Event-based surveillance (EBS) systems monitor a broad range of information sources to detect early signals of disease emergence, including new and unknown diseases. Following the emergence of a newly identified coronavirus –so-called COVID-19, in humans in December 2019 in Wuhan, China, we conducted a retrospective analysis of the capacity of three Event-Based Systems (EBS) systems (ProMED, HealthMap and PADI-web) to detect early signals of this emergence. We evaluated the changes in the online news vocabulary coinciding with the period before / after the identification of COVID-19, as well as the assessment of its contagiousness and pandemic potential. ProMED was the timeliest EBS, detecting signals one day before the official notification. At this early stage, the specific vocabulary was related to “pneumonia symptoms” and “mystery illness”. Once COVID-19 was identified, the vocabulary changed to virus family and specific COVID-19 acronyms. Our results suggest the three EBS systems are complementary regarding data sources, and all need improvements regarding timeliness. EBS methods should be adapted to the different stages of disease emergence to improve the early detection of future emergence of unknown pathogens.

Background. Chemosensitive disorders are very frequent in the early stages of COVID-19 and in paucisymptomatic cases. These patients are typically placed in home quarantine. This study has the aim of validating a new olfactory and gustatory objective evaluation test in these patients.Methods. Thirty-three home-quarantined COVID-19 patients have undergone a self-administered chemosensitive test the day before the control swab. On this occasion, the patients underwent operator-administered already validated tests. The results were finally compared.Results. The differences between the results of the two tests were not significant for both the olfaction (P = 0.201) and the taste (P = 0.180).Conclusion. The olfactory and gustatory evaluation by self-administered test can be considered a valid tool, fundamental for obtaining objective qualitative and quantitative data on the extent of chemosensitive disorders in home-quarantined COVID-19 patients.

Introduction: The COVID-19 pandemic has raised controversies regarding safe and effective care of head and neck cancer patients. It is unknown how much the pandemic has changed surgeon practice. Methods: A questionnaire was distributed to head and neck surgeons assessing opinions related to treatment and concerns for the safety of patients, self, family, and staff. Results: A total of 67 head and neck surgeons responded during the study period. Surgeons continued to recommend primary surgical treatment for oral cavity cancers. Respondents were more likely to consider non-surgical therapy for patients with early glottic cancers and HPV-mediated oropharynx cancer. Surgeons were least likely to be concerned for their own health and safety and had the greatest concern for their resident trainees. Conclusions: This study highlights differences in the willingness of head and neck surgeons to delay surgery or alter plans during times when hospital resources are scarce and risk is high.

The coronavirus disease 2019 (COVID-19) pandemic has touched almost every continent. Personal protective equipment (PPE) is the final line of protection of healthcare workers (HCW). There is variation as well as controversy of infection control recommendation with regards to the use of PPE for HCW between institutions. The aim of this narrative review is to of examine and summarise the available evidence to guide recommendation for the safety of HCW. A literature search was conducted on the PubMed, MedLine, and Embase databases with the keywords “personal protective equipment”, “COVID 19”, “n95”, “health care worker”, and “mortality”. SARS-nCoV-2 is highly contagious. 3.5-20% of HCW has been reported to be infected. The mortality ranges from 0.53-1.94%. PPE is part of the measure within a package of prevention and control of pandemic, rather than a replacement of. Respirators are more effective than masks in preventing aerosol transmission to HCWs. Extended use may be considered if guidelines are adhered. PAPRs if available should be used in high risk procedures. Transmission of viruses is multimodal, and in the setting of a novel pathogen with high case fatality with no proven effective interventions, PPE that affords the best protection should be available to HCWs.

The identification of novel SARS coronavirus in 2019 and the diffusion of COVID-19 prompted a new topic with an increased number of related scientific publications. Here we discuss the “spreading of papers” by analysing the first 60 papers following the “paper zero”.

BACKGROUNDCoronavirus has serially overtaken our metropolitan hospitals. At peak, patients with acute respiratory distress syndrome may outnumber mechanical ventilators. In our Miami hospital system COVID-19 cases have multiplied for 4 weeks and elective surgery has been suspended.METHODSAn otolaryngologic triage committee was created to appropriately allocate resources to patients. Hospital ethicists provided support. Our tumor conference screened patients for non-surgical options. Patients were tested twice for Sars-CoV-2 before performing urgent contaminated operations. N95 masks and protective equipment were conserved when possible. Patients with low-grade cancers were advised to delay surgery, and other difficult decisions were made.RESULTSHundreds of surgeries were cancelled. Sixty-five cases supervised over three weeks are tabulated. Physicians and patients expressed discomfort regarding perceived deviations from standards, but risk of Covid-19 exposure tempered these discussions.CONCLUSIONSWe describe the use of actively managed surgical triage to fairly balance our patient’s health with public health concerns.

Background This study describes a novel approach in reducing SARS-CoV-2 transmission during tracheostomy. Methods Five patients underwent tracheostomy between 01 April 2020 and 17 April 2020. A clear and sterile plastic drape was used as an additional physical barrier against droplets and aerosols. Operative diagnosis; droplet count and distribution on plastic sheet and face shields were documented. Results Tracheostomy was performed for patients with carcinoma of tonsil (n=2) and nasopharynx (n=1), and aspiration pneumonia (n=2). Droplet contamination was noted on all plastic sheets (n=5). Droplet contamination was most severe over the central surface at 91.5% (86.7%-100.0%) followed by the left and right lateral surfaces at 5.2% (6.7%-10.0%) and 3.3% (6.7%-10.0%) respectively. No droplet contamination was noted on all face shields. Conclusion Plastic drapes can help reduce viral transmission to health care providers during tracheostomy. Face shields may be spared which in turn helps to conserve resources during the COVID-19 pandemic.

Background The WHO recommends testing any suspected person with Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV-2), in order to limit the spread of the epidemic. In Italy, some Regions opted for extensive testing, whereas others limited tests to selected subjects. To assess the influence of different strategies, we examined the incidence of death and severe cases in Italy. Methods Data on new cases of SARS-CoV-2, number of tests, deaths, and admissions to Intensive Care Units (ICU) were retrieved in each Italian Region, from February 24th to March 18th, 2020. As an index of different screening strategies, the number of tests/positive test results (T/P) ratio as of March 7th, 2020, was considered. The cumulative number of deaths and of new severe cases, between March 23thand 25th was recorded. The association of those two outcomes with the number of T/P ratio was assessed using linear regression models. Results In the interval between March 23th-25th, recorded deaths (*million inhabitants) were 14(3-54), whereas severe cases were 31(10-112). Both the number of deaths and that of severe cases showed a significant correlation (R2 .38 and .37, with p<.01) with the T/P ratio. Deaths and severe cases were associated with higher mean personal income and lower density of General Practioners (GPs). The association of T/P with severe cases and deaths retained statistical significance after adjusting for mean personal income (R2 .20 and .21, respectively; both p=.04) and GPs density (R2.22 and .21, respectively; both p=.03). Conclusions A more aggressive screening strategy for SARS-Cov-2, was associated with lower rates of death and severe disease in Regions of Italy.

No current treatment options were successful in containing the ongoing pandemic COVID-19 caused by SARS-CoV-2. It is essential to understand the molecular players of SARS-CoV-2 to find a suitable treatment method and to develop an effective antiviral drug as early as possible. Global researchers have undertaken accelerated structural studies of key proteins involved in host-virus interaction, replication, and transcription. In silico studies support structural biologist with preliminary information to efficiently drive further studies and characterization. From the genome sequence, most SARS-CoV-2 annotated ORF has a conserved sequence similar to SARS-CoV-1, except for ORF8 and ORF10. The function of ORF8 protein in SARS-CoV-2 is uncertain. Herein, we had modelled the ORF8 protein and studied its putative function using various substrates as a probe to determine its biological significance. The modelled SARS-CoV-2 (mORF87A) protein shows IgG characteristic folds and thus may belong to IgG superfamily. Further, we studied the binding efficacy of various antiviral drugs against the modelled ORF8 of SARS-CoV-2 (mORF8) to repurpose the drug and to use them as a probe to study its function by studying the binding/active sites interaction. Remdesivir had the highest binding affinity to ORF8 protein of SARS-CoV-2. The high affinity of the adenosine analogue yields critical information about the non-canonical RNA dependent RNA polymerase (RdRp) function of ORF8 protein. We hypothesize that the ORF8 protein may be a non-canonical RdRp in SARS-CoV-2 with ability to bind to canonical nsp12 complex.

The first cases of patients infected with SARS-Cov-2 virus were recorded in China in November 2019, and then rapidly spread to all countries around the world, causing a global pandemic. Much is known about the pathophysiology of this virus infection, but perhaps not enough. One of the aspects still to be investigated is the correlation between the renin-angiotensin system (RAS) and SARS-Cov-2 infection. RAS is a physiological system with a key role in regulating the different functions of the human body. SARS-CoV-2, uses the enzyme ACE-2 as a potential factor of cell penetration and infectivity, moreover in the different stages of infection a functional variation of the RAS system has been noted in different targets and at different times. In particular, in this article, we discuss the role of RAS on SARS-Cov-2 infection, and possible therapies that acting modifiers the system.

An acute respiratory disease, caused by a novel coronavirus (SARS-CoV-2) has spread throughout China and other countries and received worldwide attention. On 30 January 2020, World Health Organization (WHO) officially declared the SARS-CoV-2 epidemic as a public health emergency of international concern. At the moment of writing this article (April 2020) a total of 2.240.191 cases confirmed worldwide since the outbreak and 153.822 deaths in 166 countries or regions confirmed cases globally had been reported. Meanwhile, several independent research groups have identified that SARS-CoV-2 has highly identical genome with SARS-COV-1. The novel coronavirus uses the same receptor, angiotensin-converting enzyme 2 (ACE2) as that for SARS-CoV, and mainly spreads through the respiratory tract. The clinical symptoms of patients include fever, cough, fatigue and a small population of patients appeared gastrointestinal infection symptoms. Currently, there are few specific therapeutic strategies, but several potent candidates of antivirals and repurposed drugs are under urgent investigation. In this review, we summarized the current treatment and scientific advancements to combat the epidemic novel coronavirus. Keywords: SARS-CoV-2, treatment, coronavirus, infection, pneumonia

For some patients with SARS-CoV-2, the worst clinical damage is not caused by the virus itself, but by an overactive inflammatory state. In fact, in some people the immune system goes into overdrive and launches a large-scale assault on the tissue known as cytokine storm. This excessive immune reaction can damage tissue and eventually kill people. Several tests show that blocking such cytokine storms can be effective, studies are underway to test drugs that act by reducing cytokine response, such as tocilizumab and sarilumab that bind interleukin 6 (IL-6) or anikinra which is the interleukin 1 receptor antagonist (IL-1). However, other drugs that block the cytokine cascade can also be considered. In this article we describe the scientific and molecular motivation for the use of drugs that act by modulating the inflammatory system in patients with SARS-CoV-2, considering in particular an old drug that has been in use for many years for other therapeutic indications such as colchicine, and that could be favorable its use to block the cytokine cascade in SARS-CoV-2 patients, with low cost and good tolerability.

About 300 million people worldwide are affected by rheumatic diseases and over 5 and a half million men and women affected by rheumatological diseases are present in Italy. These are chronic diseases and therefore require treatment and diagnostic tests for long periods of time. Patient needs must be met even in these difficult months marked by the COVID-19 pandemic. The guarantee of therapeutic continuity is important and increasingly dangerous is the lack of many drugs. This is because many antimalarial and anti-inflammatory drugs have entered the protocols for treatment from Sars Cov 2. Without taking these medicines, which for years have also been used in rheumatology, there is a risk of reactivating serious diseases including rheumatoid arthritis, ankylosing spondylitis or systemic Lupus erythematosus.

Objective: The global outbreak of COVID-19 is emerged recently and this poses stress on health and well-being of the people in the worldwide including in Indonesia. Public interest in this new issue largely reflects people’s attention to COVID-19 and their willingness to take precautionary actions. This study aimed to examine public awareness on the prevention of COVID-19 using Google Trend (GT) . Methods: Using GT, we retrieved public query data for the term of (coronavirus, handwashing, hand sanitizer, and facemask) between 12 December 2019 and 4 April 2020 in the specific locations of Indonesia nationwide and several provinces. The correlation between daily search volumes on the topic related to COVID-19 and the daily number of people infected with COVID-19 was analyzed. Results: Our studies observed the overall search trend of RSV regarding COVID-19 after the global outbreak and the announcement of first covid-19 case in Indonesia, the search related to COVID-19, and other defined terms in Indonesia increased rapidly. In addition, search related to face mask were gradually increased. Searches for face mask and hand sanitizer is more popular than handwashing. There is a positive correlation between daily RSV on COVID-19 and other defined terms and the daily number of people infected with COVID-19 nationwide ( p <0·05). There are various interest to RSV related to COVID-19, and public awareness of COVID-19 was almost similar in some provinces, particularly searches related to facemask and hand sanitizer. Conclusion: Our findings demonstrates that GT could potentially define the proper timing and location for practicing appropriate risk communication strategies to prevent the spread of emerging disease. The study demonstrates that government should strengthen the publicity of COVID- 19 nationally, reinforce the public’s awareness on the prevention of COVID-19 and finally inform the importance of protecting individuals with appropriate and affordable precautionary measures.

The world is confronting a dire situation due to the recent pandemic of the novel coronavirus disease (2019-nCoV) with so far mortality cases of 100,000 all over the world. Currently, there are no effective enough treatment options for this previously unknown virus. The current drugs in pipline and some plausible drug are overviewed in this paper. The potential molecular targets of each steps of the 2019-nCoV drug life cycle is discussed and highlights here. Although different types of anti-viral targets are applicable for 2019-nCoV drug screenings, the more promising targets can be considered as protease and RNA polymerase. Based on the results from antiviral agents repurposing and clinical studies, the remdesivir could be an encouraging drug in the frontline to be administrated for 2019-nCoV. Much progress in understanding the 2019-nCoV the molecular details of its life cycle followed by the identification of therapeutic targets seems to be an efficient approach in discovering potential drugs.

Gaurav S Desai*Department of Obstetrics and GynecologyBandra Bhabha Municipal General HospitalMumbai, IndiaCorresponding AuthorGaurav S Desai MS FCPSDepartment of Obstetrics and GynecologyBandra Bhabha Municipal General HospitalMumbai, India+91-8169936775Running title: COVID 19 in pregnancyAuthor contributions: GSD was responsible for this manuscript

In December 2019, the new acute respiratory syndrome coronavirus 2 (SARS-Cov-2) emerged in Wuhan, China, with an infection of pandemic proportions. Data from Wuhan showed that mortality from coronavirus disease 2019 (COVID-19) is strongly associated with cardiovascular diseases. Similar to SARS-Cov-1, which was responsible for the SARS epidemic from 2002 to 2004, SARS-Cov-2 also utilizes the host protein angiotensin II-converting enzyme (ACE2) as a coreceptor to gain intracellular entry. Hence, upregulation of ACE2 has been proposed as a potential factor in infectivity and a higher risk of harmful outcomes of COVID-19. In this context, data obtained from experimental models of hyperthyroidism have demonstrated increased cardiac ACE2, which can theoretically facilitate SARS-Cov-2 entry. However, there is currently no consistent scientific research on how COVID-19 specifically affects hyperthyroid patients, and more clinical and experimental evidence is urgently required to clarify this point. In this review, we highlight important known and unknown features of COVID-19 related to ACE2 and hyperthyroidism.

Objective: Surgical/anesthetic management of patients undergoing surgical tracheostomy for Covid-19 pneumonia aiming at minimizing the risk of health care workers (HCWs) infection. Design, Setting and Paticipants: Twenty-three Caucasian patients, mean age 67 years, with long-term orotracheal intubation for severe acute respiratory syndrome Covid-19 pneumonia were submitted to surgical tracheostomy, between February 3rd and March 22nd 2020, according to our specific procedure. Main outcomes and Measures: Air exposure time (AET) and frequency of infection in HCWs. Results: No complication, in terms of bleeding or tracheostomy cannula displacement, was observed. No HCWs involved in the procedures contracted Covid-19. Conclusions: The tracheostomy technique we describe minimizes the risk of surgeon’s exposure to patient’s aerosol drops/expired air and the possibility of HCWs infection during the procedure carried out in patients with Covid-19 pneumonia. The details and advantages of our approach with respect to “standard” tracheotomy and percutaneous procedures are discussed.

AbstractThe human microbiome, especially the microbiomes of the gastrointestinal and respiratory tracts, are potentially important in determining susceptibility to COVID-19 and the immunopathology that leads to severe disease. Data is beginning to be gathered on the risk factors for severe disease in the coronavirus disease of 2019 (COVID-19). This data will be discussed in connection with some highlights of what is being learned about the human microbiome and its relationship with viral illnesses and inflammation-related chronic diseases. In particular, possible roles for diet, lifestyle, and microbiota manipulation as means of reducing rates of severe viral disease will be explored. Some potential pharmaceutical approaches to treating severe COVID-19 disease, involving the microbiome, mast cells and hypersensitivity responses, are also discussed. It is proposed that chronic low-grade infections and/or dysbiosis may underlie the age-related diseases that are risk factors for severe disease from SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). It is also suggested that the connection between these chronic diseases and COVID-19 may have implications for understanding some of the reasons for the severity of COVID-19 in a proportion of patients. Whether or not the hypothesis of a causal role for dysbiosis or prior infection is correct, some of the suggested treatment approaches might still be worth investigating.Keywords: microbiome, COVID-19, Westernized diet, exercise, stress, mast cells, cytokine storm, IL-6, plant-based diet, inflammation, dysbiosisIntroductionResearchers are rapidly gaining knowledge about COVID-19 to help address the current global pandemic, with a focus on treatment and prevention of the spread of the disease[1–3]. This article has two primary aims. The first aim is to examine the characteristics of the disease and the individuals who are most susceptible to severe disease to see if they can help reveal how humans can become less susceptible. A second aim is to explore whether these considerations might suggest treatment approaches that have potential to help at least some of those who are already suffering from severe disease. It is hoped that this review will be able to suggest areas of research that could be helpful in dealing with both the current pandemic and with other similar diseases or future epidemics.The emphasis here will be on the human microbiome and the diet, lifestyle and medical intervention factors that often affect it. This emphasis arises from the increasing research showing the profound impact of the human microbiome on immune function and many aspects of diverse disease processes[4,5]. The human genetic makeup is certainly important; however, the microbiotas inhabiting different parts of the human body are increasingly being shown to be crucial factors. It has been estimated that there are as many bacterial cells in the human body as human cells[6], and numerous microbial metabolites from the microbiome reach the blood stream and are increasingly being investigated[7]. This has led to the human microbiome being called the second genome[8]. One advantage of focusing on this second genome is that studies are showing that it can be altered much more easily than the human genome, apparently with beneficial effects, such as in the treatment of antibiotic-associated diarrhea due to Clostridiodes dificile infection using fecal microbiota transplants[9].The rapid changes in diet, lifestyle, environmental exposures and medical interventions in the last 75 years has led to changes in the human microbiome that may not be optimally compatible with our evolved immune responses to pathogens. This perspective is closely related to the hygiene hypothesis[10] and its newer forms, such as the altered microflora hypothesis[11] and an extension of these earlier hypotheses that focuses on the potentially pathogenic microbes within the post-hunter-gatherer era microbiota (PHM)[12]. Throughout this review, attention will be paid to factors that might lead to the establishment of these potentially pathogenic microbes, which include environmental microbes that are less coevolved with their human hosts and thus could have greater immune suppressing/dysregulating potential.

KEYPOINTSCOVID-19 patients often require prolonged mechanical ventilation, and tracheostomy is a common choice.Shared guidelines for intensive care unit patient tracheostomies for COVID-19 patients do not exist.Our survey indicates the timing and technique of COVID-19 tracheostomies vary considerably among hospitals in Lombardy, Italy.Otolaryngologists are seldom involved with decision-making regarding tracheostomies for intensive care unit COVID-19 patients.Evidence-based interventions are essential for providing the best care to invasively ventilated COVID-19 patients.KEYWORDSSARS-Cov-2; COVID-19; coronavirus; tracheostomy; percutaneous tracheotomy; surgical tracheostomy; intubation; ventilation.INTRODUCTIONAfter identifying the first Italian COVID-19 infected patient on 20 February 2020, a rapidly escalating infection cluster was discovered. On 21 February, a response coordinated by a governmental task force progressively led to a countrywide lockdown beginning on 9 March. Italy became the first Western country to address COVID-19, which on 20 March, the World Health Organization declared a pandemic.Although pneumology, infectious disease, and intensive care units (ICUs), as well as emergency departments, have carried the heaviest healthcare burden during this outbreak,1 other departments must also address the increased infectious risk while meeting patient needs. Given the number of COVID-19 patients requiring long-term invasive ventilation, a surge in tracheostomies have ensued. Otolaryngologists have quickly become involved in patient management, despite previously having been ’second-line’ specialists during infectious outbreaks.2 This unprecedented need for tracheostomies reopened decades-old debates about ICU patient tracheostomy timing, techniques and operators: supporters of late versus early tracheostomies, percutaneous tracheostomies (PTs) versus open surgical tracheostomies (STs) and otolaryngologists versus anaesthesiologists.This unprecedented situation similarly affected all hospitals in the region, overburdening ICUs and inpatient units. Our study aimed to illustrate the COVID-19 healthcare situation and investigate ICU tracheostomy management decisions.MATERIALS AND METHODSWe prepared a 13-item questionnaire asking the following: the number of COVID-19 patients treated, ICU dedicated beds, tracheostomies performed and their timing, preferred tracheostomy techniques with reasons for choosing PT or ST. The questionnaire was sent to each otolaryngology department in the Lombardy region, during the first week of April 2020. Department directors, instructed to collect data by collaborating directly with their respective ICUs, responded by phone the following week.

Recently (2019), a novel coronavirus (SARS-CoV-2) first reported in Wuhan, China has been declared a pandemic by the World Health Organization and is rapidly spreading throughout the globe which is associated with high morbidity and mortality, especially in the elderly and those with existing chronic conditions. SARS-CoV-2 infects cells through interaction of its surface glycoprotein with the human angiotensin converting enzyme 2 (ACE-2). This study conducted a analysis of mutation frequency in the surface glycoprotein of 796 sequenced SARS-CoV-2 isolates from different geographical locations in the GISAID and GenBank databases. Multiple sequence alignment analysis of the surface glycoprotein identified 64 different mutations at the protein level spanning multiple geographic locations globally. A cluster of mutations was identified in the receptor binding domain (RBD) of the surface glycoprotein. Significantly, the analysis showed that 68.5% of the isolates contain a D614 residue compared to 31.5% which contain a G614 suggesting virus is spreading in two forms. Furthermore, our investigation found that one isolate from Belgium had acquired 5 cumulative mutations in the surface glycoprotein indicating possible antigenic drift. The findings of this study are of critical importance for the design of vaccines and novel drugs against this severe acute respiratory syndrome coronavirus.

CaseA 35-year-old pregnant woman, 34 weeks gestation, was admitted to a tertiary hospital after 3 hours of clear vaginal fluid discharge. Labor occurred spontaneously on that day, and a healthy female baby was delivered with no evidence of infection (SARS-CoV-2 negative upon throat swab). This was the mother’s second pregnancy and delivery. On the second day after vaginal delivery, the patient presented with persistent low fever and dry cough. Laboratory investigations showed white blood cell count (WBC) 7.1×\(10^{9}\)/L (reference range 3.5-9.5), neutrophil ratio (N%) 84.7% (reference range 40-75), lymphocyte count (L#) 0.69×\(10^{9}\)/L (reference range 1.1-3.2), and C-reactive protein (CRP) 73.63 mg/L (reference range 0.0-0.4). Throat swabs from the patient tested positive for SARS-CoV-2 by real-time RT-PCR assays, and the chest CT scan showed multiple infiltrations of different sizes in both lungs and a small amount of fluid on both sides of the chest. Considering these findings, the patient was diagnosed with SARS-CoV-2 and isolated. She had no other history of comorbidities, and was treated with i.v. antibiotics and hormones, and was administered oxygen through a nasal catheter (Figure 1). The patient experienced dyspnea and cyanosis on the following day. Considering her critical condition, she was transferred to the intensive care unit (ICU) for further treatment.After transferring to the ICU, she quickly developed severe acute respiratory distress syndrome (ARDS), and her symptoms did not improve after she was given a non-invasive ventilator. The CT scan showed a density shadow and a large-scale ground-glass opacity in both lungs, which had progressed in severity compared with the scan on Day 2 post-delivery. She required tracheal intubation on the 14th day of hospitalization. Gram-positive and gram-negative bacteria (Acinetobacter baumannii, Klebsiella pneumoniae) were positively cultured in her sputum. Antibiotics were administered according to the results of a drug sensitivity test. Empirical antifungal treatment was also given. Antiviral, nutritional and symptomatic treatments were also performed simultaneously. After 11 days of ICU treatment, the patient’s condition significantly improved. Tracheal intubation was removed and replaced with non-invasive ventilator. The patient was changed to high-flow humidified oxygen several days later, and she was transferred to the general ward for treatment. Her symptoms and primary treatment strategy are illustrated as shown in Figure 1.

Two papers in this issue, on births to Covid-19 infected mothers, are important additions to this rapidly evolving literature. They are both broadly reassuring.The paper from Lombardy, the epicentre of the pandemic in Italy, is the first detailed report of pregnancies from this large region (Ferrazzi et al. BJOG 2020 xxxx). Among 42 affected women, 19 developed pneumonia, of whom seven required oxygen and four critical care. Eighteen babies were delivered by Caesarean, although in eight the indication was unrelated to Covid-19. Three babies tested positive for SARS-COV-2. Two to women who had developed Covid-19 postnatally and had breast-fed without a mask; the presumed source was the mother. One baby who delivered vaginally and did not breast-feed, developed respiratory symptoms requiring one day’s ventilation and tested positive. No mothers or babies died.The paper from China reports SARS-COV-2 viral tests in a range of body fluids from mothers and babies with COVID-19, cared for at Renmin Hospital of Wuhan University (RHWU) (Yanting Wu et al. BJOG 2020 xxxx). This hospital appears on the Global Research Identifier Database (GRID) here https://grid.ac/institutes/grid.412632.0. Readers should know that the GRID database reports that RHWU has the following English aliases “People’s Hospital of Wuhan University”, “Hubei Provincial People’s Hospital”, “First Affiliated Hospital of Wuhan University”, “Wuhan University Renmin Hospital” and “Hubei General Hospital”. This raises the possibility that some or all of the cases may have been reported previously.With this proviso, the detailed information that 1/9 stool samples, 0/13 vaginal samples, and 1/3 breast milk samples were positive is important. Of the five babies who have delivered, none tested positive for Covid-19, although two, both preterm, had pneumonia diagnosed on chest x ray. Apart from one biochemical pregnancy in the first trimester in which a serum human chorionic gonadotrophin of 25.9 IU/L reverted to negative, no mothers or babies died.Taken together with other accumulating data, it is already clear that Covid-19 is less severe in pregnancy than the two previous coronavirus infections, Severe Acute Respiratory Syndrome-related coronavirus (SARS) and Middle East Respiratory Syndrome-related coronavirus (MERS). Nevertheless, four of the mothers from Lombardy required critical care, and there have been other reports of both mother and baby deaths in association with Covid-19. It remains an important disease in pregnancy, which should be taken seriously.No disclosures. A completed disclosure of interest form is available to view online as supporting information.

The emergence and outbreak of coronavirus disease 2019 (COVID-19) poses great challenges to our society, economy, and public health, and has already become an international public health emergency. The prevention and control of COVID-19 requires early detection and the timely and effective control of virus dissemination. Front-line medical personnel in the outpatient and emergency departments of hospitals, quarantine centers, and entry and exit ports are key to the early detection and control of COVID-19. Based on experiences in the prevention and control of other new and recurrent infectious diseases, epidemiologists previously proposed the concept of “vital sign zero” and the “Identify-Isolate-Inform” (3I) system for the detection and control of infectious diseases. The use of “vital sign zero” and the “3I system” for COVID-19 will facilitate the prevention and control of new infections, provide more timely treatment and effective isolation of patients, and protect the safety and health of medical workers. These concepts will also prevent the spread of COVID-19 and help to ensure public health and safety.