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A novel betacoronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread rapidly across the globe since December 2019. Coronavirus disease 2019 (COVID-19) has a significantly higher mortality rate than seasonal influenza and has disproportionately affected older adults, especially those with cardiovascular disease and related risk factors. Adverse cardiovascular sequalae, such has myocarditis, acute myocardial infarction, and heart failure, have been reported in patients with COVID-19. No established treatment is currently available; however, several therapies, including remdesivir, hydroxychloroquine and chloroquine, and interleukin (IL)-6 inhibitors, are being used off-label and evaluated in ongoing clinical trials. Considering these therapies are not familiar to cardiovascular clinicians managing these patients, this review describes the pharmacology of these therapies in the context of their use in patients with cardiovascular-related conditions.

Due to the COVID-19 pandemic, many countries have implemented a complete lock-down of their population that may not be sustainable for long. To identify the best strategy to replace this full lock-down, sophisticated models that rely on mobility data have been developed. In this study, using the example of France as a case-study, we develop a simple model considering contacts between age classes to derive the general impact of partial lock-down strategies targeted at specific age groups. We found that epidemic suppression can only be achieved by targeting isolation of young and middle age groups with high efficiency. All other strategies tested result in a flatter epidemic curve, with outcomes in (e.g. mortality and health system over-capacity) dependent of the age groups targeted and the isolation efficiency. Targeting only the elderly can decrease the expected mortality burden, but in proportions lower than more integrative strategies involving several age groups. While not aiming to provide quantitative forecasts, our study shows the benefits and constraints of different partial lock-down strategies, which could help guide decision-making.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and the resulting COVID‐19 pandemic present important diagnostic challenges. Several diagnostic strategies are available to identify or rule out current infection, identify people in need of care escalation, or to test for past infection and immune response. Point‐of‐care antigen and molecular tests to detect current SARS‐CoV‐2 infection have the potential to allow earlier detection and isolation of confirmed cases compared to laboratory‐based diagnostic methods, with the aim of reducing household and community transmission.

BACKGROUND: There is considerable variation in disease behavior among patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19). Genomewide association analysis may allow for the identification of potential genetic factors involved in the development of Covid-19. METHODS: We conducted a genomewide association study involving 1980 patients with Covid-19 and severe disease (defined as respiratory failure) at seven hospitals in the Italian and Spanish epicenters of the SARS-CoV-2 pandemic in Europe. After quality control and the exclusion of population outliers, 835 patients and 1255 control participants from Italy and 775 patients and 950 control participants from Spain were included in the final analysis. In total, we analyzed 8,582,968 single-nucleotide polymorphisms and conducted a meta-analysis of the two case–control panels. RESULTS: We detected cross-replicating associations with rs11385942 at locus 3p21.31 and with rs657152 at locus 9q34.2, which were significant at the genomewide level (P<5×10−8) in the meta-analysis of the two case–control panels (odds ratio, 1.77; 95% confidence interval [CI], 1.48 to 2.11; P=1.15×10−10; and odds ratio, 1.32; 95% CI, 1.20 to 1.47; P=4.95×10−8, respectively). At locus 3p21.31, the association signal spanned the genes SLC6A20, LZTFL1, CCR9, FYCO1, CXCR6 and XCR1. The association signal at locus 9q34.2 coincided with the ABO blood group locus; in this cohort, a blood-group–specific analysis showed a higher risk in blood group A than in other blood groups (odds ratio, 1.45; 95% CI, 1.20 to 1.75; P=1.48×10−4) and a protective effect in blood group O as compared with other blood groups (odds ratio, 0.65; 95% CI, 0.53 to 0.79; P=1.06×10−5). CONCLUSIONS: We identified a 3p21.31 gene cluster as a genetic susceptibility locus in patients with Covid-19 with respiratory failure and confirmed a potential involvement of the ABO blood-group system. (Funded by Stein Erik Hagen and others.)

The current COVID-19 pandemic has highlighted the risk faced by older adults, who are more susceptible to complications, including acute respiratory distress syndrome, usually as a result of pneumonia. Comorbidities, impaired immunity and frailty, including a reduced ability to cough and to clear secretions from the lungs, can all contribute to this complication. Older people are therefore more likely to develop severe pneumonia, suffer from respiratory failure, and die. Viruses are thought to cause about 50% of cases of pneumonia. Viral pneumonia is generally less severe than bacterial pneumonia but can act as a precursor to it. Preventing any pneumonia in older adults is preferable to treating it. Identification of the early stages of pneumonia in older patients can prove difficult. Traditional symptoms and signs, including fever, may be absent. Limited evidence suggests that many tests that are useful in younger patients do not help diagnose infections in older adults. The onset of pneumonia in elderly people can often be rapid, and the prognosis is poor in severe pneumonia: as many as one in five will die. The older you are, the more prevalent severe pneumonia becomes.

Dear Editor, Coronavirus disease, first emerged in Wuhan, China, rapidly spread all over the country since December 2019. Up to now, the epidemic situation in China remains stable, while the global march of the virus is seemingly unstoppable, especially in South Korea, Iran and Italy. Here, we reported what dermatologists could do to cope with novel coronavirus from a Chinese dermatologist’s perspective. Dermatologists in epidemic areas may receive and cure confirmed or suspected patients in dermatological wards. Tao et al. recommended emergency management plans in dermatology departments. Suspected or confirmed novel coronavirus patients should be strictly handled according to rules and regulations on nosocomial infection. Zhang et al. identified self‐reported drug hypersensitivity (11.4%) and urticaria (1.4%) in 140 patients infected by novel coronavirus. Teleconsultation could be provided by dermatologists; if it is not effective, bedside consultation is needed. In outpatient and emergency in the department of dermatology, pre‐examination and triage are needed to differentiate patients with fever. Patients with symptoms of fever, cough and dyspnoea, with or without epidemiological contact history, should be referred to the fever clinic. Dermatologists should participate in the diagnosis and treatment of patients who have fever and rash after pre‐examination and triage. Strict protection to prevent cross‐infection should be re‐emphasized. [...]

Background: Coronavirus disease 2019 (COVID-19) is caused by the novel betacoronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Most people infected with SARS-CoV-2 have mild disease with unspecific symptoms, but about 5% become critically ill withrespiratory failure, septic shock and multiple organ failure. An unknown proportion of infected individuals never experience COVID-19symptoms although they are infectious, that is, they remain asymptomatic. Those who develop the disease, go through a presymptomaticperiod during which they are infectious. Universal screening for SARS-CoV-2 infections to detect individuals who are infected before theypresent clinically, could therefore be an important measure to contain the spread of the disease.

Italy and South Korea have two distinctly different healthcare systems, causing them to respond to public health crises such as the COVID-19 pandemic in markedly different ways. Differences exist in medical education for both countries, allowing South Korean medical graduates to have a more holistic education in comparison to their Italian counterparts, who specialize in medical education earlier on. Additionally, there are fewer South Korean physicians per 1000 people in South Korea compared to Italian physicians per 1000 people in Italy. However, both countries have a national healthcare system with universal healthcare coverage. Despite this underlying similarity, the two countries addressed COVID-19 in nearly opposite manners. South Korea employed technology and the holistic education of its physician community, despite having a smaller proportion of physicians in society, to its advantage by implementing efficacious drive-through centers that test suspected individuals rapidly and with little to no contact with healthcare staff, decreasing the possibility of transmission of COVID-19. Conversely, Italy is presently considered the epicenter of the outbreak in Europe and has recorded the highest death toll of any country outside of mainland China. This is partially due to the reactionary nature of Italy’s public health measures compared to South Korea’s proactive response. The different healthcare responses of South Korea and Italy can inform decisions made by public health bodies in other countries, especially in countries across the Americas, which can selectively adopt policies that have worked in curtailing the spread of COVID-19 and learn from mistakes made by both countries.

In order to address the COVID-19 pandemic, countries and health institutions must have the capacity to respond with human resources that are sufficient in quantity and possess the skills and capacities necessary to meet the needs of the population in a timely, relevant, efficient, and effective manner. Effective management of human resources will allow health systems to respond in a timely manner, improve health care outcomes, rationalize the use of resources, and reduce the stress on staff. The COVID-19 pandemic presents challenges to ensure the availability of health personnel in areas of high demand with the necessary capacities to respond adequately to increased demand and expansion of services as well as the possible reduction in available personnel due to, among other things, illness, risk situations, and personal or family issues. Planning of human resources is essential to ensure preparedness for response, enhance surge capacity, and ensure a sufficient supply of health workers that are more efficient and productive, providing them with the training, protections, rights, recognition, and tools necessary to undertake their roles.

To the Editor, Recently, the associations between COVID‐19 and its comorbidities including hypertension, diabetes, obesity, cardiovascular disease, chronic obstructive pulmonary disease, chronic kidney disease, immunosuppression and other diseases have been reported in the many studies.1 However, there is no clear evidence about whether patients with asthma were at a higher risk of severe or fatal COVID‐19. Respiratory viral infections are one of the most common triggers for asthma exacerbations. Some studies have provided data about the prevalence of asthma in severe or fatal COVID‐19 patients.2-5 Higher levels of evidence are required to investigate the association between severe or fatal COVID‐19 and asthma. Thus, we performed this systematic review and meta‐analysis. We systematically conducted an electronic literature search in PubMed, EMBASE, Cochrane library, Web of Science and China National Knowledge Infrastructure (CNKI), using the keywords “asthma” or “respiratory diseases” AND “2019‐nCoV” or “novel coronavirus” or “coronavirus disease 2019” or “SARS‐CoV‐2” or “COVID‐19” from their inception up to 5 August 2020. The search was not restricted by language. Studies were selected if they fulfilled the following entry criteria: (a) patients must be diagnosed with COVID‐19 infection and (b) provided information of asthma with severe or non‐severe or between death and survivors. Abstracts, letters, case reports, literature review articles, letters to the editor and/or editorials were excluded. For each study, the following data were abstracted: name of the first author, country where the cohort was conducted, size of the cohort, numbers of males and females, age range or mean and outcomes of interest. The severity of the disease was mainly determined on the basis of symptom (eg patients with pulse oxygen saturation less than 90%, or required mechanical ventilation, or with acute respiratory distress syndrome, or admitted to intensive care unit). For non‐random controlled studies, a nine‐item Newcastle‐Ottawa Scale (NOS) was used as an assessment tool for selection, comparability and outcome assessment by two investigators (YW and GA). A total score of ≥7 indicated a high‐quality study, whereas a total score of <7 was considered to a low‐quality study. If necessary, the primary authors were contacted to retrieve further data. The literature search, eligible study selection and data extraction were performed independently by two authors (YW and GA). Any disagreements were resolved with a third investigator or by consensus. Review Manager 5.3 (Cochrane Collaboration) was used to calculate the individual and pooled odds ratio (OR) with their relative 95% confidence interval (95% CI). Heterogeneity among studies was assessed with Cochran's Q test and the I2 statistic, with an I2 < 25%, 25%‐50% and greater than 50% represented low, moderate and high heterogeneity, respectively. In addition, sensitivity analysis was conducted to evaluate the stability of the outcome and was performed by excluding 1 study at a time. P < .05 was considered statistically significant. This study is registered with PROSPERO, number CRD42020203058. In total, the search strategy retrieved 457 studies based on our search criteria. After exclusion of duplicate records and studies that did not fulfil our inclusion criteria, 72 articles remained and we further evaluated the full texts of these 72 literatures. Of these, we excluded 58 studies owing to lack of sufficient information for estimation of OR and not an outcome of interest. Finally, a total of 14 publications representing data from 17 694 participants were included in this meta‐analysis.1-14 The sample size of patients ranged from 69 to 9946. Six studies were from America, two studies from Mexico, two studies from China and four studies from other countries. Asthma is defined according to the patient's medical history. All studies were published in English. The details of each included study are presented in Table 1. The NOS scores of these studies ranged from 7 to 9, which indicated that all data sets were of high quality (Table S1). The meta‐analysis showed that patients with severe COVID‐19 disease were not associated with an increased risk of asthma than non‐severe COVID‐19 patients (OR = 1.36, 95% CI: 0.79‐2.34, P = .27; I2 = 77%) (Figure 1A). Moreover, asthma was not associated with increased risk of mortality in patients with COVID‐19 (OR = 1.03, 95% CI: 0.55‐1.93, P = .92; I2 = 76%) (Figure 1B). The subgroup analysis based on countries suggested no significant relationship between asthma and risk of severe COVID‐19 disease in America (OR = 1.30, 95% CI: 0.57 to 2.98, P = .53; I2 = 84%). Sensitivity analyses by omitting each study at a time did not significantly alter the direction of the overall estimates.