a large California county navigated the streams in the policy-making process and used the window of opportunity provided by the pandemic to address a major public health problem: the incarceration of over 2 million people, disproportionately African American and Latinx, in overcrowded, unsafe jails, prisons, and detention centers. We highlight tactics and strategies used, challenges faced, and implications for health educators as policy advocates during and beyond the pandemic.", "Ethnicity and COVID-19: an urgent public health research priority ", "Vulnerable Immigrant Populations in the New York Metropolitan Area and COVID-19: Lessons Learned in the Epicenter of the Crisis The epicenter of the COVID-19 crisis since March 17, 2020\u2014the New York metropolitan area\u2014is home to some of the largest Latino immigrant communities in the nation. These communities have long faced barriers to health care access, challenges due to immigration status, and financial and labor instability. The COVID-19 pandemic has aggravated these existing issues in a vulnerable, often forgotten, immigrant community. It is challenging for this population to access public information regarding COVID-19 testing, treatment, and assistance programs because this information is seldom disseminated in Spanish and even less frequently in Portuguese. While long-term solutions will require time and changes to policy, some short-term measures can mitigate the current situation. The authors share their experience from Newark, New Jersey, where partnerships of public and private community-based organizations (CBOs) have been successful in establishing trust between the health care system and a fearful Latino community. The Ironbound Initiative, a student group at Rutgers New Jersey Medical School in Newark, New Jersey, has partnered with Mantena Global Care, a Brazilian CBO in Newark, to facilitate dissemination of COVID-19\u2013relevant information. Medical student volunteers, removed from their clinical duties, serve as virtual patient navigators, using social media to reach community members with the goals of improving awareness of precautions to take during the pandemic and of increasing access to needed medical care. These students have collaborated with colleagues in other disciplines to provide necessary legal guidance to community members fearful of seeking care because of their immigration status. The authors urge other academic institutions across the country to recruit multidisciplinary teams of medical, health professional, and law students invested in their local communities and to empower students to partner with CBOs, immigrant community leaders, faith-based organizations, hospitals, and local authorities to support these vulnerable communities during this crisis.", "African American children are at higher risk of COVID-19 infection ", "What does and does not correlate with COVID-19 death rates We correlate county-level COVID-19 death rates with key variables using both linear regression and negative binomial mixed models, although we focus on linear regression models. We include four sets of variables: socio-economic variables, county-level health variables, modes of commuting, and climate and pollution patterns. Our analysis studies daily death rates from April 4, 2020 to May 27, 2020. We estimate correlation patterns both across states, as well as within states. For both models, we find higher shares of African American residents in the county are correlated with higher death rates. However, when we restrict ourselves to correlation patterns within a given state, the statistical significance of the correlation of death rates with the share of African Americans, while remaining positive, wanes. We find similar results for the share of elderly in the county. We find that higher amounts of commuting via public transportation, relative to telecommuting, is correlated with higher death rates. The correlation between driving into work, relative to telecommuting, and death rates is also positive across both models, but statistically significant only when we look across states and counties. We also find that a higher share of people not working, and thus not commuting either because they are elderly, children or unemployed, is correlated with higher death rates. Counties with higher home values, higher summer temperatures, and lower winter temperatures have higher death rates. Contrary to past work, we do not find a correlation between pollution and death rates. Also importantly, we do not find that death rates are correlated with obesity rates, ICU beds per capita, or poverty rates. Finally, our model that looks within states yields estimates of how a given state's death rate compares to other states after controlling for the variables included in our model; this may be interpreted as a measure of how states are doing relative to others. We find that death rates in the Northeast are substantially higher compared to other states, even when we control for the four sets of variables above. Death rates are also statistically significantly higher in Michigan, Louisiana, Iowa, Indiana, and Colorado. California's death rate is the lowest across all states.", "Hospitalization and Mortality among Black Patients and White Patients with Covid-19 BACKGROUND: Many reports on coronavirus disease 2019 (Covid-19) have highlighted age- and sex-related differences in health outcomes. More information is needed about racial and ethnic differences in outcomes from Covid-19. METHODS: In this retrospective cohort study, we analyzed data from patients seen within an integrated-delivery health system (Ochsner Health) in Louisiana between March 1 and April 11, 2020, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the virus that causes Covid-19) on qualitative polymerase-chain-reaction assay. The Ochsner Health population is 31% black non-Hispanic and 65% white non-Hispanic. The primary outcomes were hospitalization and in-hospital death. RESULTS: A total of 3626 patients tested positive, of whom 145 were excluded (84 had missing data on race or ethnic group, 9 were Hispanic, and 52 were Asian or of another race or ethnic group). Of the 3481 Covid-19\u2013positive patients included in our analyses, 60.0% were female, 70.4% were black non-Hispanic, and 29.6% were white non-Hispanic. Black patients had higher prevalences of obesity, diabetes, hypertension, and chronic kidney disease than white patients. A total of 39.7% of Covid-19\u2013positive patients (1382 patients) were hospitalized, 76.9% of whom were black. In multivariable analyses, black race, increasing age, a higher score on the Charlson Comorbidity Index (indicating a greater burden of illness), public insurance (Medicare or Medicaid), residence in a low-income area, and obesity were associated with increased odds of hospital admission. Among the 326 patients who died from Covid-19, 70.6% were black. In adjusted time-to-event analyses, variables that were associated with higher in-hospital mortality were increasing age and presentation with an elevated respiratory rate; elevated levels of venous lactate, creatinine, or procalcitonin; or low platelet or lymphocyte counts. However, black race was not independently associated with higher mortality (hazard ratio for death vs. white race, 0.89; 95% confidence interval, 0.68 to 1.17). CONCLUSIONS: In a large cohort in Louisiana, 76.9% of the patients who were hospitalized with Covid-19 and 70.6% of those who died were black, whereas blacks comprise only 31% of the Ochsner Health population. Black race was not associated with higher in-hospital mortality than white race, after adjustment for differences in sociodemographic and clinical characteristics on admission.", "COVID-19 and the US response: accelerating health inequities Health inequities have long defined health and the healthcare system in the USA. The clinical and research capacity across the USA is unparalleled, yet compared to other high and even some middle-income countries, the average health indicators of the population remain suboptimal in 2020, a finding at least in part explained by inequity in healthcare access. In this context, COVID-19 has rapidly emerged as a major threat to the public's health. While it was initially thought that severe acute respiratory syndrome coronavirus 2 would be the great equaliser as it would not discriminate, it is clear that COVID-19 incidence and mortality have rapidly reinforced health disparities drawn by historical and contemporary inequities. Here, we synthesise the data highlighting specific risks among particular marginalised and under-resourced communities including those in jails, prisons and detention centers, immigrants and the undocumented, people with disabilities and people experiencing homelessness across the USA. The drivers of these disparities are pervasive structural risks including limited access to preventive services, inability to comply with physical distancing recommendations, underlying health disparities and intersecting stigmas particularly affecting racial and ethnic minorities across the country, including African Americans, Latinx Americans and Native Americans. Advancing the COVID-19 response, saving lives and restarting the economy necessitate rapidly addressing these inequities rather than ignoring and even reinforcing them.", "COVID-19 and Racial/Ethnic Disparities ", "Race/Ethnicity, Underlying Medical Conditions, Homelessness, and Hospitalization Status of Adult Patients with COVID-19 at an Urban Safety-Net Medical Center - Boston, Massachusetts, 2020 As of July 5, 2020, approximately 2.8 million coronavirus disease 2019 (COVID-19) cases and 130,000 COVID-19-associated deaths had been reported in the United States (1). Populations historically affected by health disparities, including certain racial and ethnic minority populations, have been disproportionally affected by and hospitalized with COVID-19 (2-4). Data also suggest a higher prevalence of infection with SARS-CoV-2, the virus that causes COVID-19, among persons experiencing homelessness (5). Safety-net hospitals,\u0086 such as Boston Medical Center (BMC), which provide health care to persons regardless of their insurance status or ability to pay, treat higher proportions of these populations and might experience challenges during the COVID-19 pandemic. This report describes the characteristics and clinical outcomes of adult patients with laboratory-confirmed COVID-19 treated at BMC during March 1-May 18, 2020. During this time, 2,729 patients with SARS-CoV-2 infection were treated at BMC and categorized into one of the following mutually exclusive clinical severity designations: exclusive outpatient management (1,543; 56.5%), non-intensive care unit (ICU) hospitalization (900; 33.0%), ICU hospitalization without invasive mechanical ventilation (69; 2.5%), ICU hospitalization with mechanical ventilation (119; 4.4%), and death (98; 3.6%). The cohort comprised 44.6% non-Hispanic black (black) patients and 30.1% Hispanic or Latino (Hispanic) patients. Persons experiencing homelessness accounted for 16.4% of patients. Most patients who died were aged &#8805;60 years (81.6%). Clinical severity differed by age, race/ethnicity, underlying medical conditions, and homelessness. A higher proportion of Hispanic patients were hospitalized (46.5%) than were black (39.5%) or non-Hispanic white (white) (34.4%) patients, a finding most pronounced among those aged <60 years. A higher proportion of non-ICU inpatients were experiencing homelessness (24.3%), compared with homeless patients who were admitted to the ICU without mechanical ventilation (15.9%), with mechanical ventilation (15.1%), or who died (15.3%). Patient characteristics associated with illness and clinical severity, such as age, race/ethnicity, homelessness, and underlying medical conditions can inform tailored strategies that might improve outcomes and mitigate strain on the health care system from COVID-19.", "COVID-19 and African Americans. ", "This Time Must Be Different: Disparities During the COVID-19 Pandemic African Americans and Latinos are overrepresented among cases of and deaths from COVID-19 nationally and in many of the U.S. regions hardest hit by the pandemic. The editorialist discusses lessons that we should have learned from prior experiences and strategies to reduce observed disparities.", "NON-WHITE ETHNICITY, MALE SEX, AND HIGHER BODY MASS INDEX, BUT NOT MEDICATIONS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM ARE ASSOCIATED WITH CORONAVIRUS DISEASE 2019 (COVID-19) HOSPITALISATION: REVIEW OF THE FIRST 669 CASES FROM THE UK BIOBANK Background: Cardiometabolic morbidity and medications, specifically Angiotensin Converting Enzyme inhibitors (ACEi) and Angiotensin Receptor Blockers (ARBs), have been linked with adverse outcomes from coronavirus disease 2019 (COVID-19). This study aims to investigate factors associated with COVID-19 positivity for the first 669 UK Biobank participants; compared with individuals who tested negative, and with the untested, presumed negative, rest of the population. Methods: We studied 1,474 participants from the UK Biobank who had been tested for COVID-19. Given UK testing policy, this implies a hospital setting, suggesting at least moderate to severe symptoms. We considered the following exposures: age, sex, ethnicity, body mass index (BMI), diabetes, hypertension, hypercholesterolaemia, ACEi/ARB use, prior myocardial infarction (MI), and smoking. We undertook comparisons between: 1) COVID-19 positive and COVID-19 tested negative participants; and 2) COVID-19 tested positive and the remaining participants (tested negative plus untested, n=501,837). Logistic regression models were used to investigate univariate and mutually adjusted associations. Results: Among participants tested for COVID-19, non-white ethnicity, male sex, and greater BMI were independently associated with COVID-19 positive result. Non-white ethnicity, male sex, greater BMI, diabetes, hypertension, prior MI, and smoking were independently associated with COVID-19 positivity compared to the remining cohort (test negatives plus untested). However, similar associations were observed when comparing those who tested negative for COVID-19 with the untested cohort; suggesting that these factors associate with general hospitalisation rather than specifically with COVID-19. Conclusions: Among participants tested for COVID-19 with presumed moderate to severe symptoms in a hospital setting, non-white ethnicity, male sex, and higher BMI are associated with a positive result. Other cardiometabolic morbidities confer increased risk of hospitalisation, without specificity for COVID-19. Notably, ACE/ARB use did not associate with COVID-19 status.", "Are African American and Hispanics Disproportionately Affected by COVID-19 Because of Higher Obesity Rates? INTRODUCTION: On March 13, 2020 the WHO declared COVID-19 a pandemic. Shortly after that, it was reported that mortality rates in New York City (NYC), the epicenter of the pandemic in the United States, were found to be significantly higher in African American and Hispanics. The aim of this manuscript is to evaluate the mortality rates in NYC among the different ethnic groups and the different boroughs as it relates to the obesity rates to see whether this issue merits further evaluation. METHODS: COVID-19 data was obtained from the official New York (NY) authorities in relation to total number of cases in the different boroughs of NYC. Age adjusted COVID-19 related mortality rates of the different ethnic groups were also obtained. This data was cross compared to historic community health data on obesity rates previously published and also obesity rates among the different ethnic groups in NYC. RESULTS: The two NYC boroughs that have the highest mortality rates are The Bronx (6%) and Brooklyn (5.4%). Both The Bronx and Brooklyn were also found to have the highest obesity rates 32% and 27% respectively. The two ethnic groups with the highest obesity rates (Hispanics and African Americans) were also found to have the highest age adjusted mortality rates per 100,000 compared to the other ethnic groups (22.8% and 19.8% respectively). CONCLUSION: Hispanics and African Americans in NYC seem to be disproportionately affected by the COVID-19 pandemic because of the higher incidence of mortality rates. Obesity may have played a role in the high incidence of mortality in those ethnic groups.", "Time courses of COVID-19 infection and local variation in socioeconomic and health disparities in England Objective: To identify factors associated with local variation in the time course of COVID-19 case burden in England. Methods: We analyzed laboratory-confirmed COVID-19 case data for 150 upper tier local authorities, from the period from January 30 to May 6, 2020, as reported by Public Health England. Using methods suitable for time-series data, we identified clusters of local authorities with distinct trajectories of daily cases, after adjusting for population size. We then tested for differences in sociodemographic, economic, and health disparity factors between these clusters. Results: Two clusters of local authorities were identified: a higher case trajectory that rose faster over time to reach higher peak infection levels, and a lower case trajectory cluster that emerged more slowly, and had a lower peak. The higher case trajectory cluster (79 local authorities) had higher population density (p<0.001), higher proportion of Black and Asian residents (p=0.03; p=0.02), higher multiple deprivation scores (p<0.001), a lower proportions of older adults (p=0.005), and higher preventable mortality rates (p=0.03). Local authorities with higher proportions of Black residents were more likely to belong to the high case trajectory cluster, even after adjusting for population density, deprivation, proportion of older adults and preventable mortality (p=0.04). Conclusion: Areas belonging to the trajectory with significantly higher COVID-19 case burden were more deprived, and had higher proportions of ethnic minority residents. A higher proportion of Black residents in regions belonging to the high trajectory cluster was not fully explained by differences in population density, deprivation, and other overall health disparities between the clusters.", "COVID-19 Pandemic: Exacerbating Racial/Ethnic Disparities in Long-Term Services and Supports. What services are available and where racial and ethnic minorities receive long-term services and supports (LTSS) have resulted in a lower quality of care and life for racial/ethnic minority users. These disparities are only likely to worsen during the COVID-19 pandemic, as the pandemic has disproportionately affected racial and ethnic minority communities both in the rate of infection and virus-related mortality. By examining these disparities in the context of the pandemic, we bring to light the challenges and issues faced in LTSS by minority communities with regard to this virus as well as the disparities in LTSS that have always existed.", "Improved measurement of racial/ethnic disparities in COVID-19 mortality in the United States Different estimation methods produce diverging accounts of racial/ethnic disparities in COVID-19 mortality in the United States. The Center for Disease Control's decision to present the racial/ethnic distribution of COVID-19 deaths at the state level alongside the weighted racial/ethnic distribution of the counties within each state reporting those death -- in effect, a geographic adjustment -- makes it seem that Whites have the highest death rates. Age adjustment procedures used by others, including the New York City Department of Health and Mental Hygiene, lead to the opposite conclusion that Blacks and Hispanics are dying from COVID-19 at higher rates than Whites. In this paper, we use indirect standardization methods to adjust per capita death rates for both age and geography simultaneously, avoiding the one-sided adjustment procedures currently in use. Using CDC data, we find age-and-place-adjusted COVID-19 death rates are 80% higher for Blacks and over 50% higher for Hispanics, relative to Whites, on a national level. State-specific estimates show wide variation in mortality disparities. Comparison with nonepidemic mortality reveals potential roles for preexisting health disparities and differential rates of infection and care.", "The outbreak that was always here: Racial trauma in the context of COVID-19 and implications for mental health providers. The present commentary offers a timely exploration of the racial trauma experienced by Asian, Black, and Latinx communities as it relates to COVID-19. Instances of individual, cultural, and structural racism and implications for mental health are discussed. Evidence-based strategies are identified for mental health professionals in order to support healing and mitigate the risk of further racial traumas. (PsycInfo Database Record (c) 2020 APA, all rights reserved).", "Being African American and Rural: A Double Jeopardy from Covid\u201019 ", "Demographics, Comorbidities, and Outcomes in Hospitalized Covid-19 Patients in Rural Southwest Georgia. Background: There is limited data on outcomes in patients with coronavirus disease 2019 (Covid-19) in rural United States (US). This study aimed to describe the demographics, and outcomes of hospitalized Covid-19 patients in rural Southwest Georgia.Methods: Using electronic medical records, we analyzed data from all hospitalized Covid-19 patients who either diedor survived to discharge between March 2, 2020 and May 6, 2020.Results: Of the 522 patients, 92 died in hospital (17.6%). Median age was 63 years, 58% were females, and 87% African-Americans. Hypertension (79.7%), obesity (66.5%), and diabetes mellitus (42.3%) were the most common comorbidities. Males had higher overall mortality compared to females (23% v 13.8%). Immunosuppression [odds ratio (OR) 3.6; (confidence interval {CI): 1.52-8.47, p = 0.003)], hypertension (OR 3.36; CI:1.3-8.6, p = 0.01), age \u226565 years (OR 3.1; CI:1.7-5.6, p < 0.001), and morbid obesity (OR 2.29; CI:1.11-4.69, p = 0.02), were independent predictors of in-hospital mortality. Female gender was an independent predictor of decreased in-hospital mortality. Mortality in intubated patients was 67%. Mortality was 8.9% in <50 years, compared to 20% in \u226550 years.Conclusions: Immunosuppression, hypertension, age \u226565 years, and morbid obesity were independent predictors of mortality, whereas female gender was protective for mortality in hospitalized Covid-19 patients in rural Southwest Georgia. Key Messages:Patients hospitalized with Covid-19 in rural US have higher comorbidity burden.Immunosuppression, hypertension, age \u226565 years, and morbid obesity are independent predictors of increased mortality.Female gender is an independent predictor of reduced mortality.", "Physical Distancing in COVID-19 May Exacerbate Experiences of Social Isolation among People Living with HIV ", "Coronavirus disease 19 in minority populations of Newark, New Jersey BACKGROUND: The purpose of this study is to report the clinical features and outcomes of Black/African American (AA) and Latino Hispanic patients with Coronavirus disease 2019 (COVID-19) hospitalized in an inter-city hospital in the state of New Jersey. METHODS: This is a retrospective cohort study of AA and Latino Hispanic patients with COVID-19 admitted to a 665-bed quaternary care, teaching hospital located in Newark, New Jersey. The study included patients who had completed hospitalization between March 10, 2020, and April 10, 2020. We reviewed demographics, socioeconomic variables and incidence of in-hospital mortality and morbidity. Logistic regression was used to identify predictor of in-hospital death. RESULTS: Out of 416 patients, 251 (60%) had completed hospitalization as of April 10, 2020. The incidence of In-hospital mortality was 38.6% (n = 97). Most common symptoms at initial presentation were dyspnea 39% (n = 162) followed by cough 38%(n = 156) and fever 34% (n = 143). Patients were in the highest quartile for population's density, number of housing units and disproportionately fell into the lowest median income quartile for the state of New Jersey. The incidence of septic shock, acute kidney injury (AKI) requiring hemodialysis and admission to an intensive care unit (ICU) was 24% (n = 59), 21% (n = 52), 33% (n = 82) respectively. Independent predictors of in-hospital mortality were older age, lower serum Hemoglobin < 10 mg/dl, elevated serum Ferritin and Creatinine phosphokinase levels > 1200 U/L and > 1000 U/L. CONCLUSIONS: Findings from an inter-city hospital's experience with COVID-19 among underserved minority populations showed that, more than one of every three patients were at risk for in-hospital death or morbidity. Older age and elevated inflammatory markers at presentation were associated with in-hospital death.", "A case-control and cohort study to determine the relationship between ethnic background and severe COVID-19 Background. People of minority ethnic background may be disproportionately affected by severe COVID-19 for reasons that are unclear. We sought to examine the relationship between ethnic background and (1) hospital admission for severe COVID-19; (2) in-hospital mortality. Methods. We conducted a case-control study of 872 inner city adult residents admitted to hospital with confirmed COVID-19 (cases) and 3,488 matched controls randomly sampled from a primary healthcare database comprising 344,083 people resident in the same region. To examine in-hospital mortality, we conducted a cohort study of 1827 adults consecutively admitted with COVID-19. Data collected included hospital admission for COVID-19, demographics, comorbidities, in-hospital mortality. The primary exposure variable was self-defined ethnicity. Results. The 872 cases comprised 48.1% Black, 33.7% White, 12.6% Mixed/Other and 5.6% Asian patients. In conditional logistic regression analyses, Black and Mixed/Other ethnicity were associated with higher admission risk than white (OR 3.12 [95% CI 2.63-3.71] and 2.97 [2.30- 3.85] respectively). Adjustment for comorbidities and deprivation modestly attenuated the association (OR 2.28 [1.87-2.79] for Black, 2.66 [2.01-3.52] for Mixed/Other). Asian ethnicity was not associated with higher admission risk (OR 1.20 [0.86-1.66]). In the cohort study of 1827 patients, 455 (28.9%) died over a median (IQR) of 8 (4-16) days. Age and male sex, but not Black (adjusted HR 0.84 [0.63-1.11]) or Mixed/Other ethnicity (adjusted HR 0.69 [0.43-1.10]), were associated with in-hospital mortality. Asian ethnicity was associated with higher in-hospital mortality (adjusted HR 1.54 [0.98-2.41]). Conclusions. Black and Mixed ethnicity are independently associated with greater admission risk with COVID-19 and may be risk factors for development of severe disease. Comorbidities and socioeconomic factors only partly account for this and additional ethnicity-related factors may play a large role. The impact of COVID-19 may be different in Asians.", "Social Vulnerability and Equity: The Disproportionate Impact of COVID\u201019 As the architect of racial disparity, racism shapes the vulnerability of communities. Socially vulnerable communities are less resilient in their ability to respond to and recover from natural and man\u2010made disasters when compared to resourced communities. This essay argues that racism exposes existing practices and structures in public administration that, along with the effects of COVID\u201019, have led to disproportionate infection and death rates of Black people. Using the Centers for Disease Control's Social Vulnerability Index (SVI) authors analyze the ways Black bodies occupy the most vulnerable communities, making them bear the brunt of COVID\u201019\u2019s impact. Findings suggest that existing disparities exacerbate COVID\u201019 outcomes for Black people. Targeted universalism is offered as an administrative framework to meet the needs of all people impacted by COVID\u201019. This article is protected by copyright. All rights reserved.", "Social Vulnerability and Racial Inequality in COVID-19 Deaths in Chicago. Although the current COVID-19 crisis is felt globally, at the local level, COVID-19 has disproportionately affected poor, highly segregated African American communities in Chicago. To understand the emerging pattern of racial inequality in the effects of COVID-19, we examined the relative burden of social vulnerability and health risk factors. We found significant spatial clusters of social vulnerability and risk factors, both of which are significantly associated with the increased COVID-19-related death rate. We also found that a higher percentage of African Americans was associated with increased levels of social vulnerability and risk factors. In addition, the proportion of African American residents has an independent effect on the COVID-19 death rate. We argue that existing inequity is often highlighted in emergency conditions. The disproportionate effects of COVID-19 in African American communities are a reflection of racial inequality and social exclusion that existed before the COVID-19 crisis.", "At the epicenter of the American Coronavirus outbreak - New York inner city hospital COVID-19 experience and current data: a retrospective analysis. BACKGROUND In the midst of COVID-19 pandemic, emerging clinical data across the globe has equipped front line health care workers, policy makers and researchers to better understand and combat the illness more prepared. OBJECTIVE Correlation of clinical and laboratory parameters with patients requiring mechanical ventilation and mortality in patients infected with SARS-CoV-2. METHODS Review of patients with SARS-CoV-2 confirmed infection admitted and managed by our institution during the last month. Patients were grouped into intubated and non-intubated and sub grouped to alive and deceased. Comprehensive analysis using the following parameters were performed, Age, Sex, Ethnicity, Body Mass Index (BMI), Comorbidities, Inflammatory markers, Laboratory values, cardiac and renal function, electrocardiogram (EKG), Chest x ray findings, temperature, treatment groups, hospital acquired SARS-CoV-2 patients. RESULTS A total of 184 patients were included in our study with age ranging from 28-97 years, mean of 64.72, 73 females (39.67%), 111 males (60.33%), with a mean BMI of 29.10. We had 114 African Americans (61.96%), 58 Hispanics (31.52%), 11 Asians (5.98%), 1 Caucasian (0.54%), with mean number of comorbidities of 1.70. Overall mortality rate was 17.39%, 16.30% of our patients required mechanical ventilation and 11.41% had hospital acquired SARS-CoV-2 infection. Pertinent and statistically significant results in the Intubated (I-T) versus Non Intubated (NI-T) SARS-CoV-2 confirmed patients for the following parameters with P values were: Age P=.01, BMI P= .07, African American Ethnicity P< .001, Hispanic Ethnicity P=.02, DM P=.001, Cr P=0.29, BUN P=.001, Procalcitonin P=.03, CRP P=.007, LDH P= .001, Glucose P=.01, Temperature P=.004, bilateral (B/L) pulmonary infiltrates in CXR P<.001, B/L patchy opacity P=.02. In the living and deceased subgroups of SARS-CoV-2 confirmed patients (linking to or against mortality) were BMI P=.04, LOS P<.001, HTN P=.02, Multiple comorbidity P=.045, BUN P=.04, EKG findings with arrhythmias/block P= .02. CONCLUSIONS We arrived at the following conclusions based on a comprehensive review of our study group, data collection and statistical analysis. Parameters that were strongly correlated with the need for mechanical ventilation were younger age group, overweight, Hispanic ethnicity, higher core body temperature , EKG findings with sinus tachycardia and bilateral diffuse pulmonary infiltrates on the CXR. Those intubated exhibited increased disease severity with significantly elevated levels of serum Procalcitonin, C reactive protein (CRP), Lactate Dehydrogenase (LDH), Mean glucose, Creatinine, Blood urea nitrogen (BUN). Mortality was strongly correlated with BMI, African American ethnicity, Hypertension, presence of multiple comorbidities with a mean of 2.32, worsening renal function with acute kidney injury or acute on chronic kidney injury and EKG findings of arrhythmias and heart blocks. CLINICALTRIAL", "Intersecting ethnic and native\u2013migrant inequalities in the economic impact of the COVID-19 pandemic in the UK Analyzing new nationwide data from the Understanding Society COVID-19 survey (N = 10,336), this research examines intersecting ethnic and native\u2013migrant inequalities in the impact of COVID-19 on people\u2019s economic well-being in the UK. The results show that compared with UK-born white British, black, Asian and minority ethnic (BAME) migrants in the UK are more likely to experience job loss during the COVID-19 lockdown, while BAME natives are less likely to enjoy employment protection such as furloughing. Although UK-born white British are more likely to reduce their work hours during the COVID-19 pandemic than BAME migrants, they are less likely to experience income loss and face increased financial hardship during the pandemic than BAME migrants. The findings show that the pandemic exacerbates entrenched socio-economic inequalities along intersecting ethnic and native\u2013migrant lines. They urge governments and policy makers to place racial justice at the center of policy developments in response to the pandemic.", "Racial and Ethnic Disparities in SARS-CoV-2 Pandemic: Analysis of a COVID-19 Observational Registry for a Diverse U.S. Metropolitan Population Importance: Despite emerging reports of poor COVID-19 outcomes among African Americans, data on race and ethnic susceptibility to SARS-CoV-2 infection are limited. Objective: To determine socio-demographic factors associated with higher likelihood of SARS-CoV-2 infection. To explore mediating pathways for race disparities in the SARS-CoV-2 pandemic. Design: Cross sectional analysis of COVID-19 Surveillance and Outcomes Registry (CURATOR). Multivariable logistic regression models were fitted to provide likelihood estimates (adjusted Odds Ratios: aOR, 95% confidence intervals: CI) of positive SARS-CoV-2 test. Structural Equation Modeling (SEM) framework was utilized to explore three mediation pathways (low income, high population density, high comorbidity burden) for association between African American race and SARS-CoV-2 infection. Setting: A large healthcare system comprising of one central tertiary care, seven large community hospitals and an expansive ambulatory and emergency care network in the Greater Houston area. Participants: Individuals of all ages, races, ethnicities and sex tested for SARS-CoV-2. Exposure: Socio-demographic (age, sex, race, ethnicity, household income, residence population density) and comorbidity (hypertension, diabetes, obesity, cardiac disease) factors. Main Outcome: Positive reverse transcriptase polymerized chain reaction test for SARS-CoV-2. Results: Among 4,513 tested individuals, 754 (16.7%) tested positive. Overall mean (SD) age was 50.6 (18.9) years, 62% females and 26% were African American. African American race was associated with higher comorbidity burden, lower socio-economic status, and higher population density residence. In the fully adjusted model, African American race (vs. White; aOR, CI: 1.84, 1.49-2.27) and Hispanic ethnicity (vs. non-Hispanic; aOR, CI: 1.70, 1.35-2.14) had a higher likelihood of infection. Older individuals and males were also at a higher risk of SARS-CoV-2 infection. The SEM framework demonstrated a statistically significant (p = 0.008) indirect effect of African American race on SARS-CoV-2 infection mediated via a pathway that included residence in densely populated zip code. Conclusions and Relevance: There is strong evidence of race and ethnic disparities in the SARS-CoV-2 pandemic potentially mediated through unique social determinants of health.", "Racial segregation, testing sites access, and COVID-19 incidence rate in Massachusetts, USA The U.S. has merely 4% of the world population but 25% of the world's COVID-19 cases. Massachusetts has been in the leading position of total cases since the outbreak in the U.S. Racial residential segregation is a fundamental cause of racial disparities in health. Moreover, disparities of access to health care have a large impact on COVID-19 cases. Thus, this study estimates racial segregation and disparities in testing sites access and employs economic, demographic, and transportation variables at the city/town level in Massachusetts. Spatial regression models are applied to evaluate the relationships between COVID-19 incidence rate and related variables. This is the first study to apply spatial analysis methods across neighborhoods in the U.S. to examine the COVID-19 incidence rate. The findings are: 1) residential segregations of Hispanic and Non-Hispanic Black/African Americans have a significantly positive association with COVID-19 incidence rate, indicating the higher susceptibility of COIVD-19 infections among minority; 2) The Black has the shortest drive time to testing sites, followed by Hispanic, Asian, and Whites. The drive time to testing sites is significantly negatively associated with the COVID-19 incidence rate, implying the importance of testing location being accessed by all populations; 3) Poverty rate and road density are significant explanatory variables. Importantly, overcrowding represented by more than one person per room is a significant variable found to be positively associated with COVID-19 incidence rate, suggesting the effectiveness of social distancing for reducing infection; 4) Different from previous studies, elderly population rate is not statistically significant with incidence rate because the elderly population in Massachusetts is less distributed in the hot spot regions of COVID-19 infections. The findings in this study provide useful insights for policymakers to propose new strategies to contain the COVID-19 transmissions in Massachusetts.", "Genetic susceptibility for COVID-19-associated sudden cardiac death in African Americans ", "Covid-19: Black people and other minorities are hardest hit in US ", "Racial/ethnic and socioeconomic disparities of Covid-19 attacks rates in Suffolk County communities We investigated the dependence of Covid-19 attack rates on demographic and socioeconomic factors for the communities in Suffolk County (Long Island, New York State), presently the 5th most-affected county in the United States. Confirming the previous observations that minorities are disproportionately impacted by the Covid-19 disease, we found that the attack rate is strongly correlated with the minority population proportion, with an alarmingly high $\\sim4$-fold attack rate increase for Black and Hispanic populations.", "Addressing Health Inequities Exacerbated by COVID-19 Among Youth With HIV: Expanding Our Toolkit. Adolescents and young adults, aged 13-24 years, are disproportionately affected by HIV in the United States. Youth with HIV (YHIV) face many psychosocial and structural challenges resulting in poor clinical outcomes including lower rates of medication adherence and higher rates of uncontrolled HIV. The Johns Hopkins Intensive Primary Care clinic, a longstanding HIV care program in Baltimore, Maryland, cares for 76 YHIV (aged 13-24 years). The multidisciplinary team provides accessible, evidenced-based, culturally sensitive, coordinated and comprehensive patient and family-centered HIV primary care. However, the ability to provide these intensive, in-person services was abruptly disrupted by the necessary institutional, state, and national coronavirus disease 2019 (COVID-19) mitigation strategies. As most of our YHIV are from marginalized communities (racial/ethnic, sexual, and gender minorities) with existing health and social inequities that impede successful clinical outcomes and increase HIV disparities, there was heightened concern that COVID-19 would exacerbate these inequities and amplify the known HIV disparities. We chronicle the structural and logistic approaches that our team has taken to proactively address the social determinants of health that will be negatively impacted by the COVID-19 pandemic, while supporting YHIV to maintain medication adherence and viral suppression.", "Six feet apart or six feet under: The impact of COVID-19 on the Black community To date, 110,000+ people in the United States have died from the COVID-19 pandemic. In this paper, the authors will discuss COVID-19 relative to Black people and their overrepresentation among those who are infected and died from the disease. Their dying, death, and grief experiences are explored through a cultural and spiritual lens. The physical distancing, social isolation, misinformation, and restrictive burials and cremations now elicited by this unprecedented pandemic have had diminished familial, cultural, emotional, and economic impacts on the Black community. Implications for public health and Black peoples' involvement in the political process are also addressed.", "Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit Importance: In late December 2019, an outbreak caused by a novel severe acute respiratory syndrome coronavirus 2 emerged in Wuhan, China. Data on the clinical characteristics and outcomes of infected patients in urban communities in the US are limited. Objectives: To describe the clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and to perform a comparative analysis of hospitalized and ambulatory patient populations. Design, Setting, and Participants: This study is a case series of 463 consecutive patients with COVID-19 evaluated at Henry Ford Health System in metropolitan Detroit, Michigan, from March 9 to March 27, 2020. Data analysis was performed from March to April 2020. Exposure: Laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection. Main Outcomes and Measures: Demographic data, underlying comorbidities, clinical presentation, complications, treatment, and outcomes were collected. Results: Of 463 patients with COVID-19 (mean [SD] age, 57.5 [16.8] years), 259 (55.9%) were female, and 334 (72.1%) were African American. Most patients (435 [94.0%]) had at least 1 comorbidity, including hypertension (295 patients [63.7%]), chronic kidney disease (182 patients [39.3%]), and diabetes (178 patients [38.4%]). Common symptoms at presentation were cough (347 patients [74.9%]), fever (315 patients [68.0%]), and dyspnea (282 patients [60.9%]). Three hundred fifty-five patients (76.7%) were hospitalized; 141 (39.7%) required intensive care unit management and 114 (80.8%) of those patients required invasive mechanical ventilation. Male sex (odds ratio [OR], 2.0; 95% CI, 1.3-3.2; P = .001), severe obesity (OR, 2.0; 95% CI, 1.4-3.6; P = .02), and chronic kidney disease (OR, 2.0; 95% CI, 1.3-3.3; P = .006) were independently associated with intensive care unit admission. Patients admitted to the intensive care unit had longer length of stay and higher incidence of respiratory failure and acute respiratory distress syndrome requiring invasive mechanical ventilation, acute kidney injury requiring dialysis, shock, and mortality (57 patients [40.4%] vs 15 patients [7.0%]) compared with patients in the general practice unit. Twenty-nine (11.2%) of those discharged from the hospital were readmitted and, overall, 20.0% died within 30 days. Male sex (OR, 1.8; 95% CI, 1.1-3.1; P = .03) and age older than 60 years (OR, 5.3; 95% CI, 2.9-9.7; P < .001) were significantly associated with mortality, whereas African American race was not (OR, 0.98; 95% CI, 0.54-1.8; P = .86). Conclusions and Relevance: In this review of urban metropolitan patients with COVID-19, most were African American with a high prevalence of comorbid conditions and high rates of hospitalization, intensive care unit admission, complications, and mortality due to COVID-19.", "The Disproportionate Impact of COVID-19 on Racial and Ethnic Minorities in the United States. ", "Western Washington State COVID-19 Experience: Keys to Flattening the Curve and Effective Health System Response BACKGROUND: Washington State experienced the first major outbreak of COVID-19 in the United States and despite a significant number of cases, has seen a relatively low death rate per million population compared to other states with major outbreaks and has seen a substantial decrease in the projections for healthcare utilization, i.e. \u201cflattening the curve\u201d. This consensus report seeks to identify the key factors contributing to the effective health system disaster response in western WA. METHODS: A multidisciplinary, expert panel including individuals and organizations who were integral to managing the public health and emergency healthcare system response were engaged in a consensus process to identify the key themes and lessons learned and develop recommendations for ongoing management of the COVID-19 pandemic. RESULTS: Six key themes were identified including: early communication and coordination among stakeholders; regional coordination of the healthcare system response; rapid development and access to viral testing; proactive management of long-term care & skilled nursing facilities; proactive management of vulnerable populations; and effective physical distancing in the community. CONCLUSIONS: Based on the lessons learned in each of the areas identified by the panel, 11 recommendations are provided to support the healthcare system disaster response in managing future outbreaks.", "COVID-19 and inequality: are we all in this together? ", "Social Workers Must Address Intersecting Vulnerabilities among Noninstitutionalized, Black, Latinx, and Older Adults of Color during the COVID-19 Pandemic. Scant attention has been paid to intersecting vulnerabilities experienced by Black, Latinx, and older adults of color (BLOAC) that increase COVID-19 related risks. Structural inequities have resulted in disproportionate rates of chronic conditions and limited access to care. Media coverage, focused on COVID-19 mortality among institutionalized older adults (OA), has overlooked community-dwelling OA, leaving their unique risks unaddressed in research and intervention efforts. Key vulnerabilities impacting noninstitutionalized BLOAC exacerbating adverse health outcomes during COVID-19 are discussed, and recommendations are given for gerontological social work (GSW) education, training, and practice to meet the needs of BLOAC during the COVID-19 pandemic.", "Clinical, Behavioral and Social Factors Associated with Racial Disparities in Hospitalized and Ambulatory COVID-19 Patients from an Integrated Health Care System in Georgia Introduction: Racial and ethnic minorities have shouldered a disproportioned burden of coronavirus disease 2019 (COVID-19) infection to date in the US, but data on the various drivers of these disparities is limited. Objectives: To describe the characteristics and outcomes of COVID-19 patients and explore factors associated with hospitalization risk by race. Methods: Case series of 448 consecutive patients with confirmed COVID-19 seen at Kaiser Permanente Georgia (KPGA), an integrated health care system serving the Atlanta metropolitan area, from March 3 to May 12, 2020. KPGA members with laboratory-confirmed COVID-19. Multivariable analyses for hospitalization risk also included an additional 3489 persons under investigation (PUI) with suspected infection. COVID-19 treatment and outcomes, underlying comorbidities and quality of care management metrics, socio-demographic and other individual and community-level social determinants of health (SDOH) indicators. Results: Of 448 COVID-19 positive members, 68,3% was non-Hispanic Black (n=306), 18% non-Hispanic White (n=81) and 13,7% Other race (n=61). Median age was 54 [IQR 43-63) years. Overall, 224 patients were hospitalized, median age 60 (50-69) years. Black race was a significant factor in the Confirmed + PUI, female and male models (ORs from 1.98 to 2.19). Obesity was associated with higher hospitalization odds in the confirmed, confirmed + PUI, Black and male models (ORs from 1.78 to 2.77). Chronic disease control metrics (diabetes, hypertension, hyperlipidemia) were associated with lower odds of hospitalization ranging from 48% to 35% in the confirmed + PUI and Black models. Self-reported physical inactivity was associated with 50% higher hospitalization odds in the Black and Female models. Residence in the Northeast region of Atlanta was associated with lower hospitalization odds in the Confirmed + PUI, White and female models (ORs from 0.22 to 0.64) Conclusions: We found that non-Hispanic Black KPGA members had a disproportionately higher risk of infection and, after adjusting for covariates, twice the risk of hospitalization compared to other race groups. We found no significant differences in clinical outcomes or mortality across race/ethnicity groups. In addition to age, sex and comorbidity burden, pre-pandemic self-reported exercise, metrics on quality of care and control of underlying cardio-metabolic diseases, and location of residence in Atlanta were significantly associated with hospitalization risk by race groups. Beyond well-known physiologic and clinical factors, individual and community-level social indicators and health behaviors must be considered as interventions designed to reduce COVID-19 disparities and the systemic effects of racism are implemented.", "Risk Factors for Mortality of COVID-19 Patients Background: Lethality rates of COVID-19 are so different between countries and continents. This lethality seems to be very low in Africa and Asia, but exceedingly high in western Europe and North America. Many factors could have a role in this disparity such as comorbidities. Advanced age, obesity, cardiovascular disease, diabetes and cancer were the most frequently cited in the reported COVID-19 data. The main objective was to analyse the association between the COVID-19 mortality and the mentioned factors in 164 countries. Methods: The Data of COVID-19 deaths, latitude degrees, population age distribution, cardiovascular diseases, obesity, diabetes and cancer were extracted from different online sources. For the statistical analysis, we used Spearman to measure the correlation coefficient between numbers of deaths and the mentioned factors until June 29, 2020. Results: The correlation between COVID-19 mortality and latitude, high age, obesity, CVD and number of cancer patients per 100,000 is significant at 0.01 level with r = 0.489, r=0.511, r=0.489, r=0.561 and r=0.536 respectively. The correlation between the number of deaths and diabetes is less strong than the previous ones, and the correlation coefficient is r= 0.154. Conclusion: The great lethality of COVID-19 in western Europe and North America can be explained in part by the highest of age, cancer and CVD percentage in these regions. It seems also plausible that the increased obesity in the USA and vitamin D deficiency in Europe may contribute to increasing the number of COVID-19 deaths.", "Black Lives in a Pandemic: Implications of Systemic Injustice for End-of-Life Care In recent months, Covid-19 has devastated African American communities across the nation, and a Minneapolis police officer murdered George Floyd. The agents of death may be novel, but the phenomena of long-standing epidemics of premature black death and of police violence are not. This essay argues that racial health and health care disparities, rooted as they are in systemic injustice, ought to carry far more weight in clinical ethics than they generally do. In particular, this essay examines palliative and end-of-life care for African Americans, highlighting the ways in which American medicine, like American society, has breached trust. In the experience of many African American patients struggling against terminal illness, health care providers have denied them a say in their own medical decision-making. In the midst of the Covid-19 pandemic, African Americans have once again been denied a say with regard to the rationing of scarce medical resources such as ventilators, in that dominant and ostensibly race-neutral algorithms sacrifice black lives. Is there such thing as a \"good\" or \"dignified\" death when African Americans are dying not merely of Covid-19 but of structural racism?", "Differences in race and other state-level characteristics and associations with mortality from COVID-19 infection ", "Clinical features, diagnostics, and outcomes of patients presenting with acute respiratory illness: a comparison of patients with and without COVID-19 BACKGROUND: Emerging data on the clinical presentation, diagnostics, and outcomes of patients with COVID-19 have largely been presented as case series. Few studies have compared these clinical features and outcomes of COVID-19 to other acute respiratory illnesses. METHODS: We examined all patients presenting to an emergency department in San Francisco, California between February 3 and March 31, 2020 with an acute respiratory illness who were tested for SARS-CoV-2. We determined COVID-19 status by PCR and metagenomic next generation sequencing (mNGS). We compared demographics, comorbidities, symptoms, vital signs, and laboratory results including viral diagnostics using PCR and mNGS. Among those hospitalized, we determined differences in treatment (antibiotics, antivirals, respiratory support) and outcomes (ICU admission, ICU interventions, acute respiratory distress syndrome, cardiac injury). FINDINGS: In a cohort of 316 patients, 33 (10%) tested positive for SARS-CoV-2; 31 patients, all without COVID-19, tested positive for another respiratory virus (16%). Among patients with additional viral testing, no co-infections with SARS-CoV-2 were identified by PCR or mNGS. Patients with COVID-19 reported longer symptoms duration (median 7 vs. 3 days), and were more likely to report fever (82% vs. 44%), fatigue (85% vs. 50%), and myalgias (61% vs 27%); p<0.001 for all comparisons. Lymphopenia (55% vs 34%, p=0.018) and bilateral opacities on initial chest radiograph (55% vs. 24%, p=0.001) were more common in patients with COVID-19. Patients with COVID-19 were more often hospitalized (79% vs. 56%, p=0.014). Of 186 hospitalized patients, patients with COVID-19 had longer hospitalizations (median 10.7d vs. 4.7d, p<0.001) and were more likely to develop ARDS (23% vs. 3%, p<0.001). Most comorbidities, home medications, signs and symptoms, vital signs, laboratory results, treatment, and outcomes did not differ by COVID-19 status. INTERPRETATION: While we found differences in clinical features of COVID-19 compared to other acute respiratory illnesses, there was significant overlap in presentation and comorbidities. Patients with COVID-19 were more likely to be admitted to the hospital, have longer hospitalizations and develop ARDS, and were unlikely to have co-existent viral infections. These findings enhance understanding of the clinical characteristics of COVID-19 in comparison to other acute respiratory illnesses.", "Regional differences in reported Covid-19 cases show genetic correlations with higher socio-economic status and better health, potentially confounding studies on the genetics of disease susceptibility Background: In March 2020, England showed a rapid increase in Covid-19 cases. Susceptibility for infectious diseases like Covid-19 is likely to be partly genetic. Mapping the genetic susceptibility for Covid-19 outcomes may reveal biological mechanisms that could potentially aid in drug or vaccine developments. However, as the disease spreads unevenly across the country, regional allele frequency differences could become spuriously associated with disease prevalence. Methods: A regional genome-wide association study (RGWAS) was conducted in 396,042 individuals from England to investigate the association between 1.2 million genetic variants and regional differences in daily reported Covid-19 cases from March 1st to April 18th 2020. Results: The polygenic signal increases during the first weeks of March, peaking at March 13th with the measured genetic variants explaining ~3% of the variance, including two genome-wide significant loci. The explained variance starts to drop at the end of March and reaches almost zero on April 18th. The majority of this temporary polygenic signal is due to genes associated with higher educational attainment and better health. Conclusions: The temporary positive relationship between Covid-19 cases and regional socio-economic status (SES) at the beginning of the Covid-19 outbreak may reflect 1) a higher degree of international travelers, 2) more social contacts, and/or 3) better testing capacities in higher SES regions. These signals are in the opposite direction of expected disease risk increasing effects, which has the potential to cancel out signals of interest. Genetic association studies should be aware of the timing and location of cases as this can introduce interfering polygenic signals that reflect regional differences in genes associated with behavior.", "Explainable machine learning models to understand determinants of COVID-19 mortality in the United States COVID-19 mortality is now the leading cause of death per day in the United States,ranking higher than heart disease and cancer.Multiple projection models have been built and used to understand the prevalence of disease and anticipated mortality.These models take into account various epidemiologic factors of disease spread and more recently some of the mitigation measures.The authors developed a dataset with many of the socioeconomic, demographic, travel, and health care features likely to impact COVID-19 mortality.The dataset was compiled using 20 variables for each of the fifty states in the United States.We subsequently developed two independent machine learning models using Catboost regression and random forest.Both the models showed similar level of accuracy.CatBoost regression model obtained R2 score of 0.99 on the training data set and 0.50 on the test.Random forest model similarly obtained a R2 score of 0.88 on the training data set and 0.39 on the test set. To understand the relative importance of features on COVID-19 mortality in the United States,we subsequently used SHAP feature importance and Boruta algorithm.Both the models show that high population density, pre-existing need for medical care and foreign travel may increase transmission and thus COVID-19 mortality whereas the effect of geographic, climate and racial disparities on COVID-19 related mortality is not clear.Location based understanding of key determinants of COVID-19 mortality, is needed for focused targeting of mitigation and control measures.Explanatory models such as these are also critical to resource management and policy framework.", "Excess mortality and potential undercounting of COVID-19 deaths by demographic group in Ohio Background: There are significant gaps in our understanding of the mortality effects of COVID-19 due to evolving diagnosis criteria, shortages of testing supplies, and challenges faced by physicians in treating patients in crisis environments. Accurate information on the number of deaths caused by COVID-19, both population wide and for demographic subgroups, is vital for policy makers and health care providers. Methods: We performed a retrospective study of weekly data for Ohio, a large American state. To estimate expected mortality in 2020 we employed data from 2010 through 2019, adjusted for secular trends and seasonality. We estimated excess mortality as the number of observed deaths less the number of expected deaths. We conducted the analysis for the entire population and by gender, race, age, and county of residence. Findings: We estimated 1,485 (95% CI 680-2,345) excess all-cause deaths in Ohio from March 15, 2020 through May 23, 2020. When limited to deaths due to natural causes, the estimated excess number of deaths increased to 2,504 (95% CI 1,633-3,221), reflecting the countervailing effect of a decrease in deaths due to external causes. While the largest number excess of deaths was observed in the 80+ age group, excess deaths comprised 45.3% (95% CI 21.8-60.9) of observed deaths in the groups corresponding to ages between 20 and 49 years old. Our estimate of 729 (95% CI 355-966) excess deaths for this group substantially exceeds the reported number of COVID-19 deaths of 51. We found elevated excess deaths for older individuals, blacks, and males. Interpretation: Our methodology addressed some of the challenges of estimating the number of deaths caused by COVID-19. Our finding of high proportional levels of excess deaths among younger age groups suggests that increases in the infection rates for this cohort may have a greater mortality impact than expected. Funding: None.", "Community Susceptibility and Resiliency to COVID\u201019 Across the Rural\u2010Urban Continuum in the United States PURPOSE: This study creates a COVID\u201019 susceptibility scale at the county level, describes its components, and then assesses the health and socioeconomic resiliency of susceptible places across the rural\u2010urban continuum. METHODS: Factor analysis grouped 11 indicators into 7 distinct susceptibility factors for 3,079 counties in the conterminous United States. Unconditional mean differences are assessed using a multivariate general linear model. Data from 2018 are primarily taken from the US Census Bureau and CDC. RESULTS: About 33% of rural counties are highly susceptible to COVID\u201019, driven by older and health\u2010compromised populations, and care facilities for the elderly. Major vulnerabilities in rural counties include fewer physicians, lack of mental health services, higher disability, and more uninsured. Poor Internet access limits telemedicine. Lack of social capital and social services may hinder local pandemic recovery. Meat processing facilities drive risk in micropolitan counties. Although metropolitan counties are less susceptible due to healthier and younger populations, about 6% are at risk due to community spread from dense populations. Metropolitan vulnerabilities include minorities at higher health and diabetes risk, language barriers, being a transportation hub that helps spread infection, and acute housing distress. CONCLUSIONS: There is an immediate need to know specific types of susceptibilities and vulnerabilities ahead of time to allow local and state health officials to plan and allocate resources accordingly. In rural areas it is essential to shelter\u2010in\u2010place vulnerable populations, whereas in large metropolitan areas general closure orders are needed to stop community spread. Pandemic response plans should address vulnerabilities.", "Covid-19 and the rise of racism ", "Disproportionate burden of COVID-19 among racial minorities and those in congregate settings among a large cohort of people with HIV. BACKGROUND Many people living with HIV (PLWH) have comorbidities which are risk factors for severe COVID-19 or have exposures that may lead to acquisition of SARS-CoV-2. There are few studies, however, on the demographics, comorbidities, clinical presentation or outcomes of COVID-19 in people with HIV. OBJECTIVE To evaluate risk factors, clinical manifestations and outcomes in a large cohort of PLWH with COVID-19. METHODS We systematically identified all PLWH who were diagnosed with COVID-19 at a large hospital from March 3 to April 26, 2020 during an outbreak in Massachusetts. We analyzed each of the cases to extract information including demographics, medical comorbidities, clinical presentation, and illness course after COVID-19 diagnosis. RESULTS We describe a cohort of 36 PLWH with confirmed COVID-19 and another 11 patients with probable COVID-19. Almost 85% of PLWH with confirmed COVID-19 had a comorbidity associated with severe disease, including obesity, cardiovascular disease, or hypertension. Approximately 77% of PLWH with COVID-19 were non-Hispanic Black or Latinx whereas only 40% of the PLWH in our clinic were Black or Latinx. Nearly half of PLWH with COVID-19 had exposure to congregate settings. In addition to people with confirmed COVID-19, we identified another 11 individuals with probable COVID-19, almost all of whom had negative PCR testing. CONCLUSION In the largest cohort to date of PLWH and confirmed COVID-19, almost all had a comorbidity associated with severe disease, highlighting the importance of non-HIV risk factors in this population. The racial disparities and frequent link to congregate settings in PLWH and COVID-19 need to be explored urgently.", "A culturally specific mental health and spirituality approach for African Americans facing the COVID-19 pandemic. A series of 15-min videos were produced to provide resources to pastors in African-American communities to aid them in conveying accurate public and mental health information about COVID-19. Video presenters included trusted experts in public and mental health and pastors with considerable experience responding to the needs of the African-American community during the COVID-19 pandemic. Four culturally specific core themes to consider when providing care to African Americans who are at increased risk during the pandemic were identified: ritual disruption, negative reactions for not following public health guidelines, trauma, and culture and trust. (PsycInfo Database Record (c) 2020 APA, all rights reserved).", "How bad is it? Suicidality in the middle of the COVID\u201019 pandemic OBJECTIVE: The current paper examines the intersection between social vulnerability, individual risk, and social/psychological resources with adult suicidality during the COVID\u201019 pandemic. METHOD: Data come from a national sample (n = 10,368) of U.S. adults. Using an online platform, information was gathered during the third week of March 2020, and post\u2010stratification weighted to proportionally represent the U.S. population in terms of age, gender, race/ethnicity, income, and geography. RESULTS: Nearly 15 percent of sampled respondents were categorized as high risk, scoring 7+ on the Suicide Behaviors Questionnaire\u2010Revised (SBQ\u2010R). This level of risk varied across social vulnerability groupings: Blacks, Native Americans, Hispanics, families with children, unmarried, and younger respondents reported higher SBQ\u2010R scores than their counterparts (p < .000). Regression results confirm these bivariate differences and also reveal that risk factors (food insecurity, physical symptoms, and CES\u2010D symptomatology) are positive and significantly related to suicidality (p < .000). Additionally, resource measures are significant and negatively related to suicidality (p < .000). CONCLUSIONS: These results provide some insight on the impact COVID\u201019 is having on the general U.S. population. Practitioners should be prepared for what will likely be a significant mental health fall\u2010out in the months and years ahead.", "On Race and the Environment in the COVID-19 Pandemic ", "Assessing racial and ethnic disparities using a COVID-19 outcomes continuum for New York State PURPOSE: Heightened COVID-19 mortality among Black non-Hispanic and Hispanic communities (relative to white non-Hispanic) is well established. This study aims to estimate the relative contributions to fatality disparities in terms of differences in SARS-CoV-2 infections, diagnoses, and disease severity. METHODS: We constructed COVID-19 outcome continua (similar to the HIV care continuum) for white non-Hispanic, Black non-Hispanic, and Hispanic adults in New York State. For each stage in the COVID-19 outcome continua (population, infection experience, diagnosis, hospitalization, fatality), we synthesized the most recent publicly-available data. We described each continuum using overall percentages, fatality rates, and relative changes between stages, with comparisons between race and ethnicity using risk ratios. RESULTS: Estimated per-population COVID-19 fatality rates were 0.03%, 0.18%, and 0.12% for white non-Hispanic, Black non-Hispanic, and Hispanic adults. The 3.48-fold disparity for Hispanic, relative to white, communities was explained by differences in infection-experience, whereas the 5.38-fold disparity for non-Hispanic Black, relative to white, communities was primarily driven by differences in both infection-experience and in the need for hospitalization, given infection. CONCLUSIONS: These findings suggest the most impactful stages upon which to intervene with programs and policies to build COVID-19 health equity.", "COVID-19 Emergence and Social and Health Determinants in Colorado: A Rapid Spatial Analysis The aim of this rapid analysis was to investigate the spatial patterns of COVID-19 emergence across counties in Colorado. In the U.S. West, Colorado has the second highest number of cases and deaths, second only to California. Colorado is also reporting, like other states, that communities of color and low-income persons are disproportionately affected by COVID-19. Using GIS and correlation analysis, this study explored COVID-19 incidence and deaths from March 14 to April 8, 2020, with social determinants and chronic conditions. Preliminary results demonstrate that COVID-19 incidence intensified in mountain communities west of Denver and along the Urban Front Range, and evolved into new centers of risk in eastern Colorado. Overall, the greatest increase in COVID-19 incidence was in northern Colorado, i.e., Weld County, which reported the highest rates in the Urban Front Range. Social and health determinants associated with higher COVID-19-related deaths were population density and asthma, indicative of urban areas, and poverty and unemployment, suggestive of rural areas. Furthermore, a spatial overlap of high rates of chronic diseases with high rates of COVID-19 may suggest a broader syndemic health burden, where comorbidities intersect with inequality of social determinants of health.", "Air pollution, racial disparities and COVID-19 mortality ", "Association of hypertension, diabetes, stroke, cancer, kidney disease, and high-cholesterol with COVID-19 disease severity and fatality: a systematic review Objective: To undertake a review and critical appraisal of published/preprint reports that offer methods of determining the effects of hypertension, diabetes, stroke, cancer, kidney issues, and high-cholesterol on COVID-19 disease severity. Data sources: Google Scholar, PubMed, COVID-19 Open Research Dataset: a resource of over 128,000 scholarly articles, including over 59,000 articles with full text related to COVID-19, SARS-CoV-2, and coronaviruses. Methods: A search was conducted by two authors independently on the freely available COVID-19 Open Research Dataset (CORD-19). We developed an automated search engine to screen a total of 59,000 articles in a few seconds. The search engine was built using a retrieval function that ranks a set of documents based on the query terms appearing in each document regardless of their proximity within the document. Filtering of the articles was then undertaken using keywords and questions, e.g. \"Effects of diabetes on COVID/normal coronavirus/SARS-CoV-2/nCoV/COVID-19 disease severity, mortality?\". The search terms were repeated for all the comorbidities considered in this paper. Additional articles were retrieved by searching via Google Scholar and PubMed. Findings: A total of 54 articles were considered for a full review. It was observed that diabetes, hypertension, and cholesterol levels possess an apparent relation to COVID-19 severity. Other comorbidities, such as cancer, kidney disease, and stroke, must be further evaluated to determine a strong relationship to the virus. Reports associating cancer, kidney disease, and stroke with COVID-19 should be carefully interpreted, not only because of the size of the samples, but also because patients could be old, have a history of smoking, or have any other clinical condition suggesting that these factors might be associated with the poor COVID-19 outcomes rather than the comorbidity itself. Such reports could lead many oncologists and physicians to change their treatment strategies without solid evidence and recommendations. Further research regarding this relationship and its clinical management is warranted. Additionally, treatment options must be examined further to provide optimal treatment and ensure better outcomes for patients suffering from these comorbidities. It should be noted that, whether definitive measurements exist or not, the care of patients as well as the research involved should be largely prioritized to tackle this deadly pandemic.", "Ethnicity and outcomes in patients hospitalised with COVID-19 infection in East London: an observational cohort study Background: Preliminary studies suggest that people from Black, Asian and Minority Ethnic (BAME) backgrounds experience higher mortality from COVID-19 but the underlying reasons remain unclear. Methods: Prospective analysis of registry data describing patients admitted to five acute NHS Hospitals in east London, UK for COVID-19. Emergency hospital admissions with confirmed SARS-CoV-2 aged 16 years or over were included. Data, including ethnicity, social deprivation, frailty, patient care and detailed risk factors for mortality, were extracted from hospital electronic records. Multivariable survival analysis was used to assess associations between ethnic group and mortality accounting for the effects of age, sex and various other risk factors. Results are presented as hazard ratios (HR) or odds ratios (OR) with 95% confidence intervals. Findings: 1996 adult patients were admitted between 1st March and 13th May 2020. After excluding 259 patients with missing ethnicity data, 1737 were included in our analysis of whom 511 had died by day 30 (29%). 538 (31%) were from Asian, 340 (20%) Black and 707 (40%) white backgrounds. Compared to white patients, those from BAME backgrounds were younger, with differing co-morbidity profiles and less frailty. Asian and black patients were more likely to be admitted to intensive care and to receive invasive ventilation (OR 1.54, [1.06-2.23]; p=0.023 and 1.80 [1.20-2.71]; p=0.005, respectively). After adjustment for age and sex, patients from Asian (HR 1.49 [1.19-1.86]; p<0.001) and black (HR 1.30 [1.02-1.65]; p=0.036) backgrounds were more likely to die. These findings persisted across a range of risk-factor adjusted analyses. Interpretation: Patients from Asian and Black backgrounds are more likely to die from COVID-19 infection despite controlling for all previously identified confounders. Higher rates of invasive ventilation in intensive care indicate greater acute disease severity. Our analyses suggest that patients of Asian and Black backgrounds suffered disproportionate rates of premature death from COVID-19.", "COVID-19: Unique public health issues facing Black, Asian and minority ethnic communities Abstract The 2019 coronavirus disease is a serious public health emergency, with serious adverse implications for populations, healthcare systems, and economies globally. Recently, concerns have been raised about possible association between ethnicity, incidence and outcomes of COVID-19 arisen from early government data. In this review, we will explore the possible association using both recent COVID-19 studies and studies of previous pandemics. We call for data on ethnicity to be routinely collected by governments, as part of international collaboration, alongside other patient demographics and further research to robustly determine magnitude of association. Moreover, governments must learn from previous pandemics and recommended strategies to mitigate risks on minority ethnicities due to socioeconomic disadvantages.", "Assessing Differential Impacts of COVID-19 on Black Communities PURPOSE: Given incomplete data reporting by race, we used data on COVID-19 cases and deaths in US counties to describe racial disparities in COVID-19 disease and death and associated determinants. METHODS: Using publicly available data (accessed April 13, 2020), predictors of COVID-19 cases and deaths were compared between disproportionately (>13%) black and all other (<13% black) counties. Rate ratios were calculated and population attributable fractions (PAF) were estimated using COVID-19 cases and deaths via zero-inflated negative binomial regression model. National maps with county-level data and an interactive scatterplot of COVID-19 cases were generated. RESULTS: Nearly ninety-seven percent of disproportionately black counties (656/677) reported a case and 49% (330/677) reported a death versus 81% (1987/2,465) and 28% (684/ 2465), respectively, for all other counties. Counties with higher proportions of black people have higher prevalence of comorbidities and greater air pollution. Counties with higher proportions of black residents had more COVID-19 diagnoses (RR 1.24, 95% CI 1.17-1.33) and deaths (RR 1.18, 95% CI 1.00-1.40), after adjusting for county-level characteristics such as age, poverty, comorbidities, and epidemic duration. COVID-19 deaths were higher in disproportionally black rural and small metro counties. The PAF of COVID-19 diagnosis due to lack of health insurance was 3.3% for counties with <13% black residents and 4.2% for counties with >13% black residents. CONCLUSIONS: Nearly twenty-two percent of US counties are disproportionately black and they accounted for 52% of COVID-19 diagnoses and 58% of COVID-19 deaths nationally. County-level comparisons can both inform COVID-19 responses and identify epidemic hot spots. Social conditions, structural racism, and other factors elevate risk for COVID-19 diagnoses and deaths in black communities.", "Inequalities in COVID19 mortality related to ethnicity and socioeconomic deprivation Background: Initial reports suggest that ethnic minorities may be experiencing more severe clinical outcomes of coronavirus disease 2019 (COVID19) infections. We therefore assessed the association between ethnic composition, income deprivation and COVID19 mortality rates in England. Methods: We performed a cross-sectional ecological analysis across upper tier local authorities in England. We assessed the association between the proportion of the population from Black, Asian and Minority Ethnic (BAME) backgrounds, income deprivation and COVID19 mortality rates using negative binomial regression models, whilst adjusting for population density, proportion of the population aged 50-79 and 80+ years, and the duration of the epidemic in each area. Findings: Local authorities with a greater proportion of residents from ethnic minority backgrounds had statistically significantly higher COVID19 mortality rates, as did local authorities with a greater proportion of residents experiencing deprivation relating to low income. After adjusting for income deprivation and other covariates, each percentage point increase in the proportion of the population from BAME backgrounds was associated with a 1% increase in the COVID19 mortality rate [IRR=1.01, 95%CI 1.01 to 1.02]. Each percentage point increase in the proportion of the population experiencing income deprivation was associated with a 2% increase in the COVID19 mortality rate [IRR=1.02, 95%CI 1.01 to 1.04]. Interpretation: This study provides evidence that both income deprivation and ethnicity are associated with greater COVID19 mortality. To reduce these inequalities governments need to target effective control measures at these disadvantaged communities, ensuring investment of resources reflects their greater need and vulnerability to the pandemic. Funding: National Institute of Health Research; Medical Research Council", "COVID-19 Among African Americans: From Preliminary Epidemiological Surveillance Data to Public Health Action ", "At the epicenter of the American Coronavirus outbreak - New York inner city hospital COVID-19 experience and current data: a retrospective analysis BACKGROUND: In the midst of COVID-19 pandemic, emerging clinical data across the globe has equipped front line health care workers, policy makers and researchers to better understand and combat the illness more prepared. OBJECTIVE: Correlation of clinical and laboratory parameters with patients requiring mechanical ventilation and mortality in patients infected with SARS-CoV-2. METHODS: Review of patients with SARS-CoV-2 confirmed infection admitted and managed by our institution during the last month. Patients were grouped into intubated and non-intubated and sub grouped to alive and deceased. Comprehensive analysis using the following parameters were performed, Age, Sex, Ethnicity, Body Mass Index (BMI), Comorbidities, Inflammatory markers, Laboratory values, cardiac and renal function, electrocardiogram (EKG), Chest x ray findings, temperature, treatment groups, hospital acquired SARS-CoV-2 patients. RESULTS: A total of 184 patients were included in our study with age ranging from 28-97 years, mean of 64.72, 73 females (39.67%), 111 males (60.33%), with a mean BMI of 29.10. We had 114 African Americans (61.96%), 58 Hispanics (31.52%), 11 Asians (5.98%), 1 Caucasian (0.54%), with mean number of comorbidities of 1.70. Overall mortality rate was 17.39%, 16.30% of our patients required mechanical ventilation and 11.41% had hospital acquired SARS-CoV-2 infection. Pertinent and statistically significant results in the Intubated (I-T) versus Non Intubated (NI-T) SARS-CoV-2 confirmed patients for the following parameters with P values were: Age P=.01, BMI P= .07, African American Ethnicity P< .001, Hispanic Ethnicity P=.02, DM P=.001, Cr P=0.29, BUN P=.001, Procalcitonin P=.03, CRP P=.007, LDH P= .001, Glucose P=.01, Temperature P=.004, bilateral (B/L) pulmonary infiltrates in CXR P<.001, B/L patchy opacity P=.02. In the living and deceased subgroups of SARS-CoV-2 confirmed patients (linking to or against mortality) were BMI P=.04, LOS P<.001, HTN P=.02, Multiple comorbidity P=.045, BUN P=.04, EKG findings with arrhythmias/block P= .02. CONCLUSIONS: We arrived at the following conclusions based on a comprehensive review of our study group, data collection and statistical analysis. Parameters that were strongly correlated with the need for mechanical ventilation were younger age group, overweight, Hispanic ethnicity, higher core body temperature , EKG findings with sinus tachycardia and bilateral diffuse pulmonary infiltrates on the CXR. Those intubated exhibited increased disease severity with significantly elevated levels of serum Procalcitonin, C reactive protein (CRP), Lactate Dehydrogenase (LDH), Mean glucose, Creatinine, Blood urea nitrogen (BUN). Mortality was strongly correlated with BMI, African American ethnicity, Hypertension, presence of multiple comorbidities with a mean of 2.32, worsening renal function with acute kidney injury or acute on chronic kidney injury and EKG findings of arrhythmias and heart blocks.", "Meta-regression of COVID-19 prevalence/fatality on socioeconomic characteristics of data from top 50 U.S. large cities To screen potential risk and protective socioeconomic factors for Coronavirus disease 2019 (COVID-19) prevalence and fatality, meta-regression of data from top 50 U.S. large-population cities was performed. The population estimate (in 2019) of each country to which the city belongs was abstracted from the \"County Population Totals: 2010-2019.\" From the \"Johns Hopkins Coronavirus Resource Center,\" the cumulative number of confirmed cases and deaths of COVID-19 in each country was obtained on May 22, 2020. Socioeconomic characteristics of each country were extracted from the \"2014-2018 American Community Survey (ACS) 5-Year Data Profile\" and \"Small Area Income and Poverty Estimates (SAIPE) Program (for 2018).\" Radom-effects meta-regression was performed using OpenMetaAnalyst (http://www.cebm.brown.edu/openmeta/index.html). A coefficient (slope of the meta-regression line) for COVID-19 prevalence was significantly negative for male sex, education attainment, computer and Internet use, and private health insurance. Whereas, the coefficient was significantly positive for black race, never matrimony, unemployment, and poverty. In the multivariable model, the coefficient was significantly negative for male sex (P = 0.036) and computer use (P = 0.024), and significantly positive for never matrimony (P < 0.001). A coefficient for COVID-19 fatality was significantly negative for no health insurance, and significantly positive for elderly, unemployment, and public coverage. In the multivariable model, the coefficient was significantly positive for only elderly (P = 0.002). In conclusion, a number of socioeconomic factors, e.g. male sex (negatively for prevalence), elderly (positively for fatality), never matrimony (positively for prevalence), and computer use (negatively for prevalence) may be associated with COVID-19.", "The Expression and Polymorphism of Entry Machinery for COVID-19 in Human: Juxtaposing Population Groups, Gender, and Different Tissues (1) Background: Combating viral disease outbreaks has doubtlessly been one of the major public health challenges for the 21st century. (2) Methods: The host entry machinery required for COVID-19 (SARS-CoV-2) infection was examined for the gene expression profiles and polymorphism. (3) Results: Lung, kidney, small intestine, and salivary glands were among the tissues which expressed the entry machinery coding genes Ace2, Tmprss2, CtsB, and CtsL. The genes had no significant expression changes between males and females. The four human population groups of Europeans, Africans, Asians, and Americans had specific and also a common pool of rare variants for the X-linked locus of ACE2 receptor. Several specific and common ACE2 variants including S19P, I21T/V, E23K, A25T, K26R, T27A, E35D/K, E37K, Y50F, N51D/S, M62V, N64K, K68E, F72V, E75G, M82I, T92I, Q102P, G220S, H239Q, G326E, E329G, G352V, D355N, H378R, Q388L, P389H, E467K, H505R, R514G/*, and Y515C were of the utmost importance to the viral entry and infection. The variants of S19P, I21T, K26R, T27A, E37K, N51D, N64K, K68E, F72V, M82I, G326E, H378R, Q388L, and P389H also had significant differences in frequencies among the population groups. Most interestingly, the analyses revealed that more than half of the variants can exist in males, i.e., as hemizygous. (4) Conclusions: The rare variants of human ACE2 seem to be one of the determinant factors associated with fitness in the battle against SARS viruses. The hemizygous viral-entry booster variants of ACE2 describe the higher SARS-CoV-2 mortality rate in males. This is also supported by the lack of gender bias for the gene expression profiles of entry machinery. A personalized medicine strategy is conceived for isolating high-risk individuals in epidemic circumstances.", "Racial and ethnic determinants of Covid-19 risk Background Racial and ethnic minorities have disproportionately high hospitalization rates and mortality related to the novel coronavirus disease 2019 (Covid-19). There are comparatively scant data on race and ethnicity as determinants of infection risk. Methods We used a smartphone application (beginning March 24, 2020 in the United Kingdom [U.K.] and March 29, 2020 in the United States [U.S.]) to recruit 2,414,601 participants who reported their race/ethnicity through May 25, 2020 and employed logistic regression to determine the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for a positive Covid-19 test among racial and ethnic groups. Results We documented 8,858 self-reported cases of Covid-19 among 2,259,841 non-Hispanic white; 79 among 9,615 Hispanic; 186 among 18,176 Black; 598 among 63,316 Asian; and 347 among 63,653 other racial minority participants. Compared with non-Hispanic white participants, the risk for a positive Covid-19 test was increased across racial minorities (aORs ranging from 1.24 to 3.51). After adjustment for socioeconomic indices and Covid-19 exposure risk factors, the associations (aOR [95% CI]) were attenuated but remained significant for Hispanic (1.58 [1.24-2.02]) and Black participants (2.56 [1.93-3.39]) in the U.S. and South Asian (1.52 [1.38-1.67]) and Middle Eastern participants (1.56 [1.25-1.95]) in the U.K. A higher risk of Covid-19 and seeking or receiving treatment was also observed for several racial/ethnic minority subgroups. Conclusions Our results demonstrate an increase in Covid-19 risk among racial and ethnic minorities not completely explained by other risk factors for Covid-19, comorbidities, and sociodemographic characteristics. Further research investigating these disparities are needed to inform public health measures.", "Promoting health equity in the era of COVID-19() ", "Differential expression of COVID-19-related genes in European Americans and African Americans The Coronavirus disease 2019 (COVID-19) pandemic has affected African American populations disproportionately in regards to both morbidity and mortality. A multitude of factors likely account for this discrepancy. Gene expression represents the interaction of genetics and environment. To elucidate whether levels of expression of genes implicated in COVID-19 vary in African Americans as compared to European Americans, we re-mine The Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression (GTEx) RNA-Seq data. Multiple genes integral to infection, inflammation and immunity are differentially regulated across the two populations. Most notably, F8A2 and F8A3, which encode the HAP40 protein that mediates early endosome movement in Huntington\u2019s Disease, are more highly expressed by up to 24-fold in African Americans. Such differences in gene expression can establish prognostic signatures and have critical implications for precision treatment of diseases such as COVID-19. We advocate routine inclusion of information such as postal code, education level, and profession (as a proxies for socioeconomic condition) and race in the metadata about each individual sampled for sequencing studies. This relatively simple change would enable large-scale data-driven approaches to dissect relationships among race, socio-economic factors, and disease.", "COVID-19 Pandemic: Exacerbating Racial/Ethnic Disparities in Long-Term Services and Supports What services are available and where racial and ethnic minorities receive long-term services and supports (LTSS) have resulted in a lower quality of care and life for racial/ethnic minority users. These disparities are only likely to worsen during the COVID-19 pandemic, as the pandemic has disproportionately affected racial and ethnic minority communities both in the rate of infection and virus-related mortality. By examining these disparities in the context of the pandemic, we bring to light the challenges and issues faced in LTSS by minority communities with regard to this virus as well as the disparities in LTSS that have always existed.", "Understanding the effects of COVID-19 on the health and safety of immigrant hospitality workers in the United States The U.S. tourism and hospitality workforce is disproportionately represented by immigrants and minorities, particularly in low-wage jobs with adverse work conditions. Immigrant hotel and foodservice workers face excess chronic stress and related syndemic risks, exacerbated by social, political, and economic inequities. COVID-19 has suddenly intensified the stressful and already difficult circumstances of immigrant service sector workers. The travel and tourism sector is one of the hardest hit due to widespread travel restrictions and shelter-in-place orders designed to curb infection spread. Restrictions and lockdowns have devastated tourism-dependent destinations and displaced millions of vulnerable workers, causing them to lose their livelihoods. Compared to the general workforce, a sizeable increase in occupational stress has already been observed in the hospitality/tourism sector over the past 15\u201320 years. COVID-19 and related fears add further strains on immigrant hotel and foodservice workers, potentially exerting a significant toll on mental and physical health and safety.", "Ethnic disparities in hospitalisation for COVID-19 in England: The role of socioeconomic factors, mental health, and inflammatory and pro-inflammatory factors in a community-based cohort study BACKGROUND: Differentials in COVID-19 hospitalisations and mortality according to ethnicity have been reported but their origin is uncertain. We examined the role of socioeconomic, mental health, and pro-inflammatory factors in a community-based sample. METHODS: We used data on 340,966 men and women (mean age 56.2 years) from the UK Biobank study, a prospective cohort study with linkage to hospitalisation for COVID-19. Logistic regression models were used to estimate associations between ethnicity and hospitalisation for COVID-19. RESULTS: There were 640 COVID-19 cases (571/324,306 White, 31/4,485 Black, 21/5,732 Asian, 17/5,803 Other). Compared to the White study members and after adjusting for age and sex, Black individuals had over a 4-fold increased risk of COVID-19 infection (odds ratio; 95% confidence interval: 4.32; 3.00-6.23), and there was a doubling of risk in the Asian group (2.12; 1.37, 3.28) and the 'other' non-white group (1.84; 1.13, 2.99). After controlling for potential explanatory factors which included neighbourhood deprivation, household crowding, smoking, body size, inflammation, glycated haemoglobin, and mental illness, these effect estimates were attenuated by 33% for Blacks, 52% for Asians and 43% for Other, but remained raised for Blacks (2.66; 1.82, 3.91), Asian (1.43; 0.91, 2.26) and other non-white groups (1.41; 0.87, 2.31). CONCLUSIONS: There were clear ethnic differences in risk of COVID-19 hospitalisation and these do not appear to be fully explained by measured factors. If replicated, our results have implications for health policy, including the targeting of prevention advice and vaccination coverage.", "COVID-19 pandemic highlights racial health inequities ", "When Blackness Does Not Fade After a Pandemic: An Appeal to Acknowledge the Unequal Burden of Social Isolation Social distancing is one of the few tools that the everyman has to combat the Coronavirus disease. However, for those who are subject to racialized stereotypes about work productivity, educational ability, and other assumptions, the choice to socially distance can have many unintended consequences. This article is an appeal to our posterity, inviting a conversation about how we will remember the Coronavirus\u2019 impact on our lives. Will we selectively provide compassion for the racial groups we perceive more favorable when this is over? Or will we play favorites when it is time to pick up the pieces? This article provides scenarios and commentary on how social distancing could affect Black American populations \u2013 regardless of income or socioeconomic status. It argues that history has not been kind to Black Americans who have bought into mass national causes, and that there is an opportunity here to act differently.", "Ethnicity and COVID-19 in children with comorbidities ", "The impact of ethnicity on clinical outcomes in COVID-19: A systematic review BACKGROUND: The relationship between ethnicity and COVID-19 is uncertain. We performed a systematic review to assess whether ethnicity has been reported in patients with COVID-19 and its relation to clinical outcomes. METHODS: We searched EMBASE, MEDLINE, Cochrane Library and PROSPERO for English-language citations on ethnicity and COVID-19 (1(st) December 2019-15(th) May 2020). We also reviewed: COVID-19 articles in NEJM, Lancet, BMJ, JAMA, clinical trial protocols, grey literature, surveillance data and preprint articles on COVID-19 in MedRxiv to evaluate if the association between ethnicity and clinical outcomes were reported and what they showed. PROSPERO:180654. FINDINGS: Of 207 articles in the database search, five reported ethnicity; two reported no association between ethnicity and mortality. Of 690 articles identified from medical journals, 12 reported ethnicity; three reported no association between ethnicity and mortality. Of 209 preprints, 34 reported ethnicity \u2013 13 found Black, Asian and Minority Ethnic (BAME) individuals had an increased risk of infection with SARS-CoV-2 and 12 reported worse clinical outcomes, including ITU admission and mortality, in BAME patients compared to White patients. Of 12 grey literature reports, seven with original data reported poorer clinical outcomes in BAME groups compared to White groups. INTERPRETATION: Data on ethnicity in patients with COVID-19 in the published medical literature remains limited. However, emerging data from the grey literature and preprint articles suggest BAME individuals are at an increased risk of acquiring SARS-CoV-2 infection compared to White individuals and also worse clinical outcomes from COVID-19. Further work on the role of ethnicity in the current pandemic is of urgent public health importance. FUNDING: NIHR", "COVID-19 Infections and Outcomes in a Live Registry of Heart Failure Patients Across an Integrated Health Care System Background: Patients with comorbid conditions have a higher risk of mortality with SARS-CoV-2 (COVID-19) infection, but the impact on heart failure patients living near a disease hotspot is unknown. Therefore, we sought to characterize the prevalence and outcomes of COVID-19 in a live registry of heart failure patients across an integrated health care system in Connecticut. Methods: In this retrospective analysis, the Yale Heart Failure Registry (NCT04237701) that includes 26,703 patients with heart failure across a 6-hospital integrated health care system in Connecticut, was queried on April 16th, 2020 for all patients tested for COVID-19. Sociodemographic and geospatial data as well as, clinical management, respiratory failure, and patient mortality were obtained via the real-time registry. Data on COVID-19 specific care was extracted by retrospective chart review. Results: COVID-19 testing was performed on 900 symptomatic patients, comprising 3.4% of the Yale Heart Failure Registry (N=26,703). Overall, 206 (23%) were COVID-19+. As compared to COVID-19-, these patients were more likely to be older, black, have hypertension, coronary artery disease, and were less likely to be on renin angiotensin blockers (P<0.05, all). COVID-19- patients tended to be more diffusely spread across the state whereas COVID-19+ were largely clustered around urban centers. 20% of COVID-19+ patients died, and age was associated with increased risk of death [OR 1.92 95% CI (1.33-2.78); P<0.001]. Among COVID-19+ patients who were [\u2265]85 years of age rates of hospitalization were 87%, rates of death 36%, and continuing hospitalization 62% at time of manuscript preparation. Conclusions: In this real-world snapshot of COVID-19 infection among a large cohort of heart failure patients, we found that a small proportion had undergone testing. Patients found to be COVID-19+ tended to be black with multiple comorbidities and clustered around lower socioeconomic status communities. Elderly COVID-19+ patients were very likely to be admitted to the hospital and experience high rates of mortality.", "Sharpening the global focus on ethnicity and race in the time of COVID-19 ", "Are black and Hispanic persons disproportionately affected by COVID-19 because of higher obesity rates? BACKGROUND: On March 13, 2020, the World Health Organization declared COVID-19 a pandemic. Shortly after that, it was reported that mortality rates in New York City (NYC), the epicenter of the pandemic in the United States, were found to be significantly higher in black and Hispanic populations. OBJECTIVES: The aim of this article is to evaluate the mortality rates in NYC among the different ethnic groups and the different boroughs as they relate to the obesity rates to see whether this issue merits further evaluation. SETTING: NYC. METHODS: COVID-19 data were obtained from the official New York authorities in relation to total number of cases in the different boroughs of NYC. Age-adjusted COVID-19-related mortality rates of the different ethnic groups were also obtained. These data were cross-compared with historic community health data on obesity rates previously published and also obesity rates among the different ethnic groups in NYC. RESULTS: The 2 NYC boroughs that have the highest mortality rates are the Bronx (6%) and Brooklyn (5.4%). Both the Bronx and Brooklyn were also found to have the highest obesity rates at 32% and 27%, respectively. The 2 ethnic groups with the highest obesity rates (Hispanic and black) were also found to have the highest age-adjusted mortality rates per 100,000 compared with the other ethnic groups (22.8% and 19.8%, respectively). CONCLUSIONS: The Hispanic and black populations in NYC seem to be disproportionately affected by the COVID-19 pandemic because of the higher incidence of mortality rates. Obesity may have played a role in the high incidence of mortality in those ethnic groups.", "Glucose 6 Phosphate Dehydrogenase Deficiency: An Actionable Risk Factor for Patients with COVID-19? Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common X-linked mutation that is more prevalent in African, Asian, Latin American and Mediterranean populations. Although most individuals are asymptomatic, exposure to certain food, drugs, or infections can trigger acute hemolytic anemia. Given the potential for coronavirus to trigger oxidative stress, unrecognized G6PD deficiency in the presence of the COVID-19 viral infection may cause hemolytic crisis and worse outcome in affected individuals. Further, since certain drugs that may be used to treat COVID-19 infection may cause hemolytic crisis in individuals with G6PD deficiency, it may be warranted to recommend adding G6PD deficiency to the list of screening elements in a COVID-19 workup for those patients where there is a high suspicion for this genetic mutation.", "The association of race and COVID-19 mortality BACKGROUND: COVID-19 mortality disproportionately affects the Black population in the United States (US). To explore this association a cohort study was undertaken. METHODS: We assembled a cohort of 505,992 patients receiving ambulatory care at Bronx Montefiore Health System (BMHS) between 1/1/18 and 1/1/20 to evaluate the relative risk of hospitalization and death in two time-periods, the pre-COVID time-period (1/1/20\u20132/15/20) and COVID time-period (3/1/20\u20134/15/20). COVID testing, hospitalization and mortality were determined with the Black and Hispanic patient population compared separately to the White population using logistic modeling. Evaluation of the interaction of pre-COVID and COVID time periods and race, with respect to mortality was completed. FINDINGS: A total of 9,286/505,992 (1.8%) patients were hospitalized during either or both pre-COVID or COVID periods. Compared to Whites the relative risk of hospitalization of Black patients did not increase in the COVID period (p for interaction=0.12). In the pre- COVID period, compared to Whites, the odds of death for Blacks and Hispanics adjusted for comorbidity was statistically equivalent. In the COVID period compared to Whites the adjusted odds of death for Blacks was 1.6 (95% CI 1.2\u20132.0, p = 0.001). There was a significant increase in Black mortality risk from pre-COVID to COVID periods (p for interaction=0.02). Adjustment for relevant clinical and social indices attenuated but did not fully explain the observed difference in Black mortality. INTERPRETATION: The BMHS COVID experience demonstrates that Blacks do have a higher mortality with COVID incompletely explained by age, multiple reported comorbidities and available metrics of sociodemographic disparity. FUNDING: N/A", "Air pollution, racial disparities, and COVID-19 mortality ", "Racial demographics and COVID-19 confirmed cases and deaths: a correlational analysis of 2886 US counties BACKGROUND: Recent news reports state that racial minority groups, such as African-Americans, are experiencing a greater COVID-19 burden, as measured by confirmed cases and deaths. Limited racial data is available on a national level. METHODS: We conducted the first nationwide analysis to examine COVID-19 and race on a county level. We obtained datasets on COVID-19 cases and deaths, and racial population totals, by US county. We examined if correlations exist between the racial percentages and percentages of confirmed COVID-19 cases and deaths by county. RESULTS: A positive correlation existed between percentages of African-Americans living in a county and who have COVID-19 (r = 0.254, P < 0.0001), who have died from COVID-19 (r = 0.268, P < 0.0001), and case mortality (r = 0.055, P = 0.003). Positive correlations also existed between percentages of Asian-Americans living in counties and these factors. Negative correlations existed between percentages of Whites living in counties and these factors. CONCLUSIONS: A weak, albeit very significant, positive relationship exists between the percentage of African-Americans living in a county and the percentage of COVID-19 confirmed cases, confirmed deaths and case mortality in the county. This is in support of many city and statewide analyses, and we urge for targeted resources towards work that further examine these racial associations.", "Finding Tentative Causes for the reduced impact of Covid-19 on the Health Systems of poorer and developing nations: An ecological study of the effect of demographic, climatological and health-related factors on the global spread of Covid-19 Objective - The objective of this study is to evaluate the association with different factors empirically found to affect the spread and the severity of Covid-19. Evidently there is less likelihood of having one single and absolute solution to this pandemic. It is pragmatic to look for a multi-pronged and collaborative assembly of probable solutions, which is the higher objective of this study. Design - Ecological study. Setting - Global setting including 45 countries from all six inhabited continents Population Two (2) or three (3) countries from each geographical region of the continents selected on the basis of population Main outcome - measures correlation factors derived from comparisons between different sets of variables Results - Empirical trends suggested in the existing literature were quantified in a global setting establishing clear trends. Correlation between the proportion of the population affected and median age, prime climate zones, malaria and tuberculosis incidence, BCG coverage and mitigation measures were established. Conclusions The study findings suggest that demographic and climatological factors, high endemicity of TB and Malaria, and universal BCG programmes may have a cushioning effect in the impact of Covid-19 on health systems of poorer and developing nations. In the light of these findings more emphasis is necessary on the protective effects of BCG and antiviral properties of antimalarial drugs.", "Understanding COVID-19 Risks and Vulnerabilities among Black Communities in America: The Lethal Force of Syndemics Black communities in the United States are bearing the brunt of the COVID-19 pandemic and the underlying conditions that exacerbate its negative consequences. Syndemic theory provides a useful framework for understanding how such interacting epidemics to develop under conditions of health and social disparity. Multiple historical and present-day factors have created the syndemic conditions within which Black Americans experience the lethal force of COVID-19. These factors include racism and its manifestations (e.g., chattel slavery, mortgage redlining, political gerrymandering, lack of Medicaid expansion, employment discrimination, and healthcare provider bias). Improving racial disparities in COVID-19 will require that we implement policies that address structural racism at the root of these disparities.", "Widening Disparities Among Patients with Rheumatic Diseases in the COVID-19 Era: An Urgent Call to Action Recent data from multiple public health departments across the U.S. highlighting the disproportionate burden of COVID-19 infections in vulnerable populations serve as an urgent call to action. As rheumatologists, we are acutely aware of the higher morbidity and mortality, and for a number of our diseases, the higher incidence and prevalence among racial/ethnic minorities and individuals of lower socioeconomic status (SES). Comorbidities are frequent, timely access to subspecialty care is limited, receipt of high quality care is less common, and care is more often fragmented with frequent, avoidable acute care use.", "Covid-19: Racism may be linked to ethnic minorities' raised death risk, says PHE ", "Racial Impact on Infections and Deaths due to COVID-19 in New York City Redlining is the discriminatory practice whereby institutions avoided investment in certain neighborhoods due to their demographics. Here we explore the lasting impacts of redlining on the spread of COVID-19 in New York City (NYC). Using data available through the Home Mortgage Disclosure Act, we construct a redlining index for each NYC census tract via a multi-level logistical model. We compare this redlining index with the COVID-19 statistics for each NYC Zip Code Tabulation Area. Accurate mappings of the pandemic would aid the identification of the most vulnerable areas and permit the most effective allocation of medical resources, while reducing ethnic health disparities.", "Impact of COVID\u201019 Stay\u2010at\u2010Home Orders on Weight\u2010Related Behaviors Among Patients with Obesity OBJECTIVE: How the impact of the COVID\u201019 stay\u2010at\u2010home orders are influencing physical, mental, and financial health among vulnerable populations, including those with obesity is unknown. The aim of the current study was to explore the health implications of COVID\u201019 AMong a sample of adults with obesity. METHODS: A retrospective medical chart review identified patients with obesity from an obesity medicine clinic and a bariatric surgery (MBS) practice. Patients completed an online survey from April 15, 2020 to May 31, 2020 to assess COVID\u201019 status and health behaviors during stay\u2010at\u2010home orders. Logistic regression models examined the impact of these orders on anxiety and depression by ethnic group. RESULTS: A total of 123 patients (87% female, mean age 51.2 years [SD 13.0], mean BMI 40.2 [SD 6.7], 49.2% Non\u2010Hispanic white, 28.7% Non\u2010Hispanic black, 16.4% Hispanic, 7% other ethnicity, 33.1% completed MBS were included. Two patients tested positive for SARS\u2010CoV\u20102 and 14.6% reported symptoms. 72.8% reported increased anxiety and 83.6% increased depression since stay\u2010at\u2010home orders were initiated. 69.6% reported more difficultly in achieving weight loss goals, less exercise time (47.9%) and intensity (55.8%), increased stockpiling of food (49.6%) and stress eating (61.2%). Hispanics were less likely to report anxiety vs non\u2010Hispanic whites (aOR 0.16; 95% CI, 0.05\u20100.49; P = 0.009). CONCLUSIONS: Results here showed the COVID\u201019 pandemic is having a significant impact on patients with obesity regardless of infection status. These results can inform clinicians and healthcare professionals about effective strategies to minimize COVID\u201019 negative outcomes for this vulnerable population now and in post\u2010COVID\u201019 recovery efforts. This article is protected by copyright. All rights reserved.", "The COVID-19 Pandemic: a Call to Action to Identify and Address Racial and Ethnic Disparities The Coronavirus disease 2019 (COVID-19) pandemic has significantly impacted and devastated the world. As the infection spreads, the projected mortality and economic devastation are unprecedented. In particular, racial and ethnic minorities may be at a particular disadvantage as many already assume the status of a marginalized group. Black Americans have a long-standing history of disadvantage and are in a vulnerable position to experience the impact of this crisis and the myth of Black immunity to COVID-19 is detrimental to promoting and maintaining preventative measures. We are the first to present the earliest available data in the peer-reviewed literature on the racial and ethnic distribution of COVID-19-confirmed cases and fatalities in the state of Connecticut. We also seek to explode the myth of Black immunity to the virus. Finally, we call for a National Commission on COVID-19 Racial and Ethnic Health Disparities to further explore and respond to the unique challenges that the crisis presents for Black and Brown communities.", "Characteristics of U.S. Nursing Homes with COVID-19 Cases BACKGROUND/OBJECTIVES: The 2019 coronavirus disease (COVID-19) has been documented in a large share of nursing homes throughout the United States, leading to high rates of mortality for residents. To understand how to prevent and mitigate future outbreaks, it is imperative that we understand which nursing homes are more likely to experience COVID-19 cases. Our aim was to examine the characteristics of nursing homes with documented COVID-19 cases in the 30 states reporting the individual facilities affected. DESIGN: We constructed a database of nursing homes with verified COVID-19 cases as of May 11, 2020, via correspondence with and publicly available reports from state departments of health. We linked this information to nursing home characteristics and used regression analysis to examine the association between these characteristics and the likelihood of having a documented COVID-19 case. SETTING: All nursing homes from 30 states that reported COVID-19 cases at the facility-level. PARTICIPANTS: Nursing home residents in states reporting data. MEASUREMENTS: Whether a nursing home had a reported COVID-19 case (yes/no), and conditional on having a case, the number of cases at a nursing home. RESULTS: Of 9,395 nursing homes in our sample, 2,949 (31.4%) had a documented COVID-19 case. Larger facility size, urban location, greater percentage of African American residents, non-chain status, and state were significantly (P < .05) related to the increased probability of having a COVID-19 case. Five-star rating, prior infection violation, Medicaid dependency, and ownership were not significantly related. CONCLUSION: COVID-19 cases in nursing homes are related to facility location and size and not traditional quality metrics such as star rating and prior infection control citations.", "Addressing inequities in COVID-19 morbidity and mortality: research and policy recommendations The COVID-19 pandemic is the greatest global public health crisis since the 1918 influenza outbreak. As of early June, the novel coronavirus has infected more than 6.3 million people worldwide and more than 1.9 million in the United States (US). The total number of recorded deaths due to COVID-19 are growing at an alarming rate globally (\u00b3383,000) and nationally (\u00b3109,000) Evidence is mounting regarding the heavier burden of COVID-19 infection, morbidity, and mortality on the underserved populations in the US. This commentary focuses on this global health pandemic and how mitigation of the virus relies heavily on health behavior change to slow its spread, highlighting how the pandemic specifically affects the most socially and economically disadvantaged populations in the US. The commentary also offers short, intermediate and long-term research and policy focused recommendations. Both the research and policy recommendations included in this commentary emphasize equity-driven: (1) research practices, including applying a social determinants and health equity lens on monitoring, evaluation, and clinical trials activities on COVID-19; and (2) policy actions, such as dedicating resources to prioritize high-risk communities for testing, treatment, and prevention approaches and implementing organizational, institutional, and legislative policies that address the social and economic barriers to overall well-being that these populations face during a pandemic. It is our hope that these recommendations will generate momentum in delivering timely, effective, and lifesaving changes.", "Widening Disparities Among Patients with Rheumatic Diseases in the COVID\u201019 Era: An Urgent Call to Action Recent data from multiple public health departments across the U.S. highlighting the disproportionate burden of COVID\u201019 infections in vulnerable populations serve as an urgent call to action. As rheumatologists, we are acutely aware of the higher morbidity and mortality, and for a number of our diseases, the higher incidence and prevalence among racial/ethnic minorities and individuals of lower socioeconomic status (SES). Comorbidities are frequent, timely access to subspecialty care is limited, receipt of high quality care is less common, and care is more often fragmented with frequent, avoidable acute care use.", "The disproportionate effect of COVID-19 mortality on ethnic minorities: Genetics or health inequalities? ", "Historical Insights on Coronavirus Disease 2019 (COVID-19), the 1918 Influenza Pandemic, and Racial Disparities: Illuminating a Path Forward The coronavirus disease 2019 (COVID-19) pandemic is exacting a disproportionate toll on ethnic minority communities and magnifying existing disparities in health care access and treatment. To understand this crisis, physicians and public health researchers have searched history for insights, especially from a great outbreak approximately a century ago: the 1918 influenza pandemic. However, of the accounts examining the 1918 influenza pandemic and COVID-19, only a notable few discuss race. Yet, a rich, broader scholarship on race and epidemic disease as a \u201csampling device for social analysis\u201d exists. This commentary examines the historical arc of the 1918 influenza pandemic, focusing on black Americans and showing the complex and sometimes surprising ways it operated, triggering particular responses both within a minority community and in wider racial, sociopolitical, and public health structures. This analysis reveals that critical structural inequities and health care gaps have historically contributed to and continue to compound disparate health outcomes among communities of color. Shifting from this context to the present, this article frames a discussion of racial health disparities through a resilience approach rather than a deficit approach and offers a blueprint for approaching the COVID-19 crisis and its afterlives through the lens of health equity.", "Assessing Differential Impacts of COVID-19 on Black Communities Purpose Given incomplete data reporting by race, we used data on COVID-19 cases and deaths in US counties to describe racial disparities in COVID-19 disease and death and associated determinants. Methods Using publicly available data (accessed April 13, 2020), predictors of COVID-19 cases and deaths were compared between disproportionately (>13%) black and all other (<13% black) counties. Rate ratios were calculated and population attributable fractions (PAF) were estimated using COVID-19 cases and deaths via zero-inflated negative binomial regression model. National maps with county-level data and an interactive scatterplot of COVID-19 cases were generated. Results Nearly ninety-seven percent of disproportionately black counties (656/677) reported a case and 49% (330/677) reported a death versus 81% (1987/2,465) and 28% (684/ 2465), respectively, for all other counties. Counties with higher proportions of black people have higher prevalence of comorbidities and greater air pollution. Counties with higher proportions of black residents had more COVID-19 diagnoses (RR 1.24, 95% CI 1.17-1.33) and deaths (RR 1.18, 95% CI 1.00-1.40), after adjusting for county-level characteristics such as age, poverty, comorbidities, and epidemic duration. COVID-19 deaths were higher in disproportionally black rural and small metro counties. The PAF of COVID-19 diagnosis due to lack of health insurance was 3.3% for counties with <13% black residents and 4.2% for counties with >13% black residents. Conclusions Nearly twenty-two percent of US counties are disproportionately black and they accounted for 52% of COVID-19 diagnoses and 58% of COVID-19 deaths nationally. County-level comparisons can both inform COVID-19 responses and identify epidemic hot spots. Social conditions, structural racism, and other factors elevate risk for COVID-19 diagnoses and deaths in black communities.", "Neighborhood income and physical distancing during the COVID-19 pandemic in the U.S. Introduction: Although physical distancing has been the primary strategy to reduce the spread of COVID-19 in the U.S., people's ability to distance may vary by socioeconomic characteristics, leading to higher transmission risk in low-income neighborhoods. Methods: We used mobility data from a large, anonymized sample of smartphone users to assess the relationship between neighborhood median household income and physical distancing during the COVID-19 epidemic. We assessed changes in several behaviors including: spending the day entirely at home; working outside the home; and visits to supermarkets, parks, hospitals, and other locations. We also assessed differences in effects of state policies on physical distancing across neighborhood income levels. Results: We found a strong gradient between neighborhood income and physical distancing. Compared to January and February 2020, the proportion of individuals spending the day entirely at home in April 2020 increased by 10.9 percentage points in low-income neighborhoods and by 27.1 percentage points in high-income neighborhoods. During April 2020, people in low-income neighborhoods were more likely to work outside the home, compared to people in higher-income neighborhoods, but not more likely to visit non-work locations. State physical distancing orders were associated with a 1.5 percentage-point increase (95% CI [0.9, 2.1], p < 0.001) in staying home in low-income neighborhoods and a 2.4 percentage point increase (95% CI [1.4, 3.4], p < 0.001) in high-income neighborhoods. Discussion: People in lower-income neighborhoods have faced barriers to physical distancing, particularly the need to work outside the home. State physical distancing policies have not mitigated these disparities.", "Governments and international institutions should urgently attend to the unjust disparities that COVID-19 is exposing and causing ", "COVID-19: A Closer Lens Generations of nurses to come, now called heroes in the media, will have challenges in providing care for persons during this global pandemic. COVID-19 has impacted all demographics, regardless of race, gender, or socioeconomic class globally. African Americans have experienced a disproportionate number of deaths related to COVID-19 in the New Orleans and surrounding Metropolitan areas. According to the Louisiana Department of Health (2020), fifty-seven percent (57.40%) of the deaths in Louisiana related to COVID-19 have been African American (Black) and fifty-five percent (55.2%) have been males as of May 11, 2020. Social determinants of health are the conditions in which people age and the conditions they are born, grow, age and work. These conditions include neighborhoods, schools, and places of employment. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels (World Health Organization, 2020). Years later the same community that comprised \"pre-and post-Katrina\" are now facing this pandemic.", "Six feet apart or six feet under: The impact of COVID-19 on the Black community. To date, 110,000+ people in the United States have died from the COVID-19 pandemic. In this paper, the authors will discuss COVID-19 relative to Black people and their overrepresentation among those who are infected and died from the disease. Their dying, death, and grief experiences are explored through a cultural and spiritual lens. The physical distancing, social isolation, misinformation, and restrictive burials and cremations now elicited by this unprecedented pandemic have had diminished familial, cultural, emotional, and economic impacts on the Black community. Implications for public health and Black peoples' involvement in the political process are also addressed.", "A multi-hazards earth science perspective on the COVID-19 pandemic: the potential for concurrent and cascading crises Meteorological and geophysical hazards will concur and interact with coronavirus disease (COVID-19) impacts in many regions on Earth. These interactions will challenge the resilience of societies and systems. A comparison of plausible COVID-19 epidemic trajectories with multi-hazard time-series curves enables delineation of multi-hazard scenarios for selected countries (United States, China, Australia, Bangladesh) and regions (Texas). In multi-hazard crises, governments and other responding agents may be required to make complex, highly compromised, hierarchical decisions aimed to balance COVID-19 risks and protocols with disaster response and recovery operations. Contemporary socioeconomic changes (e.g. reducing risk mitigation measures, lowering restrictions on human activity to stimulate economic recovery) may alter COVID-19 epidemiological dynamics and increase future risks relating to natural hazards and COVID-19 interactions. For example, the aggregation of evacuees into communal environments and increased demand on medical, economic, and infrastructural capacity associated with natural hazard impacts may increase COVID-19 exposure risks and vulnerabilities. COVID-19 epidemiologic conditions at the time of a natural hazard event might also influence the characteristics of emergency and humanitarian responses (e.g. evacuation and sheltering procedures, resource availability, implementation modalities, and assistance types). A simple epidemic phenomenological model with a concurrent disaster event predicts a greater infection rate following events during the pre-infection rate peak period compared with post-peak events, highlighting the need for enacting COVID-19 counter measures in advance of seasonal increases in natural hazards. Inclusion of natural hazard inputs into COVID-19 epidemiological models could enhance the evidence base for informing contemporary policy across diverse multi-hazard scenarios, defining and addressing gaps in disaster preparedness strategies and resourcing, and implementing a future-planning systems approach into contemporary COVID-19 mitigation strategies. Our recommendations may assist governments and their advisors to develop risk reduction strategies for natural and cascading hazards during the COVID-19 pandemic. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10669-020-09772-1) contains supplementary material, which is available to authorized users.", "Can Vitamin D and L-Cysteine Co-Supplementation Reduce 25(OH)-Vitamin D Deficiency and the Mortality Associated with COVID-19 in African Americans? Early reports indicate an association between the severity of the COVID-19 infection and the widespread 25-hydroxy vitamin D deficiency known to exist in populations around the world. Vitamin D deficiency is extremely common among African American (AA) communities, where the COVID-19 infection rate is three-fold higher, and the mortality rate nearly six-fold higher, compared with rates in predominantly white communities. COVID-19 infection primarily affects the lungs and airways. Previous reports have linked 25-hydroxy vitamin D deficiency with subclinical interstitial lung disease. AA are at risk for lower cellular glutathione (GSH) levels, and GSH deficiency epigenetically impairs VD biosynthesis pathway genes. Compared with vitamin D alone, co-supplementation of vitamin D and L-cysteine (a GSH precursor) showed a better efficacy in improving levels of GSH and VD-regulatory genes at the cellular/tissue level, increasing 25(OH) vitamin D levels, and reducing inflammation biomarkers in the blood in mice studies. We propose that randomized clinical trials are needed to examine the potential of co-supplementation with anti-inflammatory antioxidants, vitamin D and L-cysteine in correcting the 25(OH)VD deficiency and preventing the 'cytokine storm,' one of the most severe consequences of infection with COVID-19, thereby preventing the adverse clinical effects of COVID-19 infection in the vulnerable AA population.", "Severe obesity is associated with higher in-hospital mortality in a cohort of patients with COVID-19 in the Bronx, New York BACKGROUND & AIMS: New York is the current epicenter of Coronavirus disease 2019 (COVID-19) pandemic. The underrepresented minorities, where the prevalence of obesity is higher, appear to be affected disproportionately. Our objectives were to assess the characteristics and early outcomes of patients hospitalized with COVID-19 in the Bronx and investigate whether obesity is associated with worse outcomes independently from age, gender and other comorbidities. METHODS: This retrospective study included the first 200 patients admitted to a tertiary medical center with COVID-19. The electronic medical records were reviewed at least three weeks after admission. The primary endpoint was in-hospital mortality. RESULTS: 200 patients were included (female sex: 102, African American: 102). The median BMI was 30 kg/m(2). The median age was 64 years. Hypertension (76%), hyperlipidemia (46.2%), and diabetes (39.5%) were the three most common comorbidities. Fever (86%), cough (76.5%), and dyspnea (68%) were the three most common symptoms. 24% died during hospitalization (BMI < 25 kg/m(2): 31.6%, BMI 25\u201334 kg/m(2): 17.2%, BMI \u2265 35 kg/m(2): 34.8%, p = 0.03). Increasing age (analyzed in quartiles), male sex, BMI \u2265 35 kg/m(2) (reference: BMI 25\u201334 kg/m(2)), heart failure, CAD, and CKD or ESRD were found to have a significant univariate association with mortality. The multivariate analysis demonstrated that BMI \u2265 35 kg/m(2) (reference: BMI 25\u201334 kg/m(2), OR: 3.78; 95% CI: 1.45\u20139.83; p = 0.006), male sex (OR: 2.74; 95% CI: 1.25\u20135.98; p = 0.011) and increasing age (analyzed in quartiles, OR: 1.73; 95% CI: 1.13\u20132.63; p = 0.011) were independently associated with higher in-hospital mortality. Similarly, age, male sex, BMI \u2265 35 kg/m(2) and current or prior smoking were significant predictors for increasing oxygenation requirements in the multivariate analysis, while male sex, age and BMI \u2265 35 kg/m(2) were significant predictors in the multivariate analysis for the outcome of intubation. CONCLUSIONS: In this cohort of hospitalized patients with COVID-19 in a minority-predominant population, severe obesity, increasing age, and male sex were independently associated with higher in-hospital mortality and in general worse in-hospital outcomes.", "Racial disparities in knowledge, attitudes and practices related to COVID-19 in the USA BACKGROUND: Recent reports indicate racial disparities in the rates of infection and mortality from the 2019 novel coronavirus (coronavirus disease 2019 [COVID-19]). The aim of this study was to determine whether disparities exist in the levels of knowledge, attitudes and practices (KAPs) related to COVID-19. METHODS: We analyzed data from 1216 adults in the March 2020 Kaiser Family Foundation 'Coronavirus Poll', to determine levels of KAPs across different groups. Univariate and multivariate regression analysis was used to identify predictors of KAPs. RESULTS: In contrast to White respondents, Non-White respondents were more likely to have low knowledge (58% versus 30%; P < 0.001) and low attitude scores (52% versus 27%; P < 0.001), but high practice scores (81% versus 59%; P < 0.001). By multivariate regression, White race (odds ratio [OR] 3.06; 95% confidence interval [CI]: 1.70-5.50), higher level of education (OR 1.80; 95% CI: 1.46-2.23) and higher income (OR 2.06; 95% CI: 1.58-2.70) were associated with high knowledge of COVID-19. Race, sex, education, income, health insurance status and political views were all associated with KAPs. CONCLUSIONS: Racial and socioeconomic disparity exists in the levels of KAPs related to COVID-19. More work is needed to identify educational tools that tailor to specific racial and socioeconomic groups.", "COVID-19\u2013Associated Collapsing Glomerulopathy: An Emerging Entity ", "COVID-19 Deaths: Which Explanatory Variables Matter the Most? As Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) spreads around the World, many questions about the disease are being answered; however, many more remain poorly understood. Although the situation is rapidly evolving, with datasets being continually corrected or updated, it is crucial to understand what factors may be driving transmission through different populations. While studies are beginning to highlight specific parameters that may be playing a role, few have attempted to thoroughly estimate the relative importance of these disparate variables that likely include: climate, population demographics, and imposed state interventions. In this report, we compiled a database of more than 28 potentially explanatory variables for each of the 50 U.S. states through early May 2020. Using a combination of traditional statistical and modern machine learning approaches, we identified those variables that were the most statistically significant, and, those that were the most important. These variables were chosen to be fiduciaries of a range of possible drivers for COVID-19 deaths in the USA. We found that population-weighted density (PWD), some \"stay at home\" metrics, monthly temperature and precipitation, race/ethnicity, and chronic low respiratory death rate, were all statistically significant. Of these, PWD and mobility metrics dominated. This suggests that the biggest impact on COVID-19 deaths was, at least initially, a function of where you lived, and not what you did. However, clearly, increasing social distancing has the net effect of (at least temporarily) reducing the effective PWD. Our results strongly support the idea that the loosening of \"lock-down\" orders should be tailored to the local PWD. In contrast to these variables, while still statistically significant, race/ethnicity, health, and climate effects could only account for a few percent of the variability in deaths. Where associations were anticipated but were not found, we discuss how limitations in the parameters chosen may mask a contribution that might otherwise be present.", "COVID-19 and Racial Disparities ", "Inequity and the disproportionate impact of COVID-19 on communities of color in the United States: The need for a trauma-informed social justice response. COVID-19 has had disproportionate contagion and fatality in Black, Latino, and Native American communities and among the poor in the United States. Toxic stress resulting from racial and social inequities have been magnified during the pandemic, with implications for poor physical and mental health and socioeconomic outcomes. It is imperative that our country focus and invest in addressing health inequities and work across sectors to build self-efficacy and long-term capacity within communities and systems of care serving the most disenfranchised, now and in the aftermath of the COVID-19 epidemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).", "County-Level Proportions of Black and Hispanic populations, and Socioeconomic Characteristics in Association with Confirmed COVID-19 Cases and Deaths in the United States Objectives. The objective of this study was to investigate potential county-level disparities among racial/ethnic and economic groups in COVID-19 burden which was measured using confirmed cases and deaths in 100,000 population. Design. Secondary data analysis Using county-level data for 3,142 US counties was conducted in 2020. Hierarchical linear regression and concentration curve analyses were performed. The combined association of COVID-19 cases and deaths was examined separately by sociodemographic and economic characteristics of the county population. Data from the American Community Survey (ACS) 5-year estimates (2014-2018), Area Health Resources File (AHRF) 2018-2019, and 2020 COVID-19 data from Johns Hopkins University were used in this study. Results. After adjusting for covariates, US counties with a higher proportion of the black population, and a higher proportion of adults with less than high school diploma had disproportionately higher COVID-19 cases and deaths ({beta}>0, p<0.05). A higher proportion of the Hispanic population was associated with higher confirmed cases ({beta}= 1.03, 95% CI= 0.57-1.5), and higher housing cost to household income ratio was associated with higher deaths ({beta}= 3.74, 95% CI= 2.14-5.37). This can potentially aggravate the existing health disparities among these population groups. Conclusions. Identification of disproportionately impacted population groups can pave the way towards narrowing the disparity gaps and guide policymakers and stakeholders in designing and implementing population group-specific interventions to mitigate the negative consequences of COVID-19 pandemic.", "Disparities in Vulnerability to Severe Complications from COVID-19 in the United States This paper provides the first nationally representative estimates of vulnerability to severe complications from COVID-19 overall and across race-ethnicity and socioeconomic status. We use the Panel Study of Income Dynamics (PSID) to examine the prevalence of specific health conditions associated with complications from COVID-19 and to calculate, for each individual, an index of the risk of severe complications from respiratory infections developed by DeCaprio et al. (2020). We show large disparities across race-ethnicity and socioeconomic status in the prevalence of conditions, including hypertension, which are associated with the risk of severe complications from COVID-19. Moreover, we show that these disparities emerge early in life, prior to age 65, leading to higher vulnerability to such complications. Our results suggest particular attention should be paid to the risk of adverse outcomes in midlife for non-Hispanic blacks, adults with a high school degree or less, and low-income Americans.", "Functional prediction and comparative population analysis of variants in genes for proteases and innate immunity related to SARS-CoV-2 infection New coronavirus SARS-CoV-2 is capable to infect humans and cause a novel disease COVID-19. Aiming to understand a host genetic component of COVID-19, we focused on variants in genes encoding proteases and genes involved in innate immunity that could be important for susceptibility and resistance to SARS-CoV-2 infection. Analysis of sequence data of coding regions of FURIN, PLG, PRSS1, TMPRSS11a, MBL2 and OAS1 genes in 143 unrelated individuals from Serbian population identified 22 variants with potential functional effect. In silico analyses (PolyPhen-2, SIFT, MutPred2 and Swiss-Pdb Viewer) predicted that 10 variants could impact the structure and/or function of proteins. These protein-altering variants (p.Gly146Ser in FURIN; p.Arg261His and p.Ala494Val in PLG; p.Asn54Lys in PRSS1; p.Arg52Cys, p.Gly54Asp and p.Gly57Glu in MBL2; p.Arg47Gln, p.Ile99Val and p.Arg130His in OAS1) may have predictive value for inter-individual differences in the response to the SARS-CoV-2 infection. Next, we performed comparative population analysis for the same variants using extracted data from the 1000 genomes project. Population genetic variability was assessed using delta MAF and Fst statistics. Our study pointed to 7 variants in PLG, TMPRSS11a, MBL2 and OAS1 genes with noticeable divergence in allelic frequencies between populations worldwide. Three of them, all in MBL2 gene, were predicted to be damaging, making them the most promising population-specific markers related to SARS-CoV-2 infection. Comparing allelic frequencies between Serbian and other populations, we found that the highest level of genetic divergence related to selected loci was observed with African, followed by East Asian, Central and South American and South Asian populations. When compared with European populations, the highest divergence was observed with Italian population. In conclusion, we identified 4 variants in genes encoding proteases (FURIN, PLG and PRSS1) and 6 in genes involved in the innate immunity (MBL2 and OAS1) that might be relevant for the host response to SARS-CoV-2 infection.", "ACE2 coding variants in different populations and their potential impact on SARS-CoV-2 binding affinity The susceptibility of different populations to the SARS-CoV-2 infection is not yet understood. A deeper analysis of the genomes of individuals from different populations might explain their risk for infection. In this study, a combined analysis of ACE2 coding variants in different populations and computational chemistry calculations are conducted in order to probe the potential effects of ACE2 coding variants on SARS-CoV-2/ACE2 binding affinity. Our study reveals novel interaction data on the variants and SARS-CoV-2. We could show that ACE2-K26R; which is more frequent in the Ashkenazi Jewish population decrease the electrostatic attraction between SARS-CoV-2 and ACE2. On the contrary, ACE2-I468V, R219C, K341R, D206G, G211R were found to increase the electrostatic attraction and increase the binding to SARS-CoV-2; ordered by the strength of binding from weakest to strongest. I468V, R219C, K341R, D206G and G211R were more frequent in East Asian, South Asian, African and African American, European and European and South Asian populations, respectively. SARS-CoV-2/ACE2 interface in the WT protein and corresponding variants is showed to be a dominated by van der Waals (vdW) interactions. All the mutations except K341R induce an increase in the vdW attractions between the ACE2 and the SARS-CoV-2. The largest increase of is observed for the R219C mutant.", "Pandemic Influenza Planning in the United States from a Health Disparities Perspective We explored how different socioeconomic and racial/ethnic groups in the United States might fare in an influenza pandemic on the basis of social factors that shape exposure, vulnerability to influenza virus, and timeliness and adequacy of treatment. We discuss policies that might differentially affect social groups\u2019 risk for illness or death. Our purpose is not to establish the precise magnitude of disparities likely to occur; rather, it is to call attention to avoidable disparities that can be expected in the absence of systematic attention to differential social risks in pandemic preparedness plans. Policy makers at the federal, state, and local levels should consider potential sources of socioeconomic and racial/ethnic disparities during a pandemic and formulate specific plans to minimize these disparities.", "People experiencing homelessness urgently need to be recognised as a high risk group for COVID-19. History shows that pandemics rarely impact on the population equally - the 14th century Black Death plague reduced the global population by a third, with the greatest number of deaths occurring among the poor.1 Fast forward six centuries, and the same pandemic inequities are prevailing due to COVID-19; with Smith and Judd articulating that \"while COVID-19 has the potential to impact everyone in society, these impacts will be felt differentially\u2026 the most vulnerable will be hardest hit\"2 in their recent Health Promotion Journal of Australia editorial.", "COVID-19 and Health Disparities: the Reality of \u201cthe Great Equalizer\u201d ", "Impact of Covid-19 on the media system. Communicative and democratic consequences of news consumption during the outbreak COVID-19 is a phenomenon of enormous magnitude and relevance Its impact has affected various social domains, including the media and journalism Since the beginning of this health crisis, the news has become a valuable resource for citizens Studying the dynamics of information consumption is highly relevant both for its ability to transform the media system and for its incidence in democracy The objective of this research is to analyse the influence of the new coronavirus on news consumption, the credibility given by citizens to the media as well as their ability to detect fake news To answer these questions, we have conducted an exploratory analysis based on the secondary data from the online surveys of the Pew Research Center\u2019s American Trends Panel in the United States, comparing data before and after the outbreak The results confirm the impact of Covid-19 on the media system The findings suggest the emergence of important developments such as the resurgence of the role of legacy media, especially television, and the fact that citizens who usually remain far from the information have reconnected with the news Therefore, the existing inequalities regarding news consumption among citizens have been reduced, in part This generates potential benefits for democracy in terms of equality and accessibility concerning public affairs", "Promoting health equity in the era of COVID-19 ", "COVID-19: Global Health Equity in Pandemic Response Novel Coronavirus Disease (COVID-19): Global Health Equity in Pandemic Response.", "\u201cClinical Characteristics, Outcomes and Prognosticators in Adult Patients Hospitalized with COVID-19\u201d BACKGROUND: COVID-19 is a novel disease caused by SARS-CoV-2. METHODS: We conducted a retrospective evaluation of patients admitted with COVID-19 to one site in March 2020. Patients were stratified into three groups: survivors who did not receive mechanical ventilation (MV), survivors who received MV and those who received MV and died during hospitalization. RESULTS: There were 140 hospitalizations; 22 deaths (mortality rate 15.7%), 83 (59%) survived and did not receive MV, 35 (25%) received MV and survived; 18 (12.9%) received MV and died. Thee mean age of each group was 57.8, 55.8 and 72.7 years respectively (p=.0001). Of those who received MV and died, 61% were male (p=.01). More than half the patients (n=90, 64%) were African American. First measured d-dimer >575.5 ng/mL, procalcitonin > 0.24 ng/mL, LDH > 445.6 units/L and BNP > 104.75 pg/mL had odds ratios of 10.5, 5, 4.5 and 2.9 respectively for MV (p < .05 for all). Peak BNP > 167.5 pg/mL had an odds ratio of 6.7 for inpatient mortality when mechanically ventilated (p= .02). CONCLUSIONS: Age and gender may impact outcomes in COVID-19. D-dimer, procalcitonin, LDH and BNP may serve as early indicators of disease trajectory.", "Racial Capitalism: A Fundamental Cause of Novel Coronavirus (COVID-19) Pandemic Inequities in the United States Racial capitalism is a fundamental cause of the racial and socioeconomic inequities within the novel coronavirus pandemic (COVID-19) in the United States. The overrepresentation of Black death reported in Detroit, Michigan is a case study for this argument. Racism and capitalism mutually construct harmful social conditions that fundamentally shape COVID-19 disease inequities because they (a) shape multiple diseases that interact with COVID-19 to influence poor health outcomes; (b) affect disease outcomes through increasing multiple risk factors for poor, people of color, including racial residential segregation, homelessness, and medical bias; (c) shape access to flexible resources, such as medical knowledge and freedom, which can be used to minimize both risks and the consequences of disease; and (d) replicate historical patterns of inequities within pandemics, despite newer intervening mechanisms thought to ameliorate health consequences. Interventions should address social inequality to achieve health equity across pandemics.", "Differences in race and other state\u2010level characteristics and associations with mortality from COVID\u201019 infection As reporting of COVID\u201019 at the US state level has become more granular, many states have reported a higher proportion of deaths among African\u2010Americans. In our study, we assessed state level data on race, population density, age, obesity rates, insurance data, GDP, per capita healthcare resources (hospital\u2010beds/ventilators per\u2010capita), median household income and high\u2010school graduation rates. We report a higher death rate among states with a greater proportion of African\u2010American residents despite adjusting for case rates and state\u2010level factors. To the best of our knowledge this is the first study looking at state level data (from across the US) and mortality with COVID\u201019. This article is protected by copyright. All rights reserved.", "Disparities In Outcomes Among COVID-19 Patients In A Large Health Care System In California. As the coronavirus disease (COVID-19) pandemic spreads throughout the United States, evidence is mounting that racial and ethnic minorities and socioeconomically disadvantaged groups are bearing a disproportionate burden of illness and death. We conducted a retrospective cohort analysis of COVID-19 patients at Sutter Health, a large integrated health care system in northern California, to measure potential disparities. We used Sutter's integrated electronic health record to identify adults with suspected and confirmed COVID-19, and used multivariable logistic regression to assess risk of hospitalization, adjusting for known risk factors, such as race/ethnicity, sex, age, health, and socioeconomic variables. We analyzed 1,052 confirmed cases of COVID-19 from January 1-April 8, 2020. Among our findings, we observed that, compared with non-Hispanic white patients, African Americans had 2.7 times the odds of hospitalization, after adjusting for age, sex, comorbidities, and income. We explore possible explanations for this, including societal factors that either result in barriers to timely access to care or create circumstances in which patients view delaying care as the most sensible option. Our study provides real-world evidence that there are racial and ethnic disparities in the presentation of COVID-19. [Editor's Note: This Fast Track Ahead Of Print article is the accepted version of the peer-reviewed manuscript. The final edited version will appear in an upcoming issue of Health Affairs.].", "COVID-19 and racial disparities ", "COVID-19 and the Widening Gap in Health Inequity. The coronavirus disease 2019 (COVID-19) pandemic has brought to light significant health inequities that have existed in our society for decades. Blacks, Hispanics, Native Americans, and immigrants are the populations most likely to experience disparities related to burden of disease, health care, and health outcomes. Increasingly, national and state statistics on COVID-19 report disproportionately higher mortality rates in blacks. There has never been a more pressing time for us to enact progressive and far-reaching changes in social, economic, and political policies that will shape programs aimed at improving the health of all people living in the United States.", "Covid-19: Racism may be linked to ethnic minorities' raised death risk, says PHE. ", "Covid-19 by Race and Ethnicity: A National Cohort Study of 6 Million United States Veterans BACKGROUND: There is growing concern that racial and ethnic minority communities around the world are experiencing a disproportionate burden of morbidity and mortality from symptomatic SARS-Cov-2 infection or coronavirus disease 2019 (Covid-19). Most studies investigating racial and ethnic disparities to date have focused on hospitalized patients or have not characterized who received testing or those who tested positive for Covid-19. OBJECTIVE: To compare patterns of testing and test results for coronavirus 2019 (Covid-19) and subsequent mortality by race and ethnicity in the largest integrated healthcare system in the United States. DESIGN: Retrospective cohort study. SETTING: United States Department of Veterans Affairs (VA). PARTICIPANTS: 5,834,543 individuals in care, among whom 62,098 were tested and 5,630 tested positive for Covid-19 between February 8 and May 4, 2020. EXPOSURES: Self-reported race/ethnicity. MAIN OUTCOME MEASURES: We evaluated associations between race/ethnicity and receipt of Covid-19 testing, a positive test result, and 30-day mortality, accounting for a wide range of demographic and clinical risk factors including comorbid conditions, site of care, and urban versus rural residence. RESULTS: Among all individuals in care, 74% were non-Hispanic white (white), 19% non-Hispanic black (black), and 7% Hispanic. Compared with white individuals, black and Hispanic individuals were more likely to be tested for Covid-19 (tests per 1000: white=9.0, [95% CI 8.9 to 9.1]; black=16.4, [16.2 to 16.7]; and Hispanic=12.2, [11.9 to 12.5]). While individuals from minority backgrounds were more likely to test positive (black vs white: OR 1.96, 95% CI 1.81 to 2.12; Hispanic vs white: OR 1.73, 95% CI 1.53 to 1.96), 30-day mortality did not differ by race/ethnicity (black vs white: OR 0.93, 95% CI 0.64 to 1.33; Hispanic vs white: OR 1.07, 95% CI 0.61 to 1.87). CONCLUSIONS: Black and Hispanic individuals are experiencing an excess burden of Covid-19 not entirely explained by underlying medical conditions or where they live or receive care. While there was no observed difference in mortality by race or ethnicity, our findings may underestimate risk in the broader US population as health disparities tend to be reduced in VA.", "Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit IMPORTANCE: In late December 2019, an outbreak caused by a novel severe acute respiratory syndrome coronavirus 2 emerged in Wuhan, China. Data on the clinical characteristics and outcomes of infected patients in urban communities in the US are limited. OBJECTIVES: To describe the clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and to perform a comparative analysis of hospitalized and ambulatory patient populations. DESIGN, SETTING, AND PARTICIPANTS: This study is a case series of 463 consecutive patients with COVID-19 evaluated at Henry Ford Health System in metropolitan Detroit, Michigan, from March 9 to March 27, 2020. Data analysis was performed from March to April 2020. EXPOSURE: Laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection. MAIN OUTCOMES AND MEASURES: Demographic data, underlying comorbidities, clinical presentation, complications, treatment, and outcomes were collected. RESULTS: Of 463 patients with COVID-19 (mean [SD] age, 57.5 [16.8] years), 259 (55.9%) were female, and 334 (72.1%) were African American. Most patients (435 [94.0%]) had at least 1 comorbidity, including hypertension (295 patients [63.7%]), chronic kidney disease (182 patients [39.3%]), and diabetes (178 patients [38.4%]). Common symptoms at presentation were cough (347 patients [74.9%]), fever (315 patients [68.0%]), and dyspnea (282 patients [60.9%]). Three hundred fifty-five patients (76.7%) were hospitalized; 141 (39.7%) required intensive care unit management and 114 (80.8%) of those patients required invasive mechanical ventilation. Male sex (odds ratio [OR], 2.0; 95% CI, 1.3-3.2; P = .001), severe obesity (OR, 2.0; 95% CI, 1.4-3.6; P = .02), and chronic kidney disease (OR, 2.0; 95% CI, 1.3-3.3; P = .006) were independently associated with intensive care unit admission. Patients admitted to the intensive care unit had longer length of stay and higher incidence of respiratory failure and acute respiratory distress syndrome requiring invasive mechanical ventilation, acute kidney injury requiring dialysis, shock, and mortality (57 patients [40.4%] vs 15 patients [7.0%]) compared with patients in the general practice unit. Twenty-nine (11.2%) of those discharged from the hospital were readmitted and, overall, 20.0% died within 30 days. Male sex (OR, 1.8; 95% CI, 1.1-3.1; P = .03) and age older than 60 years (OR, 5.3; 95% CI, 2.9-9.7; P < .001) were significantly associated with mortality, whereas African American race was not (OR, 0.98; 95% CI, 0.54-1.8; P = .86). CONCLUSIONS AND RELEVANCE: In this review of urban metropolitan patients with COVID-19, most were African American with a high prevalence of comorbid conditions and high rates of hospitalization, intensive care unit admission, complications, and mortality due to COVID-19.", "From the EditorCommentary: Addressing Inequities in the Era of COVID-19: The Pandemic and the Urgent Need for Critical Race Theory ", "COVID-19 and the other pandemic: populations made vulnerable by systemic inequity ", "Equality, Inclusion, and Diversity in Healthcare During the COVID-19 Pandemic ", "The Perfect Moral Storm: Diverse Ethical Considerations in the COVID-19 Pandemic The COVID-19 pandemic has both exposed and created deep rifts in society. It has thrust us into deep ethical thinking to help justify the difficult decisions many will be called upon to make and to protect from decisions that lack ethical underpinnings. This paper aims to highlight ethical issues in six different areas of life highlighting the enormity of the task we are faced with globally. In the context of COVID-19, we consider health inequity, dilemmas in triage and allocation of scarce resources, ethical issues associated with research, ethical considerations relating to tracing apps, and exit strategies such as immunity passports and COVID-19 vaccines. Finally, we consider environmental issues in light of COVID-19. The paper also offers some ethical reflection on these areas as many parts of the world contemplate the recovery phase.", "Health equity and distributive justice considerations in critical care resource allocation ", "Sickle cell trait and the potential risk of severe coronavirus disease 2019\u2014A mini\u2010review Coronavirus Disease 2019 (COVID\u201019) pandemic is a rapidly evolving public health problem. The severity of COVID\u201019 cases reported hitherto has varied greatly from asymptomatic to severe pneumonia and thromboembolism with subsequent mortality. An improved understanding of risk factors for adverse clinical outcomes may shed some light on novel personalized approaches to optimize clinical care in vulnerable populations. Emerging trends in the United States suggest possibly higher mortality rates of COVID\u201019 among African Americans, although detailed epidemiological study data is pending. Sickle cell disease (SCD) disproportionately affects Black/African Americans in the United States as well as forebearers from sub\u2010Saharan Africa, the Western Hemisphere (South America, the Caribbean, and Central America), and some Mediterranean countries. The carrier frequency for SCD is high among African Americans. This article underscores the putative risks that may be associated with COVID\u201019 pneumonia in sickle cell trait as well as potential opportunities for individualized medical care in the burgeoning era of personalized medicine.", "Collapsing Glomerulopathy in a Patient With Coronavirus Disease 2019 (COVID-19) ", "COVID-19\u2013Related Glomerulopathy: A Report of 2 Cases of Collapsing Focal Segmental Glomerulosclerosis Coronavirus disease 19 (COVID-19), an infectious disease caused by the SARS-CoV-2 virus, has been associated with acute kidney injury (AKI), presumably due to acute tubular injury. However, this does not explain the sometimes severe proteinuria and hematuria often observed. We present 2 African American patients with glomerulopathy demonstrated by kidney biopsy in the setting of AKI and COVID-19 infection. Kidney biopsies showed collapsing variant of focal segmental glomerulosclerosis (FSGS) in addition to acute tubular injury. Both patients were homozygous for APOL1. COVID-19 infection likely caused the interferon surge as a second hit causing podocyte injury leading to collapsing FSGS. APOL1 testing should be strongly considered in African American patients with nephrotic range proteinuria. More data from future kidney biopsies will further elucidate the pathology of kidney injury and glomerular involvement from COVID-19 infections.", "Older age and comorbidity are independent mortality predictors in a large cohort of 1305 COVID\u201019 patients in Michigan, United States INTRODUCTION: Higher comorbidity and older age have been reported as correlates of poor outcomes in COVID\u201019 patients worldwide, however US data is scarce. We evaluated mortality predictors of COVID\u201019 in a large cohort of hospitalized patients in the US. DESIGN: Retrospective, multicenter cohort of inpatients diagnosed with COVID\u201019 by RT\u2010PCR from March 1\u2010April 1,2020 was performed, and outcome data evaluated from March 1\u2010April 17, 2020. Measures included demographics, comorbidities, clinical presentation, laboratory values, and imaging on admission. Primary outcome was mortality. Secondary outcomes included length of stay, time to death, and development of acute kidney injury in the first 48\u2010hours. RESULTS: 1305 patients were hospitalized during the evaluation period. Mean age was 61.0\u00b116.3, 53.8% were male and 66.1% African\u2010American. Mean BMI was 33.2\u00b18.8 kg/m2. Median Charlson Comorbidity Index (CCI) was 2 (1\u20104), 72.6% of patients had at least one comorbidity, with hypertension (56.2%) and diabetes mellitus (30.1%) being the most prevalent. ACE\u2010I/ARB use and NSAIDs use were widely prevalent (43.3% and 35.7% respectively). Mortality occurred in 200 (15.3%) of patients with median time of 10 (6\u201014) days. Age >60 (aOR:1.93,95% CI:1.26\u20102.94), and CCI>3 (aOR:2.71,95% CI:1.85\u20103.97) were independently associated with mortality by multivariate analyses. NSAIDs and ACE\u2010I/ARB use had no significant effects on renal failure in the first 48 hours. CONCLUSION: Advanced age and an increasing number of comorbidities are independent predictors of in\u2010hospital mortality for COVID\u201019 patients. NSAIDs and ACE\u2010I/ARB use prior to admission is not associated with renal failure or increased mortality.", "Imaging evaluation of COVID-19 in the emergency department PURPOSE: The purpose of this study is to elucidate the chest imaging findings of suspected COVID-19 patients presenting to the emergency department and the relationship with their demographics and RT-PCR testing results. METHODS: Patients presenting to the ED between March 12 and March 28, 2020, with symptoms suspicious for COVID-19 and subsequent CXR and/or CT exam were selected. Patients imaged for other reasons with findings suspicious for COVID-19 were also included. Demographics, laboratory test results, and history were extracted from the medical record. Descriptive statistics were used to explore the relationship between imaging and these factors. RESULTS: A total of 227 patients from the emergency department were analyzed (224 CXRs and 25 CTs). Of the 192 patients with COVID-19 results, 173 (90.1%) had COVID-19 RT-PCR (+). Abnormal imaging (CXR, 85.7% and/or CT, 100%) was noted in 155 (89.6%) of COVID-19 RT-PCR (+) cases. The most common imaging findings were mixed airspace/interstitial opacities (39.8%) on CXR and peripheral GGOs on CT (92%). The most common demographic were African Americans (76.8%). Furthermore, 97.1% of African Americans were RT-PCR (+) compared to 65.8% of Caucasians. CONCLUSION: We found a similar spectrum of thoracic imaging findings in COVID-19 patients as previous studies. The most common demographic were African Americans (76.8%). Furthermore, 97.1% of African Americans were RT-PCR (+) compared to 65.8% of Caucasians. Both CT and CXR can accurately identify COVID-19 pneumonitis in 89.6% of RT-PCR (+) cases, 89.5% of false negatives, and 72.7% of cases with no RT-PCR result.", "Disparities in the Population at Risk of Severe Illness From COVID-19 by Race/Ethnicity and Income ", "Towards Equity in Health: Researchers Take Stock For the 2016 end-of-the-year editorial, the PLOS Medicine editors asked 7 global health leaders to discuss developments relevant to the equitable provision of medical care to all populations. The result is a collection of expert views on ethical trial design, research during outbreaks, high-burden infectious diseases, diversity in research and protection of migrants.", "Multivariate Analysis of Factors Affecting COVID-19 Case and Death Rate in U.S. Counties: The Significant Effects of Black Race and Temperature Objectives: Coronavirus disease-19 (COVID-19) has spread rapidly around the world, and many risk factors including patient demographics, social determinants of health, environmental variables, underlying health conditions, and adherence to social distancing have been hypothesized to affect case and death rates. However, little has been done to account for the potential confounding effects of these factors. Using a large multivariate analysis, this study illuminates modulators of COVID-19 incidence and mortality in U.S. counties while controlling for risk factors across multiple domains. Methods: Data on COVID-19 and various risk factors in all U.S. counties was collected from publicly available data sources through April 14, 2020. Counties with at least 50 COVID-19 cases were included in case analyses and those with at least 10 deaths were included in mortality models. The 661 counties meeting inclusion criteria for number of cases were grouped into quartiles and comparisons of risk factors were made using t-tests between the highest and lowest quartiles. Similar comparisons for 217 counties were made for above average and below average deaths/100,000. Adjusted linear and logistic regression analyses were performed to evaluate the independent effects of factors that significantly impacted cases and deaths. Results: Univariate analyses demonstrated numerous significant differences between cohorts for both cases and deaths. Risk factors associated with increased cases and/or deaths per 100,000 included increased GDP per capita, decreased social distancing, increased age, increased percent Black, decreased percent Hispanic, decreased percent Asian, decreased health, increased poverty, increased diabetes, increased coronary heart disease, increased physical inactivity, increased alcohol consumption, increased tobacco use, and decreased access to primary care. Multivariate regression analyses demonstrated Black race is a risk factor for worse COVID-19 outcome independent of comorbidities, poverty, access to health care, and other mitigating factors. Lower daily temperatures was also an independent risk factor in case load but not deaths. Conclusions: U.S. counties with a higher proportion of Black residents are associated with increased COVID-19 cases and deaths. However, the various suggested mechanisms, such as socioeconomic and healthcare predispositions, did not appear to drive the effect of race in our model. Counties with higher average daily temperatures are also associated with decreased COVID-19 cases but not deaths. Several theories are posited to explain these findings, including prevalence of vitamin D deficiency. Additional studies are needed to further understand these effects.", "African-American COVID-19 Mortality: A Sentinel Event ", "Law, Structural Racism, and the COVID-19 Pandemic Racial and ethnic minorities have always been the most impacted by pandemics because of: disparities in exposure to the virus; disparities in susceptibility to contracting the virus; and disparities in treatment. This article explains how structural racism, the ways in which laws are used to advantage the majority and disadvantage racial and ethnic minorities, has caused these disparities. Specifically, this article focuses on how employment, housing, health care, and COVID-19 relief laws have been manipulated to disadvantage racial and ethnic minorities, making minorities more susceptible to COVID-19 infection and death. This article uses Blumenshine\u2019s 2008 framework to outline how structural racism causes racial and ethnic minorities\u2019 disparities in exposure to viruses, in susceptibility to contracting viruses, in treatment of viruses, and in infection and death rates. This article discusses how historical and current practices of structural racism in existing employment, housing, and health care laws and the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) cause disparities in COVID-19 infections and deaths. This article suggests legal solutions to address structural racism as well as public health solutions to help mitigate the racialized effects of the disease.", "Assessing capacity to social distance and neighborhood-level health disparities during the COVID-19 pandemic The COVID-19 pandemic has yielded disproportionate impacts on communities of color in New York City (NYC). Researchers have noted that social disadvantage may result in limited capacity to socially distance, and consequent disparities. Here, we investigate the role of neighborhood social disadvantage on the ability to socially distance, infections, and mortality. We combine Census Bureau and NYC open data with SARS-CoV-2 testing data using supervised dimensionality-reduction with Bayesian Weighted Quantile Sums regression. The result is a ZIP code-level index with relative weights for social factors facilitating infection risk. We find a positive association between neighborhood social disadvantage and infections, adjusting for the number of tests administered. Neighborhood infection risk is also associated with capacity to socially isolate, as measured by NYC subway data. Finally, infection risk is associated with COVID-19-related mortality. These analyses support that differences in capacity to socially isolate is a credible pathway between disadvantage and COVID-19 disparities.", "Multisystem Inflammatory Syndrome in Children (MIS\u2010C) Related to COVID\u201019: A New York City Experience In December 2019, the 2019 novel coronavirus disease (COVID\u201019) caused by Severe Acute Respiratory Syndrome Coronavirus\u20102 (SARS\u2010CoV\u20102) first emerged in Wuhan, China. This has now spread worldwide and was declared a pandemic by March 2020. Initially, the pediatric population was described as low risk for severe COVID\u201019. However, reports have emerged recently of cases of COVID\u201019 in children with a systemic inflammatory disease, with features that overlap with Kawasaki Disease (KD). We describe the first 15 cases with multi\u2010system inflammatory syndrome in children (MIS\u2010C), temporally related to COVID\u201019, who presented for care to a tertiary pediatric referral center in New York City. We discuss the disproportionate burden of disease among Hispanic/Latino and black/African\u2010American ancestry, the distinct cytokine signature across the disease spectrum (IL\u20101/IL\u20106), and the potential role and pathogenesis of SARS\u2010CoV\u20102 in this new clinical entity. This article is protected by copyright. All rights reserved.", "Children are at risk from COVID-19 ", "Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread rapidly across the USA, causing extensive morbidity and mortality, particularly in the African American community. Autopsy can considerably contribute to our understanding of many disease processes and could provide crucial information to guide management of patients with coronavirus disease 2019 (COVID-19). We report on the relevant cardiopulmonary findings in, to our knowledge, the first autopsy series of ten African American decedents, with the cause of death attributed to COVID-19. METHODS: Autopsies were performed on ten African American decedents aged 44-78 years with cause of death attributed to COVID-19, reflective of the dominant demographic of deaths following COVID-19 diagnosis in New Orleans. Autopsies were done with consent of the decedents' next of kin. Pulmonary and cardiac features were examined, with relevant immunostains to characterise the inflammatory response, and RNA labelling and electron microscopy on representative sections. FINDINGS: Important findings include the presence of thrombosis and microangiopathy in the small vessels and capillaries of the lungs, with associated haemorrhage, that significantly contributed to death. Features of diffuse alveolar damage, including hyaline membranes, were present, even in patients who had not been ventilated. Cardiac findings included individual cell necrosis without lymphocytic myocarditis. There was no evidence of secondary pulmonary infection by microorganisms. INTERPRETATION: We identify key pathological states, including thrombotic and microangiopathic pathology in the lungs, that contributed to death in patients with severe COVID-19 and decompensation in this demographic. Management of these patients should include treatment to target these pathological mechanisms. FUNDING: None.", "The experience on COVID-19 and cancer from an oncology hub institution in Milan, Lombardy Region Abstract The rapid outbreak of the SARS-CoV-2 related disease (COVID-19) has spread rapidly to a pandemic proportion, increasing the demands on health systems for the containment and management of COVID-19. Cancer has been reported as a major risk factor for adverse outcomes of and death from COVID-19. We extracted data from the World Health Organization\u2019s progress reports and from the Italian Council of Medicine. In addition, we retrieved clinical data on cancer patients with confirmed COVID-19 in our Institution. As of April 2nd, 2020, 110 574 COVID-19 cases and 13 157 deaths have been described in Italy, representing a global share of 5.1% and 28.9% for incidence and mortality, respectively. In Italy, we report the analysis of the Italian Medical Council on 909 patients who died from COVID-19, of whom 16.5% were cancer patients. The population was enriched with subjects with multiple co-morbid non-communicable diseases, with less than 1% of the population presenting no co-morbid conditions. At the patient level, we identified nine patients referred to our department in the last two months who were receiving standard of care or experimental medications in the curative and palliative settings. The median age was 68 years (range: 42\u201379 years), and patients carried a median of one co-morbid condition (0\u20132); two out of nine patients presented with severe COVID-19 presentation, and were receiving inpatient care. None of the patients receiving immunotherapy experienced severe adverse outcomes, and four patients were discharged with complete reversal of the clinical syndrome and SARS-CoV-2 clearance. Learning from the experience of countries with a high burden, efforts must be made to assure the access of cancer patients to treatments, prioritizing the cancer health interventions based on their intrinsic value, and limiting the exposure to an unacceptable risk of infection for both health providers and patients. Any significant work in the design and implementation of health system actions, including in clinical care, must be framed as an initiative under the Global Response Agenda and through a community approach, with the intention of pursuing common goals to tackle COVID-19 and cancer, as \u2018One Community\u2019 working for \u2018One Health\u2019s.", "Taking a Closer Look at COVID-19, Health Inequities, and Racism. ", "Clinical Features of Critical Coronavirus Disease 2019 in Children OBJECTIVES: We sought to describe the presentation, course, and outcomes of hospitalized pediatric coronavirus disease 2019 patients, with detailed description of those requiring mechanical ventilation, and comparisons between critically ill and noncritical hospitalized pediatric patients. DESIGN: Observational cohort study. SETTING: Riley Hospital for Children at Indiana University Health in Indianapolis in the early weeks of the coronavirus disease 2019 pandemic. PATIENTS: All hospitalized pediatric patients with confirmed coronavirus disease 2019 as of May 4, 2020, were included. INTERVENTIONS: Patients received therapies including hydroxychloroquine, remdesivir, tocilizumab, and convalescent serum and were managed according to an institutional algorithm based on evidence available at the time of presentation. MEASUREMENTS AND MAIN RESULTS: Of 407 children tested for severe acute respiratory syndrome-coronavirus 2 at our hospital, 24 were positive, and 19 required hospitalization. Seven (36.8%) were critically ill in ICU, and four (21%) required mechanical ventilation. Hospitalized children were predominantly male (14, 74%) and African-American or Hispanic (14, 74%), with a bimodal distribution of ages among young children less than or equal to 2 years old (8, 42%) and older adolescents ages 15-18 (6, 32%). Five of seven (71.4%) of critically ill patients were African-American (n = 3) or Hispanic (n = 2). Critical illness was associated with older age (p = 0.017), longer duration of symptoms (p = 0.036), and lower oxygen saturation on presentation (p = 0.016); with more thrombocytopenia (p = 0.015); higher C-reactive protein (p = 0.031); and lower WBC count (p = 0.039). Duration of mechanical ventilation averaged 14.1 days. One patient died. CONCLUSIONS: Severe, protracted coronavirus disease 2019 is seen in pediatric patients, including those without significant comorbidities. We observed a greater proportion of hospitalized children requiring mechanical ventilation than has been reported to date. Older children, African-American or Hispanic children, and males may be at risk for severe coronavirus disease 2019 requiring hospitalization. Hypoxia, thrombocytopenia, and elevated C-reactive protein may be useful markers of critical illness. Data regarding optimal management and therapies for pediatric coronavirus disease 2019 are urgently needed.", "When Public Health Crises Collide: Social Disparities and COVID-19 In To Have or to Be?, psychoanalyst Erich Fromm writes about pursuit after domination of nature, material abundance, and unlimited happiness, which made modern society become more interested in having than in being. Income, in his view, should not be as accentuated as to create different experiences of life for different groups [1]. Of the concepts that Fromm presents, the domination of nature, which facilitates zoonotic spillover events by increasing the overlap between the habitat of various species with that of humans [2-5], and the gap between the rich and the poor, which recently has become the widest in years [6], become particularly relevant in context of the COVID-19 pandemic.", "Clinical and Genetic Characteristics of Covid-19 Patients from UK Biobank OBJECTIVE: To explore both clinical and genetic risk factors for Covid-19 in a cohort from the United Kingdom. DESIGN: Prospective cohort study. PARTICIPANTS: 669 positive Covid-19 patients within a cohort of 502,536 UK Biobank participants, recruited between 2006 and 2010. MAIN OUTCOME MEASURES: The main outcome measure was Covid-19 positive status, determined by the presence of any positive test for a single individual. We also assessed risk factors for inpatient and outpatient status for Covid-19 positive individuals. RESULTS: We found that black participants were at over three times increased risk of testing positive for Covid-19, relative to white participants, even after adjusting for confounders (adjusted relative risk [ARR] 3.14, 95% confidence interval [CI] 2.28 to 4.31). Asian participants were also at higher risk of Covid-19 (ARR 2.03, 95% CI 1.40 to 2.95). Next, we analyzed the association of comorbidities with Covid-19. We found that participants were at increased risk of Covid-19 if they had chronic obstructive pulmonary disease (ARR 1.54, 95% CI 1.02 to 2.31) or ischemic heart disease (ARR 1.56, 95% CI 1.18 to 2.07). However, there was no evidence that either angiotensin converting enzyme inhibitors (ARR 1.32, 95% CI 0.95 to 1.84) or angiotensin II receptor blockers (ARR 1.37, 95% CI 0.94 to 1.98) increased the risk of Covid-19. We confirmed that blood type A was associated with Covid-19 relative to blood type O individuals, and we also found that the HLA variant DQA1_509 was enriched in Covid-19 positive cases, even after Bonferroni correction (P = 1.0 \u00d7 10(\u22125)). CONCLUSIONS: In this study, we found that black and Asian participants were at increased risk of Covid-19, even after adjusting for confounders. We also identified a novel genetic association with the HLA variant DQA1_509. Further investigations of genetic associations with Covid-19 may lead to important discoveries of genetic drivers of severe disease.", "Cardiac sequelae of novel coronavirus disease 2019 (COVID-19): a clinical case series BACKGROUND: COVID-19 caused by severe acute respiratory syndrome coronavirus 2 most commonly manifests with fever and respiratory illness. The cardiovascular manifestations have become more prevalent but can potentially go unrecognized. We look to describe cardiac manifestations in three patients with COVID-19 using cardiac enzymes, electrocardiograms, and echocardiography. CASE SUMMARIES: The first patient, a 67-year-old Caucasian female with non-ischaemic dilated cardiomyopathy, presented with dyspnoea on exertion and orthopnoea 1 week after testing positive for COVID-19. Echocardiogram revealed large pericardial effusion with findings consistent with tamponade. A pericardial drain was placed, and fluid studies were consistent with viral pericarditis, treated with colchicine, hydroxychloroquine, and methylprednisolone. Follow-up echocardiograms showed apical hypokinesis, that later resolved, consistent with Takotsubo syndrome. The second patient, a 46-year-old African American male with obesity and type 2 diabetes mellitus presented with fevers, cough, and dyspnoea due to COVID-19. Clinical course was complicated with pulseless electrical activity arrest; he was found to have D-dimer and troponin elevation, and inferior wall ST elevation on ECG concerning for STEMI due to microemboli. The patient succumbed to the illness. The third patient, a 76-year-old African American female with hypertension, presented with diarrhoea, fever, and myalgia, and was found to be COVID-19 positive. Clinical course was complicated, with acute troponin elevation, decreased cardiac index, and severe hypokinesis of the basilar wall suggestive of reverse Takotsubo syndrome. The cardiac index improved after pronation and non-STEMI therapy; however, the patient expired due to worsening respiratory status. DISCUSSION: These case reports demonstrate cardiovascular manifestations of COVID-19 that required monitoring and urgent intervention.", "Moving Health Education and Behavior Upstream: Lessons From COVID-19 for Addressing Structural Drivers of Health Inequities In this Perspective, we build on social justice and emancipatory traditions within the field of health education, and the field's long-standing commitment to building knowledge and shared power to promote health equity, to examine lessons and opportunities for health education emerging from the COVID-19 pandemic. Examining patterns that emerged as the pandemic unfolded in Metropolitan Detroit, with disproportionate impacts on African American and low-income communities, we consider conditions that contributed to excess exposure, mortality, and reduced access to critical health protective resources. Using a life course framework, we consider enduring impacts of the pandemic for health equity. Finally, we suggest several strategic actions in three focal areas-environment, occupation, and housing-that can be taken by health educators working in partnership with community members, researchers, and decision makers, using, for example, a community-based participatory research approach, to reduce adverse impacts of COVID-19 and promote long-term equity in health.", "COVID-19\u2013related Genes in Sputum Cells in Asthma. Relationship to Demographic Features and Corticosteroids Rationale: Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). ACE2 (angiotensin-converting enzyme 2), and TMPRSS2 (transmembrane protease serine 2) mediate viral infection of host cells. We reasoned that differences in ACE2 or TMPRSS2 gene expression in sputum cells among patients with asthma may identify subgroups at risk for COVID-19 morbidity. Objectives: To determine the relationship between demographic features and sputum ACE2 and TMPRSS2 gene expression in asthma. Methods: We analyzed gene expression for ACE2 and TMPRSS2, and for ICAM-1 (intercellular adhesion molecule 1) (rhinovirus receptor as a comparator) in sputum cells from 330 participants in SARP-3 (Severe Asthma Research Program-3) and 79 healthy control subjects. Measurements and Main Results: Gene expression of ACE2 was lower than TMPRSS2, and expression levels of both genes were similar in asthma and health. Among patients with asthma, male sex, African American race, and history of diabetes mellitus were associated with higher expression of ACE2 and TMPRSS2. Use of inhaled corticosteroids (ICS) was associated with lower expression of ACE2 and TMPRSS2, but treatment with triamcinolone acetonide did not decrease expression of either gene. These findings differed from those for ICAM-1, where gene expression was increased in asthma and less consistent differences were observed related to sex, race, and use of ICS. Conclusions: Higher expression of ACE2 and TMPRSS2 in males, African Americans, and patients with diabetes mellitus provides rationale for monitoring these asthma subgroups for poor COVID-19 outcomes. The lower expression of ACE2 and TMPRSS2 with ICS use warrants prospective study of ICS use as a predictor of decreased susceptibility to SARS-CoV-2 infection and decreased COVID-19 morbidity.", "Lessons from Hurricane Katrina for predicting the indirect health consequences of the COVID-19 pandemic Beyond their immediate effects on mortality, disasters have widespread, indirect impacts on mental and physical well-being by exposing survivors to stress and potential trauma. Identifying the disaster-related stressors that predict health adversity will help officials prepare for the coronavirus disease 2019 (COVID-19) pandemic. Using data from a prospective study of young, low-income mothers who survived Hurricane Katrina, we find that bereavement, fearing for loved ones\u2019 well-being, and lacking access to medical care and medications predict adverse mental and physical health 1 y postdisaster, and some effects persist 12 y later. Adjusting for preexisting health and socioeconomic conditions attenuates, but does not eliminate, these associations. The findings, while drawn from a demographically unique sample, suggest that, to mitigate the indirect effects of COVID-19, lapses in medical care and medication use must be minimized, and public health resources should be directed to those with preexisting medical conditions, their social networks, and the bereaved.", "Covid-19: Review of ethnic disparities is labelled \"whitewash\" for lack of recommendations. ", "Disparities In Outcomes Among COVID-19 Patients In A Large Health Care System In California As the novel coronavirus disease (COVID-19) pandemic spreads throughout the United States, evidence is mounting that racial and ethnic minorities and socioeconomically disadvantaged groups are bearing a disproportionate burden of illness and death. We conducted a retrospective cohort analysis of COVID-19 patients at Sutter Health, a large integrated health system in northern California, to measure potential disparities. We used Sutter's integrated electronic health record to identify adults with suspected and confirmed COVID-19, and we used multivariable logistic regression to assess risk of hospitalization, adjusting for known risk factors, such as race/ethnicity, sex, age, health, and socioeconomic variables. We analyzed 1,052 confirmed cases of COVID-19 from the period January 1-April 8, 2020. Among our findings, we observed that compared with non-Hispanic white patients, non-Hispanic African American patients had 2.7 times the odds of hospitalization, after adjustment for age, sex, comorbidities, and income. We explore possible explanations for this, including societal factors that either result in barriers to timely access to care or create circumstances in which patients view delaying care as the most sensible option. Our study provides real-world evidence of racial and ethnic disparities in the presentation of COVID-19.", "Letter to the Editor in Response to: COVID-19: Magnifying the Effect of Health Disparities ", "Acknowledging and Addressing COVID-19 Health Disparities in the American South ", "Black Lives in a Pandemic: Implications of Systemic Injustice for End\u2010of\u2010Life Care In recent months, Covid\u201019 has devastated African American communities across the nation, and a Minneapolis police officer murdered George Floyd. The agents of death may be novel, but the phenomena of long\u2010standing epidemics of premature black death and of police violence are not. This essay argues that racial health and health care disparities, rooted as they are in systemic injustice, ought to carry far more weight in clinical ethics than they generally do. In particular, this essay examines palliative and end\u2010of\u2010life care for African Americans, highlighting the ways in which American medicine, like American society, has breached trust. In the experience of many African American patients struggling against terminal illness, health care providers have denied them a say in their own medical decision\u2010making. In the midst of the Covid\u201019 pandemic, African Americans have once again been denied a say with regard to the rationing of scarce medical resources such as ventilators, in that dominant and ostensibly race\u2010neutral algorithms sacrifice black lives. Is there such thing as a \u201cgood\u201d or \u201cdignified\u201d death when African Americans are dying not merely of Covid\u201019 but of structural racism?", "Health Disparities and the Coronavirus Disease 2019 (COVID-19) Pandemic in the USA ", "Similarities and differences in COVID-19 awareness, concern, and symptoms by race and ethnicity in the United States: A cross-sectional survey BACKGROUND: Existing health disparities based on race and ethnicity in the United States are contributing to disparities in morbidity and mortality in the COVID-19 pandemic. We conducted an online survey of American adults to assess similarities and differences by race and ethnicity groups with respect to COVID-19 symptoms, estimates of the extent of the pandemic, knowledge of control measures, and stigma. OBJECTIVE: Describe similarities and differences in COVID-19 symptoms, knowledge, and beliefs by race and ethnicity among adults in the US. METHODS: We conducted a cross-sectional survey from March 27, 2020 through April 1, 2020. Participants were recruited on social media platforms and completed the survey on a secure, online survey platform. We used chi square tests to compare characteristics related to COVID-19 by race and ethnicity. Statistical tests were corrected using the Holm Bonferroni correction to account for multiple comparisons. RESULTS: A total of 1,435 (3.6% Asian, 11.0% non-Hispanic Black, 38.2% Hispanic, 40.9% non-Hispanic white, and 6.3% other or multiple races) participants completed the survey. Only one symptom (sore throat) was found to be different based on race and ethnicity (p = 0.003), which was less frequently reported by Asian (5.8%), non-Hispanic Black (5.7%), and other/multiple race (8.9%) participants compared to those who were Hispanic (18.1%) or non-Hispanic white (16.2%). Non-Hispanic white and Asian participants were more likely to estimate that the number of current cases was at least 100,000 (p = 0.004) and were more likely to answer all 14 COVID-19 knowledge scale questions correctly (Asian, 25.0%; non-Hispanic White, 30.7%) compared to Hispanic (19.7%) and non-Hispanic Black (15.8%) participants. CONCLUSIONS: We observed differences with respect to knowledge of appropriate methods to prevent infection by the novel coronavirus that causes COVID-19. Deficits in knowledge of proper control methods might further exacerbate existing race/ethnicity disparities. Additional research is needed to identify trusted sources of information in Hispanic and non-Hispanic Black communities and effective messaging to disseminate correct COVID-19 prevention and treatment information.", "Severe obesity is associated with higher in-hospital mortality in a cohort of patientswith COVID-19 in the Bronx, New York Background & Aims: New York is the current epicenter of Coronavirus disease 2019 (COVID-19) pandemic. The underrepresented minorities, where the prevalence of obesity is higher, appear to be affected disproportionately. Our objectives were to assess the characteristics and early outcomes of patients hospitalized with COVID-19 in the Bronx and investigate whether obesity is associated with worse outcomes. Methods: This retrospective study included the first 200 patients admitted to a tertiary medical center with COVID-19. The electronic medical records were reviewed at least three weeks after admission. The primary endpoint was in-hospital mortality. Results: 200 patients were included (female sex: 102, African American: 102). The median BMI was 30 kg/m2. The median age was 64 years. Hypertension (76%), hyperlipemia (46.2%), and diabetes (39.5%) were the three most common comorbidities. Fever (86%), cough (76.5%), and dyspnea (68%) were the three most common symptoms. 24% died during hospitalization (BMI <25 kg/m2: 31.6%, BMI 25-34 kg/m2: 17.2%, BMI[\u2265]35 kg/m2: 34.8%, p= 0.03). The multivariate analysis for mortality, demonstrates that BMI[\u2265]35 kg/m2 (OR: 3.78; 95% CI: 1.45 - 9.83; p=0.006), male sex (OR: 2.74; 95% CI: 1.25 - 5.98; p=0.011) and increasing age (OR: 1.73; 95% CI: 1.13 - 2.63; p=0.011) were independently associated with higher inhospital mortality. Similar results were obtained for the outcomes of increasing oxygen requirement and intubation. Conclusions: In this cohort of hospitalized patients with COVID-19 in a minority-predominant population, severe obesity, increasing age, and male sex were associated with higher in-hospital mortality and in general worse in-hospital outcomes.", "Clinical Characteristics and Outcomes of Community- and Hospital-Acquired Acute Kidney Injury with COVID-19 in a US Inner City Hospital System INTRODUCTION: Emerging data have described poor clinical outcomes from infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) among African American patients and those from underserved socioeconomic groups. We sought to describe the clinical characteristics and outcomes of acute kidney injury (AKI) in this special population. METHODS: This is a retrospective study conducted in an underserved area with a predominance of African American patients with coronavirus disease 2019 (COVID-19). Descriptive statistics were used to characterize the sample population. The onset of AKI and relation to clinical outcomes were determined. Multivariate logistic regression was used to determine factors associated with AKI. RESULTS: Nearly half (49.3%) of the patients with COVID-19 had AKI. Patients with AKI had a significantly lower baseline estimated glomerular filtration rate (eGFR) and higher FiO2 requirement and D-dimer levels on admission. More subnephrotic proteinuria and microhematuria was seen in these patients, and the majority had a pre-renal urine electrolyte profile. Patients with hospital-acquired AKI (HA-AKI) as opposed to those with community-acquired AKI (CA-AKI) had higher rates of in-hospital death (52 vs. 23%, p = 0.005), need for vasopressors (42 vs. 25%, p = 0.024), and need for intubation (55 vs. 25%, p = 0.006). A history of heart failure was significantly associated with AKI after adjusting for baseline eGFR (OR 3.382, 95% CI 1.121\u201313.231, p = 0.032). CONCLUSION: We report a high burden of AKI among underserved COVID-19 patients with multiple comorbidities. Those who had HA-AKI had worse clinical outcomes compared to those who with CA-AKI. A history of heart failure is an independent predictor of AKI in patients with COVID-19.", "COVID-19 Among African Americans: From Preliminary Epidemiological Surveillance Data to Public Health Action. ", "\"Clinical Characteristics, Outcomes and Prognosticators in Adult Patients Hospitalized with COVID-19\" BACKGROUND: COVID-19 is a novel disease caused by SARS-CoV-2. METHODS: We conducted a retrospective evaluation of patients admitted with COVID-19 to one site in March 2020. Patients were stratified into three groups: survivors who did not receive mechanical ventilation (MV), survivors who received MV and those who received MV and died during hospitalization. RESULTS: There were 140 hospitalizations; 22 deaths (mortality rate 15.7%), 83 (59%) survived and did not receive MV, 35 (25%) received MV and survived; 18 (12.9%) received MV and died. Thee mean age of each group was 57.8, 55.8 and 72.7 years respectively (p=.0001). Of those who received MV and died, 61% were male (p=.01). More than half the patients (n=90, 64%) were African American. First measured d-dimer >575.5 ng/mL, procalcitonin > 0.24 ng/mL, LDH > 445.6 units/L and BNP > 104.75 pg/mL had odds ratios of 10.5, 5, 4.5 and 2.9 respectively for MV (p < .05 for all). Peak BNP > 167.5 pg/mL had an odds ratio of 6.7 for inpatient mortality when mechanically ventilated (p= .02). CONCLUSIONS: Age and gender may impact outcomes in COVID-19. D-dimer, procalcitonin, LDH and BNP may serve as early indicators of disease trajectory.", "Social Equity and COVID\u201019: The Case of African Americans Emerging statistics demonstrate that COVID\u201019 disproportionately affects African Americans. The effects of COVID\u201019 for this population are inextricably linked to areas of systemic oppression and disenfranchisement, which are further exacerbated by COVID\u201019: (1) healthcare inequality; (2) segregation, overall health, and food insecurity; (3) underrepresentation in government and the medical profession; and (4) inequalities in participatory democracy and public engagement. Following a discussion of these issues, this article shares early and preliminary lessons and strategies on how public administration scholars and practitioners can lead in crafting equitable responses to this global pandemic to uplift the African American community. This article is protected by copyright. All rights reserved.", "The impact of the COVID-19 pandemic on marginalized populations in the United States: A research agenda International and national crises often highlight inequalities in the labor market that disproportionately affect individuals from marginalized backgrounds. The COVID-19 pandemic, and the resulting changes in society due to social distancing measures, has showcased inequities in access to decent work and experiences of discrimination resulting in many of the vulnerable populations in the United States experiencing a much harsher impact on economic and work-related factors. The purpose of this essay is to describe how the COVID-19 pandemic may differentially affect workers of color, individuals from low-income backgrounds, and women in complex ways. First, this essay will discuss disproportionate representation of workers from low-income and racial/ethnic minority backgrounds in sectors most affected by COVID-19. Second, it will discuss the lack of decent work for low-income workers who perform \"essential\" tasks. Third, this essay will highlight economic and work-related implications of increased discrimination Asian Americans are experiencing in society. Finally, role conflict and stress for women who are managing additional unpaid work, including caretaking responsibilities, while needing to continue to engage in paid work will be examined. A research agenda will be set forth throughout the essay, calling for vocational psychologists to engage in research that fully examines how the COVID-19 pandemic is affecting vulnerable communities.", "Race, Socioeconomic Deprivation, and Hospitalization for COVID-19 in English participants of a National Biobank Preliminary reports suggest that the Coronavirus Disease 2019 (COVID-19) pandemic has led to disproportionate morbidity and mortality among historically disadvantaged populations. The extent to which these disparities are related to socioeconomic versus biologic factors is largely unknown. We investigate the racial and socioeconomic associations of COVID-19 hospitalization among 418,794 participants of the UK Biobank, of whom 549 (0.13%) had been hospitalized. Both black participants (odds ratio 3.4; 95%CI 2.4-4.9) and Asian participants (odds ratio 2.1; 95%CI 1.5-3.2) were at substantially increased risk as compared to white participants. We further observed a striking gradient in COVID-19 hospitalization rates according to the Townsend Deprivation Index - a composite measure of socioeconomic deprivation - and household income. Adjusting for such factors led to only modest attenuation of the increased risk in black participants, adjusted odds ratio 3.1 (95%CI 2.0-4.8). These observations confirm and extend earlier preliminary and lay press reports of higher morbidity in non-white individuals in the context of a large population of participants in a national biobank. The extent to which this increased risk relates to variation in pre-existing comorbidities, differences in testing or hospitalization patterns, or additional disparities in social determinants of health warrants further study.", "Occupational Health Science in the Time of COVID-19: Now more than Ever Workers bear a heavy share of the burden of how countries contend with COVID-19; they face numerous serious threats to their occupational health ranging from those associated with direct exposure to the virus to those reflecting the conflicts between work and family demands. Ten experts were invited to comment on occupational health issues unique to their areas of expertise. The topics include work-family issues, occupational health issues faced by emergency medical personnel, the transition to telework, discrimination against Asian-Americans, work stressors, presenteeism, the need for supportive supervision, safety concerns, economic stressors, and reminders of death at work. Their comments describe the nature of the occupational health concerns created by COVID-19 and discuss both unanswered research questions and recommendations to help organizations reduce the impacts of COVID-19 on workers.", "Even more to handle: Additional sources of stress and trauma for clients from marginalized racial and ethnic groups in the United States during the COVID-19 pandemic In addition the general stressors occurring as a result of the COVID-19 pandemic, individuals who are members of marginalized racial or ethnic minority groups in the United States may face additional stressors, such as pandemic-related, racially-based prejudice and discrimination and the magnification of pre-existing health disparities and their effects. Such stressors may increase pandemic-related and general health risks both directly and indirectly and increase the risk for both general and traumatic stress. These stressors and their historical and social contexts are discussed, and implications for clinicians are provided.", "Disparities in COVID-19 Testing and Positivity in New York City INTRODUCTION: Existing socioeconomic and racial disparities in healthcare access in New York City have likely impacted the public health response to coronavirus disease 2019 (COVID-19). An ecological study was performed to determine the spatial distribution of COVID-19 testing by ZIP Code Tabulation Area and investigate if testing was associated with race or SES. METHODS: Data were obtained from the New York City Coronavirus data repository and the 2018 American Community Survey 5-year estimates. A combined index of SES was created using principal component analysis, and incorporated household income, gross rent, poverty, education, working class status, unemployment, and occupants per room. Multivariable Poisson regressions were performed to predict the number of total tests and the ratio of positive tests to total tests performed, using the SES index, racial composition, and Hispanic composition as predictors. RESULTS: The number of total tests significantly increased with the increasing proportion of white residents (\u03b2=0.004, SE=0.001, p=0.0032), but not with increasing Hispanic composition or SES index score. The ratio of positive tests to total tests significantly decreased with the increasing proportion of white residents in the ZIP Code Tabulation Area (\u03b2= \u20130.003, SE=0.0006, p<0.001) and with increasing SES index score (\u03b2= \u20130.0016, SE=0.0007, p=0.0159). CONCLUSIONS: In New York City, COVID-19 testing has not been proportional to need; existing socioeconomic and racial disparities in healthcare access have likely impacted public health response. There is urgent need for widespread testing and public health outreach for the most vulnerable communities in New York City.", "COVID-19 outcomes, risk factors and associations by race: a comprehensive analysis using electronic health records data in Michigan Medicine Importance: Blacks/African-Americans are overrepresented in the number of COVID-19 infections, hospitalizations and deaths. Reasons for this disparity have not been well-characterized but may be due to underlying comorbidities or sociodemographic factors. Objective: To systematically determine patient characteristics associated with racial/ethnic disparities in COVID-19 outcomes. Design: A retrospective cohort study with comparative control groups. Setting: Patients tested for COVID-19 at University of Michigan Medicine from March 10, 2020 to April 22, 2020. Participants: 5,698 tested patients and two sets of comparison groups who were not tested for COVID-19: randomly selected unmatched controls (n = 7,211) and frequency-matched controls by race, age, and sex (n = 13,351). Main Outcomes and Measures: We identified factors associated with testing and testing positive for COVID-19, being hospitalized, requiring intensive care unit (ICU) admission, and mortality (in/out-patient during the time frame). Factors included race/ethnicity, age, smoking, alcohol consumption, healthcare utilization, and residential-level socioeconomic characteristics (SES; i.e., education, unemployment, population density, and poverty rate). Medical comorbidities were defined from the International Classification of Diseases (ICD) codes, and were aggregated into a comorbidity score. Results: Of 5,698 patients, (median age, 47 years; 38% male; mean BMI, 30.1), the majority were non-Hispanic Whites (NHW, 59.2%) and non-Hispanic Black/African-Americans (NHAA, 17.2%). Among 1,119 diagnosed, there were 41.2% NHW and 37.4% NHAA; 44.8% hospitalized, 20.6% admitted to ICU, and 3.8% died. Adjusting for age, sex, and SES, NHAA were 1.66 times more likely to be hospitalized (95% CI, 1.09-2.52; P=.02), 1.52 times more likely to enter ICU (95% CI, 0.92-2.52; P=.10). In addition to older age, male sex and obesity, high population density neighborhood (OR, 1.27 associated with one SD change [95% CI, 1.20-1.76]; P=.02) was associated with hospitalization. Pre-existing kidney disease led to 2.55 times higher risk of hospitalization (95% CI, 1.62-4.02; P<.001) in the overall population and 11.9 times higher mortality risk in NHAA (95% CI, 2.2-64.7, P=.004). Conclusions and Relevance: Pre-existing type II diabetes/kidney diseases and living in high population density areas were associated with high risk for COVID-19 susceptibility and poor prognosis. Association of risk factors with COVID-19 outcomes differed by race. NHAA patients were disproportionately affected by obesity and kidney disease.", "Disparities in Coronavirus 2019 Reported Incidence, Knowledge, and Behavior Among US Adults IMPORTANCE: Data from the coronavirus disease 2019 (COVID-19) pandemic in the US show large differences in hospitalizations and mortality across race and geography. However, there are limited data on health information, beliefs, and behaviors that might indicate different exposure to risk. OBJECTIVE: To determine the association of sociodemographic characteristics with reported incidence, knowledge, and behavior regarding COVID-19 among US adults. DESIGN, SETTING, AND PARTICIPANTS: A US national survey study was conducted from March 29 to April 13, 2020, to measure differences in knowledge, beliefs, and behavior about COVID-19. The survey oversampled COVID-19 hotspot areas. The survey was conducted electronically. The criteria for inclusion were age 18 years or older and residence in the US. Data analysis was performed in April 2020. MAIN OUTCOMES AND MEASURES: The main outcomes were incidence, knowledge, and behaviors related to COVID-19 as measured by survey response. RESULTS: The survey included 5198 individuals (mean [SD] age, 48 [18] years; 2336 men [45%]; 3759 white [72%], 830 [16%] African American, and 609 [12%] Hispanic). The largest differences in COVID-19\u2013related knowledge and behaviors were associated with race/ethnicity, sex, and age, with African American participants, men, and people younger than 55 years showing less knowledge than other groups. African American respondents were 3.5 percentage points (95% CI, 1.5 to 5.5 percentage points; P = .001) more likely than white respondents to report being infected with COVID-19, as were men compared with women (3.2 percentage points; 95% CI, 2.0 to 4.4 percentage points; P < .001). Knowing someone who tested positive for COVID-19 was more common among African American respondents (7.2 percentage points; 95% CI, 3.4 to 10.9 percentage points; P < .001), people younger than 30 years (11.6 percentage points; 95% CI, 7.5 to 15.7 percentage points; P < .001), and people with higher incomes (coefficient on earning \u2265$100 000, 12.3 percentage points; 95% CI, 8.7 to 15.8 percentage points; P < .001). Knowledge of potential fomite spread was lower among African American respondents (\u22129.4 percentage points; 95% CI, \u221213.1 to \u22125.7 percentage points; P < .001), Hispanic respondents (\u22124.8 percentage points; 95% CI, \u22128.9 to \u22120.77 percentage points; P = .02), and people younger than 30 years (\u221210.3 percentage points; 95% CI, \u221214.1 to \u22126.5 percentage points; P < .001). Similar gaps were found with respect to knowledge of COVID-19 symptoms and preventive behaviors. CONCLUSIONS AND RELEVANCE: In this survey study of US adults, there were gaps in reported incidence of COVID-19 and knowledge regarding its spread and symptoms and social distancing behavior. More effort is needed to increase accurate information and encourage appropriate behaviors among minority communities, men, and younger people."], "neg": ["Characteristics of in peripheral blood of 70 hospitalized patients and 8 diarrhea patients with COVID-19 Objective: To analyze the blood test indicators of patients after infection of COVID-19 in Chongqing and analyze the clinical indicators of 8 patients with diarrhea. Materials and Methods: From January 26, 2019 to February 13, 2020, 70 patients diagnosed with 2019-nCoV according to the World Health Organization interim guidance for NCP and divided into diarrhea and non-diarrhea groups. The laboratory tests liver and kidney function, blood routine, coagulation function, and immune status. Results: The study population included 70 hospitalized patients with confirmed CONV-2019. NCP patients (43males and 27 females) with a mean age of 48.57\u00b117.80 (9~82) years and only 4.3% of patients have lung-related diseases. The positive rate of ESR, CRP, PT, IL6, lymphocyte count, GGT, Prealbumin and CD4 was more than 50%. We further analyzed the differences between 8 diarrhea patients and 62 non-diarrhea patients. Among these indicators, only Lymphocyte, CRP, Prealbumin and Cystatin C positive rate is more than 50%. Although there is no statistical difference in GGT, 100% of the 7 patients tested decreased. Conclusion: Our data recommended that the ESR, CRP, PT, IL6, lymphocyte count, GGT, prealbumin and CD4 have important value in the diagnosis of COVID-19, and the decrease of GGT may be an important indicator for judging the intestinal dysfunction of patients.", "The remaining unknowns: A determination of the current research priorities for COVID-19 by the global health research community ", "New insights into genetic susceptibility of COVID-19: an ACE2 and TMPRSS2 polymorphism analysis BACKGROUND: Coronavirus Disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has now been confirmed worldwide. Yet, COVID-19 is strangely and tragically selective. Morbidity and mortality due to COVID19 rise dramatically with age and co-existing health conditions, including cancer and cardiovascular diseases. Human genetic factors may contribute to the extremely high transmissibility of SARS-CoV-2 and to the relentlessly progressive disease observed in a small but significant proportion of infected individuals, but these factors are largely unknown. MAIN BODY: In this study, we investigated genetic susceptibility to COVID-19 by examining DNA polymorphisms in ACE2 and TMPRSS2 (two key host factors of SARS-CoV-2) from ~ 81,000 human genomes. We found unique genetic susceptibility across different populations in ACE2 and TMPRSS2. Specifically, ACE2 polymorphisms were found to be associated with cardiovascular and pulmonary conditions by altering the angiotensinogen-ACE2 interactions, such as p.Arg514Gly in the African/African-American population. Unique but prevalent polymorphisms (including p.Val160Met (rs12329760), an expression quantitative trait locus (eQTL)) in TMPRSS2, offer potential explanations for differential genetic susceptibility to COVID-19 as well as for risk factors, including those with cancer and the high-risk group of male patients. We further discussed that polymorphisms in ACE2 or TMPRSS2 could guide effective treatments (i.e., hydroxychloroquine and camostat) for COVID-19. CONCLUSION: This study suggested that ACE2 or TMPRSS2 DNA polymorphisms were likely associated with genetic susceptibility of COVID-19, which calls for a human genetics initiative for fighting the COVID-19 pandemic.", "Reflections on the COVID-19 Pandemic in the USA: Will We Better Prepared Next Time? Abstract The United States (US) spends more on healthcare than any other country with little evidence of better, or even comparable, outcomes. We reflect on the US and the COVID-19 pandemic and focus on cultural, economic and structural barriers that threaten both current and future responses to infectious diseases emergencies. These include the US healthcare delivery model, the defunding of public health, a scarcity of infectious diseases physicians, the market failure of vaccines and anti-infectives and the concept of American exceptionalism. Without institutionalizing the lessons learned, the US will be positioned to repeat the missteps of COVID-19 with the next pandemic.", "New insights into the evolution of the Trypanosoma cruzi clade provided by a new trypanosome species tightly linked to Neotropical Pteronotus bats and related to an Australian lineage of trypanosomes BACKGROUND: Bat trypanosomes are implicated in the evolution of the T. cruzi clade, which harbours most African, European and American trypanosomes from bats and other trypanosomes from African, Australian and American terrestrial mammals, including T. cruzi and T. rangeli, the agents of the American human trypanosomiasis. The diversity of bat trypanosomes globally is still poorly understood, and the common ancestor, geographical origin, and evolution of species within the T. cruzi clade remain largely unresolved. METHODS: Trypanosome sequences were obtained from cultured parasites and from museum archived liver/blood samples of bats captured from Guatemala (Central America) to the Brazilian Atlantic Coast. Phylogenies were inferred using Small Subunit (SSU) rRNA, glycosomal glyceraldehyde phosphate dehydrogenase (gGAPDH), and Spliced Leader (SL) RNA genes. RESULTS: Here, we described Trypanosoma wauwau n. sp. from Pteronotus bats (Mormoopidae) placed in the T. cruzi clade, then supporting the bat-seeding hypothesis whereby the common ancestor of this clade likely was a bat trypanosome. T. wauwau was sister to the clade T. spp-Neobats from phyllostomid bats forming an assemblage of trypanosome species exclusively of Noctilionoidea Neotropical bats, which was sister to an Australian clade of trypanosomes from indigenous marsupials and rodents, which possibly evolved from a bat trypanosome. T. wauwau was found in 26.5 % of the Pteronotus bats examined, and phylogeographical analysis evidenced the wide geographical range of this species. To date, this species was not detected in other bats, including those that were sympatric or shared shelters with Pteronotus. T. wauwau did not develop within mammalian cells, and was not infective to Balb/c mice or to triatomine vectors of T. cruzi and T. rangeli. CONCLUSIONS: Trypanosoma wauwau n. sp. was linked to Pteronotus bats. The positioning of the clade T. wauwau/T.spp-Neobats as the most basal Neotropical bat trypanosomes and closely related to an Australian lineage of trypanosomes provides additional evidence that the T. cruzi clade trypanosomes likely evolved from bats, and were dispersed in bats within and between continents from ancient to unexpectedly recent times. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13071-015-1255-x) contains supplementary material, which is available to authorized users.", "The Emergence of COVID-19 in the U.S.: A Public Health and Political Communication Crisis. The coronavirus public health crisis is also a political-communication and health-communication crisis. In this commentary, we describe the key communication-related phenomena and evidence of concerning effects manifested in the U.S. during the initial response to the pandemic. We outline the conditions of communication about coronavirus that contribute toward deleterious outcomes, including partisan cueing, conflicting science, downplayed threats, emotional arousal, fragmented media, and Trump's messaging. We suggest these have contributed toward divergent responses by media sources, partisan leaders, and the public alike, leading to different attitudes and beliefs as well as varying protective actions taken by members of the public to reduce their risk. In turn, these divergent communication phenomena will likely amplify geographic variation in and inequities in COVID-19 disease outcomes. We conclude with some suggestions for future research, particularly surrounding communication about health inequity and strategies for reducing partisan divergence in views of public health issues in the future.", "Projecting the impact of COVID-19 pandemic on childhood obesity in the U.S.: A microsimulation model OBJECTIVE: The COVID-19 pandemic in the U.S. led to nationwide stay-at-home orders and school closures. Declines in energy expenditure resulting from canceled physical education classes and reduced physical activity (PA) may elevate childhood obesity risk. This study estimated the impact of COVID-19 on childhood obesity. METHODS: A microsimulation model simulated the trajectory of a nationally representative kindergarten cohort's body mass index z-scores (BMIz) and childhood obesity prevalence from April 2020 to March 2021 under the control scenario without COVID-19 and under the 4 alternative scenarios with COVID-19\u2014Scenario 1: 2-month nationwide school closure in April and May 2020; Scenario 2: Scenario 1 followed by a 10% reduction in daily PA in summer from June to August; Scenario 3: Scenario 2 followed by 2-month school closure in September and October; and Scenario 4: Scenario 3 followed by an additional 2-month school closure in November and December. RESULTS: Relative to the control scenario without COVID-19, Scenarios 1, 2, 3, and 4 were associated with an increase in the mean BMIz by 0.056 (95% confidence interval (95%CI): 0.055\u20130.056), 0.084 (95%CI: 0.084\u20130.085), 0.141 (95%CI: 0.140\u20130.142), and 0.198 (95%CI: 0.197\u20130.199), respectively, and an increase in childhood obesity prevalence by 0.640 (95%CI: 0.515\u20130.765), 0.972 (95%CI: 0.819\u20131.126), 1.676 (95%CI: 1.475\u20131.877), and 2.373 (95%CI: 2.135\u20132.612) percentage points, respectively. Compared to girls and non-Hispanic whites and Asians, the impact of COVID-19 on childhood obesity was modestly larger among boys and non-Hispanic blacks and Hispanics, respectively. CONCLUSION: Public health interventions are urgently called to promote an active lifestyle and engagement in PA among children to mitigate the adverse impact of COVID-19 on unhealthy weight gains and childhood obesity.", "Mitigating the Impact of COVID-19 on Oncology: Clinical and Operational Lessons from a Prospective Radiation Oncology Cohort Tested for COVID-19 BACKGROUND AND PURPOSE: The COVID-19 pandemic warrants operational initiatives to minimize transmission, particularly among cancer patients who are thought to be at high-risk. Within our department, a multidisciplinary tracer team prospectively monitored all patients under investigation, tracking their test status, treatment delays, clinical outcomes, employee exposures and quarantines. MATERIALS AND METHODS: Prospective cohort tested for SARS-COV-2 infection over 35 consecutive days of the early pandemic (03/19/2020-04/22/2020). RESULTS: A total of 121 Radiation Oncology patients underwent RT-PCR testing during this timeframe. Of the 7 (6%) confirmed-positive cases, 6 patients were admitted (including 4 warranting intensive care), 2 of whom died from acute respiratory distress syndrome. Radiotherapy was deferred or interrupted for 40 patients awaiting testing. As the median turnaround time for RT-PCR testing decreased from 1.5 (IQR: 1-4) to \u22641-day (P<0.001), the median treatment delay also decreased from 3.5 (IQR: 1.75-5) to 1 business day (IQR: 1-2) [P<0.001]. Each patient was an exposure risk to a median of 5 employees (IQR: 3-6.5) through prolonged close contact. During this timeframe, 39 care-team members were quarantined for a median of 3 days (IQR: 2-11), with a peak of 17 employees simultaneously quarantined. Following implementation of a \u201cdual PPE policy,\u201d newly quarantined employees decreased from 2.9 to 0.5 per day. CONCLUSION: The severe adverse events noted among these confirmed-positive cases support the notion that cancer patients are vulnerable to COVID-19. Active tracking, rapid diagnosis, and aggressive source control can mitigate the adverse effects on treatment delays, workforce incapacitation, and ideally outcomes."]}, {"query": "how has lack of testing availability led to underreporting of true incidence of Covid-19?", "pos": ["The SARS, MERS and novel coronavirus (COVID-19) epidemics, the newest and biggest global health threats: what lessons have we learned? OBJECTIVES: To provide an overview of the three major deadly coronaviruses and identify areas for improvement of future preparedness plans, as well as provide a critical assessment of the risk factors and actionable items for stopping their spread, utilizing lessons learned from the first two deadly coronavirus outbreaks, as well as initial reports from the current novel coronavirus (COVID-19) epidemic in Wuhan, China. METHODS: Utilizing the Centers for Disease Control and Prevention (CDC, USA) website, and a comprehensive review of PubMed literature, we obtained information regarding clinical signs and symptoms, treatment and diagnosis, transmission methods, protection methods and risk factors for Middle East Respiratory Syndrome (MERS), Severe Acute Respiratory Syndrome (SARS) and COVID-19. Comparisons between the viruses were made. RESULTS: Inadequate risk assessment regarding the urgency of the situation, and limited reporting on the virus within China has, in part, led to the rapid spread of COVID-19 throughout mainland China and into proximal and distant countries. Compared with SARS and MERS, COVID-19 has spread more rapidly, due in part to increased globalization and the focus of the epidemic. Wuhan, China is a large hub connecting the North, South, East and West of China via railways and a major international airport. The availability of connecting flights, the timing of the outbreak during the Chinese (Lunar) New Year, and the massive rail transit hub located in Wuhan has enabled the virus to perforate throughout China, and eventually, globally. CONCLUSIONS: We conclude that we did not learn from the two prior epidemics of coronavirus and were ill-prepared to deal with the challenges the COVID-19 epidemic has posed. Future research should attempt to address the uses and implications of internet of things (IoT) technologies for mapping the spread of infection.", "Increased Detection coupled with Social Distancing and Health Capacity Planning Reduce the Burden of COVID-19 Cases and Fatalities: A Proof of Concept Study using a Stochastic Computational Simulation Model Objective: In absence of any vaccine, the Corona Virus Disease 2019 (COVID-19) pandemic is being contained through a non-pharmaceutical measure termed Social Distancing (SD). However, whether SD alone is enough to flatten the epidemic curve is debatable. Using a Stochastic Computational Simulation Model, we investigated the impact of increasing SD, hospital beds and COVID-19 detection rates in preventing COVID-19 cases and fatalities. Research Design and Methods: The Stochastic Simulation Model was built using the EpiModel package in R. As a proof of concept study, we ran the simulation on Kasaragod, the most affected district in Kerala. We added 3 compartments to the SEIR model to obtain a SEIQHRF (Susceptible-Exposed-Infectious-Quarantined-Hospitalised-Recovered-Fatal) model. Results: Implementing SD only delayed the appearance of peak prevalence of COVID-19 cases. Doubling of hospital beds could not reduce the fatal cases probably due to its overwhelming number compared to the hospital beds. Increasing detection rates could significantly flatten the curve and reduce the peak prevalence of cases (increasing detection rate by 5 times could reduce case number to half). Conclusions: An effective strategy to contain the epidemic spread of COVID-19 in India is to increase detection rates in combination with SD measures and increase in hospital beds.", "COVID-19 related mortality and spread of disease in long-term care: first findings from a living systematic review of emerging evidence Background: Policy responses to mitigate the impact of the COVID-19 pandemic on long-term care (LTC) require robust and timely evidence on mortality and spread of the disease in these settings. The aim of this living systematic review is to synthesise early international evidence on mortality rates and incidence of COVID-19 among people who use and provide LTC. Methods: We report the initial findings of a living systematic review (CRD42020183557), including studies identified through database searches up to 29 May 2020. We searched seven databases (MEDLINE; Embase; CINAHL Plus; Web of Science; Global Health; WHO COVID-19 Research Database; medRxiv) to identify all studies reporting primary data on COVID-19 related mortality and incidence of disease among LTC users and staff. We excluded studies not focusing on LTC. Included primary studies were critically appraised and results on number of deaths and COVID-19 related mortality rates, case fatality rates, and excess deaths (co-primary outcomes), as well as incidence of disease, hospitalisations, and ICU admissions were synthesised narratively. We further included official figures on number of deaths in LTC. Findings: A total of 30 study reports for 27 unique primary studies or outbreak reports were included. Outbreak investigations in LTC facilities found COVID-19 incidence rates of between 0.0% and 71.7% among residents and between 1.5% and 64.0% among staff. Mortality rates varied from 0.0% to 9.9% of all residents at outbreak facilities, with case fatality rates between 0.0% and 33.7%. In included studies, no LTC staff members had died. LTC residents accounted for between 0% (Hong Kong) and 82% (Canada) of COVID-related deaths, according to official figures. Interpretation: Long-term care users have been particularly vulnerable to the COVID-19 pandemic. However, we found wide variation in spread of disease and mortality rates between outbreaks at individual LTC facilities. Further research into the factors determining successful prevention and containment of COVID-19 outbreaks is needed to protect long-term care users and staff.", "Special report: Early use of ICD-10-CM code \"U07.1, COVID-19\" to identify 2019 novel coronavirus cases in Military Health System administrative data. This report describes early exploratory analysis of ICD-10-CM code U07.1 (2019-nCoV acute respiratory disease [COVID-19]) to assess the use of administrative data for case ascertainment, syndromic surveillance, and future epidemiological studies. Out of the 2,950 possible COVID-19 cases identified between 1 April 2020 and 4 May 2020, 600 (20.3%) were detected in the Defense Medical Surveillance System (DMSS) and not in the Disease Reporting System internet (DRSi) or in Health Level 7 laboratory data from the Composite Health Care System. Among the 150 out of 600 cases identified exclusively in the DMSS and selected for Armed Forces Health Longitudinal Technology Application (AHLTA) review, 16 (10.7%) had a certified positive lab result in AHLTA, 17 (11.3%) met Council of State and Territorial Epidemiologists (CSTE) criteria for a probable case, 46 (30.7%) were not cases based on CSTE criteria, and 71 (47.3%) had evidence of a positive lab result from an outside source. Lack of full capture of lab results may continue to be a challenge as the variety of available tests expands. Administrative data may provide an important stopgap measure for detecting lab positive cases, pending incorporation of new COVID-19 tests and standardization of test and result nomenclature.", "Testing times in Coronavirus disease (Covid-19): A tale of two nations The Coronavirus Disease (Covid-19) pandemic is caused by the severe acute respiratory syndrome virus 2 and was first identified in Wuhan, China, in December 2019. The disease spread globally, leading to the World Health Organization declaring it a pandemic in March 2020. The condition is often fatal in its severe form. As it is a previously unknown virus, no treatment is identified or any vaccine available. The burden of disease control and containment, therefore, falls upon a robust and geographically appropriate testing strategy. Testing policies are modified, in turn, by the rapidly evolving patterns of the disease in various nations and by the evolving nature of tests in development. It is, therefore, helpful to study different national models to learn from the experience of different countries. This article compares testing strategies in the UK and India as the two countries travel different paths in controlling the pandemic. The UK is one of the most severely affected countries in the world. Initially restricted to hospitalised patients, the UK has broadened the scope of testing to many categories of individuals. In contrast, India appears to have a lower prevalence of the infection. However, the large Indian population and relatively insufficient testing capacities so far have led India to adopt a different testing trajectory, with the testing currently focused on high-risk groups in the community and hospitals. Owing to the rapidly changing nature of the disease, there can be no \u2018one-size-fits-all\u2019 policy but should be based on country-specific circumstances.", "Modelling the epidemiological trend and behavior of COVID-19 in Italy As of March 16, 2020, over 185,000 across the world, Italy became the red hotspot for the COVID-19 pandemic after China. With over 35,000 cases and 2900 deaths reported in the month of March in Italy, it is necessary to stimulate epidemic trend to understand the behavior of COVID-19 in Italy. By S.E.I.R. simulation, we estimated the most representative epidemic parameters occurred from March 1 to 14, 2020, thus being able to evaluate the consistency of the containment rules and identify possible Sars-Cov-2 local mutations. Our estimations are based on some assumptions and limitations exited.", "Predicting Whom to Test is More Important Than More Tests - Modeling the Impact of Testing on the Spread of COVID-19 Virus By True Positive Rate Estimation I estimate plausible true positive (TP) rates for the number of COVID-19 tests per day, most relevant when the number of test is on the same order of magnitude as number of infected persons. I then modify a standard SEIR model to model current growth patterns and detection rates in South Korea and New York state. Although reducing transmission rates have the largest impact, increasing TP rates by ~10% in New York can have an impact equal to adding tens of thousands of new tests per day. Increasing both TP rates and tests per day together can have significant impacts and likely be more easily sustained than social distancing restrictions. Systematic and standardized data collection, even beyond contact tracking, should be ongoing and quickly made available for research teams to maximize the efficacy of testing.", "Protecting Chinese healthcare workers while combating the 2019 novel coronavirus Hospital-associated transmission is an important route of spreading the 2019 novel coronavirus (2019-nCoV) infection and pneumonia (Corona Virus Disease 2019, COVID-19) [1]. Healthcare workers (HCWs) are at high risk while combating COVID-19 at the very frontline, and nosocomial outbreaks among HCWs are not unusual in similar settings; the 2003 severe acute respiratory syndrome (SARS) outbreak led to over 966 HCW infections with 1.4% deaths in mainland China [2]. As of 11 February 2020, 3019 HCWs might have been infected with 2019-nCov in China, 1716 HCW cases were confirmed by nucleic acid testing[3], and at least 6 HCWs died, including the famous whistleblower Dr Li Wenliang. In view of this severe situation, we are recommending urgent interventions to help to protect HCWs.", "Forecasting the cumulative number of COVID-19 deaths in China: a Boltzmann function-based modeling study The COVID-19 outbreak is ongoing in China. Here, Boltzmann function-based analyses reveal the potential total numbers of COVID-19 deaths: 3,260 (95% confidence interval [CI], 3187\u20133394) in China; 110 (95% CI, 109\u2013112) in Hubei Province; 3,174 (95% CI, 3095\u20133270) outside Hubei; 2,550 (95% CI, 2494\u20132621) in Wuhan City; and 617 (95% CI, 607\u2013632) outside Wuhan.", "Estimation of Unreported Novel Coronavirus (SARS-CoV-2) Infections from Reported Deaths: A Susceptible\u2013Exposed\u2013Infectious\u2013Recovered\u2013Dead Model In the midst of the novel coronavirus (SARS-CoV-2) epidemic, examining reported case data could lead to biased speculations and conclusions. Indeed, estimation of unreported infections is crucial for a better understanding of the current emergency in China and in other countries. In this study, we aimed to estimate the unreported number of infections in China prior to the 23 January 2020 restrictions. To do this, we developed a Susceptible\u2013Exposed\u2013Infectious\u2013Recovered\u2013Dead (SEIRD) model that estimated unreported infections from the reported number of deaths. Our approach relied on the fact that observed deaths were less likely to be affected by ascertainment biases than reported infections. Interestingly, we estimated that the basic reproductive number (R(0)) was 2.43 (95%CI = 2.42\u20132.44) at the beginning of the epidemic and that 92.9% (95%CI = 92.5%\u201393.1%) of total cases were not reported. Similarly, the proportion of unreported new infections by day ranged from 52.1% to 100%, with a total of 91.8% (95%CI = 91.6%\u201392.1%) of infections going unreported. Agreement between our estimates and those from previous studies proves that our approach is reliable for estimating the prevalence and incidence of undocumented SARS-CoV-2 infections. Once it has been tested on Chinese data, our model could be applied to other countries with different surveillance and testing policies.", "Hyperlocal Postcode Based Crowdsourced Surveillance Systems in the COVID-19 Pandemic Response The SARS-CoV-2 pandemic has rapidly saturated healthcare resources across the globe and has led to a restricted screening process, hindering efforts at comprehensive case detection. This has not only facilitated community spread but has also resulted in an underestimation of the true incidence of disease, a statistic which is useful for policy making aimed at controlling the current pandemic and in preparing for future outbreaks. In this perspective, we present a crowdsourced platform developed by us for the true estimation of all SARS-CoV-2 infections in the community, through active self-reporting and layering other authentic datasets. The granularity of data captured by this system could prove to be useful in assisting governments to identify SARS-CoV-2 hotspots in the community facilitating lifting of restrictions in a controlled fashion.", "Ascertainment rate of novel coronavirus disease (COVID-19) in Japan We analyzed the epidemiological dataset of confirmed cases with COVID-19 in Japan as of 28 February 2020 and estimated the number of severe and non-severe cases, accounting for under-ascertainment. The ascertainment rate of non-severe cases was estimated at 0.44 (95% confidence interval: 0.37, 0.50), indicating that unbiased number of non-cases would be more than twice the reported count. Severe cases are twice more likely diagnosed and reported than other cases.", "Estimate of COVID-19 case prevalence in India based on surveillance data of patients with severe acute respiratory illness In absence of extensive testing for SARS-CoV-2, true prevalence of COVID-19 cases in India remain unknown. In this study, a conservative estimate of prevalence of COVID-19 is calculated based on the age wise COVID-19 positivity rate among patients with severe respiratory illness as reported by Indian Council of Medical Research. Calculations in the study estimates a cumulative number of 17151 COVID-19 positive cases by the end of April 2, 2020.", "The Challenge of Using Epidemiological Case Count Data: The Example of Confirmed COVID-19 Cases and the Weather The publicly available data on COVID-19 cases provides an opportunity to better understand this new disease. However, strong attention needs to be paid to the limitations of the data to avoid making inaccurate conclusions. This article, which focuses on the relationship between the weather and COVID-19, raises the concern that the same factors influencing the spread of the disease might also affect the number of tests performed and who gets tested. For example, weather conditions impact the prevalence of respiratory diseases with symptoms similar to COVID-19, and this will likely influence the number of tests performed. This general limitation could severely undermine any similar analysis using existing COVID-19 data or similar epidemiological data, which could, therefore, mislead decision-makers on questions of great policy relevance.", "\u2018These are answers we need.\u2019 WHO plans global study to discover true extent of coronavirus infections In an effort to understand how many people have been infected with the new coronavirus, the World Health Organization (WHO) is planning a coordinated study to test blood samples for the presence of antibodies to the virus Called Solidarity II, the program, which will involve more than half a dozen countries around the globe, will launch in the coming days, says Maria Van Kerkhove, who is helping coordinate WHO\u2019s COVID-19 response Knowing the true number of cases\u2014including mild ones\u2014will help pin down the prevalence and mortality rate of COVID-19 in different age groups It will also help policymakers decide how long shutdowns and quarantines should last \u201cThese are answers we need, and we need the right answers to drive policy,\u201d WHO\u2019s executive director for health emergencies, Michael Ryan, told a press briefing on 27 March", "A Cautionary Tale of False-Negative Nasopharyngeal COVID-19 Testing Abstract There remains diagnostic uncertainty regarding the sensitivity of reverse transcription polymerase chain reaction in detection of SARS-CoV-2 from nasopharyngeal specimens. We present a case where two nasopharyngeal specimens were negative, followed by a positive sputum sample. Serial testing for COVID-19 is indicated in patients with high pretest probability of disease.", "Impact of virus testing on COVID-19 case fatality rate: estimate using a fixed-effects model Background In response to the SARS-CoV2 pandemic, governments have adopted a variety of public health measures. There are variations in how much testing has been done across countries. South Korea, Germany, and Iceland take the bet of massive testing of their population. Whereas tests were not performed widely in southern European countries. As the former undergo a lower case-fatality rate due to the COVID-19 than the latter, the impact of the testing strategy must be investigated. In this study, we aimed to evaluate the impact of testing on the case fatality rate. Methods We use data on inpatients across French geographic areas and propose a novel methodology that exploits policy discontinuities at region borders to estimate the effect of COVID-19 tests on the case-fatality rate. In France, testing policies are determined locally. We compare all contiguous department pairs located on the opposite sides of a region border. The heterogeneity in testing rate between department pairs together with the similarities in other dimensions allow us to mimic the existence of treatment and control groups and to identify the impact of testing on mortality. Results The increase of one percentage point in the test rate is associated with a decrease of 0.001 percentage point in the death rate. In other words, for each additional 1000 tests, one person would have remained alive. Conclusion Massive population testing could have a significant effect on mortality in different ways. Mass testing may help decision-makers to implement healthcare measures to limit the spread of the disease.", "A simplified model for expected development of the SARS-CoV-2 (Corona) spread in Germany and US after social distancing Widespread opinions and discussion exist regarding the efficiency of social distancing after crucial spread of the SARS-CoV-2 virus during the actual Covid-19 pandemic. While Germany has released a federal law that prohibits any type of direct contact for more than 2 people other countries including the US released curfews. People are now wondering whether these measures are helpful to stop or hamper the Covid-19 pandemic and to limit the spread of the new corona virus. A quantitative statement on this question depends on many parameters that are difficult to grasp mathematically and cannot therefore be made conclusively (they include consistent adherence to the measures decided, the estimated number of unreported cases, the possible limitation by test capacities, possible mutations of the virus, etc ...). However, it turns out that a reduction in the actual daily new infection rate (actual daily growth rate of reported cases, in short: infection rate) from the current value of 30-35% in the US to 10% would be extremely effective in stopping the spread of the virus. The severe restrictions in Germany which closed any public events, schools and universities a week ago might already have contributed to a reduction of the growth rate of reported cases below 30%.", "Lessons from a rapid systematic review of early SARS-CoV-2 serosurveys Background. As the world grapples with the COVID-19 pandemic, there is increasing global interest in the role of serological testing for population monitoring and to inform public policy. However, limitations in serological study designs and test standards raise concerns about the validity of seroprevalence estimates and their utility in decision-making. There is now a critical window of opportunity to learn from early SARS-CoV-2 serology studies. We aimed to synthesize the results of SARS-CoV-2 serosurveillance projects from around the world and provide recommendations to improve the coordination, strategy, and methodology of future serosurveillance efforts. Methods. This was a rapid systematic review of cross-sectional and cohort studies reporting seroprevalence outcomes for SARS-CoV 2. We included completed, ongoing, and proposed serosurveys. The search included electronic databases (PubMed, MedRXIV, BioRXIV, and WHO ICTPR); five medical journals (NEJM, BMJ, JAMA, The Lancet, Annals of Internal Medicine); reports by governments, NGOs, and health systems; and media reports (Google News) from December 1, 2019 to May 1, 2020. We extracted data on study characteristics and critically appraised prevalence estimates using Joanna Briggs Institute criteria. Results. Seventy records met inclusion criteria, describing 73 studies. Of these, 23 reported prevalence estimates: eight preprints, 14 news articles, and one government report. These studies had a total sample size of 35,784 and reported 42 prevalence estimates. Seroprevalence estimates ranged from 0.4% to 59.3%. No estimates were found to have a low risk of bias (43% high risk, 21% moderate risk, 36% unclear). Fifty records reported characteristics of ongoing or proposed serosurveys. Overall, twenty countries have completed, ongoing, or proposed serosurveys. Discussion. Study design, quality, and prevalence estimates of early SARS-CoV2 serosurveys are heterogeneous, suggesting that the urgency to examine seroprevalence may have compromised methodological rigour. Based on the limitations of included studies, future serosurvey investigators and stakeholders should ensure that: i) serological tests used undergo high-quality independent evaluations that include cross-reactivity; ii) all reports of serosurvey results, including media, describe the test used, sample size, and sampling method; and iii) initiatives are coordinated to prevent test fatigue, minimize redundant efforts, and encourage better study methodology. Other. PROSPERO: CRD42020183634. No third-party funding.", "Early trends for SARS-CoV-2 infection in central and north Texas and impact on other circulating respiratory viruses Rapid diagnosis and isolation are key to containing the quick spread of a pandemic agent like severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), which has spread globally since its initial outbreak in Wuhan province in China. SARS-CoV-2 is novel and the effect on typically prevalent seasonal viruses is just becoming apparent. We present our initial data on the prevalence of respiratory viruses in the month of March 2020. This is a retrospective cohort study post launching of SARS-CoV-2 testing at Baylor Scott and White Hospital (BSWH), Temple, Texas. Testing for SARS-CoV-2 was performed by real-time reverse transcription polymerase chain reaction assay and results were shared with State public health officials for immediate interventions. More than 3500 tests were performed during the first 2 weeks of testing for SARS-CoV-2 and identified 168 (4.7%) positive patients. Sixty-two (3.2%) of the 1912 ambulatory patients and 106 (6.3%) of the 1659 emergency department/inpatients tested were positive. The highest rate of infection (6.9%) was seen in patients aged 25 to 34 years, while the lowest rate of infection was seen among patients aged <25 years old (2%). County-specific patient demographic information was shared with respective public health departments for epidemiological interventions. Incidentally, this study showed that there was a significant decrease in the occurrence of seasonal respiratory virus infections, perhaps due to increased epidemiological awareness about SARS-CoV-2 among the general public, as well as the social distancing measures implemented in response to SARS-CoV-2. Data extracted for BSWH from the Centers for Disease Control and Prevention's National Respiratory and Enteric Virus Surveillance System site revealed that Influenza incidence was 8.7% in March 2020, compared with 25% in March 2019. This study was intended to provide an initial experience of dealing with a pandemic and the role of laboratories in crisis management. This study provided SARS-CoV-2 testing data from ambulatory and inpatient population. Epidemiological interventions depend on timely availability of accurate diagnostic tests and throughput capacity of such systems during large outbreaks like SARS-CoV-2.", "Counting Coronavirus Disease 2019 (COVID-19) Cases: Case Definitions, Screened Populations and Testing Techniques Matter While counting cases of disease appears straightforward, there are issues to consider when enumerating disease counts during an epidemic. For example, for Coronavirus Disease-2019 (COVID-19), how is a case defined? Hubei province in China changed its case definition twice in a fortnight-from laboratory-confirmed cases to clinically-confirmed cases without laboratory tests, and back to laboratory-confirmed cases. This caused confusion in the reported number of cases. If a confirmed case requires laboratory testing, what is the population who are laboratory-tested? Due to limited laboratory testing capacity in the early phase of an emerging epidemic, only \"suspected cases\" are laboratory-tested in most countries. This will result in underdiagnosis of confirmed cases and also raises the question: how is a \"suspect case\" defined? With the passage of time and increased capability to perform laboratory tests, more people can be screened and the number of confirmed cases will increase. What are the technical considerations of laboratory testing? This includes specimen collection (variable collection methods), samples collected (upper or lower respiratory tract biospecimens), time of collection in relation to course of disease, different laboratory test methods and kits (not all of which may be standardised or approved by authorities such as the Food and Drug Administration). Are approved laboratory facilities and trained manpower available, and how are test results interpreted and false-negatives excluded? These issues will affect the accuracy of disease counts, which in turn will have implications on how we mount an appropriate response to the outbreak.", "A first study on the impact of current and future control measures on the spread of COVID-19 in Germany The novel coronavirus (SARS-CoV-2), identified in China at the end of December 2019 and causing the disease COVID-19, has meanwhile led to outbreaks all over the globe, with about 571,700 confirmed cases and about 26,500 deaths as of March 28th, 2020. We present here the preliminary results of a mathematical study directed at informing on the possible application or lifting of control measures in Germany. The developed mathematical models allow to study the spread of COVID-19 among the population in Germany and to asses the impact of non-pharmaceutical interventions. The overall goal is to suggest strategies for the mitigation of the current outbreak, slowing down the spread of the virus and thus reducing the peak in daily diagnosed cases, the demand for hospitalization or intensive care units admissions, and eventually fatalities.", "Real-time forecasts of the COVID-19 epidemic in China from February 5th to February 24th, 2020 The initial cluster of severe pneumonia cases that triggered the COVID-19 epidemic was identified in Wuhan, China in December 2019. While early cases of the disease were linked to a wet market, human-to-human transmission has driven the rapid spread of the virus throughout China. The Chinese government has implemented containment strategies of city-wide lockdowns, screening at airports and train stations, and isolation of suspected patients; however, the cumulative case count keeps growing every day. The ongoing outbreak presents a challenge for modelers, as limited data are available on the early growth trajectory, and the epidemiological characteristics of the novel coronavirus are yet to be fully elucidated. We use phenomenological models that have been validated during previous outbreaks to generate and assess short-term forecasts of the cumulative number of confirmed reported cases in Hubei province, the epicenter of the epidemic, and for the overall trajectory in China, excluding the province of Hubei. We collect daily reported cumulative confirmed cases for the 2019-nCoV outbreak for each Chinese province from the National Health Commission of China. Here, we provide 5, 10, and 15 day forecasts for five consecutive days, February 5th through February 9th, with quantified uncertainty based on a generalized logistic growth model, the Richards growth model, and a sub-epidemic wave model. Our most recent forecasts reported here, based on data up until February 9, 2020, largely agree across the three models presented and suggest an average range of 7409\u20137496 additional confirmed cases in Hubei and 1128\u20131929 additional cases in other provinces within the next five days. Models also predict an average total cumulative case count between 37,415 and 38,028 in Hubei and 11,588\u201313,499 in other provinces by February 24, 2020. Mean estimates and uncertainty bounds for both Hubei and other provinces have remained relatively stable in the last three reporting dates (February 7th \u2013 9th). We also observe that each of the models predicts that the epidemic has reached saturation in both Hubei and other provinces. Our findings suggest that the containment strategies implemented in China are successfully reducing transmission and that the epidemic growth has slowed in recent days.", "Estimates of the severity of COVID-19 disease Background: A range of case fatality ratio (CFR) estimates for COVID 19 have been produced that differ substantially in magnitude. Methods: We used individual-case data from mainland China and cases detected outside mainland China to estimate the time between onset of symptoms and outcome (death or discharge from hospital). We next obtained age-stratified estimates of the CFR by relating the aggregate distribution of cases by dates of onset to the observed cumulative deaths in China, assuming a constant attack rate by age and adjusting for the demography of the population, and age and location-based under ascertainment. We additionally estimated the CFR from individual linelist data on 1,334 cases identified outside mainland China. We used data on the PCR prevalence in international residents repatriated from China at the end of January 2020 to obtain age-stratified estimates of the infection fatality ratio (IFR). Using data on age stratified severity in a subset of 3,665 cases from China, we estimated the proportion of infections that will likely require hospitalisation. Findings: We estimate the mean duration from onset-of-symptoms to death to be 17.8 days (95% credible interval, crI 16.9,19.2 days) and from onset-of-symptoms to hospital discharge to be 22.6 days (95% crI 21.1,24.4 days). We estimate a crude CFR of 3.67% (95% crI 3.56%,3.80%) in cases from mainland China. Adjusting for demography and under-ascertainment of milder cases in Wuhan relative to the rest of China, we obtain a best estimate of the CFR in China of 1.38% (95% crI 1.23%,1.53%) with substantially higher values in older ages. Our estimate of the CFR from international cases stratified by age (under 60 or 60 and above) are consistent with these estimates from China. We obtain an overall IFR estimate for China of 0.66% (0.39%,1.33%), again with an increasing profile with age. Interpretation: These early estimates give an indication of the fatality ratio across the spectrum of COVID-19 disease and demonstrate a strong age-gradient in risk.", "COVID-19 projections for reopening Connecticut Closure of schools and the statewide \"Stay Safe, Stay Home\" order have effectively reduced COVID-19 transmission in Connecticut, with model projections estimating incidence at about 1,300 new infections per day. If close interpersonal contact increases quickly in Connecticut following reopening on May 20, the state is at risk of a substantial increase of COVID-19 infections, hospitalizations, and deaths by late Summer 2020. Real-time metrics including case counts, hospitalizations, and deaths may fail to provide enough advance warning to avoid resurgence. Substantial uncertainty remains in our knowledge of cumulative COVID-19 incidence, the proportion of infected individuals who are asymptomatic, infectiousness of children, the effects of testing and contact tracing on isolation of infected individuals, and how contact patterns may change following reopening.", "Trends and Prediction in Daily New Cases and Deaths of COVID-19 in the United States: An Internet Search-Interest Based Model BACKGROUND AND OBJECTIVES: The daily incidence and deaths of coronavirus disease 2019 (COVID-19) in the USA are poorly understood. Internet search interest was found to be correlated with COVID-19 daily incidence in China, but has not yet been applied to the USA. Therefore, we examined the association of internet search-interest with COVID-19 daily incidence and deaths in the USA. METHODS: We extracted COVID-19 daily new cases and deaths in the USA from two population-based datasets, namely 1-point-3-acres.com and the Johns Hopkins COVID-19 data repository. The internet search-interest of COVID-19-related terms was obtained using Google Trends. The Pearson correlation test and general linear model were used to examine correlations and predict trends, respectively. RESULTS: There were 636,282 new cases and,325 deaths of COVID-19 in the USA from March 1 to April 15, 2020, with a crude mortality of 4.45%. The daily new cases peaked at 35,098 cases on April 10, 2020 and the daily deaths peaked at 2,494 on April 15, 2020. The search interest of COVID, \u201cCOVID pneumonia\u201d and \u201cCOVID heart\u201d were correlated with COVID-19 daily incidence, with 12 or 14 days of delay (Pearson\u2019s r = 0.978, 0.978 and 0.979, respectively) and deaths with 19 days of delay (Pearson\u2019s r = 0.963, 0.958 and 0.970, respectively). The 7-day follow-up with prospectively collected data showed no significant correlations of the observed data with the predicted daily new cases or daily deaths, using search interest of COVID, COVID heart, and COVID pneumonia. CONCLUSIONS: Search terms related to COVID-19 are highly correlated with the COVID-19 daily new cases and deaths in the USA.", "Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review. BACKGROUND Coronavirus disease 2019 (COVID-19) is a rapidly emerging disease that has been classified a pandemic by the World Health Organization (WHO). To support WHO with their recommendations on quarantine, we conducted a rapid review on the effectiveness of quarantine during severe coronavirus outbreaks. OBJECTIVES We conducted a rapid review to assess the effects of quarantine (alone or in combination with other measures) of individuals who had contact with confirmed cases of COVID-19, who travelled from countries with a declared outbreak, or who live in regions with high transmission of the disease. SEARCH METHODS An information specialist searched PubMed, Ovid MEDLINE, WHO Global Index Medicus, Embase, and CINAHL on 12 February 2020 and updated the search on 12 March 2020. WHO provided records from daily searches in Chinese databases up to 16 March 2020. SELECTION CRITERIA Cohort studies, case-control-studies, case series, time series, interrupted time series, and mathematical modelling studies that assessed the effect of any type of quarantine to control COVID-19. We also included studies on SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) as indirect evidence for the current coronavirus outbreak. DATA COLLECTION AND ANALYSIS Two review authors independently screened 30% of records; a single review author screened the remaining 70%. Two review authors screened all potentially relevant full-text publications independently. One review author extracted data and assessed evidence quality with GRADE and a second review author checked the assessment. We rated the certainty of evidence for the four primary outcomes: incidence, onward transmission, mortality, and resource use. MAIN RESULTS We included 29 studies; 10 modelling studies on COVID-19, four observational studies and 15 modelling studies on SARS and MERS. Because of the diverse methods of measurement and analysis across the outcomes of interest, we could not conduct a meta-analysis and conducted a narrative synthesis. Due to the type of evidence found for this review, GRADE rates the certainty of the evidence as low to very low. Modeling studies consistently reported a benefit of the simulated quarantine measures, for example, quarantine of people exposed to confirmed or suspected cases averted 44% to 81% incident cases and 31% to 63% of deaths compared to no measures based on different scenarios (incident cases: 4 modelling studies on COVID-19, SARS; mortality: 2 modelling studies on COVID-19, SARS, low-certainty evidence). Very low-certainty evidence suggests that the earlier quarantine measures are implemented, the greater the cost savings (2 modelling studies on SARS). Very low-certainty evidence indicated that the effect of quarantine of travellers from a country with a declared outbreak on reducing incidence and deaths was small (2 modelling studies on SARS). When the models combined quarantine with other prevention and control measures, including school closures, travel restrictions and social distancing, the models demonstrated a larger effect on the reduction of new cases, transmissions and deaths than individual measures alone (incident cases: 4 modelling studies on COVID-19; onward transmission: 2 modelling studies on COVID-19; mortality: 2 modelling studies on COVID-19; low-certainty evidence). Studies on SARS and MERS were consistent with findings from the studies on COVID-19. AUTHORS' CONCLUSIONS Current evidence for COVID-19 is limited to modelling studies that make parameter assumptions based on the current, fragmented knowledge. Findings consistently indicate that quarantine is important in reducing incidence and mortality during the COVID-19 pandemic. Early implementation of quarantine and combining quarantine with other public health measures is important to ensure effectiveness. In order to maintain the best possible balance of measures, decision makers must constantly monitor the outbreak situation and the impact of the measures implemented. Testing in representative samples in different settings could help assess the true prevalence of infection, and would reduce uncertainty of modelling assumptions. This review was commissioned by WHO and supported by Danube-University-Krems.", "COVID-19, Australia: Epidemiology Report 15 (Reporting week to 23:59 AEST 10 May 2020). Confirmed cases in Australia notified up to 10 May 2020: notifications = 6,971; deaths = 98. The incidence of new cases of COVID-19 has reduced dramatically since a peak in mid-March. The reduction in international travel, social distancing measures and public health action have likely been effective in slowing the spread of the disease, in the Australian community. Cases of COVID-19 continue to be notified by jurisdictions, albeit at a slowed rate. Testing rates over the past week have increased markedly, with a very low proportion of people testing positive. These low rates of detection are indicative of low levels of COVID-19 transmission. It is important that testing rates and community adherence to public health measures remain high to support the continued suppression of the virus, particularly in vulnerable high-risk groups and settings. In the past reporting week new cases in Australia are mostly considered to be locally acquired, consistent with the drop in international travel. Most locally-acquired cases can be linked back to a known case or cluster. Although the proportion of locally-acquired cases has increased, the overall rate of cases, regardless of place of acquisition, continues to decrease. The crude case fatality rate in Australia remains low (1.4%), compared with the WHO reported global rate (6.9%). The low case fatality rate is likely reflective of high case detection and high quality of health care services in Australia. Deaths from COVID-19 in Australia have occurred predominantly among the elderly and those with comorbidities, with no deaths occurring in those under 40 years. The highest rate of COVID-19 continues to be among people aged 60-79 years, with a third of these cases associated with several outbreaks linked to cruise ships. The lowest rate of disease is in young children, a pattern reflected in international reports. Internationally, cases continue to increase, with some areas such as Brazil and India showing a dramatic rise in reported cases. Although some low-income countries have currently reported few cases, it is possible that this is due to limited diagnostic and public health capacity, and may not be reflective of disease occurrence.", "Using ILI surveillance to estimate state-specific case detection rates and forecast SARS-CoV-2 spread in the United States Detection of SARS-CoV-2 infections to date has relied on RT-PCR testing. However, a failure to identify early cases imported to a country, bottlenecks in RT-PCR testing, and the existence of infections which are asymptomatic, sub-clinical, or with an alternative presentation than the standard cough and fever have resulted in an under-counting of the true prevalence of SARS-CoV-2. Here, we show how publicly available CDC influenza-like illness (ILI) outpatient surveillance data can be repurposed to estimate the detection rate of symptomatic SARS-CoV-2 infections. We find a surge of non-influenza ILI above the seasonal average and show that this surge is correlated with COVID case counts across states. By quantifying the number of excess ILI patients in March relative to previous years and comparing excess ILI to confirmed COVID case counts, we estimate the syndromic case detection rate of SARS-CoV-2 in the US to be less than 13%. If only 1/3 of patients infected with SARS-CoV-2 sought care, the ILI surge would correspond to more than 8.7 million new SARS-CoV-2 infections across the US during the three week period from March 8 to March 28. Combining excess ILI counts with the date of onset of community transmission in the US, we also show that the early epidemic in the US was unlikely to be doubling slower than every 4 days. Together these results suggest a conceptual model for the COVID epidemic in the US in which rapid spread across the US are combined with a large population of infected patients with presumably mild-to-moderate clinical symptoms. We emphasize the importance of testing these findings with seroprevalence data, and discuss the broader potential to use syndromic time series for early detection and understanding of emerging infectious diseases.", "Early transmission dynamics of COVID-19 in a southern hemisphere setting: Lima-Peru: February 29(th)\u2013March 30(th), 2020. The COVID-19 pandemic that emerged in Wuhan China has generated substantial morbidity and mortality impact around the world during the last four months. The daily trend in reported cases has been rapidly rising in Latin America since March 2020 with the great majority of the cases reported in Brazil followed by Peru as of April 15(th), 2020. Although Peru implemented a range of social distancing measures soon after the confirmation of its first case on March 6(th), 2020, the daily number of new COVID-19 cases continues to accumulate in this country. We assessed the early COVID-19 transmission dynamics and the effect of social distancing interventions in Lima, Peru. We estimated the reproduction number, R, during the early transmission phase in Lima from the daily series of imported and autochthonous cases by the date of symptoms onset as of March 30(th), 2020. We also assessed the effect of social distancing interventions in Lima by generating short-term forecasts grounded on the early transmission dynamics before interventions were put in place. Prior to the implementation of the social distancing measures in Lima, the local incidence curve by the date of symptoms onset displays near exponential growth dynamics with the mean scaling of growth parameter, p, estimated at 0.9 (95%CI: 0.9,1.0) and the reproduction number at 2.3 (95% CI: 2.0, 2.5). Our analysis indicates that school closures and other social distancing interventions have helped slow down the spread of the novel coronavirus, with the nearly exponential growth trend shifting to an approximately linear growth trend soon after the broad scale social distancing interventions were put in place by the government. While the interventions appear to have slowed the transmission rate in Lima, the number of new COVID-19 cases continue to accumulate, highlighting the need to strengthen social distancing and active case finding efforts to mitigate disease transmission in the region.", "Optimal Allocation of COVID-19 Test Kits Among Accredited Testing Centers in the Philippines Testing is crucial for early detection, isolation, and treatment of coronavirus disease (COVID-19)-infected individuals. However, in resource-constrained countries such as the Philippines, test kits have limited availability. As of 12 April 2020, there are 11 testing centers in the country that have been accredited by the Department of Health (DOH) to conduct testing. In this paper, we determine the optimal percentage allocation of COVID-19 test kits among accredited testing centers in the Philippines that gives an equitable chance to all infected individuals to be tested. Heterogeneity in testing accessibility, population density of municipalities, and the capacity of testing facilities are included in the model. Our results showed that the range of optimal allocation per testing center are: Research Institute for Tropical Medicine (4.17%-6.34%), San Lazaro Hospital (14.65%-24.03%), University of the Philippines-National Institutes of Health (16.25%-44.80%), Lung Center of the Philippines (15.8%-26.40%), Baguio General Hospital Medical Center (0.58%-0.76%), The Medical City, Pasig City (5.96%-25.51%), St. Luke's Medical Center, Quezon City (1.09%-6.70%), Bicol Public Health Laboratory (0.06%-0.08%), Western Visayas Medical Center (0.71%-4.52%), Vicente Sotto Memorial Medical Center (1.02%-2.61%), and Southern Philippines Medical Center (approx 0.01%). If there will be changes in the number of testing centers, our model can still be used to modify the test kit allocation. Our results can serve as a guide to the authorities in distributing the COVID-19 test kits. These can also be used to determine the capacity of testing centers and the effects of increasing its number. The model can also be used for proposing additional number and location of new testing centers.", "SCALE19: A scalable and cost-efficient method for testing Covid-19 based on hierarchical group testing Containment of Covid-19 requires an extensive testing of the affected population. Some propose global testing to effectively contain Covid-19. Current tests for Covid-19 are administered individually. These tests for Covid-19 are expensive and are limited due to the lack of resources and time. We propose a simple and efficient group testing method for Covid-19. We propose a group testing method where test subjects are grouped and tested. Depending on the result of the group test, subsequent sub groups are formed and tested recursively based on a quartery search algorithm. We designed and built an evaluation model that simulates test subject population, infected test subjects according to available Covid-19 statistics, and the group testing processes in SCALE19. We considered several population models including USA and the world. Our results show that we can significantly reduce the required number of tests up to 89% without sacrificing the accuracy of the individual test of the entire population. For USA, up to 280 million tests can be reduced from the total US population of 331 million and it would be equivalent saving of $28 billion assuming a cost of $100 per test. For the world, 6.96 billion tests can be reduced from the total population of 7.8 billion and it would be equivalent to saving $696 billion. We propose SCALE19 can significantly reduce the total required number of tests compared to individual tests of the entire population. We believe SCALE19 is efficient and simple to be deployed in containment of Covid-19.", "A time series method to analyze incidence pattern and estimate reproduction number of COVID-19 The ongoing pandemic of Coronavirus disease (COVID-19) emerged in Wuhan, China in the end of 2019. It has already affected more than 300,000 people, with the number of deaths nearing 13000 across the world. As it has been posing a huge threat to global public health, it is of utmost importance to identify the rate at which the disease is spreading. In this study, we propose a time series model to analyze the trend pattern of the incidence of COVID-19 outbreak. We also incorporate information on total or partial lockdown, wherever available, into the model. The model is concise in structure, and using appropriate diagnostic measures, we showed that a time-dependent quadratic trend successfully captures the incidence pattern of the disease. We also estimate the basic reproduction number across different countries, and find that it is consistent except for the United States of America. The above statistical analysis is able to shed light on understanding the trends of the outbreak, and gives insight on what epidemiological stage a region is in. This has the potential to help in prompting policies to address COVID-19 pandemic in different countries.", "Estimation of the basic reproduction number, average incubation time, asymptomatic infection rate, and case fatality rate forCOVID-19: Meta-analysis and sensitivity analysis The coronavirus disease 2019 (COVID-19) has been found to be caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, comprehensive knowledge of COVID-19 remains incomplete and many important features are still unknown. This manuscripts conduct a meta-analysis and a sensitivity study to answer the questions: What is the basic reproduction number? How long is the incubation time of the disease on average? What portion of infections are asymptomatic? And ultimately, what is the case fatality rate? Our studies estimate the basic reproduction number to be 3.15 with the 95% interval (2.41, 3.90), the average incubation time to be 5.08 days with the 95% confidence interval (4.77, 5.39) (in day), the asymptomatic infection rate to be 46% with the 95% confidence interval (18.48%, 73.60%), and the case fatality rate to be 2.72% with 95% confidence interval (1.29%, 4.16%) where asymptomatic infections are accounted for.", "Using viral genomics to estimate undetected infections and extent of superspreading events for COVID-19 Asymptomatic infections and limited testing capacity have led to under-reporting of SARS-CoV-2 cases. This has hampered the ability to ascertain true infection numbers, evaluate the effectiveness of surveillance strategies, determine transmission dynamics, and estimate reproductive numbers. Leveraging both viral genomic and time series case data offers methods to estimate these parameters. Using a Bayesian inference framework to fit a branching process model to viral phylogeny and time series case data, we estimated time-varying reproductive numbers and their variance, the total numbers of infected individuals, the probability of case detection over time, and the estimated time to detection of an outbreak for 12 locations in Europe, China, and the United States. The median percentage of undetected infections ranged from 13% in New York to 92% in Shanghai, China, with the length of local transmission prior to two cases being detected ranging from 11 days (95% CI: 4-21) in California to 37 days (9-100) in Minnesota. The probability of detection was as low as 1% at the start of local epidemics, increasing as the number of reported cases increased exponentially. The precision of estimates increased with the number of full-length viral genomes in a location. The viral phylogeny was informative of the variance in the reproductive number with the 32% most infectious individuals contributing 80% of total transmission events. This is the first study that incorporates both the viral genomes and time series case data in the estimation of undetected COVID-19 infections. Our findings suggest the presence of undetected infections broadly and that superspreading events are contributing less to observed dynamics than during the SARS epidemic in 2003. This genomics-informed modeling approach could estimate in near real-time critical surveillance metrics to inform ongoing COVID-19 response efforts.", "Making sense of the Global Coronavirus Data: The role of testing rates in understanding the pandemic and our exit strategy The Coronavirus disease 2019(COVID-19) outbreak has caused havoc across the world. Subsequently, research on COVID-19 has focused on number of cases and deaths and predicted projections have focused on these parameters. We propose that the number of tests performed is a very important denominator in understanding the COVID-19 data. We analysed the number of diagnostic tests performed in proportion to the number of cases and subsequently deaths across different countries and projected pandemic outcomes. We obtained real time COVID-19 data from the reference website Worldometer at 0900 BST on Saturday 4th April, 2020 and collated the information obtained on the top 50 countries with the highest number of COVID 19 cases. We analysed this data according to the number of tests performed as the main denominator. Country wise population level pandemic projections were extrapolated utilising three models - 1) inherent case per test and death per test rates at the time of obtaining the data (4/4/2020 0900 BST) for each country; 2) rates adjusted according to the countries who conducted at least 100000 tests and 3) rates adjusted according to South Korea. We showed that testing rates impact on the number of cases and deaths and ultimately on future projections for the pandemic across different countries. We found that countries with the highest testing rates per population have the lowest death rates and give us an early indication of an eventual COVID-19 mortality rate. It is only by continued testing on a large scale that will enable us to know if the increasing number of patients who are seriously unwell in hospitals across the world are the tip of the iceberg or not. Accordingly, obtaining this information through a rapid increase in testing globally is the only way which will enable us to exit the COVID-19 pandemic and reduce economic and social instability.", "COVID-19: Should We Test Everyone? Since the beginning of 2020, the coronavirus disease 2019 (COVID-19) has spread rapidly in the city of Wuhan, P.R. China, and subsequently, across the world. The swift spread of the virus is largely attributed to its stealth transmissions in which infected patients may be asymptomatic. Undetected transmissions present a remarkable challenge for the containment of the virus and pose an appalling threat to the public. An urgent question that has been asked by the public is\"Should I be tested for COVID-19 if I am sick?\". While different regions established their own criteria for screening infected cases, the screening criteria have been modified based on new evidence and understanding of the virus as well as the availability of resources. The shortage of test kits and medical personnel has considerably limited our ability to do as many tests as possible. Public health officials and clinicians are facing a dilemma of balancing the limited resources and unlimited demands. On one hand, they are striving to achieve the best outcome by optimizing the usage of the scant resources. On the other hand, they are challenged by the patients' frustrations and anxieties, stemming from the concerns of not being tested for COVID-19 for not meeting the definition of PUI (person under investigation). In this paper, we evaluate the situation from the statistical viewpoint by factoring into the considerations of the uncertainty and inaccuracy of the test, an issue that is often overlooked by the general public. We aim to shed light on the tough situation by providing evidence-based reasoning from the statistical angle, and we expect this examination will help the general public understand and assess the situation rationally. Most importantly, the development offers recommendations for physicians to make sensible evaluations to optimally use the limited resources for the best medical outcome.", "Study of Non-Pharmacological Interventions on COVID-19 Spread COVID-19 disease has emerged as one of the life threatening threat to the society. It is caused by a novel beta coronavirus. It began as unidentified pneumonia of unknown aetiology in Wuhan City, Hubei province in China emerged in December 2019. No vaccine has been produced till now. Mathematical models are used to study impact of different measures used to decrease pandemic. Mathematical models have been designed to estimate the numbers of spreaders in different scenarios in the present manuscript. In the present manuscript, three different mathematical models have been proposed with different scenarios such as screening, quarantine and NPIs for estimating number of virus spreaders. the analysis shows that the numbers of COVID-19 patients will be more without screening the peoples coming from other countries. Since, every people suffering with COVID-19 disease are spreaders. The screening and quarantine with NPIs have been implemented to study their impact on the spreaders. It has been found that NPI measures are able to reduce number of spreaders. The NPI measures reduces the growth of the spread function and providing decision makers more time to prepare with in dealing of the disease.", "The Rate of Underascertainment of Novel Coronavirus (2019-nCoV) Infection: Estimation Using Japanese Passengers Data on Evacuation Flights From 29 to 31 January 2020, a total of 565 Japanese citizens were evacuated from Wuhan, China on three chartered flights. All passengers were screened upon arrival in Japan for symptoms consistent with novel coronavirus (2019-nCoV) infection and tested for presence of the virus. Assuming that the mean detection window of the virus can be informed by the mean serial interval (estimated at 7.5 days), the ascertainment rate of infection was estimated at 9.2% (95% confidence interval: 5.0, 20.0). This indicates that the incidence of infection in Wuhan can be estimated at 20,767 infected individuals, including those with asymptomatic and mildly symptomatic infections. The infection fatality risk (IFR)\u2014the actual risk of death among all infected individuals\u2014is therefore 0.3% to 0.6%, which may be comparable to Asian influenza pandemic of 1957\u20131958.", "A deeper look at COVID-19 CFR: health care impact and roots of discrepancy Intensive care capacity and proper testing play a paramount role in the COVID-19 Case Fatality Rate (CFR). Nevertheless, the real impact of such important measures has not been appreciated due to the lack of proper metrics. In this work, we have proposed a method for estimating a lower bound for the number of positive cases by using the reported data on the oldest age group and the regions' population distributions. The proposed estimation method improved the expected similarity between the age-distribution of positive cases and regions' population. Further, we have provided a quantitative measure for the impact of intensive care on the critical cases by comparing the CFR among those who did and did not receive intensive care. Our findings showed that the chance of living among non-ICU receivers is less than half of ICU receivers (~24% vs ~60%).", "Analysis of a mathematical model for COVID-19 population dynamics in Lagos, Nigeria This work examines the impact of various non-pharmaceutical control measures (government and personal) on the population dynamics of the novel coronavirus disease 2019 (COVID-19) in Lagos, Nigeria, using an appropriately formulated mathematical model. Using the available data, since its first reported case on 16 March 2020, we seek to develop a predicative tool for the cumulative number of reported cases and the number of active cases in Lagos; we also estimate the basic reproduction number of the disease outbreak in the aforementioned State in Nigeria. Using numerical simulations, we show the effect of control measures, specifically the common social distancing, use of face mask and case detection (via contact tracing and subsequent testings) on the dynamics of COVID-19. We also provide forecasts for the cumulative number of reported cases and active cases for different levels of the control measures being implemented. Numerical simulations of the model show that if at least 55% of the population comply with the social distancing regulation with about 55% of the population effectively making use of face masks while in public, the disease will eventually die out in the population and that, if we can step up the case detection rate for symptomatic individuals to about 0.8 per day, with about 55% of the population complying with the social distancing regulations, it will lead to a great decrease in the incidence (and prevalence) of COVID-19.", "Initial human transmission dynamics of the pandemic (H1N1) 2009 virus in North America Background Between 5 and 25 April 2009, pandemic (H1N1) 2009 caused a substantial, severe outbreak in Mexico, and subsequently developed into the first global pandemic in 41 years. We determined the reproduction number of pandemic (H1N1) 2009 by analyzing the dynamics of the complete case series in Mexico City during this early period. Methods We analyzed three mutually exclusive datasets from Mexico City Distrito Federal which constituted all suspect cases from 15 March to 25 April: confirmed pandemic (H1N1) 2009 infections, non\u2010pandemic influenza A infections and patients who tested negative for influenza. We estimated the initial reproduction number from 497 suspect cases identified prior to 20 April, using a novel contact network methodology incorporating dates of symptom onset and hospitalization, variation in contact rates, extrinsic sociological factors, and uncertainties in underreporting and disease progression. We tested the robustness of this estimate using both the subset of laboratory\u2010confirmed pandemic (H1N1) 2009 infections and an extended case series through 25 April, adjusted for suspected ascertainment bias. Results The initial reproduction number (95% confidence interval range) for this novel virus is 1\u00b751 (1\u00b732\u20131\u00b771) based on suspected cases and 1\u00b743 (1\u00b729\u20131\u00b757) based on confirmed cases before 20 April. The longer time series (through 25 April) yielded a higher estimate of 2\u00b704 (1\u00b784\u20132\u00b725), which reduced to 1\u00b744 (1\u00b738\u20131\u00b751) after correction for ascertainment bias. Conclusions The estimated transmission characteristics of pandemic (H1N1) 2009 suggest that pharmaceutical and non\u2010pharmaceutical mitigation measures may appreciably limit its spread prior the development of an effective vaccine.", "Adjusting Coronavirus prevalence estimates for laboratory test kit error Testing representative populations to determine the prevalence or percent of the population with active SARS-Cov-2 (COVID-19) infection and/or antibodies to infection is being recommended as essential for making public policy decisions to open-up or to continue enforcing national, state and local government rules to shelter-in-place. However, all laboratory tests are imperfect and have estimates of sensitivity and specificity less than 100% - in some cases considerably less than 100%. That error will lead to biased prevalence estimates. If the true prevalence of COVID-19 is low, possibly in the range of 1-5%, then testing error will lead to a constant background of bias that will most likely be larger and possibly much larger than the true prevalence itself. As a result, what is needed is a method for adjusting prevalence estimates for testing error. In this paper we outline methods for adjusting prevalence estimates for testing error both prospectively in studies being planned and retrospectively in studies that have been conducted. The methods if employed would also help to harmonize study results within countries and around the world. Adjustment can lead to more accurate prevalence estimates and to better policy decisions.", "COVID-19 in Italy: impact of containment measures and prevalence estimates of infection in the general population Since the beginning of the COVID-19 epidemic in Italy, the Italian Government implemented several restrictive measures to contain the spread of the infection. Data shows that, among these measures, the lockdown implemented as of 9 March had a positive impact, in particular the central and southern regions of Italy, while other actions appeared to be less effective. When the true prevalence of a disease is unknown, it is possible estimate it, based on mortality data and the assumptive case-fatality rate of the disease. Given these assumptions, the estimated period-prevalence of COVID-19 in Italy varies from 0.35% in Sicity to 13.3% in Lombardy.", "Using influenza surveillance networks to estimate state-specific prevalence of SARS-CoV-2 in the United States Detection of SARS-CoV-2 infections to date has relied heavily on RT-PCR testing. However, limited test availability, high false-negative rates, and the existence of asymptomatic or sub-clinical infections have resulted in an under-counting of the true prevalence of SARS-CoV-2. Here, we show how influenza-like illness (ILI) outpatient surveillance data can be used to estimate the prevalence of SARS-CoV-2. We found a surge of non-influenza ILI above the seasonal average in March 2020 and showed that this surge correlated with COVID-19 case counts across states. If 1/3 of patients infected with SARS-CoV-2 in the US sought care, this ILI surge would have corresponded to more than 8.7 million new SARS-CoV-2 infections across the US during the three-week period from March 8 to March 28, 2020. Combining excess ILI counts with the date of onset of community transmission in the US, we also show that the early epidemic in the US was unlikely to have been doubling slower than every 4 days. Together these results suggest a conceptual model for the COVID-19 epidemic in the US characterized by rapid spread across the US with over 80% infected patients remaining undetected. We emphasize the importance of testing these findings with seroprevalence data and discuss the broader potential to use syndromic surveillance for early detection and understanding of emerging infectious diseases.", "COVID-19 trend in Bangladesh: deviation from epidemiological model and critical analysis of the possible factors Background: Since its first report on March 08, COVID-19 positive cases and number of deaths are increasing in Bangladesh. In the first month of COVID-19 infection, incidence of daily positive cases did follow the susceptible, infected and recovered (SIR) based predictions we reported in April, but started to deviate in the following month. COVID-19 transmission and disease progression depends on multifaceted determinants e.g. viral genetics, host immunity, social distancing, co-morbidity, socio-demographic and environmental parameters. Therefore deviation in confirmed cases from predicted model may appear and warrant thorough investigation. In this short report, we tried to demonstrate and analyze the possible factors associated with the deviation which included preventive intervention strategies, socioeconomic capabilities, climatic and meteorological indexes, acquired immunity of Bangladeshi population, demographic characteristics, health indicators and food habits. Findings: The key factor responsible for the deviation was found to be the number of tests performed. Having population with low median age, young age groups are being mostly infected. Low prevalence of non-communicable diseases among them and strong immunity compared to the elderly might have kept most of them asymptomatic with silent recovery. Warm temperature, humidity and UV index of Bangladesh during this summer period might have contributed to the slow progression of infection. Longer daylight mediated immunity, fresh air circulations and ventilation, less density in rural areas and certain food habits perhaps helped the large number of populations to restrict the infection. Conclusion: Despite all these helpful determinants in Bangladesh, person to person contact is still the leading risk factor for COVID-19 transmission. Infection may increase rapidly if safe distance and preventive measures are not strictly followed while resuming the normal social and work life. A global second wave may hit in many countries in autumn and as well as in Bangladesh in mid-October when winter starts to approach. Strong collaborative action plans, strategies and implementation are needed immediately to prevent catastrophe.", "Quantifying the effect of quarantine control in Covid-19 infectious spread using machine learning Since the first recording of what we now call Covid-19 infection in Wuhan, Hubei province, China on Dec 31, 2019, the disease has spread worldwide and met with a wide variety of social distancing and quarantine policies. The effectiveness of these responses is notoriously difficult to quantify as individuals travel, violate policies deliberately or inadvertently, and infect others without themselves being detected. Moreover, the publicly available data on infection rates are themselves unreliable due to limited testing and even possibly under-reporting. In this paper, we attempt to interpret and extrapolate from publicly available data using a mixed first-principles epidemiological equations and data-driven neural network model. Leveraging our neural network augmented model, we focus our analysis on four locales: Wuhan, Italy, South Korea and the United States of America, and compare the role played by the quarantine and isolation measures in each of these countries in controlling the effective reproduction number Rt of the virus. Our results unequivocally indicate that the countries in which rapid government interventions and strict public health measures for quarantine and isolation were implemented were successful in halting the spread of infection and prevent it from exploding exponentially. In the case of Wuhan especially, where the available data were earliest available, we have been able to test the predicting ability of our model by training it from data in the January 24 till March 3 window, and then matching the predictions up to April 1. Even for Italy and South Korea, we have a buffer window of one week (25 March - 1 April) to validate the predictions of our model. In the case of the US, our model captures well the current infected curve growth and predicts a halting of infection spread by 20 April 2020. We further demonstrate that relaxing or reversing quarantine measures right now will lead to an exponential explosion in the infected case count, thus nullifying the role played by all measures implemented in the US since mid March 2020.", "Trends in excess cancer and cardiovascular deaths in Scotland during the COVID-19 pandemic 30 December 2019 to 20 April 2020 Understanding the trends in causes of death for different diseases during the current COVID-19 pandemic is important to determine whether there are excess deaths beyond what is normally expected. Using the most recent report from National Records Scotland (NRS) on 29 April 2020, we examined the percentage difference in crude numbers of deaths in 2020 compared to the average for 2015-2019 by week of death within calendar year. To determine if trends were similar, suggesting underreporting/underdiagnosed COVID-19 related deaths, we also looked at the trends in % differences for cardiovascular disease deaths. From the first 17 weeks' of data, we found a peak in excess deaths between weeks 14 of 2020, about four weeks after the first case in Scotland was detected on 1 March 2020-- but by week 17 these excesses had diminished around the time lockdown in the UK began. Similar observations were seen for cardiovascular disease-related deaths. These observations suggest that the short-term increase in excess cancer and cardiovascular deaths might be associated with undetected/unconfirmed deaths related to COVID-19. Both of these conditions make patients more susceptible to infection and lack of widespread access to testing for COVID-19 are likely to have resulted in under-estimation of COVID-19 mortality. These data further suggest that the cumulative toll of COVID-19 on mortality is likely undercounted. More detailed analysis is needed to determine if these excesses were directly or indirectly related to COVID-19. Disease specific mortality will need constant monitoring for the foreseeable future as changes occur in increasing capacity and access to testing, reporting criteria, changes to health services and different measures are implemented to control the spread of the COVID-19. Multidisciplinary, multi-institutional, national and international collaborations for complementary and population specific data analysis is required to respond and mitigate adverse effects of the COVID-19 pandemic and to inform planning for future pandemics.", "Using Supervised Machine Learning and Empirical Bayesian Kriging to reveal Correlates and Patterns of COVID-19 Disease outbreak in sub-Saharan Africa: Exploratory Data Analysis Introduction: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. Knowledge of coronavirus-related risk factors can help countries build more systematic and successful responses to COVID-19 disease outbreak. Here we used Supervised Machine Learning and Empirical Bayesian Kriging (EBK) techniques to reveal correlates and patterns of COVID-19 Disease outbreak in sub-Saharan Africa (SSA). Methods: We analyzed time series aggregate data compiled by Johns Hopkins University on the outbreak of COVID-19 disease across SSA. COVID-19 data was merged with additional data on socio-demographic and health indicator survey data for 39 of SSA 48 countries that reported confirmed cases and deaths from coronavirus between February 28, 2020 through March 26, 2020. We used supervised machine learning algorithm, Lasso for variable selection and statistical inference. EBK was used to also create a raster estimating the spatial distribution of COVID-19 disease outbreak. Results: The lasso Cross-fit partialing out predictive model ascertained seven variables significantly associated with the risk of coronavirus infection (i.e. new HIV infections among pediatric, adolescent, and middle-aged adult PLHIV, time (days), pneumococcal conjugate-based vaccine, incidence of malaria and diarrhea treatment). Our study indicates, the doubling time in new coronavirus cases was 3 days. The steady three-day decrease in coronavirus outbreak rate of change (ROC) from 37% on March 23, 2020 to 23% on March 26, 2020 indicates the positive impact of countries' steps to stymie the outbreak. The interpolated maps show that coronavirus is rising every day and appears to be severely confined in South Africa. In the West African region (i.e. Burkina Faso, Ghana, Senegal, CotedIviore, Cameroon, and Nigeria), we predict that new cases and deaths from the virus are most likely to increase. Interpretation: Integrated and efficiently delivered interventions to reduce HIV, pneumonia, malaria and diarrhea, are essential to accelerating global health efforts. Scaling up screening and increasing COVID-19 testing capacity across SSA countries can help provide better understanding on how the pandemic is progressing and possibly ensure a sustained decline in the ROC of coronavirus outbreak. Funding: Authors were wholly responsible for the costs of data collation and analysis.", "I Just Can\u2019t Get Enough (of Experts): The Numbers of COVID-19 and the Need for a European Approach to Testing This article offers a reflection on the testing strategies deployed in the generation of epidemiological data in the European Union (EU). I will argue that, while in the early days of the pandemic, Member States proceeded to testing in a rather scattered way, the shortage of resources seems to have acted as a driver of coordination, which is now increasingly being discussed at EU level. I will examine the legal and institutional framework supporting such embryonic coordination efforts and offer a preliminary assessment of their implications for a European approach to epidemiological knowledge-making.", "On Identifying and Mitigating Bias in the Estimation of the COVID-19 Case Fatality Rate The relative case fatality rates (CFRs) between groups and countries are key measures of relative risk that guide policy decisions regarding scarce medical resource allocation during the ongoing COVID-19 pandemic. In the middle of an active outbreak when surveillance data is the primary source of information, estimating these quantities involves compensating for competing biases in time series of deaths, cases, and recoveries. These include time- and severity- dependent reporting of cases as well as time lags in observed patient outcomes. In the context of COVID-19 CFR estimation, we survey such biases and their potential significance. Further, we analyze theoretically the effect of certain biases, like preferential reporting of fatal cases, on naive estimators of CFR. We provide a partially corrected estimator of these naive estimates that accounts for time lag and imperfect reporting of deaths and recoveries. We show that collection of randomized data by testing the contacts of infectious individuals regardless of the presence of symptoms would mitigate bias by limiting the covariance between diagnosis and death. Our analysis is supplemented by theoretical and numerical results and a simple and fast open-source codebase at https://github.com/aangelopoulos/cfr-covid-19 .", "How much is coronavirus spreading under the radar? ", "Reporting errors in infectious disease outbreaks, with an application to Pandemic Influenza A/H1N1 BACKGROUND: Effectively responding to infectious disease outbreaks requires a well-informed response. Quantitative methods for analyzing outbreak data and estimating key parameters to characterize the spread of the outbreak, including the reproductive number and the serial interval, often assume that the data collected is complete. In reality reporting delays, undetected cases or lack of sensitive and specific tests to diagnose disease lead to reporting errors in the case counts. Here we provide insight on the impact that such reporting errors might have on the estimation of these key parameters. RESULTS: We show that when the proportion of cases reported is changing through the study period, the estimates of key epidemiological parameters are biased. Using data from the Influenza A/H1N1 outbreak in La Gloria, Mexico, we provide estimates of these parameters, accounting for possible reporting errors, and show that they can be biased by as much as 33%, if reporting issues are not accounted for. CONCLUSIONS: Failure to account for missing data can lead to misleading and inaccurate estimates of epidemic parameters.", "The confounded crude case-fatality rates for COVID-19 hide more than they reveal - a comparison of age-specific and age-adjusted rates between six countries Background The reported crude case-fatality rates (CFRs) vary widely between countries. The serious limitations of using crude rates for comparisons are sometimes overlooked. In this paper we examined to what extent the age distribution of the cases is responsible for the differences in CFRs between countries. Methods Data on COVID-19 were extracted from the reports of individual countries. Overall and age-specific CFRs were available for six countries. The CFRs by country were adjusted for age using the direct method, using the combined age-specific number of cases of all six countries as the standard population. Findings The age distribution of the cases varied widely between countries. The crude CFRs varied between 1.6% and 11%. The differences in the age-specific CFRs were much smaller and the age-adjusted rates were much closer than the crude rates. The ratio of the crude CFR for the country with the highest to that with the lowest, was reduced substantially from 7.4 to 2.3 for the age-adjusted rates. Conclusions The age structure of the cases dramatically impacts on the differences in the crude CFRs between countries. Adjusting for age substantially reduces this variation. Other factors such as the differences in the definition of the denominators, the definition of a case and the standard of healthcare are likely to account for much of the residual variation. It is misleading to compare the crude COVID-19 CFRs between countries and should be avoided. Comparisons should be based on age-specific and age-adjusted rates. Key words: COVID-19, case-fatality rates, age-specific rates, age-adjusted rates, confounding", "Group Testing for Sars-Cov-2 to Enable Rapid Scale-Up of Testing and Real-Time Surveillance of Incidence High-throughput molecular testing for SARS-CoV-2 may be enabled by group testing in which pools of specimens are screened, and individual specimens tested only after a pool tests positive. Several labs have recently published examples of pooling strategies applied to SARS-CoV-2 specimens, but overall guidance on efficient pooling strategies is lacking. Therefore we developed a model of the efficiency and accuracy of specimen pooling algorithms based on available data on SAR-CoV-2 viral dynamics. For a fixed number of tests, we estimate that programs using group testing could screen 2 to 20 times as many specimens compared to individual testing; increase the total number of true positive infections identified; and improve the positive predictive value of results. We compare outcomes that may be expected in different testing situations and provide general recommendations for group testing implementation. A free, publicly-available web calculator is provided to help inform laboratory decisions on SARS-CoV-2 pooling algorithms.", "How many lives can be saved? A global view on the impact of testing, herd immunity and demographics on COVID-19 fatality rates In this work, we assess the global impact of COVID-19 showing how demographic factors, testing policies and herd immunity are key for saving lives. We extend a standard epidemiological SEIR model in order to: (a) identify the role of demographics (population size and population age distribution) on COVID-19 fatality rates; (b) quantify the maximum number of lives that can be saved according to different testing strategies, different levels of herd immunity, and specific population characteristics; and (d) infer from the observed case fatality rates (CFR) what the true fatality rate might be. Different from previous SEIR model extensions, we implement a Bayesian Melding method in our calibration strategy which enables us to account for data limitation on the total number of deaths. We derive a distribution of the set of parameters that best replicate the observed evolution of deaths by using information from both the model and the data.", "Preliminary estimation of the novel coronavirus disease (COVID-19) cases in Iran: A modelling analysis based on overseas cases and air travel data Abstract As of March 1, 2020, Iran had reported 987 novel coronavirus disease (COVID-19) cases, including 54 associated deaths. At least six neighboring countries (Bahrain, Iraq, Kuwait, Oman, Afghanistan, and Pakistan) had reported imported COVID-19 cases from Iran. In this study, air travel data and the numbers of cases from Iran imported into other Middle Eastern countries were used to estimate the number of COVID-19 cases in Iran. It was estimated that the total number of cases in Iran was 16 533 (95% confidence interval: 5925\u201335 538) by February 25, 2020, before the UAE and other Gulf Cooperation Council countries suspended inbound and outbound flights from Iran.", "Decrease in Hospital Admissions for Transient Ischemic Attack, Mild, and Moderate Stroke During the COVID-19 Era BACKGROUND AND PURPOSE: Since the onset of the coronavirus 2019 (COVID-19) pandemic, doctors and public authorities have demonstrated concern about the reduction in quality of care for other health conditions due to social restrictions and lack of resources. Using a population-based stroke registry, we investigated the impact of the onset of the COVID-19 pandemic in stroke admissions in Joinville, Brazil. METHODS: Patients admitted after the onset of COVID-19 restrictions in the city (defined as March 17, 2020) were compared with those admitted in 2019. We analyzed differences between stroke incidence, types, severity, reperfusion therapies, and time from stroke onset to admission. Statistical tests were also performed to compare the 30 days before and after COVID-19 to the same period in 2019. RESULTS: We observed a decrease in total stroke admissions from an average of 12.9/100 000 per month in 2019 to 8.3 after COVID-19 (P=0.0029). When compared with the same period in 2019, there was a 36.4% reduction in stroke admissions. There was no difference in admissions for severe stroke (National Institutes of Health Stroke Scale score >8), intraparenchymal hemorrhage, and subarachnoid hemorrhage. CONCLUSIONS: The onset of COVID-19 was correlated with a reduction in admissions for transient, mild, and moderate strokes. Given the need to prevent the worsening of symptoms and the occurrence of medical complications in these groups, a reorganization of the stroke-care networks is necessary to reduce collateral damage caused by COVID-19.", "A Comprehensive Public Health Evaluation of Lockdown as a Non-pharmaceutical Intervention on COVID-19 Spread in India: National Trends Masking State Level Variations INTRODUCTION: India has been under four phases of a national lockdown from March 25 to May 31 in response to the COVID-19 pandemic. Unmasking the state-wise variation in the effect of the nationwide lockdown on the progression of the pandemic could inform dynamic policy interventions towards containment and mitigation. METHODS: Using data on confirmed COVID-19 cases across 20 states that accounted for more than 99% of the cumulative case counts in India till May 31, 2020, we illustrate the masking of state-level trends and highlight the variations across states by presenting evaluative evidence on some aspects of the COVID-19 outbreak: case-fatality rates, doubling times of cases, effective reproduction numbers, and the scale of testing. RESULTS: The estimated effective reproduction number R for India was 3.36 (95% confidence interval (CI): [3.03, 3.71]) on March 24, whereas the average of estimates from May 25 - May 31 stands at 1.27 (95% CI: [1.26, 1.28]). Similarly, the estimated doubling time across India was at 3.56 days on March 24, and the past 7-day average for the same on May 31 is 14.37 days. The average daily number of tests have increased from 1,717 (March 19\u201325) to 131,772 (May 25\u201331) with an estimated testing shortfall of 4.58 million tests nationally by May 31. However, various states exhibit substantial departures from these national patterns. CONCLUSIONS: Patterns of change over lockdown periods indicate the lockdown has been effective in slowing the spread of the virus nationally. The COVID-19 outbreak in India displays large state-level variations and identifying these variations can help in both understanding the dynamics of the pandemic and formulating effective public health interventions. Our framework offers a holistic assessment of the pandemic across Indian states and union territories along with a set of interactive visualization tools that are daily updated at covind19.org.", "Excess mortality during the Covid-19 pandemic: Early evidence from England and Wales. The Covid-19 pandemic has claimed many lives in the UK and globally. The objective of this paper is to study whether the number of deaths not registered as Covid-19-related has increased compared to what would have been expected in the absence of the pandemic. Reasons behind this might include Covid-19 underreporting, avoiding visits to hospitals or GPs, and the effects of the lockdown. I used weekly ONS data on the number of deaths in England and Wales that did not officially involve Covid-19 over the period 2015-2020. Simply observing trends is not sufficient as spikes in deaths may occasionally occur. I thus followed a difference-in-differences econometric approach to study whether there was a relative increase in deaths not registered as Covid-19-related during the pandemic, compared to a control. Results suggest that there were an additional 968 weekly deaths that officially did not involve Covid-19, compared to what would have otherwise been expected. It is possible that some people are dying from Covid-19 without being diagnosed, and/or that there are excess deaths due to other causes as a result of the pandemic. Analysing the cause of death for any excess non-covid-19 deaths will shed light upon the reasons for the increase in such deaths and will help design appropriate policy responses to save lives.", "\"No test is better than a bad test\": Impact of diagnostic uncertainty in mass testing on the spread of Covid-19 Background: The cessation of lock-down measures will require an effective testing strategy. Much focus at the beginning of the UK's Covid-19 epidemic was directed to deficiencies in the national testing capacity. The quantity of tests may seem an important focus, but other characteristics are likely more germane. False positive tests are more probable than positive tests when the overall population has a low prevalence of the disease, even with highly accurate tests. Methods: We modify an SIR model to include quarantines states and test performance using publicly accessible estimates for the current situation. Three scenarios for cessation of lock-down measures are explored: (1) immediate end of lock-down measures, (2) continued lock-down with antibody testing based immunity passports, and (3) incremental relaxation of lock-down measures with active viral testing. Sensitivity, specifcity, prevalence and test capacity are modified for both active viral and antibody testing to determine their population level effect on the continuing epidemic. Findings: Diagnostic uncertainty can have a large effect on the epidemic dynamics of Covid-19 within the UK. The dynamics of the epidemic are more sensitive to test performance and targeting than test capacity. The quantity of tests is not a substitute for an effective strategy. Poorly targeted testing has the propensity to exacerbate the peak in infections. Interpretation: The assessment that 'no test is better than a bad test' is broadly supported by the present analysis. Antibody testing is unlikely to be a solution to the lock-down, regardless of test quality or capacity. A well designed active viral testing strategy combined with incremental relaxation of the lock-down measures is shown to be a potential strategy to restore some social activity whilst continuing to keep infections low.", "Covid-19: Deadline for roll out of UK's tracing app will be missed. ", "COVID-19 in Bangladesh: Data deficiency to delayed decision ", "Continued and Serious Lockdown Could Minimize Many Newly Transmitted Cases of COVID-19 in the U.S.: Wavelets, Deterministic Models, and Data All the newly reported COVID-19 cases of April in the U.S. have not acquired the virus in the same month. We estimate that there was an average of 29,000/day COVID-19 cases in the U.S. transmitted from infected to susceptible during April 1-24, 2020 after adjusting for under-reported and under-diagnosed. We have provided model-based predictions of COVID-19 for the low and high range of transmission rates and with varying degrees of preventive measures including the lockdowns. We predict that even if 10% of the susceptible and 20 % of the infected who were not identified as of April 23, 2020, do not adhere to proper care or do not obey lockdown, then by the end of May and by end of June 50,000 and 55,000 new cases will emerge, respectively. These values for the months of May and June with worse adherence rates of 50% by susceptible and infected (but not identified) will be 251,000 and 511,000, respectively. Continued and serious lockdown measures could bring this average daily new cases to a further low at 4,300/day to 8,000/day in May.", "Impact of Social Vulnerability on COVID-19 Incidence and Outcomes in the United States Importance: Prior pandemics have disparately affected socially vulnerable communities. Whether regional variations in social vulnerability to disasters influence COVID-19 outcomes and incidence in the U.S. is unknown. Objective: To examine the association of Social Vulnerability Index (SVI), a percentile-based measure of county-level social vulnerability to disasters, and its sub-components (socioeconomic status, household composition, minority status, and housing type/transportation accessibility) with the case fatality rate (CFR) and incidence of COVID-19. Design: Ecological study of counties with at least 50 confirmed COVID-19 cases as of April 4th, 2020. Generalized linear mixed-effects models with state-level clustering were applied to estimate county-level associations of overall SVI and its sub-component scores with COVID-19 CFR (deaths/100 cases) and incidence (cases/1000 population), adjusting for population percentage aged >65 years, and for comorbidities using the average Hierarchical Condition Category (HCC) score. Counties with high SVI (\u2265median) and high CFR (\u2265median) were identified. Setting: Population-based study of U.S. county-level data. Participants: U.S. counties with at least 50 confirmed COVID-19 cases. Main outcomes and measures: COVID-19 CFR and incidence. Results: Data from 433 counties including 283,256 cases and 6,644 deaths were analyzed. Median SVI was 0.46 [Range: 0.01-1.00], and median CFR and incidence were 1.9% [Range: 0-13.3] and 1.2 per 1000 people [Range: 0.6-38.8], respectively. Higher SVI, indicative of greater social vulnerability, was associated with higher CFR (RR: 1.19 [1.05, 1.34], p=0.005, per-1% increase), an association that strengthened after adjustment for age>65 years and comorbidities (RR: 1.63 [1.38, 1.91], p<0.001), and was further confirmed in a sensitivity analysis limited to six states with the highest testing levels. Although the association between overall SVI and COVID-19 incidence was not significant, the SVI sub-components of socioeconomic status and minority status were both predictors of higher incidence and CFR. A combination of high SVI (\u22650.46) and high adjusted CFR (\u22652.3%) was observed in 28.9% of counties. Conclusions and Relevance: Social vulnerability is associated with higher COVID-19 case fatality. High social vulnerability and CFR coexist in more than 1 in 4 U.S. counties. These counties should be targeted by public policy interventions to help alleviate the pandemic burden on the most vulnerable population.", "Mortality from COVID-19 in 12 countries and 6 states of the United States Importance: Reliable estimates of COVID-19 mortality are crucial to aid control strategies and to assess the effectiveness of interventions. Objective: Project COVID-19 mortality trends to October 1, 2020, in 12 countries or regions that constitute >90% of the global COVID-19 deaths reported as of April 12, 2020. Design, Setting, and Participants: The Global COVID-19 Assessment of Mortality (GCAM) is an open, transparent, and continuously updated (www.cghr.org/covid) statistical model that combines actual COVID-19 mortality counts with Bayesian inference to forecast COVID-19 deaths, the date of peak deaths, and the duration of excess mortality. The analyses covered a total of 700 million population above age 20 in 12 countries or regions: USA; Italy; Spain; France; UK; Iran; Belgium; a province of China (Hubei, which accounted for 90% of reported Chinese deaths); Germany; the Netherlands; Switzerland; and Canada; and six US states: New York, New Jersey, Michigan, Louisiana, California, and Washington. Results: Forecasted deaths across the 12 current high-burden countries sum 167,000 to 593,000 (median 253,000). The trajectory of US deaths (49,000-249,000 deaths; median 86,000)- over half of which are expected in states beyond the initial six states analysed in this study- will have the greatest impact on the eventual total. Mortality ranges are 25,000-109,000 (median 46,000) in the UK; 23,000-31,000 (median 26,000) in Italy; 21,000-37,000 (median 26,000) in France and 21,000-32,000 (median 25,000) in Spain. Estimates are most precise for Hubei, China, where the epidemic curve is complete, and least precise in California, where it is ongoing. New York has the highest cumulative median mortality rate per million (1135), about 12-fold that of Germany. Mortality trajectories are notably flatter in Germany, California, and Washington State, each of which took physical distancing and testing strategies seriously. Using past country-specific mortality as a guide, GCAM predicts surge capacity needs, reaching more than twice existing capacity in a number of places., In every setting, the results might be sensitive to undercounts of COVID-19 deaths, which are already apparent. Conclusion and Relevance: Mortality from COVID-19 will be substantial across many settings, even in the best case scenario. GCAM will provide continually updated and increasingly precise estimates as the pandemic progresses.", "How lethal is the novel coronavirus, and how many undetected cases there are? The importance of being tested. There is big concern for estimating the lethality and the extent of undetected infections associated with the novel coronavirus SARS-CoV2 outbreak. While detailed epidemiological models are certainly needed, I suggest here an orthogonal approach based on a minimum number of parameters robustly fitted from the cumulative data easily accessible for all countries at the John Hopkins University database that became the worldwide reference for the pandemics. I show that, after few days from the beginning of the outbreak, the apparent death rate can be extrapolated to infinite time through regularized regression such as rescaled ridge regression. The variation from country to country of these extrapolated death rates appears to depend almost only (r^2=0.91) on the ratio between performed tests and detected cases even when the instantaneous apparent lethality rates are as different as 9% in Italy and 0.4% in Germany. Extrapolating to the limit of infinite number of tests, I obtain a death rate of 0.012+/- 0.012, in agreement with other estimates. The inverse relationship between the extrapolated death rate and the intensity tests allows estimating that more than 50% of cases were undetected in most countries, with more than 90% undetected cases in countries severely hit by the epidemics such as Italy. Finally, I propose to adopt the ratio between the cumulative number of recovered and deceased persons as an indicator that can anticipate the halting of the epidemics.", "County-level factors influence the trajectory of Covid-19 incidence With new cases of Covid-19 surging in the United States, we need to better understand how the spread of novel coronavirus varies across all segments of the population. We use hierarchical exponential growth curve modeling techniques to examine whether community social and economic characteristics uniquely influence the incidence of Covid-19 cases in the urban built environment. We show that, as of May 3, 2020, confirmed coronavirus infections are concentrated along demographic and socioeconomic lines in New York City and surrounding areas, the epicenter of the Covid-19 pandemic in the United States. Furthermore, we see evidence that, after the onset of the pandemic, timely enactment of physical distancing measures such as school closures is imperative in order to limit the extent of the coronavirus spread in the population. Public health authorities must impose nonpharmaceutical measures early on in the pandemic and consider community-level factors that associate with a greater risk of viral transmission.", "Number of International Arrivals Predicts Severity of the first Global Wave of the COVID-19 Pandemic Background: Reported death rates from different countries during the COVID-19 pandemic vary. Lack of universal testing and death underreporting make between-country comparisons difficult. The country-level determinants of COVID-19 mortality are unknown. Objective: Derive a measure of COVID-related death rates that is comparable across countries and identify its country-level predictors. Methods: An ecological study design of publicly available data was employed. Countries reporting >25 COVID-related deaths until May 1, 2020 were included. The outcome was the mean mortality rate from COVID-19, an estimate of the country-level daily increase in reported deaths during the ascending phase of the epidemic curve. Potential predictors assessed were most recently published Demographic parameters (population and population density, percentage population living in urban areas, median age, average body mass index, smoking prevalence), Economic parameters (Gross Domestic Product per capita; environmental parameters: pollution levels, mean temperature (January-April)), co-morbidities (prevalence of diabetes, hypertension and cancer), health systems parameters (WHO Health Index and hospital beds per 10,000 population and international arrivals). Multivariable linear regression was used to analyse the data. Results: Thirty-one countries were included. Of all country-level predictors included in the multivariable model, only total number of international arrivals was significantly associated with the mean death rate: Beta 0.3798 (95% Confidence Interval 0.2414, 0.5182), P <0.001. Conclusion: International travel was directly associated with the mortality slope and thus potentially the spread of COVID-19. Stopping international travel, particularly from affected areas, may be the most effective strategy to control COVID outbreak and prevent related deaths.", "Insights from early mathematical models of 2019-nCoV acute respiratory disease (COVID-19) dynamics In December 2019, a novel coronavirus (SARS-CoV-2) has been identified to cause acute respiratory disease in humans. An outbreak of this disease has been reported in mainland China with the city of Wuhan as the recognized epicenter. The disease has also been exported to other countries, including the Philippines, but the level of spread is still under control (as of 08 February 2020). To describe and predict the dynamics of the disease, several preliminary mathematical models are formulated by various international study groups. Here, the insights that can be drawn from these models are discussed, especially as inputs for designing strategies to control the epidemics. Proposed model-based strategies on how to prevent the spread of the disease in local setting, such as during large social gatherings, are also presented. The model shows that the exposure time is a significant factor in spreading the disease. With a basic reproduction number equal to 2, and 14-day infectious period, an infected person staying more than 9 hours in the event could infect other people. Assuming the exposure time is 18 hours, the model recommends that attendees of the social gathering should have a protection with more than 70 percent effectiveness.", "Estimating number of global importations of COVID-19 from Wuhan, risk of transmission outside mainland China and COVID-19 introduction index between countries outside mainland China Background The emergence of a novel coronavirus (SARS-CoV-2) in Wuhan, China in early December 2019 has caused widespread transmission within the country, with over 1,000 deaths reported to date. Other countries have since reported coronavirus disease 2019 (COVID-19) importation from China, with some experiencing local transmission and even case importation from countries outside China. We aim to estimate the number of cases imported from Wuhan to each country or territory outside mainland China, and with these estimates assess the risk of onward local transmission and the relative potential of case importation between countries outside China. Methods We used the reported number of cases imported from Wuhan and flight data to generate an uncertainty distribution for the estimated number of imported cases from Wuhan to each location outside mainland China. This uncertainty was propagated to quantify the local outbreak risk using a branching process model. A COVID-19 introduction index was derived for each pair of donor and recipient countries, accounting for the local outbreak risk in the donor country and the between-country connectivity. Results We identified 13 countries or territories outside mainland China that may have under-detected COVID-19 importation from Wuhan, such as Thailand and Indonesia. In addition, 16 countries had a local outbreak risk estimate exceeding 50%, including four outside Asia. The COVID-19 introduction index highlights potential locations outside mainland China from which cases may be imported to each recipient country. Conclusions As SARS-CoV-2 continues to spread globally, more epicentres may emerge outside China. Hence, it is important for countries to remain alert for the possibilities of viral introduction from other countries outside China, even before local transmission in a source country becomes known.", "Presentation of new onset anosmia during the COVID-19 pandemic. INTRODUCTION Anosmia has not been formally recognised as a symptom of COVID-19 infection. Growing anecdotal evidence suggests increasing incidence of cases of anosmia during the current pandemic, suggesting that COVID-19 may cause olfactory dysfunction. The objective was to characterise patients reporting new onset anosmia during the COVID-19 pandemic METHODOLOGY: Design: Survey of 2428 patients reporting new onset anosmia during the COVID-19 pandemic. SETTING Volunteer sample of patients seeking medical advice of recent onset self-diagnosed loss of sense of smell RESULTS: 2428 surveys were completed within 7 days; 64% respondents were under 40. The majority of respondents reported onset of their anosmia in the last week. Of the cohort, 17% did not report any other symptom thought to be associated with COVID-19. In patients who reported other symptoms, 51% reported either cough or fever and therefore met current guidelines for self-isolation. CONCLUSIONS Anosmia is reported in conjunction with well-reported symptoms of coronas virus, but 1 in 6 patients with recent onset anosmia report this as an isolated symptom. This might help identify otherwise asymptomatic carriers of disease and trigger targeted testing. Further study with COVID-19 testing is required to identify the proportion of patients in whom new onset anosmia can be attributed to COVID-19.", "The true case fatality of COVID19: An analytical solution The exact risk of dying from COVID-19 has remained elusive and a topic of debate. The observed case fatality rates of 46 different countries are hypothesized to be dependent on their testing rates. An analytical test to this hypothesis suggests that the case fatality rate of COVID-19 could be consistent to a certain degree across all countries and states. The current global fatality rate is estimated to be around 1% and expected to converge between 1-3% when the pandemic ends. This model can be helpful to estimate the true infection rate for individual countries.", "BETS: The dangers of selection bias in early analyses of the coronavirus disease (COVID-19) pandemic The coronavirus disease 2019 (COVID-19) has quickly grown from a regional outbreak in Wuhan, China to a global pandemic. Early estimates of the epidemic growth and incubation period of COVID-19 may have been biased due to sample selection. Using detailed case reports from 14 locations in and outside mainland China, we obtained 378 Wuhan-exported cases who left Wuhan before an abrupt travel quarantine. We developed a generative model we call BETS for four key epidemiological events---Beginning of exposure, End of exposure, time of Transmission, and time of Symptom onset (BETS)---and derived explicit formulas to correct for the sample selection. We gave a detailed illustration of why some early and highly influential analyses of the COVID-19 pandemic were severely biased. All our analyses, regardless of which subsample and model were being used, point to an epidemic doubling time of 2 to 2.5 days during the early outbreak in Wuhan. A Bayesian nonparametric analysis further suggests that about 5% of the symptomatic cases may not develop symptoms within 14 days of infection and that men may be much more likely than women to develop symptoms within 2 days of infection.", "Molecular Diagnosis of Severe Acute Respiratory Syndrome : The State of the Art Severe acute respiratory syndrome (SARS) first appeared in Guangdong Province, China, in November 2002. Although virus isolation and serology were useful early in the SARS outbreak for diagnosing new cases, these tests are not generally useful because virus culture requires a BSL-3 laboratory and seroconversion is often delayed until 2 to 3 weeks after infection. The first qualitative reverse transcriptase-polymerase chain reaction tests for SARS-coronavirus (CoV) were sensitive and capable of detecting 1 to 10 genome equivalents. These assays were quickly supplemented with quantitative real-time assays that helped elucidate the natural history of SARS, particularly the initial presence of low viral loads in the upper respiratory tract and high viral loads in the lower respiratory tract. The unique natural history of SARS-CoV infection dictates the testing of both respiratory and nonrespiratory specimens, the testing of multiple specimens from the same patient, and sending out positives to be confirmed by a reference laboratory. Commercially available reverse transcriptase-polymerase chain reaction tests for SARS have recently appeared; however, meaningful evaluations of these assays have not yet been performed and their true performance has not been determined. These and other issues related to diagnosis of SARS-CoV infection are discussed in this review.", "Laboratory readiness and response for novel coronavirus (2019-nCoV) in expert laboratories in 30 EU/EEA countries, January 2020 Timely detection of novel coronavirus (2019-nCoV) infection cases is crucial to interrupt the spread of this virus. We assessed the required expertise and capacity for molecular detection of 2019-nCoV in specialised laboratories in 30 European Union/European Economic Area (EU/EEA) countries. Thirty-eight laboratories in 24 EU/EEA countries had diagnostic tests available by 29 January 2020. A coverage of all EU/EEA countries was expected by mid-February. Availability of primers/probes, positive controls and personnel were main implementation barriers.", "Spreading of COVID-19 in Brazil: Impacts and uncertainties in social distancing strategies Brazil's continental dimension poses a challenge to the control of the spread of COVID-19. Due to the country specific scenario of high social and demographic heterogeneity, combined with limited testing capacity, lack of reliable data, under-reporting of cases, and restricted testing policy, the focus of this study is twofold: (i) to develop a generalized SEIRD model that implicitly takes into account the quarantine measures, and (ii) to estimate the response of the COVID-19 spread dynamics to perturbations/uncertainties. By investigating the projections of cumulative numbers of confirmed and death cases, as well as the effective reproduction number, we show that the model parameter related to social distancing measures is one of the most influential along all stages of the disease spread and the most influential after the infection peak. Due to such importance in the outcomes, different relaxation strategies of social distancing measures are investigated in order to determine which strategies are viable and less hazardous to the population. The results highlight the need of keeping social distancing policies to control the disease spread. Specifically, the considered scenario of abrupt social distancing relaxation implemented after the occurrence of the peak of positively diagnosed cases can prolong the epidemic, with a significant increase of the projected numbers of confirmed and death cases. An even worse scenario could occur if the quarantine relaxation policy is implemented before evidence of the epidemiological control, indicating the importance of the proper choice of when to start relaxing social distancing measures.", "Epidemiological and clinical characteristics of the early phase of the COVID-19 epidemic in Brazil Background: The first case of COVID-19 was detected in Brazil on February 25, 2020. We report the epidemiological, demographic, and clinical findings for confirmed COVID-19 cases during the first month of the epidemic in Brazil. Methods: Individual-level and aggregated COVID-19 data were analysed to investigate demographic profiles, socioeconomic drivers and age-sex structure of COVID-19 tested cases. Basic reproduction numbers (R0) were investigated for Sao Paulo and Rio de Janeiro. Multivariate logistic regression analyses were used to identify symptoms associated with confirmed cases and risk factors associated with hospitalization. Laboratory diagnosis for eight respiratory viruses were obtained for 2,429 cases. Findings: By March 25, 1,468 confirmed cases were notified in Brazil, of whom 10% (147 of 1,468) were hospitalised. Of the cases acquired locally (77.8%), two thirds (66.9% of 5,746) were confirmed in private laboratories. Overall, positive association between higher per capita income and COVID-19 diagnosis was identified. The median age of detected cases was 39 years (IQR 30-53). The median R0 was 2.9 for Sao Paulo and Rio de Janeiro. Cardiovascular disease/hypertension were associated with hospitalization. Co-circulation of six respiratory viruses, including influenza A and B and human rhinovirus was detected in low levels. Interpretation: Socioeconomic disparity determines access to SARS-CoV-2 testing in Brazil. The lower median age of infection and hospitalization compared to other countries is expected due to a younger population structure. Enhanced surveillance of respiratory pathogens across socioeconomic statuses is essential to better understand and halt SARS-CoV-2 transmission.", "Epidemiological characteristics of novel coronavirus infection: A statistical analysis of publicly available case data Following the first report of coronavirus disease 2019 (COVID-19) in Sapporo City, Hokkaido Prefecture, Japan on 14 February 2020, a surge of cases was observed in Hokkaido during February and March. As of 6 March, 90 cases were diagnosed in Hokkaido. Unfortunately, many infected persons may not have been recognized as cases due to having mild or no symptoms. We therefore estimated the actual number of COVID-19 cases in (i) Hokkaido Prefecture and (ii) Sapporo City using data on cases diagnosed outside these areas. The estimated cumulative incidence in Hokkaido as of 27 February was 2297 cases (95% confidence interval [CI]: 382, 7091) based on data on travelers outbound from Hokkaido. The cumulative incidence in Sapporo City as of 28 February was estimated at 2233 cases (95% CI: 0, 4893) based on the count of confirmed cases within Hokkaido. Both approaches resulted in similar estimates, indicating higher incidence of infections in Hokkaido than were detected by the surveillance system. This quantification of the gap between detected and estimated cases can help inform public health response as it provides insight into the possible scope of undetected transmission.", "Characterization of the COVID-19 pandemic and the impact of uncertainties, mitigation strategies, and underreporting of cases in South Korea, Italy, and Brazil By April 7th, 2020, the Coronavirus disease 2019 (COVID-19) has infected one and a half million people worldwide, accounting for over 80 thousand of deaths in 209 countries and territories around the world. The new and fast dynamics of the pandemic are challenging the health systems of different countries. In the absence of vaccines or effective treatments, mitigation policies, such as social isolation and lock-down of cities, have been adopted, but the results vary among different countries. Some countries were able to control the disease at the moment, as is the case of South Korea. Others, like Italy, are now experiencing the peak of the pandemic. Finally, countries with emerging economies and social issues, like Brazil, are in the initial phase of the pandemic. In this work, we use mathematical models with time-dependent coefficients, techniques of inverse and forward uncertainty quantification, and sensitivity analysis to characterize essential aspects of the COVID-19 in the three countries mentioned above. The model parameters estimated for South Korea revealed effective social distancing and isolation policies, border control, and a high number in the percentage of reported cases. In contrast, underreporting of cases was estimated to be very high in Brazil and Italy. In addition, the model estimated a poor isolation policy at the moment in Brazil, with a reduction of contact around 40%, whereas Italy and South Korea estimated numbers for contact reduction are at 75% and 90%, respectively. This characterization of the COVID-19, in these different countries under different scenarios and phases of the pandemic, supports the importance of mitigation policies, such as social distancing. In addition, it raises serious concerns for socially and economically fragile countries, where underreporting poses additional challenges to the management of the COVID-19 pandemic by significantly increasing the uncertainties regarding its dynamics.", "Modelling fatality curves of COVID-19 and the effectiveness of intervention strategies The main objective of the present paper is twofold: first, to model the fatality curves of the COVID-19 disease, as represented by the cumulative number of deaths as a function of time; and second, to use the corresponding mathematical model to study the effectiveness of possible intervention strategies. We applied the Richards growth model (RGM) to the COVID-19 fatality curves from several countries, where we used the data from the Johns Hopkins University database up to April 1, 2020. Countries selected for analysis were China, Italy, Spain, Iran, and Brazil. The RGM was shown to describe very well the fatality curves of China, which is in a late stage of the COVID-19 outbreak, as well as of Italy, Spain, and Iran, which supposedly are in the middle of the outbreak at the time of this writing. As for Brazil, which is still in the so-called exponential growth regime, we used the generalized growth model which is more appropriate for such cases. An analytic formula for the efficiency of intervention strategies within the context of the RGM is derived. Our findings show that there is only a narrow window of opportunity, after the onset of the epidemic, during which effective countermeasures can be taken. We applied our intervention model to the COVID-19 fatality curve of Italy to illustrate the effect of several possible interventions.", "The basic reproduction number and prediction of the epidemic size of the novel coronavirus (COVID-19) in Shahroud, Iran Objectives: To estimate the basic reproduction number (R0) of COVID-19 in the early stage of the epidemic and predict the expected number of new cases in Shahroud, Northeast of Iran. Methods: The R0 of COVID-19 was estimated using the serial interval distribution and the number of incidence cases. The serial interval was fit with a gamma distribution. The probable incidence and cumulative incidence in the next 30 days were predicted using the assumption that daily incidence follows a Poisson distribution determined by daily infectiousness. Data analysis was done using earlyR and projections packages in R software. Results: The maximum-likelihood value of R0 was 2.7 (95% confidence interval (CI): 2.1 to 3.4) for the COVID-19 epidemic in the early 14 days and decreased to 1.13 (95% CI: 1.03 to 1.25) by the end of the day 41. The expected average number of new cases in Shahroud is 9.0 case/day with a standard deviation of 3.8, which means an estimated total of 271 (95% CI: 178-383) new cases in the next 30 days. Conclusions: It is essential to reduce the R0 to values below one. Therefore, we strongly recommend enforcing and continuing the current preventive measures, restricting travel, and providing screening tests for a larger proportion of the population.", "The Mathematics of Testing with Application to Prevalence of COVID-19 We formulate three basic assumptions that should ideally guide any well-designed COVID-19 prevalence study. We provide, on the basis of these assumptions alone, a full derivation of mathematical formulas required for statistical analysis of testing data. In particular, we express the disease prevalence in a population through those for its homogeneous subpopulations. Although some of these formulas are routinely employed in prevalence studies, the study design often contravenes the assumptions upon which these formulas vitally depend. We also designed a natural prevalence estimator from the testing data and studied some of its properties. The results are equally valid for diseases other than COVID-19 as well as in non-epidemiological settings.", "Predictions, role of interventions and effects of a historic national lockdown in India's response to the COVID-19 pandemic: data science call to arms Importance: India has taken strong and early public health measures for arresting the spread of the COVID-19 epidemic. With only 536 COVID-19 cases and 11 fatalities, India - a democracy of 1.34 billion people - took the historic decision of a 21-day national lockdown on March 25. The lockdown was further extended to May 3, soon after the analysis of this paper was completed. Objective: To study the short- and long-term impact of an initial 21-day lockdown on the total number of COVID-19 cases in India compared to other less severe non-pharmaceutical interventions using epidemiological forecasting models and Bayesian estimation algorithms; to compare effects of hypothetical durations of lockdown from an epidemiological perspective; to study alternative explanations for slower growth rate of the virus outbreak in India, including exploring the association of the number of cases and average monthly temperature; and finally, to outline the pivotal role of reliable and transparent data, reproducible data science methods, tools and products as we reopen the country and prepare for a post lock-down phase of the pandemic. Design, Setting, and Participants: We use the daily data on the number of COVID-19 cases, of recovered and of deaths from March 1 until April 7, 2020 from the 2019 Novel Coronavirus Visual Dashboard operated by the Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE). Additionally, we use COVID-19 incidence counts data from Kaggle and the monthly average temperature of major cities across the world from Wikipedia. Main Outcome and Measures: The current time-series data on daily proportions of cases and removed (recovered and death combined) from India are analyzed using an extended version of the standard SIR (susceptible, infected, and removed) model. The eSIR model incorporates time-varying transmission rates that help us predict the effect of lockdown compared to other hypothetical interventions on the number of cases at future time points. A Markov Chain Monte Carlo implementation of this model provided predicted proportions of the cases at future time points along with credible intervals (CI). Results: Our predicted cumulative number of COVID-19 cases in India on April 30 assuming a 1-week delay in people's adherence to a 21-day lockdown (March 25 - April 14) and a gradual, moderate resumption of daily activities after April 14 is 9,181 with upper 95% CI of 72,245. In comparison, the predicted cumulative number of cases under \"no intervention\" and \"social distancing and travel bans without lockdown\" are 358 thousand and 46 thousand (upper 95% CI of nearly 2.3 million and 0.3 million) respectively. An effective lockdown can prevent roughly 343 thousand (upper 95% CI 1.8 million) and 2.4 million (upper 95% CI 38.4 million) COVID-19 cases nationwide compared to social distancing alone by May 15 and June 15, respectively. When comparing a 21-day lockdown with a hypothetical lockdown of longer duration, we find that 28-, 42-, and 56-day lockdowns can approximately prevent 238 thousand (upper 95% CI 2.3 million), 622 thousand (upper 95% CI 4.3 million), 781 thousand (upper 95% CI 4.6 million) cases by June 15, respectively. We find some suggestive evidence that the COVID-19 incidence rates worldwide are negatively associated with temperature in a crude unadjusted analysis with Pearson correlation estimates [95% confidence interval] between average monthly temperature and total monthly incidence around the world being -0.185 [-0.548, 0.236] for January, -0.110 [-0.362, 0.157] for February, and -0.173 [-0.314, -0.026] for March. Conclusions and Relevance: The lockdown, if implemented correctly in the end, has a high chance of reducing the total number of COVID-19 cases in the short term, and buy India invaluable time to prepare its healthcare and disease monitoring system. Our analysis shows we need to have some measures of suppression in place after the lockdown for the best outcome. We cannot heavily rely on the hypothetical prevention governed by meteorological factors such as temperature based on current evidence. From an epidemiological perspective, a longer lockdown between 42-56 days is preferable. However, the lockdown comes at a tremendous price to social and economic health through a contagion process not dissimilar to that of the coronavirus itself. Data can play a defining role as we design post-lockdown testing, reopening and resource allocation strategies. Software: Our contribution to data science includes an interactive and dynamic app (covind19.org) with short- and long-term projections updated daily that can help inform policy and practice related to COVID-19 in India. Anyone can visualize the observed data for India and create predictions under hypothetical scenarios with quantification of uncertainties. We make our prediction codes freely available (https://github.com/umich-cphds/cov-ind-19) for reproducible science and for other COVID-19 affected countries to use them for their prediction and data visualization work.", "A model to predict SARS-CoV-2 infection based on the first three-month surveillance data in Brazil. Background: COVID-19 diagnosis is a critical problem, mainly due to the lack or delay in the test results. We aimed to obtain a model to predict SARS-CoV-2 infection in suspected patients reported to the Brazilian surveillance system. Methods: We analyzed suspected patients reported to the National Surveillance System that corresponded to the following case definition: patients with respiratory symptoms and fever, who traveled to regions with local or community transmission or who had close contact with a suspected or confirmed case. Based on variables routinely collected, we obtained a multiple model using logistic regression. The area under the receiver operating characteristic curve (AUC) and accuracy indicators were used for validation. Results: We described 1468 COVID-19 cases (confirmed by RT-PCR) and 4271 patients with other illnesses. With a data subset, including 80% of patients from Sao Paulo (SP) and Rio Janeiro (RJ), we obtained a function which reached an AUC of 95.54% (95% CI: 94.41% - 96.67%) for the diagnosis of COVID-19 and accuracy of 90.1% (sensitivity 87.62% and specificity 92.02%). In a validation dataset including the other 20% of patients from SP and RJ, this model exhibited an AUC of 95.01% (92.51% - 97.5%) and accuracy of 89.47% (sensitivity 87.32% and specificity 91.36%). Conclusion: We obtained a model suitable for the clinical diagnosis of COVID-19 based on routinely collected surveillance data. Applications of this tool include early identification for specific treatment and isolation, rational use of laboratory tests, and input for modeling epidemiological trends.", "Predictive accuracy of a hierarchical logistic model of cumulative SARS-CoV-2 case growth Background: Infectious disease predictions models, including virtually all epidemiological models describing the spread of the SARS-CoV-2 pandemic up to June 2020, are rarely evaluated. The aim of the present study was to investigate the predictive accuracy of a prognostic model for forecasting the development of the cumulative number of reported SARS-CoV-2 cases in countries and administrative regions worldwide. Methods: The cumulative number of reported SARS-CoV-2 cases was forecasted in 251 regions with a horizon of two weeks, one month, and two months using a previously described hierarchical logistic model at the end of March 2020. Forecasts were compared to actual observations by using a series of evaluation metrics. Results: On average, predictive accuracy was very high in nearly all regions at the two weeks forecast, high in most regions at the one month forecast, and notable in the majority of the regions at the two months forecast. Higher accuracy was associated with the availability of more data for estimation and with a more pronounced cumulative case growth from the first case to the date of estimation. In some strongly affected regions, cumulative case counts were considerably underestimated. Conclusions: With keeping its limitations in mind, the investigated model can be used for the preparation and distribution of resources during the SARS-CoV-2 pandemic. Future research should primarily address the model's assumptions and its scope of applicability. In addition, establishing a relationship with known mechanisms and traditional epidemiological models of disease transmission would be desirable.", "Is social connectedness a risk factor for the spreading of COVID-19 among older adults? The Italian paradox Italy was one of the first European countries affected by the new coronavirus (COVID-19) pandemic, with over 105,000 infected people and close to 13,000 deaths, until March 31(st). The pandemic has hit especially hard because of the country's demographic structure, with a high percentage of older adults. The authors explore the possibility, recently aired in some studies, of extensive intergenerational contact as a possible determinant of the severity of the pandemic among the older Italian adults. We analyzed several variables to test this hypothesis, such as the percentage of infected patients aged >80 years, available nursing home beds, COVID-19 incidence rate, and the number of days from when the number of positive tests exceeded 50 (epidemic maturity). We also included in the analysis mean household size and percentage of households comprising one person, in the region. Paradoxically, the results are opposite of what was previously reported. The pandemic was more severe in regions with higher family fragmentation and increased availability of residential health facilities.", "Uncertainty Quantification in Epidemiological Models for COVID-19 Pandemic The main goal of this paper is to develop the forward and inverse modeling of the Coronavirus (COVID-19) pandemic using novel computational methodologies in order to accurately estimate and predict the pandemic. This leads to governmental decisions support in implementing effective protective measures and prevention of new outbreaks. To this end, we use the logistic equation and the SIR system of ordinary differential equations to model the spread of the COVID-19 pandemic. For the inverse modeling, we propose Bayesian inversion techniques, which are robust and reliable approaches, in order to estimate the unknown parameters of the epidemiological models. We use an adaptive Markov-chain Monte-Carlo (MCMC) algorithm for the estimation of a posteriori probability distribution and confidence intervals for the unknown model parameters as well as for the reproduction number. Furthermore, we present a fatality analysis for COVID-19 in Austria, which is also of importance for governmental protective decision making. We perform our analyses on the publicly available data for Austria to estimate the main epidemiological model parameters and to study the effectiveness of the protective measures by the Austrian government. The estimated parameters and the analysis of fatalities provide useful information for decision makers and makes it possible to perform more realistic forecasts of future outbreaks.", "Case- fatality rate in COVID- 19 patients: A meta-analysis of publicly accessible database A novel coronavirus was reported in Wuhan, China in December 2019 to cause severe acute respiratory symptoms (COVID- 19). In this meta-analysis, we estimated case fatality rate from COVID- 19 infection by random effect meta-analysis model with country level data. Publicly accessible web database WorldOMeter (https://www.worldometers.info/coronavirus/) was accessed on 24th March 2020 GMT and reported total number of cases, total death, active cases and seriously ill/ critically ill patients were retrieved. Primary outcome of this meta-analysis was case fatality rate defined by total number of deaths divided by total number of diagnosed cases. Pooled case fatality rate (95% CI) was 1.78 (1.34- 2.22) %. Between country heterogeneity was 0.018 (p<0.0001). Pooled estimate of composite poor outcome (95% CI) was 4.06 (3.24- 4.88) % at that point of time after exclusion of countries reported small number of cases. Pooled mortality rate (95% CI) was 33.97 (27.44- 40.49) % amongst closed cases (where patients have recovered or died) with. Meta regression analysis identified statistically significant association between health expenditure and mortality amongst closed cases (p=0.037).", "Maybe not an overreaction ", "Semiparametric Bayesian Inference for the Transmission Dynamics of COVID-19 with a State-Space Model The outbreak of Coronavirus Disease 2019 (COVID-19) is an ongoing pandemic affecting over 200 countries and regions. Inference about the transmission dynamics of COVID-19 can provide important insights into the speed of disease spread and the effects of mitigation policies. We develop a novel Bayesian approach to such inference based on a probabilistic compartmental model using data of daily confirmed COVID-19 cases. In particular, we consider a probabilistic extension of the classical susceptible-infectious-recovered model, which takes into account undocumented infections and allows the epidemiological parameters to vary over time. We estimate the disease transmission rate via a Gaussian process prior, which captures nonlinear changes over time without the need of specific parametric assumptions. We utilize a parallel-tempering Markov chain Monte Carlo algorithm to efficiently sample from the highly correlated posterior space. Predictions for future observations are done by sampling from their posterior predictive distributions. Performance of the proposed approach is assessed using simulated datasets. Finally, our approach is applied to COVID-19 data from four states of the United States: Washington, New York, California, and Illinois. An R package BaySIR is made available at https://github.com/tianjianzhou/BaySIR for the public to conduct independent analysis or reproduce the results in this paper.", "Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (COVID-19) BACKGROUND: Estimation of the fraction and contagiousness of undocumented novel coronavirus (COVID-19) infections is critical for understanding the overall prevalence and pandemic potential of this disease. Many mild infections are typically not reported and, depending on their contagiousness, may support stealth transmission and the spread of documented infection. METHODS: Here we use observations of reported infection and spread within China in conjunction with mobility data, a networked dynamic metapopulation model and Bayesian inference, to infer critical epidemiological characteristics associated with the emerging coronavirus, including the fraction of undocumented infections and their contagiousness. RESULTS: We estimate 86% of all infections were undocumented (95% CI: [82%\u221290%]) prior to the Wuhan travel shutdown (January 23, 2020). Per person, these undocumented infections were 52% as contagious as documented infections ([44%\u221269%]) and were the source of infection for two-thirds of documented cases. Our estimate of the reproductive number (2.23; [1.77\u20133.00]) aligns with earlier findings; however, after travel restrictions and control measures were imposed this number falls considerably. CONCLUSIONS: A majority of COVID-19 infections were undocumented prior to implementation of control measures on January 23, and these undocumented infections substantially contributed to virus transmission. These findings explain the rapid geographic spread of COVID-19 and indicate containment of this virus will be particularly challenging. Our findings also indicate that heightened awareness of the outbreak, increased use of personal protective measures, and travel restriction have been associated with reductions of the overall force of infection; however, it is unclear whether this reduction will be sufficient to stem the virus spread.", "Estimation of seroprevalence of novel coronavirus disease (COVID-19) using preserved serum at an outpatient setting in Kobe, Japan: A cross-sectional study. Summary Background Coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 has been affecting many people on earth and our society. Japan is known to have relatively less number of infections as well as deaths among developed nations. However, accurate prevalence of COVID-19 in Japan remains unknown. Therefore, we conducted a cross-sectional study to estimate seroprevalence of SARS-CoV-2 infection. Methods We conducted a cross-sectional serologic testing for SARS-CoV-2 antibody using 1,000 samples from patients at outpatient settings who visited the clinic from March 31 to April 7, 2020, stratified by decade of age and sex. Results There were 33 positive IgG among 1,000 serum samples (3.3%, 95%CI: 2.3-4.6%). By applying this figure to the census of Kobe City (poplation: 1,518,870), it is estimated that the number of people with positive IgG be 50,123 (95%CI: 34,934-69,868). Age and sex adjusted prevalence of positivity was 2.7% (95%CI 1.8-3.9%), and the estimated number of people with positive IgG was 40,999 (95%CI: 27,333-59,221). These numbers were 396 to 858 fold more than confirmed cases with PCR testing in Kobe City. Conclusions Our cross-sectional serological study suggests that the number of people with seropositive for SARS-CoV-2 infection in Kobe, Japan is far more than the confirmed cases by PCR testing.", "Epidemiological Analysis of the First 1389 Cases of COVID-19 in Poland: A Preliminary Report BACKGROUND The World Health Organization has declared COVID-19 a global pandemic. This paper presents an epidemiological analysis of the first phase of the COVID-19 epidemic in Poland. MATERIAL AND METHODS This cross-sectional study was carried out between 3 and 27 March 2020 on a sample of 1389 laboratory-confirmed COVID-19 cases in Poland. Data were obtained from epidemiological reports collected by the Chief Sanitary Inspectorate. Analysis includes the number of COVID-19 cases, number of deaths, number of hospitalizations, number of people quarantined, and number of laboratory tests performed. RESULTS The first case was confirmed on 4 March 2020. Over 24 days after the first case, the total number of confirmed infections rose to 1389 (34,000 laboratory tests were performed). The highest incidence rates (over 5 per 100,000) were observed in the 2 central administrative regions (Mazowieckie and L\u00f3dzkie) and in the south-western region of Dolnoslaskie, which borders the Czech Republic and Germany. Based on available data about age and sex, a clearly higher incidence was observed in the 20-29 years (4.0 per 100,000), 40-49 years (4.1 per 100,000), and 50-59 years (4.3 per 100,000) age groups. In the period analyzed (24 days), there were 16 confirmed deaths (average age 65.5 years; 81.2% males). CONCLUSIONS The proportion of women and men with confirmed COVID-19 infection was similar to the sex ratio in the general population. Infections were relatively less common in those aged under 20 years. The largest numbers of confirmed cases were detected in 3 of the 4 largest cities, each of which has an international airport.", "Paucity and disparity of publicly available sex-disaggregated data for the COVID-19 epidemic hamper evidence-based decision-making COVID-19 has joined the long list of human disorders with sexually dimorphic expression. Increased lethality in men was evident in the first large reports from ChinaCDC and WHO-China, and the gender gap appeared even wider in the early Italian outbreak. Newspapers and scientific journals alike have commented on this finding and the preexisting conditions, biological processes, and gender role behavior differences that may underlie it. However, as for other diseases, and in spite of years of advocating for the collection of raw epidemiological data and the analysis of clinical trial data sets by sex, very little appeared to be released about sex differences in characteristics of the epidemics beyond infection and death rates, such as severity of disease, comorbidities, rate of recovery, length of hospital stay, or number of tests for the SARS-CoV-2 coronavirus. These data are critical not only for scientists to understand the pathophysiology of disease, but also to inform decision-making by countries and healthcare systems on how to prioritize testing and best allocate scarce resources and relief funds. Systematic analysis of official websites for the 20 countries and 6 US states reporting the highest number of cases on March 21, 2020, revealed a wide disparity in sex-disaggregated data made available to the public and scholars. Only a handful of the countries reported cases by sex separately. None of the other characteristics, including fatality rates, were stratified by sex at the time. Beyond suboptimal sex disaggregation, our analysis found a paucity of usable raw data sets and a generalized lack of standardization of captured data, making comparisons difficult. A second round of data capture in April found more complete, but even more disparate, information. Our analysis revealed a wide range of sex ratios among confirmed cases, which changed over time. In countries where a male-biased sex ratio was initially reported, the reported proportion of women among cases dramatically increased in under 3 weeks. In contrast, men were consistently over-represented in severe cases, intensive care admissions, and deaths. We also show that the sex ratio varies with age, with a complex pattern, reproduced across the 6 countries for which data were found. Accurate, peer-reviewed, statistical analysis of harmonized, sex-disaggregated data for other characteristics of epidemics, such as availability of testing, suspected source of infection, or comorbidities will be critical to understand where the observed disparities come from and to generate evidence-based recommendations for decision-making by institutions and governments around the world.", "Modelling the COVID-19 epidemics in Brasil: Parametric identification and public health measures influence A SIRU-type epidemic model is proposed for the prediction of COVID-19 spreading within Brasil, and analyse the influence of public health measures on simulating the control of this infectious disease. Since the reported cases are typically only a fraction of the total number of the symptomatic infectious individuals, the model accounts for both reported and unreported cases. Also, the model allows for the time variation of both the transmission rate and the fraction of asymptomatic infectious that become reported symptomatic individuals, so as to reflect public health interventions, towards its control, along the course of the epidemic evolution. An analytical exponential behaviour for the accumulated reported cases evolution is assumed at the onset of the epidemy, for explicitly estimating initial conditions, while a Bayesian inference approach is adopted for parametric estimations employing the present direct problem model with the data from the known portion of the epidemics evolution, represented by the time series for the reported cases of infected individuals. The direct-inverse problem analysis is then employed with the actual data from China, with the first half been employed for the parametric estimation and the second half for validation of the predictive capability of the proposed approach. The full dataset for China is then employed in another parameter identification, including the average times that asymptomatic infectious individuals and that symptomatic individuals are infectious. Following this validation, the available data on reported cases in Brasil from February 15th till March 29th, 2020, is used for estimating parameters and then predict the epidemy evolution under these conditions. Finally, public health interventions are simulated, aimed at diminishing the effects of the disease spreading, by acting on both the transmission rate and the fraction of the total number of the symptomatic infectious individuals, considering time variable exponential behaviours for these two parameters, usually assumed constant in epidemic evolutions without intervention. It is demonstrated that a combination of actions to affect both parameters can have a much faster and effective result in the control of the epidemy dynamics.", "Transmission Dynamics of COVID-19 and Impact on Public Health Policy In this work we construct a mathematical model for the transmission and spread of coronavirus disease 2019 or COVID-19. Our model features delay terms to account for (a) the time lapse or latency period between contracting the disease and displaying symptoms, and (b) the time lag in testing patients for the virus due to the limited numbers of testing facilities currently available. We find that the delay introduces a significant disparity between the actual and reported time-trajectories of cases in a particular region. Specifically, the reported case histories lag the actual histories by a few days. Hence, to minimize the spread of the disease, lockdowns and similarly drastic social isolation measures need to be imposed some time before the reported figures are approaching their peak values. We then account for the social reality that lockdowns can only be of a limited duration in view of practical considerations. We find that the most effective interval for imposing such a limited-time lockdown is one where the midpoint of the lockdown period coincides with the actual peak of the spread of the disease in the absence of the lockdown. We further show that the true effectivity of imposing a lockdown may be misrepresented and grossly underestimated by the reported case trajectories in the days following the action.", "The Late Arrival of COVID-19 in Africa - Mitigating Pan-Continental Spread ", "Can the COVID-19 epidemic be controlled on the basis of daily test reports? This paper studies if and to which extent COVID-19 epidemics can be controlled by authorities taking decisions on public health measures on the basis of daily reports of swab test results, active cases and total cases. A suitably simplified process model is derived to support the controllability analysis, highlighting the presence of very significant time delay; the model is validated with data from several outbreaks. The analysis shows that suppression strategies can be effective if strong enough and enacted early on. It also shows how mitigation strategies can fail because of the combination of delay, unstable dynamics, and uncertainty in the feedback loop; approximate conditions based on the theory of limitation of linear control are given for feedback control to be feasible.", "Benchmarking the CoVID-19 pandemic across countries and states in the U.S.A. under heterogeneous testing Public health officials need to make urgent decisions to reduce the potential impact of the CoVID-19 pandemic. Benchmarking based on the increase in total cases or case fatality rates is one way of comparing performance across countries or territories (such as states in the USA), and could inform policy decisions about COVID-19 mitigation strategies. But comparing cases and fatality across territories is challenging due to heterogeneity in testing and health systems. We show two complementary ways of benchmarking across countries or US states. First, we used multivariate regressions to estimate the test-elasticity-of-COVID-19-case-incidence. We found a 10% increase in testing yielded ~9% (95% CI:4.2-13.4%; p<0.001) increase in reported cases across countries, and ~2% (95%CI:0.1-3.4%; p=0.03) increase across US states during the week ending April 10th, 2020. We found comparable negative elasticities for fatality rates (across countries: beta;=-0.77, 95%CI:-1.40- -0.14; p=0.02; US states: beta;=-0.15, 95%CI:-0.30-0.01; p=0.06). Our results were robust to various model specifications. Second, we decomposed the growth in cases into test growth and positive test ratio (PTR) growth to intuitively visualize the components of case growth. We hope these results can help support evidence-based decisions by public health officials as more consistent data hopefully becomes available.", "Laboratory Testing Methods for Novel Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) Following the first reports of coronavirus disease-19 (COVID-19) by China to the World Health Organization (WHO) on 31st December 2019, more than 4,302,774 novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) cases have been reported by authorities in 212 countries and territories by 12th May 2020. The outbreak and spread of COVID-19 worldwide, highlights the critical need for developing rapid and accurate diagnostic testing methods for emerging human coronavirus (CoV) infections. Testing is crucial to track the spread of disease during a pandemic, and to swiftly permit public health interventions including isolation, quarantine, and appropriate clinical management of afflicted individuals. The key components of viral diagnostic tests are (1) collection of the appropriate sample (blood, nasal swab, and throat swab), (2) availability of the genetic and proteomic sequences of the novel virus for analysis, and (3) rapid and accurate laboratory testing methods. The current gold standard for the molecular diagnosis of SARS-CoV-2 infection is the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for the qualitative and quantitative detection of viral nucleic acids. Other relevant laboratory methods include enzyme-linked immunoassays (EIA) for viral antibody and antigen detection, and serum viral neutralization (SVN) assays for antibody neutralization determination. The challenges faced in developing a diagnostic test for a novel pathogen are the ability to measure low viral loads for early detection, to provide low or no cross-reactivity with other viral strains and to deliver results rapidly. Several point-of-care molecular devices are currently being integrated for fast and accurate diagnosis of SARS-CoV-2 infections. This review discusses the current laboratory methods available to test for coronaviruses by focusing on the present COVID-19 outbreak.", "COVID-19 in England: spatial patterns and regional outbreaks Aims: to investigate the spatiotemporal distribution of COVID-19 cases in England; to provide spatial quantification of risk at a high resolution; to provide information for prospective antigen and serological testing. Approach: We fit a spatiotemporal Negative Binomial generalised linear model to Public Health England SARS-CoV-2 testing data at the Lower Tier Local Authority region level. We assume an order-1 autoregressive model for case progression within regions, coupling discrete spatial units via observed commuting data and time-varying measures of traffic flow. We fit the model via maximum likelihood estimation in order to calculate region-specific risk of ongoing transmission, as well as measuring regional uncertainty in incidence. Results: We detect marked heterogeneity across England in COVID-19 incidence, not only in raw estimated incidence, but in the characteristics of within-region and between-region dynamics of PHE testing data. There is evidence for a spatially diverse set of regions having a higher daily increase of cases than others, having accounted for current case numbers, population size, and human mobility. Uncertainty in model estimates is generally greater in rural regions. Conclusions: A wide range of spatial heterogeneity in COVID-19 epidemic distribution and infection rate exists in England currently. Future work should incorporate fine-scaled demographic and health covariates, with continued improvement in spatially-detailed case reporting data. The method described here may be used to measure heterogeneity in real-time as behavioural and social interventions are relaxed, serving to identify \"hotspots\" of resurgent cases occurring in diverse areas of the country, and triggering locally-intensive surveillance and interventions as needed. Caveats: There is general concern over the ability of PHE testing data to capture the true prevalence of infection within the population, though this approach is designed to provide measures of spatial prevalence based on testing that can be used to guide further future testing effort. Now-casts of epidemic characteristics are presented based on testing data alone (as opposed to \"true\" prevalence in any one area). The model used in this analysis is phenomenological for ease and speed of principled parameter inference; we choose the model which best fits the current spatial case timeseries, without attempting to enforce \"SIR\"-type epidemic dynamics.", "Ongoing outbreak of COVID-19 in Iran: challenges and signs of concern Since the first outbreak in China, the Coronavirus Disease 2019 (COVID-19) has rapidly spread around the world. Iran was one of the first countries outside of China to report infections with COVID-19. With nearly 100 exported cases to various other countries, it has since been the epicentre of the outbreak in the Middle east. By examining the age-stratified COVID-19 case fatality rates across the country and 14 university hospitals in Tehran, we find that, in younger age groups, the reported cases on 13/03/2020 only capture less than 10% of symptomatic cases in the population. This indicates significant levels of under-reporting in Iran. Using the 18 full-genome sequences from cases with a travel history or link to Iran, as well as the one full genome sequence obtained from within the country, we estimate the time to the most recent common ancestor of sequences which suggests the likely start of the outbreak on 21/01/2020 (95% HPD: 05/12/2019 - 14/02/2020) with an approximate doubling time of 3.07 (95% HPD: 1.68 - 16.27). Also, based on known exported cases to Oman, Kuwait, Lebanon, and China, we estimate the outbreak size on 25 February and 6 March to be around 13,700 (95% CI: 7,600 - 33,300) and 60,500 (43,200 - 209,200), respectively. Knowing the size of the outbreak at two time points and the typical doubling times associated with the COVID-19 epidemics in countries across Europe and North America, we can independently verify that the likely start of epidemic in Iran is around 15/01/2020 (27/12/2019 - 24/01/2020). Our assessment of the fate of the epidemic based on current levels of non-pharmaceutical interventions implemented by the government suggests upward of 10 million cases (IQR: 6.7M - 18M) and 100,000 ICU beds required (IQR: 77K - 140K) during the peak of the epidemic with more than 100,000 cumulative deaths (IQR: 180K - 240K). We also predict a peak in demand for ICU beds on 21/04/2020 (IQR: 06/04/2020 - 23/05/2020). The large span of the peak of the ICU demand is a result of two separate peaks, with the first occurring at around 15/4/2020 and the second in approximately a months time. The latter is also expected to last longer and is based on the relatively relaxed social distancing measures in place. The exact magnitude and timing of the peaks strictly depends on levels of interventions and can change significantly upon new information or change of policy. We caution that a lack of, or relaxed, stringent intervention measures, during a period of highly under-reported spread, would likely lead to the healthcare system becoming overwhelmed in the next few months.", "Frequency of testing for COVID 19 infection and the presence of higher number of available beds per country predict outcomes with the infection, not the GDP of the country - A descriptive statistical analysis Introduction: The novel coronavirus epidemic which originated in late 2019 from China has wreaked havoc on millions across the world with illness, death and socioeconomic recession. As of now no valid treatment or preventative strategy has evolved worldwide and governments across the world have been forced to take the draconian step of social isolation in communities by enforcing lockdowns. Aim of this Study: This study aims to correlate the rates of infection with the novel coronavirus and total deaths as the primary output variable. In addition the strength of association between infection rates and total death in comparison to GDP share of the respective countries, physicians, hospital beds and rates of testing for COVID 19 infection per thousand patients, is being assessed, in a bid to develop a model which would help to develop tools to reduce the impact of this disease. Material & Methods Data relating to number of cases, severity, cases recovered and deaths worldwide and specifically for the top six countries affected was collected from the WHO COVID-19 situation report which is being updated on a daily basis till 22nd March 2020, the date of analysis. Additional data related to GDP, physician and hospital bed per 1000 patients were procured from the World Bank database. All data were collected in a file in CSV format. Analysis was conducted in Jupyter notebook with Python 3.8.2 software and also with XL-Stat statistical software for excel. The analytical strategy was descriptive with no inferential overtones. Results: COVID 19 infection strongly correlates with total deaths (r : 0.89), with a predicted death rate of 25 patients per 1000 affected. There was no correlation between the GDP growth of the country and number of treating physicians/1000 patient population with any COVID 19 related outcome. However there was a negative correlation between COVID 19-related deaths and the number of beds available per 1000 population [r=-0.34]. Importantly there is an inverse correlation between the number of tests conducted per million population with the rates of active infections [r=-0.12] , new cases [r=-0.38] and new deaths [r=-0.28] in COVID 19. Conclusion: This is the first study to assess parameters other than age and sex and sets out a robust dataset which indicates an increased risk of worsening outcomes with lesser number of beds and testing, suggesting that the need of the hour is to increase available bed numbers and to increase rates of testing.", "Test, test, test for COVID-19 antibodies: the importance of sensitivity, specificity and predictive powers Abstract SARS-CoV-2 antibody tests of varying specificity and sensitivity are now available. For informing individuals whether they have had COVID-19, they need to be very accurate. For measuring population prevalence of past infection, the numbers of false positives and negatives need to be roughly equal. With a series of worked examples for a notional population of 100,000 people, we show that even test systems with a high specificity can yield a large number of false positive results, especially where the population prevalence is low. For example, at a true population prevalence of 5%, using a test with 99% sensitivity and specificity, 16% of positive results will be false and thus 950 people will be incorrectly informed they have had the infection. Further confirmatory testing may be needed. Giving false reassurance upon which personal or societal decisions might be based could be harmful for individuals, undermine public confidence and foster further outbreaks.", "Antibody tests for identification of current and past infection with SARS-CoV-2. BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and resulting COVID-19 pandemic present important diagnostic challenges. Several diagnostic strategies are available to identify current infection, rule out infection, identify people in need of care escalation, or to test for past infection and immune response. Serology tests to detect the presence of antibodies to SARS-CoV-2 aim to identify previous SARS-CoV-2 infection, and may help to confirm the presence of current infection. OBJECTIVES To assess the diagnostic accuracy of antibody tests to determine if a person presenting in the community or in primary or secondary care has SARS-CoV-2 infection, or has previously had SARS-CoV-2 infection, and the accuracy of antibody tests for use in seroprevalence surveys. SEARCH METHODS We undertook electronic searches in the Cochrane COVID-19 Study Register and the COVID-19 Living Evidence Database from the University of Bern, which is updated daily with published articles from PubMed and Embase and with preprints from medRxiv and bioRxiv. In addition, we checked repositories of COVID-19 publications. We did not apply any language restrictions. We conducted searches for this review iteration up to 27 April 2020. SELECTION CRITERIA We included test accuracy studies of any design that evaluated antibody tests (including enzyme-linked immunosorbent assays, chemiluminescence immunoassays, and lateral flow assays) in people suspected of current or previous SARS-CoV-2 infection, or where tests were used to screen for infection. We also included studies of people either known to have, or not to have SARS-CoV-2 infection. We included all reference standards to define the presence or absence of SARS-CoV-2 (including reverse transcription polymerase chain reaction tests (RT-PCR) and clinical diagnostic criteria). DATA COLLECTION AND ANALYSIS We assessed possible bias and applicability of the studies using the QUADAS-2 tool. We extracted 2x2 contingency table data and present sensitivity and specificity for each antibody (or combination of antibodies) using paired forest plots. We pooled data using random-effects logistic regression where appropriate, stratifying by time since post-symptom onset. We tabulated available data by test manufacturer. We have presented uncertainty in estimates of sensitivity and specificity using 95% confidence intervals (CIs). MAIN RESULTS We included 57 publications reporting on a total of 54 study cohorts with 15,976 samples, of which 8526 were from cases of SARS-CoV-2 infection. Studies were conducted in Asia (n = 38), Europe (n = 15), and the USA and China (n = 1). We identified data from 25 commercial tests and numerous in-house assays, a small fraction of the 279 antibody assays listed by the Foundation for Innovative Diagnostics. More than half (n = 28) of the studies included were only available as preprints. We had concerns about risk of bias and applicability. Common issues were use of multi-group designs (n = 29), inclusion of only COVID-19 cases (n = 19), lack of blinding of the index test (n = 49) and reference standard (n = 29), differential verification (n = 22), and the lack of clarity about participant numbers, characteristics and study exclusions (n = 47). Most studies (n = 44) only included people hospitalised due to suspected or confirmed COVID-19 infection. There were no studies exclusively in asymptomatic participants. Two-thirds of the studies (n = 33) defined COVID-19 cases based on RT-PCR results alone, ignoring the potential for false-negative RT-PCR results. We observed evidence of selective publication of study findings through omission of the identity of tests (n = 5). We observed substantial heterogeneity in sensitivities of IgA, IgM and IgG antibodies, or combinations thereof, for results aggregated across different time periods post-symptom onset (range 0% to 100% for all target antibodies). We thus based the main results of the review on the 38 studies that stratified results by time since symptom onset. The numbers of individuals contributing data within each study each week are small and are usually not based on tracking the same groups of patients over time. Pooled results for IgG, IgM, IgA, total antibodies and IgG/IgM all showed low sensitivity during the first week since onset of symptoms (all less than 30.1%), rising in the second week and reaching their highest values in the third week. The combination of IgG/IgM had a sensitivity of 30.1% (95% CI 21.4 to 40.7) for 1 to 7 days, 72.2% (95% CI 63.5 to 79.5) for 8 to 14 days, 91.4% (95% CI 87.0 to 94.4) for 15 to 21 days. Estimates of accuracy beyond three weeks are based on smaller sample sizes and fewer studies. For 21 to 35 days, pooled sensitivities for IgG/IgM were 96.0% (95% CI 90.6 to 98.3). There are insufficient studies to estimate sensitivity of tests beyond 35 days post-symptom onset. Summary specificities (provided in 35 studies) exceeded 98% for all target antibodies with confidence intervals no more than 2 percentage points wide. False-positive results were more common where COVID-19 had been suspected and ruled out, but numbers were small and the difference was within the range expected by chance. Assuming a prevalence of 50%, a value considered possible in healthcare workers who have suffered respiratory symptoms, we would anticipate that 43 (28 to 65) would be missed and 7 (3 to 14) would be falsely positive in 1000 people undergoing IgG/IgM testing at days 15 to 21 post-symptom onset. At a prevalence of 20%, a likely value in surveys in high-risk settings, 17 (11 to 26) would be missed per 1000 people tested and 10 (5 to 22) would be falsely positive. At a lower prevalence of 5%, a likely value in national surveys, 4 (3 to 7) would be missed per 1000 tested, and 12 (6 to 27) would be falsely positive. Analyses showed small differences in sensitivity between assay type, but methodological concerns and sparse data prevent comparisons between test brands. AUTHORS' CONCLUSIONS The sensitivity of antibody tests is too low in the first week since symptom onset to have a primary role for the diagnosis of COVID-19, but they may still have a role complementing other testing in individuals presenting later, when RT-PCR tests are negative, or are not done. Antibody tests are likely to have a useful role for detecting previous SARS-CoV-2 infection if used 15 or more days after the onset of symptoms. However, the duration of antibody rises is currently unknown, and we found very little data beyond 35 days post-symptom onset. We are therefore uncertain about the utility of these tests for seroprevalence surveys for public health management purposes. Concerns about high risk of bias and applicability make it likely that the accuracy of tests when used in clinical care will be lower than reported in the included studies. Sensitivity has mainly been evaluated in hospitalised patients, so it is unclear whether the tests are able to detect lower antibody levels likely seen with milder and asymptomatic COVID-19 disease. The design, execution and reporting of studies of the accuracy of COVID-19 tests requires considerable improvement. Studies must report data on sensitivity disaggregated by time since onset of symptoms. COVID-19-positive cases who are RT-PCR-negative should be included as well as those confirmed RT-PCR, in accordance with the World Health Organization (WHO) and China National Health Commission of the People's Republic of China (CDC) case definitions. We were only able to obtain data from a small proportion of available tests, and action is needed to ensure that all results of test evaluations are available in the public domain to prevent selective reporting. This is a fast-moving field and we plan ongoing updates of this living systematic review.", "Estimation of local novel coronavirus (COVID-19) cases in Wuhan, China from off-site reported cases and population flow data from different sources Backgrounds: In December 2019, a novel coronavirus (COVID-19) pneumonia hit Wuhan, Hubei Province, China and spread to the rest of China and overseas. The emergence of this virus coincided with the Spring Festival Travel Rush in China. It is possible to estimate total number of cases of COVID-19 in Wuhan, by 23 January 2020, given the cases reported in other cities and population flow data between cities. Methods: We built a model to estimate the total number of cases in Wuhan by 23 January 2020, based on the number of cases detected outside Wuhan city in China, with the assumption that if the same screening effort used in other cities applied in Wuhan. We employed population flow data from different sources between Wuhan and other cities/regions by 23 January 2020. The number of total cases was determined by the maximum log likelihood estimation. Findings: From overall cities/regions data, we predicted 1326 (95% CI: 1177, 1484), 1151 (95% CI: 1018, 1292) and 5277 (95% CI: 4732, 5859) as total cases in Wuhan by 23 January 2020, based on different source of data from Changjiang Daily newspaper, Tencent, and Baidu. From separate cities/regions data, we estimated 1059 (95% CI: 918, 1209), 5214 (95% CI: 4659, 5808) as total cases in Wuhan in Wuhan by 23 January 2020, based on different sources of population flow data from Tencent and Baidu. Conclusion: Sources of population follow data and methods impact the estimates of local cases in Wuhan before city lock down. Keyword: COVID-19; mobility; pneumonia; transportation; outbreaks", "Coronavirus disease (COVID-19) Community Testing Team in Scotland: A 14-day review, 6 to 20 February 2020 In response to the outbreak of COVID-19, we set up a team to carry out sampling in the community. This enabled individuals to remain in self-isolation in their own homes and to prevent healthcare settings and services from being overwhelmed by admissions for sampling of suspected cases. There is evidence that this is a cost effective, safe and necessary service to complement COVID-19 testing in hospitals.", "Now-casting the COVID-19 epidemic: The use case of Japan, March 2020 Background Reporting delays in disease surveillance impair the ability to assess the current dynamic of an epidemic. In continuously updated epidemic curves, case numbers for the most recent epidemic week or day usually appear to be lower than the previous, suggesting a decline of the epidemic. In reality, the epidemic curve may still be on the rise, because reporting delay prevents the most recent cases to appear in the case count. In context of the COVID-19 epidemic and for countries planning large international gatherings, such as the Summer Olympic Games in Japan 2020, the ability to assess the actual stage of an epidemic is of outmost importance. Methods We applied now-casting onto COVID-19 data provided by the nCoV-2019 Data Working Group to evaluate the .true count of cases, by taking into account reporting delays occurring between date of symptom onset and date of confirmation. Findings We calculated a decrease of reporting delay, from a median delay of ten days in calendar week four 2020 to six days in calendar week eight, resulting in an overall mean of 4.3 days. The confidence intervals of the now-casting indicated an increase of cases in the last reporting days, while case country in that same time period suggested a decline. Interpretation As a specific use case this tool may be of particular value for the challenging risk assessment and risk communication in the context of the Summer Olympic Games in Japan 2020 and similar situations elsewhere.", "Estimating the Early Outbreak Cumulative Incidence of COVID-19 in the United States: Three Complementary Approaches Effectively designing and evaluating public health responses to the ongoing COVID-19 pandemic requires accurate estimation of the weekly incidence of COVID-19. Unfortunately, a lack of systematic testing across the United States (US) due to equipment shortages and varying testing strategies has hindered the usefulness of the reported positive COVID-19 case counts. We introduce three complementary approaches to estimate the cumulative incidence of symptomatic COVID-19 during the early outbreak in each state in the US as well as in New York City, using a combination of excess influenza-like illness reports, COVID-19 test statistics, and COVID-19 mortality reports. Instead of relying on an estimate from a single data source or method that may be biased, we provide multiple estimates, each relying on different assumptions and data sources. Across our three approaches, there is a consistent conclusion that estimated state-level COVID-19 symptomatic case counts from March 1 to April 4, 2020 varied from 5 to 50 times greater than the official positive test counts. Nationally, our estimates of COVID-19 symptomatic cases in the US as of April 4 have a likely range of 2.2 to 5.1 million cases, with possibly as high as 8.1 million cases, up to 26 times greater than the cumulative confirmed cases of about 311,000. Extending our method to May 16, 2020, we estimate that cumulative symptomatic incidence ranges from 6.0 to 12.2 million, which compares with 1.5 million positive test counts. Our approaches demonstrate the value of leveraging existing influenza-like-illness surveillance systems during the flu season for measuring the burden of new diseases that share symptoms with influenza-like-illnesses. Our methods may prove useful in assessing the burden of COVID-19 during upcoming flu seasons in the US and other countries with comparable influenza surveillance systems.", "Determination of daily reproduction numbers of SARS-CoV2 based on death cases suggests more rapid initial spread in Italy and the United States Population density, behaviour and cultural habits strongly influence the spread of pathogens. Consequently, key epidemiological parameters may vary from country to country. Confirmed COVID-19 cases in in China have been used to estimate those parameters, that vary largely (reviewed in 1). The estimates also depend on testing frequency and case definitions that are prone to change during ongoing epidemics, providing additional uncertainties. The rise in fatal cases due to SARS-CoV2 could be a more reliable parameter, since missing of deaths is less likely. In the absence of changes in the management of severe COVID-19 cases, the rise in death cases should be proportional to the rise in virus infections. Although the fluctuating low numbers of fatal cases very early in the epidemic may lead to some uncertainty, more than 100 deaths per day are reported since 10.03.2020 in Italy and since 21.03.2020 in the US. Therefore, the dynamics of deaths were analysed to estimate the daily reproduction numbers (Rt) and the effectiveness of control measures. Thus, our analysis provides evidence that basic epidemiological parameters differ between countries to an extent compromising epidemiological predictions of the pandemic. It also suggests that suppression of spread in Italy and the US may be more difficult to achieve. Although we assume that variations in social behaviour are responsible for the different estimates of R0, selection of more rapidly spreading variants of SARS-CoV-2 cannot be excluded. Despite uncertainty in the reliability of the data used and lack of information on possible changes in the effectiveness of registration of COVID-19 deaths during the observation period, our findings should be considered as a working hypothesis demanding further investigations. As the number of deaths rapidly increases worldwide, we encourage more sophisticated modelling of the epidemic based on the dynamics of death cases by experts in the field.", "Using statistics and mathematical modelling to understand infectious disease outbreaks: COVID-19 as an example During an infectious disease outbreak, biases in the data and complexities of the underlying dynamics pose significant challenges in mathematically modelling the outbreak and designing policy. Motivated by the ongoing response to COVID-19, we provide a toolkit of statistical and mathematical models beyond the simple SIR-type differential equation models for analysing the early stages of an outbreak and assessing interventions. In particular, we focus on parameter estimation in the presence of known biases in the data, and the effect of non-pharmaceutical interventions in enclosed subpopulations, such as households and care homes. We illustrate these methods by applying them to the COVID-19 pandemic.", "Estimating the COVID-19 Infection Rate: Anatomy of an Inference Problem As a consequence of missing data on tests for infection and imperfect accuracy of tests, reported rates of population infection by the SARS CoV-2 virus are lower than actual rates of infection. Hence, reported rates of severe illness conditional on infection are higher than actual rates. Understanding the time path of the COVID-19 pandemic has been hampered by the absence of bounds on infection rates that are credible and informative. This paper explains the logical problem of bounding these rates and reports illustrative findings, using data from Illinois, New York, and Italy. We combine the data with assumptions on the infection rate in the untested population and on the accuracy of the tests that appear credible in the current context. We find that the infection rate might be substantially higher than reported. We also find that the infection fatality rate in Italy is substantially lower than reported.", "A cascade of causes that led to the COVID-19 tragedy in Italy and in other European Union countries ", "Estimating unobserved SARS-CoV-2 infections in the United States By March 2020, COVID-19 led to thousands of deaths and disrupted economic activity worldwide. As a result of narrow case definitions and limited capacity for testing, the number of unobserved SARS-CoV-2 infections during its initial invasion of the US remains unknown. We developed an approach for estimating the number of unobserved infections based on data that are commonly available shortly after the emergence of a new infectious disease. The logic of our approach is, in essence, that there are bounds on the amount of exponential growth of new infections that can occur during the first few weeks after imported cases start appearing. Applying that logic to data on imported cases and local deaths in the US through March 12, we estimated that 22,876 (95% posterior predictive interval: 7,451 - 53,044) infections occurred in the US by this date. By comparing the model's predictions of symptomatic infections to local cases reported over time, we obtained daily estimates of the proportion of symptomatic infections detected by surveillance. This revealed that detection of symptomatic infections decreased throughout February as exponential growth of infections outpaced increases in testing. Between February 21 and March 12, we estimated an increase in detection of symptomatic infections, which was strongly correlated (median: 0.97, 95% PPI: 0.85 - 0.98) with increases in testing. These results suggest that testing was a major limiting factor in assessing the extent of SARS-CoV-2 transmission during its initial invasion of the US.", "The Effect of Stay-at-Home Orders on COVID-19 Infections in the United States Background In March and April 2020, public health authorities in the United States acted to mitigate transmission of and hospitalizations from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). These actions were not coordinated at the national level, which raises the question of what might have happened if they were. It also creates an opportunity to use spatial and temporal variation to measure their effect with greater accuracy. Methods We combine publicly available data sources on the timing of stay-at-home orders and daily confirmed COVID-19 cases at the county level in the United States (N = 132,048). We then derive from the classic SIR model a two-way fixed-effects model and apply it to the data with controls for unmeasured differences between counties and over time. This enables us to estimate the effect of stay-at-home orders while accounting for local variation in factors like health systems and demographics, and temporal variation in national mitigation actions, access to tests, or exposure to media reports that could influence the course of the disease. Findings Mean county-level daily growth in COVID-19 infections peaked at 17.2% just before stay-at-home orders were issued. Two way fixed-effects regression estimates suggest that orders were associated with a 3.8 percentage point (95% CI 0.7 to 8.6) reduction in the growth rate after one week and an 8.6 percentage point (3.0 to 14.1) reduction after two weeks. By day 22 the reduction (18.2 percentage points, 12.3 to 24.0) had surpassed the growth at the peak, indicating that growth had turned negative and the number of new daily infections was beginning to decline. A hypothetical national stay-at-home order issued on March 13, 2020 when a national emergency was declared might have reduced cumulative county infections by 62.3%, and might have helped to reverse exponential growth in the disease by April 5. Interpretation Although stay-at-home orders impose great costs to society, delayed responses and piecemeal application of these orders generate similar costs without obtaining the full potential benefits suggested by this analysis. The results here suggest that a coordinated nationwide stay-at-home order may have reduced by hundreds of thousands the current number of infections and by thousands the total number of deaths from COVID-19. Future efforts in the United States and elsewhere to control pandemics should coordinate stay-at-home orders at the national level, especially for diseases for which local spread has already occurred and testing availability is delayed. Since stay-at-home orders reduce infection growth rates, early implementation when infection counts are still low would be most beneficial.", "Generic probabilistic modelling and non-homogeneity issues for the UK epidemic of COVID-19 Coronavirus COVID-19 spreads through the population mostly based on social contact. To gauge the potential for widespread contagion, to cope with associated uncertainty and to inform its mitigation, more accurate and robust modelling is centrally important for policy making. We provide a flexible modelling approach that increases the accuracy with which insights can be made. We use this to analyse different scenarios relevant to the COVID-19 situation in the UK. We present a stochastic model that captures the inherently probabilistic nature of contagion between population members. The computational nature of our model means that spatial constraints (e.g., communities and regions), the susceptibility of different age groups and other factors such as medical pre-histories can be incorporated with ease. We analyse different possible scenarios of the COVID-19 situation in the UK. Our model is robust to small changes in the parameters and is flexible in being able to deal with different scenarios. This approach goes beyond the convention of representing the spread of an epidemic through a fixed cycle of susceptibility, infection and recovery (SIR). It is important to emphasise that standard SIR-type models, unlike our model, are not flexible enough and are also not stochastic and hence should be used with extreme caution. Our model allows both heterogeneity and inherent uncertainty to be incorporated. Due to the scarcity of verified data, we draw insights by calibrating our model using parameters from other relevant sources, including agreement on average (mean field) with parameters in SIR-based models.", "Phenomenological Modelling of COVID-19 epidemics in Sri Lanka, Italy and Hebei Province of China The COVID-19 pandemic has resulted in increasing number of infections and deaths on a daily basis. There is no specific treatment or vaccine identified and the focus has been preventive measures based on statistical and mathematical models. These have relied on analyzing the behavior of populations and characteristics of the infection and applying modelling techniques. The analysis of epidemiological curve fitting on number of daily infections across affected countries could give useful insights on the characteristics of the epidemic. A variety of phenomenological models are available to capture dynamics of disease spread and growth. Data for this study used the number of daily new infections and cumulative number of infections in COVID-19 in three selected countries, Sri Lanka, Italy and Hebei province of China, from the first day of appearance of cases to 20th April 2020. In this study Gompertz, Logistic and Exponential growth curves were fitted on cumulative number of infections across countries. Akaikes information criteria (AIC) was used in determining the best fitting curve for each country. Results revealed that the most appropriate growth curves for Sri Lanka, Italy and China-Hebei are Exponential, Gompertz and Logistic curves respectively. The overall growth rate and final epidemic size evaluated from best models for the three countries and short-term forecasts were also generated. Log incidences over time in each country were regressed before and after the identified peak time of the respective outbreaks of countries. Hence, doubling time/halving time together with daily growth rates and predictions were estimated. Findings altogether demonstrate that outbreak seems extinct in Hebei-China whereas further transmissions are possible in Sri Lanka. In Italy, current outbreak transmits in a decreasing rate. Keywords: Novel Coronavirus (COVID-19), Phenomenological Models, Epidemiological Curve, Prediction", "Weather Conditions and COVID-19 Transmission: Estimates and Projections Background: Understanding and projecting the spread of COVID-19 requires reliable estimates of how weather components are associated with the transmission of the virus. Prior research on this topic has been inconclusive. Identifying key challenges to reliable estimation of weather impact on transmission we study this question using one of the largest assembled databases of COVID-19 infections and weather. Methods: We assemble a dataset that includes virus transmission and weather data across 3,739 locations from December 12, 2019 to April 22, 2020. Using simulation, we identify key challenges to reliable estimation of weather impacts on transmission, design a statistical method to overcome these challenges, and validate it in a blinded simulation study. Using this method and controlling for location-specific response trends we estimate how different weather variables are associated with the reproduction number for COVID-19. We then use the estimates to project the relative weather-related risk of COVID-19 transmission across the world and in large cities. Results: We show that the delay between exposure and detection of infection complicates the estimation of weather impact on COVID-19 transmission, potentially explaining significant variability in results to-date. Correcting for that distributed delay and offering conservative estimates, we find a negative relationship between temperatures above 25 degrees Celsius and estimated reproduction number ([R]), with each degree Celsius associated with a 3.1% (95% CI, 1.5% to 4.8%) reduction in [R]. Higher levels of relative humidity strengthen the negative effect of temperature above 25 degrees. Moreover, one millibar of additional pressure increases [R] by approximately 0.8 percent (95% CI, 0.6% to 1%) at the median pressure (1016 millibars) in our sample. We also find significant positive effects for wind speed, precipitation, and diurnal temperature on [R]. Sensitivity analysis and simulations show that results are robust to multiple assumptions. Despite conservative estimates, weather effects are associated with a 43% change in [R] between the 5th and 95th percentile of weather conditions in our sample. Conclusions: These results provide evidence for the relationship between several weather variables and the spread of COVID-19. However, the (conservatively) estimated relationships are not strong enough to seasonally control the epidemic in most locations.", "Forecasting the Worldwide Spread of COVID-19 based on Logistic Model and SEIR Model Background: With the outbreak of coronavirus disease 2019 (COVID-19), a sudden case increase in late February 2020 led to deep concern globally. Italy, South Korea, Iran, France, Germany, Spain, the US and Japan are probably the countries with the most severe outbreaks. Collecting epidemiological data and predicting epidemic trends are important for the development and measurement of public intervention strategies. Epidemic prediction results yielded by different mathematical models are inconsistent; therefore, we sought to compare different models and their prediction results to generate objective conclusions. Methods: We used the number of cases reported from January 23 to March 20, 2020, to estimate the possible spread size and peak time of COVID-19, especially in 8 high-risk countries. The logistic growth model, basic SEIR model and adjusted SEIR model were adopted for prediction. Given that different model inputs may infer different model outputs, we implemented three model predictions with three scenarios of epidemic development. Results: When comparing all 8 countries short-term prediction results and peak predictions, the differences among the models were relatively large. The logistic growth model estimated a smaller epidemic size than the basic SERI model did; however, once we added parameters that considered the effects of public health interventions and control measures, the adjusted SERI model results demonstrated a considerably rapid deceleration of epidemic development. Our results demonstrated that contact rate, quarantine scale, and the initial quarantine time and length are important factors in controlling epidemic size and length. Conclusions: We demonstrated a comparative assessment of the predictions of the COVID-19 outbreak in eight high-risk countries using multiple methods. By forecasting epidemic size and peak time as well as simulating the effects of public health interventions, the intent of this paper is to help clarify the transmission dynamics of COVID-19 and recommend operation suggestions to slow down the epidemic. It is suggested that the quick detection of cases, sufficient implementation of quarantine and public self-protection behaviors are critical to slow down the epidemic.", "Are Online Searches for the Novel Coronavirus (COVID-19) Related to Media or Epidemiology? A Cross-sectional Study Abstract Background Previous studies on the novel Coronavirus (COVID-19) have found strong correlations between online searches and the epidemiology of the disease. Aim Our aim was to determine if online searches for COVID-19 related to international media announcements or national epidemiology. Methods Searches for \u201ccoronavirus\u201d were made on Google Trends from December 31, 2019 to April 13, 2020 for 40 European countries. The online COVID-19 searches for all countries were correlated with each other. COVID-10 epidemiology (i.e. incidence and mortality) was correlated with the national online searches. Major announcements by the World Health Organization (WHO) were taken into consideration with peaks in online searches. Correlations were made using Spearman's rank correlation coefficient. Results Overall, the online searches for COVID-19 were not correlated with the actual incidence and mortality of COVID-19. The mean Spearman correlation for incidence was 0.20 (range -0.66 to 0.76) and for mortality was 0.35 (range -0.75 to 0.85). Online searches in Europe were all strongly synchronized with each other; a mean Spearman correlation of 0.93 (range 0.62 to 0.99). Conclusions Online searches for COVID-19 in Europe are not correlated with epidemiology but strongly correlated with international WHO announcements. Our study challenges previous Google Trends studies and emphasizes the role of the WHO in raising awareness of a new disease.", "TB infection and BCG vaccination: Are we protected from COVID-19? Abstract Objectives The incidence of emerging COVID-19 disease is variable across the different parts of the world. Apart from travel patterns, other factors determining this difference may include host immune response. Aim of this study was to assess the effect of TB endemicity and BCG coverage on COVID-19. Study design Cross sectional study. Methods We reviewed available data regarding tuberculosis incidence, BCG coverage (as per WHO), and COVID-19 incidence of 174 countries. We divided the countries into four cohorts depending upon annual TB incidence and BCG coverage. Results Countries with high TB incidence had lower COVID-19 as compared to countries with low TB incidence. Similarly, countries with high BCG coverage had lower incidence of COVID-19 suggesting some protective mechanisms in TB endemic areas. Although, the ecological differences and different testing strategies between countries could not be accounted for in this analysis. Conclusion Higher TB incidence and BCG coverage were found to be associated with lesser incidence of COVID-19. This outcome paves the way for further research into pathogenesis and immune response in COVID-19.", "Early analysis of the Australian COVID-19 epidemic As of 18 April 2020, there had been 6,533 confirmed cases of COVID-19 in Australia. Of these, 67 had died from the disease. The daily count of new confirmed cases was declining. This suggests that the collective actions of the Australian public and government authorities in response to COVID-19 were sufficiently early and assiduous to avert a public health crisis - for now. Analysing factors, such as the intensity and timing public health interventions, that contribute to individual country experiences of COVID-19 will assist in the next stage of response planning globally. Using data from the Australian national COVID-19 database, we describe how the epidemic and public health response unfolded in Australia up to 13 April 2020. We estimate that the effective reproduction number was likely below 1 (the threshold value for control) in each Australian state since mid-March and forecast that hospital ward and intensive care unit occupancy will remain below capacity thresholds over the next two weeks.", "Are official confirmed cases and fatalities counts good enough to study the COVID-19 pandemic dynamics? A critical assessment through the case of Italy As the COVID-19 outbreak is developing the two most frequently reported statistics seem to be the raw confirmed case and case fatalities counts. Focusing on Italy, one of the hardest hit countries, we look at how these two values could be put in perspective to reflect the dynamics of the virus spread. In particular, we find that merely considering the confirmed case counts would be very misleading. The number of daily tests grows, while the daily fraction of confirmed cases to total tests has a change point. It (depending on region) generally increases with strong fluctuations till (around, depending on region) 15th-22nd March and then decreases linearly after. Combined with the increasing trend of daily performed tests, the raw confirmed case counts are not representative of the situation and are confounded with the sampling effort. This we observe when regressing on time the logged fraction of positive tests and for comparison the logged raw confirmed count. Hence, calibrating model parameters for this virus's dynamics should not be done based only on confirmed case counts (without rescaling by the number of tests), but take also fatalities and hospitalization count under consideration as variables not prone to be distorted by testing efforts. Furthermore, reporting statistics on the national level does not say much about the dynamics of the disease, which are taking place at the regional level. These findings are based on the official data of total death counts up to 15th April 2020 released by ISTAT and up to 10th May 2020 for the number of cases. In this work we do not fit models but we rather investigate whether this task is possible at all. This work also informs about a new tool to collect and harmonize official statistics coming from different sources in the form of a package for the R statistical environment and presents the COVID-19 Data Hub.", "Early trends for SARS-CoV-2 infection in central and north Texas and impact on other circulating respiratory viruses Introduction: Rapid diagnosis and isolation are key to containing the rapid spread of a pandemic agent like SARS-CoV-2, which has spread globally since its initial outbreak in Wuhan province in China. SARS-CoV-2 is novel to most parts of the world including USA and the effect on normally prevalent viruses is just becoming apparent. We present our initial data on the prevalence of respiratory viruses in the month of March, 2020. Methods: This is a retrospective cohort study post launching of SARS-CoV-2 testing at BSWH, Temple TX. Testing for SARS-CoV-2 was performed by real-time RT-PCR assay and results were shared with State public health officials for immediate interventions. Results: More than 3500 tests were performed during the first two weeks of testing for SARS-CoV-2 and identified 168 (4.7%) positive patients. Sixty-two (3.2%) of the 1,912 ambulatory patients and 106 (6.3%) of the 1,659 ED/inpatients were tested positive. Higher rate of infection (6.9%) were noted in the patients belonging to age group 25-34 years and least number of positive cases were noted in <25 years old (2%) group. The TX State county specific patient demographic information was shared with respective public health departments for epidemiological interventions. Incidentally, this study showed that there was a sudden decrease in the occurrence of other infections due to seasonal viruses, perhaps due to increased epidemiological awareness, about SARS-CoV-2, among general public. Authors would also like to share a small study on SARS-CoV-2 serological assay for the detection of IgG antibodies. Conclusions: This study was intended to provide an initial experience of dealing with a pandemic and the role of laboratories in crisis management. Epidemiological interventions depend on timely availability of accurate diagnostic tests and throughput capacity of such systems during large outbreaks like SARS-CoV-2.", "Efficient prevalence estimation and infected sample identification with group testing for SARS-CoV-2 The ongoing pandemic of SARS-CoV-2, a novel coronavirus, caused over 3 million reported cases of coronavirus disease 2019 (COVID-19) and 200,000 reported deaths between December 2019 and April 2020(1). Cases and deaths will increase as the virus continues its global march outward. In the absence of effective pharmaceutical interventions or a vaccine, wide-spread virological screening is required to inform where restrictive isolation measures should be targeted and when they can be lifted(2\u20136). However, limitations on testing capacity have restricted the ability of governments and institutions to identify individual clinical cases, appropriately measure community prevalence, and mitigate transmission. Group testing offers a way to increase efficiency, by combining samples and testing a small number of pools(7\u20139). Here, we evaluate the effectiveness of group testing designs for individual identification or prevalence estimation of SARS-CoV-2 infection when testing capacity is limited. To do this, we developed mathematical models for epidemic spread, incorporating empirically measured individual-level viral kinetics to simulate changing viral loads in a large population over the course of an epidemic. We used these to construct representative populations and assess pooling strategies for community screening, accounting for variability in viral load samples, dilution effects, changing prevalence and resource constraints. We confirmed our group testing framework through pooled tests on de-identified human nasopharyngeal specimens with viral loads representative of the larger population. We show that group testing designs can both accurately estimate overall prevalence using a small number of measurements and substantially increase the identification rate of infected individuals in resource-limited settings.", "Multi-Stage Group Testing Improves Efficiency of Large-Scale COVID-19 Screening BACKGROUND: SARS-CoV-2 test kits are in critical shortage in many countries. This limits large-scale population testing and hinders the effort to identify and isolate infected individuals. OBJECTIVE: Herein, we developed and evaluated multi-stage group testing schemes that test samples in groups of various pool sizes in multiple stages. Through this approach, groups of negative samples can be eliminated with a single test, avoiding the need for individual testing and achieving considerable savings of resources. STUDY DESIGN: We designed and parameterized various multi-stage testing schemes and compared their efficiency at different prevalence rates using computer simulations. RESULTS: We found that three-stage testing schemes with pool sizes of maximum 16 samples can test up to three and seven times as many individuals with the same number of test kits for prevalence rates of around 5% and 1%, respectively. We propose an adaptive approach, where the optimal testing scheme is selected based on the expected prevalence rate. CONCLUSION: These group testing schemes could lead to a major reduction in the number of testing kits required and help improve large-scale population testing in general and in the context of the current COVID-19 pandemic.", "Group testing as a strategy for the epidemiologic monitoring of COVID-19 Sample pooling consists in combining samples from multiple individuals into a single pool that is then tested using a unique test-kit. A positive test means that at least one individual within the pool is infected. Here, we propose an analysis and applications of sample pooling to the epidemiologic monitoring of COVID-19. We first introduce a model of the RT-qPCR process used to test for the presence of virus in a sample and construct a statistical model for the viral load in a typical infected individual inspired by the clinical data from Jones et. al. (2020). We then propose a method for the measure of the prevalence in a population, based on group testing, taking into account the increased number of false negatives associated with this method. Finally, we present an application of sample pooling for the prevention of epidemic outbreak in closed connected communities (e.g. nursing homes).", "Modeling infectious disease dynamics in the complex landscape of global health. Despite some notable successes in the control of infectious diseases, transmissible pathogens still pose an enormous threat to human and animal health. The ecological and evolutionary dynamics of infections play out on a wide range of interconnected temporal, organizational, and spatial scales, which span hours to months, cells to ecosystems, and local to global spread. Moreover, some pathogens are directly transmitted between individuals of a single species, whereas others circulate among multiple hosts, need arthropod vectors, or can survive in environmental reservoirs. Many factors, including increasing antimicrobial resistance, increased human connectivity and changeable human behavior, elevate prevention and control from matters of national policy to international challenge. In the face of this complexity, mathematical models offer valuable tools for synthesizing information to understand epidemiological patterns, and for developing quantitative evidence for decision-making in global health.", "Real-time monitoring the transmission potential of COVID-19 in Singapore, March 2020 BACKGROUND: As of March 31, 2020, the ongoing COVID-19 epidemic that started in China in December 2019 is now generating local transmission around the world. The geographic heterogeneity and associated intervention strategies highlight the need to monitor in real time the transmission potential of COVID-19. Singapore provides a unique case example for monitoring transmission, as there have been multiple disease clusters, yet transmission remains relatively continued. METHODS: Here we estimate the effective reproduction number, R(t), of COVID-19 in Singapore from the publicly available daily case series of imported and autochthonous cases by date of symptoms onset, after adjusting the local cases for reporting delays as of March 17, 2020. We also derive the reproduction number from the distribution of cluster sizes using a branching process analysis that accounts for truncation of case counts. RESULTS: The local incidence curve displays sub-exponential growth dynamics, with the reproduction number following a declining trend and reaching an estimate at 0.7 (95% CI 0.3, 1.0) during the first transmission wave by February 14, 2020, while the overall R based on the cluster size distribution as of March 17, 2020, was estimated at 0.6 (95% CI 0.4, 1.02). The overall mean reporting delay was estimated at 6.4 days (95% CI 5.8, 6.9), but it was shorter among imported cases compared to local cases (mean 4.3 vs. 7.6 days, Wilcoxon test, p < 0.001). CONCLUSION: The trajectory of the reproduction number in Singapore underscores the significant effects of successful containment efforts in Singapore, but it also suggests the need to sustain social distancing and active case finding efforts to stomp out all active chains of transmission.", "Covid-19: \"Illogical\" lack of testing is causing healthy staff to self-isolate, BMA chief warns. ", "Group testing performance evaluation for SARS-CoV-2 massive scale screening and testing BACKGROUND: The capacity of the current molecular testing convention does not allow high-throughput and community level scans of COVID-19 infections. The diameter in the current paradigm of shallow tracing is unlikely to reach the silent clusters that might be as important as the symptomatic cases in the spread of the disease. Group testing is a feasible and promising approach when the resources are scarce and when a relatively low prevalence regime is observed on the population. METHODS: We employed group testing with a sparse random pooling scheme and conventional group test decoding algorithms both for exact and inexact recovery. RESULTS: Our simulations showed that significant reduction in per case test numbers (or expansion in total test numbers preserving the number of actual tests conducted) for very sparse prevalence regimes is available. Currently proposed COVID-19 group testing schemes offer a gain up to 15X-20X scale-up. There is a good probability that the required scale up to achieve massive scale testing might be greater in certain scenarios. We investigated if further improvement is available, especially in sparse prevalence occurrence where outbreaks are needed to be avoided by population scans. CONCLUSION: Our simulations show that sparse random pooling can provide improved efficiency gains compared to conventional group testing or Reed-Solomon error correcting codes. Therefore, we propose that special designs for different scenarios could be available and it is possible to scale up testing capabilities significantly.", "Transmission dynamics of the COVID-19 epidemic in India, and evaluating the impact of asymptomatic carriers and role of expanded testing in the lockdown exit strategy: a modelling approach Background: The coronavirus disease 2019 (COVID-19) has caused over 3 200 000 cases and 230 000 deaths as on 2 May 2020, and has quickly become an unprecedented global health threat. India, with its unique challenges in fighting this pandemic, imposed one of the worlds strictest and largest population-wide lockdown on 25 March 2020. Here, we estimated key epidemiological parameters and evaluated the effect of control measures on the COVID-19 epidemic in India and its states. Through a modeling approach that accounted for asymptomatics, we assessed the impact of lockdown relaxation and increased testing. Methods: We estimated the basic reproduction number and effective reproduction number at a national and state level in India after adjusting for imported cases and reporting lag using established statistical methods, using time-series data from 4 March to 25 April 2020. Using a dynamic SEIR-QDPA model fitted to data from India, we forecasted the size and temporality of the ongoing first wave while accounting for the interventions in place. We used the model to simulate lockdown relaxation under various scenarios to evaluate its effect on the size and temporality of the second wave. We also evaluated the feasibility of increased testing as a containment strategy after restrictions are relaxed and its impact on the epidemic size and resumption of socio-economic activities, while taking into account the changes in transmission dynamics brought about by asymptomatic carriers. Findings: The median delay from symptom onset to detection (reporting lag) was estimated to be 2{middle dot}68 days (95% CI 2{middle dot}00-3{middle dot}00) with an IQR of 2{middle dot}03 days (95% CI 1{middle dot}00-3{middle dot}00). The R0 for India was estimated to be 2{middle dot}083 (95% CI 2{middle dot}044-2{middle dot}122 ; R2 = 0{middle dot}972), while the Rt gradually down trended from 1{middle dot}665 (95%CI 1{middle dot}539-1{middle dot}789) on 30 March to 1{middle dot}159 (95% CI 1{middle dot}128-1{middle dot}189) on 21 April. 60{middle dot}7% of confirmed COVID-19 cases in our sample were found to be asymptomatic. We observed that delaying the lockdown relaxation increases the time to new rise in active cases after the relaxation in a linear fashion. If lockdown was reintroduced after a fixed relaxation period, the magnitude of the second peak could be reduced by delaying the relaxation and decreasing the duration of relaxation. These benefits were greater in case of a gradual relaxation as compared to a sudden lifting of lockdown. We found that detecting a higher proportion of cases through testing significantly decreases the total infections. This positive impact of testing progressively increased at higher transmission rates when restrictions were relaxed. We found that similar containment targets could be achieved by both, a combination of high testing and less social restrictions, and a combination of lower testing with intensive social distancing. Interpretation: The nationwide social distancing interventions in India since 25 March have reduced the effective transmission levels, though sub-threshold Rt remains to be achieved. If lockdown is to be extended, additional benefits for mitigating the second wave can be achieved if it is extended farther after the peak of active cases has passed. Intensive social distancing is inherently enough to contain the epidemic, however, testing will play a pivotal role in the lockdown exit strategy by impeding the epidemic growth enough to allow for a greater resumption of socio-economic activities, thus minimizing the social and economic fallout resulting from severe restrictions. Considering that asymptomatics play an undeniable role in the transmission of COVID-19, dependence on presence of symptoms for control strategies, behavioural changes and testing should be reduced.", "Hindsight is 2020 vision: Characterisation of the global response to the COVID-19 pandemic Since the initial outbreak in Wuhan (Hubei, China) in December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19), has rapidly spread to cause one of the most pressing challenges facing our world today: the COVID-19 pandemic. Within four months of the first reported cases, more than two and a half million cases were confirmed with over two hundred thousand deaths globally, and many countries had taken extreme measures to stop the spread. In this work, we analyse the response to the COVID-19 outbreak for 103 countries over the period 22 January to 13 April 2020. We utilise a novel stochastic epidemiological model that includes a regulatory mechanism that captures the level of tolerance to rising confirmed cases within the response behaviour. Using approximate Bayesian computation, we identify that the top ten outbreaks as of 31 March are characterised by a high tolerance to rising cases tallies, whereas countries that avoided severe outbreak have a low tolerance. Countries that recovered rapidly also have a higher identification rate. As of 13 April, almost all countries show declines in transmission rates and basic reproductive numbers. Furthermore, countries approaching recovery also increased their identification rate between 31 March and 13 April. We also demonstrate that uncertainty in undocumented infections dramatically impacts uncertainty in predictions. Overall, we recommend that broader testing is required to understand the magnitude of undocumented infections.", "Self-screening to reduce medical resource consumption facing the COVID-19 pandemic ", "Estimation of COVID-19 burden in Egypt ", "Use of the Demographic and Health Survey framework as a population surveillance strategy for COVID-19 ", "COVID-19-New Insights on a Rapidly Changing Epidemic. ", "Standardization and Age-Distribution of COVID-19: Implications for Variability in Case Fatality and Outbreak Identification Background: Epidemiological data from the COVID-19 pandemic has demonstrated variability in attack rates by age, and country-to-country variability in case fatality ratio (CFR). Objective: To use direct and indirect standardization for insights into the impact of age-specific under-reporting on between-country variability in CFR, and apparent size of COVID-19 epidemics. Design: Post-hoc secondary data analysis (case studies), and mathematical modeling. Setting: China, global. Interventions: None. Measurements: Data were extracted from a sentinel epidemiological study by the Chinese Center for Disease Control (CCDC) that describes attack rates and CFR for COVID-19 in China prior to February 12, 2020. Standardized morbidity ratios (SMR) were used to impute missing cases and adjust CFR. Age-specific attack rates and CFR were applied to different countries with differing age structures (Italy, Japan, Indonesia, and Egypt), in order to generate estimates for CFR, apparent epidemic size, and time to outbreak recognition for identical age-specific attack rates. Results: SMR demonstrated that 50-70% of cases were likely missed during the Chinese epidemic. Adjustment for under-recognition of younger cases decreased CFR from 2.4% to 0.8% (assuming 50% case ascertainment in older individuals). Standardizing the Chinese epidemic to countries with older populations (Italy, and Japan) resulted in larger apparent epidemic sizes, higher CFR and earlier outbreak recognition. The opposite effect was demonstrated for countries with younger populations (Indonesia, and Egypt). Limitations: Secondary data analysis based on a single country at an early stage of the COVID-19 pandemic, with no attempt to incorporate second order effects (ICU saturation) on CFR. Conclusion: Direct and indirect standardization are simple tools that provide key insights into between-country variation in the apparent size and severity of COVID-19 epidemics.", "Counting Coronavirus Disease 2019 (COVID-19) Cases: Case Definitions, Screened Populations and Testing Techniques Matter. While counting cases of disease appears straightforward, there are issues to consider when enumerating disease counts during an epidemic. For example, for Coronavirus Disease-2019 (COVID-19), how is a case defined? Hubei province in China changed its case definition twice in a fortnight-from laboratory-confirmed cases to clinically-confirmed cases without laboratory tests, and back to laboratory-confirmed cases. This caused confusion in the reported number of cases. If a confirmed case requires laboratory testing, what is the population who are laboratory-tested? Due to limited laboratory testing capacity in the early phase of an emerging epidemic, only \"suspected cases\" are laboratory-tested in most countries. This will result in underdiagnosis of confirmed cases and also raises the question: how is a \"suspect case\" defined? With the passage of time and increased capability to perform laboratory tests, more people can be screened and the number of confirmed cases will increase. What are the technical considerations of laboratory testing? This includes specimen collection (variable collection methods), samples collected (upper or lower respiratory tract biospecimens), time of collection in relation to course of disease, different laboratory test methods and kits (not all of which may be standardised or approved by authorities such as the Food and Drug Administration). Are approved laboratory facilities and trained manpower available, and how are test results interpreted and false-negatives excluded? These issues will affect the accuracy of disease counts, which in turn will have implications on how we mount an appropriate response to the outbreak.", "COVID-19 epidemic in Malaysia: Impact of lock-down on infection dynamics COVID-19 epidemic in Malaysia started as a small wave of 22 cases in January 2020 through imported cases. It was followed by a bigger wave mainly from local transmissions resulting in 651 cases. The following wave saw unexpectedly three digit number of daily cases following a mass gathering urged the government to choose a more stringent measure. A limited lock-down approach called Movement Control Order (MCO) was immediately initiated to the whole country as a way to suppress the epidemic trajectory. The lock-down causes a major socio-economic disruption thus the ability to forecast the infection dynamic is urgently required to assist the government on timely decisions. Limited testing capacity and limited epidemiological data complicate the understanding of the future infection dynamic of the COVID-19 epidemic. Three different epidemic forecasting models was used to generate forecasts of COVID-19 cases in Malaysia using daily reported cumulative case data up until 1st April 2020 from the Malaysia Ministry of Health. The forecasts were generated using a Curve Fitting Model with Probability Density Function and Skewness Effect, the SIR Model, and a System Dynamic Model. Method one based on curve fitting with probability density function estimated that the peak will be on 19th April 2020 with an estimation of 5,637 infected persons. Method two based on SIR Model estimated that the peak will be on 20th - 31st May 2020 if Movement Contro (MCO) is in place with an estimation of 630,000 to 800,000 infected persons. Method three based on System Dynamic Model estimated that the peak will be on 17th May 2020 with an estimation of 22,421 infected persons. Forecasts from each of model suggested the epidemic may peak between middle of April to end of May 2020. Keywords: COVID-19, Infection dynamic, Prediction Modeling, SIR, System Learning, Lock-down", "Covid-19 Incidence Rate Evolution Modeling using Dual Wave Gaussian-Lorentzian Composite Functions Modeling the evolution of Covid-19 incidence rate is critical to deciding and assessing non-medical intervention strategies that can lead to successful containment of the pandemic. This research presents a mathematical model to empirically assess measures related to various pandemic containment strategies, their similarities and a probabilistic estimate on the evolution of Covid-19 incidence rates. The model is built on the principle that, the exponential rise and decay of the number of confirmed Covid-19 infections can be construed as a set of concurrent non-linear waves. These waves can be characterized by a linear combination of Gaussian and Cauchy Lorentz functions collectively termed as Gaussian-Lorentzian Composite (GLC) function. The GLC function is used for non-linear approximation of officially confirmed Covid-19 incidence rates in each country. Results of fitting GLC based models to incidence rate trends of 20 different countries proves that the models can empirically explain the growth and decay trajectory Covid-19 infections in a given population.", "A novel comprehensive metric to assess COVID-19 testing outcomes: Effects of geography, government, and policy response Testing and case identification are key strategies in controlling the COVID-19 pandemic. Contact tracing and isolation are only possible if cases have been identified. The effectiveness of testing must be tracked, but a single comprehensive metric is not available to assess testing effectiveness, and no timely estimates of case detection rate are available globally, making inter-country comparisons difficult. The purpose of this paper was to propose a single, comprehensive metric, called the COVID-19 Testing Index (CovTI) scaled from 0 to 100, that incorporated several testing metrics. The index was based on case-fatality rate, test positivity rate, active cases, and an estimate of the detection rate. It used parsimonious modeling to estimate the true total number of COVID-19 cases based on deaths, testing, health system capacity, and government transparency. Publicly reported data from 188 countries and territories were included in the index. Estimates of detection rates aligned with previous estimates in literature (R2=0.97). As of June 3, 2020, the states with the highest CovTI included Iceland, Australia, New Zealand, Hong Kong, and Thailand, and some island nations. Globally, CovTI increased from April 20 ([x]=43.2) to June 3 ([x]=52.2) but declined in ca. 10% of countries. Bivariate analyses showed the average in countries with open public testing policies (59.7, 95% CI 55.6-63.8) were significantly higher than countries with no testing policy (30.2, 95% CI 18.1-42.3) (p<0.0001). A multiple linear regression model assessed the association of independent grouping variables with CovTI. Open public testing and extensive contact tracing were shown to significantly increase CovTI, after adjusting for extrinsic factors, including geographic isolation and centralized forms of government. This tool may be useful for policymakers to assess testing effectiveness, inform decisions, and identify model countries. It may also serve as a tool for researchers in analyses by combining it with other databases.", "Host response-based screening to identify undiagnosed cases of COVID-19and expand testing capacity The COVID-19 pandemic has created unprecedented challenges in diagnostic testing. At the beginning of the epidemic, a confluence of factors resulted in delayed deployment of PCR-based diagnostic tests, resulting in lack of testing of individuals with symptoms of the disease. Although these tests are now more widely available, it is estimated that a three- to ten-fold increase in testing capacity will be required to ensure adequate surveillance as communities reopen(1). In response to these challenges, we evaluated potential roles of host-response based screening in the diagnosis of COVID-19. Previous work from our group showed that the nasopharyngeal (NP) level of CXCL10, a protein produced as part of the host response to viral infection, is a sensitive predictor of respiratory virus infection across a wide spectrum of viruses(2). Here, we show that NP CXCL10 is elevated during SARS-CoV-2 infection and use a CXCL10-based screening strategy to identify four undiagnosed cases of COVID-19 in Connecticut in early March. In a second set of samples tested at the Yale New Haven Hospital, we show that NP CXCL10 had excellent performance as a rule-out test (NPV 0.99, 95% C.I. 0.985-0.997). Our results demonstrate how biomarker-based screening could be used to leverage existing PCR testing capacity to rapidly enable widespread testing for COVID-19.", "Hundreds of severe pediatric COVID-19 infections in Wuhan prior to the lockdown Before January 22, 2020, only one pediatric case of COVID-19 was reported in mainland China. However, a retrospective surveillance study identified six children who had been hospitalized for COVID-19 in one of three central Wuhan hospitals between January 7th and January 15th. Given that Wuhan has over 395 other hospitals, there may have been far more severe pediatric cases than reported. There were six and 43 children out of 336 who tested positive for COVID-19 and influenza, respectively among all pediatric admissions during the 9-day period. By using this ratio in a detailed analysis of influenza surveillance data and COVID-19 epidemic dynamics (see Appendix), we estimate that there were 313 [95% CI: 171-520] children hospitalized for COVID-19 in Wuhan during January 7-15, 2020 (Figure). Under an epidemic doubling time of 7.31 days4, we estimate that there were 1105 [95% CI: 592, 1829] cumulative pediatric COVID-19 hospitalizations prior to the January 23rd lockdown, which far surpasses the 425 confirmed cases reported across all age groups, none of which were children under age 15. Children are strikingly absent from COVID-19 reports and limited data suggest that pediatric infections are overwhelmingly mild5. Thus, our estimates for hundreds of severe pediatric cases likely translates to thousands or even tens of thousands of mildly infected children, suggesting that the force of infection from children may be grossly underestimated and the infection fatality rate overestimated from confirmed case counts alone. This highlights the urgent need for more robust surveillance to gauge the true extent and severity of COVID-19 in all ages.", "POOLING FOR SARS-CoV-2 CONTROL IN CARE INSTITUTIONS Workers and residents in Care Homes are considered at special risk for the acquisition of SARS-CoV-2 infection, due to the infectivity and high mortality rate in the case of residents, compared to other containment areas. The aims of the present study, based in our local experience, were (a) to describe SARS-CoV-2 prevalence in institutionalized people in Galicia (Spain) during the Coronavirus pandemic and (b) to evaluate the expected performance of a pooling strategy using RT-PCR for the next rounds of screening of institutionalized people. Distribution of SARS-CoV-2 infection at Care Houses was uneven. As the virus circulation global rate was low in our area, the number of people at risk of acquiring the infection continues to be very high. In this work, we have successfully demonstrated that pooling of different groups of samples at low prevalence clusters, can be done with a small average delay on quantification cycle (Cq) values. A new surveillance system with guaranteed protection is required for small clusters, previously covered with individual testing. Our proposal for Care Houses, once prevalence zero is achieved, would include successive rounds of testing using a pooling solution for transmission control preserving testing resources. Scale-up of this method may be of utility to confront larger clusters to avoid the viral circulation and keeping them operative.", "Influenza-Negative Influenza-Like Illness (fnILI) Z-Score as a Proxy for Incidence and Mortality of COVID-19 Though ideal for determining the burden of disease, SARS-CoV2 test shortages preclude its implementation as a robust surveillance system in the US. We correlated the use of the derivative influenza-negative influenza-like illness (fnILI) z-score from the CDC as a proxy for incident cases and disease-specific deaths. For every unit increase of fnILI z-score, the number of cases increased by 70.2 (95%CI[5.1,135.3]) and number of deaths increased by 2.1 (95%CI[1.0,3.2]). FnILI data may serve as an accurate outcome measurement to track the spread of the and allow for informed and timely decision-making on public health interventions.", "Testing for COVID-19: a few points to remember. Diagnostic approaches to COVID-19 include clinical history, PCR tests for the presence of SARS-CoV-2 virus and detection of antibodies. By combining these three approaches, the seroprevalence of anti-SARS-CoV-2 antibodies can be examined in healthcare teams. The aim of the study was to examine the seroprevalence of anti-SARS-CoV-2 antibodies in a population of healthcare professionals 6 - 8 weeks after the first COVID-19 case was detected in the Czech Republic. A total of 269 subjects were enrolled in the study (187 women, 82 men) with a median age of 45.9 years (21 - 71 years). We used a questionnaire to ascertain travel history and clinical signs of any respiratory tract infection. Blood samples were collected, and IgG levels were analysed in all samples. The level of IgA antibodies was analysed in those positive for IgG. PCR testing was performed in cases testing positive for presence of antibodies. The enzyme-linked immunosorbent assay (ELISA) test system for SARS-CoV-2 from Euroimmun (Germany) was used to analyse immunoglobulin levels. 17 % of the tested cohort reported symptoms compatible with COVID-19 and 35.8 % reported history of international travel. There were 5 subjects positive IgG cases (of 269; 1.85 %), and one IgA positive and IgG borderline positive subject (0.37 %). There was only one PCR positive subject. Anti SARS-CoV-2 antibodies were thus detected in 2.22% of participating health professionals. This article shows the pitfalls of the testing methods and highlights the necessity of using a correct testing algorithm, considering the character of the tested population and the expected low prevalence.", "Outdoor Air Pollutant Concentration and COVID-19 Infection in Wuhan, China COVID-19 infection, first reported in Wuhan, China in December 2019, has become a global pandemic, causing significantly high infections and mortalities in Italy, the UK, the US, and other parts of the world. Based on the statistics reported by John Hopkins University, 4.7M people worldwide and 84,054 people in China have been confirmed positive and infected with COVID-19, as of 18 May 2020. Motivated by the previous studies which show that the exposures to air pollutants may increase the risk of influenza infection, our study examines if such exposures will also affect Covid-19 infection. To the best of our understanding, we are the first group in the world to rigorously explore the effects of outdoor air pollutant concentrations, meteorological conditions and their interactions, and lockdown interventions, on Covid-19 infection in China. Since the number of confirmed cases is likely to be under-reported due to the lack of testing capacity, the change in confirmed case definition, and the undiscovered and unreported asymptotic cases, we use the rate of change in the daily number of confirmed infection cases instead as our dependent variable. Even if the number of reported infections is under-reported, the rate of change will still accurately reflect the relative change in infection, provided that the trend of under-reporting remains the same. In addition, the rate of change in daily infection cases can be distorted by the government imposed public health interventions, including the lockdown policy, inter-city and intra-city mobility, and the change in testing capacity and case definition. Hence, the effects of the lockdown policy and the inter-city and intra-city mobility, and the change in testing capacity and case definition are all taken into account in our statistical modelling. Furthermore, we adopt the generalized linear regression models covering both the Negative Binomial Regression and the Poisson Regression. These two regression models, when combined with different time-lags (to reflect the COVID-19 incubation period and delay due to official confirmation) in air pollutant exposure (PM2.5), are used to fit the COVID-19 infection model. Our statistical study has shown that higher PM2.5 concentration is significantly correlated with a higher rate of change in the daily number of confirmed infection cases in Wuhan, China (p < 0.05). We also determine that a higher dew point interacting with a higher PM2.5 concentration is correlated with a higher rate of change in the daily number of confirmed infection cases, while a higher UV index and a higher PM2.5 concentration are correlated with a lower rate of change. Furthermore, we find that PM2.5 concentration eight days ago has the strongest predictive power for COVID-19 Infection. Our study bears significance to the understanding of the effect of air pollutant (PM2.5) on COVID-19 infection, the interaction effects of both the air pollutant concentration (PM2.5) and the meteorological conditions on the rate of change in infection, as well as the insights into whether lockdown should have an effect on COVID-19 infection.", "The effect of inter-city travel restrictions on geographical spread of COVID-19: Evidence from Wuhan, China Background: To contain the spread of COVID-19, a cordon sanitaire was put in place in Wuhan prior to the Lunar New Year, on 23 January 2020, restricting travel to other parts of China. We assess the efficacy of the cordon sanitaire to delay the introduction and onset of local transmission of COVID-19 in other major cities in mainland China. Methods: We estimated the number of infected travellers from Wuhan to other major cities in mainland China from November 2019 to March 2020 using previously estimated COVID-19 prevalence in Wuhan and publicly available mobility data. We focused on Beijing, Chongqing, Hangzhou, and Shenzhen as four representative major cities to identify the potential independent contribution of the cordon sanitaire and holiday travel. To do this, we simulated outbreaks generated by infected arrivals in these destination cities using stochastic branching processes. We also modelled the effect of the cordon sanitaire in combination with reduced transmissibility scenarios representing the effect of local non-pharmaceutical interventions. Findings: In the four cities, given the potentially high prevalence of COVID-19 in Wuhan between Dec 2019 and early Jan 2020, local transmission may have been seeded as early as 2 - 8 January 2020. By the time the cordon sanitaire was imposed, simulated case counts were likely in the hundreds. The cordon sanitaire alone did not substantially affect the epidemic progression in these cities, although it may have had some effect in smaller cities. Interpretation: Our results indicate that the cordon sanitaire may not have prevented COVID-19 spread in major Chinese cities; local non-pharmaceutical interventions were likely more important for this.", "Rapid Detection of Novel Coronavirus (COVID-19) by Reverse Transcription-Loop-Mediated Isothermal Amplification Novel Corona virus (COVID-19 or 2019-nCoV) is an emerging global health concern that requires a rapid diagnostic test. Quantitative reverse transcription PCR (qRT-PCR) is currently the standard for COVID-19 detection; however, Reverse Transcription Loop-Mediated Isothermal Amplification (RT-LAMP) may allow for faster and cheaper field based testing at point-of-risk. The objective of this study was to develop a rapid screening diagnostic test that could be completed in under 30 minutes. Simulated patient samples were generated by spiking serum, urine, saliva, oropharyngeal swabs, and nasopharyngeal swabs with a portion of the COVID-19 nucleic sequence. The samples were tested using RT-LAMP as well as by conventional qRT-PCR. Specificity of the RT-LAMP was evaluated by also testing against other related coronaviruses. RT-LAMP specifically detected COVID-19 in simulated patient samples. This test was performed in under 30 minutes. This approach could be used for monitoring of exposed individuals or potentially aid with screening efforts in the field and potential ports of entry.", "COVID19 - The need for Public Health in a time of emergency ", "Analytical sensitivity and efficiency comparisons of SARS-COV-2 qRT-PCR primer-probe sets The recent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exemplifies the critical need for accurate and rapid diagnostic assays to prompt clinical and public health interventions. Currently, several quantitative reverse-transcription polymerase chain reaction (qRT-PCR) assays are being used by clinical, research, and public health laboratories. However, it is currently unclear if results from different tests are comparable. Our goal was to evaluate the primer-probe sets used in four common diagnostic assays available on the World Health Organization (WHO) website. To facilitate this effort, we generated RNA transcripts to be used as assay standards and distributed them to other laboratories for internal validation. We then used (1) RNA transcript standards, (2) full-length SARS-CoV-2 RNA, (3) pre-COVID-19 nasopharyngeal swabs, and (4) clinical samples from COVID-19 patients to determine analytical efficiency and sensitivity of the qRT-PCR primer-probe sets. We show that all primer-probe sets can be used to detect SARS-CoV-2 at 500 virus copies per reaction, except for the RdRp-SARSr (Charite) confirmatory primer-probe set which has low sensitivity. Our findings characterize the limitations of currently used primer-probe sets and can assist other laboratories in selecting appropriate assays for the detection of SARS-CoV-2.", "COVID-19, Australia: Epidemiology Report 17 (Fortnightly reporting period ending 24 May 2020). Confirmed cases in Australia notified up to 24 May 2020: notifications = 7,135; deaths = 102. The incidence of COVID-19 has markedly reduced since a peak in mid-March. There have been no cases reported in SA, the NT or the ACT in the last four weeks. The numbers of new cases reported from other jurisdictions continue to be very low. Testing rates have been higher across all jurisdictions, with Victoria reporting an 85% testing rate increase and NSW a 40% increase over this period. The positivity rate nationally continues to remain very low at less than 0.1% over the reporting period. Continued high rates of testing are necessary to detect and mitigate the spread of COVID-19 in the community. Over the past fortnight, 45% of cases acquired their infection overseas. Of cases considered to be locally acquired over this period, most were associated with contacts of confirmed cases or were associated with known outbreaks. The highest rate of COVID-19 continues to be among people aged 65-79 years. Three-quarters of all cases in this age group have been associated with overseas travel, including several outbreaks linked to cruise ships. The lowest rate of disease is in children under 18, a pattern reflected in international reports. A small proportion of cases overall have experienced severe disease, requiring hospitalisation or intensive care with some fatalities. The crude case fatality rate amongst Australian cases is 1.4%. People who are older and have one or more comorbidities are more likely to experience severe disease. A combination of early case identification, physical distancing, public health measures and a reduction in international travel have likely been effective in slowing the spread of the disease in Australia. In addition, the median number of days between symptom onset and diagnostic testing has improved considerably from 7 days in the early phase of the outbreak to 1 day in the latest phase of the epidemic. Internationally, as at 24 May 2020, there have been recent increases in the number of daily cases reported globally. The largest numbers of both cases and deaths have been reported in the United States. Of the confirmed cases reported globally, the case fatality rate is approximately 6.5%. Countries in South America are starting to see rapid acceleration, while the United States is seeing a very slow decline in its daily new case numbers. In the South East Asia region, India and Bangladesh are seeing accelerating epidemics, compounded by the recovery from Cyclone Amphan. Increasing numbers of cases are also being reported in Africa, although the numbers are much smaller. In the Pacific there are very few daily new cases reported.", "Level of underreporting including underdiagnosis before the first peak of COVID-19 in various countries: Preliminary retrospective results based on wavelets and deterministic modeling ", "Smart Pooled sample Testing for COVID-19: A Possible Solution for Sparsity of Test Kits There is an exponential growth of COVID-19. The adaptation of preventive measures to limit the spread of infection among the people is the best solution to this health issue. The identification of infected cases and their isolation from healthy people is one of the most important preventive measures. In this regard, screening of the samples from a large number of people is needed which requires a lot of reagent kits for the detection of SARS-CoV-2. The use of smart pooled sample testing with the help of algorithms may be a quite useful strategy in the current prevailing scenario of the COVID-19 pandemic. With the help of this strategy, the optimum number of samples to be pooled for a single test may be determined based on the total positivity rate of the particular community.", "Estimation of SARS-CoV-2 Infection Prevalence in Santa Clara County To reliably estimate the demand on regional health systems and perform public health planning, it is necessary to have a good estimate of the prevalence of infection with SARS-CoV-2 (the virus that causes COVID-19) in the population. In the absence of wide-spread testing, we provide one approach to infer prevalence based on the assumption that the fraction of true infections needing hospitalization is fixed and that all hospitalized cases of COVID-19 in Santa Clara are identified. Our goal is to estimate the prevalence of SARS-CoV-2 infections, i.e. the true number of people currently infected with the virus, divided by the total population size. Our analysis suggests that as of March 17, 2020, there are 6,500 infections (0.34% of the population) of SARS-CoV-2 in Santa Clara County. Based on adjusting the parameters of our model to be optimistic (respectively pessimistic), the number of infections would be 1,400 (resp. 26,000), corresponding to a prevalence of 0.08% (resp. 1.36%). If the shelter-in-place led to R0 < 1, we would expect the number of infections to remain about constant for the next few weeks. However, even if this were true, we expect to continue to see an increase in hospitalized cases of COVID-19 in the short term due to the fact that infection of SARS-CoV-2 on March 17th can lead to hospitalizations up to 14 days later.", "Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2) Estimation of the prevalence and contagiousness of undocumented novel coronavirus [severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2)] infections is critical for understanding the overall prevalence and pandemic potential of this disease. Here, we use observations of reported infection within China, in conjunction with mobility data, a networked dynamic metapopulation model, and Bayesian inference, to infer critical epidemiological characteristics associated with SARS-CoV-2, including the fraction of undocumented infections and their contagiousness. We estimate that 86% of all infections were undocumented [95% credible interval (CI): 82-90%] before the 23 January 2020 travel restrictions. The transmission rate of undocumented infections per person was 55% the transmission rate of documented infections (95% CI: 46-62%), yet, because of their greater numbers, undocumented infections were the source of 79% of the documented cases. These findings explain the rapid geographic spread of SARS-CoV-2 and indicate that containment of this virus will be particularly challenging.", "SARS-CoV-2 epidemiology and control, different scenarios for Turkey BACKGROUND/AIM: Coronavirus Infectious Disease 2019 (COVID-19) is now a pandemic spreading in most countries including Turkey. MATERIALS AND METHODS: The current knowledge of COVID-19 and the virus causing it, SARS-CoV-2, was reviewed. The epidemiology and control in different countries was compared and the differences discussed. RESULTS: The population attack rates and case fatality rates vary from country to country with Lombardy in northern Italy reporting an attack rate in the general population of 0.37% compared to 0.004% in Hong Kong. The differences are caused by different testing strategies and reporting systems. CONCLUSION: Turkey is early in the outbreak. Different control strategies are available with South Korea, Hong Kong and Singapore being models to follow.", "COVID- 19 Infection in Children: Estimating Pediatric Morbidity and Mortality BACKGROUND: Estimates of pediatric morbidity and mortality from COVID-19 are vital for planning optimal use of human and material resources throughout this pandemic. METHODS: Government websites from countries with minimum 1000 cases in adults and children on April 13, 2020 were searched to find the number of cases confirmed in children, the age range, and the number leading to hospitalization, intensive care unit (ICU) admission or death. A systematic literature search was performed April 13, 2020 to find additional data from cases series. RESULTS: Data on pediatric cases were available from government websites for 23 of the 70 countries with minimum 1000 cases by April 13, 2020. Of 424 978 cases in these 23 countries, 8113 (1.9%) occurred in children. Nine publications provided data from 4251 cases in 4 additional countries. Combining data from the websites and the publications, 330 of 2361 cases required admission (14%). The ICU admission rate was 2.2 % of confirmed cases (44 of 2031) and 7.2% of admitted children (23 of 318). Death was reported for 15 cases. CONCLUSION: Children accounted for 1.9% of confirmed cases. The true incidence of pediatric infection and disease will only be known once testing is expanded to individuals with less severe or no symptoms. Admission rates vary from 0.3 to 10% of confirmed cases (presumably varying with the threshold for testing) with about 7% of admitted children requiring ICU care. Death is rare in middle and high income countries.", "Coronavirus cases have dropped sharply in South Korea. What\u2019s the secret to its success? Europe is now the epicenter of the COVID-19 pandemic Case counts and deaths are soaring in Italy, Spain, France, and Germany, and many countries have imposed lockdowns and closed borders Meanwhile, the United States, hampered by a fiasco with delayed and faulty test kits, is just guessing at its COVID-19 burden, though experts believe it is on the same trajectory as countries in Europe", "Estimating the impact of COVID-19 control measures using a Bayesian model of physical distancing Extensive physical distancing measures are currently the primary intervention against coronavirus disease 2019 (COVID-19) worldwide. It is therefore urgent to estimate the impact such measures are having. We introduce a Bayesian epidemiological model in which a proportion of individuals are willing and able to participate in distancing measures, with the timing of these measures informed by survey data on attitudes to distancing and COVID-19.We fit our model to reported COVID-19 cases in British Columbia, Canada, using an observation model that accounts for both underestimation and the delay between symptom onset and reporting. We estimate the impact that physical distancing (also known as social distancing)has had on the contact rate and examine the projected impact of relaxing distancing measures. We find that distancing has had a strong impact, consistent with declines in reported cases and in hospitalization and intensive care unit numbers. We estimate that approximately 0.78 (0.66-0.89 90% CI) of contacts have been removed for individuals in British Columbia practising physical distancing and that this fraction is above the threshold of 0.45 at which prevalence is expected to grow. However, relaxing distancing measures beyond this threshold re-starts rapid exponential growth. Because the extent of underestimation is unknown, the data are consistent with a wide range in the prevalence of COVID-19 in the population; changes to testing criteria over time introduce additional uncertainty. Our projections indicate that intermittent distancing measures - if sufficiently strong and robustly followed - could control COVID-19 transmission, but that if distancing measures are relaxed too much, the epidemic curve would grow to high prevalence.", "Changes in testing rates could mask the novel coronavirus disease (COVID-19) growth rate Since the novel coronavirus disease (COVID-19) emerged in December 2019 in China, it has rapidly spread around the world, leading to one of the most significant pandemic events of recent history. Deriving reliable estimates of the COVID-19 epidemic growth rate is quite important to guide the timing and intensity of intervention strategies. Indeed, many studies have quantified the epidemic growth rate using time-series of reported cases during the early phase of the outbreak to estimate the basic reproduction number, R0. Using daily time series of COVID-19 incidence, we illustrate how epidemic curves of reported cases may not always reflect the true epidemic growth rate due to changes in testing rates, which could be influenced by limited diagnostic testing capacity during the early epidemic phase.", "How Reliable are Test Numbers for Revealing the COVID-19 Ground Truth and Applying Interventions? The number of confirmed cases of COVID-19 is often used as a proxy for the actual number of ground truth COVID-19 infected cases in both public discourse and policy making. However, the number of confirmed cases depends on the testing policy, and it is important to understand how the number of positive cases obtained using different testing policies reveals the unknown ground truth. We develop an agent-based simulation framework in Python that can simulate various testing policies as well as interventions such as lockdown based on them. The interaction between the agents can take into account various communities and mobility patterns. A distinguishing feature of our framework is the presence of another `flu'-like illness with symptoms similar to COVID-19, that allows us to model the noise in selecting the pool of patients to be tested. We instantiate our model for the city of Bengaluru in India, using census data to distribute agents geographically, and traffic flow mobility data to model long-distance interactions and mixing. We use the simulation framework to compare the performance of three testing policies: Random Symptomatic Testing (RST), Contact Tracing (CT), and a new Location Based Testing policy (LBT). We observe that if a sufficient fraction of symptomatic patients come out for testing, then RST can capture the ground truth quite closely even with very few daily tests. However, CT consistently captures more positive cases. Interestingly, our new LBT, which is operationally less intensive than CT, gives performance that is comparable with CT. In another direction, we compare the efficacy of these three testing policies in enabling lockdown, and observe that CT flattens the ground truth curve maximally, followed closely by LBT, and significantly better than RST.", "Guidance for rebooting electrophysiology through the COVID-19 pandemic from the Heart Rhythm Society and the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology Endorsed by the American College of Cardiology Abstract Coronavirus disease 2019 (COVID-19) has presented substantial challenges to patient care and impacted health care delivery, including cardiac electrophysiology practice throughout the globe. Based upon the undetermined course and regional variability of the pandemic, there is uncertainty as to how and when to resume and deliver electrophysiology services for arrhythmia patients. This joint document from representatives of the Heart Rhythm Society, American Heart Association, and American College of Cardiology seeks to provide guidance for clinicians and institutions reestablishing safe electrophysiological care. To achieve this aim, we address regional and local COVID-19 disease status, the role of viral screening and serologic testing, return-to-work considerations for exposed or infected health care workers, risk stratification and management strategies based on COVID-19 disease burden, institutional preparedness for resumption of elective procedures, patient preparation and communication, prioritization of procedures, and development of outpatient and periprocedural care pathways.", "Estimation of COVID-19 under-reporting in Brazilian States through SARI Due to its impact, COVID-19 has been stressing the academy to search for curing, mitigating, or controlling it. However, when it comes to controlling, there are still few studies focused on under-reporting estimates. It is believed that under-reporting is a relevant factor in determining the actual mortality rate and, if not considered, can cause significant misinformation. Therefore, the objective of this work is to estimate the under-reporting of cases and deaths of COVID-19 in Brazilian states using data from the Infogripe on notification of Severe Acute Respiratory Infection (SARI). The methodology is based on the concepts of inertia and the use of event detection techniques to study the time series of hospitalized SARI cases. The estimate of real cases of the disease, called novelty, is calculated by comparing the difference in SARI cases in 2020 (after COVID-19) with the total expected cases in recent years (2016 to 2019) derived from a seasonal exponential moving average. The results show that under-reporting rates vary significantly between states and that there are no general patterns for states in the same region in Brazil.", "Variable pool testing for infection spread estimation We present a method for efficient estimation of the prevalence of infection in a population with high accuracy using only a small number of tests. The presented approach uses pool testing with a mix of pool sizes of various sizes. The test results are then combined to generate an accurate estimation over a wide range of infection probabilities. This method does not require an initial guess on the infection probability. We show that, using the suggested method, even a set of only $50$ tests with a total of only $1000$ samples can produce reasonable estimation over a wide range of probabilities. A measurement set with only $100$ tests is shown to achieve $25\\%$ accuracy over infection probabilities from $0.001$ to $0.5$. The presented method is applicable to COVID-19 testing.", "COVID-19 and homelessness in England: a modelling study of theCOVID-19 pandemic among people experiencing homelessness, and theimpact of a residential intervention to isolate vulnerable people andcare for people with symptoms Background: There is an ongoing pandemic of the viral respiratory disease COVID-19. People experiencing homelessness are vulnerable to infection and severe disease. Health and housing authorities in England have developed a residential intervention that aims to isolate those vulnerable to severe disease (COVID-PROTECT) and care for people with symptoms (COVID CARE). Methods: We used a discrete-time Markov chain model to forecast COVID-19 infections among people experiencing homelessness, given strong containment measures in the general population and some transmission among 35,817 people living in 1,065 hostels, and 11,748 people sleeping rough (the 'do nothing' scenario). We then estimated demand for beds if those eligible are offered COVID-PROTECT and COVID-CARE. We estimated the reduction in the number of COVID-19 cases, deaths, and hospital admissions that could be achieved by these interventions. We also conducted sensitivity and scenario analyses to identify programme success factors. Results: In a 'do nothing' scenario, we estimate that 34% of the homeless population could get COVID-19 between March and August 2020, with 364 deaths, 4,074 hospital admissions and 572 critical care admissions. In our 'base intervention' scenario, demand for COVID-PROTECT peaks at 9,934 beds, and demand for COVID-CARE peaks at 1,366 beds. The intervention could reduce transmission by removing symptomatic individuals from the community, and preventing vulnerable individuals from being infected. This could lead to a reduction of 164 deaths, 2,624 hospital admissions, and 248 critical care admissions over this period. Sensitivity analyses showed that the number of deaths is sensitive to transmission of COVID-19 in COVID-PROTECT. If COVID-PROTECT capacity is limited, scenario analyses show the benefit of prioritising people who are vulnerable to severe disease. Conclusion: Supportive accommodation can mitigate the impact of the COVID-19 pandemic on the homeless population of England, and reduce the burden on acute hospitals.", "Underestimation of COVID-19 cases in Japan: an analysis of RT-PCR testing for COVID-19 among 47 prefectures in Japan. BACKGROUND Under the unique Japanese policy to restrict reverse transcriptase-polymerase chain reaction (RT-PCR) testing against severe acute respiratory syndrome coronavirus 2, a nationwide number of its confirmed cases and mortality remains to be low. Yet the information is lacking on geographical differences of these measures and their associated factors. AIM Evaluation of prefecture-based geographical differences and associated predictors for the incidence and number of RT-PCR tests for COVID-19. DESIGN Cross-sectional study using regression and correlation analysis. METHODS We retrieved domestic laboratory-confirmed cases, deaths, and the number of RT-PCR testing for COVID-19 from January 15 to April 6, 2020 in 47 prefectures in Japan, using publicly-available data by the Ministry of Health, Labour and Welfare. We did descriptive analyses of these three measures and identified significant predictors for the incidence and RT-PCR testing through multiple regression analyses and correlates with the number of deaths through correlation analysis. RESULTS The median prefectural-level incidence and number of RT-PCR testing per 100,000 population were 1.14 and 38.6, respectively. Multiple regression analyses revealed that significant predictors for the incidence were prefectural-level population (p < 0.001) and the number of RT-PCR testing (p = 0.03); and those for RT-PCR testing were the incidence (p = 0.025), available beds (p = 0.045) and cluster infections (p = 0.034). CONCLUSION Considering bidirectional association between the incidence and RT-PCR testing, there may have been an underdiagnosed population for the infection. The restraint policy for RT-PCR testing should be revisited to meet the increasing demand under the COVID-19 epidemic.", "COVID-19 outbreak in Algeria: A mathematical Model to predict cumulative cases Introduction: Since December 29, 2019 a pandemic of new novel coronavirus-infected pneumonia named COVID-19 has started from Wuhan, China, has led to 254 996 confirmed cases until midday March 20, 2020. Sporadic cases have been imported worldwide, in Algeria, the first case reported on February 25, 2020 was imported from Italy, and then the epidemic has spread to other parts of the country very quickly with 139 confirmed cases until March 21, 2020. Methods: It is crucial to estimate the cases number growth in the early stages of the outbreak, to this end, we have implemented the Alg-COVID-19 Model which allows to predict the incidence and the reproduction number R0 in the coming months in order to help decision makers. The Alg-COVIS-19 Model initial equation 1, estimates the cumulative cases at t prediction time using two parameters: the reproduction number R0 and the serial interval SI. Results: We found R0=2.55 based on actual incidence at the first 25 days, using the serial interval SI= 4,4 and the prediction time t=26. The herd immunity HI estimated is HI=61%. Also, The Covid-19 incidence predicted with the Alg-COVID-19 Model fits closely the actual incidence during the first 26 days of the epidemic in Algeria Fig. 1.A. which allows us to use it.", "COVID-19 outbreak on the Diamond Princess cruise ship: estimating the epidemic potential and effectiveness of public health countermeasures BACKGROUND: Cruise ships carry a large number of people in confined spaces with relative homogeneous mixing. On 3 February, 2020, an outbreak of COVID-19 on cruise ship Diamond Princess was reported with 10 initial cases, following an index case on board around 21-25(th) January. By 4(th) February, public health measures such as removal and isolation of ill passengers and quarantine of non-ill passengers were implemented. By 20(th) February, 619 of 3,700 passengers and crew (17%) were tested positive. METHODS: We estimated the basic reproduction number from the initial period of the outbreak using SEIR models. We calibrated the models with transient functions of countermeasures to incidence data. We additionally estimated a counterfactual scenario in absence of countermeasures, and established a model stratified by crew and guests to study the impact of differential contact rates among the groups. We also compared scenarios of an earlier versus later evacuation of the ship. RESULTS: The basic reproduction rate was initially 4 times higher on-board compared to the [Formula: see text] in the epicentre in Wuhan, but the countermeasures lowered it substantially. Based on the modeled initial [Formula: see text] of 14.8, we estimated that without any interventions within the time period of 21 January to 19 February, 2920 out of the 3700 (79%) would have been infected. Isolation and quarantine therefore prevented 2307 cases, and lowered the [Formula: see text] to 1.78. We showed that an early evacuation of all passengers on 3 February would have been associated with 76 infected persons in their incubation time. CONCLUSIONS: Conclusions: The cruise ship conditions clearly amplified an already highly transmissible disease. The public health measures prevented more than 2000 additional cases compared to no interventions. However, evacuating all passengers and crew early on in the outbreak would have prevented many more passengers and crew from infection.", "On the assessment of more reliable COVID-19 infected number: the italian case. COVID-19 (SARS-CoV-2) is the most recent pandemic disease the world is currently managing. It started in China at the end of 2019, and it is diffusing throughout Italy, one of the most affected countries, and it is currently spreading through European countries and USA. Patients affected by COVID-19 are identified employing medical swabs applied mainly to (i) citizens with COVID-19 symptoms such as flu or high temperature, or (ii) citizens that had contacts with COVID-19 patients. A percentage of COVID-19 affected patients needs hospitalisation, whereas a portion needs to be treated in Intensive Care Units (ICUs). Nevertheless, it is a matter of current intuition that COVID-19 infected citizens are more than those detected, and sometime the infection is detected too late. Thus there are many efforts in both tracking people activities as well as diffusing low cost reliable COVID-19 tests for early detection. Starting from mortality rates of diseases caused by viruses in the same family (e.g. MERS, SARS, H1N1), we study the relations between the number of COVID-19 infections and the number of deaths, through Italian regions. We thus assess several infections being higher than the ones currently measured. We thus focus on the characterisation of the pandemic diffusion by estimating the infected number of patients versus the number of death. We use such an estimated number of infections, to foresee the effects of restriction actions adopted by governments to constrain virus diffusion. We finally think that our model can support the healthcare system to react when COVID-19 is increasing.", "Cruise Ships, Nursing Homes and Prisons as COVID-19 Epicenters: A \u2018Wicked Problem\u201d with Breakthrough Solutions? ", "Preliminary Results of Initial Testing for Coronavirus (COVID-19) in the Emergency Department INTRODUCTION: On March 10, 2020, the World Health Organization declared a global pandemic due to widespread infection of the novel coronavirus 2019 (COVID-19). We report the preliminary results of a targeted program of COVID-19 infection testing in the ED in the first 10 days of its initiation at our institution. METHODS: We conducted a review of prospectively collected data on all ED patients who had targeted testing for acute COVID-19 infection at two EDs during the initial 10 days of testing (March 10\u201319, 2020). During this initial period with limited resources, testing was targeted toward high-risk patients per Centers for Disease Control and Prevention guidelines. Data collected from patients who were tested included demographics, clinical characteristics, and test qualifying criteria. We present the data overall and by test results with descriptive statistics. RESULTS: During the 10-day study period, the combined census of the study EDs was 2157 patient encounters. A total of 283 tests were ordered in the ED. The majority of patients were 18\u201364 years of age, male, non-Hispanic white, had an Emergency Severity Index score of three, did not have a fever, and were discharged from the ED. A total of 29 (10.2%) tested positive. Symptoms-based criteria most associated with COVID-19 were the most common criteria identified for testing (90.6%). All other criteria were reported in 5.51\u201343.0% of persons being tested. Having contact with a person under investigation was significantly more common in those who tested positive compared to those who tested negative (63% vs 24.5%, respectively). The majority of patients in both results groups had at least two qualifying criteria for testing (75.2%). CONCLUSION: In this review of prospectively collected data on all ED patients who had targeted testing for acute COVID-19 infection at two EDs in the first 10 days of testing, we found that 10.2% of those tested were identified as positive. The continued monitoring of testing and results will help providers understand how COVID-19 is progressing in the community.", "An IDEA for Short Term Outbreak Projection: Nearcasting Using the Basic Reproduction Number BACKGROUND: Communicable disease outbreaks of novel or existing pathogens threaten human health around the globe. It would be desirable to rapidly characterize such outbreaks and develop accurate projections of their duration and cumulative size even when limited preliminary data are available. Here we develop a mathematical model to aid public health authorities in tracking the expansion and contraction of outbreaks with explicit representation of factors (other than population immunity) that may slow epidemic growth. METHODOLOGY: The Incidence Decay and Exponential Adjustment (IDEA) model is a parsimonious function that uses the basic reproduction number R(0), along with a discounting factor to project the growth of outbreaks using only basic epidemiological information (e.g., daily incidence counts). PRINCIPAL FINDINGS: Compared to simulated data, IDEA provides highly accurate estimates of total size and duration for a given outbreak when R(0) is low or moderate, and also identifies turning points or new waves. When tested with an outbreak of pandemic influenza A (H1N1), the model generates estimated incidence at the i+1(th) serial interval using data from the i(th) serial interval within an average of 20% of actual incidence. CONCLUSIONS AND SIGNIFICANCE: This model for communicable disease outbreaks provides rapid assessments of outbreak growth and public health interventions. Further evaluation in the context of real-world outbreaks will establish the utility of IDEA as a tool for front-line epidemiologists.", "Estimating the number of SARS-CoV-2 infections in the United States We apply a model developed by The COVID-19 Response Team [S. Flaxman, S. Mishra, A. Gandy, et al., ''Estimating the number of infections and the impact of non- pharmaceutical interventions on COVID-19 in 11 European countries,'' tech. rep., Imperial College London, 2020.] to estimate the total number of SARS-CoV-2 infections in the United States. Across the United States we estimate as of April 18, 2020 the fraction of the population infected was 4.6% [3.6%, 5.8%], 21 times the portion of the population with a positive test result. Excluding New York state, which we estimate accounts for over half of infections in the United States, we estimate an infection rate of 2.3% [2.1%, 2.8%]. We include the timing of each state's implementation of interventions including encouraging social distancing, closing schools, banning public events, and a lockdown / stay-at-home order. We assume fatalities are reported correctly and infer the number and timing of infections based on the infection fatality rate measured in populations that were tested universally for SARS-CoV-2. Underreporting of deaths would drive our estimates to be too low. Reporting of deaths on the wrong day could drive errors in either direction. This model does not include effects of herd immunity; in states where the estimated infection rate is very high - namely, New York - our estimates may be too high.", "Spatial Disparities in Coronavirus Incidence and Mortality in the United States: An Ecological Analysis as of May 2020 PURPOSE: This ecological analysis investigates the spatial patterns of the COVID\u201019 epidemic in the United States in relation to socioeconomic variables that characterize US counties. METHODS: Data on confirmed cases and deaths from COVID\u201019 for 2,814 US counties were obtained from Johns Hopkins University. We used Geographic Information Systems (GIS) to map the spatial aspects of this pandemic and investigate the disparities between metropolitan and nonmetropolitan communities. Multiple regression models were used to explore the contextual risk factors of infections and death across US counties. We included population density, percent of population aged 65+, percent population in poverty, percent minority population, and percent of the uninsured as independent variables. A state\u2010level measure of the percent of the population that has been tested for COVID\u201019 was used to control for the impact of testing. FINDINGS: The impact of COVID\u201019 in the United States has been extremely uneven. Although densely populated large cities and their surrounding metropolitan areas are hotspots of the pandemic, it is counterintuitive that incidence and mortality rates in some small cities and nonmetropolitan counties approximate those in epicenters such as New York City. Regression analyses support the hypotheses of positive correlations between COVID\u201019 incidence and mortality rates and socioeconomic factors including population density, proportions of elderly residents, poverty, and percent population tested. CONCLUSIONS: Knowledge about the spatial aspects of the COVID\u201019 epidemic and its socioeconomic correlates can inform first responders and government efforts. Directives for social distancing and to \u201cshelter\u2010in\u2010place\u201d should continue to stem the spread of COVID\u201019.", "Protocol of a population-based prospective COVID-19 cohort study Munich, Germany (KoCo19) Background: The SARS-CoV-2 pandemic is leading to the global introduction of public health interventions to prevent the spread of the virus and avoid the overload of health care systems, especially for the most severely affected patients. Scientific studies to date have focused primarily on describing the clinical course of patients, identifying treatment options and developing vaccines. In Germany, as in many other regions, current tests for SARS-CoV2 are not being conducted on a representative basis and in a longitudinal design. Furthermore, knowledge about the immune status of the population is lacking. Yet these data are needed to understand the dynamics of the pandemic and to thus appropriately design and evaluate interventions. For this purpose, we recently started a prospective population-based cohort in Munich, Germany, with the aim to better understand the state and dynamics of the pandemic. Methods: In 100, randomly selected constituencies out of 755, 3,000 Munich households are identified via random route and offered enrollment into the study. All household members are asked to complete a baseline questionnaire and subjects [\u2265]14 years of age are asked to provide a venous blood sample of [\u2264]3 ml for the determination of SARS-CoV-2 IgG/IgA status. The residual plasma and the blood pellet are preserved for later genetic and molecular biological investigations. For twelve months, each household member is asked to keep a diary of daily symptoms, whereabouts and contacts via WebApp. If symptoms suggestive for COVID-19 are reported, family members, including children <14 years, are offered a pharyngeal swab taken at the Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, for molecular testing for SARS-CoV-2. In case of severe symptoms, participants will be transferred to a Munich hospital. For one year, the study teams re-visits the households for blood sampling every six weeks. Discussion: With the planned study we will establish a reliable epidemiological tool to improve the understanding of the spread of SARS-CoV-2 and to better assess the effectiveness of public health measures as well as their socio-economic effects. This will support policy makers in managing the epidemic based on scientific evidence.", "More than just smell - COVID-19 is associated with severe impairment of smell, taste, and chemesthesis Recent anecdotal and scientific reports have provided evidence of a link between COVID-19 and chemosensory impairments such as anosmia. However, these reports have downplayed or failed to distinguish potential effects on taste, ignored chemesthesis, generally lacked quantitative measurements, and were mostly restricted to data from single countries. Here, we report the development, implementation and initial results of a multi-lingual, international questionnaire to assess self-reported quantity and quality of perception in three distinct chemosensory modalities (smell, taste, and chemesthesis) before and during COVID-19. In the first 11 days after questionnaire launch, 4039 participants (2913 women, 1118 men, 8 other, ages 19-79) reported a COVID-19 diagnosis either via laboratory tests or clinical assessment. Importantly, smell, taste and chemesthetic function were each significantly reduced compared to their status before the disease. Difference scores (maximum possible change {+/-}100) revealed a mean reduction of smell (-79.7{+/-}28.7, mean{+/-}SD), taste (-69.0{+/-}32.6), and chemesthetic (-37.3{+/-}36.2) function during COVID-19. Qualitative changes in olfactory ability (parosmia and phantosmia) were relatively rare and correlated with smell loss. Importantly, perceived nasal obstruction did not account for smell loss. Furthermore, chemosensory impairments were similar between participants in the laboratory test and clinical assessment groups. These results show that COVID-19-associated chemosensory impairment is not limited to smell, but also affects taste and chemesthesis. The multimodal impact of COVID-19 and lack of perceived nasal obstruction suggest that SARS-CoV-2 infection may disrupt sensory-neural mechanisms.", "The socio-economic determinants of the coronavirus disease (COVID-19) pandemic The magnitude of the coronavirus disease (COVID-19) pandemic has an enormous impact on the social life and the economic activities in almost every country in the world. Besides the biological and epidemiological factors, a multitude of social and economic criteria also govern the extent of the coronavirus disease spread in the population. Consequently, there is an active debate regarding the critical socio-economic determinants that contribute to the resulting pandemic. In this paper, we contribute towards the resolution of the debate by leveraging Bayesian model averaging techniques and country level data to investigate the potential of 35 determinants, describing a diverse set of socio-economic characteristics, in explaining the coronavirus pandemic outcome.", "Estimating the global spread of COVID-19 Limited and inconsistent testing and differences in age distribution, health care resources, social distancing, and policies have caused large variations in the extent and dynamics of the COVID-19 pandemic across nations, complicating the estimation of prevalence, the infection fatality rate (IFR), and other factors important to care providers and policymakers. Using data for all 84 countries with reliable testing data (spanning 4.75 billion people) we develop a dynamic epidemiological model integrating data on cases, deaths, excess mortality and other factors to estimate how asymptomatic transmission, disease acuity, hospitalization, and behavioral and policy responses to risk condition prevalence and IFR across nations and over time. For these nations we estimate IFR averages 0.68% (0.64%-0.7%). Cases and deaths through June 18, 2020 are estimated to be 11.8 and 1.48 times official reports, respectively, at 88.5 (85-95.3) million and 600 (586-622) thousand. Prevalence and IFR vary substantially, e.g., Ecuador (18%; 0.61%), Chile (15.5%; 0.57%), Mexico (8.8%; 0.69%), Iran (7.9%; 0.44%), USA (5.3%; 0.99%), UK (5.2%; 1.59%), Iceland (1.65%, 0.56%), New Zealand (0.1%, 0.64%), but all nations remain well below the level needed for herd immunity. By alerting the public earlier and reducing contacts, extensive testing when the pandemic was declared could have averted 35.3 (32.7-42.7) million cases and 197 (171-232) thousand deaths. However, future outcomes are less dependent on testing and more contingent on the willingness of communities and governments to reduce transmission. Absent breakthroughs in treatment or vaccination and with mildly improved responses we project 249 (186-586) million cases and 1.75 (1.40-3.67) million deaths in the 84 countries by Spring 2021.", "Fast spread of COVID-19 in Europe and the US suggests the necessity of early, strong and comprehensive interventions The COVID-19 pandemic caused more than 800,000 infections and 40,000 deaths by the end of March 2020. However, some of the basic epidemiological parameters, such as the exponential epidemic growth rate and R(0) are debated. We developed an inference approach to control for confounding factors in data collection, such as underreporting and changes in surveillance intensities, and fitted a mathematical model to infection and death count data collected from eight European countries and the US. In all countries, the early epidemic grew exponentially at rates between 0.19\u20130.29/day (epidemic doubling times between 2.4\u20133.7 days). This suggests a highly infectious virus with an R(0) likely between 4.0 and 7.1. We show that similar levels of intervention efforts are needed, no matter the goal is mitigation or containment. Early, strong and comprehensive intervention efforts to achieve greater than 74\u201386% reduction in transmission are necessary.", "Test performance evaluation of SARS-CoV-2 serological assays BACKGROUND: Serological tests are crucial tools for assessments of SARS-CoV-2 exposure, infection and potential immunity. Their appropriate use and interpretation require accurate assay performance data. METHOD: We conducted an evaluation of 10 lateral flow assays (LFAs) and two ELISAs to detect anti-SARS-CoV-2 antibodies. The specimen set comprised 128 plasma or serum samples from 79 symptomatic SARS-CoV-2 RT-PCR-positive individuals; 108 pre-COVID-19 negative controls; and 52 recent samples from individuals who underwent respiratory viral testing but were not diagnosed with Coronavirus Disease 2019 (COVID-19). Samples were blinded and LFA results were interpreted by two independent readers, using a standardized intensity scoring system. RESULTS: Among specimens from SARS-CoV-2 RT-PCR-positive individuals, the percent seropositive increased with time interval, peaking at 81.8\u2013100.0% in samples taken >20 days after symptom onset. Test specificity ranged from 84.3\u2013100.0% in pre-COVID-19 specimens. Specificity was higher when weak LFA bands were considered negative, but this decreased sensitivity. IgM detection was more variable than IgG, and detection was highest when IgM and IgG results were combined. Agreement between ELISAs and LFAs ranged from 75.7\u201394.8%. No consistent cross-reactivity was observed. CONCLUSION: Our evaluation showed heterogeneous assay performance. Reader training is key to reliable LFA performance, and can be tailored for survey goals. Informed use of serology will require evaluations covering the full spectrum of SARS-CoV-2 infections, from asymptomatic and mild infection to severe disease, and later convalescence. Well-designed studies to elucidate the mechanisms and serological correlates of protective immunity will be crucial to guide rational clinical and public health policies.", "An empirical estimate of the infection fatality rate of COVID-19 from the first Italian outbreak Background: The coronavirus 2019 (COVID-19) pandemic has been spread-ing globally for months, yet the infection fatality ratio of the disease is still uncertain. This is partly because of inconsistencies in testing and death reporting standards across countries. Our purpose is to provide accurate estimates which do not rely on testing and death count data directly but only use population level statistics. Methods: We collected demographic and death records data from the Italian Institute of Statistics. We focus on the area in Italy that experienced the initial outbreak of COVID-19 and estimated a Bayesian model fitting age-stratified mortality data from 2020 and previous years. We also assessed the sensitivity of our estimates to alternative assumptions on the proportion of population infected. Findings: We estimate an overall infection fatality rate of 1.29% (95% credible interval [CrI] 0.89 - 2.01), as well as large differences by age, with a low infection fatality rate of 0.05% for under 60 year old (CrI 0-.19) and a substantially higher 4.25% (CrI 3.01-6.39) for people above 60 years of age. In our sensitivity analysis, we found that even under extreme assumptions, our method delivered useful information. For instance, even if only 10% of the population were infected, the infection fatality rate would not rise above 0.2% for people under 60. Interpretation: Our empirical estimates based on population level data show a sharp difference in fatality rates between young and old people and firmly rule out overall fatality ratios below 0.5% in populations with more than 30% over 60 years old.", "Excess cases of influenza-like illnesses synchronous with coronavirus disease (COVID-19) epidemic, France, March 2020 Several French regions where coronavirus disease (COVID-19) has been reported currently show a renewed increase in ILI cases in the general practice-based Sentinelles network. We computed the number of excess cases by region from 24 February to 8 March 2020 and found a correlation with the number of reported COVID-19 cases so far. The data suggest larger circulation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the French population than apparent from confirmed cases.", "COVID-19, Australia: Epidemiology Report 16 (Reporting week to 23:59 AEST 17 May 2020). Confirmed cases in Australia notified up to 17 May 2020: notifications = 7,075; deaths = 100. The incidence of new cases of COVID-19 has reduced dramatically since a peak in mid-March. Social distancing measures, public health action and the reduction in international travel have likely been effective in slowing the spread of the disease, in the Australian community. Testing rates over the past week have increased markedly, with a continued very low proportion of people testing positive. These low rates of detection are indicative of low levels of COVID-19 transmission. It is important that testing rates and community adherence to public health measures remain high to support the continued suppression of the virus, particularly in vulnerable high-risk groups and settings. New cases of COVID-19 are currently being reported by by only some jurisdictions, albeit at relatively low rates. Although case numbers are low, new cases tend to still be a mix of overseas-acquired and locally-acquired infections. Most locally-acquired cases can be linked back to a known case or cluster. Although the proportion of locally-acquired cases has increased, the overall rate of new cases, regardless of place of acquisition, continues to decrease. The crude case fatality rate in Australia remains low (1.4%), compared with the WHO reported global rate (6.9%). The low case fatality rate is likely reflective of high case detection and high quality of health care services in Australia. Deaths from COVID-19 in Australia have occurred predominantly among the elderly and those with comorbidities, with no deaths occurring in those under 40 years. The highest rate of COVID-19 continues to be among people aged 60-79 years. One third of all cases in this age group have been associated with several outbreaks linked to cruise ships. The lowest rate of disease is in young children, a pattern reflected in international reports. Internationally, while the number of new cases each day remains relatively stable at the global level, some areas such as Brazil and India are showing a dramatic rise in reported cases. Although some low-income countries have so far reported few cases, it is possible that this is due to limited diagnostic and public health capacity, and may not be reflective of true disease incidence.", "The COVID-19 (SARS-CoV-2) Uncertainty Tripod in Brazil: Assessments on model-based predictions with large under-reporting The COVID-19 pandemic (SARS-CoV-2 virus) is the defying global health crisis of our time. The absence of mass testing and the relevant presence of asymptomatic individuals causes the available data of the COVID-19 pandemic in Brazil to be largely under-reported regarding the number of infected individuals and deaths. We propose an adapted Susceptible-Infected-Recovered (SIR) model which explicitly incorporates the under-reporting and the response of the population to public policies (such as confinement measures, widespread use of masks, etc) to cast short-term and long-term predictions. Large amounts of uncertainty could provide misleading models and predictions. In this paper, we discuss the role of uncertainty in these prediction, which is illustrated regarding three key aspects. First, assuming that the number of infected individuals is under-reported, we demonstrate an anticipation regarding the peak of infection. Furthermore, while a model with a single class of infected individuals yields forecasts with increased peaks, a model that considers both symptomatic and asymptomatic infected individuals suggests a decrease of the peak of symptomatic. Second, considering that the actual amount of deaths is larger than what is being register, then demonstrate the increase of the mortality rates. Third, when consider generally under-reported data, we demonstrate how the transmission and recovery rate model parameters change qualitatively and quantitatively. We also investigate the effect of the\"COVID-19 under-reporting tripod\", i.e. the under-reporting in terms of infected individuals, of deaths and the true mortality rate. If two of these factors are known, the remainder can be inferred, as long as proportions are kept constant. The proposed approach allows one to determine the margins of uncertainty by assessments on the observed and true mortality rates.", "Learning as We Go: An Examination of the Statistical Accuracy of COVID19 Daily Death Count Predictions This paper provides a formal evaluation of the predictive performance of a model (and its various updates) developed by the Institute for Health Metrics and Evaluation (IHME) for predicting daily deaths attributed to COVID19 for each state in the United States. The IHME models have received extensive attention in social and mass media, and have influenced policy makers at the highest levels of the United States government. For effective policy making the accurate assessment of uncertainty, as well as accurate point predictions, are necessary because the risks inherent in a decision must be taken into account, especially in the present setting of a novel disease affecting millions of lives. To assess the accuracy of the IHME models, we examine both forecast accuracy as well as the predictive performance of the 95% prediction intervals provided by the IHME models. We find that the initial IHME model underestimates the uncertainty surrounding the number of daily deaths substantially. Specifically, the true number of next day deaths fell outside the IHME prediction intervals as much as 70% of the time, in comparison to the expected value of 5%. In addition, we note that the performance of the initial model does not improve with shorter forecast horizons. Regarding the updated models, our analyses indicate that the later models do not show any improvement in the accuracy of the point estimate predictions. In fact, there is some evidence that this accuracy has actually decreased over the initial models. Moreover, when considering the updated models, while we observe a larger percentage of states having actual values lying inside the 95% prediction intervals (PI), our analysis suggests that this observation may be attributed to the widening of the PIs. The width of these intervals calls into question the usefulness of the predictions to drive policy making and resource allocation.", "COVID-19 Fatality Rate and Performed Swabs in Italy: a Misleading Perception. BACKGROUND CoronaVirus Disease 2019 (COVID-19) fatality rate in Italy is controversial and is largely affecting discussion on the impact of containment measures that are straining the world's social and economic fabric, such as large-scale use of isolation and quarantine, closing borders, imposing limits on public gatherings, and implementing nationwide lockdowns. OBJECTIVE The scientific community, citizens, politicians and mass media are arguing over data that seem to suggest that Italy has a significantly higher number of COVID-19-related deaths than in the rest of the world. Moreover, Italian citizens have a misleading perception related to the number of actually performed swab tests. Citizens and mass media denounce that the coverage obtained by COVID-19 swab testing in Italy is not in line with other countries all over the world. METHODS In this paper, we try to clarify, with a set of statistical analysis conducted world-wide, both aspects by highlighting the actual numbers and by comparing them with the official data available. RESULTS The analysis clearly shows that the Italian COVID-19 fatality and mortality rate are in line with the official world scenario, and these findings are true also for the number of COVID-19 swabs performed in Italy and in Lombardy Region. CONCLUSIONS Up-to-date analysis of this type may simplify the understanding of the pandemic evolution. CLINICALTRIAL", "Age-dependent effects in the transmission and control of COVID-19 epidemics The COVID-19 pandemic has shown a markedly low proportion of cases among children. Age disparities in observed cases could be explained by children having lower susceptibility to infection, lower propensity to show clinical symptoms, or both. We evaluate these possibilities by fitting an age-structured mathematical model to epidemic data from six countries. We estimate that clinical symptoms occur in 25% (95% CrI: 19-32%) of infections in 10-19-year-olds, rising to 76% (68-82%) in over-70s, and that susceptibility to infection in under-20s is approximately half that of older adults. Accordingly, we find that interventions aimed at children may have a relatively small impact on total cases, particularly if the transmissibility of subclinical infections is low. The age-specific clinical fraction and susceptibility we have estimated has implications for the expected global burden of COVID-19 because of demographic differences across settings: in younger populations, the expected clinical attack rate would be lower, although it is likely that comorbidities in low-income countries will affect disease severity. Without effective control measures, regions with older populations may see disproportionally more clinical cases, particularly in the later stages of the pandemic.", "A Computational Model for Estimating the Progression of COVID-19 Cases in the US West and East Coasts The ongoing coronavirus disease 2019 (COVID-19) pandemic is of global concern and has recently emerged in the US. In this paper, we construct a stochastic variant of the SEIR model to make a quasi-worst-case scenario prediction of the COVID-19 outbreak in the US West and East Coasts. The model is then fitted to current data and implemented using Runge-Kutta methods. Our computation results predict that the number of new cases would peak around mid-April and begin to abate by July, and that the number of cases of COVID-19 might be significantly mitigated by having greater numbers of functional testing kits available for screening. The model also showed how small changes in variables can make large differences in outcomes and highlights the importance of healthcare preparedness during pandemics.", "Socioeconomic disparities in subway use and COVID-19 outcomes in New York City Background: The United States CDC has reported that racial and ethnic disparities in the COVID-19 pandemic may in part be due to socioeconomic disadvantages that require individuals to continue to work outside their home and a lack of paid sick leave. However, data-driven analyses of the socioeconomic determinants of COVID-19 burden are still needed. Using data from New York City (NYC), we aimed to determine how socioeconomic factors impact human mobility and COVID-19 burden. Methods/Summary: New York City has a large amount of heterogeneity in socioeconomic status (SES) and demographics among neighborhoods. We used this heterogeneity to conduct a cross-sectional spatial analysis of the associations between human mobility (i.e., subway ridership), sociodemographic factors, and COVID-19 incidence as of April 26, 2020. We also conducted a secondary analysis of NYC boroughs (which are equivalent to counties in the city) to assess the relationship between the decline in subway use and the time it took for each borough to end the exponential growth period of COVID-19 cases. Findings: Areas with the lower median income, a greater percentage of individuals who identify as non-white and/or Hispanic/Latino, a greater percentage of essential workers, and a greater percentage of healthcare workers had more subway use during the pandemic. The positive associations between subway use and median income, and between subway use and percent non-white and/or Hispanic/Latino do not remain when adjusted for the percent of essential workers. This suggests essential work is what drives subway use in lower SES zip codes and communities of color. Increased subway use was associated with a higher rate of COVID-19 cases per 100,000 population when adjusted for testing effort (aRR=1.11; 95% CI: 1.03 - 1.19), but this association was weaker once we adjusted for median income (aRR=1.06; 95% CI: 1.00 - 1.12). All sociodemographic variables were significantly associated with the rate of positive cases per 100,000 population when adjusting for testing effort (except percent uninsured) and adjusting for both income and testing effort. The risk factor with the strongest association with COVID-19 was the percent of individuals in essential work (aRR = 1.59, 95% CI: 1.36 - 1.86). We found that subway use declined prior to any executive order, and there was an estimated 28-day lag between the onset of reduced subway use and the end of the exponential growth period of SARS-CoV-2 within New York City boroughs. Interpretation: Our results suggest that the ability to stay home during the pandemic has been constrained by SES and work circumstances. Poorer neighborhoods are not afforded the same reductions in mobility as their richer counterparts. Furthermore, lower SES neighborhoods have higher disease burdens, which may be due to inequities in ability to shelter-in-place, and/or due to the plethora of other existing health disparities that increase vulnerability to COVID-19. Furthermore, the extended lag time between the dramatic fall in subway ridership and the end of the exponential growth phase for COVID-19 cases is important for future policy, because it demonstrates that if there is a resurgence, and stay-at-home orders are re-issued, then cities can expect to wait a month before reported cases will plateau.", "Analysis of the Worldwide Corona Virus (COVID-19) Pandemic Trend;A Modelling Study to Predict Its Spread Objective: The Coronavirus (COVID-19) has advanced into 197 countries and territories leaving behind a total of 372,757 confirmed cases and 16231 deaths. Methods: One the basis of WHO situation reports data of COVID-19 along with daily official reports from the Japan, China and the Korea we modeled the spread of COVID19 by using the Successive Approximation Method. We defined the two state of data to find the mean ratio (\u03b7) of the present cases count to the sum of previous and present cases. This ratio further predicts the future state of COVID-19 pandemic. Results: The mean ratio (\u03b7) of expected cases were found 0.485, while the mean ratio for deaths was found to be 0.49. We calculated worldwide expected lower bound value for confirmed cases 247007 cases with maximum limit of 1667719 cases and minimum deaths count 8660 with upper limit of 117397 deaths in next 30 days. While in the case of Iran, a large increase in the number of deaths are expected in the upcoming 30 days with lower bound value of 1140 deaths and maximum value of 598478 deaths. Interpretation: Iran whole population is on risk.", "Coast-to-coast spread of SARS-CoV-2 in the United States revealed by genomic epidemiology Since its emergence and detection in Wuhan, China in late 2019, the novel coronavirus SARS-CoV-2 has spread to nearly every country around the world, resulting in hundreds of thousands of infections to date. The virus was first detected in the Pacific Northwest region of the United States in January, 2020, with subsequent COVID-19 outbreaks detected in all 50 states by early March. To uncover the sources of SARS-CoV-2 introductions and patterns of spread within the U.S., we sequenced nine viral genomes from early reported COVID-19 patients in Connecticut. Our phylogenetic analysis places the majority of these genomes with viruses sequenced from Washington state. By coupling our genomic data with domestic and international travel patterns, we show that early SARS-CoV-2 transmission in Connecticut was likely driven by domestic introductions. Moreover, the risk of domestic importation to Connecticut exceeded that of international importation by mid-March regardless of our estimated impacts of federal travel restrictions. This study provides evidence for widespread, sustained transmission of SARS-CoV-2 within the U.S. and highlights the critical need for local surveillance.", "Reagents hold up European COVID-19 tests Politicians in the UK and the Netherlands claim that delays in the rollout of COVID-19 testing are because of a shortage of reagents\u2014typically enzymes and buffers\u2014used in antigen tests to determine the presence of the coronavirus that causes COVID-19 Politicians in the Netherlands have accused Roche of withholding the latest chemical formula for a buffer used in its polymerase chain reaction\u2013based COVID-19 tests And Dutch media outlets say Roche is keeping reagents for its tests within its home country of Switzerland The company tells C&EN that it is doing all it can to provide COVID-19 test kits, as well as the required reagents, in Europe and beyond In the UK, \u201ca critical constraint on the ability to rapidly increase testing capacity is the availability of the chemical reagents,\u201d UK government minister Michael Gove told journalists March 31 UK politicians are under scrutiny because the country\u2019s testing lags Germany\u2019s as well", "Temperature and precipitation associate with Covid-19 new daily cases: A correlation study between weather and Covid-19 pandemic in Oslo, Norway Abstract This study aims to analyze the correlation between weather and covid-19 pandemic in the capital city of Norway, Oslo. This study employed a secondary data analysis of covid-19 surveillance data from the Norwegian public health institute and weather data from the Norwegian Meteorological institute. The components of weather include minimum temperature (\u00b0C), maximum temperature (\u00b0C), temperature average (\u00b0C), normal temperature (\u00b0C), precipitation level (mm) and wind speed (m/s). Since normality was not fulfilled, a non-parametric correlation test was used for data analysis. Maximum temperature (r = 0.347; p = .005), normal temperature(r = 0.293; p = .019), and precipitation level (r = \u22120.285; p = .022) were significantly correlated with covid-19 pandemic. The finding serves as an input to a strategy making against the prevention of covid-19 as the country prepare to enter into a new weather season.", "How best to use limited tests? Improving COVID-19 surveillance in long-term care Background: Long-term care facilities (LTCFs) are particularly vulnerable to nosocomial outbreaks of coronavirus disease 2019 (COVID-19), with high rates of transmission and mortality. Timely epidemiological surveillance is essential to detect and respond to outbreaks, but testing resources are highly limited in the current pandemic context. Methods: We used an individual-based transmission model to simulate COVID-19 spread along inter-individual contact networks in the LTCF setting. A range of surveillance strategies were evaluated for their ability to detect simulated outbreaks, assuming limited availability of standard RT-PCR tests. Various epidemiological scenarios were considered, including COVID-19 importation from patient transfers or staff members infected in the community. Findings: We estimated a median delay of 7 (95% uncertainty interval: 2-15) days from importation of an asymptomatic COVID-19-infected patient to first presentation of COVID-19 symptoms among any patients or staff, at which point an additional 7 (0-25) individuals were infected but did not (yet) show symptoms. Across a range of scenarios, the reference surveillance strategy (testing individuals with COVID-like symptoms with signs of severity) took a median 11-21 days to detect an outbreak. Group testing (pooling specimens from multiple individuals for a single RT-PCR test) patients and staff with any COVID-like symptoms was both the most timely and efficient strategy, detecting outbreaks up to twice as quickly as the reference, and more quickly than other considered strategies while using fewer tests. Maximizing use of available tests via testing cascades was more effective than group testing only when substantial testing resources were available (on the order of 1 test/20 beds/day). Including not merely those with symptoms but also newly admitted patients in group tests and testing cascades reduced delays in outbreak detection for LTCFs actively admitting patients potentially already infected with COVID-19. Interpretation: Improving COVID-19 surveillance can alert healthcare institutions to emerging outbreaks before they escalate, informing a need for urgent public health intervention in settings with ongoing nosocomial transmission.", "Estimating the COVID-19 infection rate: Anatomy of an inference problem As a consequence of missing data on tests for infection and imperfect accuracy of tests, reported rates of cumulative population infection by the SARS CoV-2 virus are lower than actual rates of infection. Hence, reported rates of severe illness conditional on infection are higher than actual rates. Understanding the time path of the COVID-19 pandemic has been hampered by the absence of bounds on infection rates that are credible and informative. This paper explains the logical problem of bounding these rates and reports illustrative findings, using data from Illinois, New York, and Italy. We combine the data with assumptions on the infection rate in the untested population and on the accuracy of the tests that appear credible in the current context. We find that the infection rate might be substantially higher than reported. We also find that the infection fatality rate in Illinois, New York, and Italy is substantially lower than reported.", "A simulation-based procedure to estimate base rates from Covid-19 antibody test results I: Deterministic test reliabilities We design a procedure (the complete Python code may be obtained at: https://github.com/abhishta91/antibody_montecarlo) using Monte Carlo (MC) simulation to establish the point estimators described below and confidence intervals for the base rate of occurrence of an attribute (e.g., antibodies against Covid-19) in an aggregate population (e.g., medical care workers) based on a test. The requirements for the procedure are the test's sample size (N) and total number of positives (X), and the data on test's reliability. The modus is the prior which generates the largest frequency of observations in the MC simulation with precisely the number of test positives (maximum-likelihood estimator). The median is the upper bound of the set of priors accounting for half of the total relevant observations in the MC simulation with numbers of positives identical to the test's number of positives. Our rather preliminary findings are: The median and the confidence intervals suffice universally; The estimator X/N may be outside of the two-sided 95% confidence interval; Conditions such that the modus, the median and another promising estimator which takes the reliability of the test into account, are quite close; Conditions such that the modus and the latter estimator must be regarded as logically inconsistent; Conditions inducing rankings among various estimators relevant for issues concerning over- or underestimation.", "Direct Measurement of Rates of Asymptomatic Infection and Clinical Care-Seeking for Seasonal Coronavirus The pandemic potential of the novel coronavirus (nCoV) that emerged in Wuhan, China, during December 2019 is strongly tied to the number and contagiousness of undocumented human infections. Here we present findings from a proactive longitudinal sampling study of acute viral respiratory infections that documents rates of asymptomatic infection and clinical care seeking for seasonal coronavirus. We find that the majority of infections are asymptomatic by most symptom definitions and that only 4% of individuals experiencing a seasonal coronavirus infection episode sought medical care for their symptoms. These numbers indicate that a very high percentage of seasonal coronavirus infections are undocumented and provide a reference for understanding the spread of the emergent nCoV.", "Relative Coronavirus Disease 2019 Mortality: A Swiss Population-based Study Objective: Severity of the coronavirus disease 2019 (covid-19) has been assessed in terms of absolute mortality in SARS-CoV-2 positive cohorts. An assessment of mortality relative to mortality in the general population is presented. Design: Retrospective population-based study. Setting: Individual information on symptomatic confirmed SARS-CoV-2 patients and subsequent deaths from any cause were compared to the all-cause mortality in the Swiss population of 2018. Starting February 23, 2020, mortality in covid-19 patients was monitored for 80 days and compared to the population mortality observed in the same time-of-year starting February 23, 2018. Participants: 5 160 595 inhabitants of Switzerland aged 35 to 95 without covid-19 (general population in spring 2018) and 20 769 persons tested positively for covid-19 (spring 2020). Measurements: Sex- and age-specific mortality rates were estimated using Cox proportional hazards models. Absolute probabilities of death were predicted and risk was assessed in terms of relative mortality by taking the ratio between the sex- and age-specific absolute mortality in covid19 patients and the corresponding mortality in the 2018 general population. Results: A confirmed SARS-CoV-2 infection substantially increased the probability of death across all patient groups, ranging from nine (6 to 15) times the population mortality in 35-year old infected females to a 53-fold increase (46 to 59) for 95 year old infected males. The highest relative risks were observed among males and older patients. The magnitude of these effects was smaller compared to increases observed in absolute mortality risk. Male covid-19 patients exceeded the population hazard for males (hazard ratio 1.20, 1.00 to 1.44). Each additional year of age increased the population hazard in covid-19 patients (hazard ratio 1.04, 1.03 to 1.05). Limitations: Information about the distribution of relevant comorbidities was not available on population level and the associated risk was not quantified. Conclusions: Health care professionals, decision makers, and societies are provided with an additional population-adjusted assessment of covid-19 mortality risk. In combination with absolute measures of risk, the relative risks presented here help to develop a more comprehensive understanding of the actual impact of covid-19.", "Disparities in COVID-19 Reported Incidence, Knowledge, and Behavior Abstract Background: Data from the COVID-19 pandemic in the United States show large differences in hospitalizations and mortality across race and geography. However, there is limited data on health information, beliefs, and behaviors that might indicate different exposure to risk. Methods: A sample of 5,198 respondents in the United States (80% population representative, 20% oversample of hotspot areas in New York City, Seattle, New Orleans, and Detroit) was conducted from March 29th to April 13th to measure differences in knowledge, beliefs and behavior regarding COVID-19. Linear regression was used to understand racial, geographic, political, and socioeconomic differences in COVID-19 reported incidence knowledge, and behaviors after adjusting for state-specific and survey date fixed effects. Results: The largest differences in COVID-19 knowledge and behaviors are associated with race/ethnicity, gender, and age. African-Americans, men, and people <55 years old are less likely to know how the disease is spread, less likely to know symptoms of COVID-19, wash their hands less frequently, and leave the home more often. Differences by income, political orientation, and living in a hotspot area are much smaller. Conclusions: There are wide gaps in COVID-19 reported incidence, knowledge regarding disease spread and symptoms, and in social distancing behavior. The findings suggest more effort is needed to increase accurate information and encourage appropriate behaviors among minority communities, men, and younger people.", "Estimation of Excess Deaths Associated With the COVID-19 Pandemic in the United States, March to May 2020. Importance Efforts to track the severity and public health impact of coronavirus disease 2019 (COVID-19) in the United States have been hampered by state-level differences in diagnostic test availability, differing strategies for prioritization of individuals for testing, and delays between testing and reporting. Evaluating unexplained increases in deaths due to all causes or attributed to nonspecific outcomes, such as pneumonia and influenza, can provide a more complete picture of the burden of COVID-19. Objective To estimate the burden of all deaths related to COVID-19 in the United States from March to May 2020. Design, Setting, and Population This observational study evaluated the numbers of US deaths from any cause and deaths from pneumonia, influenza, and/or COVID-19 from March 1 through May 30, 2020, using public data of the entire US population from the National Center for Health Statistics (NCHS). These numbers were compared with those from the same period of previous years. All data analyzed were accessed on June 12, 2020. Main Outcomes and Measures Increases in weekly deaths due to any cause or deaths due to pneumonia/influenza/COVID-19 above a baseline, which was adjusted for time of year, influenza activity, and reporting delays. These estimates were compared with reported deaths attributed to COVID-19 and with testing data. Results There were approximately 781 000 total deaths in the United States from March 1 to May 30, 2020, representing 122 300 (95% prediction interval, 116 800-127 000) more deaths than would typically be expected at that time of year. There were 95 235 reported deaths officially attributed to COVID-19 from March 1 to May 30, 2020. The number of excess all-cause deaths was 28% higher than the official tally of COVID-19-reported deaths during that period. In several states, these deaths occurred before increases in the availability of COVID-19 diagnostic tests and were not counted in official COVID-19 death records. There was substantial variability between states in the difference between official COVID-19 deaths and the estimated burden of excess deaths. Conclusions and Relevance Excess deaths provide an estimate of the full COVID-19 burden and indicate that official tallies likely undercount deaths due to the virus. The mortality burden and the completeness of the tallies vary markedly between states.", "Evolving Epidemiology and Impact of Non-pharmaceutical Interventions on the Outbreak of Coronavirus Disease 2019 in Wuhan, China BACKGROUND We described the epidemiological features of the coronavirus disease 2019 (Covid-19) outbreak, and evaluated the impact of non-pharmaceutical interventions on the epidemic in Wuhan, China. METHODS Individual-level data on 25,961 laboratory-confirmed Covid-19 cases reported through February 18, 2020 were extracted from the municipal Notifiable Disease Report System. Based on key events and interventions, we divided the epidemic into four periods: before January 11, January 11-22, January 23 - February 1, and February 2-18. We compared epidemiological characteristics across periods and different demographic groups. We developed a susceptible-exposed-infectious-recovered model to study the epidemic and evaluate the impact of interventions. RESULTS The median age of the cases was 57 years and 50.3% were women. The attack rate peaked in the third period and substantially declined afterwards across geographic regions, sex and age groups, except for children (age <20) whose attack rate continued to increase. Healthcare workers and elderly people had higher attack rates and severity risk increased with age. The effective reproductive number dropped from 3.86 (95% credible interval 3.74 to 3.97) before interventions to 0.32 (0.28 to 0.37) post interventions. The interventions were estimated to prevent 94.5% (93.7 to 95.2%) infections till February 18. We found that at least 59% of infected cases were unascertained in Wuhan, potentially including asymptomatic and mild-symptomatic cases. CONCLUSIONS Considerable countermeasures have effectively controlled the Covid-19 outbreak in Wuhan. Special efforts are needed to protect vulnerable populations, including healthcare workers, elderly and children. Estimation of unascertained cases has important implications on continuing surveillance and interventions.", "Modeling COVID 19 in the Basque Country: from introduction to control measure response In March 2020, a multidisciplinary task force (so-called Basque Modelling Task Force, BMTF) was created to assist the Basque Health managers and the Basque Government during the COVID-19 responses. BMTF is a modeling team, working on different approaches, including statistical methods and artificial intelligence. In this paper we describe and present the results obtained by one of the modeling approaches developed within the BMTF, a stochastic SHARUCD-type models able to describe the disease incidence data, provided by the Basque Health Service, with a single parameter set. Data inspection has shown that the partial lockdown measures were effective to slowdown disease transmission in the Basque Country. Short and longer-term predictions are tested with good results adjusted to the current epidemiological data. The growth rate {lambda} is calculated from the model and from the data and the implications for the reproduction ratio r are shown. At the moment, the reproduction ratio r is estimated to be below the threshold behavior of r = 1, but still close to 1, meaning that although the number of new cases are decelerating, a careful monitoring of the development of the outbreak is required. Besides projections on the national health system needs during the increased population demand on hospital admissions, models were able to describe COVID-19 epidemic in the Basque Country, from introduction to control measure response and are now being used to monitor disease transmission when the country lockdown is gradually lifted. These are the first made public available modeling results for the Basque Country and the efforts will be continued taking into consideration the updated data and new information that are generated over time.", "SARS-CoV-2 specific antibody responses in COVID-19 patients A new coronavirus, SARS-CoV-2, has recently emerged to cause a human pandemic. Whereas molecular diagnostic tests were rapidly developed, serologic assays are still lacking, yet urgently needed. Validated serologic assays are important for contact tracing, identifying the viral reservoir and epidemiological studies. Here, we developed serological assays for the detection of SARS-CoV-2 neutralizing, spike- and nucleocapsid-specific antibodies. Using serum samples from patients with PCR-confirmed infections of SARS-CoV-2, other coronaviruses, or other respiratory pathogenic infections, we validated and tested various antigens in different in-house and commercial ELISAs. We demonstrate that most PCR-confirmed SARS-CoV-2 infected individuals seroconverted, as revealed by sensitive and specific in-house ELISAs. We found that commercial S1 IgG or IgA ELISAs were of lower specificity while sensitivity varied between the two, with IgA showing higher sensitivity. Overall, the validated assays described here can be instrumental for the detection of SARS-CoV-2-specific antibodies for diagnostic, seroepidemiological and vaccine evaluation studies.", "Generalized logistic growth modeling of the COVID-19 outbreak in 29 provinces in China and in the rest of the world Background: the COVID-19 has been successfully contained in China but is spreading all over the world. We use phenomenological models to dissect the development of the epidemics in China and the impact of the drastic control measures both at the aggregate level and within each province. We use the experience from China to analyze the calibration results on Japan, South Korea, Iran, Italy and Europe, and make future scenario projections. Methods: we calibrate the logistic growth model, the generalized logistic growth model, the generalized growth model and the generalized Richards model to the reported number of infected cases from Jan. 19 to March 10 for the whole of China, 29 provinces in China, four severely affected countries and Europe as a whole. The different models provide upper and lower bounds of our scenario predictions. Results: We quantitatively document four phases of the outbreak in China with a detailed analysis on the heterogenous situations across provinces. Based on Chinese experience, we identify a high risk in Japan with estimated total confirmed cases as of March 25 being 1574 (95% CI: [880, 2372]), and 5669 (95% CI: [988, 11340]) by June. For South Korea, we expect the number of infected cases to approach the ceiling, 7928 (95% CI: [6341, 9754]), in 20 days. We estimate 0.15% (95% CI: [0.03%, 0.30%]) of Italian population to be infected in a positive scenario. We would expect 114867 people infected in Europe in 10 days, in a negative but probable scenario, corresponding to 0.015% European population. Conclusions: The extreme containment measures implemented by China were very effective with some instructive variations across provinces. For other countries, it is almost inevitable to see the continuation of the outbreak in the coming months. Japan and Italy are in serious situations with no short-term end to the outbreak to be expected. There is a significant risk concerning the upcoming July 2020 Summer Olympics in Tokyo. Iran's situation is highly uncertain with unclear and negative future scenarios, while South Korea is approaching the end of the outbreak. Both Europe and the USA are at early stages of the outbreak, posing significant health and economic risks to the world in absence of serious measures.", "Lies, Gosh Darn Lies, and Not Enough Good Statistics: Why Epidemic Model Parameter Estimation Fails An opportunity exists in exploring epidemic modeling as a novel way to determine physiological and demic parameters for genetic association studies on a population/environmental (quasi) epidemiological study level. First, the spread of SARS-COV-2 has produced population specific lineages; second, epidemic spread model parameters are tied directly to these physiological and demic rates (e. g. incubation time, recovery time, transmission rate); and third, these parameters may serve as novel phenotypes to associate with region-specific genetic mutations as well as demic characteristics (e. g. age structure, cultural observance of personal space, crowdedness). Therefore, we sought to understand whether the parameters of epidemic models could be determined from the trajectory of infections, recovery, and hospitalizations prior to peak, and also to evaluate the quality and comparability of data between jurisdictions reporting their statistics necessary for the analysis of model parameters across populations. We found that, analytically, the pre-peak growth of an epidemic is limited by a subset of the model variates, and that the rate limiting variables are dominated by the expanding eigenmode of their equations. The variates quickly converge to the ratio of eigenvector components of the positive growth rate, which determines the doubling time. There are 9 parameters and 4 independent components in the eigenmode, leaving 5 undetermined parameters. Those parameters can be strikingly population dependent, and can have significant impact on estimates of hospital loads downstream. Without a sound framework, measurements of infection rates and other parameters are highly corrupted by uneven testing rates to uneven counting and reporting of relevant values. From the standpoint of phenotype parameters, this means that structured experiments must be performed to estimate these parameters in order to perform genetic association studies, or to construct viable models that accurately predict critical quantities such as hospitalization loads.", "Machine Learning to Detect Self-Reporting of Symptoms, Testing Access, and Recovery Associated With COVID-19 on Twitter: Retrospective Big Data Infoveillance Study BACKGROUND: The coronavirus disease (COVID-19) pandemic is a global health emergency with over 6 million cases worldwide as of the beginning of June 2020. The pandemic is historic in scope and precedent given its emergence in an increasingly digital era. Importantly, there have been concerns about the accuracy of COVID-19 case counts due to issues such as lack of access to testing and difficulty in measuring recoveries. OBJECTIVE: The aims of this study were to detect and characterize user-generated conversations that could be associated with COVID-19-related symptoms, experiences with access to testing, and mentions of disease recovery using an unsupervised machine learning approach. METHODS: Tweets were collected from the Twitter public streaming application programming interface from March 3-20, 2020, filtered for general COVID-19-related keywords and then further filtered for terms that could be related to COVID-19 symptoms as self-reported by users. Tweets were analyzed using an unsupervised machine learning approach called the biterm topic model (BTM), where groups of tweets containing the same word-related themes were separated into topic clusters that included conversations about symptoms, testing, and recovery. Tweets in these clusters were then extracted and manually annotated for content analysis and assessed for their statistical and geographic characteristics. RESULTS: A total of 4,492,954 tweets were collected that contained terms that could be related to COVID-19 symptoms. After using BTM to identify relevant topic clusters and removing duplicate tweets, we identified a total of 3465 (<1%) tweets that included user-generated conversations about experiences that users associated with possible COVID-19 symptoms and other disease experiences. These tweets were grouped into five main categories including first- and secondhand reports of symptoms, symptom reporting concurrent with lack of testing, discussion of recovery, confirmation of negative COVID-19 diagnosis after receiving testing, and users recalling symptoms and questioning whether they might have been previously infected with COVID-19. The co-occurrence of tweets for these themes was statistically significant for users reporting symptoms with a lack of testing and with a discussion of recovery. A total of 63% (n=1112) of the geotagged tweets were located in the United States. CONCLUSIONS: This study used unsupervised machine learning for the purposes of characterizing self-reporting of symptoms, experiences with testing, and mentions of recovery related to COVID-19. Many users reported symptoms they thought were related to COVID-19, but they were not able to get tested to confirm their concerns. In the absence of testing availability and confirmation, accurate case estimations for this period of the outbreak may never be known. Future studies should continue to explore the utility of infoveillance approaches to estimate COVID-19 disease severity.", "An SEIR Model for Assessment of Current COVID-19 Pandemic Situation in the UK The ongoing COVID-19 pandemic spread to the UK in early 2020 with the first few cases being identified in late January. A rapid increase in confirmed cases started in March, and the number of infected people is however unknown, largely due to the rather limited testing scale. A number of reports published so far reveal that the COVID-19 has long incubation period, high fatality ratio and non-specific symptoms, making this novel coronavirus far different from common seasonal influenza. In this note, we present a modified SEIR model which takes into account the time lag effect and probability distribution of model states. Based on the proposed model, it is estimated that the actual total number of infected people by 1 April in the UK might have already exceeded 610,000. Average fatality rates under different assumptions at the beginning of April 2020 are also estimated. Our model also reveals that the R0 value is between 7.5-9 which is much larger than most of the previously reported values. The proposed model has a potential to be used for assessing future epidemic situations under different intervention strategies.", "Humanity tested The world needs mass at-home serological testing for antibodies elicited by SARS-CoV-2, and rapid and frequent point-of-care testing for the presence of the virus\u2019 RNA in selected populations.", "Covid-19 infection and attributable mortality in UK Long Term Care Facilities: Cohort study using active surveillance and electronic records (March-June 2020) Background: Rates of Covid-19 infection have declined in many countries, but outbreaks persist in residents of long-term care facilities (LTCFs) who are at high risk of severe outcomes. Epidemiological data from LTCFs are scarce. We used population-level active surveillance to estimate incidence of, and risk factors for Covid-19, and attributable mortality in elderly residents of LTCFs. Methods: Cohort study using individual-level electronic health records from 8,713 residents and daily counts of infection for 9,339 residents and 11,604 staff across 179 UK LTCFs. We modelled risk factors for infection and mortality using Cox proportional hazards and estimated attributable fractions. Findings: 2,075/9,339 residents developed Covid-19 symptoms (22.2% [95% confidence interval: 21.4%; 23.1%]), while 951 residents (10.2% [9.6%; 10.8%]) and 585 staff (5.0% [4.7%; 5.5%]) had laboratory confirmed infections. Confirmed infection incidence in residents and staff respectively was 152.6 [143.1; 162.6] and 62.3 [57.3; 67.5] per 100,000 person-days. 121/179 (67.6%) LTCFs had at least one Covid-19 infection or death. Lower staffing ratios and higher occupancy rates were independent risk factors for infection. 1,694 all-cause deaths occurred in 8,713 (19.4% [18.6%; 20.3%]) residents. 217 deaths occurred in 607 residents with confirmed infection (case-fatality rate: 35.7% [31.9%; 39.7%]). 567/1694 (33.5%) of all-cause deaths were attributable to Covid-19, 28.0% of which occurred in residents with laboratory-confirmed infection. The remainder of excess deaths occurred in asymptomatic or symptomatic residents in the context of limited testing for infection, suggesting substantial under-ascertainment. Interpretation: 1 in 5 residents had symptoms of infection during the pandemic, but many cases were not tested. Higher occupancy and lower staffing levels increase infection risk. Disease control measures should integrate active surveillance and testing with fundamental changes in staffing and care home occupancy to protect staff and residents from infection. Funding: Economic and Social Research Council [ES/V003887/1].", "A two-wave epidemiological model of COVID-19 outbreaks using MS-Excel(R) The emergence of the coronavirus SARS-CoV-2 has raised a global issue and a pandemic disease outbreak, COVID-19, was declared by the World Health Organization on March 12th, 2020. The new virus is rapidly spreading in humans and cases of severe acute respiratory syndromes are being reported worldwide. Health authority advisors and governments from small towns to large countries need to quickly manage and deal with growing epidemiological data on a daily basis. In this work, current available data from reported cases and deaths over time were analyzed and treated. Lethality has been calculated by finding linearization of death cases against reported ones, using a time-delayed data transposition. A two-wave statistical model, 2WM, based on the superposition of normal distributions was used to fit current data and to estimate the evolution of infections and deaths, using Microsoft Excel(R). The model showed good agreement even for apparent single wave behavior in some countries and can easily be extended to any number of waves. A gamma distribution was used as a risk function to estimate death probability from patient admission to reported death. Evolution of fatality cases over time can then be estimated from the model with reasonable accuracy. Data from South Korea, China, Australia, Germany, Italy and Spain were used to validate the model. Data from The United States, United Kingdom and Brazil were used to study the epidemiology as the pandemic progresses. Additionally, the 2WM was applied to world data and to the Brazilian state of Santa Catarina. The model was implemented in MS-Excel, a popular and easy to use analytical tool. A template spreadsheet is provided as supplementary material. Constant lethality can be determined from the initial stage of the pandemic wave. Values ranged from 1.7% to 15.3%, depending on the degree of possible sub notification cases. Even for places with low testing, a linear relationship can be found. The two-wave model can be fine-tuned to properly adjust the data. The second wave pattern was estimated according to the first wave parameter. The accuracy for estimating COVID-19 evolution was compared to the classic SIR model with good agreement. According to the model, based on current trends, health protocols and policies, approximately 10,000,000 cases and 860,000 deaths will be recorded worldwide. Approximately 99% of that number would be reached by the end of July 2020 given constant conditions.", "Bayesian analysis of tests with unknown specificity and sensitivity When testing for a rare disease, prevalence estimates can be highly sensitive to uncertainty in the specificity and sensitivity of the test. Bayesian inference is a natural way to propagate these uncertainties, with hierarchical modeling capturing variation in these parameters across experiments. Another concern is the people in the sample not being representative of the general population. Statistical adjustment cannot without strong assumptions correct for selection bias in an opt-in sample, but multilevel regression and poststratification can at least adjust for known differences between sample and population. We demonstrate these models with code in R and Stan and discuss their application to a controversial recent study of COVID-19 antibodies in a sample of people from the Stanford University area. Wide posterior intervals make it impossible to evaluate the quantitative claims of that study regarding the number of unreported infections. For future studies, the methods described here should facilitate more accurate estimates of disease prevalence from imperfect tests performed on non-representative samples.", "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review Importance: The current rapid worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection justifies the global effort to identify effective preventive strategies and optimal medical management. While data are available for adult patients with coronavirus disease 2019 (COVID-19), limited reports have analyzed pediatric patients infected with SARS-CoV-2. Objective: To evaluate currently reported pediatric cases of SARS-CoV-2 infection. Evidence Review: An extensive search strategy was designed to retrieve all articles published from December 1, 2019, to March 3, 2020, by combining the terms coronavirus and coronavirus infection in several electronic databases (PubMed, Cochrane Library, and CINAHL), and following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Retrospective cross-sectional and case-control studies, case series and case reports, bulletins, and national reports about the pediatric SARS-CoV-2 infection were included. The risk of bias for eligible observational studies was assessed according to the Strengthening the Reporting of Observational Studies in Epidemiology reporting guideline. Findings: A total of 815 articles were identified. Eighteen studies with 1065 participants (444 patients were younger than 10 years, and 553 were aged 10 to 19 years) with confirmed SARS-CoV-2 infection were included in the final analysis. All articles reflected research performed in China, except for 1 clinical case in Singapore. Children at any age were mostly reported to have mild respiratory symptoms, namely fever, dry cough, and fatigue, or were asymptomatic. Bronchial thickening and ground-glass opacities were the main radiologic features, and these findings were also reported in asymptomatic patients. Among the included articles, there was only 1 case of severe COVID-19 infection, which occurred in a 13-month-old infant. No deaths were reported in children aged 0 to 9 years. Available data about therapies were limited. Conclusions and Relevance: To our knowledge, this is the first systematic review that assesses and summarizes clinical features and management of children with SARS-CoV-2 infection. The rapid spread of COVID-19 across the globe and the lack of European and US data on pediatric patients require further epidemiologic and clinical studies to identify possible preventive and therapeutic strategies.", "Predicting the number of reported and unreported cases for the COVID-19 epidemic in South Korea, Italy, France and Germany We model the COVID-19 coronavirus epidemic in South Korea, Italy, France, and Germany. We use early reported case data to predict the cumulative number of reported cases to a final size. The key features of our model are the timing of implementation of major public policies restricting social movement, the identification and isolation of unreported cases, and the impact of asymptomatic infectious cases.", "COVID-19: Recovering estimates of the infected fatality rate during an ongoing pandemic through partial data In an ongoing epidemic, the case fatality rate is not a reliable estimate of a disease's severity. This is particularly so when a large share of asymptomatic or pauci-symptomatic patients escape testing, or when overwhelmed healthcare systems are forced to limit testing further to severe cases only. By leveraging data on COVID-19, we propose a novel way to estimate a disease's infected fatality rate, the true lethality of the disease, in the presence of sparse and partial information. We show that this is feasible when the disease has turned into a pandemic and data comes from a large number of countries, or regions within countries, as long as testing strategies vary sufficiently. For Italy, our method estimates an IFR of 1.1% (95% CI: 0.2% - 2.1%), which is strongly in line with other methods. At the global level, our method estimates an IFR of 1.6% (95% CI: 1.1% - 2.1%). This method also allows us to show that the IFR varies according to each country's age structure and healthcare capacity.", "Who is more susceptible to Covid-19 infection and mortality in the States? Background: A novel coronavirus was detected in Wuhan, China and reported to WHO on 31 December 2019. WHO declared a global pandemic on 11 March 2020. The first case in the US was reported in January 2020. Since mid-March 2020, the number of confirmed cases has increased exponentially in the States, with 1.1 million confirmed cases, and 57.4 thousand deaths as of 30 April 2020. Even though some believe that this new lethal coronavirus does not show any partiality to the rich, previous epidemiological studies find that the poor in the US are more susceptible to the epidemics due to their limited access to preventive measures and crowded living conditions. In this study, we postulate that the rich is more susceptible to Covid-19 infection during the early stage before social distancing measures have been introduced. This may be attributed to the higher mobility (both inter- and intra-city), given their higher tendency to travel for business/education, and to more social interactions. However, we postulate after the lockdown/social distancing has been imposed, the infection among the rich may be reduced due to better living conditions. Further, the rich may be able to afford better medical treatment once infected, hence a relatively lower mortality. In contrast, without proper medical insurance coverage, the poor may be prevented from receiving timely and proper medical treatment, hence a higher mortality. Method: We will collect the number of confirmed Covid-19 cases in the US during the period of Jan 2020 to Apr 2020 from Johns Hopkins University, also the number of Covid-19 tests in the US from the health departments across the States. County-level socio-economic status (SES) including age, sex, race/ethnicity, income, education, occupation, employment status, immigration status, and housing price, will be collected from the US Census Bureau. State/county-level health conditions including the prevalence of chronic diseases will be collected from the US CDC. State/county-level movement data including international and domestic flights will be collected from the US Bureau of Transportation Statistics. We will also collect the periods of lockdown/social distancing. Regression models are constructed to examine the relationship between SES, and Covid-19 infection and mortality at the state/county-level before and after lockdown/social distancing, while accounting for Covid-19 testing capacities and co-morbidities. Expected Findings: We expect that there is a positive correlation between Covid-19 infection and SES at the state/county-level in the US before social distancing. In addition, we expect a negative correlation between Covid-19 mortality and SES.", "Coronavirus Disease (COVID-19) in Children: Indian Perspectives ", "COVID-19 attack rate increases with city size The current outbreak of novel coronavirus disease 2019 (COVID-19) poses an unprecedented global health and economic threat to interconnected human societies. Until a vaccine is developed, strategies for controlling the outbreak rely on aggressive social distancing. These measures largely disconnect the social network fabric of human societies, especially in urban areas. Here, we estimate the growth rates and reproductive numbers of COVID-19 in US cities from March 14th through March 19th to reveal a power-law scaling relationship to city population size. This means that COVID-19 is spreading faster on average in larger cities with the additional implication that, in an uncontrolled outbreak, larger fractions of the population are expected to become infected in more populous urban areas. We discuss the implications of these observations for controlling the COVID-19 outbreak, emphasizing the need to implement more aggressive distancing policies in larger cities while also preserving socioeconomic activity.", "Ascertainment rate of novel coronavirus disease (COVID-19) in Japan OBJECTIVE: To estimate the ascertainment rate of novel coronavirus (COVID-19). METHODS: We analyzed the epidemiological dataset of confirmed cases with COVID-19 in Japan as of 28 February 2020. A statistical model was constructed to describe the heterogeneity of reporting rate by age and severity. We estimated the number of severe and non-severe cases, accounting for under-ascertainment. RESULTS: The ascertainment rate of non-severe cases was estimated at 0.44 (95% confidence interval: 0.37, 0.50), indicating that unbiased number of non-cases would be more than twice the reported count. CONCLUSIONS: Severe cases are twice more likely diagnosed and reported than other cases. Considering that reported cases are usually dominated by non-severe cases, the adjusted total number of cases is also about a double of observed count. Our finding is critical in interpreting the reported data, and it is advised to interpret mild case data of COVID-19 as always under-ascertained.", "Localising an asset-based COVID-19 response in Ecuador ", "Global coronavirus disease 2019: what has daily cumulative index taught us? ABSTRACT In addition to the absolute case number, a rapid increase in the number of COVID-19 cases within a short time was supposed to result in insufficiency of the healthcare system and further negatively affect patients\u2019 outcomes. This study was conducted to investigate the association between the outcomes of COVID-19 patients and daily cumulative index (DCI), which was defined as the average daily number of new cases of COVID-19 and calculated by cumulative cases/number of days between the first reported case and March 6, 2020 by country. Spearman's rank correlation analyses were conducted to evaluate the relationship between mortality, incidence, and DCI. In this study, we found that DCI was positively correlated with incidence (adjusted risk ratio [aRR] = 1.01, 95% [confidence interval, CI] = 1.00-1.02, p < 0.01). Higher correlation between mortality and DCI (mortality rate: r = 0.397, p = 0.018; mortality per 1,000,000 people: r = 0.0.428, p = 0.004) was observed than disease incidence. DCI remained statistically associated with mortality per 1,000,000 people after adjustment of Health Care Index (aRR = 1.02, 95% CI = 1.01-1.03, p < 0.001) or Healthcare Access and Quality Index (aRR = 1.02, 95% CI = 1.01-1.04, p < 0.01. Reducing DCI through strict infection control measures can help slow the increasing number of COVID-19 cases and further improve outcome in COVID-19 patients.", "Global analysis of daily new COVID-19 cases reveals many static-phase countries including US and UK potentially with unstoppable epidemics The COVID-19 epidemics are differentially progressing in different countries. Here, comparative analyses of daily new cases reveal that 61 most affected countries can be classified into four types: downward (22), upward (20), static-phase (12) and uncertain ones (7). In particular, the 12 static-phase countries including US and UK are characterized by largely constant numbers of daily new cases in the past over 14 days. Furthermore, these static-phase countries are overall significantly lower in testing density but higher in the level of positive COVID-19 tests than downward countries. These findings suggest that the testing capacity in static-phase countries is lagging behind the spread of the outbreak, i.e., daily new cases (confirmed) are likely less than daily new infections and the remaining undocumented infections are thus still expanding, resulting in unstoppable epidemics. As such, increasing the testing capacity and/or reducing the COVID-19 transmission are urgently needed to stop the severing crisis in static-phase countries.", "Covid-19: Africa's case numbers are rising rapidly, WHO warns. ", "Geographic Differences in COVID-19 Cases, Deaths, and Incidence - United States, February 12-April 7, 2020 Community transmission of coronavirus disease 2019 (COVID-19) was first detected in the United States in February 2020. By mid-March, all 50 states, the District of Columbia (DC), New York City (NYC), and four U.S. territories had reported cases of COVID-19. This report describes the geographic distribution of laboratory-confirmed COVID-19 cases and related deaths reported by each U.S. state, each territory and freely associated state,* DC, and NYC during February 12-April 7, 2020, and estimates cumulative incidence for each jurisdiction. In addition, it projects the jurisdiction-level trajectory of this pandemic by estimating case doubling times on April 7 and changes in cumulative incidence during the most recent 7-day period (March 31-April 7). As of April 7, 2020, a total of 395,926 cases of COVID-19, including 12,757 related deaths, were reported in the United States. Cumulative COVID-19 incidence varied substantially by jurisdiction, ranging from 20.6 cases per 100,000 in Minnesota to 915.3 in NYC. On April 7, national case doubling time was approximately 6.5 days, although this ranged from 5.5 to 8.0 days in the 10 jurisdictions reporting the most cases. Absolute change in cumulative incidence during March 31-April 7 also varied widely, ranging from an increase of 8.3 cases per 100,000 in Minnesota to 418.0 in NYC. Geographic differences in numbers of COVID-19 cases and deaths, cumulative incidence, and changes in incidence likely reflect a combination of jurisdiction-specific epidemiologic and population-level factors, including 1) the timing of COVID-19 introductions; 2) population density; 3) age distribution and prevalence of underlying medical conditions among COVID-19 patients (1-3); 4) the timing and extent of community mitigation measures; 5) diagnostic testing capacity; and 6) public health reporting practices. Monitoring jurisdiction-level numbers of COVID-19 cases, deaths, and changes in incidence is critical for understanding community risk and making decisions about community mitigation, including social distancing, and strategic health care resource allocation.", "Hazardous Postoperative Outcomes of Unexpected COVID-19 Infected Patients: A Call for Global Consideration of Sampling all Asymptomatic Patients Before Surgical Treatment BACKGROUND: In December 2019, a novel coronavirus was identified as the cause of many pneumonia cases in China and eventually declared as a pandemic as the virus spread globally. Few reports were published on the outcome of surgical procedures in diagnosed COVID-19 patients and even fewer on the surgical outcomes of asymptomatic undiagnosed COVID-19 surgical patients. We aimed to review all published data regarding surgical outcomes of preoperatively asymptomatic untested coronavirus disease 2019 (COVID-19) patients. METHODS: This report is a review on the perioperative period in COVID-19 patients who were preoperatively asymptomatic and not tested for COVID-19. Searches were conducted in PubMed April 4th, 2020. All publications, of any design, were considered for inclusion. RESULTS: Four reports were identified through our literature search, comprising 64 COVID-19 carriers, of them 51 were diagnosed only in the postoperative period. Synthesis of these reports, concerning the postoperative outcomes of patients diagnosed with COVID-19 during the perioperative period, suggested a 14/51 (27.5%) postoperative mortality rate and severe mostly pulmonic complications, as well as medical staff exposure and transmission. CONCLUSIONS: COVID-19 may have potential hazardous implications on the perioperative course. Our review presents results of unacceptable mortality rate and a high rate of severe complications. These observations warrant further well-designed studies, yet we believe it is time for a global consideration of sampling all asymptomatic patients before surgical treatment.", "Correlations of Online Search Engine Trends With Coronavirus Disease (COVID-19) Incidence: Infodemiology Study BACKGROUND: The coronavirus disease (COVID-19) is the latest pandemic of the digital age. With the internet harvesting large amounts of data from the general population in real time, public databases such as Google Trends (GT) and the Baidu Index (BI) can be an expedient tool to assist public health efforts. OBJECTIVE: The aim of this study is to apply digital epidemiology to the current COVID-19 pandemic to determine the utility of providing adjunctive epidemiologic information on outbreaks of this disease and evaluate this methodology in the case of future pandemics. METHODS: An epidemiologic time series analysis of online search trends relating to the COVID-19 pandemic was performed from January 9, 2020, to April 6, 2020. BI was used to obtain online search data for China, while GT was used for worldwide data, the countries of Italy and Spain, and the US states of New York and Washington. These data were compared to real-world confirmed cases and deaths of COVID-19. Chronologic patterns were assessed in relation to disease patterns, significant events, and media reports. RESULTS: Worldwide search terms for shortness of breath, anosmia, dysgeusia and ageusia, headache, chest pain, and sneezing had strong correlations (r>0.60, P<.001) to both new daily confirmed cases and deaths from COVID-19. GT COVID-19 (search term) and GT coronavirus (virus) searches predated real-world confirmed cases by 12 days (r=0.85, SD 0.10 and r=0.76, SD 0.09, respectively, P<.001). Searches for symptoms of diarrhea, fever, shortness of breath, cough, nasal obstruction, and rhinorrhea all had a negative lag greater than 1 week compared to new daily cases, while searches for anosmia and dysgeusia peaked worldwide and in China with positive lags of 5 days and 6 weeks, respectively, corresponding with widespread media coverage of these symptoms in COVID-19. CONCLUSIONS: This study demonstrates the utility of digital epidemiology in providing helpful surveillance data of disease outbreaks like COVID-19. Although certain online search trends for this disease were influenced by media coverage, many search terms reflected clinical manifestations of the disease and showed strong correlations with real-world cases and deaths.", "Estimating cases of COVID-19 from Daily Death Data in Italy COVID-19 is an emerging infectious disease which has been declared a pan- demic by the World Health Organisation. Due to limited testing capacity for this new virus, variable symptomatology the majority of infected showing non-specific mild or no symptoms it is likely current prevalence data is an underestimate. Methods: We present an estimate of the number of cases of COVID-19 com- pared to the number of confirmed case in Italy based on the daily reported deaths and information about the incubation period, time from symptom on- set to death and reported case fatality rate. Results: Our model predicts that on the 31st of January 2020 when the first 3 infected cases had been identified by Italian authorise there were already nearly 30 cases in Italy, and by the 24th of February 2020 only 0.5% cases had been detected and confirmed by Italian authorities. While official statistics had 132 confirmed case we believe a more accurate estimate would be closer to 26000. With a case-doubling period of about 2.5 days.", "Measuring Icebergs: Using Different Methods to Estimate the Number of COVID-19 Cases in Portugal and Spain The world is suffering from a pandemic called COVID-19, caused by the SARS-CoV-2 virus. The different national governments have problems evaluating the reach of the epidemic, having limited resources and tests at their disposal. Hence, any means to evaluate the number of persons with symptoms compatible with COVID-19 with reasonable level of accuracy is useful. In this paper we present the initial results of the @CoronaSurveys project. The objective of this project is the collection and publication of data concerning the number of people that show symptoms compatible with COVID-19 in different countries using open anonymous surveys. While this data may be biased, we conjecture that it is still useful to estimate the number of infected persons with the COVID-19 virus at a given point in time in these countries, and the evolution of this number over time. We show here the initial results of the @CoronaSurveys project in Spain and Portugal.", "COVID-19 pandemic in the African continent: forecasts of cumulative cases, new infections, and mortality Background: Africa is the last major region to capitulate to the SARS-CoV-2 (COVID-19) pandemic. The first confirmed COVID-19 case in the region was reported on February 14, but what lies ahead in terms of the course and magnitude of infection remains speculative. To the best of our knowledge, no study, using a robust methodology, provides the immediate and long-term trajectory of COVID-19 for the entire region or accounts for its local context. This paper is the first systematic attempt to provide estimates on how many people would contract the virus and how many would die in the coming few months across Africa. Methods: The forecasts on caseloads and incidences are from a co-variate-based instrumental variable regression model. Fatality rates from Italy and China were further applied to generate mortality estimates after adjustments were made for differences in age-structure, health service quality, and living standards between each of the African countries and those of the reference population. We cover all countries that reported a confirmed case as of March 31, 2020. Results: By the end of June, 16,283,085 people will contract COVID-19 (95% CI 718,403 to 98, 358, 799). With a cumulative caseload of 5,413,4517 (95% CI 1,332,953 to 8,489,940) and 906,625 (95% CI 173, 821 to 4,742,917) Northern and Eastern Africa will respectively be the most and least affected sub-regions in the continent. Cumulative COVID-19 cases on June 30, 2020 are expected to reach 2,912, 864 (95% CI 465,028 to 18,286,358) in Southern Africa, 2,787, 913 (95% CI 517, 489 to 15,056,314) in Western Africa, and 1,185,742 (95% CI 229, 111 to 6,138,692) in Central Africa. New infections (incidence) for the month of April are expected to be the highest in Djibouti, 32.8 per 1000 (95% CI 6.25 to 171.77), while Morocco 1045 (95% CI 167 to 6,547) will register the highest number of deaths. Conclusion: Our study shows that countries that are least urbanized and have a low level of socio-economic development, hence least connected to the outside world, are likely to register lower and slower transmissions, at least at the early stage of the epidemic. However, the same set of enabling factors that worked for their benefit are likely to go against them in implementing interventions that have lessened the impact of the disease elsewhere.", "Analysis of SARS-CoV-2 Antibodies in COVID-19 Convalescent Plasma using a Coronavirus Antigen Microarray The current practice for diagnosis of COVID-19, based on SARS-CoV-2 PCR testing of pharyngeal or respiratory specimens in a symptomatic patient at high epidemiologic risk, likely underestimates the true prevalence of infection. Serologic methods can more accurately estimate the disease burden by detecting infections missed by the limited testing performed to date. Here, we describe the validation of a coronavirus antigen microarray containing immunologically significant antigens from SARS-CoV-2, in addition to SARS-CoV, MERS-CoV, common human coronavirus strains, and other common respiratory viruses. A comparison of antibody profiles detected on the array from control sera collected prior to the SARS-CoV-2 pandemic versus convalescent blood specimens from virologically confirmed COVID-19 cases demonstrates complete discrimination of these two groups. This array can be used as a diagnostic tool, as an epidemiologic tool to more accurately estimate the disease burden of COVID-19, and as a research tool to correlate antibody responses with clinical outcomes.", "Flattening the curve before it flattens us: hospital critical care capacity limits and mortality from novel coronavirus (SARS-CoV2) cases in US counties ABSTRACT Background As of March 26, 2020, the United States had the highest number of confirmed cases of Novel Coronavirus (COVID-19) of any country in the world. Hospital critical care is perhaps the most important medical system choke point in terms of preventing deaths in a disaster scenario such as the current COVID-19 pandemic. We therefore brought together previously established disease modeling estimates of the growth of the COVID-19 epidemic in the US under various social distancing contact reduction assumptions, with local estimates of the potential critical care surge response across all US counties. Methods Estimates of spatio-temporal COVID-19 demand and medical system critical care supply were calculated for all continental US counties. These estimates were statistically summarized and mapped for US counties, regions and urban versus non-urban areas. Estimates of COVID-19 infections and patients needing critical care were calculated from March 24, 2020 to April 24, 2020 for three different estimated population levels - 0%, 25%, and 50% - of contact reduction (through actions such as social distancing). Multiple national public and private datasets were linked and harmonized in order to calculate county-level critical care bed counts that included currently available beds and those that could be made available under four surge response scenarios - very low, low, medium, and high - as well as excess deaths stemming from inaccessible critical care. Results Surge response scenarios ranged from a very low total supply 77,588 critical care beds to a high total of 278,850 critical care beds. Over the four week study period, excess deaths from inaccessible critical care ranged from 24,688 in the very low response scenario to 13,268 in the high response scenario. Northeastern and urban counties were projected to be most affected by excess deaths due to critical care shortages, and counties in New York, Colorado, and Virginia were projected to exceed their critical care bed limits despite high levels of COVID-19 contact reduction. Over the four week study period, an estimated 12,203-19,594 excess deaths stemming from inaccessible critical care could be averted through greater preventive actions such as travel restrictions, publicly imposed contact precautions, greater availability of rapid testing for COVID-19, social distancing, self-isolation when sick, and similar interventions. An estimated 4,029-11,420 excess deaths stemming from inaccessible critical care could be averted through aggressive critical care surge response and preparations, including high clearance of ICU and non-ICU critical care beds and extraordinary measures like using a single ventilator for multiple patients. Conclusions Unless the epidemic curve of COVID-19 cases is flattened over an extended period of time, the US COVID-19 epidemic will cause a shortage of critical care beds and drive up otherwise preventable deaths. The findings here support value of preventive actions to flatten the epidemic curve, as well as the value of exercising extraordinary surge capacity measures to increase access to hospital critical care for severely ill COVID-19 patients.", "The many estimates of the COVID-19 case fatality rate ", "COVID-19: The unreasonable effectiveness of simple models When the novel coronavirus disease SARS-CoV2 (COVID-19) was officially declared a pandemic by the WHO in March 2020, the scientific community had already braced up in the effort of making sense of the fast-growing wealth of data gathered by national authorities all over the world. However, despite the diversity of novel theoretical approaches and the comprehensiveness of many widely established models, the official figures that recount the course of the outbreak still sketch a largely elusive and intimidating picture. Here we show unambiguously that the dynamics of the COVID-19 outbreak belongs to the simple universality class of the SIR model and extensions thereof. Our analysis naturally leads us to establish that there exists a fundamental limitation to any theoretical approach, namely the unpredictable non-stationarity of the testing frames behind the reported figures. However, we show how such bias can be quantified self-consistently and employed to mine useful and accurate information from the data. In particular, we describe how the time evolution of the reporting rates controls the occurrence of the apparent epidemic peak, which typically follows the true one in countries that were not vigorous enough in their testing at the onset of the outbreak. The importance of testing early and resolutely appears as a natural corollary of our analysis, as countries that tested massively at the start clearly had their true peak earlier and less deaths overall.", "Excess cases of Influenza like illnesses in France synchronous with COVID19 invasion. Several French regions where COVID19 has been reported currently show a renewed increase in ILI cases in the general practice based Sentinelles network. Here we computed the number of excess cases by region and found correlation with the number of reported COVID19 cases so far. These data suggest larger circulation of SARS-CoV-2 in the French population than apparent from confirmed cases.", "Estimate of Covid-19 prevalence using imperfect data The real number of people who were truly infected with SARS-CoV-2, is certainly significantly larger than the official record. Few countries have tracking and testing procedures that are sufficiently robust to discover nearly all infections. In most countries they are inadequate, hence the true extent of the pandemic is unknown. The current study proposes the estimate of the COVID-19 extent for countries with sufficiently high number of deaths and cases. The estimate is based on a simple model of mortality. This model was developed for a reference country with a large number of cases and high intensity of COVID-19 testing. The model is then applied to compute apparent mortality in the target and reference countries. The number of cases in the target country is then estimated assuming constant underlying true mortality. The estimate of cases in most countries is significantly higher than the official record. As of April 12, 2020, the global estimate is 5.2 million compared to 1.8 million in the official record. The models developed in this study are available at covid-model.net. The model ignores several factors that are known to influence mortality, such as the demographics and health condition of population, state of epidemic and sociological differences between countries. While the model is rough, it nevertheless provides a unified approach to producing a systematic global estimate of the extent of the COVID-19 epidemic and can be useful for its monitoring.", "COVID-19, Australia: Epidemiology Report 15 (Reporting week to 23:59 AEST 10 May 2020) Confirmed cases in Australia notified up to 10 May 2020: notifications = 6,971; deaths = 98. The incidence of new cases of COVID-19 has reduced dramatically since a peak in mid-March. The reduction in international travel, social distancing measures and public health action have likely been effective in slowing the spread of the disease, in the Australian community. Cases of COVID-19 continue to be notified by jurisdictions, albeit at a slowed rate. Testing rates over the past week have increased markedly, with a very low proportion of people testing positive. These low rates of detection are indicative of low levels of COVID-19 transmission. It is important that testing rates and community adherence to public health measures remain high to support the continued suppression of the virus, particularly in vulnerable high-risk groups and settings. In the past reporting week new cases in Australia are mostly considered to be locally acquired, consistent with the drop in international travel. Most locally-acquired cases can be linked back to a known case or cluster. Although the proportion of locally-acquired cases has increased, the overall rate of cases, regardless of place of acquisition, continues to decrease. The crude case fatality rate in Australia remains low (1.4%), compared with the WHO reported global rate (6.9%). The low case fatality rate is likely reflective of high case detection and high quality of health care services in Australia. Deaths from COVID-19 in Australia have occurred predominantly among the elderly and those with comorbidities, with no deaths occurring in those under 40 years. The highest rate of COVID-19 continues to be among people aged 60-79 years, with a third of these cases associated with several outbreaks linked to cruise ships. The lowest rate of disease is in young children, a pattern reflected in international reports. Internationally, cases continue to increase, with some areas such as Brazil and India showing a dramatic rise in reported cases. Although some low-income countries have currently reported few cases, it is possible that this is due to limited diagnostic and public health capacity, and may not be reflective of disease occurrence.", "Phase-adjusted estimation of the number of Coronavirus Disease 2019 cases in Wuhan, China An outbreak of clusters of viral pneumonia due to a novel coronavirus (2019-nCoV/SARS-CoV-2) happened in Wuhan, Hubei Province in China in December 2019. Since the outbreak, several groups reported estimated R(0) of Coronavirus Disease 2019 (COVID-19) and generated valuable prediction for the early phase of this outbreak. After implementation of strict prevention and control measures in China, new estimation is needed. An infectious disease dynamics SEIR (Susceptible, Exposed, Infectious, and Removed) model was applied to estimate the epidemic trend in Wuhan, China under two assumptions of R(t). In the first assumption, R(t) was assumed to maintain over 1. The estimated number of infections would continue to increase throughout February without any indication of dropping with R(t) = 1.9, 2.6, or 3.1. The number of infections would reach 11,044, 70,258, and 227,989, respectively, by 29 February 2020. In the second assumption, R(t) was assumed to gradually decrease at different phases from high level of transmission (R(t) = 3.1, 2.6, and 1.9) to below 1 (R(t) = 0.9 or 0.5) owing to increasingly implemented public health intervention. Several phases were divided by the dates when various levels of prevention and control measures were taken in effect in Wuhan. The estimated number of infections would reach the peak in late February, which is 58,077\u201384,520 or 55,869\u201381,393. Whether or not the peak of the number of infections would occur in February 2020 may be an important index for evaluating the sufficiency of the current measures taken in China. Regardless of the occurrence of the peak, the currently strict measures in Wuhan should be continuously implemented and necessary strict public health measures should be applied in other locations in China with high number of COVID-19 cases, in order to reduce R(t) to an ideal level and control the infection.", "Mortality rate and estimate of fraction of undiagnosed COVID-19 cases in the US in March and April 2020 We use a simple model to derive a mortality probability distribution for a patient as a function of days since diagnosis (considering diagnoses made between 25 February and 29 March 2020). The peak of the mortality probability is the 13th day after diagnosis. The overall shape and peak location of this probability curve are similar to the onset-to-death probability distribution in a case study using Chinese data. The total mortality probability of a COVID-19 patient in the US diagnosed between 25 February and 29 March is about 21%. We speculate that this high value is caused by severe under-testing of the population to identify all COVID-19 patients. With this probability, and an assumption that the true probability is 2.4%, we estimate that 89% of all SARS-CoV-2 infection cases were not diagnosed during this period. When the same method is applied to data extended to 25 April, we found that the total mortality probability of a patient diagnosed in the US after 1 April is about 6.4%, significantly lower than for the earlier period. We attribute this drop to increasingly available tests. Given the assumption that the true mortality probability is 2.4%, we estimate that 63% of all SARS-CoV-2 infection cases were not diagnosed during this period (1 - 25 April).", "Bayesian nowcasting with adjustment for delayed and incomplete reporting to estimate COVID-19 infections in the United States Real-time estimates of the true size and trajectory of local COVID-19 epidemics are key metrics to guide policy responses. We developed a Bayesian nowcasting approach that explicitly accounts for reporting delays and secular changes in case ascertainment to generate real-time estimates of COVID-19 epidemiology on the basis of reported cases and deaths. Using this approach, we estimate time trends in infections, symptomatic cases, and deaths for all 50 US states and the District of Columbia from early-March through June 11, 2020. At the beginning of June, our best estimates of the effective reproduction number (Rt) are close to 1 in most states, indicating a stabilization of incidence, but there is considerable variability in the level of incidence and the estimated proportion of the population that has already been infected.", "COVID-19: Developing from an Outbreak to A Pandemic ", "An age-structured epidemiological model of the Belgian COVID-19 epidemic COVID-19 has prompted many countries to implement extensive social distancing to stop the rapid spread of the virus, in order to prevent overloading health care systems. Yet, the main epidemic parameters of this virus are not well understood. In the absence of broad testing or serological surveillance, it is hard to evaluate or predict the impact of different strategies to exit implemented lock-down measures. An age-structured epidemiological model was developed, which distinguishes between the younger versus older population (e.g. < 65 and >= 65). Because the illness severity is markedly different for these two populations, such a separation is necessary then estimating the model based on death and hospitalization incidence data. The model was applied to data of the Belgian epidemic and used to predict how the epidemic would react to a relaxing of social distancing measures.", "Evaluation of Group Testing for SARS-CoV-2 RNA During the current COVID-19 pandemic, testing kit and RNA extraction kit availability has become a major limiting factor in the ability to determine patient disease status and accurately quantify prevalence. Current testing strategies rely on individual tests of cases matching restrictive diagnostic criteria to detect SARS-CoV-2 RNA, limiting testing of asymptomatic and mild cases. Testing these individuals is one effective way to understand and reduce the spread of COVID-19. Here, we develop a pooled testing strategy to identify these low-risk individuals. Drawing on the well-studied group testing literature, modeling suggests practical changes to testing protocols which can reduce test costs and stretch a limited test kit supply. When most tests are negative, pooling reduces the total number of tests up to four-fold at 2% prevalence and eight-fold at 0.5% prevalence. At current SARS-CoV-2 prevalence, randomized group testing optimized per country could double the number of tested individuals from 1.8M to 3.6M using only 672k more tests. This strategy is well-suited to supplement testing for asymptomatic and mild cases who would otherwise go untested, and enable them to adopt behavioral changes to slow the spread of COVID-19.", "Preliminary Results of Initial Testing for Coronavirus (COVID-19) in the Emergency Department INTRODUCTION: On March 10, 2020, the World Health Organization declared a global pandemic due to widespread infection of the novel coronavirus 2019 (COVID-19). We report the preliminary results of a targeted program of COVID-19 infection testing in the ED in the first 10 days of its initiation at our institution. METHODS: We conducted a review of prospectively collected data on all ED patients who had targeted testing for acute COVID-19 infection at two EDs during the initial 10 days of testing (March 10-19, 2020). During this initial period with limited resources, testing was targeted toward high-risk patients per Centers for Disease Control and Prevention guidelines. Data collected from patients who were tested included demographics, clinical characteristics, and test qualifying criteria. We present the data overall and by test results with descriptive statistics. RESULTS: During the 10-day study period, the combined census of the study EDs was 2157 patient encounters. A total of 283 tests were ordered in the ED. The majority of patients were 18-64 years of age, male, non-Hispanic white, had an Emergency Severity Index score of three, did not have a fever, and were discharged from the ED. A total of 29 (10.2%) tested positive. Symptoms-based criteria most associated with COVID-19 were the most common criteria identified for testing (90.6%). All other criteria were reported in 5.51-43.0% of persons being tested. Having contact with a person under investigation was significantly more common in those who tested positive compared to those who tested negative (63% vs 24.5%, respectively). The majority of patients in both results groups had at least two qualifying criteria for testing (75.2%). CONCLUSION: In this review of prospectively collected data on all ED patients who had targeted testing for acute COVID-19 infection at two EDs in the first 10 days of testing, we found that 10.2% of those tested were identified as positive. The continued monitoring of testing and results will help providers understand how COVID-19 is progressing in the community.", "Development of Reverse Transcription Loop-Mediated Isothermal Amplification Assays Targeting SARS-CoV-2 Epidemics of coronavirus disease 2019 (COVID-19) now have >100,000 confirmed cases worldwide. Diagnosis of COVID-19 is currently performed by quantitative RT-PCR methods, but the capacity of quantitative RT-PCR methods is limited by their requirement of high-level facilities and instruments. Herein, reverse transcription loop-mediated isothermal amplification (RT-LAMP) assays to detect genomic RNA of SARS-CoV-2, the causative virus of COVID-19, were developed and evaluated. RT-LAMP assays in this study can detect as low as 100 copies of SARS-CoV-2 RNA. Cross-reactivity of RT-LAMP assays to other human coronaviruses was not observed. A colorimetric detection method was adapted for this RT-LAMP assay so that the tests potentially performed in higher throughput.", "Data-driven Identification of Number of Unreported Cases for COVID-19: Bounds and Limitations Accurate forecasts for COVID-19 are necessary for better preparedness and resource management. Specifically, deciding the response over months or several months requires accurate long-term forecasts which is particularly challenging as the model errors accumulate with time. A critical factor that can hinder accurate long-term forecasts, is the number of unreported/asymptomatic cases. While there have been early serology tests to estimate this number, more tests need to be conducted for more reliable results. To identify the number of unreported/asymptomatic cases, we take an epidemiology data-driven approach. We show that we can identify lower bounds on this ratio or upper bound on actual cases as a factor of reported cases. To do so, we propose an extension of our prior heterogeneous infection rate model, incorporating unreported/asymptomatic cases. We prove that the number of unreported cases can be reliably estimated only from a certain time period of the epidemic data. In doing so, we construct an algorithm called Fixed Infection Rate method, which identifies a reliable bound on the learned ratio. We also propose two heuristics to learn this ratio and show their effectiveness on simulated data. We use our approaches to identify the upper bounds on the ratio of actual to reported cases for New York City and several US states. Our results demonstrate with high confidence that the actual number of cases cannot be more than 35 times in New York, 40 times in Illinois, 38 times in Massachusetts and 29 times in New Jersey, than the reported cases.", "Effectiveness of isolation, testing, contact tracing and physical distancing on reducing transmission of SARS-CoV-2 in different settings Isolation of symptomatic cases and tracing of contacts has been used as an early COVID-19 containment measure in many countries, with additional physical distancing measures also introduced as outbreaks have grown. To maintain control of infection while also reducing disruption to populations, there is a need to understand what combination of measures - including novel digital tracing approaches and less intensive physical distancing - may be required to reduce transmission. Using a model of individual-level transmission stratified by setting (household, work, school, other) based on BBC Pandemic data from 40,162 UK participants, we simulated the impact of a range of different testing, isolation, tracing and physical distancing scenarios. As well as estimating reduction in effective reproduction number, we estimated, for a given level of COVID-19 incidence, the number of contacts that would be newly quarantined each day under different strategies. Under optimistic but plausible assumptions, we estimated that combined testing and tracing strategies would reduce transmission more than mass testing or self-isolation alone (50-65% compared to 2-30%). If limits are placed on gatherings outside of home/school/work (e.g. maximum of 4 daily contacts in other settings), then manual contact tracing of acquaintances only could have a similar effect on transmission reduction as detailed contact tracing. In a scenario where there were 10,000 new symptomatic cases per day, we estimated in most contact tracing strategies, 140,000 to 390,000 contacts would be newly quarantined each day. Consistent with previous modelling studies and country-specific COVID-19 responses to date, our analysis estimates that a high proportion of cases would need to self-isolate and a high proportion of their contacts to be successfully traced to ensure an effective reproduction number that is below one in the absence of other measures. If combined with moderate physical distancing measures, self-isolation and contact tracing would be more likely to achieve control.", "Caution Warranted: Using the Institute for Health Metrics and Evaluation Model for Predicting the Course of the COVID-19 Pandemic The Institute for Health Metrics and Evaluation model for predicting the course of the coronavirus disease 2019 pandemic has attracted considerable attention, including from the U.S. government. The appearance of certainty of model estimates is seductive when the world is desperate to know what lies ahead, but caution is warranted regarding the validity and usefulness of the model projections for policymakers.", "Global, Regional and National Incidence and Case-fatality rates of Novel Coronavirus (COVID-19) across 154 countries and territories: A systematic assessment of cases reported from January to March 16, 2020 Background: The 2019 novel coronavirus disease (COVID-19) outbreak turned into a pandemic, with hundreds of thousands of cases reported globally. The number of cases dramatically increased beginning in early March 2020. Aim: We assessed the cumulative change in the incidence and case-fatality rates of COVID-19 at the global, regional, and national levels from January to March 16, 2020, in 154 affected countries and territories globally. Methods: We collected data of COVID-19 cases using the GitHub repository, which provided real-time surveillance information developed by the Center for Systems Science and Engineering (CSSE), Johns Hopkins University (USA). Information such as confirmed COVID-19 cases, deaths, and recoveries reported across all affected countries was collected from January 22 to March 16, 2020. We estimated the change in the incidence rate, case-fatality rate, and recovery rate from January 22 to February 29 and from March 1 to March 16, 2020. Results: From January 22 to March 16, 2020, globally, the number of incident COVID-19 cases increased by 276.2%, and Europe recorded 65,281 new cases from March 1 to 16, 2020. Overall, the case-fatality rate was 3.92%, with a high COVID-19 fatality rate in Italy (7.7%), Iran (5.7%), China (4.2%) and the United Kingdom (3.6%). The estimated percentage change in COVID-19 cases from March 1 to 16, 2020, was highest in Belgium (105.8/100,000 population), followed by Qatar (439/100,000 population) and Portugal (331/100,000 population). The overall recovery rate of COVID-19 was 43%; China (35.5%) had the highest recovery rate, while the United States of America recorded a recovery rate of 0.3%. Conclusion: Overall, all the COVID-19-affected countries showed an upward trend in incidence, with little change in the incidence rate of -0.20% from January to Mid-March. The case-fatality rate was found to be 3.92%, and the recovery rate was observed to be less than half (43%) among COVID-19 patients. Italy, Iran, and Spain had the largest numbers of new cases of COVID-19 from March 1 to 16, 2020.", "Connecting BCG Vaccination and COVID-19: Additional Data The reasons for a wide variation in severity of coronavirus disease 2019 (COVID-19) across the affected countries of the world are not known. Two recent studies have suggested a link between the BCG vaccination policy and the morbidity and mortality due to COVID-19. In the present study we compared the impact of COVID-19 in terms of case fatality rates (CFR) between countries with high disease burden and those with BCG revaccination policies presuming that revaccination practices would have provided added protection to the population against severe COVID-19. We found a significant difference in the CFR between the two groups of countries. Our data further supports the view that universal BCG vaccination has a protective effect on the course of COVID-19 probably preventing progression to severe disease and death. Clinical trials of BCG vaccine are urgently needed to establish its beneficial role in COVID-19 as suggested by the epidemiological data, especially in countries without a universal BCG vaccination policy. Keywords: COVID-19, BCG vaccination, case fatality ratio, mortality, low resource countries", "Testing for COVID-19 ", "On the impact of early non-pharmaceutical interventions as containment strategies against the COVID-19 pandemic Background The novel coronavirus SARS-CoV-2 (COVID-19) emerged in December 2019 in Wuhan, China and has spread since then to around 210 countries and territories by April 2020. Consequently, countries have adopted physical distance measures in an attempt to mitigate the uncontrolled spread of the virus. A critical question for policymakers to inform evidence-based practice is if and how physical distance measures slowed the propagation of COVID-19 in the early phase of the pandemic. Methods This study aims to quantify the effects of physical distance mitigation measures on the propagation of the COVID-19 pandemic. Data from John Hopkins University on confirmed cases and testing data from the Our World in Data were used in an interrupted time series analysis to estimate the effects of physical distance measures on the growth rates of the pandemic in 12 countries of Asia, Africa, and Europe. Findings We found that physical distance measures produced a significant decrease in the growth rates of the COVID-19 pandemic in five countries (Austria, Belgium, Italy, Malaysia, and South Korea). The test-positivity rate was significant in understanding the slowing growth rate of COVID-19 cases caused by the mitigation measures, as it provides important context that is missing from analysis based only on confirmed case data. Interpretation Physical distance interventions effectively slowed the progression of the COVID-19 pandemic. The results of this study could inform infectious disease mitigation policies based on physical distance measures by quantifying the differential health outcomes of a pandemic with and without physical distance interventions.", "Cumulative incidence and diagnosis of SARS-CoV-2 infection in New York PURPOSE: New York State (NYS) is an epicenter of the SARS-CoV-2 pandemic in the United States. Reliable estimates of cumulative incidence in the population are critical to tracking the extent of transmission and informing policies. METHODS: We conducted a statewide seroprevalence study among a 15,101 patron convenience sample at 99 grocery stores in 26 counties throughout NYS. SARS-CoV-2 cumulative incidence was estimated from antibody reactivity by first post-stratification weighting then adjusting by antibody test characteristics. The percent diagnosed was estimated by dividing diagnoses by estimated infection-experienced adults. RESULTS: Based on 1,887 of 15,101 reactive results (12.5%), estimated cumulative incidence through March 29 was 14.0% (95% CI: 13.3-14.7%), corresponding to 2,139,300 (95% CI: 2,035,800-2,242,800) infection-experienced adults. Cumulative incidence was highest in New York City (NYC) 22.7% (95% CI: 21.5-24.0%) and higher among Hispanic/Latino (29.2%), non-Hispanic black/African American (20.2%), and non-Hispanic Asian (12.4%) than non-Hispanic white adults (8.1%, p<.0001). An estimated 8.9% (95% CI: 8.4-9.3%) of infections in NYS were diagnosed, with diagnosis highest among adults \u226555 years (11.3%, 95% CI: 10.4-12.2%). CONCLUSIONS: From the largest US serosurvey to date, we estimated > 2 million adult New York residents were infected through late March, with substantial disparities, although cumulative incidence remained below herd immunity thresholds. Monitoring, testing, and contact tracing remain essential public health strategies.", "Estimating SARS-CoV-2 seroprevalence and epidemiological parameters with uncertainty from serological surveys Establishing how many people have already been infected by SARS-CoV-2 is an urgent priority for controlling the COVID-19 pandemic. Patchy virological testing has hampered interpretation of confirmed case counts, and unknown rates of asymptomatic and mild infections make it challenging to develop evidence-based public health policies. Serological tests that identify past infection can be used to estimate cumulative incidence, but the relative accuracy and robustness of various sampling strategies has been unclear. Here, we used a flexible framework that integrates uncertainty from test characteristics, sample size, and heterogeneity in seroprevalence across tested subpopulations to compare estimates from sampling schemes. Using the same framework and making the assumption that serological positivity indicates immune protection, we propagated these estimates and uncertainty through dynamical models to assess the uncertainty in the epidemiological parameters needed to evaluate public health interventions. We examined the relative accuracy of convenience samples versus structured surveys to estimate population seroprevalence, and found that sampling schemes informed by demographics and contact networks outperform uniform sampling. The framework can be adapted to optimize the design of serological surveys given particular test characteristics and capacity, population demography, sampling strategy, and modeling approach, and can be tailored to support decision-making around introducing or removing interventions.", "The role of asymptomatic SARS-CoV-2 infections: rapid living systematic review and meta-analysis Background: There is substantial disagreement about the level of asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a population. The disagreement results, in part, from the interpretation of studies that report a proportion of asymptomatic people with SARS-CoV-2 detected at a single point. Review questions: 1. Amongst people who become infected with SARS-CoV-2, what proportion does not experience symptoms at all during their infection? 2. Amongst people with SARS-CoV-2 infection who are asymptomatic when diagnosed, what proportion will develop symptoms later? 3. What proportion of SARS-CoV-2 transmission is accounted for by people who are either asymptomatic throughout infection, or pre-symptomatic? Methods: Rapid living systematic review (protocol https://osf.io/9ewys/). We searched Pubmed, Embase, bioRxiv and medRxiv using a living evidence database of SARS-CoV-2 literature on 25.03.2020. We included studies of people with SARS-CoV-2 diagnosed by reverse transcriptase PCR (RT-PCR) that documented follow-up and symptom status at the beginning and end of follow-up and modelling studies. Study selection, data extraction and bias assessment were done by one reviewer and verified by a second, with disagreement resolved by discussion or a third reviewer. We used a common-effect model to synthesise proportions from comparable studies. Results: We screened 89 studies and included 11. We estimated an upper bound for the proportion of asymptomatic SARS-CoV-2 infections of 29% (95% confidence interval 23 to 37%) in eight studies. Selection bias and likely publication bias affected the family case investigation studies. One statistical modelling study estimated the true proportion of asymptomatic infections at 18% (95% credibility interval 16 to 20%). Estimates of the proportions of pre-symptomatic individual in four studies were too heterogeneous to combine. In modelling studies, 40-60% of all SARS-CoV-2 infections are the result of transmission from pre-symptomatic individuals, with a smaller contribution from asymptomatic individuals. Conclusions: An intermediate contribution of pre-symptomatic and asymptomatic infections to overall SARS-CoV-2 transmission means that combination prevention, with enhanced hand and respiratory hygiene, testing tracing and isolation strategies and social distancing, will continue to be needed. The findings of this systematic review of publications early in the pandemic suggests that most SARS-CoV-2 infections are not asymptomatic throughout the course of infection.", "How much of SARS-CoV-2 Infections is India detecting? A model-based estimation Background and Rationale: Amid SARS-CoV-2 outbreak, the low number of infections for a population size of 1.38 billion is widely discussed, but with no definite answers. Methods: We used the model proposed by Bommer and Vollmer to assess the quality of official case records. The infection fatality rates were taken from Verity et al (2020). Age distribution of the population for India and states are taken from the Census of India (2011). Reported number of deaths and SARS-CoV-2 confirmed cases from https://www.covid19india.org. The reported numbers of samples tests were collected from the reports of the Indian Council for Medical Research (ICMR). Results: The findings suggest that India is detecting just 3.6% of the total number of infections with a huge variation across its states. Among 13 states which have more than 100 COVID-19 cases, the detection rate varies from 81.9% (of 410 estimated infections) in Kerala to 0.8% (of 35487 estimated infections) in Madhya Pradesh and 2.4% (of 7431 estimated infections) in Gujarat. Conclusion: As the study reports a lower number of deaths and higher recovery rates in the states with a high detection rate, thus suggest that India must enhance its testing capacity and go for widespread testing. Late detection puts patients in greater need of mechanical ventilation and ICU care, which imposes greater costs on the health system. The country should also adopt population-level random testing to assess the prevalence of the infection.", "Fever and mobility data indicate social distancing has reduced incidence of communicable disease in the United States In March of 2020, many U.S. state governments encouraged or mandated restrictions on social interactions to slow the spread of COVID-19, the disease caused by the novel coronavirus SARS-CoV-2 that has spread to nearly 180 countries. Estimating the effectiveness of these social-distancing strategies is challenging because surveillance of COVID-19 has been limited, with tests generally being prioritized for high-risk or hospitalized cases according to temporally and regionally varying criteria. Here we show that reductions in mobility across U.S. counties with at least 100 confirmed cases of COVID-19 led to reductions in fever incidences, as captured by smart thermometers, after a mean lag of 6.5 days ($90\\%$ within 3--10 days) that is consistent with the incubation period of COVID-19. Furthermore, counties with larger decreases in mobility subsequently achieved greater reductions in fevers ($p<0.01$), with the notable exception of New York City and its immediate vicinity. These results indicate that social distancing has reduced the transmission of influenza like illnesses, including COVID 19, and support social distancing as an effective strategy for slowing the spread of COVID-19.", "Performance & Quality Evaluation of Marketed COVID-19 RNA Detection Kits Compared to other coronaviruses, COVID-19 has a longer incubation period and features asymptomatic infection at a high rate (>25%). Therefore, early detection of infection is the key to early isolation and treatment. Direct detection of the virus itself has advantages over indirect detection. Currently, the most sensitive and commercially validated method for COVID-19 testing is RT-qPCR, designed to detect amplified virus-specific RNA. Reliable testing has proven to be a bottleneck in early diagnosis of virus infection in all countries dealing with the pandemic. Significant performance and quality issues with available testing kits have caused confusion and serious health risks. In order to provide better understanding of the Quality and performance of COVID-19 RNA detection kits on the market, we designed a system to evaluate the specificity (quantitation), sensitivity (LOD) and robustness of the kits using positive RNA and pseudovirus controls based on COVID-19 genomic sequence. We evaluated 8 Nucleic Acid qPCR Kits approved in China, some of which are also approved in the US and EU. Our study showed that half of these 8 kits lack 1:1 linear relationship for virus RNA copy: qPCR signal. Of the 4 with linear response, 2 demonstrated sensitivity at 1 Copy viral RNA/Reaction, suitable for early detection of virus infection. Furthermore, we established the best RNA extraction, handling and qPCR procedures allowing highly sensitive and consistent performance using BGI qPCR kits. Our study provides an effective method to assess and compare performance quality of all COVID-19 nucleic acid testing kits, globally.", "Early Transmission Dynamics of Novel Coronavirus (COVID-19) in Nigeria On 31 December 2019, the World Health Organization (WHO) was notified of a novel coronavirus disease in China that was later named COVID-19. On 11 March 2020, the outbreak of COVID-19 was declared a pandemic. The first instance of the virus in Nigeria was documented on 27 February 2020. This study provides a preliminary epidemiological analysis of the first 45 days of COVID-19 outbreak in Nigeria. We estimated the early transmissibility via time-varying reproduction number based on the Bayesian method that incorporates uncertainty in the distribution of serial interval (time interval between symptoms onset in an infected individual and the infector), and adjusted for disease importation. By 11 April 2020, 318 confirmed cases and 10 deaths from COVID-19 have occurred in Nigeria. At day 45, the exponential growth rate was 0.07 (95% confidence interval (CI): 0.05\u20130.10) with a doubling time of 9.84 days (95% CI: 7.28\u201315.18). Separately for imported cases (travel-related) and local cases, the doubling time was 12.88 days and 2.86 days, respectively. Furthermore, we estimated the reproduction number for each day of the outbreak using a three-weekly window while adjusting for imported cases. The estimated reproduction number was 4.98 (95% CrI: 2.65\u20138.41) at day 22 (19 March 2020), peaking at 5.61 (95% credible interval (CrI): 3.83\u20137.88) at day 25 (22 March 2020). The median reproduction number over the study period was 2.71 and the latest value on 11 April 2020, was 1.42 (95% CrI: 1.26\u20131.58). These 45-day estimates suggested that cases of COVID-19 in Nigeria have been remarkably lower than expected and the preparedness to detect needs to be shifted to stop local transmission.", "CDC\u2019s coronavirus test runs into early problems Early batches of a kit developed by the US government to diagnose the novel coronavirus infection have been plagued by problems that initially limited their use and cast doubt on their accuracy The problems were first reported by the Washington Post, and C&EN learned soon after that the kits contained faulty reagents that led to inconclusive readouts The Centers for Disease Control and Prevention (CDC) has started an investigation into what exactly went wrong with the tests The CDC designed and manufactured the test kit, which detects the RNA genome of the virus, called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) The US Food and Drug Administration has approved its use in public health departments nationwide As of March 5, SARS-CoV-2 has killed 10 people in the US and infected nearly 100 Several hundred people have been tested, but the CDC has now stopped reporting testing numbers in favor of [truncated]", "National Governance of Public Health Responses in a Pandemic? The world is currently facing the worst pandemic in a century and we were caught unprepared. COVID-19 has proven highly contagious and with severe consequences that are still unfolding. As of 16 April 2020, there were over 2 million confirmed cases and over 136,000 related deaths reported worldwide. Over 1 million of those confirmed cases were in the preceding 14 days, with the USA accounting for nearly half of those. Furthermore, the International Monetary Fund (IMF) is now warning that the world is about to suffer the worst economic recession since the Great Depression in the 1920s.", "Evaluating the massive underreporting and undertesting of COVID-19 cases in multiple global epicenters Abstract Background With continuous global COVID-19 outbreak, differing case numbers and mortality rates are observed. While actual case numbers appear vague, mortality numbers related to COVID-19 seem more precise. In this study, we used the mortality rate as the main indicator to evaluate the extent of underreporting and underdetection of COVID-19 cases. Methods We have analyzed all available data provided by the World Health Organization on the development of international COVID-19 cases and mortality numbers on March 17th, 2020. A crude case-fatality risk (cCFR) and adjusted case-fatality risk (aCFR) was calculated for China, South Korea, Japan, Italy, France, Spain, Germany, Iran and the United States. Additionally, a fold-change (FC) was derived for each country. Results The highest aCFR and FC were detected for Spain. Based on their FC values, an extremely high number of undetected COVID-19 cases was displayed in France, the United States, Italy and Spain. For these countries, our findings indicate a detection rate of only 1-2% of total actual COVID-19 cases. Conclusions Due to limited testing capacities, mortality numbers may serve as a better indicator for COVID-19 case spread in many countries. Our data indicate that countries like France, Italy, the United States, Iran and Spain have extremely high numbers of undetected and underreported cases. Differences in testing availability and capacity, containment as well as overall health care and medical infrastructure result in significantly different mortality rates and COVID-19 case numbers for each respective country.", "Prevalence and Severity of Coronavirus Disease 2019 (COVID-19) Illness in Symptomatic Pregnant and Postpartum Women Stratified by Hispanic Ethnicity. ", "Emerging Polynomial Growth Trends in COVID-19 Pandemic Data and Their Reconciliation with Compartment Based Models We study the reported data from the COVID-19 pandemic outbreak in January - May 2020 in 119 countries. We observe that the time series of active cases in individual countries (the difference of the total number of confirmed infections and the sum of the total number of reported deaths and recovered cases) display a strong agreement with polynomial growth and at a later epidemic stage also with a combined polynomial growth with exponential decay. Our results are also formulated in terms of compartment type mathematical models of epidemics. Within these models the universal scaling characterizing the observed regime in an advanced epidemic stage can be interpreted as an algebraic decay of the relative reproduction number $R_0$ as $T_M/t$, where $T_M$ is a constant and $t$ is the duration of the epidemic outbreak. We show how our findings can be applied to improve predictions of the reported pandemic data and estimate some epidemic parameters. Note that although the model shows a good agreement with the reported data we do not make any claims about the real size of the pandemics as the relation of the observed reported data to the total number of infected in the population is still unknown.", "Syndromic Surveillance for COVID-19 in Canada Background: Syndromic surveillance through web or phone-based polling has been used to track the course of infectious diseases worldwide. Our study objective was to describe the characteristics, symptoms, and self-reported testing rates of respondents in three different COVID-19 symptom surveys in Canada. Methods: Data sources consisted of two distinct Canada-wide web-based surveys, and phone polling in Ontario. All three sources contained self-reported information on COVID-19 symptoms and testing. In addition to describing respondent characteristics, we examined symptom frequency and the testing rate among the symptomatic, as well as rates of symptoms and testing across respondent groups. Results: We found that 1.6% of respondents experienced a symptom on the day of their survey, 15% of Ontario households had a symptom in the previous week, and 44% of Canada-wide respondents had a symptom in the previous month over March-April 2020. Across the three surveys, SARS-CoV-2-testing was reported in 2-9% of symptomatic responses. Women, younger and middle-aged adults (versus older adults) and Indigenous/First nations/Inuit/Metis were more likely to report at least one symptom, and visible minorities were more likely to report the combination of fever with cough or shortness of breath. Interpretation: The low rate of testing among those reporting symptoms suggests significant opportunity to expand testing among community-dwelling residents of Canada. Syndromic surveillance data can supplement public health reports and provide much-needed context to gauge the adequacy of current SARS-CoV-2 testing rates.", "Estimation of true number of COVID-19 infected people in Japan using LINE questionnaire The authors estimated the true number of COVID-19 infected people in Japan using the LINE questionnaire data and the PCR test results. A statistically significant correlation was observed between the infection rate per prefecture with PCR test and the rate of high fever. Using this correlation, true number of COVID-19 infected people in Japan was estimated approximately twenty thousand (+/\u2212 ten thousand) as of April 1, 2020.", "Testing COVID-19 tests faces methodological challenges Abstract In battling the COVID-19 pandemic, testing is essential. The detection of viral RNA allows the identification of infected persons, while the detection of antibodies may reveal a response to a previous infection. Tests for coronavirus should be rigorously evaluated in terms of their analytical and clinical performance. This poses not only logistic challenges, but also methodological ones. Some of these are generic for the diagnostic accuracy paradigm, while others are more specific for tests for viruses. Problematic for evaluations of the clinical performance of tests for viral RNA is the absence of an independent reference standard. Many studies lack rigor in terms of the recruitment of study participants. Study reports are often insufficiently informative, which makes it difficult to assess the applicability of study findings. Attempts to summarize the performance of these tests in terms of a single estimate of the clinical sensitivity fails to do justice to the identifiable sources of the large heterogeneity in mechanisms for generating false negative results.", "Estimation of the actual disease occurrence based on official case numbers during a COVID outbreak in Germany 2020 Since the beginning of March 2020, the cumulative numbers of cases of infection with the novel coronavirus SARS-CoV-2 in Germany have been reported on a daily basis. The reports originate from national laws, according to which positive test findings must be submitted to the Federal Health Authorities, the Robert Koch Institute, via the local health authorities. Since an enormous number of unreported cases can be expected, the question of how widespread the disease has been in the population cannot be answered based on these administrative reports. Using mathematical modeling, however, estimates can be made. These estimates indicate that the small numbers of diagnostic tests carried out at the beginning of the outbreak overlooked considerable parts of the infection. In order to cover the initial phase of future waves of the disease, wide-spread and comprehensive tests are recommended.", "Multiple drivers of the COVID-19 spread: role of climate, international mobility, and region-specific conditions The novel Coronavirus Disease 2019 (COVID-19) has spread quickly across the globe. Here, we evaluated the role of climate (temperature and precipitation), region-specific susceptibility (BCG vaccination, malaria infection, and elderly population) and international traveller population (human mobility) in shaping the geographical patterns of COVID-19 cases across 1,055 countries/regions, and examined the sequential shift of multiple drivers of the accumulated cases from December, 2019 to April 12, 2020. The accumulated numbers of COVID-19 cases (per 1 million population) were well explained by a simple regression model. The explanatory power (R2) of the model increased up to > 70% in April 2020 as the COVID-19 spread progressed. Climate, host mobility, and host susceptibility largely explained the variance of the COVID-19 cases (per 1 million population), and their explanatory power improved as the pandemic progressed; the relative importance of host mobility and host susceptibility have been greater than that of climate. The number of days from outbreak onset showed greater explanatory power in the earlier stages of COVID-19 spread but rapidly lost its influence. Our findings demonstrate that the COVID-19 pandemic is deterministically driven by climate suitability, cross-border human mobility, and region-specific susceptibility. The present distribution of COVID-19 cases has not reached an equilibrium and is changing daily, especially in the Southern Hemisphere. Nevertheless, the present results, based on mapping the spread of COVID-19 and identifying multiple drivers of this outbreak trajectory, may contribute to a better understanding of the COVID-19 disease transmission risk and the measures against long-term epidemic.", "Application of pooled testing in screening and estimating the prevalence of Covid-19 The recent emergence of the COVID-19 pandemic has posed an unprecedented healthcare challenge and catastrophic economic and social consequences to the countries across the world. The situation is even worse for emerging economies like India. WHO recommends mass scale testing as one of the most effective ways to contain its spread and fight the pandemic. But, due to the high cost and shortage of test kits, specifically in India, the testing is restricted to only those who are symptomatic. In this context, pooled testing is recommended by some experts as a partial solution to overcome this problem. In this article, we explain the basic statistical theory behind the pooled testing procedure for screening as well as prevalence estimation. In real world situations, the tests are imperfect, and lead to false positive and false negative results. We provide theoretical explanation of the impact of these diagnostic errors on the performances of individual testing and pooled testing procedures. Finally, we study the effect of misspecification of sensitivity and specificity of tests on the estimate of prevalence, an issue, which is debated a lot among the scientists in the context of COVID-19. Our theoretical investigations lead to some interesting and precise understanding of some of these issues.", "Case fatality rate in COVID-19: a systematic review and meta-analysis Background: Estimating the prevalence of severe or critical illness and case fatality of COVID-19 outbreak in December, 2019 remains a challenge due to biases associated with surveillance, data synthesis and reporting. We aimed to address this limitation in a systematic review and meta-analysis and to examine the clinical, biochemical and radiological risk factors in a meta-regression. Methods: PRISMA guidelines were followed. PubMed, Scopus and Web of Science were searched using pre-specified keywords on March 07, 2020. Peer-reviewed empirical studies examining rates of severe illness, critical illness and case fatality among COVID-19 patients were examined. Numerators and denominators to compute the prevalence rates and risk factors were extracted. Random-effects meta-analyses were performed. Results were corrected for publication bias. Meta-regression analyses examined the moderator effects of potential risk factors. Results: The meta-analysis included 29 studies representing 2,090 individuals. Pooled rates of severe illness, critical illness and case fatality among COVID-19 patients were 15%, 5% and 0.8% respectively. Adjusting for potential underreporting and publication bias, increased these estimates to 26%, 16% and 7.4% respectively. Increasing age and elevated LDH consistently predicted severe / critical disease and case fatality. Hypertension; fever and dyspnea at presentation; and elevated CRP predicted increased severity. Conclusions: Risk factors that emerged in our analyses predicting severity and case fatality should inform clinicians to define endophenotypes possessing a greater risk. Estimated case fatality rate of 7.4% after correcting for publication bias underscores the importance of strict adherence to preventive measures, case detection, surveillance and reporting.", "Network structure of COVID-19 spread and the lacuna in India's testing strategy We characterize the network of COVID-19 spread in India and find that the transmission rate is 0.43, with daily case growth driven by individuals who contracted the virus abroad. We explore the question of whether this represents exponentially decaying dynamics or is simply an artefact of India's testing strategy. Testing has largely been limited to individuals travelling from high-risk countries and their immediate contacts, meaning that the network reflects positive identifications from a biased testing sample. Given generally low levels of testing and an almost complete absence of testing for community spread, there is significant risk that we may be missing out on the actual nature of outbreak. India still has an apparently low current caseload, with possibly a small window of time to act, and should therefore aggressively and systematically expand random testing for community spread, including for asymptomatic cases. This will help understand true transmission characteristics and plan appropriately for the immediate future.", "Estimating the number of SARS-CoV-2 infections and the impact of social distancing in the United States Understanding the number of individuals who have been infected with the novel coronavirus SARS-CoV-2, and the extent to which social distancing policies have been effective at limiting its spread, are critical for effective policy going forward. Here we present estimates of the extent to which confirmed cases in the United States undercount the true number of infections, and analyze how effective social distancing measures have been at mitigating or suppressing the virus. Our analysis uses a Bayesian model of COVID-19 fatalities with a likelihood based on an underlying differential equation model of the epidemic. We provide analysis for four states with significant epidemics: California, Florida, New York, and Washington. Our short-term forecasts suggest that these states may be following somewhat different trajectories for growth of the number of cases and fatalities.", "Major testing issues in US Delays and restrictions on who can be tested for the covid-19 virus in the US have raised the risk that it is spreading undetected, reports Colin Barras", "Using early data to estimate the actual infection fatality ratio from COVID-19 in France Background. The number of screening tests carried out in France and the methodology used to target the patients tested do not allow for a direct computation of the actual number of cases and the infection fatality ratio (IFR). The main objective was to estimate the actual number of people infected with COVID-19 during the observation window in France and to deduce the IFR. Methods. We develop a 'mechanistic-statistical' approach coupling a SIR epidemiological model describing the unobserved epidemiological dynamics, a probabilistic model describing the data acquisition process and a statistical inference method. Results. The actual number of infected cases in France is probably higher than the observations: we find here a factor x 8 (95%-CI: 5-12) which leads to an IFR in France of 0.5% (95%-CI: 0.3-0.8) based on hospital death counting data. Adjusting for the number of deaths in nursing homes, we obtain an IFR of 0.8% (95%-CI: 0.45-1.25). Conclusions. This IFR is consistent with previous findings in China (0.66%) and in the UK (0.9%) and lower than the value previously computed on the Diamond Princess cruse ship data (1.3%).", "Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak Abstract Backgrounds An ongoing outbreak of a novel coronavirus (2019-nCoV) pneumonia hit a major city in China, Wuhan, December 2019 and subsequently reached other provinces/regions of China and other countries. We present estimates of the basic reproduction number, R 0, of 2019-nCoV in the early phase of the outbreak. Methods Accounting for the impact of the variations in disease reporting rate, we modelled the epidemic curve of 2019-nCoV cases time series, in mainland China from January 10 to January 24, 2020, through the exponential growth. With the estimated intrinsic growth rate (\u03b3), we estimated R 0 by using the serial intervals (SI) of two other well-known coronavirus diseases, MERS and SARS, as approximations for the true unknown SI. Findings The early outbreak data largely follows the exponential growth. We estimated that the mean R 0 ranges from 2.24 (95%CI: 1.96\u20132.55) to 3.58 (95%CI: 2.89\u20134.39) associated with 8-fold to 2-fold increase in the reporting rate. We demonstrated that changes in reporting rate substantially affect estimates of R 0. Conclusion The mean estimate of R 0 for the 2019-nCoV ranges from 2.24 to 3.58, and is significantly larger than 1. Our findings indicate the potential of 2019-nCoV to cause outbreaks.", "Cremation based estimates suggest significant under- and delayed reporting of COVID-19 epidemic data in Wuhan and China Background: Epidemiological data provide important information for decision making. COVID-19 statistics from China fall outside of recognized and accepted medical norms. As the epicenter of the COVID-19 initial outbreak, the epidemiological information from Wuhan affects the response and preparation of other parts of China and rest of the world. Here we estimated the incidence, death and starting time of the COVID-19 outbreak in Wuhan and China based on medical literature from China, official and non-official Chinese data sources. Methods: Data sources included literature on COVID-19 in China, official Chinese government figures, state-run and non state-run media reports. Our estimates are based on investigative media reports of crematory operations in Wuhan, which is considered as a common data end point to life. A range of estimates is presented by an exponential growth rate model from lockdown (Jan 23,2020) until the intervention started to show effects, which was estimated 14.5 days after lockdown. Results: For the cumulative infections and total deaths, under different assumptions of death rates (from 2.5% to 10%) and doubling time 6.4 days, the estimates projected on February 7, 2020 in Wuhan range from 305,000 to 1,272,000 for infections and from 6,811 to 7,223 for deaths - on the order of at least 10 times the official figures (13,603 and 545). The implied starting time of the outbreak is October 2019. Under the assumption of the official 3.14% death rate and doubling time of 2.54 days (which was derived based on Chinese official data), the infection cases reached 2.2 million on February 7. The estimates of cumulative deaths, based on both funeral urns distribution and continuous full capacity operation of cremation services up to March 23, 2020, give results around 36,000, more than 10 times of the official death toll of 2,524. Conclusions: Our study indicates a significant under-reporting in Chinese official data on the COVID-19 epidemic in Wuhan. The magnitude of discrepancy between our estimates based on cremation related data and Chinese official figures in early February, the critical time for response to the COVID-19 pandemic, suggests the need to reevaluate official statistics from China and consider all available and reasonable data sources for a better understanding of the COVID-19 pandemic.", "Changes in testing rates could mask the novel coronavirus disease (COVID-19) growth rate Abstract Since the novel coronavirus disease (COVID-19) emerged in December 2019 in China, it has rapidly propagated to around the world, leading to one of the most significant pandemic events of recent history. Deriving reliable estimates of the COVID-19 epidemic growth rate is quite important to guide the timing and intensity of intervention strategies. Indeed, many studies have quantified the epidemic growth rate using time-series of reported cases during the early phase of the outbreak to estimate the basic reproduction number, R 0. Using daily time series of COVID-19 incidence, we illustrate how epidemic curves of reported cases may not always reflect the true epidemic growth rate due to changes in testing rates, which could be influenced by limited diagnostic testing capacity during the early epidemic phase.", "CoronaSurveys: Using Surveys with Indirect Reporting to Estimate the Incidence and Evolution of Epidemics The world is suffering from a pandemic called COVID-19, caused by the SARS-CoV-2 virus. National governments have problems evaluating the reach of the epidemic, due to having limited resources and tests at their disposal. This problem is especially acute in low and middle-income countries (LMICs). Hence, any simple, cheap and flexible means of evaluating the incidence and evolution of the epidemic in a given country with a reasonable level of accuracy is useful. In this paper, we propose a technique based on (anonymous) surveys in which participants report on the health status of their contacts. This indirect reporting technique, known in the literature as network scale-up method, preserves the privacy of the participants and their contacts, and collects information from a larger fraction of the population (as compared to individual surveys). This technique has been deployed in the CoronaSurveys project, which has been collecting reports for the COVID-19 pandemic for more than two months. Results obtained by CoronaSurveys show the power and flexibility of the approach, suggesting that it could be an inexpensive and powerful tool for LMICs.", "COVID-19 pandemic: examining the faces of spatial differences in the morbidity and mortality in sub-Saharan Africa, Europe and USA. Background: COVID-19, the disease associated with the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is currently a global pandemic with several thousands of confirmed cases of infection and death. However, the death rate across affected countries shows variation deserving of critical evaluation. Methods: In this study, we evaluated differentials in COVID-19 confirmed cases of infection and associated deaths of selected countries in Sub-Sahara Africa (Nigeria and Ghana), South Africa, Europe (Italy, Spain, Sweden and UK) and USA. Data acquired for various standard databases on mutational shift of the SARS-CoV-2 virus based on geographical location, BCG vaccination policy, malaria endemicity, climatic conditions (temperature), differential healthcare approaches were evaluated over a period of 45 days from the date of reporting the index case. Results: The number of confirmed cases of infection and associated deaths in Sub-Sahara Africa were found to be very low compared to the very high values in Europe and USA over the same period. Recovery rate from COVID-19 is not correlated with the mutational attributes of the virus with the sequenced strain from Nigeria having no significant difference (p>0.05) from other geographical regions. Significantly higher (p<0.05) infection rate and mortality from COVID-19 were observed in countries (Europe and USA) without a current universal BCG vaccination policy compared to those with one (Sub-Sahara African countries). Countries with high malaria burden had significantly lower (p<0.05) cases of COVID-19 than those with low malaria burden. A strong negative correlation (-0.595) between mean annual temperature and COVID-19 infection and death was observed with 14.8% variances between temperature and COVID-19 occurrence among the countries. A clear distinction was observed in the COVID-19 disease management between the developed countries (Europe and USA) and Sub-Sahara Africa. Conclusions: The study established that the wide variation in the outcome of the COVID-19 disease burden in the selected countries are attributable largely to climatic condition (temperature) and differential healthcare approaches to management of the disease. We recommend consideration and mainstreaming of these findings for urgent intervention and management of COVID-19 across these continents.", "The impact of changes in diagnostic testing practices on estimates of COVID-19 transmission in the United States Estimates of the reproductive number for novel pathogens such as SARS-CoV-2 are essential for understanding the potential trajectory of the epidemic and the level of intervention that is needed to bring the epidemic under control. However, most methods for estimating the basic reproductive number (R(0)) and time-varying effective reproductive number (R(t)) assume that the fraction of cases detected and reported is constant through time. We explore the impact of secular changes in diagnostic testing and reporting on estimates of R(0) and R(t) using simulated data. We then compare these patterns to data on reported cases of COVID-19 and testing practices from different United States (US) states. We find that changes in testing practices and delays in reporting can result in biased estimates of R(0) and R(t). Examination of changes in the daily number of tests conducted and the percent of patients testing positive may be helpful for identifying the potential direction of bias. Changes in diagnostic testing and reporting processes should be monitored and taken into consideration when interpreting estimates of the reproductive number of COVID-19.", "KCDC Risk Assessments on the Initial Phase of the COVID-19 Outbreak in Korea OBJECTIVES: This study aims to evaluate the risk assessments of coronavirus 2019 (COVID-19) in the Korea Centers for Disease Control and Prevention (KCDC), from the point of detection to the provision of basic information to the relevant public health authorities. METHODS: To estimate the overall risk of specific public health events, probability, and impact at the country-level were evaluated using available information. To determine the probability of particular public health events, the risk of importation and risk of transmission were taken into consideration. KCDC used 5 levels (\u201cvery low,\u201d \u201clow,\u201d \u201cmoderate,\u201d \u201chigh,\u201d and \u201cvery high\u201d) for each category and overall risk was eventually decided. RESULTS: A total of 8 risk assessments were performed on 8 separate occasions between January 8(th) to February 28(th), 2020, depending on the detection and report of COVID-19 cases in other countries. The overall risk of the situation in each assessment increased in severity over this period: \u201clow\u201d (first), \u201cmoderate\u201d (second), \u201chigh\u201d (third), \u201chigh\u201d (fourth), \u201chigh\u201d (fifth), \u201chigh\u201d (sixth), \u201chigh\u201d (seventh), and \u201cvery high\u201d (eighth). CONCLUSION: The KCDC\u2019s 8 risk assessments were utilized to activate national emergency response mechanisms and eventually prepare for the pandemic to ensure the containment and mitigation of COVID-19 with non-pharmaceutical public health measures.", "COVID-19 mathematical model reopening scenarios for Sao Paulo - Brazil The objective of the current investigation was to produce a generalized computational model to predict consequences of various reopening scenarios on COVID-19 infections rates and available hospital resources in Sao Paulo - Brazil. We were able to use the Susceptible-Exposed-Infected-Recovered (SEIR) model to fit both accumulated death data and corrected accumulated cases data associated with COVID-19 for both Brazil and the state of Sao Paulo. In addition, we were able to simulate the consequences of reopening under different possible scenarios in Brazil, in special for the state of Sao Paulo. The model was able to provide a predicted scenario in which reopening could occur with minimal impact on human life considering people careful behavior in combination with continued social distancing measures.", "New blood tests for antibodies could show true scale of coronavirus pandemic How many COVID-19 cases have gone undetected? And are those who had mild cases of the disease\u2014perhaps so mild they dismissed it as a cold or allergies\u2014immune to new infections? If so, they could slow the spread of the burgeoning pandemic Labs and companies around the world have raced to develop antibody tests, and a few have been used in small studies and received commercial approval, including several from China But so far, large-scale data from such tests\u2014for example showing what fraction of people in the hard-hit city of Wuhan, China, might now be immune\u2014is still lacking or at least not public Scientists hope that will soon change as more tests become available", "Forecasting the Impact of Coronavirus Disease During Delivery Hospitalization: An Aid for Resources Utilization Abstract Background The ongoing Coronavirus disease (COVID-19) pandemic has severely impacted the United States. In cases of infectious disease outbreak, forecasting models are often developed for resources utilization. Pregnancy and delivery pose unique challenges, given the altered maternal immune system and the fact that the majority of American women choose to deliver in the hospital setting. Objectives The aim of our study is to forecast the incidence of COVID-19 in general population and to forecast the overall incidence, severe cases, critical cases and fatal COVID-19 cases during delivery hospitalization in the United States. Study design We use a phenomenological model with generalized logistic growth models to forecast the incidence of COVID-19 in the United States from 4/15/2020 \u2013 12/31/2020. Incidence data from 3/1/2020 \u2013 4/14/2020 were used to provide best-fit model solution. Subsequently, Monte-Carlo simulation was performed for each week from 3/1/2020 \u2013 12/31/2020 to estimate the incidence of COVID-19 in delivery hospitalizations using the available data estimate. Results From 3/1/2020 \u2013 12/31/2020, our model forecasted a total of 860,475 cases of COVID-19 in general population across the United States. The cumulative incidence for COVID-19 during delivery hospitalization is anticipated to be 16,601 (95% CI, 9,711 \u2013 23,491) cases. Among those, 3,308 (95% CI, 1,755 \u2013 4,861) cases are expected to be severe, 681 (95% CI, 1324 \u2013 1,038) critical and 52 (95% CI, 23 \u2013 81) maternal mortality. Assuming similar baseline maternal mortality rate as the year of 2018, we projected an increase in maternal mortality rate in the US to at least 18.7 (95% CI, 18.0 \u2013 19.5) deaths per 100,000 live birth as a direct result of COVID-19. Conclusions COVID-19 infection in pregnant women is expected to severely impact obstetrical care. From 3/1/2020 \u2013 12/31/2020, we project 3,308 severe and 681 critical cases, with about 52 COVID-19 related maternal mortalities during delivery hospitalization in the United States. These data might be helpful for counseling and resource allocation.", "Estimation of testing bias in covid-19 COVID-19 testing studies have become a standard approach for estimating prevalence and fatality rates which then assist in public health decision making to contain and mitigate the spread of the disease. The sampling designs used are often biased in that they do not reflect the true underlying populations. For instance, individuals with strong symptoms are more likely to be tested than those with no symptoms. This results in biased estimates of prevalence (too high) and over-estimation of fatality rates. Typical post-sampling corrections are not always possible. Here we present a simple bias correction methodology derived and adapted from a correction for publication bias in meta analysis studies. The methodology is general enough to allow a wide variety of customization making it more useful in practice. Implementation is easily done using already collected information. We show via an example that the bias corrections can provide dramatic reductions in estimation error.", "The impact of contact tracing and household bubbles on deconfinement strategies for COVID-19: an individual-based modelling study Background. The rising COVID-19 pandemic caused many governments to impose policies restricting social interactions. These policies have slowed down the spread of the SARS-CoV-2 virus to the extent that restric- tions can be gradually lifted. Models can be useful to assess the consequences of deconfinement strategies with respect to business, school and leisure activities. Methods. We adapted the individual-based model \"STRIDE\" to simulate interactions between the 11 million inhabitants of Belgium at the levels of households, workplaces, schools and communities. We calibrated our model to observed hospital incidence and seroprevalence data. STRIDE can explore contact tracing options and account for repetitive leisure contacts in extended household settings (so called \"household bubbles\") with varying levels of connectivity. Findings. Household bubbles have the potential to reduce the number of COVID-19 hospital admissions by up to 90%. The effectiveness of contact tracing depends on its timing, as it becomes futile more than 4 days after the index case developed symptoms. Assuming that children have a lower level of susceptibility and lower probability to experience symptomatic SARS-CoV-2 infection, (partial) school closure options have relatively little impact on COVID-19 burden. Interpretation. Not only the absolute number and intensity of physical contacts drive the transmission dynamics and COVID-19 burden, also their repetitiveness is influential. Contact tracing seems essential for a controlled and persistent release of lockdown measures, but requires timely compliance to testing, reporting and self-isolation. Rapid tracing and testing, and communication ensuring continued involvement of the population are therefore essential.", "The spread of the COVID\u201019 coronavirus: Health agencies worldwide prepare for the seemingly inevitability of the COVID\u201019 coronavirus becoming endemic While it is too late to confine the COVID\u201019 coronovirus outbreak to China, a wealth of data spurs epidemiological and vaccine research. [Image: see text]", "Substantial underestimation of SARS-CoV-2 infection in the United States due to incomplete testing and imperfect test accuracy Accurate estimates of the burden of SARS-CoV-2 infection are critical to informing pandemic response. Current confirmed COVID-19 case counts in the U.S. do not capture the total burden of the pandemic because testing has been primarily restricted to individuals with moderate to severe symptoms due to limited test availability. Using a semi-Bayesian probabilistic bias analysis to account for incomplete testing and imperfect diagnostic accuracy, we estimated 6,275,072 cumulative infections compared to 721,245 confirmed cases (1.9% vs. 0.2% of the population) as of April 18, 2020. Accounting for uncertainty, the number of infections was 3 to 20 times higher than the number of confirmed cases. 86% (simulation interval: 64-99%) of this difference was due to incomplete testing, while 14% (0.3-36%) was due to imperfect test accuracy. Estimates of SARS-CoV-2 infections that transparently account for testing practices and diagnostic accuracy reveal that the pandemic is larger than confirmed case counts suggest.", "Mobility traces and spreading of COVID-19 We use human mobility models, for which we are experts, and attach a virus infection dynamics to it, for which we are not experts but have taken it from the literature, including recent publications. This results in a virus spreading dynamics model. The results should be verified, but because of the current time pressure, we publish them in their current state. Recommendations for improvement are welcome. We come to the following conclusions: 1. Complete lockdown works. About 10 days after lockdown, the infection dynamics dies down. This assumes that lockdown is complete, which can be guaranteed in the simulation, but not in reality. Still, it gives strong support to the argument that it is never too late for complete lockdown. 2. As a rule of thumb, we would suggest complete lockdown no later than once 10% of hospital capacities available for COVID-19 are in use, and possibly much earlier. This is based on the following insights: a. Even after lockdown, the infection dynamics continues at home, leading to another tripling of the cases before the dynamics is slowed. b. There will be many critical cases coming from people who were infected before lockdown. Because of the exponential growth dynamics, their number will be large. c. Researchers with more detailed disease progression models should improve upon these statements. 3. Our simulations say that complete removal of infections at child care, primary schools, workplaces and during leisure activities will not be enough to sufficiently slow down the infection dynamics. It would have been better, but still not sufficient, if initiated earlier. 4. Infections in public transport play an important role. In the simulations shown later, removing infections in the public transport system reduces the infection speed and the height of the peak by approximately 20%. Evidently, this depends on the infection parameters, which are not well known. -- This does not point to reducing public transport capacities as a reaction to the reduced demand, but rather use it for lower densities of passengers and thus reduced infection rates. 5. In our simulations, removal of infections at child care, primary schools, workplaces, leisure activities, and in public transport may barely have been sufficient to control the infection dynamics if implemented early on. Now according to our simulations it is too late for this, and (even) harsher measures will have to be initiated until possibly a return to such a restrictive, but still somewhat functional regime will again be possible. Evidently, all of these results have to be taken with care. They are based on preliminary infection parameters taken from the literature, used inside a model that has more transport/movement details than all others that we are aware of but still not enough to describe all aspects of reality, and suffer from having to write computer code under time pressure. Optimally, they should be confirmed independently. Short of that, given current knowledge we believe that they provide justification for \"complete lockdown\" at the latest when about 10% of available hospital capacities for COVID-19 are in use (and possibly earlier; we are no experts of hospital capabilities). What was not investigated in detail in our simulations was contact tracing, i.e. tracking down the infection chains and moving all people along infection chains into quarantine. The case of Singapore has so far shown that this may be successful. Preliminary simulation of that tactic shows that it is difficult to implement for COVID-19, since the incubation time is rather long, people are contagious before they feel sick, or maybe never feel sufficiently sick at all. We will investigate in future work if and how contact tracing can be used together with a restrictive, but not totally locked down regime. When opening up after lockdown, it would be important to know the true fraction of people who are already immune, since that would slow down the infection dynamics by itself. For Wuhan, the currently available numbers report that only about 0.1% of the population was infected, which would be very far away from \"herd immunity\". However, there have been and still may be many unknown infections.", "Explaining the Bomb-Like Dynamics of COVID-19 with Modeling and the Implications for Policy Using a Bayesian approach to epidemiological compartmental modeling, we demonstrate the bomb-like behavior of exponential growth in COVID-19 cases can be explained by transmission of asymptomatic and mild cases that are typically unreported at the beginning of pandemic events due to lower prevalence of testing. We studied the exponential phase of the pandemic in Italy, Spain, and South Korea, and found the R0 to be 2.56 (95% CrI, 2.41-2.71), 3.23 (95% CrI, 3.06-3.4), and 2.36 (95% CrI, 2.22-2.5) if we use Bayesian priors that assume a large portion of cases are not detected. Weaker priors regarding the detection rate resulted in R0 values of 9.22 (95% CrI, 9.01-9.43), 9.14 (95% CrI, 8.99-9.29), and 8.06 (95% CrI, 7.82-8.3) and assumes nearly 90% of infected patients are identified. Given the mounting evidence that potentially large fractions of the population are asymptomatic, the weaker priors that generate the high R0 values to fit the data required assumptions about the epidemiology of COVID-19 that do not fit with the biology, particularly regarding the timeframe that people remain infectious. Our results suggest that models of transmission assuming a relatively lower R0 value that do not consider a large number of asymptomatic cases can result in misunderstanding of the underlying dynamics, leading to poor policy decisions and outcomes.", "Accelerated infection testing at scale: a proposal for inference with single test on multiple patients In pandemics or epidemics, public health authorities need to rapidly test a large number of individuals, both to determine the line of treatment as well as to know the spread of infection to plan containment, mitigation and future responses. However, the lack of adequate testing kits could be a bottleneck, especially in the case of unanticipated new diseases, such as COVID-19, where the testing technology, manufacturing capability, distribution, human skills and laboratories might be unavailable or in short supply. In addition, the cost of the standard PCR test is approximately USD 48, which is prohibitive for poorer patients and most governments. We address this bottleneck by proposing a test methodology that pools the sample from two (or more) patients in a single test. The key insight is that a single negative result from a pooled sample likely implies negative infection of all the individual patients. and It thereby rules out further tests for the patients. This protocol, therefore, requires significantly fewer tests. This may, however, result in somewhat increased false negatives. Our simulations show that combining samples from two patients with 7% underlying likelihood of infection implies that 36% fewer test kits are required, with 14% additional units of time for testing.", "COVID-19 Fatality and Comorbidity Risk Factors among Confirmed Patients in Mexico As of April 18, 2020, 2.16 million patients in the world had been tested positive with Coronavirus (COVID-19) and 146,088 had died, which accounts for a case fatality rate of 6.76%. In Mexico, according to official statistics (April 18), 7,497 cases have been confirmed with 650 deaths, for a case fatality rate of 8.67%. These estimates, however, may not reflect the final fatality risk among COVID-19 confirmed patients, because they are based on cross-sectional counts of diagnosed and deceased patients, and therefore are not adjusted by time of exposure and right-censorship. In this paper we estimate fatality risks based on survival analysis methods, calculated from individual-level data on symptomatic patients confirmed with COVID-19 recently released by the Mexican Ministry of Health. The estimated fatality risk after 35 days of onset of symptoms is 12.38% (95% CI: 11.37-13.47). Fatality risks sharply rise with age, and significantly increase for males (59%) and individuals with comorbidities (38%-168%, depending on the disease). Two reasons may explain the high COVID-19 related fatality risk observed in Mexico, despite its younger age structure: the high selectivity and self-selectivity in testing and the high prevalence of chronic-degenerative diseases.", "Simulating the infected population and spread trend of 2019-nCov under different policy by EIR model Chinese government has taken strong measures in response to the epidemic of new coronavirus (2019-nCoV) from Jan.23, 2020. The number of confirmed infected individuals are still increasing rapidly. Estimating the accurate infected population and the future trend of epidemic spreading under control measures is significant and urgent. There have been reports external icon of spread from an infected patient with no symptoms to a close contact, which means the incubation individuals may has the possibility of infectiousness. However, the traditional transmission model, Susceptible-Exposed-Infectious-Recovered (SEIR) model, assumes that the exposed individual is being infected but without infectiousness. Thus, the estimating infected populations based on SEIR model from the existing literatures seems too far more than the official reported data. Here, we inferred that the epidemic could be spread by exposed (incubation) individuals. Then, we provide a new Exposed-identified-Recovered (EIR) model, and simulated the epidemic spreading processes from free propagation phase to extremely control phase. Then, we estimate of the size of the epidemic and forecast the future development of the epidemics under strong prevention interventions. According to the spread characters of 2019-nCov, we construct a novel EIR compartment system dynamics model. This model integrates two phases of the epidemic spreading: before intervention and after intervention. We assume that 2019-nCov is firstly spread without intervention then the government started to take strong quarantine measures. Use the latest reported official data, we estimate the basic parameters of the model and the basic reproduction number of 2019-nCov. Then, based on this model, we simulate the future spread of the epidemics. Both the infected population and the spreading trend of 2019-nCov under different prevention policy scenarios are estimated. The epidemic spreading trends under different quarantine rate and action starting date of prevention policy are simulated and compared.", "Is tracking and modeling Covid-19 infection dynamics for Bangladesh using daily data feasible? Given the low Covid-19 testing coverage in the country, this study tested whether the daily change in the number of new Covid-19 cases is due to increase (or decrease) in the number of tests done daily. We performed Granger causality test based on vector autoregressive models on Bangladesh case and test numbers between 8 March and 5 June 2020, using publicly available data. The test results show that the daily number of tests Granger-cause the number of new cases (p <0.001), meaning the daily number of new cases is perhaps due to an increase in test capacity rather than a change in the infection rates. From the results of this test we can infer that if the number of daily tests does not increase substantially, data on new infections will not give much information for understanding covid-19 infection dynamics in Bangladesh.", "Asymptomatic cases with SARS\u2010CoV\u20102 infection On 31 March 2020, Chinese Health Authorization announced that numbers of asymptomatic cases with severe acute respiratory syndrome coronavirus 2 (SARS\u2010CoV\u20102) infection will be made to the public daily. This was a very important step since different counties have different capacities for the detection of SARS\u2010CoV\u20102 infection and control strategy for the Coronavirus Disease 2019 outbreak. We summarized the characteristics of asymptomatic SARS\u2010CoV\u20102 infections and the transmission potential of asymptomatic cases. Then we provided guidelines for the management of asymptomatic cases through quarantine and nucleic acid/serology tests.", "Evolving status of the 2019 novel coronavirus infection: Proposal of conventional serologic assays for disease diagnosis and infection monitoring The novel coronavirus (nCoV-2019) outbreak in Wuhan, China has spread rapidly nationwide, with some cases occurring in other parts of the world. Although most patients present with mild febrile illness with patchy pulmonary inflammation, a significant portion develop severe acute respiratory distress syndrome (ARDS), with a current case fatality of 2.3-3%. Diagnosis is based on clinical history and laboratory and chest radiographic findings, but confirmation currently relies on nucleic acid-based assays. The latter are playing an important role in facilitating patient isolation, treatment and assessment of infectious activities. However, due to their limited capacity to handle an epidemic of the current scale and insufficient supply of assay kits, only a portion of suspected cases can be tested, leading to incompleteness and inaccuracy in updating new cases, as well as delayed diagnosis. Furthermore, there has not been enough time to assess specificity and sensitivity. Conventional serological assays, such as enzyme-linked immunoassay (ELISA) for specific IgM and IgG antibodies, should offer a high-throughput alternative, which allows for uniform tests for all suspected patients, and can facilitate more complete identification of infected cases and avoidance of unnecessary cross infection among unselected patients. This article is protected by copyright. All rights reserved.", "Associations between psychiatric disorders, COVID-19 testing probability and COVID-19 testing results: Findings from a population-based study Background The novel COVID-19 pandemic has affected over 2.4 million people worldwide. Little is known about COVID-19 testing rates and COVID-19 test outcomes in people with mental illness. We hypothesized that people with psychiatric disorders are less likely to undergo COVID-19 testing and more likely to test positive. Methods We used data on COVID-19 testing in the UK Biobank (UKB) cohort to compare the prevalence of COVID-19 testing and test outcomes among individuals with psychiatric disorders to those without such diagnoses. We further investigated associations of testing probability and outcome with psychiatric diagnostic categories. Outcomes Individuals with psychiatric disorders were overrepresented among the 1 474 UKB participants with test data: 23% of the COVID-19 test sample had a psychiatric diagnosis compared to 10% in the full cohort (p<0.0001). This overrepresentation persisted for each of the specific psychiatric disorders tested. Furthermore, individuals with a psychiatric disorder (p=0.01), particularly with substance use disorder (p<0.005), had negative test results significantly more often than individuals without psychiatric disorders. Sensitivity analyses confirmed our results. Interpretation In contrast with our hypotheses, UKB participants with psychiatric disorders have been tested for COVID-19 more frequently than individuals without a psychiatric history, pleading against the notion that limited health care access is preventing them from undergoing testing. Among those tested, test outcomes were more frequently negative for UKB participants with psychiatric disorders than in others, countering arguments that people with mental illness are more prone to contract the virus. Funding No external funding sources participated in any stage of the present study.", "Measures of frequency: calculating prevalence and incidence in the era of COVID-19. ", "A demographic scaling model for estimating the total number of COVID-19 infections Background: The total number of COVID-19 infections is critical information for decision makers when assessing the progress of the pandemic, its implications, and policy options. Despite efforts to carefully monitor the COVID-19 pandemic, the reported number of confirmed cases is likely to underestimate the actual number of infections. We aim to estimate the total number of COVID-19 infections in a straightforward manner using a demographic scaling approach based on life tables. Methods: We use data on total number of COVID-19 attributable deaths, population counts, and life tables as well as information on infection fatality rates as reported in Verity et al. (2020) for Hubei, China. We develop a scaling approach based on life tables and remaining life expectancy to map infection fatality rates between two countries to account for differences in their age structure, health status, and the health care system. The scaled infection fatality rates can be used in combination with COVID-19 attributable deaths to calculate estimates of the total number of infected. We also introduce easy to apply formulas to quantify the bias that would be required in death counts and infection fatality rates in order to reproduce a certain estimate of infections. Findings: Across the 10 countries with most COVID-19 deaths as of April 17, 2020, our estimates suggest that the total number of infected is approximately 4 times the number of confirmed cases. The uncertainty, however, is high, as the lower bound of the 95% prediction interval suggests on average twice as many infections than confirmed cases, and the upper bound 10 times as many. Country-specific variation is high. For Italy, our estimates suggest that the total number of infected is approximately 1 million, or almost 6 times the number of confirmed cases. For the U.S., our estimate of 1.4 million is close to being twice as large as the number of confirmed cases, and the upper bound of 3 million is more than 4 times the number of confirmed cases. For Germany, where testing has been comparatively extensive, we estimate that the total number of infected is only 1.2 times (upper bound: 3 times) than the number of confirmed cases. Comparing our results with findings from local seroprevalence studies and applying our bias formulas shows that some of their infection estimates would only be possible if just a small fraction of COVID-19 related deaths were recorded, indicating that these seroprevalence estimates might not be representative for the total population. Interpretation: As many countries lack population based seroprevalence studies, straightforward demographic adjustment can be used to deliver useful estimates of the total number of infected cases. Our results imply that the total number COVID-19 cases may be approximately 4 times (95%: 2 to 10 times) that of the confirmed cases. Although these estimates are uncertain and vary across countries, they indicate that the COVID-19 pandemic is much more broadly spread than what confirmed cases would suggest, and the number of asymptomatic cases or cases with mild symptoms may be high. In cases in which estimates from local seroprevalence studies or from simulation models exist, our approach can provide a simple benchmark to assess the quality of those estimates.", "Is reporting many cases of COVID-19 in Iran due to strength or weakness of iran\u2019s health system? ", "From China: hope and lessons for COVID-19 control ", "Assessing the interactions between COVID-19 and influenza in the United States The 2019\u20132020 influenza sentinel surveillance data exhibits unexpected trends. Typical influenza seasons have a small herald wave, followed by a decrease due to school closure during holidays, and then a main post-holiday peak that is significantly larger than the pre-holiday wave. During the 2019\u20132020 influenza season, influenza-like illness data in the United States appears to have a markedly lower main epidemic peak compared to what would be expected based on the pre-holiday peak. We hypothesize that the 2019\u20132020 influenza season does have a lower than expected burden and that this deflation is due to a behavioral or ecological interaction with COVID-19. We apply an intervention analysis to assess if this influenza season deviates from expectations, then we compare multiple hypothesized drivers of the decrease in influenza in a spatiotemporal regression model. Lastly, we develop a mechanistic metapopulation model, incorporating transmission reduction that scales with COVID-19 risk perception. We find that the 2019\u20132020 ILI season is smaller and decreases earlier than expected based on prior influenza seasons, and that the increase in COVID-19 risk perception is associated with this decrease. Additionally, we find that a 5% average reduction in transmission is sufficient to reproduce the observed flu dynamics. We propose that precautionary behaviors driven by COVID-19 risk perception or increased isolation driven by undetected COVID-19 spread dampened the influenza season. We suggest that when surveillance for a novel pathogen is limited, surveillance streams of co-circulating infections may provide a signal.", "Estimation of Excess Deaths Associated With the COVID-19 Pandemic in the United States, March to May 2020 Importance: Efforts to track the severity and public health impact of coronavirus disease 2019 (COVID-19) in the United States have been hampered by state-level differences in diagnostic test availability, differing strategies for prioritization of individuals for testing, and delays between testing and reporting. Evaluating unexplained increases in deaths due to all causes or attributed to nonspecific outcomes, such as pneumonia and influenza, can provide a more complete picture of the burden of COVID-19. Objective: To estimate the burden of all deaths related to COVID-19 in the United States from March to May 2020. Design, Setting, and Population: This observational study evaluated the numbers of US deaths from any cause and deaths from pneumonia, influenza, and/or COVID-19 from March 1 through May 30, 2020, using public data of the entire US population from the National Center for Health Statistics (NCHS). These numbers were compared with those from the same period of previous years. All data analyzed were accessed on June 12, 2020. Main Outcomes and Measures: Increases in weekly deaths due to any cause or deaths due to pneumonia/influenza/COVID-19 above a baseline, which was adjusted for time of year, influenza activity, and reporting delays. These estimates were compared with reported deaths attributed to COVID-19 and with testing data. Results: There were approximately 781\u00e2\u0080\u00af000 total deaths in the United States from March 1 to May 30, 2020, representing 122\u00e2\u0080\u00af300 (95% prediction interval, 116\u00e2\u0080\u00af800-127\u00e2\u0080\u00af000) more deaths than would typically be expected at that time of year. There were 95\u00e2\u0080\u00af235 reported deaths officially attributed to COVID-19 from March 1 to May 30, 2020. The number of excess all-cause deaths was 28% higher than the official tally of COVID-19-reported deaths during that period. In several states, these deaths occurred before increases in the availability of COVID-19 diagnostic tests and were not counted in official COVID-19 death records. There was substantial variability between states in the difference between official COVID-19 deaths and the estimated burden of excess deaths. Conclusions and Relevance: Excess deaths provide an estimate of the full COVID-19 burden and indicate that official tallies likely undercount deaths due to the virus. The mortality burden and the completeness of the tallies vary markedly between states.", "Incidence, clinical outcomes, and transmission dynamics of hospitalized 2019 coronavirus disease among 9,596,321 individuals residing in California and Washington, United States: a prospective cohort study Background: The United States is now the country reporting the highest number of 2019 coronavirus disease (COVID-19) cases and deaths. However, little is known about the epidemiology and burden of severe COVID-19 to inform planning within healthcare systems and modeling of intervention impact. Methods: We assessed incidence, duration of hospitalization, and clinical outcomes of acute COVID-19 inpatient admissions in a prospectively-followed cohort of 9,596,321 individuals enrolled in comprehensive, integrated healthcare delivery plans from Kaiser Permanente in California and Washington state. We also estimated the effective reproductive number (RE) describing transmission in the study populations. Results: Data covered 1277 hospitalized patients with laboratory- or clinically-confirmed COVID-19 diagnosis by April 9, 2020. Cumulative incidence of first COVID-19 acute inpatient admission was 10.6-12.4 per 100,000 cohort members across the study regions. Mean censoring-adjusted duration of hospitalization was 10.7 days (2.5-97.5%iles: 0.8-30.1) among survivors and 13.7 days (2.5-97.5%iles: 1.7-34.6) among non-survivors. Among all hospitalized confirmed cases, censoring-adjusted probabilities of ICU admission and mortality were 41.9% (95% confidence interval: 34.1-51.4%) and 17.8% (14.3-22.2%), respectively, and higher among men than women. We estimated RE was 1.43 (1.17-1.73), 2.09 (1.63-2.69), and 1.47 (0.07-2.59) in Northern California, Southern California, and Washington, respectively, for infections acquired March 1, 2020. RE declined to 0.98 (0.76-1.27), 0.89 (0.74-1.06), and 0.92 (0.05-1.55) respectively, for infections acquired March 20, 2020. Conclusions: We identify high probability of ICU admission, long durations of stay, and considerable mortality risk among hospitalized COVID-19 cases in the western United States. Reductions in RE have occurred in conjunction with implementation of non-pharmaceutical interventions.", "Early epidemiological analysis of the coronavirus disease 2019 outbreak based on crowdsourced data: a population-level observational study Summary Background As the outbreak of coronavirus disease 2019 (COVID-19) progresses, epidemiological data are needed to guide situational awareness and intervention strategies. Here we describe efforts to compile and disseminate epidemiological information on COVID-19 from news media and social networks. Methods In this population-level observational study, we searched DXY.cn, a health-care-oriented social network that is currently streaming news reports on COVID-19 from local and national Chinese health agencies. We compiled a list of individual patients with COVID-19 and daily province-level case counts between Jan 13 and Jan 31, 2020, in China. We also compiled a list of internationally exported cases of COVID-19 from global news media sources (Kyodo News, The Straits Times, and CNN), national governments, and health authorities. We assessed trends in the epidemiology of COVID-19 and studied the outbreak progression across China, assessing delays between symptom onset, seeking care at a hospital or clinic, and reporting, before and after Jan 18, 2020, as awareness of the outbreak increased. All data were made publicly available in real time. Findings We collected data for 507 patients with COVID-19 reported between Jan 13 and Jan 31, 2020, including 364 from mainland China and 143 from outside of China. 281 (55%) patients were male and the median age was 46 years (IQR 35\u201360). Few patients (13 [3%]) were younger than 15 years and the age profile of Chinese patients adjusted for baseline demographics confirmed a deficit of infections among children. Across the analysed period, delays between symptom onset and seeking care at a hospital or clinic were longer in Hubei province than in other provinces in mainland China and internationally. In mainland China, these delays decreased from 5 days before Jan 18, 2020, to 2 days thereafter until Jan 31, 2020 (p=0\u00b70009). Although our sample captures only 507 (5\u00b72%) of 9826 patients with COVID-19 reported by official sources during the analysed period, our data align with an official report published by Chinese authorities on Jan 28, 2020. Interpretation News reports and social media can help reconstruct the progression of an outbreak and provide detailed patient-level data in the context of a health emergency. The availability of a central physician-oriented social network facilitated the compilation of publicly available COVID-19 data in China. As the outbreak progresses, social media and news reports will probably capture a diminishing fraction of COVID-19 cases globally due to reporting fatigue and overwhelmed health-care systems. In the early stages of an outbreak, availability of public datasets is important to encourage analytical efforts by independent teams and provide robust evidence to guide interventions. Funding Fogarty International Center, US National Institutes of Health.", "Geographic Differences in COVID-19 Cases, Deaths, and Incidence - United States, February 12-April 7, 2020. Community transmission of coronavirus disease 2019 (COVID-19) was first detected in the United States in February 2020. By mid-March, all 50 states, the District of Columbia (DC), New York City (NYC), and four U.S. territories had reported cases of COVID-19. This report describes the geographic distribution of laboratory-confirmed COVID-19 cases and related deaths reported by each U.S. state, each territory and freely associated state,* DC, and NYC during February 12-April 7, 2020, and estimates cumulative incidence for each jurisdiction. In addition, it projects the jurisdiction-level trajectory of this pandemic by estimating case doubling times on April 7 and changes in cumulative incidence during the most recent 7-day period (March 31-April 7). As of April 7, 2020, a total of 395,926 cases of COVID-19, including 12,757 related deaths, were reported in the United States. Cumulative COVID-19 incidence varied substantially by jurisdiction, ranging from 20.6 cases per 100,000 in Minnesota to 915.3 in NYC. On April 7, national case doubling time was approximately 6.5 days, although this ranged from 5.5 to 8.0 days in the 10 jurisdictions reporting the most cases. Absolute change in cumulative incidence during March 31-April 7 also varied widely, ranging from an increase of 8.3 cases per 100,000 in Minnesota to 418.0 in NYC. Geographic differences in numbers of COVID-19 cases and deaths, cumulative incidence, and changes in incidence likely reflect a combination of jurisdiction-specific epidemiologic and population-level factors, including 1) the timing of COVID-19 introductions; 2) population density; 3) age distribution and prevalence of underlying medical conditions among COVID-19 patients (1-3); 4) the timing and extent of community mitigation measures; 5) diagnostic testing capacity; and 6) public health reporting practices. Monitoring jurisdiction-level numbers of COVID-19 cases, deaths, and changes in incidence is critical for understanding community risk and making decisions about community mitigation, including social distancing, and strategic health care resource allocation.", "Development of a dual-gene loop-mediated isothermal amplification (LAMP) detection assay for SARS-CoV-2: A preliminary study Severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) has emerged as a rapidly spreading global pathogen stressing the need for development of rapid testing protocols ever than before. The aim of present study was to develop a SARS-CoV-2 detection protocol which can be performed within minimal resources and timeframe. For this purpose, we implemented the reverse transcription loop-mediated isothermal amplification (RT-LAMP) methodology for the qualitative detection of SARS-CoV-2 RNA. In order to improve the detection capability, the RT-LAMP assay was developed to simultaneously amplify two viral genes: ORF1a and N. A total of 45 SARS-CoV-2 associated coronavirus disease 2019 (COVID-19) cases were enrolled. Viral RNA was extracted from the nasopharyngeal swab samples and analyzed simultaneously using PCR and RT-LAMP protocols. Overall, our SARS-CoV-2 dual gene RT-LAMP assay was found to be 95% accurate in detecting positive cases and showed no cross-reactivity or false-positive result in non-COVID-19 samples. Further evaluation on larger and multi-centric cohorts is currently underway to establish the diagnostic accuracy and subsequent implementation into clinical practice and at point-of-care settings.", "Fear, Access, and the Real-Time Estimation of Etiological Parameters for Outbreaks of Novel Pathogens Early analysis of outbreaks of novel pathogens to evaluate their likely public health impact depends on fitting predictive models to data gathered and updated in real-time. Both transmission rates and the critical threshold (i.e. the pathogen's 'reproductive number') are inferred by finding the values that provide the best model fit to reported case incidence. These models and inferred results are then the basic tools used for public health planning: how many people expected to be infected, at what scales of time and space, and whether potential intervention strategies impact disease transmission and spread. An underlying assumption, however, is that the ability to observe new cases is either constant, or at least constant relative to diagnostic test availability. We present a demonstration, discussion, and mathematical analysis of how this assumption of predictable observability in disease incidence can drastically impact model accuracy. We also demonstrate how to tailor estimations of these parameters to a few examples of different types of shifting influences acting on detection, depending on the likely sensitivity of surveillance systems to errors from sources such as clinical testing rates and differences in healthcare-seeking behavior from the public over time. Finally, we discuss the implications of these corrections for both historical and current outbreaks.", "SARS\u2010CoV\u20102 Testing and Outcomes in the First 30 Days after the First Case of COVID\u201019 at an Australian Children\u2019s Hospital OBJECTIVE: International studies describing COVID\u201019 in children have shown low proportions of paediatric cases and generally a mild clinical course. We aimed to present early data on children tested for SARS\u2010CoV\u20102 at a large Australian tertiary children\u2019s hospital according to the state health department guidelines, which varied over time. METHODS: We conducted a retrospective cohort study at The Royal Children\u2019s Hospital, Melbourne, Australia. It included all paediatric patients (aged 0\u201318 years) who presented to the Emergency Department (ED) or the Respiratory Infection Clinic (RIC) and were tested for SARS\u2010CoV\u20102. The 30\u2010day study period commenced after the first confirmed positive case was detected at the hospital on 21(st) March 2020, until 19(th) April 2020. We recorded epidemiological and clinical data. RESULTS: There were 433 patients in whom SARS\u2010CoV\u20102 testing was performed in ED (331 (76%)) or RIC (102 (24%)). There were 4 (0.9%) who had positive SARS\u2010CoV\u20102 detected, none of whom were admitted to hospital or developed severe disease. Of these SARS\u2010CoV\u20102 positive patients, 1/4 (25%) had a comorbidity, which was asthma. Of the SARS\u2010CoV\u20102 negative patients, 196/429 (46%) had comorbidities. Risk factors for COVID\u201019 were identified in 4/4 SARS\u2010CoV\u20102 positive patients and 47/429 (11%) SARS\u2010CoV\u20102 negative patients. CONCLUSIONS: Our study identified a very low rate of SARS\u2010CoV\u20102 positive cases in children presenting to a tertiary ED or RIC, none of whom were admitted to hospital. A high proportion of patients who were SARS\u2010CoV\u20102 negative had comorbidities.", "Dynamic Estimation of Epidemiological Parameters of COVID-19 Outbreak and Effects of Interventions on Its Spread A key challenge for estimating the epidemiological parameters of the COVID-19 outbreak in Wuhan is the discrepancy between the officially reported number of infections and the true number of infections. A common approach to tackling the challenge is to use the number of infections exported from Wuhan to infer the true number in the city. This approach can only provide a static estimate of the epidemiological parameters before Wuhan lockdown on January 23, 2020, because there are almost no exported cases thereafter. Here, we propose a method to dynamically estimate the epidemiological parameters of the COVID-19 outbreak in Wuhan by recovering true numbers of infections from day-to-day official numbers. Using the method, we provide a comprehensive retrospection on how the disease had progressed in Wuhan from January 19 to March 5, 2020. Particularly, we estimate that the outbreak sizes by January 23 and March 5 were 11,239 [95% CI 4,794--22,372] and 124,506 [95% CI 69,526--265,113], respectively. The effective reproduction number attained its maximum on January 24 (3.42 [95% CI 3.34--3.50]) and became less than 1 from February 7 (0.76 [95% CI 0.65--0.92]). We also estimate the effects of two major government interventions on the spread of COVID-19 in Wuhan. In particular, transportation suspension and large scale hospitalization respectively prevented 33,719 and 90,072 people from getting infected in the nine-day time period right after its implementation.", "Epidemic Surveillance of Covid-19: Considering Uncertainty and Under-Ascertainment Epidemic surveillance is a fundamental part of public health practice. Addressing under-ascertainment of cases is relevant in most surveillance systems, especially in pandemics of new diseases with a large spectrum of clinical presentations as it may influence timings of policy implementation and public risk perception. From this perspective, this article presents and discusses early evidence on under-ascertainment of COVID-19 and its motifs, options for surveillance, and reflections around their importance to tailor public health measures. In the case of COVID-19, systematically addressing and estimating under-ascertainment of cases is essential to tailor timely public health measures, and communicating these findings is of the utmost importance for policy making and public perception.", "Covid-19 pandemic by the \"real-time\" monitoring: the Tunisian case and lessons for global epidemics in the context of 3PM strategies Covid-19 is neither the first nor the last viral epidemic which societies around the world are, were and will be affected by. Which lessons should be taken from the current pandemic situation? The Covid-19 disease is still not well characterised, and many research teams all over the world are working on prediction of the epidemic scenario, protective measures to populations and sub-populations, therapeutic and vaccination issues, amongst others. Contextually, countries with currently low numbers of Covid-19-infected individuals such as Tunisia are intended to take lessons from those countries which already reached the exponential phase of the infection distribution as well as from those which have the exponential phase behind them and record a minor number of new cases such as China. To this end, in Tunisia, the pandemic wave has started with a significant delay compared with Europe, the main economic partner of the country. In this paper, we do analyse the current pandemic situation in this country by studying the infection evolution and considering potential protective strategies to prevent a pandemic scenario. The model is predictive based on a large number of undetected Covid-19 cases that is particularly true for some country regions such as Sfax. Infection distribution and mortality rate analysis demonstrate a highly heterogeneous picture over the country. Qualitative and quantitative comparative analysis leads to a conclusion that the reliable \"real-time\" monitoring based on the randomised laboratory tests is the optimal predictive strategy to create the most effective evidence-based preventive measures. In contrast, lack of tests may lead to incorrect political decisions causing either unnecessary over-protection of the population that is risky for a long-term economic recession, or under-protection of the population leading to a post-containment pandemic rebound. Recommendations are provided in the context of advanced predictive, preventive and personalised (3P) medical approach.", "Use of excess mortality associated with the COVID-19 epidemic as an epidemiological surveillance strategy - preliminary results of the evaluation of six Brazilian capitals In early 2020, the World Health Organization (WHO) recognized the pandemic situation of the new coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2), which causes Coronavirus Disease-2019 (COVID-19). In Brazil by the end of April 2020, another 110 thousand cases and 5,000 deaths had been confirmed. The scarcity of laboratory resources and overload of the care network, added to the broad clinical spectrum of the disease, can make it difficult to capture all mortality from this disease through epidemiological surveillance based on individual notification of cases. The aim of this study was to evaluate the excess of deaths in Brazilian capitals with the highest incidence of COVID-19, as a way of validating the method, we also evaluated a capital with low incidence. We assessed weekly mortality from all causes during the year 2020, up to the epidemiological week 17, compared with the previous year. The data were obtained through the National Civil Registry Information Center (CNIRC, acronym in Portuguese). We estimate the expected mortality and the 95% confidence interval by projecting the observed mortality in 2019 for the population of 2020. In the five capitals with the highest incidences it was possible to identify excess deaths in the pandemic period, the age group most affected were those over 60 years old, 31% of the excess deaths occurred in the population between 20 and 59 years old. There was a strong correlation (r = 0.94) between the excess of deaths in each city and the number of deaths confirmed by epidemiological surveillance. There was no excess of deaths in the capital with the lowest incidence, nor among the population under 20 years old. We estimate that epidemiological surveillance managed to capture only 52% of all mortality associated with the COVID-19 pandemic in the cities studied. Considering the simplicity of the method, its low cost and reliability for assessing the real burden of the disease, we believe that the assessment of excess mortality associated with the COVID-19 pandemic should be widely used as a complementary tool to regular epidemiological surveillance and its use should be encouraged by WHO.", "Estimating the incidence reporting rates of new influenza pandemics at an early stage using travel data from the source country During the surveillance of influenza pandemics, underreported data are a public health challenge that complicates the understanding of pandemic threats and can undermine mitigation efforts. We propose a method to estimate incidence reporting rates at early stages of new influenza pandemics using 2009 pandemic H1N1 as an example. Routine surveillance data and statistics of travellers arriving from Mexico were used. Our method incorporates changes in reporting rates such as linearly increasing trends due to the enhanced surveillance. From our results, the reporting rate was estimated at 0\u00b746% during early stages of the pandemic in Mexico. We estimated cumulative incidence in the Mexican population to be 0\u00b77% compared to 0\u00b7003% reported by officials in Mexico at the end of April. This method could be useful in estimation of actual cases during new influenza pandemics for policy makers to better determine appropriate control measures.", "Power-law distribution in the number of confirmed COVID-19 cases COVID-19 is an emerging respiratory infectious disease caused by the coronavirus SARS-CoV-2. It was first reported on in early December 2019 in Wuhan, China and within three month spread as a pandemic around the whole globe. Here, we study macro-epidemiological patterns along the time course of the pandemic. We compute the distribution of confirmed COVID-19 cases and deaths for countries worldwide and for counties in the US, and show that both distributions follow a truncated power-law over five orders of magnitude. We are able to explain the origin of this scaling behavior as a dual-scale process: the large-scale spread of the virus between countries and the small-scale accumulation of case numbers within each country. Assuming exponential growth on both scales, the critical exponent of the power-law is determined by the ratio of large-scale to small-scale growth rates. We confirm this theory in numerical simulations in a simple meta-population model, describing the epidemic spread in a network of interconnected countries. Our theory gives a mechanistic explanation why most COVID-19 cases occurred within a few epicenters, at least in the initial phase of the outbreak. Assessing how well a simple dual-scale model predicts the early spread of epidemics, despite the huge contrasts between countries, could help identify critical temporal and spatial scales of response in which to mitigate future epidemic threats.", "Modeling COVID-19: Forecasting and analyzing the dynamics of the outbreak in Hubei and Turkey As the pandemic of Coronavirus Disease 2019 (COVID-19) rages throughout the world, accurate modeling of the dynamics thereof is essential. However, since the availability and quality of data varies dramatically from region to region, accurate modeling directly from a global perspective is difficult, if not altogether impossible. Nevertheless, via local data collected by certain regions, it is possible to develop accurate local prediction tools, which may be coupled to develop global models. In this study, we analyze the dynamics of local outbreaks of COVID-19 via a coupled system of ordinary differential equations (ODEs). Utilizing the large amount of data available from the ebbing outbreak in Hubei, China as a testbed, we estimate the basic reproductive number, R0 of COVID-19 and predict the total cases, total deaths, and other features of the Hubei outbreak with a high level of accuracy. Through numerical experiments, we observe the effects of quarantine, social distancing, and COVID-19 testing on the dynamics of the outbreak. Using knowledge gleaned from the Hubei outbreak, we apply our model to analyze the dynamics of outbreak in Turkey. We provide forecasts for the peak of the outbreak and the total number of cases/deaths in Turkey, for varying levels of social distancing, quarantine, and COVID-19 testing.", "COVID-19, Australia: Epidemiology Report 17 (Fortnightly reporting period ending 24 May 2020) Confirmed cases in Australia notified up to 24 May 2020: notifications = 7,135; deaths = 102. The incidence of COVID-19 has markedly reduced since a peak in mid-March. There have been no cases reported in SA, the NT or the ACT in the last four weeks. The numbers of new cases reported from other jurisdictions continue to be very low. Testing rates have been higher across all jurisdictions, with Victoria reporting an 85% testing rate increase and NSW a 40% increase over this period. The positivity rate nationally continues to remain very low at less than 0.1% over the reporting period. Continued high rates of testing are necessary to detect and mitigate the spread of COVID-19 in the community. Over the past fortnight, 45% of cases acquired their infection overseas. Of cases considered to be locally acquired over this period, most were associated with contacts of confirmed cases or were associated with known outbreaks. The highest rate of COVID-19 continues to be among people aged 65-79 years. Three-quarters of all cases in this age group have been associated with overseas travel, including several outbreaks linked to cruise ships. The lowest rate of disease is in children under 18, a pattern reflected in international reports. A small proportion of cases overall have experienced severe disease, requiring hospitalisation or intensive care with some fatalities. The crude case fatality rate amongst Australian cases is 1.4%. People who are older and have one or more comorbidities are more likely to experience severe disease. A combination of early case identification, physical distancing, public health measures and a reduction in international travel have likely been effective in slowing the spread of the disease in Australia. In addition, the median number of days between symptom onset and diagnostic testing has improved considerably from 7 days in the early phase of the outbreak to 1 day in the latest phase of the epidemic. Internationally, as at 24 May 2020, there have been recent increases in the number of daily cases reported globally. The largest numbers of both cases and deaths have been reported in the United States. Of the confirmed cases reported globally, the case fatality rate is approximately 6.5%. Countries in South America are starting to see rapid acceleration, while the United States is seeing a very slow decline in its daily new case numbers. In the South East Asia region, India and Bangladesh are seeing accelerating epidemics, compounded by the recovery from Cyclone Amphan. Increasing numbers of cases are also being reported in Africa, although the numbers are much smaller. In the Pacific there are very few daily new cases reported.", "COVID-19 outbreak in Italy: estimation of reproduction numbers over two months toward the Phase 2 After two months from the first case in COVID-19 outbreak, Italy counts more than 190,000 confirmed positive cases. From the beginning of April 2020, the nationwide lockdown started to show early effects by reducing the total cumulative incidence reached by the epidemic wave. This allows the government to program the measures to loosen lockdown restrictions for the so called \"Phase 2\". Here we provided the reproduction number estimation both in space and in time from February 24th to April 24th, 2020 across two months into the epidemic. Our estimates suggest basic reproduction number averaged over all the regions of 3.29, confirming that epidemiological figures of the SARS-CoV-2 epidemic in Italy are higher than those observed at the early stage of Wuhan (China) outbreak. Based on the SARS-CoV-2 transmission dynamics reported here, we gave a quantitative evaluation of the efficiency of the government measures to low the reproduction number under the unity (control regime). We estimated that among the worst hit regions in Italy, Lombardy reached the control regime on March 22nd followed by Emilia-Romagna (March 23th), Veneto (March 25th) and Piemonte (March 26th). Overall, we found that the mean value of time to reach the control regime in all the country is about 31 days from the February 24th and about 14 days from the first day of nationwide lockdown (March 12th). Finally, we highlighted the interplay between the reproduction number and two demographic indices in order to probe the \"state of activity\" of the epidemic for each Italian region in the control regime. We believe that this approach can provide a tool in the management of \"Phase 2\", potentially helping in challenging decision to continue, ease or tighten up restrictions.", "Measures of frequency: calculating prevalence and incidence in the era of COVID-19 ", "Tracing DAY-ZERO and Forecasting the Fade out of the COVID-19 Outbreak in Lombardy, Italy: A Compartmental Modelling and Numerical Optimization Approach. Italy currently constitutes the epicenter of the novel coronavirus disease (COVID-19) pandemic, having surpassed China's death toll. The disease is sweeping through Lombardy, which remains in lockdown since the 8th of March. As of the same day, the isolation measures taken in Lombardy have been extended to the entire country. Here, we provide estimates for: (a) the DAY-ZERO of the outbreak in Lombardy, Italy; (b) the actual number of exposed/infected cases in the total population; (c) the basic reproduction number (R0); (d) the \"effective\" per-day disease transmission; and, importantly, (e) a forecast for the fade out of the outbreak, on the basis of the COVID-19 Community Mobility Reports released by Google on March 29. Methods. To deal with the uncertainty in the number of actual exposed/ infected cases in the total population, we address a compartmental Susceptible/ Exposed/ Infectious/ Recovered/ Dead (SEIRD) model with two compartments of infectious persons: one modelling the total cases in the population and another modelling the confirmed cases. The parameters of the model corresponding to the recovery period, the time from the onset of symptoms to death, the case fatality ratio, and the time from exposure to the time that an individual starts to be infectious, have been set as reported from clinical studies on COVID-19. For the estimation of the DAY-ZERO of the outbreak in Lombardy, as well as of the ``effective\" per-day transmission rate for which no clinical data are available, we have used the SEIRD simulator to fit the numbers of new daily cases from February 21 to the 8th of March, the lockdown day of Lombardy and of all Italy. This was accomplished by solving a mixed-integer optimization problem with the aid of genetic algorithms. Based on the computed values, we also provide an estimation of the basic reproduction number $R_0$. Furthermore, based on an estimation for the reduction in the \"effective\" transmission rate of the disease as of March 8 that reflects the suspension of almost all activities in Italy, we ran the simulator to forecast the fade out of the epidemic. For this purpose, we considered the reduction in mobility in Lombardy as released on March 29 by Google COVID-19 Community Mobility Reports, the effect of social distancing, and the draconian measures taken by the government on March 20 and March 21, 2020. Results. Based on the proposed methodological procedure, we estimated that the DAY-ZERO was most likely between January 5 and January 23 with the most probable date the 15th of January 2020. The actual cumulative number of exposed cases in the total population in Lombardy on March 8 was of the order of 15 times the confirmed cumulative number of infected cases. The \"effective\" per-day disease transmission rate for the period until March 8 was found to be 0.686 (95% CI:0.660, 0.713), while the basic reproduction number R0 was found to be 4.51 (95% CI: 4.14, 4.90). Importantly, simulations show that the COVID-19 pandemic in Lombardy is expected to fade out by the end of May - early June, 2020, if the draconian, as of March 20 and March 21, measures are maintained.", "Presence of SARS-Coronavirus-2 RNA in Sewage and Correlation with Reported COVID-19 Prevalence in the Early Stage of the Epidemic in The Netherlands [Image: see text] In the current COVID-19 pandemic, a significant proportion of cases shed SARS-Coronavirus-2 (SARS-CoV-2) with their faeces. To determine if SARS-CoV-2 RNA was present in sewage during the emergence of COVID-19 in The Netherlands, sewage samples of six cities and the airport were tested using four qRT-PCR assays, three targeting the nucleocapsid gene (N1\u2013N3) and one the envelope gene (E). No SARS-CoV-2 RNA was detected on February 6, 3 weeks before the first Dutch case was reported. On March 4/5, one or more gene fragments were detected in sewage of three sites, in concentrations of 2.6\u201330 gene copies per mL. In Amersfoort, N3 was detected in sewage 6 days before the first cases were reported. As the prevalence of COVID-19 in these cities increased in March, the RNA signal detected by each qRT-PCR assay increased, for N1\u2013N3 up to 790\u20132200 gene copies per mL. This increase correlated significantly with the increase in reported COVID-19 prevalence. The detection of the virus RNA in sewage, even when the COVID-19 prevalence is low, and the correlation between concentration in sewage and reported prevalence of COVID-19, indicate that sewage surveillance could be a sensitive tool to monitor the circulation of the virus in the population.", "Evaluation of Sample Pooling for Screening of SARS-CoV-2 Background: The coronavirus disease (COVID-19) pandemic has revealed the global public health importance of robust diagnostic testing. To overcome the challenge of nucleic acid (NA) extraction and testing kit availability efficient method is urgently needed. Objectives: To establish an efficient, time and resource-saving and cost-effective methods, and to propose an ad hoc pooling approach for mass screening of SARS-CoV-2 Methods: Direct clinical sample and NA pooling approach was used for the standard reverse transcriptase polymerase chain reaction (RT-PCR) test of the SARS CoV-2 targeting the envelop (E) and open reading frame (ORF1ab) genomic region of the virus. In this approach, experimental pools were created using SARS CoV-2 positive clinical samples spiked with up to 9 negative samples prior to NA extraction step to have a final extraction volume of 200L (maximum dilution factor of 10). Viral NA was also subsequently extracted from each pool and tested using the SARS CoV-2 RT-PCR assay. Results: We found that a single positive sample can be amplified and detected in pools of up to 7 samples depending on the ct value of the original sample, corresponding to high, medium, and low SARS CoV-2 viral copies/reaction. However, to minimize false negativity of the assay with pooling strategies and with unknown false negativity rate of the assay under validation, we recommend poling of 4 in 1 using the standard protocols of the assay, reagents and equipment. The predictive algorithm indicated a pooling ratio of 4 in 1 was expected to retain accuracy of the test irrespective of the ct value (relative RNA copy number) of the sample spiked and result in a 237% increase in testing efficiency. Conclusions: The approaches showed its concept in easily customized and resource-saving manner and would allow expanding of current screening capacities and enable the expansion of detection in the community.", "Adjusting confirmed COVID-19 case counts for testing volume When assessing the relative prevalence of the novel coronavirus (COVID-19), observers often point to the number of COVID-19 cases that have been confirmed through viral testing. However, comparisons based on confirmed case counts alone can be misleading since a higher case count may reflect either a higher disease prevalence or a better rate of disease detection. Using weekly records of viral test results for each state in the US, I demonstrate how confirmed case counts can be adjusted based on the percentage of COVID-19 tests that come back positive. A regression analysis indicates that case counts track better with future hospitalizations and deaths when employing this simple adjustment for testing coverage. Viral testing results can be used as a leading indicator of COVID-19 prevalence, but data reporting standards should be improved, and care should be taken to account for testing coverage when comparing confirmed case counts.", "COVID-19 Testing, Epidemic Features, Hospital Outcomes, and Household Prevalence, New York State-March 2020 BACKGROUND: The United States' COVID-19 epidemic has grown extensively since February 2020, with substantial associated hospitalizations and mortality; New York State (NYS) has emerged as the national epicenter. We report on the extent of testing and test results during the month of March in NYS, along with risk factors, outcomes, and household prevalence among initial cases subject to in-depth investigations. METHODS: Specimen collection for COVID-19 testing was conducted in healthcare settings, community-based collection sites, and by home testing teams. Information on demographics, risk factors, and hospital outcomes of cases was obtained through epidemiological investigations and an electronic medical records match, and summarized descriptively. Active testing of initial case's households enabled estimation of household prevalence. RESULTS: During March In NYS, outside of New York City, a total of 47,326 persons tested positive for SARS-CoV-2, out of 141,495 tests (33% test-positive), with the highest number of cases located in the metropolitan region counties. Among 229 initial cases diagnosed through March 12, by March 30 13% were hospitalized and 2% died. Testing conducted among 498 members of these case's households found prevalent infection among 57%; excluding first-reported cases 38%. In these homes, we found a significant age gradient in prevalence, from 23% among those <5 years to 68% among those &#8805;65 years (p<.0001). CONCLUSIONS: New York State faced a substantial and increasing COVID-19 outbreak during March 2020. The earliest cases had high levels of infection in their households and by the end of the month, the risks of hospitalization and death were high.", "Suitability and Sufficiency of Telehealth Clinician-Observed, Participant-Collected Samples for SARS-CoV-2 Testing: The iCollect Cohort Pilot Study BACKGROUND: The severe acute respiratory coronavirus 2 (SARS-CoV-2) pandemic calls for expanded opportunities for testing, including novel testing strategies such as home-collected specimens. OBJECTIVE: We aimed to understand whether oropharyngeal swab (OPS), saliva, and dried blood spot (DBS) specimens collected by participants at home and mailed to a laboratory were sufficient for use in diagnostic and serology tests of SARS-CoV-2. METHODS: Eligible participants consented online and were mailed a participant-collection kit to support collection of three specimens for SARS-CoV-2 testing: saliva, OPS, and DBS. Participants performed the specimen collection procedures during a telehealth video appointment while clinical observers watched and documented the suitability of the collection. The biological sufficiency of the specimens for detection of SARS-CoV-2 by reverse transcriptase\u2013polymerase chain reaction and serology testing was assessed by laboratorians using visual inspection and quantification of the nucleic acid contents of the samples by ribonuclease P (RNase P) measurements. RESULTS: Of the enrolled participants,153/159 (96.2%) returned their kits, which were included in this analysis. All these participants attended their video appointments. Clinical observers assessed that of the samples collected, 147/153 (96.1%) of the saliva samples, 146/151 (96.7%) of the oropharyngeal samples, and 135/145 (93.1%) of the DBS samples were of sufficient quality for submission for laboratory testing; 100% of the OPS samples and 98% of the saliva samples had cycle threshold values for RNase P <30, indicating that the samples contained sufficient nucleic acid for RNA-PCR testing for SARS-CoV-2. CONCLUSIONS: These pilot data indicate that most participant-collected OPS, saliva, and DBS specimens are suitable and sufficient for testing for SARS-CoV-2 RNA and serology. Clinical observers rated the collection of specimens as suitable for testing, and visual and quantitative laboratory assessment indicated that the specimens were biologically sufficient. These data support the utility of participant-collected and mailed-in specimens for SARS-CoV-2 testing. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/19054", "Scenario analysis of non-pharmaceutical interventions on global COVID-19 transmissions This paper introduces a dynamic panel SIR (DP-SIR) model to investigate the impact of non-pharmaceutical interventions (NPIs) on the COVID-19 transmission dynamics with panel data from 9 countries across the globe. By constructing scenarios with different combinations of NPIs, our empirical findings suggest that countries may avoid the lockdown policy with imposing school closure, mask wearing and centralized quarantine to reach similar outcomes on controlling the COVID-19 infection. Our results also suggest that, as of April 4th, 2020, certain countries such as the U.S. and Singapore may require additional measures of NPIs in order to control disease transmissions more effectively, while other countries may cautiously consider to gradually lift some NPIs to mitigate the costs to the overall economy.", "FALSE-NEGATIVE RESULTS OF INITIAL RT-PCR ASSAYS FOR COVID-19: A SYSTEMATIC REVIEW Background: Cases with negative reverse transcription-polymerase chain reaction (RT-PCR) results at initial testing for suspicion of SARS-CoV-2 infection, and found to be positive in a subsequent test, are considered as RT-PCR false-negative cases. False-negative cases have important implications for COVID-19 management, isolation, and risk of transmission. We aimed to review and critically appraise evidence about the proportion of RT-PCR false-negatives at initial testing for COVID-19. Methods: We performed a systematic review and critical appraisal of literature with high involvement of stakeholders in the review process. We searched on MEDLINE, EMBASE, LILACS, the WHO database of COVID-19 publications, the EPPI-Centre living systematic map of evidence about COVID-19, and the living systematic review developed by the University of Bern (ISPM). Two authors screened and selected studies according to the eligibility criteria and collected data of included studies (no-independent verification). Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. We calculated the false-negative proportion with the corresponding 95% CI using a multilevel mixed-effect logistic regression model using STATA 16. Certainty of the evidence about false-negative cases was rated using the GRADE approach for tests and strategies. The information is current up to 6 April 2020. Findings: Five studies enrolling 957 patients were included. All studies were affected by several biases and applicability concerns. Pooled estimation of false-negative proportion was 0.085 (95% CI= 0.034 to 0.196; tau-squared = 1.08; 95% CI= 0.27 to 8.28; p<0.001); however, this estimation is highly affected by unexplained heterogeneity, and its interpretation should be avoided. The certainty of the evidence was judged as very low, due to the risk of bias, indirectness, and inconsistency issues. Conclusions: The collected evidence has several limitations, including risk of bias issues, high heterogeneity, and concerns about its applicability. Nonetheless, our findings reinforce the need for repeated testing in patients with suspicion of SARS-Cov-2 infection given that up to 29% of patients could have an initial RT-PCR false-negative result. Systematic review registration: Protocol available on OSF website: https://osf.io/gp38w/", "Multi-parametric disease dynamics study and analysis of the COVID-19 epidemic and implementation of population-wide intrusions: The Indian perspective The outbreak of COVID-19 had spread at a deadly rate since its onset at Wuhan, China and is now spread across 216 countries and has affected more than 6 million people all over the world. The global response throughout the world has been primarily the implementation of lockdown measures, testing and contact tracing to minimise the spread of the disease. The aim of the present study was to predict the COVID-19 prevalence and disease progression rate in Indian scenario in order to provide an analysis that can shed light on comprehending the trends of the outbreak and outline an impression of the epidemiological stage for each state of a diverse country like India. In addition, the forecast of COVID-19 incidence trends of these states can help take safety measures and policy design for this epidemic in the days to come. In order to achieve the same, we have utilized an approach where we test modelling choices of the spatially unambiguous kind, proposed by the wave of infections spreading from the initial slow progression to a higher curve. We have estimated the parameters of an individual state using factors like population density and mobility. The findings can also be used to strategize the testing and quarantine processes to manipulate the spread of the disease in the future. This is especially important for a country like India that has several limitations about healthcare infrastructure, diversity in socioeconomic status, high population density, housing conditions, health care coverage that can be important determinants for the overall impact of the pandemic. The results of our 5-phase model depict a projection of the state wise infections/disease over time. The model can generate live graphs as per the change in the data values as the values are automatically being fetched from the crowd-sourced database.", "Estimating the Global Infection Fatality Rate of COVID-19 COVID-19 has become a global pandemic, resulting in nearly three hundred thousand deaths distributed heterogeneously across countries. Estimating the infection fatality rate (IFR) has been elusive due to the presence of asymptomatic or mildly symptomatic infections and lack of testing capacity. We analyze global data to derive the IFR of COVID-19. Estimates of COVID-19 IFR in each country or locality differ due to variable sampling regimes, demographics, and healthcare resources. We present a novel statistical approach based on sampling effort and the reported case fatality rate of each country. The asymptote of this function gives the global IFR. Applying this asymptotic estimator to cumulative COVID-19 data from 139 countries reveals a global IFR of 1.04% (CI: 0.77%,1.38%). Deviation of countries' reported CFR from the estimator does not correlate with demography or per capita GDP, suggesting variation is due to differing testing regimes or reporting guidelines by country. Estimates of IFR through seroprevalence studies and point estimates from case studies or sub-sampled populations are limited by sample coverage and cannot inform a global IFR, as mortality is known to vary dramatically by age and treatment availability. Our estimated IFR aligns with many previous estimates and is the first attempt at a global estimate of COVID-19 IFR.", "Back-projection of COVID-19 diagnosis counts to assess infection incidence and control measures: analysis of Australian data Back-projection is an epidemiological analysis method that was developed to estimate HIV incidence using surveillance data on AIDS diagnoses. It was used extensively during the 1990s for this purpose as well as in other epidemiological contexts. Surveillance data on COVID-19 diagnoses can be analysed by the method of back-projection using information about the probability distribution of the time between infection and diagnosis, which is primarily determined by the incubation period. This paper demonstrates the value of such analyses using daily diagnoses from Australia. It is shown how back-projection can be used to assess the pattern of COVID-19 infection incidence over time and to assess the impact of control measures by investigating their temporal association with changes in incidence patterns. For Australia, these analyses reveal that peak infection incidence coincided with the introduction of border closures and social distancing restrictions, while the introduction of subsequent social distancing measures coincided with a continuing decline in incidence to very low levels. These associations were not directly discernible from the daily diagnosis counts, which continued to increase after the first stage of control measures. It is estimated that a one week delay in peak incidence would have led to a fivefold increase in total infections. Furthermore, at the height of the outbreak, half to three-quarters of all infections remained undiagnosed. Automated data analytics of routinely collected surveillance data are a valuable monitoring tool for the COVID-19 pandemic and may be useful for calibrating transmission dynamics models.", "Is there a link between temperatures and COVID-19 contagions? Evidence from Italy This study analyzes the link between temperatures and COVID-19 contagions in a sample of Italian regions during the period ranging from February 24 to April 15. To that end, Bayesian Model Averaging techniques are used to analyze the relevance of the temperatures together with a set of additional climate, environmental, demographic, social and policy factors. The robustness of individual covariates is measured through posterior inclusion probabilities. The empirical analysis provides conclusive evidence on the role played by the temperatures given that it appears as the most relevant determinant of contagions. This finding is robust to (i) the prior distribution elicitation, (ii) the procedure to assign weights to the regressors, (iii) the presence of measurement errors in official data due to under-reporting, (iv) the employment of different metrics of temperatures or (v) the inclusion of additional correlates. In a second step, relative importance metrics that perform an accurate partitioning of the R2 of the model are calculated. The results of this approach support the evidence of the model averaging analysis, given that temperature is the top driver explaining 45% of regional contagion disparities. The set of policy-related factors appear in a second level of importance, whereas factors related to the degree of social connectedness or the demographic characteristics are less relevant.", "Risk of secondary infection waves of COVID-19 in an insular region: the case of the Balearic Islands, Spain The Spanish government declared the lockdown on March 14th, 2020 to tackle the fast-spreading of COVID-19. As a consequence the Balearic Islands remained almost fully isolated due to the closing of airports and ports, These isolation measures and the home-based confinement have led to a low incidence of COVID-19 in this region. We propose a compartmental model for the spread of COVID-19 including five compartments (Susceptible, Latent, Infected, Diseased, and Recovered), and the mobility between municipalities. The model parameters are calibrated with the temporal series of confirmed cases provided by the Spanish Ministry of Health. After calibration, the proposed model captures the trend of the official confirmed cases before and after the lockdown. We show that the estimated number of cases depends strongly on the initial dates of the local outbreak onset and the number of imported cases before the lockdown. Our estimations indicate that the population has not reached the level of herd immunization necessary to prevent future outbreaks. While the low incidence, in comparison to mainland Spain, has prevented the saturation of the health system, this low incidence translates into low immunization rates, therefore facilitating the propagation of new outbreaks that could lead to secondary waves of COVID-19 in the region. These findings warn about scenarios regarding after-lockdown-policies and the risk of second outbreaks, emphasize the need for widespread testing, and could potentially be extrapolated to other insular and continental regions.", "Early dynamics of transmission and control of COVID-19: a mathematical modelling study Background: An outbreak of the novel coronavirus SARS-CoV-2 has led to 46,997 confirmed cases as of 13th February 2020. Understanding the early transmission dynamics of the infection and evaluating the effectiveness of control measures is crucial for assessing the potential for sustained transmission to occur in new areas. Methods: We combined a stochastic transmission model with data on cases of novel coronavirus disease (COVID-19) in Wuhan and international cases that originated in Wuhan to estimate how transmission had varied over time during January and February 2020. Based on these estimates, we then calculated the probability that newly introduced cases might generate outbreaks in other areas. Findings: We estimated that the median daily reproduction number, Rt , declined from 2.35 (95% CI: 1.15-4.77) one week before travel restrictions were introduced on 23rd January to 1.05 (95% CI: 0.413-2.39) one week after. Based on our estimates of Rt,we calculated that in locations with similar transmission potential as Wuhan in early January, once there are at least four independently introduced cases, there is a more than 50% chance the infection will establish within that population. Interpretation: Our results show that COVID-19 transmission likely declined in Wuhan during late January 2020, coinciding with the introduction of control measures. As more cases arrive in international locations with similar transmission potential to Wuhan pre-control, it is likely many chains of transmission will fail to establish initially, but may still cause new outbreaks eventually.", "Special report: Early use of ICD-10-CM code \"U07.1, COVID-19\" to identify 2019 novel coronavirus cases in Military Health System administrative data This report describes early exploratory analysis of ICD-10-CM code U07.1 (2019-nCoV acute respiratory disease [COVID-19]) to assess the use of administrative data for case ascertainment, syndromic surveillance, and future epidemiological studies. Out of the 2,950 possible COVID-19 cases identified between 1 April 2020 and 4 May 2020, 600 (20.3%) were detected in the Defense Medical Surveillance System (DMSS) and not in the Disease Reporting System internet (DRSi) or in Health Level 7 laboratory data from the Composite Health Care System. Among the 150 out of 600 cases identified exclusively in the DMSS and selected for Armed Forces Health Longitudinal Technology Application (AHLTA) review, 16 (10.7%) had a certified positive lab result in AHLTA, 17 (11.3%) met Council of State and Territorial Epidemiologists (CSTE) criteria for a probable case, 46 (30.7%) were not cases based on CSTE criteria, and 71 (47.3%) had evidence of a positive lab result from an outside source. Lack of full capture of lab results may continue to be a challenge as the variety of available tests expands. Administrative data may provide an important stopgap measure for detecting lab positive cases, pending incorporation of new COVID-19 tests and standardization of test and result nomenclature.", "The Effect of Large-Scale Anti-Contagion Policies on the Coronavirus (COVID-19) Pandemic Governments around the world are responding to the novel coronavirus (COVID-19) pandemic with unprecedented policies designed to slow the growth rate of infections. Many actions, such as closing schools and restricting populations to their homes, impose large and visible costs on society. In contrast, the benefits of these policies, in the form of infections that did not occur, cannot be directly observed and are currently understood through process-based simulations. Here, we compile new data on 1,659 local, regional, and national anti-contagion policies recently deployed in the ongoing pandemic across localities in China, South Korea, Iran, Italy, France, and the United States (US). We then apply reduced-form econometric methods, commonly used to measure the effect of policies on economic growth, to empirically evaluate the effect that these anti-contagion policies have had on the growth rate of infections. In the absence of any policy actions, we estimate that early infections of COVID-19 exhibit exponential growth rates of roughly 42% per day. We find that anti-contagion policies collectively have had significant effects slowing this growth. Our results suggest that similar policies may have different impacts on different populations, but we obtain consistent evidence that the policy packages now deployed are achieving large, beneficial, and measurable health outcomes. We estimate that, to date, current policies have already prevented or delayed on the order of 62 million infections across these six countries. These findings may help inform whether or when these ongoing policies should be lifted or intensified, and they can support decision-making in the other 180+ countries where COVID-19 has been reported.", "Correcting under-reported COVID-19 case numbers: estimating the true scale of the pandemic The COVID-19 virus has spread worldwide in a matter of a few months, while healthcare systems struggle to monitor and report current cases. Testing results have struggled with the relative capabilities, testing policies and preparedness of each affected country, making their comparison a non-trivial task. Since severe cases, which more likely lead to fatal outcomes, are detected at a higher rate than mild cases, the reported virus mortality is likely inflated in most countries. Lockdowns and changes in human behavior modulate the underlying growth rate of the virus. Under-sampling of infection cases may lead to the under-estimation of total cases, resulting in systematic mortality estimation biases. For healthcare systems worldwide it is important to know the expected number of cases that will need treatment. In this manuscript, we identify a generalizable growth rate decay reflecting behavioral change. We propose a method to correct the reported COVID-19 cases and death numbers by using a benchmark country (South Korea) with near-optimal testing coverage, with considerations on population demographics. We extrapolate expected deaths and hospitalizations with respect to observations in countries that passed the exponential growth curve. By applying our correction, we predict that the number of cases is highly under-reported in most countries and a significant burden on worldwide hospital capacity.", "Racial segregation, testing sites access, and COVID-19 incidence rate in Massachusetts, USA The U.S. has merely 4% of the world population but 25% of the world's COVID-19 cases. Massachusetts has been in the leading position of total cases since the outbreak in the U.S. Racial residential segregation is a fundamental cause of racial disparities in health. Moreover, disparities of access to health care have a large impact on COVID-19 cases. Thus, this study estimates racial segregation and disparities in testing sites access and employs economic, demographic, and transportation variables at the city/town level in Massachusetts. Spatial regression models are applied to evaluate the relationships between COVID-19 incidence rate and related variables. This is the first study to apply spatial analysis methods across neighborhoods in the U.S. to examine the COVID-19 incidence rate. The findings are: 1) residential segregations of Hispanic and Non-Hispanic Black/African Americans have a significantly positive association with COVID-19 incidence rate, indicating the higher susceptibility of COIVD-19 infections among minority; 2) The Black has the shortest drive time to testing sites, followed by Hispanic, Asian, and Whites. The drive time to testing sites is significantly negatively associated with the COVID-19 incidence rate, implying the importance of testing location being accessed by all populations; 3) Poverty rate and road density are significant explanatory variables. Importantly, overcrowding represented by more than one person per room is a significant variable found to be positively associated with COVID-19 incidence rate, suggesting the effectiveness of social distancing for reducing infection; 4) Different from previous studies, elderly population rate is not statistically significant with incidence rate because the elderly population in Massachusetts is less distributed in the hot spot regions of COVID-19 infections. The findings in this study provide useful insights for policymakers to propose new strategies to contain the COVID-19 transmissions in Massachusetts.", "Resident physician exposure to novel coronavirus (2019-nCoV, SARS-CoV-2) within New York City during exponential phase of COVID-19 pandemic: Report of the New York City Residency Program Directors COVID-19 Research Group Background From March 2-April 12, 2020, New York City (NYC) experienced exponential growth of the COVID-19 pandemic due to novel coronavirus (SARS-CoV-2). Little is known regarding how physicians have been affected. We aimed to characterize COVID-19 impact on NYC resident physicians. Methods IRB-exempt and expedited cross-sectional analysis through survey to NYC residency program directors (PDs) April 3-12, 2020, encompassing events from March 2-April 12, 2020. Findings From an estimated 340 residency programs around NYC, recruitment yielded 91 responses, representing 24 specialties and 2,306 residents. 45.1% of programs reported at least one resident with confirmed COVID-19: 101 resident physicians were confirmed COVID-19-positive, with additional 163 residents presumed positive for COVID-19 based on symptoms but awaiting or unable to obtain testing. 56.5% of programs had a resident waiting for, or unable to obtain, COVID-19 testing. Two COVID-19-positive residents were hospitalized, with one in intensive care. Among specialties with >100 residents represented, negative binomial regression indicated that infection risk differed by specialty (p=0.039). Although most programs (80%) reported quarantining a resident, with 16.8% of residents experiencing quarantine, 14.9% of COVID-19-positive residents were not quarantined. 90 programs, encompassing 99.2% of the resident physicians, reported reuse or extended mask use, and 43 programs, encompassing 60.4% of residents, felt that personal protective equipment (PPE) was suboptimal. 65 programs (74.7%) have redeployed residents elsewhere to support COVID-19 efforts. Interpretation Many resident physicians around NYC have been affected by COVID-19 through direct infection, quarantine, or redeployment. Lack of access to testing and concern regarding suboptimal PPE are common among residency programs. Infection risk may differ by specialty. Funding AHA, MPB, RWSC, CGM, LRDG, and JDH are supported by NEI Core Grant P30EY019007, and unrestricted grant from RPB. ACP and JS are supported by Parker Family Chair. SXX is supported by University of Pennsylvania.", "Universal Screening for SARS-CoV-2 in Women Admitted for Delivery ", "Confidence in the dynamic spread of epidemics under biased sampling conditions The interpretation of sampling data plays a crucial role in policy response to the spread of a disease during an epidemic, such as the COVID-19 epidemic of 2020. However, this is a non-trivial endeavor due to the complexity of real world conditions and limits to the availability of diagnostic tests, which necessitate a bias in testing favoring symptomatic individuals. A thorough understanding of sampling confidence and bias is necessary in order make accurate conclusions. In this manuscript, we provide a stochastic model of sampling for assessing confidence in disease metrics such as trend detection, peak detection, and disease spread estimation. Our model simulates testing for a disease in an epidemic with known dynamics, allowing us to use Monte-Carlo sampling to assess metric confidence. We use this method to show that trends in the disease may be identified using under $10000$ biased samples each day, and an estimate of disease spread can be made with additional $1000-2000$ unbiased samples each day. We also demonstrate that the model can be used to assess more advanced metrics by finding the precision and recall of a strategy for finding peaks in the dynamics.", "Is there evidence that BCG vaccination has non-specific protective effects for COVID 19 infections or is it an illusion created by lack of testing? The goal of this paper is to showcase that the COVID-19 disease pattern is evolving and to study the relationship between mandatory BCG policy and caseload/million or death/per million. We analyze seven recent publications on the impact of BCG vaccinations on the development of COVID19 illness and extend presented findings using the latest data from April 10, 2020. We analyze data from 98 countries and we extend existing models by adding the dimension of COVID-19-related testing conducted by the analyzed countries. Similarly to prior studies, we find that COVID-19 attributable case and death incidences across countries share a relationship with the BCG vaccination inclusion in the national immunization program of a country when testing is not taken into consideration. However, this relationship vanishes when we add the dimension of testing. We observe that case and death incidences conditional on testing do not get affected by the BCG vaccination inclusion in the national immunization program of a country. Therefore, we show that there is no statistical evidence to support the assertion that inclusion of BCG vaccination in national immunization program (NIP) has any impact of COVID 19 infections (cases) or mortality.", "COVID-19 incidence and R decreased on the Isle of Wight after the launch of the Test, Trace, Isolate programme In May 2020 the UK introduced a Test, Trace, Isolate programme in response to the COVID-19 pandemic. The programme was first rolled out on the Isle of Wight and included Version 1 of the NHS contact tracing app. We used COVID-19 daily case data to infer incidence of new infections and estimate the reproduction number R for each of 150 Upper Tier Local Authorities in England, and at the National level, before and after the launch of the programme on the Isle of Wight. We used Bayesian and Maximum-Likelihood methods to estimate R, and compared the Isle of Wight to other areas using a synthetic control method. We observed significant decreases in incidence and R on the Isle of Wight immediately after the launch. These results are robust across each of our approaches. Our results show that the sub-epidemic on the Isle of Wight was controlled significantly more effectively than the sub-epidemics of most other Upper Tier Local Authorities, changing from having the third highest reproduction number R (of 150) before the intervention to the tenth lowest afterwards. The data is not yet available to establish a causal link. However, the findings highlight the need for further research to determine the causes of this reduction, as these might translate into local and national non-pharmaceutical intervention strategies in the period before a treatment or vaccination becomes available.", "CoViD--19: An Automatic, Semiparametric Estimation Method for the Population Infected in Italy To date, official data on the number of people infected with the SARS-CoV-2 , responsible for the CoViD19 , have been released by the Italian Government just on the basis of a non representative sample of population which tested positive for the swab. However a reliable estimation of the number of infected, including asymptomatic people, turns out to be crucial in the preparation of operational schemes and to estimate the future number of people, who will require, to different extents, medical attentions. In order to overcome the current data shortcoming, this paper proposes a bootstrap driven, estimation procedure for the number of people infected with the SARSCoV2. This method is designed to be robust, automatic and suitable to generate estimations at regional level. Obtained results show that, while official data at March the 12th report 12.839 cases in Italy, people infected wiyh the SARSCoV2 could be as high as 105.789.", "Modeling behavioral change and COVID-19 containment in Mexico: A trade-off between lockdown and compliance Abstract Sanitary Emergency Measures (SEM) were implemented in Mexico on March 30th, 2020 requiring the suspension of non-essential activities. This action followed a Healthy Distance Sanitary action on March 23rd, 2020. The aim of both measures was to reduce community transmission of COVID-19 in Mexico by lowering the effective contact rate. Using a modification of the Kermack-McKendrick SEIR model we explore the effect of behavioral changes required to lower community transmission by introducing a time-varying contact rate, and the consequences of disease spread in a population subject to suspension of non-essential activities. Our study shows that there exists a trade-off between the proportion of the population under SEM and the average time an individual is committed to all the behavioral changes needed to achieve an effective social distancing. This trade-off generates an optimum value for the proportion of the population under strict mitigation measures, significantly below 1 in some cases, that minimizes maximum COVID-19 incidence. We study the population-level impact of three key factors: the implementation of behavior change control measures, the time horizon necessary to reduce the effective contact rate and the proportion of people under SEM in combating COVID-19. Our model is fitted to the available data. The initial phase of the epidemic, from February 17th to March 23rd, 2020, is used to estimate the contact rates, infectious periods and mortality rate using both confirmed cases (by date of symptoms initiation), and daily mortality. Data on deaths after march 23rd, 2020 is used to estimate the mortality rate after the mitigation measures are implemented. Our simulations indicate that the most likely dates for maximum incidence are between late May and early June, 2020 under a scenario of high SEM compliance and low SEM abandonment rate.", "Coronavirus disease 2019 in children: Surprising findings in the midst of a global pandemic Question Coronavirus disease 2019 (COVID-19) is affecting millions of people worldwide. It seems that it affects mostly adults older than 40 years of age, and the death rate is highest for older individuals in the population. What should I tell parents worried about their children contracting the coronavirus (SARS-CoV-2) causing COVID-19, and what symptoms should I look for to determine if there is a need to test for the virus?Answer The COVID-19 global pandemic affects all ages. Severe respiratory manifestations have been the mainstay of illness in adults, with what seems to be rapid deterioration necessitating mechanical ventilation. Only 5% of those tested and found to have COVID-19 have been younger than 19 years, possibly owing to limited testing, as the symptoms in children are usually mild. Symptoms in children include fever, dry cough, rhinorrhea, sore throat, and fatigue, and in 10% diarrhea or vomiting. Rarely dyspnea or hypoxemia were also described. Blood tests and imaging have been shown to be of little value in children and should only be ordered for those in whom you would normally order these investigations for viral-like illness. No specific therapy is available and supportive care with rest, fluids, and antipyretics for children is the recommended approach. Ibuprofen or acetaminophen for fever and pain can be given. Antiviral and immunomodulatory treatment is not recommended at this time for otherwise healthy children, and corticosteroids should also not be used. Children with immunocompromised states should be isolated and avoid contact with others.", "Evaluating the massive underreporting and undertesting of COVID-19 cases in multiple global epicenters BACKGROUND: With continuous global COVID-19 outbreak, differing case numbers and mortality rates are observed. While actual case numbers appear vague, mortality numbers related to COVID-19 seem more precise. In this study, we used the mortality rate as the main indicator to evaluate the extent of underreporting and underdetection of COVID-19 cases. METHODS: We have analyzed all available data provided by the World Health Organization on the development of international COVID-19 cases and mortality numbers on March 17th, 2020. A crude case-fatality risk (cCFR) and adjusted case-fatality risk (aCFR) was calculated for China, South Korea, Japan, Italy, France, Spain, Germany, Iran and the United States. Additionally, a fold-change (FC) was derived for each country. RESULTS: The highest aCFR and FC were detected for Spain. Based on their FC values, an extremely high number of undetected COVID-19 cases was displayed in France, the United States, Italy and Spain. For these countries, our findings indicate a detection rate of only 1-2% of total actual COVID-19 cases. CONCLUSIONS: Due to limited testing capacities, mortality numbers may serve as a better indicator for COVID-19 case spread in many countries. Our data indicate that countries like France, Italy, the United States, Iran and Spain have extremely high numbers of undetected and underreported cases. Differences in testing availability and capacity, containment as well as overall health care and medical infrastructure result in significantly different mortality rates and COVID-19 case numbers for each respective country.", "Epidemiological, Clinical Characteristics and Outcome of Medical Staff Infected with COVID-19 in Wuhan, China: A Retrospective Case Series Analysis Backgrounds Since December 2019, a novel coronavirus epidemic has emerged in Wuhan city, China and then rapidly spread to other areas. As of 20 Feb 2020, a total of 2,055 medical staff confirmed with coronavirus disease 2019 (COVID-19) caused by SARS-Cov-2 in China had been reported. We sought to explore the epidemiological, clinical characteristics and prognosis of novel coronavirus-infected medical staff. Methods In this retrospective study, 64 confirmed cases of novel coronavirus-infected medical staff admitted to Union Hospital, Wuhan between 16 Jan, 2020 to 15 Feb, 2020 were included. Two groups concerned were extracted from the subjects based on duration of symptoms: group 1 (<= 10 days) and group 2 (>10 days). Epidemiological and clinical data were analyzed and compared across groups. The Kaplan-Meier plot was used to inspect the change in hospital discharge rate. The Cox regression model was utilized to identify factors associated with hospital discharge. Findings The median age of medical staff included was 35 years old. 64% were female and 67% were nurses. None had an exposure to Huanan seafood wholesale market or wildlife. A small proportion of the cohort had contact with specimens (5%) as well as patients in fever clinics (8%) and isolation wards (5%). Fever (67%) was the most common symptom, followed by cough (47%) and fatigue (34%). The median time interval between symptoms onset and admission was 8.5 days. On admission, 80% of medical staff showed abnormal IL-6 levels and 34% had lymphocytopenia. Chest CT mainly manifested as bilateral (61%), subpleural (80%) and ground-glass (52%) opacities. During the study period, no patients was transferred to intensive care unit or died, and 34 (53%) had been discharged. Higher body mass index (BMI) (HR 0.14; 95% CI 0.03-0.73), fever (HR 0.24; 95% CI 0.09-0.60) and higher levels of IL-6 on admission (HR 0.31; 95% CI 0.11-0.87) were unfavorable factors for discharge. Interpretation In this study, medical staff infected with COVID-19 have relatively milder symptoms and favorable clinical course, which may be partly due to their medical expertise, younger age and less underlying diseases. Smaller BMI, absence of fever symptoms and normal IL-6 levels on admission are favorable for discharge for medical staff. Further studies should be devoted to identifying the exact patterns of SARS-CoV-2 infection among medical staff.", "Diagnostic Testing for Severe Acute Respiratory Syndrome\u2013Related Coronavirus-2: A Narrative Review Diagnostic testing to identify persons infected with severe acute respiratory syndrome\u2013related coronavirus-2 (SARS\u2013CoV-2) infection is central to control the global pandemic of COVID-19 that began in late 2019. In a few countries, the use of diagnostic testing on a massive scale has been a cornerstone of successful containment strategies. In contrast, the United States, hampered by limited testing capacity, has prioritized testing for specific groups of persons. Real-time reverse transcriptase polymerase chain reaction\u2013based assays performed in a laboratory on respiratory specimens are the reference standard for COVID-19 diagnostics. However, point-of-care technologies and serologic immunoassays are rapidly emerging. Although excellent tools exist for the diagnosis of symptomatic patients in well-equipped laboratories, important gaps remain in screening asymptomatic persons in the incubation phase, as well as in the accurate determination of live viral shedding during convalescence to inform decisions to end isolation. Many affluent countries have encountered challenges in test delivery and specimen collection that have inhibited rapid increases in testing capacity. These challenges may be even greater in low-resource settings. Urgent clinical and public health needs currently drive an unprecedented global effort to increase testing capacity for SARS\u2013CoV-2 infection. Here, the authors review the current array of tests for SARS\u2013CoV-2, highlight gaps in current diagnostic capacity, and propose potential solutions.", "Serological tests facilitate identification of asymptomatic SARS\u2010CoV\u20102 infection in Wuhan, China The Wuhan City has ended the lockdown and people have been allowed to resume working since April 8 if meeting a set of COVID\u201019\u2010associated tests including SARS\u2010CoV\u20102 nucleic acid test (NAT) of nasopharyngeal swabs, chest CT scan or a SARS\u2010CoV\u20102\u2010specific serological test. Here, we reported the positive rate of COVID\u201019 tests based on NAT, chest CT scan and a serological SARS\u2010CoV\u20102 test, from April 3 to 15 in one hospital in Qingshan Destrict, Wuhan. We observed a ~10% SARS\u2010CoV\u20102\u2010specific IgG positive rate from 1,402 tests. Combination of SARS\u2010CoV\u20102 NAT and a specific serological test might facilitate the detection of COVID\u201019 infection, or the asymptomatic SARS\u2010CoV\u20102\u2010infected subjects. Large\u2010scale investigation is required to evaluate the herd immunity of the city, for the resuming people and for the re\u2010opened city. This article is protected by copyright. All rights reserved.", "Basic prediction methodology for covid-19: estimation and sensitivity considerations The purpose of the present paper is to present simple estimation and prediction methods for basic quantities in an emerging epidemic like the ongoing covid-10 pandemic. The simple methods have the advantage that relations between basic quantities become more transparent, thus shedding light to which quantities have biggest impact on predictions, with the additional conclusion that uncertainties in these quantities carry over to high uncertainty also in predictions. A simple non-parametric prediction method for future cumulative case fatalities, as well as future cumulative incidence of infections (assuming a given infection fatality risk f), is presented. The method uses cumulative reported case fatalities up to present time as input data. It is also described how the introduction of preventive measures of a given magnitude \u03c1 will affect the two incidence predictions, using basic theory of epidemic models. This methodology is then reversed, thus enabling estimation of the preventive magnitude \u03c1, and of the resulting effective reproduction number RE. However, the effects of preventive measures only start affecting case fatalities some 3-4 weeks later, so estimates are only available after this time has elapsed. The methodology is applicable in the early stage of an outbreak, before, say, 10% of the community have been infected. Beside giving simple estimation and prediction tools for an ongoing epidemic, another important conclusion lies in the observation that the two quantities f (infection fatality risk) and \u03c1 (the magnitude of preventive measures) have very big impact on predictions. Further, both of these quantities currently have very high uncertainty: current estimates of f lie in the range 0.2% up to 2% ([9], [7]), and the overall effect of several combined preventive measures is clearly very uncertain. The two main findings from the paper are hence that, a) any prediction containing f, and/or some preventive measures, contain a large amount of uncertainty (which is usually not acknowledged well enough), and b) obtaining more accurate estimates of in particular f, should be highly prioritized. Seroprevalence testing of random samples in a community where the epidemic has ended are urgently needed.", "Exercising caution in correlating COVID-19 incidence and mortality rates with BCG vaccination policies due to variable rates of SARS CoV-2 testing TThe Bacillus Calmette-Guerin (BCG) vaccine provides protection against tuberculosis (TB), and is proposed to provide protection to non-TB infectious diseases. The COVID-19 outbreak results from infection with the novel coronavirus SARS-CoV-2 (CoV-2) and was declared a pandemic on March 11th, 2020. We queried whether the BCG vaccine offers protection against CoV-2 infection. We observed that countries with a current universal BCG vaccination policy have a significantly lower COVID-19 incidence than countries which never had a universal BCG policy or had one in the past. However, population density, median age, TB incidence, urban population, and, most significantly, CoV-2 testing rate, were also connected with BCG policy and could potentially confound the analysis. By limiting the analysis to countries with high CoV-2 testing rates, defined as greater than 2,500 tests per million inhabitants, these parameters were no longer statistically associated with BCG policy. When analyzing only countries with high testing rates, there was no longer a significant association between the number of COVID-19 cases per million inhabitants and the BCG vaccination policy. Although preliminary, our analyses indicate that the BCG vaccination may not offer protection against CoV-2 infection. While reporting biases may confound our observations, our findings support exercising caution in determining potential correlation between BCG vaccination and COVID-19 incidence, in part due significantly lower rates of CoV-2 testing per million inhabitants in countries with current universal BCG vaccination policy.", "Untangling factors associated with country-specific COVID-19 incidence, mortality and case fatality rates during the first quarter of 2020 At early stages of the COVID-19 pandemic which we are experiencing, the publicly reported incidence, mortality and case fatality rates (CFR) vary significantly between countries. Here we aim to untangle factors that are associated with the differences during the first quarter of the year 2020. Number of performed COVID-19 tests has a strong correlation with country-specific incidence (p <2\u00d710-16) and mortality rate (p = 5.1\u00d710-8). Using multivariate linear regression we show that incidence and mortality rates correlate significantly with GDP per capita (p = 2.6\u00d710-15 and 7.0\u00d710-4, respectively), country-specific duration of the outbreak (2.6\u00d710-4 and 0.0019), fraction of citizens over 65 years old (p = 0.0049 and 3.8\u00d710-4) and level of press freedom (p = 0.021 and 0.019) which cumulatively explain 80% of variability of incidence and more than 60% of variability of mortality of the disease during the period analyzed. Country hemisphere demonstrated significant correlation only with mortality (p = 0.17 and 0.036) whereas population density (p = 0.94 and p = 0.75) and latitude (p = 0.61 and 0.059) did not reach significance in our model. Case fatality rate is shown to rise as the outbreak progresses (p = 0.028). We rank countries by COVID-19 mortality corrected for incidence and the factors that were shown to affect it, and by CFR corrected for outbreak duration, yielding very similar results. Among the countries where the outbreak started after the 15th of February and with at least 1000 registered patients during the period analyzed, the lowest corrected CFR are seen in Israel, South Africa and Chile. The ranking results should be considered with caution as they do not consider all confounding factors or data reporting biases.", "Radiation therapy considerations during the COVID-19 Pandemic: Literature review and expert opinions ", "Importations of COVID-19 into African countries and risk of onward spread Background The emergence of a novel coronavirus (SARS-CoV-2) in Wuhan, China, at the end of 2019 has caused widespread transmission around the world. As new epicentres in Europe and America have arisen, of particular concern is the increased number of imported coronavirus disease 2019 (COVID-19) cases in Africa, where the impact of the pandemic could be more severe. We aim to estimate the number of COVID-19 cases imported from 12 major epicentres in Europe and America to each African country, as well as the probability of reaching 10,000 infections in total by the end of March, April, and May following viral introduction. Methods We used the reported number of cases imported from the 12 major epicentres in Europe and America to Singapore, as well as flight data, to estimate the number of imported cases in each African country. Under the assumption that Singapore has detected all the imported cases, the estimates for Africa were thus conservative. We then propagated the uncertainty in the imported case count estimates to simulate the onward spread of the virus, until 10,000 infections are reached or the end of May, whichever is earlier. Specifically, 1,000 simulations were run separately under two scenarios, where the reproduction number under the stay-at-home order was assumed to be 1.5 and 1.0 respectively. Findings We estimated Morocco, Algeria, South Africa, Egypt, Tunisia, and Nigeria as having the largest number of COVID-19 cases imported from the 12 major epicentres. Based on our 1,000 simulation runs, Morocco and Algeria's estimated probability of reaching 10,000 infections by end of March was close to 100% under both scenarios. In particular, we identified countries with less than 100 cases in total reported by end of April whilst the estimated probability of reaching 10,000 infections by then was higher than 50% even under the more optimistic scenario. Conclusion Our study highlights particular countries that are likely to reach (or have reached) 10,000 infections far earlier than the reported data suggest, calling for the prioritization of resources to mitigate the further spread of the epidemic.", "Estimation of COVID-19 burden in Egypt \u2013 Authors' reply ", "Exit strategies: optimising feasible surveillance for detection, elimination and ongoing prevention of COVID-19 community transmission Background Following successful implementation of strong containment measures by the community, Australia is now close to the point of eliminating detectable community transmission of COVID-19. We aimed to develop an efficient, rapid and scalable surveillance strategy for detecting all remaining COVID-19 community transmission through exhaustive identification of every active transmission chain. We also identified measures to enable early detection and effective management of any reintroduction of transmission once containment measures are lifted to ensure strong containment measures do not need to be reinstated. Methods We compared efficiency and sensitivity to detect community transmission chains through testing of: hospital cases; primary care fever and cough patients; or asymptomatic community members, using surveillance evaluation methods and mathematical modelling, varying testing capacities and prevalence of COVID-19 and non-COVID-19 fever and cough, and the reproduction number. System requirements for increasing testing to allow exhaustive identification of all transmission chains, and then enable complete follow-up of all cases and contacts within each chain, were assessed per million population. Findings Assuming 20% of cases are asymptomatic and all symptomatic COVID-19 cases present to primary care, with high transmission (R=2.2) there are a median of 13 unrecognised community cases (5 infectious) when a transmission chain is identified through hospital surveillance versus 3 unrecognised cases (1 infectious) through primary care surveillance. 3 unrecognised community upstream community cases themselves are estimated to generate a further 22-33 contacts requiring follow-up. The unrecognised community cases rise to 5 if only 50% of symptomatic cases present to primary care. Screening for asymptomatic disease in the community cannot exhaustively identify all transmission under any of the scenarios assessed. The additional capacity required to screen all fever and cough primary care patients would be approximately 2,000 tests/million population per week using 1/16 pooling of samples. Interpretation Screening all syndromic fever and cough primary care presentations, in combination with exhaustive and meticulous case and contact identification and management, enables appropriate early detection and elimination of community transmission of COVID-19. If testing capacity is limited, interventions such as pooling allow increased case detection, even given reduced test sensitivity. Wider identification and testing of all upstream contacts, (i.e. potential sources of infection for identified cases, and their related transmission chains) is critical, and to be done exhaustively requires more resources than downstream contact tracing. The most important factor in determining the performance of such a surveillance system is community participation in screening and follow up, and as such, appropriate community engagement, messaging and support to encourage presentation and compliance is essential. We provide operational guidance on implementing such a system.", "Test, test, test for COVID-19 antibodies: the importance of sensitivity, specificity and predictive powers Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody tests of varying specificity and sensitivity are now available. For informing individuals whether they have had coronavirus disease 2019 (COVID-19), they need to be very accurate. For measuring population prevalence of past infection, the numbers of false positives and negatives need to be roughly equal. With a series of worked examples for a notional population of 100,000 people, we show that even test systems with a high specificity can yield a large number of false positive results, especially where the population prevalence is low. For example, at a true population prevalence of 5%, using a test with 99% sensitivity and specificity, 16% of positive results will be false and thus 950 people will be incorrectly informed they have had the infection. Further confirmatory testing may be needed. Giving false reassurance on which personal or societal decisions might be based could be harmful for individuals, undermine public confidence and foster further outbreaks.", "Importance of untested infectious individuals for the suppression of COVID-19 epidemics A mathematical model which accounts for tested and untested infectious individuals is calibrated during the early stages of COVID-19 outbreaks in Germany, the Hubei province, Italy, Spain and the UK. The predicted percentage of untested infected individuals depends on the specific outbreak but we found that they typically represent 50% to 80% of the infected individuals. Even when unreported cases are taken into account, we estimate that less than 8% of the population would have been exposed to SARS-CoV-2 by 09/04/2020 in the analysed outbreaks. These levels are far from the 70-85% needed to ensure herd immunity and we predict a resurgence of infection if ongoing lockdowns in the analysed outbreaks are fully lifted. We propose that partially lifted lockdowns together with fast and thorough testing allowing for quick isolation of both symptomatic and asymptomatic cases could lead to suppression of secondary waves of COVID-19 epidemics.", "Understanding Unreported Cases in the COVID-19 Epidemic Outbreak in Wuhan, China, and the Importance of Major Public Health Interventions We develop a mathematical model to provide epidemic predictions for the COVID-19 epidemic in Wuhan, China. We use reported case data up to 31 January 2020 from the Chinese Center for Disease Control and Prevention and the Wuhan Municipal Health Commission to parameterize the model. From the parameterized model, we identify the number of unreported cases. We then use the model to project the epidemic forward with varying levels of public health interventions. The model predictions emphasize the importance of major public health interventions in controlling COVID-19 epidemics.", "A model for COVID-19 transmission in Connecticut To support public health policymakers in Connecticut as they begin phased lifting of social distancing restrictions, we developed a county-structured compartmental SEIR-type model of SARS-CoV-2 transmission and COVID-19 disease progression. We calibrated this model to the local dynamics of deaths and hospitalizations and the exact timing of state interventions, including school closures and stay-at-home order. In this technical report, we describe the details of the model design, implementation and calibration, and show projections of epidemic development through the Summer of 2020 under different assumptions about the increase in contact rates following partial state reopening. Our model results are consistent with high effectiveness of state lockdown measures, but changes in human interaction patterns during the coming months are unknown. In addition, a lot of uncertainty remains with respect to several key epidemiological parameters and the effectiveness of increased testing and contact tracing capacity. As more information becomes available, we will update the projections presented in this report.", "COVID-19: Are Africa\u2019s diagnostic challenges blunting response effectiveness? Since its emergence in Wuhan, China in December 2019, novel Coronavirus disease - 2019 (COVID-19) has rapidly spread worldwide, achieving pandemic status on 11 (th) March, 2020. As of 1 (st) April 2020, COVID-19, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), had infected over 800,000 people and caused over 40,000 deaths in 205 countries and territories. COVID-19 has had its heaviest toll on Europe, United States and China. As of 1 (st) of April 2020, the number of confirmed COVID-19 cases in Africa was relatively low, with the highest number registered by South Africa, which had reported 1,380 confirmed cases. On the same date (also the date of this review), Africa had reported 5,999 confirmed cases, of which 3,838 (almost 65%) occurred in South Africa, Algeria, Egypt, Morocco and Tunisia, with the remaining 2,071 cases distributed unevenly across the other African countries. We speculate that while African nations are currently experiencing much lower rates of COVID-19 relative to other continents, their significantly lower testing rates may grossly underestimate incidence rates. Failure to grasp the true picture may mean crucial windows of opportunity shut unutilized, while limited resources are not deployed to maximum effect. In the absence of extensive testing data, an overestimation of spread may lead to disproportionate measures being taken, causing avoidable strain on livelihoods and economies. Here, based on the African situation, we discuss COVID-19 diagnostic challenges and how they may blunt responses.", "Assessment of Lockdown Effect in Some States and Overall India: A Predictive Mathematical Study on COVID-19 Outbreak In the absence of neither an effective treatment or vaccine and with an incomplete understanding of the epidemiological cycle, Govt. has implemented a nationwide lockdown to reduce COVID-19 transmission in India. To study the effect of social distancing measure, we considered a new mathematical model on COVID-19 that incorporates lockdown effect. By validating our model to the data on notified cases from five different states and overall India, we estimated several epidemiologically important parameters as well as the basic reproduction number ($R_{0}$). Combining the mechanistic mathematical model with different statistical forecast models, we projected notified cases in the six locations for the period May 17, 2020, till May 31, 2020. A global sensitivity analysis is carried out to determine the correlation of two epidemiologically measurable parameters on the lockdown effect and also on $R_{0}$. Our result suggests that lockdown will be effective in those locations where a higher percentage of symptomatic infection exists in the population. Furthermore, a large scale COVID-19 mass testing is required to reduce community infection. Ensemble model forecast suggested a high rise in the COVID-19 notified cases in most of the locations in the coming days. Furthermore, the trend of the effective reproduction number ($R_{t}$) during the projection period indicates if the lockdown measures are completely removed after May 17, 2020, a high spike in notified cases may be seen in those locations. Finally, combining our results, we provided an effective lockdown policy to reduce future COVID-19 transmission in India.", "On the evolutionary epidemiology of SARS-CoV-2 There is no doubt that the novel coronavirus SARS-CoV-2 that causes COVID-19 is mutating and thus has the potential to adapt during the current pandemic. Whether this evolution will lead to changes in the transmission, the duration, or the severity of the disease is not clear. This has led to considerable scientific and media debate, from raising alarms about evolutionary change to dismissing it. Here we review what little is currently known about the evolution of SARS-CoV-2 and extend existing evolutionary theory to consider how selection might be acting upon the virus during the COVID-19 pandemic. While there is currently no definitive evidence that SARS-CoV-2 is undergoing further adaptation, continued, evidence-based, analysis of evolutionary change is important so that public health measures can be adjusted in response to substantive changes in the infectivity or severity of COVID-19.", "One-step RNA extraction for RT-qPCR detection of 2019-nCoV The global outbreak of coronavirus disease 2019 (COVID-19) has placed an unprecedented burden on healthcare systems as the virus spread from the initial 27 reported cases in the city of Wuhan, China to a global pandemic in under three months1. Resources essential to monitoring virus transmission have been challenged with a demand for expanded surveillance. The CDC 2019-nCoV Real-Time Diagnostic Panel uses a real-time reverse transcription quantitative polymerase chain reaction (RT-qPCR) consisting of two TaqMan probe and primer sets specific for the 2019-nCoV N gene, which codes for the nucleocapsid structural protein that encapsulates viral RNA, for the qualitative detection of 2019-nCoV viral RNA in respiratory samples. To isolate RNA from respiratory samples, the CDC lists RNA extraction kits from three manufacturers. In anticipation of a limited supply chain of RNA extraction kits and the need for test scalability, we sought to identify alternative RNA extraction methods. Here we show that direct lysis of respiratory samples can be used in place of RNA extraction kits to run the CDC 2019-nCoV Real-Time Diagnostic assay with the additional benefits of higher throughput, lower cost, faster turnaround and possibly higher senitivity and improved saftey.", "Incorporating and Addressing Testing Bias Within Estimates of Epidemic Dynamics for SARS-CoV-2 The disease burden of SARS-CoV-2 as measured by tests from various countries present varying estimates of infection and fatality rates. Models based on these acquired data may suffer from systematic errors and large estimation variances due to the biases associated with testing and lags between the infection and death counts. Here, we present an augmented compartment model to predict epidemic dynamics while explicitly modeling for the sampling bias involved in testing. Our simulations show that sampling biases in favor of patients with higher disease manifestation could significantly affect direct estimates of infection and fatality rates calculated from the numbers of confirmed cases and deaths, and serological testing can partially mitigate these biased estimates. We further recommend a strategy to obtain unbiased estimates, calculating the dependence of expected confidence on a randomized sample size, showing that relatively small sample sizes can provide statistically significant estimates for SARS-CoV-2 related death rates.", "Laboratory diagnosis of emerging human coronavirus infections \u2013 the state of the art The three unprecedented outbreaks of emerging human coronavirus (HCoV) infections at the beginning of the twenty-first century have highlighted the necessity for readily available, accurate and fast diagnostic testing methods. The laboratory diagnostic methods for human coronavirus infections have evolved substantially, with the development of novel assays as well as the availability of updated tests for emerging ones. Newer laboratory methods are fast, highly sensitive and specific, and are gradually replacing the conventional gold standards. This presentation reviews the current laboratory methods available for testing coronaviruses by focusing on the coronavirus disease 2019 (COVID-19) outbreak going on in Wuhan. Viral pneumonias typically do not result in the production of purulent sputum. Thus, a nasopharyngeal swab is usually the collection method used to obtain a specimen for testing. Nasopharyngeal specimens may miss some infections; a deeper specimen may need to be obtained by bronchoscopy. Alternatively, repeated testing can be used because over time, the likelihood of the SARS-CoV-2 being present in the nasopharynx increases. Several integrated, random-access, point-of-care molecular devices are currently under development for fast and accurate diagnosis of SARS-CoV-2 infections. These assays are simple, fast and safe and can be used in the local hospitals and clinics bearing the burden of identifying and treating patients.", "Clinical meanings of rapid serological assay in patients tested for SARS-Co2 RT-PCR Background RT-PCR test for identifiction of viral nucleic acid is the current standard diagnostic method for the diagnosis of COVID-19 disease but technical reasons limit the utilization of this assay on large scale screenings. Method We verified in a consecutive series of 191 symptomatic patients the clinical information that new rapid serological colorimetric test qualitatively analyzing IgM/IgG expression can provide with respect to standard assay and with respect to clinical outcome of patients. Results Rapid serological test showed a sensitivity of 30% and a specificity of 89% with respect to the standard assay but, interestingly, these performances improve after 8 days of symptoms appearance. After 10 days of symptoms the predictive value of rapid serological test is higher than that of standard assay. When the behaviour of the two immunoglobulins was evaluated with respect to time length of symptoms appearance, no significant difference in immunoglobulins behaviour was shown. Conclusions The rapid serological test analyzed in the present study is candidate to provide information on immunoreaction of the subject to COVID-19 exposure.", "Clinical Testing For Covid-19 Abstract As the novel coronavirus SARS-CoV-2 caused COVID-19 cases in the United States the initial test was developed and performed at the Center for Disease Control (CDC). As the number of cases increased the demand for tests multiplied, leading the CDC to utilize the Emergency Utilization Authorization to allow clinical and commercial laboratories to develop tests to detect the presence of the virus. Many nucleic acid tests based on reverse transcriptase-polymerase chain reaction (RT-PCR) were developed, each with different techniques, specifications and turnaround time. As the illnesses turned into a pandemic, testing became more crucial. The test supply became inadequate to meet the need that it had to be prioritized according to guidance. For surveillance, the need for serologic tests emerged. Here we review the timeline of test development, the turn-around times, the various approved tests and compare them as regards the genes they detect. We concentrate on the point-of-care tests and discuss the basis for new serologic tests. We discuss the testing guidance for prioritization and their application in a hospital setting. As SARS-CoV-2 virus arrived in the USA causing the COVID-19 illness, one of the most talked about issues in the management of the disease and the resulting pandemic has been clinical testing. A unique situation arose of a communicable and highly contagious disease necessitating the rapid diagnosis of patients and the identification of non-symptomatic infected persons. Unfortunately, the USA did not have a Food and Drug Administration (FDA) approved laboratory test for the illness. The FDA ultimately utilized its Emergency Use Authorizations (EUA) on February 4, 2020 to allow for more rapid and widespread development and implementation of in-vitro testing.1 Indeed, companies and organizations utilized the EUA to file applications for new tests based on different methodologies, amounting to 48 applications in the span of 3 months from the beginning of February to the end of April 2020. In addition, multiple other tests were put in place under a separate authorization by a Presidential memorandum in early March allowing laboratories that carry Clinical Laboratory Improvement Amendment (CLIA) certification to put tests in place without an EUA from the FDA. This created an unprecedented situation where the medical community and the public may not be familiar with the various new tests for COVID-19 that are offered to patients and hospitals. The purpose of this review is to provide information, up-to-date as of the date of submission of the manuscript to the journal, on the various tests that have been developed, their scientific basis and their interpretation. We give a real-world example demonstrating the time lag in the return of test results and review testing prioritization guidance since the supply of tests remains below the perceived need.", "Linking Statistics With Testing Policy to Manage COVID-19 in the Community OBJECTIVES: To determine the public health surveillance severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing volume needed, both for acute infection and seroprevalence. METHODS: Required testing volumes were developed using standard statistical methods based on test analytical performance, disease prevalence, desired precision, and population size. RESULTS: Widespread testing for individual health management cannot address surveillance needs. The number of people who must be sampled for public health surveillance and decision making, although not trivial, is potentially in the thousands for any given population or subpopulation, not millions. CONCLUSIONS: While the contributions of diagnostic testing for SARS-CoV-2 have received considerable attention, concerns abound regarding the availability of sufficient testing capacity to meet demand. Different testing goals require different numbers of tests and different testing strategies; testing strategies for national or local disease surveillance, including monitoring of prevalence, receive less attention. Our clinical laboratory and diagnostic infrastructure are capable of incorporating required volumes for many local, regional, and national public health surveillance studies into their current and projected testing capacity. However, testing for surveillance requires careful design and randomization to provide meaningful insights.", "An overview of coronaviruses including the SARS-2 coronavirus \u2013 Molecular biology, epidemiology and clinical implications Abstract Coronavirus infections have emerged as epidemic and pandemic threats in last two decades. After the H1N1 influenza pandemic in 2009, recently diagnosed novel betacoronavirus or severe acute respiratory syndrome coronavirus (SARS-CoV)-2 has spread across 203 countries and territories in all 5 major continents. World Health Organization (WHO) declared this as a public health emergency of international concern on January 30, 2020. Subsequently on February 11, 2020 a new name was given to this disease i.e. COVID-19 by an expert group from WHO. As of April 12, 2020, 10:00 CET, GMT+2:00, 1,696,588 confirmed cases and 105,952 confirmed deaths have been reported to the WHO. (Coronavirus disease 2019, situation report 83). It possibly originated from a small animal market in Wuhan, China. A cluster of patients were admitted with unusual pneumonia not responding to treatment in various hospitals. Epidemiological, genomic analysis and correlation with other coronaviruses led to the isolation of new coronavirus, closely resembling the bat coronaviruses, from such patients in Wuhan. They were identified as the SARS-CoV-2. This virus infection presents as influenza like illness in the affected people. Fever, cough, respiratory distress with fatigue, diarrhea, nausea and vomiting are common symptoms seen in adults. This may progress on to respiratory distress, hypoxia, need for oxygen supplementation and ventilator support as seen in patients in the SARS-CoV-1 epidemic (2003) in Guangdong, China. The transmissibility of SARS-CoV-1 was less as compared to SARS-CoV-2 infection, and it was well controlled with good public health efforts. The present COVID-19 epidemic is still in the acceleration phase of 3 and 4 in various countries. Without any effective antiviral agents available at present, the need of the hour is early case detection, isolation of cases, use of good preventive care measures by the household contacts and in the hospital set up. The results of ongoing clinical trials on hydroxychloroquine, azithromycin alone or in combination and a new antiviral agent remdesivir may help to treat some of the infections. A need for effective vaccine is being seen an as good preventive strategy in this pandemic. However the results of clinical trials and incorporation of vaccines in public health programs is a long way to go.", "Incidence trend of 2019 novel coronavirus diseases (COVID-19) in China/ \u4e0a\u6d77\u9884\u9632\u533b\u5b66 Objective To investigate the epidemical characteristics and analyze the incidence trend of 2019 novel coronavirus diseases (COVID-19) in China. Methods The daily new confirmed cases of 2019 novel coronavirus diseases (COVID-19) in China from January 25 to February 8,2020 were collected for epidemiological descriptive analysis. Results During the period from January 25 to February 8, 2020, the number of daily new confirmed cases fell for five consecutive days, from 890 cases on February 3 to 509 cases on February 8. Conclusion The incidence of 2019 novel coronavirus diseases (COVID-19) slowed down in 30 provinces (autonomous regions and municipalities directly under the central government) except Hubei and Xinjiang production and construction corps , but the overall situation is still not optimistic. It is imperative to pay close attention to the origin and destination of migrant workers and the incidence of disease in various areas, and take targeted measures to strengthen prevention and control of the disease.", "Preliminary epidemiological analysis on children and adolescents with novel coronavirus disease 2019 outside Hubei Province, China: an observational study utilizing crowdsourced data Background: The outbreak of coronavirus disease 2019 (COVID-19) continues to expand across the world. Though both the number of cases and mortality rate in children and adolescents is reported to be low in comparison to adults, limited data has been reported on the outbreak with respect to pediatric patients. To elucidate information, we utilized crowdsourced data to perform a preliminary epidemiologic analysis of pediatric patients with COVID-19 Methods: In this observational study, data was collected from two open-access, line list crowdsourced online databases. Pediatric cases of COVID-19 were defined as patients \u226419 years of age with a laboratory confirmed diagnosis. The primary outcomes were case counts and cumulative case counts. Secondary outcomes included days between symptoms onset and first medical care and days between first medical care and reporting. Tertiary outcomes were rate of travel to Wuhan, rate of infected family members and rates of symptoms. Results: A total of 82 patients were included. The median age was 10 [IQR: 5-15] years. Patients from mainland China (outside Hubei) accounted for 46.3% of cases, while the remaining 53.7% of cases were international. Males and females accounted for 52.4% and 32.9% of cases, respectively, with the remaining 14.6% being designated as unknown. A male skew persisted across subgroup analyses by age group (p=1.0) and location (inside/outside China) (p=0.22). While the number of reported international cases has been steadily increasing over the study period, the number of reported cases in China rapidly decreased from the start point. The median reporting delay was 3 [IQR: 2-4.8] days. The median delay between symptom onset and first seeking medical care was 1 [IQR: 0-3.25] day. In international cases, time to first seeking medical care was a median of 2.5 days longer than in China (p=0.04). When clinical features were reported, fever was the most common presentation (68.0%), followed by cough (36.0%). Conclusions: The number of reported international pediatric COVID-19 cases is rapidly increasing. COVID-19 infections are, to-date, more common in males than females in both the children and adolescent age groups. Additionally, this male predominance remains the case both inside and outside of China. Crowdsourced data enabled early analysis of epidemiologic variables in pediatric patients with COVID-19. Further data sharing is required to enable analyses that are required to understand the course of this infection in children.", "Connecting clusters of COVID-19: an epidemiological and serological investigation Summary Background Elucidation of the chain of disease transmission and identification of the source of coronavirus disease 2019 (COVID-19) infections are crucial for effective disease containment. We describe an epidemiological investigation that, with use of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological assays, established links between three clusters of COVID-19. Methods In Singapore, active case-finding and contact tracing were undertaken for all COVID-19 cases. Diagnosis for acute disease was confirmed with RT-PCR testing. When epidemiological information suggested that people might have been nodes of disease transmission but had recovered from illness, SARS-CoV-2 IgG serology testing was used to establish past infection. Findings Three clusters of COVID-19, comprising 28 locally transmitted cases, were identified in Singapore; these clusters were from two churches (Church A and Church B) and a family gathering. The clusters in Church A and Church B were linked by an individual from Church A (A2), who transmitted SARS-CoV-2 infection to the primary case from Church B (F1) at a family gathering they both attended on Jan 25, 2020. All cases were confirmed by RT-PCR testing because they had active disease, except for A2, who at the time of testing had recovered from their illness and tested negative. This individual was eventually diagnosed with past infection by serological testing. ELISA assays showed an optical density of more than 1\u00b74 for SARS-CoV-2 nucleoprotein and receptor binding domain antigens in titres up to 1/400, and viral neutralisation was noted in titres up to 1/320. Interpretation Development and application of a serological assay has helped to establish connections between COVID-19 clusters in Singapore. Serological testing can have a crucial role in identifying convalescent cases or people with milder disease who might have been missed by other surveillance methods. Funding National Research Foundation (Singapore), National Natural Science Foundation (China), and National Medical Research Council (Singapore).", "Modeling COVID-19 latent prevalence to assess a public health intervention at a state and regional scale Background: Emergence of COVID-19 caught the world off-guard and unprepared, initiating a global pandemic. In the absence of evidence, individual communities had to take timely action to reduce the rate of disease spread and avoid overburdening their healthcare systems. Although a few predictive models have been published to guide these decisions, most have not taken into account spatial differences and have included assumptions that do not match the local realities. Access to reliable information that is adapted to local context is critical for policymakers to make informed decisions during a rapidly evolving pandemic. Objective: The goal of this study was to develop an adapted susceptible-infected-removed (SIR) model to predict the trajectory of the COVID-19 pandemic in North Carolina and the Charlotte metropolitan region and to incorporate the effect of a public health intervention to reduce disease spread, while accounting for unique regional features and imperfect detection. Methods: Three SIR models were fit to prevalence data from the state and the greater Charlotte region and then rigorously compared. One of these models (SIR-Int) accounted for a stay-at-home intervention and imperfect detection of COVID-19 cases. Results: Presently, the COVID-19 outbreak is rapidly decelerating in NC and the Charlotte region. Infection curves are flattening at both the state and regional level. Relatively speaking, the greater Charlotte region has responded more favorably to the stay-at-home intervention than NC as a whole. While an initial basic SIR model served the purpose of informing decision making in the early days of the pandemic, its forecast increasingly did not fit the data over time. However, as the pandemic and local conditions evolved, the SIR-Int model provided a good fit to the data. Conclusions: Using local data and continuous attention to model adaptation, our findings have enabled policymakers, public health officials and health systems to do capacity planning and evaluate the impact of a public health intervention. Our SIR-Int model for estimated latent prevalence was reasonably flexible, highly accurate, and demonstrated the efficacy of a stay-at-home order at both the state and regional level. Our results highlight the importance of incorporating local context into pandemic forecast modeling, as well as the need to remain vigilant and informed by the data as we enter into a critical period of the outbreak.", "Periodic COVID-19 Testing in Emergency Department Staff Background: As the number of COVID-19 cases in the US continues to rise and hospitals are experiencing personal protective equipment (PPE) shortages, healthcare workers have been disproportionately affected by COVID-19 infection. Since COVID-19 testing is now available, some have raised the question of whether we should be routinely testing asymptomatic healthcare workers. Methods: Using publicly available data on COVID-19 infections and emergency department visits, as well as internal hospital staffing information, we generated a mathematical model to predict the impact of periodic COVID-19 testing in asymptomatic members of the emergency department staff in regions affected by COVID-19 infection. We calculated various transmission constants based on the Diamond Princess cruise ship data, used a logistic model to calculate new infections, and we created a Markov model according to average COVID-19 incubation time. Results: Our model predicts that after 30 days, with a transmission constant of 1.219e-4 new infections per person2, weekly COVID-19 testing of healthcare workers (HCW) would reduce new HCW and patient infections by 5.1% and bi-weekly testing would reduce both by 2.3%. At a transmission constant of 3.660e-4 new infections per person,2 weekly testing would reduce infections by 21.1% and bi-weekly testing would reduce infections by 9.7-9.8%. For a lower transmission constant of 4.067e-5 new infections per person2, weekly and biweekly HCW testing would result in a 1.54% and 0.7% reduction in infections respectively. Conclusion: Periodic COVID-19 testing for emergency department staff in regions that are heavily-affected by COVID-19 and/or facing resource constraints may reduce COVID-19 transmission significantly among healthcare workers and previously-uninfected patients.", "The impact of COVID-19 control measures on social contacts and transmission in Kenyan informal settlements Background Many low- and middle-income countries have implemented control measures against coronavirus disease 2019 (COVID-19). However, it is not clear to what extent these measures explain the low numbers of recorded COVID-19 cases and deaths in Africa. One of the main aims of control measures is to reduce respiratory pathogen transmission through direct contact with others. In this study we collect contact data from residents of informal settlements around Nairobi, Kenya to assess if control measures have changed contact patterns, and estimate the impact of changes on the basic reproduction number (R0). Methods We conducted a social contact survey with 213 residents of five informal settlements around Nairobi in early May 2020, four weeks after the Kenyan government introduced enhanced physical distancing measures and a curfew between 7pm and 5am. Respondents were asked to report all direct physical and non-physical contacts made the previous day, alongside a questionnaire asking about the social and economic impact of COVID-19 and control measures. We examined contact patterns by demographic factors, including socioeconomic status. We described the impact of COVID-19 and control measures on income and food security. We compared contact patterns during control measures to patterns from non-pandemic periods to estimate the change in R0. Findings We estimate that control measures reduced physical and non-physical contacts, reducing the R0 from around 2.6 to between 0.5 and 0.7, depending on the pre-COVID-19 comparison matrix used. Masks were worn by at least one person in 92% of contacts. Respondents in the poorest socioeconomic quintile reported 1.5 times more contacts than those in the richest. 86% of respondents reported a total or partial loss of income due to COVID-19, and 74% reported eating less or skipping meals due to having too little money for food. Interpretation COVID-19 control measures have had a large impact on direct contacts and therefore transmission, but have also caused considerable economic and food insecurity. Reductions in R0 are consistent with the linear epidemic growth in Kenya and other sub-Saharan African countries that implemented similar, early control measures. However, negative and inequitable impacts on economic and food security may mean control measures are not sustainable in the longer term.", "Modes of contact and risk of transmission in COVID-19 among close contacts Background Rapid spread of SARS-CoV-2 in Wuhan prompted heightened surveillance in Guangzhou and elsewhere in China. Modes of contact and risk of transmission among close contacts have not been well estimated. Methods We included 4950 closes contacts from Guangzhou, and extracted data including modes of contact, laboratory testing, clinical characteristics of confirmed cases and source cases. We used logistic regression analysis to explore the risk factors associated with infection of close contacts. Results Among 4950 closes contacts, the median age was 38.0 years, and males accounted for 50.2% (2484). During quarantine period, 129 cases (2.6%) were diagnosed, with 8 asymptomatic (6.2%), 49 mild (38.0%), and 5 (3.9%) severe to critical cases. The sensitivity of throat swab was 71.32% and 92.19% at first to second PCR test. Among different modes of contact, household contacts were the most dangerous in catching with infection of COVID-19, with an incidence of 10.2%. As the increase of age for close contacts and severity of source cases, the incidence of COVID-19 presented an increasing trend from 1.8% (0-17 years) to 4.2% (60 or over years), and from 0.33% for asymptomatic, 3.3% for mild, to 6.2% for severe and critical source cases, respectively. Manifestation of expectoration in source cases was also highly associated with an increased risk of infection in their close contacts (13.6%). Secondary cases were in general clinically milder and were less likely to have common symptoms than those of source cases. Conclusions In conclusion, the proportion of asymptomatic and mild infections account for almost half of the confirmed cases among close contacts. The household contacts were the main transmission mode, and clinically more severe cases were more likely to pass the infection to their close contacts. Generally, the secondary cases were clinically milder than those of source cases.", "Using Digital Surveillance Tools for Near Real-Time Mapping of the Risk of International Infectious Disease Spread: Ebola as a Case Study In our increasingly interconnected world, it is crucial to understand the risk of an outbreak originating in one country or region and spreading to the rest of the world. Digital disease surveillance tools such as ProMED and HealthMap have the potential to serve as important early warning systems as well as complement the field surveillance during an ongoing outbreak. Here we present a flexible statistical model that uses data produced from digital surveillance tools (ProMED and HealthMap) to forecast short term incidence trends in a spatially explicit manner. The model was applied to data collected by ProMED and HealthMap during the 2013-2016 West African Ebola epidemic. The model was able to predict each instance of international spread 1 to 4 weeks in advance. Our study highlights the potential and limitations of using publicly available digital surveillance data for assessing outbreak dynamics in real-time.", "Analyzing Vaccine Trials in Epidemics With Mild and Asymptomatic Infection Vaccine efficacy against susceptibility to infection (VE(S)), regardless of symptoms, is an important endpoint of vaccine trials for pathogens with a high proportion of asymptomatic infection, because such infections may contribute to onward transmission and long-term sequelae, such as congenital Zika syndrome. However, estimating VE(S) is resource-intensive. We aimed to identify approaches for accurately estimating VE(S) when limited information is available and resources are constrained. We modeled an individually randomized vaccine trial by generating a network of individuals and simulating an epidemic. The disease natural history followed a \u201csusceptible-exposed-infectious/symptomatic (or infectious/asymptomatic)-recovered\u201d model. We then used 7 approaches to estimate VE(S), and we also estimated vaccine efficacy against progression to symptoms (VE(P)). A corrected relative risk and an interval-censored Cox model accurately estimate VE(S) and only require serological testing of participants once, while a Cox model using only symptomatic infections returns biased estimates. Only acquiring serological endpoints in a 10% sample and imputing the remaining infection statuses yields unbiased VE(S) estimates across values of the basic reproduction number (R(0)) and accurate estimates of VE(P) for higher R(0) values. Identifying resource-preserving methods for accurately estimating VE(S) and VE(P) is important in designing trials for diseases with a high proportion of asymptomatic infection.", "2264. The Burden of Respiratory Viral Illness in HIV-Infected Patients BACKGROUND: Among individuals living with human immunodeficiency virus (HIV), pulmonary complications are the most frequent cause of morbidity and mortality. Although bacterial and fungal pathogens are well-described etiologies of lung disease, the role of respiratory viruses remains poorly understood. We sought to describe the burden of respiratory viral illness in HIV-infected inpatients admitted to our tertiary care center. METHODS: All HIV-infected inpatients from August 2015 to March 2018 were approached if they presented with respiratory symptoms, defined as cough, dyspnea, sore throat, rhinorrhea, wheezing, or stridor. Eighty patients were enrolled. After obtaining informed consent, nasopharyngeal swabs and blood were collected. If the subject underwent bronchoscopy per the treating physician, excess bronchoalveolar lavage (BAL) sample was collected. Demographic and clinical data were recorded for each subject. Multiplex PCR testing of all respiratory samples was performed. RESULTS: Of the 70 HIV-infected patients that have undergone complete analysis, 23 (33%) tested positive for respiratory viruses. Of these, 11 (48%) were positive for rhinovirus, 3 were positive for influenza A (13%), 2 for parainfluenza 3 (9%), 2 for coronavirus (9%), and one each tested positive for adenovirus, parainfluenza 4, respiratory syncytial virus and influenza B. One patient had co-infection with rhinovirus and human metapneumovirus. Patients infected with a respiratory virus had severe illness as nearly half (10/23; 48%) required intensive care, 5 (22%) required mechanical ventilation, 4 (17%) were discharged to a higher level of care, and 3 (13%) died. CONCLUSION: The role of respiratory viruses on the lung health of HIV-infected patients is poorly defined. In this study, respiratory viruses were identified in over a third of HIV-infected inpatients, representing a substantial disease burden. Moreover, these patients demonstrated significant disease severity. Given these findings, there is a need for future studies of viral infections in HIV-infected individuals to elucidate mechanisms of susceptibility to reduce the burden of pulmonary morbidity in this vulnerable population. DISCLOSURES: All authors: No reported disclosures.", "A spatial model to optimise predictions of COVID-19 incidence risk in Belgium using symptoms as reported in a large-scale online survey Although COVID-19 has been spreading throughout Belgium since February, 2020, its spatial dynamics in Belgium remain poorly understood, due to the limited testing of suspected cases. We analyse data of COVID-19 symptoms, as self-reported in a weekly online survey, which is open to all Belgian citizens. We predict symptoms' incidence using binomial models for spatially discrete data, and we introduce these as a covariate in the spatial analysis of COVID-19 incidence, as reported by the Belgian government during the days following a survey round. The symptoms' incidence predictions explain a significant proportion of the variation in the relative risks based on the confirmed cases, and exceedance probability maps of the symptoms' incidence and the confirmed cases' relative risks pinpoint the same high-risk region. We conclude that these results can be used to develop public monitoring tools in scenarios with limited lab testing capacity, and to supplement test-based information otherwise.", "Are antibodies tests accurate? Understanding predictive values and uncertainty of serology tests for the novel coronavirus. Antibodies testing in the coronavirus era is frequently promoted, but the underlying statistics behind their validation has come under more scrutiny in recent weeks. We provide calculations, interpretations, and plots of positive and negative predictive values under a variety of scenarios. Prevalence, sensitivity, and specificity are estimated within ranges of values from researchers and antibodies manufacturers. Illustrative examples are highlighted, and interactive plots are provided in the Supplementary Material. Implications are discussed for society overall and across diverse locations with different levels of disease burden. Specifically, the proportion of positive serology tests that are false can differ drastically from up to 3% to 88% for people from different places with different proportions of infected people in the populations while the false negative rate is typically under 10%.", "[Epidemic trend of corona virus disease 2019 (COVID-19) in mainland China]. Objective: In order to master the epidemic trend of corona virus disease 2019 (COVID-19) and evaluate the effect of prevention and control, we evaluate the epidemic dynamics of COVID-19 in mainland China, Hubei province, Wuhan city and other provinces outside Hubei from January 16 to February 14, 2020. Methods: We collected the daily number of new confirmed COVID-19 cases by nucleic acid detection reported by the National Health Commission from January 16, 2020 to February 14, 2020. The analysis includes the epidemic curve of the new confirmed cases, multiple of the new confirmed cases for period-over-period, multiple of the new confirmed cases for fixed-base, and the period-over-period growth rate of the new confirmed cases. Results: From January 16 to February 14, 2020, the cumulative number of new confirmed cases of COVID-19 in mainland China was 50 031, including 37 930 in Hubei province, 22 883 in Wuhan city and 12 101 in other provinces outside Hubei. The peak of the number of new confirmed cases in other provinces outside Hubei was from January 31 to February 4, 2020, and the peak of new confirmed cases in Wuhan city and Hubei province was from February 5 to February 9, 2020. The number of new confirmed cases in other provinces outside Hubei showed a significant decline (23% compared with the peak) from February 5 to February 9, 2020, while the number of new confirmed cases in Wuhan city (30% compared with the peak) and Hubei Province (37% compared with the peak) decreased significantly from February 10 to February 14, 2020. Conclusion: The epidemic prevention and control measures taken by the state and governments at all levels have shown very significant effects, effectively curbing the spread of the COVID-19 epidemic in China.", "Extrapolation of Infection Data for the CoVid-19 Virus and Estimate of the Pandemic Time Scale. Predictions about the further development of the Corona pandemic are widely diverging. Here, a simple yet powerful algorithm is introduced for extrapolating infection rate and number of total infections from available data. The calculation predicts that under present conditions the infection rate in Germany will culminate in a few weeks and decrease to low values by mid-June 2020. Total number of infections will reach several 100,000 though.", "Modelling the evolution of COVID-19 in high-incidence European countries and regions: estimated number of infections and impact of past and future intervention measures A previously developed mechanistic model of COVID-19 transmission has been adapted and applied here to study the evolution of the disease and the effect of intervention measures in some European countries and territories where the disease had major impact. A clear impact of the major intervention measures on the reproduction number (Rt) has been found in all studied countries and territories, as already suggested by the drop in the number of deaths over time. Interestingly, the impact of such major intervention measures seems to be the same in most of these countries. The model has also provided realistic estimates of the total number of infections, active cases and future outcome. While the predictive capabilities of the model are much more uncertain before the peak of the outbreak, we could still reliably predict the evolution of the disease after a major intervention by assuming the afterwards reproduction number from current study. More challenging is to foresee the long-term impact of softer intervention measures, but this model can estimate the outcome of different scenarios and help planning changes in the implementation of control measures in a given country or region.", "Infectious Disease Outbreak Response: Mind the Rights Gap The international organization responsible for international coordinated response to disease outbreaks\u2014the World Health Organization (WHO)\u2014was given permission to receive reports from sources other than the state in revisions to the International Health Regulations (IHR) in 2005. However, the organization struggles to protect its corresponding right to receive reports from non-state actors on outbreak events. This article examines the consequences of this implementation gap between what is stated in the IHR\u2014the right of WHO to receive reports from non-state actors on outbreak events\u2014and the reality that states remain able and willing to act to ensure that this right is not exercised. The article examines two recent cases: the first detection of Middle East Respiratory Syndrome (MERS) outbreak in Saudi Arabia, and the first months of the Ebola outbreak in Guinea. Both cases demonstrate how the WHO has struggled to balance states\u2019 concern with managing risk communication against WHO\u2019s right to receive reports from non-state actors. The article argues that to realize the full potential of a transparent disease outbreak reporting process, there is a need for a human rights framework that expressly articulates its right to receive reports and outlines appropriate behaviour for the WHO, states, and non-state actors.", "Understanding Economic and Health Factors Impacting the Spread of COVID-19 Disease The rapid spread of the Coronavirus 2019 disease (COVID-19) had drastically impacted life all over the world. While some economies are actively recovering from this pestilence, others are experiencing fast and consistent disease spread, compelling governments to impose social distancing measures that have put a halt on routines, especially in densely-populated areas. Aiming at bringing more light on key economic and public health factors affecting the disease spread, this initial study utilizes a quantitative statistical analysis based on the most recent publicly-available COVID-19 datasets. The study had shown and explained multiple significant relationships between the COVID-19 data and other country-level statistics. We have also identified and statistically profiled four major country-level clusters with relation to different aspects of COVID-19 development and country-level economic and health indicators. Specifically, this study has identified potential COVID-19 under-reporting traits as well as various economic factors that impact COVID-19 Diagnosis, Reporting, and Treatment. Based on the country clusters, we have also described the four disease development scenarios, which are tightly knit to country-level economic and public health factors. Finally, we have highlighted the potential limitation of reporting and measuring COVID-19 and provided recommendations on further in-depth quantitative research.", "COVID-19: Unique public health issues facing Black, Asian and minority ethnic communities Abstract The 2019 coronavirus disease is a serious public health emergency, with serious adverse implications for populations, healthcare systems, and economies globally. Recently, concerns have been raised about possible association between ethnicity, incidence and outcomes of COVID-19 arisen from early government data. In this review, we will explore the possible association using both recent COVID-19 studies and studies of previous pandemics. We call for data on ethnicity to be routinely collected by governments, as part of international collaboration, alongside other patient demographics and further research to robustly determine magnitude of association. Moreover, governments must learn from previous pandemics and recommended strategies to mitigate risks on minority ethnicities due to socioeconomic disadvantages.", "A mathematical model for the spatiotemporal epidemic spreading of COVID19 An outbreak of a novel coronavirus, named SARS-CoV-2, that provokes the COVID-19 disease, was first reported in Hubei, mainland China on 31 December 2019. As of 20 March 2020, cases have been reported in 166 countries/regions, including cases of human-to-human transmission around the world. The proportions of this epidemics is probably one of the largest challenges faced by our interconnected modern societies. According to the current epidemiological reports, the large basic reproduction number, R_0 ~ 2.3, number of secondary cases produced by an infected individual in a population of susceptible individuals, as well as an asymptomatic period (up to 14 days) in which infectious individuals are undetectable without further analysis, pave the way for a major crisis of the national health capacity systems. Recent scientific reports have pointed out that the detected cases of COVID19 at young ages is strikingly short and that lethality is concentrated at large ages. Here we adapt a Microscopic Markov Chain Approach (MMCA) metapopulation mobility model to capture the spread of COVID-19. We propose a model that stratifies the population by ages, and account for the different incidences of the disease at each strata. The model is used to predict the incidence of the epidemics in a spatial population through time, permitting investigation of control measures. The model is applied to the current epidemic in Spain, using the estimates of the epidemiological parameters and the mobility and demographic census data of the national institute of statistics (INE). The results indicate that the peak of incidence will happen in the first half of April 2020 in absence of mobility restrictions. These results can be refined with improved estimates of epidemiological parameters, and can be adapted to precise mobility restrictions at the level of municipalities. The current estimates largely compromises the Spanish health capacity system, in particular that for intensive care units, from the end of March. However, the model allows for the scrutiny of containment measures that can be used for health authorities to forecast with accuracy their impact in prevalence of COVID--19. Here we show by testing different epidemic containment scenarios that we urge to enforce total lockdown to avoid a massive collapse of the Spanish national health system.", "Estimating the undetected infections in the Covid-19 outbreak by harnessing capture-recapture methods A major open question, affecting the policy makers decisions, is the estimation of the true size of COVID-19 infections. Most of them are undetected, because of a large number of asymptomatic cases. We provide an efficient, easy to compute and robust lower bound estimator for the number of undetected cases. A \"modified\" version of the Chao estimator is proposed, based on the cumulative time-series distribution of cases and deaths. Heterogeneity has been accounted for by assuming a geometrical distribution underlying the data generation process. An (approximated) analytical variance formula has been properly derived to compute reliable confidence intervals at 95%. An application to Austrian situation is provided and results from other European Countries are mentioned in the discussion.", "Changing transmission dynamics of COVID-19 in China: a nationwide population-based piecewise mathematical modelling study Background: The first case of COVID-19 atypical pneumonia was reported in Wuhan, China on December 1, 2019. Since then, at least 33 other countries have been affected and there is a possibility of a global outbreak. A tremendous amount of effort has been made to understand its transmission dynamics; however, the temporal and spatial transmission heterogeneity and changing epidemiology have been mostly ignored. The epidemic mechanism of COVID-19 remains largely unclear. Methods: Epidemiological data on COVID-19 in China and daily population movement data from Wuhan to other cities were obtained and analyzed. To describe the transmission dynamics of COVID-19 at different spatio-temporal scales, we used a three-stage continuous-time Susceptible-Exposed-Infectious-Recovered (SEIR) meta-population model based on the characteristics and transmission dynamics of each stage: 1) local epidemic from December 1, 2019 to January 9, 2020; 2) long-distance spread due to the Spring Festival travel rush from January 10 to 22, 2020; and 3) intra-provincial transmission from January 23, 2020 when travel restrictions were imposed. Together with the basic reproduction number (R_0) for mathematical modelling, we also considered the variation in infectivity and introduced the controlled reproduction number (R_c) by assuming that exposed individuals to be infectious; we then simulated the future spread of COVID across Wuhan and all the provinces in mainland China. In addition, we built a novel source tracing algorithm to infer the initial exposed number of individuals in Wuhan on January 10, 2020, to estimate the number of infections early during this epidemic. Findings: The spatial patterns of disease spread were heterogeneous. The estimated controlled reproduction number (R_c) in the neighboring provinces of Hubei province were relatively large, and the nationwide reproduction number (except for Hubei) ranged from 0.98 to 2.74 with an average of 1.79 (95% CI 1.77-1.80). Infectivity was significantly greater for exposed than infectious individuals, and exposed individuals were predicted to have become the major source of infection after January 23. For the epidemic process, most provinces reached their epidemic peak before February 10, 2020. It is expected that the maximum number of infections will be approached by the end of March. The final infectious size is estimated to be about 58,000 for Wuhan, 20,800 for the rest of Hubei province, and 17,000 for the other provinces in mainland China. Moreover, the estimated number of the exposed individuals is much greater than the officially reported number of infectious individuals in Wuhan on January 10, 2020. Interpretation: The transmission dynamics of COVID-19 have been changing over time and were heterogeneous across regions. There was a substantial underestimation of the number of exposed individuals in Wuhan early in the epidemic, and the Spring Festival travel rush played an important role in enhancing and accelerating the spread of COVID-19. However, China's unprecedented large-scale travel restrictions quickly reduced R_c. The next challenge for the control of COVID-19 will be the second great population movement brought by removing these travel restrictions.", "Underreporting of death by COVID-19 in Brazil's second most populous state The COVID-19 pandemic brings to light the reality of the Brazilian health system. The underreporting of COVID-19 deaths in the state of Minas Gerais (MG), where is concentrated the second largest population of the country, reveals government unpreparedness, as there is a low capacity of testing in the population, which prevents the real understanding of the general panorama of Sars-Cov-2 dissemination. The goals of this research are to analyze the causes of deaths in the different Brazilian government databases (ARPEN and SINAN) and to assess whether there are sub-records shown by the unexpected increase in the frequency of deaths from causes clinically similar to COVID-19. A descriptive and quantitative analysis of the number of COVID-19 deaths and similar causes was made in different databases. Ours results demonstrate that the different official sources had a discrepancy of 209.23% between these data referring to the same period. There was also a 648.61% increase in SARS deaths in 2020, when compared to the average of previous years. Finally, it was shown that there was an increase in the rate of pneumonia and respiratory insufficiency (RI) by 5.36% and 5.72%, respectively. In conclusion, there is an underreporting of COVID-19 deaths in MG due to the unexplained excess of SARS deaths, Respiratory insufficiency and pneumonia compared to previous years.", "Internationally lost COVID-19 cases Abstract Background With its epicenter in Wuhan, China, the COVID-19 outbreak was declared a pandemic by the World Health Organization (WHO). While many countries have implemented flight restrictions to China, an increasing number of cases with or without travel background to China are confirmed daily. These developments support concerns on possible unidentified and unreported international COVID-19 cases, which could lead to new local disease epicenters. Methods We have analyzed all available data on the development of international COVID-19 cases from January 20th, 2020 until February 18th, 2020. COVID-19 cases with and without travel history to China were divided into cohorts according to the Healthcare Access and Quality Index (HAQ-Index) of each country. Chi-square and Post-hoc testing were performed. Results While COVID-19 cases with travel history to China seem to peak for each HAQ-cohort, the number of non-travel related COVID-19 cases seem to continuously increase in the HAQ-cohort of countries with higher medical standards. Further analyses demonstrate a significantly lower proportion of reported COVID-19 cases without travel history to China in countries with lower HAQ (HAQ I vs. HAQ II, posthoc p < 0.01). Conclusions Our data indicate that countries with lower HAQ-index may either underreport COVID-19 cases or are unable to adequately detect them. Although our data may be incomplete and must be interpreted with caution, inconsistencies in reporting COVID-19 cases is a serious problem which might sabotage efforts to contain the virus.", "Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review BACKGROUND: Coronavirus disease 2019 (COVID-19) is a rapidly emerging disease that has been classified a pandemic by the World Health Organization (WHO). To support WHO with their recommendations on quarantine, we conducted a rapid review on the effectiveness of quarantine during severe coronavirus outbreaks. OBJECTIVES: We conducted a rapid review to assess the effects of quarantine (alone or in combination with other measures) of individuals who had contact with confirmed cases of COVID-19, who travelled from countries with a declared outbreak, or who live in regions with high transmission of the disease. SEARCH METHODS: An information specialist searched PubMed, Ovid MEDLINE, WHO Global Index Medicus, Embase, and CINAHL on 12 February 2020 and updated the search on 12 March 2020. WHO provided records from daily searches in Chinese databases up to 16 March 2020. SELECTION CRITERIA: Cohort studies, case-control-studies, case series, time series, interrupted time series, and mathematical modelling studies that assessed the effect of any type of quarantine to control COVID-19. We also included studies on SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) as indirect evidence for the current coronavirus outbreak. DATA COLLECTION AND ANALYSIS: Two review authors independently screened 30% of records; a single review author screened the remaining 70%. Two review authors screened all potentially relevant full-text publications independently. One review author extracted data and assessed evidence quality with GRADE and a second review author checked the assessment. We rated the certainty of evidence for the four primary outcomes: incidence, onward transmission, mortality, and resource use. MAIN RESULTS: We included 29 studies; 10 modelling studies on COVID-19, four observational studies and 15 modelling studies on SARS and MERS. Because of the diverse methods of measurement and analysis across the outcomes of interest, we could not conduct a meta-analysis and conducted a narrative synthesis. Due to the type of evidence found for this review, GRADE rates the certainty of the evidence as low to very low. Modeling studies consistently reported a benefit of the simulated quarantine measures, for example, quarantine of people exposed to confirmed or suspected cases averted 44% to 81% incident cases and 31% to 63% of deaths compared to no measures based on different scenarios (incident cases: 4 modelling studies on COVID-19, SARS; mortality: 2 modelling studies on COVID-19, SARS, low-certainty evidence). Very low-certainty evidence suggests that the earlier quarantine measures are implemented, the greater the cost savings (2 modelling studies on SARS). Very low-certainty evidence indicated that the effect of quarantine of travellers from a country with a declared outbreak on reducing incidence and deaths was small (2 modelling studies on SARS). When the models combined quarantine with other prevention and control measures, including school closures, travel restrictions and social distancing, the models demonstrated a larger effect on the reduction of new cases, transmissions and deaths than individual measures alone (incident cases: 4 modelling studies on COVID-19; onward transmission: 2 modelling studies on COVID-19; mortality: 2 modelling studies on COVID-19; low-certainty evidence). Studies on SARS and MERS were consistent with findings from the studies on COVID-19. AUTHORS' CONCLUSIONS: Current evidence for COVID-19 is limited to modelling studies that make parameter assumptions based on the current, fragmented knowledge. Findings consistently indicate that quarantine is important in reducing incidence and mortality during the COVID-19 pandemic. Early implementation of quarantine and combining quarantine with other public health measures is important to ensure effectiveness. In order to maintain the best possible balance of measures, decision makers must constantly monitor the outbreak situation and the impact of the measures implemented. Testing in representative samples in different settings could help assess the true prevalence of infection, and would reduce uncertainty of modelling assumptions. This review was commissioned by WHO and supported by Danube-University-Krems.", "[The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]. Objective: An outbreak of 2019 novel coronavirus diseases (COVID-19) in Wuhan, China has spread quickly nationwide. Here, we report results of a descriptive, exploratory analysis of all cases diagnosed as of February 11, 2020. Methods: All COVID-19 cases reported through February 11, 2020 were extracted from China's Infectious Disease Information System. Analyses included: 1) summary of patient characteristics; 2) examination of age distributions and sex ratios; 3) calculation of case fatality and mortality rates; 4) geo-temporal analysis of viral spread; 5) epidemiological curve construction; and 6) subgroup analysis. Results: A total of 72 314 patient records-44 672 (61.8%) confirmed cases, 16 186 (22.4%) suspected cases, 10567 (14.6%) clinical diagnosed cases (Hubei only), and 889 asymptomatic cases (1.2%)-contributed data for the analysis. Among confirmed cases, most were aged 30-79 years (86.6%), diagnosed in Hubei (74.7%), and considered mild (80.9%). A total of 1 023 deaths occurred among confirmed cases for an overall case-fatality rate of 2.3%. The COVID-19 spread outward from Hubei sometime after December 2019 and by February 11, 2020, 1 386 counties across all 31 provinces were affected. The epidemic curve of onset of symptoms peaked in January 23-26, then began to decline leading up to February 11. A total of 1 716 health workers have become infected and 5 have died (0.3%). Conclusions: The COVID-19 epidemic has spread very quickly. It only took 30 days to expand from Hubei to the rest of Mainland China. With many people returning from a long holiday, China needs to prepare for the possible rebound of the epidemic.", "Update: Public Health Response to the Coronavirus Disease 2019 Outbreak - United States, February 24, 2020. An outbreak of coronavirus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (SARS-CoV-2) began in Wuhan, Hubei Province, China in December 2019, and has spread throughout China and to 31 other countries and territories, including the United States (1). As of February 23, 2020, there were 76,936 reported cases in mainland China and 1,875 cases in locations outside mainland China (1). There have been 2,462 associated deaths worldwide; no deaths have been reported in the United States. Fourteen cases have been diagnosed in the United States, and an additional 39 cases have occurred among repatriated persons from high-risk settings, for a current total of 53 cases within the United States. This report summarizes the aggressive measures (2,3) that CDC, state and local health departments, multiple other federal agencies, and other partners are implementing to slow and try to contain transmission of COVID-19 in the United States. These measures require the identification of cases and contacts of persons with COVID-19 in the United States and the recommended assessment, monitoring, and care of travelers arriving from areas with substantial COVID-19 transmission. Although these measures might not prevent widespread transmission of the virus in the United States, they are being implemented to 1) slow the spread of illness; 2) provide time to better prepare state and local health departments, health care systems, businesses, educational organizations, and the general public in the event that widespread transmission occurs; and 3) better characterize COVID-19 to guide public health recommendations and the development and deployment of medical countermeasures, including diagnostics, therapeutics, and vaccines. U.S. public health authorities are monitoring the situation closely, and CDC is coordinating efforts with the World Health Organization (WHO) and other global partners. Interim guidance is available at https://www.cdc.gov/coronavirus/index.html. As more is learned about this novel virus and this outbreak, CDC will rapidly incorporate new knowledge into guidance for action by CDC, state and local health departments, health care providers, and communities.", "SARS-CoV-2 diagnostic testing in Africa: needs and challenges ", "Disentangling Increased Testing From Covid-19 Epidemic Spread To design effective disease control strategies, it is critical to understand the incidence of diseases. In the Covid-19 epidemic in the United States (caused by outbreak of the SARS-CoV-2 virus), testing capacity was initially very limited and has been increasing at the same time as the virus has been spreading. When estimating the incidence, it can be difficult to distinguish whether increased numbers of positive tests stem from increases in the spread of the virus or increases in testing. This has made it very difficult to identify locations in which the epidemic poses the largest public health risks. Here, we use a probabilistic model to quantify beliefs about testing strategies and understand implications regarding incidence. We apply this model to estimate the incidence in each state of the United States, and find that: (1) the Covid-19 epidemic is likely to be more widespread than reported by limited testing, (2) the Covid-19 epidemic growth in the summer months is likely smaller than it was during the spring months, and (3) the regions which are at highest risk of Covid-19 epidemic outbreaks are not always those with the largest number of positive test results.", "Identification and control are the priority. ", "Estimating the prevalence and risk of COVID-19 among international travelers and evacuees of Wuhan through modeling and case reports Coronavirus disease 2019 (COVID-19) started in Wuhan, China and has spread through other provinces and countries through infected travelers. On January 23(rd), 2020, China issued a quarantine and travel ban on Wuhan because travelers from Wuhan were thought to account for the majority of exported COVID-19 cases to other countries. Additionally, countries evacuated their citizens from Wuhan after institution of the travel ban. Together, these two populations account for the vast majority of the \u201ctotal cases with travel history to China\u201d as designated by the World Health Organization (WHO). The current study aims to assess the prevalence and risk of COVID-19 among international travelers and evacuees of Wuhan. We first used case reports from Japan, Singapore, and Korea to investigate the date of flights of infected travelers. We then used airline traveler data and the number of infected exported cases to correlate the cases with the number of travelers for multiple countries. Our findings suggest that the risk of COVID-19 infection is highest among Wuhan travelers between January 19(th) and 22(nd), 2020, with an approximate infection rate of up to 1.3% among international travelers. We also observed that evacuee infection rates varied heavily between countries and propose that the timing of the evacuation and COVID-19 testing of asymptomatic evacuees played significant roles in the infection rates among evacuees. These findings suggest COVID-19 cases and infectivity are much higher than previous estimates, including numbers from the WHO and the literature, and that some estimates of the infectivity of COVID-19 may need re-assessment.", "Estimating the Unreported Number of Novel Coronavirus (2019-nCoV) Cases in China in the First Half of January 2020: A Data-Driven Modelling Analysis of the Early Outbreak Background: In December 2019, an outbreak of respiratory illness caused by a novel coronavirus (2019-nCoV) emerged in Wuhan, China and has swiftly spread to other parts of China and a number of foreign countries. The 2019-nCoV cases might have been under-reported roughly from 1 to 15 January 2020, and thus we estimated the number of unreported cases and the basic reproduction number, R(0), of 2019-nCoV. Methods: We modelled the epidemic curve of 2019-nCoV cases, in mainland China from 1 December 2019 to 24 January 2020 through the exponential growth. The number of unreported cases was determined by the maximum likelihood estimation. We used the serial intervals (SI) of infection caused by two other well-known coronaviruses (CoV), Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) CoVs, as approximations of the unknown SI for 2019-nCoV to estimate R(0). Results: We confirmed that the initial growth phase followed an exponential growth pattern. The under-reporting was likely to have resulted in 469 (95% CI: 403\u2013540) unreported cases from 1 to 15 January 2020. The reporting rate after 17 January 2020 was likely to have increased 21-fold (95% CI: 18\u201325) in comparison to the situation from 1 to 17 January 2020 on average. We estimated the R(0) of 2019-nCoV at 2.56 (95% CI: 2.49\u20132.63). Conclusion: The under-reporting was likely to have occurred during the first half of January 2020 and should be considered in future investigation.", "How will country-based mitigation measures influence the course of the COVID-19 epidemic? ", "Is Group Testing Ready for Prime-time in Disease Identification? Large scale disease screening is a complicated process in which high costs must be balanced against pressing public health needs. When the goal is screening for infectious disease, one approach is group testing in which samples are initially tested in pools and individual samples are retested only if the initial pooled test was positive. Intuitively, if the prevalence of infection is small, this could result in a large reduction of the total number of tests required. Despite this, the use of group testing in medical studies has been limited, largely due to skepticism about the impact of pooling on the accuracy of a given assay. While there is a large body of research addressing the issue of testing errors in group testing studies, it is customary to assume that the misclassification parameters are known from an external population and/or that the values do not change with the group size. Both of these assumptions are highly questionable for many medical practitioners considering group testing in their study design. In this article, we explore how the failure of these assumptions might impact the efficacy of a group testing design and, consequently, whether group testing is currently feasible for medical screening. Specifically, we look at how incorrect assumptions about the sensitivity function at the design stage can lead to poor estimation of a procedure's overall sensitivity and expected number of tests. Furthermore, if a validation study is used to estimate the pooled misclassification parameters of a given assay, we show that the sample sizes required are so large as to be prohibitive in all but the largest screening programs", "Cumulative incidence and diagnosis of SARS-CoV-2 infection in New York Importance: New York State (NYS) is an epicenter of the United States' COVID-19 epidemic. Reliable estimates of cumulative incidence of SARS-CoV-2 infection in the population are critical to tracking the extent of transmission and informing policies, but US data are lacking, in part because societal closure complicates study conduct. Objective: To estimate the cumulative incidence of SARS-CoV-2 infection and percent of infections diagnosed in New York State, overall and by region, age, sex, and race and ethnicity. Design: Statewide cross-sectional seroprevalence study, conducted April 19-28, 2020. Setting: Grocery stores (n=99) located in 26 counties throughout NYS, which were essential businesses that remained open during a period of societal closure and attract a heterogenous clientele. Participants: Convenience sample of patrons >=18 years and residing in New York State, recruited consecutively upon entering stores and via an in-store flyer. Exposures: Region (New York City, Westchester/Rockland, Long Island, Rest of New York State), age, sex, race and ethnicity. Main Outcomes: Primary outcome: cumulative incidence of SARS-CoV-2 infection, based on dry-blood spot (DBS) SARS-CoV-2 antibody reactivity; secondary outcome: percent of infections diagnosed. Results: Among 15,101 adults with suitable DBS specimens, 1,887 (12.5%) were reactive using a validated SARS-CoV-2 IgG microsphere immunoassay (sensitivity 87.9%, specificity 99.75%). Following post-stratification weighting on region, sex, age, and race and ethnicity and adjustment for assay characteristics, estimated cumulative incidence through March 29 was 14.0% (95% CI: 13.3-14.7%), corresponding to 2,139,300 (95% CI: 2,035,800-2,242,800) infection-experienced adults. Cumulative incidence was higher among Hispanic/Latino (29.2%, 95% CI: 27.2-31.2%), non-Hispanic black/African American (20.2% 95% CI, 18.1-22.3%), and non-Hispanic Asian (12.4%, 95% CI: 9.4-15.4%) adults than non-Hispanic white adults (8.1%, 95% CI: 7.4-8.7%, p<.0001). Cumulative incidence was highest in New York City (NYC) 22.7% (95% CI: 21.5%-24.0). Dividing diagnoses reported to NYS by estimated infection-experienced adults, an estimated 8.9% (95% CI: 8.4-9.3%) of infections were diagnosed, with those [\u2265]55 years most likely to be diagnosed (11.3%, 95% CI: 10.4-12.2%). Conclusions and Relevance: Over 2 million adults were infected through late March 2020, with substantial variations by subpopulations. As this remains below herd immunity thresholds, monitoring, testing, and contact tracing remain essential public health strategies.", "The incidence of the novel coronavirus SARS-CoV-2 among asymptomatic patients: a systematic review BACKGROUND: the recent outbreak of the coronavirus disease 2019 (COVID\u201019) has quickly spread globally since its discovery in Wuhan, China, in December 2019. A comprehensive strategy, including surveillance, diagnostics, research, and clinical treatment is urgently needed to win the battle against COVID-19. Recently, numerous studies reported the incidence of SARS-CoV-2 in asymptomatic patients. Yet, the incidence and viral transmission from the asymptomatic cases are not apparent yet. AIM: this study aims to systematically review the published literature on SARS-CoV-2 in the asymptomatic patients to estimate the incidence of COVID-19 among asymptomatic cases, as well as describe its epidemiological and clinical significance. METHOD: the literature was searched through four scientific databases: PubMed, Web of Science, Scopus, and Science Direct. RESULTS: a total of 63 studies satisfied the inclusion criteria where the majority of the reported studies were from China. However, there was a lack of SARS-CoV-2 epidemiological studies from several countries worldwide, tracing the actual incidence of COVID-19, especially in asymptomatic patients. Studies with a large sample size (n>1000) estimated that percentage of people contracting SARS-CoV-2 and are likely to be asymptomatic ranges from 1.2-12.9%. However, the other studies with a smaller sample size reported a much higher incidence and indicated that up to 87.9% of COVID-19 infected individuals could be asymptomatic. Most of these studies indicated that asymptopatics are a potential source of infection to the community. CONCLUSION: this review highlighted the need for more robust and well-designed studies to better estimate COVID-19 incidence among asymptomatic patients worldwide. The early identification of the asymptomatic cases, as well as monitoring and tracing close contact, could help in mitigating the spread of COVID-19.", "Estimating the extent of true asymptomatic COVID-19 and its potential for community transmission: systematic review and meta-analysis Background: The prevalence of true asymptomatic COVID-19 cases is critical to policy makers considering the effectiveness of mitigation measures against the SARS-CoV-2 pandemic. We aimed to synthesize all available research on the asymptomatic rates and transmission rates where possible. Methods: We searched PubMed, Embase, Cochrane COVID-19 trials, and European PMC for pre-print platforms such as MedRxiv. We included primary studies reporting on asymptomatic prevalence where: (a) the sample frame includes at-risk population, and (b) there was sufficiently long follow up to identify pre-symptomatic cases. Meta-analysis used fixed effect and random effects models. Results: We screened 571 articles and included five low risk-of-bias studies from three countries (China (2), USA (2), Italy (1)) that tested 9,242 at-risk people, of which 413 were positive and 65 were asymptomatic. Diagnosis in all studies was confirmed using a RT-qPCR test. The proportion of asymptomatic cases ranged from 6% to 41%. Meta-analysis (fixed effect) found that the proportion of asymptomatic cases was 16% (95% CI: 12% - 20%) overall; higher in non-aged care 19% (15% - 24%), and lower in long-term aged care 8% (4% - 14%). Two studies provided direct evidence of forward transmission of the infection by asymptomatic cases but suggested lower rates than symptomatic cases. Conclusion: Our estimates of the prevalence of asymptomatic COVID-19 cases are lower than many highly publicized studies, but still substantial. Further robust epidemiological evidence is urgently needed, including in sub-populations such as children, to better understand the importance of asymptomatic cases for driving spread of the pandemic.", "Early trends for SARS\u2010CoV\u20102 infection in central and north Texas and impact on other circulating respiratory viruses Rapid diagnosis and isolation are key to containing the quick spread of a pandemic agent like severe acute respiratory syndrome\u2010related coronavirus 2 (SARS\u2010CoV\u20102), which has spread globally since its initial outbreak in Wuhan province in China. SARS\u2010CoV\u20102 is novel and the effect on typically prevalent seasonal viruses is just becoming apparent. We present our initial data on the prevalence of respiratory viruses in the month of March 2020. This is a retrospective cohort study post launching of SARS\u2010CoV\u20102 testing at Baylor Scott and White Hospital (BSWH), Temple, Texas. Testing for SARS\u2010CoV\u20102 was performed by real\u2010time reverse transcription polymerase chain reaction assay and results were shared with State public health officials for immediate interventions. More than 3500 tests were performed during the first 2 weeks of testing for SARS\u2010CoV\u20102 and identified 168 (4.7%) positive patients. Sixty\u2010two (3.2%) of the 1912 ambulatory patients and 106 (6.3%) of the 1659 emergency department/inpatients tested were positive. The highest rate of infection (6.9%) was seen in patients aged 25 to 34 years, while the lowest rate of infection was seen among patients aged <25 years old (2%). County\u2010specific patient demographic information was shared with respective public health departments for epidemiological interventions. Incidentally, this study showed that there was a significant decrease in the occurrence of seasonal respiratory virus infections, perhaps due to increased epidemiological awareness about SARS\u2010CoV\u20102 among the general public, as well as the social distancing measures implemented in response to SARS\u2010CoV\u20102. Data extracted for BSWH from the Centers for Disease Control and Prevention's National Respiratory and Enteric Virus Surveillance System site revealed that Influenza incidence was 8.7% in March 2020, compared with 25% in March 2019. This study was intended to provide an initial experience of dealing with a pandemic and the role of laboratories in crisis management. This study provided SARS\u2010CoV\u20102 testing data from ambulatory and inpatient population. Epidemiological interventions depend on timely availability of accurate diagnostic tests and throughput capacity of such systems during large outbreaks like SARS\u2010CoV\u20102.", "A framework for identifying regional outbreak and spread of COVID-19 from one-minute population-wide surveys Coronavirus infection spreads in clusters and therefore early identification of these clusters is critical for slowing down the spread of the virus. Here, we propose that daily population-wide surveys that assess the development of symptoms caused by the virus could serve as a strategic and valuable tool for identifying such clusters to inform epidemiologists, public health officials, and policy makers. We show preliminary results from a survey of over 38,000 Israelis and call for an international consortium to extend this concept in order to develop predictive models. We expect such data to allow: Faster detection of spreading zones and patients; Obtaining a current snapshot of the number of people in each area who have developed symptoms; Predicting future spreading zones several days before an outbreak occurs; Evaluating the effectiveness of the various social distancing measures taken, and their contribution to reduce the number of symptomatic people. Such information can provide a valuable tool for decision makers to decide which areas need strengthening of social distancing measures and which areas can be relieved. Researchers from the U.S, Spain, and Italy have adopted our approach and we are collaborating to further improve it. We call with urgency for other countries to join this international consortium, and to share methods and data collected from these daily, simple, one-minute surveys.", "Population age structure only partially explains the large number of COVID-19 deaths at the oldest ages To date any attention paid to the age shape of COVID-19 deaths has been mostly in relation to attempts to understand the differences in case fatality rates between countries. The aim of this paper is to explore differences in age distribution of deaths from COVID-19 among European countries which have old age structures. We do this by way of a cross-country comparison and put forward some reasons for potential differences.", "Accounting for underreporting in mathematical modelling of transmission and control of COVID-19 in Iran BACKGROUND: Iran has been the hardest hit country by the outbreak of SARS-CoV-2 in the Middle East with 74,877 confirmed cases and 4,683 deaths as of 15 April 2020. With a relatively high case fatality ratio and limited testing capacity, the number of confirmed cases reported is suspected to suffer from significant under-reporting. Therefore, understanding the transmission dynamics of COVID-19 and assessing the effectiveness of the interventions that have taken place in Iran while accounting for the uncertain level of underreporting is of critical importance. We use a mathematical epidemic model utilizing official confirmed data and estimates of underreporting to understand how transmission in Iran has been changing between February and April 2020. METHODS: We developed a compartmental transmission model to estimate the effective reproduction number and its fluctuations since the beginning of the outbreak in Iran. We associate the variations in the effective reproduction number with a timeline of interventions and national events. The estimation method also accounts for the underreporting due to low case ascertainment by estimating the percentage of symptomatic cases using delay adjusted case fatality ratio based on the distribution of the delay from hospitalization to death. FINDINGS: Our estimates of the effective reproduction number ranged from 0.66 to 1.73 between February and April 2020, with a median of 1.16. We estimate a reduction in the effective reproduction number during this period, from 1.73 (95% CI 1.60-1.87) on 1 March 2020 to 0.69 (95% CI 0.68-0.70) on 15 April 2020, due to various non-pharmaceutical interventions including school closures, a ban on public gatherings including sports and religious events, and full or partial closure of non-essential businesses. Based on these estimates and given that a near complete containment is no longer feasible, it is likely that the outbreak may continue until the end of the 2020 if the current level of physical distancing and interventions continue and no effective vaccination or therapeutic are developed and made widely available. INTERPRETATION: The series of non-pharmaceutical interventions and the public compliance that took place in Iran are found to be effective in slowing down the speed of the spread of COVID-19 within the studied time period. However, we argue that if the impact of underreporting is overlooked, the estimated transmission and control dynamics could mislead the public health decisions, policy makers, and general public especially in the earlier stages of the outbreak. FUNDING: Nil.", "Testing Case Number of Coronavirus Disease 2019 in China with Newcomb-Benford Law The coronavirus disease 2019 bursted out about two months ago in Wuhan has caused the death of more than a thousand people. China is fighting hard against the epidemics with the helps from all over the world. On the other hand, there appear to be doubts on the reported case number. In this article, we propose a test of the reported case number of coronavirus disease 2019 in China with Newcomb-Benford law. We find a $p$-value of $92.8\\%$ in favour that the cumulative case numbers abide by the Newcomb-Benford law. Even though the reported case number can be lower than the real number of affected people due to various reasons, this test does not seem to indicate the detection of frauds.", "Using random testing in a feedback-control loop to manage a safe exit from the COVID-19 lockdown We argue that frequent sampling of the fraction of infected people (either by random testing or by analysis of sewage water), is central to managing the COVID-19 pandemic because it both measures in real time the key variable controlled by restrictive measures, and anticipates the load on the healthcare system due to progression of the disease. Knowledge of random testing outcomes will (i) significantly improve the predictability of the pandemic, (ii) allow informed and optimized decisions on how to modify restrictive measures, with much shorter delay times than the present ones, and (iii) enable the real-time assessment of the efficiency of new means to reduce transmission rates. Here we suggest, irrespective of the size of a suitably homogeneous population, a conservative estimate of 15000 for the number of randomly tested people per day which will suffice to obtain reliable data about the current fraction of infections and its evolution in time, thus enabling close to real-time assessment of the quantitative effect of restrictive measures. Still higher testing capacity permits detection of geographical differences in spreading rates. Furthermore and most importantly, with daily sampling in place, a reboot could be attempted while the fraction of infected people is still an order of magnitude higher than the level required for a relaxation of restrictions with testing focused on symptomatic individuals. This is demonstrated by considering a feedback and control model of mitigation where the feed-back is derived from noisy sampling data.", "News from the front: Excess mortality and life expectancy in two major epicentres of the COVID-19 pandemic in Italy Existing studies commonly rely on national official reports to estimate the impact of COVID-19 on population health and human life. However, relying on national reports is problematic because classification and estimation of COVID-19 mortality are not consistent across countries. Likewise, delay coronavirus test results and shortage of testing kits can result in undercounting of coronavirus deaths. To overcome these problems, this study exploits all cause daily death registrations data provide by the Italian Statistical Office (ISTAT) from 1st January to 4th April 2020. This allows us to: 1) calculate excess mortality in 2020 compared to the years 2015 to 2019; and 2) estimate life expectancy on a seasonal and annual basis. We focus our analysis on Bergamo and Brescia, the two hardest hit provinces in Lombardy, northern Italy. Given the clustering nature of the epidemic, focusing on the areas with high concentration of severe illness and deaths allows us to capture the true impact of COVID-19 on mortality and life expectancy, which are likely to be underestimated in the national level data. We find that on the period 1 Jan to 4 April 2020, seasonal life expectancy in Bergamo reduced by around 8.1 and 6.5 years compared to 2019 for men and women respectively (4.5 and 3.4 years in Brescia). The drop in period life expectancy for 2020 may total up to 3 years in the case of men and 2 years in the case of women. Such a sharp decrease in life expectancy has not been experienced in modern history since the Second World War. This study shows that, in the absence of public health interventions to reduce the spread of the virus, COVID-19 has set life expectancy in Bergamo and Brescia back to the Italian life expectancy of 15 years ago.", "Global epidemiology of coronavirus disease 2019 (COVID-19): disease incidence, daily cumulative index, mortality, and their association with country healthcare resources and economic status ABSTRACT It has been 2 months since the first case of coronavirus disease 2019 (COVID-19) was reported in Wuhan, China. So far, COVID-19 has affected 85 403 patients in 57 countries/territories and has caused 2924 deaths in 9 countries. However, epidemiological data differ between countries. Although China had higher morbidity and mortality than other sites, the number of new daily cases in China has been lower than outside of China since 26 February 2020. The incidence ranged from 61.44 per 1 000 000 people in the Republic of Korea to 0.0002 per 1 000 000 people in India. The daily cumulative index (DCI) of COVID-19 (cumulative cases/no. of days between the first reported case and 29 February 2020) was greatest in China (1320.85), followed by the Republic of Korea (78.78), Iran (43.11) and Italy (30.62). However, the DCIs in other countries/territories were <10 per day. Several effective measures including restricting travel from China, controlling the distribution of masks, extensive investigation of COVID-19 spread, and once-daily press conferences by the government to inform and educate people were aggressively conducted in Taiwan. This is probably the reason why there was only 39 cases (as of 29 February 2020) with a DCI of 1 case per day in Taiwan, which is much lower than that of nearby countries such as the Republic of Korea and Japan. In addition, the incidence and mortality were correlated with the DCI. However, further study and continued monitoring are needed to better understand the underlying mechanism of COVID-19.", "Using observational data to quantify bias of traveller-derived COVID-19 prevalence estimates in Wuhan, China BACKGROUND: The incidence of coronavirus disease 2019 (COVID-19) in Wuhan, China, has been estimated using imported case counts of international travellers, generally under the assumptions that all cases of the disease in travellers have been ascertained and that infection prevalence in travellers and residents is the same. However, findings indicate variation among locations in the capacity for detection of imported cases. Singapore has had very strong epidemiological surveillance and contact tracing capacity during previous infectious disease outbreaks and has consistently shown high sensitivity of case-detection during the COVID-19 outbreak. METHODS: We used a Bayesian modelling approach to estimate the relative capacity for detection of imported cases of COVID-19 for 194 locations (excluding China) compared with that for Singapore. We also built a simple mathematical model of the point prevalence of infection in visitors to an epicentre relative to that in residents. FINDINGS: The weighted global ability to detect Wuhan-to-location imported cases of COVID-19 was estimated to be 38% (95% highest posterior density interval [HPDI] 22\u201364) of Singapore's capacity. This value is equivalent to 2\u00b78 (95% HPDI 1\u00b75\u20134\u00b74) times the current number of imported and reported cases that could have been detected if all locations had had the same detection capacity as Singapore. Using the second component of the Global Health Security index to stratify likely case-detection capacities, the ability to detect imported cases relative to Singapore was 40% (95% HPDI 22\u201367) among locations with high surveillance capacity, 37% (18\u201368) among locations with medium surveillance capacity, and 11% (0\u201342) among locations with low surveillance capacity. Treating all travellers as if they were residents (rather than accounting for the brief stay of some of these travellers in Wuhan) contributed modestly to underestimation of prevalence. INTERPRETATION: Estimates of case counts in Wuhan based on assumptions of 100% detection in travellers could have been underestimated by several fold. Furthermore, severity estimates will be inflated several fold since they also rely on case count estimates. Finally, our model supports evidence that underdetected cases of COVID-19 have probably spread in most locations around the world, with greatest risk in locations of low detection capacity and high connectivity to the epicentre of the outbreak. FUNDING: US National Institute of General Medical Sciences, and Fellowship Foundation Ramon Areces.", "Adjusted fatality rates of COVID19 pandemic: a comparison across countries Background: A key impact measure of COVID-19 pandemic is the case fatality rate (CFR), but estimating it during an epidemic is challenging as the true number of cases may remain elusive. Objective: To estimate the CFR applying a delay-adjusted method across countries, exploring differences to simple methods and potential correlation to country level variables. Methods: Secondary analysis of publicly available data from countries with [\u2265]500 cases by April 30th. We calculated CFR adjusting for delay time from diagnosis to death and using simple methods for comparison. We performed a random effects meta-analysis to pooling CFRs for all countries and for those with high testing coverage and low positivity rate. We explored correlation of adjusted CFR with age structure and health care resources at country level. Results: We included 107 countries and the Diamond Princess cruise-ship. The overall delay adjusted CFR was 2.8% (95%CI: 2.1 to 3.1) while naive CFR was 5.1% (95%CI: 4.1 to 6.2). In countries with high testing coverage/low positivity rate the pooled adjusted CFR was 2.1% (95%CI: 1.5 to 3.0), there was a correlation with age over 65 years ({beta} = 0.12; 95%CI: 0.06 to 0.18), but not with number of physician or critical care beds. Naive method underestimated the CFR of the CFR with a median of 1.3% across countries. Conclusion: Our best estimation of CFR across countries is 2% and varies according to the aged population size. Modelers and policy makers may consider these results to assess the impact of lockdowns or other mitigation policies.", "Public health measures to slow community spread of COVID-19 ;The Journal of Infectious Diseases ;Oxford Academic COVID-19 was initially identified in an outbreak of viral pneumonia in Wuhan in December 2019, and has now been recognized in 77 countries with over 90,000 laboratory-confirmed cases and over 3,000 deaths as of 3 March 2020 [1] The epidemiology of COVID-19 has recently become clearer as incident cases continue to rise and researchers refine estimates of the severity, transmissibility, and populations affected Based on available data, COVID-19 is efficiently transmitted in the community, and the proportion of infections leading to severe illness is particularly high among adults \u226550 years of age and among individuals with comorbid health conditions Although rare, severe cases have also been reported among younger individuals Thus far, the estimated basic reproductive number (R0) of COVID-19 is higher than that of influenza [2], as is the case fatality risk for adults and older individuals An estimated 80% of COVID-19 cases are mild [1] This is not a glass half full statistic, as 20% of infections result in clinically severe cases that have the potential to overwhelm already overburdened health facilities Given the lack of vaccines and effective antivirals, nonpharmaceutical interventions (NPIs) are the most effective available interventions for local and global control and mitigation of COVID-19 To date, measures aimed at slowing introduction of infection globally have included travel restrictions, isolation of confirmed cases, and quarantine of exposed persons In the United States, NPIs have reduced the number of infected persons entering the country, but recent outbreaks in multiple US states make it clear that these measures have delayed but not prevented community transmission In 2009, NPIs were able to delay large epidemic waves of pandemic influenza A(H1N1)pdm09 in some locations until after the summer, since influenza transmission tends to be reduced by higher temperatures and humidity It is unclear whether COVID-19 transmission will be heavily affected by seasonal weather variation, given that transmission is now occurring in multiple tropical and sub-tropical locations", "Estimating the daily trend in the size of the COVID-19 infected population in Wuhan There has been an outbreak of coronavirus disease (COVID-19) in Wuhan city, Hubei province, China since December 2019. Cases have been exported to other parts of China and more than 20 countries. We provide estimates of the daily trend in the size of the epidemic in Wuhan based on detailed information of 10,940 confirmed cases outside Hubei province.", "Estimates of the Undetected Rate among the SARS-CoV-2 Infected using Testing Data from Iceland Testing for SARS-CoV-2 in the United States is currently targeted to individuals whose symptoms and/or jobs place them at a high presumed risk of infection. An open question is, what is the share of infections that are undetected under current testing guidelines? To answer this question, we turn to COVID-19 testing data from Iceland. The criteria for testing within the Icelandic medical system, processed by the National University Hospital of Iceland (NUHI), have also been targeted at high-risk individuals, but additionally most Icelanders qualify for voluntary testing through the biopharmaceutical company deCODE genetics. We use results from Iceland's two testing programs to estimate the share of infections that are undetected under standard (NUHI) testing guidelines. Because of complications in the deCODE testing regime, it is not possible to estimate a single value for this this undetected rate; however, a range can be estimated. Our primary estimates for the fraction of infections that are undetected range from 88.7% to 93.6%.", "Modelling transmission and control of the COVID-19 pandemic in Australia We develop an agent-based model for a fine-grained computational simulation of the ongoing COVID-19 pandemic in Australia. This model is calibrated to reproduce key characteristics of COVID-19 transmission. An important calibration outcome is the age-dependent fraction of symptomatic cases, with this fraction for children found to be one-fifth of such fraction for adults. We apply the model to compare several intervention strategies, including restrictions on international air travel, case isolation, home quarantine, social distancing with varying levels of compliance, and school closures. School closures are not found to bring decisive benefits, unless coupled with high level of social distancing compliance. We report several trade-offs, and an important transition across the levels of social distancing compliance, in the range between 70% and 80% levels, with compliance at the 90% level found to control the disease within 13--14 weeks, when coupled with effective case isolation and international travel restrictions.", "Estimating the early death toll of COVID-19 in the United States BACKGROUND: Efforts to track the severity and public health impact of the novel coronavirus, COVID-19, in the US have been hampered by testing issues, reporting lags, and inconsistency between states. Evaluating unexplained increases in deaths attributed to broad outcomes, such as pneumonia and influenza (P&I) or all causes, can provide a more complete and consistent picture of the burden caused by COVID-19. METHODS: We evaluated increases in the occurrence of deaths due to P&I above a seasonal baseline (adjusted for influenza activity) or due to any cause across the United States in February and March 2020. These estimates are compared with reported deaths due to COVID-19 and with testing data. RESULTS: There were notable increases in the rate of death due to P&I in February and March 2020. In a number of states, these deaths pre-dated increases in COVID-19 testing rates and were not counted in official records as related to COVID-19. There was substantial variability between states in the discrepancy between reported rates of death due to COVID-19 and the estimated burden of excess deaths due to P&I. The increase in all-cause deaths in New York and New Jersey is 1.5\u20133 times higher than the official tally of COVID-19 confirmed deaths or the estimated excess death due to P&I. CONCLUSIONS: Excess P&I deaths provide a conservative estimate of COVID-19 burden and indicate that COVID-19-related deaths are missed in locations with inadequate testing or intense pandemic activity.", "On Accelerated Testing for COVID-19 Using Group Testing COVID-19 has resulted in a global health crisis that may become even more acute over the upcoming months. One of the main reasons behind the current rapid growth of COVID-19 in the U.S. population is the limited availability of testing kits and the relatively-high cost of screening tests. In this draft, we demonstrate the effectiveness of group testing (pooling) ideas to accelerate testing for COVID-19. This draft is semi-tutorial in nature and is written for a broad audience with interest in mathematical formulations relevant to COVID-19 testing. Therefore, ideas are presented through illustrative examples rather than through purely theoretical formulations. The focus is also on pools of size less than 64 such as what is practical with current RT-PCR technology.", "Variation of positiveness to enhance testing of specimens during an epidemic Rapid testing of appropriate specimens from patients suspected for a disease during an epidemic, such as the current Coronavirus outbreak, is of a great importance for the disease management and control. We propose a method to enhance processing large amounts of collected samples. The method is based on mixing samples in testing tubes in a specific configuration, as opposed to testing single samples in each tube, and accounting for natural virus amounts in infected patients from variation of positiveness in test tubes. To illustrate the efficiency of the suggested method we carry out numerical tests for actual scenarios under various tests. Applying the proposed method enhances the number of tests by order of magnitudes, where all positives are identified with no false negatives, and the effective testing time can be reduced drastically even when the uncertainty in the test is relatively high.", "Dynamic profile for the detection of anti-SARS-CoV-2 antibodies using four immunochromatographic assays Abstract In order to fight the SARS-CoV-2 pandemic infection, there is a growing need and demand for diagnostic tools that are complementary and different from the RT-PCR currently in use. Multiple serological tests are or will be very soon available but need to be evaluated and validated. We have thus tested 4 immunochromatographic tests for the detection of antibodies to SARS-CoV-2. In addition, we assessed the kinetics of antibody appearance using these assays in 22 patients after they were tested positive by RT-PCR. We observed great heterogeneity in antiboy detection post-symptom onset. The median antibody detection time was between 8 and 10 days according to the manufacturers. All the tests showed a sensitivity of 60 to 80% on day 10 and 100% on day 15. In addition, a single cross-reaction was observed with other human coronavirus infections. Thus, immunochromatographic tests for the detection of anti-SARS-CoV-2 antibodies may have their place for the diagnostic panel of COVID-19.", "Importance of diagnostics in epidemic and pandemic preparedness Diagnostics are fundamental for successful outbreak containment. In this supplement, \u2018Diagnostic preparedness for WHO Blueprint pathogens\u2019, we describe specific diagnostic challenges presented by selected priority pathogens most likely to cause future epidemics. Some challenges to diagnostic preparedness are common to all outbreak situations, as highlighted by recent outbreaks of Ebola, Zika and yellow fever. In this article, we review these overarching challenges and explore potential solutions. Challenges include fragmented and unreliable funding pathways, limited access to specimens and reagents, inadequate diagnostic testing capacity at both national and community levels of healthcare and lack of incentives for companies to develop and manufacture diagnostics for priority pathogens during non-outbreak periods. Addressing these challenges in an efficient and effective way will require multiple stakeholders\u2014public and private\u2014coordinated in implementing a holistic approach to diagnostics preparedness. All require strengthening of healthcare system diagnostic capacity (including surveillance and education of healthcare workers), establishment of sustainable financing and market strategies and integration of diagnostics with existing mechanisms. Identifying overlaps in diagnostic development needs across different priority pathogens would allow more timely and cost-effective use of resources than a pathogen by pathogen approach; target product profiles for diagnostics should be refined accordingly. We recommend the establishment of a global forum to bring together representatives from all key stakeholders required for the response to develop a coordinated implementation plan. In addition, we should explore if and how existing mechanisms to address challenges to the vaccines sector, such as Coalition for Epidemic Preparedness Innovations and Gavi, could be expanded to cover diagnostics.", "COVID-19, Australia: Epidemiology Report 16 (Reporting week to 23:59 AEST 17 May 2020) Confirmed cases in Australia notified up to 17 May 2020: notifications = 7,075; deaths = 100. The incidence of new cases of COVID-19 has reduced dramatically since a peak in mid-March. Social distancing measures, public health action and the reduction in international travel have likely been effective in slowing the spread of the disease, in the Australian community. Testing rates over the past week have increased markedly, with a continued very low proportion of people testing positive. These low rates of detection are indicative of low levels of COVID-19 transmission. It is important that testing rates and community adherence to public health measures remain high to support the continued suppression of the virus, particularly in vulnerable high-risk groups and settings. New cases of COVID-19 are currently being reported by by only some jurisdictions, albeit at relatively low rates. Although case numbers are low, new cases tend to still be a mix of overseas-acquired and locally-acquired infections. Most locally-acquired cases can be linked back to a known case or cluster. Although the proportion of locally-acquired cases has increased, the overall rate of new cases, regardless of place of acquisition, continues to decrease. The crude case fatality rate in Australia remains low (1.4%), compared with the WHO reported global rate (6.9%). The low case fatality rate is likely reflective of high case detection and high quality of health care services in Australia. Deaths from COVID-19 in Australia have occurred predominantly among the elderly and those with comorbidities, with no deaths occurring in those under 40 years. The highest rate of COVID-19 continues to be among people aged 60-79 years. One third of all cases in this age group have been associated with several outbreaks linked to cruise ships. The lowest rate of disease is in young children, a pattern reflected in international reports. Internationally, while the number of new cases each day remains relatively stable at the global level, some areas such as Brazil and India are showing a dramatic rise in reported cases. Although some low-income countries have so far reported few cases, it is possible that this is due to limited diagnostic and public health capacity, and may not be reflective of true disease incidence.", "Testing Asymptomatic Emergency Department Patients for Coronavirus Disease 2019 (COVID-19) in a Low-prevalence Region ", "Transmission and epidemiological characteristics of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infected Pneumonia (COVID-19): preliminary evidence obtained in comparison with 2003-SARS Objectives: Latest epidemic data of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infected Pneumonia (COVID-19) was collected and a detailed statistical analysis was carried out to make comparison with 2003-SARS in order to provide scientific reference for the prevention and control of COVID-19. Methods: The information of COVID-19 and 2003-SARS from websites of NHCPRC and the World Health Organization was collected, and then the transmission dynamics of the two kinds of infectious diseases were analyzed. The information of 853 confirmed COVID-19 patients obtained from the website of health committees of 18 provinces. A descriptive epidemiological analysis method was employed to carefully analyze the epidemic characteristics. Subsequently, the COVID-19 epidemic data in Wuhan and other inland regions of China was analyzed separately and compared. A multivariate function model was constructed based on the confirmed COVID-19 case data. Results: The growth rate of new cases and deaths of COVID-19 were significantly faster than those of 2003-SARS. The number of confirmed cases in Wuhan and other inland areas both showed increasing trends. 853 confirmed COVID-19 cases aged 1 months to 94 years and the average age was (45.05 \u00b1 17.22) years. The gender ratio (M: F) was 1.12: 1. Conclusions: The fatality rate of COVID-19 is lower than that of 2003-SARS and the cure rate is higher. The age of COVID-19 patients is mainly concentrated in the 30-50 years old (60.61%). The harm of the first-generation COVID-19 patients is higher than that of secondary cases.", "Group Testing for COVID-19: How to Stop Worrying and Test More The corona virus disease 2019 (COVID-19) caused by the novel corona virus has an exponential rate of infection. COVID-19 is particularly notorious as the onset of symptoms in infected patients are usually delayed and there exists a large number of asymptomatic carriers. In order to prevent overwhelming of medical facilities and large fatality rate, early stage testing and diagnosis are key requirements. In this article, we discuss the methodologies from the group testing literature and its relevance to COVID-19 diagnosis. Specifically, we investigate the efficiency of group testing using polymerase chain reaction (PCR) for COVID-19. Group testing is a method in which multiple samples are pooled together in groups and fewer tests are performed on these groups to discern all the infected samples. We study the effect of dilution due to pooling in group testing and show that group tests can perform well even in the presence of dilution effects. We present multiple group testing algorithms that could reduce the number of tests performed for COVID-19 diagnosis. We analyze the efficiency of these tests and provide insights on their practical relevance. With the use of algorithms described here, test plans can be developed that can enable testing centers to increase the number of diagnosis performed without increasing the number of PCR tests. The codes for generating test plans are available online at [1].", "Estimating Preventable COVID19 Infections Related to Elective Outpatient Surgery in Washington State: A Quantitative Model Background: As the number of suspected and confirmed COVID19 cases in the US continues to rise, the US surgeon general, Centers for Disease Control and Prevention, and several specialty societies have issued recommendations to consider canceling elective surgeries. However, these recommendations have also faced controversy and opposition. Objective: The goal of this study is to provide a quantitative analysis and model for preventable COVID19 infections from elective outpatient or ambulatory surgery cases, which can also be adapted to analyze COVID19 transmission in other healthcare settings. Furthermore, given the controversy over the appropriate handling of elective surgical cases during this pandemic, we hope that our results may have a positive impact on health policy and public health. Methods: Using previously published information on elective ambulatory or outpatient surgical procedures and publicly available data on COVID19 infections in the US and on the Diamond Princess cruise ship, we calculated a transmission rate and generated a mathematical model to predict a lower bound for the number of healthcare-acquired COVID19 infections that could be prevented by canceling or postponing elective outpatient surgeries in Washington state. Results: Our model predicts that over the course of 30 days, at least 2445 preventable patient infections and at least 1557 preventable healthcare worker (HCW) infections would occur in WA state alone if elective outpatient procedures were to continue as usual. The majority of these infections are caused by transmission from HCW who became infected at work. Conclusion: Given the large numbers of COVID19 infections that could be prevented by canceling elective outpatient surgeries, our findings support the recommendations of the US Surgeon General, CDC, American College of Surgeons (ACS), American Society of Anesthesiologists (ASA), and Anesthesia Patient Safety Foundation (APSF) to consider rescheduling or postponing elective surgeries until the COVID19 pandemic is under better control in the US.", "Confronting Another Pandemic: Lessons from HIV can Inform Our COVID-19 Response The novel coronavirus 2019 illness (COVID-19) has completely transformed and uprooted lives across the globe. While different diseases, there are critical observations and lessons to be learned from the ongoing HIV epidemic to inform our response to COVID-19. We reflect on how this relates to (1) testing, including contact tracing; (2) health system redesign; (3) telehealth; (4) health disparities; (5) political denial, with inadequate and uncoordinated governmental response; (6) occupational exposure; and (7) complex reactions among healthcare providers. Decades of experiences with HIV provide an important framework for moving forward as we combat COVID-19.", "Reconstructing and forecasting the COVID-19 epidemic in the United States using a 5-parameter logistic growth model BACKGROUND: Many studies have modeled and predicted the spread of COVID-19 (coronavirus disease 2019) in the U.S. using data that begins with the first reported cases. However, the shortage of testing services to detect infected persons makes this approach subject to error due to its underdetection of early cases in the U.S. Our new approach overcomes this limitation and provides data supporting the public policy decisions intended to combat the spread of COVID-19 epidemic. METHODS: We used Centers for Disease Control and Prevention data documenting the daily new and cumulative cases of confirmed COVID-19 in the U.S. from January 22 to April 6, 2020, and reconstructed the epidemic using a 5-parameter logistic growth model. We fitted our model to data from a 2-week window (i.e., from March 21 to April 4, approximately one incubation period) during which large-scale testing was being conducted. With parameters obtained from this modeling, we reconstructed and predicted the growth of the epidemic and evaluated the extent and potential effects of underdetection. RESULTS: The data fit the model satisfactorily. The estimated daily growth rate was 16.8% overall with 95% CI: [15.95, 17.76%], suggesting a doubling period of 4 days. Based on the modeling result, the tipping point at which new cases will begin to decline will be on April 7th, 2020, with a peak of 32,860 new cases on that day. By the end of the epidemic, at least 792,548 (95% CI: [789,162, 795,934]) will be infected in the U.S. Based on our model, a total of 12,029 cases were not detected between January 22 (when the first case was detected in the U.S.) and April 4. CONCLUSIONS: Our findings demonstrate the utility of a 5-parameter logistic growth model with reliable data that comes from a specified period during which governmental interventions were appropriately implemented. Beyond informing public health decision-making, our model adds a tool for more faithfully capturing the spread of the COVID-19 epidemic.", "Epidemic size of novel coronavirus-infected pneumonia in the Epicenter Wuhan: using data of five-countries' evacuation action Background: Since late December 2019, novel coronavirus-infected pneumonia (NCP) emerged in Wuhan, Hubei province, China. Meanwhile, NCP rapidly spread from China to other countries, and several countries' government rush to evacuate their citizens from Wuhan. We analyzed the infection rate of the evacuees and extrapolated the results in Wuhan's NCP incidence estimation. Methods: We collected the total number and confirmed cases of 2019-nCov infection in the evacuation of Korea, Japan, Germany, Singapore, and France and estimated the infection rate of the 2019 novel coronavirus (2019-nCov) among people who were evacuated from Wuhan with a meta-analysis. NCP incidence of Wuhan was indirectly estimated based on data of evacuation. Results: From Jan 29 to Feb 2, 2020, 1916 people have been evacuated from Wuhan, among them 17 have been confirmed 2019-nCov infected. The infection rate is estimated to be 1.1% (95% CI 0.4%-3.1%) using one group meta-analysis method with random effect model. We then estimated that almost 110,000 (95% CI: 40,000-310,000) people were infected with 2019-nCov in Wuhan around Feb 2, 2020, assuming the infection risk of evacuees is close to Chinese citizens in Wuhan. Conclusions: At the beginning of the outbreak, incidence of NCP may be vastly underestimated. Our result emphasizes that 2019-nCov has proposed a huge public health threats in Wuhan. We need to respond more rapidly, take large-scale public health interventions and draconian measures to limiting population mobility and control the epidemic.", "The Novel Coronavirus, 2019-nCoV, is Highly Contagious and More Infectious Than Initially Estimated The novel coronavirus (2019-nCoV) is a recently emerged human pathogen that has spread widely since January 2020. Initially, the basic reproductive number, R0, was estimated to be 2.2 to 2.7. Here we provide a new estimate of this quantity. We collected extensive individual case reports and estimated key epidemiology parameters, including the incubation period. Integrating these estimates and high-resolution real-time human travel and infection data with mathematical models, we estimated that the number of infected individuals during early epidemic double every 2.4 days, and the R0 value is likely to be between 4.7 and 6.6. We further show that quarantine and contact tracing of symptomatic individuals alone may not be effective and early, strong control measures are needed to stop transmission of the virus.", "SARS-CoV-2 Serology: Much Hype, Little Data ", "Fundamental principles of epidemic spread highlight the immediate need for large-scale serological surveys to assess the stage of the SARS-CoV-2 epidemic The spread of a novel pathogenic infectious agent eliciting protective immunity is typically characterised by three distinct phases: (I) an initial phase of slow accumulation of new infections (often undetectable), (II) a second phase of rapid growth in cases of infection, disease and death, and (III) an eventual slow down of transmission due to the depletion of susceptible individuals, typically leading to the termination of the (first) epidemic wave. Before the implementation of control measures (e.g. social distancing, travel bans, etc) and under the assumption that infection elicits protective immunity, epidemiological theory indicates that the ongoing epidemic of SARS-CoV-2 will conform to this pattern. Here, we calibrate a susceptible-infected-recovered (SIR) model to data on cumulative reported SARS-CoV-2 associated deaths from the United Kingdom (UK) and Italy under the assumption that such deaths are well reported events that occur only in a vulnerable fraction of the population. We focus on model solutions which take into consideration previous estimates of critical epidemiological parameters such as the basic reproduction number (R0), probability of death in the vulnerable fraction of the population, infectious period and time from infection to death, with the intention of exploring the sensitivity of the system to the actual fraction of the population vulnerable to severe disease and death. Our simulations are in agreement with other studies that the current epidemic wave in the UK and Italy in the absence of interventions should have an approximate duration of 2-3 months, with numbers of deaths lagging behind in time relative to overall infections. Importantly, the results we present here suggest the ongoing epidemics in the UK and Italy started at least a month before the first reported death and have already led to the accumulation of significant levels of herd immunity in both countries. There is an inverse relationship between the proportion currently immune and the fraction of the population vulnerable to severe disease. This relationship can be used to determine how many people will require hospitalisation (and possibly die) in the coming weeks if we are able to accurately determine current levels of herd immunity. There is thus an urgent need for investment in technologies such as virus (or viral pseudotype) neutralization assays and other robust assays which provide reliable read-outs of protective immunity, and for the provision of open access to valuable data sources such as blood banks and paired samples of acute and convalescent sera from confirmed cases of SARS-CoV-2 to validate these. Urgent development and assessment of such tests should be followed by rapid implementation at scale to provide real-time data. These data will be critical to the proper assessment of the effects of social distancing and other measures currently being adopted to slow down the case incidence and for informing future policy direction.", "Timeliness of infectious disease reporting, the Netherlands, 2003 to 2017: law change reduced reporting delay, disease identification delay is next BACKGROUND: Timely notification of infectious diseases is essential for effective disease control and needs regular evaluation. AIM: Our objective was to evaluate the effects that statutory adjustments in the Netherlands in 2008 and raising awareness during outbreaks had on notification timeliness. METHODS: In a retrospective analyses of routine surveillance data obtained between July 2003 and November 2017, delays between disease onset and laboratory confirmation (disease identification delay), between laboratory confirmation and notification to Municipal Health Services (notification delay) and between notification and reporting to the National Institute for Public Health and the Environment (reporting delay) were analysed for 28 notifiable diseases. Delays before (period 1) and after the law change (periods 2 and 3) were compared with legal timeframes. We studied the effect of outbreak awareness in 10 outbreaks and the effect of specific guidance messages on disease identification delay for two diseases. RESULTS: We included 144,066 notifications. Average notification delay decreased from 1.4 to 0.4 days across the three periods (six diseases; p < 0.05), reporting delay decreased mainly in period 2 (from 0.5 to 0.1 days, six diseases; p < 0.05). In 2016\u20132017, legal timeframes were met overall. Awareness resulted in decreased disease identification delay for three diseases: measles and rubella (outbreaks) and psittacosis (specific guidance messages). CONCLUSIONS: Legal adjustments decreased notification and reporting delays, increased awareness reduced identification delays. As disease identification delay dominates the notification chain, insight in patient, doctor and laboratory delay is necessary to further improve timeliness and monitor the impact of control measures during outbreaks.", "There are asymptomatic and pre-symptomatic patients infected with COVID-19. So what? Pandemic response implications Abstract Asymptomatic but infectious people have been reported in many infectious diseases. Asymptomatic and pre-symptomatic carriers would be a hidden reservoir of COVID-19. Aim This review identifies primary empirical evidence about the ability of asymptomatic carriers to infect others with COVID-19 pandemic and reflects on the implications for control measures. Methods A systematic review is followed by a narrative report and commentary inclusion criteria were: studies reporting primary data on asymptomatic or pre-symptomatic patients, who were considered to have passed on COVID-19 infection; and published in indexed journals or in peer review between January 1 and March 31, 2020. Results Nine articles reported on 83 asymptomatic or pre-symptomatic persons. Conclusions The evidence confirms COVID-19 transmission from people who were asymptomatic at the time. A series of implications for health service response are laid out. Keywords: Covid-19, Asymptomatic, Pre-symptomatic, Public Health", "Predictors of COVID-19 incidence, mortality, and epidemic growth rate at the country level Background. The burden of the coronavirus disease 2019 (COVID-19) pandemic has been geographically disproportionate. Certain weather factors and population characteristics are thought to drive transmission, but studies examining these factors are limited. We aimed to identify weather, sociodemographic, and geographic drivers of COVID-19 at the global scale using a comprehensive collection of country/territory-level data, and to use discovered associations to estimate the timing of community transmission. Methods. We examined COVID-19 cases and deaths reported up to May 2, 2020 across 205 countries and territories in relation to weather data collected from capital cities for the eight weeks prior to and four weeks after the date of the first reported case, as well as country/territory-level population, geographic, and planetary data. We performed univariable and multivariable regression modeling and odds ratio analyses to investigate associations with COVID-19 cases, deaths, and epidemic growth rate. We also conducted maximum likelihood analysis to estimate the timing of initial community spread. Findings. Lower temperature (p<0.0001), lower humidity (p=0.006), higher altitude (p=0.0080), higher percentage of urban population (p<0.0001), increased air travelers (p=0.00019), and higher prevalence of obesity (p<0.0001) were strong independent predictors of national COVID-19 incidence, mortality, and epidemic growth rate. Temperature at 5-7 weeks before the first reported case best predicted epidemic growth, suggesting that significant community transmission was occurring on average 1-2 months prior to detection. Interpretation. The results of this ecologic analysis demonstrate that global COVID-19 burden and timing of country-level epidemic growth can be predicted by weather and population factors. In particular, we find that cool, dry, and higher altitude environments, as well as more urban and obese populations, may be conducive to more rapid epidemic spread. Funding sources: None.", "Dynamic Modeling to Identify Mitigation Strategies for Covid-19 Pandemic Relevant pandemic-spread scenario simulations provide guiding principles for containment and mitigation policy developments. Here we devise a simple model to predict the effectiveness of different mitigation strategies. The model consists of a set of simple differential equations considering the population size, reported and unreported infections, reported and unreported recoveries and the number of Covid-19-inflicted deaths. For simplification, we assume that Covid-19 survivors are immune (e.g. mutations are not considered) and that the virus can only be passed on by persons with undetected infections. While the latter assumption is a simplification (it is neglected that e.g. hospital staff may be infected by detected patients with symptoms), it was introduced here to keep the model as simple as possible. Moreover, the current version of the model does not account for age-dependent differences in the death rates, but considers higher mortality rates due to temporary shortage of intensive care units. Some of the model parameters have been fitted to the reported cases outside of China1 from January 22 to March 12 of the 2020 Covid-19 pandemic. The other parameters were chosen in a plausible range to the best of our knowledge. We compared infection rates, the total number of people getting infected and the number of deaths in six different scenarios. Social distancing or increased testing can contain or drastically reduce the infections and the predicted number of deaths when compared to a situation without mitigation. We find that mass-testing alone and subsequent isolation of detected cases can be an effective mitigation strategy, alone and in combination with social distancing. However, unless one assumes that the virus can be globally defeated by reducing the number of infected persons to zero, testing must be upheld, albeit at reduced intensity, to prevent subsequent waves of infection. The model suggests that testing strategies can be equally effective as social distancing, though at much lower economical costs. We discuss how our mathematical model may help to devise an optimal mix of mitigation strategies against the Covid-19 pandemic. The website corona-lab.ch provides an interactive simulation tool based on the presented model.", "Estimating the presymptomatic transmission of COVID19 using incubation period and serial interval data We estimated the fraction and timing of presymptomatic transmissions of COVID19 with mathematical models combining the available data of the incubation period and serial interval. We found that up to 79.7% transmissions could be presymptomatic among the imported cases in China outside Wuhan. The average timing of presymptomatic transmissions is 3.8 days (SD = 6.1) before the symptom onset, which is much earlier than previously assumed.", "Transmission in Latent Period Causes A Large Number of Infected People in the United States By April 29, 2020, the cumulative number of confirmed cases in the United States has exceeded one million, becoming the country with the most serious pandemic in the world. It is urgent to analyze the real situation and follow-up trend of the epidemic in the United States. The proposed model divides the time period into two different phases, before and after March 21, 2020. The results show that the basic reproduction number in the early period of propagation in the United States is estimated to be 4.06 (95% CI: 1.86-6.73) based on the confirmed cases data ranging from January 21, 2020 to March 21, 2020. The normalized contributions to R_0 for three different categories of communicators were estimated, including the numbers of the latent population (in incubation period) L, the documented infectious population Id, and the undocumented infectious population Iu. The results show that L contributes 16.17% (95% CI: 12.86% - 21.60%) to R_0, Id contributes 55.13% (95% CI: 43.15% - 63.97%), and Iu contributes 28.70% (95% CI: 19.29% - 40.07%) to R0. The metapopulation network was used to simulate the true spread of COVID-19 in the United States, and the Bayesian inference was applied to estimate the key parameters including the rate of the number of the susceptibles and the infected beta, the infection ratio between undocumented and documented transmission 1, the infection ratio between latent and documented transmission 2, the proportion of confirmed cases in the infectious population x, and the duration of latent period (incubation period) TL . From the analysis of phase one, 1 was estimated to be 0.40 (95% CI: 0.17 - 0.54), 2 was estimated to be 0.06 (95% CI: 0.02 - 0.11), x was estimated to be 0.70 (95% CI: 0.55 - 0.78), T_L was estimated to be 8.41 (95% CI: 6.64 - 9.42). As of April 13, 2020, it was estimated that only 45% (95% CI: 35% - 73%) of symptom onset cases in the United States have been documnented. The infectivity of undocumented infectious population was 0.59 (95% CI: 0.21 - 0.70) of that of the documented infectious population, while that of the latent population was 0.19 (95% CI: 0.11 - 0.27) of that of the documented infectious population. The incubation period of COVID-19 was estimated to be 10.69 days (95% CI: 10.02 - 11.74). We estimated that if the current control interventions are continued, the pandemic situation in the United States is likely to keep climbing up, and the cumulative number of confirmed cases is expected to reach more than 1.7 million in July and continue to grow. We also performed component analysis and sensitivity analysis, researching the compositions of the people with COVID-19, and considering that there is only a random time delay between the number of patients in the incubation period and the actual number of patients.", "Reconstructing the global dynamics of under-ascertained COVID-19 cases and infections Background: Asymptomatic or subclinical SARS-CoV-2 infections are often unreported, which means that confirmed case counts may not accurately reflect underlying epidemic dynamics. Understanding the level of ascertainment (the ratio of confirmed symptomatic cases to the true number of symptomatic individuals) and undetected epidemic progression is crucial to informing COVID-19 response planning, including the introduction and relaxation of control measures. Estimating case ascertainment over time allows for accurate estimates of specific outcomes such as seroprevalence, which is essential for planning control measures. Methods: Using reported data on COVID-19 cases and fatalities globally, we estimated the proportion of symptomatic cases (i.e. any person with any of fever >= to 37.5C, cough, shortness of breath, sudden onset of anosmia, ageusia or dysgeusia illness) that were reported in 210 countries and territories, given those countries had experienced more than ten deaths. We used published estimates of the case fatality ratio (CFR) as an assumed baseline. We then calculated the ratio of this baseline CFR to an estimated local delay-adjusted CFR to estimate the level of under-ascertainment in a particular location. We then fit a Bayesian Gaussian process model to estimate the temporal pattern of under-ascertainment. Results: We estimate that, during March 2020, the median percentage of symptomatic cases detected across the 84 countries which experienced more than ten deaths ranged from 2.38% (Bangladesh) to 99.6% (Chile). Across the ten countries with the highest number of total confirmed cases as of 6th July 2020, we estimated that the peak number of symptomatic cases ranged from 1.4 times (Chile) to 17.8 times (France) larger than reported. Comparing our model with national and regional seroprevalence data where available, we find that our estimates are consistent with observed values. Finally, we estimated seroprevalence for each country. Despite low case detection in some countries, our results that adjust for this still suggest that all countries have had only a small fraction of their populations infected as of July 2020. Conclusions: We found substantial under-ascertainment of symptomatic cases, particularly at the peak of the first wave of the SARS-CoV-2 pandemic, in many countries. Reported case counts will therefore likely underestimate the rate of outbreak growth initially and underestimate the decline in the later stages of an epidemic. Although there was considerable under-reporting in many locations, our estimates were consistent with emerging serological data, suggesting that the proportion of each country's population infected with SARS-CoV-2 worldwide is generally low.", "Critical evaluation of FDA-approved respiratory multiplex assays for public health surveillance Introduction: Clinical management and identification of respiratory diseases has become more rapid and increasingly specific due to widespread use of PCR(polymerase chain reaction) multiplex technologies. Although significantly improving clinical diagnosis, multiplexed PCR assays could have a greater impact on local and global disease surveillance. The authors wish to propose methods of evaluating respiratory multiplex assays to maximize diagnostic yields specifically for surveillance efforts. Areas covered: The authors review multiplexed assays and critically assess what barriers have limited these assays for disease surveillance and how these barriers might be addressed. The manuscript focuses specifically on the case study of using multiplexed assays for surveillance of respiratory pathogens. The authors also provide a method of validation of specific surveillance measures. Expert commentary: Current commercially available respiratory multiplex PCR assays are widely used for clinical diagnosis; however, specific barriers have limited their use for surveillance. Key barriers include differences in testing phase requirements and diagnostic performance evaluation. In this work the authors clarify phase testing requirements and introduce unique diagnostic performance measures that simplify the use of these assays on a per target basis for disease surveillance.", "Covid-19: Pandemonium in our time While pandemonium has come to mean wild and noisy disorder, the reference here is to John Milton's epic poem Paradise Lost and the upheaval following Lucifer's banishment from Heaven and his construction of Pand\u00e6monium as his hub. Today's avalanche of conflicting news on how to deal with the coronavirus disease 2019 (Covid-19) brings to mind the Trinity nuclear bomb test with Enrico Fermi estimating its strength by releasing small pieces of paper into the air and measuring their displacement by the shock wave. Fermi's result, in fact not far from the true value, emphasised his ability to make good approximations with few or no actual data. The current wave of Covid-19 presents just this kind of situation as it engulfs the world from ground zero in Wuhan, China. Much information is indeed missing, but datasets that might lead to useful ideas on how to handle this pandemic are steadily accumulating.", "Scalable and Resilient SARS-CoV2 testing in an Academic Centre The emergence of the novel coronavirus SARS-CoV-2 has led to a pandemic infecting more than two million people worldwide in less than four months, posing a major threat to healthcare systems. This is compounded by the shortage of available tests causing numerous healthcare workers to unnecessarily self-isolate. We provide a roadmap instructing how a research institute can be repurposed in the midst of this crisis, in collaboration with partner hospitals and an established diagnostic laboratory, harnessing existing expertise in virus handling, robotics, PCR, and data science to derive a rapid, high throughput diagnostic testing pipeline for detecting SARS-CoV-2 in patients with suspected COVID-19. The pipeline is used to detect SARS-CoV-2 from combined nose-throat swabs and endotracheal secretions/ bronchoalveolar lavage fluid. Notably, it relies on a series of in-house buffers for virus inactivation and the extraction of viral RNA, thereby reducing the dependency on commercial suppliers at times of global shortage. We use a commercial RT-PCR assay, from BGI, and results are reported with a bespoke online web application that integrates with the healthcare digital system. This strategy facilitates the remote reporting of thousands of samples a day with a turnaround time of under 24 hours, universally applicable to laboratories worldwide.", "Estimating population immunity without serological testing We propose an approximate methodology for estimating the overall level of immunity against COVID-19 in a population that has been affected by the recent epidemic. The methodology relies on the currently available mortality data and utilizes the properties of the SIR model. We illustrate the application of the method by estimating the recent levels of immunity in 10 US states with highest case numbers of COVID-19.", "Underestimation of COVID-19 cases in Japan: an analysis of RT-PCR testing for COVID-19 among 47 prefectures in Japan BACKGROUND: Under the unique Japanese policy to restrict reverse transcriptase-polymerase chain reaction (RT-PCR) testing against severe acute respiratory syndrome coronavirus 2, a nationwide number of its confirmed cases and mortality remains to be low. Yet the information is lacking on geographical differences of these measures and their associated factors. AIM: Evaluation of prefecture-based geographical differences and associated predictors for the incidence and number of RT-PCR tests for COVID-19. DESIGN: Cross-sectional study using regression and correlation analysis. METHODS: We retrieved domestic laboratory-confirmed cases, deaths, and the number of RT-PCR testing for COVID-19 from January 15 to April 6, 2020 in 47 prefectures in Japan, using publicly-available data by the Ministry of Health, Labour and Welfare. We did descriptive analyses of these three measures and identified significant predictors for the incidence and RT-PCR testing through multiple regression analyses and correlates with the number of deaths through correlation analysis. RESULTS: The median prefectural-level incidence and number of RT-PCR testing per 100,000 population were 1.14 and 38.6, respectively. Multiple regression analyses revealed that significant predictors for the incidence were prefectural-level population (p < 0.001) and the number of RT-PCR testing (p = 0.03); and those for RT-PCR testing were the incidence (p = 0.025), available beds (p = 0.045) and cluster infections (p = 0.034). CONCLUSION: Considering bidirectional association between the incidence and RT-PCR testing, there may have been an underdiagnosed population for the infection. The restraint policy for RT-PCR testing should be revisited to meet the increasing demand under the COVID-19 epidemic.", "Social distancing strategies for curbing the COVID-19 epidemic The SARS-CoV-2 pandemic is straining healthcare resources worldwide, prompting social distancing measures to reduce transmission intensity. The amount of social distancing needed to curb the SARS-CoV-2 epidemic in the context of seasonally varying transmission remains unclear. Using a mathematical model, we assessed that one-time interventions will be insufficient to maintain COVID-19 prevalence within the critical care capacity of the United States. Seasonal variation in transmission will facilitate epidemic control during the summer months but could lead to an intense resurgence in the autumn. Intermittent distancing measures can maintain control of the epidemic, but without other interventions, these measures may be necessary into 2022. Increasing critical care capacity could reduce the duration of the SARS-CoV-2 epidemic while ensuring that critically ill patients receive appropriate care.", "Coronavirus disease (COVID-19): a scoping review BACKGROUND: In December 2019, a pneumonia caused by a novel coronavirus (SARS-CoV-2) emerged in Wuhan, China and has rapidly spread around the world since then. AIM: This study aims to understand the research gaps related to COVID-19 and propose recommendations for future research. METHODS: We undertook a scoping review of COVID-19, comprehensively searching databases and other sources to identify literature on COVID-19 between 1 December 2019 and 6 February 2020. We analysed the sources, publication date, type and topic of the retrieved articles/studies. RESULTS: We included 249 articles in this scoping review. More than half (59.0%) were conducted in China. Guidance/guidelines and consensuses statements (n = 56; 22.5%) were the most common. Most (n = 192; 77.1%) articles were published in peer-reviewed journals, 35 (14.1%) on preprint servers and 22 (8.8%) posted online. Ten genetic studies (4.0%) focused on the origin of SARS-CoV-2 while the topics of molecular studies varied. Nine of 22 epidemiological studies focused on estimating the basic reproduction number of COVID-19 infection (R(0)). Of all identified guidance/guidelines (n = 35), only ten fulfilled the strict principles of evidence-based practice. The number of articles published per day increased rapidly until the end of January. CONCLUSION: The number of articles on COVID-19 steadily increased before 6 February 2020. However, they lack diversity and are almost non-existent in some study fields, such as clinical research. The findings suggest that evidence for the development of clinical practice guidelines and public health policies will be improved when more results from clinical research becomes available.", "Estimating the seroprevalence of SARS-CoV-2 infections: systematic review Abstract Background: Accurate seroprevalence estimates of SARS-CoV-2 in different populations could help gauge the true magnitude and spread of the infection seroprevalence. Reported estimates have varied greatly, but many have derived from biased samples, and inadequate testing methods. Objective: To estimate the range of valid seroprevalence rates of SARS-CoV-2 in different populations, and compare these seroprevalence estimates with the cumulative cases seen in the same population. Methods: We searched PubMed, Embase, the Cochrane COVID-19 trials, and Europe-PMC for published studies and pre-prints from January 2020 to 25 May 2020 that reported anti-SARS-CoV-2 IgG, IgM and/or IgA antibodies for serosurveys of either the general community or of defined sub-populations, such healthcare workers and other organizations. Results: Of the 837 studies identified, 49 were assessed and 14 were includable. Included studies represented 10 countries and 100,557 subjects: 9 from randomly selected populations, 2 from healthcare workers, 2 from industry populations, and 1of parturient women. The seroprevalence proportions in 10 studies ranged between 1%-10%, and 2 study estimates under 1%, and 2 over 10% - from the notably hard-hit regions of Gangelt in Germany and from Northwest Iran. The two studies in healthcare workers, in Italy and Spain, had seroprevalence rates at higher range of estimates, with the Barcelona hospitals having a higher rate than the Spanish national survey. For only one study was the seroprevalence estimate higher than the cumulative incidence, though these were proximate for several studies. In five studies, the seroprevalence was similar to the cumulative case numbers in the same population. For seropositive cases not previously detected as COVID-19 cases, the majority had prior COVID-like symptoms. Conclusion: The seroprevalence of SARS-CoV-2 mostly less than 10% with the level of infection lower in the general community, suggesting levels well below herd immunity. The similarity of seroprevalence and reported cases is several studies, and high symptom rates in seropositive cases suggest that gaps between seroprevalence rates and reported cases are likely due to undertesting of symptomatic people.", "Failure in initial stage containment of global COVID\u201019 epicenters With multiple virus epicenters, COVID\u201019 has been declared a pandemic by the World Health Organization. Consequently, many countries have implemented different policies to manage this crisis including curfew and lockdown. However, the efficacy of individual policies remains unclear with respect to COVID\u201019 case development. We analyzed available data on COVID\u201019 cases of eight majorly affected countries, including China, Italy, Iran, Germany, France, Spain, South Korea, and Japan. Growth rates and doubling time of cases were calculated for the first 6 weeks after the initial cases were declared for each respective country and put into context with implemented policies. Although the growth rate of total confirmed COVID\u201019 cases in China has decreased, those for Japan have remained constant. For European countries, the growth rate of COVID\u201019 cases considerably increased during the second time interval. Interestingly, the rates for Germany, Spain, and France are the highest measured in the second interval and even surpass the numbers in Italy. Although the initial data in Asian countries are encouraging with respect to case development at the initial stage, the opposite is true for European countries. Based on our data, disease management in the 2 weeks following the first reported cases is of utmost importance.", "Rapid sputum testing and not thermal screening alone should be the first-line screening test at airports: A Bayesian analysis ", "A Real-Time Statistical Model for Tracking and Forecasting COVID-19 Deaths, Prevalence and Incidence Background: Pandemics do not occur frequently and when they do there is a paucity of predictive tools that could help drive government responses to mitigate worst outcomes. Here we provide a forecasting model that is based on measurable variables and that strives for simplicity over complexity to obtain stable convergent forecasts of death, prevalence, incidence, and safe days for social easing. Methods: We assume, based on prior pandemic data, that death rate rise and fall approximately follows a Gaussian distribution, which can be asymmetric, which we describe. By taking daily death data for foreign countries and U.S. states and fitting it to an appropriate Gaussian function provides an estimate of where in the cycle a particular population lies. From that time point one can integrate remaining time to obtain a final total death. By also using measured values for the time from infection to recovery or death and a mortality factor, the prevalence (active cases) and incidence (new cases) totals and rate curves can be constructed. It is also possible by setting a downward threshold on prevalence that an estimate of a minimum date to begin relaxing social restrictions may be considered. Results: To demonstrate the model we chose the most severe hot-bed countries and U.S. states as a test-bed to evolve and improve our model and to compare with other models. The model can readily be applied to other countries by inputting data from public data bases. We also compare our forecasts to the University of Washington (UW) IHME model and are reassuringly similar yet show less variability on a weekly basis. The sum of squares for error (SSE) for international and U.S. states, respectively, that we track are: 34% and 33% for our model vs. 49% and 59% for the IHME model. Conclusions: Our model appears closest to the UW IHME model; however, there are important differences and while both models forecast many of the same results of interest, each one offers unique benefits that the other does not. We believe that the model reported here excels for its simplicity, which makes the model easy to use.", "On the true numbers of COVID-19 infections: behind the available data In December-2019 China reported several cases of a novel coronavirus later called COVID-19. In this work, we will use a probabilistic method for approximating the true daily numbers of infected. Based on two distribution functions to describe the spontaneous recovered cases on the one hand and the detected cases on the other hand. The impact of the underlying variables of these functions is discussed. The detected rate is predicted to be between 5.3% and 10,8%, which means that there would be about 38 million infected until now (10-May 2020), rather than the officially declared number of 3.99 million worldwide cases.", "The dynamics of Covid-19: weather, demographics and infection timeline We study the effects of three types of variables on the early pace of spread of Covid-19: weather variables, temperature and absolute humidity; population density; the timeline of Covid-19 infection, as outbreak of disease occurs in different dates for different regions. The regions considered were all 50 U.S. states and 110 countries (those which had enough data available by April 10th. We looked for associations between the above variables and an estimate of the growth rate of cases, the exponential coefficient, computed using data for 10 days starting when state/country reached 100 confirmed cases. The results for U.S. states indicate that one cannot expect that higher temperatures and higher levels of absolute humidity would translate into slower pace of Covid-19 infection rate, at least in the ranges of those variables during the months of February and March of 2020 (-2.4 to 24C and 2.3 to 15g/m3). In fact, the opposite is true: the higher the temperature and the absolute humidity, the faster the Covid-19 has expanded in the U.S. states, in the early stages of the outbreak. Secondly, using the highest county population density for each state, there is strong positive association between population density and (early) faster spread of Covid-19. Finally, there is strong negative association between the date when a state reached 100 accumulated cases and the speed of Covid-10 outbreak (the later, the lower the estimate of growth rate). When these variables are considered together, only population density and the timeline variable show statistical significance. We also develop the basic models for the collection of countries, without the demographic variable. Despite the evidence, in that case, that warmer and more humid countries have shown lower rates of Covid-19 expansion, the weather variables lose statistical significance when the timeline variable is added.", "[Covid-19 - deaths and analysis]. Mortality from Covid-19 is monitored in detail and compared between countries with different strategies against the virus. There is, however, often a lack of understanding of what is required in terms of measures and interpretation to enable correct comparisons. The number of deaths from Covid-19 is affected by the testing strategy and many other things that differ between countries. Therefore, today, the most reliable source for monitoring and comparing mortality from Covid-19 is total mortality. In Sweden, there is good correspondence of Covid-19 deaths and total mortality, with a tendency to a higher total mortality indicating some under-reporting of Covid-19 mortality.", "The proportion testing positive for SARS-COV-2 among the tested population in the U.S.: Benefits of the positive test ratio under scaled testing scenarios The ratios offer simple ways to account for variations in testing and reporting. Tracking the ratios in addition to cases offer a more precise view of the pandemic. Our observations underscore the need to scale mass testing with accurate and reliable tests, to implement testing systematically and report results consistently.", "Age-stratified Infection Probabilities Combined with Quarantine-Modified SEIR Model in the Needs Assessments for COVID-19 We use the age-stratified COVID-19 infection and death distributions from China (more than 44,672 infectious as of February 11, 2020) as an estimate for a study area infection and morbidity probabilities at each age group. We then apply these probabilities into the actual age-stratified population to predict infectious individuals and deaths at peak. Testing with different countries shows the predicted infectious skewing with the country median age and age stratification, as expected. We added a Q parameter to the classic SEIR compartmental model to include the effect of quarantine (Q-SEIR). The projections from the age-stratified probabilities give much lower predicted incidences of infection than the Q-SEIR model. As expected, quarantine tends to delay the peaks for both Exposed and Infectious, and to flatten the curve or lower the predicted values for each compartment. These two estimates were used as a range to inform planning and response to the COVID-19 threat.", "Early impact of COVID\u201019 on transplant center practices and policies in the United States COVID\u201019 is a novel, rapidly changing pandemic: consequently, evidence\u2010based recommendations in solid organ transplantation (SOT) remain challenging and unclear. To understand the impact on transplant activity across the United States, and center\u2010level variation in testing, clinical practice, and policies, we conducted a national survey between March 24, 2020 and March 31, 2020 and linked responses to the COVID\u201019 incidence map. Response rate was a very high 79.3%, reflecting a strong national priority to better understand COVID\u201019. Complete suspension of live donor kidney transplantation was reported by 71.8% and live donor liver by 67.7%. While complete suspension of deceased donor transplantation was less frequent, some restrictions to deceased donor kidney transplantation were reported by 84.0% and deceased donor liver by 73.3%; more stringent restrictions were associated with higher regional incidence of COVID\u201019. Shortage of COVID\u201019 tests was reported by 42.5%. Respondents reported a total of 148 COVID\u201019 recipients from <1 to >10 years posttransplant: 69.6% were kidney recipients, and 25.0% were critically ill. Hydroxychloroquine (HCQ) was used by 78.1% of respondents; azithromycin by 46.9%; tocilizumab by 31.3%, and remdesivir by 25.0%. There is wide heterogeneity in center\u2010level response across the United States; ongoing national data collection, expert discussion, and clinical studies are critical to informing evidence\u2010based practices.", "A Social Network Model of the COVID-19 Pandemic In the COVID-19 coronavirus pandemic, currently vaccines and specific anti-viral treatment are not yet available. Thus, preventing viral transmission by case isolation, quarantine, and social distancing is essential to slowing its spread. Here we model social networks using weighted graphs, where vertices represent individuals and edges represent contact. As public health measures are implemented, connectivity in the graph decreases, resulting in lower effective reproductive numbers, and reduced viral transmission. For COVID-19, model parameters were derived from the coronavirus epidemic in China, validated by epidemic data in Italy, then applied to the United States. We calculate that, in the U.S., the public is able to contain viral transmission by limiting the average number of contacts per person to less than 7 unique individuals over each 5 day period. This increases the average social distance between individuals to 10 degrees of separation.", "Multi-Stage Group Testing Improves Efficiency of Large-Scale COVID-19 Screening Abstract Background SARS-CoV-2 test kits are in critical shortage in many countries. This limits large-scale population testing and hinders the effort to identify and isolate infected individuals. Objective Herein, we developed and evaluated multi-stage group testing schemes that test samples in groups of various pool sizes in multiple stages. Through this approach, groups of negative samples can be eliminated with a single test, avoiding the need for individual testing and achieving considerable savings of resources. Study design We designed and parameterized various multi-stage testing schemes and compared their efficiency at different prevalence rates using computer simulations. Results We found that three-stage testing schemes with pool sizes of maximum 16 samples can test up to three and seven times as many individuals with the same number of test kits for prevalence rates of around 5% and 1%, respectively. We propose an adaptive approach, where the optimal testing scheme is selected based on the expected prevalence rate. Conclusion These group testing schemes could lead to a major reduction in the number of testing kits required and help improve large-scale population testing in general and in the context of the current COVID-19 pandemic.", "Robust estimation of diagnostic rate and real incidence of COVID-19 for European policymakers Policymakers need a clear and fast assessment of the real spread of the epidemic of COVID-19 in each of their respective countries. Standard measures of the situation provided by the governments include reported positive cases and total deaths. While total deaths immediately indicate that countries like Italy and Spain have the worst situation as of mid April 2020, on its own, reported cases do not provide a correct picture of the situation. The reason is that different countries diagnose diversely and present very distinctive reported case fatality rate (CFR). The same levels of reported incidence and mortality might hide a very different underlying picture. Here we present a straightforward and robust estimation of the diagnostic rate in each European country. From that estimation we obtain an uniform unbiased incidence of the epidemic. The method to obtain the diagnostic rate is transparent and empiric. The key assumption of the method is that the real CFR in Europe of COVID-19 is not strongly country-dependent. We show that this number is not expected to be biased due to demography nor the way total deaths are reported. The estimation protocol has a dynamic nature, and it has been giving converging numbers for diagnostic rates in all European countries as of mid April 2020. From this diagnostic rate, policy makers can obtain an Effective Potential Growth (EPG) updated everyday providing an unbiased assessment of the countries with more potential to have an uncontrolled situation. The method developed will be used to track possible improvements on the diagnostic rate in European countries as the epidemic evolves.", "How to Best Predict the Daily Number of New Infections of Covid-19 Knowledge about the daily number of new infections of Covid-19 is important because it is the basis for political decisions resulting in lockdowns and urgent health care measures. We use Germany as an example to illustrate shortcomings of official numbers, which are, at least in Germany, disclosed only with several days of delay and severely underreported on weekends (more than 40%). These shortcomings outline an urgent need for alternative data sources. The other widely cited source provided by the Center for Systems Science and Engineering at Johns Hopkins University (JHU) also deviates for Germany on average by 79% from the official numbers. We argue that Google Search and Twitter data should complement official numbers. They predict even better than the original values from Johns Hopkins University and do so several days ahead. These two data sources could also be used in parts of the world where official numbers do not exist or are perceived to be unreliable.", "The usefulness of SARS-CoV-2 test positive proportion as a surveillance tool Comparison of COVID-19 case numbers over time and between locations is complicated by limits to virologic testing confirm SARS-CoV-2 infection, leading to under-reporting of incidence, and by variations in testing capacity between locations and over time. The proportion of tested individuals who have tested positive (test positive proportion, TPP) can potentially be used to qualitatively assess the testing capacity of a location; a high TPP could provide evidence that too few people are tested, leading to more under-reporting. In this study we propose a simple model for testing in a population experiencing an epidemic of COVID-19, and derive an expression for TPP in terms of well-defined parameters in the model, related to testing and presence of other pathogens causing COVID-19 like symptoms. We use simulations to show situations in which the TPP is higher or lower than we expect based on these parameters, and the effect of testing strategies on the TPP. In our simulations, we find in the absence of dramatic shifts of testing practices in time or between spatial locations, the TPP is positively correlated with the incidence of infection. As a corollary, the TPP can be used to distinguish between a decline in confirmed cases due to decline in incidence (in which case TPP should decline) and a decline in confirmed cases due to testing constraints (in which case TPP should remain constant). We show that the proportion of tested individuals who present COVID-19 like symptoms (test symptomatic proportion, TSP) encodes similar information to the TPP but has different relationships with the testing parameters, and can thus provide additional information regarding dynamic changes in TPP and incidence. Finally, we compare data on confirmed cases and TPP from US states. We conjecture why states may have higher or lower TPP than average. We suggest that collection of symptom status and age/risk category of tested individuals can aid interpretation of changes in TPP and increase the utility of TPP in assessing the state of the pandemic in different locations and times.", "Considerations for pharmacoepidemiological analyses in the SARS-CoV-2 pandemic. The coronavirus disease 2019 (COVID-19) pandemic has triggered several hypotheses regarding use of specific medicines and risk of infection as well as prognosis. Under these unique circumstances, rapid answers require quick engagement in data collection and analyses, however, appropriate design and conduct of pharmacoepidemiologic studies is needed to generate valid and reliable evidence. In this paper, endorsed by the International Society for Pharmacoepidemiology, we provide methodological considerations for the conduct of pharmacoepidemiological studies in relation to the pandemic across eight domains: (1) timeliness of evidence, including the need to prioritize some questions over others in the acute phase of the pandemic; (2) the need to align observational and interventional research on efficacy; (3) the specific challenges related to 'real-time epidemiology' during an ongoing pandemic; (4) what design to use to answer a specific question; (5) considerations on the definition of exposures; (6) what covariates to collect; (7) considerations on the definition of outcomes; and (8) the need for transparent reporting. This article is protected by copyright. All rights reserved.", "Bayesian modeling of COVID-19 cases with a correction to account for under-reported cases The novel of COVID-19 disease started in late 2019 making the worldwide governments came across a high number of critical and death cases, beyond constant fear of the collapse in their health systems. Since the beginning of the pandemic, researchers and authorities are mainly concerned with carrying out quantitative studies (modeling and predictions) overcoming the scarcity of tests that lead us to under- reporting cases. To address these issues, we introduce a Bayesian approach to the SIR model with correction for under-reporting in the analysis of COVID-19 cases in Brazil. The proposed model was enforced to obtain estimates of important quantities such as the reproductive rate and the average infection period, along with the more likely date when the pandemic peak may occur. Several under-reporting scenarios were considered in the simulation study, showing how impacting is the lack of information in the modeling.", "Testing for COVID-19: willful ignorance or selfless behavior? Widespread testing is key to controlling the spread of COVID-19. But should we worry about self-selection bias in the testing? The recent literature on willful ignorance says we should \u2013 people often avoid health information. In the context of COVID-19, such willful ignorance can bias testing data. Furthermore, willful ignorance often arises when selfish wants conflict with social benefits, which might be particularly likely for potential \u2018super-spreaders\u2019 \u2013 people with many social interactions \u2013 given people who test positive are urged to self-isolate for two weeks. We design a survey in which participants (n = 897) choose whether to take a costless COVID-19 test. We find that 70% would take a test. Surprisingly, the people most likely to widely spread COVID-19 \u2013 the extraverts, others who meet more people in their daily lives and younger people \u2013 are the most willing to take a test. People's ability to financially or emotionally sustain self-isolation does not matter to their decision. We conclude that people are selfless in their decision to test for COVID-19. Our results are encouraging \u2013 they imply that COVOD-19 testing may succeed in targeting those who generate the largest social benefits from self-isolation if infected, which strengthens the case for widespread testing.", "The effect of human mobility and control measures on the COVID-19 epidemic in China The ongoing coronavirus disease 2019 (COVID-19) outbreak expanded rapidly throughout China. Major behavioral, clinical, and state interventions were undertaken to mitigate the epidemic and prevent the persistence of the virus in human populations in China and worldwide. It remains unclear how these unprecedented interventions, including travel restrictions, affected COVID-19 spread in China. We used real-time mobility data from Wuhan and detailed case data including travel history to elucidate the role of case importation in transmission in cities across China and to ascertain the impact of control measures. Early on, the spatial distribution of COVID-19 cases in China was explained well by human mobility data. After the implementation of control measures, this correlation dropped and growth rates became negative in most locations, although shifts in the demographics of reported cases were still indicative of local chains of transmission outside of Wuhan. This study shows that the drastic control measures implemented in China substantially mitigated the spread of COVID-19.", "The Appropriate Use of Testing for COVID-19 Many public officials are calling for increased testing for the 2019 novel coronavirus disease (COVID-19), and some governments have taken extraordinary measures to increase the availability of testing. However, little has been published about the sensitivity and specificity of the reverse transcriptase-polymerase chain reaction (RT-PCR) nasopharyngeal swabs that are commonly used for testing. This narrative review evaluates the literature regarding the accuracy of these tests, and makes recommendations based on this literature. In brief, a negative RT-PCR nasopharyngeal swab test is insufficient to rule out COVID-19. Thus, over-reliance on the results of the test may be dangerous, and the push for widespread testing may be overstated.", "Severe underestimation of COVID-19 case numbers: effect of epidemic growth rate and test restrictions To understand the scope and development of the COVID-19 pandemic, knowledge of the number of infected persons is essential. Often, the number of \"confirmed cases\", which is based on positive RT-PCR test results, is regarded as a reasonable indicator. However, limited COVID-19 test capacities in many countries are restricting the amount of testing that can be done. This can lead to the implementation of testing policies that restrict access to COVID-19 tests, and to testing backlogs and delays. As a result, confirmed case numbers can be significantly lower than the actual number of infections, especially during rapid growth phases of the epidemic. This study examines the quantitative relation between infections and reported confirmed case numbers for two different testing strategies, \"limited\" and \"inclusive\" testing, in relation to the growth rate of the epidemic. The results indicate that confirmed case numbers understate the actual number of infections substantially; during rapid growth phases where the daily growth rate can reach or exceed 30%, as has been seen in many countries, the confirmed case numbers under-report actual infections by up to 50 to 100-fold.", "Characterizing COVID-19 case detection utilizing influenza surveillance data in the United States, January-March, 2020 COVID-19 reached the US in January, 2020, but state and local case detection efforts varied in timing and scale. We conducted a state-level ecological analysis of COVID-19 epidemiology alongside CDC influenza surveillance data and policy timelines. Our findings show wide variation in COVID-19 case detection and influenza-like-illness activity between states.", "Reconciling early-outbreak estimates of the basic reproductive number and its uncertainty: framework and applications to the novel coronavirus (SARS-CoV-2) outbreak A novel coronavirus (SARS-CoV-2) has recently emerged as a global threat. As the epidemic progresses, many disease modelers have focused on estimating the basic reproductive number Ro -- the average number of secondary cases caused by a primary case in an otherwise susceptible population. The modeling approaches and resulting estimates of Ro vary widely, despite relying on similar data sources. Here, we present a novel statistical framework for comparing and combining different estimates of Ro across a wide range of models by decomposing the basic reproductive number into three key quantities: the exponential growth rate $r$, the mean generation interval $\\bar G$, and the generation-interval dispersion $\\kappa$. We then apply our framework to early estimates of Ro for the SARS-CoV-2 outbreak. We show that many early Ro estimates are overly confident. Our results emphasize the importance of propagating uncertainties in all components of Ro, including the shape of the generation-interval distribution, in efforts to estimate Ro at the outset of an epidemic.", "Assessing Differential Impacts of COVID-19 on Black Communities Purpose Given incomplete data reporting by race, we used data on COVID-19 cases and deaths in US counties to describe racial disparities in COVID-19 disease and death and associated determinants. Methods Using publicly available data (accessed April 13, 2020), predictors of COVID-19 cases and deaths were compared between disproportionately (>13%) black and all other (<13% black) counties. Rate ratios were calculated and population attributable fractions (PAF) were estimated using COVID-19 cases and deaths via zero-inflated negative binomial regression model. National maps with county-level data and an interactive scatterplot of COVID-19 cases were generated. Results Nearly ninety-seven percent of disproportionately black counties (656/677) reported a case and 49% (330/677) reported a death versus 81% (1987/2,465) and 28% (684/ 2465), respectively, for all other counties. Counties with higher proportions of black people have higher prevalence of comorbidities and greater air pollution. Counties with higher proportions of black residents had more COVID-19 diagnoses (RR 1.24, 95% CI 1.17-1.33) and deaths (RR 1.18, 95% CI 1.00-1.40), after adjusting for county-level characteristics such as age, poverty, comorbidities, and epidemic duration. COVID-19 deaths were higher in disproportionally black rural and small metro counties. The PAF of COVID-19 diagnosis due to lack of health insurance was 3.3% for counties with <13% black residents and 4.2% for counties with >13% black residents. Conclusions Nearly twenty-two percent of US counties are disproportionately black and they accounted for 52% of COVID-19 diagnoses and 58% of COVID-19 deaths nationally. County-level comparisons can both inform COVID-19 responses and identify epidemic hot spots. Social conditions, structural racism, and other factors elevate risk for COVID-19 diagnoses and deaths in black communities.", "A novel IDEA: The impact of serial interval on a modified-Incidence Decay and Exponential Adjustment (m-IDEA) model for projections of daily COVID-19 cases The SARS-CoV-2 virus causes the disease COVID-19, and has caused high morbidity and mortality worldwide. Empirical models are useful tools to predict future trends of disease progression such as COVID-19 over the near-term. A modified Incidence Decay and Exponential Adjustment (m-IDEA) model was developed to predict the progression of infectious disease outbreaks. The modification allows for the production of precise daily estimates, which are critical during a pandemic of this scale for planning purposes. The m-IDEA model was employed using a range of serial intervals given the lack of knowledge on the true serial interval of COVID-19. Both deterministic and stochastic approaches were applied. Model fitting was accomplished through minimizing the sum-of-square differences between predicted and observed daily incidence case counts, and performance was retrospectively assessed. The performance of the m-IDEA for projection cases in the near-term was improved using shorter serial intervals (1\u20134 days) at early stages of the pandemic, and longer serial intervals at mid-to late-stages (5\u20139 days) thus far. This, coupled with epidemiological reports, suggests that the serial interval of COVID-19 might increase as the pandemic progresses, which is rather intuitive: Increasing serial intervals can be attributed to gradual increases in public health interventions such as facility closures, public caution and social distancing, thus increasing the time between transmission events. In most cases, the stochastic approach captured the majority of future reported incidence data, because it accounts for the uncertainty around the serial interval of COVID-19. As such, it is the preferred approach for using the m-IDEA during dynamic situation such as in the midst of a major pandemic.", "Prognostication and Proactive Planning in COVID-19 Abstract Accurate prognostication is challenging in the setting of SARS-CoV-2, the virus responsible for COVID-19, due to rapidly changing data, studies that are not generalizable and lack of morbidity and functional outcomes in survivors. To provide meaningful guidance to patients, existing mortality data must be considered and appropriately applied. While most people infected with SARS-CoV-2 will recover, mortality increases with age and co-morbidity in those who develop severe illness.", "Deaths from Covid-19: Who are the forgotten victims? Background: With the spreading global pandemic of coronavirus disease 2019 (Covid-19) there has been disruption to normal clinical activity in response to the increased demand on health services. There are reports of a reduction in non-Covid-19 emergency presentations. Consequentially, there are concerns that deaths from non-Covid-19 causes could increase. We examined recent reported population-based mortality rates, compared with expected rates, and compared any excess in deaths with the number of deaths attributed to Covid-19. Methods: National agency and death registration reports were searched for numbers of deaths attributed to Covid-19 and overall mortality that had been publicly reported by 16 April 2020. Data on the number of deaths attributed to Covid-19, the total number of deaths registered in the population and the historical average over at least 3 years were collected. Data were available for 3 Northern European countries (England & Wales, Scotland and the Netherlands) and New York State, United States of America. Results: There was an increase in observed, compared with expected, mortality in Scotland (+27%), England and Wales (+35%), the Netherlands (+60%) and New York state (+26%). Of these deaths, only 43% in Scotland and England and Wales, 49% in the Netherlands and 30% in New York state were attributed to Covid-19 leaving a number of excess deaths not attributed to Covid-19. Conclusions: A substantial proportion of excess deaths observed during the current COVID-19 pandemic are not attributed to COVID-19 and may represent an excess of deaths due to other causes.", "Early impact of COVID-19 on transplant center practices and policies in the United States COVID-19 is a novel, rapidly changing pandemic: consequently, evidence-based recommendations in solid organ transplantation (SOT) remain challenging and unclear. To understand the impact on transplant activity across the United States, and center-level variation in testing, clinical practice, and policies, we conducted a national survey between March 24, 2020 and March 31, 2020 and linked responses to the COVID-19 incidence map. Response rate was a very high 79.3%, reflecting a strong national priority to better understand COVID-19. Complete suspension of live donor kidney transplantation was reported by 71.8% and live donor liver by 67.7%. While complete suspension of deceased donor transplantation was less frequent, some restrictions to deceased donor kidney transplantation were reported by 84.0% and deceased donor liver by 73.3%; more stringent restrictions were associated with higher regional incidence of COVID-19. Shortage of COVID-19 tests was reported by 42.5%. Respondents reported a total of 148 COVID-19 recipients from <1 to >10 years posttransplant: 69.6% were kidney recipients, and 25.0% were critically ill. Hydroxychloroquine (HCQ) was used by 78.1% of respondents; azithromycin by 46.9%; tocilizumab by 31.3%, and remdesivir by 25.0%. There is wide heterogeneity in center-level response across the United States; ongoing national data collection, expert discussion, and clinical studies are critical to informing evidence-based practices.", "Intensive COVID-19 testing associated with reduced mortality - an ecological analysis of 108 countries Background Intensive screening and testing for COVID-19 could facilitate early detection and isolation of infected persons and thereby control the size of the epidemic. It could also facilitate earlier and more targeted therapy. These factors could plausibly reduce attributable mortality which was the hypothesis tested in this study. Methods Linear regression was used to assess the country-level association between COVID-19 attributable mortality per 100 000 inhabitants (mortality/capita) and COVID-19 tests/capita (number of tests/100 000 inhabitants) controlling for the cumulative number of COVID-19 infections/100 000 inhabitants (cases/capita), the age of the epidemic (number of days between first case reported and 8 April), national health expenditure per capita and WHO world region. Results The COVID-19 mortality rate varied between 0.3 and 3110 deaths/100 000 inhabitants (median 30, IQR 8-105). The intensity of testing per 100 000 also varied considerably (median 21,970, IQR 2,735-89,095) as did the number of COVID-19 cases per 100 000 (median 1,600, IQR 340-4,760 cases/100 000). In the multivariate model, the COVID-19 mortality rate was negatively associated with tests/capita (Coef. -0.036, 95% CI -0.047- -0.025) and positively associated with cases/capita (Coef. 0.093, 95% CI 0.819- 1.034). Conclusions The results are compatible with the hypothesis that intensive testing and isolation could play a role in reducing COVID-10 mortality rates.", "A Spatio\u2010Temporal Analysis of the Environmental Correlates of COVID\u201019 Incidence in Spain The novel SARS\u2010CoV2 has disrupted health systems and the economy, and public health interventions to slow its spread have been costly. How and when to ease restrictions to movement hinges in part on whether SARS\u2010CoV2 will display seasonality due to variations in temperature, humidity, and hours of sunshine. Here, we address this question by means of a spatio\u2010temporal analysis in Spain of the incidence of COVID\u201019, the disease caused by the virus. Use of spatial Seemingly Unrelated Regressions (SUR) allows us to model the incidence of reported cases of the disease per 100,000 population as an interregional contagion process, in addition to a function of temperature, humidity, and sunshine. In the analysis we also control for GDP per capita, percentage of older adults in the population, population density, and presence of mass transit systems. The results support the hypothesis that incidence of the disease is lower at higher temperatures and higher levels of humidity. Sunshine, in contrast, displays a positive association with incidence of the disease. Our control variables also yield interesting insights. Higher incidence is associated with higher GDP per capita and presence of mass transit systems in the province; in contrast, population density and percentage of older adults display negative associations with incidence of COVID\u201019.", "Estimating the Fraction of Unreported Infections in Epidemics with a Known Epicenter: an Application to COVID-19 We develop a simple analytical method to estimate the fraction of unreported infections in epidemics with a known epicenter and estimate the number of unreported COVID-19 infections in the US during the first half of March 2020. Our method utilizes the covariation in initial reported infections across US regions and the number of travelers to these regions from the epicenter, along with the results of a randomized testing study in Iceland. We estimate that 4%-14% (1.5%-10%) of actual infections had been reported in US up to March 16, accounting for an assumed reporting lag of 8 (5) days.", "The impact of the undetected COVID-19 cases on its transmission dynamics Objective: The COVID-19 pandemic is currently ongoing. Presently, due to the unavailability of a definitive vaccine to decrease its acquiring, it is essential to understand its transmissibility in the community by undetected cases to control its transmission. This study aims to study this context using mathematical modelling. Methods: A COVID-19 transmission model was framed that estimated the basic reproduction number (R_0, a measurement of disease risk) using the next-generation method. It explored the contribution of exposed and infected (detected and undetected) individuals, and environmental pathogen to the overall risk of infection spreading, utilizing the publicly reported data of this infection in Maharashtra between March 22, 2020, and May 4, 2020. A sensitivity analysis was performed to study the effect of a rising number of undetected cases to R_0. Results: The estimated basic reproduction number is R_0=4.63, which increases rapidly with the rise in the undetected COVID-19 cases. Although the exposed individuals made the largest contribution to infection transmission (R_1=2.42), the contaminated environment also played a significant role. Conclusions: It is crucial to identify the individuals exposed and infected to COVID-19 disease and isolate them to control its transmission. The awareness of the role of fomites in infection transmission is also important in this regard.", "Time Course of COVID-19 epidemic in Algeria: Retrospective estimate of the actual burden Since December 2019, the five continents have been incrementally invaded by SARS-CoV-2. Africa is the last and least affected to date. However, Algeria is among the first countries affected since February 25, 2020. In order to benefit from its experience in the least affected countries, this study aims to describe the current situation of the epidemic and then retrospectively estimate its real burden. As a first part of the study, we described the indicators of the epidemic as; the cumulative and daily reported cases and deaths, and we computed the R0 evolution. Secondly, we used the New York City cases-fatality rate standardized by Algerian age structure, to retrospectively estimate the actual burden. We found that reported cases are in a clear diminution, but, the epidemic epicentre is moving from Blida to other cities. We noted a clear peak in daily cases-fatality from March 30, to April 17, 2020, Fig. 3, due to underestimating the actual infections of the first 25 days. Since May 8, 2020, the daily R0 is around one, Fig. 4. Moreover, we noticed 31% reduction of its mean value from 1,41 to 0,97 between the last two months. The Algerian Age-Standardized Infection Fatality Rate we found is 0,88%. Based on that, we demonstrated that only 1,5% of actual infections were detected and reported before March 30, and 20% after March 31, Fig. 5. Therefore, the actual infections burden is currently five times higher than reported. At the end, we found that at least 0,2 % of the population have been infected until May 27. Consequently, the acquired herd immunity to date is therefore not sufficient to avoid a second wave. We believe that, the under estimation of the actual burden of the epidemic is probably due to the lack of testing capacities, however, all the indicators show that the situation is currently controlled. This requires more vigilance for the next weeks during the gradual easing of the preventive measures.", "Incorporating Human Movement Data to Improve Epidemiological Estimates for 2019-nCoV Estimating the key epidemiological features of the novel coronavirus (2019-nCoV) epidemic proves to be challenging, given incompleteness and delays in early data reporting, in particular, the severe under-reporting bias in the epicenter, Wuhan, Hubei Province, China. As a result, the current literature reports widely varying estimates. We developed an alternative geo-stratified debiasing estimation framework by incorporating human mobility with case reporting data in three stratified zones, i.e., Wuhan, Hubei Province excluding Wuhan, and mainland China excluding Hubei. We estimated the latent infection ratio to be around 0.12% (18,556 people) and the basic reproduction number to be 3.24 in Wuhan before the city's lockdown on January 23, 2020. The findings based on this debiasing framework have important implications to prioritization of control and prevention efforts.", "Oscillations in USA COVID-19 Incidence and Mortality Data reflect societal factors The COVID-19 pandemic currently in process differs from other infectious disease calamities that have previously plagued humanity in the vast amount of information that is produces each day, which includes daily estimates of the disease incidence and mortality data. Apart from providing actionable information to public health authorities on the trend of the pandemic, the daily incidence reflects the process of disease in a susceptible population and thus reflects the pathogenesis of COVID-19, the public health response and diagnosis and reporting. Both daily new cases and daily mortality data in the US exhibit periodic oscillatory patterns. By analyzing NYC and LA testing data, we demonstrate that this oscillation in the number of cases can be strongly explained by the daily variation in testing. This seems to rule out alternative hypotheses such as increased infections on certain days of the week as driving this oscillation. Similarly, we show that the apparent oscillation in mortality in the US data is mostly an artifact of reporting, which disappears in datasets that record death by episode date, such as the NYC and LA datasets. Periodic oscillations in COVID-19 incidence and mortality data reflect testing and reporting practices and contingencies. Thus, these contingencies should be considered first prior to suggesting social or biological mechanisms.", "Estimation of Basic Reproduction Number of the COVID-19 Epidemic in Denmark using a Two-Step Model Objective: To conduct an early estimation of the Basic Reproduction Number (BRN) induced by government interference, and to project resulting day to day number of in-patients, ICU-patients and cumulative number of deaths in a Danish setting. Method: We used the Kermack and McKendrick model with varying basic reproduction number to estimate number infected and age stratified percentages to estimate number of in-patients, ICU-patients and cumulative number of deaths. Changes in basic reproduction number was estimated based on current in-patient numbers. Results: The basic reproductive number in the time period of February 27th to March 18th was found to be 2.65, however, this number was reduced to 1.99 after March 18th. Keywords: COVID-19, basic reproduction number, Danish population", "Quantifying spatiotemporal heterogeneity of MERS-CoV transmission in the Middle East region: A combined modelling approach Abstract MERS coronavirus cases notified in the Middle East region since the identification of the virus in 2012 have displayed variations in time and across geography. Through a combined modelling approach, we estimate the rates of generation of cases along the zoonotic and human-to-human transmission routes and assess their spatiotemporal heterogeneity. We consider all cases notified to WHO from March 2012 to mid-September 2014. We use a stochastic modelling of the time series of case incidence in the Middle East region to estimate time- and space-dependent zoonotic and human-to-human transmission parameters. The model also accounts for possible lack of identification of secondary transmissions among notified cases. This approach is combined with the analysis of imported cases out of the region to assess the rate of underreporting of cases. Out of a total of 32 possible models, based on different parameterisation and scenario considered, the best-fit model is characterised by a large heterogeneity in time and across space for both zoonotic and human-to-human transmission. The variation in time that occurred during Spring 2014 led to a 17-fold and 3-fold increase in the two transmissions, respectively, bringing the reproductive rate to values above 1 during that period for all regions under study. The model suggests that 75% of MERS-CoV cases are secondary cases (human-to-human transmission), which is substantially higher than the 34% of reported cases with an epidemiological link to another case. Overall, estimated reporting rate is 0.26. Our findings show a higher level of spatial heterogeneity in zoonotic transmission compared to human-to-human, highlighting the strong environmental component of the epidemic. Since sporadic introductions are predicted to be a small proportion of notified cases and are responsible for triggering secondary transmissions, a more comprehensive understanding of zoonotic source and path of transmission could be critical to limit the epidemic spread.", "COVID-19: The unreasonable effectiveness of simple models Abstract When the novel coronavirus disease SARS-CoV2 (COVID-19) was officially declared a pandemic by the WHO in March 2020, the scientific community had already braced up in the effort of making sense of the fast-growing wealth of data gathered by national authorities all over the world. However, despite the diversity of novel theoretical approaches and the comprehensiveness of many widely established models, the official figures that recount the course of the outbreak still sketch a largely elusive and intimidating picture. Here we show unambiguously that the dynamics of the COVID-19 outbreak belongs to the simple universality class of the SIR model and extensions thereof. Our analysis naturally leads us to establish that there exists a fundamental limitation to any theoretical approach, namely the unpredictable non-stationarity of the testing frames behind the reported figures. However, we show how such bias can be quantified self-consistently and employed to mine useful and accurate information from the data. In particular, we describe how the time evolution of the reporting rates controls the occurrence of the apparent epidemic peak, which typically follows the true one in countries that were not vigorous enough in their testing at the onset of the outbreak. The importance of testing early and resolutely appears as a natural corollary of our analysis, as countries that tested massively at the start clearly had their true peak earlier and less deaths overall.", "Excess mortality during the Covid-19 pandemic: Early evidence from England and Wales The Covid-19 pandemic has claimed many lives in the UK and globally. The objective of this paper is to study whether the number of deaths not registered as Covid-19-related has increased compared to what would have been expected in the absence of the pandemic. Reasons behind this might include Covid-19 underreporting, avoiding visits to hospitals or GPs, and the effects of the lockdown. I used weekly ONS data on the number of deaths in England and Wales that did not officially involve Covid-19 over the period 2015-2020. Simply observing trends is not sufficient as spikes in deaths may occasionally occur. I thus followed a difference-in-differences econometric approach to study whether there was a relative increase in deaths not registered as Covid-19-related during the pandemic, compared to a control. Results suggest that there were an additional 968 weekly deaths that officially did not involve Covid-19, compared to what would have otherwise been expected. It is possible that some people are dying from Covid-19 without being diagnosed, and/or that there are excess deaths due to other causes as a result of the pandemic. Analysing the cause of death for any excess non-covid-19 deaths will shed light upon the reasons for the increase in such deaths and will help design appropriate policy responses to save lives.", "Clinical Performance of SARS-CoV-2 Molecular Testing Molecular testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the gold standard for diagnosis of coronavirus disease 2019 (COVID-19), but the test clinical performance is poorly understood. From 3/10/2020-5/1/2020 NewYork-Presbyterian laboratories performed 27,377 SARS-CoV-2 molecular assays from 22,338 patients. Repeat testing was performed in 3,432 patients, of which 2,413 had negative and 1,019 had positive first day results. Repeat-tested patients were more likely to be older, male, African-American or Hispanic, and to have severe disease. Among the patients with initially negative results, 18.6% became positive upon repeat-testing. Only 58.1% of any-time positive patients had a result of \"detected\" on the first test. The clinical sensitivity of COVID-19 molecular assays is estimated between 66.2% and 95.6%, depending on the unknown number of false negative results in single-tested patients. Conversion to a negative result is unlikely to occur before 15 to 20 days after initial testing or 20-30 days after the onset of symptoms, with 50% conversion occurring at 28 days after initial testing. Forty-nine initially-positive patients converted to negative and then back to positive in subsequent days. Conversion from first day negative to positive results increased linearly with each day of testing, reaching 25% probability in 20 days. In summary, our study provides estimates of the clinical performance of SARS-CoV-2 molecular assays and suggests time frames for appropriate repeat testing, namely 15 to 20 days after a positive test and the same or next 2 days after a negative test in a patient with high suspicion for COVID-19.", "COVID-19 Spread in India: Dynamics, Modeling, and Future Projections COVID-19 is an extremely infectious disease with a relatively large virus incubation period in the affected people who may be asymptomatic. Therefore, to reduce the transmission of this pathogen, several countries have taken many intervention measures. In this paper, we show that the impact of these measures in India is different from several other countries. It is shown that an early lockdown in late March 2020 changed the initial exponential growth curve of COVID-19 to a linear one, but a surge in the number of cases from late April 2020 brought India back to a quadratic trajectory. A regional analysis shows the disparate impact of the intervention in different states. It is further shown that the number of reported infections correlates with the number of tests, and therefore regions with limited diagnostics resources may not have a realistic estimate of the virus spread. This insufficiency of diagnostic test data is also reflected in an increasing positivity rate for India nearly 2.5 months after the lockdown, inconsistent with the trends observed for other geographical regions. Nonetheless, future projections are made using different epidemiological models based on the available data, and a comparative study is presented. In the absence of a reliable estimate of the true number of infections, these projections will have a limited accuracy: with that limitation, the most optimistic prediction suggests a continuing virus transmission through September 2020.", "COVID-19 peak estimation and effect of nationwide lockdown in India There was a fury of the pandemic because of novel coronavirus (2019-nCoV/SARS-CoV-2) that happened in Wuhan, Hubei province, in China in December 2019. Since then, many model predictions on the COVID-19 pandemic in Wuhan and other parts of China have been reported. The first incident of coronavirus disease 2019 (COVID-19) in India was reported on 30 January 2020, which was a student from Wuhan. The number of reported cases has started to increase day by day after 30 February 2020. The purpose of this investigation is to provide a prediction of the epidemic peak for COVID-19 in India by utilizing real-time data from 30 February to 14 April 2020. We apply the well-known epidemic compartmental model \"SEIR\" to predict the epidemic peak of COVID-19, India. Since we do not have the complete detail of the infective population, using the available infected population data, we identify the R0 by using polynomial regression. By using the third-order polynomial equation, we estimate that the basic reproduction number for the epidemic in India is R0 = 3.3 (95%CI, 3.1 to 3.5), and the epidemic peak could be reached by September 2020.", "Cotton tipped plastic swabs for SARS-CoV-2 RT-qPCR diagnosis to prevent supplies shortage. Nasopharyngeal sampling protocols for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis guidelines only recommend synthetic fiber swabs. We show that simple and cheap cotton tipped plastic swabs do not inhibit PCR and have equivalent performance to rayon swabs. Cotton tipped plastic swabs are massively produced worldwide and would prevent swabs supplies shortage during current high SARS-CoV-2 testing demands, particularly on developing countries.", "Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak BACKGROUNDS: An ongoing outbreak of a novel coronavirus (2019-nCoV) pneumonia hit a major city in China, Wuhan, December 2019 and subsequently reached other provinces/regions of China and other countries. We present estimates of the basic reproduction number, R0, of 2019-nCoV in the early phase of the outbreak. METHODS: Accounting for the impact of the variations in disease reporting rate, we modelled the epidemic curve of 2019-nCoV cases time series, in mainland China from January 10 to January 24, 2020, through the exponential growth. With the estimated intrinsic growth rate (\u00ce\u00b3), we estimated R0 by using the serial intervals (SI) of two other well-known coronavirus diseases, MERS and SARS, as approximations for the true unknown SI. FINDINGS: The early outbreak data largely follows the exponential growth. We estimated that the mean R0 ranges from 2.24 (95%CI: 1.96-2.55) to 3.58 (95%CI: 2.89-4.39) associated with 8-fold to 2-fold increase in the reporting rate. We demonstrated that changes in reporting rate substantially affect estimates of R0. CONCLUSION: The mean estimate of R0 for the 2019-nCoV ranges from 2.24 to 3.58, and is significantly larger than 1. Our findings indicate the potential of 2019-nCoV to cause outbreaks.", "[Epidemic trend of corona virus disease 2019 (COVID-19) in mainland China] Objective: In order to master the epidemic trend of corona virus disease 2019 (COVID-19) and evaluate the effect of prevention and control, we evaluate the epidemic dynamics of COVID-19 in mainland China, Hubei province, Wuhan city and other provinces outside Hubei from January 16 to February 14, 2020. Methods: We collected the daily number of new confirmed COVID-19 cases by nucleic acid detection reported by the National Health Commission from January 16, 2020 to February 14, 2020. The analysis includes the epidemic curve of the new confirmed cases, multiple of the new confirmed cases for period-over-period, multiple of the new confirmed cases for fixed-base, and the period-over-period growth rate of the new confirmed cases. Results: From January 16 to February 14, 2020, the cumulative number of new confirmed cases of COVID-19 in mainland China was 50 031, including 37 930 in Hubei province, 22 883 in Wuhan city and 12 101 in other provinces outside Hubei. The peak of the number of new confirmed cases in other provinces outside Hubei was from January 31 to February 4, 2020, and the peak of new confirmed cases in Wuhan city and Hubei province was from February 5 to February 9, 2020. The number of new confirmed cases in other provinces outside Hubei showed a significant decline (23% compared with the peak) from February 5 to February 9, 2020, while the number of new confirmed cases in Wuhan city (30% compared with the peak) and Hubei Province (37% compared with the peak) decreased significantly from February 10 to February 14, 2020. Conclusion: The epidemic prevention and control measures taken by the state and governments at all levels have shown very significant effects, effectively curbing the spread of the COVID-19 epidemic in China.", "The novel coronavirus outbreak: what can be learned from China in public reporting? The new coronavirus outbreak gets everyone\u2019s attention. China\u2019s national actions against the outbreak have contributed great contributions to the world. China has been learning from practice for better reporting and is fast to adapt itself. In this article we discuss China\u2019s practice in public reporting and its implications to global health. Confirmed cases, dynamic suspected cases, recovered cases, and deaths have been reported both in accumulative numbers and their daily updates. Some ratio indictors reporting (fatality rate, recovery rate, etc.), trend reporting, and global surveillance have been applied as well. Some improvements can still be made. It is necessary to further explore the influential factors behind the indicators for interventions. Recommendations are made to the World Health Organization and other countries for better public reporting and surveillance.", "Testing lags and emerging COVID-19 outbreaks in federal penitentiaries in Canada Objectives: To provide the first known comprehensive analysis of COVID-19 outcomes in a federal penitentiary system. We examined the following COVID-19 outcomes within federal penitentiaries and contrasted them with the overall population in the penitentiaries' respective provincial jurisdictions: testing, prevalence, the proportion recovered, and fatality. Methods: Data for prisons were obtained from the Correctional Service of Canada and, for the general population, from COVID-19 Esri Canadian Outbreak Tracking Hub. Data were retrieved between March 30 and April 21, 2020, and are accurate to this date. Penitentiary-, province- and sex-specific frequency statistics for each outcome were calculated. Results: Data on 50 of 51 penitentiaries (98%) were available. Of these, 72% of penitentiaries reported fewer tests per 1000 population than the Canadian general population average (16 tests/1000 population), and 24% of penitentiaries reported zero tests. Penitentiaries with high levels of testing were those that already had elevated COVID-19 prevalence. Five penitentiaries reported an outbreak (at least one case). Hardest hit penitentiaries were those in Quebec and British Columbia, with some prisons reporting COVID-19 prevalence of 30% to 40%. Of these, two were women's prisons. Female prisoners were over-represented among cases (31% of cases overall, despite representing 5% of the total prison population). Conclusion: Increased sentinel or universal testing may be appropriate given the confined nature of prison populations. This, along with rigorous infection prevention control practices and the potential release of prisoners, will be needed to curb current outbreaks and those likely to come.", "Towards reduction in bias in epidemic curves due to outcome misclassification through Bayesian analysis of time-series of laboratory test results: Case study of COVID-19 in Alberta, Canada and Philadelphia, USA The aim of our work was to better understand misclassification errors in identification of true cases of COVID-19 and to study the impact of these errors in epidemic curves. We examined publically available time-series data of laboratory tests for SARS-CoV-2 viral infection, the causal agent for COVID-19, to try to explore, using a Bayesian approach, about the sensitivity and specificity of the PCR-based diagnostic test. Data originated from Alberta, Canada (available on 3/28/2020) and city of Philadelphia, USA (available on 3/31/2020). Our analysis revealed that the data were compatible with near-perfect specificity but it was challenging to gain information about sensitivity (prior and posterior largely overlapped). We applied these insights to uncertainty/bias analysis of epidemic curves into jurisdictions under the assumptions of both improving and degrading sensitivity. If the sensitivity improved from 60 to 95%, the observed and adjusted epidemic curves likely fall within the 95% confidence intervals of the observed counts. However, bias in the shape and peak of the epidemic curves can be pronounced, if sensitivity either degrades or remains poor in the 60\u201370% range. In the extreme scenario, hundreds of undiagnosed cases, even among tested, are possible, potentially leading to further unchecked contagion should these cases not self-isolate. The best way to better understand bias in the epidemic curves of COVID-19 due to errors in testing is to empirically evaluate misclassification of diagnosis in clinical settings and apply this knowledge to adjustment of epidemic curves, a task for which the Bayesian method we presented is well-suited.", "Predicting the number of reported and unreported cases for the COVID-19 epidemics in China, South Korea, Italy, France, Germany and United Kingdom The novel coronavirus (SARS-CoV-2) is currently causing concern in the medical, epidemiological and mathematical communities as the virus is rapidly spreading around the world. Internationally, there are more than 1,200,000 cases detected and confirmed in the world on April 6. The asymptomatic and mild symptomatic cases are just going to be really crucial for us to understand what is driving this epidemic to transmit rapidly. Combining a mathematical model of severe (SARS-CoV-2) transmission with data from China, South Korea, Italy, France, Germany and United Kingdom, we provide the epidemic predictions of the number of reported and unreported cases for the SARS-CoV-2 epidemics and evaluate the effectiveness of control measures for each country.", "Belgian Covid-19 Mortality, Excess Deaths, Number of Deaths per Million, and Infection Fatality Rates (8 March - 9 May 2020) Objective. Scrutiny of COVID-19 mortality in Belgium over the period 8 March-9 May 2020 (Weeks 11-19), using number of deaths per million, infection fatality rates, and the relation between COVID-19 mortality and excess death rates. Data. Publicly available COVID-19 mortality (2020); overall mortality (2009-2020) data in Belgium and demographic data on the Belgian population; data on the nursing home population; results of repeated sero-prevalence surveys in March-April 2020. Statistical methods. Reweighing, missing-data handling, rate estimation, visualization. Results. Belgium has virtually no discrepancy between COVID-19 reported mortality (confirmed and possible cases) and excess mortality. There is a sharp excess death peak over the study period; the total number of excess deaths makes April 2020 the deadliest month of April since WWII, with excess deaths far larger than in early 2017 or 2018, even though influenza-induced January 1951 and February 1960 number of excess deaths were similar in magnitude. Using various sero-prevalence estimates, infection fatality rates (IFRs; fraction of deaths among infected cases) are estimated at 0.38-0.73% for males and 0.20-0.39% for females in the non-nursing home population (non-NHP), and at 0.79-1.52% for males and 0.88-1.31% for females in the entire population. Estimates for the NHP range from 38 to 73% for males and over 22 to 37% for females. The IFRs rise from nearly 0% under 45 years, to 4.3% and 13.2% for males in the non-NHP and the general population, respectively, and to 1.5% and 11.1% for females in the non-NHP and general population, respectively. The IFR and number of deaths per million is strongly influenced by extensive reporting and the fact that 66.0% of the deaths concerned NH residents. At 764 (our re-estimation of the figure 735, presented by \"Our World in Data\"), the number of COVID-19 deaths per million led the international ranking on May 9, 2020, but drops to 262 in the non-NHP. The NHP is very specific: age-related increased risk; highly prevalent comorbidities that, while non-fatal in themselves, exacerbate COVID-19; larger collective households that share inadvertent vectors such as caregivers and favor clustered outbreaks; initial lack of protective equipment, etc. High-quality health care countries have a relatively older but also more frail population [1], which is likely to contribute to this result.", "Analysis of the epidemic growth of the early 2019-nCoV outbreak using internationally confirmed cases Background: On January 23, 2020, a quarantine was imposed on travel in and out of Wuhan, where the 2019 novel coronavirus (2019-nCoV) outbreak originated from. Previous analyses estimated the basic epidemiological parameters using symptom onset dates of the confirmed cases in Wuhan and outside China. Methods: We obtained information on the 46 coronavirus cases who traveled from Wuhan before January 23 and have been subsequently confirmed in Hong Kong, Japan, Korea, Macau, Singapore, and Taiwan as of February 5, 2020. Most cases have detailed travel history and disease progress. Compared to previous analyses, an important distinction is that we used this data to informatively simulate the infection time of each case using the symptom onset time, previously reported incubation interval, and travel history. We then fitted a simple exponential growth model with adjustment for the January 23 travel ban to the distribution of the simulated infection time. We used a Bayesian analysis with diffuse priors to quantify the uncertainty of the estimated epidemiological parameters. We performed sensitivity analysis to different choices of incubation interval and the hyperparameters in the prior specification. Results: We found that our model provides good fit to the distribution of the infection time. Assuming the travel rate to the selected countries and regions is constant over the study period, we found that the epidemic was doubling in size every 2.9 days (95% credible interval [CrI], 2 days--4.1 days). Using previously reported serial interval for 2019-nCoV, the estimated basic reproduction number is 5.7 (95% CrI, 3.4--9.2). The estimates did not change substantially if we assumed the travel rate doubled in the last 3 days before January 23, when we used previously reported incubation interval for severe acute respiratory syndrome (SARS), or when we changed the hyperparameters in our prior specification. Conclusions: Our estimated epidemiological parameters are higher than an earlier report using confirmed cases in Wuhan. This indicates the 2019-nCoV could have been spreading faster than previous estimates.", "Charting the challenges behind the testing of COVID-19 in developing countries: Nepal as a case study Abstract The infrastructure needed to detect SARS-CoV-2 infection (COVID-19) that complies completely with WHO guidelines is lacking across many parts of the globe, especially in developing countries, including Nepal. We outline the problems faced by such countries and suggest that the national and international community should collaborate in the development and adoption of novel protocols for the rapid detection of COVID-19 according to locally available infrastructure, in order to fight against the outbreak.", "Understanding and Interpretation of Case Fatality Rate of Coronavirus Disease 2019 ", "A comparison of group testing architectures for COVID-19 testing An important component of every country's COVID-19 response is fast and efficient testing -- to identify and isolate cases, as well as for early detection of local hotspots. For many countries, producing a sufficient number of tests has been a serious limiting factor in their efforts to control COVID-19 infections. Group testing is a well-established mathematical tool, which can provide a serious and rapid improvement to this situation. In this note, we compare several well-established group testing schemes in the context of qPCR testing for COVID-19. We include example calculations, where we indicate which testing architectures yield the greatest efficiency gains in various settings. We find that for identification of individuals with COVID-19, array testing is usually the best choice, while for estimation of COVID-19 prevalence rates in the total population, Gibbs-Gower testing usually provides the most accurate estimates given a fixed and relatively small number of tests. This note is intended as a helpful handbook for labs implementing group testing methods.", "Using observational data to quantify bias of traveller-derived COVID-19 prevalence estimates in Wuhan, China BACKGROUND: The incidence of coronavirus disease 2019 (COVID-19) in Wuhan, China, has been estimated using imported case counts of international travellers, generally under the assumptions that all cases of the disease in travellers have been ascertained and that infection prevalence in travellers and residents is the same. However, findings indicate variation among locations in the capacity for detection of imported cases. Singapore has had very strong epidemiological surveillance and contact tracing capacity during previous infectious disease outbreaks and has consistently shown high sensitivity of case-detection during the COVID-19 outbreak. METHODS: We used a Bayesian modelling approach to estimate the relative capacity for detection of imported cases of COVID-19 for 194 locations (excluding China) compared with that for Singapore. We also built a simple mathematical model of the point prevalence of infection in visitors to an epicentre relative to that in residents. FINDINGS: The weighted global ability to detect Wuhan-to-location imported cases of COVID-19 was estimated to be 38% (95% highest posterior density interval [HPDI] 22-64) of Singapore's capacity. This value is equivalent to 2\u00b78 (95% HPDI 1\u00b75-4\u00b74) times the current number of imported and reported cases that could have been detected if all locations had had the same detection capacity as Singapore. Using the second component of the Global Health Security index to stratify likely case-detection capacities, the ability to detect imported cases relative to Singapore was 40% (95% HPDI 22-67) among locations with high surveillance capacity, 37% (18-68) among locations with medium surveillance capacity, and 11% (0-42) among locations with low surveillance capacity. Treating all travellers as if they were residents (rather than accounting for the brief stay of some of these travellers in Wuhan) contributed modestly to underestimation of prevalence. INTERPRETATION: Estimates of case counts in Wuhan based on assumptions of 100% detection in travellers could have been underestimated by several fold. Furthermore, severity estimates will be inflated several fold since they also rely on case count estimates. Finally, our model supports evidence that underdetected cases of COVID-19 have probably spread in most locations around the world, with greatest risk in locations of low detection capacity and high connectivity to the epicentre of the outbreak. FUNDING: US National Institute of General Medical Sciences, and Fellowship Foundation Ramon Areces.", "Testing for tracing or testing just for treating? A comparative analysis between strategies to face COVID-19 pandemic. There is some consensus in Europe and Asia about testing rates being crucial to controlling COVID-19 pandemics. There are though misconceptions on what means an effective high testing rate. This paper demonstrates that the rate of tests per detected case (Tests/Case) is the important variable, correlating negatively with the number of deaths. The higher the Tests/Case rate, the lower the death rate, as this predictor is causally related to contact tracing and isolation of the vectors of the disease. Doubling Tests/Case typically divides by three the number of deaths. On the other hand, per capita testing rate is a poor predictor for the performance of policies to fight the pandemics. The number of tests per 1,000 inhabitants (Tests/1,000) tends to correlate positively with the number of deaths. In some cases, high levels of Tests/1,000 just mean an epidemic that ran out of control, with an explosion of cases that demands high testing rates just to confirm the diagnosis of the very sick.", "Modeling reductions in SARS-CoV-2 transmission and hospital burden achieved by prioritizing testing using a clinical prediction rule Prompt identification of cases is critical for slowing the spread of COVID-19. However, many areas have faced diagnostic testing shortages, requiring difficult decisions to be made regarding who receives a test, without knowing the implications of those decisions on population-level transmission dynamics. Clinical prediction rules (CPRs) are commonly used tools to guide clinical decisions. We used data from electronic health records to develop a parsimonious 5-variable CPR to identify those who are most likely to test positive, and found that its application to prioritize testing increases the proportion of those testing positive in settings of limited testing capacity. To consider the implications of these gains in daily case detection on the population level, we incorporated testing using the CPR into a compartmentalized disease transmission model. We found that prioritized testing led to a delayed and lowered infection peak (i.e. 'flattens the curve'), with the greatest impact at lower values of the effective reproductive number (such as with concurrent social distancing measures), and when higher proportions of infectious persons seek testing. Additionally, prioritized testing resulted in reductions in overall infections as well as hospital and intensive care unit (ICU) burden. In conclusion, we present a novel approach to evidence-based allocation of limited diagnostic capacity, to achieve public health goals for COVID-19.", "A Method to Identify the Missing COVID-19 Cases in the U.S. and Results for mid-April 2020 I use the COVID-19 death rate in South Korea and a method relating the ratio of death rates in a U.S. state to its share of cumulative positive tests to estimate the total cases of COVID-19 in the U.S. and to estimate the extent of infection and the unidentified share of the infected population in each of the lower-48 states and in New York City in mid-April, 2020. I identify a logarithmic relationship between the cumulative death rate in a state and its cumulative positive share of tests. Using this relationship, I find that 4.3-5.4 million people, 1.4-1.7% of the U.S. population, were infected, with rates of infection that ranged from 0.1% in more rural states to 8-10% in New York state and 11-13% in New York City. Only 16-20% of these infected individuals were identified later through testing.", "Laboratory surveillance for SARS-CoV-2 in India: Performance of testing & descriptive epidemiology of detected COVID-19, January 22 - April 30, 2020. Background & objectives India has been reporting the cases of coronavirus disease 2019 (COVID-19) since January 30, 2020. The Indian Council of Medical Research (ICMR) formulated and established laboratory surveillance for COVID-19. In this study, an analysis of the surveillance data was done to describe the testing performance and descriptive epidemiology of COVID-19 cases by time, place and person. Methods The data were extracted from January 22 to April 30, 2020. The frequencies of testing performance were described over time and by place. We described cases by time (epidemic curve by date of specimen collection; seven-day moving average), place (area map) and person (attack rate by age, sex and contact status), and trends were represented along with public health measures and events. Results Between January 22 and April 30, 2020, a total of 1,021,518 individuals were tested for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Testing increased from about 250 individuals per day in the beginning of March to 50,000 specimens per day by the end of April 2020. Overall, 40,184 (3.9%) tests were reported positive. The proportion of positive cases was highest among symptomatic and asymptomatic contacts, 2-3-fold higher than among those with severe acute respiratory infection, or those with an international travel history or healthcare workers. The attack rate (per million) by age was highest among those aged 50-69 yr (63.3) and was lowest among those under 10 yr (6.1). The attack rate was higher among males (41.6) than females (24.3). The secondary attack rate was 6.0 per cent. Overall, 99.0 per cent of 736 districts reported testing and 71.1 per cent reported COVID-19 cases. Interpretation & conclusions The coverage and frequency of ICMR's laboratory surveillance for SARS-CoV-2 improved over time. COVID-19 was reported from most parts of India, and the attack rate was more among men and the elderly and common among close contacts. Analysis of the data indicates that for further insight, additional surveillance tools and strategies at the national and sub-national levels are needed.", "Real time estimation of the risk of death from novel coronavirus (2019-nCoV) infection: Inference using exported cases The exported cases of 2019 novel coronavirus (2019-nCoV) infection who were confirmed in other countries provide a chance to estimate the cumulative incidence and confirmed case fatality risk (cCFR) in China. Knowledge of the cCFR is critical to characterize the severity and understand pandemic potential of 2019-nCoV in the early stage of epidemic. Using the exponential growth rate of the incidence, the present study statistically estimated the cCFR and the basic reproduction number, i.e., the average number of secondary cases generated by a single primary case in a naive population. As of 24 January 2020, with 23 exported cases, and estimating the growth rate from 8 December 2019 (scenario 1) and using the data since growth of exported cases (scenario 2), the cumulative incidence in China was estimated at 5433 cases (95% confidence interval (CI): 3883, 7160) and 17780 cases (95% CI: 9646, 28724), respectively. The latest estimates of the cCFR were 4.6% (95% CI: 3.1-6.6) for scenario 1 and 7.7% (95% CI: 4.9-11.3%) for scenario 2, respectively. The basic reproduction number was estimated to be 2.2 (95% CI: 2.1, 2.3) and 3.7 (95% CI: 3.1, 4.3) for scenarios 1 and 2, respectively. Based on the results, we note that current 2019-nCoV epidemic has a substation potential to cause a pandemic. The proposed approach can provide insights into early risk assessment using only publicly available data.", "Population modeling of early COVID-19 epidemic dynamics in French regions and estimation of the lockdown impact on infection rate We propose a population approach to model the beginning of the French COVID-19 epidemic at the regional level. We rely on an extended Susceptible-Exposed-Infectious-Recovered (SEIR) mechanistic model, a simplified representation of the average epidemic process. Combining several French public datasets on the early dynamics of the epidemic, we estimate region-specific key parameters conditionally on this mechanistic model through Stochastic Approximation Expectation Maximization (SAEM) optimization using Monolix software. We thus estimate basic reproductive numbers by region before isolation (between 2.4 and 3.1), the percentage of infected people over time (between 2.0 and 5.9% as of May 11th, 2020) and the impact of nationwide household confinement on the infection rate (decreasing the transmission rate by 72% toward a Re ranging from 0.7 to 0.9). We conclude that a lifting of the lockdown should be accompanied by further interventions to avoid an epidemic rebound.", "ESTIMATION OF COVID-19 CASES IN FRANCE AND IN DIFFERENT COUNTRIES: HOMOGENEISATION BASED ON MORTALITY Every day the authorities of different countries provide an estimate of the number of persons affected by Covid-19 and a count of fatality. We propose to use the fatality reported in each country to provide a better estimate (Ct0-estimated) of the number of cases at a given time t0. Ct0-estimated = (Ft0 / Fr-est) * (1+ [C(est-d) / C(est-3d)])6 With Ft0: number of actual fatalities reported in a country at time t0; Fr-est: estimated fatality rate; C(est-d): estimated fatalities 18 days before t0; C(est-3d): estimated fatalities 21 days before t0. Based on Ct0-estimated calculated using a fatality rate of 2%, we assessed the number of cases April 10th, 2020 in Belgium, China, France, Germany, Iran, Italy, South Korea, Netherlands, Spain, United Kingdom and USA. This number reached 2,872,097 in France and 924,892 persons in Germany. The proposed formulas also make it possible to evaluate the impact of policies to prevent the spread of epidemic on the appearance of new cases.", "Global transmission network of SARS-CoV-2: from outbreak to pandemic BACKGROUND. The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is straining health systems around the world. Although the Chinese government implemented a number of severe restrictions on people\u2019s movement in an attempt to contain its local and international spread, the virus had already reached many areas of the world in part due to its potent transmissibility and the fact that a substantial fraction of infected individuals develop little or no symptoms at all. Following its emergence, the virus started to generate sustained transmission in neighboring countries in Asia, Western Europe, Australia, Canada and the United States, and finally in South America and Africa. As the virus continues its global spread, a clear and evidence-based understanding of properties and dynamics of the global transmission network of SARS-CoV-2 is essential to design and put in place efficient and globally coordinated interventions. METHODS. We employ molecular surveillance data of SARS-CoV-2 epidemics for inference and comprehensive analysis of its global transmission network before the pandemic declaration. Our goal was to characterize the spatial-temporal transmission pathways that led to the establishment of the pandemic. We exploited a network-based approach specifically tailored to emerging outbreak settings. Specifically, it traces the accumulation of mutations in viral genomic variants via mutation trees, which are then used to infer transmission networks, revealing an up-to-date picture of the spread of SARS-CoV-2 between and within countries and geographic regions. RESULTS AND CONCLUSIONS. The analysis suggest multiple introductions of SARS-CoV-2 into the majority of world regions by means of heterogeneous transmission pathways. The transmission network is scale-free, with a few genomic variants responsible for the majority of possible transmissions. The network structure is in line with the available temporal information represented by sample collection times and suggest the expected sampling time difference of few days between potential transmission pairs. The inferred network structural properties, transmission clusters and pathways and virus introduction routes emphasize the extent of the global epidemiological linkage and demonstrate the importance of internationally coordinated public health measures.", "COVID-19 Testing, Epidemic Features, Hospital Outcomes, and Household Prevalence, New York State\u2014March 2020 BACKGROUND: The United States\u2019 COVID-19 epidemic has grown extensively since February 2020, with substantial associated hospitalizations and mortality; New York State (NYS) has emerged as the national epicenter. We report on the extent of testing and test results during the month of March in NYS, along with risk factors, outcomes, and household prevalence among initial cases subject to in-depth investigations. METHODS: Specimen collection for COVID-19 testing was conducted in healthcare settings, community-based collection sites, and by home testing teams. Information on demographics, risk factors, and hospital outcomes of cases was obtained through epidemiological investigations and an electronic medical records match, and summarized descriptively. Active testing of initial case\u2019s households enabled estimation of household prevalence. RESULTS: During March In NYS, outside of New York City, a total of 47,326 persons tested positive for SARS-CoV-2, out of 141,495 tests (33% test-positive), with the highest number of cases located in the metropolitan region counties. Among 229 initial cases diagnosed through March 12, by March 30 13% were hospitalized and 2% died. Testing conducted among 498 members of these case\u2019s households found prevalent infection among 57%; excluding first-reported cases 38%. In these homes, we found a significant age gradient in prevalence, from 23% among those <5 years to 68% among those \u226565 years (p<.0001). CONCLUSIONS: New York State faced a substantial and increasing COVID-19 outbreak during March 2020. The earliest cases had high levels of infection in their households and by the end of the month, the risks of hospitalization and death were high.", "Modeling the COVID-19 outbreak in the United States The COVID-19 contagion has developed at an alarming rate in the US and as of April 24, 2020, tens of thousands of people have already died from the disease. In the event of an outbreak like such, forecasting the extent of the mortality that will occur is crucial to aid the implementation of effective interventions. Mortality depends on two factors: the case fatality rate and the case incidence. We combine a cohort-based model that determines case fatality rates along with a modified logistic model that evaluates the case incidence to determine the number of deaths in all the US states over time; the model is also able to include the impact of interventions. Both models yield exceptional goodness-of-fit. The model predicted a range of death outcomes (79k to 246k) all of which are considerably greater than the figures presented in mainstream media. This model can be used more effectively than current models to estimate the number of deaths during an outbreak, allowing for better planning.", "Transmissibility of 2019 Novel Coronavirus: zoonotic vs. human to human transmission, China, 2019-2020 Objectives: The novel coronavirus (2019-nCoV) originating from Wuhan has rapidly spread throughout China. While the origin of the outbreak remains uncertain, accumulating evidence links a wet market in Wuhan for the early spread of 2019-nCoV. Similarly, the influence of the marketplace on the early transmission dynamics is yet to be investigated. Methods: Using the daily series of COVID-19 incidenceincluding contact history with the market, we have conducted quantitative modeling analyses to estimate the reproduction numbers (R) for the market-to-human and human-to-human transmission together with the reporting probability and the early effects of public health interventions. Results: Our mean R estimates for China in 2019-2020 are estimated at 0.37 (95%CrI: 0.02-1.78) for market-to-human transmission, and 3.87 (95%CrI: 3.18-4.78) for human-to-human transmission, respectively. Moreover we estimated that the reporting rate cases stemming from market-to-human transmission was 3-31 fold higher than that for cases stemming from human-to-human transmission, suggesting that contact history with the wet market played a key role in identifying COVID-19 cases. Conclusions: Our findings suggest that the proportions of asymptomatic and subclinical patients constitute a substantial component of the epidemic's magnitude. Findings suggest that the development of rapid diagnostic tests could help bring the epidemic more rapidly under control.", "Bringing together emerging and endemic zoonoses surveillance: shared challenges and a common solution Early detection of disease outbreaks in human and animal populations is crucial to the effective surveillance of emerging infectious diseases. However, there are marked geographical disparities in capacity for early detection of outbreaks, which limit the effectiveness of global surveillance strategies. Linking surveillance approaches for emerging and neglected endemic zoonoses, with a renewed focus on existing disease problems in developing countries, has the potential to overcome several limitations and to achieve additional health benefits. Poor reporting is a major constraint to the surveillance of both emerging and endemic zoonoses, and several important barriers to reporting can be identified: (i) a lack of tangible benefits when reports are made; (ii) a lack of capacity to enforce regulations; (iii) poor communication among communities, institutions and sectors; and (iv) complexities of the international regulatory environment. Redirecting surveillance efforts to focus on endemic zoonoses in developing countries offers a pragmatic approach that overcomes some of these barriers and provides support in regions where surveillance capacity is currently weakest. In addition, this approach addresses immediate health and development problems, and provides an equitable and sustainable mechanism for building the culture of surveillance and the core capacities that are needed for all zoonotic pathogens, including emerging disease threats.", "National Smoking Rates Correlate Inversely with COVID-19 Mortality ABSTRACT Introduction: Recent studies show cigarette smokers are markedly under-represented among patients hospitalized for COVID-19 in over a dozen countries. It is unclear if this may be related to confounding factors such as age distribution, access to care, and inaccurate records. We hypothesized that these concerns could be avoided by studying smoking prevalence in relation to COVID-19 mortality. Since climate has been identified as a factor in COVID-19, we studied groups of countries with relatively comparable temperatures. Methods: The 20 hottest and 20 coldest countries in the Johns Hopkins Mortality Analysis database with a minimum mortality rate of .3 deaths/100,000 were selected on the basis of the average temperatures of their largest city. Mortality rates were determined as of May 1, 2020 and correlated with national smoking rate adjusting for sex ratio, obesity, temperature, and elderly population. Results: A highly significant inverse correlation between current daily smoking prevalence and COVID-19 mortality rate was noted for the group of hot countries (R=-.718, p = .0002), cold countries (R=-.567, p=.0046), and the combined group (R=-.324, p=.0207). However, after adjustments only the regression for hot countries and the combined group remained significant. In hot countries, for each percentage point increase in smoking rate mortality decreased by .147 per 100,000 population (95% CI .102- 192, p=.0066). This resulted in mortality rates several-fold elevated in the countries with the lowest smoking rates relative to the highest smoking rates. In the combined group, mortality decreased by .257 per 100,000 population (95% CI .175-.339, p=.0034). Discussion: These findings add support to the finding of an inverse relationship between current smoking and seriously symptomatic COVID-19. However, we conclude that the difference in mortality between the highest and lowest smoking countries appears too large to be due primarily to the effects of smoking per se. A potentially beneficial effect of smoking is surprising, but compatible with a number of hypothetical mechanisms which deserve exploration: 1) Studies show smoking alters ACE2 expression which may affect COVID-19 infection or its progression to serious lung pathology. 2) Nicotine has anti-inflammatory activity and also appears to alter ACE2 expression. 3) Nitric oxide in cigarette smoke is known to be effective in treating pulmonary hypertension and has shown in vitro antiviral effects including against SARS-CoV-2. 4) Smoking has complicated effects on the immune system involving both up and down regulation, any of which might alone or in concert antagonize progression of COVID-19. 5) Smokers are exposed to hot vapors which may stimulate immunity in the respiratory tract by various heat-related mechanisms (e.g. heat shock proteins). Studies of steam and sauna treatments have shown efficacy in other viral respiratory conditions. At this time there is no clear evidence that smoking is protective against COVID-19, so the established recommendations to avoid smoking should be emphasized. The interaction of smoking and COVID-19 will only be reliably determined by carefully designed prospective study, and there is reason to believe that there are unknown confounds that may be spuriously suggesting a protective effect of smoking. However, the magnitude of the apparent inverse association of COVID-19 and smoking and its myriad clinical implications suggest the importance of further investigation.", "Spatiotemporal evolution of coronavirus disease 2019 mortality in Brazil in 2020 ", "Novel coronavirus: From discovery to clinical diagnostics Abstract A novel coronavirus designated as 2019-nCoV first appeared in Wuhan, China in late December 2019. Dozens of people died in China, and thousands of people infected as 2019-nCoV continues to spread around the world. We have described the discovery, emergence, genomic characteristics, and clinical diagnostics of 2019-nCoV.", "Optimising SARS-CoV-2 pooled testing for low-resource settings ", "Simulation-based Estimation of the Spread of COVID-19 in Iran Background: The 2019 Coronavirus (COVID-19) has turned into a global pandemic with unprecedented challenges for the global community. Understanding the state of the disease and planning for future trajectories relies heavily on data on the spread and mortality. Yet official data coming from various countries are highly unreliable: symptoms similar to common cold in majority of cases and limited screening resources and delayed testing procedures may contribute to under-estimation of the burden of disease. Anecdotal and more limited data are available, but few have systematically combined those with official statistics into a coherent view of the epidemic. This study is a modeling-in-real-time of the emerging outbreak for understanding the state of the disease. Our focus is on the case of the spread of disease in Iran, as one of the epicenters of the disease in the first months of 2020. Method: We develop a simple dynamic model of the epidemic to provide a more reliable picture of the state of the disease based on existing data. Building on the generic SEIR (Susceptible, Exposed, Infected, and Recovered) framework we incorporate two behavioral and logistical considerations. First we capture the endogenous changes in contact rate (average contact per person) as more death are reported. As a result the reproduction number changes endogenously in the model. Second we differentiate reported and true cases by including simple formulations for how only a fraction of cases might be diagnosed, and how that fraction changes in response to epidemic's progression. In estimating the model we use both the official data as well as the discovered infected travelers and unofficial medical community estimates and triangulate these sources to build a more complete picture. Calibration is completed by forming a likelihood function for observing the actual time series data conditional on model parameters, and conducting a Markov Chain Monte Carlo simulations. The model is used to estimate current \"true\" cases of infection and death. We analyze the future trajectory of the disease under six conditions related to the seasonal effects and policy measures targeting social distancing. Findings: The model closely replicates the past data but also shows the true number of cases is likely far larger. We estimate about 493,000 current infected cases (90% CI: 271K-810K) as of March 20th, 2020. Our estimate for cumulative cases of infection until that date is 916,000 (90% CI: 508K, 1.5M), and for total death is 15,485 (90% CI: 8.4K, 25.8K). These numbers are significantly (more than one order of magnitude) higher than official statistics. The trajectory of the epidemic until the end of June could take various paths depending on the impact of seasonality and policies targeting social distancing. In the most optimistic scenario for seasonal effects, depending on policy measures, 1.6 million Iranians (90% CI: 0.9M-2.6M) are likely to get infected, and death toll will reach about 58,000 cases (90% CI: 32K-97K), while in the more pessimistic scenarios, death toll may exceed 103,000 cases (90% CI: 56K-172K). Implication: Our results suggest that the number of cases and deaths may be over an order of magnitude larger than official statistics in Iran. Absent extended testing capacity other countries may face a significant under-count of existing cases and thus be caught off guard about the actual toll of the epidemic.", "Infection Density and Epidemic Size of COVID-19 in China outside the Hubei province The novel coronavirus (COVID-19) has spread to almost all countries in the world, claiming more than 160,000 lives and sickening more than 2,400,000 people by April 21, 2020. There has been research showing that on average, each infected person spreads the infection to more than two persons. Therefore the majority of the population is at risk of infection if no intervention measures were undertaken. The true size of the COVID-19 epidemic remains unknown, as a significant proportion of infected individuals only exhibit mild symptoms or are even asymptomatic. A timely assessment of the evolving epidemic size is crucial for resource allocation and triage decisions. In this article, we modify the back-calculation algorithm to obtain a lower bound estimate of the number of COVID-19 infected persons in China outside the Hubei province. We estimate the infection density among infected and show that the drastic control measures enforced throughout China following the lockdown of Wuhan City effectively slowed down the spread of the disease in two weeks. Our findings from China are expected to provide guidelines and enlightenment for surveillance and control activities of COVID-19 in other countries around the world.", "Increasing testing throughput and case detection with a pooled-sample Bayesian approach in the context of COVID-19 Rapid and widespread implementation of infectious disease surveillance is a critical component in the response to novel health threats. Molecular assays are the preferred method to detect a broad range of pathogens with high sensitivity and specificity. The implementation of molecular assay testing in a rapidly evolving public health emergency can be hindered by resource availability or technical constraints. In the context of the COVID-19 pandemic, the applicability of a pooled-sample testing protocol to screen large populations more rapidly and with limited resources is discussed. A Bayesian inference analysis in which hierarchical testing stages can have different sensitivities is implemented and benchmarked against early COVID-19 testing data. Optimal pool size and increases in throughput and case detection are calculated as a function of disease prevalence. Even for moderate losses in test sensitivity upon pooling, substantial increases in testing throughput and detection efficiency are predicted, suggesting that sample pooling is a viable avenue to circumvent current testing bottlenecks for COVID-19.", "The close relationship between sudden loss of smell and COVID-19 Abstract Introduction The real number of COVID-19 cases may be underestimated since several countries have difficulty offering laboratory tests for all the population. Therefore, finding a symptom with a high predictive value would help in diagnostic and isolation strategies. Objective To correlate the sudden loss of the sense of smell in the context of the COVID-19 pandemic with results of diagnostic tests for COVID-19. Material and methods This is a cross-sectional observational study. An online questionnaire was digitally addressed to 725 outpatients in Brazil who reported partial or total sudden loss of the sense of smell from March to April 2020. Results Total or partial sudden loss of the sense of smell showed high Positive Predictive Value (PPV) for COVID-19 diagnosis, during the COVID-19 pandemic in Brazil (88.8%). There were no differences between groups tested positive and negative in regard to demographic and clinical characteristics such as presence of allergy, rhinitis, neither to olfactory recovery time. Conclusion The identification of sudden loss of the sense of smell during COVID-19 pandemic may serve as a sentinel symptom and may be a warning to establish measures to prevent the transmission of the disease.", "Microbiology The management and containment of many treatable and preventable infectious diseases in resource-poor countries is limited by the failure to make an accurate diagnosis. Most of the world's population lacks access to accurate, affordable, easy-to-use, quality-assured, reliable, and accessible diagnostic tests and misdiagnosis of infectious diseases is common and compromises patient care. Laboratory diagnostics are also needed for the detection and surveillance of the increasing levels of antimicrobial resistance. Accurate clinical diagnosis in resource-poor settings relies strongly on the laboratory service, and the need to support the development of a quality-assured laboratory service in such settings is increasingly recognized. International organizations are actively working with local and national providers to improve laboratory services. The development of laboratory services will contribute to improved health for the local population, protection against emerging pathogens, and ensure better use of scarce health care resources.", "Coronavirus infections: Epidemiological, clinical and immunological features and hypotheses Coronaviruses (CoVs) are a large family of enveloped, positive-strand RNA viruses Four human CoVs (HCoVs), the non-severe acute respiratory syndrome (SARS)-like HCoVs (namely HCoV 229E, NL63, OC43, and HKU1), are globally endemic and account for a substantial fraction of upper respiratory tract infections Non-SARS-like CoV can occasionally produce severe diseases in frail subjects but do not cause any major (fatal) epidemics In contrast, SARS like CoVs (namely SARS-CoV and Middle-East respiratory syndrome coronavirus, MERS-CoV) can cause intense short-lived fatal outbreaks The current epidemic caused by the highly contagious SARS-CoV-2 and its rapid spread globally is of major concern There is scanty knowledge on the actual pandemic potential of this new SARS-like virus It might be speculated that SARS-CoV-2 epidemic is grossly underdiagnosed and that the infection is silently spreading across the globe with two consequences: (i) clusters of severe infections among frail subjects could haphazardly occur linked to unrecognized index cases;(ii) the current epidemic could naturally fall into a low-level endemic phase when a significant number of subjects will have developed immunity Understanding the role of paucisymptomatic subjects and stratifying patients according to the risk of developing severe clinical presentations is pivotal for implementing reasonable measures to contain the infection and to reduce its mortality Whilst the future evolution of this epidemic remains unpredictable, classic public health strategies must follow rational patterns The emergence of yet another global epidemic underscores the permanent challenges that infectious diseases pose and underscores the need for global cooperation and preparedness, even during inter-epidemic periods", "Estimation of Undetected Covid-19 Infections in India Background and Objectives: While the number of detected COVID-19 infections are widely available, an understanding of the extent of undetected COVID- 19 cases is urgently needed for an effective tackling of the pandemic and as a guide to lifting the lockdown. The aim of this work is to estimate and predict the true number of COVID-19 (detected and undetected) infections in India for short to medium forecast horizons. In particular, using publicly available COVID-19 infection data upto 16th April 2020, we predict the true number of infections in India during and upto the end of the formal lockdown period (21st April 2020). Methods: The high death rate observed in most COVID-19 hit countries is suspected to be a function of the undetected infections existing in the population. An estimate of the age weighted infection fatality rate (IFR) of the disease of 0.41%, specifically calculated by taking into account the age structure of Indian population, is already available in the literature. In addition, the recorded case fatality rate (CFR= 0.70%) of Kerala, the only state in India to report single digit new infections over the second week of April, is used as a second estimate of the IFR. These estimates are used to formulate a relationship between deaths recorded and the true number of infections. The estimated undetected and detected cases time series based on these two IFR estimates are then used to fit a discrete time multivariate infection model to predict the total infections at the end of the formal lockdown period. Results: In two consecutive fortnights during the lockdown, it was noted that the rise in detected infections has decreased by 2.7 times. For an IFR of 0.41%, the rise in undetected infections decreased by 3.2 times and the predicted number of total infections in India is 3.14 lakhs. While for an IFR of 0.70%, the rise in undetected cases decreased by 3.3 times and the total number of infections predicted on 21st April is 1.75 lakhs. Interpretation and Conclusions: The behaviour of the undetected cases over time effectively illustrates the effects of lockdown and increased testing. From our estimates, it is found that the lockdown has brought down the undetected to detected cases ratio, and has consequently dampened the increase in the number of total cases. However, even though the rate of rise in total infections has fallen, the lifting of the lockdown should be done keeping in mind that 1.75 to 3 lakhs undetected cases will already exist in the population on 21st April.", "Data From the COVID-19 Epidemic in Florida Suggest That Younger Cohorts Have Been Transmitting Their Infections to Less Socially Mobile Older Adults We analyzed the daily incidence of newly reported COVID-19 cases among adults aged 20-39 years, 40-59 years, and 60 or more years in the sixteen most populous counties of the state of Florida from March 1 through June 27, 2020. In all 16 counties, an increase in reported COVID-19 case incidence was observed in all three age groups soon after the governor-ordered Full Phase 1 reopening went into effect. Trends in testing, hospitalization and mortality do not support the hypothesis that the observed increase in case incidence was merely the result of liberalization of testing criteria. Parameter estimates from a parsimonious two-group heterogeneous SIR model strongly support the hypothesis that younger persons, having first acquired their infections through increasing social contact with their peers, then transmitted their infections to older, less socially mobile individuals.", "Social and administrative issues related to the COVID-19 pandemic in Pakistan: better late than never The study critically reviewed Pakistan\u2019s provincial updates of coronavirus disease 2019 (COVID-19) and discussed the current challenges faced by the government in a given context. The coronavirus-associated death tolls have been increasing rapidly in a country. The provincial status of confirmed cases of coronavirus is higher in Punjab, followed by the Sindh, Khyber Pakhtunkhwa (KPK), and Balochistan. The case fatality ratio shows that KPK has a higher ratio, i.e., 5.11%, followed by the Punjab, i.e., 1.82%; Sindh, i.e., 1.80%; Balochistan, i.e., 1.28%; Gilgit-Baltistan, i.e., 0.71%; and Federal territory, i.e., 0.66%. The country has a less testing capacity to identify more suspected coronavirus patients. The study calculated that if we increase five times our testing capacity from the current date, the total registered cases will be reached to 137,370 and death tolls will increase up to 3090. It is highly needed to increase testing capacity across Pakistan in order to minimize the outbreak of coronavirus. The provincial government should follow the Federal Government instructions to contain coronavirus by increasing testing capacities, tracing suspected patients, smart lockdowns, emergency relief to the poor, and vigilant monitoring system.", "Maximum Likelihood Estimation of the Negative Binomial Dispersion Parameter for Highly Overdispersed Data, with Applications to Infectious Diseases BACKGROUND: The negative binomial distribution is used commonly throughout biology as a model for overdispersed count data, with attention focused on the negative binomial dispersion parameter, k. A substantial literature exists on the estimation of k, but most attention has focused on datasets that are not highly overdispersed (i.e., those with k\u22651), and the accuracy of confidence intervals estimated for k is typically not explored. METHODOLOGY: This article presents a simulation study exploring the bias, precision, and confidence interval coverage of maximum-likelihood estimates of k from highly overdispersed distributions. In addition to exploring small-sample bias on negative binomial estimates, the study addresses estimation from datasets influenced by two types of event under-counting, and from disease transmission data subject to selection bias for successful outbreaks. CONCLUSIONS: Results show that maximum likelihood estimates of k can be biased upward by small sample size or under-reporting of zero-class events, but are not biased downward by any of the factors considered. Confidence intervals estimated from the asymptotic sampling variance tend to exhibit coverage below the nominal level, with overestimates of k comprising the great majority of coverage errors. Estimation from outbreak datasets does not increase the bias of k estimates, but can add significant upward bias to estimates of the mean. Because k varies inversely with the degree of overdispersion, these findings show that overestimation of the degree of overdispersion is very rare for these datasets.", "[Dynamic basic reproduction number based evaluation for current prevention and control of COVID-19 outbreak in China]. Objective: To evaluate the current status of the prevention and control of coronavirus disease (COVID-19) outbreak in China, establish a predictive model to evaluate the effects of the current prevention and control strategies, and provide scientific information for decision- making departments. Methods: Based on the epidemic data of COVID-19 openly accessed from national health authorities, we estimated the dynamic basic reproduction number R(0)(t) to evaluate the effects of the current COVID-19 prevention and control strategies in all the provinces (municipalities and autonomous regions) as well as in Wuhan and the changes in infectivity of COVID-19 over time. Results: For the stability of the results, 24 provinces (municipality) with more than 100 confirmed COVID-19 cases were included in the analysis. At the beginning of the outbreak, the R(0)(t) showed unstable trend with big variances. As the strengthening of the prevention and control strategies, R(0)(t) began to show a downward trend in late January, and became stable in February. By the time of data analysis, 18 provinces (municipality) (75%) had the R(0)(t)s less than 1. The results could be used for the decision making to free population floating conditionally. Conclusions: Dynamic R(0)(t) is useful in the evaluation of the change in infectivity of COVID-19, the prevention and control strategies for the COVID-19 outbreak have shown preliminary effects, if continues, it is expected to control the COVID-19 outbreak in China in near future.", "Investigating the Impact of Asymptomatic Carriers on COVID-19 Transmission Coronavirus disease 2019 (COVID-19) is a novel human respiratory disease caused by the SARS-CoV-2 virus. Asymptomatic carriers of the virus display no clinical symptoms but are known to be contagious. Recent evidence reveals that this sub-population, as well as persons with mild, represent a major contributor in the propagation of COVID-19. The asymptomatic sub-population frequently escapes detection by public health surveillance systems. Because of this, the currently accepted estimates of the basic reproduction number (Ro) of the virus are inaccurate. It is unlikely that a pathogen can blanket the planet in three months with an Ro in the vicinity of 3, as reported in the literature. In this manuscript, we present a mathematical model taking into account asymptomatic carriers. Our results indicate that an initial value of the effective reproduction number could range from 5.5 to 25.4, with a point estimate of 15.4, assuming mean parameters. The first three weeks of the model exhibit exponential growth, which is in agreement with average case data collected from thirteen countries with universal health care and robust communicable disease surveillance systems; the average rate of growth in the number of reported cases is 23.3% per day during this period.", "An updated estimation of the risk of transmission of the novel coronavirus (2019-nCov) The basic reproduction number of an infectious agent is the average number of infections one case can generate over the course of the infectious period, in a na\u00efve, uninfected population. It is well-known that the estimation of this number may vary due to several methodological issues, including different assumptions and choice of parameters, utilized models, used datasets and estimation period. With the spreading of the novel coronavirus (2019-nCoV) infection, the reproduction number has been found to vary, reflecting the dynamics of transmission of the coronavirus outbreak as well as the case reporting rate. Due to significant variations in the control strategies, which have been changing over time, and thanks to the introduction of detection technologies that have been rapidly improved, enabling to shorten the time from infection/symptoms onset to diagnosis, leading to faster confirmation of the new coronavirus cases, our previous estimations on the transmission risk of the 2019-nCoV need to be revised. By using time-dependent contact and diagnose rates, we refit our previously proposed dynamics transmission model to the data available until January 29th(,) 2020 and re-estimated the effective daily reproduction ratio that better quantifies the evolution of the interventions. We estimated when the effective daily reproduction ratio has fallen below 1 and when the epidemics will peak. Our updated findings suggest that the best measure is persistent and strict self-isolation. The epidemics will continue to grow, and can peak soon with the peak time depending highly on the public health interventions practically implemented.", "Monitoring the COVID-19 epidemic in the context of widespread local transmission ", "A population-based study of the prevalence of COVID-19 infection in Espirito Santo, Brazil: methodology and results of the first stage BACKGROUND: COVID-19 is affecting almost the entire world, causing more than four hundred thousand deaths and undermining the health care systems, as much as the economy, of the afflicted countries. The strategies for prevention depend on largely lacking information, as infection prevalence and virus pathogenicity. This study aimed to determine the prevalence, the pathogenicity, and the speed of infection spreading in a large population in Brazil. MATERIALS AND METHODS: This is a serial cross-sectional study designed on a population basis and structured over houses as the sampling units. The sampling consisted of four visits at 15 days intervals in randomly selected census-designated sectors of the State major municipalities (reference municipalities) and two visits at 30 days intervals in smaller municipalities of the same regions of those of reference. At each visit, the investigators sampled houses and sampled one individual in each house for data collection. After the informed consent, the investigators performed a rapid antibody detection test (Celer Technology, Inc) and applied a questionnaire containing clinical and demographic questions. RESULTS: From May 13th to 15th, the investigators performed 6,393 rapid tests in 4,612 individuals of the reference municipalities, 1,163 individuals of the smaller municipalities, and 166 contacts of the positive individuals. Ninety-seven dwellers were positive in the reference municipalities, giving a prevalence of 2.1% (CI 95%: 1.67-2.52%). In the smaller municipalities, the figure was 0.26% (CI 95%: 0.05%-0.75%) (three positives). There was an association of the positive result with female sex (p = 0.013) and houses with five dwellers or more (p = 0.003). Seventy-eight positive individuals reported symptoms in the previous 15 days (80.4%), being anosmia (45.4%), cough (40.2%), and myalgia (38.1%) the more frequent. About one-third of them reported fever (28.9%). CONCLUSIONS: The results reveal a still small prevalence of infection in the study area, despite the significant number of sick people overloading the health system. The figures indicate an important underreporting in the area and a frequency that still can grow, making necessary public health actions for the containment of the transmission.", "The effectiveness of interventions to reduce COVID-19 transmission in a large urban jail Objectives: To estimate the impact of various mitigation strategies on COVID-19 transmission in a U.S. jail beyond those offered in national guidelines. Methods: We developed a stochastic dynamic transmission model of COVID-19 in one large urban U.S. jail among staff and incarcerated individuals. We divided the outbreak into four intervention phases: the start of the outbreak, depopulation of the jail, increased proportion of people in single cells, and asymptomatic testing. We used the next generation method to estimate the basic reproduction ratio, R0, in each phase. We estimated the fraction of new cases, hospitalizations, and deaths averted by these interventions along with the standard measures of sanitization, masking, and social distancing interventions. Results: For the first outbreak phase, the estimated R0 was 8.23 (95% CrI: 5.01-12.90), and for the subsequent phases, R0, phase 2 = 3.58 (95% CrI: 2.46-5.08), R0, phase 3 = 1.72 (95% CrI: 1.41-2.12), and R0, phase 4 = 0.45 (95% CrI: 0.32-0.59). In total, the jail's interventions prevented approximately 83% of projected cases and hospitalizations and 89% of deaths over 83 days. Conclusions: Depopulation, single celling, and asymptomatic testing within jails can be effective strategies to mitigate COVID-19 transmission in addition to standard public health measures. Policy Implications: Decision-makers should prioritize reductions in the jail population, single celling, and testing asymptomatic populations, as additional measures to manage COVID-19 within correctional settings.", "Bayesian adjustment for preferential testing in estimating the COVID-19 infection fatality rate: Theory and methods A key challenge in estimating the infection fatality rate (IFR) of COVID-19 is determining the total number of cases. The total number of cases is not known because not everyone is tested but also, more importantly, because tested individuals are not representative of the population at large. We refer to the phenomenon whereby infected individuals are more likely to be tested than non-infected individuals, as\"preferential testing.\"An open question is whether or not it is possible to reliably estimate the IFR without any specific knowledge about the degree to which the data are biased by preferential testing. In this paper we take a partial identifiability approach, formulating clearly where deliberate prior assumptions can be made and presenting a Bayesian model, which pools information from different samples. Results suggest that when limited knowledge is available about the magnitude of preferential testing, reliable estimation of the IFR is still possible so long as there is sufficient\"heterogeneity of bias\"across samples.", "New threat: 2019 novel Coronavirus infection and infection control perspective in Turkey ", "Accounting for incomplete testing in the estimation of epidemic parameters As the COVID-19 pandemic spreads across the world, it is important to understand its features and responses to public health interventions in real-time. The field of infectious diseases epidemiology has highly advanced modeling strategies that yield relevant estimates. These include the doubling time of the epidemic and various other representations of the numbers of cases identified over time. Crude estimates of these quantities suffer from dependence on the underlying testing strategies within communities. We clarify the functional relationship between testing and the epidemic parameters, and thereby derive sensitivity analyses that explore the range of possible truths under various testing dynamics. We derive the required adjustment to the estimates of interest for New York City. We demonstrate that crude estimates that assume stable testing or complete testing can be biased.", "Understanding Epidemic Data and Statistics: A case study of COVID-19 The 2019-Novel-Coronavirus (COVID-19) has affected 181 countries and out of about 1197405 confirmed cases (By April 5). Understanding the transmission dynamics of the infection in each country which affected on a daily basis and evaluating the effectiveness of control policies is critical for our further actions. To date, the statistics of COVID-19 reported cases show more than 80 percent of infected had a mild case of disease, while around 14 percent of infected experienced a severe one and about 5 percent are categorized as critical disease victims. Today's report (2020-04-05; daily updates in the prepared website) shows the confirmed cases of COVID-19 in the US, Spain, Italy, and Germany are 308850, 126168, 124632, and 96092; respectively. Calculating the total Case Fatality Rate (CFR) of Italy (2020-04-04), about 13.3% of confirmed cases passed away. Compared to South Korea's rate of 1.8% (7 times lower than Italy) and China's 4% (69% lower than Italy), the CFR of Italy is too high. There are some effective policies that yield significant changes in the trend of cases. The lockdown policy in China, Italy, and Spain (the effect observed after some days), Shutdown of all non-essential companies in Hubei (the effect observed after 5 days), combined policy in South Korea, and reducing working hours in Iran.", "Influence of countries adopted policies for COVID-19 reduction under the view of the airborne transmission framework Daily new cases dataset since January 2020 were used to search for evidences of SARS-CoV-2 community transmission as the main nowadays cause of constant infection rates among countries. Despite traditional forms of transmission of this virus (droplets and aerosols in medical facilities), new evidence suggests aerosols forming patterns in the atmosphere as a main factor of community transmission outside medical spaces. Following these findings, this research focused on comparing some countries and the adopted policy used as preventive framework for virus community transmission. Countries social distancing policy aspect, of one to two meters of physical distance, was statistically analyzed from January to early May 2020, and countries were divided into those implementing only social physical distance and those implementing distancing with additional transmission isolation (with masks and city disinfection). Correlating countries social distancing policy adoption with other preventive measures such as social isolation and COVID-19 testing, a new indicator results, derived from SIR models and Weibull parameterization, show that only social physical distance measure could act as a factor for SARS-CoV-2 transmission with respect to atmosphere carrier potential. In this sense, the type of social distancing framework adopted by some countries without additional measures might represent a main model for the constant reproductive spread patterns of SARS-CoV-2 within the community transmission. Finally, the findings have important implications for the policy making to be adopted globally as well as individual-scale preventive methods.", "Implications of social distancing in Brazil in the COVID-19 pandemic ", "Modeling serological testing to inform relaxation of social distancing for COVID-19 control The value of serological testing to inform the public health response to the SARS-CoV-2 pandemic is debated. Using a transmission model, we examined how serology can be implemented to allow seropositive individuals to resume more normal levels of social interaction while offsetting the risks. We simulated the use of widespread serological testing with realistic assay characteristics, in which seropositive individuals partially restore their social contacts and act as immunological \u2018shields\u2019. If social distancing is relaxed by 50% at the same time that quarterly serological screening is initiated, approximately 120,000 deaths could be averted and a quarter of the US population could be released from social distancing in the first year of the epidemic, compared to a scenario without serological testing. This strategy has the potential to substantially flatten the COVID-19 epidemic curve while also allowing a substantial number of individuals to safely return to social and economic interactions.", "Early real-time estimation of the basic reproduction number of emerging or reemerging infectious diseases in a community with heterogeneous contact pattern: Using data from Hong Kong 2009 H1N1 Pandemic Influenza as an illustrative example Emerging and re-emerging infections such as SARS (2003) and pandemic H1N1 (2009) have caused concern for public health researchers and policy makers due to the increased burden of these diseases on health care systems. This concern has prompted the use of mathematical models to evaluate strategies to control disease spread, making these models invaluable tools to identify optimal intervention strategies. A particularly important quantity in infectious disease epidemiology is the basic reproduction number, R(0.) Estimation of this quantity is crucial for effective control responses in the early phase of an epidemic. In our previous study, an approach for estimating the basic reproduction number in real time was developed. This approach uses case notification data and the structure of potential transmission contacts to accurately estimate R(0) from the limited amount of information available at the early stage of an outbreak. Based on this approach, we extend the existing methodology; the most recent method features intra- and inter-age groups contact heterogeneity. Given the number of newly reported cases at the early stage of the outbreak, with parsimony assumptions on removal distribution and infectivity profile of the diseases, experiments to estimate real time R(0) under different levels of intra- and inter-group contact heterogeneity using two age groups are presented. We show that the new method converges more quickly to the actual value of R(0) than the previous one, in particular when there is high-level intra-group and inter-group contact heterogeneity. With the age specific contact patterns, number of newly reported cases, removal distribution, and information about the natural history of the 2009 pandemic influenza in Hong Kong, we also use the extended model to estimate R(0) and age-specific R(0).", "The Hypothesis of Testing: Paradoxes arising out of reported coronavirus case-counts Many statisticians, epidemiologists, economists and data scientists have registered serious reservations regarding the reported coronavirus case-counts. Limited testing capacity across the country has been widely identified as a key driver of suppressed coronavirus case-counts. The calls to increase testing capacity are well-justified as they become a more frequent point of discussion in the public sphere. While expanded testing is a laudable goal, selection bias will impact estimates of disease prevalence and the effective reproduction number until the entire population is sampled. Moreover, tests are imperfect as false positive/negative rates interact in complex ways with selection bias. In this paper, we attempt to clarify this interaction. Through simple calculations, we demonstrate pitfalls and paradoxes that can arise when considering case-count data in the presence of selection bias and measurement error. The discussion guides several suggestions on how to improve current case-count reporting.", "Would India Really Touch the Peak of SARS COVID 19 Cases or Deaths in Near Future? Background: The Government, Health System and even an individual citizen of India is alarmed expecting the height of pandemic of SARS-COVID-19 in near future. Many experts worldwide predict it to happen in India between end of May and end of July. Objectives: The aim of this research was to find an answer that whether India would come across the looming conditions of SARS-COVID-19 in coming days given the prevailing circumstances so far. Methods: The proposed approach used fundamental concept of Statistics by fixing the standard reference to the number of daily new tests conducted by a country. We thus computed the percentage of daily new cases and daily new deaths, in using such references. The trends were studied using simple line chart. The theory of three sigma was also used to build the upper bound for daily new cases and deaths, specifically for India to see the extreme conditions. Results: The analysis was done using data from January to till May 18, 2020 for India, Italy, USA and UK. The trend of India was almost fix between ~2% to ~6% till May 18, 2020. On contrary, Italy, USA and UK were touched the Peak on March 29, 2020 (24.38%), April 26, 2020 (23.51%) and April 24, 2020 (24.91%), respectively and declining since then. Similar trends were also noted in daily new deaths, except Italy. Conclusions: The proposed new concept for fixing universal reference provides a consistent and coherent results. It is thus clear from observed data so far that India is not going to encounter the frightened conditions or peak, like, Italy, USA, and UK for pandemic SARS-COVID-19, given the existing conditions, excluding the current migration.", "Determinants of COVID-19 incidence and mortality: A cross-country analysis Objective: We undertook this study to explore the role of important determinants affecting global COVID-19 incidence and mortality taking multifactorial disease dynamics into consideration. Design: Secondary data as on March 28, 2020 were obtained for 97 countries. Association of COVID-19 cumulative incidence and mortality measures were assessed with ten indictors representing health system characteristics, climate, demography, promptness of international travel restriction and population movement using Generalized Linear Modelling. Main outcome measures: Country-specific COVID-19 cumulative incidence, cumulative cause-specific mortality and case fatality rate. Results: Significant inter-country variation in incidence and mortality rates were observed. Five variables were found to be associated with cumulative incidence: testing rate per 1000 population ({beta} = 0.119, p < 0.01), UHC index ({beta} = 0.043, p = 0.04), percentage elderly population ({beta} = 0.122, p < 0.01), percentage below-poverty line population ({beta} = -0.048, p < 0.01) and disability adjusted life years due to NCDs ({beta} = -0.013, p < 0.01). Case fatality rate was observed to be associated with testing rate per 1000 population ({beta} = -0.058, p = 0.03) and population density ({beta} = 0.002, p = 0.02), while the cumulative cause-specific mortality was associated with only percentage elderly population ({beta} = 0.096, p = 0.04) in the country. Conclusions: Health system response, population susceptibility and demography were the most important factors determining the progression. Policy response should focus towards increasing testing, primarily targeting high population density areas. Health system strengthening and reduction in population risk factors should be long term goals for a better response to such epidemics.", "From a single host to global spread. The global mobility based modelling of the COVID-19 pandemic implies higher infection and lower detection rates than current estimates. Background: Since the outbreak of the COVID-19 pandemic, multiple efforts of modelling of the geo-temporal transmissibility of the virus have been undertaken, but none succeeded in describing the pandemic at the global level. We propose a set of parameters for the first COVID-19 Global Epidemic and Mobility Model (GLEaM). The simulation starting with just a single pre-symptomatic, yet infectious, case in Wuhan, China, results in an accurate prediction of the number of diagnosed cases after 125 days in multiple countries across three continents. Methods: We have built a modified SIR model and parameterized it analytically, according to the literature and by fitting the missing parameters to the observed dynamics of the virus spread. We compared our results with the number of diagnosed cases in sixeight selected countries which provide reliable statistics but differ substantially in terms of strength and speed of undertaken precautions. The obtained 95% confidence intervals for the predictions fit well to the empirical data. Findings: The parameters that successfully model the pandemic are: the basic reproduction number R0, ~4.4; a latent non-infectious period of 1.1. days followed by 4.6 days of the presymptomatic infectious period; the probability of developing severe symptoms, 0.01; the probability of being diagnosed when presenting severe symptoms of 0.6; the probability of diagnosis for cases with mild symptoms or asymptomatic, 0.001. Also, the higher the testing rate per country, the lower the discrepancy between data (diagnosed cases) and model. Interpretation: Parameters that successfully reproduce the observed number of cases indicate that both R0 and the prevalence of the virus might be underestimated. This is in concordance with the newest research on undocumented COVID-19 cases. Consequently, the actual mortality rate is putatively lower than estimated. Confirmation of the pandemic characteristic by further refinement of the model and screening tests is crucial for developing an effective strategy for the global epidemiological crisis.", "Data-based analysis, modelling and forecasting of the COVID-19 outbreak Since the first suspected case of coronavirus disease-2019 (COVID-19) on December 1st, 2019, in Wuhan, Hubei Province, China, a total of 40,235 confirmed cases and 909 deaths have been reported in China up to February 10, 2020, evoking fear locally and internationally. Here, based on the publicly available epidemiological data for Hubei, China from January 11 to February 10, 2020, we provide estimates of the main epidemiological parameters. In particular, we provide an estimation of the case fatality and case recovery ratios, along with their 90% confidence intervals as the outbreak evolves. On the basis of a Susceptible-Infectious-Recovered-Dead (SIDR) model, we provide estimations of the basic reproduction number (R(0)), and the per day infection mortality and recovery rates. By calibrating the parameters of the SIRD model to the reported data, we also attempt to forecast the evolution of the outbreak at the epicenter three weeks ahead, i.e. until February 29. As the number of infected individuals, especially of those with asymptomatic or mild courses, is suspected to be much higher than the official numbers, which can be considered only as a subset of the actual numbers of infected and recovered cases in the total population, we have repeated the calculations under a second scenario that considers twenty times the number of confirmed infected cases and forty times the number of recovered, leaving the number of deaths unchanged. Based on the reported data, the expected value of R(0) as computed considering the period from the 11th of January until the 18th of January, using the official counts of confirmed cases was found to be \u223c4.6, while the one computed under the second scenario was found to be \u223c3.2. Thus, based on the SIRD simulations, the estimated average value of R(0) was found to be \u223c2.6 based on confirmed cases and \u223c2 based on the second scenario. Our forecasting flashes a note of caution for the presently unfolding outbreak in China. Based on the official counts for confirmed cases, the simulations suggest that the cumulative number of infected could reach 180,000 (with a lower bound of 45,000) by February 29. Regarding the number of deaths, simulations forecast that on the basis of the up to the 10th of February reported data, the death toll might exceed 2,700 (as a lower bound) by February 29. Our analysis further reveals a significant decline of the case fatality ratio from January 26 to which various factors may have contributed, such as the severe control measures taken in Hubei, China (e.g. quarantine and hospitalization of infected individuals), but mainly because of the fact that the actual cumulative numbers of infected and recovered cases in the population most likely are much higher than the reported ones. Thus, in a scenario where we have taken twenty times the confirmed number of infected and forty times the confirmed number of recovered cases, the case fatality ratio is around \u223c0.15% in the total population. Importantly, based on this scenario, simulations suggest a slow down of the outbreak in Hubei at the end of February.", "Evolving epidemiology and transmission dynamics of coronavirus disease 2019 outside Hubei province, China: a descriptive and modelling study BACKGROUND: The coronavirus disease 2019 (COVID-19) epidemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began in Wuhan city, Hubei province, in December, 2019, and has spread throughout China. Understanding the evolving epidemiology and transmission dynamics of the outbreak beyond Hubei would provide timely information to guide intervention policy. METHODS: We collected individual information from official public sources on laboratory-confirmed cases reported outside Hubei in mainland China for the period of Jan 19 to Feb 17, 2020. We used the date of the fourth revision of the case definition (Jan 27) to divide the epidemic into two time periods (Dec 24 to Jan 27, and Jan 28 to Feb 17) as the date of symptom onset. We estimated trends in the demographic characteristics of cases and key time-to-event intervals. We used a Bayesian approach to estimate the dynamics of the net reproduction number (R(t)) at the provincial level. FINDINGS: We collected data on 8579 cases from 30 provinces. The median age of cases was 44 years (33\u201356), with an increasing proportion of cases in younger age groups and in elderly people (ie, aged >64 years) as the epidemic progressed. The mean time from symptom onset to hospital admission decreased from 4\u00b74 days (95% CI 0\u00b70\u201314\u00b70) for the period of Dec 24 to Jan 27, to 2\u00b76 days (0\u00b70\u20139\u00b70) for the period of Jan 28 to Feb 17. The mean incubation period for the entire period was estimated at 5\u00b72 days (1\u00b78\u201312\u00b74) and the mean serial interval at 5\u00b71 days (1\u00b73\u201311\u00b76). The epidemic dynamics in provinces outside Hubei were highly variable but consistently included a mixture of case importations and local transmission. We estimated that the epidemic was self-sustained for less than 3 weeks, with mean Rt reaching peaks between 1\u00b708 (95% CI 0\u00b774\u20131\u00b754) in Shenzhen city of Guangdong province and 1\u00b771 (1\u00b732\u20132\u00b717) in Shandong province. In all the locations for which we had sufficient data coverage of Rt, Rt was estimated to be below the epidemic threshold (ie, <1) after Jan 30. INTERPRETATION: Our estimates of the incubation period and serial interval were similar, suggesting an early peak of infectiousness, with possible transmission before the onset of symptoms. Our results also indicate that, as the epidemic progressed, infectious individuals were isolated more quickly, thus shortening the window of transmission in the community. Overall, our findings indicate that strict containment measures, movement restrictions, and increased awareness of the population might have contributed to interrupt local transmission of SARS-CoV-2 outside Hubei province. FUNDING: National Science Fund for Distinguished Young Scholars, National Institute of General Medical Sciences, and European Commission Horizon 2020.", "Evaluating Incidence and Impact Estimates of the COVID-19 Outbreak from Wuhan before Lockdown Background: Wuhan, China was the epicenter of COVID-19 pandemic. The goal of current study is to understand the infection transmission dynamics before intervention measures were taken. Methods: Data and key events were searched through pubmed and internet. Epidemiological data were calculated using data extracted from a variety of data sources. Results: We established a timeline showing by January 1, 2020, Chinese authorities had been presented convincing evidence of human-to-human transmission; however, it was not until January 20, 2020 that this information was shared with the public. Our study estimated that there would have been 10989 total infected cases if interventions were taken on January 2, 2020, versus 239875 cases when lockdown was put in place on January 23, 2020. Conclusions: China's withholding of key information about the 2020 COVID-19 outbreak and its delayed response ultimately led to the largest public health crisis of this century and could have been avoided with earlier countermeasures.", "Early dynamics of transmission and control of COVID-19: a mathematical modelling study BACKGROUND: An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to 95 333 confirmed cases as of March 5, 2020. Understanding the early transmission dynamics of the infection and evaluating the effectiveness of control measures is crucial for assessing the potential for sustained transmission to occur in new areas. Combining a mathematical model of severe SARS-CoV-2 transmission with four datasets from within and outside Wuhan, we estimated how transmission in Wuhan varied between December, 2019, and February, 2020. We used these estimates to assess the potential for sustained human-to-human transmission to occur in locations outside Wuhan if cases were introduced. METHODS: We combined a stochastic transmission model with data on cases of coronavirus disease 2019 (COVID-19) in Wuhan and international cases that originated in Wuhan to estimate how transmission had varied over time during January, 2020, and February, 2020. Based on these estimates, we then calculated the probability that newly introduced cases might generate outbreaks in other areas. To estimate the early dynamics of transmission in Wuhan, we fitted a stochastic transmission dynamic model to multiple publicly available datasets on cases in Wuhan and internationally exported cases from Wuhan. The four datasets we fitted to were: daily number of new internationally exported cases (or lack thereof), by date of onset, as of Jan 26, 2020; daily number of new cases in Wuhan with no market exposure, by date of onset, between Dec 1, 2019, and Jan 1, 2020; daily number of new cases in China, by date of onset, between Dec 29, 2019, and Jan 23, 2020; and proportion of infected passengers on evacuation flights between Jan 29, 2020, and Feb 4, 2020. We used an additional two datasets for comparison with model outputs: daily number of new exported cases from Wuhan (or lack thereof) in countries with high connectivity to Wuhan (ie, top 20 most at-risk countries), by date of confirmation, as of Feb 10, 2020; and data on new confirmed cases reported in Wuhan between Jan 16, 2020, and Feb 11, 2020. FINDINGS: We estimated that the median daily reproduction number (R(t)) in Wuhan declined from 2\u00b735 (95% CI 1\u00b715\u20134\u00b777) 1 week before travel restrictions were introduced on Jan 23, 2020, to 1\u00b705 (0\u00b741\u20132\u00b739) 1 week after. Based on our estimates of R(t), assuming SARS-like variation, we calculated that in locations with similar transmission potential to Wuhan in early January, once there are at least four independently introduced cases, there is a more than 50% chance the infection will establish within that population. INTERPRETATION: Our results show that COVID-19 transmission probably declined in Wuhan during late January, 2020, coinciding with the introduction of travel control measures. As more cases arrive in international locations with similar transmission potential to Wuhan before these control measures, it is likely many chains of transmission will fail to establish initially, but might lead to new outbreaks eventually. FUNDING: Wellcome Trust, Health Data Research UK, Bill & Melinda Gates Foundation, and National Institute for Health Research.", "Preliminary evaluation of COVID-19 disease outcomes, test capacities and management approaches among African countries. Background: Following the declaration of COVID-19 as a global pandemic and the report of index case in Africa, the number of countries in Africa with confirmed cases of the infection has grown tremendously with disease now being reported in almost all countries on the continent, with the exemption of Lesotho after 75 days. It is therefore necessary to evaluate the disease outcomes among the African countries as the situation unfolds for early identification of best practices for adoption. Methods: In this study, COVID-19 disease outcomes (confirmed cases, deaths and recoveries), testing capacities and disease management approaches among African countries were evaluated. The relationship between COVID-19 infections in African countries and their performance on global resilient indices including the Human Development Index (HDI), performance on Sustainable Development Goals (SDGs) and the Global Risk Index (GRI) were also examined. Data acquired from various standard databases were evaluated over a period of 75 days from the date of reporting the index case. Results: This study has revealed compelling spatial differences in the incidence, deaths and recoveries from COVID-19 among African countries. Egypt, South Africa, Morocco and Algeria were clustered as countries with highest values of COVID-19 disease outcomes on the continent during the 75-day period of observation. The cluster analysis and comparison of countries in terms of percentage recovered cases of confirmed infections revealed that Mauritius, Mauritania, Gambia, Burkina Faso, Madagascar, Togo and Uganda had the highest scores. Comparative analysis of COVID-19 across the world revealed that the parameters were relatively inconsequential in Oceania and Africa continents, while Europe, North America and Asia had significantly higher cases of disease outcomes. For COVID-19 testing capacities, South Africa, Ghana and Egypt are leading in total number of tests carried out. However when the number of tests carried out were related to population number of the countries, Djibouti, Mauritius, Ghana and South Africa are found to be the leading countries. With respect to management of the disease in Africa, all the countries adopted the WHO protocols, personal hygiene, economic palliatives and social distancing measures. Only three countries in Africa (Madagascar, Togo and Burkina Faso) had a state supported initiative to utilise traditional medicines or herbs as alternatives to control COVID-19. Additionally, most of the countries are providing prompt treatment of the patients with a range of drugs especially Hydroxychloroquine, Chloroquine and Chloroquine-Azithromycin combination. The study found that no strong relationship currently exists between the global resilient indicators (HDI, SDG and GRI) and COVID-19 cases across Africa. Conclusions: This study has revealed compelling spatial differences in disease outcomes among African countries and also found testing capacities for COVID-19 to be abysmally low in relation to the population. During the 75 days of observation, African countries have recorded significantly low number of deaths associated with COVID-19 and relatively high recovery rates. Countries in Africa with higher rate of recovery from the disease were found to have adopted strict adherence to some of WHO protocol to contain the disease, isolate all those who test positive to the disease and provide prompt treatment of the patients with a range of drugs especially Hydroxychloroquine, Chloroquine and Chloroquine-Azithromycin combination. The study recommends that the approaches adopted by the African countries which achieved high recovery rates from COVID-19 should be integrated into healthcare management plans for the disease across the continent even as the situation unfolds.", "Clinical and Radiographic Presentations of COVID-19 among Patients Receiving Radiation Therapy for Thoracic Malignancies The 2019 novel coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a pandemic affecting healthcare centers across the globe. Patients with cancer have been reported to be particularly vulnerable to infection, morbidity, and severe events. Given the high proportion of asymptomatic carriers and concerns regarding speed and availability of laboratory testing, novel detection strategies are necessary to supplement traditional screening methods and facilitate mitigation of viral transmission. Recent data support the diagnostic consistency and potential value of computed tomography (CT) scans to aid early diagnosis of COVID-19. Volumetric CT image-guidance is commonly employed in patients undergoing radiotherapy and presents a unique opportunity to screen for COVID-specific lung changes. This case series describes the presentation of SARS-CoV-2 infections among three patients undergoing thoracic radiotherapy across multiple institutions. We highlight their clinical symptoms, imaging findings, potential confounders, and clinical workflow to triage these patients to the next level of care.", "Differences by country-level income in COVID-19 cases, deaths, case-fatality rates, and rates per million population in the first five months of the pandemic Abstract Objective: To describe differences by country-level income in COVID-19 cases, deaths, case-fatality rates, incidence rates, and death rates per million population. Methods: Publicly available data on COVID-19 cases and deaths from December 31, 2019 to June 3, 2020 were analyzed. Kruskal-Wallis tests were used to examine associations of country-level income with COVID-19 cases, deaths, case-fatality rates, incidence rates, and death rates. Results: A total of 380,803 deaths out of 6,348,204 COVID-19 cases were reported from 210 countries and territories globally in the period under study, and the global case-fatality rate was 6.0%. Of the total globally reported cases and deaths, the percentages of cases and deaths were 59.9% and 75.0% for high-income countries, and 30.9% and 20.7% for upper-middle-income countries. Countries in higher-income categories had higher incidence rates and death rates. Between April and May, the incidence rates in higher-income groups of countries decreased, but in other groups, it increased. Conclusions In the first five months of the COVID-19 pandemic, most cases and deaths were reported from high-income and upper-middle-income countries, and those countries had higher incidence rates and death rates per million population than did lower-middle and low-income countries. Keywords: COVID-19, incidence rate, death rate, case fatality rate, income, and country", "RT-qPCR Testing of SARS-CoV-2: A Primer Testing for the presence of coronavirus is an essential diagnostic tool for monitoring and managing the current COVID-19 pandemic. The only reliable test in current use for testing acute infection targets the genome of SARS-CoV-2, and the most widely used method is quantitative fluorescence-based reverse transcription polymerase chain reaction (RT-qPCR). Despite its ubiquity, there is a significant amount of uncertainty about how this test works, potential throughput and reliability. This has resulted in widespread misrepresentation of the problems faced using this test during the current COVID-19 epidemic. This primer provides simple, straightforward and impartial information about RT-qPCR.", "Time-adjusted Analysis Shows Weak Associations Between BCG Vaccination Policy and COVID-19 Disease Progression In this study, we ascertain the associations between BCG vaccination policies and progression of COVID-19 through analysis of various time-adjusted indicators either directly extracted from the incidence and death reports, or estimated as parameters of disease progression models. We observe weak correlation between BCG vaccination status and indicators related to disease reproduction characteristics. We did not find any associations with case fatality rates (CFR), but the differences in CFR estimates are at present likely dominated by differences in testing and case reporting between countries.", "A Statistical Analysis Of CoV-19 Positive Test Frequency Data Indicates A Need For Greater Attention To CoV-19 Test Quality And Pre-Wuhan Cov-19 Prevalence Increased attention to analysis of SARS-CoV-2 (CoV-19) positive test frequency data is essential for achievement of better knowledge of the natural history of the virus in human populations, improved accuracy of CoV-19 epidemiological data, and development of public response policies that are better crafted to address the current CoV-19-induced global crisis. A statistical analysis of currently available positive test frequency data reveals a surprisingly uniform relationship between the number of CoV-19 test performed and the number of positive tests obtained. The uniformity is particularly striking for United States CoV-19 test data. Such observations warrant closer evaluation of other factors, besides virus spread, that may also contribute to the nature of the coronavirus pandemic. These include indigenous CoV-19 and the quality of CoV-19 testing.", "The need for COVID-19 research in low- and middle-income countries In the early months of the pandemic, most reported cases and deaths due to COVID-19 occurred in high-income countries. However, insufficient testing could have led to an underestimation of true infections in many low- and middle-income countries. As confirmed cases increase, the ultimate impact of the pandemic on individuals and communities in low- and middle-income countries is uncertain. We therefore propose research in three broad areas as urgently needed to inform responses in low- and middle-income countries: transmission patterns of SARS-CoV-2, the clinical characteristics of the disease, and the impact of pandemic prevention and response measures. Answering these questions will require a multidisciplinary approach led by local investigators and in some cases additional resources. Targeted research activities should be done to help mitigate the potential burden of COVID-19 in low- and middle-income countries without diverting the limited human resources, funding, or medical supplies from response activities.", "Assessment of Specimen Pooling to Conserve SARS CoV-2 Testing Resources OBJECTIVES: To establish the optimal parameters for group testing of pooled specimens for the detection of SARS-CoV-2. METHODS: The most efficient pool size was determined to be five specimens using a web-based application. From this analysis, 25 experimental pools were created using 50 \u00b5L from one SARS-CoV-2 positive nasopharyngeal specimen mixed with 4 negative patient specimens (50 \u00b5L each) for a total volume of 250 \u00b5L. Viral RNA was subsequently extracted from each pool and tested using the CDC SARS-CoV-2 RT-PCR assay. Positive pools were consequently split into individual specimens and tested by extraction and PCR. This method was also tested on an unselected group of 60 nasopharyngeal specimens grouped into 12 pools. RESULTS: All 25 pools were positive with cycle threshold (Ct) values within 0 and 5.03 Ct of the original individual specimens. The analysis of 60 specimens determined that 2 pools were positive followed by identification of 2 individual specimens among the 60 tested. This testing was accomplished while using 22 extractions/PCR tests, a savings of 38 reactions. CONCLUSIONS: When the incidence rate of SARS-CoV-2 infection is 10% or less, group testing will result in the saving of reagents and personnel time with an overall increase in testing capability of at least 69%.", "Prevalence Threshold and Temporal Interpretation of Screening Tests: The Example of the SARS-CoV-2 (COVID-19) Pandemic The curvilinear relationship between a screening test's positive predictive value (PPV) and its target disease prevalence is proportional. In consequence, there is an inflection point of maximum curvature in the screening curve defined as a function of the sensitivity and specificity beyond which the rate of change of a test's PPV declines sharply relative to disease prevalence. Herein, we demonstrate a mathematical model exploring this phenomenon and define the prevalence threshold point where this change occurs. Understanding where this prevalence point lies in the curve has important implications for the interpretation of test results, the administration of healthcare systems, the implementation of public health measures, and in cases of pandemics like SARS-CoV-2, the functioning of society at large. To illustrate the methods herein described, we provide the example of the screening strategies used in the SARS-CoV-2 (COVID-19) pandemic, and calculate the prevalence threshold statistic of different tests available today. This concept can help contextualize the validity of a screening test in real time, thereby enhancing our understanding of the dynamics of the current pandemic.", "The Coronavirus 2019 pandemic in Canada: the impact of public health interventions on the course of the outbreak in Alberta and other provinces Background: The SARS-CoV-2 disease 2019 (COVID-19) pandemic has spread across the world with varying impact on health systems and outcomes. We assessed how the type and timing of public- health interventions impacted the course of the outbreak in Alberta and other Canadian provinces. Methods: We used publicly-available data to summarize rates of laboratory data and mortality in relation to measures implemented to contain the outbreak and testing strategy. We estimated the transmission potential of SARS-CoV-2 before the state of emergency declaration for each province (R0) and at the study end date (Rt). Results: The first cases were confirmed in Ontario (January 25) and British Columbia (January 28). All provinces implemented the same health-policy measures between March 12 and March 30. Alberta had a higher percentage of the population tested (3.8%) and a lower mortality rate (3/100,000) than Ontario (2.6%; 11/100,000) or Quebec (3.1%; 31/100,000). British Columbia tested fewer people (1.7%) and had similar mortality as Alberta. Data on provincial testing strategies were insufficient to inform further analyses. Mortality rates increased with increasing rates of lab- confirmed cases in Ontario and Quebec, but not in Alberta. R0 was similar across all provinces, but varied widely from 2.6 (95% confidence intervals 1.9-3.4) to 6.4 (4.3-8.5), depending on the assumed time interval between onset of symptoms in a primary and a secondary case (serial interval). The outbreak is currently under control in Alberta, British Columbia and Nova Scotia (Rt <1). Interpretation: COVID-19-related health outcomes varied by province despite rapid implementation of similar health-policy interventions across Canada. Insufficient information about provincial testing strategies and a lack of primary data on serial interval are major limitations of existing data on the Canadian COVID-19 outbreak.", "Epidemiological Trends of Coronavirus Disease 2019 in China Background: The Coronavirus Disease 2019 (COVID-19) epidemic broke out in Wuhan, China, and it spread rapidly. Since January 23, 2020, China has launched a series of unusual and strict measures, including the lockdown of Wuhan city to contain this highly contagious disease. We collected the epidemiological data to analyze the trend of this epidemic in China. Methods: We closely tracked the Chinese and global official websites to collect the epidemiological information about COVID-19. The number of total and daily new confirmed cases of COVID-19 in China was presented to illustrate the trend of this epidemic. Results: On January 23, 2020, 835 confirmed COVID-19 cases were reported in China. On February 6, 2020, there were 31211 cases. By February 20, 2020, the number reached as high as 75,993. Most cases were distributed in and around Wuhan, Hubei province. Since January 23, 2020, the number of daily new cases in China except Hubei province reached a peak of 890 on the eleventh day and then it declined to a low level of 34 within two full-length incubation periods (28 days), and the number of daily new cases in Hubei also started to decrease on the twelfth day, from 3156 on February 4, 2020 to 955 on February 15, 2020. Conclusion: The COVID-19 epidemic has been primarily contained in China. The battle against this epidemic in China has provided valuable experiences for the rest of the world. Strict measures need to be taken as earlier as possible to prevent its spread.", "Regional difference in the rate of spread of SARS-CoV-2 ", "Flocked swab might be one main reason causing the high false-negative rate in COVID-19 screening----the advantages of a novel silicone swab RNA testing using RT-PCR can provide direct evidence for diagnoses of COVID-19 which has brought unexpected disasters and changes to our human society. However, the absorption of cotton swab for RNA lysates may lead to a low concentration of detectable RNA, which might be one of the main reasons for the unstable positive detecting rate. We designed and manufactured a kind of silicone swab with concave-convex structure, and further compared the effects of silicone and cotton swab on RNA extraction. Principal component analysis and Paired Wilcoxcon test suggested that a higher RNA concentration and A260/A280 would be obtained using silicone swab. The results indicated that our silicone swab had a more excellent ability to sample than the cotton swab, characterized by the higher quantity and quality of extracted RNA. Thus, we advised that the current cotton swabs need to be improved urgently in COVID-19 diagnoses and the process of \u201csample collection\u201d and \u201csample pre-processing\u201d must be standardized and emphasized. Highlights The current cotton swabs need to be improved urgently in COVID-19 screening.", "Estimation of COVID-19 transmission rates in California and the U.S. with reporting delays We estimated time-varying reproduction numbers of COVID-19 transmission in counties and regions of California and in states of the United States, using the Wallinga-Teunis method of estimations applied to publicly available data. The serial interval distribution assumed incorporates wide uncertainty in delays from symptom onset to case reporting. This assumption contributes smoothing and a small but meaningful increase in numerical estimates of reproduction numbers due to the likely existence of secondary cases not yet reported. Transmission in many areas of the U.S. may not yet be controlled, including areas in which case counts appear to be stable or slowly declining.", "Using Machine Learning to Estimate Unobserved COVID-19 Infections in North America. BACKGROUND The detection of coronavirus disease 2019 (COVID-19) cases remains a huge challenge. As of April 22, 2020, the COVID-19 pandemic continues to take its toll, with >2.6 million confirmed infections and >183,000 deaths. Dire projections are surfacing almost every day, and policymakers worldwide are using projections for critical decisions. Given this background, we modeled unobserved infections to examine the extent to which we might be grossly underestimating COVID-19 infections in North America. METHODS We developed a machine-learning model to uncover hidden patterns based on reported cases and to predict potential infections. First, our model relied on dimensionality reduction to identify parameters that were key to uncovering hidden patterns. Next, our predictive analysis used an unbiased hierarchical Bayesian estimator approach to infer past infections from current fatalities. RESULTS Our analysis indicates that, when we assumed a 13-day lag time from infection to death, the United States, as of April 22, 2020, likely had at least 1.3 million undetected infections. With a longer lag time-for example, 23 days-there could have been at least 1.7 million undetected infections. Given these assumptions, the number of undetected infections in Canada could have ranged from 60,000 to 80,000. Duarte's elegant unbiased estimator approach suggested that, as of April 22, 2020, the United States had up to >1.6 million undetected infections and Canada had at least 60,000 to 86,000 undetected infections. However, the Johns Hopkins University Center for Systems Science and Engineering data feed on April 22, 2020, reported only 840,476 and 41,650 confirmed cases for the United States and Canada, respectively. CONCLUSIONS We have identified 2 key findings: (1) as of April 22, 2020, the United States may have had 1.5 to 2.029 times the number of reported infections and Canada may have had 1.44 to 2.06 times the number of reported infections and (2) even if we assume that the fatality and growth rates in the unobservable population (undetected infections) are similar to those in the observable population (confirmed infections), the number of undetected infections may be within ranges similar to those described above. In summary, 2 different approaches indicated similar ranges of undetected infections in North America. LEVEL OF EVIDENCE Prognostic Level V. See Instructions for Authors for a complete description of levels of evidence.", "Evaluation of Pool-based Testing Approaches to Enable Population-wide Screening for COVID-19 Background: Rapid testing for an infection is paramount during a pandemic to prevent continued viral spread and excess morbidity and mortality. This study aimed to determine whether alternative testing strategies based on sample pooling can increase the speed and throughput of screening for SARS-CoV-2. Methods: A mathematical modelling approach was chosen to simulate six different testing strategies based on key input parameters (infection rate, test characteristics, population size, testing capacity etc.). The situations in five countries (US, DE, UK, IT and SG) currently experiencing COVID-19 outbreaks were simulated to reflect a broad variety of population sizes and testing capacities. The primary study outcome measurements that were finalised prior to any data collection were time and number of tests required; number of cases identified; and number of false positives. Findings: The performance of all tested methods depends on the input parameters, i.e. the specific circumstances of a screening campaign. To screen one tenth of each country's population at an infection rate of 1% - e.g. when prioritising frontline medical staff and public workers -, realistic optimised testing strategies enable such a campaign to be completed in ca. 29 days in the US, 71 in the UK, 25 in Singapore, 17 in Italy and 10 in Germany (ca. eight times faster compared to individual testing). When infection rates are considerably lower, or when employing an optimal, yet logistically more complex pooling method, the gains are more pronounced. Pool-based approaches also reduces the number of false positive diagnoses by 50%. Interpretation: The results of this study provide a clear rationale for adoption of pool-based testing strategies to increase speed and throughput of testing for SARS-CoV-2. The current individual testing approach unnecessarily wastes valuable time and resources.", "COVID-19 in the Shadows of MERS-CoV in the Kingdom of Saudi Arabia. Middle East Respiratory Syndrome Coronavirus (MERS-CoV) has plagued the Middle East since it was first reported in 2012. Recently, at the end of December 2019, a cluster of pneumonia cases were reported from Wuhan city, Hubei Province, China, linked to a wet seafood market with a new coronavirus identified as the etiologic agent currently named SARS-CoV-2. Most cases are in Mainland China with international spread to 25 countries. The novelty of the virus, the rapid national and international spread, and the lack of therapeutic and preventative strategies have led the WHO International Health Regulation emergency committee to declare the disease as Public Health Emergency of International Concern (PHEIC) on January 30, 2020. As it relates to countries with the ongoing MERS-CoV community cases and hospital acquired infections, there will be a huge challenge for HCWs to deal with both coronaviruses, especially with the lack of standardized and approved point of care testing. This challenge will now be faced by the whole global health community dealing with COVID-19 since both coronaviruses have similar presentation. Those patients should now be tested for both MERS-CoV and SARS-CoV-2 simultaneously, and with the continuing wide international spread of SARS-CoV-2, the travel history to China in the last 14 days will be of less significance.", "A demographic scaling model for estimating the total number of COVID-19 infections Understanding how widely COVID-19 has spread is critical for examining the pandemic's progression. Despite efforts to carefully monitor the pandemic, the number of confirmed cases may underestimate the total number of infections. We introduce a demographic scaling model to estimate COVID-19 infections using an broadly applicable approach that is based on minimal data requirements: COVID-19 related deaths, infection fatality rates (IFRs), and life tables. As many countries lack reliable estimates of age-specific IFRs, we scale IFRs between countries using remaining life expectancy as a marker to account for differences in age structures, health conditions, and medical services. Across 10 countries with most COVID-19 deaths as of May 13, 2020, the number of infections is estimated to be four [95% prediction interval: 2-11] times higher than the number of confirmed cases. Cross-country variation is high. The estimated number of infections is 1.4 million (six times the number of confirmed cases) for Italy; 3.1 million (2.2 times the number of confirmed cases) for the U.S.; and 1.8 times the number of confirmed cases for Germany, where testing has been comparatively extensive. Our prevalence estimates, however, are markedly lower than most others based on local seroprevalence studies. We introduce formulas for quantifying the bias that is required in our data on deaths in order to reproduce estimates published elsewhere. This bias analysis shows that either COVID-19 deaths are severely underestimated, by a factor of two or more; or alternatively, the seroprevalence based results are overestimates and not representative for the total population.", "Monitoring and forecasting the number of reported and unreported cases of the COVID-19 epidemic in Brazil using Particle Filter In this paper, we combine algorithm of Liu & West for the Particle Filter (PF) with SIRU-type epidemic model to monitor and forecast cases of Covid-19 in Brazil from February up to September. We filter the number of cumulative reported cases and estimate model parameters and more importantly unreported infectious cases (asymptomatic and symptomatic infectious individuals). The parameters under study are related to the attenuation factor of the transmission rate and the fraction of asymptomatic infectious becoming reported as symptomatic infectious. Initially, the problem is analysed through Particle Swarm Optimization (PSO) based simulations to provide initial guesses, which are then refined by means of PF simulations. Subsequently, two additional steps are performed to verify the capability of the adjusted model to predict and forecast new cases. According to the results, the pandemic peak is expected to take place in mid-June 2020 with about 25,000 news cases per day. As medical and hospital resources are limited, this result shows that public health interventions are essential and should not be relaxed prematurely, so that the coronavirus pandemic is controlled and conditions are available for the treatment of the most severe cases.", "Dynamic basic reproduction number based evaluation for current prevention and control of COVID-19 outbreak in China/ \u4e2d\u534e\u6d41\u884c\u75c5\u5b66\u6742\u5fd7 Objective@#To evaluate the current status of the prevention and control of coronavirus disease (COVID-19) outbreak in China, establish a predictive model to evaluate the effects of the current prevention and control strategies, and provide scientific information for decision- making departments.@*Methods@#Based on the epidemic data of COVID-19 openly accessed from national health authorities, we estimated the dynamic basic reproduction number R0(t) to evaluate the effects of the current COVID-19 prevention and control strategies in all the provinces (municipalities and autonomous regions) as well as in Wuhan and the changes in infectivity of COVID-19 over time.@*Results@#For the stability of the results, 24 provinces (municipality) with more than 100 confirmed COVID-19 cases were included in the analysis. At the beginning of the outbreak, the R0(t) showed unstable trend with big variances. As the strengthening of the prevention and control strategies, R0(t) began to show a downward trend in late January, and became stable in February. By the time of data analysis, 18 provinces (municipality) (75%) had the R0(t)s less than 1. The results could be used for the decision making to free population floating conditionally.@* Conclusions@#Dynamic R0(t) is useful in the evaluation of the change in infectivity of COVID-19, the prevention and control strategies for the COVID-19 outbreak have shown preliminary effects, if continues, it is expected to control the COVID-19 outbreak in China in near future.", "Forecasting the novel coronavirus COVID-19 What will be the global impact of the novel coronavirus (COVID-19)? Answering this question requires accurate forecasting the spread of confirmed cases as well as analysis of the number of deaths and recoveries. Forecasting, however, requires ample historical data. At the same time, no prediction is certain as the future rarely repeats itself in the same way as the past. Moreover, forecasts are influenced by the reliability of the data, vested interests, and what variables are being predicted. Also, psychological factors play a significant role in how people perceive and react to the danger from the disease and the fear that it may affect them personally. This paper introduces an objective approach to predicting the continuation of the COVID-19 using a simple, but powerful method to do so. Assuming that the data used is reliable and that the future will continue to follow the past pattern of the disease, our forecasts suggest a continuing increase in the confirmed COVID-19 cases with sizable associated uncertainty. The risks are far from symmetric as underestimating its spread like a pandemic and not doing enough to contain it is much more severe than overspending and being over careful when it will not be needed. This paper describes the timeline of a live forecasting exercise with massive potential implications for planning and decision making and provides objective forecasts for the confirmed cases of COVID-19.", "Doubling Time of the COVID-19 Epidemic by Chinese Province COVID-19 epidemic doubling time by Chinese province was increasing from January 20 through February 9, 2020. The harmonic mean of the arithmetic mean doubling time estimates ranged from 1.4 (Hunan, 95% CI, 1.2\u20132.0) to 3.1 (Xinjiang, 95% CI, 2.1\u20134.8), with an estimate of 2.5 days (95% CI, 2.4\u20132.6) for Hubei.", "Analysis of temporal trends in potential COVID-19 cases reported through NHS Pathways England The NHS Pathways triage system collates data on enquiries to 111 and 999 services in England. Since the 18th of March 2020, these data have been made publically available for potential COVID-19 symptoms self-reported by members of the public. Trends in such reports over time are likely to reflect behaviour of the ongoing epidemic within the wider community, potentially capturing valuable information across a broader severity profile of cases than hospital admission data. We present a fully reproducible analysis of temporal trends in NHS Pathways reports until 14th May 2020, nationally and regionally, and demonstrate that rates of growth/decline and effective reproduction number estimated from these data may be useful in monitoring transmission. This is a particularly pressing issue as lockdown restrictions begin to be lifted and evidence of disease resurgence must be constantly reassessed. We further assess the correlation between NHS Pathways reports and a publicly available NHS dataset of COVID-19-associated deaths in England, finding that enquiries to 111/999 were strongly associated with daily deaths reported 16 days later. Our results highlight the potential of NHS Pathways as the basis of an early warning system. However, this dataset relies on self-reported symptoms, which are at risk of being severely biased. Further detailed work is therefore necessary to investigate potential behavioural issues which might otherwise explain our conclusions.", "Estimating the true (population) infection rate for COVID-19: A Backcasting Approach with Monte Carlo Methods Differences in COVID-19 testing and tracing across countries, as well as changes in testing within each country over time, make it difficult to estimate the true (population) infection rate based on the confirmed number of cases obtained through RNA viral testing. We applied a backcasting approach, coupled with Monte Carlo methods, to estimate a distribution for the true (population) cumulative number of infections (infected and recovered) for 15 countries where reliable data are available. We find a positive relationship between the testing rate per 1,000 people and the implied true detection rate of COVID-19, and a negative relationship between the proportion who test positive and the implied true detection rate. Our estimates suggest that the true number of people infected across our sample of 15 developed countries is 18.2 (5-95% CI: 11.9-39.0) times greater than the reported number of cases. In individual countries, the true number of cases exceeds the reported figure by factors that range from 1.7 (5-95% CI: 1.1-3.6) for Australia to 35.6 (5-95% CI: 23.2-76.3) for Belgium.", "Malaria and Parasitic Neglected Tropical Diseases: Potential Syndemics with COVID-19? The COVID-19 pandemic, caused by SARS-CoV-2, have surpassed 5 million cases globally. Current models suggest that low- and middle-income countries (LMICs) will have a similar incidence but substantially lower mortality rate than high-income countries. However, malaria and neglected tropical diseases (NTDs) are prevalent in LMICs, and coinfections are likely. Both malaria and parasitic NTDs can alter immunologic responses to other infectious agents. Malaria can induce a cytokine storm and pro-coagulant state similar to that seen in severe COVID-19. Consequently, coinfections with malaria parasites and SARS-CoV-2 could result in substantially worse outcomes than mono-infections with either pathogen, and could shift the age pattern of severe COVID-19 to younger age-groups. Enhancing surveillance platforms could provide signals that indicate whether malaria, NTDs, and COVID-19 are syndemics (synergistic epidemics). Based on the prevalence of malaria and NTDs in specific localities, efforts to characterize COVID-19 in LMICs could be expanded by adding testing for malaria and NTDs. Such additional testing would allow the determination of the rates of coinfection and comparison of severity of outcomes by infection status, greatly improving the understanding of the epidemiology of COVID-19 in LMICs and potentially helping to mitigate its impact.", "Towards reduction in bias in epidemic curves due to outcome misclassification through Bayesian analysis of time-series of laboratory test results: case study of COVID-19 in Alberta, Canada and Philadelphia, USA BACKGROUND: Despite widespread use, the accuracy of the diagnostic test for SARS-CoV-2 infection is poorly understood. The aim of our work was to better quantify misclassification errors in identification of true cases of COVID-19 and to study the impact of these errors in epidemic curves using publicly available surveillance data from Alberta, Canada and Philadelphia, USA. METHODS: We examined time-series data of laboratory tests for SARS-CoV-2 viral infection, the causal agent for COVID-19, to try to explore, using a Bayesian approach, the sensitivity and specificity of the diagnostic test. RESULTS: Our analysis revealed that the data were compatible with near-perfect specificity, but it was challenging to gain information about sensitivity. We applied these insights to uncertainty/bias analysis of epidemic curves under the assumptions of both improving and degrading sensitivity. If the sensitivity improved from 60 to 95%, the adjusted epidemic curves likely falls within the 95% confidence intervals of the observed counts. However, bias in the shape and peak of the epidemic curves can be pronounced, if sensitivity either degrades or remains poor in the 60\u201370% range. In the extreme scenario, hundreds of undiagnosed cases, even among the tested, are possible, potentially leading to further unchecked contagion should these cases not self-isolate. CONCLUSION: The best way to better understand bias in the epidemic curves of COVID-19 due to errors in testing is to empirically evaluate misclassification of diagnosis in clinical settings and apply this knowledge to adjustment of epidemic curves.", "COVID-19 in Italy: impact of containment measures and prevalence estimates of infection in the general population. Since the beginning of the COVID-19 epidemic in Italy, the Italian Government implemented several restrictive measures to contain the spread of the infection. Data shows that, among these measures, the lockdown implemented as of 9 March had a positive impact, in particular the central and southern regions of Italy, while other actions appeared to be less effective. When the true prevalence of a disease is unknown, it is possible estimate it, based on mortality data and the assumptive case-fatality rate of the disease. Given these assumptions, the estimated period-prevalence of COVID-19 in Italy varies from 0.35% in Sicity to 13.3% in Lombardy.", "COVID-19 in the Shadows of MERS-CoV in the Kingdom of Saudi Arabia Middle East Respiratory Syndrome Coronavirus (MERS-CoV) has plagued the Middle East since it was first reported in 2012. Recently, at the end of December 2019, a cluster of pneumonia cases were reported from Wuhan city, Hubei Province, China, linked to a wet seafood market with a new coronavirus identified as the etiologic agent currently named SARS-CoV-2. Most cases are in Mainland China with international spread to 25 countries. The novelty of the virus, the rapid national and international spread, and the lack of therapeutic and preventative strategies have led the WHO International Health Regulation emergency committee to declare the disease as Public Health Emergency of International Concern (PHEIC) on January 30, 2020. As it relates to countries with the ongoing MERS-CoV community cases and hospital acquired infections, there will be a huge challenge for HCWs to deal with both coronaviruses, especially with the lack of standardized and approved point of care testing. This challenge will now be faced by the whole global health community dealing with COVID-19 since both coronaviruses have similar presentation. Those patients should now be tested for both MERS-CoV and SARS-CoV-2 simultaneously, and with the continuing wide international spread of SARS-CoV-2, the travel history to China in the last 14 days will be of less significance.", "TB infection and BCG vaccination: are we protected from COVID-19? OBJECTIVES: The incidence of emerging coronavirus disease 2019 (COVID-19) disease is variable across the different parts of the world. Apart from travel patterns, other factors determining this difference may include host immune response. The aim of this study was to assess the effect of tuberculosis (TB) endemicity and Bacille Calmette-Guerin (BCG) coverage on COVID-19. STUDY DESIGN: This was a cross-sectional study. METHODS: We reviewed available data regarding TB incidence, BCG coverage (as per the World Health Organization), and COVID-19 incidence of 174 countries. We divided the countries into four cohorts depending on annual TB incidence and BCG coverage. RESULTS: Countries with high TB incidence had lower COVID-19 than countries with low TB incidence. Similarly, countries with high BCG coverage had lower incidence of COVID-19, suggesting some protective mechanisms in TB-endemic areas. However, the ecological differences and different testing strategies between countries could not be accounted for in this analysis. CONCLUSION: Higher TB incidence and BCG coverage were found to be associated with lesser incidence of COVID-19. This outcome paves the way for further research into pathogenesis and immune response in COVID-19.", "Sentinel Event Surveillance to Estimate Total SARS-CoV-2 Infections, United States Human infections with a novel coronavirus (SARS-CoV-2) were first identified via syndromic surveillance in December of 2019 in Wuhan China. Since identification, infections (coronavirus disease-2019; COVID-19) caused by this novel pathogen have spread globally, with more than 180,000 confirmed cases as of March 16, 2020. Effective public health interventions, including social distancing, contact tracing, and isolation/quarantine rely on the rapid and accurate identification of confirmed cases. However, testing capacity (having sufficient tests and laboratory throughput) to support these non-pharmaceutical interventions remains a challenge for containment and mitigation of COVID-19 infections. We undertook a sentinel event strategy (where single health events signal emerging trends) to estimate the incidence of COVID-19 in the US. Data from a recent national conference, the Conservative Political Action Conference, (CPAC) near Washington, DC and from the outbreak in Wuhan, China were used to fit a simple exponential growth model to estimate the total number of incident SARS- CoV-2 infections in the United States on March 1, 2020, and to forecast subsequent infections potentially undetected by current testing strategies. Our analysis and forecasting estimates a total of 54,100 SARS-CoV-2 infections (80 % CI 5,600 to 125,300) have occurred in the United States to March 12, 2020. Our forecast predicts that a very substantial number of infections are undetected, and without extensive and far-reaching non-pharmaceutical interventions, the number of infections should be expected to grow at an exponential rate.", "Rapid implementation of mobile technology for real-time epidemiology of COVID-19 The rapid pace of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic (COVID-19) presents challenges to the robust collection of population-scale data to address this global health crisis. We established the COronavirus Pandemic Epidemiology (COPE) consortium to bring together scientists with expertise in big data research and epidemiology to develop a COVID-19 Symptom Tracker mobile application that we launched in the UK on March 24, 2020 and the US on March 29, 2020 garnering more than 2.8 million users as of May 2, 2020. This mobile application offers data on risk factors, herald symptoms, clinical outcomes, and geographical hot spots. This initiative offers critical proof-of-concept for the repurposing of existing approaches to enable rapidly scalable epidemiologic data collection and analysis which is critical for a data-driven response to this public health challenge.", "Protocol of a population-based prospective COVID-19 cohort study Munich, Germany (KoCo19) BACKGROUND: Due to the SARS-CoV-2 pandemic, public health interventions have been introduced globally in order to prevent the spread of the virus and avoid the overload of health care systems, especially for the most severely affected patients. Scientific studies to date have focused primarily on describing the clinical course of patients, identifying treatment options and developing vaccines. In Germany, as in many other regions, current tests for SARS-CoV2 are not conducted on a representative basis and in a longitudinal design. Furthermore, knowledge about the immune status of the population is lacking. Nonetheless, these data are needed to understand the dynamics of the pandemic and hence to appropriately design and evaluate interventions. For this purpose, we recently started a prospective population-based cohort in Munich, Germany, with the aim to develop a better understanding of the state and dynamics of the pandemic. METHODS: In 100 out of 755 randomly selected constituencies, 3000 Munich households are identified via random route and offered enrollment into the study. All household members are asked to complete a baseline questionnaire and subjects \u226514 years of age are asked to provide a venous blood sample of \u22643 ml for the determination of SARS-CoV-2 IgG/IgA status. The residual plasma and the blood pellet are preserved for later genetic and molecular biological investigations. For twelve months, each household member is asked to keep a diary of daily symptoms, whereabouts and contacts via WebApp. If symptoms suggestive for COVID-19 are reported, family members, including children < 14 years, are offered a pharyngeal swab taken at the Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, for molecular testing for SARS-CoV-2. In case of severe symptoms, participants will be transferred to a Munich hospital. For one year, the study teams re-visits the households for blood sampling every six weeks. DISCUSSION: With the planned study we will establish a reliable epidemiological tool to improve the understanding of the spread of SARS-CoV-2 and to better assess the effectiveness of public health measures as well as their socio-economic effects. This will support policy makers in managing the epidemic based on scientific evidence.", "Global prediction of unreported SARS-CoV2 infection from observed COVID-19 cases Summary: Estimation of infectiousness and fatality of the SARS-CoV-2 virus in the COVID-19 global pandemic is complicated by ascertainment bias resulting from incomplete and non-representative samples of infected individuals. We developed a strategy for overcoming this bias to obtain more plausible estimates of the true values of key epidemiological variables. We fit mechanistic Bayesian latent-variable SIR models to confirmed COVID-19 cases, deaths, and recoveries, for all regions (countries and US states) independently. Bayesian averaging over models, we find that the raw infection incidence rate underestimates the true rate by a factor, the case ascertainment ratio CARt that depends upon region, and show how CARt changes over time. At the regional onset of COVID-19, the predicted global median for each case confirmed was 13 infections unreported (CARt = 0.07 C.I. (0.02, 0.4)). As the infection spread, the median CARt rose to 9 unreported cases for every one diagnosed as of April 15, 2020 (CARt = 0.1 C.I. (0.02, 0.5)). We also estimate that the median global initial reproduction number R0 is 3.3 (C.I (1.5, 8.3)) and the total infection fatality rate near the onset is 0.17% (C.I. (0.05%, 0.9%)). However the time-dependent reproduction number Rt and infection fatality rate as of April 15 were 1.2 (C.I. (0.6, 2.5)) and 0.8% (C.I. (0.2%,4%)), respectively. We find that there is great variability between country- and state-level values. Our estimates are consistent with recent serological estimates of cumulative infections for the state of New York, but inconsistent with claims that very large fractions of the population have already been infected in most other regions. For most regions, our estimates imply a great deal of uncertainty about the current state and trajectory of the epidemic.", "Population-scale Longitudinal Mapping of COVID-19 Symptoms, Behavior, and Testing Identifies Contributors to Continued Disease Spread in the United States Despite social distancing and shelter-in-place policies, COVID-19 continues to spread in the United States. A lack of timely information about factors influencing COVID-19 spread and testing has hampered agile responses to the pandemic. We developed How We Feel, an extensible web and mobile application that aggregates self-reported survey responses, to fill gaps in the collection of COVID-19-related data. How We Feel collects longitudinal and geographically localized information on users' health, behavior, and demographics. Here we report results from over 500,000 users in the United States from April 2, 2020 to May 12, 2020. We show that self- reported surveys can be used to build predictive models of COVID-19 test results, which may aid in identification of likely COVID-19 positive individuals. We find evidence among our users for asymptomatic or presymptomatic presentation, as well as for household and community exposure, occupation, and demographics being strong risk factors for COVID-19. We further reveal factors for which users have been SARS-CoV-2 PCR tested, as well as the temporal dynamics of self- reported symptoms and self-isolation behavior in positive and negative users. These results highlight the utility of collecting a diverse set of symptomatic, demographic, and behavioral self- reported data to fight the COVID-19 pandemic.", "Estimating COVID-19 Prevalence in the United States: A Sample Selection Model Approach Background: Public health efforts to determine population infection rates from coronavirus disease 2019 (COVID-19) have been hampered by limitations in testing capabilities and the large shares of mild and asymptomatic cases. We developed a methodology that corrects observed positive test rates for non-random sampling to estimate population infection rates across U.S. states from March 31 to April 7. Methods We adapted a sample selection model that corrects for non-random testing to estimate population infection rates. The methodology compares how the observed positive case rate vary with changes in the size of the tested population, and applies this gradient to infer total population infection rates. Model identification requires that variation in testing rates be uncorrelated with changes in underlying disease prevalence. To this end, we relied on data on day-to-day changes in completed tests across U.S. states for the period March 31 to April 7, which were primarily influenced by immediate supply-side constraints. We used this methodology to construct predicted infection rates across each state over the sample period. We also assessed the sensitivity of the results to controls for state-specific daily trends in infection rates. Results The median population infection rate over the period March 31 to April 7 was 0.9% (IQR 0.64 1.77). The three states with the highest prevalence over the sample period were New York (8.5%), New Jersey (7.6%), and Louisiana (6.7%). Estimates from models that control for state-specific daily trends in infection rates were virtually identical to the baseline findings. The estimates imply a nationwide average of 12 population infections per diagnosed case. We found a negative bivariate relationship (corr. = -0.51) between total per capita state testing and the ratio of population infections per diagnosed case. Interpretation The effectiveness of the public health response to the coronavirus pandemic will depend on timely information on infection rates across different regions. With increasingly available high frequency data on COVID-19 testing, our methodology could be used to estimate population infection rates for a range of countries and subnational districts. In the United States, we found widespread undiagnosed COVID-19 infection. Expansion of rapid diagnostic and serological testing will be critical in preventing recurrent unobserved community transmission and identifying the large numbers individuals who may have some level of viral immunity.", "Testing Asymptomatic Emergency Department Patients for Coronavirus of 2019 (COVID\u201019) in a Low Prevalence Region The first cases of Coronavirus of 2019 (COVID\u201019) were reported in Wuhan, China in December 2019(1). The literature demonstrates geographical variation with regards to estimates of infection incidence, suggesting that COVID\u201019 has been underdiagnosed in certain regions(2,3). The rate of asymptomatic infection has been estimated to be as high as 30.8%, which may help explain variation in incidence, particularly in regions with differing screening practices (3). Transmission of COVID\u201019 by asymptomatic carriers has been reported in multiple family units, indicating that this mode of infection is important in understanding disease epidemiology and population risk(4,5).", "Population-scale testing can suppress the spread of COVID-19 We propose an additional intervention that would contribute to the control of the COVID-19 pandemic, offer more protection for people working in essential jobs, and help guide an eventual reopening of society. The intervention is based on: (1) testing every individual (2) repeatedly, and (3) self-quarantine of infected individuals. Using a standard epidemiological model (SIR), we show here that by identification and isolation of the majority of infectious individuals, including those who may be asymptomatic, the reproduction number R0 of SARS-CoV-2 would be reduced well below 1.0, and the epidemic would collapse. We replicate these observations in a more complex stochastic dynamic model on a social network graph. We also find that the testing regime would be additive to other interventions, and be effective at any level of prevalence. If adopted as a policy, any industrial society could sustain the regime for as long as it takes to find a safe and effective cure or vaccine. Our model also indicates that unlike sampling-based tests, population-scale testing does not need to be very accurate: false negative rates up to 15% could be tolerated if 80% comply with testing every ten days, and false positives can be almost arbitrarily high when a high fraction of the population is already effectively quarantined. Testing at the required scale would be feasible if existing qPCR-based methods are scaled up and multiplexed. A mass produced, low throughput field test kit could also be carried out at home. Economic analysis also supports the feasibility of the approach: current reagent costs for tests are in the range of a dollar or less, and the estimated benefits for population-scale testing are so large that the policy would be cost-effective even if the costs were larger by more than two orders of magnitude. To identify both active and previous infections, both viral RNA and antibodies could be tested. All technologies to build such test kits, and to produce them in the scale required to test the entire world's population exist already. Integrating them, scaling up production, and implementing the testing regime will require resources and planning, but at a scale that is very small compared to the effort that every nation would devote to defending itself against a more traditional foe.", "New statistical model for misreported data with application to current public health challenges The main goal of this work is to present a new model able to deal with potentially misreported continuous time series. The proposed model is able to handle the autocorrelation structure in continuous time series data, which might be partially or totally underreported or overreported. Its performance is illustrated through a comprehensive simulation study considering several autocorrelation structures and two real data applications on human papillomavirus incidence in Girona (Catalunya, Spain) and COVID-19 incidence in the Chinese region of Heilongjiang.", "A Cautionary Tale of False-Negative Nasopharyngeal COVID-19 Testing There remains diagnostic uncertainty regarding the sensitivity of reverse transcription polymerase chain reaction in detection of SARS-CoV-2 from nasopharyngeal specimens. We present a case where two nasopharyngeal specimens were negative, followed by a positive sputum sample. Serial testing for COVID-19 is indicated in patients with high pretest probability of disease.", "Reliability and usefulness of a rapid IgM\u2010IgG antibody test for the diagnosis of SARS-CoV-2 infection: a preliminary report. ", "Predict the next moves of COVID-19: reveal the temperate and tropical countries scenario The spread of COVID-19 engulfs almost all the countries and territories of the planet, and infections and fatality are increasing rapidly. The first epi-center of its' massive spread was in Wuhan, Hubei province, China having a temperate weather, but the spread has got an unprecedented momentum in European temperate countries mainly in Italy and Spain (as of March 30, 2020). However, Malaysia and Singapore and the neighboring tropical countries of China got relatively low spread and fatality that created a research interest on whether there are potential impacts of weather condition on COVID-19 spread. Adopting the SIR (Susceptible Infected Removed) deviated model to predict potential cases and death in the coming days from COVID-19 was done using the secondary and official sources of data. This study shows that COVID-19 spread and fatality tend to be high across the world but compared to tropical countries, it is going to be incredibly high in the temperate countries having lower temperature (7-16\u00b0C) and humidity (80-90%) in last March. However, some literature predicted that this might not to be true, rather irrespective of weather conditions there might be a continuous spread and death. Moreover, a large number of asymptotic COVID-19 carrier in both temperate and tropical countries may re-outbreak in the coming winter. Therefore, a comprehensive global program with the leadership of WHO for testing of entire population of the world is required, which will be very useful for the individual states to take proper political action, social movement and medical services.", "Longitudinal analyses of the relationship between development density and the COVID-19 morbidity and mortality rates: Early evidence from 1,165 metropolitan counties in the United States This longitudinal study aimed to investigative the impacts of development density on the spread and mortality rates of COVID-19 in metropolitan counties in the United States. Multilevel Linear Modeling (MLM) were employed to model the infection rate and the mortality rate of COVID-19, accounting for the hierarchical (two-level) and longitudinal structure of the data. This study found that large metropolitan size (measured in terms of population) lead to significantly higher COVID-19 infection rates and higher mortality rates. After controlling for metropolitan size and other confounding variables, county density leads to significantly lower infection rates and lower death rates. These findings recommend that urban planners and health professionals continue to advocate for compact development and continue to oppose urban sprawl for this and many other reasons documented in the literature, including the positive relationship between compact development and fitness and general health.", "Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2) Estimation of the prevalence and contagiousness of undocumented novel coronavirus (SARS-CoV2) infections is critical for understanding the overall prevalence and pandemic potential of this disease. Here we use observations of reported infection within China, in conjunction with mobility data, a networked dynamic metapopulation model and Bayesian inference, to infer critical epidemiological characteristics associated with SARS-CoV2, including the fraction of undocumented infections and their contagiousness. We estimate 86% of all infections were undocumented (95% CI: [82%\u201390%]) prior to 23 January 2020 travel restrictions. Per person, the transmission rate of undocumented infections was 55% of documented infections ([46%\u201362%]), yet, due to their greater numbers, undocumented infections were the infection source for 79% of documented cases. These findings explain the rapid geographic spread of SARS-CoV2 and indicate containment of this virus will be particularly challenging.", "Do the current cases reported to the WHO provide a realistic incidence rate of countries infected with COVID-19? ", "COVID-19 diagnostic approaches: different roads to the same destination \u201cSARS-CoV2\u201d, a previously unknown strain of coronaviruses caused a severe respiratory disease called Coronavirus disease (COVID-19) which emerged from Wuhan city of China on 30 December 2019, and declared as Global health problem by World Health Organisation within a month. In less than two and half months (11 March, 2020) it was declared as a pandemic disease due to its rapid spreading ability, it covered more than 211 countries infecting around 1.7 million persons and claiming around 1.1 lakhs lives within merely 100 days of its emergence. Containment of the infection of this virus is the only available measure to control the disease as no vaccine or specific antiviral treatment is available. Confirmed detection of the virus followed by isolation of the infected person at the earliest possible is the only measure to prevent this disease. Although there are number of methods available for detection of virus and to combat this disease in the present pandemic situation, but these available diagnostic methods have their own limitations. The speedy and exponential global spread of this disease strongly urges the fast and economic diagnostics tools. Additional to the available diagnostic methods, there is a sudden surge for development of various of methods and platforms to diagnose the COVID-19. The review summarized the advantage and disadvantage of various diagnostic approaches being used presently for COVID-19, newer detection methods in developmental stage and the feasibility of advanced platforms like newer nano-sensor based on-the-spot detection technologies.", "The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak Abstract Coronavirus disease (COVID-19) is caused by SARS-COV2 and represents the causative agent of a potentially fatal disease that is of great global public health concern. Based on the large number of infected people that were exposed to the wet animal market in Wuhan City, China, it is suggested that this is likely the zoonotic origin of COVID-19. Person-to-person transmission of COVID-19 infection led to the isolation of patients that were subsequently administered a variety of treatments. Extensive measures to reduce person-to-person transmission of COVID-19 have been implemented to control the current outbreak. Special attention and efforts to protect or reduce transmission should be applied in susceptible populations including children, health care providers, and elderly people. In this review, we highlights the symptoms, epidemiology, transmission, pathogenesis, phylogenetic analysis and future directions to control the spread of this fatal disease.", "Short-Term Covid-19 Forecast for Latecomers The number of Covid-19 cases is increasing dramatically worldwide. Therefore, the availability of reliable forecasts for the number of cases in the coming days is of fundamental importance. We propose a simple statistical method for short-term real-time forecasting of the number of Covid-19 cases and fatalities in countries that are latecomers -- i.e., countries where cases of the disease started to appear some time after others. In particular, we propose a penalized (LASSO) regression with an error correction mechanism to construct a model of a latecomer in terms of the other countries that were at a similar stage of the pandemic some days before. By tracking the number of cases and deaths in those countries, we forecast through an adaptive rolling-window scheme the number of cases and deaths in the latecomer. We apply this methodology to Brazil, and show that (so far) it has been performing very well. These forecasts aim to foster a better short-run management of the health system capacity.", "Rapid surveillance of COVID-19 in the United States using a prospective space-time scan statistic: Detecting and evaluating emerging clusters Abstract Coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China in December 2019, and is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 is a pandemic with an estimated death rate between 1% and 5%; and an estimated R 0 between 2.2 and 6.7 according to various sources. As of March 28th, 2020, there were over 649,000 confirmed cases and 30,249 total deaths, globally. In the United States, there were over 115,500 cases and 1891 deaths and this number is likely to increase rapidly. It is critical to detect clusters of COVID-19 to better allocate resources and improve decision-making as the outbreaks continue to grow. Using daily case data at the county level provided by Johns Hopkins University, we conducted a prospective spatial-temporal analysis with SaTScan. We detect statistically significant space-time clusters of COVID-19 at the county level in the U.S. between January 22nd-March 9th, 2020, and January 22nd-March 27th, 2020. The space-time prospective scan statistic detected \u201cactive\u201d and emerging clusters that are present at the end of our study periods \u2013 notably, 18 more clusters were detected when adding the updated case data. These timely results can inform public health officials and decision makers about where to improve the allocation of resources, testing sites; also, where to implement stricter quarantines and travel bans. As more data becomes available, the statistic can be rerun to support timely surveillance of COVID-19, demonstrated here. Our research is the first geographic study that utilizes space-time statistics to monitor COVID-19 in the U.S.", "Report from the American Society for Microbiology COVID-19 International Summit, 23 March 2020: Value of Diagnostic Testing for SARS\u2013CoV-2/COVID-19 ", "Evaluating efficiency of pooling specimens for PCR-based detection of COVID-19 In the age of a pandemic, such as the ongoing one caused by SARS-CoV-2, the world faces limited supply of tests, PPE and reagents, and factories are struggling to meet the growing demands. This study aimed to evaluate the efficacy of pooling specimen for testing of SARS-CoV-2 virus, to determine whether costs and resource savings could be achieved without impacting the sensitivity of the testing. Ten specimens were pooled for testing, containing either one or two known positive specimen of varying viral concentrations. Pooling specimens did not affect the sensitivity of detecting SARS-CoV-2, and the PCR cycle threshold (Ct) between testing of pooling specimen and subsequent individual testing was not significantly different using paired t-test. This study also identified cost savings garnered from pooling of specimen for testing at 4 differing prevalence rates, ranging from 0.1-10%. Pooling specimens to test for COVID-19 infection in low prevalence areas or in low risk population can dramatically decrease the resources burden on lab operations by up to 80%. This paves the possibility for large-scale population screening, allowing for assured policy decisions by governmental bodies to ease lockdown restrictions in areas with low incidence of infection, or with lower risk populations.", "Projection of COVID-19 Cases and Deaths in the US as Individual States Re-open May 4,2020 In March and April 2020, control measures enforcing social distancing and restricting individual movement and contact were adopted across the United States in an effort to slow the spread and growth of COVID-19. However, a number of states have now begun to ease these restrictions. Here, we evaluate the effects of loosening stay-at-home orders on COVID-19 incidence and related outcomes. We use a metapopulation model applied at county resolution to simulate the spread and growth of COVID-19 incidence in the United States. We calibrate the model against county-level daily case and death data collected from February 21, 2020 to May 2, 2020, and project the outbreak in 3,142 US counties for 6 weeks into the future. Projections for daily reported cases, daily new infections (both reported and unreported), new and cumulative hospital bed demand, ICU bed and ventilator demand, as well as daily mortality, are generated. We observe a rebound in COVID-19 incidence and deaths beginning in late May, approximately 2 to 4 weeks after states begin to reopen. Importantly, the lag between infection acquisition and case confirmation, coupled with insufficient broader testing and contact tracing, will mask any rebound and exponential growth of the COVID-19 until it is well underway.", "Covid-19 pandemic by the \u201creal-time\u201d monitoring: the Tunisian case and lessons for global epidemics in the context of 3PM strategies Covid-19 is neither the first nor the last viral epidemic which societies around the world are, were and will be affected by. Which lessons should be taken from the current pandemic situation? The Covid-19 disease is still not well characterised, and many research teams all over the world are working on prediction of the epidemic scenario, protective measures to populations and sub-populations, therapeutic and vaccination issues, amongst others. Contextually, countries with currently low numbers of Covid-19-infected individuals such as Tunisia are intended to take lessons from those countries which already reached the exponential phase of the infection distribution as well as from those which have the exponential phase behind them and record a minor number of new cases such as China. To this end, in Tunisia, the pandemic wave has started with a significant delay compared with Europe, the main economic partner of the country. In this paper, we do analyse the current pandemic situation in this country by studying the infection evolution and considering potential protective strategies to prevent a pandemic scenario. The model is predictive based on a large number of undetected Covid-19 cases that is particularly true for some country regions such as Sfax. Infection distribution and mortality rate analysis demonstrate a highly heterogeneous picture over the country. Qualitative and quantitative comparative analysis leads to a conclusion that the reliable \u201creal-time\u201d monitoring based on the randomised laboratory tests is the optimal predictive strategy to create the most effective evidence-based preventive measures. In contrast, lack of tests may lead to incorrect political decisions causing either unnecessary over-protection of the population that is risky for a long-term economic recession, or under-protection of the population leading to a post-containment pandemic rebound. Recommendations are provided in the context of advanced predictive, preventive and personalised (3P) medical approach.", "Epidemiology of the 2020 pandemic of COVID\u201019 in the state of Georgia: Inadequate critical care resources and impact after 7 weeks of community spread OBJECTIVES: Novel coronavirus (COVID\u201019) is a global pandemic currently spreading rapidly across the United States. We provide a comprehensive look at COVID\u201019 epidemiology across the state of Georgia, which includes vast rural communities that may be disproportionately impacted by the spread of this infectious disease. METHODS: All 159 Georgia counties were included in this study. We examined the geographic variation of COVID\u201019 in Georgia from March 3 through April 24, 2020 by extracting data on incidence and mortality from various national and state datasets. We contrasted county\u2010level mortality rates per 100,000 population (MRs) by county\u2010level factors. RESULTS: Metropolitan Atlanta had the overall highest number of confirmed cases; however, the southwestern rural parts of Georgia, surrounding the city of Albany, had the highest bi\u2010weekly increases in incidence rate. Among counties with >10 cases, MRs were highest in the rural counties of Randolph (233.2), Terrell (182.5), Early (136.3), and Dougherty (114.2). Counties with the highest MRs (22.5\u20132332 per 100,000) had a higher proportion of: non\u2010Hispanic Blacks residents, adults aged 60+, adults earning <$20,000 annually, and residents living in rural communities when compared with counties with lower MRs. These counties also had a lower proportion of the population with a college education, lower number of ICU beds per 100,000 population, and lower number of primary care physicians per 10,000 population. CONCLUSIONS: While urban centers in Georgia account for the bulk of COVID\u201019 cases, high mortality rates and low critical care capacity in rural Georgia are also of critical concern.", "A Commentary on Rural\u2010Urban Disparities in COVID\u201019 Testing Rates per 100,000 and Risk Factors ", "An Evolving Approach to the Laboratory Assessment of COVID\u201019 As the COVID\u201019 outbreak has evolved in each country, the approach to the laboratory assessment of SARS\u2010CoV\u20102 infection has had to evolve as well. This review addresses the evolving approach to the laboratory assessment of COVID\u201019 and discusses how algorithms for testing have been driven, in part, by the demand for testing overwhelming the capacity to accomplish such testing. This review focused on testing in the United States as this testing is evolving whereas in China and other countries such as South Korea testing is widely available and includes both molecular testing for SARS\u2010CoV\u20102 as well as serological testing using both ELISA methodology and lateral flow immunoassay methodology. Although commercial testing systems are becoming available, there will likely be insufficient numbers of such tests due to high demand. Serological testing will be the next testing issue as the COVID\u201019 begins to subside. This will allow immunity testing as well as will allow the parameters of the COVID\u201019 outbreak to be defined. This article is protected by copyright. All rights reserved.", "Bounding the Predictive Values of COVID-19 Antibody Tests COVID-19 antibody tests have imperfect accuracy. There has been lack of clarity on the meaning of reported rates of false positives and false negatives. For risk assessment and clinical decision making, the rates of interest are the positive and negative predictive values of a test. Positive predictive value (PPV) is the chance that a person who tests positive has been infected. Negative predictive value (NPV) is the chance that someone who tests negative has not been infected. The medical literature regularly reports different statistics, sensitivity and specificity. Sensitivity is the chance that an infected person receives a positive test result. Specificity is the chance that a non-infected person receives a negative result. Knowledge of sensitivity and specificity permits one to predict the test result given a person's true infection status. These predictions are not directly relevant to risk assessment or clinical decisions, where one knows a test result and wants to predict whether a person has been infected. Given estimates of sensitivity and specificity, PPV and NPV can be derived if one knows the prevalence of the disease, the rate of illness in the population. There is considerable uncertainty about the prevalence of COVID-19. This paper addresses the problem of inference on the PPV and NPV of COVID-19 antibody tests given estimates of sensitivity and specificity and credible bounds on prevalence. I explain the methodological problem, show how to estimate bounds on PPV and NPV, and apply the findings to some tests authorized by the FDA.", "False positives in reverse transcription PCR testing for SARS-CoV-2 Background: Large-scale testing for SARS-CoV-2 by RT-PCR is a key element of the response to COVID-19, but little attention has been paid to the potential frequency and impacts of false positives. Method: From a meta-analysis of external quality assessments of RT-PCR assays of RNA viruses, we derived a conservative estimate of the range of false positive rates that can reasonably be expected in SARS-CoV-2 testing, and analyzed the effect of such rates on analyses of regional test data and estimates of population prevalence and asymptomatic ratio. Findings: Review of external quality assessments revealed false positive rates of 0-16.7%, with an interquartile range of 0.8-4.0%. Such rates would have large impacts on test data when prevalence is low. Inclusion of such rates significantly alters four published analyses of population prevalence and asymptomatic ratio. Interpretation: The high false discovery rate that results, when prevalence is low, from false positive rates typical of RT-PCR assays of RNA viruses raises questions about the usefulness of mass testing; and indicates that across a broad range of likely prevalences, positive test results are more likely to be wrong than are negative results, contrary to public health advice about SARS-CoV-2 testing. There are myriad clinical and case management implications. Failure to appreciate the potential frequency of false positives and the consequent unreliability of positive test results across a range of scenarios could unnecessarily remove critical workers from service, expose uninfected individuals to greater risk of infection, delay or impede appropriate medical treatment, lead to inappropriate treatment, degrade patient care, waste personal protective equipment, waste human resources in unnecessary contact tracing, hinder the development of clinical improvements, and weaken clinical trials. Measures to raise awareness of false positives, reduce their frequency, and mitigate their effects should be considered.", "Incidence, clinical characteristics and prognostic factor of patients with COVID-19: a systematic review and meta-analysis Background: Recently, Coronavirus Disease 2019 (COVID-19) outbreak started in Wuhan, China. Although the clinical features of COVID-19 have been reported previously, data regarding the risk factors associated with the clinical outcomes are lacking. Objectives: To summary and analyze the clinical characteristics and identify the predictors of disease severity and mortality. Methods: The PubMed, Web of Science Core Collection, Embase, Cochrane and MedRxiv databases were searched through February 25, 2020. Meta-analysis of Observational Studies in Epidemiology (MOOSE) recommendations were followed. We extracted and pooled data using random-effects meta-analysis to summary the clinical feature of the confirmed COVID-19 patients, and further identify risk factors for disease severity and death. Heterogeneity was evaluated using the I2 method and explained with subgroup analysis and meta-regression. Results: A total of 30 studies including 53000 patients with COVID-19 were included in this study, the mean age was 49.8 years (95% CI, 47.5-52.2 yrs) and 55.5% were male. The pooled incidence of severity and mortality were 20.2% (95% CI, 15.1-25.2%) and 3.1% (95% CI, 1.9-4.2%), respectively. The predictor for disease severity included old age (\u2265 50 yrs, odds ratio [OR] = 2.61; 95% CI, 2.29-2.98), male (OR =1.348, 95% CI, 1.195-1.521), smoking (OR =1.734, 95% CI, 1.146-2.626) and any comorbidity (OR = 2.635, 95% CI, 2.098-3.309), especially chronic kidney disease (CKD, OR = 6.017; 95% CI, 2.192-16.514), chronic obstructive pulmonary disease (COPD, OR = 5.323; 95% CI, 2.613-10.847) and cerebrovascular disease (OR = 3.219; 95% CI, 1.486-6.972). In terms of laboratory results, increased lactate dehydrogenase (LDH), C-reactive protein (CRP) and D-dimer and decreased blood platelet and lymphocytes count were highly associated with severe COVID-19 (all for P < 0.001). Meanwhile, old age (\u2265 60 yrs, RR = 9.45; 95% CI, 8.09-11.04), followed by cardiovascular disease (RR = 6.75; 95% CI, 5.40-8.43) hypertension (RR = 4.48; 95% CI, 3.69-5.45) and diabetes (RR = 4.43; 95% CI, 3.49-5.61) were found to be independent prognostic factors for the COVID-19 related death. Conclusions: To our knowledge, this is the first evidence-based medicine research to explore the risk factors of prognosis in patients with COVID-19, which is helpful to identify early-stage patients with poor prognosis and adapt effective treatment.", "Early and massive testing saves lives: COVID-19 related infections and deaths in the United States during March of 2020 To optimize epidemiologic interventions, predictors of mortality should be identified. The US COVID-19 epidemic data, reported up to 31 March 2020, were analyzed using kernel regularized least squares regression. Six potential predictors of mortality were investigated: (i) the number of diagnostic tests performed in testing week I; (ii) the proportion of all tests conducted during week I of testing; (iii) the cumulative number of (test-positive) cases through 3-31-2020, (iv) the number of tests performed/million citizens; (v) the cumulative number of citizens tested; and (vi) the apparent prevalence rate, defined as the number of cases/million citizens. Two metrics estimated mortality: the number of deaths and the number of deaths/million citizens. While both expressions of mortality were predicted by the case count and the apparent prevalence rate, the number of deaths/million citizens was {approx}3.5 times better predicted by the apparent prevalence rate than the number of cases. In eighteen states, early testing/million citizens/population density was inversely associated with the cumulative mortality reported by 31 March, 2020. Findings support the hypothesis that early and massive testing saves lives. Other factors --e.g., population density-- may also influence outcomes. To optimize national and local policies, the creation and dissemination of high resolution geo-referenced, epidemic data is recommended.", "Targeted Proteomics for the Detection of SARS-CoV-2 Proteins Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). The rapid, sensitive and specific diagnosis of SARS-CoV-2 by fast and unambiguous testing is widely recognized to be critical in responding the current outbreak. Since the current testing capacity by conventional PCR based methods is insufficient because of shortages of supplies such as RNA extraction kits and PCR reagents, alternative and/or complementary testing assays should be developed. Here, we exploit the potential of targeted mass spectrometry based proteomic technologies to solve the current issue of insufficient SARS-CoV-2 diagnostic testing capacity. We have assessed the limit of detection by parallel reaction monitoring (PRM) on an Orbitrap Eclipse mass spectrometer for target tryptic peptides of several SARS-CoV-2 proteins from a sample of virus infected Vero cells. For Nucleocapsid protein the limit of detection was found to be in the mid-attomole range (0.9 \u00d7 10\u221212 g), which would theoretically correspond to approximately 10,000 SARS-CoV-2 particles, under the assumption that all viral proteins are assembled in macromolecular virus particles. Whether or not this sensitivity is sufficient to play a role in SARS-CoV-2 detection in patient material such as swabs or body fluids largely depends on the amount of viral proteins present in such samples and is subject of further research. If yes, mass spectrometry based methods could serve as a complementary protein based diagnostic tool and further steps should be focused on sample preparation protocols and on improvements in sample throughput.", "Are we equal in adversity? Does Covid-19 affect women and men differently? BACKGROUND & OBJECTIVES: This article examines whether women are less prone than men to Covid-19 infections and their complications. DATA SOURCES: We reviewed available databases and searched systematically for publications. To be taken into account, data had to be broken down by gender. There was no study evaluation nor quantification synthesis, due to the large heterogeneity of the studies. Nineteen databases were selected. 73 publications were considered and 33 were selected, to which 12 more were added. RESULTS: Globally, the proportion of men and women who tested positive is comparable. However, men are about 60% more likely to be severely ill or to die from the complications of Covid-19 than are women. LIMITATIONS: The study was hampered by a large heterogeneity in testing and reporting of the data. CONCLUSIONS: Although in the pandemic men die more frequently than women from Covid-19, it is not clear whether this is due to biological differences between men and women, differences in behavioral habits, or differences in the rates of co-morbidities. IMPLICATIONS OF KEY FINDINGS: Countries and studies should report their data by age, gender and co-morbidities. This may have implications in terms of vaccination strategies, the choice of treatments and future consequences for long-term health issues concerning gender equality.", "Quantitative assessment of the role of undocumented infection in the 2019 novel coronavirus (COVID-19) pandemic An urgent problem in controlling COVID-19 spreading is to understand the role of undocumented infection. We develop a five-state model for COVID-19, taking into account the unique features of the novel coronavirus, with key parameters determined by the government reports and mathematical optimization. Tests using data from China, South Korea, Italy, and Iran indicate that the model is capable of generating accurate prediction of the daily accumulated number of confirmed cases and is entirely suitable for real-time prediction. The drastically disparate testing and diagnostic standards/policies among different countries lead to large variations in the estimated parameter values such as the duration of the outbreak, but such uncertainties have little effect on the occurrence time of the inflection point as predicted by the model, indicating its reliability and robustness. Model prediction for Italy suggests that insufficient government action leading to a large fraction of undocumented infection plays an important role in the abnormally high mortality in that country. With the data currently available from United Kingdom, our model predicts catastrophic epidemic scenarios in the country if the government did not impose strict travel and social distancing restrictions. A key finding is that, if the percentage of undocumented infection exceeds a threshold, a non-negligible hidden population can exist even after the the epidemic has been deemed over, implying the likelihood of future outbreaks should the currently imposed strict government actions be relaxed. This could make COVID-19 evolving into a long-term epidemic or a community disease a real possibility, suggesting the necessity to conduct universal testing and monitoring to identify the hidden individuals.", "Excess mortality during COVID-19 in five European countries and a critique of mortality analysis data INTRODUCTION The COVID-19 pandemic is an ongoing event disrupting lives, health systems, and economies worldwide. Clear data about the pandemic's impact is lacking, namely regarding mortality. This work aims to study the impact of COVID-19 through the analysis of all-cause mortality data made available by different European countries, and to critique their mortality surveillance data. METHODS European countries that had publicly available data about the number of deaths per day/week were selected (England and Wales, France, Italy, Netherlands and Portugal). Two different methods were selected to estimate the excess mortality due to COVID19: (DEV) deviation from the expected value from homologue periods, and (RSTS) remainder after seasonal time series decomposition. We estimate total, age- and gender-specific excess mortality. Furthermore, we compare different policy responses to COVID-19. RESULTS Excess mortality was found in all 5 countries, ranging from 10.6% in Portugal (DEV) to 98.5% in Italy (DEV). Furthermore, excess mortality is higher than COVID-attributed deaths in all 5 countries. DISCUSSION The impact of COVID-19 on mortality appears to be larger than officially attributed deaths, in varying degrees in different countries. Comparisons between countries would be useful, but large disparities in mortality surveillance data could not be overcome. Unreliable data, and even a lack of cause-specific mortality data undermine the understanding of the impact of policy choices on both direct and indirect deaths during COVID-19. European countries should invest more on mortality surveillance systems to improve the publicly available data.", "COVID-19 pandemic, healthcare providers\u2019 contamination and death: an international view ", "Comparing the impact of various interventions to control the spread of COVID-19 in 12 countries ", "Unmasking the Actual COVID-19 Case Count This report presents a novel approach to estimate the number of COVID-19 cases, including undocumented infections, in the US, by combining CDC\u2019s influenza-like illness surveillance data with aggregated prescription data. We estimated that the cumulative number of COVID-19 cases in the US by April 4 was above 2.5 million.", "Covid-19 prevalence estimation by random sampling in the wider population - Optimal sample pooling under varying assumptions about true prevalence The number of confirmed Covid-19 cases in a population is used as a coarse measurement for the burden of disease. However, this number depends heavily on the sampling intensity and the various test criteria used in different jurisdictions. A wide range of sources indicate that a large fraction of cases go undetected. Estimates of the true prevalence of Covid-19 can be made by random sampling in the wider population. Here we use simulations to explore confidence intervals of prevalence estimates under different sampling intensities and degrees of sample pooling.", "Common Pitfalls in the Interpretation of COVID-19 Data and Statistics Policymakers, experts and the general public heavily rely on the data that are being reported in the context of the coronavirus pandemic. Daily data releases on confirmed COVID-19 cases and deaths provide information on the course of the pandemic.", "Breaking the back of COVID-19: Is Bangladesh doing enough testing? Following detection of the first 100 confirmed cases of COVID-19 in early April, Bangladesh stepped up its efforts to strengthen testing capacity in order to curb the spread of the disease across the country. This paper sheds light on the position of Bangladesh in relation to its South Asian neighbors India and Pakistan with respect to testing capacity and ability to detect cases with increased testing. It also analyzes recent data on case counts and testing numbers in Bangladesh, to provide an idea regarding the number of extra tests needed to detect a substantial number of cases within a short period of time. Findings indicate that compared to India and Pakistan, Bangladesh was able to detect more cases by increasing testing levels and expand its testing capacity by performing more per capita tests. In spite of these achievements, the rate of reported cases per 100 tests was consistently higher for Bangladesh compared to India, which suggests that in addition to increased testing, other factors, such as, effective enforcement of social distancing and efficient contact tracing are just as important in curbing the spread of the disease. The analysis reveals that current testing levels in Bangladesh are not adequate. Based on the findings, we recommend a 30-50% growth of the current test rate in the next few days so that by detecting and isolating more cases, Bangladesh could, in effect, contain the spread of new infections. The challenge, however, is to mobilize resources necessary to expand geographical coverage and improve testing quality while enforcing social distancing and performing efficient contact tracing.", "Methods to infer transmission risk factors in complex outbreak data Data collected during outbreaks are essential to better understand infectious disease transmission and design effective control strategies. But analysis of such data is challenging owing to the dependency between observations that is typically observed in an outbreak and to missing data. In this paper, we discuss strategies to tackle some of the ongoing challenges in the analysis of outbreak data. We present a relatively generic statistical model for the estimation of transmission risk factors, and discuss algorithms to estimate its parameters for different levels of missing data. We look at the problem of computational times for relatively large datasets and show how they can be reduced by appropriate use of discretization, sufficient statistics and some simple assumptions on the natural history of the disease. We also discuss approaches to integrate parametric model fitting and tree reconstruction methods in coherent statistical analyses. The methods are tested on both real and simulated datasets of large outbreaks in structured populations.", "Forecasting Transmission Dynamics of COVID-19 Epidemic in India under Various Containment Measures- A Time-Dependent State-Space SIR Approach Objectives Our primary objective is to predict the dynamics of COVID-19 epidemic in India while adjusting for the effects of various progressively implemented containment measures. Apart from forecasting the major turning points and parameters associated with the epidemic, we intend to provide an epidemiological assessment of the impact of these containment measures in India. Methods We propose a method based on time-series SIR model to estimate time-dependent modifiers for transmission rate of the infection. These modifiers are used in state-space SIR model to estimate reproduction number R0, expected total incidence, and to forecast the daily prevalence till the end of the epidemic. We consider four different scenarios, two based on current developments and two based on hypothetical situations for the purpose of comparison. Results Assuming gradual relaxation in lockdown post 17 May 2020, we expect the prevalence of infecteds to cross 9 million, with at least 1 million severe cases, around the end of October 2020. For the same case, estimates of R0 for the phases no-intervention, partial-lockdown and lockdown are 4.46 (7.1), 1.47 (2.33), and 0.817 (1.29) respectively, assuming 14-day (24-day) infectious period. Conclusions Estimated modifiers give consistent estimates of unadjusted R0 across different scenarios, demonstrating precision. Results corroborate the effectiveness of lockdown measures in substantially reducing R0. Also, predictions are highly sensitive towards estimate of infectious period.", "Optimization of group size in pool testing strategy for SARS\u2010CoV\u20102: A simple mathematical model Coronavirus disease (Covid\u201019) has reached unprecedented pandemic levels and is affecting almost every country in the world. Ramping up the testing capacity of a country supposes an essential public health response to this new outbreak. A pool testing strategy where multiple samples are tested in a single reverse transcriptase\u2010polymerase chain reaction (RT\u2010PCR) kit could potentially increase a country's testing capacity. The aim of this study is to propose a simple mathematical model to estimate the optimum number of pooled samples according to the relative prevalence of positive tests in a particular healthcare context, assuming that if a group tests negative, no further testing is done whereas if a group tests positive, all the subjects of the group are retested individually. The model predicts group sizes that range from 11 to 3 subjects. For a prevalence of 10% of positive tests, 40.6% of tests can be saved using testing groups of four subjects. For a 20% prevalence, 17.9% of tests can be saved using groups of three subjects. For higher prevalences, the strategy flattens and loses effectiveness. Pool testing individuals for severe acute respiratory syndrome coronavirus 2 is a valuable strategy that could considerably boost a country's testing capacity. However, further studies are needed to address how large these groups can be, without losing sensitivity on the RT\u2010PCR. The strategy best works in settings with a low prevalence of positive tests. It is best implemented in subgroups with low clinical suspicion. The model can be adapted to specific prevalences, generating a tailored to the context implementation of the pool testing strategy.", "Bayesian Network Analysis of Covid-19 data reveals higher Infection Prevalence Rates and lower Fatality Rates than widely reported Widely reported statistics on Covid-19 across the globe fail to take account of both the uncertainty of the data and possible explanations for this uncertainty. In this paper we use a Bayesian Network (BN) model to estimate the Covid-19 infection prevalence rate (IPR) and infection fatality rate (IFR) for different countries and regions, where relevant data are available. This combines multiple sources of data in a single model. The results show that Chelsea Mass. USA and Gangelt Germany have relatively higher infection prevalence rates (IPR) than Santa Clara USA, Kobe, Japan and England and Wales. In all cases the infection prevalence is significantly higher than what has been widely reported, with much higher community infection rates in all locations. For Santa Clara and Chelsea, both in the USA, the most likely IFR values are 0.3-0.4%. Kobe, Japan is very unusual in comparison with the others with values an order of magnitude less than the others at, 0.001%. The IFR for Spain is centred around 1%. England and Wales lie between Spain and the USA/German values with an IFR around 0.8%. There remains some uncertainty around these estimates but an IFR greater than 1% looks remote for all regions/countries. We use a Bayesian technique called \"virtual evidence\" to test the sensitivity of the IFR to two significant sources of uncertainty: survey quality and uncertainty about Covid-19 death counts. In response the adjusted estimates for IFR are most likely to be in the range 0.3%-0.5%.", "COVID-19 Antibody Seroprevalence in Santa Clara County, California Background Addressing COVID-19 is a pressing health and social concern. To date, many epidemic projections and policies addressing COVID-19 have been designed without seroprevalence data to inform epidemic parameters. We measured the seroprevalence of antibodies to SARS-CoV-2 in Santa Clara County. Methods On 4/3-4/4, 2020, we tested county residents for antibodies to SARS-CoV-2 using a lateral flow immunoassay. Participants were recruited using Facebook ads targeting a representative sample of the county by demographic and geographic characteristics. We report the prevalence of antibodies to SARS-CoV-2 in a sample of 3,330 people, adjusting for zip code, sex, and race/ethnicity. We also adjust for test performance characteristics using 3 different estimates: (i) the test manufacturer's data, (ii) a sample of 37 positive and 30 negative controls tested at Stanford, and (iii) a combination of both. Results The unadjusted prevalence of antibodies to SARS-CoV-2 in Santa Clara County was 1.5% (exact binomial 95CI 1.11-1.97%), and the population-weighted prevalence was 2.81% (95CI 2.24-3.37%). Under the three scenarios for test performance characteristics, the population prevalence of COVID-19 in Santa Clara ranged from 2.49% (95CI 1.80-3.17%) to 4.16% (2.58-5.70%). These prevalence estimates represent a range between 48,000 and 81,000 people infected in Santa Clara County by early April, 50-85-fold more than the number of confirmed cases. Conclusions The population prevalence of SARS-CoV-2 antibodies in Santa Clara County implies that the infection is much more widespread than indicated by the number of confirmed cases. Population prevalence estimates can now be used to calibrate epidemic and mortality projections.", "Comparison of two commercial molecular tests and a laboratory-developed modification of the CDC 2019-nCOV RT-PCR assay for the qualitative detection of SARS-CoV-2 from upper respiratory tract specimens We compared the ability of 2 commercial molecular amplification assays [RealTime SARS-CoV-2 on the m2000 (Abbott) and ID NOW COVID-19 (Abbott)] and a laboratory developed test [modified CDC 2019-nCoV RT-PCR assay with RNA extraction by eMag(R) (bioMeriux) and amplification on QuantStudio 6 or ABI 7500 Real-Time PCR System (Life Technologies)] to detect SARS-CoV-2 RNA in upper respiratory tract specimens. Discrepant results were adjudicated by medical record review. 200 nasopharyngeal swab specimens in viral transport medium were collected from symptomatic patients between March 27 and April 9, 2020. Results were concordant for 167 specimens (84.3% overall agreement), including 94 positive and 73 negative specimens. The RealTime SARS-CoV-2 assay on the m2000 yielded 33 additional positive results, 25 of which were also positive by the modified CDC assay but not by the ID NOW COVID-19 assay. In a follow-up evaluation, 97 patients for whom a dry nasal swab specimen yielded negative results by the ID NOW COVID-19 assay had a paired nasopharyngeal swab specimen collected in viral transport medium and tested by the RealTime SARS-CoV-2 assay; SARS-CoV-2 RNA was detected in 13 (13.4%) of these specimens. Medical record review deemed all discrepant results to be true positives. The ID NOW COVID-19 test was fastest (as soon as 5 minute for positive and 13 minute for negative result.) The RealTime SARS-CoV-2 assay on the m2000 detected more cases of COVID-19 infection than the modified CDC assay or the ID NOW COVID-19 test.", "Computed Tomography Features of Coronavirus Disease 2019 (COVID-19): A Review for Radiologists Coronavirus Disease 2019 (COVID-19) pneumonia has become a global pandemic. Although the rate of new infections in China has decreased, currently, 169 countries report confirmed cases, with many nations showing increasing numbers daily. Testing for COVID-19 infection is performed via reverse transcriptase polymerase chain reaction, but availability is limited in many parts of the world. The role of chest computed tomography is yet to be determined and may vary depending on the local prevalence of disease and availability of laboratory testing. A common but nonspecific pattern of disease with a somewhat predictable progression is seen in patients with COVID-19. Specifically, patchy ground-glass opacities in the periphery of the lower lungs may be present initially, eventually undergoing coalescence, consolidation, and organization, and ultimately showing features of fibrosis. In this article, we review the computed tomography features of COVID-19 infection. Familiarity with these findings and their evolution will help radiologists recognize potential COVID-19 and recognize the significant overlap with other causes of acute lung injury.", "Trends and prediction in daily incidence and deaths of COVID-19 in the United States: a search-interest based model BACKGROUND AND OBJECTIVES: The coronavirus disease 2019 (COVID-19) infected more than 586,000 patients in the U.S. However, its daily incidence and deaths in the U.S. are poorly understood. Internet search interest was found correlated with COVID-19 daily incidence in China, but not yet applied to the U.S. Therefore, we examined the association of internet search-interest with COVID-19 daily incidence and deaths in the U.S. METHODS: We extracted the COVDI-19 daily incidence and death data in the U.S. from two population-based datasets. The search interest of COVID-19 related terms was obtained using Google Trends. Pearson correlation test and general linear model were used to examine correlations and predict future trends, respectively. RESULTS: There were 555,245 new cases and 22,019 deaths of COVID-19 reported in the U.S. from March 1 to April 12, 2020. The search interest of COVID, \u201cCOVID pneumonia,\u201d and \u201cCOVID heart\u201d were correlated with COVDI-19 daily incidence with ~12-day of delay (Pearson\u2019s r=0.978, 0.978 and 0.979, respectively) and deaths with 19-day of delay (Pearson\u2019s r=0.963, 0.958 and 0.970, respectively). The COVID-19 daily incidence and deaths appeared to both peak on April 10. The 4-day follow-up with prospectively collected data showed moderate to good accuracies for predicting new cases (Pearson\u2019s r=\u22120.641 to \u22120.833) and poor to good accuracies for daily new deaths (Pearson\u2019s r=0.365 to 0.935). CONCLUSIONS: Search terms related to COVID-19 are highly correlated with the trends in COVID-19 daily incidence and deaths in the U.S. The prediction-models based on the search interest trend reached moderate to good accuracies."], "neg": ["Massive and rapid COVID-19 testing is feasible by extraction-free SARS-CoV-2 RT-qPCR Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The most widely used method of COVID-19 diagnostics is a reverse transcription quantitative polymerase chain reaction (RT-qPCR) assay, detecting the presence of SARS-CoV-2 RNA in patient samples, typically from nasopharyngeal swabs. The RNA extraction is a major bottleneck in current COVID-19 testing, in terms of turn-around, logistics, component availability and cost, which delays or completely precludes COVID-19 diagnostics in many settings. Efforts to simplify the current methods are important, as increased diagnostic availability and efficiency is expected to benefit patient care and infection control. Here, we describe methods to circumvent RNA extraction in COVID-19 testing by performing RT-qPCR directly on heat-inactivated subject samples as well as samples lysed with readily available detergents. Our data, including cross-comparisons with clinically diagnosed patient samples, suggest that direct RT-qPCR is a viable option to extraction-based COVID-19 diagnostics. We argue that significant savings in terms of time and cost can be achieved by embracing RNA-extraction-free protocols, that feeds directly into the established PCR-based testing pipeline. This could aid the expansion of COVID-19 testing.", "A simulation of a COVID-19 epidemic based on a deterministic SEIR model An epidemic disease caused by a new coronavirus has spread in Northern Italy with a strong contagion rate. We implement an SEIR model to compute the infected population and number of casualties of this epidemic. The example may ideally regard the situation in the Italian Region of Lombardy, where the epidemic started on February 25, but by no means attempts to perform a rigorous case study in view of the lack of suitable data and uncertainty of the different parameters, namely, the variation of the degree of home isolation and social distancing as a function of time, the number of initially exposed individuals and infected people, the incubation and infection periods and the fatality rate. First, we perform an analysis of the results of the model, by varying the parameters and initial conditions (in order the epidemic to start, there should be at least one exposed or one infected human). Then, we consider the Lombardy case and calibrate the model with the number of dead individuals to date (April 19, 2020) and constraint the parameters on the basis of values reported in the literature. The peak occurs at day 37 (April 1) approximately, when there is a rapid decrease, with a reproduction ratio R0 = 3 initially, 1.38 at day 22 and 0.64 after day 35, indicating different degrees of lockdown. The predicted death toll is almost 14000 casualties, with 2.4 million infected individuals at the end of the epidemic. The incubation period providing a better fit of the dead individuals is 4.25 days and the infection period is 4 days, with a fatality rate of 0.00144/day [values based on the reported (official) number of casualties]. The infection fatality rate (IFR) is 0.57 %, and 2.36 % if twice the reported number of casualties is assumed. However, these rates depend on the initially exposed individuals. If approximately nine times more individuals are exposed, there are three times more infected people at the end of the epidemic and IFR = 0.47 %. If we relax these constraints and use a wider range of lower and upper bounds for the incubation and infection periods, we observe that a higher incubation period (13 versus 4.25 days) gives the same IFR (0.6 versus 0.57 %), but nine times more exposed individuals in the first case. Therefore, a precise determination of the fatality rate is subject to the knowledge of the characteristics of the epidemic. We plan to perform again these calculations and publish a short note when the epidemic is over and the complete and precise data is available. Besides the specific example, the analysis proposed in this work shows how isolation measures, social distancing and knowledge of the diffusion conditions help us to understand the dynamics of the epidemic. Hence, the importance to quantify the process to verify the effectiveness of the isolation.", "Excess registered deaths in England and Wales during the COVID-19 pandemic, March 2020 to May 2020 Official counts of COVID-19 deaths have been criticized for potentially including people who did not die of COVID-19 but merely died with COVID-19. I address that critique by fitting a generalized additive model to weekly counts of all deaths registered in England and Wales during the 2010s. The model produces baseline rates of death registrations expected without the COVID-19 pandemic, and comparing those baselines to recent counts of registered deaths exposes the emergence of excess deaths late in March 2020. By April's end, England and Wales registered 45,300 $\\pm$ 3200 excess deaths of adults aged 45+. Through 22 May, the last day of available all-deaths data, 56,600 $\\pm$ 4400 were registered (about 53% of which were of men). Both the ONS's corresponding count of 43,205 death certificates which mention COVID-19, and the Department of Health and Social Care's count of 33,671 deaths, are appreciably less, implying that their counting methods have underestimated, not overestimated, the pandemic's true death toll. If underreporting rates have held steady during May, about 59,000 direct and indirect COVID-19 deaths might have been registered through the end of May but not yet publicly reported in full.", "Perspectives on the death investigation during the COVID-19 pandemic Abstract The pandemic of COVID-19 caused by 2019-nCoV outbreaks in most of the countries, which has subsequently spread rapidly and become a pandemic worldwide. Due to the strong infectivity of COVID-19 and lack of experience of performing an autopsy to infectious disease-induced death, the pandemic created some challenges for forensic practitioners. In this article, we summarize the experience of how we handle the confirmed or suspected infectious cases, and give some perspectives for the future.", "Innovative screening tests for COVID-19 in South Korea. Recently, the number of Corona Virus Disease 2019 (COVID-19) cases has increased remarkably in South Korea, so the triage clinics and emergency departments (ED) are expected to be overcrowded with patients with presumed infection. As of March 21st, there was a total of 8,799 confirmed cases of COVID-19 and 102 related deaths in South Korea that was one of the top countries with high incidence rates [1]. This sharp increase in infection is associated with 1) outbreaks in individual provinces, 2) deployment of rapid and aggressive screening tests, 3) dedicated healthcare staffs for virus screening tests, 4) quarantine inspection data transparency and accurate data reporting, and 5) public health lessons from previous Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) outbreaks. This commentary introduces innovative screening tests that are currently used in South Korea for COVID-19, e.g., Drive-Through and Walk-Through tests, and compare the advantages and disadvantages of both methods.", "The current state of COVID-19 in Australia: importation and spread Background: The rapid global spread of coronavirus disease (COVID-19) is unprecedented. The outbreak has quickly spread to more than 100 countries reporting over 100,000 confirmed cases. Australia reported its first case of COVID-19 on 25th January 2020 and has since implemented travel restrictions to stop further introduction of the virus. Methods: We analysed daily global COVID-19 data published by the World Health Organisation to investigate the spread of the virus thus far. To assess the current risk of COVID-19 importation and local spread in Australia we predict international passenger flows into Australia during 2020. Findings: Our analysis of global data shows that Australia can expect a similar growth rate of reported cases as observed in France and the United States. We identify travel patterns of Australian citizens/residents and foreign travellers that can inform the implementation of new and the alteration of existing travel restrictions related to COVID-19. Interpretation: Our findings identify the risk reduction potential of current travel bans, based on the proportion of returning travellers to Australia that are residents or visitors. The similarity of the exponential growth in the epidemic curve in Australia to other countries guides forecasts of COVID-19 growth in Australia, and opportunities for drawing lessons from other countries with more advanced outbreaks.", "A Novel Coronavirus from Patients with Pneumonia in China, 2019 In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)", "Associations between immune-suppressive and stimulating drugs and novel COVID-19\u2014a systematic review of current evidence BACKGROUND: Cancer and transplant patients with COVID-19 have a higher risk of developing severe and even fatal respiratory diseases, especially as they may be treated with immune-suppressive or immune-stimulating drugs. This review focuses on the effects of these drugs on host immunity against COVID-19. METHODS: Using Ovid MEDLINE, we reviewed current evidence for immune-suppressing or -stimulating drugs: cytotoxic chemotherapy, low-dose steroids, tumour necrosis factor\u03b1 (TNF\u03b1) blockers, interlukin-6 (IL-6) blockade, Janus kinase (JAK) inhibitors, IL-1 blockade, mycophenolate, tacrolimus, anti-CD20 and CTLA4-Ig. RESULTS: 89 studies were included. Cytotoxic chemotherapy has been shown to be a specific inhibitor for severe acute respiratory syndrome coronavirus in in vitro studies, but no specific studies exist as of yet for COVID-19. No conclusive evidence for or against the use of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of COVID-19 patients is available, nor is there evidence indicating that TNF\u03b1 blockade is harmful to patients in the context of COVID-19. COVID-19 has been observed to induce a pro-inflammatory cytokine generation and secretion of cytokines, such as IL-6, but there is no evidence of the beneficial impact of IL-6 inhibitors on the modulation of COVID-19. Although there are potential targets in the JAK-STAT pathway that can be manipulated in treatment for coronaviruses and it is evident that IL-1 is elevated in patients with a coronavirus, there is currently no evidence for a role of these drugs in treatment of COVID-19. CONCLUSION: The COVID-19 pandemic has led to challenging decision-making about treatment of critically unwell patients. Low-dose prednisolone and tacrolimus may have beneficial impacts on COVID-19. The mycophenolate mofetil picture is less clear, with conflicting data from pre-clinical studies. There is no definitive evidence that specific cytotoxic drugs, low-dose methotrexate for auto-immune disease, NSAIDs, JAK kinase inhibitors or anti-TNF\u03b1 agents are contraindicated. There is clear evidence that IL-6 peak levels are associated with severity of pulmonary complications."]}, {"query": "how does the coronavirus respond to changes in the weather", "pos": ["Association between climate variables and global transmission oF SARS-CoV-2 Abstract In this study, we aimed at analyzing the associations between transmission of and deaths caused by SARS-CoV-2 and meteorological variables, such as average temperature, minimum temperature, maximum temperature, and precipitation. Two outcome measures were considered, with the first aiming to study SARS-CoV-2 infections and the second aiming to study COVID-19 mortality. Daily data as well as data on SARS-CoV-2 infections and COVID-19 mortality obtained between December 1, 2019 and March 28, 2020 were collected from weather stations around the world. The country's population density and time of exposure to the disease were used as control variables. Finally, a month dummy variable was added. Daily data by country were analyzed using the panel data model. An increase in the average daily temperature by one degree Fahrenheit reduced the number of cases by approximately 6.4 cases/day. There was a negative correlation between the average temperature per country and the number of cases of SARS-CoV-2 infections. This association remained strong even with the incorporation of additional variables and controls (maximum temperature, average temperature, minimum temperature, and precipitation) and fixed country effects. There was a positive correlation between precipitation and SARS-CoV-2 transmission. Countries with higher rainfall measurements showed an increase in disease transmission. For each average inch/day, there was an increase of 56.01 cases/day. COVID-19 mortality showed no significant association with temperature.", "Effective transmission across the globe: the role of climate in COVID-19 mitigation strategies ", "Temperature Decreases Spread Parameters of the New Covid-19 Case Dynamics (1) Background: The virulence of coronavirus diseases due to viruses like SARS-CoV or MERS-CoV decreases in humid and hot weather. The putative temperature dependence of infectivity by the new coronavirus SARS-CoV-2 or covid-19 has a high predictive medical interest. (2) Methods: External temperature and new covid-19 cases in 21 countries and in the French administrative regions were collected from public data. Associations between epidemiological parameters of the new case dynamics and temperature were examined using an ARIMA model. (3) Results: We show that, in the first stages of the epidemic, the velocity of contagion decreases with country- or region-wise temperature. (4) Conclusions: Results indicate that high temperatures diminish initial contagion rates, but seasonal temperature effects at later stages of the epidemy remain questionable. Confinement policies and other eviction rules should account for climatological heterogeneities, in order to adapt the public health decisions to possible geographic or seasonal gradients.", "Effect of Environmental Conditions on SARS-CoV-2 Stability in Human Nasal Mucus and Sputum We found that environmental conditions affect the stability of severe acute respiratory syndrome coronavirus 2 in nasal mucus and sputum. The virus is more stable at low-temperature and low-humidity conditions, whereas warmer temperature and higher humidity shortened half-life. Although infectious virus was undetectable after 48 hours, viral RNA remained detectable for 7 days.", "Distribution of the SARS-CoV-2 Pandemic and Its Monthly Forecast Based on Seasonal Climate Patterns This paper investigates whether the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) pandemic could have been favored by specific weather conditions and other factors. It is found that the 2020 winter weather in the region of Wuhan (Hubei, Central China)-where the virus first broke out in December and spread widely from January to February 2020-was strikingly similar to that of the Northern Italian provinces of Milan, Brescia and Bergamo, where the pandemic broke out from February to March. The statistical analysis was extended to cover the United States of America, which overtook Italy and China as the country with the highest number of confirmed COronaVIrus Disease 19 (COVID-19) cases, and then to the entire world. The found correlation patterns suggest that the COVID-19 lethality significantly worsens (4 times on average) under weather temperatures between 4 &#8728; C and 12 &#8728; C and relative humidity between 60% and 80%. Possible co-factors such as median population age and air pollution were also investigated suggesting an important influence of the former but not of the latter, at least, on a synoptic scale. Based on these results, specific isotherm world maps were generated to locate, month by month, the world regions that share similar temperature ranges. From February to March, the 4-12 &#8728; C isotherm zone extended mostly from Central China toward Iran, Turkey, West-Mediterranean Europe (Italy, Spain and France) up to the United State of America, optimally coinciding with the geographic regions most affected by the pandemic from February to March. It is predicted that in the spring, as the weather gets warm, the pandemic will likely worsen in northern regions (United Kingdom, Germany, East Europe, Russia and North America) while the situation will likely improve in the southern regions (Italy and Spain). However, in autumn, the pandemic could come back and affect the same regions again. The Tropical Zone and the entire Southern Hemisphere, but in restricted colder southern regions, could avoid a strong pandemic because of the sufficiently warm weather during the entire year and because of the lower median age of their population. Google-Earth-Pro interactive-maps covering the entire world are provided as supplementary files.", "The Challenge of Using Epidemiological Case Count Data: The Example of Confirmed COVID-19 Cases and the Weather The publicly available data on COVID-19 cases provides an opportunity to better understand this new disease. However, strong attention needs to be paid to the limitations of the data to avoid making inaccurate conclusions. This article, which focuses on the relationship between the weather and COVID-19, raises the concern that the same factors influencing the spread of the disease might also affect the number of tests performed and who gets tested. For example, weather conditions impact the prevalence of respiratory diseases with symptoms similar to COVID-19, and this will likely influence the number of tests performed. This general limitation could severely undermine any similar analysis using existing COVID-19 data or similar epidemiological data, which could, therefore, mislead decision-makers on questions of great policy relevance.", "Temperature dependence of COVID-19 transmission The recent coronavirus pandemic follows in its early stages an almost exponential expansion, with the number of cases N reasonably well fit by N e\u03b1t, in many countries. We analyze the rate \u03b1 in different countries, choosing as a starting point in each country the first day with 30 cases and fitting for the following 12 days, capturing thus the early exponential growth in a rather homogeneous way. We look for a link between the rate \u03b1 and the average temperature T of each country, in the month of the epidemic growth. We analyze a {\\it base} set of 42 countries, which developed the epidemic at an earlier stage, an {\\it intermediate} set of 88 countries and an {\\it extended} set of 125 countries, which developed the epidemic more recently. Fitting with a linear behavior \u03b1(T), we find increasing evidence in the three datasets for a decreasing growth rate as a function of T, at $99.66\\%$C.L., $99.86\\%$C.L. and $99.99995 \\%$ C.L. ($p$-value $5 \\cdot 10^{-7}$, or 5$\\sigma$ detection) in the {\\it base}, {\\it intermediate} and {\\it extended} dataset, respectively. The doubling time is expected to increase by $40\\%\\sim 50\\%$, going from $5^\\circ$ C to $25^\\circ$ C. In the {\\it base} set, going beyond a linear model, a peak at about $(7.7\\pm 3.6)^\\circ C$ seems to be present in the data, but such evidence disappears for the larger datasets. Moreover we have analyzed the possible existence of a bias: poor countries, typically located in warm regions, might have less intense testing. By excluding countries below a given GDP per capita from the dataset, we find that this affects our conclusions only slightly and only for the {\\it extended} dataset. The significance always remains high, with a $p$-value of about $10^{-3}-10^{-4}$ or less. Our findings give hope that, for northern hemisphere countries, the growth rate should significantly decrease as a result of both warmer weather and lockdown policies. In general the propagation should be hopefully stopped by strong lockdown, testing and tracking policies, before the arrival of the next cold season.", "The complex associations of climate variability with seasonal influenza A and B virus transmission in subtropical Shanghai, China Abstract Most previous studies focused on the association between climate variables and seasonal influenza activity in tropical or temperate zones, little is known about the associations in different influenza types in subtropical China. The study aimed to explore the associations of multiple climate variables with influenza A (Flu-A) and B virus (Flu-B) transmissions in Shanghai, China. Weekly influenza virus and climate data (mean temperature (MeanT), diurnal temperature range (DTR), relative humidity (RH) and wind velocity (Wv)) were collected between June 2012 and December 2018. Generalized linear models (GLMs), distributed lag non-linear models (DLNMs) and regression tree models were developed to assess such associations. MeanT exerted the peaking risk of Flu-A at 1.4 \u00b0C (2-weeks\u2019 cumulative relative risk (RR): 14.88, 95% confidence interval (CI): 8.67\u201323.31) and 25.8 \u00b0C (RR: 12.21, 95%CI: 6.64\u201319.83), Flu-B had the peak at 1.4 \u00b0C (RR: 26.44, 95%CI: 11.52\u201351.86). The highest RR of Flu-A was 23.05 (95%CI: 5.12\u201388.45) at DTR of 15.8 \u00b0C, that of Flu-B was 38.25 (95%CI: 15.82\u201387.61) at 3.2 \u00b0C. RH of 51.5% had the highest RR of Flu-A (9.98, 95%CI: 4.03\u201326.28) and Flu-B (4.63, 95%CI: 1.95\u201311.27). Wv of 3.5 m/s exerted the peaking RR of Flu-A (7.48, 95%CI: 2.73\u201330.04) and Flu-B (7.87, 95%CI: 5.53\u201311.91). DTR \u2265 12 \u00b0C and MeanT <22 \u00b0C were the key drivers for Flu-A and Flu-B, separately. The study found complex non-linear relationships between climate variability and different influenza types in Shanghai. We suggest the careful use of meteorological variables in influenza prediction in subtropical regions, considering such complex associations, which may facilitate government and health authorities to better minimize the impacts of seasonal influenza.", "A close look at the biology of SARS-CoV-2, and the potential influence of weather conditions and seasons on COVID-19 case spread BACKGROUND: There is sufficient epidemiological and biological evidence of increased human susceptibility to viral pathogens such as Middle East respiratory syndrome coronavirus, respiratory syncytial virus, human metapneumovirus and influenza virus, in cold weather. The pattern of outbreak of the coronavirus disease 2019 (COVID-19) in China during the flu season is further proof that meteorological conditions may potentially influence the susceptibility of human populations to coronaviruses, a situation that may become increasingly evident as the current global pandemic of COVID-19 unfolds. MAIN BODY: A very rapid spread and high mortality rates have characterized the COVID-19 pandemic in countries north of the equator where air temperatures have been seasonally low. It is unclear if the currently high rates of COVID-19 infections in countries of the northern hemisphere will wane during the summer months, or if fewer people overall will become infected with COVID-19 in countries south of the equator where warmer weather conditions prevail through most of the year. However, apart from the influence of seasons, evidence based on the structural biology and biochemical properties of many enveloped viruses similar to the novel severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2 (aetiology of COVID-19), support the higher likelihood of the latter of the two outcomes. Other factors that may potentially impact the rate of virus spread include the effectiveness of infection control practices, individual and herd immunity, and emergency preparedness levels of countries. CONCLUSION: This report highlights the potential influence of weather conditions, seasons and non-climatological factors on the geographical spread of cases of COVID-19 across the globe.", "Will heat kill the coronavirus? We don't know if changing seasons will help stem the outbreak, says Michael Le Page", "Seasonality and uncertainty in COVID-19 growth rates The virus causing COVID-19 has spread rapidly worldwide and threatens millions of lives. It remains unknown if summer weather will reduce its continued spread, thereby alleviating strains on hospitals and providing time for vaccine development. Early insights from laboratory studies of related coronaviruses predicted that COVID-19 would decline at higher temperatures, humidity, and ultraviolet light. Using current, fine-scaled weather data and global reports of infection we developed a model that explained 36% of variation in early growth rates before intervention, with 17% based on weather or demography and 19% based on country-specific effects. We found that ultraviolet light was most strongly associated with lower COVID-19 growth rates. Projections suggest that, in the absence of intervention, COVID-19 will decrease temporarily during summer, rebound by autumn, and peak next winter. However, uncertainty remains high and the probability of a weekly doubling rate remained >20% throughout the summer in the absence of control. Consequently, aggressive policy interventions will likely be needed in spite of seasonal trends.", "Multivariate Analysis of Black Race and Environmental Temperature on COVID-19 In the US BACKGROUND: There has been much interest in environmental temperature and race as modulators of Coronavirus disease-19 (COVID-19) infection and mortality. However, in the United States race and temperature correlate with various other social determinants of health, comorbidities, and environmental influences that could be responsible for noted effects. This study investigates the independent effects of race and environmental temperature on COVID-19 incidence and mortality in United States counties. METHODS: Data on COVID-19 and risk factors in all United States counties was collected. 661 counties with at least 50 COVID-19 cases and 217 with at least 10 deaths were included in analyses. Upper and lower quartiles for cases/100,000 people and halves for deaths/100,000 people were compared with t-tests. Adjusted linear and logistic regression analyses were performed to evaluate the independent effects of race and environmental temperature. RESULTS: Multivariate regression analyses demonstrated Black race is a risk factor for increased COVID-19 cases (OR=1.22, 95% CI: 1.09-1.40, P=0.001) and deaths independent of comorbidities, poverty, access to health care, and other risk factors. Higher environmental temperature independently reduced caseload (OR=0.81, 95% CI: 0.71-0.91, P=0.0009), but not deaths. CONCLUSIONS: Higher environmental temperatures correlated with reduced COVID-19 cases, but this benefit does not yet appear in mortality models. Black race was an independent risk factor for increased COVID-19 cases and deaths. Thus, many proposed mechanisms through which Black race might increase risk for COVID-19, such as socioeconomic and healthcare-related predispositions, are inadequate in explaining the full magnitude of this health disparity.", "The effect of latitude and PM(2.5) on spreading of SARS-CoV-2 in tropical and temperate zone countries() The present work describes spreading of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) at the tropical and temperate zones which are explained based on insolation energy, Particulate Matter (PM(2.5)), latitude, temperature, humidity, Population Density (PD), Human Development Index (HDI) and Global Health Security Index (GHSI) parameters. In order to analyze the spreading of SARS-CoV-2 by statistical data based on the confirmed positive cases which are collected between December 31, 2019 to April 25, 2020. The present analysis reveals that the outbreak of SARS-CoV-2 in the major countries lie on the Equator is 78,509 cases, the countries lie on the Tropic of Cancer is 62,930 cases (excluding China) and the countries lie on the Tropic of Capricorn is 22,842 cases. The tropical countries, which comes between the Tropic of Cancer and Tropic of Capricorn is reported to be 1,77,877 cases. The temperate zone countries, which are above and below the tropical countries are reported to be 25, 66,171 cases so, the pandemic analysis describes the correlation between latitude, temperate zones, PM(2.5) and local environmental factors. Hence, the temperature plays a pivotal role in the spreading of coronavirus at below 20 \u00b0C. The spreading of SARS-CoV-2 cases in Northern and Southern Hemispheres has inverse order against absorption of insolated energy. In temperate zone countries, the concentration of PM(2.5) at below 20 \u03bcg/m(3) has higher spreading rate of SARS-CoV-2 cases. The effect of insolation energy and PM(2.5), it is confirmed that the spreading of SARS-CoV-2 is explained by dumb-bell model and solid/liquid interface formation mechanism. The present meta-analysis also focuses on the impact of GHSI, HDI, PD and PM(2.5) on spreading of SARS-CoV-2 cases.", "The effect of ambient temperature on worldwide COVID-19 cases and deaths - an epidemiological study Background The role of ambient temperature in the spread of SARS-CoV-2 infections and subsequent deaths due to COVID-19 remains contentious. Coronaviruses such as the 2003 SARS-CoV showed an increased risk of transmission during cooler days. We sought to analyse the effects of ambient temperature on SARS-COV-2 transmission and deaths related to the virus. Methods The world population of COVID-19 cases and attributable deaths from the 23rd January 2020 to 11th April 2020 were analysed. Temperature 5 days before cases and 23 days prior to deaths (to account for the time lag of incubation period and time from symptoms to death) was compared to the average temperature experienced by the world population. Results The total number of cases during this period was 1,605,788 and total number of deaths was 103,471. The median temperature at the time of COVID-19 infection was 9.12C (10-90th percentile 4.29-17.97C) whilst the median temperature of the world population for the same period was 9.61C warmer at 18.73C (10-90th percentile 4.09-28.49C) with a notional p-value = 5.1 x10-11. The median temperature at the time of a COVID-19 death was 9.72C (10-90th percentile 5.39-14.11C) whilst the median temperature of the world population was 7.55C warmer at 17.27C (10-90th percentile 2.57C-27.76C) with a notional p-value = 1.1 x10-10. 80% of all COVID-19 related cases and deaths occurred between 4.29C and 17.97C. Conclusion A definitive association between infection rate and death from COVID-19 and ambient temperature exists, with the highest risk occurring around 9C. Governments should maintain vigilance with containment strategies when the ambient temperatures correspond to this highest risk.", "Temperature significantly changes COVID-19 transmission in (sub)tropical cities of Brazil Abstract The coronavirus disease 2019 (COVID-19) outbreak has become a severe public health issue. The novelty of the virus prompts a search for understanding of how ecological factors affect the transmission and survival of the virus. Several studies have robustly identified a relationship between temperature and the number of cases. However, there is no specific study for a tropical climate such as Brazil. This work aims to determine the relationship of temperature to COVID-19 infection for the state capital cities of Brazil. Cumulative data with the daily number of confirmed cases was collected from February 27 to April 1, 2020, for all 27 state capital cities of Brazil affected by COVID-19. A generalized additive model (GAM) was applied to explore the linear and nonlinear relationship between annual average temperature compensation and confirmed cases. Also, a polynomial linear regression model was proposed to represent the behavior of the growth curve of COVID-19 in the capital cities of Brazil. The GAM dose-response curve suggested a negative linear relationship between temperatures and daily cumulative confirmed cases of COVID-19 in the range from 16.8 \u00b0C to 27.4 \u00b0C. Each 1 \u00b0C rise of temperature was associated with a \u22124.8951% (t = \u22122.29, p = 0.0226) decrease in the number of daily cumulative confirmed cases of COVID-19. A sensitivity analysis assessed the robustness of the results of the model. The predicted R-squared of the polynomial linear regression model was 0.81053. In this study, which features the tropical temperatures of Brazil, the variation in annual average temperatures ranged from 16.8 \u00b0C to 27.4 \u00b0C. Results indicated that temperatures had a negative linear relationship with the number of confirmed cases. The curve flattened at a threshold of 25.8 \u00b0C. There is no evidence supporting that the curve declined for temperatures above 25.8 \u00b0C. The study had the goal of supporting governance for healthcare policymakers.", "Investigation of effective climatology parameters on COVID-19 outbreak in Iran SARS CoV-2 (COVID-19) Coronavirus cases are confirmed throughout the world and millions of people are being put into quarantine. A better understanding of the effective parameters in infection spreading can bring about a logical measurement toward COVID-19. The effect of climatic factors on spreading of COVID-19 can play an important role in the new Coronavirus outbreak. In this study, the main parameters, including the number of infected people with COVID-19, population density, intra-provincial movement, and infection days to end of the study period, average temperature, average precipitation, humidity, wind speed, and average solar radiation investigated to understand how can these parameters effects on COVID-19 spreading in Iran? The Partial correlation coefficient (PCC) and Sobol'-Jansen methods are used for analyzing the effect and correlation of variables with the COVID-19 spreading rate. The result of sensitivity analysis shows that the population density, intra-provincial movement have a direct relationship with the infection outbreak. Conversely, areas with low values of wind speed, humidity, and solar radiation exposure to a high rate of infection that support the virus's survival. The provinces such as Tehran, Mazandaran, Alborz, Gilan, and Qom are more susceptible to infection because of high population density, intra-provincial movements and high humidity rate in comparison with Southern provinces.", "Seasonality of respiratory viruses and bacterial pathogens BACKGROUND: Seasonal variation has been observed for various bacterial and viral infections. We aimed to further study seasonality of respiratory viruses and bacterial pathogens in relation to antibiotic use, as well as meteorological parameters. METHODS: An ecologic study of antibiotic exposure, meteorological parameters, detection of respiratory viruses and clinical isolates of Clostridioides difficile, Methicillin-resistant Staphylococcus aureus (MRSA), Streptococcus pneumoniae, and Escherichia coli and Klebsiella pneumoniae (grouped together as gram-negative bacteria; GNB) in Rhode Island from 2012 to 2016. RESULTS: Peak detection of C. difficile occurred 3 months after the peak in antibiotic prescriptions filled (OR = 1.24, 95% CI, 1.07\u20131.43; P = 0.006). Peak MRSA detection was noted 7 months after the peak in antibiotic prescriptions filled (OR = 1.69, 95% CI, 1.21\u20132.35; P = 0.003) and 10 months after the peak in respiratory virus detection (OR = 1.04, 95% CI, 1.01\u20131.06; P = 0.003). Peak GNB detection was noted 2 months after the peak mean monthly ambient temperature (OR = 1.69, 95% C.I., 1.20\u20132.39; P = 0.004). Peak detection of S. pneumoniae was noted at the same time as the peak in detection of respiratory viruses (OR = 1.01, 95% C.I., 1.00\u20131.01; P = 0.015). CONCLUSIONS: We identified distinct seasonal variation in detection of respiratory viruses and bacterial pathogens. C. difficile seasonality may, in part, be related to antibiotic prescriptions filled; GNB seasonality may be related to ambient temperature and S. pneumoniae may be related to concurrent respiratory viral infections. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13756-019-0574-7) contains supplementary material, which is available to authorized users.", "Association of COVID-19 pandemic with meteorological parameters over Singapore Abstract Meteorological parameters are the critical factors affecting the transmission of infectious diseases such as Middle East Respiratory Syndrome (MERS), Severe Acute Respiratory Syndrome (SARS), and influenza. Consequently, infectious disease incidence rates are likely to be influenced by the weather change. This study investigates the role of Singapore's hot tropical weather in COVID-19 transmission by exploring the association between meteorological parameters and the COVID-19 pandemic cases in Singapore. This study uses the secondary data of COVID-19 daily cases from the webpage of Ministry of Health (MOH), Singapore. Spearman and Kendall rank correlation tests were used to investigate the correlation between COVID-19 and meteorological parameters. Temperature, dew point, relative humidity, absolute humidity, and water vapor showed positive significant correlation with COVID-19 pandemic. These results will help the epidemiologists to understand the behavior of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus against meteorological variables. This study finding would be also a useful supplement to help the local healthcare policymakers, Center for Disease Control (CDC), and the World Health Organization (WHO) in the process of strategy making to combat COVID-19 in Singapore.", "Can the summer temperature drop COVID-19 cases? Abstract Objective In spite of huge global, national and local preventive measures including travel restriction, social distancing and quarantines, outbreak of novel coronavirus SARS-CoV-2 develops COVID-19 worldwide pandemic. SARS-CoV-2 emerging from Wuhan, China took only three months to cover > 200 countries worldwide by infecting more than 2.4 million people and killing more than 150000 people. Though, this infection at the early stage creates seasonal flu-like symptoms with a higher illness, it eventually causes a higher mortality. Epidemiological studies not only find the causes of many health issues, but also suggest preventive measures. This study aimed to see the link between environment temperature and COVID-19 cases. Study design The monthly average environment temperature (MAET) and various COVID-19 cases of a country were collected, and analyzed to see the relationship between these parameters. Methods Univariate analysis and statistical modeling were used to determine the relationship between environment temperature and different COVID-19 cases. Results This study found that the majorities of the countries having higher COVID-19 cases are located in the higher latitude (colder region) in the globe. As of 20th April data available, statistical analyses by various methods have found that strong negative correlations with statistical significance exist between MAET and several COVID-19 cases including total cases, active cases and cases per million of a country [Spearman correlation coefficients were -0.45, -0.42, and -0.50 for total cases, active cases and cases/per million, respectively]. Analysis by statistical log-linear regression model further supports that the chance of COVID-19 patients is fewer in warmer countries than in colder countries. Conclusion This pilot study proposes that cold environment may be an additional risk factor for COVID-19 cases.", "The association between the seasonality of pediatric pandemic influenza virus outbreak and ambient meteorological factors in Shanghai BACKGROUND AND OBJECTIVES: The number of pediatric patients diagnosed with influenza types A and B is increasing annually, especially in temperate regions such as Shanghai (China). The onset of pandemic influenza viruses might be attributed to various ambient meteorological factors including temperature, relative humidity (Rh), and PM(1) concentrations, etc. The study aims to explore the correlation between the seasonality of pandemic influenza and these factors. METHODS: We recruited pediatric patients aged from 0 to 18 years who were diagnosed with influenza A or B from July 1st, 2017 to June 30th, 2019 in Shanghai Children\u2019s Medical Centre (SCMC). Ambient meteorological data were collected from the Shanghai Meteorological Service (SMS) over the same period. The correlation of influenza outbreak and meteorological factors were analyzed through preliminary Pearson\u2019s r correlation test and subsequent time-series Poisson regression analysis using the distributed lag non-linear model (DLNM). RESULTS: Pearson\u2019s r test showed a statistically significant correlation between the weekly number of influenza A outpatients and ambient meteorological factors including weekly mean, maximum, minimum temperature and barometric pressure (P < 0.001), and PM(1) (P < 0.01). While the weekly number of influenza B outpatients was statistically significantly correlated with weekly mean, maximum and minimum temperature (P < 0.001), barometric pressure and PM(1) (P < 0.01), and minimum Rh (P < 0.05). Mean temperature and PM(1) were demonstrated to be the statistically significant variables in the DLNM with influenza A and B outpatients through time-series Poisson regression analysis. A U-shaped curve relationship was noted between the mean temperature and influenza A cases (below 15 \u00b0C and above 20 \u00b0C), and the risks increased for influenza B with mean temperature below 10 \u00b0C. PM(1) posed a risk after a concentration of 23 ppm for both influenza A and B. High PM(1), low and the high temperature had significant effects upon the number of influenza A cases, whereas low temperature and high PM(1) had significant effects upon the number of influenza B cases. CONCLUSION: This study indicated that mean temperature and PM(1) were the primary factors that were continually associated with the seasonality of pediatric pandemic influenza A and B and the recurrence in the transmission and spread of influenza viruses.", "Coronavirus pandemic versus temperature in the context of Indian subcontinent: a preliminary statistical analysis The novel coronavirus (COVID-19) has unleashed havoc across different countries and was declared a pandemic by the World Health Organization. Since certain evidences indicate a direct relationship of various viruses with the weather (temperature in particular), the same is being speculated about COVID-19; however, it is still under investigation as the pandemic is advancing the world over. In this study, we tried to analyze the spread of COVID-19 in the Indian subcontinent with respect to the local temperature regimes from March 9, 2020, to May 27, 2020. To establish the relation between COVID-19 and temperature in India, three different ecogeographical regions having significant temperature differences were taken into consideration for the analysis. We observed that except Maharashtra, Rajasthan and Kashmir showed a significantly positive correlation between the number of COVID-19 cases and the temperature during the period of study. The evidences based on the results presented in this research lead us to believe that the increasing temperature is beneficial to the COVID-19 spread, and the cases are going to rise further with the increasing temperature over India. We, therefore, conclude that the existing data, though limited, suggest that the spread of COVID-19 in India is not explained by the variation of temperature alone and is most likely driven by a host of other factors related to epidemiology, socioeconomics and other climatic factors. Based on the results, it is suggested that temperature should not be considered as a yardstick for planning intervention strategies for controlling the COVID-19 pandemic.", "Seasonality of Respiratory Viral Infections The seasonal cycle of respiratory viral diseases has been widely recognized for thousands of years, as annual epidemics of the common cold and influenza disease hit the human population like clockwork in the winter season in temperate regions. Moreover, epidemics caused by viruses such as severe acute respiratory syndrome coronavirus (SARS-CoV) and the newly emerging SARS-CoV-2 occur during the winter months. The mechanisms underlying the seasonal nature of respiratory viral infections have been examined and debated for many years. The two major contributing factors are the changes in environmental parameters and human behavior. Studies have revealed the effect of temperature and humidity on respiratory virus stability and transmission rates. More recent research highlights the importance of the environmental factors, especially temperature and humidity, in modulating host intrinsic, innate, and adaptive immune responses to viral infections in the respiratory tract. Here we review evidence of how outdoor and indoor climates are linked to the seasonality of viral respiratory infections. We further discuss determinants of host response in the seasonality of respiratory viruses by highlighting recent studies in the field. Expected final online publication date for the Annual Review of Virology, Volume 7 is September 29, 2020. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.", "Effect of weather on COVID-19 spread in the US: A prediction model for India in 2020 Abstract The effect of weather on COVID-19 spread is poorly understood. Recently, few studies have claimed that warm weather can possibly slowdown the global pandemic, which has already affected over 1.6 million people worldwide. Clarification of such relationships in the worst affected country, the US, can be immensely beneficial to understand the role of weather in transmission of the disease in the highly populated countries, such as India. We collected the daily data of new cases in 50 US states between Jan 1\u2013Apr 9, 2020 and also the corresponding weather information (i.e., temperature (T) and absolute humidity (AH)). Distribution modeling of new cases across AH and T, helped identify the narrow and vulnerable AH range. We validated the results for 10-day intervals against monthly observations, and also worldwide trends. The results were used to predict Indian regions which would be vulnerable to weather based spread in upcoming months of 2020. COVID-19 spread in the US is significant for states with 4 < AH < 6 g/m3 and number of new cases > 10,000, irrespective of the chosen time intervals for study parameters. These trends are consistent with worldwide observations, but do not correlate well with India so far possibly due the total cases reported per interval < 10,000. The results clarify the relationship between weather parameters and COVID-19 spread. The vulnerable weather parameters will help classify the risky geographic areas in different countries. Specifically, with further reporting of new cases in India, prediction of states with high risk of weather based spread will be apparent.", "Seasonality of Respiratory Viral Infections. The seasonal cycle of respiratory viral diseases has been widely recognized for thousands of years, as annual epidemics of the common cold and influenza disease hit the human population like clockwork in the winter season in temperate regions. Moreover, epidemics caused by viruses such as severe acute respiratory syndrome coronavirus (SARS-CoV) and the newly emerging SARS-CoV-2 occur during the winter months. The mechanisms underlying the seasonal nature of respiratory viral infections have been examined and debated for many years. The two major contributing factors are the changes in environmental parameters and human behavior. Studies have revealed the effect of temperature and humidity on respiratory virus stability and transmission rates. More recent research highlights the importance of the environmental factors, especially temperature and humidity, in modulating host intrinsic, innate, and adaptive immune responses to viral infections in the respiratory tract. Here we review evidence of how outdoor and indoor climates are linked to the seasonality of viral respiratory infections. We further discuss determinants of host response in the seasonality of respiratory viruses by highlighting recent studies in the field. Expected final online publication date for the Annual Review of Virology, Volume 7 is September 29, 2020. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.", "COVID-19 transmission in Mainland China is associated with temperature and humidity: a time-series analysis COVID-19 has become a pandemic. The influence of meteorological factors on the transmission and spread of COVID-19 if of interest. This study sought to examine the associations of daily average temperature (AT) and relative humidity (ARH) with the daily count of COVID-19 cases in 30 Chinese provinces (in Hubei from December 1, 2019 to February 11, 2020 and in other provinces from January 20, 2020 to Februarys 11, 2020). A Generalized Additive Model (GAM) was fitted to quantify the province-specific associations between meteorological variables and the daily cases of COVID-19 during the study periods. In the model, the 14-day exponential moving averages (EMAs) of AT and ARH, and their interaction were included with time trend and health-seeking behavior adjusted. Their spatial distributions were visualized. AT and ARH showed significantly negative associations with COVID-19 with a significant interaction between them (0.04, 95% confidence interval: 0.004-0.07) in Hubei. Every 1\u00b0C increase in the AT led to a decrease in the daily confirmed cases by 36% to 57% when ARH was in the range from 67% to 85.5%. Every 1% increase in ARH led to a decrease in the daily confirmed cases by 11% to 22% when AT was in the range from 5.04\u00b0C to 8.2\u00b0C. However, these associations were not consistent throughout Mainland China.", "The sensitivity and specificity analyses of ambient temperature and population size on the transmission rate of the novel coronavirus (COVID-19) in different provinces of Iran On 10 April 2020, Iran reported 68,192 COVID-19 cumulative cases including 4232 death and 35,465 recovery cases. Numerous factors could influence the transmission rate and survival of coronavirus. On this basis and according to the latest epidemiological researches, both ambient temperature (AT) and population size (PS) can be considered as significant transmissibility factors for coronavirus. The analysis of receiver operating characteristics (ROC) allows measuring the performance of a classification model using the confusion matrix. This study intends to investigate the sensitivity of AT and PS on the transmission rate of the novel coronavirus in different provinces of Iran. For this purpose, the information of each province of Iran including the annual average of AT and the number of healthy and diseased cases are categorized. Subsequently, the sensitivity and specificity analyses of both AT and PS factors are performed. The obtained results confirm that AT and PS have low sensibility and high sensitivity, respectively. Thus, there is no scientific reason to confirm that the number of COVID-19 cases in warmer climates is less than that of moderate or cold climates. Therefore, it is recommended that the cities/provinces with a population of over 1.7 million people have stricter inspections and more precise controls as their management policy.", "Increasing Temperature and Relative Humidity Accelerates Inactivation of SARS-CoV-2 on Surfaces Coronavirus disease 2019 (COVID-19) was first identified in China in late 2019 and is caused by newly identified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Previous studies had reported the stability of SARS-CoV-2 in cell culture media and deposited onto surfaces under a limited set of environmental conditions. Here, we broadly investigated the effects of relative humidity, temperature, and droplet size on the stability of SARS-CoV-2 in a simulated clinically relevant matrix dried on nonporous surfaces. The results show that SARS-CoV-2 decayed more rapidly when either humidity or temperature was increased but that droplet volume (1 to 50 \u03bcl) and surface type (stainless steel, plastic, or nitrile glove) did not significantly impact decay rate. At room temperature (24\u00b0C), virus half-life ranged from 6.3 to 18.6 h depending on the relative humidity but was reduced to 1.0 to 8.9 h when the temperature was increased to 35\u00b0C. These findings suggest that a potential for fomite transmission may persist for hours to days in indoor environments and have implications for assessment of the risk posed by surface contamination in indoor environments. IMPORTANCE Mitigating the transmission of SARS-CoV-2 in clinical settings and public spaces is critically important to reduce the number of COVID-19 cases while effective vaccines and therapeutics are under development. SARS-CoV-2 transmission is thought to primarily occur through direct person-to-person transfer of infectious respiratory droplets or through aerosol-generating medical procedures. However, contact with contaminated surfaces may also play a significant role. In this context, understanding the factors contributing to SARS-CoV-2 persistence on surfaces will enable a more accurate estimation of the risk of contact transmission and inform mitigation strategies. To this end, we have developed a simple mathematical model that can be used to estimate virus decay on nonporous surfaces under a range of conditions and which may be utilized operationally to identify indoor environments in which the virus is most persistent.", "Investigation of effective climatology parameters on COVID-19 outbreak in Iran Abstract SARS CoV-2 (COVID-19) Coronavirus cases are confirmed throughout the world and millions of people are being put into quarantine. A better understanding of the effective parameters in infection spreading can bring about a logical measurement toward COVID-19. The effect of climatic factors on spreading of COVID-19 can play an important role in the new Coronavirus outbreak. In this study, the main parameters, including the number of infected people with COVID-19, population density, intra-provincial movement, and infection days to end of the study period, average temperature, average precipitation, humidity, wind speed, and average solar radiation investigated to understand how can these parameters effects on COVID-19 spreading in Iran? The Partial correlation coefficient (PCC) and Sobol\u2019-Jansen methods are used for analyzing the effect and correlation of variables with the COVID-19 spreading rate. The result of sensitivity analysis shows that the population density, intra-provincial movement have a direct relationship with the infection outbreak. Conversely, areas with low values of wind speed, humidity, and solar radiation exposure to a high rate of infection that support the virus's survival. The provinces such as Tehran, Mazandaran, Alborz, Gilan, and Qom are more susceptible to infection because of high population density, intra-provincial movements and high humidity rate in comparison with Southern provinces.", "Will COVID-19 pandemic diminish by summer-monsoon in India? Lesson from the first lockdown The novel Coronavirus (2019-nCoV) was identified in Wuhan, Hubei Province, China, in December 2019 and has created a medical emergency worldwide. It has spread rapidly to multiple countries and has been declared a pandemic by the World Health Organization. In India, it is already reported more than 18 thousand cases and more than 600 deaths due to Coronavirus disease 2019 (COVID-19) till April 20, 2020. Previous studies on various viral infections like influenza have supported an epidemiological hypothesis that the cold and dry (low absolute humidity) environments favor the survival and spread of droplet-mediated viral diseases. These viral transmissions found attenuated in warm and humid (high absolute humidity) environments. However, the role of temperature, humidity, and absolute humidity in the transmission of COVID-19 has not yet been well established. Therefore the study to investigate the meteorological condition for incidence and spread of COVID-19 infection, to predict the epidemiology of the infectious disease, and to provide a scientific basis for prevention and control measures against the new disease is required for India. In this work, we analyze the local weather patterns of the Indian region affected by the COVID-19 virus for March and April months, 2020. We have investigated the effect of meteorological parameters like Temperature, relative humidity, and absolute humidity on the rate of spread of COVID-19 using daily confirm cases in India. We have used daily averaged meteorological data for the last three years (2017-2019) for March and April month and the same for the year 2020 for March 1 to April 15. We found a positive association (Pearsons r=0.56) between temperature and daily COVID-19 cases over India. We found a negative association of humidity (RH and AH) with daily COVID-19 Cases (Persons r=-0.62, -0.37). We have also investigated the role of aerosol in spreading the pandemic across India because its possible airborne nature. For this, we have investigated the association of aerosols (AOD) and other pollutions (NO2) with COVID-19 cases during the study period and also during the first lockdown period (25 March-15 April) in India. We found a negative association in March when there were few cases, but in April, it shows positive association when the number of cases is more (for AOD it was r=-0.41 and r=0.28 respectively). During the lockdown period, aerosols (AOD) and other pollutants (NO2; an indicator of PM2.5) reduced sharply with a percentage drop of about 36 and 37, respectively. This reduction may have reduced the risk for COVID-19 through air transmission due to the unavailability of aerosol particles as a base. HYSPLIT forward trajectory model also shows that surface aerosols may travel up to 4 km according to wind and direction within three h of its generation. If coronavirus becomes airborne as suggested by many studies, then it may have a higher risk of transmission by aerosols particles. So relaxing in the lockdown and environmental rules in terms of pollutant emissions from power plants, factories, and other facilities would be a wrong choice and could result in more COVID-19 incidences and deaths in India. Therefore the current study, although limited, suggests that it is doubtful that the spread of COVID-19 would slow down in India due to meteorological factors, like high temperature and high humidity. Because a large number of cases have already been reported in the range of high Tem, high Relative, and high absolute humidity regions of India. Thus our results in no way suggest that COVID-19 would not spread in warm, humid regions or during summer/monsoon. So effective public health interventions should be implemented across India to slow down the transmission of COVID-19. If COVID-19 is indeed sensitive to environmental factors, it could be tested in the coming summer-monsoon for India. So the only summer is not going to help India until monsoon is coming. Only government mitigations strategies would be helpful, whether its lockdown, aggressive and strategic testing, medical facilities, imposing social distancing, encouraging to use face mask or monitoring by a mobile application (Aarogya Setu).", "An environmental determinant of viral respiratory disease The evident seasonality of influenza suggests a significant role for weather and climate as one of several determinants of viral respiratory disease (VRD), including social determinants which play a major role in shaping these phenomena. Based on the current mechanistic understanding of how VRDs are transmitted by small droplets, we identify an environmental variable, Air Drying Capacity (ADC), as an atmospheric state-variable with significant and direct relevance to the transmission of VRD. ADC dictates the evolution and fate of droplets under given temperature and humidity conditions. The definition of this variable is rooted in the Maxwell theory of droplet evolution via coupled heat and mass transfer between droplets and the surrounding environment. We present the climatology of ADC, and compare its observed distribution in space and time to the observed prevalence of influenza and COVID-19 from extensive global data sets. Globally, large ADC values appear to significantly constrain the observed transmission and spread of VRD, consistent with the significant coherency of the observed seasonal cycles of ADC and influenza. Our results introduce a new environmental determinant, rooted in the mechanism of VRD transmission, with potential implications for explaining seasonality of influenza, and for describing how environmental conditions may impact to some degree the evolution of similar VRDs, such as COVID-19.", "Distribution of the SARS-CoV-2 Pandemic and Its Monthly Forecast Based on Seasonal Climate Patterns This paper investigates whether the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) pandemic could have been favored by specific weather conditions and other factors. It is found that the 2020 winter weather in the region of Wuhan (Hubei, Central China)\u2014where the virus first broke out in December and spread widely from January to February 2020\u2014was strikingly similar to that of the Northern Italian provinces of Milan, Brescia and Bergamo, where the pandemic broke out from February to March. The statistical analysis was extended to cover the United States of America, which overtook Italy and China as the country with the highest number of confirmed COronaVIrus Disease 19 (COVID-19) cases, and then to the entire world. The found correlation patterns suggest that the COVID-19 lethality significantly worsens (4 times on average) under weather temperatures between 4 \u00b0C and 12 \u00b0C and relative humidity between 60% and 80%. Possible co-factors such as median population age and air pollution were also investigated suggesting an important influence of the former but not of the latter, at least, on a synoptic scale. Based on these results, specific isotherm world maps were generated to locate, month by month, the world regions that share similar temperature ranges. From February to March, the 4\u201312 \u00b0C isotherm zone extended mostly from Central China toward Iran, Turkey, West-Mediterranean Europe (Italy, Spain and France) up to the United State of America, optimally coinciding with the geographic regions most affected by the pandemic from February to March. It is predicted that in the spring, as the weather gets warm, the pandemic will likely worsen in northern regions (United Kingdom, Germany, East Europe, Russia and North America) while the situation will likely improve in the southern regions (Italy and Spain). However, in autumn, the pandemic could come back and affect the same regions again. The Tropical Zone and the entire Southern Hemisphere, but in restricted colder southern regions, could avoid a strong pandemic because of the sufficiently warm weather during the entire year and because of the lower median age of their population. Google-Earth-Pro interactive-maps covering the entire world are provided as supplementary files.", "Statistical analysis of the impact of environmental temperature on the exponential growth rate of cases infected by COVID-19 We perform a statistical analysis for understanding the effect of the environmental temperature on the exponential growth rate of the cases infected by COVID-19 for US and Italian regions. In particular, we analyze the datasets of regional infected cases, derive the growth rates for regions characterized by a readable exponential growth phase in their evolution spread curve and plot them against the environmental temperatures averaged within the same regions, derive the relationship between temperature and growth rate, and evaluate its statistical confidence. The results clearly support the first reported statistically significant relationship of negative correlation between the average environmental temperature and exponential growth rates of the infected cases. The critical temperature, which eliminates the exponential growth, and thus the COVID-19 spread in US regions, is estimated to be TC = 86.1 \u00b1 4.3 F0.", "Is temperature reducing the transmission of COVID-19 ? ", "A relationship between acute respiratory illnesses and weather. Weekly data from 7 years (2004-2010) of primary-care counts of acute respiratory illnesses (ARIs) and local weather readings were used to adjust a multivariate time-series vector error correction model with covariates (VECMX). Weather variables were included through a partial least squares index that consisted of weekly minimum temperature (coefficient = - 0\u00b726), weekly median of relative humidity (coefficient = 0\u00b722) and weekly accumulated rainfall (coefficient = 0\u00b75). The VECMX long-term test reported significance for trend (0\u00b701, P = 0\u00b700) and weather index (1\u00b769, P = 0\u00b700). Short-term relationship was influenced by seasonality. The model accounted for 76% of the variability in the series (adj. R 2 = 0\u00b776), and the co-integration diagnostics confirmed its appropriateness. The procedure is easily reproducible by researchers in all climates, can be used to identify relevant weather fluctuations affecting the incidence of ARIs, and could help clarify the influence of contact rates on the spread of these diseases.", "Temperature and precipitation associate with Covid-19 new daily cases: A correlation study between weather and Covid-19 pandemic in Oslo, Norway This study aims to analyze the correlation between weather and covid-19 pandemic in the capital city of Norway, Oslo. This study employed a secondary data analysis of covid-19 surveillance data from the Norwegian public health institute and weather data from the Norwegian Meteorological institute. The components of weather include minimum temperature (\u00b0C), maximum temperature (\u00b0C), temperature average (\u00b0C), normal temperature (\u00b0C), precipitation level (mm) and wind speed (m/s). Since normality was not fulfilled, a non-parametric correlation test was used for data analysis. Maximum temperature (r = 0.347; p = .005), normal temperature(r = 0.293; p = .019), and precipitation level (r = -0.285; p = .022) were significantly correlated with covid-19 pandemic. The finding might serve as an input to a strategy making in the prevention of covid-19 as the country prepare to enter into a new weather season.", "The role of climate during the COVID\u201019 epidemic in New South Wales, Australia Previous research has identified a relationship between climate and occurrence of SARS\u2010CoV and MERS\u2010CoV cases, information that can be used to reduce the risk of infection. Using COVID\u201019 notification and postcode data from New South Wales, Australia during the exponential phase of the epidemic in 2020, we used time series analysis to investigate the relationship between 749 cases of locally acquired COVID\u201019 and daily rainfall, 9 a.m. and 3 p.m. temperature, and 9 a.m. and 3 p.m. relative humidity. Lower 9 a.m. relative humidity (but not rainfall or temperature) was associated with increased case occurrence; a reduction in relative humidity of 1% was predicted to be associated with an increase of COVID\u201019 cases by 6.11%. During periods of low relative humidity, the public health system should anticipate an increased number of COVID\u201019 cases.", "Do Humidity and Temperature Impact the Spread of the Novel Coronavirus? ", "Potential impact of seasonal forcing on a SARS-CoV-2 pandemic A novel coronavirus (SARS-CoV-2) first detected in Wuhan, China, has spread rapidly since December 2019, causing more than 80,000 confirmed infections and 2,700 fatalities (as of Feb 27, 2020). Imported cases and transmission clusters of various sizes have been reported globally suggesting a pandemic is likely. Here, we explore how seasonal variation in transmissibility could modulate a SARS-CoV-2 pandemic. Data from routine diagnostics show a strong and consistent seasonal variation of the four endemic coronaviruses (229E, HKU1, NL63, OC43) and we parameterize our model for SARS-CoV-2 using these data. The model allows for many subpopulations of different size with variable parameters. Simulations of different scenarios show that plausible parameters result in a small peak in early 2020 in temperate regions of the Northern Hemisphere and a larger peak in winter 2020/2021. Variation in transmission and migration rates can result in substantial variation in prevalence between regions. While the uncertainty in parameters is large, the scenarios we explore show that transient reductions in the incidence rate might be due to a combination of seasonal variation and infection control efforts but do not necessarily mean the epidemic is contained. Seasonal forcing on SARS-CoV-2 should thus be taken into account in the further monitoring of the global transmission. The likely aggregated effect of seasonal variation, infection control measures and transmission rate variation is a prolonged pandemic wave with lower prevalence at any given time, thereby providing a window of opportunity for better preparation of health care systems.", "The Benefits of Transmission Dynamics Models in Understanding Emerging Infectious Diseases Abstract Factors associated with the emergence and transmission of infectious diseases often do not follow the assumptions of traditional statistical models such as linearity and independence of outcomes. Transmission dynamics models are well suited to address infectious disease scenarios that do not conform to these assumptions. For example, these models easily account for changes in the incidence rates of infection as the proportions of susceptible and infectious persons change in the population. Fundamental concepts relating to these methods, such as the basic reproductive number, the effective reproductive number and the susceptible-infected-recovered compartmental models, are reviewed. In addition, comparisons and contrasts are made between the following concepts: microparasites and macroparasites, deterministic and stochastic models, difference and differential equations and homogeneous and heterogeneous mixing patterns. Finally, examples of how transmission dynamics models are being applied to factors associated with emerging infectious diseases, such as zoonotic origins, microbial adaption and change, human susceptibility and climate change, are reviewed.", "Roles of meteorological conditions in COVID-19 transmission on a worldwide scale The novel coronavirus (SARS-CoV-2/ 2019-nCoV) identified in Wuhan, China, in December 2019 has caused great damage to public health and economy worldwide with over 140,000 infected cases up to date. Previous research has suggested an involvement of meteorological conditions in the spread of droplet-mediated viral diseases, such as influenza. However, as for the recent novel coronavirus, few studies have discussed systematically about the role of daily weather in the epidemic transmission of the virus. Here, we examine the relationships of meteorological variables with the severity of the outbreak on a worldwide scale. The confirmed case counts, which indicates the severity of COVID-19 spread, and four meteorological variables, i.e., air temperature, relative humidity, wind speed, and visibility, were collected daily between January 20 and March 11 (52 days) for 430 cities and districts all over China, 21 cities/ provinces in Italy, 21 cities/ provinces in Japan, and 51 other countries around the world. Four different time delays of weather (on the day, 3 days ago, 7 days ago, and 14 days ago) as to the epidemic situation were taken for modeling and we finally chose the weather two weeks ago to model against the daily epidemic situation as its correlated with the outbreak best. Taken Chinese cities as a discovery dataset, it was suggested that temperature, wind speed, and relative humidity combined together could best predict the epidemic situation. The meteorological model could well predict the outbreak around the world with a high correlation (r2>0.6) with the real data. Using this model, we further predicted the possible epidemic situation in the future 12 days in several high-latitude cities with potential outbreak. This model could provide more information for government's future decisions on COVID-19 outbreak control.", "Asymmetric nexus between temperature and COVID-19 in the top ten affected provinces of China: A current application of quantile-on-quantile approach The present study examines the asymmetrical effect of temperature on COVID-19 (Coronavirus Disease) from 22 January 2020 to 31 March 2020 in the 10 most affected provinces in China. This study used the Sim & Zhou' quantile-on-quantile (QQ) approach to analyze how the temperature quantities affect the different quantiles of COVID-19. Daily COVID-19 and, temperature data collected from the official websites of the Chinese National Health Commission and Weather Underground Company (WUC) respectively. Empirical results have shown that the relationship between temperature and COVID-19 is mostly positive for Hubei, Hunan, and Anhui, while mostly negative for Zhejiang and Shandong provinces. The remaining five provinces Guangdong, Henan, Jiangxi, Jiangsu, and Heilongjiang are showing the mixed trends. These differences among the provinces can be explained by the differences in the number of COVID-19 cases, temperature, and the province's overall hospital facilitations. The study concludes that maintaining a safe and comfortable atmosphere for patients while COVID-19 is being treated may be rational.", "The Seasonal End of Human Coronavirus Hospital Admissions with Implications for SARS-CoV-2 The seasonality of influenza viruses and endemic human coronaviruses was tracked over an 8-year period to assess key epidemiologic reduction points in disease incidence for an urban area in the northeast United States. Patients admitted to a pediatric hospital with worsening respiratory symptoms were tested using a multiplex PCR assay from nasopharyngeal swabs. The additive seasonal effects of outdoor temperatures and indoor relative humidity (RH) were evaluated. The 8-year average peak activity of human coronaviruses occurred in the first week of January, when droplet and contact transmission was enabled by the low indoor RH of 20-30%. Previous studies have shown that an increase in RH to 50% has been associated with markedly reduced viability and transmission of influenza virus and animal coronaviruses. As disease incidence was reduced by 50% in early March, to 75% in early April, to greater than 99% at the end of April, a relationship was observed from colder temperatures in January with a low indoor RH to a gradual increase in outdoor temperatures in April with an indoor RH of 45-50%. As a lipid-bound, enveloped virus with similar size characteristics to endemic human coronaviruses, SARS-CoV-2 should be subject to the same dynamics of reduced viability and transmission with increased humidity. In addition to the major role of social distancing, the transition from lower to higher indoor RH with increasing outdoor temperatures could have an additive effect on the decrease in SARS-CoV-2 cases in May. Over the 8-year period of this study, human coronavirus activity was either zero or >99% reduction in the months of June through September, and the implication would be that SARS-Cov-2 may follow a similar pattern.", "Correlation between climate indicators and COVID-19 pandemic in New York, USA This study analyzed the association between COVID-19 and climate indicators in New York City, USA. We used secondary published data from New York city health services and National weather service, USA. The climate indicators included in the study are average temperature, minimum temperature, maximum temperature, rainfall, average humidity, wind speed, and air quality. Kendall and Spearman rank correlation tests were chosen for data analysis. We find that average temperature, minimum temperature, and air quality were significantly associated with the COVID-19 pandemic. The findings of this study will help World Health Organization and health regulators such as Center for Disease Control (CDC) to combat COVID-19 in New York and the rest of the world.", "Temperature and Humidity Do Not Influence Global COVID-19 Incidence as Inferred from Causal Models The relationship between meteorological factors such as temperature and humidity with COVID-19 incidence is still unclear after 6 months of the beginning of the pandemic. Some literature confirms the association of temperature with disease transmission while some oppose the same. This work intends to determine whether there is a causal association between temperature, humidity and Covid-19 cases. Three different causal models were used to capture stochastic, chaotic and symbolic natured time-series data and to provide a robust & unbiased analysis by constructing networks of causal relationships between the variables. Granger-Causality method, Transfer Entropy method & Convergent Cross-Mapping (CCM) was done on data from regions with different temperatures and cases greater than 50,000 as of 13th May 2020. From the Granger-Causality test we found that in only Canada, the United Kingdom, temperature and daily new infections are causally linked. The same results were obtained from Convergent Cross Mapping for India. Again using Granger-Causality test, we found that in Russia only, relative humidity is causally linked to daily new cases. Thus, a Generalized Additive Model with a smoothing spline function was fitted for these countries to understand the directionality. Using the combined results of the said models, we were able to conclude that there is no evidence of a causal association between temperature, humidity and Covid-19 cases.", "Statistical investigation of relationship between spread of coronavirus disease (COVID-19) and environmental factors based on study of four mostly affected places of China and five mostly affected places of Italy COVID-19 is a new type of coronavirus disease which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It originated in China in the month of December 2019 and quickly started to spread within the country. On 31st December 2019, it was first reported to country office of World Health Organization (WHO) in China. Since then, it has spread to most of the countries around the globe. However, there has been a recent rise in trend in believing that it would go away during summer days, which has not yet been properly investigated. In this paper, relationship of daily number of confirmed cases of COVID-19 with three environmental factors, viz. maximum relative humidity (RH_max), maximum temperature (T_max) and highest wind speed (WS_max), considering the incubation period, have been investigated statistically, for four of the most affected places of China, viz. Beijing, Chongqing, Shanghai, Wuhan and five of the most affected places of Italy, viz. Bergamo, Cremona, Lodi, Milano. It has been found that the relationship with maximum relative humidity and highest wind is mostly negligible, whereas relationship with maximum temperature is ranging between negligible to moderate.", "Development of an Assessment Method for Investigating the Impact of Climate and Urban Parameters in Confirmed Cases of COVID-19: A New Challenge in Sustainable Development Sustainable development has been a controversial global topic, and as a complex concept in recent years, it plays a key role in creating a favorable future for societies. Meanwhile, there are several problems in the process of implementing this approach, like epidemic diseases. Hence, in this study, the impact of climate and urban factors on confirmed cases of COVID-19 (a new type of coronavirus) with the trend and multivariate linear regression (MLR) has been investigated to propose a more accurate prediction model. For this propose, some important climate parameters, including daily average temperature, relative humidity, and wind speed, in addition to urban parameters such as population density, were considered, and their impacts on confirmed cases of COVID-19 were analyzed. The analysis was performed for three case studies in Italy, and the application of the proposed method has been investigated. The impacts of parameters have been considered with a delay time from one to nine days to find out the most suitable combination. The result of the analysis demonstrates the effectiveness of the proposed model and the impact of climate parameters on the trend of confirmed cases. The research hypothesis approved by the MLR model and the present assessment method could be applied by considering several variables that exhibit the exact delay of them to new confirmed cases of COVID-19.", "Evaluating the impact of the weather conditions on the influenza propagation BACKGROUND: Predicting the details of how an epidemic evolves is highly valuable as health institutions need to better plan towards limiting the infection propagation effects and optimizing their prediction and response capabilities. Simulation is a cost- and time-effective way of predicting the evolution of the infection as the joint influence of many different factors: interaction patterns, personal characteristics, travel patterns, meteorological conditions, previous vaccination, etc. The work presented in this paper extends EpiGraph, our influenza epidemic simulator, by introducing a meteorological model as a modular component that interacts with the rest of EpiGraph\u2019s modules to refine our previous simulation results. Our goal is to estimate the effects of changes in temperature and relative humidity on the patterns of epidemic influenza based on data provided by the Spanish Influenza Sentinel Surveillance System (SISSS) and the Spanish Meteorological Agency (AEMET). METHODS: Our meteorological model is based on the regression model developed by AB and JS, and it is tuned with influenza surveillance data obtained from SISSS. After pre-processing this data to clean it and reconstruct missing samples, we obtain new values for the reproduction number of each urban region in Spain, every 10 minutes during 2011. We simulate the propagation of the influenza by setting the date of the epidemic onset and the initial influenza-illness rates for each urban region. RESULTS: We show that the simulation results have the same propagation shape as the weekly influenza rates as recorded by SISSS. We perform experiments for a realistic scenario based on actual meteorological data from 2010-2011, and for synthetic values assumed under simplified predicted climate change conditions. Results show that a diminishing relative humidity of 10% produces an increment of about 1.6% in the final infection rate. The effect of temperature changes on the infection spread is also noticeable, with a decrease of 1.1% per extra degree.Conclusions: Using a tool like ours could help predict the shape of developing epidemics and its peaks, and would permit to quickly run scenarios to determine the evolution of the epidemic under different conditions. We make EpiGraph source code and epidemic data publicly available.", "Effects of meteorological conditions and air pollution on COVID-19 transmission: Evidence from 219 Chinese cities The spatial distribution of the COVID-19 infection in China cannot be explained solely by geographical distance and regulatory stringency. In this research we investigate how meteorological conditions and air pollution, as concurring factors, impact COVID-19 transmission, using data on new confirmed cases from 219 prefecture cities from January 24 to February 29, 2020. Results revealed a kind of nonlinear dose-response relationship between temperature and coronavirus transmission. We also found that air pollution indicators are positively correlated with new confirmed cases, and the coronavirus further spreads by 5-7% as the AQI increases by 10 units. Further analysis based on regional divisions revealed that in northern China the negative effects of rising temperature on COVID-19 is counteracted by aggravated air pollution. In the southern cities, the ambient temperature and air pollution have a negative interactive effect on COVID-19 transmission, implying that rising temperature restrains the facilitating effects of air pollution and that they jointly lead to a decrease in new confirmed cases. These results provide implications for the control and prevention of this disease and for the anticipation of another possible pandemic.", "On the global trends and spread of the COVID-19 outbreak: preliminary assessment of the potential relation between location-specific temperature and UV index The novel coronavirus, since its first outbreak in December, has, up till now, affected approximately 114,542 people across 115 countries. Many international agencies are devoting efforts to enhance the understanding of the evolving COVID-19 outbreak on an international level, its influences, and preparedness. At present, COVID-19 appears to affect individuals through person-to-person means, like other commonly found cold or influenza viruses. It is widely known and acknowledged that viruses causing influenza peak during cold temperatures and gradually subside in the warmer temperature, owing to their seasonality. Thus, COVID-19, due to its regular flu-like symptoms, is also expected to show similar seasonality and subside as the global temperatures rise in the northern hemisphere with the onset of spring. Despite these speculations, however, the systematic analysis in the global perspective of the relation between COVID-19 spread and meteorological parameters is unavailable. Here, by analyzing the region- and city-specific affected global data and corresponding meteorological parameters, we show that there is an optimum range of temperature and UV index strongly affecting the spread and survival of the virus, whereas precipitation, relative humidity, cloud cover, etc. have no effect on the virus. Unavailability of pharmaceutical interventions would require greater preparedness and alert for the effective control of COVID-19. Under these conditions, the information provided here could be very helpful for the global community struggling to fight this global crisis. It is, however, important to note that the information presented here clearly lacks any physiological evidences, which may merit further investigation. Thus, any attempt for management, implementation, and evaluation strategies responding to the crisis arising due to the COVID-19 outbreak must not consider the evaluation presented here as the foremost factor.", "Temperature and relative humidity are not major contributing factor on the occurrence of COVID-19 pandemic: An observational study in 57 countries The world searching for hope has already experienced a huge loss of lives due to COVID-19 caused by SARS-CoV-2 started in Wuhan, China. There are speculations that climatic conditions can slowdown the transmission of COVID-19.Findings from the early outbreak indicated the possible association of air temperature and relative humidity in COVID-19 occurrence in China. Current study focused on whether climatic conditions(temperature and relative humidity)are having any influence in the occurrence of COVID-19 when the outbreak has been classified as pandemic. To determine the effect of daily average temperature and average relative humidity on log-transformed total daily cases of COVID-19, polynomial regression as a quadratic term and linear regression were done. Linear regression analysis was also carried out to explore the same effect on selected countries. Present study observed no correlation between the climatic conditions (the daily average temperature and relative humidity) and the number of cases of COVID-19. Similar result was found in relation between daily average temperature and average number of cases per day in country-wise analysis. However, about 93.5% cases of COVID-19 occurred between 10C to 160C and the average number of cases per day was lower in high temperature country than low temperature country with exceptions. The minimum effect of summer temperature may not be effective to control the pandemic rather need to apply the control measures of COVID-19.", "Weather Conditions and COVID-19 Transmission: Estimates and Projections Background: Understanding and projecting the spread of COVID-19 requires reliable estimates of how weather components are associated with the transmission of the virus. Prior research on this topic has been inconclusive. Identifying key challenges to reliable estimation of weather impact on transmission we study this question using one of the largest assembled databases of COVID-19 infections and weather. Methods: We assemble a dataset that includes virus transmission and weather data across 3,739 locations from December 12, 2019 to April 22, 2020. Using simulation, we identify key challenges to reliable estimation of weather impacts on transmission, design a statistical method to overcome these challenges, and validate it in a blinded simulation study. Using this method and controlling for location-specific response trends we estimate how different weather variables are associated with the reproduction number for COVID-19. We then use the estimates to project the relative weather-related risk of COVID-19 transmission across the world and in large cities. Results: We show that the delay between exposure and detection of infection complicates the estimation of weather impact on COVID-19 transmission, potentially explaining significant variability in results to-date. Correcting for that distributed delay and offering conservative estimates, we find a negative relationship between temperatures above 25 degrees Celsius and estimated reproduction number ([R]), with each degree Celsius associated with a 3.1% (95% CI, 1.5% to 4.8%) reduction in [R]. Higher levels of relative humidity strengthen the negative effect of temperature above 25 degrees. Moreover, one millibar of additional pressure increases [R] by approximately 0.8 percent (95% CI, 0.6% to 1%) at the median pressure (1016 millibars) in our sample. We also find significant positive effects for wind speed, precipitation, and diurnal temperature on [R]. Sensitivity analysis and simulations show that results are robust to multiple assumptions. Despite conservative estimates, weather effects are associated with a 43% change in [R] between the 5th and 95th percentile of weather conditions in our sample. Conclusions: These results provide evidence for the relationship between several weather variables and the spread of COVID-19. However, the (conservatively) estimated relationships are not strong enough to seasonally control the epidemic in most locations.", "Evidence that high temperatures and intermediate relative humidity might favor the spread of COVID-19 in tropical climate: A case study for the most affected Brazilian cities This study aimed to analyze how meteorological conditions such as temperature, humidity and rainfall can affect the spread of COVID-19 in five Brazilian (S\u00e3o Paulo, Rio de Janeiro, Bras\u00edlia, Manaus and Fortaleza) cities. The cities selected were those with the largest number of confirmed cases considering data of April 13. Variables such as number of cumulative cases, new daily cases and contamination rate were employed for this study. Our results showed that higher mean temperatures and average relative humidity favored the COVID-19 transmission, differently from reports from coldest countries or periods of time under cool temperatures. Thus, considering the results obtained, intersectoral policies and actions are necessary, mainly in cities where the contamination rate is increasing rapidly. Thus, prevention and protection measures should be adopted in these cities aiming to reduce transmission and the possible collapse of the health system.", "Climate factors and incidence of Middle East respiratory syndrome coronavirus Abstract Background Our understanding of climate factors and their links to the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) outbreaks is incomplete. This study aimed to estimate the monthly incidence of MERS-CoV cases and to investigate their correlation to climate factors. Methods The study used aggregated monthly MERS-CoV cases that reported to the Saudi Center for Disease Prevention and Control from the Riyadh Region between November 1, 2012 and December 31, 2018. Data on the meteorological situation throughout the study period was calculated based on Google reports on the Riyadh Region (24.7136\u00b0N, 46.6753\u00b0E). The Poisson regression was used to estimate the incidence rate ratio (IRR) and its 95% confidence intervals (CI) for each climate factor. Results A total of 712 MERS-CoV cases were included in the analysis (mean age 54.2\u00b19.9 years), and more than half (404) (56.1%) MERS-CoV cases were diagnosed during a five-month period from April to August. The highest peak timing positioned in August 2015, followed by April 2014, June 2017, March 2015, and June 2016. High temperatures (IRR=1.054, 95% CI: 1.043\u20131.065) and a high ultraviolet index (IRR=1.401, 95% CI: 1.331\u20131.475) were correlated with a higher incidence of MERS-CoV cases. However, low relative humidity (IRR=0.956, 95% CI: 0.948\u20130.964) and low wind speed (IRR=0.945, 95% CI: 0.912\u20130.979) were correlated with a lower incidence of MERS-CoV cases. Conclusion The novel coronavirus, MERS-CoV, is influenced by climate conditions with increasing incidence between April and August. High temperature, high ultraviolet index, low wind speed, and low relative humidity are contributors to increased MERS-CoV cases. The climate factors must be evaluated in hospitals and community settings and integrated into guidelines to serve as source of control measures to prevent and eliminate the risk of infection.", "Weather: driving force behind the transmission of severe acute respiratory syndrome in China? Background: The association between weather and severe acute respiratory syndrome (SARS) transmission in Beijing and Hong Kong in the 2003 epidemic was studied to examine the effect of weather on SARS transmission. Methods: Pearson\u2019s correlation analyses and negative binomial regression analyses were used to quantify the correlations between the daily newly reported number of SARS cases and weather variables, using daily disease notification data and meteorological data from the two locations. Results: The results indicate that there were inverse association between the number of daily cases and maximum and/or minimum temperatures whereas air pressure was found to be positively associated with SARS transmission. Conclusion: The study suggests that weather might be a contributory factor in the 2003 SARS epidemic, in particular in the transmission among the community members.", "The effects of regional climatic condition on the spread of COVID-19 at global scale The pandemic outbreak of the novel coronavirus epidemic disease (COVID-19) is spreading like a diffusion-reaction in the world and almost 208 countries and territories are being affected around the globe. It became a sever health and socio-economic problem, while the world has no vaccine to combat this virus. This research aims to analyze the connection between the fast spread of COVID-19 and regional climate parameters over a global scale. In this research, we collected the data of COVID-19 cases from the time of 1st reported case to the 5th June 2020 in different affected countries and regional climatic parameters data from January 2020 to 5th June 2020. It was found that most of the countries located in the relatively lower temperature region show a rapid increase in the COVID-19 cases than the countries locating in the warmer climatic regions despite their better socio-economic conditions. A correlation between metrological parameters and COVID-19 cases was observed. Average daylight hours are correlated to total the COVID-19 cases with a coefficient of determination of 0.42, while average high-temperature shows a correlation of 0.59 and 0.42 with total COVID-19 cases and death cases respectively. The finding of the study will help international health organizations and local administrations to combat and well manage the spread of COVID-19.", "Maximum Daily Temperature, Precipitation, Ultra-Violet Light and Rates of Transmission of SARS-Cov-2 in the United States BACKGROUND: Previous reports have suggested that transmission of SARS-CoV-2 is reduced by higher temperatures and higher humidity. We analyzed case-data from the United States to investigate effects of temperature, precipitation, and UV Light on community transmission of SARS-CoV-2. METHODS: Daily reported cases of SARS-CoV-2 across the United States from 01/22/2020 to 04/03/2020 were analyzed. We used negative binomial regression modelling to investigate whether daily maximum temperature, precipitation, UV Index and the incidence 5 days later were related. We performed sensitivity analyses at 3 days, 7 days and 9 days to assess transmission lags. RESULTS: A maximum temperature greater than 52\u00b0F on a given day was associated with a lower rate of new cases at 5 days[IRR: 0.85(0.76,0.96)p=0.009]. Among observations with daily temperatures below 52\u00b0F, there was a significant inverse association between the maximum daily temperature and the rate of cases at 5 days [IRR 0.98(0.97,0.99)p=0.001]. The rate of new cases was predicted to be lower for theoretical states that maintained a stable maximum daily temperature above 52\u00b0F with a predicted 23-fewer cases per-million per-day by 25 days of the epidemic. A 1-unit higher UV index was associated with a lower rate at 5 days [IRR 0.97(0.95,0.99)p=0.004]. Precipitation was not associated with a greater rate of cases at 5 days [IRR 0.98(0.89,1.08)p=0.65]. CONCLUSION: The incidence of disease declines with increasing temperature up until 52\u00b0F and is lower at warmer versus cooler temperatures. However, the association between temperature and transmission is small and transmission is likely to remain high at warmer temperatures.", "Analyzing the Effect of Temperature on the Outspread of COVID-19 around the Globe The emergence of the pandemic around the world owing to COVID-19 is putting the world into a big threat. Many factors may be involved in the transmission of this deadly disease but not much-supporting data are available. Till now no proper evidences has been reported supporting that temperature changes can affect COVID-19 transmission. This work aims to correlate the effect of temperature with that of Total Cases, Recovery, Death, and Critical cases all around the globe. All the data were collected in April and the maximum and minimum temperature and the average temperature were collected from January to April (i.e the months during which the disease was spread). Regression was conducted to find a non-linear relationship between Temperate and the cases. It was evident that indeed temperature does have a significant effect on the total cases and recovery rate around the globe. It was also evident from the study that the countries with lower temperatures are the hotspots for COVID-19. The Study depicted a non-linear dose-response between temperature and the transmission, indicating the existence of the best temperature for its transmission. This study can indeed put some light on how temperature can be a significant factor in COVID-19 transmission.", "Analysis of meteorological conditions and prediction of epidemic trend of 2019-nCoV infection in 2020 Objective: To investigate the meteorological condition for incidence and spread of 2019-nCoV infection, to predict the epidemiology of the infectious disease, and to provide a scientific basis for prevention and control measures against the new disease. Methods: The meteorological factors during the outbreak period of the novel coronavirus pneumonia in Wuhan in 2019 were collected and analyzed, and were confirmed with those of Severe Acute Respiratory Syndrome (SARS) in China in 2003. Data of patients infected with 2019-nCoV and SARS coronavirus were collected from WHO website and other public sources. Results: This study found that the suitable temperature range for 2019-nCoV coronavirus survival is (13-24 degree Celsius), among which 19 degree Celsius lasting about 60 days is conducive to the spread between the vector and humans; the humidity range is 50%-80%, of which about 75% humidity is conducive to the survival of the coronavirus; the suitable precipitation range is below 30 mm/ month. Cold air and continuous low temperature over one week are helpful for the elimination of the virus. The prediction results show that with the approach of spring, the temperature in north China gradually rises, and the coronavirus spreads to middle and high latitudes along the temperature line of 13-18 degree Celsius. The population of new coronavirus infections is concentrated in Beijing, Tianjin, Hebei, Jiangsu, Zhejiang, Shanghai and other urban agglomerations. Starting from May 2020, the Beijing-Tianjin-Hebei urban agglomeration, the Central China Zhengzhou-Wuhan urban agglomeration, the eastern Jiangsu-Zhejiang-Shanghai urban agglomeration, and the southern Pearl River Delta urban agglomeration are all under a high temperature above 24 degree Celsius, which is not conducive to the survival and reproduction of coronaviruses, so the epidemic is expected to end. Conclusions: A wide range of continuous warm and dry weather is conducive to the survival of 2019-nCoV. The coming of spring, in addition to the original Wuhan-Zhengzhou urban agglomeration in central China, means that the prevention and control measures in big cities located in mid-latitude should be strengthened, especially the monitoring of transportation hubs. The Pearl River Delta urban agglomeration is a concentrated area of population in south China, with a faster temperature rise than those in mid-high latitudes, and thus the prevention in this area should be prioritized. From a global perspective, cities with a mean temperature below 24 degree Celsius are all high-risk cities for 2019-nCoV transmission before June.", "The correlation between the spread of COVID-19 infections and weather variables in 30 Chinese provinces and the impact of Chinese government mitigation plans. On February 1, 2020, China announced a novel coronavirus CoVID-19 outbreak to the public. CoVID-19 was classified as an epidemic by the World Health Organization (WHO). Although the disease was discovered and concentrated in Hubei Province, China, it was exported to all of the other Chinese provinces and spread globally. As of this writing, all plans have failed to contain the novel coronavirus disease, and it has continued to spread to the rest of the world. This study aimed to explore and interpret the effect of environmental and metrological variables on the spread of coronavirus disease in 30 provinces in China, as well as to investigate the impact of new China regulations and plans to mitigate further spread of infections. This article forecasts the size of the disease spreading based on time series forecasting. The growing size of CoVID-19 in China for the next 210 days is estimated by predicting the expected confirmed and recovered cases. The results revealed that weather conditions largely influence the spread of coronavirus in most of the Chinese provinces. This study has determined that increasing temperature and short-wave radiation would positively increase the number of confirmed cases, mortality rate, and recovered cases. The findings of this study agree with the results of our previous study.", "Effects of temperature variation and humidity on the death of COVID-19 in Wuhan, China Abstract Meteorological parameters are the important factors influencing the infectious diseases such as severe acute respiratory syndrome (SARS) and influenza. This study aims to explore the association between Corona Virus Disease 2019 (COVID-19) deaths and weather parameters. In this study, we collected the daily death numbers of COVID-19, meteorological parameters and air pollutant data from 20 January 2020 to 29 February 2020 in Wuhan, China. Generalized additive model was applied to explore the effect of temperature, humidity and diurnal temperature range on the daily death counts of COVID-19. There were 2299 COVID-19 death counts in Wuhan during the study period. A positive association with COVID-19 daily death counts was observed for diurnal temperature range (r = 0.44), but negative association for relative humidity (r = \u22120.32). In addition, one unit increase in diurnal temperature range was only associated with a 2.92% (95% CI: 0.61%, 5.28%) increase in COVID-19 deaths in lag 3. However, both 1 unit increase of temperature and absolute humidity were related to the decreased COVID-19 death in lag 3 and lag 5, with the greatest decrease both in lag 3 [\u22127.50% (95% CI: \u221210.99%, \u22123.88%) and \u221211.41% (95% CI: \u221219.68%, \u22122.29%)]. In summary, this study suggests the temperature variation and humidity may also be important factors affecting the COVID-19 mortality.", "Incidence of common respiratory viral infections related to climate factors in hospitalized children in Hong Kong. Hong Kong has a subtropical climate and an influenza seasonality lying approximately mid-way (March-June) between those of the Northern (November-March) and Southern (June-September) hemispheres. Respiratory syncytial virus (RSV) shares a similar seasonality to that of influenza in Hong Kong and is another important respiratory infection of childhood. Daily virus incidence data from public hospitals in Hong Kong's New Territory East Cluster, together with Hong Kong climate data were obtained for 2000-2007. Statistical time-series analysis using monthly time windows showed that influenza A and RSV incidence increased with higher environmental relative humidity, whereas influenza B incidence decreased with higher environmental temperatures. The other climate variables (including vapour pressure as a measure of absolute humidity) were not significantly related to the incidence of these respiratory viruses. Data from this study further reinforces the concept that the relationship between climate factors and respiratory virus incidence differ between subtropical/tropical and temperate countries.", "Quantifying socioeconomic activities and weather effects on the global spread of COVID-19 epidemic The COVID-19 has caused more than three million infections and over two hundred thousand deaths by April 20201. Limiting socioeconomic activities (SA) is among the most adopted governmental mitigating efforts to combat the transmission of the virus, though the degree varies dramatically among different regimes2. This study aims to quantify the contribution from the SA and weather conditions to the transmission of COVID-19 at global scale. Ruling out the unobservable factors including medical facilities and other control policies (MOC) through region-by-time fixed effects3,4, we show that the limiting SA has a leading contribution to lower the reproductive number by 18.3%, while weather conditions, including ultraviolet, relative humidity, and wind explain a smaller amount of variation. Temperature might have a non-monotonic impact on the transmission. We further show that in developed countries5 and China, the SA effect is more pronounced whereas the weather effect is significantly downplayed possibly because people tend to stay indoors most of the time with a controlled climate. We finally estimate the reduced reproductive number and the population spared from infections due to restricting SA at 40,964, 180,336, 174,494, in China, United States, and Europe respectively. From late January to mid-April, all regions, except for China, Australia, and south Korea show a steep upward trend of spared infections due to restricting SA. US and Europe, in particular, show far steeper upward trends of spared infections in the analyzed timeframe, signaling a greater risk of reopening the economy too soon.", "Potential Factors Influencing Repeated SARS Outbreaks in China Within last 17 years two widespread epidemics of severe acute respiratory syndrome (SARS) occurred in China, which were caused by related coronaviruses (CoVs): SARS-CoV and SARS-CoV-2. Although the origin(s) of these viruses are still unknown and their occurrences in nature are mysterious, some general patterns of their pathogenesis and epidemics are noticeable. Both viruses utilize the same receptor\u2014angiotensin-converting enzyme 2 (ACE2)\u2014for invading human bodies. Both epidemics occurred in cold dry winter seasons celebrated with major holidays, and started in regions where dietary consumption of wildlife is a fashion. Thus, if bats were the natural hosts of SARS-CoVs, cold temperature and low humidity in these times might provide conducive environmental conditions for prolonged viral survival in these regions concentrated with bats. The widespread existence of these bat-carried or -released viruses might have an easier time in breaking through human defenses when harsh winter makes human bodies more vulnerable. Once succeeding in making some initial human infections, spreading of the disease was made convenient with increased social gathering and holiday travel. These natural and social factors influenced the general progression and trajectory of the SARS epidemiology. However, some unique factors might also contribute to the origination of SARS in Wuhan. These factors are discussed in different scenarios in order to promote more research for achieving final validation.", "The most eagerly awaited summer of the Anthropocene: A perspective of SARS-CoV-2 decay and seasonal change Abstract To date, the world perhaps has never waited for the summer so impatiently in the entire Anthropocene, owing to the debate whether increasing temperature and humidity will decrease the environmental endurance of SARS-CoV-2. We present the perspective on the seasonal change on SARS-CoV-2 decay and COVID-19 spread. Our arguments are based on: i) structural similarity of coronavirus with several enteric viruses, and its vulnerability; ii) reports related to decay of those similar transmissible gastroenteritis viruses (TGEV) like norovirus and iii) improvement in the human immunity during summer with respect to winter. We present reasons why we can be optimistic about the slowdown of corona in the upcoming summer.", "Estimated Effects of Projected Climate Change on the Basic Reproductive Number of the Lyme Disease Vector Ixodes scapularis Background: The extent to which climate change may affect human health by increasing risk from vector-borne diseases has been under considerable debate. Objectives: We quantified potential effects of future climate change on the basic reproduction number (R(0)) of the tick vector of Lyme disease, Ixodes scapularis, and explored their importance for Lyme disease risk, and for vector-borne diseases in general. Methods: We applied observed temperature data for North America and projected temperatures using regional climate models to drive an I. scapularis population model to hindcast recent, and project future, effects of climate warming on R(0). Modeled R(0) increases were compared with R(0) ranges for pathogens and parasites associated with variations in key ecological and epidemiological factors (obtained by literature review) to assess their epidemiological importance. Results: R(0) for I. scapularis in North America increased during the years 1971\u20132010 in spatio-temporal patterns consistent with observations. Increased temperatures due to projected climate change increased R(0) by factors (2\u20135 times in Canada and 1.5\u20132 times in the United States), comparable to observed ranges of R(0) for pathogens and parasites due to variations in strains, geographic locations, epidemics, host and vector densities, and control efforts. Conclusions: Climate warming may have co-driven the emergence of Lyme disease in northeastern North America, and in the future may drive substantial disease spread into new geographic regions and increase tick-borne disease risk where climate is currently suitable. Our findings highlight the potential for climate change to have profound effects on vectors and vector-borne diseases, and the need to refocus efforts to understand these effects. Citation: Ogden NH, Radojevi\u0107 M, Wu X, Duvvuri VR, Leighton PA, Wu J. 2014. Estimated effects of projected climate change on the basic reproductive number of the Lyme disease vector Ixodes scapularis. Environ Health Perspect 122:631\u2013638; http://dx.doi.org/10.1289/ehp.1307799", "Containing the spread of coronavirus disease 2019 (COVID-19): Meteorological factors and control strategies Abstract The novel coronavirus disease 2019 (COVID-19) has spread globally and the meteorological factors vary greatly across the world. Understanding the effect of meteorological factors and control strategies on COVID-19 transmission is critical to contain the epidemic. Using individual-level data in mainland China, Hong Kong, and Singapore, and the number of confirmed cases in other regions, we explore the effect of temperature, relative humidity, and control measures on the spread of COVID-19. We find that high temperature mitigates the transmission of the disease. High relative humidity promotes COVID-19 transmission when temperature is low, but tends to reduce transmission when temperature is high. Implementing classical control measures can dramatically slow the spread of the disease. However, due to the occurrence of pre-symptomatic infections, the effect of the measures to shorten treatment time is markedly reduced and the importance of contact quarantine and social distancing increases.", "The higher temperature and ultraviolet, the lower COVID-19 prevalence \u2013 Meta-regression of data from large U.S. cities ", "A rate equation approach to model the denaturation or replication behavior of the SARS coronavirus As a newly emerging virus, little is known about the SARS coronavirus, whose outbreak has brought away several hundred people\u2019s lives over the world in the year of 2003 and is seriously imperiling the human health. Revealing the denaturation and replication mechanisms of SARS coronavirus has great importance for successfully fighting SARS. However, experiments related to SARS coronavirus are extremely dangerous and therefore restricted only to certain specific labs with high safety standard. Clearly, predicting the behaviors of SARS coronavirus in a wide variety of environmental conditions, which are not easily accessible, are thus critically necessary. In this study, we proposed to quantify the survival time of SARS coronavirus either in vitro or in vivo, through introducing thermal rate process models established from the well-known Arrhenius law. The complex physical and chemical behaviors of the SARS coronavirus can then be attributed to its activation energy, frequency factor, damage function as well as the surrounding environmental conditions. Based on the first data on stability and resistance of SARS coronavirus measured by members of WHO laboratory network, the rate coefficients involved in the above equations were estimated for the first time. Predictions on the survival time of SARS coronavirus in different temperature scale were then performed. It was found theoretically that, such survival time falls in an extremely wide range, say from several seconds in high temperature to an almost infinitely long time in a low temperature environment, which has already or is being supported by the currently available tests data. Applications of the present theory to interpret several existing phenomena were presented and their implementations in developing new technical ways for SARS prevention and clinical therapy were discussed. Uncertainties involved in the theoretical models were also analyzed and predicted. Parametric studies were performed to test the effects of the rate coefficients to the survival time of SARS coronavirus. Some important factors, which can significantly vary the denaturation or replication process of SARS coronavirus were pointed out. Through regulating the parameters involved in the equation, certain potential therapies either through drug delivery or engineering approach to treat the SARS disease can possibly be established. Extension of the present model for further studies was also suggested. This study opens a new theoretical way for probing into the complex behaviors of SARS coronavirus. Modellierung der Denaturierung oder Repliziryng von SARS-Korona-Viren Zusammenfassung Der Kenntnisstand \u00fcber die Eigenschaften des in 2003 neu aufgetretenen SARS Korona Virus, der einige Hundert Menschenleben gekostet hat, ist relativ gering. Die Ermittlung des Denaturierungs- und Replizierungsmechanismuses des SARS Virus ist f\u00fcr seine Bek\u00e4mpfung von hoher Bedeutung. Experimentelle Untersuchungen an diesem extrem gef\u00e4hrlichen Virus d\u00fcrfen nur durch Laboratorien mit einem hohen Sicherheitsstandard erfolgen. Die Vorhersage des Verhaltens des SARS Virus in unterschiedlichen Umgebungsbedingungen ist dabei erforderlich. In der vorliegenden Studie wird die \u00fcberlebensdauer des Virus unter Labor- und realen Bedingungen durch Anwendung der bekannten Arrhenius-Beziehung f\u00fcr temperaturabh\u00e4ngige Vorg\u00e4nge ermittelt. Das physikalische und chemische Verhalten des SARS Virus wird anhand der zugrundeliegenden Modell- Parameter beschrieben. Basierend auf den ersten Messungen von Mitgliedern des WHO-laboratory-network \u00fcber die Stabilit\u00e4t und Widerstandsf\u00e4higkeit des Virus wurden erstmalig die Geschwindigkeitskoeffizienten des Berechnungsmodells bestimmt. Vorhersagen der \u00dcberlebensdauer des SARS-Virus unter unterschiedlichen Temperaturbedingungen wurden ausgef\u00fchrt. Das sich hieraus ergebende, sehr unterschiedliche Ausma\u00df der \u00dcberlebensf\u00e4higkeit in Abh\u00e4ngigkeit der Umgebungstemperatur ist durch den Vergleich mit verf\u00fcgbaren experimentellen Ergebnissen best\u00e4tigt worden. Die Anwendung der vorgestellten Modellierung zur Interpretation realer Ph\u00e4nomene und zur Entwicklung technischer Ma\u00dfnahmen zur Vorbeugung und klinischen Therapierung von SARS wird diskutiert. Der Einflu\u00df von Unsicherheiten des Modells wird analysiert und abgesch\u00e4tzt. Parametrische Studien sind durchgef\u00fchrt worden, um den Einflu\u00df der Geschwindigkeitskoeffizienten auf die \u00dcberlebensdauer des SARS Virus darzustellen. Einige wichtige Einflu\u00dfgr\u00f6\u00dfen auf die Denaturierung und Replikationsf\u00e4higkeit des SARS Virus werden aufgezeigt. Durch eine Variation der Modellparameter kann die potentielle Wirksamkeit medikament\u00f6ser oder physikalischer Therapien abgesch\u00e4tzt werden. Erweiterungsm\u00f6glichkeiten des vorgestellten Modells werden vorgeschlagen. Die vorliegende Studie erm\u00f6glicht neue, theoretische Vorgehensweisen zur Untersuchung des komplexen Verhaltensmusters des SARS Virus.", "Enteric involvement of coronaviruses: is faecal\u2013oral transmission of SARS-CoV-2 possible? ", "Neural network based country wise risk prediction of COVID-19 The recent worldwide outbreak of the novel corona-virus (COVID-19) opened up new challenges to the research community. Artificial intelligence (AI) driven methods can be useful to predict the parameters, risks, and effects of such an epidemic. Such predictions can be helpful to control and prevent the spread of such diseases. The main challenges of applying AI is the small volume of data and the uncertain nature. Here, we propose a shallow Long short-term memory (LSTM) based neural network to predict the risk category of a country. We have used a Bayesian optimization framework to optimized and automatically design country-specific networks. We have combined the trend data and weather data together for the prediction. The results show that the proposed pipeline outperforms against state-of-the-art methods for 170 countries data and can be a useful tool for such risk categorization. The tool can be used to predict long-duration outbreak of such an epidemic such that we can take preventive steps earlier.", "Temperature, Humidity, and Latitude Analysis to Estimate Potential Spread and Seasonality of Coronavirus Disease 2019 (COVID-19) Importance: Coronavirus disease 2019 (COVID-19) infection has resulted in a global crisis. Investigating the potential association of climate and seasonality with the spread of this infection could aid in preventive and surveillance strategies. Objective: To examine the association of climate with the spread of COVID-19 infection. Design, Setting, and Participants: This cohort study examined climate data from 50 cities worldwide with and without substantial community spread of COVID-19. Eight cities with substantial spread of COVID-19 (Wuhan, China; Tokyo, Japan; Daegu, South Korea; Qom, Iran; Milan, Italy; Paris, France; Seattle, US; and Madrid, Spain) were compared with 42 cities that have not been affected or did not have substantial community spread. Data were collected from January to March 10, 2020. Main Outcomes and Measures: Substantial community transmission was defined as at least 10 reported deaths in a country as of March 10, 2020. Climate data (latitude, mean 2-m temperature, mean specific humidity, and mean relative humidity) were obtained from ERA-5 reanalysis. Results: The 8 cities with substantial community spread as of March 10, 2020, were located on a narrow band, roughly on the 30\u00b0 N to 50\u00b0 N corridor. They had consistently similar weather patterns, consisting of mean temperatures of between 5 and 11 \u00b0C, combined with low specific humidity (3-6 g/kg) and low absolute humidity (4-7 g/m3). There was a lack of substantial community establishment in expected locations based on proximity. For example, while Wuhan, China (30.8\u00b0 N) had 3136 deaths and 80\u00e2\u0080\u00af757 cases, Moscow, Russia (56.0\u00b0 N), had 0 deaths and 10 cases and Hanoi, Vietnam (21.2\u00b0 N), had 0 deaths and 31 cases. Conclusions and Relevance: In this study, the distribution of substantial community outbreaks of COVID-19 along restricted latitude, temperature, and humidity measurements was consistent with the behavior of a seasonal respiratory virus. Using weather modeling, it may be possible to estimate the regions most likely to be at a higher risk of substantial community spread of COVID-19 in the upcoming weeks, allowing for concentration of public health efforts on surveillance and containment.", "Changes in temperature alter susceptibility to a virus following a host shift Host shifts - where a pathogen jumps between different host species - are an important source of emerging infectious disease. With ongoing climate change there is an increasing need to understand the effect changes in temperature may have on emerging infectious disease. We investigated whether species\u2019 susceptibilities change with temperature and ask if susceptibility is greatest at different temperatures in different species. We infected 45 species of Drosophilidae with an RNA virus and measured how viral load changes with temperature. We found the host phylogeny explained a large proportion of the variation in viral load at each temperature, with strong phylogenetic correlations between viral loads across temperature. The variance in viral load increased with temperature, whilst the mean viral load did not, such that as temperature increased the most susceptible species become more susceptible, and the least susceptible less so. We found no significant relationship between a species\u2019 susceptibility across temperatures and proxies for thermal optima; critical thermal maximum and minimum or basal metabolic rate. These results suggest that whilst the rank order of species susceptibilities can remain the same with changes in temperature, the likelihood of host shifts into a given species may increase or decrease. Author Summary Emerging infectious diseases are often the result of a host shift, where a pathogen jumps from one host species into another. Understanding the factors underlying host shifts is a major goal for infectious disease researchers. This effort has been further complicated by the fact that host-parasite interactions are now taking place in a period of unprecedented global climatic warming. Here, we ask how host shifts are affected by temperature by carrying out experimental infections using an RNA virus across a wide range of related species, at three different temperatures. We find that as temperature increases the most susceptible species become more susceptible, and the least susceptible less so. This has important consequences for our understanding of host shift events in a changing climate, and suggests that temperature changes may affect the likelihood of a host shift into certain species.", "Meteorological Conditions and Covid-19 in Large U.S. Cities To determine whether prevalence of Coronavirus disease 2019 (Covid-19) is modulated by meteorological conditions, we herein conducted meta-regression of data in large U.S. cities. We selected 33 large U.S. cities with a population of >500,000. The integrated numbers of confirmed Covid-19 cases in the country to which the city belongs on 14 May 2020, the estimated population in 2019 in the country, and monthly meteorological conditions at the city for 4 months (from January to April 2020) were obtained. Meteorological conditions consisted of mean temperature (F), total precipitation (inch), mean wind speed (MPH), mean sky cover, and mean relative humidity (%). Monthly data for 4 months were averaged or integrated. The Covid-19 prevalence was defined as the integrated number of Covid-19 cases divided by the population. Random-effects meta-regression was performed by means of OpenMetaAnalyst. In a meta-regression graph, Covid-19 prevalence (plotted as the logarithm transformed prevalence on the y-axis) was depicted as a function of a given factor (plotted as a meteorological datum on the x-axis). A slope of the meta-regression line was significantly negative (coefficient, -0.069; P < 0.001) for the mean temperature and significantly positive for the mean wind speed (coefficient, 0.174; P = 0.027) and the sky cover (coefficient, 2.220; P = 0.023). In conclusion, lower temperature and higher wind speed/sky cover may be associated with higher Covid-19 prevalence, which should be confirmed by further epidemiological researches adjusting for various risk and protective factors (in addition to meteorological conditions) of Covid-19.", "Possible environmental effects on the spread of COVID-19 in China Abstract At the end of 2019, a novel coronavirus, designated as SARS-CoV-2, emerged in Wuhan, China and was identified as the causal pathogen of COVID-19. The epidemic scale of COVID-19 has increased dramatically, with confirmed cases increasing across China and globally. Understanding the potential affecting factors involved in COVID-19 transmission will be of great significance in containing the spread of the epidemic. Environmental and meteorological factors might impact the occurrence of COVID-19, as these have been linked to various diseases, including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), whose causative pathogens belong to the same virus family as SARS-CoV-2. We collected daily data of COVID-19 confirmed cases, air quality and meteorological variables of 33 locations in China for the outbreak period of 29 January 2020 to 15 February 2020. The association between air quality index (AQI) and confirmed cases was estimated through a Poisson regression model, and the effects of temperature and humidity on the AQI-confirmed cases association were analyzed. The results show that the effect of AQI on confirmed cases associated with an increase in each unit of AQI was statistically significant in several cities. The lag effect of AQI on the confirmed cases was statistically significant on lag day 1 (relative risk (RR) = 1.0009, 95% confidence interval (CI): 1.0004, 1.0013), day 2 (RR = 1.0007, 95% CI: 1.0003, 1.0012) and day 3 (RR = 1.0008, 95% CI: 1.0003, 1.0012). The AQI effect on the confirmed cases might be stronger in the temperature range of 10 \u00b0C \u2264 T < 20 \u00b0C than in other temperature ranges, while the RR of COVID-19 transmission associated with AQI was higher in the relative humidity (RH) range of 10% \u2264 RH < 20%. Results may suggest an enhanced impact of AQI on the COVID-19 spread under low RH.", "Spread of SARS-CoV-2 through Latin America and the Caribbean region: a look from its economic conditions, climate and air pollution indicators We have evaluated the spread of SARS-CoV-2 through Latin America and the Caribbean (LAC) region by means of a correlation between climate and air pollution indicators, namely, average temperature, minimum temperature, maximum temperature, rainfall, average relative humidity, wind speed, and air pollution indicators PM(10), PM(2.5), and NO(2) with the COVID-19 daily new cases and deaths. The study focuses in the following LAC cities: Mexico City (Mexico), Santo Domingo (Dominican Republic), San Juan (Puerto Rico), Bogot\u00e1 (Colombia), Guayaquil (Ecuador), Manaus (Brazil), Lima (Per\u00fa), Santiago (Chile), S\u00e3o Paulo (Brazil) and Buenos Aires (Argentina). The results show that average temperature, minimum temperature, and air quality were significantly associated with the spread of COVID-19 in LAC. Additionally, humidity, wind speed and rainfall showed a significant relationship with daily cases, total cases and mortality for various cities. Income inequality and poverty levels were also considered as a variable for qualitative analysis. Our findings suggest that and income inequality and poverty levels in the cities analyzed were related to the spread of COVID-19 positive and negative, respectively. These results might help decision-makers to design future strategies to tackle the spread of COVID-19 in LAC and around the world.", "Factors determining the diffusion of COVID-19 and suggested strategy to prevent future accelerated viral infectivity similar to COVID Abstract This study has two goals. The first is to explain the geo-environmental determinants of the accelerated diffusion of COVID-19 in Italy that is generating a high level of deaths. The second is to suggest a strategy to cope with future epidemic threats having accelerated viral infectivity in society. Using data on N = 55 Italian province capitals, and data of infected individuals at as of April 7th, 2020, results reveal that the accelerate and vast diffusion of COVID-19 in North Italy has a high association with air pollution of cities measured with days exceeding the limits set for PM10 (particulate matter 10 \u03bcm or less in diameter) or ozone in previous years. In particular, hinterland cities with average higher number of days exceeding the limits set for PM10 (and a low intensity of wind speed) have a very high number of infected people on 7th April 2020 (arithmetic mean about 2200 infected, with average polluted days greater than 80), than coastal cities also having days of exceeding the limits set for PM10 or ozone but with high intensity of wind speed (arithmetic mean about 944.70 infected individuals, with about 60 average polluted days); moreover, cities having more than 100 days of air pollution (exceeding the limits set for PM10), they have a very high average number of infected people (about 3350 infected individuals, 7th April 2020), whereas cities having less than 100 days of air pollution, they have a lower average number of infected individuals (about 1014). The findings here also suggest that to minimize the impact of future epidemics similar to COVID-19, the max number of days per year in which Italian provincial capitals can exceed the limits set for PM10 or for ozone, considering their meteorological conditions, is about 48 days. Moreover, results here reveal that the explanatory variable of air pollution in cities under study seems to be a more important predictor in the initial phase of diffusion (on 17th March 2020, b1 = 1.27, p < 0.001) than interpersonal contacts (b2 = 0.31, p < 0.05). In the second phase of maturity of the transmission dynamics of COVID-19, air pollution reduces intensity (on 7th April 2020 with b\u20321 = 0.81, p < 0.001) also because of indirect effect of lockdown, whereas coefficient of transmission by interpersonal contacts has stability (b\u20322 = 0.31, p < 0.01). This result reveals that accelerated transmissions dynamics of COVID-19 is due to mainly to the mechanism of \u201cair pollution-to-human transmission\u201d rather than \u201chuman-to-human transmission\u201d. Overall, then, transmission dynamics of viral infectivity, such as COVID-19, is due to systemic causes: general factors that are the same for all regions (e.g., biological characteristics of virus, incubation period, etc.) and specific factors which are different for each region (e.g., complex interaction between air pollution, meteorological conditions and biological characteristics of viral infectivity) and health level of individuals (habits, immune system, age, sex, etc.). Lessons learned for COVID-19 in the case study of Italy suggest that a proactive strategy to cope with future epidemics is to also apply especially an environmental and sustainable policy based on reduction of levels of air pollution mainly in hinterland and polluting cities- having low wind speed, high percentage of moisture and fog days-that seem to have an environment that may damage immune system of people and foster a fast transmission dynamics of viral infectivity in society. Hence, in the presence of polluting industrialization in regions that can trigger the mechanism of air pollution-to-human transmission dynamics of viral infectivity, this study must conclude that a comprehensive strategy to prevent future epidemics similar to COVID-19 has to be also designed in environmental and socioeconomic terms, that is also based on sustainability science and environmental science, and not only in terms of biology, healthcare and health sector.", "Modeling the role of respiratory droplets in Covid-19 type pandemics In this paper, we develop a first principles model that connects respiratory droplet physics with the evolution of a pandemic such as the ongoing Covid-19. The model has two parts. First, we model the growth rate of the infected population based on a reaction mechanism. The advantage of modeling the pandemic using the reaction mechanism is that the rate constants have sound physical interpretation. The infection rate constant is derived using collision rate theory and shown to be a function of the respiratory droplet lifetime. In the second part, we have emulated the respiratory droplets responsible for disease transmission as salt solution droplets and computed their evaporation time, accounting for droplet cooling, heat and mass transfer, and finally, crystallization of the dissolved salt. The model output favourably compares with the experimentally obtained evaporation characteristics of levitated droplets of pure water and salt solution, respectively, ensuring fidelity of the model. The droplet evaporation/desiccation time is, indeed, dependent on ambient temperature and is also a strong function of relative humidity. The multi-scale model thus developed and the firm theoretical underpinning that connects the two scales\u2014macro-scale pandemic dynamics and micro-scale droplet physics\u2014thus could emerge as a powerful tool in elucidating the role of environmental factors on infection spread through respiratory droplets.", "Temperature and precipitation associate with Covid-19 new daily cases: A correlation study between weather and Covid-19 pandemic in Oslo, Norway Abstract This study aims to analyze the correlation between weather and covid-19 pandemic in the capital city of Norway, Oslo. This study employed a secondary data analysis of covid-19 surveillance data from the Norwegian public health institute and weather data from the Norwegian Meteorological institute. The components of weather include minimum temperature (\u00b0C), maximum temperature (\u00b0C), temperature average (\u00b0C), normal temperature (\u00b0C), precipitation level (mm) and wind speed (m/s). Since normality was not fulfilled, a non-parametric correlation test was used for data analysis. Maximum temperature (r = 0.347; p = .005), normal temperature(r = 0.293; p = .019), and precipitation level (r = \u22120.285; p = .022) were significantly correlated with covid-19 pandemic. The finding serves as an input to a strategy making against the prevention of covid-19 as the country prepare to enter into a new weather season.", "Impact of mitigating interventions and temperature on the instantaneous reproduction number in the COVID-19 epidemic among 30 US metropolitan areas Background: After more than three months into the coronavirus disease (COVID-19) epidemic, over 170,000 people had died worldwide. The current study aims to evaluate how mitigating interventions affected the epidemic process in the 30 largest metropolitan areas in the US and whether temperature played a role in the epidemic process. Methods: Publicly available COVID-19 cases and deaths data and weather data were analyzed at the metropolitan level. The time-varying reproductive numbers were used to explore the trends. Results: We found that virus transmissibility, measured by instantaneous reproduction number (Rt), had declined significantly since the end of March for all areas and almost all of them reached a Rt of 1 or below by April 15, 2020. Cities with warm temperature tended to have a lower peak Rt than that of cities with cold temperature. However, large geographic variations exist. Conclusions: Though the end of epidemic of COVID-19 is near, temperature may have some weak effects on the virus transmission, and the return of the coronavirus outbreak is still possible.", "Large-scale Lassa fever outbreaks in Nigeria: quantifying the association between disease reproduction number and local rainfall Lassa fever (LF) is increasingly recognised as an important rodent-borne viral haemorrhagic fever presenting a severe public health threat to sub-Saharan West Africa. In 2017\u201318, LF caused an unprecedented epidemic in Nigeria and the situation was worsening in 2018\u201319. This work aims to study the epidemiological features of epidemics in different Nigerian regions and quantify the association between reproduction number (R) and state rainfall. We quantify the infectivity of LF by the reproduction numbers estimated from four different growth models: the Richards, three-parameter logistic, Gompertz and Weibull growth models. LF surveillance data are used to fit the growth models and estimate the Rs and epidemic turning points (\u03c4) in different regions at different time periods. Cochran's Q test is further applied to test the spatial heterogeneity of the LF epidemics. A linear random-effect regression model is adopted to quantify the association between R and state rainfall with various lag terms. Our estimated Rs for 2017\u201318 (1.33 with 95% CI 1.29\u20131.37) was significantly higher than those for 2016\u201317 (1.23 with 95% CI: (1.22, 1.24)) and 2018\u201319 (ranged from 1.08 to 1.36). We report spatial heterogeneity in the Rs for epidemics in different Nigerian regions. We find that a one-unit (mm) increase in average monthly rainfall over the past 7 months could cause a 0.62% (95% CI 0.20%\u20131.05%)) rise in R. There is significant spatial heterogeneity in the LF epidemics in different Nigerian regions. We report clear evidence of rainfall impacts on LF epidemics in Nigeria and quantify the impact.", "Emerging and Re-emerging Pathogens and Diseases, and Health Consequences of a Changing Climate ", "Higher Air Temperature, Pressure, and Ultraviolet Are Associated with Less Covid-19 Incidence A recent study from China suggests that high temperature and ultraviolet (UV) radiation cannot decrease the epidemics of Coronavirus disease 2019 (Covid-19). To determine whether COVID-19 incidence is modulated by meteorological factors, meta-regression of Japanese prefectural data was herein conducted. We extracted 1) cumulative numbers of confirmed Covid-19 patients in each Japanese prefecture from January to April 2020; 2) populations per 1-km2 inhabitable area in each prefecture in 2020; and 3) meteorological factors at each prefectural capital city from January to April 2020. Meteorological factors included monthly mean air temperature (degree Celsius), wind speed (m/s), sea level air pressure (hPa), relative humidity (%), and percentage of possible sunshine (%); monthly total of sunshine duration (h) and precipitation (mm); and monthly mean daily maximum ultraviolet (UV) index. To adjust for prefectural population density, we defined the incidence of Covid-19 as the cumulative number of Covid-19 patients divided by the population per 100-km2 inhabitable area. Random-effects meta-regression was performed, and its graph depicted Covid-19 incidence (plotted as the logarithm transformed incidence on the y-axis) as a function of a given meteorological factor (plotted on the x-axis). A slope of the meta-regression line was significantly negative as a function of the mean air temperature (coefficient, -0.127; P = 0.023), the mean sea level air pressure (coefficient, -0.351; P < 0.001), and the mean daily maximum UV index (coefficient, -0.001; P = 0.012) which indicated that Covid-19 incidence decreased significantly as air temperature, air pressure, and UV increased. In conclusion, higher air temperature, air pressure, and UV may be associated with less Covid-19 incidence.", "Susceptible supply limits the role of climate in the early SARS-CoV-2 pandemic Preliminary evidence suggests that climate may modulate the transmission of SARS-CoV-2. Yet it remains unclear whether seasonal and geographic variations in climate can substantially alter the pandemic trajectory, given high susceptibility is a core driver. Here, we use a climate-dependent epidemic model to simulate the SARS-CoV-2 pandemic probing different scenarios based on known coronavirus biology. We find that while variations in weather may be important for endemic infections, during the pandemic stage of an emerging pathogen the climate drives only modest changes to pandemic size. A preliminary analysis of non-pharmaceutical control measures indicates that they may moderate the pandemic-climate interaction via susceptible depletion. Our findings suggest, without effective control measures, strong outbreaks are likely in more humid climates and summer weather will not substantially limit pandemic growth.", "The most eagerly awaited summer of the Anthropocene: A perspective of SARS-CoV-2 decay and seasonal change To date, the world perhaps has never waited for the summer so impatiently in the entire Anthropocene, owing to the debate whether increasing temperature and humidity will decrease the environmental endurance of SARS-CoV-2. We present the perspective on the seasonal change on SARS-CoV-2 decay and COVID-19 spread. Our arguments are based on: i) structural similarity of coronavirus with several enteric viruses, and its vulnerability; ii) reports related to decay of those similar transmissible gastroenteritis viruses (TGEV) like norovirus and iii) improvement in the human immunity during summer with respect to winter. We present reasons why we can be optimistic about the slowdown of corona in the upcoming summer.", "Stability of SARS-CoV-2 in different environmental conditions ", "Several countries in one: a mathematical modeling analysis for COVID-19 in inner Brazil Early 2020 and the world experiences its very first pandemic of globalized era. A novel coronavirus, SARS-Cov-2, is the causative agent of severe pneumonia and rapidly spread through many nations, crashing health systems. In Brazil, the emergence of local epidemics in major metropolitan areas is a concern. In a huge and heterogeneous country, with regional disparities and climate diversity, several factors can modulate the dynamics of COVID-19. What should be the scenario for an inner Brazil and what can we do to control infection transmission in each one of these locations? In this paper, a mathematical model was developed to simulate disease transmission among individuals in several scenarios, differing by the intensity and type of control measures. Mitigation strategies rely on social distancing of all individuals, and detection and isolation of infected ones. The model shows that control effort varies among cities. The social distancing is the most efficient method to control disease transmission but improving detection and isolation of infected individuals can help loosening this mitigation strategy.", "Association between climate variables and global transmission oF SARS-CoV-2 In this study, we aimed at analyzing the associations between transmission of and deaths caused by SARS-CoV-2 and meteorological variables, such as average temperature, minimum temperature, maximum temperature, and precipitation. Two outcome measures were considered, with the first aiming to study SARS-CoV-2 infections and the second aiming to study COVID-19 mortality. Daily data as well as data on SARS-CoV-2 infections and COVID-19 mortality obtained between December 1, 2019 and March 28, 2020 were collected from weather stations around the world. The country's population density and time of exposure to the disease were used as control variables. Finally, a month dummy variable was added. Daily data by country were analyzed using the panel data model. An increase in the average daily temperature by one degree Fahrenheit reduced the number of cases by approximately 6.4 cases/day. There was a negative correlation between the average temperature per country and the number of cases of SARS-CoV-2 infections. This association remained strong even with the incorporation of additional variables and controls (maximum temperature, average temperature, minimum temperature, and precipitation) and fixed country effects. There was a positive correlation between precipitation and SARS-CoV-2 transmission. Countries with higher rainfall measurements showed an increase in disease transmission. For each average inch/day, there was an increase of 56.01 cases/day. COVID-19 mortality showed no significant association with temperature.", "Web-based forecasting system for the airborne spread of livestock infectious disease using computational fluid dynamics Livestock infectious diseases, such as foot-and-mouth disease (FMD), cause substantial economic damage to livestock farms and their related industries. Among various causes of disease spread, airborne dispersion has previously been considered to be an important factor that could not be controlled by preventive measures to stop the spread of disease that focus on direct and indirect contact. Forecasting and predicting airborne virus spread are important to make time for developing strategies and to minimise the damage of the disease. To predict the airborne spread of the disease a modelling approach is important since field experiments using sensors are ineffective because of the rarefied concentrations of virus in the air. The simulation of airborne spread during past outbreaks required improvement both for farmers and for policy decision makers. In this study a free license computational fluid dynamics (CFD) code was used to simulate airborne virus spread. Forecasting data from the Korea Meteorological Administration (KMA) was directly connected in the developed model for real-time forecasting for 48 h in three-hourly intervals. To reduce computation time, scalar transport for airborne virus spread was simulated based on a database for the CFD computed airflow in the investigated area using representative wind conditions. The simulation results, and the weather data were then used to make a database for a web-based forecasting system that could be accessible to users.", "The Weather Impacts the Outbreak of COVID-19 in Mainland China Recent literature has suggested that climate conditions have considerably significant influences on the transmission of coronavirus COVID-19. However, there is a lack of comprehensive study that investigates the relationships between multiple weather factors and the development of COVID-19 pandemic while excluding the impact of social factors. In this paper, we study the relationships between six main weather factors and the infection statistics of COVID-19 on 250 cities in Mainland China. Our correlation analysis using weather and infection statistics indicates that all the studied weather factors are correlated with the spread of COVID-19, where precipitation shows the strongest correlation. We also build a weather-aware predictive model that forecasts the number of infected cases should there be a second wave of the outbreak in Mainland China. Our predicted results show that cities located in different geographical areas are likely to be challenged with the second wave of COVID-19 at very different time periods and the severity of the outbreak varies to a large degree, in correspondence with the varying weather conditions.", "The correlation between the spread of COVID-19 infections and weather variables in 30 Chinese provinces and the impact of Chinese government mitigation plans On February 1, 2020, China announced a novel coronavirus CoVID-19 outbreak to the public. CoVID-19 was classified as an epidemic by the World Health Organization (WHO). Although the disease was discovered and concentrated in Hubei Province, China, it was exported to all of the other Chinese provinces and spread globally. As of this writing, all plans have failed to contain the novel coronavirus disease, and it has continued to spread to the rest of the world. This study aimed to explore and interpret the effect of environmental and metrological variables on the spread of coronavirus disease in 30 provinces in China, as well as to investigate the impact of new China regulations and plans to mitigate further spread of infections. This article forecasts the size of the disease spreading based on time series forecasting. The growing size of CoVID-19 in China for the next 210 days is estimated by predicting the expected confirmed and recovered cases. The results revealed that weather conditions largely influence the spread of coronavirus in most of the Chinese provinces. This study has determined that increasing temperature and short-wave radiation would positively increase the number of confirmed cases, mortality rate, and recovered cases. The findings of this study agree with the results of our previous study.", "Associations of ambient air pollutants and meteorological factors with COVID-19 transmission in 31 Chinese provinces: A time-series study Background: Evidence regarding the effects of ambient air pollutants and meteorological factors on COVID-19 transmission is limited. Objectives: To explore the associations of air pollutants and meteorological factors with COVID-19 confirmed cases across 31 Chinese provinces during the outbreak period. Methods: The number of COVID-19 confirmed cases, air pollutant concentrations and meteorological factors in 31 Chinese provinces from January 25 to February 29, 2020 were extracted from authoritative electronic databases. The associations were estimated for a single-day lag (lag0-lag6) as well as moving averages lag (lag01-lag05) using generalized additive mixed models (GAMMs), adjusted for time trends, day of the week, holidays and meteorological variables. Region-specific analyses and meta-analysis were conducted in five selected regions with diverse air pollution levels and weather conditions. Nonlinear exposure-response analyses were performed. Results: We examined 77,578 COVID-19 confirmed cases across 31 Chinese provinces during the study period. An increase of each interquartile range in PM2.5, PM10, SO2, NO2, O3 and CO at lag4 corresponded to 1.40 (1.37-1.43), 1.35 (1.32-1.37), 1.01 (1.00-1.02), 1.08 (1.07-1.10), 1.28 (1.27-1.29) and 1.26 (1.24-1.28) odds ratios (ORs) of daily COVID-19 confirmed new cases, respectively. For 1 oc, 1% and 1 m/s increase in temperature, relative humidity and wind velocity, the ORs were 0.97 (0.97-0.98), 0.96 (0.96-0.97), and 0.94 (0.92-0.95), respectively. The estimates of PM2.5, PM10, NO2 and all meteorological factors remained statistically significant after meta-analysis for the five selected regions. The exposure-response relationships showed that higher concentrations of air pollutants and lower meteorological factors were associated with daily COVID-19 confirmed new cases increasing. Conclusions: Higher air pollutant concentrations and lower temperature, relative humidity and wind velocity may favor COVID-19 transmission. As summer months are arriving in the Northern Hemisphere, the environmental factors and implementation of public health control measures may play an optimistic role in controlling COVID-19 epidemic.", "Seasonality of infectious diseases and severe acute respiratory syndrome\u2013what we don't know can hurt us Summary The novel severe acute respiratory syndrome (SARS) coronavirus caused severe disease and heavy economic losses before apparently coming under complete control. Our understanding of the forces driving seasonal disappearance and recurrence of infectious diseases remains fragmentary, thus limiting any predictions about whether, or when, SARS will recur. It is true that most established respiratory pathogens of human beings recur in wintertime, but a new appreciation for the high burden of disease in tropical areas reinforces questions about explanations resting solely on cold air or low humidity. Seasonal variation in host physiology may also contribute. Newly emergent zoonotic diseases such as ebola or pandemic strains of influenza have recurred in unpredictable patterns. Most established coronaviruses exhibit winter seasonality, with a unique ability to establish persistent infections in a minority of infected animals. Because SARS coronavirus RNA can be detected in the stool of some individuals for at least 9 weeks, recurrence of SARS from persistently shedding human or animal reservoirs is biologically plausible.", "Effects of temperature and humidity on the daily new cases and new deaths of COVID-19 in 166 countries The coronavirus disease 2019 (COVID-19) pandemic is the defining global health crisis of our time and the greatest challenge facing the world. Meteorological parameters are reportedly crucial factors affecting respiratory infectious disease epidemics; however, the effect of meteorological parameters on COVID-19 remains controversial. This study investigated the effects of temperature and relative humidity on daily new cases and daily new deaths of COVID-19, which has useful implications for policymakers and the public. Daily data on meteorological conditions, new cases and new deaths of COVID-19 were collected for 166 countries (excluding China) as of March 27, 2020. Log-linear generalized additive model was used to analyze the effects of temperature and relative humidity on daily new cases and daily new deaths of COVID-19, with potential confounders controlled for, including wind speed, median age of the national population, Global Health Security Index, Human Development Index and population density. Our findings revealed that temperature and relative humidity were both negatively related to daily new cases and deaths. A 1 \u00b0C increase in temperature was associated with a 3.08% (95% CI: 1.53%, 4.63%) reduction in daily new cases and a 1.19% (95% CI: 0.44%, 1.95%) reduction in daily new deaths, whereas a 1% increase in relative humidity was associated with a 0.85% (95% CI: 0.51%, 1.19%) reduction in daily new cases and a 0.51% (95% CI: 0.34%, 0.67%) reduction in daily new deaths. The results remained robust when different lag structures and the sensitivity analysis were used. These findings provide preliminary evidence that the COVID-19 pandemic may be partially suppressed with temperature and humidity increases. However, active measures must be taken to control the source of infection, block transmission and prevent further spread of COVID-19.", "Meteorological impact on the COVID-19 pandemic: A study across eight severely affected regions in South America The role of meteorological factors in the transmission of the COVID-19 still needs to be determined. In this study, the daily new cases of the eight severely affected regions in four countries of South America and their corresponding meteorological data (average temperature, maximum temperature, minimum temperature, average wind speed, visibility, absolute humidity) were collected. Daily number of confirmed and incubative cases, as well as time-dependent reproductive number (R(t)) was calculated to indicate the transmission of the diseases in the population. Spearman's correlation coefficients were assessed to show the correlation between meteorological factors and daily confirmed cases, daily incubative cases, as well as Rt. In particular, the results showed that there was a highly significant correlation between daily incubative cases and absolute humidity throughout the selected regions. Multiple linear regression model further confirmed the negative correlation between absolute humidity and incubative cases. The absolute humidity is predicted to show a decreasing trend in the coming months from the meteorological data of recent three years. Our results suggest the necessity of continuous controlling policy in these areas and some other complementary strategies to mitigate the contagious rate of the COVID-19.", "A spatio-temporal analysis for exploring the effect of temperature on COVID-19 early evolution in Spain Abstract The new SARS-CoV-2 coronavirus, which causes the COVID-19 disease, was reported in Wuhan, China, in December 2019. This new pathogen has spread rapidly around more than 200 countries, in which Spain has one of the world's highest mortality rates so far. Previous studies have supported an epidemiological hypothesis that weather conditions may affect the survival and spread of droplet-mediated viral diseases. However, some contradictory studies have also been reported in the same research line. In addition, many of these studies have been performed considering only meteorological factors, which can limit the reliability of the results. Herein, we report a spatio-temporal analysis for exploring the effect of daily temperature (mean, minimum and maximum) on the accumulated number of COVID-19 cases in the provinces of Spain. Non-meteorological factors such as population density, population by age, number of travellers and number of companies have also been considered for the analysis. No evidence suggesting a reduction in COVID-19 cases at warmer mean, minimum and maximum temperatures has been found. Nevertheless, these results need to be interpreted cautiously given the existing uncertainty about COVID-19 data, and should not be extrapolated to temperature ranges other than those analysed here for the early evolution period.", "Impact of global warming on viral diseases: what is the evidence? Global warming is believed to induce a gradual climate change. Hence, it was predicted that tropical insects might expand their habitats thereby transmitting pathogens to humans. Although this concept is a conclusive presumption, clear evidence is still lacking\u2014at least for viral diseases. Epidemiological data indicate that seasonality of many diseases is further influenced by strong single weather events, interannual climate phenomena, and anthropogenic factors. So far, emergence of new diseases was unlinked to global warming. Re-emergence and dispersion of diseases was correlated with translocation of pathogen-infected vectors or hosts. Coupled ocean/atmosphere circulations and \u2018global change\u2019 that also includes shifting of demographic, social, and economical conditions are important drivers of viral disease variability whereas global warming at best contributes.", "14 Climate change and infectious diseases Publisher Summary The worldwide upturn in the occurrence of both new (emerging) and reemerging or spreading infectious diseases highlights the importance of underlying environmental and social conditions as determinants of the generation, spread, and impact of infectious diseases in human populations. Human ecology is undergoing rapid transition. This encompasses urbanization, rising consumerism, changes in working conditions, population aging, marked increases in mobility, changes in culture and behavior, evolving health-care technologies, and other factors. Global climate change is becoming a further, and major, large-scale influence on the pattern of infectious disease transmission. It is likely to become increasingly important over at least the next halfcentury, as the massive, highinertial, and somewhat unpredictable process of climate change continues. The many ways in which climate change does and will influence infectious diseases are subject to a plethora of modifying influences by other factors and processes: constitutional characteristics of hosts, vectors and pathogens; the prevailing ambient conditions; and coexistent changes in other social, economic, behavioral, and environmental factors. This global anthropogenic process, climate change, along with other unprecedented global environmental changes, is beginning to destabilize and weaken the planet's life-support systems. Infectious diseases, unlike other diseases, depend on the biology and behavior\u2014each often climate-sensitive\u2014of two or more parties. Hence, these diseases will be particularly susceptible to changes as the world's climate and its climate-sensitive geochemical and ecological systems undergo change over the coming decades.", "Catastrophe \u00e9volutive, quelle pourrait-\u00eatre l\u2019influence des conditions m\u00e9t\u00e9orologiques sur l\u2019\u00e9volution de la pand\u00e9mie CoViD-19? R\u00e9sum\u00e9 Une des pr\u00e9occupations classiques de la gestion des catastrophes est d\u2019en conna\u00eetre l\u2019\u00e9volutivit\u00e9. Quelle est celle de la CoViD-19? Un questionnaire a \u00e9t\u00e9 adress\u00e9 \u00e0 des confr\u00e8res de 14 pays situ\u00e9s dans la zone chaude intertropicale pour \u00e9tablir une comparaison avec deux pays temp\u00e9r\u00e9s. Nous avons pu disposer des cas relev\u00e9s et des conditions m\u00e9t\u00e9orologiques de six \u00eeles fran\u00e7aises et de six pays africains francophones pour lesquels les mesures barri\u00e8res gouvernementales ont \u00e9t\u00e9 identiques \u00e0 celles prises en Italie et en France. Le r\u00f4le positif de la temp\u00e9rature qui diminue la diffusion de la CoViD-19 et sa l\u00e9talit\u00e9 a pu \u00eatre mis en \u00e9vidence. Dans les \u00eeles tropicales fran\u00e7aises, les cas import\u00e9s (avions, bateaux) ont repr\u00e9sent\u00e9 en moyenne 33% de la totalit\u00e9 des cas sans influence sur la propagation virale, rest\u00e9e faible. La saisonnalit\u00e9 de la CoViD-19 doit faire craindre son retour \u00e0 l\u2019entr\u00e9e de l\u2019hiver et inciter \u00e0 mieux pr\u00e9parer personnels et moyens. Summary One of the classic factors in disaster management is knowing its scalability. What is it in the case of CoViD-19? A questionnaire was sent to our colleagues from 14 countries located in the intertropical hot zone to establish a comparison with two temperate countries. We were able to collect the recorded cases and weather conditions from six French islands and six French-speaking African countries for which the government barrier measures were identical to those taken in Italy and France. We highlighted the positive role of temperature, which decreases the diffusion and the lethality of CoViD-19. In the French tropical islands, imported cases (by air, ships) represented a large percentage of cases (33% on average) which had no influence on the viral spread, which remained low. The seasonality of CoViD-19 should raise concern for its return at the start of winter and encourage better preparation of personnel and resources.", "Eco-epidemiological assessment of the COVID-19 epidemic in China, January\u2013February 2020 Background: The outbreak of COVID-19 in China in early 2020 provides a rich data source for exploring the ecological determinants of this new infection, which may be of relevance as the pandemic develops. Objectives: Assessing the spread of the COVID-19 across China, in relation to associations between cases and ecological factors including population density, temperature, solar radiation and precipitation. Methods: Open-access COVID-19 case data include 18,069 geo-located cases in China during January and February 2020, which were mapped onto a 0.25\u00b0 latitude/longitude grid together with population and weather data (temperature, solar radiation and precipitation). Of 15,539 grid cells, 559 (3.6%) contained at least one case, and these were used to construct a Poisson regression model of cell-weeks. Weather parameters were taken for the preceding week given the established 5\u20137 day incubation period for COVID-19. The dependent variable in the Poisson model was incident cases per cell-week and exposure was cell population, allowing for clustering of cells over weeks, to give incidence rate ratios. Results: The overall COVID-19 incidence rate in cells with confirmed cases was 0.12 per 1,000. There was a single confirmed case in 113/559 (20.2%) of cells, while two grid cells recorded over 1,000 confirmed cases. Weekly means of maximum daily temperature varied from \u221228.0\u00b0C to 30.1\u00b0C, minimum daily temperature from \u221242.4\u00b0C to 23.0\u00b0C, maximum solar radiation from 0.04 to 2.74 MJm(\u22122) and total precipitation from 0 to 72.6 mm. Adjusted incidence rate ratios suggested brighter, warmer and drier conditions were associated with lower incidence. Conclusion: Though not demonstrating cause and effect, there were appreciable associations between weather and COVID-19 incidence during the epidemic in China. This does not mean the pandemic will go away with summer weather but demonstrates the importance of using weather conditions in understanding and forecasting the spread of COVID-19.", "Relationship between COVID-19 and weather: Case study in a tropical country This study aimed to evaluate the relationship between weather factors (temperature, humidity, solar radiation, wind speed, and rainfall) and COVID-19 infection in the State of Rio de Janeiro, Brazil. Solar radiation showed a strong (-0.609, p < 0.01) negative correlation with the incidence of novel coronavirus (SARS-CoV-2). Temperature (maximum and average) and wind speed showed negative correlation (p < 0.01). Therefore, in this studied tropical state, high solar radiation can be indicated as the main climatic factor that suppress the spread of COVID-19. High temperatures, and wind speed also are potential factors. Therefore, the findings of this study show the ability to improve the organizational system of strategies to combat the pandemic in the State of Rio de Janeiro, Brazil, and other tropical countries around the word.", "No Evidence for Temperature-Dependence of the COVID-19 Epidemic The pandemic of the COVID-19 disease extended from China across the north-temperate zone, and more recently to the tropics and southern hemisphere. We find no evidence that spread rates decline with temperatures above 20 oC, suggesting that the COVID-19 disease is unlikely to behave as a seasonal respiratory virus.", "Air transportation, population density and temperature predict the spread of COVID-19 in Brazil There is evidence that COVID-19, the disease caused by the betacoronavirus SARS-CoV-2, is sensitive to environmental conditions. However, such conditions often correlate with demographic and socioeconomic factors at larger spatial extents, which could confound this inference. We evaluated the effect of meteorological conditions (temperature, solar radiation, air humidity and precipitation) on 292 daily records of cumulative number of confirmed COVID-19 cases across the 27 Brazilian capital cities during the 1st month of the outbreak, while controlling for an indicator of the number of tests, the number of arriving flights, population density, proportion of elderly people and average income. Apart from increasing with time, the number of confirmed cases was mainly related to the number of arriving flights and population density, increasing with both factors. However, after accounting for these effects, the disease was shown to be temperature sensitive: there were more cases in colder cities and days, and cases accumulated faster at lower temperatures. Our best estimate indicates that a 1 \u00b0C increase in temperature has been associated with a decrease in confirmed cases of 8%. The quality of the data and unknowns limit the analysis, but the study reveals an urgent need to understand more about the environmental sensitivity of the disease to predict demands on health services in different regions and seasons.", "A four year seasonal survey of the relationship between outdoor climate and epidemiology of viral respiratory tract infections in a temperate climate Abstract Background The relation between weather conditions, viral transmission and seasonal activity of respiratory viruses is not fully understood. Objectives To investigate the impact of outdoor weather in a temperate climate setting on the seasonal epidemiology of viruses causing respiratory tract infections, particularly influenza A (IFA). Study design In total, 20,062 clinical nasopharyngeal swab samples referred for detection of respiratory pathogens using a multiplex PCR panel, between October 2010 and July 2013, were included. Results of PCR detection were compared with local meteorological data for the same period. Results Low temperature and vapor pressure (VP) were associated with weekly incidence of IFA, respiratory syncytial virus, metapneumovirus, bocavirus and adenovirus but no association with relative humidity was found. The incidence of human rhinovirus and enterovirus was independent of temperature. During seasonal IFA outbreaks, the weekly drop of average temperature (compared with the week before) was strongly associated with the IFA incidence recorded the following week. Conclusion A sudden drop in outdoor temperature might activate the annual influenza epidemic in a temperate climate by facilitating aerosol spread in dry air. These conditions also seem to affect the incidence of other respiratory pathogens but not human rhino- or enterovirus, suggesting that routes of infection other than aerosol may be relevant for these agents.", "Seasonality of viral respiratory infections in southeast of Brazil: the influence of temperature and air humidity Viruses are the major cause of lower respiratory tract infections in childhood and the main viruses involved are Human Respiratory Syncytial Virus (HRSV), Human Metapneumovirus (HMPV), Influenzavirus A and B (FLUA and FLUB), Human Parainfluenza Virus 1, 2 and 3 (HPIV1, 2 and 3) and Human Rhinovirus (HRV). The purposes of this study were to detect respiratory viruses in hospitalized children younger than six years and identify the influence of temperature and relative air humidity on the detected viruses. Samples of nasopharyngeal washes were collected from hospitalized children between May/2004 and September/2005. Methods of viral detection were RT-PCR, PCR and HRV amplicons were confirmed by hybridization. Results showed 54% (148/272) of viral positivity. HRSV was detected in 29% (79/272) of the samples; HRV in 23.1% (63/272); HPIV3 in 5.1% (14/272); HMPV in 3.3% (9/272); HPIV1 in 2.9% (8/272); FLUB in 1.4% (4/272), FLUA in 1.1% (3/272), and HPIV2 in 0.3% (1/272). The highest detection rates occurred mainly in the spring 2004 and in the autumn 2005. It was observed that viral respiratory infections tend to increase as the relative air humidity decreases, showing significant association with monthly averages of minimal temperature and minimal relative air humidity. In conclusion, viral respiratory infections vary according to temperature and relative air humidity and viral respiratory infections present major incidences it coldest and driest periods.", "Impact of meteorological factors on the COVID-19 transmission: A multi-city study in China The purpose of the present study is to explore the associations between novel coronavirus disease 2019 (COVID-19) case counts and meteorological factors in 30 provincial capital cities of China. We compiled a daily dataset including confirmed case counts, ambient temperature (AT), diurnal temperature range (DTR), absolute humidity (AH) and migration scale index (MSI) for each city during the period of January 20th to March 2nd, 2020. First, we explored the associations between COVID-19 confirmed case counts, meteorological factors, and MSI using non-linear regression. Then, we conducted a two-stage analysis for 17 cities with more than 50 confirmed cases. In the first stage, generalized linear models with negative binomial distribution were fitted to estimate city-specific effects of meteorological factors on confirmed case counts. In the second stage, the meta-analysis was conducted to estimate the pooled effects. Our results showed that among 13 cities that have less than 50 confirmed cases, 9 cities locate in the Northern China with average AT below 0 \u00b0C, 12 cities had average AH below 4 g/m3, and one city (Haikou) had the highest AH (14.05 g/m3). Those 17 cities with 50 and more cases accounted for 90.6% of all cases in our study. Each 1 \u00b0C increase in AT and DTR was related to the decline of daily confirmed case counts, and the corresponding pooled RRs were 0.80 (95% CI: 0.75, 0.85) and 0.90 (95% CI: 0.86, 0.95), respectively. For AH, the association with COVID-19 case counts were statistically significant in lag 07 and lag 014. In addition, we found the all these associations increased with accumulated time duration up to 14 days. In conclusions, meteorological factors play an independent role in the COVID-19 transmission after controlling population migration. Local weather condition with low temperature, mild diurnal temperature range and low humidity likely favor the transmission.", "Significance of geographical factors to the COVID-19 outbreak in India Recently, the large outbreak of COVID-19 cases all over the world has whacked India with about 30,000 confirmed cases within the first 3 months of transmission. The present study used long-term climatic records of air temperature (T), rainfall (R), actual evapotranspiration (AET), solar radiation (SR), specific humidity (SH), wind speed (WS) with topographic altitude (E) and population density (PD) at the regional level to investigate the spatial association with the number of COVID-19 infections (NI). Bivariate analysis failed to find any significant relation (except SR) with the number of infected cases within 36 provinces in India. Variable Importance of Projection (VIP) through Partial Least Square (PLS) technique signified higher importance of SR, T, R and AET. However, generalized additive model fitted with the log-transformed value of input variables and applying spline smoothening to PD and E, significantly found high accuracy of prediction (R(2) = 0.89), and thus well-explained complex heterogeneity among the association of regional parameters with COVID-19 cases in India. Our study suggests that comparatively hot and dry regions in lower altitude of the Indian territory are more prone to the infection by COVID-19 transmission. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40808-020-00838-2) contains supplementary material, which is available to authorized users.", "Impact of global change on transmission of human infectious diseases Global change, which refers to large-scale changes in the earth system and human society, has been changing the outbreak and transmission mode of many infectious diseases. Climate change affects infectious diseases directly and indirectly. Meteorological factors including temperature, precipitation, humidity and radiation influence infectious disease by modulating pathogen, host and transmission pathways. Meteorological disasters such as droughts and floods directly impact the outbreak and transmission of infectious diseases. Climate change indirectly impacts infectious diseases by altering the ecological system, including its underlying surface and vegetation distribution. In addition, anthropogenic activities are a driving force for climate change and an indirect forcing of infectious disease transmission. International travel and rural-urban migration are a root cause of infectious disease transmission. Rapid urbanization along with poor infrastructure and high disease risk in the rural-urban fringe has been changing the pattern of disease outbreaks and mortality. Land use changes, such as agricultural expansion and deforestation, have already changed the transmission of infectious disease. Accelerated air, road and rail transportation development may not only increase the transmission speed of outbreaks, but also enlarge the scope of transmission area. In addition, more frequent trade and other economic activities will also increase the potential risks of disease outbreaks and facilitate the spread of infectious diseases.", "Models of transmission of COVID-19 with time under the influence of meteorological determinants Based on the statistical analyses of the data on the number of confirmed COVID-19 cases and meteorological determinants in some of the severely affected cities in Spain, Italy and the USA, some models are constructed showing the relationship of I' (the number of infected individuals divided by the total population of a city) with temperature, relative humidity, wind velocity and time. Three models are based on the data before lockdown/travel restrictions in these cities, and the other three models are based on data both before and after lockdown/travel restrictions. These models, in general, indicate that the transmission of COVID-19 could be relatively high either for elevated temperatures with lower relative humidity or for lower temperatures with higher relative humidity conditions. Although one model indicates exponential increase in number of infection cases with time, the more statistically significant models show that the number of cases varies quadratically with time. We have discussed in short, how all these features could be linked with the alterations of structural characteristics of the SARS-CoV-2 virus. Finally, the possibility of natutal disappearance of COVID-19 pandemic, at the global level, has been discussed in the context of the most statistically significant model.", "Epidemiological aspects of astrovirus and coronavirus in poults in the South Eastern Region of Brazil A survey of Turkey Coronavirus (TCoV) and Astrovirus (TAstV-2) prevalence was carried out from February to December during 2006 year in semiarid region of Brazil, from a turkey producer area, localized in South Eastern of Brazil. To asses the risk factor related to clinical material, climatic condition and type of RT-PCR applied, cloacal swabs (CS), faeces, sera, bursa of Fabricius (BF), thymus (TH) and spleen (SP) and ileum-caeca region were collected from 30-day-old poults suffering of enteritis episode characterized as poult enteritis mortality syndrome (PEMS). The PEMS clinical features were characterized by watery to foamy faeces, light brown-yellow in colour and low mortality rate. Meteorological data (rainfall and relative humidity) observed during along the study presented monthly average temperature ranging from 39.3 and 31.2\u00baC, precipitation in rainy season from 40 to 270.3 mm/month, and no rain during dry season. Simplex RT-PCR gave odds ratio (OR) values suggesting that ileum-caeca region is at higher chance (OR=1.9; p=0.9741) to have both viral RNA than faeces (OR=1.5; p=0.7319). However, multiplex RT-PCR showed 3.98 (p=0.89982) more chance to give positive results in faeces than CS at dry season. The major risk factors seem to be low rate of humidity and high temperatures at winter, probably responsible for spread, easily, the TCoV and TAstv-2 among the flocks. The positive results of both virus suggested that they can play an important role in enteric disorders, associated to low humidity and high temperatures frequently found in tropical countries.", "Effect modification of environmental factors on influenza-associated mortality: a time-series study in two Chinese cities BACKGROUND: Environmental factors have been associated with transmission and survival of influenza viruses but no studies have ever explored the role of environmental factors on severity of influenza infection. METHODS: We applied a Poisson regression model to the mortality data of two Chinese metropolitan cities located within the subtropical zone, to calculate the influenza associated excess mortality risks during the periods with different levels of temperature and humidity. RESULTS: The results showed that high absolute humidity (measured by vapor pressure) was significantly (p < 0.05) associated with increased risks of all-cause and cardiorespiratory deaths, but not with increased risks of pneumonia and influenza deaths. The association between absolute humidity and mortality risks was found consistent among the two cities. An increasing pattern of influenza associated mortality risks was also found across the strata of low to high relative humidity, but the results were less consistent for temperature. CONCLUSIONS: These findings highlight the need for people with chronic cardiovascular and respiratory diseases to take extra caution against influenza during hot and humid days in the subtropics and tropics.", "The nexus between COVID-19, temperature and exchange rate in Wuhan city: New findings from partial and multiple wavelet coherence This study attempts to document the nexus between weather, COVID-19 outbreak in Wuhan and the Chinese economy. We used daily average temperature (hourly data), daily new confirmed cases of COVID-19 in Wuhan, and RMB (Chinese currency) exchange rate to represent the weather, COVID-19 outbreak and the Chinese economy, respectively. The methodology of Wavelet Transform Coherence (WTC), Partial Wavelet Coherence (PWC) and Multiple Wavelet Coherence (MWC) is employed to analyze the daily data collected from 21st January 2020 to 31st March 2020. The results have revealed a significant coherence between the series at different time-frequency combinations. The overall results suggest the insignificance of an increase in temperature to contain or slow down the new COVID-19 infections. The RMB exchange rate and the COVID-19 showed an out phase coherence at specific time-frequency spots suggesting a negative but limited impact of the COVID-19 outbreak in Wuhan on the Chinese export economy. Our results are contrary to many earlier studies which suggest a significant role of temperature in slowing down the COVID-19 spread. These results can have important policy implications for the containment of COVID-19 spread and macro-economic management with respect to changes in the weather.", "Climatic influences on the worldwide spread of SARS-CoV-2 The rapid global spread of the novel, pathogenic, SARS-CoV-2 causing the severe acute respiratory disease COVID-19, becomes a major health problem worldwide and pose the need for international predictive programs. Given the lack of both specific drugs and an efficient preventive vaccine, the expectation that SARS-CoV-2 transmission rate might decrease in temperate regions during summer, dominated the social scene. Here, we attempted a prediction of the worldwide spread of the infections based on climatic data, expressed by 19 bioclimatic variables. The calculated probability maps shown that potential areas of infection follow a shift from the Tropical to Temperate and Mediterranean Bioclimatic regions, and back to the Tropics again. Maps show an increased probability of infections in Europe, followed by an expansion covering areas of the Middle East and Northern Africa, as well as Eastern coastal areas of North America, South-Eastern coastal areas of Latin America and two areas of Southern Australia, and later return to areas of Southeastern Asia, in a manner similar to that of influenza strains (H3N2). Our approach may therefore be of value for the worldwide spread of SARS-CoV-2, suggesting an optimistic scenario of asynchronous seasonal global outbreaks, like other viral respiratory diseases. Consequently, we suggest the incorporation of a climatic impact in the design and implementation of public health policies. Maps of our model are available (constantly updated up to the saturation of the model) at: https://navaak.shinyapps.io/CVRisk/.", "Multiple drivers of the COVID-19 spread: role of climate, international mobility, and region-specific conditions The novel Coronavirus Disease 2019 (COVID-19) has spread quickly across the globe. Here, we evaluated the role of climate (temperature and precipitation), region-specific susceptibility (BCG vaccination, malaria infection, and elderly population) and international traveller population (human mobility) in shaping the geographical patterns of COVID-19 cases across 1,055 countries/regions, and examined the sequential shift of multiple drivers of the accumulated cases from December, 2019 to April 12, 2020. The accumulated numbers of COVID-19 cases (per 1 million population) were well explained by a simple regression model. The explanatory power (R2) of the model increased up to > 70% in April 2020 as the COVID-19 spread progressed. Climate, host mobility, and host susceptibility largely explained the variance of the COVID-19 cases (per 1 million population), and their explanatory power improved as the pandemic progressed; the relative importance of host mobility and host susceptibility have been greater than that of climate. The number of days from outbreak onset showed greater explanatory power in the earlier stages of COVID-19 spread but rapidly lost its influence. Our findings demonstrate that the COVID-19 pandemic is deterministically driven by climate suitability, cross-border human mobility, and region-specific susceptibility. The present distribution of COVID-19 cases has not reached an equilibrium and is changing daily, especially in the Southern Hemisphere. Nevertheless, the present results, based on mapping the spread of COVID-19 and identifying multiple drivers of this outbreak trajectory, may contribute to a better understanding of the COVID-19 disease transmission risk and the measures against long-term epidemic.", "Short-term effects of weather parameters on COVID-19 morbidity in select US cities Abstract Little is known about the environmental conditions that drive the spatiotemporal patterns of SARS-CoV-2, and preliminary research suggests an association with weather parameters. However, the relationship with temperature and humidity is not yet apparent for COVID-19 cases in US cities first impacted. The objective of this study is to evaluate the association between COVID-19 cases and weather parameters in select US cities. A case-crossover design with a distributed lag nonlinear model was used to evaluate the contribution of ambient temperature and specific humidity on COVID-19 cases in select US cities. The case-crossover examines each COVID case as its own control at different time periods (before and after transmission occurred). We modeled the effect of temperature and humidity on COVID-19 transmission using a lag period of 7 days. A subset of 8 cities were evaluated for the relationship with weather parameters and 5 cities were evaluated in detail. Short-term exposure to humidity was positively associated with COVID-19 transmission in 4 cities. The associations were small with \u00be cities exhibiting higher COVID19 transmission with specific humidity that ranged from 6 to 9 g/kg. Our results suggest that weather should be considered in infectious disease modeling efforts and future work is needed over a longer time period and across different locations to clearly establish the weather-COVID19 relationship.", "Possible environmental effects on the spread of COVID-19 in China At the end of 2019, a novel coronavirus, designated as SARS-CoV-2, emerged in Wuhan, China and was identified as the causal pathogen of COVID-19. The epidemic scale of COVID-19 has increased dramatically, with confirmed cases increasing across China and globally. Understanding the potential affecting factors involved in COVID-19 transmission will be of great significance in containing the spread of the epidemic. Environmental and meteorological factors might impact the occurrence of COVID-19, as these have been linked to various diseases, including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), whose causative pathogens belong to the same virus family as SARS-CoV-2. We collected daily data of COVID-19 confirmed cases, air quality and meteorological variables of 33 locations in China for the outbreak period of 29 January 2020 to 15 February 2020. The association between air quality index (AQI) and confirmed cases was estimated through a Poisson regression model, and the effects of temperature and humidity on the AQI-confirmed cases association were analyzed. The results show that the effect of AQI on confirmed cases associated with an increase in each unit of AQI was statistically significant in several cities. The lag effect of AQI on the confirmed cases was statistically significant on lag day 1 (relative risk (RR) = 1.0009, 95% confidence interval (CI): 1.0004, 1.0013), day 2 (RR = 1.0007, 95% CI: 1.0003, 1.0012) and day 3 (RR = 1.0008, 95% CI: 1.0003, 1.0012). The AQI effect on the confirmed cases might be stronger in the temperature range of 10 \u00b0C &#8804; T < 20 \u00b0C than in other temperature ranges, while the RR of COVID-19 transmission associated with AQI was higher in the relative humidity (RH) range of 10% &#8804; RH < 20%. Results may suggest an enhanced impact of AQI on the COVID-19 spread under low RH.", "Temperature significantly changes COVID-19 transmission in (sub)tropical cities of Brazil The coronavirus disease 2019 (COVID-19) outbreak has become a severe public health issue. The novelty of the virus prompts a search for understanding of how ecological factors affect the transmission and survival of the virus. Several studies have robustly identified a relationship between temperature and the number of cases. However, there is no specific study for a tropical climate such as Brazil. This work aims to determine the relationship of temperature to COVID-19 infection for the state capital cities of Brazil. Cumulative data with the daily number of confirmed cases was collected from February 27 to April 1, 2020, for all 27 state capital cities of Brazil affected by COVID-19. A generalized additive model (GAM) was applied to explore the linear and nonlinear relationship between annual average temperature compensation and confirmed cases. Also, a polynomial linear regression model was proposed to represent the behavior of the growth curve of COVID-19 in the capital cities of Brazil. The GAM dose-response curve suggested a negative linear relationship between temperatures and daily cumulative confirmed cases of COVID-19 in the range from 16.8 \u00b0C to 27.4 \u00b0C. Each 1 \u00b0C rise of temperature was associated with a -4.8951% (t = -2.29, p = 0.0226) decrease in the number of daily cumulative confirmed cases of COVID-19. A sensitivity analysis assessed the robustness of the results of the model. The predicted R-squared of the polynomial linear regression model was 0.81053. In this study, which features the tropical temperatures of Brazil, the variation in annual average temperatures ranged from 16.8 \u00b0C to 27.4 \u00b0C. Results indicated that temperatures had a negative linear relationship with the number of confirmed cases. The curve flattened at a threshold of 25.8 \u00b0C. There is no evidence supporting that the curve declined for temperatures above 25.8 \u00b0C. The study had the goal of supporting governance for healthcare policymakers.", "Besides the climate model, other variables driving the COVID-19 spread in Brazil() ", "Preliminary evidence that higher temperatures are associated with lower incidence of COVID-19, for cases reported globally up to 29th February 2020 Seasonal variation in COVID-19 incidence could impact the trajectory of the pandemic. Using global line-list data on COVID-19 cases reported until 29th February 2020 and global gridded temperature data, and after adjusting for surveillance capacity and time since first imported case, higher average temperature was strongly associated with lower COVID-19 incidence for temperatures of 1\u00b0C and higher. However, temperature explained a relatively modest amount of the total variation in COVID-19 incidence. These preliminary findings support stringent containment efforts in Europe and elsewhere.", "Impact of weather on COVID-19 pandemic in Turkey The coronavirus pandemic, which has numerous global implications, has led people to believe that nothing will be the same as before. The present day is dominated by studies on determining the factors that affect, taking preventive actions, and trying to find an effective treatment on top priority. Meteorological parameters are among the crucial factors affecting infectious diseases. The present study examines the correlation between weather and coronavirus disease 2019 (COVID-19) by considering nine cities in Turkey. In this regard, temperature (\u00b0C), dew point (\u00b0C), humidity (%), and wind speed (mph) are considered as parameters of weather. Research states that the incubation period of COVID-19 varies from 1\u00e2\u0080\u00afday to 14\u00e2\u0080\u00afdays. Therefore, the effects of each parameter within 1, 3, 7, and 14\u00e2\u0080\u00afdays are examined. In addition, the population is included as an effective parameter for evaluation. The analyses are conducted based on Spearman's correlation coefficients. The results showed that the highest correlations were observed for population, wind speed 14\u00e2\u0080\u00afdays ago, and temperature on the day, respectively. The study results may guide authorities and decision-makers on taking specific measures for the cities.", "An updated min-review on environmental route of the SARS-CoV-2 transmission The risk of newly emerging diseases is constantly present in a world where changes occur significantly in climatic, commercial, and ecological conditions, in addition to the development of biomedical investigations in new situations. An epidemic respiratory disease instigated by a new coronavirus was initially identified in and has resulted in the current global dissemination. This viral strain and its related disease has been termed \u201cSARS-CoV-2\u201d and \u201ccoronavirus disease 2019\u201d (abbreviated \u201cCOVID-19\u201d or \u201c2019-nCoV\u201d), respectively, which is transmitted simply between individuals. The World Health Organization (WHO) announced the COVID-19 outburst as a pandemic on March 11, which necessitates a cooperative endeavour globally for mitigating the spread of COVID-19. The absence of previous, and minimum present-day information, particularly concerning the path of contagion have precluded the control of this disease. The present article, therefore, describes the SARS-CoV-2 paths of contagion such as drinking water, solid waste, sewer water, ambient air, and the rest of emerging likely paths.", "Characterising the epidemic spread of Influenza A/H3N2 within a city through phylogenetics Infecting large portions of the global population, seasonal influenza is a major burden on societies around the globe. While the global source sink dynamics of the different seasonal influenza viruses have been studied intensively, it\u2019s local spread remains less clear. In order to improve our understanding of how influenza is transmitted on a city scale, we collected an extremely densely sampled set of influenza sequences alongside patient metadata. To do so, we sequenced influenza viruses isolated from patients of two different hospitals, as well as private practitioners in Basel, Switzerland during the 2016/2017 influenza season. The genetic sequences reveal that repeated introductions into the city drove the influenza season. We then reconstruct how the effective reproduction number changed over the course of the season. We find trends in transmission dynamics correlated positively with trends in temperature, but not relative humidity nor school holidays. Alongside the genetic sequence data that allows us to see how individual cases are connected, we gathered patient information, such as the age or household status. Zooming into the local transmission outbreaks suggests that the elderly were to a large extent infected within their own transmission network, while school children likely drove the spread within the remaining transmission network. These patterns will be valuable to plan interventions combating the spread of respiratory diseases within cities given that similar patterns are observed for other influenza seasons and cities. Author summary As shown with the current SARS-CoV-2 pandemic, respiratory diseases can quickly spread around the globe. While it can be hugely important to understand how diseases spread around the globe, local spread is most often the main driver of novel infections of respiratory diseases such as SARS-CoV-2 or influenza. We here use genetic sequence data alongside patient information to better understand what the drives the local spread of influenza by looking at the 2016/2017 influenza season in Basel, Switzerland as an example. The genetic sequence data allows us to reconstruct the how the transmission dynamics changed over the course of the season, which we correlate to changes, but not humidity or school holidays. Additionally, the genetic sequence data allows us to see how individual cases are connected. Using patient information, such as age and household status our analyses suggest that the elderly mainly transmit within their own transmission network. Additionally, they suggest that school aged children, but not pre-school aged children are important drivers of the local spread of influenza.", "The temperature and regional climate effects on communitarian COVID-19 contagion in Mexico throughout phase 1 Abstract Due to the close relationship between the incidence of infectious diseases by epidemics and environmental conditions, this research explores the temperature, evaporation, precipitation and regional climate effects on the local transmission of coronavirus SARS-CoV-2 inside 31 states and capital of Mexico since February 29 (national onset) to March 31, 2020. Statistical analysis was conducted to explore the association between the daily local COVID-19 confirmed positive cases (LCPC) and both climate characteristics and the daily weather reported by the regional meteorological stations. In this work, the local transmission ratio (LTR) was calculated with the regional LCPC divided by the number of the effective contagion days since regional onset in each state. The results showed a negative association between temperature (mean, max and min) and climate classification with both LCPC and LTR variables. The precipitation associated positively with LCPC and LTR. The associations between the climate classification with LCPC and LTR are statistically significant. The tropical climate (mean temperature around 25.95 \u00b0C and mean precipitation around 8.74 mm) delayed the regional onset. However, the regional onset in dry climates emerged earlier as consequence of the lower temperatures and higher precipitations (20.57 \u00b0C and 20.87 mm respectively) than the observed in the tropical climate. The fastest regional onsets were observed in tempered climates in states where the lowest temperatures and lowest precipitations were registered (19.65 \u00b0C and 8.48 mm respectively). Meteorological factors influenced the trend on the regional outbreaks in Mexican's states likely by the host predisposition and susceptibility during the cold winter season. In Mexico, the climate characteristics played a crucial role on the local infection during the phase 1 being the tempered regions (as Michoac\u00e1n, Jalisco, Puebla, etc.) more vulnerable than the dry (as Chihuahua, Durango or Zacatecas, etc.) or tropical areas (as Colima, Campeche, Morelos etc.).", "Relationship between Average Daily Temperature and Average Cumulative Daily Rate of Confirmed Cases of COVID-19 The rapid outbreak of the new Coronavirus (COVID-19) pandemic and the spread of the virus worldwide, especially in the Northern Hemisphere, have prompted various investigations about the impact of environmental factors on the rate of development of this epidemic. Different studies have called the attention to various parameters that may have influenced the spread of the virus, and in particular, the impact of climatic parameters has been emphasized. The main purpose of this study is to investigate the correlation between the average daily temperature and the rate of coronavirus epidemic growth in the infected regions. The main hypothesis object of our research is that between regions exhibiting a significant difference in the mean daily temperature, a significant difference is also observed in the average cumulative daily rate of confirmed cases, and that this does not happen if there is no significant difference in mean daily temperature. To test this research hypothesis, we carried on the case study of three regions in each of five countries and analyzed the correlation through F-test, and Independent-Samples T-Test. In all five selected countries, we found that when there is a significant difference in the daily mean temperature between two regions of a country, a significant difference exists also in the average cumulative daily rate of confirmed cases. Conversely, if there are no significant differences in the mean daily temperature of two regions in the same country, no significant difference is observed in the average cumulative daily rate of confirmed cases for these regions.", "Climatic factors influence COVID-19 outbreak as revealed by worldwide mortality The COVID-19 outbreak is triggering a global crisis that is challenging governments, health systems and the scientific community worldwide. A central question in the COVID-19 pandemic is whether climatic factors modulate its progression. This information is key to epidemiologists and healthcare decision-makers for improving their management plans. Previous attempts to assess the impact of climatic parameters have yielded ambiguous results, either because they were using geographically or temporally restricted data, or because they were comparing infection rates across countries, which were measured differently depending on local screening strategies. In March 2020, the spread of COVID-19 dramatically increased the number of countries recording deaths, providing an opportunity to use mortality rate, which is measured more homogeneously across countries than infection rates, as a descriptor of the COVID-19 outbreak over a large latitudinal range. Here, using data recorded in 208 territories from 88 countries, we show that mortality rate is negatively influenced by warmer air temperature and positively affected by higher relative humidity. Each additional Celsius degree decreases mortality rate by ~4%, while a 1% increase in relative humidity raises mortality rate by ~2%. Temperature is positively correlated with UV-index, for which one unit of increase results in a ~15% decrease in the mortality rate. We also show that other factors contribute to the dynamics of the COVID-19 outbreak, such as the proportion of vulnerable age classes in the population, access to a non-overwhelmed health system, as well as governmental travel restrictions for controlling the spread of the disease. All of them are critical factors impacting the mortality rate of COVID-19. The influence of climatic factors is a warning to all southern hemisphere countries where winter is coming soon. Northern hemisphere countries should also be warned that climatic factors alone will likely not be sufficient to contain the disease.", "Do Weather Temperature and Median-age affect COVID-19 Transmission? It was observed that the coldest countries and the eldest in terms of median-age were most distressed by COVID-19 pandemic, while the warmest countries and that have younger-aged population were the least affected. Therefore, this study utilized the non-linear least squares method to estimate the impact of weather temperatures and median age on COVID-19 cases per million in thirty-nine countries divided into two groups. The first group composed of twenty-four countries that announced the first COVID-19 case in January 2020, while the second group contains fifteen countries that witnessed the pandemic for the first time in February of the same year. The study revealed some major findings, which are: COVID-19 cases per million were not significantly affected by weather temperature or the median age in \u201cJanuary-group\u201d countries (after 72.67 days on average), while COVID-19 cases per million increased significantly by decreasing temperatures, and increasing the median age in case of \u201cFebruary-group\u201d countries (after an average of 44.80 days). This means that weather temperature and median age may influence the transmission rates of COVID-19 in its early stages, while weather temperature or median age no longer have effects in the advanced stages of the pandemic.", "REGIONAL DETERMINANTS OF THE EXPANSION OF COVID-19 IN BRAZIL Objective: This study investigates the regional differences in the occurrence of COVID-19 in Brazil and its relationship with climatic and demographic factors, for this, using data about identified cases of COVID-19 on Brazil from February 26 to April 04, 2020. Methods: A model using the Polynomial Regression with cubic adjustments of the number of days of contagion, demographic density, city population and climatic factors was designed to explain the spread of COVID-19 in Brazil. Main results: It was evidenced that temperature variation maintains a relationship with the reduction in the number of cases of COVID-19, but on a very small scale. With a simulation of 30 days of contagion, a variation of -0.9% was found for each increase of 1 C. Conclusion: Temperature, despite being an intervening factor in the variation in the number of COVID-19 cases, has a reduced magnitude effect. Cities with higher temperatures do not necessarily it is more protected from the SARS-CoV-2 than those with lower temperatures, however, strong statistical significance was found, this relationship deserves to be investigated in other tests with longer time series, wide and with especially non-linear data adjustments.", "Influence of socio-ecological factors on COVID-19 risk: a cross-sectional study based on 178 countries/regions worldwide BACKGROUND: The initial outbreak of COVID-19 caused by SARS-CoV-2 in China in 2019 has been severely tested in other countries worldwide. We aimed to describe the spatial distribution of the COVID-19 pandemic worldwide and assess the effects of various socio-ecological factors on COVID-19 risk. METHODS: We collected COVID-19 pandemic infection data and social-ecological data of 178 countries/regions worldwide from three database. We used spatial econometrics method to assess the global and local correlation of COVID-19 risk indicators for COVID-19. To estimate the adjusted incidence rate ratio (IRR), we modelled negative binomial regression analysis with spatial information and socio-ecological factors. FINDINGS: The study indicated that 37, 29 and 39 countries/regions were strongly opposite from the IR, CMR and DCI index \"spatial autocorrelation hypothesis\", respectively. The IRs were significantly positively associated with GDP per capita, the use of at least basic sanitation services and social insurance program coverage, and were significantly negatively associated with the proportion of the population spending more than 25% of household consumption or income on out-of-pocket health care expenses and the poverty headcount ratio at the national poverty lines. The CMR was significantly positively associated with urban populations, GDP per capita and current health expenditure, and was significantly negatively associated with the number of hospital beds, number of nurses and midwives, and poverty headcount ratio at the national poverty lines. The DCI was significantly positively associated with urban populations, population density and researchers in R&D, and was significantly negatively associated with the number of hospital beds, number of nurses and midwives and poverty headcount ratio at the national poverty lines. We also found that climatic factors were not significantly associated with COVID-19 risk. CONCLUSION: Countries/regions should pay more attention to controlling population flow, improving diagnosis and treatment capacity, and improving public welfare policies.", "Association between viral seasonality and meteorological factors Numerous viruses can cause upper respiratory tract infections. They often precede serious lower respiratory tract infections. Each virus has a seasonal pattern, with peaks in activity in different seasons. We examined the effects of daily local meteorological data (temperature, relative humidity, \u201chumidity-range\u201d and dew point) from Edinburgh, Scotland on the seasonal variations in viral transmission. We identified the seasonality of rhinovirus, adenovirus, influenza A and B viruses, human parainfluenza viruses 1\u20133 (HPIV), respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) from the 52060 respiratory samples tested between 2009 and 2015 and then confirmed the same by a generalised linear model. We also investigated the relationship between meteorological factors and viral seasonality. Non-enveloped viruses were present throughout the year. Following logistic regression adenovirus, influenza viruses A, B, RSV and HMPV preferred low temperatures; RSV and influenza A virus preferred a narrow \u201chumidity-range\u201d and HPIV type 3 preferred the season with lower humidity. A change (i.e. increase or decrease) in specific meteorological factors is associated with an increase in activity of specific viruses at certain times of the year.", "Exponential phase of covid19 expansion is not driven by climate at global scale The pandemic state of COVID-19 caused by the SARS CoV-2 put the world in quarantine and is causing an unprecedented economic crisis. However, COVID-19 is spreading in different rates at different countries. Here, we tested the effect of three classes of predictors, i.e., socioeconomic, climatic and transport, on the rate of daily increase of COVID-19. We found that global connections, represented by countries importance in the global air transportation network, is the main explanation for the growth rate of COVID-19 in different countries. Climate, geographic distance and socioeconomics did not affect this big picture analysis. Geographic distance and climate were significant barriers in the past but were surpassed by the human engine that allowed us to colonize almost every corner on Earth. Based on our global analysis, the global network of air transportation could lead to a worst-case scenario of synchronous global pandemic if board control measures in international airports were not taken and are not sustained during this pandemic. Despite all limitations of a global analysis, our results indicate that the current claims that the growth rate of COVID-19 may be lower in tropical countries should be taken very carefully, at risk to disturb well-established and effective policy of social isolation that may help to avoid higher mortality rates due to collapse of national health systems. This is the case of Brazil, a well-connected tropical country that presents the second highest increase rate of COVID-19 and might experience a serious case of human-induced disasters if decision makers take into consideration unsupported claims of the growth rate of COVID-19 might be lower in tropical countries.", "Assessing the interactions between COVID-19 and influenza in the United States The 2019\u20132020 influenza sentinel surveillance data exhibits unexpected trends. Typical influenza seasons have a small herald wave, followed by a decrease due to school closure during holidays, and then a main post-holiday peak that is significantly larger than the pre-holiday wave. During the 2019\u20132020 influenza season, influenza-like illness data in the United States appears to have a markedly lower main epidemic peak compared to what would be expected based on the pre-holiday peak. We hypothesize that the 2019\u20132020 influenza season does have a lower than expected burden and that this deflation is due to a behavioral or ecological interaction with COVID-19. We apply an intervention analysis to assess if this influenza season deviates from expectations, then we compare multiple hypothesized drivers of the decrease in influenza in a spatiotemporal regression model. Lastly, we develop a mechanistic metapopulation model, incorporating transmission reduction that scales with COVID-19 risk perception. We find that the 2019\u20132020 ILI season is smaller and decreases earlier than expected based on prior influenza seasons, and that the increase in COVID-19 risk perception is associated with this decrease. Additionally, we find that a 5% average reduction in transmission is sufficient to reproduce the observed flu dynamics. We propose that precautionary behaviors driven by COVID-19 risk perception or increased isolation driven by undetected COVID-19 spread dampened the influenza season. We suggest that when surveillance for a novel pathogen is limited, surveillance streams of co-circulating infections may provide a signal.", "Projecting the transmission dynamics of SARS-CoV-2 through the post-pandemic period There is an urgent need to project how transmission of the novel betacoronavirus SARS-CoV-2 will unfold in coming years. These dynamics will depend on seasonality, the duration of immunity, and the strength of cross-immunity to/from the other human coronaviruses. Using data from the United States, we measured how these factors affect transmission of human betacoronaviruses HCoV-OC43 and HCoV-HKU1. We then built a mathematical model to simulate transmission of SARS-CoV-2 through the year 2025. We project that recurrent wintertime outbreaks of SARS-CoV-2 will probably occur after an initial pandemic wave. We summarize the full range of plausible transmission scenarios and identify key data still needed to distinguish between them, most importantly longitudinal serological studies to determine the duration of immunity to SARS-CoV-2.", "Effects of temperature variation and humidity on the mortality of COVID-19 in Wuhan Object Meteorological parameters are the important factors influencing the infectious diseases like severe acute respiratory syndrome (SARS). This study aims to explore the association between coronavirus disease (COVID-19) death and weather parameters. Methods In this study, we collected the daily death number of COVID-19, meteorological and air pollutant data from 20 January, 2020 to 29 February, 2020 in Wuhan, China. Then, the generalized additive model was applied to explore the impact of temperature, humidity and diurnal temperature range on daily mortality of COVID-19. Results There were in total 2299 COVID-19 mortality counts in Wuhan. A positive association with COVID-19 mortality was observed for diurnal temperature range (r = 0.44), but negative association for relative humidity (r = -0.32). In addition, each 1 unit increase in diurnal temperature range was only associated with a 2.92% (95% CI: 0.61%, 5.28%) increase in COVID-19 mortality at lag 3. However, both per 1 unit increase of temperature and absolute humidity were related to the decreased COVID-19 mortality at lag 3 and lag 5, respectively. Conclusion In summary, this study suggests the temperature variation and humidity may be important factors affecting the COVID-19 mortality.", "Climate affects global patterns of COVID-19 early outbreak dynamics Environmental factors, including seasonal climatic variability, can strongly impact on spatio-temporal patterns of infectious disease outbreaks, but relationships between Covid-19 dynamics and climate remain controversial. We assessed the impact of temperature and humidity on the global patterns of Covid-19 early outbreak dynamics during January-March 2020. Here we show that Covid-19 growth rates peaked in temperate regions of the Northern Hemisphere with mean temperature of ~5 C, and specific humidity of 4-6 g/m3 during the outbreak period, while they were lower both in warmer/wetter and colder/dryer regions. Relationships between Covid-19 and climate were robust to the potential confounding effects of air pollution and socio-economic variables, including population size, density and health expenditure. The strong relationship between local climate and Covid-19 growth rates suggests the possibility of seasonal variation in the spatial pattern of outbreaks, with temperate regions of the Southern Hemisphere becoming at particular risk of severe outbreaks during the austral autumn-winter.", "Modeling the Control of COVID-19: Impact of Policy Interventions and Meteorological Factors In this paper, we propose a dynamical model to describe the transmission of COVID-19, which is spreading in China and many other countries. To avoid a larger outbreak in the worldwide, Chinese government carried out a series of strong strategies to prevent the situation from deteriorating. Home quarantine is the most important one to prevent the spread of COVID-19. In order to estimate the effect of population quarantine, we divide the population into seven categories for simulation. Based on a Least-Squares procedure and officially published data, the estimation of parameters for the proposed model is given. Numerical simulations show that the proposed model can describe the transmission of COVID-19 accurately, the corresponding prediction of the trend of the disease is given. The home quarantine strategy plays an important role in controlling the disease spread and speeding up the decline of COVID-19. The control reproduction number of most provinces in China are analyzed and discussed adequately. We should pay attention to that, though the epidemic is in decline in China, the disease still has high risk of human-to-human transmission continuously. Once the control strategy is removed, COVID-19 may become a normal epidemic disease just like flu. Further control for the disease is still necessary, we focus on the relationship between the spread rate of the virus and the meteorological conditions. A comprehensive meteorological index is introduced to represent the impact of meteorological factors on both high and low migration groups. As the progress on the new vaccine, we design detail vaccination strategies for COVID-19 in different control phases and show the effectiveness of efficient vaccination. Once the vaccine comes into use, the numerical simulation provide a promptly prospective research.", "Warmer weather and global trends in the coronavirus COVID-19 Predicting COVID-19 epidemic development in the upcoming warm season has attracted much attention in the hope of providing helps to fight the epidemic. It requires weather (environmental) factors to be included in prediction models, but there are few models to achieve it successfully. In this study, we proposed a new concept of environmental infection rate (RE), based on floating time of respiratory droplets in the air and inactivation rate of virus to solve the problem. More than half of the particles in the droplets can float in the atmosphere for 1-2 hours. The prediction results showed that high RE values (>3.5) are scattered around 30N in winter (Dec.-Feb.). As the weather warms, its distribution area expands and extends to higher latitudes of northern hemisphere, reaching its maximum in April, and then shrinking northward. These indicated that the spread of COVID-19 in most parts of the northern hemisphere is expected to decline after Apr., but the risks in high latitudes will remain high in May. In the south of southern hemisphere, the RE values tend to subside from Apr. to July. The high modeled RE values up to July, however, suggested that warmer weather will not stop COVID-19 from spreading. Public health intervention is needed to overcome the outbreak.", "The Relationship between the Global Burden of Influenza from 2017-2019 and COVID-19 Background SARS-CoV-2 and Influenza are lipid-enveloped viruses with differential morbidity and mortality but shared modes of transmission. We assessed whether historical patterns of regional influenza burden are reflected in the observed heterogeneity in COVID-19 cases across and within regions of the world. Methods Weekly surveillance data reported in FluNet from January 2017-December 2019 for influenza and World Health Organization for COVID-19 (to May 31, 2020) across the seven World Bank regions were used to assess the total and annual number of influenza and COVID-19 cases per country, within and across all regions, to generate comparative descending ranks from highest to lowest burden of disease. Results Across and within regions, rankings of influenza and COVID-19 were relatively consistent. Europe and Central Asia and North America ranked first and second for COVID-19 and second and first for influenza, respectively. East Asia and the Pacific traditionally ranked higher for influenza but to date, has been less affected by COVID-19. Between regions, Sub-Saharan Africa ranked amongst the least affected by both influenza and COVID-19. Conclusion Consistency in distribution of the burden of COVID-19 and influenza suggest shared individual, structural, and environmental determinants of transmission. Regions with discrepancies between influenza and COVID-19 burden may provide further insight into the potential impact of non-pharmacologic interventions and intersections with environmental conditions. Ultimately, forecasting trends and informing interventions for novel respiratory pathogens like COVID-19 should leverage patterns in the relative burden of past respiratory pathogens and the relative impact of non-pharmacologic intervention strategies as prior information.", "Correlation of the global spread of coronavirus disease-19 with atmospheric air temperature Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an enveloped virus that may be sensitive to heat. We assessed whether the spread of coronavirus disease 2019 (COVID-19) correlates with air temperature. We also studied whether additional climate, geographical, and population variables were correlated. The total number of confirmed COVID-19 cases and mortality rates reported in each country between 1st Jan and 31st Mar 2020 were compared with the country's three-month average atmospheric air temperature, precipitation and latitude. Spearman's correlation coefficient (rs) was used to identify significant correlations. Our analysis included a total of 748,555 confirmed COVID-19 cases worldwide. The total number of patients with COVID-19 decreased with increasing atmospheric air temperature (rs = -0.54, 95%CI: [-0.64, -0.42]; P <0.001) and increased with an increasing latitude (rs =0.60, 95%CI: [0.48, 0.70]; P <0.001). Our findings justify further studies to examine the effect of air temperature on infectivity of SAR-CoV-2.", "Anomalous atmospheric circulation favored the spread of COVID-19 in Europe The current pandemic caused by the coronavirus SARS-CoV-2 is having negative health, social and economic consequences worldwide. In Europe, the pandemic started to develop strongly at the end of February and beginning of March 2020. It has subsequently spread over the continent, with special virulence in northern Italy and inland Spain. In this study we show that an unusual persistent anticyclonic situation prevailing in southwestern Europe during February 2020 (i.e. anomalously strong positive phase of the North Atlantic and Arctic Oscillations) could have resulted in favorable conditions, in terms of air temperature and humidity, in Italy and Spain for a quicker spread of the virus compared with the rest of the European countries. It seems plausible that the strong atmospheric stability and associated dry conditions that dominated in these regions may have favored the virus's propagation, by short-range droplet transmission as well as likely by long-range aerosol (airborne) transmission.", "Will environmental changes in temperature affect the course of COVID-19? While the outbreak has reached every region of the world, it is undeniable that countries in the southern hemisphere seem to be less affected, where cases have been reported, these have been imported and travel related. We analyzed the climate temperature from various regions according to their current ongoing human-to-human transmission status. We studied 3 groups; Group 1, 10 provinces from China with majority of COVID-19 cases; Group 2, areas where continuous horizontal transmission outside of China had been reported; and group 3, areas where imported cases had been detected and no horizontal transmission had been documented after at least seven days since the first case was reported. The regions without ongoing human-to-human transmission showed significantly higher temperatures when compared to China and countries with ongoing human-to-human transmission, with over an 11-degree difference. The average rainfall during the study period was significantly higher in those regions without OHHT when compared to the Chinese provinces with ongoing human-to-human transmission and the regions with active transmission of SARS-CoV-2. Our findings show statistically significant differences between regions with ongoing human-to-human transmission of COVID-19 cases compared to those regions without horizontal transmission. This phenomenon could have implications in the behavior of the ongoing COVID-19 outbreak in the following months.", "Higher solar irradiance is associated with a lower incidence of COVID-19 We studied the relationship between the incidence of coronavirus disease 2019 (COVID-19), demographical, and climatological measurements in different regions across the world. Lower solar irradiance and higher population density were independent predictors of greater COVID-19 outbreaks. Further studies on the potential protective effect of sunlight over COVID-19 are warranted.", "Evidence that higher temperatures are associated with lower incidence of COVID-19 in pandemic state, cumulative cases reported up to March 27, 2020 Seasonal temperature variation may impact the trajectories of COVID-19 in different global regions. Cumulative data reported by the World Health Organization, for dates up to March 27, 20201, show association between COVID-19 incidence and regions at or above 30\u00b0 latitude. Historic climate data also show significant reduction of case rates with mean maximum temperature above approximately 22.5 degrees Celsius. Variance at the local level, however, could not be well explained by geography and temperature. These preliminary findings support continued countermeasures and study of SARS-CoV-2/COVID-19 transmission rates by temperature and humidity.", "Short-Term Effects of Ambient Ozone, PM2.5, and Meteorological Factors on COVID-19 Confirmed Cases and Deaths in Queens, New York The outbreak of coronavirus disease 2019 (COVID-19), caused by the virus SARS-CoV-2, has been rapidly increasing in the United States. Boroughs of New York City, including Queens county, turn out to be the epicenters of this infection. According to the data provided by the New York State Department of Health, most of the cases of new COVID-19 infections in New York City have been found in the Queens county where 42,023 people have tested positive, and 3221 people have died as of 20 April 2020. Person-to-person transmission and travels were implicated in the initial spread of the outbreaks, but factors related to the late phase of rapidly spreading outbreaks in March and April are still uncertain. A few previous studies have explored the links between air pollution and COVID-19 infections, but more data is needed to understand the effects of short-term exposures of air pollutants and meteorological factors on the spread of COVID-19 infections, particularly in the U.S. disease epicenters. In this study, we have focused on ozone and PM2.5, two major air pollutants in New York City, which were previously found to be associated with respiratory viral infections. The aim of our regression modeling was to explore the associations among ozone, PM2.5, daily meteorological variables (wind speed, temperature, relative humidity, absolute humidity, cloud percentages, and precipitation levels), and COVID-19 confirmed new cases and new deaths in Queens county, New York during March and April 2020. The results from these analyses showed that daily average temperature, daily maximum eight-hour ozone concentration, average relative humidity, and cloud percentages were significantly and positively associated with new confirmed cases related to COVID-19; none of these variables showed significant associations with new deaths related to COVID-19. The findings indicate that short-term exposures to ozone and other meteorological factors can influence COVID-19 transmission and initiation of the disease, but disease aggravation and mortality depend on other factors.", "COVID-19 and climate: global evidence from 117 countries Visual inspection of world maps shows that coronavirus disease 2019 (COVID-19) is less prevalent in countries closer to the equator, where heat and humidity tend to be higher. Scientists disagree how to interpret this observation because the relationship between COVID-19 and climatic conditions may be confounded by many factors. We regress confirmed COVID-19 cases per million inhabitants in a country against the country\u2019s distance from the equator, controlling key confounding factors: air travel, distance to Wuhan, testing intensity, cell phone usage, vehicle concentration, urbanization, and income. A one-degree increase in absolute latitude is associated with a 2.6% increase in cases per million inhabitants (p value <0.001). The Northern hemisphere may see a decline in new COVID-19 cases during summer and a resurgence during winter.", "Meteorological factors and domestic new cases of coronavirus disease (COVID-19) in nine Asian cities: A time-series analysis AIM To investigate the associations of meteorological factors and the daily new cases of coronavirus disease (COVID-19) in nine Asian cities. METHOD Pearson correlation and generalized additive modeling were performed to assess the relationships between daily new COVID-19 cases and meteorological factors (daily average temperature and relative humidity) with the most updated data currently available. RESULTS The Pearson correlation showed that daily new confirmed cases of COVID-19 were more correlated with the average temperature than with relative humidity. Daily new confirmed cases were negatively correlated with the average temperature in Beijing (r=-0.565, P<0.01), Shanghai (r=-0.471, P<0.01), and Guangzhou (r=-0.530, P<0.01) , yet in contrast, positively correlated with that in Japan (r=0.441, P<0.01). In most of the cities (Shanghai, Guangzhou, Hong Kong, Seoul, Tokyo, and Kuala Lumpur), generalized additive modeling analysis showed the number of daily new confirmed cases was positively associated with both average temperature and relative humidity, especially in lagged 3d model, where a positive influence of temperature on the daily new confirmed cases was discerned in 5 cities except in Beijing, Wuhan, Korea, and Malaysia. Nevertheless, the results were inconsistent across cities and lagged time, suggesting meteorological factors were unlikely to greatly influence the COVID-19 epidemic. CONCLUSION The associations between meteorological factors and the number of COVID-19 daily cases are inconsistent across cities and lagged time. Large-scale public health measures and expanded regional research are still required until a vaccine becomes available and herd immunity is established.", "Weathering the pandemic: How the Caribbean Basin can use viral and environmental patterns to predict, prepare and respond to COVID\u201019 The 2020 coronavirus pandemic is developing at different paces throughout the world. Some areas, like the Caribbean Basin, have yet to see the virus strike at full force. When it does, there is reasonable evidence to suggest the consequent COVID\u201019 outbreaks will overwhelm healthcare systems and economies. This is particularly concerning in the Caribbean as pandemics can have disproportionately higher mortality impacts on lower and middle income countries. Preliminary observations from our team and others suggest that temperature and climatological factors could influence the spread of this novel coronavirus, making spatiotemporal predictions of its infectiousness possible. This review studies geographic and time\u2010based distribution of known respiratory viruses in the Caribbean Basin in an attempt to foresee how the pandemic will develop in this region. This review is meant to aid in planning short\u2010 and long\u2010term interventions to manage outbreaks at the international, national and sub\u2010national levels in the region. This article is protected by copyright. All rights reserved.", "Let the sun shine in: effects of ultraviolet radiation on invasive pneumococcal disease risk in Philadelphia, Pennsylvania BACKGROUND: Streptococcus pneumoniae is a common cause of community acquired pneumonia and bacteremia. Excess wintertime mortality related to pneumonia has been noted for over a century, but the seasonality of invasive pneumococcal disease (IPD) has been described relatively recently and is poorly understood. Improved understanding of environmental influence on disease seasonality has taken on new urgency due to global climate change. METHODS: We evaluated 602 cases of IPD reported in Philadelphia County, Pennsylvania, from 2002 to 2007. Poisson regression models incorporating seasonal smoothers were used to identify associations between weekly weather patterns and case counts. Associations between acute (day-to-day) environmental fluctuations and IPD occurrence were evaluated using a case-crossover approach. Effect modification across age and sex strata was explored, and meta-regression models were created using stratum-specific estimates for effect. RESULTS: IPD incidence was greatest in the wintertime, and spectral decomposition revealed a peak at 51.0 weeks, consistent with annual periodicity. After adjustment for seasonality, yearly increases in reporting, and temperature, weekly incidence was found to be associated with clear-sky UV index (IRR per unit increase in index: 0.70 [95% CI 0.54-0.91]). The effect of UV index was highest among young strata and decreased with age. At shorter time scales, only an association with increases in ambient sulphur oxides was linked to disease risk (OR for highest tertile of exposure 0.75, 95% CI 0.60 to 0.93). CONCLUSION: We confirmed the wintertime predominance of IPD in a major urban center. The major predictor of IPD in Philadelphia is extended periods of low UV radiation, which may explain observed wintertime seasonality. The mechanism of action of diminished light exposure on disease occurrence may be due to direct effects on pathogen survival or host immune function via altered 1,25-(OH)(2)-vitamin-D metabolism. These findings may suggest less diminution in future IPD risk with climate change than would be expected if wintertime seasonality was driven by temperature.", "Environmental factors on the SARS epidemic: air temperature, passage of time and multiplicative effect of hospital infection. The study sought to identify factors involved in the emergence, prevention and elimination of severe acute respiratory syndrome (SARS) in Hong Kong during 11 March to 22 May 2003. A structured multiphase regression analysis was used to estimate the potential effects of weather, time and interaction effect of hospital infection. In days with a lower air temperature during the epidemic, the risk of increased daily incidence of SARS was 18.18-fold (95% confidence interval 5.6-58.8) higher than in days with a higher temperature. The total daily new cases might naturally decrease by an average of 2.8 patients for every 10 days during the epidemic. The multiplicative effect of infected hospital staff with patients in an intensive care unit (ICU) and the proportion of SARS patients in ICUs might respectively increase the risk of a larger SARS epidemic in the community. The provision of protective gear in hospitals was also a very important factor for the prevention of SARS infection. SARS transmission appeared to be dependent on seasonal temperature changes and the multiplicative effect of hospital infection. SARS also appeared to retreat naturally over time.", "Possible meteorological influence on the severe acute respiratory syndrome (SARS) community outbreak at Amoy Gardens, Hong Kong. The largest community outbreak of Severe Acute Respiratory Syndrome (SARS) occurred in the Amoy Gardens residential estate in Hong Kong, in March and April of 2003. It affected more than 300 residents, or 1.7 percent of the total Amoy Gardens population. An airborne pathway has been hypothesized as a possible mode for the spread of the disease. If that hypothesis is correct, meteorological factors may have played a contributory role; the virus-laden aerosols may have been transported between apartment blocks by the ambient wind, low mixing heights may have prevented the efficient dispersion of the aerosols, and a fall in temperature may have fostered the survival of the virus or increased the susceptibility of the exposed population. This information, used in combination with weather forecasts available several days ahead from meteorological services, should be useful for mitigation considerations in the unlikely event of a similar occurrence.", "Preventing Airborne Disease Transmission: Review of Methods for Ventilation Design in Health Care Facilities Health care facility ventilation design greatly affects disease transmission by aerosols. The desire to control infection in hospitals and at the same time to reduce their carbon footprint motivates the use of unconventional solutions for building design and associated control measures. This paper considers indoor sources and types of infectious aerosols, and pathogen viability and infectivity behaviors in response to environmental conditions. Aerosol dispersion, heat and mass transfer, deposition in the respiratory tract, and infection mechanisms are discussed, with an emphasis on experimental and modeling approaches. Key building design parameters are described that include types of ventilation systems (mixing, displacement, natural and hybrid), air exchange rate, temperature and relative humidity, air flow distribution structure, occupancy, engineered disinfection of air (filtration and UV radiation), and architectural programming (source and activity management) for health care facilities. The paper describes major findings and suggests future research needs in methods for ventilation design of health care facilities to prevent airborne infection risk.", "Climate Change and the Geographic Distribution of Infectious Diseases Our ability to predict the effects of climate change on the spread of infectious diseases is in its infancy. Numerous, and in some cases conflicting, predictions have been developed, principally based on models of biological processes or mapping of current and historical disease statistics. Current debates on whether climate change, relative to socioeconomic determinants, will be a major influence on human disease distributions are useful to help identify research needs but are probably artificially polarized. We have at least identified many of the critical geophysical constraints, transport opportunities, biotic requirements for some disease systems, and some of the socioeconomic factors that govern the process of migration and establishment of parasites and pathogens. Furthermore, we are beginning to develop a mechanistic understanding of many of these variables at specific sites. Better predictive understanding will emerge in the coming years from analyses regarding how these variables interact with each other.", "ICU admissions and in-hospital deaths linked to covid-19 in the Paris region are correlated with previously observed ambient temperature OBJECTIVE To study the effect of weather on severity indicators of coronavirus disease 2019 (covid-19). DESIGN Ecological study. SETTING Paris region. POPULATION Severely ill patients with covid-19. MAIN OUTCOME MEASURES Daily covid-19-related intensive care unit (ICU) admission and in-hospital deaths in the Paris region, and the daily weather characteristics of Paris midtown. RESULTS Daily ICU admissions and in-hospital deaths were strongly and negatively correlated to ambient temperatures, with a time lag. The highest Pearson correlation coefficients and statistically significant P values were found 8 days before occurrence of ICU admissions and 15 days before deaths. CONCLUSIONS The study findings show a strong effect of previously observed ambient temperature that has an effect on severity indicators of covid-19.", "Stability of SARS coronavirus in human specimens and environment and its sensitivity to heating and UV irradiation. OBJECTIVE The causal agent for SARS is considered as a novel coronavirus that has never been described both in human and animals previously. The stability of SARS coronavirus in human specimens and in environments was studied. METHODS Using a SARS coronavirus strain CoV-P9, which was isolated from pharyngeal swab of a probable SARS case in Beijing, its stability in mimic human specimens and in mimic environment including surfaces of commonly used materials or in household conditions, as well as its resistance to temperature and UV irradiation were analyzed. A total of 10(6) TCID50 viruses were placed in each tested condition, and changes of the viral infectivity in samples after treatments were measured by evaluating cytopathic effect (CPE) in cell line Vero-E6 at 48 h after infection. RESULTS The results showed that SARS coronavirus in the testing condition could survive in serum, 1:20 diluted sputum and feces for at least 96 h, whereas it could remain alive in urine for at least 72 h with a low level of infectivity. The survival abilities on the surfaces of eight different materials and in water were quite comparable, revealing reduction of infectivity after 72 to 96 h exposure. Viruses stayed stable at 4 degrees C, at room temperature (20 degrees C) and at 37 degrees C for at least 2 h without remarkable change in the infectious ability in cells, but were converted to be non-infectious after 90-, 60- and 30-min exposure at 56 degrees C, at 67 degrees C and at 75 degrees C, respectively. Irradiation of UV for 60 min on the virus in culture medium resulted in the destruction of viral infectivity at an undetectable level. CONCLUSION The survival ability of SARS coronavirus in human specimens and in environments seems to be relatively strong. Heating and UV irradiation can efficiently eliminate the viral infectivity.", "Statistical analysis of the impact of environmental temperature on the exponential growth rate of cases infected by COVID-19 We perform a statistical analysis for understanding the effect of the environmental temperature on the exponential growth rate of the cases infected by COVID-19 for US and Italian regions. In particular, we analyze the datasets of regional infected cases, derive the growth rates for regions characterized by a readable exponential growth phase in their evolution spread curve and plot them against the environmental temperatures averaged within the same regions, derive the relationship between temperature and growth rate, and evaluate its statistical confidence. The results clearly support the first reported statistically significant relationship of negative correlation between the average environmental temperature and exponential growth rates of the infected cases. The critical temperature, which eliminates the exponential growth, and thus the COVID-19 spread in US regions, is estimated to be T(C) = 86.1 \u00b1 4.3 F(0).", "Impact of temperature on the dynamics of the COVID-19 outbreak in China A COVID-19 outbreak emerged in Wuhan, China at the end of 2019 and developed into a global pandemic during March 2020. The effects of temperature on the dynamics of the COVID-19 epidemic in China are unknown. Data on COVID-19 daily confirmed cases and daily mean temperatures were collected from 31 provincial-level regions in mainland China between Jan. 20 and Feb. 29, 2020. Locally weighted regression and smoothing scatterplot (LOESS), distributed lag nonlinear models (DLNMs), and random-effects meta-analysis were used to examine the relationship between daily confirmed cases rate of COVID-19 and temperature conditions. The daily number of new cases peaked on Feb. 12, and then decreased. The daily confirmed cases rate of COVID-19 had a biphasic relationship with temperature (with a peak at 10 \u00b0C), and the daily incidence of COVID-19 decreased at values below and above these values. The overall epidemic intensity of COVID-19 reduced slightly following days with higher temperatures with a relative risk (RR) was 0.96 (95% CI: 0.93, 0.99). A random-effect meta-analysis including 28 provinces in mainland China, we confirmed the statistically significant association between temperature and RR during the study period (Coefficient = -0.0100, 95% CI: -0.0125, -0.0074). The DLNMs in Hubei Province (outside of Wuhan) and Wuhan showed similar patterns of temperature. Additionally, a modified susceptible-exposed-infectious-recovered (M-SEIR) model, with adjustment for climatic factors, was used to provide a complete characterization of the impact of climate on the dynamics of the COVID-19 epidemic.", "Decline in temperature and humidity increases the occurrence of influenza in cold climate BACKGROUND: Both temperature and humidity may independently or jointly contribute to the risk of influenza infections. We examined the relations between the level and decrease of temperature, humidity and the risk of influenza A and B virus infections in a subarctic climate. METHODS: We conducted a case-crossover study among military conscripts (n = 892) seeking medical attention due to respiratory symptoms during their military training period and identified 66 influenza A and B cases by PCR or serology. Meteorological data such as measures of average and decline in ambient temperature and absolute humidity (AH) during the three preceding days of the onset (hazard period) and two reference periods, prior and after the onset were obtained. RESULTS: The average temperature preceding the influenza onset was \u22126.8 \u00b1 5.6\u00b0C and AH 3.1 \u00b1 1.3 g/m(3). A decrease in both temperature and AH during the hazard period increased the occurrence of influenza so that a 1\u00b0C decrease in temperature and 0.5 g decrease per m(3) in AH increased the estimated risk by 11% [OR 1.11 (1.03 to 1.20)] and 58% [OR 1.58 (1.28 to 1.96)], respectively. The occurrence of influenza infections was positively associated with both the average temperature [OR 1.10 per 1\u00b0C (95% confidence interval 1.02 to 1.19)] and AH [OR 1.25 per g/m(3) (1.05 to 1.49)] during the hazard period prior to onset. CONCLUSION: Our results demonstrate that a decrease rather than low temperature and humidity per se during the preceding three days increase the risk of influenza episodes in a cold climate.", "SARS-CoV-2 infection: the environmental endurance of the virus can be influenced by the increase of temperature The COVID-19 disease, a respiratory disease transmitted by a new betacoronavirus SARS-CoV-2. As for other viral respiratory agents, SARS-CoV-2 spreads by person to person through respiratory droplets and direct contact and potentially by indirect contact through fomites. The goal of the current study is to evaluate whether the increase of temperature can influence the environmental endurance of SARS-CoV-2.We tested SARS-CoV-2 environmental stability in parallel at room temperature (RT, 20-25 Celsius degrees) and at average maximum temperature of June (JT) estimated at 28 Celsius degrees in Italy. The virus inoculated on plastic surface was harvested at predefined time-points and tested to evaluate viral titres on Vero cells by TCID50. Our results confirm that fomite transmission of the emerging SARS-CoV2 is possible, since the virus remains viable on surfaces up to 84 hours at both RT and JT. Moreover, a remarkable difference between the two temperatures exists, suggesting that virus vitality can be influenced by the environmental temperature. Our results support the hypothesis that in the hot season the increase of temperature could influence the environmental endurance of SARS-CoV2 and reduce Covid-19 transmission probability.", "Weather variables impact on COVID-19 incidence We test the hypothesis of COVID-19 contagion being influenced by meteorological parameters such as temperature or humidity. We analysed data at high spatial resolution (regions in Italy and counties in the USA) and found that while at low resolution this might seem the case, at higher resolution no correlation is found. Our results are consistent with a poor outdoors transmission of the disease. However, a possible indirect correlation between good weather and a decrease in disease spread may occur, as people spend longer time outdoors.", "Prediction of the Number of COVID-19 Confirmed Cases Based on K-Means-LSTM COVID-19 is a pandemic disease that began to rapidly spread in the US with the first case detected on January 19, 2020, in Washington State. March 9, 2020, and then increased rapidly with total cases of 25,739 as of April 20, 2020. The Covid-19 pandemic is so unnerving that it is difficult to understand how any person is affected by the virus. Although most people with coronavirus 81%, according to the U.S. Centers for Disease Control and Prevention (CDC), will have little to mild symptoms, others may rely on a ventilator to breathe or not at all. SEIR models have broad applicability in predicting the outcome of the population with a variety of diseases. However, many researchers use these models without validating the necessary hypotheses. Far too many researchers often\"overfit\"the data by using too many predictor variables and small sample sizes to create models. Models thus developed are unlikely to stand validity check on a separate group of population and regions. The researcher remains unaware that overfitting has occurred, without attempting such validation. In the paper, we present a combination algorithm that combines similar days features selection based on the region using Xgboost, K Means, and long short-term memory (LSTM) neural networks to construct a prediction model (i.e., K-Means-LSTM) for short-term COVID-19 cases forecasting in Louisana state USA. The weighted k-means algorithm based on extreme gradient boosting is used to evaluate the similarity between the forecasts and past days. The results show that the method with K-Means-LSTM has a higher accuracy with an RMSE of 601.20 whereas the SEIR model with an RMSE of 3615.83.", "Correlation between weather and Covid-19 pandemic in Jakarta, Indonesia This study aims to analyze the correlation between weather and covid-19 pandemic in Jakarta Indonesia. This study employed a secondary data analysis of surveillance data of covid-19 from the Ministry of Health of the Republic of Indonesia and weather from the Meteorological Department of the Republic of Indonesia. The components of weather include minimum temperature (\u00b0C), maximum temperature (\u00b0C), temperature average (\u00b0C), humidity (%), and amount of rainfall (mm). Spearman-rank correlation test was used for data analysis. Among the components of the weather, only temperature average (\u00b0C) was significantly correlated with covid-19 pandemic (r = 0.392; p < .01). The finding serves as an input to reduce the incidence rate of covid-19 in Indonesia.", "Effects of school closure on incidence of pandemic influenza in Alberta, Canada. BACKGROUND Control of pandemic influenza by social-distancing measures, such as school closures, is a controversial aspect of pandemic planning. However, investigations of the extent to which these measures actually affect the progression of a pandemic have been limited. OBJECTIVE To examine correlations between the incidence of pandemic H1N1 (pH1N1) influenza in Alberta, Canada, in 2009 and school closures or weather changes, and to estimate the effects of school closures and weather changes on pH1N1 transmission. DESIGN Mathematical transmission models were fit to data that compared the pattern of confirmed pH1N1 cases with the school calendar and weather patterns. SETTING Alberta, Canada, from 19 April 2009 to 2 January 2010. DATA SOURCES 2009 virologic test results, 2006 census data, 2009 daily temperature and humidity data, and 2009 school calendars. MEASUREMENTS Age-specific daily counts of positive results for pH1N1 from the complete database of 35 510 specimens submitted to the Alberta Provincial Laboratory for Public Health for virologic testing from 19 April 2009 to 2 January 2010. RESULTS The ending and restarting of school terms had a major effect in attenuating the first wave and starting the second wave of pandemic influenza cases. Mathematical models suggested that school closure reduced transmission among school-age children by more than 50% and that this was a key factor in interrupting transmission. The models also indicated that seasonal changes in weather had a significant effect on the temporal pattern of the epidemic. LIMITATIONS Data probably represent a small sample of all viral infections. The mathematical models make simplifying assumptions in order to make simulations and analysis feasible. CONCLUSION Analysis of data from unrestricted virologic testing during an influenza pandemic provides compelling evidence that closing schools can have dramatic effects on transmission of pandemic influenza. School closure seems to be an effective strategy for slowing the spread of pandemic influenza in countries with social contact networks similar to those in Canada. PRIMARY FUNDING SOURCE Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, and Public Health Agency of Canada.", "Impact of temperature on the dynamics of the COVID-19 outbreak in China Abstract A COVID-19 outbreak emerged in Wuhan, China at the end of 2019 and developed into a global pandemic during March 2020. The effects of temperature on the dynamics of the COVID-19 epidemic in China are unknown. Data on COVID-19 daily confirmed cases and daily mean temperatures were collected from 31 provincial-level regions in mainland China between Jan. 20 and Feb. 29, 2020. Locally weighted regression and smoothing scatterplot (LOESS), distributed lag nonlinear models (DLNMs), and random-effects meta-analysis were used to examine the relationship between daily confirmed cases rate of COVID-19 and temperature conditions. The daily number of new cases peaked on Feb. 12, and then decreased. The daily confirmed cases rate of COVID-19 had a biphasic relationship with temperature (with a peak at 10 \u00b0C), and the daily incidence of COVID-19 decreased at values below and above these values. The overall epidemic intensity of COVID-19 reduced slightly following days with higher temperatures with a relative risk (RR) was 0.96 (95% CI: 0.93, 0.99). A random-effect meta-analysis including 28 provinces in mainland China, we confirmed the statistically significant association between temperature and RR during the study period (Coefficient = \u22120.0100, 95% CI: \u22120.0125, \u22120.0074). The DLNMs in Hubei Province (outside of Wuhan) and Wuhan showed similar patterns of temperature. Additionally, a modified susceptible-exposed-infectious-recovered (M-SEIR) model, with adjustment for climatic factors, was used to provide a complete characterization of the impact of climate on the dynamics of the COVID-19 epidemic.", "Changes in temperature alter the potential outcomes of virus host shifts Host shifts\u2013where a pathogen jumps between different host species\u2013are an important source of emerging infectious disease. With on-going climate change there is an increasing need to understand the effect changes in temperature may have on emerging infectious disease. We investigated whether species\u2019 susceptibilities change with temperature and ask if susceptibility is greatest at different temperatures in different species. We infected 45 species of Drosophilidae with an RNA virus and measured how viral load changes with temperature. We found the host phylogeny explained a large proportion of the variation in viral load at each temperature, with strong phylogenetic correlations between viral loads across temperature. The variance in viral load increased with temperature, while the mean viral load did not. This suggests that as temperature increases the most susceptible species become more susceptible, and the least susceptible less so. We found no significant relationship between a species\u2019 susceptibility across temperatures, and proxies for thermal optima (critical thermal maximum and minimum or basal metabolic rate). These results suggest that whilst the rank order of species susceptibilities may remain the same with changes in temperature, some species may become more susceptible to a novel pathogen, and others less so.", "COVID-19 and globalization ", "COVID-19 transmission in Mainland China is associated with temperature and humidity: A time-series analysis Abstract COVID-19 has become a pandemic. The influence of meteorological factors on the transmission and spread of COVID-19 is of interest. This study sought to examine the associations of daily average temperature (AT) and relative humidity (ARH) with the daily count of COVID-19 cases in 30 Chinese provinces (in Hubei from December 1, 2019 to February 11, 2020 and in other provinces from January 20, 2020 to Februarys 11, 2020). A Generalized Additive Model (GAM) was fitted to quantify the province-specific associations between meteorological variables and the daily cases of COVID-19 during the study periods. In the model, the 14-day exponential moving averages (EMAs) of AT and ARH, and their interaction were included with time trend and health-seeking behavior adjusted. Their spatial distributions were visualized. AT and ARH showed significantly negative associations with COVID-19 with a significant interaction between them (0.04, 95% confidence interval: 0.004\u20130.07) in Hubei. Every 1 \u00b0C increase in the AT led to a decrease in the daily confirmed cases by 36% to 57% when ARH was in the range from 67% to 85.5%. Every 1% increase in ARH led to a decrease in the daily confirmed cases by 11% to 22% when AT was in the range from 5.04 \u00b0C to 8.2 \u00b0C. However, these associations were not consistent throughout Mainland China.", "Climatic influence on the magnitude of COVID-19 outbreak: a stochastic model-based global analysis This study examines the association between community transmission of COVID-19 cases and climatic predictors, considering travel information and annual parasite index across the three climatic zones, i.e., tropical, subtropical, and temperate. A Boosted Regression Tree model has been employed to understand the association between the COVID-19 cases. The results show that average temperature and average relative humidity are the major contributors in explaining the differentials of COVID-19 transmission in temperate and subtropical regions whereas the mean diurnal temperature range and temperature seasonality are the most significant determinants in tropical regions. The average temperature is the most influential factor affecting the number of COVID-19 cases in France, Turkey, the US, the UK, and Germany, and the cases decrease sharply above 10oC. Among the tropical countries, India found to be most affected by mean diurnal temperature, and Brazil fazed by temperature seasonality. Most of the temperate countries like France, USA, Turkey, UK, and Germany with an average temperature between 5-12oC had high number of COVID-19 cases. The findings are expected to add to the ongoing debates on the influence of climatic factors influencing the number of COVID-19 cases and could help researchers and policymakers to make appropriate decisions for preventing the spread.", "Projections for COVID-19 pandemic in India and effect of temperature and humidity BACKGROUND AND AIMS: As, the COVID-19 has been deemed a pandemic by World Health Organization (WHO), and since it spreads everywhere throughout the world, investigation in relation to this disease is very much essential. Investigation of pattern in the occurrence of COVID-19, to check the influence of different meteorological factors on the incidence of COVID-19 and prediction of incidence of COVID-19 are the objectives of this paper. METHODS: For trend analysis, Sen's Slope and Man-Kendall test have been used, Generalized Additive Model (GAM) of regression has been used to check the influence of different meteorological factors on the incidence and to predict the frequency of COVID-19, and Verhulst (Logistic) Population Model has been used. RESULTS: Statistically significant linear trend found for the daily-confirmed cases of COVID-19. The regression analysis indicates that there is some influence of the interaction of average temperature (AT) and average relative humidity (ARH) on the incidence of COVID-19. However, this result is not consistent throughout the study area. The projections have been made up to 21st May, 2020. CONCLUSIONS: Trend and regression analysis give an idea of the incidence of COVID-19 in India while projection made by Verhulst (Logistic) Population Model for the confirmed cases of the study area are encouraging as the sample prediction is as same as the actual number of confirmed COVID-19 cases.", "High Temperature and High Humidity Reduce the Transmission of COVID-19 With the ongoing global pandemic of COVID-19, a question is whether the coming summer in the northern hemisphere will reduce the transmission intensity of COVID-19 with increased humidity and temperature. In this paper, we investigate this problem using the data from the cases with symptom-onset dates from January 19 to February 10, 2020 for 100 Chinese cities, and cases with confirmed dates from March 15 to April 25 for 1,005 U.S. counties. Statistical analysis is performed to assess the relationship between the transmissibility of COVID-19 and the temperature/humidity, by controlling for various demographic, socio-economic, geographic, healthcare and policy factors and correcting for cross-sectional correlation. We find a similar influence of the temperature and relative humidity on effective reproductive number (R values) of COVID-19 for both China and the U.S. before lockdown in both countries: one-degree Celsius increase in temperature reduces R value by about 0.023 (0.026 (95% CI [-0.0395,-0.0125]) in China and 0.020 (95% CI [-0.0311, -0.0096]) in the U.S.), and one percent relative humidity rise reduces R value by 0.0078 (0.0076 (95% CI [-0.0108,-0.0045]) in China and 0.0080 (95% CI [-0.0150,-0.0010]) in the U.S.). If assuming a 30 degree and 25 percent increase in temperature and relative humidity from winter to summer in the northern hemisphere, we expect the R values to decline about 0.89 (0.69 by temperature and 0.20 by humidity). Given the notion that the non-intervened R values are around 2.5 to 3, only weather factors cannot make the R values below their critical condition of R<1, under which the epidemic diminishes gradually. Therefore, public health intervention such as social distancing is crucial to block the transmission of COVID-19 even in summer.", "Genetic drift and environmental spreading dynamics of COVID-19 Objective To delineate the genetic and environmental determinants of COVID-19 spreading. Design Retrospective case series. Setting Spain, Italy, Sweden, Finland, Norway. Participants All laboratory-confirmed infection cases (n=168,089) collected from February 21st to April 14th 2020. Main outcome measures Infection spreading velocity according to viral mutation load and to climate region. Results The mean doubling time of COVID-19 was 6.63 days in northern Italy, 5.87 days in central areas, and 5.38 days in southern Italy, with shorter COVID-19 doubling time in warmer regions. Spain extended this trend, with a mean COVID-19 doubling time of 4.2 days. At the other end of the spectrum, slower diffusion across progressively colder regions was observed in Scandinavia, with 9.4 days COVID-19 doubling time in Sweden, 10.8 days in Finland and 12.95 days in Norway. Mutations and mutation rates of SARS-CoV-2 versus COVID-19 spreading were analyzed worldwide. Models of increased aggressiveness of SARS-CoV-2 upon progressive acquisition of genetic changes were not supported by regional mutation data. Conclusion Current propagation models suggest dependence of COVID-19 pandemic spreading on wintertime conditions, with expected waning over the summer. Our findings indicate association of COVID-19 to a sharp North/South climate gradient, with faster spreading in southern regions. Thus, warmer climate conditions may not limit SARS-CoV-2 diffusion. Very cold regions may be better spared by recurrent courses of infection.", "COVID-19: Open-data resources for monitoring, modeling, and forecasting the epidemic We provide an insight into the open-data resources pertinent to the study of the spread of the Covid-19 pandemic and its control. We identify the variables required to analyze fundamental aspects like seasonal behavior, regional mortality rates, and effectiveness of government measures. Open-data resources, along with data-driven methodologies, provide many opportunities to improve the response of the different administrations to the virus. We describe the present limitations and difficulties encountered in most of the open-data resources. To facilitate the access to the main open-data portals and resources, we identify the most relevant institutions, on a global scale, providing Covid-19 information and/or auxiliary variables (demographics, mobility, etc.). We also describe several open resources to access Covid-19 datasets at a country-wide level (i.e., China, Italy, Spain, France, Germany, US, etc.). To facilitate the rapid response to the study of the seasonal behavior of Covid-19, we enumerate the main open resources in terms of weather and climate variables. We also assess the reusability of some representative open-data sources.", "Nature of transmission of Covid19 in India We examine available data on the number of individuals infected by the Covid-19 virus, across several different states in India, over the period January 30, 2020 to April 10, 2020. It is found that the growth of the number of infected individuals $N(t)$ can be modeled across different states with a simple linear function $N(t)=\\gamma+\\alpha t$ beyond the date when reasonable number of individuals were tested (and when a countrywide lockdown was imposed). The slope $\\alpha$ is different for different states. Following recent work by Notari (arxiv:2003.12417), we then consider the dependency of the $\\alpha$ for different states on the average maximum and minimum temperatures, the average relative humidity and the population density in each state. It turns out that like other countries, the parameter $\\alpha$, which determines the rate of rise of the number of infected individuals, seems to have a weak correlation with the average maximum temperature of the state. In contrast, any significant variation of $\\alpha$ with humidity or minimum temperature seems absent with almost no meaningful correlation. Expectedly, $\\alpha$ increases (slightly) with increase in the population density of the states; however, the degree of correlation here too is negligible. These results seem to barely suggest that a natural cause like a hot summer (larger maximum temperatures) may contribute towards reducing the transmission of the virus, though the role of minimum temperature, humidity and population density remains somewhat obscure from the inferences which may be drawn from presently available data.", "Risk assessment strategies for early detection and prediction of infectious disease outbreaks associated with climate change. A new generation of surveillance strategies is being developed to help detect emerging infections and to identify the increased risks of infectious disease outbreaks that are expected to occur with climate change. These surveillance strategies include event-based surveillance (EBS) systems and risk modelling. The EBS systems use open-source internet data, such as media reports, official reports, and social media (such as Twitter) to detect evidence of an emerging threat, and can be used in conjunction with conventional surveillance systems to enhance early warning of public health threats. More recently, EBS systems include artificial intelligence applications such machine learning and natural language processing to increase the speed, capacity and accuracy of filtering, classifying and analysing health-related internet data. Risk modelling uses statistical and mathematical methods to assess the severity of disease emergence and spread given factors about the host (e.g. number of reported cases), pathogen (e.g. pathogenicity) and environment (e.g. climate suitability for reservoir populations). The types of data in these models are expanding to include health-related information from open-source internet data and information on mobility patterns of humans and goods. This information is helping to identify susceptible populations and predict the pathways from which infections might spread into new areas and new countries. As a powerful addition to traditional surveillance strategies that identify what has already happened, it is anticipated that EBS systems and risk modelling will increasingly be used to inform public health actions to prevent, detect and mitigate the climate change increases in infectious diseases.", "A case-crossover analysis of the impact of weather on primary cases of Middle East respiratory syndrome BACKGROUND: Middle East respiratory syndrome coronavirus (MERS-CoV) is endemic in dromedary camels in the Arabian Peninsula, and zoonotic transmission to people is a sporadic event. In the absence of epidemiological data on the reservoir species, patterns of zoonotic transmission have largely been approximated from primary human cases. This study aimed to identify meteorological factors that may increase the risk of primary MERS infections in humans. METHODS: A case-crossover design was used to identify associations between primary MERS cases and preceding weather conditions within the 2-week incubation period in Saudi Arabia using univariable conditional logistic regression. Cases with symptom onset between January 2015 \u2013 December 2017 were obtained from a publicly available line list of human MERS cases maintained by the World Health Organization. The complete case dataset (N = 1191) was reduced to approximate the cases most likely to represent spillover transmission from camels (N = 446). Data from meteorological stations closest to the largest city in each province were used to calculate the daily mean, minimum, and maximum temperature ((\u03bf)C), relative humidity (%), wind speed (m/s), and visibility (m). Weather variables were categorized according to strata; temperature and humidity into tertiles, and visibility and wind speed into halves. RESULTS: Lowest temperature (Odds Ratio = 1.27; 95% Confidence Interval = 1.04\u20131.56) and humidity (OR = 1.35; 95% CI = 1.10\u20131.65) were associated with increased cases 8\u201310 days later. High visibility was associated with an increased number of cases 7 days later (OR = 1.26; 95% CI = 1.01\u20131.57), while wind speed also showed statistically significant associations with cases 5\u20136 days later. CONCLUSIONS: Results suggest that primary MERS human cases in Saudi Arabia are more likely to occur when conditions are relatively cold and dry. This is similar to seasonal patterns that have been described for other respiratory diseases in temperate climates. It was hypothesized that low visibility would be positively associated with primary cases of MERS, however the opposite relationship was seen. This may reflect behavioural changes in different weather conditions. This analysis provides key initial evidence of an environmental component contributing to the development of primary MERS-CoV infections.", "Assessing the relationship between surface levels of PM2.5 and PM10 particulate matter impact on COVID-19 in Milan, Italy The novel coronavirus disease (COVID-19) is a highly pathogenic, transmittable and invasive pneumococcal disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which emerged in December 2019 and January 2020 in Wuhan city, Hubei province, China and fast spread later on the middle of February 2020 in the Northern part of Italy and Europe. This study investigates the correlation between the degree of accelerated diffusion and lethality of COVID-19 and the surface air pollution in Milan metropolitan area, Lombardy region, Italy. Daily average concentrations of inhalable particulate matter (PM) in two size fractions PM2.5, PM10 and maxima PM10 ground level atmospheric pollutants together air quality and climate variables (daily average temperature, relative humidity, wind speed, atmospheric pressure field and Planetary Boundary Layer-PBL height) collected during 1 January-30 April 2020 were analyzed. In spite of being considered primarily transmitted by indoor bioaerosols droplets and infected surfaces, or direct human-to-human personal contacts, it seems that high levels of urban air pollution, weather and specific climate conditions have a significant impact on the increased rates of confirmed COVID-19 Total number, Daily New and Total Deaths cases, possible attributed not only to indoor but also to outdoor airborne bioaerosols distribution. Our analysis demonstrates the strong influence of daily averaged ground levels of particulate matter concentrations, positively associated with average surface air temperature and inversely related to air relative humidity on COVID-19 cases outbreak in Milan. Being a novel pandemic coronavirus (SARS-CoV-2) version, COVID-19 might be ongoing during summer conditions associated with higher temperatures and low humidity levels. Presently is not clear if this protein \"spike\" of the new coronavirus COVID-19 is involved through attachment mechanisms on indoor or outdoor airborne aerosols in the infectious agent transmission from a reservoir to a susceptible host in some agglomerated urban areas like Milan is.", "Spread of SARS-CoV-2 Coronavirus likely to be constrained by climate As new cases of COVID-19 are being confirmed pressure is mounting to increase understanding of the factors underlying the spread the disease. Using data on local transmissions until the 23rd of March 2020, we develop an ensemble of 200 ecological niche models to project monthly variation in climate suitability for spread of SARS-CoV-2 throughout a typical climatological year. Although cases of COVID-19 are reported all over the world, most outbreaks display a pattern of clustering in relatively cool and dry areas. The predecessor SARS-CoV-1 was linked to similar climate conditions. Should the spread of SARS CoV-2 continue to follow current trends, asynchronous seasonal global outbreaks could be expected. According to the models, temperate warm and cold climates are more favorable to spread of the virus, whereas arid and tropical climates are less favorable. However, model uncertainties are still high across much of sub- Saharan Africa, Latin America and South East Asia. While models of epidemic spread utilize human demography and mobility as predictors, climate can also help constrain the virus. This is because the environment can mediate human-to-human transmission of SARS-CoV-2, and unsuitable climates can cause the virus to destabilize quickly, hence reducing its capacity to become epidemic.", "The transmission of SARS-CoV-2 is likely comodulated by temperature and by relative humidity Quantifying the role of temperature and humidity on the transmission of SARS-CoV-2 has been confounded by a lack of controlled experiments, the sudden rise in detection rates, and changing weather patterns. In this paper we focus our analysis on data from Colombia, which presents unique economic, demographic and geological characteristics that favor the study of temperature and humidity upon SARS-CoV-2 transmission: the weather varies dramatically across five natural regions (from the Caribbean coast and the Amazon rainforest to the Andean mountains), there are no pronounced seasons, there is a central port of entry, the use of public transportation dominates inter- and intracity travel, and indoor climate control is rare. While only controlled experiments can precisely quantify the role of temperature and humidity upon SARS-CoV-2 transmission, we observe significant attenuation of transmission in climates with sustained daily maximum temperatures above 30 degrees Celsius and simultaneous mean relative humidity below 78%. We hypothesize that temperature and relative humidity comodulate the infectivity of SARS-CoV-2 within respiratory droplets.", "Ancestral origin, antigenic resemblance and epidemiological insights of novel coronavirus (SARS-CoV-2): Global burden and Bangladesh perspective SARS-CoV-2, a new coronavirus strain responsible for COVID-19 has emerged in Wuhan City, China and still continuing its worldwide pandemic nature. Considering the severity of the disease, a number of studies are underway, and full genomic sequences have already been released in the last few weeks to enable the understanding of the evolutionary origin and molecular characteristics of this virus. Bioinformatics analysis, satellite derived imaging data and epidemiological attributes were employed to investigate origin, immunogenic resemblance and global threat of newly pandemic SARS-CoV-2 including Bangladesh perspective. Based on currently available genomic information, a phylogeny study was employed focusing four types of representative viral proteins (spike, membrane, envelope and nucleoprotein) of SARS-CoV-2, HCoV-229E, HCoV-OC43, SARS-CoV, HCoV-NL63, HKU1, MERS-CoV, HKU4, HKU5 and BufCoV-HKU26. The findings clearly demonstrated that SARS-CoV-2 exhibited evolutionary convergent relation with previously reported SARS-CoV. It was also found that SARS-CoV-2 proteins were highly similar and identical to SARS-CoV proteins, though proteins from other coronaviruses showed lower level of similarity and identical patterns. The cross-checked conservancy analysis of SARS-CoV-2 antigenic epitopes showed significant conservancy with antigenic epitopes derived from SARS-CoV. The study also prioritized the temperature comparison through satellite imaging alongside compiling and analyzing the epidemiological outbreak information on the 2019 novel coronavirus based on several open datasets on COVID-19 (SARS-CoV-2) and discussed possible threats to Bangladesh.", "Prioritizing and Analyzing the Role of Climate and Urban Parameters in the Confirmed Cases of COVID-19 Based on Artificial Intelligence Applications Nowadays, an infectious disease outbreak is considered one of the most destructive effects in the sustainable development process. The outbreak of new coronavirus (COVID-19) as an infectious disease showed that it has undesirable social, environmental, and economic impacts, and leads to serious challenges and threats. Additionally, investigating the prioritization parameters is of vital importance to reducing the negative impacts of this global crisis. Hence, the main aim of this study is to prioritize and analyze the role of certain environmental parameters. For this purpose, four cities in Italy were selected as a case study and some notable climate parameters\u2014such as daily average temperature, relative humidity, wind speed\u2014and an urban parameter, population density, were considered as input data set, with confirmed cases of COVID-19 being the output dataset. In this paper, two artificial intelligence techniques, including an artificial neural network (ANN) based on particle swarm optimization (PSO) algorithm and differential evolution (DE) algorithm, were used for prioritizing climate and urban parameters. The analysis is based on the feature selection process and then the obtained results from the proposed models compared to select the best one. Finally, the difference in cost function was about 0.0001 between the performances of the two models, hence, the two methods were not different in cost function, however, ANN-PSO was found to be better, because it reached to the desired precision level in lesser iterations than ANN-DE. In addition, the priority of two variables, urban parameter, and relative humidity, were the highest to predict the confirmed cases of COVID-19.", "Role of a Habitat's Air Humidity in Covid-19 Mortality Transient local over-dry environment might be a contributor and an explanation for the observed asynchronous local rises in Covid-19 mortality. We propose that a habitat's air humidity negatively correlate with Covid-19 morbidity and mortality, and support this hypothesis on the example of publicly available data from German federal states.", "COVID\u201019: A relationship to climate and environmental conditions? ", "Impact of weather on COVID-19 pandemic in Turkey Abstract The coronavirus pandemic, which has numerous global implications, has led people to believe that nothing will be the same as before. The present day is dominated by studies on determining the factors that affect, taking preventive actions, and trying to find an effective treatment on top priority. Meteorological parameters are among the crucial factors affecting infectious diseases. The present study examines the correlation between weather and coronavirus disease 2019 (COVID-19) by considering nine cities in Turkey. In this regard, temperature (\u00b0C), dew point (\u00b0C), humidity (%), and wind speed (mph) are considered as parameters of weather. Research states that the incubation period of COVID-19 varies from 1 day to 14 days. Therefore, the effects of each parameter within 1, 3, 7, and 14 days are examined. In addition, the population is included as an effective parameter for evaluation. The analyses are conducted based on Spearman's correlation coefficients. The results showed that the highest correlations were observed for population, wind speed 14 days ago, and temperature on the day, respectively. The study results may guide authorities and decision-makers on taking specific measures for the cities.", "Influence of meteorological factors and air pollution on the outbreak of severe acute respiratory syndrome Summary Objectives To understand the association between the outbreak of severe acute respiratory syndrome (SARS) and meteorological factors and air pollution. Study design An ecological study was conducted. Methods Three hundred and fifty primary probable SARS cases diagnosed in mainland China between 1 January and 31 May 2003, and their 6727 close contacts during the period of their clinical symptoms before admission, were included in this study. Of the 6727 close contacts, 135 (2.0%) later developed clinical symptoms and were diagnosed as probable SARS cases. The daily meteorological data and daily air pollution data during the same SARS outbreak period in mainland China were used in the data analysis. Logistic regression analyses were conducted to explore the association between the secondary attack rate of SARS and meteorological factors and air pollution. Results In univariate analyses, daily average temperature (DAT), daily average air pressure (DAAP), and daily average relative humidity (DARH) were inversely associated with secondary attack rate (P<0.001); a significant positive association was found for daily hours of sunshine (DHS) (P<0.001). In multivariate analyses, factors associated with secondary attack rate were DAAP (odds ratio (OR)=0.53, 95% confidence interval (CI): 0.42, 0.66), DARH (OR=0.73, 95% CI: 0.53, 1.00), and daily average wind velocity (DAWV; OR=0.81, 95% CI: 0.68, 0.96). Adjustment for the onset time of a primary case led to little change in the results. In addition, in Hebei Province, a major affected area in China, only DAWV (OR=0.38, 95% CI: 0.20, 0.72) was a significant predictor of secondary attack rate with adjustment for the onset time of primary case. In Inner Mongolia, another major affected area in China, DAWV (OR=0.50, 95% CI: 0.26, 0.94) and DHS (OR=0.27, 95% CI: 0.09, 0.81) were significant predictors of secondary attack rate with adjustment for the onset time of primary case. Conclusions Our results suggest that the SARS outbreak was significantly associated with DAWV, and that DAAP, DARH and DHS may also have influenced the SARS outbreak to some extent. However, because of ecological fallacy and uncontrolled confounding effects that may have biased the results, the association between the SARS outbreak and these meteorological factors and air pollution deserve further investigation.", "Impacts of regional climate on the COVID-19 pandemic The COVID-19 pandemic has led to six million confirmed cases by May 31, 2020. Impacts of regional weather and climate on epidemics have been investigated but need further study with new methods. We combined the number of monthly confirmed new cases and death with month, latitude, temperature, humidity, rainfall, and sunshine ultraviolet (UV) to explore the climate impact on epidemics in 116 countries and territories with at least 1000 confirmed cases. Correlation and regression analyses were performed with Stata. Humid subtropical climate regions had the most confirmed COVID-19 cases (24.4%). The case mortality in temperate marine regions was the highest (11.6%). Case-weighted means of the latitude, monthly maximum temperature, relative humidity, rainfall, and sunshine UV were 36.7 degrees, 20.5, 63%, 63mm, and 53.5, respectively. The case mortality was 7.44% in cold regions but only 4.68% in hot regions, 7.14% in rainy regions but only 3.86% in rainless regions, and 7.40% in cloudy regions but only 4.64% in sunny regions. Monthly confirmed cases increase as the temperature, rainfall, and sunshine UV rise in cold regions (r=0.34, 0.26, 0.26, respectively), but no correlation in hot regions. Every 1 increase in monthly maximum temperature leads to an increase in the natural logarithm of monthly confirmed new cases by 2.4% in cold regions. Monthly confirmed cases increase as the temperature, rainfall, and sunshine UV rise in arid regions (r=0.29, 0.28, 0.26, respectively), but no correlation in humid regions. Monthly confirmed new cases increase as the temperature and sunshine UV rise in rainy regions (r=0.30, 0.29), but no correlation in rainless regions. Monthly confirmed new deaths increase as the temperature and sunshine UV rise in cloudy regions (r=0.30, 0.30), but no correlation in sunny regions. It is wise to escape from an epicenter full of miasma to a hot sunny place in dry season without pollution. As peaking in the spring depends on the climate, the peak will go in the summer.", "The Effects of \"Fangcang, Huoshenshan, and Leishenshan\" Makeshift Hospitals and Temperature on the Mortality of COVID-19 Background In December 2019, a novel coronavirus disease (COVID-19) broke out in Wuhan, China, however, the factors affecting the mortality remain unclear. Methods Thirty-two days of data that were shared by China National Health Commission and China Weather Net were collected using standard forms. The difference in the mortality of confirmed and severe cases before and after the use of Fangcang, Huoshenshan, and Leishenshan makeshift hospitals (MSHs) was tested using Mann-Whitney U test. We also studied whether air temperature (AT) could affect the above outcomes of COVID-19 cases by performing Spearman analysis. Results The mortality of confirmed cases was significantly decreased both in Wuhan (U = 1, P < 0.001) and Hubei (U = 0, P < 0.001), while in non-Hubei regions, as a contrast, the mortality of confirmed cases remained unchanged (U = 40, P = 0.139). However, another eight days later, changes in the mortality in non-Hubei regions also became significant (U = 73, P = 0.039). Mortality of confirmed cases was found to be significantly correlated with temperature both in Wuhan (r = -0.441, P = 0.012) and Hubei (r = -0.440, P = 0.012). Conclusions Our findings indicated that both the use of MSHs and the rise of AT were beneficial to the survival of COVID-19 cases.", "Correlation Analysis of Rubella Incidence and Meteorological Variables Based on Chinese Medicine Theory of Yunqi OBJECTIVE: To analyze the correlations between the incidence of rubella and meteorological factors over the same period and previous periods including 1, 2, 3 and 4 year ago (defined according to Chinese medicine Yunqi theory of \"pestilence occurring after 3 years\") and establish the rubella-meteorological forecast models for Beijing area, China. METHODS: Data regarding the incidence of rubella between 1990 and 2004 from Beijing Center for Disease Control and Prevention, and the meteorological variables including daily average temperatures, daily average wind speeds, average precipitations, average relative humidity, average vapor pressures and average low cloud covers between 1986 and 2004 were collected from the Beijing Meteorological Observatory. Descriptive statistics and back-propagation artificial neural network for forecast model\u2019s establishment were adopted for data analysis. RESULTS: The average temperature and relative humidity have a great contribution (100%) to the rubella morbidity. But the combination of other meteorological factors contributed to improve the accuracy of rubella-meteorological forecast models. The forecast accuracy could be improved by 76% through utilizing a combination of meteorological variables spanning from 3 years ago to the present rather than utilizing data from a single year or dating back to more earlier time than 3 years. CONCLUSIONS: There is a close relationship between the incidence of rubella and meteorological variables in current year and previous 3 years. This finding suggests that rubella prediction would benefit from consideration to previous climate changes.", "Susceptibility and Sustainability of India against CoVid19: a multivariate approach Purpose: We are currently in the middle of a global crisis. Covid19 pandemic has suddenly threatened the existence of human life. Till date, as no medicine or vaccine is discovered, the best way to fight against this pandemic is prevention. The impact of different environmental, social, economic and health parameters is unknown and under research. It is important to identify the factors which can weaken the virus, and the nations which are more vulnerable to this virus. Materials and Methods: Data of weather, vaccination trends, life expectancy, lung disease, number of infected people in the pre-lockdown and post-lockdown period of highly infected nations are collected. These are extracted from authentic online resources and published reports. Analysis is done to find the possible impact of each parameter on CoVid19. Results: CoVid19 has no linear correlation with any of the selected parameters, though few parameters have depicted non-linear relationship in the graphs. Further investigations have shown better result for some parameters. A combination of the parameters results in a better correlation with infection rate. Conclusions: Though depending on the study outcome, the impact of CoVid19 in India can be predicted, the required lockdown period cannot be calculated due to data limitation.", "Climatic changes and their role in emergence and re-emergence of diseases Global warming and the associated climate changes are predictable. They are enhanced by burning of fossil fuels and the emission of huge amounts of CO(2) gas which resulted in greenhouse effect. It is expected that the average global temperature will increase with 2\u20135 \u00b0C in the next decades. As a result, the earth will exhibit marked climatic changes characterized by extremer weather events in the coming decades, such as the increase in temperature, rainfall, summertime, droughts, more frequent and stronger tornadoes and hurricanes. Epidemiological disease cycle includes host, pathogen and in certain cases intermediate host/vector. A complex mixture of various environmental conditions (e.g. temperature and humidity) determines the suitable habitat/ecological niche for every vector host. The availability of suitable vectors is a precondition for the emergence of vector-borne pathogens. Climate changes and global warming will have catastrophic effects on human, animal and environmental ecosystems. Pathogens, especially neglected tropical disease agents, are expected to emerge and re-emerge in several countries including Europe and North America. The lives of millions of people especially in developing countries will be at risk in direct and indirect ways. In the present review, the role of climate changes in the spread of infectious agents and their vectors is discussed. Examples of the major emerging viral, bacterial and parasitic diseases are also summarized.", "Isolation and identification of human coronavirus 229E from frequently touched environmental surfaces of a university classroom that is cleaned daily Frequently touched surfaces of a university classroom that is cleaned daily contained viable human coronavirus 229E (CoV-229E). Tests of a CoV-229E laboratory strain under conditions that simulated the ambient light, temperature, and relative humidity conditions of the classroom revealed that some of the virus remained viable on various surfaces for 7 days, suggesting CoV-229E is relatively stable in the environment. Our findings reinforce the notion that contact transmission may be possible for this virus.", "Assessing the relationship between ground levels of ozone (O3) and nitrogen dioxide (NO2) with coronavirus (COVID-19) in Milan, Italy This paper investigates the correlation between the high level of coronavirus SARS-CoV-2 infection accelerated transmission and lethality, and surface air pollution in Milan metropolitan area, Lombardy region in Italy. For January-April 2020 period, time series of daily average inhalable gaseous pollutants ozone (O3) and nitrogen dioxide (NO2), together climate variables (air temperature, relative humidity, wind speed, precipitation rate, atmospheric pressure field and Planetary Boundary Layer) were analyzed. In spite of being considered primarily transmitted by indoor bioaerosols droplets and infected surfaces or direct human-to-human personal contacts, it seems that high levels of urban air pollution, and climate conditions have a significant impact on SARS-CoV-2 diffusion. Exhibited positive correlations of ambient ozone levels and negative correlations of NO2 with the increased rates of COVID-19 infections (Total number, Daily New positive and Total Deaths cases), can be attributed to airborne bioaerosols distribution. The results show positive correlation of daily averaged O3 with air temperature and inversely correlations with relative humidity and precipitation rates. Viral genome contains distinctive features, including a unique N-terminal fragment within the spike protein, which allows coronavirus attachment on ambient air pollutants. At this moment it is not clear if through airborne diffusion, in the presence of outdoor and indoor aerosols, this protein \"spike\" of the new COVID-19 is involved in the infectious agent transmission from a reservoir to a susceptible host during the highest nosocomial outbreak in some agglomerated industrialized urban areas like Milan is. Also, in spite of collected data for cold season (winter-early spring) period, when usually ozone levels have lower values than in summer, the findings of this study support possibility as O3 can acts as a COVID-19 virus incubator. Being a novel pandemic coronavirus version, it might be ongoing during summer conditions associated with higher air temperatures, low relative humidity and precipitation levels.", "Global Warming and Its Health Impact Since the mid-19(th) century, human activities have increased greenhouse gases such as carbon dioxide, methane, and nitrous oxide in the Earth's atmosphere that resulted in increased average temperature. The effects of rising temperature include soil degradation, loss of productivity of agricultural land, desertification, loss of biodiversity, degradation of ecosystems, reduced fresh-water resources, acidification of the oceans, and the disruption and depletion of stratospheric ozone. All these have an impact on human health, causing non-communicable diseases such as injuries during natural disasters, malnutrition during famine, and increased mortality during heat waves due to complications in chronically ill patients. Direct exposure to natural disasters has also an impact on mental health and, although too complex to be quantified, a link has even been established between climate and civil violence. Over time, climate change can reduce agricultural resources through reduced availability of water, alterations and shrinking arable land, increased pollution, accumulation of toxic substances in the food chain, and creation of habitats suitable to the transmission of human and animal pathogens. People living in low-income countries are particularly vulnerable. Climate change scenarios include a change in distribution of infectious diseases with warming and changes in outbreaks associated with weather extreme events. After floods, increased cases of leptospirosis, campylobacter infections and cryptosporidiosis are reported. Global warming affects water heating, rising the transmission of water-borne pathogens. Pathogens transmitted by vectors are particularly sensitive to climate change because they spend a good part of their life cycle in a cold-blooded host invertebrate whose temperature is similar to the environment. A warmer climate presents more favorable conditions for the survival and the completion of the life cycle of the vector, going as far as to speed it up as in the case of mosquitoes. Diseases transmitted by mosquitoes include some of the most widespread worldwide illnesses such as malaria and viral diseases. Tick-borne diseases have increased in the past years in cold regions, because rising temperatures accelerate the cycle of development, the production of eggs, and the density and distribution of the tick population. The areas of presence of ticks and diseases that they can transmit have increased, both in terms of geographical extension than in altitude. In the next years the engagement of the health sector would be working to develop prevention and adaptation programs in order to reduce the costs and burden of climate change.", "Factors determining the diffusion of COVID-19 and suggested strategy to prevent future accelerated viral infectivity similar to COVID This study has two goals. The first is to explain the geo-environmental determinants of the accelerated diffusion of COVID-19 that is generating a high level of deaths. The second is to suggest a strategy to cope with future epidemic threats similar to COVID-19 having an accelerated viral infectivity in society. Using data on sample of N = 55 Italian province capitals, and data of infected individuals at as of April 7th, 2020, results reveal that the accelerate and vast diffusion of COVID-19 in North Italy has a high association with air pollution of cities measured with days exceeding the limits set for PM10 (particulate matter 10 \u00b5m or less in diameter) or ozone. In particular, hinterland cities with average high number of days exceeding the limits set for PM10 (and also having a low wind speed) have a very high number of infected people on 7th April 2020 (arithmetic mean is about 2200 infected individuals, with average polluted days greater than 80 days per year), whereas coastal cities also having days exceeding the limits set for PM10 or ozone but with high wind speed have about 944.70 average infected individuals, with about 60 average polluted days per year; moreover, cities having more than 100 days of air pollution (exceeding the limits set for PM10), they have a very high average number of infected people (about 3350 infected individuals, 7th April 2020), whereas cities having less than 100 days of air pollution per year, they have a lower average number of infected people (about 1014 individuals). The findings here also suggest that to minimize the impact of future epidemics similar to COVID-19, the max number of days per year that Italian provincial capitals or similar industrialized cities can exceed the limits set for PM10 or for ozone, considering their meteorological conditions, is about 48 days. Moreover, results here reveal that the explanatory variable of air pollution in cities seems to be a more important predictor in the initial phase of diffusion of viral infectivity (on 17th March 2020, b1 = 1.27, p < 0.001) than interpersonal contacts (b2 = 0.31, p < 0.05). In the second phase of maturity of the transmission dynamics of COVID-19, air pollution reduces intensity (on 7th April 2020 with b'1 = 0.81, p < 0.001) also because of the indirect effect of lockdown, whereas regression coefficient of transmission based on interpersonal contacts has a stable level (b'2 = 0.31, p < 0.01). This result reveals that accelerated transmission dynamics of COVID-19 is due to mainly to the mechanism of \"air pollution-to-human transmission\" (airborne viral infectivity) rather than \"human-to-human transmission\". Overall, then, transmission dynamics of viral infectivity, such as COVID-19, is due to systemic causes: general factors that are the same for all regions (e.g., biological characteristics of virus, incubation period, etc.) and specific factors which are different for each region and/or city (e.g., complex interaction between air pollution, meteorological conditions and biological characteristics of viral infectivity) and health level of individuals (habits, immune system, age, sex, etc.). Lessons learned for COVID-19 in the case study here suggest that a proactive strategy to cope with future epidemics is also to apply especially an environmental and sustainable policy based on reduction of levels of air pollution mainly in hinterland and polluting cities- (having low wind speed, high percentage of moisture and number of fog days) -that seem to have an environment that foster a fast transmission dynamics of viral infectivity in society. Hence, in the presence of polluting industrialization in regions that can trigger the mechanism of air pollution-to-human transmission dynamics of viral infectivity, this study must conclude that a comprehensive strategy to prevent future epidemics similar to COVID-19 has to be also designed in environmental and socioeconomic terms, that is also based on sustainability science and environmental science, and not only in terms of biology, medicine, healthcare and health sector.", "Transmissibility of COVID-19 in 11 major cities in China and its association with temperature and humidity in Beijing, Shanghai, Guangzhou, and Chengdu BACKGROUND: The new coronavirus disease COVID-19 began in December 2019 and has spread rapidly by human-to-human transmission. This study evaluated the transmissibility of the infectious disease and analyzed its association with temperature and humidity to study the propagation pattern of COVID-19. METHODS: In this study, we revised the reported data in Wuhan based on several assumptions to estimate the actual number of confirmed cases considering that perhaps not all cases could be detected and reported in the complex situation there. Then we used the equation derived from the Susceptible-Exposed-Infectious-Recovered (SEIR) model to calculate R0 from January 24, 2020 to February 13, 2020 in 11 major cities in China for comparison. With the calculation results, we conducted correlation analysis and regression analysis between R0 and temperature and humidity for four major cities in China to see the association between the transmissibility of COVID-19 and the weather variables. RESULTS: It was estimated that the cumulative number of confirmed cases had exceeded 45 000 by February 13, 2020 in Wuhan. The average R0 in Wuhan was 2.7, significantly higher than those in other cities ranging from 1.8 to 2.4. The inflection points in the cities outside Hubei Province were between January 30, 2020 and February 3, 2020, while there had not been an obvious downward trend of R0 in Wuhan. R0 negatively correlated with both temperature and humidity, which was significant at the 0.01 level. CONCLUSIONS: The transmissibility of COVID-19 was strong and importance should be attached to the intervention of its transmission especially in Wuhan. According to the correlation between R0 and weather, the spread of disease will be suppressed as the weather warms.", "A Preliminary Investigation on the Statistical Correlations between SARS-CoV-2 Spread and Local Meteorology The statistical correlation between meteorological parameters and the spread of Coronavirus Disease-2019 (COVID-19) was investigated in five provinces of Italy selected according to the number of infected individuals and the different trends of infection in the early stages of the epidemic: Bergamo and Brescia showed some of the highest trends of infections while nearby Cremona and Mantova, showed lower trends. Pesaro\u2013Urbino province was included for further investigation as it was comparably affected by the epidemic despite being the area far from the Po valley. Moving means of the variables were considered to take into account the variability of incubation periods and uncertainties in the epidemiological data. The same analyzes were performed normalizing the number of new daily cases based on the number of checks performed. For each province, the moving mean of adjusted and unadjusted new daily cases were independently plotted versus each meteorological parameter, and linear regressions were determined in the period from 29th of February 2020 to 29th of March 2020. Strong positive correlations were observed between new cases and temperatures within three provinces representing 86.5% of the contagions. Strong negative correlations were observed between the moving means of new cases and relative humidity values for four provinces and more than 90% of the contagions.", "Meteorological factors correlate with transmission of 2019-nCoV: Proof of incidence of novel coronavirus pneumonia in Hubei Province, China Objective: many potential factors contribute to the outbreak of COVID-19.It aims to explore the effects of various meteorological factors on the incidence of COVID-19. Methods: Taking Hubei province of China as an example, where COVID-19 was first reported and there were the most cases, we collected 53 days of confirmed cases (total 67773 cases) and ten meteorological parameters up to March 10. Correlation analysis and linear regression were used to judge the relationship of meteorological factors and increment of COVID-19 confirmed cases. Results: Under 95% CI, the increment of confirmed cases in Hubei were correlated with four meteorological parameters of average pressure, average temperature, minimum temperature and average water vapor pressure (equivalent to absolute humidity).The average pressure was positively correlated with the increment (r=+0.358).The negative correlations included average temperature (r=-0.306), minimum temperature (r=-0.347), and average water vapor pressure (r=-0.326). The linear regression results show if minimum temperature increases by 1\u2103, the incremental confirmed cases in Hubei decreases by 72.470 units on average. Conclusion: Statistically, the incidence of COVID-19 was correlated with average pressure, average temperature, minimum temperature and average water vapor pressure. It is positively correlated with the average pressure and negatively correlated with the other three parameters. Compared with relative humidity, 2019-nCov is more sensitive to water vapor pressure. The reason why the epidemic situation in Hubei expanded rapidly is significantly related to the climate characteristics of low temperature and dryness of Hubei in winter.", "Spring Weather and COVID-19 Deaths in the U.S. This study used statistically robust regression models to control for a large set of confounders (including county-level time-invariant factors and time trends, regional-level daily variation, state-level social distancing measures, ultraviolet light, and levels of ozone and fine particulate matter, PM2.5) to estimate a reliable rather than simple regression for the impact of weather on the most accurately measured outcome of COVID-19, death. When the average minimum temperature within a five-day window increased by one degree Fahrenheit in spring 2020, daily death rates in northern U.S. counties increased by an estimated 5.1%. When ozone concentration over a five-day window rose by one part per billion, daily death rates in southern U.S. counties declined by approximately 2.0%. Maximum temperature, precipitation, PM2.5, and ultraviolet light did not significantly associate with COVID-19 mortality. The mechanism that may drive the observed association of minimum temperature on COVID-19 deaths in spring months may be increased mobility and contacts. The effect of ozone may be related to its disinfectant properties, but this requires further confirmation.", "Effects of weather and policy intervention on COVID-19 infection in Ghana Even though laboratory and epidemiological studies have demonstrated the effects of ambient temperature on the transmission and survival of coronaviruses, not much has been done on the effects of weather on the spread of COVID-19. This study investigates the effects of temperature, humidity, precipitation, wind speed and the specific government policy intervention of partial lockdown on the new cases of COVID-19 infection in Ghana. Daily data on confirmed cases of COVID-19 from March 13, 2020 to April 21, 2020 were obtained from the official website of Our World in Data (OWID) dedicated to COVID-19 while satellite climate data for the same period was obtained from the official website of NASA's Prediction of Worldwide Energy Resources (POWER) project. Considering the nature of the data and the objectives of the study, a time series generalized linear model which allows for regressing on past observations of the response variable and covariates was used for model fitting. The results indicate significant effects of maximum temperature, relative humidity and precipitation in predicting new cases of the disease. Also, results of the intervention analysis indicate that the null hypothesis of no significant effect of the specific policy intervention of partial lockdown should be rejected (p-value=0.0164) at a 5\\% level of significance. These findings provide useful insights for policymakers and the public.", "Public health measures to slow community spread of COVID-19 ;The Journal of Infectious Diseases ;Oxford Academic COVID-19 was initially identified in an outbreak of viral pneumonia in Wuhan in December 2019, and has now been recognized in 77 countries with over 90,000 laboratory-confirmed cases and over 3,000 deaths as of 3 March 2020 [1] The epidemiology of COVID-19 has recently become clearer as incident cases continue to rise and researchers refine estimates of the severity, transmissibility, and populations affected Based on available data, COVID-19 is efficiently transmitted in the community, and the proportion of infections leading to severe illness is particularly high among adults \u226550 years of age and among individuals with comorbid health conditions Although rare, severe cases have also been reported among younger individuals Thus far, the estimated basic reproductive number (R0) of COVID-19 is higher than that of influenza [2], as is the case fatality risk for adults and older individuals An estimated 80% of COVID-19 cases are mild [1] This is not a glass half full statistic, as 20% of infections result in clinically severe cases that have the potential to overwhelm already overburdened health facilities Given the lack of vaccines and effective antivirals, nonpharmaceutical interventions (NPIs) are the most effective available interventions for local and global control and mitigation of COVID-19 To date, measures aimed at slowing introduction of infection globally have included travel restrictions, isolation of confirmed cases, and quarantine of exposed persons In the United States, NPIs have reduced the number of infected persons entering the country, but recent outbreaks in multiple US states make it clear that these measures have delayed but not prevented community transmission In 2009, NPIs were able to delay large epidemic waves of pandemic influenza A(H1N1)pdm09 in some locations until after the summer, since influenza transmission tends to be reduced by higher temperatures and humidity It is unclear whether COVID-19 transmission will be heavily affected by seasonal weather variation, given that transmission is now occurring in multiple tropical and sub-tropical locations", "Open Data Resources for Fighting COVID-19 We provide an insight into the open data resources pertinent to the study of the spread of Covid-19 pandemic and its control. We identify the variables required to analyze fundamental aspects like seasonal behaviour, regional mortality rates, and effectiveness of government measures. Open data resources, along with data-driven methodologies, provide many opportunities to improve the response of the different administrations to the virus. We describe the present limitations and difficulties encountered in most of the open-data resources. To facilitate the access to the main open-data portals and resources, we identify the most relevant institutions, at a world scale, providing Covid-19 information and/or auxiliary variables (demographics, mobility, etc.). We also describe several open resources to access Covid-19 data-sets at a country-wide level (i.e. China, Italy, Spain, France, Germany, U.S., etc.). In an attempt to facilitate the rapid response to the study of the seasonal behaviour of Covid-19, we enumerate the main open resources in terms of weather and climate variables. CONCO-Team: The authors of this paper belong to the CONtrol COvid-19 Team, which is composed of different researches from universities of Spain, Italy, France, Germany, United Kingdom and Argentina. The main goal of CONCO-Team is to develop data-driven methods for the better understanding and control of the pandemic.", "Sunlight exposure increased Covid-19 recovery rates: A study in the central pandemic area of Indonesia Abstract This study aims to present the correlation between sunlight exposure and Covid-19 statuses in Jakarta, Indonesia. The secondary data analysis was derived from surveillance data for Covid-19 from government authorities, including the Ministry of Health, the Meteorological, Climatological, and Geophysical Agency, and the local government of Jakarta. Three statuses related to Covid-19 were examined in the study: incidence, death, and recovered. Meanwhile, sunlight exposure was presented as daily duration of it. Only the number of recovered patients correlated significantly with sunlight exposure (p-value = .025; r = 0.350). This study's findings showed that sunlight exposure was associated with recovery from Covid-19.", "Climate effect on COVID-19 spread rate: an online surveillance tool Background: COVID-19 outbreak poses an unprecedented challenge for societies, healthcare organizations and economies. In the present analysis we coupled climate data with COVID-19 spread rates worldwide, and in a single country (USA). Methods: Data of confirmed COVID-19 cases was derived from the COVID-19 Global Cases by the CSSE at Johns Hopkins University up to March 19, 2020. We assessed disease spread by two measures: replication rate (RR), the slope of the logarithmic curve of confirmed cases, and the rate of spread (RoS), the slope of the linear regression of the logarithmic curve. Results: Based on predefined criteria, the mean COVID-19 RR was significantly lower in warm climate countries (0.12\u00b1 0.02) compared with cold countries (0.24\u00b1 0.01), (P<0.0001). Similarly, RoS was significantly lower in warm climate countries 0.12\u00b1 0.02 vs. 0.25\u00b1 0.01 than in cold climate countries (P<0.001). In all countries (independent of climate classification) both RR and RoS displayed a moderate negative correlation with temperature R= -0.69, 95% confidence interval [CI], -0.87 to -0.36; P<0.001 and R= -0.72, 95% confidence interval [CI], -0.87 to -0.36; P<0.001, respectively. We identified a similar moderate negative correlation with the dew point temperature. Additional climate variables did not display a significant correlation with neither RR nor RoS. Finally, in an ancillary analysis, COVID-19 intra-country model using an inter-state analysis of the USA did not identify yet correlation between climate parameters and RR or RoS as of March, 19, 2020. Conclusions: Our analysis suggests a plausible negative correlation between warmer climate and COVID-19 spread rate as defined by RR and RoS worldwide. This initial correlation should be interpreted cautiously and be further validated over time, the pandemic is at different stages in various countries as well as in regions within these countries. As such, some associations may be more affected by local transmission patterns rather than by climate. Importantly, we provide an online surveillance dashboard (https://covid19.net.technion.ac.il/) to further assess the association between climate parameters and outbreak dynamics worldwide as time goes by", "Short-Term Effects of Ambient Ozone, PM(2.5,) and Meteorological Factors on COVID-19 Confirmed Cases and Deaths in Queens, New York The outbreak of coronavirus disease 2019 (COVID-19), caused by the virus SARS-CoV-2, has been rapidly increasing in the United States. Boroughs of New York City, including Queens county, turn out to be the epicenters of this infection. According to the data provided by the New York State Department of Health, most of the cases of new COVID-19 infections in New York City have been found in the Queens county where 42,023 people have tested positive, and 3221 people have died as of 20 April 2020. Person-to-person transmission and travels were implicated in the initial spread of the outbreaks, but factors related to the late phase of rapidly spreading outbreaks in March and April are still uncertain. A few previous studies have explored the links between air pollution and COVID-19 infections, but more data is needed to understand the effects of short-term exposures of air pollutants and meteorological factors on the spread of COVID-19 infections, particularly in the U.S. disease epicenters. In this study, we have focused on ozone and PM(2.5), two major air pollutants in New York City, which were previously found to be associated with respiratory viral infections. The aim of our regression modeling was to explore the associations among ozone, PM(2.5), daily meteorological variables (wind speed, temperature, relative humidity, absolute humidity, cloud percentages, and precipitation levels), and COVID-19 confirmed new cases and new deaths in Queens county, New York during March and April 2020. The results from these analyses showed that daily average temperature, daily maximum eight-hour ozone concentration, average relative humidity, and cloud percentages were significantly and positively associated with new confirmed cases related to COVID-19; none of these variables showed significant associations with new deaths related to COVID-19. The findings indicate that short-term exposures to ozone and other meteorological factors can influence COVID-19 transmission and initiation of the disease, but disease aggravation and mortality depend on other factors.", "Environmental Factors Affecting the Transmission of Respiratory Viruses Many viruses are capable of infecting the human respiratory tract to cause disease. These viruses display various transmission patterns among humans; however, they all share the ability to transmit from person to person, and their human transmissibility is influenced by the environment in which pathogen and host meet. This review aims to summarize recent and significant observations regarding the impact of environmental factors such as weather and climate, humidity, temperature, and airflow on the transmission of human respiratory viruses. Where possible, knowledge gaps that require further scientific study will be identified.", "Meteorological impacts on the incidence of COVID-19 in the U.S. Since the World Health Organization has declared the current outbreak of the novel coronavirus (COVID-19) a global pandemic, some have been anticipating that the mitigation could happen in the summer like seasonal influenza, while medical solutions are still in a slow progress. Experimental studies have revealed a few evidences that coronavirus decayed quickly under the exposure of heat and humidity. This study aims to carry out an epidemiological investigation to establish the association between meteorological factors and COVID-19 in high risk areas of the United States (U.S.). We analyzed daily new confirmed cases of COVID-19 and seven meteorological measures in top 50 U.S. counties with the most accumulative confirmed cases from March 22, 2020 to April 22, 2020. Our analyses indicate that each meteorological factor and COVID-19 more likely have a nonlinear association rather than a linear association over the wide ranges of temperature, relative humidity, and precipitation observed. Average temperature, minimum relative humidity, and precipitation were better predictors to address the meteorological impact on COVID-19. By including all the three meteorological factors in the same model with their lagged effects up to 3 days, the overall impact of the average temperature on COVID-19 was found to peak at 68.45 \u00b0F and decrease at higher degrees, though the overall relative risk percentage (RR %) reduction did not become significantly negative up to 85 \u00b0F. There was a generally downward trend of RR % with the increase of minimum relative humidity; nonetheless, the trend reversed when the minimum relative humidity exceeded 91.42%. The overall RR % of COVID-19 climbed to the highest level of 232.07% (95% confidence interval = 199.77, 267.85) with 1.60 inches of precipitation, and then started to decrease. When precipitation exceeded 1.85 inches, its impact on COVID-19 became significantly negative. Our findings alert people to better have self-protection during the pandemic rather than expecting that the natural environment can curb coronavirus for human beings.", "An Innovative Big Data Predictive Analytics Framework over Hybrid Big Data Sources with an Application for Disease Analytics Nowadays, big data are everywhere. Examples of big data include weather data, web-search data, disease reports, as well as epidemic data and statistics. These big data can be easily generated and collected from a wide variety of data sources. A data science framework\u2014such as predictive analytics framework\u2014helps mining data from various big data sources to find useful information and discover knowledge, which can then be transformed into wisdom for appropriate actions. In this paper, we present an innovative big data predictive analytics framework over hybrid big data sources. To demonstrate the effectiveness and practicality of our framework, we conduct several case studies, including one on applying the framework to disease analytics. More specifically, we integrate, incorporate and analyze weather data and web-search data to predict and forecast dengue cases based on a hybrid of three kernels in support vector machine (SVM) ensemble. Results show how our predictive analytics framework benefits health agencies in disease control and prevention.", "Arctic Oscillation: possible trigger of COVID-19 outbreak The current COVID-19 pandemic is having detrimental consequences worldwide. The pandemic started to develop strongly by the end of January and beginning of February 2020, first in China with subsequent rapid spread to other countries with new epicenters of the outbreaks concentrated mainly within the 30-50 degrees North latitudinal band (e.g., South Korea, Japan, Iran, Italy, Spain). Simultaneously, an unusual persistent anticyclonic situation prevailing at latitudes around 40 degrees North was observed on global scale, in line with an anomalously strong positive phase of the Arctic Oscillation. This atypical situation could have resulted in favorable meteorological conditions for a quicker spread of the virus over the latitude band detailed above. This possible connection needs further attention in order to understand the meteorological and climatological factors related to the COVID-19 outbreak, and for anticipating the spatio-temporal distribution of possible future pandemics.", "Study of the Dependence of Effective Reproduction Number of COVID-19 on the Temperature and Humidity: A Case Study with the Indian States Corona Virus Disease 2019 (COVID-19) started in Wuhan province of China in November 2019 and within a short time, it was declared as a worldwide pandemic by World Health Organisation due to very fast worldwide spread of the virus. In the absence of any vaccine, various mitigation measures were used. In the past, the effect of temperature and humidity on the spread of the virus was studied for a very early phase of the data with mixed results. We are studying the impact of COVID-19 on the maximum temperature and relative humidity of a place using Indian states as test cases for SIR, SIRD, and SEIR models. We used a linear regression method to look for any dependency between effective reproduction number with maximum temperature and relative humidity. Most of the states show a correlation with the negative slope between the effective reproduction number with the maximum temperature and the relative humidity. It indicates that the effective reproduction number goes down as maximum temperature or relative humidity rise. But, the regression coefficient R2 is low for these correlations which means that the correlation is not strong.", "Predictors of COVID-19 incidence, mortality, and epidemic growth rate at the country level Background. The burden of the coronavirus disease 2019 (COVID-19) pandemic has been geographically disproportionate. Certain weather factors and population characteristics are thought to drive transmission, but studies examining these factors are limited. We aimed to identify weather, sociodemographic, and geographic drivers of COVID-19 at the global scale using a comprehensive collection of country/territory-level data, and to use discovered associations to estimate the timing of community transmission. Methods. We examined COVID-19 cases and deaths reported up to May 2, 2020 across 205 countries and territories in relation to weather data collected from capital cities for the eight weeks prior to and four weeks after the date of the first reported case, as well as country/territory-level population, geographic, and planetary data. We performed univariable and multivariable regression modeling and odds ratio analyses to investigate associations with COVID-19 cases, deaths, and epidemic growth rate. We also conducted maximum likelihood analysis to estimate the timing of initial community spread. Findings. Lower temperature (p<0.0001), lower humidity (p=0.006), higher altitude (p=0.0080), higher percentage of urban population (p<0.0001), increased air travelers (p=0.00019), and higher prevalence of obesity (p<0.0001) were strong independent predictors of national COVID-19 incidence, mortality, and epidemic growth rate. Temperature at 5-7 weeks before the first reported case best predicted epidemic growth, suggesting that significant community transmission was occurring on average 1-2 months prior to detection. Interpretation. The results of this ecologic analysis demonstrate that global COVID-19 burden and timing of country-level epidemic growth can be predicted by weather and population factors. In particular, we find that cool, dry, and higher altitude environments, as well as more urban and obese populations, may be conducive to more rapid epidemic spread. Funding sources: None.", "Climatic-niche evolution of SARS CoV-2 Adaptation of species to new environments is governed by natural selection that discriminates among genetic variations and favors survival of the fittest. Here, we propose climate plays an important role in the evolution of SARS CoV-2 and the spread of COVID-19 all over the world which was previously not known. To understand the climatic factors responsible for shaping the molecular determinants of the novel coronavirus, genotyping SARS CoV-2 across different latitudes and Koppen\u2019s climate is imperative. It seems this virus follows inverse latitudinal biodiversity gradient due to its preference towards Koppen\u2019s temperate (C) and cold climate (D). Our molecular phylogenetic analysis revealed division of 176 SARS CoV-2 strains into two variant groups, G1 and G2, well defined by four mutations. Initially, SARS CoV-2 was restricted to a \u201chumid-subtropical\u201d (Cfa) climate of southeast China, which soon spread all over the world having C climate. Genomic information superimposed on global Koppen\u2019s climate map elucidates that the gradation \u201chumid-subtropical\u201d (Cfa) and \u201cmarine-temperate\u201d (Cfb) to \u201chumid-continental\u201d (Dfa-Dfb) climate drives the evolution of G1 into G2 variant group. It seems an early infection in Europe and USA is due to the dominance of C climate. Russia and North America were infected through linkage of C to D climate and South America from C to A climate. Our study elucidates viruses are sensitive to climate and combined genomic and climatic studies provide crucial information about the pathogenesis and natural spreading pathways during a pandemic which will enable us to take pre-emptive precautionary measures in such outbreaks. Graphical Abstract In Brief The authors elucidate adaptation of SARS CoV-2 to different climates by studying phylogenetics and the distribution of strains on Koppen\u2019s climate map. Highlights SARS CoV-2 follows inverse latitudinal gradient. Phylogenetic network divides SARS CoV-2 strains into two variant groups, G1 and G2. G1 strains is restricted to Koppen\u2019s \u201ctemperate\u201d climate (mainly Cfa-Cfb). G2 strains has evolved from G1 to sustain in \u201chumid-continental\u201d (Dfa-Dfb) and \u201ctropical-savannah\u201d (Aw) climate.", "Change of influenza pandemics because of climate change: Complex network simulations Introduction Airborne influenza virus transmission is depending on climate. Infected individuals are able to travel to any country in the world within one day. In this study we combine these two insights to investigate the influence of climate change on pandemic spreading patterns of airborne infectious diseases, like influenza. Well-known recent examples for pandemics are severe acute respiratory syndrome (SARS, 2002/2003) and H1N1 (Influenza A virus subtype, 2009), which have demonstrated the vulnerability of a strongly connected world. Methods Our study is based on a complex network approach including the following datasets: \u2013global air traffic data (from openflights.org) with information on airports, direct flight connections, and airplane types; \u2013global population grid [from Socioeconomic Data and Applications Center (SEDAC), NASA]; \u2013WATCH-Forcing-Data-ERA-Interim (WFDEI) climate reanalysis data (1980\u20132015) and RCP6.0 climate projection data (2016\u20132040): temperature, specific humidity, surface air pressure, water vapour pressure. We use the dependency between water vapour pressure and influenza transmission rate to give every location around the globe a unique transmission rate time series from 1980 until 2040. Local disease development is simulated with a stochastic SEIR compartmental model. All individuals (including infectious ones) are able to migrate from location to location via air traffic to simulate global dissemination of the virus. Results Our results show which regions are most vulnerable to climate change in terms of influenza pandemics towards key target locations (defined by highest degree, highest population, highest betweenness centrality). Furthermore, we point out the influence of climate change on pandemics from 1980 until 2040. A significant trend in the pandemic rate of spreading can be seen on a global scale. Climate change causes an influenza pandemic to proceed 5 days slower (global average) in the year 2040 compared to the year 1980. This trend varies from country to country. For example, pandemics originating from Chad show an accelerated (6 days faster) spread. Conclusion The presented results focus on the effect that climate change has on spreading patterns of airborne infectious diseases. The change from 1980 until 2040 of important influencing variables like population distribution, varying air traffic, vaccine research, hygiene, and healthcare are neglected to separate the impact of climate change.", "Prioritizing and Analyzing the Role of Climate and Urban Parameters in the Confirmed Cases of COVID-19 Based on Artificial Intelligence Applications Nowadays, an infectious disease outbreak is considered one of the most destructive effects in the sustainable development process. The outbreak of new coronavirus (COVID-19) as an infectious disease showed that it has undesirable social, environmental, and economic impacts, and leads to serious challenges and threats. Additionally, investigating the prioritization parameters is of vital importance to reducing the negative impacts of this global crisis. Hence, the main aim of this study is to prioritize and analyze the role of certain environmental parameters. For this purpose, four cities in Italy were selected as a case study and some notable climate parameters-such as daily average temperature, relative humidity, wind speed-and an urban parameter, population density, were considered as input data set, with confirmed cases of COVID-19 being the output dataset. In this paper, two artificial intelligence techniques, including an artificial neural network (ANN) based on particle swarm optimization (PSO) algorithm and differential evolution (DE) algorithm, were used for prioritizing climate and urban parameters. The analysis is based on the feature selection process and then the obtained results from the proposed models compared to select the best one. Finally, the difference in cost function was about 0.0001 between the performances of the two models, hence, the two methods were not different in cost function, however, ANN-PSO was found to be better, because it reached to the desired precision level in lesser iterations than ANN-DE. In addition, the priority of two variables, urban parameter, and relative humidity, were the highest to predict the confirmed cases of COVID-19.", "A mechanism-based parameterisation scheme to investigate the association between transmission rate of COVID-19 and meteorological factors on plains in China The novel coronavirus disease 2019 (COVID-19), which first emerged in Hubei province, China, has become a pandemic. However, data regarding the effects of meteorological factors on its transmission are limited and inconsistent. A mechanism-based parameterisation scheme was developed to investigate the association between the scaled transmission rate (STR) of COVID-19 and the meteorological parameters in 20 provinces/municipalities located on the plains in China. We obtained information on the scale of population migrated from Wuhan, the world epicentre of the COVID-19 outbreak, into the study provinces/municipalities using mobile-phone positioning system and big data techniques. The highest STRs were found in densely populated metropolitan areas and in cold provinces located in north-eastern China. Population density had a non-linear relationship with disease spread (linearity index, 0.9). Among various meteorological factors, only temperature was significantly associated with the STR after controlling for the effect of population density. A negative and exponential relationship was identified between the transmission rate and the temperature (correlation coefficient, -0.56; 99% confidence level). The STR increased substantially as the temperature in north-eastern China decreased below 0 \u00b0C (the STR ranged from 3.5 to 12.3 when the temperature was between -9.41 \u00b0C and -13.87 \u00b0C), whilst the STR showed less temperature dependence in the study areas with temperate weather conditions (the STR was 1.21 \u00b1 0.57 when the temperature was above 0 \u00b0C). Therefore, a higher population density was linearly whereas a lower temperature (<0 \u00b0C) was exponentially associated with an increased transmission rate of COVID-19. These findings suggest that the mitigation of COVID-19 spread in densely populated and/or cold regions will be a great challenge.", "Effects of meteorological conditions and air pollution on COVID-19 transmission: Evidence from 219 Chinese cities. The spatial distribution of the COVID-19 infection in China cannot be explained solely by geographical distance and regulatory stringency. In this research we investigate how meteorological conditions and air pollution, as concurring factors, impact COVID-19 transmission, using data on new confirmed cases from 219 prefecture cities from January 24 to February 29, 2020. Results revealed a kind of nonlinear dose-response relationship between temperature and coronavirus transmission. We also found that air pollution indicators are positively correlated with new confirmed cases, and the coronavirus further spreads by 5-7% as the AQI increases by 10 units. Further analysis based on regional divisions revealed that in northern China the negative effects of rising temperature on COVID-19 is counteracted by aggravated air pollution. In the southern cities, the ambient temperature and air pollution have a negative interactive effect on COVID-19 transmission, implying that rising temperature restrains the facilitating effects of air pollution and that they jointly lead to a decrease in new confirmed cases. These results provide implications for the control and prevention of this disease and for the anticipation of another possible pandemic.", "The dynamics of Covid-19: weather, demographics and infection timeline We study the effects of three types of variables on the early pace of spread of Covid-19: weather variables, temperature and absolute humidity; population density; the timeline of Covid-19 infection, as outbreak of disease occurs in different dates for different regions. The regions considered were all 50 U.S. states and 110 countries (those which had enough data available by April 10th. We looked for associations between the above variables and an estimate of the growth rate of cases, the exponential coefficient, computed using data for 10 days starting when state/country reached 100 confirmed cases. The results for U.S. states indicate that one cannot expect that higher temperatures and higher levels of absolute humidity would translate into slower pace of Covid-19 infection rate, at least in the ranges of those variables during the months of February and March of 2020 (-2.4 to 24C and 2.3 to 15g/m3). In fact, the opposite is true: the higher the temperature and the absolute humidity, the faster the Covid-19 has expanded in the U.S. states, in the early stages of the outbreak. Secondly, using the highest county population density for each state, there is strong positive association between population density and (early) faster spread of Covid-19. Finally, there is strong negative association between the date when a state reached 100 accumulated cases and the speed of Covid-10 outbreak (the later, the lower the estimate of growth rate). When these variables are considered together, only population density and the timeline variable show statistical significance. We also develop the basic models for the collection of countries, without the demographic variable. Despite the evidence, in that case, that warmer and more humid countries have shown lower rates of Covid-19 expansion, the weather variables lose statistical significance when the timeline variable is added.", "UV light influences covid-19 activity through big data: trade offs between northern subtropical, tropical, and southern subtropical countries UV (ultraviolet) light is an important factor should be considered to predict coronavirus epidemic growth pace. UV is different from weather temperature since UV is electromagnetic wavelength from 10 nm to 400 nm in size, shorter than of visible lights. For some people, UV light can lead to cancer from unprotected sun exposure, however, for tropical people, which have been used to live in such condition, have resisted from negative effect high UV index. Moreover, UV has the capability to inactivate virus. This conclusion has been discussed deeply with biological experts. Although UV light has the ability to inactivate viruses, it may be meaningless in areas with high air pollution where UV light turns into heat.", "Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2): An Update Coronaviruses (CoVs) belong to the family of Coronaviridae, the order Nidovirales, and the genus Coronavirus. They are the largest group of viruses causing respiratory and gastrointestinal infections. Morphologically, CoVs are enveloped viruses containing a non-segmented positive-sense, single-stranded ribonucleic acid (RNA) viruses. CoVs are categorized into four important genera that include Alphacoronavirus, Betacoronavirus, Gammacoronavirus, and Deltacoronavirus. A novel member of human CoV that has recently emerged in Wuhan, China, is now formally named as SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). This is a unique strain of RNA viruses that have not been previously observed in humans. The virus has wide host adaptability and is capable of causing severe diseases in humans, masked palm civets, mice, dogs, cats, camels, pigs, chickens, and bats. The SARS-CoV-2 typically causes respiratory and gastrointestinal sickness in both humans and animals. It can be transmitted through aerosols and direct/indirect contact, as well as during medical cases and laboratory sample handling. Specific structural proteins, which might be found on the surface of the virus, play an important role in the pathogenesis and development of the complications. The disease is characterized by distinct medical signs and symptoms that include high fever, chills, cough, and shortness of breath or difficulty in breathing. The infected people may also present with other symptoms such as diarrhea, myalgia, fatigue, expectoration, and hemoptysis. It is important from the public health and economic point of view as it affects the growth of the country, which is majorly attributed to the restriction in the movement of the people and the cost associated with the control and prevention of the disease. Since there is no specific therapeutic intervention nor a vaccine available against the virus, supportive management and treatment with non-specific therapeutic agents (repurposed drugs) may provide relief to the patients. Some preventive strategies of the disease include blocking the routes of transmission of the infections, disinfection of instruments used during medical case handling, using personal protective equipment, proper and early diagnosis of the disease, avoiding contact with the sick patients, and quarantine of the infected/exposed people.", "Estimating weekly excess mortality at subnational level in Italy during the COVID-19 pandemic Background Excess mortality from all-cause has been estimated at national level for different countries, to provide a picture of the total burden of the COVID-19 pandemic. Nevertheless, there have been no attempts at modelling it at high spatial resolution, needed to understand geographical differences in the mortality patterns, to evaluate temporal lags and to plan for future waves of the pandemic. Methods This is the first subnational study on excess mortality during the COVID-19 pandemic in Italy, the third most-hit country. We considered municipality level and estimated all-cause mortality weekly trends based on the first four months of 2016 -- 2019. We specified a Bayesian hierarchical model allowing for spatial heterogeneity as well as for non-linear smooth spatio-temporal terms. We predicted the weekly mortality rates at municipality level for 2020 based on the modelled spatio-temporal trends (i.e.~in the absence of the pandemic) and estimated the excess mortality and the uncertainty surrounding it. Results We found strong evidence of excess mortality for Northern Italy, with higher mortality rates than expected from the end of February in Lombardia, with total excess deaths of 23,946 (23,013 -- 24,786), and the beginning of March for North East and North West with total excess deaths of 8,033 (7,061 -- 9,044) and 1,588 (404 -- 2,700) respectively. We found marked geographical differences, with percent excess of up to 88.9% (81.9% -- 95.2%) at the peak of the pandemic, in the city of Bergamo (Lombardia).", "Assessing the relationship between ground levels of ozone (O3) and nitrogen dioxide (NO2) with coronavirus (COVID-19) in Milan, Italy Abstract This paper investigates the correlation between the high level of coronavirus SARS-CoV-2 infection accelerated transmission and lethality, and surface air pollution in Milan metropolitan area, Lombardy region in Italy. For January\u2013April 2020 period, time series of daily average inhalable gaseous pollutants ozone (O3) and nitrogen dioxide (NO2), together climate variables (air temperature, relative humidity, wind speed, precipitation rate, atmospheric pressure field and Planetary Boundary Layer) were analyzed. In spite of being considered primarily transmitted by indoor bioaerosols droplets and infected surfaces or direct human-to-human personal contacts, it seems that high levels of urban air pollution, and climate conditions have a significant impact on SARS-CoV-2 diffusion. Exhibited positive correlations of ambient ozone levels and negative correlations of NO2 with the increased rates of COVID-19 infections (Total number, Daily New positive and Total Deaths cases), can be attributed to airborne bioaerosols distribution. The results show positive correlation of daily averaged O3 with air temperature and inversely correlations with relative humidity and precipitation rates. Viral genome contains distinctive features, including a unique N-terminal fragment within the spike protein, which allows coronavirus attachment on ambient air pollutants. At this moment it is not clear if through airborne diffusion, in the presence of outdoor and indoor aerosols, this protein \u201cspike\u201d of the new COVID-19 is involved in the infectious agent transmission from a reservoir to a susceptible host during the highest nosocomial outbreak in some agglomerated industrialized urban areas like Milan is. Also, in spite of collected data for cold season (winter-early spring) period, when usually ozone levels have lower values than in summer, the findings of this study support possibility as O3 can acts as a COVID-19 virus incubator. Being a novel pandemic coronavirus version, it might be ongoing during summer conditions associated with higher air temperatures, low relative humidity and precipitation levels.", "Asymmetric nexus between temperature and COVID-19 in the top ten affected provinces of China: A current application of quantile-on-quantile approach Abstract The present study examines the asymmetrical effect of temperature on COVID-19 (Coronavirus Disease) from 22 January 2020 to 31 March 2020 in the 10 most affected provinces in China. This study used the Sim & Zhou' quantile-on-quantile (QQ) approach to analyze how the temperature quantities affect the different quantiles of COVID-19. Daily COVID-19 and, temperature data collected from the official websites of the Chinese National Health Commission and Weather Underground Company (WUC) respectively. Empirical results have shown that the relationship between temperature and COVID-19 is mostly positive for Hubei, Hunan, and Anhui, while mostly negative for Zhejiang and Shandong provinces. The remaining five provinces Guangdong, Henan, Jiangxi, Jiangsu, and Heilongjiang are showing the mixed trends. These differences among the provinces can be explained by the differences in the number of COVID-19 cases, temperature, and the province's overall hospital facilitations. The study concludes that maintaining a safe and comfortable atmosphere for patients while COVID-19 is being treated may be rational.", "Sub-continental Atmosphere and Inherent Immune System may have Impact on Novel Corona Virus' 2019 (nCovid-19) Prevalence in South East Asia Pandemic enveloped RNA Novel Corona Virus' 2019 (SARS-CoV-2) appears as a beating reed which induce overwhelming outbreak all over the world since November 2019 to till date. Inherent Immunity developed by traditional food habit, exposure to various antigens and vitamin D induced sunlight exposure. Meteorological parameters are the important factors which influencing the severe acute respiratory syndrome (SARS) like infectious disease. Aim of this review to enhance our knowledge and explore the association among build up immunity, weather parameters and Corona virus disease (COVID-19) death. In this review we emphasize role of meteorological factor included degree of sun exposure and effect of temperature on enveloped lipid bi-layer structure of Novel corona virus. These meteorological factors and inherent immunity may have impact on SARS-CoV-2 incidence among South East Asian including Bangladeshi. In summary, this study suggests that temperature-humidity variation, inherent immunity and lower life expectancy of South East Asia may be important.", "Spatial modeling cannot currently differentiate SARS-CoV-2 coronavirus and human distributions on the basis of climate in the United States The SARS-CoV-2 coronavirus is wreaking havoc globally, yet knowledge of its biology is limited. Climate and seasonality influence the distributions of many diseases, and studies suggest a link between SARS-CoV-2 and cool weather. One such study, building species distribution models (SDMs), predicted SARS-CoV-2 risk may remain concentrated in the Northern Hemisphere, shifting northward in summer months. Others have highlighted issues with SARS-CoV-2 SDMs, notably: the primary niche of the virus is the host it infects, climate may be a weak distributional predictor, global prevalence data have issues, and the virus is not in a population equilibrium. While these issues should be considered, climate still may be important for predicting the future distribution of SARS-CoV-2. To further examine if there is a link, we model with raw cases and population scaled cases for SARS-CoV-2 county-level data from the United States. We show that SDMs built from population scaled cases data cannot be distinguished from control models built from raw human population data, while SDMs built on raw data fail to predict the current known distribution of cases in the US. The population scaled analyses indicate that climate may not play a central role in current US viral distribution and that human population density is likely a primary driver. Still, we do find slightly more population scaled viral cases in cooler areas. This coupled with our geographically constrained focus make it so we cannot rule out climate as a partial driver of the US SARS-CoV-2 distribution. Climate's role on SARS-CoV-2 should continue to be cautiously examined, but at this time we should assume that SARS-CoV-2 can spread anywhere in the US.", "Similar virus spectra and seasonality in paediatric patients with acute respiratory disease, Ghana and Germany Abstract Epidemiological differences between tropical and temperate regions regarding viruses causing acute respiratory infection are poorly understood. This is in part because methodological differences limit the comparability of data from these two regions. Using identical molecular detection methods, we tested 1174 Ghanaian and 539 German children with acute respiratory infections sampled over 12 months for the 15 most common respiratory viruses by PCR. A total 43.2% of the Ghanaian and 56.6% of the German children tested positive for at least one respiratory virus. The pneumoviruses respiratory syncytial virus and human metapneumovirus were most frequently detected, in 13.1% and 25.1% within the Ghanaian and German children, respectively. At both study sites, pneumoviruses were more often observed at younger ages (p <0.001). In the Ghanaian rainy season, enveloped viruses were detected twice as often as non-enveloped viruses (prevalence rate ratio (PR) 2.0, 95% CI 1.7\u20132.4). In contrast, non-enveloped viruses were more frequent during the Ghanaian dry season (PR 0.6, 95% CI 0.4\u20130.8). In Germany, enveloped viruses were also more frequently detected during the relatively colder winter season (PR 1.6, 95% CI 1.2\u20132.1) and non-enveloped viruses during summer (PR 0.7, 95% CI 0.5\u20130.9). Despite a distance of about 5000 km and a difference of 44\u00b0 latitude separating Germany and Ghana, virus spectra, age associations and seasonal fluctuation showed similarities between sites. Neither respiratory viruses overall, nor environmentally stable (non-enveloped) viruses in particular were more frequent in tropical Ghana. The standardization of our sampling and laboratory testing revealed similarities in acute respiratory infection virus patterns in tropical and temperate climates.", "The impact of temperature and absolute humidity on the coronavirus disease 2019 (COVID-19) outbreak - evidence from China OBJECTIVE To investigate the impact of temperature and absolute humidity on the coronavirus disease 2019 (COVID-19) outbreak. DESIGN Ecological study. SETTING 31 provincial-level regions in mainland China. MAIN OUTCOME MEASURES Data on COVID-19 incidence and climate between Jan 20 and Feb 29, 2020. RESULTS The number of new confirm COVID-19 cases in mainland China peaked on Feb 1, 2020. COVID-19 daily incidence were lowest at -10 and highest at 10 ,while the maximum incidence was observed at the absolute humidity of approximately 7 g/m3. COVID-19 incidence changed with temperature as daily incidence decreased when the temperature rose. No significant association between COVID-19 incidence and absolute humidity was observed in distributed lag nonlinear models. Additionally, A modified susceptible-exposed-infectious-recovered (M-SEIR) model confirmed that transmission rate decreased with the increase of temperature, leading to further decrease of infection rate and outbreak scale. CONCLUSION Temperature is an environmental driver of the COVID-19 outbreak in China. Lower and higher temperatures might be positive to decrease the COVID-19 incidence. M-SEIR models help to better evaluate environmental and social impacts on COVID-19.", "Association of COVID-19 pandemic with meteorological parameters over Singapore Meteorological parameters are the critical factors affecting the transmission of infectious diseases such as Middle East Respiratory Syndrome (MERS), Severe Acute Respiratory Syndrome (SARS), and influenza. Consequently, infectious disease incidence rates are likely to be influenced by the weather change. This study investigates the role of Singapore's hot tropical weather in COVID-19 transmission by exploring the association between meteorological parameters and the COVID-19 pandemic cases in Singapore. This study uses the secondary data of COVID-19 daily cases from the webpage of Ministry of Health (MOH), Singapore. Spearman and Kendall rank correlation tests were used to investigate the correlation between COVID-19 and meteorological parameters. Temperature, dew point, relative humidity, absolute humidity, and water vapor showed positive significant correlation with COVID-19 pandemic. These results will help the epidemiologists to understand the behavior of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus against meteorological variables. This study finding would be also a useful supplement to help the local healthcare policymakers, Center for Disease Control (CDC), and the World Health Organization (WHO) in the process of strategy making to combat COVID-19 in Singapore.", "A climatologic investigation of the SARS-CoV outbreak in Beijing, China The first cases of severe acute respiratory syndrome (SARS) were identified in November 2002, in Guangdong Province, China. The epidemic spread rapidly within China and internationally, with 8454 recorded infections and 792 deaths by June 15, 2003. Temperature, relative humidity, and wind velocity were the three key meteorological determinants affecting the transmission of SARS. The peak spread of SARS occurred at a mean temperature of 16.9\u00b0C (95% CI, 10.7\u00b0C to 23.1\u00b0C), with a mean relative humidity of 52.2% (95% CI, 33.0% to 71.4%) and wind speed of 2.8 ms(\u22121) (95% CI, 2.0 to 3.6 ms(\u22121)). In northern China, these conditions are most likely to occur in the spring and suggest that SARS has a seasonal nature akin to viruses such as influenza and the common cold. A regression equation [Formula: see text] was derived to represent the optimal climatic conditions for the 2003 SARS epidemic. Further investigations in other regions are necessary to verify these results.", "Effect of weather on COVID-19 spread in the US: A prediction model for India in 2020 The effect of weather on COVID-19 spread is poorly understood. Recently, few studies have claimed that warm weather can possibly slowdown the global pandemic, which has already affected over 1.6 million people worldwide. Clarification of such relationships in the worst affected country, the US, can be immensely beneficial to understand the role of weather in transmission of the disease in the highly populated countries, such as India. We collected the daily data of new cases in 50 US states between Jan 1-Apr 9, 2020 and also the corresponding weather information (i.e., temperature (T) and absolute humidity (AH)). Distribution modeling of new cases across AH and T, helped identify the narrow and vulnerable AH range. We validated the results for 10-day intervals against monthly observations, and also worldwide trends. The results were used to predict Indian regions which would be vulnerable to weather based spread in upcoming months of 2020. COVID-19 spread in the US is significant for states with 4 < AH < 6 g/m3 and number of new cases > 10,000, irrespective of the chosen time intervals for study parameters. These trends are consistent with worldwide observations, but do not correlate well with India so far possibly due the total cases reported per interval < 10,000. The results clarify the relationship between weather parameters and COVID-19 spread. The vulnerable weather parameters will help classify the risky geographic areas in different countries. Specifically, with further reporting of new cases in India, prediction of states with high risk of weather based spread will be apparent.", "Effects of temperature and humidity on the daily new cases and new deaths of COVID-19 in 166 countries Abstract The coronavirus disease 2019 (COVID-19) pandemic is the defining global health crisis of our time and the greatest challenge facing the world. Meteorological parameters are reportedly crucial factors affecting respiratory infectious disease epidemics; however, the effect of meteorological parameters on COVID-19 remains controversial. This study investigated the effects of temperature and relative humidity on daily new cases and daily new deaths of COVID-19, which has useful implications for policymakers and the public. Daily data on meteorological conditions, new cases and new deaths of COVID-19 were collected for 166 countries (excluding China) as of March 27, 2020. Log-linear generalized additive model was used to analyze the effects of temperature and relative humidity on daily new cases and daily new deaths of COVID-19, with potential confounders controlled for, including wind speed, median age of the national population, Global Health Security Index, Human Development Index and population density. Our findings revealed that temperature and relative humidity were both negatively related to daily new cases and deaths. A 1 \u00b0C increase in temperature was associated with a 3.08% (95% CI: 1.53%, 4.63%) reduction in daily new cases and a 1.19% (95% CI: 0.44%, 1.95%) reduction in daily new deaths, whereas a 1% increase in relative humidity was associated with a 0.85% (95% CI: 0.51%, 1.19%) reduction in daily new cases and a 0.51% (95% CI: 0.34%, 0.67%) reduction in daily new deaths. The results remained robust when different lag structures and the sensitivity analysis were used. These findings provide preliminary evidence that the COVID-19 pandemic may be partially suppressed with temperature and humidity increases. However, active measures must be taken to control the source of infection, block transmission and prevent further spread of COVID-19.", "Any contribution of the season change to the spread of covid-19 caused by sars-cov-2? Background: Most people raise a similar concern during this tough time of the COVID-19 pandemic caused by SARS-CoV-2 infection regarding when this outbreak will come to end. A recent thorough-general study on the success of China dealing with COVID-19 outbreak has concluded to recommend the need for a multi-sectoral approach to prevent future outbreaks of emerging infectious diseases including for the still-occurring COVID-19 outbreak with the initiative for the highest interest of the health of mankind Discussion: The prevalence of SARS-CoV as the predecessor of SARS-CoV-2 has been concluded to be more suitable in spring than autumn and winter, with nothing prevalence in summer. No coincidence that SARS-CoV-2 infection has outbreak around the world from January 2020 to the present, April 2020, as ever predicted to reoccur based on its predecessor, SARS-CoV, that have prevalence been high since January, February, March, April, until early May 2003. As opposed to other seasons, summer has low atmospheric pressure as its exemption that provenly causes virus inactivation. Conclusions: The denotative nature of SARS-CoV-2 seems to reflect its predecessor, SARS-CoV, which begins nearing the end of the year and reaches its optimum hence in spring, thereafter, finally ends in summer. Low atmospheric pressure in the summer impresses that it is the potential cause of ending the outbreak by deactivating SARS-CoV-2, apart from the hot temperature of weather. The knowledge to be gained here is further closely correlated to the fact that coronavirus is able to have genetic recombination that may bring about new genotypes and, consequently, outbreaks later occurring.", "Nexus between COVID-19, temperature and exchange rate in Wuhan City: New findings from Partial and Multiple Wavelet Coherence Abstract This study attempts to document the nexus between weather, covid-19 outbreak in Wuhan and the Chinese economy. We employ 24-h daily average temperature, daily new confirmed cases of a covid-19 in Wuhan, and RMB exchange rate to represent the weather, covid-19 outbreak, and Chinese economy, respectively. The methodology of Wavelet Transform Coherence (WTC), Partial Wavelet Coherence (PWC), and Multiple Wavelet Coherence (MWC) is used to analyze the daily data collected from 21st January 2020 to 31st March 2020. Results reveal significant coherence between series at different time-frequency combinations. Overall results show the insignificance of an increase in temperature to contain new covid-19 infections. The Renminbi exchange rate showed a negative coherence at specific time-frequency spots suggesting a negative but limited impact of the covid-19 outbreak in Wuhan on the Chinese export economy. Our results are contrary to many earlier studies, which show a significant impact of increased temperature in slowing down covid-19 spread. These results can have important implications for economic and containment policy making regarding the covid-19 outbreak.", "A Novel Methodology for Epidemic Risk Assessment: the case of COVID-19 outbreak in Italy We propose a novel data-driven framework for assessing the a-priori epidemic risk of a geographical area and for identifying high-risk areas within a country. Our risk index is evaluated as a function of three different components: the hazard of the disease, the exposure of the area and the vulnerability of its inhabitants. As an application, we discuss the case of COVID-19 outbreak in Italy. We characterize each of the twenty Italian regions by using available historical data on air pollution, human mobility, winter temperature, housing concentration, health care density, population size and age. We find that the epidemic risk is higher in some of the Northern regions with respect to Central and Southern Italy. The corresponding risk index shows correlations with the available official data on the number of infected individuals, patients in intensive care and deceased patients, and can help explaining why regions such as Lombardia, Emilia-Romagna, Piemonte and Veneto have suffered much more than the rest of the country. Although the COVID-19 outbreak started in both North (Lombardia and Veneto) and Central Italy (Lazio) almost at the same time, when the first cases were officially certified at the beginning of 2020, the disease has spread faster and with heavier consequences in regions with higher epidemic risk. Our framework can be extended and tested on other epidemic data, such as those on seasonal flu, and applied to other countries. We also present a policy model connected with our methodology, which helps policy-makers to take informed decisions.", "Temperature significant change COVID-19 Transmission in 429 cities Background There is no evidence supporting that temperature changes COVID-19 transmission. Methods We collected the cumulative number of confirmed cases of all cities and regions affected by COVID-19 in the world from January 20 to February 4, 2020, and calculated the daily means of the average, minimum and maximum temperatures in January. Then, restricted cubic spline function and generalized linear mixture model were used to analyze the relationships. Results There were in total 24,232 confirmed cases in China and 26 overseas countries. In total, 16,480 cases (68.01%) were from Hubei Province. The lgN rose as the average temperature went up to a peak of 8.72\u2103 and then slowly declined. The apexes of the minimum temperature and the maximum temperature were 6.70\u2103 and 12.42\u2103 respectively. The curves shared similar shapes. Under the circumstance of lower temperature, every 1\u2103 increase in average, minimum and maximum temperatures led to an increase of the cumulative number of cases by 0.83, 0.82 and 0.83 respectively. In the single-factor model of the higher-temperature group, every 1\u2103 increase in the minimum temperature led to a decrease of the cumulative number of cases by 0.86. Conclusion The study found that, to certain extent, temperature could significant change COVID-19 transmission, and there might be a best temperature for the viral transmission, which may partly explain why it first broke out in Wuhan. It is suggested that countries and regions with a lower temperature in the world adopt the strictest control measures to prevent future reversal.", "The association between temperature, rainfall and humidity with common climate-sensitive infectious diseases in Bangladesh Bangladesh is one of the world\u2019s most vulnerable countries for climate change. This observational study examined the association of temperature, humidity and rainfall with six common climate-sensitive infectious diseases in adults (malaria, diarrheal disease, enteric fever, encephalitis, pneumonia and bacterial meningitis) in northeastern Bangladesh. Subjects admitted to the adult medicine ward of a tertiary referral hospital in Sylhet, Bangladesh from 2008 to 2012 with a diagnosis of one of the six chosen climate-sensitive infectious diseases were enrolled in the study. Climate-related data were collected from the Bangladesh Meteorological Institute. Disease incidence was then analyzed against mean temperature, humidity and average rainfall for the Sylhet region. Statistical significance was determined using Mann-Whitney test, Chi-square test and ANOVA testing. 5033 patients were enrolled (58% male, 42% female, ratio 1.3:1). All six diseases showed highly significant (p = 0.01) rises in incidence between the study years 2008 (540 cases) and 2012 (1330 cases), compared with no significant rise in overall all-cause hospital admissions in the same period (p = 0.19). The highest number of malaria (135), diarrhea (266) and pneumonia (371) cases occurred during the rainy season. On the other hand, the maximum number of enteric fever (408), encephalitis (183) and meningitis (151) cases occurred during autumn, which follows the rainy season. A positive (P = 0.01) correlation was observed between increased temperature and the incidence of malaria, enteric fever and diarrhea, and a negative correlation with encephalitis, meningitis and pneumonia. Higher humidity correlated (P = 0.01) with a higher number of cases of malaria and diarrhea, but inversely correlated with meningitis and encephalitis. Higher incidences of encephalitis and meningitis occurred while there was low rainfall. Incidences of diarrhea, malaria and enteric fever, increased with rainfall, and then gradually decreased. The findings support a relationship between weather patterns and disease incidence, and provide essential baseline data for future large prospective studies.", "Short-term effects of specific humidity and temperature on COVID-19 morbidity in select US cities Little is known about the environmental conditions that drive the spatiotemporal patterns of SARS-CoV-2. Preliminary research suggests an association with meteorological parameters. However, the relationship with temperature and humidity is not yet apparent for COVID-19 cases in US cities first impacted. The objective of this study is to evaluate the association between COVID-19 cases and meteorological parameters in select US cities. A case-crossover design with a distributed lag nonlinear model was used to evaluate the contribution of ambient temperature and specific humidity on COVID-19 cases in select US cities. The case-crossover examines each COVID case as its own control at different time periods (before and after transmission occurred). We modeled the effect of temperature and humidity on COVID-19 transmission using a lag period of 7 days. A subset of 8 cities were evaluated for the relationship with meteorological parameters and 5 cities were evaluated in detail. Short-term exposure to humidity was positively associated with COVID-19 transmission in 4 cities. The associations were small with 3 out of 4 cities exhibiting higher COVID19 transmission with specific humidity that ranged from 6 to 9 g/kg. Our results suggest that weather should be considered in infectious disease modeling efforts. Future work is needed over a longer time period and across different locations to clearly establish the weather-COVID19 relationship.", "Analysis on Novel Coronavirus (COVID-19) Using Machine Learning Methods In this paper, we are working on a pandemic of novel coronavirus (COVID-19). COVID-19 is an infectious disease, it creates severe damage in the lungs. COVID-19 causes illness in humans and has killed many people in the entire world. However, this virus is reported as a pandemic by the World Health Organization (WHO) and all countries are trying to control and lockdown all places. The main objective of this work is to solve the five different tasks such as I) Predicting the spread of coronavirus across regions. II) Analyzing the growth rates and the types of mitigation across countries. III) Predicting how the epidemic will end. IV) Analyzing the transmission rate of the virus. V) Correlating the coronavirus and weather conditions. The advantage of doing these tasks to minimize the virus spread by various mitigation, how well the mitigations are working, how many cases have been prevented by this mitigations, an idea about the number of patients that will recover from the infection with old medication, understand how much time will it take to for this pandemic to end, we will be able to understand and analyze how fast or slow the virus is spreading among regions and the infected patient to reduce the spread based clear understanding of the correlation between the spread and weather conditions. In this paper, we propose a novel Support Vector Regression method to analysis five different tasks related to novel coronavirus. In this work, instead of simple regression line we use the supported vectors also to get better classification accuracy. Our approach is evaluated and compared with other well-known regression models on standard available datasets. The promising results demonstrate its superiority in both efficiency and accuracy.", "Transmissibility of COVID-19 in 11 major cities in China and its association with temperature and humidity in Beijing, Shanghai, Guangzhou, and Chengdu BACKGROUND: The new coronavirus disease COVID-19 began in December 2019 and has spread rapidly by human-to-human transmission. This study evaluated the transmissibility of the infectious disease and analyzed its association with temperature and humidity to study the propagation pattern of COVID-19. METHODS: In this study, we revised the reported data in Wuhan based on several assumptions to estimate the actual number of confirmed cases considering that perhaps not all cases could be detected and reported in the complex situation there. Then we used the equation derived from the Susceptible-Exposed-Infectious-Recovered (SEIR) model to calculate R(0) from January 24, 2020 to February 13, 2020 in 11 major cities in China for comparison. With the calculation results, we conducted correlation analysis and regression analysis between R(0) and temperature and humidity for four major cities in China to see the association between the transmissibility of COVID-19 and the weather variables. RESULTS: It was estimated that the cumulative number of confirmed cases had exceeded 45 000 by February 13, 2020 in Wuhan. The average R(0) in Wuhan was 2.7, significantly higher than those in other cities ranging from 1.8 to 2.4. The inflection points in the cities outside Hubei Province were between January 30, 2020 and February 3, 2020, while there had not been an obvious downward trend of R(0) in Wuhan. R(0) negatively correlated with both temperature and humidity, which was significant at the 0.01 level. CONCLUSIONS: The transmissibility of COVID-19 was strong and importance should be attached to the intervention of its transmission especially in Wuhan. According to the correlation between R(0) and weather, the spread of disease will be suppressed as the weather warms.", "Temperature, humidity, and wind speed are associated with lower Covid-19 incidence In absence of empirical research data, there has been considerable speculative hypothesis on the relationship between climatic factors (such as temperature and humidity) and the incidence of Covid-19. This study analyzed the data from 310 regions across 116 countries that reported confirmed cases of Covid-19 by March 12, 2020, and found that temperature, humidity, and wind speed were inversely associated with the incidence rate of Covid-19 after adjusting for the regional and temporal trend in the incidence of Covid-19, columnar density of ozone, precipitation probability, sea-level air-pressure, and length of daytime.", "Role of temperature and humidity in the modulation of the doubling time of COVID-19 cases COVID-19 is having a great impact on public health, mortality and economy worldwide, in spite of the efforts to prevent its epidemy. The SARS-CoV-2 genome is different from that of MERS-CoV and SARS-CoV, although also expected to spread differently according to meteorological conditions. Our main goal is to investigate the role of some meteorological variables on the expansion of this outbreak. In this study, an exponential model relating the number of accumulated confirmed cases and time was considered. The rate of COVID-19 spread, using as criterion the doubling time of the number of confirmed cases, was used as dependent variable in a linear model that took four independent meteorological variables: temperature, humidity, precipitation and wind speed. Only China cases were considered, to control both cultural aspects and containment policies. Confirmed cases and the 4 meteorological variables were gathered between January 23 and March 1 (39 days) for the 31 provinces of Mainland China. Several periods of time were sampled for each province, obtaining more than one value for the rate of disease progression. Two different periods of time were tested, of 12 and 15 days, along with 3 and 5 different starting points in time, randomly chosen. The median value for each meteorological variable was computed, using the same time period; models with adjusted R square above 0.75 were selected. The rate of progression and doubling time were computed and used to fit a linear regression model. Models were evaluated using alpha=0.05. Results indicate that the doubling time correlates positively with temperature and inversely with humidity, suggesting that a decrease in the rate of progression of COVID-19 with the arrival of spring and summer in the north hemisphere. A 20oC increase is expected to delay the doubling time in 1.8 days. Those variables explain 18% of the variation in disease doubling time; the remaining 82% may be related to containment measures, general health policies, population density, transportation or cultural aspects.", "Statistical analysis of the impact of environmental temperature on the exponential growth rate of cases infected by COVID-19 We perform a statistical analysis for understanding the effect of the environmental temperature on the exponential growth rate of the cases infected by COVID-19 for US and Italian regions. In particular, we analyze the datasets of regional infected cases, derive the growth rates for regions characterized by readable exponential growth phase in their evolution spread curve and plot them against the environmental temperatures averaged within the same regions, derive the relationship between temperature and growth rate, and evaluate its statistical confidence. The results clearly support the first reported statistically significant relationship of negative correlation between the average environmental temperature and exponential growth rates of the infected cases. The critical temperature, which eliminates the exponential growth, and thus the COVID-19 spread in US regions, is estimated to be Tc = 86.1 \u00b1 4.3 F.", "Eco-epidemiological assessment of the COVID-19 epidemic in China, January-February 2020 Background: The outbreak of COVID-19 in China in early 2020 provides a rich data source for exploring the ecological determinants of this new infection, which may be of relevance elsewhere. Objectives: Assessing the spread of the COVID-19 across China, in relation to associations between cases and ecological factors including population density, temperature, solar radiation and precipitation. Methods: Open-access COVID-19 case data include 18,069 geo-located cases in China during January and February 2020, which were mapped onto a 0.25\u00b0 latitude/longitude grid together with population and weather data (temperature, solar radiation and precipitation). Of 15,539 grid cells, 559 (3.6%) contained at least one case, and these were used to construct a Poisson regression model of cell-weeks. Weather parameters were taken for the preceding week given the established 5-7 day incubation period for COVID-19. The dependent variable in the Poisson model was incident cases per cell-week and exposure was cell population, allowing for clustering of cells over weeks, to give incidence rate ratios. Results: The overall COVID-19 incidence rate in cells with confirmed cases was 0.12 per 1,000. There was a single case in 113/559 (20.2%) of cells, while two grid cells recorded over 1,000 cases. Weekly means of maximum daily temperature varied from -28.0 to 30.1 \u00b0C, minimum daily temperature from -42.4 to 23.0 \u00b0C, maximum solar radiation from 0.04 to 2.74 MJm-2 and total precipitation from 0 to 72.6 mm. Adjusted incidence rate ratios suggested brighter, warmer and drier conditions were associated with lower incidence. Conclusion: Though not demonstrating cause and effect, there were appreciable associations between weather and COVID-19 incidence during the epidemic in China. This does not mean the pandemic will go away with summer weather but demonstrates the importance of using weather conditions in understanding and forecasting the spread of COVID-19.", "Does weather affect the growth rate of COVID-19, a study to comprehend transmission dynamics on human health The undefendable outbreak of novel coronavirus (SARS-COV-2) lead to a global health emergency due to its higher transmission rate and longer symptomatic duration, created a health surge in a short time. Since Nov 2019 the outbreak in China, the virus is spreading exponentially everywhere. The current study focuses on the relationship between environmental parameters and the growth rate of COVID-19. The statistical analysis suggests that the temperature changes retarded the growth rate and found that -6.28{degrees}C and +14.51{degrees}C temperature is the favorable range for COVID-19 growth. Gutenberg- Richter's relationship is used to estimate the mean daily rate of exceedance of confirmed cases concerning the change in temperature. Temperature is the most influential parameter that reduces the growth at the rate of 13-16 cases/day with a 1{degrees}C rise in temperature.", "Effects of temperature variation and humidity on the death of COVID-19 in Wuhan, China Meteorological parameters are the important factors influencing the infectious diseases such as severe acute respiratory syndrome (SARS) and influenza. This study aims to explore the association between Corona Virus Disease 2019 (COVID-19) deaths and weather parameters. In this study, we collected the daily death numbers of COVID-19, meteorological parameters and air pollutant data from 20 January 2020 to 29 February 2020 in Wuhan, China. Generalized additive model was applied to explore the effect of temperature, humidity and diurnal temperature range on the daily death counts of COVID-19. There were 2299 COVID-19 death counts in Wuhan during the study period. A positive association with COVID-19 daily death counts was observed for diurnal temperature range (r = 0.44), but negative association for relative humidity (r = -0.32). In addition, one unit increase in diurnal temperature range was only associated with a 2.92% (95% CI: 0.61%, 5.28%) increase in COVID-19 deaths in lag 3. However, both 1 unit increase of temperature and absolute humidity were related to the decreased COVID-19 death in lag 3 and lag 5, with the greatest decrease both in lag 3 [-7.50% (95% CI: -10.99%, -3.88%) and -11.41% (95% CI: -19.68%, -2.29%)]. In summary, this study suggests the temperature variation and humidity may also be important factors affecting the COVID-19 mortality.", "An initial investigation of the association between the SARS outbreak and weather: with the view of the environmental temperature and its variation. OBJECTIVE To understand the association between the SARS outbreak and the environmental temperature, and to provide a scientific basis for prevention and control measures against it. METHODS The daily numbers of the probable SARS patients and the daily meteorological factors during the SARS outbreak period in Hong Kong, Guangzhou, Beijing, and Taiyuan were used in the data analysis. Ecological analysis was conducted to explore the association between the daily numbers of probable SARS patients and the environmental temperature and its variations. RESULTS There was a significant correlation between the SARS cases and the environmental temperature seven days before the onset and the seven day time lag corresponds well with the known incubation period for SARS. The optimum environmental temperature associated with the SARS cases was between 16 degrees C to 28 degrees C, which may encourage virus growth. A sharp rise or decrease in the environmental temperature related to the cold spell led to an increase of the SARS cases because of the possible influence of the weather on the human immune system. This study provided some evidence that there is a higher possibility for SARS to reoccur in spring than that in autumn and winter. CONCLUSION Current knowledge based on case studies of the SARS outbreak in the four cities suggested that the SARS outbreaks were significantly associated with the temperature and its variations. However, because the fallacy and the uncontrolled confounding effects might have biased the results, the possibility of other meteorological factors having an affect on the SARS outbreaks deserves further investigation.", "Effect of Temperature on the Transmission of COVID-19: A Machine Learning Case Study in Spain The novel coronavirus (COVID-19) has already spread to almost every country in the world and has infected over 3 million people. To understand the transmission mechanism of this highly contagious virus, it is necessary to study the potential factors, including meteorological conditions. Here, we present a machine learning approach to study the effect of temperature, humidity and wind speed on the number of infected people in the three most populous autonomous communities in Spain. We find that there is a moderate inverse correlation between temperature and the daily number of infections. This correlation manifests for temperatures recorded up to 6 days before the onset, which corresponds well to the known mean incubation period of COVID-19. We also show that the correlation for humidity and wind speed is not significant.", "Stability of SARS-CoV-2 in different environmental conditions Stability of SARS-CoV-2 in different environmental conditions.", "Role of meteorological temperature and relative humidity in the January-February 2020 propagation of 2019-nCoV in Wuhan, China Identified in December 2019, the 2019-nCoV emerged in Wuhan, China, and its spread increased rapidly, with cases arising across Mainland China and several other countries. By January 2020, the potential risks imposed by 2019-nCoV in human health and economical activity were promptly highlighted. Considerable efforts have been devoted for understanding the transmission mechanisms aimed to pursue public policies oriented to mitigate the number of infected and deaths. An important question requiring some attention is the role of meteorological variables (e.g., temperature and humidity) in the 2019-nCoV transmission. Correlations between meteorological temperature and relative humidity with the number of daily confirmed cases were explored in this work for the epicenter city of Wuhan, China for the period from 29 January to March 6, 2020. Long-term trend of temperature and relative humidity was obtained with a 14-days adjacent-averaging filter, and lagged correlations of the number of daily confirmed cases were explored. The analysis showed negative correlations between temperatures with the number of daily confirmed cases. Maximum correlations were found for 6-day lagged temperatures, which is likely reflecting the incubation period of the virus. It was postulated that the indoor crowding effect is responsible of the high incidence of 2019-nCoV cases, where low absolute humidity and close human contact facilitate the transport of aerosol droplets.", "Stability of SARS\u2010CoV\u20102 and other coronaviruses in the environment and on common touch surfaces and the influence of climatic conditions: A review Although the unprecedented efforts the world has been taking to control the spread of the human coronavirus disease (COVID\u201019) and its causative aetiology [severe acute respiratory syndrome coronavirus 2 (SARS\u2010CoV\u20102)], the number of confirmed cases has been increasing drastically. Therefore, there is an urgent need for devising more efficient preventive measures, to limit the spread of the infection until an effective treatment or vaccine is available. The preventive measures depend mainly on the understanding of the transmission routes of this virus, its environmental stability, and its persistence on common touch surfaces. Due to the very limited knowledge about SARS\u2010CoV\u20102, we can speculate its stability in the light of previous studies conducted on other human and animal coronaviruses. In this review, we present the available data on the stability of coronaviruses (CoVs), including SARS\u2010CoV\u20102, from previous reports to help understand its environmental survival. According to available data, possible airborne transmission of SARS\u2010CoV\u20102 has been suggested. SARS\u2010CoV\u20102 and other human and animal CoVs have remarkably short persistence on copper, latex and surfaces with low porosity as compared to other surfaces like stainless steel, plastics, glass and highly porous fabrics. It has also been reported that SARS\u2010CoV\u20102 is associated with diarrhoea and that it is shed in the faeces of COVID\u201019 patients. Some CoVs show persistence in human excrement, sewage and waters for a few days. These findings suggest a possible risk of faecal\u2013oral, foodborne and waterborne transmission of SARS\u2010CoV\u20102 in developing countries that often use sewage\u2010polluted waters in irrigation and have poor water treatment systems. CoVs survive longer in the environment at lower temperatures and lower relative humidity. It has been suggested that large numbers of COVID\u201019 cases are associated with cold and dry climates in temperate regions of the world and that seasonality of the virus spread is suspected.", "Diverse local epidemics reveal the distinct effects of population density, demographics, climate, depletion of susceptibles, and intervention in the first wave of COVID-19 in the United States The SARS-CoV-2 pandemic has caused significant mortality and morbidity worldwide, sparing almost no community. As the disease will likely remain a threat for years to come, an understanding of the precise influences of human demographics and settlement, as well as the dynamic factors of climate, susceptible depletion, and intervention, on the spread of localized epidemics will be vital for mounting an effective response. We consider the entire set of local epidemics in the United States; a broad selection of demographic, population density, and climate factors; and local mobility data, tracking social distancing interventions, to determine the key factors driving the spread and containment of the virus. Assuming first a linear model for the rate of exponential growth (or decay) in cases/mortality, we find that population-weighted density, humidity, and median age dominate the dynamics of growth and decline, once interventions are accounted for. A focus on distinct metropolitan areas suggests that some locales benefited from the timing of a nearly simultaneous nationwide shutdown, and/or the regional climate conditions in mid-March; while others suffered significant outbreaks prior to intervention. Using a first-principles model of the infection spread, we then develop predictions for the impact of the relaxation of social distancing and local climate conditions. A few regions, where a significant fraction of the population was infected, show evidence that the epidemic has partially resolved via depletion of the susceptible population (i.e.,\"herd immunity\"), while most regions in the United States remain overwhelmingly susceptible. These results will be important for optimal management of intervention strategies, which can be facilitated using our online dashboard.", "Can the summer temperatures reduce COVID-19 cases? OBJECTIVE: Despite huge global, national, and local preventive measures including travel restriction, social distancing, and quarantines, the outbreak of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) develops the coronavirus disease 2019 (COVID-19) worldwide pandemic. SARS-CoV-2 emerging from Wuhan, China, took only three months to cover >200 countries worldwide by infecting more than 2.4 million people and killing more than 150,000 people. Although this infection at the early stage creates seasonal flu-like symptoms with a higher illness, it eventually causes a higher mortality. Epidemiological studies not only find the causes of many health issues but also suggest preventive measures. This study aimed to see the link between environment temperature and COVID-19 cases. STUDY DESIGN: The monthly average environment temperature (MAET) and various COVID-19 cases of a country were collected and analyzed to see the relationship between these parameters. METHODS: Univariate analysis and statistical modeling were used to determine the relationship between environment temperature and different COVID-19 cases. RESULTS: This study found that the majorities of the countries having higher COVID-19 cases are located in the higher latitude (colder region) in the globe. As of 20th April data available, statistical analyses by various methods have found that strong negative correlations with statistical significance exist between MAET and several COVID-19 cases including total cases, active cases, and cases per million of a country (Spearman correlation coefficients were -0.45, -0.42, and -0.50 for total cases, active cases, and cases/per million, respectively). Analysis by the statistical log-linear regression model further supports that the chance of patients to contract COVID-19 is less in warmer countries than in colder countries. CONCLUSION: This pilot study proposes that cold environment may be an additional risk factor for COVID-19 cases.", "Evidence that high temperatures and intermediate relative humidity might favor the spread of COVID-19 in tropical climate: A case study for the most affected Brazilian cities Abstract This study aimed to analyze how meteorological conditions such as temperature, humidity and rainfall can affect the spread of COVID-19 in five Brazilian (S\u00e3o Paulo, Rio de Janeiro, Bras\u00edlia, Manaus and Fortaleza) cities. The cities selected were those with the largest number of confirmed cases considering data of April 18. Variables such as number of cumulative cases, new daily cases and contamination rate were employed for this study. Our results showed that higher mean temperatures and average relative humidity favored the COVID-19 transmission, differently from reports from coldest countries or periods of time under cool temperatures. Thus, considering the results obtained, intersectoral policies and actions are necessary, mainly in cities where the contamination rate is increasing rapidly. Thus, prevention and protection measures should be adopted in these cities aiming to reduce transmission and the possible collapse of the health system.", "Trends of SARS-Cov-2 infection in 67 countries: Role of climate zone, temperature, humidity and curve behavior of cumulative frequency on duplication time Summary Objective. To analyze the role of temperature, humidity, date of first case diagnosed (DFC) and the behavior of the growth-curve of cumulative frequency (CF) [number of days to rise (DCS) and reach the first 100 cases (D100), and the difference between them (\u0394DD)] with the doubling time (Td) of Covid-19 cases in 67 countries grouped by climate zone. Design. Retrospective incident case study. Setting. WHO based register of cumulative incidence of Covid-19 cases. Participants. 1,706,914 subjects diagnosed between 12-29-2019 and 4-15-2020. Exposures. SARS-Cov-2 virus, ambient humidity, temperature and climate areas (temperate, tropical/subtropical). Main outcome measures. Comparison of DCS, D100, \u0394DD, DFC, humidity, temperature, Td for the first (Td10) and second (Td20) ten days of the CF growth-curve between countries according to climate zone, and identification of factors involved in Td, as well as predictors of CF using lineal regression models. Results. Td10 and Td20 were \u22653 days longer in tropical/subtropical vs. temperate areas (2.8[plusmn]1.2 vs. 5.7[plusmn]3.4; p=1.41E-05 and 4.6[plusmn]1.8 vs. 8.6[plusmn]4.2; p=9.7E-05, respectively). The factors involved in Td10 (DFC and \u0394DD) were different than those in Td20 (Td10 and climate areas). After D100, the fastest growth-curves during the first 10 days, were associated with Td10<2 and Td10<3 in temperate and tropical/subtropical countries, respectively. The fold change Td20/Td10 >2 was associated with earlier flattening of the growth-curve. In multivariate models, Td10, DFC and ambient temperature were negatively related with CF and explained 44.7% (r2 = 0.447) of CF variability at day 20 of the growth-curve, while Td20 and DFC were negatively related with CF and explained 63.8% (r2 = 0.638) of CF variability towards day 30 of the growth-curve. Conclusions. The larger Td in tropical/subtropical countries is positively related to DFC and temperature. Td and environmental factors explain 64% of CF variability in the best of cases. Therefore, other factors, such as pandemic containment measures, would explain the remaining variability.", "The Impact of Weather on Influenza and Pneumonia Mortality in New York City, 1975\u20132002: A Retrospective Study The substantial winter influenza peak in temperate climates has lead to the hypothesis that cold and/or dry air is a causal factor in influenza variability. We examined the relationship between cold and/or dry air and daily influenza and pneumonia mortality in the cold season in the New York metropolitan area from 1975\u20132002. We conducted a retrospective study relating daily pneumonia and influenza mortality for New York City and surroundings from 1975\u20132002 to daily air temperature, dew point temperature (a measure of atmospheric humidity), and daily air mass type. We identified high mortality days and periods and employed temporal smoothers and lags to account for the latency period and the time between infection and death. Unpaired t-tests were used to compare high mortality events to non-events and nonparametric bootstrapped regression analysis was used to examine the characteristics of longer mortality episodes. We found a statistically significant (p = 0.003) association between periods of low dew point temperature and above normal pneumonia and influenza mortality 17 days later. The duration (r = \u22120.61) and severity (r = \u22120.56) of high mortality episodes was inversely correlated with morning dew point temperature prior to and during the episodes. Weeks in which moist polar air masses were common (air masses characterized by low dew point temperatures) were likewise followed by above normal mortality 17 days later (p = 0.019). This research supports the contention that cold, dry air may be related to influenza mortality and suggests that warning systems could provide enough lead time to be effective in mitigating the effects.", "Effect of ambient air pollutants and meteorological variables on COVID-19 incidence OBJECTIVE: To determine whether ambient air pollutants and meteorological variables are associated with daily COVID-19 incidence. DESIGN: A retrospective cohort from January 25 to February 29, 2020. SETTING: Cities of Wuhan, Xiaogan, and Huanggang, China. PATIENTS: The COVID-19 cases detected each day. METHODS: We collected daily data of COVID-19 incidence, 8 ambient air pollutants (particulate matter of &#8804;2.5 \u00b5m [PM2.5], particulate matter &#8804;10 \u00b5m [PM10], sulfur dioxide [SO2], carbon monoxide [CO], nitrogen dioxide [NO2], and maximum 8-h moving average concentrations for ozone [O3-8h]) and 3 meteorological variables (temperature, relative humidity, and wind) in China's 3 worst COVID-19-stricken cities during the study period. The multivariate Poisson regression was performed to understand their correlation. RESULTS: Daily COVID-19 incidence was positively associated with PM2.5 and humidity in all cities. Specifically, the relative risk (RR) of PM2.5 for daily COVID-19 incidences were 1.036 (95% confidence interval [CI], 1.032-1.039) in Wuhan, 1.059 (95% CI, 1.046-1.072) in Xiaogan, and 1.144 (95% CI, 1.12-1.169) in Huanggang. The RR of humidity for daily COVID-19 incidence was consistently lower than that of PM2.5, and this difference ranged from 0.027 to 0.111. Moreover, PM10 and temperature also exhibited a notable correlation with daily COVID-19 incidence, but in a negative pattern The RR of PM10 for daily COVID-19 incidence ranged from 0.915 (95% CI, 0.896-0.934) to 0.961 (95% CI, 0.95-0.972, while that of temperature ranged from 0.738 (95% CI, 0.717-0.759) to 0.969 (95% CI, 0.966-0.973). CONCLUSIONS: Our data show that PM2.5 and humidity are substantially associated with an increased risk of COVID-19 and that PM10 and temperature are substantially associated with a decreased risk of COVID-19.", "The role of environmental factors to transmission of SARS-CoV-2 (COVID-19) The current outbreak of the novel coronavirus disease 2019 (COVID-19) in more than 250 countries has become a serious threat to the health of people around the world. Human-to-human transmission of the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurs most often when people are in the incubation stage of the disease or are carriers and have no symptoms. Therefore, in this study, was discussed the role of environmental factors and conditions such as temperature, humidity, wind speed as well as food, water and sewage, air, insects, inanimate surfaces, and hands in COVID-19 transmission. The results of studies on the stability of the SARS-CoV-2 on different levels showed that the resistance of this virus on smooth surfaces was higher than others. Temperature increase and sunlight can facilitate the destruction of SARS-COV-2 and the stability of it on surfaces. When the minimum ambient air temperature increases by 1 \u00b0C, the cumulative number of cases decreases by 0.86%. According to the latest evidence, the presence of coronavirus in the sewer has been confirmed, but there is no evidence that it is transmitted through sewage or contaminated drinking water. Also, SARS-COV-2 transmission through food, food packages, and food handlers has not been identified as a risk factor for the disease. According to the latest studies, the possibility of transmitting SARS-COV-2 bioaerosol through the air has been reported in the internal environment of ophthalmology. The results additionally show that infectious bio-aerosols can move up to 6 feet. There have been no reports of SARS-COV-2 transmission by blood-feeding arthropods such as mosquitoes.", "Environmental concern regarding the effect of humidity and temperature on 2019-nCoV survival: fact or fiction The new coronavirus, called 2019-nCoV, is a new type of virus that was first identified in Wuhan, China, in December 2019. Environmental conditions necessary for survival and spread of 2019-nCoV are somewhat transparent but unlike animal coronaviruses. We are poorly aware of their survival in environment and precise factors of their transmission. Countries located in east and west of globe did not have a significant impact on prevalence of disease among communities, and on the other hand, north and south have provided a model for relative prediction of disease outbreaks. The 2019-nCoV can survive for up to 9 days at 25 \u00b0C, and if this temperature rises to 30 \u00b0C, its lifespan will be shorter. The 2019-nCoV is sensitive to humidity, and lifespan of viruses in 50% humidity is longer than that of 30%. Also, temperature and humidity are important factors influencing the COVID-19 mortality rate and may facilitate 2019-nCoV transmission. Thus, considering the available and recent evidence, it seems that low temperatures, as well as dry and unventilated air, may affect stability and transmissibility of 2019-nCoV.", "Impact Of Temperature and Sunshine Duration on Daily New Cases and Death due to COVID-19 Background: The coronavirus pandemic (COVID-19) control has now become a critical issue for public health. Many ecological factors are proven to influence the transmission and survival of the virus. In this study, we aim to determine the association of different climate factors with the spread and mortality due to COVID-19. Methods: The climate indicators included in the study were duration of sunshine, average minimum temperature and average maximum temperature, with cumulative confirmed cases, deceased and recovered cases. The data was performed for 138 different countries of the world, between January 2020 to May 2020. Both univariate and multivariate was performed for cumulative and month-wise analysis using SPSS software. Results: The average maximum temperature, and sunshine duration was significantly associated with COVID-19 confirmed cases, deceased and recovered. For every one degree increase in mean average temperature, the confirmed, deceased and recovered cases decreased by 2047(p=0.03), 157(p=0.016), 743 (p=0.005) individuals. The association remained significant even after adjusting for environmental such as sunshine duration as well as non-environmental variables. Average sunshine duration was inversely correlated with increase in daily new cases ({rho}= -2261) and deaths ({rho}= -0.2985). Conclusion: Higher average temperature and longer sunshine duration was strongly associated with COVID-19 cases and deaths in 138 countries. Hence the temperature is an important factor in SARS CoV-2 survival and this study will help in formulating better preventive measures to combat COVID-19 based on their climatic conditions.", "Early transmission of COVID-19 has an optimal temperature but late transmission decreases in warm climate The COVID-19 novel virus, as an emerging highly pathogenic agent, has caused a pandemic. Revealing the influencing factors affecting transmission of COVID-19 is essential to take effective control measures. Several previous studies suggested that the spread of COVID-19 was likely associated with temperature and/or humidity. But, a recent extensive review indicated that conclusions on associations between climate and COVID-19 were elusive with high uncertainty due to caveats in most previous studies, such as limitations in time and space, data quality and confounding factors. In this study, by using a more extensive global dataset covering 578 time series from China, USA, Europe and the rest of the world, we show that climate show distinct impacts on early and late transmission of COVID-19 in the world after excluding the confounding factors. The early transmission ability of COVID-19 peaked around 6.3{degrees}C without or with little human intervention, but the later transmission ability was reduced in high temperature conditions under human intervention, probably driven by increased control efficiency of COVID-19. The transmission ability was positively associated with the founding population size of early reported cases and population size of a location. Our study suggested that with the coming summer seasons, the transmission risk of COVID-19 would increase in the high-latitude or high-altitude regions but decrease in low-latitude or low-altitude regions; human intervention is essential in containing the spread of COVID-19 around the world.", "A spatio-temporal analysis for exploring the effect of temperature on COVID-19 early evolution in Spain The new SARS-CoV-2 coronavirus, which causes the COVID-19 disease, was reported in Wuhan, China, in December 2019. This new pathogen has spread rapidly around more than 200 countries, in which Spain has one of the world's highest mortality rates so far. Previous studies have supported an epidemiological hypothesis that weather conditions may affect the survival and spread of droplet-mediated viral diseases. However, some contradictory studies have also been reported in the same research line. In addition, many of these studies have been performed considering only meteorological factors, which can limit the reliability of the results. Herein, we report a spatio-temporal analysis for exploring the effect of daily temperature (mean, minimum and maximum) on the accumulated number of COVID-19 cases in the provinces of Spain. Non-meteorological factors such as population density, population by age, number of travellers and number of companies have also been considered for the analysis. No evidence suggesting a reduction in COVID-19 cases at warmer mean, minimum and maximum temperatures has been found. Nevertheless, these results need to be interpreted cautiously given the existing uncertainty about COVID-19 data, and should not be extrapolated to temperature ranges other than those analysed here for the early evolution period.", "Diverse local epidemics reveal the distinct effects of population density, demographics, climate, depletion of susceptibles, and intervention in the first wave of COVID-19 in the United States The SARS-CoV-2 pandemic has caused significant mortality and morbidity worldwide, sparing almost no community. As the disease will likely remain a threat for years to come, an understanding of the precise influences of human demographics and settlement, as well as the dynamic factors of climate, susceptible depletion, and intervention, on the spread of localized epidemics will be vital for mounting an effective response. We consider the entire set of local epidemics in the United States; a broad selection of demographic, population density, and climate factors; and local mobility data, tracking social distancing interventions, to determine the key factors driving the spread and containment of the virus. Assuming first a linear model for the rate of exponential growth (or decay) in cases/mortality, we find that population-weighted density, humidity, and median age dominate the dynamics of growth and decline, once interventions are accounted for. A focus on distinct metropolitan areas suggests that some locales benefited from the timing of a nearly simultaneous nationwide shutdown, and/or the regional climate conditions in mid-March; while others suffered significant outbreaks prior to intervention. Using a first-principles model of the infection spread, we then develop predictions for the impact of the relaxation of social distancing and local climate conditions. A few regions, where a significant fraction of the population was infected, show evidence that the epidemic has partially resolved via depletion of the susceptible population (i.e., \"herd immunity\"), while most regions in the United States remain overwhelmingly susceptible. These results will be important for optimal management of intervention strategies, which can be facilitated using our online dashboard.", "Global COVID-19 transmission rate is influenced by precipitation seasonality and the speed of climate temperature warming The novel coronavirus disease 2019 (COVID-19) became a rapidly spreading worldwide epidemic; thus, it is a global priority to reduce the speed of the epidemic spreading. Several studies predicted that high temperature and humidity could reduce COVID-19 transmission. However, exceptions exist to this observation, further thorough examinations are thus needed for their confirmation. In this study, therefore, we used a global dataset of COVID-19 cases and global climate databases and comprehensively investigated how climate parameters could contribute to the growth rate of COVID-19 cases while statistically controlling for potential confounding effects using spatial analysis. We also confirmed that the growth rate decreased with the temperature; however, the growth rate was affected by precipitation seasonality and warming velocity rather than temperature. In particular, a lower growth rate was observed for a higher precipitation seasonality and lower warming velocity. These effects were independent of population density, human life quality, and travel restrictions. The results indicate that the temperature effect is less important compared to these intrinsic climate characteristics, which might thus be useful for explaining the exceptions. However, the contributions of the climate parameters to the growth rate were moderate; rather, the contribution of travel restrictions in each country was more significant. Although our findings are preliminary owing to data-analysis limitations, they may be helpful when predicting COVID-19 transmission.", "Effects of air temperature and relative humidity on coronavirus survival on surfaces. Assessment of the risks posed by severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV) on surfaces requires data on survival of this virus on environmental surfaces and on how survival is affected by environmental variables, such as air temperature (AT) and relative humidity (RH). The use of surrogate viruses has the potential to overcome the challenges of working with SARS-CoV and to increase the available data on coronavirus survival on surfaces. Two potential surrogates were evaluated in this study; transmissible gastroenteritis virus (TGEV) and mouse hepatitis virus (MHV) were used to determine effects of AT and RH on the survival of coronaviruses on stainless steel. At 4 degrees C, infectious virus persisted for as long as 28 days, and the lowest level of inactivation occurred at 20% RH. Inactivation was more rapid at 20 degrees C than at 4 degrees C at all humidity levels; the viruses persisted for 5 to 28 days, and the slowest inactivation occurred at low RH. Both viruses were inactivated more rapidly at 40 degrees C than at 20 degrees C. The relationship between inactivation and RH was not monotonic, and there was greater survival or a greater protective effect at low RH (20%) and high RH (80%) than at moderate RH (50%). There was also evidence of an interaction between AT and RH. The results show that when high numbers of viruses are deposited, TGEV and MHV may survive for days on surfaces at ATs and RHs typical of indoor environments. TGEV and MHV could serve as conservative surrogates for modeling exposure, the risk of transmission, and control measures for pathogenic enveloped viruses, such as SARS-CoV and influenza virus, on health care surfaces.", "Temperature, Humidity, and Latitude Analysis to Estimate Potential Spread and Seasonality of Coronavirus Disease 2019 (COVID-19) IMPORTANCE: Coronavirus disease 2019 (COVID-19) infection has resulted in a global crisis. Investigating the potential association of climate and seasonality with the spread of this infection could aid in preventive and surveillance strategies. OBJECTIVE: To examine the association of climate with the spread of COVID-19 infection. DESIGN, SETTING, AND PARTICIPANTS: This cohort study examined climate data from 50 cities worldwide with and without substantial community spread of COVID-19. Eight cities with substantial spread of COVID-19 (Wuhan, China; Tokyo, Japan; Daegu, South Korea; Qom, Iran; Milan, Italy; Paris, France; Seattle, US; and Madrid, Spain) were compared with 42 cities that have not been affected or did not have substantial community spread. Data were collected from January to March 10, 2020. MAIN OUTCOMES AND MEASURES: Substantial community transmission was defined as at least 10 reported deaths in a country as of March 10, 2020. Climate data (latitude, mean 2-m temperature, mean specific humidity, and mean relative humidity) were obtained from ERA-5 reanalysis. RESULTS: The 8 cities with substantial community spread as of March 10, 2020, were located on a narrow band, roughly on the 30\u00b0 N to 50\u00b0 N corridor. They had consistently similar weather patterns, consisting of mean temperatures of between 5 and 11 \u00b0C, combined with low specific humidity (3-6 g/kg) and low absolute humidity (4-7 g/m(3)). There was a lack of substantial community establishment in expected locations based on proximity. For example, while Wuhan, China (30.8\u00b0 N) had 3136 deaths and 80 757 cases, Moscow, Russia (56.0\u00b0 N), had 0 deaths and 10 cases and Hanoi, Vietnam (21.2\u00b0 N), had 0 deaths and 31 cases. CONCLUSIONS AND RELEVANCE: In this study, the distribution of substantial community outbreaks of COVID-19 along restricted latitude, temperature, and humidity measurements was consistent with the behavior of a seasonal respiratory virus. Using weather modeling, it may be possible to estimate the regions most likely to be at a higher risk of substantial community spread of COVID-19 in the upcoming weeks, allowing for concentration of public health efforts on surveillance and containment.", "Association of meteorological factors with childhood viral acute respiratory infections in subtropical China: an analysis over 11 years. The objective of this study was to obtain a better understanding of the effects of meteorological factors on the prevalence and seasonality of common respiratory viruses in China, which has a subtropical climate. A retrospective study was conducted by identifying children admitted to a hospital with acute respiratory infections due to seven common viruses between January 2001 and December 2011. A total of 42,104 nasopharyngeal samples were tested for respiratory syncytial virus (RSV), influenza A and B viruses (IV-A and IV-B), parainfluenza viruses 1-3 (PIV-1, PIV-2, PIV-3), and adenovirus (ADV) by direct immunofluorescence assay. Meteorological data were obtained from Suzhou Weather Bureau. Correlations of viral prevalence with meteorological factors were evaluated using Spearman rank correlation and partial correlation. Multivariate time-series analysis including an autoregressive integrated moving average (ARIMA) model and generalized linear Poisson models was conducted to study the effect of meteorological factors on the prevalence of respiratory virus infection. RSV and IV-A activity showed distinctive winter peak, whereas PIV-3 and ADV peaked in the summer. Incidence of RSV was correlated with low environmental temperature, and PIV-3 only with high temperature. IV-A activity was correlated with both low temperature and high relative humidity. ADV activity was correlated with high total rainfall. In the ARIMA model, RSV-associated hospitalizations were predictable, and the monthly number of RSV cases decreased by 11.25 % (95 % CI: 5.34 % to 16.79 %) for every 1 \u00b0C increase in the average temperature. Seasonality of certain respiratory virus may be explained by meteorological influences. The impact of meteorological factors on the prevalence of RSV may be useful for predicting the activity of this virus.", "The Association of Social Distancing, Population Density, and Temperature with the SARS-CoV-2 Instantaneous Reproduction Number in Counties Across the United States Importance: The Covid-19 pandemic has been marked by considerable heterogeneity in outbreaks across the United States. Local factors that may be associated with variation in SARS-CoV-2 transmission have not been well studied. Objective: To examine the association of county-level factors with variation in the SARS-CoV-2 reproduction number over time. Design: Observational study Setting: 211 counties in 46 states and the District of Columbia between February 25, 2020 and April 23, 2020. Participants: Residents within the counties (55% of the US population) Exposures: Social distancing as measured by percent change in visits to non-essential businesses, population density, lagged daily wet bulb temperatures. Main Outcomes and Measures: The instantaneous reproduction number (Rt) which is the estimated number of cases generated by one case at a given time during the pandemic. Results: Median case incidence was 1185 cases and fatality rate was 43.7 deaths per 100,000 people for the top decile of 21 counties, nearly ten times the incidence and fatality rate in the lowest density quartile. Average Rt in the first two weeks was 5.7 (SD 2.5) in the top decile, compared to 3.1 (SD 1.2) in the lowest quartile. In multivariable analysis, a 50% decrease in visits to non-essential businesses was associated with a 57% decrease in Rt (95% confidence interval, 56% to 58%). Cumulative temperature effects over 4 to 10 days prior to case incidence were nonlinear; relative Rt decreased as temperatures warmed above 32F to 53F, which was the point of minimum Rt, then increased between 53F and 66F, at which point Rt began to decrease. At 55F, and with a 70% reduction in visits to non-essential business, 96% of counties were estimated to fall below a threshold Rt of 1.0, including 86% of counties among the top density decile and 98% of counties in the lowest density quartile. Conclusions and Relevance: Social distancing, lower population density, and temperate weather change were associated with a decreased SARS-Co-V-2 Rt in counties across the United States. These relationships can inform selective public policy planning in communities during the SARS-CoV-2 pandemic.", "Examine the impact of weather and ambient air pollutant parameters on daily case of COVID-19 in India. The present study presents a view on exploring the relationship pattern between COVID 19 daily cases with weather parameters and air pollutants in mainland India. We consider mean temperature, relative humidity, solar radiation, rainfall, wind speed, PM2.5, PM10, SO2, NO2 and CO as independent variable and daily COVID 19 cases as dependent variable for 18 states during 18th march to 30th April, 2020.After dividing the dataset for 0 to 10 day, 10 to 25 days and 0 to 44 days, the current study applied Akaike s Information Criteria (AIC) and Generalized Additive Model (GAM) to examine the kind of relationship between independent variables with COVID 19 cases. Initially GAM model result shows variables like temperature and solar radiation has positive relation (p<0.05) in 0 to 10 days study with daily cases. In 25 days dataset it significantly shows that temperature has positive relation above 23 degree centigrade, SO2 has a negative relationship and relative humidity has negative (between 30% to 45% and > 60%) and a positive relationship (45% to 60%) with COVID 19 cases (p=0.05). 44 days dataset has six parameters includes temperature as positive, relative humidity as negative (between 0 to 45%) and then positive (after >45%), NO2 as Positive (0 to 35 microgram/m3) followed by negative trend (after > 40 microgram/m3), SO2 and rainfall as negative relation. After sensitive analysis, it is found that weather variables like relative humidity, solar radiation and rainfall are more sensitive than temperature and wind speed. Whereas pollutants like NO2, PM2.5, PM10 and CO are more sensitive variables than SO2 in this study. In summary this study finds temperature, relative humidity, solar radiation, wind speed, SO2, PM2.5, and CO may be important factors associated with COVID 19 pandemic. Keywords: Weather parameter, Air pollutants, Daily COVID 19 cases, Akaike s Information Criteria (AIC), Generalized Additive Model (GAM) and Sensitive analysis.", "Temperature dependence of COVID-19 transmission The recent coronavirus pandemic follows in its early stages an almost exponential growth, with the number of cases quite well fit in time by $N(t)\\propto e^{\\alpha t}$, in many countries. We analyze the rate $\\alpha$ for each country, starting from a threshold of 30 total cases and using the next 12 days, capturing thus the early growth homogeneously. We look for a link between $\\alpha$ and the average temperature $T$ of each country, in the month of the epidemic growth. We analyze a {\\it base} set of 42 countries, which developed the epidemic earlier, an {\\it intermediate} set of 88 countries and an {\\it extended} set of 125 countries, which developed the epidemic more recently. Applying a linear fit $\\alpha(T)$, we find increasing evidence for a decreasing $\\alpha$ as a function of $T$, at $99.66\\%$C.L., $99.86\\%$C.L. and $99.99995 \\%$ C.L. ($p$-value $5 \\cdot 10^{-7}$, or 5$\\sigma$ detection) in the {\\it base}, {\\it intermediate} and {\\it extended} dataset, respectively. The doubling time is expected to increase by $40\\%\\sim 50\\%$, going from $5^\\circ$ C to $25^\\circ$ C. In the {\\it base} set, going beyond a linear model, a peak at $(7.7\\pm 3.6)^\\circ C$ seems to be present, but its evidence disappears for the larger datasets. We also analyzed a possible bias: poor countries, often located in warm regions, might have less intense testing. By excluding countries below a given GDP per capita, we find that our conclusions are only slightly affected and only for the {\\it extended} dataset. The significance remains high, with a $p$-value of $10^{-3}-10^{-4}$ or less. Our findings give hope that, for northern hemisphere countries, the growth rate should significantly decrease as a result of both warmer weather and lockdown policies. In general the propagation should be hopefully stopped by strong lockdown, testing and tracking policies, before the arrival of the cold season.", "Respiratory syncytial virus bronchiolitis, weather conditions and air pollution in an Italian urban area: An observational study Abstract Background In this study we sought to evaluate the association between viral bronchiolitis, weather conditions, and air pollution in an urban area in Italy. Methods We included infants hospitalized for acute bronchiolitis from 2004 to 2014. All infants underwent a nasal washing for virus detection. A regional agency network collected meteorological data (mean temperature, relative humidity and wind velocity) and the following air pollutants: sulfur dioxide, nitrogen oxide, carbon monoxide, ozone, benzene and suspended particulate matter measuring less than 10 \u00b5m (PM10) and less than 2.5 \u00b5m (PM2.5) in aerodynamic diameter. We obtained mean weekly concentration data for the day of admission, from the urban background monitoring sites nearest to each child's home address. Overdispersed Poisson regression model was fitted and adjusted for seasonality of the respiratory syncytial virus (RSV) infection, to evaluate the impact of individual characteristics and environmental factors on the probability of a being positive RSV. Results Of the 723 nasal washings from the infants enrolled, 266 (68%) contained RSV, 63 (16.1%) rhinovirus, 26 (6.6%) human bocavirus, 20 (5.1%) human metapneumovirus, and 16 (2.2%) other viruses. The number of RSV-positive infants correlated negatively with temperature (p < 0.001), and positively with relative humidity (p < 0.001). Air pollutant concentrations differed significantly during the peak RSV months and the other months. Benzene concentration was independently associated with RSV incidence (p = 0.0124). Conclusions Seasonal weather conditions and concentration of air pollutants seem to influence RSV-related bronchiolitis epidemics in an Italian urban area.", "COVID-19: Effects of weather conditions on the propagation of respiratory droplets As the number of confirmed cases of Coronavirus disease 2019 (COVID-19) continues to increase, there has been a rising concern regarding the effect of weather conditions, especially over the upcoming summer, on the transmission of this disease. In this study, we assess the transmission of COVID-19 under different weather conditions by investigating the propagation of infectious respiratory droplets. A comprehensive mathematical model is established to explore their evaporation, heat transfer and kinematics under different temperature, humidity and ventilation conditions. The transmitting pathway of COVID-19 through respiratory droplets is divided into short-range droplet contacts and long-range aerosol exposure. We show that the effect of weather conditions is not monotonic: low temperature and high humidity facilitate droplet contact transmission, while high temperature and low humidity promote the formation of aerosol particles and accumulation of particles with a diameter of 2.5 m or less (PM2.5). Our model suggests that the 6 ft of social distance recommended by the Center for Disease Control and Prevention (CDC) may be insufficient in certain environmental conditions, as the droplet spreading distance can be as long as 6 m (19.7 ft) in cold and humid weather. The results of this study suggest that the current pandemic may not ebb in the summer of the northern hemisphere without proper intervention, as there is an increasing chance of aerosol transmission. We also emphasize that the meticulous design of building ventilation systems is critical in containing both the droplet contact infections and aerosol exposures.", "A chemical cocktail during the COVID-19 outbreak in Beijing, China: Insights from six-year aerosol particle composition measurements during the Chinese New Year holiday The rapidly spread coronavirus disease (COVID-19) has limited people's outdoor activities and hence caused substantial reductions in anthropogenic emissions around the world. However, the air quality in some megacities has not been improved as expected due to the complex responses of aerosol chemistry to the changes in precursors and meteorology. Here we demonstrate the responses of primary and secondary aerosol species to the changes in anthropogenic emissions during the COVID-19 outbreak in Beijing, China along with the Chinese New Year (CNY) holiday effects on air pollution by using six-year aerosol particle composition measurements. Our results showed large reductions in primary aerosol species associated with traffic, cooking and coal combustion emissions by 30\u201350% on average during the CNY, while the decreases in secondary aerosol species were much small (5\u201312%). These results point towards a future challenge in mitigating secondary air pollution because the reduced gaseous precursors may not suppress secondary aerosol formation efficiently under stagnant meteorological conditions. By analyzing the long-term measurements from 2012 to 2020, we found considerable increases in the ratios of nitrate to sulfate, secondary to primary OA, and sulfur and nitrogen oxidation capacity despite the overall decreasing trends in mass concentrations of most aerosol species, suggesting that the decreases in anthropogenic emissions have facilitated secondary formation processes during the last decade. Therefore, a better understanding of the mechanisms driving the chemical responses of secondary aerosol to the changes in anthropogenic emissions under complex meteorological environment is essential for future mitigation of air pollution in China.", "Association between ambient temperature and COVID-19 infection in 122 cities from China Abstract Background Coronavirus disease 2019 (COVID-19) has become a severe public health problem globally. Both epidemiological and laboratory studies have shown that ambient temperature could affect the transmission and survival of coronaviruses. This study aimed to determine whether the temperature is an essential factor in the infection caused by this novel coronavirus. Methods Daily confirmed cases and meteorological factors in 122 cities were collected between January 23, 2020, to February 29, 2020. A generalized additive model (GAM) was applied to explore the nonlinear relationship between mean temperature and COVID-19 confirmed cases. We also used a piecewise linear regression to determine the relationship in detail. Results The exposure-response curves suggested that the relationship between mean temperature and COVID-19 confirmed cases was approximately linear in the range of <3 \u00b0C and became flat above 3 \u00b0C. When mean temperature (lag0\u201314) was below 3 \u00b0C, each 1 \u00b0C rise was associated with a 4.861% (95% CI: 3.209\u20136.513) increase in the daily number of COVID-19 confirmed cases. These findings were robust in our sensitivity analyses. Conclusions Our results indicate that mean temperature has a positive linear relationship with the number of COVID-19 cases with a threshold of 3 \u00b0C. There is no evidence supporting that case counts of COVID-19 could decline when the weather becomes warmer, which provides useful implications for policymakers and the public.", "A mechanism-based parameterisation scheme to investigate the association between transmission rate of COVID-19 and meteorological factors on plains in China The novel coronavirus disease 2019 (COVID-19), which first emerged in Hubei province, China, has become a pandemic. However, data regarding the effects of meteorological factors on its transmission are limited and inconsistent. A mechanism-based parameterisation scheme was developed to investigate the association between the scaled transmission rate (STR) of COVID-19 and the meteorological parameters in 20 provinces/municipalities located on the plains in China. We obtained information on the scale of population migrated from Wuhan, the world epicentre of the COVID-19 outbreak, into the study provinces/municipalities using mobile-phone positioning system and big data techniques. The highest STRs were found in densely populated metropolitan areas and in cold provinces located in north-eastern China. Population density had a non-linear relationship with disease spread (linearity index, 0.9). Among various meteorological factors, only temperature was significantly associated with the STR after controlling for the effect of population density. A negative and exponential relationship was identified between the transmission rate and the temperature (correlation coefficient, \u22120.56; 99% confidence level). The STR increased substantially as the temperature in north-eastern China decreased below 0 \u00b0C (the STR ranged from 3.5 to 12.3 when the temperature was between \u22129.41 \u00b0C and \u221213.87 \u00b0C), whilst the STR showed less temperature dependence in the study areas with temperate weather conditions (the STR was 1.21 \u00b1 0.57 when the temperature was above 0 \u00b0C). Therefore, a higher population density was linearly whereas a lower temperature (<0 \u00b0C) was exponentially associated with an increased transmission rate of COVID-19. These findings suggest that the mitigation of COVID-19 spread in densely populated and/or cold regions will be a great challenge.", "Chapter Three Climate Change and the Neglected Tropical Diseases Abstract Climate change is expected to impact across every domain of society, including health. The majority of the world's population is susceptible to pathological, infectious disease whose life cycles are sensitive to environmental factors across different physical phases including air, water and soil. Nearly all so-called neglected tropical diseases (NTDs) fall into this category, meaning that future geographic patterns of transmission of dozens of infections are likely to be affected by climate change over the short (seasonal), medium (annual) and long (decadal) term. This review offers an introduction into the terms and processes deployed in modelling climate change and reviews the state of the art in terms of research into how climate change may affect future transmission of NTDs. The 34 infections included in this chapter are drawn from the WHO NTD list and the WHO blueprint list of priority diseases. For the majority of infections, some evidence is available of which environmental factors contribute to the population biology of parasites, vectors and zoonotic hosts. There is a general paucity of published research on the potential effects of decadal climate change, with some exceptions, mainly in vector-borne diseases.", "Impact of Daily Weather on COVID-19 outbreak in India The COVID-19 pandemic has outspread obstreperously in India. As of June 04, 2020, more than 2 lakh cases have been confirmed with a death rate of 2.81%. It has been noticed that, out of each 1000 tests, 53 result positively infected. In order to investigate the impact of weather conditions on daily transmission occurring in India, daily data of Maximum (TMax), Minimum (TMin), Mean (TMean) and Dew Point Temperature (TDew), Diurnal Temperature range (TRange), Average Relative Humidity, Range in Relative Humidity, and Wind Speed (WS) over 9 most affected cities are analysed in several time frames: weather of that day, 7, 10, 12, 14, 16 days before transmission. Spearman rank correlation (r) shows significant but low correlation with most of the weather parameters, however, comparatively better association exists on 14 days lag. Diurnal range in Temperature and Relative Humidity shows non-significant correlation. Analysis shows, COVID-19 cases likely to be increased with increasing air temperature, however role of humidity is not clear. Among weather parameters, Minimum Temperature was relatively better correlate than other. 80% of the total confirmed cases were registered when TMax, TMean, TMin, TRange, TDew, and WS on 12-16 days ago vary within a range of 33.6-41.3 deg C, 29.8-36.5 deg C, 24.8-30.4 deg C, 7.5-15.2 deg C, 18.7-23.6 deg C, and 4.2-5.75 m/s respectively, hence, it gives an idea of susceptible weather conditions for such transmission in India. Using Support Vector Machine based regression, the daily cases are profoundly estimated with more than 80% accuracy, which indicate that coronavirus transmission cannot be well linearly correlated with any single weather parameters, rather multivariate non-linear approach must be employed. Accounting lag of 12-16 days, the association found to be excellent, thus depict that there is an incubation period of 12-16 days for coronavirus transmission in Indian scenario.", "Identification of climate factors related to human infection with avian influenza A H7N9 and H5N1 viruses in China Human influenza infections display a strongly seasonal pattern. However, whether H7N9 and H5N1 infections correlate with climate factors has not been examined. Here, we analyzed 350 cases of H7N9 infection and 47 cases of H5N1 infection. The spatial characteristics of these cases revealed that H5N1 infections mainly occurred in the South, Middle, and Northwest of China, while the occurrence of H7N9 was concentrated in coastal areas of East and South of China. Aside from spatial-temporal characteristics, the most adaptive meteorological conditions for the occurrence of human infections by these two viral subtypes were different. We found that H7N9 infections correlate with climate factors, especially temperature (TEM) and relative humidity (RHU), while H5N1 infections correlate with TEM and atmospheric pressure (PRS). Hence, we propose a risky window (TEM 4\u201314 \u00b0C and RHU 65\u201395%) for H7N9 infection and (TEM 2\u201322 \u00b0C and PRS 980-1025 kPa) for H5N1 infection. Our results represent the first step in determining the effects of climate factors on two different virus infections in China and provide warning guidelines for the future when provinces fall into the risky windows. These findings revealed integrated predictive meteorological factors rooted in statistic data that enable the establishment of preventive actions and precautionary measures against future outbreaks.", "Eco-epidemiological assessment of the COVID-19 epidemic in China, January-February 2020 Background: The outbreak of COVID-19 in China in early 2020 provides a rich data source for exploring the ecological determinants of this new infection, which may be of relevance as the pandemic develops.Objectives: Assessing the spread of the COVID-19 across China, in relation to associations between cases and ecological factors including population density, temperature, solar radiation and precipitation.Methods: Open-access COVID-19 case data include 18,069 geo-located cases in China during January and February 2020, which were mapped onto a 0.25\u00b0 latitude/longitude grid together with population and weather data (temperature, solar radiation and precipitation). Of 15,539 grid cells, 559 (3.6%) contained at least one case, and these were used to construct a Poisson regression model of cell-weeks. Weather parameters were taken for the preceding week given the established 5-7 day incubation period for COVID-19. The dependent variable in the Poisson model was incident cases per cell-week and exposure was cell population, allowing for clustering of cells over weeks, to give incidence rate ratios.Results: The overall COVID-19 incidence rate in cells with confirmed cases was 0.12 per 1,000. There was a single confirmed case in 113/559 (20.2%) of cells, while two grid cells recorded over 1,000 confirmed cases. Weekly means of maximum daily temperature varied from -28.0\u00b0C to 30.1\u00b0C, minimum daily temperature from -42.4\u00b0C to 23.0\u00b0C, maximum solar radiation from 0.04 to 2.74 MJm-2 and total precipitation from 0 to 72.6 mm. Adjusted incidence rate ratios suggested brighter, warmer and drier conditions were associated with lower incidence.Conclusion: Though not demonstrating cause and effect, there were appreciable associations between weather and COVID-19 incidence during the epidemic in China. This does not mean the pandemic will go away with summer weather but demonstrates the importance of using weather conditions in understanding and forecasting the spread of COVID-19.", "Forecasting the COVID-19 Pandemic with Climate Variables for Top Five Burdening and Three South Asian Countries Background: The novel coronavirus (COVID-19) is now in a horrific situation around the world. Prediction about the number of infected and death cases may help to take immediate action to prevent the epidemic as well as control the situation of a country. The ongoing debate about the climate factors may need more validation with more studies. The climate factors of the top-five affected countries and three south Asian countries have considered in this study to have a real-time forecast and robust validation about the impact of climate variables. Methods: The ARIMA model have included to model the univariate cumulative confirmed and death cases separately. The MLP, ELM and likelihood-based GLM count time series also considered as they consider the external variables as exogenous regressors. As the death count includes zero itself, zero-inflated count time series model has included instead of likelihood-based GLM. The better fitting of the ARIMA model will validate the underwhelm of meteorological factors was the initial hypothesis. The best model has identified through the application and comparison with the real data points. Results: The results depict that there is an influence of meteorological variables like temperature and humidity mostly for all the selected countries cumulative confirm cases excluding Italy and Sri-Lanka. However, the best models for deaths count of each country also identify the impact of meteorological variables for each country. Conclusion: The authors make the sixty days ahead forecast for each country which will be beneficial for the policymakers.", "The temperature and regional climate effects on communitarian COVID-19 contagion in Mexico throughout phase 1 Due to the close relationship between the incidence of infectious diseases by epidemics and environmental conditions, this research explores the temperature, evaporation, precipitation and regional climate effects on the local transmission of coronavirus SARS-CoV-2 inside 31 states and capital of Mexico since February 29 (national onset) to March 31, 2020. Statistical analysis was conducted to explore the association between the daily local COVID-19 confirmed positive cases (LCPC) and both climate characteristics and the daily weather reported by the regional meteorological stations. In this work, the local transmission ratio (LTR) was calculated with the regional LCPC divided by the number of the effective contagion days since regional onset in each state. The results showed a negative association between temperature (mean, max and min) and climate classification with both LCPC and LTR variables. The precipitation associated positively with LCPC and LTR. The associations between the climate classification with LCPC and LTR are statistically significant. The tropical climate (mean temperature around 25.95\u00e2\u0080\u00af\u00b0C and mean precipitation around 8.74\u00e2\u0080\u00afmm) delayed the regional onset. However, the regional onset in dry climates emerged earlier as consequence of the lower temperatures and higher precipitations (20.57\u00e2\u0080\u00af\u00b0C and 20.87\u00e2\u0080\u00afmm respectively) than the observed in the tropical climate. The fastest regional onsets were observed in tempered climates in states where the lowest temperatures and lowest precipitations were registered (19.65\u00e2\u0080\u00af\u00b0C and 8.48\u00e2\u0080\u00afmm respectively). Meteorological factors influenced the trend on the regional outbreaks in Mexican's states likely by the host predisposition and susceptibility during the cold winter season. In Mexico, the climate characteristics played a crucial role on the local infection during the phase 1 being the tempered regions (as Michoac\u00e1n, Jalisco, Puebla, etc.) more vulnerable than the dry (as Chihuahua, Durango or Zacatecas, etc.) or tropical areas (as Colima, Campeche, Morelos etc.).", "Causal empirical estimates suggest COVID-19 transmission rates are highly seasonal Nearly every country is now combating the 2019 novel coronavirus (COVID-19). It has been hypothesized that if COVID-19 exhibits seasonality, changing temperatures in the coming months will shift transmission patterns around the world. Such projections, however, require an estimate of the relationship between COVID-19 and temperature at a global scale, and one that isolates the role of temperature from confounding factors, such as public health capacity. This paper provides the first plausibly causal estimates of the relationship between COVID-19 transmission and local temperature using a global sample comprising of 166,686 confirmed new COVID-19 cases from 134 countries from January 22, 2020 to March 15, 2020. We find robust statistical evidence that a 1\u00b0C increase in local temperature reduces transmission by 13% [-21%, -4%, 95%CI]. In contrast, we do not find that specific humidity or precipitation influence transmission. Our statistical approach separates effects of climate variation on COVID-19 transmission from other potentially correlated factors, such as differences in public health responses across countries and heterogeneous population densities. Using constructions of expected seasonal temperatures, we project that changing temperatures between March 2020 and July 2020 will cause COVID-19 transmission to fall by 43% on average for Northern Hemisphere countries and to rise by 71% on average for Southern Hemisphere countries. However, these patterns reverse as the boreal winter approaches, with seasonal temperatures in January 2021 increasing average COVID-19 transmission by 59% relative to March 2020 in northern countries and lowering transmission by 2% in southern countries. These findings suggest that Southern Hemisphere countries should expect greater transmission in the coming months. Moreover, Northern Hemisphere countries face a crucial window of opportunity: if contagion-containing policy interventions can dramatically reduce COVID-19 cases with the aid of the approaching warmer months, it may be possible to avoid a second wave of COVID-19 next winter.", "Meteorological factors and the incidence of mumps in Fujian Province, China, 2005\u20132013: Non-linear effects Abstract Background Mumps is still an important public health issue in the world with several recent outbreaks. The seasonable distribution of the disease suggested that meteorological factors may influence the incidence of mumps. The aim of this study was to explore the possible association between meteorological factors and the incidence of mumps, and to provide scientific evidence to relevant health authorities for the disease control and prevention. Methods We obtained the data of mumps cases and daily meteorological factors in Fujian Province in Eastern China over the period of 2005\u20132013. Using distributed lag non-linear model (DLNM) approach, we assessed the relationship between the meteorological factors and mumps incidence. Results The effects of meteorological factors on the mumps incidence were all non-linear. Compared with the lowest risk values, the upper level of precipitation, atmospheric pressure and relative humidity could increase the risk of mumps, whereas the low level of wind velocity, temperature, diurnal temperature range and sunshine duration may also increase the risk. Moderate atmospheric pressure and low wind velocity had larger cumulative effects within 30lagdays and the relative risks were 10.02 (95%CI: 2.47\u201340.71) and 12.45 (95%CI: 1.40\u2013110.78). For temperature, the cumulative effect within 30lagdays of minimum temperature was higher than that from maximum temperature in most populations. The cumulative effects of minimum temperature for males, children aged 10\u201314 and students were higher than those in other populations. Conclusions Meteorological factors, especially temperature and wind velocity, should be taken into consideration in the prevention and warning of possible mumps epidemic. Special attention should be paid to the vulnerable populations, such as teenagers and young adults.", "Multivariate Analysis of Factors Affecting COVID-19 Case and Death Rate in U.S. Counties: The Significant Effects of Black Race and Temperature Objectives: Coronavirus disease-19 (COVID-19) has spread rapidly around the world, and many risk factors including patient demographics, social determinants of health, environmental variables, underlying health conditions, and adherence to social distancing have been hypothesized to affect case and death rates. However, little has been done to account for the potential confounding effects of these factors. Using a large multivariate analysis, this study illuminates modulators of COVID-19 incidence and mortality in U.S. counties while controlling for risk factors across multiple domains. Methods: Data on COVID-19 and various risk factors in all U.S. counties was collected from publicly available data sources through April 14, 2020. Counties with at least 50 COVID-19 cases were included in case analyses and those with at least 10 deaths were included in mortality models. The 661 counties meeting inclusion criteria for number of cases were grouped into quartiles and comparisons of risk factors were made using t-tests between the highest and lowest quartiles. Similar comparisons for 217 counties were made for above average and below average deaths/100,000. Adjusted linear and logistic regression analyses were performed to evaluate the independent effects of factors that significantly impacted cases and deaths. Results: Univariate analyses demonstrated numerous significant differences between cohorts for both cases and deaths. Risk factors associated with increased cases and/or deaths per 100,000 included increased GDP per capita, decreased social distancing, increased age, increased percent Black, decreased percent Hispanic, decreased percent Asian, decreased health, increased poverty, increased diabetes, increased coronary heart disease, increased physical inactivity, increased alcohol consumption, increased tobacco use, and decreased access to primary care. Multivariate regression analyses demonstrated Black race is a risk factor for worse COVID-19 outcome independent of comorbidities, poverty, access to health care, and other mitigating factors. Lower daily temperatures was also an independent risk factor in case load but not deaths. Conclusions: U.S. counties with a higher proportion of Black residents are associated with increased COVID-19 cases and deaths. However, the various suggested mechanisms, such as socioeconomic and healthcare predispositions, did not appear to drive the effect of race in our model. Counties with higher average daily temperatures are also associated with decreased COVID-19 cases but not deaths. Several theories are posited to explain these findings, including prevalence of vitamin D deficiency. Additional studies are needed to further understand these effects.", "The rise and fall of infectious disease in a warmer world Now-outdated estimates proposed that climate change should have increased the number of people at risk of malaria, yet malaria and several other infectious diseases have declined. Although some diseases have increased as the climate has warmed, evidence for widespread climate-driven disease expansion has not materialized, despite increased research attention. Biological responses to warming depend on the non-linear relationships between physiological performance and temperature, called the thermal response curve. This leads performance to rise and fall with temperature. Under climate change, host species and their associated parasites face extinction if they cannot either thermoregulate or adapt by shifting phenology or geographic range. Climate change might also affect disease transmission through increases or decreases in host susceptibility and infective stage (and vector) production, longevity, and pathology. Many other factors drive disease transmission, especially economics, and some change in time along with temperature, making it hard to distinguish whether temperature drives disease or just correlates with disease drivers. Although it is difficult to predict how climate change will affect infectious disease, an ecological approach can help meet the challenge.", "Containing the Spread of Coronavirus Disease 2019 (COVID-19): Meteorological Factors and Control Strategies The novel coronavirus disease 2019 (COVID-19) has spread globally and the meteorological factors vary greatly across the world. Understanding the effect of meteorological factors and control strategies on COVID-19 transmission is critical to contain the epidemic. Using individual-level data in mainland China, Hong Kong, and Singapore, and the number of confirmed cases in other regions, we explore the effect of temperature, relative humidity, and control measures on the spread of COVID-19. We found that high temperature mitigates the transmission of the disease. High relative humidity promotes COVID-19 transmission when temperature is low, but tends to reduce transmission when temperature is high. Implementing classical control measures can dramatically slow the spread of the disease. However, due to the occurrence of pre-symptomatic infections, the effect of the measures to shorten onset-to-isolation time is markedly reduced and the importance of contact tracing and quarantine and social distancing increases. The analytic results also highlight the importance of early intervention to contain the spread of COVID-19.", "Enhanced COVID-19 data for improved prediction of survival The current COVID-19 pandemic, caused by the rapid world-wide spread of the SARS-CoV-2 virus, is having severe consequences for human health and the world economy. The virus effects individuals quite differently, with many infected patients showing only mild symptoms, and others showing critical illness. To lessen the impact of the pandemic, one important question is which factors predict the death of a patient? Here, we construct an enhanced COVID-19 dataset by processing two existing databases (from Kaggle and WHO) and using natural language processing methods to enhance the data by adding local weather conditions and research sentiment. Author summary In this study, we contribute an enhanced COVID-19 dataset, which contains 183 samples and 43 features. Application of Extreme Gradient Boosting (XGBoost) on the enhanced dataset achieves 95% accuracy in predicting patients survival, with country-wise research sentiment, and then age and local weather, showing the most importance. All data and source code are available at http://ab.inf.uni-tuebingen.de/publications/papers/COVID-19.", "Weathering the pandemic: How the Caribbean Basin can use viral and environmental patterns to predict, prepare, and respond to COVID-19 The 2020 coronavirus pandemic is developing at different paces throughout the world. Some areas, like the Caribbean Basin, have yet to see the virus strike at full force. When it does, there is reasonable evidence to suggest the consequent COVID-19 outbreaks will overwhelm healthcare systems and economies. This is particularly concerning in the Caribbean as pandemics can have disproportionately higher mortality impacts on lower and middle-income countries. Preliminary observations from our team and others suggest that temperature and climatological factors could influence the spread of this novel coronavirus, making spatiotemporal predictions of its infectiousness possible. This review studies geographic and time-based distribution of known respiratory viruses in the Caribbean Basin in an attempt to foresee how the pandemic will develop in this region. This review is meant to aid in planning short- and long-term interventions to manage outbreaks at the international, national, and subnational levels in the region.", "Effects of temperature and humidity on the spread of COVID-19: A systematic review. Background: Faced with the global pandemic of COVID-19, declared by World Health Organization (WHO) on March 11th 2020, and the need to better understand the seasonal behavior of the virus, our team conducted this systematic review to describe current knowledge about the emergence and replicability of the virus and its correlation with different weather factors such as temperature and relative humidity. Methods: The review was registered with the PROSPERO database. The electronic databases PubMed, Scopus, Web of Science, Cochrane Library, LILACS, OpenGrey and Google Scholar were examined with the searches restricted to the years 2019 and 2020. Risk of bias assessment was performed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist tool. The GRADE tool was used to assess the quality of the evidence. Results: The initial screening identified 517 articles. After examination of the full texts, seventeen studies met the review's eligibility criteria. Great homogeneity was observed in the findings regarding the effect of temperature and humidity on the seasonal viability and transmissibility of COVID-19. Cold and dry conditions were potentiating factors on the spread of the virus. After quality assessment, four studies had a high risk of bias and thirteen studies were scored as moderate risk of bias. The certainty of evidence was graded as low for both outcomes evaluated. Conclusion: Considering the existing scientific evidence, warm and wet climates seem to reduce the spread of COVID-19. The certainty of the evidence generated was graded as low. However, these variables alone could not explain most of the variability in disease transmission.", "Does weather affect the growth rate of COVID-19, a study to comprehend transmission dynamics on human health Abstract The undefendable outbreak of novel coronavirus (SARS-COV-2) lead to a global health emergency due to its higher transmission rate and longer symptomatic duration, created a health surge in a short time. Since Nov 2019 the outbreak in China, the virus is spreading exponentially everywhere. The current study focuses on the relationship between environmental parameters and the growth rate of COVID-19. The statistical analysis suggests that the temperature changes retarded the growth rate and found that -6.28\u00b0C and +14.51\u00b0C temperature is the favorable range for COVID-19 growth. Gutenberg- Richter's relationship is used to estimate the mean daily rate of exceedance of confirmed cases concerning the change in temperature. Indeed, temperature is the most influential parameter that reduces the growth at the rate of 13-17 cases/day with a 1\u00b0C rise in temperature.", "Assessing Climate Change Impact on Ecosystems and Infectious Disease: Important Roles for Genomic Sequencing and a One Health Perspective Changes in the Earth\u2019s climate and weather continue to impact the planet\u2019s ecosystems, including the interface of infectious disease agents with their hosts and vectors. Environmental disasters, natural and human-made activities raise risk factors that indirectly facilitate infectious disease outbreaks. Subsequently, changes in habitat, displaced populations, and environmental stresses that affect the survival of species are amplified over time. The recurrence and spread of vector-borne (e.g., mosquito, tick, aphid) human, animal, and plant pathogens to new geographic locations are also influenced by climate change. The distribution and range of humans, agricultural animals and plants, wildlife and native plants, as well as vectors, parasites, and microbes that cause neglected diseases of the tropics as well as other global regions are also impacted. In addition, genomic sequencing can now be applied to detect signatures of infectious pathogens as they move into new regions. Molecular detection assays complement metagenomic sequencing to help us understand the microbial community found within the microbiomes of hosts and vectors, and help us uncover mechanistic relationships between climate variability and pathogen transmission. Our understanding of, and responses to, such complex dynamics and their impacts can be enhanced through effective, multi-sectoral One Health engagement coupled with applications of both traditional and novel technologies. Concerted efforts are needed to further harness and leverage technology that can identify and track these impacts of climate changes in order to mitigate and adapt to their effects.", "Impact of meteorological factors on the COVID-19 transmission: A multi-city study in China Abstract The purpose of the present study is to explore the associations between novel coronavirus disease 2019 (COVID-19) case counts and meteorological factors in 30 provincial capital cities of China. We compiled a daily dataset including confirmed case counts, ambient temperature (AT), diurnal temperature range (DTR), absolute humidity (AH) and migration scale index (MSI) for each city during the period of January 20th to March 2nd, 2020. First, we explored the associations between COVID-19 confirmed case counts, meteorological factors, and MSI using non-linear regression. Then, we conducted a two-stage analysis for 17 cities with more than 50 confirmed cases. In the first stage, generalized linear models with negative binomial distribution were fitted to estimate city-specific effects of meteorological factors on confirmed case counts. In the second stage, the meta-analysis was conducted to estimate the pooled effects. Our results showed that among 13 cities that have less than 50 confirmed cases, 9 cities locate in the Northern China with average AT below 0 \u00b0C, 12 cities had average AH below 4 g/m3, and one city (Haikou) had the highest AH (14.05 g/m3). Those 17 cities with 50 and more cases accounted for 90.6% of all cases in our study. Each 1 \u00b0C increase in AT and DTR was related to the decline of daily confirmed case counts, and the corresponding pooled RRs were 0.80 (95% CI: 0.75, 0.85) and 0.90 (95% CI: 0.86, 0.95), respectively. For AH, the association with COVID-19 case counts were statistically significant in lag 07 and lag 014. In addition, we found the all these associations increased with accumulated time duration up to 14 days. In conclusions, meteorological factors play an independent role in the COVID-19 transmission after controlling population migration. Local weather condition with low temperature, mild diurnal temperature range and low humidity likely favor the transmission.", "Correlation between climate indicators and COVID-19 pandemic in New York, USA Abstract This study analyzed the association between COVID-19 and climate indicators in New York City, USA. We used secondary published data from New York city health services and National weather service, USA. The climate indicators included in the study are average temperature, minimum temperature, maximum temperature, rainfall, average humidity, wind speed, and air quality. Kendall and Spearman rank correlation tests were chosen for data analysis. We find that average temperature, minimum temperature, and air quality were significantly associated with the COVID-19 pandemic. The findings of this study will help World Health Organization and health regulators such as Center for Disease Control (CDC) to combat COVID-19 in New York and the rest of the world.", "Effect of ambient air pollutants and meteorological variables on COVID-19 incidence OBJECTIVE: To determine whether ambient air pollutants and meteorological variables are associated with daily COVID-19 incidence. DESIGN: A retrospective cohort from January 25 to February 29, 2020. SETTING: Cities of Wuhan, Xiaogan, and Huanggang, China. PATIENTS: The COVID-19 cases detected each day. METHODS: We collected daily data of COVID-19 incidence, 8 ambient air pollutants (particulate matter of \u22642.5 \u00b5m [PM(2.5)], particulate matter \u226410 \u00b5m [PM(10)], sulfur dioxide [SO(2)], carbon monoxide [CO], nitrogen dioxide [NO(2)], and maximum 8-h moving average concentrations for ozone [O(3)-8h]) and 3 meteorological variables (temperature, relative humidity, and wind) in China\u2019s 3 worst COVID-19\u2013stricken cities during the study period. The multivariate Poisson regression was performed to understand their correlation. RESULTS: Daily COVID-19 incidence was positively associated with PM(2.5) and humidity in all cities. Specifically, the relative risk (RR) of PM(2.5) for daily COVID-19 incidences were 1.036 (95% confidence interval [CI], 1.032\u20131.039) in Wuhan, 1.059 (95% CI, 1.046\u20131.072) in Xiaogan, and 1.144 (95% CI, 1.12\u20131.169) in Huanggang. The RR of humidity for daily COVID-19 incidence was consistently lower than that of PM(2.5), and this difference ranged from 0.027 to 0.111. Moreover, PM(10) and temperature also exhibited a notable correlation with daily COVID-19 incidence, but in a negative pattern The RR of PM(10) for daily COVID-19 incidence ranged from 0.915 (95% CI, 0.896\u20130.934) to 0.961 (95% CI, 0.95\u20130.972, while that of temperature ranged from 0.738 (95% CI, 0.717\u20130.759) to 0.969 (95% CI, 0.966\u20130.973). CONCLUSIONS: Our data show that PM(2.5) and humidity are substantially associated with an increased risk of COVID-19 and that PM(10) and temperature are substantially associated with a decreased risk of COVID-19.", "Influence of wind and relative humidity on the social distancing effectiveness to prevent COVID-19 airborne transmission: A numerical study It has been confirmed that the coronavirus disease 2019 (COVID-19) can transmit through droplets created when an infected human coughs or sneezes. Accordingly, 1.83-m (6-feet) social distancing is advised to reduce the spread of the disease among humans. This is based on the assumption that no air circulation exists around people. However, it is not well investigated whether the ambient wind and relative humidity (RH) will cause SARS-CoV-2 laden droplets to transport farther in the air, making the current social distancing policy insufficient. To provide evidence and insight into the \u201csocial distancing\u201d guidelines, a validated computational fluid-particle dynamics (CFPD) model was employed to simulate the transient transport, condensation/evaporation, and deposition of SARS-CoV-2 laden droplets emitted by coughs, with different environmental wind velocities and RHs. Initial droplet diameters range from 2 to 2000 \u03bcm, and the wind velocities range from 0 to 16 km/h, representing different wind forces from calm air to moderate breeze. The comparison between a steady-state wind and a gust with a constant frequency has also been performed. Ambient RHs are 40% and 99.5%. The distances between the two virtual humans are 1.83 m and 3.05 m (6 feet and 10 feet). The facial covering effect on reducing the airborne transmission of the cough droplets has also been evaluated. Numerical results indicate that the ambient wind will enhance the complexity of the secondary flows with recirculation between the two virtual humans. Microdroplets follow the airflow streamlines well and deposit on both human bodies and head regions, even with the 3.05-m (10-feet) separation distance. The rest of the microdroplets can transport in the air farther than 3.05 m (10 feet) due to wind convection, causing a potential health risk to nearby people. High RH will increase the droplet sizes due to the hygroscopic growth effect, which increases the deposition fractions on both humans and the ground. With the complex environmental wind and RH conditions, the 6-feet social distancing policy may not be sufficient to protect the inter-person aerosol transmission, since the suspending micro-droplets were influenced by convection effects and can be transported from the human coughs/sneezes to the other human in less than 5 s. Thus, due to the complex real-world environmental ventilation conditions, a social distance longer than 6 feet needs to be considered. Wearing masks should also be recommended for both infected and healthy humans to reduce the airborne cough droplet numbers.", "Does temperature and humidity influence the spread of Covid-19?: A preliminary report INTRODUCTION: Climate change has been known to influence infectious diseases. The reason for this being the fact; disease agents and their vectors each have particular environments that are optimal for growth, survival, transport, and dissemination. MATERIALS AND METHODS: The WHO's website was accessed to look for the Novel Coronavirus (COVID-19) situation dashboard and comprehensively study and assess the report. An attempt was made to look for countries, areas or territories with maximum and minimum number of cases of lab confirmed COVID cases. Further, we entered the words \u201cClimate\u201c in google for each of the aforementioned countries and searched for the results. A comparison was established by including countries from both the hemispheres (northern and southern). The preliminary analysis was based on the reports from countries with established testing facilities for Covid-19. RESULTS: The report suggests that countries with higher number of cases are the countries with cold weather. These are also the countries with low humidity which could be favoring the transmission and survival of the SARS-COV-2. CONCLUSIONS: The results though preliminary point to a pattern which favors the hypothesis that the extensive spread of Covid-19 maybe limited by temperature and humidity.", "Sub-continental Atmosphere and Inherent Immune System may have Impact on Novel Corona Virus' 2019 (nCovid-19) Prevalence in South East Asia. Pandemic enveloped RNA Novel Corona Virus' 2019 (SARS-CoV-2) appears as a beating reed which induce overwhelming outbreak all over the world since November 2019 to till date. Inherent Immunity developed by traditional food habit, exposure to various antigens and vitamin D induced sunlight exposure. Meteorological parameters are the important factors which influencing the severe acute respiratory syndrome (SARS) like infectious disease. Aim of this review to enhance our knowledge and explore the association among build up immunity, weather parameters and Corona virus disease (COVID-19) death. In this review we emphasize role of meteorological factor included degree of sun exposure and effect of temperature on enveloped lipid bi-layer structure of Novel corona virus. These meteorological factors and inherent immunity may have impact on SARS-CoV-2 incidence among South East Asian including Bangladeshi. In summary, this study suggests that temperature-humidity variation, inherent immunity and lower life expectancy of South East Asia may be important.", "Influence of wind and relative humidity on the social distancing effectiveness to prevent COVID-19 airborne transmission: A numerical study It has been confirmed that the coronavirus disease 2019 (COVID-19) can transmit through droplets created when an infected human coughs or sneezes. Accordingly, 1.83-m (6-feet) social distancing is advised to reduce the spread of the disease among humans. This is based on the assumption that no air circulation exists around people. However, it is not well investigated whether the ambient wind and relative humidity (RH) will cause SARS-CoV-2 laden droplets to transport farther in the air, making the current social distancing policy insufficient. To provide evidence and insight into the \"social distancing\" guidelines, a validated computational fluid-particle dynamics (CFPD) model was employed to simulate the transient transport, condensation/evaporation, and deposition of SARS-CoV-2 laden droplets emitted by coughs, with different environmental wind velocities and RHs. Initial droplet diameters range from 2 to 2000\u00e2\u0080\u00af\u00b5m, and the wind velocities range from 0 to 16\u00e2\u0080\u00afkm/h, representing different wind forces from calm air to moderate breeze. The comparison between a steady-state wind and a gust with a constant frequency has also been performed. Ambient RHs are 40% and 99.5%. The distances between the two virtual humans are 1.83\u00e2\u0080\u00afm and 3.05\u00e2\u0080\u00afm (6 feet and 10 feet). The facial covering effect on reducing the airborne transmission of the cough droplets has also been evaluated. Numerical results indicate that the ambient wind will enhance the complexity of the secondary flows with recirculation between the two virtual humans. Microdroplets follow the airflow streamlines well and deposit on both human bodies and head regions, even with the 3.05-m (10-feet) separation distance. The rest of the microdroplets can transport in the air farther than 3.05\u00e2\u0080\u00afm (10 feet) due to wind convection, causing a potential health risk to nearby people. High RH will increase the droplet sizes due to the hygroscopic growth effect, which increases the deposition fractions on both humans and the ground. With the complex environmental wind and RH conditions, the 6-feet social distancing policy may not be sufficient to protect the inter-person aerosol transmission, since the suspending micro-droplets were influenced by convection effects and can be transported from the human coughs/sneezes to the other human in less than 5\u00e2\u0080\u00afs. Thus, due to the complex real-world environmental ventilation conditions, a social distance longer than 6 feet needs to be considered. Wearing masks should also be recommended for both infected and healthy humans to reduce the airborne cough droplet numbers.", "The Effects of Temperature and Relative Humidity on the Viability of the SARS Coronavirus The main route of transmission of SARS CoV infection is presumed to be respiratory droplets. However the virus is also detectable in other body fluids and excreta. The stability of the virus at different temperatures and relative humidity on smooth surfaces were studied. The dried virus on smooth surfaces retained its viability for over 5 days at temperatures of 22\u201325\u00b0C and relative humidity of 40\u201350%, that is, typical air-conditioned environments. However, virus viability was rapidly lost (>3 log(10)) at higher temperatures and higher relative humidity (e.g., 38\u00b0C, and relative humidity of >95%). The better stability of SARS coronavirus at low temperature and low humidity environment may facilitate its transmission in community in subtropical area (such as Hong Kong) during the spring and in air-conditioned environments. It may also explain why some Asian countries in tropical area (such as Malaysia, Indonesia or Thailand) with high temperature and high relative humidity environment did not have major community outbreaks of SARS.", "A climatologic investigation of the SARS-CoV outbreak in Beijing, China The first cases of severe acute respiratory syndrome (SARS) were identified in November 2002, in Guangdong Province, China. The epidemic spread rapidly within China and internationally, with 8454 recorded infections and 792 deaths by June 15, 2003. Temperature, relative humidity, and wind velocity were the three key meteorological determinants affecting the transmission of SARS. The peak spread of SARS occurred at a mean temperature of 16.9 degrees C (95% CI, 10.7 degrees C to 23.1 degrees C), with a mean relative humidity of 52.2% (95% CI, 33.0% to 71.4%) and wind speed of 2.8 ms(-1) (95% CI, 2.0 to 3.6 ms(-1)). In northern China, these conditions are most likely to occur in the spring and suggest that SARS has a seasonal nature akin to viruses such as influenza and the common cold. A regression equation (Y=218.692-0.698X(t)-2.043X(h)+2.282X(w)) was derived to represent the optimal climatic conditions for the 2003 SARS epidemic. Further investigations in other regions are necessary to verify these results.", "Predict the next moves of COVID-19: reveal the temperate and tropical countries scenario The spread of COVID-19 engulfs almost all the countries and territories of the planet, and infections and fatality are increasing rapidly. The first epi-center of its' massive spread was in Wuhan, Hubei province, China having a temperate weather, but the spread has got an unprecedented momentum in European temperate countries mainly in Italy and Spain (as of March 30, 2020). However, Malaysia and Singapore and the neighboring tropical countries of China got relatively low spread and fatality that created a research interest on whether there are potential impacts of weather condition on COVID-19 spread. Adopting the SIR (Susceptible Infected Removed) deviated model to predict potential cases and death in the coming days from COVID-19 was done using the secondary and official sources of data. This study shows that COVID-19 spread and fatality tend to be high across the world but compared to tropical countries, it is going to be incredibly high in the temperate countries having lower temperature (7-16\u00b0C) and humidity (80-90%) in last March. However, some literature predicted that this might not to be true, rather irrespective of weather conditions there might be a continuous spread and death. Moreover, a large number of asymptotic COVID-19 carrier in both temperate and tropical countries may re-outbreak in the coming winter. Therefore, a comprehensive global program with the leadership of WHO for testing of entire population of the world is required, which will be very useful for the individual states to take proper political action, social movement and medical services.", "Assessing the relationship between surface levels of PM2.5 and PM10 particulate matter impact on COVID-19 in Milan, Italy Abstract The novel coronavirus disease (COVID-19) is a highly pathogenic, transmittable and invasive pneumococcal disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which emerged in December 2019 and January 2020 in Wuhan city, Hubei province, China and fast spread later on the middle of February 2020 in the Northern part of Italy and Europe. This study investigates the correlation between the degree of accelerated diffusion and lethality of COVID-19 and the surface air pollution in Milan metropolitan area, Lombardy region, Italy. Daily average concentrations of inhalable particulate matter (PM) in two size fractions PM2.5, PM10 and maxima PM10 ground level atmospheric pollutants together air quality and climate variables (daily average temperature, relative humidity, wind speed, atmospheric pressure field and Planetary Boundary Layer-PBL height) collected during 1 January\u201330 April 2020 were analyzed. In spite of being considered primarily transmitted by indoor bioaerosols droplets and infected surfaces, or direct human-to-human personal contacts, it seems that high levels of urban air pollution, weather and specific climate conditions have a significant impact on the increased rates of confirmed COVID-19 Total number, Daily New and Total Deaths cases, possible attributed not only to indoor but also to outdoor airborne bioaerosols distribution. Our analysis demonstrates the strong influence of daily averaged ground levels of particulate matter concentrations, positively associated with average surface air temperature and inversely related to air relative humidity on COVID-19 cases outbreak in Milan. Being a novel pandemic coronavirus (SARS-CoV-2) version, COVID-19 might be ongoing during summer conditions associated with higher temperatures and low humidity levels. Presently is not clear if this protein \u201cspike\u201d of the new coronavirus COVID-19 is involved through attachment mechanisms on indoor or outdoor airborne aerosols in the infectious agent transmission from a reservoir to a susceptible host in some agglomerated urban areas like Milan is.", "Optimal temperature zone for the dispersal of COVID-19 Abstract It is essential to know the environmental parameters within which the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can survive to understand its global dispersal pattern. We found that 60.0% of the confirmed cases of coronavirus disease 2019 (COVID-19) occurred in places where the air temperature ranged from 5 \u00b0C to 15 \u00b0C, with a peak in cases at 11.54 \u00b0C. Moreover, approximately 73.8% of the confirmed cases were concentrated in regions with absolute humidity of 3 g/m3 to 10 g/m3. SARS-CoV-2 appears to be spreading toward higher latitudes. Our findings suggest that there is an optimal climatic zone in which the concentration of SARS-CoV-2 markedly increases in the ambient environment (including the surfaces of objects). These results strongly imply that the COVID-19 pandemic may spread cyclically and outbreaks may recur in large cities in the mid-latitudes in autumn 2020.", "No Association of COVID-19 transmission with temperature or UV radiation in Chinese cities No Association of COVID-19 transmission with temperature or UV radiation in Chinese cities", "Climate change and infectious diseases: What can we expect? Global climate change, driven by anthropogenic greenhouse gas emissions, is being particularly felt in Canada, with warming generally greater than in the rest of the world. Continued warming will be accompanied by changes in precipitation, which will vary across the country and seasons, and by increasing climate variability and extreme weather events. Climate change will likely drive the emergence of infectious diseases in Canada by northward spread from the United States and introduction from elsewhere in the world via air and sea transport. Diseases endemic to Canada are also likely to re-emerge. This special issue describes key infectious disease risks associated with climate change. These include emergence of tick-borne diseases in addition to Lyme disease, the possible introduction of exotic mosquito-borne diseases such as malaria and dengue, more epidemics of Canada-endemic vector-borne diseases such as West Nile virus, and increased incidence of foodborne illnesses. Risk is likely to be compounded by an aging population affected by chronic diseases, which results in greater sensitivity to infectious diseases. Identifying emerging disease risks is essential to assess our vulnerability, and a starting point to identify where public health effort is required to reduce the vulnerability and exposure of the Canadian population.", "Association between ambient temperature and COVID-19 infection in 122 cities from China BACKGROUND: Coronavirus disease 2019 (COVID-19) has become a severe public health problem globally. Both epidemiological and laboratory studies have shown that ambient temperature could affect the transmission and survival of coronaviruses. This study aimed to determine whether the temperature is an essential factor in the infection caused by this novel coronavirus. METHODS: Daily confirmed cases and meteorological factors in 122 cities were collected between January 23, 2020, to February 29, 2020. A generalized additive model (GAM) was applied to explore the nonlinear relationship between mean temperature and COVID-19 confirmed cases. We also used a piecewise linear regression to determine the relationship in detail. RESULTS: The exposure-response curves suggested that the relationship between mean temperature and COVID-19 confirmed cases was approximately linear in the range of <3 \u00b0C and became flat above 3 \u00b0C. When mean temperature (lag0-14) was below 3 \u00b0C, each 1 \u00b0C rise was associated with a 4.861% (95% CI: 3.209-6.513) increase in the daily number of COVID-19 confirmed cases. These findings were robust in our sensitivity analyses. CONCLUSIONS: Our results indicate that mean temperature has a positive linear relationship with the number of COVID-19 cases with a threshold of 3 \u00b0C. There is no evidence supporting that case counts of COVID-19 could decline when the weather becomes warmer, which provides useful implications for policymakers and the public.", "Effects of temperature on COVID-19 transmission Coronavirus disease 2019 (COVID19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV2), it was first identified in 2019 in Wuhan, China and has resulted in the 2019-20 coronavirus pandemic. As of March 1, 2020, 79,968 patients in China and 7169 outside of China had tested positive for COVID19 and a mortality rate of 3.6% has been observed amongst Chinese patients. Its primary mode of transmission is via respiratory droplets from coughs and sneezes. The virus can remain viable for up to three days on plastic and stainless steel or in aerosols for upto 3 hours and is relatively more stable than the known human coronaviruses. It is stable in faeces at room temperature for at least 1-2 days and can be stable in infected patients for up to 4 days. Heat at 56 degree Celsius kills the SARS coronavirus at around 10000 units per 15 minutes. Thus, temperature is an important factor in survival of COVID19 virus and this article focuses on understanding the relationship between temperature and COVID19 transmission from the data available between January-March 2020.", "Investigating a serious challenge in the sustainable development process: Analysis of confirmed cases of COVID-19 (new type of Coronavirus) through a binary classification using artificial intelligence and regression analysis Nowadays, sustainable development is considered a key concept and solution in creating a promising and prosperous future for human societies. Nevertheless, there are some predicted and unpredicted problems that epidemic diseases are real and complex problems. Hence, in this research work, a serious challenge in the sustainable development process was investigated using the classification of confirmed cases of COVID-19 (new version of Coronavirus) as one of the epidemic diseases. Hence, binary classification modeling was used by the group method of data handling (GMDH) type of neural network as one of the artificial intelligence methods. For this purpose, the Hubei province in China was selected as a case study to construct the proposed model, and some important factors, namely maximum, minimum, and average daily temperature, the density of a city, relative humidity, and wind speed, were considered as the input dataset, and the number of confirmed cases was selected as the output dataset for 30 days. The proposed binary classification model provides higher performance capacity in predicting the confirmed cases. In addition, regression analysis has been done and the trend of confirmed cases compared with the fluctuations of daily weather parameters (wind, humidity, and average temperature). The results demonstrated that the relative humidity and maximum daily temperature had the highest impact on the confirmed cases. The relative humidity in the main case study, with an average of 77.9%, affected positively, and maximum daily temperature, with an average of 15.4 \u25e6C, affected negatively, the confirmed cases.", "Impact of weather indicators on the COVID-19 outbreak: A multi-state study in India The present study examines the impact of weather indicators on the COVID-19 outbreak in the majorly affected states of India. In this study, we hypothesize that the weather indicators could significantly influence the impact of the corona virus. The Kendall and Spearman rank correlation tests were chosen to conduct the statistical analysis. In this regard, we compiled a daily dataset including confirmed case counts, Recovered case counts, Deceased cases, Average Temperature, Maximum Relative Humidity, Maximum Wind Speed for six most affected states of India during the period of March 25, 2020 to April 24, 2020. We investigated that the average Humidity and Average Temperature seven days ago play a significant role in the recovery of coronavirus cases. The rise in average temperature will improve the recovery rate in the days to come. The cities with very high humidity levels or dry weather conditions have high probabilities of recovery from COVID-19. The findings of this research will help the policymakers to identify risky geographic areas and enforce timely preventive measures.", "COVID-19 and Environmental factors. A PRISMA-compliant systematic review The emergence of a novel human coronavirus, SARS-CoV-2, has become a global health concern causing severe respiratory tract infections in humans. Human-to-human transmissions have been described with incubation times between 2-10 days, facilitating its airborne spread via droplets. The impact of environmental factors on the coronavirus disease 2019 (COVID-19) outbreak is under consideration. We therefore reviewed the literature on all available information about the impact of environmental factors on human coronaviruses. Temperature, humidity and other environmental factors have been recorded as environmental drivers of the COVID-19 outbreak in China and in other countries. Higher temperatures might be positive to decrease the COVID-19 incidence. In our review, the analysis of 23 studies show evidence that high temperature and high humidity reduce the COVID-19 transmission. However, further studies concerning other environmental (namely meteorological) factors role should be conducted in order to further prove this correlation. As no specific therapies are available for SARS-CoV-2, early containment and prevention of further spread will be crucial to stop the ongoing outbreak and to control this novel infectious thread.", "Methods for air cleaning and protection of building occupants from airborne pathogens Abstract This article aims to draw the attention of the scientific community towards the elevated risks of airborne transmission of diseases and the associated risks of epidemics or pandemics. The complexity of the problem and the need for multidisciplinary research is highlighted. The airborne route of transmission, i.e. the generation of pathogen laden droplets originating in the respiratory tract of an infected individual, the survivability of the pathogens, their dispersal indoors and their transfer to a healthy person are reviewed. The advantages and the drawbacks of air dilution, filtration, ultraviolet germicidal irradiation (UVGI), photocatalytic oxidation (PCO), plasmacluster ions and other technologies for air disinfection and purification from pathogens are analyzed with respect to currently used air distribution principles. The importance of indoor air characteristics, such as temperature, relative humidity and velocity for the efficiency of each method is analyzed, taking into consideration the nature of the pathogens themselves. The applicability of the cleaning methods to the different types of total volume air distribution used at present indoors, i.e. mixing, displacement and underfloor ventilation, as well as advanced air distribution techniques (such as personalized ventilation) is discussed.", "Stability of SARS-CoV-2 and other coronaviruses in the environment and on common touch surfaces and the influence of climatic conditions: a review Although the unprecedented efforts the world has been taking to control the spread of the human coronavirus disease (COVID-19) and its causative etiology [Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2)], the number of confirmed cases has been increasing drastically. Therefore, there is an urgent need for devising more efficient preventive measures, to limit the spread of the infection until an effective treatment or vaccine is available. The preventive measures depend mainly on the understanding of the transmission routes of this virus, its environmental stability, and its persistence on common touch surfaces. Due to the very limited knowledge about SARS-CoV-2, we can speculate its stability in the light of previous studies conducted on other human and animal coronaviruses. In this review, we present the available data on the stability of coronaviruses (CoVs), including SARS-CoV-2, from previous reports to help understand its environmental survival. According to available data, possible airborne transmission of SARS-CoV-2 has been suggested. SARS-CoV-2 and other human and animal CoVs have remarkably short persistence on copper, latex, and surfaces with low porosity as compared to other surfaces like stainless steel, plastics, glass, and highly porous fabrics. It has also been reported that SARS-CoV-2 is associated with diarrhea and that it is shed in the feces of COVID-19 patients. Some CoVs show persistence in human excrement, sewage, and waters for a few days. These findings suggest a possible risk of fecal-oral, foodborne, and waterborne transmission of SARS-CoV-2 in developing countries that often use sewage-polluted waters in irrigation and have poor water treatment systems. CoVs survive longer in the environment at lower temperatures and lower relative humidity. It has been suggested that large numbers of COVID-19 cases are associated with cold and dry climates in temperate regions of the world and that seasonality of the virus spread is suspected.", "Correlation between meteorological factors and COVID-19 infection in the Belem Metropolitan Region Many factors can influence then spread of viruses and respiratory infections. Studies have suggested that there is a direct relationship between environmental issues and population density with cases of COVID-19. In this sense, this research aims to analyze, through correlational study and Krigagem, the relationship of meteorological and demographic variables with cases of COVID-19 in regions of subtropical climate in Brazil. The results suggest that population and demographic density (hab/km2) are risk factors for the spread of SAR-CoV-2 and an increase in the daily case record of COVID-19. The distribution of cases according to age group did not present a significant disparity between men and women. Relative humidity (RH)%, average temperature Celsius, minimum temperature Celsius, maximum temperature Celsius, wind speed m/s and daily precipitation (rain) mm show negative relationships with cases of COVID-19 in regions of humid equatorial climate. Analysis between associations of environmental factors, wind, temperature and HR in a region is extremely important to understand the dynamics of SARS-CoV-2 in the environment. In the northern region of Brazil, low wind speed, high temperatures and high RH are observed, environmental factors that, when associated, reduce the transmission process because it hinders the movement of the virus in the environment. In this sense, it is suggested that the transmission of SARS-CoV-2 in this region is disseminated through fluids in the air between man/man and by contact between objects/men. Therefore, strategic public policies to combat the pandemic must consider the environmental factors of the regions involved and control and/or blocking the transit of people.", "Survival of the Enveloped Virus Phi6 in Droplets as a Function of Relative Humidity, Absolute Humidity, and Temperature Infectious diseases caused by enveloped viruses, such as influenza, severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS), cause thousands of deaths and billions of dollars of economic losses per year. Studies have found a relationship among temperature, humidity, and influenza virus incidence, transmission, or survival; however, there are contradictory claims about whether absolute humidity (AH) or relative humidity (RH) is most important in mediating virus infectivity. Using the enveloped bacteriophage Phi6, which has been suggested as a surrogate for influenza viruses and coronaviruses, we designed a study to discern whether AH, RH, or temperature is a better predictor of virus survival in droplets. Our results show that Phi6 survived best at high (>85%) and low (<60%) RHs, with a significant decrease in infectivity at mid-range RHs (\u223c60 to 85%). At an AH of less than 22 g \u00b7 m(\u22123), the loss in infectivity was less than 2 orders of magnitude; however, when the AH was greater than 22 g \u00b7 m(\u22123), the loss in infectivity was typically greater than 6 orders of magnitude. At a fixed RH of 75%, infectivity was very sensitive to temperature, decreasing two orders of magnitude between 19\u00b0C and 25\u00b0C. We used random forest modeling to identify the best environmental predictors for modulating virus infectivity. The model explained 83% of variation in Phi6 infectivity and suggested that RH is the most important factor in controlling virus infectivity in droplets. This research provides novel information about the complex interplay between temperature, humidity, and the survival of viruses in droplets. IMPORTANCE Enveloped viruses are responsible for a number of infectious diseases resulting in thousands of deaths and billions of dollars of economic losses per year in the United States. There has been a lively debate in the literature over whether absolute humidity (AH) or relative humidity (RH) modulates virus infectivity. We designed a controlled study and used advanced statistical modeling techniques specifically to address this question. By providing an improved understanding of the relationship between environmental conditions and virus infectivity, our work will ultimately lead to improved strategies for predicting and controlling disease transmission.", "How diseases rise and fall with the seasons\u2014and what it could mean for coronavirus Scientists and doctors have observed for thousands of years that some diseases, such as polio and influenza, rise and fall with the seasons But why? Ongoing research in animals and humans suggests a variety of causes, including changes in the environment (like pH, temperature, and humidity) and even seasonal and daily changes to our own immune systems Figuring out those answers could one day make all the difference in minimizing the impact of infectious disease outbreaks\u2014such as coronavirus disease 2019", "Seasonality and selective trends in viral acute respiratory tract infections Abstract Influenza A and B, and many unrelated viruses including rhinovirus, RSV, adenovirus, metapneumovirus and coronavirus share the same seasonality, since these viral acute respiratory tract infections (vARIs) are much more common in winter than summer. Unfortunately, early investigations that used recycled \u201cpedigree\u201d virus strains seem to have led microbiologists to dismiss the common folk belief that vARIs often follow chilling. Today, incontrovertible evidence shows that ambient temperature dips and host chilling increase the incidence and severity of vARIs. This review considers four possible mechanisms, M1 - 4, that can explain this link: (M1) increased crowding in winter may enhance viral transmission; (M2) lower temperatures may increase the stability of virions outside the body; (M3) chilling may increase host susceptibility; (M4) lower temperatures or host chilling may activate dormant virions. There is little evidence for M1 or M2, which are incompatible with tropical observations. Epidemiological anomalies such as the repeated simultaneous arrival of vARIs over wide geographical areas, the rapid cessation of influenza epidemics, and the low attack rate of influenza within families are compatible with M4, but not M3 (in its simple form). M4 seems to be the main driver of seasonality, but M3 may also play an important role.", "The sensitivity and specificity analyses of ambient temperature and population size on the transmission rate of the novel coronavirus (COVID-19) in different provinces of Iran Abstract On 10 April 2020, Iran reported 68,192 COVID-19 cumulative cases including 4232 death and 35,465 recovery cases. Numerous factors could influence the transmission rate and survival of coronavirus. On this basis and according to the latest epidemiological researches, both ambient temperature (AT) and population size (PS) can be considered as significant transmissibility factors for coronavirus. The analysis of receiver operating characteristics (ROC) allows measuring the performance of a classification model using the confusion matrix. This study intends to investigate the sensitivity of AT and PS on the transmission rate of the novel coronavirus in different provinces of Iran. For this purpose, the information of each province of Iran including the annual average of AT and the number of healthy and diseased cases are categorized. Subsequently, the sensitivity and specificity analyses of both AT and PS factors are performed. The obtained results confirm that AT and PS have low sensibility and high sensitivity, respectively. Thus, there is no scientific reason to confirm that the number of COVID-19 cases in warmer climates is less than that of moderate or cold climates. Therefore, it is recommended that the cities/provinces with a population of over 1.7 million people have stricter inspections and more precise controls as their management policy.", "COVID-19 in Egypt: Uncovered figures or a different situation? ", "The role of absolute humidity on transmission rates of the COVID-19 outbreak A novel coronavirus (COVID-19) was identified in Wuhan, Hubei Province, China, in December 2019 and has caused over 40,000 cases worldwide to date. Previous studies have supported an epidemiological hypothesis that cold and dry (low absolute humidity) environments facilitate the survival and spread of droplet-mediated viral diseases, and warm and humid (high absolute humidity) environments see attenuated viral transmission (i.e., influenza). However, the role of absolute humidity in transmission of COVID-19 has not yet been established. Here, we examine province-level variability of the basic reproductive numbers of COVID-19 across China and find that changes in weather alone (i.e., increase of temperature and humidity as spring and summer months arrive in the North Hemisphere) will not necessarily lead to declines in COVID-19 case counts without the implementation of extensive public health interventions.", "Impact of meteorological parameters on the Covid-19 incidence. The case of the city of Oran, Algeria. Several studies have confirmed the impact of weather conditions on the evolution of the Covid-19 pandemic. We wanted to verify this phenomenon in the city of Oran in Algeria, which experienced its first case of Covid19 on March 19, 2020. The data studied are the new Covid19 cases, the average, minimum and maximum temperatures, as well as the relative humidity rate. A first analysis of the data with a Spearman rank correlation test did not yield significant results. Taking into account the average incubation period to adjust the data made it possible, during a second analysis, to show that the minimum temperature is significantly correlated with the new cases of Covid19 in Oran. This study can help establish prevention policies against Covid19, especially during fall in temperatures in autumn and winter.", "Susceptible supply limits the role of climate in the COVID-19 pandemic Preliminary evidence suggests that climate may modulate the transmission of SARS-CoV-2. Yet it remains unclear whether seasonal and geographic variations in climate can substantially alter the pandemic trajectory, given high susceptibility is a core driver. Here, we use a climate-dependent epidemic model to simulate the SARS-CoV-2 pandemic probing different scenarios of climate-dependence based on known coronavirus biology. We find that while variations in humidity may be important for endemic infections, during the pandemic stage of an emerging pathogen such as SARS-CoV-2 climate may drive only modest changes to pandemic size and duration. Our results suggest that, in the absence of effective control measures, significant cases in the coming months are likely to occur in more humid (warmer) climates, irrespective of the climate-dependence of transmission and that summer temperatures will not substantially limit pandemic growth."], "neg": ["Chest computed tomography findings and dynamic changes of severe coronavirus disease 2019/ \u4e2d\u534e\u4f20\u67d3\u75c5\u6742\u5fd7 Objective@#To investigate the features of chest CT imaging and dynamic changes of severe coronavirus disease 2019 (COVID-19).@*Methods@#The clinical and computed tomography (CT) data of 17 patients diagnosed with severe COVID-19 admitted to Chongqing Public Health Medical Center from January 24 to February 6, 2020 were collected. The first chest CT manifestations and the dynamic changes of imaging during treatment were retrospectively analyzed.@*Results@#The first chest CT manifestations of the 17 patients showed that 16 cases presented with peripheral and subpleural distributions, and 2 cases presented with 3 lobes involved, one case with 4 lobes involved and 14 cases with 5 lobes involved, and 17 cases presented with ground-glass opacities, ten cases with consolidation, seven cases with subpleural line, nine cases with air bronchogram, 3 cases with thickened lobular septum, two cases with bronchiectasis, two cases with pleural effusion, two cases with lymphadenopathy with the short diameter of 1.0-1.2cm. Among 16 patients who underwent repeated CT examination, the lesions of 8 patients showed continuous improvement, and those of the other 8 patients showed fluctuating changes.@*Conclusions@#The CT findings of severe COVID-19 patients are mainly ground-glass opacities and consolidation, with the peripheral distribution. The range of lesions is wide, with 5-lobe involvement mostly. Lymphadenopathy or pleural effusion is rare. Chest CT is useful for the evaluation for the therapeutic effects.", "Review and Meta-Analyses of TAAR1 Expression in the Immune System and Cancers Since its discovery in 2001, the major focus of TAAR1 research has been on its role in monoaminergic regulation, drug-induced reward and psychiatric conditions. More recently, TAAR1 expression and functionality in immune system regulation and immune cell activation has become a topic of emerging interest. Here, we review the immunologically-relevant TAAR1 literature and incorporate open-source expression and cancer survival data meta-analyses. We provide strong evidence for TAAR1 expression in the immune system and cancers revealed through NCBI GEO datamining and discuss its regulation in a spectrum of immune cell types as well as in numerous cancers. We discuss connections and logical directions for further study of TAAR1 in immunological function, and its potential role as a mediator or modulator of immune dysregulation, immunological effects of psychostimulant drugs of abuse, and cancer progression.", "A Tale of Two Communities: Characterizing Reddit Response to COVID-19 through /r/China_Flu and /r/Coronavirus The COVID-19 pandemic has deeply impacted people's lives around the globe. During the extended lockdowns caused by the pandemic, online communities are crucial for people to access information and share experiences. In particular, two\"new\"communities have emerged on Reddit: /r/China_flu and /r/Coronavirus. By studying activities and users in these two communities, we provide a characterization of people's responses to COVID-19 on Reddit. First, we find that user activity peaks around March 17, when the World Health Organization (WHO) announced COVID-19 as a pandemic. Shortly after that, the activity levels of both communities have been declining week by week. We further illustrate the central role of these two communities in the emergence of COVID-related communities. Second, we study the differences between these two communities. /r/Coronavirus is recommended as the official community for COVID-19 on Reddit, while /r/China_flu adopts a loose moderation practice. As a result, we observe that these two communities are gradually growing apart and more extremism is being found in /r/China_flu. Finally, we examine the spillover effect of the COVID-19 pandemic on user activity across the entire Reddit platform. Our results show significant changes in user activities outside COVID-related communities. In subreddits related to finance, food, and countries/cities, user activity is recovering to the pre-pandemic level in late April and May as countries reopen, but subreddits related to travel and sports remain highly impacted and show lower activity levels than the pre-pandemic period. Our work highlights the strength of Reddit as a source for understanding public reactions to COVID-19 and the importance of content moderation on the Internet during a pandemic.", "Can atmospheric pollution be considered a co-factor in extremely high level of SARS-CoV-2 lethality in Northern Italy? Abstract This paper investigates the correlation between the high level of Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) lethality and the atmospheric pollution in Northern Italy. Indeed, Lombardy and Emilia Romagna are Italian regions with both the highest level of virus lethality in the world and one of Europe\u2019s most polluted area. Based on this correlation, this paper analyzes the possible link between pollution and the development of acute respiratory distress syndrome and eventually death. We provide evidence that people living in an area with high levels of pollutant are more prone to develop chronic respiratory conditions and suitable to any infective agent. Moreover, a prolonged exposure to air pollution leads to a chronic inflammatory stimulus, even in young and healthy subjects. We conclude that the high level of pollution in Northern Italy should be considered an additional co-factor of the high level of lethality recorded in that area.", "Letter to the Editor: Note on published research on the effects of COVID-19 on the environment without sufficient depth of science Dear Editor-in-Chief: We have given two articles published recently in Science of the Total Environment by Mandal and Pal (2020) and Zambrano-Monserrate et al. (2020) a thorough reading. Both articles present a significant association between the novel Coronavirus (COVID-19) social distancing policies and improvement in environmental quality such as air pollution, land surface temperature, and noise. Both articles present good research, complemented by detailed explanations and displays, yet we have a few concerns that affect the interpretation and meaning of the results.", "Stability and inactivation of SARS coronavirus The SARS-coronavirus (SARS-CoV) is a newly emerged, highly pathogenic agent that caused over 8,000 human infections with nearly 800 deaths between November 2002 and September 2003. While direct person-to-person transmission via respiratory droplets accounted for most cases, other modes have not been ruled out. Faecal shedding is common and prolonged and has caused an outbreak in Hong Kong. We studied the stability of SARS-CoV under different conditions, both in suspension and dried on surfaces, in comparison with other human-pathogenic viruses, including human coronavirus HCoV-229E. In suspension, HCoV-229E gradually lost its infectivity completely while SARS-CoV retained its infectivity for up to 9 days; in the dried state, survival times were 24 h versus 6 days. Thermal inactivation at 56\u00b0C was highly effective in the absence of protein, reducing the virus titre to below detectability; however, the addition of 20% protein exerted a protective effect resulting in residual infectivity. If protein-containing solutions are to be inactivated, heat treatment at 60\u00b0C for at least 30 min must be used. Different fixation procedures, e.g. for the preparation of immunofluorescence slides, as well as chemical means of virus inactivation commonly used in hospital and laboratory settings were generally found to be effective. Our investigations confirm that it is possible to care for SARS patients and to conduct laboratory scientific studies on SARS-CoV safely. Nevertheless, the agent\u2019s tenacity is considerably higher than that of HCoV-229E, and should SARS re-emerge, increased efforts need to be devoted to questions of environmental hygiene.", "PepMapper: A Collaborative Web Tool for Mapping Epitopes from Affinity-Selected Peptides Epitope mapping from affinity-selected peptides has become popular in epitope prediction, and correspondingly many Web-based tools have been developed in recent years. However, the performance of these tools varies in different circumstances. To address this problem, we employed an ensemble approach to incorporate two popular Web tools, MimoPro and Pep-3D-Search, together for taking advantages offered by both methods so as to give users more options for their specific purposes of epitope-peptide mapping. The combined operation of Union finds as many associated peptides as possible from both methods, which increases sensitivity in finding potential epitopic regions on a given antigen surface. The combined operation of Intersection achieves to some extent the mutual verification by the two methods and hence increases the likelihood of locating the genuine epitopic region on a given antigen in relation to the interacting peptides. The Consistency between Intersection and Union is an indirect sufficient condition to assess the likelihood of successful peptide-epitope mapping. On average from 27 tests, the combined operations of PepMapper outperformed either MimoPro or Pep-3D-Search alone. Therefore, PepMapper is another multipurpose mapping tool for epitope prediction from affinity-selected peptides. The Web server can be freely accessed at: http://informatics.nenu.edu.cn/PepMapper/", "Knowledge-based repositioning of the anti-HCV direct antiviral agent Sofosbuvir as SARS-CoV-2 treatment The new human coronavirus named SARS-CoV-2 is a positive-sense RNA virus for which no specific drugs are currently available. A knowledge-based analysis strongly suggests a possible repositioning of the anti-HCV direct antiviral agent (DAA) Sofosbuvir as treatment for SARS-CoV-2. Indeed, the RNA-dependent RNA-polymerases (RdRp) of the two viruses show high sequence and structural homology, supporting the likelihood of binding the Sofosbuvir molecule with similar efficiency. Such a repositioning would allow the containment of the SARS-CoV-2 pandemic and limit the progression of disease to potentially deadly COVID19."]}, {"query": "what are the best masks for preventing infection by Covid-19?", "pos": ["The SARS, MERS and novel coronavirus (COVID-19) epidemics, the newest and biggest global health threats: what lessons have we learned? OBJECTIVES: To provide an overview of the three major deadly coronaviruses and identify areas for improvement of future preparedness plans, as well as provide a critical assessment of the risk factors and actionable items for stopping their spread, utilizing lessons learned from the first two deadly coronavirus outbreaks, as well as initial reports from the current novel coronavirus (COVID-19) epidemic in Wuhan, China. METHODS: Utilizing the Centers for Disease Control and Prevention (CDC, USA) website, and a comprehensive review of PubMed literature, we obtained information regarding clinical signs and symptoms, treatment and diagnosis, transmission methods, protection methods and risk factors for Middle East Respiratory Syndrome (MERS), Severe Acute Respiratory Syndrome (SARS) and COVID-19. Comparisons between the viruses were made. RESULTS: Inadequate risk assessment regarding the urgency of the situation, and limited reporting on the virus within China has, in part, led to the rapid spread of COVID-19 throughout mainland China and into proximal and distant countries. Compared with SARS and MERS, COVID-19 has spread more rapidly, due in part to increased globalization and the focus of the epidemic. Wuhan, China is a large hub connecting the North, South, East and West of China via railways and a major international airport. The availability of connecting flights, the timing of the outbreak during the Chinese (Lunar) New Year, and the massive rail transit hub located in Wuhan has enabled the virus to perforate throughout China, and eventually, globally. CONCLUSIONS: We conclude that we did not learn from the two prior epidemics of coronavirus and were ill-prepared to deal with the challenges the COVID-19 epidemic has posed. Future research should attempt to address the uses and implications of internet of things (IoT) technologies for mapping the spread of infection.", "Decontamination of surgical face masks and N95 respirators by dry heat pasteurization for one hour at 70\u00b0C BACKGROUND: The need for protective masks greatly exceeds their global supply during the current COVID-19 pandemic. METHODS: We optimized the temperature used in the dry heat pasteurization method to destroy pathogens and decontaminate masks while retaining their filtering capacity. RESULTS: The current study showed that dry heat at both 60\u00b0C and 70\u00b0C for 1 hour could successfully kill 6 species of respiratory bacteria and one fungi species, and inactivate the H1N1 indicator virus. After being heated at 70\u00b0C for 1, 2, and 3 hours, the N95 respirators and surgical face masks showed no changes in their shape and components. The filtering efficiency of bacterial aerosol for N95 respirators were 98%, 98%, and 97% after being heated for 1, 2, and 3 hour, respectively, all of which were over the 95% efficiency required and similar to the value before being heated (99%). The filtering efficiency for surgical face masks was 97%, 97%, and 96% for 1, 2, and 3 hours of heating, respectively, all of which were also similar to the value before being heated (97%). CONCLUSIONS: This method can be used at home and can significantly resolve the current shortage of masks.", "Simple Economical Solution for Personal Protection Equipment (Face Mask/Shield) for Health Care Staff During COVID 19 Coronavirus disease 2019 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. It has taken a toll of lots of lives since its outbreak. Infection prevention at present is an appropriate control measure in addition to other measure like hand hygiene and personal protective equipment (PPE). In our country with a large population, supplying PPE to all the health care workers of all hospitals definitely is an economic burden. Hence we have come up with an economic and simple solution for face mask. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12070-020-01863-4) contains supplementary material, which is available to authorized users.", "Surgical mask partition reduces the risk of non-contact transmission in a golden Syrian hamster model for Coronavirus Disease 2019 (COVID-19) BACKGROUND: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is believed to be mostly transmitted by medium-to-large sized respiratory droplets although airborne transmission is theoretically possible in healthcare settings involving aerosol-generating procedures. Exposure to respiratory droplets can theoretically be reduced by surgical mask usage. However, there is a lack of experimental evidence supporting surgical mask usage for prevention of COVID-19. METHODS: We used a well-established golden Syrian hamster SARS-CoV-2 model. We placed SARS-CoV-2-challenged index hamsters and na\u00efve hamsters into closed system units each comprising two different cages separated by a polyvinyl chloride air porous partition with unidirectional airflow within the isolator. The effect of a surgical mask partition placed in between the cages was investigated. Besides clinical scoring, hamster specimens were tested for viral load, histopathology, and viral nucleocapsid antigen expression. RESULTS: Non-contact transmission was found in 66.7% (10/15) of exposed na\u00efve hamsters. Surgical mask partition for challenged index or na\u00efve hamsters significantly reduced transmission to 25% (6/24, P=0.018). Surgical mask partition for challenged index hamsters significantly reduced transmission to only 16.7% (2/12, P=0.019) of exposed na\u00efve hamsters. Unlike the severe COVID-19 manifestations of challenged hamsters, infected na\u00efve hamsters had lower clinical scores, milder histopathological changes, and lower viral nucleocapsid antigen expression in respiratory tract tissues. CONCLUSIONS: SARS-CoV-2 could be transmitted by respiratory droplets or airborne droplet nuclei in the hamster model. Such transmission could be reduced by surgical mask usage, especially when masks were worn by infected individuals.", "Aerosol Filtration Efficiency of Common Fabrics Used in Respiratory Cloth Masks The emergence of a pandemic affecting the respiratory system can result in a significant demand for face masks. This includes the use of cloth masks by large sections of the public, as can be seen during the current global spread of COVID-19. However, there is limited knowledge available on the performance of various commonly available fabrics used in cloth masks. Importantly, there is a need to evaluate filtration efficiencies as a function of aerosol particulate sizes in the 10 nm to 10 \u00b5m range, which is particularly relevant for respiratory virus transmission. We have carried out these studies for several common fabrics including cotton, silk, chiffon, flannel, various synthetics, and their combinations. Although the filtration efficiencies for various fabrics when a single layer was used ranged from 5 to 80% and 5 to 95% for particle sizes of <300 nm and >300 nm, respectively, the efficiencies improved when multiple layers were used and when using a specific combination of different fabrics. Filtration efficiencies of the hybrids (such as cotton-silk, cotton-chiffon, cotton-flannel) was >80% (for particles <300 nm) and >90% (for particles >300 nm). We speculate that the enhanced performance of the hybrids is likely due to the combined effect of mechanical and electrostatic-based filtration. Cotton, the most widely used material for cloth masks performs better at higher weave densities (i.e., thread count) and can make a significant difference in filtration efficiencies. Our studies also imply that gaps (as caused by an improper fit of the mask) can result in over a 60% decrease in the filtration efficiency, implying the need for future cloth mask design studies to take into account issues of \"fit\" and leakage, while allowing the exhaled air to vent efficiently. Overall, we find that combinations of various commonly available fabrics used in cloth masks can potentially provide significant protection against the transmission of aerosol particles.", "Just the Facts: Protecting frontline clinicians during the COVID-19 pandemic There is no patient emergency more important than protecting health care workers during a pandemic.", "Personal protective equipment (PPE) for both anesthesiologists and other airway managers: principles and practice during the COVID-19 pandemic Healthcare providers are facing a coronavirus disease pandemic. This pandemic may last for many months, stressing the Canadian healthcare system in a way that has not previously been seen. Keeping healthcare providers safe, healthy, and available to work throughout this pandemic is critical. The consistent use of appropriate personal protective equipment (PPE) will help assure its availability and healthcare provider safety. The purpose of this communique is to give both anesthesiologists and other front-line healthcare providers a framework from which to understand the principles and practices surrounding PPE decision-making. We propose three types of PPE including: 1) PPE for droplet and contact precautions, 2) PPE for general airborne, droplet, and contact precautions, and 3) PPE for those performing or assisting with high-risk aerosol-generating medical procedures.", "Facial Skin Temperature and Discomfort When Wearing Protective Face Masks: Thermal Infrared Imaging Evaluation and Hands Moving the Mask. Individual respiratory protective devices and face masks represent critical tools in protecting health care workers in hospitals and clinics, and play a central role in decreasing the spread of the high-risk pandemic infection of 2019, coronavirus disease (COVID-19). The aim of the present study was to compare the facial skin temperature and the heat flow when wearing medical surgical masks to the same factors when wearing N95 respirators. A total of 20 subjects were recruited and during the evaluation, each subject was invited to wear a surgical mask or respirator for 1 h. The next day in the morning at the same hour, the same subject wore a N95 mask for 1 h with the same protocol. Infrared thermal evaluation was performed to measure the facial temperature of the perioral region and the perception ratings related to the humidity, heat, breathing difficulty, and discomfort were recorded. A significant difference in heat flow and perioral region temperature was recorded between the surgical mask and the N95 respirator (p < 0.05). A statistically significant difference in humidity, heat, breathing difficulty, and discomfort was present between the groups. The study results suggest that N95 respirators are able to induce an increased facial skin temperature, greater discomfort and lower wearing adherence when compared to the medical surgical masks.", "Decontamination of filtering facepiece respirators in primary care using medical autoclave Objective: There are widespread shortages of personal protective equipment as a result of the coronavirus disease 2019 (COVID-19) pandemic. Reprocessing filtering facepiece respirators may provide an alternative solution in keeping health care professionals safe. Design: prospective, bench-to-bedside Setting: A primary care-based study using filtering facepiece particles (FFP) type 2 respirators without exhalation valve (3M Aura 1862+, Maco Pharma ZZM002), FFP2 respirators with valve (3M Aura 9322+ and San Huei 2920V), and valved FFP type 3 respirators (Safe Worker 1016). Interventions: All masks were reprocessed using a medical autoclave (34-minute total cycle time of steam sterilization, with 17 minutes at 121 degrees Celsius) and subsequently tested up to 3 times whether these decontaminated respirators retained their integrity (seal check, pressure drop) and ability to filter small particles (0.3-5.0 microns) in the laboratory using a particle penetration test. Results: We tested 32 respirators, and 63 samples for filter capacity. All 27 FFP-2 respirators retained their shape, whereas half of the sterilized FFP-3 respirators (Safe Worker 1116) showed deformities and failed the seal check. The filtering capacity of the 3M Aura 1862 was best retained after 1, 2, and 3 sterilization cycles (0.3 microns: 99.3+/-0.3% (new) versus 97.0+/-1.3, 94.2+/-1.3% or 94.4+/-1.6, p<0.001). Of the other FFP-2 respirators, the San Huei 2920V had 95.5+/-0.7% at baseline versus 92.3+/-1.7% versus 90.0+/-0.7 after one- and two-time sterilization, respectively (p<0.001). The tested FFP-3 respirator (Safe Worker 1016) had a filter capacity of 96.5+/-0.7% at baseline and 60.3+/-5.7% after one-time sterilization (p<0.001). Breathing and pressure resistance tests indicated no relevant pressure changes between respirators that were used once, twice or thrice. Conclusion: This study shows that selected FFP2-type respirators may be reprocessed for use in primary care, as the tested masks retain their shape, ability to retain particles and breathing comfort after decontamination using a medical autoclave.", "Infection Prevention and Control: A Biodefense Measure Infection prevention and control (IPC) is the foundation for preventing the spread of infectious diseases, regardless of source, during medical treatment. Biological attacks will inevitably involve the medical management of sick individuals, which will not only tax the healthcare system, but also highlight the vital importance of infection control. Reducing the capacity for disease transmission will be pivotal in not only the early stages of an outbreak or biological attack, but also during times of crisis. Infection control programs also conduct disease surveillance and reporting to public health departments, which is crucial during an attack or outbreak. Infection control failures, like those in the 2013\u20132016 Ebola virus disease outbreak and continued Middle East respiratory syndrome (MERS) outbreaks, act as amplifiers for pathogen transmission. In the event of a biological attack, the strength and stamina of a hospital\u2019s infection control program will be critical to early recognition, isolation, treatment, and reducing the spread of infection.", "Knowledge, Attitude, and Practices of Healthcare Workers Regarding the Use of Face Mask to Limit the Spread of the New Coronavirus Disease (COVID-19) Introduction Many countries including Pakistan are currently using face masks in their pandemic control plans. Being highly prevalent, the correct use of these masks is particularly important, as an incorrect use and disposal may actually increase the rate of transmission. The purpose of this study was to investigate the knowledge, attitude, and practices of healthcare workers (HCWs) in wearing a surgical face mask to limit the spread of the new coronavirus disease 2019 (COVID-19). Materials and Methods This survey was conducted by interviewing HCWs using a questionnaire consisting of the basic demographic characteristics, and the knowledge, attitude, and practices regarding the use of surgical face mask to limit the new COVID-19 exposure. Each correct answer was scored 1 and each incorrect answer scored 0. The total number of questions was 16, and the final score was calculated and then labeled according to the percentage (out of 16) of correct responses as good (>80%), moderate (60-80%), and poor (<60%). Results A total of 392 participants with a mean age of 42.37 \u00b1 13.34 years (341 males and 51 females) were included in the study. The overall final results were good in 138 (35.2%), moderate in 178 (45.4%), and poor in 76 (19.3%). Around 43.6% of participants knew about the correct method of wearing the masks, 68.9% knew that there are three layers, 53% stated that the middle layer act as a filter media barrier, and 75.5% knew the recommended maximum duration of wearing it. The majority (88.2%) of participants knew that a cloth face mask is not much effective, around 79.8% knew that used face mask cannot be re-used, and 44.8% knew about the yellow-coded bag for disposal. Conclusions Knowledge, attitude, and practice of HCWs regarding the use of face masks were found to be inadequate. Studied HCWs had a positive attitude but moderate-to-poor level of knowledge and practice regarding the use of face mask. HCWs and general public awareness campaigns regarding the proper use of face mask by utilizing all social media available resources would be helpful during this pandemic.", "Calibrated Intervention and Containment of the COVID-19 Pandemic COVID-19 has infected more than 823,000 people globally and resulted in over 40,000 deaths as of April 1, 2020. Swift government response to contain the outbreak requires accurate and continuous census of the infected population, particularly with regards to viral carriers without severe symptoms. We take on this task by converting the symptom onset time distribution, which we calibrated, into the percentage of the latent, pre-symptomatic and symptomatic groups through a novel mathematical procedure. We then estimate the reduction of the basic reproduction number $R_0$ under specific disease control practices such as contact tracing, testing, social distancing, wearing masks and staying at home. When these measures are implemented in parallel, their effects on $R_0$ multiply. For example, if 70% of the general public wear masks and contact tracing is conducted at 60% efficiency within a 4-day time frame, epidemic growth will be flattened in the hardest hit countries. Finally, we analyze the bell-shaped curves of epidemic evolution from various affected regions and point out the significance of a universal decay rate of -0.32/day in the final eradication of the disease.", "Association between 2019-nCoV transmission and N95 respirator use ", "Covid-19: Hong Kong government supplies reusable face masks to all residents ", "Face masks and containment of COVID-19: experience from South Korea ", "Utility of Cloth Masks in Preventing Respiratory Infections: A Systematic Review Background: Using face masks is one of the possible prevention methods against respiratory pathogens. A number of studies and reviews have been performed regarding the use of medical grade masks like surgical masks, N95 respirators etc. However, the use of cloth masks has received little attention. Objectives: The purpose of this review is to analyze the available data regarding the use of cloth masks for the prevention of respiratory infections. We intended to use data from both clinical and non-clinical studies to arrive at our conclusion. Methods: We used PubMed, Cochrane Library and Google Scholar as our source databases. Both clinical and non-clinical studies, which had data regarding the efficacy of cloth masks, were selected. Articles not containing analyzable data including opinion articles, review articles etc. were excluded. After screening the search results, ten studies could be included in our review. Data relevant to our objective was extracted from each study including clinical efficacy, compliance, filtration efficacy etc. Data from some studies were simplified for the purpose of comparison. Extracted data was summarized and categorized for detailed analysis. Qualitative synthesis of the data was performed. But the heterogeneity between the studies did not allow for a meta-analysis. Discussion: The review was limited by a lack of sufficient clinical studies. Lack of standardization between studies was another limitation. Although cloth masks generally perform poorer than the medical grade masks, they may be better than no masks at all. Filtration efficacy varied greatly depending on the material used, with some materials showing a filtration efficacy above 90%. However, leakage could reduce efficacy of masks by about 50%. Standardization of cloth masks and appropriate use is essential for cloth masks to be effective. However, result of a randomized controlled trial suggest that they may be ineffective in the healthcare setting.", "Aerosol blocking assessment by different types of fabrics for homemade respiratory masks: spectroscopy and imaging study During the COVID-19 pandemic, there is no agreement, until the current date, about the recommendations of homemade face mask use for the general population, and one of the reasons is a lack of information about their real protective rule on spreading aerosols and viruses. This is a comparative study regarding the relative efficiencies of commercial respiratory masks (medical masks) and homemade fabric masks, which may guide authorities across the globe, following the 'Advice on the use of masks in the context of COVID-19', by the World Health Organization. We described two optical methodologies for charactering respiratory masks. It happens that the aerosol scattering coefficient is linear as a function of its concentration inside the mask chamber. Quantitative optical properties of scattering for a large batch fabrication of masks were demonstrated, making the mask N95 suitable for use as a reference standard.", "Waste Not, Want Not: Re-Usability of N95 Masks ", "Association of country-wide coronavirus mortality with demographics, testing, lockdowns, and public wearing of masks. Background. Wide variation between countries has been noted in per-capita mortality from the disease (COVID-19) caused by the SARS-CoV-2 virus. Determinants of this variation are not fully understood. Methods. Potential predictors of country-wide per-capita coronavirus-related mortality were studied, including age, sex ratio, temperature, urbanization, viral testing, smoking, duration of infection, lockdowns, and public mask-wearing norms and policies. Multivariable linear regression analysis was performed. Results. In univariate (but not multivariable) analyses, prevalence of smoking, per-capita gross domestic product, and colder average country temperature were positively associated with coronavirus-related mortality. In a multivariable analysis of 183 countries, urbanization, the duration of the infection in the country, and percent of the population at least 60 years of age were all positively associated with per-capita mortality, while duration of mask-wearing by the public was negatively associated with mortality (all p<0.001). In countries with cultural norms or government policies supporting public mask-wearing, per-capita coronavirus mortality increased on average by just 5.4% each week, as compared with 48% each week in remaining countries. In the multivariable analysis, lockdowns tended to be associated with less mortality (p=0.31), and per-capita testing with higher reported mortality (p=0.26), though neither association was statistically significant. Conclusions. Societal norms and government policies supporting the wearing of masks by the public are independently associated with less mortality from COVID-19.", "Protecting health care workers from SARS and other respiratory pathogens: A review of the infection control literature BACKGROUND: Severe Acute Respiratory Syndrome (SARS) was responsible for outbreaks in Canada, China, Hong Kong, Vietnam, and Singapore. SARS focused attention on the adequacy of and compliance with infection control practices in preventing airborne and droplet-spread transmission of infectious agents. METHODS: This paper presents a review of the current scientific knowledge with respect to the efficacy of personal protective equipment in preventing the transmission of respiratory infections. The effectiveness of infection control polices and procedures used in clinical practice is examined. RESULTS: Literature searches were conducted in several databases for articles published in the last 15 years that related to infection control practices, occupational health and safety issues, environmental factors, and other issues of importance in protecting workers against respiratory infections in health care settings. CONCLUSION: Failure to implement appropriate barrier precautions is responsible for most nosocomial transmissions. However, the possibility of a gradation of infectious particles generated by aerosolizing procedures suggests that traditional droplet transmission prevention measures may be inadequate in some settings. Further research is needed in this area.", "General Information Many bacteria, viruses, parasites, fungi and prions may cause serious infections and lead to the isolation of those who are infected from those who are susceptible. Isolation may be done in single rooms or in special isolation units. A modern isolate for patients with infections comprises (1) a sluice with a good space for dressing and undressing of personal protective equipment (PPE) and for hand hygiene, (2) a large patient room and (3) a bathroom/disinfection room with own decontaminator or autoclave and with separate entrance from the patient\u2019s room. Isolates for airborne and droplet-transmitted infections have in addition a defined negative air pressure and hepafiltered exhaust. In all isolates, doors must be closed in such a way that contaminants do not escape the isolate. A modern isolate for patients with impaired immune defence is similar to the infection isolates, with following exceptions: usually no need for decontaminator, hepafiltered clean air into the room and with a defined positive air pressure. A positive pressure isolate should never be used for patients with infections, and a negative pressure isolate should never be used for patients with impaired immune defence, except if the patient also has an infection that needs isolation.", "Critical levels of mask efficiency and of mask adoption that theoretically extinguish respiratory virus epidemics Using a respiratory virus epidemiological model we derive equations for the critical levels of mask efficiency (fraction blocked) and mask adoption (fraction of population wearing masks) that lower the effective reproduction number to unity. The model extends a basic epidemiological model and assumes that a specified fraction of a population dons masks at a given initial number of infections. The model includes a contribution from the ocular (nasolacrimal duct) route, and does not include contributions from contact (fomite) routes. The model accommodates dose-response (probability of infection) functions that are linear or non-linear. Our motivation to study near-population-wide mask wearing arises from the concept that, between two mask wearers, the concentration of particles at inhalation should be the square of the mask penetration fraction. This combination, or team, of masks can provide a strong dose-lowering squaring effect, which enables the use of lower-efficiency, lower-cost, lower pressure-drop (easier breathing) masks. For an epidemic with basic reproduction number R0=2.5 and with a linear dose-response, the critical mask efficiency is calculated to be 0.5 for a mask adoption level of 0.8 of the population. Importantly, this efficiency is well below that of a N95 mask, and well above that of some fabric masks. Numerical solutions of the model at near-critical levels of mask efficiency and mask adoption demonstrate avoidance of epidemics. To be conservative we use mask efficiencies measured with the most-penetrating viral-particle sizes. The critical mask adoption level for surgical masks with an efficiency of 0.58 is computed to be 0.73. With surgical masks (or equally efficient substitutes) and 80% and 90% adoption levels, respiratory epidemics with R0 of about 3 and 4, respectively, would be theoretically extinguished.", "A quantitative assessment of the efficacy of surgical and N95 masks to filter influenza virus in patients with acute influenza infection. We assessed the in vivo efficacy of surgical and N95 (respirator) masks to filter reverse transcription-polymerase chain reaction (RT-PCR)-detectable virus when worn correctly by patients with laboratory-confirmed acute influenza. Of 26 patients with a clinical diagnosis of influenza, 19 had the diagnosis confirmed by RT-PCR, and 9 went on to complete the study. Surgical and N95 masks were equally effective in preventing the spread of PCR-detectable influenza.", "Preventing COVID-19 in low- and middle-income countries ", "Use of N95, Surgical, and Cloth Masks to Prevent COVID-19 in Health Care and Community Settings: Living Practice Points From the American College of Physicians (Version 1) ", "Perceptions of Occupational Risk and Changes in Clinical Practice of U.S. Vitreoretinal Surgery Fellows during the COVID-19 Pandemic PURPOSE: To assess perceptions of occupational risk and changes to clinical practice of ophthalmology trainees in the United States during the COVID-19 pandemic. DESIGN: An anonymous, non-validated, cross-sectional survey was conducted online. Data was collected from April 7-16, 2020. PARTICIPANTS: 2019-2020 second year U.S. vitreoretinal surgery fellows in two-year vitreoretinal surgery training programs were invited to participate. INTERVENTION: Online survey. MAIN OUTCOME MEASURES: Survey questions assessed policies guiding COVID-19 response, known or suspected exposure to SARS-CoV-2, changes in clinical duties and volume, and methods to reduce occupational risk including availability of personal protective equipment. RESULTS: Completed responses were obtained from 62 of 87 eligible recipients (71.2% response rate). Training settings included academic (58.1%), hybrid academic/private practice (35.5%), and private practice only settings (6.5%). Overall, 19.4% of respondents reported an exposure to a COVID-19 positive patient, 14.5% reported self-quarantining due to possible exposure, and 11.3% reported being tested for COVID-19. In regards to PPE, N95 masks were available in the emergency room (n=40, 64.5%), office (n=35, 56.5%), and operating room settings (n=35, 56.5%). Perceived comfort level with PPE recommendations was significantly associated with availability of an N95 respirator mask in the clinic (p<0.001), emergency room (p<0.001) or operating room (p=0.002) settings. Additional risk mitigation methods outside of PPE were: reduction in patient volume (n=62, 100%), limiting patient companions (n=59, 95.2%), use of a screening process (n=59, 95.2%), use of a slit lamp face shield (n=57, 91.9%), temperature screening of all persons entering clinical space (n=34, 54.84%), and placement of face mask on patients (n=33, 53.2%). Overall, 16.1% reported additional clinical duties within the scope of ophthalmology, and 3.2% reported being re-deployed to non-ophthalmology services. 98.4% of respondents expected a reduction in surgical case volume. No respondents reported loss of employment or reduction in pay or benefits due to COVID-19. CONCLUSION: and Relevance: Suspected or confirmed clinical exposure to COVID-19 positive patients occurred in approximately one-fifth of trainee respondents. Perceived comfort level with PPE standards was significantly associated with N95 respirator mask availability. As surgical training programs grapple with the COVID-19 pandemic, analysis of trainees' concerns may inform development of mitigation strategies.", "Covid-19: Major US medical organisations urge people to wear masks. ", "Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19) BACKGROUND: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, Coronavirus Disease 2019 (COVID-19), affecting thousands of people around the world. Urgent guidance for clinicians caring for the sickest of these patients is needed. METHODS: We formed a panel of 36 experts from 12 countries. All panel members completed the World Health Organization conflict of interest disclosure form. The panel proposed 53 questions that are relevant to the management of COVID-19 in the ICU. We searched the literature for direct and indirect evidence on the management of COVID-19 in critically ill patients in the ICU. We identified relevant and recent systematic reviews on most questions relating to supportive care. We assessed the certainty in the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, then generated recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. Recommendations were either strong or weak, or in the form of best practice recommendations. RESULTS: The Surviving Sepsis Campaign COVID-19 panel issued 54 statements, of which 4 are best practice statements, 9 are strong recommendations, and 35 are weak recommendations. No recommendation was provided for 6 questions. The topics were: (1) infection control, (2) laboratory diagnosis and specimens, (3) hemodynamic support, (4) ventilatory support, and (5) COVID-19 therapy. CONCLUSION: The Surviving Sepsis Campaign COVID-19 panel issued several recommendations to help support healthcare workers caring for critically ill ICU patients with COVID-19. When available, we will provide new recommendations in further releases of these guidelines. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00134-020-06022-5) contains supplementary material, which is available to authorized users.", "Understanding the Impact of Face Mask Usage Through Epidemic Simulation of Large Social Networks Evidence from the 2003 SARS epidemic and 2009 H1N1 pandemic shows that face masks can be an effective non-pharmaceutical intervention in minimizing the spread of airborne viruses. Recent studies have shown that using face masks is correlated to an individual\u2019s age and gender, where females and older adults are more likely to wear a mask than males or youths. There are only a few studies quantifying the impact of using face masks to slow the spread of an epidemic at the population level, and even fewer studies that model their impact in a population where the use of face masks depends upon the age and gender of the population. We use a state-of-the-art agent-based simulation to model the use of face masks and quantify their impact on three levels of an influenza epidemic and compare different mitigation scenarios. These scenarios involve changing the demographics of mask usage, the adoption of mask usage in relation to a perceived threat level, and the combination of masks with other non-pharmaceutical interventions such as hand washing and social distancing. Our results shows that face masks alone have limited impact on the spread of influenza. However, when face masks are combined with other interventions such as hand sanitizer, they can be more effective. We also observe that monitoring social internet systems can be a useful technique to measure compliance. We conclude that educating the public on the effectiveness of masks to increase compliance can reduce morbidity and mortality.", "COVID-19: What Should Interventional Radiologists Know and What Can They Do? The outbreak of coronavirus disease 2019 (COVID-19) in late December 2019 in Wuhan, China, has been characterized as a \u201cpandemic\u201d by the World Health Organization and has resulted in 81,603 confirmed cases in China, among the 334,981 cases confirmed in 189 countries as of 09:00 am, March 24, 2020 (China central standard time). During the past 3 months, hundreds of thousands of Chinese health care workers, including interventional radiologists (IRs), have been fighting this battle against the horrifying COVID-19 disease. As IRs, what should we know and what can we do when facing this challenge? This paper shares the experience we have gone through.", "Medical masks vs N95 respirators for preventing COVID\u201019 in healthcare workers: A systematic review and meta\u2010analysis of randomized trials BACKGROUND: Respiratory protective devices are critical in protecting against infection in healthcare workers at high risk of novel 2019 coronavirus disease (COVID\u201019); however, recommendations are conflicting and epidemiological data on their relative effectiveness against COVID\u201019 are limited. PURPOSE: To compare medical masks to N95 respirators in preventing laboratory\u2010confirmed viral infection and respiratory illness including coronavirus specifically in healthcare workers. DATA SOURCES: MEDLINE, Embase, and CENTRAL from January 1, 2014, to March 9, 2020. Update of published search conducted from January 1, 1990, to December 9, 2014. STUDY SELECTION: Randomized controlled trials (RCTs) comparing the protective effect of medical masks to N95 respirators in healthcare workers. DATA EXTRACTION: Reviewer pair independently screened, extracted data, and assessed risk of bias and the certainty of the evidence. DATA SYNTHESIS: Four RCTs were meta\u2010analyzed adjusting for clustering. Compared with N95 respirators; the use of medical masks did not increase laboratory\u2010confirmed viral (including coronaviruses) respiratory infection (OR 1.06; 95% CI 0.90\u20101.25; I (2) = 0%; low certainty in the evidence) or clinical respiratory illness (OR 1.49; 95% CI: 0.98\u20102.28; I (2) = 78%; very low certainty in the evidence). Only one trial evaluated coronaviruses separately and found no difference between the two groups (P = .49). LIMITATIONS: Indirectness and imprecision of available evidence. CONCLUSIONS: Low certainty evidence suggests that medical masks and N95 respirators offer similar protection against viral respiratory infection including coronavirus in healthcare workers during non\u2013aerosol\u2010generating care. Preservation of N95 respirators for high\u2010risk, aerosol\u2010generating procedures in this pandemic should be considered when in short supply.", "The preventive strategies of GI physicians during the COVID-19 pandemic ", "Do Face Masks Create a False Sense of Security? A COVID-19 Dilemma Face masks have become an emblem of the public response to COVID-19, with many governments mandating their use in public spaces. The logic is that face masks are low cost and might help prevent some transmission. However, from the start, the assumption that face masks are \"low cost\" was questioned. Early on, there were warnings of the opportunity cost of public use of medical masks given shortages of personal protective equipment for healthcare providers. This led to recommendations for cloth masks and other face coverings, with little evidence of their ability to prevent transmission. However, there may also be a high cost to these recommendations if people rely on face masks in place of other more effective ways to break transmission, such as staying home. We use SafeGraph smart device location data to show that the representative American in states that have face mask mandates spent 20-30 minutes less time at home, and increase visits to a number of commercial locations, following the mandate. Since the reproductive rate of SAR-COV2, the pathogen that causes COVID-19 is hovering right around one, such substitution behavior could be the difference between controlling the epidemic and a resurgence of cases.", "COVID-19 and non-traditional mask use: How do various materials compare in reducing the infection risk for mask wearers? ", "Respiratory consequences of N95-type Mask usage in pregnant healthcare workers\u2014a controlled clinical study BACKGROUND: Outbreaks of emerging infectious diseases have led to guidelines recommending the routine use of N95 respirators for healthcare workers, many of whom are women of childbearing age. The respiratory effects of prolonged respirator use on pregnant women are unclear although there has been no definite evidence of harm from past use. METHODS: We conducted a two-phase controlled clinical study on healthy pregnant women between 27 to 32 weeks gestation. In phase I, energy expenditure corresponding to the workload of routine nursing tasks was determined. In phase II, pulmonary function of 20 subjects was measured whilst at rest and exercising to the predetermined workload while breathing ambient air first, then breathing through N95-mask materials. RESULTS: Exercising at 3 MET while breathing through N95-mask materials reduced mean tidal volume (TV) by 23.0 % (95 % CI \u221233.5 % to \u221210.5 %, p < 0.001) and lowered minute ventilation (VE) by 25.8 % (95 % CI \u221234.2 % to \u221215.8 %, p < 0.001), with no significant change in breathing frequency compared to breathing ambient air. Volumes of oxygen consumption (VO(2)) and carbon dioxide expired (VCO(2)) were also significantly reduced; VO(2) by 13.8 % (95 % CI \u221224.2 % to \u22123 %, p = 0.013) and VCO(2) by 17.7 %, (95 % CI \u221228.1 % to \u22128.6 %, p = 0.001). Although no changes in the inspired oxygen and carbon dioxide concentrations were demonstrated, breathing through N95-mask materials during low intensity work (3 MET) reduced expired oxygen concentration by 3.2 % (95 % CI: \u22124.1 % to \u22122.2 %, p < 0.001), and increased expired carbon dioxide by 8.9 % (95 % CI: 6.9 % to 13.1 %; p <0.001) suggesting an increase in metabolism. There were however no changes in the maternal and fetal heart rates, finger-tip capillary lactate levels and oxygen saturation and rating of perceived exertion at the work intensity investigated. CONCLUSIONS: Breathing through N95 mask materials have been shown to impede gaseous exchange and impose an additional workload on the metabolic system of pregnant healthcare workers, and this needs to be taken into consideration in guidelines for respirator use. The benefits of using N95 mask to prevent serious emerging infectious diseases should be weighed against potential respiratory consequences associated with extended N95 respirator usage. TRIAL REGISTRATION: The study was registered at clinicaltrials.gov, identifier NCT00265926.", "Cloth masks versus medical masks for COVID-19 protection ", "Simple Economical Solution for Personal Protection Equipment (Face Mask/Shield) for Health Care Staff During COVID 19 Coronavirus disease 2019 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. It has taken a toll of lots of lives since its outbreak. Infection prevention at present is an appropriate control measure in addition to other measure like hand hygiene and personal protective equipment (PPE). In our country with a large population, supplying PPE to all the health care workers of all hospitals definitely is an economic burden. Hence we have come up with an economic and simple solution for face mask.", "A Scalable Method of Applying Heat and Humidity for Decontamination of N95 Respirators During the COVID-19 Crisis A lack of N95 respirators during the COVID-19 crisis has placed healthcare workers at risk. It is important for any N95 reuse strategy to determine the effects that proposed protocols would have on the physical functioning of the mask, as well as the practical aspects of implementation. Here we propose and implement a method of heating N95 respirators with moisture (85{degrees}C, 60-85% humidity). We test both mask filtration efficiency and fit to validate this process. Our tests focus on the 3M 1860 and 3M 8210 Plus N95 models. After five cycles of the heating procedure, both respirators pass quantitative fit testing (score of >100) and show no degradation of mask filtration efficiency. We also test the Chen Heng V9501 KN95 and HKYQ N95 finding no degradation of mask filtration efficiency, however even for unheated masks these scored <50 for every fit test. The heating method presented here is scalable from individual masks to over a thousand a day with a single industrial convection oven, making this method practical for local application inside health-care facilities.", "Fast and economic cardboard cutout use to increase compliance of face mask wear during COVID-19 pandemic() ", "The need of health policy perspective to protect Healthcare Workers during COVID-19 pandemic. A GRADE rapid review on the N95 respirators effectiveness. Background Protecting Health Care Workers (HCWs) during routine care of suspected or confirmed COVID-19 patients is of paramount importance to halt the SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2) pandemic. The WHO, ECDC and CDC have issued conflicting guidelines on the use of respiratory filters (N95) by HCWs. Methods We searched PubMed, Embase and The Cochrane Library from the inception to March 21, 2020 to identify randomized controlled trials (RCTs) comparing N95 respirators versus surgical masks for prevention of COVID-19 or any other respiratory infection among HCWs. The grading of recommendations, assessment, development, and evaluation (GRADE) was used to evaluate the quality of evidence. Findings Four RCTs involving 8736 HCWs were included. We did not find any trial specifically on prevention of COVID-19. However, wearing N95 respirators can prevent 73 more (95% CI 46-91) clinical respiratory infections per 1000 HCWs compared to surgical masks (2 RCTs; 2594 patients; low quality of evidence). A protective effect of N95 respirators in laboratory-confirmed bacterial colonization (RR= 0.41; 95%CI 0.28-0.61) was also found. A trend in favour of N95 respirators was observed in preventing laboratory-confirmed respiratory viral infections, laboratory-confirmed respiratory infection, and influenza like illness. Interpretation We found no direct high quality evidence on whether N95 respirators are better than surgical masks for HCWs protection from SARS-CoV-2. However, low quality evidence suggests that N95 respirators protect HCWs from clinical respiratory infections. This finding should be contemplated to decide the best strategy to support the resilience of healthcare systems facing the potentially catastrophic SARS-CoV-2 pandemic.", "[Rapid review of the use of community-wide surgical masks and acute respiratory infections]. OBJECTIVE To assess the effectiveness of using surgical masks in community settings to reduce the probability of infection by SARS-CoV-2 or other acute viral respiratory infection, compared to not using surgical masks. MATERIALS AND METHODS We followed the Cochrane rapid review methodology. The search strategy encompasses one academic database and pre-prints until April 1, 2020. Titles and abstracts were reviewed by one investigator. The full text review was divided among three researchers. The results were synthesized in a narrative way. RESULTS 713 manuscripts were identified, of which 21 met the inclusion criteria. Of six systematic reviews, four found no reduction in the probability of transmission. Experimental home studies found no differences in the probability of contagion associated with the use of mouth masks. Only one modeling study estimated a 20% reduction in the incidence of acute respiratory disease, assuming that 10 to 50% of the population use the surgical masks correctly. CONCLUSIONS The scientific evidence is inconclusive to recommend or discourage the use of surgical masks at the population level. Considering the potential negative effects, official recommendations should await for the results of natural experiments currently occurring in countries that have recommended the use of face masks at the population level.", "Covid-19 and the N95 respirator shortage: Closing the gap Due to extreme shortages of personal protective equipment caused by the COVID-19 pandemic, many healthcare workers will be forced to recycle protective masks intended for disposal after a single use. We propose investigating the use of ultraviolet germicidal irradiation to sterilize masks of SARS-CoV-2 for safer reuse.", "Physical interventions to interrupt or reduce the spread of respiratory viruses. Part 1 - Face masks, eye protection and person distancing: systematic review and meta-analysis Abstract OBJECTIVE: To examine the effectiveness of eye protection, face masks, or person distancing on interrupting or reducing the spread of respiratory viruses. DESIGN: Update of a Cochrane review that included a meta-analysis of observational studies during the SARS outbreak of 2003. DATA SOURCES: Eligible trials from the previous review; search of Cochrane Central Register of Controlled Trials, PubMed, Embase and CINAHL from October 2010 up to 1 April 2020; and forward and backward citation analysis. DATA SELECTION: Randomised and cluster-randomised trials of people of any age, testing the use of eye protection, face masks, or person distancing against standard practice, or a similar physical barrier. Outcomes included any acute respiratory illness and its related consequences. DATA EXTRACTION AND ANALYSIS: Six authors independently assessed risk of bias using the Cochrane tool and extracted data. We used a generalised inverse variance method for pooling using a random-effects model and reported results with risk ratios and 95% Confidence Intervals (CI). RESULTS: We included 15 randomised trials investigating the effect of masks (14 trials) in healthcare workers and the general population and of quarantine (1 trial). We found no trials testing eye protection. Compared to no masks there was no reduction of influenza-like illness (ILI) cases (Risk Ratio 0.93, 95%CI 0.83 to 1.05) or influenza (Risk Ratio 0.84, 95%CI 0.61-1.17) for masks in the general population, nor in healthcare workers (Risk Ratio 0.37, 95%CI 0.05 to 2.50). There was no difference between surgical masks and N95 respirators: for ILI (Risk Ratio 0.83, 95%CI 0.63 to 1.08), for influenza (Risk Ratio 1.02, 95%CI 0.73 to 1.43). Harms were poorly reported and limited to discomfort with lower compliance. The only trial testing quarantining workers with household ILI contacts found a reduction in ILI cases, but increased risk of quarantined workers contracting influenza. All trials were conducted during seasonal ILI activity. CONCLUSIONS: Most included trials had poor design, reporting and sparse events. There was insufficient evidence to provide a recommendation on the use of facial barriers without other measures. We found insufficient evidence for a difference between surgical masks and N95 respirators and limited evidence to support effectiveness of quarantine. Based on observational evidence from the previous SARS epidemic included in the previous version of our Cochrane review we recommend the use of masks combined with other measures.", "Medical mask versus cotton mask for preventing respiratory droplet transmission in micro environments Abstract The objective of this study was to investigate whether cotton mask worn by respiratory infection person could suppress respiratory droplet levels compared to medical mask. We recruited adult volunteers with confirmed influenza and suspected cases of coronavirus disease 2019 (COVID-19) to wear medical masks and self-designed triple-layer cotton masks in a regular bedroom and a car with air conditioning. Four 1-hour repeated measurements (two measurements for bedroom the others for car) of particles with a size range of 20\u20131000 nm measured by number concentrations (NC0.02\u20131), temperature and relatively humidity, and cough/sneeze counts per hour were conducted for each volunteer. The paired t-tests were used for within-group comparisons in a bedroom and in a car. The results showed that there was no significant difference in NC0.02\u20131 or cough/sneeze counts between volunteers with medical masks and cotton masks in a bedroom or a car. We concluded that the cotton mask could be a potential substitute for medical mask for respiratory infection person in microenvironment with air conditioning. Healthy people may daily use cotton mask in the community since cotton mask is washable and reusable.", "Community Pharmacists in Taiwan at the Frontline Against the Novel Coronavirus Pandemic: Gatekeepers for the Rationing of Personal Protective Equipment Compared with other countries, Taiwan has had relatively few cases during the COVID-19 pandemic. One of the many measures the government implemented was a system for rationing and distributing surgical masks to the public while prioritizing allocation of masks to health care workers. This essay describes the role of community pharmacists in implementing the system and distributing masks to the public.", "Airborne/Droplet Infection Isolation Airborne/droplet infection is caused by infected agents in the air around a person. Microbial pathogenic agents that are mainly transmitted airborne are aerosols, re-aerosols, microbe-carrying particles, huge amounts of bacteria-carrying airborne skin cells, dust, droplets and droplet nuclei. At the same time, there is always a contact transmission from contaminated environment, equipment, textiles and waste. Droplet nuclei are small evaporated droplet residues (<5 \u03bcm) produced by coughing, sneezing, shouting, singing and speaking very distinct\u2014especially the consonants. Droplet nuclei remain for many hours in the air and may be carried by normal air currents in long distances outside the room. Therefore, \u201cdroplet isolation and droplet precaution\u201d is included in the airborne isolation regime. The source of infection is usually a patient but may also be a healthy carrier. The patient should be placed in isolate dedicated for airborne infections.", "Evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as coronavirus disease 2019 (COVID-19) pandemic: A global health emergency Abstract According to data compiled by researchers at Johns Hopkins University in Baltimore, Maryland, more than two and half million cases of coronavirus disease 2019 (COVID-19), caused by a newly discovered virus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have been confirmed on April 20, 2020 (Nature, 2020b). Since the emergence of this infectious disease in Asia (Wuhan, China) late last year, it has been subsequently span to every continent of the world except Antarctica (Rodr\u00edguez-Morales et al., 2020). Along with a foothold in every country, the current disease pandemic is disrupting practically every aspect of life all over the world. As the outbreak are continuing to evolve, several research activities have been conducted for better understanding the origin, functions, treatments, and preventions of this novel coronavirus. This review will be a summa of the key features of novel coronavirus (nCoV), the virus causing disease 2019 and the present epidemic situation worldwide up to April 20, 2020. It is expected that this record will play an important role to take more preventive measures for overcoming the challenges faced during this current pandemic.", "How Efficient Can Non-Professional MasksSuppress COVID-19 Pandemic? The coronavirus disease 2019 (COVID-19) pandemic is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which can be transmitted via respiratory secretions. Since there are currently no specific therapeutics or vaccines available against the SARS-CoV-2, the commen nonpharmaceutical interventions (NPIs) are still the main measures to curb the COVID-19 epidemic. Face mask wearing is one important measure to suppress the pandemic. In order to know how efficient is face mask wearing in reducing the pandemic even with low efficiency non-professional face masks, we exploit physical abstraction to model the non-professional face masks made from cotton woven fabrics and characterize them by a parameter virus penetration rate (VPR){gamma}. Monte Carlo simulations exhibit that the effective reproduction number R of COVID-19 or similar pandemics can be approximately reduced by factor {gamma}4 with respect to the basic reproduction number R0,if the face masks with 70% <{gamma}< 90% are universally applied for the entire network. Furthermore, thought experiments and practical exploitation examples in country-level and city-level are enumerated and discussed to support our discovery in this study and indicate that the outbreak of a COVID-19 like pandemic can be even suppressed by the low efficiency non-professional face masks.", "The preventive effect of hydrocolloid dressing to prevent facial pressure and facial marks during use of medical protective equipment in Covid-19 pandemic ", "Predictive value of the user seal check in determining half-face respirator fit Summary Guidelines issued by the Centers for Disease Control and Prevention and the World Health Organization state that healthcare workers should wear N95 masks or higher-level protection during all contact with suspected cases of severe acute respiratory syndrome. Before use, the manufacturer recommends performing a user seal check to ensure that the mask is fitted correctly. This study aimed to test the ability of the user seal check to detect poorly fitting masks. This study is a retrospective review of a mask-fitting programme carried out in the intensive care unit of the Prince of Wales Hospital in Hong Kong. In this programme, all staff were tested with two types of N95 mask and one type of N100 mask. The results of the documented user seal check were then compared with the formal fit-test results from a PortaCount. Using a PortaCount reading of 100 as the criterion for a correctly fitted mask, the user seal check wrongly indicated that the mask fitted on 18\u201331% of occasions, and wrongly indicated that it did not fit on 21\u201340% of occasions. These data indicate that the user seal check should not be used as a surrogate fit test. Its usefulness as a pre-use test must also be questioned.", "Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus Since December 2019, an epidemic caused by novel coronavirus (2019-nCoV) infection has occurred unexpectedly in China. As of 8 pm, 31 January 2020, more than 20 pediatric cases have been reported in China. Of these cases, ten patients were identified in Zhejiang Province, with an age of onset ranging from 112 days to 17 years. Following the latest National recommendations for diagnosis and treatment of pneumonia caused by 2019-nCoV (the 4th edition) and current status of clinical practice in Zhejiang Province, recommendations for the diagnosis and treatment of respiratory infection caused by 2019-nCoV for children were drafted by the National Clinical Research Center for Child Health, the National Children\u2019s Regional Medical Center, Children\u2019s Hospital, Zhejiang University School of Medicine to further standardize the protocol for diagnosis and treatment of respiratory infection in children caused by 2019-nCoV.", "Your COVID-19 Intubation Kit ", "Pretreated household materials carry similar filtration protection against pathogens when compared with surgical masks The past 4 months, the emergence and spread of novel 2019 SARS-Cov-2 (COVID-19) has led to a global pandemic which is rapidly depleting supplies of personal protective equipment worldwide. There are currently over 1.6 million confirmed cases of COVID-19 worldwide which has resulted in more the 100,000 deaths. As these numbers grow daily, hospitals are being forced to reuse surgical masks in hopes of conserving their dwindling supply. Since COVID-19 will most likely have effects that last for many months, our nationwide shortage of masks poses a long term issue that must be addressed immediately. Based on a previous study by Quan et al., a salt-based soaking strategy has been reported to enhance the filtration ability of surgical masks. We propose a similar soaking process which uses materials widely available in anyone's household. We tested this method of pretreating a variety of materials with a salt-based solution by a droplet test using fluorescently stained nanoparticles similar in size to the COVID-19 virus. Our results show that this filter significantly reduces the amount of penetration of these particles. This will allow for healthcare workers to create a disposable added layer of protection to their surgical masks, N95s, or homemade masks by using household available products.", "To mask or not to mask: Modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic Face mask use by the general public for limiting the spread of the COVID-19 pandemic is controversial, though increasingly recommended, and the potential of this intervention is not well understood. We develop a compartmental model for assessing the community-wide impact of mask use by the general, asymptomatic public, a portion of which may be asymptomatically infectious. Model simulations, using data relevant to COVID-19 dynamics in the US states of New York and Washington, suggest that broad adoption of even relatively ineffective face masks may meaningfully reduce community transmission of COVID-19 and decrease peak hospitalizations and deaths. Moreover, mask use decreases the effective transmission rate in nearly linear proportion to the product of mask effectiveness (as a fraction of potentially infectious contacts blocked) and coverage rate (as a fraction of the general population), while the impact on epidemiologic outcomes (death, hospitalizations) is highly nonlinear, indicating masks could synergize with other non-pharmaceutical measures. Notably, masks are found to be useful with respect to both preventing illness in healthy persons and preventing asymptomatic transmission. Hypothetical mask adoption scenarios, for Washington and New York state, suggest that immediate near universal (80%) adoption of moderately (50%) effective masks could prevent on the order of 17--45% of projected deaths over two months in New York, while decreasing the peak daily death rate by 34--58%, absent other changes in epidemic dynamics. Even very weak masks (20% effective) can still be useful if the underlying transmission rate is relatively low or decreasing: In Washington, where baseline transmission is much less intense, 80% adoption of such masks could reduce mortality by 24--65% (and peak deaths 15--69%), compared to 2--9% mortality reduction in New York (peak death reduction 9--18%). Our results suggest use of face masks by the general public is potentially of high value in curtailing community transmission and the burden of the pandemic. The community-wide benefits are likely to be greatest when face masks are used in conjunction with other non-pharmaceutical practices (such as social-distancing), and when adoption is nearly universal (nation-wide) and compliance is high.", "Infection control in paediatric office settings Transmission of infection in the paediatric office is of increasing concern. The present document discusses routes of transmission of infection and the principles of current infection control measures. Prevention includes appropriate office design and administrative policies, triage, routine practices for the care of all patients (eg, hand hygiene; use of gloves, masks, eye protection and gowns for specific procedures; adequate cleaning, disinfection and sterilization of surfaces and equipment including toys, and aseptic technique for invasive procedures), and additional precautions for specific infections. Personnel should be adequately immunized, and those infected should follow work-restriction policies.", "Practical tips for using masks in the COVID-19 pandemic ", "Use of masks by health care workers ", "Simple Respiratory Protection\u2014Evaluation of the Filtration Performance of Cloth Masks and Common Fabric Materials Against 20\u20131000 nm Size Particles A shortage of disposable filtering facepiece respirators can be expected during a pandemic respiratory infection such as influenza A. Some individuals may want to use common fabric materials for respiratory protection because of shortage or affordability reasons. To address the filtration performance of common fabric materials against nano-size particles including viruses, five major categories of fabric materials including sweatshirts, T-shirts, towels, scarves, and cloth masks were tested for polydisperse and monodisperse aerosols (20\u20131000 nm) at two different face velocities (5.5 and 16.5 cm s(\u22121)) and compared with the penetration levels for N95 respirator filter media. The results showed that cloth masks and other fabric materials tested in the study had 40\u201390% instantaneous penetration levels against polydisperse NaCl aerosols employed in the National Institute for Occupational Safety and Health particulate respirator test protocol at 5.5 cm s(\u22121). Similarly, varying levels of penetrations (9\u201398%) were obtained for different size monodisperse NaCl aerosol particles in the 20\u20131000 nm range. The penetration levels of these fabric materials against both polydisperse and monodisperse aerosols were much higher than the penetrations for the control N95 respirator filter media. At 16.5 cm s(\u22121) face velocity, monodisperse aerosol penetrations slightly increased, while polydisperse aerosol penetrations showed no significant effect except one fabric mask with an increase. Results obtained in the study show that common fabric materials may provide marginal protection against nanoparticles including those in the size ranges of virus-containing particles in exhaled breath.", "N-95 Face Mask for Prevention of Bird Flu Virus: An Appraisal of Nanostructure and Implication for Infectious Control ", "Potential utilities of mask\u2010wearing and instant hand hygiene for fighting SARS\u2010CoV\u20102 The surge of patients in the pandemic of COVID\u201019 caused by the novel coronavirus SARS\u2010CoV\u20102 may overwhelm the medical systems of many countries. Mask\u2010wearing and handwashing can slow the spread of the virus, but currently, masks are in shortage in many countries, and timely handwashing is often impossible. In this study, the efficacy of three types of masks and instant hand wiping was evaluated using the avian influenza virus to mock the coronavirus. Virus quantification was performed using real\u2010time reverse transcription\u2010polymerase chain reaction. Previous studies on mask\u2010wearing were reviewed. The results showed that instant hand wiping using a wet towel soaked in water containing 1.00% soap powder, 0.05% active chlorine, or 0.25% active chlorine from sodium hypochlorite removed 98.36%, 96.62%, and 99.98% of the virus from hands, respectively. N95 masks, medical masks, and homemade masks made of four\u2010layer kitchen paper and one\u2010layer cloth could block 99.98%, 97.14%, and 95.15% of the virus in aerosols. Medical mask\u2010wearing which was supported by many studies was opposed by other studies possibly due to erroneous judgment. With these data, we propose the approach of mask\u2010wearing plus instant hand hygiene (MIH) to slow the exponential spread of the virus. This MIH approach has been supported by the experiences of seven countries in fighting against COVID\u201019. Collectively, a simple approach to slow the exponential spread of SARS\u2010CoV\u20102 was proposed with the support of experiments, literature review, and control experiences.", "Will an imperfect vaccine curtail the COVID-19 pandemic in the U.S.? The novel coronavirus (COVID-19) that emerged from Wuhan city of China in late December 2019 continue to pose devastating public health and economic challenges across the world. Although the community-wide implementation of basic non-pharmaceutical intervention measures, such as social-distancing, quarantine of suspected COVID-19 cases, isolation of confirmed cases, use of face masks in public, and contact-tracing, have been quite effective in curtailing and mitigating the burden of the pandemic, it is universally believed that the use of an anti-COVID-19 vaccine is necessary to build the community herd immunity needed to effectively control and eliminate the pandemic. This study is based on the design and use of a mathematical model for assessing the population-level impact of a hypothetical imperfect anti-COVID-19 vaccine on the control of COVID-19. An analytical expression for the minimum number of unvaccinated susceptible individuals needed to be vaccinated to achieve vaccine-induced community herd immunity is derived. The epidemiological consequence of the herd immunity threshold is that the disease can be effectively controlled or eliminated if the minimum herd immunity threshold is achieved in the community. Simulations of the model, using baseline parameter values obtained from fitting the model with mortality data relevant to COVID-19 dynamics in the US states of New York and Florida, as well as for the entire US, show that, for an anti-COVID-19 vaccine with an assumed protective efficacy of 80%, the minimum herd immunity threshold for the entire US, state of New York and state of Florida are, respectively, 90%, 84% and 85%. Furthermore, it was shown that, while a significantly large increase in vaccination rate (from baseline) is necessarily needed to eliminate COVID-19 from the entire US, the pandemic can be eliminated from the states of New York and Florida if the vaccination rate is marginally increased (by as low as 10%) from its baseline value. The prospect of COVID-19 elimination in the US or in the two states of New York and Florida is greatly enhanced if the vaccination program is combined with a public mask use program or an effective social-distancing measure. Such combination of strategies significantly reduces the vaccine-induced herd immunity threshold. Finally, it is shown that the vaccination program is more likely to lead to COVID-19 elimination in the state of Florida, followed by the state of New York and then the entire US.", "Aerosol Filtration Efficiency of Common Fabrics Used in Respiratory Cloth Masks [Image: see text] The emergence of a pandemic affecting the respiratory system can result in a significant demand for face masks. This includes the use of cloth masks by large sections of the public, as can be seen during the current global spread of COVID-19. However, there is limited knowledge available on the performance of various commonly available fabrics used in cloth masks. Importantly, there is a need to evaluate filtration efficiencies as a function of aerosol particulate sizes in the 10 nm to 10 \u03bcm range, which is particularly relevant for respiratory virus transmission. We have carried out these studies for several common fabrics including cotton, silk, chiffon, flannel, various synthetics, and their combinations. Although the filtration efficiencies for various fabrics when a single layer was used ranged from 5 to 80% and 5 to 95% for particle sizes of <300 nm and >300 nm, respectively, the efficiencies improved when multiple layers were used and when using a specific combination of different fabrics. Filtration efficiencies of the hybrids (such as cotton\u2013silk, cotton\u2013chiffon, cotton\u2013flannel) was >80% (for particles <300 nm) and >90% (for particles >300 nm). We speculate that the enhanced performance of the hybrids is likely due to the combined effect of mechanical and electrostatic-based filtration. Cotton, the most widely used material for cloth masks performs better at higher weave densities (i.e., thread count) and can make a significant difference in filtration efficiencies. Our studies also imply that gaps (as caused by an improper fit of the mask) can result in over a 60% decrease in the filtration efficiency, implying the need for future cloth mask design studies to take into account issues of \u201cfit\u201d and leakage, while allowing the exhaled air to vent efficiently. Overall, we find that combinations of various commonly available fabrics used in cloth masks can potentially provide significant protection against the transmission of aerosol particles.", "Extended use or re-use of single-use surgical masks and filtering facepiece respirators: A rapid evidence review Background The COVID-19 pandemic has led to unprecedented demand for personal protective equipment. Shortages of surgical masks and filtering facepiece respirators has led to the extended use or re-use of single-use respirators and surgical masks by frontline healthcare workers. The evidence base underpinning such practices has been questioned. Objectives To summarise guidance and synthesise systematic review evidence on extended use, re-use or reprocessing of single-use surgical masks or filtering facepiece respirators. Methods A targeted search of the World Health Organization, European Centre for Disease Prevention and Control, the US Centers for Disease Control and Prevention, and Public Health England websites was conducted to identify guidance. Four databases (Medline, Pubmed, Epistemonikos, Cochrane Database of Systematic Reviews) and three preprint repositories (Litcovid, MedRxiv and Open Science Framework) were searched for relevant systematic reviews. Record screening and data extraction was conducted by two reviewers. Quality of included systematic reviews was appraised using the AMSTAR-2 checklist. Findings were integrated and narratively synthesised to highlight the extent to which key claims in guidance documents were supported by research evidence. Results Six guidance documents were identified. All note that extended use or re-use of single-use surgical masks and respirators (with or without reprocessing) should be considered only in situations of critical shortage. Extended use was generally favoured over re-use because of reduced risk of contact transmission. Four high-quality systematic reviews were included: three focused on reprocessing (decontamination) of N95 respirators and one focused on reprocessing of surgical masks. There was limited evidence on the impact of extended use on masks and respirators. Vaporised hydrogen peroxide and ultraviolet germicidal irradiation were highlighted as the most promising reprocessing methods, but evidence on the relative efficacy and safety of different methods was limited. We found no well-established methods for reprocessing respirators at scale. Conclusions: There is limited evidence on the impact of extended use and re-use of surgical masks and respirators. Where extended use or re-use is being practiced, healthcare organisations should ensure that policies and systems are in place to ensure these practices are carried out safely and in line with available guidance.", "Ozone disinfectants like soclean CPAP sanitizer can be used to sterilize cloth and n95 masks in the protection against COVID-19 ", "The need of health policy perspective to protect Healthcare Workers during COVID-19 pandemic. A GRADE rapid review on the N95 respirators effectiveness Protecting Health Care Workers (HCWs) during routine care of suspected or confirmed COVID-19 patients is of paramount importance to halt the SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2) pandemic. The WHO, ECDC and CDC have issued conflicting guidelines on the use of respiratory filters (N95) by HCWs. We searched PubMed, Embase and The Cochrane Library from the inception to March 21, 2020 to identify randomized controlled trials (RCTs) comparing N95 respirators versus surgical masks for prevention of COVID-19 or any other respiratory infection among HCWs. The grading of recommendations, assessment, development, and evaluation (GRADE) was used to evaluate the quality of evidence. Four RCTs involving 8736 HCWs were included. We did not find any trial specifically on prevention of COVID-19. However, wearing N95 respirators can prevent 73 more (95% CI 46-91) clinical respiratory infections per 1000 HCWs compared to surgical masks (2 RCTs; 2594 patients; low quality of evidence). A protective effect of N95 respirators in laboratory-confirmed bacterial colonization (RR = 0.41; 95%CI 0.28-0.61) was also found. A trend in favour of N95 respirators was observed in preventing laboratory-confirmed respiratory viral infections, laboratory-confirmed respiratory infection, and influenza like illness. We found no direct high quality evidence on whether N95 respirators are better than surgical masks for HCWs protection from SARS-CoV-2. However, low quality evidence suggests that N95 respirators protect HCWs from clinical respiratory infections. This finding should be contemplated to decide the best strategy to support the resilience of healthcare systems facing the potentially catastrophic SARS-CoV-2 pandemic.", "Mathematical Modeling of the Effectiveness of Facemasks in Reducing the Spread of Novel Influenza A (H1N1) On June 11, 2009, the World Health Organization declared the outbreak of novel influenza A (H1N1) a pandemic. With limited supplies of antivirals and vaccines, countries and individuals are looking at other ways to reduce the spread of pandemic (H1N1) 2009, particularly options that are cost effective and relatively easy to implement. Recent experiences with the 2003 SARS and 2009 H1N1 epidemics have shown that people are willing to wear facemasks to protect themselves against infection; however, little research has been done to quantify the impact of using facemasks in reducing the spread of disease. We construct and analyze a mathematical model for a population in which some people wear facemasks during the pandemic and quantify impact of these masks on the spread of influenza. To estimate the parameter values used for the effectiveness of facemasks, we used available data from studies on N95 respirators and surgical facemasks. The results show that if N95 respirators are only 20% effective in reducing susceptibility and infectivity, only 10% of the population would have to wear them to reduce the number of influenza A (H1N1) cases by 20%. We can conclude from our model that, if worn properly, facemasks are an effective intervention strategy in reducing the spread of pandemic (H1N1) 2009.", "Mask crisis during the COVID-19 outbreak On December 31, 2019, the World Health Organization (WHO) reported a cluster of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province, China. As of February 29, 2020, the National Health Commission of China has reported 79,389 confirmed cases of SARS-CoV-2 infection in 34 provinces. The masks can be used to block respiratory transmission from human to human, and are an effective way to control influenza. It is, therefore, necessary to wear a mask when respiratory infectious diseases are prevalent. China has a population of 1.4 billion. Assuming that two-thirds of the people in China must wear a mask every day, the daily demand for masks will reach 900 million. The Chinese government has taken many measures to solve these problems. Additionally, more measures should be taken to properly dispose of mask garbage. Although the outbreak originated in China, person-to-person transmission of SARS-CoV-2 has been confirmed, which means that it can be spread to anywhere in the world if prevention measures fail. The issues regarding face mask shortages and garbage in China, therefore, deserve worldwide attention.", "Assessment of a respiratory face mask for capturing air pollutants and pathogens including human influenza and rhinoviruses. Background Prevention of infection with airborne pathogens and exposure to airborne particulates and aerosols (environmental pollutants and allergens) can be facilitated through use of disposable face masks. The effectiveness of such masks for excluding pathogens and pollutants is dependent on the intrinsic ability of the masks to resist penetration by airborne contaminants. This study evaluated the relative contributions of a mask, valve, and Micro Ventilator on aerosol filtration efficiency of a new N95 respiratory face mask. Methods The test mask was challenged, using standardized methods, with influenza A and rhinovirus type 14, bacteriophage \u03a6\u03a7174, Staphylococcus aureus (S. aureus), and model pollutants. The statistical significance of results obtained for different challenge microbial agents and for different mask configurations (masks with operational or nonoperational ventilation fans and masks with sealed Smart Valves) was assessed. Results The results demonstrate >99.7% efficiency of each test mask configuration for exclusion of influenza A virus, rhinovirus 14, and S. aureus and >99.3% efficiency for paraffin oil and sodium chloride (surrogates for PM2.5). Statistically significant differences in effectiveness of the different mask configurations were not identified. The efficiencies of the masks for excluding smaller-size (i.e., rhinovirus and bacteriophage \u03a6\u03a7174) vs. larger-size microbial agents (influenza virus, S. aureus) were not significantly different. Conclusions The masks, with or without features intended for enhancing comfort, provide protection against both small- and large-size pathogens. Importantly, the mask appears to be highly efficient for filtration of pathogens, including influenza and rhinoviruses, as well as the fine particulates (PM2.5) present in aerosols that represent a greater challenge for many types of dental and surgical masks. This renders this individual-use N95 respiratory mask an improvement over the former types of masks for protection against a variety of environmental contaminants including PM2.5 and pathogens such as influenza and rhinoviruses.", "Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study BACKGROUND: A range of public health measures have been implemented to suppress local transmission of coronavirus disease 2019 (COVID-19) in Hong Kong. We examined the effect of these interventions and behavioural changes of the public on the incidence of COVID-19, as well as on influenza virus infections, which might share some aspects of transmission dynamics with COVID-19. METHODS: We analysed data on laboratory-confirmed COVID-19 cases, influenza surveillance data in outpatients of all ages, and influenza hospitalisations in children. We estimated the daily effective reproduction number (R(t)) for COVID-19 and influenza A H1N1 to estimate changes in transmissibility over time. Attitudes towards COVID-19 and changes in population behaviours were reviewed through three telephone surveys done on Jan 20\u201323, Feb 11\u201314, and March 10\u201313, 2020. FINDINGS: COVID-19 transmissibility measured by R(t) has remained at approximately 1 for 8 weeks in Hong Kong. Influenza transmission declined substantially after the implementation of social distancing measures and changes in population behaviours in late January, with a 44% (95% CI 34\u201353%) reduction in transmissibility in the community, from an estimated R(t) of 1\u00b728 (95% CI 1\u00b726\u20131\u00b730) before the start of the school closures to 0\u00b772 (0\u00b770\u20130\u00b774) during the closure weeks. Similarly, a 33% (24\u201343%) reduction in transmissibility was seen based on paediatric hospitalisation rates, from an R(t) of 1\u00b710 (1\u00b706\u20131\u00b712) before the start of the school closures to 0\u00b773 (0\u00b768\u20130\u00b777) after school closures. Among respondents to the surveys, 74\u00b75%, 97\u00b75%, and 98\u00b78% reported wearing masks when going out, and 61\u00b73%, 90\u00b72%, and 85\u00b71% reported avoiding crowded places in surveys 1 (n=1008), 2 (n=1000), and 3 (n=1005), respectively. INTERPRETATION: Our study shows that non-pharmaceutical interventions (including border restrictions, quarantine and isolation, distancing, and changes in population behaviour) were associated with reduced transmission of COVID-19 in Hong Kong, and are also likely to have substantially reduced influenza transmission in early February, 2020. FUNDING: Health and Medical Research Fund, Hong Kong.", "Disposable masks: Disinfection and sterilization for reuse, and non-certified manufacturing, in the face of shortages during the COVID-19 pandemic The COVID-19 pandemic is posing a huge global health threat. To deal with this problem, in addition to research and work in the medical field, the main health measures being taken in the workplace and at home involve the establishment of safety protocols, which include distance measures, hygiene and the use of personal protective equipment, such as masks, etc. The WHO still does not recommend the use of masks for the general population. However, their successful use in China, South Korea and the Czech Republic has encouraged their widespread use, and the shortage that already existed. This has caused that companies and individuals are looking at the best way to reuse them, and to manufacture, homemade or not, of non-certified masks. This paper is based on two objectives: to consult the scientific literature to identify the main strategies for disinfecting them, and to determine the effectiveness of non-certified disposable masks. A rapid review has been conducted in which the main publications and other information available online have been analyzed. Results showed that the most promising methods are those that use hydrogen peroxide vapor, ultraviolet radiation, moist heat, dry heat and ozone gas. Soapy water, alcohol, bleach immersion, ethylene oxide, ionizing radiation, microwave, high temperature, autoclave or steam are not fully recommended. Regarding the effectiveness of surgical masks compared to PPE, the former have been seen to be slightly less effective than PPE. As for other types of masks the effectiveness of homemade or non-certified masks is very low.", "How Could This Happen?: Narrowing Down the Contagion of COVID-19 and Preventing Acute Respiratory Distress Syndrome (ARDS) In this rapid commentary, a mini-review is given of the present state-of-knowledge regarding the etiology and epidemiology of the new coronavirus 2019-nCoV and the risks for developing Acute respiratory distress syndrome (ARDS). The available knowledge on the viral genomics, molecular biology and pathogenicity of viruses of the Coronaviridae family and other Nidovirales, forms a helpful template for understanding the present pandemic outbreak. However, important questions remain unanswered about the underlying mechanism causing the very high case fatality ratios (CFR) and mechanisms regarding severe reactions like ARDS, fatal cardiac and renal failures, associated with a number of important comorbidity factors. Immunological reactions to lung alveoles in particular (involving lung macrophages and alveolar epithelial cell damage) in late phase ARDS in SARS-like CoV diseases, so far may not have received enough attention. Finally a shortlist of questions for high priority further research is suggested.", "How can we prevent staff-to-staff transmission of coronavirus? ", "Covid-19: Each discarded face mask is a potential biohazard ", "AORN Guidance Statement: Human and Avian Influenza and Severe Acute Respiratory Syndrome ", "Online National Health Agency Mask Guidance for the Public in Light of COVID-19: Content Analysis BACKGROUND: The rapid global spread of the coronavirus disease (COVID-19) has compelled national governments to issue guidance on the use of face masks for members of the general public. To date, no work has assessed how this guidance differs across governments. OBJECTIVE: This study seeks to contribute to a rational and consistent global response to infectious disease by determining how guidelines differ across nations and regions. METHODS: A content analysis of health agency mask guidelines on agency websites was performed in late March 2020 among 25 countries and regions with large numbers of COVID-19 cases. Countries and regions were assigned across the coding team by language proficiency, with Google Translate used as needed. When available, both the original and English language version of guidance were reviewed. RESULTS: All examined countries and regions had some form of guidance online, although detail and clarity differed. Although 9 countries and regions recommended surgical, medical, or unspecified masks in public and poorly ventilated places, 16 recommended against people wearing masks in public. There were 2 countries that explicitly recommended against fabric masks. In addition, 12 failed to outline the minimum basic World Health Organization guidance for masks. CONCLUSIONS: Online guidelines for face mask use to prevent COVID-19 in the general public are currently inconsistent across nations and regions, and have been changing often. Efforts to create greater standardization and clarity should be explored in light of the status of COVID-19 as a global pandemic.", "Alternative Qualitative Fit Testing Method for N95 Equivalent Respirators in the Setting of Resource Scarcity at the George Washington University The 2019 Novel Coronavirus (COVID-19) has caused an acute shortage of personal protective equipment (PPE) globally as well as shortage in the ability to test PPE such as respirator fit testing. This limits not only the ability to fit PPE to medical practitioners, but also the ability to rapidly prototype and produce alternative sources of PPE as it is difficult to validate fit. At the George Washington University, we evaluated an easily sourced method of qualitative fit testing using a nebulizer or atomizer and a sodium saccharin solution in water. If aerosolized saccharin entered candidate masks due to poor fit or inadequate filtration, then a sweet taste was detected in the mouth of the user. This method was tested against previously fit tested Milwaukee N95 and 3D Printed Reusable N95 Respirator as a positive control. A Chinese sourced KN95, cotton cloth material, and surgical mask were tested as other masks of interest. Sensitivity testing was done with no mask prior to fit test. A sweet taste was detected for both the surgical mask and cotton cloth, demonstrating a lack of seal. However, there was no sweet taste detected for the Milwaukee N95, 3D Printed Reusable N95 Respirator, or Chinese KN95. These results demonstrate this could be a valuable methodology for rapid prototyping, evaluation, and validation of fit in a non-clinical environment for use in creation of PPE. This method should be not be used without confirmation in a formal qualitative or quantitative fit test but can be used to preserve those resources until developers are confident that potential new N95 comparable respirators will pass. We strongly suggest validation of masks and respirators with Occupational Safety and Health Administration (OSHA) approved fit testing prior to use in a clinical environment.", "Filter quality of electret masks in filtering 14.6\u2013594 nm aerosol particles: Effects of five decontamination methods This study investigates the effects of five decontamination methods on the filter quality (q(f)) of three commercially available electret masks\u2014N95, Gauze and Spunlace nonwoven masks. Newly developed evaluation methods, the overall filter quality (q(f,o)) and the q(f) ratio were applied to evaluate the effectiveness of decontamination methods for respirators. A scanning mobility particle sizer is utilized to measure the concentration of polydispersed particles with diameter 14.6\u2013594 nm. The penetration of particles and pressure drop (\u0394p) through the mask are used to determine q(f) and q(f,o). Experimental results reveal that the most penetrating particle size (MPS) for the pre-decontaminated N95, Gauze and Spunlace masks were 118 nm, 461 nm and 279 nm, respectively, and the respective penetration rates were 2.6%, 23.2% and 70.0%. The \u0394p through the pretreated N95 masks was 9.2 mm H(2)O at the breathing flow rate of heavy-duty workers, exceeding the \u0394p values obtained through Gauze and Spunlace masks. Decontamination increased the sizes of the most penetrating particles, changing the q(f) values of all of the masks: q(f) fell as particle size increased because the penetration increased. Bleach increased the \u0394p of N95, but destroyed the Gauze mask. However, the use of an autoclave reduces the \u0394p values of both the N95 and the Gauze mask. Neither the rice cooker nor ethanol altered the \u0394p of the Gauze mask. Chemical decontamination methods reduced the q(f,o) values for the three electret masks. The value of q(f,o) for PM(0.1) exceeded that for PM(0.1\u20130.6), because particles smaller than 100 nm had lower penetration, resulting in a better q(f) for a given pressure drop. The values of q(f,o), particularly for PM(0.1), reveal that for the tested treatments and masks, physical decontamination methods are less destructive to the filter than chemical methods. Nevertheless, when purchasing new or reusing FFRs, penetration should be regarded as the priority.", "Airborne route and bad use of ventilation systems as non-negligible factors in SARS-CoV-2 transmission Summary The world is facing a pandemic of unseen proportions caused by a corona virus named SARS-CoV-2 with unprecedent worldwide measures being taken to tackle its contagion. Person-to-person transmission is accepted but WHO only considers aerosol transmission when procedures or support treatments that produce aerosol are performed. However, transmission mechanisms are not fully understood and there is evidence for an airborne route to be considered as the virus remains viable in aerosols for at least 3h and that mask usage was the best intervention to prevent infection. Heating, Ventilating and Air Conditioning Systems (HVAC) are used as a primary infection disease control measure. However, they may contribute to the transmission/spreading of airborne diseases as proposed in the past for SARS. The authors believe that airborne transmission is possible and that HVAC systems when not adequately used may contribute to the transmission of the virus, as suggested by descriptions of from Japan, Germany, and the Diamond Princess Cruise Ship. Previous SARS outbreaks reported at Amoy Gardens, Emergency Rooms and Hotels, for example, also suggested airborne transmission. Further studies are warranted to confirm our hypotheses but the assumption of such way of transmission would cause a major shift in measures recommended to prevent infection such as the disseminated use of masks and structural changes to hospital and other facilities HVAC systems.", "Airborne Precautions and Personal Protective Equipment: The Powered Air-Purifying Respirator-Only Approach Airborne isolation of patients and use of respirators are a foundational strategy to prevent transmission of pathogens like tuberculosis and novel respiratory viruses via airborne route in healthcare settings. Healthcare personnel respiratory protection programs utilize respirators, which may or may not require fit testing for each individual. This chapter reviews the different types of respirators, which include the more common N95 respirator masks and the somewhat less commonly used powered air-purifying respirators, and the levels of protection offered by each type. The chapter also reviews considerations and controversies regarding use of N95 respirators and PAPRs and situations when a PAPR-only approach might work. In each healthcare facility, the epidemiology and risk assessment of the facility, available evidence in published literature, and certain regulatory standards must inform the clinical policies, protocols, and procedures. Key unanswered questions and further areas for research are outlined.", "Comprehensive review of mask utility and challenges during the COVID-19 pandemic. Masks are widely discussed during the course of the ongoing COVID-19 pandemic. Most hospitals have implemented universal masking for their healthcare workers, and the Center for Disease Control currently advises even the general public to wear cloth masks when outdoors. The pertinent need for masks arises from plausible dissemination of the SARS-CoV-2 through close contacts, as well as the possibility of virus transmission from asymptomatic, pre-symptomatic, and mildly symptomatic individuals. Given current global shortages in personal protective equipment, the efficacy of various types of masks: N95 respirators, surgical masks, and cloth masks are researched. To accommodate limited supplies, techniques for extended use, reuse, and sterilization of masks are strategized. However, masks alone may not greatly slow down the COVID-19 pandemic unless they are coupled with adequate social distancing, diligent hand hygiene, and other proven preventive measures.", "SARS preventive and risk behaviours of Hong Kong air travellers. This study aims to investigate Severe Acute Respiratory Syndrome (SARS)-related behaviours of travellers returning to Hong Kong by air. A total of 820 travellers returning to Hong Kong by air were interviewed about their SARS-related behaviours in April 2003. Three quarters of the respondents wore a mask most/all of the time on board, 15% did so in public places at the travel destination. Perceived susceptibility to SARS at the destination predicted mask-wearing in public places and avoidance of crowded places, and perceived efficacy was a predictor for mask-wearing during flight. Approximately 16% of the respondents stated that they would delay their medical consultation for flu-like symptoms until returning to Hong Kong. Nearly 18.2% stated that they would not wear a mask in public places at the destination if they had flu-like symptoms. Education programmes, special services and effective thermal screening are required to minimize the chance of the spread of SARS by air travellers.", "The efficacy of medical masks and respirators against respiratory infection in healthcare workers OBJECTIVE: We aimed to examine the efficacy of medical masks and respirators in protecting against respiratory infections using pooled data from two homogenous randomised control clinical trials (RCTs). METHODS: The data collected on 3591 subjects in two similar RCTs conducted in Beijing, China, which examined the same infection outcomes, were pooled. Four interventions were compared: (i) continuous N95 respirator use, (ii) targeted N95 respirator use, (iii) medical mask use and (iv) control arm. The outcomes were laboratory\u2010confirmed viral respiratory infection, influenza A or B, laboratory\u2010confirmed bacterial colonisation and pathogens grouped by mode of transmission. RESULTS: Rates of all outcomes were consistently lower in the continuous N95 and/or targeted N95 arms. In adjusted analysis, rates of laboratory\u2010confirmed bacterial colonisation (RR 0.33, 95% CI 0.21\u20100.51), laboratory\u2010confirmed viral infections (RR 0.46, 95% CI 0.23\u20100.91) and droplet\u2010transmitted infections (RR 0.26, 95% CI 0.16\u20100.42) were significantly lower in the continuous N95 arm. Laboratory\u2010confirmed influenza was also lowest in the continuous N95 arm (RR 0.34, 95% CI 0.10\u20101.11), but the difference was not statistically significant. Rates of laboratory\u2010confirmed bacterial colonisation (RR 0.54, 95% CI 0.33\u20100.87) and droplet\u2010transmitted infections (RR 0.43, 95% CI 0.25\u20100.72) were also lower in the targeted N95 arm, but not in medical mask arm. CONCLUSION: The results suggest that the classification of infections into droplet versus airborne transmission is an oversimplification. Most guidelines recommend masks for infections spread by droplets. N95 respirators, as \u201cairborne precautions,\u201d provide superior protection for droplet\u2010transmitted infections. To ensure the occupational health and safety of healthcare worker, the superiority of respirators in preventing respiratory infections should be reflected in infection control guidelines.", "Perioperative Management of Patients Infected with the Novel Coronavirus: Recommendation from the Joint Task Force of the Chinese Society of Anesthesiology and the Chinese Association of Anesthesiologists The outbreak of the new Coronavirus disease, COVID-19, has been involved in 77,262 cases in China as well as in 27 other countries as of February 24, 2020. Because the virus is novel to human beings, and there is no vaccine yet available, every individual is susceptible and can become infected. Healthcare workers are at high risk, and unfortunately, more than 3,000 healthcare workers in China have been infected. Anesthesiologists are among healthcare workers who are at an even higher risk of becoming infected because of their close contact with infected patients and high potential of exposure to respiratory droplets or aerosol from their patients\u2019 airways. In order to provide healthcare workers with updated recommendations on the management of patients in the perioperative setting as well as for emergency airway management outside of the operating room, the two largest anesthesia societies, the Chinese Society of Anesthesiology (CSA) and the Chinese Association of Anesthesiologists (CAA) have formed a task force to produce the recommendations. The task force hopes to help healthcare workers, particularly anesthesiologists, optimize the care of their patients and protect patients, healthcare workers, and the public from becoming infected. The recommendations were created mainly based on the practice and experience of anesthesiologists who provide care to patients in China. Therefore, adoption of these recommendations outside of China must be done with caution, and the local environment, culture, uniqueness of the healthcare system, and patients\u2019 needs should be considered. The task force will continuously update the recommendations and incorporate new information in future versions.", "A comprehensive Chinese experience against SARS-CoV-2 in ophthalmology The 2019 novel coronavirus disease (COVID-19) has now swept through the continents and poses a global threat to public health. Several investigations have been conducted to identify whether COVID-19 can be transmitted through the ocular route, and the conclusion is that it is a potential route but remains uncertain. Due to the face-to-face communication with patients, frequent exposure to tears and ocular discharge, and the unavoidable use of equipment which requires close proximity, ophthalmologists carry a high risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Based on 33 articles published by Chinese scholars, guidelines and clinical practice experience in domestic hospitals, we have summarized the Chinese experience through the lens of ophthalmology, hoping to make a contribution to protecting ophthalmologists and patients around the world.", "Mathematical assessment of the impact of non-pharmaceutical interventions on curtailing the 2019 novel Coronavirus A pandemic of a novel Coronavirus emerged in December of 2019 (COVID-19), causing devastating public health impact across the world. In the absence of a safe and effective vaccine or antivirals, strategies for controlling and mitigating the burden of the pandemic are focused on non-pharmaceutical interventions, such as social-distancing, contact-tracing, quarantine, isolation, and the use of face-masks in public. We develop a new mathematical model for assessing the population-level impact of the aforementioned control and mitigation strategies. Rigorous analysis of the model shows that the disease-free equilibrium is locally-asymptotically stable if a certain epidemiological threshold, known as the reproduction number (denoted by [Formula: see text]), is less than unity. Simulations of the model, using data relevant to COVID-19 transmission dynamics in the US state of New York and the entire US, show that the pandemic burden will peak in mid and late April, respectively. The worst-case scenario projections for cumulative mortality (based on the baseline levels of anti-COVID non-pharmaceutical interventions considered in the study) decrease dramatically by 80% and 64%, respectively, if the strict social-distancing measures implemented are maintained until the end of May or June, 2020. The duration and timing of the relaxation or termination of the strict social-distancing measures are crucially-important in determining the future trajectory of the COVID-19 pandemic. This study shows that early termination of the strict social-distancing measures could trigger a devastating second wave with burden similar to those projected before the onset of the strict social-distancing measures were implemented. The use of efficacious face-masks (such as surgical masks, with estimated efficacy [Formula: see text] 70%) in public could lead to the elimination of the pandemic if at least 70% of the residents of New York state use such masks in public consistently (nationwide, a compliance of at least 80% will be required using such masks). The use of low efficacy masks, such as cloth masks (of estimated efficacy less than 30%), could also lead to significant reduction of COVID-19 burden (albeit, they are not able to lead to elimination). Combining low efficacy masks with improved levels of the other anti-COVID-19 intervention strategies can lead to the elimination of the pandemic. This study emphasizes the important role social-distancing plays in curtailing the burden of COVID-19. Increases in the adherence level of social-distancing protocols result in dramatic reduction of the burden of the pandemic, and the timely implementation of social-distancing measures in numerous states of the US may have averted a catastrophic outcome with respect to the burden of COVID-19. Using face-masks in public (including the low efficacy cloth masks) is very useful in minimizing community transmission and burden of COVID-19, provided their coverage level is high. The masks coverage needed to eliminate COVID-19 decreases if the masks-based intervention is combined with the strict social-distancing strategy.", "Hospital infectious disease emergency preparedness: A survey of infection control professionals BACKGROUND: Hospital preparedness for infectious disease emergencies is imperative for local, regional, and national response planning. METHODS: A secondary data analysis was conducted of a survey administered to Infection Control Professionals (ICPs) in May, 2005. RESULTS: Most hospitals have ICP representation on their disaster committee, around-the-clock infection control support, a plan to prioritize health care workers to receive vaccine or antivirals, and non-health care facility surge beds. Almost 20% lack a surge capacity plan. Some lack negative pressure rooms for current patient loads or any surge capacity. Less than half have a plan for rapid set-up of negative pressure, and Midwest hospitals are less likely than other areas to have such plans. Smaller hospitals have less negative pressure surge capacity than do larger hospitals. About half have enough health care workers to respond to a surge that involves \u226450 patients; few can handle \u2265100 patients. Many do not have sufficient ventilators or can handle \u226410 additional ventilated patients. Most do not have enough National Institute for Occupational Safety and Health\u2013approved respirators, and less than half have sufficient surgical masks to handle a significant surge. CONCLUSIONS: United States hospitals lack negative pressure, health care worker, and medical equipment/supplies surge capacity. Hospitals must continue to address gaps in infectious disease emergency planning.", "The anesthesiologist and COVID-19 ", "To mask or not to mask children to overcome COVID-19 It has been reported that asymptomatic people can transmit the new coronavirus disease 2019 (COVID-19) and become important sources of COVID-19. To reduce the role of asymptomatic or poorly symptomatic people in COVID-19, universal use of face masks in addition to hand hygiene and safety distance seems extremely useful. Consequently, preparing the healthy child to use face masks is strongly needed. To obtain maximal compliance, reasons for mask wearing without attempts of removing must be clearly explained. Moreover, child's will must not be forced.Conclusion: On the basis of clinical findings, we think that the universal use of facial masks seems necessary when people have to go out in their everyday lives. In addition to the availability of masks of different sizes capable of adapting perfectly to the face, it is necessary that the use of masks in children is preceded by a strong parental work and school lessons on this issue and other hygiene topics with the main aim to obtain child cooperation. What is Known: \u00e2\u0080\u00a2 Asymptomatic people can transmit and become important sources of COVID-19. \u00e2\u0080\u00a2 Asymptomatic cases are common also in pediatrics. What is New: \u00e2\u0080\u00a2 Universal use of face masks for success against COVID-19 seems necessary also in pediatric age when people have to go out in their everyday lives. \u00e2\u0080\u00a2 In addition to the availability of masks of different sizes capable of adapting perfectly to the face, it is necessary that the use of masks in children is preceded by a strong parental work and school lessons with the main aim to obtain child cooperation.", "Covid-19: Important potential side effects of wearing face masks that we should bear in mind ", "Personal Protective Equipment Mindfulness may not be a term usually associated with personal protective equipment (PPE), but it is a useful concept for the discussion of putting together, layer by layer, the protective barriers that allow the safe provision of care for patients with highly hazardous communicable diseases. Each piece of the full PPE ensemble will have limitations that must be understood by the wearer. Close and careful attention to behaviors in the patient care environment becomes good PPE etiquette. Donning, or putting on PPE, carefully and fully before attending to a patient\u2019s needs is fundamental but not intuitive. Removing PPE is a high-risk procedure that can be performed safely with practice, coaching, and observation. Mitigating risk depends on awareness to all areas of potential contamination and a mindful approach to delivering safe patient care.", "Cluster randomised controlled trial to examine medical mask use as source control for people with respiratory illness RATIONALE: Medical masks are commonly used by sick individuals with influenza-like illness (ILI) to prevent spread of infections to others, but clinical efficacy data are absent. OBJECTIVE: Determine whether medical mask use by sick individuals with ILI protects well contacts from related respiratory infections. SETTING: 6 major hospitals in 2 districts of Beijing, China. DESIGN: Cluster randomised controlled trial. PARTICIPANTS: 245 index cases with ILI. INTERVENTION: Index cases with ILI were randomly allocated to medical mask (n=123) and control arms (n=122). Since 43 index cases in the control arm also used a mask during the study period, an as-treated post hoc analysis was performed by comparing outcomes among household members of index cases who used a mask (mask group) with household members of index cases who did not use a mask (no-mask group). MAIN OUTCOME MEASURE: Primary outcomes measured in household members were clinical respiratory illness, ILI and laboratory-confirmed viral respiratory infection. RESULTS: In an intention-to-treat analysis, rates of clinical respiratory illness (relative risk (RR) 0.61, 95% CI 0.18 to 2.13), ILI (RR 0.32, 95% CI 0.03 to 3.13) and laboratory-confirmed viral infections (RR 0.97, 95% CI 0.06 to 15.54) were consistently lower in the mask arm compared with control, although not statistically significant. A post hoc comparison between the mask versus no-mask groups showed a protective effect against clinical respiratory illness, but not against ILI and laboratory-confirmed viral respiratory infections. CONCLUSIONS: The study indicates a potential benefit of medical masks for source control, but is limited by small sample size and low secondary attack rates. Larger trials are needed to confirm efficacy of medical masks as source control. TRIAL REGISTRATION NUMBER: ACTRN12613000852752; Results.", "Could nitric oxide help to prevent or treat COVID-19? Abstract The nasal cavity and turbinates play important physiological functions by filtering, warming and humidifying inhaled air. Paranasal sinuses continually produce nitric oxide (NO), a reactive oxygen species that diffuses to the bronchi and lungs to produce bronchodilatory and vasodilatory effects. Studies indicate that NO may also help to reduce respiratory tract infection by inactivating viruses and inhibiting their replication in epithelial cells cultured in vitro. In view of the pandemic caused by the novel coronavirus (SARS-CoV-2), clinical trials have been designed to examine the effects of inhaled nitric oxide in COVID-19 subjects. We discuss here additional lifestyle factors such as mouth breathing which may affect the antiviral response against SARS-CoV-2 by bypassing the filtering effect of the nose and by decreasing NO levels in the airways. Simple devices that promote nasal breathing during sleep may help prevent the common cold, suggesting potential benefits against coronavirus infection. In the absence of effective treatments against COVID-19, the alternative strategies proposed here should be considered and studied in more detail.", "Flexible Nanoporous Template for the Design and Development of Reusable Anti-COVID-19 Hydrophobic Face Masks [Image: see text] Since the outbreak of the severe respiratory disease caused by the novel coronavirus (COVID-19), the use of face masks has become ubiquitous worldwide to control the rapid spread of this pandemic. As a result, the world is currently facing a face mask shortage, and some countries have placed limits on the number of masks that can be bought by each person. Although the surgical grade N95 mask provides the highest level of protection currently available, its filtration efficiency for sub-300 nm particles is around 85% due to its wider pore size (\u223c300 nm). Because the COVID-19 virus shows a diameter of around 65\u2013125 nm, there is a need for developing more efficient masks. To overcome these issues, we demonstrate the development of a flexible, nanoporous membrane to achieve a reusable N95 mask with a replaceable membrane and enhanced filtration efficiency. We first developed a flexible nanoporous Si-based template on a silicon-on-insulator wafer using KOH etching and then used the template as a hard mask during a reactive ion etching process to transfer the patterns onto a flexible and lightweight (<0.12 g) polymeric membrane. Pores with sizes down to 5 nm were achieved with a narrow distribution. Theoretical calculations show that airflow rates above 85 L/min are possible through the mask, which confirms its breathability over a wide range of pore sizes, densities, membrane thicknesses, and pressure drops. Finally, the membrane is intrinsically hydrophobic, which contributes to antifouling and self-cleaning as a result of droplets rolling and sliding on the inclined mask area.", "Letter to the Editor Re: Coronavirus disease 2019: The harms of exaggerated information and non\u2010evidence\u2010based measures Letter to the Editor Re: Coronavirus disease 2019: The harms of exaggerated information and non-evidence-based measures Prof. Ioannidis clearly and correctly identifies a real issue of the current emergency, namely that related to misinformation. This misinformation led to an erroneous perception of risk in some cases with the consequent lack of adoption of preventive interventions and in others to unmotivated and irrational behavior (e.g. panic shopping, shortage of supplies for personal protection such as face masks, etc).", "Face masks for the public during the covid-19 crisis. ", "A rapid screening method for testing the efficiency of masks in breaking down aerosols The highest risk of novel coronavirus SARS-CoV-2 to be spread through human-to-human transmission has boosted the use of personal protective equipment at worldwide level. In Europe, the medical face masks must be tested to certify the essential requirements in agreement with European Standard EN 14683:2019, and face masks for industrial use in agreement with European Standard EN 149:2009. Due to the need of large quantitative of medical and non-medical face masks in coronavirus outbreak, several Italian industries are working for shift a portion of their manufacturing capacity for producing medical and non-medical face mask. For screening evaluation of the effectiveness of personal protective equipment produced by reconverted industries, ARPA Lazio and the Department of Chemical Science and Technologies of Tor Vergata University have set-up an analytical system able to simulate the respiratory action and to measure the percentage of particles that pass through the face masks using optical particle counter (based on the EN 16890: 2017 that uses the same light scattering principle to evaluate the filter filtration efficiency). This set-up was challenged using face masks produced by reconverted industries and the data were compared with ones obtained using medical face mask.", "What face mask for what use in the context of COVID-19 pandemic? The French guidelines Summary In the context of the COVID-19 pandemic, wearing a face mask has become usual and ubiquitous, in both hospitals and community. However, the general public is consuming surgical or filtering face piece (FFP) masks irrespective of their specificity, leading to global supply shortage for the most exposed persons, which are healthcare workers. This underlines the urgent need to clarify the indications of the different categories of mask, in order to rationalize their use. The study herein specifies the French position for the rational use of respiratory protective equipment for healthcare workers.", "Custom-made 3D-printed face masks in case of pandemic crisis situations with a lack of commercially available FFP2/3 masks In the case of pandemic crisis situations, a crucial lack of protective material such as protective face masks for healthcare professionals can occur. A proof of concept (PoC) and prototype are presented, demonstrating a reusable custom-made three-dimensionally (3D) printed face mask based on materials and techniques (3D imaging and 3D printing) with global availability. The individualized 3D protective face mask consists of two 3D-printed reusable polyamide composite components (a face mask and a filter membrane support) and two disposable components (a head fixation band and a filter membrane). Computer-aided design (CAD) was used to produce the reusable components of the 3D face mask based on individual facial scans, which were acquired using a new-generation smartphone with two cameras and a face scanning application. 3D modelling can easily be done by CAD designers worldwide with free download software. The disposable non-woven melt-blown filter membrane is globally available from industrial manufacturers producing FFP2/3 protective masks for painting, construction, agriculture, and the textile industry. Easily available Velcro fasteners were used as a disposable head fixation band. A cleaning and disinfection protocol is proposed. Leakage and virological testing of the reusable components of the 3D face mask, following one or several disinfection cycles, has not yet been performed and is essential prior to its use in real-life situations. This PoC should allow the reader to consider making and/or virologically testing the described custom-made 3D-printed face masks worldwide. The surface tessellation language (STL) format of the original virtual templates of the two reusable components described in this paper can be downloaded free of charge using the hyperlink (Supplementary Material online).", "Perceptions of Occupational Risk and Changes in Clinical Practice of U.S. Vitreoretinal Surgery Fellows during the COVID-19 Pandemic Abstract Purpose To assess perceptions of occupational risk and changes to clinical practice of ophthalmology trainees in the United States during the COVID-19 pandemic. Design An anonymous, non-validated, cross-sectional survey was conducted online. Data was collected from April 7-16, 2020. Participants 2019-2020 second year U.S. vitreoretinal surgery fellows in two-year vitreoretinal surgery training programs were invited to participate. Intervention Online survey. Main outcome measures Survey questions assessed policies guiding COVID-19 response, known or suspected exposure to SARS-CoV-2, changes in clinical duties and volume, and methods to reduce occupational risk including availability of personal protective equipment. Results Completed responses were obtained from 62 of 87 eligible recipients (71.2% response rate). Training settings included academic (58.1%), hybrid academic/private practice (35.5%), and private practice only settings (6.5%). Overall, 19.4% of respondents reported an exposure to a COVID-19 positive patient, 14.5% reported self-quarantining due to possible exposure, and 11.3% reported being tested for COVID-19. In regards to PPE, N95 masks were available in the emergency room (n=40, 64.5%), office (n=35, 56.5%), and operating room settings (n=35, 56.5%). Perceived comfort level with PPE recommendations was significantly associated with availability of an N95 respirator mask in the clinic (p<0.001), emergency room (p<0.001) or operating room (p=0.002) settings. Additional risk mitigation methods outside of PPE were: reduction in patient volume (n=62, 100%), limiting patient companions (n=59, 95.2%), use of a screening process (n=59, 95.2%), use of a slit lamp face shield (n=57, 91.9%), temperature screening of all persons entering clinical space (n=34, 54.84%), and placement of face mask on patients (n=33, 53.2%). Overall, 16.1% reported additional clinical duties within the scope of ophthalmology, and 3.2% reported being re-deployed to non-ophthalmology services. 98.4% of respondents expected a reduction in surgical case volume. No respondents reported loss of employment or reduction in pay or benefits due to COVID-19. Conclusion and Relevance: Suspected or confirmed clinical exposure to COVID-19 positive patients occurred in approximately one-fifth of trainee respondents. Perceived comfort level with PPE standards was significantly associated with N95 respirator mask availability. As surgical training programs grapple with the COVID-19 pandemic, analysis of trainees\u2019 concerns may inform development of mitigation strategies.", "High-Risk Aerosol-Generating Procedures in COVID-19: Respiratory Protective Equipment Considerations. The correct selection and utilization of respiratory personal protective equipment is of the utmost importance in the current COVID-19 pandemic. This is especially true for health care workers exposed to high-risk aerosol-generating procedures, including otolaryngologists, ophthalmologists, neurosurgeons, maxillofacial surgeons, and laparoscopic surgeons. This communication provides a review of approved forms of respiratory protection and compares their characteristics, including surgical masks, N95 respirator, elastomeric respirators, powered air-purifying respirators, and controlled air-purifying respirators. For standard airborne precautions, N95 respirator are appropriate for respiratory protection. However, high-risk aerosol-generating procedures may create aerosolization of high viral loads that represent increased risk to health care workers. In these situations, enhanced respiratory protection with filters certified as 99, 100, or HEPA (high-efficiency particulate air) may be appropriate.", "Covid-19: Hong Kong government supplies reusable face masks to all residents. ", "Determining the filtration efficiency of half-face medical protection mask (N99) against viral aerosol Hospital-based outbreaks of severe acute respiratory syndrome (SARS) have once again highlighted the vulnerability of healthcare workers (HCWs). Use of personal respiratory protective equipment was the main method used by HCWs to avoid nosocomial transmission. This paper describes the technology used to evaluate the filtration efficiency of the half-face medical protection mask (N99), manufactured by Firmshield Biotechnology, against viral aerosol. Viral aerosol was generated and then sampled simultaneously with and without the test mask. This enables a percentage efficiency value to be calculated against test phage f2 aerosols (surrogates of viral pathogen aerosols). At the same time the mask filtration efficiency against NaCl particle aerosol was determined by use of TSI8130 equipment and face-fit factor was tested by use of TSI8020 equipment. The half-face medical protection mask (N99) evaluated by use of the viral aerosol had a filtration efficiency >99%. The mask filtration efficiency against NaCl particle aerosol was 99.634 \u00b1 0.024% and it had a good face-fit factor. This half-face medical protection mask (N99) can protect the wearer from viral aerosol disease transmission. The test method can be used to assess filtration efficacy against viral aerosol of masks used for respiratory protection.", "Availability, consistency and evidence-base of policies and guidelines on the use of mask and respirator to protect hospital health care workers: a global analysis BACKGROUND: Currently there is an ongoing debate and limited evidence on the use of masks and respirators for the prevention of respiratory infections in health care workers (HCWs). This study aimed to examine available policies and guidelines around the use of masks and respirators in HCWs and to describe areas of consistency between guidelines, as well as gaps in the recommendations, with reference to the WHO and the CDC guidelines. METHODS: Policies and guidelines related to mask and respirator use for the prevention of influenza, SARS and TB were examined. Guidelines from the World Health Organization (WHO), the Center for Disease Control and Prevention (CDC), three high-income countries and six low/middle-income countries were selected. RESULTS: Uniform recommendations are made by the WHO and the CDC in regards to protecting HCWs against seasonal influenza (a mask for low risk situations and a respirator for high risk situations) and TB (use of a respirator). However, for pandemic influenza and SARS, the WHO recommends mask use in low risk and respirators in high risk situations, whereas, the CDC recommends respirators in both low and high risk situations. Amongst the nine countries reviewed, there are variations in the recommendations for all three diseases. While, some countries align with the WHO recommendations, others align with those made by the CDC. The choice of respirator and the level of filtering ability vary amongst the guidelines and the different diseases. Lastly, none of the policies discuss reuse, extended use or the use of cloth masks. CONCLUSION: Currently, there are significant variations in the policies and recommendations around mask and respirator use for protection against influenza, SARS and TB. These differences may reflect the scarcity of level-one evidence available to inform policy development. The lack of any guidelines on the use of cloth masks, despite widespread use in many low and middle-income countries, remains a policy gap. Health organizations and countries should jointly evaluate the available evidence, prioritize research to inform evidence gaps, and develop consistent policy on masks and respirator use in the health care setting.", "Outbreak of a new coronavirus: what anaesthetists should know ", "Protecting healthcare workers from SARS-CoV-2 infection: practical indications The World Health Organization has recently defined the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection a pandemic. The infection, that may cause a potentially very severe respiratory disease, now called coronavirus disease 2019 (COVID-19), has airborne transmission via droplets. The rate of transmission is quite high, higher than common influenza. Healthcare workers are at high risk of contracting the infection particularly when applying respiratory devices such as oxygen cannulas or noninvasive ventilation. The aim of this article is to provide evidence-based recommendations for the correct use of \u201crespiratory devices\u201d in the COVID-19 emergency and protect healthcare workers from contracting the SARS-CoV-2 infection.", "Mask-wearing and respiratory infection in healthcare workers in Beijing, China OBJECTIVES: The aim of the study was to determine rates of mask-wearing, of respiratory infection and the factors associated with mask-wearing and of respiratory infection in healthcare workers (HCWs) in Beijing during the winter of 2007/2008. METHODS: We conducted a survey of 400 HCWs working in eight hospitals in Beijing by face to face interview using a standardized questionnaire. RESULTS: We found that 280/400 (70.0%) of HCWs were compliant with mask-wearing while in contact with patients. Respiratory infection occurred in 238/400 (59.5%) subjects from November, 2007 through February, 2008. Respiratory infection was higher among females (odds ratio [OR], 2.00 [95% confidence interval {CI}, 1.16-3.49]) and staff working in larger hospitals (OR, 1.72 [95% CI, 1.09-2.72]), but was lower among subjects with seasonal influenza vaccination (OR, 0.46 [95% CI, 0.28-0.76]), wearing medical masks (reference: cotton-yarn; OR, 0.60 [95% CI, 0.39-0.91]) or with good mask-wearing adherence (OR, 0.60 [95% CI, 0.37-0.98]). The risk of respiratory infection of HCWs working in low risk areas was similar to that of HCWs in high risk area. CONCLUSION: Our data suggest that female HCWs and staffs working in larger hospitals are the focus of prevention and control of respiratory infection in Beijing hospitals. Mask-wearing and seasonal influenza vaccination are protective for respiratory infection in HCWs; the protective efficacy of medical masks is better than that of cotton yarn ones; respiratory infection of HCWs working in low risk areas should also be given attention.", "How to train health personnel to protect themselves from SARS-CoV-2 (novel coronavirus) infection when caring for a patient or suspected case ", "Informing Homemade Emergency Facemask Design: The Ability of Common Fabrics to Filter Ultrafine Particles Objectives: To examine the ability of fabrics which might be used to create homemade face masks to filter out ultrafine (smaller than 1m in diameter) particles. Method: Twenty commonly available fabrics and materials were evaluated for their ability to reduce air concentrations of ultrafine particles. Further assessment was made on the filtration ability of select fabrics while damp and of fabric combinations which might be used to construct homemade masks. Results: Single fabric layers blocked a range of ultrafine particles. When fabrics were layered, significantly more ultrafine particles were filtered. Several fabric combinations were successful in removing similar amounts of ultrafine particles when compared to an N95 mask and surgical mask. Conclusions: The current coronavirus pandemic has left many communities without access to commercial facemasks. Our findings suggest that face masks made from layered common fabric can help filter ultrafine particles and provide some protection for the wearer when commercial facemasks are unavailable.", "Dispersal of Respiratory Droplets With Open vs Closed Oxygen Delivery Masks Implications for the Transmission of Severe Acute Respiratory Syndrome Nosocomial transmission of droplet-borne respiratory infections such as severe acute respiratory syndrome (SARS) may be influenced by the choice of oxygen face mask. A subject inhaled saline mist and exhaled through three oxygen masks to illustrate the pattern of dispersal of pulmonary gas. In two commonly used masks, exhaled gas formed a plume emanating from the side vents, while a third mask with a valved manifold, which was modified by adding a respiratory filter, retained the droplets. Maintaining respiratory isolation during the administration of oxygen may reduce the risk of the nosocomial transmission of respiratory infections such as SARS.", "Cost-effectiveness analysis of N95 respirators and medical masks to protect healthcare workers in China from respiratory infections BACKGROUND: There are substantial differences between the costs of medical masks and N95 respirators. Cost-effectiveness analysis is required to assist decision-makers evaluating alternative healthcare worker (HCW) mask/respirator strategies. This study aims to compare the cost-effectiveness of N95 respirators and medical masks for protecting HCWs in Beijing, China. METHODS: We developed a cost-effectiveness analysis model utilising efficacy and resource use data from two cluster randomised clinical trials assessing various mask/respirator strategies conducted in HCWs in Level 2 and 3 Beijing hospitals for the 2008\u201309 and 2009\u201310 influenza seasons. The main outcome measure was the incremental cost-effectiveness ratio (ICER) per clinical respiratory illness (CRI) case prevented. We used a societal perspective which included intervention costs, the healthcare costs of CRI in HCWs and absenteeism costs. RESULTS: The incremental cost to prevent a CRI case with continuous use of N95 respirators when compared to medical masks ranged from US $490\u2013$1230 (approx. 3000-7600 RMB). One-way sensitivity analysis indicated that the CRI attack rate and intervention effectiveness had the greatest impact on cost-effectiveness. CONCLUSIONS: The determination of cost-effectiveness for mask/respirator strategies will depend on the willingness to pay to prevent a CRI case in a HCW, which will vary between countries. In the case of a highly pathogenic pandemic, respirator use in HCWs would likely be a cost-effective intervention.", "COVID-19 infection prevention and control practices in Wuhan radiotherapy ", "Principles and Practice of SARS-CoV-2 Decontamination of N95 Masks with UV-C A mainstay of personal protective equipment (PPE) during the COVID-19 pandemic is the N95 filtering facepiece respirator. N95 respirators are commonly used to protect healthcare workers from respiratory pathogens, including the novel coronavirus SARS-CoV-2, and are increasingly employed by other frontline workers and the general public. Under routine circumstances, these masks are disposable, single-use items, but extended use and reuse practices have been broadly enacted to alleviate critical supply shortages during the COVID-19 pandemic. While extended-time single use presents a low risk of pathogen transfer, repeated donning and doffing of potentially contaminated masks presents increased risk of pathogen transfer. Therefore, efficient and safe decontamination methods for N95 masks are needed to reduce the risk of reuse and mitigate local supply shortages. Here we review the available literature concerning use of germicidal ultraviolet-C (UV-C) light to decontaminate N95 masks. We propose a practical method for repeated point-of-use decontamination, using commercially-available UV-C crosslinker boxes from molecular biology laboratories or a simple low-cost, custom-designed and fabricated device to expose each side of the mask to 800-1200 mJ/cm2 of UV-C. We measure the dose that penetrated to the interior of the respirators and model the potential germicidal action on SARS-CoV-2. Our experimental results, in combination with modeled data, suggest that a two-minute UV-C treatment cycle should induce a >3-log-order reduction in viral bioburden on the surface of the respirators, and a 2-log order reduction throughout the interior. The resulting exposure is 100-fold less than the dose expected to damage the masks, facilitating repeated decontamination. As such, UV-C germicidal irradiation (UVGI) is a practical strategy for small-scale point-of-use decontamination of N95s.", "Decontamination of face masks with steam for mask reuse in fighting the pandemic COVID\u201019: experimental supports The COVID\u201019 pandemic caused by the novel coronavirus SARS\u2010CoV\u20102 has claimed many lives worldwide. Wearing medical masks or N95 masks (namely N95 respirators) can slow the virus spread and reduce the infection risk. Reuse of these masks can minimize waste, protect the environment, and help to solve the current imminent shortage of masks. Disinfection of used masks is needed for reuse of them with safety, but improper decontamination can damage the blocking structure of masks. In this study, we demonstrated, using avian coronavirus of infectious bronchitis virus to mimic SARS\u2010CoV\u20102, that medical masks and N95 masks remained their blocking efficacy after being steamed on boiling water even for 2 hours. We also demonstrated that three brands of medical masks blocked over 99% viruses in aerosols. The avian coronavirus was completely inactivated after being steamed for 5 minutes. Together, this study suggested that medical masks are adequate for use on most social occasions, and both medical masks and N95 masks can be reused for a few days with steam decontamination between use. This article is protected by copyright. All rights reserved.", "Use of Face Masks in Dermatology Department During the COVID\u201019 Outbreak ", "Covid-19: skin damage with prolonged wear of FFP3 masks ", "Widespread use of face masks in public may slow the spread of SARS CoV-2: an ecological study Background The reasons for the large differences between countries in the sizes of their SARS CoV2 epidemics is unknown. Individual level studies have found that the use of face masks was protective for the acquisition and transmission of a range of respiratory viruses including SARS CoV1. We hypothesized that population level usage of face masks may be negatively associated SARS CoV2 spread. Methods At a country level, linear regression was used to assess the association between COVID19 diagnoses per inhabitant and the national promotion of face masks in public (coded as a binary variable), controlling for the age of the COVID19 epidemic and testing intensity. Results Eight of the 49 countries with available data advocated wearing face masks in public: China, Czechia, Hong Kong, Japan, Singapore, South Korea, Thailand and Malaysia. In multivariate analysis face mask use was negatively associated with number of COVID19 cases/inhabitant (coef. -326, 95% CI -601- -51, P=0.021). Testing intensity was positively associated with COVID-19 cases (coef. 0.07, 95% CI 0.05-0.08, P<0.001). Conclusion Whilst these results are susceptible to residual confounding, they do provide ecological level support to the individual level studies that found face mask usage to reduce the transmission and acquisition of respiratory viral infections.", "Mask crisis during the COVID-19 outbreak. On December 31, 2019, the World Health Organization (WHO) reported a cluster of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province, China. As of February 29, 2020, the National Health Commission of China has reported 79,389 confirmed cases of SARS-CoV-2 infection in 34 provinces. The masks can be used to block respiratory transmission from human to human, and are an effective way to control influenza. It is, therefore, necessary to wear a mask when respiratory infectious diseases are prevalent. China has a population of 1.4 billion. Assuming that two-thirds of the people in China must wear a mask every day, the daily demand for masks will reach 900 million. The Chinese government has taken many measures to solve these problems. Additionally, more measures should be taken to properly dispose of mask garbage. Although the outbreak originated in China, person-to-person transmission of SARS-CoV-2 has been confirmed, which means that it can be spread to anywhere in the world if prevention measures fail. The issues regarding face mask shortages and garbage in China, therefore, deserve worldwide attention.", "Anesthesia Management and Perioperative Infection Control in Patients With the Novel Coronavirus Anesthesiologists have a high risk of infection with COVID-19 during perioperative care and as first responders to airway emergencies. The potential of becoming infected can be reduced by a systematic and integrated approach that assesses infection risk. The latter leads to an acceptable choice of materials and techniques for personal protection and prevention of cross-contamination to other patients and staff. The authors have presented a protocolized approach that uses diagnostic criteria to clearly define benchmarks from the medical history along with clinical symptoms and laboratory tests. Patients can then be rapidly assigned into 1 of 3 risk categories that direct the choice of protective materials and/or techniques. Each hospital can adapt this approach to develop a system that fits its individual resources. Educating medical staff about the proper use of high-risk areas for containment serves to protect staff and patients.", "Precautions for Operating Room Team Members During the COVID-19 Pandemic BACKGROUND: The novel coronavirus SARS-CoV-2 (COVID-19) can infect healthcare workers. We developed an institutional algorithm to protect operating room team members during the COVID-19 pandemic and rationally conserve personal protective equipment (PPE). STUDY DESIGN: An interventional platform (operating room, interventional suite, and endoscopy) PPE taskforce was convened by the hospital and medical school leadership and tasked with developing a common algorithm for PPE use, to be used throughout the interventional platform. In conjunction with our infectious disease experts, we developed our guidelines based on potential patterns of spread, risk of exposure, and conservation of PPE. RESULTS: A decision tree algorithm describing our institutional guidelines for precautions for operating room team members was created. This algorithm is based on urgency of operation, anticipated viral burden at the surgical site, opportunity for a procedure to aerosolize virus, and likelihood a patient could be infected based on symptoms and testing. CONCLUSIONS: Despite COVID-19 being a new threat, we have shown that by developing an easy-to-follow decision tree algorithm for the interventional platform teams, we can ensure optimal health care worker safety.", "The scientific rationale for the use of simple masks or improvised facial coverings to trap exhaled aerosols and possibly reduce the breathborne spread of COVID-19 ", "Industry 4.0 technologies and their applications in fighting COVID-19 pandemic Abstract Background and aims COVID 19 (Coronavirus) pandemic has created surge demand for essential healthcare equipment, medicines along with the requirement for advance information technologies applications. Industry 4.0 is known as the fourth industrial revolution, which has the potential to fulfil customised requirement during COVID-19 crisis. This revolution has started with the applications of advance manufacturing and digital information technologies. Methods A detailed review of the literature is done on the technologies of Industry 4.0 and their applications in the COVID-19 pandemic, using appropriate search words on the databases of PubMed, SCOPUS, Google Scholar and Research Gate. Results We found several useful technologies of Industry 4.0 which help for proper control and management of COVID-19 pandemic and these have been discussed in this paper. The available technologies of Industry 4.0 could also help the detection and diagnosis of COVID-19 and other related problems and symptoms. Conclusions Industry 4.0 can fulfil the requirements of customised face masks, gloves, and collect information for healthcare systems for proper controlling and treating of COVID-19 patients. We have discussed ten major technologies of Industry 4.0 which help to solve the problems of this virus. It is useful to provide day to day update of an infected patient, area-wise, age-wise and state-wise with proper surveillance systems. We also believe that the proper implementation of these technologies would help to enhance education and communication regarding public health. These Industry 4.0 technologies could provide a lot of innovative ideas and solution for fighting local and global medical emergencies.", "Recent progress and challenges in drug development against COVID-19 coronavirus (SARS-CoV-2) - an update on the status Abstract Coronaviruses are a large group of viruses known to cause illnesses that vary between the common cold and more severe diseases to include severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). A novel coronavirus was identified in December 2019 in Wuhan city, Hubei province, China. This virus represents a new strain that has not been previously identified in humans. The virus is now known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the resulting disease is called coronavirus disease 2019 (COVID-19). The World Health Organization (WHO) declared the novel coronavirus outbreak a global pandemic in March 2020. Despite rigorous global containment and quarantine efforts, the incidence of COVID-19 continues to rise, with more than 1,948,617 laboratory-confirmed cases and over 121,846 deaths worldwide. Currently, no specific medication is recommended to treat COVID-19 patients. However, governments and pharmaceutical companies are struggling to quickly find an effective drug to defeat the coronavirus. In the current review, we summarize the existing state of knowledge about COVID-19, available medications, and treatment options. Favilavir is an antiviral drug that is approved in Japan for common influenza treatment and is now approved to treat symptoms of COVID-19 in China. Moreover, Chloroquine and hydroxychloroquine, drugs used to treat malaria and arthritis, respectively, were recommended by the National Health Commission of the People's Republic of China for treatment of COVID-19. Presently, chloroquine and hydroxychloroquine are under investigation by the US Food and Drug Administration (FDA) as a treatment for COVID-19. The first COVID-19 vaccine is not expected to be ready for clinical trials before the end of the year.", "Gastrointestinal endoscopy during COVID-19 pandemic: an updated review of guidelines and statements from international and national societies ", "The use of facemasks to prevent respiratory infection: a literature review in the context of the Health Belief Model. INTRODUCTION Acute respiratory infections are prevalent and pose a constant threat to society. While the use of facemasks has proven to be an effective barrier to curb the aerosol spread of such diseases, its use in the local community is uncommon, resulting in doubts being cast on its effectiveness in preventing airborne infections during epidemics. We thus aimed to conduct a literature review to determine the factors that influence the use of facemasks as a primary preventive health measure in the community. METHODS A search for publications relating to facemask usage was performed on Medline, PubMed, Google, World Health Organization and Singapore government agencies' websites, using search terms such as 'facemask', 'mask', 'influenza', 'respiratory infection', 'personal protective equipment', 'disease prevention', 'compliance' and 'adherence'. Findings were framed under five components of the Health Belief Model: perceived susceptibility, perceived benefits, perceived severity, perceived barriers and cues to action. RESULTS We found that individuals are more likely to wear facemasks due to the perceived susceptibility and perceived severity of being afflicted with life-threatening diseases. Although perceived susceptibility appeared to be the most significant factor determining compliance, perceived benefits of mask-wearing was found to have significant effects on mask-wearing compliance as well. Perceived barriers include experience or perception of personal discomfort and sense of embarrassment. Media blitz and public health promotion activities supported by government agencies provide cues to increase the public's usage of facemasks. CONCLUSION Complex interventions that use multipronged approaches targeting the five components of the Health Belief Model, especially perceived susceptibility, are needed to increase the use of facemasks in the community. Further studies are required to evaluate the effectiveness of implemented interventions.", "Mathematical assessment of the impact of non-pharmaceutical interventions on curtailing the 2019 novel Coronavirus A novel Coronavirus pandemic emerged in December of 2019, causing devastating public health impact across the world. In the absence of a safe and effective vaccine or antiviral, strategies for mitigating the burden of the pandemic are focused on non-pharmaceutical interventions, such as social-distancing, contact-tracing, quarantine, isolation and the use of face-masks in public. We develop a new mathematical model for assessing the population-level impact of these mitigation strategies. Simulations of the model, using data relevant to COVID-19 transmission in New York state and the entire US, show that the pandemic will peak in mid and late April, respectively. The worst-case scenario projections for cumulative mortality (based on the baseline levels of anti-COVID non-pharmaceutical interventions considered in the study) in New York State and the entire US decrease dramatically by 80% and 64%, respectively, if the strict social-distancing measures implemented are maintained until the end of May or June, 2020. This study shows that early termination of strict social-distancing could trigger a devastating second wave with burden similar to that projected before the onset of strict social-distance. The use of efficacious face-masks (efficacy greater than 70%) could lead to the elimination of the pandemic if at least 70% of the residents of New York state use such masks consistently (nationwide, a compliance of at least 80% will be required using such masks). The use of low efficacy masks, such as cloth masks (of efficacy less than 30%), could also lead to significant reduction of COVID-19 burden (albeit, they are not able to lead to elimination). Combining low efficacy masks with improved levels of other anti-COVID-19 intervention measures can lead to elimination of the pandemic. The mask coverage needed to eliminate COVID-19 decreases if mask-use is combined with strict social-distancing.", "Skincare experts offer advice for those wearing face masks for long periods ", "The Respiratory Protection Effectiveness Clinical Trial (ResPECT): a cluster-randomized comparison of respirator and medical mask effectiveness against respiratory infections in healthcare personnel BACKGROUND: Although N95 filtering facepiece respirators and medical masks are commonly used for protection against respiratory infections in healthcare settings, more clinical evidence is needed to understand the optimal settings and exposure circumstances for healthcare personnel to use these devices. A lack of clinically germane research has led to equivocal, and occasionally conflicting, healthcare respiratory protection recommendations from public health organizations, professional societies, and experts. METHODS: The Respiratory Protection Effectiveness Clinical Trial (ResPECT) is a prospective comparison of respiratory protective equipment to be conducted at multiple U.S. study sites. Healthcare personnel who work in outpatient settings will be cluster-randomized to wear N95 respirators or medical masks for protection against infections during respiratory virus season. Outcome measures will include laboratory-confirmed viral respiratory infections, acute respiratory illness, and influenza-like illness. Participant exposures to patients, coworkers, and others with symptoms and signs of respiratory infection, both within and beyond the workplace, will be recorded in daily diaries. Adherence to study protocols will be monitored by the study team. DISCUSSION: ResPECT is designed to better understand the extent to which N95s and MMs reduce clinical illness among healthcare personnel. A fully successful study would produce clinically relevant results that help clinician-leaders make reasoned decisions about protection of healthcare personnel against occupationally acquired respiratory infections and prevention of spread within healthcare systems. TRIAL REGISTRATION: The trial is registered at clinicaltrials.gov, number NCT01249625 (11/29/2010).", "Facial protection in the era of COVID-19: A narrative review We live in extraordinary times, where COVID-19 pandemic has brought the whole world to a screeching halt. Tensions and contradictions that surround the pandemic ridden world include the availability, and the lack thereof, various facial protection measures to mitigate the viral spread. Here, we comprehensively explore the different types of facial protection measures, including masks, needed both for the public and the healthcare workers (HCW). We discuss the anatomy, the critical issues of disinfection and reusability of masks, the alternative equipment available for the protection of the facial region from airborne diseases, such as face shields and powered air-purifying respirators (PAPR), and the skin health impact of prolonged wearing of facial protection by HCW. Clearly, facial protection, either in the form of masks or alternates, appears to have mitigated the pandemic as seen from the minimal COVID-19 spread in countries where public mask wearing is strictly enforced. On the contrary, the healthcare systems, that appear to have been unprepared for emergencies of this nature, should be appropriately geared to handle the imbalance of supply and demand of personal protective equipment including face masks. These are two crucial lessons we can learn from this tragic experience.", "Facemask shortage and the coronavirus disease (COVID-19) outbreak: Reflection on public health measures To the best of our knowledge, this is the first study to investigate the facemask shortage during the novel coronavirus pneumonia (COVID-19) outbreak in China. We have summarized in detail the management strategies implemented by the Chinese governments during the outbreaks. By considering three scenarios for the outbreak development, we simulated the facemasks availability from late-December 2019 to late-April 2020 and estimated the duration of sufficient facemask supplies. Our findings showed that if the COVID-19 outbreak occurred only in Wuhan city or Hubei province, facemask shortage would not appear with the existing public health measures. However, if the outbreak occurred in the whole of China, a shortage of facemask could be substantial assuming no alternative public health measures. Supplies of facemasks in the whole of China would have been sufficient for both healthcare workers and the general population if the COVID-19 outbreak only occurred in Wuhan city or Hubei province. However, if the outbreak occurred in the whole of China, facemask supplies in China could last for 5 days if under the existing public health measures and a shortage of 853 million facemasks is expected by 30 Apr 2020. Assuming a gradually decreased import volume, we estimated that dramatic increase in productivity (42.7 times of the usual level) is needed to mitigate the facemask crisis by the end of April. In light of the COVID-19 outbreak in China, a shortage of facemasks and other medical resources can considerably compromise the efficacy of public health measures. Effective public health measures should also consider the adequacy and affordability of medical resources. Global collaboration should be strengthened to prevent the development of a global pandemic from a regional epidemic via easing the medical resources crisis in the affected countries.", "Rapid Ramp-up of Powered Air-Purifying Respirator (PAPR) Training for Infection Prevention and Control during the COVID-19 Pandemic ", "Mask use during COVID-19: A risk adjusted strategy In the context of Coronavirus Disease (2019) (COVID-19) cases globally, there is a lack of consensus across cultures on whether wearing face masks is an effective physical intervention against disease transmission. This study 1) illustrates transmission routes of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2); 2) addresses controversies surrounding the mask from perspectives of attitude, effectiveness, and necessity of wearing the mask with evidence that the use of mask would effectively interrupt the transmission of infectious diseases in both hospital settings and community settings; and 3) provides suggestion that the public should wear the mask during COVID-19 pandemic according to local context. To achieve this goal, government should establish a risk adjusted strategy of mask use to scientifically publicize the use of masks, guarantee sufficient supply of masks, and cooperate for reducing health resources inequities.", "N95 acne Two women, aged 27 and 45 years, presented to the Dermatology Outpatient Clinic with acne vulgaris. Both had nodular acne in a similar distribution over the cheeks, chin, and perioral areas (Fig. 1). Each had a history of acne vulgaris as a teenager. Both were healthcare assistants working in the Singapore General Hospital throughout the severe acute respiratory syndrome (SARS) crisis, had worn N95 masks continuously for about 3 months whilst on the wards, and had suffered an outbreak of acne of the skin occluded by the mask. They were treated with topical retinoid and systemic antimicrobials, and both responded well.", "[Validation of surgical masks during COVID19 emergency: activities at the University of Napoli Federico II]/ Validazione di maschere chirurgiche nella fase di emergenza COVID19: lesperienza dellUniversita degli Studi di Napoli Federico II SUMMARY: During COVID-19 pandemic crisis, Italian Government has approved Law Decree no 18 of 17 march 2020, in which art 15 allows enterprises to produce, import and commercialize surgical masks notwithstanding the current rules of product certification It is just required that the interested enterprises send to the Italian National Institute of Health a selfcertification in which they declare the technical characteristics of the masks and that masks are produced according to the safety requirements In this context, a technical-scientific unit was established at the University of Napoli Federico II to provide interested enterprises with state-of-the-art consultancy, testing and measurement services, adhering to rigorous scientific protocols Characterization tests were carried out on 163 surgical masks and/or materials for their construction and they have enabled the identification of pre-screening criteria to simplify the procedure for evaluating surgical masks using methods for assessing the filtration efficiency of particles and aerosols Based on experimental results, it has been observed that a filtration efficiency for particles with sizes larger that 650 nm (PFE&gt;650) exceeding 35% might guarantees a bacterial filtration efficiency (BFE) higher than 95% while BFE values higher than 98% are obtained when the PFE&gt;650 is larger than 40% PFE measurement is extremely simpler with respect to BFE, the latter being time-consuming and requiring specific equipment and methods for its realization Many tested materials have shown the capability to assure high filtration efficiencies but Spundonded-Meltblown-Spunbonded (SMS), that are layers of non-woven fabric with different weights of Meltblown, can simultaneously guarantee high particle filtration efficiencies with pressure drop values (breathability) in the limits to classify the surgical masks as Type II/IIR In fact, the fabric products analyzed so far have not been able to simultaneously guarantee adequate BFE and breathability values On the contrary, Spunbonds of adequate weights can virtually verify both requirements and accredit themselves as possible materials for the production of surgical masks, at least of Type I Further studies are needed to verify the possibility of producing low-cost, reusable surgical masks that could meet the criteria of circular economy A seguito dellepidemia da COVID-19, in Italia lart 15 del decreto-legge 17 marzo 2020 n 18 ha permesso di produrre, importare e immettere in commercio mascherine chirurgiche in deroga alle vigenti disposizioni mediante linvio allIstituto Superiore di Sanita di una autocertificazione da parte dei soggetti interessati nella quale siano attestate le caratteristiche tecniche delle mascherine e sia dichiarato che le stesse rispettano tutti i requisiti di sicurezza In questo ambito, e stato istituito presso lUniversita degli Studi di Napoli Federico II, un presidio tecnico-scientifico per fornire alle aziende interessate servizi di consulenza, prova e misurazione, allo stato dellarte e aderenti a rigorosi protocolli scientifici Nel corso di queste attivita, il presidio tecnico scientifico ha effettuato prove di caratterizzazione su 163 mascherine chirurgiche e/o materiali per la loro costruzione Queste hanno permesso di individuare dei criteri di pre-screening per semplificare la procedura di valutazione delle mascherine chirurgiche utilizzando metodi di valutazione dellefficienza di filtrazione di polveri e di aerosol In particolare, si e osservato che una efficienza di filtrazione polveri con diametro superiore a 650 nm (PFE&gt;650) maggiore del 35% garantisce un livello di efficienza di filtrazione batterica (BFE) superiore al 95% mentre valori della BFE superiori al 98% sono ottenuti quando il valore della PFE&gt;650 e superiore al 40% La misura della PFE e una misura estremamente pio semplice rispetto alla prova di BFE che richiede tempo, specifiche attrezzature e metodi per la sua realizzazione Alcuni materiali provati hanno mostrato la possibilita di garantire elevate efficienze di filtrazi ne ma solo gli Spundonded-Meltblown-Spunbonded (SMS) che sono stratificazioni di tessuto non tessuto a diverse grammature di Meltblown, riescono a garantire contemporaneamente alte efficienze di filtrazione polveri con i valori di perdite di carico (respirabilita) richiesti per classificare una mascherina chirurgica come Tipo II/IIR secondo la normativa vigente Infatti, i prodotti in tessuto fino ad ora analizzati non sono stati in grado di garantire contemporaneamente adeguati valori di BFE e di respirabilita Al contrario, assemblati di Spunbond di adeguata grammatura e spessore potrebbero virtualmente verificare entrambi i requisiti e accreditarsi come possibili materiali per la produzione di maschere chirurgiche di Tipo I Ulteriori studi saranno necessari per verificare la possibilita di ottenere mascherine chirurgiche a basso costo e che possano essere riutilizzate nellottica di una maggiore sostenibilita ambientale e di una maggiore sicurezza degli approvvigionamenti", "Guidelines for TMS/tES Clinical Services and Research through the COVID-19 Pandemic BACKGROUND: The COVID-19 pandemic has broadly disrupted biomedical treatment and research including non-invasive brain stimulation (NIBS). Moreover, the rapid onset of societal disruption and evolving regulatory restrictions may not have allowed for systematic planning of how clinical and research work may continue throughout the pandemic or be restarted as restrictions are abated. The urgency to provide and develop NIBS as an intervention for diverse neurological and mental health indications, and as a catalyst of fundamental brain research, is not dampened by the parallel efforts to address the most life-threatening aspects of COVID-19; rather in many cases the need for NIBS is heightened including the potential to mitigate mental health consequences related to COVID-19. OBJECTIVE: To facilitate the re-establishment of access to NIBS clinical services and research operations during the current COVID-19 pandemic and possible future outbreaks, we develop and discuss a framework for balancing the importance of NIBS operations with safety considerations, while addressing the needs of all stakeholders. We focus on Transcranial Magnetic Stimulation (TMS) and low intensity transcranial Electrical Stimulation (tES) - including transcranial Direct Current Stimulation (tDCS) and transcranial Alternating Current Stimulation (tACS). METHODS: The present consensus paper provides guidelines and good practices for managing and reopening NIBS clinics and laboratories through the immediate and ongoing stages of COVID-19. The document reflects the analysis of experts with domain relevant expertise spanning NIBS technology, clinical services, and basic and clinical research \u2013 with an international perspective. We outline regulatory aspects, human resources, NIBS optimization, as well as accommodations for specific demographics. RESULTS: A model based on three phases (early COVID-19 impact, current practices, and future preparation) with an 11-step checklist (spanning removing or streamlining in-person protocols, incorporating telemedicine, and addressing COVID-19-associated adverse events) is proposed. Recommendations on implementing social distancing and sterilization of NIBS related equipment, specific considerations of COVID-19 positive populations including mental health comorbidities, as well as considerations regarding regulatory and human resource in the era of COVID-19 are outlined. We discuss COVID-19 considerations specifically for clinical (sub-)populations including pediatric, stroke, addiction, and the elderly. Numerous case-examples across the world are described. CONCLUSION: There is an evident, and in cases urgent, need to maintain NIBS operations through the COVID-19 pandemic, including anticipating future pandemic waves and addressing effects of COVID-19 on brain and mind. The proposed robust and structured strategy aims to address the current and anticipated future challenges while maintaining scientific rigor and managing risk.", "Medical mask or N95 respirator: When and how to use? COVID-19 pandemic is now a global threat on human health reaching up to 2 million infected people all around the World. Since its first recognition in Wuhan, many topics were discussed intensively about COVID-19, both in the public and scientific community. Personal protective equipments and especially masks were among the hottest topics during this pandemic. Regardless of which mask is used, performing hand hygiene frequently with an alcohol-based hand rub or with soap and water if hands are dirty; is the most effective preventive measure for COVID-19. The type of mask used when caring for COVID-19 patients will vary according to the setting, type of personnel/person, and activity. Although the main transmission route for COVID-19 is droplets, during aerosol generating procedures airborne transmission may occur. Keeping the distancing and medical masks and eye protection during close contact efficiently protects against respiratory diseases transmitted via droplets. Airborne precautions include goggles and respiratory protection with the use of an N95 or an equivalent mask respirator to prevent airborne transmission.", "Covid-19 pandemic and the skin - What should dermatologists know? Abstract The World has changed dramatically since the COVID-19 pandemic began. Together with our social, occupational, and personal life, the new corona virus poses novel challenges for all physicians, including dermatologists. Despite the virus not being dermatotropic, several skin conditions have emerged, mainly as a result of prolonged contact to personal protective equipment and excessive personal hygiene. Pressure injury, contact dermatitis, itch, pressure urticaria, and exacerbation of pre-existing skin diseases, including seborrheic dermatitis and acne, have been described. We have focused on the dermatologic aspects of COVID-19 infection, so that dermatologist may be aware of the skin complications and the preventive measures to be taken in the COVID-19 pandemic.", "Physical distancing, face masks, and eye protection for prevention of COVID-19 ", "Transmission of Influenza A in a Student Office Based on Realistic Person-to-Person Contact and Surface Touch Behaviour Influenza A viruses result in the deaths of hundreds of thousands of individuals worldwide each year. In this study, influenza A transmission in a graduate student office is simulated via long-range airborne, fomite, and close contact routes based on real data from more than 3500 person-to-person contacts and 127,000 surface touches obtained by video-camera. The long-range airborne, fomite and close contact routes contribute to 54.3%, 4.2% and 44.5% of influenza A infections, respectively. For the fomite route, 59.8%, 38.1% and 2.1% of viruses are transmitted to the hands of students from private surfaces around the infected students, the students themselves and other susceptible students, respectively. The intranasal dose via fomites of the students\u2019 bodies, belongings, computers, desks, chairs and public facilities are 8.0%, 6.8%, 13.2%, 57.8%, 9.3% and 4.9%, respectively. The intranasal dose does not monotonously increase or decrease with the virus transfer rate between hands and surfaces. Mask wearing is much more useful than hand washing for control of influenza A in the tested office setting. Regular cleaning of high-touch surfaces, which can reduce the infection risk by 2.14%, is recommended and is much more efficient than hand-washing.", "Rationale for universal face masks in public against COVID-19 ", "The COVID-19 pandemic from an ophthalmologist\u2019s perspective Abstract The current COVID-19 pandemic is rapidly spreading around the world. The first doctor to report this new disease was an ophthalmologist: this exemplifies the role of ophthalmologists in an infectious disease pandemic. Here we review how SARS-Cov2 affects the eye and discuss implications for ophthalmologists.", "Extended use of face masks during the COVID-19 pandemic - Thermal conditioning and spray-on surface disinfection The current COVID-19 pandemic has resulted in globally constrained supplies for face masks and personal protective equipment (PPE). Production capacity is limited in many countries and the future course of the pandemic will likely continue with shortages for high quality masks and PPE in the foreseeable future. Hence, expectations are that mask reuse, extended wear and similar approaches will enhance the availability of personal protective measures. Repeated thermal disinfection could be an important option and likely easier implemented in some situations, at least on the small scale, than UV illumination, irradiation or hydrogen peroxide vapor exposure. An overview on thermal responses and ongoing filtration performance of multiple face mask types is provided. Most masks have adequate material properties to survive a few cycles (i.e. 30 min disinfection steps) of thermal exposure in the 75 \u00b0C regime. Some are more easily affected, as seen by the fusing of plastic liner or warping, given that preferred conditioning temperatures are near the softening point for some of the plastics and fibers used in these masks. Hence adequate temperature control is equally important. As guidance, disinfectants sprayed via dilute solutions maintain a surface presence over extended time at 25 and 37 \u00b0C. Some spray-on alcohol-based solutions containing disinfectants were gently applied to the top surface of masks. Neither moderate thermal aging (less than 24 h at 80 and 95 \u00b0C) nor gentle application of surface disinfectant sprays resulted in measurable loss of mask filter performance. Subject to bio-medical concurrence (additional checks for virus kill efficiency) and the use of low risk non-toxic disinfectants, such strategies, either individually or combined, by offering additional anti-viral properties or short term refreshing, may complement reuse options of professional masks or the now ubiquitous custom-made face masks with their often unknown filtration effectiveness.", "The importance of preventing COVID-19 in surgical wards cannot be overemphasized ", "Disinfection of N95 masks artificially contaminated with SARS-CoV-2 and ESKAPE bacteria using hydrogen peroxide plasma: impact on the reutilization of disposable devices INTRODUCTION: One of the serious consequences of the SARS-CoV-2 pandemic is the shortage of protective equipment for health personnel. N95 masks are considered one of the essential protective equipment in the management of patients with COVID-19. The shortage of N95 masks implies potential health risks for health personnel and significant economic losses for the health institution. The objective of this work was to investigate the disinfection of N95 masks artificially contaminated with SARS-CoV-2 and ESKAPE bacteria by using hydrogen peroxide plasma. MATERIAL AND METHODS: We examined the disinfection capacity of hydrogen peroxide plasma against the SARS-CoV-2 and two members of the ESKAPE bacteria (Acinetobacter baumannii and Staphylococcus aureus) through a study of artificial contamination in situ of N95 masks. Amplification of specific genes by RT-PCR of SARS-CoV-2 and microbiological culture of ESKAPE bacteria was performed before and after the disinfection process. RESULTS: SARS-CoV-2 was not detected in all assays using five different concentrations of the virus, and A. baumannii and S. aureus were not cultivable with inoculums of 10(2) to 10(6) CFU after disinfection tests of N95 masks with hydrogen peroxide plasma. CONCLUSION: Disinfection of N95 masks by using the hydrogen peroxide plasma technology can be an alternative for their reuse in a shortage situation. Implications for the use of disinfection technologies of N95 masks and the safety of health personnel are discussed.", "Strategies for Rational Use of Personal Protective Equipment (PPE) Among Healthcare Providers During the COVID-19 Crisis As the coronavirus 2019 (COVID-19) began spreading globally with no clear treatment in sight, prevention became a major part of controlling the disease and its effects. COVID-19 spreads from the aerosols of an infected individual whether they are showing any symptoms or not. Therefore, it becomes nearly impossible to point exactly where the patient is. This is where personal protective equipment (PPE) comes in. These are masks, respirators, gloves, and in hospitals where the contact with the infected and confirmed patient is direct, also gowns or body covers. The PPEs play a major role in the prevention and control of the COVID-19. The PPE is able to prevent any invasion of the virus particles into the system of an individual which is why it is an essential item to have for healthcare workers. Due to the high demand for PPEs all around the world, it is important to optimize the use of protective gear and ration the supplies so that the demand are met. However, there are guidelines recommended by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) to maintain the supply in the wake of this increased demand of PPE, how the manufacturers should track their supplies, and how the recipients should manage them. Various strategies can be used to increase the re-use of PPEs during the COVID-19 pandemic that has modified the donning and doffing procedure.", "Respiratory protection for healthcare workers treating Ebola virus disease (EVD): Are facemasks sufficient to meet occupational health and safety obligations? ", "The feasibility of generalized face mask usage during the COVID-19 pandemic: a perspective from Latin America ", "Where to buy face masks? Survey of applications using Taiwan\u2019s open data in the time of coronavirus disease 2019 The coronavirus disease 2019 (COVID-19) had spread rapidly since late December 2019. Personal protective equipment was essential to prevent transmission. Owing to shortage of face masks, Taiwan government began to implement quasi rationing on February 6, 2020, by allowing each resident to purchase two masks in seven days. Taiwan National Health Insurance Administration offered online data with real-time updates on face mask availability in all contracted pharmacies and selected local health centers. Based on the open data, numerous software applications quickly emerged to assist the public in finding sales locations efficiently. METHODS: Up until March 15, 2020, the Public Digital Innovation Space of Taiwan government had recorded 134 software applications of face mask availability, and 24 software applications were excluded due to defect, duplicate, and unavailability. These applications were analyzed according to platform, developer type, and display mode. RESULTS: Of the 110 valid software applications, 67 (60.9%) applications were deployed on websites, followed by 21 (19.1%) on social networking sites, 19 (17.3%) as mobile applications, and 3 (2.7%) in other modes. Nearly two thirds (n = 70) of applications were developed by individuals, one third (n = 37) by commercial companies, only two applications by central and local governments, and one by a nongovernmental organization. With respect to the display mode, 47 (42.7%) applications adopted map-view only, 41 (37.3%) adopted table-view only, and 19 (17.3%) adopted both modes. Of the remaining three applications, two offered voice user interfaces and one used augmented reality. CONCLUSION: Taiwan\u2019s open data strategy facilitated rapid development of software applications for information dissemination to the public during the COVID-19 crisis. The transparency of real-time data could help alleviate the panic of the public. The collaborative contributions from the grassroots in disasters were priceless treasures.", "Masks and medical care: Two keys to Taiwan's success in preventing COVID-19 spread ", "The importance of preventing COVID\u201019 in surgical wards cannot be overemphasized ", "Are we ready for the new coronavirus? ", "The effectiveness of surgical face masks: what the literature shows. The use and withdrawal of surgical face masks in recent years has occurred in an ad hoc manner that is incompatible with evidence-based practice. Much of the literature on masks consists of anecdotal evidence or summaries of previous studies. The rationale for wearing masks has shifted from protection of the patient to protection of the health care professional wearing the mask. Currently there is little evidence that wearing a surgical mask provides sufficient protection from all the hazards likely to be encountered in an acute health care setting: the use of a respirator and face shield should be considered depending on the circumstances.", "Comprehensive review of mask utility and challenges during the COVID-19 pandemic Masks are widely discussed during the course of the ongoing COVID-19 pandemic Most hospitals have implemented universal masking for their healthcare workers, and the Center for Disease Control currently advises even the general public to wear cloth masks when outdoors The pertinent need for masks arises from plausible dissemination of the SARS-CoV-2 through close contacts, as well as the possibility of virus transmission from asymptomatic, pre-symptomatic, and mildly symptomatic individuals Given current global shortages in personal protective equipment, the efficacy of various types of masks: N95 respirators, surgical masks, and cloth masks are researched To accommodate limited supplies, techniques for extended use, reuse, and sterilization of masks are strategized However, masks alone may not greatly slow down the COVID-19 pandemic unless they are coupled with adequate social distancing, diligent hand hygiene, and other proven preventive measures", "SARS-CoV-2/COVID-19: Empfehlungen zu Diagnostik und Therapie COVID-19, a new viral disease affecting primarily the respiratory system and the lung, has caused a pandemic with serious challenges to health systems around the world. In about 20% of patients, severe symptoms occur after a mean incubation period of 5 \u2013 6 days; 5% of patients need intensive care therapy. Morbidity is about 1 \u2013 2%. Protecting health care workers is of paramount importance in order to prevent hospital acquired infections. Therefore, during all procedures associated with aerosol production, a personal safety equipment consisting of a FFP2/FFP3 (N95) respiratory mask, gloves, safety glasses and a waterproof overall should be used. Therapy is based on established recommendations issued for patients with acute lung injury (ARDS). Lung protective ventilation, prone position, restrictive fluid management and an adequate management of organ failures are the mainstays of therapy. In case of fulminant lung failure, veno-venous extracorporeal membrane oxygenation may be used as a rescue in experienced centres. New, experimental therapies evolve with ever increasing frequency; currently, however, there is no evidence based recommendation possible. If off-label and compassionate use of these drugs is considered, an individual benefit-risk assessment is necessary, since serious side effects have been reported.", "Masks and closed-loop ventilators prevent environmental contamination by COVID-19 patients in negative-pressure environments Herein, we report that nosocomial infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be mitigated by using surgical masks and closed looped ventilation for both non-critical and critical patients. These preventive measures resulted in no viral contamination of surfaces in negative pressure environments.", "Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial. CONTEXT Data about the effectiveness of the surgical mask compared with the N95 respirator for protecting health care workers against influenza are sparse. Given the likelihood that N95 respirators will be in short supply during a pandemic and not available in many countries, knowing the effectiveness of the surgical mask is of public health importance. OBJECTIVE To compare the surgical mask with the N95 respirator in protecting health care workers against influenza. DESIGN, SETTING, AND PARTICIPANTS Noninferiority randomized controlled trial of 446 nurses in emergency departments, medical units, and pediatric units in 8 tertiary care Ontario hospitals. INTERVENTION Assignment to either a fit-tested N95 respirator or a surgical mask when providing care to patients with febrile respiratory illness during the 2008-2009 influenza season. MAIN OUTCOME MEASURES The primary outcome was laboratory-confirmed influenza measured by polymerase chain reaction or a 4-fold rise in hemagglutinin titers. Effectiveness of the surgical mask was assessed as noninferiority of the surgical mask compared with the N95 respirator. The criterion for noninferiority was met if the lower limit of the 95% confidence interval (CI) for the reduction in incidence (N95 respirator minus surgical group) was greater than -9%. RESULTS Between September 23, 2008, and December 8, 2008, 478 nurses were assessed for eligibility and 446 nurses were enrolled and randomly assigned the intervention; 225 were allocated to receive surgical masks and 221 to N95 respirators. Influenza infection occurred in 50 nurses (23.6%) in the surgical mask group and in 48 (22.9%) in the N95 respirator group (absolute risk difference, -0.73%; 95% CI, -8.8% to 7.3%; P = .86), the lower confidence limit being inside the noninferiority limit of -9%. CONCLUSION Among nurses in Ontario tertiary care hospitals, use of a surgical mask compared with an N95 respirator resulted in noninferior rates of laboratory-confirmed influenza. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00756574", "Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta\u2010analysis OBJECTIVE: Previous meta\u2010analyses concluded that there was insufficient evidence to determine the effect of N95 respirators. We aimed to assess the effectiveness of N95 respirators versus surgical masks for prevention of influenza by collecting randomized controlled trials (RCTs). METHODS: We searched PubMed, EMbase and The Cochrane Library from the inception to January 27, 2020 to identify relevant systematic reviews. The RCTs included in systematic reviews were identified. Then we searched the latest published RCTs from the above three databases and searched ClinicalTrials.gov for unpublished RCTs. Two reviewers independently extracted the data and assessed risk of bias. Meta\u2010analyses were conducted to calculate pooled estimates by using RevMan 5.3 software. RESULTS: A total of six RCTs involving 9 171 participants were included. There were no statistically significant differences in preventing laboratory\u2010confirmed influenza (RR = 1.09, 95% CI 0.92\u20101.28, P > .05), laboratory\u2010confirmed respiratory viral infections (RR = 0.89, 95% CI 0.70\u20101.11), laboratory\u2010confirmed respiratory infection (RR = 0.74, 95% CI 0.42\u20101.29) and influenzalike illness (RR = 0.61, 95% CI 0.33\u20101.14) using N95 respirators and surgical masks. Meta\u2010analysis indicated a protective effect of N95 respirators against laboratory\u2010confirmed bacterial colonization (RR = 0.58, 95% CI 0.43\u20100.78). CONCLUSION: The use of N95 respirators compared with surgical masks is not associated with a lower risk of laboratory\u2010confirmed influenza. It suggests that N95 respirators should not be recommended for general public and nonhigh\u2010risk medical staff those are not in close contact with influenza patients or suspected patients.", "Mass Air Medical Repatriation of Coronavirus Disease 2019 Patients Abstract Recent coronavirus disease 2019 (COVID-19) events have presented challenges to health care systems worldwide. Air medical movement of individuals with potential infectious disease poses unique challenges and threats to crews and receiving personnel. The US Department of Health and Human Services air medical evacuation teams of the National Disaster Medical System directly supported 39 flights, moving over 2,000 individuals. Infection control precautions focused on source and engineering controls, personal protective equipment, safe work practices to limit contamination, and containment of the area of potential contamination. Source control to limit transmission distance was used by requiring all passengers to wear masks (surgical masks for persons under investigation and N95 for known positives). Engineering controls used plastic sheeting to segregate and treat patients who developed symptoms while airborne. Crews used Tyvek (Dupont Richmond, VA) suits with booties and a hood, a double layer of gloves, and either a powered air-purifying respirator or an N95 mask with a face shield. For those outside the 6-ft range, an N95 mask and gloves were worn. Safe work practices were used, which included mandatory aircraft surface decontamination, airflow exchanges, and designated lavatories. Although most patients transported were stable, to the best of our knowledge, this represents the largest repatriation of potentially contagious patients in history without infection of any transporting US Department of Health and Human Services air medical evacuation crews.", "Facemasks and similar barriers to prevent respiratory illness such as COVID-19: A rapid systematic review The current pandemic of COVID-19 has lead to conflicting opinions on whether wearing facemasks outside of health care facilities protects against the infection. To better understand the value of wearing facemasks we undertook a rapid systematic review of existing scientific evidence about development of respiratory illness, linked to use of facemasks in community settings. METHODS: We included all study designs. There were 31 eligible studies (including 12 RCTs). Narrative synthesis and random-effects meta-analysis of attack rates for primary and secondary prevention in 28 studies were performed. Results were reported by design, setting and type of face barrier in primary prevention, and by who wore the facemask (index patient or well contacts) in secondary prevention trials. The preferred outcome was influenza-like illness (ILI) but similar outcomes were pooled with ILI when ILI was unavailable. GRADE quality assessment was based on RCTs with support from observational studies. RESULTS: Where specific information was available, most studies reported about use of medical grade (surgical paper masks). In 3 RCTs, wearing a facemask may very slightly reduce the odds of developing ILI/respiratory symptoms, by around 6% (OR 0.94, 95% CI 0.75 to 1.19, I2 29%, low certainty evidence). Greater effectiveness was suggested by observational studies. When both house-mates and an infected household member wore facemasks the odds of further household members becoming ill may be modestly reduced by around 19% (OR 0.81, 95%CI 0.48 to 1.37, I 2 45%, 5 RCTs, low certainty evidence). The protective effect was very small if only the well person(OR 0.93, 95% CI 0.68 to 1.28, I2 11%, 2 RCTs, low uncertainty evidence) or the infected person wore the facemask (very low certainty evidence). DISCUSSION: Based on the RCTs we would conclude that wearing facemasks can be very slightly protective against primary infection from casual community contact, and modestly protective against household infections when both infected and uninfected members wear facemasks. However, the RCTs often suffered from poor compliance and controls using facemasks. Across observational studies the evidence in favour of wearing facemasks was stronger. We expect RCTs to under-estimate the protective effect and observational studies to exaggerate it. The evidence is not sufficiently strong to support widespread use of facemasks as a protective measure against COVID-19. However, there is enough evidence to support the use of facemasks for short periods of time by particularly vulnerable individuals when in transient higher risk situations. Further high quality trials are needed to assess when wearing a facemask in the community is most likely to be protective.", "Cloth Masks May Prevent Transmission of COVID-19: An Evidence-Based, Risk-Based Approach ", "Tackling the COVID-19 Pandemic Abstract After the initial breakout of the SARS-CoV-2 epidemic (now called COVID-19)\u2014in Wuhan, China\u2014and its subsequent fast dispersion throughout the world, many questions regarding its pathogenesis, genetic evolution, prevention, and transmission routes remain unanswered but fast explored. More than 100,000 confirmed, infected cases within a relatively short period of time globally corroborated the presumption that a pandemic will develop; such a pandemic will require a suite of global intervention measures. Consequently, different countries have reacted differently to the COVID-19 outbreak, but a uniform global response is necessary for tackling the pandemic. Managing the present or future COVID-19 outbreaks is not impossible but surely difficult. Barring the live-animal trade at the markets; revising the regulations and rules of customs, import or export across borders; supporting and expediting projects to develop vaccines and antiviral drugs; immediate quarantine of the involved regions; and also producing and supplying a large number of protective facemasks and preventing its stockpiling or smuggling are the main actions suggested to deal with the present or a forthcoming COVID-19 outbreak. Increasing numbers of infected cases had heightened concerns about the public health and welfare. Thus, preparing for the next probable pandemic of COVID-19 demands scrutinization of the lessons we have learnt so far.", "Medical masks and Respirators for the Protection of Healthcare Workers from SARS-CoV-2 and other viruses Abstract The use of medical masks and respirators as personal protective equipment is pivotal to reducing the level of biological hazard to which healthcare workers are exposed during the outbreak of highly diffusible pathogens, such as the recent novel coronavirus SARS-CoV-2. Unfortunately, during this pandemic, supplies are rapidly running out worldwide, with potential consequences for the rate of occupational infections. Also, knowledge about specific characteristics of respirators is of utmost importance to select the proper type according to the clinical setting. A wide variety of literature is available on the topic, but mostly based on Influenza viruses infection models. Clinical evidence on the use of respirators is poor and interest in the topic has not been constant over time. A better understanding of SARS-CoV-2 transmission is needed, together with high-quality clinical data on the use of respirators or alternative devices. Moreover, healthcare workers, regardless of their level of experience, should receive specific training. This review aims to summarize the available evidence on the use of medical masks and respirators in the context of viral infections, especially the current coronavirus disease 2019 (COVID-19).", "Stockpile of personal protective equipment in hospital settings: Preparedness for influenza pandemics BACKGROUND: Personal protective equipment (PPE) is known to be a crucial means of preventing influenza pandemics; however, the amount of PPE that should be stored in hospital settings has been unclear. OBJECTIVES: The purpose of this paper is to propose a PPE calculation system to help hospitals to decide their PPE stockpile. METHODS: We searched influenza guidelines from a number of countries and research papers on protective devices and infectious diseases. The PPE calculation system included factors such as the influenza pandemic period, risk classification by health care workers (HCW) type, and the type and number of PPE for a HCW per day. RESULTS: We concluded that 4 sets of PPE (N95 respirators, double gloves, gowns, and goggles) per day should be prepared for HCWs in a high-risk group. Similarly, 2 sets of appropriate PPE, depending on the risk level, are required for medium- and low-risk groups. In addition, 2 surgical masks are required for every worker and inpatient and 1 for each outpatient. The PPE stockpile should be prepared to cover at least an 8-week pandemic. CONCLUSION: Purchasing a PPE stockpile requires a sizable budget. The PPE calculation system in this paper will hopefully support hospitals in deciding their PPE stockpile.", "Evaluation of the rationale for concurrent use of N95 filtering facepiece respirators with loose-fitting powered air-purifying respirators during aerosol-generating medical procedures The concurrent use of N95 filtering facepiece respirators with powered air-purifying respirators during aerosol-generating medical procedures in patients with severe respiratory pathogens has been promoted as offering additional protection against infectious agents. The purpose of this article is to examine the impact of this additional respiratory equipment upon protection and personal performance. The presumed additive protective effect of an N95 filtering facepiece respirator used concurrently with a powered air-purifying respirator has not been subjected to rigorous scientific investigation. The burden imposed by additional respiratory protective equipment should not be discounted, and the potentially minor contribution to protection may be offset by the negative impact on personal performance. Novel uses of protective equipment occasionally are spawned during crisis situations, but their generalized applicability to healthcare workers should ultimately be evidence-based.", "Establishing and Managing a Temporary Coronavirus Disease 2019 Specialty Hospital in Wuhan, China ", "Decontamination Methods for Reuse of Filtering Facepiece Respirators Importance: The novel coronavirus disease 2019 (COVID-19) has proven to be highly infectious, putting health care professionals around the world at increased risk. Furthermore, there are widespread shortages of necessary personal protective equipment (PPE) for these individuals. Filtering facepiece respirators, such as the N95 respirator, intended for single use, can be reused in times of need. We explore the evidence for decontamination or sterilization of N95 respirators for health care systems seeking to conserve PPE while maintaining the health of their workforce. Observations: The filtration properties and fit of N95 respirators must be preserved to function adequately over multiple uses. Studies have shown that chemical sterilization using soap and water, alcohols, and bleach render the respirator nonfunctional. Decontamination with microwave heat and high dry heat also result in degradation of respirator material. UV light, steam, low-dry heat, and commercial sterilization methods with ethylene oxide or vaporized hydrogen peroxide appear to be viable options for successful decontamination. Furthermore, since the surface viability of the novel coronavirus is presumed to be 72 hours, rotating N95 respirator use and allowing time decontamination of the respirators is also a reasonable option. We describe a protocol and best practice recommendations for redoffing decontaminated N95 and rotating N95 respirator use. Conclusions and Relevance: COVID-19 presents a high risk for health care professionals, particularly otolaryngologists, owing to the nature of viral transmission, including possible airborne transmission and high viral load in the upper respiratory tract. Proper PPE is effective when used correctly, but in times of scarce resources, institutions may turn to alternative methods of preserving and reusing filtering facepiece respirators. Based on studies conducted on the decontamination of N95 respirators after prior outbreaks, there are several options for institutions to consider for both immediate and large-scale implementation.", "Precaution of 2019 novel coronavirus infection in department of oral and maxillofacial surgery Abstract The epidemic of the 2019 novel coronavirus (2019-nCoV) infection has presented as a critical period. Until February 23th 2020, more than 77 000 cases of 2019-nCoV infection have been confirmed in China, which has a great impact on economy and society. It has also interferred with ordinary medical practice of oral and maxillofacial surgery seriously. In order to protect oral and maxillofacial surgery medical staff from 2019-nCoV infection during the outbreak period, this paper suggests the necessary medical protective measures for oral and maxillofacial surgery outpatient and ward.", "Wearing masks and the fight against the novel coronavirus (COVID-19) ", "Do slit lamp shields and face masks protect ophthalmologists amidst COVID-19? Unlike face masks which provided some protection against both aerosols and droplets, slit lamp shields conferred protection only against direct large droplet transmission, with a limited role in reducing aerosol transmission risk.", "Evaluation of respiratory protection programs and practices in California hospitals during the 2009\u20132010 H1N1 influenza pandemic BACKGROUND: Emergence of the novel 2009 influenza A H1N1 virus in California led to an evaluation of hospital respiratory protection programs (RPPs) and practices by the California Department of Public Health during the 2009\u20132010 influenza season. METHODS: Onsite evaluation of 16 hospitals consisted of interviews with managers and health care workers about RPPs and practices, review of written RPPs, and limited observations of personnel using respirators. Data were analyzed using descriptive statistics. RESULTS: All hospitals had implemented policies requiring the minimum use of N95 filtering facepiece respirators when working with patients with H1N1 virus infection; 95.5% of health care workers (n = 199) reported they would wear at least this level of protection when in close contact with a patient with confirmed or suspected H1N1 virus infection. However, evaluation of written RPPs indicated deficiencies in required areas, most commonly in recordkeeping, designation of a program administrator, program evaluation, employee training, and fit testing procedures. CONCLUSIONS: Health care workers were aware of respiratory protection required when providing care for patients with confirmed or suspected H1N1 virus infection. Hospitals should improve written RPPs, fully implement written procedures, and conduct periodic program evaluation to ensure effectiveness of respirator use for health care worker protection. Increased accessibility of resources tailored for hospital respirator program administrators may be helpful.", "FFP3, FFP2, N95, surgical masks and respirators: what should we be wearing for ophthalmic surgery in the COVID-19 pandemic? ", "Cloth Masks May Prevent Transmission of COVID-19: An Evidence-Based, Risk-Based Approach As the COVID-19 pandemic progressed across the world, governments, international agencies, policymakers, and public health officials began recommending widespread use of nonmedical cloth masks to reduce the transmission of SARS-CoV-2. The authors of this article suggest that there is convincing evidence to support this recommendation.", "Medical masks vs N95 respirators for preventing COVID-19 in healthcare workers: A systematic review and meta-analysis of randomized trials BACKGROUND: Respiratory protective devices are critical in protecting against infection in healthcare workers at high risk of novel 2019 coronavirus disease (COVID-19); however, recommendations are conflicting and epidemiological data on their relative effectiveness against COVID-19 are limited. PURPOSE: To compare medical masks to N95 respirators in preventing laboratory-confirmed viral infection and respiratory illness including coronavirus specifically in healthcare workers. DATA SOURCES: MEDLINE, Embase, and CENTRAL from January 1, 2014, to March 9, 2020. Update of published search conducted from January 1, 1990, to December 9, 2014. STUDY SELECTION: Randomized controlled trials (RCTs) comparing the protective effect of medical masks to N95 respirators in healthcare workers. DATA EXTRACTION: Reviewer pair independently screened, extracted data, and assessed risk of bias and the certainty of the evidence. DATA SYNTHESIS: Four RCTs were meta-analyzed adjusting for clustering. Compared with N95 respirators; the use of medical masks did not increase laboratory-confirmed viral (including coronaviruses) respiratory infection (OR 1.06; 95% CI 0.90-1.25; I2 = 0%; low certainty in the evidence) or clinical respiratory illness (OR 1.49; 95% CI: 0.98-2.28; I2 = 78%; very low certainty in the evidence). Only one trial evaluated coronaviruses separately and found no difference between the two groups (P = .49). LIMITATIONS: Indirectness and imprecision of available evidence. CONCLUSIONS: Low certainty evidence suggests that medical masks and N95 respirators offer similar protection against viral respiratory infection including coronavirus in healthcare workers during non-aerosol-generating care. Preservation of N95 respirators for high-risk, aerosol-generating procedures in this pandemic should be considered when in short supply.", "Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings. METHODS: We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047. FINDINGS: Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0\u00b718, 95% CI 0\u00b709 to 0\u00b738; risk difference [RD] \u221210\u00b72%, 95% CI \u221211\u00b75 to \u22127\u00b75; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2\u00b702 per m; p(interaction)=0\u00b7041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0\u00b715, 95% CI 0\u00b707 to 0\u00b734, RD \u221214\u00b73%, \u221215\u00b79 to \u221210\u00b77; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12\u201316-layer cotton masks; p(interaction)=0\u00b7090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0\u00b722, 95% CI 0\u00b712 to 0\u00b739, RD \u221210\u00b76%, 95% CI \u221212\u00b75 to \u22127\u00b77; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings. INTERPRETATION: The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance. FUNDING: World Health Organization.", "Aerosol formation during non-contact 'air-puff' tonometry and its significance for prevention of COVID-19 Objective To evaluate the aerosol concentration(PM2 5,PM10 0 and aerosol particle number) formation in non-contact 'air-puff' tonometry and provide suggestions for medical workers to take appropriate daily protection during the prevalence of 2019-nCoV Methods A cross-sectional study was carried out in this study Thirty healthy subjects were enrolled on February 22, 2020 at Eye Hospital of Wenzhou Medical University The intraocular pressure (IOP) was measured by non-contact 'air-puff' tonometer in the ophthalmic consulting room and the hall with or without masks PM2 5, PM10 0 and aerosol particles were recorded by air quality detector The cumulative effects of IOP measurement, PM2 5, PM10 0 and aerosol particle number were analyzed, and the aerosol density of subjects with and without masks was compared Results The PM2 5, PM10 0 and aerosol particles produced by the non-contact 'air-puff' tonometry and increased with the increase of spray times The IOP curves of 60 eyes of 30 subjects were measured respectively in two environments of medical consulting room and medical institution hall It was found that PM2 5, pm10 0 and particle number fluctuated and increased with the increase of IOP measurement person times, showing cumulative effect, and the accumulation speed of aerosol density in hall was faster than that in consulting room The density of PM2 5 and PM10 0 produced without gauze mask were (53 417&plusmn;2 306) and (85 350&plusmn;3 488) &mu;g/m 3 , which were higher than those of (50 567&plusmn;0 862) and (80 617&plusmn;1 463) &mu;g/m 3 with gauze mask The differences were statistically significant ( P =0 028, 0 019) Conclusions Aerosol can be produced by non-contact 'air-puff' tonometer spraying, and it fluctuates with the increase of spraying times, showing a cumulative effect The aerosol accumulation is higher in the hall with insufficient air circulation And more aerosol can be produced without gauze mask", "What Type of Face Mask Is Appropriate for Everyone-Mask-Wearing Policy amidst COVID-19 Pandemic? ", "Recommendations for the prevention, mitigation and containment of the emerging SARS-CoV-2 (COVID-19) pandemic in haemodialysis centres COVID-19, a disease caused by a novel coronavirus, is a major global human threat that has turned into a pandemic. This novel coronavirus has specifically high morbidity in the elderly and in comorbid populations. Uraemic patients on dialysis combine an intrinsic fragility and a very frequent burden of comorbidities with a specific setting in which many patients are repeatedly treated in the same area (haemodialysis centres). Moreover, if infected, the intensity of dialysis requiring specialized resources and staff is further complicated by requirements for isolation, control and prevention, putting healthcare systems under exceptional additional strain. Therefore, all measures to slow if not to eradicate the pandemic and to control unmanageably high incidence rates must be taken very seriously. The aim of the present review of the European Dialysis (EUDIAL) Working Group of ERA-EDTA is to provide recommendations for the prevention, mitigation and containment in haemodialysis centres of the emerging COVID-19 pandemic. The management of patients on dialysis affected by COVID-19 must be carried out according to strict protocols to minimize the risk for other patients and personnel taking care of these patients. Measures of prevention, protection, screening, isolation and distribution have been shown to be efficient in similar settings. They are essential in the management of the pandemic and should be taken in the early stages of the disease.", "Pretreated household materials carry similar filtration protection against pathogens when compared with surgical masks OBJECTIVE: The past 4 months, the emergence and spread of novel 2019 SARS-Cov-2 (COVID-19) has led to a global pandemic which is rapidly depleting supplies of personal protective equipment worldwide. There are currently over 1.6 million confirmed cases of COVID-19 worldwide which has resulted in more the 100,000 deaths. As these numbers grow daily, hospitals are being forced to reuse surgical masks in hopes of conserving their dwindling supply. Since COVID-19 will most likely have effects that last for many months, our nationwide shortage of masks poses a long term issue that must be addressed immediately. METHODS: Based on a previous study by Quan et al., a salt-based soaking strategy has been reported to enhance the filtration ability of surgical masks. We propose a similar soaking process which uses materials widely available in anyone's household. We tested this method of pretreating a variety of materials with a salt-based solution by a droplet test using fluorescently stained nanoparticles similar in size to the COVID-19 virus. RESULTS: In this study, we found that paper towels and surgical masks pretreated with the salt-based solution showed a noticeable increase in filtration of nanoparticles similar in size to the COVID-19 virus. We also show that the TWEEN20 used by Quan et al. is not a critical component for the solution, and using salt alone in solution still provides a dramatically increased level of protection. CONCLUSIONS: We believe this method will allow for healthcare workers to create a disposable added layer of protection to their surgical masks, N95s, or homemade masks by using household available products. Adoption of this method may play an essential role in ensuring the safety of healthcare workers during the COVID-19 pandemic and any pandemics that may arise in the future.", "Personal protective equipment (PPE) for anesthesiologists: the need for national guidelines ", "The role of masks and respirator protection against SARS-CoV-2 ", "Cochrane Review: Interventions for the interruption or reduction of the spread of respiratory viruses BACKGROUND: Viral epidemics or pandemics such as of influenza or severe acute respiratory syndrome (SARS) pose a significant threat. Antiviral drugs and vaccination may not be adequate to prevent catastrophe in such an event. OBJECTIVES: To systematically review the evidence of effectiveness of interventions to interrupt or reduce the spread of respiratory viruses (excluding vaccines and antiviral drugs, which have been previously reviewed). SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, issue 4); MEDLINE (1966 to November 2006); OLDMEDLINE (1950 to 1965); EMBASE (1990 to November 2006); and CINAHL (1982 to November 2006). SELECTION CRITERIA: We scanned 2300 titles, excluded 2162 and retrieved the full papers of 138 trials, including 49 papers of 51 studies. The quality of three randomised controlled trials (RCTs) was poor; as were most cluster RCTs. The observational studies were of mixed quality. We were only able to meta\u2010analyse case\u2010control data. We searched for any interventions to prevent viral transmission of respiratory viruses (isolation, quarantine, social distancing, barriers, personal protection and hygiene). Study design included RCTs, cohort studies, case\u2010control studies, cross\u2010over studies, before\u2010after, and time series studies. DATA COLLECTION AND ANALYSIS: We scanned the titles, abstracts and full text articles using a standardised form to assess eligibility. RCTs were assessed according to randomisation method, allocation generation, concealment, blinding, and follow up. Non\u2010RCTs were assessed for the presence of potential confounders and classified as low, medium, and high risk of bias. MAIN RESULTS: The highest quality cluster RCTs suggest respiratory virus spread can be prevented by hygienic measures around younger children. Additional benefit from reduced transmission from children to other household members is broadly supported in results of other study designs, where the potential for confounding is greater. The six case\u2010control studies suggested that implementing barriers to transmission, isolation, and hygienic measures are effective at containing respiratory virus epidemics. We found limited evidence that the more uncomfortable and expensive N95 masks were superior to simple surgical masks. The incremental effect of adding virucidals or antiseptics to normal handwashing to decrease respiratory disease remains uncertain. The lack of proper evaluation of global measures such as screening at entry ports and social distancing prevent firm conclusions about these measures. AUTHORS' CONCLUSIONS: Many simple and probably low\u2010cost interventions would be useful for reducing the transmission of epidemic respiratory viruses. Routine long\u2010term implementation of some of the measures assessed might be difficult without the threat of a looming epidemic. PLAIN LANGUAGE SUMMARY: Interventions to interrupt or reduce the spread of respiratory viruses Although respiratory viruses usually only cause minor disease, they can cause epidemics. Approximately 10% to 15% of people worldwide contract influenza annually, with attack rates as high as 50% during major epidemics. Global pandemic viral infections have been devastating because of their wide spread. In 2003 the severe acute respiratory syndrome (SARS) epidemic affected \u02dc8,000 people, killed 780, and caused an enormous social and economic crisis. A new avian influenza pandemic caused by the H5N1 strain might be more catastrophic. Single measures (particularly the use of vaccines or antiviral drugs) may be insufficient to interrupt the spread. We found 51 studies including randomised controlled trials (RCTs) and observational studies with a mixed risk of bias. Respiratory virus spread might be prevented by hygienic measures around younger children. These might also reduce transmission from children to other household members. Implementing barriers to transmission, isolation, and hygienic measures may be effective at containing respiratory virus epidemics. There was limited evidence that (more uncomfortable and expensive) N95 masks were superior to simple ones. Adding virucidals or antiseptics to normal handwashing is of uncertain benefit. There is insufficient evaluation of global measures such as screening at entry ports and social distancing.", "[Management and prevention of common skin problems during epidemic prevention and control of COVID-19]. In the ongoing fight against the epidemic of COVID-19, the medical staff has been under tremendous pressure. Wearing the protective equipment (masks, goggles, and protective screens) with a poor breathability for a long time causes various skin problems, such as allergies, excessive skin hydration, local mechanical injuries, and even secondary infections. In addition, in a closed environment, compression and friction aggravate skin reactions, which may compromise duty performance of the medical staff. It is therefore essential to provide timely treatment opinions and prevention methods for common skin problems. We also give suggestions concerning the preparation of medical kit for skin protection in the epidemic area.", "Covid-19: should the public wear face masks? ", "Medical mask versus cotton mask for preventing respiratory droplet transmission in micro environments The objective of this study was to investigate whether cotton mask worn by respiratory infection person could suppress respiratory droplet levels compared to medical mask. We recruited adult volunteers with confirmed influenza and suspected cases of coronavirus disease 2019 (COVID-19) to wear medical masks and self-designed triple-layer cotton masks in a regular bedroom and a car with air conditioning. Four 1-hour repeated measurements (two measurements for bedroom the others for car) of particles with a size range of 20-1000 nm measured by number concentrations (NC0.02-1), temperature and relatively humidity, and cough/sneeze counts per hour were conducted for each volunteer. The paired t-tests were used for within-group comparisons in a bedroom and in a car. The results showed that there was no significant difference in NC0.02-1 or cough/sneeze counts between volunteers with medical masks and cotton masks in a bedroom or a car. We concluded that the cotton mask could be a potential substitute for medical mask for respiratory infection person in microenvironment with air conditioning. Healthy people may daily use cotton mask in the community since cotton mask is washable and reusable.", "Novel coronavirus disease (COVID-19): a pandemic (epidemiology, pathogenesis and potential therapeutics) The coronavirus disease (COVID-19) is highly pathogenic viral infection caused by SARS-CoV-2. Currently, COVID-19 has caused global health concern. It is assumed that COVID-19 has zoonotic origin based on the large number of infected people who were exposed to the wet market in Wuhan City, China. The phylogenetic analysis has revealed that SARS-CoV-2 has significant sequence similarity with severe acute respiratory syndrome-like (SARS-like) bat viruses, thus bats could be primary possible reservoir. The intermediate host and there subsequent transfer is not known yet, although human to human transfer is widely confirmed. The transmission of COVID-19 infection from one person to another resulted in the isolation of patients who were subsequently given a variety of treatments. To monitor the current outbreak, robust steps have been taken around the globe to reduce the transmission of COVID-19 infection particularly banning international and domestic flights, inducting lockdowns in vulnerable areas, social distancing etc. No clinically approved antiviral drug or vaccine against COVID-19 is reported yet. However, in clinical trials, few broad-spectrum antiviral drugs were evaluated against COVID-19 infection which resulted in clinical recovery. In this article emergence and pathogenicity of COVID-19 infection along with potential therapeutic strategies are analyzed to combat the COVID-19 pandemic.", "Obstetricians on the Coronavirus Disease 2019 (COVID-19) Front Lines and the Confusing World of Personal Protective Equipment As health care systems struggle to maintain adequate supplies of personal protective equipment, there is confusion and anxiety among obstetricians and others about how to best protect themselves, their coworkers, and their patients. Although use of personal protective equipment is a critical strategy to protect health care personnel from coronavirus disease 2019 (COVID-19), other strategies also need to be implemented on labor and delivery units to reduce the risk of health care\u2013associated transmission, including screening of all pregnant women who present for care (case identification), placing a mask on and rapidly isolating ill pregnant women, and minimizing the number of personnel who enter the room of an ill patient (physical distancing). Although the mechanism of transmission of COVID-19 is not known with certainty, current evidence suggests that COVID-19 is transmitted primarily through respiratory droplets. Therefore, strict adherence to hand hygiene and consistent use of recommended personal protective equipment are cornerstones for reducing transmission. In addition, it is critical that health care professionals receive training on and practice correct donning (putting on) and doffing (removing) of personal protective equipment and avoid touching their faces as well as their facial protection to minimize self-contamination.", "Community Use Of Face Masks And COVID-19: Evidence From A Natural Experiment Of State Mandates In The US. State policies mandating public or community use of face masks or covers in mitigating novel coronavirus disease (COVID-19) spread are hotly contested. This study provides evidence from a natural experiment on effects of state government mandates in the US for face mask use in public issued by 15 states plus DC between April 8 and May 15. The research design is an event study examining changes in the daily county-level COVID-19 growth rates between March 31, 2020 and May 22, 2020. Mandating face mask use in public is associated with a decline in the daily COVID-19 growth rate by 0.9, 1.1, 1.4, 1.7, and 2.0 percentage-points in 1-5, 6-10, 11-15, 16-20, and 21+ days after signing, respectively. Estimates suggest as many as 230,000-450,000 COVID-19 cases possibly averted By May 22, 2020 by these mandates. The findings suggest that requiring face mask use in public might help in mitigating COVID-19 spread. [Editor's Note: This Fast Track Ahead Of Print article is the accepted version of the peer-reviewed manuscript. The final edited version will appear in an upcoming issue of Health Affairs.].", "Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review Objective To review systematically the evidence of effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses. Data sources Cochrane Library, Medline, OldMedline, Embase, and CINAHL, without restrictions on language or publication. Data selection Studies of any intervention to prevent the transmission of respiratory viruses (isolation, quarantine, social distancing, barriers, personal protection, and hygiene). A search of study designs included randomised trials, cohort, case-control, crossover, before and after, and time series studies. After scanning of the titles, abstracts and full text articles as a first filter, a standardised form was used to assess the eligibility of the remainder. Risk of bias of randomised studies was assessed for generation of the allocation sequence, allocation concealment, blinding, and follow-up. Non-randomised studies were assessed for the presence of potential confounders and classified as being at low, medium, or high risk of bias. Data synthesis 58 papers of 59 studies were included. The quality of the studies was poor for all four randomised controlled trials and most cluster randomised controlled trials; the observational studies were of mixed quality. Meta-analysis of six case-control studies suggested that physical measures are highly effective in preventing the spread of severe acute respiratory syndrome: handwashing more than 10 times daily (odds ratio 0.45, 95% confidence interval 0.36 to 0.57; number needed to treat=4, 95% confidence interval 3.65 to 5.52), wearing masks (0.32, 0.25 to 0.40; NNT=6, 4.54 to 8.03), wearing N95 masks (0.09, 0.03 to 0.30; NNT=3, 2.37 to 4.06), wearing gloves (0.43, 0.29 to 0.65; NNT=5, 4.15 to 15.41), wearing gowns (0.23, 0.14 to 0.37; NNT=5, 3.37 to 7.12), and handwashing, masks, gloves, and gowns combined (0.09, 0.02 to 0.35; NNT=3, 2.66 to 4.97). The combination was also effective in interrupting the spread of influenza within households. The highest quality cluster randomised trials suggested that spread of respiratory viruses can be prevented by hygienic measures in younger children and within households. Evidence that the more uncomfortable and expensive N95 masks were superior to simple surgical masks was limited, but they caused skin irritation. The incremental effect of adding virucidals or antiseptics to normal handwashing to reduce respiratory disease remains uncertain. Global measures, such as screening at entry ports, were not properly evaluated. Evidence was limited for social distancing being effective, especially if related to risk of exposure\u2014that is, the higher the risk the longer the distancing period. Conclusion Routine long term implementation of some of the measures to interrupt or reduce the spread of respiratory viruses might be difficult. However, many simple and low cost interventions reduce the transmission of epidemic respiratory viruses. More resources should be invested into studying which physical interventions are the most effective, flexible, and cost effective means of minimising the impact of acute respiratory tract infections.", "Can wearing face masks in public affect transmission route and viral load in COVID-19? The mandatory face mask wearing was implemented in the Czech Republic and Slovakia shortly after the COVID-19 outbreak in Central Europe. So far, the number of COVID-19-associated deaths per 100,000 individuals is far lower in these countries as compared with other neighbouring or close countries. The use of face masks in public may not protect the general public from contracting the virus, however, presumptively decreases the viral load and contributes to a favourable clinical outcome in COVID-19 disease. A certain time is required for antigen-specific T cells and B cells to fully develop. Obligatory face mask wearing in public favours the virus transmission through oral mucosa and/or conjunctival epithelium, which enables the adaptive immune responses to evolve. In the case of inhalation of high loads of SARS-CoV-2, the time for the development of fully protective adaptive immune responses seems to be insufficient. Then, a less specific and more damaging innate immune response prevails.", "Australian Government releases face masks to protect against coronavirus ", "COVID-19 and Other Pandemics: How Might They Be Prevented? Pandemics such as influenza, smallpox, and plague have caused the loss of hundreds of millions of lives and have occurred for many centuries. Fortunately, they have been largely eliminated by the use of vaccinations and drugs. More recently, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and now Coronavirus Disease 2019 (COVID-19) have arisen, and given the current absence of highly effective approved vaccines or drugs, brute-force approaches involving physical barriers are being used to counter virus spread. A major basis for physical protection from respiratory infections is eye, nose, and mouth protection. However, eye protection with goggles is problematic due to \u201cfogging\u201d, while nose/mouth protection is complicated by the breathing difficulties associated with non-valved respirators. Here, we give a brief review of the origins and development of face masks and eye protection to counter respiratory infections on the basis of experiments conducted 100 years ago, work that was presaged by the first use of personal protective equipment, \u201cPPE\u201d, by the plague doctors of the 17(th) Century. The results of the review lead to two conclusions: first, that eye protection using filtered eye masks be used to prevent ocular transmission; second, that new, pre-filtered, valved respirators be used to even more effectively block viral transmission.", "The use of face masks during the COVID\u201019 pandemic in Poland: A survey study of 2315 young adults Face masks wearing during the coronavirus disease 2019 (COVID\u201019) pandemic became ubiquitous. The aim of our study was to assess the use of face masks among young adults during the current viral pandemic. The survey was based on specially created Google Forms and posted on numerous Facebook groups for young people in Poland. Seven days were considered as a recall period. A total of 2315 answers were obtained, 2307 were finally analysis, as eight questionnaires were removed because of data incompleteness. 60.4% of responders declared using the face masks. Those who reported an atopic predisposition wore face masks significantly (P = .007) more commonly (65.5% and 57.7%, respectively). Cloth masks (46.2%) appeared to be most popular ones, followed by surgical masks (39.2%), respirators (N95 and FFP) (13.3%), half\u2010face elastomeric respirators (0.8%) and full\u2010face respirators (0.4%). Females significantly more frequently (P = .0001) used cloth masks; respirators, half\u2010face elastomeric respirators and full\u2010face respirators were used more commonly by males (P < .0001, P = .001 and P = .001, respectively). 23.9% of responders who used single\u2010use mask wore it again. Moreover, 73.6% participants declared mask decontamination; however, the procedures were not always appropriate. We suggest that our results may be of help in construction of general public education campaigns on the proper use of face masks.", "The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2 Abstract Background Face mask usage by the healthy population in the community to reduce risk of transmission of respiratory viruses remains controversial. We assessed the effect of community-wide mask usage to control coronavirus disease 2019 (COVID-19) in Hong Kong Special Administrative Region (HKSAR). Methods Patients presenting with respiratory symptoms at outpatient clinics or hospital wards were screened for COVID-19 per protocol. Epidemiological analysis was performed for confirmed cases, especially persons acquiring COVID-19 during mask-off and mask-on settings. The incidence of COVID-19 per-million-population in HKSAR with community-wide masking was compared to that of non-mask-wearing countries which are comparable with HKSAR in terms of population density, healthcare system, BCG vaccination and social distancing measures but not community-wide masking. Compliance of face mask usage in the HKSAR community was monitored. Findings Within first 100 days (31 December 2019 to 8 April 2020), 961 COVID-19 patients were diagnosed in HKSAR. The COVID-19 incidence in HKSAR (129.0 per-million-population) was significantly lower (p<0.001) than that of Spain (2983.2), Italy (2250.8), Germany (1241.5), France (1151.6), U.S. (1102.8), U.K. (831.5), Singapore (259.8), and South Korea (200.5). The compliance of face mask usage by HKSAR general public was 96.6% (range: 95.7% to 97.2%). We observed 11 COVID-19 clusters in recreational \u2018mask-off\u2019 settings compared to only 3 in workplace \u2018mask-on\u2019 settings (p = 0.036 by Chi square test of goodness-of-fit). Conclusion Community-wide mask wearing may contribute to the control of COVID-19 by reducing virus shedding in saliva and respiratory droplets from individuals with subclinical or mild COVID-19.", "Effect of ethanol cleaning on the permeability of FFP2 mask In this study we assessed the effect of ethanol on the filtering properties of FFP2 masks. The permeability of parts of a FFP2 mask was measured before and after six cleanings with ethanol. As for any porous medium, the filtering properties of a mask are related to the size and tortuosity of the pores of the filter, and are quantified by its permeability. Any damage to the filter will change its permeability. We show here that after six cleaning cycles, the permeability remains very close to the permeability before cleaning. Amid the COVID-19 pandemic and the shortage of protective masks, this study suggests that ethanol could be used to sanitize a FFP2 mask without significantly altering its filtering properties. Additional measurements on FFP2 and N95 masks from different manufacturers need to be performed to validate this study.", "COVID-19: Taiwan\u2019s epidemiological characteristics and public and hospital responses BACKGROUND: Coronavirus disease 19 (COVID-19) is a global health threat with significant medical, economic, social and political implications. The optimal strategies for combating COVID-19 have not been fully determined and vary across countries. METHODS: By the end of February 2020 in Taiwan, 2,150 patients received diagnostic COVID-19 testing and 39 confirmed cases were detected. This is a relatively lower rate of infection compared to other Asian countries. In this article, we summarize the epidemiological characteristics of the 39 infected patients as well as public and hospital responses to COVID-19. RESULTS: Thirty-nine COVID-19 cases and one death have been confirmed in Taiwan. Seventeen of these patients were infected by family members or in hospital wards, emphasizing how COVID-19 is mostly spread by close contact. We examined how hospital have responded to COVID-19, including their implementation of patient route control, outdoor clinics, hospital visit restrictions and ward and staff modifications. We also studied the public\u2019s use of face masks in response to COVID-19. These strategies may reduce the spread of COVID-19 in other countries. CONCLUSION: The emergence and spread of COVID-19 is a threat to health worldwide. Taiwan has reported lower infected cases and its strategies may contribute to further disease prevention and control.", "A cluster randomised trial of cloth masks compared with medical masks in healthcare workers OBJECTIVE: The aim of this study was to compare the efficacy of cloth masks to medical masks in hospital healthcare workers (HCWs). The null hypothesis is that there is no difference between medical masks and cloth masks. SETTING: 14 secondary-level/tertiary-level hospitals in Hanoi, Vietnam. PARTICIPANTS: 1607 hospital HCWs aged \u226518 years working full-time in selected high-risk wards. INTERVENTION: Hospital wards were randomised to: medical masks, cloth masks or a control group (usual practice, which included mask wearing). Participants used the mask on every shift for 4 consecutive weeks. MAIN OUTCOME MEASURE: Clinical respiratory illness (CRI), influenza-like illness (ILI) and laboratory-confirmed respiratory virus infection. RESULTS: The rates of all infection outcomes were highest in the cloth mask arm, with the rate of ILI statistically significantly higher in the cloth mask arm (relative risk (RR)=13.00, 95% CI 1.69 to 100.07) compared with the medical mask arm. Cloth masks also had significantly higher rates of ILI compared with the control arm. An analysis by mask use showed ILI (RR=6.64, 95% CI 1.45 to 28.65) and laboratory-confirmed virus (RR=1.72, 95% CI 1.01 to 2.94) were significantly higher in the cloth masks group compared with the medical masks group. Penetration of cloth masks by particles was almost 97% and medical masks 44%. CONCLUSIONS: This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. Further research is needed to inform the widespread use of cloth masks globally. However, as a precautionary measure, cloth masks should not be recommended for HCWs, particularly in high-risk situations, and guidelines need to be updated. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry: ACTRN12610000887077.", "Rational use of face masks in the COVID-19 pandemic ", "Risk of SARS-CoV-2 transmission by aerosols, the rational use of masks, and protection of healthcare workers from COVID-19 OBJECTIVES: To determine the risk of SARS-CoV-2 transmission by aerosols, to provide evidence on the rational use of masks, and to discuss additional measures important for the protection of healthcare workers from COVID-19. METHODS: Literature review and expert opinion. SHORT CONCLUSION: SARS-CoV-2, the pathogen causing COVID-19, is considered to be transmitted via droplets rather than aerosols, but droplets with strong directional airflow support may spread further than 2 m. High rates of COVID-19 infections in healthcare-workers (HCWs) have been reported from several countries. Respirators such as filtering face piece (FFP) 2 masks were designed to protect HCWs, while surgical masks were originally intended to protect patients (e.g., during surgery). Nevertheless, high quality standard surgical masks (type II/IIR according to European Norm EN 14683) appear to be as effective as FFP2 masks in preventing droplet-associated viral infections of HCWs as reported from influenza or SARS. So far, no head-to-head trials with these masks have been published for COVID-19. Neither mask type completely prevents transmission, which may be due to inappropriate handling and alternative transmission pathways. Therefore, compliance with a bundle of infection control measures including thorough hand hygiene is key. During high-risk procedures, both droplets and aerosols may be produced, reason why respirators are indicated for these interventions.", "Respiratory and facial protection: a critical review of recent literature Summary Infectious micro-organisms may be transmitted by a variety of routes. This is dependent on the particular pathogen and includes bloodborne, droplet, airborne, and contact transmission. Some micro-organisms are spread by more than one route. Respiratory and facial protection is required for those organisms which are usually transmitted via the droplet and/or airborne routes or when airborne particles have been created during \u2018aerosol-generating procedures\u2019. This article presents a critical review of the recently published literature in this area that was undertaken by Health Protection Scotland and the Healthcare Infection Society and which informed the development of guidance on the use of respiratory and facial protection equipment by healthcare workers.", "Coronavirus disease 2019 in pregnancy: early lessons The worldwide incidence of coronavirus disease 2019 (COVID-19) infection is rapidly increasing, but there exists limited information on coronavirus disease 2019 in pregnancy. Here, we present our experience with 7 confirmed cases of coronavirus disease 2019 in pregnancy presenting to a single large New York City tertiary care hospital. Of the 7 patients, 5 presented with symptoms of coronavirus disease 2019, including cough, myalgias, fevers, chest pain, and headache. Of the 7 patients, 4 were admitted to the hospital, including 2 who required supportive care with intravenous hydration. Of note, the other 2 admitted patients who were asymptomatic on admission to the hospital, presenting instead for obstetrically indicated labor inductions, became symptomatic after delivery, each requiring intensive care unit admission.", "A Novel Questionnaire to Ergonomically Assess Respirators among Health Care Staff: Development and Validation BACKGROUND: Health care workers are at a high risk of exposure to infectious diseases spread by airborne transmission. N95 respirators are the most common respirators used in the health care system and negligence in using them may cause health problems. Hence, more emphasis should be on ergonomic aspects of this mask. This study aimed to develop a tool for ergonomic evaluation of these respirators. MATERIALS AND METHODS: After reviewing previous studies and employees\u2019 problems in the use of the N95 respirators, 50 questionnaires were designed and their validity was assessed. Then, the questionnaire was completed by 290 staff members of Masih Daneshvari Hospital and its internal consistency and reproducibility were investigated using Cronbach\u2019s alpha coefficient and test-retest method, respectively. Confirmatory factor analysis was used to assess its consistency and internal consistency (construct validity). RESULTS: With the confirmation of the face and content validities, internal consistency (0.89) calculated by the Cronbach\u2019s alpha coefficient and reproducibility of the questionnaire (0.997; p<0.001) assessed by using the ICC Index, were approved. Following examining internal consistency and stability, the questionnaire convergent construct validity was also confirmed using confirmatory factor analysis. CONCLUSION: The questionnaire contained 42 items and it is beneficial to use it in the health care system to evaluate the ergonomic problems of the respirators and to have optimal choice in this respect. Also, it can be used in the promotion of the staffs\u2019 behavior in wearing these respirators when necessary.", "Face shields for infection control: A review Face shields are personal protective equipment devices that are used by many workers (e.g., medical, dental, veterinary) for protection of the facial area and associated mucous membranes (eyes, nose, mouth) from splashes, sprays, and spatter of body fluids. Face shields are generally not used alone, but in conjunction with other protective equipment and are therefore classified as adjunctive personal protective equipment. Although there are millions of potential users of face shields, guidelines for their use vary between governmental agencies and professional societies and little research is available regarding their efficacy.", "Practice Corner COVID-19: What We Have Learned So Far ", "Are face masks useful for limiting the spread of COVID-19? ", "Response and Operating Room Preparation for the COVID-19 Outbreak: A Perspective from the National Heart Centre Singapore Abstract The outbreak of COVID-19, a respiratory disease from a novel coronavirus that was first detected in Wuhan City, Hubei Province, China is now a public health emergency and fast approaching a pandemic. Singapore, as a major international transportation hub in Asia, is one of the worst hit countries of COVID-19. With the advent of local transmission of cases, we share our preparation and response planning for the operating room from the National Heart Centre Singapore, the largest cardiothoracic tertiary center in Singapore. Protection of staff and patients, environmental concerns as well as other logistic and equipment issues must be considered.", "How ophthalmologists should understand and respond to the current epidemic of novel coronavirus pneumonia/ \u773c\u79d1\u533b\u751f\u548c\u7814\u7a76\u4eba\u5458\u5982\u4f55\u7406\u89e3\u548c\u5e94\u5bf9\u65b0\u578b\u51a0\u72b6\u75c5\u6bd2\u80ba\u708e\u7684\u6d41\u884c The new coronavirus pneumonia (COVID-19)that caused by 2019 new coronavirus (2019-nCoV) and first appeared in Wuhan, China, in December 2019 has attracted great attention from both the Chinese government and the international community.The International Committee on Viral Classification named the virus \"Severe Acute Respiratory Syndrome Coronavirus 2\" (SARS-CoV-2), and the WHO named the pneumonia it causesCOVID-19\". At present, the disease is centered in Wuhan City and is spreading rapidly to all parts of China, as well as twenty other countries.About 20% of the people infected during the SARS epidemic in 2003 were employees in hospital environments.COVID-19 has infected an even greater number of heath care workers.Therefore, ophthalmologists need to understand the disease and recognize the importance of taking preventive measures.Although ophthalmologists do not work on the front lines of the outbreak, due to their area of expertise, a variety of situations, such as infection consultations or ophthalmic emergency treatments, can lead to the exposure of ophthalmologists to high-risk environments.This risk will only increase as the number of infected patients continues to increase.When dealing with seemingly normal ophthalmic patients, the vigilance of ophthalmologists and associated staff tends to be significantly reduced.To better protect patients, families, and health care workers, it is strongly recommended that in addition to the standard precautions for the care of all patients, strict contact precautions and droplet precautions need to be taken by ophthalmologists.These measures include (1) wearing an efficient mask (an N95 mask); (2) always performing hand hygiene before and after examining a patient; (3) wearing sterile gloves when entering a patient\u2019s room and touching a patient; (4) wearing a gown when contact is expected with items and environmental surfaces surrounding a patient or when the patient is incontinent or has diarrhea or a surgical or other invasive wound with oozing fluid; (5) cleaning and disinfecting ophthalmic equipment and correctly handling medical waste after examination to prevent transmission to patients who are subsequently examined; (6) wearing goggles and a disposable mask to cover the front and sides of the face before touching a patient, as the virus could spread through the ocular surface; (7) performing the relevant screening for COVID-19 for regular patients who have conjunctivitis and respiratory symptoms at the same time; (8) prohibiting the use of infected patients as potential donors for corneal transplants and temporarily adding donor 2019-CoV screening to the medical standard of the eye bank during the outbreak; (9) for the purposes of scientific research, diagnosis, and other special needs, packing, shipping, and transporting collected specimens according to the relevant dangerous biological goods regulations.", "To mask or not to mask children to overcome COVID-19 It has been reported that asymptomatic people can transmit the new coronavirus disease 2019 (COVID-19) and become important sources of COVID-19. To reduce the role of asymptomatic or poorly symptomatic people in COVID-19, universal use of face masks in addition to hand hygiene and safety distance seems extremely useful. Consequently, preparing the healthy child to use face masks is strongly needed. To obtain maximal compliance, reasons for mask wearing without attempts of removing must be clearly explained. Moreover, child\u2019s will must not be forced. Conclusion: On the basis of clinical findings, we think that the universal use of facial masks seems necessary when people have to go out in their everyday lives. In addition to the availability of masks of different sizes capable of adapting perfectly to the face, it is necessary that the use of masks in children is preceded by a strong parental work and school lessons on this issue and other hygiene topics with the main aim to obtain child cooperation.", "Decision Support Algorithm for Selecting an Antivirus Mask over COVID-19 Pandemic under Spherical Normal Fuzzy Environment With the rapid outbreak of COVID-19, most people are facing antivirus mask shortages. Therefore, it is necessary to reasonably select antivirus masks and optimize the use of them for everyone. However, the uncertainty of the effects of COVID-19 and limits of human cognition add to the difficulty for decision makers to perfectly realize the purpose. To maximize the utility of the antivirus mask, we proposed a decision support algorithm based on the novel concept of the spherical normal fuzzy (SpNoF) set. In it, firstly, we analyzed the new score and accuracy function, improved operational rules, and their properties. Then, in line with these operations, we developed the SpNoF Bonferroni mean operator and the weighted Bonferroni mean operator, some properties of which are also examined. Furthermore, we established a multi-criteria decision-making method, based on the proposed operators, with SpNoF information. Finally, a numerical example on antivirus mask selection over the COVID-19 pandemic was given to verify the practicability of the proposed method, which the sensitive and comparative analysis was based on and was conducted to demonstrate the availability and superiority of our method.", "Silk fabric as a protective barrier for personal protective equipment and as a functional material for face coverings during the COVID-19 pandemic Background The worldwide shortage of single-use N95 respirators and surgical masks due to the COVID-19 pandemic has forced many health care personnel to prolong the use of their existing equipment as much as possible. In many cases, workers cover respirators with available masks in an attempt to extend their effectiveness against the virus. Due to low mask supplies, many people instead are using face coverings improvised from common fabrics. Our goal was to determine what fabrics would be most effective in both practices. Methods and findings We examined the hydrophobicity of fabrics (silk, cotton, polyester), as measured by their resistance to the penetration of small and aerosolized water droplets, an important transmission avenue for the virus causing COVID-19. We also examined the breathability of these fabrics and their ability to maintain hydrophobicity despite undergoing repeated cleaning. Tests were done when fabrics were fashioned as an overlaying barrier and also when constructed as do-it-yourself face coverings. As a protective barrier and face covering, silk is more effective at impeding the penetration and absorption of droplets due to its greater hydrophobicity relative to other tested fabrics. Silk face coverings repelled droplets as well as masks, but unlike masks they are hydrophobic and can be readily sterilized for immediate reuse. Conclusions Silk is an effective hydrophobic barrier to droplets, more breathable than other fabrics that trap humidity, and are readily re-useable via cleaning. Therefore, silk can serve as an effective material for protecting respirators under clinical conditions and as a material for face coverings.", "Reply to \u201cThe outbreak of COVID-19: An overview\u201d ", "Understanding face mask use to prevent coronavirus and other illnesses: Development of a multidimensional face mask perceptions scale Face masks are an avenue to curb the spread of coronavirus, but few people in Western societies wear face masks. Social scientists have rarely studied face mask wearing, leaving little guidance for methods to encourage these behaviours. In the current article, we provide an approach to address this issue by developing the 32-item and 8-dimension Face Mask Perceptions Scale (FMPS). We begin by developing an over-representative item list in a qualitative study, wherein participants' responses are used to develop items to ensure content relevance. This item list is then reduced via exploratory factor analysis in a second study, and the eight dimensions of the scale are supported. We also support the validity of the FMPS, as the scale significantly relates to both face mask wearing and health perceptions. We lastly confirm the factor structure of the FMPS in a third study via confirmatory factor analysis. From these efforts, we identify an avenue that social scientists can aid in preventing coronavirus and illness more broadly - by studying face mask perceptions and behaviours.", "Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases Summary WHO interim guidelines recommend offering extracorporeal membrane oxygenation (ECMO) to eligible patients with acute respiratory distress syndrome (ARDS) related to coronavirus disease 2019 (COVID-19). The number of patients with COVID-19 infection who might develop severe ARDS that is refractory to maximal medical management and require this level of support is currently unknown. Available evidence from similar patient populations suggests that carefully selected patients with severe ARDS who do not benefit from conventional treatment might be successfully supported with venovenous ECMO. The need for ECMO is relatively low and its use is mostly restricted to specialised centres globally. Providing complex therapies such as ECMO during outbreaks of emerging infectious diseases has unique challenges. Careful planning, judicious resource allocation, and training of personnel to provide complex therapeutic interventions while adhering to strict infection control measures are all crucial components of an ECMO action plan. ECMO can be initiated in specialist centres, or patients can receive ECMO during transportation from a centre that is not specialised for this procedure to an expert ECMO centre. Ensuring that systems enable safe and coordinated movement of critically ill patients, staff, and equipment is important to improve ECMO access. ECMO preparedness for the COVID-19 pandemic is important in view of the high transmission rate of the virus and respiratory-related mortality.", "COVID-19 Global Pandemic Planning: Decontamination and Reuse Processes for N95 Respirators Coronavirus disease 2019 (COVID-19) is an illness caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was first identified as a cluster of respiratory illness in Wuhan City, Hubei Province, China in December 2019, and has rapidly spread across the globe to greater than 200 countries. Healthcare providers are at an increased risk for contracting the disease due to occupational exposure and require appropriate personal protective equipment (PPE), including N95 respirators. The rapid worldwide spread of high numbers of COVID-19 cases has facilitated the need for a substantial supply of PPE that is largely unavailable in many settings, thereby creating critical shortages. Creative solutions for the decontamination and safe reuse of PPE to protect our frontline healthcare personnel are essential. Here, we describe the development of a process that began in late February 2020 for selecting and implementing the use of hydrogen peroxide vapor (HPV) as viable method to reprocess N95 respirators. Since pre-existing HPV decontamination chambers were not available, we optimized the sterilization process in an operating room after experiencing initial challenges in other environments. Details are provided about the prioritization and implementation of processes for collection and storage, pre-processing, HPV decontamination, and post-processing of filtering facepiece respirators (FFRs). Important lessons learned from this experience include, developing an adequate reserve of PPE for effective reprocessing and distribution, and identifying a suitable location with optimal environmental controls (i.e., operating room). Collectively, information presented here provides a framework for other institutions considering decontamination procedures for N95 respirators.", "Providing evidence on the ongoing health care workers\u2019 mask debate The scarcity of facemasks, particularly N95 respirators, combined with the lack of solid data to address the suitability of each mask type for adequate health care worker (HCW) protection have caused turmoil among HCWs. Current recommendations suggest mask usage solely during HCW contact with Covid-19 patients, namely plain medical mask for low-risk contacts and N95 for aerosol generating procedures. The distinction regarding the escalation of mask complexity depending on contact type is nevertheless based on plausible theoretical assumptions rather than hard evidence of a clear benefit. Conversely, we suggest that at least a plain mask should be used during all HCWs\u2019 contacts in healthcare facilities which constitute a highly probable but often overlooked means of SARS-CoV-2 transmission among HCWs.", "Physical interventions to interrupt or reduce the spread of respiratory viruses. BACKGROUND Viral epidemics or pandemics of acute respiratory infections like influenza or severe acute respiratory syndrome pose a global threat. Antiviral drugs and vaccinations may be insufficient to prevent their spread. OBJECTIVES To review the effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses. SEARCH STRATEGY We searched The Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL 2010, Issue 3), which includes the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to October 2010), OLDMEDLINE (1950 to 1965), EMBASE (1990 to October 2010), CINAHL (1982 to October 2010), LILACS (2008 to October 2010), Indian MEDLARS (2008 to October 2010) and IMSEAR (2008 to October 2010). SELECTION CRITERIA In this update, two review authors independently applied the inclusion criteria to all identified and retrieved articles and extracted data. We scanned 3775 titles, excluded 3560 and retrieved full papers of 215 studies, to include 66 papers of 67 studies. We included physical interventions (screening at entry ports, isolation, quarantine, social distancing, barriers, personal protection, hand hygiene) to prevent respiratory virus transmission. We included randomised controlled trials (RCTs), cohorts, case-controls, before-after and time series studies. DATA COLLECTION AND ANALYSIS We used a standardised form to assess trial eligibility. We assessed RCTs by randomisation method, allocation generation, concealment, blinding and follow up. We assessed non-RCTs for potential confounders and classified them as low, medium and high risk of bias. MAIN RESULTS We included 67 studies including randomised controlled trials and observational studies with a mixed risk of bias. A total number of participants is not included as the total would be made up of a heterogenous set of observations (participant people, observations on participants and countries (object of some studies)). The risk of bias for five RCTs and most cluster-RCTs was high. Observational studies were of mixed quality. Only case-control data were sufficiently homogeneous to allow meta-analysis. The highest quality cluster-RCTs suggest respiratory virus spread can be prevented by hygienic measures, such as handwashing, especially around younger children. Benefit from reduced transmission from children to household members is broadly supported also in other study designs where the potential for confounding is greater. Nine case-control studies suggested implementing transmission barriers, isolation and hygienic measures are effective at containing respiratory virus epidemics. Surgical masks or N95 respirators were the most consistent and comprehensive supportive measures. N95 respirators were non-inferior to simple surgical masks but more expensive, uncomfortable and irritating to skin. Adding virucidals or antiseptics to normal handwashing to decrease respiratory disease transmission remains uncertain. Global measures, such as screening at entry ports, led to a non-significant marginal delay in spread. There was limited evidence that social distancing was effective, especially if related to the risk of exposure. AUTHORS' CONCLUSIONS Simple and low-cost interventions would be useful for reducing transmission of epidemic respiratory viruses. Routine long-term implementation of some measures assessed might be difficult without the threat of an epidemic.", "Fundamental protective mechanisms of face masks against droplet infections Many governments have instructed the population to wear simple mouth-and-nose covers or surgical face masks to protect themselves from droplet infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in public. However, the basic protection mechanisms and benefits of these masks remain controversial. Therefore, the aim of this work is to show from a fluid physics point of view under which circumstances these masks can protect against droplet infection. First of all, we show that the masks protect people in the surrounding area quite well, since the flow resistance of the face masks effectively prevents the spread of exhaled air, e.g. when breathing, speaking, singing, coughing and sneezing. Secondly, we provide visual evidence that typical household materials used by the population to make masks do not provide highly efficient protection against respirable particles and droplets with a diameter of 0.3\u20132 \u03bcm as they pass through the materials largely unfiltered. According to our tests, only vacuum cleaner bags with fine dust filters show a comparable or even better filtering effect than commercial particle filtering FFP2/N95/KN95 half masks. Thirdly, we show that even simple mouth-and-nose covers made of good filter material cannot reliably protect against droplet infection in contaminated ambient air, since most of the air flows through gaps at the edge of the masks. Only a close-fitting, particle-filtering respirator without an outlet valve offers good self-protection and protection against droplet infection. Nevertheless, wearing simple homemade or surgical face masks in public is highly recommended if no particle filtrating respiratory mask is available. Firstly, because they protect against habitual contact of the face with the hands and thus serve as self-protection against contact infection. Secondly, because the flow resistance of the masks ensures that the air stays close to the head when breathing, speaking, singing, coughing and sneezing, thus protecting other people if they have sufficient distance from each other. However, if the distance rules cannot be observed and the risk of inhalation-based infection becomes high because many people in the vicinity are infectious and the air exchange rate is small, improved filtration efficiency masks are needed, to take full advantage of the three fundamental protective mechanisms these masks provide.", "ASE Statement on Protection of Patients and Echocardiography Service Providers During the 2019 Novel Coronavirus Outbreak ", "Evaluation of Protection Level, Respiratory Safety, and Practical Aspects of Commercially Available Snorkel Masks as Personal Protection Devices Against Aerosolized Contaminants and SARS-CoV2 Introduction: The \u201cSevere Acute Respiratory Syndrome Coronavirus 2\u2033 (SARS-CoV2) pandemic has led to a worldwide shortage of personal protection devices (PPD) for medical and paramedical personnel. Adaptation of commercially available snorkel masks to serve as full face masks has been proposed. Even not formally approved as PPD, they are publicized on social media as suitable for this use. Concerns about actual protection levels and risk of carbon dioxide (CO(2)) accumulation while wearing them for extended periods made us perform a systematic testing of various brands, in order to verify whether they are as safe and effective as claimed. Methods: A \u2018fit\u2019 test was performed, analogous to gas mask testing. Respiratory safety was evaluated by measuring end-tidal CO(2) and oxygen saturation while wearing the masks in rest and during physical exercise. Masks were tested with 3D adaptors to mount regular bacterial-viral ventilator filters when available, or with snorkel openings covered with N95/FFP2 cloth. Results: Modified masks performed reasonably well on the fit test, comparable to regular N95/FFP2 masks. Not all ventilator filters are equally protective. For all masks, a small initial increase in end-tidal CO(2) was noted, remaining within physiological limits. 3D printed adaptors are safer, have more flexibility and reliability than makeshift adaptations. Conclusions: These masks can offer benefit as a substitute for complete protective gear as they are easier to don and remove and offer full-face protection. They may be more comfortable to wear for extended periods. Proper selection of mask size, fit testing, quality of 3D printed parts, and choice of filter are important.", "COVID-19 and Dialysis Units: What Do We Know Now and What Should We Do? ", "Role of respirators in controlling the spread of novel coronavirus (COVID\u201019) amongst dental healthcare providers: a review During the ongoing COVID\u201019 pandemic, healthcare professionals are at the forefront of managing the highly infectious coronavirus. As the most common route of transmission is via aerosols and droplet inhalation, it is critical for healthcare workers to have the correct personal protective equipment (PPE) including gowns, masks and goggles. Surgical masks are not effective in preventing the influenza and SARS, so they are unlikely to be able to resist contaminated aerosols from entering the respiratory system. Therefore, it is vital to use respirators which have been proven to offer better protection against droplets, aerosols and fluid penetration and which form a tight seal around the mouth and nose. Various types of respirators are used in healthcare settings, such as half\u2010mask filtering facepiece respirators (FFRs) and powered air\u2010purifying respirators (PAPRs). The most commonly used FFR is the N95 disposable respirator, which is tight fitting and has a 95% or above particle filtering efficiency for a median particle size of 0.3 \u00b5m. This review discusses respirators, their purpose, types, clinical efficiency and proper donning and doffing techniques.", "Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis BACKGROUND: Conflicting recommendations exist related to whether masks have a protective effect on the spread of respiratory viruses. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was consulted to report this systematic review. Relevant articles were retrieved from PubMed, Web of Science, ScienceDirect, Cochrane Library, and Chinese National Knowledge Infrastructure (CNKI), VIP (Chinese) database. RESULTS: A total of 21 studies met our inclusion criteria. Meta-analyses suggest that mask use provided a significant protective effect (OR = 0.35 and 95% CI = 0.24-0.51). Use of masks by healthcare workers (HCWs) and non-healthcare workers (Non-HCWs) can reduce the risk of respiratory virus infection by 80% (OR = 0.20, 95% CI = 0.11-0.37) and 47% (OR = 0.53, 95% CI = 0.36-0.79). The protective effect of wearing masks in Asia (OR = 0.31) appeared to be higher than that of Western countries (OR = 0.45). Masks had a protective effect against influenza viruses (OR = 0.55), SARS (OR = 0.26), and SARS-CoV-2 (OR = 0.04). In the subgroups based on different study designs, protective effects of wearing mask were significant in cluster randomized trials and observational studies. CONCLUSIONS: This study adds additional evidence of the enhanced protective value of masks, we stress that the use masks serve as an adjunctive method regarding the COVID-19 outbreak.", "Facemask shortage and the novel coronavirus disease (COVID-19) outbreak: Reflections on public health measures Abstract Background A novel coronavirus disease (COVID-19) outbreak due to the severe respiratory syndrome coronavirus (SARS-CoV-2) infection occurred in China in late December 2019. Facemask wearing with proper hand hygiene is considered an effective measure to prevent SARS-CoV-2 transmission, but facemask wearing has become a social concern due to the global facemask shortage. China is the major facemask producer in the world, contributing to 50% of global production. However, a universal facemask wearing policy would put an enormous burden on the facemask supply. Methods We performed a policy review concerning facemasks using government websites and mathematical modelling shortage analyses based on data obtained from the National Health Commission (NHC), the Ministry of Industry and Information Technology (MIIT), the Centre for Disease Control and Prevention (CDC), and General Administration of Customs (GAC) of the People's Republic of China. Three scenarios with respect to wearing facemasks were considered: (1) a universal facemask wearing policy implementation in all regions of mainland China; (2) a universal facemask wearing policy implementation only in the epicentre (Hubei province, China); and (3) no implementation of a universal facemask wearing policy. Findings Regardless of different universal facemask wearing policy scenarios, facemask shortage would occur but eventually end during our prediction period (from 20 Jan 2020 to 30 Jun 2020). The duration of the facemask shortage described in the scenarios of a country-wide universal facemask wearing policy, a universal facemask wearing policy in the epicentre, and no universal facemask wearing policy were 132, seven, and four days, respectively. During the prediction period, the largest daily facemask shortages were predicted to be 589\u00b75, 49\u00b73, and 37\u00b75 million in each of the three scenarios, respectively. In any scenario, an N95 mask shortage was predicted to occur on 24 January 2020 with a daily facemask shortage of 2\u00b72 million. Interpretation Implementing a universal facemask wearing policy in the whole of China could lead to severe facemask shortage. Without effective public communication, a universal facemask wearing policy could result in societal panic and subsequently, increase the nationwide and worldwide demand for facemasks. These increased demands could cause a facemask shortage for healthcare workers and reduce the effectiveness of outbreak control in the affected regions, eventually leading to a pandemic. To fight novel infectious disease outbreaks, such as COVID-19, governments should monitor domestic facemask supplies and give priority to healthcare workers. The risk of asymptomatic transmission and facemask shortages should be carefully evaluated before introducing a universal facemask wearing policy in high-risk regions. Public health measures aimed at improving hand hygiene and effective public communication should be considered along with the facemask policy.", "Exhaled Air Dispersion during Coughing with and without Wearing a Surgical or N95 Mask OBJECTIVES: We compared the expelled air dispersion distances during coughing from a human patient simulator (HPS) lying at 45\u00b0 with and without wearing a surgical mask or N95 mask in a negative pressure isolation room. METHODS: Airflow was marked with intrapulmonary smoke. Coughing bouts were generated by short bursts of oxygen flow at 650, 320, and 220L/min to simulate normal, mild and poor coughing efforts, respectively. The coughing jet was revealed by laser light-sheet and images were captured by high definition video. Smoke concentration in the plume was estimated from the light scattered by smoke particles. Significant exposure was arbitrarily defined where there was \u2265 20% of normalized smoke concentration. RESULTS: During normal cough, expelled air dispersion distances were 68, 30 and 15 cm along the median sagittal plane when the HPS wore no mask, a surgical mask and a N95 mask, respectively. In moderate lung injury, the corresponding air dispersion distances for mild coughing efforts were reduced to 55, 27 and 14 cm, respectively, p < 0.001. The distances were reduced to 30, 24 and 12 cm, respectively during poor coughing effort as in severe lung injury. Lateral dispersion distances during normal cough were 0, 28 and 15 cm when the HPS wore no mask, a surgical mask and a N95 mask, respectively. CONCLUSIONS: Normal cough produced a turbulent jet about 0.7 m towards the end of the bed from the recumbent subject. N95 mask was more effective than surgical mask in preventing expelled air leakage during coughing but there was still significant sideway leakage.", "Do facemasks protect against COVID\u201019? ", "Reuse of N95 Masks ", "Wearing face masks in public during the influenza season may reflect other positive hygiene practices in Japan BACKGROUND: Although the wearing of face masks in public has not been recommended for preventing influenza, these devices are often worn in many Asian countries during the influenza season. In Japan, it is thought that such behavior may be an indicator of other positive hygiene practices. The aim of this study, therefore, was to determine if wearing a face mask in public is associated with other positive hygiene practices and health behaviors among Japanese adults. METHODS: We initially recruited around 3,000 Japanese individuals ranging from 20 to 69 years of age who were registered with a web survey company. Participants were asked to recall their personal hygiene practices during the influenza season of the previous year. Logistic regression analysis was then used to examine the associations between wearing a face mask in public and personal hygiene practices and health behaviors. RESULTS: A total of 3,129 persons responded to the survey, among whom 38% reported that they had worn a face mask in public during the previous influenza season. Wearing a face mask in public was associated with various self-reported hygiene practices including: frequent hand washing (adjusted Odds Ratio [OR]: 1.67; 95% Confidence Interval [95%CI]: 1.34-1.96), occasional hand washing (OR: 1.43; 95%CI: 1.10-1.75), frequently avoiding crowds (OR: 1.85; 95%CI: 1.70-1.98), occasionally avoiding crowds (OR: 1.65; 95%CI: 1.53-1.76), frequent gargling (OR: 1.68; 95%CI: 1.51-1.84), occasional gargling (OR: 1.46; 95%CI: 1.29-1.62), regularly avoiding close contact with an infected person (OR: 1.50; 95%CI: 1.33-1.67), occasionally avoiding close contact with an infected person (OR: 1.31; 95%CI: 1.16-1.46), and being vaccinated of influenza in the last season (OR: 1.31; 95%CI: 1.17-1.45). CONCLUSIONS: Overall, this study suggests that wearing a face mask in public may be associated with other personal hygiene practices and health behaviors among Japanese adults. Rather than preventing influenza itself, face mask use might instead be a marker of additional, positive hygiene practices and other favorable health behaviors in the same individuals.", "COVID-19 Pandemic: Survey of future use of personal protective equipment in optometric practice Abstract Purpose The aim of this project was to evaluate which personal protective equipment (PPE) eye care practitioners (ECP) will use during the next months and also what they will ask the patient to use in clinical practice. Methods A social-media survey was carried out, asking 257 optometrists and opticians in Germany, Austria and Switzerland (i) which PPE they intended to use in the future (after lockdown and before herd immunity and / or vaccine availability) and (ii) what they would ask the patient to do in terms of this. Results 75% of the ECPs planned on wearing masks during refractions and 69% when fitting contact lens. 62% of the ECPs also expected their patients to wear masks in these tasks. This number is higher than for distance tasks such as fitting frames. Around 90% of the ECPs would, in addition to hand washing, disinfect their hands and around 80% expected their patients to do so too. Less than one third of ECPs favoured wearing safety spectacles, gloves and / or protective facial shields. 73% planed on disinfecting frames after they would have been tried on by customers. Conclusions In summary, most ECPs planed on continuing to use higher standards of PPE. Those, who intended to wear masks themselves, would ask their patients to also do so, combined with hand disinfection.", "Covid-19: What is the evidence for cloth masks? ", "COVID-19, a worldwide public health emergency Abstract A new coronavirus outbreak emerged on the 31st of December 2019 in Wuhan, China, causing commotion among the medical community and the rest of the world. This new species of coronavirus has been termed 2019-nCoV and has caused a considerable number of cases of infection and deaths in China and, to a growing degree, beyond China, becoming a worldwide public health emergency. 2019-nCoV has high homology to other pathogenic coronaviruses, such as those originating from bat-related zoonosis (SARS-CoV), which caused approximately 646 deaths in China at the start of the decade. The mortality rate for 2019-nCoV is not as high (approximately 2\u20133%), but its rapid propagation has resulted in the activation of protocols to stop its spread. This pathogen has the potential to become a pandemic. It is therefore vital to follow the personal care recommendations issued by the World Health Organization.", "COVID-19: Transmission, prevention, and potential therapeutic opportunities The novel coronavirus disease (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), remains a global challenge. Despite intense research efforts worldwide, an effective vaccine and viable treatment options have eluded investigators. Therefore, infection prevention, early viral detection and identification of successful treatment protocols provide the best approach in controlling disease spread. In this review, current therapeutic options, preventive methods and transmission routes of COVID-19 are discussed.", "Surgical mask filter and fit performance BACKGROUND: Surgical masks have been used since the early 1900s to minimize infection of surgical wounds from wearer-generated bacteria. There is ongoing debate, however, whether surgical masks can meet the expectations of respiratory protection devices. The goal of this study was to evaluate the filter performance and facial fit of a sample of surgical masks. METHODS: Filter penetration was measured for at least 3 replicates of 9 surgical masks using monodisperse latex sphere aerosols (0.895, 2.0, and 3.1 \u03bcm) at 6 L/min and 0.075-\u03bcm sodium chloride particles at 84 L/min. Facial fit was measured on 20 subjects for the 5 masks with lowest particle penetration, using both qualitative and quantitative fit tests. RESULTS: Masks typically used in dental settings collected particles with significantly lower efficiency than those typically used in hospital settings. All subjects failed the unassisted qualitative fit test on the first exercise (normal breathing). Eighteen subjects failed the assisted qualitative fit tests; 60% failed on the first exercise. Quantitative fit factors ranged from 2.5 to 9.6. CONCLUSION: None of these surgical masks exhibited adequate filter performance and facial fit characteristics to be considered respiratory protection devices.", "Coronavirus (COVID-19) outbreak: what the department of endoscopy should know Italy recorded its first case of confirmed acute respiratory illness because of coronavirus on February 18, 2020, soon after the initial reports in China. Since that time, Italy and nations throughout the world have adopted very stringent and severe measures to protect populations from spread of infection. Despite these measures, the number of infected people is growing exponentially, with a significant number of patients developing acute respiratory insufficiency. Endoscopy departments face significant risk for diffusion of respiratory diseases that can be spread via an airborne route, including aspiration of oral and fecal material via endoscopes. The purpose of this article is to discuss the measures, with specific focus on personal protection equipment and dress code modalities, implemented in our hospital to prevent further dissemination of COVID-19 infection.", "What Is Required to Prevent a Second Major Outbreak of SARS-CoV-2 upon Lifting Quarantine in Wuhan City, China Summary Background The Chinese government implemented a metropolitan-wide quarantine of Wuhan city on 23rd January 2020 to curb the epidemic of the coronavirus COVID-19. Lifting of this quarantine is imminent. We modelled the effects of two key health interventions on the epidemic when the quarantine is lifted. Methods We constructed a compartmental dynamic model to forecast the trend of the COVID-19 epidemic at different quarantine lifting dates and investigated the impact of different rates of public contact and facial mask usage on the epidemic. Results We projected a declining trend of the COVID-19 epidemic if the current quarantine strategy continues, and Wuhan would record the last new confirmed cases in late April 2020. At the end of the epidemic, 65,733 (45,722-99,015) individuals would be infected by the virus, among which 16,166 (11,238-24,603, 24.6%) were through public contacts, 45,996 (31,892-69,565, 69.7%) through household contact, and 3,571 (2,521-5,879, 5.5%) through hospital contacts (including 778 (553-1,154) non-COVID-19 patients and 2,786 (1,969-4,791) medical staff). A total of 2,821 (1,634-6,361) would die of COVID-19 related pneumonia in Wuhan. Early quarantine lifting on 21st March is viable only if Wuhan residents sustain a high facial mask usage of \u226585% and a pre-quarantine level public contact rate. Delaying city resumption to mid/late April would relax the requirement of facial mask usage to \u226575% at the same contact rate. Conclusions The prevention of a second epidemic is viable after the metropolitan-wide quarantine is lifted but requires a sustaining high facial mask usage and a low public contact rate.", "Prevalence of preventive behaviors and associated factors during early phase of the H1N1 influenza epidemic BACKGROUND: The community plays an important role in controlling influenza A/H1N1. There is a dearth of data investigating adoption of preventive behaviors in the initial phase of the A/H1N1 pandemic. METHODS: Three round of random, population-based, anonymous telephone survey were conducted in Hong Kong during the pre-community outbreak phase (May 7 to June 6, 2009) of the influenza A/H1N1 pandemic in Hong Kong (n = 999). RESULTS: Respectively, 46.65%, 88.75%, and 21.5% washed hands more than 10 times/day, wore face masks when having influenza-like illness (ILI), and wore face masks regularly in public areas. Perceptions related to bodily damages, efficacy of frequent handwashing, nonavailability of effective vaccines, high chance of having a large scale local outbreak, and mental distress because of influenza A/H1N1 were associated with frequent handwashing (odds ratio [OR], 1.46 to 2.15). Perceived vaccine availability was associated with face mask use when having ILI (OR, 1.60). Perceived fatality, efficacy of wearing face masks, and mental distress because of influenza A/H1N1 were associated with face mask use in public areas (OR, 1.53 to 2.52). CONCLUSION: Preventive behaviors were prevalently adopted by the public and were associated with cognitive and affective factors. Prevention efforts should take public perceptions into account, and emerging infectious diseases provide good chances for promoting hygiene.", "I. Anaesthesia and SARS ", "Assessment the protection performance of different level personal respiratory protection masks against viral aerosol New viral disease such as SARS and H1N1 highlighted the vulnerability of healthcare workers to aerosol-transmitted viral infections. This paper was to assess the protection performance of different level personal respiratory protection equipments against viral aerosol. Surgical masks, N95 masks and N99 masks were purchased from the market. The masks were sealed onto the manikin in the aerosol testing chamber. Viral aerosol was generated and then sampled simultaneously before and after the tested mask using biosamplers. This allows a percentage efficiency value to be calculated against test phage SM702 aerosols which surrogates of viral pathogens aerosol. At the same time, the masks face fit factor was determined by TSI8020. The viral aerosol particles aerodynamic diameter was 0.744 \u03bcm, and GSD was 1.29. The protection performance of the material of all the tested masks against viral aerosol was all >95 %. All the five surgical masks face fit factor were <8. F model N95 mask and H model N99 mask face fit factor were all >160. G model N95 mask face fit factor was 8.2. The protection performances of N95 or N99 masks were many times higher than surgical mask when considering the face fit factor. Surgical masks cannot offer sufficient protection against the inhalation of viral aerosol because they cannot provide a close face seal.", "A cluster randomized clinical trial comparing fit\u2010tested and non\u2010fit\u2010tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers Please cite this paper as: MacIntyre et al. (2011) A cluster randomized clinical trial comparing fit\u2010tested and non\u2010fit\u2010tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750\u20102659.2010.00198.x. Background We compared the efficacy of medical masks, N95 respirators (fit tested and non fit tested), in health care workers (HCWs). Methods A cluster randomized clinical trial (RCT) of 1441 HCWs in 15 Beijing hospitals was performed during the 2008/2009 winter. Participants wore masks or respirators during the entire work shift for 4 weeks. Outcomes included clinical respiratory illness (CRI), influenza\u2010like illness (ILI), laboratory\u2010confirmed respiratory virus infection and influenza. A convenience no\u2010mask/respirator group of 481 health workers from nine hospitals was compared. Findings The rates of CRI (3\u00b79% versus 6\u00b77%), ILI (0\u00b73% versus 0\u00b76%), laboratory\u2010confirmed respiratory virus (1\u00b74% versus 2\u00b76%) and influenza (0\u00b73% versus 1%) infection were consistently lower for the N95 group compared to medical masks. By intention\u2010to\u2010treat analysis, when P values were adjusted for clustering, non\u2010fit\u2010tested N95 respirators were significantly more protective than medical masks against CRI, but no other outcomes were significant. The rates of all outcomes were higher in the convenience no\u2010mask group compared to the intervention arms. There was no significant difference in outcomes between the N95 arms with and without fit testing. Rates of fit test failure were low. In a post hoc analysis adjusted for potential confounders, N95 masks and hospital level were significant, but medical masks, vaccination, handwashing and high\u2010risk procedures were not. Interpretation Rates of infection in the medical mask group were double that in the N95 group. A benefit of respirators is suggested but would need to be confirmed by a larger trial, as this study may have been underpowered. The finding on fit testing is specific to the type of respirator used in the study and cannot be generalized to other respirators. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN: ACTRN12609000257268 (http://www.anzctr.org.au).", "Addressing the corona virus outbreak: will a novel filtered eye mask help? Abstract Objective Non-hermetically sealed eye protection does not fully protect the eyes from airborne particles. Hermetically sealed eye protection fully protects the eyes from particles, but tend to fog up rendering unusable. The purpose of this study was build and test a filtered eye mask (FEM) to protect the eyes from airborne particles while being usable without excessive fog build up. Methods The steps performed to build the FEM were described. A hermetically-sealed standard eye mask (SEM) and a FEM were examined at 1minute, 5minutes and 60minute period for performance metrics relating to fog. Results The SEM showed minimal fog at 1-minute, very foggy at 5-minutes and dripping with condensation at 60minutes. The FEM was clear at 1-minute, 5-minutes and showed minimal fog at 60minutes. Conclusion The FEM may play an important role in preventing novel coronavirus (COVID-19) exposure by protecting the eyes from airborne particles and preventing fog, rendering it usable. Further research is strongly recommended.", "A reality check on the use of face masks during the COVID-19 outbreak in Hong Kong ", "Nasopharyngeal wash in preventing and treating upper respiratory tract infections: Could it prevent COVID-19? Rapid transmission of the severe acute respiratory syndrome coronavirus 2 has led to the novel coronavirus disease 2019 (COVID-19) pandemic. The current emphasis is on preventive strategies such as social distancing, face mask, and hand washing. The technique of nasopharyngeal wash to prevent the virus from inhabiting and replicating in the nasal and pharyngeal mucosa has been suggested to be useful in reducing symptoms, transmission, and viral shedding in cases of viral acute respiratory tract infections. In rapid systematic review, we found studies showing some improvement in prevention and treatment of upper respiratory tract infections. We postulate that hypertonic saline gargles and nasal wash may be useful in prevention and for care of patients with COVID-19. The present evidence emphasizes the need of randomized controlled trials to evaluate the role and mechanism of nasopharyngeal wash in COVID-19.", "SARS-CoV-2 outbreak: How can pharmacists help? Coronaviruses (CoVs) are a large family of viruses that cause disorders ranging from a mild cold to severe disease. Some of the CoVs are zoonotic, meaning they can be transmitted from animals to humans. In December 2019, the world awoke to a new zoonotic strain of CoV that was named SARS-CoV-2 (standing for severe acute respiratory syndrome coronavirus 2), which has been classified as a high-consequence infectious disease. In addition, serious complications related to COVID-19 have been reported in some patients. These include acute respiratory distress syndrome, acute renal failure, septic shock and ventilator-associated pneumonia. The pharmacist, as a healthcare practitioner, can play an important role in hindering the spread of COVID-19, and can be an active participant in national and community efforts to fight and contain this outbreak.", "Educating Surgeons to Educate Patients about the COVID-19 Pandemic Abstract: The spring of 2020 has been a trying time for the global medical community as it has faced the latest pandemic, COVID-19. This contagious and lethal virus has impacted patients and healthcare workers alike. Elective surgeries have been suspended and the very core of our healthcare system is being strained. The following brief communication reviews pertinent details about the virus, delaying elective surgeries and what patients can do during this time. The goal is to disseminate factual data that surgeons can then use to educate their patients.", "Labor and delivery guidance for COVID-19 This document addresses the current coronavirus disease 2019 (COVID-19) pandemic for providers and patients in labor and delivery (L&D). The goals are to provide guidance regarding methods to appropriately screen and test pregnant patients for COVID-19 prior to, and at admission to L&D reduce risk of maternal and neonatal COVID-19 disease through minimizing hospital contact and appropriate isolation; and provide specific guidance for management of L&D of the COVID-19\u2013positive woman, as well as the critically ill COVID-19\u2013positive woman. The first 5 sections deal with L&D issues in general, for all women, during the COVID-19 pandemic. These include Section 1: Appropriate screening, testing, and preparation of pregnant women for COVID-19 before visit and/or admission to L&D Section 2: Screening of patients coming to L&D triage; Section 3: General changes to routine L&D work flow; Section 4: Intrapartum care; Section 5: Postpartum care; Section 6 deals with special care for the COVID-19\u2013positive or suspected pregnant woman in L&D and Section 7 deals with the COVID-19\u2013positive/suspected woman who is critically ill. These are suggestions, which can be adapted to local needs and capabilities.", "The efficacy of masks for influenza-like illness in the community: A protocol for systematic review and meta-analysis BACKGROUND: During the COVID-19 period, there was a huge gap in the understanding of masks between east and west. At the same time, the mechanism of the mask and the effect after use, also appeared differences. The Objective of this Meta-analysis is to systematically evaluate the efficacy of masks for influenza in the community. METHODS: The Web of Science, PubMed, The Cochrane Library, EMBASE and Clinical Trials will be electronically searched to collect randomized controlled trials regarding the efficacy of masks for influenza in the community through Apr 2020. Two researchers independently screened and evaluated the obtained studies and extracted the outcome indexes. Revman 5.3 software will be used for the meta-analysis. RESULTS: The outbreak is continuing, and we need to be prepared for a long fight. If masks are effective, we need to promote their use as soon as possible. If masks are ineffective, strong evidence should be given. This is an urgent task and our team will finish it as soon as possible. CONCLUSION: Provide stronger evidence to solve the problem, should we wear masks or not right now.", "To mask or not to mask children to overcome COVID-19 It has been reported that asymptomatic people can transmit the new coronavirus disease 2019 (COVID-19) and become important sources of COVID-19. To reduce the role of asymptomatic or poorly symptomatic people in COVID-19, universal use of face masks in addition to hand hygiene and safety distance seems extremely useful. Consequently, preparing the healthy child to use face masks is strongly needed. To obtain maximal compliance, reasons for mask wearing without attempts of removing must be clearly explained. Moreover, child's will must not be forced.Conclusion: On the basis of clinical findings, we think that the universal use of facial masks seems necessary when people have to go out in their everyday lives. In addition to the availability of masks of different sizes capable of adapting perfectly to the face, it is necessary that the use of masks in children is preceded by a strong parental work and school lessons on this issue and other hygiene topics with the main aim to obtain child cooperation.What is Known:\u00e2\u0080\u00a2 Asymptomatic people can transmit and become important sources of COVID-19.\u00e2\u0080\u00a2 Asymptomatic cases are common also in pediatrics.What is New:\u00e2\u0080\u00a2 Universal use of face masks for success against COVID-19 seems necessary also in pediatric age when people have to go out in their everyday lives.\u00e2\u0080\u00a2 In addition to the availability of masks of different sizes capable of adapting perfectly to the face, it is necessary that the use of masks in children is preceded by a strong parental work and school lessons with the main aim to obtain child cooperation.", "Resumption of activity in gastroenterology departments. Recommendations by SEPD, AEEH, GETECCU and AEG Abstract The set of measures proposed by SEPD, AEEH, GETECCU and AEG are aimed to help departments in their resumption of usual activity. We have prepared a number of practical recommendations regarding patient management and the stepwise resumption of healthcare activity. These recommendations are based on the sparse, changing evidence available, and will be updated in the future according to daily needs and the availability of expendable materials to suit them; in each department they will be implemented depending upon the cumulative incidence of SARS-CoV-2 infection in each region, and the burden the pandemic has represented for each hospital. The general objectives of these recommendations include: \u2022 To protect our patients against the risks of infection with SARS-CoV-2 and to provide them with high-quality care. \u2022 To protect all healthcare professionals against the risks of infection with SARS-CoV-2. \u2022 To resume normal functioning of our departments in a setting of ongoing risk for infection with SARS-CoV-2.", "Adolescents\u2019 face mask usage and contact transmission in novel Coronavirus The global outbreak of coronavirus has become an international public health threat. Prevention is of paramount importance to contain its spread. This study observes face mask wearing behavior and contact transmission problems in Taiwan. Teachers track student status in class. In addition to measuring body temperature and regular disinfection, classrooms require ventilation wear mask, provide alcohol spray and avoid sharing the microphone. Both questionnaire surveys and experimental were utilized. A total of 160 adults residing in Taiwan participated in the survey. The dye simulated the possible virus area on the mask surface during usage. Subjects were required to complete a questionnaire and simulate the spread of contact transmission when using a computer. Eighty-one % of respondents reported consistent use of surgical masks several times a day. They reported taking their masks off in relatively safe areas. Most people reported using one mask per day and storing the masks in their pockets. As a result, masks surface become a contamination source. In the contact experiment, ten adults were requested to don and doff a surgical mask while doing a word processing task. The extended contamination areas were recorded and identified by image analysis. The results show an average contamination area of the workspace is significant 530 cm(2). When the hand touches the surface of the mask, it may spread the virus to the subsequent contact area.", "Sterilization of disposable face masks by means of standardized dry and steam sterilization processes; an alternative in the fight against mask shortages due to COVID-19 ", "N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial. Importance Clinical studies have been inconclusive about the effectiveness of N95 respirators and medical masks in preventing health care personnel (HCP) from acquiring workplace viral respiratory infections. Objective To compare the effect of N95 respirators vs medical masks for prevention of influenza and other viral respiratory infections among HCP. Design, Setting, and Participants A cluster randomized pragmatic effectiveness study conducted at 137 outpatient study sites at 7 US medical centers between September 2011 and May 2015, with final follow-up in June 2016. Each year for 4 years, during the 12-week period of peak viral respiratory illness, pairs of outpatient sites (clusters) within each center were matched and randomly assigned to the N95 respirator or medical mask groups. Interventions Overall, 1993 participants in 189 clusters were randomly assigned to wear N95 respirators (2512 HCP-seasons of observation) and 2058 in 191 clusters were randomly assigned to wear medical masks (2668 HCP-seasons) when near patients with respiratory illness. Main Outcomes and Measures The primary outcome was the incidence of laboratory-confirmed influenza. Secondary outcomes included incidence of acute respiratory illness, laboratory-detected respiratory infections, laboratory-confirmed respiratory illness, and influenzalike illness. Adherence to interventions was assessed. Results Among 2862 randomized participants (mean [SD] age, 43 [11.5] years; 2369 [82.8%]) women), 2371 completed the study and accounted for 5180 HCP-seasons. There were 207 laboratory-confirmed influenza infection events (8.2% of HCP-seasons) in the N95 respirator group and 193 (7.2% of HCP-seasons) in the medical mask group (difference, 1.0%, [95% CI, -0.5% to 2.5%]; P = .18) (adjusted odds ratio [OR], 1.18 [95% CI, 0.95-1.45]). There were 1556 acute respiratory illness events in the respirator group vs 1711 in the mask group (difference, -21.9 per 1000 HCP-seasons [95% CI, -48.2 to 4.4]; P = .10); 679 laboratory-detected respiratory infections in the respirator group vs 745 in the mask group (difference, -8.9 per 1000 HCP-seasons, [95% CI, -33.3 to 15.4]; P = .47); 371 laboratory-confirmed respiratory illness events in the respirator group vs 417 in the mask group (difference, -8.6 per 1000 HCP-seasons [95% CI, -28.2 to 10.9]; P = .39); and 128 influenzalike illness events in the respirator group vs 166 in the mask group (difference, -11.3 per 1000 HCP-seasons [95% CI, -23.8 to 1.3]; P = .08). In the respirator group, 89.4% of participants reported \"always\" or \"sometimes\" wearing their assigned devices vs 90.2% in the mask group. Conclusions and Relevance Among outpatient health care personnel, N95 respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza. Trial Registration ClinicalTrials.gov Identifier: NCT01249625.", "COVID-19 coronavirus: recommended personal protective equipment for the orthopaedic and trauma surgeon PURPOSE: With the COVID-19 crisis, recommendations for personal protective equipment (PPE) are necessary for protection in orthopaedics and traumatology. The primary purpose of this study is to review and present current evidence and recommendations for personal protective equipment and safety recommendations for orthopaedic surgeons and trauma surgeons. METHODS: A systematic review of the available literature was performed using the keyword terms \u201cCOVID-19\u201d, \u201cCoronavirus\u201d, \u201csurgeon\u201d, \u201chealth-care workers\u201d, \u201cprotection\u201d, \u201cmasks\u201d, \u201cgloves\u201d, \u201cgowns\u201d, \u201chelmets\u201d, and \u201caerosol\u201d in several combinations. The following databases were assessed: Pubmed, Cochrane Reviews, Google Scholar. Due to the paucity of available data, it was decided to present it in a narrative manner. In addition, participating doctors were asked to provide their guidelines for PPE in their countries (Austria, Luxembourg, Switzerland, Germany, UK) for consideration in the presented practice recommendations. RESULTS: World Health Organization guidance for respiratory aerosol-generating procedures (AGPs) such as intubation in a COVID19 environment was clear and included the use of an FFP3 (filtering face piece level 3) mask and face protection. However, the recommendation for surgical AGPs, such as the use of high-speed power tools in the operating theatre, was not clear until the UK Public Health England (PHE) guidance of 27 March 2020. This guidance included FFP3 masks and face protection, which UK surgeons quickly adopted. The recommended PPE for orthopaedic surgeons, working in a COVID19 environment, should consist of level 4 surgical gowns, face shields or goggles, double gloves, FFP2-3 or N95-99 respirator masks. An alternative to the mask, face shield and goggles is a powered air-purifying respirator, particularly if the surgeons fail the mask fit test or are required to undertake a long procedure. However, there is a high cost and limited availabilty of these devices at present. Currently available surgical helmets and toga systems may not be the solution due to a permeable top for air intake. During the current COVID-19 crisis, it appeared that telemedicine can be considered as an electronic personal protective equipment by reducing the number of physical contacts and risk contamination. CONCLUSION: Orthopaedic and trauma surgery using power tools, pulsatile lavage and electrocautery are surgical aerosol-generating procedures and all body fluids contain virus particles. Raising awareness of these issues will help avoid occupational transmission of COVID-19 to the surgical team by aerosolization of blood or other body fluids and hence adequate PPE should be available and used during orthopaedic surgery. In addition, efforts have to be made to improve the current evidence in this regard. LEVEL OF EVIDENCE: IV.", "UNIVERSAL MASKING DURING COVID-19 PANDEMIC - CURRENT EVIDENCE AND CONTROVERSIES. The emergence of coronavirus disease 19 pandemic and novel research on the high transmissibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has raised controversies over the use of face masks to prevent community transmission. Specific regulations need to be fulfilled to use a face mask as part of the personal protective equipment and high quality of evidence supporting its use to prevent respiratory viral infections, including SARS-CoV-2, is lacking. However, its widespread use is becoming a standard practice in some countries and discrepancies between health authorities on their policy have led to controversy. The aim of this review is to provide an outlook on recent research in this matter and areas of opportunity.", "Rapid evidence summary on SARS-CoV-2 survivorship and disinfection, and a reusable PPE protocol using a double-hit process In the COVID-19 pandemic caused by SARS-CoV-2, hospitals are stretched beyond capacity. There are widespread reports of dwindling supplies of personal protective equipment (PPE), which are paramount to protect frontline medical/nursing staff and to minimize further spread of the virus. We carried out a rapid review to summarize the existing evidence on SARS-CoV-2 survivorship and methods to disinfect PPE gear, particularly N95 filtering facepiece respirators (FFR). In the absence of data on SARS-CoV-2, we focused on the sister virus SARS-CoV-1. We propose a two-step disinfection process, which is conservative in the absence of robust evidence on SARS-CoV-2. This disinfection protocol is based on an initial storage of PPE for \u22654 days, followed by ultraviolet light (UVC), dry heat treatment, or chemical disinfection. Importantly, each of the two steps is based on independent disinfection mechanisms, so that our proposed protocol is a multiplicative system, maximising the efficacy of our disinfection process. This method could be rapidly implemented in other healthcare settings, while testing of each method is undertaken, increasing the frontline supply of PPE, and avoiding many of the upstream issues of supply chain disruption currently being faced.", "[Expert consensus on preventing nosocomial transmission during respiratory care for critically ill patients infected by 2019 novel coronavirus pneumonia]. Definite evidence has shown that the novel coronavirus (COVID-19) could be transmitted from person to person, so far more than 1 700 bedside clinicians have been infected. A lot of respiratory treatments for critically ill patients are deemed as high-risk factors for nosocomial transmission, such as intubation, manual ventilation by resuscitator, noninvasive ventilation, high-flow nasal cannula, bronchoscopy examination, suction and patient transportation, etc, due to its high possibility to cause or worsen the spread of the virus. As such, we developed this consensus recommendations on all those high-risk treatments, based on the current evidence as well as the resource limitation in some areas, with the aim to reduce the nosocomial transmission and optimize the treatment for the COVID-19 pneumonia patients. Those recommendations include: (1)Standard prevention and protection, and patient isolation; (2)Patient wearing mask during HFNC treatment; (3)Using dual limb ventilator with filters placed at the ventilator outlets, or using heat-moisture exchanger (HME) instead of heated humidification in single limb ventilator with HME placed between exhalation port and mask; avoid using mask with exhalation port on the mask; (4)Placing filter between resuscitator and mask or artificial airway; (5)For spontaneous breathing patients, placing mask for patients during bronchoscopy examination; for patients receiving noninvasive ventilation, using the special mask with bronchoscopy port to perform bronchoscopy; (6)Using sedation and paralytics during intubation, cuff pressure should be maintained between 25-30 cmH(2)O(1 cmH(2)O=0.098 kPa); (7)In-line suction catheter is recommended and it can be used for one week; (8)Dual-limb heated wire circuits are recommended and only changed with visible soiled; (9)For patients who need breathing support during transportation, placing an HME between ventilator and patient; (10)PSV is recommended for implementing spontaneous breathing trial (SBT), avoid using T-piece to do SBT. When tracheotomy patients are weaned from ventilator, HME should be used, avoid using T-piece or tracheostomy mask. (11)Avoid unnecessary bronchial hygiene therapy; (12) For patients who need aerosol therapy, dry powder inhaler metered dose inhaler with spacer is recommended for spontaneous breathing patients; while vibrating mesh nebulizer is recommended for ventilated patients and additional filter is recommended to be placed at the expiratory port of ventilation during nebulization.", "[Expert consensus on preventing nosocomial transmission during respiratory care for critically ill patients infected by 2019 novel coronavirus pneumonia] Definite evidence has shown that the novel coronavirus (COVID-19) could be transmitted from person to person, so far more than 1,700 bedside clinicians have been infected. A lot of respiratory treatments for critically ill patients are deemed as high-risk factors for nosocomial transmission, such as intubation, manual ventilation by resuscitator, noninvasive ventilation, high-flow nasal cannula, bronchoscopy examination, suction and patient transportation, etc, due to its high possibility to cause or worsen the spread of the virus. As such, we developed this consensus recommendations on all those high-risk treatments, based on the current evidence as well as the resource limitation in some areas, with the aim to reduce the nosocomial transmission and optimize the treatment for the COVID-19 pneumonia patients. Those recommendations include: (1) Standard prevention and protection, and patient isolation; (2) Patient wearing mask during HFNC treatment; (3) Using dual limb ventilator with filters placed at the ventilator outlets, or using heat-moisture exchanger (HME) instead of heated humidification in single limb ventilator with HME placed between exhalation port and mask; avoid using mask with exhalation port on the mask; (4) Placing filter between resuscitator and mask or artificial airway; (5) For spontaneous breathing patients, placing mask for patients during bronchoscopy examination; for patients receiving noninvasive ventilation, using the special mask with bronchoscopy port to perform bronchoscopy; (6) Using sedation and paralytics during intubation, cuff pressure should be maintained between 25-30 cmH(2)O; (7) In-line suction catheter is recommended and it can be used for one week; (8) Dual-limb heated wire circuits are recommended and only changed with visible soiled; (9. For patients who need breathing support during transportation, placing an HME between ventilator and patient; (10) PSV is recommended for implementing spontaneous breathing trial (SBT), avoid using T-piece to do SBT. When tracheotomy patients are weaned from ventilator, HME should be used, avoid using T-piece or tracheostomy mask. (11) Avoid unnecessary bronchial hygiene therapy; (12) For patients who need aerosol therapy, dry powder inhaler metered dose inhaler with spacer is recommended for spontaneous breathing patients; while vibrating mesh nebulizer is recommended for ventilated patients and additional filter is recommended to be placed at the expiratory port of ventilation during nebulization.", "Possibly critical role of wearing masks in general population in controlling COVID\u201019 Coronavirus disease 2019 (COVID\u201019), caused by severe acute respiratory syndrome coronavirus 2 (SARS\u2010CoV\u20102), is now overwhelming spreading in the world. As of April 11, 2020, totally 1.61 million COVID\u201019 patients were confirmed in more than 200 countries and regions with 99690 deaths. This article is protected by copyright. All rights reserved.", "Novel coronavirus SARS-CoV-2 and COVID-19. Practice recommendations for obstetric anaesthesia: what we have learned thus far \u2022 Pregnancy does not seem to be associated with more severe COVID-19 infections. \u2022 Risk of antenatal vertical transmission of COVID-19 is low. \u2022 Epidural analgesia should be considered, provided platelet counts are not low. \u2022 Droplet precautions are indicated for all women with suspected COVID-19. \u2022 Airborne precautions recommended for general anaesthesia or higher risk thereof.", "[Validation of surgical masks during COVID19 emergency: activities at the University of Napoli Federico II]. SUMMARY During COVID-19 pandemic crisis, Italian Government has approved Law Decree no. 18 of 17 march 2020, in which art. 15 allows enterprises to produce, import and commercialize surgical masks notwithstanding the current rules of product certification. It is just required that the interested enterprises send to the Italian National Institute of Health a selfcertification in which they declare the technical characteristics of the masks and that masks are produced according to the safety requirements. In this context, a technical-scientific unit was established at the University of Napoli Federico II to provide interested enterprises with state-of-the-art consultancy, testing and measurement services, adhering to rigorous scientific protocols. Characterization tests were carried out on 163 surgical masks and/or materials for their construction and they have enabled the identification of pre-screening criteria to simplify the procedure for evaluating surgical masks using methods for assessing the filtration efficiency of particles and aerosols. Based on experimental results, it has been observed that a filtration efficiency for particles with sizes larger that 650 nm (PFE>650) exceeding 35% might guarantees a bacterial filtration efficiency (BFE) higher than 95% while BFE values higher than 98% are obtained when the PFE>650 is larger than 40%. PFE measurement is extremely simpler with respect to BFE, the latter being time-consuming and requiring specific equipment and methods for its realization. Many tested materials have shown the capability to assure high filtration efficiencies but Spundonded-Meltblown-Spunbonded (SMS), that are layers of non-woven fabric with different weights of Meltblown, can simultaneously guarantee high particle filtration efficiencies with pressure drop values (breathability) in the limits to classify the surgical masks as Type II/IIR. In fact, the fabric products analyzed so far have not been able to simultaneously guarantee adequate BFE and breathability values. On the contrary, Spunbonds of adequate weights can virtually verify both requirements and accredit themselves as possible materials for the production of surgical masks, at least of Type I. Further studies are needed to verify the possibility of producing low-cost, reusable surgical masks that could meet the criteria of circular economy.", "Policies on the use of respiratory protection for hospital health workers to protect from coronavirus disease (COVID-19) ", "Letter to the Editor Re: Coronavirus disease 2019: The harms of exaggerated information and non-evidence-based measures ", "Preventing Facial Pressure Injury for Health Care Providers Adhering to COVID-19 Personal Protective Equipment Requirements OBJECTIVE: To determine if a repurposed silicone-based dressing used underneath a N95 mask is a safe and beneficial option for facial skin injury prevention without compromising the mask's seal. METHODS: Since February 21, 2020, staff in high risk areas such as the ED and ICU of King Hamad University Hospital have worn N95 masks when doing aerosol-generating procedures to protect against the novel coronavirus 2019. At that time, without education enablers or resources that could be directly translated into practice, the hospital's Pressure Injury Prevention Committee explored and created a stepwise process to protect the skin under these masks. This procedure was developed over time and tested to make sure that it did not interfere with the effectiveness of the N95 mask seal. RESULTS: Skin protection was achieved by repurposing a readily available silicone border dressing cut into strips. This was tested on 10 volunteer staff members of various skin types and both sexes who became part of this evidence generation project. Oxygen saturation values taken before and after the 4-hour wear test confirmed that well-fitted facial protection did not compromise the mask seal, but rather improved it. An added advantage was increased comfort with less friction as self-reported by the staff. An educational enabler to prevent MDRPI from N95 mask wear was an important additional resource for the staff. CONCLUSIONS: This creative and novel stepwise process of developing a safe skin protection method by which staff could apply a repurposed silicone border dressing beneath an N95 mask was largely effective and aided by the creation of the enabler.", "Application of refined management in the prevention and control of coronavirus disease 2019 epidemic in non-isolated areas of a general hospital Objective: This article summarizes the experience in the prevention and control of coronavirus disease 2019(COVID-19) epidemic in non-isolated areas in a general hospital. Methods: Based on refined management theory, we professionally developed the standards for prevention and control of COVID-19 in non-isolated areas, systematically implemented various prevention and control measures, performed gridding audit, effectively communicated among teams and between doctors and patients assisted by information techniques, and reported results for quality improvement. Results: There was no hospital acquired COVID-19 infections among staff in the hospital. The rates of mask wearing, epidemiological history screening and the medical supplies disinfection were all 100% in the hospital. The accuracy rate of mask wearing of patients and their families was 73.79% and the compliance of their hand hygiene was 40.78%. Conclusion: Refined management strategies for the prevention and control of COVID-19 infection in non-isolated areas of the general hospital are effective. The accuracy rate of mask wearing and hand hygiene compliance of patients and their families need to be further improved.", "The COVID-19 pandemic, personal protective equipment and respirator: A narrative review INTRODUCTION: The coronavirus disease 2019 pandemic has touched almost every continent. Personal protective equipment (PPE) is the final line of protection of healthcare workers (HCW). There is variation as well as controversy of infection control recommendation with regards to the use of PPE for HCW between institutions. The aim of this narrative review is to of examine and summarise the available evidence to guide recommendation for the safety of HCW. METHOD: A literature search was conducted on the PubMed, MedLine and Embase databases with the keywords \"personal protective equipment,\" \"COVID 19,\" \"n95,\" \"health care worker\" and \"mortality.\" RESULTS: SARS-nCoV-2 is highly contagious. About 3.5%-20% of HCW has been reported to be infected. The mortality ranges from 0.53% to 1.94%. PPE is part of the measure within a package of prevention and control of pandemic, rather than a replacement of. Respirators are more effective than masks in preventing aerosol transmission to HCWs. Extended use may be considered if guidelines are adhered. Powered air-purifying respirators if available should be used in high-risk procedures. CONCLUSION: Transmission of viruses is multimodal and in the setting of a novel pathogen with high case fatality with no proven effective interventions, PPE that affords the best protection should be available to HCWs.", "Covid-19: hoarding and misuse of protective gear is jeopardising the response, WHO warns. ", "Characterization of a novel, low-cost, scalable vaporized hydrogen peroxide system for sterilization of N95 respirators and other COVID-19 related personal protective equipment. Due to the virulence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pathogen responsible for the respiratory disease termed COVID-19, there has been a significant increase in demand for surgical masks and N95 respirators in medical clinics as well as within communities operating during the COVID-19 epidemic. Thus, community members, business owners, and even medical personnel have resorted to alternative methods for sterilizing face coverings and N95 respirators for reuse. While significant work has shown that vaporized hydrogen peroxide (VHP) can be used to sterilize N95 respirators, the cost and installation time for these sterilization systems limit their accessibility. To this end, we have designed and constructed a novel, cost-effective, and scalable VHP system that can be used to sterilize N95 respirators and other face coverings for clinical and community applications. N95 respirators inoculated with P22 bacteriophage showed a greater than 6-log10 reduction in viral load when sterilized in the VHP system for one 60-minute cycle. Further, N95 respirators treated with 20 cycles in this VHP system showed comparable filtration efficiency to untreated N95 respirators in a 50 to 200 nanometer particulate challenge filtration test. While a 23% average increase in water droplet roll-off time was observed for N95 respirators treated with 5 cycles in the sterilization, no breakdown in fluid resistance was detected. These data suggest that our VHP system is effective in sterilizing N95 respirators and other polypropylene masks for reuse. Relating to the present epidemic, deployment of this system reduces the risk of COVID-19 community transmission while conserving monetary resources otherwise spent on the continuous purchase of disposable N95 respirators and other face coverings. In summary, this novel, scientifically validated sterilization system can be easily built at a low cost and implemented in a wide range of settings.", "The \"Double Eights Mask Brace\" Improves the Fit and Protection and Protection of a Basic Surgical Mask Amidst Covid-19 Pandemic Study Objective: The COVID-19 pandemic has resulted in widespread shortages in personal protective equipment, including N95 respirators. While basic surgical facemasks are more commonly available, their efficacy is limited due primarily to their poor face seal. This pilot study examined the impact of a rubber band mask brace on a basic surgical mask, as determined by quantitative fit testing. Methods: Subjects wearing a basic surgical facemask and the rubber band mask brace underwent quantitative fit testing using machinery designed to certify N95 mask fit. Subjects were tested with the brace anchored behind their eyes, with a paperclip behind the head, and on the side knobs of their face shields. The primary outcome measure was whether the subject passed the quantitative fit test at or above the OSHA verified standard for N95 masks. Results: Subjects (n=11) were 54.5% female, with a median height of 70 inches (IQR 68-74), weight of 170 lbs (IQR 145-215) and BMI of 24.6 (IQR 22.2-27.2), and encompassing 5 distinct N95 mask fit types. We found that 45%, 100% and 100% of subjects passed the quantitative fit test when the brace was anchored behind the ears, with a paperclip and on a face shield respectively. Conclusion: Of the 11 subjects included in the analysis, across a range of body habitus and N95 mask fit types, all passed the quantitative fit test when the mask brace was anchored on either face shield or with a paperclip. This data suggests the brace would offer an improved margin of safety when worn with a basic surgical mask.", "A randomized clinical trial of three options for N95 respirators and medical masks in health workers. RATIONALE We compared three policy options for the use of medical masks and N95 respirators in healthcare workers (HCWs). OBJECTIVES A cluster randomized clinical trial of 1,669 hospital-based HCWs in Beijing, China in the winter of 2009-2010. METHODS Participants were randomized to medical masks, N95 respirators, or targeted use of N95 respirators while doing high-risk procedures or barrier nursing. Outcomes included clinical respiratory illness (CRI) and laboratory-confirmed respiratory pathogens in symptomatic subjects. MEASUREMENTS AND MAIN RESULTS The rate of CRI was highest in the medical mask arm (98 of 572; 17%), followed by the targeted N95 arm (61 of 516; 11.8%), and the N95 arm (42 of 581; 7.2%) (P < 0.05). Bacterial respiratory tract colonization in subjects with CRI was highest in the medical mask arm (14.7%; 84 of 572), followed by the targeted N95 arm (10.1%; 52 of 516), and lowest in the N95 arm (6.2%; 36 of 581) (P = 0.02). After adjusting for confounders, only continuous use of N95 remained significant against CRI and bacterial colonization, and for just CRI compared with targeted N95 use. Targeted N95 use was not superior to medical masks. CONCLUSIONS Continuous use of N95 respirators was more efficacious against CRI than intermittent use of N95 or medical masks. Most policies for HCWs recommend use of medical masks alone or targeted N95 respirator use. Continuous use of N95s resulted in significantly lower rates of bacterial colonization, a novel finding that points to more research on the clinical significance of bacterial infection in symptomatic HCWs. This study provides further data to inform occupational policy options for HCWs. Clinical trial registered with Australian New Zealand Clinical Trials Registry http://www.anzctr.org.au (ACTRN 12609000778280).", "Facial protection for healthcare workers during pandemics: a scoping review BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to personal protective equipment (PPE) shortages, requiring mask reuse or improvisation. We provide a review of medical-grade facial protection (surgical masks, N95 respirators and face shields) for healthcare workers, the safety and efficacy of decontamination methods, and the utility of alternative strategies in emergency shortages or resource-scarce settings. METHODS: We conducted a scoping review of PubMed and grey literature related to facial protection and potential adaptation strategies in the setting of PPE shortages (January 2000 to March 2020). Limitations included few COVID-19-specific studies and exclusion of non-English language articles. We conducted a narrative synthesis of the evidence based on relevant healthcare settings to increase practical utility in decision-making. RESULTS: We retrieved 5462 peer-reviewed articles and 41 grey literature records. In total, we included 67 records which met inclusion criteria. Compared with surgical masks, N95 respirators perform better in laboratory testing, may provide superior protection in inpatient settings and perform equivalently in outpatient settings. Surgical mask and N95 respirator conservation strategies include extended use, reuse or decontamination, but these strategies may result in inferior protection. Limited evidence suggests that reused and improvised masks should be used when medical-grade protection is unavailable. CONCLUSION: The COVID-19 pandemic has led to critical shortages of medical-grade PPE. Alternative forms of facial protection offer inferior protection. More robust evidence is required on different types of medical-grade facial protection. As research on COVID-19 advances, investigators should continue to examine the impact on alternatives of medical-grade facial protection.", "Art of prevention: Life in the time of coronavirus Abstract The novel coronavirus disease 2019 (COVID-19) has continued to progress since its discovery in December 2019. A cluster of patients with atypical pneumonia identified in Wuhan, China, served as the epicenter of this recent epidemic. This family of viruses is responsible for the common cold along with the infamous severe acute respiratory syndrome epidemic in 2002 and Middle East respiratory syndrome in 2012. The Southern China Wholesale Market reportedly has connections to the original 27 cases in Wuhan, China. The worldwide confirmed case total has eclipsed 1,450,000, with more than 83,000 deaths. Patient presentation ranges from mild respiratory illness to acute respiratory distress syndrome and subsequent death. Early epidemiologic studies of viral spread support the hypothesis that COVID-19 can remain latent with an extended and infectious incubation period. The U.S. government has issued level 3 precautions for most international travel, along with prohibiting entry to foreign nationals traveling from China, Iran, the United Kingdom, the Republic of Ireland, and the European Schengen area (e.g., France, Italy, Germany). Prevention remains the mainstay in treating and defeating the COVID-19 epidemic. Anyone infected or suspected of being infected should self-quarantine at home or admit themselves to a specified hospital with infrastructure to handle the situation. The combination of prevention and containment provides the best opportunity to stall the spread of COVID-19.", "Masks and COVID-19 ", "Nonmedical Masks in Public for Respiratory Pandemics: Droplet Retention by Two-Layer Textile Barrier Fully Protects Germ-free Mice from Bacteria in Droplets Due to the shortage of masks during the pandemic, we recently demonstrated that household textiles are effective environmental droplet barriers (EDBs) with identical droplet retention potential as medical masks. To further promote the implementation of a universal community droplet reduction solution based on a synchronized encouragement/enforcement of mask utilization by the public based on widely available textiles (mask fabrication without the need for sewing machines), here we conducted a study using germ-free mice to determine to what extent textiles were effective in vivo. Using a bacterial-suspension spray simulation model of droplet ejection (mimicking a sneeze), we quantified the extent by which 100% cotton textile prevented the contamination of germ-free animals on the other side of the textile-barrier (simulating a properly worn mask). Of relevance, all mice protected with textiles remained germ-free after two sprays (inoculation dose: >600 bacterial droplet units per 56.75cm2) compared to the contamination of mice not protected by a textile (0/12 vs 6/6, Fisher\u2019s exact, p<0.0001). In a second phase of the experiment with 12 germ-free mice exposed again to 10-fold more droplets remained germ-free, while 100% of mice at 180cm became colonized with a single spray (0/8 vs 4/4, Fisher exact, p=0.002). Collectively, barriers protected all mice (even with low-density textiles, heavy vs. light fabric, T-test, p=0.0028) when using textile-EDB to cover the cages (0/20 vs 10/10, Fisher exact, p<0.0001). This study demonstrated, in vivo, that widely available household textiles are 100% effective at preventing contamination of the environment and the exposed animals by microbe-carrying droplets.", "Coronavirus outbreaks: prevention and management recommendations ", "A Quantitative Assessment of the Total Inward Leakage of NaCl Aerosol Representing Submicron-Size Bioaerosol Through N95 Filtering Facepiece Respirators and Surgical Masks Respiratory protection provided by a particulate respirator is a function of particle penetration through filter media and through faceseal leakage. Faceseal leakage largely contributes to the penetration of particles through a respirator and compromises protection. When faceseal leaks arise, filter penetration is assumed to be negligible. The contribution of filter penetration and faceseal leakage to total inward leakage (TIL) of submicron-size bioaerosols is not well studied. To address this issue, TIL values for two N95 filtering facepiece respirator (FFR) models and two surgical mask (SM) models sealed to a manikin were measured at 8 L and 40 L breathing minute volumes with different artificial leak sizes. TIL values for different size (20\u2013800 nm, electrical mobility diameter) NaCl particles representing submicron-size bioaerosols were measured using a scanning mobility particle sizer. Efficiency of filtering devices was assessed by measuring the penetration against NaCl aerosol similar to the method used for NIOSH particulate filter certification. Results showed that the most penetrating particle size (MPPS) was ~45 nm for both N95 FFR models and one of the two SM models, and ~350 nm for the other SM model at sealed condition with no leaks as well as with different leak sizes. TIL values increased with increasing leak sizes and breathing minute volumes. Relatively, higher efficiency N95 and SM models showed lower TIL values. Filter efficiency of FFRs and SMs influenced the TIL at different flow rates and leak sizes. Overall, the data indicate that good fitting higher-efficiency FFRs may offer higher protection against submicron-size bioaerosols.", "User acceptance of reusable respirators in health care BACKGROUND: Inclusion of reusable respirators, such as elastomeric half-face respirators (EHFRs) and powered air-purifying respirators (PAPRs), in hospital respiratory protection inventories may represent 1 solution to the problem of N95 respirator shortages experienced during pandemics. User acceptance of these devices is 1 potential barrier to implementing such a strategy in respiratory protection programs. METHODS: To assess user attitudes toward various respirators, health care workers enrolled in respiratory protection programs in a medical system using EHFRs, N95s, and PAPRs and completed an online questionnaire that addressed attitudes, beliefs, and respirator preferences under different risk scenarios. Responses were compared between user groups. RESULTS: Of 1,152 participants, 53% currently used N95s, 24% used EHFRs, and 23% used PAPRs. N95 users rated their respirators more favorably compared with EHFR and PAPR users (P < .001) regarding comfort and communication, however, EHFR users rated their respirators much more highly regarding sense of protection (P < .001). For all user groups, reusable respirators were significantly more likely (odds ratios 2.3-7.7) to be preferred over N95 filtering facepiece respirators in higher risk scenarios compared to \u201cusual circumstance\u201d scenarios. CONCLUSIONS: Despite somewhat less favorable ratings on comfort and communication, experienced EHFR and PAPR users still prefer reusable respirators over N95s in certain higher risk scenarios. This suggests that reusable respirators are an acceptable alternative to N95 respirators in health care and offer 1 viable solution to prevent pandemic-generated respirator shortages.", "Approaching Otolaryngology Patients During the COVID-19 Pandemic Objective. To describe coronavirus disease 2019 (COVID-19) patient presentations requiring otolaryngology consultation and provide recommendations for protective measures based on the experience of ear, nose, and throat (ENT) departments in 4 Chinese hospitals during the COVID-19 pandemic. Study Design. Retrospective case series. Setting. Multicenter. Subjects and Methods. Twenty hospitalized COVID-19 patients requiring ENT consultation from 3 designated COVID-19 hospitals in Wuhan, Shanghai, and Shenzhen were identified. Data on demographics, comorbidities, COVID-19 symptoms and severity, consult reason, treatment, and personal protective equipment (PPE) use were collected and analyzed. Infection control strategies implemented for ENT outpatients and emergency room visits at the Eye and ENT Hospital of Fudan University were reported. Results. Median age was 63 years, 55% were male, and 95% were in severe or critical condition. Six tracheotomies were performed. Posttracheotomy outcomes were mixed (2 deaths, 2 patients comatose, all living patients still hospitalized). Other consults included epistaxis, pharyngitis, nasal congestion, hyposmia, rhinitis, otitis externa, dizziness, and tinnitus. At all hospitals, powered air-supply filter respirators (PAPRs) were used for tracheotomy or bleeding control. PAPR or N95-equivalent masks plus full protective clothing were used for other complaints. No inpatient ENT providers were infected. After implementation of infection control strategies for outpatient clinics, emergency visits, and surgeries, no providers were infected at the Eye and ENT Hospital of Fudan University. Conclusions and Relevance. COVID-19 patients require ENT consultation for many reasons, including tracheotomy. Otolaryngologists play an indispensable role in the treatment of COVID-19 patients but, due to their work, are at high risk of exposure. Appropriate protective strategies can prevent infection of otolaryngologists.", "The First 75 Days of Novel Coronavirus (SARS-CoV-2) Outbreak: Recent Advances, Prevention, and Treatment The recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, previously known as 2019-nCoV) outbreak has engulfed an unprepared world amidst a festive season. The zoonotic SARS-CoV-2, believed to have originated from infected bats, is the seventh member of enveloped RNA coronavirus. Specifically, the overall genome sequence of the SARS-CoV-2 is 96.2% identical to that of bat coronavirus termed BatCoV RaTG13. Although the current mortality rate of 2% is significantly lower than that of SARS (9.6%) and Middle East respiratory syndrome (MERS) (35%), SARS-CoV-2 is highly contagious and transmissible from human to human with an incubation period of up to 24 days. Some statistical studies have shown that, on average, one infected patient may lead to a subsequent 5.7 confirmed cases. Since the first reported case of coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 on December 1, 2019, in Wuhan, China, there has been a total of 60,412 confirmed cases with 1370 fatalities reported in 25 different countries as of February 13, 2020. The outbreak has led to severe impacts on social health and the economy at various levels. This paper is a review of the significant, continuous global effort that was made to respond to the outbreak in the first 75 days. Although no vaccines have been discovered yet, a series of containment measures have been implemented by various governments, especially in China, in the effort to prevent further outbreak, whilst various medical treatment approaches have been used to successfully treat infected patients. On the basis of current studies, it would appear that the combined antiviral treatment has shown the highest success rate. This review aims to critically summarize the most recent advances in understanding the coronavirus, as well as the strategies in prevention and treatment.", "The role of the orthopaedic surgeon in the COVID-19 era: cautions and perspectives The current coronavirus disease 2019 (COVID-19) pandemic has revolutionized global healthcare in an unprecedented way and with unimaginable repercussions. Resource reallocation, socioeconomic confinement and reorganization of production activities are current challenges being faced both at the national and international levels, in a frame of uncertainty and fear. Hospitals have been restructured to provide the best care to COVID-19 patients while adopting preventive strategies not to spread the infection among healthcare providers and patients affected by other diseases. As a consequence, the concept of urgency and indications for elective treatments have been profoundly reshaped. In addition, several providers have been recruited in COVID-19 departments despite their original occupation, resulting in a profound rearrangement of both inpatient and outpatient care. Orthopaedic daily practice has been significantly affected by the pandemic. Surgical indications have been reformulated, with elective cases being promptly postponed and urgent interventions requiring exceptional attention, especially in suspected or COVID-19(+) patients. This has made a strong impact on inpatient management, with the need of a dedicated staff, patient isolation and restrictive visiting hour policies. On the other hand, outpatient visits have been limited to reduce contacts between patients and the hospital personnel, with considerable consequences on post-operative quality of care and the human side of medical practice. In this review, we aim to analyze the effect of the COVID-19 pandemic on the orthopaedic practice. Particular attention will be dedicated to opportune surgical indication, perioperative care and safe management of both inpatients and outpatients, also considering repercussions of the pandemic on resident education and ethical implications.", "Novel tip to prevent ear irritation with surgical face masks (FRSM) during the coronavirus (COVID-19) pandemic. ", "Guide to Understanding the 2019 Novel Coronavirus ", "Increased Flare of Acne Caused by Long\u2010Time Mask Wearing During COVID\u201019 Pandemic among General Population ", "Masks and Coronavirus Disease 2019 (COVID-19). ", "Bacteria bound to cloth; glucoprotamin; toluidine blue O; surgical helmets versus filtering masks ", "COVID-19 - ESSKA guidelines and recommendations for resuming elective surgery The roadmap to elective surgery resumption after this COVID-19 pandemic should be progressive and cautious. The aim of this paper was to give recommendations and guidelines for resuming elective orthopedic surgery in the safest environment possible. Elective surgery should be performed in COVID-free facilities and hospital stay should be as short as possible. For matters of safety, patients considered first for surgery should be carefully selected according to COVID infection status/exposure, age, ASA physical status classification system / risk factors, socio-professional situation and surgical indication. A strategy for resuming elective surgery in four phases is proposed. Preoperative testing for COVID-19 infection is highly recommended. In any cases, COVID symptoms including fever and increased temperature should be constantly monitored until the day of surgery. Elective surgery should be postponed at the slightest suspicion of a COVID-19 infection. In case of surgery, adapted personal protective equipment in terms of gowns, gloves, masks and eye protection is highly recommended and described.", "Perioperative Considerations in Urgent Surgical Care of Suspected and Confirmed Coronavirus Disease 2019 Orthopaedic Patients: Operating Room Protocols and Recommendations in the Current Coronavirus Disease 2019 Pandemic By April 7, 2020, severe acute respiratory syndrome coronavirus 2 was responsible for 1,383,436 confirmed cases of Coronavirus disease 2019 (COVID-19), involving 209 countries around the world; 378,881 cases have been confirmed in the United States. During this pandemic, the urgent surgical requirements will not stop. As an example, the most recent Centers of Disease Control and Prevention reports estimate that there are 2.8 million trauma patients hospitalized in the United States. These data illustrate an increase in the likelihood of encountering urgent surgical patients with either clinically suspected or confirmed COVID-19 in the near future. Preparation for a pandemic involves considering the different levels in the hierarchy of controls and the different phases of the pandemic. Apart from the fact that this pandemic certainly involves many important health, economic, and community ramifications, it also requires several initiatives to mandate what measures are most appropriate to prepare for mitigating the occupational risks. This article provides evidence-based recommendations and measures for the appropriate personal protective equipment for different clinical and surgical activities in various settings. To reduce the occupational risk in treating suspected or confirmed COVID-19 urgent orthopaedic patients, recommended precautions and preventive actions (triage area, ED consultation room, induction room, operating room, and recovery room) are reviewed.", "Anaesthesia and COVID-19: infection control Summary The world is currently facing an unprecedented healthcare crisis caused by a pandemic novel beta coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The pathogen is spread by human-to-human transmission via droplets exposure and contact transfer, causing mild symptoms in the majority of cases, but critical illness, bilateral viral pneumonia, and acute respiratory distress syndrome (ARDS) in a minority. Currently, controlling infection to prevent the spread of SARS-CoV-2 is the primary public healthcare intervention used. The pace of transmission and global scale of SARS-CoV-2 infections has implications for strategic oversight, resource management, and responsiveness in infection control. This article presents a summary of learning points in epidemiological infection control from the SARS epidemic, alongside a review of evidence connecting current understanding of the virologic and environmental contamination properties of SARS-CoV-2. We present suggestions for how personal protective equipment policies relate to the viral pandemic context and how the risk of transmission by and to anaesthetists, intensivists, and other healthcare workers can be minimised.", "Use of N95, Surgical, and Cloth Masks to Prevent COVID-19 in Health Care and Community Settings: Living Practice Points From the American College of Physicians (Version 1) Controversy exists around the appropriate types of masks and the situations in which they should be used in community and health care settings for the prevention of SARS-CoV-2 infection. In this article, the American College of Physicians (ACP) provides recommendations based on the best available evidence through 14 April 2020 on the effectiveness of N95 respirators, surgical masks, and cloth masks in reducing transmission of infection. The ACP plans periodic updates of these recommendations on the basis of ongoing surveillance of the literature for 1 year from the initial search date.", "Practice of habitual and volitional health behaviors to prevent severe acute respiratory syndrome among Chinese adolescents in Hong Kong Abstract Purpose To explore factors relating to the practice of habitual and volitional health behaviors against the severe acute respiratory syndrome (SARS) among Chinese adolescents in Hong Kong. Methods A community telephone survey was conducted with 230 Chinese adolescents. Random-digit dialing of the local residential telephone directory was used to select respondents, who were asked to provide information on their practice of SARS preventive health behaviors and associated factors as specified by the Health Belief Model. These factors included perceived threat of SARS, perceived benefits and barriers in practicing SARS preventive health behaviors, cues to action, knowledge of SARS, and self-efficacy. Hierarchical regression analyses were conducted to determine salient correlates of habitual and volitional health behaviors against SARS. Results About 54.8% of respondents reported practicing all three recommended habitual health behaviors. Another 47.8% indicated consistent practice of volitional health behavior of facemask-wearing to prevent SARS. Results of hierarchical regression analyses showed that habitual health behaviors against SARS were related to perceived health threat and environmental cues. For facemask-wearing, salient correlates were environmental cues, rates of SARS habitual health behaviors, younger age, and perceived health threat. Conclusions The Health Belief Model is useful in understanding Chinese adolescents\u2019 practice of health behaviors, especially volitional health behaviors.", "The myth of masks: a tale of risk selection in the COVID\u201019 pandemic ", "The use of facemasks by the general population to prevent transmission of Covid 19 infection: A systematic review. Background The pandemic of COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2), has become a serious worldwide public health emergency. This systematic review aims to summarize the available evidence regarding the role of face mask in community settings in slowing the spread of respiratory viruses such as SARS- CoV-2. Methods The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used for this review. A literature search using PUBMED, Google Scholar, and Cochrane database were performed using Medical subject heading (MeSH) words from the year 2000-2020. The articles focused on the use of masks and N95 respirators in healthcare workers were excluded. Results A total of 305 records were identified, out of which 14 articles were included in the review based upon quality and eligibility criteria. All the articles mentioned about the role of face masks in preventing the spread of respiratory viruses like influenza, SARS, and SARS-CoV-2, in the community or experimental setting. Studies also suggested that early initiation of face mask usage was more effective. Masks were also reported to be more effective in viruses that transmit easily from asymptomatic individuals, as is now known in SARS-CoV-2. Conclusion Theoretical, experimental, and clinical evidence suggested that usage of face masks in a general population offered significant benefit in preventing the spread of respiratory viruses especially in the pandemic situation, but its utility is limited by inconsistent adherence to mask usage.", "\u2018Masking the evidence\u2019: perspectives of the COVID\u201019 pandemic The COVID\u201019 pandemic presents a severe and acute public health emergency around the world. The event of the pandemic has seen an upsurge in the general public wearing of disposable surgical masks (DSM) and other types of face masks. The World Health Organisation of mask wearing has been widely debated in the press a(WHO) have changed their advice, to now recommend the routine wearing of fabric masks by the general public as a means of preventing the spread of COVID\u201019 (WHO 2020a).", "Why not use the Easybreath snorkeling mask to prevent COVID-19 transmission during endoscopy procedures when FFP2 are lacking? ", "COVID-19 pandemic and personal protective equipment shortage: protective efficacy comparing masks and scientific methods for respirator reuse BACKGROUND AND AIMS: The abrupt outbreak of the novel coronavirus disease 2019 and its rapid spread over many healthcare systems throughout the world has led to a shortage in personal protective equipment (PPE), which cannot be solved by reducing their use or by increasing production. It is thus necessary to promote PPE rational use, highlighting possible differences in terms of efficacy and promoting an effective technique to reuse them. METHODS: A literature search was performed on PubMed, Scopus, Cochrane database, and Google Scholar, and from the 25 top cited articles, 15 were selected for relevance and impact. RESULTS: Most studies on previous respiratory virus epidemics to date suggest surgical masks are not inferior compared with N95 respirators in terms of protective efficacy among healthcare workers. Therefore, the use of N95 respirators should be limited to high-risk situations. Concerning respirator reuse, highly energetic, short-wave, ultraviolet germicidal irradiation (UVGI) at 254 nm was determined to decontaminate N95 respirators from viral respiratory agents, but UVGI requires careful consideration of the type of respirator and of the biologic target. CONCLUSIONS: Rational use and successful reuse of respirators can help in the shortage of PPE during a pandemic. Further studies testing UVGI and other decontamination techniques are an unmet need. The definitive answer to pandemic issues can be found in artificial intelligence and deep learning. These groundbreaking modalities could help in identifying high-risk patients and in suggesting appropriate types and use of PPE.", "Response to COVID-19 in Taiwan: Big Data Analytics, New Technology, and Proactive Testing. ", "Public Masking: An Urgent Need to Revise Global Policies to Protect against COVID-19 Public Masking: An Urgent Need to Revise Global Policies to Protect against Novel Coronavirus Disease (COVID-19).", "Universal Masking during Covid-19 Pandemic - Current Evidence and Controversies The emergence of coronavirus disease 19 pandemic and novel research on the high transmissibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has raised controversies over the use of face masks to prevent community transmission. Specific regulations need to be fulfilled to use a face mask as part of the personal protective equipment and high quality of evidence supporting its use to prevent respiratory viral infections, including SARS-CoV-2, is lacking. However, its widespread use is becoming a standard practice in some countries and discrepancies between health authorities on their policy have led to controversy. The aim of this review is to provide an outlook on recent research in this matter and areas of opportunity.", "Immediate-use steam sterilization sterilizes N95 masks without mask damage ", "Review of economic evaluations of mask and respirator use for protection against respiratory infection transmission BACKGROUND: There has been increasing debate surrounding mask and respirator interventions to control respiratory infection transmission in both healthcare and community settings. As decision makers are considering the recommendations they should evaluate how to provide the most efficient protection strategies with minimum costs. The aim of this review is to identify and evaluate the existing economic evaluation literature in this area and to offer advice on how future evaluations on this topic should be conducted. METHODS: We searched the Scopus database for all literature on economic evaluation of mask or respirator use to control respiratory infection transmission. Reference lists from the identified studies were also manually searched. Seven studies met our inclusion criteria from the initial 806 studies identified by the search strategy and our manual search. RESULTS: Five studies considered interventions for seasonal and/or pandemic influenza, with one also considering SARS (Severe Acute Respiratory Syndrome). The other two studies focussed on tuberculosis transmission control interventions. The settings and methodologies of the studies varied greatly. No low-middle income settings were identified. Only one of the reviewed studies cited clinical evidence to inform their mask/respirator intervention effectiveness parameters. Mask and respirator interventions were generally reported by the study authors to be cost saving or cost-effective when compared to no intervention or other control measures, however the evaluations had important limitations. CONCLUSIONS: Given the large cost differential between masks and respirators, there is a need for more comprehensive economic evaluations to compare the relative costs and benefits of these interventions in situations and settings where alternative options are potentially applicable. There are at present insufficient well conducted cost-effectiveness studies to inform decision-makers on the value for money of alternative mask/respirator options.", "Infection prevention and control in paediatric office settings Transmission of infection in the paediatric office is an issue of increasing concern. This document discusses routes of transmission of infection and the principles of current infection control measures. Prevention includes appropriate office design and administrative policies, triage, routine practices for the care of all patients (e.g., hand hygiene; use of gloves, masks, eye protection, and gowns for specific procedures; adequate cleaning, disinfection, and sterilization of surfaces and equipment, including toys; and aseptic technique for invasive procedures), and additional precautions for specific infections. Personnel should be adequately immunized, and those infected should follow work-restriction policies.", "N95 Mask Decontamination using Standard Hospital Sterilization Technologies The response to the COVID19 epidemic is generating severe shortages of personal protective equipment around the world. In particular, the supply of N95 respirator masks has become severely depleted with supplies having to be rationed and health care workers having to use masks for prolonged periods in many countries. We sought to test the ability of 4 different decontamination methods including autoclave treatment, ethylene oxide gassing, ionized hydrogen peroxide fogging and vaporized hydrogen peroxide exposure to decontaminate 4 different N95 masks of experimental contamination with SARS-CoV-2 or vesicular stomatitis virus as a surrogate. In addition, we sought to determine whether masks would tolerate repeated cycles of decontamination while maintaining structural and functional integrity. We found that one cycle of treatment with all modalities was effective in decontamination and was associated with no structural or functional deterioration. Vaporized hydrogen peroxide treatment was tolerated to at least 5 cycles by masks. Most notably, standard autoclave treatment was associated with no loss of structural or functional integrity to a minimum of 10 cycles for the 3 pleated mask models. The molded N95 mask however tolerated only 1 cycle. This last finding may be of particular use to institutions globally due to the virtually universal accessibility of autoclaves in health care settings.", "Leveraging Wettability Engineering to Develop Three-Layer DIY Face Masks From Low-Cost Materials With the rapid spread of COVID-19 worldwide, the demand for appropriate face masks in the market has also skyrocketed. To ease strain on the supply of masks to the essential healthcare sector, it has become imperative that ordinary people rely more on home-made masks that can be easily put together using commonly available materials, while at the same time performing reasonably at arresting the ingress or egress of airborne droplets. Here, we propose a simple do-it-yourself (DIY) method for preparing a three-layered face mask that deploys two hydrophobic polypropylene nonwoven layers interspaced with a hydrophilic cellulosic cloth. The first hydrophobic layer, facing the user, allows high-momentum droplets (e.g., expelled by a sneeze or cough) to pass through and get absorbed in the next hydrophilic layer, thereby keeping the skin in contact with the mask dry and comfortable. The third (outermost) hydrophobic layer prevents penetration of the liquids from the middle layer to the outside, and also arrests any airborne droplets on its exterior. Simple tests show that our masks perform better in arresting the droplet transmission as compared to surgical masks available in the market. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s41403-020-00115-9) contains supplementary material, which is available to authorized users.", "Preventing intra-hospital infection and transmission of COVID-19 in healthcare workers Abstract Coronavirus disease 2019 (COVID-19) poses an occupational health risk to healthcare workers. Several thousand healthcare workers have already been infected, mainly in China. Preventing intra-hospital transmission of the communicable disease is therefore a priority. Based on the Systems Engineering Initiative for Patient Safety model, the strategies and measures to protect healthcare workers in an acute tertiary hospital are described along the domains of work task, technologies and tools, work environmental factors, and organizational conditions. The principle of zero occupational infection remains an achievable goal that all healthcare systems need to strive for in the face of a potential pandemic.", "Epidemiology reveals mask wearing by the public is crucial for COVID-19 control Abstract Objective The pandemic 2019 Coronavirus disease (COVID-19) is the greatest concern globally. Here we analyzed the epidemiological features of China, South Korea, Italy and Spain to find out the relationship of major public health events and epidemiological curves. Study design In this study we describe and analyze the epidemiological characteristics of COVID-19 in and outside China. We use GAM to generate the epidemiological curves and simulate infection curves with reported incubation period. Results The epidemiological curved derived from the GAM suggested that the infection curve can reflect the public health measurements sensitively. Under the massive actions token in China, the infection curve flattened at 23rd of January. While surprisingly, even before Wuhan lockdown and first level response of public emergency in Guangdong and Shanghai, those infection curve came to the reflection point both at 21st of January, which indicated the mask wearing by the public before 21st Jan were the key measure to cut off the transmission. In the countries outside China, infection curve also changed in response to measures, but its rate of decline was much smaller than the curve of China's. Conclusion The present analysis comparing the epidemiological curves in China, South Korea, Italy and Spain supports the importance of mask wearing by the public. Analysis of the infection curve helped to clarify the impact of important public health events, evaluate the efficiencies of prevention measures, and showed wearing masks in public resulted in significantly reduced daily infected cases.", "High-Risk Aerosol-Generating Procedures in COVID-19: Respiratory Protective Equipment Considerations The correct selection and utilization of respiratory personal protective equipment is of the utmost importance in the current COVID-19 pandemic. This is especially true for health care workers exposed to high-risk aerosol-generating procedures, including otolaryngologists, ophthalmologists, neurosurgeons, maxillofacial surgeons, and laparoscopic surgeons. This communication provides a review of approved forms of respiratory protection and compares their characteristics, including surgical masks, N95 respirator, elastomeric respirators, powered air-purifying respirators, and controlled air-purifying respirators. For standard airborne precautions, N95 respirator are appropriate for respiratory protection. However, high-risk aerosol-generating procedures may create aerosolization of high viral loads that represent increased risk to health care workers. In these situations, enhanced respiratory protection with filters certified as 99, 100, or HEPA (high-efficiency particulate air) may be appropriate.", "The Battle Against Coronavirus Disease 2019 (COVID-19): Emergency Management and Infection Control in a Radiology Department Abstract Objective To describe the strategy and the emergency management and infection control procedure of our radiology department during the coronavirus disease 2019 (COVID-19) outbreak. Methods We set up emergency management and sensing control teams. The team formulated various measures: reconfiguration of the radiology department, personal protection and training of staff, examination procedures for patients suspected of or confirmed with COVID-19 as well as patients without an exposure history or symptoms. Those with suspected or confirmed COVID-19 infection were scanned in the designated fever-CT unit. Results From January 21, 2020, to March 9, 2020, 3,083 people suspected or confirmed to be infected with COVID-19 underwent fever-CT examinations. Including initial examinations and re-examinations, the total number of fever-CT examinations numbered 3,340. As a result of our precautions, none of the staff of the radiology department were infected with COVID-19. Conclusion Strategic planning and adequate protections can help protect patients and staff against a highly infectious disease while maintaining function at a high-volume capacity.", "Utility of Substandard Face Mask Options for Health Care Workers During the COVID-19 Pandemic ", "Coronavirus disease 2019 (COVID-19) pandemic: International variation of personal protective equipment (PPE) and infection prevention and control (IPC) guidelines ", "Covid-19: countermeasure for N95 mask-induced pressure sore ", "Face Mask-induced Itch: A Self-questionnaire Study of 2,315 Responders During the COVID-19 Pandemic. Little is known about itch related to the use of face masks. This internet survey study investigated the prevalence, intensity and clinical characteristics of itch related to the use of face masks by the general public during the COVID-19 pandemic. A total of 2,315 replies were received, of which 2,307 were included in the final analysis. Of the respondents, 1,393 (60.4%) reported using face masks during the previous week, and, of these, 273 (19.6%) participants reported having itch. Subjects who reported sensitive skin and atopic predisposition, and those with facial dermatoses (acne, atopic dermatitis or seborrhoeic dermatitis) were at significantly higher risk of itch development. The high-est rating of itch for the whole group on the Itch Numeral Rating Scale was 4.07 \u00b1 2.06 (itch of moderate intensity). Responders who wore masks for longer periods more frequently reported itch. Almost 30% of itchy subjects reported scratching their face without removing the mask, or after removing the mask and then scratching. Wearing face masks is linked to development of itch, and scratching can lead to incorrect use of face masks, resulting in reduced protection.", "A history of the medical mask and the rise of throwaway culture ", "Correspondence: Angiotensin-converting enzyme 2 coated nanoparticles containing respiratory masks, chewing gums and nasal filters may be used for protection against COVID-19 infection \u2022 World has encountered a novel pandemic called as COVID-19. \u2022 All people need protective items such as masks and gloves worldwide. \u2022 Preventing COVID-19 infection has become the most important issue. \u2022 ACE2 containing nanomaterials may be used in the respiratory masks, gloves and clothes. \u2022 Using nanotechnology to prevent this pandemic may be hope for fighting against COVID-19.", "How Ophthalmologists Should Understand and Respond to the Current Epidemic of Novel Coronavirus Pneumonia (COVID-19)/ \u4e2d\u534e\u5b9e\u9a8c\u773c\u79d1\u6742\u5fd7 The new coronavirus pneumonia that first appeared in Wuhan, China, in December 2019 has attracted great attention from both the Chinese government and the international community. The International Committee on Viral Classification named the virus &quot;Severe Acute Respiratory Syndrome Coronavirus 2&quot; (SARS-CoV-2), and the WHO named the pneumonia it causes &quot;Coronavirus Disease 2019&quot; (COVID-19). At present, the disease is centered in Wuhan City and is spreading rapidly to all parts of China, as well as twenty other countries. About 20% of the people infected during the SARS epidemic in 2003 were employees in hospital environments. COVID-19 has infected an even greater number of heath care workers. Therefore, ophthalmologists need to understand the disease and recognize the importance of taking preventive measures. Although ophthalmologists do not work on the front lines of the outbreak, due to their area of expertise, a variety of situations, such as infection consultations or ophthalmic emergency treatments, can lead to the exposure of ophthalmologists to high-risk environments. This risk will only increase as the number of infected patients continues to increase. When dealing with seemingly normal ophthalmic patients, the vigilance of ophthalmologists and associated staff tends to be significantly reduced. To better protect patients, families, and health care workers, it is strongly recommended that in addition to the standard precautions for the care of all patients, strict contact precautions and droplet precautions need to be taken by ophthalmologists. These measures include 1) wearing an efficient mask (an N95 mask); 2) always performing hand hygiene before and after examining a patient; (3) wearing sterile gloves when entering a patient\u2019s room and touching a patient; (4) wearing a gown when contact is expected with items and environmental surfaces surrounding a patient or when the patient is incontinent or has diarrhea or a surgical or other invasive wound with oozing fluid; 5) cleaning and disinfecting ophthalmic equipment and correctly handling medical waste after examination to prevent transmission to patients who are subsequently examined; 6) wearing goggles and a disposable mask to cover the front and sides of the face before touching a patient, as the virus could spread through the ocular surface; 7) performing the relevant screening for novel coronavirus pneumonia for regular patients who have conjunctivitis and respiratory symptoms at the same time; 8) prohibiting the use of infected patients as potential donors for corneal transplants and temporarily adding donor SARS-CoV-2 screening to the medical standard of the eye bank during the outbreak; and 9) for the purposes of scientific research, diagnosis, and other special needs, packing, shipping, and transporting collected specimens according to the relevant dangerous biological goods regulations.", "[Expert consensus on preventing nosocomial transmission during respiratory care for critically ill patients infected by 2019 novel coronavirus pneumonia]. Definite evidence has shown that the novel coronavirus (COVID-19) could be transmitted from person to person, so far more than 1,700 bedside clinicians have been infected. A lot of respiratory treatments for critically ill patients are deemed as high-risk factors for nosocomial transmission, such as intubation, manual ventilation by resuscitator, noninvasive ventilation, high-flow nasal cannula, bronchoscopy examination, suction and patient transportation, etc, due to its high possibility to cause or worsen the spread of the virus. As such, we developed this consensus recommendations on all those high-risk treatments, based on the current evidence as well as the resource limitation in some areas, with the aim to reduce the nosocomial transmission and optimize the treatment for the COVID-19 pneumonia patients. Those recommendations include: (1) Standard prevention and protection, and patient isolation; (2) Patient wearing mask during HFNC treatment; (3) Using dual limb ventilator with filters placed at the ventilator outlets, or using heat-moisture exchanger (HME) instead of heated humidification in single limb ventilator with HME placed between exhalation port and mask; avoid using mask with exhalation port on the mask; (4) Placing filter between resuscitator and mask or artificial airway; (5) For spontaneous breathing patients, placing mask for patients during bronchoscopy examination; for patients receiving noninvasive ventilation, using the special mask with bronchoscopy port to perform bronchoscopy; (6) Using sedation and paralytics during intubation, cuff pressure should be maintained between 25-30 cmH(2)O; (7) In-line suction catheter is recommended and it can be used for one week; (8) Dual-limb heated wire circuits are recommended and only changed with visible soiled; (9. For patients who need breathing support during transportation, placing an HME between ventilator and patient; (10) PSV is recommended for implementing spontaneous breathing trial (SBT), avoid using T-piece to do SBT. When tracheotomy patients are weaned from ventilator, HME should be used, avoid using T-piece or tracheostomy mask. (11) Avoid unnecessary bronchial hygiene therapy; (12) For patients who need aerosol therapy, dry powder inhaler metered dose inhaler with spacer is recommended for spontaneous breathing patients; while vibrating mesh nebulizer is recommended for ventilated patients and additional filter is recommended to be placed at the expiratory port of ventilation during nebulization.", "Human Coronavirus Data from Four Clinical Trials of Masks and Respirators There are few published data on the protection of masks or respirators against coronavirus infections. This is an important research question to inform the response to the COVID-19 epidemic. The transmission modes of human coronaviruses are similar, thought to be by droplet, contact and sometimes airborne routes. There are several randomised clinical trials of masks and respirators, but most used clinical endpoints or tested only for influenza. In four trials which we conducted, we tested for human coronaviruses, but only composite viral endpoints were reported in the trials. We reviewed and analysed the coronavirus data from four of our trials. Laboratory-confirmed coronavirus infections were identified in our community household trial (1 case), health worker trials (8 cases) and trial of mask use by sick patients (19 cases). No coronavirus infections were transmitted in households to parents who wore P2 or surgical masks, but one child with coronavirus infection transmitted infection to a parent in the control arm. No transmissions to close contacts occurred when worn by sick patients with coronavirus infections. There was a higher risk of coronavirus infection in HCWs who wore a mask compared to a respirator, but the difference was not statistically significant. These are the only available data on coronavirus infections associated with mask or respirator use. More clinical trials are needed to assess the efficacy of respiratory protection against coronavirus infections.", "Effectiveness of Masks and Respirators Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis This systematic review and meta-analysis quantified the protective effect of facemasks and respirators against respiratory infections among healthcare workers. Relevant articles were retrieved from Pubmed, EMBASE, and Web of Science. Meta-analyses were conducted to calculate pooled estimates. Meta-analysis of randomized controlled trials (RCTs) indicated a protective effect of masks and respirators against clinical respiratory illness (CRI) (risk ratio [RR] = 0.59; 95% confidence interval [CI]:0.46\u20130.77) and influenza-like illness (ILI) (RR = 0.34; 95% CI:0.14\u20130.82). Compared to masks, N95 respirators conferred superior protection against CRI (RR = 0.47; 95% CI: 0.36\u20130.62) and laboratory-confirmed bacterial (RR = 0.46; 95% CI: 0.34\u20130.62), but not viral infections or ILI. Meta-analysis of observational studies provided evidence of a protective effect of masks (OR = 0.13; 95% CI: 0.03\u20130.62) and respirators (OR = 0.12; 95% CI: 0.06\u20130.26) against severe acute respiratory syndrome (SARS). This systematic review and meta-analysis supports the use of respiratory protection. However, the existing evidence is sparse and findings are inconsistent within and across studies. Multicentre RCTs with standardized protocols conducted outside epidemic periods would help to clarify the circumstances under which the use of masks or respirators is most warranted.", "Americans are told to wear cloth masks. ", "Respiratory protection for healthcare workers caring for COVID-19 patients ", "Electrostatic Charged Nanofiber Filter for Filtering Airborne Novel Coronavirus (COVID-19) and Nano-aerosols The World Health Organization declared the novel coronavirus (COVID-19) outbreak as a pandemic on March 12, 2020. Within 3-1/2 months since outbreak in December 2019, over 1.3 million people have been infected across 206 countries with over 70,000 deaths. COVID-19 has a size of 60-140nm with mean size of the nano-aerosols, 100nm. The virus can be airborne by attaching to human secretion (fine particles, nasal/saliva droplets) of infected person or suspended fine particulates in air. While NIOSH has standardized N95 and N98 at 300nm, to-date there is no filter standards, nor special filter technologies, tailored for capturing airborne viruses and 100nm nano-aerosols. The latter also are present in high number concentration in atmospheric pollutants. This study addresses developing novel charged PVDF nanofiber filter technology to effectively capture the deadly airborne coronavirus with our target set at 100nm (nano-aerosol), and not 300nm. The virus and its attached particle were simulated by sodium chloride aerosols, 50-500nm, generated from sub-micron aerosol generator. PVDF nanofibers were produced with fiber diameters 84, 191, 349 and 525nm with excellent morphology. The fibers were subsequently charged by corona discharge. The amounts of charged fibers in a filter were increased to achieve high efficiency of 90% for the virus filter but the electrical interference between neighbouring fibers resulted in progressively marginal increase in efficiency and concurrently much higher pressure drop across the filter. The quality factor which measured the efficiency-to-pressure-drop kept decreasing. By redistributing the fibers in the filter into several modules, each separated by a permeable scrim material, the electrical interference was reduced, if not fully mitigated. Also, the additional scrim materials introduced macropores into the filter that further reduced the airflow resistance. With this approach, the quality factor can maintain relatively constant with increasing fiber amounts to achieve high filter efficiency. The optimal amounts of fiber in each module depended on the diameter of fibers in the module. Small fiber diameter that has already high performance required small amount of fibers per module. In contrast, large diameter fiber required more amounts of fiber per module to compensate for the poorer performance without incurring higher pressure drop. This approach was applied to develop four new nanofiber filters tailored for capturing 100nm airborne COVID-19 to achieve over 90% efficiency with pressure drop below 30Pa (3.1mm water). One filter developed meeting the 90% efficiency has ultralow pressure drop of only 18Pa (1.9mm water) while another filter meeting the 30Pa limit has high efficiency reaching 94%. These optimized filters based on rigorous engineering approach provide the badly needed technology for protecting the general public from the deadly airborne COVID-19 and other viruses, and nano-aerosols from air pollution which lead to chronic diseases.", "The use of exhaled nitric oxide and peak expiratory flow to demonstrate improved breathability and antimicrobial properties of novel face mask made with sustainable filter paper and Folium Plectranthii amboinicii oil: additional option for mask shortage during COVID-19 pandemic BACKGROUND: Medical face masks are integral personal protective equipment against infectious airborne disease and become scarce during epidemic outbreaks such as COVID-19. A novel, sustainably manufactured face mask with antimicrobial and anti-inflammatory properties from oil of Folium Plectranthii amboinicii can be an effective alternative to internationally sold masks. METHODS: This prospective, randomized study assigned subjects (n=67) to either conventional surgical face mask or Lamdong Medical College (LMC) face mask for three hours. Fractional concentration of nitric oxide in exhaled breath (FE(NO)) and peak expiratory flow (PEF) was measured before and after mask use. Subjective reporting on respiratory symptoms was also analyzed. Masks were then incubated and analyzed for microorganism growth. RESULTS: Subjects assigned the LMC mask had a lowered FE(NO) (p<0.05) compared to conventional face masks after mask wearing. Subjects with LMC mask use reported higher comfortability (p<0.05), breathability (p<0.05), and lower allergy symptoms (p<0.05). The LMC mask has visually less microorganism growth in the cultured medium, measured by sterile ring radius. CONCLUSIONS: The LMC face mask is a renewably manufactured personal protective tool with antibacterial capacity that can serve as an effective alternative to internationally sold surgical face mask during shortage of mask due to COVID-19.", "Role of respirators in controlling the spread of novel coronavirus (COVID-19) amongst dental healthcare providers: a review During the ongoing COVID-19 pandemic, healthcare professionals are at the forefront of managing the highly infectious coronavirus. As the most common route of transmission is via aerosols and droplet inhalation, it is critical for healthcare workers to have the correct personal protective equipment (PPE) including gowns, masks and goggles. Surgical masks are not effective in preventing the influenza and SARS, so they are unlikely to be able to resist contaminated aerosols from entering the respiratory system. Therefore, it is vital to use respirators which have been proven to offer better protection against droplets, aerosols and fluid penetration and which form a tight seal around the mouth and nose. Various types of respirators are used in healthcare settings, such as half-mask filtering facepiece respirators (FFRs) and powered air-purifying respirators (PAPRs). The most commonly used FFR is the N95 disposable respirator, which is tight fitting and has a 95% or above particle filtering efficiency for a median particle size of 0.3 \u00b5m. This review discusses respirators, their purpose, types, clinical efficiency and proper donning and doffing techniques.", "Counting the cost of COVID-19 Coronavirus disease 2019 (COVID-19) is the name given by the World Health Organization (WHO) to the highly contagious and infectious disease caused by the Novel Corona Virus or SARS-CoV-2, which was first reported on 31 December 2019 in Wuhan city of the capital of China's Hubei province. Due to the rapid increase in the number of infections worldwide, the WHO in March 2020, declared COVID-19 as a pandemic. Historically, first coronavirus had surfaced in 1965 with symptoms of common cold. Since then five different strands of this virus have emerged, most lethal of them was the Severe Acute Respiratory Syndrome (SARS), which infected about eight thousand people, killing ten percent of them. The COVID-19 is not the most deadly pandemic world has ever witnessed as the Spanish influenza pandemic, during 1918\u201319, killed more than fifty million people. Indeed COVID-19 has turned out to be the most lethal of all coronaviruses as it has infected at least three million people killing more than two hundred thousands of them in the first 4 months of its spread. Many politicians and social scientists have dubbed the depression, being caused by COVID-19, worse than that caused by the Second World War. In this article, we shall analyze economic, social, cultural, educational and political impact of the COVID-19.", "Occupation-Related Respiratory Infections Revisited Occupational pulmonary infectious diseases include tuberculosis (TB) and many viral pathogens, including influenza, coronavirus (severe acute respiratory syndrome or SARS), varicella, respiratory syncytial virus, and hantavirus. This review focuses on TB, influenza, and SARS, because the published literature is extensive for these 3 infections. The lessons from these 3 are relevant for all nosocomial pulmonary infectious diseases.", "Cellulose-based virus-retentive filters: a review Viral filtration is a critical step in the purification of biologics and in the monitoring of microbiological water quality. Viral filters are also essential protection elements against airborne viral particles. The present review first focuses on cellulose-based filter media currently used for size-exclusion and/or adsorptive filtration of viruses from biopharmaceutical and environmental water samples. Data from spiking studies quantifying the viral filtration performance of cellulosic filters are detailed, i.e., first, the virus reduction capacity of regenerated cellulose hollow fiber filters in the manufacturing process of blood products and, second, the efficiency of virus recovery/concentration from water samples by the viradel (virus adsorption\u2013elution) method using charge modified, electropositive cellulosic filters or conventional electronegative cellulose ester microfilters. Viral analysis of field water samples by the viradel technique is also surveyed. This review then describes cellulose-based filter media used in individual protection equipment against airborne viral pathogens, presenting innovative filtration media with virucidal properties. Some pros and cons of cellulosic viral filters and perspectives for cellulose-based materials in viral filtration are underlined in the review.", "Evidence-based, cost-effective interventions to suppress the COVID-19 pandemic: a rapid systematic review Background: Countries vary in their response to the COVID-19 pandemic. Some emphasise social distancing, while others focus on other interventions. Evidence on the effectiveness and cost-effectiveness of these interventions is urgently needed to guide public health policy and avoid unnecessary damage to the economy and other harms. We aimed to provide a comprehensive summary of the evidence on epidemic control, with a focus on cost-effectiveness. Methods: MEDLINE (1946 to March week 3, 2020) and Embase (1974 to March 27, 2020) were searched using a range of terms related to epidemic control. Reviews, randomized trials, observational studies, and modelling studies were included. Articles reporting on the effectiveness or cost-effectiveness of at least one intervention were included and grouped into higher-quality (randomized trials) and lower-quality evidence (other study designs). Findings: We found 1,653 papers; 34 were included. Higher-quality evidence was only available to support the effectiveness of hand washing and face masks. Modelling studies suggested that these measures are highly cost-effective. For other interventions, only evidence from observational and modelling studies was available. A cautious interpretation of this body of lower-quality evidence suggests that: (1) the most cost-effective interventions are swift contact tracing and case isolation, surveillance networks, protective equipment for healthcare workers, and early vaccination (when available); (2) home quarantines and stockpiling antivirals are less cost-effective; (3) social distancing measures like workplace and school closures are effective but costly, making them the least cost-effective options; (4) combinations are more cost-effective than single interventions; (5) interventions are more cost-effective when adopted early and for severe viruses like SARS-CoV-2. For H1N1 influenza, contact tracing was estimated to be 4,363 times more cost-effective than school closures ($2,260 vs. $9,860,000 per death prevented). Conclusions: A cautious interpretation of this body of evidence suggests that for COVID-19: (1) social distancing is effective but costly, especially when adopted late and (2) adopting as early as possible a combination of interventions that includes hand washing, face masks, swift contact tracing and case isolation, and protective equipment for healthcare workers is likely to be the most cost-effective strategy.", "Revisi\u00f3n r\u00e1pida del uso de cubrebocas quir\u00fargicos en \u00e1mbito comunitario e infecciones respiratorias agudas./ [Rapid review of the use of community-wide surgical masks and acute respiratory infections] OBJECTIVE: To assess the effectiveness of using surgical masks in community settings to reduce the probability of infection by SARS-CoV-2 or other acute viral respiratory infection, compared to not using surgical masks. MATERIALS AND METHODS: We followed the Cochrane rapid review methodology. The search strategy encompasses one academic database and pre-prints until April 1, 2020. Titles and abstracts were reviewed by one investigator. The full text review was divided among three researchers. The results were synthesized in a narrative way. RESULTS: 713 manuscripts were identified, of which 21 met the inclusion criteria. Of six systematic reviews, four found no reduction in the probability of transmission. Experimental home studies found no differences in the probability of contagion associated with the use of mouth masks. Only one modeling study estimated a 20% reduction in the incidence of acute respiratory disease, assuming that 10 to 50% of the population use the surgical masks correctly. CONCLUSIONS: The scientific evidence is inconclusive to recommend or discourage the use of surgical masks at the population level. Considering the potential negative effects, official recommendations should await for the results of natural experiments currently occurring in countries that have recommended the use of face masks at the population level.", "Resident physician exposure to novel coronavirus (2019-nCoV, SARS-CoV-2) within New York City during exponential phase of COVID-19 pandemic: Report of the New York City Residency Program Directors COVID-19 Research Group Background From March 2-April 12, 2020, New York City (NYC) experienced exponential growth of the COVID-19 pandemic due to novel coronavirus (SARS-CoV-2). Little is known regarding how physicians have been affected. We aimed to characterize COVID-19 impact on NYC resident physicians. Methods IRB-exempt and expedited cross-sectional analysis through survey to NYC residency program directors (PDs) April 3-12, 2020, encompassing events from March 2-April 12, 2020. Findings From an estimated 340 residency programs around NYC, recruitment yielded 91 responses, representing 24 specialties and 2,306 residents. 45.1% of programs reported at least one resident with confirmed COVID-19: 101 resident physicians were confirmed COVID-19-positive, with additional 163 residents presumed positive for COVID-19 based on symptoms but awaiting or unable to obtain testing. 56.5% of programs had a resident waiting for, or unable to obtain, COVID-19 testing. Two COVID-19-positive residents were hospitalized, with one in intensive care. Among specialties with >100 residents represented, negative binomial regression indicated that infection risk differed by specialty (p=0.039). Although most programs (80%) reported quarantining a resident, with 16.8% of residents experiencing quarantine, 14.9% of COVID-19-positive residents were not quarantined. 90 programs, encompassing 99.2% of the resident physicians, reported reuse or extended mask use, and 43 programs, encompassing 60.4% of residents, felt that personal protective equipment (PPE) was suboptimal. 65 programs (74.7%) have redeployed residents elsewhere to support COVID-19 efforts. Interpretation Many resident physicians around NYC have been affected by COVID-19 through direct infection, quarantine, or redeployment. Lack of access to testing and concern regarding suboptimal PPE are common among residency programs. Infection risk may differ by specialty. Funding AHA, MPB, RWSC, CGM, LRDG, and JDH are supported by NEI Core Grant P30EY019007, and unrestricted grant from RPB. ACP and JS are supported by Parker Family Chair. SXX is supported by University of Pennsylvania.", "Being a front-line dentist during the Covid-19 pandemic: a literature review Coronavirus is an enveloped virus with positive-sense single-stranded RNA. Coronavirus infection in humans mainly affects the upper respiratory tract and to a lesser extent the gastrointestinal tract. Clinical symptoms of coronavirus infections can range from relatively mild (similar to the common cold) to severe (bronchitis, pneumonia, and renal involvement). The disease caused by the 2019 novel coronavirus (2019-nCoV) was called Covid-19 by the World Health Organization in February 2020. Face-to-face communication and consistent exposure to body fluids such as blood and saliva predispose dental care workers at serious risk for 2019-nCoV infection. As demonstrated by the recent coronavirus outbreak, information is not enough. During dental practice, blood and saliva can be scattered. Accordingly, dental practice can be a potential risk for dental staff, and there is a high risk of cross-infection. This article addresses all information collected to date on the virus, in accordance with the guidelines of international health care institutions, and provides a comprehensive protocol for managing possible exposure to patients or those suspected of having coronavirus.", "Institution of a Novel Process for N95 Respirator Disinfection with Vaporized Hydrogen Peroxide in the setting of the COVID-19 Pandemic at a Large Academic Medical Center Abstract Personal protective equipment (PPE) has been an invaluable yet limited resource when it comes to protecting healthcare workers against infection during the COVID-19 pandemic. In the US, N95 respirator supply chains are severely strained and conservation strategies are needed. A multidisciplinary team at the Washington University School of Medicine, Barnes Jewish Hospital, and BJC Healthcare was formed to implement a program to disinfect N95 respirators. The process described extends the life of N95 respirators using vaporized hydrogen peroxide (VHP) disinfection and allows healthcare workers to retain their own N95 respirator across a large metropolitan health care system.", "Escalating infection control response to the rapidly evolving epidemiology of the coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in Hong Kong OBJECTIVE: To describe the infection control preparedness measures undertaken for coronavirus disease (COVID-19) due to SARS-CoV-2 (previously known as 2019 novel coronavirus) in the first 42 days after announcement of a cluster of pneumonia in China, on December 31, 2019 (day 1) in Hong Kong. METHODS: A bundled approach of active and enhanced laboratory surveillance, early airborne infection isolation, rapid molecular diagnostic testing, and contact tracing for healthcare workers (HCWs) with unprotected exposure in the hospitals was implemented. Epidemiological characteristics of confirmed cases, environmental samples, and air samples were collected and analyzed. RESULTS: From day 1 to day 42, 42 of 1,275 patients (3.3%) fulfilling active (n = 29) and enhanced laboratory surveillance (n = 13) were confirmed to have the SARS-CoV-2 infection. The number of locally acquired case significantly increased from 1 of 13 confirmed cases (7.7%, day 22 to day 32) to 27 of 29 confirmed cases (93.1%, day 33 to day 42; P < .001). Among them, 28 patients (66.6%) came from 8 family clusters. Of 413 HCWs caring for these confirmed cases, 11 (2.7%) had unprotected exposure requiring quarantine for 14 days. None of these was infected, and nosocomial transmission of SARS-CoV-2 was not observed. Environmental surveillance was performed in the room of a patient with viral load of 3.3 \u00d7 10(6) copies/mL (pooled nasopharyngeal and throat swabs) and 5.9 \u00d7 10(6) copies/mL (saliva), respectively. SARS-CoV-2 was identified in 1 of 13 environmental samples (7.7%) but not in 8 air samples collected at a distance of 10 cm from the patient\u2019s chin with or without wearing a surgical mask. CONCLUSION: Appropriate hospital infection control measures was able to prevent nosocomial transmission of SARS-CoV-2.", "Aerodynamic Characteristics and RNA Concentration of SARS-CoV-2 Aerosol in Wuhan Hospitals during COVID-19 Outbreak Background The ongoing outbreak of COVID-19 has spread rapidly and sparked global concern. While the transmission of SARS-CoV-2 through human respiratory droplets and contact with infected persons is clear, the aerosol transmission of SARS-CoV-2 has been little studied. Methods Thirty-five aerosol samples of three different types (total suspended particle, size segregated and deposition aerosol) were collected in Patient Areas (PAA) and Medical Staff Areas (MSA) of Renmin Hospital of Wuhan University (Renmin) and Wuchang Fangcang Field Hospital (Fangcang), and Public Areas (PUA) in Wuhan, China during COVID-19 outbreak. A robust droplet digital polymerase chain reaction (ddPCR) method was employed to quantitate the viral SARS-CoV-2 RNA genome and determine aerosol RNA concentration. Results The ICU, CCU and general patient rooms inside Renmin, patient hall inside Fangcang had undetectable or low airborne SARS-CoV-2 concentration but deposition samples inside ICU and air sample in Fangcang patient toilet tested positive. The airborne SARS-CoV-2 in Fangcang MSA had bimodal distribution with higher concentration than those in Renmin during the outbreak but turned negative after patients number reduced and rigorous sanitization implemented. PUA had undetectable airborne SARS-CoV-2 concentration but obviously increased with accumulating crowd flow. Conclusions Room ventilation, open space, proper use and disinfection of toilet can effectively limit aerosol transmission of SARS-CoV-2. Gathering of crowds with asymptomatic carriers is a potential source of airborne SARS-CoV-2. The virus aerosol deposition on protective apparel or floor surface and their subsequent resuspension is a potential transmission pathway and effective sanitization is critical in minimizing aerosol transmission of SARS-CoV-2.", "Personal protective equipment during the COVID-19 pandemic - a narrative review. Personal protective equipment has become an important and emotive subject during the current coronavirus (COVID-19) epidemic. COVID-19 is predominantly caused by contact or droplet transmission attributed to relatively large respiratory particles which are subject to gravitational forces and travel only approximately one metre from the patient. Airborne transmission may occur if patient respiratory activity or medical procedures generate respiratory aerosols. These aerosols contain particles that may travel much longer distances and remain airborne longer, but their infective potential is uncertain. Contact, droplet and airborne transmission are each relevant during airway manoeuvres in infected patients, particularly during tracheal intubation. Personal protective equipment is an important component, but only one part, of a system protecting staff and other patients from COVID-19 cross-infection. Appropriate use significantly reduces risk of viral transmission. Personal protective equipment should logically be matched to the potential mode of viral transmission occurring during patient care - contact, droplet, or airborne. Recommendations from international organisations are broadly consistent, but equipment use is not. Only airborne precautions include a fitted high-filtration mask, and this should be reserved for aerosol-generating procedures. Uncertainty remains around certain details of personal protective equipment including use of hoods, mask type and the potential for re-use of equipment.", "A RAPID SYSTEMATIC REVIEW OF THE EFFICACY OF FACE MASKS AND RESPIRATORS AGAINST CORONAVIRUSES AND OTHER RESPIRATORY TRANSMISSIBLE VIRUSES FOR THE COMMUNITY, HEALTHCARE WORKERS AND SICK PATIENTS ABSTRACT Background The pandemic of COVID-19 is growing, and a shortage of masks and respirators has been reported globally. Policies of health organizations for healthcare workers are inconsistent, with a change in policy in the US for universal face mask use. The aim of this study was to review the evidence around the efficacy of masks and respirators for healthcare workers, sick patients and the general public. Methods A systematic review of randomized controlled clinical trials on use of respiratory protection by healthcare workers, sick patients and community members was conducted. Articles were searched on Medline and Embase using key search terms. Results A total of 19 randomised controlled trials were included in this study \u2013 8 in community settings, 6 in healthcare settings and 5 as source control. Most of these randomised controlled trials used different interventions and outcome measures. In the community, masks appeared to be more effective than hand hygiene alone, and both together are more protective. Randomised controlled trials in health care workers showed that respirators, if worn continually during a shift, were effective but not if worn intermittently. Medical masks were not effective, and cloth masks even less effective. When used by sick patients randomised controlled trials suggested protection of well contacts. Conclusion The study suggests that community mask use by well people could be beneficial, particularly for COVID-19, where transmission may be pre-symptomatic. The studies of masks as source control also suggest a benefit, and may be important during the COVID-19 pandemic in universal community face mask use as well as in health care settings. Trials in healthcare workers support the use of respirators continuously during a shift. This may prevent health worker infections and deaths from COVID-19, as aerosolisation in the hospital setting has been documented.", "How and why use the EasyBreath\u00ae Decathlon surface snorkeling mask as a personal protective equipment during the COVID-19 pandemic? During the COVID-19 outbreak, personal protective equipment is widely used to limit infection of caregivers. Innovative solutions have been described to overcome supply shortage. The adaptation of the EasyBreath\u00ae surface snorkeling mask by the Prakash team has benefited from outstanding media coverage. We present four 3D-printed devices that we have modified from the initial innovative design in order to adapt to local constraints. We tested the mask during surgery. The modifications that we made provide better ergonomics, visibility and communication capacities, but that have no official approval for use and can therefore only be recommended in the absence of a validated alternative solution. 3D printing is a tool of prime importance in the production of devices for medical use in health crisis situations.", "Healthcare worker mask reuse in a global pandemic: Using idle resources to create an inexpensive, scalable, and accessible UV system for N95 sterilization As the current COVID-19 pandemic illustrates, not all hospitals and other facilities are equipped with enough personal protective equipment to meet the demand in a crisis. Healthcare workers around the world utilize N95 masks to protect themselves and their patients, yet during this global pandemic they are forced to re-wear what is intended to be single-use masks. This poses significant risk to these healthcare workers along with the populations they are trying to protect. Ultraviolet germicidal irradiation (UVGI) has been validated previously as a way to effectively sterilize these masks between use, however, not all facilities have access to the high cost commercial UV-C lamp sterilization equipment. However, UV-C bulbs are sitting idle in biosafety cabinets (BSCs) at universities and research facilities around the globe that have been shuttered to slow the spread of COVID-19. These bulbs may also be available in existing medical centers where infectious diseases are commonly treated. Therefore, we have developed a method to modify existing light fixtures, or create custom light fixtures compatible with new or existing common UV-C bulbs. This system is scalable and can be created for less than 50 US dollars, on site, at the point of need, and leverages resources that are currently untapped and sitting unused in public and private research facilities. The freely-accessible design can be easily modified for use around the world. Hospitals can obtain this potentially life-saving UVGI resource with minimal funds, via collaboration between research facilities to obtain the UV-C meters and limited availability UVGI bulbs. While mask reuse is not ideal, we must do what we can in emergency situations to protect our frontline healthcare workers and the communities they serve.", "Unipolar ion emission enhances respiratory protection against fine and ultrafine particles Abstract We developed a novel concept that allows to considerably improve the performance of conventionally used filtering-facepiece respirators against fine and ultrafine aerosols including airborne viral and bacterial agents. The concept is based on the continuous emission of unipolar ions. The effect was evaluated through the real-time monitoring of the concentration and size distribution of fine and ultrafine aerosol particles. The measurements were conducted inside and outside of a respiratory mask that was face sealed on a breathing manikin. A commonly used Type N95 respirator and surgical mask were utilized for the tests. The manikin was placed in a 24.3-m3 indoor test chamber and exposed to polydisperse surrogate aerosols simulating viral and bacterial particles with respect to the aerodynamic size. The particle penetration through the mask was found to decrease by one-to-two orders of magnitude as a result of continuous unipolar ion emission in the chamber. The flux of air ions migrated to the breathing zone and imparted electrical charges of the same polarity to the aerosol particles and the respirator filter surface. This created an electrostatic shield along the external surface of the filter, thus enhancing the protection characteristics provided by the respirator. The above performance enhancement effect is crucial for minimizing the infectious risk in the cases when the conventional filtering-facepiece respirators are not able to provide an adequate protection against airborne viruses and bacteria.", "Analytical and numerical investigation of the airflow in face masks used for protection against COVID-19 virus -- implications for mask design and usage The use of face masks for the general public has been suggested in literature as a means to decrease virus transmission during the global COVID-19 pandemic. However, literature findings indicate that most mask designs do not provide reliable protection. This paper investigates the hypothesis that the impaired protection is mainly due to imperfect fitting of the masks, so that airflow, which contains virus-transporting droplets, can leak through gaps into or out of the mask. The fluid dynamics of face masks are investigated via analytical and numerical computations. The results demonstrate that the flow can be satisfactorily predicted by simplified analytical 1D-flow models, by efficient 2D-flow simulations and by 3D-flow simulations. The present results show that already gap heights larger than 0.1mm can result in the mask not fulfilling FFP2 or FFP3 standards, and for gap heights of ca. 1mm most of the airflow and droplets may pass through the gap. The implications of these findings are discussed and improvements to existing mask designs are suggested.", "Guidance for Cardiac Electrophysiology During the Coronavirus (COVID-19) Pandemic from the Heart Rhythm Society COVID-19 Task Force; Electrophysiology Section of the American College of Cardiology; and the Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, American Abstract Covid-19 is a global pandemic that is wreaking havoc with the health and economy of much of human civilization. Electrophysiologists have been impacted personally and professionally by this global catastrophe. In this joint document from representatives of the HRS, ACC and AHA we identify the potential risks of exposure to patients, allied health care staff, industry representatives and hospital administrators. We describe the impact of COVID-19 on cardiac arrhythmias and methods of triage based on acuity and patient comorbidities. We provide guidance for managing invasive and non-invasive electrophysiology procedures, clinic visits and cardiac device interrogations. We discuss resource conservation and the role of tele-medicine in remote patient care along with management strategies for affected patients.", "Aerosol-generating otolaryngology procedures and the need for enhanced PPE during the COVID-19 pandemic: a literature review BACKGROUND: Adequate personal protective equipment is needed to reduce the rate of transmission of COVID-19 to health care workers. Otolaryngology groups are recommending a higher level of personal protective equipment for aerosol-generating procedures than public health agencies. The objective of the review was to provide evidence that a.) demonstrates which otolaryngology procedures are aerosol-generating, and that b.) clarifies whether the higher level of PPE advocated by otolaryngology groups is justified. MAIN BODY: Health care workers in China who performed tracheotomy during the SARS-CoV-1 epidemic had 4.15 times greater odds of contracting the virus than controls who did not perform tracheotomy (95% CI 2.75\u20137.54). No other studies provide direct epidemiological evidence of increased aerosolized transmission of viruses during otolaryngology procedures. Experimental evidence has shown that electrocautery, advanced energy devices, open suctioning, and drilling can create aerosolized biological particles. The viral load of COVID-19 is highest in the upper aerodigestive tract, increasing the likelihood that aerosols generated during procedures of the upper aerodigestive tract of infected patients would carry viral material. Cough and normal breathing create aerosols which may increase the risk of transmission during outpatient procedures. A significant proportion of individuals infected with COVID-19 may not have symptoms, raising the likelihood of transmission of the disease to inadequately protected health care workers from patients who do not have probable or confirmed infection. Powered air purifying respirators, if used properly, provide a greater level of filtration than N95 masks and thus may reduce the risk of transmission. CONCLUSION: Direct and indirect evidence suggests that a large number of otolaryngology-head and neck surgery procedures are aerosol generating. Otolaryngologists are likely at high risk of contracting COVID-19 during aerosol generating procedures because they are likely exposed to high viral loads in patients infected with the virus. Based on the precautionary principle, even though the evidence is not definitive, adopting enhanced personal protective equipment protocols is reasonable based on the evidence. Further research is needed to clarify the risk associated with performing various procedures during the COVID-19 pandemic, and the degree to which various personal protective equipment reduces the risk.", "Textile Masks and Surface Covers\u2014A Spray Simulation Method and a \u201cUniversal Droplet Reduction Model\u201d Against Respiratory Pandemics The main form of COVID-19 transmission is via \u201coral-respiratory droplet contamination\u201d (droplet: very small drop of liquid) produced when individuals talk, sneeze, or cough. In hospitals, health-care workers wear facemasks as a minimum medical \u201cdroplet precaution\u201d to protect themselves. Due to the shortage of masks during the pandemic, priority is given to hospitals for their distribution. As a result, the availability/use of medical masks is discouraged for the public. However, for asymptomatic individuals, not wearing masks in public could easily cause the spread of COVID-19. The prevention of \u201cenvironmental droplet contamination\u201d (EnvDC) from coughing/sneezing/speech is fundamental to reducing transmission. As an immediate solution to promote \u201cpublic droplet safety,\u201d we assessed household textiles to quantify their potential as effective environmental droplet barriers (EDBs). The synchronized implementation of a universal \u201ccommunity droplet reduction solution\u201d is discussed as a model against COVID-19. Using a bacterial-suspension spray simulation model of droplet ejection (mimicking a sneeze), we quantified the extent by which widely available clothing fabrics reduce the dispersion of droplets onto surfaces within 1.8 m, the minimum distance recommended for COVID-19 \u201csocial distancing.\u201d All textiles reduced the number of droplets reaching surfaces, restricting their dispersion to <30 cm, when used as single layers. When used as double-layers, textiles were as effective as medical mask/surgical-cloth materials, reducing droplet dispersion to <10 cm, and the area of circumferential contamination to ~0.3%. The synchronized implementation of EDBs as a \u201ccommunity droplet reduction solution\u201d (i.e., face covers/scarfs/masks and surface covers) will reduce COVID-19 EnvDC and thus the risk of transmitting/acquiring COVID-19.", "Personal protective equipment and Covid 19- a risk to healthcare staff? ", "Endoscopy during the Covid-19 outbreak: experience and recommendations from a single center in a high-incidence scenario Abstract A dramatic SARS-Cov-2 outbreak is hitting Italy hard. To face the new scenario all the hospitals have been re-organised in order to reduce all the outpatient services and to devote almost all their personnel and resources to the management of Covid-19 patients. As a matter of fact, all the services have undergone a deep re-organization guided by: the necessity to reduce exams, to create an environment that helps reduce the virus spread, and to preserve the medical personnel from infection. In these days a re-organization of the endoscopic unit, sited in a high-incidence area, has been adopted, with changes to logistics, work organization and patients selection. With the present manuscript, we want to support gastroenterologists and endoscopists in the organization of a \u201cnew\u201d endoscopy unit that responds to the \u201cnew\u201d scenario, while remaining fully aware that resources availability and local circumstances may extremely vary from unit to unit.", "COVID-19: Role of Ambulatory Surgery Facilities in This Global Pandemic Coronavirus Disease 2019 (COVID-19) has now become a global pandemic. This has led the United States to declare a national emergency and resulted in a ban on all elective diagnostic and therapeutic procedures as well as elective surgery in inpatient and outpatient settings. Ambulatory surgery facilities (ASF) that perform only elective procedures are thus likely to be closed. However, these facilities may be able to assist acute care hospitals as essential (urgent and emergent) surgeries and diagnostic and therapeutic procedures will still need to be performed. The aim of this article is to explore the potential contribution of ASFs in the current health care crisis. It is important to understand that COVID-19\u2013related information is continually evolving, and thus, the discussion provided here is subject to change.", "The efficiency of surgical masks of varying design and composition Five different types of surgical mask of varying design and composition of natural and synthetic fibres were tested for their efficiency in vivo by means of a special test chamber. Contaminated particles escaping through or around the mask during speech by the wearer could be collected and sized. Analysis of the data showed that the gross efficiency of all the masks was high, but that some masks were distinctly better at small particle \u201cfiltration\u201d than others. There was a significant difference in efficiency between the best and worst masks. The best masks contained more fabric, were softer and were pleated, while the worst were stiffer, smaller and not pleated. Reusable cotton fabric masks were as effective as synthetic fabric masks when made to a good design.", "The Practice of Wearing Surgical Masks during the COVID-19 Pandemic. ", "Virus transmission during orthopedic surgery on patients with COVID-19 - a brief narrative review. Background and purpose - COVID-19 is among the most impactful pandemics that the society has experienced. Orthopedic surgery involves procedures generating droplets and aerosols and there is concern amongst surgeons that otherwise rational precautionary principles are being set aside due to lack of scientific evidence and a shortage of personal protective equipment (PPE). This narrative review attempts to translate relevant knowledge into practical recommendations for healthcare workers involved in orthopedic surgery on patients with known or suspected COVID-19.Patients and methods - We unsystematically searched in PubMed, reference lists, and the WHO's web page for relevant publications concerning problems associated with the PPE used in perioperative practice when a patient is COVID-19 positive or suspected to be. A specific search for literature regarding COVID-19 was extended to include publications from the SARS epidemic in 2002/3.Results - Transmission of infectious viruses from patient to surgeon during surgery is possible, but does not appear to be a considerable problem in clinical practice. Seal-leakage is a problem with surgical masks. Due to the lack of studies and reports, the possibility of transmission of SARS-CoV-2 from patient to surgeon during droplet- and aerosol-generating procedures is unknown.Interpretation - Surgical masks should be used only in combination with a widely covering visor and when a respirator (N95, FFP2, P3) is not made available. Furthermore, basic measures to reduce shedding of droplets and aerosols during surgery and correct and consistent use of personal protective equipment is important.", "Preparedness among Ophthalmologists: During and Beyond the COVID-19 Pandemic ", "Strategies for the reuse of N95 and N99 respiratory masks during the COVID-19 pandemic The COVID-19 pandemic presents a strain of unprecedented scale on health systems around the world. In order to reliably protect medical personnel, and thus to contain the spread of the pandemic, it is essential to provide N95 or N99 (European FFP2 or FFP3) respiratory masks (FFRs). Such masks are currently in extreme shortage: To guarantee their supply sufficiently and for all cases, it would absolutely necessary to reuse them. In recent years, the scientific literature has laid out various possibilities to disinfect the FFRs for their reuse several times. We identify the most promising disinfection methods for the current critical situation (internationally) and project further methods and modifications beyond these.", "Custom-Fit Three-Dimensional-Printed BiPAP Mask to Improve Compliance in Patients Requiring Long-Term Noninvasive Ventilatory Support Noninvasive ventilator support using bi-level positive airway pressure/continuous positive airway pressure (BiPAP/CPAP) is commonly utilized for chronic medical conditions like sleep apnea and neuromuscular disorders like amyotrophic lateral sclerosis (ALS) that lead to weakness of respiratory muscles. Generic masks come in standard sizes and are often perceived by patients as being uncomfortable, ill-fitting, and leaky. A significant number of patients are unable to tolerate the masks and eventually stop using their devices. The goal of this project is to develop custom-fit masks to increase comfort, decrease air leakage, and thereby improve patient compliance. A single-patient case study of a patient with variant ALS was performed to evaluate the custom-fit masks. His high nose bridge and overbite of lower jaw caused poor fit with generic masks, and he was noncompliant with his machine. Using desktop Stereolithography three-dimensional (3D) printing and magnetic resonance imaging (MRI) data, a generic mask was extended with a rigid interface such that it was complementary to the patient's unique facial contours. Patient or clinicians interactively select a desired mask shape using a newly developed computer program. Subsequently, a compliant silicone layer was applied to the rigid interface. Ten different custom-fit mask designs were made using computer-aided design software. Patient evaluated the comfort, extent of leakage, and satisfaction of each mask via a questionnaire. All custom-fit masks were rated higher than the standard mask except for two. Our results suggest that modifying generic masks with a 3D-printed custom-fit interface is a promising strategy to improve compliance with BiPAP/CPAP machines.", "Protecting Labor and Delivery Personnel from COVID-19 during the Second Stage of Labor The novel coronavirus disease 2019 (COVID-19) is spreading fast and is affecting the clinical workers at much higher risk than the general population. Little is known about COVID-19 effect on pregnant women; however, the emerging evidence suggests they may be at high risk of asymptomatic disease. In light of projected shortage of personal protective equipment (PPE), there is an aggressive attempt at conservation. In obstetrics, the guidelines on PPE use are controversial and differ among hospitals, globally, as well as nationally. The centers for disease control and prevention (CDC) recommend using N95 respirators, which are respirators that offer a higher level of protection instead of a facemask for when performing or present for an aerosol-generating procedures (AGP). However, the second stage of labor is not considered an AGP. The second stage of labor can last up to 4 hours. During that time, labor and delivery personnel is in close contact to patients, who are exerting extreme effort during and frequently blow out their breath, cough, shout, and vomit, all of which put the health care team at risk, considering that COVID-19 transmission occurs through aerosol generated by coughing and sneezing. The CDC and the American College of Obstetricians and Gynecologists (ACOG) do not provide clarification on the use of N95 during the second stage. We recommend that labor and delivery personnel have the utmost caution and be granted the protection they need to protect themselves and other patients. This includes providing labor and delivery personnel full PPE including N95 for the second stage of labor. This is critical to ensure the adequate protection for health care workers and to prevent spread to other health care workers and patients. Key Points: Second stage of labor exposes providers to aerosol. COVID-19 risk during second stage of labor is high. N95 should be used during second stage of labor.", "The N-95 mask: invaluable ally in the battle against the COVID-19 pandemic The present COVID-19 pandemic, caused by the airborne SARS-CoV-2 virus, has highlighted the vital importance of appropriate personal protective equipment for all exposed health care workers The single most important part of this armor is the N-95 mask With the awareness that the virus is spread by both droplets and through the aerosolized route, the N-95 provides protection that a surgical mask cannot match This timely review looks at the special advantages that an N-95 offers over a surgical mask with specific reference to the COVID-19 epidemic It also emphasizes the crucial importance of ensuring quality masks with a proper fit Finally, with acute scarcities of N-95 masks being reported from hospitals globally, it reviews recent literature which attempts to prolong the life of these masks with extended use, reuse and decontamination of used masks", "Universal public use of surgical mask and respiratory viral infection ", "Universal masking in hospitals in the COVID-19 era: Is it time to consider shielding? With concerns for presymptomatic transmission of COVID-19 and increasing burden of contact tracing and employee furloughs, several hospitals have supplemented pre-existing infection prevention measures with universal masking of all personnel in hospitals. Other hospitals are currently faced with the dilemma of whether or not to proceed with universal masking in a time of critical mask shortages. We summarize the rationale behind a universal masking policy in healthcare settings, important considerations before implementing such a policy and the challenges with universal masking. We also discusses proposed solutions such as universal face shields.", "Knowledge and Beliefs towards Universal Safety Precautions to flatten the curve during Novel Coronavirus Disease (nCOVID-19) Pandemic among general Public in India: Explorations from a National Perspective Background: The novel Coronavirus disease (COVID-19) is being considered as the most serious health threat that the world has never witnessed in the recent times and significantly affecting the daily routine of mankind by emerging as a global pandemic. Yet, as there is no treatment nor a vaccine that was approved so far, universal safety precautions (USPs) and mitigating strategies are the only way to deal with this emergency crisis. However, knowledge and beliefs towards USPs among the general public in countries such as India with a large population are lacking. Methods: A prospective, cross-sectional, web-based online survey was conducted among the general public in India during March 2020. A 20-items self-administered survey questionnaire was developed and randomly distributed among the public using google document forms through social media networks. Descriptive statistics were used in representing the study characteristics, and the Chi-square test was used in assessing the associations among the study variables with a p-value of < 0.05 was considered as statistically significant. Results: Of 1287 participants, 1117 have given their consent of willingness and completed the questionnaire with a response rate of 86.8%. The mean age of the study participants was 28.8 \u00b1 10.9 years, where the majority of them belong to the age category <25 years, and sex was equally distributed. Based upon the socio-demographic information, the majority were post-graduates (32.9%), professional job holders (45%) and belonged to the upper-middle (40%) economic class. Overall, the knowledge and beliefs towards USPs and mitigating strategies among participants varied between moderate to high, with statistically significant associations with their socio-demographic characteristics. Conclusions: Although the knowledge and beliefs of the general public in India towards USPs are encouraging, there is a need for long-term educational interventions as the dynamics and severity of COVID-19 have been changing day-by-day rapidly. The findings of this study could guide the public health authorities in making and implementing decisions to combat this pandemic. Keywords: Coronavirus, COVID-19, outbreak, Pandemic, universal precautions, SARS-CoV-2.", "Application of refined management in prevention and control of the coronavirus disease 2019 epidemic in non-isolated areas of a general hospital Abstract Objective This article summarizes the experience in the prevention and control of coronavirus disease 2019(COVID-19) epidemic in non-isolated areas in a general hospital. Methods Based on refined management theory, we professionally developed the standards for prevention and control of COVID-19 in non-isolated areas, systematically implemented various prevention and control measures, performed gridding audits, effectively communicated among teams and between medical staff and patients assisted by information techniques, and reported results for quality improvement. Results There was no hospital-acquired COVID-19 infections among staff in the hospital. The rates of mask-wearing, epidemiological history screening, and the medical supplies disinfection were all 100% in the hospital. The accuracy rate of mask-wearing of patients and their families was 73.79% and the compliance rate of their hand hygiene was 40.78%. Conclusion Refined management strategies for the prevention and control of COVID-19 infection in non-isolated areas of the general hospital are effective. The accuracy rate of mask-wearing and hand hygiene compliance of patients and their families need to be further improved.", "Association between 2019-nCoV transmission and N95 respirator use 2019-nCoV had caused pneumonia outbreak in Wuhan. Existing evidence have confirmed the human-to-human transmission of 2019-nCoV. We retrospectively collected infection data from 2 January to 22 January at six departments from Zhongnan Hospital of Wuhan University. In our study, we found N95 respirators, disinfection and hand washing can help to reduce the risk of 2019-nCoV infection in medical staffs. Our results call for re-emphasizing strict occupational protection code in battling this novel contagious disease. The risk of 2019-nCoV infection was higher in the open area than in the quarantined area. N95 may be more effective for 2019-nCoV infections.", "Masks and Coronavirus Disease 2019 (COVID-19) ", "Current knowledge of COVID-19 and infection prevention and control strategies in healthcare settings: A global analysis OBJECTIVE: In the current absence of a vaccine for COVID-19, public health responses aim to break the chain of infection by focusing on the mode of transmission. We reviewed the current evidence on the transmission dynamics and on pathogenic and clinical features of COVID-19 to critically identify any gaps in the current infection prevention and control (IPC) guidelines. METHODS: In this study, we reviewed global COVID-19 IPC guidelines by organizations such as the World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC), and the European Centre for Disease Prevention and Control (ECDC). Guidelines from 2 high-income countries (Australia and United Kingdom) and from 1 middle-income country (China) were also reviewed. We searched publications in English on \u2018PubMed\u2019 and Google Scholar. We extracted information related to COVID-19 transmission dynamics, clinical presentations, and exposures that may facilitate transmission. We then compared these findings with the recommended IPC measures. RESULTS: Nosocomial transmission of SARS-CoV-2 in healthcare settings occurs through droplets, aerosols, and the oral\u2013fecal or fecal\u2013droplet route. However, the IPC guidelines fail to cover all transmission modes, and the recommendations also conflict with each other. Most guidelines recommend surgical masks for healthcare providers during routine care and N95 respirators for aerosol-generating procedures. However, recommendations regarding the type of face mask varied, and the CDC recommends cloth masks when surgical masks are unavailable. CONCLUSION: IPC strategies should consider all the possible routes of transmission and should target all patient care activities involving risk of person-to-person transmission. This review may assist international health agencies in updating their guidelines.", "Respirators and surgical facemasks for COVID-19: implications for MRI \u2022 Respirators used for COVID-19 protection have not been tested for MR safety. \u2022 Three of four respirators tested contained ferromagnetic components. \u2022 These respirators are \u2018MR unsafe\u2019. \u2022 Respirators used for COVID-19 protection should be reviewed locally for MR safety. \u2022 Surgical masks offer a WHO approved safe alternative for MR staff.", "Wearing face masks regardless of symptoms is crucial for preventing the spread of COVID-19 in hospitals ", "Update to device-related pressure ulcers: SECURE prevention. COVID-19, face masks and skin damage. The 2019 novel coronavirus disease (COVID-19) pandemic has brought the effects of device-related pressure ulcers (DRPU) into sharp focus. With the increased use of personal protective equipment (PPE), including face masks, continuous positive airway pressure (CAPP) masks and other devices, the incidence of DRPUs among health professionals and patients alike has risen starkly. As such, the Journal of Wound Care (JWC) consensus document, Device-related pressure ulcers: SECURE prevention, published in February 2020, is more relevant than ever. To help support patients and frontline health professionals, JWC is republishing the consensus in a digital format, along with a new introductory article outlining the DRPU risks posed by PPE and other medical devices used by patients and health professionals during the pandemic, and how the skin damage can be avoided. The aim is to provide frontline staff with a clear, simple strategy on how to prevent the risk of personal skin damage and/or DRPU during the pandemic, as well as point them in the direction of more indepth guidance on long-term strategies for prevention, for both themselves and patients.", "A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients BACKGROUND: The pandemic of COVID-19 is growing, and a shortage of masks and respirators has been reported globally. Policies of health organizations for healthcare workers are inconsistent, with a change in policy in the US for universal face mask use. The aim of this study was to review the evidence around the efficacy of masks and respirators for healthcare workers, sick patients and the general public. METHODS: A systematic review of randomized controlled clinical trials on use of respiratory protection by healthcare workers, sick patients and community members was conducted. Articles were searched on Medline and Embase using key search terms. RESULTS: A total of 19 randomised controlled trials were included in this study - 8 in community settings, 6 in healthcare settings and 5 as source control. Most of these randomised controlled trials used different interventions and outcome measures. In the community, masks appeared to be effective with and without hand hygiene, and both together are more protective. Randomised controlled trials in health care workers showed that respirators, if worn continually during a shift, were effective but not if worn intermittently. Medical masks were not effective, and cloth masks even less effective. When used by sick patients randomised controlled trials suggested protection of well contacts. CONCLUSION: The study suggests that community mask use by well people could be beneficial, particularly for COVID-19, where transmission may be pre-symptomatic. The studies of masks as source control also suggest a benefit, and may be important during the COVID-19 pandemic in universal community face mask use as well as in health care settings. Trials in healthcare workers support the use of respirators continuously during a shift. This may prevent health worker infections and deaths from COVID-19, as aerosolisation in the hospital setting has been documented.", "Use of personal protective equipment to protect against respiratory infections in Pakistan: A systematic review Abstract Like other low-income countries, limited data are available on the use of personal protective equipment (PPE) in Pakistan. We conducted a systematic review of studies on PPE use for respiratory infections in healthcare settings in Pakistan. MEDLINE, Embase and Goggle Scholar were searched for clinical, epidemiological and laboratory-based studies in English, and 13 studies were included; all were observational/cross-sectional studies. The studies examined PPE use in hospital (n=7), dental (n=4) or laboratory (n=2) settings. Policies and practices on PPE use were inconsistent. Face masks and gloves were the most commonly used PPE to protect from respiratory and other infections. PPE was not available in many facilities and its use was limited to high-risk situations. Compliance with PPE use was low among healthcare workers, and reuse of PPE was reported. Clear policies on the use of PPE and available PPE are needed to avoid inappropriate practices that could result in the spread of infection. Large, multimethod studies are recommended on PPE use to inform national infection-control guidelines.", "Decontamination Methods for Reuse of Filtering Facepiece Respirators. Importance The novel coronavirus disease 2019 (COVID-19) has proven to be highly infectious, putting health care professionals around the world at increased risk. Furthermore, there are widespread shortages of necessary personal protective equipment (PPE) for these individuals. Filtering facepiece respirators, such as the N95 respirator, intended for single use, can be reused in times of need. We explore the evidence for decontamination or sterilization of N95 respirators for health care systems seeking to conserve PPE while maintaining the health of their workforce. Observations The filtration properties and fit of N95 respirators must be preserved to function adequately over multiple uses. Studies have shown that chemical sterilization using soap and water, alcohols, and bleach render the respirator nonfunctional. Decontamination with microwave heat and high dry heat also result in degradation of respirator material. UV light, steam, low-dry heat, and commercial sterilization methods with ethylene oxide or vaporized hydrogen peroxide appear to be viable options for successful decontamination. Furthermore, since the surface viability of the novel coronavirus is presumed to be 72 hours, rotating N95 respirator use and allowing time decontamination of the respirators is also a reasonable option. We describe a protocol and best practice recommendations for redoffing decontaminated N95 and rotating N95 respirator use. Conclusions and Relevance COVID-19 presents a high risk for health care professionals, particularly otolaryngologists, owing to the nature of viral transmission, including possible airborne transmission and high viral load in the upper respiratory tract. Proper PPE is effective when used correctly, but in times of scarce resources, institutions may turn to alternative methods of preserving and reusing filtering facepiece respirators. Based on studies conducted on the decontamination of N95 respirators after prior outbreaks, there are several options for institutions to consider for both immediate and large-scale implementation.", "Expert consensus on the procedure of interventional diagnosis and treatment of cancer patients during the COVID-19 epidemic Abstract Since December 2019, coronavirus disease (COVID-19) has spread rapidly from Wuhan, Hubei province, to other regions of China. To reduce and prevent cross-over infections in the interventional diagnosis and treatment of tumor patients. The Interventional Oncology Branch of the China Anti-Cancer Association organized specialists to compile the corresponding expert consensus. The consensus summarizes the critical points for COVID-19 prevention, focusing on the management of outpatients, inpatients, and interventional operating room in this particular time.", "Harmonizing the COVID-19 cacophony: People need guidance ", "Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis. BACKGROUND Conflicting recommendations exist related to which facial protection should be used by health care workers to prevent transmission of acute respiratory infections, including pandemic influenza. We performed a systematic review of both clinical and surrogate exposure data comparing N95 respirators and surgical masks for the prevention of transmissible acute respiratory infections. METHODS We searched various electronic databases and the grey literature for relevant studies published from January 1990 to December 2014. Randomized controlled trials (RCTs), cohort studies and case-control studies that included data on health care workers wearing N95 respirators and surgical masks to prevent acute respiratory infections were included in the meta-analysis. Surrogate exposure studies comparing N95 respirators and surgical masks using manikins or adult volunteers under simulated conditions were summarized separately. Outcomes from clinical studies were laboratory-confirmed respiratory infection, influenza-like illness and workplace absenteeism. Outcomes from surrogate exposure studies were filter penetration, face-seal leakage and total inward leakage. RESULTS We identified 6 clinical studies (3 RCTs, 1 cohort study and 2 case-control studies) and 23 surrogate exposure studies. In the meta-analysis of the clinical studies, we found no significant difference between N95 respirators and surgical masks in associated risk of (a) laboratory-confirmed respiratory infection (RCTs: odds ratio [OR] 0.89, 95% confidence interval [CI] 0.64-1.24; cohort study: OR 0.43, 95% CI 0.03-6.41; case-control studies: OR 0.91, 95% CI 0.25-3.36); (b) influenza-like illness (RCTs: OR 0.51, 95% CI 0.19-1.41); or (c) reported workplace absenteeism (RCT: OR 0.92, 95% CI 0.57-1.50). In the surrogate exposure studies, N95 respirators were associated with less filter penetration, less face-seal leakage and less total inward leakage under laboratory experimental conditions, compared with surgical masks. INTERPRETATION Although N95 respirators appeared to have a protective advantage over surgical masks in laboratory settings, our meta-analysis showed that there were insufficient data to determine definitively whether N95 respirators are superior to surgical masks in protecting health care workers against transmissible acute respiratory infections in clinical settings.", "Masks for Prevention of Respiratory Virus Infections, Including SARS-CoV-2, in Health Care and Community Settings: A Living Rapid Review BACKGROUND: Recommendations on masks for preventing coronavirus disease 2019 (COVID-19) vary. PURPOSE: To examine the effectiveness of N95, surgical, and cloth masks in community and health care settings for preventing respiratory virus infections, and effects of reuse or extended use of N95 masks. DATA SOURCES: Multiple electronic databases, including the World Health Organization COVID-19 database and medRxiv preprint server (2003 through 14 April 2020; surveillance through 2 June 2020), and reference lists. STUDY SELECTION: Randomized trials of masks and risk for respiratory virus infection, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and observational studies of mask use and coronavirus infection risk were included. New evidence will be incorporated by using living review methods. DATA EXTRACTION: One reviewer abstracted data and assessed methodological limitations; a second reviewer provided verification. DATA SYNTHESIS: 39 studies (18 randomized controlled trials and 21 observational studies; 33 867 participants) were included. No study evaluated reuse or extended use of N95 masks. Evidence on SARS-CoV-2 was limited to 2 observational studies with serious limitations. Community mask use was possibly associated with decreased risk for SARS-CoV-1 infection in observational studies. In high- or moderate-risk health care settings, observational studies found that risk for infection with SARS-CoV-1 and Middle East respiratory syndrome coronavirus probably decreased with mask use versus nonuse and possibly decreased with N95 versus surgical mask use. Randomized trials in community settings found possibly no difference between N95 versus surgical masks and probably no difference between surgical versus no mask in risk for influenza or influenza-like illness, but compliance was low. In health care settings, N95 and surgical masks were probably associated with similar risks for influenza-like illness and laboratory-confirmed viral infection; clinical respiratory illness had inconsistency. Bothersome symptoms were common. LIMITATIONS: There were few SARS-CoV-2 studies, observational studies have methodological limitations, and the review was done by using streamlined methods. CONCLUSION: Evidence on mask effectiveness for respiratory infection prevention is stronger in health care than community settings. N95 respirators might reduce SARS-CoV-1 risk versus surgical masks in health care settings, but applicability to SARS-CoV-2 is uncertain. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality. Update Alerts: The authors have specified in the Methods section the interval and stop date for updates to this Living Review. As Annals receives updates, they will appear in the Comments section of the article on Annals.org. Reader inquiries about updates that are not available at approximately the specified intervals should be submitted as Comments to the article.", "Skin Reactions to Non\u2010glove Personal Protective Equipment: An Emerging Issue in the COVID\u201019 Pandemic Protecting healthcare workers (HCWs) is crucial during Corona Virus Disease 2019 pandemic and requires wearing personal protective equipment (PPE) [1]. While most of the studies have focused on the skin reactions caused by gloves, other PPE such as gowns, respirator masks, face shields and goggles are also worn by HCWs for long hours during the current epidemic and skin irritations caused by these equipment may cause discouragement of health workers from using them [2]. In this letter we have focused on the reaction caused by non\u2010glove PPE.", "Perioperative preparations for COVID -19 -The Pediatric Cardiac Team Perspective ", "The Facemask in Public and Healthcare Workers\u2013 A Need not a Belief Abstract Since the declaration of the COVID-19 pandemic, a lot of data has invaded our lives, and the conflicting findings have caused us to be frantic about the correct course action. Strict isolation and social distancing measures can flatten the coronavirus infectious curve, and the use of facemask needs to be encouraged and facilitated in crowded places, particularly in hospitals where the 6-feet social distancing cannot be adopted because of physical barriers.", "Efficacy of three face masks in preventing inhalation of airborne contaminants in dental practice ABSTRACT Background Up-to-date studies are needed on the protection provided by face masks used by dentists. We assessed the relative filtering efficacy of two currently used surgical face masks (one a molded mask, the other a tie-on mask) and a certified personal particulate respirator, all made by a single manufacturer. Methods The authors sprayed bicarbonate particulate against a porcelain surface (representing the patient's mouth) and collected it via a mannequin head (representing the dentist's head) placed 40 centimeters away and a tube with two airflow rates (0.5 cubic meters per hour and 9 m3/hour). They calculated the dry residue weight. They performed three separate runs for each mask and three runs with no mask at the two airflow rates with and without aerosol. Results With no mask (control), the authors recorded significant weight gains at both airflow rates with and without vaporization. With vaporization, the three masks were associated with different dry residue weights (P < .03 with the Kruskal-Wallis test at both flow rates), the respirator providing the lowest amount. The respirator provided an efficiency of 94 to 96 percent, compared with 90 to 92 percent and 85 to 86 percent for the molded and tie-on surgical masks, respectively. Conclusions These data provide independent evidence that a certified personal respirator can be more effective than high-quality surgical masks in dental settings. Clinical Implications Dentists should be aware that a certified particulate respirator can provide them with superior filtering protection.", "Practice and technique of using face mask amongst adults in the community: a cross-sectional descriptive study BACKGROUND: The proper use of face mask comprises the correct practice and wearing technique and is important in preventing the spread of respiratory infections. Previous studies have addressed only the aspect of practice and failed to provide a detailed account of face mask usage amongst community-based populations. This study examined the practice and technique of using face mask amongst adults. METHODS: A cross-sectional descriptive design was adopted. A quota sample of 1500 adults was recruited in Hong Kong during a nonepidemic state between January and February 2017. The participants\u2019 practice of using face mask in five given situations was assessed using a questionnaire. Their technique in using face mask, including 12 steps, was assessed using an observation checklist. Statistical tests were used to compare the differences in practice and technique amongst adults of different gender and age groups. RESULTS: Findings revealed that the performance of the participants in both categories was unsatisfactory. In terms of practice, less than one-fifth of the participants reported that they always wore face mask when taking care of family members with fever (14.7%) or respiratory infections (19.5%). Male adults and those aged 55\u201364 reported low frequency in using face mask during required situations. In terms of technique, none of the participants performed all the required steps in using face mask correctly. More than 90% of the participants did not perform hand hygiene before putting on (91.5%), taking off (97.3%), or after disposing (91.5%) face mask. Adults aged 55 and above performed poorer than adults in the younger age groups. CONCLUSION: Compared with previous findings obtained during an epidemic, the performance of the participants during a nonepidemic state was less satisfactory. The possibility of developing fatigue after exposure to repeated epidemics was discussed. This study contributes to a comprehensive understanding of the use of face mask in a community and reveals the underperformed areas. Effort is required to enhance the proper practice of using face mask, convey the message that hand hygiene is an essential step in wearing and taking off a face mask and increase the public\u2019s general concern in the value of using face mask.", "Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations Abstract This document outlines recommendations for physiotherapy management for COVID-19 in the acute hospital setting. It includes: recommendations for physiotherapy workforce planning and preparation; a screening tool for determining requirement for physiotherapy; and recommendations for the selection of physiotherapy treatments and personal protective equipment. It is intended for use by physiotherapists and other relevant stakeholders in the acute care setting caring for adult patients with confirmed or suspected COVID-19.", "An apparatus for nondestructive and rapid comparison of mask approaches in defense against infected respiratory aerosols At the front lines of the world's response to the COVID-19 pandemic are hero-clinicians facing a lack of critical supplies including protective medical grade breathing masks and filtering materials. At the same time, the general public is now being advised to wear masks to help stop the spread. As a result, in the absence of centrally coordinated production and distribution efforts, supply chains for masks, respirators, and materials for advanced filtration technology are immensely burdened. Here we describe experimental efforts to nondestructively quantify three vital characteristics of mask approaches: breathability, material filtration effectiveness, and sensitivity to fit. We focus on protection against water aerosols $>$0.3$\\mu$m using off-the-shelf particulate, flow, and pressure sensors, permitting rapid comparative evaluation of these three properties. We present and discuss both the pressure drop and the particle transmission as a function of flow to permit comparison of relative protection for a set of proposed filter and mask designs. The design considerations of the testing apparatus can be reproduced by university laboratories and medical facilities and used for rapid local quality control of respirator masks which are of uncertified origin, monitoring the long-term effects of various disinfection schemes, and evaluating improvised products not designed or marketed for filtration.", "Preventing Infection of Patients and Healthcare Workers Should Be the New Normal in the Era of Novel Coronavirus Epidemics ", "Radiotherapy Workflow and Protection Procedures During the Coronavirus Disease 2019 (COVID-19) Outbreak: Experience of the Hubei Cancer Hospital in Wuhan, China Abstract The epidemic of Coronavirus Disease 2019 (COVID-19) first broke out in Wuhan in December 2019, and reached its peak in Wuhan in February 2020. It became a major public health challenge for China, and evolved into a global pandemic in March 2020. For radiation oncology departments, the COVID-19 pandemic presents a unique challenge for disease protection and prevention for both patients and staff, owing to the weakened immune systems of cancer patients and the need to deliver timely and uninterrupted radiotherapy. At the Hubei Cancer Hospital, the only hospital in Wuhan that specializes in oncology, we organized an emergency infection control team to lead special efforts to combat COVID-19 during this challenging time. Under its lead, the following measures were implemented in the radiation oncology department: the radiotherapy clinic was divided into different infection control zones with varying levels of protection; special staff and patient infection control training sessions were conducted and appropriate measures deployed; daily symptom testing criteria were implemented for patients undergoing treatment; special rotating schedules and infection control methods were implemented for various staff members such as medical physicists/dosimetrists and radiation therapists; modified radiotherapy workflow and specialized treatment area cleaning and disinfection policies and procedures were designed and executed; and special medical waste disposal methods were implemented. We began treating patients using this new COVID-19 radiotherapy treatment workflow and infection control measures on January 30, 2020. During more than one and a half months of uninterrupted radiation oncology clinical operation through the worst of the Wuhan outbreak, no known COVID-19 infection occurred at our radiotherapy center to our patients or employees. This report may provide valuable information for other radiation oncology departments during this unprecedented public health crisis.", "A Reusable Mask for Coronavirus Disease 2019 (COVID-19) The outbreak of Novel Coronavirus is causing an intensely feared globally. World Health Organization has even declared that it is a global health emergency. The simplest method to limit the spread of this new virus and for people to protect themselves as well as the others is to wear a mask in crowded places. The sudden increase demand on face mask has caused manufacturers the inability to not provide enough products in a short time and the situation properly will stay the same for a period of time. In this article, we aim to give an idea on how to save the number of face masks used but still provides the same protective values using a Cardiopulmonary resuscitation (CPR) mask and a common surgical facemask.", "Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine The epidemic of coronavirus disease 2019 (COVID-19), originating in Wuhan, China, has become a major public health challenge for not only China but also countries around the world. The World Health Organization announced that the outbreaks of the novel coronavirus have constituted a public health emergency of international concern. As of February 26, 2020, COVID-19 has been recognized in 34 countries, with a total of 80,239 laboratory-confirmed cases and 2,700 deaths. Infection control measures are necessary to prevent the virus from further spreading and to help control the epidemic situation. Due to the characteristics of dental settings, the risk of cross infection can be high between patients and dental practitioners. For dental practices and hospitals in areas that are (potentially) affected with COVID-19, strict and effective infection control protocols are urgently needed. This article, based on our experience and relevant guidelines and research, introduces essential knowledge about COVID-19 and nosocomial infection in dental settings and provides recommended management protocols for dental practitioners and students in (potentially) affected areas.", "2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings ", "Protection of Upper Respiratory Tract, Mouth and Eyes Pathogenic bacteria and viruses may invade via upper and lower respiratory tract and via eye mucosa. When an infected person coughs or sneezes heavily, small, invisible droplets with the infective agent may reach a good distance from the source. By using the right form of protection at the right time, infection and disease are prevented. The present chapter is focused on the protection against airborne infections.", "Messaging Mask Wearing During the COVID-19 Crisis: Ideological Differences As the U.S. Government works to slow the spread of the novel coronavirus, messaging is important in getting individuals to comply with public health recommendations, especially as the response from the public seems to be polarized along partisan and ideological lines. Using a recent Centers for Disease Control recommendation of wearing facemasks, I use Regulatory Focus Theory to predict that conservatives will be more responsive to messages related to promotion, while liberals are more responsive to messages related to prevention. Using a pre-registered experimental design, I find no evidence that prevention messages influence attitudes toward mask wearing. Promotion messages, however, cause conservatives to become less supportive of mask wearing, in contrast to theoretical predictions. These findings suggest that, related to messaging about mask wearing, strong ideological differences do not emerge related to the focus of the message.", "A randomised controlled pilot study to compare filtration factor of a novel non-fit-tested high-efficiency particulate air (HEPA) filtering facemask with a fit-tested N95 mask Summary Use of a fit-tested N95 or FFP2 mask is recommended to protect against transmission of airborne pathogens. This poses considerable logistic problems when preparing for, or dealing with, an epidemic. Some of these problems might be overcome by use of a compact reusable high-efficiency particulate air filtering mask that can be cut to size. We carried out a randomised controlled cross-over study to compare the efficacy of such a mask (Totobobo, Dream Lab One Pte Ltd, Singapore) with fit-tested N95 masks (1860 or 1860s or 1862; 3M, St Paul, MN, USA) in 22 healthy volunteers. The median (interquartile range) reduction in airborne particle counts was significantly higher [193-fold (145\u2013200)] for N95 masks than for Totobobo masks [135-fold (83\u2013184)] (P <0.05). There was no statistically significant difference between the proportion of subjects achieving a reduction of \u2265100-fold between N95 (19/22) and Totobobo (16/22) masks. We conclude that use of the Totobobo mask without fit testing cannot be recommended, but its performance is sufficiently promising to warrant further investigation.", "Covid-19: What's the current advice for UK doctors? UK employers have a legal obligation under the Health and Safety at Work Act 1974 to protect staff from harm And the Control of Substances Hazardous to Health Regulations place a duty to carry out individual risk assessments to identify hazards, quantify risks, and put suitable controls in place, says Steven Nimmo, editor of the Occupational Medicine Journal \u201cIf the risk assessment establishes that personal protective equipment (PPE) is required then your employer must provide it, properly fit it, and provide suitable instruction and training in its use,\u201d he says Public Health England\u2019s guidance says that clinicians preparing to assess a patient with suspected covid-19 must wear PPE, which as a minimum should be a correctly fitted FFP3 respirator, gown, gloves, and eye protection 1 Doctors seeing patients with confirmed covid-19 must wear full PPE, including a FFP3 respirator, disposable eye protection, and preferably a visor, a long sleeved disposable gown, and gloves, PHE says For symptomatic, unconfirmed patients, doctors should wear a fluid resistant surgical mask, gloves, apron and eye protection if there is a risk of splashing into the eyes, PHE recommends 2 \u201cPregnant women and children are not at high risk,\u201d Nimmo says \u201cBut the above legal obligations still apply Immunosuppressed people may well be \u2026[TRUNCATED]", "COVID-19 Infection: Implications for Perioperative and Critical Care Physicians Healthcare systems worldwide are responding to Coronavirus Disease 2019 (COVID-19), an emerging infectious syndrome caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus. Patients with COVID-19 can progress from asymptomatic or mild illness to hypoxemic respiratory failure or multisystem organ failure, necessitating intubation and intensive care management. Healthcare providers, and particularly anesthesiologists, are at the frontline of this epidemic, and they need to be aware of the best available evidence to guide therapeutic management of patients with COVID-19 and to keep themselves safe while doing so. Here, the authors review COVID-19 pathogenesis, presentation, diagnosis, and potential therapeutics, with a focus on management of COVID-19\u2013associated respiratory failure. The authors draw on literature from other viral epidemics, treatment of acute respiratory distress syndrome, and recent publications on COVID-19, as well as guidelines from major health organizations. This review provides a comprehensive summary of the evidence currently available to guide management of critically ill patients with COVID-19.", "Disposable N95 Masks Pass Qualitative Fit-Test But Have Decreased Filtration Efficiency after Cobalt-60 Gamma Irradiation The current COVID-19 pandemic has led to a dramatic shortage of masks and other personal protective equipment (PPE) in hospitals around the globe. One component of PPE that is in particular demand are disposable N95 face masks. To alleviate this, many methods of N95 mask sterilization have been studied and proposed with the hope of being able to safely reuse masks. Two major considerations must be made when re-sterilizing masks: (1) the sterilization method effectively kills pathogens, penetrating into the fibers of the mask, and (2) the method does not degrade the operational integrity of the N95 filters. We studied Cobalt-60 gamma irradiation as a method of effective sterilization without inducing mask degradation. Significant literature exists supporting the use of gamma radiation as a sterilization method, with viral inactivation of SARS-CoV reported at doses of at most 10 kGy, with other studies supporting 5 kGy for many types of viruses. However, concerns have been raised about the radiation damaging the fiber material within the mask, specifically by causing cross-linking of polymers, leading to cracking and degradation during fitting and/or deployment. A set of 3M 8210 and 9105 masks were irradiated using MIT's Co-60 irradiator. Three masks of each type received 0 kiloGray (kGy), 10 kGy and 50 kGy of approximately 1.3 MeV gamma radiation from the circular cobalt sources, at a dose rate of 2.2 kGy per hour. Following this sterilization procedure, the irradiated masks passed a OSHA Gerson Qualitative Fit Test QLFT 50 (saccharin apparatus) when donned correctly, performed at the Brigham and Women's Hospital, in a blinded study repeated in triplicate. However, the masks' filtration of 0.3 um particles was significantly degraded, even at 10 kGy. These results suggest against gamma, and possibly all ionizing radiation, as a method of disposable N95 sterilization. Even more importantly, they argue against using the qualitative fit test alone to assess mask integrity.", "Is the fit of N95 facial masks effected by disinfection? A study of heat and UV disinfection methods using the OSHA protocol fit test. The current COVID-19 pandemic has highlighted global supply chain shortcomings in the US hospital delivery system, most notably personal protective equipment (PPE) and COVID-19 is found on these masks ~ 7 days. Recent work from our group has shown two promising disinfection methods for N95 facial masks, dry heat (hot air (75C, 30 min) and UVGI which is UVGI 254 nm, 8W, 30 min. Using N95 five models of N95 masks from three different manufacturers we determined the following: 1) Hot air treated N95 masks applied over 5 cycles did not degrade the fit of masks (1.5% change in fit factor, p = .67), 2) UVGI treated N95 masks applied over 10 cycles were significantly degraded in fit and did not pass quantitative fit testing using OSHA testing protocols on a human model (-77.4% change in fit factor, p = .0002).", "Commercially available endoscopy facemasks to prevent aerosolizing spread of droplets during COVID-19 outbreak ", "Facial protection in the era of COVID\u201019: a narrative review We live in extraordinary times, where COVID\u201019 pandemic has brought the whole world to a screeching halt. Tensions and contradictions that surround the pandemic ridden world include the availability, and the lack thereof, various facial protection measures to mitigate the viral spread. Here, we comprehensively explore the different type of facial protection measures, including masks, needed both for the pubic and the health care workers (HCW). We discuss the anatomy, the critical issues of disinfection and reusability of masks, the alternative equipment available for the protection of the facial region from airborne diseases, such as face shields and powered air purifying respirators (PAPR), and the skin\u2010health impact of prolonged wearing of facial protection by HCW. Clearly, facial protection, either in the form of masks or alternates, appears to have mitigated the pandemic as seen from the minimal COVID\u201019 spread in countries where public mask wearing is strictly enforced. On the contrary, the healthcare systems, that appear to have been unprepared for emergencies of this nature, should be appropriately geared to handle the imbalance of supply and demand of personal protective equipment including face masks. These are two crucial lessons we can learn from this tragic experience.", "Cuidado respiratorio en COVID-19 Resumen Antecedentes El COVID-19 forma parte de la familia de los virus conocida como Coronaviridae. El nuevo pat\u00f3geno \u03b2-coronavirus del subg\u00e9nero Sarbecovirus se denomin\u00f3 inicialmente como el nuevo coronavirus (2019-nCoV); fue identificado en un brote de neumon\u00eda en Wuhan. Los pacientes desarrollan alteraciones en el sistema respiratorio, pudiendo llegar a padecer neumon\u00eda severa, edema pulmonar o s\u00edndrome de dificultad respiratoria aguda. Objetivo Revisar la evidencia cient\u00edfica disponible relacionada con el cuidado del sistema respiratorio, estableciendo pautas generales de tratamiento. M\u00e9todos Revisi\u00f3n narrativa de la literatura. Se realiz\u00f3 una b\u00fasqueda, selecci\u00f3n y revisi\u00f3n de art\u00edculos originales y secundarios escritos en ingl\u00e9s o espa\u00f1ol, en las diferentes bases de datos: NCBI, CENTRAL, MEDLINE y EMBASE, publicados hasta marzo del 2020. Resultados No se ha definido un tratamiento espec\u00edfico ante la nueva enfermedad, teniendo como principal medida terap\u00e9utica el control sintom\u00e1tico. Se recomienda utilizar elementos de bioseguridad: gafas, gorros, guantes, bata larga impermeable, tapabocas de alta eficiencia en personal sanitario (FFP2 o N95). En el paciente sintom\u00e1tico, utilizar tapabocas quir\u00fargico, jab\u00f3n hospitalario, toallas de papel y alcohol al 70% o isoprop\u00edlico. Utilizar ox\u00edgeno mediante sistemas de bajo flujo. En ventilaci\u00f3n mec\u00e1nica, programar modos VCP o VCV, Vt 4-6ml/kg, Fr\u226435, FiO2 para PaO2 de 60mmHg o SpO2 de 92-96%, PEEP 12-17cmH2O, ventilaci\u00f3n prono si PAFI\u2264150 con una relaci\u00f3n 16/8 o 18/6, \u00f3xido n\u00edtrico 5-20ppm. Conclusiones Usar equipos de bioseguridad con el fin de interrumpir la transmisi\u00f3n. En hipoxemia, utilizar sistemas de oxigenoterapia a bajo flujo. Usar estrategias de protecci\u00f3n pulmonar, disminuci\u00f3n de vol\u00famenes corrientes, presiones de meseta y frecuencias respiratorias, implementaci\u00f3n de valores de PEEP elevados, bajos valores de presi\u00f3n de conducci\u00f3n y ventilaci\u00f3n en prono, los cuales han demostrado mejorar\u00eda en la hipoxemia y la sobrevida en pacientes con s\u00edndrome de dificultad respiratoria aguda. Abstract Background COVID-19 is part of the family of viruses known as Coronaviridae. The new pathogen \u03b2-coronavirus of the subgenus Sarbecovirus was initially named as a novel coronavirus (2019-nCoV), identified in a pneumonia outbreak in Wuhan. Patients developed alterations in the respiratory system leading to severe pneumonia, pulmonary oedema, and acute respiratory distress syndrome. Objective To review the available scientific evidence related to the care of the respiratory system in order to establish general treatment guidelines. Methods Narrative review of the literature was carried out that included a search, selection, and review of original and secondary articles written in English or Spanish in the different databases: NCBI, CENTRAL, MEDLINE and EMBASE published up to March 2020. Results No specific treatment for the new disease has been defined, with symptomatic control as the main therapeutic measure. The use of biosecurity elements, such as goggles, hats, gloves, long waterproof aprons, high efficiency masks for healthcare personnel (FFP2 or N95) is recommended. In symptomatic patients use surgical masks, hospital soap, paper towels, and 70% alcohol or isopropyl alcohol. Use oxygen through low flow systems. A mechanical ventilation program in VCP or VCV modes, Vt 4-6ml/Kg, Fr\u226435, FiO2 for PaO2 =60mmHg or SpO2 92-96%, PEEP 12-17cmH2O, prone ventilation if PAFI\u2264150 with ratio 16/8 or 18/6, nitric oxide 5-20ppm. Conclusions Use biosecurity equipment in order to prevent transmission. In hypoxaemia use low flow oxygen therapy systems. Use lung protection strategies, decrease in tidal volumes, plateau pressures and respiratory rates, plus implementation of high PEEP values, low conduction pressure values and prone ventilation. These have been shown to improve hypoxaemia and survival in patients with acute respiratory distress syndrome.", "Masks for Prevention of Respiratory Virus Infections, Including SARS-CoV-2, in Health Care and Community Settings: A Living Rapid Review BACKGROUND: Recommendations on masks for preventing coronavirus disease 2019 (COVID-19) vary. PURPOSE: To examine the effectiveness of N95, surgical, and cloth masks in community and health care settings for preventing respiratory virus infections, and effects of reuse or extended use of N95 masks. DATA SOURCES: Multiple electronic databases, including the World Health Organization COVID-19 database and medRxiv preprint server (2003 through 14 April 2020; surveillance through 2 June 2020), and reference lists. STUDY SELECTION: Randomized trials of masks and risk for respiratory virus infection, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and observational studies of mask use and coronavirus infection risk were included. New evidence will be incorporated by using living review methods. DATA EXTRACTION: One reviewer abstracted data and assessed methodological limitations; a second reviewer provided verification. DATA SYNTHESIS: 39 studies (18 randomized controlled trials and 21 observational studies; 33 867 participants) were included. No study evaluated reuse or extended use of N95 masks. Evidence on SARS-CoV-2 was limited to 2 observational studies with serious limitations. Community mask use was possibly associated with decreased risk for SARS-CoV-1 infection in observational studies. In high- or moderate-risk health care settings, observational studies found that risk for infection with SARS-CoV-1 and Middle East respiratory syndrome coronavirus probably decreased with mask use versus nonuse and possibly decreased with N95 versus surgical mask use. Randomized trials in community settings found possibly no difference between N95 versus surgical masks and probably no difference between surgical versus no mask in risk for influenza or influenza-like illness, but compliance was low. In health care settings, N95 and surgical masks were probably associated with similar risks for influenza-like illness and laboratory-confirmed viral infection; clinical respiratory illness had inconsistency. Bothersome symptoms were common. LIMITATIONS: There were few SARS-CoV-2 studies, observational studies have methodological limitations, and the review was done by using streamlined methods. CONCLUSION: Evidence on mask effectiveness for respiratory infection prevention is stronger in health care than community settings. N95 respirators might reduce SARS-CoV-1 risk versus surgical masks in health care settings, but applicability to SARS-CoV-2 is uncertain. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.", "Inpatient Care of Patients with COVID-19: A Guide for Hospitalists Abstract Since its emergence in December 2019, the virus known as severe acute respiratory syndrome coronavirus 2 has quickly caused a pandemic. This virus causes a disease now known as coronavirus disease 2019, or COVID-19. As an increasing proportion of the at-risk population becomes infected, and patients with severe illness are hospitalized, it is essential for hospitalists to remain current on how to best care for people with suspected or confirmed disease. Establishing a system for logistical planning, and accurate information sharing is strongly recommended. Infection control remains the ultimate goal. As such, healthcare workers should be educated on universal and isolation precautions, and the appropriate use of personal protective equipment. Social distancing should be encouraged to prevent the spread of infection, and creative and innovative ways to reduce contact may need to be considered. Moreover, it is imperative to prepare for contingencies as medical staff will inevitably get sick or become unavailable. Hospitalists have the difficult task of caring for patients, while also adapting to the many logistical and social elements of a pandemic.", "Anesthetic Management of Patients Undergoing Aortic Dissection Repair With Suspected Severe Acute Respiratory Syndrome Coronavirus-2 Infection Severe acute respiratory syndrome coronavirus-2 is still active in Wuhan, China, and is spreading to the rest of the world. Recently, perioperative anesthetic management in patients with suspected or confirmed coronavirus-2 has been reported. However, little has been reported on the anesthetic management of patients undergoing aortic dissection repair in patients with suspected severe acute respiratory syndrome coronavirus-2 infection. During the outbreak in Wuhan, the authors\u2019 team completed 4 cases of aortic dissection repair successfully in patients with suspected severe acute respiratory syndrome coronavirus-2 infection. The purpose of the present report is to summarize current knowledge and experiences on anesthetic management in this patient population and to provide clinical practice guidelines on anesthetic management and infection prevention and control in these critically ill patients.", "Reusable and Recyclable Graphene Masks with Outstanding Superhydrophobic and Photothermal Performances The 2019 coronavirus outbreak (COVID-19) is affecting over 210 countries and territories, and it is spreading mainly by respiratory droplets. The use of disposable surgical masks is common for patients, doctors, and even the general public in highly risky areas. However, the current surgical masks cannot self-sterilize in order to reuse or be recycled for other applications. The resulting high economic and environmental costs are further damaging societies worldwide. Herein, we reported a unique method for functionalizing commercially available surgical masks with outstanding self-cleaning and photothermal properties. A dual-mode laser-induced forward transfer method was developed for depositing few-layer graphene onto low-melting temperature nonwoven masks. Superhydrophobic states were observed on the treated masks' surfaces, which can cause the incoming aqueous droplets to bounce off. Under sunlight illumination, the surface temperature of the functional mask can quickly increase to over 80 \u00b0C, making the masks reusable after sunlight sterilization. In addition, this graphene-coated mask can be recycled directly for use in solar-driven desalination with outstanding salt-rejection performance for long-term use. These roll-to-roll production-line-compatible masks can provide us with better protection against this severe virus. The environment can also benefit from the direct recycling of these masks, which can be used for desalinating seawater.", "Novel Coronavirus 2019 (2019-nCoV) Infection: Part I - Preparedness and Management in the Pediatric Intensive Care Unit in Resource-limited Settings First reported in China, the 2019 novel coronavirus has been spreading across the globe. Till 26 March, 2020, 416,686 cases have been diagnosed and 18,589 have died the world over. The coronavirus disease mainly starts with a respiratory illness and about 5-16% require intensive care management for acute respiratory distress syndrome (ARDS) and multi-organ dysfunction. Children account for about 1-2% of the total cases, and 6% of these fall under severe or critical category requiring pediatric intensive care unit (PICU) care. Diagnosis involves a combination of clinical and epidemiological features with laboratory confirmation. Preparedness strategies for managing this pandemic are the need of the hour, and involve setting up cohort ICUs with isolation rooms. Re-allocation of resources in managing this crisis involves careful planning, halting elective surgeries and training of healthcare workers. Strict adherence to infection control like personal protective equipment and disinfection is the key to contain the disease transmission. Although many therapies have been tried in various regions, there is a lack of strong evidence to recommend anti-virals or immunomodulatory drugs.", "Preventing Facial Pressure Injury for Health Care Providers Adhering to COVID-19 Personal Protective Equipment Requirements OBJECTIVE: To determine if a repurposed silicone-based dressing used underneath a N95 mask is a safe and beneficial option for facial skin injury prevention without compromising the mask\u2019s seal. METHODS: Since February 21, 2020, staff in high risk areas such as the ED and ICU of King Hamad University Hospital have worn N95 masks when doing aerosol-generating procedures to protect against the novel coronavirus 2019. At that time, without education enablers or resources that could be directly translated into practice, the hospital\u2019s Pressure Injury Prevention Committee explored and created a stepwise process to protect the skin under these masks. This procedure was developed over time and tested to make sure that it did not interfere with the effectiveness of the N95 mask seal. RESULTS: Skin protection was achieved by repurposing a readily available silicone border dressing cut into strips. This was tested on 10 volunteer staff members of various skin types and both sexes who became part of this evidence generation project. Oxygen saturation values taken before and after the 4-hour wear test confirmed that well-fitted facial protection did not compromise the mask seal, but rather improved it. An added advantage was increased comfort with less friction as self-reported by the staff. An educational enabler to prevent MDRPI from N95 mask wear was an important additional resource for the staff. CONCLUSIONS: This creative and novel stepwise process of developing a safe skin protection method by which staff could apply a repurposed silicone border dressing beneath an N95 mask was largely effective and aided by the creation of the enabler.", "Associations between wearing masks, washing hands, and social distancing practices, and risk of COVID-19 infection in public: a cohort-based case-control study in Thailand Objective. To investigate whether wearing masks, washing hands and social distancing practices are associated with lower risk of COVID-19 infection. Design. A retrospective cohort-based case-control study. All participants were retrospectively interviewed by phone about their preventive measures against COVID-19 infection. Setting. Thailand, using the data from contact tracing of COVID-19 patients associated with nightclub, boxing stadium and state enterprise office clusters from the Surveillance Rapid Response Team, Department of Disease Control, Ministry of Public Health. Contacts were tested for COVID-19 using PCR assays per national contact tracing guidelines. Participants. A cohort of 1,050 asymptomatic contacts of COVID-19 patients between 1 and 31 March 2020. Main outcome measures. Diagnosis of COVID-19 by 21 April 2020. Odds ratios for COVID-19 infection and population attributable fraction were calculated. Exposure. The study team retrospectively asked about wearing masks, washing hands, and social distancing practices during the contact period through telephone interviews. Results. Overall, 211 (20%) were diagnosed with COVID-19 by 21 Apr 2020 (case group) while 839 (80%) were not (control group). Fourteen percent of cases (29/210) and 24% of controls (198/823) reported wearing either non-medical or medical masks all the time during the contact period. Wearing masks all the time (adjusted odds ratio [aOR] 0.23; 95%CI 0.09-0.60) was associated with lower risk of COVID-19 infections compared to not wearing masks, while wearing masks sometimes (aOR 0.87; 95%CI 0.41-1.84) was not. Shortest distance of contact >1 meter (aOR 0.15; 95%CI 0.04-0.63), duration of close contact [\u2264]15 minutes (aOR 0.24; 95%CI 0.07-0.90) and washing hands often (aOR 0.33; 95%CI 0.13-0.87) were significantly associated with lower risk of infection. Sharing a cigarette (aOR 3.47; 95%CI 1.09-11.02) was associated with higher risk of infection. Type of mask was not independently associated with risk of infection. Those who wore masks all the time were more likely to wash hands and practice social distancing. We estimated that if everyone wore a mask all the time, washed hands often, did not share a dish, cup or cigarette, had shortest distance of contact >1 meter and had duration of close contact [\u2264]15 minutes, cases would have been reduced by 84%. Conclusions. Our findings support consistently wearing non-medical masks, washing hands, and social distancing in public to prevent COVID-19 infections.", "Transmission routes of 2019-nCoV and controls in dental practice A novel \u03b2-coronavirus (2019-nCoV) caused severe and even fetal pneumonia explored in a seafood market of Wuhan city, Hubei province, China, and rapidly spread to other provinces of China and other countries. The 2019-nCoV was different from SARS-CoV, but shared the same host receptor the human angiotensin-converting enzyme 2 (ACE2). The natural host of 2019-nCoV may be the bat Rhinolophus affinis as 2019-nCoV showed 96.2% of whole-genome identity to BatCoV RaTG13. The person-to-person transmission routes of 2019-nCoV included direct transmission, such as cough, sneeze, droplet inhalation transmission, and contact transmission, such as the contact with oral, nasal, and eye mucous membranes. 2019-nCoV can also be transmitted through the saliva, and the fetal\u2013oral routes may also be a potential person-to-person transmission route. The participants in dental practice expose to tremendous risk of 2019-nCoV infection due to the face-to-face communication and the exposure to saliva, blood, and other body fluids, and the handling of sharp instruments. Dental professionals play great roles in preventing the transmission of 2019-nCoV. Here we recommend the infection control measures during dental practice to block the person-to-person transmission routes in dental clinics and hospitals.", "Covid-19: are face masks a good long term strategy? ", "An Interim Solution to the Decreased Availability of Respirators Against COVID-19 ", "Shelter hospital mode: How do we prevent COVID-19 hospital-acquired infection? ", "Medical mask with plasma sterilizing layer In this brief report we propose a new design of a medical mask with a plasma layer, which provides both additional air filtration from microdrops, bacteria and viruses due to the electrostatic effect and self-disinfecting of surfaces by a pulsed barrier discharge. The key features of the mask are the mutual arrangement of the layers, the direction of air flows and the synchronization of the discharge with respiration, which ensures the safe wearing of the mask and high degree of protection against pathogenic microorganisms.", "Rational use of face mask in a tertiary care hospital setting during COVID-19 pandemic: An observational study Masks play a role in the protection of health-care workers (HCWs) from acquiring respiratory infections, including coronavirus disease 2019 (COVID-19) in health-care settings. This observational study was conducted among 382 HCWs in a tertiary care setting over a period of 1 month. Descriptive analysis was done to assess the rational and recommended use of masks/respirators during COVID-19 pandemic using a structured observation checklist as a survey tool. A total of 374 HCWs were included, 64.9% of whom were using face masks rationally as mentioned per risk area categorization with a predominance of triple-layered mask during all 4 weeks. Overall, 64.1% used masks correctly. Clear guidelines and strategies can help to increase the compliance of HCWs with rational use of face masks.", "Custom-made 3D-printed face masks in case of pandemic crisis situations with a lack of commercially available FFP2/3 masks Abstract In the case of pandemic crisis situations, a crucial lack of protective material such as protective face masks for healthcare professionals can occur. A proof of concept (PoC) and prototype are presented, demonstrating a reusable custom-made three-dimensionally (3D) printed face mask based on materials and techniques (3D imaging and 3D printing) with global availability. The individualized 3D protective face mask consists of two 3D-printed reusable polyamide composite components (a face mask and a filter membrane support) and two disposable components (a head fixation band and a filter membrane). Computer-aided design (CAD) was used to produce the reusable components of the 3D face mask based on individual facial scans, which were acquired using a new-generation smartphone with two cameras and a face scanning application. 3D modelling can easily be done by CAD designers worldwide with free download software. The disposable non-woven melt-blown filter membrane is globally available from industrial manufacturers producing FFP2/3 protective masks for painting, construction, agriculture, and the textile industry. Easily available Velcro fasteners were used as a disposable head fixation band. A cleaning and disinfection protocol is proposed. Leakage and virological testing of the reusable components of the 3D face mask, following one or several disinfection cycles, has not yet been performed and is essential prior to its use in real-life situations. This PoC should allow the reader to consider making and/or virologically testing the described custom-made 3D-printed face masks worldwide. The surface tessellation language (STL) format of the original virtual templates of the two reusable components described in this paper can be downloaded free of charge using the hyperlink ( Supplementary Material online).", "COVID-19: lessons from the Italian reproductive medical experience ", "The scientific rationale for the use of simple masks or improvised facial coverings to trap exhaled aerosols and possibly reduce the breathborne spread of COVID-19 The medical community agrees that breathborne infectious materials can be spread with exhaled aerosols and that asymptomatic people, i.e., those showing no symptoms, could be unknowingly infectious. With the current worldwide pandemic of the respiratory coronavirus disease 2019 (COVID-19), various health bodies and governments are recommending that the population wear some form of mask or improvised facial covers while out in public in an effort to reduce the spread of disease . The general concept is that more accessible masks or mask-like materials (scarves, bandanas, etc.) could serve to reduce the amount of infectious aerosol from infected people, and reduce the viral load in the environment. This editorial addresses the underlying scientific rationale that such inexpensive or improvised could indeed serve to reduce the emissions of infectious aerosol by the mechanism of surface adhesion and particle kinetics in addition to the filtration effect.", "Insights into the Recent 2019 Novel Coronavirus (SARS-CoV-2) in Light of Past Human Coronavirus Outbreaks Coronaviruses (CoVs) are RNA viruses that have become a major public health concern since the Severe Acute Respiratory Syndrome-CoV (SARS-CoV) outbreak in 2002. The continuous evolution of coronaviruses was further highlighted with the emergence of the Middle East Respiratory Syndrome-CoV (MERS-CoV) outbreak in 2012. Currently, the world is concerned about the 2019 novel CoV (SARS-CoV-2) that was initially identified in the city of Wuhan, China in December 2019. Patients presented with severe viral pneumonia and respiratory illness. The number of cases has been mounting since then. As of late February 2020, tens of thousands of cases and several thousand deaths have been reported in China alone, in addition to thousands of cases in other countries. Although the fatality rate of SARS-CoV-2 is currently lower than SARS-CoV, the virus seems to be highly contagious based on the number of infected cases to date. In this review, we discuss structure, genome organization, entry of CoVs into target cells, and provide insights into past and present outbreaks. The future of human CoV outbreaks will not only depend on how the viruses will evolve, but will also depend on how we develop efficient prevention and treatment strategies to deal with this continuous threat.", "Universal Masking is Urgent in the COVID-19 Pandemic: SEIR and Agent Based Models, Empirical Validation, Policy Recommendations We present two models for the COVID-19 pandemic predicting the impact of universal face mask wearing upon the spread of the SARS-CoV-2 virus--one employing a stochastic dynamic network based compartmental SEIR (susceptible-exposed-infectious-recovered) approach, and the other employing individual ABM (agent-based modelling) Monte Carlo simulation--indicating (1) significant impact under (near) universal masking when at least 80% of a population is wearing masks, versus minimal impact when only 50% or less of the population is wearing masks, and (2) significant impact when universal masking is adopted early, by Day 50 of a regional outbreak, versus minimal impact when universal masking is adopted late. These effects hold even at the lower filtering rates of homemade masks. To validate these theoretical models, we compare their predictions against a new empirical data set we have collected that includes whether regions have universal masking cultures or policies, their daily case growth rates, and their percentage reduction from peak daily case growth rates. Results show a near perfect correlation between early universal masking and successful suppression of daily case growth rates and/or reduction from peak daily case growth rates, as predicted by our theoretical simulations. Our theoretical and empirical results argue for urgent implementation of universal masking. As governments plan how to exit societal lockdowns, it is emerging as a key NPI; a\"mouth-and-nose lockdown\"is far more sustainable than a\"full body lockdown\", on economic, social, and mental health axes. An interactive visualization of the ABM simulation is at http://dek.ai/masks4all. We recommend immediate mask wearing recommendations, official guidelines for correct use, and awareness campaigns to shift masking mindsets away from pure self-protection, towards aspirational goals of responsibly protecting one's community.", "Evaluation of the user seal check on gross leakage detection of 3 different designs of N95 filtering facepiece respirators BACKGROUND: The use of N95 respirators prevents spread of respiratory infectious agents, but leakage hampers its protection. Manufacturers recommend a user seal check to identify on-site gross leakage. However, no empirical evidence is provided. Therefore, this study aims to examine validity of a user seal check on gross leakage detection in commonly used types of N95 respirators. METHODS: A convenience sample of 638 nursing students was recruited. On the wearing of 3 different designs of N95 respirators, namely 3M-1860s, 3M-1862, and Kimberly-Clark 46827, the standardized user seal check procedure was carried out to identify gross leakage. Repeated testing of leakage was followed by the use of a quantitative fit testing (QNFT) device in performing normal breathing and deep breathing exercises. Sensitivity, specificity, predictive values, and likelihood ratios were calculated accordingly. RESULTS: As indicated by QNFT, prevalence of actual gross leakage was 31.0%-39.2% with the 3M respirators and 65.4%-65.8% with the Kimberly-Clark respirator. Sensitivity and specificity of the user seal check for identifying actual gross leakage were approximately 27.7% and 75.5% for 3M-1860s, 22.1% and 80.5% for 3M-1862, and 26.9% and 80.2% for Kimberly-Clark 46827, respectively. Likelihood ratios were close to 1 (range, 0.89-1.51) for all types of respirators. CONCLUSIONS: The results did not support user seal checks in detecting any actual gross leakage in the donning of N95 respirators. However, such a check might alert health care workers that donning a tight-fitting respirator should be performed carefully.", "Infection control influence of Middle East respiratory syndrome coronavirus: A hospital-based analysis BACKGROUND: Middle East respiratory syndrome coronavirus (MERS-CoV) caused multiple outbreaks. Such outbreaks increase economic and infection control burdens. We studied the infection control influence of MERS-CoV using a hospital-based analysis. METHODS: Our hospital had 17 positive and 82 negative cases of MERS-CoV between April 1, 2013, and June 3, 2013. The study evaluated the impact of these cases on the use of gloves, surgical masks, N95 respirators, alcohol-based hand sanitizer, and soap, as well as hand hygiene compliance rates. RESULTS: During the study, the use of personal protective equipment during MERS-CoV compared with theperiod before MERS-CoV increased dramatically from 2,947.4 to 10,283.9 per 1,000 patient-days (P<.0000001) for surgical masks and from 22 to 232 per 1,000 patient-days (P <.0000001) for N95 masks. The use of alcohol-based hand sanitizer and soap showed a significant increase in utilized amount (P<.0000001). Hand hygiene compliance rates increased from 73% just before the occurrence of the first MERS case to 88% during MERS cases (P = .0001). The monthly added cost was $16,400 for included infection control items. CONCLUSIONS: There was a significant increase in the utilization of surgical masks, respirators, soap and alcohol-based hand sanitizers. Such an increase is a challenge and adds cost to the healthcare system.", "COVID-19 global pandemic planning: Decontamination and reuse processes for N95 respirators Coronavirus disease 2019 (COVID-19) is an illness caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was first identified as a cluster of respiratory illness in Wuhan City, Hubei Province, China, in December 2019, and has rapidly spread across the globe to greater than 200 countries. Healthcare providers are at an increased risk for contracting the disease due to occupational exposure and require appropriate personal protective equipment (PPE), including N95 respirators. The rapid worldwide spread of high numbers of COVID-19 cases has facilitated the need for a substantial supply of PPE that is largely unavailable in many settings, thereby creating critical shortages. Creative solutions for the decontamination and safe reuse of PPE to protect our frontline healthcare personnel are essential. Here, we describe the development of a process that began in late February 2020 for selecting and implementing the use of hydrogen peroxide vapor (HPV) as viable method to reprocess N95 respirators. Since pre-existing HPV decontamination chambers were not available, we optimized the sterilization process in an operating room after experiencing initial challenges in other environments. Details are provided about the prioritization and implementation of processes for collection and storage, pre-processing, HPV decontamination, and post-processing of filtering facepiece respirators. Important lessons learned from this experience include, developing an adequate reserve of PPE for effective reprocessing and distribution, and identifying a suitable location with optimal environmental controls (i.e. operating room). Collectively, information presented here provides a framework for other institutions considering decontamination procedures for N95 respirators. IMPACT STATEMENT: There is a critical shortage of personal protective equipment (PPE) around the globe. This article describes the safe collection, storage, and decontamination of N95 respirators using hydrogen peroxide vapor (HPV). This article is unique because it describes the HPV process in an operating room, and is therefore, a deployable method for many healthcare settings. Results presented here offer creative solutions to the current PPE shortage.", "It's Not the Heat, It's the Humidity: Effectiveness of a Rice Cooker-Steamer for Decontamination of Cloth and Surgical Face Masks and N95 Respirators ", "Evaluation of the efficiency of medical masks and the creation of new medical masks. The effectiveness of medical masks in preventing respiratory infection was investigated by testing bacterial leakage, filtration efficiency, respiratory resistance and oxygen concentration of the enclosed space. Polypropylene (PP) fibres were treated with dimethyldioctadecylammonium bromide to impart a positive electrical charge capable of attracting bacteria. The fluffed PP fibres were used to make a polypropylene mask and to edge standard surgical and N-95 respirators to prevent leakage. A PP napkin was created by melting and blowing PP. The PP edging seal dramatically reduced bacterial leakage of standard masks and was more effective than adhesive paper tape edging in reducing respiratory resistance. Bacterial or viral filtration efficiency was almost 100% for the PP mask and the PP napkin. The specially designed PP mask with a synthetic adhesive at the edge of the mask may be more effective than the standard surgical mask and the N-95 respirator. The PP napkin is an important tool in preventing the spread of pathogens.", "What All We Should Know About Masks in COVID-19 Pandemic ", "Examining the policies and guidelines around the use of masks and respirators by healthcare workers in China, Pakistan and Vietnam. BACKGROUND There is an ongoing debate regarding the type of respiratory protection that should be recommended for use for healthcare workers. MATERIALS AND METHODS A cross-sectional survey was conducted in three countries: China, Pakistan and Vietnam. RESULTS In China and Pakistan, the infection control guidelines were developed to be in line with the recommendations from the World Health Organization (WHO) and the Centers for Disease Control and Prevention, while in the Vietnamese guidelines the recommendations correspond with the WHO suggestions only. The guidelines from all three countries document the need for training and fit testing; however there is no system to monitor the training and fit testing programs. Across the three countries, there was some inconsistency with regard to the types of products (i.e. masks vs. respirators) recommended for influenza, severe acute respiratory syndrome (SARS) and tuberculosis. CONCLUSIONS Available evidence should be examined and a comprehensive policy should be developed on the use of masks and respirators. The policy should address critical areas such as regulation, training, fit testing and reuse.", "Assessment of Fabric Masks as Alternatives to Standard Surgical Masks in Terms of Particle Filtration Efficiency In response to the critical shortage of medical masks resulting from the COVID-19 pandemic, large portions of the population are mobilizing to produce cloth masks using locally-sourced fabrics, however the efficacy of these masks as a means of protecting the wearer from airborne particles carrying virus is not well known. Further, existing protocols are designed for testing the fit and performance N95 respirators and tight-fitting facemasks rather than the relatively more loose-fitting surgical mask style most cloth masks follow. In this study tools and methods typically used to assess tight-fitting facemasks were modified to assess the efficacy of community-produced fabric and commercially-produced surgical masks in terms of protecting the wearer from airborne particles that may be carrying virus. Two TSI PortaCount (model 8028) instruments were operated concurrently to collect particle counts (particles/cm^3) in size range 0.02 to >1 um from ambient air and air just inside the breathing zone of the mask (1 measurement per second, evaluation period of 1 minute per test). Percent particle removal was determined for ten home-made, fabric masks of different designs, with and without filter layers, as well as three commercially-produced surgical-type masks. N95 masks were used to validate the method, and a 3M model 1826 surgical mask was used as a baseline for comparison of other masks of this style. Home-made masks worn as designed always had lower particle removal rates than the 3M masks, achieving between 38% and 96% of this baseline. As has been previously observed by Cooper et al. (1983), adding a layer of nylon stocking over the masks minimized the flow of air around the edges of the masks and improved particle filtration efficiency for all masks, including all commercial products tested. Use of a nylon stocking overlayer brought the particle filtration efficiency for five of the ten fabric masks above the 3M surgical mask baseline. This rapid testing method (<2 hours per mask design) provides a holistic evaluation of mask particle removal efficacy (material, design, and fit), and use of this method for testing a wider range of mask materials and designs will provide the public and health care providers with information needed to optimize health protection given resources at hand.", "Prevalence of facemask use among general public when visiting wet market during Covid-19 pandemic: An observational study. Background In late December 2019, an outbreak of a novel coronavirus disease (COVID-19; previously known as 2019-nCoV) was epidemiologically linked to seafood and wet animal wholesale market in Wuhan, Hubei, China. This has instigated stigma among the general population as the wet market is viewed as a high-risk location for getting infected with coronavirus. Objective This study investigated the prevalence of facemask use among general population visiting the wet market. This study also investigated the demographic factors contributing to unacceptable facemask practice. Setting This prospective observational study was done among visitor to a district wet market selling range of live or freshly slaughtered animals during COVID-19 pandemic outbreak. Methods Individuals entering through dedicated entry point were observed for the type, category and practice of wearing personal protective equipment. Inclusion criteria for this study were any individuals entering the wet market. Subjects were categorized into two groups of acceptable and unacceptable facemask practice. The Pearson chi-square was used to test for differences in investigated variables in the univariate setting and Binary Logistic regression model was used in the multivariate setting. Main outcome measure Prevalence, acceptance practice and odds ratio of unacceptance of facemask use. Results Among 1697 individuals included in the final analysis, 1687 (99.7%) was observed wearing facemask with 1338 (78.8%) using medical-grade facemask. Among them, 1615 (95.7%) individuals facemask practice was acceptable while the reaming 72 (4.3%) individuals were observed with unacceptable facemask practice. Individuals using medical-grade facemask and high-risk age group are 6.4 times (OR=6.40; 95% CI, 2.00-20.43; p=.002) and 2.06 times practice (OR=2.06; 95% CI, 1.08-3.94; p=.028). More likely to practice unacceptable facemask use respectively. Conclusion High saturation of facemask among the general population is an adequate indicator of public hygiene measures strategy which can help to mitigate the COVID-19 epidemic impact. Alarmingly, the unacceptable facemask practice among high-risk population raises the need for a targeted approach by healthcare authorities to ensure satisfactory facemask use.", "COVID-19\u2013We urgently need to start developing an exit strategy Abstract Aim The purpose of this perspective is to review the options countries have to exit the draconian \u201clock downs\u201d in a carefully staged manner. Methods Experts from different countries experiencing Corona Virus Infectious Disease 2019 (COVID-19) review evidence and country specific approaches and results of their interventions. Results Three key factors are important: 1. Reintroduction from countries with ongoing community transmission; 2. The need for extensive testing capacity and widespread community testing, and 3. Adequate supply of personal protective equipment, PPE, to protect health care workers. Lifting social distancing is discussed at length. How to open manufacturing, construction and logistics. The opening og higher educational institutions and schools. The use of electronic surveillance is discussed. Conclusion Each country has to decide what is the best path forward. However, we can learn from each other and the approach is in reality very similar.", "Mass masking in the COVID-19 epidemic: people need guidance ", "The Practice of Wearing Surgical Masks during the COVID-19 Pandemic ", "Is safeguard compromised? Surgical mouth mask harboring hazardous microorganisms in dental practice CONTEXT: Dental personals are more prone to acquire infections through saliva and aerosols. Surgical masks (SMs) are used by dental professionals to reduce microorganism shedding from the mouth, nose, and face of the patient. AIMS: This aim of the study is to assess the bacterial and fungal presence and their prevalence over the contaminated surgical mask in dental practice. SETTINGS AND DESIGN: This study was conducted with sample size 240 used surgical masks collected from 130 dental personnel. SUBJECTS AND METHODS: A cross-sectional questionnaire survey was conducted with analysis involved inoculation of external and internal surfaces in an enrichment media for isolation of bacteria and fungi. Group of isolated bacteria and fungi were preliminarily identified by morphology and using Gram's stain and lacto-phenol cotton blue mediums. Data were analyzed using paired t-test; the significant level of P < 0.050. RESULTS: Microbiological analysis of samples revealed bacteria Staphylococci 26.35% as a predominant species followed by Pseudomonas 17.82% and Streptococci 15.50%. Aspergillus fungal species was also present in 6.97%. Mean \u00b1 SD of bacterial and fungal contamination on inside/outside area of the used masks was 48 \u00b1 26 and 180 \u00b1 110 cfu/ml/piece and 14 \u00b1 6 and 32 \u00b1 13 cfu/ml/piece, respectively, P < 0.001. The used surgical masks from dental department personnel working outpatient dental department had relatively higher bacterial and fungal contamination than the other dental departments. CONCLUSIONS: To reduce a load of microorganism contamination in the clinical environment, more awareness campaigns should be implemented in daily routine and air quality of dental departments should be improved with necessary protective measures.", "Facemasks for the prevention of infection in healthcare and community settings. Facemasks are recommended for diseases transmitted through droplets and respirators for respiratory aerosols, yet recommendations and terminology vary between guidelines. The concepts of droplet and airborne transmission that are entrenched in clinical practice have recently been shown to be more complex than previously thought. Several randomised clinical trials of facemasks have been conducted in community and healthcare settings, using widely varying interventions, including mixed interventions (such as masks and handwashing), and diverse outcomes. Of the nine trials of facemasks identified in community settings, in all but one, facemasks were used for respiratory protection of well people. They found that facemasks and facemasks plus hand hygiene may prevent infection in community settings, subject to early use and compliance. Two trials in healthcare workers favoured respirators for clinical respiratory illness. The use of reusable cloth masks is widespread globally, particularly in Asia, which is an important region for emerging infections, but there is no clinical research to inform their use and most policies offer no guidance on them. Health economic analyses of facemasks are scarce and the few published cost effectiveness models do not use clinical efficacy data. The lack of research on facemasks and respirators is reflected in varied and sometimes conflicting policies and guidelines. Further research should focus on examining the efficacy of facemasks against specific infectious threats such as influenza and tuberculosis, assessing the efficacy of cloth masks, investigating common practices such as reuse of masks, assessing compliance, filling in policy gaps, and obtaining cost effectiveness data using clinical efficacy estimates.", "[risk Assessment for Aerosol Infection by the New Corona Virus and Protection by Respirators] INTRODUCTION: SARS-CoV-2 is dispersed from patients by talking, coughing and sneezing. The generated micro-droplets aerosols can travel up to 8 meters, stay suspended for long periods and preserve viral infectivity for a median of 2.7 hours. An unprotected person exposed to this cloud, might inhale a considerable amount of infectious viral doses, which will attach to the ACE 2 receptors on alveoli epithelium, resulting in infection. N95 respirators and surgical masks block 95% and 50-60% respectively of inhalable particles and protect the wearer from infection. Surgical masks and N95 without exhalation valve, protect both the wearer and the environment from carriers and sick people.", "Non-pharmaceutical public health interventions for pandemic influenza: an evaluation of the evidence base BACKGROUND: In an influenza pandemic, the benefit of vaccines and antiviral medications will be constrained by limitations on supplies and effectiveness. Non-pharmaceutical public health interventions will therefore be vital in curtailing disease spread. However, the most comprehensive assessments of the literature to date recognize the generally poor quality of evidence on which to base non-pharmaceutical pandemic planning decisions. In light of the need to prepare for a possible pandemic despite concerns about the poor quality of the literature, combining available evidence with expert opinion about the relative merits of non-pharmaceutical interventions for pandemic influenza may lead to a more informed and widely accepted set of recommendations. We evaluated the evidence base for non-pharmaceutical public health interventions. Then, based on the collective evidence, we identified a set of recommendations for and against interventions that are specific to both the setting in which an intervention may be used and the pandemic phase, and which can be used by policymakers to prepare for a pandemic until scientific evidence can definitively respond to planners' needs. METHODS: Building on reviews of past pandemics and recent historical inquiries, we evaluated the relative merits of non-pharmaceutical interventions by combining available evidence from the literature with qualitative and quantitative expert opinion. Specifically, we reviewed the recent scientific literature regarding the prevention of human-to-human transmission of pandemic influenza, convened a meeting of experts from multiple disciplines, and elicited expert recommendation about the use of non-pharmaceutical public health interventions in a variety of settings (healthcare facilities; community-based institutions; private households) and pandemic phases (no pandemic; no US pandemic; early localized US pandemic; advanced US pandemic). RESULTS: The literature contained a dearth of evidence on the efficacy or effectiveness of most non-pharmaceutical interventions for influenza. In an effort to inform decision-making in the absence of strong scientific evidence, the experts ultimately endorsed hand hygiene and respiratory etiquette, surveillance and case reporting, and rapid viral diagnosis in all settings and during all pandemic phases. They also encouraged patient and provider use of masks and other personal protective equipment as well as voluntary self-isolation of patients during all pandemic phases. Other non-pharmaceutical interventions including mask-use and other personal protective equipment for the general public, school and workplace closures early in an epidemic, and mandatory travel restrictions were rejected as likely to be ineffective, infeasible, or unacceptable to the public. CONCLUSION: The demand for scientific evidence on non-pharmaceutical public health interventions for influenza is pervasive, and present policy recommendations must rely heavily on expert judgment. In the absence of a definitive science base, our assessment of the evidence identified areas for further investigation as well as non-pharmaceutical public health interventions that experts believe are likely to be beneficial, feasible and widely acceptable in an influenza pandemic.", "COVID-19 and ENT Pediatric otolaryngology during the COVID-19 pandemic. Guidelines of the French Association of Pediatric Otorhinolaryngology (AFOP) and French Society of Otorhinolaryngology (SFORL) ABSTRACT Objective: joint guidelines of the French Pediatric Otolaryngology Society (AFOP) and of the French Society of otorhinolaryngology \u2013 Head and neck Surgery (SFORL) on the management of paediatric otolaryngology patients in the context of the COVID-19 pandemic. Methods: A nation-wide workgroup drew guidelines based on clinical experience, national and local recommendations and scientific literature. Proposals may have to be updated on a day-to-day basis. Results: In children, incidence of symptomatic COVID-19 (1-5%) is low and of good prognosis. The indications for nasal flexible endoscopy should be drastically limited. If undertaken, full Personal Protective Equipment (PPE) including FFP2 masks are required, as well as use of a sheath. Saline nose wash done by caregivers other than parents at home should require PPE. Unless foreign body tracheobronchial aspiration is clinically obvious, CT-scan should be performed to confirm indication of endoscopy. Surgical indications should be limited to emergencies and to cases that cannot be delayed beyond 2 months (especially endonasal, endopharyngeal laryngo-tracheobronchial procedures). Postponement should ideally be a group decision and recorded as such in the medical file. Surgical techniques should be adapted to limit the risk of viral dissemination in the air, avoiding the use of drills, microdebriders, monopolar cautery or lasers. Continuous suction should be placed near the operating field. In case of confirmed Covid-19 cases, or suspected cases (or in some centres systematically), PPE with FFP2 mask should be worn by all staff members present in the operating room.", "An Efficient Ethanol-Vacuum Method for the Decontamination and Restoration of Polypropylene Microfiber Medical Masks & Respirators A critical shortage of respirators, masks and other personal protective equipment (PPE) exists across all sectors of society afflicted by the COVID-19 pandemic, placing medical staff and service workers at heightened risk and hampering efforts to reduce transmission rates. Of particular need are the N95 medical face respirators that filter 95% of all airborne particles at and above 0.3 um in diameter, many of which use meltblown microfibers of charged polypropylene (e.g, the 3M 8200). An intensive search is underway to find reliable methods to lengthen the useful life of these normally disposable units. It is currently believed that these masks and respirators cannot be cleaned with 70 to 75% alcohol-water solutions, as past wet/dry experiments show that filtration efficiency can drop by ~40% after the first such treatment. This has been interpreted as the liquids disrupting the surface charge on the fibers and has led to a recent CDC/NIOSH advisory against using alcohol for their decontamination. We have replicated the drop in efficiency after alcohol treatment. However, we find that the efficiency can be recovered by more effective drying, which we achieve with a vacuum chamber. Drying at pressures of < ~6 mBar (0.6 kPa) restores the measured filtering efficiency to within 2% or so of the pre-washing value, which we have sustained for 5 cleaning-drying cycles so far in three models of N95 masks. The mechanism seems to be the removal of water molecules adsorbed on the fiber surfaces, a hypothesis which is supported by two independent observations: (A) the filtering efficiency increases non-linearly with the weight loss during drying, and (B) filtration efficiency shows an abrupt recovery as the vacuum pressure drops from 13 to 6 mBar, the range physically attributable to the removal of adsorbed water. These results are not compatible with the electrostatic discharge hypothesis, and rather suggest that water molecules adsorbed to the fiber surface are reducing the filtration efficiency via surface tension interactions (e.g., wicking between the fibers and coating their surfaces with a film). Such a degradation mechanism has two implications: (A) Respirators decontaminated by a soak in 70% v/v ethanol regain their filtration efficiency once they are fully dry. We employ vacuum chambers in this study, which are inexpensive and commonly available. (B) This mechanism presents the possibility that mask filtration performance may be subject to degradation by other sources of moisture, and that the mask would continue to be compromised even if it appears dry. The mask would need to be vacuum-dried to restore its performance. This study introduces a number of methods which could be developed and validated for use in resource-limited settings. As the pandemic spreads to rural areas and developing nations, these would allow for local efforts to decontaminate, restore, monitor, and test medical masks.", "COVID-19: A critical care perspective informed by lessons learnt from other viral epidemics ", "COVID\u201019 epidemic: Skin protection for health care workers must not be ignored Since first reported in 2019, pneumonia associated with 2019 novel coronavirus disease (COVID\u201019) has rapidly developed into an outbreak across the world.(1) Number of the patients of all age groups has increased significantly.(2) In order to curb the spread of the epidemic, thousands of health care workers (HCWs) have joined the front line of the fight against this highly contagious disease.(3) When taking care of patients with COVID\u201019 pneumonia, HCWs must first protect themselves by performing adequate hand hygiene and using protective equipment including medical mask, goggles/face shield, gown and gloves.(4) However, the wearing of these personal protective equipment (PPE) on a daily basis and the frequent use of hand disinfectants often cause skin problems which could reduce their enthusiasm for overloaded work and make them anxious at all stages of the pandemic.", "Beyond the assistance: additional exposure situations to COVID-19 for healthcare workers ", "Effect of gamma sterilization on filtering efficiency of various respiratory face-masks Three types of respiratory masks viz N95, non-woven fabric and double layer cotton cloth are being used as an essential inhalation protective measure against COVID-19 by suppressing the entry of respiratory droplets. The filtering efficiency of these masks were tested before and after sterilisation using gamma radiation for the two flow rate conditions corresponding normal breath rate (20lpm) and during sneezing/coughing (90lpm).Sterilisation is carried out using a gamma irradiator containing Co-60 source for the two dose exposures viz. 15kGy and 25kGy. The filtering efficiency for surgical (non-woven fabric) and double layer cotton cloth mask is found to vary from 18% to 22% for the cumulative particle of size [\u2265] 0.3 micron in both un-irradiated and irradiated condition. The filtration efficiency of N95 mask is found to be reduced to 70% for the most penetrating particle size (0.3 micron) with the flow rate of 20lpm and further reduced for particles in the range of 0.1 and 0.2 micron with flow rate of 90 lpm. The reduction in efficiency after gamma sterilization is associated with reduction of electrostatic interaction of filter medium with particles laden in the air stream. Even with reduced filtering efficiency due to gamma sterilisation, the N95 masks are much superior than the surgical and cloth masks. Instead of disposing N95 mask after single use, they can be reused a few times as N70 mask during this pandemic crisis after sterilisation using gamma radiation.", "[Rational use of respiratory protective equipment: advice for health care professionals in time of COVID-19]. The current COVID-19 pandemic has led to a worldwide shortage of respiratory protective equipment. In order to offer maximum protection against infection for all healthcare workers, we need to optimise our use of the available equipment. This article provides practical advice on which type of mask is indicated in what specific situation, what requirements the mask should meet and how to optimise the local workflow, including the re-use of masks after decontamination.", "Novel Coronavirus International Public Health Emergency: Guidance on Radiation Oncology Facility Operation ", "The need of health policy perspective to protect Healthcare Workers during COVID-19 pandemic. A GRADE rapid review on the N95 respirators effectiveness Protecting Health Care Workers (HCWs) during routine care of suspected or confirmed COVID-19 patients is of paramount importance to halt the SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2) pandemic. The WHO, ECDC and CDC have issued conflicting guidelines on the use of respiratory filters (N95) by HCWs. We searched PubMed, Embase and The Cochrane Library from the inception to March 21, 2020 to identify randomized controlled trials (RCTs) comparing N95 respirators versus surgical masks for prevention of COVID-19 or any other respiratory infection among HCWs. The grading of recommendations, assessment, development, and evaluation (GRADE) was used to evaluate the quality of evidence. Four RCTs involving 8736 HCWs were included. We did not find any trial specifically on prevention of COVID-19. However, wearing N95 respirators can prevent 73 more (95% CI 46\u201391) clinical respiratory infections per 1000 HCWs compared to surgical masks (2 RCTs; 2594 patients; low quality of evidence). A protective effect of N95 respirators in laboratory-confirmed bacterial colonization (RR = 0.41; 95%CI 0.28\u20130.61) was also found. A trend in favour of N95 respirators was observed in preventing laboratory-confirmed respiratory viral infections, laboratory-confirmed respiratory infection, and influenza like illness. We found no direct high quality evidence on whether N95 respirators are better than surgical masks for HCWs protection from SARS-CoV-2. However, low quality evidence suggests that N95 respirators protect HCWs from clinical respiratory infections. This finding should be contemplated to decide the best strategy to support the resilience of healthcare systems facing the potentially catastrophic SARS-CoV-2 pandemic.", "PPG Donating 80,000 Masks to Support Coronavirus Relief Efforts ", "Can we use these masks? Rapid Assessment of the Inhalation Resistance Performance of Uncertified Medical Face Masks in the Context of Restricted Resources Imposed during a Public Health Emergency In the case of a public health emergency such as the COVID-19 pandemic, access to large quantities of appropriate personal protection equipment (PPE) has presented a significant problem. A shortage of face masks and respirators has been widely reported across the world. A concerted effort to manufacture high volumes has not unsurprisingly put pressure on the supply chain and the important certification processes. PPE procured or donated as uncertified stock requires rigorous, expedient and scientifically informed evidence before decisions can be made regarding suitable deployment, expensive certification, return or possible destruction of stock. This paper reports a series of experiments devised in reaction to this situation. In this study, an experimental methodology for the assessment of the filtration performance of samples of real-world, uncertified, fluid resistant surgical masks (FRSM type IIR) was evaluated in the resource limited (lockdown) environment of the COVID-19 pandemic. A steady-state flow rig was adapted to incorporate a bespoke filter flow chamber for mounting face masks in order to evaluate the resistance to air flow as an indicator of mask inhalation performance. Pure air was drawn through a specified control surface area at known flow rate conditions; the resistance to the air flow through the masks was measured as the resulting pressure drop. Over 60 tests were performed from 4 different, randomly sampled batches and compared to a control sample of EN Type IIR certified FRSM masks. Steady-state volumetric airflow rates of 30 and 95 lmin-1 were chosen to represent deep breathing and vigorous exercise conditions respectively. The results showed that the sample masks produced a pressure drop of between 26% to 58% compared to the control batch at the lower flow rate and 22% to 55% at the higher rate. The results for each sample were consistent across both flow rates. Within the group of masks tested, two sets (between 48% and 58% of the reference set) showed the potential to be professionally assessed for appropriate deployment in a suitable setting. Although the absolute values of pressure drop measured by this method are unlikely to correlate with other testing approaches, the observed, indicative trends and relative performance of the masks is key to this approach. Critically, this method does not replace certification but it has enabled a public body to quickly make decisions; certify, re-assign, refund, thus saving time and resources. The total time spent conducting the tests was less than 8 hours and the low cost method proposed can be repurposed for low resource regions.", "CORONA-steps for tracheotomy in COVID-19 patients: A staff-safe method for airway management \u2022 The recent outbreak of SARS\u2010CoV\u20102 has assumed worldwide proportion. \u2022 Tracheostomy in intubated COVID-19 patients requires adjunctive safeguards. \u2022 A step-by-step approach named CORONA is proposed in order to recall essential recommendations during the surgical procedure. \u2022 The CORONA-method would allow a secure space in which health workers can guarantee their activity, safely.", "Coronavirus Disease 2019 (COVID-19) Pneumonia in a Hemodialysis Patient Coronavirus disease 2019 (COVID-19) is a highly infective disease caused by the severe acute respiratory syndrome coronavirus 2 virus (SARS-CoV-2). Previous studies of the COVID-19 pneumonia outbreak were based on information from the general population. Limited data are available for hemodialysis patients with COVID-19 pneumonia. This report describes the clinical characteristics of COVID-19 in an in-center hemodialysis patient, as well as our experience in implementing steps to prevent the spread of COVID-19 pneumonia among in-center hemodialysis patients. The diagnosis, infection control, and treatment of COVID-19 in hemodialysis patients are discussed in this report, and we conclude with recommendations for how a dialysis facility can respond to COVID-19 based on our experiences.", "Facial mask: A necessity to beat COVID-19 ", "Selection of homemade mask materials for preventing transmission of COVID-19: a laboratory study The Coronavirus Disease 2019 (COVID-19) has swept the whole world with high mortality. Since droplet transmission is the main route of transmission, wearing a mask serves as a crucial preventive measure. However, the virus has spread quite quickly, causing severe mask shortage. Finding alternative materials for homemade masks while ensuring the significant performance indicators will help alleviate the shortage of masks. Referring to the national standard for the \"Surgical Mask\" of China, 17 materials to be selected for homemade masks were tested in four key indicators: pressure difference, particle filtration efficiency, bacterial filtration efficiency and resistance to surface wetting. Eleven single-layer materials met the standard of pressure difference ([\u2264]49 Pa), of which 3 met the standard of resistance to surface wetting ([\u2265]3), 1 met the standard of particle filtration efficiency ([\u2265]30%), but none met the standard of bacterial filtration efficiency ([\u2265]95%). Based on the testing results of single-layer materials, fifteen combinations of paired materials were tested. The results showed that three double-layer materials including double-layer medical non-woven fabric, medical non-woven fabric plus non-woven shopping bag, and medical non-woven fabric plus granular tea towel could meet all the standards of pressure difference, particle filtration efficiency, and resistance to surface wetting, and were close to the standard of the bacterial filtration efficiency. In conclusion, if resources are severely lacking and medical masks cannot be obtained, homemade masks using available materials, based on the results of this study, can minimize the chance of infection to the maximum extent.", "Current knowledge of COVID-19 and infection prevention and control strategies in healthcare settings: A global analysis OBJECTIVE: In the current absence of a vaccine for COVID-19, public health responses aim to break the chain of infection by focusing on the mode of transmission. We reviewed the current evidence on the transmission dynamics and on pathogenic and clinical features of COVID-19 to critically identify any gaps in the current infection prevention and control (IPC) guidelines. METHODS: In this study, we reviewed global COVID-19 IPC guidelines by organizations such as the World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC), and the European Centre for Disease Prevention and Control (ECDC). Guidelines from 2 high-income countries (Australia and United Kingdom) and from 1 middle-income country (China) were also reviewed. We searched publications in English on 'PubMed' and Google Scholar. We extracted information related to COVID-19 transmission dynamics, clinical presentations, and exposures that may facilitate transmission. We then compared these findings with the recommended IPC measures. RESULTS: Nosocomial transmission of SARS-CoV-2 in healthcare settings occurs through droplets, aerosols, and the oral-fecal or fecal-droplet route. However, the IPC guidelines fail to cover all transmission modes, and the recommendations also conflict with each other. Most guidelines recommend surgical masks for healthcare providers during routine care and N95 respirators for aerosol-generating procedures. However, recommendations regarding the type of face mask varied, and the CDC recommends cloth masks when surgical masks are unavailable. CONCLUSION: IPC strategies should consider all the possible routes of transmission and should target all patient care activities involving risk of person-to-person transmission. This review may assist international health agencies in updating their guidelines.", "Performance of fabrics for home-made masks against spread of respiratory infection through droplets: a quantitative mechanistic study Respiratory infections may spread through droplets, airborne particles, and aerosols from infected individuals through coughing, sneezing, and speaking. In the case of Coronavirus Disease 2019 (COVID-19), droplet spread can occur from symptomatic as well as pre-symptomatic and asymptomatic persons. The U.S. Centers for Disease Control and Prevention (CDC) has therefore recently recommended home-made cloth face coverings for use by the general public in areas of significant community-based transmission. Because medical masks and N95 respirators are in short supply, these are to be reserved for healthcare workers. There is, however, little information on the effectiveness of home-made face coverings in reducing droplet dissemination. Here, we ascertained the performance of ten different fabrics, ranging from cotton to silk, in blocking high velocity droplets, using a 3-layered commercial medical mask as a benchmark material. We also assessed their breathability and ability to soak water. We reason that the materials should be as breathable as possible, without compromising blocking efficiency, to reduce air flow through the sides of the mask since such flow would defeat the purpose of the mask. We found that most home fabrics substantially block droplets, even as a single layer. With two layers, blocking performance can reach that of surgical mask without significantly compromising breathability. Furthermore, we observed that home fabrics are hydrophilic to varying degrees, and hence soak water. In contrast, medical masks are hydrophobic, and tend to repel water. Incoming droplets are thus soaked and 'held back' by home fabrics, which might offer an as of yet untapped and understudied advantage of home-made cloth masks. Overall, our study suggests that most double-layered cloth face coverings may help reduce droplet transmission of respiratory infections.", "Assessment of N95 respirator decontamination and re-use for SARS-CoV-2 The unprecedented pandemic of SARS-CoV-2 has created worldwide shortages of personal protective equipment, in particular respiratory protection such as N95 respirators. SARS-CoV-2 transmission is frequently occurring in hospital settings, with numerous reported cases of nosocomial transmission highlighting the vulnerability of healthcare workers. In general, N95 respirators are designed for single use prior to disposal. Here, we have analyzed four readily available and often used decontamination methods: UV, 70% ethanol, 70C heat and vaporized hydrogen peroxide for inactivation of SARS-CoV-2 on N95 respirators. Equally important we assessed the function of the N95 respirators after multiple wear and decontamination sessions.", "Analysis of SteraMist ionized hydrogen peroxide technology in the sterilization of N95 respirators and other PPE: a quality improvement study OBJECTIVE: The COVID-19 pandemic has led to widespread shortages of personal protective equipment (PPE) for healthcare workers, including filtering facepiece respirators (FFRs) such as N95 masks. These masks are normally intended for single use, but their sterilization and subsequent reuse could substantially mitigate a world-wide shortage. DESIGN: Quality assurance. SETTING: A sealed environment chamber installed in the animal facility of an academic medical center. INTERVENTIONS: One to five sterilization cycles using ionized hydrogen peroxide (iHP), generated by SteraMist\u00ae equipment (TOMI; Frederick, MD). MAIN OUTCOME MEASURES: Personal protective equipment, including five N95 mask models from three manufacturers, were evaluated for efficacy of sterilization following iHP treatment (measured with bacterial spores in standard biological indicator assemblies). Additionally, N95 masks were assessed for their ability to efficiently filter particles down to 0.3\u03bcm and for their ability to form an airtight seal using a quantitative fit test. Filtration efficiency was measured using ambient particulate matter at a university lab and an aerosolized NaCl challenge at a National Institute for Occupational Safety and Health (NIOSH) pre-certification laboratory. RESULTS: The data demonstrate that N95 masks sterilized using SteraMist iHP technology retain function up to five cycles, the maximum number tested to date. Some but not all PPE could also be sterilized using an iHP environmental chamber, but pre-treatment with a handheld iHP generator was required for semi-enclosed surfaces such as respirator hoses. CONCLUSIONS: A typical iHP environment chamber with a volume of ~80 m(3) can treat ~7000 masks per day, as well as other items of PPE, making this an effective approach for a busy medical center.", "Pneumask: Modified Full-Face Snorkel Masks as Reusable Personal Protective Equipment for Hospital Personnel Here we adapt and evaluate a full-face snorkel mask for use as personal protective equipment (PPE) for health care workers, who lack appropriate alternatives during the COVID-19 crisis in the spring of 2020. The design (referred to as Pneumask) consists of a custom snorkel-specific adapter that couples the snorkel-port of the mask to a rated filter (either a medical-grade ventilator inline filter or an industrial filter). This design has been tested for the sealing capability of the mask, filter performance, CO2 buildup and clinical usability. These tests found the Pneumask capable of forming a seal that exceeds the standards required for half-face respirators or N95 respirators. Filter testing indicates a range of options with varying performance depending on the quality of filter selected, but with typical filter performance exceeding or comparable to the N95 standard. CO2 buildup was found to be roughly equivalent to levels found in half-face elastomeric respirators in literature. Clinical usability tests indicate sufficient visibility and, while speaking is somewhat muffled, this can be addressed via amplification (Bluetooth voice relay to cell phone speakers through an app) in noisy environments. We present guidance on the assembly, usage (donning and doffing) and decontamination protocols. The benefit of the Pneumask as PPE is that it is reusable for longer periods than typical disposable N95 respirators, as the snorkel mask can withstand rigorous decontamination protocols (that are standard to regular elastomeric respirators). With the dire worldwide shortage of PPE for medical personnel, our conclusions on the performance and efficacy of Pneumask as an N95-alternative technology are cautiously optimistic.", "Visualizing the effectiveness of face masks in obstructing respiratory jets The use of face masks in public settings has been widely recommended by public health officials during the current COVID-19 pandemic. The masks help mitigate the risk of cross-infection via respiratory droplets; however, there are no specific guidelines on mask materials and designs that are most effective in minimizing droplet dispersal. While there have been prior studies on the performance of medical-grade masks, there are insufficient data on cloth-based coverings, which are being used by a vast majority of the general public. We use qualitative visualizations of emulated coughs and sneezes to examine how material- and design-choices impact the extent to which droplet-laden respiratory jets are blocked. Loosely folded face masks and bandana-style coverings provide minimal stopping-capability for the smallest aerosolized respiratory droplets. Well-fitted homemade masks with multiple layers of quilting fabric, and off-the-shelf cone style masks, proved to be the most effective in reducing droplet dispersal. These masks were able to curtail the speed and range of the respiratory jets significantly, albeit with some leakage through the mask material and from small gaps along the edges. Importantly, uncovered emulated coughs were able to travel notably farther than the currently recommended 6-ft distancing guideline. We outline the procedure for setting up simple visualization experiments using easily available materials, which may help healthcare professionals, medical researchers, and manufacturers in assessing the effectiveness of face masks and other personal protective equipment qualitatively.", "Injection Molded Autoclavable, Scalable, Conformable (iMASC) system for aerosol-based protection There is a dire need for personal protective equipment (PPE) within healthcare settings during the COVID-19 pandemic. In particular, single use disposable N95 face masks have been limited in supply. We have developed an Injection Molded Autoclavable, Scalable, Conformable (iMASC) system for aerosol-based protection. The iMASC system was designed as a reusable liquid silicone rubber mask with disposable N95 filter cartridges that can fit most face sizes and shapes. This system reduced the amount of N95 filter while preserving breathability and fit. Using finite element analysis, we demonstrated mask deformation and reaction forces from facial scans of twenty different wearers. In addition, we validated these findings by succesful fit testing in twenty participants in a prospective clinical trial. The iMASC system has the potential to protect our healthcare workers with a reusable N95-comparable face mask that is rapidly scalable.", "Developing Guidelines for COVID-19 Management: A Moving Target. An invited commentary on \"Evidence Based Management Guideline for the COVID-19 Pandemic - Review article\" ", "Using the Pillars of Infection Prevention to Build an Effective Program for Reducing the Transmission of Emerging and Reemerging Infections Preventing transmission of emerging infectious diseases remains a challenge for infection prevention and occupational safety programs. The recent Ebola and measles outbreaks highlight the need for pre-epidemic planning, early identification, and appropriate isolation of infected individuals and health care personnel protection. To optimally allocate limited infection control resources, careful consideration of major modes of transmission, the relative infectiousness of the agent, and severity of the pathogen-specific disease are considered. A framework to strategically approach pathogens proposed for health care settings includes generic principles (1) elimination of potential exposure, (2) implementation of administrative controls, (3) facilitation of engineering and environmental controls, and (4) protection of the health care worker and patient using hand hygiene and personal protective equipment. Additional considerations are pre-epidemic vaccination and incremental costs and benefits of infection prevention interventions. Here, major strategies for preventing health-care-associated transmissions are reviewed, including reducing exposure; vaccination; administrative, engineering, and environmental controls; and personal protective equipment. Examples from recent outbreaks are used to highlight key infection prevention aspects and controversies.", "Pulmonary Pathology of Early-Phase 2019 Novel Coronavirus (COVID-19) Pneumonia in Two Patients With Lung Cancer Abstract There is currently a lack of pathologic data on the novel coronavirus (severe acute respiratory syndrome coronavirus 2) pneumonia, or coronavirus disease 2019 (COVID-19), from autopsy or biopsy. Two patients who recently underwent lung lobectomies for adenocarcinoma were retrospectively found to have had COVID-19 at the time of the operation. These two cases thus provide important first opportunities to study the pathology of COVID-19. Pathologic examinations revealed that apart from the tumors, the lungs of both patients exhibited edema, proteinaceous exudate, focal reactive hyperplasia of pneumocytes with patchy inflammatory cellular infiltration, and multinucleated giant cells. Hyaline membranes were not prominent. Because both patients did not exhibit symptoms of pneumonia at the time of operation, these changes likely represent an early phase of the lung pathology of COVID-19 pneumonia.", "Can Masks Be Reused After Hot Water Decontamination During the COVID-19 Pandemic? Masks have become one of the most indispensable pieces of personal protective equipment and are important strategic products during the coronavirus disease 2019 (COVID-19) pandemic. Due to the huge mask demand\u2013supply gap all over the world, the development of user-friendly technologies and methods is urgently needed to effectively extend the service time of masks. In this article, we report a very simple approach for the decontamination of masks for multiple reuse during the COVID-19 pandemic. Used masks were soaked in hot water at a temperature greater than 56 \u00b0C for 30 min, based on a recommended method to kill COVID-19 virus by the National Health Commission of the People\u2019s Republic of China. The masks were then dried using an ordinary household hair dryer to recharge the masks with electrostatic charge to recover their filtration function (the so-called \u201chot water decontamination + charge regeneration\u201d method). Three kinds of typical masks (disposable medical masks, surgical masks, and KN95-grade masks) were treated and tested. The filtration efficiencies of the regenerated masks were almost maintained and met the requirements of the respective standards. These findings should have important implications for the reuse of polypropylene masks during the COVID-19 pandemic. The performance evolution of masks during human wear was further studied, and a company (Zhejiang Runtu Co., Ltd.) applied this method to enable their workers to extend the use of masks. Mask use at the company was reduced from one mask per day per person to one mask every three days per person, and 122 500 masks were saved during the period from 20 February to 30 March 2020. Furthermore, a new method for detection of faulty masks based on the penetrant inspection of fluorescent nanoparticles was established, which may provide scientific guidance and technical methods for the future development of reusable masks, structural optimization, and the formulation of comprehensive performance evaluation standards.", "Low-cost measurement of facemask efficacy for filtering expelled droplets during speech Mandates for mask use in public during the recent COVID-19 pandemic, worsened by global shortage of commercial supplies, have led to widespread use of homemade masks and mask alternatives. It is assumed that wearing such masks reduces the likelihood for an infected person to spread the disease, but many of these mask designs have not been tested in practice. We have applied a simple optical measurement method to evaluate the efficacy of masks to reduce the transmission of respiratory droplets during regular speech. We compare a variety of commonly available mask types and observe that some mask types approach the performance of standard surgical masks, while some mask alternatives, such as neck fleece or bandanas, offer very little protection. Our measurement setup is inexpensive and can be built and operated by non-experts, allowing for rapid evaluation of mask performance during speech, sneezing, or coughing.", "Importance of face masks for COVID-19 \u2013 a call for effective public education Considerable debates about the general community use of face masks for protection against COVID-19 stemmed out from differing views taken by health authorities. Misconceptions and stigmatization towards the use of face masks may hinder the containment of the COVID-19 pandemic. We address this previous debate by analyzing the advice on the community use of masks across different credible health authorities: countries that promoted the use of masks acknowledged that masks are effective, but also explained the importance of their proper use along with other hygiene measures. In contrast, authorities that recommended against the community use of masks mainly cited shortage of supplies, the argument that the public do not have the adequate skills to wear them, or that wearing masks might reduce compliance with other important behaviors. We suggest promoting effective behavioral changes in personal protective measures by teaching microbiological knowledge instead of just listing out the \u201cdos-and-don\u2019ts\u201d.", "3-D Printed Protective Equipment during COVID-19 Pandemic While the number of coronavirus cases from 2019 continues to grow, hospitals are reporting shortages of personal protective equipment (PPE) for frontline healthcare workers. Furthermore, PPE for the eyes and mouth, such as face shields, allow for additional protection when working with aerosols. 3-D printing enables the easy and rapid production of lightweight plastic frameworks based on open-source data. The practicality and clinical suitability of four face shields printed using a fused deposition modeling printer were examined. The weight, printing time, and required tools for assembly were evaluated. To assess the clinical suitability, each face shield was worn for one hour by 10 clinicians and rated using a visual analogue scale. The filament weight (21\u201342 g) and printing time (1:40\u20133:17 h) differed significantly between the four frames. Likewise, the fit, wearing comfort, space for additional PPE, and protection varied between the designs. For clinical suitability, a chosen design should allow sufficient space for goggles and N95 respirators as well as maximum coverage of the facial area. Consequently, two datasets are recommended. For the final selection of the ideal dataset to be used for printing, scalability and economic efficiency need to be carefully balanced with an acceptable degree of protection.", "Mask is the possible key for self\u2010isolation in COVID\u201019 pandemic Ma's research shows N95 masks, medical masks, even homemade masks could block at least 90% of the virus in aerosols(1). This study puts the debate on whether the public wear masks back on the table. Recently Science interviewed Dr. Gao, director\u2010general of Chinese Center for Disease Control and Prevention (CDC). This article is protected by copyright. All rights reserved.", "On respiratory droplets and face masks Face mask filters\u2014textile, surgical, or respiratory\u2014are widely used in an effort to limit the spread of airborne viral infections. Our understanding of the droplet dynamics around a face mask filter, including the droplet containment and leakage from and passing through the cover, is incomplete. We present a fluid dynamics study of the transmission of respiratory droplets through and around a face mask filter. By employing multiphase computational fluid dynamics in a fully coupled Eulerian\u2013Lagrangian framework, we investigate the droplet dynamics induced by a mild coughing incident and examine the fluid dynamics phenomena affecting the mask efficiency. The model takes into account turbulent dispersion forces, droplet phase-change, evaporation, and breakup in addition to the droplet\u2013droplet and droplet\u2013air interactions. The model mimics real events by using data, which closely resemble cough experiments. The study shows that the criteria employed for assessing the face mask performance must be modified to take into account the penetration dynamics of airborne droplet transmission, the fluid dynamics leakage around the filter, and reduction of efficiency during cough cycles. A new criterion for calculating more accurately the mask efficiency by taking into account the penetration dynamics is proposed. We show that the use of masks will reduce the airborne droplet transmission and will also protect the wearer from the droplets expelled from other subjects. However, many droplets still spread around and away from the cover, cumulatively, during cough cycles. Therefore, the use of a mask does not provide complete protection, and social distancing remains important during a pandemic. The implications of the reduced mask efficiency and respiratory droplet transmission away from the mask are even more critical for healthcare workers. The results of this study provide evidence of droplet transmission prevention by face masks, which can guide their use and further improvement.", "Suggestions on the prevention of COVID-19 for health care workers in department of otorhinolaryngology head and neck surgery Abstract The epidemic of the Coronavirus Disease 2019 (COVID-19) has presented as a grim and complex situation recently. More than 77,000 cases of COVID-19 has been confirmed in China until February 25th, 2020, which are causing great impact on economy and society, as well as seriously interfering with ordinary medical practice in the department of otorhinolaryngology head and neck surgery. This article discussed medical precautions required in the clinic, inpatient ward and operation room of otorhinolaryngology head and neck department, which aims to protect health care workers from COVID-19.", "Supporting the Health Care Workforce During the COVID-19 Global Epidemic. ", "A review of medical masks and respirators for use during an influenza pandemic ", "A proposal for the return to routine endoscopy during the COVID-19 pandemic Abstract In response to the COVID-19 pandemic, many jurisdictions and gastroenterological societies around the world have suspended nonurgent endoscopy. Subject to country-specific variability, it is projected that with current mitigation measures in place, the peak incidence of active COVID-19 infections may be delayed by over 6 months. Although this aims to prevent the overburdening of healthcare systems, prolonged deferral of elective endoscopy will become unsustainable. Herein, we propose that by incorporating readily available point-of-care tests and conducting accurate clinical risk assessments, a safe and timely return to elective endoscopy is feasible. Our algorithm not only focuses on the safety of patients and healthcare workers, but also assists in rationalizing the use of invaluable resources such as personal protective equipment.", "COVID-19 among medical personnel in the operating room ", "[The network investigation on knowledge, attitude and practice about COVID-19 of the residents in Anhui Province]. Objective: To analyze the current situation of the knowledge, attitudes and practice about COVID-19 of the residents in Anhui Province. Methods: Anonymous network sampling survey was carried out with an electronic questionnaire that designed by the questionnaire star, and a total of 4 016 subjects from Anhui province were investigated. The content of the survey includes that the basic information of subjects,the residents' knowledge, attitudes and practice about COVID-19, as well as their satisfaction with the prevention and control measures adopted by the government and health authorities and the suggestions on future prevention. The questionnaire doesn't involve any privacy information, and all questions were mandatory to ensure the response rate. Results: The M (P(25), P(75)) age the 4 016 subjects was 21 (19, 24) years old, and the ranging from 7 to 80 years old. The number of males was 1 431 (35.6%). Social networking tools such as WeChat and QQ were the main sources of epidemic information for residents (97.8%, 3 929 respondents). Residents had higher awareness rate of cough (99.5%,n=3 997) and fever (96.0%, n=3 857) symptoms, the transmission by droplets (99.5%, n=3 995), aerosol transmission (81.1%, n=3 258), and contact transmission (92.3%, n=3 708), but lower awareness of symptoms os muscle pain or fatigue (62.7%, n=2 518). 92.6% of the subjects (n=3 720) think that the outbreak was scary. In terms of psychological behavior scores, the results showed that female (9.38\u00b14.81), the urban (9.37\u00b15.02) and the medical workers (10.79\u00b15.19) had a poorer mental health than the male (8.45\u00b15.00), the rural (8.71\u00b14.75) and the non-medical workers (the students: 8.85\u00b14.83; public institude workers: 9.02\u00b15.08; others: 8.97\u00b15.39) (P<0.05). 71.9% of the residents (n=2 887) were satisfied with the local epidemic control measures. The residents took various of the measures to prevent and control the epidemic. The ratio of residents that could achieve \"no gathering and less going out\" , \"wear masks when going out \" and \" do not go to crowded and closed places \" was up to 97.4% (n=3 913), 93.6% (n=3 758) and 91.5% (n=3 673) respectively. Conclusion: The residents in Anhui province have a good KAP about COVID-19, yet it is necessary to strengthen the community publicity, the mental health maintenance of residents and students' health education.", "Facemasks prevent influenza-like illness: implications for COVID-19 The coronavirus disease 2019 (COVID-19) pandemic is causing a huge toll on individuals, families, communities and societies across the world. Currently, whether wearing facemasks in public should be a measure to prevent transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) remains contraversial.1 This is largely because there have been no randomized controlled trials (RCTs) for coronavirus to directly support this. However, lessons may be taken from published RCTs examining influenza-like illness (ILI).2,3 Recent studies suggested that SARS-CoV-2 shares similar transmission route with influenza virus,4 and the incidence of community transmission of SARS-CoV-2 in individuals with ILI is high.5 Therefore, we undertook this meta-analysis of RCTs examining the efficacy of wearing facemasks to prevent ILI in community settings, irrespective of confirmatory testing for the causative virus. We undertook a systematic literature search for RCTs related to facemasks and ILI between 1966 and April 2020 using PUBMED, EMBASE, and Cochrane library. RCTs undertaken in community (not hospital) settings comparing wearing and not wearing facemasks for ILI were included. Incidence of ILI (e.g., fever, cough, headache, sore throat, aches or pains in muscles or joints) was estimated per group. Relative risk (RR) and 95% confidence interval (CI) were calculated. We screened 899 related abstracts and eventually included 8 RCTs (Figure S1). Basic characteristics and quality of included RCTs are listed in Supplement. Participants wearing facemasks had a significantly lower risk of developing ILI than those not wearing facemasks (pooled RR=0.81, 95% CI: 0.70-0.95) and there was no heterogeneity (Figure 1). The decreased risk of ILI was more pronounced if everyone wore facemask irrespective of whether they were infected or not (RR=0.77, 95% CI: 0.65-0.91), compared to those wearing facemasks when infected (RR=0.95, 95% CI: 0.58-1.56) or uninfected (RR=1.26, 95% CI: 0.69-2.31). This study shows that wearing facemasks, irrespective of infection status, is effective in preventing ILI spread in the community. This situation mirrors what is happening now in public settings where we do not know who has been infected and who has not. Although there are no RCTs of facemasks for SARS-CoV-2, as with other simple measures such as social distancing and handwashing, these data support the recommendation to wear facemasks in public to further reduce transmission of SARS-CoV-2 and flatten the curve of this pandemic, especially when social distancing is impractical, such as shopping, or travelling with public transport for work that cannot be done from home.", "Coronavirus infection prevention by wearing masks The coronavirus disease 2019 (COVID-19) [2019-nCoV; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] was first detected in Wuhan, China at the end of 2019. In current status, spread of CO-VID-19 in person-to-person could be caused mainly by respiratory droplets, which leads to the spread of the influenza virus in both community and clinicians. Thus, in order to reduce the risk of that, the urgent management strategies against COVID-19 are to block transmission, isolation, protection, and using drug or vaccine updated on an ongoing basis. unfortunately, no drugs or vaccines still has yet been allowed to treat patients with COVID-19, so the rapid detection of effective intercessions against COVID-19 is seemed a major challenge on the all world. Herein, this article attempts summarizing to introduce the characterization of COVID-19, the influence of droplets travel in person-to-person transmission and the effect of wearing masks in the infection prevention of influenza virus, as well as understanding its advantage and role in the coronavirus infection prevention.", "Protecting Medical Trainees on the Coronavirus Disease 2019 (COVID-19) Frontlines Saves Us All ", "Masks and closed-loop ventilators prevent environmental contamination by COVID-19 patients in negative-pressure environments Abstract Herein, we report that nosocomial infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be mitigated by using surgical masks and closed looped ventilation for both non-critical and critical patients. These preventive measures resulted in no viral contamination of surfaces in negative pressure environments.", "Sensitivity and specificity of the user-seal-check in determining the fit of N95 respirators Summary N95 respirators are recommended by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) to prevent the inhalation of droplets which may transmit respiratory pathogens. The reliability of N95 respirators in preventing transmission depends on their fit to the wearer. Quantitative fit testing (QNFT) is the gold standard used to determine this fit objectively. The manufacturers of the respirators also recommend performing a self-reported user-seal-check to detect for leakage. This study aims to investigate the capability of the user-seal-check in determining the fit of N95 respirators by investigating the sensitivity and specificity of the user-seal-check compared with QNFT. A prospective and cross-sectional research design was used. A total of 204 local Chinese undergraduate nursing students were recruited to test two commonly used respirator models (3M 1860S and 3M 1862). The results of the user-seal-check were compared with the results of the gold standard QNFT using the Condensation Nucleus Counter Fit Tester System. The sensitivity and specificity of the user-seal-check results obtained with the respirators were calculated. The results indicated low sensitivity, accuracy and predictive value of the user-seal-check in determining the fit of the N95 respirators. The user-seal-check was not found to be reliable as a substitute for QNFT. The results also suggested that the user-seal-check may be unreliable for detecting gross leakage. We recommend that QNFT is used to determine the fit of N95 respirators.", "How Ophthalmologists Should Understand and Respond to the Current Epidemic of Novel Coronavirus Pneumonia (COVID-19) The new coronavirus pneumonia that first appeared in Wuhan, China, in December 2019 has attracted great attention from both the Chinese government and the international community The International Committee on Viral Classification named the virus &amp;quot;Severe Acute Respiratory Syndrome Coronavirus 2&amp;quot;(SARS-CoV-2), and the WHO named the pneumonia it causes &amp;quot;Coronavirus Disease 2019&amp;quot;(COVID-19) At present, the disease is centered in Wuhan City and is spreading rapidly to all parts of China, as well as twenty other countries About 20% of the people infected during the SARS epidemic in 2003 were employees in hospital environments COVID-19 has infected an even greater number of heath care workers Therefore, ophthalmologists need to understand the disease and recognize the importance of taking preventive measures Although ophthalmologists do not work on the front lines of the outbreak, due to their area of expertise, a variety of situations, such as infection consultations or ophthalmic emergency treatments, can lead to the exposure of ophthalmologists to high-risk environments This risk will only increase as the number of infected patients continues to increase When dealing with seemingly normal ophthalmic patients, the vigilance of ophthalmologists and associated staff tends to be significantly reduced To better protect patients, families, and health care workers, it is strongly recommended that in addition to the standard precautions for the care of all patients, strict contact precautions and droplet precautions need to be taken by ophthalmologists These measures include 1) wearing an efficient mask (an N95 mask);2) always performing hand hygiene before and after examining a patient;(3) wearing sterile gloves when entering a patient\u2019s room and touching a patient;(4) wearing a gown when contact is expected with items and environmental surfaces surrounding a patient or when the patient is incontinent or has diarrhea or a surgical or other invasive wound with oozing fluid;5) cleaning and disinfecting ophthalmic equipment and correctly handling medical waste after examination to prevent transmission to patients who are subsequently examined;6) wearing goggles and a disposable mask to cover the front and sides of the face before touching a patient, as the virus could spread through the ocular surface;7) performing the relevant screening for novel coronavirus pneumonia for regular patients who have conjunctivitis and respiratory symptoms at the same time;8) prohibiting the use of infected patients as potential donors for corneal transplants and temporarily adding donor SARS-CoV-2 screening to the medical standard of the eye bank during the outbreak;and 9) for the purposes of scientific research, diagnosis, and other special needs, packing, shipping, and transporting collected specimens according to the relevant dangerous biological goods regulations", "Rationale for universal face masks in public against COVID\u201019 ", "Risks of viral contamination in healthcare professionals during laparoscopy in the Covid-19 pandemic Abstract The Covid-19 pandemic has markedly changed our practices. This article analyses the risks of contamination among healthcare professionals (HCPs) during laparoscopic surgery on patients with Covid-19. Harmful effects of aerosols from a pneumoperitoneum with the virus present have not yet been quantified. Measures for the protection of HCPs are an extrapolation of those taken during other epidemics. They must still be mandatory to minimise the risk of viral contamination. Protection measures include personal protection equipment for HCPs, adaptation of surgical technique (method for obtaining pneumoperitoneum, filters, preferred intracorporeal anastomosis, precautions during the exsufflation of the pneumoperitoneum), and organisation of the operating room.", "Face mask use in the general population and optimal resource allocation during the COVID-19 pandemic The ongoing novel coronavirus disease (COVID-19) pandemic has rapidly spread in early 2020, causing tens of thousands of deaths, over a million cases and widespread socioeconomic disruption. With no vaccine available and numerous national healthcare systems reaching or exceeding capacity, interventions to limit transmission are urgently needed. While there is broad agreement that travel restrictions and closure of non-essential businesses and schools are beneficial in limiting local and regional spread, recommendations around the use of face masks for the general population are less consistent internationally. In this study, we examined the role of face masks in mitigating the spread of COVID-19 in the general population, using epidemic models to estimate the total reduction of infections and deaths under various scenarios. In particular, we examined the optimal deployment of face masks when resources are limited, and explored a range of supply and demand dynamics. We found that face masks, even with a limited protective effect, can reduce infections and deaths, and can delay the peak time of the epidemic. We consistently found that a random distribution of masks in the population was a suboptimal strategy when resources were limited. Prioritizing coverage among the elderly was more beneficial, while allocating a proportion of available resources for diagnosed infected cases provided further mitigation under a range of scenarios. In summary, face mask use, particularly for a pathogen with relatively common asymptomatic carriage, can effectively provide some mitigation of transmission, while balancing provision between vulnerable healthy persons and symptomatic persons can optimize mitigation efforts when resources are limited.", "Effect of preventive actions and health care factors in controlling the outbreaks of COVID-19 pandemic With the insurgence of the COVID-19 pandemic, a large number of people died in the past several months, and the situation is ongoing with increasing panic and vulnerability. Due to the lack of drugs and prophylaxis against COVID-19, most of the countries are now relying on preventive measures focusing on maintaining social distance. However, this social distancing can create global socio-economic threats and psychological disorders. Therefore, these control measures need to have an assessment to evaluate their potential in containing the situation. In this study, we analyzed the outcome of COVID-19 in response to control measures, health care facilities, and prevalent diseases. Based on our findings, the number of COVID-19 deaths found to reduce with increased medical personnel and hospital beds. We found 0.23, 0.16, and 0.21 as the measurement of non-linear relationship between COVID-19 case fatality and number of physicians, nurses and midwives, and hospital beds and these relationships are highly significant with p-value of 0.000007, 0.0046, and 0.0196, respectively. Importantly, we observed a significant correlation between the reduction of COVID-19 cases and the earliness of preventive initiation. As a result, enhancing health care facilities as well as imposing those control measures in a short time could be valuable to prevent the currently raging COVID-19 pandemic. The apathy of taking immediate health care action from the nations has identified as one of the critical reasons to make the circumstances worst. Gambia, Nicaragua, Burundi, Namibia, and Nepal have marked in a state of danger based on the comparative study towards the health care action for the top twenty burdening and least affected countries. Interestingly, no association in most diseases except for few cases has found between the comorbidities and severity of COVID-19, which warranted further investigation at the pathobiological level. We believe that this study could provide a guide for future COVID-19 research.", "To mask or not to mask: Modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic Face mask use by the general public for limiting the spread of the COVID-19 pandemic is controversial, though increasingly recommended, and the potential of this intervention is not well understood. We develop a compartmental model for assessing the community-wide impact of mask use by the general, asymptomatic public, a portion of which may be asymptomatically infectious. Model simulations, using data relevant to COVID-19 dynamics in the US states of New York and Washington, suggest that broad adoption of even relatively ineffective face masks may meaningfully reduce community transmission of COVID-19 and decrease peak hospitalizations and deaths. Moreover, mask use decreases the effective transmission rate in nearly linear proportion to the product of mask effectiveness (as a fraction of potentially infectious contacts blocked) and coverage rate (as a fraction of the general population), while the impact on epidemiologic outcomes (death, hospitalizations) is highly nonlinear, indicating masks could synergize with other non-pharmaceutical measures. Notably, masks are found to be useful with respect to both preventing illness in healthy persons and preventing asymptomatic transmission. Hypothetical mask adoption scenarios, for Washington and New York state, suggest that immediate near universal (80%) adoption of moderately (50%) effective masks could prevent on the order of 17\u201345% of projected deaths over two months in New York, while decreasing the peak daily death rate by 34\u201358%, absent other changes in epidemic dynamics. Even very weak masks (20% effective) can still be useful if the underlying transmission rate is relatively low or decreasing: In Washington, where baseline transmission is much less intense, 80% adoption of such masks could reduce mortality by 24\u201365% (and peak deaths 15\u201369%), compared to 2\u20139% mortality reduction in New York (peak death reduction 9\u201318%). Our results suggest use of face masks by the general public is potentially of high value in curtailing community transmission and the burden of the pandemic. The community-wide benefits are likely to be greatest when face masks are used in conjunction with other non-pharmaceutical practices (such as social-distancing), and when adoption is nearly universal (nation-wide) and compliance is high.", "COVID-19: emerging protective measures The COVID-19 (Coronavirus disease 2019) spreads primarily through droplets of saliva or discharge from the nose. COVID-19 is predominantly considered as an unavoidable pandemic, and scientists are very curious about how to provide the best protection to the public before a vaccine can be made available. There is an urge to manufacture a greater number of masks to prevent any aerosol with microbes. Hence, we aim to develop an efficient viral inactivation system by exploiting active compounds from naturally occurring medicinal plants and infusing them into nanofiber-based respiratory masks. Our strategy is to develop fibrous filtration with three-layered masks using the compounds from medicinal plants for viral deactivation. These masks will be beneficial not just to healthcare workers but common citizens as well. In the absence of vaccination, productive masks can be worn to prevent transmission of airborne pathogenic aerosols and control diseases.", "Effectiveness of Surgical and Cotton Masks in Blocking SARS\u2013CoV-2: A Controlled Comparison in 4 Patients ", "Recharging improves efficiency of decontaminated N95 masks N95 masks form a critical part of the personal protective equipment used by frontline health-care workers, and are typically meant for one-time usage. However, the recent COVID pandemic has resulted in a serious shortage of these masks leading to a worldwide effort to develop decontamination and re-use procedures. A major factor contributing to the filtration efficiency of N95 masks is the presence of an intermediate layer of charged polypropylene electret fibers that trap particles through electrostatic or electrophoretic effects. This charge degrades quickly when the mask is used. Moreover, simple decontamination procedures (e.g. use of alcohol) immediately degrade any remaining charge from the polypropylene, thus severely impacting the filtration efficiency post decontamination. In this brief report, we summarize preliminary results on the development of a simple laboratory setup allowing measurement of charge and filtration efficiency in N95 masks. We show how the charge on the mask changes due to decontamination treatments, and correlate with reduced filtration efficiency. Additionally, we propose and show that it is possible to recharge the masks post-decontamination treatment and recover filtration efficiency. Importantly, recharging can be performed using readily available equipment and materials, and so can be employed both in urban and rural settings. We emphasize that because of the current worldwide lockdown, the measurements reported in this report are preliminary, performed with hastily constructed home-built equipment on a small variety of masks available to us. Although we are confident in our results, we encourage groups with special-purpose equipment to redo and verify our experiments.", "Modeling Control Strategies of Respiratory Pathogens Effectively controlling infectious diseases requires quantitative comparisons of quarantine, infection control precautions, case identification and isolation, and immunization interventions. We used contact network epidemiology to predict the effect of various control policies for a mildly contagious disease, such as severe acute respiratory syndrome, and a moderately contagious disease, such as smallpox. The success of an intervention depends on the transmissibility of the disease and the contact pattern between persons within a community. The model predicts that use of face masks and general vaccination will only moderately affect the spread of mildly contagious diseases. In contrast, quarantine and ring vaccination can prevent the spread of a wide spectrum of diseases. Contact network epidemiology can provide valuable quantitative input to public health decisionmaking, even before a pathogen is well characterized.", "The Time for Universal Masking of the Public for Coronavirus Disease 2019 Is Now In this perspective, we recommend universal masking of the US public during coronavirus disease 2019 due to the high contagiousness of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), viral shedding of viable SARS-CoV-2 from asymptomatic individuals, and the likely contribution of masking to core distancing public health strategies for curbing transmission.", "Operational Strategies to Prevent COVID-19 spread in Radiology: Experience from a Singapore Radiology Department after SARS Abstract As COVID-19 infection spreads globally, the demand for chest imaging will inevitably rise with an accompanying increase in risk of disease transmission to frontline radiology staff. Radiology departments should implement strict infection control measures and robust operational plans to minimise disease transmission and mitigate potential impact of possible staff infection. In this article, the authors share several operational guidelines and strategies implemented in our practice to reduce spread of COVID-19 while maintaining clinical and educational needs of a teaching hospital.", "Medical mask or N95 respirator: When and how to use? COVID-19 pandemic is now a global threat to human health reaching up to 2 million infected people all around the world. Since its first recognition in Wuhan, many topics were discussed intensively about COVID-19, both in the public and scientific community. Personal protective equipment, especially masks, has been among the hottest topics during this pandemic. Regardless of which mask is used, performing hand hygiene frequently with an alcohol-based hand rub or with soap and water if hands are dirty is the most effective preventive measure for COVID-19. The type of mask used when caring for COVID-19 patients will vary according to the setting, type of personnel/person, and activity. Although the main transmission route for COVID-19 is droplets, during aerosol generating procedures airborne transmission may occur. Keeping the distancing and medical masks and eye protection during close contact efficiently protects against respiratory diseases transmitted via droplets. Airborne precautions include goggles and respiratory protection with the use of an N95 or an equivalent mask respirator to prevent airborne transmission.", "Masks and thermometers: Paramount measures to stop the rapid spread of SARS-CoV-2 in the United States Abstract In the United States, there is currently an exponential growth for the COVID-19 cases. The US president\u2019s coronavirus guidelines for Americans \u201c30 Days to Slow The Spread\u201d are necessary. To effectively curb the rapid spread of SARS-CoV-2, two more control measures masks and thermometers are strongly suggested to be included in the Guidelines.", "A Reusable Mask for Coronavirus Disease 2019 (COVID-19) Abstract The outbreak of Novel Coronavirus is causing an intensely feared globally. World Health Organization has even declared that it is a global health emergency. The simplest method to limit the spread of this new virus and for people to protect themselves as well as the others is to wear a mask in crowded places. The sudden increase demand on face mask has caused manufacturers the inability to not provide enough products in a short time and the situation properly will stay the same for a period of time. In this article, we aim to give an idea on how to save the number of face masks used but still provides the same protective values using a Cardiopulmonary resuscitation (CPR) mask and a common surgical facemask.", "Proposed approach for reusing surgical masks in COVID-19 pandemic ", "Novel tip to prevent ear irritation with surgical face masks (FRSM) during the coronavirus (COVID-19) pandemic ", "Stepping up infection control measures in ophthalmology during the novel coronavirus outbreak: an experience from Hong Kong PURPOSE: Coronavirus disease (COVID-19) has rapidly emerged as a global health threat. The purpose of this article is to share our local experience of stepping up infection control measures in ophthalmology to minimise COVID-19 infection of both healthcare workers and patients. METHODS: Infection control measures implemented in our ophthalmology clinic are discussed. The measures are based on detailed risk assessment by both local ophthalmologists and infection control experts. RESULTS: A three-level hierarchy of control measures was adopted. First, for administrative control, in order to lower patient attendance, text messages with an enquiry phone number were sent to patients to reschedule appointments or arrange drug refill. In order to minimise cross-infection of COVID-19, a triage system was set up to identify patients with fever, respiratory symptoms, acute conjunctivitis or recent travel to outbreak areas and to encourage these individuals to postpone their appointments for at least 14 days. Micro-aerosol generating procedures, such as non-contact tonometry and operations under general anaesthesia were avoided. Nasal endoscopy was avoided as it may provoke sneezing and cause generation of droplets. All elective clinical services were suspended. Infection control training was provided to all clinical staff. Second, for environmental control, to reduce droplet transmission of COVID-19, installation of protective shields on slit lamps, frequent disinfection of equipment, and provision of eye protection to staff were implemented. All staff were advised to measure their own body temperatures before work and promptly report any symptoms of upper respiratory tract infection, vomiting or diarrhoea. Third, universal masking, hand hygiene, and appropriate use of personal protective equipment (PPE) were promoted. CONCLUSION: We hope our initial experience in stepping up infection control measures for COVID-19 infection in ophthalmology can help ophthalmologists globally to prepare for the potential community outbreak or pandemic. In order to minimise transmission of COVID-19, ophthalmologists should work closely with local infection control teams to implement infection control measures that are appropriate for their own clinical settings.", "Cloth masks versus medical masks for COVID-19 protection. ", "Efficacy of face mask in preventing respiratory virus transmission: a systematic review and meta-analysis Background: Conflicting recommendations exist related to whether masks have a protective effect on the spread of respiratory viruses. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was consulted to report this systematic review. Relevant articles were retrieved from PubMed, Web of Science, ScienceDirect, Cochrane Library, and Chinese National Knowledge Infrastructure (CNKI), VIP (Chinese) database. Results: A total of 21 studies met our inclusion criteria. Meta-analyses suggest that mask use provided a significant protective effect (OR = 0.35 and 95% CI = 0.24-0.51). Use of masks by healthcare workers (HCWs) and non-healthcare workers (Non-HCWs) can reduce the risk of respiratory virus infection by 80% (OR = 0.20, 95% CI = 0.11-0.37) and 47% (OR = 0.53, 95% CI = 0.36-0.79). The protective effect of wearing masks in Asia (OR = 0.31) appeared to be higher than that of Western countries (OR = 0.45). Masks had a protective effect against influenza viruses (OR = 0.55), SARS (OR = 0.26), and SARS-CoV-2 (OR = 0.04). In the subgroups based on different study designs, protective effects of wearing mask were significant in cluster randomized trials, case-control studies and retrospective studies. Conclusions: This study adds additional evidence of the enhanced protective value of masks, we stress that the use masks serve as an adjunctive method regarding the COVID-19 outbreak.", "A national prospective cohort study of SARS/COV2 pandemic outcomes in the U.S.: The CHASING COVID Cohort Introduction: The Chasing COVID Cohort (C3) study is a US-based, geographically and socio-demographically diverse sample of adults (18 and older) enrolled into a prospective cohort study during the upswing of the U.S. COVID-19 pandemic. Methods: We used internet-based strategies to enroll C3 participants beginning March 28th, 2020. Following baseline questionnaire completion, study participants will be contacted monthly (for 6 months) to complete assessments of engagement in non-pharmaceutical interventions (e.g., use of cloth masks, avoiding large gatherings); COVID-19 symptoms; SARS/COV2 testing and diagnosis; hospitalizations; healthcare access; and uptake of health messaging. Dried blood spot (DBS) specimens will be collected at the first follow-up assessment (last week of April 2020) and at month 3 (last week of June 2020) and stored until a validated serologic test is available. Results: As of April 20, 2020, the number of people that completed the baseline survey and provided contact information for follow-up was 7,070. Participants resided in all 50 US states, the District of Columbia, Puerto Rico, and Guam. At least 24% of participants were frontline workers (healthcare and other essential workers). Twenty-three percent (23%) were 60+ years, 24% were Black or Hispanic, 52% were men, and 52% were currently employed. Nearly 20% reported recent COVID-like symptoms (cough, fever or shortness of breath) and a high proportion reported engaging in non-pharmaceutical interventions that reduce SARS/COV2 spread (93% avoided groups >20, 58% wore masks; 73% quarantined). More than half (54%) had higher risk for severe COVID-19 illness should they become infected with SARS/COV2 based on age, underlying health conditions (e.g., chronic lung disease), or daily smoking. Discussion: A geographically and socio-demographically diverse group of participants was rapidly enrolled in the C3 during the upswing of the SARS/COV2 pandemic. Strengths of the C3 include the potential for direct observation of, and risk factors for, seroconversion and incident COVID disease (among those with or without antibodies to SARS/COV2) in areas of active transmission.", "Calculating an institutional personal protective equipment (PPE) burn rate to project future usage patterns during the 2020 COVID-19 pandemic ", "International Committee of the Red Cross (ICRC): General guidance for the management of the dead related to COVID-19 Abstract Based on its forensic capacity and experience gained worldwide from the management of the dead in emergencies, including epidemics, the International Committee of the Red Cross has been asked by the authorities and other relevant stakeholders in some of its operational contexts to advise on the management of the dead from COVID-19 infection, for which it has prepared the following guidance. This includes advice on the handling of COVID-19 fatalities and a set of considerations for managers faced with the need to plan for adequately responding to a possible surge in fatalities caused by COVID-19.", "Coronavirus (COVID-19) Outbreak: What the Department of Radiology Should Know Abstract In December 2019, a novel coronavirus (COVID-19) pneumonia emerged in Wuhan, China. Since then, this highly contagious COVID-19 has been spreading worldwide, with a rapid rise in the number of deaths. Novel COVID-19\u2013infected pneumonia (NCIP) is characterized by fever, fatigue, dry cough, and dyspnea. A variety of chest imaging features have been reported, similar to those found in other types of coronavirus syndromes. The purpose of the present review is to briefly discuss the known epidemiology and the imaging findings of coronavirus syndromes, with a focus on the reported imaging findings of NCIP. Moreover, the authors review precautions and safety measures for radiology department personnel to manage patients with known or suspected NCIP. Implementation of a robust plan in the radiology department is required to prevent further transmission of the virus to patients and department staff members.", "Protecting healthcare workers from pandemic influenza: N95 or surgical masks? OBJECTIVE The successful management of an influenza pandemic will be reliant on the expertise of healthcare workers at high risk for occupationally acquired influenza. Recommended infection control measures for healthcare workers include surgical masks to protect against droplet-spread respiratory transmissible infections and N95 masks to protect against aerosol-spread infections. A literature review was undertaken for evidence of superior protective value of N95 masks or surgical masks for healthcare workers against influenza and extraneous factors influencing conferred protection. METHODS Four scientific search engines using 12 search sequences identified 21 mask studies in healthcare settings for the prevention of transmission of respiratory syncytial virus, Bordetella pertussis, and severe acute respiratory syndrome. Each was critically assessed in accordance with Australian National Health Medical Research Council guidelines. An additional 25 laboratory-based publications were also reviewed. RESULTS All studies reviewed used medium or lower level evidence study design. In the majority of studies, important confounders included the unrecognized impact of concurrent bundling of other infection control measures, mask compliance, contamination from improper doffing of masks, and ocular inoculation. Only three studies directly compared the protective value of surgical masks with N95 masks. The majority of laboratory studies identified both mask types as having a range of filtration efficiency, yet N95 masks afford superior protection against particles of a similar size to influenza. CONCLUSIONS World Health Organization guidelines recommend surgical masks for all patient care with the exception of N95 masks for aerosol generating procedures. Because of the paucity of high-quality studies in the healthcare setting, the advocacy of mask types is not entirely evidence-based. Evidence from laboratory studies of potential airborne spread of influenza from shedding patients indicate that guidelines related to the current 1-meter respiratory zone may need to be extended to a larger respiratory zone and include protection from ocular inoculation.", "Airborne transmission and precautions: facts and myths SUMMARY Airborne transmission occurs only when infectious particles of <5\u03bcm, known as aerosols, are propelled into the air. The prevention of such transmission is expensive, requiring N95 respirators and negative pressure isolation rooms. This lecture first discussed whether respiratory viral infections are airborne with reference to published reviews of studies before 2008, comparative trials of surgical masks and N95 respirators, and relevant new experimental studies. However, the most recent experimental study, using naturally infected influenza volunteers as the source, showed negative results from all the manikins that were exposed. Modelling studies by ventilation engineers were then summarized to explain why these results were not unexpected. Second, the systematic review commissioned by the World Health Organization on what constituted aerosol-generating procedures was summarized. From the available evidence, endotracheal intubation either by itself or combined with other procedures (e.g. cardiopulmonary resuscitation or bronchoscopy) was consistently associated with increased risk of transmission by the generation of aerosols.", "Tackling Corona Virus Disease 2019 (COVID 19) in Workplaces Coronaviruses are zoonotic viruses and six species of Coronaviruses are known to cause human disease such as cause common cold, severe acute respiratory syndrome and the Middle East Respiratory Syndrome. In January 2020, scientists in Wuhan, China isolated a novel coronavirus (SARS-CoV-2), responsible for an outbreak of unknown pneumonia that had not been previously reported among humans. This virus spreads from person to person, through respiratory droplets, close contact, and by touching surfaces or objects contaminated by the virus. The incubation period varies between 2 days and 14 days. Symptoms usually include fever, cough, difficulty in breathing, pneumonia, severe acute respiratory syndrome. Older age and co-morbid conditions increase the fatality. Any person with a history of travel to and from COVID-19 affected countries in the past 14 days or any person who has had close contact with a laboratory confirmed COVID-19 are suspect cases and needs evaluation. Currently no vaccine is available and treatment is mainly supportive. Measures at workplace should include- avoiding non-essential travel, identifying and isolating sick employees at the earliest, hand hygiene, respiratory hygiene, environmental hygiene and social distancing.", "Obstetric Anesthesia During the Coronavirus Disease 2019 Pandemic With increasing numbers of Coronavirus Disease 2019 (COVID19) cases due to efficient human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the United States, preparation for the unpredictable setting of labor and delivery is paramount. The priorities are 2-fold in the management of obstetric patients with COVID-19 infection or persons under investigation (PUI): (1) caring for the range of asymptomatic to critically ill pregnant and postpartum women; (2) protecting health care workers and beyond from exposure during the delivery hospitalization (health care providers, personnel, family members). The goal of this review is to provide evidence-based recommendations or, when evidence is limited, expert opinion for anesthesiologists caring for pregnant women during the COVID19 pandemic with a focus on preparedness and best clinical obstetric anesthesia practice.", "Respiratory management in severe acute respiratory syndrome coronavirus 2 infection The severe acute respiratory syndrome coronavirus 2 pandemic is to date affecting more than a million of patients and is challenging healthcare professionals around the world. Coronavirus disease 2019 may present with a wide range of clinical spectrum and severity, including severe interstitial pneumonia with high prevalence of hypoxic respiratory failure requiring intensive care admission. There has been increasing sharing experience regarding the patient\u2019s clinical features over the last weeks which has underlined the need for general guidance on treatment strategies. We summarise the evidence existing in the literature of oxygen and positive pressure treatments in patients at different stages of respiratory failure and over the course of the disease, including environment and ethical issues related to the ongoing coronavirus disease 2019 infection.", "Effectiveness of Surgical and Cotton Masks in Blocking SARS-CoV-2: A Controlled Comparison in 4 Patients ", "Role of viral bioaerosols in nosocomial infections and measures for prevention and control Abstract The presence of patients with diverse pathologies in hospitals results in an environment that can be rich in various microorganisms including respiratory and enteric viruses, leading to outbreaks in hospitals or spillover infections to the community. All hospital patients are at risk of nosocomial viral infections, but vulnerable groups such as older adults, children and immuno-compromised/-suppressed patients are at particular risk of severe outcomes including prolonged hospitalization or death. These pathogens could transmit through direct or indirect physical contact, droplets or aerosols, with increasing evidence suggesting the importance of aerosol transmission in nosocomial infections of respiratory and enteric viruses. Factors affecting the propensity to transmit and the severity of disease transmitted via the aerosol route include the biological characteristics affecting infectivity of the viruses and susceptibility of the host, the physical properties of aerosol particles, and the environmental stresses that alter these properties such as temperature and humidity. Non-specific systematic and individual-based interventions designed to mitigate the aerosol route are available although empirical evidence of their effectiveness in controlling transmission of respiratory and enteric viruses in healthcare settings are sparse. The relative importance of aerosol transmission in healthcare setting is still an on-going debate, with particular challenge being the recovery of infectious viral bioaerosols from real-life settings and the difficulty in delineating transmission events that may also be a result of other modes of transmission. For the prevention and control of nosocomial infections via the aerosol route, more research is needed on identifying settings, medical procedures or equipment that may be associated with an increased risk of aerosol transmission, including defining which procedures are aerosol-generating; and on the effectiveness of systematic interventions on aerosol transmission of respiratory and enteric viruses in healthcare settings.", "Face masks for all and all for face masks in the COVID-19 pandemic: community level production to face the global shortage and shorten the epidemic The current COVID-19 pandemic caused a global shortage of medical masks, leaving most exposed health personnel without appropriate protection.Since the beginning of the outbreak, the WHO has revised several times the recommendations on general use of facemasks. In various countries, the public was advised to wear facemasks, in order to ensure them to healthcare workers. Until recently, WHO recommended to limit the use of facemasks to symptomatic people and advised against off-standard solutions. Moreover, recommendations differ among and within countries, causing public confusion and individual initiative.There is wide consensus that universal appropriate use of masks may contribute both to contain the epidemic and to reduce the burden on national procurement, if a community production approach is followed. Especially in low-middle income countries, due to the scarce capacity of national industrial production or import, the use of masks produced at community level may become the only viable option.For the purpose ad hoc guidelines will be needed.Current knowledge and experience call for further and updated review of global and national guidelines in order to provide clear and consistent criteria to ensure the widest availability and appropriate use of facial protection, bearing in mind populations in socio-economic disadvantaged settings.", "Mask is the possible key for self-isolation in COVID-19 pandemic ", "Hand Hygiene, Mask-Wearing Behaviors and Its Associated Factors during the COVID-19 Epidemic: A Cross-Sectional Study among Primary School Students in Wuhan, China Although the emphasis on behaviors of hand-washing and mask-wearing was repeated during the pandemic of Coronavirus Disease 2019 (COVID-19), not everyone paid enough attention to this. A descriptive statistic was used to make sense of the status of hand hygiene and mask-wearing among primary school students in Wuhan, China. A binary logistic regression analysis was conducted to identify the risk factors affecting the behaviors of hand-washing and mask-wearing. p < 0.05 (two-sides) was considered as significant at statistics. 42.05% of the primary school students showed a good behavior of hand-washing, while 51.60% had a good behavior of mask-wearing. Gender, grade, out-going history, father\u2019s occupation, mother\u2019s educational background, and the time filling out the survey were significantly associated with hand hygiene, whereas grade, mother\u2019s educational background, and residence were associated with mask-wearing. The behaviors of hand-washing and mask-wearing among primary school students were influenced by gender, grade, shady is back tell a friendand other factors, therefore, parents should make efforts of behavior guidance whereas governments should enlarge medium publicity.", "Role of Mask/Respirator Protection Against SARS-CoV-2 ", "The effect of uncontrolled travelers and social distancing on the spread of novel coronavirus disease (COVID-19) in Colombia ", "Transmission of communicable respiratory infections and facemasks BACKGROUND: Respiratory protection efficiency of facemasks is critically important in the battle against communicable respiratory infections such as influenza and severe acute respiratory syndrome (SARS). We studied the spatial distributions of simulated virus-laden respiratory droplets when human subjects wore facemasks and were exposed to regulatory viral droplets by conducting in vivo experiments in facemask use. METHODS: Transmission pathway of aerosols of Fluorescein-KCl solution through facemasks and protective efficiency of facemasks were examined by using normal surgical facemasks and two facemasks with exhaust valves (Facemask A) and exhaust holes (Facemask B) covered with the same surgical filters situated at the back of the facemasks. Fluorescein-KCl solution was sprayed onto the faces of participants wearing the facemasks and performing intermittent exercises on a treadmill in a climatic chamber. RESULTS: Experimental results showed that when droplets spread onto a person face-to-face over short distances, 92.3% to 99.5% of droplets were blocked by the front surface of the facemask, whereas only 0.5% to 7.7% of droplets reached the back of the facemask. Both facemasks A and B had near or over 99% protection efficiency, compared with that of 95.5% to 97% of surgical facemasks. Using the same filters as normal surgical masks, facemasks A and B provided more effective respiratory protection against communicable respiratory infections such as influenza and SARS by the location of the breathing pathway to the back of the facemasks. CONCLUSIONS: Separating the breathing pathway from the virus-contaminated area in facemasks can provide more effective protection against communicable respiratory infections such as influenza and SARS.", "Lockdown exit strategies and risk of a second epidemic peak: a stochastic agent-based model of SARS-CoV-2 epidemic in France Most European countries have responded to the COVID-19 threat by nationwide implementation of barrier measures and lockdown. However, assuming that population immunity will build up through the epidemic, it is likely to rebound once these measures are relaxed, possibly leading to a second or multiple repeated lockdowns. In this report, we present results of epidemiological modelling that has helped inform policy making in France. We used a stochastic agent-based microsimulation model of the COVID-19 epidemic in France, and examined the potential impact of post-quarantine measures, including social distancing, mask-wearing, and shielding of the population the most vulnerable to severe COVID-19 infection, on the disease's cumulative incidence and mortality, and on ICU-bed occupancy. The model calibrated well and variation of model parameter values had little impact on outcome estimates. While quarantine is effective in containing the viral spread, it would be unlikely to prevent a rebound of the epidemic once lifted, regardless of its duration. Both social distancing and mask-wearing, although effective in slowing the epidemic and in reducing mortality, would also be ineffective in ultimately preventing the overwhelming of ICUs and a second lockdown. However, these measures coupled with shielding of vulnerable people would be associated with better outcomes, including lower cumulative incidence, mortality, and maintaining an adequate number of ICU beds to prevent a second lockdown. Benefits would nonetheless be markedly reduced if these measures were not applied by most people or not maintained for a sufficiently long period, as herd immunity progressively establishes in the less vulnerable population.", "A simple model to show the relative risk of viral aerosol infection and the benefit of wearing masks in different settings with implications for Covid-19 . Background . Widespread use of masks in the general population is being used in many countries for Covid-19 . There has been reluctance on the part of the WHO and some governments to recommend this . Methodology . A basic model has been constructed to show the relative risk of aerosol from normal breathing in various situations together with the benefit from use of masks which is multiplicative . Results . Social distancing at 2 metres is validated but in confined areas is time limited and the use of masks in the absence of extremely good ventilation is important. Where social distancing is not possible at all times or an infectious person is in a confined area for a prolonged period there is a higher risk of infection requiring protection . Conclusions . The use of masks should be factored into models and used at an early stage as widespread use of more efficient masks could have a large impact on control and spread of infection . Public health planning requires stockpiling masks and encouraging everyone to have suitable masks in their household when supplies are normalised . The use of a cloth mask will be better than no protection at all .", "Anesthetic and surgical management of tracheostomy in a patient with COVID-19 Abstract The ongoing pandemic coronavirus disease-2019 (COVID-19) infection causes severe respiratory dysfunction and has become an emergent issue for worldwide healthcare. Since COVID-19 spreads through contact and droplet infection routes, careful attention to infection control and surgical management is important to prevent cross-contamination of patients and medical staff. Tracheostomy is an effective method to treat severe respiratory dysfunction with prolonged respiratory management and should be performed as a high-risk procedure. Strict precaution and sufficient use of muscle relaxants are essential during tracheostomy to minimize cross-contamination among healthcare workers in the hospital. Here, we describe the anesthetic and surgical management of tracheostomy in a patient with COVID-19.", "Rational use of face mask in a tertiary care hospital setting during COVID-19 pandemic: An observational study. Masks play a role in the protection of health-care workers (HCWs) from acquiring respiratory infections, including coronavirus disease 2019 (COVID-19) in health-care settings. This observational study was conducted among 382 HCWs in a tertiary care setting over a period of 1 month. Descriptive analysis was done to assess the rational and recommended use of masks/respirators during COVID-19 pandemic using a structured observation checklist as a survey tool. A total of 374 HCWs were included, 64.9% of whom were using face masks rationally as mentioned per risk area categorization with a predominance of triple-layered mask during all 4 weeks. Overall, 64.1% used masks correctly. Clear guidelines and strategies can help to increase the compliance of HCWs with rational use of face masks.", "Universal use of face masks for success against COVID-19: evidence and implications for prevention policies ", "Occupational skin disease among health care workers during the coronavirus (COVID-19) epidemic ", "Helmet Modification to PPE with 3D Printing During the COVID-19 Pandemic at Duke University Medical Center: A Novel Technique Abstract Care for patients during COVID-19 poses challenges that require the protection of staff with recommendations that health care workers wear at minimum, an N95 mask or equivalent while performing an aerosol-generating procedure with a face shield. The United States faces shortages of personal protective equipment, and surgeons who use loupes and headlights have difficulty using these in conjunction with face shields. Most arthroplasty surgeons use surgical helmet systems, but in the current pandemic, many hospitals have delayed elective arthroplasty surgeries and the helmet systems are going unused. As a result, the authors have begun retrofitting these arthroplasty helmets to serve as personal protective equipment (PPE). The purpose of this paper is to outline the conception, design, donning technique, and safety testing of these arthroplasty helmets being re-purposed as PPE.", "Maximizing the Calm Before the Storm: Tiered Surgical Response Plan for Novel Coronavirus (COVID-19) Abstract The novel coronavirus (COVID-19) was first diagnosed in Wuhan, China in December 2019 and has now spread throughout the world, being verified by the World Health Organization as a Pandemic on March 11th. This had led to the calling of a national emergency on March 13th in the United States. Many hospitals, healthcare networks, and specifically Departments of Surgery are asking the same questions of how to cope and plan for surge capacity, personnel attrition, novel infrastructure utilization, and resource exhaustion. Herein, we present a tiered plan for surgical department planning based on incident command levels. This includes Acute Care Surgeon deployment (given their critical care training and vertically integrated position in the hospital), recommended infrastructure and transfer utilization, triage principles, and faculty, resident and advanced care practitioner deployment.", "Textile Masks and Surface Covers - A 'Universal Droplet Reduction Model' Against Respiratory Pandemics The main form of COVID-19 transmission is via oral-respiratory droplet contamination (droplet; very small drop of liquid) produced when individuals talk, sneeze or cough. In hospitals, health-care workers wear facemasks as a minimum medical droplet precaution to protect themselves. Due to the shortage of masks during the pandemic, priority is given to hospitals for their distribution. As a result, the availability/use of medical masks is discouraged for the public. However, given that asymptomatic individuals, not wearing masks within the public, can be highly contagious for COVID-19, prevention of environmental droplet contamination (EnDC) from coughing/sneezing/speech is fundamental to reducing transmission. As an immediate solution to promote public droplet safety, we assessed household textiles to quantify their potential as effective environmental droplet barriers (EDBs). The synchronized implementation of a universal community droplet reduction solution is discussed as a model against COVID-19. Using a bacterial-suspension spray simulation model of droplet ejection (mimicking a sneeze), we quantified the extent by which widely available clothing fabrics reduce the dispersion of droplets onto surfaces within 1.8m, the minimum distance recommended for COVID-19 social distancing. All textiles reduced the number of droplets reaching surfaces, restricting their dispersion to <30cm, when used as single layers. When used as double-layers, textiles were as effective as medical mask/surgical-cloth materials, reducing droplet dispersion to <10cm, and the area of circumferential contamination to ~0.3%. The synchronized implementation of EDBs as a community droplet reduction solution (i.e., face covers/scarfs/masks & surface covers) could reduce EnDC and the risk of transmitting or acquiring infectious respiratory pathogens, including COVID-19.", "Brief guideline for the prevention of COVID-19 infection in head and neck and otolaryngology surgeons IMPORTANCE: Anatomically, viral density is greater in the nasal cavity and the nasopharynx. It is to be expected that instrumentation in or through those areas will entail a higher risk of transmission. That's why head and neck and otolaryngologist surgeons are among the most vulnerable health professionals. OBSERVATIONS: Surgeons should essentially perform procedures they require. Surgeries should be performed with personal protective equipment suitable for the high risk of aerosolization: goggles, N95 face mask, facial mask, blood-repelling gown and gloves. It is advisable to have the cooperative COVID-19 test in all patients. Telemedicine is a useful resource if resources allow it. CONCLUSIONS AND RELEVANCE: Otolaryngologists and related specialists are among the groups at higher risk when performing surgeries and upper airway examinations. There are no emergencies in a pandemic. The care of health professionals is crucial to combating this health situation.", "Inside China and COVID-19: Questions and answers ", "Autoclave Sterilization and Ethanol Treatment of Re-used Surgical Masks and N95 Respirators during COVID-19: Impact on their Performance and Integrity BACKGROUND: An exceptionally high demand for surgical masks and N95 filtering facepiece respirators (FFRs) during the COVID-19 pandemic has considerably exceeded their supply. These disposable devices are generally not approved for routine decontamination and re-use as standard of care while this practice has widely occurred in hospitals. The US Centers for Disease Control and Prevention allowed it \u201cas a crisis capacity strategy.\u201d However, limited testing was conducted on the impact of specific decontamination methods on the performance of N95 FFRs and no data was presented for surgical masks. AIM: We evaluated common surgical masks and N95 respirators with respect to the changes in their performance and integrity resulting from autoclave sterilization and a 70% ethanol treatment; these methods are frequently utilized for re-used filtering facepieces in hospitals. METHODS: The filter collection efficiency and pressure drop were determined for unused masks and N95 FFRs, and for those subjected to the treatments in a variety of ways. The collection efficiency was measured for particles of approximately 0.037\u20133.2 \u03bcm to represent aerosolized single viruses, their agglomerates, bacteria and larger particles carriers. FINDINGS: The initial collection efficiency and the filter breathability may be compromised by sterilization in an autoclave and ethanol treatment. The effect depends on a protective device, particle size, breathing flow rate, type of treatment and other factors. Additionally, physical damages were observed in N95 respirators after autoclaving. CONCLUSION: Strategies advocating decontamination and re-use of filtering facepieces in hospitals should be re-assessed considering the data obtained in this study.", "COVID-19: what has been learned and to be learned about the novel coronavirus disease The outbreak of Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2), has thus far killed over 3,000 people and infected over 80,000 in China and elsewhere in the world, resulting in catastrophe for humans. Similar to its homologous virus, SARS-CoV, which caused SARS in thousands of people in 2003, SARS-CoV-2 might also be transmitted from the bats and causes similar symptoms through a similar mechanism. However, COVID-19 has lower severity and mortality than SARS but is much more transmissive and affects more elderly individuals than youth and more men than women. In response to the rapidly increasing number of publications on the emerging disease, this article attempts to provide a timely and comprehensive review of the swiftly developing research subject. We will cover the basics about the epidemiology, etiology, virology, diagnosis, treatment, prognosis, and prevention of the disease. Although many questions still require answers, we hope that this review helps in the understanding and eradication of the threatening disease.", "Effectiveness of Cloth Masks for Protection Against Severe Acute Respiratory Syndrome Coronavirus 2 Cloth masks have been used in healthcare and community settings to protect the wearer from respiratory infections. The use of cloth masks during the coronavirus disease (COVID-19) pandemic is under debate. The filtration effectiveness of cloth masks is generally lower than that of medical masks and respirators; however, cloth masks may provide some protection if well designed and used correctly. Multilayer cloth masks, designed to fit around the face and made of water-resistant fabric with a high number of threads and finer weave, may provide reasonable protection. Until a cloth mask design is proven to be equally effective as a medical or N95 mask, wearing cloth masks should not be mandated for healthcare workers. In community settings, however, cloth masks may be used to prevent community spread of infections by sick or asymptomatically infected persons, and the public should be educated about their correct use.", "Modified N95 Mask Delivers High Inspired Oxygen Concentrations While Effectively Filtering Aerosolized Microparticles STUDY OBJECTIVE: In a pandemic, hypoxic patients will require an effective oxygen (O(2)) delivery mask that protects them from inhaling aerosolized particles produced by others, as well as protecting the health care provider from exposure from the patient. We modified an existing N95 mask to optimize O(2) supplementation while maintaining respiratory isolation. METHODS: An N95 mask was modified to deliver O(2) by inserting a plastic manifold consisting of a 1-way inspiratory valve, an O(2) inlet and a gas reservoir. In a prospective repeated-measures study, we studied 10 healthy volunteers in each of 3 phases, investigating (1) the fractional inspiratory concentrations of O(2) (F(I)O(2)) delivered by the N95 O(2) mask, the Hi-Ox(80) O(2) mask, and the nonrebreathing mask during resting ventilation and hyperventilation, each at 3 O(2) flow rates; (2) the ability of the N95 mask, the N95 O(2) mask, and the nonrebreathing mask to filter microparticles from ambient air; and (3) to contain microparticles generated inside the mask. RESULTS: The F(I)O(2)s (median [range]) delivered by the Hi-Ox(80) O(2) mask, the N95 O(2) mask, and the nonrebreathing mask during resting ventilation, at 8 L/minute O(2) flow, were 0.90 (0.79 to 0.96), 0.68 (0.60 to 0.85), and 0.59 (0.52 to 0.68), respectively. During hyperventilation, the FiO(2)s of all 3 masks were clinically equivalent. The N95 O(2) mask, but not the nonrebreathing mask, provided the same efficiency of filtration of internal and external particles as the original N95, regardless of O(2) flow into the mask. CONCLUSION: An N95 mask can be modified to administer a clinically equivalent FiO(2) to a nonrebreathing mask while maintaining its filtration and isolation capabilities.", "COVID-19: emerging protective measures. The COVID-19 (Coronavirus disease 2019) spreads primarily through droplets of saliva or discharge from the nose. COVID-19 is predominantly considered as an unavoidable pandemic, and scientists are very curious about how to provide the best protection to the public before a vaccine can be made available. There is an urge to manufacture a greater number of masks to prevent any aerosol with microbes. Hence, we aim to develop an efficient viral inactivation system by exploiting active compounds from naturally occurring medicinal plants and infusing them into nanofiber-based respiratory masks. Our strategy is to develop fibrous filtration with three-layered masks using the compounds from medicinal plants for viral deactivation. These masks will be beneficial not just to healthcare workers but common citizens as well. In the absence of vaccination, productive masks can be worn to prevent transmission of airborne pathogenic aerosols and control diseases.", "The more I fear about COVID-19, the more I wear medical masks: A survey on risk perception and medical masks uses The legal behaviors in using medical masks in public have been finally promulgated by the Vietnamese Government after 47 days since the WHO declared the Public Health Emergency of International Concern (PHEIC) due to the COVID-19 pandemic. From a sample of 345 Vietnamese respondents aged from 15 to 47 years, this brief note found that the risk perception of COVID-19 danger significantly increases the likelihood of wearing the medical masks. In addition, there is a weak evidence about the differences in age under the COVID-19 outbreaks. More noticeably, those who use masks before COVID-19 pandemic tend to maintain their behaviors. Our results offer the insightful into Vietnamese citizens responses in terms of using medical masks; even the uses of this method are still controversial. Our results are robust by performing Exploratory Factor Analysis for five features and further regressions.", "Proper Use of Surgical N95 Respirators and Surgical Masks in the OR Abstract Proper adherence to infection control precautions, including appropriate selection and use of personal protective equipment (PPE), is of significant importance to the health and well-being of perioperative personnel. Surgical masks are intended for use as a barrier to protect the wearer\u2019s face from large droplets and splashes of blood and other body fluids; however, surgical and high-filtration surgical laser masks do not provide enough protection to be considered respiratory PPE. Potential exposure to airborne contaminants and infectious agents, including those present in surgical smoke, necessitates the use of respiratory PPE, such as a surgical N95 particulate filtering facepiece respirator. Filtering facepiece respirators greatly reduce a wide size range of particles from entering the wearer\u2019s breathing zone and are designed to protect the user from both droplet and airborne particles. Every health care worker who must use a respirator to control hazardous exposures in the workplace must be trained to properly use the respirator and pass a fit test before using it in the workplace.", "Perspectives from the Cancer and Aging Research Group: Caring for the vulnerable older patient with cancer and their caregivers during the COVID-19 crisis in the United States ", "Personal protective equipment during the coronavirus disease (COVID) 2019 pandemic - a narrative review Personal protective equipment has become an important and emotive subject during the current coronavirus disease 2019 epidemic. Coronavirus disease 2019 is predominantly caused by contact or droplet transmission attributed to relatively large respiratory particles which are subject to gravitational forces and travel only approximately 1 metre from the patient. Airborne transmission may occur if patient respiratory activity or medical procedures generate respiratory aerosols. These aerosols contain particles that may travel much longer distances and remain airborne longer, but their infective potential is uncertain. Contact, droplet and airborne transmission are each relevant during airway manoeuvres in infected patients, particularly during tracheal intubation. Personal protective equipment is an important component, but only one part, of a system protecting staff and other patients from coronavirus disease 2019 cross-infection. Appropriate use significantly reduces risk of viral transmission. Personal protective equipment should logically be matched to the potential mode of viral transmission occurring during patient care - contact, droplet or airborne. Recommendations from international organisations are broadly consistent, but equipment use is not. Only airborne precautions include a fitted high-filtration mask, and this should be reserved for aerosol generating procedures. Uncertainty remains around certain details of personal protective equipment including use of hoods, mask type and the potential for re-use of equipment.", "Community Universal Face Mask Use during the COVID 19 pandemic\u2014from households to travelers and public spaces ", "Navigating the challenges of the COVID-19 outbreak: perspectives from the radiation oncology service in singapore Abstract In December 2019, pneumonia of unknown cause was reported by China to WHO. The outbreak was found to be caused by a coronavirus which was officially named \u201csevere acute respiratory syndrome coronavirus 2\u201d (SARS-CoV-2), and the disease caused by it was named \u2018COVID-19\u2019. The first case in Singapore was confirmed on 23rd January 2020. With lessons learnt from the SARS epidemic in 2003 and the H1N1 flu pandemic in 2009, Singapore was much better prepared to deal with the virus outbreak. The government has taken swift measures to contain and break the chain of transmission. Healthcare workers face the challenge of keeping patients and staff safe from the disease. There is a higher risk of mortality of COVID-19 in cancer patients and hence unique considerations for a radiation oncology department operating in an infectious disease outbreak. This article is the recommendations and adapted workflow from the two National Cancer Centres in Singapore with the endorsement by the working committee of the Chapter of Radiation Oncology, Academy of Medicine, Singapore. It highlights the challenges that radiation oncology departments in Singapore face and the appropriate recommended responses. This includes interventions, business continuity plans and workflow in managing a COVID-19 positive patient on radiotherapy.", "Wearing a N95 mask increases rescuer's fatigue and decreases chest compression quality in simulated cardiopulmonary resuscitation OBJECTIVES: N95 mask is essential for healthcare workers dealing with the coronavirus disease 2019 (COVID-19). However, N95 mask causes discomfort breathing with marked reduction in air exchange. This study was designed to investigate whether the use of N95 mask affects rescuer's fatigue and chest compression quality during cardiopulmonary resuscitation (CPR). METHODS: After a brief review of CPR, each participant performed a 2-minute continuous chest compression on a manikin wearing N95 (N95 group, n = 40) or surgical mask (SM group, n = 40). Compression rate and depth, the proportions of correct compression rate, depth, complete chest recoil and hand position were documented. Participants' fatigue was assessed using Borg score. RESULTS: Significantly lower mean chest compression rate and depth were both achieved in the N95 group than in the SM group (p < 0.05, respectively). In addition, the proportion of correct compression rate (61 \u00b1 19 vs. 75 \u00b1 195, p = 0.0067), depth (67 \u00b1 16 vs. 90 \u00b1 14, p < 0.0001) and complete recoil (91 \u00b1 16 vs. 98 \u00b1 5%, p = 0.0248) were significantly decreased in the N95 group as compared to the SM group. At the end of compression, the Borg score in the N95 group was significantly higher than that in the SM group (p = 0.027). CONCLUSION: Wearing a N95 mask increases rescuer's fatigue and decreases chest compression quality during CPR. Therefore, the exchange of rescuers during CPR should be more frequent than that recommended in current guidelines when N95 masks are applied.", "Design of a Self-powered Smart Mask for COVID-19 Usage of a face mask has become mandatory in many countries after the outbreak of SARS-CoV-2, and its usefulness in combating the pandemic is a proven fact. There have been many advancements in the design of a face mask and the present treatise describes a face mask in which a simple textile triboelectric nanogenerator (TENG) serves the purpose of filtration of SARS-CoV-2. The proposed mask is designed with multilayer protection sheets, in which the first two layers act as triboelectric (TE) filter and the outer one is a smart filter. The conjugated effect of contact electrification, and electrostatic induction of the proposed smart mask are effective in inactivating the span of virus-ladden aerosols in a bidirectional way. Five pairs of triboseries fabrics i.e. nylon - polyester, cotton - polyester, poly(methyl methacrylate) - PVDF, lylon - PVDF and polypropylene - polyester have been optimized in this study in terms of their effective tribo-electric charge densities as 83.13, 211.48, 38.62, 69 and 74.25 nC/m2, respectively. This smart mask can be used by a wide range of people because of its simple mechanism, self-driven (harvesting mechanical energy from daily activities, e.g. breathing, talking, or other facial movements functionalities, and effective filtration efficiency and thus, it is expected to be potentially beneficial to slow down the devastating impact of COVID-19.", "Effect of various decontamination procedures on disposable N95 mask integrity and SARS-CoV-2 infectivity The COVID-19 pandemic has created a high demand on personal protective equipment, including disposable N95 masks. Given the need for mask reuse, we tested the feasibility of vaporized hydrogen peroxide (VHP), ultraviolet light (UV), and ethanol decontamination strategies on N95 mask integrity and the ability to remove the infectious potential of SARS-CoV-2. FIT test data showed functional degradation by both ethanol and UV decontamination to different degrees. VHP treated masks showed no significant change in function after two treatments. We also report a single SARS-CoV-2 virucidal experiment using Vero E6 cell infection. We hope our data will guide further research for evidenced-based decisions for disposable N95 mask reuse and help protect caregivers from SARS-CoV-2 and other pathogens.", "Peripheral nerve blocks in a patient with suspected COVID-19 infection ", "Working through the COVID-19 outbreak: Rapid review and recommendations for MSK and allied heath personnel Abstract The coronavirus (COVID-19) pandemic has caused the world to undergo unprecedented change in a short space of time. This disease has devastated the economy, infringed personal freedom, and has taken a toll on healthcare systems worldwide. This review aims to highlight aspects of this pandemic with a specific emphasis on musculoskeletal work within the secondary care setting.", "Considerations in performing endoscopy during the COVID-19 pandemic ", "Decontamination of face masks with steam for mask reuse in fighting the pandemic COVID-19: Experimental supports The coronavirus disease 2019 pandemic caused by the novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has claimed many lives worldwide. Wearing medical masks (MMs) or N95 masks ([N95Ms] namely N95 respirators) can slow the virus spread and reduce the infection risk. Reuse of these masks can minimize waste, protect the environment, and help solve the current imminent shortage of masks. Disinfection of used masks is needed for their reuse with safety, but improper decontamination can damage the blocking structure of masks. In this study, we demonstrated using the avian coronavirus of infectious bronchitis virus to mimic SARS-CoV-2 that MMs and N95Ms retained their blocking efficacy even after being steamed on boiling water for 2 hours. We also demonstrated that three brands of MMs blocked over 99% viruses in aerosols. The avian coronavirus was completely inactivated after being steamed for 5 minutes. Altogether, this study suggested that MMs are adequate for use on most social occasions and both MMs and N95Ms can be reused for a few days with steam decontamination between use.", "Coronavirus Disease 2019 (COVID-19) and dermatologists: Potential biological hazards of laser surgery in epidemic area ", "Nursing care for patients with COVID-19 on extracorporeal membrane oxygenation (ECMO) support In Japan, four medical facilities including our own - the National Center for Global health and Medicine (NCGM) - have been designated for the treatment of specified infectious diseases by the Minister of Health, Labour, and Welfare Here, we report our nursing care for patients with severe COVID-19 on extracorporeal membrane oxygenation (ECMO) support In addition to infection control measures in the form of an N95 mask, a water-repellent isolation gown, a cap, a shielded mask on top of the N95, and double-layered gloves, nurses were required to wear one-piece suits (DuPont\u2122 Tyvek\u00ae) and use powered air-purifying respirators (PAPRs) While closed system catheters are normally changed once a day to limit aerosol exposure, they are now changed once every 4 days Nursing care included equipment checks, monitoring of hemodynamics and respiratory status, management of anticoagulants, observation of the patient\u2019s general condition, management of sedatives and analgesics, prevention of medical device-related pressure ulcers and bedsores, and maintenance of hygiene Fundamentally sound nursing remains the best practice for patient treatment and management During nursing care for patients with COVID-19 on ECMO, infection control measures should be faithfully and properly followed", "Waste Not, Want Not: Re-Usability of N95 Masks As the spread of COVID-19 illnesses continues to escalate amidst a substandard supply of protective equipment for health care providers, the question of extended use or reuse of N95 masks has emerged. As well, the relative effectiveness of the N95 compared to other mask types have been entertained. A recent article by Abd-Elsayed and Karri aim to put these topics into focus. Additionally, personal correspondence between Drs. Richard Prielipp (University of Minnesota Department of Anesthesiology) and Peter Tsai (inventor of the N95 mask) offers perspectives on managing the reuse of this central element of protective equipment.", "Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care The recent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated coronavirus disease has gripped the entire international community and caused widespread public health concerns. Despite global efforts to contain the disease spread, the outbreak is still on a rise because of the community spread pattern of this infection. This is a zoonotic infection, similar to other coronavirus infections, that is believed to have originated in bats and pangolins and later transmitted to humans. Once in the human body, this coronavirus (SARS-CoV-2) is abundantly present in nasopharyngeal and salivary secretions of affected patients, and its spread is predominantly thought to be respiratory droplet/contact in nature. Dental professionals, including endodontists, may encounter patients with suspected or confirmed SARS-CoV-2 infection and will have to act diligently not only to provide care but at the same time prevent nosocomial spread of infection. Thus, the aim of this article is to provide a brief overview of the epidemiology, symptoms, and routes of transmission of this novel infection. In addition, specific recommendations for dental practice are suggested for patient screening, infection control strategies, and patient management protocol.", "COVID-19 Pandemic: International Variation of Personal Protective Equipment and Infection Prevention and Control Guidelines ", "Surgical Mask\u2013the Saviour: from its Invention to the COVID-19 Era The earliest available evidence attributes the discovery of droplets as a mode of transmission of disease to Carl Fl\u00fcgge, a German bacteriologist, a contemporary of Emil Kocher, in 1897. This finding was instrumental in the development of the gauze mask introduced by Johann von Mikulicz Radecki in the same year. A surgical mask has become an indispensable tool in the armamentarium to fight the COVID 19 pandemic. Surgical masks which were once limited to the confines of healthcare setups are now donned by the members of the general public. It has become imperative that a healthcare worker selects the right kind of respiratory protective equipment to protect himself and his patients. The surgical mask has become essential, in a way, for survival.", "Impact of population mask wearing on Covid-19 post lockdown COVID-19, caused by SARS-CoV2 is a rapidly spreading global pandemic. Although precise transmission routes and dynamics are unknown, SARS-CoV2 is thought primarily to spread via contagious respiratory droplets. Unlike with SARS-CoV, maximal viral shedding occurs in the early phase of illness, and this is supported by models that suggest 40-80% of transmission events occur from pre- and asymptomatic individuals. One widely-discussed strategy to limit transmission of SARS-CoV2, particularly from presymptomatic individuals, has been population-level wearing of masks. Modelling for pandemic influenza suggests some benefit in reducing total numbers infected with even 50% mask-use. COVID-19 has a higher hospitalization and mortality rate than influenza, and the impacts on these parameters, and critically, at what point in the pandemic trajectory mask-use might exert maximal benefit are completely unknown. We derived a simplified SIR model to investigate the effects of near-universal mask-use on COVID-19 assuming 8 or 16% mask efficacy. We decided to model, in particular, the impact of masks on numbers of critically-ill patients and cumulative mortality, since these are parameters that are likely to have the most severe consequences in the COVID-19 pandemic. Whereas mask use had a relatively minor benefit on critical-care and mortality rates when transmissibility (Reff) was high, the reduction on deaths was dramatic as the effective R approached 1, as might be expected after aggressive social-distancing measures such as wide-spread lockdowns. One major concern with COVID-19 is its potential to overwhelm healthcare infrastructures, even in resource-rich settings, with one third of hospitalized patients requiring critical-care. We incorporated this into our model, increasing death rates for when critical-care resources have been exhausted. Our simple model shows that modest efficacy of masks could avert substantial mortality in this scenario. Importantly, the effects on mortality became hyper-sensitive to mask-wearing as the effective R approaches 1, i.e. near the tipping point of when the infection trajectory is expected to revert to exponential growth, as would be expected after effective lockdown. Our model suggests that mask-wearing might exert maximal benefit as nations plan their post-lockdown strategies and suggests that mask-wearing should be included in further more sophisticated models of the current pandemic.", "Facial protection in the era of COVID-19: a narrative review We live in extraordinary times, where COVID-19 pandemic has brought the whole world to a screeching halt. Tensions and contradictions that surround the pandemic ridden world include the availability, and the lack thereof, various facial protection measures to mitigate the viral spread. Here, we comprehensively explore the different type of facial protection measures, including masks, needed both for the pubic and the health care workers (HCW). We discuss the anatomy, the critical issues of disinfection and reusability of masks, the alternative equipment available for the protection of the facial region from airborne diseases, such as face shields and powered air purifying respirators (PAPR), and the skin-health impact of prolonged wearing of facial protection by HCW. Clearly, facial protection, either in the form of masks or alternates, appears to have mitigated the pandemic as seen from the minimal COVID-19 spread in countries where public mask wearing is strictly enforced. On the contrary, the healthcare systems, that appear to have been unprepared for emergencies of this nature, should be appropriately geared to handle the imbalance of supply and demand of personal protective equipment including face masks. These are two crucial lessons we can learn from this tragic experience.", "Comparison of SARS-CoV-2 Exit Strategies Building Blocks We consider and compare various exit strategy building blocks and key measures to mitigate the current SARS-CoV-2 pandemic, some already proposed as well as improvements we suggest. Our comparison is based on a computerized simulation integrating accumulated SARS-CoV-2 epidemiological knowledge. Our results stress the importance of immediate on-symptom isolation of suspected cases and household members, and the beneficial effects of prompt testing capacity. Our findings expose significant epidemic-suppression differences among strategies with seemingly similar economic cost stressing the importance of not just the portion of population and business that is released, but also the pattern. The most effective building blocks are the ones that integrate several base strategies - they allow to release large portions of the population while still achieving diminishing viral spread. However, it may come with a price on somewhat more complex schemes. For example, our simulations indicate that dividing the population into two groups completely released except for taking turns on a long weekend (Fri-Tue) self-isolation once every two weeks, while protecting the 5% most sensitive population would reduce R below 1 even if ten percent of the population does not follow it. We further simulate the contrasting approach of a stratified population release in a hope to achieve herd immunity, which for the time being seems inferior to other suggested building blocks. Knowing the tradeoff between building blocks could help optimize exit strategies to be more effective and suitable for a particular area or country, while maximizing human life as well as economic value. Given our results, we believe that pandemic can be controlled within a reasonable amount of time and at a reasonable socio-economic burden.", "Masking the general population might attenuate COVID-19 outbreaks The effect of masking the general population on a COVID-19 epidemic is estimated by computer simulation using two separate state-of-the-art web-based softwares, one of them calibrated for the SARS-CoV-2 virus. The questions addressed are these: 1. Can mask use by the general population limit the spread of SARS-CoV-2 in a country? 2. What types of masks exist, and how elaborate must a mask be to be effective against COVID-19? 3. Does the mask have to be applied early in an epidemic? 4. A brief general discussion of masks and some possible future research questions regarding masks and SARS-CoV-2. Results are as follows: (1) The results indicate that any type of mask, even simple home-made ones, may be effective. Masks use seems to have an effect in lowering new patients even the protective effect of each mask (here dubbed\"one-mask protection\") is low. Strict adherence to mask use does not appear to be critical. However, increasing the one-mask protection to>50% was found to be advantageous. Masks seemed able to reduce overflow of capacity, e.g. of intensive care. As the default parameters of the software included another intervention, it seems possible to combine mask and other interventions. (2) Masks do seem to reduce the number of new cases even if introduced at a late stage in an epidemic. However, early implementation helps reduce the cumulative and total number of cases. (3) The simulations suggest that it might be possible to eliminate a COVID-19 outbreak by widespread mask use during a limited period. The results from these simulations are encouraging, but do not necessarily represent the real-life situation, so it is suggested that clinical trials of masks are now carried out while continuously monitoring effects and side-effects.", "Effects of wearing N95 and surgical facemasks on heart rate, thermal stress and subjective sensations Aim: The study was aimed at investigating the effects of wearing N95 and surgical facemasks with and without nano-functional treatments on thermophysiological responses and the subjective perception of discomfort. Method: Five healthy male and five healthy female participants performed intermittent exercise on a treadmill while wearing the protective facemasks in a climate chamber controlled at an air temperature of 25\u00b0C and a relative humidity of 70%. Four types of facemasks, including N95 (3M 8210) and surgical facemasks, which were treated with nano-functional materials, were used in the study. Results: (1) The subjects had significantly lower average heart rates when wearing nano-treated and untreated surgical facemasks than when wearing nano-treated and untreated N95 facemasks. (2) The outer surface temperature of both surgical facemasks was significantly higher than that of both N95 facemasks. On the other hand, the microclimate and skin temperatures inside the facemask were significantly lower than those in both N95 facemasks. (3) Both surgical facemasks had significantly higher absolute humidity outside the surface than both N95 facemasks. The absolute humidity inside the surgical facemask was significantly lower than that inside both N95 facemasks. (4) Both surgical facemasks were rated significantly lower for perception of humidity, heat, breath resistance and overall discomfort than both N95 facemasks. The ratings for other sensations, including feeling unfit, tight, itchy, fatigued, odorous and salty, that were obtained while the subjects were wearing the surgical facemasks were significantly lower than when the subjects were wearing the N95 facemasks. (5) Subjective preference for the nano-treated surgical facemasks was the highest. There was significant differences in preference between the nano-treated and untreated surgical facemasks and between the surgical and N95 facemasks. Discussion: We discuss how N95 and surgical facemasks induce significantly different temperature and humidity in the microclimates of the facemasks, which have profound influences on heart rate and thermal stress and subjective perception of discomfort.", "Practical strategies for a safe and effective delivery of aerosolized medications to patients with COVID-19 Abstract The COVID-19, the disease caused by a novel coronavirus and named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread rapidly across the globe. It has caused outbreaks of illness due to person-to-person transmission of the virus mainly via close contacts and droplets produced by an infected person's cough or sneeze. Exhaled droplets from infected patients with COVID-19 can be inhaled into the lungs and leads to respiratory illness such as pneumonia and acute respiratory distress syndrome. Although aerosol therapy is a mainstay procedure used to treat pulmonary diseases at home and healthcare settings, it has a potential for fugitive emissions during therapy due to the generation of aerosols and droplets as a source of respiratory pathogens. Delivering aerosolized medications to patients with COVID-19 can aggravate the spread of the novel coronavirus. This has been a real concern for caregivers and healthcare professionals who are susceptible to unintended inhalation of fugitive emissions during therapy. Due to a scarcity of information in this area of clinical practice, the purpose of this paper is to explain how to deliver aerosolized medications to mild-, sub-intensive, and intensive patients with COVID-19 and how to protect staff from exposure to exhaled droplets during aerosol therapy.", "Modifying reusable elastomeric respirators to utilise breathing system filters with 3D printed adapters, a safe alternative to N95 during COVID-19 The COVID-19 pandemic has caused a worldwide shortage of personal protective equipment including N95 and FFP3 respirators. Reusable elastomeric respirators are suitable alternatives when used with compatible filters. These filters may be difficult to source and elastomeric respirators are not recommended for surgical use as the exhaled air is not filtered. Breathing system filters are routinely used in anaesthetic circuits to filter virus and bacteria. In this study, we designed 3D printed adapters that allowed elastomeric respirators to utilise breathing system filters and made simple modifications to the respirators to filter exhaled breaths. We then evaluated the performance and safety of our modified elastomeric respirators with quantitative fit tests. We recruited 8 volunteers to perform quantitative fit tests. Fit factors, respiratory rate and end-tidal carbon dioxide were recorded before and after wearing the modified respirators for 1 hour. All 8 volunteers obtained fit factors of 200+, the maximum achievable, for all tests exercises in all fit tests. The mean (range) end-tidal carbon dioxide was 4.5 (3.9-5.5) kPa and 4.6 (range 4.1-5.3) kPa before and after 1 hour of usage. The mean (range) respiratory rate was 16.5 (11-24) min-1 and 17.4 (15-22) min-1 before and after 1 hour of usage. Four (50%) did not experience any subjective discomfort while 2 (25%) reported pressure on the face, 1 (12.5%) reported exhalation resistance and 1 (12.5%) reported transient dizziness with exertion. Breathing system filters combined with properly fitted reusable elastomeric respirators is a safe alternative to N95 during the COVID-19 pandemic.", "Comparing dynamics and determinants of SARS-CoV-2 transmissions among health care workers of adult and pediatric settings in central Paris Background: From the start of the pandemic, health-care workers (HCW) have paid a heavy toll to the coronavirus disease-19 (COVID-19) outbreak. Objectives: To describe the dynamics and determinants of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in HCW. Design: Prospective observational study conducted from February 24th until April 10th, 2020. Setting: Comparison of a 1,500-bed adult and a 600-bed pediatric setting of a tertiary-care university hospital located in central Paris. Participants: All symptomatic HCW screened for SARS-CoV-2 on a nasopharyngeal swab. Measurements: HCW screened positive were prospectively questioned on their profession, symptoms, occupational and non-occupational exposures to SARS-CoV-2. Results: Among 1344 symptomatic HCW tested, 373 were positive (28%) and 336 (90%) corresponding questionnaires were completed. Three hospitalizations and no death were reported. Most HCW (70%) had patient-facing occupational activities (22% in COVID-19 dedicated units). The total number of HCW cases peaked on March 23rd, then decreased slowly, concomitantly with a continuous increase of compliance to preventive measures (including universal medical masking and personal protective equipment (PPE) for direct care to COVID-19 patients). Attack rates were of 3.2% and 2.3% in the adult and pediatric setting, respectively (p=0.0022). In the adult setting, HCW more frequently reported exposure to COVID-19 patients without PPE (25% versus 15%, p=0.046). Report of contacts with children attending out-of-home care facilities dramatically decreased over the study period. Limitations: Lack of COVID-19 negative controls and recall bias. Conclusion: Universal masking, reinforcement of hand hygiene, and PPE with medical masks for patients' care allowed protection of HCW and containment of the outbreak. Residual transmissions were related to persistent exposures with undiagnosed patients or colleagues and not to contacts with children attending out-of-home care facilities.", "Professional and Home-Made Face Masks Reduce Exposure to Respiratory Infections among the General Population BACKGROUND: Governments are preparing for a potential influenza pandemic. Therefore they need data to assess the possible impact of interventions. Face-masks worn by the general population could be an accessible and affordable intervention, if effective when worn under routine circumstances. METHODOLOGY: We assessed transmission reduction potential provided by personal respirators, surgical masks and home-made masks when worn during a variety of activities by healthy volunteers and a simulated patient. PRINCIPAL FINDINGS: All types of masks reduced aerosol exposure, relatively stable over time, unaffected by duration of wear or type of activity, but with a high degree of individual variation. Personal respirators were more efficient than surgical masks, which were more efficient than home-made masks. Regardless of mask type, children were less well protected. Outward protection (mask wearing by a mechanical head) was less effective than inward protection (mask wearing by healthy volunteers). CONCLUSIONS/SIGNIFICANCE: Any type of general mask use is likely to decrease viral exposure and infection risk on a population level, in spite of imperfect fit and imperfect adherence, personal respirators providing most protection. Masks worn by patients may not offer as great a degree of protection against aerosol transmission.", "COVID-19 Outbreak Among Three Affiliated Homeless Service Sites \u2014 King County, Washington, 2020 On March 30, 2020, Public Health - Seattle and King County (PHSKC) was notified of a confirmed case of coronavirus disease 2019 (COVID-19) in a resident of a homeless shelter and day center (shelter A). Residents from two other homeless shelters (B and C) used shelter A's day center services. Testing for SARS-CoV-2, the virus that causes COVID-19, was offered to available residents and staff members at the three shelters during March 30-April 1, 2020. Among the 181 persons tested, 19 (10.5%) had positive test results (15 residents and four staff members). On April 1, PHSKC and CDC collaborated to conduct site assessments and symptom screening, isolate ill residents and staff members, reinforce infection prevention and control practices, provide face masks, and advise on sheltering-in-place. Repeat testing was offered April 7-8 to all residents and staff members who were not tested initially or who had negative test results. Among the 118 persons tested in the second round of testing, 18 (15.3%) had positive test results (16 residents and two staff members). In addition to the 31 residents and six staff members identified through testing at the shelters, two additional cases in residents were identified during separate symptom screening events, and four were identified after two residents and two staff members independently sought health care. In total, COVID-19 was diagnosed in 35 of 195 (18%) residents and eight of 38 (21%) staff members who received testing at the shelter or were evaluated elsewhere. COVID-19 can spread quickly in homeless shelters; rapid interventions including testing and isolation to identify cases and minimize transmission are necessary. CDC recommends that homeless service providers implement appropriate infection control practices, apply physical distancing measures including ensuring resident's heads are at least 6 feet (2 meters) apart while sleeping, and promote use of cloth face coverings among all residents (1).", "Laboratory biosafety for handling emerging viruses Abstract Emerging viruses are viruses whose occurrence has risen within the past twenty years, or whose presence is likely to increase in the near future. Diseases caused by emerging viruses are a major threat to global public health. In spite of greater awareness of safety and containment procedures, the handling of pathogenic viruses remains a likely source of infection, and mortality, among laboratory workers. There is a steady increase in both the number of laboratories and scientist handling emerging viruses for diagnostics and research. The potential for harm associated to work with these infectious agents can be minimized through the application of sound biosafety concepts and practices. The main factors to the prevention of laboratory-acquired infection are well-trained personnel who are knowledgable and biohazard aware, who are perceptive of the various ways of transmission, and who are professional in safe laboratory practice management. In addition, we should emphasize that appropriate facilities, practices and procedures are to be used by the laboratory workers for the handling of emerging viruses in a safe and secure manner. This review is aimed at providing researchers and laboratory personnel with basic biosafety principles to protect themselves from exposure to emerging viruses while working in the laboratory. This paper focuses on what emerging viruses are, why emerging viruses can cause laboratory-acquired infection, how to assess the risk of working with emerging viruses, and how laboratory-acquired infection can be prevented. Control measures used in the laboratory designed as such that they protect workers from emerging viruses and safeguard the public through the safe disposal of infectious wastes are also addressed.", "The Face Mask How a Real Protection becomes a Psychological Symbol during Covid-19? 'The Mask' has become a byword and a precious possession universally. Except for its use by the medical fraternity, answers to the common questions-whether it provides enough protection, which type is optimal for the general public and who really needs to don it, remain poorly understood. For a frontline healthcare worker, wearing mask is a necessity as an important person protection equipment, it is perhaps the most-powerful psychological symbol for the general public. Surprisingly, it even undermines all other recommended practices of infection control and breaking the transmission chain of Covid-19, like hand washing, personal hygiene and social distancing. 'The mask' has evolved with time and yet there is a need to further improve the design for safety, tolerability and comfort. In this review we present the journey of face mask, originating from the first masks aimed at stopping the bad smell to its industrial use to its all-important place in the medical field. Various types of face masks, their filtration efficiency, reusability and current recommendations for their use are presented.", "Initial impacts of global risk mitigation measures taken during the combatting of the COVID-19 pandemic Abstract This paper presents an analysis of risk mitigation measures taken by countries around the world facing the current COVID-19 outbreak. In light of the current pandemic the authors collated and clustered (using harmonised terminology) the risk mitigation measures taken around the globe in the combat to contain, and since March 11 2020, to limit the spread of the SARS-CoV-2 virus known to cause the Coronavirus disease 2019 (COVID-19). This overview gathers lessons learnt, providing an update on the current knowledge for authorities, sectors and first responders on the effectiveness of said measures, and may allow enhanced prevention, preparedness and response for future outbreaks. Various measures such as mobility restrictions, physical distancing, hygienic measures, socio-economic restrictions, communication and international support mechanisms have been clustered and are reviewed in terms of the nature of the actions taken and their qualitative early-perceived impact. At the time of writing, it is still too premature to express the quantitative effectiveness of each risk mitigation cluster, but it seems that the best mitigation results are reported when applying a combination of voluntary and enforceable measures.", "Medical masks and Respirators for the Protection of Healthcare Workers from SARS-CoV-2 and other viruses The use of medical masks and respirators as personal protective equipment is pivotal to reducing the level of biological hazard to which healthcare workers are exposed during the outbreak of highly diffusible pathogens, such as the recent novel coronavirus SARS-CoV-2. Unfortunately, during this pandemic, supplies are rapidly running out worldwide, with potential consequences for the rate of occupational infections. Also, knowledge about specific characteristics of respirators is of utmost importance to select the proper type according to the clinical setting. A wide variety of literature is available on the topic, but mostly based on Influenza viruses infection models. Clinical evidence on the use of respirators is poor and interest in the topic has not been constant over time. A better understanding of SARS-CoV-2 transmission is needed, together with high-quality clinical data on the use of respirators or alternative devices. Moreover, healthcare workers, regardless of their level of experience, should receive specific training. This review aims to summarize the available evidence on the use of medical masks and respirators in the context of viral infections, especially the current coronavirus disease 2019 (COVID-19).", "Protective measures for COVID-19 for healthcare providers and laboratory personnel In the COVID-19 pandemic, which affects the whole world, healthcare professionals (HCP) are at high risk of transmission due to their direct contact with patients with COVID-19. Therefore, how to ensure the triage of the patient with acute respiratory symptoms should be determined in advance, the contact distance should be arranged to be at least 2 m, COVID-19 suspect or diagnosed patient should be instructed to wear a surgical mask. During the care of these patients, HCP should wear their personal protective equipment (PPE) in accordance with the procedure and should not neglect hand hygiene. The samples of the patient with known or suspected COVID-19, patient should also be known to be risky in terms of contamination, and a risk assessment should be performed for the procedures to be performed in laboratories. The PPE should be used in accordance with the procedure to be performed. The protection of the HCP, who sacrifice at the risk of life, is possible only by complying with infection control and precautions.", "Potential utilities of mask-wearing and instant hand hygiene for fighting SARS-CoV-2 The surge of patients in the pandemic of COVID-19 caused by the novel coronavirus SARS-CoV-2 may overwhelm the medical systems of many countries. Mask-wearing and handwashing can slow the spread of the virus, but currently, masks are in shortage in many countries, and timely handwashing is often impossible. In this study, the efficacy of three types of masks and instant hand wiping was evaluated using the avian influenza virus to mock the coronavirus. Virus quantification was performed using real-time reverse transcription-polymerase chain reaction. Previous studies on mask-wearing were reviewed. The results showed that instant hand wiping using a wet towel soaked in water containing 1.00% soap powder, 0.05% active chlorine, or 0.25% active chlorine from sodium hypochlorite removed 98.36%, 96.62%, and 99.98% of the virus from hands, respectively. N95 masks, medical masks, and homemade masks made of four-layer kitchen paper and one-layer cloth could block 99.98%, 97.14%, and 95.15% of the virus in aerosols. Medical mask-wearing which was supported by many studies was opposed by other studies possibly due to erroneous judgment. With these data, we propose the approach of mask-wearing plus instant hand hygiene (MIH) to slow the exponential spread of the virus. This MIH approach has been supported by the experiences of seven countries in fighting against COVID-19. Collectively, a simple approach to slow the exponential spread of SARS-CoV-2 was proposed with the support of experiments, literature review, and control experiences.", "[Position Paper for the State of the Art Application of Respiratory Support in Patients with COVID-19 - German Respiratory Society]. Against the background of the pandemic caused by infection with the SARS-CoV-2, the German Society for Pneumology and Respiratory Medicine (DGP e.V.), in cooperation with other associations, has designated a team of experts in order to answer the currently pressing questions about therapy strategies in dealing with COVID-19 patients suffering from acute respiratory insufficiency (ARI).The position paper is based on the current knowledge that is evolving daily. Many of the published and cited studies require further review, also because many of them did not undergo standard review processes.Therefore, this position paper is also subject to a continuous review process and will be further developed in cooperation with the other professional societies.This position paper is structured into the following five topics:1. Pathophysiology of acute respiratory insufficiency in patients without immunity infected with SARS-CoV-22. Temporal course and prognosis of acute respiratory insufficiency during the course of the disease3. Oxygen insufflation, high-flow oxygen, non-invasive ventilation and invasive ventilation with special consideration of infectious aerosol formation4. Non-invasive ventilation in ARI5. Supply continuum for the treatment of ARIKey points have been highlighted as core statements and significant observations. Regarding the pathophysiological aspects of acute respiratory insufficiency (ARI), the pulmonary infection with SARS-CoV-2 COVID-19 runs through three phases: early infection, pulmonary manifestation and severe hyperinflammatory phase.There are differences between advanced COVID-19-induced lung damage and those changes seen in Acute Respiratory Distress Syndromes (ARDS) as defined by the Berlin criteria. In a pathophysiologically plausible - but currently not yet histopathologically substantiated - model, two types (L-type and H-type) are distinguished, which correspond to an early and late phase. This distinction can be taken into consideration in the differential instrumentation in the therapy of ARI.The assessment of the extent of ARI should be carried out by an arterial or capillary blood gas analysis under room air conditions and must include the calculation of the oxygen supply (measured from the variables of oxygen saturation, the Hb value, the corrected values of the H\u00fcfner number and the cardiac output). In principle, aerosols can cause transmission of infectious viral particles. Open systems or leakage systems (so-called vented masks) can prevent the release of respirable particles. Procedures in which the invasive ventilation system must be opened, and endotracheal intubation must be carried out are associated with an increased risk of infection.The protection of personnel with personal protective equipment should have very high priority because fear of contagion must not be a primary reason for intubation. If the specifications for protective equipment (eye protection, FFP2 or FFP-3 mask, gown) are adhered to, inhalation therapy, nasal high-flow (NHF) therapy, CPAP therapy or NIV can be carried out according to the current state of knowledge without increased risk of infection to the staff. A significant proportion of patients with respiratory failure presents with relevant hypoxemia, often also caused by a high inspiratory oxygen fraction (FiO2) including NHF, and this hypoxemia cannot be not completely corrected. In this situation, CPAP/NIV therapy can be administered under use of a mouth and nose mask or a respiratory helmet as therapy escalation, as long as the criteria for endotracheal intubation are not fulfilled.In acute hypoxemic respiratory insufficiency, NIV should be performed in an intensive care unit or in a comparable unit by personnel with appropriate expertise. Under CPAP/NIV, a patient can deteriorate rapidly. For this reason, continuous monitoring with readiness to carry out intubation must be ensured at all times. If CPAP/NIV leads to further progression of ARI, intubation and subsequent invasive ventilation should be carried out without delay if no DNI order is in place.In the case of patients in whom invasive ventilation, after exhausting all guideline-based measures, is not sufficient, extracorporeal membrane oxygenation procedure (ECMO) should be considered to ensure sufficient oxygen supply and to remove CO2.", "Personal protective equipment and possible routes of airborne spread during the COVID\u201019 pandemic We welcomed Professor Cook's article clarifying the use of personal protective equipment (PPE) in protecting staff during the current COVID-19 pandemic [1]. There remains considerable debate about the extent to which airborne spread of SARS-CoV-2 occurs. Small droplets (< 5\u00b5m) are thought to remain suspended in the air and could theoretically be inhaled into the lungs causing infection [2]. Loose fitting \"surgical\" masks will not prevent such inhalation and only a tight-fitting filtering mask is adequate. Conversely larger (> 5\u00b5m) particles do not remain suspended in the air [2] and can only cause infection if they are immediately inhaled, or after contact with a surface they land on.", "Infection preventionists' experience during the first months of the 2009 novel H1N1 influenza A pandemic BACKGROUND: A novel strain of influenza A (H1N1) was identified in April 2009 and developed into a pandemic by June 2009. This rapid and unexpected event had enormous implications for infection preventionists (IP) internationally. Lessons learned from this event should guide future pandemic planning efforts. METHODS: Focus groups were conducted at the Association for Professionals in Infection Control and Epidemiology, Inc, (APIC) 2009 conference to evaluate IPs' experience with the novel H1N1 influenza pandemic and assess their perceived needs related to novel H1N1 topics and products required for future education and reference materials. RESULTS: Forty IPs (37 from the United States and 3 international) participated in the focus groups. Needed reference materials identified by attendees included infection prevention guidance for nonacute care settings; occupational health polices; and brief, multilanguage patient/family educational materials. Educational topics on which IPs need to be trained include isolation precautions/personal protective equipment recommendations for novel H1N1 patients, coordination between hospitals and community response agencies, and surge management. The rapidly changing and conflicting recommendations related to patient management made responding to this event challenging. IPs require synthesized infection prevention guidelines developed in a concise, real-time format. CONCLUSION: IPs must continue to partner with public health and other response agencies to address gaps in pandemic planning.", "The Case for Masks \u2013 Health Care Workers Can Benefit, Too ", "HUMAN CORONAVIRUS DATA FROM FOUR CLINICAL TRIALS OF MASKS AND RESPIRATORS There are few published data on the protection of masks or respirators against coronavirus infections. This is an important research question to inform the response to the COVID-19 epidemic. The transmission modes of human coronaviruses are similar, thought to be by droplet, contact and sometimes airborne routes. There are several randomised clinical trials of masks and respirators, but most used clinical endpoints or tested only for influenza. In four trials which we conducted, we tested for human coronaviruses, but only composite viral endpoints were reported in the trials. We reviewed and analysed the coronavirus data from four of our trials. Laboratory-confirmed coronavirus infections were identified in our community household trial (1 case), health worker trials (8 cases) and trial of mask use by sick patients (19 cases). No coronavirus infections were transmitted in households to parents who wore P2 or surgical masks, but one child with coronavirus infection transmitted infection to a parent in the control arm. No transmissions to close contacts occurred when worn by sick patients with coronavirus infections. There was a higher risk of coronavirus infection in HCWs who wore a mask compared to a respirator, but the difference was not statistically significant. These are the only available data on coronavirus infections associated with mask or respirator use. More clinical trials are needed to assess the efficacy of respiratory protection against coronavirus infections.", "COVID-19 and the Social Distancing Paradox: dangers and solutions Background: Without proven effect treatments and vaccines, Social Distancing is the key protection factor against COVID-19. Social distancing alone should have been enough to protect again the virus, yet things have gone very differently, with a big mismatch between theory and practice. What are the reasons? A big problem is that there is no actual social distancing data, and the corresponding people behavior in a pandemic is unknown. We collect the world-first dataset on social distancing during the COVID-19 outbreak, so to see for the first time how people really implement social distancing, identify dangers of the current situation, and find solutions against this and future pandemics. Methods: Using a sensor-based social distancing belt we collected social distance data from people in Italy for over two months during the most critical COVID-19 outbreak. Additionally, we investigated if and how wearing various Personal Protection Equipment, like masks, influences social distancing. Results: Without masks, people adopt a counter-intuitively dangerous strategy, a paradox that could explain the relative lack of effectiveness of social distancing. Using masks radically changes the situation, breaking the paradoxical behavior and leading to a safe social distance behavior. In shortage of masks, DIY (Do It Yourself) masks can also be used: even without filtering protection, they provide social distancing protection. Goggles should be recommended for general use, as they give an extra powerful safety boost. Generic Public Health policies and media campaigns do not work well on social distancing: explicit focus on the behavioral problems of necessary mobility are needed.", "A Comprehensive Literature Review on the Clinical Presentation, and Management of the Pandemic Coronavirus Disease 2019 (COVID-19) Coronavirus disease 2019 (COVID-19) is a declared global pandemic. There are multiple parameters of the clinical course and management of the COVID-19 that need optimization. A hindrance to this development is the vast amount of misinformation present due to scarcely sourced manuscript preprints and social media. This literature review aims to presents accredited and the most current studies pertaining to the basic sciences of SARS-CoV-2, clinical presentation and disease course of COVID-19, public health interventions, and current epidemiological developments. The review on basic sciences aims to clarify the jargon in virology, describe the virion structure of SARS-CoV-2 and present pertinent details relevant to clinical practice. Another component discussed is the brief history on the series of experiments used to explore the origins and evolution of the phylogeny of the viral genome of SARS-CoV-2. Additionally, the clinical and epidemiological differences between COVID-19 and other infections causing outbreaks (SARS, MERS, H1N1) are elucidated. Emphasis is placed on evidence-based medicine to evaluate the frequency of presentation of various symptoms to create a stratification system of the most important epidemiological risk factors for COVID-19. These can be used to triage and expedite risk assessment. Furthermore, the limitations and statistical strength of the diagnostic tools currently in clinical practice are evaluated. Criteria on rapid screening, discharge from hospital and discontinuation of self-quarantine are clarified. Epidemiological factors influencing the rapid rate of spread of the SARS-CoV-2 virus are described. Accurate information pertinent to improving prevention strategies is also discussed. The penultimate portion of the review aims to explain the involvement of micronutrients such as vitamin C and vitamin D in COVID19 treatment and prophylaxis. Furthermore, the biochemistry of the major candidates for novel therapies is briefly reviewed and a summary of their current status in the clinical trials is presented. Lastly, the current scientific data and status of governing bodies such as the Center of Disease Control (CDC) and the WHO on the usage of controversial therapies such as angiotensin-converting enzyme (ACE) inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs) (Ibuprofen), and corticosteroids usage in COVID-19 are discussed. The composite collection of accredited studies on each of these subtopics of COVID-19 within this review will enable clarification and focus on the current status and direction in the planning of the management of this global pandemic.", "Predicting support for non-pharmaceutical interventions during infectious outbreaks: a four region analysis. Non-pharmaceutical interventions (NPIs) are an important public health tool for responding to infectious disease outbreaks, including pandemics. However, little is known about the individual characteristics associated with support for NPIs, or whether they are consistent across regions. This study draws on survey data from four regions--Hong Kong, Singapore, Taiwan, and the United States--collected following the Severe Acute Respiratory Syndrome (SARS) outbreak of 2002-03, and employs regression techniques to estimate predictors of NPI support. It finds that characteristics associated with NPI support vary widely by region, possibly because of cultural variation and prior experience, and that minority groups tend to be less supportive of NPIs when arrest is the consequence of noncompliance. Prior experience of face-mask usage also results in increased support for future usage, as well as other NPIs. Policymakers should be attentive to local preferences and to the application of compulsory interventions. It is speculated here that some public health interventions may serve as 'gateway' exposures to future public health interventions.", "Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations Summary As coronavirus disease 2019 (COVID-19) spreads across the world, the intensive care unit (ICU) community must prepare for the challenges associated with this pandemic. Streamlining of workflows for rapid diagnosis and isolation, clinical management, and infection prevention will matter not only to patients with COVID-19, but also to health-care workers and other patients who are at risk from nosocomial transmission. Management of acute respiratory failure and haemodynamics is key. ICU practitioners, hospital administrators, governments, and policy makers must prepare for a substantial increase in critical care bed capacity, with a focus not just on infrastructure and supplies, but also on staff management. Critical care triage to allow the rationing of scarce ICU resources might be needed. Researchers must address unanswered questions, including the role of repurposed and experimental therapies. Collaboration at the local, regional, national, and international level offers the best chance of survival for the critically ill.", "All eyes on Coronavirus\u2014What do we need to know as ophthalmologists ", "Uncertainty, risk analysis and change for Ebola personal protective equipment guidelines ", "What is required to prevent a second major outbreak of the novel coronavirus SARS-CoV-2 upon lifting the metropolitan-wide quarantine of Wuhan city, China Background: The Chinese government implemented a metropolitan-wide quarantine of Wuhan city on 23rd January 2020 to curb the epidemic of the coronavirus COVID-19. Lifting of this quarantine is imminent. We modelled the effects of two key health interventions on the epidemic when the quarantine is lifted. Method: We constructed a compartmental dynamic model to forecast the trend of the COVID-19 epidemic at different quarantine lifting dates and investigated the impact of different rates of public contact and facial mask usage on the epidemic. Results: We estimated that at the end of the epidemic, a total of 65,572 (46,156-95,264) individuals would be infected by the virus, among which 16,144 (14,422-23,447, 24.6%) would be infected through public contacts, 45,795 (32,390-66,395, 69.7%) through household contact, 3,633 (2,344-5,865, 5.5%) through hospital contacts (including 783 (553-1,134) non-COVID-19 patients and 2,850 (1,801-4,981) medical staff members). A total of 3,262 (1,592-6,470) would die of COVID-19 related pneumonia in Wuhan. For an early lifting date (21st March), facial mask needed to be sustained at a relatively high rate (\u226585%) if public contacts were to recover to 100% of the pre-quarantine level. In contrast, lifting the quarantine on 18th April allowed public person-to-person contact adjusted back to the pre-quarantine level with a substantially lower level of facial mask usage (75%). However, a low facial mask usage (<50%) combined with an increased public contact (>100%) would always lead a significant second outbreak in most quarantine lifting scenarios. Lifting the quarantine on 25th April would ensure a smooth decline of the epidemics regardless of the combinations of public contact rates and facial mask usage. Conclusion: The prevention of a second epidemic is viable after the metropolitan-wide quarantine is lifted but requires a sustaining high facial mask usage and a low public contact rate.", "UV Sterilization of Personal Protective Equipment with Idle Laboratory Biosafety Cabinets During the Covid-19 Pandemic Personal protective equipment (PPE), including surgical masks and N95 respirators, is crucially important to the safety of both patients and medical personnel, particularly in the event of infectious pandemics. As the incidence of Coronavirus Disease (COVID-19) is increasing exponentially in the United States and worldwide, healthcare provider demand for these necessities is currently outpacing supply. As such, strategies to safely expand the lifespan of the supply of medical equipment are critically important. In the recent days, weeks, and months, in the midst of the current pandemic, there has been a concerted effort to identify viable ways to conserve Personal Protective Equipment, including sterilization after use. Some hospitals have already begun using UV-C light to sterilize N95 respirators, but many lack the space or equipment to implement existing protocols. In this study, we outline a procedure by which N95 respirators may be sterilized using ultraviolet (UV) radiation in biosafety cabinets (BSCs), a common element of many academic, public health, and hospital laboratories. The primary obstacle to this approach is the possibility the UV radiation levels vary within BSCs. To account for this potential variation in dosing across the base of the BSC, we tested the UV-C radiation in two randomly chosen idle BSCs in our research institute and observed a maximum ratio between the minimum and maximum recorded intensities within a given BSC to be 1.98. Based on these values, we calculated that an N95 mask placed within a BSC with a manufacturer reported fluence of 100 W/cm^2 should be effectively sanitized for reuse after approximately 15-20 minutes per side. Our results provide support to healthcare organizations looking for alternative methods to extend their reserves of PPE. It is our hope that with an easily implemented strategy, as we have presented here, idle BSCs can be utilized to alleviate the PPE shortage by providing a way to sterilize PPE to allow safe daily re-use. This should be tested on a larger scale, and confirmed in a virology laboratory before adoption, though we contend that in extremis, this method would be preferred compared to re-use without sterilization.", "Prevention program for the COVID-19 in a children\u2019s digestive endoscopy center The pneumonia caused by the coronavirus disease-2019 (COVID-19) outbreak in Wuhan, China constitutes a public health emergency of international concern. The gastrointestinal symptoms of vomiting, diarrhea and abdominal pain and the detection of COVID-19 nucleic acid from fecal specimens in a small number of patients suggest the possibility of transmission via the gastrointestinal tract. People of all ages are vulnerable to this virus, including children. Digestive endoscopy is an invasive procedure during which children cannot wear masks; therefore, they have higher risks of exposure to COVID-19, and the digestive endoscopy center is a relatively high-risk area for COVID-19 infection. Based on these factors and in combination with related policies and regulations, a prevention and control program for the COVID-19 pneumonia in a children's digestive endoscopy center was established to prevent the COVID-19 nosocomial infection.", "Respiratory Protection Considerations for Healthcare Workers During the COVID-19 Pandemic. The COVID-19 pandemic has resulted in a surge of patients that exceeds available human and physical resources in many settings, triggering the implementation of crisis standards of care. High-quality respiratory protection is essential to reduce exposure among healthcare workers, yet dire shortages of personal protective equipment in the United States threaten the health and safety of this essential workforce. In the context of rapidly changing conditions and incomplete data, this article outlines 3 important strategies to improve healthcare workers' respiratory protection. At a minimum, healthcare workers delivering care to patients with confirmed or suspected COVID-19 should wear N95 respirators and full-face shields. Several mechanisms exist to boost and protect the supply of N95 respirators, including rigorous decontamination protocols, invoking the Defense Production Act, expanded use of reusable elastomeric respirators, and repurposing industrial N95 respirators. Finally, homemade facial coverings do not protect healthcare workers and should be avoided. These strategies, coupled with longer-term strategies of investments in protective equipment research, infrastructure, and data systems, provide a framework to protect healthcare workers immediately and enhance preparedness efforts for future pandemics.", "Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic? OBJECTIVE: This study examined homemade masks as an alternative to commercial face masks. METHODS: Several household materials were evaluated for the capacity to block bacterial and viral aerosols. Twenty-one healthy volunteers made their own face masks from cotton t-shirts; the masks were then tested for fit. The number of microorganisms isolated from coughs of healthy volunteers wearing their homemade mask, a surgical mask, or no mask was compared using several air-sampling techniques. RESULTS: The median-fit factor of the homemade masks was one-half that of the surgical masks. Both masks significantly reduced the number of microorganisms expelled by volunteers, although the surgical mask was 3 times more effective in blocking transmission than the homemade mask. CONCLUSION: Our findings suggest that a homemade mask should only be considered as a last resort to prevent droplet transmission from infected individuals, but it would be better than no protection. (Disaster Med Public Health Preparedness. 2013;0:1\u20136)", "Taking the right measures to control COVID-19 ", "Decontamination of Surgical Face Masks and N95 Respirators by Dry Heat Pasteurization for One Hour at 70\u00b0C BACKGROUND: The need for protective masks greatly exceeds their global supply during the current COVID-19 pandemic. METHODS: We optimized the temperature used in the dry heat pasteurization method to destroy pathogens and decontaminate masks while retaining their filtering capacity. RESULTS: The current study showed that dry heat at both 60\u00b0C and 70\u00b0C for one hour could successfully kill six species of respiratory bacteria and one fungi species, and inactivate the H1N1 indicator virus. After being heated at 70\u00b0C for 1 h, 2 h, and 3 h, the N95 respirators and surgical face masks showed no changes in their shape and components. The filtering efficiency of bacterial aerosol for N95 respirators were 98%, 98%, and 97% after being heated for 1 h, 2 h, and 3 h, respectively, all of which were over the 95% efficiency required and similar to the value before being heated (99%). The filtering efficiency for surgical face masks was 97%, 97%, and 96% for 1 h, 2 h, and 3 h of heating, respectively, all of which were also similar to the value before being heated (97%). CONCLUSIONS: This method can be used at home and can resolve the current shortage of masks.", "COVID-19: Prevention and control measures in community On January 30, 2020, the WHO declared the COVID-19 outbreak a public health emergency of international concern and, in March 2020, began to characterize it as a pandemic in order to emphasize the gravity of the situation and urge all countries to take action in detecting infection and preventing spread. Unfortunately, there is no medication that has been approved by the FDA, gone through controlled studies and demonstrated an effect on the virus for this global pandemic. Although there are cures for illnesses and developments made by leaps and bounds in our day, the strongest and most effective weapon that society has against this virus that is affecting not just health but also economics, politics, and social order, is the prevention of its spread. The main points in preventing the spread in society are hand hygiene, social distancing and quarantine. With increased testing capacity, detecting more COVID-19 positive patients in the community will also enable the reduction of secondary cases with stricter quarantine rules.", "Analysis of national and international guidelines on respiratory protection equipment for COVID-19 in healthcare settings. Introduction Consistent guidelines on respiratory protection for healthcare professionals combined with improved global supply chains are critical to protect staff and patients from COVID-19. We summarized and compared the guidelines published by national and international societies/organizations on facemasks and respirators to prevent COVID-19 in healthcare settings. Methods From the 1st January to the 2nd April 2020, guidelines published in four countries (France, Germany, United States, United Kingdom), and two international organizations (US and European Center for Diseases Control, and World Health Organization) were reviewed to analyze the mask and respirators recommended as PPE for the care of patients during the COVID-19 outbreak. Guidelines were eligible for analysis if they (1) included specific guidelines, (2) were written for HCP protection, (3) targeting healthcare settings. The strategy recommended for optimizing supplies and overcoming shortages was collected. Observations The guidelines publication process on respiratory protections varied greatly across countries. Some referred to a unique guide whereas others saw the issue of multiple recommendations by various societies and organization. In term of chronology, most guidelines were published in March with either downgraded (US and European CDC), relatively stable (WHO, Germany, and UK), or a mixing of high and low level equipment (France). The recommendation of respirators was universally recommended for aerosol generating procedures (AGP) across countries, although the type of respirators and what constituted an AGP was variable. Some guidance maintained the use of N95/99 for all contact with confirmed COVID-19 cases (i.e. Germany) whereas others, recommended a surgical mask (i.e. WHO, UK, France). The strategies to overcome shortage of respiratory protection equipment were based on minimizing the need and rationalizing the use, but also prolonging their use, reusing them after cleaning/sterilization, or using cloth masks. Conclusions Stable and consistent guidelines inside and across countries, clearly detailing the respiratory protection type, and the circumstances in which they need to be used may prevent the confusion among frontline staff, and avoid shortage.", "Resistance to synthetic blood penetration of National Institute for Occupational Safety and Health-approved N95 filtering facepiece respirators and surgical N95 respirators BACKGROUND: Surgical N95 filtering facepiece respirators (FFRs), certified by the National Institute for Occupational Safety and Health (NIOSH) as a respirator and cleared by the Food and Drug Administration (FDA) as a surgical mask, are often used to protect from the inhalation of infectious aerosols and from splashes/sprays of body fluids in health care facilities. A shortage of respirators can be expected during a pandemic. The availability of surgical N95 FFRs can potentially be increased by incorporating FDA clearance requirements in the NIOSH respirator approval process. METHODS: Fluid resistance of NIOSH-approved N95 FFRs, and FDA-cleared surgical N95 FFRs and surgical masks was tested using the ASTM F1862 method at 450 and 635 cm/sec velocities and compared with the results from a third-party independent laboratory. Blood penetration through different layers of filter media of masks were also analyzed visually. RESULTS: Four N95 FFR models showed no test failures at both velocities. The penetration results obtained in the NIOSH laboratory were comparable to those from the third-party independent laboratory. The number of respirator samples failing the test increased with increasing test velocity. CONCLUSIONS: The results indicate that several NIOSH-approved N95 FFR models would likely pass FD clearance requirements for resistance to synthetic blood penetration.", "The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2 BACKGROUND: Face mask usage by the healthy population in the community to reduce risk of transmission of respiratory viruses remains controversial. We assessed the effect of community-wide mask usage to control coronavirus disease 2019 (COVID-19) in Hong Kong Special Administrative Region (HKSAR). METHODS: Patients presenting with respiratory symptoms at outpatient clinics or hospital wards were screened for COVID-19 per protocol. Epidemiological analysis was performed for confirmed cases, especially persons acquiring COVID-19 during mask-off and mask-on settings. The incidence of COVID-19 per million population in HKSAR with community-wide masking was compared to that of non-mask-wearing countries which are comparable with HKSAR in terms of population density, healthcare system, BCG vaccination and social distancing measures but not community-wide masking. Compliance of face mask usage in the HKSAR community was monitored. FINDINGS: Within first 100 days (31 December 2019 to 8 April 2020), 961 COVID-19 patients were diagnosed in HKSAR. The COVID-19 incidence in HKSAR (129.0 per million population) was significantly lower (p<0.001) than that of Spain (2983.2), Italy (2250.8), Germany (1241.5), France (1151.6), U.S. (1102.8), U.K. (831.5), Singapore (259.8), and South Korea (200.5). The compliance of face mask usage by HKSAR general public was 96.6% (range: 95.7% to 97.2%). We observed 11 COVID-19 clusters in recreational 'mask-off' settings compared to only 3 in workplace 'mask-on' settings (p\u00e2\u0080\u00af=\u00e2\u0080\u00af0.036 by Chi square test of goodness-of-fit). CONCLUSION: Community-wide mask wearing may contribute to the control of COVID-19 by reducing the amount of emission of infected saliva and respiratory droplets from individuals with subclinical or mild COVID-19.", "Hepatic and gastrointestinal involvement in coronavirus disease 2019 (COVID-19): What do we know till now? Abstract Since December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of coronavirus disease 2019 (COVID-19), has posed a serious threat to global health and is currently causing a major pandemic. While patients typically present with fever and a respiratory illness, mounting evidence indicates that patients might also report extra-pulmonary manifestations, including those affecting the liver and gastrointestinal tract. This involvement may have important implications to the disease management, transmission, and prognosis, especially in patients with pre-existing hepatic or digestive co-morbidities. In this review, the characteristics and possible explanations of hepatic and gastrointestinal involvement caused by SARS-CoV-2 infection are summarized, adding to our knowledge of the spectrum of COVID-19. In addition, preventive measures implemented in endoscopy departments to prevent further dissemination of SARS-CoV-2 infection are proposed.", "The adverse skin reactions of health care workers using personal protective equipment for COVID-19 In December 2019, a new coronavirus was found in Wuhan, Hubei Province, China, and spread rapidly throughout the country, attracting global attention. On February 11, the World Health Organization (WHO) officially named the disease caused by 2019-nCoV coronavirus disease 2019 (COVID-19). With the increasing number of cases, health care workers (HCWs) from all over China volunteered to work in Hubei Province. Because of the strong infectivity of COVID-19, HCWs need to wear personal protective equipment (PPE), such as N95 masks, latex gloves, and protective clothing. Due to the long-term use of PPE, many adverse skin reactions may occur. Therefore, the purpose of this study is to explore the adverse skin reactions among HCWs using PPE. Questionnaires were used for the research; a quantitative study was carried out to determine the incidence of adverse skin reactions among HCWs using PPE. A total of 61 valid questionnaires were collected. The most common adverse skin reactions among HCWs wearing N95 masks were nasal bridge scarring (68.9%) and facial itching (27.9%). The most common adverse skin reactions among HCWs wearing latex gloves were dry skin (55.7%), itching (31.2%), and rash (23.0%). The most common adverse skin reactions among HCWs wearing protective clothing were dry skin (36.1%) and itching (34.4%). When most HCWs wear PPE for a long period of time, they will experience adverse skin reactions. The incidence of adverse skin reactions to the N95 mask was 95.1%, that to latex gloves was 88.5%, and that to protective clothing was 60.7%.", "Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis OBJECTIVE: Previous meta-analyses concluded that there was insufficient evidence to determine the effect of N95 respirators. We aimed to assess the effectiveness of N95 respirators versus surgical masks for prevention of influenza by collecting randomized controlled trials (RCTs). METHODS: We searched PubMed, EMbase and The Cochrane Library from the inception to January 27, 2020 to identify relevant systematic reviews. The RCTs included in systematic reviews were identified. Then we searched the latest published RCTs from the above three databases and searched ClinicalTrials.gov for unpublished RCTs. Two reviewers independently extracted the data and assessed risk of bias. Meta-analyses were conducted to calculate pooled estimates by using RevMan 5.3 software. RESULTS: A total of six RCTs involving 9 171 participants were included. There were no statistically significant differences in preventing laboratory-confirmed influenza (RR = 1.09, 95% CI 0.92-1.28, P > .05), laboratory-confirmed respiratory viral infections (RR = 0.89, 95% CI 0.70-1.11), laboratory-confirmed respiratory infection (RR = 0.74, 95% CI 0.42-1.29) and influenzalike illness (RR = 0.61, 95% CI 0.33-1.14) using N95 respirators and surgical masks. Meta-analysis indicated a protective effect of N95 respirators against laboratory-confirmed bacterial colonization (RR = 0.58, 95% CI 0.43-0.78). CONCLUSION: The use of N95 respirators compared with surgical masks is not associated with a lower risk of laboratory-confirmed influenza. It suggests that N95 respirators should not be recommended for general public and nonhigh-risk medical staff those are not in close contact with influenza patients or suspected patients.", "COVID\u201019: Face masks and human\u2010to\u2010human transmission In December 2019, transmission of the novel coronavirus (SARS-CoV-2) that causes coronavirus disease 2019(COVID-19) occurred in Wuhan, China1 .And later the virus began to be transmitted from person to person2 .Face masks are a type of personal protective equipment used to prevent the spread of respiratory infections\uff0cit may be effective at helping prevent transmission of respiratory viruses and bacteria3 .Here, we share a case of face masks are be used to prevent the transmission of COVID-19 infection.", "Personal Protective Equipment: Current Best Practices for Orthopaedic Teams Abstract The COVID-19 pandemic caused by the SARS-CoV-2 virus is challenging healthcare providers across the world. Current best practices for personal protective equipment (PPE) during this time are rapidly evolving and fluid due to the novel and acute nature of the pandemic and the dearth of high-level evidence. Routine infection control practices augmented by airborne precautions are paramount when treating the COVID-19 positive patient. Best practices for PPE use in patients who have unknown COVID-19 status are a highly charged and emotional issue. The variables to be considered include protection of patients and healthcare providers, accuracy and availability of testing, and responsible use of PPE resources. This article also explores the concerns of surgeons regarding possible transmission to their own family members as a result of caring for COVID-19 patients.", "Surgery in COVID-19 patients: operational directives The current COVID-19 pandemic underlines the importance of a mindful utilization of financial and human resources. Preserving resources and manpower is paramount in healthcare. It is important to ensure the ability of surgeons and specialized professionals to function through the pandemic. A conscious effort should be made to minimize infection in this sector. A high mortality rate within this group would be detrimental. This manuscript is the result of a collaboration between the major Italian surgical and anesthesiologic societies: ACOI, SIC, SICUT, SICO, SICG, SIFIPAC, SICE, and SIAARTI. We aim to describe recommended clinical pathways for COVID-19-positive patients requiring acute non-deferrable surgical care. All hospitals should organize dedicated protocols and workforce training as part of the effort to face the current pandemic.", "What face mask for what use in the context of COVID-19 pandemic? The French guidelines In the context of the COVID-19 pandemic, wearing a face mask has become usual and ubiquitous, in both hospitals and community. However, the general public is consuming surgical or filtering face piece (FFP) masks irrespective of their specificity, leading to global supply shortage for the most exposed persons, which are healthcare workers. This underlines the urgent need to clarify the indications of the different categories of mask, in order to rationalize their use. The study herein specifies the French position for the rational use of respiratory protective equipment for healthcare workers.", "Protecting healthcare staff from severe acute respiratory syndrome: filtration capacity of multiple surgical masks Summary Guidelines issued by the Centers for Disease Control and Prevention and the World Health Organisation state that healthcare workers should wear N95 masks or higher-level protection during all contact with suspected severe acute respiratory syndrome (SARS). In areas where N95 masks are not available, multiple layers of surgical masks have been tried to prevent transmission of SARS. The in vivo filtration capacity of a single surgical mask is known to be poor. However, the filtration capacity of a combination of masks is unknown. This was a crossover trial of one, two, three and five surgical masks in six volunteers to determine the in vivo filtration efficiency of wearing more than one surgical mask. We used a Portacount to measure the difference in ambient particle counts inside and outside the masks. The best combination of five surgical masks scored a fit factor of 13.7, which is well below the minimum level of 100 required for a half face respirator. Multiple surgical masks filter ambient particles poorly. They should not be used as a substitute for N95 masks unless there is no alternative.", "Skin Reactions of N95 masks and Medial Masks among Health Care Personnel: A self\u2010report questionnaire survey in China ", "Hydrogen Peroxide Vapor sterilization of N95 respirators for reuse Abstract Reprocessing of used N95 respirators may ameliorate supply chain constraints during the COVID-19 pandemic and provide a higher filtration crisis alternative. The FDA Medical Countermeasures Initiative previously funded a study of HP vapor decontamination of respirators using a Clarus C system (Bioquell, Horsham, PA) which normally is used to fumigate hospital rooms. The process preserved respirator function, but it is unknown if HP vapor would be virucidal since respirators have porous fabric that may harbor virus. We evaluated the virucidal activity of HP vapor using a BQ-50 system (Bioquell, Horsham, PA) after inoculating 3M 1870 N95 respirators (3M, St. Paul, MN) with 3 aerosolized bacteriophage that are a reasonable proxy for SARS-CoV-2. Inoculation resulted in contamination of the respirator with 9.87e4 plaque forming units (PFU) of phage phi-6, 4.17e7 PFU of phage T7 and 1.35e7 PFU of phage T1. Respirators were reprocessed with BQ-50 with a long aeration phase to reduce HP vapors. Virucidal activity was measured by a standard plaquing assay prior to and after sterilization. A single HP vapor cycle resulted in complete eradication of phage from masks (limit of detection 10 PFU, lower than the infectious dose of the majority of respiratory viral pathogens). After 5 cycles, the respirators appeared similar to new with no deformity. Use of a Bioquell machine can be scaled to permit simultaneous sterilization of a large number of used but otherwise intact respirators. HP vapor reprocessing may ease shortages and provide a higher filtration crisis alternative to non-NIOSH masks.", "Contamination by respiratory viruses on outer surface of medical masks used by hospital healthcare workers BACKGROUND: Medical masks are commonly used in health care settings to protect healthcare workers (HCWs) from respiratory and other infections. Airborne respiratory pathogens may settle on the surface of used masks layers, resulting in contamination. The main aim of this study was to study the presence of viruses on the surface of medical masks. METHODS: Two pilot studies in laboratory and clinical settings were carried out to determine the areas of masks likely to contain maximum viral particles. A laboratory study using a mannequin and fluorescent spray showed maximum particles concentrated on upper right, middle and left sections of the medical masks. These findings were confirmed through a small clinical study. The main study was then conducted in high-risk wards of three selected hospitals in Beijing China. Participants (n = 148) were asked to wear medical masks for a shift (6\u20138 h) or as long as they could tolerate. Used samples of medical masks were tested for presence of respiratory viruses in upper sections of the medical masks, in line with the pilot studies. RESULTS: Overall virus positivity rate was 10.1% (15/148). Commonly isolated viruses from masks samples were adenovirus (n = 7), bocavirus (n = 2), respiratory syncytial virus (n = 2) and influenza virus (n = 2). Virus positivity was significantly higher in masks samples worn for > 6 h (14.1%, 14/99 versus 1.2%, 1/49, OR 7.9, 95% CI 1.01\u201361.99) and in samples used by participants who examined > 25 patients per day (16.9%, 12/71 versus 3.9%, 3/77, OR 5.02, 95% CI 1.35\u201318.60). Most of the participants (83.8%, 124/148) reported at least one problem associated with mask use. Commonly reported problems were pressure on face (16.9%, 25/148), breathing difficulty (12.2%, 18/148), discomfort (9.5% 14/148), trouble communicating with the patient (7.4%, 11/148) and headache (6.1%, 9/148). CONCLUSION: Respiratory pathogens on the outer surface of the used medical masks may result in self-contamination. The risk is higher with longer duration of mask use (> 6 h) and with higher rates of clinical contact. Protocols on duration of mask use should specify a maximum time of continuous use, and should consider guidance in high contact settings. Viruses were isolated from the upper sections of around 10% samples, but other sections of masks may also be contaminated. HCWs should be aware of these risks in order to protect themselves and people around them.", "Fast and easy disinfection of coronavirus-contaminated face masks using ozone gas produced by a dielectric barrier discharge plasma generator Face masks are one of the currently available options for preventing the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has caused the 2019 pandemic. However, with the increasing demand for protection, face masks are becoming limited in stock, and the concerned individuals and healthcare workers from many countries are now facing the issue of the reuse of potentially contaminated masks. Although various technologies already exist for the sterilization of medical equipment, most of them are not applicable for eliminating virus from face masks. Thus, there is an urgent need to develop a fast and easy method of disinfecting contaminated face masks. In this study, using a human coronavirus (HCoV-229E) as a surrogate for SARS-CoV-2 contamination on face masks, we show that the virus loses its infectivity to a human cell line (MRC-5) when exposed for a short period of time (1 min) to ozone gas produced by a dielectric barrier discharge plasma generator. Scanning electron microscopy and particulate filtration efficiency (PFE) tests revealed that there was no structural or functional deterioration observed in the face masks even after they underwent excessive exposure to ozone (five 1-minute exposures). Interestingly, for face masks exposed to ozone gas for 5 min, the amplification of HCoV-229E RNA by reverse transcription polymerase chain reaction suggested a loss of infectivity under the effect of ozone, primarily owing to the damage caused to viral envelopes or envelope proteins. Ozone gas is a strong oxidizing agent with the ability to kill viruses on hard-to-reach surfaces, including the fabric structure of face masks. These results suggest that it may be possible to rapidly disinfect contaminated face masks using a plasma generator in a well-ventilated place.", "Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis BACKGROUND: Conflicting recommendations exist related to whether masks have a protective effect on the spread of respiratory viruses. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was consulted to report this systematic review. Relevant articles were retrieved from PubMed, Web of Science, ScienceDirect, Cochrane Library, and Chinese National Knowledge Infrastructure (CNKI), VIP (Chinese) database. RESULTS: A total of 21 studies met our inclusion criteria. Meta-analyses suggest that mask use provided a significant protective effect (OR = 0.35 and 95% CI = 0.24\u20130.51). Use of masks by healthcare workers (HCWs) and non-healthcare workers (Non-HCWs) can reduce the risk of respiratory virus infection by 80% (OR = 0.20, 95% CI = 0.11\u20130.37) and 47% (OR = 0.53, 95% CI = 0.36\u20130.79). The protective effect of wearing masks in Asia (OR = 0.31) appeared to be higher than that of Western countries (OR = 0.45). Masks had a protective effect against influenza viruses (OR = 0.55), SARS (OR = 0.26), and SARS-CoV-2 (OR = 0.04). In the subgroups based on different study designs, protective effects of wearing mask were significant in cluster randomized trials and observational studies. CONCLUSIONS: This study adds additional evidence of the enhanced protective value of masks, we stress that the use masks serve as an adjunctive method regarding the COVID-19 outbreak.", "Update to device-related pressure ulcers: SECURE prevention. COVID-19, face masks and skin damage The 2019 novel coronavirus disease (COVID-19) pandemic has brought the effects of device-related pressure ulcers (DRPU) into sharp focus. With the increased use of personal protective equipment (PPE), including face masks, continuous positive airway pressure (CAPP) masks and other devices, the incidence of DRPUs among health professionals and patients alike has risen starkly. As such, the Journal of Wound Care (JWC) consensus document, Device-related pressure ulcers: SECURE prevention, published in February 2020, is more relevant than ever. To help support patients and frontline health professionals, JWC is republishing the consensus in a digital format, along with a new introductory article outlining the DRPU risks posed by PPE and other medical devices used by patients and health professionals during the pandemic, and how the skin damage can be avoided. The aim is to provide frontline staff with a clear, simple strategy on how to prevent the risk of personal skin damage and/or DRPU during the pandemic, as well as point them in the direction of more indepth guidance on long-term strategies for prevention, for both themselves and patients.", "The Relationship Between COVID-19 Infection and Risk Perception, Knowledge, Attitude As Well As Four Non-pharmaceutical Interventions (NPIs) During the Late Period Of The COVID-19 Epidemic In China An Online Cross-sectional Survey of 8158 Adults Background: So far, there has been no published population study on the relationship between COVID19 infection and public risk perception, information source, knowledge, attitude and four nonpharmaceutical interventions(NPI: hand washing, proper coughing habits, social distancing and mask wearing) during the COVID-19 outbreak in China. Methods: An online survey of 8158 Chinese adults between 22 February to 5 March 2020 was conducted. Bivariate associations between categorical variables were examined using Fisher exact test. We also explored the determinants of four NPIs as well as their association with COVID19 infection using logistic regression. Results: Of 8158 adults included, 57 (0.73%) were infected with COVID19. The overwhelming majority of respondents showed a positive attitude (99.2%), positive risk perception (99.9%) and high knowledge levels that were among the strongest predictors of four highly adopted NPIs (hand washing:96.8%; proper coughing: 93.1%; social distancing:87.1%; mask wearing:97.9%). There was an increased risk of COVID19 infection for those who not washing hands (2.28% vs 0.65%; RR=3.53: 95%CI: 1.538.15; P<0.009); not practicing proper coughing (1.79% vs 0.73%; RR=2.44: 95%CI: 1.15-5.15;P=0.026); not practicing social distancing (1.52% vs 0.58%; RR=2.63:95%CI:1.48 4.67; P=0.002); and not wearing a mask (7.41% vs 0.6%; RR=12.38:95%CI:5.81-26.36; P<0.001). For those who did practice all other three NPIs, wearing mask was associated with significantly reduced risk of infection compared to those who did not wear a mask (0.6% vs 16.7%; p=0.035). Similarly, for those who did not practice all or part of the other three NPIs, wearing mask was also associated with significantly reduced risk of infection. In a penalised logistic regression model including all four NPIs, wearing a mask was the only significant predictor of COVID19 infection among four NPIs (OR=7.20; 95%CI:2.2423.11; p<0.001). Conclusions: We found high levels of risk perception, positive attitude, desirable knowledge as well as a high level of adopting four NPIs. The relevant knowledge, risk perception and attitude were strong predictors of adapting the four NPIs. Mask wearing, among four personal NPIs, is the most effective protective measure against COVID19 infection with added preventive effect among those who practised all or part of the other three NPIs.", "Coronavirus disease 2019 (covid-19): a guide for UK GPs. ", "One world, one health: The novel coronavirus COVID-19 epidemic() ", "COVID-19 pandemic and personal protective equipment shortage: protective efficacy comparing masks and scientific methods for respirator reuse Abstract Background and Aims The abrupt outbreak of COVID-19 and its rapid spread over many health care systems in the world led to personal protective equipment (PPE) shortening, which cannot be faced only by the reduction in their consumption nor by the expensive and time-requiring implementation of their production. It is thus necessary to promote PPE rational use, highlighting possible differences in terms of efficacy among them and promoting an effective technique to reuse them. Methods A literature search was performed on PubMed, Scopus, Cochrane database, and Google Scholar and from 25 top cited papers, 15 were selected for relevance and impact. Results Most studies on prior respiratory virus epidemic to date suggest surgical masks not to be inferior compared with N95 respirators in terms of protective efficacy among health care workers. The use of N95 respirators should be then limited in favor of high-risk situations. Concerning respirators reuse, highly energetic short-wave ultraviolet germicidal irradiation (UVGI) at 254 nm was proficiently applied to determine N95 respirators decontamination from viral respiratory agents, but it requires careful consideration of the type of respirator and of the biological target. Conclusions Rational use and successful reuse of respirators can help facing PPE shortening during a pandemic. Further evidences testing UVGI and other decontamination techniques are an unmet need. The definitive answer to pandemic issues can be found in artificial intelligence and deep learning: these groundbreaking modalities could help in identifying high-risk patients and in suggesting appropriate types and use of PPE.", "Why N95 Should Be the Standard for All COVID-19 Inpatient Care Guidelines differ in their guidance on the use of N95 respirators versus medical masks for frontline health care workers working with patients with COVID-19, particularly when aerosolized procedures are not involved. This article makes the case that the existing data are inconclusive regarding the comparative effectiveness of N95 versus medical masks and could be misinterpreted. The authors suggest a reevaluation of this evidence or acknowledgement of these deficiencies in the setting of guidelines.", "Management of patients with suspected or confirmed COVID-19, in the radiology department Abstract Objectives From December 2019, a novel coronavirus named COVID-19 was reported in China. Within 3 months, the World Health Organization defined COVID-19 as a pandemic, with more than 370,000 cases and 16,000 deaths worldwide. In consideration of the crucial role of diagnostic testing during COVID-19, the aim of this technical note was to provide a complete synthesis of approaches implemented for the management of suspected or confirmed COVID-19 patients. Key Findings The planning of a robust plan to prevent the transmission of the virus to patients and department staff members should be fundamental in each radiology service. Moreover, the speed of spread and the incidence of the pandemic make it necessary to optimize the use of personal protective devices and dedicated COVID-19 equipment, given the limited availability of supplies. Conclusion In the management of radiographic and CT imaging, staff should take special precautions to limit contamination between patients and other patients or professionals. Implications for practice An isolated imaging room should be dedicated to suspected or confirmed COVID-19 cases, including radiography and CT scanners. This paper will provide guidance concerning disposable protective gear to be utilized, as well as on the cleaning and sanitation of radiology room and equipment.", "Effectiveness of Cloth Masks for Protection Against Severe Acute Respiratory Syndrome Coronavirus 2. Cloth masks have been used in healthcare and community settings to protect the wearer from respiratory infections. The use of cloth masks during the coronavirus disease (COVID-19) pandemic is under debate. The filtration effectiveness of cloth masks is generally lower than that of medical masks and respirators; however, cloth masks may provide some protection if well designed and used correctly. Multilayer cloth masks, designed to fit around the face and made of water-resistant fabric with a high number of threads and finer weave, may provide reasonable protection. Until a cloth mask design is proven to be equally effective as a medical or N95 mask, wearing cloth masks should not be mandated for healthcare workers. In community settings, however, cloth masks may be used to prevent community spread of infections by sick or asymptomatically infected persons, and the public should be educated about their correct use.", "COVID-19 and the Risk to Health Care Workers: A Case Report ", "COVID-19 and the Efficacy of Different Types of Respiratory Protective Equipment Used by Health Care Providers in a Health Care Setting Coronavirus, the virus that caused the global pandemic at the beginning of 2020 and affected millions across the globe, presented as an enormous challenge to health care providers around the world. With increasing numbers of infected patients presenting daily, health care workers are struggling to take effective measures to protect themselves from transmission against the highly contagious coronavirus. This case helps us understand the implications of coronavirus-infected patients on the health care providers directly responsible for the management of these patients and the relative efficacy of different types of respiratory protective equipment mainly N95 masks and surgical masks in preventing the spread of infection among those at the front lines providing care.", "The use of masks and respirators to prevent transmission of influenza: a systematic review of the scientific evidence Please cite this paper as: bin\u2010Reza et al. (2012) The use of masks and respirators to prevent transmission of influenza: a systematic review of the scientific evidence. Influenza and Other Respiratory Viruses 6(4), 257\u2013267. There are limited data on the use of masks and respirators to reduce transmission of influenza. A systematic review was undertaken to help inform pandemic influenza guidance in the United Kingdom. The initial review was performed in November 2009 and updated in June 2010 and January 2011. Inclusion criteria included randomised controlled trials and quasi\u2010experimental and observational studies of humans published in English with an outcome of laboratory\u2010confirmed or clinically\u2010diagnosed influenza and other viral respiratory infections. There were 17 eligible studies. Six of eight randomised controlled trials found no significant differences between control and intervention groups (masks with or without hand hygiene; N95/P2 respirators). One household trial found that mask wearing coupled with hand sanitiser use reduced secondary transmission of upper respiratory infection/influenza\u2010like illness/laboratory\u2010confirmed influenza compared with education; hand sanitiser alone resulted in no reduction. One hospital\u2010based trial found a lower rate of clinical respiratory illness associated with non\u2010fit\u2010tested N95 respirator use compared with medical masks. Eight of nine retrospective observational studies found that mask and/or respirator use was independently associated with a reduced risk of severe acute respiratory syndrome (SARS). Findings, however, may not be applicable to influenza and many studies were suboptimal. None of the studies established a conclusive relationship between mask/respirator use and protection against influenza infection. Some evidence suggests that mask use is best undertaken as part of a package of personal protection especially hand hygiene. The effectiveness of masks and respirators is likely linked to early, consistent and correct usage.", "Physiologic and other effects and compliance with long-term respirator use among medical intensive care unit nurses BACKGROUND: Long-term use of respiratory protection may be necessary, but compliance may be low, and physiologic effects have not been well evaluated. METHODS: Ten nurses participated; physiologic effects, subjective symptoms, and compliance with wearing an N95 alone or with a surgical mask overlay were assessed. Longitudinal analysis based on multivariate linear regression models assessed changes in outcome variables (CO(2), O(2), heart rate, perceived comfort items, compliance measures, and others). Analyses compared changes over time, and compared wearing only an N95 to wearing an N95 with a surgical mask overlay. RESULTS: Most nurses (90%, n = 9) tolerated wearing respiratory protection for two 12-hour shifts. CO(2) levels increased significantly compared with baseline measures, especially when comparing an N95 with a surgical mask to only an N95, but changes were not clinically relevant. Perceived exertion; perceived shortness of air; and complaints of headache, lightheadedness, and difficulty communicating also increased over time. Almost one-quarter (22%) of respirator removals were due to reported discomfort. N95 adjustments increased over time, but other compliance measures did not vary by time. Compliance increased on day 2, except for adjustments, touching under the N95, and eye touches. CONCLUSION: Long-term use of respiratory protection did not result in any clinically relevant physiologic burden for health care personnel, although many subjective symptoms were reported. N95 compliance was fairly high.", "Would everyone wearing face masks help us slow the pandemic? As cases of coronavirus disease 2019 (COVID-19) ballooned last month, people in Europe and North America scrambled to get their hands on surgical masks to protect themselves Health officials jumped in to discourage them, worried about the limited supply of masks for health care personnel \u201cSeriously people-STOP BUYING MASKS!\u201d began a 29 February tweet from U S Surgeon General Jerome Adams The World Health Organization and U S Centers for Disease Control and Prevention (CDC) have both said that only people with COVID-19 symptoms and those caring for them should wear masks But some health experts, including the director of the Chinese Center for Disease Control and Prevention, think that\u2019s a mistake Health authorities in parts of Asia have encouraged all citizens to wear masks in public to prevent the spread of the virus, regardless of whether they have symptoms And the Czech Republic took the uncommon step last week of making nose and mouth coverings mandatory in public spaces, prompting a grassroots drive to hand make masks", "Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacity BACKGROUND: Due to the SARS-CoV2 pandemic, medical face masks are widely recommended for a large number of individuals and long durations. The effect of wearing a surgical and a FFP2/N95 face mask on cardiopulmonary exercise capacity has not been systematically reported. METHODS: This prospective cross-over study quantitated the effects of wearing no mask (nm), a surgical mask (sm) and a FFP2/N95 mask (ffpm) in 12 healthy males (age 38.1 \u00b1 6.2 years, BMI 24.5 \u00b1 2.0 kg/m(2)). The 36 tests were performed in randomized order. The cardiopulmonary and metabolic responses were monitored by ergo-spirometry and impedance cardiography. Ten domains of comfort/discomfort of wearing a mask were assessed by questionnaire. RESULTS: The pulmonary function parameters were significantly lower with mask (forced expiratory volume: 5.6 \u00b1 1.0 vs 5.3 \u00b1 0.8 vs 6.1 \u00b1 1.0 l/s with sm, ffpm and nm, respectively; p = 0.001; peak expiratory flow: 8.7 \u00b1 1.4 vs 7.5 \u00b1 1.1 vs 9.7 \u00b1 1.6 l/s; p < 0.001). The maximum power was 269 \u00b1 45, 263 \u00b1 42 and 277 \u00b1 46 W with sm, ffpm and nm, respectively; p = 0.002; the ventilation was significantly reduced with both face masks (131 \u00b1 28 vs 114 \u00b1 23 vs 99 \u00b1 19 l/m; p < 0.001). Peak blood lactate response was reduced with mask. Cardiac output was similar with and without mask. Participants reported consistent and marked discomfort wearing the masks, especially ffpm. CONCLUSION: Ventilation, cardiopulmonary exercise capacity and comfort are reduced by surgical masks and highly impaired by FFP2/N95 face masks in healthy individuals. These data are important for recommendations on wearing face masks at work or during physical exercise.", "Mathematical assessment of the impact of non-pharmaceutical interventions on curtailing the 2019 novel Coronavirus A pandemic of a novel Coronavirus emerged in December of 2019 (COVID-19), causing devastating public health impact across the world. In the absence of a safe and effective vaccine or antivirals, strategies for con- trolling and mitigating the burden of the pandemic are focused on non-pharmaceutical interventions, such as social-distancing, contact-tracing, quarantine, isolation and the use of face-masks in public. We develop a new mathematical model for assessing the population-level impact of the aforementioned control and mitigation strategies. Rigorous analysis of the model shows that the disease-free equilibrium is locally-asymptotically stable if a certain epidemiological threshold, known as the reproduction number (denoted by Rc), is less than unity. This equilibrium is globally-asymptotically stable, for a special case of the model where quarantined-susceptible individuals do not acquire COVID-19 infection during quarantine, when Rc is less than unity. The epidemiological consequence of this theoretical result is that, the community-wide implementation of control interventions that can bring (and maintain) Rc to a value less than unity will lead to the effective control (or elimination) of COVID-19 in the community. Simulations of the model, using data relevant to COVID-19 transmission dynamics in the US state of New York and the entire US, show that the pandemic burden will peak in mid and late April, respectively. The worst-case scenario projections for cumulative mortality (based on baseline levels of interventions) are 105, 100 for New York state and 164, 000 for the entire US by the end of the pandemic. These numbers dramatically decreased by 80% and 64%, respectively, if adherence to strict social-distancing measures is improved and maintained until the end of May or June. The duration and timing of the relaxation or termination of the strict social-distancing measures are crucially important in determining the future trajectory of the COVID-19 pandemic. This study shows that early termination of the strict social-distancing measures could trigger a devastating second wave with burden similar to those projected before the onset of the strict social-distance measures were implemented. The use of efficacious face-masks (such as surgical masks, with estimated efficacy \u2265 70%) in public could lead to the elimination of the pandemic if at least 70% of the residents of New York state use such masks in public consistently (nationwide, a compliance of at least 80% will be required using such masks). The use of low efficacy masks, such as cloth masks (of estimated efficacy less than 30%), could also lead to significant reduction of COVID-19 burden (albeit, they are not able to lead to elimination). Combining low efficacy masks with improved levels of the other anti-COVID-19 intervention strategies can lead to the elimination of the pandemic. This study emphasizes the important role social-distancing plays in curtailing the burden of COVID-19. Increases in the adherence level of social-distancing protocols result in dramatic reduction of the burden of the pandemic, and the timely implementation of social-distancing measures in numerous states of the US may have averted a catastrophic outcome with respect to the burden of COVID-19. Using face-masks in public (including the low efficacy cloth masks) is very useful in minimizing community transmission and burden of COVID-19, provided their coverage level is high. The masks coverage needed to eliminate COVID-19 decreases if the masks-based intervention is combined with the strict social-distancing strategy.", "Severe acute respiratory syndrome and dentistry A retrospective view ABSTRACT Background Severe acute respiratory syndrome, or SARS, which has created panic in Asia and in some parts of North America, is the first epidemic of the new century. Although it has been well-contained, sporadic cases continue to emerge. Objectives The authors trace the emergence of the SARS outbreak from southern China and its spread worldwide, discuss the viral etiology of the infection and its clinical features, and review the infection control guidelines issued during the outbreak by the health authorities in Hong Kong, the Centers for Disease Control and Prevention, the World Health Organization and the American Dental Association. They also review the prospects for a new outbreak and preventive measures. Overview The disease, which is caused by a novel coronavirus termed the \u201cSARS coronavirus,\u201d or SARS-CoV, essentially spreads through droplet infection and affects people of any age. It has a mortality rate ranging from 10 to 15 percent. A major hallmark of this disease has been the rate at which it has affected health care workers through nosocomial transmission; in some countries, up to one-fourth to one-third of those infected were in this category. However, no dental health care worker has been affected by SARS in a nosocomial or dental setting. Conclusions and Clinical Implications Researchers believe that a combination of factors, including the universal infection control measures that the dental community has implemented and/or the low degree of viral shedding in the prodromal phase of SARS, may have obviated the spread of the disease in dental settings. The dental community should reflect on this outbreak to reinforce the currently applied infection control measures.", "Novel corona virus disease (COVID-19) in pregnancy: What clinical recommendations to follow? ", "AGA Institute Rapid Recommendations for Gastrointestinal Procedures During the COVID-19 Pandemic ", "Can the Elastic of Surgical Face Masks Stimulate Ear Protrusion in Children? In this period of the Covid-19 pandemic, a protective mask has become a common object of use to contain virus transmission. The imminent need for masks has led many governments to produce them, including surgical masks with elastic loops or masks with side cuts at the ears. Among those on the market, surgical masks with elastic loops are the ones most chosen by parents for their children. These elastics cause constant compression on the skin and, consequently, on the cartilage of the auricle, leading to erythematous and painful lesions of the retroauricular skin when the masks are used for many hours a day. Pre-adolescent children have undeveloped auricular cartilage with less resistance to deformation; prolonged pressure from the elastic loops of the mask at the hollow or, even worse, at the anthelix level can influence the correct growth and angulation of the outer ear. In fact, unlike when using conservative methods for the treatment of protruding ears, this prolonged pressure can increase the cephaloauricular angle of the outer auricle. It is important for the authorities supplying the masks to be aware of this potential risk and for alternative solutions to be found while maintaining the possibility of legitimate prevention of the potential spread of the virus. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266.", "COVID-19 in endoscopy: Time to do more? ", "Face Masks Considerably Reduce Covid-19 Cases in Germany We use the synthetic control method to analyze the effect of face masks on the spread of Covid-19 in Germany. Our identification approach exploits regional variation in the point in time when face masks became compulsory. Depending on the region we analyse, we find that face masks reduced the cumulative number of registered Covid-19 cases between 2.3% and 13% over a period of 10 days after they became compulsory. Assessing the credibility of the various estimates, we conclude that face masks reduce the daily growth rate of reported infections by around 40%.", "How to protect the protectors: 10 lessons to learn for doctors fighting the COVID-19 coronavirus ", "Maintaining mask stockpiles in the COVID-19 pandemic: Taiwan as a learning model ", "Coronavirus Disease (COVID-19): A primer for emergency physicians INTRODUCTION: Rapid worldwide spread of Coronavirus Disease 2019 (COVID-19) has resulted in a global pandemic. OBJECTIVE: This review article provides emergency physicians with an overview of the most current understanding of COVID-19 and recommendations on the evaluation and management of patients with suspected COVID-19. DISCUSSION: Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for causing COVID-19, is primarily transmitted from person-to-person through close contact (approximately 6 ft) by respiratory droplets. Symptoms of COVID-19 are similar to other viral upper respiratory illnesses. Three major trajectories include mild disease with upper respiratory symptoms, non-severe pneumonia, and severe pneumonia complicated by acute respiratory distress syndrome (ARDS). Emergency physicians should focus on identifying patients at risk, isolating suspected patients, and informing hospital infection prevention and public health authorities. Patients with suspected COVID-19 should be asked to wear a facemask. Respiratory etiquette, hand washing, and personal protective equipment are recommended for all healthcare personnel caring for suspected cases. Disposition depends on patient symptoms, hemodynamic status, and patient ability to self-quarantine. CONCLUSION: This narrative review provides clinicians with an updated approach to the evaluation and management of patients presenting to the emergency department with suspected COVID-19.", "An experimental trial of recombinant human interferon alpha nasal drops to prevent coronavirus disease 2019 in medical staff in an epidemic area Objective To investigate the efficacy and safety of recombinant human interferon alpha1b (rhIFN-\u03b1) nasal drops in healthy medical staff to prevent 2019 novel coronavirus disease (COVID-19). Methods A prospective, open-label study was conducted. Starting January 21, 2020, at Taihe Hospital in Shiyan City, Hubei Province, 2944 medical staff members were recruited and allocated into a low-risk group or a high-risk group according to whether they were directly exposed to the coronavirus. Participants in the low-risk group received rhIFN-\u03b1 nasal drops (2-3 drops/nostril/time, 4 times/day) for 28 days; those in the high-risk group received rhIFN-\u03b1 nasal drops combined with thymosin-\u03b11 (1.6 mg, hypodermic injection, once a week). The primary outcome was new-onset COVID-19 over 28 days. The secondary outcome was new-onset fever or respiratory symptoms but with negative pulmonary images. The results were compared with the number of new cases in medical staff in the same areas of Hubei Province (including Wuhan) during the same period. Adverse reactions to interferon nasal drops were also observed. Results Among the 2944 subjects in our study, 2415 were included in the low-risk group, including 997 doctors and 1418 nurses with average ages of 37.38 and 33.56 years, respectively; 529 were included in the high-risk group, including 122 doctors and 407 nurses with average ages of 35.24 and 32.16 years, respectively. The 28-day incidence of COVID-19 was zero in both the high- and low-risk groups. The 28-day incidence of new-onset clinical symptoms with negative images for pneumonia was also zero in both the high- and low-risk groups. As controls, a total of 2035 medical personnel with confirmed COVID-19 pneumonia from the same area (Hubei Province) was observed between January 21 to February 23, 2020. There were no serious adverse effects in the 2944 subjects treated during the intervention period. Conclusion In this investigator-initiated open-label study, we observed that rhIFN-\u03b1 nasal drops can effectively prevent COVID-19 in treated medical personnel. Our results also indicate that rhIFN-\u03b1 nasal drops have potential promise for protecting susceptible healthy people during the coronavirus pandemic.", "Nasal plugs for preventing respiratory infections. Nasal plugs were made from an N-95 respirator, surgical mask or a cotton ball and inserted into the nares of volunteer healthcare workers for 30 min. Initial and persistent respiratory resistance, choking sensation, and discomfort in the mouth and nose areas were recorded for the three different nasal plugs, the N-95 respirator and a surgical mask. Nasal plugs were more convenient and better tolerated than the masks. The ability of the nasal plug material to prevent infection by droplet transmission was also tested. A piece of each material was placed on a blood agar plate, the volunteer coughed onto the plate and the material was removed. Bacterial colonies only grew in the areas not previously covered by the nasal plug material. The cotton ball nasal plug is probably as effective as the N-95 respirator or surgical masks at preventing infection, and is much cheaper.", "Emergency management for preventing and controlling nosocomial infection of 2019 novel coronavirus: implications for the dermatology department. As of Feb 15, 2019, the novel coronavirus (2019-nCoV) has rapidly spread throughout China and across the world with more than 60,000 laboratory-confirmed cases. Due to the current lack of specific treatment and the risk of transmission during the viral incubation period, infection prevention and control of 2019-nCoV are both urgent and critical to global health. In this article, we aim to highlight the necessity of implementing protective measures, and recommend how to set proper emergency management plans for preventing and controlling nosocomial infection of 2019-nCoV in dermatology departments.", "COVID 19\u2014An eye on the virus ", "Universal use of face masks for success against COVID-19: evidence and implications for prevention policies Cloth masks are a simple, economic and sustainable alternative to surgical mask as a means of source control of SARS-CoV-2 for general community.", "Respiratory Protection Considerations for Healthcare Workers During the COVID-19 Pandemic The COVID-19 pandemic has resulted in a surge of patients that exceeds available human and physical resources in many settings, triggering the implementation of crisis standards of care. High-quality respiratory protection is essential to reduce exposure among healthcare workers, yet dire shortages of personal protective equipment in the United States threaten the health and safety of this essential workforce. In the context of rapidly changing conditions and incomplete data, this article outlines 3 important strategies to improve healthcare workers' respiratory protection. At a minimum, healthcare workers delivering care to patients with confirmed or suspected COVID-19 should wear N95 respirators and full-face shields. Several mechanisms exist to boost and protect the supply of N95 respirators, including rigorous decontamination protocols, invoking the Defense Production Act, expanded use of reusable elastomeric respirators, and repurposing industrial N95 respirators. Finally, homemade facial coverings do not protect healthcare workers and should be avoided. These strategies, coupled with longer-term strategies of investments in protective equipment research, infrastructure, and data systems, provide a framework to protect healthcare workers immediately and enhance preparedness efforts for future pandemics.", "How effective can homemade face masks be? With cases of COVID-19 growing rapidly in the US and evidence mounting that the virus responsible, SARS-CoV-2, can be spread by infected people before they develop symptoms, the US Centers for Disease Control and Prevention recommended April 3 that people wear cloth face coverings in public places This guidance is a shift from the center\u2019s previous position that healthy people needed to wear masks only when caring for a sick person The recommendation also follows recent calls by experts on social media and other platforms for the general public to don nonmedical, cloth masks to help reduce the transmission of the novel coronavirus \u201cMembers of the general public should wear non-medical fabric face masks when going out in public in one additional societal effort to slow the spread of the virus down,\u201d Tom Inglesby, director of the Johns Hopkins Center for Health Security, tweeted March 29 These experts hope the View: PDF ;Full Text HTML", "A cloth mask for under-resourced healthcare settings in the COVID19 pandemic INTRODUCTION: COVID19 pandemic poses a global threat, with many unknowns. The potential for resource limited countries to suffer huge mortality is of major concern. Prevention and risk reduction strategies are paramount in the current absence of effective treatment or a vaccine. There is a global shortage of personal protective equipment. AIMS: This short paper describes the rationale for and development of a cloth homemade mask and has a step by step video. RESULTS: The template is reproducible around the world and is both washable and cheap. CONCLUSION: This article describes a simple way to make a cloth mask, suitable if medical masks are not available.", "Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity ", "A multipurpose portable negative air flow isolation chamber for aerosol generating medical procedures during the COVID-19 pandemic ", "Reimagining the Administrative State in Times of Global Health Crisis: An Anatomy of Taiwan\u2019s Regulatory Actions in Response to the COVID-19 Pandemic ", "Severe Acute Respiratory Syndrome: What Have We Learned ", "Facial Skin Temperature and Discomfort When Wearing Protective Face Masks: Thermal Infrared Imaging Evaluation and Hands Moving the Mask Individual respiratory protective devices and face masks represent critical tools in protecting health care workers in hospitals and clinics, and play a central role in decreasing the spread of the high-risk pandemic infection of 2019, coronavirus disease (COVID-19). The aim of the present study was to compare the facial skin temperature and the heat flow when wearing medical surgical masks to the same factors when wearing N95 respirators. A total of 20 subjects were recruited and during the evaluation, each subject was invited to wear a surgical mask or respirator for 1 h. The next day in the morning at the same hour, the same subject wore a N95 mask for 1 h with the same protocol. Infrared thermal evaluation was performed to measure the facial temperature of the perioral region and the perception ratings related to the humidity, heat, breathing difficulty, and discomfort were recorded. A significant difference in heat flow and perioral region temperature was recorded between the surgical mask and the N95 respirator (p < 0.05). A statistically significant difference in humidity, heat, breathing difficulty, and discomfort was present between the groups. The study results suggest that N95 respirators are able to induce an increased facial skin temperature, greater discomfort and lower wearing adherence when compared to the medical surgical masks.", "Decontamination of N95 masks against coronavirus: a scoping review Background: At present, it remains uncertain which method to decontaminate N95 is most suitable and should be recommended to healthcare professionals worldwide. Objectives: The aim of this scoping review was to map and compile the available evidence about the effectiveness of decontaminating N95 masks against coronavirus. Methods: We selected studies written in English assessing or discussing decontamination strategies of N95 masks against coronavirus. The search and study screening were performed in PubMed and SCOPUS by two independent researchers. A descriptive analysis was performed considering the study design of included studies. Results: We included nineteen studies. Eight articles were letter to the editors, five were in vitro studies, three were literature reviews, and three were classified as other study designs. The use of vaporized hydrogen peroxide and ultraviolet irradiation were the strategies most cited. However, there is a lack of evidence and consensus related to the best method of N95 masks decontamination. Conclusion: The evidence towards decontamination strategies of N95 masks against coronavirus remains scarce. Vaporized hydrogen peroxide and ultraviolet irradiation seem the current standard for N95 masks decontamination.", "2019 Novel Coronavirus Disease Epidemic: Skin Protection for Healthcare Workers Must Not Be Ignored ", "Estimating the Effect and Cost-Effectiveness of Facemasks in Reducing the Spread of the Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) in Uganda Evidence that face masks provide effective protection against respiratory infections in the community is scarce. However, face masks are widely used by health workers as part of droplet precautions when caring for patients with respiratory infections. It would therefore be reasonable to suggest that consistent widespread use of face masks in the community could prevent further spread of the Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2). In this study we examine public face mask wearing in Uganda where a proportion wears masks to protect against acquiring, and the other to prevent from transmitting SARS-CoV-2. The objective of this study was to determine what percentage of the population would have to wear face masks to reduce susceptibility to and infectivity of COVID-19 in Uganda, keeping the basic reproduction number below unity and/or flattening the curve. We used an SEIAQRD model for the analysis. Results show that implementation of facemasks has a relatively large impact on the size of the coronavirus epidemic in Uganda. We find that the critical mask adherence is 5 per 100 when 80% wear face masks. A cost-effective analysis shows that utilizing funds to provide 1 public mask to the population has a per capita compounded cost of USD 1.34. If provision of face masks is done simultaneously with supportive care, the per capita compounded cost is USD 1.965, while for the case of only treatment and no provision of face masks costs each Ugandan USD 4.0579. We conclude that since it is hard to achieve a 100% adherence to face masks, government might consider provision of face masks in conjunction with provision of care.", "Providing evidence on the ongoing health care workers' mask debate The scarcity of facemasks, particularly N95 respirators, combined with the lack of solid data to address the suitability of each mask type for adequate health care worker (HCW) protection have caused turmoil among HCWs. Current recommendations suggest mask usage solely during HCW contact with Covid-19 patients, namely plain medical mask for low-risk contacts and N95 for aerosol generating procedures. The distinction regarding the escalation of mask complexity depending on contact type is nevertheless based on plausible theoretical assumptions rather than hard evidence of a clear benefit. Conversely, we suggest that at least a plain mask should be used during all HCWs' contacts in healthcare facilities which constitute a highly probable but often overlooked means of SARS-CoV-2 transmission among HCWs.", "COVID-19 epidemic: disentangling the re-emerging controversy about medical facemasks from an epidemiological perspective ", "Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings. METHODS: We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047. FINDINGS: Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25\u00e2\u0080\u0088697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10\u00e2\u0080\u0088736, pooled adjusted odds ratio [aOR] 0\u00b718, 95% CI 0\u00b709 to 0\u00b738; risk difference [RD] -10\u00b72%, 95% CI -11\u00b75 to -7\u00b75; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2\u00b702 per m; pinteraction=0\u00b7041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0\u00b715, 95% CI 0\u00b707 to 0\u00b734, RD -14\u00b73%, -15\u00b79 to -10\u00b77; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12-16-layer cotton masks; pinteraction=0\u00b7090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0\u00b722, 95% CI 0\u00b712 to 0\u00b739, RD -10\u00b76%, 95% CI -12\u00b75 to -7\u00b77; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings. INTERPRETATION: The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance. FUNDING: World Health Organization."], "neg": ["Mortality Rate of Infection With COVID-19 in Korea From the Perspective of Underlying Disease On December 31, 2019 the China National Health Commission (NHC) reported that an unknown cause of pneumonia had been detected in Wuhan in Hubei province. On February 12, the disease caused by the novel coronavirus (2019-nCoV) was given a formal name, COVID-19. On January 20, 2020, the first case of COVID-19 was confirmed in Korea. The age-specific death rate was the highest among patients over 70 years of age, with underlying diseases in their circulatory system, such as myocardial infarction, cerebral infraction, arrythmia, and hypertension. Patients with underlying disease who are 70 years of age or older should recognize that there is a high possibility of developing a serious disease in case of viral infection and follow strict precautions.", "What further should be done to control COVID-19 outbreaks in addition to cases isolation and contact tracing measures? ", "COVID-19 in Canada: Predictions for the future and control lessons from Asia COVID-19 has spread with unequal efficiency in various parts of the world. In several European countries including Italy, the increase in the number of COVID-19 cases has followed a consistent, exponential pattern of spread. However, some countries, notably Taiwan and Hong Kong, have achieved a different outcome and have managed to bring the COVID-19 outbreak in their countries rapidly under control, without entering the exponential pattern and with very few cases. They have used several different approaches to COVID-19 outbreak control, including the innovative use of smartphone technology and the widespread use of surgical face masks. We show through our models, that Canada has followed the same, consistent COVID-19 exponential growth pattern that is seen in Italy. Both nationally and in its most heavily affected provinces, there is exponential growth of COVID-19 cases, making it possible to make predictions for the future, if no further interventions are made in public health policy. In particular, we argue for the urgent introduction of surgical face masks in health care and other settings and the harnessing of the power of smartphone technology on a national scale.", "Disease control of 2019-novel coronavirus infection in hospital: West China urgent recommendation/ \u65b0\u578b\u51a0\u72b6\u75c5\u6bd2\u611f\u67d3\u533b\u9662\u5185\u9632\u63a7\u7684\u534e\u897f\u7d27\u6025\u63a8\u8350 China is facing the serious situation of 2019-novel coronavirus (2019-nCoV) infection. The health care institutions have actively participated in the prevention, diagnosis, and treatment of the disease. Proper regulation of in-hospital policy may help control virus spreading. We developed seven key clinical questions about the prevention and control of 2019-novel coronavirus infection in a hospital, and provided recommendations based on the best available evidence and expert experience. We interpret the recommendations for better feasibility in Chinese hospital. We hope to provide evidence and reference for the domestic medical institutions to reasonably adjust the hospital workflow during 2019-nCoV infection period.", "Community acquired respiratory virus infections in cancer patients\u2014Guideline on diagnosis and management by the Infectious Diseases Working Party of the German Society for haematology and Medical Oncology Abstract Background Community acquired viruses (CRVs) may cause severe disease in cancer patients. Thus, efforts should be made to diagnose CRV rapidly and manage CRV infections accordingly. Methods A panel of 18 clinicians from the Infectious Diseases Working Party of the German Society for Haematology and Medical Oncology have convened to assess the available literature and provide recommendations on the management of CRV infections including influenza, respiratory syncytial virus, parainfluenza virus, human metapneumovirus and adenovirus. Results CRV infections in cancer patients may lead to pneumonia in approximately 30% of the cases, with an associated mortality of around 25%. For diagnosis of a CRV infection, combined nasal/throat swabs or washes/aspirates give the best results and nucleic acid amplification based-techniques (NAT) should be used to detect the pathogen. Hand hygiene, contact isolation and face masks have been shown to be of benefit as general infection management. Causal treatment can be given for influenza, using a neuraminidase inhibitor, and respiratory syncytial virus, using ribavirin in addition to intravenous immunoglobulins. Ribavirin has also been used to treat parainfluenza virus and human metapneumovirus, but data are inconclusive in this setting. Cidofovir is used to treat adenovirus pneumonitis. Conclusions CRV infections may pose a vital threat to patients with underlying malignancy. This guideline provides information on diagnosis and treatment to improve the outcome.", "Highlight of Immune Pathogenic Response and Hematopathologic Effect in SARS-CoV, MERS-CoV, and SARS-Cov-2 Infection A sudden outbreak of COVID-19 caused by a novel coronavirus, SARS-CoV-2, in Wuhan, China in December 2019 quickly grew into a global pandemic, putting at risk not only the global healthcare system, but also the world economy. As the disease continues to spread rapidly, the development of prophylactic and therapeutic approaches is urgently required. Although some progress has been made in understanding the viral structure and invasion mechanism of coronaviruses that may cause severe cases of the syndrome, due to the limited understanding of the immune effects caused by SARS-CoV-2, it is difficult for us to prevent patients from developing acute respiratory distress syndrome (ARDS) and pulmonary fibrosis (PF), the major complications of coronavirus infection. Therefore, any potential treatments should focus not only on direct killing of coronaviruses and prevention strategies by vaccine development, but also on keeping in check the acute immune/inflammatory responses, resulting in ARDS and PF. In addition, potential treatments currently under clinical trials focusing on killing coronaviruses or on developing vaccines preventing coronavirus infection largely ignore the host immune response. However, taking care of SARS-CoV-2 infected patients with ARDS and PF is considered to be the major difficulty. Therefore, further understanding of the host immune response to SARS-CoV-2 is extremely important for clinical resolution and saving medication cost. In addition to a breif overview of the structure, infection mechanism, and possible therapeutic approaches, we summarized and compared the hematopathologic effect and immune responses to SARS-CoV, MERS-CoV, and SARS-CoV-2. We also discussed the indirect immune response caused by SARS and direct infection, replication, and destroying of immune cells by MERS-CoV. The molecular mechanisms of SARS-CoV and MERS-CoV infection-induced lymphopenia or cytokine storm may provide some hint toward fight against SARS-CoV-2, the novel coronavirus. This may provide guidance over using immune therapy as a combined treatment to prevent patients developing severe respiratory syndrome and largely reduce complications.", "Anesthetic and surgical management of tracheostomy in a patient with COVID-19 OBJECTIVE: The ongoing pandemic coronavirus disease-2019 (COVID-19) infection causes severe respiratory dysfunction and has become an emergent issue for worldwide healthcare. Since COVID-19 spreads through contact and droplet infection routes, careful attention to infection control and surgical management is important to prevent cross-contamination of patients and medical staff. Tracheostomy is an effective method to treat severe respiratory dysfunction with prolonged respiratory management and should be performed as a high-risk procedure METHOD: The anesthetic and surgical considerations in this case involved difficult goals of the patient safety and the management of infection among health care workers. Our surgical procedure was developed based on the previous experiences of severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). RESULTS: We described the management procedures for tracheostomy in a patient with COVID-19, including the anesthesia preparation, surgical procedures, required medical supplies (a N95 mask or powered air purifying respirator, goggles, face shield, cap, double gloves, and a water-resistant disposable gown), and appropriate consultation with an infection prevention team. CONCLUSION: Appropriate contact, airborne precautions, and sufficient use of muscle relaxants are essential for performing tracheostomy in a patient with COVID-19.", "Coronaviren als Ursache respiratorischer Infektionen BACKGROUND: There are six human pathogenic coronaviruses (CoV), which mainly cause infections of the respiratory system. In everyday clinical practice, it is helpful to know the relevance and characteristics of these pathogens. OBJECTIVE: To present the epidemiology, clinical picture and differences of human pathogenic CoV and to provide information on the diagnostics and treatment of patients suspected of having CoV infections. MATERIAL AND METHODS: Selective literature search, presentation of results and discussion of fundamental works and expert recommendations, including publications by the World Health Organization (WHO), the European Centre for Disease Prevention and Control (ECDC) and the Robert Koch Institute. RESULTS: The four endemic human CoVs (HCoV-NL63, HCoV-229E, HCoV-OC43 and HCoV-HKU1) mainly cause mild respiratory tract infections. In addition to these four endemic HCoV, the two epidemic CoV, severe acute respiratory syndrome (SARS)-CoV and Middle East respiratory syndrome (MERS)-CoV can cause severe pneumonia. The SARS-CoV has not been detected in humans in the last 15 years and MERS-CoV has been circulating mainly on the Arabian Peninsula since 2012; however, neither a specific treatment nor approved vaccines exist for any of the six human pathogenic CoVs. CONCLUSION: All six human CoVs can be diagnosed using RT-PCR on respiratory specimens but this is rarely necessary for the four endemic strains. In current clinical practice SARS-CoV has no importance as it has not been detected in humans for 15 years; however, a possible MERS-CoV infection should be taken into account in patients with typical symptoms and travel history to endemic regions. In this case, rapid diagnostic and general hygiene practices are important to prevent further transmission."]}, {"query": "how long does coronavirus remain stable  on surfaces?", "pos": ["Body fluids may contribute to human-to-human transmission of severe acute respiratory syndrome coronavirus 2: evidence and practical experience BACKGROUND: In December 2019, an unbelievable outbreak of pneumonia associated with coronavirus was reported in the city of Wuhan, Hubei Province. This virus was called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although much effort has been spent on clarifying the transmission route of SARS-CoV-2, but, very little evidence is available regarding the relationship between human body fluids and transmission of SARS-CoV-2 virus. Considerable evidence from hospital in Wuhan indicates that strict rules to avoid occupational exposure to patients\u2019 body fluids in healthcare settings, particularly among every medical staff, limited person-to-person transmission of nosocomial infections by direct or indirect contact. CONCLUSION: We tried to provide important information for understanding the possible transmission routes of SARS-CoV-2 via body fluids including bronchoalveolar-lavage, saliva, blood, urine, feces, sputum, tears, and semen in order to control coronavirus disease 2019 (COVID-19) occurrences.", "Issues Concerning Survival of Viruses on Surfaces Viruses are the causative agents of an estimated 60% of human infections worldwide. The most common viral illnesses are produced by enteric and respiratory viruses. Transmission of these viruses from an infected person or animal to a new host can occur via several routes. Existing studies strongly suggest that contaminated fomites or surfaces play an important role in the spreading of viral diseases. The potential of viral spreading via contaminated surfaces depends particularly on the ability of the virus to maintain infectivity whilst it is in the environment. This is affected by a combination of biological, physical and chemical factors. This review summarises current knowledge about the influence of environmental factors on the survival and spread of viruses via contaminated surfaces.", "Disease management strategies in SARS ", "A Guide to COVID\u201019: a global pandemic caused by the novel coronavirus SARS\u2010CoV\u20102 The emergence of the SARS\u2010CoV\u20102 strain of the human coronavirus has thrown the world into the midst of a new pandemic. In the human body, the virus causes COVID\u201019, a disease characterized by shortness of breath, fever, and pneumonia, which can be fatal in vulnerable individuals. SARS\u2010CoV\u20102 has characteristics of past human coronaviruses, with close genomic similarities to SARS\u2010CoV, the virus that causes the disease SARS. Like these related coronaviruses, SARS\u2010CoV\u20102 is transmitted through the inhalation of droplets and interaction with contaminated surfaces. Across the world, laboratories are developing candidate vaccines for the virus \u2013 with vaccine trials underway in the US and the United Kingdom \u2010 and considering various drugs for possible treatments and prophylaxis. Here, we provide an overview of SARS\u2010CoV\u20102 by analyzing its virology, epidemiology, and modes of transmission while examining the current progress of testing procedures and possible treatments through drugs and vaccines.", "Detection of air and surface contamination by SARS-CoV-2 in hospital rooms of infected patients Understanding the particle size distribution in the air and patterns of environmental contamination of SARS-CoV-2 is essential for infection prevention policies. Here we screen surface and air samples from hospital rooms of COVID-19 patients for SARS-CoV-2 RNA. Environmental sampling is conducted in three airborne infection isolation rooms (AIIRs) in the ICU and 27 AIIRs in the general ward. 245 surface samples are collected. 56.7% of rooms have at least one environmental surface contaminated. High touch surface contamination is shown in ten (66.7%) out of 15 patients in the first week of illness, and three (20%) beyond the first week of illness (p = 0.01, &#967;2 test). Air sampling is performed in three of the 27 AIIRs in the general ward, and detects SARS-CoV-2 PCR-positive particles of sizes >4 \u00b5m and 1-4 \u00b5m in two rooms, despite these rooms having 12 air changes per hour. This warrants further study of the airborne transmission potential of SARS-CoV-2.", "Does Copper treating of commonly touched surfaces reduce healthcare acquired infections? A Systematic Review and meta-analysis Background Healthcare acquired infections (HAIs) cause substantial morbidity and mortality. Copper appears to have strong viricidal properties under laboratory conditions. Aim We conducted a systematic review to examine the potential effect of copper treating of commonly touched surfaces in healthcare facilities. Methods We included controlled trials comparing the effect of copper-treated surfaces (furniture or bed linens) in hospital rooms versus standard rooms on hospital acquired infections (HAIs). Two reviewers independently screened retrieved articles, extracted data, and assessed the risk of bias of included studies. The primary outcome was the occurrence of healthcare acquired infections. Findings We screened 638 records; 7 studies comprising 12362 patients were included. All of included studies were judged to be at high risk in [\u2265]2 of the 7 domains of bias. All 7 included studies reported the effect of copper-treated surfaces HAIs. Overall, we found low quality evidence of a potential clinical importance that copper-treated hard surfaces and/or bed linens and clothes reduced healthcare acquired infections by 27% (RR 0.73; 95% CI 0.57 to 0.94). Conclusion Given the clinical and economic costs of healthcare acquired infections, the potentially protective effect of copper-treated surfaces appears important. The current evidence is insufficient to make a strong positive recommendation. However, it would appear worthwhile and urgent to conduct larger-scale publicly funded clinical trials of the impact of copper coating.", "Covid-19 and mobile phone hygiene in healthcare settings ", "Synergistic effects of anionic surfactants on coronavirus (SARS-CoV-2) virucidal efficiency of sanitizing fluids to fight COVID-19 Our surrounding environment, especially often-touched contaminated surfaces, plays an important role in the transmission of pathogens in society. The shortage of effective sanitizing fluids, however, became a global challenge quickly after the coronavirus disease-19 (COVID-19) outbreak in December 2019. In this study, we present the effect of surfactants on coronavirus (SARS-CoV-2) virucidal efficiency in sanitizing fluids. Sodium dodecylbenzenesulfonate (SDBS), sodium laureth sulfate (SLS), and two commercial dish soap and liquid hand soap were studied with the goal of evaporation rate reduction in sanitizing liquids to maximize surface contact time. Twelve fluids with different recipes composed of ethanol, isopropanol, SDBS, SLS, glycerin, and water of standardized hardness (WSH) were tested for their evaporation time and virucidal efficiency. Evaporation time increased by 17-63% when surfactant agents were added to the liquid. In addition, surfactant incorporation enhanced the virucidal efficiency between 15-27% according to the 4-field test in the EN 16615:2015 European Standard method. Most importantly, however, we found that surfactant addition provides a synergistic effect with alcohols to inactivate the SARS-CoV-2 virus. This study provides a simple, yet effective solution to improve the virucidal efficiency of commonly used sanitizers.", "Stability of Middle East respiratory syndrome coronavirus (MERS-CoV) under different environmental conditions. The stability of Middle East respiratory syndrome coronavirus (MERS-CoV) was determined at 20\u00b0C--40% relative humidity (RH); 30\u00b0C--30% RH and 30\u00b0C--80% RH. MERS-CoV was more stable at low temperature/low humidity conditions and could still be recovered after 48 hours. During aerosolisation of MERS-CoV, no decrease in stability was observed at 20\u00b0C--40% RH. These data suggest the potential of MERS-CoV to be transmitted via contact or fomite transmission due to prolonged environmental presence.", "Prevalence and acceptance of glove wearing practice among general population when visiting high risk are during local COVID-19 outbreak . Background Healthcare authorities have generally advised against wearing glove by the general population. However, the use of gloves has become a common sight in public places raising the question of the necessity of glove wearing practice by the general population Objective This study aims to investigate the prevalence and types of glove used as well as the acceptance of the glove practice by individuals visiting the high-risk area during Covid-19 pandemic. Setting This prospective observational study was conducted among individuals visiting a wet market and district specialist hospital During Covid-19 pandemic. The required data was recorded based on observation by trained data collectors who were stationed at the strategic entry point. Methods Individuals entering through dedicated entry point were observed for the type, category and practice of wearing personal protective equipment. Inclusion criteria for this study were any individuals entering the facilities from entry points without respiratory symptoms. Exclusion criteria for this study were individuals less than 2 years old, visiting the emergency department, facility staff, individuals who are suspected of multiple entry and individuals who are exiting the treatment facility entrance. Patients were categorized into two groups of acceptable and unacceptable glove practice. The Pearson chi-square was used to test for differences in investigated variables in the univariate setting. Main outcome measure Prevalence, acceptance of glove wearing practice. Results A total of 75 individuals (2.3%) compromising of 45 (60.0%) individuals from hospitals and 30 (40.0%) individuals from wet markets were seen wearing glove amongst 3322 individuals observed during the data collection period. A higher proportion of individuals visiting wet market (30.0%) were observed with unacceptable glove practice compared to individuals visiting the hospital (8.9%), {chi}2 (1) = 5.60, p=.018. Similarly, a Higher proportion of glove use among non-Malay (53.3%) compared to Malay (46.7%) was observed in hospital compared to a higher proportion of glove use among Malay compared to non-Malay (16.7%) visiting wet market, {chi}2 (1) = 10.20, p=.001. As for glove use, we found that male were using more medical-grade glove (78.8%) compared to non-medical grade glove (21.2%) while an equal amount of medical (50.0%) and non-medical grade glove (50.0%) was used among female, {chi}2 (1) = 6.546, p=.011. Besides, we found that higher proportion of individual using medical-grade glove was using medical grade facemask (68.3%) which was similar to the proportion of individuals using non-medical glove was using non-medical facemask (66.7%), {chi}2 (1) = 5.25, p=.022. Conclusion We present the prevalence and characteristics of glove wearing practice in high-risk location during the current COVID-19 outbreak in Malaysia. Facing a worldwide public health emergency with limited effective clinical treatment, the role of glove-wearing in mitigating COVID-19 transmission is questionable. If needed, the compliance to proper glove-wearing could be improved through targeted public health education", "SARS-CoV-2: air/aerosols and surfaces in laboratory and clinical settings ", "Deposition of respiratory virus pathogens on frequently touched surfaces at airports BACKGROUND: International and national travelling has made the rapid spread of infectious diseases possible. Little information is available on the role of major traffic hubs, such as airports, in the transmission of respiratory infections, including seasonal influenza and a pandemic threat. We investigated the presence of respiratory viruses in the passenger environment of a major airport in order to identify risk points and guide measures to minimize transmission. METHODS: Surface and air samples were collected weekly at three different time points during the peak period of seasonal influenza in 2015\u201316 in Finland. Swabs from surface samples, and air samples were tested by real-time PCR for influenza A and B viruses, respiratory syncytial virus, adenovirus, rhinovirus and coronaviruses (229E, HKU1, NL63 and OC43). RESULTS: Nucleic acid of at least one respiratory virus was detected in 9 out of 90 (10%) surface samples, including: a plastic toy dog in the children\u2019s playground (2/3 swabs, 67%); hand-carried luggage trays at the security check area (4/8, 50%); the buttons of the payment terminal at the pharmacy (1/2, 50%); the handrails of stairs (1/7, 14%); and the passenger side desk and divider glass at a passport control point (1/3, 33%). Among the 10 respiratory virus findings at various sites, the viruses identified were: rhinovirus (4/10, 40%, from surfaces); coronavirus (3/10, 30%, from surfaces); adenovirus (2/10, 20%, 1 air sample, 1 surface sample); influenza A (1/10, 10%, surface sample). CONCLUSIONS: Detection of pathogen viral nucleic acids indicates respiratory viral surface contamination at multiple sites associated with high touch rates, and suggests a potential risk in the identified airport sites. Of the surfaces tested, plastic security screening trays appeared to pose the highest potential risk, and handling these is almost inevitable for all embarking passengers.", "Increasing Temperature and Relative Humidity Accelerates Inactivation of SARS-CoV-2 on Surfaces Coronavirus disease 2019 (COVID-19) was first identified in China in late 2019 and is caused by newly identified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Previous studies had reported the stability of SARS-CoV-2 in cell culture media and deposited onto surfaces under a limited set of environmental conditions. Here, we broadly investigated the effects of relative humidity, temperature, and droplet size on the stability of SARS-CoV-2 in a simulated clinically relevant matrix dried on nonporous surfaces. The results show that SARS-CoV-2 decayed more rapidly when either humidity or temperature was increased but that droplet volume (1 to 50 \u03bcl) and surface type (stainless steel, plastic, or nitrile glove) did not significantly impact decay rate. At room temperature (24\u00b0C), virus half-life ranged from 6.3 to 18.6 h depending on the relative humidity but was reduced to 1.0 to 8.9 h when the temperature was increased to 35\u00b0C. These findings suggest that a potential for fomite transmission may persist for hours to days in indoor environments and have implications for assessment of the risk posed by surface contamination in indoor environments. IMPORTANCE Mitigating the transmission of SARS-CoV-2 in clinical settings and public spaces is critically important to reduce the number of COVID-19 cases while effective vaccines and therapeutics are under development. SARS-CoV-2 transmission is thought to primarily occur through direct person-to-person transfer of infectious respiratory droplets or through aerosol-generating medical procedures. However, contact with contaminated surfaces may also play a significant role. In this context, understanding the factors contributing to SARS-CoV-2 persistence on surfaces will enable a more accurate estimation of the risk of contact transmission and inform mitigation strategies. To this end, we have developed a simple mathematical model that can be used to estimate virus decay on nonporous surfaces under a range of conditions and which may be utilized operationally to identify indoor environments in which the virus is most persistent.", "Evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as coronavirus disease 2019 (COVID-19) pandemic: A global health emergency Abstract According to data compiled by researchers at Johns Hopkins University in Baltimore, Maryland, more than two and half million cases of coronavirus disease 2019 (COVID-19), caused by a newly discovered virus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have been confirmed on April 20, 2020 (Nature, 2020b). Since the emergence of this infectious disease in Asia (Wuhan, China) late last year, it has been subsequently span to every continent of the world except Antarctica (Rodr\u00edguez-Morales et al., 2020). Along with a foothold in every country, the current disease pandemic is disrupting practically every aspect of life all over the world. As the outbreak are continuing to evolve, several research activities have been conducted for better understanding the origin, functions, treatments, and preventions of this novel coronavirus. This review will be a summa of the key features of novel coronavirus (nCoV), the virus causing disease 2019 and the present epidemic situation worldwide up to April 20, 2020. It is expected that this record will play an important role to take more preventive measures for overcoming the challenges faced during this current pandemic.", "Lack of SARS-CoV-2 RNA environmental contamination in a tertiary referral hospital for infectious diseases in Northern Italy ", "Coronavirus disinfection in histopathology. The 2019 Coronavirus epidemic, provisionally called 2019-nCoV, was first identified in Wuhan, China, in persons exposed to a seafood or wet market. There is an international push to contain the virus and prevent its spread. It is feasible that potentially infectious samples may be received in histopathology laboratories for diagnosis. This technical note presents disinfection procedures and histotechnology processes that should alleviate the risk of infection to laboratory staff. Using data obtained from similar coronaviruses, e.g. severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), experts are confident that 70% ethanol and 0.1% sodium hypochlorite should inactivate the virus. Formalin fixation and heating samples to 56oC, as used in routine tissue processing, were found to inactivate several coronaviruses and it is believed that 2019-nCoV would be similarly affected.", "Severe Acute Respiratory Syndrome Coronavirus on Hospital Surfaces Background. Health care workers continued to contract severe acute respiratory syndrome (SARS), even after barrier precautions were widely implemented. Methods. We explored the possible contribution of contaminated hospital surfaces to SARS transmission by swabbing surfaces in 2 hospitals and testing the swab samples by reverse-transcriptase polymerase chain reaction (RT-PCR) and viral culture. Results. Twenty-six of 94 swab samples tested positive for viral RNA. Swab samples of respiratory secretions from each of the 4 patients examined tested positive by RT-PCR, as were 12 of 43 swabs from patient rooms and 10 of 47 swabs from other parts of the hospital, including the computer mouses at 2 nursing stations and the handrail of the public elevator. Specimens from areas with patients with SARS in the most infectious phase of illness (days 5\u201315 after onset) were more likely to be RNA positive than were swab specimens from elsewhere (24 of 63 samples vs. 2 of 31 samples; P = .001). All cultures showed no growth. Conclusions. Although the viruses identified may have been noninfectious, health care workers should be aware that SARS coronavirus can contaminate environmental surfaces in the hospital, and fomites should be considered to be a possible mode of transmission of SARS.", "SARS-CoV-2 in the environment: Modes of transmission, early detection and potential role of pollutions Abstract The coronavirus disease 2019 (COVID-19) is spreading globally having a profound effect on lives of millions of people, causing worldwide economic disruption. Curbing the spread of COVID-19 and future pandemics may be accomplished through understanding the environmental context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and adoption of effective detection tools and mitigation policies. This article aims to examine the latest investigations on SARS-CoV-2 plausible environmental transmission modes, employment of wastewater surveillance for early detection of COVID-19, and elucidating the role of solid waste, water, and atmospheric quality on viral infectivity. Transmission of SARS-CoV-2 via faecal-oral or bio-aerosols lacks robust evidence and remains debatable. However, improper disinfection and defected plumbing systems in indoor environments such as hospitals and high-rise towers may facilitate the transport of virus-laden droplets of wastewater causing infection. Clinical and epidemiological studies are needed to present robust evidence that SARS-CoV-2 is transmissible via aerosols, though quantification of virus-laden aerosols at low concentrations presents a challenge. Wastewater surveillance of SARS-CoV-2 can be an effective tool in early detection of outbreak and determination of COVID-19 prevalence within a population, complementing clinical testing and providing decision makers guidance on restricting or relaxing movement. While poor air quality increases susceptibility to diseases, evidence for air pollution impact on COVID-19 infectivity is not available as infections are dynamically changing worldwide. Solid waste generated by households with infected individuals during the lockdown period may facilitate the spread of COVID-19 via fomite transmission route but has received little attention from the scientific community. Water bodies receiving raw sewage may pose risk of infection but this has not been investigated to date. Overall, our understanding of the environmental perspective of SARS-CoV-2 is imperative to detecting outbreak and predicting pandemic severity, allowing us to be equipped with the right tools to curb any future pandemic.", "Operation of ultrasonography services in a dedicated paediatric hospital and a university hospital in Greece under the COVID-19 pandemic Ultrasonography (US) is one of the most common diagnostic imaging tests in children. During the coronavirus disease 2019 (COVID-19) pandemic, it is important to operate with a plan designed to protect health care workers, to prevent transmission of infection from child and parents to another child or an accompanying person in the US suite, and to save valuable protective material and resources. Measures during routine US in children can be challenging both in general hospitals with paediatric units and in dedicated paediatric hospitals. Special considerations include: a) cancellation or rescheduling of unnecessary imaging tests, b) a relevant questionnaire on the request form informing about patient and accompanying person\u2019s symptoms and likely exposure in addition to general triage, c) appropriate patient and parent protective measures, d) recruitment and selection of US machines in different protected areas depending on the possibility or certainty for the infection, e) regular personnel protective measures and personal hand hygiene, f) routine disinfection of probes and adjacent surfaces and g) machine/room deep disinfection, if required. Our purpose is to present the modified US services in children during the COVID-19 pandemic in two hospitals based on the instructions of the national organization of public health in Greece and what is known about the mode of transmission of the virus.", "Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents Currently, the emergence of a novel human coronavirus, SARS-CoV-2, has become a global health concern causing severe respiratory tract infections in humans. Human-to-human transmissions have been described with incubation times between 2-10 days, facilitating its spread via droplets, contaminated hands or surfaces. We therefore reviewed the literature on all available information about the persistence of human and veterinary coronaviruses on inanimate surfaces as well as inactivation strategies with biocidal agents used for chemical disinfection, e.g. in healthcare facilities. The analysis of 22 studies reveals that human coronaviruses such as Severe Acute Respiratory Syndrome (SARS) coronavirus, Middle East Respiratory Syndrome (MERS) coronavirus or endemic human coronaviruses (HCoV) can persist on inanimate surfaces like metal, glass or plastic for up to 9 days, but can be efficiently inactivated by surface disinfection procedures with 62-71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite within 1 minute. Other biocidal agents such as 0.05-0.2% benzalkonium chloride or 0.02% chlorhexidine digluconate are less effective. As no specific therapies are available for SARS-CoV-2, early containment and prevention of further spread will be crucial to stop the ongoing outbreak and to control this novel infectious thread.", "COVID-19 outbreak: succinct advice for dentists and oral healthcare professionals ", "Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals The ongoing outbreak of coronavirus disease 2019 (COVID-19) has spread rapidly on a global scale. Although it is clear that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted through human respiratory droplets and direct contact, the potential for aerosol transmission is poorly understood1-3. Here we investigated the aerodynamic nature of SARS-CoV-2 by measuring viral RNA in aerosols in different areas of two Wuhan hospitals during the outbreak of COVID-19 in February and March 2020. The concentration of SARS-CoV-2 RNA in aerosols that was detected in isolation wards and ventilated patient rooms was very low, but it was higher in the toilet areas used by the patients. Levels of airborne SARS-CoV-2 RNA in the most public areas was undetectable, except in two areas that were prone to crowding; this increase was possibly due to individuals infected with SARS-CoV-2 in the crowd. We found that some medical staff areas initially had high concentrations of viral RNA with aerosol size distributions that showed peaks in the submicrometre and/or supermicrometre regions; however, these levels were reduced to undetectable levels after implementation of rigorous sanitization procedures. Although we have not established the infectivity of the virus detected in these hospital areas, we propose that SARS-CoV-2 may have the potential to be transmitted through aerosols. Our results indicate that room ventilation, open space, sanitization of protective apparel, and proper use and disinfection of toilet areas can effectively limit the concentration of SARS-CoV-2 RNA in aerosols. Future work should explore the infectivity of aerosolized virus.", "Reducing hand recontamination of healthcare workers during COVID-19 ", "Detection of Severe Acute Respiratory Syndrome Coronavirus 2 RNA on Surfaces in Quarantine Rooms We investigated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) environmental contamination in 2 rooms of a quarantine hotel after 2 presymptomatic persons who stayed there were laboratory-confirmed as having coronavirus disease. We detected SARS-CoV-2 RNA on 8 (36%) of 22 surfaces, as well as on the pillow cover, sheet, and duvet cover.", "Rapid Inactivation of SARS-CoV-2 by Silicon Nitride, Copper, and Aluminum Nitride Introduction Viral disease spread by contaminated commonly touched surfaces is a global concern. Silicon nitride, an industrial ceramic that is also used as an implant in spine surgery, has known antibacterial activity. The mechanism of antibacterial action relates to the hydrolytic release of surface disinfectants. It is hypothesized that silicon nitride can also inactivate the coronavirus SARS-CoV-2. Methods SARS-CoV-2 virions were exposed to 15 wt.% aqueous suspensions of silicon nitride, aluminum nitride, and copper particles. The virus was titrated by the TCD50 method using VeroE6/TMPRSS2 cells, while viral RNA was evaluated by real-time RT-PCR. Immunostaining and Raman spectroscopy were used as additional probes to investigate the cellular responses to virions exposed to the respective materials. Results All three tested materials showed >99% viral inactivation at one and ten minutes of exposure. Degradation of viral RNA was also observed with all materials. Immunofluorescence testing showed that silicon nitride-treated virus failed to infect VeroE6/TMPRSS2 cells without damaging them. In contrast, the copper-treated virus suspension severely damaged the cells due to copper ion toxicity. Raman spectroscopy indicated differential biochemical cellular changes due to infection and metal toxicity for two of the three materials tested. Conclusions Silicon nitride successfully inactivated the SARS-CoV-2 in this study. The mechanism of action was the hydrolysis-mediated surface release of nitrogen-containing disinfectants. Both aluminum nitride and copper were also effective in the inactivation of the virus. However, while the former compound affected the cells, the latter compound had a cytopathic effect. Further studies are needed to validate these findings and investigate whether silicon nitride can be incorporated into personal protective equipment and commonly touched surfaces, as a strategy to discourage viral persistence and disease spread.", "Estimation of SARS-CoV-2 emissions from non-symptomatic cases Importance: Cases of the coronavirus disease 2019 (COVID-19) with no or mild symptoms were reported to frequently transmit the disease even without direct contact. The severe acute respiratory syndrome virus (SARS-COV-2) was found at very high concentrations in swab and sputum of such cases. Objective: We aimed to estimate virus release from such cases into different aerosol sizes by normal breathing and coughing, and what exposure can result from this in a room shared with such as case. Data Sources and Model: We combined the size-distribution of exhaled breath aerosols for coughing and normal breathing with viral sputum concentrations as approximation for lung lining liquid to obtain an estimate of emitted virus levels. The resulting emission data fed a single-compartment model of airborne concentrations in a room of 50m3, the size of a small office or medical exam room. Results: The estimated viral load in aerosols emitted by patients while breathing normally was on average 0.34 copies/cm3 and could go up to 11.5 copies/cm3. The corresponding numbers for coughing patients were 10,900 copies/cm3 and 366,000 copies/cm3, respectively, per cough. The resulting concentrations in a room with a coughing emitter were always very high, up to 2.02*10^9 copies/m3. However, also regular breathing aerosol from high emitters was predicted to lead to several thousand copies/m3. Conclusions and Relevance: These very high predicted virus concentrations may provide an explanation why for COVID-19, frequent community transmissions from non-symptomatic cases and also high infection rates in medical staff in hospital settings were reported. Our findings suggest that strict respiratory protection is needed when there is a chance to be in the same room with a patient - whether symptomatic or not - especially if this was for a prolonged time.", "Persistence of infectious SARS-CoV-2 on inert surfaces and hand-mediated transmission. ", "Investigating SARS-CoV-2 surface and air contamination in an acute healthcare setting during the peak of the COVID-19 pandemic in London. BACKGROUND Evaluation of SARS-CoV-2 surface and air contamination during the COVID-19 pandemic in London. METHODS We performed this prospective cross-sectional observational study in a multi-site London hospital. Air and surface samples were collected from seven clinical areas, occupied by patients with COVID-19, and a public area of the hospital. Three or four 1.0 m3 air samples were collected in each area using an active air sampler. Surface samples were collected by swabbing items in the immediate vicinity of each air sample. SARS-CoV-2 was detected by RT-qPCR and viral culture; the limit of detection for culturing SARS-CoV-2 from surfaces was determined. RESULTS Viral RNA was detected on 114/218 (52.3%) of surfaces and 14/31 (38.7%) air samples but no virus was cultured. The proportion of surface samples contaminated with viral RNA varied by item sampled and by clinical area. Viral RNA was detected on surfaces and in air in public areas of the hospital but was more likely to be found in areas immediately occupied by COVID-19 patients than in other areas (67/105 (63.8%) vs. 29/64 (45.3%) (odds ratio 0.5, 95% confidence interval 0.2-0.9, p=0.025, Chi squared test)). The high PCR Ct value for all samples (>30) indicated that the virus would not be culturable. CONCLUSIONS Our findings of extensive viral RNA contamination of surfaces and air across a range of acute healthcare settings in the absence of cultured virus underlines the potential risk from environmental contamination in managing COVID-19, and the need for effective use of PPE, physical distancing, and hand/surface hygiene.", "A new Sephadex\u2122-based method for removing microbicidal and cytotoxic residues when testing antiseptics against viruses: Experiments with a human coronavirus as a model Abstract The relative lack of efficient methods for evaluating antiseptic antiviral activity, together with weaknesses in the existing European Standard (i.e. NF EN 14476+A1), underlines the need to seek a new method which could allow a more precise evaluation of the antiseptic antiviral activity of chemical agents. This protocol is based on an original gel-based filtration method, using \u201cin-house\u201d G-25 and G-10 Sephadex\u2122 columns. This method allows the neutralization of both the activity and the cytotoxicity of a large range of molecules, according to their molecular size, in only 1min. The viral model used was the human coronavirus (HCoV) 229E chosen for (i) its increasing medical interest, (ii) its potential resistance and (iii) its representing enveloped viruses mentioned in the European Standard. First, the protocol was validated and it was demonstrated that it was fully operational for evaluating antiviral antiseptic potentiality and useful to screen potentially antiseptic molecules. Second, chlorhexidine (CHX) and hexamidine (HXM) were assessed for their potential anti-HCoV 229E antiseptic activities. It was demonstrated clearly that (i) HXM had no activity on the HCoV 229E and (ii) CHX showed a moderate anti-HCoV 229E activity but insufficient to be antiseptic.", "High-flow nasal cannula may be no safer than non-invasive positive pressure ventilation for COVID-19 patients ", "Stability of the COVID-19 virus under wet, dry and acidic conditions COVID-19 has become a pandemic and is spreading fast worldwide. The COVID-19 virus is transmitted mainly through respiratory droplets and close contact. However, the fecal-oral transmission of the virus has not been ruled out and it is important to ascertain how acidic condition in the stomach affects the infectivity of the virus. Besides, it is unclear how stable the COVID-19 virus is under dry and wet conditions. In the present study, we have shown that the COVID-19 virus is extremely infectious as manifested by the infection of Vero-E6 cells by one PFU (Plaque Forming Unit) of the virus. We then investigated the stability of the COVID-19 virus in wet, dry and acidic (pH2.2) environments at room temperature. Results showed that the COVID-19 virus could survive for three days in wet and dry environments, but the dry condition is less favorable for the survival of the virus. Our study also demonstrated that the COVID-19 virus at a relative high titer (1.2 x 103 PFU) exhibits a certain degree of tolerance to acidic environment at least for 60 minutes. When the virus titer was \u22641.0 x 103 PFU, acid treatment (pH2.2) for 30 or 60 minute resulted in virus inactivation. It suggests that the virus at a high concentration may survive in the acidic environment of the stomach. The finding of the present study will contribute to the control of the spread of the COVID-19 virus.", "Novel 2019-coronavirus on new year's Eve. An ongoing apocalyptic outbreak of a new virus causing pneumonia-like clusters in Wuhan city, China, has gleamed the world. The outbreak, confirmed on the New Year's Eve 2020, has known no boundaries since then. The number has surpassed that of Severe Acute Respiratory Syndrome (SARS) and Middle East respiratory syndrome (MERS), and is uninterruptedly escalating. Being an RNA virus, it has a propensity to mutate due to the low proofreading capacity of RNA-dependent RNA polymerase. Step-wise mutations have led to the gradual spillover of virus and after crossing the inter-species interface, the virus has adapted itself for a stable human-to-human transmission. The disease caused by severe acute respiratory syndrome coronavirus (CoV)-2 (SARS-CoV-2) can prove deadlier if the so-called 'super-spreading events' emerge with time. Recent research has shown the maximum homology of 99% of SARS-CoV-2 to pangolins associated coronavirus, owing to which these can serve as potential intermediate host. India is responding swiftly to the emergency situation, and the whole of the country is under lockdown since 25 March 2020, to ensure social distancing. All the international flights are padlocked and the travellers are being screened at airports and seaports via thermal sensors, and quarantine for a period of 14 days is recommended. Three hundred and forty-five patients across the country tested positive with six fatalities as of 22 March 2020. No specific anti-CoV drugs are currently available. Patients are being treated with protease drugs are inhibitors, remdesivir, chloroquine, angiotensin-converting enzyme 2 inhibitors, ivermectin, sarilumab and tocilizumab, though none of these is Food and Drug Administration approved and are undergoing trials. Preventive measures such as social distancing, quarantine, cough etiquettes, proper hand washing, cleaning and decontaminating the surfaces are the mainstay for curbing the transmission of this virus. The present review highlights the update of novel SARS-CoV-2 in context to the Indian scenario.", "Survival of aerosolized coronavirus in the ambient air Abstract An inactivation of airborne pathogenic Middle East Respiratory Syndrome (MERS-CoV) virus was investigated under controlled laboratory conditions. Two sets of climatic conditions were used in the experiments; (1) representing common office environment (25\u00b0C and 79% RH) and (2) climatic conditions of the Middle Eastern region where the virus was originated from (38\u00b0C and 24% RH). At the lower temperature, the virus demonstrated high robustness and strong capability to survive with about 63.5% of microorganisms remaining infectious 60min after aerosolisation. Fortunately, virus decay was much stronger for hot and dry air scenario with only 4.7% survival over 60min procedure.", "Airborne route and bad use of ventilation systems as non-negligible factors in SARS-CoV-2 transmission Summary The world is facing a pandemic of unseen proportions caused by a corona virus named SARS-CoV-2 with unprecedent worldwide measures being taken to tackle its contagion. Person-to-person transmission is accepted but WHO only considers aerosol transmission when procedures or support treatments that produce aerosol are performed. However, transmission mechanisms are not fully understood and there is evidence for an airborne route to be considered as the virus remains viable in aerosols for at least 3h and that mask usage was the best intervention to prevent infection. Heating, Ventilating and Air Conditioning Systems (HVAC) are used as a primary infection disease control measure. However, they may contribute to the transmission/spreading of airborne diseases as proposed in the past for SARS. The authors believe that airborne transmission is possible and that HVAC systems when not adequately used may contribute to the transmission of the virus, as suggested by descriptions of from Japan, Germany, and the Diamond Princess Cruise Ship. Previous SARS outbreaks reported at Amoy Gardens, Emergency Rooms and Hotels, for example, also suggested airborne transmission. Further studies are warranted to confirm our hypotheses but the assumption of such way of transmission would cause a major shift in measures recommended to prevent infection such as the disseminated use of masks and structural changes to hospital and other facilities HVAC systems.", "Severe acute respiratory syndrome coronavirus 2 (the cause of COVID 19) in different types of clinical specimens and implications for cytopathology specimen: An editorial review with recommendations ", "Contact lens practice in the time of COVID-19 ", "SARS-CoV-2 RNA detection of hospital isolation wards hygiene monitoring during the Coronavirus Disease 2019 outbreak in a Chinese hospital Abstract Objectives The aim of this paper was to monitor the presence of SARS-Cov-2 among hospital environment surfaces, sewage, and personal protective equipment (PPE) of staffs in isolation wards in the First Affiliated Hospital of Zhejiang University, China. Methods Surfaces of objects were routinely wiped with 1000mg/L chlorine containing disinfectant. Air and sewage disinfection was proceeded routinely and strictly. Hospital environmental surfaces and PPE of staffs in isolation wards were sampled using swabs. The sewage from various inlet and outlets were sampled. The respiratory and stool specimens of patients were collected. The respiratory specimens of staffs in the isolation wards were also sampled once a week. Quantitative real-time reverse transcription PCR (qRT-PCR) methods were used to confirm the existence of SARS-Cov-2 RNA. Viral culture was done for the samples positive for SARS-Cov-2 RNA. Results During the study period, 33 laboratory-confirmed patients were hospitalized in isolation wards in the hospital. None of SARS-Cov-2 RNA was detected among the 36 objects surface samples and 9 staffs PPE samples in isolation wards. Though the 3 sewage samples from the inlet of preprocessing disinfection pool were positive for SARS-CoV-2 RNA and the sample from the outlet of preprocessing disinfection pool was weakly positive, the sewage sample from the outlet of the last disinfection pool was negative. All of the 5 sewage samples from various points were negative by viral culture of SARS-Cov-2. None of the respiratory specimens of staffs in the isolation wards were positive. Conclusions Though SARS-Cov-2 RNA of the sewage samples were positive from inlets of the sewage disinfection pool and negative from the outlet of the last sewage disinfection pool, no viable virus was detected by culture. The monitoring data in this study suggested that the strict disinfection and hand hygiene could decrease the hospital-associated COVID-19 infection risk of the staffs in isolation wards.", "Biocides and Novel Antimicrobial Agents for the Mitigation of Coronaviruses In December, 2019, a highly infectious and rapidly spreading new pneumonia of unknown cause was reported to the Chinese WHO Country Office. A cluster of these cases had appeared in Wuhan, a city in the Hubei Province of China. These infections were found to be caused by a new coronavirus which was given the name \u201c2019 novel coronavirus\u201d (2019-nCoV). It was later renamed \u201csevere acute respiratory syndrome coronavirus 2,\u201d or SARS-CoV-2 by the International Committee on Taxonomy of Viruses on February 11, 2020. It was named SARS-CoV-2 due to its close genetic similarity to the coronavirus which caused the SARS outbreak in 2002 (SARS-CoV-1). The aim of this review is to provide information, primarily to the food industry, regarding a range of biocides effective in eliminating or reducing the presence of coronaviruses from fomites, skin, oral/nasal mucosa, air, and food contact surfaces. As several EPA approved sanitizers against SARS-CoV-2 are commonly used by food processors, these compounds are primarily discussed as much of the industry already has them on site and is familiar with their application and use. Specifically, we focused on the effects of alcohols, povidone iodine, quaternary ammonium compounds, hydrogen peroxide, sodium hypochlorite (NaOCl), peroxyacetic acid (PAA), chlorine dioxide, ozone, ultraviolet light, metals, and plant-based antimicrobials. This review highlights the differences in the resistance or susceptibility of different strains of coronaviruses, or similar viruses, to these antimicrobial agents.", "Effect of Environmental Conditions on SARS-CoV-2 Stability in Human Nasal Mucus and Sputum. We found that environmental conditions affect the stability of severe acute respiratory syndrome coronavirus 2 in nasal mucus and sputum. The virus is more stable at low-temperature and low-humidity conditions, whereas warmer temperature and higher humidity shortened half-life. Although infectious virus was undetectable after 48 hours, viral RNA remained detectable for 7 days.", "[Technologies and requirements of protection and disinfection in key places during COVID-19 outbreak]. COVID-19 a new respiratory infectious disease, has become an important public health problem. Inappropriate protection and disinfection measures are potential risk factors of transmission and outbreak of COVID-19 in key places. This theme issue is concerned with the prevention and control of COVID-19. Comprehensive measures and suggestions for protection and disinfection are put forward from perspectives of functional areas in key places, such as hotels, mobile cabin hospitals, passenger transport stations and public transport facilities, environment and facilities, personal protection, operation management system, etc., so as to provide technical support for the prevention and control of new respiratory infectious diseases.", "Extensive Viable Middle East Respiratory Syndrome (MERS) Coronavirus Contamination in Air and Surrounding Environment in MERS Isolation Wards Background. The largest outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) outside the Middle East occurred in South Korea in 2015 and resulted in 186 laboratory-confirmed infections, including 36 (19%) deaths. Some hospitals were considered epicenters of infection and voluntarily shut down most of their operations after nearly half of all transmissions occurred in hospital settings. However, the ways that MERS-CoV is transmitted in healthcare settings are not well defined. Methods. We explored the possible contribution of contaminated hospital air and surfaces to MERS transmission by collecting air and swabbing environmental surfaces in 2 hospitals treating MERS-CoV patients. The samples were tested by viral culture with reverse transcription polymerase chain reaction (RT-PCR) and immunofluorescence assay (IFA) using MERS-CoV Spike antibody, and electron microscopy (EM). Results. The presence of MERS-CoV was confirmed by RT-PCR of viral cultures of 4 of 7 air samples from 2 patients' rooms, 1 patient's restroom, and 1 common corridor. In addition, MERS-CoV was detected in 15 of 68 surface swabs by viral cultures. IFA on the cultures of the air and swab samples revealed the presence of MERS-CoV. EM images also revealed intact particles of MERS-CoV in viral cultures of the air and swab samples. Conclusions. These data provide experimental evidence for extensive viable MERS-CoV contamination of the air and surrounding materials in MERS outbreak units. Thus, our findings call for epidemiologic investigation of the possible scenarios for contact and airborne transmission, and raise concern regarding the adequacy of current infection control procedures.", "Human Coronavirus 229E Remains Infectious on Common Touch Surface Materials The evolution of new and reemerging historic virulent strains of respiratory viruses from animal reservoirs is a significant threat to human health. Inefficient human-to-human transmission of zoonotic strains may initially limit the spread of transmission, but an infection may be contracted by touching contaminated surfaces. Enveloped viruses are often susceptible to environmental stresses, but the human coronaviruses responsible for severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) have recently caused increasing concern of contact transmission during outbreaks. We report here that pathogenic human coronavirus 229E remained infectious in a human lung cell culture model following at least 5 days of persistence on a range of common nonbiocidal surface materials, including polytetrafluoroethylene (Teflon; PTFE), polyvinyl chloride (PVC), ceramic tiles, glass, silicone rubber, and stainless steel. We have shown previously that noroviruses are destroyed on copper alloy surfaces. In this new study, human coronavirus 229E was rapidly inactivated on a range of copper alloys (within a few minutes for simulated fingertip contamination) and Cu/Zn brasses were very effective at lower copper concentration. Exposure to copper destroyed the viral genomes and irreversibly affected virus morphology, including disintegration of envelope and dispersal of surface spikes. Cu(I) and Cu(II) moieties were responsible for the inactivation, which was enhanced by reactive oxygen species generation on alloy surfaces, resulting in even faster inactivation than was seen with nonenveloped viruses on copper. Consequently, copper alloy surfaces could be employed in communal areas and at any mass gatherings to help reduce transmission of respiratory viruses from contaminated surfaces and protect the public health.", "Modelling the thermal inactivation of viruses from the Coronaviridae family in suspensions or on surfaces with various relative humidities. Temperature and relative humidity are major factors determining virus inactivation in the environment. This article reviews inactivation data of coronaviruses on surfaces and in liquids from published studies and develops secondary models to predict coronaviruses inactivation as a function of temperature and relative humidity. A total of 102 D-values (time to obtain a log10 reduction of virus infectivity), including values for SARS-CoV-2, were collected from 26 published studies. The values obtained from the different coronaviruses and studies were found to be generally consistent. Five different models were fitted to the global dataset of D-values. The most appropriate model considered temperature and relative humidity. A spreadsheet predicting the inactivation of coronaviruses and the associated uncertainty is presented and can be used to predict virus inactivation for untested temperatures, time points or new coronavirus strains.", "Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore The coronavirus disease 2019 (COVID-19) outbreak has been designated a public health emergency of international concern. To prepare for a pandemic, hospitals need a strategy to manage their space, staff, and supplies so that optimum care is provided to patients. In addition, infection prevention measures need to be implemented to reduce in-hospital transmission. In the operating room, these preparations involve multiple stakeholders and can present a significant challenge. Here, we describe the outbreak response measures of the anesthetic department staffing the largest (1,700-bed) academic tertiary level acute care hospital in Singapore (Singapore General Hospital) and a smaller regional hospital (Sengkang General Hospital). These include engineering controls such as identification and preparation of an isolation operating room, administrative measures such as modification of workflow and processes, introduction of personal protective equipment for staff, and formulation of clinical guidelines for anesthetic management. Simulation was valuable in evaluating the feasibility of new operating room set-ups or workflow. We also discuss how the hierarchy of controls can be used as a framework to plan the necessary measures during each phase of a pandemic, and review the evidence for the measures taken. These containment measures are necessary to optimize the quality of care provided to COVID-19 patients and to reduce the risk of viral transmission to other patients or healthcare workers.", "A study of the probable transmission routes of MERS\u2010CoV during the first hospital outbreak in the Republic of Korea Infections caused by the Middle East respiratory syndrome coronavirus (MERS\u2010CoV) are a serious health issue due to their prevalence and associated mortality. However, the transmission routes of the virus remain unclear, and thus, the current recommended control strategies are not evidence based. In this study, we investigated the transmission routes of MERS\u2010CoV during the first nosocomial outbreak in the Republic of Korea in May 2015 using a multi\u2010agent modeling framework. We identified seven hypothesized transmission modes based on the three main transmission routes (long\u2010range airborne, close contact, and fomite). The infection risks for each hypothesis were estimated using the multi\u2010agent modeling framework. Least\u2010squares fitting was conducted to compare the distribution of the predicted infection risk in the various scenarios with that of the reported attack rates and to identify the hypotheses with the best fit. In the scenarios in which the index patient was a super\u2010spreader, our model simulations suggested that MERS\u2010CoV probably spread via the long\u2010range airborne route. However, it is possible that the index patient shed an average viral load comparable to the loads reported in the literature, and that transmission occurred via a combined long\u2010range airborne and close contact route.", "MERS-CoV as an emerging respiratory illness: A review of prevention methods Abstract Introduction Middle East Respiratory Coronavirus Virus (MERS-CoV) first emerged from Saudi Arabia in 2012 and has since been recognized as a significant human respiratory pathogen on a global level. Methods In this narrative review, we focus on the prevention of MERS-CoV. We searched PubMed, Embase, Cochrane, Scopus, and Google Scholar, using the following terms: \u2018MERS\u2019, \u2018MERS-CoV\u2019, \u2018Middle East respiratory syndrome\u2019 in combination with \u2018prevention\u2019 or \u2018infection control\u2019. We also reviewed the references of each article to further include other studies or reports not identified by the search. Results As of Nov 2019, a total of 2468 laboratory-confirmed cases of MERS-CoV were diagnosed mostly from Middle Eastern regions with a mortality rate of at least 35%. A major outbreak that occurred outside the Middle East (in South Korea) and infections reported from 27 countries. MERS-CoV has gained recognition as a pathogen of global significance. Prevention of MERS-CoV infection is a global public health priority. Healthcare facility transmission and by extension community transmission, the main amplifier of persistent outbreaks, can be prevented through early identification and isolation of infected humans. While MERS-CoV vaccine studies were initially hindered by multiple challenges, recent vaccine development for MERS-CoV is showing promise. Conclusions The main factors leading to sustainability of MERS-CoV infection in high risk courtiers is healthcare facility transmission. MERS-CoV transmission in healthcare facility mainly results from laps in infection control measures and late isolation of suspected cases. Preventive measures for MERS-CoV include disease control in camels, prevention of camel to human transmission.", "Corrigendum to \"Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents\" [J Hosp Infect 104 (2020) 246-251] ", "Infections nosocomiales \u00e0 coronavirus humains chez le nouveau-n\u00e9 1 Travail financ\u00e9 en partie par la Soci\u00e9t\u00e9 fran\u00e7aise de p\u00e9diatrie (bourse de DEA), le minist\u00e8re de la sant\u00e9 (PHRC 97) et le CCLIN\u2013Ouest. A. Gagneur est boursier de la Soci\u00e9t\u00e9 fran\u00e7aise de p\u00e9diatrie. R\u00e9sum\u00e9 Les coronavirus humains sont des virus envelopp\u00e9s \u00e0 ARN de la famille des Coronaviridae avec deux s\u00e9rogroupes identifi\u00e9s : 229-E et OC-43. Ces virus poss\u00e8dent le plus grand ARN viral connu. Ce g\u00e9nome est un ARN simple brin positif associ\u00e9 \u00e0 une prot\u00e9ine phosphoryl\u00e9e de la nucl\u00e9ocapside, la prot\u00e9ine N. L\u2019enveloppe des coronavirus humains contient deux ou trois glycoprot\u00e9ines membranaires : S ou spike protein, M ou prot\u00e9ine de membrane et HE ou h\u00e9magglutine-est\u00e9rase. Le r\u00f4le pathog\u00e8ne de ces virus est mal connu en raison des difficult\u00e9s diagnostiques. Cependant la mise au point de l\u2019immunofluorescence avec anticorps monoclonaux et des techniques d\u2019amplification g\u00e9nique permet de nouvelles recherches \u00e9pid\u00e9miologiques. Les coronavirus peuvent survivre jusqu\u2019\u00e0 six jours en suspension et trois heures apr\u00e8s s\u00e9chage, ce qui sugg\u00e8re un r\u00f4le nosocomial potentiel. Deux \u00e9tudes prospectives r\u00e9alis\u00e9es dans une unit\u00e9 de r\u00e9animation n\u00e9onatale et p\u00e9diatrique ont r\u00e9v\u00e9l\u00e9 une relation significative entre l\u2019existence de pr\u00e9l\u00e8vement nasopharyng\u00e9s positifs et la survenue de sympt\u00f4mes respiratoires. Des pr\u00e9l\u00e8vements positifs chez le personnel sugg\u00e8rent une contamination patient-personnel ou personnel\u2013patient. En raison de leur survie possible sur les surfaces et de l\u2019efficacit\u00e9 d\u00e9montr\u00e9e des agents d\u00e9sinfectants, des mesures universelles de pr\u00e9vention associant lavage des mains et d\u00e9sinfection des surfaces peuvent \u00eatre propos\u00e9es. Abstract Human coronaviruses, with two known serogroups named 229-E and OC-43, are enveloped positive-stranded RNA viruses. The large RNA is surrounded by a nucleoprotein (protein N). The envelop contains 2 or 3 glycoproteins: spike protein (or protein S), matrix protein (or protein M) and a hemagglutinin (or protein HE). Their pathogen role remains unclear because their isolation is difficult. Reliable and rapid methods as immunofluorescence with monoclonal antibodies and reverse transcription-polymerase chain reaction allow new researches on epidemiology. Human coronaviruses can survive for as long as 6 days in suspension and 3 hours after drying on surfaces, suggesting that they could be a source of hospital-acquired infections. Two prospective studies conducted in a neonatal and paediatric intensive care unit demonstrated a significant association of coronavirus-positive naso-pharyngal samples with respiratory illness in hospitalised preterm neonates. Positive samples from staff suggested either a patient-to-staff or a staff-to-patient transmission. No cross-infection were observed from community-acquired respiratory-syncitial virus or influenza-infected children to neonates. Universal precautions with hand washing and surface desinfection could be proposed to prevent coronavirus transmission.", "Detection of SARS-CoV-2 on high-touch surfaces in a clinical microbiology laboratory ", "Generic aspects of the airborne spread of human pathogens indoors and emerging air decontamination technologies Indoor air can be an important vehicle for a variety of human pathogens. This review provides examples of airborne transmission of infectious agents from experimental and field studies and discusses how airborne pathogens can contaminate other parts of the environment to give rise to secondary vehicles leading air-surface-air nexus with possible transmission to susceptible hosts. The following groups of human pathogens are covered because of their known or potential airborne spread: vegetative bacteria (staphylococci and legionellae), fungi (Aspergillus, Penicillium, and Cladosporium spp and Stachybotrys chartarum), enteric viruses (noro- and rotaviruses), respiratory viruses (influenza and coronaviruses), mycobacteria (tuberculous and nontuberculous), and bacterial spore formers (Clostridium difficile and Bacillus anthracis). An overview of methods for experimentally generating and recovering airborne human pathogens is included, along with a discussion of factors that influence microbial survival in indoor air. Available guidelines from the U.S. Environmental Protection Agency and other global regulatory bodies for the study of airborne pathogens are critically reviewed with particular reference to microbial surrogates that are recommended. Recent developments in experimental facilities to contaminate indoor air with microbial aerosols are presented, along with emerging technologies to decontaminate indoor air under field-relevant conditions. Furthermore, the role that air decontamination may play in reducing the contamination of environmental surfaces and its combined impact on interrupting the risk of pathogen spread in both domestic and institutional settings is discussed.", "Survival of human coronaviruses 229E and OC43 in suspension and after drying onsurfaces: a possible source ofhospital-acquired infections Abstract Strains OC43 and 229E of human coronaviruses (HCoV) cause one-third of common colds and hospital-acquired upper respiratory tract HCoV infections have been reported in premature newborns. To evaluate possible sources of infection, virus survival was studied in aqueous suspensions and on absorptive and non-absorptive surfaces representative of a hospital environment. Virus susceptibility to chemical disinfection with standard products was also characterized. Virus survived in saline solution for as long as six days but less in culture medium, with or without added cells. After drying, HCoV-229E infectivity was still detectable after 3h on various surfaces (aluminum, sterile latex surgical gloves, sterile sponges) but HCoV-OC43 survived 1h or less. Of the various chemical disinfectants tested, Proviodine\u00ae reduced the virus infectious titre by at least 50%. This study suggests that surfaces and suspensions can be considered as possible sources of contamination that may lead to hospital-acquired infections with HCoV and should be appropriately disinfected.", "Hygienic hand antiseptics: Should they not have activity and label claims against viruses? Abstract Enteric and respiratory viruses are among the most frequent causes of human infections, and hands play an important role in the spread of these and many other viral diseases. Regular and proper hand hygiene by caregivers and food handlers in particular is essential to decontaminate hands and potentially interrupt such spread. What would be considered a proper decontamination of hands? Handwashing with regular soap and water is often considered sufficient, but what of hygienic handwash and handrub antiseptic products? Are they more effective? The evidence suggests that some clearly are. Activity against bacteria may not reflect the ability of hygienic hand antiseptics to deal with viruses, especially those that are nonenveloped. In spite of the acknowledged importance of hands as vehicles for viruses, there is a lack of suitable regulatory mechanism for handwash or handrub products to make claims of efficacy against viruses. This is in contrast with the ability of general-purpose disinfectants to make antiviral claims, although transmission of viruses from surfaces other than those of reusable medical devices may play only a minor role in virus transmission. This review discusses the (1) recent information on the relative importance of viruses as human pathogens, particularly those causing enteric and respiratory infections; (2) the survival of relevant viruses on human hands in comparison with common gram-negative and gram-positive bacteria; (3) the potential of hands to transfer or receive such contamination on casual contact; (4) role of hands in the spread of viruses; (5) the potential of hygienic measures to eliminate viruses from contaminated hands; (6) relative merits of available protocols to assess the activity of hygienic hand antiseptics against viruses; and (7) factors considered crucial in any tests to assess the activity of hygienic hand antiseptics against viruses. In addition, this review proposes surrogate viruses in such testing and discusses issues for additional consideration by researchers, manufacturers, end-users, and regulators. (Am J Infect Control 2002;30:355-72)", "Statistical Explorations and Univariate Timeseries Analysis on COVID-19 Datasets to Understand the Trend of Disease Spreading and Death \u201cSevere Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)\u201d, the novel coronavirus, is responsible for the ongoing worldwide pandemic. \u201cWorld Health Organization (WHO)\u201d assigned an \u201cInternational Classification of Diseases (ICD)\u201d code\u2014\u201cCOVID-19\u201d-as the name of the new disease. Coronaviruses are generally transferred by people and many diverse species of animals, including birds and mammals such as cattle, camels, cats, and bats. Infrequently, the coronavirus can be transferred from animals to humans, and then propagate among people, such as with \u201cMiddle East Respiratory Syndrome (MERS-CoV)\u201d, \u201cSevere Acute Respiratory Syndrome (SARS-CoV)\u201d, and now with this new virus, namely \u201cSARS-CoV-2\u201d, or human coronavirus. Its rapid spreading has sent billions of people into lockdown as health services struggle to cope up. The COVID-19 outbreak comes along with an exponential growth of new infections, as well as a growing death count. A major goal to limit the further exponential spreading is to slow down the transmission rate, which is denoted by a \u201cspread factor (f)\u201d, and we proposed an algorithm in this study for analyzing the same. This paper addresses the potential of data science to assess the risk factors correlated with COVID-19, after analyzing existing datasets available in \u201courworldindata.org (Oxford University database)\u201d, and newly simulated datasets, following the analysis of different univariate \u201cLong Short Term Memory (LSTM)\u201d models for forecasting new cases and resulting deaths. The result shows that vanilla, stacked, and bidirectional LSTM models outperformed multilayer LSTM models. Besides, we discuss the findings related to the statistical analysis on simulated datasets. For correlation analysis, we included features, such as external temperature, rainfall, sunshine, population, infected cases, death, country, population, area, and population density of the past three months\u2014January, February, and March in 2020. For univariate timeseries forecasting using LSTM, we used datasets from 1 January 2020, to 22 April 2020.", "Evaluation of Ultraviolet-C Light for Rapid Decontamination of Airport Security Bins in the Era of SARS-CoV-2 BACKGROUND: Contaminated surfaces are a potential source for spread of respiratory viruses including SARS-CoV-2. Ultraviolet-C (UV-C) light is effective against RNA and DNA viruses and could be useful for decontamination of high-touch fomites that are shared by multiple users. METHODS: A modification of the American Society for Testing and Materials standard quantitative carrier disk test method (ASTM E-2197-11) was used to examine the effectiveness of UV-C light for rapid decontamination of plastic airport security bins inoculated at 3 sites with methicillin-resistant Staphylococcus aureus (MRSA) and bacteriophages MS2, PhiX174, and Phi6, an enveloped RNA virus used as a surrogate for coronaviruses. Reductions of 3 log(10) on inoculated plastic bins were considered effective for decontamination. RESULTS: UV-C light administered as 10-, 20-, or 30-second cycles in proximity to a plastic bin reduced contamination on each of the test sites, including vertical and horizontal surfaces. The 30-second cycle met criteria for decontamination of all 3 test sites for all the test organisms except bacteriophage MS2 which was reduced by greater than 2 log(10) PFU at each site. CONCLUSIONS: UV-C light is an attractive technology for rapid decontamination of airport security bins. Further work is needed to evaluate the utility of UV-C light in real-world settings and to develop methods to provide automated movement of bins through a UV-C decontamination process.", "Protective measures for COVID-19 for healthcare providers and laboratory personnel In the COVID-19 pandemic, which affects the whole world, healthcare professionals (HCP) are at high risk of transmission due to their direct contact with patients with COVID-19. Therefore, how to ensure the triage of the patient with acute respiratory symptoms should be determined in advance, the contact distance should be arranged to be at least 2 m, COVID-19 suspect or diagnosed patient should be instructed to wear a surgical mask. During the care of these patients, HCP should wear their personal protective equipment (PPE) in accordance with the procedure and should not neglect hand hygiene. The samples of the patient with known or suspected COVID-19, patient should also be known to be risky in terms of contamination, and a risk assessment should be performed for the procedures to be performed in laboratories. The PPE should be used in accordance with the procedure to be performed. The protection of the HCP, who sacrifice at the risk of life, is possible only by complying with infection control and precautions.", "SARS-CoV-2 RNA contamination of inanimate surfaces and virus viability in a health care emergency unit OBJECTIVES: To detect possible SARS-CoV-2 RNA contamination of inanimate surfaces in areas at high risk of aerosol formation by patients with COVID-19. METHODS: Sampling was performed in the emergency unit and the sub-intensive care ward. SARS-CoV-2 RNA was extracted from swabbed surfaces and objects and subjected to real-time reverse transcriptase\u2013polymerase chain reaction (RT-PCR) targeting RNA-dependent RNA polymerase and E genes. Virus isolation from positive samples was attempted in vitro on Vero E6 cells. RESULTS: Twenty-six samples were collected and only two were positive for low-level SARS-CoV-2 RNA, both collected on the external surface of Continuous Positive Airway Pressure (CPAP) helmets. All transport media were inoculated onto susceptible cells, however, none induced a cytopathic effect on day 7 of culture. CONCLUSIONS: Even though daily contact with inanimate surfaces and patient fomites in contaminated areas may be a medium of infection, our data obtained in real life conditions suggest that it might be less extensive than hitherto recognized.", "COVID-19 pandemic: Impact of lockdown, contact and non-contact transmissions on infection dynamics COVID-19 coronavirus pandemic has virtually locked down the entire world of human population, and through its rapid and unstoppable spread COVID-19 has essentially compartmentalised the population merely into susceptible, exposed, infected and recovered classes. Adapting the classical epidemic modelling framework, two distinct routes of COVID-19 transmission are incorporated into a model: (a) direct person-to-person contact transmission, and (b) indirect airborne and fomites-driven transmission. The indirect non-contact transmission route needs to explored in models of COVID-19 spread, because evidences show that this route of transmission is entirely viable with hugely uncertain level of relative contribution. This theoretical study based on model simulations demonstrates the following: (1) Not incorporating indirect transmission route in the model leads to underestimation of the basic reproduction number, and hence will impact on the COVID-19 mitigation decisions; (2) Lockdown measures can suppress the primary infection peak, but will lead to a secondary peak whose relative strength and time of occurrence depend on the success and duration of the lockdown measures; (3) To make lockdown effective, a considerable level of reduction in both contact and non-contact transmission rates over a long period is required; (4) To bring down the infection cases below any hypothetical health-care capacity, reduction of non-contact transmission rate is key, and hence active measures should be taken to reduce non-contact transmission (e.g., extensive uses of areal and aerosol disinfectant in public spaces to improve contaminated surfaces and air); (5) Any premature withdrawal of lockdown following the sign of a brief retracement in the infection cases can backfire, and can lead to a quicker, sharper and higher secondary peak, due to reactivation of the two transmission routes. Based on these results, this study recommends that any exit policy from lockdown, should take into account the level of transmission reduction in both routes, the absolute scale of which will vary among countries depending on their health-service capacity, but should be computed using accurate time-series data on infection cases and transmission rates.", "Role of the Microbial Burden in the Acquisition and Control of Healthcare Associated Infections: The Utility of Solid Copper Surfaces For more than a century, healthcare has been challenged to keep environmental surfaces clean to control microbes and improve patient outcomes. However despite an annual cost exceeding ten billion dollars cleaning with disinfection has done little to reduce the incidence of healthcare-associated infections (HAI). This chapter will review the scientific evidence delineating the role that the environment and healthcare workers play in the acquisition and movement of the microbes implicated in HAI and how through controlling the microbial burden of the built clinical environment it is possible to mitigate the rate of HAI acquisition. Specifically evidence demonstrating the effectiveness of solid copper surfaces for its ability to continuously limit the concentration of bacteria found on surfaces and objects within the built environment will be reviewed in concert with a discussion of how through the mitigation of the environmental burden copper surfaces are able to concomitantly reduce the incidence of HAI. Insights provided by this chapter are intended to facilitate an understanding and importance of the need to use a comprehensive or systems based approach to fight healthcare associated infections.", "Preventive and Control Measures for the \u00ef\u00bb\u00bfCoronavirus Pandemic in Clinical Dentistry A severe public health crisis has been declared worldwide since coronavirus disease 2019 (COVID-19) was classified as a pandemic of acute respiratory infectious disease by the World Health Organisation (WHO). China has taken strict measures to curb the spread of the disease to save lives, and has managed to control the outbreak. COVID-19 is mainly transmitted through respiratory droplets and close physical contact, so it is challenging to prevent nosocomial infection and possible spread during dental treatment. Since the initial phase of the COVID-19 outbreak, a disease prevention and control strategy based on the new concept of population risk classification and rational use of personal protective equipment has been implemented by the Peking University Hospital of Stomatology. Nosocomial infection prevention and control concepts and measures relating to dental diagnosis and treatment are critically checked in the hospital. Our experiences in handling this situation are shared here and may have wide-ranging implications for infection prevention and control (IPC) for COVID-19 in dental practices worldwide.", "COVID-19 Surface Persistence: A Recent Data Summary and Its Importance for Medical and Dental Settings Recently, due to the coronavirus pandemic, many guidelines and anti-contagion strategies continue to report unclear information about the persistence of coronavirus disease 2019 (COVID-19) in the environment. This certainly generates insecurity and fear in people, with an important psychological component that is not to be underestimated at this stage of the pandemic. The purpose of this article is to highlight all the sources currently present in the literature concerning the persistence of the different coronaviruses in the environment as well as in medical and dental settings. As this was a current study, there are still not many sources in the literature, and scientific strategies are moving towards therapy and diagnosis, rather than knowing the characteristics of the virus. Such an article could be an aid to summarize virus features and formulate new guidelines and anti-spread strategies.", "How should data on airborne transmission of SARS-CoV-2 change occupational health guidelines? ", "Action and problems related to the COVID-19 outbreak in India ", "A rate equation approach to model the denaturation or replication behavior of the SARS coronavirus As a newly emerging virus, little is known about the SARS coronavirus, whose outbreak has brought away several hundred people\u2019s lives over the world in the year of 2003 and is seriously imperiling the human health. Revealing the denaturation and replication mechanisms of SARS coronavirus has great importance for successfully fighting SARS. However, experiments related to SARS coronavirus are extremely dangerous and therefore restricted only to certain specific labs with high safety standard. Clearly, predicting the behaviors of SARS coronavirus in a wide variety of environmental conditions, which are not easily accessible, are thus critically necessary. In this study, we proposed to quantify the survival time of SARS coronavirus either in vitro or in vivo, through introducing thermal rate process models established from the well-known Arrhenius law. The complex physical and chemical behaviors of the SARS coronavirus can then be attributed to its activation energy, frequency factor, damage function as well as the surrounding environmental conditions. Based on the first data on stability and resistance of SARS coronavirus measured by members of WHO laboratory network, the rate coefficients involved in the above equations were estimated for the first time. Predictions on the survival time of SARS coronavirus in different temperature scale were then performed. It was found theoretically that, such survival time falls in an extremely wide range, say from several seconds in high temperature to an almost infinitely long time in a low temperature environment, which has already or is being supported by the currently available tests data. Applications of the present theory to interpret several existing phenomena were presented and their implementations in developing new technical ways for SARS prevention and clinical therapy were discussed. Uncertainties involved in the theoretical models were also analyzed and predicted. Parametric studies were performed to test the effects of the rate coefficients to the survival time of SARS coronavirus. Some important factors, which can significantly vary the denaturation or replication process of SARS coronavirus were pointed out. Through regulating the parameters involved in the equation, certain potential therapies either through drug delivery or engineering approach to treat the SARS disease can possibly be established. Extension of the present model for further studies was also suggested. This study opens a new theoretical way for probing into the complex behaviors of SARS coronavirus. Modellierung der Denaturierung oder Repliziryng von SARS-Korona-Viren Zusammenfassung Der Kenntnisstand \u00fcber die Eigenschaften des in 2003 neu aufgetretenen SARS Korona Virus, der einige Hundert Menschenleben gekostet hat, ist relativ gering. Die Ermittlung des Denaturierungs- und Replizierungsmechanismuses des SARS Virus ist f\u00fcr seine Bek\u00e4mpfung von hoher Bedeutung. Experimentelle Untersuchungen an diesem extrem gef\u00e4hrlichen Virus d\u00fcrfen nur durch Laboratorien mit einem hohen Sicherheitsstandard erfolgen. Die Vorhersage des Verhaltens des SARS Virus in unterschiedlichen Umgebungsbedingungen ist dabei erforderlich. In der vorliegenden Studie wird die \u00fcberlebensdauer des Virus unter Labor- und realen Bedingungen durch Anwendung der bekannten Arrhenius-Beziehung f\u00fcr temperaturabh\u00e4ngige Vorg\u00e4nge ermittelt. Das physikalische und chemische Verhalten des SARS Virus wird anhand der zugrundeliegenden Modell- Parameter beschrieben. Basierend auf den ersten Messungen von Mitgliedern des WHO-laboratory-network \u00fcber die Stabilit\u00e4t und Widerstandsf\u00e4higkeit des Virus wurden erstmalig die Geschwindigkeitskoeffizienten des Berechnungsmodells bestimmt. Vorhersagen der \u00dcberlebensdauer des SARS-Virus unter unterschiedlichen Temperaturbedingungen wurden ausgef\u00fchrt. Das sich hieraus ergebende, sehr unterschiedliche Ausma\u00df der \u00dcberlebensf\u00e4higkeit in Abh\u00e4ngigkeit der Umgebungstemperatur ist durch den Vergleich mit verf\u00fcgbaren experimentellen Ergebnissen best\u00e4tigt worden. Die Anwendung der vorgestellten Modellierung zur Interpretation realer Ph\u00e4nomene und zur Entwicklung technischer Ma\u00dfnahmen zur Vorbeugung und klinischen Therapierung von SARS wird diskutiert. Der Einflu\u00df von Unsicherheiten des Modells wird analysiert und abgesch\u00e4tzt. Parametrische Studien sind durchgef\u00fchrt worden, um den Einflu\u00df der Geschwindigkeitskoeffizienten auf die \u00dcberlebensdauer des SARS Virus darzustellen. Einige wichtige Einflu\u00dfgr\u00f6\u00dfen auf die Denaturierung und Replikationsf\u00e4higkeit des SARS Virus werden aufgezeigt. Durch eine Variation der Modellparameter kann die potentielle Wirksamkeit medikament\u00f6ser oder physikalischer Therapien abgesch\u00e4tzt werden. Erweiterungsm\u00f6glichkeiten des vorgestellten Modells werden vorgeschlagen. Die vorliegende Studie erm\u00f6glicht neue, theoretische Vorgehensweisen zur Untersuchung des komplexen Verhaltensmusters des SARS Virus.", "Enteric involvement of coronaviruses: is faecal\u2013oral transmission of SARS-CoV-2 possible? ", "Changes in the Clinical Practice of Ophthalmology during the Coronavirus Disease 2019 (COVID-19) Outbreak: an Experience from Daegu, Korea ", "Likelihood of survival of coronavirus in a respiratory droplet deposited on a solid surface We predict and analyze the drying time of respiratory droplets from a COVID-19 infected subject, which is a crucial time to infect another subject. Drying of the droplet is predicted by using a diffusion-limited evaporation model for a sessile droplet placed on a partially wetted surface with a pinned contact line. The variation in droplet volume, contact angle, ambient temperature, and humidity are considered. We analyze the chances of the survival of the virus present in the droplet based on the lifetime of the droplets under several conditions and find that the chances of the survival of the virus are strongly affected by each of these parameters. The magnitude of shear stress inside the droplet computed using the model is not large enough to obliterate the virus. We also explore the relationship between the drying time of a droplet and the growth rate of the spread of COVID-19 in five different cities and find that they are weakly correlated.", "Non-pharmaceutical behavioural measures for droplet-borne biological hazards prevention: Health-EDRM for COVID-19 (SARS-CoV-2) pandemic Introduction: Non-pharmaceutical interventions to facilitate response to the COVID-19 pandemic, a disease caused by novel coronavirus SARS-CoV-2, are urgently needed. Using the WHO health emergency and disaster risk management (health-EDRM) framework, behavioural measures for droplet-borne communicable disease, with their enabling and limiting factors at various implementation levels were evaluated. Sources of data: Keyword search was conducted in PubMed, Google Scholar, Embase, Medline, Science Direct, WHO and CDC online publication database. Using OCEBM as review criteria, 105 English-language articles, with ten bottom-up, non-pharmaceutical prevention measures, published between January 2000 and May 2020 were identified and examined. Areas of Agreement: Evidence-guided behavioural measures against COVID-19 transmission for global at-risk communities are identified. Area of Concern: Strong evidence-based systematic behavioural studies for COVID-19 prevention are lacking. Growing points: Very limited research publications are available for non-pharmaceutical interventions to facilitate pandemic response. Areas timely for research: Research with strong implementation feasibility that targets resource-poor settings with low baseline Health-EDRM capacity is urgently need.", "Effectiveness of hand hygiene and provision of information in preventing influenza cases requiring hospitalization Abstract Background The objective of the study was to investigate the effectiveness of non-pharmacological interventions in preventing cases of influenza requiring hospitalization. Methods We performed a multicenter case-control study in 36 hospitals, in 2010 in Spain. Hospitalized influenza cases confirmed by reverse-transcription polymerase chain reaction and three matched controls (two hospital and one community control) per case were selected. The use of non-pharmacological measures seven days before the onset of symptoms (frequency of hand washing, use of alcohol-based hand sanitizers and handwashing after touching contaminated surfaces) was collected. Results We studied 813 cases hospitalized for influenza and 2274 controls. The frequency of hand washing 5-10 times (adjusted odds ratio [aOR]=0.65) and >10 times (aOR=0.59) and handwashing after contact with contaminated surfaces (aOR=0.65) were protective factors and were dose-responsive (p<0.001). Alcohol-based hand sanitizers were associated with marginal benefits (aOR=0.82). Conclusions Frequent handwashing should be recommended to prevent influenza cases requiring hospitalization.", "The COVID-19 pandemic: Important considerations for contact lens practitioners A novel coronavirus (CoV), the Severe Acute Respiratory Syndrome Coronavirus - 2 (SARS-CoV-2), results in the coronavirus disease 2019 (COVID-19). As information concerning the COVID-19 disease continues to evolve, patients look to their eye care practitioners for accurate eye health guidance. There is currently no evidence to suggest an increased risk of contracting COVID-19 through contact lens (CL) wear compared to spectacle lens wear and no scientific evidence that wearing standard prescription spectacles provides protection against COVID-19 or other viral transmissions. During the pandemic there will potentially be significant changes in access to local eyecare. Thus, it is imperative CL wearers are reminded of the steps they should follow to minimise their risk of complications, to reduce their need to leave isolation and seek care. Management of adverse events should be retained within optometric systems if possible, to minimise the impact on the wider healthcare service, which will be stretched. Optimal CL care behaviours should be the same as those under normal circumstances, which include appropriate hand washing (thoroughly with soap and water) and drying (with paper towels) before both CL application and removal. Daily CL cleaning and correct case care for reusable CL should be followed according to appropriate guidelines, and CL exposure to water must be avoided. Where the availability of local clinical care is restricted, practitioners should consider advising patients to reduce or eliminate sleeping in their CL (where patients have the appropriate knowledge about correct daily care and access to suitable lens-care products) or consider the option of moving patients to daily disposable lenses (where patients have appropriate lens supplies available). Patients should also avoid touching their face, including their eyes, nose and mouth, with unwashed hands and avoid CL wear altogether if unwell (particularly with any cold or flu-like symptoms).", "epic2: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England Executive Summary National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were commissioned by the Department of Health (DH) and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were published in January 2001.1 These guidelines describe the precautions healthcare workers should take in three areas: standard principles for preventing HCAI, which include hospital environmental hygiene, hand hygiene, the use of personal protective equipment, and the safe use and disposal of sharps; preventing infections associated with the use of short-term indwelling urethral catheters; and preventing infections associated with central venous catheters. The evidence for these guidelines was identified by multiple systematic reviews of experimental and non-experimental research and expert opinion as reflected in systematically identified professional, national and international guidelines, which were formally assessed by a validated appraisal process. In 2003, we developed complementary national guidelines for preventing HCAI in primary and community care on behalf of the National Collaborating Centre for Nursing and Supportive Care (National Institute for Healthand Clinical Excellence).2 A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective in preventing HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. Consequently, the DH commissioned a review of new evidence published following the last systematic reviews. We have now updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the original epic guidelines published in 2001 remain robust, relevant and appropriate but that adjustments need to be made to some guideline recommendations following a synopsis of the evidence underpinning the guidelines. These updated national guidelines (epic2) provide comprehensive recommendations for preventing HCAI in hospitals and other acute care settings based on the best currently available evidence. Because this is not always the best possible evidence, we have included a suggested agenda for further research in each section of the guidelines. National evidence-based guidelines are broad principles of best practice which need to be integrated into local practice guidelines. To monitor implementation, we have suggested key audit criteria for each section of recommendations. Clinically effective infection prevention and control practice is an essential feature of protecting patients. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and the risk of patients acquiring an infection during episodes of healthcare in NHS hospitals in England can be minimised.", "Prevention of Infection and Disruption of the Pathogen Transfer Chain in Elective Surgery The COVID-19 pandemic has caused us all to stop our normal activities and consider how we can safely return to caring for our patients. There are many common practices (such as an increased use of personal protective equipment) which we are all familiar with that can be easily incorporated into our daily routines. Other actions, such as cleaning more surfaces with solutions such as dilute povidone iodine or changing the air filtration systems used within operating room theaters, may require more extensive efforts on our behalf. In this article, we have attempted to highlight some of the changes that arthroplasty surgeons may need to instigate when we are able to resume elective joint arthroplasty procedures in an effort to disrupt the chain of pathogen transfer.", "Extended use of face masks during the COVID-19 pandemic - Thermal conditioning and spray-on surface disinfection The current COVID-19 pandemic has resulted in globally constrained supplies for face masks and personal protective equipment (PPE). Production capacity is limited in many countries and the future course of the pandemic will likely continue with shortages for high quality masks and PPE in the foreseeable future. Hence, expectations are that mask reuse, extended wear and similar approaches will enhance the availability of personal protective measures. Repeated thermal disinfection could be an important option and likely easier implemented in some situations, at least on the small scale, than UV illumination, irradiation or hydrogen peroxide vapor exposure. An overview on thermal responses and ongoing filtration performance of multiple face mask types is provided. Most masks have adequate material properties to survive a few cycles (i.e. 30 min disinfection steps) of thermal exposure in the 75 \u00b0C regime. Some are more easily affected, as seen by the fusing of plastic liner or warping, given that preferred conditioning temperatures are near the softening point for some of the plastics and fibers used in these masks. Hence adequate temperature control is equally important. As guidance, disinfectants sprayed via dilute solutions maintain a surface presence over extended time at 25 and 37 \u00b0C. Some spray-on alcohol-based solutions containing disinfectants were gently applied to the top surface of masks. Neither moderate thermal aging (less than 24 h at 80 and 95 \u00b0C) nor gentle application of surface disinfectant sprays resulted in measurable loss of mask filter performance. Subject to bio-medical concurrence (additional checks for virus kill efficiency) and the use of low risk non-toxic disinfectants, such strategies, either individually or combined, by offering additional anti-viral properties or short term refreshing, may complement reuse options of professional masks or the now ubiquitous custom-made face masks with their often unknown filtration effectiveness.", "Survival of Respiratory Viruses on Fresh Produce In addition to enteric viruses of fecal origin, emerging zoonotic viruses such as respiratory coronaviruses and influenza viruses may potentially be transmitted via contaminated foods. The goal of this study was to determine the recovery efficiencies and the survival of two respiratory viruses, namely, adenovirus 2 (Ad2) and coronavirus 229E (CoV229E), on fresh produce in comparison to the enteric poliovirus 1 (PV1). Adenovirus was recovered with efficiencies of 56.5, 31.8, and 34.8 % from lettuce, strawberries, and raspberries, respectively. Coronavirus was recovered from lettuce with an efficiency of 19.6 % yet could not be recovered from strawberries. Poliovirus was recovered with efficiencies of 76.7 % from lettuce, but only 0.06 % from strawberries. For comparison purposes, the survival of Ad2, CoV229E, and PV1 was determined for periods up to 10 days on produce. The enteric PV1 survived better than both respiratory viruses on lettuce and strawberries, with only \u22641.03 log(10) reductions after 10 days of storage at 4 \u00b0C compared to CoV229E not being recovered after 4 days on lettuce and reductions of 1.97 log(10) and 2.38 log(10) of Ad2 on lettuce and strawberries, respectively, after 10 days. Nevertheless, these respiratory viruses were able to survive for at least several days on produce. There is therefore the potential for transfer to the hands and subsequently to the mucosa via rubbing the eyes or nose. In addition, some respiratory coronaviruses (e.g., severe acute respiratory syndrome coronavirus) and adenoviruses are also capable of replication in the gut and there is thus some potential for acquisition through the consumption of contaminated produce.", "How long does Coronavirus survive on different surfaces? Dental practices now need to be more vigilant than ever and pay extra attention to hygiene in the surgery Hospitals are currently operating an hourly total clean policy and it would be prudent for dental practices to look to operate something similar to reduce the possibility of viral transmission The Government is encouraging people to stay at home and maintain social distancing during the pandemic However, key workers must go to work, use public transport and mix with high risk people People also need to go to supermarkets to get their groceries The surfaces in these public places are likely to be contaminated;these germs can then be brought into homes or dental practices", "Perioperative COVID-19 Defense: An Evidence-Based Approach for Optimization of Infection Control and Operating Room Management We describe an evidence-based approach for optimization of infection control and operating room management during the Coronavirus Disease 2019 (COVID-19) pandemic. Confirmed modes of viral transmission are primarily, but not exclusively, contact with contaminated environmental surfaces and aerosolization. Evidence-based improvement strategies for attenuation of residual environmental contamination involve a combination of deep cleaning with surface disinfectants and ultraviolet light (UV-C). (1) Place alcohol-based hand rubs on the intravenous (IV) pole to the left of the provider. Double glove during induction. (2) Place a wire basket lined with a zip closure plastic bag on the IV pole to the right of the provider. Place all contaminated instruments in the bag (eg, laryngoscope blades and handles) and close. Designate and maintain clean and dirty areas. After induction of anesthesia, wipe down all equipment and surfaces with disinfection wipes that contain a quaternary ammonium compound and alcohol. Use a top-down cleaning sequence adequate to reduce bioburden. Treat operating rooms using UV-C. (3) Decolonize patients using preprocedural chlorhexidine wipes, 2 doses of nasal povidone-iodine within 1 hour of incision, and chlorhexidine mouth rinse. (4) Create a closed lumen IV system and use hub disinfection. (5) Provide data feedback by surveillance of Enterococcus, Staphylococcusaureus, Klebsiella, Acinetobacter, Pseudomonas, and Enterobacter spp. (ESKAPE)transmission. (6) To reduce the use of surgical masks and to reduce potential COVID-19 exposure, use relatively long (eg, 12hours) staff shifts. If there are 8 essential cases to be done (each lasting 1\u20132 hours), the ideal solution is to have 2 teams complete the 8 cases, not 8 first case starts. (7) Do 1 case in each operating room daily, with terminal cleaning after each case including UV-C or equivalent. (8) Do not have patients go into a large, pooled phase I postanesthesia care unit because of the risk of contaminating facility at large along with many staff. Instead, have most patients recover in the room where they had surgery as is done routinely in Japan. These 8 programmatic recommendations stand on a substantial body of empirical evidence characterizing the epidemiology of perioperative transmission and infection development made possible by support from the Anesthesia Patient Safety Foundation (APSF).", "Environmental chemistry is most relevant to study coronavirus pandemics ", "Performing dermoscopy in the COVID\u201019 pandemic ", "Sustainability of SARS-CoV-2 in aerosols: Should we worry about airborne transmission? ", "Relevance of SARS-CoV-2 in food safety and food hygiene: potential preventive measures, suggestions and nanotechnological approaches Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is easily transmitted from person to person, which has fueled the ongoing pandemic. Governments in different countries have taken drastic actions such as complete lockdown. However, little attention has been paid to food safety and its potential linkage with the coronavirus disease (COVID-19) pandemic. SARS-CoV-2 spread from staff to food products or food surfaces is conceivable. At least, instead of consuming unpackaged or uncovered foods, consumption of boiled or canned foods processed at high temperatures should be preferred. Before consumption, consumers should clean the surface of canned foods. In addition to recommending or enforcing simple precautions, such as using masks, governments must conduct mandatory SARS-CoV-2 tests regularly and intermittently for personnel who handle food materials or supporting materials (e.g., plastic pouches). Local markets, such as those in Wuhan, which sell live animals and exotic foods for consumption, are a concern. Trade of exotic or wild animals, unhygienic marketplace conditions, and not cooking at high temperatures ought to be prohibited. The consumption of vitamins, minerals, and other food-derived compounds such as omega fatty acids is a prudent way to improve the performance of the immune system. In addition, nano-encapsulated materials with controlled release properties may be useful in protecting food products and packaging from SARS-CoV-2 contamination.", "Detection of Novel Coronavirus on the Surface of Environmental Materials Contaminated by COVID-19 Patients in the Republic of Korea This study aimed to determine the presence of SARS-CoV-2 on surfaces frequently touched by COVID-19 patients, and assess the scope of contamination and transmissibility in facilities where the outbreaks occurred. In the course of this epidemiological investigation, a total of 80 environmental specimens were collected from 6 hospitals (68 specimens) and 2 \u201cmass facilities\u201d (6 specimens from a rehabilitation center and 6 specimens from an apartment building complex). Specific reverse transcriptase-polymerase chain reaction targeting of RNA-dependent RNA polymerase, and envelope genes, were used to identify the presence of this novel coronavirus. The 68 specimens from 6 hospitals (A, B, C, D, E, and G), where prior disinfection/cleaning had been performed before environmental sampling, tested negative for SARS-CoV-2. However, 2 out of 12 specimens (16.7%) from 2 \u201cmass facilities\u201d (F and H), where prior disinfection/cleaning had not taken place, were positive for SARS-CoV-2 RNA polymerase, and envelope genes. These results suggest that prompt disinfection and cleaning of potentially contaminated surfaces is an effective infection control measure. By inactivating SARS-CoV-2 with disinfection/cleaning the infectivity and transmission of the virus is blocked. This investigation of environmental sampling may help in the understanding of risk assessment of the COVID-19 outbreak in \u201cmass facilities\u201d and provide guidance in using effective disinfectants on contaminated surfaces.", "The antiviral action of common household disinfectants and antiseptics against murine hepatitis virus, a potential surrogate for SARS coronavirus BACKGROUND: The 2003 outbreak of severe acute respiratory syndrome (SARS) infected over 8000 people and killed 774. Transmission of SARS occurred through direct and indirect contact and large droplet nuclei. The World Health Organization recommended the use of household disinfectants, which have not been previously tested against SARS coronavirus (SARS-CoV), to disinfect potentially contaminated environmental surfaces. There is a need for a surrogate test system given the limited availability of the SARS-CoV for testing and biosafety requirements necessary to safely handle it. In this study, the antiviral activity of standard household products was assayed against murine hepatitis virus (MHV), as a potential surrogate for SARS-CoV. METHODS: A surface test method, which involves drying an amount of virus on a surface and then applying the product for a specific contact time, was used to determine the virucidal activity. The virus titers and log reductions were determined by the Reed and Muench tissue culture infective dose (TCID)(50) end point method. RESULTS: When tested as directed, common household disinfectants or antiseptics, containing either 0.050% of triclosan, 0.12% of PCMX, 0.21% of sodium hypochlorite, 0.23% of pine oil, or 0.10% of a quaternary compound with 79% of ethanol, demonstrated a 3-log reduction or better against MHV without any virus recovered in a 30-second contact time. CONCLUSION: Common household disinfectants and antiseptics were effective at inactivating MHV, a possible surrogate for SARS-CoV, from surfaces when used as directed. In an outbreak caused by novel agents, it is important to know the effectiveness of disinfectants and antiseptics to prevent or reduce the possibility of human-to-human transmission via surfaces.", "Potential role of inanimate surfaces for the spread of coronaviruses and their inactivation with disinfectant agents Summary The novel human coronavirus SARS-CoV-2 has become a global health concern causing severe respiratory tract infections in humans. Human-to-human transmissions have been described, probably via droplets but possibly also via contaminated hands or surfaces. In a recent review on the persistence of human and veterinary coronaviruses on inanimate surfaces it was shown that human coronaviruses such as Severe Acute Respiratory Syndrome (SARS) coronavirus, Middle East Respiratory Syndrome (MERS) coronavirus or endemic human coronaviruses (HCoV) can persist on inanimate surfaces like metal, glass or plastic for up to 9 days. Some disinfectant agents effectively reduce coronavirus infectivity within 1 minute such 62%\u201371% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite. Other compounds such as 0.05%\u20130.2% benzalkonium chloride or 0.02% chlorhexidine digluconate are less effective. An effective surface disinfection may help to ensure an early containment and prevention of further viral spread.", "Isothermal evaporation rate of deposited liquid aerosols and the SARS-CoV-2 coronavirus survival It is shown that the evaporation rate of a liquid sample containing the culture of coronavirus affects its survival on a substrate. Possible mechanisms of such influence can be due to the appearance of large, about 140 bar, non comprehensive capillary pressures and the associated dynamic forces during the movement of the evaporation front in a sample with the virus. A simulation of isothermal evaporation of a thin liquid sample based on the Stefan problem was performed. The comparison of simulation data and recent experiments on the coronavirus survival on various surfaces showed that the rate of isothermal evaporation of aqueous samples, which is higher for heat-conducting materials, correlates well with the lifetime of the coronavirus on these surfaces.", "COVID-19 in dental settings ", "2019 Novel Coronavirus (COVID-19) Pandemic: Built Environment Considerations To Reduce Transmission With the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that results in coronavirus disease 2019 (COVID-19), corporate entities, federal, state, county, and city governments, universities, school districts, places of worship, prisons, health care facilities, assisted living organizations, daycares, homeowners, and other building owners and occupants have an opportunity to reduce the potential for transmission through built environment (BE)-mediated pathways. Over the last decade, substantial research into the presence, abundance, diversity, function, and transmission of microbes in the BE has taken place and revealed common pathogen exchange pathways and mechanisms. In this paper, we synthesize this microbiology of the BE research and the known information about SARS-CoV-2 to provide actionable and achievable guidance to BE decision makers, building operators, and all indoor occupants attempting to minimize infectious disease transmission through environmentally mediated pathways. We believe this information is useful to corporate and public administrators and individuals responsible for building operations and environmental services in their decision-making process about the degree and duration of social-distancing measures during viral epidemics and pandemics. Author Video: An author video summary of this article is available.", "Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals. The ongoing COVID-19 outbreak has spread rapidly on a global scale. While the transmission of SARS-CoV-2 via human respiratory droplets and direct contact is clear, the potential for aerosol transmission is poorly understood1-3. This study investigated the aerodynamic nature of SARS-CoV-2 by measuring viral RNA in aerosols in different areas of two Wuhan hospitals during the COVID-19 outbreak in February and March 2020. The concentration of SARS-CoV-2 RNA in aerosols detected in isolation wards and ventilated patient rooms was very low, but it was elevated in the patients' toilet areas. Levels of airborne SARS-CoV-2 RNA in the majority of public areas was undetectable except in two areas prone to crowding, possibly due to infected carriers in the crowd. We found that some medical staff areas initially had high concentrations of viral RNA with aerosol size distributions showing peaks in submicrometre and/or supermicrometre regions, but these levels were reduced to undetectable levels after implementation of rigorous sanitization procedures. Although we have not established the infectivity of the virus detected in these hospital areas, we propose that SARS-CoV-2 may have the potential to be transmitted via aerosols. Our results indicate that room ventilation, open space, sanitization of protective apparel, and proper use and disinfection of toilet areas can effectively limit the concentration of SARS-CoV-2 RNA in aerosols. Future work should explore the infectivity of aerosolized virus.", "The daily impact of COVID-19 in gastroenterology A new strain of coronavirus, called SARS-CoV-2, emerged in Wuhan, China, in December 2019, probably originating from a wild-animal contamination. Since then, the situation rapidly evolved from a cluster of patients with pneumonia, to a regional epidemic and now to a pandemic called COrona VIrus Disease 2019 (COVID-19). This evolution is related to the peculiar modes of transmission of the disease and to the globalization and lifestyle of the 21st century that created the perfect scenario for virus spread. Even though research has not evidenced particular susceptibility of inflammatory bowel disease (IBD) patients to SARS-CoV-2 infection, immunosuppressive and immunomodulatory treatments were considered potential risk factors. In this context, initiating treatments with these agents should be cautiously weighted and regular ongoing treatments shall be continued, while the dose of corticosteroids should be reduced whenever possible. Due to the increased risk of contamination, elective endoscopic procedures and surgeries should be postponed and IBD online appointments shall be considered. IBD patients shall also follow the recommendations provided to the general population, such as minimization of contact with infected or suspected patients and to wash hands frequently. In the absence of effective treatments and vaccines, this pandemic can only be controlled through prevention of SARS-CoV-2 transmission with the main objectives of providing patients the best healthcare possible and reduce mortality.", "An Environmental and Health Perspective for COVID-19 Outbreak: Meteorology and Air Quality Influence, Sewage Epidemiology Indicator, Hospitals Disinfection, Drug Therapies and Recommendations Abstract This Opinion Paper wishes to provide a summary of recent findings and solutions for a better understanding of the environmental and health problems associated with COVID-19. The list of topics covered is large: meteorology and air quality factors with correlation number of infections, sewage waters as a way to reveal the scale of COVID-19 outbreak, current hospital disinfection procedures and new eco-friendly technologies and list of drug therapies recommend waiting for the desired vaccine to come. During the last two months we did notice an increase in the scientific literature regarding COVID-19 with a partial vision of this problem. The current Opinion Paper is one of the first attempts, to my understanding, to summarize and integrate environmental and human health aspects related to the monitoring, fate and treatment solutions for COVID-19. That being said I believe that this Opinion Paper can serve as multipurpose document, not only for scientists of different disciplines but for social media and citizens in general.", "Analysis of the Worldwide Corona Virus (COVID-19) Pandemic Trend;A Modelling Study to Predict Its Spread Objective: The Coronavirus (COVID-19) has advanced into 197 countries and territories leaving behind a total of 372,757 confirmed cases and 16231 deaths. Methods: One the basis of WHO situation reports data of COVID-19 along with daily official reports from the Japan, China and the Korea we modeled the spread of COVID19 by using the Successive Approximation Method. We defined the two state of data to find the mean ratio (\u03b7) of the present cases count to the sum of previous and present cases. This ratio further predicts the future state of COVID-19 pandemic. Results: The mean ratio (\u03b7) of expected cases were found 0.485, while the mean ratio for deaths was found to be 0.49. We calculated worldwide expected lower bound value for confirmed cases 247007 cases with maximum limit of 1667719 cases and minimum deaths count 8660 with upper limit of 117397 deaths in next 30 days. While in the case of Iran, a large increase in the number of deaths are expected in the upcoming 30 days with lower bound value of 1140 deaths and maximum value of 598478 deaths. Interpretation: Iran whole population is on risk.", "Environmental and Decontamination Issues for Human Coronaviruses and Their Potential Surrogates Pandemic COVID\u201019 gives ample reason to generally review coronavirus (CoV) containment. For establishing some preliminary views on decontamination and disinfection, surrogate CoVs have commonly been assessed. This review serves to examine the existing science in regards to CoV containment generically and then to translate these findings into timely applications for COVID\u201019. There is widespread dissemination of CoVs in the immediate patient environment, and CoVs can potentially be spread via respiratory secretions, urine, and stool. Interpretations of the spread however must consider whether studies examine for viral RNA, virus viability by culture, or both. Pre\u2010symptomatic, asymptomatic, and post\u2010fourteen day virus excretion from patients may complicate the epidemiology. Whereas droplet spread is accepted, there continues to be controversy over the extent of possible airborne spread and especially now for SARS\u2010CoV\u20102. CoVs are stable in body secretions and sewage at reduced temperatures. In addition to temperature, dryness or relative humidity, initial viral burden, concomitant presence of bioburden, and the type of surface can all affect stability. Generalizing, CoVs can be susceptible to radiation, temperature extremes, pH extremes, peroxides, halogens, aldehydes, many solvents, and several alcohols. Whereas detergent surfactants can have some direct activity, these agents are better used as complements to a complex disinfectant solution. Disinfectants with multiple agents and adverse pH are more likely to be best active at higher water temperatures. Real\u2010life assessments should be encouraged with working dilutions. The use of decontamination and disinfection should be balanced with considerations of patient and caregiver safety. Processes should also be balanced with considerations for other potential pathogens that must be targeted. Given some CoV differences and given that surrogate testing provides experimental correlates at best, direct assessments with SARS\u2010CoV, MERS\u2010CoV, and SARS\u2010CoV\u20102 are required. This article is protected by copyright. All rights reserved.", "Stability and inactivation of SARS coronavirus The SARS-coronavirus (SARS-CoV) is a newly emerged, highly pathogenic agent that caused over 8,000 human infections with nearly 800 deaths between November 2002 and September 2003. While direct person-to-person transmission via respiratory droplets accounted for most cases, other modes have not been ruled out. Faecal shedding is common and prolonged and has caused an outbreak in Hong Kong. We studied the stability of SARS-CoV under different conditions, both in suspension and dried on surfaces, in comparison with other human-pathogenic viruses, including human coronavirus HCoV-229E. In suspension, HCoV-229E gradually lost its infectivity completely while SARS-CoV retained its infectivity for up to 9 days; in the dried state, survival times were 24 h versus 6 days. Thermal inactivation at 56\u00b0C was highly effective in the absence of protein, reducing the virus titre to below detectability; however, the addition of 20% protein exerted a protective effect resulting in residual infectivity. If protein-containing solutions are to be inactivated, heat treatment at 60\u00b0C for at least 30 min must be used. Different fixation procedures, e.g. for the preparation of immunofluorescence slides, as well as chemical means of virus inactivation commonly used in hospital and laboratory settings were generally found to be effective. Our investigations confirm that it is possible to care for SARS patients and to conduct laboratory scientific studies on SARS-CoV safely. Nevertheless, the agent\u2019s tenacity is considerably higher than that of HCoV-229E, and should SARS re-emerge, increased efforts need to be devoted to questions of environmental hygiene.", "Stability of human metapneumovirus and human coronavirus NL63 on medical instruments and in the patient environment ", "Countermeasures against novel coronavirus in dental clinics The cause of acute respiratory disease first reported in December 2019 in Wuhan City, Hubei Province, China, was a coronavirus called \"SARS-CoV-2\", which quickly spread throughout the world In Japan, 8,116 people, including cruise ship passengers and crew, have been infected (as of 10:30 a m , April 13), and the number of infected people is rapidly increasing (Table 1) Notably, the basal reproduction number (infectivity) of this infection is estimated R0 2 0-2 5 [Report of the WHO-China Joint Mission on CoronavirusDisease 2019 (February 16-24, 2020)], which is slightly higher than the usual influenza (measles: 12-18, rubella: 5-7, influenza/Spanish flu: 2-3) In addition to droplet and contact infections, aerosol infections have been pointed out as possible routes of infection Coronaviruses can survive on metal, glass, and plastic surfaces for up to 9 days at room temperature, and have been found to infect health care workers who are supposed to be on the defensive In particular, the risk of coronavirus exposure among dentists is the most serious in all industries What should the dental office do about this infection? In this issue, we introduce a special part of this series, \"Emergency Contribution: Countermeasures for novel Coronavirus Infection in Dental Clinics", "Self-disinfecting surfaces and infection control Abstract According to World Health Organization, every year in the European Union, 4 million patients acquire a healthcare associated infection. Even though some microorganisms represent no threat to healthy people, hospitals harbor different levels of immunocompetent individuals, namely patients receiving immunosuppressors, with previous infections, or those with extremes of age (young children and elderly), requiring the implementation of effective control measures. Public spaces have also been found an important source of infectious disease outbreaks due to poor or none infection control measures applied. In both places, surfaces play a major role on microorganisms\u2019 propagation, yet they are very often neglected, with very few guidelines about efficient cleaning measures and microbiological assessment available. To overcome surface contamination problems, new strategies are being designed to limit the microorganisms\u2019 ability to survive over surfaces and materials. Surface modification and/or functionalization to prevent contamination is a hot-topic of research and several different approaches have been developed lately. Surfaces with anti-adhesive properties, with incorporated antimicrobial substances or modified with biological active metals are some of the strategies recently proposed. This review intends to summarize the problems associated with contaminated surfaces and their importance on infection spreading, and to present some of the strategies developed to prevent this public health problem, namely some already being commercialized.", "Ammonia as an In Situ Sanitizer: Influence of Virus Genome Type on Inactivation. UNLABELLED Treatment of human excreta and animal manure (HEAM) is key in controlling the spread of persistent enteric pathogens, such as viruses. The extent of virus inactivation during HEAM storage and treatment appears to vary with virus genome type, although the reasons for this variability are not clear. Here, we investigated the inactivation of viruses of different genome types under conditions representative of HEAM storage or mesophilic digestion. The goals were to characterize the influence of HEAM solution conditions on inactivation and to determine the potential mechanisms involved. Specifically, eight viruses representing the four viral genome types (single-stranded RNA [ssRNA], double-stranded RNA [dsRNA], single-stranded DNA [ssDNA], and double-stranded DNA [dsDNA]) were exposed to synthetic solutions with well-controlled temperature (20 to 35\u00b0C), pH (8 to 9), and ammonia (NH3) concentrations (0 to 40 mmol liter(-1)). DNA and dsRNA viruses were considerably more resistant than ssRNA viruses, resulting in up to 1,000-fold-longer treatment times to reach a 4-log inactivation. The apparently slower inactivation of DNA viruses was rationalized by the higher stability of DNA than that of ssRNA in HEAM. Pushing the system toward harsher pH (>9) and temperature (>35\u00b0C) conditions, such as those encountered in thermophilic digestion and alkaline treatments, led to more consistent inactivation kinetics among ssRNA and other viruses. This suggests that the dependence of inactivation on genome type disappeared in favor of protein-mediated inactivation mechanisms common to all viruses. Finally, we recommend the use of MS2 as a conservative indicator to assess the inactivation of ssRNA viruses and the stable \u03a6X174 or dsDNA phages as indicators for persistent viruses. IMPORTANCE Viruses are among the most environmentally persistent pathogens. They can be present in high concentrations in human excreta and animal manure (HEAM). Therefore, appropriate treatment of HEAM is important prior to its reuse or discharge into the environment. Here, we investigated the factors that determine the persistence of viruses in HEAM, and we determined the main mechanisms that lead to their inactivation. Unlike other organisms, viruses can have four different genome types (double- or single-stranded RNA or DNA), and the viruses studied herein represent all four types. Genome type appeared to be the major determinant for persistence. Single-stranded RNA viruses are the most labile, because this genome type is susceptible to degradation in HEAM. In contrast, the other genome types are more stable; therefore, inactivation is slower and mainly driven by the degradation of viral proteins. Overall, this study allows us to better understand the behavior of viruses in HEAM.", "Viral survival How long do viruses like cold, flu and coronavirus survive outside the body? What factors affect this?", "Obstetricians on the Coronavirus Disease 2019 (COVID-19) Front Lines and the Confusing World of Personal Protective Equipment As health care systems struggle to maintain adequate supplies of personal protective equipment, there is confusion and anxiety among obstetricians and others about how to best protect themselves, their coworkers, and their patients. Although use of personal protective equipment is a critical strategy to protect health care personnel from coronavirus disease 2019 (COVID-19), other strategies also need to be implemented on labor and delivery units to reduce the risk of health care\u2013associated transmission, including screening of all pregnant women who present for care (case identification), placing a mask on and rapidly isolating ill pregnant women, and minimizing the number of personnel who enter the room of an ill patient (physical distancing). Although the mechanism of transmission of COVID-19 is not known with certainty, current evidence suggests that COVID-19 is transmitted primarily through respiratory droplets. Therefore, strict adherence to hand hygiene and consistent use of recommended personal protective equipment are cornerstones for reducing transmission. In addition, it is critical that health care professionals receive training on and practice correct donning (putting on) and doffing (removing) of personal protective equipment and avoid touching their faces as well as their facial protection to minimize self-contamination.", "Presence of SARS-CoV-2 RNA in isolation ward environment 28 days after exposure Recent studies have reported that surfaces and objects in the rooms of infected patients that are frequently touched by both medical staff and patients could be contaminated with SARS-CoV-2. In December 2019, Wuhan China suffered the earliest from this COVID-19 pandemic, and we took that opportunity to investigate whether the SARS-CoV-2 RNA exists in the ward environment after a long time from exposure. We found that on the 28th day following the discharge of COVID-19 patients, SARS-CoV-2 RNA could still be detected on the surfaces of pagers and in drawers in the isolation wards. Thorough disinfection of the ward environment was subsequently performed, after which these surfaces in the isolation wards tested negative for the presence of SARS-CoV-2 RNA. The findings remind us that the contaminated environment in the wards may become potential infectious resources and that despite a long time from exposure, the thorough disinfection in the COVID-10 units after is still necessary.", "Sustainability of Coronavirus on different surfaces COVID-19 is the name of the disease supposedly manifested in December 2019 from Wuhan, because of virus named as SARS-CoV-2. Now this disease has spread to almost all other parts of the world. COVID-19 pandemic has various reasons for its dramatic worldwide increase. Here, we have studied Coronavirus sustainability on various surfaces. Various disinfectants and their roles are discussed from the available literature. The infection capabilities of SARS-CoV-1 and SARS-CoV-2 for different materials are discussed and finally studies infection decay for SARS-CoV-1 and SARS-CoV-2.", "15 Cleaning and decontamination of the healthcare environment Abstract: Evidence is accumulating for the role of cleaning in controlling hospital infections. Hospital pathogens such as meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), norovirus, multi-resistant Gram-negative bacilli and Clostridium difficile persist in the healthcare environment for considerable lengths of time. Cleaning with both detergent and disinfectant-based regimens help control these pathogens in both routine and outbreak situations. The most important transmission risk comes from organisms on frequently handled items because hand contact with a contaminated site could deliver a pathogen to a patient. Cleaning practices should be tailored to clinical risk, near-patient areas and hand-touch-sites and scientifically evaluated for all surfaces and equipment in today\u2019s hospitals.", "Stability of SARS-CoV-2 in different environmental conditions ", "Coronaviruses widespread on nonliving surfaces: important questions and promising answers. The world is facing, while writing this review, a global pandemic due to one of the types of the coronaviruses (i.e., COVID-19), which is a new virus. Among the most important reasons for the transmission of infection between humans is the presence of this virus active on the surfaces and materials. Here, we addressed important questions such as do coronaviruses remain active on the inanimate surfaces? Do the types of inanimate surfaces affect the activity of coronaviruses? What are the most suitable ingredients that used to inactivate viruses? This review article addressed many of the works that were done in the previous periods on the survival of many viruses from the coronaviruses family on various surfaces such as steel, glass, plastic, Teflon, ceramic tiles, silicon rubber and stainless steel copper alloys, Al surface, sterile sponges, surgical gloves and sterile latex. The impacts of environmental conditions such as temperature and humidity were presented and discussed. The most important active ingredients that can deactivate viruses on the surfaces were reported here. We hope that these active ingredients will have the same effect on COVID-19.", "Persistence of Bacteriophage Phi 6 on Porous and Non-Porous Surfaces; Potential for use as Ebola or Coronavirus Surrogate The infection of healthcare workers during the 2013 -2016 Ebola outbreak raised concerns about fomite transmission. In the wake of the Coronavirus Disease 2019 (COVID-19) pandemic, investigations are ongoing to determine the role of fomites in coronavirus transmission as well. The bacteriophage Phi 6 has a phospholipid envelope and is commonly used in environmental studies as a surrogate for human enveloped viruses. The persistence of Phi 6 was evaluated as a surrogate for EBOV and coronaviruses on porous and nonporous hospital surfaces. Phi 6 was suspended in a body fluid simulant and inoculated onto 1 cm2 coupons of steel, plastic, and two fabric curtain types. The coupons were placed at two controlled absolute humidity (AH) levels; a low AH of 3.0 g/m3 and a high AH of 14.4 g/m3 Phi 6 declined at a slower rate on all materials under low AH conditions with a decay rate of 0.06 log10PFU/d to 0.11 log10PFU/d, as compared to the higher AH conditions with a decay rate of 0.65 log10PFU/h to 1.42 log10PFU/d. There was a significant difference in decay rates between porous and non-porous surfaces at both low AH (P < 0.0001) and high AH (P < 0.0001). Under these laboratory-simulated conditions, Phi 6 was found to be a conservative surrogate for EBOV under low AH conditions, in that it persisted longer than Ebola virus in similar AH conditions. Additionally, some coronaviruses persist longer than phi6 under similar conditions, therefore Phi6 may not be a suitable surrogate for coronaviruses.IMPORTANCE Understanding the persistence of enveloped viruses helps inform infection control practices and procedures in healthcare facilities and community settings. These data convey to public health investigators that enveloped viruses can persist and remain infective on surfaces, thus demonstrating a potential risk for transmission. Under these laboratory-simulated western indoor hospital conditions, Phi 6 was used to assess suitability as a surrogate for environmental persistence research related to enveloped viruses, including EBOV and coronaviruses.", "Mechanistic Transmission Modeling of COVID-19 on the Diamond Princess Cruise Ship Demonstrates the Importance of Aerosol Transmission Background The current prevailing position is that coronavirus disease 2019 (COVID-19) is transmitted primarily through large respiratory droplets within close proximity (i.e., 1-2 m) of infected individuals. However, quantitative information on the relative importance of specific transmission pathways of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (i.e., droplets, aerosols, and fomites across short- and long-range distances) remains limited. Methods To evaluate the relative importance of multiple transmission routes for SARS-CoV-2, we leveraged detailed information available from the Diamond Princess Cruise Ship outbreak that occurred in early 2020. We developed a framework that combines stochastic Markov chain and negative exponential dose-response modeling with available empirical data on mechanisms of SARS-CoV-2 dynamics and human behaviors, which informs a modified version of the Reed-Frost epidemic model to predict daily and cumulative daily case counts on the ship. We modeled 21,600 scenarios to generate a matrix of solutions across a full range of assumptions for eight unknown or uncertain epidemic and mechanistic transmission factors, including the magnitude of droplet and aerosol emissions from infected individuals, the infectious dose for deposition of droplets and aerosols to the upper and lower respiratory tracts, and others. Findings A total of 132 model iterations met acceptability criteria (R2 > 0.95 for modeled vs. reported cumulative daily cases and R2 > 0 for daily cases). Analyzing only these successful model iterations yields insights into the likely values for uncertain parameters and quantifies the likely contributions of each defined mode of transmission. Mean estimates of the contributions of short-range, long-range, and fomite transmission modes to infected cases aboard the ship across the entire simulation time period were 35%, 35%, and 30%, respectively. Mean estimates of the contributions of large respiratory droplets and small respiratory aerosols were 41% and 59%. Short-range transmission was the dominant mode after passenger quarantine began, albeit due primarily to aerosol transmission, not droplets. Interpretation Our results demonstrate that aerosol inhalation was likely the dominant contributor to COVID-19 transmission among passengers aboard the Diamond Princess Cruise Ship. Moreover, close-range and long-range transmission likely contributed similarly to disease progression aboard the ship, with fomite transmission playing a smaller role. The passenger quarantine also affected the importance of each mode, demonstrating the impacts of the interventions. Although cruise ships represent unique built environments with high ventilation rates and no air recirculation, these findings underscore the importance of implementing public health measures that target the control of inhalation of aerosols in addition to ongoing measures targeting control of large droplet and fomite transmission, not only aboard cruise ships but in other indoor environments as well.", "On the airborne aspect of COVID-19 coronovirus It is a widely accepted view that COVID 19 is either transmitted via surface contamination or via close contact of an un-infected person with an infected person. Surface contamination usually happens when infected water droplets from exhalation/sneeze/cough of COVID sick person settle on nearby surfaces. To curb this, social distancing and good hand hygiene advise is advocated by World health Organization (WHO). We argue that COVID 19 coronovirus can also be airborne in a puff cloud loaded with infected droplets generated by COVID sick person. An elementary calculation shows that a $5~\\mu m$ respiratory infected droplet can remain suspended for about 9.0 minutes and a $2~\\mu m$ droplet can remain suspended for about an hour! And social distancing advise of 3 feet by WHO and 6 feet by CDC (Centers for Disease Control and Prevention) may not be sufficient in some circumstances as discussed in the text.", "Sentinel Coronavirus Environmental Monitoring Can Contribute to Detecting Asymptomatic SARS-CoV-2 Virus Spreaders and Can Verify Effectiveness of Workplace COVID-19 Controls Detecting all workplace asymptomatic COVID-19 virus spreaders would require daily testing of employees, which is not practical. Over a two week period, nine workplace locations were chosen to test employees for SARS-CoV-2 infection (841 tests) and high-frequency-touch point environmental surfaces (5,500 tests) for Coronavirus using Eurofins COVID-19 SentinelTM RT-PCR methods. Of the 9 locations, 3 had one or employees infected with SARS-CoV-2, neither of whom had symptoms at the time of testing nor developed symptoms. Locations with Coronavirus contaminated surfaces were 10 times more likely to have clinically positive employees than locations with no or very few positive surfaces. Break room chairs, workbenches, and door handles were the most frequently contaminated surfaces. Coronavirus RNA was detected at very low concentrations (RT-PCR 34 to 38 Cq). Environmental monitoring can be used to validate intervention strategies and be useful to verify the effectiveness of such strategies on a regular basis.", "Certainties and Uncertainties Facing Emerging Respiratory Infectious Diseases: Lessons from SARS Every emerging infectious disease is a challenge to the whole of mankind. There are uncertainties regarding whether there will be a pandemic, if it will be caused by the highly pathogenic H5N1 influenza virus, when or where it will occur, how imminent or how severe it will be. No one can accurately predict if and when a given virus will become a pandemic virus. Pandemic prevention strategies must be based on preparing for the unexpected and being capable of reacting accordingly. There is growing evidence that infection control measures were helpful in containment of severe acute respiratory syndrome (SARS) as well as avian influenza. Compliance of standard infection control measures, intensive promotion of hand and respiratory hygiene, vigilance and triage of patients with febrile illness, and specific infection control measures are key components to contain a highly contagious disease in hospital and to protect healthcare workers, patients and visitors. The importance of standard precautions for any patient and cleaning and disinfection for the healthcare environment cannot be overemphasized. SARS illustrated dramatically the potential of air travel and globalization for the dissemination of an emerging infectious disease. To prevent the potential serious consequences of pandemic influenza, timely implementation of pharmaceutical and non-pharmaceutical interventions locally within the outbreak area is the key to minimizing global spread. Herein, we relate our perspective on useful lessons derived from a review of the SARS epidemic that may be useful to physicians, especially when looking ahead to the next epidemic.", "How ophthalmologists should understand and respond to the current epidemic of novel coronavirus pneumonia/ \u773c\u79d1\u533b\u751f\u548c\u7814\u7a76\u4eba\u5458\u5982\u4f55\u7406\u89e3\u548c\u5e94\u5bf9\u65b0\u578b\u51a0\u72b6\u75c5\u6bd2\u80ba\u708e\u7684\u6d41\u884c The new coronavirus pneumonia (COVID-19)that caused by 2019 new coronavirus (2019-nCoV) and first appeared in Wuhan, China, in December 2019 has attracted great attention from both the Chinese government and the international community.The International Committee on Viral Classification named the virus \"Severe Acute Respiratory Syndrome Coronavirus 2\" (SARS-CoV-2), and the WHO named the pneumonia it causesCOVID-19\". At present, the disease is centered in Wuhan City and is spreading rapidly to all parts of China, as well as twenty other countries.About 20% of the people infected during the SARS epidemic in 2003 were employees in hospital environments.COVID-19 has infected an even greater number of heath care workers.Therefore, ophthalmologists need to understand the disease and recognize the importance of taking preventive measures.Although ophthalmologists do not work on the front lines of the outbreak, due to their area of expertise, a variety of situations, such as infection consultations or ophthalmic emergency treatments, can lead to the exposure of ophthalmologists to high-risk environments.This risk will only increase as the number of infected patients continues to increase.When dealing with seemingly normal ophthalmic patients, the vigilance of ophthalmologists and associated staff tends to be significantly reduced.To better protect patients, families, and health care workers, it is strongly recommended that in addition to the standard precautions for the care of all patients, strict contact precautions and droplet precautions need to be taken by ophthalmologists.These measures include (1) wearing an efficient mask (an N95 mask); (2) always performing hand hygiene before and after examining a patient; (3) wearing sterile gloves when entering a patient\u2019s room and touching a patient; (4) wearing a gown when contact is expected with items and environmental surfaces surrounding a patient or when the patient is incontinent or has diarrhea or a surgical or other invasive wound with oozing fluid; (5) cleaning and disinfecting ophthalmic equipment and correctly handling medical waste after examination to prevent transmission to patients who are subsequently examined; (6) wearing goggles and a disposable mask to cover the front and sides of the face before touching a patient, as the virus could spread through the ocular surface; (7) performing the relevant screening for COVID-19 for regular patients who have conjunctivitis and respiratory symptoms at the same time; (8) prohibiting the use of infected patients as potential donors for corneal transplants and temporarily adding donor 2019-CoV screening to the medical standard of the eye bank during the outbreak; (9) for the purposes of scientific research, diagnosis, and other special needs, packing, shipping, and transporting collected specimens according to the relevant dangerous biological goods regulations.", "Sanitizing agents for virus inactivation and disinfection Viral epidemics develop from the emergence of new variants of infectious viruses. The lack of effective antiviral treatments for the new viral infections coupled with rapid community spread of the infection often result in major human and financial loss. Viral transmissions can occur via close human\u2010to\u2010human contact or via contacting a contaminated surface. Thus, careful disinfection or sanitization is essential to curtail viral spread. A myriad of disinfectants/sanitizing agents/biocidal agents are available that can inactivate viruses, but their effectiveness is dependent upon many factors such as concentration of agent, reaction time, temperature, and organic load. In this work, we review common commercially available disinfectants agents available on the market and evaluate their effectiveness under various application conditions. In addition, this work also seeks to debunk common myths about viral inactivation and highlight new exciting advances in the development of potential sanitizing agents.", "Recommendations for the prevention of transmission of SARS during GI endoscopy ", "Virus survival in evaporated saliva microdroplets deposited on inanimate surfaces The novel coronavirus respiratory syndrome (COVID-19) has now spread worldwide. The relative contribution of viral transmission via fomites is still unclear. SARS-CoV-2 has been shown to survive on inanimate surfaces for several days, yet the factors that determine its survival on surfaces are not well understood. Here we combine microscopy imaging with virus viability assays to study survival of three bacteriophages suggested as good models for human respiratory pathogens: the enveloped Phi6 (a surrogate for SARS-CoV-2), and the non-enveloped PhiX174 and MS2. We measured virus viability in human saliva microdroplets, SM buffer, and water following deposition on glass surfaces at various relative humidities (RH). Although saliva microdroplets dried out rapidly at all tested RH levels (unlike SM that remained hydrated at RH \u2265 57%), survival of all three viruses in dry saliva microdroplets was significantly higher than in water or SM. Thus, RH and hydration conditions are not sufficient to explain virus survival, indicating that the suspended medium, and association with saliva components in particular, likely affect physicochemical properties that determine virus survival. The observed high virus survival in dry saliva deposited on surfaces, under a wide range of RH levels, can have profound implications for human public health, specifically the COVID-19 pandemic.", "Uncertainties about the transmission routes of 2019 novel coronavirus ", "A COVID-19 Infection Risk Model for Frontline Health Care Workers The number of confirmed COVID-19 cases admitted in hospitals is continuously increasing in the Philippines. Frontline health care workers are faced with imminent risks of getting infected. In this study, we formulate a theoretical model to calculate the risk of being infected in health care facilities considering the following factors: the average number of encounters with a suspected COVID-19 patient per hour; interaction time for each encounter; work shift duration or exposure time; crowd density, which may depend on the amount of space available in a given location; and availability and effectiveness of protective gears and facilities provided for the frontline health care workers. Based on the simulation results, we recommend the following: (i) decrease the rate of patient encounter per frontline health care worker, e.g., maximum of three encounters per hour in a 12-hour work shift duration; (ii) decrease the interaction time between the frontline health care worker and the patients, e.g., less than 40 minutes for the whole day; (iii) increase the clean and safe space for social distancing, e.g., maximum of 10% crowd density, and if possible, implement compartmentalization of patients; and/or (iv) provide effective protective gears and facilities, e.g., 95% effective, that the frontline health care workers can use during their shift. Moreover, the formulated model can be used for other similar scenarios, such as identifying infection risk in public transportation, school classroom settings, offices, and mass gatherings.", "Estimated Inactivation of Coronaviruses by Solar Radiation With Special Reference to COVID\u201019 Using a model developed for estimating solar inactivation of viruses of biodefense concerns, we calculated the expected inactivation of SARS\u2010CoV\u20102 virus, cause of COVID\u201019 pandemic, by artificial UVC and by solar ultraviolet radiation in several cities of the world during different times of the year. The UV sensitivity estimated here for SARS\u2010CoV\u20102 is compared with those reported for other ssRNA viruses, including influenza A virus. The results indicate that SARS\u2010CoV\u20102 aerosolized from infected patients and deposited on surfaces could remain infectious outdoors for considerable time during the winter in many temperate\u2010zone cities, with continued risk for re\u2010aerosolization and human infection. Conversely, the presented data indicate that SARS\u2010CoV\u20102 should be inactivated relatively fast (faster than influenza A) during summer in many populous cities of the world, indicating that sunlight should have a role in the occurrence, spread rate, and duration of coronavirus pandemics.", "Back to the Basics: Diluted Bleach for COVID-19 ", "Dermatology practices as vectors for COVID-19 transmission: A call for immediate cessation of nonemergent dermatology visits ", "Persistence of SARS-CoV-2 in the environment and COVID-19 transmission risk from environmental matrices and surfaces The Coronavirus disease 2019 (COVID-19) is spreading around the world, representing a global pandemic, counting, as of June 5th, 2020, over 6,600,000 confirmed cases and more than 390,000 deaths, with exponentially increasing numbers. In the first half of 2020, because of the widespread of the COVID-19, researches were focused on the monitoring of SARS-CoV-2 in water, wastewater, sludge, air, and on surfaces, in order to assess the risk of contracting the viral infection from contaminated environments. So far, the survival of the novel Coronavirus out of the human body has been reported for short time periods (from hours to few days, in optimized in vitro conditions), mainly because of the need of an host organism which could consent the viral attack, and due to the weak external membrane of the virus. SARS-CoV-2 viral shedding strategies in the environment, either through animate and unanimate matrices, or exploiting the organic matter in water, wastewater, and waste in general, have been discussed in the present article. We concluded that, besides the high infectuousness of the novel Coronavirus, the transmission of the pathogen may be efficiently contained applying the adequate preventive measures (e.g., personal protection equipments, and disinfecting agents), indicated by national and international health authories.", "COVID\u201019: Infection prevention and control guidance for all ultrasound practitioners The severe acute respiratory syndrome coronavirus (SARS\u2010CoV\u20102), an enveloped virus, is the causative agent of the disease known as COVID\u201019 (coronavirus disease\u20102019). Proper infection prevention and control measures and good hygiene practices are essential to prevent spread of COVID\u201019 and protect both patients and the healthcare worker. These guidelines are relevant to all ultrasound practitioners and provides guidance on cleaning and disinfection of ultrasound equipment, the environment and PPE (protective personal equipment) during the COVID\u201019 outbreak in the Australasian region.", "Evaluation of the survivability of MS2 viral aerosols deposited on filtering face piece respirator samples incorporating antimicrobial technologies BACKGROUND: Respiratory protective devices exposed to pathogenic microorganisms present a potential source of transmission of infection during handling. In this study, the efficacy of 4 antimicrobial respirators to decontaminate MS2, a surrogate for pathogenic viruses, was evaluated and compared with control N95 filtering face piece respirators, which did not contain any known antimicrobial components. METHODS: MS2 containing droplet nuclei were generated using a Collison nebulizer and loaded onto respirator coupons at a face velocity of 13.2 cm/seconds for 30 minutes. The coupons were incubated at 2 different temperature and relative humidity (RH) conditions and analyzed for viable MS2 at different time intervals. RESULTS: Results showed that log(10) reduction of MS2 was not statistically significant (P > .05) between the control and antimicrobial respirator coupons, when stored at 22\u00b0C and 30% RH up to 20 hours. Coupons from 1 of the 4 antimicrobial respirators showed an average MS2 log(10) reduction of 3.7 at 37\u00b0C and 80% RH for 4 hours, which was statistically significant (P \u2264 .05) compared with coupons from the control respirators. CONCLUSION: Results from this study suggest that MS2 virus decontamination efficacy of antimicrobial respirators is dependent on the antimicrobial agent and storage conditions.", "Putting some context to the aerosolization debate around SARS-CoV-2 ", "Environmental contamination by SARS-CoV-2 of an imported case during incubation period Abstract We collected environmental surface samples prior to and after disinfection of a quarantine room to evaluate the stability of SARS-CoV-2 during the incubation period of an imported case traveling to Qingdao, China. Overall, 11 of 23 (47.8%) of the first batch of environmental surface samples (within 4 h after case confirmation) were tested positive for SARS-CoV-2. Whereas only 2 of 23 (8.7%) of the second batch of environmental samples (after first disinfection) were tested positive for SARS-CoV-2. The majority of samples from the bedroom (70%) were positive for SARS-CoV-2, followed by 50% of samples from the bathroom and that of 33% from the corridor. The inner walls of toilet bowl and sewer inlet were the most contaminated sites with the highest viral loads. SARS-CoV-2 was widely distributed on object surfaces in a quarantine room of a later diagnosed COVID-19 case during the incubation period. Proper disinfection is crucial to minimize community transmission of this highly contagious virus.", "Microbial transmission in an outpatient clinic and impact of an intervention with an ethanol-based disinfectant BACKGROUND: Halting the spread of harmful microbes requires an understanding of their transmission via hands and fomites. Previous studies explored acute and long-term care environments but not outpatient clinics. Objectives of this study were to track microbial movement throughout an outpatient clinic and evaluate the impact of a disinfectant spray intervention targeting high-touch point surfaces. METHODS: At the start of the clinic day, a harmless viral tracer was placed onto 2 fomites: a patient room door handle and front desk pen. Patient care, cleaning, and hand hygiene practices continued as usual. Facility fomites (n = 19), staff hands (n = 4), and patient hands (n = 3-4) were sampled after 2, 3.5, and 6 hours. Tracer concentrations at baseline (before intervention) were evaluated 6 hours after seeding. For the intervention trials, high-touch surfaces were cleaned 4 hours after seeding with an ethanol-based disinfectant and sampled 2 hours after cleaning. RESULTS: At 2, 3.5, and 6 hours after seeding, virus was detected on all surfaces and hands sampled, with examination room door handles and nurses\u2019 station chair arms yielding the highest concentrations. Virus concentrations decreased by 94.1% after the disinfectant spray intervention (P = .001). CONCLUSIONS: Microbes spread quickly in an outpatient clinic, reaching maximum contamination levels 2 hours after inoculation, with the highest contamination on examination room door handles and nurses\u2019 station chairs. This study emphasizes the importance of targeted disinfection of high-touch surfaces.", "The Potential Impact of Intensified Community Hand Hygiene Interventions on Respiratory tract Infections: A Modelling Study Increased hand hygiene amongst the general public has been widely promoted as one of the most important non-pharmaceutical interventions for reducing transmission during the ongoing COVID-19 pandemic and is likely to continue to play a key role in long-term efforts to suppress transmission before a vaccine can be deployed. For other respiratory tract infections community hand hygiene interventions are supported by evidence from randomised trials, but information on how effectiveness in reducing transmission scales with achieved changes in hand hygiene behaviour is lacking. This information is of critical importance when considering the potential value of substantially enhancing community hand hygiene frequency to help suppress COVID-19. Here, we developed a simple model-based framework for understanding the key determinants of the effectiveness of changes in hand hygiene behaviour in reducing transmission and use it to explore the potential impact of interventions aimed at achieving large-scale population-wide changes in hand hygiene behaviour. Our analyses show that the effect of hand hygiene is highly dependent on the duration of viral persistence on hands and that hand washing needs to be performed very frequently or immediately after hand contamination events in order to substantially reduce the probability of infection. Hand washing at a lower frequency, such as every 30 minutes or with a delay of 15 minutes after contamination events, may be adequate to reduce the probability of infection when viral survival on hands is longer, such as when hands are contaminated with mucus. Immediate hand washing after contamination is more effective than hand washing at fixed-time intervals even when the total number of hand washing events is similar. This event-prompted hand washing strategy is consistently more effective than fixed-time strategy regardless of hand contamination rates and should be highlighted in hand hygiene campaigns.", "Persistence of Bacteriophage Phi 6 on Porous and Non-Porous Surfaces; Potential for use as Ebola or Coronavirus Surrogate. The infection of healthcare workers during the 2013 -2016 Ebola outbreak raised concerns about fomite transmission. In the wake of the Coronavirus Disease 2019 (COVID-19) pandemic, investigations are ongoing to determine the role of fomites in coronavirus transmission as well. The bacteriophage Phi 6 has a phospholipid envelope and is commonly used in environmental studies as a surrogate for human enveloped viruses. The persistence of Phi 6 was evaluated as a surrogate for EBOV and coronaviruses on porous and nonporous hospital surfaces. Phi 6 was suspended in a body fluid simulant and inoculated onto 1 cm2 coupons of steel, plastic, and two fabric curtain types. The coupons were placed at two controlled absolute humidity (AH) levels; a low AH of 3.0 g/m3 and a high AH of 14.4 g/m3 Phi 6 declined at a slower rate on all materials under low AH conditions with a decay rate of 0.06 log10PFU/d to 0.11 log10PFU/d, as compared to the higher AH conditions with a decay rate of 0.65 log10PFU/h to 1.42 log10PFU/d. There was a significant difference in decay rates between porous and non-porous surfaces at both low AH (P < 0.0001) and high AH (P < 0.0001). Under these laboratory-simulated conditions, Phi 6 was found to be a conservative surrogate for EBOV under low AH conditions, in that it persisted longer than Ebola virus in similar AH conditions. Additionally, some coronaviruses persist longer than phi6 under similar conditions, therefore Phi6 may not be a suitable surrogate for coronaviruses.IMPORTANCE Understanding the persistence of enveloped viruses helps inform infection control practices and procedures in healthcare facilities and community settings. These data convey to public health investigators that enveloped viruses can persist and remain infective on surfaces, thus demonstrating a potential risk for transmission. Under these laboratory-simulated western indoor hospital conditions, Phi 6 was used to assess suitability as a surrogate for environmental persistence research related to enveloped viruses, including EBOV and coronaviruses.", "Toilets dominate environmental detection of SARS-CoV-2 virus in a hospital Background: Respiratory and faecal aerosols play a suspected role in transmitting the SARS-CoV-2 virus. We performed extensive environmental sampling in a dedicated hospital building for Covid-19 patients in both toilet and non-toilet environments, and analysed the associated environmental factors. Methods: We collected data of the Covid-19 patients. 107 surface samples, 46 air samples, two exhaled condensate samples, and two expired air samples were collected were collected within and beyond the four three-bed isolation rooms. We reviewed the environmental design of the building and the cleaning routines. We conducted field measurement of airflow and CO2 concentrations. Findings: The 107 surface samples comprised 37 from toilets, 34 from other surfaces in isolation rooms (ventilated at 30-60 L/s), and 36 from other surfaces outside isolation rooms in the hospital. Four of these samples were positive, namely two ward door-handles, one bathroom toilet-seat cover and one bathroom door-handle; and three were weakly positive, namely one bathroom toilet seat, one bathroom washbasin tap lever and one bathroom ceiling-exhaust louvre. One of the 46 air samples was weakly positive, and this was a corridor air sample. The two exhaled condensate samples and the two expired air samples were negative. Interpretation: The faecal-derived aerosols in patients' toilets contained most of the detected SARS-CoV-2 virus in the hospital, highlighting the importance of surface and hand hygiene for intervention.", "Air contamination with SARS-CoV-2 in the operating room Angiotensin converting enzyme 2 (ACE2) is a target cell receptor for internalization and proliferation of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). When ACE2-highly expressed tissues are manipulated, SARS-CoV-2 containing aerosols may be generated. Normal breathing and speaking are capable of producing aerosols so mask ventilation, suction of airway tract and bucking during tracheal intubation and extubation are clinical procedures capable of significant aerosol production. Whilst no data have been reported on the distribution of SARS-CoV-2 in the operating room (OR), contamination in the OR can be estimated from the intensive care unit (ICU) data. ICU data showed that SARS-CoV-2 was detected on all types of surface and in air within about 4 m from coronavirus disease 2019 (COVID-19) patients. High concentrations of SARS-CoV-2 was detected in the personal protective equipment (PPE) removal room and medical staff office. Submicron virus-laden aerosols could result from resuspension of particles containing SARS-CoV-2 sticking the PPE surface; removal could produce the initial velocity. Supermicron virus-laden aerosol could come from floor deposited SARS-CoV-2, which were carried across different areas by medical staff (e.g., shoe). Knowledge of aerosol generation and distribution in the OR will aid the design of strategies to reduce transmission risk.", "COVID-19: Transmission, prevention, and potential therapeutic opportunities The novel coronavirus disease (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), remains a global challenge. Despite intense research efforts worldwide, an effective vaccine and viable treatment options have eluded investigators. Therefore, infection prevention, early viral detection and identification of successful treatment protocols provide the best approach in controlling disease spread. In this review, current therapeutic options, preventive methods and transmission routes of COVID-19 are discussed.", "Human Coronaviruses: Insights into Environmental Resistance and Its Influence on the Development of New Antiseptic Strategies The Coronaviridae family, an enveloped RNA virus family, and, more particularly, human coronaviruses (HCoV), were historically known to be responsible for a large portion of common colds and other upper respiratory tract infections. HCoV are now known to be involved in more serious respiratory diseases, i.e. bronchitis, bronchiolitis or pneumonia, especially in young children and neonates, elderly people and immunosuppressed patients. They have also been involved in nosocomial viral infections. In 2002\u20132003, the outbreak of severe acute respiratory syndrome (SARS), due to a newly discovered coronavirus, the SARS-associated coronavirus (SARS-CoV); led to a new awareness of the medical importance of the Coronaviridae family. This pathogen, responsible for an emerging disease in humans, with high risk of fatal outcome; underline the pressing need for new approaches to the management of the infection, and primarily to its prevention. Another interesting feature of coronaviruses is their potential environmental resistance, despite the accepted fragility of enveloped viruses. Indeed, several studies have described the ability of HCoVs (i.e. HCoV 229E, HCoV OC43 (also known as betacoronavirus 1), NL63, HKU1 or SARS-CoV) to survive in different environmental conditions (e.g. temperature and humidity), on different supports found in hospital settings such as aluminum, sterile sponges or latex surgical gloves or in biological fluids. Finally, taking into account the persisting lack of specific antiviral treatments (there is, in fact, no specific treatment available to fight coronaviruses infections), the Coronaviridae specificities (i.e. pathogenicity, potential environmental resistance) make them a challenging model for the development of efficient means of prevention, as an adapted antisepsis-disinfection, to prevent the environmental spread of such infective agents. This review will summarize current knowledge on the capacity of human coronaviruses to survive in the environment and the efficacy of well-known antiseptic-disinfectants against them, with particular focus on the development of new methodologies to evaluate the activity of new antiseptic-disinfectants on viruses.", "Coronavirus (COVID-19) outbreak: what the department of endoscopy should know Italy recorded its first case of confirmed acute respiratory illness because of coronavirus on February 18, 2020, soon after the initial reports in China. Since that time, Italy and nations throughout the world have adopted very stringent and severe measures to protect populations from spread of infection. Despite these measures, the number of infected people is growing exponentially, with a significant number of patients developing acute respiratory insufficiency. Endoscopy departments face significant risk for diffusion of respiratory diseases that can be spread via an airborne route, including aspiration of oral and fecal material via endoscopes. The purpose of this article is to discuss the measures, with specific focus on personal protection equipment and dress code modalities, implemented in our hospital to prevent further dissemination of COVID-19 infection.", "Preventive Behaviors Conveyed on YouTube to Mitigate Transmission of COVID-19: Cross-Sectional Study BACKGROUND: Accurate information and guidance about personal behaviors that can reduce exposure to severe acute respiratory syndrome coronavirus 2 are among the most important elements in mitigating the spread of coronavirus disease 2019 (COVID-19). With over 2 billion users, YouTube is a media channel that millions turn to when seeking information. OBJECTIVE: At the time of this study, there were no published studies investigating the content of YouTube videos related to COVID-19. This study aims to address this gap in the current knowledge. METHODS: The 100 most widely viewed YouTube videos uploaded throughout the month of January 2020 were reviewed and the content covered was described. Collectively, these videos were viewed over 125 million times. RESULTS: Fewer than one-third of the videos covered any of the seven key prevention behaviors listed on the US Centers for Disease Control and Prevention website. CONCLUSIONS: These results represent an important missed opportunity for disease prevention.", "2019 NOVEL CORONAVIRUS ", "COVID-19 Pandemic: Prevention and protection measures to be adopted at the workplace SARS-CoV-2, identified in Wuhan, China, for the first time in December 2019, is a new viral strain, which has not been previously identified in humans; it can be transmitted both by air and via direct and indirect contact; however, the most frequent way it spreads is via droplets. Like the other viruses belonging to the same family of coronaviruses, it can cause from mild flu-like symptoms, such as cold, sore throat, cough and fever, to more severe ones such as pneumonia and breathing difficulties, and it can even lead to death. Since no effective specific drug therapy has been found yet, nor any vaccine capable of limiting the spread of this pathogen, it is important for ways of preventing the spread of this infection to be established. The purpose of our research was to provide a protocol to prevent the spread of SARS-CoV-2 infection in light of the limited information related to this coronavirus. In detail, we analysed and searched targeted evidence-based guidelines issued in the various countries affected by this epidemic up till now. In addition, we analyzed the recommendations for the prevention and control of other epidemics caused by other pathogens belonging to the same family of coronaviruses or others that present the same mechanisms of transmission. General organizational measures regarding the containment and management of the epidemiological emergency of COVID-19 have been imposed by the competent authorities for an adequate and proportionate management of the evolution of the epidemiological situation. The prevention and protection organizational measures therefore aim to minimize the probability of being exposed to SARS-CoV-2. For this purpose, measures must also be taken at work to avoid new infections or even the spread of the virus where it has already been present. Furthermore, environmental measures are aimed at reducing the risk of transmission of SARS-CoV-2 to individuals through contact with infected subjects, objects, equipment, or contaminated environmental surfaces. Protective devices must be used whenever there is potentially close contact with a suspect case, especially when the potentially infected person does not wear a surgical mask that could reduce the spread of viruses in the environment. By adopting this specific prevention and protection measures recommended in the workplace, it will be possible to help overcome this COVID-19 pandemic.", "Biological and social aspects of Coronavirus Disease 2019 (COVID-19) related to oral health The expansion of coronavirus disease 2019 (COVID-19) throughout the world has alarmed all health professionals. Especially in dentistry, there is a growing concern due to it's high virulence and routes of transmission through saliva aerosols. The virus keeps viable on air for at least 3 hours and on plastic and stainless-steel surfaces up to 72 hours. In this sense, dental offices, both in the public and private sectors, are high-risk settings of cross infection among patients, dentists and health professionals in the clinical environment (including hospital's intensive dental care facilities). This manuscript aims to compile current available evidence on prevention strategies for dental professionals. Besides, we briefly describe promising treatment strategies recognized until this moment. The purpose is to clarify dental practitioners about the virus history and microbiology, besides guiding on how to proceed during emergency consultations based on international documents. Dentists should consider that a substantial number of individuals (including children) who do not show any signs and symptoms of COVID-19 may be infected and can disseminate the virus. Currently, there is no effective treatment and fast diagnosis is still a challenge. All elective dental treatments and non-essential procedures should be postponed, keeping only urgent and emergency visits to the dental office. The use of teledentistry (phone calls, text messages) is a very promising tool to keep contact with the patient without being at risk of infection.", "COVID-19 Diagnostics, Tools, and Prevention The Coronavirus Disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), outbreak from Wuhan City, Hubei province, China in 2019 has become an ongoing global health emergency. The emerging virus, SARS-CoV-2, causes coughing, fever, muscle ache, and shortness of breath or dyspnea in symptomatic patients. The pathogenic particles that are generated by coughing and sneezing remain suspended in the air or attach to a surface to facilitate transmission in an aerosol form. This review focuses on the recent trends in pandemic biology, diagnostics methods, prevention tools, and policies for COVID-19 management. To meet the growing demand for medical supplies during the COVID-19 era, a variety of personal protective equipment (PPE) and ventilators have been developed using do-it-yourself (DIY) manufacturing. COVID-19 diagnosis and the prediction of virus transmission are analyzed by machine learning algorithms, simulations, and digital monitoring. Until the discovery of a clinically approved vaccine for COVID-19, pandemics remain a public concern. Therefore, technological developments, biomedical research, and policy development are needed to decipher the coronavirus mechanism and epidemiological characteristics, prevent transmission, and develop therapeutic drugs.", "Ultraviolet and COVID\u201019 pandemic BACKGROUND: COVID\u201019 virus causes coronavirus disease. AIMS: It is a highly contagious viral infection. PATIENTS/METHODS/RESULTS/CONCLUSION: In this article, we will discuss the potential phototherapy problems and also alternative options for dermatologists, ultraviolet treatment against COVID\u201019 virus, and vitamin D\u2013associated problems in these coronavirus days.", "Sports balls as potential SARS-CoV-2 transmission vectors Abstract Objects passed from one player to another have not been assessed for their ability to transmit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We found that the surface of sport balls, notably a football, tennis ball, golf ball, and cricket ball could not harbour inactivated virus when it was swabbed onto the surface, even for 30 seconds. However, when high concentrations of 5,000 dC/mL and 10,000 dC/mL are directly pipetted onto the balls, it could be detected after for short time periods. Sports objects can only harbour inactivated SARS-CoV-2 under specific, directly transferred conditions, but wiping with a dry tissue or moist \u2018baby wipe\u2019 or dropping and rolling the balls removes all detectable viral traces. This has helpful implications to sporting events.", "COVID-19: Health prevention and control in non-healthcare settings ", "Transmission of SARS-CoV-2: an update of current literature Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent for the 2019 coronavirus disease (COVID-19) pandemic, has caused a public health emergency. The need for additional research in viral pathogenesis is essential as the number of cases and deaths rise. Understanding the virus and its ability to cause disease has been the main focus of current literature; however, there is much unknown. Studies have revealed new findings related to the full transmission potential of SARS-CoV-2 and its subsequent ability to cause infection by different means. The virus is hypothesized to be of increased virulence compared with previous coronavirus that caused epidemics, in part due to its overall structural integrity and resilience to inactivation. To date, many studies have discussed that the rationale behind its transmission potential is that viral RNA has unexpectedly been detected in multiple bodily fluids, with some samples having remained positive for extended periods of time. Additionally, the receptor by which the virus gains cellular entry, ACE2, has been found to be expressed in different human body systems, thereby potentiating its infection in those locations. In this evidence-based comprehensive review, we discuss various potential routes of transmission of SARS-CoV-2\u2014respiratory/droplet, indirect, fecal-oral, vertical, sexual, and ocular. Understanding these different routes is important as they pertain to clinical practice, especially in taking preventative measures to mitigate the spread of SARS-CoV-2.", "SARS-CoV-2 RNA detection in the air and on surfaces in the COVID-19 ward of a hospital in Milan, Italy The COVID-19 outbreak has rapidly progressed worldwide finding the health system, scientists and society unprepared to face a little-known, fast spreading, and extremely deadly virus. Italy is one of the countries hardest hit by the pandemic, resulting in healthcare facilities bearing heavy burdens and severe restrictive measures. Despite efforts to clarify the virus transmission, especially in indoor scenarios, several aspects of SARS-CoV-2 spread are still rudimentary. This study evaluated the contamination of the air and surfaces by SARS-CoV-2 RNA in the COVID-19 isolation ward of a hospital in Milan, Italy. A total of 42 air and surface samples were collected inside five different zones of the ward including contaminated (COVID-19 patients' area), semi-contaminated (undressing room), and clean areas. SARS-CoV-2 RNA detection was performed using real time reverse transcription polymerase chain reaction. Overall, 24.3% of swab samples were positive, but none of these were collected in the clean area. Thus, the positivity rate was higher in contaminated (35.0%) and semi-contaminated (50.0%) areas than in clean areas (0.0%; P<0.05). The most contaminated surfaces were hand sanitizer dispensers (100.0%), medical equipment (50.0%), medical equipment touch screens (50.0%), shelves for medical equipment (40.0%), bedrails (33.3%), and door handles (25.0%). All the air samples collected from the contaminated area, namely the intensive care unit and corridor, were positive while viral RNA was not detected in either semi-contaminated or clean areas. These results showed that environmental contamination did not involve clean areas, but the results also support the need for strict disinfection, hand hygiene and protective measures for healthcare workers as well as the need for airborne isolation precautions.", "Reply to \u201cDoes hand hygiene reduce SARS-CoV-2 transmission?\u201d ", "What Does COVID-19 Mean for the Pathology-Urology Interaction? ", "Rapid evidence summary on SARS-CoV-2 survivorship and disinfection, and a reusable PPE protocol using a double-hit process In the COVID-19 pandemic caused by SARS-CoV-2, hospitals are stretched beyond capacity. There are widespread reports of dwindling supplies of personal protective equipment (PPE), which are paramount to protect frontline medical/nursing staff and to minimize further spread of the virus. We carried out a rapid review to summarize the existing evidence on SARS-CoV-2 survivorship and methods to disinfect PPE gear, particularly N95 filtering facepiece respirators (FFR). In the absence of data on SARS-CoV-2, we focused on the sister virus SARS-CoV-1. We propose a two-step disinfection process, which is conservative in the absence of robust evidence on SARS-CoV-2. This disinfection protocol is based on an initial storage of PPE for \u22654 days, followed by ultraviolet light (UVC), dry heat treatment, or chemical disinfection. Importantly, each of the two steps is based on independent disinfection mechanisms, so that our proposed protocol is a multiplicative system, maximising the efficacy of our disinfection process. This method could be rapidly implemented in other healthcare settings, while testing of each method is undertaken, increasing the frontline supply of PPE, and avoiding many of the upstream issues of supply chain disruption currently being faced.", "Environmental survival and microbicide inactivation of coronaviruses ", "Coronavirus disease 2019 and the cardiovascular system: Impacts and implications ", "Efficacy of a novel iodine complex solution, CupriDyne, in inactivating SARS-CoV-2 The coronavirus known as SARS-CoV-2, which causes COVID-19 disease, is presently responsible for a global pandemic wherein more than 3.5 million people have been infected and more than 250,000 killed to-date. There is currently no vaccine for COVID-19, leaving governments and public health agencies with little defense against the virus aside from advising or enforcing best practices for virus transmission prevention, which include hand-washing, physical distancing, use of face covers, and use of effective disinfectants. In this study, a novel iodine complex called CupriDyne\u00ae was assessed for its ability to inactivate SARS-CoV-2. CupriDyne was shown to be effective in inactivating the virus in a time-dependent manner, reducing virus titers by 99% (2 logs) after 30 minutes, and reducing virus titers to below the detection limit after 60 minutes. The novel iodine complex tested herein offers a safe and gentle alternative to conventional disinfectants for use on indoor and outdoor surfaces.", "Covid-19: Impact on Perianesthesia Nursing Areas ", "Environmental Contamination of SARS-CoV-2 in a Non-Healthcare Setting Revealed by Sensitive Nested RT-PCR Fomite-mediated transmission has been identified as a possible route for disease spread of the COVID-19 pandemic. In healthcare settings, evidence of environmental contamination by SARS-CoV-2 has been found in patients' rooms and toilets. Here, we investigate environmental contamination of SARS-CoV-2 in non-healthcare settings and assessed the efficacy of cleaning and disinfection in removing SARS-CoV-2 contamination. A total of 428 environmental swabs and six air samples was taken from accommodation rooms, toilets and elevators that have been used by COVID-19 cases. Through the use of a sensitive nested RT-PCR assay, we found two SARS-CoV-2 RNA positive samples from the room resided by a COVID-19 case, highlighting the risk of fomite-mediated transmission in non-healthcare settings and the importance of surface disinfection of spaces occupied by cases. Of note, we did not find evidence for air-borne transmission, nor of environmental contamination of elevators, which were transiently exposed to infected persons.", "On airborne transmission and control of SARS-Cov-2 Abstract The COVID-19 pandemic is creating a havoc situation across the globe that modern society has ever seen. Despite of their paramount importance, the transmission routes of SARS-Cov-2 still remain debated among various sectors. Evidences compiled here strongly suggest that the COVID-19 could be transmitted via air in inadequately ventilated environments that are housing the infected by SARS-Cov-2. Existing experimental data showed that coronavirus survival was negatively impacted by ozone, high temperature and low humidity. Here, regression analysis showed that the spread of SARS-Cov-2 was reduced by increasing ambient ozone concentration level (48.83\u201394.67 \u03bcg/m3) (p-value = 0.039) and decreasing relative humidity (23.33\u201382.67%) (p-value = 0.002) and temperature (\u221213.17-19 \u00b0C) (p-value = 0.003) observed for Chinese cities during Jan-March 2020. Besides using these environmental implications, social distancing and wearing a mask are strongly encouraged to maximize the fight against the COVID-19 transmission. At no other time than now are the scientists in various disciplines around the world badly needed by the society to collectively confront this disastrous pandemic.", "Air and surface contamination in non-health care settings among 641 environmental specimens of 39 COVID-19 cases Background Little is known about the SARS-CoV-2 contamination of environmental surfaces and air in non-health care settings among COVID-19 cases. Methods and findings We explored the SARS-CoV-2 contamination of environmental surfaces and air by collecting air and swabbing environmental surfaces among 39 COVID-19 cases in Guangzhou, China. The specimens were tested by RT-PCR testing. The information collected for COVID-19 cases included basic demographic, clinical severity, onset of symptoms, radiological testing, laboratory testing and hospital admission. A total of 641 environmental surfaces and air specimens were collected among 39 COVID-19 cases before disinfection. Among them, 20 specimens (20/641, 3.1%) were tested positive from 9 COVID-19 cases (9/39, 23.1%), with 5 (5/101, 5.0%) positive specimens from 3 asymptomatic cases, 5 (5/220, 2.3%) from 3 mild cases, and 10 (10/374, 2.7%) from 3 moderate cases. All positive specimens were collected within 3 days after diagnosis, and 10 (10/42, 23.8%) were found in toilet (5 on toilet bowl, 4 on sink/faucet/shower, 1 on floor drain), 4 (4/21, 19.0%) in anteroom (2 on water dispenser/cup/bottle, 1 on chair/table, 1 on TV remote), 1 (1/8, 12.5%) in kitchen (1 on dining-table), 1 (1/18, 5.6%) in bedroom (1 on bed/sheet pillow/bedside table), 1 (1/5, 20.0%) in car (1 on steering wheel/seat/handlebar) and 3 (3/20, 21.4%) on door knobs. Air specimens in room (0/10, 0.0%) and car (0/1, 0.0%) were all negative. Conclusions SARS-CoV-2 was found on environmental surfaces especially in toilet, and could survive for several days. We provided evidence of potential for SARS-CoV-2 transmission through contamination of environmental surfaces.", "Editorial JTH 16 \u2013The Coronavirus Disease COVID-19 and implications for transport and health ", "Exaggerated risk of transmission of COVID-19 by fomites ", "Transmission of pathogen-laden expiratory droplets in a coach bus Abstract Droplet dispersion carrying viruses/bacteria in enclosed/crowded buses may induce transmissions of respiratory infectious diseases, but the influencing mechanisms have been rarely investigated. By conducting high-resolution CFD simulations, this paper investigates the evaporation and transport of solid-liquid mixed droplets (initial diameter 10 \u03bcm and 50 \u03bcm, solid to liquid ratio is 1:9) exhaled in a coach bus with 14 thermal manikins. Five air-conditioning supply directions and ambient relative humidity (RH = 35% and 95%) are considered. Results show that ventilation effectiveness, RH and initial droplet size significantly influence droplet transmissions in coach bus. 50 \u03bcm droplets tend to evaporate completely within 1.8 s and 7 s as RH = 35% and 95% respectively, while 0.2 s or less for 10 \u03bcm droplets. Thus 10 \u03bcm droplets diffuse farther with wider range than 50 \u03bcm droplets which tend to deposit more on surfaces. Droplet dispersion pattern differs due to various interactions of gravity, ventilation flows and the upward thermal body plume. The fractions of droplets suspended in air, deposited on wall surfaces are quantified. This study implies high RH, backward supply direction and passengers sitting at nonadjacent seats can effectively reduce infection risk of droplet transmission in buses. Besides taking masks, regular cleaning is also recommended since 85%-100% of droplets deposit on object surfaces.", "Can N95 respirators be reused after disinfection? And for how many times? The Coronavirus Disease 2019 (COVID-19) pandemic has led to a major shortage of N95 respirators, which protect healthcare professionals and the public who may come into contact with the virus. It is necessary to determine the conditions that would allow the safe reuse respirators and personal protection in this crisis. We found that heating (<100 {degrees}C) under various humidities (up to 100% RH at 75 {degrees}C) and ultraviolet (UV) irradiation were the most promising candidates for mask reuse in the modern hospital infrastructure (up to 20 cycles), when tested on a fabric with particle filtration efficiency [\u2265]95%. Treatments involving certain liquids and vapors may require caution, as steam, alcohol, and bleach all led to degradation in filtration efficiency, leaving the user vulnerable to viral aerosols.", "Fecal-Oral Transmission of SARS-CoV-2 In Children: is it Time to Change Our Approach? Starting from 2 pediatric cases of COVID-19, with confirmation at nasopharyngeal and rectal swabs, we considered the lesson learnt from previous Coronavirus epidemics and reviewed evidence on the current outbreak. Surveillance with rectal swabs might be extended to infants and children, for the implications for household contacts and isolation timing.", "The intensity of COVID-19 outbreaks is modulated by variation in SARS-CoV-2 free-living survival and environmental transmission COVID-19 has circled the globe, rapidly expanding into a pandemic within a matter of weeks. While early studies revealed important features of SARS-CoV-2 transmission, the role of variation in free-living virus survival in modulating the dynamics of outbreaks remains unclear. Using an empirically determined understanding of SARS-CoV-2 natural history and detailed, country-level case data, we elucidate how variation in free-living virus survival influences key features of COVID-19 epidemics. Our findings suggest that COVID-19\u2019s basic reproductive number ([Formula: see text]) and other key signatures of outbreak intensity are defined by transmission between infected individuals and the environment. Summarizing, we propose that variation in environmental transmission may explain observed differences in disease dynamics from setting to setting, and can inform public health interventions.", "Reducing antibiotic prescribing and addressing the global problem of antibiotic resistance by targeted hygiene in the home and everyday life settings: A Position Paper Antimicrobial resistance (AMR) continues to threaten global health. Although global and national AMR action plans are in place, infection prevention and control is primarily discussed in the context of healthcare facilities with home and everyday life settings barely addressed. As seen with the recent global SARS-CoV-2 pandemic, everyday hygiene measures can play an important role in containing the threat from infectious microorganisms. This position paper has been developed following a meeting of global experts in London, 2019. It presents evidence that home and community settings are important for infection transmission and also the acquisition and spread of AMR. It also demonstrates that the targeted hygiene approach offers a framework for maximizing protection against colonization and infections, thereby reducing antibiotic prescribing and minimizing selection pressure for the development of antibiotic resistance. If combined with the provision of clean water and sanitation, targeted hygiene can reduce the circulation of resistant bacteria in homes and communities, regardless of a country's Human Development Index (overall social and economic development). Achieving a reduction of AMR strains in healthcare settings requires a mirrored reduction in the community. The authors call upon national and international policy makers, health agencies and healthcare professionals to further recognize the importance of targeted hygiene in the home and everyday life settings for preventing and controlling infection, in a unified quest to tackle AMR.", "Increasing Temperature and Relative Humidity Accelerates Inactivation of SARS-CoV-2 on Surfaces Coronavirus disease 2019 (COVID-19) was first identified in China in late 2019 and is caused by newly identified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Previous studies had reported the stability of SARS-CoV-2 in cell culture media and deposited onto surfaces under a limited set of environmental conditions. Here, we broadly investigated the effects of relative humidity, temperature, and droplet size on the stability of SARS-CoV-2 in a simulated clinically relevant matrix dried on nonporous surfaces. The results show that SARS-CoV-2 decayed more rapidly when either humidity or temperature was increased but that droplet volume (1 to 50 \u00b5l) and surface type (stainless steel, plastic, or nitrile glove) did not significantly impact decay rate. At room temperature (24\u00b0C), virus half-life ranged from 6.3 to 18.6 h depending on the relative humidity but was reduced to 1.0 to 8.9 h when the temperature was increased to 35\u00b0C. These findings suggest that a potential for fomite transmission may persist for hours to days in indoor environments and have implications for assessment of the risk posed by surface contamination in indoor environments.IMPORTANCE Mitigating the transmission of SARS-CoV-2 in clinical settings and public spaces is critically important to reduce the number of COVID-19 cases while effective vaccines and therapeutics are under development. SARS-CoV-2 transmission is thought to primarily occur through direct person-to-person transfer of infectious respiratory droplets or through aerosol-generating medical procedures. However, contact with contaminated surfaces may also play a significant role. In this context, understanding the factors contributing to SARS-CoV-2 persistence on surfaces will enable a more accurate estimation of the risk of contact transmission and inform mitigation strategies. To this end, we have developed a simple mathematical model that can be used to estimate virus decay on nonporous surfaces under a range of conditions and which may be utilized operationally to identify indoor environments in which the virus is most persistent.", "An updated min-review on environmental route of the SARS-CoV-2 transmission The risk of newly emerging diseases is constantly present in a world where changes occur significantly in climatic, commercial, and ecological conditions, in addition to the development of biomedical investigations in new situations. An epidemic respiratory disease instigated by a new coronavirus was initially identified in and has resulted in the current global dissemination. This viral strain and its related disease has been termed \u201cSARS-CoV-2\u201d and \u201ccoronavirus disease 2019\u201d (abbreviated \u201cCOVID-19\u201d or \u201c2019-nCoV\u201d), respectively, which is transmitted simply between individuals. The World Health Organization (WHO) announced the COVID-19 outburst as a pandemic on March 11, which necessitates a cooperative endeavour globally for mitigating the spread of COVID-19. The absence of previous, and minimum present-day information, particularly concerning the path of contagion have precluded the control of this disease. The present article, therefore, describes the SARS-CoV-2 paths of contagion such as drinking water, solid waste, sewer water, ambient air, and the rest of emerging likely paths.", "Microbicides and the environmental control of nosocomial viral infections Abstract Viruses are important causes of acute and chronic diseases in humans. Newer viruses are still being discovered and those that are already known are being incriminated in the aetiology of clinical conditions with hitherto unknown causes. Apart from frequently causing infections in the general community, many types of viruses are also significant nosocomial pathogens. While it is generally agreed that we underestimate the proportion of nosocomial infections that are viral, due to a lack of routine monitoring, viruses easily account for more than 30% of the cases of hospital-acquired infections in many paediatric settings. Indeed, the relative importance of viruses in this respect is increasing due to a number of societal and demographic changes as well as alterations in healthcare practices. Safe vaccines against many common nosocomial viral agents are currently unavailable while there is also a virtual lack of effective and affordable chemotherapy against them. There is, therefore, renewed emphasis on preventive strategies by better understanding of the relative importance of various vehicles in the nosocomial spread of viruses and by infection control using microbicides. This, in turn, has stimulated considerable interest in the development of formulations that are not only safer but which also have demonstrated activity against major types of nosocomial viral pathogens. Further, much work is now underway to design better methods to assess the virucidal activity of microbicides used to decontaminate hands, reusable medical devices and environmental surfaces in critical areas of healthcare settings. It is anticipated that these approaches will result in reducing the health and economic impact of nosocomial infections due to viruses.", "COVID-19 and Laparoscopic Surgery: Scoping Review of Current Literature and Local Expertise BACKGROUND: The current coronavirus disease (COVID-19) pandemic is holding the world in its grip. Epidemiologists have shown that the mortality risks are higher when the health care system is subjected to pressure from COVID-19. It is therefore of great importance to maintain the health of health care providers and prevent contamination. An important group who will be required to treat patients with COVID-19 are health care providers during semiacute surgery. There are concerns that laparoscopic surgery increases the risk of contamination more than open surgery; therefore, balancing the safety of health care providers with the benefit of laparoscopic surgery for the patient is vital. OBJECTIVE: We aimed to provide an overview of potential contamination routes and possible risks for health care providers; we also aimed to propose research questions based on current literature and expert opinions about performing laparoscopic surgery on patients with COVID-19. METHODS: We performed a scoping review, adding five additional questions concerning possible contaminating routes. A systematic search was performed on the PubMed, CINAHL, and Embase databases, adding results from gray literature as well. The search not only included COVID-19 but was extended to virus contamination in general. We excluded society and professional association statements about COVID-19 if they did not add new insights to the available literature. RESULTS: The initial search provided 2007 records, after which 267 full-text papers were considered. Finally, we used 84 papers, of which 14 discussed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Eight papers discussed the added value of performing intubation in a low-pressure operating room, mainly based on the SARS outbreak experience in 2003. Thirteen papers elaborated on the risks of intubation for health care providers and SARS-CoV-2, and 19 papers discussed this situation with other viruses. They conclude that there is significant evidence that intubation and extubation is a high-risk aerosol-producing procedure. No papers were found on the risk of SARS-CoV-2 and surgical smoke, although 25 papers did provide conflicting evidence on the infection risk of human papillomavirus, hepatitis B, polio, and rabies. No papers were found discussing tissue extraction or the deflation risk of the pneumoperitoneum after laparoscopic surgery. CONCLUSIONS: There seems to be consensus in the literature that intubation and extubation are high-risk procedures for health care providers and that maximum protective equipment is needed. On the other hand, minimal evidence is available of the actual risk of contamination of health care providers during laparoscopy itself, nor of operating room pressure, surgical smoke, tissue extraction, or CO(2) deflation. However, new studies are being published daily from current experiences, and society statements are continuously updated. There seems to be no reason to abandon laparoscopic surgery in favor of open surgery. However, the risks should not be underestimated, surgery should be performed on patients with COVID-19 only when necessary, and health care providers should use logic and common sense to protect themselves and others by performing surgery in a safe and protected environment.", "Investigating SARS-CoV-2 surface and air contamination in an acute healthcare setting during the peak of the COVID-19 pandemic in London BACKGROUND: Evaluation of SARS-CoV-2 surface and air contamination during the COVID-19 pandemic in London. METHODS: We performed this prospective cross-sectional observational study in a multi-site London hospital. Air and surface samples were collected from seven clinical areas, occupied by patients with COVID-19, and a public area of the hospital. Three or four 1.0 m3 air samples were collected in each area using an active air sampler. Surface samples were collected by swabbing items in the immediate vicinity of each air sample. SARS-CoV-2 was detected by RT-qPCR and viral culture; the limit of detection for culturing SARS-CoV-2 from surfaces was determined. RESULTS: Viral RNA was detected on 114/218 (52.3%) of surfaces and 14/31 (38.7%) air samples but no virus was cultured. The proportion of surface samples contaminated with viral RNA varied by item sampled and by clinical area. Viral RNA was detected on surfaces and in air in public areas of the hospital but was more likely to be found in areas immediately occupied by COVID-19 patients than in other areas (67/105 (63.8%) vs. 29/64 (45.3%) (odds ratio 0.5, 95% confidence interval 0.2-0.9, p=0.025, Chi squared test)). The high PCR Ct value for all samples (>30) indicated that the virus would not be culturable. CONCLUSIONS: Our findings of extensive viral RNA contamination of surfaces and air across a range of acute healthcare settings in the absence of cultured virus underlines the potential risk from environmental contamination in managing COVID-19, and the need for effective use of PPE, physical distancing, and hand/surface hygiene.", "Survival of rhinoviruses on human fingers Abstract Rhinovirus is the main cause of the common cold, which remains the most frequent infection worldwide among humans. Knowledge and understanding of the rhinovirus transmission route is important to reduce morbidity as only preventive measures are effective. In this study, we investigated the potential of rhinovirus to survive on fingers. Rhinovirus-B14 was deposited on fingers for 30, 60, 90 and 120 min. Survival was defined as the ability of the virus to grow after 7 days, confirmed by immunofluorescence. Rhinovirus survival was not dependent on incubation time on fingers. Droplet disruption had no influence on survival. Survival was frequent with high rhinovirus concentrations, but rare with low-concentration droplets, which corresponded to the usual rhinovirus concentrations in mucus observed in children and adults, respectively. Our study confirms that rhinovirus infectiousness is related to the viral concentration in droplets and suggests that children represent the main transmission source, which occurs only rarely via adults. It confirms also that rhinovirus hand-related transmission is possible and supports hand hygiene as a key prevention measure.", "Detection of Severe Acute Respiratory Syndrome Coronavirus 2 RNA on Surfaces in Quarantine Rooms. We investigated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) environmental contamination in 2 rooms of a quarantine hotel after 2 presymptomatic persons who stayed there were laboratory-confirmed as having coronavirus disease. We detected SARS-CoV-2 RNA on 8 (36%) of 22 surfaces, as well as on the pillow cover, sheet, and duvet cover.", "The contribution of asymptomatic SARS-CoV-2 infections to transmission - a model-based analysis of the Diamond Princess outbreak Background: Some key gaps in the understanding of SARS-CoV-2 infection remain. One of them is the contribution to transmission from individuals experiencing asymptomatic infections. We aimed to characterise the proportion and infectiousness of asymptomatic infections using data from the outbreak on the Diamond Princess cruise ship. Methods: We used a transmission model of COVID-19 with asymptomatic and presymptomatic states calibrated to outbreak data from the Diamond Princess, to quantify the contribution of asymptomatic infections to transmission. Data available included the date of symptom onset for symptomatic disease for passengers and crew, the number of symptom agnostic tests done each day, and date of positive test for asymptomatic and presymptomatic individuals. Findings: On the Diamond Princess 74% (70-78%) of infections proceeded asymptomatically, i.e. a 1:3.8 case-to-infection ratio. Despite the intense testing 53%, (51-56%) of infections remained undetected, most of them asymptomatic. Asymptomatic individuals were the source for 69% (20-85%) of all infections. While the data did not allow identification of the infectiousness of asymptomatic infections, assuming no or low infectiousness resulted in posterior estimates for the net reproduction number of an individual progressing through presymptomatic and symptomatic stages in excess of 15. Interpretation: Asymptomatic SARS-CoV-2 infections may contribute substantially to transmission. This is essential to consider for countries when assessing the potential effectiveness of ongoing control measures to contain COVID-19.", "Understanding the Mosaic of COVID-19: A Review of the Ongoing Crisis In late 2019, a queer type of pneumonia emerged in Wuhan city in the central part of China. On investigation, it was found to be caused by the coronavirus. Human coronaviruses were discovered in the 1960s. There are a total of seven types of coronaviruses that infect humans: 229E and NL63 are the alpha coronaviruses; OC43, HKU1, MERS-CoV, and SARS-CoV are beta coronaviruses, and SARS-CoV-2 or COVID-19 is a novel coronavirus. COVID-19 surfaced in China at the culmination of the year 2019. The pandemic then fanned out rapidly, involving Italy, Japan, South Korea, Iran, and the rest of the world.", "Stability of SARS-CoV-2 on environmental surfaces and in human excreta At room temperature, SARS-CoV-2 was stable on environmental surfaces and remained viable up to 7 days on smooth surfaces. This virus could survive for several hours in feces and 3-4 days in urine.", "Factors affecting stability and infectivity of SARS-CoV-2 BACKGROUND: In late 2019, a novel human coronavirus, SARS-CoV-2, emerged in Wuhan, China. This virus has caused a global pandemic involving more than 200 countries. SARS-CoV-2 is highly adapted to humans and readily transmits from person-to-person. AIM: The aim of this study was to investigate the infectivity of SARS-CoV-2 under various environmental factors, disinfectants and different pH conditions. The efficacy of a variety of laboratory virus inactivation methods and home disinfectants against SARS-CoV-2 were investigated. METHODS: The residual virus in dried form or in solution was titrated on Vero E6 cell line at day 0, 1, 3, 5, and 7 after incubation at different temperatures. The viability of virus was determined after treatment with different disinfectants and pH solutions at room temperature (20\u00e2\u0088\u00bc25oC). FINDINGS: SARS-CoV-2 was able to retain viability for 3-5 days in dried form or 7 days in solution at room temperature. SARS-CoV-2 could be detected under a wide range of pH conditions from pH4 to pH11 for several days and 1 to 2 days in stool at room temperature but lost 5 logs of infectivity. A variety of commonly used disinfectants and laboratory inactivation procedures were found to reduce viral viability effectively. CONCLUSION: This study demonstrates the stability of SARS-CoV-2 on environmental surfaces and raises the possibility of faecal-oral transmission. Commonly used fixatives, nucleic acid extraction methods and heat inactivation were found to significantly reduce viral infectivity that could ensure hospital and laboratory safety during the COVID-19 pandemic.", "Inanimate surfaces as potential source of 2019-nCoV spread and their disinfection with biocidal agents The WHO has declared COVID-19 illness a global health concern which is caused by 2019-nCoV, causing severe respiratory tract infections in humans. Transmissibility among individual to individual have been reported through droplets and probably also via contaminated surfaces and hands. Human coronaviruses can persist on inanimate surfaces such as plastic, glass, fibers and metals up to nine days. 2019-nCoV remains infectious in air for 3 h and on inanimate surfaces such as cardboard, copper, plastic and steel up to 24, 4, 72 and 48 h respectively. Disinfectant activity of various biocidal agents against coronaviruses like ethanol (62\u201371%), sodium hypochlorite (0.1%) and hydrogen peroxide (0.5%) can be regarded effective against 2019-nCoV as well. As no vaccine and antiviral therapies have been discovered for 2019-nCoV, prevention of further spread will viable option to control the ongoing and future outbreaks.", "Perioperative Considerations in Urgent Surgical Care of Suspected and Confirmed Coronavirus Disease 2019 Orthopaedic Patients: Operating Room Protocols and Recommendations in the Current Coronavirus Disease 2019 Pandemic By April 7, 2020, severe acute respiratory syndrome coronavirus 2 was responsible for 1,383,436 confirmed cases of Coronavirus disease 2019 (COVID-19), involving 209 countries around the world; 378,881 cases have been confirmed in the United States. During this pandemic, the urgent surgical requirements will not stop. As an example, the most recent Centers of Disease Control and Prevention reports estimate that there are 2.8 million trauma patients hospitalized in the United States. These data illustrate an increase in the likelihood of encountering urgent surgical patients with either clinically suspected or confirmed COVID-19 in the near future. Preparation for a pandemic involves considering the different levels in the hierarchy of controls and the different phases of the pandemic. Apart from the fact that this pandemic certainly involves many important health, economic, and community ramifications, it also requires several initiatives to mandate what measures are most appropriate to prepare for mitigating the occupational risks. This article provides evidence-based recommendations and measures for the appropriate personal protective equipment for different clinical and surgical activities in various settings. To reduce the occupational risk in treating suspected or confirmed COVID-19 urgent orthopaedic patients, recommended precautions and preventive actions (triage area, ED consultation room, induction room, operating room, and recovery room) are reviewed.", "Factors involved in the aerosol transmission of infection and control of ventilation in healthcare premises Summary The epidemics of severe acute respiratory syndrome (SARS) in 2003 highlighted both short- and long-range transmission routes, i.e. between infected patients and healthcare workers, and between distant locations. With other infections such as tuberculosis, measles and chickenpox, the concept of aerosol transmission is so well accepted that isolation of such patients is the norm. With current concerns about a possible approaching influenza pandemic, the control of transmission via infectious air has become more important. Therefore, the aim of this review is to describe the factors involved in: (1) the generation of an infectious aerosol, (2) the transmission of infectious droplets or droplet nuclei from this aerosol, and (3) the potential for inhalation of such droplets or droplet nuclei by a susceptible host. On this basis, recommendations are made to improve the control of aerosol-transmitted infections in hospitals as well as in the design and construction of future isolation facilities.", "Anaesthesia and COVID-19: infection control Summary The world is currently facing an unprecedented healthcare crisis caused by a pandemic novel beta coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The pathogen is spread by human-to-human transmission via droplets exposure and contact transfer, causing mild symptoms in the majority of cases, but critical illness, bilateral viral pneumonia, and acute respiratory distress syndrome (ARDS) in a minority. Currently, controlling infection to prevent the spread of SARS-CoV-2 is the primary public healthcare intervention used. The pace of transmission and global scale of SARS-CoV-2 infections has implications for strategic oversight, resource management, and responsiveness in infection control. This article presents a summary of learning points in epidemiological infection control from the SARS epidemic, alongside a review of evidence connecting current understanding of the virologic and environmental contamination properties of SARS-CoV-2. We present suggestions for how personal protective equipment policies relate to the viral pandemic context and how the risk of transmission by and to anaesthetists, intensivists, and other healthcare workers can be minimised.", "Sustainability of Coronavirus on different surfaces Abstract COVID-19 is the name of the disease supposedly manifested in December 2019 from Wuhan, because of virus named as SARS-CoV-2. Now this disease has spread to almost all other parts of the world. COVID-19 pandemic has various reasons for its dramatic worldwide increase. Here, we have studied Coronavirus sustainability on various surfaces. Various disinfectants and their roles are discussed from the available literature. The infection capabilities of SARS-CoV-1 and SARS-CoV-2 for different materials are discussed and finally studies infection decay for SARS-CoV-1 and SARS-CoV-2.", "Experimental and numerical study of potential infection risks from exposure to bioaerosols in one BSL-3 laboratory Laboratory-acquired infections (LAIs) are defined as infections of laboratory staff by exposure to pathogenic microorganisms during an experimental procedure. For a biosafety level-3 (BSL-3) laboratory with a high potential of exposure, reducing risks and threats relevant to LAIs has become a critical concern, especially after the recent outbreak of Novel Coronavirus causing COVID-19 in Wuhan, China. This study aimed to investigate the spatial-temporal characteristics of bioaerosol dispersion and deposition of two kinds of bioaerosols (Serratia marcescens and phage \u03a6X174). A combination of laboratory experiment and numerical simulation was adopted to explore bioaerosol removal. Three-dimensional concentration iso-surface mapping in conjunction with flow field analysis was employed to elucidate bioaerosol migration and deposition behavior. The total deposition number and unit area deposition ratio were calculated for different surfaces. The results indicate that bioaerosol concentration remains stable for up to 400 s after release, and that almost 70% of all bioaerosol particles become deposited on the surfaces of walls and equipment. Vortex flow regions and high-concentration regions were determined, and the most severely contaminated surfaces and locations were identified. Our results could provide the scientific basis for controlling the time interval between different experiments and also provide guidelines for a laboratory disinfection routine. Furthermore, future work regarding laboratory layout optimization and high efficiency air distribution for bioaerosol removal in a BSL-3 laboratory should be emphasized.", "Lack of SARS-CoV-2 RNA environmental contamination in a tertiary referral hospital for infectious diseases in Northern Italy. ", "Understanding the indoor pre-symptomatic transmission mechanism of COVID-19 Discovering the mechanism that enables pre-symptomatic individuals to transmit the SARS-CoV-2 virus has a significant impact on the possibility of controlling COVID-19 pandemic. To this end, we have developed an evidence based quantitative mechanistic mathematical model. The model explicitly tracks the dynamics of contact and airborne transmission between individuals indoors, and was validated against the observed fundamental attributes of the epidemic, the secondary attack rate (SAR) and serial interval distribution. Using the model we identified the dominant driver of pre-symptomatic transmission, which was found to be contact route, while the contribution of the airborne route is negligible. We provide evidence that a combination of rather easy to implement measures of frequent hand washing, cleaning fomites and avoiding physical contact decreases the risk of infection by an order of magnitude, similarly to wearing masks and gloves.", "Presence of SARS-CoV-2 RNA in Isolation Ward Environment 28 Days after Exposure ", "Studies on the survival of canine coronavirus under different environmental conditions Abstract Canine coronavirus (CCV) is a common faecal agent which is difficult to isolate. This study shows CCV to survive well at temperatures below \u221220\u00b0C but not at temperatures above 4\u00b0C. The presence of faecal material markedly reduced CCV survival times at temperatures ranging from 20\u00b0C to \u221270\u00b0C. Thus, it is suggested that diagnostic faecal material should be diluted 1:10 (w/v) with growth medium and examined at the earliest opportunity.", "Coronaviruses widespread on nonliving surfaces: important questions and promising answers The world is facing, while writing this review, a global pandemic due to one of the types of the coronaviruses (i.e., COVID-19), which is a new virus. Among the most important reasons for the transmission of infection between humans is the presence of this virus active on the surfaces and materials. Here, we addressed important questions such as do coronaviruses remain active on the inanimate surfaces? Do the types of inanimate surfaces affect the activity of coronaviruses? What are the most suitable ingredients that used to inactivate viruses? This review article addressed many of the works that were done in the previous periods on the survival of many viruses from the coronaviruses family on various surfaces such as steel, glass, plastic, Teflon, ceramic tiles, silicon rubber and stainless steel copper alloys, Al surface, sterile sponges, surgical gloves and sterile latex. The impacts of environmental conditions such as temperature and humidity were presented and discussed. The most important active ingredients that can deactivate viruses on the surfaces were reported here. We hope that these active ingredients will have the same effect on COVID-19.", "Chapter 5 Virus Transmission and Epidemiology Abstract For transmission of a virus to occur, a virus must enter a host through a portal of entry, replicate or disseminate within the host, and be transmitted to a new host through a portal of exit. Unless delivered directly into bodily tissues through a bite or needle, most viruses interact with the epithelium at the site of entry. Localized infections replicate at the initial site of infection, while systemic infections spread to additional areas of the body. Viruses are shed into the environment most often through the same route they entered the body. The stability of virions within the environment is dependent upon virion and environmental factors. Epidemiology is the study of how diseases are transmitted through a population. Epidemiologists perform descriptive or analytic studies to characterize the chain of viral infection throughout a population and design control measures to interrupt it.", "An overview of COVID-19 Pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection emerged in Wuhan City, Hubei Province, China in December 2019. By Feb. 11, 2020, the World Health Organization (WHO) officially named the disease resulting from infection with SARS-CoV-2 as coronavirus disease 2019 (COVID-19). COVID-19 represents a spectrum of clinical manifestations that typically include fever, dry cough, and fatigue, often with pulmonary involvement. SARS-CoV-2 is highly contagious and most individuals within the population at large are susceptible to infection. Wild animal hosts and infected patients are currently the main sources of disease which is transmitted via respiratory droplets and direct contact. Since the outbreak, the Chinese government and scientific community have acted rapidly to identify the causative agent and promptly shared the viral gene sequence, and have carried out measures to contain the epidemic. Meanwhile, recent research has revealed critical aspects of SARS-CoV-2 biology and disease pathogenesis; other studies have focused on epidemiology, clinical features, diagnosis, management, as well as drug and vaccine development. This review aims to summarize the latest research findings and to provide expert consensus. We will also share ongoing efforts and experience in China, which may provide insight on how to contain the epidemic and improve our understanding of this emerging infectious disease, together with updated guidance for prevention, control, and critical management of this pandemic.", "Meteorological factors and domestic new cases of coronavirus disease (COVID-19) in nine Asian cities: A time-series analysis AIM To investigate the associations of meteorological factors and the daily new cases of coronavirus disease (COVID-19) in nine Asian cities. METHOD Pearson correlation and generalized additive modeling were performed to assess the relationships between daily new COVID-19 cases and meteorological factors (daily average temperature and relative humidity) with the most updated data currently available. RESULTS The Pearson correlation showed that daily new confirmed cases of COVID-19 were more correlated with the average temperature than with relative humidity. Daily new confirmed cases were negatively correlated with the average temperature in Beijing (r=-0.565, P<0.01), Shanghai (r=-0.471, P<0.01), and Guangzhou (r=-0.530, P<0.01) , yet in contrast, positively correlated with that in Japan (r=0.441, P<0.01). In most of the cities (Shanghai, Guangzhou, Hong Kong, Seoul, Tokyo, and Kuala Lumpur), generalized additive modeling analysis showed the number of daily new confirmed cases was positively associated with both average temperature and relative humidity, especially in lagged 3d model, where a positive influence of temperature on the daily new confirmed cases was discerned in 5 cities except in Beijing, Wuhan, Korea, and Malaysia. Nevertheless, the results were inconsistent across cities and lagged time, suggesting meteorological factors were unlikely to greatly influence the COVID-19 epidemic. CONCLUSION The associations between meteorological factors and the number of COVID-19 daily cases are inconsistent across cities and lagged time. Large-scale public health measures and expanded regional research are still required until a vaccine becomes available and herd immunity is established.", "Weathering the pandemic: How the Caribbean Basin can use viral and environmental patterns to predict, prepare and respond to COVID\u201019 The 2020 coronavirus pandemic is developing at different paces throughout the world. Some areas, like the Caribbean Basin, have yet to see the virus strike at full force. When it does, there is reasonable evidence to suggest the consequent COVID\u201019 outbreaks will overwhelm healthcare systems and economies. This is particularly concerning in the Caribbean as pandemics can have disproportionately higher mortality impacts on lower and middle income countries. Preliminary observations from our team and others suggest that temperature and climatological factors could influence the spread of this novel coronavirus, making spatiotemporal predictions of its infectiousness possible. This review studies geographic and time\u2010based distribution of known respiratory viruses in the Caribbean Basin in an attempt to foresee how the pandemic will develop in this region. This review is meant to aid in planning short\u2010 and long\u2010term interventions to manage outbreaks at the international, national and sub\u2010national levels in the region. This article is protected by copyright. All rights reserved.", "How Ophthalmologists Should Understand and Respond to the Current Epidemic of Novel Coronavirus Pneumonia (COVID-19)/ \u4e2d\u534e\u5b9e\u9a8c\u773c\u79d1\u6742\u5fd7 The new coronavirus pneumonia that first appeared in Wuhan, China, in December 2019 has attracted great attention from both the Chinese government and the international community. The International Committee on Viral Classification named the virus &quot;Severe Acute Respiratory Syndrome Coronavirus 2&quot; (SARS-CoV-2), and the WHO named the pneumonia it causes &quot;Coronavirus Disease 2019&quot; (COVID-19). At present, the disease is centered in Wuhan City and is spreading rapidly to all parts of China, as well as twenty other countries. About 20% of the people infected during the SARS epidemic in 2003 were employees in hospital environments. COVID-19 has infected an even greater number of heath care workers. Therefore, ophthalmologists need to understand the disease and recognize the importance of taking preventive measures. Although ophthalmologists do not work on the front lines of the outbreak, due to their area of expertise, a variety of situations, such as infection consultations or ophthalmic emergency treatments, can lead to the exposure of ophthalmologists to high-risk environments. This risk will only increase as the number of infected patients continues to increase. When dealing with seemingly normal ophthalmic patients, the vigilance of ophthalmologists and associated staff tends to be significantly reduced. To better protect patients, families, and health care workers, it is strongly recommended that in addition to the standard precautions for the care of all patients, strict contact precautions and droplet precautions need to be taken by ophthalmologists. These measures include 1) wearing an efficient mask (an N95 mask); 2) always performing hand hygiene before and after examining a patient; (3) wearing sterile gloves when entering a patient\u2019s room and touching a patient; (4) wearing a gown when contact is expected with items and environmental surfaces surrounding a patient or when the patient is incontinent or has diarrhea or a surgical or other invasive wound with oozing fluid; 5) cleaning and disinfecting ophthalmic equipment and correctly handling medical waste after examination to prevent transmission to patients who are subsequently examined; 6) wearing goggles and a disposable mask to cover the front and sides of the face before touching a patient, as the virus could spread through the ocular surface; 7) performing the relevant screening for novel coronavirus pneumonia for regular patients who have conjunctivitis and respiratory symptoms at the same time; 8) prohibiting the use of infected patients as potential donors for corneal transplants and temporarily adding donor SARS-CoV-2 screening to the medical standard of the eye bank during the outbreak; and 9) for the purposes of scientific research, diagnosis, and other special needs, packing, shipping, and transporting collected specimens according to the relevant dangerous biological goods regulations.", "Optimal temperature zone for the dispersal of COVID-19 It is essential to know the environmental parameters within which the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can survive to understand its global dispersal pattern. We found that 60.0% of the confirmed cases of coronavirus disease 2019 (COVID-19) occurred in places where the air temperature ranged from 5 \u00b0C to 15 \u00b0C, with a peak in cases at 11.54 \u00b0C. Moreover, approximately 73.8% of the confirmed cases were concentrated in regions with absolute humidity of 3 g/m3 to 10 g/m3. SARS-CoV-2 appears to be spreading toward higher latitudes. Our findings suggest that there is an optimal climatic zone in which the concentration of SARS-CoV-2 markedly increases in the ambient environment (including the surfaces of objects). These results strongly imply that the COVID-19 pandemic may spread cyclically and outbreaks may recur in large cities in the mid-latitudes in autumn 2020.", "Surface Disinfection The patient-care areas in a dental setting become contaminated with bacterial and viral pathogens during patient treatment. Incorporating standard precautions set forth by CDC and OSHA guidelines will reduce the risk of disease transmission. Contaminated environmental surfaces, including clinical contact and housekeeping surfaces, become a reservoir of infectious material with the potential to spread an infection to health-care personnel and patients. Transmission of pathogens can occur by direct or indirect contact of clinical contact surfaces and the hands of health-care personnel. Proper infection control protocol of these surfaces includes cleaning, disinfecting, and the use of barriers to prevent the spread of infectious pathogens. This chapter will provide an overview of the disinfection protocol of environmental surfaces in the dental setting. The topics include the various chemical formulations of hospital disinfectants and their proper use, as well as physical barriers that aim to reduce the degree of contamination in the dental treatment area thus decreasing the probability of cross-infection and disease transmission.", "Environmental investigation of respiratory pathogens during the Hajj 2016 and 2018 Abstract Background Respiratory tract infections are common in the context of the Hajj pilgrimage and respiratory pathogens can be transmitted via contact with contaminated surfaces. We sampled surfaces during the Hajj to detect the presence of respiratory bacteria and viruses. Methods Frequently touched surfaces at Mecca, Mina, Arafat and Medina were sampled. The common respiratory pathogens were tested by qPCR. Results 70/142 (49.3%) environmental samples collected were positive for at least one respiratory pathogen. Among the positive samples, Klebsiella pneumoniae was the bacterium most frequently tested positive (57.1%), followed by Streptococcus pneumoniae (12.9%), Staphylococcus aureus (10.0%) and Haemophilus influenzae (7.1%). 32.9% positive samples tested positive for rhinovirus and 1.4% for coronavirus. Surfaces with the highest rates of positive samples were kitchen tables (100%), water fountain faucet (73.3%) and edge of water coolers lid (84.6%). Samples collected in Mina were the most frequently contaminated with 68.8% being positive for at least one pathogen and 18.8% positive for a combination of multiple pathogens. Conclusion These preliminary results indicate that respiratory pathogens are common in environmental surfaces from areas frequented by Hajj pilgrims. Further larger-scale studies are needed to better assess the possible role of environmental respiratory pathogens in respiratory infections in Hajj pilgrims.", "Air and surface measurements of SARS-CoV-2 inside a bus during normal operation Transmission pathways of SARS-CoV-2 are through aerosol, droplet and touching infected material. Indoor locations are more likely environments for the diffusion of the virus contagion among people, but direct detection of SARS-CoV-2 in air or on surfaces is quite sparse, especially regarding public transport. In fact, an important demand is to know how and if it is safe to use them. To understand the possible spreading of COVID-19 inside a city bus during normal operation and the effectiveness of the protective measures adopted for transportation, we analysed the air and the surfaces most usually touched by passengers. The measurements were carried out across the last week of the lockdown and the first week when gradually all the travel restrictions were removed.", "Air and environmental sampling for SARS-CoV-2 around hospitalized patients with coronavirus disease 2019 (COVID-19) BACKGROUND: The role of severe respiratory coronavirus virus 2 (SARS-CoV-2)\u2013laden aerosols in the transmission of coronavirus disease 2019 (COVID-19) remains uncertain. Discordant findings of SARS-CoV-2 RNA in air samples were noted in early reports. METHODS: Sampling of air close to 6 asymptomatic and symptomatic COVID-19 patients with and without surgical masks was performed with sampling devices using sterile gelatin filters. Frequently touched environmental surfaces near 21 patients were swabbed before daily environmental disinfection. The correlation between the viral loads of patients\u2019 clinical samples and environmental samples was analyzed. RESULTS: All air samples were negative for SARS-CoV-2 RNA in the 6 patients singly isolated inside airborne infection isolation rooms (AIIRs) with 12 air changes per hour. Of 377 environmental samples near 21 patients, 19 (5.0%) were positive by reverse-transcription polymerase chain reaction (RT-PCR) assay, with a median viral load of 9.2 \u00d7 10(2) copies/mL (range, 1.1 \u00d7 10(2) to 9.4 \u00d7 10(4) copies/mL). The contamination rate was highest on patients\u2019 mobile phones (6 of 77, 7.8%), followed by bed rails (4 of 74, 5.4%) and toilet door handles (4 of 76, 5.3%). We detected a significant correlation between viral load ranges in clinical samples and positivity rate of environmental samples (P < .001). CONCLUSION: SARS-CoV-2 RNA was not detectable by air samplers, which suggests that the airborne route is not the predominant mode of transmission of SARS-CoV-2. Wearing a surgical mask, appropriate hand hygiene, and thorough environmental disinfection are sufficient infection control measures for COVID-19 patients isolated singly in AIIRs. However, this conclusion may not apply during aerosol-generating procedures or in cohort wards with large numbers of COVID-19 patients.", "Stability of SARS coronavirus in human specimens and environment and its sensitivity to heating and UV irradiation. OBJECTIVE The causal agent for SARS is considered as a novel coronavirus that has never been described both in human and animals previously. The stability of SARS coronavirus in human specimens and in environments was studied. METHODS Using a SARS coronavirus strain CoV-P9, which was isolated from pharyngeal swab of a probable SARS case in Beijing, its stability in mimic human specimens and in mimic environment including surfaces of commonly used materials or in household conditions, as well as its resistance to temperature and UV irradiation were analyzed. A total of 10(6) TCID50 viruses were placed in each tested condition, and changes of the viral infectivity in samples after treatments were measured by evaluating cytopathic effect (CPE) in cell line Vero-E6 at 48 h after infection. RESULTS The results showed that SARS coronavirus in the testing condition could survive in serum, 1:20 diluted sputum and feces for at least 96 h, whereas it could remain alive in urine for at least 72 h with a low level of infectivity. The survival abilities on the surfaces of eight different materials and in water were quite comparable, revealing reduction of infectivity after 72 to 96 h exposure. Viruses stayed stable at 4 degrees C, at room temperature (20 degrees C) and at 37 degrees C for at least 2 h without remarkable change in the infectious ability in cells, but were converted to be non-infectious after 90-, 60- and 30-min exposure at 56 degrees C, at 67 degrees C and at 75 degrees C, respectively. Irradiation of UV for 60 min on the virus in culture medium resulted in the destruction of viral infectivity at an undetectable level. CONCLUSION The survival ability of SARS coronavirus in human specimens and in environments seems to be relatively strong. Heating and UV irradiation can efficiently eliminate the viral infectivity.", "Study on the resistance of severe acute respiratory syndrome-associated coronavirus Abstract In this study, the persistence of severe acute respiratory syndrome-associated coronavirus (SARS-CoV) was observed in feces, urine and water. In addition, the inactivation of SARS-CoV in wastewater with sodium hypochlorite and chlorine dioxide was also studied. In vitro experiments demonstrated that the virus could only persist for 2 days in hospital wastewater, domestic sewage and dechlorinated tap water, while 3 days in feces, 14 days in PBS and 17 days in urine at 20\u00b0C. However, at 4\u00b0C, the SARS-CoV could persist for 14 days in wastewater and at least 17 days in feces or urine. SARS-CoV is more susceptible to disinfectants than Escherichia coli and f2 phage. Free chlorine was found to inactivate SARS-CoV better than chlorine dioxide. Free residue chlorine over 0.5mg/L for chlorine or 2.19mg/L for chlorine dioxide in wastewater ensures complete inactivation of SARS-CoV while it does not inactivate completely E. coli and f2 phage.", "Scientific Opinion on an update on the present knowledge on the occurrence and control of foodborne viruses A review of the biology, epidemiology, diagnosis and public health importance of foodborne viruses was performed. Data needs to support a risk assessment were also identified. In addition possible control options and their anticipated impact to prevent or reduce the number of foodborne viral human infections were identified, including the scientific reasons for and against the establishment of food safety criteria and process hygiene criteria for viruses for certain food categories. Food may be contaminated by virus during all stages of the food supply chain, and transmission can occur by consumption of food contaminated during the production process (primary production, or during further processing), or contaminated by infected food handlers. Transmission of zoonotic viruses (e.g. HEV) can also occur by consumption of products of animal origin. Viruses do not multiply in foods, but may persist for extended periods of time as infectious particles in the environment, or in foods. At the EU\u2010level it is unknown how much viral disease can be attributed to foodborne spread. The relative contribution of different sources (shellfish, fresh produce, food handler including asymptomatic shedders, food handling environment) to foodborne illness has not been determined. The Panel recommends focusing controls on preventive measures to avoid viral contamination rather than trying to remove/inactivate these viruses from food. Also, it is recommended to introduce a microbiological criteria for viruses in bivalve molluscs, unless they are labelled \u201cto be cooked before consumption\u201d. The criteria could be used by food business operators to validate their control options. Furthermore, it is recommended to refine the regulatory standards and monitoring approaches in order to improve public health protection. Introduction of virus microbiological criteria for classification of bivalve molluscs production areas should be considered. A virus monitoring programme for compliance with these criteria should be risk based according to the findings of a sanitary survey.", "A Surface Coating that Rapidly Inactivates SARS-CoV-2. SARS-CoV-2, the virus that causes the disease COVID-19, remains viable on solids for periods of up to one week, so one potential route for human infection is via exposure to an infectious dose from a solid. We have fabricated and tested a coating that is designed to reduce the longevity of SARS-CoV-2 on solids. The coating consists of cuprous oxide (Cu2O) particles bound with polyurethane. After one hour on coated glass or stainless steel, the viral titer was reduced by about 99.9% on average compared to the uncoated sample. An advantage of a polyurethane-based coating is that polyurethane is already used to coat a large number of everyday objects. Our coating adheres well to glass and stainless steel, as well as everyday items that people may fear to touch during a pandemic, such as a doorknob, a pen, and a credit card keypad button. The coating performs well in the cross-hatch durability test and remains intact and active after 13 days immersed in water, or after exposure to multiple cycles of exposure to virus and disinfection.", "Being a front-line dentist during the Covid-19 pandemic: a literature review Coronavirus is an enveloped virus with positive-sense single-stranded RNA. Coronavirus infection in humans mainly affects the upper respiratory tract and to a lesser extent the gastrointestinal tract. Clinical symptoms of coronavirus infections can range from relatively mild (similar to the common cold) to severe (bronchitis, pneumonia, and renal involvement). The disease caused by the 2019 novel coronavirus (2019-nCoV) was called Covid-19 by the World Health Organization in February 2020. Face-to-face communication and consistent exposure to body fluids such as blood and saliva predispose dental care workers at serious risk for 2019-nCoV infection. As demonstrated by the recent coronavirus outbreak, information is not enough. During dental practice, blood and saliva can be scattered. Accordingly, dental practice can be a potential risk for dental staff, and there is a high risk of cross-infection. This article addresses all information collected to date on the virus, in accordance with the guidelines of international health care institutions, and provides a comprehensive protocol for managing possible exposure to patients or those suspected of having coronavirus.", "Povidone-Iodine Demonstrates Rapid In Vitro Virucidal Activity Against SARS-CoV-2, The Virus Causing COVID-19 Disease INTRODUCTION: As of 22 June 2020, Severe Acute Respiratory Syndrome (SARS)-coronavirus (CoV)-2 has infected more than 8.95 million people worldwide, causing > 468,000 deaths. The virus is transmitted through respiratory droplets and physical contact from contaminated surfaces to the mucosa. Hand hygiene and oral decontamination among other measures are key to preventing the spread of the virus. We report the in vitro virucidal activity of topical and oral povidone-iodine (PVP-I) products against SARS-CoV-2. METHODS: Suspension assays were used to assess the virucidal activity of PVP-I against SARS-CoV-2. Products were tested at a contact time of 30 s for virucidal activity. Viral titres were calculated using the Spearman\u2013K\u00e4rber method and reported as median tissue culture infectious dose (TCID(50))/mL. RESULTS: All four products [antiseptic solution (PVP-I 10%), skin cleanser (PVP-I 7.5%), gargle and mouth wash (PVP-I 1%) and throat spray (PVP-I 0.45%)] achieved \u2265 99.99% virucidal activity against SARS-CoV-2, corresponding to \u2265 4 log(10) reduction of virus titre, within 30 s of contact. CONCLUSION: This study provides evidence of rapid and effective virucidal activity of PVP-I against SARS-CoV-2. PVP-I-based products are widely available for medical and personal use for hand hygiene and oral decontamination, and could be readily integrated into coronavirus disease, COVID-19, infection control measures in hospital and community settings. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40121-020-00316-3) contains supplementary material, which is available to authorized users.", "Aerodynamic Characteristics and RNA Concentration of SARS-CoV-2 Aerosol in Wuhan Hospitals during COVID-19 Outbreak Background The ongoing outbreak of COVID-19 has spread rapidly and sparked global concern. While the transmission of SARS-CoV-2 through human respiratory droplets and contact with infected persons is clear, the aerosol transmission of SARS-CoV-2 has been little studied. Methods Thirty-five aerosol samples of three different types (total suspended particle, size segregated and deposition aerosol) were collected in Patient Areas (PAA) and Medical Staff Areas (MSA) of Renmin Hospital of Wuhan University (Renmin) and Wuchang Fangcang Field Hospital (Fangcang), and Public Areas (PUA) in Wuhan, China during COVID-19 outbreak. A robust droplet digital polymerase chain reaction (ddPCR) method was employed to quantitate the viral SARS-CoV-2 RNA genome and determine aerosol RNA concentration. Results The ICU, CCU and general patient rooms inside Renmin, patient hall inside Fangcang had undetectable or low airborne SARS-CoV-2 concentration but deposition samples inside ICU and air sample in Fangcang patient toilet tested positive. The airborne SARS-CoV-2 in Fangcang MSA had bimodal distribution with higher concentration than those in Renmin during the outbreak but turned negative after patients number reduced and rigorous sanitization implemented. PUA had undetectable airborne SARS-CoV-2 concentration but obviously increased with accumulating crowd flow. Conclusions Room ventilation, open space, proper use and disinfection of toilet can effectively limit aerosol transmission of SARS-CoV-2. Gathering of crowds with asymptomatic carriers is a potential source of airborne SARS-CoV-2. The virus aerosol deposition on protective apparel or floor surface and their subsequent resuspension is a potential transmission pathway and effective sanitization is critical in minimizing aerosol transmission of SARS-CoV-2.", "Viral contamination of aerosol and surfaces through toilet use in health care and other settings BACKGROUND: The airborne spreading of enteric viruses can occur through the aerosol and droplets produced by toilet flushing. These can contaminate the surrounding environment, but few data exist to estimate the risk of exposure and infection. For this reason environmental monitoring of air and selected surfaces was carried out in 2 toilets of an office building and in 3 toilets of a hospital before and after cleaning operations. METHODS: To reveal the presence of norovirus, enterovirus, rhinovirus, human rotavirus, and Torque teno virus and to quantify human adenovirus and bacteria counts, molecular and cultural methods were used. RESULTS: On the whole, viruses were detected on 78% of surfaces and in 81% of aerosol. Among the researched viruses, only human adenovirus and Torque teno virus were found in both surface and air samples. In several cases the same adenovirus strain was concurrently found in all matrices. Bacterial counts were unrelated to viral presence and cleaning did not seem to substantially reduce contamination. CONCLUSIONS: The data collected in our study confirm that toilets are an important source of viral contamination, mainly in health care settings, where disinfection can have a crucial role in preventing virus spread.", "SARS-CoV-2 infection: the environmental endurance of the virus can be influenced by the increase of temperature The COVID-19 disease, a respiratory disease transmitted by a new betacoronavirus SARS-CoV-2. As for other viral respiratory agents, SARS-CoV-2 spreads by person to person through respiratory droplets and direct contact and potentially by indirect contact through fomites. The goal of the current study is to evaluate whether the increase of temperature can influence the environmental endurance of SARS-CoV-2.We tested SARS-CoV-2 environmental stability in parallel at room temperature (RT, 20-25 Celsius degrees) and at average maximum temperature of June (JT) estimated at 28 Celsius degrees in Italy. The virus inoculated on plastic surface was harvested at predefined time-points and tested to evaluate viral titres on Vero cells by TCID50. Our results confirm that fomite transmission of the emerging SARS-CoV2 is possible, since the virus remains viable on surfaces up to 84 hours at both RT and JT. Moreover, a remarkable difference between the two temperatures exists, suggesting that virus vitality can be influenced by the environmental temperature. Our results support the hypothesis that in the hot season the increase of temperature could influence the environmental endurance of SARS-CoV2 and reduce Covid-19 transmission probability.", "Survival of Severe Acute Respiratory Syndrome Coronavirus Background. The primary modes of transmission of severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV) appear to be direct mucus membrane contact with infectious droplets and through exposure to formites. Knowledge of the survival characteristics of the virus is essential for formulating appropriate infection-control measures. Methods. Survival of SARS-CoV strain GVU6109 was studied in stool and respiratory specimens. Survival of the virus on different environmental surfaces, including a laboratory request form, an impervious disposable gown, and a cotton nondisposable gown, was investigated. The virucidal effects of sodium hypochlorite, house detergent, and a peroxygen compound (Virkon S; Antec International) on the virus were also studied. Results. SARS-CoV GVU6109 can survive for 4 days in diarrheal stool samples with an alkaline pH, and it can remain infectious in respiratory specimens for >7 days at room temperature. Even at a relatively high concentration (10(4) tissue culture infective doses/mL), the virus could not be recovered after drying of a paper request form, and its infectivity was shown to last longer on the disposable gown than on the cotton gown. All disinfectants tested were shown to be able to reduce the virus load by >3 log within 5 min. Conclusions. Fecal and respiratory samples can remain infectious for a long period of time at room temperature. The risk of infection via contact with droplet-contaminated paper is small. Absorbent material, such as cotton, is preferred to nonabsorptive material for personal protective clothing for routine patient care where risk of large spillage is unlikely. The virus is easily inactivated by commonly used disinfectants.", "Respiratory Tract Viral Infections ", "Stability and Viability of SARS-CoV-2 ", "Temporary carriage of bovine coronavirus and bovine respiratory syncytial virus by fomites and human nasal mucosa after exposure to infected calves BACKGROUND: In order to prevent spread of the endemic pathogens bovine coronavirus (BCoV) and bovine respiratory syncytial virus (BRSV) between herds, knowledge of indirect transmission by personnel and fomites is fundamental. The aims of the study were to determine the duration of viral RNA carriage and the infectivity of viral particles on fomites and human nasal mucosa after exposure to BCoV and BRSV. During two animal infection experiments, swabs were collected from personnel (nasal mucosa) and their clothes, boots and equipment after contact with calves shedding either virus. Viral RNA was quantified by RT-qPCR or droplet digital RT-PCR (RT-ddPCR), and selected samples with high levels of viral RNA were tested by cell culture for infectivity. RESULTS: For BCoV, 46% (n = 80) of the swabs from human nasal mucosa collected 30 min after exposure were positive by RT-qPCR. After two, four and six hours, 15%, 5% and 0% of the swabs were positive, respectively. Infective virions were not detected in mucosal swabs (n = 2). A high viral RNA load was detected on 97% (n = 44) of the fomites 24 h after exposure, and infective virions were detected in two of three swabs. For BRSV, 35% (n = 26) of the human nasal mucosa swabs collected 30 min after exposure, were positive by RT-ddPCR, but none were positive for infective virions. Of the fomites, 89% (n = 38) were positive for BRSV RNA 24 h after exposure, but all were negative for infective viruses. CONCLUSIONS: The results indicate that human nasal mucosa can carry both BCoV and BRSV RNA after exposure to virus shedding calves, but the carriage seems short-lived and the transmission potential is likely limited. High viral loads on contaminates fomites 24 h after exposure to infected animals, and detection of infective BCoV, indicate that contaminated fomites represent a significant risk for indirect transmission between herds.", "Molecular mechanism of evolution and human infection with the novel coronavirus (2019-nCoV) Since December, 2019, an outbreak of pneumonia caused by the new coronavirus (2019-nCoV) has hit the city of Wuhan in the Hubei Province. With the continuous development of the epidemic, it has become a national public health crisis and calls for urgent antiviral treatments or vaccines. The spike protein on the coronavirus envelope is critical for host cell infection and virus vitality. Previous studies showed that 2019-nCoV is highly homologous to human SARS-CoV and attaches host cells though the binding of the spike receptor binding domain (RBD) domain to the angiotensin-converting enzyme II (ACE2). However, the molecular mechanisms of 2019-nCoV binding to human ACE2 and evolution of 2019-nCoV remain unclear. In this study, we have extensively studied the RBD-ACE2 complex, spike protein, and free RBD systems of 2019-nCoV and SARS-CoV using protein-protein docking and molecular dynamics (MD) simulations. It was shown that the RBD-ACE2 binding free energy for 2019-nCoV is significantly lower than that for SARS-CoV, which is consistent with the fact that 2019-nCoV is much more infectious than SARS-CoV. In addition, the spike protein of 2019-nCoV shows a significantly lower free energy than that of SARS-CoV, suggesting that 2019-nCoV is more stable and able to survive a higher temperature than SARS-CoV. This may also provide insights into the evolution of 2019-nCoV because SARS-like coronaviruses are thought to have originated in bats that are known to have a higher body-temperature than humans. It was also revealed that the RBD of 2019-nCoV is much more flexible especially near the binding site and thus will have a higher entropy penalty upon binding ACE2, compared to the RBD of SARS-CoV. That means that 2019-nCoV will be much more temperature-sensitive in terms of human infection than SARS-CoV. With the rising temperature, 2019-nCoV is expected to decrease its infection ability much faster than SARS-CoV, and get controlled more easily. The present findings are expected to be helpful for the disease prevention and control as well as drug and vaccine development of 2019-nCoV.", "Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1 A novel human coronavirus, now named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, referred to as HCoV-19 here) that emerged in Wuhan, China in late 2019 is now causing a pandemic. Here, we analyze the aerosol and surface stability of HCoV-19 and compare it with SARS-CoV-1, the most closely related human coronavirus.2 We evaluated the stability of HCoV-19 and SARS-CoV-1 in aerosols and on different surfaces and estimated their decay rates using a Bayesian regression model", "Sampling methods for recovery of human enteric viruses from environmental surfaces Abstract Acute gastroenteritis causes the second highest infectious disease burden worldwide. Human enteric viruses have been identified as leading causative agents of acute gastroenteritis as well as foodborne illnesses in the U.S. and are generally transmitted by fecal-oral contamination. There is growing evidence of transmission occurring via contaminated fomite including food contact surfaces. Additionally, human enteric viruses have been shown to remain infectious on fomites over prolonged periods of time. To better understand viral persistence, there is a need for more studies to investigate this phenomenon. Therefore, optimization of surface sampling methods is essential to aid in understanding environmental contamination to ensure proper preventative measures are being applied. In general, surface sampling studies are limited and highly variable among recovery efficiencies and research parameters used (e.g., virus type/density, surface type, elution buffers, tools). This review aims to discuss the various factors impacting surface sampling of viruses from fomites and to explore how researchers could move towards a more sensitive and standard sampling method.", "Survival of surrogate coronaviruses in water Abstract The emergence of a previously unknown coronavirus infection, Severe Acute Respiratory Syndrome (SARS), demonstrated that fecally contaminated liquid droplets are a potential vehicle for the spread of a respiratory virus to large numbers of people. To assess potential risks from this pathway, there is a need for surrogates for SARS coronavirus to provide representative data on viral survival in contaminated water. This study evaluated survival of two surrogate coronaviruses, transmissible gastroenteritis (TGEV) and mouse hepatitis (MHV). These viruses remained infectious in water and sewage for days to weeks. At 25\u00b0C, time required for 99% reduction in reagent-grade water was 22 days for TGEV and 17 days for MHV. In pasteurized settled sewage, times for 99% reduction were 9 days for TGEV and 7 days for MHV. At 4\u00b0C, there was <1log10 infectivity decrease for both viruses after four weeks. Coronaviruses can remain infectious for long periods in water and pasteurized settled sewage, suggesting contaminated water is a potential vehicle for human exposure if aerosols are generated.", "Characterization of a novel, low-cost, scalable ozone gas system for sterilization of N95 respirators and other COVID-19 related use cases. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an elusive and highly pathogenic agent, has resulted in the ongoing COVID-19 pandemic affecting numerous populations worldwide. New studies investigating the tenacity of SARS-CoV-2 have highlighted its ability to persist on a myriad of surfaces for several days, including gowns and shoes. As a result, there is a global need for sterilization of a variety of potentially-contaminated items, ranging from clothing to personal protective equipment like face coverings. To this end, we have designed and constructed a cost-effective, scalable, and sustainable sterilization system that uses ozone gas to inactivate viral particles. We sought to determine the efficacy of the system in the sterilization of viral particles as well as its ability to sterilize N95 respirators for reuse. N95 respirators inoculated with P22 bacteriophage and sterilized in the ozone system showed a 6-log10 reduction in viral load when treated at 25 ppm for 150 minutes. Further, N95 respirators treated with five 150-minute cycles at 35 ppm for a total concentration-time product (CT) of 26,250 ppm*min in the ozone system showed comparable filtration efficiency to untreated N95 respirators in a 50 to 200 nmr particulate challenge filtration test. Interestingly, the surgical N95 respirators tested showed complete inactivation of fluid resistance and degradation of the elasticity of polyisoprene straps after five cycles in the sterilization system. Taken together, these data suggest that while our ozone system may negatively affect certain protective aspects of surgical N95 respirators, it does effectively sterilize viral particles and can be utilized for a multitude of other use cases, including sterilizing polypropylene face coverings after potential SARS-CoV-2 contamination. In addition to providing long-term environmental benefits, deployment of this system during the ongoing pandemic reduces the risk of COVID-19 community transmission while conserving monetary resources otherwise spent on the continuous purchase of disposable face coverings.", "Should I be worried about carrying the virus that causes COVID\u201019 home on my clothes? ", "Severe acute respiratory syndrome coronavirus 2 RNA contamination of inanimate surfaces and virus viability in a health care emergency unit OBJECTIVES: To detect possible severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA contamination of inanimate surfaces in areas at high risk of aerosol formation by patients with coronavirus disease 2019 (COVID-19). METHODS: Sampling was performed in the emergency unit and the sub-intensive care ward. SARS-CoV-2 RNA was extracted from swabbed surfaces and objects and subjected to real-time RT-PCR targeting RNA-dependent RNA polymerase and E genes. Virus isolation from positive samples was attempted in vitro on Vero E6 cells. RESULTS: Twenty-six samples were collected and only two were positive for low-level SARS-CoV-2 RNA, both collected on the external surface of continuous positive airway pressure helmets. All transport media were inoculated onto susceptible cells, but none induced a cytopathic effect on day 7 of culture. CONCLUSIONS: Even though daily contact with inanimate surfaces and patient fomites in contaminated areas may be a medium of infection, our data obtained in real-life conditions suggest that it might be less extensive than hitherto recognized.", "Minimization of spreading of SARS-CoV-2 via household waste produced by subjects affected by COVID-19 or in quarantine Abstract Currently available evidence supports that the predominant route of human-to-human transmission of the SARS-CoV-2 is through respiratory droplets. Indirect hands contact with surfaces contaminated by infectious droplets subsequently touching the mouth, nose or eyes seems to be another route of an indirect contact transmission. Persistence of the virus on different surfaces and other materials has been reported in recent studies: SARS-CoV-2 was more stable on plastic and stainless steel than on copper and cardboard. Viable virus was detected up to 72 h after application to different surfaces, although infectivity decay was also observed. This evidence suggests the likelihood that waste generated from patients affected by COVID-19 or subjects in quarantine treated in private houses or in areas different from hospitals and medical centres could be contaminated by SARS-CoV-2. Consequently, waste streams may represent a route for viral spreading being a potential risk also for the operators directly involved in the different phases of waste management. To address this concern, a specific multidisciplinary working group was settled by the Italian National Institute of Health (ISS) during the COVID-19 emergency, in order to establish guidelines related to solid waste collection, delivering, withdrawal, transport, treatment and disposal. Temporary stop of waste sorting, instructions for the population on how to package waste, instructions for Companies and operators for the adoption of adequate personal protection equipment (PPE), the use and sanitation of proper vehicles were among the main recommendations provided to the community by publications of freely downloadable reports and infographics in layman language. Incineration, sterilization and properly managed landfills were identified as the facilities to be preferentially adopted for the treatment of this kind of waste, considering the main inactivation strategies of SARS-CoV-2 (e.g. treatment length > 9 days and temperature > 70 \u00b0C for more than 5 min).", "Coronavirus Infection in Cats Cats are susceptible to natural infection with several strains of feline coronavirus that result in either effusive and noneffusive feline infectious peritonitis or enteritis. Excretion of coronavirus by infected cats into the environment occurs by way of feces, oronasal secretions, and possibly urine. Clinical diagnosis of coronavirus infection is made by evaluating the case history, physical findings, laboratory results, and coronavirus antibody titers as well as ruling out analogous diseases. An intranasal temperature-sensitive feline infectious peritonitis coronavirus vaccine is available for use in healthy cats 16 weeks of age or older.", "Does COVID-19 Spread Through Droplets Alone? ", "An Opportunistic Pathogen Afforded Ample Opportunities: Middle East Respiratory Syndrome Coronavirus The human coronaviruses (CoV) include HCoV-229E, HCoV-OC43, HCoV-NL63, and HCoV-HKU1, some of which have been known for decades. The severe acute respiratory syndrome (SARS) CoV briefly emerged into the human population but was controlled. In 2012, another novel severely human pathogenic CoV\u2014the Middle East Respiratory Syndrome (MERS)-CoV\u2014was identified in the Kingdom of Saudi Arabia; 80% of over 2000 human cases have been recorded over five years. Targeted research remains key to developing control strategies for MERS-CoV, a cause of mild illness in its camel reservoir. A new therapeutic toolbox being developed in response to MERS is also teaching us more about how CoVs cause disease. Travel-related cases continue to challenge the world\u2019s surveillance and response capabilities, and more data are needed to understand unexplained primary transmission. Signs of genetic change have been recorded, but it remains unclear whether there is any impact on clinical disease. How camels came to carry the virus remains academic to the control of MERS. To date, human-to-human transmission has been inefficient, but virus surveillance, characterisation, and reporting are key to responding to any future change. MERS-CoV is not currently a pandemic threat; it is spread mainly with the aid of human habit and error.", "Distributions and risks of SARS-CoV-2 in hospital outdoor environment The outbreak of coronavirus infectious disease-2019 (COVID-19) pneumonia since 2019 has rapidly spread throughout over 200 countries around the world. Till 14th May 2020, there are over 4 million confirmed cases and 300,000 deaths globally. To date, numerous studies focus on the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in indoor areas for its main transmission routes via human respiratory droplets and direct contact. It remains unclear about the distribution and transmission risks of SARS-CoV-2 in outdoor environment despite its threats to healthy people and communities. Here, we investigated the presence of SARS-CoV-2 virus in 73 specimens from outdoor environment of three hospitals in Wuhan. We found SARS-CoV-2 in soils (205-550 copies/g), wastewaters (255 to 1.9x104 copies/L) and aerosols (285-1130 copies/m3) in locations close to departments receiving COVID-19 patients or in wastewater treatment sectors, which revealed significant viral spill-over in hospital outdoor environment that was possibly via respiratory droplets from patients or airborne aerosols from wastewater containing SARS-CoV-2. In contrast, SARS-CoV-2 was not detected in other areas or on surfaces with regular disinfection. Soils eventually behave as viral receptors through deposition and potentially a secondary source spreading SARS-CoV-2 for a prolonged time. Our findings map the high-risk areas in hospital outdoor environment possessing spread risks of SARS-CoV-2, which require particular attention and complete sanitation for preventing SARS-CoV-2 outdoor transmission.", "Management of the SARS-CoV-2 (Covid 19) coronavirus epidemic in hemodialysis units Summary The current outbreak of SARS-CoV-2 represents a special risk for renal patients due to their comorbidities and advanced age. The usual performance of hemodialysis treatment s in collective rooms increases the risk. The specific information at this time in this regard is very limited. This manuscript includes a proposal for action to prevent infection in the N ephrology S ervices, and in particular in H emodialysis U nits, with the objective of early identification of patients who meet the definition of a suspected case of infection by SARS-CoV-2 and propose circuits and mechanisms to carry out hemodialysis treatment s. They are recommendations in continuous review and can be modified if the epidemiological situation, the diagnostic and therapeutic options so require.", "Efficacy of various disinfectants against SARS coronavirus Summary The recent severe acute respiratory syndrome (SARS) epidemic in Asia and Northern America led to broad use of various types of disinfectant in order to control the public spread of the highly contagious virus. However, only limited data were available to demonstrate their efficacy against SARS coronavirus (SARS-CoV). We therefore investigated eight disinfectants for their activity against SARS-CoV according to prEN 14476. Four hand rubs were tested at 30s (Sterillium, based on 45% iso-propanol, 30% n-propanol and 0.2% mecetronium etilsulphate; Sterillium Rub, based on 80% ethanol; Sterillium Gel, based on 85% ethanol; Sterillium Virugard, based on 95% ethanol). Three surface disinfectants were investigated at 0.5% for 30min and 60min (Mikrobac forte, based on benzalkonium chloride and laurylamine; Kohrsolin FF, based on benzalkonium chloride, glutaraldehyde and didecyldimonium chloride; Dismozon pur, based on magnesium monoperphthalate), and one instrument disinfectant was investigated at 4% for 15min, 3% for 30min and 2% for 60min [Korsolex basic, based on glutaraldehyde and (ethylenedioxy)dimethanol]. Three types of organic load were used: 0.3% albumin, 10% fetal calf serum, and 0.3% albumin with 0.3% sheep erythrocytes. Virus titres were determined by a quantitative test (endpoint titration) in 96-well microtitre plates. With all tested preparations, SARS-CoV was inactivated to below the limit of detection (reduction factor mostly \u22654), regardless of the type of organic load. In summary, SARS-CoV can be inactivated quite easily with many commonly used disinfectants.", "Current knowledge of COVID-19 and infection prevention and control strategies in healthcare settings: A global analysis OBJECTIVE: In the current absence of a vaccine for COVID-19, public health responses aim to break the chain of infection by focusing on the mode of transmission. We reviewed the current evidence on the transmission dynamics and on pathogenic and clinical features of COVID-19 to critically identify any gaps in the current infection prevention and control (IPC) guidelines. METHODS: In this study, we reviewed global COVID-19 IPC guidelines by organizations such as the World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC), and the European Centre for Disease Prevention and Control (ECDC). Guidelines from 2 high-income countries (Australia and United Kingdom) and from 1 middle-income country (China) were also reviewed. We searched publications in English on \u2018PubMed\u2019 and Google Scholar. We extracted information related to COVID-19 transmission dynamics, clinical presentations, and exposures that may facilitate transmission. We then compared these findings with the recommended IPC measures. RESULTS: Nosocomial transmission of SARS-CoV-2 in healthcare settings occurs through droplets, aerosols, and the oral\u2013fecal or fecal\u2013droplet route. However, the IPC guidelines fail to cover all transmission modes, and the recommendations also conflict with each other. Most guidelines recommend surgical masks for healthcare providers during routine care and N95 respirators for aerosol-generating procedures. However, recommendations regarding the type of face mask varied, and the CDC recommends cloth masks when surgical masks are unavailable. CONCLUSION: IPC strategies should consider all the possible routes of transmission and should target all patient care activities involving risk of person-to-person transmission. This review may assist international health agencies in updating their guidelines.", "SARS-CoV-2 and Coronavirus Disease 2019: What We Know So Far In December 2019, a cluster of fatal pneumonia cases presented in Wuhan, China. They were caused by a previously unknown coronavirus. All patients had been associated with the Wuhan Wholefood market, where seafood and live animals are sold. The virus spread rapidly and public health authorities in China initiated a containment effort. However, by that time, travelers had carried the virus to many countries, sparking memories of the previous coronavirus epidemics, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), and causing widespread media attention and panic. Based on clinical criteria and available serological and molecular information, the new disease was called coronavirus disease of 2019 (COVID-19), and the novel coronavirus was called SARS Coronavirus-2 (SARS-CoV-2), emphasizing its close relationship to the 2002 SARS virus (SARS-CoV). The scientific community raced to uncover the origin of the virus, understand the pathogenesis of the disease, develop treatment options, define the risk factors, and work on vaccine development. Here we present a summary of current knowledge regarding the novel coronavirus and the disease it causes.", "Transmission of SARS-CoV-2 via fecal-oral and aerosols\u2013borne routes: Environmental dynamics and implications for wastewater management in underprivileged societies Abstract The advent of novel human coronavirus (SARS-CoV-2) and its potential transmission via fecal-oral and aerosols-borne routes are upcoming challenges to understand the fate of the virus in the environment. In this short communication, we specifically looked at the possibilities of these transmission routes based on the available literature directly related to the SARS-CoV-2 as well as on the closer phylogenetic relatives such as SARS-CoV-1. The available data suggest that, in addition to human-to-human contact, the virus may spread via fecal-oral and aerosols-borne routes. Existing knowledge states that coronaviruses have low stability in the environment due to the natural action of oxidants that disrupt the viral envelope. Previous recommended dosage of chlorination has been found to be not sufficient to inactivate SARS-CoV-2 in places where viral load is high such as hospitals and airports. Although there is no current evidence showing that coronaviruses can be transmitted through contaminated drinking water, there is a growing concern on the impact of the current pandemic wave on underprivileged societies because of their poor wastewater treatment infrastructures, overpopulation, and outbreak management strategies. More research is encouraged to trace the actual fate of SARS-CoV-2 in the environment and to develop/revise the disinfection strategies accordingly.", "COVID-19: A Risk Assessment Perspective [Image: see text] COVID-19 is a newly emerging viral respiratory disease first identified in Wuhan, China, in December 2019. The disease is caused by the coronavirus SARS-CoV-2, which is related to the viruses that cause SARS and MERS. While the case fatality ratio for COVID-19 (5%) is far lower than that for SARS (11%) and MERS (34%), COVID-19 is spreading relatively uncontrolled at this time across the globe. In contrast, SARS appears to be contained, and MERS is controlled. This paper will explore why COVID-19 is able to progress to a global pandemic that affects our daily lives to an extent not known in recent history. The COVID-19 outbreak and spread will be examined based on the current literature, using a researcher\u2019s perspective of risk assessment and risk mitigation; this approach will be related to public health.", "High Temperature and High Humidity Reduce the Transmission of COVID-19 With the ongoing global pandemic of COVID-19, a question is whether the coming summer in the northern hemisphere will reduce the transmission intensity of COVID-19 with increased humidity and temperature. In this paper, we investigate this problem using the data from the cases with symptom-onset dates from January 19 to February 10, 2020 for 100 Chinese cities, and cases with confirmed dates from March 15 to April 25 for 1,005 U.S. counties. Statistical analysis is performed to assess the relationship between the transmissibility of COVID-19 and the temperature/humidity, by controlling for various demographic, socio-economic, geographic, healthcare and policy factors and correcting for cross-sectional correlation. We find a similar influence of the temperature and relative humidity on effective reproductive number (R values) of COVID-19 for both China and the U.S. before lockdown in both countries: one-degree Celsius increase in temperature reduces R value by about 0.023 (0.026 (95% CI [-0.0395,-0.0125]) in China and 0.020 (95% CI [-0.0311, -0.0096]) in the U.S.), and one percent relative humidity rise reduces R value by 0.0078 (0.0076 (95% CI [-0.0108,-0.0045]) in China and 0.0080 (95% CI [-0.0150,-0.0010]) in the U.S.). If assuming a 30 degree and 25 percent increase in temperature and relative humidity from winter to summer in the northern hemisphere, we expect the R values to decline about 0.89 (0.69 by temperature and 0.20 by humidity). Given the notion that the non-intervened R values are around 2.5 to 3, only weather factors cannot make the R values below their critical condition of R<1, under which the epidemic diminishes gradually. Therefore, public health intervention such as social distancing is crucial to block the transmission of COVID-19 even in summer.", "An overview of coronaviruses including the SARS-2 coronavirus \u2013 Molecular biology, epidemiology and clinical implications Abstract Coronavirus infections have emerged as epidemic and pandemic threats in last two decades. After the H1N1 influenza pandemic in 2009, recently diagnosed novel betacoronavirus or severe acute respiratory syndrome coronavirus (SARS-CoV)-2 has spread across 203 countries and territories in all 5 major continents. World Health Organization (WHO) declared this as a public health emergency of international concern on January 30, 2020. Subsequently on February 11, 2020 a new name was given to this disease i.e. COVID-19 by an expert group from WHO. As of April 12, 2020, 10:00 CET, GMT+2:00, 1,696,588 confirmed cases and 105,952 confirmed deaths have been reported to the WHO. (Coronavirus disease 2019, situation report 83). It possibly originated from a small animal market in Wuhan, China. A cluster of patients were admitted with unusual pneumonia not responding to treatment in various hospitals. Epidemiological, genomic analysis and correlation with other coronaviruses led to the isolation of new coronavirus, closely resembling the bat coronaviruses, from such patients in Wuhan. They were identified as the SARS-CoV-2. This virus infection presents as influenza like illness in the affected people. Fever, cough, respiratory distress with fatigue, diarrhea, nausea and vomiting are common symptoms seen in adults. This may progress on to respiratory distress, hypoxia, need for oxygen supplementation and ventilator support as seen in patients in the SARS-CoV-1 epidemic (2003) in Guangdong, China. The transmissibility of SARS-CoV-1 was less as compared to SARS-CoV-2 infection, and it was well controlled with good public health efforts. The present COVID-19 epidemic is still in the acceleration phase of 3 and 4 in various countries. Without any effective antiviral agents available at present, the need of the hour is early case detection, isolation of cases, use of good preventive care measures by the household contacts and in the hospital set up. The results of ongoing clinical trials on hydroxychloroquine, azithromycin alone or in combination and a new antiviral agent remdesivir may help to treat some of the infections. A need for effective vaccine is being seen an as good preventive strategy in this pandemic. However the results of clinical trials and incorporation of vaccines in public health programs is a long way to go.", "Evaluation of an Electrostatic Spray Disinfectant Technology for Rapid Decontamination of Portable Equipment and Large Open Areas in the Era of SARS-CoV-2 In the setting of the coronavirus disease 2019 pandemic, efficient methods are needed to decontaminate shared portable devices and large open areas such as waiting rooms. We found that wheelchairs, portable equipment, and waiting room chairs were frequently contaminated with potential pathogens. After minimal manual pre-cleaning of areas with visible soiling, application of a dilute sodium hypochlorite disinfectant using an electrostatic sprayer provided rapid and effective decontamination and eliminated the benign virus bacteriophage MS2 from inoculated surfaces.", "Letter to the Editor Regarding: \u201cAn Imperative Need for Research on the Role of Environmental Factors in Transmission of Novel Coronavirus (COVID-19)\u201d \u2014Secondhand and Thirdhand Smoke As Potential Sources of COVID-19 ", "Experimental and numerical study of potential infection risks from exposure to bioaerosols in one BSL-3 laboratory Laboratory-acquired infections (LAIs) are defined as infections of laboratory staff by exposure to pathogenic microorganisms during an experimental procedure. For a biosafety level-3 (BSL-3) laboratory with a high potential of exposure, reducing risks and threats relevant to LAIs has become a critical concern, especially after the recent outbreak of Novel Coronavirus causing COVID-19 in Wuhan, China. This study aimed to investigate the spatial-temporal characteristics of bioaerosol dispersion and deposition of two kinds of bioaerosols (Serratia marcescens and phage &#934;X174). A combination of laboratory experiment and numerical simulation was adopted to explore bioaerosol removal. Three-dimensional concentration iso-surface mapping in conjunction with flow field analysis was employed to elucidate bioaerosol migration and deposition behavior. The total deposition number and unit area deposition ratio were calculated for different surfaces. The results indicate that bioaerosol concentration remains stable for up to 400 s after release, and that almost 70% of all bioaerosol particles become deposited on the surfaces of walls and equipment. Vortex flow regions and high-concentration regions were determined, and the most severely contaminated surfaces and locations were identified. Our results could provide the scientific basis for controlling the time interval between different experiments and also provide guidelines for a laboratory disinfection routine. Furthermore, future work regarding laboratory layout optimization and high efficiency air distribution for bioaerosol removal in a BSL-3 laboratory should be emphasized.", "Soft matter science and the COVID-19 pandemic Much of the science underpinning the global response to the COVID-19 pandemic lies in the soft matter domain. Coronaviruses are composite particles with a core of nucleic acids complexed to proteins surrounded by a protein-studded lipid bilayer shell. A dominant route for transmission is via air-borne aerosols and droplets. Viral interaction with polymeric body fluids, particularly mucus, and cell membranes control their infectivity, while their interaction with skin and artificial surfaces underpins cleaning and disinfection and the efficacy of masks and other personal protective equipment. The global response to COVID-19 has highlighted gaps in the soft matter knowledge base. We survey these gaps and suggest questions that can (and need to) be tackled, both in response to COVID-19 and to better prepare for future viral pandemics.", "Spread of SARS-CoV-2 Coronavirus likely to be constrained by climate As new cases of COVID-19 are being confirmed pressure is mounting to increase understanding of the factors underlying the spread the disease. Using data on local transmissions until the 23rd of March 2020, we develop an ensemble of 200 ecological niche models to project monthly variation in climate suitability for spread of SARS-CoV-2 throughout a typical climatological year. Although cases of COVID-19 are reported all over the world, most outbreaks display a pattern of clustering in relatively cool and dry areas. The predecessor SARS-CoV-1 was linked to similar climate conditions. Should the spread of SARS CoV-2 continue to follow current trends, asynchronous seasonal global outbreaks could be expected. According to the models, temperate warm and cold climates are more favorable to spread of the virus, whereas arid and tropical climates are less favorable. However, model uncertainties are still high across much of sub- Saharan Africa, Latin America and South East Asia. While models of epidemic spread utilize human demography and mobility as predictors, climate can also help constrain the virus. This is because the environment can mediate human-to-human transmission of SARS-CoV-2, and unsuitable climates can cause the virus to destabilize quickly, hence reducing its capacity to become epidemic.", "Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations Abstract This document outlines recommendations for physiotherapy management for COVID-19 in the acute hospital setting. It includes: recommendations for physiotherapy workforce planning and preparation; a screening tool for determining requirement for physiotherapy; and recommendations for the selection of physiotherapy treatments and personal protective equipment. It is intended for use by physiotherapists and other relevant stakeholders in the acute care setting caring for adult patients with confirmed or suspected COVID-19.", "SARS-CoV-2 (COVID-19) by the numbers The COVID-19 pandemic is a harsh reminder of the fact that, whether in a single human host or a wave of infection across continents, viral dynamics is often a story about the numbers. In this article we provide a one-stop, curated graphical source for the key numbers (based mostly on the peer-reviewed literature) about the SARS-CoV-2 virus that is responsible for the pandemic. The discussion is framed around two broad themes: i) the biology of the virus itself; ii) the characteristics of the infection of a single human host.", "Severe acute respiratory syndrome (SARS) in intensive care units (ICUs): limiting the risk to healthcare workers Abstract The global epidemic of severe acute respiratory syndrome (SARS) during the first half of 2003 resulted in over 8000 cases with more than 800 deaths. Many of those who eventually died, did so in the critical (intensive) care units of various hospitals around the world, and many secondary cases of SARS arose in healthcare workers looking after such patients in these units. Research on SARS coronavirus (SARS CoV) demonstrated that this virus belongs to the same family of viruses, the Coronaviridae that causes the common cold, with some important differences. Properties of this virus have been discovered which can be used to develop important infection control policies within hospitals to limit the number of secondary cases. These properties include environmental survival, transmissibility, viral load in various organs and fluids and periods of symptomatic illness during which infectivity is greatest. Various barrier methods were used throughout the epidemic to protect healthcare workers from SARS, with varying degrees of success. Treatment of SARS patients has mainly involved steroid therapy, with or without ribavirin, but there is no consensus on the best treatment protocol, as yet. This review focuses on the implications of SARS for healthcare workers and patients on critical care units.", "2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings ", "Coronavirus disease 2019 (COVID-19): A literature review Abstract In early December 2019, an outbreak of coronavirus disease 2019 (COVID-19), caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), occurred in Wuhan City, Hubei Province, China. On January 30, 2020 the World Health Organization declared the outbreak as a Public Health Emergency of International Concern. As of February 14, 2020, 49,053 laboratory-confirmed and 1,381 deaths have been reported globally. Perceived risk of acquiring disease has led many governments to institute a variety of control measures. We conducted a literature review of publicly available information to summarize knowledge about the pathogen and the current epidemic. In this literature review, the causative agent, pathogenesis and immune responses, epidemiology, diagnosis, treatment and management of the disease, control and preventions strategies are all reviewed.", "A COVID-19 epidemic model integrating direct and fomite transmission as well as household structure This paper stresses its base contribution on a new SIR-type model for COVID-19 including direct and fomite transmission as well as the effect of distinct household structures. To what extent increasing the physical-distancing-related contact radius and enhancing mass control (public curfew, lockdown, workplace clearance, and school closure) reduce the number of predicted active cases is studied via parameter estimation.", "Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents Summary Currently, the emergence of a novel human coronavirus, SARS-CoV-2, has become a global health concern causing severe respiratory tract infections in humans. Human-to-human transmissions have been described with incubation times between 2-10 days, facilitating its spread via droplets, contaminated hands or surfaces. We therefore reviewed the literature on all available information about the persistence of human and veterinary coronaviruses on inanimate surfaces as well as inactivation strategies with biocidal agents used for chemical disinfection, e.g. in healthcare facilities. The analysis of 22 studies reveals that human coronaviruses such as Severe Acute Respiratory Syndrome (SARS) coronavirus, Middle East Respiratory Syndrome (MERS) coronavirus or endemic human coronaviruses (HCoV) can persist on inanimate surfaces like metal, glass or plastic for up to 9 days, but can be efficiently inactivated by surface disinfection procedures with 62\u201371% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite within 1 minute. Other biocidal agents such as 0.05\u20130.2% benzalkonium chloride or 0.02% chlorhexidine digluconate are less effective. As no specific therapies are available for SARS-CoV-2, early containment and prevention of further spread will be crucial to stop the ongoing outbreak and to control this novel infectious thread.", "COVID-19 and ENT Surgery ABSTRACT In Otorhinolaryngology - Head and Neck Surgery, clinical examination and invasive procedures on the respiratory tract and on airway-connected cavities such as paranasal sinuses and the middle ear expose people to direct transmission of SARS-CoV-2 by inhalation or ocular projection of contaminated droplets, and to indirect transmission by contact with contaminated hands, objects or surfaces. Estimating an R0 of Covid-19 at around 3 justified postponing non-urgent face-to-face consultations and expanding the use of teleconsultation in order to limit the risks of SARS-CoV-2 infection of patients or health workers and comply with the lockdown. The health authority recommends cancellation of all medical or surgical activities which are not urgent as long as this does not involve a loss of chance for the patient. The purpose of this cancellation is to significantly increase critical care capacity, prioritize the reception of patients with Covid-19, prioritize the allocation of staff and provision of the equipment necessary for their medical or surgical management, and contribute to the smooth running of downstream critical care within their establishment. Another goal is to reduce the risks of patient contamination within healthcare facilities. This document provides guidance on how to proceed with and adapt ENT surgery in the current pandemic context, as well as on the management of postponed operations. This best practice advice must of course be adapted in each region according to the development of the epidemic and pre-existing arrangements. Their local application can only be decided within the framework of collaboration between the ENT teams, the operational hygiene units and all the other specialties concerned.", "Isolation and identification of human coronavirus 229E from frequently touched environmental surfaces of a university classroom that is cleaned daily Frequently touched surfaces of a university classroom that is cleaned daily contained viable human coronavirus 229E (CoV-229E). Tests of a CoV-229E laboratory strain under conditions that simulated the ambient light, temperature, and relative humidity conditions of the classroom revealed that some of the virus remained viable on various surfaces for 7 days, suggesting CoV-229E is relatively stable in the environment. Our findings reinforce the notion that contact transmission may be possible for this virus.", "Novel Coronavirus Disease (COVID-19) The present outbreak of the novel coronavirus initially called as \u201c2019 novel coronavirus\u201d or \u201c2019-nCoV\u201d by the World Health Organization (WHO), is also known as \u201cWuhan coronavirus\u201d or \u201cWuhan pneumonia\u201d, as it started in the Wuhan city of China in early December of 2019. This new coronavirus-associated acute respiratory deadly disease is now officially named as Corona Virus Disease-19 (COVID-19) by the WHO. From China, this epidemic has now spread to all over the world. On 11 March 2020, the WHO recognised COVID-19 as a pandemic. A pandemic refers to a disease that has spread to several countries, continents, if not worldwide. While the information available on this newly identified virus is limited and evolving, here is a quick run-down of what has been figured out so far.", "Factors affecting stability and infectivity of SARS-CoV-2 BACKGROUND: In late 2019, a novel human coronavirus, SARS-CoV-2, emerged in Wuhan, China. This virus has caused a global pandemic involving more than 200 countries. SARS-CoV-2 is highly adapted to humans and readily transmits from person-to-person. AIM: The aim of this study was to investigate the infectivity of SARS-CoV-2 under various environmental factors, disinfectants and different pH conditions. The efficacy of a variety of laboratory virus inactivation methods and home disinfectants against SARS-CoV-2 were investigated. METHODS: The residual virus in dried form or in solution was titrated on Vero E6 cell line at day 0, 1, 3, 5, and 7 after incubation at different temperatures. The viability of virus was determined after treatment with different disinfectants and pH solutions at room temperature (20\u223c25(o)C). FINDINGS: SARS-CoV-2 was able to retain viability for 3-5 days in dried form or 7 days in solution at room temperature. SARS-CoV-2 could be detected under a wide range of pH conditions from pH4 to pH11 for several days and 1 to 2 days in stool at room temperature but lost 5 logs of infectivity. A variety of commonly used disinfectants and laboratory inactivation procedures were found to reduce viral viability effectively. CONCLUSION: This study demonstrates the stability of SARS-CoV-2 on environmental surfaces and raises the possibility of faecal-oral transmission. Commonly used fixatives, nucleic acid extraction methods and heat inactivation were found to significantly reduce viral infectivity that could ensure hospital and laboratory safety during the COVID-19 pandemic.", "A multi-scale model of virus pandemic: Heterogeneous interactive entities in a globally connected world This paper is devoted to the multidisciplinary modelling of a pandemic initiated by an aggressive virus, specifically the so-called \\textit{SARS--CoV--2 Severe Acute Respiratory Syndrome, corona virus n.2}. The study is developed within a multiscale framework accounting for the interaction of different spatial scales, from the small scale of the virus itself and cells, to the large scale of individuals and further up to the collective behaviour of populations. An interdisciplinary vision is developed thanks to the contributions of epidemiologists, immunologists and economists as well as those of mathematical modellers. The first part of the contents is devoted to understanding the complex features of the system and to the design of a modelling rationale. The modelling approach is treated in the second part of the paper by showing both how the virus propagates into infected individuals, successfully and not successfully recovered, and also the spatial patterns, which are subsequently studied by kinetic and lattice models. The third part reports the contribution of research in the fields of virology, epidemiology, immune competition, and economy focused also on social behaviours. Finally, a critical analysis is proposed looking ahead to research perspectives.", "Solar ultraviolet radiation sensitivity of SARS-CoV-2 ", "Protection and disinfection policies against SARS-CoV-2 (COVID-19). In late December 2019, reports from China of the incidence of pneumonia with unknown etiology were sent to the World Health Organization (WHO). Shortly afterwards, the cause of this disease was identified as the novel beta-coronavirus, SARS-CoV-2, and its genetic sequence was published on January 12, 2020. Human-to-human transmission via respiratory droplets and contact with aerosol infected surfaces are the major ways of transmitting this virus. Here we attempted to collect information on virus stability in the air and on surfaces and ways of preventing of SARS-CoV-2 spreading.", "Coronavirus SARS\u2010CoV\u20102: filtering fact from fiction in the infodemic: Q&A with virologist Professor Urs Greber As the severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) continues to spread across the world, and the associated lung disease COVID-19 remains difficult to treat, information from media and private communication flows at high speed, often through unfiltered channels. Much of this information is speculative, as it derives from preliminary and inconclusive studies, and creates confusion as well as anxiety. This phenomenon was recently labelled as \"infodemic\" by the World Health Organization.", "SARS in Hospital Emergency Room Thirty-one cases of severe acute respiratory syndrome (SARS) occurred after exposure in the emergency room at the National Taiwan University Hospital. The index patient was linked to an outbreak at a nearby municipal hospital. Three clusters were identified over a 3-week period. The first cluster (5 patients) and the second cluster (14 patients) occurred among patients, family members, and nursing aids. The third cluster (12 patients) occurred exclusively among healthcare workers. Six healthcare workers had close contact with SARS patients. Six others, with different working patterns, indicated that they did not have contact with a SARS patient. Environmental surveys found 9 of 119 samples of inanimate objects to be positive for SARS coronavirus RNA. These observations indicate that although transmission by direct contact with known SARS patients was responsible for most cases, environmental contamination with the SARS coronavirus may have lead to infection among healthcare workers without documented contact with known hospitalized SARS patients.", "Persistence of SARS-CoV-2 in the environment and COVID-19 transmission risk from environmental matrices and surfaces() The Coronavirus disease 2019 (COVID-19) is spreading around the world, representing a global pandemic, counting, as of June 5th, 2020, over 6,600,000 confirmed cases and more than 390,000 deaths, with exponentially increasing numbers. In the first half of 2020, because of the widespread of the COVID-19, researches were focused on the monitoring of SARS-CoV-2 in water, wastewater, sludge, air, and on surfaces, in order to assess the risk of contracting the viral infection from contaminated environments. So far, the survival of the novel Coronavirus out of the human body has been reported for short time periods (from hours to few days, in optimized in vitro conditions), mainly because of the need of an host organism which could consent the viral attack, and due to the weak external membrane of the virus. SARS-CoV-2 viral shedding strategies in the environment, either through animate and unanimate matrices, or exploiting the organic matter in water, wastewater, and waste in general, have been discussed in the present article. We concluded that, besides the high infectuousness of the novel Coronavirus, the transmission of the pathogen may be efficiently contained applying the adequate preventive measures (e.g., personal protection equipments, and disinfecting agents), indicated by national and international health authories.", "Reusable and Recyclable Graphene Masks with Outstanding Superhydrophobic and Photothermal Performances The 2019 coronavirus outbreak (COVID-19) is affecting over 210 countries and territories, and it is spreading mainly by respiratory droplets. The use of disposable surgical masks is common for patients, doctors, and even the general public in highly risky areas. However, the current surgical masks cannot self-sterilize in order to reuse or be recycled for other applications. The resulting high economic and environmental costs are further damaging societies worldwide. Herein, we reported a unique method for functionalizing commercially available surgical masks with outstanding self-cleaning and photothermal properties. A dual-mode laser-induced forward transfer method was developed for depositing few-layer graphene onto low-melting temperature nonwoven masks. Superhydrophobic states were observed on the treated masks' surfaces, which can cause the incoming aqueous droplets to bounce off. Under sunlight illumination, the surface temperature of the functional mask can quickly increase to over 80 \u00b0C, making the masks reusable after sunlight sterilization. In addition, this graphene-coated mask can be recycled directly for use in solar-driven desalination with outstanding salt-rejection performance for long-term use. These roll-to-roll production-line-compatible masks can provide us with better protection against this severe virus. The environment can also benefit from the direct recycling of these masks, which can be used for desalinating seawater.", "Clinical Data on Hospital Environmental Hygiene Monitoring and Medical Staff Protection during the Coronavirus Disease 2019 Outbreak Background: The outbreak of coronavirus disease 2019 (COVID-19) has placed unprecedented challenges on hospital environmental hygiene and medical staff protection. It is crucial to assess hospital environmental hygiene to understand the most important environmental issues for controlling the spread of COVID-19 in hospitals. Objective: To detect the presence of COVID-19 in the samples from the area at risk of contamination in the First Hospital of Jilin University. Methods: Viruses in the air were collected by natural sedimentation and air particle sampler methods. Predetermined environmental surfaces were sampled using swabs at seven o'clock in the morning before disinfection. The real-time reverse-transcription PCR method was used to detect the existence of COVID-19 pathogens. Results: Viruses could be detected on the surfaces of the nurse station in the isolation area with suspected patients and in the air of the isolation ward with an intensive care patient. Conclusion: Comprehensive monitoring of hospital environmental hygiene during pandemic outbreaks is conducive to the refinement of hospital infection control. It is of great significance to ensure the safety of medical treatment and the quality of hospital infection control through the monitoring of environmental hygiene.", "Transmission routes of 2019-nCoV and controls in dental practice A novel \u03b2-coronavirus (2019-nCoV) caused severe and even fetal pneumonia explored in a seafood market of Wuhan city, Hubei province, China, and rapidly spread to other provinces of China and other countries. The 2019-nCoV was different from SARS-CoV, but shared the same host receptor the human angiotensin-converting enzyme 2 (ACE2). The natural host of 2019-nCoV may be the bat Rhinolophus affinis as 2019-nCoV showed 96.2% of whole-genome identity to BatCoV RaTG13. The person-to-person transmission routes of 2019-nCoV included direct transmission, such as cough, sneeze, droplet inhalation transmission, and contact transmission, such as the contact with oral, nasal, and eye mucous membranes. 2019-nCoV can also be transmitted through the saliva, and the fetal\u2013oral routes may also be a potential person-to-person transmission route. The participants in dental practice expose to tremendous risk of 2019-nCoV infection due to the face-to-face communication and the exposure to saliva, blood, and other body fluids, and the handling of sharp instruments. Dental professionals play great roles in preventing the transmission of 2019-nCoV. Here we recommend the infection control measures during dental practice to block the person-to-person transmission routes in dental clinics and hospitals.", "Zoonotic origins of human coronaviruses Mutation and adaptation have driven the co-evolution of coronaviruses (CoVs) and their hosts, including human beings, for thousands of years. Before 2003, two human CoVs (HCoVs) were known to cause mild illness, such as common cold. The outbreaks of severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS) have flipped the coin to reveal how devastating and life-threatening an HCoV infection could be. The emergence of SARS-CoV-2 in central China at the end of 2019 has thrusted CoVs into the spotlight again and surprised us with its high transmissibility but reduced pathogenicity compared to its sister SARS-CoV. HCoV infection is a zoonosis and understanding the zoonotic origins of HCoVs would serve us well. Most HCoVs originated from bats where they are non-pathogenic. The intermediate reservoir hosts of some HCoVs are also known. Identifying the animal hosts has direct implications in the prevention of human diseases. Investigating CoV-host interactions in animals might also derive important insight on CoV pathogenesis in humans. In this review, we present an overview of the existing knowledge about the seven HCoVs, with a focus on the history of their discovery as well as their zoonotic origins and interspecies transmission. Importantly, we compare and contrast the different HCoVs from a perspective of virus evolution and genome recombination. The current CoV disease 2019 (COVID-19) epidemic is discussed in this context. In addition, the requirements for successful host switches and the implications of virus evolution on disease severity are also highlighted.", "The COVID-19 pandemic: implications for the cytology laboratory The coronavirus disease 2019 (COVID-19) is a pandemic caused by the SARS-CoV-2 virus. The infection has predominantly respiratory transmission and is transmitted through large droplets or aerosols, and less commonly by contact with infected surfaces or fomites. The alarming spread of the infection and the severe clinical disease that it may cause have led to the widespread institution of social distancing measures. Because of repeated exposure to potentially infectious patients and specimens, health care and laboratory personnel are particularly susceptible to contract COVID-19. This review paper provides an assessment of the current state of knowledge about the disease and its pathology, and the potential presence of the virus in cytology specimens. It also discusses the measures that cytology laboratories can take to function during the pandemic, and minimize the risk to their personnel, trainees, and pathologists. In addition, it explores potential means to continue to educate trainees during the COVID-19 pandemic.", "What makes a foodborne virus: comparison between coronaviruses with human noroviruses In order to answer the question whether coronaviruses (CoVs) can be transmitted via foods, this review made a comparison between CoVs with the most recognized foodborne virus, human noroviruses (NoVs). As a result, although CoVs indeed have shown the possibilities to remain infectious on foods and/or food packaging materials long enough (from several days to several weeks) to potentially cause transmission, they seem to be less persistent than NoVs towards common disinfection practices with alcohols, chlorine and ultraviolet (UV). More importantly, the chance of foodborne transmission of CoVs is considered low as CoVs mainly spread through the respiratory tract and there is no clear evidence showing CoVs can follow fecal-oral routes like human NoVs and other foodborne viruses.", "Surface Alterations to Impart Antiviral Properties to Combat COVID-19 Transmission A global epidemic caused by highly transmittable COVID-19 is causing severe loss of human life. In this study, two aspects of reducing transmission of COVID-19 virus, due to surface contact, are discussed: first refers to the effect of nanocarbon fullerene C(60) coating on surface, that causes lipid peroxidation on the phospholipid layer present in the outer envelope of COVID-19; the second aspect refers to creating hydrophobic surfaces by texturing them, so that the contact area between virus and surface is minimized due to the presence of entrapped air between the topographies. These can be similar to micro-/nano-multiscale textured surfaces that have anti-biofouling properties. Fullerene-coated surfaces can be seen as a possible solution to decrease the adhesion of virus on the surface, as they will be hydrophobic as well as toxic to the envelope.", "Protection and disinfection policies against SARS-CoV-2 (COVID-19) In late December 2019, reports from China of the incidence of pneumonia with unknown etiology were sent to the World Health Organization (WHO). Shortly afterwards, the cause of this disease was identified as the novel beta-coronavirus, SARS-CoV-2, and its genetic sequence was published on January 12, 2020. Human-to-human transmission via respiratory droplets and contact with aerosol infected surfaces are the major ways of transmitting this virus. Here we attempted to collect information on virus stability in the air and on surfaces and ways of preventing of SARS-CoV-2 spreading.", "Simulated Sunlight Rapidly Inactivates SARS-CoV-2 on Surfaces Previous studies have demonstrated that SARS-CoV-2 is stable on surfaces for extended periods under indoor conditions. In the present study, simulated sunlight rapidly inactivated SARS-CoV-2 suspended in either simulated saliva or culture media and dried on stainless steel coupons. Ninety percent of infectious virus was inactivated every 6.8 minutes in simulated saliva and every 14.3 minutes in culture media when exposed to simulated sunlight representative of the summer solstice at 40\u00b0N latitude at sea level on a clear day. Significant inactivation also occurred, albeit at a slower rate, under lower simulated sunlight levels. The present study provides the first evidence that sunlight may rapidly inactivate SARS-CoV-2 on surfaces, suggesting that persistence, and subsequently exposure risk, may vary significantly between indoor and outdoor environments. Additionally, these data indicate that natural sunlight may be effective as a disinfectant for contaminated nonporous materials.", "Absence of contamination of personal protective equipment (PPE) by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ", "Prevention of nosocomial COVID-19: Another challenge of the pandemic ", "Aerosol and Surface Distribution of Severe Acute Respiratory Syndrome Coronavirus 2 in Hospital Wards, Wuhan, China, 2020 To determine distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards in Wuhan, China, we tested air and surface samples. Contamination was greater in intensive care units than general wards. Virus was widely distributed on floors, computer mice, trash cans, and sickbed handrails and was detected in air &#8776;4 m from patients.", "Environmental surface testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during prolonged isolation of an asymptomatic carrier Environmental surface testing was performed to search for evidence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) environmental contamination by an asymptomatic SARS-CoV-2 carrier with persistently high viral loads under isolation. No evidence of environmental contamination was found. Further studies are needed to measure environmental contamination by SARS-CoV-2 carriers and to determine reasonable isolation periods.", "What We Know So Far (As of March 26, 2020) About COVID-19 \u2013 An MRT Point of View ", "Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1 ", "Can N95 Respirators Be Reused after Disinfection? How Many Times? [Image: see text] The coronavirus disease 2019 (COVID-19) pandemic has led to a major shortage of N95 respirators, which are essential for protecting healthcare professionals and the general public who may come into contact with the virus. Thus, it is essential to determine how we can reuse respirators and other personal protective equipment in these urgent times. We investigated multiple commonly used disinfection schemes on media with particle filtration efficiency of 95%. Heating was recently found to inactivate the virus in solution within 5 min at 70 \u00b0C and is among the most scalable, user-friendly methods for viral disinfection. We found that heat (\u226485 \u00b0C) under various humidities (\u2264100% relative humidity, RH) was the most promising, nondestructive method for the preservation of filtration properties in meltblown fabrics as well as N95-grade respirators. At 85 \u00b0C, 30% RH, we were able to perform 50 cycles of heat treatment without significant changes in the filtration efficiency. At low humidity or dry conditions, temperatures up to 100 \u00b0C were not found to alter the filtration efficiency significantly within 20 cycles of treatment. Ultraviolet (UV) irradiation was a secondary choice, which was able to withstand 10 cycles of treatment and showed small degradation by 20 cycles. However, UV can potentially impact the material strength and subsequent sealing of respirators. Finally, treatments involving liquids and vapors require caution, as steam, alcohol, and household bleach all may lead to degradation of the filtration efficiency, leaving the user vulnerable to the viral aerosols.", "Prolonged presence of SARS-CoV-2 in feces of pediatric patients during the convalescent phase Background: Severe acute respiratory coronavirus 2 (SARS-CoV-2) is a newly identified virus which mainly spreads from person-to-person. Fecal shedding of SARS-CoV-2 has been constantly reported in patients with coronavirus disease 2019 (COVID-19). Most published studies focus on adult populations, whereas data concerning pediatric patients is relatively scarce. Methods: From January 17, 2020 to March 6, 2020, three pediatric cases of COVID-19 were reported in Qingdao, Shandong Province, China. Epidemiological, clinical, laboratory, and radiological characteristics and treatment data of these children were collected. Real-time fluorescence reverse-transcriptase-polymerase-chain reaction (RT-PCR) was performed to detect SARS-CoV-2 RNA in throat swabs and fecal specimens. Results: All the three pediatric cases were household contacts of adults whose symptoms developed earlier. There has been no evidence showing the virus was transmitted from the children to others. Severity of disease of these children was mild to moderate and fever was the most consistent and predominant symptom at onset of illness (two cases had body temperature higher than 38.5 Celsius). All children showed increased lymphocytes (>4.4*109/L) with normal white blood cell counts on admission. One child had elevated serum levels of procalcitonin and C-reaction protein. Radiological changes were not typical for COVID-19. All children showed good response to supportive treatment. Clearance of SARS-CoV-2 in respiratory tract occurred within two weeks after abatement of fever, whereas persistent presence of viral RNA was found in stools of all children. One case had fecal SARS-CoV-2 turned negative 8 days after throat swabs showing negative, while that of another child lagged behind for 20 days. At the time of writing, one child still had positive results for RT-PCR analysis in stools after negative conversion of viral RNA in respiratory samples (over 19 days behind). Conclusions: Pediatric patients with COVID-19 are very different from adult patients in regards to epidemiological, clinical, laboratory, and radiological characteristics. Prolonged shedding of SARS-CoV-2 in stools of infected children indicates the potential for the virus to be transmitted through fecal excretion. Massive efforts should be made at all levels to prevent spreading of the infection among children after reopening of kindergartens and schools.", "Airborne spread of infectious agents in the indoor environment BACKGROUND: Since the 2003 severe acute respiratory syndrome epidemic, scientific exploration of infection control is no longer restricted to microbiologists or medical scientists. Many studies have reported on the release, transport, and exposure of expiratory droplets because of respiratory activities. This review focuses on the airborne spread of infectious agents from mucus to mucus in the indoor environment and their spread as governed by airflows in the respiratory system, around people, and in buildings at different transport stages. METHODS: We critically review the literature on the release of respiratory droplets, their transport and dispersion in the indoor environment, and the ultimate exposure of a susceptible host, as influenced by airflows. RESULTS: These droplets or droplet nuclei are transported by expired airflows, which are sometimes affected by the human body plume and use of a face mask, as well as room airflow. Room airflow is affected by human activities such as walking and door opening, and some droplets are eventually captured by a susceptible individual because of his or her inspired flows; such exposure can eventually lead to long-range spread of airborne pathogens. Direct exposure to the expired fine droplets or droplet nuclei results in short-range airborne transmission. Deposition of droplets and direct personal exposure to expired large droplets can lead to the fomite route and the droplet-borne route, respectively. CONCLUSIONS: We have shown the opportunities for infection control at different stages of the spread. We propose that the short-range airborne route may be important in close contact, and its control may be achieved by face masks for the source patients and use of personalized ventilation. Our discussion of the effect of thermal stratification and expiratory delivery of droplets leads to the suggestion that displacement ventilation may not be applicable to hospital rooms where respiratory infection is a concern.", "Perioperative COVID-19 Defense: An Evidence-Based Approach for Optimization of Infection Control and Operating Room Management We describe an evidence-based approach for optimization of infection control and operating room management during the coronavirus disease 2019 (COVID-19) pandemic. Confirmed modes of viral transmission are primarily, but not exclusively, contact with contaminated environmental surfaces and aerosolization. Evidence-based improvement strategies for attenuation of residual environmental contamination involve a combination of deep cleaning with surface disinfectants and ultraviolet light (UV-C). (1) Place alcohol-based hand rubs on the intravenous (IV) pole to the left of the provider. Double glove during induction. (2) Place a wire basket lined with a zip closure plastic bag on the IV pole to the right of the provider. Place all contaminated instruments in the bag (eg, laryngoscope blades and handles) and close. Designate and maintain clean and dirty areas. After induction of anesthesia, wipe down all equipment and surfaces with disinfection wipes that contain a quaternary ammonium compound and alcohol. Use a top-down cleaning sequence adequate to reduce bioburden. Treat operating rooms using UV-C. (3) Decolonize patients using preprocedural chlorhexidine wipes, 2 doses of nasal povidone-iodine within 1 hour of incision, and chlorhexidine mouth rinse. (4) Create a closed lumen IV system and use hub disinfection. (5) Provide data feedback by surveillance of Enterococcus, Staphylococcus aureus, Klebsiella, Acinetobacter, Pseudomonas, and Enterobacter spp. (ESKAPE) transmission. (6) To reduce the use of surgical masks and to reduce potential COVID-19 exposure, use relatively long (eg, 12 hours) staff shifts. If there are 8 essential cases to be done (each lasting 1-2 hours), the ideal solution is to have 2 teams complete the 8 cases, not 8 first case starts. (7) Do 1 case in each operating room daily, with terminal cleaning after each case including UV-C or equivalent. (8) Do not have patients go into a large, pooled phase I postanesthesia care unit because of the risk of contaminating facility at large along with many staff. Instead, have most patients recover in the room where they had surgery as is done routinely in Japan. These 8 programmatic recommendations stand on a substantial body of empirical evidence characterizing the epidemiology of perioperative transmission and infection development made possible by support from the Anesthesia Patient Safety Foundation (APSF).", "Are Quaternary Ammonium Compounds, the Workhorse Disinfectants, Effective against Severe Acute Respiratory Syndrome-Coronavirus-2? A novel virus named Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) emerged from Wuhan, China in late 2019. Since then, the virus has quickly spread worldwide, leading the World Health Organization to declare it as a pandemic; by the end of April 2020, the number of cases exceeded 3 million. Due to the high infectivity rate, SARS-CoV-2 is difficult to contain, making disinfectant protocols vital, especially for essential, highly trafficked areas such as hospitals, grocery stores, and delivery centers. According to the Centers for Disease Control and Prevention, best practices to slow the spread rely on good hand hygiene, including proper handwashing practices as well as the use of alcohol-based hand sanitizers. However, they provide warning against sanitizing products containing benzalkonium chloride (BAC), which has sparked concern in both the scientific community as well as the general public as BAC, a common quaternary ammonium compound (QAC), is ubiquitous in soaps and cleaning wipes as well as hospital sanitation kits. This viewpoint aims to highlight the outdated and incongruous data in the evaluation of BAC against the family of known coronaviruses and points to the need for further evaluation of the efficacy of QACs against coronaviruses.", "Saliva: potential diagnostic value and transmission of 2019-nCoV 2019-nCoV epidemic was firstly reported at late December of 2019 and has caused a global outbreak of COVID-19 now. Saliva, a biofluid largely generated from salivary glands in oral cavity, has been reported 2019-nCoV nucleic acid positive. Besides lungs, salivary glands and tongue are possibly another hosts of 2019-nCoV due to expression of ACE2. Close contact or short-range transmission of infectious saliva droplets is a primary mode for 2019-nCoV to disseminate as claimed by WHO, while long-distance saliva aerosol transmission is highly environment dependent within indoor space with aerosol-generating procedures such as dental practice. So far, no direct evidence has been found that 2019-nCoV is vital in air flow for long time. Therefore, to prevent formation of infectious saliva droplets, to thoroughly disinfect indoor air and to block acquisition of saliva droplets could slow down 2019-nCoV dissemination. This review summarizes diagnostic value of saliva for 2019-nCoV, possibly direct invasion into oral tissues, and close contact transmission of 2019-nCoV by saliva droplets, expecting to contribute to 2019-nCoV epidemic control.", "Airborne Transmission Route of COVID-19: Why 2 Meters/6 Feet of Inter-Personal Distance Could Not Be Enough The COVID-19 pandemic caused the shutdown of entire nations all over the world. In addition to mobility restrictions of people, the World Health Organization and the Governments have prescribed maintaining an inter-personal distance of 1.5 or 2 m (about 6 feet) from each other in order to minimize the risk of contagion through the droplets that we usually disseminate around us from nose and mouth. However, recently published studies support the hypothesis of virus transmission over a distance of 2 m from an infected person. Researchers have proved the higher aerosol and surface stability of SARS-COV-2 as compared with SARS-COV-1 (with the virus remaining viable and infectious in aerosol for hours) and that airborne transmission of SARS-CoV can occur besides close-distance contacts. Indeed, there is reasonable evidence about the possibility of SARS-COV-2 airborne transmission due to its persistence into aerosol droplets in a viable and infectious form. Based on the available knowledge and epidemiological observations, it is plausible that small particles containing the virus may diffuse in indoor environments covering distances up to 10 m from the emission sources, thus representing a kind of aerosol transmission. On-field studies carried out inside Wuhan Hospitals showed the presence of SARS-COV-2 RNA in air samples collected in the hospitals and also in the surroundings, leading to the conclusion that the airborne route has to be considered an important pathway for viral diffusion. Similar findings are reported in analyses concerning air samples collected at the Nebraska University Hospital. On March 16th, we have released a Position Paper emphasizing the airborne route as a possible additional factor for interpreting the anomalous COVID-19 outbreaks in northern Italy, ranked as one of the most polluted areas in Europe and characterized by high particulate matter (PM) concentrations. The available information on the SARS-COV-2 spreading supports the hypothesis of airborne diffusion of infected droplets from person to person at a distance greater than two meters (6 feet). The inter-personal distance of 2 m can be reasonably considered as an effective protection only if everybody wears face masks in daily life activities.", "Preventive and Control Measures for the \ufeffCoronavirus Pandemic in Clinical Dentistry. A severe public health crisis has been declared worldwide since coronavirus disease 2019 (COVID-19) was classified as a pandemic of acute respiratory infectious disease by the World Health Organisation (WHO). China has taken strict measures to curb the spread of the disease to save lives, and has managed to control the outbreak. COVID-19 is mainly transmitted through respiratory droplets and close physical contact, so it is challenging to prevent nosocomial infection and possible spread during dental treatment. Since the initial phase of the COVID-19 outbreak, a disease prevention and control strategy based on the new concept of population risk classification and rational use of personal protective equipment has been implemented by the Peking University Hospital of Stomatology. Nosocomial infection prevention and control concepts and measures relating to dental diagnosis and treatment are critically checked in the hospital. Our experiences in handling this situation are shared here and may have wide-ranging implications for infection prevention and control (IPC) for COVID-19 in dental practices worldwide.", "Environmental contamination by SARS-CoV-2 in a designated hospital for coronavirus disease 2019 BACKGROUND: COVID-19 is characterized by risk of nosocomial transmission; however, the extent of environmental contamination and its potential contribution of environmental contamination to SARS-CoV-2 transmission are poorly understood. This study aimed to investigate whether environmental contamination may play a role in SARS-CoV-2 transmission. METHODS: Air samples were collected by natural precipitation, and environmental surface samples were collected by conventional surface swabbing. SARS-CoV-2 RNA detection was performed using reverse transcription polymerase chain reaction. RESULTS: Viral RNA was not detected in the 44 air samples. The positive rates in 200 environmental surface samples in medical areas (24.83%) was higher than that in living quarters (3.64%), with a significant difference (P<0.05). The positive rates were 25.00% and 37.50% for the general isolation ward and ICU, respectively, and no significant difference was observed between them (P=0.238). The top five sampling sites with a positive rate in medical areas were beepers (50.00%), water machine buttons (50.00%), elevator buttons (42.86%), computer mouses (40.00%), and telephones (40.00%). CONCLUSIONS: Most of the touchable surfaces in the designated hospital for COVID-19 were heavily contaminated, suggesting that the environment is a potential medium of disease transmission. These results emphasize the need for strict environmental surface hygiene practices and enhanced hand hygiene to prevent the spread of the virus.", "New and emerging infectious diseases (Ebola, Middle Eastern respiratory syndrome coronavirus, carbapenem-resistant Enterobacteriaceae, Candida auris): Focus on environmental survival and germicide susceptibility ", "Infection control and anesthesia: Lessons learned from the Toronto SARS outbreak PURPOSE: To describe the outbreak of severe acute respiratory syndrome (SARS) in Toronto, its impact on anesthesia practice and the infection control guidelines adopted to manage patients in the operating room (OR) and to provide emergency intubation outside the OR. CLINICAL FEATURES: The SARS outbreak in Toronto was the result of a single index patient. The causative virus, SARS-CoV, is moderately contagious, and is spread by droplets and contact. The virus gains access to host through the mucosa of the respiratory tract and the eyes. It can affect both healthy and compromised patients. The use of several precautionary measures such as goggles, gloves, gowns and facemasks and the application of various infection control strategies designed to minimize the spread of the virus are discussed. CONCLUSION: In containing the spread of SARS, vigilance and strict infection control are important. This results in the rediscovery of standards of infection control measures in daily anesthesia practice.", "Biosafety in the preparation and processing of cytology specimens with potential coronavirus (COVID\u201019) infection: Perspectives from Taiwan This commentary focuses on the cytopathology laboratory, the authors' experiences with coronavirus (COVID\u201019) in Taiwan, and current guidelines on COVID\u201019 infection prevention and control. The objective of this report is to provide cytopathology professionals a timely, in\u2010depth, evidence\u2010based review of biosafety practices for those at risk for coronavirus (COVID\u201019) infection.", "Effects of humidity and other factors on the generation and sampling of a coronavirus aerosol Suspensions of transmissible gastroenteritis virus (TGEV), a porcine coronavirus, were nebulized at rates of 0.1\u20130.2 ml/min into moving air using a Collison nebulizer or a plastic medical nebulizer operating at pressures ranging from 7 to 15 psi. The airborne viruses were collected on heating, ventilating, and air conditioning (HVAC) filters in an experimental apparatus and also sampled upstream of these test filters using AGI-30 and BioSampler impinger samplers. To study the effects of relative humidity (RH) on TGEV collection by the filters and samplers, the virus was nebulized into air at 30, 50, 70, and 90% RH. There were no significant changes in virus titer in the nebulizer suspension before and after nebulization for either nebulizer at any of the pressures utilized. Aerosolization efficiency \u2013 the ratio of viable virus sampled with impingers to the quantity of viable virus nebulized \u2013 decreased with increasing humidity. BioSamplers detected more airborne virus than AGI-30 samplers at all RH levels. This difference was statistically significant at 30 and 50% RH. Nebulizer type and pressure did not significantly affect the viability of the airborne virus. Virus recovery from test filters relative to the concentration of virus in the nebulizer suspension was less than 10%. The most and the least virus were recovered from filter media at 30% and 90% RH, respectively. The results suggest that TGEV, and perhaps other coronaviruses, remain viable longer in an airborne state and are sampled more effectively at low RH than at high humidity.", "Possible aerosol transmission of COVID-19 and special precautions in dentistry Since its emergence in December 2019, corona virus disease 2019 (COVID-19) has impacted several countries, affecting more than 90 thousand patients and making it a global public threat. The routes of transmission are direct contact, and droplet and possible aerosol transmissions. Due to the unique nature of dentistry, most dental procedures generate significant amounts of droplets and aerosols, posing potential risks of infection transmission. Understanding the significance of aerosol transmission and its implications in dentistry can facilitate the identification and correction of negligence in daily dental practice. In addition to the standard precautions, some special precautions that should be implemented during an outbreak have been raised in this review.", "The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) in Dentistry. Management of Biological Risk in Dental Practice The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a novel coronavirus first identified in Wuhan, China, and the etiological agent of Coronavirus Disease-2019 (COVID-19). This infection spreads mainly through direct contact with Fl\u00fcgge micro droplets or core droplets that remain suspended as aerosol. Moreover, it has been reported that infected subjects, both with and without clinical signs of COVID-19, can transmit the virus. Since the infection typically enters through mouth, nose, and eyes, dentistry is one of the medical practices at highest risk of infection due to the frequent production of aerosol and the constant presence of saliva. The World Health Organization (WHO) has suggested that only emergency/urgent procedures should be performed during the coronavirus outbreak. Considering the virus\u2019 route of transmission, a specific protocol should be applied to reduce the risk of infection in addition to measures that prevent the spread of infection from a patient to another person or medical tools and equipment (cross-infection). This protocol should be implemented by modifying both patient management and clinical practice, introducing particular devices and organizational practices. This paper aims to discuss and suggest the most appropriate procedures in every aspect of dental practice to reduce infection risk.", "Se pr\u00e9parer pour la pand\u00e9mie de COVID-19: revue des moyens d\u00e9ploy\u00e9s dans un bloc op\u00e9ratoire d'un grand h\u00f4pital tertiaire au Singapour./ Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore The coronavirus disease 2019 (COVID-19) outbreak has been designated a public health emergency of international concern. To prepare for a pandemic, hospitals need a strategy to manage their space, staff, and supplies so that optimum care is provided to patients. In addition, infection prevention measures need to be implemented to reduce in-hospital transmission. In the operating room, these preparations involve multiple stakeholders and can present a significant challenge. Here, we describe the outbreak response measures of the anesthetic department staffing the largest (1,700-bed) academic tertiary level acute care hospital in Singapore (Singapore General Hospital) and a smaller regional hospital (Sengkang General Hospital). These include engineering controls such as identification and preparation of an isolation operating room, administrative measures such as modification of workflow and processes, introduction of personal protective equipment for staff, and formulation of clinical guidelines for anesthetic management. Simulation was valuable in evaluating the feasibility of new operating room set-ups or workflow. We also discuss how the hierarchy of controls can be used as a framework to plan the necessary measures during each phase of a pandemic, and review the evidence for the measures taken. These containment measures are necessary to optimize the quality of care provided to COVID-19 patients and to reduce the risk of viral transmission to other patients or healthcare workers.", "SARS-CoV-2 human disinfection chambers: a critical analysis ", "Collection and disinfection of forensic biological specimens in five cases concerning COVID-19 in Guangzhou, China There have been many cases of pneumonia caused by novel coronavirus infections in China and around the world. This will inevitably lead to a rise in the number of patients. At the present time, clinical and forensic autopsies have given guidance and explanations in relation to the problem of COVID-19 transmission and defense. However, less attention is paid to the handling of COVID-19 biological samples in forensic practice. Particularly, COVID-19 can survive on some surfaces for days. Since there were many cases involving COVID-19 during the epidemic, this article shares the methods and strategies for handling such inspection materials and the biological samples related specifically to COVID-19 cases.", "Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2): An Update Coronaviruses (CoVs) belong to the family of Coronaviridae, the order Nidovirales, and the genus Coronavirus. They are the largest group of viruses causing respiratory and gastrointestinal infections. Morphologically, CoVs are enveloped viruses containing a non-segmented positive-sense, single-stranded ribonucleic acid (RNA) viruses. CoVs are categorized into four important genera that include Alphacoronavirus, Betacoronavirus, Gammacoronavirus, and Deltacoronavirus. A novel member of human CoV that has recently emerged in Wuhan, China, is now formally named as SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). This is a unique strain of RNA viruses that have not been previously observed in humans. The virus has wide host adaptability and is capable of causing severe diseases in humans, masked palm civets, mice, dogs, cats, camels, pigs, chickens, and bats. The SARS-CoV-2 typically causes respiratory and gastrointestinal sickness in both humans and animals. It can be transmitted through aerosols and direct/indirect contact, as well as during medical cases and laboratory sample handling. Specific structural proteins, which might be found on the surface of the virus, play an important role in the pathogenesis and development of the complications. The disease is characterized by distinct medical signs and symptoms that include high fever, chills, cough, and shortness of breath or difficulty in breathing. The infected people may also present with other symptoms such as diarrhea, myalgia, fatigue, expectoration, and hemoptysis. It is important from the public health and economic point of view as it affects the growth of the country, which is majorly attributed to the restriction in the movement of the people and the cost associated with the control and prevention of the disease. Since there is no specific therapeutic intervention nor a vaccine available against the virus, supportive management and treatment with non-specific therapeutic agents (repurposed drugs) may provide relief to the patients. Some preventive strategies of the disease include blocking the routes of transmission of the infections, disinfection of instruments used during medical case handling, using personal protective equipment, proper and early diagnosis of the disease, avoiding contact with the sick patients, and quarantine of the infected/exposed people.", "Stability and infectivity of coronaviruses in inanimate environments Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly contagious virus that can transmit through respiratory droplets, aerosols, or contacts. Frequent touching of contaminated surfaces in public areas is therefore a potential route of SARS-CoV-2 transmission. The inanimate surfaces have often been described as a source of nosocomial infections. However, summaries on the transmissibility of coronaviruses from contaminated surfaces to induce the coronavirus disease 2019 are rare at present. This review aims to summarize data on the persistence of different coronaviruses on inanimate surfaces. The literature was systematically searched on Medline without language restrictions. All reports with experimental evidence on the duration persistence of coronaviruses on any type of surface were included. Most viruses from the respiratory tract, such as coronaviruses, influenza, SARS-CoV, or rhinovirus, can persist on surfaces for a few days. Persistence time on inanimate surfaces varied from minutes to up to one month, depending on the environmental conditions. SARS-CoV-2 can be sustained in air in closed unventilated buses for at least 30 min without losing infectivity. The most common coronaviruses may well survive or persist on surfaces for up to one month. Viruses in respiratory or fecal specimens can maintain infectivity for quite a long time at room temperature. Absorbent materials like cotton are safer than unabsorbent materials for protection from virus infection. The risk of transmission via touching contaminated paper is low. Preventive strategies such as washing hands and wearing masks are critical to the control of coronavirus disease 2019.", "Environmental and decontamination issues for human coronaviruses and their potential surrogates Pandemic coronavirus disease-2019 (COVID-19) gives ample reason to generally review coronavirus (CoV) containment. For establishing some preliminary views on decontamination and disinfection, surrogate CoVs have commonly been assessed. This review serves to examine the existing science in regard to CoV containment generically and then to translate these findings into timely applications for COVID-19. There is widespread dissemination of CoVs in the immediate patient environment, and CoVs can potentially be spread via respiratory secretions, urine, and stool. Interpretations of the spread however must consider whether studies examine for viral RNA, virus viability by culture, or both. Presymptomatic, asymptomatic, and post-14 day virus excretion from patients may complicate the epidemiology. Whereas droplet spread is accepted, there continues to be controversy over the extent of possible airborne spread and especially now for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). CoVs are stable in body secretions and sewage at reduced temperatures. In addition to temperature, dryness or relative humidity, initial viral burden, concomitant presence of bioburden, and the type of surface can all affect stability. Generalizing, CoVs can be susceptible to radiation, temperature extremes, pH extremes, peroxides, halogens, aldehydes, many solvents, and several alcohols. Whereas detergent surfactants can have some direct activity, these agents are better used as complements to a complex disinfectant solution. Disinfectants with multiple agents and adverse pH are more likely to be best active at higher water temperatures. Real-life assessments should be encouraged with working dilutions. The use of decontamination and disinfection should be balanced with considerations of patient and caregiver safety. Processes should also be balanced with considerations for other potential pathogens that must be targeted. Given some CoV differences and given that surrogate testing provides experimental correlates at best, direct assessments with SARS-CoV, Middle East respiratory syndrome-related coronavirus (MERS-CoV), and SARS-CoV-2 are required.", "A Practical Decontamination Framework for COVID-19 Front-line Workers Returning Home Supplemental Digital Content is available in the text", "Environmental contamination by SARS-CoV-2 in a designated hospital for coronavirus disease 2019 BACKGROUND: Coronavirus disease 2019 (COVID-19) is characterized by risk of nosocomial transmission; however, the extent of environmental contamination and its potential contribution of environmental contamination to SARS-CoV-2 transmission are poorly understood. This study aimed to investigate whether environmental contamination may play a role in SARS-CoV-2 transmission. METHODS: Air samples were collected by natural precipitation, and environmental surface samples were collected by conventional surface swabbing. SARS-CoV-2 RNA detection was performed using reverse transcription polymerase chain reaction. RESULTS: Viral RNA was not detected in the 44 air samples. The positive rates in 200 environmental surface samples in medical areas (24.83%) was higher than that in living quarters (3.64%), with a significant difference (P < .05). The positive rates were 25.00% and 37.50% for the general isolation ward and intensive care unit, respectively, and no significant difference was observed between them (P\u00e2\u0080\u00af=\u00e2\u0080\u00af.238). The top 5 sampling sites with a positive rate in medical areas were beepers (50.00%), water machine buttons (50.00%), elevator buttons (42.86%), computer mouses (40.00%), and telephones (40.00%). CONCLUSIONS: Most of the touchable surfaces in the designated hospital for COVID-19 were heavily contaminated, suggesting that the environment is a potential medium of disease transmission. These results emphasize the need for strict environmental surface hygiene practices and enhanced hand hygiene to prevent the spread of the virus.", "Efficient and quick inactivation of SARS coronavirus and other microbes exposed to the surfaces of some metal catalysts. OBJECTIVE To study the two metal catalysts Ag/Al2O3 and Cu/Al2O3 that interdict the transmission pathway for SARS and other respiratory infectious diseases. METHODS Two metal catalysts Ag/Al2O3 and Cu/Al2O3 were pressed into wafers. One hundred microL 10(6) TCID50/mL SARS-CoV, 100 microL 10(6) PFU/mL recombinant baculovirus expressing hamster's prion protein (haPrP) protein and roughly 10(6) E. coli were slowly dropped onto the surfaces of the catalyst wafers and exposed for 5 and 20 min, respectively. After eluted from the surfaces of wafers, the infectivity of viruses and propagation of bacteria were measured. The expression of PrP protein was determined by Western blot. The morphological changes of bacteria were observed by electronic microscopy. RESULTS After exposure to the catalysts surfaces for 5 and 20 min, the infectivity of SARS-CoV in Vero cells and baculovirus in Sf9 cells dropped down to a very low and undetectable level, and no colony was detected using bacteria culture method. The expression of haPrP protein reduced to 21.8% in the preparation of Sf9 cells infected with recombinant baculovirus exposed for 5 min and was undetectable exposed for 20 min. Bacterial membranes seemed to be cracked and the cytoplasm seemed to be effluent from cell bodies. CONCLUSION Exposures to the surfaces of Ag/Al2O3 and Cu/Al2O3 destroy the replication and propagation abilities of SARS-CoV, baculovirus and E. coli. Inactivation ability of metal catalysts needs to interact with air, utilizing oxygen molecules in air. Efficiently killing viruses and bacteria on the surfaces of the two metal catalysts has a promising potential for air-disinfection in hospitals, communities, and households.", "Droplet evaporation residue indicating SARS-COV-2 survivability on surfaces SARS-CoV-2 survives and remains viable on surfaces for several days under different environments as reported in recent studies. However, it is unclear how the viruses survive for such a long time and why their survivability varies across different surfaces. To address these questions, we conduct systematic experiments investigating the evaporation of droplets produced by a nebulizer and human-exhaled gas on surfaces. We found that these droplets do not disappear with evaporation, but instead shrink to a size of a few micrometers (referred to as residues), persist for more than 24 hours, and are highly durable against changes of environmental conditions. The characteristics of these residues change significantly across surface types. Specifically, surfaces with high thermal conductivity like copper do not leave any resolvable residues, while stainless steel, plastic, and glass surfaces form residues from a varying fraction of all deposited droplets at 40% relative humidity. Lowering humidity level suppresses the formation of residues while increasing humidity level enhances it. Our results suggest that these microscale residues can potentially insulate the virus against environmental changes, allowing them to survive inhospitable environments and remain infectious for prolonged durations after deposition. Our findings can also be extended to other viruses transmitted through respiratory droplets (e.g., SARS-CoV, flu viruses, etc.), and can thus lead to practical guidelines for disinfecting surfaces and other prevention measures (e.g., humidity control) for limiting viral transmission.", "Middle East respiratory syndrome coronavirus on inanimate surfaces: A risk for health care transmission The Middle East Respiratory syndrome coronavirus (MERS-CoV) has been responsible for multiple health care\u2013associated outbreaks. We investigated whether high-touch surfaces in 3 rooms of laboratory-confirmed MERS-CoV patients were contaminated with MERS-CoV RNA. We found 2 out of 51 surfaces were contaminated with MERS-CoV viral genetic material. Hence, environmental contamination may be a potential source of health care transmission and outbreaks. Meticulous environmental cleaning may be important in preventing transmission within the health care setting.", "The COVID\u201019 Pandemic: An Epidemiologic, Public Health, and Clinical Brief ", "A new infectious disease challenge: Urbani severe acute respiratory syndrome (SARS) associated coronavirus ", "Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: the possible role of dry surface contamination Summary Viruses with pandemic potential including H1N1, H5N1, and H5N7 influenza viruses, and severe acute respiratory syndrome (SARS)/Middle East respiratory syndrome (MERS) coronaviruses (CoV) have emerged in recent years. SARS-CoV, MERS-CoV, and influenza virus can survive on surfaces for extended periods, sometimes up to months. Factors influencing the survival of these viruses on surfaces include: strain variation, titre, surface type, suspending medium, mode of deposition, temperature and relative humidity, and the method used to determine the viability of the virus. Environmental sampling has identified contamination in field-settings with SARS-CoV and influenza virus, although the frequent use of molecular detection methods may not necessarily represent the presence of viable virus. The importance of indirect contact transmission (involving contamination of inanimate surfaces) is uncertain compared with other transmission routes, principally direct contact transmission (independent of surface contamination), droplet, and airborne routes. However, influenza virus and SARS-CoV may be shed into the environment and be transferred from environmental surfaces to hands of patients and healthcare providers. Emerging data suggest that MERS-CoV also shares these properties. Once contaminated from the environment, hands can then initiate self-inoculation of mucous membranes of the nose, eyes or mouth. Mathematical and animal models, and intervention studies suggest that contact transmission is the most important route in some scenarios. Infection prevention and control implications include the need for hand hygiene and personal protective equipment to minimize self-contamination and to protect against inoculation of mucosal surfaces and the respiratory tract, and enhanced surface cleaning and disinfection in healthcare settings.", "The COVID-19 Pandemic: A Comprehensive Review of Taxonomy, Genetics, Epidemiology, Diagnosis, Treatment, and Control A pneumonia outbreak with unknown etiology was reported in Wuhan, Hubei province, China, in December 2019, associated with the Huanan Seafood Wholesale Market. The causative agent of the outbreak was identified by the WHO as the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), producing the disease named coronavirus disease-2019 (COVID-19). The virus is closely related (96.3%) to bat coronavirus RaTG13, based on phylogenetic analysis. Human-to-human transmission has been confirmed even from asymptomatic carriers. The virus has spread to at least 200 countries, and more than 1,700,000 confirmed cases and 111,600 deaths have been recorded, with massive global increases in the number of cases daily. Therefore, the WHO has declared COVID-19 a pandemic. The disease is characterized by fever, dry cough, and chest pain with pneumonia in severe cases. In the beginning, the world public health authorities tried to eradicate the disease in China through quarantine but are now transitioning to prevention strategies worldwide to delay its spread. To date, there are no available vaccines or specific therapeutic drugs to treat the virus. There are many knowledge gaps about the newly emerged SARS-CoV-2, leading to misinformation. Therefore, in this review, we provide recent information about the COVID-19 pandemic. This review also provides insights for the control of pathogenic infections in humans such as SARS-CoV-2 infection and future spillovers.", "Aerosol and Surface Distribution of Severe Acute Respiratory Syndrome Coronavirus 2 in Hospital Wards, Wuhan, China, 2020 To determine distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards in Wuhan, China, we tested air and surface samples. Contamination was greater in intensive care units than general wards. Virus was widely distributed on floors, computer mice, trash cans, and sickbed handrails and was detected in air \u22484 m from patients.", "COVID-19 pandemic and the stethoscope: don't forget to sanitize ", "Preventing SARS-CoV-2 transmission in rehabilitation pools and therapeutic water environments. SARS-CoV-2 is mainly transmitted by respiratory droplets and contact with contaminated surfaces. It can be retrieved in faeces but there is no evidence of faecal-oral transmission, which is the main route of contamination in recreational waters. Standard cleaning and disinfecting procedure, microbiologic control and health rules aim to prevent infectious risk regardless of the microorganisms. In the context of progressive lockdown exit and hospital activities recovery, we assessed the risk of SARS-CoV-2 transmission in rehabilitation pools and therapeutic water environments in order to provide specific recommendations to control the spread of SARS-CoV-2 while ensuring essential rehabilitation cares for patients.", "Dental care and infection-control procedures during the COVID-19 pandemic: the experience in Taipei City Hospital, Taiwan Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has now widely spread globally. The main transmission routes of SARS-CoV-2 comprise human-to-human droplet infection, including inhalation and contact infection of patient\u2019s saliva, blood and other body fluids through oral mucosa, nasal mucosa, and the eyes, and orofecal transmission. Dental treatment necessitates close-proximity, face-to-face practices and can generate droplets or aerosols containing water, saliva, blood, microorganisms, and other debris during the procedure. Therefore, dental professionals are at a high risk of SARS-CoV-2 infection. To prevent nosocomial SARS-CoV-2 spread during dental procedures, Taipei City Hospital established a dental patient triage and workflow algorithm for the provision of dental services during the COVID-19 pandemic. Given the highly contagious nature of SARS-CoV-2, it is imperative to institute an appropriate standard procedural policy for patient management and recommendation of dental treatment at hospitals during the COVID-19 pandemic.", "What Dentists Need to Know about COVID-19 Abstract This article aims at collecting all information needed for dentists regarding the COVID-19 pandemic throughout the world by reviewing articles published by now. In late 2019, a pneumonia outbreak of uncertain etiology happened in Wuhan, China. There were many reports related to a live-animal and seafood market, supporting that the pathogens were transferred from animals to humans, rapidly evolving into transmission from human to human. The pathogen was classified as 2019 Novel Corona Virus (2019-nCoV), and the disease was named COrona VIrus Disease 2019 (COVID-19). Given that COVID-19 has lately been detected in infected patients\u2019 saliva, the COVID-19 outbreak is an alert that all dental and other health professionals must be vigilant in defending against the infectious disease spread, and it may enable to assess whether non-invasive saliva diagnostic for COVID-19. There has so far been no evidence from randomized controlled trials to prescribe any particular anti-nCoV treatment or vaccine, and COVID-19 management has been widely supportive. Since the ACE-2 was expressing on oral cavity mucosa, there is a potentially huge COVID-19 infectious vulnerability risk for oral cavity and brought up a proof for the future prevention procedure in dental practice and daily life. As a result, the whole dental teams should be vigilant and keep patients and themselves in a safe environment by following the guideline in this study.", "Effects of temperature and humidity on the daily new cases and new deaths of COVID-19 in 166 countries Abstract The coronavirus disease 2019 (COVID-19) pandemic is the defining global health crisis of our time and the greatest challenge facing the world. Meteorological parameters are reportedly crucial factors affecting respiratory infectious disease epidemics; however, the effect of meteorological parameters on COVID-19 remains controversial. This study investigated the effects of temperature and relative humidity on daily new cases and daily new deaths of COVID-19, which has useful implications for policymakers and the public. Daily data on meteorological conditions, new cases and new deaths of COVID-19 were collected for 166 countries (excluding China) as of March 27, 2020. Log-linear generalized additive model was used to analyze the effects of temperature and relative humidity on daily new cases and daily new deaths of COVID-19, with potential confounders controlled for, including wind speed, median age of the national population, Global Health Security Index, Human Development Index and population density. Our findings revealed that temperature and relative humidity were both negatively related to daily new cases and deaths. A 1 \u00b0C increase in temperature was associated with a 3.08% (95% CI: 1.53%, 4.63%) reduction in daily new cases and a 1.19% (95% CI: 0.44%, 1.95%) reduction in daily new deaths, whereas a 1% increase in relative humidity was associated with a 0.85% (95% CI: 0.51%, 1.19%) reduction in daily new cases and a 0.51% (95% CI: 0.34%, 0.67%) reduction in daily new deaths. The results remained robust when different lag structures and the sensitivity analysis were used. These findings provide preliminary evidence that the COVID-19 pandemic may be partially suppressed with temperature and humidity increases. However, active measures must be taken to control the source of infection, block transmission and prevent further spread of COVID-19.", "Masks and closed-loop ventilators prevent environmental contamination by COVID-19 patients in negative-pressure environments Abstract Herein, we report that nosocomial infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be mitigated by using surgical masks and closed looped ventilation for both non-critical and critical patients. These preventive measures resulted in no viral contamination of surfaces in negative pressure environments.", "How Ophthalmologists Should Understand and Respond to the Current Epidemic of Novel Coronavirus Pneumonia (COVID-19) The new coronavirus pneumonia that first appeared in Wuhan, China, in December 2019 has attracted great attention from both the Chinese government and the international community The International Committee on Viral Classification named the virus &amp;quot;Severe Acute Respiratory Syndrome Coronavirus 2&amp;quot;(SARS-CoV-2), and the WHO named the pneumonia it causes &amp;quot;Coronavirus Disease 2019&amp;quot;(COVID-19) At present, the disease is centered in Wuhan City and is spreading rapidly to all parts of China, as well as twenty other countries About 20% of the people infected during the SARS epidemic in 2003 were employees in hospital environments COVID-19 has infected an even greater number of heath care workers Therefore, ophthalmologists need to understand the disease and recognize the importance of taking preventive measures Although ophthalmologists do not work on the front lines of the outbreak, due to their area of expertise, a variety of situations, such as infection consultations or ophthalmic emergency treatments, can lead to the exposure of ophthalmologists to high-risk environments This risk will only increase as the number of infected patients continues to increase When dealing with seemingly normal ophthalmic patients, the vigilance of ophthalmologists and associated staff tends to be significantly reduced To better protect patients, families, and health care workers, it is strongly recommended that in addition to the standard precautions for the care of all patients, strict contact precautions and droplet precautions need to be taken by ophthalmologists These measures include 1) wearing an efficient mask (an N95 mask);2) always performing hand hygiene before and after examining a patient;(3) wearing sterile gloves when entering a patient\u2019s room and touching a patient;(4) wearing a gown when contact is expected with items and environmental surfaces surrounding a patient or when the patient is incontinent or has diarrhea or a surgical or other invasive wound with oozing fluid;5) cleaning and disinfecting ophthalmic equipment and correctly handling medical waste after examination to prevent transmission to patients who are subsequently examined;6) wearing goggles and a disposable mask to cover the front and sides of the face before touching a patient, as the virus could spread through the ocular surface;7) performing the relevant screening for novel coronavirus pneumonia for regular patients who have conjunctivitis and respiratory symptoms at the same time;8) prohibiting the use of infected patients as potential donors for corneal transplants and temporarily adding donor SARS-CoV-2 screening to the medical standard of the eye bank during the outbreak;and 9) for the purposes of scientific research, diagnosis, and other special needs, packing, shipping, and transporting collected specimens according to the relevant dangerous biological goods regulations", "Catalytic inactivation of SARS coronavirus, Escherichia coli and yeast on solid surface Catalytic oxidation is a potential way to disinfect air through a air-condition system. We find that the SARS coronavirus, bacteria and yeast are completely inactivated in 5 min on Ag catalyst surface and in 20 min on Cu catalyst surface at room temperature in air. Scanning electron microscopy (SEM) images show that the yeast cells are dramatically destructed on the Ag/Al(2)O(3) and Cu/Al(2)O(3) surfaces, which indicates that the inactivation is caused by catalytic oxidation rather than by toxicity of heavy metals.", "Risks of viral contamination in healthcare professionals during laparoscopy in the Covid-19 pandemic Abstract The Covid-19 pandemic has markedly changed our practices. This article analyses the risks of contamination among healthcare professionals (HCPs) during laparoscopic surgery on patients with Covid-19. Harmful effects of aerosols from a pneumoperitoneum with the virus present have not yet been quantified. Measures for the protection of HCPs are an extrapolation of those taken during other epidemics. They must still be mandatory to minimise the risk of viral contamination. Protection measures include personal protection equipment for HCPs, adaptation of surgical technique (method for obtaining pneumoperitoneum, filters, preferred intracorporeal anastomosis, precautions during the exsufflation of the pneumoperitoneum), and organisation of the operating room.", "Stability of SARS-CoV-2 on Critical Personal Protective Equipment The spread of COVID-19 in healthcare settings is concerning, with healthcare workers representing a disproportionately high percentage of confirmed cases. Although SARS-CoV-2 virus has been found to persist on surfaces for a number of days, the extent and duration of fomites as a mode of transmission, particularly in healthcare settings, has not been fully characterized. To shed light on this critical matter, the present study provides the first comprehensive assessment of SARS-CoV-2 stability on experimentally contaminated personal protective equipment (PPE) widely used by healthcare workers and the general public. Persistence of viable virus was monitored over 21 days on eight different materials, including nitrile medical examination gloves, reinforced chemical resistant gloves, N-95 and N-100 particulate respirator masks, Tyvek, plastic, cotton, and stainless steel. Unlike previous reports, viable SARS-CoV-2 in the presence of a soil load persisted for up to 21 days on experimentally inoculated PPE, including materials from filtering facepiece respirators (N-95 and N-100 masks) and a plastic visor. Conversely, when applied to 100% cotton fabric, the virus underwent rapid degradation and became undetectable in less than 24 hours. These findings underline the importance of appropriate handling of contaminated PPE during and following use in high-risk settings and provide interesting insight into the potential utility of cotton, including cotton masks, in limiting COVID-19 transmission.", "Stability and Viability of SARS-CoV-2. ", "[SARS: diagnosis, therapy, and especially prevention]. The main purpose of this review is to analyze some aspects of the severe acute respiratory syndrome, SARS, in order to obtain useful data to suggest preventive actions to reduce the spreading of the disease. Many elements have been examined to reach some conclusions and to allow an updated discussion. Surgical masks protect more the patient than the caregiver. Simple or double surgical masks may be useful, as double gloving protects the hands of the surgical personnel against percutaneous transmission of HIV eventually present in contaminated blood. The frequent substitution of the external masks with a new one will improve the filtering activity against droplets produced by cough or sneezes of the patient. The use of respiratory masks may be suggested in hospitals or in restricted ventilated areas where, even if coronavirus variant is considered an environmental contaminant more than a respiratory risk, droplets nuclei may persist in the air and add consistent dangers to the heath-care givers. Considering that large and medium droplets may infect floors and surfaces, in addition to gloves, gowns, masks and eyes protection, the available list of viral and bacterial factors implicated in SARS ethiology suggests a better hand antisepsis using frequently the alcohol based gels (containing an high percentage of emollients substances), if available. A liquid soap with triclosan can also be used, if the health-care workers compliance to hand washing increases, as expected in this explosive situation. On the basis of the results of some experimental data, the environmental disinfection may be effected with ethyl alcohol 70% in water. Disinfection of floors or larger surfaces may be obtained with chlorine compounds solutions, after an accurate pre-cleaning. When corrosion, bleaching or gas production have to be avoided, chlorine compounds may be substituted by phenolic detergent disinfectants.", "Spatial spread of an epidemic through public transportation systems with a hub Abstract This article investigates an epidemic spreading among several locations through a transportation system, with a hub connecting these locations. Public transportation is not only a bridge through which infections travel from one location to another but also a place where infections occur since individuals are typically in close proximity to each other due to the limited space in these systems. A mathematical model is constructed to study the spread of an infectious disease through such systems. A variant of the next generation method is proposed and used to provide upper and lower bounds of the basic reproduction number for the model. Our investigation indicates that increasing transportation efficiency, and improving sanitation and ventilation of the public transportation system decrease the chance of an outbreak occurring. Moreover, discouraging unnecessary travel during an epidemic also decreases the chance of an outbreak. However, reducing travel by infectives while allowing susceptibles to travel may not be enough to avoid an outbreak.", "Stability of SARS-CoV-2 in different environmental conditions Stability of SARS-CoV-2 in different environmental conditions.", "Stability of SARS\u2010CoV\u20102 and other coronaviruses in the environment and on common touch surfaces and the influence of climatic conditions: A review Although the unprecedented efforts the world has been taking to control the spread of the human coronavirus disease (COVID\u201019) and its causative aetiology [severe acute respiratory syndrome coronavirus 2 (SARS\u2010CoV\u20102)], the number of confirmed cases has been increasing drastically. Therefore, there is an urgent need for devising more efficient preventive measures, to limit the spread of the infection until an effective treatment or vaccine is available. The preventive measures depend mainly on the understanding of the transmission routes of this virus, its environmental stability, and its persistence on common touch surfaces. Due to the very limited knowledge about SARS\u2010CoV\u20102, we can speculate its stability in the light of previous studies conducted on other human and animal coronaviruses. In this review, we present the available data on the stability of coronaviruses (CoVs), including SARS\u2010CoV\u20102, from previous reports to help understand its environmental survival. According to available data, possible airborne transmission of SARS\u2010CoV\u20102 has been suggested. SARS\u2010CoV\u20102 and other human and animal CoVs have remarkably short persistence on copper, latex and surfaces with low porosity as compared to other surfaces like stainless steel, plastics, glass and highly porous fabrics. It has also been reported that SARS\u2010CoV\u20102 is associated with diarrhoea and that it is shed in the faeces of COVID\u201019 patients. Some CoVs show persistence in human excrement, sewage and waters for a few days. These findings suggest a possible risk of faecal\u2013oral, foodborne and waterborne transmission of SARS\u2010CoV\u20102 in developing countries that often use sewage\u2010polluted waters in irrigation and have poor water treatment systems. CoVs survive longer in the environment at lower temperatures and lower relative humidity. It has been suggested that large numbers of COVID\u201019 cases are associated with cold and dry climates in temperate regions of the world and that seasonality of the virus spread is suspected.", "Environmental contamination of the SARS-CoV-2 in healthcare premises: An urgent call for protection for healthcare workers Importance A large number of healthcare workers (HCWs) were infected by SARS-CoV-2 during the ongoing outbreak of COVID-19 in Wuhan, China. Hospitals are significant epicenters for the human-to-human transmission of the SARS-CoV-2 for HCWs, patients, and visitors. No data has been reported on the details of hospital environmental contamination status in the epicenter of Wuhan. Objective To investigate the extent to which SARS-CoV-2 contaminates healthcare settings, including to identify function zones of the hospital with the highest contamination levels and to identify the most contaminated objects, and personal protection equipment (PPE) in Wuhan, China. Design A field investigation was conducted to collect the surface swabs in various environments in the hospital and a laboratory experiment was conducted to examine the presence of the SARS-CoV-2 RNA. Setting Six hundred twenty-six surface samples were collected within the Zhongnan Medical Center in Wuhan, China in the mist of the COVID-19 outbreak between February 7 - February 27, 2020. Participants Dacron swabs were aseptically collected from the surfaces of 13 hospital function zones, five major objects, and three major personal protection equipment (PPE). The SARS-CoV-2 RNAs were detected by reverse transcription-PCR (RT-PCR). Main Outcomes and Measures SARS-CoV-2 RNAs Results The most contaminated zones were the intensive care unit specialized for taking care of novel coronavirus pneumonia (NCP) (31.9%), Obstetric Isolation Ward specialized for pregnant women with NCP (28.1%), and Isolation Ward for NCP (19.6%). We classified the 13 zones into four contamination levels. The most contaminated objects are self-service printers (20.0%), desktop/keyboard (16.8%), and doorknob (16.0%). Both hand sanitizer dispensers (20.3%) and gloves (15.4%) were most contaminated PPE. Conclusions and Relevance Many surfaces were contaminated with SARS-CoV-2 across the hospital in various patient care areas, commonly used objects, medical equipment, and PPE. The 13 hospital function zones were classified into four contamination levels. These findings emphasize the urgent need to ensure adequate environmental cleaning, strengthen infection prevention training, and improve infection prevention precautions among HCWs during the outbreak of COVID-19. The findings may have important implications for modifying and developing urgently needed policy to better protect healthcare workers during this ongoing pandemic of SARS-CoV-2.", "Consideration of the Aerosol Transmission for COVID\u201019 and Public Health This article analyzes the available evidence to address airborne, aerosol transmission of the SARS\u2010CoV\u20102. We review and present three lines of evidence: case reports of transmission for asymptomatic individuals in association with studies that show that normal breathing and talking produce predominantly small droplets of the size that are subject to aerosol transport; limited empirical data that have recorded aerosolized SARS\u2010CoV\u20102 particles that remain suspended in the air for hours and are subject to transport over distances including outside of rooms and intrabuilding, and the broader literature that further supports the importance of aerosol transmission of infectious diseases. The weight of the available evidence warrants immediate attention to address the significance of aerosols and implications for public health protection.", "World Federation for Ultrasound in Medicine and Biology Position Statement: How to Perform a Safe Ultrasound Examination and Clean Equipment in the Context of COVID-19 ", "Impact of the Coronavirus (COVID-19) pandemic on surgical practice - Part 1 (Review Article) The Coronavirus (COVID-19) pandemic has resulted in over 2.3 million confirmed cases and over 160,000 deaths. The impact of COVID-19 on surgical practice is widespread ranging from workforce and staffing issues, procedural prioritisation, viral transmission risk intraoperatively, changes to perioperative practice and ways of working alongside the impact on surgical education and training. Whilst there has been a growing literature base describing the early clinical course of COVID-19 and on aspects of critical care related to treating these patients, there has been a dearth of evidence on how this pandemic will affect surgical practice. This paper seeks to review the current evidence and offers recommendations for changes to surgical practice to minimise the effect of the COVID-19 pandemic.", "Potential Fecal Transmission of SARS-CoV-2: Current Evidence and Implications for Public Health Abstract Coronavirus disease 2019 (COVID-19) emerged in Hubei Province, China in December 2019 and has since become a global pandemic, with hundreds of thousands of cases and over 165 affected countries. Primary routes of transmission of the causative virus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), are through respiratory droplets and close person-to-person contact. While information about other potential modes of transmission are relatively sparse, evidence supporting the possibility of a fecally-mediated mode of transmission has been accumulating. Here, current knowledge on the potential for fecal transmission is briefly reviewed and the possible implications are discussed from a public health perspective.", "The emergence of novel coronavirus disease (COVID-19) in Bangladesh: Present status, challenges, and future management Immediate after the official declaration of COVID-19 in Bangladesh on 8 March 2020, it has created public panic which results in price plummeting of the capital market and price hike of many essential commodities. Worldwide, the outbreak of COVID-19 has declared a pandemic. In response, the Government of Bangladesh has initiated some strict measures such as stopping the entry of passengers from Europe, stopping on-arrival visas and self-quarantine for 2 weeks for all passengers return from abroad. Still, many loopholes exist at the entry points of Bangladesh. Most of the people of Bangladesh are yet to aware of the consequences of COVID-19. In this backdrop, this article has attempted to create public awareness about COVID-19, providing some guidelines to restrict this deadly disease, enlisting current challenges of this disease in Bangladesh. This review would be helpful to undertake future management practices against the fearsome COVID-19 in Bangladesh.", "Detection of SARS-CoV-2 RNA on public surfaces in a densely populated urban area of Brazil Importance: The COVID-19 pandemic has resulted in more than 3.5 million cases and 245 thousand deaths worldwide as of May 6, 2020. Determining the extent of the presence of the virus on public surfaces is critical for understanding the potential risk of infection in these areas. Objective: To evaluate the presence of SARS-CoV-2 RNA on public surfaces in a densely populated urban area in Brazil. Design and Setting: A total of 101 samples were collected from different surfaces in public places in the region of Belo Horizonte with the highest number of COVID-19 cases. Samples were collected near the hospital and public transportation areas using sterile swabs, and then submitted to nucleic acid extraction and genomic detection and quantification by one-step qPCR. Results: Seventeen of the 101 samples tested positive (16.8%) for SARS-CoV-2 RNA, including samples from bus stations/terminals, public squares, and sidewalks, including those near hospitals. Conclusions and Relevance: Our data indicated the contamination of public surfaces by SARS-CoV-2, especially near hospital areas, highlighting the risk of infection for the population. Constant monitoring of the virus in urban areas is required as a strategy to fight the pandemic and prevent further infections.", "Transmission of COVID-19 virus by droplets and aerosols: A critical review on the unresolved dichotomy The practice of social distancing and wearing masks has been popular worldwide in combating the contraction of COVID-19. Undeniably, although such practices help control the COVID-19 pandemic to a greater extent, the complete control of viral-laden droplet and aerosol transmission by such practices is poorly understood. This review paper intends to outline the literature concerning the transmission of viral-laden droplets and aerosols in different environmental settings and demonstrates the behavior of droplets and aerosols resulted from a cough-jet of an infected person in various confined spaces. The case studies that have come out in different countries have, with prima facie evidence, manifested that the airborne transmission plays a profound role in contracting susceptible hosts. Interestingly, the nosocomial transmission by airborne SARS-CoV-2 viral-laden aerosols in healthcare facilities may be plausible. Hence, clearly defined, science-based administrative, clinical, and physical measures are of paramount importance to eradicate the COVID-19 pandemic from the world.", "High-touch surfaces: microbial neighbours at hand Despite considerable efforts, healthcare-associated infections (HAIs) continue to be globally responsible for serious morbidity, increased costs and prolonged length of stay. Among potentially preventable sources of microbial pathogens causing HAIs, patient care items and environmental surfaces frequently touched play an important role in the chain of transmission. Microorganisms contaminating such high-touch surfaces include Gram-positive and Gram-negative bacteria, viruses, yeasts and parasites, with improved cleaning and disinfection effectively decreasing the rate of HAIs. Manual and automated surface cleaning strategies used in the control of infectious outbreaks are discussed and current trends concerning the prevention of contamination by the use of antimicrobial surfaces are taken into consideration in this manuscript.", "Respiratory Viruses Abstract This article is an overview of the most clinically important respiratory viruses including the recently emerged highly pathogenic coronaviruses and other viruses that are transmitted via the respiratory tract. In this article, we highlight a description of the agent, its life cycle, epidemiology, pathogenesis, clinical features, diagnosis and management of the infection. The viruses in this article are respiratory syncytial virus, parainfluenza virus, human metapneumovirus, rhinovirus, seasonal and emerging coronaviruses, adenovirus, bocavirus and other viruses associated with the respiratory tract for their life cycle.", "The COVID-19 pandemic: considerations for the waste and wastewater services sector Abstract This article discusses the potential ramifications of the COVID-19 pandemic on waste and wastewater services, focusing on critical points where alternative operating procedures or additional mitigation measures may be advisable. Key concerns are (i) the long half-life of the virus on materials such as waste containers, bags, and in wastewater, and (ii) possible transmission via contaminated waste surfaces and aerosols from wastewater systems. There are opportunities to further the science of wastewater-based epidemiology by monitoring viral RNA in wastewater to assess disease prevalence and spread in defined populations, which may prove beneficial for informing COVID-19 related public health policy.", "Routes of transmission of influenza A H1N1, SARS CoV, and norovirus in air cabin: Comparative analyses Identifying the exact transmission route(s) of infectious diseases in indoor environments is a crucial step in developing effective intervention strategies. In this study, we proposed a comparative analysis approach and built a model to simulate outbreaks of 3 different in\u2010flight infections in a similar cabin environment, that is, influenza A H1N1, severe acute respiratory syndrome (SARS) coronavirus (CoV), and norovirus. The simulation results seemed to suggest that the close contact route was probably the most significant route (contributes 70%, 95% confidence interval [CI]: 67%\u201072%) in the in\u2010flight transmission of influenza A H1N1 transmission; as a result, passengers within 2 rows of the index case had a significantly higher infection risk than others in the outbreak (relative risk [RR]: 13.4, 95% CI: 1.5\u2010121.2, P = .019). For SARS CoV, the airborne, close contact, and fomite routes contributed 21% (95% CI: 19%\u201023%), 29% (95% CI: 27%\u201031%), and 50% (95% CI: 48%\u201053%), respectively. For norovirus, the simulation results suggested that the fomite route played the dominant role (contributes 85%, 95% CI: 83%\u201087%) in most cases; as a result, passengers in aisle seats had a significantly higher infection risk than others (RR: 9.5, 95% CI: 1.2\u201077.4, P = .022). This work highlighted a method for using observed outbreak data to analyze the roles of different infection transmission routes.", "Environmental contamination by SARS-CoV-2 of an imported case during incubation period We collected environmental surface samples prior to and after disinfection of a quarantine room to evaluate the stability of SARS-CoV-2 during the incubation period of an imported case traveling to Qingdao, China. Overall, 11 of 23 (47.8%) of the first batch of environmental surface samples (within 4 h after case confirmation) were tested positive for SARS-CoV-2. Whereas only 2 of 23 (8.7%) of the second batch of environmental samples (after first disinfection) were tested positive for SARS-CoV-2. The majority of samples from the bedroom (70%) were positive for SARS-CoV-2, followed by 50% of samples from the bathroom and that of 33% from the corridor. The inner walls of toilet bowl and sewer inlet were the most contaminated sites with the highest viral loads. SARS-CoV-2 was widely distributed on object surfaces in a quarantine room of a later diagnosed COVID-19 case during the incubation period. Proper disinfection is crucial to minimize community transmission of this highly contagious virus.", "The role of environmental factors to transmission of SARS-CoV-2 (COVID-19) The current outbreak of the novel coronavirus disease 2019 (COVID-19) in more than 250 countries has become a serious threat to the health of people around the world. Human-to-human transmission of the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurs most often when people are in the incubation stage of the disease or are carriers and have no symptoms. Therefore, in this study, was discussed the role of environmental factors and conditions such as temperature, humidity, wind speed as well as food, water and sewage, air, insects, inanimate surfaces, and hands in COVID-19 transmission. The results of studies on the stability of the SARS-CoV-2 on different levels showed that the resistance of this virus on smooth surfaces was higher than others. Temperature increase and sunlight can facilitate the destruction of SARS-COV-2 and the stability of it on surfaces. When the minimum ambient air temperature increases by 1 \u00b0C, the cumulative number of cases decreases by 0.86%. According to the latest evidence, the presence of coronavirus in the sewer has been confirmed, but there is no evidence that it is transmitted through sewage or contaminated drinking water. Also, SARS-COV-2 transmission through food, food packages, and food handlers has not been identified as a risk factor for the disease. According to the latest studies, the possibility of transmitting SARS-COV-2 bioaerosol through the air has been reported in the internal environment of ophthalmology. The results additionally show that infectious bio-aerosols can move up to 6 feet. There have been no reports of SARS-COV-2 transmission by blood-feeding arthropods such as mosquitoes.", "Environmental concern regarding the effect of humidity and temperature on 2019-nCoV survival: fact or fiction The new coronavirus, called 2019-nCoV, is a new type of virus that was first identified in Wuhan, China, in December 2019. Environmental conditions necessary for survival and spread of 2019-nCoV are somewhat transparent but unlike animal coronaviruses. We are poorly aware of their survival in environment and precise factors of their transmission. Countries located in east and west of globe did not have a significant impact on prevalence of disease among communities, and on the other hand, north and south have provided a model for relative prediction of disease outbreaks. The 2019-nCoV can survive for up to 9 days at 25 \u00b0C, and if this temperature rises to 30 \u00b0C, its lifespan will be shorter. The 2019-nCoV is sensitive to humidity, and lifespan of viruses in 50% humidity is longer than that of 30%. Also, temperature and humidity are important factors influencing the COVID-19 mortality rate and may facilitate 2019-nCoV transmission. Thus, considering the available and recent evidence, it seems that low temperatures, as well as dry and unventilated air, may affect stability and transmissibility of 2019-nCoV.", "Strengthening ICU health security for a coronavirus epidemic ", "The severe acute respiratory syndrome (SARS) The world was shocked in early 2003 when a pandemic of severe acute respiratory syndrome (SARS) was imminent. The outbreak of this novel disease, caused by a novel coronavirus (the SARS-coronavirus), hit hardest in the Asian Pacific region, though eventually it spread to five continents. The speed of the spread of the SARS epidemic was unprecedented due to the highly efficient intercontinental transportation. An international collaborative effort through the World Health Organization (WHO) has helped to identify the aetiological agent about 1 month after the onset of the epidemic. The power of molecular biology and bioinformatics has enabled the complete decoding of the viral genome within weeks. Over 1000 publications on the phylogeny, epidemiology, genomics, laboratory diagnostics, antiviral, immunization, pathogenesis, clinical disease, and management accumulated within just 1 year. Although the exact animal reservoir of virus and how it evolved into a human pathogen are still obscure, accurate diagnosis and epidemiological control of the disease are now possible. This article reviews what is currently known about the virus and the disease.", "PrivyTRAC: Privacy and Security Preserving Contact Tracing System Smartphone location-based methods have been proposed and implemented as an effective alternative to traditional labor intensive contact tracing methods. However, there are serious privacy and security concerns that may impede wide-spread adoption in many societies. Furthermore, these methods rely solely on proximity to patients, based on Bluetooth or GPS signal for example, ignoring lingering effects of virus, including COVID-19, present in the environment. This results in inaccurate risk assessment and incomplete contact tracing. A new system concept, called PrivyTRAC, preserves user privacy, increases security and improves accuracy of smartphone contact tracing. PrivyTRAC enhances users' and patients' privacy by letting users conduct self-evaluation based on the risk maps download to their smartphones. No user information is transmitted to external locations or devices, and no personally identifiable patient information is embedded in the risk maps as they are processed anonymized and aggregated locations of confirmed patients. The risk maps consider both spatial proximity and temporal effects to improve the accuracy of the infection risk estimation. Experiments conducted in the paper illustrate improvement of PrivyTRAC over proximity based methods in terms of true and false positives. An approach to further improve infection risk estimation by incorporating both positive and negative local test results from contacts of confirmed cases is also described.", "Textile Masks and Surface Covers - A 'Universal Droplet Reduction Model' Against Respiratory Pandemics The main form of COVID-19 transmission is via oral-respiratory droplet contamination (droplet; very small drop of liquid) produced when individuals talk, sneeze or cough. In hospitals, health-care workers wear facemasks as a minimum medical droplet precaution to protect themselves. Due to the shortage of masks during the pandemic, priority is given to hospitals for their distribution. As a result, the availability/use of medical masks is discouraged for the public. However, given that asymptomatic individuals, not wearing masks within the public, can be highly contagious for COVID-19, prevention of environmental droplet contamination (EnDC) from coughing/sneezing/speech is fundamental to reducing transmission. As an immediate solution to promote public droplet safety, we assessed household textiles to quantify their potential as effective environmental droplet barriers (EDBs). The synchronized implementation of a universal community droplet reduction solution is discussed as a model against COVID-19. Using a bacterial-suspension spray simulation model of droplet ejection (mimicking a sneeze), we quantified the extent by which widely available clothing fabrics reduce the dispersion of droplets onto surfaces within 1.8m, the minimum distance recommended for COVID-19 social distancing. All textiles reduced the number of droplets reaching surfaces, restricting their dispersion to <30cm, when used as single layers. When used as double-layers, textiles were as effective as medical mask/surgical-cloth materials, reducing droplet dispersion to <10cm, and the area of circumferential contamination to ~0.3%. The synchronized implementation of EDBs as a community droplet reduction solution (i.e., face covers/scarfs/masks & surface covers) could reduce EnDC and the risk of transmitting or acquiring infectious respiratory pathogens, including COVID-19.", "COVID-19: what has been learned and to be learned about the novel coronavirus disease The outbreak of Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2), has thus far killed over 3,000 people and infected over 80,000 in China and elsewhere in the world, resulting in catastrophe for humans. Similar to its homologous virus, SARS-CoV, which caused SARS in thousands of people in 2003, SARS-CoV-2 might also be transmitted from the bats and causes similar symptoms through a similar mechanism. However, COVID-19 has lower severity and mortality than SARS but is much more transmissive and affects more elderly individuals than youth and more men than women. In response to the rapidly increasing number of publications on the emerging disease, this article attempts to provide a timely and comprehensive review of the swiftly developing research subject. We will cover the basics about the epidemiology, etiology, virology, diagnosis, treatment, prognosis, and prevention of the disease. Although many questions still require answers, we hope that this review helps in the understanding and eradication of the threatening disease.", "Environmental and Decontamination Issues for Human Coronaviruses and Their Potential Surrogates Pandemic COVID-19 gives ample reason to generally review coronavirus (CoV) containment. For establishing some preliminary views on decontamination and disinfection, surrogate CoVs have commonly been assessed. This review serves to examine the existing science in regards to CoV containment generically and then to translate these findings into timely applications for COVID-19. There is widespread dissemination of CoVs in the immediate patient environment, and CoVs can potentially be spread via respiratory secretions, urine, and stool. Interpretations of the spread however must consider whether studies examine for viral RNA, virus viability by culture, or both. Pre-symptomatic, asymptomatic, and post-fourteen day virus excretion from patients may complicate the epidemiology. Whereas droplet spread is accepted, there continues to be controversy over the extent of possible airborne spread and especially now for SARS-CoV-2. CoVs are stable in body secretions and sewage at reduced temperatures. In addition to temperature, dryness or relative humidity, initial viral burden, concomitant presence of bioburden, and the type of surface can all affect stability. Generalizing, CoVs can be susceptible to radiation, temperature extremes, pH extremes, peroxides, halogens, aldehydes, many solvents, and several alcohols. Whereas detergent surfactants can have some direct activity, these agents are better used as complements to a complex disinfectant solution. Disinfectants with multiple agents and adverse pH are more likely to be best active at higher water temperatures. Real-life assessments should be encouraged with working dilutions. The use of decontamination and disinfection should be balanced with considerations of patient and caregiver safety. Processes should also be balanced with considerations for other potential pathogens that must be targeted. Given some CoV differences and given that surrogate testing provides experimental correlates at best, direct assessments with SARS-CoV, MERS-CoV, and SARS-CoV-2 are required. This article is protected by copyright. All rights reserved.", "Effects of air temperature and relative humidity on coronavirus survival on surfaces. Assessment of the risks posed by severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV) on surfaces requires data on survival of this virus on environmental surfaces and on how survival is affected by environmental variables, such as air temperature (AT) and relative humidity (RH). The use of surrogate viruses has the potential to overcome the challenges of working with SARS-CoV and to increase the available data on coronavirus survival on surfaces. Two potential surrogates were evaluated in this study; transmissible gastroenteritis virus (TGEV) and mouse hepatitis virus (MHV) were used to determine effects of AT and RH on the survival of coronaviruses on stainless steel. At 4 degrees C, infectious virus persisted for as long as 28 days, and the lowest level of inactivation occurred at 20% RH. Inactivation was more rapid at 20 degrees C than at 4 degrees C at all humidity levels; the viruses persisted for 5 to 28 days, and the slowest inactivation occurred at low RH. Both viruses were inactivated more rapidly at 40 degrees C than at 20 degrees C. The relationship between inactivation and RH was not monotonic, and there was greater survival or a greater protective effect at low RH (20%) and high RH (80%) than at moderate RH (50%). There was also evidence of an interaction between AT and RH. The results show that when high numbers of viruses are deposited, TGEV and MHV may survive for days on surfaces at ATs and RHs typical of indoor environments. TGEV and MHV could serve as conservative surrogates for modeling exposure, the risk of transmission, and control measures for pathogenic enveloped viruses, such as SARS-CoV and influenza virus, on health care surfaces.", "Clinical characteristics of 2019 novel coronavirus infection in China Background: Since December 2019, acute respiratory disease (ARD) due to 2019 novel coronavirus (2019-nCoV) emerged in Wuhan city and rapidly spread throughout China. We sought to delineate the clinical characteristics of these cases. Methods: We extracted the data on 1,099 patients with laboratory-confirmed 2019-nCoV ARD from 552 hospitals in 31 provinces/provincial municipalities through January 29th, 2020. Results: The median age was 47.0 years, and 41.90% were females. Only 1.18% of patients had a direct contact with wildlife, whereas 31.30% had been to Wuhan and 71.80% had contacted with people from Wuhan. Fever (87.9%) and cough (67.7%) were the most common symptoms. Diarrhea is uncommon. The median incubation period was 3.0 days (range, 0 to 24.0 days). On admission, ground-glass opacity was the typical radiological finding on chest computed tomography (50.00%). Significantly more severe cases were diagnosed by symptoms plus reverse-transcriptase polymerase-chain-reaction without abnormal radiological findings than non-severe cases (23.87% vs. 5.20%, P<0.001). Lymphopenia was observed in 82.1% of patients. 55 patients (5.00%) were admitted to intensive care unit and 15 (1.36%) succumbed. Severe pneumonia was independently associated with either the admission to intensive care unit, mechanical ventilation, or death in multivariate competing-risk model (sub-distribution hazards ratio, 9.80; 95% confidence interval, 4.06 to 23.67). Conclusions: The 2019-nCoV epidemic spreads rapidly by human-to-human transmission. Normal radiologic findings are present among some patients with 2019-nCoV infection. The disease severity (including oxygen saturation, respiratory rate, blood leukocyte/lymphocyte count and chest X-ray/CT manifestations) predict poor clinical outcomes.", "Resistance of Enteric Viruses on Fomites Human enteric viruses are associated with several clinical features, especially gastroenteritis. Large amounts of these viruses can be released in the environment and spread to people. Enteric viruses are nonenveloped viruses and have displayed good survival in the environment. They can be significantly resistant in food and water but also on fomites, and this is thought to play a role in transmission, leading to sporadic cases or outbreaks. The survival of enteric viruses on fomites relies on many factors including the virus itself, fomite properties, and extrinsic environmental factors such as temperature or relative humidity. Several reports in the literature have found an association with gastroenteritis cases or outbreaks and fomites naturally contaminated by enteric viruses. However, the study of virus survival following natural contamination is challenging, and most published studies are laboratory based, using experimental contamination. In addition, recent and detailed data on the resistance of each of the main enteric viruses on fomites are scarce. Many approaches, both physical and chemical, can be used to inactivate enteric viruses, the efficacy of which depends on the virus and the disinfection conditions.", "Minimization of spreading of SARS-CoV-2 via household waste produced by subjects affected by COVID-19 or in quarantine Currently available evidence supports that the predominant route of human-to-human transmission of the SARS-CoV-2 is through respiratory droplets. Indirect hands contact with surfaces contaminated by infectious droplets subsequently touching the mouth, nose or eyes seems to be another route of an indirect contact transmission. Persistence of the virus on different surfaces and other materials has been reported in recent studies: SARS-CoV-2 was more stable on plastic and stainless steel than on copper and cardboard. Viable virus was detected up to 72 h after application to different surfaces, although infectivity decay was also observed. This evidence suggests the likelihood that waste generated from patients affected by COVID-19 or subjects in quarantine treated in private houses or in areas different from hospitals and medical centres could be contaminated by SARS-CoV-2. Consequently, waste streams may represent a route for viral spreading being a potential risk also for the operators directly involved in the different phases of waste management. To address this concern, a specific multidisciplinary working group was settled by the Italian National Institute of Health (ISS) during the COVID-19 emergency, in order to establish guidelines related to solid waste collection, delivering, withdrawal, transport, treatment and disposal. Temporary stop of waste sorting, instructions for the population on how to package waste, instructions for Companies and operators for the adoption of adequate personal protection equipment (PPE), the use and sanitation of proper vehicles were among the main recommendations provided to the community by publications of freely downloadable reports and infographics in layman language. Incineration, sterilization and properly managed landfills were identified as the facilities to be preferentially adopted for the treatment of this kind of waste, considering the main inactivation strategies of SARS-CoV-2 (e.g. treatment length > 9 days and temperature > 70 \u00b0C for more than 5 min).", "Disinfection effect of pulsed xenon ultraviolet irradiation on SARS-CoV-2 and implications for environmental risk of COVID-19 transmission Prolonged survival of SARS-CoV-2 on environmental surfaces and personal protective equipment (PPE) may lead to these surfaces transmitting disease to others. This article reports the effectiveness of a pulsed xenon ultraviolet (PX-UV) disinfection system in reducing the load of SARS-CoV-2 on hard surfaces and N95 respirators. Chamber slides and N95 respirator material were directly inoculated with SARS-CoV-2 and exposed to different durations of PX-UV disinfection. For hard surfaces, disinfection for 1, 2, and 5 minutes resulted in 3.53 Log10, >4.54 Log10, and >4.12 Log10 reductions in viral load, respectively. For N95 respirators, disinfection for 5 minutes resulted in >4.79 Log10 reduction in viral load. We found that PX-UV significantly reduces SARS-CoV-2 on hard surfaces and N95 respirators. With the potential to rapidly disinfectant environmental surfaces and N95 respirators, PX-UV devices are a promising technology for the reduction of environmental and PPE bioburden and to enhance both HCW and patient safety by reducing the risk of exposure to SARS-CoV-2.", "Considerations in performing endoscopy during the COVID-19 pandemic ", "Experimental aerosol survival of SARS-CoV-2 in artificial saliva and tissue culture media at medium and high humidity SARS-CoV-2, the causative agent of the COVID-19 pandemic, may be transmitted via airborne droplets or contact with surfaces onto which droplets have deposited. In this study, the ability of SARS-CoV-2 to survive in the dark, at two different relative humidity values and within artificial saliva, a clinically relevant matrix, was investigated. SARS-CoV-2 was found to be stable, in the dark, in a dynamic small particle aerosol under the four experimental conditions we tested and viable virus could still be detected after 90 minutes. The decay rate and half-life was determined and decay rates ranged from 0.4 to 2.27 % per minute and the half lives ranged from 30 to 177 minutes for the different conditions. This information can be used for advice and modelling and potential mitigation strategies.", "Environmental Contamination of SARS-CoV-2 in Healthcare Premises Abstract Objectives A large number of healthcare workers (HCWs) were infected by SARS-CoV-2 during the ongoing outbreak of COVID-19 in Wuhan, China. Hospitals are significant epicenters for the human-to-human transmission of the SARS-CoV-2 for HCWs, patients, and visitors. No data has been reported on the details of hospital environmental contamination status in the epicenter of Wuhan. Methods We collected 626 surface swabs within the Zhongnan Medical Center in Wuhan in the mist of the COVID-19 outbreak between February 7 - February 27, 2020. Dacron swabs were aseptically collected from the surfaces of 13 hospital function zones, five major objects, and three major PPE. The SARS-CoV-2 RNAs were detected by reverse transcription-PCR. Results The most contaminated zones were the intensive care unit specialized for taking care of novel coronavirus pneumonia (NCP) (31.9%), Obstetric Isolation Ward specialized for pregnant women with NCP (28.1%), and Isolation Ward for NCP (19.6%). We classified the 13 zones into four contamination levels. The most contaminated objects were self-service printers (20.0%), desktop/keyboard (16.8%), and doorknob (16.0%). Both hand sanitizer dispensers (20.3%) and gloves (15.4%) were the most contaminated PPE. Conclusion Our findings emphasize the urgent need to ensure adequate environmental cleaning, strengthen infection prevention training, and improve infection prevention among HCWs during the outbreak of COVID-19.", "COVID-19: Effects of weather conditions on the propagation of respiratory droplets As the number of confirmed cases of Coronavirus disease 2019 (COVID-19) continues to increase, there has been a rising concern regarding the effect of weather conditions, especially over the upcoming summer, on the transmission of this disease. In this study, we assess the transmission of COVID-19 under different weather conditions by investigating the propagation of infectious respiratory droplets. A comprehensive mathematical model is established to explore their evaporation, heat transfer and kinematics under different temperature, humidity and ventilation conditions. The transmitting pathway of COVID-19 through respiratory droplets is divided into short-range droplet contacts and long-range aerosol exposure. We show that the effect of weather conditions is not monotonic: low temperature and high humidity facilitate droplet contact transmission, while high temperature and low humidity promote the formation of aerosol particles and accumulation of particles with a diameter of 2.5 m or less (PM2.5). Our model suggests that the 6 ft of social distance recommended by the Center for Disease Control and Prevention (CDC) may be insufficient in certain environmental conditions, as the droplet spreading distance can be as long as 6 m (19.7 ft) in cold and humid weather. The results of this study suggest that the current pandemic may not ebb in the summer of the northern hemisphere without proper intervention, as there is an increasing chance of aerosol transmission. We also emphasize that the meticulous design of building ventilation systems is critical in containing both the droplet contact infections and aerosol exposures.", "COVID\u201019 dentistry\u2010related aspects: a literature overview A new coronavirus (Sars\u2010CoV\u20102) was detected in China at the end of 2019 and has since caused a worldwide pandemic. This virus is responsible for an acute respiratory syndrome (COVID\u201019), distinguished by a potentially lethal interstitial bilateral pneumonia. Because Sars\u2010CoV\u20102 is highly infective through airborne contamination, the high infection risk in the dental environment is a serious problem for both professional practitioners and patients. This literature overview provides a description of the clinical aspects of COVID\u201019 and its transmission, while supplying valuable information regarding protection and prevention measures.", "Environmental Detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) from Medical Equipment in Long-Term Care Facilities undergoing COVID-19 Outbreaks We conducted environmental sampling at long-term care facilities to determine the extent of surface contamination with SARS-CoV-2 virus. Medical equipment used throughout the facility was determined to be contaminated.", "An Imperative Need for Research on the Role of Environmental Factors in Transmission of Novel Coronavirus (COVID-19) ", "Selections from the current literature ", "How Should the Rehabilitation Community Prepare for 2019-nCoV? Abstract With the 2019-nCoV pandemic spreading quickly in USA and the world, it is urgent that the rehabilitation community quickly understands the epidemiology of the virus and what we can and must do to face this microbial adversary at the early stages of this likely long global pandemic. The 2019-nCoV is a novel virus so the majority of world\u2019s population does not have prior immunity to it. It is more infectious and fatal than seasonal influenza, and definitive treatment and a vaccine are months away. Our arsenal against it are currently mainly social distancing and infection control measures.", "Transmission potential of asymptomatic and paucisymptomatic SARS-CoV-2 infections: a three-family cluster study in China Data concerning the transmission of SARS-CoV-2 in asymptomatic and paucisymptomatic patients are lacking. We report a three-family cluster of infections involving asymptomatic and paucisymptomatic transmission. Eight (53%) of 15 members from three families were confirmed with SARS-CoV-2 infection. Of eight patients, three were asymptomatic and one was paucisymptomatic. An asymptomatic mother transmitted the virus to her son, and a paucisymptomatic father transmitted the virus to his three-month-old daughter. SARS-CoV-2 was detected in the environment of one household. The complete genomes of SARS-CoV-2 from the patients were >99.9% identical and were clustered with other SARS-CoV-2 sequences reported from China and other countries.", "Saliva\u2014Friend and Foe in the COVID-19 Outbreak The coronavirus disease 2019 (COVID-19) outbreak, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global ongoing pandemic. Timely, accurate and non-invasive SARS-CoV-2 detection in both symptomatic and asymptomatic patients, as well as determination of their immune status, will facilitate effective large-scale pandemic control measures to prevent the spread of COVID-19. Saliva is a biofluid whose anatomical source and location is of particularly strategic relevance to COVID-19 transmission and monitoring. This review focuses on the role of saliva as both a foe (a common mode of viral transmission via salivary droplets and potentially aerosols) and a friend (as a non-invasive diagnostic tool for viral detection and immune status surveillance) in combating COVID-19.", "Concerns for activated breathing control (ABC) with breast cancer in the era of COVID-19: Maximizing infection control while minimizing heart dose ", "Luminore CopperTouch\u00e2\u0084\u00a2 surface coating effectively inactivates SARS-CoV-2, Ebola and Marburg viruses in vitro We investigated the ability of Luminore CopperTouch copper and copper-nickel surfaces to inactivate filoviruses and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For this purpose, we compared viral titers in Vero cells from viral droplets exposed to copper surfaces for 30 min. The copper and copper-nickel surfaces inactivated 99.9% of the viral titer of both Ebola and Marburg viruses. The copper surfaces also inactivated 99% of SARS-CoV-2 titers in 2 hours to close to the limit of detection. These data add Ebolavirus, Marburgvirus, and SARS-CoV-2 (COVID-19) to the list of pathogens that can be inactivated by exposure to copper ions, validating Luminore CopperTouch technology (currently the only Environmental Protection Agency [EPA]-registered cold spray antimicrobial surface technology) as an efficacious, cost-friendly tool to improve infection control in hospitals, long-term care facilities, schools, hotels, buses, trains, airports, and other highly trafficked areas.", "SARS-CoV-2 in environmental samples of quarantined households The role of environmental transmission of SARS-CoV-2 remains unclear. Particularly the close contact of persons living together or cohabitating in domestic quarantine could result in high risk for exposure to the virus within the households. Therefore, the aim of this study was to investigate the whereabouts of the virus and whether useful precautions to prevent the dissemination can be given. 21 households under quarantine conditions were randomly selected for this study. All persons living in each household were recorded in terms of age, sex and time of household quarantine. Throat swabs for analysis were obtained from all adult individuals and most of the children. Air, wastewater samples and surface swabs (commodities) were obtained and analysed by RT-PCR. Positive swabs were cultivated to analyse for viral infectivity. 26 of all 43 tested adults (60.47 %) tested positive by RT-PCR. All 15 air samples were PCR-negative. 10 of 66 wastewater samples were positive for SARS-CoV-2 (15.15 %) as well as 4 of 119 object samples (3.36 %). No statistically significant correlation between PCR-positive environmental samples and the extent of infection spread inside the household could be observed. No infectious virus could be isolated under cell culture conditions. As we cannot rule out transmission through surfaces, hygienic behavioural measures are important in the households of SARS-CoV-2 infected individuals to avoid potential transmission through surfaces. The role of the domestic environment, in particular the wastewater load in washbasins and showers, in the transmission of SARS CoV-2 should be further clarified.", "Chemical disinfection of non-porous inanimate surfaces experimentally contaminated with four human pathogenic viruses. The chemical disinfection of virus-contaminated non-porous inanimate surfaces was investigated using coxsackievirus B3, adenovirus type 5, parainfluenza virus type 3 and coronavirus 229E as representatives of important nosocomial viral pathogens. A 10 microliter amount of the test virus, suspended in either faeces or mucin, was placed onto each stainless steel disk (about 1 cm in diameter) and the inoculum allowed to dry for 1 h under ambient conditions. Sixteen disinfectant formulations were selected for this study based on the findings of an earlier investigation with a human rotavirus. After 1 min exposure to 20 microliters of the disinfectant, the virus from the disks was immediately eluted into tryptose phosphate broth and plaque assayed. Using an efficacy criterion of a 3 log10 or greater reduction in virus infectivity titre and irrespective of the virus suspending medium, only the following five disinfectants proved to be effective against all the four viruses tested: (1) 2% glutaraldehyde normally used as an instrument soak, (2) a strongly alkaline mixture of 0.5% sodium o-benzyl-p-chlorophenate and 0.6% sodium lauryl sulphate, generally used as a domestic disinfectant cleaner for hard surfaces, (3) a 0.04% solution of a quaternary ammonium compound containing 7% hydrochloric acid, which is the basis of many toilet bowl cleaners, (4) chloramine T at a minimum free chlorine level of 3000 p.p.m. and (5) sodium hypochlorite at a minimum free chlorine concentration of 5000 p.p.m. Of those chemicals suitable for use as topical antiseptics, 70% ethanol alone or products containing at least 70% ethanol were ineffective only against coxsackievirus B3. These results emphasize the care needed in selecting chemical disinfectants for routine use in infection control.", "Hand touches on the surfaces of a healthcare waiting area ", "A Comprehensive Literature Review on the Clinical Presentation, and Management of the Pandemic Coronavirus Disease 2019 (COVID-19) Coronavirus disease 2019 (COVID-19) is a declared global pandemic. There are multiple parameters of the clinical course and management of the COVID-19 that need optimization. A hindrance to this development is the vast amount of misinformation present due to scarcely sourced manuscript preprints and social media. This literature review aims to presents accredited and the most current studies pertaining to the basic sciences of SARS-CoV-2, clinical presentation and disease course of COVID-19, public health interventions, and current epidemiological developments. The review on basic sciences aims to clarify the jargon in virology, describe the virion structure of SARS-CoV-2 and present pertinent details relevant to clinical practice. Another component discussed is the brief history on the series of experiments used to explore the origins and evolution of the phylogeny of the viral genome of SARS-CoV-2. Additionally, the clinical and epidemiological differences between COVID-19 and other infections causing outbreaks (SARS, MERS, H1N1) are elucidated. Emphasis is placed on evidence-based medicine to evaluate the frequency of presentation of various symptoms to create a stratification system of the most important epidemiological risk factors for COVID-19. These can be used to triage and expedite risk assessment. Furthermore, the limitations and statistical strength of the diagnostic tools currently in clinical practice are evaluated. Criteria on rapid screening, discharge from hospital and discontinuation of self-quarantine are clarified. Epidemiological factors influencing the rapid rate of spread of the SARS-CoV-2 virus are described. Accurate information pertinent to improving prevention strategies is also discussed. The penultimate portion of the review aims to explain the involvement of micronutrients such as vitamin C and vitamin D in COVID19 treatment and prophylaxis. Furthermore, the biochemistry of the major candidates for novel therapies is briefly reviewed and a summary of their current status in the clinical trials is presented. Lastly, the current scientific data and status of governing bodies such as the Center of Disease Control (CDC) and the WHO on the usage of controversial therapies such as angiotensin-converting enzyme (ACE) inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs) (Ibuprofen), and corticosteroids usage in COVID-19 are discussed. The composite collection of accredited studies on each of these subtopics of COVID-19 within this review will enable clarification and focus on the current status and direction in the planning of the management of this global pandemic.", "Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations Summary As coronavirus disease 2019 (COVID-19) spreads across the world, the intensive care unit (ICU) community must prepare for the challenges associated with this pandemic. Streamlining of workflows for rapid diagnosis and isolation, clinical management, and infection prevention will matter not only to patients with COVID-19, but also to health-care workers and other patients who are at risk from nosocomial transmission. Management of acute respiratory failure and haemodynamics is key. ICU practitioners, hospital administrators, governments, and policy makers must prepare for a substantial increase in critical care bed capacity, with a focus not just on infrastructure and supplies, but also on staff management. Critical care triage to allow the rationing of scarce ICU resources might be needed. Researchers must address unanswered questions, including the role of repurposed and experimental therapies. Collaboration at the local, regional, national, and international level offers the best chance of survival for the critically ill.", "Persistance du SARS-CoV-2 infectieux sur les surfaces inertes et transmission par les mains./ Persistence of infectious SARS-CoV-2 on inert surfaces and hand-mediated transmission ", "Detection of Airborne Severe Acute Respiratory Syndrome (SARS) Coronavirus and Environmental Contamination in SARS Outbreak Units Severe acute respiratory syndrome (SARS) is characterized by a risk of nosocomial transmission; however, the risk of airborne transmission of SARS is unknown. During the Toronto outbreaks of SARS, we investigated environmental contamination in SARS units, by employing novel air sampling and conventional surface swabbing. Two polymerase chain reaction (PCR)\u2013positive air samples were obtained from a room occupied by a patient with SARS, indicating the presence of the virus in the air of the room. In addition, several PCR-positive swab samples were recovered from frequently touched surfaces in rooms occupied by patients with SARS (a bed table and a television remote control) and in a nurses\u2019 station used by staff (a medication refrigerator door). These data provide the first experimental confirmation of viral aerosol generation by a patient with SARS, indicating the possibility of airborne droplet transmission, which emphasizes the need for adequate respiratory protection, as well as for strict surface hygiene practices", "COVID-19: Special Precautions in Ophthalmic Practice and FAQs on Personal Protection and Mask Selection The Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory coronavirus-2, was first reported in December 2019. The World Health Organization declared COVID-19 a pandemic on March 11, 2020 and as of April 17, 2020, 210 countries are affected with >2,000,000 infected and 140,000 deaths. The estimated case fatality rate is around 6.7%. We need to step up our infection control measures immediately or else it may be too late to contain or control the spread of COVID-19. In case of local outbreaks, the risk of infection to healthcare workers and patients is high. Ophthalmic practice carries some unique risks and therefore high vigilance and special precautions are needed. We share our protocols and experiences in the prevention of infection in the current COVID-19 outbreak and the previous severe acute respiratory syndrome epidemic in Hong Kong. We also endeavor to answer the key frequently asked questions in areas of the coronaviruses, COVID-19, disease transmission, personal protection, mask selection, and special measures in ophthalmic practices. COVID-19 is highly infectious and could be life-threatening. Using our protocol and measures, we have achieved zero infection in our ophthalmic practices in Hong Kong and China. Preventing spread of COVID-19 is possible and achievable.", "Lung cancer management challenges amidst COVID-19 pandemic: hope lives here ", "Effects of temperature and humidity on the spread of COVID-19: A systematic review. Background: Faced with the global pandemic of COVID-19, declared by World Health Organization (WHO) on March 11th 2020, and the need to better understand the seasonal behavior of the virus, our team conducted this systematic review to describe current knowledge about the emergence and replicability of the virus and its correlation with different weather factors such as temperature and relative humidity. Methods: The review was registered with the PROSPERO database. The electronic databases PubMed, Scopus, Web of Science, Cochrane Library, LILACS, OpenGrey and Google Scholar were examined with the searches restricted to the years 2019 and 2020. Risk of bias assessment was performed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist tool. The GRADE tool was used to assess the quality of the evidence. Results: The initial screening identified 517 articles. After examination of the full texts, seventeen studies met the review's eligibility criteria. Great homogeneity was observed in the findings regarding the effect of temperature and humidity on the seasonal viability and transmissibility of COVID-19. Cold and dry conditions were potentiating factors on the spread of the virus. After quality assessment, four studies had a high risk of bias and thirteen studies were scored as moderate risk of bias. The certainty of evidence was graded as low for both outcomes evaluated. Conclusion: Considering the existing scientific evidence, warm and wet climates seem to reduce the spread of COVID-19. The certainty of the evidence generated was graded as low. However, these variables alone could not explain most of the variability in disease transmission.", "Infection control in non\u2010clinical areas during the COVID\u201019 pandemic Large numbers of healthcare workers have acquired coronavirus disease (COVID-19) in the workplace [1]. SARS-CoV-2 is easily transmissible as each person with COVID-19 infects approximately 2.2 close contacts, and asymptomatic transmission has been reported [2,3]. SARS-CoV-2 survives in aerosols and on surfaces from hours to days, respectively [4]. Therefore, we believe non-clinical areas are potentially high-risk for transmission between healthcare workers, and often neglected by infection prevention and control protocols. To alert others to this risk and how it may be reduced, we describe our non-clinical workplace infection prevention and control measures that have been modified from those originally developed during the 2003 severe acute respiratory syndrome epidemic [5].", "COVID-19 Outbreak: An Overview on Dentistry Coronavirus disease 2019, also called COVID-19, is the latest infectious disease to rapidly develop worldwide [...].", "An Evaluation of Cleaning Practices at a Teaching Hospital BACKGROUND: The COVID-19 outbreak has highlighted the role of hospital-acquired infections in spreading epidemics. Adequately cleaning surfaces in patient rooms is an essential part of this fight to reduce the spread. Traditional audits, however, are insufficient. This study assesses surface cleaning practices using UV marker technology and the extent to which this technology can help improve cleaning audits and practices. METHODS: 144 audits (1,235 surfaces) were retrieved. UV marker cleaning audits conducted at a major teaching hospital in 2018 after implementing a new cleaning protocol. In addition, semi-structured interviews were conducted with cleaning staff and supervisors. RESULTS: On average, 63% of surfaces were appropriately cleaned. Toilet handles (80%) and toilet seats underside (83%) scored highest while main room sink fixtures (54%), light switch (55%) and bedrails (56%) scored lowest. Training, staffing and time constraints may play a role in low cleaning rates. DISCUSSION: The high-touch patient surfaces in the bedroom remain neglected and a potential source of infections. UV marker audits provided an objective measure of cleaning practices that managers and staff were unaware of. CONCLUSION: UV markers audits can play a key role in revealing deficiencies in cleaning practices and help in raising awareness of these deficiencies and improving cleaning practices.", "Detection of Air and Surface Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Hospital Rooms of Infected Patients Understanding the particle size distribution in the air and patterns of environmental contamination of SARS-CoV-2 is essential for infection prevention policies. We aimed to detect SARS-CoV-2 surface and air contamination and study associated patient-level factors. 245 surface samples were collected from 30 airborne infection isolation rooms of COVID-19 patients, and air sampling was conducted in 3 rooms. Air sampling detected SARS-CoV-2 PCR-positive particles of sizes >4 \u03bcm and 1-4 \u03bcm in two rooms, which warrants further study of the airborne transmission potential of SARS-CoV-2. 56.7% of rooms had at least one environmental surface contaminated. High touch surface contamination was shown in ten (66.7%) out of 15 patients in the first week of illness, and three (20%) beyond the first week of illness (p = 0.01).", "Environmental Contamination and Viral Shedding in MERS Patients During MERS-CoV Outbreak in South Korea Background. Although Middle East Respiratory Syndrome coronavirus (MERS-CoV) is characterized by a risk of nosocomial transmission, the detailed mode of transmission and period of virus shedding from infected patients are poorly understood. The aims of this study were to investigate the potential role of environmental contamination by MERS-CoV in healthcare settings and to define the period of viable virus shedding from MERS patients. Methods. We investigated environmental contamination from 4 patients in MERS-CoV units of 2 hospitals. MERS-CoV was detected by reverse transcription polymerase chain reaction (PCR) and viable virus was isolated by cultures. Results. Many environmental surfaces of MERS patient rooms, including points frequently touched by patients or healthcare workers, were contaminated by MERS-CoV. Viral RNA was detected up to five days from environmental surfaces following the last positive PCR from patients\u2019 respiratory specimens. MERS-CoV RNA was detected in samples from anterooms, medical devices, and air-ventilating equipment. In addition, MERS-CoV was isolated from environmental objects such as bed sheets, bedrails, IV fluid hangers, and X-ray devices. During the late clinical phase of MERS, viable virus could be isolated in 3 of the 4 enrolled patients on day 18 to day 25 after symptom onset. Conclusions. Most of touchable surfaces in MERS units were contaminated by patients and health care workers and the viable virus could shed through respiratory secretion from clinically fully recovered patients. These results emphasize the need for strict environmental surface hygiene practices, and sufficient isolation period based on laboratory results rather than solely on clinical symptoms.", "The Effects of Temperature and Relative Humidity on the Viability of the SARS Coronavirus The main route of transmission of SARS CoV infection is presumed to be respiratory droplets. However the virus is also detectable in other body fluids and excreta. The stability of the virus at different temperatures and relative humidity on smooth surfaces were studied. The dried virus on smooth surfaces retained its viability for over 5 days at temperatures of 22\u201325\u00b0C and relative humidity of 40\u201350%, that is, typical air-conditioned environments. However, virus viability was rapidly lost (>3 log(10)) at higher temperatures and higher relative humidity (e.g., 38\u00b0C, and relative humidity of >95%). The better stability of SARS coronavirus at low temperature and low humidity environment may facilitate its transmission in community in subtropical area (such as Hong Kong) during the spring and in air-conditioned environments. It may also explain why some Asian countries in tropical area (such as Malaysia, Indonesia or Thailand) with high temperature and high relative humidity environment did not have major community outbreaks of SARS.", "Fomite transmission and disinfection strategies for SARS-CoV-2 and related viruses Contaminated objects or surfaces, referred to as fomites, play a critical role in the spread of viruses, including SARS-CoV-2, the virus responsible for the COVID-19 pandemic. The long persistence of viruses (hours to days) on surfaces calls for an urgent need for surface disinfection strategies to intercept virus transmission and the spread of the disease. Elucidating the physicochemical processes and surface science underlying the adsorption and transfer of virus between surfaces, as well as their inactivation, are important in understanding how the disease is transmitted, and in developing effective interception strategies. This review aims to summarize the current knowledge and underlying physicochemical processes of virus transmission, in particular via fomites, and common disinfection approaches. Gaps in knowledge and needs for further research are also identified. The review focuses on SARS-CoV-2, but will supplement the discussions with related viruses.", "Saliva is a non\u2010negligible factor in the spread of COVID\u201019 SARS\u2010CoV\u20102, a novel emerging coronavirus, has caused severe disease (COVID\u201019), and rapidly spread worldwide since the beginning of 2020. SARS\u2010CoV\u20102 mainly spreads by coughing, sneezing, droplet inhalation, and contact. SARS\u2010CoV\u20102 has been detected in saliva samples, making saliva a potential transmission route for COVID\u201019. The participants in dental practice confront a particular risk of SARS\u2010CoV\u20102 infection due to close contact with the patients and potential exposure to saliva\u2010contaminated droplets and aerosols generated during dental procedures. In addition, saliva\u2010contaminated surfaces could lead to potential cross\u2010infection. Hence, the control of saliva\u2010related transmission in the dental clinic is critical, particularly in the epidemic period of COVID\u201019. Based on our experience of the COVID\u201019 epidemic, some protective measures that can help reduce the risk of saliva\u2010related transmission are suggested, in order to avoid the potential spread of SARS\u2010CoV\u20102 among patients, visitors, and dental practitioners.", "Safety during crisis: Rapid on\u2010site evaluation at the time of COVID\u201019 pandemic The COVID\u201019 pandemic is posing a worldwide challenge to control and contain. SARS\u2010CoV\u20102 is a highly infectious virus. Health care providers at the front lines are at high risk of getting the infection and the risk applies also to laboratory personnel as they deal with specimens that might be contaminated with infectious materiel. Cytopathology teams specifically are at high risk of dealing with contaminated material because of patients encounter during fine\u2010needle aspiration biopsies or Rapid On\u2010Site Evaluation (ROSE) for adequacy. In our article, we discuss alternative safer staining methods to the widely used Diff\u2013Quick stain that can be utilized for ROSE to decrease the risk of viral exposure during the current COVID\u201019 pandemic.", "Assessing the relationship between surface levels of PM2.5 and PM10 particulate matter impact on COVID-19 in Milan, Italy Abstract The novel coronavirus disease (COVID-19) is a highly pathogenic, transmittable and invasive pneumococcal disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which emerged in December 2019 and January 2020 in Wuhan city, Hubei province, China and fast spread later on the middle of February 2020 in the Northern part of Italy and Europe. This study investigates the correlation between the degree of accelerated diffusion and lethality of COVID-19 and the surface air pollution in Milan metropolitan area, Lombardy region, Italy. Daily average concentrations of inhalable particulate matter (PM) in two size fractions PM2.5, PM10 and maxima PM10 ground level atmospheric pollutants together air quality and climate variables (daily average temperature, relative humidity, wind speed, atmospheric pressure field and Planetary Boundary Layer-PBL height) collected during 1 January\u201330 April 2020 were analyzed. In spite of being considered primarily transmitted by indoor bioaerosols droplets and infected surfaces, or direct human-to-human personal contacts, it seems that high levels of urban air pollution, weather and specific climate conditions have a significant impact on the increased rates of confirmed COVID-19 Total number, Daily New and Total Deaths cases, possible attributed not only to indoor but also to outdoor airborne bioaerosols distribution. Our analysis demonstrates the strong influence of daily averaged ground levels of particulate matter concentrations, positively associated with average surface air temperature and inversely related to air relative humidity on COVID-19 cases outbreak in Milan. Being a novel pandemic coronavirus (SARS-CoV-2) version, COVID-19 might be ongoing during summer conditions associated with higher temperatures and low humidity levels. Presently is not clear if this protein \u201cspike\u201d of the new coronavirus COVID-19 is involved through attachment mechanisms on indoor or outdoor airborne aerosols in the infectious agent transmission from a reservoir to a susceptible host in some agglomerated urban areas like Milan is.", "Optimal temperature zone for the dispersal of COVID-19 Abstract It is essential to know the environmental parameters within which the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can survive to understand its global dispersal pattern. We found that 60.0% of the confirmed cases of coronavirus disease 2019 (COVID-19) occurred in places where the air temperature ranged from 5 \u00b0C to 15 \u00b0C, with a peak in cases at 11.54 \u00b0C. Moreover, approximately 73.8% of the confirmed cases were concentrated in regions with absolute humidity of 3 g/m3 to 10 g/m3. SARS-CoV-2 appears to be spreading toward higher latitudes. Our findings suggest that there is an optimal climatic zone in which the concentration of SARS-CoV-2 markedly increases in the ambient environment (including the surfaces of objects). These results strongly imply that the COVID-19 pandemic may spread cyclically and outbreaks may recur in large cities in the mid-latitudes in autumn 2020.", "Transmission Potential of SARS-CoV-2 in Viral Shedding Observed at the University of Nebraska Medical Center Lack of evidence on SARS-CoV-2 transmission dynamics has led to shifting isolation guidelines between airborne and droplet isolation precautions. During the initial isolation of 13 individuals confirmed positive with COVID-19 infection, air and surface samples were collected in eleven isolation rooms to examine viral shedding from isolated individuals. While all individuals were confirmed positive for SARS-CoV-2, symptoms and viral shedding to the environment varied considerably. Many commonly used items, toilet facilities, and air samples had evidence of viral contamination, indicating that SARS-CoV-2 is shed to the environment as expired particles, during toileting, and through contact with fomites. Disease spread through both direct (droplet and person-to-person) as well as indirect contact (contaminated objects and airborne transmission) are indicated, supporting the use of airborne isolation precautions.", "Inactivation of Viruses on Surfaces by Ultraviolet Germicidal Irradiation In many outbreaks caused by viruses, the transmission of the agents can occur through contaminated environmental surfaces. Because of the increasing incidence of viral infections, there is a need to evaluate novel engineering control methods for inactivation of viruses on surfaces. Ultraviolet germicidal irradiation (UVGI) is considered a promising method to inactivate viruses. This study evaluated UVGI effectiveness for viruses on the surface of gelatin-based medium in a UV exposure chamber. The effects of UV dose, viral nucleic acid type (single-stranded RNA, ssRNA; single-stranded DNA, ssDNA; double-stranded RNA, dsRNA; and double-stranded DNA, dsDNA), and relative humidity on the virus survival fraction were investigated. For 90% viral reduction, the UV dose was 1.32 to 3.20 mJ/cm(2) for ssRNA, 2.50 to to 4.47 mJ/cm(2) for ssDNA, 3.80 to 5.36 mJ/cm(2) for dsRNA, and 7.70 to 8.13 mJ/cm(2) for dsDNA. For all four tested viruses, the UV dose for 99% viral reduction was 2 times higher than those for 90% viral reduction. Viruses on a surface with single-stranded nucleic acid (ssRNA and ssDNA) were more susceptible to UV inactivation than viruses with double-stranded nucleic acid (dsRNA and dsDNA). For the same viral reduction, the UV dose at 85% relative humidity (RH) was higher than that at 55% RH. In summary, results showed that UVGI was an effective method for inactivation of viruses on surfaces.", "SARS: Epidemiology, Clinical Presentation, Management, and Infection Control Measures Severe acute respiratory syndrome (SARS) is a recently recognized febrile respiratory illness that first appeared in southern China in November 2002, has since spread to several countries, and has resulted in more than 8000 cases and more than 750 deaths. The disease has been etiologically linked to a novel coronavirus that has been named the SARS-associated coronavirus. It appears to be spread primarily by large droplet transmission. There is no specific therapy, and management consists of supportive care. This article summarizes currently available information regarding the epidemiology, clinical features, etiologic agent, and modes of transmission of the disease, as well as infection control measures appropriate to contain SARS.", "Coronavirus Infections in Children Including COVID-19: An Overview of the Epidemiology, Clinical Features, Diagnosis, Treatment and Prevention Options in Children Coronaviruses (CoVs) are a large family of enveloped, single-stranded, zoonotic RNA viruses. Four CoVs commonly circulate among humans: HCoV2-229E, -HKU1, -NL63 and -OC43. However, CoVs can rapidly mutate and recombine leading to novel CoVs that can spread from animals to humans. The novel CoVs severe acute respiratory syndrome coronavirus (SARS-CoV) emerged in 2002 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012. The 2019 novel coronavirus (SARS-CoV-2) is currently causing a severe outbreak of disease (termed COVID-19) in China and multiple other countries, threatening to cause a global pandemic. In humans, CoVs mostly cause respiratory and gastrointestinal symptoms. Clinical manifestations range from a common cold to more severe disease such as bronchitis, pneumonia, severe acute respiratory distress syndrome, multi-organ failure and even death. SARS-CoV, MERS-CoV and SARS-CoV-2 seem to less commonly affect children and to cause fewer symptoms and less severe disease in this age group compared with adults, and are associated with much lower case-fatality rates. Preliminary evidence suggests children are just as likely as adults to become infected with SARS-CoV-2 but are less likely to be symptomatic or develop severe symptoms. However, the importance of children in transmitting the virus remains uncertain. Children more often have gastrointestinal symptoms compared with adults. Most children with SARS-CoV present with fever, but this is not the case for the other novel CoVs. Many children affected by MERS-CoV are asymptomatic. The majority of children infected by novel CoVs have a documented household contact, often showing symptoms before them. In contrast, adults more often have a nosocomial exposure. In this review, we summarize epidemiologic, clinical and diagnostic findings, as well as treatment and prevention options for common circulating and novel CoVs infections in humans with a focus on infections in children.", "Evaluating the virucidal efficacy of hydrogen peroxide vapour Summary Background Surface contamination has been implicated in the transmission of certain viruses, and surface disinfection can be an effective measure to interrupt the spread of these agents. Aim To evaluate the in-vitro efficacy of hydrogen peroxide vapour (HPV), a vapour-phase disinfection method, for the inactivation of a number of structurally distinct viruses of importance in the healthcare, veterinary and public sectors. The viruses studied were: feline calicivirus (FCV, a norovirus surrogate); human adenovirus type 1; transmissible gastroenteritis coronavirus of pigs (TGEV, a severe acute respiratory syndrome coronavirus [SARS-CoV] surrogate); avian influenza virus (AIV); and swine influenza virus (SwIV). Methods The viruses were dried on stainless steel discs in 20- or 40-\u03bcL aliquots and exposed to HPV produced by a Clarus L generator (Bioquell, Horsham, PA, USA) in a 0.2-m3 environmental chamber. Three vaporized volumes of hydrogen peroxide were tested in triplicate for each virus: 25, 27 and 33mL. Findings No viable viruses were identified after HPV exposure at any of the vaporized volumes tested. HPV was virucidal (>4-log reduction) against FCV, adenovirus, TGEV and AIV at the lowest vaporized volume tested (25mL). For SwIV, due to low virus titre on the control discs, >3.8-log reduction was shown for the 25-mL vaporized volume and >4-log reduction was shown for the 27-mL and 33-mL vaporized volumes. Conclusion HPV was virucidal for structurally distinct viruses dried on surfaces, suggesting that HPV can be considered for the disinfection of virus-contaminated surfaces.", "Risk of SARS-CoV-2 infection from contaminated water systems Following the outbreak of severe acute respiratory syndrome coronavirus (SARS-CoV-2) in China, airborne water droplets (aerosols) have been identified as the main transmission route, although other transmission routes are likely to exist. We quantify SARS-CoV-2 virus survivability within water and the risk of infection posed by faecal contaminated water within 39 countries. We identify that the virus can remain stable within water for up to 25 days, and country specific relative risk of infection posed by faecal contaminated water is related to the environment. Faecal contaminated rivers, waterways and water systems within countries with high infection rates can provide infectious doses >100 copies within 100 ml of water. The implications for freshwater systems, the coastal marine environment and virus resurgence are discussed.", "Effects of temperature on COVID-19 transmission Coronavirus disease 2019 (COVID19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV2), it was first identified in 2019 in Wuhan, China and has resulted in the 2019-20 coronavirus pandemic. As of March 1, 2020, 79,968 patients in China and 7169 outside of China had tested positive for COVID19 and a mortality rate of 3.6% has been observed amongst Chinese patients. Its primary mode of transmission is via respiratory droplets from coughs and sneezes. The virus can remain viable for up to three days on plastic and stainless steel or in aerosols for upto 3 hours and is relatively more stable than the known human coronaviruses. It is stable in faeces at room temperature for at least 1-2 days and can be stable in infected patients for up to 4 days. Heat at 56 degree Celsius kills the SARS coronavirus at around 10000 units per 15 minutes. Thus, temperature is an important factor in survival of COVID19 virus and this article focuses on understanding the relationship between temperature and COVID19 transmission from the data available between January-March 2020.", "Response to Letters to the Editor about the Safe Handling of Containers of Expressed Human Milk in all Settings During the SARS-CoV-2 (COVID-19) Pandemic. ", "Severe acute respiratory syndrome and dentistry A retrospective view ABSTRACT Background Severe acute respiratory syndrome, or SARS, which has created panic in Asia and in some parts of North America, is the first epidemic of the new century. Although it has been well-contained, sporadic cases continue to emerge. Objectives The authors trace the emergence of the SARS outbreak from southern China and its spread worldwide, discuss the viral etiology of the infection and its clinical features, and review the infection control guidelines issued during the outbreak by the health authorities in Hong Kong, the Centers for Disease Control and Prevention, the World Health Organization and the American Dental Association. They also review the prospects for a new outbreak and preventive measures. Overview The disease, which is caused by a novel coronavirus termed the \u201cSARS coronavirus,\u201d or SARS-CoV, essentially spreads through droplet infection and affects people of any age. It has a mortality rate ranging from 10 to 15 percent. A major hallmark of this disease has been the rate at which it has affected health care workers through nosocomial transmission; in some countries, up to one-fourth to one-third of those infected were in this category. However, no dental health care worker has been affected by SARS in a nosocomial or dental setting. Conclusions and Clinical Implications Researchers believe that a combination of factors, including the universal infection control measures that the dental community has implemented and/or the low degree of viral shedding in the prodromal phase of SARS, may have obviated the spread of the disease in dental settings. The dental community should reflect on this outbreak to reinforce the currently applied infection control measures.", "Inactivation of surrogate coronaviruses on hard surfaces by health care germicides BACKGROUND: In the 2003 severe acute respiratory syndrome outbreak, finding viral nucleic acids on hospital surfaces suggested surfaces could play a role in spread in health care environments. Surface disinfection may interrupt transmission, but few data exist on the effectiveness of health care germicides against coronaviruses on surfaces. METHODS: The efficacy of health care germicides against 2 surrogate coronaviruses, mouse hepatitis virus (MHV) and transmissible gastroenteritis virus (TGEV), was tested using the quantitative carrier method on stainless steel surfaces. Germicides were o-phenylphenol/p-tertiary amylphenol) (a phenolic), 70% ethanol, 1:100 sodium hypochlorite, ortho-phthalaldehyde (OPA), instant hand sanitizer (62% ethanol), and hand sanitizing spray (71% ethanol). RESULTS: After 1-minute contact time, for TGEV, there was a log(10) reduction factor of 3.2 for 70% ethanol, 2.0 for phenolic, 2.3 for OPA, 0.35 for 1:100 hypochlorite, 4.0 for 62% ethanol, and 3.5 for 71% ethanol. For MHV, log(10) reduction factors were 3.9 for 70% ethanol, 1.3 for phenolic, 1.7 for OPA, 0.62 for 1:100 hypochlorite, 2.7 for 62% ethanol, and 2.0 for 71% ethanol. CONCLUSION: Only ethanol reduced infectivity of the 2 coronaviruses by >3-log(10) after 1 minute. Germicides must be chosen carefully to ensure they are effective against viruses such as severe acute respiratory syndrome coronavirus.", "Hygiene at home: A bulwark against COVID-19 to be protect from SARS-CoV-2 ", "SARS-CoV-2 RNA detection of hospital isolation wards hygiene monitoring during the Coronavirus Disease 2019 outbreak in a Chinese hospital OBJECTIVES: The aim of this paper was to monitor the presence of SARS-Cov-2 among hospital environment surfaces, sewage, and personal protective equipment (PPE) of staffs in isolation wards in the First Affiliated Hospital of Zhejiang University, China. METHODS: Surfaces of objects were routinely wiped with 1000mg/L chlorine containing disinfectant. Air and sewage disinfection was proceeded routinely and strictly. Hospital environmental surfaces and PPE of staffs in isolation wards were sampled using swabs. The sewage from various inlet and outlets were sampled. The respiratory and stool specimens of patients were collected. The respiratory specimens of staffs in the isolation wards were also sampled once a week. Quantitative real-time reverse transcription PCR (qRT-PCR) methods were used to confirm the existence of SARS-Cov-2 RNA. Viral culture was done for the samples positive for SARS-Cov-2 RNA. RESULTS: During the study period, 33 laboratory-confirmed patients were hospitalized in isolation wards in the hospital. None of SARS-Cov-2 RNA was detected among the 36 objects surface samples and 9 staffs PPE samples in isolation wards. Though the 3 sewage samples from the inlet of preprocessing disinfection pool were positive for SARS-CoV-2 RNA and the sample from the outlet of preprocessing disinfection pool was weakly positive, the sewage sample from the outlet of the last disinfection pool was negative. All of the 5 sewage samples from various points were negative by viral culture of SARS-Cov-2. None of the respiratory specimens of staffs in the isolation wards were positive. CONCLUSIONS: Though SARS-Cov-2 RNA of the sewage samples were positive from inlets of the sewage disinfection pool and negative from the outlet of the last sewage disinfection pool, no viable virus was detected by culture. The monitoring data in this study suggested that the strict disinfection and hand hygiene could decrease the hospital-associated COVID-19 infection risk of the staffs in isolation wards.", "Modeling the Stability of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) on Skin, Currency, and Clothing A new coronavirus (SARS-CoV-2) emerged in the winter of 2019 in Wuhan, China, and rapidly spread around the world. The extent and efficiency of SARS-CoV-2 pandemic is far greater than previous coronaviruses that emerged in the 21st Century. Here, we modeled stability of SARS-CoV-2 on skin, paper currency, and clothing to determine if these surfaces may factor in the fomite transmission dynamics of SARS-CoV-2. Skin, currency, and clothing samples were exposed to SARS-CoV-2 under laboratory conditions and incubated at three different temperatures (4C, 22C, and 37C). Stability was evaluated at 0 hours (h), 4 h, 8 h, 24 h, 72 h, 96 h, 7 days, and 14 days post-exposure. SARS-CoV-2 was shown to be stable on skin through the duration of the experiment at 4C (14 days). Virus remained stable on skin for at least 96 h at 22C and for at least 8h at 37C. There were minimal differences between the tested currency samples. The virus remained stable on the $1 U.S.A. Bank Note for at least 96 h at 4C while viable virus was not detected on the $20 U.S.A. Bank Note samples beyond 72 h. The virus remained stable on both Bank Notes for at least 8 h at 22C and 4 h at 37C. Clothing samples were similar in stability to the currency with the virus being detected for at least 96 h at 4C and at least 4 h at 22C. No viable virus was detected on clothing samples at 37C after initial exposure. This study confirms the inverse relationship between virus stability and temperature. Furthermore, virus stability on skin demonstrates the need for continued hand hygiene practices to minimize fomite transmission both in the general population as well as workplaces where close contact is common.", "Precautions and recommendations for orthodontic settings during the COVID-19 outbreak: A review Abstract Introduction Coronavirus disease 2019 (COVID-19) is contagious disease caused by the SARS-CoV-2 virus. It emerged as a global pandemic early in 2020, affecting more than 2000 countries and territories. The infection is highly contagious with disease transmission reported from asymptomatic carriers, including children. It spreads through person-to-person contact, via aerosol and droplets. The practice of social distancing \u2013 maintaining a distance of 1 \u2013 2 meters or 6 feet -- between people has been widely recommended to slow or halt the spread. This places orthodontists at high risk of acquiring and transmitting the infection. The objective of this review is to report to orthodontists on the emergence, epidemiology, risks, and precautions during disease crisis. This should help increase awareness, reinforce infection control and prevent cross-transmission within the orthodontic facility. Methods A comprehensive literature review of English and non-English articles was performed in March, 2020 using (CORD-19 2020) dataset, PubMed, MEDLINE, Scopus, and Google Scholar to search for infection control and disease transmission in orthodontics. Results This review emphasizes minimizing aerosol production and reinforcing strict infection control measures. Compliance with highest level of personal protection and restriction of treatment to emergency cases is recommended during the outbreak. Surface disinfection, adequate ventilation, and decontamination of instruments and supplies following the guidelines is required. Conclusion Reinforcing strict infection control measures and minimizing personal contact and aerosol production are keys to prevent contamination within the orthodontic settings. Although no cases of COVID-19 cross-transmission within a dental facility have been reported, the risk exists and the disease is still emerging. Further studies are required.", "Detection of air and surface contamination by SARS-CoV-2 in hospital rooms of infected patients Understanding the particle size distribution in the air and patterns of environmental contamination of SARS-CoV-2 is essential for infection prevention policies. Here we screen surface and air samples from hospital rooms of COVID-19 patients for SARS-CoV-2 RNA. Environmental sampling is conducted in three airborne infection isolation rooms (AIIRs) in the ICU and 27 AIIRs in the general ward. 245 surface samples are collected. 56.7% of rooms have at least one environmental surface contaminated. High touch surface contamination is shown in ten (66.7%) out of 15 patients in the first week of illness, and three (20%) beyond the first week of illness (p = 0.01, \u03c7(2) test). Air sampling is performed in three of the 27 AIIRs in the general ward, and detects SARS-CoV-2 PCR-positive particles of sizes >4 \u00b5m and 1\u20134 \u00b5m in two rooms, despite these rooms having 12 air changes per hour. This warrants further study of the airborne transmission potential of SARS-CoV-2.", "Stability of SARS-CoV-2 and other coronaviruses in the environment and on common touch surfaces and the influence of climatic conditions: a review Although the unprecedented efforts the world has been taking to control the spread of the human coronavirus disease (COVID-19) and its causative etiology [Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2)], the number of confirmed cases has been increasing drastically. Therefore, there is an urgent need for devising more efficient preventive measures, to limit the spread of the infection until an effective treatment or vaccine is available. The preventive measures depend mainly on the understanding of the transmission routes of this virus, its environmental stability, and its persistence on common touch surfaces. Due to the very limited knowledge about SARS-CoV-2, we can speculate its stability in the light of previous studies conducted on other human and animal coronaviruses. In this review, we present the available data on the stability of coronaviruses (CoVs), including SARS-CoV-2, from previous reports to help understand its environmental survival. According to available data, possible airborne transmission of SARS-CoV-2 has been suggested. SARS-CoV-2 and other human and animal CoVs have remarkably short persistence on copper, latex, and surfaces with low porosity as compared to other surfaces like stainless steel, plastics, glass, and highly porous fabrics. It has also been reported that SARS-CoV-2 is associated with diarrhea and that it is shed in the feces of COVID-19 patients. Some CoVs show persistence in human excrement, sewage, and waters for a few days. These findings suggest a possible risk of fecal-oral, foodborne, and waterborne transmission of SARS-CoV-2 in developing countries that often use sewage-polluted waters in irrigation and have poor water treatment systems. CoVs survive longer in the environment at lower temperatures and lower relative humidity. It has been suggested that large numbers of COVID-19 cases are associated with cold and dry climates in temperate regions of the world and that seasonality of the virus spread is suspected.", "Environmental sampling for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during a coronavirus disease (COVID-19) outbreak aboard a commercial cruise ship Background A COVID-19 outbreak occurred in a cruise ship with 3711 passengers and crew in 2020. This study is to test the hypothesis that environmental surfaces played important roles in transmission for SARS-CoV-2 during this outbreak. Methods We sampled environmental surfaces including air from common areas in the cruise ship and cabins in which confirmed COVID-19 cases and non-cases had stayed after they left the cabins. We tested the samples for SARS-CoV-2 by rt-PCR and conducted viral isolation. Findings Of 601 samples tested, SARS-CoV-2 RNA was detected from 58 samples (10%) from case-cabins from which they left 1-17 days before sampling, but not from non-case-cabins. Except for one sample from an air hood in a corridor, SARS-CoV-2 RNA was not detected from samples in common areas. SARS-CoV-2 RNA was not detected from all 14 air samples. RNA was most often detected on the floor around toilet in the bathroom (39%, 13/33, cycle quantification (Cq): 26.21-37.62) and bed pillow (34%, 11/32, Cq: 34.61-38.99). There was no difference in the detection proportion between cabins for symptomatic (15%, 28/189, Cq: 29.79-38.86) and asymptomatic cases (21%, 28/131, Cq: 26.21-38.99). No SARS-CoV-2 virus was isolated from any of the samples. Interpretation The environment around the COVID-19 cases was extensively contaminated from SARS-CoV-2 during COVID-19 outbreak in the cruise ship. Transmission risk of SARS-CoV-2 from symptomatic and asymptomatic patients seems to be similar and the environmental surface could involve viral transmission through direct contact.", "Homegrown Ultraviolet Germicidal Irradiation for Hospital-Based N95 Decontamination during the COVID-19 Pandemic Coronavirus disease (COVID-19), the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, is responsible for the 2020 global pandemic and characterized by high transmissibility and morbidity. Healthcare workers (HCWs) are at risk of contracting COVID-19, and this risk is mitigated through the use of personal protective equipment such as N95 Filtering Facepiece Respirators (FFRs). The high demand for FFRs is not currently met by global supply chains, potentially placing HCWs at increased exposure risk. Effective FFR decontamination modalities exist, which could maintain respiratory protection for HCWs in the midst of the current pandemic, through the decontamination and re-use of FFRs. Here, we present a locally-implemented ultraviolet-C germicidal irradiation (UVGI)-based FFR decontamination pathway, utilizing a home-built UVGI array assembled entirely with previously existing components available at our institution. We provide recommendations on the construction of similar systems, as well as guidance and strategies towards successful institutional implementation of FFR decontamination.", "Stability of bovine coronavirus on lettuce surfaces under household refrigeration conditions Fecal suspensions with an aerosol route of transmission were responsible for a cluster of severe acute respiratory syndrome (SARS) cases in 2003 in Hong Kong. Based on that event, the World Health Organization recommended that research be implemented to define modes of transmission of SARS coronavirus through sewage, feces, food and water. Environmental studies have shown that animal coronaviruses remain infectious in water and sewage for up to a year depending on the temperature and humidity. In this study, we examined coronavirus stability on lettuce surfaces. A cell culture adapted bovine coronavirus, diluted in growth media or in bovine fecal suspensions to simulate fecal contamination was used to spike romaine lettuce. qRT-PCR detected viral RNA copy number ranging from 6.6 \u00d7 10(4) to 1.7 \u00d7 10(6) throughout the experimental period of 30 days. Whereas infectious viruses were detected for at least 14 days, the amount of infectious virus varied, depending upon the diluent used for spiking the lettuce. UV and confocal microscopic observation indicated attachment of residual labeled virions to the lettuce surface after the elution procedure, suggesting that rates of inactivation or detection of the virus may be underestimated. Thus, it is possible that contaminated vegetables may be potential vehicles for coronavirus zoonotic transmission to humans.", "A framework for nosocomial transmission of emerging coronaviruses ", "A Review of Coronavirus Disease-2019 (COVID-19) There is a new public health crises threatening the world with the emergence and spread of 2019 novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus originated in bats and was transmitted to humans through yet unknown intermediary animals in Wuhan, Hubei province, China in December 2019. There have been around 96,000 reported cases of coronavirus disease 2019 (COVID-2019) and 3300 reported deaths to date (05/03/2020). The disease is transmitted by inhalation or contact with infected droplets and the incubation period ranges from 2 to 14 d. The symptoms are usually fever, cough, sore throat, breathlessness, fatigue, malaise among others. The disease is mild in most people; in some (usually the elderly and those with comorbidities), it may progress to pneumonia, acute respiratory distress syndrome (ARDS) and multi organ dysfunction. Many people are asymptomatic. The case fatality rate is estimated to range from 2 to 3%. Diagnosis is by demonstration of the virus in respiratory secretions by special molecular tests. Common laboratory findings include normal/ low white cell counts with elevated C-reactive protein (CRP). The computerized tomographic chest scan is usually abnormal even in those with no symptoms or mild disease. Treatment is essentially supportive; role of antiviral agents is yet to be established. Prevention entails home isolation of suspected cases and those with mild illnesses and strict infection control measures at hospitals that include contact and droplet precautions. The virus spreads faster than its two ancestors the SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV), but has lower fatality. The global impact of this new epidemic is yet uncertain.", "The role of absolute humidity on transmission rates of the COVID-19 outbreak A novel coronavirus (COVID-19) was identified in Wuhan, Hubei Province, China, in December 2019 and has caused over 40,000 cases worldwide to date. Previous studies have supported an epidemiological hypothesis that cold and dry (low absolute humidity) environments facilitate the survival and spread of droplet-mediated viral diseases, and warm and humid (high absolute humidity) environments see attenuated viral transmission (i.e., influenza). However, the role of absolute humidity in transmission of COVID-19 has not yet been established. Here, we examine province-level variability of the basic reproductive numbers of COVID-19 across China and find that changes in weather alone (i.e., increase of temperature and humidity as spring and summer months arrive in the North Hemisphere) will not necessarily lead to declines in COVID-19 case counts without the implementation of extensive public health interventions.", "Coronaviruses in wastewater processes: source, fate and potential risks Abstract The last 17 years have seen three major outbreaks caused by coronaviruses, with the latest outbreak, COVID-19, declared a pandemic by the World Health Organization. The frequency of these outbreaks, their mortality and associated disruption to normal life calls for concerted efforts to understand their occurrence and fate in different environments. There is an increased interest in the occurrence of coronaviruses in wastewater from the perspective of wastewater-based epidemiology. However, there is no comprehensive review of the knowledge on coronavirus occurrence, fate and potential transmission in wastewater. This paper, provides a review of the literature on the occurrence of coronaviruses in wastewater treatment processes. We discuss the presence of viral RNA in feces as a result of gastrointestinal infections resulting in diarrhoea. We also review the literature on their presence, survival and potential removal in common wastewater treatment processes. The detection of infectious viral particles in feces of patients raises questions on the potential risks of infection for people exposed to untreated sewage/wastewater. We, therefore, discuss the potential risk of infection with coronaviruses for workers in wastewater treatment plants and the public that may be exposed through faulty plumbing or burst sewer networks. The disruption of life and mortalities warrants a much more focused research on the role of environments, such as wastewater and surface water, in disease transmission. The current wealth of knowledge on coronaviruses in wastewater based on the reviewed literature is scant and therefore calls for further studies."], "neg": ["Prevalence and genetic diversity analysis of human coronaviruses among cross-border children BACKGROUND: More than a decade after the outbreak of human coronaviruses (HCoVs) SARS in Guangdong province and Hong Kong SAR of China in 2002, there is still no reoccurrence, but the evolution and recombination of the coronaviruses in this region are still unknown. Therefore, surveillance on the prevalence and the virus variation of HCoVs circulation in this region is conducted. METHODS: A total of 3298 nasopharyngeal swabs samples were collected from cross-border children (<6 years, crossing border between Southern China and Hong Kong SAR) showing symptoms of respiratory tract infection, such as fever (body temperature > 37.5 \u00b0C), from 2014 May to 2015 Dec. Viral nucleic acids were analyzed and sequenced to study the prevalence and genetic diversity of the four human coronaviruses. The statistical significance of the data was evaluated with Fisher chi-square test. RESULTS: 78 (2.37%; 95%CI 1.8-2.8%) out of 3298 nasopharyngeal swabs specimens were found to be positive for OC43 (36;1.09%), HKU1 (34; 1.03%), NL63 (6; 0.18%) and 229E (2;0.01%). None of SARS or MERS was detected. The HCoVs predominant circulating season was in transition of winter to spring, especially January and February and NL63 detected only in summer and fall. Complex population with an abundant genetic diversity of coronaviruses was circulating and they shared homology with the published strains (99-100%). Besides, phylogenetic evolutionary analysis indicated that OC43 coronaviruses were clustered into three clades (B,D,E), HKU1 clustered into two clades(A,B) and NL63 clustered into two clades(A,B). Moreover, several novel mutations including nucleotides substitution and the insertion of spike of the glycoprotein on the viral surface were discovered. CONCLUSIONS: The detection rate and epidemic trend of coronaviruses were stable and no obvious fluctuations were found. The detected coronaviruses shared a conserved gene sequences in S and RdRp. However, mutants of the epidemic strains were detected, suggesting continuous monitoring of the human coronaviruses is in need among cross-border children, who are more likely to get infected and transmit the viruses across the border easily, in addition to the general public.", "Female Genital System ", "Ocular manifestation as first sign of Coronavirus Disease 2019 (COVID-19): interest of telemedicine during the pandemic context Abstract We report here the case of a 27-year-old man who consulted by telemedicine during the Coronavirus Disease 2019 (COVID-19) pandemic, due to foreign body sensation and left eye redness. Examination revealed unilateral eyelid edema and moderate conjunctival hyperemia. A few hours later the patient experienced intense headache and developed fever, cough and severe dyspnea. A nasopharyngeal swab proved positive for SARS-CoV-2. This case demonstrates that conjunctivitis can be the inaugural manifestation of the COVID-19 infection. It illustrates the interest of telemedicine in ophthalmology during the COVID-19 pandemic, since moderate conjunctival hyperemia can be the first sign of a severe respiratory distress.", "Commentary on: The SARS, MERS and novel coronavirus (COVID-19) epidemics, the newest and biggest global health threats: what lessons have we learned? A One Health approach to coronaviruses ", "The evidence of SARS-CoV-2 infection on ocular surface Abstract This is a cross-sectional study of patients who received a COVID-19 diagnosis between December 30, 2019 and February 7, 2020 at Tongji Hospital. A total of 102 patients (48 Male [47%] and 54 Female [53%]) with clinical symptoms, Rt, and chest Computed Tomography (CT) abnormalities were identified with a clinical diagnosis of COVID-19. Patients had a mean [SD] gestational age of 57.63 [14.90] years. Of a total of 102 patients identified, 72 patients (36 men [50%] and 36 women [50%]; mean [SD] age, 58.68 [14.81] years) were confirmed to have COVID-19 by laboratory diagnosis with a SARS-CoV-2 RT-PCR assay. Only two patients (2.78%) with conjunctivitis were identified from 72 patients with a laboratory confirmed COVID-19. Of those two patients, SARS-CoV-2 RNA fragments were found in ocular discharges by SARS-CoV-2 RT-PCR in only one patient. Our findings suspect the incidence of SARS-CoV-2 infection through the ocular surface is extremely low, while the nosocomial infection of SARS-CoV-2 through the eyes after occupational exposure is a potential route. To lower the SARS-CoV-2 nosocomial infection, all health care professionals should wear protective goggles. The inefficient diagnostic method and the sampling time lag may contribute to the lower positive rate of conjunctival swab samples of SARS-CoV-2.", "Utilising Media and Text-Based Sources An often-underestimated, valuable source of naturally occurring data is that of media sources, such as television programmes, documentaries, newspapers, and magazines. Often in traditional textbooks these are positioned as secondary sources. We argue that they can be considered primary data, as well as naturally occurring data. This type of naturally occurring data is of interest for qualitative research, and in this chapter, we focus on the use of policy documents, medical notes, health guidelines, as well as other data sources such as police transcripts, court transcripts, and social care reports whereby health is invoked, to illustrate the value of analysing texts that occur naturally in the field of health.", "Evolutionary dynamics of HIV at multiple spatial and temporal scales Infectious diseases remain a formidable challenge to human health, and understanding pathogen evolution is crucial to designing effective therapeutics and control strategies. Here, we review important evolutionary aspects of HIV infection, highlighting the concept of selection at multiple spatial and temporal scales. At the smallest scale, a single cell may be infected by multiple virions competing for intracellular resources. Recombination and phenotypic mixing introduce novel evolutionary dynamics. As the virus spreads between cells in an infected individual, it continually evolves to circumvent the immune system. We discuss evolutionary mechanisms of HIV pathogenesis and progression to AIDS. Viral spread throughout the human population can lead to changes in virulence and the transmission of immune-evading variation. HIV emerged as a human pathogen due to selection occurring between different species, adapting from related viruses of primates. HIV also evolves resistance to antiretroviral drugs within a single infected host, and we explore the possibility for the spread of these strains between hosts, leading to a drug-resistant epidemic. We investigate the role of latency, drug-protected compartments, and direct cell-to-cell transmission on viral evolution. The introduction of an HIV vaccine may select for viral variants that escape vaccine control, both within an individual and throughout the population. Due to the strong selective pressure exerted by HIV-induced morbidity and mortality in many parts of the world, the human population itself may be co-evolving in response to the HIV pandemic. Throughout the paper, we focus on trade-offs between costs and benefits that constrain viral evolution and accentuate how selection pressures differ at different levels of selection. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00109-012-0892-1) contains supplementary material, which is available to authorized users.", "Activity of and effect of subcutaneous treatment with the broad-spectrum antiviral lectin griffithsin in two laboratory rodent models. Griffithsin (GRFT) is a red-alga-derived lectin that binds the terminal mannose residues of N-linked glycans found on the surface of human immunodeficiency virus type 1 (HIV-1), HIV-2, and other enveloped viruses, including hepatitis C virus (HCV), severe acute respiratory syndrome coronavirus (SARS-CoV), and Ebola virus. GRFT displays no human T-cell mitogenic activity and does not induce production of proinflammatory cytokines in treated human cell lines. However, despite the growing evidence showing the broad-spectrum nanomolar or better antiviral activity of GRFT, no study has reported a comprehensive assessment of GRFT safety as a potential systemic antiviral treatment. The results presented in this work show that minimal toxicity was induced by a range of single and repeated daily subcutaneous doses of GRFT in two rodent species, although we noted treatment-associated increases in spleen and liver mass suggestive of an antidrug immune response. The drug is systemically distributed, accumulating to high levels in the serum and plasma after subcutaneous delivery. Further, we showed that serum from GRFT-treated animals retained antiviral activity against HIV-1-enveloped pseudoviruses in a cell-based neutralization assay. Overall, our data presented here show that GRFT accumulates to relevant therapeutic concentrations which are tolerated with minimal toxicity. These studies support further development of GRFT as a systemic antiviral therapeutic agent against enveloped viruses, although deimmunizing the molecule may be necessary if it is to be used in long-term treatment of chronic viral infections."]}]}