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Objective To examine transmission and evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in shipboard quarantine of the Diamond Princess cruise ship. Methods We obtained the full SARS-CoV-2 genome sequences of 28 samples from the Global Initiative on Sharing All Influenza Data database. The samples were collected between 10 and 25 February 2020 and came for individuals who had been tested for SARS-CoV-2 during the quarantine on the cruise ship. These samples were later sequenced in either Japan or the United States of America. We analysed evolution dynamics of SARS-CoV-2 using computational tools of phylogenetics, natural selection pressure and genetic linkage. Findings The SARS-CoV-2 outbreak in the cruise most likely originated from either a single person infected with a virus variant identical to the WIV04 isolates, or simultaneously with another primary case infected with a virus containing the 11083G > T mutation. We identified a total of 24 new viral mutations across 64.2% (18/28) of samples, and the virus evolved into at least five subgroups. Increased positive selection of SARS-CoV-2 were statistically significant during the quarantine (Tajima's D: -2.03, P< 0.01; Fu and Li's D: -2.66, P< 0.01; and Zeng's E: -2.37, P < 0.01). Linkage disequilibrium analysis confirmed that ribonucleic acid (RNA) recombination with the 11083G > T mutation also contributed to the increase of mutations among the viral progeny. Conclusion The findings indicate that the 11083G > T mutation of SARS-CoV-2 spread during shipboard quarantine and arose through de novo RNA recombination under positive selection pressure. Objectif Etudier la transmission et l'evolution du coronavirus 2 du syndrome respiratoire aigu severe (SARS-CoV-2) lors d'une quarantaine a bord du navire de croisiere Diamond Princess. Methodes Nous avons obtenu l'ensemble des sequences genetiques du SARS-CoV-2 de 28 echantillons issus de la base de donnees de l'Initiative mondiale de partage des donnees sur la grippe aviaire (GISAID). Ces echantillons ont ete collectes entre le 10 et le 25 fevrier 2020 et preleves sur des individus soumis a un test de depistage du SARS-CoV-2 durant la quarantaine a bord du navire. Ils ont ensuite ete sequences soit au Japon, soit aux Etats-Unis d'Amerique. Nous avons analyse la dynamique d'evolution du SARS-CoV-2 a l'aide d'outils informatiques de phylogenetique, de pression selective naturelle et de liaison genetique. Resultats Lepidemie de SARS-CoV-2 a bord provient vraisemblablement d'une seule personne infectee par un variant identique aux isolats WIV04, ou simultanement d un autre cas primaire d infection par un virus contenant la mutation 11083G > T. Nous avons detecte au total 24 nouvelles mutations virales dans 64,2% (18/28) des echantillons, et le virus a evolue en cinq sous-groupes minimum. La selection positive accrue de SARS-CoV-2 s'est revelee statistiquement significative durant la quarantaine (D de Tajima: -2,03, P < 0,01; D de Fu et Li: -2,66, P < 0,01; et E de Zeng: -2,37, P < 0,01). Lanalyse du desequilibre de liaison a confirme que la recombinaison de l'acide ribonucleique (ARN) avec la mutation 11083G > T avait egalement contribue a la hausse des mutations dans la lignee virale. Conclusion Ces resultats indiquent que la mutation 11083G > T du SARS-CoV-2 s'est repandue durant la quarantaine a bord du navire, et par le biais d'une recombinaison de novo de l'ARN sous une pression selective positive. Objetivo Examinar la transmision y la evolucion del coronavirus del sindrome respiratorio agudo grave 2 (SARS-CoV-2) en la cuarentena del crucero Diamond Princess. Metodos Obtuvimos las secuencias completas del genoma del SARSCoV-2 de 28 muestras de la base de datos de la Global Initiative on Sharing All Influenza Data. Las muestras se recogieron entre el 10 y el 25 de febrero de 2020 y procedian de individuos a los que se les habia hecho la prueba del SARS-CoV-2 durante la cuarentena en el crucero. Estas muestras se secuenciaron posteriormente en Japon o en los Estados Unidos de America. Se analizo la dinamica evolutiva del SARS-CoV-2 utilizando herramientas computacionales de filogenetica, presion de seleccion natural y enlace genetico. Resultados Lo mas probable es que el brote de SARS-CoV-2 en el crucero se haya originado a partir de una sola persona infectada con una variante del virus identica a las cepas WIV04, o bien simultaneamente con otro caso primario infectado con un virus que contenia la mutacion 11083G > T. Identificamos un total de 24 nuevas mutaciones virales en el 64,2% (18/28) de las muestras y el virus evoluciono en al menos cinco subgrupos. El aumento de la seleccion positiva del SARS-CoV-2 fue estadisticamente significativo durante la cuarentena (D de Tajima -2,03, P < 0,01; D de Fu y Li: -2,66, p < 0,01; y E de Zeng: -2,37, P < 0,01). El analisis de desequilibrio de linaje confirmo que la recombinacion del acido ribonucleico (ARN) con la mutacion 11083G > T tambien contribuyo al aumento de las mutaciones entre la progenie viral. Conclusion Los resultados indican que la mutacion 11083G > T del SARS-CoV-2 se propago durante la cuarentena en el crucero y surgio por recombinacion de novo del ARN bajo presion de seleccion positiva., Introduction On 31 December 2019, Chinese authorities alerted the World Health Organization (WHO) of an outbreak of a novel coronavirus causing severe illness with pneumonia-like symptoms. The virus was later [...]

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in South Korea on January 20, 2020 (1). By April 21, 2020, a total of 10,683 cases of coronavirus [...]

Context.--The novel coronavirus disease 2019 (COVID-19) pandemic is significantly changing methodologic approaches in all branches of the health system. From a forensic point of view, this event is partly changing the manner in which forensic pathologists and all those who work in autopsy services operate, but above all, it is changing the patterns established for years by which cadavers are analyzed postmortem. Objective.--To present a review of the literature and a proposal for COVID-19 autopsy protocols. To contain the infection risk, a revision of all the protocols that until now have been applied to the examination of bodies that require autopsy services is required. Data Sources.--Currently, the diagnosis and postmortem analysis of positive or suspected COVID-19 cases plays a crucial role in scientific research. A review of the main recommendations proposed by international scien tific societies regarding the risk of infection during autopsy was carried out. Scientific papers currently available via the PubMed NCBI search engine on COVID-19 postmortem diagnosis were also examined. Conclusions.--Throughout the history of medicine, autopsy has been fundamental to the understanding of multiple pathogenic processes that are investigated postmortem. The purpose of the study is to propose an operating protocol that can be useful for all clinical and forensic autopsies, with particular reference to the correct methods to be applied to the examination of positive or suspected COVID-19 cases, regarding both the autopsy procedure and the collection and analysis of biological samples. (Arch Pathol Lab Med. 2020;144:1048-1056; doi: 10.5858/arpa.2020-0165-SA), Coronaviruses (Coronaviridae) are a large family of microorganisms existing in nature in the form of positive-strand RNA viruses that infect vertebrates. (1,2) The family includes the subfamily Orthocoronavirinae, to which [...]

BACKGROUND. The effects of the novel coronavirus disease 2019 (COVID-19) in pregnancy remain relatively unknown. We present a case of second trimester pregnancy with symptomatic COVID-19 complicated by severe preeclampsia and placental abruption. METHODS. We analyzed the placenta for the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through molecular and immunohistochemical assays and by and electron microscopy and measured the maternal antibody response in the blood to this infection. RESULTS. SARS-CoV-2 localized predominantly to syncytiotrophoblast cells at the materno-fetal interface of the placenta. Histological examination of the placenta revealed a dense macrophage infiltrate, but no evidence for the vasculopathy typically associated with preeclampsia. CONCLUSION. This case demonstrates SARS-CoV-2 invasion of the placenta, highlighting the potential for severe morbidity among pregnant women with COVID-19. FUNDING. Beatrice Kleinberg Neuwirth Fund and Fast Grant Emergent Ventures funding from the Mercatus Center at George Mason University. The funding bodies did not have roles in the design of the study or data collection, analysis, and interpretation and played no role in writing the manuscript., Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel betacoronavirus causing the deadly pandemic of coronavirus disease 2019 (COVID-19). The risks and specific effects of SARS-CoV-2 in pregnant [...]

Objective To estimate the effect of airline travel restrictions on the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) importation. Methods We extracted passenger volume data for the entire global airline network, as well as the dates of the implementation of travel restrictions and the observation of the first case of coronavirus disease (COVID-19) in each country or territory, from publicly available sources. We calculated effective distance between every airport and the city of Wuhan, China. We modelled the risk of SARS-CoV-2 importation by estimating survival probability, expressing median time of importation as a function of effective distance. We calculated the relative change in importation risk under three different hypothetical scenarios that all resulted in different passenger volumes. Findings We identified 28 countries with imported cases of COVID-19 as at 26 February 2020. The arrival time of the virus at these countries ranged from 39 to 80 days since identification of the first case in Wuhan. Our analysis of relative change in risk indicated that strategies of reducing global passenger volume and imposing travel restrictions at a further 10 hub airports would be equally effective in reducing the risk of importation of SARS-CoV-2; however, this reduction is very limited with a close-to-zero median relative change in risk. Conclusion The hypothetical variations in observed travel restrictions were not sufficient to prevent the global spread of SARS-CoV-2; further research should also consider travel by land and sea. Our study highlights the importance of strengthening local capacities for disease monitoring and control. [phrase omitted] [phrase omitted] Objectif Evaluer les effets des restrictions de voyage par voie aerienne sur le risque d'importer le coronavirus 2 du syndrome respiratoire aigu severe (SARS-CoV-2). Methodes Nous avons preleve les donnees sur le volume de passagers pour l'ensemble du reseau aerien dans le monde, ainsi que les dates de mise en reuvre des restrictions de voyage et l'observation du premier cas de maladie a coronavirus (COVID-19) dans chaque pays ou territoire, a partir de sources accessibles au public. Nous avons calcule la distance reelle entre chaque aeroport et la ville de Wuhan, en Chine. Nous avons modelise le risque d'importation du SARS-CoV-2 en estimant sa probabilite de survie, la periode mediane d'importation etant exprimee en fonction de la distance reelle. Nous avons determine l'evolution relative du risque d'importation selon trois scenarios hypothetiques, qui ont tous debouche sur differents volumes de passagers. Resultats Nous avons identifie 28 pays ayant importe des cas de COVID-19 au 26 fevrier 2020. La date d'arrivee du virus dans ces pays s'est etalee sur une periode de 39 a 80 jours depuis la detection du premier cas a Wuhan. Notre analyse de l'evolution relative du risque a indique que les strategies de reduction du nombre global de passagers et de restriction des voyages dans 10 aeroports de premiere categorie auraient eu le meme niveau d'efficacite dans la diminution du risque d'importation du SARS-CoV-2. Neanmoins, cette diminution est tres limitee, avec une evolution relative mediane du risque proche de zero. Conclusion Les variations hypothetiques presentes dans les restrictions de voyage observees n'etaient pas suffisantes pour eviter la propagation du SARS-CoV-2 aux quatre coins de la planete. Les futures recherches a ce propos devraient egalement tenir compte des deplacements par voie terrestre et maritime. Notre etude souligne l'importance de renforcer les capacites locales de surveillance et de controle des maladies. [phrase omitted] Objetivo Estimar el efecto de las restricciones a los viajes en avion sobre el riesgo de importacion del coronavirus tipo 2 del sindrome respiratorio agudo grave (SARS-CoV-2). Metodos Se obtuvieron los datos sobre el volumen de pasajeros de toda la red global de aerolineas, asi como las fechas en las que se implementaron las restricciones de viaje y la observacion del primer caso de la enfermedad del coronavirus (COVID-19) en cada pais o territorio, a partir de fuentes a disposicion del publico. Se calculo la distancia efectiva entre cada aeropuerto y la ciudad de Wuhan, China. Se diseno un modelo del riesgo de importacion del SARS-CoV-2 al estimar la probabilidad de supervivencia, que indica el tiempo medio de importacion en funcion de la distancia efectiva. Se calculo el cambio relativo en el riesgo de importacion bajo tres escenarios hipoteticos diferentes que arrojaron valores distintos sobre el volumen de pasajeros. Resultados Se identificaron 28 paises con casos importados de la COVID-19 al 26 de febrero de 2020. El tiempo de llegada del virus a estos paises oscilo entre 39 y 80 dias desde la identificacion del primer caso en Wuhan. El analisis que se expone aqui sobre el cambio relativo del riesgo indico que las estrategias orientadas a reducir el volumen de pasajeros a nivel mundial y a imponer restricciones a los viajes en otros 10 aeropuertos centrales serian igualmente efectivas para reducir el riesgo de importacion del SARS-CoV-2; sin embargo, esta reduccion es muy limitada si se tiene en cuenta que el cambio relativo medio del riesgo es casi nulo. Conclusion Las variaciones hipoteticas de las restricciones de viaje que se observaron no fueron suficientes para impedir la propagacion global del SRAS-CoV-2; ademas, se deberia analizar la posibilidad de viajar por tierra y por mar en las investigaciones futuras. Este estudio destaca la importancia de fortalecer la capacidad local para monitorear y controlar la enfermedad., Introduction As of 25 May 2020, 347 697 deaths resulting from 5 392 654 laboratory-confirmed infectious cases of coronavirus disease (COVID-19) had been reported. (1,2) Global travel contributed to the [...]

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has raised serious concerns because of its rapid dissemination worldwide. Italy is one of the countries with the highest number of coronavirus disease [...]

On December 31, 2019, a cluster of atypical pneumonia in Wuhan, China, was reported to the regional office of the World Health Organization (WHO). Its etiology was later identified as [...]

Background COVID-19 could have even more dire consequences in refugees camps than in general populations. Bangladesh has confirmed COVID-19 cases and hosts almost 1 million Rohingya refugees from Myanmar, with 600,000 concentrated in the Kutupalong-Balukhali Expansion Site (mean age, 21 years; standard deviation [SD], 18 years; 52% female). Projections of the potential COVID-19 burden, epidemic speed, and healthcare needs in such settings are critical for preparedness planning. Methods and findings To explore the potential impact of the introduction of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the Kutupalong-Balukhali Expansion Site, we used a stochastic Susceptible Exposed Infectious Recovered (SEIR) transmission model with parameters derived from emerging literature and age as the primary determinant of infection severity. We considered three scenarios with different assumptions about the transmission potential of SARS-CoV-2. From the simulated infections, we estimated hospitalizations, deaths, and healthcare needs expected, age-adjusted for the Kutupalong-Balukhali Expansion Site age distribution. Our findings suggest that a large-scale outbreak is likely after a single introduction of the virus into the camp, with 61%-92% of simulations leading to at least 1,000 people infected across scenarios. On average, in the first 30 days of the outbreak, we expect 18 (95% prediction interval [PI], 2-65), 54 (95% PI, 3-223), and 370 (95% PI, 4-1,850) people infected in the low, moderate, and high transmission scenarios, respectively. These reach 421,500 (95% PI, 376,300-463,500), 546,800 (95% PI, 499,300-567,000), and 589,800 (95% PI, 578,800-595,600) people infected in 12 months, respectively. Hospitalization needs exceeded the existing hospitalization capacity of 340 beds after 55-136 days, between the low and high transmission scenarios. We estimate 2,040 (95% PI, 1,660-2,500), 2,650 (95% PI, 2,030-3,380), and 2,880 (95% PI, 2,090-3,830) deaths in the low, moderate, and high transmission scenarios, respectively. Due to limited data at the time of analyses, we assumed that age was the primary determinant of infection severity and hospitalization. We expect that comorbidities, limited hospitalization, and intensive care capacity may increase this risk; thus, we may be underestimating the potential burden. Conclusions Our findings suggest that a COVID-19 epidemic in a refugee settlement may have profound consequences, requiring large increases in healthcare capacity and infrastructure that may exceed what is currently feasible in these settings. Detailed and realistic planning for the worst case in Kutupalong-Balukhali and all refugee camps worldwide must begin now. Plans should consider novel and radical strategies to reduce infectious contacts and fill health worker gaps while recognizing that refugees may not have access to national health systems., Author(s): Shaun Truelove 1,2,3,4, Orit Abrahim 1,3, Chiara Altare 1,3, Stephen A. Lauer 1,2, Krya H. Grantz 1,2, Andrew S. Azman 1,2,3, Paul Spiegel 1,3,* Introduction Severe acute respiratory syndrome [...]

Phylogenetic analyses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) suggest virus emergence weeks, if not months, before the World Health Organization was notified of the original cluster of cases [...]

Background and objectives of an informal network coordinated by WHo Mathematical and computational models are useful tools for elucidating the non-linear transmission dynamics of epidemics, for analysing epidemiological data and [...]