covid-19_article.txt

In December 2019, the outbreak of pneumonia caused by a novel coronavirus, severe acute 
respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a serious pandemic in China and other 
countries worldwide. So far, more than 460,000 confirmed cases were diagnosed in nearly 190 
countries, causing globally over 20,000 deaths. Currently, the epidemic is still spreading and there is 
no effective means to prevent the infection. Vaccines are proved to be the most effective and 
economical means to prevent and control infectious diseases. Several countries, companies, and 
institutions announced their programs and progress on vaccine development against the virus. While 
most of the vaccines are under design and preparation, there are some that have entered efficacy 
evaluation in animals and initial clinical trials. This review mainly focused on the progress and our 
prospects on field of vaccine development against SARS-CoV-2.

18 years ago, in 2002, the world was astonished by the appearance of Severe Acute Respiratory 
Syndrome (SARS), supported by a zoonotic coronavirus, called SARS-CoV, from the Guangdong 
Province of southern China. After about 10 years, in 2012, another similar coronavirus triggered the 
Middle East Respiratory Syndrome (MERS-CoV) in Saudi Arabia. Both caused severe pneumonia killing 
774 and 858 people with 8700 cases of confirmed infection for the former, and 2494 for the latter, 
causing significant economic losses. 8 years later, despite the MERS outbreak remaining in certain 
parts of the world, at the end of 2019, a new zoonotic coronavirus (SARS-CoV-2) and responsible of 
coronavirus Disease (COVID-19), arose from Wuhan, Hubei Province, China. It spread rapidly and to 
date has killed 3,242 persons with more than 81,000 cases of infection in China and causing over 
126,000 global cases and 5,414 deaths in 166 other countries around the world, especially Italy. SARS-CoV-2 
would seem to have come from a bat, but the intermediate reservoir continues to be unknown. 
Nonetheless, as for SARS-CoV and MERS CoV, the Spillover effect linked to animal-human 
promiscuity, human activities including deforestation, illegal bush-trafficking and bushmeat, cannot 
be excluded. Recently, however, evidence of inter-human only transmission of SARS-CoV-2 has been 
accumulated and thus, the outbreak seems to be spreading by human-to-human transmission 
throughout a large part of the world. Herein we will provide with an update on the main features of 
COVID-19 and suggest possible solutions how to halt the expansion of this novel pandemic.

The diagnosis of COVID-19 is based on the positive of etiological test. The current etiological test of 
COVID-19 cost long time, and have high false negative rate, may resulting delay the measures of 
disease treatment and prevention. We suggested that COVID-19 should be diagnosed as 3 types: 
suspected case, clinical diagnosed case, and definite diagnosed case.

Ongoing outbreak of pneumonia caused by novel coronavirus (2019-nCoV) began in December 2019 
in Wuhan, China, and the number of new patients continues to increase. Even though it began to 
spread to many other parts of the world, such as other Asian countries, the Americas, Europe, and the 
Middle East, the impact of secondary outbreaks caused by exported cases outside China remains 
unclear. We conducted simulations to estimate the impact of potential secondary outbreaks in a 
community outside China. Simulations using stochastic SEIR model were conducted, assuming one 
patient was imported to a community. Among 45 possible scenarios we prepared, the worst scenario 
resulted in the total number of persons recovered or removed to be 997 (95% CrI 990-1000) at day 
100 and a maximum number of symptomatic infectious patients per day of 335 (95% CrI 232-478). 
Calculated mean basic reproductive number (R0) was 6.5 (Interquartile range, IQR 5.6-7.2). However, 
better case scenarios with different parameters led to no secondary cases. Altering parameters, 
especially time to hospital visit. could change the impact of a secondary outbreak. With these multiple 
scenarios with different parameters, healthcare professionals might be able to better prepare for this 
viral infection.

The ongoing outbreak of the novel coronavirus disease (COVID-19) that occurred in China is rapidly 
spreading globally. China's bond and strict containment measures have been proved (in practice) to 
significantly reduce the spread of the epidemic. This was obtained through the use of emergency 
control measures in the epidemic areas and the integration of resources from multiple systems, 
including business, community, technology, education, and transportation, across the country. In 
order to better understand how China has managed to reduce the public health and economic 
impacts of the COVID-19 epidemic, this editorial systematically reviews the specific measures for 
infection prevention and control of the disease. The best practices for COVID-19 eradication in China 
provide evidence-based strategies that could be replicated in other countries.

Coronavirus (COVID-19) is a humanitarian emergency, which started in Wuhan in China in early 
December 2019, brought into the notice of the authorities in late December, early January 2020, and, 
after investigation, was declared as an emergency in the third week of January 2020. The WHO 
declared this as Public Health Emergency of International Concern (PHEIC) on 31th of January 2020, 
and finally a pandemic on 11th March 2020. As of March 24th, 2020, the virus has caused a casualty of 
over 16,600 people worldwide with more than 380,000 people confirmed as infected by it, of which 
more than 10,000 cases are serious. Mainly based on Chinese newspapers, social media and other 
digital platform data, this paper analyzes the timeline of the key actions taken by the government and 
people over three months in five different phases. It found that although there was an initial delay in 
responding, a unique combination of strong governance, strict regulation, strong community 
vigilance and citizen participation, and wise use of big data and digital technologies, were some of the 
key factors in China's efforts to combat this virus. Being inviable and non-measurable (unlike radioactive exposure), 
appropriate and timely information is very important to form the basic 
foundation of mitigation and curative measures. Infodemic, as it is termed by WHO, is a key word, 
where different stakeholder's participation, along with stricter regulation, is required to reduce the 
impact of fake news in this information age and social media. Although different countries will need 
different approaches, focusing on its humanitarian nature and addressing infodemic issues are the 
two critical factors for future global mitigation efforts.

The impact of communicable diseases (infectious diseases) on human health is obvious. The sudden 
outbreak of COVID-19 (Corona Virus Disease 2019) has made people realise the threat of 
communicable diseases to mankind. As a city of many migrants, Zhuhai Special Economic Zone 
experienced great challenges brought about by the COVID-19 epidemic. Experience has been 
acquired from all aspects of this. A highly reactive, multifunctional and efficient emergency 
management system should be established, and the significance of information communication 
should be fully understood for the future.

The Public Health Emergency of International Concern declared the widespread outbreak of SARS-CoV-2 
as a global pandemic emergency, which has resulted in 1,773,086 confirmed cases including 
111,652 human deaths, as on 13 April 2020, as reported to World Health Organization. As of now, 
there are no vaccines or antiviral drugs declared to be officially useful against the infection. 
Saikosaponin is a group of oleanane derivatives reported in Chinese medicinal plants and are 
described for their anti-viral, anti-tumor, anti-inflammatory, anticonvulsant, antinephritis and 
hepatoprotective activities. They have also been known to have anti-coronaviral property by 
interfering the early stage of viral replication including absorption and penetration of the virus. Thus, 
the present study was undertaken to screen and evaluate the potency of different Saikosaponins 
against different sets of SARS-CoV-2 binding protein via computational molecular docking 
simulations. Docking was carried out on a Glide module of Schrodinger Maestro 2018-1 MM Share 
Version on NSP15 (PDB ID: 6W01) and Prefusion 2019-nCoV spike glycoprotein (PDB ID: 6VSB) from 
SARS-CoV-2. From the binding energy and interaction studies, the Saikosaponins U and V showed the 
best affinity towards both the proteins suggesting them to be future research molecule as they mark 
the desire interaction with NSP15, which is responsible for replication of RNA and also with 2019-
nCoV spike glycoprotein which manage the connection with ACE2. [Formula: see text] Communicated 
by Ramaswamy H. Sarma.

Italy is fighting against one of the worst medical emergency since the 1918 Spanish Flu. Pressure on 
the hospitals is tremendous. As for official data on March 14th: 8372 admitted in hospitals, 1518 in 
intensive care units, 1441 deaths (175 more than the day before). Unfortunately, hospitals are not 
prepared: even where a plan for massive influx of patients is present, it usually focuses on sudden 
onset disaster trauma victims (the most probable case scenario), and it has not been tested, validated, 
or propagated to the staff. Despite this, the All Hazards Approach for management of major incidents 
and disasters is still valid and the "4S" theory (staff, stuff, structure, systems) for surge capacity can be 
guidance to respond to this disaster.

A growing body of literature on the 2019 novel coronavirus (SARS-CoV-2) is becoming available, but a 
synthesis of available data has not been conducted. We performed a scoping review of currently 
available clinical, epidemiological, laboratory, and chest imaging data related to the SARS-CoV-2 
infection. We searched MEDLINE, Cochrane CENTRAL, EMBASE, Scopus and LILACS from 01 January 
2019 to 24 February 2020. Study selection, data extraction and risk of bias assessment were 
performed by two independent reviewers. Qualitative synthesis and meta-analysis were conducted 
using the clinical and laboratory data, and random-effects models were applied to estimate pooled 
results. A total of 61 studies were included (59,254 patients). The most common disease-related 
symptoms were fever (82%, 95% confidence interval (CI) 56%-99%; n = 4410), cough (61%, 95% CI 39%-81%; n = 3985), 
muscle aches and/or fatigue (36%, 95% CI 18%-55%; n = 3778), dyspnea (26%, 95% CI 12%-41%; n = 3700), 
headache in 12% (95% CI 4%-23%, n = 3598 patients), sore throat in 10% (95% CI 5%-17%, n = 1387) and 
gastrointestinal symptoms in 9% (95% CI 3%-17%, n = 1744). 
Laboratory findings were described in a lower number of patients and revealed lymphopenia (0.93 × 109/L, 95% CI 0.83-1.03 × 109/L, n = 464) 
and abnormal C-reactive protein (33.72 mg/dL, 95% CI 21.54-45.91 mg/dL; n = 1637). 
Radiological findings varied, but mostly described ground-glass opacities and consolidation. 
Data on treatment options were limited. All-cause mortality was 0.3% (95% CI 0.0%-1.0%; n = 53,631). 
Epidemiological studies showed that mortality was higher in males and elderly patients. 
The majority of reported clinical symptoms and laboratory findings related to SARS-CoV-2 infection are non-specific. 
Clinical suspicion, accompanied by a relevant epidemiological history, should be followed by early imaging and virological assay.

Satisfactory outcome was observed in one mild case and one severe case of COVID-19 pneumonia after 
the use of the online/offline multidisciplinary quarantine observation form, online monitoring, and 
classified diagnosis and treatment, as well as strict compliance with quarantine measures. Conditions of 
both patients were improved, and cross-infection and disease onset clustering were not observed. The 
multidisciplinary self-quarantine model provides early judgment, identification, and treatment of 
disease, improves compliance with early rehabilitation, increases confidence in recovery, and enhances 
self-management capabilities. This model is applicable to the current novel coronavirus pneumonia 
epidemic and can actively promote the management of suspected or confirmed mild cases, monitoring 
of critical cases, and self-management of discharged patients. The application of this new management 
model is worthy of being promoted in our specialized treatment facilities and in countries with severe 
epidemics.

We propose a mathematical model to investigate the current outbreak of the coronavirus disease 
2019 (COVID-19) in Wuhan, China. Our model describes the multiple transmission pathways in the 
infection dynamics, and emphasizes the role of the environmental reservoir in the transmission and 
spread of this disease. Our model also employs non-constant transmission rates which change with 
the epidemiological status and environmental conditions and which reflect the impact of the on-
going disease control measures. We conduct a detailed analysis of this model, and demonstrate its 
application using publicly reported data. Among other findings, our analytical and numerical results 
indicate that the coronavirus infection would remain endemic, which necessitates long-term disease 
prevention and intervention programs.

In December 2019, the outbreak of the novel coronavirus disease (COVID-19) in China spread 
worldwide, becoming an emergency of major international concern. SARS-CoV-2 infection causes 
clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus. Human-to-human 
transmission via droplets, contaminated hands or surfaces has been described, with 
incubation times of 2-14 days. Early diagnosis, quarantine, and supportive treatments are essential to 
cure patients. This paper reviews the literature on all available information about the epidemiology, 
diagnosis, isolation and treatments of COVID-19. Treatments, including antiviral agents, chloroquine 
and hydroxychloroquine, corticosteroids, antibodies, convalescent plasma transfusion and vaccines, 
are discussed in this article. In addition, registered trials investigating treatment options for COVID-19 
infection are listed.

In response to the outbreak of COVID-19, we set up a team to carry out sampling in the community. 
This enabled individuals to remain in self-isolation in their own homes and to prevent healthcare 
settings and services from being overwhelmed by admissions for sampling of suspected cases. There 
is evidence that this is a cost effective, safe and necessary service to complement COVID-19 testing in 
hospitals.

Every month, DTB scans sources of information on treatments, disease management and other 
healthcare topics for key items to bring to our readers' attention and help them keep up to date. To 
do this, we produce succinct, contextualised summaries of the information concerned.

Since December 2019, a viral pneumonia, named coronavirus disease 2019 (COVID-19), from Wuhan, 
China, has swept the world. Although the case fatality rate is not high, the number of people infected 
is large and there is still a large number of patients dying. With the collation and publication of more 
and more clinical data, a large number of data suggest that there are mild or severe cytokine storms 
in severe patients, which is an important cause of death. Therefore, treatment of the cytokine storm 
has become an important part of rescuing severe COVID-19 patients. Interleukin-6 (IL-6) plays an 
important role in cytokine release syndrome. If it is possible to block the signal transduction pathway 
of IL-6, it is expected to become a new method for the treatment of severe COVID-19 patients. 
Tocilizumab is an IL-6 receptor (IL-6R) blocker that can effectively block the IL-6 signal transduction 
pathway and thus is likely to become an effective drug for patients with severe COVID-19.

COVID-19 case fatalities surged during the month of March 2020 in Italy, reaching over 10,000 by 28 March 2020. 
This number exceeds the number of fatalities in China (3,301) recorded from January to March, 
even though the number of diagnosed cases was similar (85,000 Italy vs. 80,000 China). Case 
Fatality Rates (CFR) could be somewhat unreliable because the estimation of total case numbers is 
limited by several factors, including insufficient testing and limitations in test kits and materials, such 
as NP swabs and PPE for testers. Sero prevalence of SARS-CoV-2 antibodies may help in more 
accurate estimations of the total number of cases. Nevertheless, the disparity in the 
differences in the total number of fatalities between Italy and China suggests investigation into several factors, such as 
demographics, sociological interactions, availability of medical equipment (ICU beds and PPE), 
variants in immune proteins (e.g., HLA, IFNs), past immunity to related CoVs, and mutations in SARS-CoV-2, 
could impact survival of severe COVID-19 illness survival and the number of case fatalities.

Emergency trauma radiology, although a relatively new subspecialty of radiology, plays a critical role 
in both the diagnosis/triage of acutely ill patients, but even more important in providing leadership 
and taking the lead in the preparedness of imaging departments in dealing with novel highly 
infectious communicable diseases and mass casualties. This has become even more apparent in 
dealing with COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, first emerged in 
late 2019. We review the symptoms, epidemiology, and testing for this disease. We discuss 
characteristic imaging findings of COVID-19 in relation to other modern coronavirus diseases 
including SARS and MERS. We discuss roles that community radiology clinics, outpatient radiology 
departments, and emergency radiology departments can play in the diagnosis of this disease. We 
review practical methods to reduce spread of infections within radiology departments.

The 2019 novel coronavirus disease (COVID-19) is running rampantly in China and is swiftly spreading 
to other countries in the world, which causes a great concern on the global public health. The absence 
of specific therapeutic treatment or effective vaccine against COVID-19 call for other avenues of the 
prevention and control measures. Media reporting is thought to be effective to curb the spreading of 
an emergency disease in the early stage. Cross-correlation analysis based on our collected data 
demonstrated a strong correlation between media data and the infection case data. Thus we 
proposed a deterministic dynamical model to examine the interaction of the disease progression and 
the media reports and to investigate the effectiveness of media reporting on mitigating the spread of 
COVID-19. The basic reproduction number was estimated as 5.3167 through parameterization of the 
model with the number of cumulative confirmed cases, the number of cumulative deaths and the 
daily number of media items. Sensitivity analysis suggested that, during the early phase of the COVID-19 
outbreak, enhancing the response rate of the media reporting to the severity of COVID-19, 
and enhancing the response rate of the public awareness to the media reports, both can bring forward the 
peak time and reduce the peak size of the infection significantly. These findings suggested that 
besides improving the medical levels, media coverage can be considered as an effective way to 
mitigate the disease spreading during the initial stage of an outbreak.

The outbreak of a novel coronavirus (COVID-19) generated an outbreak of public opinions in the 
Chinese Sina-microblog. To help in designing effective communication strategies during a major 
public health emergency, we propose a multiple-information susceptible-discussing-immune (M-SDI) 
model in order to understand the patterns of key information propagation on social networks. We 
develop the M-SDI model, based on the public discussion quantity and take into account of the 
behavior that users may re-enter another related topic or Weibo after discussing one. Data fitting 
using the real data of COVID-19 public opinion obtained from Chinese Sina-microblog can 
parameterize the model to make accurate prediction of the public opinion trend until the next major 
news item occurs. The reproduction ratio has fallen from 1.7769 and maintained around 0.97, which 
reflects the peak of public opinion has passed but it will continue for a period of time.

To rapidly assess possible community transmission in Noord-Brabant, the Netherlands, healthcare 
workers (HCW) with mild respiratory complaints and without epidemiological link (contact with 
confirmed case or visited areas with active circulation) were tested for severe acute respiratory 
syndrome coronavirus 2 (SARS-CoV-2). Within 2 days, 1,097 HCW in nine hospitals were tested; 45 
(4.1%) were positive. Of six hospitals with positive HCW, two accounted for 38 positive HCW. The 
results informed local and national risk management.

The renin-angiotensin system (RAS) plays a main role in regulating blood pressure and electrolyte and 
liquid balance. Previous evidence suggests that RAS may represent an important target for the 
treatment of lung pathologies, especially for acute respiratory distress syndrome and chronic fibrotic 
disease. The scientific community has recently focused its attention on angiotensin-converting 
enzyme (ACE) inhibitors and angiotensin receptor 1 (AT1R) inhibitors and their possible benefit/harms 
for patients infected by Coronavirus disease (COVID-19) who experience pneumonia, but there are still 
some doubts about the effects of these drugs in this setting.

Adjusting for delay from confirmation to death, we estimated case and infection fatality ratios (CFR, 
IFR) for coronavirus disease (COVID-19) on the Diamond Princess ship as 2.6% (95% confidence 
interval (CI): 0.89-6.7) and 1.3% (95% CI: 0.38-3.6), respectively. Comparing deaths on board with 
expected deaths based on naive CFR estimates from China, we estimated CFR and IFR in China to be 
1.2% (95% CI: 0.3-2.7) and 0.6% (95% CI: 0.2-1.3), respectively.

The World Health Organization has recognized the pandemic nature of the coronavirus disease 19 
(COVID-19) outbreak. A large proportion of positive patients require hospitalization, while 5-6% of 
them may need more aggressive therapies in intensive care. Most governments have recommended 
social separation and severe measures of prevention of further spreading of the epidemic. Because 
hemodialysis (HD) patients need to access hospital and dialysis center facilities 3 times a week, this 
category of patients requires special attention. In this editorial, we tried to summarize the experience 
of our centers that hopefully may contribute to help other centers and colleagues that are facing the 
coming wave of the epidemic. Special algorithms for COVID-19 spreading in the dialysis population, 
recommendations for isolation and preventive measures in positive HD patients, and finally directions 
to manage logistics and personnel are reported. These recommendations should be considered 
neither universal nor absolute. Instead, they require local adjustments based on geographic location, 
cultural and social environments, and level of available resources.

Currently, the outbreak of COVID-19 is rapidly spreading especially in Wuhan city, and threatens 14 
million people in central China. In the present study we applied the Moran index, a strong statistical 
tool, to the spatial panel to show that COVID-19 infection is spatially dependent and mainly spread 
from Hubei Province in Central China to neighbouring areas. Logistic model was employed according 
to the trend of available data, which shows the difference between Hubei Province and outside of it. 
We also calculated the reproduction number R0 for the range of [2.23, 2.51] via SEIR model. The 
measures to reduce or prevent the virus spread should be implemented, and we expect our data-
driven modeling analysis providing some insights to identify and prepare for the future virus control.

The outbreak of COVID-19 caused by SARS-CoV-2 in Wuhan and other cities of China is a growing 
global concern. Delay in diagnosis and limited hospital resources lead to a rapid spread of COVID-19. 
In this study, we investigate the effect of delay in diagnosis on the disease transmission with a new 
formulated dynamic model. Sensitivity analyses and numerical simulations reveal that, improving the 
proportion of timely diagnosis and shortening the waiting time for diagnosis can not eliminate 
COVID-19 but can effectively decrease the basic reproduction number, significantly reduce the 
transmission risk, and effectively prevent the endemic of COVID-19, e.g., shorten the peak time and 
reduce the peak value of new confirmed cases and new infection, decrease the cumulative number of 
confirmed cases and total infection. More rigorous prevention measures and better treatment of 
patients are needed to control its further spread, e.g., increasing available hospital beds, shortening 
the period from symptom onset to isolation of patients, quarantining and isolating the suspected 
cases as well as all confirmed patients.

Background: The psychological and behavioral responses during the early stage of Coronavirus 
disease 2019 (COVID-19) in South Korea were investigated to guide the public as full and active 
participants of public health emergency preparedness (PHEP), which is essential to improving 
resilience and reducing the population's fundamental vulnerability. Methods: Data were collected 
through an online survey four weeks after the Korea Centers for Disease Control and Prevention 
(KCDC) confirmed the first case in South Korea; 973 subjects were included in the analysis. Results: 
Respondents' perceived risk of COVID-19 infection; the majority of respondents reported that their 
perceived chance of infection was "neither high nor low" (51.3%). The average perceived severity 
score was higher than perceived susceptibility; 48.6 % reported that the severity would be "high," 
while 19.9% reported "very high." Many respondents reported taking precautions, 67.8% reported 
always practicing hand hygiene, and 63.2% reported always wearing a facial mask when outside. 
Approximately 50% reported postponing or canceling social events, and 41.5% were avoiding 
crowded places. Practicing precautionary behaviors associated strongly with perceived risk and 
response efficacy of the behavior. Conclusions: Our study confirmed the significance of the 
psychological responses, which associated with behavioral responses and significantly influenced the 
public's level of public health emergency preparedness regarding the COVID-19 pandemic. This result 
has consequences not only for implementing public health strategies for the pandemic but also for 
understanding future emerging infectious diseases.

Responding to an outbreak of a novel coronavirus [agent of coronavirus disease 2019 (COVID-19)] in 
December 2019, China banned travel to and from Wuhan city on 23 January 2020 and implemented a 
national emergency response. We investigated the spread and control of COVID-19 using a data set 
that included case reports, human movement, and public health interventions. The Wuhan shutdown 
was associated with the delayed arrival of COVID-19 in other cities by 2.91 days. Cities that 
implemented control measures preemptively reported fewer cases on average (13.0) in the first week 
of their outbreaks compared with cities that started control later (20.6). Suspending intracity public 
transport, closing entertainment venues, and banning public gatherings were associated with 
reductions in case incidence. The national emergency response appears to have delayed the growth 
and limited the size of the COVID-19 epidemic in China, averting hundreds of thousands of cases by 
19 February (day 50).

The outbreak of 2019-novel coronavirus (2019-nCoV) infection poses a serious threat to global public 
health. Vaccination is an effective way to prevent the epidemic of the virus. 2019-nCoV along with 
severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome 
coronavirus (MERS-CoV) belong to the same β-genus of coronavirus family. Basing on the previous 
experience and the technical platform of developing SARS-CoV and MERS-CoV vaccines, scientists 
from all over the world are working hard and quickly on the related fields. There are substantial 
progress in these fields including characterizing the 2019-nCoV virus, identification of candidate 
antigens and epitopes, establishment of animal models, characterizing the immune responses, and 
the design of vaccines. The development of 2019-nCoV vaccines covers all types: inactivated virus 
vaccine, recombinant protein vaccine, viral vector-based vaccine, mRNA vaccine, and DNA vaccine, et 
al. As of March 2020, two 2019-nCoV vaccines have entered phase I clinical trials. One is named as 
Ad5-nCoV developed by the Chinese Institute of Biotechnology of the Academy of Military Medical 
Sciences and Tianjin Cansino Biotechnology Inc. Ad5-nCoV is based on the replication-defective 
adenovirus type 5 as the vector to express 2019-nCoV spike protein. The another vaccine is mRNA
-1273 developed by the National Institute of Allergy and Infectious Diseases and Moderna, Inc.. RNA
-1273 is an mRNA vaccine expressing 2019-nCoV spike protein. Although the rapid development of 
2019-nCoV vaccine, it still faces many unknown challenges, including the antigenic characteristics of 
the 2019-nCoV, the influence of antigenic variation, the protective immune response of host, the 
protection of the elderly population, and the downstream manufacturing process of the new vaccine. 
The safety and efficacy of vaccines are the first priority for vaccine development and should be 
carefully evaluated.

Background and Purpose- Hyperacute assessment and management of patients with stroke, termed 
code stroke, is a time-sensitive and high-stakes clinical scenario. In the context of the current 
coronavirus disease 2019 (COVID-19) pandemic caused by the SARS-CoV-2 virus, the ability to deliver 
timely and efficacious care must be balanced with the risk of infectious exposure to the clinical team. 
Furthermore, rapid and effective stroke care remains paramount to achieve maximal functional 
recovery for those needing admission and to triage care appropriately for those who may be 
presenting with neurological symptoms but have an alternative diagnosis. Methods- Available 
resources, COVID-19-specific infection prevention and control recommendations, and expert 
consensus were used to identify clinical screening criteria for patients and provide the required 
nuanced considerations for the healthcare team, thereby modifying the conventional code stroke 
processes to achieve a protected designation. Results- A protected code stroke algorithm was 
developed. Features specific to prenotification and clinical status of the patient were used to define 
precode screening. These include primary infectious symptoms, clinical, and examination features. A 
focused framework was then developed with regard to a protected code stroke. We outline the 
specifics of personal protective equipment use and considerations thereof including aspects of crisis 
resource management impacting team role designation and human performance factors during a 
protected code stroke. Conclusions- We introduce the concept of a protected code stroke during a 
pandemic, as in the case of COVID-19, and provide a framework for key considerations including 
screening, personal protective equipment, and crisis resource management. These considerations and 
suggested algorithms can be utilized and adapted for local practice.

The recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, previously known as 2019-
nCoV) outbreak has engulfed an unprepared world amidst a festive season. The zoonotic SARS-CoV-
2, believed to have originated from infected bats, is the seventh member of enveloped RNA 
coronavirus. Specifically, the overall genome sequence of the SARS-CoV-2 is 96.2% identical to that of 
bat coronavirus termed BatCoV RaTG13. Although the current mortality rate of 2% is significantly 
lower than that of SARS (9.6%) and Middle East respiratory syndrome (MERS) (35%), SARS-CoV-2 is 
highly contagious and transmissible from human to human with an incubation period of up to 24 
days. Some statistical studies have shown that, on average, one infected patient may lead to a 
subsequent 5.7 confirmed cases. Since the first reported case of coronavirus disease 2019 (COVID-19) 
caused by the SARS-CoV-2 on December 1, 2019, in Wuhan, China, there has been a total of 60,412 
confirmed cases with 1370 fatalities reported in 25 different countries as of February 13, 2020. 
The outbreak has led to severe impacts on social health and the economy at various levels. This paper is a 
review of the significant, continuous global effort that was made to respond to the outbreak in the 
first 75 days. Although no vaccines have been discovered yet, a series of containment measures have 
been implemented by various governments, especially in China, in the effort to prevent further 
outbreak, whilst various medical treatment approaches have been used to successfully treat infected 
patients. On the basis of current studies, it would appear that the combined antiviral treatment has 
shown the highest success rate. This review aims to critically summarize the most recent advances in 
understanding the coronavirus, as well as the strategies in prevention and treatment.

Human coronaviruses SARS-CoV-2 appeared at the end of 2019 and led to a pandemic with high 
morbidity and mortality. As there are currently no effective drugs targeting this virus, drug 
repurposing represents a short-term strategy to treat millions of infected patients at low costs. 
Hydroxychloroquine showed an antiviral effect in vitro. In vivo it showed efficacy, especially when 
combined with azithromycin in a preliminary clinical trial. Here we demonstrate that the combination 
of hydroxychloroquine and azithromycin has a synergistic effect in vitro on SARS-CoV-2 at 
concentrations compatible with that obtained in human lung.

COVID-19, the disease caused by the novel SARS-CoV-2, a betacoronavirus structurally similar to 
SARS-CoV. Based on both structural and syndromic similarities with SARS-CoV, a hypothesis is formed 
on SARS-CoV-2 potential to affect the host's metabolism as part of its lifecycle. This hypothesis is 
evaluated by (a) exploratory analysis of SARS-CoV/human transcriptomic interaction data and gene 
set enrichment analysis (b) a confirmatory, focused review of the literature based on the findings by 
(a). A STRING Viruses (available search for human - SARS-CoV (NCBI taxonomy Id: 9606 vs. NCBI 
taxonomy Id: 694009) genomic interactions reveals ten human proteins, interacting with SARS-CoV: 
SGTA, FGL2, SPECC1, STAT3, PHB, BCL2L1, PPP1CA, CAV1, JUN, XPO1. Gene set enrichment analyses 
(GSEA) with STRING on this network revealed their role as a putative protein - protein interaction 
network (PPI; Enrichment p-value = 0.0296) mediating, viral parasitism, interleukin as well as insulin 
signaling, diabetes and triglyceride catabolism. In the literature, SARS-CoV has been known to cause 
de novo diabetes by ACE2-dependent uptake on pancreatic isle cells, and furthermore dysregulate 
lipid autophagy in favor of the viral lifecycle. Conversely, currently there are only non-causative, 
observational evidence of worse outcomes for COVID-19 patients with comorbid diabetes or 
hyperglycemia. No study has reported on the lipid profiles of COVID-19 patients; however, lipid-
targeting molecules have been proposed as agents against SARS-CoV-2. Future studies, reporting on 
lipid and glucose metabolism of COVID-19 patients could help elucidate the disease's seculae and aid 
drug design.