AbstractThe novel coronavirus, also known as COVID-19, has infected at least 1 million persons worldwide. It has also accounted for a number of deaths. No doubt, it has dealt a drastic blow to businesses and the global economy, leaving behind a huge crisis. Thus, the present study discusses management strategies to counter the short and long-term effects of the COVID-19 pandemic on businesses.IntroductionThe novel coronavirus pneumonia is an acute respiratory disease. In December 2019, this disease emerged in Wuhan, China. The Chinese government called it SARS-CoV-2 which was subsequently named COVID-19 by the World Health Organization (WHO) [1]. In January 2020, WHO confirmed it as a sustained human to human disease [2]. The World Health Organization has declared Covid-19 a full-blown pandemic, which means it's a crisis-level disease outbreak in multiple countries. This disease is extremely rare and its unexpected occurrence has major consequences for just about everybody. Covid-19 is similar to past zoonotic coronaviruses, including SARS. It's less lethal than SARS, but spreads more easily. The death rate is under 2 percent, and for people under the age of 60 under 1 percent.In a bid to control its spread, this disease has led to flight cancellations, border closure, postponement of business meetings and so on. In fact, the impact of this pandemic will take years to be fully quantified. Social distancing -- basically keeping people away from each other (as well as avoiding human physical contact and washing hands) has been one of the mostly talked about method of preventing a full-scale outbreak. However, this has led to severe consequences to businesses and even job losses. This is because business is usually conducted by bringing people together, not keeping them apart. People come to work, have meetings, travel to meet with clients, attend trade conferences and purposefully interact with each other to forward the interests of the organization. Thus, this brings to concern how to keep business alive while keeping people apart. No doubt, the COVID-19 pandemic has led to huge economic and business crisis. For instance, oil prices crashed to an 18-year low of $20.09 a barrel, thereby sending a devastating blow to energy demand. In view of the imminent crisis to businesses, it is imperative that efficient management strategies are adapted to this unusual and unpleasant situation. Thus, the present study highlights these key approaches.Immediate stepsTo prevent further escalation of the situation, the following first steps should be observed. They are as follows:·         Appoint a crisis response team that meets daily.·         Monitor government, medical, industry and local sources for updates for the team.·         Implement a communications plan to transparently inform all employees.·         Develop and implement a comprehensive crisis response.·         Develop or update, then communicate and enforce, a remote-work policy.Long-term actionsScenario planning·         Organizations must act with imperative when developing and implementing enhanced risk management practices, focusing on the opportunities scenario planning offers in creating pre-emptive action plans.·         Scenarios enable organizations to see the bigger picture and make effective trade-off decisions on issues like: how much stock to hold – and where, or how to balance the cost of inventory versus the cost of failing to satisfy customers. Simulations can be run swiftly to identify “sweet spots” between apparently conflicting objectives, based on real-time inventory data, customer demand, and supplier capability. Increasingly enabled by AI and automation, these scenarios can help prescribe rather than just predict.·         By analyzing past events and hypothesizing future threats, organizations are able to identify strategic and concentrated supplies that are at risk in major crises, and most importantly, recognize when current internal risk capacities prove insufficient.Supplier risk management·         Real-time supplier data such as system performance category alerts and geopolitical events helps manage performance and issue resolution.·         When alerted, proactive measures should be taken by organizations to uncover additional exposure levels by reaching out to suppliers (from tier 1, tier 2 and below) outside of affected regions to identify upstream supply dependencies within their supply chains.·         Further, organizations could benefit from balancing supply and demand and working with internal stakeholders as well as critical suppliers to contractually agree on logistic-based costs and necessary buffer stock, so as to reduce sudden price increases in the face of a crisis.Technology upgrades·         In line with the technology-enabled business climate we currently operate in, organizations should rethink the way their employees collaborate with each other and customers - within the office, regionally and globally.·         By investing in internal technology, organizations can teach employees how to effectively leverage powered execution tools such as cloud-office technology and zero-touch models. This will help ensure that not only in times of crisis are teams better equipped to work remotely, but as the business environment continues to shift, employees are able to adapt alongside it and continue serving customers.ConclusionIn conclusion, as the novel coronavirus continues to take its toll on businesses as well as the global economy, hope is not lost for business to bounce back strongly. However, this can only be achieved by ensuring that effective short and long-term management strategies are implemented and followed to the letter.References1.            Chan JF-W, Yuan S, Kok K-H, To KK-W, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020;395(10223):514-23.2.            Organization WH. Coronavirus disease 2019 (COVID-19) situation report–34. Geneva, Switzerland: World Health Organization; 2020.

The COVID-19 pandemic has placed an extraordinary demand on the United States healthcare system. Many institutions have cancelled elective and non-urgent procedures to conserve resources and limit exposure. While operational definitions of elective and urgent categories exist, there is a degree of surgeon judgment in designation. In the present commentary, we provide a framework for prioritizing head and neck surgery during the pandemic. Unique considerations for the head and neck patient are examined including risk to the oncology patient, outcomes following delay in head and neck cancer therapy, and risk of transmission during otolaryngologic surgery. Our case prioritization criteria consist of four categories: urgent – proceed with surgery, less urgent – consider postpone > 30 days, less urgent – consider postpone 30–90 days, and case-by-case basis. Finally, we discuss our preoperative clinical pathway for transmission mitigation including defining low-risk and high-risk surgery for transmission and role of preoperative COVID-19 testing.

The 2019 novel coronavirus disease (COVID-19) has presented the world and physicians with a unique public health challenge. In light of its high transmissibility and large burden on the healthcare system, many hospitals and practices have opted to cancel elective surgeries in order to mobilize resources, ration personal protective equipment and guard patients from the virus. Head and neck cancer physicians are particularly affected by these changes given their scope of practice, complex patient population, and interventional focus. In this viewpoint, we discuss some of the many challenges faced by head and neck surgeons in this climate. Additionally, we outline the utility of telemedicine as a potential strategy for allowing physicians to maintain an effective continuum of care.

In December 2019, the world started to face a new pandemic situation, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although COVID-19 clinical manifestations are mainly respiratory, major cardiac complications are being reported. Cardiac manifestations etiology seems to be multifactorial, comprising direct viral myocardial damage, hypoxia, hypotension, enhanced inflammatory status, ACE2-receptors downregulation, drug toxicity, endogenous catecholamine adrenergic status, among others. Studies evaluating COVID-19 patients presenting cardiac injury markers show that it is associated with poorer outcomes, and arrhythmic events are not uncommon. Besides, drugs currently used to treat the COVID-19 are known to prolong the QT interval and can have a proarrhythmic propensity. This review focus on COVID-19 cardiac and arrhythmic manifestations and, in parallel, makes an appraisal of other virus epidemics as SARS-CoV, MERS-CoV, and H1N1 influenza.

Doubling Time (DT) is typically calculated for growth curves that show exponential growth, such as the cumulative number of COVID-19 cases day by day. DT represents the time it takes before the number of COVID-19 cases, in a certain country or area, doubles. Throughout the ongoing COVID-19 outbreak, DT values are continually changing. These changes are influenced by the measures that are recommended by the health authorities and implemented by governments. After the government-imposed shutdowns of Nordic Countries that were announced around the 12th of March 2020, we followed the development of the DT in the region. Governments put in place measures never before experienced during peace time; working from home, closed schools and kindergartens, travel bans and social distancing. We conducted analyses to evaluate the effectiveness of these measures. Does it work? The initial set of results following the shutdown are encouraging, demonstrating a trend towards slower growth; however, this could be reversed if the measures that are in place now are abandoned too early. Premature optimism can be very costly. In this report we describe a method for monitoring the epidemic in real time and evaluating the effectiveness of the implemented measures.

IntroductionPneumonia caused by the 2019 novel coronavirus disease (COVID-19) is a highly infectious disease, which has aroused widespread concern all over the world. COVID-19 pneumonia was first reported in Wuhan, Hubei province, China, in December 2019, followed by an outbreak outside of Hubei province and even the whole country. Because of the great efforts of Chinese government and medical staff, the epidemics of coronavirus has been effectively controlled in China now. As a newly emerged virus, there was a lack of awareness among medical staff in the early stage of the epidemics, so that the initial outbreak in Wuhan has not been well recognized. Pregnant women and newborns are susceptible people, so it is very important to ensure the safety of mothers and infants. In order to prevent the second Wuhan from appearing again in another country, this paper refers to the current guidelines for the management of pregnant women during the epidemic period of COVID-19 in China, and summarizes the clinical experience in the actual diagnosis and treatment of our hospital during the outbreak of the coronavirus epidemics.Because the new coronavirus is particularly infectious, outpatient service is the first window to contact patients with potential virus infection, it is very important to manage the medical staff, pregnant women and their accompanying family members in the outpatient obstetrical department, which is helpful for early detection, early diagnosis, early isolation and early treatment of coronavirus. The effective management of outpatient obstetrical department is one of the key factors to avoid the expansion of the coronavirus epidemics (See figure1).

Objective: To review studies published with pregnant women infected with SARS-CoV-2 and analyze the evolution of them and also of the newborn in order to learn about this pathology in pregnant women. Search strategy: Systematic review in the PUBMED and GOOGLE Scholar databases until March 30, 2020. This research was extended to the references of such articles. Selection criteria: Observational studies that examined maternal and perinatal outcomes of pregnant women with SARS-CoV-2 are published. Data collection and analysis: Data about study characteristics, maternal y perinatal outcomes variable extracted. Main results: We found 14 publications regarding a total of 83 pregnant women with SARS-CoV-2 and results of 84 newborns. The average gestational age was 37 weeks. The most common symptom was fever, and 30% of the pregnant women had lymphopenia on admission to hospital. Cesarean section was performed in 89% of the patients; 70% of them were indicated by SARS-CoV-2. The most common obstetric complication was premature rupture of membranes in 9.6% of them. The need for ventilation support was low. The use of antivirals, corticosteroids, and drugs for the pathology management was scarce, except for antibiotics. Preterm birth was 25%, perinatal mortality was low, and there was no maternal death. There was no evidence of vertical transmission. Conclusion: Maternal and perinatal morbidity-mortality is lower than in other known respiratory diseases. Currently, it appears to be no benefit from antivirals and other drugs, beyond the general support of the disease, and vertical transmission of the virus has not been demonstrated.

Coronavirus disease (COVID-19) with orbital complication in young childCOVID-19 is a current ongoing global health emergencyCoronaviruses cause sinonasal symptoms similar to common cold and loss of smellEndoscopic sinus surgery is an aerosol-generating procedure with high risk of COVID-19 transmissionCOVID-19 infection was related to a case of preseptal orbital cellulitisCovid-19 infection should be suspected in current cases of orbital cellulitis and management plan modified to protect medical professionals

One standout observation regarding the clinical epidemiology in the current COVID-19 pandemic is the relatively low incidence and generally mild presentation of the infections in children (Ludvigsson, 2020)⁠. Indeed, only 230 pediatric cases with 3 neonates have been reported in China through February 6 2020 (Lu & Shi, 2020)⁠ with a total of only 9 infected and hospitalized cases identified between December 8 2019 and February 6 2020 out of a total of 31,211 cases of COVID-19 reported (Wei et al., 2020). Moreover the course in infants and children was mild with infection rarely progressing to lower respiratory tract infections (Hong et al., 2020), and no deaths have been reported in this age group (Lu & Shi, 2020)⁠.Since SARS-CoV-2 is highly contagious, it is anomalous that the infection rate is so low in infants and children given the high risk of inevitable close contact they have with adults. So far, several theories to explain this anomaly include lack of nicotine exposure in children, and reduced expression of ACE2 cell surface receptors needed by SARS-CoV-2 to gain entry to host at younger ages (Song et al., 2012).Here we postulate another possibility for lower incidence and milder disease is high lactoferrin content in breast or some infant formula feedings.Lactoferrin (Lf), which is highly concentrated in human milk as well as often added to modern infant formulas has demonstrable broad-range antiviral properties (Wakabayashi et al., 2014) including against SARS-CoV, which uses the same ACE2 surface receptor to invade hosts as SARS-CoV2 (Lang et al., 2011), thus, it is not inconceivable that nutritional lactoferrin in breast milk or infant formula contributed to reduced incidence as well as milder course of COVID-19 in infants and young children. This intriguing possibility can be assessed by carefully noting the feeding history of pediatric COVID-19 cases.Author list:

Background: This case highlights challenges in the assessment and management of the “difficult airway” patient in the SARS-CoV-2 (COVID-19) pandemic era. Methods: A 60-year-old male with history of recent TORS resection, free flap reconstruction and tracheostomy for p16+ squamous cell carcinoma presented with stridor and dyspnea one month after decannulation. Careful planning by a multidisciplinary team allowed for appropriate staffing and personal protective equipment, preparations for emergency airway management, evaluation via nasopharyngolaryngoscopy, and COVID testing. The patient was found to be COVID negative and underwent imaging which revealed new pulmonary nodules and a tracheal lesion. Results: The patient was safely transorally intubated in the operating room. The tracheal lesion was removed endoscopically and tracheostomy was avoided. Conclusions: This case highlights the importance of careful and collaborative decision making for the management of head and neck cancer and other “difficult airway” patients during the COVID-19 epidemic.

5 KEY POINTSIn an outbreak, early healthcare personnel segregation should be considered to ensure that the provision of essential services may continue if a single team is quarantinedEstablishing a sustainable PPE usage guideline for healthcare workers early in the outbreak is of paramount importanceDesign and simulation of work processes for emergency airway creation should be considered in every otolaryngology department dealing with the COVID-19 outbreakScreening and postponement of non-urgent patient follow-ups frees up manpower and resourcesThe use of videoconferencing aids in restoring essential department activities and telemedicine may be a useful tool to explore in otolaryngology clinicsWord count: 1494

Since December 2019, a number of patients with novel coronavirus pneumonia (NCP) have been identified in Wuhan, Hubei Province, China. NCP has rapidly spread to other provinces and cities in China and other countries in the world. Due to the rapid increase in reported cases in China and around the world, on January 30, 2020, the World Health Organization (WHO) Emergency Committee announced that NCP is a Public Health Emergency of International Concern (PHEIC). However, there are relatively few suggestions and measures for tumor patients, especially patients with head and neck tumors. This article summarizes the prevention and control of disease in our medical institution to provide a reference for front-line head and neck surgeons.

Published in Journal of Cardiovascular Electrophysiology. DOI forthcoming.Author list and affiliationNorman C. Wang, MD, MS; Sandeep K. Jain, MD; N.A. Mark Estes III, MD; William W. Barrington, MD; Raveen Bazaz, MD; Aditya Bhonsale, MD, MHS; Krishna Kancharla, MBBS; Alaa A. Shalaby, MD, MSc; Andrew H. Voigt, MD; Samir Saba, MD Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PennsylvaniaAuthor disclosures: Dr. Wang serves as a consultant for Abbott. Dr. Jain serves as a consultant for Medtronic, receives research support from Medtronic, and is a research investigator for Abbott, Boston Scientific, and Medtronic. Dr. Estes serves as a consultant for Abbott, Boston Scientific, and Medtronic. Dr. Saba receives research support from Abbott and Boston Scientific. The remaining authors have nothing to disclose. University of Pittsburgh Medical Center receives institutional cardiac electrophysiology fellowship support from Abbott, Boston Scientific, and Medtronic.Funding: This manuscript did not receive any specific grant(s) from funding agencies in the public, commercial, or not-for-profit sectors.Proposed Tweet: Priority plan for invasive cardiac EP procedures during the COVID-19 pandemic. #EPeeps #COVID19

Respiratory complications have been well remarked in the novel coronavirus disease (SARS-CoV-2/COVID-19), yet an emerging body of research indicates that cardiac involvement may be implicated in poor outcomes for these patients. This review seeks to gather and distill the existing body of literature that describes the cardiac implications of COVID-19. Notably, COVID-19 patients with pre-existing cardiovascular disease are counted in greater frequency in intensive care unit settings, and ultimately suffer greater rates of mortality. Other studies have noted cardiac presentations for COVID-19, rather than respiratory, such as acute pericarditis and left ventricular dysfunction. In some patients there has been evidence of acute myocardial injury, with correspondingly increased serum troponin I levels. With regard to surgical interventions, there is a dearth of data describing myocardial protection during cardiac surgery for COVID-19 patients. Although some insights have been garnered in the study of cardiovascular diseases for these patients, these insights remain fragmented and have yet to cement clear guidelines for actionable clinical practice. Further studies are imperative for a more cohesive understanding of the cardiac pathophysiology in COVID-19 patients to promote more informed treatment and, ultimately, better clinical outcomes. 

In December 31st 2019, an episode of Acute respiratory Disease syndrome (ARDS) was first noted in Wuhan, Hubei Province, China. On 11th February 2020 WHO office gave the name as COVID-19 and universal advisory group on scientific classification of infections named SARS-COV-2. In view of the mass of the contaminated population that were wide opened to the creature meat advertise in Wuhan City, China, recommended that it is likely of the zoonotic starting point and has influenced 186 nations and regions .About 25% and 75% of the confirmed cases were from China and outside China separately with most elevated mortality and dreariness in Italy. Spurting hereditary qualities and clinical confirmation advocate a homology pathogenesis model as that of SARS CoV and MERS CoV in which the cytokine tempest and raised chemokine’s trigger safe structure in exaggerated way prompting various organ disappointment and lead to death in extreme cases. Individual to-individual course of COVID-19 contamination prompted the isolation of patients that were in this way regulated a decent variety of treatment. Extra special Surveillance and endeavour’s to diminish flow ought to be applied in hazard residents including youngsters, medicinal services suppliers. Confirmation of COVID-19 contamination requires nucleic corrosive testing by RT-PCR of tests of respiratory tract and clinical determination assume an indispensable job in early examination and assessment of ailment way. We systematically survey the sources, aetiology, disease transmission, pathogenesis, clinical indications, examination and prevention of COVID – 19, inspected from significant conveyed articles to provide extraordinary reference to expert.

Dear Editor,Thank you for the opportunity to respond to Dr Sahu’s letter1. We would like to thank Dr Sahu and his team for their valuable points and ourselves recognise and acknowledge the gaps in our early commentary2 which reflected on the early practice at our hospital, with an aim to help fellow obstetricians with the management of COVID-19 at the start of the outbreak. Since then, more literature has been published providing us with greater knowledge regarding this new infection. Guidance from the Royal College of Obstetricians and Gynaecologists (RCOG)3 and International Society of Ultrasound in Obstetrics and Gynaecology (ISUOG)4 amongst others help us streamline management of COVID-19 in pregnant patients.Both guidelines concur that radiographic investigations should be performed in pregnant patients – protecting the fetus by using a radiation shield over the gravid uterus. Chest CT has high sensitivity up to 97% for diagnosis of COVID-19 and may be considered as primary tool for COVID-19 detection.Both guidelines recommend the use of antenatal corticosteroids (ANC) for the usual indications but cautions use in critically ill women with COVID-19 infection as it may worsen their clinical condition. Importantly, urgent deliveries should not be delayed for the administration of ANC.Li et al5 compared clinical characteristics, maternal and neonatal outcomes of pregnant women with and without COVID-19. They found that COVID-19 infection generally causes mild respiratory symptoms in pregnant women, with no deaths or severe respiratory complications requiring critical care. They observed a higher rate of preterm deliveries in confirmed cases (33.3%) compared to control groups (¬5%). This study included two patients who had vaginal deliveries prior to COVID-19 diagnosis. Their newborns did not show any respiratory symptoms.New reports of SARS-COV-2 IgM in infants6 at birth suggest possibility of vertical transmission although COVID-19 infection in newborns is more commonly likely due to neonatal transmission.During breastfeeding, the main risk for infants lies in their close contact with mothers and transmission of infective respiratory droplets. Infected mothers wishing to breastfeed should do so with precautions such as wearing surgical masks, practising good hand hygiene and thorough cleaning of equipment after use. While the decision for separation of mother and baby has serious consequences on bonding and mental health, we continue to advise separation of baby from mothers infected with COVID-19 due to risk of neonatal transmission.Current data suggests that the adverse effects of COVID-19 in pregnancy are less severe than those of SARS-CoV and MERS-CoV. All presently reported patients were diagnosed in the third trimester and the potential effects of COVID-19 infections in the first and second trimesters remain to be investigated.As Dr Sahu mentioned, comparative studies are scarce. Establishment of international registries will improve our understanding of COVID-19 in pregnancy. Meanwhile, we shall continue to support one another and work together in the fight against this pandemic.We would like to thank the all departments from the Division of Obstetrics and Gynaecology, Infectious Diseases Department and all staff in KK Womens’ and Children’s Hospital for leading the COVID-19 fight locally.Monica Shi Qi Chua1, Jill Cheng Sim Lee2, Suzanna Sulaiman1, Hak Koon Tan31Department of Obstetrics and Gynaecology,2Department of Urogynaecology,3Division of Obstetrics and GynaecologyKK Women’s and Children’s Hospital, Singapore

Coronavirus disease 2019 (COVID-19), which was first reported in Wuhan in December 2019, is now widespread with outbreaks reaching across the world1. The hospital-acquired transmission rate of COVID-19 is about 41%2, which is due to human-to-human transmission. Compared to COVID-19, SARS3 and MERS4 appear to have a lower morbidity rate and a higher mortality rate of ~ 10% and 37%, respectively.Despite the high number of infections in the most developed south-eastern coastal provinces of mainland China, such as Zhejiang, they may exceed the mortality rate, as the global mortality rate of COVID-19 is about 3.4%5, while lower mortality rates are reported for these areas. However, no deaths are reported in Zhejiang for 1171 confirmed cases and only four deaths are confirmed in Guangdong, with 1322 true positive cases (0.3%)6,7. This is a clear evidence that mortality rates are directly related to the quality of crisis management.In contrast to all the previous outbreaks and pandemics, there is one untapped hope that could make dealing with the COVID-19 pandemic possible after all, i.e. artificial intelligence (AI) and its related technologies. For example, bioinformatics can benefit from advances in generative AI8, machine learning can assist in accurate detection of the infection9, social media analysis can raise awareness and identify cases which are not reported by governments10, simulations based on reinforcement learning11 can identify pandemic outbreak pace and magnitude and assist policy makers in their decisions.The pandemic risk of COVID-19 results from several factors: (i) it is difficult to differentiate COVID-19 because the outbreak of the disease is associated with respiratory symptoms that are common to many other respiratory diseases such as colds and flu, which usually have a high prevalence during the cold season, (ii) COVI-19 is quite persistent and enjoys low temperatures, (iii) the transmission rate is quite high (41%), in almost 80% of cases patients do not show typical symptoms and they could be carrier and transmit the disease to others12.It has been estimated that there will be more deaths in developing countries, especially in countries with higher population density and lower hygienic index, and developed countries which has lots of international connections, which could contribute to an uncontrolled pandemic. Therefore, AI and its sub-branches could contribute to better management of the disease in these countries and could be beneficial in addition to human factors. Successful control of COVID-19, which has a high morbidity rate and resembles the primary symptoms of harmless respiratory diseases, depends on early diagnosis. A 14-day quarantine of false positive individuals leads to a heavy burden on health systems and ineffective disease management. Perhaps the first application of AI in a real struggle is to explore its true potential in the initial diagnosis of COVID-19 and the identification of subsequent outbreaks.Fortunately, the first experiment in this area was promising, in which the initial diagnosis of the disease based on a 10-15 minute computer tomography (CT) showed a diagnosis rate of 81% and with the help of AI, the detection rate could be improved up to 90% within seconds13.What AI can potentially do to win people’s battle against COVID-19 is (i) early detection of the disease with a high degree of accuracy that can save time and lead to a good decision, (ii) avoiding unnecessary quarantine of healthy people, and (iii) early diagnosis of sick individuals that can prevent further transmission of the disease. Furthermore, taking into account the demographic factors of the patient, such as sex, age and lifestyle in each country, AI can help to predict the circulation of the disease in the country and the direct use of available facilities where they are most needed. It is also possible to identify high-risk groups, related professions and companies to prevent the spread of the disease. As a point-of-care device, AI can save time, costs, energy and many lives.AI is highly valued in developing countries, which have fewer opportunities to deal with the disease than developed countries. It can lead to the right decisions being taken at the right time and in the right place, thus providing a fair and rational distribution of opportunities to control the virus in high-risk regions. This may make developing countries less vulnerable to deaths, but given the severe economic sanctions imposed on some countries, such as Iran, many nominated companies operating in the AI sector are reluctant to do so and stand still. The fight against COVID-19 in developing countries requires full support, and in the end the whole world will benefit from it.We also believe that it is necessary to initiate open source projects. Just a few examples show how an open source device like a ventilator can save many lives, and there are some promising efforts in this direction, such as an open source platform for surgical robotics14. The same attitude is required for algorithms and applications. At the time of writing this article, there are several preprints explaining the use of a deep learning algorithm to identify COVID-19 from pneumonia15,16 but to our knowledge, none of them have been published as open source so that other developers can use these algorithms in their application to improve their COVID-19 detection rate, which is an unnecessary investment of time and energy in reinventing the wheel in this stressed situation where time is precious and crucial.

Obstetrical view of COVID-19:

Dear Editor,At 29th of February the World Health Organization (WHO) reported 85403 confirmed globally confirmed case of COVID-19 [1]. COVID-19 is dramatically increasing in Italy, the last report from the ministry of health on the 9th of march reported the presence of 9172 confirmed cases and 733 patients in intensive care unit (ICU) [2]. We agree with Chan et al that physicians managing airway procedures are at particularly high risk to contract the COVID-19 infection [3]. We support the authors that claimed for a full protective wearing including N95 respirator, gown, cap, eye protection, and gloves, during aerosol generating procedures (AGP) [3]. However, we’d like to focus the attention on the tracheostomy procedures in COVID-19 patients since otolaryngologists, anesthesiologists and intensive care physicians are at high risk of contracting the infection during tracheostomy [3]. Tracheostomy is required in case of prolonged mechanical ventilation and intensive care unit (ICU) stay [4]. Surgical tracheostomy is an AGP associated with an increased risk severe acute respiratory distress (SARS) infection [5]. Strict adherence to infection control guidelines in SARS is mandatory in performing tracheostomy in ICU or operating room [6].Few years ago, we proposed the double lumen endotracheal tube (DLET) for percutaneous tracheostomy in critically ill patients [7]. DLET was equipped with an upper channel that allows passage of a bronchoscope during the percutaneous tracheostomy and with a lower channel exclusively dedicated to patient ventilation [7]. The lower channel is equipped with a distal cuff positioned just above the carina that may allow a safe mechanical ventilation by keeping stable gas-exchange and limiting the spread of aerosol during the procedure [7]. During the percutaneous procedure, the puncture of the anterior tracheal wall, Seldinger insertion, dilatation, and cannula positioning were all performed with the DLET correctly placed in the trachea. The DLET was removed at the end of the tracheostomy when the cannula is inserted and correctly positioned with the FFB [7].Surgical tracheostomy in COVID-19 patients should be done with a close collaboration between otolaryngologists, preforming the surgical procedure, and anesthesiologists or intensive care physicians managing the general anesthesia and the airway.When a surgical tracheostomy is done under general anesthesia, just before the surgeon makes the tracheal stoma, the endotracheal tube is withdrawn, so that the cuff of the tube is not in the surgical field [8]. But when the surgeon makes the tracheal incision, ventilation is lost and the surgeon has to be quick enough to create the soma and insert the tracheostomy tube in a short time [8]. During this procedure a large spread of aerosol may occur. To avoid the aerosol, we suggest to push down the endotracheal tube beyond the site chosen for the tracheal stoma at the beginning of the procedure. The endotracheal tube should reach the tracheal carina so the cuff is surely distal to the tracheostomy site. By checking the airway pressure and the end-tidal CO2, on the mechanical ventilator we can realize if the endotracheal tube is still in the lower tract of the trachea or in the endobronchial tract. Our previous experience with the DLET demonstrated that the endotracheal tube and the tracheal cannula can be simultaneously inserted inside the trachea [7]. According to this, pushing down the endotracheal tube and cuffed it at the level of the carina may avoid the spread of aerosol and, then, may add an extra security for the medical staff during a procedure at high risk of generating aerosol.ReferencesCoronavirus disease 2019 (COVID-19) Situation Report – 40.https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200229-sitrep-40-covid-19.pdfItalian Minister of Health. COVID-19 Italian cases.http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioContenutiNuovoCoronavirus.jsp?lingua=italiano&id=5351&area=nuovoCoronavirus&menu=vuotoChan YJK, Wong EWY, Lam W. Practical Aspects of Otolaryngologic Clinical Services During the 2019 Novel Coronavirus EpidemicAn Experience in Hong Kong. JAMA Otolaryngol Head Neck Surg. Published online March 20, 2020. doi:10.1001/jamaoto.2020.0488Vargas M, Sutherasan Y, Antonelli M, Brunetti I, Corcione A, Laffey JG, et al. Tracheostomy procedures in the intensive care unit: an international survey. Critical Care 2015;19:291-301Tran K, Cimon K, Severn M et al. Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic Review. . PLoS ONE 2012; 7(4): e35797. doi:10.1371/journal.pone.0035797Chun-Wing A, Yin -Chun L, Kit-Ying L. Management of Critically Ill Patients with Severe Acute Respiratory Syndrome (SARS). Int. J. Med. Sci. 2004 1(1): 1-10Vargas M, Servillo G, Tessitore G, Aloj F, Brunetti I, Arditi E, et al. Percutaneous dilatational tracheostomy with a double-lumen endotracheal tube. A Comparison of Feasibility, Gas Exchange, and Airway Pressures. Chest 2015; 147:1267-74Walts PA, Sudish CM, DeCamp MM. Techniques of surgical tracheostomy. Clin Chest Med 24 (2003) 413 – 422

Background: The Coronavirus disease – 2019 (COVID-19) pandemic is a global health crisis and Otolaryngologists are at increased occupational risk of contracting COVID-19. There are currently no uniform best-practice recommendations for Otolaryngologic surgery in the setting of COVID-19.Methods: We reviewed relevant publications and position statements regarding the management of Otolaryngology patients in the setting of COVID-19. Recommendations regarding clinical practice during the Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) outbreaks were also reviewed.Results: Enhanced personal protective equipment (N95 respirator and face shield or powered air-purifying respirator, disposable cap and gown, gloves) is required for any Otolaryngology patient with unknown, suspected, or positive COVID-19 status. Elective procedures should be postponed indefinitely, and clinical practice should be limited to patients with urgent or emergent needs. Conclusion: We summarize current best-practice recommendations for Otolaryngologists to ensure safety for themselves, their clinical staff, and their patients.

The 2019 novel coronavirus disease (COVID-19) is a highly contagious zoonosis produced by SARS-CoV-2 that is spread human-to-human by respiratory secretions. It was declared by the WHO as a public health emergency. The most susceptible populations, needing mechanical ventilation, are the elderly and people with associated comorbidities.There is an important risk of contagion for anesthetists, dentists, head and neck surgeons, maxillofacial surgeons, ophthalmologists and otolaryngologists.  Health workers represent between 3.8% to 20% of the infected population; some 15% will develop severe complaints and among them, many will lose their lives. A large number of patients do not have overt signs and symptoms (fever/respiratory), yet pose a real risk to surgeons (who should know this fact and must therefore apply respiratory protective strategies for all patients they encounter).All interventions that have the potential to aerosolize aerodigestive secretions should be avoided or used only when mandatory. Health workers who are: pregnant, over 55-65 years of age, with a history of chronic diseases (uncontrolled hypertension, diabetes mellitus, chronic obstructive pulmonary diseases and all clinical scenarios where immunosuppression is feasible, including that induced to treat chronic inflammatory conditions and organ transplants) should avoid the clinical attention of a potentially infected patient. Healthcare facilities should prioritize urgent and emergency visits and procedures until the present condition stabilizes; truly elective care should cease and discussed on a case-by-case basis for cancer patients.For those who are working with COVID-19 infected patients’ isolation is compulsory in the following settings: a) unprotected close contact with COVID-19 pneumonia patients: b) onset of fever, cough, shortness of breath and other symptoms (gastrointestinal complaints, anosmia and dysgeusia have been reported in a minority of cases).For any care or intervention in the upper aerodigestive tract region, irrespective of the setting and a confirmed diagnosis (e.g.; rhinoscopy or flexible laryngoscopy in the outpatient setting and tracheostomy or rigid endoscopy under anesthesia) it is strongly recommended that all healthcare personnel wear personal protective equipment (PPE) such as N95, gown, cap, eye protection and gloves.The procedures described are essential in trying to maintain safety of healthcare workers during COVID-19 pandemic. In particular, otolaryngologists, head and neck, and maxillofacial surgeons are per se exposed to the greatest risk of infection while caring for COVID-19 positive subjects, and their protection should be considered a priority in the present circumstances.

A novel respiratory pathogen, SARS-CoV-2 has recently received worldwide attention and has been declared a public health emergency of global concern. Entry of SARS-CoV-2 is mediated through the viral spike glycoprotein (S2). Afterwards, the virus gets hold of the host cell machinery by employing the use of viral main protease 3CLpro and NSP15 endoribonuclease. In the present in silico study, active site mapping of the viral virulence factors was rendered by means of DoG Site Scorer. The possibility of repurposing of 2-deoxy-D-glucose (2-DG), a radio-chemo-modifier drug used for optimizing cancer therapy, and one of its derivative (1, 3, 4, 6-Tetra-O-acetyl-2-deoxy-D-glucopyranose, has been investigated by conducting ligand-receptor docking. Binding pose depictions of ligands and viral receptors were assessed by employing molecular dynamics analysis. Molinspiration and Toxicity Estimation Software tools were used to assess the drug likeliness, bioactivity indices and ADMETox values. 2-DG can dock efficiently with viral main protease 3CLpro as well as NSP15 endoribonuclease, thus efficiently inactivating these viral receptors leading to incapacitation of the SARS-CoV-2 virus. Such incapacitation was possible by means of formation of a hydrogen bond between 2-DG and proline residues of viral protease. The 2-DG derivative formed a hydrogen bond with the glutamine amino acid residues of the viral spike glycoprotein. The present in silico study supports the potential benefits of using 2-DG and its glucopyranose derivative as repurposed drugs/prodrugs for mitigating the novel COVID-19 infection. Since both these moieties present no signs of serious toxicity, further empirical studies on model systems and human clinical trials to ascertain effective dose-response are warranted and should be urgently initiated.

COVID-19 has emerged as a new viral illness with potential for significant morbidity and mortality. Pregnant women are high risk for contracting the virus or suffering from complications, however data regarding the effect of COVID-19 on pregnancy is limited to case reports from affected countries. The pathophysiology of COVID-19 infection may provide insights of the threat to mother and fetus. In this review we collate available evidence of harm caused by COVID-19 to mothers and their offspring in all trimesters. Obstetricians must understand the risks posed by this pandemic to effectively counsel women who are currently pregnant or planning conception.

Since end of December 2019, a cluster of patients with pneumonia of unknown origin was reported from Wuhan, Hubei province, China. They shared a connection with the Huanan South China Seafood Market in Wuhan, and now it has been confirmed that the disease is caused by a novel coronavirus (officially named COVID-19). According to real-time statistics from Johns Hopkins University in the United States, as of 5:30 on the 31st, Beijing time, the number of confirmed cases of COVID-19 pneumonia in the world has exceeded 770,000, reaching 777,286, and the number of deaths has reached 37,140. Currently, clinicians have found some atypical cases with positive chest CT findings may present with negative results of RT-PCR for COVID-19. The timely diagnosis, isolation and treatment of these patients will help control the further spread of COVID-19.