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Introduction: Conflict-induced displacement makes affected populations more vulnerable to HIV transmission. However, this vulnerability does not always necessarily translate into more HIV infections. The extent to which conflict and displacement affect HIV transmission depends upon numerouscompeting and interacting factors such as loss of livelihoods; availability of education; the type and the length of conflict; the living arrangements and conditions of internally displaced persons (IDPs), whether formal or informal settlement; the context of their new location; and access to health services, including HIV and sexual and reproductive health programs. These factors also have direct implications for HIV vulnerability. Vulnerability results from individual and societal factors that affect adversely one’s ability to exert control over one’s own health. The factors pertaining to the quality of coverage of services and programs also influence HIV vulnerability. The characteristics of the HIV epidemic, the prevalence in the local populations, the interactions with armed forces, the occurrence of sexual violence and the risk behaviours associated with the new situations conditions of IDPs directly affect the risk of HIV transmission. HIV risk is defined as the probability that a person may acquire HIV infection by, for example, unprotected sex with partners or injecting drug use with shared needles and syringes...

Background: Several guidelines to guide clinical practice among esophagogastric surgeons during the COVID-19 pandemic were produced. However, none provide reflection of current service provision. This international survey aimed to clarify the changes observed in esophageal and gastric cancer management and surgery during the COVID-19 pandemic. Methods: An online survey covering key areas for esophagogastric cancer services, including staging investigations and oncological and surgical therapy before and during (at two separate time-points—24th March 2020 and 18th April 2020) the COVID-19 pandemic were developed. Results: A total of 234 respondents from 225 centers and 49 countries spanning six continents completed the first round of the online survey, of which 79% (n = 184) completed round 2. There was variation in the availability of staging investigations ranging from 26.5% for endoscopic ultrasound to 62.8% for spiral computed tomography scan. Definitive chemoradiotherapy was offered in 14.8% (adenocarcinoma) and 47.0% (squamous cell carcinoma) of respondents and significantly increased by almost three-fold and two-fold, respectively, in both round 1 and 2. There were uncertainty and heterogeneity surrounding prioritization of patients undergoing cancer resections. Of the surgeons symptomatic with COVID-19, only 40.2% (33/82) had routine access to COVID-19 polymerase chain reaction testing for staff. Of those who had testing available (n = 33), only 12.1% (4/33) had tested positive. Conclusions: These data highlight management challenges and several practice variations in caring for patients with esophagogastric cancers. Therefore, there is a need for clear consistent guidelines to be in place in the event of a further pandemic to ensure a standardized level of oncological care for patients with esophagogastric cancers.

BACKGROUND Person to person spread of COIVD-19 in the UK has now been confirmed. There are limited case series reporting the impact on women affected by coronaviruses (CoV) during pregnancy. In women affected by SARS and MERS, the case fatality rate appeared higher in women affected in pregnancy compared with non-pregnant women. We conducted a rapid, review to guide management of women affected by COVID -19 during pregnancy and developed interim practice guidance with the RCOG and RCPCH to inform maternity and neonatal service planning METHODS Searches were conducted in PubMed and MedRxiv to identify primary case reports, case series, observational studies or randomised-controlled trial describing women affected by coronavirus in pregnancy and on neonates. Data was extracted from relevant papers and the review was drafted with representatives of the RCPCH and RCOG who also provided expert consensus on areas where data were lacking...

Background: Interleukin-6 (IL-6) is known to be detrimental in coronavirus disease 2019 (COVID-19) because of its involvement in driving cytokine storm. This systematic review and meta-analysis aimed to assess the safety and efficacy of anti-IL-6 signaling (anti-IL6/IL-6R/JAK) agents on COVID-19 based on the current evidence. Methods: Studies were identified through systematic searches of PubMed, EMBASE, ISI Web of Science, Cochrane library, ongoing clinical trial registries (clinicaltrials.gov), and preprint servers (medRxiv, ChinaXiv) on August 10, 2020, as well as eligibility checks according to predefined selection criteria. Statistical analysis was performed using Review Manager (version 5.3) and STATA 12.0. Results: Thirty-one studies were included in the pooled analysis of mortality, and 12 studies were identified for the analysis of risk of secondary infections. For mortality analysis, 5630 COVID-19 cases including 2,132 treated patients and 3,498 controls were analyzed. Anti-IL-6 signaling agents plus standard of care (SOC) significantly decreased the mortality rate compared to SOC alone (pooled OR = 0.61, 95% CI 0.45–0.84, p = 0.002). For the analysis of secondary infection risk, 1,624 patients with COVID-19 including 639 treated patients and 985 controls were included, showing that anti-IL-6 signaling agents did not increase the rate of secondary infections (pooled OR = 1.21, 95% CI 0.70–2.08, p = 0.50). By contrast, for patients with critical COVID-19 disease, anti-IL-6 signaling agents failed to reduce mortality compared to SOC alone (pooled OR = 0.75, 95% CI 0.42–1.33, p = 0.33), but they tended to increase the risk of secondary infections (pooled OR = 1.85, 95% CI 0.95–3.61, p = 0.07). A blockade of IL-6 signaling failed to reduce the mechanical ventilation rate, ICU admission rate, or elevate the clinical improvement rate. Conclusion: IL-6 signaling inhibitors reduced the mortality rate without increasing secondary infections in patients with COVID-19 based on current studies. For patients with critical disease, IL-6 signaling inhibitors did not exhibit any benefit.

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.

Background: Mounting evidence suggests that there is an undetected pool of COVID-19 asymptomatic but infectious cases. Estimating the number of asymptomatic infections has been crucial to understand the virus and contain its spread, which is, however, hard to be accurately counted. Methods: We propose an approach of machine learning based fine-grained simulator (MLSim), which integrates multiple practical factors including disease progress in the incubation period, cross-region population movement, undetected asymptomatic patients, and prevention and containment strength. The interactions among these factors are modeled by virtual transmission dynamics with several undetermined parameters, which are determined from epidemic data by machine learning techniques. When MLSim learns to match the real data closely, it also models the number of asymptomatic patients. MLSim is learned from the open Chinese global epidemic data. Findings: MLSim showed better forecast accuracy than the SEIR and LSTM-based prediction models. The MLSim learned from the data of China's mainland reveals that there could have been 150,408 (142,178-157,417) asymptomatic and had self-healed patients, which is 65% (64% - 65%) of the inferred total infections including undetected ones. The numbers of asymptomatic but infectious patients on April 15, 2020, were inferred as, Italy: 41,387 (29,037 - 57,151), Germany: 21,118 (11,484 - 41,646), USA: 354,657 (277,641 - 495,128), France: 40,379 (10,807 - 186,878), and UK: 144,424 (127,215 - 171,930). To control the virus transmission, the containment measures taken by the government were crucial. The learned MLSim also reveals that if the date of containment measures in China's mainland was postponed for 1, 3, 5, and 7 days later than Jan. 23, there would be 109,039 (129%), 183,930 (218%), 313,342 (371%), 537,555 (637%) confirmed cases on June 12. Conclusions: Machine learning based fine-grained simulators can better model the complex real-world disease transmission process, and thus can help decision-making of balanced containment measures. The simulator also revealed the potential great number of undetected asymptomatic infections, which poses a great risk to the virus containment.

13th March, 2020 - ST. JOHN’S, Antigua and Barbuda – 13th March, 2020Prime Minister the Hon. Gaston Browne today announced that the country has recorded its first confirmation of someone who has contracted the coronavirus (COVID-19). “I want to emphasize that there is no need for fear or panic, arising from this case. The person concerned is in self isolation at home, and a regime has been put in place today, not only to continue such isolation, but also to treat the condition,” noted the Prime Minister. He called on the nation to be more sensible in their behaviour and be their brother’s keeper. “Let us conjoin our efforts to prevent the spread of Covid 19 within the domestic population,” he said. “Considering the challenges of Covid 19, to include the economic impact and potential threat to our food security, we have to work diligently and collectively as a nation, of one people, with a common destiny to confront these challenges,” PM Browne concluded.

The Covid 19 epidemic has modified the way that plastic surgeons can treat their patients. At our hospital all elective surgery was canceled and only the more severe cases were admitted. The outpatient department activity has been reduced also. We present the number and diagnoses of patients, treated as in- and out-patients, during seven weeks from the onset of the epidemic, comparing our activity from the lockdown of elective surgery with the numbers and diagnoses observed during the same weeks of last year. Finally we underline the importance of using telemedicine and web-based tools to transmit images of lesions that need the surgeon’s evaluation, and can be used by the patient to keep in touch with a doctor during the distressing time of delay of the expected procedure.

Purpose of Review: The goal of this review is to provide a timely overview on efforts to develop a vaccine for the 2019 novel coronavirus SARS-CoV-2, the causative agent of coronavirus disease (COVID-19). Recent Findings: Previous research efforts to develop a severe acute respiratory syndrome coronavirus (SARS-CoV) vaccine in the years following the 2003 pandemic have opened the door for investigators to design vaccine concepts and approaches for the COVID-19 epidemic in China. Both SARS-CoV and SARS-CoV-2 exhibit a high degree of genetic similarity and bind to the same host cell ACE2 receptor. Based on previous experience with SARS-CoV vaccines, it is expected that all COVID-19 vaccines will require careful safety evaluations for immunopotentiation that could lead to increased infectivity or eosinophilic infiltration. Besides this, a COVID-19 vaccine target product profile must address vaccinating at-risk human populations including frontline healthcare workers, individuals over the age of 60, and those with underlying and debilitating chronic conditions. Among the vaccine technologies under evaluation are whole virus vaccines, recombinant protein subunit vaccines, and nucleic acid vaccines. Summary: Each current vaccine strategy has distinct advantages and disadvantages. Therefore, it is paramount that multiple strategies be advanced quickly and then evaluated for safety and efficacy. Ultimately, the safety studies to minimize undesired immunopotentiation will become the most significant bottleneck in terms of time. In December 2019, a novel coronavirus pneumonia emerged in Wuhan, China, linked initially to animal-to-human transmission in local wet markets. Subsequently, human-to-human transmission of the virus commenced, resulting in widespread respiratory illness in Wuhan and other urban areas of Hubei Province, China. The coronavirus then spread across China and at least 20 other nations. On February 11, the World Health Organization named the virus SARS-CoV-2 and the syndrome was named COVID-19, or coronavirus disease 2019. Although not as lethal as the severe acute respiratory syndrome (SARS) outbreak in 2003, COVID-19 is still characterized by severe respiratory illness and significant mortality, especially among individuals over the age of 60 years and in those with underlying chronic conditions such as diabetes and hypertension. Moreover, SARS-CoV-2 is highly transmissible with an estimated reproductive number (R0) of 2.2, i.e., one infected individual is estimated to transmit the virus to 2.2 other individuals, and a mean incubation period of 5.8 days. The finding that SARS-CoV-2 is transmitted from infected individuals without symptoms, together with its ability to cause pandemic disease within a period of weeks, suggests that control of this viral infection will be challenging without the prospect of a vaccine. Here we provide a brief overview of some of the major candidates and the challenges of implementing vaccine strategies. Since much of the information about these vaccines has not yet entered the peer-reviewed literature, for this brief overview, we rely significantly on the information made publicly available on websites and other documents.

Background: The COVID-19 pandemic is the greatest public health crisis of the last 100 years. Countries have responded with various levels of lockdown to save lives and stop health systems from being overwhelmed. At the same time, lockdowns entail large socio-economic costs. One exit strategy under consideration is a mobile phone app that traces close contacts of those infected with COVID- 19. Recent research has demonstrated the theoretical effectiveness of this solution in different disease settings. However, concerns have been raised about such apps because of the potential privacy implications. This could limit the acceptability of app-based contact tracing among the general population. As the effectiveness of this approach increases strongly with app take-up, it is crucial to understand public support for this intervention. Objectives: The objective of this study is to investigate user acceptability of a contact-tracing app in five countries hit by the pandemic. Methods We conducted a multi-country, large-scale (N = 5995) study to measure public support for digital contact tracing of COVID-19 infections. We ran anonymous online surveys in France, Germany, Italy, the UK and the US. We measured intentions to use a contact-tracing app across different installation regimes (voluntary installation vs. automatic installation by mobile phone providers), and studied how these intentions vary across individuals and countries. Results: We found strong support for the app under both regimes, in all countries, across all sub-groups of the population, and irrespective of regional-level COVID-19 mortality rates. We inves- tigated the main factors that may hinder or facilitate take-up and found that concerns about cyber security and privacy, together with lack of trust in government, are the main barriers to adoption. Conclusions: Epidemiological evidence shows that app-based contact-tracing can suppress the spread of COVID-19 if a high enough proportion of the population uses the app and that it can still reduce the number of infections if take-up is moderate. Our findings show that the willingness to install the app is very high. The available evidence suggests that app-based contact tracing may be a viable approach to control the diffusion of COVID-19.