cord-253196-et1ekgdl	2020	Two medications often used for treatment of immune-mediated conditions, hydroxychloroquine and chloroquine, have recently attracted widespread interest as potential therapies for coronavirus disease 2019. The antimalarials hydroxychloroquine (HCQ) and chloroquine (CQ) have demonstrated antiviral activity against severe acute respiratory syndromecoronavirus 2 (SARS-CoV-2) in vitro and in small, poorly controlled or uncontrolled clinical studies (1) (2) (3) . Here, we try to provide guidance regarding clinical decision making both for patients with COVID-19 and those with immune-mediated conditions, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), and strategies to mitigate further harm to these patients. At this time of crisis, it is our ethical obligation as physicians and researchers to organize and refer patients to expedited, well-performed randomized trials that can clarify if, when, and for whom antimalarial medications are helpful in COVID-19. A pilot study of hydroxychloroquine in treatment of patients with common coronavirus disease-19 (COVID-19)
cord-263549-hmdyb7hi	2020	title: Fighting COVID-19: Enabling Graduating Students to Start Internship Early at Their Own Medical School This perspective proposes one way to ensure enough doctors, nurses, and pharmacists during the COVID-19 pandemic: Enable graduating students to start internship early at their own medical school. Many medical schools have a "capstone" course in the final weeks before graduation that prepares students for internship, with content geared toward meeting common patient care challenges. The United States could provide loan repayment or other federal payment programs for any senior students willing (and competent, as judged by their medical school) to begin early. The average U.S. medical student graduates with approximately $200 000 of debt (7), so generous repayment programs would be welcome-and fitting-with potentially less bureaucracy than officially hiring students through health care systems short term. Graduate medical education (GME) leaders would need to discuss potentially giving participating students "credit" toward residency completion. Accessed at www .ama-assn.org/delivering-care/public-health/covid-19-states-call-early -medical-school-grads-bolster-workforce on 5
cord-267124-8efdzlc0	2020	In response to the pandemic spread of SARS-CoV-2, the authorities of the German federal state of Hamburg ordered mandatory autopsies in all patients dying with a diagnosis of COVID-19 confirmed by polymerase chain reaction (PCR). During autopsy, tissue samples for histology were taken from the following organs: heart, lungs, liver, kidneys, spleen, pancreas, brain, prostate and testes (in males), ovaries (in females), small bowel, saphenous vein, common carotid artery, pharynx, and muscle. In this autopsy study of 12 consecutive patients who died of COVID-19, we found a high incidence of deep venous thrombosis (58%). In studies that examined deceased patients with COVID-19 without relying on autopsy, no increased rates of pulmonary embolism were observed clinically. To our knowledge, only 3 case reports have been published on patients with COVID-19 who have undergone complete autopsy and a few more in which only lung tissue was examined (7, 8) .
cord-270970-9gtnsyts	2020	In multivariable analyses, participants who were black, were living below the poverty level, and had low health literacy were more likely to be less worried about COVID-19, to not believe that they would become infected, and to feel less prepared for an outbreak. We did a time-sensitive study among higher-risk, older adults living with 1 or more chronic conditions to determine their current awareness of COVID-19, their perception of the seriousness of its threat, their level of worry and concern related to contracting the virus, whether it is affecting their daily routine or existing plans, how prepared they feel to handle an outbreak, and their confidence in the federal government response. In our study, disparities by race, socioeconomic status, and health literacy were not reflected in ratings of the seriousness of the COVID-19 threat, demonstrated knowledge of its symptom presentation or general means to prevent it, or reported changes to daily routines and plans.
cord-273192-r1wt1oyg	2020	title: Infection Fatality Ratios for COVID-19 Among Noninstitutionalized Persons 12 and Older: Results of a Random-Sample Prevalence Study Objective: To estimate IFRs among noninstitutionalized (that is, community-dwelling) populations by age, race, ethnicity, and sex by using the first U.S. statewide random-sample study of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prevalence. Methods and Findings: We combined prevalence estimates from a statewide random sample with Indiana vital statistics data of confirmed COVID-19 deaths (4). We accounted for nonresponse by weighting prevalence estimates for age, race (dichotomized as White or non-White), and Hispanic ethnicity to reflect state demographics. We calculated the IFR by age, race, sex, and ethnicity on the basis of the cumulative number of confirmed COVID-19 deaths as of 29 April 2020, divided by the number of infections. Discussion: By using SARS-CoV-2 population prevalence data, we found that the risk for death among infected persons increased with age.
cord-275601-9y5zj9an	2020	These authors propose an "evidence ecosystem" for COVID-19–related studies that minimizes multiple low-quality reviews and helps connect evidence generation, synthesis, and decision making. These issues have been highlighted and exacerbated by the COVID-19 pandemic, where stakeholders urgently need relevant, accessible, up-to-date, and trustworthy syntheses of high-quality evidence to inform their decisions. Every week, we screen the COVID-19 database produced by the World Health Organization''s International Clinical Trials Registry Platform to identify eligible RCTs. The living mapping produced provides a description of all registered RCTs. The data retrieved and extracted can be explored through interactive data visualizations to identify research gaps and help prioritize and improve future trials. Collectively, COVID-NMA data are used to conduct systematic reviews on specific questions, meta-analyses of individual participant data (IPD), and network meta-analyses and to support the guideline development process and health decision making.
cord-275946-ofd2ipvs	2020	Accurate serologic tests to detect host antibodies to severe acute respiratory syndrome–related coronavirus-2 (SARS-CoV-2) will be critical for the public health response to the coronavirus disease 2019 pandemic. This article discusses key use cases for SARS-CoV-2 antibody detection tests and their application to serologic studies, reviews currently available assays, highlights key areas of ongoing research, and proposes potential strategies for test implementation. Appropriately designed seroepidemiologic studies will play an essential part in the public health response to the COVID-19 pandemic by characterizing transmission dynamics, refining disease burden estimates, and providing insight into the kinetics of humoral immunity to SARS-CoV-2. Serologic surveillance studies can also assess the accumulation of persons with antibody responses over time to estimate incidence of SARS-CoV-2 infection (57, 58) and can track age-and jurisdiction-specific disease susceptibility and identify at-risk populations (59) .
cord-276428-oy8e2cpx	2020	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 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 re-sponses both within a minority community and in wider racial, sociopolitical, and public health structures. We examine the historical arc of the 1918 influenza pandemic, focusing on black Americans and showing the complex, sometimes surprising ways it triggered particular responses both within a minority community and in wider racial, sociopolitical, and public health structures. Although the influenza pandemic does not reveal ready associations between deleterious social, cultural, and economic conditions and poor outcomes (aside from higher case-fatality rate) for black Americans, the gaps in historical documentation may reflect inherent disparities and consequences of limited racial/ethnic data collection.
cord-280672-6x968dwk	2020	In their article, Sudharsanan and colleagues show the importance of adjusting for the age distribution of cases of coronavirus disease 2019 before doing cross-country comparisons of case-fatality rates. Failure to recognize younger, milder cases diminishes the denominator in case-fatality ratio (CFR) calculations (that is, deaths/cases), so between-country differences in age structure explain some fraction of observed between-country variation in epidemic severity and case-fatality. In their analysis, the authors show that adjusting for differences in population age structure substantially reduces the observed differences between country-specific CFRs. To further explore the effect of age distribution on CFR, we can take the standardization approach used by Sudharsanan and colleagues and turn it on its head. When the reported CFR for February 2020 in mainland China (2.3%) is age-standardized using population pyramids from other countries (7), standardization to a country with a younger population structure, such as Indonesia, markedly reduces observed CFR (1.7%), whereas adjustment to a country with an older population, such as Italy, increases the CFR (3.9%).
cord-284694-bk6bnox0	2020	title: Cytokine Levels in the Body Fluids of a Patient With COVID-19 and Acute Respiratory Distress Syndrome: A Case Report In addition, the time from symptom onset to confirmation of COVID-19 diagnosis was relatively long, the patient''s hospital course was longer, and we wonder whether this long duration of viral replication contributed to the high cytokine levels we measured. As a result, we wonder whether tocilizumab would have affected the IL-6 levels we observed and whether it might have improved this patient''s disease course, especially because others have reported that as COVID-19 progresses to its middle and late stages, the expression of inflammatory cytokines is related to the severity of the disease (4). On the basis of our experience, we encourage additional research to determine whether inflammatory cytokines in the lungs predict the clinical course of COVID-19 and whether these cytokines should be a target for intervention and treatment.
cord-287191-e8073l9p	2020	Coronavirus disease 2019 (COVID-19) is optimized to spread widely: Its signs and symptoms are largely indistinguishable from those of other respiratory viruses. The signs and symptoms of coronavirus disease 2019 (COVID-19) are largely indistinguishable from those of other respiratory virus infections. Case detection is still primarily focused on identifying patients with fever, cough, or shortness of breath; this focus leads to underestimation of the number of infected persons, overestimation of the mortality rate, and ongoing spread of disease. To cause a nosocomial outbreak, it will take just 1 patient with occult COVID-19 who is hospitalized, tests negative for influenza virus, and is taken off precautions despite persistent respiratory symptoms. But if we are frank about the morbidity and mortality of all respiratory viruses, including SARS-CoV-2, this is the best thing we can do for our patients and colleagues regardless of COVID-19.
cord-289763-jek2pd31	2020	Data on participant characteristics were provided by NORC and included age, sex, race/ethnicity, educational attainment, household income, household size, marital status, employment status, geographic location, urban or rural location (addresses within a metropolitan statistical area were categorized as urban), receipt of influenza vaccination in the prior year, and self-rated overall health status. After adjustment for differences in participant characteristics ( Table 3) , factors that were independently associated with vaccine hesitancy (response of "no" or "not sure") include younger age (<60 years), Black race, educational attainment of less than a college degree, and not receiving an influenza vaccine in the prior year. We found several independent predictors of being hesitant to be vaccinated against COVID-19; the strongest were lower educational attainment, Black race, not having had a recent influenza vaccination, and perceived personal risk for coronavirus, consistent with the findings of a national survey conducted by RTI (20) .
cord-290070-534936lf	2020	In this article, leaders from the American College of Physicians (ACP) discuss key recommendations from ACP''s vision for U.S. health care that can advise how we can act now during the COVID-19 pandemic and in the future in service to patients, our peers, and the profession. As leaders in the American College of Physicians (ACP), we have helped develop ACP''s wide-ranging policies on health care in the United States. The American College of Physicians envisions a health care system where everyone has coverage for and access to the care they need, at a cost they and the country can afford. The The American College of Physicians supports greater investment in primary care and preventive health services, including support for the unique role played by internal medicine specialists in providing high-value primary, preventive, and comprehensive care of adult patients. Envisioning a better U.S. health care system for all: a call to action by the American College of Physicians
cord-294369-e3jyihvm	2020	BACKGROUND: The incidence and severity of coronavirus disease 2019 (COVID-19) among HIV-positive persons receiving antiretroviral therapy (ART) have not been characterized in large populations. CONCLUSION: HIV-positive patients receiving TDF/FTC have a lower risk for COVID-19 and related hospitalization than those receiving other therapies. The risks for PCR-confirmed COVID-19 diagnosis, hospitalization, ICU admission, and death among HIVpositive persons receiving ART in Spain were greater in men and those older than 70 years. The lower risk for COVID-19 diagnosis among persons receiving TDF/FTC might be the result of less intensive testing for SARS-CoV-2 infection in this group compared with those receiving other ART regimens. Molecular docking (18 -23) and other in vitro studies (24) suggest that NRTIs, such as TDF, TAF, ABC, and 3TC, might be effective against SARS-CoV-2 infection by inhibiting RNAdRNAp. This also might explain the 32% lower risk for COVID-19 diagnosis in persons receiving ABC/3TC compared with those receiving TAF/FTC.
cord-294628-ecg13s7a	2020	During the coronavirus disease 2019 (COVID-19) pandemic, Singapore implemented large-scale institutional isolation units called Community Care Facilities (CCFs) to combat the outbreak in the community by housing low-risk COVID-19 patients from April to August 2020. During the coronavirus disease 2019 (COVID-19) pandemic, Singapore implemented large-scale institutional isolation units called Community Care Facilities (CCFs) to combat the outbreak in the community by housing low-risk COVID-19 patients from April to August 2020. In the first month, a total of 3758 patients were admitted to 4 halls, 4929 in-house medical consults occurred, 136 patients were transferred to a hospital, 1 patient died 2 weeks after discharge, and no health care workers became infected. As such, isolation centers called Community Care Facilities (CCFs) were set up throughout the country to house patients with COVID-19 who were at low risk for dying of the disease.
cord-298632-xu1sgguh	2020	Across hospital systems, cost-cutting to reduce EVS staff and cleaning hours has been associated with increased nosocomial infections (1) (2) (3) . In light of evidence that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can survive on surfaces for up to 3 days (5), along with studies demonstrating that viral shedding contaminates over 80% of the interior of hospital rooms (6) and aerosolization of SARS-CoV-2 causes extensive surface contamination (7), it is now more urgent than ever to emphasize the importance of environmental cleaning. Cleaning staff have been whittled down by 25% during this time, and more than one third of hospitals have disbanded their own EVS teams to outsource this work to contractors, shedding valuable institutional experience while exacerbating high turnover and inadequate training (1). To thoroughly disinfect a hospital room, EVS workers need sufficient time, proper technique, and effective tools.
cord-300474-r5gms09p	2020	title: Update Alert 2: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults Results of 3 new meta-analysis (2-4) evaluating the association of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB) use with coronavirus disease 2019 (COVID-19) illness severity are consistent with the findings that we reported in the original manuscript. Overall, inclusion of these 3 new meta-analyses and 5 new observational studies does not change the certainty of evidence rating we reported in the original manuscript for key question 2-high-certainty evidence that ACEI or ARB use is not associated with more severe COVID-19 disease. A systematic review and meta-analysis to evaluate the clinical outcomes in COVID-19 patients on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Effects of angiotensin II receptor blockers and ACE (angiotensin-converting enzyme) inhibitors on virus infection, inflammatory status, and clinical outcomes in patients with COVID-19 and hypertension: a single-center retrospective study
cord-301183-k39e12cq	2020	title: SARS-CoV-2 RNAemia in a Healthy Blood Donor 40 Days After Respiratory Illness Resolution than 1 month after symptom resolution is concerning in light of current guidelines, which do not recommend SARS-CoV-2 screening in the general allogeneic donor population (5) . In this case, plasma viral RNA was reproducibly detected at a time point that exceeded recommendations for deferral based on time since symptom resolution (14 days). Of importance, these results are unlikely to be false-positive given that 2 different regions of the SARS-CoV-2 genome were detected in separate specimens collected on the day of donation and that quality control passed on all runs, including the absence of amplification in the negative controls. Of note, however, the infectivity of SARS-CoV-2 from blood remains unknown and, to date, we are not aware of cases of transfusion-transmitted COVID-19. Severe acute respiratory syndrome coronavirus 2 RNA detected in blood donations
cord-301852-9nza3po0	2020	Coronavirus disease 2019 has swept through prisons in much the same way it has nursing homes: after being introduced by staff or newly arrived residents, it spreads efficiently, including to many with medical vulnerabilities. The authors believe that ensuring community-standard occupational health for correctional staff during COVID-19 will protect prison residents, staff, and their communities. As COVID-19 transmission continues unabated in these settings, protecting the health and safety of correctional workers is a moral imperative and an underappreciated requirement to mitigate the pandemic''s effect on incarcerated persons and surrounding communities. Although occupational health interventions should focus primarily on correctional officers given their numbers and close, sustained contact with incarcerated persons, interventions should be adapted to reduce risk for infection for all staff. To protect correctional staff and ensure that community standards of care are afforded to incarcerated populations during the COVID-19 pandemic, prisons must: Ensuring community-standard occupational health for correctional staff during COVID-19 will protect us all.
cord-303420-3jlqx83u	2020	Unfortunately, we''ve also seen that the experience in caring for patients with the virus may have profound effects on clinicians'' mental health (2) . We have learned the value of finding meaning in times of intense grief and sorrow-a new skill for many clinicians outside palliative care. With that in mind, we share a foundational set of principles to use as guidance for building internal support for the trauma caused by the pandem-ic: looking past the illness, fostering community, promoting vulnerability, and establishing boundaries and limitations. In palliative care, these challenges bring us together and we make time to talk about them in groups; 1 example is weekly Bereavement Rounds to share grief about the death of our patients. If we take timely and targeted action, we will provide the support our fellow clinicians desperately need.
cord-307717-vf85qt8j	2020	The COVID-19 pandemic has upended clinicians'' sense of order and control, creating the potential for stress in the short term and burnout over the long term. Leaders must communicate current best practices clearly and compassionately, manage expectations, clarify work hours, and provide sufficient resources and effective personal protective equipment. Leaders should aim for work schedules that promote physical resilience by enabling adequate sleep and providing access to call rooms for hospital-based clinicians working long or multiple shifts. Health care organizations can provide information on managing stress, reducing burnout, and identifying mental health professionals available to support clinicians (3). Examples of settings for such sharing include the American College of Physicians Physician Well-Being and Discussion Forum (5), the Society of General Internal Medicine GIMConnect (6) , and the American Medical Association Physician Health (7) resources that members can access. Emphasizing clinician wellness during the COVID-19 pandemic (8) is necessary to enable them to provide high-quality care.
cord-309207-n8u8ddv7	2020	title: Loss of Smell and Taste in 2013 European Patients With Mild to Moderate COVID-19 Using a standardized online questionnaire, we collected clinical and epidemiologic data from hospitalized patients on discharge day and from ambulatory patients after the resolution of key symptoms (such as cough, fever, dyspnea, headache, myalgia, and arthralgia) (Figure) . Objective evaluations for olfactory dysfunction were performed in a subset of patients who reported total loss of smell at 1 of the study sites (EpiCURA Hospital, Hainaut, Belgium) at the time of the questionnaire. A total of 1754 patients (87%) reported loss of smell, whereas 1136 (56%) reported taste dysfunction. Mean time from the end of the disease to the evaluation was 7.8 days (SD, 6.8); mean duration of general symptoms (excluding loss of smell and taste) was 11.5 days (SD, 6.0). Most patients had loss of smell after other general and otolaryngologic symptoms (Table) .
cord-309513-dleo9rpl	2020	Biopsy lung sections were analyzed with hematoxylineosin staining, and immunostaining for SARS-CoV-2 was conducted as reported elsewhere (1) . In contrast, viral protein expression was minimally detectable on blood vessels ( Figure 2 , B, dashed black line) or in the interstitial areas between alveoli (Figure 2, B, bottom panel, blue arrows) . Immu-nostaining of Huh7 cells infected with SARS-CoV and of lung sections from an HIV-positive patient who died of fungal infection served as positive and negative staining controls, respectively (Figure 2, C) . A. Histopathologic examination revealing diffuse alveolar damage, organizing phase (A-1); denudation of alveolar lining cells (arrow 1), with presence of reactive type II pneumocyte hyperplasia (arrow 2) (A-2); intra-alveolar fibrinous exudates (arrow 3) and interstitial loose fibrosis with chronic inflammatory infiltrates (arrow 4) (A-3); and intra-alveolar loose fibrous plugs (arrow 5) (A-4). B. Immunostaining of SARS-CoV-2 in lung sections.
cord-309633-1cd74xdl	2020	MEASUREMENTS: The primary outcome measure was test positivity rate of SARS-CoV-2 infection at shelters, determined by dividing the number of positive cases by the total number of participant encounters, regardless of symptoms. CONCLUSION: Active surveillance and surge testing were used to detect multiple cases of asymptomatic and symptomatic SARS-CoV-2 infection in homeless shelters. Surge testing was initiated on 30 March 2020 (and continued through 24 April) in collaboration with Public Health-Seattle & King County''s Communicable Disease Epidemiology Team to conduct contact tracing at 6 shelters where cases of SARS-CoV-2 were previously detected ( Figure 2 ). We calculated the test positivity rate of SARS-CoV-2 infection at shelters by dividing the number of positive cases by the total number of participant encounters in the study period. Overall, 2% of participant encounters involved positive SARS-CoV-2 results, with most cases detected through surge testing events.
cord-309650-6xz9gjq0	2020	Specific risk factors for SARS-CoV-2 transmission among health care workers in a university hospital Pandemic peak SARS-CoV-2 infection and seroconversion rates in London frontline health-care workers Prevalence of SARS-CoV-2 infection among health care workers in a tertiary community hospital Asymptomatic infection by SARS-CoV-2 in healthcare workers: a study in a large teaching hospital in Wuhan, China Dynamic of SARS-CoV-2 RT-PCR positivity and seroprevalence among high-risk health care workers and hospital staff Risk factors of healthcare workers with Corona Virus Disease 2019: a retrospective cohort study in a designated hospital of Wuhan in China Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 Novel Coronavirus Disease outbreak: a cross-sectional study Analysis of the infection status of the health care workers in Wuhan during the COVID-19 outbreak: A cross-sectional study SARS-CoV-2 infection among healthcare workers in a hospital in
cord-312125-j9l6l3dx	2020	In the United States, the efficacy and safety of convalescent plasma for treating coronavirus disease 2019 (COVID-19) is currently being tested in randomized placebo-controlled clinical trials. Treatment of individual patients with COVID-19 with convalescent plasma outside such trials is also now permitted through U.S. Food and Drug Administration Emergency Use Authorization. Here, members of the National Institutes of Health COVID-19 Treatment Guidelines Panel provide their views regarding use of convalescent plasma for treating COVID-19. In March 2020, the FDA authorized expanded access to convalescent plasma for treating severe or life-threatening COVID-19 under individual-patient emergency Investigational New Drug applications. Given the lack of data from properly powered RCTs, and the need to inform regulatory decision making regarding continued access to convalescent plasma, both the FDA and the Mayo Clinic performed retrospective, indirect evaluations of efficacy by using EAP data, hypothesizing that patients who received plasma units with higher titers of neutralizing antibodies would have better clinical outcomes.
cord-313345-zwe3tmq0	2020	title: Update Alert: Masks for Prevention of Respiratory Virus Infections, Including SARS-CoV-2, in Health Care and Community Settings Masks for prevention of respiratory virus infections, including SARS-CoV-2, in health care and community settings: a living rapid review Facemasks and hand hygiene to prevent influenza transmission in households: a cluster randomized trial Risk factors for SARS infection among hospital healthcare workers in Beijing: a case control study A case-control study on the risk factors of severe acute respiratory syndromes among health care workers Factors associated with transmission of severe acute respiratory syndrome among health-care workers in Singapore Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial A cluster randomized clinical trial comparing fit-tested and non-fit-tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers. N95 Respirators vs medical masks for preventing influenza among health care personnel: a randomized clinical trial
cord-313423-g50oh15t	2020	There currently is debate regarding whether U.S. institutions and clinicians may or should restrict patient access to COVID-19 drugs and vaccines that have been granted emergency use authorization by the U.S. Food and Drug Administration. Traditional FDA approval typically supports clinical adoption of new standards of care because approval reflects a determination that a product''s benefits outweigh its risks on the basis of a demonstration of safety and substantial evidence of effectiveness, a higher threshold than that required for an EUA. Despite concerns about whether that approval was warranted, given the data existing when the EUA was granted and consensus guidelines recommending remdesivir''s use, failing to offer the drug (when available) might have been viewed as improperly withholding an intervention from which severely ill patients could expect to benefit. In contrast, if an EUA is based on weak evidence, such as observational data or uncontrolled trials-as in the case of convalescent plasma-institutions and clinicians can reasonably decline to offer the product without wronging eligible patients (8) .
cord-318876-m1v0ij84	2020	The authors of this commentary call for sexand gender-specific and differentiating factors to be urgently included in the research, prevention, and therapeutics implementation response to the coronavirus disease 2019 pandemic. We call for sex-and gender-specific and differentiating factors to be urgently included in the research, prevention, and therapeutics implementation response to the coronavirus disease 2019 (COVID-19) pandemic. Or we can investigate a priori the specific role of these factors and potentially leverage the mechanisms implicated in sex and gender differences in COVID-19 risk, progression, and outcomes, to identify effective prevention and treatment interventions for the entire population. Investigating sex hormone-influenced mechanisms and, more broadly, conducting sex-and genderinformed research may optimize the development of novel therapeutics and shed light on drug efficacy, safety profiles, and adherence to treatments currently tested for COVID-19, given that sex differences in pharmacokinetics and pharmacodynamics influence therapeutic effects and risk profiles of numerous medications, and that gender-related factors affect adherence to treatment, access to health care, and health-seeking behaviors (3) .
cord-323054-m8hkj1dm	2020	In a narrative review of 96 articles addressing clinician mental health in COVID-19 and prior pandemics, 7 themes emerged: 1) the need for resilience and stress reduction training; 2) providing for clinicians'' basic needs (food, drink, adequate rest, quarantine-appropriate housing, transportation, child care, personal protective equipment); 3) the importance of specialized training for pandemic-induced changes in job roles; 4) recognition and clear communication from leadership; 5) acknowledgment of and strategies for addressing moral injury; 6) the need for peer and social support interventions; and 7) normalization and provision of mental health support programs. Seven themes, and associated interventions, emerged from the literature (Figure) : 1) the need for resilience and stress reduction training; 2) providing for clinicians'' basic needs (food, drink, adequate rest, quarantine-appropriate housing, transportation, child care, PPE); 3) the importance of specialized training for pandemic-induced changes in job roles; 4) recognition and clear communication from leadership; 5) acknowledgment of and strategies for addressing moral injury; 6) the need for peer and social support interventions and; 7) normalization and provision of mental health support programs.
cord-325643-nszsf0nu	2020	The prevalence of anxiety was higher among nonmedical health care workers than medical personnel (20.7% versus 10.8%; adjusted prevalence ratio, 1.85 [95% CI, 1.15 to 2.99]; P = 0.011), after adjustment for age, sex, ethnicity, marital status, survey completion date, and presence of comorbid conditions. Similarly, higher mean DASS-21 anxiety and stress subscale scores and higher IES-R total and subscale scores were observed in nonmedical health care workers ( Table 2) . Discussion: Overall mean DASS-21 and IES-R scores among health care workers were lower than those in the published literature from previous disease outbreaks, such as the severe acute respiratory syndrome (SARS). In conclusion, our study highlights that nonmedical health care personnel are at highest risk for psychological distress during the COVID-19 outbreak. Psychological impact of the 2003 severe acute respiratory syndrome outbreak on health care workers in a medium size regional general hospital in Singapore
cord-330916-s99ayg1j	2020	Given the risk of bias for individual studies and the conflicting direction and magnitude of results, the evidence from both RCTs and cohort studies remains insufficiently strong to support a benefit of hydroxychloroquine or chloroquine for treatment of COVID-19 in hospitalized patients. Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data Efficacy and safety of chloroquine or hydroxychloroquine in moderate type of COVID-19: a prospective open-label randomized controlled study. Clinical outcomes of hydroxychloroquine in hospitalized patients with COVID-19: a quasi-randomized comparative study. No evidence of clinical efficacy of hydroxychloroquine in patients hospitalized for COVID-19 infection with oxygen requirement: results of a study using routinely collected data to emulate a target trial. Preliminary evidence from a multicenter prospective observational study of the safety and efficacy of chloroquine for the treatment of COVID-19.
cord-335003-7ae0galy	2020	Mackey and colleagues reported a systematic review that found high-certainty evidence that angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers are not associated with greater illness severity in patients with COVID-19. The authors present data from 3 studies that found, with moderate certainty of evidence, no relationship of ACEI or ARB use with testing positive for the virus or becoming ill from it. On the basis of further data from 14 observational studies encompassing more than 23 000 adults with COVID-19, they found high-certainty evidence that the drugs are not associated with greater illness severity. As a result of this progression from fear and theory through data and multiple analyses from different continents, we now have reasonable reassurance that drugs that alter the renin-angiotensin system (RAS) do not pose substantial threats as either COVID-19 risk factors or severity multipliers. Can angiotensin receptor-blocking drugs perhaps be harmful in the COVID-19 pandemic?
cord-337482-imxkpfrn	2020	In their article, Alagoz and colleagues explored the effect of COVID-19–related public health mandates in 3 U.S. locations. The editorialists discuss lessons from this analysis and the role of modeling to inform decision making related to the COVID-19 pandemic and future public health crises. I n their article, Alagoz and colleagues explored the effect of coronavirus disease 2019 (COVID-19)-related public health mandates in 3 U.S. locations-Dane County, Wisconsin; the Milwaukee metropolitan area; and New York City-using agent-based simulation models (1) . They modeled variations in adherence to social distancing mandates, time of intervention, and population density. Alagoz and colleagues'' study provides an opportunity to pause and assess how modeling can and should inform COVID-19 decision making. With mass vaccination months, if not years, away and few effective therapies, the timely use of nonpharmaceutical public health interventions will reduce morbidity and mortality from COVID-19. Effect of timing of and adherence to social distancing measures on COVID-19 burden in the United States.
cord-338757-fsid4a39	2020	The authors found that increased likelihood of exposure to the virus, increased susceptibility to severe consequences of the infection, and lack of health care access were all important contributors, and they concluded with pointed, domainspecific recommendations to mitigate these disparities. African Americans and Latinos are overrepresented among cases of and deaths from COVID-19, both nationally and in many of the areas hardest hit by the pandemic (2, 3) . We need robust data to guide these efforts, but better information must be coupled with urgent and effective action to decrease exposure, susceptibility, and limitations in health care to achieve the desired results. Achieving the desired population benefit of a SARS-CoV-2 vaccine will require an implementation strategy that addresses the current gaps in overall rates of adult vaccination, as well as specific issues in minority communities. Racial disparities in exposure, susceptibility, and access to health care in the US H1N1 influenza pandemic
cord-339459-z22a5yzo	2020	
cord-339509-4ezt6o0o	2020	In addition, a multisystem inflammatory syndrome (MIS) similar to Kawasaki disease has been increasingly reported in association with COVID-19 in children and young adults (3) (4) (5) . Objective: To provide what we believe to be the first report on the pathologic findings of vasculitis of the small vessels of the heart, which likely represents MIS, leading to death in a young adult after presumed resolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Gross abnormalities noted at autopsy (4 hours after death) were conjunctival injection, enlarged cervical and mediastinal lymph nodes, and vascular thrombi with focal surrounding hemorrhage in the left lower lung, which probably contributed to illness but were not likely the primary cause of death. The clinical picture in this adult patient of sudden lymphadenopathy and parotitis combined with small-vessel cardiac vasculitis after COVID-19 is strongly suggestive of a similar systemic inflammatory process. Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans
cord-355805-ajlf5je4	2020	The evidence is very uncertain about the effect of hydroxychloroquine alone compared with standard treatment on the progression or exacerbation of pulmonary lesions on CT scan in 2 RCTs (33.3% vs. The evidence is very uncertain about the effect of hydroxychloroquine alone compared with standard treatment in 2 RCTs; median, 1 day vs. The evidence is very uncertain about the effect of hydroxychloroquine alone compared with standard treatment in 2 cohort studies; 12.9% vs. No evidence of clinical efficacy of hydroxychloroquine in patients hospitalized for COVID-19 infection with oxygen requirement: results of a study using routinely collected data to emulate a target trial The Scientific Medical Policy Committee (SMPC), in collaboration with staff from ACP''s Department of Clinical Policy, developed these Practice Points based on a rapid systematic evidence review conducted by the University of Connecticut Health Outcomes, Policy, and Evidence Synthesis Group.