Author Correction: Convalescent plasma for hospitalized patients with COVID-19: an open-label, randomized controlled trial
Philippe BéginJeannie CallumErin JamulaRichard J. CookNancy M. HeddleAlan TinmouthMichelle P. ZellerGuillaume Beaudoin-BussièresLuiz AmorimRenée BazinKent Cadogan LoftsgardRichard CarlMichaël ChasséMelissa M. CushingNick DanemanDana V. DevineJeannot DumaresqDean FergussonCaroline GabeMarshall J. GlesbyNa LiYang LiuAllison McGeerNancy RobitailleBruce S. SachaisDamon C. ScalesLisa SchwartzNadine ShehataAlexis F. TurgeonHeidi WoodRyan ZarychanskiAndrés FinziDanièle MarceauAndy C. HuangHolly CarrYulia LinRosemarie LallChristopher J GrahamChristine ArsenaultValérie SalesDavinder SidhuMakeda SemretCaroline HammEneko ArhanchiagueZiad SolhNadim SrourKarim SolimanColin YeeVinçent LarocheSusan NahirniakChristina GreenawayMenaka PaiAndréanne CôtéJennifer TsangChristine Cserti‐GazdewichDanielle TalbotSébastien PoulinRodrigo Régnier Chemim GuimarãesMoira Rushton-MarovacAlexandra LangloisShuoyan NingAndrew W. ShihMélissa BoileauHarjot SinghDonna LedinghamArjuna PonnampalamMatthew YanOksana Prokopchuk‐GaukAndré PoirierGabriel GirouardKaterina PavenskiOlivier DrouinDavid HarrisMadéleine DurandEmily RimmerDaniel OvakimFrançois MénardGlenna CuccaroloJulie CarruthersKayla J. LucierValérie ArsenaultMarie‐Christine AuclairMeda AvramMichael BrassardSabrina CerroVerónica Lidia Martínez MartínezJulie MorinMarie Saint-JacquesMaxime VeilletteChantal ArmaliAmie KronDimpy ModiJoanne DuncanPauline JustumusMelanie St JohnGeneviève St‐OngeMilena Hadzi‐TosevPierre‐Marc DionLawrence McGillivaryAndre Valleteau de MoulliacSheila A. NymanStephanie PerilliPaulette Jean Van VlietShannon LaneKaterina PavenskiRebecca PereiraEmily SirotichJulie AbelsonSaara GreeneAditi KhandelwalSwarni ThakarSarah LongoSai Priya AnandMehdi BenlarbiCatherine BourassaMarianne BoutinJade Descôteaux-DinelleGabrielle Gendron‐LepageGuillaume GoyetteAnnemarie LaumaeaHalima MedjahedJérémie PrévostJonathan RichardDaniel E. KaufmannElsa Brunet‐RatnasinghamNicolas ChaumontMichael DrebotAlyssia RobinsonEmelissa J. MendozaKristina DimitrovaKathy ManguiatClark PhillipsonMichael ChanD. Gareth EvansYi-Chan LinLucie BoyerMarc CloutierMathieu DrouinÉric DucasNathalie DussaultMarie‐Josée FournierPatricia LandyMarie-Ève NolinJosée PerreaultTony TremblayIshac NazyFeng XieDavid LiuMichelle WongGus SilverioKristin WalkusMikaela BartonKatherine HavemanDarlene MuellerAshley ScottMatthew MoherGordon WoodTracey RoartyF. C. AuldGayle CarneyVirginia ThomsonRodrigo OnellKeith R. WalleyKatie DonohoeCrystal BrunkGeraldine HernándezTina JacobucciLynda LazoskyPuneet MannGeeta RavalLigia Araujo ZampieriMypinder S. SekhonAlissa WrightNicola JamesGaby ChangRoy ChenKanwal DeolJorell GantioquiElyse LarsenNamita RamdinMargaret RocheKristin RosinskiLawrence ShamMichelle StormsMark R. GillrieEtienne MahéDeepa SuryanarayanAlejandra Ugarte-TorresTraci RobinsonMitchell GibbsJulia Hews‐GirardMarnie HolmesJoanna McCarthyMeagan OdyKaren DoucetteWendy SliglAshlesha SonparK RobertsonJeffrey NarayanLeka RavindranBreanne StewartLori ZapernickStephen LeeEric SyAlexander WongKarolina GryzbSarah CraddockDennaye FuchsDanielle MyrahSana SunnySheila Rutledge HardingSiddarth KogilwaimathNancy HodgsonDawn JohnsonSimona MeierKim ThomsonAmila HeendeniyaBrett L. HoustonYoav KenyanSylvain LotherKendiss OlafsonBarret RushTerence WuerzDayna SolvasonLisa AlbensiSoumya AliasNora ChoiLaura M. CurtisMaureen HutmacherHessam H. KashaniDebra LaneNicole MartenTracey Pronyk-WardLisa RigauxRhonda SilvaQuinn TaysRenuka NaiduJane MathewsMargaret MaiVictoria MiceliLiz MolsonR. GayathriLinda SchaeferMichel Ferreira Cardia HaddadShannon LandryRobert ChernishRebecca KruisselbrinkTheresa LiuJayna JerominAtif SiddiquiCarla GirolamettoKristin KrokoszynskiCheryl MainAlison Fox‐RobichaudBram RochwergErjona KrujaDana EllinghamDisha SampatNgan TangDaniela LetoMeera KarunakaranDaniel RicciutoKelly FuscoTaneera GhateHolly RobinsonIan BallSarah ShalhoubMarat SlessarevMichael SilvermanEni NanoTracey BentallEileen CampbellJeffery KinneySeema Nair ParvathyEvridiki FeraAnthony La DelfaJeya NadarajahH. SolowEdeliza MendozaKatrina EngelDiana MonacoLaura KononowSutharsan SuntharalingamMike FralickLaveena MunshiSamia SaeedOmar HajjajElaine HsuKarim AliErick DuanGeorge FarjouLorraine JensonMary SalibLisa PattersonSwati AnantJosephine DingJane JomyPavani DasAnna GeageaSarah IngberElliot OwenAlexandra LostunTashea AlbanoAntara ChatterjeeManuel GiraldoJennifer HickeyIda LeeNea OkadaNicholas PasqualeRomina PonzielliMary RahmatShelina SaburMaria SchlagLeonita AguiarAshmina DamaniSuhyoung HongMona KokabiCarolyn PerkinsJuthaporn CowanTony GiuliviDerek R. MacFaddenJoe CyrAmanda PecarskieRebecca PorteousPriscila Ogawa VedderIrene WatpoolPhil BerardiLaith BustaniAlison GraverAkshai IyengarMagdalena KisilewiczJake MajewskiMisha MarovacRuchi MurthyKaran SharmaMarina WalcerZain ChaglaJason Pui Yin CheungErick DuanFrance ClarkeKarlo MaticManuel GiraldoJennifer HickeyIda LeeNea OkadaNicholas PasqualeRomina PonzielliMary RahmatShelina SaburMaria SchlagTravis CarpenterKevin L. SchwartzParil SutharAziz JiwajeeDaniel LindsayAftab MalikBrandon TseLarissa MatukasJoel G. RayShirley K. BellElizabeth KrokRay GuoSusan St JohnVishal D. JoshiJessica KeenChris LazongasJacqueline OstroKevin ShoreJianmin WangJinCheol ChoiPujitha NallapatiTina IrwinVictor WangPetra SheldrakeNeill K. J. AdhikariHannah WunschJacob BaileyHarley MeirovichConnie ColavecchiaEiad KahwashSachin SudMartin RomanoBryan CoburnLorenzo Del SorboJohn GrantonShahid HusainJacob PendergrastAbdu SharkawyLiz WilcoxSamia SaeedOmar HajjajMaria KulikovaSophia Z. 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FoxDiaraye BaldéLorraine MénardSuzanne MorissetteMiriam Schnorr-MelocheAndrée-Anne TurcotteCaroline ValléeStéphanie CastonguayTuyen NguyenNatalie RivestMarios RoussosEsther SimoneauAndreea BelecciuMarie-Hélène BouchardEric DaviauCynthia L. MartinNicole SabourinSolange TremblayÉmilie GagnéNancy-Lisa GagnéJulie LaroucheVanessa LaroucheVéronick TremblayVicky TremblayPierre BlanchetteDavid ClaveauMarianne LamarreDanielle TappsMartin AlbertAnatolie DucaJean‐Michel LeducJean-Samuel Boudreault-PedneaultAnnie BarsalouSuzanne Deschênes-DionStéphanie IbrahimStéphanie RidyardJulie RousseauStéphane P. AhernMarie‐Pier ArsenaultSimon-Frédéric DufresneLuigina MollicaHang Ting WangSoizic BeauDominique BeaupréMarjolaine DégarieIris DelormeMelissa FarkasMichel‐Olivier GrattonArnaud GuertinGuylaine JalbertMélanie MeilleurCharles Ratté LabrecqueÉlaine SantosJulie Trinh LuJulien AugerMarie-Claude LessardLouay MardiniYves PesantLaurie DelvesLisa DelvesSophie DenaultС. Ю. ГригороваMichelle LambertNathalie LangilleCorinne LangloisCaroline RockYannick Sardin-LaframboisePatrick ArchambaultJoannie Bélanger-PelletierEstel Duquet-DebloisVanessa Dupuis-PicardYannick HamelinSamuel LeducMélanie N. RichardMarc FortinPhilippe GervaisMarie‐Ève BoulayClaudine FerlandJakie GuertinJohane LepageAnnie RoySarit AssoulineStephen CaplanLing Yuan KongChristina CanticasCarley MayhewJohanne OuedraogoTévy-Suzy TepGerald BatistMatthew P. ChengMarina B. KleinNadine KronfliPatricia PelletierSalman QureshiDonald C. VinhRobert DziarmagaHansi PeirisKarène Proulx‐BoucherJonathan RogerMolly-Ann RothschildChung-Yan YuenSapha BarkatiJean‐Pierre RoutySondra Sinanan-PelletierRémi LeBlancÈve St‐HilairePatrick ThibeaultKarine MorinGilberte CaissieJackie Caissie ColletteL. DaigleMélissa DaigleBianca GendronNathalie GodinAngela LapointeG. MoreauLola Ouellette-BernierJoanne RockburnBrigitte Sonier-FergusonChristine WilsonRobert A. DeSimoneGrant EllsworthRebecca C. FryNoah GossRoy M. GulickCarlos VaamondeTimothy WilkinCeline ArarJonathan BerardiDennis ChenCristina Garcia-MillerArthur GoldbachLauren GrippDanielle HaydenKathleen KaneJiamin LiKinge-Ann MarcelinChristina MegillMeredith NelsonAilema PaguntalanGabriel RaabGianna RessoRoxanne RosarioNoah RossenShoran TamuraEthan ZhaoCheryl GossYoung KimEshan U. PatelSonal PaulTiffany RomeroNaima ElBadriLina FloresTricia SandovalShashi N. KapadiaLjiljana V. VasovićShanna-Kay GriffithsDaniel AlvaradoFiona GoudyMelissa LewisMarina LoizouRita LouieChantale PambrunSylvia TorranceSteven J. DrewsJanet McManusOriela CuevasWanda LafresnePatrizia RuosoChristine ShinTony SteedRachel N. WardIsabelle AllardMarc GermainSébastien GirardÉric ParentClaudia-Mireille PigeonMaria Esther LopesMargarida PêcegoNatalia Fonseca do RosárioCarlos Alexandre da Costa SilvaThais OliveiraMaria Cristina LopesSheila de Oliveira Garcia MateosLucette HallSarai ParadisoD StraussDonald M. Arnold
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In the version of this Article initially published, a versioning error led to a mistake in the third paragraph of the Discussion.In the text now reading "In our dataset, the most extreme and sustained increase in SARS-CoV-2 cases associated with school opening was in the South, where school opening was associated with a weekly increase in cases ranging from 9.8 to 21.3 per 100,000 people, " the range initially reported was "7.8 to 18.9 per 100,000." The results presented in the text and figures are unaffected.Keywords:
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Although SARS-CoV-2 may primarily enter the cells of the lungs, the small bowel may also be an important entry or interaction site, as the enterocytes are rich in angiotensin converting enzyme (ACE)-2 receptors. The initial gastrointestinal symptoms that appear early during the course of Covid-19 support this hypothesis. Furthermore, SARS-CoV virions are preferentially released apically and not at the basement of the airway cells. Thus, in the setting of a productive infection of conducting airway epithelia, the apically released SARS-CoV may be removed by mucociliary clearance and gain access to the GI tract via a luminal exposure. In addition, post-mortem studies of mice infected by SARS-CoV have demonstrated diffuse damage to the GI tract, with the small bowel showing signs of enterocyte desquamation, edema, small vessel dilation and lymphocyte infiltration, as well as mesenteric nodes with severe hemorrhage and necrosis. Finally, the small bowel is rich in furin, a serine protease which can separate the S-spike of the coronavirus into two "pinchers" (S1 and 2). The separation of the S-spike into S1 and S2 is essential for the attachment of the virion to both the ACE receptor and the cell membrane. In this special review, we describe the interaction of SARS-CoV-2 with the cell and enterocyte and its potential clinical implications.
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ResumenSe presenta un caso clínico de eventración infraumbilical complicada estrangulada con obstrucción intestinal que acude durante la pandemia de la COVID-19, causada por el virus SARS-CoV-2, al Hospital Municipal de la provincia de Buenos Aires (Argentina), con múltiples factores de riesgo y comorbilidades que potencialmente podían afectar a la evolución posoperatoria de la paciente.Se analiza, además de la técnica de plástica de pared abdominal, las medidas sanitarias implementadas para prevenir la infección del personal quirúrgico y del paciente.
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The end of 2019 was marked by the emergence of a novel coronavirus,1 now termed as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). SARS-CoV-2 causes the coronavirus disease (COVID-19). Since then, COVID-19 has spread globally to more than 190 countries and was declared a pandemic by the World Health Organization on March 11, 2020.2 Surgical care is a key component of any health system. However, during a global pandemic, it is imperative that the surgical workforce will need to adapt.3 Elective operations should be postponed, and measures need to be implemented to reduce the risk of healthcare worker (HCW) transmission. Since the first imported case of COVID-19 in January 2020, our department has rapidly put in place stringent measures to prevent HCW transmission. Despite having seen and surgically managed confirmed COVID-19 patients, we do not have any instances of HCW transmission so far. It is important to prevent the spread of COVID-19 within a department, not only for the personal health of our colleagues, but also for essential surgical services preservation to ensure that the department remains functional to carry out our duties, and maintain department morale. We outline the measures we have taken to reduce the possibility of spread of SARS-COV-2 within our department. MANPOWER SECONDMENT TO COVID-19 SCREENING CENTER The 2003 SARS outbreak left an indelible impact on Singapore, with 238 people infected and 33 deaths.4 Since then, Singapore has implemented a series of multi-agency measures to improve our country's pandemic preparedness efforts.4 The National Center for Infectious Diseases (NCID) was opened in September 2019, and is adjacent to Tan Tock Seng Hospital, one of the largest acute hospitals in Singapore. NCID is a 330-bed purpose-built facility, and also consists of a screening center, isolation wards, radiology facilities, operating theatres (OTs), and a laboratory.5 NCID is currently the front-line hospital for the screening and management of COVID-19 patients in Singapore. As a tertiary hospital linked to the NCID, it is our hospital's duty to support NCID in times of national crisis or an epidemic. Both medical and surgical departments have been deploying manpower to augment NCID's efforts in the COVID-19 pandemic. Our surgical department has been sending 25% of our deployable manpower to NCID at any 1 point in time. These teams are seconded to NCID for 10-day rotations to boost the screening center manpower. All NCID personnel are in full tier 2 personal protective equipment (PPE) during shifts, inclusive of cap, goggles, N95 mask, gown, and gloves. The screening center also functions as a full-fledged Emergency Department as some patients may have symptoms of both COVID-19 and also a concurrent medical or surgical presentation and diagnosis. MANAGING SURGICAL WORKLOAD AND SUBSPECIALTY TEAMS To cope with the decrease in manpower as outlined above, our department has instituted a 40% decrease in outpatient clinic visits – patients are triaged and appointments postponed accordingly. We have also postponed 40% of our nonurgent elective surgical cases. Ongoing elective surgical cases are limited to life, limb and organ-preserving operations – for example, malignancies, limb salvage, and aortic aneurysm surgery. Our general surgery department comprises of 8 different subspecialty teams: colorectal, upper gastrointestinal, trauma, breast and endocrine, hepatobiliary, vascular, thoracic and plastics surgery. Each subspecialty team works closely for daily work (ward rounds, clinics, surgeries). To ensure continuity of our surgical services in the unfortunate event of HCW COVID-19 transmission, each subspecialty team is divided into 2 or more sub-teams. These sub-teams function separately and do not come into contact with one another. This ensures that emergency and essential elective surgery can still go on even if 1 sub-team is infected or quarantined. Inter-hospital rotation of surgical residents has also been halted to reduce the chance of cross-hospital interaction and potential transmission of COVID-19 between HCWs. PROTOCOLS FOR SURGERY Patients undergoing essential elective surgery are screened on arrival to the hospital for fever, upper respiratory tract symptoms and contact/travel history. Patients with symptoms will be turned away from surgery and sent to the emergency department for further investigations. Full tier 2 PPE is mandatory for HCWs involved in potentially aerosolizing procedures such as intubation. For all surgeries, the anesthesia team intubates all patients in full PPE, while the surgical team waits outside the OT for 3 minutes before entering. The 3-minute rule is based on the air recycle rate of 25–30 cycles per hour in our OT. Essential elective surgery for nonsuspect cases are performed in a conventional OT with positive pressure ventilation. Emergency surgery for confirmed COVID-19 patients or suspect cases are performed in a dedicated OT in NCID. Operations done on COVID-19 patients are performed with full PPE and N95 mask, or powered air-purifying respirator in aerosolizing procedures. Surgical teams are kept to minimal numbers and are consultant led in order to minimize exposure. Most operations can be performed in full PPE and N95 masks, but our experience suggests that powered air-purifying respirator may be more ideal for prolonged surgery beyond 3 hours as it is more comfortable for the surgeon resulting in less fatigue. Similar protocols were adopted for endoscopy in view of the possibility of faecal-oral transmission of the virus, and potential shedding of SARS-COV-2 in the faeces.6 MEASURES TAKEN TO DEAL WITH COVID-19 PATIENTS IN THE WARD All patients will be screened on admission for risk factors such as fever, upper respiratory tract and contact/travel history. Patients deemed to be high risk for COVID-19, and patients with a possible pneumonia on chest X-ray will be admitted to an isolation ward. All other patients will be admitted to the general ward. All HCWs are mandated to wear a surgical mask when in contact with patients, such as in clinics and during rounds in the general ward. With increasing rates of community transmission of SARS-CoV-2, and the wide range of clinical severity and presentation, it is inevitable that COVID-19 patients may slip through the admission safety net and get admitted to a general ward (nonisolated) before diagnosis. In such situations, rapid diagnosis and isolation is imperative to break potential chains of transmission. All HCWs have been issued a real-time location system tag for contact-tracing. Upon confirmation of COVID-19, all HCWs in contact with the patient and not in full PPE protection will be swabbed and sent on home quarantine until the swabs are negative. REDUCING NONESSENTIAL GATHERINGS AND CHANCE OF INADVERTENT INFECTION All nonessential department meetings such as journal clubs and educational plenaries have been canceled. Important clinical decision-making meetings (eg, tumor boards, mortality, and morbidity discussions) have been continued either on electronic platforms such as Zoom, or in small groups with social distancing observed (sitting 1–2 m apart), albeit with everyone wearing a surgical mask. Social gatherings greater than 10 people have also been discouraged. With the announcement of the first case of COVID-19 in Singapore, we had also taken the difficult decision to freeze all nonessential overseas travel for surgeons which include planned holidays, workshops, and conferences to reduce the risk of inadvertent importation of COVID-19. CARE FOR OUR HCWS Working on the frontlines of the COVID-19 pandemic can be both physically and emotionally draining, especially when there is no end in sight. Senior staff including chiefs of service and heads of department have also been leading by example by volunteering for stints in the NCID screening center. Our department has allowed staff to take short 3-day breaks to rest and recharge. However, staff on breaks must not travel overseas and need to remain contactable and recallable in the event of surge of COVID-19 patients, or having to return to cover staff who have fallen unwell in the line of duty. Unwell surgeons are also given mandatory time off to recuperate at home. CONCLUSIONS Many of the above measures were adopted from lessons learnt during the 2003 SARS outbreak. These measures were put into place very early on during the current outbreak. The COVID-19 pandemic is expected to be long drawn. Our surgical workforce needs to be flexible and ready to adapt to an ever-evolving situation. Maintaining the health and morale of our HCWs is of utmost priority, so that we can continue to care for our patients. To date we have not had any instances of HCW transmission. We hope that we will continue to keep our HCW safe with the measures implemented. However, in the unfortunate scenario of a HCW transmission, we believe our measures will allow early identification and quick eradication of further transmission.
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Teaser: Our review found the average R0 for 2019-nCoV to be 3.28, which exceeds WHO estimates of 1.4 to 2.5.
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