# ent

id: cord-330916-s99ayg1j
type: WORK_OF_ART
entity:
  Update Alert Hydroxychloroquine or Chloroquine for the Treatment or Prophylaxis of COVID 19 date 2020


id: cord-301183-k39e12cq
type: ORG
entity:
  SARS CoV 2 AABB s Resources for FDA s Updated Information for Blood Establishments Regarding the Novel Coronavirus COVID 19 Outbreak Accessed


id: cord-276428-oy8e2cpx
type: ORG
entity:
  Budget to Reduce and Ultimately Eliminate Health Disparities Examining the Health Disparities Research Plan


id: cord-312125-j9l6l3dx
type: WORK_OF_ART
entity:
  for Treatment of COVID 19 in Hospitalized Patients Integrating Clinical Research into Epidemic Response


id: cord-294628-ecg13s7a
type: PROTEIN
entity:
  20Individualist 20societies 20people 20are and 20their 20direct 20family 20only text Singapore 2C 20with 20a 20score 20of


id: cord-294628-ecg13s7a
type: ORG
entity:
  Singapore Ministry of Health COVID 19 Situation Report Reorganisation of Healthcare System Into Three Integrated Clusters


id: cord-339459-z22a5yzo
type: GGP
entity:
  angiotensin receptor blocker AT 1 type 1 angiotensin receptor RAS renin angiotensin system SARS CoV 2


id: cord-355805-ajlf5je4
type: DNA
entity:
  Etxeandia Ikobaltzeta 1 Santa Margarita Hospital Street Ground Floor 123 Summer Street Obley 3030 SW Moody Dr Jokela 1405 West Park 207 Champaign IL 61801 Dr Humphrey 3710 SW U S Veterans Hospital


# bib

id: cord-253196-et1ekgdl
author: Yazdany, Jinoos
date: 2020-03-31
txt: ./txt/cord-253196-et1ekgdl.txt
cache: ./cache/cord-253196-et1ekgdl.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32232419/
doi: 10.7326/m20-1334
summary:
  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)

title:
  Use of Hydroxychloroquine and Chloroquine During the COVID-19 Pandemic: What Every Clinician Should Know

abstract:
  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 authors of this commentary provide guidance for clinical decision making for patients with coronavirus disease 2019 as well as for patients with rheumatologic conditions, such as systemic lupus erythematosus and rheumatoid arthritis


id: cord-263549-hmdyb7hi
author: DeWitt, Dawn E.
date: 2020-04-07
txt: ./txt/cord-263549-hmdyb7hi.txt
cache: ./cache/cord-263549-hmdyb7hi.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7326/m20-1262
doi: 10.7326/m20-1262
summary:
  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

title:
  Fighting COVID-19: Enabling Graduating Students to Start Internship Early at Their Own Medical School

abstract:
  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.


id: cord-267124-8efdzlc0
title: Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study
author: Wichmann, Dominic
date: 2020-05-06
txt: ./txt/cord-267124-8efdzlc0.txt
cache: ./cache/cord-267124-8efdzlc0.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32374815/
doi: 10.7326/m20-2003
summary:
  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) .

abstract:
  BACKGROUND: The new coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS–CoV-2), has caused more than 210 000 deaths worldwide. However, little is known about the causes of death and the virus's pathologic features. OBJECTIVE: To validate and compare clinical findings with data from medical autopsy, virtual autopsy, and virologic tests. DESIGN: Prospective cohort study. SETTING: Autopsies performed at a single academic medical center, as mandated by the German federal state of Hamburg for patients dying with a polymerase chain reaction–confirmed diagnosis of COVID-19. PATIENTS: The first 12 consecutive COVID-19–positive deaths. MEASUREMENTS: Complete autopsy, including postmortem computed tomography and histopathologic and virologic analysis, was performed. Clinical data and medical course were evaluated. Results: Median patient age was 73 years (range, 52 to 87 years), 75% of patients were male, and death occurred in the hospital (n = 10) or outpatient sector (n = 2). Coronary heart disease and asthma or chronic obstructive pulmonary disease were the most common comorbid conditions (50% and 25%, respectively). Autopsy revealed deep venous thrombosis in 7 of 12 patients (58%) in whom venous thromboembolism was not suspected before death; pulmonary embolism was the direct cause of death in 4 patients. Postmortem computed tomography revealed reticular infiltration of the lungs with severe bilateral, dense consolidation, whereas histomorphologically diffuse alveolar damage was seen in 8 patients. In all patients, SARS–CoV-2 RNA was detected in the lung at high concentrations; viremia in 6 of 10 and 5 of 12 patients demonstrated high viral RNA titers in the liver, kidney, or heart. LIMITATION: Limited sample size. CONCLUSION: The high incidence of thromboembolic events suggests an important role of COVID-19–induced coagulopathy. Further studies are needed to investigate the molecular mechanism and overall clinical incidence of COVID-19–related death, as well as possible therapeutic interventions to reduce it. PRIMARY FUNDING SOURCE: University Medical Center Hamburg-Eppendorf.


id: cord-270970-9gtnsyts
author: Wolf, Michael S.
date: 2020-04-09
txt: ./txt/cord-270970-9gtnsyts.txt
cache: ./cache/cord-270970-9gtnsyts.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7326/m20-1239
doi: 10.7326/m20-1239
summary:
  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.

title:
  Awareness, Attitudes, and Actions Related to COVID-19 Among Adults With Chronic Conditions at the Onset of the U.S. Outbreak: A Cross-sectional Survey

abstract:
  BACKGROUND: The evolving outbreak of coronavirus disease 2019 (COVID-19) is requiring social distancing and other measures to protect public health. However, messaging has been inconsistent and unclear. OBJECTIVE: To determine COVID-19 awareness, knowledge, attitudes, and related behaviors among U.S. adults who are more vulnerable to complications of infection because of age and comorbid conditions. DESIGN: Cross-sectional survey linked to 3 active clinical trials and 1 cohort study. SETTING: 5 academic internal medicine practices and 2 federally qualified health centers. PATIENTS: 630 adults aged 23 to 88 years living with 1 or more chronic conditions. MEASUREMENTS: Self-reported knowledge, attitudes, and behaviors related to COVID-19. RESULTS: A fourth (24.6%) of participants were “very worried” about getting the coronavirus. Nearly a third could not correctly identify symptoms (28.3%) or ways to prevent infection (30.2%). One in 4 adults (24.6%) believed that they were “not at all likely” to get the virus, and 21.9% reported that COVID-19 had little or no effect on their daily routine. One in 10 respondents was very confident that the federal government could prevent a nationwide outbreak. 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. Those with low health literacy had greater confidence in the federal government response. LIMITATION: Cross-sectional study of adults with underlying health conditions in 1 city during the initial week of the COVID-19 U.S. outbreak. CONCLUSION: Many adults with comorbid conditions lacked critical knowledge about COVID-19 and, despite concern, were not changing routines or plans. Noted disparities suggest that greater public health efforts may be needed to mobilize the most vulnerable communities. PRIMARY FUNDING SOURCE: National Institutes of Health.


id: cord-273192-r1wt1oyg
author: Blackburn, Justin
date: 2020-09-02
txt: ./txt/cord-273192-r1wt1oyg.txt
cache: ./cache/cord-273192-r1wt1oyg.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32877214/
doi: 10.7326/m20-5352
abstract: nan
summary:
  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.

title:
  Infection Fatality Ratios for COVID-19 Among Noninstitutionalized Persons 12 and Older: Results of a Random-Sample Prevalence Study


id: cord-275601-9y5zj9an
title: The COVID-NMA Project: Building an Evidence Ecosystem for the COVID-19 Pandemic
author: Boutron, Isabelle
date: 2020-09-15
txt: ./txt/cord-275601-9y5zj9an.txt
cache: ./cache/cord-275601-9y5zj9an.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7326/m20-5261
doi: 10.7326/m20-5261
summary:
  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.

abstract:
  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.


id: cord-275946-ofd2ipvs
title: Serodiagnostics for Severe Acute Respiratory Syndrome–Related Coronavirus-2: A Narrative Review
author: Cheng, Matthew P.
date: 2020-06-04
txt: ./txt/cord-275946-ofd2ipvs.txt
cache: ./cache/cord-275946-ofd2ipvs.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7326/m20-2854
doi: 10.7326/m20-2854
summary:
  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) .

abstract:
  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. Many use cases are envisaged, including complementing molecular methods for diagnosis of active disease and estimating immunity for individuals. At the population level, carefully designed seroepidemiologic studies will aid in the characterization of transmission dynamics and refinement of disease burden estimates and will provide insight into the kinetics of humoral immunity. Yet, despite an explosion in the number and availability of serologic assays to test for antibodies against SARS-CoV-2, most have undergone minimal external validation to date. This hinders assay selection and implementation, as well as interpretation of study results. In addition, critical knowledge gaps remain regarding serologic correlates of protection from infection or disease, and the degree to which these assays cross-react with antibodies against related coronaviruses. 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.


id: cord-276428-oy8e2cpx
author: Krishnan, Lakshmi
date: 2020-06-05
txt: ./txt/cord-276428-oy8e2cpx.txt
cache: ./cache/cord-276428-oy8e2cpx.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7326/m20-2223
doi: 10.7326/m20-2223
summary:
  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.

title:
  Historical Insights on Coronavirus Disease 2019 (COVID-19), the 1918 Influenza Pandemic, and Racial Disparities: Illuminating a Path Forward

abstract:
  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.


id: cord-280672-6x968dwk
title: Age Is Just a Number: A Critically Important Number for COVID-19 Case Fatality
author: Fisman, David N.
date: 2020-07-22
txt: ./txt/cord-280672-6x968dwk.txt
cache: ./cache/cord-280672-6x968dwk.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32698604/
doi: 10.7326/m20-4048
summary:
  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%).

abstract:
  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. The editorialists explore the effect of age distribution on these rates and other determinants of between-country variation in the severity of this disease.


id: cord-284694-bk6bnox0
author: Wang, Changsong
date: 2020-05-12
txt: ./txt/cord-284694-bk6bnox0.txt
cache: ./cache/cord-284694-bk6bnox0.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7326/l20-0354
doi: 10.7326/l20-0354
abstract: nan
summary:
  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.

title:
  Cytokine Levels in the Body Fluids of a Patient With COVID-19 and Acute Respiratory Distress Syndrome: A Case Report


id: cord-287191-e8073l9p
title: Coronavirus Disease 2019 (COVID-19): Protecting Hospitals From the Invisible
author: Klompas, Michael
date: 2020-03-11
txt: ./txt/cord-287191-e8073l9p.txt
cache: ./cache/cord-287191-e8073l9p.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7326/m20-0751
doi: 10.7326/m20-0751
summary:
  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.

abstract:
  Coronavirus disease 2019 (COVID-19) is optimized to spread widely: Its signs and symptoms are largely indistinguishable from those of other respiratory viruses. This commentary specifically addresses best ways to protect our hospitals against COVID-19.


id: cord-289763-jek2pd31
title: Attitudes Toward a Potential SARS-CoV-2 Vaccine: A Survey of U.S. Adults
author: Fisher, Kimberly A.
date: 2020-09-04
txt: ./txt/cord-289763-jek2pd31.txt
cache: ./cache/cord-289763-jek2pd31.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32886525/
doi: 10.7326/m20-3569
summary:
  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) .

abstract:
  BACKGROUND: Coronavirus disease 2019 (COVID-19) has rapidly instigated a global pandemic. Vaccine development is proceeding at an unprecedented pace. Once available, it will be important to maximize vaccine uptake and coverage. OBJECTIVE: To assess intent to be vaccinated against COVID-19 among a representative sample of adults in the United States and identify predictors of and reasons for vaccine hesitancy. DESIGN: Cross-sectional survey, fielded from 16 through 20 April 2020. SETTING: Representative sample of adults residing in the United States. PARTICIPANTS: Approximately 1000 adults drawn from the AmeriSpeak probability-based research panel, covering approximately 97% of the U.S. household population. MEASUREMENTS: Intent to be vaccinated against COVID-19 was measured with the question, “When a vaccine for the coronavirus becomes available, will you get vaccinated?” Response options were “yes,” “no,” and “not sure.” Participants who responded “no” or “not sure” were asked to provide a reason. RESULTS: A total of 991 AmeriSpeak panel members responded. Overall, 57.6% of participants (n = 571) intended to be vaccinated, 31.6% (n = 313) were not sure, and 10.8% (n = 107) did not intend to be vaccinated. Factors independently associated with vaccine hesitancy (a response of “no” or “not sure”) included younger age, Black race, lower educational attainment, and not having received the influenza vaccine in the prior year. Reasons for vaccine hesitancy included vaccine-specific concerns, a need for more information, antivaccine attitudes or beliefs, and a lack of trust. LIMITATIONS: Participants' intent to be vaccinated was explored before a vaccine was available and when the pandemic was affecting a narrower swath of the United States. Questions about specific information or factors that might increase vaccination acceptance were not included. The survey response rate was 16.1%. CONCLUSION: This national survey, conducted during the coronavirus pandemic, revealed that approximately 3 in 10 adults were not sure they would accept vaccination and 1 in 10 did not intend to be vaccinated against COVID-19. Targeted and multipronged efforts will be needed to increase acceptance of a COVID-19 vaccine when one becomes available. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.


id: cord-290070-534936lf
title: The Collision of COVID-19 and the U.S. Health System
author: Bornstein, Sue S.
date: 2020-06-02
txt: ./txt/cord-290070-534936lf.txt
cache: ./cache/cord-290070-534936lf.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7326/m20-1851
doi: 10.7326/m20-1851
summary:
  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

abstract:
  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.


id: cord-294369-e3jyihvm
author: del Amo, Julia
date: 2020-06-26
txt: ./txt/cord-294369-e3jyihvm.txt
cache: ./cache/cord-294369-e3jyihvm.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32589451/
doi: 10.7326/m20-3689
summary:
  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.

title:
  Incidence and Severity of COVID-19 in HIV-Positive Persons Receiving Antiretroviral Therapy: A Cohort Study

abstract:
  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. OBJECTIVE: To describe the incidence and severity of COVID-19 by nucleos(t)ide reverse transcriptase inhibitor (NRTI) use among HIV-positive persons receiving ART. DESIGN: Cohort study. SETTING: HIV clinics in 60 Spanish hospitals between 1 February and 15 April 2020. PARTICIPANTS: 77 590 HIV-positive persons receiving ART. MEASUREMENTS: Estimated risks (cumulative incidences) per 10 000 persons and 95% CIs for polymerase chain reaction–confirmed COVID-19 diagnosis, hospitalization, intensive care unit (ICU) admission, and death. Risk and 95% CIs for COVID-19 diagnosis and hospital admission by use of the NRTIs tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC), tenofovir alafenamide (TAF)/FTC, abacavir (ABC)/lamivudine (3TC), and others were estimated through Poisson regression models. RESULTS: Of 77 590 HIV-positive persons receiving ART, 236 were diagnosed with COVID-19, 151 were hospitalized, 15 were admitted to the ICU, and 20 died. The risks for COVID-19 diagnosis and hospitalization were greater in men and persons older than 70 years. The risk for COVID-19 hospitalization was 20.3 (95% CI, 15.2 to 26.7) among patients receiving TAF/FTC, 10.5 (CI, 5.6 to 17.9) among those receiving TDF/FTC, 23.4 (CI, 17.2 to 31.1) among those receiving ABC/3TC, and 20.0 (CI, 14.2 to 27.3) for those receiving other regimens. The corresponding risks for COVID-19 diagnosis were 39.1 (CI, 31.8 to 47.6), 16.9 (CI, 10.5 to 25.9), 28.3 (CI, 21.5 to 36.7), and 29.7 (CI, 22.6 to 38.4), respectively. No patient receiving TDF/FTC was admitted to the ICU or died. LIMITATION: Residual confounding by comorbid conditions cannot be completely excluded. CONCLUSION: HIV-positive patients receiving TDF/FTC have a lower risk for COVID-19 and related hospitalization than those receiving other therapies. These findings warrant further investigation in HIV preexposure prophylaxis studies and randomized trials in persons without HIV. PRIMARY FUNDING SOURCE: Instituto de Salud Carlos III and National Institutes of Health.


id: cord-294628-ecg13s7a
title: Managing COVID-19 in a Novel, Rapidly Deployable Community Isolation Quarantine Facility
author: Chia, Ming Li
date: 2020-09-17
txt: ./txt/cord-294628-ecg13s7a.txt
cache: ./cache/cord-294628-ecg13s7a.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7326/m20-4746
doi: 10.7326/m20-4746
summary:
  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.

abstract:
  Singapore is one of the most densely populated small island–states in the world. 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. The CCFs were created rapidly by converting existing public spaces and used a protocolized system, augmented by telemedicine to enable a low health care worker–patient ratio (98 health care workers for 3200 beds), to operate these unique facilities. 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. This article shares the authors' experience in operating these massive-scale isolation facilities while prioritizing safety for all and ensuring holistic patient care in the face of a public health crisis and lean health care resources.


id: cord-298632-xu1sgguh
title: Investing in Our First Line of Defense: Environmental Services Workers
author: Tyan, Kevin
date: 2020-05-01
txt: ./txt/cord-298632-xu1sgguh.txt
cache: ./cache/cord-298632-xu1sgguh.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32357202/
doi: 10.7326/m20-2237
summary:
  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.

abstract:
  Environmental services personnel are a critical first line of defense against the spread of COVID-19. This commentary discusses the importance of environmental cleaning during the pandemic and the essential role of environmental services personnel in patient safety.


id: cord-300474-r5gms09p
author: Mackey, Katherine
date: 2020-07-23
txt: ./txt/cord-300474-r5gms09p.txt
cache: ./cache/cord-300474-r5gms09p.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32701362/
doi: 10.7326/l20-0969
abstract: nan
summary:
  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

title:
  Update Alert 2: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults


id: cord-301183-k39e12cq
title: SARS-CoV-2 RNAemia in a Healthy Blood Donor 40 Days After Respiratory Illness Resolution
author: Pham, Tho D.
date: 2020-07-17
txt: ./txt/cord-301183-k39e12cq.txt
cache: ./cache/cord-301183-k39e12cq.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7326/l20-0725
doi: 10.7326/l20-0725
abstract: nan
summary:
  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


id: cord-301852-9nza3po0
title: Occupational Health: A Key to the Control of COVID-19 in Correctional Facilities
author: Sears, David
date: 2020-07-27
txt: ./txt/cord-301852-9nza3po0.txt
cache: ./cache/cord-301852-9nza3po0.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7326/m20-4543
doi: 10.7326/m20-4543
summary:
  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.

abstract:
  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. Yet, many correctional workers lack basic protections. The authors believe that ensuring community-standard occupational health for correctional staff during COVID-19 will protect prison residents, staff, and their communities.


id: cord-303420-3jlqx83u
title: When the Dust Settles: Preventing a Mental Health Crisis in COVID-19 Clinicians
author: Kiser, Stephanie B.
date: 2020-06-09
txt: ./txt/cord-303420-3jlqx83u.txt
cache: ./cache/cord-303420-3jlqx83u.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7326/m20-3738
doi: 10.7326/m20-3738
summary:
  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.

abstract:
  This essay describes timely and targeted actions that clinicians can take during the COVID-19 pandemic to support fellow clinicians.


id: cord-307717-vf85qt8j
title: Supporting Clinicians During the COVID-19 Pandemic
author: Dewey, Charlene
date: 2020-03-20
txt: ./txt/cord-307717-vf85qt8j.txt
cache: ./cache/cord-307717-vf85qt8j.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32196544/
doi: 10.7326/m20-1033
summary:
  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.

abstract:
  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. This commentary offers suggestions to encourage a culture that will sustain the clinician workforce during the pandemic.


id: cord-309207-n8u8ddv7
title: Loss of Smell and Taste in 2013 European Patients With Mild to Moderate COVID-19
author: Lechien, Jerome R.
date: 2020-05-26
txt: ./txt/cord-309207-n8u8ddv7.txt
cache: ./cache/cord-309207-n8u8ddv7.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32449883/
doi: 10.7326/m20-2428
abstract: nan
summary:
  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) .


id: cord-309513-dleo9rpl
title: Histopathologic Changes and SARS–CoV-2 Immunostaining in the Lung of a Patient With COVID-19
author: Zhang, Huilan
date: 2020-03-12
txt: ./txt/cord-309513-dleo9rpl.txt
cache: ./cache/cord-309513-dleo9rpl.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7326/m20-0533
doi: 10.7326/m20-0533
abstract: nan
summary:
  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.


id: cord-309633-1cd74xdl
title: Characteristics of COVID-19 in Homeless Shelters: A Community-Based Surveillance Study
author: Rogers, Julia H.
date: 2020-09-15
txt: ./txt/cord-309633-1cd74xdl.txt
cache: ./cache/cord-309633-1cd74xdl.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7326/m20-3799
doi: 10.7326/m20-3799
summary:
  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.

abstract:
  BACKGROUND: Homeless shelters are a high-risk setting for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission because of crowding and shared hygiene facilities. OBJECTIVE: To investigate SARS-CoV-2 case counts across several adult and family homeless shelters in a major metropolitan area. DESIGN: Cross-sectional, community-based surveillance study. (ClinicalTrials.gov: NCT04141917) SETTING: 14 homeless shelters in King County, Washington. PARTICIPANTS: A total of 1434 study encounters were done in shelter residents and staff, regardless of symptoms. INTERVENTION: Two strategies were used for SARS-CoV-2 testing: routine surveillance and contact tracing (“surge testing”) events. 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. Sociodemographic, clinical, and virologic variables were assessed as correlates of viral positivity. RESULTS: Among 1434 encounters, 29 (2% [95% CI, 1.4% to 2.9%]) cases of SARS-CoV-2 infection were detected across 5 shelters. Most (n = 21 [72.4%]) were detected during surge testing events rather than routine surveillance, and most (n = 21 [72.4% {CI, 52.8% to 87.3%}]) were asymptomatic at the time of sample collection. Persons who were positive for SARS-CoV-2 were more frequently aged 60 years or older than those without SARS-CoV-2 (44.8% vs. 15.9%). Eighty-six percent of persons with positive test results slept in a communal space rather than in a private or shared room. LIMITATION: Selection bias due to voluntary participation and a relatively small case count. CONCLUSION: Active surveillance and surge testing were used to detect multiple cases of asymptomatic and symptomatic SARS-CoV-2 infection in homeless shelters. The findings suggest an unmet need for routine viral testing outside of clinical settings for homeless populations. PRIMARY FUNDING SOURCE: Gates Ventures.


id: cord-309650-6xz9gjq0
title: Update Alert 4: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers
author: Chou, Roger
date: 2020-09-11
txt: ./txt/cord-309650-6xz9gjq0.txt
cache: ./cache/cord-309650-6xz9gjq0.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32915642/
doi: 10.7326/l20-1134
abstract: nan
summary:
  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


id: cord-312125-j9l6l3dx
author: Pau, Alice K.
date: 2020-09-25
txt: ./txt/cord-312125-j9l6l3dx.txt
cache: ./cache/cord-312125-j9l6l3dx.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7326/m20-6448
doi: 10.7326/m20-6448
summary:
  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.

title:
  Convalescent Plasma for the Treatment of COVID-19: Perspectives of the National Institutes of Health COVID-19 Treatment Guidelines Panel

abstract:
  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.


id: cord-313345-zwe3tmq0
author: Chou, Roger
date: 2020-07-20
txt: ./txt/cord-313345-zwe3tmq0.txt
cache: ./cache/cord-313345-zwe3tmq0.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32687391/
doi: 10.7326/l20-0948
abstract: nan
summary:
  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

title:
  Update Alert: Masks for Prevention of Respiratory Virus Infections, Including SARS-CoV-2, in Health Care and Community Settings


id: cord-313423-g50oh15t
author: Lynch, Holly Fernandez
date: 2020-11-03
txt: ./txt/cord-313423-g50oh15t.txt
cache: ./cache/cord-313423-g50oh15t.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7326/m20-6703
doi: 10.7326/m20-6703
summary:
  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) .

title:
  Emergency Approvals for COVID-19: Evolving Impact on Obligations to Patients in Clinical Care and Research

abstract:
  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. The authors provide their views on the legal, ethical, and clinical ramifications of such restriction.


id: cord-318876-m1v0ij84
title: Sex and Gender Differences in Health: What the COVID-19 Pandemic Can Teach Us
author: Spagnolo, Primavera A.
date: 2020-05-08
txt: ./txt/cord-318876-m1v0ij84.txt
cache: ./cache/cord-318876-m1v0ij84.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32384135/
doi: 10.7326/m20-1941
summary:
  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) .

abstract:
  The authors of this commentary 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 pandemic.


id: cord-323054-m8hkj1dm
title: Addressing Postpandemic Clinician Mental Health: A Narrative Review and Conceptual Framework
author: Schwartz, Rachel
date: 2020-08-21
txt: ./txt/cord-323054-m8hkj1dm.txt
cache: ./cache/cord-323054-m8hkj1dm.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32822206/
doi: 10.7326/m20-4199
summary:
  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.

abstract:
  Previous pandemics have seen high psychiatric morbidity among health care workers. Protecting clinician mental health in the aftermath of coronavirus disease 2019 (COVID-19) requires an evidence-based approach to developing and deploying comprehensive clinician mental health support. 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. In addition to the literature review, in collaboration with the Collaborative for Healing and Renewal in Medicine (CHARM) network, the authors gathered practice guidelines and resources from health care organizations and professional societies worldwide to synthesize a list of resources deemed high-yield by well-being leaders. Studies of previous pandemics demonstrate heightened distress in health care workers years after the event. The COVID-19 pandemic presents unique challenges that surpass those of previous pandemics, suggesting a significant mental health toll on clinicians. Long-term, proactive individual, organizational, and societal infrastructures for clinician mental health support are needed to mitigate the psychological costs of providing care during the COVID-19 pandemic.


id: cord-325643-nszsf0nu
title: Psychological Impact of the COVID-19 Pandemic on Health Care Workers in Singapore
author: Tan, Benjamin Y.Q.
date: 2020-04-06
txt: ./txt/cord-325643-nszsf0nu.txt
cache: ./cache/cord-325643-nszsf0nu.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.7326/m20-1083
doi: 10.7326/m20-1083
abstract: nan
summary:
  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


id: cord-330916-s99ayg1j
title: Update Alert: Hydroxychloroquine or Chloroquine for the Treatment or Prophylaxis of COVID-19
author: Hernandez, Adrian V.
date: 2020-07-15
txt: ./txt/cord-330916-s99ayg1j.txt
cache: ./cache/cord-330916-s99ayg1j.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32667853/
doi: 10.7326/l20-0945
abstract: nan
summary:
  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.


id: cord-335003-7ae0galy
title: COVID-19 and Angiotensin-Converting Enzyme Inhibitor/Angiotensin-Receptor Blocker Therapy
author: Kussmaul, William G.
date: 2020-05-15
txt: ./txt/cord-335003-7ae0galy.txt
cache: ./cache/cord-335003-7ae0galy.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32422077/
doi: 10.7326/m20-3047
summary:
  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?

abstract:
  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 editorialist discusses the findings and emphasizes that, unless further data show otherwise, clinicians should continue to prescribe these drugs for their standard indications in patients with COVID-19.


id: cord-337482-imxkpfrn
title: Maxims for a Pandemic: Time, Distance, and Data
author: Koplan, Jeffrey
date: 2020-10-27
txt: ./txt/cord-337482-imxkpfrn.txt
cache: ./cache/cord-337482-imxkpfrn.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33105096/
doi: 10.7326/m20-6934
summary:
  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.

abstract:
  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.


id: cord-338757-fsid4a39
title: This Time Must Be Different: Disparities During the COVID-19 Pandemic
author: Bibbins-Domingo, Kirsten
date: 2020-04-28
txt: ./txt/cord-338757-fsid4a39.txt
cache: ./cache/cord-338757-fsid4a39.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32343767/
doi: 10.7326/m20-2247
summary:
  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

abstract:
  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.


id: cord-339459-z22a5yzo
author: Mackey, Katherine
date: 2020-05-15
url: https://doi.org/10.7326/m20-1515
doi: 10.7326/m20-1515
title:
  Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults: A Living Systematic Review

abstract:
  BACKGROUND: The role of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) in COVID-19 disease susceptibility, severity, and treatment is unclear. PURPOSE: To evaluate, on an ongoing basis, whether use of ACEIs or ARBs either increases risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or is associated with worse COVID-19 disease outcomes, and to assess the efficacy of these medications for COVID-19 treatment. DATA SOURCES: MEDLINE (Ovid) and Cochrane Database of Systematic Reviews from 2003 to 4 May 2020, with planned ongoing surveillance for 1 year; the World Health Organization database of COVID-19 publications and medRxiv.org through 17 April 2020; and ClinicalTrials.gov to 24 April 2020, with planned ongoing surveillance. STUDY SELECTION: Observational studies and trials in adults that examined associations and effects of ACEIs or ARBs on risk for SARS-CoV-2 infection and COVID-19 disease severity and mortality. DATA EXTRACTION: Single-reviewer abstraction confirmed by another reviewer, independent evaluation by 2 reviewers of study quality, and collective assessment of certainty of evidence. DATA SYNTHESIS: Two retrospective cohort studies found that ACEI and ARB use was not associated with a higher likelihood of receiving a positive SARS-CoV-2 test result, and 1 case–control study found no association with COVID-19 illness in a large community (moderate-certainty evidence). Fourteen observational studies, involving a total of 23 565 adults with COVID-19, showed consistent evidence that neither medication was associated with more severe COVID-19 illness (high-certainty evidence). Four registered randomized trials plan to evaluate ACEIs and ARBs for treatment of COVID-19. LIMITATION: Half the studies were small and did not adjust for important confounding variables. CONCLUSION: High-certainty evidence suggests that ACEI or ARB use is not associated with more severe COVID-19 disease, and moderate-certainty evidence suggests no association between use of these medications and positive SARS-CoV-2 test results among symptomatic patients. Whether these medications increase the risk for mild or asymptomatic disease or are beneficial in COVID-19 treatment remains uncertain. PRIMARY FUNDING SOURCE: None. (PROSPERO: registration number pending)


id: cord-339509-4ezt6o0o
title: Cardiac Endotheliitis and Multisystem Inflammatory Syndrome After COVID-19
author: Fox, Sharon E.
date: 2020-07-29
txt: ./txt/cord-339509-4ezt6o0o.txt
cache: ./cache/cord-339509-4ezt6o0o.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32726150/
doi: 10.7326/l20-0882
abstract: nan
summary:
  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


id: cord-355805-ajlf5je4
author: Qaseem, Amir
date: 2020-05-13
txt: ./txt/cord-355805-ajlf5je4.txt
cache: ./cache/cord-355805-ajlf5je4.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32422063/
doi: 10.7326/m20-1998
abstract: nan
summary:
  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.

title:
  Should Clinicians Use Chloroquine or Hydroxychloroquine Alone or in Combination With Azithromycin for the Prophylaxis or Treatment of COVID-19? Living Practice Points From the American College of Physicians (Version 1)


