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Resources concerning the COVID-19 pandemic

Nutrition - collection of COVID-19 related papers

Suggestions for conducting IAEA Nutrition Studies during the COVID-19 pandemic

NAHRES participation in Webinar: COVID-19 Emergency Response: The African Nutrition Perspectives

Nuclear Medicine - collection of COVID-19 related papers

To support medical staff to be aware of medical evidence published during this heath crisis, the Section of Nuclear Medicine and Diagnostic Imaging at the International Atomic Energy Agency has prepared a compilation of Peer Reviewed published studies pertaining to Radiation Medicine.

The objective was to 1) develop an understanding of the literature that has evolved since December 2019 surrounding the novel Coronavirus 2019 infection (2019-nCoV/SARS-CoV-2) and its subsequent disease (COVID-19) in relation Medical Imaging, focusing on CT; and 2) assess the regionally available diagnostic capabilities for the COVID-19 epidemic.

The 107 publications from China, and 17 publications from outside of China were collected into a table following a systematic search, with a view to allow those in the field of medical imaging to confidently review current data. The stark ratio of geographical difference will soon be very different, but for now, a compendium of predominantly Chinese cohorts explains how medical imaging is applied, practiced, and evaluated in the context of the COVID-19 pandemic.

The systematic search is up to date from 01/12/19 till 13/04/20 and was conducted using PubMed, Web of Science, and Embase, with verified search strings. A total of 270 articles pertaining to COVID-19 were found to be relevant to Radiation Medici ne/Diagnostic Imaging, and 146 of these were excluded on the basis of language other than English or for not presenting scientifically concluded matter- these included the exclusion of editorials, commentaries, and opinion pieces.

The 124 articles presented have been stratified in addressing one (or more) of four categories A) Epidemiological data, B) Health System Burden, C) Diagnostic Methods, D) Treatment Research/Methods.

Most articles do not address the Health System burden. As noted by many global health agencies, this will be the crippling blow from this pandemic, and thus, this finding should be a call for those in medical imaging to be more observant of the access and feasibility issues surrounding the field's contribution in the management of COVID-19.

We also welcome you to browse the compilation of recommendations and guidelines published by leading societies, organisations, and institutions provided on this page.

COVID-19 13.04 NAHU Articles (Excel)

COVID-19 Imaging Findings

Radiation Oncology - collection of COVID-19 related papers

Recommendations for RTTs - published by ESTRO

Achard, V., P. Tsoutsou, and T. Zilli, Radiotherapy in the time of the Coronavirus pandemic: when less is better. Int J Radiat Oncol Biol Phys, 2020.

Aslam, S. and M.R. Mehra, COVID-19: Yet Another Coronavirus Challenge in Transplantation. The Journal of Heart and Lung Transplantation, 2020.

Cao, B., Y. Wang, D. Wen, W. Liu, J. Wang, G. Fan, L. Ruan, B. Song, Y. Cai, M. Wei, X. Li, J. Xia, N. Chen, J. Xiang, T. Yu, T. Bai, X. Xie, L. Zhang, C. Li, Y. Yuan, H. Chen, H. Li, H. Huang, S. Tu, F. Gong, Y. Liu, Y. Wei, C. Dong, F. Zhou, X. Gu, J. Xu, Z. Liu, Y. Zhang, H. Li, L. Shang, K. Wang, K. Li, X. Zhou, X. Dong, Z. Qu, S. Lu, X. Hu, S. Ruan, S. Luo, J. Wu, L. Peng, F. Cheng, L. Pan, J. Zou, C. Jia, J. Wang, X. Liu, S. Wang, X. Wu, Q. Ge, J. He, H. Zhan, F. Qiu, L. Guo, C. Huang, T. Jaki, F.G. Hayden, P.W. Horby, D. Zhang, and C. Wang, A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19. N Engl J Med, 2020.
BACKGROUND: No therapeutics have yet been proven effective for the treatment of severe illness caused by SARS-CoV-2. METHODS: We conducted a randomized, controlled, open-label trial involving hospitalized adult patients with confirmed SARS-CoV-2 infection, which causes the respiratory illness Covid-19, and an oxygen saturation (Sao2) of 94% or less while they were breathing ambient air or a ratio of the partial pressure of oxygen (Pao2) to the fraction of inspired oxygen (Fio2) of less than 300 mm Hg. Patients were randomly assigned in a 1:1 ratio to receive either lopinavir-ritonavir (400 mg and 100 mg, respectively) twice a day for 14 days, in addition to standard care, or standard care alone. The primary end point was the time to clinical improvement, defined as the time from randomization to either an improvement of two points on a seven-category ordinal scale or discharge from the hospital, whichever came first. RESULTS: A total of 199 patients with laboratory-confirmed SARS-CoV-2 infection underwent randomization; 99 were assigned to the lopinavir-ritonavir group, and 100 to the standard-care group. Treatment with lopinavir-ritonavir was not associated with a difference from standard care in the time to clinical improvement (hazard ratio for clinical improvement, 1.24; 95% confidence interval [CI], 0.90 to 1.72). Mortality at 28 days was similar in the lopinavir-ritonavir group and the standard-care group (19.2% vs. 25.0%; difference, -5.8 percentage points; 95% CI, -17.3 to 5.7). The percentages of patients with detectable viral RNA at various time points were similar. In a modified intention-to-treat analysis, lopinavir-ritonavir led to a median time to clinical improvement that was shorter by 1 day than that observed with standard care (hazard ratio, 1.39; 95% CI, 1.00 to 1.91). Gastrointestinal adverse events were more common in the lopinavir-ritonavir group, but serious adverse events were more common in the standard-care group. Lopinavir-ritonavir treatment was stopped early in 13 patients (13.8%) because of adverse events. CONCLUSIONS: In hospitalized adult patients with severe Covid-19, no benefit was observed with lopinavir-ritonavir treatment beyond standard care. Future trials in patients with severe illness may help to confirm or exclude the possibility of a treatment benefit. (Funded by Major Projects of National Science and Technology on New Drug Creation and Development and others; Chinese Clinical Trial Register number, ChiCTR2000029308.).

Chen, L., J. Xiong, L. Bao, and Y. Shi, Convalescent plasma as a potential therapy for COVID-19. The Lancet Infectious Diseases, 2020, 20(4): p. 398-400.

Filippi, A.R., E. Russi, S.M. Magrini, and R. Corvo, Covid-19 Outbreak in Northern Italy: First Practical Indications for Radiotherapy Departments. Int J Radiat Oncol Biol Phys, 2020.

Guan, W.J., Z.Y. Ni, Y. Hu, W.H. Liang, C.Q. Ou, J.X. He, L. Liu, H. Shan, C.L. Lei, D.S.C. Hui, B. Du, L.J. Li, G. Zeng, K.Y. Yuen, R.C. Chen, C.L. Tang, T. Wang, P.Y. Chen, J. Xiang, S.Y. Li, J.L. Wang, Z.J. Liang, Y.X. Peng, L. Wei, Y. Liu, Y.H. Hu, P. Peng, J.M. Wang, J.Y. Liu, Z. Chen, G. Li, Z.J. Zheng, S.Q. Qiu, J. Luo, C.J. Ye, S.Y. Zhu, N.S. Zhong, and C. China Medical Treatment Expert Group for, Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med, 2020.
BACKGROUND: Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. METHODS: We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. RESULTS: The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. CONCLUSIONS: During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.).

Habibi, R., G.L. Burci, T.C. de Campos, D. Chirwa, M. Cinà, S. Dagron, M. Eccleston-Turner, L. Forman, L.O. Gostin, B.M. Meier, S. Negri, G. Ooms, S. Sekalala, A. Taylor, A.E. Yamin, and S.J. Hoffman, Do not violate the International Health Regulations during the COVID-19 outbreak. The Lancet, 2020, 395(10225): p. 664-666.

Han, H., Q. Luo, F. Mo, L. Long, and W. Zheng, SARS-CoV-2 RNA more readily detected in induced sputum than in throat swabs of convalescent COVID-19 patients. The Lancet Infectious Diseases, 2020.

Holshue, M.L., C. DeBolt, S. Lindquist, K.H. Lofy, J. Wiesman, H. Bruce, C. Spitters, K. Ericson, S. Wilkerson, A. Tural, G. Diaz, A. Cohn, L. Fox, A. Patel, S.I. Gerber, L. Kim, S. Tong, X. Lu, S. Lindstrom, M.A. Pallansch, W.C. Weldon, H.M. Biggs, T.M. Uyeki, S.K. Pillai, and V.C.I.T. Washington State -nCo, First Case of 2019 Novel Coronavirus in the United States. N Engl J Med, 2020, 382(10): p. 929-936.
An outbreak of novel coronavirus (2019-nCoV) that began in Wuhan, China, has spread rapidly, with cases now confirmed in multiple countries. We report the first case of 2019-nCoV infection confirmed in the United States and describe the identification, diagnosis, clinical course, and management of the case, including the patient's initial mild symptoms at presentation with progression to pneumonia on day 9 of illness. This case highlights the importance of close coordination between clinicians and public health authorities at the local, state, and federal levels, as well as the need for rapid dissemination of clinical information related to the care of patients with this emerging infection.

Krengli, M., E. Ferrara, F. Mastroleo, M. Brambilla, and U. Ricardi, Running a Radiation Oncology Department at the time of coronavirus: an Italian experience. Advances in Radiation Oncology, 2020.

Lee, E.Y.P., M.-Y. Ng, and P.-L. Khong, COVID-19 pneumonia: what has CT taught us? The Lancet Infectious Diseases, 2020, 20(4): p. 384-385.

Lee, I.K., C.C. Wang, M.C. Lin, C.T. Kung, K.C. Lan, and C.T. Lee, Effective strategies to prevent coronavirus disease-2019 (COVID-19) outbreak in hospital. J Hosp Infect, 2020.

Legido-Quigley, H., N. Asgari, Y.Y. Teo, G.M. Leung, H. Oshitani, K. Fukuda, A.R. Cook, L.Y. Hsu, K. Shibuya, and D. Heymann, Are high-performing health systems resilient against the COVID-19 epidemic? Lancet, 2020, 395(10227): p. 848-850.

Li, Q., X. Guan, P. Wu, X. Wang, L. Zhou, Y. Tong, R. Ren, K.S.M. Leung, E.H.Y. Lau, J.Y. Wong, X. Xing, N. Xiang, Y. Wu, C. Li, Q. Chen, D. Li, T. Liu, J. Zhao, M. Liu, W. Tu, C. Chen, L. Jin, R. Yang, Q. Wang, S. Zhou, R. Wang, H. Liu, Y. Luo, Y. Liu, G. Shao, H. Li, Z. Tao, Y. Yang, Z. Deng, B. Liu, Z. Ma, Y. Zhang, G. Shi, T.T.Y. Lam, J.T. Wu, G.F. Gao, B.J. Cowling, B. Yang, G.M. Leung, and Z. Feng, Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med, 2020, 382(13): p. 1199-1207.
BACKGROUND: The initial cases of novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, Hubei Province, China, in December 2019 and January 2020. We analyzed data on the first 425 confirmed cases in Wuhan to determine the epidemiologic characteristics of NCIP. METHODS: We collected information on demographic characteristics, exposure history, and illness timelines of laboratory-confirmed cases of NCIP that had been reported by January 22, 2020. We described characteristics of the cases and estimated the key epidemiologic time-delay distributions. In the early period of exponential growth, we estimated the epidemic doubling time and the basic reproductive number. RESULTS: Among the first 425 patients with confirmed NCIP, the median age was 59 years and 56% were male. The majority of cases (55%) with onset before January 1, 2020, were linked to the Huanan Seafood Wholesale Market, as compared with 8.6% of the subsequent cases. The mean incubation period was 5.2 days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of the distribution at 12.5 days. In its early stages, the epidemic doubled in size every 7.4 days. With a mean serial interval of 7.5 days (95% CI, 5.3 to 19), the basic reproductive number was estimated to be 2.2 (95% CI, 1.4 to 3.9). CONCLUSIONS: On the basis of this information, there is evidence that human-to-human transmission has occurred among close contacts since the middle of December 2019. Considerable efforts to reduce transmission will be required to control outbreaks if similar dynamics apply elsewhere. Measures to prevent or reduce transmission should be implemented in populations at risk. (Funded by the Ministry of Science and Technology of China and others.).

Liang, W., W. Guan, R. Chen, W. Wang, J. Li, K. Xu, C. Li, Q. Ai, W. Lu, H. Liang, S. Li, and J. He, Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol, 2020, 21(3): p. 335-337.

Liu, K., Y. Chen, R. Lin, and K. Han, Clinical feature of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect, 2020.
BACKGROUND: Due to the general susceptibility of new coronaviruses, the clinical characteristics and outcomes of elderly and young patients may be different. OBJECTIVE: To analyze the clinical characteristics of elderly patients with new-type coronavirus pneumonia (COVID-19). METHODS: This is a retrospective study of patients with new coronavirus pneumonia (COVID-19) who were hospitalized in Hainan Provincial People's Hospital from January 15, 2020 to February 18, 2020. Compare the clinical characteristics of elderly with Young and Middle-aged patients. RESULTS: A total of 56 patients were evaluated, 18 elderly patients (32.14%), and 38 young and middle-aged patients (67.86%). The most common symptoms in both groups were fever, followed by cough and sputum. Four patients in the elderly group received negative pressure ICU for mechanical ventilation, and five patients in the young and middle-aged group. One patient died in the elderly group (5.56%), and two patients died in the young and middle-aged group (5.26%). The PSI score of the elderly group was higher than that of the young and middle-aged group (P<0.001). The proportion of patients with PSI grades IV and V was significantly higher in the elderly group than in the young and middle-aged group (P<0.05). The proportion of multiple lobe involvement in the elderly group was higher than that in the young and middle-aged group (P<0.001), and there was no difference in single lobe lesions between the two groups. The proportion of lymphocytes in the elderly group was significantly lower than that in the young and middle-aged group (P<0.001), and the C-reactive protein was significantly higher in the young group (P<0.001). The Lopinavir and Ritonavir Tablets, Chinese medicine, oxygen therapy, and mechanical ventilation were statistically different in the elderly group and the young and middle-aged group, and the P values were all <0.05.

Moss, P., G. Barlow, N. Easom, P. Lillie, and A. Samson, Lessons for managing high-consequence infections from first COVID-19 cases in the UK. Lancet, 2020, 395(10227): p. e46.

Qiao, J., What are the risks of COVID-19 infection in pregnant women? The Lancet, 2020, 395(10226): p. 760-762.

Raoult, D., P.R. Hsueh, S. Stefani, and J.M. Rolain, COVID-19 Therapeutic and Prevention. Int J Antimicrob Agents, 2020: p. 105937.

Rasmussen, S.A., J.C. Smulian, J.A. Lednicky, T.S. Wen, and D.J. Jamieson, Coronavirus Disease 2019 (COVID-19) and Pregnancy: What obstetricians need to know. Am J Obstet Gynecol, 2020.
Coronavirus Disease 2019 (COVID-19) is an emerging disease with a rapid increase in cases and deaths since its first identification in Wuhan, China, in December 2019. Limited data are available about COVID-19 during pregnancy; however, information on illnesses associated with other highly pathogenic coronaviruses (i.e., severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS)) might provide insights into COVID-19's effects during pregnancy.

Rothan, H.A. and S.N. Byrareddy, The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun, 2020: p. 102433.
Coronavirus disease (COVID-19) is caused by SARS-COV2 and represents the causative agent of a potentially fatal disease that is of great global public health concern. Based on the large number of infected people that were exposed to the wet animal market in Wuhan City, China, it is suggested that this is likely the zoonotic origin of COVID-19. Person-to-person transmission of COVID-19 infection led to the isolation of patients that were subsequently administered a variety of treatments. Extensive measures to reduce person-to-person transmission of COVID-19 have been implemented to control the current outbreak. Special attention and efforts to protect or reduce transmission should be applied in susceptible populations including children, health care providers, and elderly people. In this review, we highlights the symptoms, epidemiology, transmission, pathogenesis, phylogenetic analysis and future directions to control the spread of this fatal disease.

Simcock, R., T.V. Thomas, C.E. Mercy, A.R. Filippi, M.A. Katz, I.J. Pereira, and H. Saeed, COVID-19: Global Radiation Oncology’s Targeted Response for Pandemic Preparedness. Clinical and Translational Radiation Oncology, 2020.

Spina, S., F. Marrazzo, M. Migliari, R. Stucchi, A. Sforza, and R. Fumagalli, The response of Milan's Emergency Medical System to the COVID-19 outbreak in Italy. Lancet, 2020, 395(10227): p. e49-e50.

Thanh, H.N., T.N. Van, H.N.T. Thu, B.N. Van, B.D. Thanh, H.P.T. Thu, A.N.T. Kieu, N.N. Viet, G.B. Marks, G.J. Fox, and T.A. Nguyen, Outbreak investigation for COVID-19 in northern Vietnam. Lancet Infect Dis, 2020.

Ueda, M., R. Martins, P.C. Hendrie, T. McDonnell, J.R. Crews, T.L. Wong, B. McCreery, B. Jagels, A. Crane, D.R. Byrd, S.A. Pergam, N.E. Davidson, C. Liu, and F.M. Stewart, Managing Cancer Care During the COVID-19 Pandemic: Agility and Collaboration Toward a Common Goal. J Natl Compr Canc Netw, 2020: p. 1-4.
The first confirmed case of coronavirus disease 2019 (COVID-19) in the United States was reported on January 20, 2020, in Snohomish County, Washington. At the epicenter of COVID-19 in the United States, the Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, and University of Washington are at the forefront of delivering care to patients with cancer during this public health crisis. This Special Feature highlights the unique circumstances and challenges of cancer treatment amidst this global pandemic, and the importance of organizational structure, preparation, agility, and a shared vision for continuing to provide cancer treatment to patients in the face of uncertainty and rapid change.

Xu, Z., S. Li, S. Tian, H. Li, and L.-q. Kong, Full spectrum of COVID-19 severity still being depicted. The Lancet, 2020, 395(10228): p. 947-948.>

Weber, D.J., E.E. Sickbert-Bennett, H. Kanamori, and W.A. Rutala, New and emerging infectious diseases (Ebola, Middle Eastern respiratory syndrome coronavirus, carbapenem-resistant Enterobacteriaceae, Candida auris): Focus on environmental survival and germicide susceptibility. Am J Infect Control, 2019, 47S: p. A29-A38.