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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.

General recommendations: Administration of vaccines in accordance with the immunization schedules summarized in the following tables will provide optimal protection from vaccine preventable diseases for most individuals. However, modifications of the recommended schedule may be necessary due to missed appointments or illness. In general, interruption of an immunization series does not require restarting the vaccine series, regardless of the interval between doses. Individuals with interrupted immunization schedules should be vaccinated to complete the appropriate schedule for their current age. Refer to Timing of vaccine administration in Part 1 and vaccine-specific chapters in Part 4 for additional information. Similar, but not identical, vaccines may be available from different manufacturers; therefore, it is useful to review the relevant vaccine-specific chapters in the Canadian Immunization Guide as well as the manufacturer's product leaflet or product monograph before administering a vaccine. Refer to Principles of vaccine interchangeability in Part 1 for information about the interchangeability of similar vaccines from different manufacturers. Product monographs are periodically updated; it is a best practice to consult the information contained within the product monographs available through Health Canada's Drug Product Database.

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.

COVID-19 is associated with a systemic inflammatory response with activation of coagulation in symptomatic patients. The possibility of coagulopathies in peri- and postmenopausal women taking estrogen therapies makes it necessary to consider antithrombotic strategies, such as the use of low molecular weight heparins (LMWH) at specific prophylactic or treatment doses for each individual case, depending on the risk factors that each woman presents. For such reasons, a panel of experts from various Spanish scientific societies has met to develop usage re- commendations for managing menopausal women taking menopausal hormone therapy (MHT) or combined hormonal contraception (CHC) during the COVID-19 pandemic.

BACKGROUND: An emerging issue in the management of the novel COVID-19 coronavirus is morbidity and mortality associated with venous thrombolytic events. Apart from respiratory failure, coagulopathy is a common abnormality in patients with COVID‐19, with elevated levels of both fibrinogen and D‐dimer. For example, Oudkerk at al noted a number of case studies describing thrombolytic events in COVID-19 patients in their report, raising concerns about this issue. When considering management advice for patients with COVID-19 it is important to consider two factors. Firstly, what are the risk factors associated with thrombolytic events in COVID-19 patients? Secondly, what are the optimal strategies for prophylaxis and treatments for thrombolytic events in this patient groups? Understanding the current evidence for both risk factors and management strategies for venous thrombolytic events (VTE) in the these groups will aid clinical decision making. To contribute to this knowledge base, we conducted a rapid literature review using a systematic search method to identify relevant studies in relation to risk factors or managements of VTEs. METHODS: Studies included in this review were primary studies which assess risks and management of thrombolytic events in COVID-19 patients. The following search strategy was applied to Medline and EMBASE on 07/05/2020 with no limits. (“COVID-19” or COVID19 or COVID-19 or “coronavirus disease 2019” or “coronavirus disease-19” or “2019-nCoV disease” or “severe acute respiratory syndrome coronavirus 2” or “Wuhan coronavirus” or “COVID-19 virus” or “SARS-CoV-2” or “SARS2” or “2019-nCoV” or “2019 novel coronavirus” or “2019 novel coronavirus infection” AND (“D-dimer” or “coagulation parameter” or “venous thromboembolism” or “novel coronavirus pneumonia” or “blood coagulation” or “fibrin fibrinogen degradation products” or “vein thrombosis” or “thrombosis” or “lung embolism” or “PE” or “thromboembolism” or “venous thromboembolism” or “pulmonary embolism “).af. RESULTS: Included studies. The search returned 364 studied after duplicates were removed, of which 9 were included. Most of the studies which were included from France (4 studies) the other studies came from Italy (2 studies), China (1 study), the USA (1 study) and the Netherlands (1 study). Most studies were Retrospective case series, this includes Bozzani et al, Cui et al, Griffin et al, Klok et al, Leonard-Lorant et al, Llitjos et al, Poissy et al. There was one retrospective cohort study, Lodigiani et al, and one prospective cohort study, Helms et al [...]

Since the SARS-CoV-2 outbreak rapidly evolved into a pandemic, there is an urgent need for rapid development, identification and confirmation of efficacious antiviral prophylaxis. In this setting, the existing drugs chloroquine (CQ) and hydroxychloroquine (HCQ) which has suggestive evidence of efficacy against SARS-CoV-2 infection and COVID-19 disease has become prime candidates to be repositioned as therapeutic and preventative agents, and a growing number of clinical trials have been registered to study their preventative potential for at-risk populations using a range of dosing schemes and outcome measures. This rapid systematic review protocol aims to provide streamlined and timely synthesis on methodologies and results of randomized controlled trials assessing the efficacy of CQ and HCQ in hopes that this will constructively inform further research as well as public health policy.

The COVID-19 epidemic started in the Hubei province in China in December 2019 and then spread around the world reaching the pandemic stage at the beginning of March 2020. Since then, several countries went into lockdown. We estimate the effect of the lockdown in France on the contact rate and the effective reproduction number Re of the COVID-19. We obtain a reduction by a factor 7 (Re=0.47, 95%-CI: 0.45-0.50), compared to the estimates carried out in France at the early stage of the epidemic. We also estimate the fraction of the population that would be infected by the beginning of May, at the official date at which the lockdown should be relaxed. We find a fraction of 3.7% (95%-CI: 3.0-4.8%) of the total French population, without taking into account the number of recovered individuals before April 1st, which is not known. This proportion is seemingly too low to reach herd immunity. Thus, even if the lockdown strongly mitigated the first epidemic wave, keeping a low value of Re is crucial to avoid an uncontrolled second wave (initiated with much more infectious cases than the first wave) and to hence avoid the saturation of hospital facilities. Our approach is based on the mechanistic-statistical formalism, which uses a probabilistic model to connect the data collection process and the latent epidemiological process, which is described by a SIR-type differential equation model.

Data show that children are less severely affected with SARS-Covid-19 than adults; however, there have been a small proportion of children who have been critically unwell. In this systematic review, we aimed to identify and describe which underlying comorbidities may be associated with severe SARS-CoV-2 disease and death. The study protocol was in keeping with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A total of 1726 articles were identified of which 28 studies fulfilled the inclusion criteria. The 28 studies included 5686 participants with confirmed SARS-CoV-2 infection ranging from mild to severe disease. We focused on the 108 patients who suffered from severe/critical illness requiring ventilation, which included 17 deaths. Of the 108 children who were ventilated, the medical history was available for 48 patients. Thirty-six of the 48 patients (75%) had documented comorbidities of which 11/48 (23%) had pre-existing cardiac disease. Of the 17 patients who died, the past medical history was reported in 12 cases. Of those, 8/12 (75%) had comorbidities. Conclusion: Whilst only a small number of children suffer from COVID-19 disease compared to adults, children with comorbidities, particularly pre-existing cardiac conditions, represent a large proportion of those that became critically unwell.

At present, COVID-19 is raging all over the world. Many comorbidities, such as diabetes mellitus (OR = 2.67, 95% CI = 1.91–3.74) and hypertension (OR = 2.3, 95% CI = 1.76–3.00), have been shown to worsen the patient’s condition. However, whether cardio-cerebrovascular disease will affect COVID-19 remains unclear. In this meta-analysis, we collected studies from PubMed, Wed of Science and CNKI (Chinese) to July 25, which reported COVID-19 patients with and without cardio-cerebrovascular disease as well as their severity and mortality. The random-effect model meta-analysis was used to analyze them and get overall odds ratios (OR) with 95% CIs. Funnel plots and the Begg’s and Egger’s test were used to assess publication bias. Thirty-one studies with 23,632 patients were finally included in the meta-analysis. The results showed an OR of 3.004 (95% CI = 2.097–4.303) for COVID-19 severity and an OR of 5.587 (95% CI = 2.810–11.112) for COVID-19 mortality. Compared with cardiovascular disease, the subgroup analysis indicated that cerebrovascular disease was more likely to increase the severity (OR = 3.400, 95% CI = 1.569–7.368) and mortality (OR = 23.477, 95% CI = 3.050–180.735) of COVID-19. Therefore, it can be inferred that cardio-cerebrovascular disease is associated with an increase in the risk of severe illness and death among COVID-19 patients. This meta-analysis showed that cardio-cerebrovascular disease has a significant relation with severe and death outcomes of COVID-19. Nurses should pay special attention to COVID-19 patients with the cardio-cerebrovascular disease.

Rationale: The COVID‐19 pandemic affects diverse groups of women and men differently. The risks and consequences are disproportionately felt by certain groups, especially those living in situations of vulnerability and those who experience discrimination. It is vital that country responses to COVID-19 consider equity, gender, ethnicity, and human rights perspectives to: • prevent the expansion of inequalities; • account for the everyday lived realities of different groups that may affect the success of measures. Objectives: • To function as a “first port of call” for national health policy makers to support their efforts to integrate and enhance equity, gender, ethnicity and human rights considerations and approaches into measures responding to COVID-19; • To provide links to sources of related information and guidelines, where available.