Doing TMS Safely in a COVID World, a Paradigm Shift

By Kevin Kinback MD, Director of Advanced TMS Center

Overview: to help fellow Society members, I collated information on the impact of pandemic on medical practices, some virus considerations, telehealth operations, considerations for resuming "normal" operations in the near future, and nearly 500 references. I've spent up to 1 hour daily reading reports from hospital networks, the CA Medical Association, CDC, Medical Economics and news links. There are interesting and useful considerations related to TMS. NOTE: I haven't fully researched all listed services, references and options and I therefore don't endorse or certify their suitability, it's all "just FYI."

Impact of Pandemic on Medical Practices:

A quick internet search showed that 43 states and DC implemented "stay at home" orders in an effort to contain the pandemic caused by the SARS-CoV-2 virus. This has likely impacted TMS providers, causing a dilemma, whether it's "safe" to continue TMS treatment, while balancing exposure isks to patients, staff, doctors and indirectly all of our families, with the need to maintain practice income and meet patient needs. Many providers reduced TMS services, stopped taking new TMS patients, continued TMS as usual with personal protective equipment (PPE) and decontamination, while others have temporarily stopped TMS totally. These are all individual decisions and there is no absolute right or wrong answer on how to proceed. However, most would agree, including the CDC, that continuing TMS treatment "as usual" without at least using masks, gloves, possibly face shields, decontamination, and screening patients for personal and family symptoms or exposure risks (temperatures?) is clearly wrong and extremely irresponsible. So the tricky problem is how to continue to treating TMS patients and exactly what should be done, and then how "safe" are these measures as we restore "business as usual"?

This COVID pandemic has devastated most general businesses which have closed across the country. At least in our area, many medical & dental practices have closed to all but the most emergent cases, and the use of telehealth has literally exploded under temporary state and insurance authorization. Outgoing messages I hear from some medical and dental practices is that "we've been ordered to close to non-emergency care." This raises a discussion whether TMS is considered essential or elective. Because TMS is not indicated on actively suicidal patients for whom hospitalization or ECT is the appropriate, some may argue that all TMS is elective. If so inclined, some practices are "holding off" on new starts, but screening new TMS patients, working on authorizations for TMS, with a plan to restart once the first virus wave passes, using new safety measures and PPE. Other TMS practices, especially those treating more severely depressed patients, would deem their TMS services as essential and not elective. This may be especially true in areas where ECT or inpatient treatment is even more "risky" for virus exposure than outpatient. State and local health departments have the right to investigate medical practices and intervene if they offer "nonessential" treatment against a Governor's order, for example, cosmetic botox or spider vein removal. It does seem that for very hopeless, severely depressed patients who may worsen despite close medication management and psychotherapy, TMS would clearly not be considered elective treatment. The decision to begin TMS treatment during this crisis seems best made on a case-by-case basis between patient and doctor, after a careful assessment and open discussion of risks, benefits, and safety precautions considering the local virus prevalence. The key is how to keep TMS technicians, patients and other office staff safe during this crisis.

There are potential liability concerns for TMS practice during the pandemic. One concern is that if a TMS patient with COVID comes in daily, there is high risk of staff & other patients becoming infected. Decontamination is very difficult. Perhaps a young TMS tech thusly exposed may have mild or no symptoms, but their parent or grandparent may be in mortal danger if they contract the virus. (check the age-adjusted mortality rates, as high as 15% or more in the oldest decades). Is there liability to our practices if patients and/or staff can trace their infections to our workplaces? If we are not exactly following CDC and OSHA guidelines (a moving target in the past 2 months) can we be sued by employees for death of a family member through workplace exposure?

A recent Medical Economics article found medical practice patient volume, procedures and income to be down between 50 and 80%. Just today one local hospital system announced gross revenue reduced by 40%, while costs of extra labor, medications and PPE are skyrocketing. Just like all the parked cruise ships and grounded airplanes, we can't delay our in-person TMS treatment much longer and expect to stay in business. There is also a tremendous unmet patient need if TMS availability is limited. Even if TMS practices remain open for essential treatment, many are reporting substantial drops in the number of patients who are willing to undergo in-person TMS treatment, as well as a lot of other medical procedures and office visits. In the coming weeks, the economy will try to "restart," and has already indeed started in California, allowing some "elective" surgeries to begin, albeit with very heavy testing, guidelines, monitoring and use of PPE. There remain more questions than answers at this time on how to be safe and patients seem to be quite skittish about risks.

Meanwhile, there have been some relief options for medical caregivers, including:

• • Paycheck Protection Program-- 1% loan, forgivable if you follow guidelines and retain employees. However competition is stiff and funding is very tight and limited. 
  • Economic Injury Disaster Loan (EIDL) at 3.75% up to $2 million from SBA, $10K advance
  • SBA express bridge loan up to $25,000 with less paperwork
  • Relief for SBA 7(a), 504 or microloan waiving interest and payments for 6 mos
  • Student loans and residential mortgage forbearance for 3-6 mos (apply via servicer)
  • Professional Liability (Malpractice) discounts-- if you cut to part time, seek discount
  • Extended unemployment benefits, some allowance even for 1099 in some states
  • Extended tax filing and payment deadline to 7-15-2020, & some states
  • Employer Retention Tax Credit for first $10K paid per employee (if no PPP loan)
  • Payroll Tax delay (Social security), modifying for net operating losses, interest expense
  • Waived 10% penalty on IRA withdrawals
  • Medicare advance loans (on hold now), pause on 2% sequestration, HHS relief payments
  • Mainstreet Business Lending program, 2% loan, 6 mos deferred payments
  • For Healthcare Workers: Free hotel rooms, discounts at Walgeens (4-25-20), free food at McDonalds, free donuts Mondays at Krispy Kreme, early admission to Costco, etc.
  • Numerous other state programs--check your state med association for information

Some General Virus Considerations:

The problem comes from the high rate of asymptomatic transmission of the virus, thought to have a Ro value (basic reproduction number or the # of new infections caused by each positive case) ranging from 1.4 to 3.9, however due to lack of available widespread testing the true infection and transmission rates may be much higher. There are even "superspreaders" who have been traced to have infected dozens or more! (Stein RA. Super-spreaders in infectious diseases. Int J Infect Dis. 2011 Aug;15(8):e510-3.). This virus has an overall mortality rate between 2 and 10 times that of seasonal flu. The flu alone in the US alone kills 25,000 to 50,000 per year with over 500,000 hospitalizations and millions infected, but has a much shorter incubation and infectious period, and tends to burn out naturally each season. There is too much we still don't know about the new Coronavirus, but we can expect at least twice as many deaths compared to flu. There is talk of a 2nd wave this winter, when the COVID virus will run concurrent with annual flu. The coronaviruses are not new, first discovered by virologist June Almeida in the 1960's, and usually responsible for the common cold, but in some forms cause Sudden Acute Respiratory Syndrome (SARS) and MERS. Those words in most of us trigger memories of outbreaks with very high mortality rates of 9.2 to 37%, infecting thousands, and killing hundreds between 8 and 18 years ago. Any virus called SARS needs to be taken very seriously.

Due to lack of testing availability (we even have a shortage of swabs) as well as inaccurate testing procedures ( just last week we changed from NP to OP swabbing due to high false negatives), most infections disease experts agree that we are likely underestimating exposure by at least a factor of 10. Our current count of 2.8M infected and nearly 200,000 deaths is likely closer to 28 M already. Just this week testing in New York showed asymptomatic infection rates in the 15% range. (Centre for Evidence-Based Medicine; Heneghan C, Brassey J, Jefferson T. COVID-19: What proportion are asymptomatic? 2020 [internet publication]., Day M. Covid-19: identifying and isolating asymptomatic people helped eliminate virus in Italian village. BMJ. 2020 Mar 23;368:m1165.). We won't have the full picture until either widespread virus or antibody testing. There is one city without any distancing which will be interesting to watch, as they try to build local "herd immunity," the threshold for COVID-19 being somewhere from 29 to 74% infection rate. (the formula is Pc or critical population = 1 - 1/Ro). However, while this city may eventually be safe, it is currently a nidus of contagion if residents stray outside city limits! They are also putting their own elderly population at disproportionally higher mortality risk.

From what we know, populations in close and frequent contact, such as prisons, cruise and military ships, and nursing homes, have astronomically high infection and death rates. This raises the question for TMS technician safety, having to be within inches of patient faces during setup and takedown of TMS. While not prolonged contact, it is certainly close, frequent and repeated.

It seems that for unknown reasons, people of all ages, but mostly older people, as high as 20% are sick enough to be hospitalized. Of those, about 10% seem to require ventilators and of those, as the death rate despite heroic efforts can be in the 80% range. The infection rate for front-line health care workers, especially doing intubation and CPR is staggering, in some cases up to 30% even with full PPE. There has been talk of universal DNR's, deadly delays in CPR by minutes while staff dons PPE, and the need to "flatten the curve," by social distancing and stay at home orders. These measures ARE clearly working well and we haven't had to resort to "Y" or "T" adapters for patients to share respirators. Many companies such as Tesla are stepping up and making large numbers of low cost, emergency respirators, and BIPAP is also being used whenever possible. So far, the death rates have been DESPITE these heroic efforts in the US, and not because we have run short of ventilators. However without people staying home the infection rate is expected to flare up again, at least locally. 

Little known & COVID complications (aside from ARDS) from a great article with over 450 references: 
(https://bestpractice.bmj.com/topics/en-gb/3000168/complications#referencePop434):  

1. 1. Emotional & mental: hospitals have banned visitors, so the toll on families who can't visit those sick and dying is staggering.  Caregiver and staff burnout is also high.
   2. Financial: Insurance seems to have waived copays for care related to COVID.  However does this mean someone hospitalized as a PUI (person under investigation) for suspected infection that is not given the formal diagnosis or having a positive test, will be stuck with copays on bills in the tens of thousands?  We would hope not.  There are already over 22 million unemployment applications and even medical practices have contracted and lost revenue.  Phones once busy are simply not ringing at this time and many medical practices including psychiatry have furloughed, cut hours or laid off staff and doctors.
   3. Cardiac: There have been reports of 7-20% of patients with acute myocardial injury.  Just this week new announcements about pediatric cardiac risk, even in mild cases of COVID.
   4. Acute liver injury: up to 76% of patients had abnormal LFT's, with 14-53% acute liver injury rate.  Some antivirals increase the risk.
   5. Coagulopathy:  as emboli, DIC, venous thromboemboli, etc.
   6. Acute kidney injury:  in 3-8% of patients, with 26-40% having proneinuria or hematuria.
   7. Pancreatic injury:  mild, but in up to 17% of patients.
   8. Neurological complications: reports of Guillain-Barre, meningitis, encephalitis, enceopalopathy, thought to be direct infection found in brain and CSF.  Neurological symptoms occur in 36% of patients, more common with severe illness.  Recent reports showed cases of widespread brain swelling, inflammation and irreversible acute necrotizing encephalopathy. 

This last one is truly scary, since we don't know why so many people are asymptomatic or have only mild URI-like symptoms while others end up with neurological damage.

What will be the solution going forward? Clearly the ultimate prevention is some combination or herd immunity or universal use of an effective COVID-19 vaccine. Currently there are up to 70 various vaccines being tested, and right now 5 are in clinical trials. Competition is a good thing here, and the FDA seems to be allowing acceleration of approval, but we expect them to not compromise safety of efficacy. Clearly the winner of the vaccine race stands to profit in the tens of billions, so motivation for success is very high! Hopefully the anti-vax crowd will come to their senses when the vaccine comes out. I've been sort of prepping my patients by asking if they plan to take the COVID-19 vaccine once available, and a surprising number of patients hesitate or express doubt, so I give reassurance of safety, efficacy and the need for herd immunity. Since some projection models without current social distancing show up to a 90% infection rate, there are only two likely outcomes for most of the world: get the vaccine or get the disease. They have just developed new, rapid tests for acute infection in the past 2 weeks, with OP swabbing, with sensitivity and specificity in the 90+ % range, much better than a few weeks ago when our test had a 30% false negative rate!

Another solution is antibody testing. Currently there are MANY scams to be avoided. Just today our local health department put out a notice that there is NO specific antibody test for COVID-19. It seems that all the common cold coronaviruses cause IGG spikes which are hard to distinguish from actual COVID-19, so there are lot of false positives. It is also unknown if the IGG is actually protective against COVID, or how long this protection lasts. Hopefully the folks working on this will very quickly come up with a highly accurate and sensitive antibody test. The current recommendation as of today, is to ignore a positive coronavirus IGG test and continue protecting yourself as if it were negative. Hopefully the general public who don't read daily COVID updates as most of us do, will not be hoodwinked by these unproven and misleading virus or "home antibody" test kits hitting the market! To complicate matters this week, the WHO announced that re-infections are possible, so even those infected need to maintain full preventive measures (https://www.cnn.com/2020/04/25/us/who-immunity-antibodies-covid-19/index.html)

Finally, social distancing will be the norm until a vaccine has been widely given. Restaurants will remove at least half their tables, servers will wear mask, as should the general public. We're not even sure that confirmed cases can't be reinfected or carriers, so it seems that universal masking would be prudent. Fortunately many washable cloth masks are coming available, and we can see them being widely used by wise citizens. Medical practices will hopefully continue telehealth, but it won't be "business as usual" with in-person treatment until the vaccine arrives, so hopefully we will get permission to continue telemedicine until then.

Telehealth Operations for Psychiatry:

All insurance payors, federal and it seems nearly all states have temporarily removed all restrictions on telehealth services. Previously, specific secure technology was required, with limitations on where the doctors could be (in offices, not home) or where patients could be (in a specific clinic, not home). There are still licensing restrictions, so doctors must be licensed in states where they work and sometimes also where they live, as well as where their patients live or are located. Some emergency provisions exist but they vary by state and seem to be extremely complicated. In general, psychiatrists and psychologists seem to be way behind the curve compared to other specialists and hospitals in adopting highly advanced EMR systems. The majority of my colleagues are using "free" systems or using some electronic forms of scheduling or eRx, without an integrated practice management or telemedicine option.

Over the early and middle weeks of the COVID-19 outbreak, payors one by one relaxed guidelines, first allowing less secure, non-HIPAA compliant platforms like Zoom basic and facetime, then finally phone calls. However this is only temporary and not expected to last in it's present form past sometime in June. There have also been proclamations of payments to be equal for telemedicine to in-person care, and some payors plan to waive copayments for telehealth (i.e. pay at 100% of contracted rate). Other payors are paying out of network providers at network rates, so the telehealth industry has grown up explosively within a matter of weeks. It should be noted that public-facing products such as public shat rooms, TikTok, Facebook Live, or Twitch are still prohibited and violate HIPAA. Also note that aside from the telehealth dispensation, all other aspects of HIPAA remain in place and should be followed. NOTE: This allowance of broad telehealth platforms could END any day with short notice, so watch your email carefully.

Currently allowed non-public facing remote communication products (per HHS- medicare) are:

• • Apple FaceTime
  • Facebook Messenger viceo chat
  • Google Hangouts viceo
  • Whatsapp video chat
  • Zoom
  • Skype

Text allowed apps include (note:  texting is asynchronous communication): Signal, Jabber, Facebook Messenger, Google Hangouts,Whatsapp, and iMessage. 

End-to-end encryption is recommended with individual user accounts, logins, and passcodes to limit access and verify participants. Here is a great HHS reference for Telehealth: https://www.hhs.gov/sites/default/files/telehealth-faqs-508.pdf.

How do you document telehealth? I've reviewed emails from various payors as well as attended Webinars from the California Medical Association, as well as my own experienced billing and coding team and we have good news!

This emergency declaration allows wide use of various platforms, locations for doctors and patients (at home) and even phone sessions to be done and paid at customary rates. This must all of course be documented in notes. We have had most of our claims paid even quicker than usual for telehealth. 

Telehealth Documentation requirements in progress notes: 

1. 1. Document that the visit was in telehealth and not in person.
   2. List the specific platform using, and whether synchronous audio and/or video (phone) or asynchronous (delayed) transmission such as secure email or text.
   3. Document the patient consented to a telehealth visit (temporarily can be verbal but previously written consent was mandatory, and will shortly be mandatory again).
   4. Document the location (city, state) of both patient and clinician, and specify each is at home, office, or car, work, etc.
   5. Document whether the patient is alone, and if not, who else is present and can hear the call on either end, and that the patient is both aware and consents to the other parties. Speakerphones should be avoided if possible.  Patients should be asked if they can be overheard and given opportunity to move away from others or use earphones before starting.
   6. Document the exact start and stop time of the televisit. Optional documentation of total time of televisit may be acceptable under the emergency for now, but apparently in 2021 the start and stop times will be mandatory.
   7. If screenshots are possible, you could capture these and save to patient documents for private reference in case of any future disputes about whether the visit took place.  These can always be deleted later but must be saved and stored securely per HIPAA. 

(NOTE: be aware that patients can also record or screen-grab your image, so keep your comportment in mind. In some states consent of both parties is required for recording (like CA), so your consent form should notify patients if you want to forbid recording). 

Telehealth Billing and Coding: 

1. Change the POS (place of service) code from 11 (outpatient) to 2 (telehealth). This triggers the telehealth payment during the emergency to be the same as the original POS code would have been. It seems like nearly ALL payors are now requiring or at least allowing POS 2 to be used on all telehealth claims, combined with a modifier below.
2. Use Modifier GT for a synchronous telehealth platform, either video, audio, both or phone.
3. Use Modifier GO for asynchronous telehealth platform (email, text). However this is NOT the preferred mode of communication and could result in reduced reimbursement. These may be considered e-visits or virtual check in and may have different CPT codes.
4. Modifier 95 can also be used and indicates synchronous telemedicine. Some providers want POS code 11 (outpatient) used with MOD 95. If your Medicare MAC is reducing your payments to facility rates because of POS 2, submit corrected claims using POS 11/MOD 95 instead.   Auditing of payments is necessary to correct any coding/payment issues compared to those with the prior in-person coding.
5. CPT T1014: this is a per-minute allowance for telehealth technology cost reimbursement. Some insurance contracts DO allow billing a per minute fee, & may specify other codes for this charge. This code can be used once, with the number of units equal to the number of minutes on the audio/video link. For example a 27 minute telehealth visit would be coded as T1014, with 27 units, POS 2 (no modifier necessary). We were just advised today that Noridian Medicare is NOT paying for T1014. It won't hurt to send this code and if payment is denied, simply adjust if off the claim.  If the entire claim is denied due to T1014, then drop the T1014 CPT and resubmit the claim.
6. General visit CPT coding: During this emergency, providers are supposed to use typical office CPT codes for medication management (90791, 90792, 99213-215, psychotherapy codes, etc). NOTE that telehealth codes are NOT appropriate for TMS, ECT or other office or hospital based procedures.

NOTE: right now it seems that many payors will pay for POS 11 + MOD 95, however POS 2 + MOD GT is perhaps the most common combination. If claims are denied for incorrect POS/modifier combinations, they should be promptly rebilled with a corrected claim by adding the appropriate resubmission code in box 22 on the HCFA 1500 form. (one common resubmission code is 7, indicating replacement of prior claim submission).

However, there are an entirely different set of telehealth billing codes including codes for facilities, originating sites, etc. that would apply in the absence of this COVID emergency allowance. All those factors will come back into play once the emergency blanket authorization of telehealth ends. 

Telehealth Contracting Issues: Some psychiatric contracts allow and others prohibit telemedicine. This would be a good time for your billing and/or credentialing staff to reach out to each payor to sign any additional contracting agreement(s) to allow permanent ongoing telehealth services. They should also clarify NON-emergency codes which should be used. I t is my sincere hope that nearly all insurance will continue to allow telehealth in the future, as many patients find it convenient, and effective, especially if they have a long drive to provider offices, or limited time during work hours. For example, with telehealth, a 10-15 minute appointment for a patient at work could be done over a lunch or rest break, but a round-trip travel time of 30-45 minutes would be impossible. However, you can expect more restrictions on where the patients and doctors must be located.  Also, be sure to NOT treat patients across state lines unless you are properly licensed and insured. If you are non-contracted, be advised that while telehealth may reimburse you and/or patients during this emergency, there may be zero reimbursement for patients seeing out of network telehealth providers in the future. 

Documents and forms for Telehealth: While our office was fortunate to activate secure telehealth inside our EMR and train staff/providers within days inside of our EMR, others had more struggles, especially those without hospital-grade EMR's. Even advanced EMRs don't often include secure email for attachments or document management. Many, including us, without a document management platform, are now seeking HIPAA-compliant solutions. These would allow patients to securely receive forms and documents to fill out, digitally sign as needed, and submit to a secure portal. Office staff then drag these documents and images (such as pic of insurance card) into the EMR for permanent storage. These forms/documents can also be linked to websites for easy access, as well as pushed to patient cell phones, laptops or other devices to capture signatures contact-free in the next 1-2 years.  This also saves mountains of staff time instead of printing, clipboards, scanning, reviewing and shredding documents!

Some examples of document management platforms include: Docusign, Adobe Forms, Formstack, pdfFiller, etc.  Costs can be several hundreds of dollars a month and contracts can be required. NOTE: you MUST use a HIPAA-compliant document service, especially if they use email and cloud storage, and they MUST provide you with a Business Associate Agreement (BAA) just like any vendor you may use. 

 Telehealth Platforms, perks and Costs: 

There ARE some telehealth alternatives. It seems that most insurance payors, such as the Blue plans, Aetna, and other big names, offer FREE telehealth platforms, at least for their own patients.  However after the emergency passes, they may restrict these to use for only their own insureds. You would not need a special BAA since they are the actual insurance company's platform. However, it would be quite difficult for most providers to keep track of which platforms must be used with which certain patients going forward. I certainly wouldn't want to do it. 

Some telehealth platforms are listed and costs are likely PER provider. Note that most have various simple and free, or better and pay options.  Some have waived fees or cut costs during the emergency, so as a rule, you can expect costs to increase in the future. Hopefully maybe the T1014 or other CPT codes per minute from some insurance payors, even if paid at pennies per minute, will help offset telehealth technology costs. NOTE: Be SURE you have a HIPAA-compliant written agreement AND a BAA if you are using these vendors, especially after the emergency waivers expire.      

Doxy.me.  Free base, with other perks a la carte cost.

eVisit:  may cost $50-150/mo.

SimpleVisit:  maybe in $150/mo range.

VSee:  can cost up to $250/mo

Mend (MendFamily):  reported at $250-500 but higher end option includes some forms/questionnaire pushing to patients (may be limited to certain geographic areas).

Spruce Health:  unclear pricing or options.

Zoom Professional:  in $200/mo range

Updox:  details and pricing unknown, includes email, text, fax and appt. reminders, may integrate with EMR

 

Considerations for resuming "normal" TMS operations:

We can hopefully all agree that simply resuming or continuing TMS "as usual" without regard to the COVID-19 risks is no longer an option. There will be either new outbreaks or pockets of infection all over the country. Despite our current million US infections and > 50,000 deaths in the past 2 months, in at least some areas new case #'s are leveling off. It does seem clear that until we have widespread immunity via vaccine, a series of changes are needed in TMS practices. I'll give the list of all the possible mitigations I can imagine, with some commentary and caveats, then leave it to your readers which to apply to your practice.

Liability issues and duty to staff and patients: 

• • Keep checking med society, hospital and CDC guidelines for best practices and PPE use, post & follow them. 
  • Be aware daily of the number of new infections in your County/city, and where your patients live. Be prepared to pause TMS if there is a flare-up in your immediate area. 
  • Post a written policy & procedure for staff distancing, and modified patient flow procedures. Check compliance.
  • Consider doing 100% telehealth for TMS evals, new patients and follow-ups as long as permitted (hopefully 2021)
  • Conduct and document training for staff use of PPE & monitor compliance
  • Update your policies for paid time off and have a policy for symptomatic staff/household exposures, quarantine staff members showing symptoms or with known exposures
  • Create work-from-home job descriptions for staff use as needed
  • Remember that HIPAA regulations require a signed BYOD (Bring Your Own Device) policy for clinicians using home computers or laptops outside the office. Spammers and ransomware abound, so do extra security training and be sure antivirus and firewalls are updated on all devices. Home networks lack protections of corporate platforms. 
  • Prohibit flash drives and saving data on non-secure computers or home devices
  • Consider using Doximity Dialer or other phone emulator--be sure clinicians/staff broadcast only the office # and not their personal cell numbers or emails to patients. You can be sure this will be quickly abused by some patients, and poses a risk to staff!  Avoid texting patients (it shows your phone number unless using an emulator).
  • In nearly all states it's improper to prescribe experimental meds or treat yourself or family without proper exams, documentation and medical necessity. Some states have already disciplined doctors for writing prescriptions for each other "just in case." Be safe and if someone has symptoms, have a colleague do a "real" evaluation and rely on their expert treatment. 

NOTES:  PPE is currently nearly impossible to obtain. Local stores, Amazon, etc. are overwhelmed, out of stock. If you have a medical supplier account (Schein, McKesson, etc) then NOW is the time to "kiss up" and bribe your personal sales rep (Starbucks or other gift card?). They use "allocation" which means if you haven't had consistently high levels of prior orders, they will not let you buy even small quantities of items like gloves, masks, gowns, face shields, sanitizer, wipes, etc. We are fortunate to have accounts, but even for a small quantities of PPE we are told it's 2-4 weeks for delivery. If anyone learns of a good supplier of PPE, please share on the CTMSS forum or listserv!

Check your Medical Association guidelines for reopening practices: Here is a link to the California (CMA) guidelines just published:  https://www.cmadocs.org/Portals/CMA/files/public/CMA%20COVID%20Guidelines%20for%20Reopening.pdf

Distancing in medical offices: 

• • Remove magazines and common items (i.e. coffee bar, fridge, toys, clipboards) from waiting rooms
  • Remove most of the waiting room chairs
  • Install plastic shields or sheeting between staff and patients (like grocery stores did)
  • Put 6' marker tape on the floor to remind distance
  • Don't let patients linger or congregate in waiting or check in-out areas (post signs or use barriers)
  • Put physical barriers (like plastic folding tables) in front of check-in counters to keep distance
  • Go to touchless check-in--keep patients in cars until you text them to come in
  • MOVE your TMS room to a room with a separate entrance, don't walk patients through entire office (may require electrician for new circuits). A TMS room in deep in the bowels of the back office is the highest risk, so relocate it.
  • Separate staff and move workstations apart, locate them in unused rooms if possible
  • Collect credit card payments by phone, apple pay or other touchless system
  • Get document management to digitally import images of ID and ins cards, NOT by hand, avoid all paper
  • Train staff to maintain 6' distance from each other and patients
  • Stagger staff lunch breaks to avoid congregation
  • Close the break room for eating and have staff enjoy the Spring weather eating outside
  • Ban family members and tag-alongs for TMS patients and others
  • Stop giving injections in the office--pharmacies will do these or use home healthcare
  • Put away office based tablets and devices, push documents to patient devices or portals
  • Post a policy about all these factors and document ongoing staff training and reminders, update your website
  • Limit vitals unless absolutely necessary, maybe every 2-3 visits, or get notes from PCP and record those recent VS
  • Avoid blood draws and EKG's in offices, send patients to labs or seek other recent records instead
  • Consider using an empty room as supplemental waiting room, or better yet, space patients out if possible to avoid more than one in the waiting room. If possible use a separate exit. 

Using PPE in psychiatric offices: 

Disclaimer: psychiatrists, staff and TMS techs in primarily outpatient offices are NOT typically trained in proper PPE use. There have been healthcare worker infection rates as high as 25-30% in some areas, despite full and proper PPE use. Our local hospital requires a monitor person watching every staff member don and doff PPE, to alert the need to decontaminate if perfect procedure isn't followed. Reusing masks requires hospital grade decontamination (a very expensive vaporized hydrogen peroxide system), so do-it-yourself tricks will not work, do NOT try this. Soiled masks must be discarded. Even N95 masks per OSHA and other regulations require very extensive fit testing or they are worthless-- any leak is the same as not having a mask. There are many USDL and other great Youtube videos on respiratory and other PPE protection. Check out a "real" fit test and you will be shocked at the complexity if you haven't done it as part of hospital staff testing.  https://www.youtube.com/watch?v=D38BjgUdL5Uhttps://www.youtube.com/watch?v=6qkXV4kmp7c.   

There have been counterfeit N95 masks on the market, so be sure they are NOISH certified and properly marked. If you  want to use N95 masks properly, use a fit test kit and document periodic training of all staff ($200-300 initial cost for 100 uses, extra solution is available, as is kit use training). There are also many Phishing sites offering PPE which actually put viruses on your devices. Don't click on these sites. Be aware that PPE can give staff a false sense of security, so make them aware that gloves and the outsides of masks are always contaminated. Adjustment of masks once donned is not allowed. Improper use of PPE, especially donning and doffing, is very high risk and prone to contamination. Conduct and document repeated training on proper PPE use (youtube has many good videos, see reference--a specific order must be used). Fight the urge to over-reuse PPE, and finally, be aware that proper use of PPE is very inconvenient and expensive. Train, do more training, and then train your staff again!

PPE & disinfection Tips for TMS Practices (staff & patients) until vaccine is available: 

• • Procedure masks and cloth masks help keep the virus IN but aren't good keeping the virus away from staff.
  • All patients BEFORE coming into the office could be required to have at least a tightly fitting cloth mask at all times
  • Consider a portable handwashing station at office entrance to have staff, patients wash on entering
  • Have hand sanitizer available in treatment areas
  • Wipe down doorknobs and other surfaces, BP cuffs, often
  • Buy touchless thermal scanners and check temperature of staff and all patients (currently these are $40-80 or more each from China with $60 shipping fees, and in the $100-300 range from US medical supply).
  • Have patients tap on doors, so gloved staff can open, don't let patients touch doorknobs, light switches, etc.
  • Keep 6 distance from everyone, avoid even fist bumps, never shake hands
  • Consider giving TMS techs a fit-tested n95 mask. This can be doffed a certain # of times before contamination, but should last a full shift. Proper donning and doffing requires clean gloves which are hard to get now.
  • Assign only one TMS tech per day, to avoid having multiple people using more advanced PPE (N95, gowns, gloves)
  • Disinfect TMS and other office equipment often (CTMSS has posted guidelines on website)
  • Require or supply cloth masks for all persons & staff in your office. While not tested or perfect, everything helps.
  • If a patient or staff member who has visited your office becomes infected, you may need to bite the bullet and hire a PROFESSIONAL decontamination company such as ATI to clean your office. WARNING: time consuming and expensive, but very effective, however be aware that peroxide can damage TMS electrical components. See https://www.naahq.org/sites/default/files/naa-documents/disaster/guidelines_for_covid19_cleaning_from_ati.pdf
  • If a patient or staff member becomes infected, you may get a call from County Health contact tracing and then be forced to quarantine exposed staff members, so have a good backup plan with multiple TMS techs/staff on call. This week the CO Health Department closed a walmart after complaints of inadequate distancing, people without masks, leading to 3 deaths, to "control the outbreak." Could the County close your TMS practice if there are infections and complaints?
    (https://www.bing.com/search?q=Colorado+Aurora+Walmart+shut&filters=tnTID%3a%2225EB4D97-9BD0-4c15-A8F4- 9AC00B731EBF%22+tnVersion%3a%223496995%22+segment%3a%22popularnow.carousel%22+tnCol%3a%222%22+tn Order%3a%229b95cc7d-4974-4c1e-acb0-70a4720c3293%22&FORM=BSPN01&crslsl=0)
  • It is safe-ER to treat TMS patients or other patients who recovered from a documented case of COVID-19, however you should still consider them as potentially re-infected or a carrier and require your standard masks/distancing. We still don't know the reinfection risks, or exactly how long to quarantine after exposures--some suggest at least 7 days after symptom resolution for negative tests (consider the 30% false negative rate), and 2 weeks or more for confirmed positive cases.
  • Resist the urge during active outbreaks to do any NP or OP swabs, or other COVID testing on staff, patients or family members. This is extremely high risk, and many parameters must be followed for adequate specimens and technique. Refer them to official testing stations where this can be done safely and correctly, with reliable followup if positive.
  • Testing parameters may change during reopening of medical clinics. One local hospital is starting some elective surgery next week, but they are evaluating with a committee first, then actually rapid testing EVERY surgery patient for COVID prior to entering the hospital. This underscores the risks of asymptomatic transmission.
  • Don't let staff share workstations and devices. Clean often with wipes all keyboards, mice, monitors, power buttons, phones, doorknobs, switches, credit card machine, printer buttons, etc. Wipes are very hard to get now.
  • Update your website with guidelines for patients and post signs, update phone messages to educate patients & staff on revised safety measures and patient flow

A Special Word about Air systems (HVAC) and UV decontamination: Disclaimer: some items in this section are untested and can be very expensive, but again this whole article is FYI and food for thought, so do your homework!

• • NOW is a great time to have your office air systems cleaned and serviced, ducts cleaned, new filters, etc. If your office is already musty or stuffy to begin with, the risks are higher with heavy patient flow during the pandemic  
  • Consider changing air filters monthly instead of quarterly or upgrading them
  • Air filters have MERV ratings, higher is better, and 8-10 is typical. MERV 13 for example filters 0.3 microns, including some viruses, can last 90 days, but can restrict air flow.  Your A/C contractor can adjust air flow to compensate for a higher MERV filter.   One filter reference:  https://filterbuy.com/merv-13-air-filters/?msclkid=d9e3fe83e4101e425857a0201fd32283&utm_source=bing&utm_medium=cpc&utm_campaign=Generic%20Air%20Exact&utm_term=merv%20air%20filter&utm_content=MERV%20Air%20Filter
  • Many commercial air systems require 20% or more outside air. Find your outside air ducts and check airflow and filters there as well, and clean the intakes, cut away any foliage or spider webs, etc.  Your contractor during service should verify the % of outside fresh air.  Open dampers and maximize outside fresh air if possible.   If you're blessed with office windows, keep them open for business hours and consider a window fan for ventilation.
  • If you are in a large commercial building and sharing fresh air with other offices, be sure you are actually getting fresh OUTSIDE air and not pulling air from other offices, especially those with heavy patient or visitor flow (peds, urgent care)
  • Consider upgrading your office air filters from 1" to 2-4", and be aware that hospital grade filtration media are available for offices, and not much more expensive once installed.  Your contractor may need to enlarge filter slots.
  • There are ultraviolet (UVC) devices available to install in office air systems to keep coils clean and stronger ones to decontaminate moving air. These need to be of specific energy/distance to actually kill viruses and are strong enough to harm humans, degrade plastics, rubber and even metal and may discolor objects.  Ask your contractor about installing UV cleaners in your air systems, which also prevent mold and other buildup. 
  • UVC is being used in OR's and other areas for germicidal decontamination. There are many large portable units with wheels, ceiling mounts, handheld and tabletop units, many with remote control and motion sensors to protect humans.  These range from a few hundred for handheld to many thousands for larger units.  Some are pulsed to minimize damage to room décor.
  • Be aware that UVC is line of sight, so a "downlight" on the ceiling for example, won't decontaminate the underneath parts of TMS devices. A low belt level device in the center of a room may do better.  Check carefully for energy, distance and time required to help minimize virus contamination.   Most good systems come with UV sensor cards to put around the room in some cases up to 10 or more feet away.  They turn color to indicate adequate energy has been deposited in that area by the device.  These look like about the size of a tall office chair or higher, on wheels and can be moved to various rooms to decontaminate as needed (with proper safety).  NOTE:  specific dosing in mW/square inch, at specific distance for specific time should be specified and the UVC range is 250 nm ish, but not all UV light is germicidal.  Review all specs carefully and get expert advice from people NOT trying to sell you one. 
  • Also be aware that there are no absolute standards and many devices have good track records but are not necessarily tested or certified specifically against SARS-coV-2. It is a red flag is a device PROMISES to kill COVID, as it is too early for that claim. 
  • Any UVC cleaning system does NOT take the place of other cleaning and wiping of surfaces and can't be used on organic organisms (humans, pets, nannies, etc). Many can go on timers or remote to turn on at night.
  • Here is one example of the many UV education and suppliers: https://insights.regencylighting.com/can-uv-light-kill-viruses-like-COVID
  • Be aware that availability is very low, and costs are skyrocketing for UV disinfection systems of all types, and the prices will definitely scare you. These are increasingly hard to get and as yet not proven.  Do some homework and maybe call a disinfection company or compare vendors to learn about options.
  • UVC devices have limited number of hours, and degrade the more often they are cycled. Be sure you know the cycle life and replacement bulb/service costs.  A 10,000 hour unit sounds like a long time, but if running 24/7, will burn out in about 13 months.

References:

1. 1. CMA COVID financial toolkit:  https://www.cmadocs.org/Portals/CMA/files/public/CMA%20COVID%20Financial%20Toolkit%20for%20Medical%20Practices.pdf
   2. Mask Effectiveness:  https://www.cmadocs.org/Portals/CMA/files/public/CMA%20COVID%20Financial%20Toolkit%20for%20Medical%20Practices.pdf
   3. A bad week for NYC:  https://www.wsj.com/articles/seven-days-hundreds-of-deaths-new-yorks-worst-week-yet-tests-its-coronavirus-response-11586308180
   4. Doctors Company guide to temporarily close practice:  https://www.thedoctors.com/articles/COVID-how-to-temporarily-close-your-practice-while-minimizing-risks/?utm_source=communications+from+The+Doctors+Company&utm_campaign=d5e3d27cb8-E-194+COVID+Temp+Office+Closure+%28Members%29&utm_medium=email&utm_term=0_238c55ecb6-d5e3d27cb8-449036577
   5. Tesla making ventilators:  https://www.forbes.com/sites/alanohnsman/2020/04/06/tesla-touts-a-prototype-ventilator-for-COVID-patients-made-out-of-electric-car-parts/#2dacf6f1235b
   6. 102 year old survives COVID:  https://apple.news/AHnmM_Fs2S3WQoZsVSOEY-Q
   7. How virus kills some and hardly affects others:  https://apple.news/AhJ1HNTbOQ1y6_d_SXSxBEQ
   8. Sharing ventilators:  http://newjersey.news12.com/story/41968785/can-coventing-solve-new-jerseys-ventilator-shortage-problem
   9. CDC recommends cloth masks in public:  https://www.vox.com/2020/4/3/21202792/coronavirus-masks-n95-trump-white-house-cdc-ppe-shortage
   10. Risks of states NOT closing down:  https://www.usatoday.com/story/news/nation/2020/04/02/states-without-stay-home-orders-residents-celebrate-freedoms/5105303002/
   11. Asymptomatic spreaders:  https://www.nytimes.com/2020/03/31/health/coronavirus-asymptomatic-transmission.html
   12. N95 hospital fit testing (pictures, details):  https://mobile.twitter.com/leorahorwitzmd/status/1235018922023440385
   13. CDC says virus will persist:  https://www.npr.org/sections/health-shots/2020/03/31/824155179/cdc-director-on-models-for-the-months-to-come-this-virus-is-going-to-be-with-us
   14. Study about airborne COVID:  https://www.npr.org/sections/health-shots/2020/03/31/824155179/cdc-director-on-models-for-the-months-to-come-this-virus-is-going-to-be-with-us
   15. Convalescent plasma as treatment:  https://dgalerts.docguide.com/convalescent-plasma-possibly-helpful-treatment-5-critically-ill-patients-COVID?nl_ref=newsletter&pk_campaign=newsletter&nl_eventid=34731&ncov_site=COVID&nl_campaignid=3641
   16. Nearly 10,000 medical workers infected in Spain:  https://www.nbcnews.com/news/world/medical-workers-spain-italy-overloaded-more-them-catch-coronavirus-n1170721
   17. A chilling account from Doctor at center of crisis:  https://www.buzzfeednews.com/article/josephbernstein/elmhurst-hospital-coronavirus-ventilator-ppe-crisis
   18. Medical worker descries terrifying lung failure:  https://www.propublica.org/article/a-medical-worker-describes--terrifying-lung-failure-from-covid19-even-in-his-young-patients
   19. CDC poster for sequence of applying PPE:  https://www.cdc.gov/niosh/npptl/pdfs/PPE-Sequence-508.pdf
   20. Hack to double patients up on ventilators:  https://www.vice.com/en_us/article/qjdm53/this-risky-hack-could-double-access-to-ventilators-as-coronavirus-peaks
   21. California Med Assoc guidelines to restart practices:  https://www.cmadocs.org/Portals/CMA/files/public/CMA%20COVID%20Guidelines%20for%20Reopening.pdf
   22. Coronavirus Lingers in Air of Crowded spaces:  https://apple.news/AEJviy4CrRJee8XkL4oyfrA

Here is an excellent overview from BMJ best practice on COVID: https://bestpractice.bmj.com/topics/en-gb/3000168/pdf/3000168/Coronavirus%20disease%202019%20%28COVID%29.pdf

Scientific Reference articles (copied from BMJ website in the above BMJ reference ):

1. 1. Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020 Apr;5(4):536-44.
   2. Ren LL, Wang YM, Wu ZQ, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J (Engl). 2020 Jan 30 [Epub ahead of print].
   3. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID disease is suspected. 2020 [internet publication].
   4. World Health Organization. Pneumonia of unknown cause – China. 2020 [internet publication].
   5. World Health Organization. Novel coronavirus – China. 2020 [internet publication].
   6. Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID) in China [in Chinese]. Zhonghua Liu Xing Bing Xue Za Zhi. 2020 Feb 17;41(2):145-51.
   7. Zhan M, Qin Y, Xue X, et al. Death from COVID of 23 health care workers in China. N Engl J Med. 2020 Apr 15 [Epub ahead of print].
   8. CDC COVID Response Team. Severe outcomes among patients with coronavirus disease 2019 (COVID): United States, February 12 - March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020 Mar 27;69(12):343-6.
   9. Ludvigsson JF. Systematic review of COVID in children show milder cases and a better prognosis than adults. Acta Paediatr. 2020 Mar 23 [Epub ahead of print].
   10. CDC COVID Response Team. Coronavirus disease 2019 in children: United States, February 12 - April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020 Apr 10;69(14):422-6.
   11. Chen ZM, Fu JF, Shu Q, et al. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus. World J Pediatr. 2020 Feb 5 [Epub ahead of print].
   12. Shen KL, Yang YH. Diagnosis and treatment of 2019 novel coronavirus infection in children: a pressing issue. World J Pediatr. 2020 Feb 5 [Epub ahead of print].
   13. Hong H, Wang Y, Chung HT, et al. Clinical characteristics of novel coronavirus disease 2019 (COVID) in newborns, infants and children. Pediatr Neonatol. 2020 Apr;61(2):131-2.
   14. Dong Y, Mo X, Hu Y, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020 Mar 16 [Epub ahead of print].
   15. Castagnoli R, Votto M, Licari, A, et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review. JAMA Pediatr. 2020 Apr 22 [Epub ahead of print].
   16. Yao Y, Pan J, Liu Z, et al. No association of COVID transmission with temperature or UV radiation in Chinese cities. Eur Respir J. 2020 Apr 8 [Epub ahead of print].
   17. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020 Feb 20;382(8):727-33.
   18. Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020 Feb 22;395(10224):565-74.
   19. Tang X, Wu C, Li X, et al. On the origin and continuing evolution of SARS-CoV-2. Nat Sci Review. 2020 Mar 3 [Epub ahead of print].
   20. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395(10223):497-506.
   21. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020 Feb 15;395(10223):507-13.
   22. Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020 Mar 26;382(13):1199-207.
   23. Paraskevis D, Kostaki EG, Magiorkinis G, et al. Full-genome evolutionary analysis of the novel corona virus (2019-nCoV) rejects the hypothesis of emergence as a result of a recent recombination event. Infect Genet Evol. 2020 Jan 29;79:104212.
   24. Ji W, Wang W, Zhao X, et al. Cross-species transmission of the newly identified coronavirus 2019-nCoV. J Med Virol. 2020 Apr;92(4):433-40.
   25. Zhang T, Wu Q, Zhang Z. Probable pangolin origin of SARS-CoV-2 associated with the COVID outbreak. Curr Biol. 2020 Apr 6;30(7):1346-51.
   26. Lam TT, Shum MH, Zhu HC, et al. Identifying SARS-CoV-2 related coronaviruses in Malayan pangolins. Nature. 2020 Mar 26 [Epub ahead of print].
   27. Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020 Feb 15;395(10223):514-23.
   28. Burke RM, Midgley CM, Dratch A, et al. Active monitoring of persons exposed to patients with confirmed COVID - United States, January-February 2020. MMWR Morb Mortal Wkly Rep. 2020 Mar 6;69(9):245-6.
   29. van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020 Apr 16;382(16):1564-7.
   30. World Health Organization. Modes of transmission of virus causing COVID: implications for IPC precaution recommendations. 2020 [internet publication].
   31. Guo ZD, Wang ZY, Zhang SF, et al. Aerosol and surface distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards, Wuhan, China, 2020. Emerg Infect Dis. 2020 Apr 10;26(7).
   32. Zhang H, Kang Z, Gong H, et al. The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes. 2020 [internet publication].
   33. Zhang W, Du RH, Li B, et al. Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerg Microbes Infect. 2020 Dec;9(1):386-9.
   34. To KK, Tsang OT, Chik-Yan Yip C, et al. Consistent detection of 2019 novel coronavirus in saliva. Clin Infect Dis. 2020 Feb 12 [Epub ahead of print].
   35. Centre for Evidence-Based Medicine; Ferner RE, Murray PI, Aronson JK. Spreading SARS-CoV-2 through ocular fluids. 2020 [internet publication].
   36. Sun T, Guan J. Novel coronavirus and central nervous system. Eur J Neurol. 2020 Mar 26 [Epub ahead of print].
   37. Cheung KS, Hung IF, Chan PP, et al. Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from the Hong Kong cohort and systematic review and meta-analysis. Gastroenterology. 2020 Apr 3 [Epub ahead of print].
   38. Seah IYJ, Anderson DE, Kang AEZ, et al. Assessing viral shedding and infectivity of tears in coronavirus disease 2019 (COVID) patients. Ophthalmology. 2020 Mar 24 [Epub ahead of print].
   39. Wei XS, Wang X, Niu YR, et al. Diarrhea is associated with prolonged symptoms and viral carriage in COVID. Clin Gastroenterol Hepatol. 2020 Apr 17 [Epub ahead of print].
   40. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020 Feb 7 [Epub ahead of print].
   41. CDC COVID Response Team. Characteristics of health care personnel with COVID: United States, February 12 –April 9, 2020. MMWR Morb Mortal Wkly Rep. 2020 Apr 17;69(15):477-81.
   42. Hunter E, Price DA, Murphy E, et al. First experience of COVID screening of health-care workers in England. Lancet. 2020 Apr 22 [Epub ahead of print].
   43. McMichael TM, Clark S, Pogosjans S, et al. COVID in a long-term care facility: King County, Washington, February 27 – March 9, 2020. MMWR Morb Mortal Wkly Rep. 2020 Mar 27;69(12):339-42.
   44. Moriarty LF, Plucinski MM, Marston BJ, et al. Public health responses to COVID outbreaks on cruise ships: worldwide, February-March 2020. MMWR Morb Mortal Wkly Rep. 2020 Mar 27;69(12):347-52.
   45. Mosites E, Parker EM, Clarke KEN, et al. Assessment of SARS-CoV-2 infection prevalence in homeless shelters: four U.S. cities, March 27 – April 15, 2020. MMWR Morb Mortal Wkly Rep. 2020 Apr 22 [Epub ahead of print].
   46. Centers for Disease Control and Prevention. Interim guidance for homeless service providers to plan and respond to coronavirus disease 2019 (COVID). 2020 [internet publication].
   47. Yang H, Thompson JR. Fighting COVID outbreaks in prisons. BMJ. 2020 Apr 2;369:m1362.
   48. Ghinai I, Woods S, Ritger KA, et al. Community transmission of SARS-CoV-2 at two family gatherings: Chicago, Illinois, February – March 2020. MMWR Morb Mortal Wkly Rep. 2020 Apr 17;69(15):446-50.
   49. Mat NFC, Edinur HA, Razab MKAA, et al. A single mass gathering resulted in massive transmission of COVID infections in Malaysia with further international spread. J Travel Med. 2020 Apr 18 [Epub ahead of print].
   50. Wang Z, Ma W, Zheng X, et al. Household transmission of SARS-CoV-2. J Infect. 2020 Apr 10 [Epub ahead of print].
   51. Li W, Zhang B, Lu J, et al. The characteristics of household transmission of COVID. Clin Infect Dis. 2020 Apr 17 [Epub ahead of print].
   52. World Health Organization. Novel coronavirus (2019-nCoV) situation report - 6. 2020 [internet publication].
   53. Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID): symptoms of coronavirus. 2020 [internet publication].
   54. Lauer SA, Grantz KH, Bi Q, et al. The incubation period of coronavirus disease 2019 (COVID) from publicly reported confirmed cases: estimation and application. Ann Intern Med. 2020 Mar 10 [Epub ahead of print].
   55. Jiang X, Niu Y, Li X, et al. Is a 14-day quarantine period optimal for effectively controlling coronavirus disease 2019 (COVID)? 2020 [internet publication].
   56. Yu P, Zhu J, Zhang Z, et al. A familial cluster of infection associated with the 2019 novel coronavirus indicating potential person-to-person transmission during the incubation period. J Infect Dis. 2020 Feb 18 [Epub ahead of print].
   57. Du Z, Xu X, Wu Y, et al. Serial interval of COVID among publicly reported confirmed cases. Emerg Infect Dis. 2020 Mar 19;26(6).
   58. Wei WE, Li Z, Chiew CJ, et al. Presymptomatic transmission of SARS-CoV-2: Singapore, January 23 - March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020 Apr 10;69(14):411-5.
   59. Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med. 2020 Mar 5;382(10):970-71.
   60. Kupferschmidt K. Study claiming new coronavirus can be transmitted by people without symptoms was flawed. 2020 [internet publication].
   61. Tong ZD, Tang A, Li KF, et al. Potential presymptomatic transmission of SARS-CoV-2, Zhejiang province, China, 2020. Emerg Infect Dis. 2020 May 17;26(5).
   62. Hu Z, Song C, Xu C, et al. Clinical characteristics of 24 asymptomatic infections with COVID screened among close contacts in Nanjing, China. Sci China Life Sci. 2020 Mar 4 [Epub ahead of print].
   63. Luo SH, Liu W, Liu ZJ, et al. A confirmed asymptomatic carrier of 2019 novel coronavirus (SARS-CoV-2). Chin Med J (Engl). 2020 Mar 6 [Epub ahead of print].
   64. Lu S, Lin J, Zhang Z, et al. Alert for non-respiratory symptoms of Coronavirus Disease 2019 (COVID) patients in epidemic period: a case report of familial cluster with three asymptomatic COVID patients. J Med Virol. 2020 Mar 19 [Epub ahead of print].
   65. Li C, Ji F, Wang L, et al. Asymptomatic and human-to-human transmission of SARS-CoV-2 in a 2-family cluster, Xuzhou, China. Emerg Infect Dis. 2020 Mar 31;26(7).
   66. Mizumoto K, Kagaya K, Zarebski A, et al. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Euro Surveill. 2020 Mar;25(10).
   67. Nishiura H, Kobayashi T, Suzuki A, et al. Estimation of the asymptomatic ratio of novel coronavirus infections (COVID). Int J Infect Dis. 2020 Mar 13 [Epub ahead of print].
   68. Kimball A, Hatfield KM, Arons M, et al. Asymptomatic and presymptomatic SARS-CoV-2 infections in residents of a long-term care skilled nursing facility: King County, Washington, March 2020. MMWR Morb Mortal Wkly Rep. 2020 Apr 3;69(13):377-81.
   69. Day M. COVID: identifying and isolating asymptomatic people helped eliminate virus in Italian village. BMJ. 2020 Mar 23;368:m1165.
   70. Centre for Evidence-Based Medicine; Heneghan C, Brassey J, Jefferson T. COVID: What proportion are asymptomatic? 2020 [internet publication].
   71. Jiang XL, Zhang XL, Zhao XN, et al. Transmission potential of asymptomatic and paucisymptomatic SARS-CoV-2 infections: a three-family cluster study in China. J Infect Dis. 2020 Apr 22 [Epub ahead of print].
   72. Sutton D, Fuchs K, D'Alton M, et al. Universal screening for SARS-CoV-2 in women admitted for delivery. N Engl J Med. 2020 Apr 13 [Epub ahead of print].
   73. Qiu H, Wu J, Hong L, et al. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020 Mar 25 [Epub ahead of print].
   74. Danis K, Epaulard O, Bénet T, et al. Cluster of coronavirus disease 2019 (COVID) in the French Alps, 2020. Clin Infect Dis. 2020 Apr 11 [Epub ahead of print].
   75. Frieden TR, Lee CT. Identifying and interrupting superspreading events-implications for control of severe acute respiratory syndrome coronavirus 2. Emerg Infect Dis. 2020 Mar 18;26(6).
   76. Stein RA. Super-spreaders in infectious diseases. Int J Infect Dis. 2011 Aug;15(8):e510-3.
   77. Hui DS. Super-spreading events of MERS-CoV infection. Lancet. 2016 Sep 3;388(10048):942-3.
   78. Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020 Mar 7;395(10226):809-15.
   79. Schwartz DA. An analysis of 38 pregnant women with COVID, their newborn infants, and maternal-fetal transmission of SARS-CoV-2: maternal coronavirus infections and pregnancy outcomes. Arch Pathol Lab Med. 2020 Mar 17 [Epub ahead of print].
   80. Karimi-Zarchi M, Neamatzadeh H, Dastgheib SA, et al. Vertical transmission of coronavirus disease 19 (COVID) from infected pregnant mothers to neonates: a review. Fetal Pediatr Pathol. 2020 Apr 2;:1-5.
   81. Alzamora MC, Paredes T, Caceres D, et al. Severe COVID during pregnancy and possible vertical transmission. Am J Perinatol. 2020 Apr 18 [Epub ahead of print].
   82. Wang S, Guo L, Chen L, et al. A case report of neonatal COVID infection in China. Clin Infect Dis. 2020 Mar 12 [Epub ahead of print].
   83. Zhu H, Wang L, Fang C, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020 Feb;9(1):51-60.
   84. Zeng H, Xu C, Fan J, et al. Antibodies in infants born to mothers with COVID pneumonia. JAMA 2020 Mar 26 [Epub ahead of print].
   85. Dong L, Tian J, He S, et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA. 2020 Mar 26 [Epub ahead of print].
   86. Zeng L, Xia S, Yuan W, et al. Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID in Wuhan, China. JAMA Pediatr. 2020 Mar 26 [Epub ahead of print].
   87. Liu Y, Gayle AA, Wilder-Smith A, et al. The reproductive number of COVID is higher compared to SARS coronavirus. J Travel Med. 2020 Mar 13;27(2).
   88. Yan R, Zhang Y, Li Y, et al. Structural basis for the recognition of the SARS-CoV-2 by full-length human ACE2. Science. 2020 Mar 27;367(6485):1444-8.
   89. Chen Y, Guo Y, Pan Y, et al. Structure analysis of the receptor binding of 2019-nCoV. Biochem Biophys Res Commun. 2020 Feb 17 [Epub ahead of print].
   90. Coutard B, Valle C, de Lamballerie X, et al. The spike glycoprotein of the new coronavirus 2019-nCoV contains a furin-like cleavage site absent in CoV of the same clade. Antiviral Res. 2020 Feb 10;176:104742.
   91. Zou X, Chen K, Zou J, et al. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med. 2020 Mar 12 [Epub ahead of print].
   92. Hanff TC, Harhay MO, Brown TS, et al. Is there an association between COVID mortality and the renin-angiotensin system: a call for epidemiologic investigations. Clin Infect Dis. 2020 Mar 26 [Epub ahead of print].
   93. Zou L, Ruan F, Huang M, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020 Mar 19;382(12):1177-9.
   94. To KK, Tsang OT, Leung WS, et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. Lancet Infect Dis. 2020 Mar 23 [Epub ahead of print].
   95. Wölfel R, Corman VM, Guggemos W, et al. Virological assessment of hospitalized patients with COVID-2019. Nature. 2020 Apr 1 [Epub ahead of print].
   96. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-62.
   97. Chang, Mo G, Yuan X, et al. Time kinetics of viral clearance and resolution of symptoms in novel coronavirus infection. Am J Respir Crit Care Med. 2020 Mar 23 [Epub ahead of print].
   98. Chen C, Gao G, Xu Y, et al. SARS-CoV-2-positive sputum and feces after conversion of pharyngeal samples in patients with COVID. Ann Intern Med. 2020 Mar 30 [Epub ahead of print].
   99. Zhang T, Cui X, Zhao X, et al. Detectable SARS-CoV-2 viral RNA in feces of three children during recovery period of COVID pneumonia. J Med Virol. 2020 Mar 29 [Epub ahead of print].
   100. Xu K, Chen Y, Yuan J, et al. Factors associated with prolonged viral RNA shedding in patients with COVID. Clin Infect Dis. 2020 Apr 9 [Epub ahead of print].
   101. Zheng S, Fan J, Yu F, et al. Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January – March 2020: retrospective cohort study. BMJ. 2020 Apr 21;369:m1443. 2020 Apr 1 [Epub ahead of print].
   102. World Health Organization. Global surveillance for COVID caused by human infection with COVID virus. 2020 [internet publication].
   103. Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID): people who are at higher risk for severe illness. 2020 [internet publication].
   104. CDC COVID Response Team. Preliminary estimates of the prevalence of selected underlying health conditions among patients with coronavirus disease 2019 - United States, February 12-March 28, 2020. MMWR Morb Mortal Wkly Rep. 2020 Apr 3;69(13):382-6
   105. Emami A, Javanmardi F, Pirbonyeh N, et al. Prevalence of underlying diseases in hospitalized patients with COVID: a systematic review and meta-analysis. Arch Acad Emerg Med. 2020 Mar 24;8(1):e35.
   106. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID in the New York City area. JAMA. 2020 Apr 22 [Epub ahead of print].
   107. D'Antiga L. Coronaviruses and immunosuppressed patients: the facts during the third epidemic. Liver Transpl. 2020 Mar 20 [Epub ahead of print].
   108. Adams ML, Katz DL, Grandpre J. Population-based estimates of chronic conditions affecting risk for complications from coronavirus disease, United States. Emerg Infect Dis. 2020 Apr 23 [Epub ahead of print].
   109. Sorbello M, El-Boghdadly K, Di Giacinto I, et al. The Italian COVID outbreak: experiences and recommendations from clinical practice. Anaesthesia. 2020 Mar 27 [Epub ahead of print].
   110. Simonnet A, Chetboun M, Poissy J, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity (Silver Spring). 2020 Apr 9 [Epub ahead of print].
   111. Lighter J, Phillips M, Hochman S, et al. Obesity in patients younger than 60 years is a risk factor for COVID hospital admission. Clin Infect Dis. 2020 Apr 9 [Epub ahead of print].
   112. Liu W, Tao ZW, Lei W, et al. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chin Med J (Engl). 2020 Feb 28 [Epub ahead of print].
   113. Vardavas CI, Nikitara K. COVID and smoking: a systematic review of the evidence. Tob Induc Dis. 2020 Mar 20;18:20.
   114. Zhao Q, Meng M, Kumar R, et al. The impact of COPD and smoking history on the severity of COVID: a systemic review and meta-analysis. J Med Virol. 2020 Apr 15 [Epub ahead of print].
   115. Patanavanich R, Glantz SA; medRxiv. Smoking is associated with COVID progression: a meta-analysis. 2020 [internet publication].
   116. Leung JM, Yang CX, Tam A, et al. ACE-2 expression in the small airway epithelia of smokers and COPD patients: implications for COVID. Eur Respir J. 2020 Apr 8 [Epub ahead of print].
   117. Yu J Ouyang W, Chua ML, et al. SARS-CoV-2 transmission in patients with cancer at a tertiary care hospital in Wuhan, China. JAMA Oncol. 2020 Mar 25 [Epub ahead of print].
   118. Lei S, Jiang F, Su W, et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID infection. EClinicalMedicine. 2020 Apr 5;:100331.
   119. World Health Organization. Coronavirus disease (COVID) advice for the public. 2020 [internet publication].
   120. Centers for Disease Control and Prevention. How to protect yourself and others. 2020 [internet publication].
   121. Feng S, Shen C, Xia N, et al. Rational use of face masks in the COVID pandemic. Lancet Respir Med. 2020 Mar 20 [Epub ahead of print].
   122. World Health Organization. Advice on the use of masks in the context of COVID. 2020 [internet publication].
   123. Centers for Disease Control and Prevention. Recommendation regarding the use of cloth face coverings, especially in areas of significant community-based transmission. 2020 [internet publication].
   124. Mahase E. COVID: what is the evidence for cloth masks? BMJ. 2020 Apr 7;369:m1422.
   125. Desai AN, Mehrotra P. Medical masks. JAMA. 2020 Mar 4 [Epub ahead of print].
   126. Centre for Evidence-Based Medicine; Greenhalgh T, Chan XH, Khunti K, et al. What is the efficacy of standard face masks compared to respirator masks in preventing COVID-type respiratory illnesses in primary care staff? 2020 [internet publication].
   127. Bae S, Kim MC, Kim JY, et al. Effectiveness of surgical and cotton masks in blocking SARS-CoV-2: a controlled comparison in 4 patients. Ann Intern Med. 2020 Apr 6 [Epub ahead of print].
   128. Quilty BJ, Clifford S, CMMID nCoV working group2, et al. Effectiveness of airport screening at detecting travellers infected with novel coronavirus (2019-nCoV). Eurosurveillance. 2020 Feb;25(5).
   129. Hoehl S, Berger A, Kortenbusch M, et al. Evidence of SARS-CoV-2 infection in returning travelers from Wuhan, China. N Engl J Med. 2020 Mar 26;382(13):1278-80.
   130. Kakimoto K, Kamiya H, Yamagishi T, et al. Initial investigation of transmission of COVID among crew members during quarantine of a cruise ship: Yokohama, Japan, February 2020. MMWR Morb Mortal Wkly Rep. 2020 Mar 20;69(11):312-3.
   131. Mahase E. China coronavirus: what do we know so far? BMJ. 2020 Jan 24;368:m308.
   132. Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020 Mar 14;395(10227):912-20.
   133. Nussbaumer-Streit B, Mayr V, Dobrescu AI, et al. Quarantine alone or in combination with other public health measures to control COVID: a rapid review. Cochrane Database Syst Rev. 2020 Apr 8;(4):CD013574.
   134. Centre for Evidence-Based Medicine; Mahtani KR, Heneghan C, Aronson JK. What is the evidence for social distancing during global pandemics? 2020 [internet publication].
   135. Lewnard JA, Lo NC. Scientific and ethical basis for social-distancing interventions against COVID. Lancet Infect Dis. 2020 Mar 23 [Epub ahead of print].
   136. Koo JR, Cook AR, Park M, et al. Interventions to mitigate early spread of SARS-CoV-2 in Singapore: a modelling study. Lancet Infect Dis. 2020 Mar 23 [Epub ahead of print].
   137. Public Health England. Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID. 2020 [internet publication].
   138. ClinicalTrials.gov. Safety and immunogenicity study of 2019-nCov vaccine (mRNA-1273) to treat novel coronavirus. 2020 [internet publication].
   139. Chinese Clinical Trial Registry. A phase I clinical trial for recombinant novel coronavirus (2019-COV) vaccine (adenoviral vector). 2020 [internet publication].
   140. Thanh Le T, Andreadakis Z, Kumar A, et al. The COVID vaccine development landscape. Nat Rev Drug Discov. 2020 Apr 9 [Epub ahead of print].
   141. Razai MS, Doerholt K, Ladhani S, et al. Coronavirus disease 2019 (COVID): a guide for UK GPs. BMJ. 2020 Mar 5;368:m800.
   142. Greenhalgh T, Koh GCH, Car J. COVID: a remote assessment in primary care. BMJ. 2020 Mar 25;368:m1182.
   143. World Health Organization. Infection prevention and control during health care when COVID is suspected. 2020 [internet publication].
   144. Kampf G, Todt D, Pfaender S, et al. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect. 2020 Mar;104(3):246-51.
   145. Spellberg B, Haddix M, Lee R, et al. Community prevalence of SARS-CoV-2 among patients with influenzalike illnesses presenting to a Los Angeles medical center in March 2020. JAMA. 2020 Mar 31 [Epub ahead of print].
   146. Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020 Feb 28 [Epub ahead of print].
   147. Sun P, Qie S, Liu Z, et al. Clinical characteristics of 50466 hospitalized patients with 2019-nCoV infection. J Med Virol. 2020 Feb 28 [Epub ahead of print].
   148. Li LQ, Huang T, Wang YQ, et al. 2019 novel coronavirus patients' clinical characteristics, discharge rate and fatality rate of meta-analysis. J Med Virol. 2020 Mar 12 [Epub ahead of print].
   149. Sommer P, Lukovic E, Fagley E, et al. Initial clinical impressions of the critical care of COVID patients in Seattle, New York City, and Chicago. Anesth Analg. 2020 Mar 25 [Epub ahead of print].
   150. Goyal P, Choi JJ, Pinheiro LC, et al. Clinical characteristics of COVID in New York City. N Engl J Med. 2020 Apr 17 [Epub ahead of print].
   151. Xu XW, Wu XX, Jiang XG, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ. 2020 Feb 19;368:m606.
   152. Kim D, Quinn J, Pinsky B, et al. Rates of co-infection between SARS-CoV-2 and other respiratory pathogens. JAMA. 2020 Apr 15 [Epub ahead of print].
   153. Ding Q, Lu P, Fan Y, et al. The clinical characteristics of pneumonia patients co-infected with 2019 novel coronavirus and influenza virus in Wuhan, China. J Med Virol. 2020 Mar 20 [Epub ahead of print].
   154. Touzard-Romo F, Tapé C, Lonks JR. Co-infection with SARS-CoV-2 and human metapneumovirus. R I Med J (2013). 2020 Mar 19;103(2):75-6.
   155. Paret M, Lighter J, Pellett Madan R, et al. SARS-CoV-2 infection (COVID) in febrile infants without respiratory distress. Clin Infect Dis. 2020 Apr 17 [Epub ahead of print].
   156. Coronado Munoz A, Nawaratne U, McMann D, et al. Late-onset neonatal sepsis in a patient with COVID. N Engl J Med. 2020 Apr 22 [Epub ahead of print].
   157. Xia W, Shao J, Guo Y, et al. Clinical and CT features in pediatric patients with COVID infection: different points from adults. Pediatr Pulmonol. 2020 May;55(5):1169-74.
   158. Qin C, Zhou L, Hu Z, et al. Dysregulation of immune response in patients with COVID in Wuhan, China. Clin Infect Dis. 2020 Mar 12 [Epub ahead of print].
   159. Xie J, Tong Z, Guan X, et al. Critical care crisis and some recommendations during the COVID epidemic in China. Intensive Care Med. 2020 Mar 2 [Epub ahead of print].
   160. Royal College of Physicians. NEWS2 and deterioration in COVID. 2020 [internet publication].
   161. World Health Organization. Laboratory testing for coronavirus disease 2019 (COVID) in suspected human cases. 2020 [internet publication].
   162. Ruan ZR, Gong P, Han W, et al. A case of 2019 novel coronavirus infected pneumonia with twice negative 2019-nCoV nucleic acid testing within 8 days. Chin Med J (Engl). 2020 Mar 5 [Epub ahead of print].
   163. Wu X, Cai Y, Huang X, et al. Co-infection with SARS-CoV-2 and influenza A virus in patient with pneumonia, China. Emerg Infect Dis. 2020 Mar 11;26(6).
   164. World Health Organization. Advice on the use of point-of-care immunodiagnostic tests for COVID. 2020 [internet publication]
   165. Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID): serology testing for COVID. 2020 [internet publication].
   166. Poon LC, Yang H, Kapur A, et al. Global interim guidance on coronavirus disease 2019 (COVID‐19) during pregnancy and puerperium from FIGO and allied partners: information for healthcare professionals. 2020 [internet publication].
   167. Song F, Shi N, Shan F, et al. Emerging coronavirus 2019-nCoV pneumonia. Radiology. 2020 Feb 6:200274
   168. British Society of Thoracic Imaging. Thoracic imaging in COVID infection: guidance for the reporting radiologist - version 2. 2020 [internet publication].
   169. Tavare AN, Braddy A, Brill S, et al. Managing high clinical suspicion COVID inpatients with negative RT-PCR: a pragmatic and limited role for thoracic CT. Thorax. 2020 Apr 21 [Epub ahead of print].
   170. American College of Radiology. ACR recommendations for the use of chest radiography and computed tomography (CT) for suspected COVID infection. 2020 [internet publication].
   171. Li Z, Yi Y, Luo X, et al. Development and clinical application of a rapid IgM-IgG combined antibody test for SARS-CoV-2 infection diagnosis. J Med Virol. 2020 Feb 27 [Epub ahead of print].
   172. Shi H, Han X, Jiang N, et al. Radiological findings from 81 patients with COVID pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis. 2020 Apr;20(4):425-34.
   173. Yang W, Cao Q, Qin L, et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID): a multi-center study in Wenzhou city, Zhejiang, China. J Infect. 2020 Apr;80(4):388-93.
   174. Long C, Xu H, Shen Q, et al. Diagnosis of the coronavirus disease (COVID): rRT-PCR or CT? Eur J Radiol. 2020 Mar 25;126:108961.
   175. Salehi S, Abedi A, Balakrishnan S, et al. Coronavirus disease 2019 (COVID): a systematic review of imaging findings in 919 patients. AJR Am J Roentgenol. 2020 Mar 14;:1-7.
   176. Zhao D, Yao F, Wang L, et al. A comparative study on the clinical features of COVID pneumonia to other pneumonias. Clin Infect Dis. 2020 Mar 12 [Epub ahead of print].
   177. Zhu T, Wang Y, Zhou S, et al. A comparative study of chest computed tomography features in young and older adults with corona virus disease (COVID). J Thorac Imaging. 2020 Mar 31 [Epub ahead of print].
   178. Feng K, Yun YX, Wang XF, et al. Analysis of CT features of 15 children with 2019 novel coronavirus infection [in Chinese]. Zhonghua Er Ke Za Zhi. 2020 Feb 16;58(0):E007.
   179. Duan YN, Zhu YQ, Tang LL, et al. CT features of novel coronavirus pneumonia (COVID) in children. Eur Radiol. 2020 Apr 14 [Epub ahead of print].
   180. Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID) in China: a report of 1014 cases. Radiology. 2020 Feb 26:200642.
   181. Buonsenso D, Piano A, Raffaelli F, et al. Point-of-care lung ultrasound findings in novel coronavirus disease-19 pnemoniae: a case report and potential applications during COVID outbreak. Eur Rev Med Pharmacol Sci. 2020 Mar;24(5):2776-80.
   182. Soldati G, Smargiassi A, Inchingolo R, et al. Is there a role for lung ultrasound during the COVID pandemic? J Ultrasound Med. 2020 Mar 20 [Epub ahead of print].
   183. Soldati G, Smargiassi A, Inchingolo R, et al. Proposal for international standardization of the use of lung ultrasound for COVID patients; a simple, quantitative, reproducible method. J Ultrasound Med. 2020 Mar 30 [Epub ahead of print].
   184. Moro F, Buonsenso D, Moruzzi MC, et al. How to perform lung ultrasound in pregnant women with suspected COVID infection. Ultrasound Obstet Gynecol. 2020 Mar 24 [Epub ahead of print].
   185. Cheung JC, Lam KN. POCUS in COVID: pearls and pitfalls. Lancet Respir Med. 2020 Apr 7 [Epub ahead of print].
   186. Smith MJ, Hayward SA, Innes SM, et al. Point-of-care lung ultrasound in patients with COVID: a narrative review. Anaesthesia. 2020 Apr 10 [Epub ahead of print].
   187. Denina M, Scolfaro C, Silvestro E, et al. Lung ultrasound in children with COVID. Pediatrics. 2020 Apr 21 [Epub ahead of print].
   188. Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, et al. Clinical, laboratory and imaging features of COVID: a systematic review and meta-analysis. Travel Med Infect Dis. 2020 Mar 13:101623.
   189. Lu X, Zhang L, Du H, et al. SARS-CoV-2 infection in children. N Engl J Med. 2020 Mar 18 [Epub ahead of print].
   190. Cai J, Xu J, Lin D, et al. A case series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clin Infect Dis. 2020 Feb 28 [Epub ahead of print].
   191. Sun D, Li H, Lu XX, et al. Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center's observational study. World J Pediatr. 2020 Mar 19 [Epub ahead of print].
   192. Eliezer M, Hautefort C, Hamel AL, et al. Sudden and complete olfactory loss function as a possible symptom of COVID. JAMA Otolaryngol Head Neck Surg. 2020 Apr 8 [Epub ahead of print].
   193. Lechien JR, Chiesa-Estomba CM, De Siati DR, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID): a multicenter European study. Eur Arch Otorhinolaryngol. 2020 Apr 6 [Epub ahead of print].
   194. Spinato G, Fabbris C, Polesel J, et al. Alterations in smell or taste in mildly symptomatic outpatients with SARS-CoV-2 infection. JAMA. 2020 Apr 22 [Epub ahead of print].
   195. ENT UK. Loss of sense of smell as marker of COVID infection. 2020 [internet publication].
   196. American Academy of Otolaryngology - Head and Neck Surgery. Coronavirus disease 2019: resources. 2020 [internet publication].
   197. Wu P, Duan F, Luo C, et al. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID) in Hubei province, China. JAMA Ophthalmol. 2020 Mar 31 [Epub ahead of print].
   198. Jin X, Lian JS, Hu JH, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID) with gastrointestinal symptoms. Gut. 2020 Mar 24 [Epub ahead of print].
   199. Zhang JJ, Dong X, Cao YY, et al. Clinical characteristics of 140 patients infected by SARS-CoV-2 in Wuhan, China. Allergy. 2020 Feb 19 [Epub ahead of print].
   200. Rakel D. Clinical characteristics of COVID patients with digestive symptoms in Hubei, China. Am J Gastroenterol. 2020 Mar 28 [Epub ahead of print].
   201. Pan L, Mu M, Yang P, et al. Clinical characteristics of COVID patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Am J Gastroenterol. 2020 Apr 14 [Epub ahead of print].
   202. Nobel YR, Phipps M, Zucker J, et al. Gastrointestinal symptoms and COVID: case-control study from the United States. Gastroenterology. 2020 Apr 12 [Epub ahead of print].
   203. Chen F, Liu ZS, Zhang FR, et al. First case of severe childhood novel coronavirus pneumonia in China [in Chinese]. Zhonghua Er Ke Za Zhi. 2020 Feb 11;58(0):E005.
   204. Wang J, Wang D, Chen GC, et al. SARS-CoV-2 infection with gastrointestinal symptoms as the first manifestation in a neonate [in Chinese]. Zhongguo Dang Dai Er Ke Za Zhi. 2020 Mar;22(3):211-4.
   205. Luo S, Zhang X, Xu H. Don't overlook digestive symptoms in patients with 2019 novel coronavirus disease (COVID). Clin Gastroenterol Hepatol. 2020 Mar 20 [Epub ahead of print].
   206. Guotao L, Xingpeng Z, Zhihui D, et al. SARS-CoV-2 infection presenting with hematochezia. Med Mal Infect. 2020 Mar 27 [Epub ahead of print].
   207. Casey K, Iteen A, Nicolini R, et al. COVID pneumonia with hemoptysis: acute segmental pulmonary emboli associated with novel coronavirus infection. Am J Emerg Med. 2020 Apr 8 [Epub ahead of print]
   208. Lovato A, de Filippis C. Clinical presentation of COVID: a systematic review focusing on upper airway symptoms. Ear Nose Throat J. 2020 Apr 13 [Epub ahead of print].
   209. Recalcati S. Cutaneous manifestations in COVID: a first perspective. J Eur Acad Dermatol Venereol. 2020 Mar 26 [Epub ahead of print].
   210. Joob B, Wiwanitkit V. COVID can present with a rash and be mistaken for Dengue. J Am Acad Dermatol. 2020 Mar 22 [Epub ahead of print].
   211. Hunt M, Koziatek C. A case of COVID pneumonia in a young male with full body rash as a presenting symptom. Clin Pract Cases Emerg Med. 2020 Mar 28 [Epub ahead of print].
   212. Marzano AV, Genovese G, Fabbrocini G, et al. Varicella-like exanthem as a specific COVID-associated skin manifestation: multicenter case series of 22 patients. J Am Acad Dermatol. 2020 Apr 16 [Epub ahead of print].
   213. Lippi G, Plebani M, Michael Henry B. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID) infections: a meta-analysis. Clin Chim Acta. 2020 Mar 13;506:145-8.
   214. Tan L, Wang Q, Zhang D, et al. Lymphopenia predicts disease severity of COVID: a descriptive and predictive study. Signal Transduct Target Ther. 2020 Mar 27;5:33.
   215. Liu Y, Du X, Chen J, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID. J Infect. 2020 Apr 10 [Epub ahead of print].
   216. Lagunas-Rangel FA. Neutrophil-to-lymphocyte ratio and lymphocyte-to-C-reactive protein ratio in patients with severe coronavirus disease 2019 (COVID): a meta-analysis. J Med Virol. 2020 Apr 3 [Epub ahead of print].
   217. Tang N, Li D, Wang X, et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020 Apr;18(4):844-7.
   218. Tan C, Huang Y, Shi F, et al. C-reactive protein correlates with CT findings and predicts severe COVID early. J Med Virol. 2020 Apr 13 [Epub ahead of print].
   219. Mehta P, McAuley DF, Brown M, et al. COVID: consider cytokine storm syndromes and immunosuppression. Lancet. 2020 Mar 28;395(10229):1033-4
   220. Han H, Xie L, Liu R, et al. Analysis of heart injury laboratory parameters in 273 COVID patients in one hospital in Wuhan, China. J Med Virol. 2020 Mar 31 [Epub ahead of print].
   221. Kim H, Hong H, Yoon SH. Diagnostic performance of CT and reverse transcriptase-polymerase chain reaction for coronavirus disease 2019: a meta-analysis. Radiology. 2020 Apr 17:201343.
   222. US Food and Drug Administration. Coronavirus (COVID) update: FDA issues first emergency use authorization for point of care diagnostic. 2020 [internet publication]
   223. Omer SB, Malani P, Del Rio C. The COVID pandemic in the US: a clinical update. JAMA. 2020 Apr 6 [Epub ahead of print]
   224. Azzi L, Carcano G, Gianfagna F, et al. Saliva is a reliable tool to detect SARS-CoV-2. J Infect. 2020 Apr 13 [Epub ahead of print].
   225. Williams E, Bond K, Zhang B, et al. Saliva as a non-invasive specimen for detection of SARS-CoV-2. J Clin Microbiol. 2020 Apr 21 [Epub ahead of print].
   226. US Food and Drug Administration. Emergency use authorization: coronavirus disease 2019 (COVID) EUA information. 2020 [internet publication].
   227. US Food and Drug Administration. Coronavirus (COVID) update: FDA authorizes first test for patient at-home sample collection. 2020 [internet publication].
   228. National Institute for Health and Care Excellence. COVID rapid guideline: managing suspected or confirmed pneumonia in adults in the community. 2020 [internet publication].
   229. Centre for Evidence-Based Medicine; Heneghan C, Pluddemann A, Mahtani KR. Differentiating viral from bacterial pneumonia. 2020 [internet publication].
   230. Hani C, Trieu NH, Saab I, et al. COVID pneumonia: a review of typical CT findings and differential diagnosis. Diagn Interv Imaging. 2020 Apr 3 [Epub ahead of print].
   231. Beltrán-Corbellini Á, Chico-García JL, Martínez-Poles J, et al. Acute-onset smell and taste disorders in the context of COVID: a pilot multicenter PCR-based case-control study. Eur J Neurol. 2020 Apr 22 [Epub ahead of print].
   232. National Institute for Health and Care Excellence. COVID rapid guideline: delivery of systemic anticancer treatments. 2020 [internet publication].
   233. Centers for Disease Control and Prevention. Criteria to guide evaluation and laboratory testing for COVID. March 2020 [internet publication].
   234. Infectious Diseases Society of America. COVID prioritization of diagnostic testing. 2020 [internet publication].
   235. World Health Organization. Home care for patients with COVID presenting with mild symptoms and management of their contacts. 2020 [internet publication].
   236. World Health Organization. Updated WHO recommendations for international traffic in relation to COVID outbreak. February 2020 [internet publication].
   237. Arima Y, Shimada T, Suzuki M, et al. Severe acute respiratory syndrome coronavirus 2 infection among returnees to Japan from Wuhan, China, 2020. Emerg Infect Dis. 2020 Apr 10;26(7).
   238. Kwon KT, Ko JH, Shin H, et al. Drive-through screening center for COVID: a safe and efficient screening system against massive community outbreak. J Korean Med Sci. 2020 Mar 23;35(11):e123.
   239. Emanuel EJ, Persad G, Upshur R, et al. Fair allocation of scarce medical resources in the time of COVID. N Engl J Med. 2020 Mar 23 [Epub ahead of print].
   240. Truog RD, Mitchell C, Daley GQ. The toughest triage: allocating ventilators in a pandemic. N Engl J Med. 2020 Mar 23 [Epub ahead of print].
   241. White DB, Lo B. A framework for rationing ventilators and critical care beds during the COVID pandemic. JAMA. 2020 Mar 27 [Epub ahead of print].
   242. Cohen IG, Crespo AM, White DB. Potential legal liability for withdrawing or withholding ventilators during COVID: assessing the risks and identifying needed reforms. JAMA. 2020 Apr 1 [Epub ahead of print].
   243. British Medical Association. COVID: ethical issues. 2020 [internet publication].
   244. World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID - 16 March 2020. 2020 [internet publication].
   245. Bhatraju PK, Ghassemieh BJ, Nichols M, et al. COVID in critically ill patients in the Seattle region: case series. N Engl J Med. 2020 Mar 30 [Epub ahead of print]
   246. Garg S, Kim L, Whitaker M, et al. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019: COVID-NET, 14 states, March 1 – 30, 2020. MMWR Morb Mortal Wkly Rep. 2020 Apr 17;69(15):458-64.
   247. National Institute for Health and Care Excellence. COVID rapid guideline: managing symptoms (including at the end of life) in the community. 2020 [internet publication].
   248. National Institute for Health and Care Excellence. COVID rapid guideline: critical care in adults. 2020 [internet publication].
   249. Alhazzani W, Møller MH, Arabi YM, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with coronavirus Disease 2019 (COVID). Intensive Care Med. 2020 Mar 28 [Epub ahead of print].
   250. NHS England. Clinical guide for the optimal use of oxygen therapy during the coronavirus pandemic. 2020 [internet publication]
   251. Dondorp AM, Hayat M, Aryal D, et al. Respiratory support in novel coronavirus disease (COVID) patients, with a focus on resource-limited settings. Am J Trop Med Hyg. 2020 Apr 21 [Epub ahead of print].
   252. Caputo ND, Strayer RJ, Levitan R. Early self-proning in awake, non-intubated patients in the emergency department: a single ED's experience during the COVID pandemic. Acad Emerg Med. 2020 Apr 22 [Epub ahead of print].
   253. National Institutes of Health. Coronavirus disease 2019 (COVID) treatment guidelines. 2020 [internet publication].
   254. Centre for Evidence-Based Medicine; Park S, Brassey J, Heneghan C, et al. Managing fever in adults with possible or confirmed COVID in primary care. 2020 [internet publication].
   255. Day M. COVID: ibuprofen should not be used for managing symptoms, say doctors and scientists. BMJ. 2020 Mar 17;368:m1086.
   256. Torjesen I. Ibuprofen can mask symptoms of infection and might worsen outcomes, says European drugs agency. BMJ. 2020 Apr 22;369:m1614.
   257. European Medicines Agency. EMA gives advice on the use of non-steroidal anti-inflammatories for COVID. 2020 [internet publication].
   258. US Food and Drug Administration. FDA advises patients on use of non-steroidal anti-inflammatory drugs (NSAIDs) for COVID. 2020 [internet publication].
   259. Little P. Non-steroidal anti-inflammatory drugs and COVID. BMJ. 2020 Mar 27;368:m1185.
   260. Medicines and Healthcare products Regulatory Agency; Commission on Human Medicines. Commission on Human Medicines advice on ibuprofen and coronavirus (COVID). 2020 [internet publication].
   261. World Health Organization. The use of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with COVID. 2020 [internet publication].
   262. National Institute for Health and Care Excellence. COVID rapid evidence summary: acute use of non-steroidal anti-inflammatory drugs (NSAIDs) for people with or at risk of COVID. 2020 [internet publication].
   263. Canelli R, Connor CW, Gonzalez M, et al. Barrier enclosure during endotracheal intubation. N Engl J Med. 2020 Apr 3 [Epub ahead of print].
   264. Matava CT, Yu J, Denning S. Clear plastic drapes may be effective at limiting aerosolization and droplet spray during extubation: implications for COVID. Can J Anaesth. 2020 Apr 3 [Epub ahead of print].
   265. Lucchini A, Giani M, Isgrò S, et al. The "helmet bundle" in COVID patients undergoing non invasive ventilation. Intensive Crit Care Nurs. 2020 Apr 2:102859.
   266. Adir Y, Segol O, Kompaniets D, et al. Covid19: minimising risk to healthcare workers during aerosol producing respiratory therapy using an innovative constant flow canopy. Eur Respir J. 2020 Apr 9 [Epub ahead of print].
   267. Matthay MA, Aldrich JM, Gotts JE. Treatment for severe acute respiratory distress syndrome from COVID. Lancet Respir Med. 2020 Mar 20 [Epub ahead of print].
   268. McEnery T, Gough C, Costello RW. COVID: respiratory support outside the intensive care unit. Lancet Respir Med. 2020 Apr 9 [Epub ahead of print].
   269. NHS England. Guidance for the role and use of non-invasive respiratory support in adult patients with COVID19 (confirmed or suspected). 2020 [internet publication].
   270. National Institutes of Health. Coronavirus disease 2019 (COVID) treatment guidelines. 2020 [internet publication].
   271. Li J, Fink JB, Ehrmann S. High-flow nasal cannula for COVID patients: low risk of bio-aerosol dispersion. Eur Respir J. 2020 Apr 16 [Epub ahead of print].
   272. Wang K, Zhao W, Li J, et al. The experience of high-flow nasal cannula in hospitalized patients with 2019 novel coronavirus-infected pneumonia in two hospitals of Chongqing, China. Ann Intensive Care. 2020 Mar 30;10(1):37.
   273. Mahase E. COVID: most patients require mechanical ventilation in first 24 hours of critical care. BMJ. 2020 Mar 24;368:m1201.
   274. Gattinoni L, Coppola S, Cressoni M, et al. COVID does not lead to a "typical" acute respiratory distress syndrome. Am J Respir Crit Care Med. 2020 Mar 30 [Epub ahead of print].
   275. Gattinoni L, Chiumello D, Rossi S. COVID pneumonia: ARDS or not? Crit Care. 2020 Apr 16;24(1):154.
   276. Gattinoni L, Chiumello D, Caironi P, et al. COVID pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med. 2020 Apr 14 [Epub ahead of print].
   277. NHS England. Clinical guide for the management of critical care for adults with COVID during the coronavirus pandemic. 2020 [internet publication].
   278. American Thoracic Society; Wilson KC, Chotirmall SH, Bai C, et al. COVID‐19: interim guidance on management pending empirical evidence. 2020 [internet publication].
   279. Pan C, Chen L, Lu C, et al. Lung recruitability in SARS-CoV-2 associated acute respiratory distress syndrome: a single-center, observational study. Am J Respir Crit Care Med. 2020 Mar 23 [Epub ahead of print].
   280. Ramanathan K, Antognini D, Combes A, et al. Planning and provision of ECMO services for severe ARDS during the COVID pandemic and other outbreaks of emerging infectious diseases. Lancet Respir Med. 2020 Mar 20 [Epub ahead of print].
   281. NHS England. Clinical guide for extra corporeal membrane oxygenation (ECMO) for respiratory failure in adults during the coronavirus pandemic. 2020 [internet publication].
   282. Zeng Y, Cai Z, Xianyu Y, et al. Prognosis when using extracorporeal membrane oxygenation (ECMO) for critically ill COVID patients in China: a retrospective case series. Crit Care. 2020 Apr 15;24(1):148.
   283. Jacobs JP, Stammers AH, St Louis J, et al. Extracorporeal membrane oxygenation in the treatment of severe pulmonary and cardiac compromise in COVID: experience with 32 patients. ASAIO J. 2020 Apr 17 [Epub ahead of print].
   284. Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020 Feb 15;395(10223):473-5.
   285. Zha L, Li S, Pan L, et al. Corticosteroid treatment of patients with coronavirus disease 2019 (COVID). Med J Aust. 2020 Apr 8 [Epub ahead of print].
   286. Yang Z, Liu J, Zhou Y, et al. The effect of corticosteroid treatment on patients with coronavirus infection: a systematic review and meta-analysis. J Infect. 2020 Apr 10 [Epub ahead of print].
   287. Bhimraj A, Morgan RL, Hirsch Shumaker A, et al. Infectious Diseases Society of America guidelines on the treatment and management of patients with COVID infection. 2020 [internet publication].
   288. Dashraath P, Jing Lin Jeslyn W, Mei Xian Karen L, et al. Coronavirus disease 2019 (COVID) pandemic and pregnancy. Am J Obstet Gynecol. 2020 Mar 23 [Epub ahead of print
   289. American College of Obstetricians and Gynecologists. Novel coronavirus 2019 (COVID). 2020 [internet publication].
   290. Favre G, Pomar L, Qi X, et al. Guidelines for pregnant women with suspected SARS-CoV-2 infection. Lancet Infect Dis. 2020 Mar 3 [Epub ahead of print].
   291. Chen D, Yang H, Cao Y, et al. Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID) infection. Int J Gynaecol Obstet. 2020 Mar 20 [Epub ahead of print].
   292. American Academy of Pediatrics; Puopolo KM, Hudak ML, Kimberlin DW, et al. Management of infants
   293. Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID): considerations for inpatient obstetric healthcare settings. 2020 [internet publication].
   294. McCreary EK, Pogue JM. Coronavirus disease 2019 treatment: a review of early and emerging options. Open Forum Infect Dis. 2020 Apr;7(4):ofaa105.
   295. Sanders JM, Monogue ML, Jodlowski TZ, et al. Pharmacologic treatments for coronavirus disease 2019 (COVID): a review. JAMA. 2020 Apr 13 [Epub ahead of print].
   296. Kalil AC. Treating COVID: off-label drug use, compassionate use, and randomized clinical trials during pandemics. JAMA Mar 24 [Epub ahead of print].
   297. World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID - 18 March 2020. 2020 [internet publication].
   298. Wang M, Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020 Mar;30(3):269-71.
   299. Cortegiani A, Ingoglia G, Ippolito M, et al. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID. J Crit Care. 2020 Mar 10 [Epub ahead of print].
   300. Chinese Clinical Trial Registry. A prospective, open-label, multiple-center study for the efficacy of chloroquine phosphate in patients with novel coronavirus pneumonia (COVID). 2020 [internet publication].
   301. Chinese Clinical Trial Registry. Therapeutic effect of hydroxychloroquine on novel coronavirus pneumonia (COVID). 2020 [internet publication].
   302. Multicenter Collaboration Group of Department of Science and Technology of Guangdong Province and Health Commission of Guangdong Province for Chloroquine in the Treatment of Novel Coronavirus Pneumonia. Expert consensus on chloroquine phosphate for the treatment of novel coronavirus pneumonia [in Chinese]. Zhonghua Jie He He Hu Xi Za Zhi. 2020 Feb 20;43(0):E019.
   303. ClinicalTrials.gov. Post-exposure prophylaxis for SARS-coronavirus-2. 2020 [internet publication].
   304. ClinicalTrials.gov. Chloroquine prevention of coronavirus disease (COVID) in the healthcare setting (COPCOV). 2020 [internet publication].
   305. Gautret P, Lagier JC, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020 Mar 20:105949.
   306. Kim AHJ, Sparks JA, Liew JW, et al. A rush to judgment? Rapid reporting and dissemination of results and its consequences regarding the use of hydroxychloroquine for COVID. Ann Intern Med. 2020 Mar 30 [Epub ahead of print].
   307. Molina JM, Delaugerre C, Le Goff J, et al. No evidence of rapid antiviral clearance or clinical benefit with the combination of hydroxychloroquine and azithromycin in patients with severe COVID infection. Med Mal Infect. 2020 Mar 30 [Epub ahead of print].
   308. Chen Z, Hu J, Zhang Z, et al; medRxiv. Efficacy of hydroxychloroquine in patients with COVID: results of a randomized clinical trial. 2020 [internet publication].
   309. Tang W, Cao Z, Han M, et al; medRxiv. Hydroxychloroquine in patients with COVID: an open-label, randomized, controlled trial. 2020 [internet publication].
   310. Wong YK, Yang J, He Y. Caution and clarity required in the use of chloroquine for COVID. Lancet Rheum. 2020 Apr 2 [Epub ahead of print].
   311. Zhou D, Dai SM, Tong Q. COVID: a recommendation to examine the effect of hydroxychloroquine in preventing infection and progression. J Antimicrob Chemother. 2020 Mar 20 [Epub ahead of print].
   312. Roden DM, Harrington RA, Poppas A, et al. Considerations for drug interactions on QTc in exploratory COVID (coronavirus disease 2019) treatment. Circulation. 2020 Apr 8 [Epub ahead of print].
   313. Multicenter collaboration group of Department of Science and Technology of Guangdong Province and Health Commission of Guangdong Province for chloroquine in the treatment of novel coronavirus pneumonia. Expert consensus on chloroquine phosphate for the treatment of novel coronavirus pneumonia [in Chinese]. Zhonghua Jie He He Hu Xi Za Zhi. 2020 Mar 12;43(3):185-8.
   314. European Medicines Agency. COVID: chloroquine and hydroxychloroquine only to be used in clinical trials or emergency use programmes. 2020 [internet publication]
   315. US Food and Drug Administration. Re: request for emergency use authorization for use of chloroquine phosphate or hydroxychloroquine sulfate supplied from the strategic national stockpile for treatment of 2019 coronavirus disease. 2020 [internet publication].
   316. Holshue ML, DeBolt C, Lindquist S, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020 Mar 5;382(10):929-36.
   317. ClinicalTrials.gov. Mild/moderate 2019-nCoV remdesivir RCT. 2020 [internet publication].
   318. ClinicalTrials.gov. Severe 2019-nCoV remdesivir RCT. 2020 [internet publication].
   319. ClinicalTrials.gov. Adaptive COVID treatment trial. 2020 [internet publication].
   320. ClinicalTrials.gov. Study to evaluate the safety and antiviral activity of remdesivir (GS-5734™) in participants with severe coronavirus disease (COVID). 2020 [internet publication].
   321. ClinicalTrials.gov. Study to evaluate the safety and antiviral activity of remdesivir (GS-5734™) in participants with moderate coronavirus disease (COVID) compared to standard of care treatment. 2020 [internet publication].
   322. Gilead Sciences. Remdesivir. 2020 [internet publication].
   323. European Medicines Agency. EMA provides recommendations on compassionate use of remdesivir for COVID. 2020 [internet publication].
   324. Grein J, Ohmagari N, Shin D, et al. Compassionate use of remdesivir for patients with severe COVID. N Engl J Med. 2020 Apr 10 [Epub ahead of print].
   325. Young BE, Ong SWX, Kalimuddin S, et al. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. JAMA. 2020 Mar 3 [Epub ahead of print].
   326. Cao B, Wang Y, Wen D, et al. A trial of lopinavir–ritonavir in adults hospitalized with severe COVID. N Engl J Med. 2020 Mar 18 [Epub ahead of print].
   327. Chen L, Xiong J, Bao L, et al. Convalescent plasma as a potential therapy for COVID. Lancet Infect Dis. 2020 Apr;20(4):398-400.
   328. ClinicalTrials.gov. Anti-SARS-CoV-2 inactivated convalescent plasma in the treatment of COVID. 2020 [internet publication].
   329. Shen C, Wang Z, Zhao F, et al. Treatment of 5 critically ill patients with COVID with convalescent plasma. JAMA. 2020 Mar 27 [Epub ahead of print].
   330. Duan K, Liu B, Li C, et al. Effectiveness of convalescent plasma therapy in severe COVID patients. Proc Natl Acad Sci U S A. 2020 Apr 6 [Epub ahead of print].
   331. US Food and Drug Administration. Investigational COVID convalescent plasma: emergency INDs. 2020 [internet publication].
   332. US Food and Drug Administration. Investigational COVID convalescent plasma. 2020 [internet publication]
   333. US Food and Drug Administration. Coronavirus (COVID) update: FDA encourages recovered patients to donate plasma for development of blood-related therapies. 2020 [internet publication].
   334. ClinicalTrials.gov. Mesenchymal stem cell treatment for pneumonia patients infected with 2019 novel coronavirus. 2020 [internet publication].
   335. Jawhara S. Could intravenous immunoglobulin collected from recovered coronavirus patients protect against COVID and strengthen the immune system of new patients? Int J Mol Sci. 2020 Mar 25;21(7).
   336. Regeneron. Regeneron announces important advances in novel COVID antibody program. 2020 [internet publication].
   337. Xie Y, Cao S, Li Q, et al. Effect of regular intravenous immunoglobulin therapy on prognosis of severe pneumonia in patients with COVID. J Infect. 2020 Apr 10 [Epub ahead of print].
   338. ClinicalTrials.gov. Tocilizumab in COVID pneumonia (TOCIVID-19). 2020 [internet publication].
   339. ClinicalTrials.gov. Favipiravir combined with tocilizumab in the treatment of corona virus disease 2019. 2020 [internet publication].
   340. ClinicalTrials.gov. Tocilizumab vs CRRT in management of cytokine release syndrome (CRS) in COVID (TACOS). 2020 [internet publication].
   341. ClinicalTrials.gov. Tocilizumab for SARS-CoV2 severe pneumonitis. 2020 [internet publication]
   342. ClinicalTrials.gov. Evaluation of the efficacy and safety of sarilumab in hospitalized patients with COVID. 2020 [internet publication].
   343. ClinicalTrials.gov. Cohort multiple randomized controlled trials open-label of immune modulatory drugs and other treatments in COVID patients: sarilumab trial - CORIMUNO-19 - SARI (CORIMUNO-SARI). 2020 [internet publication]
   344. ClinicalTrials.gov. Sarilumab COVID. 2020 [internet publication].
   345. ClinicalTrials.gov. An observational case-control study of the use of siltuximab in ARDS patients diagnosed with COVID infection (SISCO). 2020 [internet publication]
   346. Ritchie AI, Singanayagam A. Immunosuppression for hyperinflammation in COVID: a double-edged sword? Lancet. 2020 Apr 4;395(10230):1111.
   347. Monteagudo LA, Boothby A, Gertner E. Continuous intravenous anakinra infusion to calm the cytokine storm in macrophage activation syndrome. ACR Open Rheumatol. 2020 Apr 8 [Epub ahead of print].
   348. Wu D, Yang XO. TH17 responses in cytokine storm of COVID: an emerging target of JAK2 inhibitor Fedratinib. J Microbiol Immunol Infect. 2020 Mar 11 [Epub ahead of print].
   349. CytoDyn Inc. Leronlimab used in seven patients with severe COVID demonstrated promise with two intubated patients in ICU, removed from ICU and extubated with reduced pulmonary inflammation. 2020 [internet publication].
   350. World Health Organization. Bacille Calmette-Guérin (BCG) vaccination and COVID. 2020 [internet publication].
   351. Gurwitz D. Angiotensin receptor blockers as tentative SARS-CoV-2 therapeutics. Drug Dev Res. 2020 Mar 4 [Epub ahead of print].
   352. ClinicalTrials.gov. Losartan for patients with COVID requiring hospitalization. 2020 [internet publication].
   353. ClinicalTrials.gov. Losartan for patients with COVID not requiring hospitalization. 2020 [internet publication].
   354. Chinese Clinical Trial Registry. A randomized, open-label, blank-controlled trial for the efficacy and safety of lopinavir-ritonavir and interferon-alpha 2b in hospitalization patients with 2019-nCoV pneumonia (novel coronavirus pneumonia, NCP). 2020 [internet publication].
   355. Chinese Clinical Trial Registry. Clinical study for safety and efficacy of favipiravir in the treatment of novel coronavirus pneumonia (COVID). 2020 [internet publication].
   356. Chinese Clinical Trial Registry. Clinical study of arbidol hydrochloride tablets in the treatment of novel coronavirus pneumonia (COVID). 2020 [internet publication].
   357. Chinese Clinical Trial Registry. Randomized, open-label, controlled trial for evaluating of the efficacy and safety of baloxavir marboxil, favipiravir, and lopinavir-ritonavir in the treatment of novel coronavirus pneumonia (COVID) patients. 2020 [internet publication]
   358. Zeng YM, Xu XL, He XQ, et al. Comparative effectiveness and safety of ribavirin plus interferon-alpha, lopinavir/ritonavir plus interferon-alpha and ribavirin plus lopinavir/ritonavir plus interferon-alpha in patients with mild to moderate novel coronavirus pneumonia. Chin Med J (Engl). 2020 Mar 5 [Epub ahead of print].
   359. Li H, Wang YM, Xu JY, et al. Potential antiviral therapeutics for 2019 novel coronavirus [in Chinese]. Zhonghua Jie He He Hu Xi Za Zhi. 2020 Mar 12;43(3):170-2.
   360. Deng L, Li C, Zeng Q, et al. Arbidol combined with LPV/r versus LPV/r alone against corona virus disease 2019: a retrospective cohort study. J Infect. 2020 Mar 11 [Epub ahead of print].
   361. ClinicalTrials.gov. Efficacy and safety of darunavir and cobicistat for treatment of pneumonia caused by 2019-nCoV (DACO-nCoV). 2020 [internet publication].
   362. Synairgen. COVID. 2020 [internet publication].
   363. Zhu Z, Lu Z, Xu T, et al. Arbidol monotherapy is superior to lopinavir/ritonavir in treating COVID. J Infect. 2020 Apr 10 [Epub ahead of print].
   364. ClinicalTrials.gov. Vitamin C infusion for the treatment of severe 2019-nCoV infected pneumonia. 2020 [internet publication].
   365. Yang Y, Islam MS, Wang J, et al. Traditional Chinese medicine in the treatment of patients infected with 2019-new coronavirus (SARS-CoV-2): a review and perspective. Int J Biol Sci. 2020 Mar 15;16(10):1708-17.
   366. World Health Organization. Coronavirus disease (COVID-2019) situation reports. 2020 [internet publication].
   367. Verity R, Okell LC, Dorigatti I, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020 Mar 30 [Epub ahead of print].
   368. Centre for Evidence-Based Medicine; Oke J, Heneghan C. Global COVID case fatality rates. 2020 [internet publication].
   369. Centre for Evidence-Based Medicine; Oke J, Heneghan C. Reconciling COVID death data in the UK. 2020 [internet publication].
   370. Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID in Italy. JAMA. 2020 Mar 23 [Epub ahead of print].
   371. Mahase E. Coronavirus COVID has killed more people than SARS and MERS combined, despite lower case fatality rate. BMJ. 2020 Feb 18;368:m641.
   372. Rajgor DD, Lee MH, Archuleta S, et al. The many estimates of the COVID case fatality rate. Lancet Infect Dis. 2020 Mar 27 [Epub ahead of print]
   373. Los Angeles County Department of Public Health. USC-LA county study: early results of antibody testing suggest number of COVID infections far exceeds number of confirmed cases in Los Angeles County. 2020 [internet publication].
   374. Bendavid E, Mulaney B, Sood N; medRxiv. COVID antibody seroprevalence in Santa Clara County, California. 2020 [internet publication].
   375. Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with COVID in China: a nationwide analysis. Eur Respir J. 2020 Mar 26 [Epub ahead of print].
   376. Grasselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020 Apr 6 [Epub ahead of print].
   377. Arentz M, Yim E, Klaff L, et al. Characteristics and outcomes of 21 critically ill patients with COVID in Washington State. JAMA. 2020 Mar 19 [Epub ahead of print].
   378. McMichael TM, Currie DW, Clark S, et al. Epidemiology of COVID in a long-term care facility in King County, Washington. N Engl J Med. 2020 Mar 27 [Epub ahead of print].
   379. Ruan Q, Yang K, Wang W, et al. Clinical predictors of mortality due to COVID based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020 Mar 3 [Epub ahead of print].
   380. Yang F, Shi S, Zhu J, et al. Analysis of 92 deceased patients with COVID. J Med Virol. 2020 Apr 15 [Epub ahead of print].
   381. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020 Feb 24 [Epub ahead of print].
   382. Gong J, Ou J, Qiu X, et al. A tool to early predict severe corona virus disease 2019 (COVID): a multicenter study using the risk nomogram in Wuhan and Guangdong, China. Clin Infect Dis. 2020 Apr 16 [Epub ahead of print].
   383. Chen T, Wu D, Chen H, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020 Mar 26;368:m1091.
   384. Deng Y, Liu W, Liu K, et al. Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 (COVID) in Wuhan, China: a retrospective study. Chin Med J (Engl). 2020 Mar 20 [Epub ahead of print].
   385. Wang Y, Lu X, Chen H, et al. Clinical course and outcomes of 344 intensive care patients with COVID. Am J Respir Crit Care Med. 2020 Apr 8 [Epub ahead of print].
   386. Du RH, Liang LR, Yang CQ, et al. Predictors of mortality for patients with COVID pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J. 2020 Apr 8 [Epub ahead of print].
   387. Li X, Xu S, Yu M, et al. Risk factors for severity and mortality in adult COVID inpatients in Wuhan. J Allergy Clin Immunol. 2020 Apr 12 [Epub ahead of print].
   388. Liu Y, Sun W, Guo Y, et al. Association between platelet parameters and mortality in coronavirus disease 2019: retrospective cohort study. Platelets. 2020 Apr 16;:1-7.
   389. Yang X, Yang Q, Wang Y, et al. Thrombocytopenia and its association with mortality in patients with COVID. J Thromb Haemost. 2020 Apr 17 [Epub ahead of print].
   390. Chen R, Liang W, Jiang M, et al. Risk factors of fatal outcome in hospitalized subjects with coronavirus disease 2019 from a nationwide analysis in China. Chest. 2020 Apr 15 [Epub ahead of print].
   391. Zhang L, Yan X, Fan Q, et al. D-dimer levels on admission to predict in-hospital mortality in patients with COVID. J Thromb Haemost. 2020 Apr 19 [Epub ahead of print].
   392. Roncon L, Zuin M, Rigatelli G, et al. Diabetic patients with COVID infection are at higher risk of ICU admission and poor short-term outcome. J Clin Virol. 2020 Apr 9;127:104354.
   393. Mo P, Xing Y, Xiao Y, et al. Clinical characteristics of refractory COVID pneumonia in Wuhan, China. Clin Infect Dis. 2020 Mar 16 [Epub ahead of print].
   394. Chen D, Xu W, Lei Z, et al. Recurrence of positive SARS-CoV-2 RNA in COVID: a case report. Int J Infect Dis. 2020 Mar 5;93:297-9.
   395. Xing Y, Mo P, Xiao Y, et al. Post-discharge surveillance and positive virus detection in two medical staff recovered from coronavirus disease 2019 (COVID), China, January to February 2020. Euro Surveill. 2020 Mar;25(10).
   396. Ye G, Pan Z, Pan Y, et al. Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation. J Infect. 2020 Mar 11 [Epub ahead of print].
   397. Yuan J, Kou S, Liang Y, et al. PCR assays turned positive in 25 discharged COVID patients. Clin Infect Dis. 2020 Apr 8 [Epub ahead of print].
   398. Xiao AT, Tong YX, Zhang S. False-negative of RT-PCR and prolonged nucleic acid conversion in COVID: rather than recurrence. J Med Virol. 2020 Apr 9 [Epub ahead of print].
   399. Tang X, Zhao S, He D, et al. Positive RT-PCR tests among discharged COVID patients in Shenzhen, China. Infect Control Hosp Epidemiol. 2020 Apr 16;:1-7.
   400. Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020 Mar 13 [Epub ahead of print].
   401. Chen JY, Qiao K, Liu F, et al. Lung transplantation as therapeutic option in acute respiratory distress syndrome for COVID-related pulmonary fibrosis. Chin Med J (Engl). 2020 Apr 1 [Epub ahead of print].
   402. Madjid M, Safavi-Naeini P, Solomon SD, et al. Potential effects of coronaviruses on the cardiovascular system: a review. JAMA Cardiol. 2020 Mar 27 [Epub ahead of print].
   403. Sala S, Peretto G, Gramegna M, et al. Acute myocarditis presenting as a reverse Tako-Tsubo syndrome in a patient with SARS-CoV-2 respiratory infection. Eur Heart J. 2020 Apr 8 [Epub ahead of print].
   404. Liu PP, Blet A, Smyth D, et al. The science underlying COVID: implications for the cardiovascular system. Circulation. 2020 Apr 15 [Epub ahead of print].
   405. Clerkin KJ, Fried JA, Raikhelkar J, et al. Coronavirus disease 2019 (COVID) and cardiovascular disease. Circulation. 2020 Mar 21 [Epub ahead of print].
   406. Hendren NS, Drazner MH, Bozkurt B, et al. Description and proposed management of the acute COVID cardiovascular syndrome. Circulation. 2020 Apr 16 [Epub ahead of print].
   407. Shi S, Qin M, Shen B, et al. Association of cardiac injury with mortality in hospitalized patients with COVID in Wuhan, China. JAMA Cardiol. 2020 Mar 25 [Epub ahead of print].
   408. He XW, Lai JS, Cheng J, et al. Impact of complicated myocardial injury on the clinical outcome of severe or critically ill COVID patients [in Chinese]. Zhonghua Xin Xue Guan Bing Za Zhi. 2020 Mar 15;48(0):E011.
   409. Guo T, Fan Y, Chen M, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID). JAMA Cardiol. 2020 Mar 27 [Epub ahead of print].
   410. Zeng JH, Liu YX, Yuan J, et al. First case of COVID complicated with fulminant myocarditis: a case report and insights. Infection. 2020 Apr 10 [Epub ahead of print].
   411. Inciardi RM, Lupi L, Zaccone G, et al. Cardiac involvement in a patient with coronavirus disease 2019 (COVID). JAMA Cardiol. 2020 Mar 27 [Epub ahead of print].
   412. Hua A, O'Gallagher K, Sado D, et al. Life-threatening cardiac tamponade complicating myo-pericarditis in COVID. Eur Heart J. 2020 Mar 30 [Epub ahead of print].
   413. Meyer P, Degrauwe S, Delden CV, et al. Typical takotsubo syndrome triggered by SARS-CoV-2 infection. Eur Heart J. 2020 Apr 14 [Epub ahead of print].
   414. Bangalore S, Sharma A, Slotwiner A, et al. ST-segment elevation in patients with COVID: a case series. N Engl J Med. 2020 Apr 17 [Epub ahead of print].
   415. National Institute for Health and Care Excellence. COVID rapid guideline: acute myocardial injury. 2020 [internet publication].416. Xiong TY, Redwood S, Prendergast B, et al. Coronaviruses and the cardiovascular system: acute and long-term implications. Eur Heart J. 2020 Mar 18 [Epub ahead of print].
   416. Cai Q, Huang D, Yu H, et al. Characteristics of liver tests in COVID patients. J Hepatol. 2020 Apr 13 [Epub ahead of print].
   417. Xu L, Liu J, Lu M, et al. Liver injury during highly pathogenic human coronavirus infections. Liver Int. 2020 Mar 14 [Epub ahead of print].
   418. Bangash MN, Patel J, Parekh D. COVID and the liver: little cause for concern. Lancet Gastroenterol Hepatol. 2020 Mar 20 [Epub ahead of print].
   419. Ye Q, Wang B, Mao J. Cytokine storm in COVID and treatment. J Infect. 2020 Apr 10 [Epub ahead of print].
   420. Wang Z, Yang B, Li Q, et al. Clinical features of 69 cases with coronavirus disease 2019 in Wuhan, China. Clin Infect Dis. 2020 Mar 16 [Epub ahead of print].
   421. Pedersen SF, Ho YC. SARS-CoV-2: a storm is raging. J Clin Invest. 2020 Mar 27 [Epub ahead of print].
   422. Zhang W, Zhao Y, Zhang F, et al. The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID): the experience of clinical immunologists from China. Clin Immunol. 2020 Mar 25;:108393.
   423. Song JC, Wang G, Zhang W, et al. Chinese expert consensus on diagnosis and treatment of coagulation dysfunction in COVID. Mil Med Res. 2020 Apr 20;7(1):19.
   424. Tang N, Bai H, Chen X, et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020 Mar 27 [Epub ahead of print].
   425. Ranucci M, Ballotta A, Di Dedda U, et al. The procoagulant pattern of patients with COVID acute respiratory distress syndrome. J Thromb Haemost. 2020 Apr 17 [Epub ahead of print].
   426. Bikdeli B, Madhavan MV, Jimenez D, et al. COVID and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up. J Am Coll Cardiol. 2020 Apr 15 [Epub ahead of print].
   427. Cui S, Chen S, Li X, et al. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020 Apr 9 [Epub ahead of print].
   428. Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID. Thromb Res. 2020 Apr 10 [Epub ahead of print].
   429. Llitjos JF, Leclerc M, Chochois C, et al. High incidence of venous thromboembolic events in anticoagulated severe COVID patients. J Thromb Haemost. 2020 Apr 22 [Epub ahead of print].
   430. Wang T, Chen R, Liu C, et al. Attention should be paid to venous thromboembolism prophylaxis in the management of COVID. Lancet Haematol. 2020 Apr 9 [Epub ahead of print].
   431. American Society Of Hematology. COVID and VTE/anticoagulation: frequently asked questions. 2020 [internet publication].
   432. Duployez C, Le Guern R, Tinez C, et al. Panton-Valentine leukocidin-secreting Staphylococcus aureus pneumonia complicating COVID. Emerg Infect Dis. 2020 Apr 16;26(8).
   433. Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID. Kidney Int. 2020 Mar 2020 Mar 20 [Epub ahead of print].
   434. Wang L, Li X, Chen H, et al. Coronavirus disease 19 infection does not result in acute kidney injury: an analysis of 116 hospitalized patients from Wuhan, China. Am J Nephrol. 2020 Mar 31;:1-6.
   435. Wang F, Wang H, Fan J, et al. Pancreatic injury patterns in patients with COVID pneumonia. Gastroenterology. 2020 Apr 1 [Epub ahead of print].
   436. Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020 Apr 10 [Epub ahead of print].
   437. Mao L, Wang M, Chen S, et al. Neurological manifestations of hospitalized patients with COVID in Wuhan, China: a retrospective case series study. 2020 [internet publication]
   438. AHA/ASA Stroke Council Leadership. Temporary emergency guidance to US stroke centers during the COVID pandemic. Stroke. 2020 Apr 1 [Epub ahead of print].
   439. Jin H, Hong C, Chen S, et al. Consensus for prevention and management of coronavirus disease 2019 (COVID) for neurologists. Stroke Vasc Neurol. 2020 Apr 1 [Epub ahead of print]
   440. Poyiadji N, Shahin G, Noujaim D, et al. COVID–associated acute hemorrhagic necrotizing encephalopathy: CT and MRI features. Radiology. 2020 Mar 31:201187.
   441. Filatov A, Sharma P, Hindi F, et al. Neurological complications of coronavirus disease (COVID): encephalopathy. Cureus. 2020 Mar 21 [Epub ahead of print].
   442. Moriguchi T, Harii N, Goto J, et al. A first case of meningitis/encephalitis associated with SARS-coronavirus-2. Int J Infect Dis. 2020 Apr 3 [Epub ahead of print].
   443. Zhao H, Shen D, Zhou H, et al. Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurol. 2020 Apr 1 [Epub ahead of print].
   444. Toscano G, Palmerini F, Ravaglia S, et al. Guillain-Barré syndrome associated with SARS-CoV-2. N Engl J Med. 2020 Apr 17 [Epub ahead of print].
   445. Sedaghat Z, Karimi N. Guillain Barre syndrome associated with COVID infection: a case report. J Clin Neurosci. 2020 Apr 15 [Epub ahead of print].
   446. Virani A, Rabold E, Hanson T, et al. Guillain-Barré syndrome associated with SARS-CoV-2 infection. IDCases. 2020 Apr 18:e00771.
   447. Jin M, Tong Q. Rhabdomyolysis as potential late complication associated with COVID. Emerg Infect Dis. 2020 Mar 20;26(7).
   448. Liu D, Li L, Wu X, et al. Pregnancy and perinatal outcomes of women with coronavirus disease (COVID) pneumonia: a preliminary analysis. AJR Am J Roentgenol. 2020 Mar 18:1-6.
   449. Di Mascio D, Khalil A, Saccone G, et al. Outcome of coronavirus spectrum infections (SARS, MERS, COVID 1 -19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2020 Mar 25;:100107.
   450. Chen L, Li Q, Zheng D, et al. Clinical characteristics of pregnant women with COVID in Wuhan, China. N Engl J Med. 2020 Apr 17 [Epub ahead of print].
   451. Centre for Evidence-Based Medicine; Greenhalgh T, Treadwell J, Burrow R, et al. NEWS (or NEWS2) score when assessing possible COVID patients in primary care? 2020 [internet publication].
   452. Ji D, Zhang D, Xu J, et al. Prediction for progression risk in patients with COVID pneumonia: the CALL score. Clin Infect Dis. 2020 Apr 9 [Epub ahead of print].
   453. Centre for Evidence-Based Medicine; Green K, Allen AJ, Suklan J, et al. What is the role of imaging and biomarkers within the current testing strategy for the diagnosis of COVID? 2020 [internet publication].
   454. Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID): if you have animals. 2020 [internet publication].
   455. IDEXX Laboratories. Leading veterinary diagnostic company sees no COVID cases in pets. 2020 [internet publication].
   456. Shi J, Wen Z, Zhong G, et al. Susceptibility of ferrets, cats, dogs, and other domesticated animals to SARS-coronavirus 2. Science. 2020 Apr 8 [Epub ahead of print].
   457. Centers for Disease Control and Prevention. Confirmation of COVID in two pet cats in New York. 2020 [internet publication]
         

        *This article represents the individuals opinion and work of the author not the Clinical TMS Society.