COVID, Volume 1, Issue 1 (September 2021) – 35 articles

The purpose of this study is to predict the short-term trend of the COVID-19 pandemic and give insights into effective response strategies. Based on the basic SIR model, a compartment method for modeling the course of an epidemic, the short-term infection change ratio $m^d$, is derived. The number of infected people can be predicted using this ratio. We calculated different $m^d$ values on a weekly basis. As we tested different combinations of $m^d$, the prediction from the combination of $m^d$ based on a week and $m^d$ based on 4 weeks was found to be statistically reliable. According to our regression analysis, our approach has an explanatory power of 96%. However, this method could only predict 1 week ahead of current data. Thus, we use LSTM, a deep learning method applied for time series data, to forecast the trend 4 weeks ahead. The forecasted trends show that the number of infected people in South Korea will reach its peak a week after the writing of this work and start to gradually decline after that. Full article

Coronavirus disease (COVID-19) is an illness caused by a novel coronavirus family. One of the practical examinations for COVID-19 is chest radiography. COVID-19 infected patients show abnormalities in chest X-ray images. However, examining the chest X-rays requires a specialist with high experience. Hence, using deep learning techniques in detecting abnormalities in the X-ray images is presented commonly as a potential solution to help diagnose the disease. Numerous research has been reported on COVID-19 chest X-ray classification, but most of the previous studies have been conducted on a small set of COVID-19 X-ray images, which created an imbalanced dataset and affected the performance of the deep learning models. In this paper, we propose several image processing techniques to augment COVID-19 X-ray images to generate a large and diverse dataset to boost the performance of deep learning algorithms in detecting the virus from chest X-rays. We also propose innovative and robust deep learning models, based on DenseNet201, VGG16, and VGG19, to detect COVID-19 from a large set of chest X-ray images. A performance evaluation shows that the proposed models outperform all existing techniques to date. Our models achieved 99.62% on the binary classification and 95.48% on the multi-class classification. Based on these findings, we provide a pathway for researchers to develop enhanced models with a balanced dataset that includes the highest available COVID-19 chest X-ray images. This work is of high interest to healthcare providers, as it helps to better diagnose COVID-19 from chest X-rays in less time with higher accuracy. Full article

Here we present a device that suppresses transfer of aerosol between nearby seating areas through the use of optically transparent, sound transmitting barriers and HEPA fan filter unit (FFU). A potential application of this device is to lower the risk of respiratory disease transmission in face-to-face, maskless meetings between individuals in a university setting. We evaluate overall aerosol transmission between users of the device. This is done for two different physical settings: a large space, such as a library, and a small space, such as an enclosed study room. We find that the device can provide lower aerosol transmission compared to the typical transmission between two individuals wearing surgical face masks separated by six feet. Full article

Coronaviruses (CoVs) are a large viral family that can evolve rapidly emerging new strains that cause outbreaks and life-loss, including SARS-CoV, MERS-CoV, and SARS-CoV-2 (COVID-19). CoVs encode a diverse number of proteins, ranging from 5 proteins in bat CoV, to 14 in SARS CoV, which could have implication on viral tropism and pathogenicity. Here, we highlight the functional protein motifs (domains) that could contribute in the coronavirus infection and severity, including SARS-CoV-2. For this role, we used the experimentally validated domain (motif) datasets that are known to be crucial for viral infection. Then, we highlight the potential molecular pathways and interactions of SARS-CoV-2 proteins within human cells. Interestingly, the C-terminal of SARS-CoV-2 nsp1 protein encodes MREL motif, which a signature motif of the tubulin superfamily, and regulate tubulin expression. The C-terminal region of nsp1 protein can bind to ribosome and regulation viral RNA translation. Full article

In the battle against the Coronavirus, over 190 territories and countries independently work on one end goal: to stop the pandemic growth. In this context, a tidal wave of data has emerged since the beginning of the COVID-19 crisis. Extant research shows that the pandemic data are partially reliable. Only a small group of nations publishes reliable records on COVID-19 incidents. We collected global data from 176 countries and explored the causal relationship between average growth ratios and progress in the reliability of pandemic data. Furthermore, we replicated and operationalized the results of prior studies regarding the conformity of COVID-19 data to Benford’s law. Our outcomes confirm that the average growth rates of new cases in the first nine months of the Coronavirus pandemic explain improvement or deterioration in Benfordness and thus reliability of COVID-19 data. We found significant evidence for the notion that nonconformity to BL rises by the growth of new cases in the initial phases of outbreaks. Full article

The coronavirus disease outbreak in 2019 (COVID-19) reached devastating pandemic proportions, still representing a challenge for all healthcare workers. Furthermore, the social environment underwent significant changes and healthcare facilities were overwhelmed by COVID-19 patients. The purpose of our study was to compare the prevalence, characteristics and outcomes of 234 patients presenting with pulmonary embolism diagnosed by computed tomography pulmonary angiography (CTPA) during the COVID-19 pandemic, to patients presenting with PE one year before, aiming to assess differences and similarities between these patients. Or main findings were: patients with PE had worse survival during the pandemic, there was an increased incidence of PE among hospitalizations in our cardiology unit during the COVID-19 pandemic, and patients hospitalized with PE during the pandemic were more likely to be obese, allowing us to infer that weight control can have a positive impact on preventing PE. Future research should establish optimal therapeutic, epidemiological and economical strategies for non-COVID patients, as the pandemic continues to put significant burden on the healthcare systems worldwide. Full article

The role of educational facilities, including schools and universities, in the SARS-CoV-2 pandemic is heavily debated. Specifically, the risk of infection in student dormitories has not been studied. This cohort study monitored students living in dormitories in Bochum, Germany, throughout the winter term of 2020/2021. Over the course of four months, participants were tested repeatedly for SARS-CoV-2 infections using RT-PCR from gargle samples and serological testing. An online questionnaire identified individual risk factors. A total of 810 (46.5% female) students participated. Of these, 590 (72.8%) students participated in the final visit. The cross-sectional antibody prevalence was n = 23 (2.8%) in November 2020 and n = 29 (4.9%) in February 2021. Of 2513 gargle samples analyzed, 19 (0.8%) tested positive for SARS-CoV-2, corresponding to 14 (2.4%) infections detected within the study period. Gargle samples available of cases with confirmed present infection were always positive. The person-time incidence rate was 112.7 (95% CI: 54.11–207.2) per 100,000 person weeks. The standardized incidence ratio was 0.9 (95% CI 0.51–1.46, p = 0.69). In conclusion, students living in student dormitories do not appear to be major drivers of SARS-CoV-2 infections. RT-PCR from gargle samples is a patient-friendly and scalable surveillance tool for detection of SARS-CoV-2 infections. Full article

Since the beginning of the pandemic, a race has been underway to detect SARS-CoV-2 virus infection (PCR screening, serological diagnostic kits), treat patients (drug repurposing, standard care) and develop a vaccine. After almost a year of active circulation worldwide, SARS-CoV-2 variants have appeared in different countries. Those variants include mutations in multiple regions of the genome, particularly in the spike gene. Because this surface protein is a key player in both the spread of the virus and the efficacy of vaccine strategies, the challenge is to efficiently monitor the appearance of spike mutations in the population. The present work describes a procedure based on the widely available Sanger technology to produce a full-length sequence of the spike gene from patient-derived samples. Full article

The ongoing pandemic (i.e., novel corona virus disease 2019 (COVID-19)) is a major crisis that humanity is facing across the globe. In response to COVID-19, every country has designed and enforced various mechanisms to control its spread, and save their citizens from this deadly disease. Besides the general containment strategies, the use of technology and person-specific data collection and processing also vary from country to country. In this brief case report, we describe the measures that South Korea (SK) has adopted in order to curb the spread of COVID-19, and the success of SK in keeping the cases at a manageable level since the start of this pandemic until present via extensive use of technology. Specifically, we describe the data collected to control this pandemic, technical framework in place to ensure co-ordination with different authorities, containment strategies, and major breakthrough SK achieved when sporadic clusters emerged throughout the nation. With this brief overview, we aim to update the research community about the unprecedented efforts SK made, utilizing previous pandemic experiences, and the successful results they have obtained so far amid this pandemic, leveraging technology. Full article

Because the SARS-CoV-2 virus primarily spreads through droplets and aerosols, a protective box could provide adequate protection by shielding medical professionals during the intubation and extubation procedures from generated droplets and aerosols. In this study, size- and time-dependent aerosol concentrations were measured inside and outside the protective box in the particle size ranging from 14 nm to 20 μm during simulated intubation and extubation procedures. An improved protective box with active ventilation was designed based on a plastic bag with armholes covered with latex sheets that utilizes a supportive frame. Coughing during the intubation and extubation procedure was simulated using an aerosol generator which dispersed the aerosol powder into the protective box. During the intubation and extubation procedure, the concentration of particles increased inside the protective box but, due to the high negative airflow, quickly dropped to background levels. The particle concentration of all measured particle sizes decreased within the same time frame. No leakage of particles was observed through the armhole openings. The presented protective box design provides excellent protection against generated droplets and aerosols. The decrease in concentration does not depend on the particle size. Outside the box, particle concentration did not change with time. Full article

In general, governments and health authorities have taken precautions during the COVID-19 pandemic to reduce the viral spread and protect vulnerable citizens. Patients with multiple myeloma (MM) have an increased risk of being infected with COVID-19 and developing a fatal course due to the related immunodeficiency. We investigated how Danish patients with MM reported their quality of life (QoL) pre-COVID and during COVID, in an ongoing longitudinal QoL survey. The responses given during the first and second wave of the COVID-19 pandemic were pooled, analyzed and compared to the same period the year before. We hypothesized that locking down the society would have caused deteriorated QoL and that patients living alone and those under the age of 65 would be particularly affected by the situation. Surprisingly, our study showed the opposite. Statistically significant and clinically relevant differences were primarily found during the first lock down and represented reduced fatigue, improved role functioning, decreased insomnia and improved physical health summaries in patients below 65 years of age. These results indicate that Danish patients with MM might have felt protected and safe by COVID restrictions. Otherwise, the questionaries used in QoL-MM survey may not have been able to capture the impact of the COVID-19 pandemic. Importantly, this indicates that QoL survey data obtained in clinical studies, in countries with highly developed health-care systems using standard questionnaires during the pandemic, allow room for interpretation without being adjusted for the impacts of the pandemic. Full article

In recent work, we proposed that effective therapeutic drugs aimed at treating the SARS-CoV-2 infection could be developed based on interdicting in the early steps of the folding pathway of key viral proteins, including the receptor binding domain (RBD) of the spike protein. In order to provide for a drug target on the protein, the earliest contact-formation event along the dominant folding pathway of the RBD spike protein was predicted employing the Sequential Collapse Model (SCM). The segments involved in the predicted earliest contact were suggested to provide optimal folding interdiction target regions (FITRs) for potential therapeutic drugs, with a focus on folding interdicting peptides (FIPs). In this paper, we extend our analysis to include 13 known single mutations of the RBD spike protein as well as the triple mutation B1.351 and the recent double mutation B1.617.2. The results show that the location of the FITR does not change in any of the 15 studied mutations, providing for a mutation-resistant drug design strategy for the RBD-spike protein. Full article

The basic approach of this research is to use an estimated series of effective reproduction number ${\mathcal{R}}_t$ and multiple series of index from Oxford COVID-19 Government Response Tracker (OxCGRT) to measure the effect of Japanese government’s response on COVID-19 epidemic by running a time-varying regression with flexible least squares method. Then, we use estimated series of time-varying coefficients obtained from the previous step as proxy variables for the government response’s effect and run stepwise regressions with policy indicators of OxCGRT to identify which specific policy can mitigate the spreading of the COVID-19 epidemic in Japan. The main finding is that the response of Japanese government on COVID-19 epidemic is basically effective. However, the effect of Japanese government’ policy is gradually weakening. Under our identification scheme, we find that policies of quarantine and movement restrictions are still most effective, but policies of public health system do not show much effectiveness in the regression analysis. Another important empirical finding is that policies of economic support are effective in reducing the spread of COVID-19. Within the framework of empirical strategy proposed in this paper, the conclusion should be explained in the context of the socio-political and health situation in Japan, but the methodology is assumed to be applicable to other countries and regions in the analysis of government performance of response to COVID-19. Full article

Large-scale efforts have been persistently undertaken for medical prophylaxis and treatment of COVID-19 disasters worldwide. A variety of novel viral spike protein-targeted vaccines have been extensively distributed for global inoculation based on accelerated approval. With concerns of emerging spike protein mutations, we revisited the early but inconclusive clinical interest in the repurposed combination of azithromycin (AZT) and zinc supplements with safety advantages. The aim of this study is to provide in vitro proof of concept for IκBα associated rapid and synergistic suppression of angiotensin-converting enzymes 2 (ACE2) following combination treatments with AZT plus zinc sulfate in two human airway cells with ACE2 expression, Calu-3 and H322M, representative cells of the human upper and lower airway origin respectively. Clinical timing of AZT combined with zinc is indicated based on suppression of the key cellular entry molecule, ACE2, of SARS-CoV-2. Full article

The 2019 coronavirus (COVID-19) outbreak has drastically changed people’s lifestyles and forced them to adopt new behaviors. To assess Italians’ reported compliance to the behavioral provisions issued by the Italian Ministry of Health against the COVID-19 pandemic and identify the socio-demographic and psychological profile of a person who is more likely to comply with them, we conducted a quantitative study with 1556 participants. Notably, in Italy, after a month of lockdown, the reported compliance with anti-COVID prescriptions was high overall. Moreover, personality traits, risk perception, well-being levels, and emotional activations appeared to play a role in promoting or hindering people’s reported compliance. These findings emphasize the importance of being aware of the reported compliance’s antecedents for defining advanced pro-compliance policies and messages and thus better manage each stage of the COVID-19 pandemic in Italy and, plausibly, in other countries. Full article

Introduction. Viral infections during pregnancy have always been considered to cause complications and adverse events and birth defects during pregnancy. In particular, we do not have any therapeutic or preventive tools aimed at protecting the mother and fetus during the gestational period during pandemics. Methods. The studies were identified by using the PubMed database published until 30 April 2021. The search was performed by using the following keywords: viral infection, SARS-CoV-2, COVID-19, vaccine, pregnancy, gestational period, pandemics, vaccination, complication, adverse events, drugs. Results. It has been reported that viral infections are considered to cause complications and adverse events during pregnancy. In this regard, pregnancy is associated with higher mortality rates and complications during viral infections. In fact, maternal immunization represents a unique approach to protect newborns from several infectious diseases. Conclusion. European Board and College of Obstetrics and Gynecology (EBCOG) and International public health institutions (WHO, CDC) report the recommendations about the use of vaccines during pregnancy. Full article

Ibuprofen is a common over-the-counter drug taken for pain relief. However, recent studies have raised concerns about its potential toxic effect with coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has been proposed that ibuprofen may increase levels of angiotensin-converting enzyme 2 (ACE2), the human receptor for SARS-CoV-2 infection. Therefore, paracetamol is suggested as an alternative to ibuprofen for treating COVID-19 symptoms. Nevertheless, the relationship between intake of paracetamol or ibuprofen and either susceptibility to infection by SARS-CoV-2 or modulation of cellular ACE2 levels remains unclear. In this study, we combined data from human medical records and cells in culture to explore the role of the intake of these drugs in COVID-19. Although ibuprofen did not influence COVID-19 infectivity or ACE2 levels, paracetamol intake was associated with a lower occurrence of COVID-19 in our cohort. We also found that paracetamol led to decreased ACE2 protein levels in cultured cells. Our work identifies a putative protective effect of paracetamol against SARS-CoV-2 infection. Future work should explore the molecular mechanisms underlying the relationship between paracetamol and COVID-19. Full article

Concurrent waves of coronavirus disease, Ebola virus disease, avian influenza A, and black fungus are jeopardizing lives in some parts of Africa and Asia. From this point of view, this review aims to summarize both the socio-economic and public health implications of these parallel outbreaks along with their best possible management approaches. Online databases (PubMed/PMC/Medline, Publons, ResearchGate, Scopus, Google Scholar, etc.) were used to collect the necessary information regarding these outbreaks. Based on the reports published and analyses performed so far, the long-lasting impacts caused by these simultaneous outbreaks on global socio-economical and public health status can be conceived from the past experiences of outbreaks, especially the COVID-19 pandemic. Moreover, prolonged restrictions by the local government may lead to food insecurity, global recession, and an enormous impact on the mental health of people of all ages, specifically in developing countries. Such overwhelming effects have already been reported to be declining the national growth of the economy as well as increasing political insecurity and shortage of basic needs. Although various actions have already been taken, including vaccination, clinical management and further research, social distancing, lockdown, etc., to improve the situation, the emerging variants and associated genetic mutations may make containment difficult, worsening the situation again. So, considering the current mutational dynamics of the pathogens and past experiences, perpetual preparedness along with updated clinical management backed by epidemiological studies and innovative scientific effort are inevitable to combat the simultaneous waves of multiple infectious diseases. Full article

The lockdown policies enacted in the spring of 2020, in response to the growing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, have remained a contentious policy tool due to the variability of outcomes they produced for some populations. While ongoing research has illustrated the unequal impact of Coronavirus disease (COVID-19) on minority populations, research in this area has been unable to fully explain the mechanisms that produce these findings. To understand why some groups have been at greater risk of contracting COVID-19, we employ structural inequality theory to better understand how inequality may impact disease transmission in a pandemic. We used a novel approach that enabled us to focus on the microprocesses of structural inequality at the zip code level to study the impact of stay-at-home pandemic policies on COVID-19 positive case rates in an urban setting across three periods of policy implementation. We then analyzed data on traffic volume, income, race, occupation, and instances of COVID-19 positive cases for each zip code in Salt Lake County, Utah (USA) between 17 February 2020 and 12 June 2020. We found that higher income, percent white, and white-collar zip codes had a greater response to the local stay-at-home order and reduced vehicular traffic by nearly 50% during lockdown. The least affluent zip codes only showed a 15% traffic decrease and had COVID-19 rates nearly 10 times higher. At this level of granularity, income and occupation were both associated with COVID-19 outcomes across all three stages of policy implementation, while race was only predictive of outcomes after the lockdown period. Our findings illuminate underlying mechanisms of structural inequality that may have facilitated unequal COVID-19 incidence rates. This study illustrates the need for more granular analyses in policy research and adds to the literature on how structural factors such as income, race, and occupation contribute to disease transmission in a pandemic. Full article

The COVID-19 disease was declared a global pandemic by the 11th of February 2020, presenting a major threat to public health worldwide. Success in the battle against COVID-19 depends on public adherence to control measures. Their adherence is greatly affected by their knowledge, perceptions, and practices; therefore, the aim of this study was to assess and understand the knowledge, perceptions, practices, and trusted information sources of COVID-19 among Irish residents. A quantitative survey was performed by means of an online questionnaire, which comprised five sections to collect data regarding demographics, knowledge, perceptions, practices, and information sources. A total of 1007 participants completed the online survey between February and March 2021. The majority of respondents (69.4% female and 30.3% male) had a correct rate of knowledge (88%) and practices (68.1%), with health organisations being the most trusted information source (70.7%); 87.4% understand good mask etiquette. Only 53.7% agreed that closing schools or mass gathering events are an effective way to reduce the spread of the virus, while 81.3% are aware that COVID-19 is more severe than the flu; 64% of respondents said that the pandemic has negatively affected their mental health. It was observed that a higher level of knowledge is positively correlated with good practices. The study concludes that most of the respondents have shown a good level of knowledge and right practices towards the COVID-19 pandemic, and that the higher the level of knowledge of individuals, the better the COVID-19 safety practices are that they perform. It has been observed that the continuous improvement on an individual’s level of knowledge of COVID-19 is essential to maintain good safety practices and reduce the spread. Full article

A diagnosis of either attention deficit/hyperactivity disorder (ADHD) or of autistic spectrum disorder (ASD) identifies an individual as unable to attend expectedly and appropriately, particularly in school settings. Until the COVID-19 pandemic, what defined the expected and the appropriate was considerate, close physical contact among people. In understanding that aerosol droplets from vocalization cause the transmission of the COVID-19 virus, what is acceptable contact has now shifted to distancing oneself from people and communicating in a way that eliminates vocal spray. The norms for socialization diametrically changed as a consequence of the pandemic. Yet, there has been no concurrent reassessment of the meaning of “disorder” related to ADHD and ASD within the school setting. A diagnosis of ADHD and/or ASD often brings with it an expectation for special education. Therefore, it is important that changes in social norms be recognized as they define the meaning of “disorder”. Investigated here is in what way each diagnosis demonstrates disorder in response to the imposed COVID-19 restrictions and how this can be anticipated to affect the schooling of those with ADHD and ASD during the pandemic. Full article

When it comes to COVID-19, access to reliable data is vital. It is crucial for the scientific community to use data reported by independent territories worldwide. This study evaluates the reliability of the pandemic data disclosed by 182 countries worldwide. We collected and assessed conformity of COVID-19 daily infections, deaths, tests, and vaccinations with Benford’s law since the beginning of the coronavirus pandemic. It is commonly accepted that the frequency of leading digits of the pandemic data shall conform to Benford’s law. Our analysis of Benfordness elicits that most countries partially distributed reliable data over the past eighteen months. Notably, the UK, Australia, Spain, Israel, and Germany, followed by 22 different nations, provided the most reliable COVID-19 data within the same period. In contrast, twenty-six nations, including Tajikistan, Belarus, Bangladesh, and Myanmar, published less reliable data on the coronavirus spread. In this context, over 31% of countries worldwide seem to have improved reliability. Our measurement of Benfordness moderately correlates with Johns Hopkin’s Global Health Security Index, suggesting that the quality of data may depend on national healthcare policies and systems. We conclude that economically or politically distressed societies have declined in conformity to the law over time. Our results are particularly relevant for policymakers worldwide. Full article

Based on hospital capacities, facts from past experience with the coronavirus disease 2019 (COVID-19) virus and the number of dark infections during the second wave ($D_{\mathrm{II}}=2D_2$), a reasonable limiting value of $140/D_2$ for the 7-day incidence per 100,000 persons (MSDIHT) and a second wave herd immunization threshold fraction value of $0.26$ in Germany were calculated. If the MSDIHT is held below this limiting value, the German hospital system can cope with the number of new seriously infected persons without any triage decisions. On the basis of the SIRV epidemics model, the classical threshold values for herd immunization were calculated for 18 countries. For these countries, the dates regarding when herd immunization against the second COVID-19 wave will be reached were estimated. Full article

The interaction of the spike (S) glycoprotein of SARS-CoV-2 with angiotensin-converting enzyme 2 (ACE2) correlates with increased virus transmissibility and disease severity in humans. Two strategies may be considered for preventive or treatment purposes: the blockage of the ACE2 receptors or the shielding of receptor-binding domains (RBD) in the Sprotein of COVID-19, as well as the S2 cleavage site that is used by the furin enzyme of the host cells in the late phase of virus activation. Herein, the interaction of carbon quantum dots (CQDs) with the Sprotein of SARS-CoV-2 was investigated using molecular docking and molecular dynamics. CQD molecules were optimized by the HF/3-21G level of theory; the probable interactions between the CQDs with Sprotein were studied by blind docking mode, considering the Sprotein as the receptor and CQDs as ligands. Ethanol, folic acid, Favipiravir, two kinds of functionalized triangular hexagonal graphene, and four kinds of functionalized CQDs were studied on a comparative basis. The results show that OH and amine-functionalized CQDs tend to interact with three branches of Sprotein, especially RBD. The fact that they can block the S2 cleavage site leads to their potential use as a therapeutic agent. Full article

SARS-CoV-2 has caused a global pandemic of an acute respiratory illness known as COVID-19. Patients with solid organ transplants receiving chronic immunosuppressive therapy are at risk of severe disease caused by opportunistic pathogens, including cytomegalovirus (CMV). We present the case of a renal transplant recipient presenting with hypoxic respiratory failure because of severe COVID-19, whose course was complicated by ganciclovir-resistant CMV pneumonitis. Full article

A novel beta coronavirus that emerged in late December 2019 triggered a global pandemic. Diagnostic methods for rapid identification of infected individuals were established in new biotechnological approaches. Vaccine production and application to individuals and measurement of SARS-CoV-2 antibodies also began. Serum samples from 240 health care workers were collected at three-month intervals over nine months. Indirect SARS-CoV-2 nucleocapsid IgG ELISA tests were used to identify humoral immune responses. All seropositive individuals and those with borderline ELISA values were tested with a specifically generated multipanel nucleocapsid fragment immunoblot. Of the 240 individuals, 24 showed seroconversion in ELISA after experiencing COVID-19. All of them showed a positive reaction against the full-length nucleocapsid protein in the immunoblot. The highest reactivity was seen either against fragment N(100–300) or in a minority against the posterior part N(200–419). In general, the staining pattern of COVID-19 patients showed four phenotypes. In contrast, three individuals classified as borderline by ELISA reacted exclusively with fragments N(1–220) and N(100–300) containing the octamer amino acid sequence FYYLGTGP, which is identical in human coronaviruses sharing this sequence with SARS-CoV-2. These represent a unique and thus fifth phenotype. This work suggests the existence of distinct phenotypic patterns of IgG production towards N-protein subdomains. Full article

One major micronutrient studied for its possible protective effect against the COVID-19 disease is vitamin D. This systematic review sought to identify and synthesize available evidence to aid the understanding of the possible effect of vitamin D deficiency on COVID-19 status and health outcomes in COVID-19 patients. Three databases (PubMed, ScienceDirect, and Google Scholar) were systematically used to obtain English language journal articles published between 1 December 2019 and 3 November 2020. The search consisted of the terms (“Vitamin D,” OR “25-Hydroxyvitamin D,” OR “Low vitamin D.”) AND (“COVID-19” OR “2019-nCoV” OR “Coronavirus” OR “SARS-CoV-2”) AND (“disease severity” OR “IMV” OR “ICU admission” OR “mortality” OR “hospitalization” OR “infection”). We followed the recommended PRISMA guidelines in executing this study. After going through the screening of the articles, eleven articles were included in the review. All the included studies reported a positive association between vitamin D sufficiency and improved COVID-19 disease outcomes. On the other hand, vitamin D deficiency was associated with poor COVID-19 disease outcomes. Specifically, two studies found that vitamin D-deficient patients were more likely to die from COVID-19 compared to vitamin D-sufficient patients. Three studies showed that vitamin D-deficient people were more likely to develop severe COVID-19 disease compared to vitamin D-sufficient people. Furthermore, six studies found that vitamin D-deficient people were more likely to be COVID-19 infected compared to vitamin D-sufficient people. Findings from these studies suggest that vitamin D may serve as a mitigating effect for COVID-19 infection, severity, and mortality. The current evidence supports the recommendations for people to eat foods rich in vitamin D such as fish, red meat, liver, and egg yolks. The evidence also supports the provision of vitamin D supplements to individuals with COVID-19 disease and those at risk of COVID-19 infection in order to boost their immunity and improve health outcomes. Full article

Quantitative fit testing was utilised to evaluate the Department of Health and Human Services in Victoria (DHHS) recommended fit check and determine pass/fail rates for self-selected P2/N95 respirators. Survey experience and training related to P2/N95 respirators were also obtained. This was an observational study at a specialist tertiary referral centre, Melbourne, Australia, between 29 May 2020 and 5 June 2020. The primary outcome was quantitative fit test pass/fail results, with fit check reported against fit test as a 2 × 2 contingency table. The secondary outcomes were the number of adjustments needed to pass, as well as the pass rates for available sizes and types of self-selected respirators, survey data for attitudes, experience and training for P2/N95 respirators. The fit check predicts respirator seal poorly (PPV 34.1%, 95% CI 25.0–40.5). In total, 69% (40/58) of respirators failed quantitative fit testing after initial respirator application and is a clinically relevant finding (first-up failure rate for P2/N95 respirators). Only one person failed the fit test for all three respirator fit tests. There was significant variability between each of the seven types of self-selected P2/N95 respirators, although sample sizes were small. Few participants were trained in the use of P2/N95 respirators or the fit check prior to COVID-19, with a high number of participants confident in achieving a P2/95 respirator seal following a fit test. The fit check alone was not a validated method in confirming an adequate seal for P2/N95 respirators. Quantitative fit testing can facilitate education, improve the seal of P2/N95 respirators, and needs to be integrated into a comprehensive Respiratory Protection Program (RPP). Full article

In March 2020, several mass gathering events were related to the Falles festival in Borriana (Spain), resulting in a 536 laboratory-confirmed COVID-19 cases outbreak among participants. This article estimates anti-SARS-CoV-2 antibodies persistence six months after and factors associated with antibody response. A prospective population-based cohort study was carried out by the Public Health Centre of Castellon and the Emergency and Clinical Analysis and Microbiology Services of Hospital de la Plana in Vila-real. In October 2020, a seroepidemiologic study was used to estimate the persistence of anti-SARS-CoV-2 antibodies against nucleocapsid protein (N) by an electrochemiluminescence immunoassay (ECLIA) was implemented. We enrolled 484 (90.2%) of the 536 members of the initial outbreak cohort and detected persistent antibodies in 479 (99%) without reinfection episodes. Five participants had a negative antibody test. Factors associated with a negative result were a lower body mass index (BMI), and less contact with other COVID-19 cases. Among the 469 participants with two ECLIA tests, 96 (20.5%) had an increase of antibodies and 373 (79.5%) a decline. Increased antibodies were associated with older age, higher BMI, more severe illness, and low current smokers. Our results show that after a COVID-19 infection, a high proportion of cases maintain detectable anti-SARS-CoV-2 antibodies. Full article