COVID-19: Expert Review of Relevant and Emerging Literature

COVID-19: Expert Reviews of Relevant and Emerging Literature2020-05-29T11:40:37-04:00

In this study, individuals were more influenced by information presented as a narrative than just by statistical information.

This study explored how types of information influence people’s behaviors during a crisis situation. Presenting information as a narrative has a persuasive effect on individuals’ decision-making behaviors. Narratives are most effective when information about the situation matches the narrative’s content. Activating affective responses (e.g., stress, anxiety) strongly affects decision behaviors. Narratives trigger a more heuristic way of processing information, which affects decision-making. This study demonstrated that narratives, either on their own or coupled with statistical information, are more effective at getting people to engage in specific behaviors than simply presenting statistical information alone.

Published on :  | By Erika Cheng

Review: Estimates of the severity of COVID-19 disease

This study estimates the time between onset of symptoms and outcome (death or discharge from hospital) for individuals with COVID-19 infections. Findings provide fatality ratios across the spectrum of COVID-19 disease and demonstrate a strong age-gradient in risk.

A range of case fatality ratio (CFR) estimates for COVID 19 have been produced that differ substantially in magnitude.

Used individual-case data from 44,672 laboratory-confirmed COVID-19 cases from mainland China, this study estimates the time between onset of symptoms and death or discharge from hospital by age. Using data on age stratified severity in a subset of 3,665 cases from China, they also estimated the proportion of infections that will likely require hospitalization.

The mean duration from onset-of-symptoms to death was 17.8 days (95% CI 16.9 to 19.2 days) and from onset-of-symptoms to hospital discharge was 22.6 days (95% CI 21.1 to 24.4 days).

The crude CFR was 3.67% (95% CI 3.56% to 3.80%) in cases from mainland China. The CFR adjusted for demography and under-ascertainment of milder cases in Wuhan relative to the rest of China was 1.38% (95% CI 1.23% to 1.53%) with substantially higher values in older ages.

The CFR from international cases stratified by age (under 60 or 60 and above) were consistent with these estimates from China.

This study predicted trajectories of COVID-19 in the coming days (until April 30, 2020) around the world using an advanced Auto-Regressive Integrated Moving Average Model (ARIMA). The model’s predictions suggest that rapid infection control measures are urgently needed to curtail the COVID-19 pandemic.

The authors used data from the John Hopkins Coronavirus resource center and dynamic modeling to generate 30 day forecasts for 20 countries.

Findings revealed linearity in the current cumulative cases and showed a rapid exponential growth phase in the world span that may occur roughly during April 8 to April 30, 2020, when they predict that the number of COVID-19 cases will skyrocket to one million in the USA, 300,000 in Italy, and 250,000 in Germany, 150,000 in the United Kingdom and 120,000 in Iran.

Other countries with a smaller number of cases but showing a sharp upward trend include Switzerland, Austria, and Canada. Cases of COVID-19 in China and South Korea remain stable.

Public health officials in these countries need to grasp the powerful wave of exponential growth before COVID-19 collapses the entire health system.

This study formulates a theoretical model to calculate the risk of being infected in health care facilities and suggest ways to minimize these risks.

The number of confirmed COVID-19 cases admitted in hospitals is continuously increasing in the Philippines. Frontline health care workers are faced with imminent risks of getting infected.

Using data from the Philippines, the authors formulate a model to investigate how many frontline workers are expected to be infected under certain scenarios. The model considers:

  • the average number of encounters with a suspected COVID-19 patient per hour,
  • interaction time for each encounter,
  • work shift duration or exposure time,
  • crowd density, which may depend on the amount of space available in a given location, and
  • availability and effectiveness of protective gear (e.g., isolation booths, N95 masks, face and eye shields) including level of protection to reduce exposure to aerosolized particles (e.g., for those tasked to do intubation either via direct or via video laryngoscopy, to do nasopharyngeal or oropharyngeal swabs).

Based on the simulation results, the authors recommend the following:

  1. Decrease the rate of patient encounter per frontline health care worker to a maximum of 3 encounters per hour in a 12-hour work shift duration. Multiple frontline triage nurses, multiple queues, multiple entrances, and proper referral systems will mitigate the risk of infection.
  2. Decrease the interaction time between the frontline health care worker and the patients, e.g., less than 40 minutes for the whole day. In other words, reduce work shift durations for frontline workers.
  3. Increase the clean and safe space for social distancing, e.g., maximum of 10% crowd density, and if possible, implement compartmentalization of patients.
  4. Provide effective PPE that the frontline health care workers can use during their shift.
Published on :  | By Erika Cheng

Review: When will the COVID-19 epidemic fade out?

A discrete-time deterministic epidemic model is used to make predictions about the peak of the COVID-19 epidemic in Italy.

Generally, transmission dynamics of infectious disease are described by modelling population movements which assume that the population mixes at random, or that each individual has a small and equal chance of coming into contact with any other individual. This paper uses a model that conceptualizes the population as elements in a network to describe the pattern of COVID-19 infections in Italy starting from January 31, 2020 and to predict when the epidemic peak will occur.

Using this model, the authors estimate that the peak in the evolution of the COVID-19 epidemic will occur in Italy between April 2 and April 13, 2020. The overall duration of the COVID-19 disease is predicted to be approximately 5 months.

This paper describes the recommendations of an expert panel on caring for critically ill ICU patients with COVID-19.

A panel of 36 experts from 12 countries proposed 53 questions relevant to the management of COVID-19 in the ICU. They reviewed the literature for evidence on this topic, and identified relevant systematic reviews on most questions relating to supportive care. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach ane generated recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility.

They issued 54 statements. Four are best practice statements, nine are strong recommendations, and 35 are weak recommendations. For six they provided no recommendation.

The topics were:

  1. infection control
  2. laboratory diagnosis and specimens
  3. hemodynamic support
  4. ventilatory support
  5. COVID-19 therapy.

This report used a SWOT analysis to determine how we should improve our ability to prevent and control the COVID-19 epidemic in China. The lessons might be applied elsewhere.

A group of experts used the Strengths (S), Weaknesses (W), Opportunities (O) and Threats (T) (SWOT) analysis method to perform a systematic analysis of the COVID-19 epidemic prevention and control strategy in China. They came out with strength-opportunity (SO), weakness-opportunity (WO), strength-threat (ST), and weakness-threat (WT) strategies for the prevention and control of the COVID-19.

They determined the highest-priority policies are:

  • reshaping the emergency system (SO1)
  • adding health emergency departments to universities and other institutions (WO2)
  • adjusting the economic structure and strengthening international and domestic linkages (ST2)
  • strengthening public intervention in responding to public health emergencies (WT1)

This case report shows how easily this virus can move from one traveler from Singapore to a resort in France and then to other countries. It highlights the difficult task ahead of us of contact tracing and isolation.

At the time this report was written, almost half of the confirmed COVID-19 cases in the United Kingdom were part of a large cluster of 13 British nationals who tested positive for SARS-CoV-2 in the UK, Spain, and France. Transmissions in this cluster happened at one ski resort in France and originated from a single infected traveler returning from a conference in Singapore where he acquired the virus.

At least 21 individuals were exposed, tested, and quarantined, and 13 of those tested positive between February 6th and 15th. It’s worth noting here the number of individuals infected, the absence of any severe illness among those infected, and one case of a “delayed positive” test during isolation after initially testing negative, at least a week after the last possible contact.

This case series from early in the Seattle outbreak showed that the most common reasons for admission to the ICU were hypoxemic respiratory failure leading to mechanical ventilation, hypotension requiring vasopressor treatment, or both, and half of these patients died within two weeks of ICU admission.

This was a case series of 24 patients from nine Seattle-area hospitals who were admitted to the ICU with COVID-19 infections. Their mean age 64 years, 63% were men, and symptoms began 7 days before admission. The most common symptoms were cough and shortness of breath, half of them had fever on admission, and 58% had diabetes.

All the patients were admitted for respiratory failure and low oxygen saturation, and 75% needed mechanical ventilation. Most also had hypotension and needed vasopressor support. None of them also tested positive for influenza A, influenza B, or other respiratory viruses.

Half the patients died between before the 18th day of ICU admission, including 4 patients who had a DNR order. Of the 12 surviving at 14 days, 5 were discharged home, 4 were remained in the hospital but not the ICU, and 3 continued to receive mechanical ventilation in the ICU.

Published on :  | By Maria Brann

Review: COVID-19 pandemic response resources

The Center for the Study of Traumatic Stress provides guidance to health and community leaders about how to utilize effective risk communication principles to prepare and update people during stressful situations.

How leaders communicate during stressful situations effects how people respond and react. To best prepare individuals for the pandemic, leaders must communicate timely, accurate, and up-to-date public health information. Specifically, it is important to follow these guidelines:

  • Provide information on a regular and timely schedule
  • Share what is known
  • Avoid speculation
  • Be truthful
  • Avoid false promises
  • Provide updated information
  • Repeat messages if needed
  • Communicate care

It is also important to remember that how messages are delivered often has a greater impact than what is said. Therefore, follow these recommendations:

  • Prepare messages in advance
  • Keep message short and simple
  • Positive messages should outweigh negative messages 3:1
  • Admit when you don’t know something
  • Follow the CCO model
    • Compassion: demonstrate you care
    • Conviction: demonstrate commitment
    • Optimism: indicate a positive view of the future
  • Prioritize messages
  • Communicate most important message first (primacy) and the second most important message goes last (recency)
Published on :  | By Maria Brann

Review: Academy of Communication in Healthcare communication tools

The COVID-19 communication tools from the Academy of Communication in Healthcare offers health providers simple strategies for more effective communication.

The Academy of Communication in Healthcare is providing free quick tip resources on their webpage to help providers communicate with patients and each other during the COVID-19 pandemic. Resources include using relationship-centered communication skills via telemedicine and with ART statements (asking, responding, telling). Recognizing that providers are most effective when they are mindful of how they say something more so than what they say, the concise tips provide useful strategies for improving communication during stressful situations.

In this article, a chief health officer argues that communication about COVID-19 must be immediate and transparent.

Similar to other countries, Australia’s government was slow to inform people about the severity of COVID-19 in a timely manner. However, Brett Sutton, chief health officer of Victoria, was quick to warn others of the impending pandemic and encouraged government officials to communicate quickly and honestly. He notes that communication is a critical health intervention, and that it is now time to move from risk communication to crisis communication, which includes being clear and responsible with communicating the good, the bad, and the ugly to increase people’s efficacy and support efforts.

This is a rapid sentinel surveillance study aimed to determine what proportion of mild, outpatient influenza-like illnesses were caused by SARS-CoV-2.

This community-based surveillance study reports a 5% rate of COVID-19 among patients presented to the ED or urgent care with mild influenza-like illness.

To date diagnostic testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, has been available only through public health laboratories. Limited testing has prioritized those with severe illness or identifiable risk factors. The incidence of community transmission by persons with mild illness and without risk factors remains ill-defined.

This study examined results from 131 tests for COVID-19 obtained between March 12-13 and 15-16, 2020 at the Los Angeles County + University of Southern California Medical Center. Test were from all patients presenting to the ED or urgent care with mild influenza-like illness. Patients who had nasopharyngeal swabs tested with polymerase chain reaction assays for influenza and respiratory syncytial virus (GeneXpert Flu, Cepheid) were automatically tested for SARS-CoV-2 (Quest Diagnostics).

Of the 131 tests,  7 were positive (5.3%; 95% CI, 2.2%-10.7%). The median age of patients who tested positive was 38 years (range, 34-44 years), 3 were male (43%), and the median duration of symptoms was 4 days (range, 2-4 days). Nearly all (6 of 7 patients) presented with fever, 5 with myalgias, only 1 with cough. Only 1 patient had a travel history (returned from Miami, Florida). All patients had mild illnesses, and all tested negative for influenza and respiratory syncytial virus.


COVID-19 Digest Links
Creative Commons License The literature reviews on this blog were created under a Creative Commons Attribution-NonCommercial 4.0 International License , which allows the reuse and adaptation of the work by noncommercial entities. These rights do not extend to the articles that the authors are reviewing.
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