Novel coronavirus (COVID-19) imaging features overlap with SARS and MERS

Although the imaging features of novel coronavirus disease 2019 (COVID-19) are variable and nonspecific, the findings reported thus far do show “significant overlap” with those of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), according to an ahead-of-print article in the American Journal of Roentgenology (AJR).
COVID-19 is diagnosed on the presence of pneumonia symptoms (e.g., dry cough, fatigue, myalgia, fever, dyspnea), as well as recent travel to China or known exposure, and chest imaging plays a vital role in both assessment of disease extent and follow-up.
As per her review of the present clinical literature concerning COVID-19, Melina Hosseiny of the University of California at Los Angeles concluded: “Early evidence suggests that initial chest imaging will show abnormality in at least 85% of patients, with 75% of patients having bilateral lung involvement initially that most often manifests as subpleural and peripheral areas of ground-glass opacity and consolidation.”
Furthermore, “older age and progressive consolidation” may imply an overall poorer prognosis.
Unlike SARS and MERS–where initial chest imaging abnormalities are more frequently unilateral–COVID-19 is more likely to involve both lungs on initial imaging.
“To our knowledge,” Hosseiny et al. continued, “pleural effusion, cavitation, pulmonary nodules, and lymphadenopathy have not been reported in patients with COVID-19.”
Ultimately, the authors of this AJR article recommended CT for follow-up in patients recovering from COVID-19 to evaluate long-term or even permanent pulmonary damage, including fibrosis–as seen in SARS and MERS infections.

Comparison of Clinical and Radiologic Features of SARS, MERS, and COVID-19 (image)

American Roentgen Ray Society

https://www.eurekalert.org/pub_releases/2020-02/arrs-anc022820.php

Quarantine on cruise ship resulted in more Corona patients

The cruise ship Diamond Princess was quarantined for over two weeks resulting in more coronavirus infected passengers than if they would have disembarked immediately. Rather the opposite to what was intended. This according to a study conducted at Umeå University in Sweden.
“The infection rate onboard the vessel was about four times higher than what can be seen on land in the worst infected areas of China. A probable cause is how close people stay to one another onboard a vessel,” says Joacim Rocklöv, Professor of epidemiology at Umeå University and principal author of the article.
After a person travelling with the cruise ship Diamond Princess disembarked in Hong Kong and was tested positive for the coronavirus, Japanese authorities decided to disallow the 3,700 passengers onboard to leave the ship when it reached Yokohama. The ship was hence put in quarantine until 19 February. Passengers who showed signs of illness were, as far as possible, separated from other passengers onboard. When the quarantine in Yokohama in the end was removed and passengers could finally disembark, a total of 619 passengers had been infected by the coronavirus.
“If the ship had been immediately evacuated upon arrival in Yokohama, and the passengers who tested positive for the coronavirus and potential others in the risk zone had been taken care of, the scenario would have looked quite different. Our calculations show that only around 70 passengers would have been infected. A number that greatly falls short of the over 600 passengers the quarantine resulted in. The precautionary measure of putting the entire ship under quarantine was understandable, but due to the high risk of transmission on the ship, the decision is now questionable,” says Joacim Rocklöv.
At the same time, the study also shows that if the precautionary measures of isolating potential carriers had not been carried out onboard, another 2,300 people would have been infected.
https://www.eurekalert.org/pub_releases/2020-02/uu-qoc022820.php

Google, Amazon and Microsoft give input to new health AI standard

The US-based Consumer Technology Association (CTA) has developed the first ever accredited standard for use of artificial intelligence in health care, with input from tech giants such as Amazon, Microsoft, and Google.
More than 50 organisations, from tech giants to startups and healthcare industry leaders, have developed the American National Standards Institute (ANSI) accredited quality mark.
The standard is part of the CTA’s new initiative on AI and is the first in a series that aims to set a foundation for implementing medical and health care solutions built on the technology.
One issue that the standard aims to resolve is the way that AI-related terms are used in different ways, leading to confusion, particularly in the healthcare industry.
The standard defines over 30 terms including machine learning, model bias, artificial neural network and trustworthiness.
The CTA has also created a working group to address this problem over the last year, which now includes a range of decision makers from 52 organisations and member companies.
It aims to create a standard based on 11 definitions and characteristics and provides a framework for better understanding AI technologies and common terminology.
The hope is that consumers, tech companies and care providers will be able to better communicate, develop and use AI-based health care technologies.
Other definitions include terms like de-identified data, synthetic data, remote patient monitoring and patient decision support system.
Among the definitions, the standard includes highly debated terms such as “assistive intelligence,” which the group defined as a category of AI software that “informs” or “drives” diagnosis or clinical management of a patient, however the health care provider makes the ultimate decisions before clinical action is taken.
Participating organisations include Amazon, which is well known to be moving into healthcare, AT&T, Eli Lilly’s Livongo Health, Microsoft, Mercedes-Benz, and Philips.
Pat Baird, regulatory head of global software standards at Philips and co-chair of the working group, said: “AI will be used for decision support and decision making, which stresses the need for professionals to be able to take ownership, apply judgement and empathy. Transparency and a common language will be key to enable the proper and safe functioning of AI.”

Google, Amazon and Microsoft give input to new health AI standard

Germany has means to respond if virus sparks economic crisis – finance minister

Germany would be in a position to enact a fiscal stimulus package should the coronavirus spark a global economic crisis, Finance Minister Olaf Scholz said in remarks published on Sunday.

The spread of the virus has raised fears of a pandemic. In Germany there have been 66 confirmed cases, and a government crisis committee on Friday widened cross-border travel guidelines and cancelled major international events.
“Should it come to major turmoil in the global economy because world markets and production centres become affected, we have all the means to act fast and decisively,” Scholz told Welt am Sonntag newspaper. “Our fiscal policy is built on a solid footing so that we can deal with a major economic crisis with full force.”
The German economy, Europe’s biggest, has been weakening as its export-oriented manufacturers languish in a recession. There are fears the coronavirus outbreak could sink Germany into a recession, given the economy’s reliance on exports and Chinese supply chains.
Chancellor Angela Merkel’s right-left government has resisted calls to take on new debt to finance a fiscal stiumuls to revive a stalling economy. Any decision to unleash a fiscal stimulus would need approval from both Merkel’s conservatives and their Social Democrat (SPD) junior coalition partners.
The SPD’s Scholz said: “If the situation demands that such a stimulus is necessary, we have the means to introduce a fiscal stimulus programme.”
Earlier this week, Economy Minister Peter Altmaier said Germany may introduce tax breaks to cushion the effect of the coronavirus should the epidemic worsen.
https://www.marketscreener.com/news/Germany-has-means-to-respond-if-coronavirus-sparks-economic-crisis-finance-minister–30089615/

In virus-hit China, coat maker adapts to make hazmat suits

The coronavirus outbreak in China is preventing clothing manufacturer Ugly Duck Industry from resuming its normal production of winter coats, so it has pivoted to another in-demand product: hazmat suits.

The company in the eastern China export hub of Wenzhou hastily repurposed its assembly line, putting the few dozen workers it could muster to produce thousands of single-use protective suits daily.
Ugly Duck—referring to the proverbial duckling that becomes a swan—is among countless Chinese manufacturers heeding calls to address desperate shortages of face masks, medical equipment, and other supplies to fight the new coronavirus.
The contagion has killed more than 2,800 people and infected some 79,000 in China, sparking global fears and a run on supplies.
Wenzhou is one the hardest-hit areas, with 504 cases and one death as of Friday, compared with 337 infections in far larger Shanghai.
Along with other cities in Zhejiang province, Wenzhou adopted harsh restrictions on residents’ movements on February 2. Ugly Duck was asked by local authorities to do its part.
“As soon as we received this mission, we reorganised our production line within 60 hours,” company president Pan Yue told AFP.
The suits are sold to the government at cost and intended for local epidemic-control efforts.

But with the virus now hitting other countries, the company plans to continue hazmat suit production even after normal operations resume as expected in the coming weeks.
“We are considering export to Italy or wherever they are needed,” Pan said. “We want to contribute to society and to the world.”
Hazmat-clad workers
Major production areas in the five-story concrete factory are ghostly quiet expanses of idle sewing machines—testament to the paralysis inflicted on Chinese manufacturing.
But in one workshop nearly the size of a football pitch, the bright-white polypropylene material is first cut into basic shapes, then stitched together in stages, and finally folded and packaged on an assembly line by workers who are also clad in the head-to-toe suits to prevent contamination.
Each worker has a bottle of hand sanitiser at their work table.

Underlining China’s enduring ability to foster mass, collective efforts, companies across China—from iPhone maker Foxconn to car manufacturer BYD—have pitched in after news that doctors in front-line epidemic areas were treating patients without proper masks or suits, or were forced to reuse single-use equipment.
Wenzhou, with around three million people in its main urban core, is famed for its commercial prowess.
A trade entrepot for centuries, it was an early pioneer in China’s manufacturing-led economic transformation beginning in the 1970s and today produces a large portion of the world’s eyeglasses and shoes.
But the city remains subdued, its factories hobbled.
Much of Ugly Duck’s roughly 300-strong labour force are migrants from less-developed provinces like Yunnan and Guizhou in China’s southwest.
Only half of the workers have managed to navigate travel restrictions and reduced rail and bus traffic.

“The outbreak has impacted the company because (production) has been delayed for a month,” said Pan.
“But we will do everything to recoup the losses.”
https://medicalxpress.com/news/2020-02-virus-hit-china-coat-maker-hazmat.html

Iran says ‘tens of thousands’ may get tested for coronavirus

Iran is preparing for the possibility of “tens of thousands” of people getting tested for the new coronavirus as the number of confirmed cases spiked again Saturday, an official said, underscoring the fear both at home and abroad over the outbreak in the Islamic Republic.

The virus and the COVID-19 illness it causes have killed 43 people out of 593 confirmed cases in Iran, Health Ministry spokesman Kianoush Jahanpour said. He disputed a report by the BBC’s Persian service citing anonymous medical officials in Iran putting the death toll at over four times as much.
But the number of known cases versus deaths would put the virus’ death rate in Iran at over 7%, much higher than other countries. That’s worried experts at the World Health Organization and elsewhere that Iran may be underreporting the number of cases now affecting it.
Yet even as Iran sends spray trucks and fumigators into the streets, officials still are trying to downplay the virus’ reach.
“During these 10 days that we are talking about the coronavirus in the country, more than 480 people of our country has been killed in traffic accidents, but no one noticed them,” Jahanpour said.
The virus has infected more than 85,000 people and caused more than 2,900 deaths since emerging in China. Iran, with 43 people dead, has the world’s highest death toll outside of China. Of the 730 confirmed cases scattered across the Mideast, the majority trace back to the Islamic Republic.

Saturday’s new toll of 593 confirmed cases represents a jump of 205 cases—a 52% increase from the 388 reported the day before. Jahanpour has warned that large increases in the number of confirmed cases would happen as Iran now has 15 laboratories testing for the virus.
Late Friday night, a BBC Persian report citing sources within Iran’s medical community put the death toll at at least 210. State television in Saudi Arabia and associated media, as well as Iranian exile groups, seized on the figure amid their wider political disputes with Tehran.
Jahanpour however disputed the report as being politically motivated, conflating other causes of deaths with the coronavirus and relying on sources without access to Iran’s coronavirus testing labs.
“The queen’s media, BBC Persian, is worried about staying behind Saudi and Albanian networks in the ‘lie competition.'” he said. Albania is home to the Iranian exile group Mujahedeen-e-Khalq.

However, at the same news conference, Jahanpour suggested “tens of thousands” could seek testing for the coronavirus. He also encouraged people to continue to avoid mass gatherings—even funerals for those who died of the virus. Authorities later banned the public from visiting patients at hospitals nationwide, state television reported.
“The safest place is our homes and our cities,” he said. “We have to reduce our visits, even attending to funerals, and of course those people who are mourning, will feel guilty if they find that their ceremony causes the disease to spread.”
Concerns continue to grow, however, as online videos showed an angry crowd setting fire to the courtyard of a medical clinic overnight in the southern city of Bandar Abbas. Semiofficial media reported those gathered wrongly believed the clinic housed people sick with the new coronavirus.

Earlier Saturday, Bahrain threatened legal prosecution against travelers who came from Iran and hadn’t been tested for the new coronavirus, and also barred public gatherings for two weeks.
The tiny island nation off the coast of Saudi Arabia has been hard-hit with cases and shut down some flights to halt the spread of the virus.
All of Bahrain’s cases link back to Iran, where even top officials have contracted the virus.
Bahrain’s Interior Ministry said in a statement that 2,292 people had come to the kingdom from Iran before the announcement of the outbreak there. Of those, only “310 citizens” had called authorities and undergone testing, the ministry said, raising the possibility of the untested being arrested and charged if they refuse.
The ministry “affirmed that the required legal proceedings would be taken against anyone who returned from Iran in February and didn’t call to make appointments for the tests,” the Interior Ministry said. “It highlighted that preventing the outbreak of the infection is the responsibility of individuals and society as a whole.”

Sunni-ruled Bahrain has engaged in a yearslong crackdown on all dissent in the island kingdom since its 2011 Arab Spring protests, which saw its majority Shiite population demand greater political freedoms. Militants have launched small, sporadic attacks in the time since which Bahrain security forces blame on Iran, the Mideast’s Shiite power.
Qatar announced Saturday its first coronavirus case, a Qatari citizen who was on an earlier evacuation flight from Iran. The United Arab Emirates said it would indefinitely shut down all nurseries across the country, home to Dubai and Abu Dhabi, beginning Sunday.
Also Saturday, Saudi Arabia announced it would bar citizens of the Gulf Cooperation Council from Islam’s holiest sites in Mecca and Medina over concerns about the virus’ spread. The GCC is a six-nation group including Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates.
Saudi Arabia on Thursday closed off the holy sites to foreign pilgrims over the coronavirus, disrupting travel for thousands of Muslims already headed to the kingdom and potentially affecting plans later this year for millions more ahead of the fasting month of Ramadan and the annual hajj pilgrimage.
It represented an unprecedented move, one that wasn’t taken even during the 1918 flu epidemic that killed tens of millions worldwide.
Meanwhile, tiny, oil-rich Kuwait simply has told its citizens not to travel abroad anywhere.
https://medicalxpress.com/news/2020-02-iran-tens-thousands-coronavirus.html

Wuhan man details what it feels like to have coronavirus

A Wuhan man who came down with the coronavirus in mid-January said he spent three agonizing weeks with worsening symptoms that began when he woke up one day feeling “sore all over.”
The coronavirus had yet to sweep China when Tiger Ye began feeling ill on Jan. 17, and he suspected nothing more than the common cold or flu, he told the Guardian.
After four days of cold medication and no improvement, he admitted himself to Tongji hospital — where he was greeted by a chaotic scene and “realized something bad was happening.”
“On arrival I saw the hospital already overwhelmed with patients. Seeing doctors in their hazmat suits in real life for the first time, something I’d only seen in documentaries about SARS,” he said.
His parents rushed him to a second hospital that had yet to be hit with a rush of patients where a CT scan showed “patchy shadows on the lower sides of both of my lungs.”
Doctors prescribed him medication and sent him to quarantine at home, where his family stocked up on food and Ye retreated to his room.
A week later, he began to develop a cough and fever, and was re-admitted to the hospital. Tests showed the infection had spread throughout his lungs, but he had yet to be diagnosed with coronavirus.
Ye said that from Jan. 21-26 was “the worst time.”
“I coughed so bad my stomach was hurting and my back ached,” he said, adding, “I thought I may have to say goodbye to this life forever.”
On Jan. 29, his older brother and grandmother — who had been delivering him food to his room — came down with symptoms. On the same day, doctors officially diagnosed Ye with the virus, and prescribed him five days of anti-HIV medication.
By Feb. 4, a test showed improvements in Ye’s lungs. His family also began to feel better. Three days later, doctors declared him coronavirus-free.
Ye said his one regret is not visiting a hospital earlier, rather than dismissing his symptoms as a cold.
“Now that I think of it, I might have missed the best time for treatment, failing to contain the virus with antiviral drugs in its early stages,” he said.
https://nypost.com/2020/02/29/wuhan-man-details-what-it-feels-like-to-have-coronavirus/