COVID, Volume 2, Issue 5 (May 2022) – 14 articles

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was first identified in December 2019 in Wuhan, the capital of China’s Hubei province, and has since spread globally, resulting in the ongoing coronavirus pandemic. The most important type of COVID-19 confrontation is the use of polymerase chain reaction testing (PCR) to detect if a person is healthy or infected with COVID-19. Many countries released different numbers about the total cases of infected persons with the pandemic based on the number of total PCRs and other statistical numbers related to this disease. The total case numbers for some countries were very promising, such that they implied that these countries were to recover soon from these diseases. At other times, some countries overestimated the total number of cases or deaths to get financial aid. Therefore, there is a need to verify and evaluate these numbers by using machine-learning algorithms that proved to be efficient in solving many problems. The convolutional neural network (CNN) is an advanced machine-learning algorithm that was deployed to detect COVID-19 from different medical images such as X-ray images. However, CNN was not used to validate the published COVID-19 statistical data. In this paper, we adapted the self-organizing UNet (SO-UNet) in the cooperative convolutional neural network (CCNN) model to detect the accuracy of the reported COVID-19 statistics. The detection is based on using COVID-19 statistical variables that are reported by reliable and credible databases provided by known global organizations. These variables are used to create multi-dimension images to train and test the CCNN model. The results showed that reported important statistics for COVID-19 could be verified using the CCNN model. It also showed that the verified data coincided with the verification reported by the most important and trusted organizations in the world. Finally, the comparison of the new model to Benford’s law outcome proved the model’s credibility and efficiency in validating COVID-19 reported data. Full article

Previous research has established the link between COVID-19 risk perception and the coping behaviors of teachers in different countries. However, these studies have revealed inconsistent result patterns. Moreover, little is known about the role of COVID-19 knowledge in the link between risk perception and the coping strategies of teachers. This study, therefore, examines the relationship between COVID-19 risk perception and the coping behaviors of teachers, as well as the moderating effect of COVID-19 knowledge in this link. Through the convenience sampling technique, a cross-sectional sample of 376 teachers was recruited to respond to a questionnaire. Correlation and multiple regression analyses were used in analyzing the data. It was revealed that COVID-19 risk perception was positively correlated with active coping strategy and negatively associated with emotional support. Further, results showed that with the a high level of COVID-19 risk perception, teachers with a high level of knowledge are less likely to adopt emotional support coping. In contrast, teachers with low knowledge levels will exhibit a higher probability of adopting emotional support coping. The study projects the need for enhancing the knowledge of teachers while conscientizing them on the risky nature of COVID-19 through health education and promotion. Full article

The SARS-CoV-2 pandemic has had a significant impact on the United States healthcare system. This is exacerbated by antimicrobial-resistant bacterial pathogens endemic to healthcare settings. Respiratory viral infections are known to predispose patients to bacterial infections, which were a major contributor to mortality in previous pandemics. This study’s goal was to gain an understanding of bacterial infections in hospitalized COVID-19 patients. A case form for COVID-19 patients with bacterial infections was developed and sent to clinicians on the Emerging Infections Network listserv. The case form included 22 questions on patient demographics, COVID-19 and bacterial infection and treatment, and patient outcome. One hundred and nine patient cases were collected and analyzed. The majority of patients (59.6%) were critically ill, and 66.9% of patients were diagnosed with sepsis. Empiric and directed antibiotics were administered to 81.6% and 94.5% of patients, respectively. Thirty-one infections were not resolved with antibiotics, and of those patients, 74.2% died. Unresolved bacterial infections were found to be a significant contributor to mortality in this case series. These bacterial infections can most likely be attributed to long hospital stays and exposure to nosocomial pathogens. Thus, unresolved nosocomial bacterial infections warrant additional attention during future events where there is a strain on the US healthcare system. Full article

The coronavirus disease (COVID-19) has exposed the unpreparedness of governments in their capacities to prevent, detect, and respond to emerging infectious diseases. Many healthcare systems have been overburdened and the coordinated efforts in different countries have focused on containment and mitigation, with varying degrees of success. A delay in the detection of and response to infectious diseases can lead to the overburdening of already challenged health systems. Containment strategies, such as social distancing, contact tracing, quarantining of exposed individuals and lockdowns, can help control the spread of the infection in communities. Still, long-term solutions should be sought to counter future outbreaks. In this paper, we focus on Zimbabwe to identify and discuss public health strategies that can result in an effective response to future infectious disease outbreaks. We consider potential solutions to facilitate early detection, control, and mitigation of any similar emerging infectious disease. We argue that sustained financial support in public health infrastructure, both locally and nationally, integrated surveillance response systems, and improved communication and research within and across public and private sectors can be instrumental in limiting the damage caused by future outbreaks. Full article

Background: The COVID-19 pandemic has had a global impact on societies, economies, and education. In Spain, one of the countries most affected by the COVID-19 in the initial year, the virus began to spread at the end of February 2020. When the Spanish government declared a state of emergency, the first restrictive measure was the closure of all educational centers on the 14th of March. All schools and universities were closed until September 2020, when students returned to classes with preventative health measures in place to prevent the spread of the virus. Methods: This study focuses on the observation of children in pre-school education. Specifically, it focuses on studying how preventative health measures that were taken in the pre-schools may have influenced children’s social relationships, basic autonomy, and learning. We used a mixed method in which field notes were taken and observational scores were assigned. Results: The following prevention measures appear to have influenced children’s relationships, autonomy, and learning: bubble groups, handwashing, teachers wearing masks, divided playgrounds so different classes cannot mix, and no toys from home or shared personal objects. Conclusions: The results of the study suggest that new health measures such as the use of masks and social distancing do appear to be affecting the communication and development of pre-school children. Continued research is needed to understand and minimize the potential negative impacts of pandemic measures on children’s development. Full article

The COVID-19 pandemic affects all parameters, especially healthcare professionals, drugs and medical supplies. The KERRA is a mixed medicinal plant capsule that is used for the treatment of patients with high fever, with food and drug administration approved by FDA Thailand. Recently, KERRA showed induced quicker recovery for COVID-19 patients. Therefore, it is possible that some ingredients in KERRA could inhibit SARS-CoV-2. In this study, two important replication-related enzymes in SARS-CoV-2, a main protease and an RNA-dependent RNA polymerase (RdRp), were used to study the effect of KERRA. The results showed that KERRA inhibited the SARS-CoV-2 main protease and SARS-CoV-2 RdRp with IC₅₀ values of 49.91 ± 1.75 ng/mL and 36.23 ± 5.23 µg/mL, respectively. KERRA displayed no cytotoxic activity on macrophage cells at concentrations lower than 1 mg/mL and exhibited anti-inflammatory activity. Additionally, KERRA was used against a feline coronavirus (feline infectious peritonitis (FIP)) infection with an EC₅₀ value of 134.3 μg/mL. This study supports the potential use of KERRA as a candidate drug for COVID-19. Full article

The COVID-19 pandemic continues to cause tremendous loss of life and put massive strain on the functioning of societies worldwide. Despite the cataclysmic proportions of this viral outbreak, as of yet, no effective curative treatment is available. COVID-19 vaccines, while effective and a scientific achievement of historical proportions, can only be utilized in prophylaxis and require vaccination of the majority of a given population. Convalescent plasma therapies require blood group testing and patient hospitalization and are difficult to put into place in the scale of a population. Monoclonal antibodies can be mass produced with hybridoma cell culture and are highly specific to viral antigens. What is more, monoclonal antibodies produce far more reproducible effects than other approaches to active immunization and can be further enhanced through engineering. Currently, there exist two approaches to COVID-19 treatment with use of monoclonal antibodies, each with several antibodies currently under development or in clinical testing. The first of the approaches utilizes monoclonal antibodies, which target viral spike proteins to block viral entry into host cell and mark viral particles for destruction by host immune cells. The second approach utilizes antibodies that neutralize cytokines, which take part in cytokine release syndrome, which is responsible for many of the most damaging symptoms associated with COVID-19, thus reducing systemic inflammation and ultimately—patient morbidity and mortality. There yet remain several challenges to overcome if monoclonal antibodies are to become mainstream therapeutic agents in the treatment of COVID-19. Despite this, this field of research is experiencing a massive forward leap and the exceptional amount of clinical data gathered so far can serve as groundwork for the development of effective and widely available antiviral monoclonal antibody treatments. Full article

Using classical and genomic epidemiology, we tracked the COVID-19 pandemic in Kenya over 23 months to determine the impact of SARS-CoV-2 variants on its progression. SARS-CoV-2 surveillance and testing data were obtained from the Kenya Ministry of Health, collected daily from 306 health facilities. COVID-19-associated fatality data were also obtained from these health facilities and communities. Whole SARS-CoV-2 genome sequencing were carried out on 1241 specimens. Over the pandemic duration (March 2020–January 2022), Kenya experienced five waves characterized by attack rates (AR) of between 65.4 and 137.6 per 100,000 persons, and intra-wave case fatality ratios (CFR) averaging 3.5%, two-fold higher than the national average COVID-19 associated CFR. The first two waves that occurred before emergence of global variants of concerns (VoC) had lower AR (65.4 and 118.2 per 100,000). Waves 3, 4, and 5 that occurred during the second year were each dominated by multiple introductions each, of Alpha (74.9% genomes), Delta (98.7%), and Omicron (87.8%) VoCs, respectively. During this phase, government-imposed restrictions failed to alleviate pandemic progression, resulting in higher attack rates spread across the country. In conclusion, the emergence of Alpha, Delta, and Omicron variants was a turning point that resulted in widespread and higher SARS-CoV-2 infections across the country. Full article

The interleukin 6 (IL-6) receptor-blocking antibody tocilizumab was repurposed in the coronavirus pandemic with the intention of blocking the excess inflammatory activation associated with severe disease. We retrospectively evaluated the response to tocilizumab based on measured levels of IL-6 as well as other inflammatory markers. In the sample of 41 patients with measured levels, 16 received tocilizumab. In the patients who received tocilizumab, there was a statistically significant relationship between both higher IL-6 levels and measured acute phase reactants with mortality, but not in those who did not. Additionally, an improved mortality after tocilizumab was suggested with those with higher IL-6 measurements, but not in those with lower levels, but this finding failed to achieve statistical significance (p = 0.14). Though this study is limited by a small sample size and retrospective design, an association is suggested between higher IL-6 levels and improved mortality after tocilizumab. Full article

Some viruses contain mimics of host chemokine receptors that influence host immunity; however, such viral mimics have not yet been reported for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this study, I focused on C-X-C motif chemokine receptor 2 (CXCR2) as a candidate chemokine receptor exploited by SARS-CoV-2. Similarities between the extracellular domain (ECD) of human CXCR2 and the SARS-CoV-2 spike glycoprotein S1 (CoV2S1) were investigated. Flow cytometric analysis of healthy donor-derived peripheral leukocytes was performed to examine the cross-reactivity between specific monoclonal antibodies against these two proteins. The results showed that CR3022, a monoclonal antibody to the receptor binding domain of CoV2S1, recognized the CXCR2 ECD, and a murine monoclonal antibody to human CXCR2 recognized recombinant CoV2S1. This reciprocal cross-reactivity suggests that CoV2S1 harbors a mimic of the CXCR2 ECD. Full article

We systematically reviewed published data on autopsies of patients who died from COVID-19 to identify pathological changes that are consistently reported in autopsies and those that were reported anecdotally, and to compare consistent findings with autopsy findings in similar diseases. The MEDLINE, Google Scholar, and Embase databases were searched for full-text articles in the English language from December 2019 to March 2021 to include publications on autopsy findings in patients whose main cause of death was COVID-19 and COVID-19-related complications. This review included 124 published papers documenting COVID-19 patient autopsies for over 1100 patients. Most frequent and consistently reported pathological findings included diffuse alveolar damage in the lungs, cardiac inflammation, and hypertrophy, vascular microthrombi, shock kidney and acute tubular necrosis, congested liver and spleen, and shock-associated changes in other organs. These findings by themselves were not unique, and were similar to other severe viral infections and septic shock. However, the frequency of diffuse alveolar damage and the extent of microvascular thrombosis were much higher among the autopsies of patients who had died from COVID-19 compared with other severe viral infections. Autopsy data confirm clinical reports of high incidences of diffuse alveolar damage and microvascular thrombosis in the most severe cases of COVID-19 that caused death. Full article

COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. The clinical presentations of the SARS-CoV-2 infection are widely variable and treatment strategies for COVID-19 are dependent on the infection phase. Timing the right treatment for the right phase of this disease is paramount, with correlations detected between the phase of the infection and the type of drug used to treat. The immune system activation following COVID-19 infection can further develop to a fulminant cytokine storm which can progress to acute respiratory distress syndrome. The inflammatory phase, or the hyperinflammation phase, is a later stage when patients develop acute respiratory distress syndrome (ARDS), sepsis, and kidney and other organ failure. In this stage, the virus is probably not necessary and all the damage is due to the immune system’s cytokine storm. Immunosuppressive or immunomodulatory agent administration is the major strategy in treating COVID-19 patients at this stage. On the other hand, immunodeficient patients who are treated with immunomodulator agents have attenuated immune systems that do not produce enough cytokines. Current data do not show an increased risk of severe COVID-19 in patients taking biologic therapies or targeted disease-modifying antirheumatic drugs. However, more comprehensive studies are needed to assess the effect of these medications, and whether they may actually be protective of the severe type of disease. Although medications for COVID-19 and for the cytokine storm are important, the main breakthrough in slowing down the pandemic was developing effective vaccines. These vaccines showed a dramatic result in reducing morbidity and mortality up to the Delta variant’s spread. However, the emergence of the new variant, Omicron, influenced the successful results we had before. This variant is more contagious but less dangerous than Delta. The aim now is to develop vaccines based on the Omicron and Delta immunogens in the future for broad protection against different variants. Full article

High-dose methylprednisolone pulse therapy is widely used in patients with severe COVID-19. This therapy is known to have sufficient clinical effectiveness, but the optimal administration method is not known. In this study, we assessed the deterioration of oxygenation after methylprednisolone pulse therapy in patients with COVID-19 according to disease severity (oxygen requirement) at initiation of therapy. Ninety-nine patients with COVID-19 who received methylprednisolone pulse therapy at Saitama Medical University Hospital in Japan between October 2020 and October 2021 were retrospectively reviewed. Clinical outcomes were compared according to the fraction of inspired oxygen as a measure of disease severity at initiation of methylprednisolone pulse therapy. Based on the F_IO₂ level at initiation of methylprednisolone pulse therapy, patients were classified into an early treatment group (F_IO₂ ≤ 0.39; n = 21), a middle treatment group (F_IO₂ 0.40–0.69; n = 38), and a late treatment group (F_IO₂ ≥ 0.70; n = 40). The frequency of administration of mechanical ventilation and the days of oxygen therapy in the middle group were lower than in the other groups. The frequency of adverse events was also lower in the middle group. Both late and early methylprednisolone pulse therapy may lead to further deterioration of COVID-19 and an increase in adverse events. Full article

SARS-CoV-2 is an RNA coronavirus responsible for Acute Respiratory Syndrome (COVID-19). In January 2021, the re-occurrence of COVID-19 infection was at its peak, considered the second wave of epidemics. In the initial stage, it was considered a double mutant strain due to two significant mutations observed in their Spike protein (E484Q and L452R). Although it was first detected in India later on, it was spread to several countries worldwide, causing high fatality due to this strain. In the present study, we investigated the spreading of B.1.617 strain worldwide through 822 genome sequences submitted in GISAID on 21 April 2021. All genome sequences were analyzed for variations in genome sequences based on their effects due to changes in nucleotides. At Allele frequency 0.05, there were a total of 47 variations in ORF1ab, 22 in Spike protein gene, 6 variations in N gene, 5 in ORF8 and M gene, four mutations in Orf7a, and one nucleotide substitution observed for ORF3a, ORF6 and ORF7b gene. The clustering for similar mutations mentioned B.1.617 sub-lineages. The outcome of this study established relative occurrence and spread worldwide. The study’s finding represented that “double mutant” strain is not only spread through traveling but it is also observed to evolve naturally with different mutations observed in B.1.617 lineage. The information extracted from the study helps to understand viral evolution and genome variations of B.1.617 lineage. The results support the need of separating B.1.617 into sub-lineages. Full article