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New Rochelle, NY, April 8, 2020--Researchers report a growing awareness of gastroesophageal reflux problems among patients who undergo endoscopic, nonsurgical treatment for esophageal achalasia, frequently requiring future surgical intervention. Peroral endoscopic myotomy (POEM) has been a treatment of choice for the past decade, but patients may develop severe heartburn and regurgitation that does not respond to medical treatment, as described in an article published in Journal of Laparoendoscopic & Advanced Surgical Techniques (JLAST), a peer-reviewed journal published by Mary Ann Liebert, Inc. Click here to read the full-text article free on the Journal of Laparoendoscopic & Advanced Surgical Techniques website through May 8, 2020.

Kamil Nurczyk, MD, Timothy Farrell, MD, and Marco Patti, MD, from University of North Carolina at Chapel Hill and Medical University of Lublin (Poland) coauthored the article entitled "Antireflux Surgery for Gastroesophageal Reflux Refractory to Medical Treatment after Peroral Endoscopic Myotomy." The authors express the concern that with POEM, one disease, achalasia (the backup of food within the esophagus) is being replaced with another, gastroesophageal reflux disease (GERD). They describe patients who experienced post-POEM reflux that was refractory to treatment with high doses of proton pump inhibitors and who required laparoscopic partial fundoplication surgery to eliminate their symptoms.

Editor-in-Chief P. Marco Fisichella, MD, MBA, Northwestern University, Feinberg School of Medicine, states: "This is the first report that confirms that the severity of reflux after POEM should not be underestimated. For years, the standard of care in the treatment of achalasia has been to perform a myotomy to relieve dysphagia coupled with a partial fundoplication to prevent reflux. However, with POEM, the advantages of a fundoplication are lost, thus subjecting the patient to reflux, which in most cases is asymptomatic. This report, however, highlights that reflux is still deleterious and resistant to medical treatment to the point of requiring another operation to correct it. The implications of this study are relevant, as it underscores how some patients who undergo POEM might need a second operation, which could be avoided should POEM be reserved only for those who might benefit the most from this procedure, such as those with type 3 achalasia. As of today, it is difficult to predict who will need a second operation -- a fundoplication -- after POEM. Yet, research should focus on identifying which patients might still benefit from POEM, while taking into account that the resultant reflux is a non-negligible complication."

Today, Cochrane publishes a new Rapid Review looking at quarantine during the COVID-19 pandemic.

The review summarizes evidence available from modelling studies that show how quarantining affects the spread of COVID-19. The studies included in the review consistently conclude that quarantine can play a role in controlling the spread of coronavirus SARS-CoV-2. While early implementation of quarantine and its combination with other public health measures may reduce spread of the disease, key uncertainties remain as to how these measures can best be adopted and when they can be relaxed.

Currently, there are no effective medicines or vaccines available to treat or prevent COVID-19. For this reason, restrictive public health measures such as isolation, physical distancing, and quarantine have been used in a number of countries to reduce transmission of the virus. Isolation refers to the separation of people with symptoms from others, whereas quarantine is the restriction of people who have no symptoms, but who have had contact with people with confirmed or suspected infection. Quarantine can be implemented on a voluntary basis or can be legally enforced by authorities, and it may be applied at an individual, group, or community level.

This Rapid Review was done in a short space of time as part of Cochrane's organizational effort to meet the need for up-to-date summaries of evidence to support decision-making in combating the effects and impact of COVID-19.

Cochrane researchers used abbreviated systematic review methods to address the following questions as quickly as possible:

Is quarantine of asymptomatic individuals who were in contact with a confirmed or suspected case of COVID-19 effective to control the COVID-19 outbreak?

Are there differences in the effectiveness of quarantine in different settings?

How effective is quarantine when combined with other interventions, such as case isolation, school closures, or antiviral drugs, in reducing transmission, incidence of diseases, and death?

Is quarantine of individuals coming from a country with a declared COVID-19 outbreak effective in controlling the COVID-19 outbreak?

The authors identified 29 relevant studies. Of these, 10 focused on COVID-19, 15 focused on related evidence on SARS (severe acute respiratory syndrome), two focused on SARS and other viruses, and two focused on MERS (Middle East respiratory syndrome). The 10 studies addressing COVID-19 were all modelling studies simulating outbreak scenarios in China, the UK, and South Korea, and on a cruise ship.

The COVID-19 modelling studies included in the review consistently report a benefit of quarantine measures and show similar findings from studies on SARS and MERS.

The authors of this Cochrane Review concluded that:

Quarantine of people exposed to confirmed cases may avert high proportions of infections and deaths compared to no measures.

The effect of quarantine of travelers from a country with a declared outbreak to avert transmission and deaths was small.

In general, the combination of quarantine with other prevention and control measures, such as school closures, travel restrictions, and physical distancing, had a greater effect on the reduction of transmissions, cases which required critical care beds, and deaths compared with quarantine alone.

More comprehensive and early implementation of prevention and control measures may be more effective in containing the COVID-19 outbreak.

The researchers rate their confidence in the results to be low or very low because of the way that the models used in the studies were developed. They are based on assumptions about the true prevalence of infection, which could be updated when we know more about this aspect of the COVID-19 pandemic.

However, the authors also stress the importance of using information about the local context in deciding on how measures such as quarantining should be adopted and when they can be lifted. Lead author Barbara Nußbaumer-Streit said "This Cochrane Review shows that while quarantine may help in containing the COVID-19 outbreak, decision-makers will need to constantly monitor the outbreak situation locally in order to maintain the best possible balance of measures in place, and that there is an acceptable trade-off between benefits and harms."

Cochrane Editor in Chief, Karla Soares-Weiser, added, "The spread of coronavirus presents a major challenge for governments all over the world. Cochrane has a duty to provide the best available evidence to support policy-making, balancing rigour with speed. We have fast-tracked this review because it addresses one of the highest priority questions we have identified. This review is particularly helpful for decision makers looking for evidence to inform their decisions around the implementation of quarantine measures."

A study published in Arthritis & Rheumatology provides evidence that the prevalence of autoimmunity--when the immune system goes awry and attacks the body itself--has increased in the United States in recent years.

For the study, researchers looked for antinuclear antibodies (ANA)--the most common marker of autoimmunity--in the blood of 14,211 participants from the U.S. National Health and Nutrition Examination Survey, with approximately one-third from each of three time periods: 1988-1991, 1999-2004, and 2011-2012.

The prevalence of ANA was 11.0% in 1988-1991, 11.5% in 1999-2004, and 15.9% in 2011-2012, which corresponds to 22, 27, and 41 million affected individuals, respectively.

"The reasons for the increasing prevalence of ANA, which were most pronounced in adolescents, males, and non-Hispanic whites, remain unclear," said senior author Frederick W. Miller, MD, PhD, of the National Institute of Environmental Health Sciences. "They are concerning, however, as they may herald an increase in autoimmune disorders, and emphasize the need for additional studies to determine the driving forces underlying these findings and to enable the development of possible preventative measures."

New research published in Academic Emergency Medicine indicates that for physicians and nurses working evening shifts in the emergency department, interacting with a therapy dog for several minutes may help lower stress.

In the 122-participant study, emergency providers randomized to a five-minute interaction with a therapy dog and handler had a significant reduction in self-reported anxiety using a visual analogue scale compared with patients randomized to coloring mandalas for five minutes with colored pencils. Also, at the end of the shift, emergency providers had lower salivary cortisol (a stress hormone) with either coloring or therapy dog interactions compared with controls.

"Many healthcare workers and laypersons believe that dog-assisted support can improve emotional well-being in the healthcare setting, but little hard data exist to scientifically evaluate this belief, especially in emergency care," said lead author Jeffrey A. Kline, MD, of the Indiana University School of Medicine. "We provide novel data to suggest that emergency care providers enjoyed seeing a dog on shift, and received a small benefit in stress reduction after the interaction. We still do not know the extent to which the benefit was from the dog, the handler, or the combination of the two."

Inflammatory bowel disease (IBD)--including Crohn's disease and ulcerative colitis--often affects women of childbearing age. A study published in Alimentary Pharmacology & Therapeutics compared the health of pregnant and non-pregnant women with IBD.

The study included 2,058 Korean women with IBD who became pregnant between 2007 and 2016 and 20,580 women of similar age who did not have IBD.

Overall, women with IBD did well during pregnancy; however, they had higher rates of Caesarean section and intrauterine growth retardation (low birth weight babies) than women without IBD. Of the patients who had Crohn's disease, those with quiescent-to-mild disease did as well as women without IBD; however, women with Crohn's disease that was not mild-to-moderate had a higher rate of miscarriage and almost a 3-fold higher rate of intrauterine growth retardation than women without IBD.

"Previous studies could be easily biased since considerable numbers of pregnant women with IBD with quiescent or mild activity were likely to be excluded. We overcame this limitation by using a nationwide database covering 98% of the 52 million citizens of an entire nation," said corresponding author Bo-In Lee, MD, PhD, of The Catholic University of Korea.

Acne is caused by chronic inflammation and is often treated with antibiotics. A recent analysis published in Dermatologic Therapy indicates that probiotics may be an effective alternative.

The analysis examined the results of all relevant published studies on the use of probiotics in creams or oral medications for treating acne. The results suggest that probiotics may help augment the skin's natural defenses against acne.

"Further research is recommended that looks into the long-term effects of probiotics on acne lesions given the short-term type of studies cited," said senior author Masoumeh Mohamadi, MD, of Rasoul Akram Hospital, in Iran.

Pre-school children who are overweight or obese have a higher risk of bone fractures during childhood than normal weight pre-schoolers, according to a study published in the Journal of Bone and Mineral Research.

The study included 466,997 children with weight and height measurements at age 4 years who were followed for a median of 4.9 years.

Fractures occurred in 9.20% of underweight, 10.06% of normal weight, 11.28% of overweight, and 13.05% of obese children. Compared with normal weight, overweight and obesity were linked with 42% and 74% higher risks of lower limb fractures, respectively, and a 10% and 19% higher risk of upper limb fractures, respectively.

"In a cohort of almost half a million children from Catalonia, Spain, we have found a strong association between pre-school overweight/obesity and the risk of fracture during childhood. More research is needed to further understand the mechanisms underlying this correlation" said senior author Daniel Prieto-Alhambra, PhD, of the University of Oxford, in the UK.

In an analysis of primary care records of 519,513 UK adults who were overweight or obese between 2000-2016 and followed up until 2019, the incidence of new cases of depression was 92 per 10,000 people per year. The risk of depression also rose with higher weight, according to the Obesity analysis.

The study also found that antidepressants were prescribed in approximately two-thirds of adults who were overweight or obese. Prescriptions for fluoxetine dropped over time (from 20.4% in 2000 to 8.8% in 2018) and prescriptions for sertraline increased (from 4.3% in 2000 to 38.9% in 2018).

"Our findings highlight the complex relationship between depression and obesity," said lead author Freya Tyrer, of the University of Leicester, in the UK. "We would like to see tailored guidance on antidepressant prescribing and services that focus on both mood and behaviors to improve outcomes for these individuals."

In a study of adults in China with lung cancer, patients who knew of their cancer diagnosis generally survived longer than those who did not.

In the Psycho-Oncology study of 29,825 patients, the median survival time in patients who knew of their diagnosis was 18.33 months versus 8.77 months for those who did not.

The study's authors noted that the survival benefits of the awareness of cancer diagnoses in patients is a controversial topic in some countries due to their culture and customs. In China, cultural, social, and legal factors play a role in not fully revealing disease status to patients with cancer. Usually, doctors first explain cancer diagnoses to patients' families, who determine whether patients will learn of their exact disease status.

"Although the complete disclosure of cancer diagnoses may cause emotional disturbance in patients immediately after being told of their diagnosis, it benefits them in the long term," said senior author Yunxiang Tang, MD, PhD, of The Second Military Medical University, in China. "Communication skills training for doctors and psychological support and education for patients and their families should be given more attention in clinical practice."

Chemotherapeutic drugs, also known as antineoplastic agents, that are prescribed to treat a range of cancer types, enter the aquatic environment via human excretion and wastewater treatment facilities. A review published in Environmental Toxicology and Chemistry indicates that very few studies have characterized the effects of antineoplastic agents that are released into aquatic environments.

The authors noted that with hundreds of antineoplastic agents in late-stage clinical development, it is essential to understand the toxicity of these compounds in aquatic environments in order to inform future regulations.

"The global population is aging, and cancer-fighting pharmaceuticals are being detected in water systems. We need to be proactive as a scientific community and identify potential gaps in our knowledge regarding the consequences of anti-neoplastic exposure in aquatic organisms," said corresponding author Christopher J. Martyniuk, of the University of Florida at the College of Veterinary Medicine.

A well-known hangover drug not only helps soothe pounding headaches but also triggers profound changes that protect the liver, USC scientists report in new findings that could help prevent alcohol-related harm.

The study focuses on dihydromyricetin (DHM), also known as ampelopsin, an over-the-counter herbal remedy. When researchers at the USC School of Pharmacy sought to understand how it works, their investigation revealed a sequence of metabolic changes responsible not only for easing headaches but also benefitting the liver.

"We know DHM helps the body to metabolize alcohol faster, but how does it work? We found it activates a cascade of mechanisms that erase alcohol from the body very quickly," said Jing Liang, a research professor of clinical pharmacy and the corresponding author of the study.

The study appears today in Alcoholism: Clinical and Experimental Research.

The findings support the utility of DHM as a dietary supplement to offset acute alcohol-related effects as well as long-term risks. In addition, the authors say the substance likely has wider applications to help people cope with binge drinking, alcoholism and liver damage.

Alcohol use disorders constitute the most common form of substance abuse. About 88,000 people die of alcohol-related deaths annually -- the third leading preventable cause of death in the United States, according to the U.S. Centers for Disease Control and Prevention. Globally, alcohol consumption contributes to 3 million deaths each year and is responsible for 5.1% of the global burden of disease, according to the World Health Organization. There is no effective therapeutic agent for the disorder without major side effects.

Meanwhile, excessive alcohol consumption is a significant cause of chronic liver disease, accounting for nearly half of the cirrhosis-associated deaths in the United States, according to the study.

DHM is derived from fruit from the Japanese raisin tree (Hovenia dulcis), which is native to Japan, Korea and Southeast Asia and now commercially grown. It's been used in China for liver ailments for 500 years, but how the substance works is unclear.

To better understand what the drug does inside the body, the scientists fed 36 mice a daily diet of alcohol for two months, gradually increasing doses to 30% of their total food intake for an average of 39.4 g/kg of ethanol per day per mouse. Then, they assessed their livers for injury and markers of stress.

The researchers focused on the liver, Liang said, because when you take a drink, alcohol circulates through the bloodstream. Though the alcohol affects the brain, it is metabolized primarily by the liver, which is significantly harmed by long-term, high levels of alcohol consumption.

"It's like stepping on a tack; your brain says it hurts. During a hangover, the fogginess in your brain is an acute reaction to what's going on in your body," said Daryl Davies, a study co-author and professor of clinical pharmacy in the USC School of Pharmacy.

Among other significant effects, the scientists found that DHM:

Triggered the liver to produce more ethanol-gobbling enzymes, including alcohol dehydrogenase (ADH) and acetaldehyde dehydrogenase (ALDH).

Boosted the efficiency of ADH and ALDH, enabling the enzymes to convert ethanol into simpler forms the body can eliminate easier.

Reduced lipid (fat) accumulation in liver tissue. Heavy doses of alcohol can negatively affect the liver's metabolism, leading to an accumulation of fat, increased stress and the eventual progression to liver diseases such as cirrhosis.

Reduced inflammatory agents, called cytokines. Excessive alcohol leads to the release of cytokines in the liver, which contributes to cellular damage to the liver and other organs.

"In total, these findings support the utility of DHM as a dietary supplement to reduce ethanol-induced liver injury via changes in lipid metabolism, enhancement of ethanol metabolism and suppressing inflammation responses to promote liver health," the study said. "This line of research suggests that DHM acts on multiple pathways to promote liver health and counteract ethanol injury."

Davies, who is also director of the Alcohol and Brain Research Laboratory at USC, said the findings also help explain how DHM works as a hangover treatment. The liver converts alcohol into an aldehyde with properties like formaldehyde, which contribute to headache and nausea. Since it takes about one hour for the body to metabolize one drink, a night of heavy drinking causes the liver to keep churning out the chemicals that make people feel woozy for so long.

"We now know what [DHM] is doing and how it's doing it mechanically, activating a cascade of energy-regulating mechanisms that speed metabolism of ethanol and its byproducts," said Joshua Silva, a doctoral student at the USC School of Pharmacy and study co-author.

The findings have important implications for helping prevent liver damage and harm from alcohol abuse.

For example, binge drinkers could use DHM for its liver protection properties, extending the function of the organ long enough for the person to get help and stop their bad drinking habit. "We may not be able to fix their problem overnight, but we can give them step-by-step improvements to help them drink less and gain health protection," Davies said.

Binge drinking is a serious problem for young adults, especially college students. About 37% of students engage in binge drinking -- five or more drinks on a single occasion for men or four or more drinks for women -- and about 10% engage in heavy alcohol use -- binge drinking on 5 or more days in the past month. Those rates are much higher than among non-college peers, according to a recent survey by the National Institutes of Health.

Excessive alcohol consumption significantly contributes to higher rates of alcohol-related liver disease at a younger age.

Excessive drinking has high social and economic costs, leading to heart disease, high blood pressure, unplanned pregnancies, violence and vehicle crashes. The CDC estimates the total economic cost at $249 billion annually.

DHM could potentially help patients who go to the doctor with early warning signs of liver damage. The substance could be used to help restore and prolong their liver function and delay the onset of liver disease while waiting for a transplant. DHM could also prove useful for liver transplant patients to help the new organ perform better so patients could enjoy a better quality of life.

"There's hope here. It could be a new lease on life for a lot of people," Davies said.

The NHS could save up to £89 million a year on unnecessary prescriptions for antibiotics, and further its efforts in the fight against antimicrobial resistance - if it was to comprehensively introduce already available and accurate point-of-care (POCTs) diagnostic tests.

These are the findings of a vast new national study, published in the Journal of Medical Economics, which has also found that £326 million is currently being spent on unwarranted antibiotics per year.

The study also showed that if new (yet to be made commercially available) POCTs were introduced, the savings made could theoretically rise to £178 million per year.

Acute respiratory infections such as bronchitis, sinusitis and pharyngitis account for over two-thirds of total UK antibiotic prescriptions, even though most are caused by viruses that do not respond to antibiotics. As it can be difficult to distinguish between bacterial and viral infections from physical symptoms alone, and because some patients demand antibiotics, physicians often end up prescribing them for viral infections.

However, 80-90% accurate POCTs, which detect protein biomarkers specific for viral or bacterial infections, can provide physicians with the ability to distinguish between bacterial and viral infections, enabling more objective evidence for a diagnosis.

Yet - despite previous studies showing at least 50-60% of surveyed GPs expressing interest in using POCTs - costs have prevented the universal introduction into the healthcare system.

A team of researchers from the US and Switzerland, led by Dr John Schneider at Avalon Health Economics LLC, have now discovered however that the price of purchasing the required amount of POCTs does offset the savings that arise from reducing the unnecessary prescribing of antibiotics.

By analysing National Institute for Health and Care Excellence (NICE) data and direct costs (antibiotics, antibiotic-related adverse events, POCTs) derived from already published literature, Dr Schneider and his team concluded that British doctors were prescribing antibiotics for 50% of acute respiratory infections, whereas bacteria were probably only responsible for around 9% of these infections. They then calculated that the annual cost for this unnecessary prescribing was over £326 million.

This was made up of the direct cost of the antibiotics, and the indirect costs of further consultations when the antibiotics didn't work and of treating unpleasant side effects as well as potentially life-threatening antibiotic-associated secondary infections such as C. difficile Infection (CDI). In contrast, the annual cost of purchasing POCTs to diagnose bacterial or viral infections and then treating those infections was much less, between £148 million and £290 million depending on the POCT, producing savings of up to £89 million.

"A major benefit of POCT is the ability to improve antibiotic stewardship in the primary and urgent care setting by providing tangible results that both increase diagnostic certainty and confidence to delay or withhold antibiotics when bacterial infection is unlikely," Dr Schneider explains.

"Without POCT, the UK health system spends over £326 million annually and with POCT this can lead to over £36 million to over £89 million in annual savings depending on the type of POCT deployed."

As well as cost savings, reducing the unnecessary prescribing of antibiotics would also directly benefit patient health - with antibiotics known to commonly cause unpleasant side effects and adverse events, including allergic reactions and secondary infections, in susceptible patients; often all without having any effect on the infection.

"Not only can point-of-care diagnostic testing help to prevent the misuse of antibiotics that leads to antibiotic resistance, which in turn benefits public and global health, but it is also beneficial to identify potential patients requiring isolation to reduce spread of disease and reduce healthcare spending and adverse event-associated morbidity carried by the individual," adds Dr Schneider.

Dr Schneider and his team believe these findings should also apply to many other countries, especially those with universal healthcare systems. He says, "outside of the UK, similar antibiotic pressures are felt in lower- and middle-income countries and access to inexpensive testing may have an even greater impact on resource limited regions. What is more astounding is that these cost savings do not include the potential costs related to the management of antibiotic resistance itself."

To introduce POCTs universally, the researchers note that a lack of reimbursement is the major limiting factor, whilst other considerations include space to accommodate a range of technologies, time to train staff, regulatory requirements and historically based uncertainty about test accuracy.

However, these costs may be partially or completely offset by enhanced workflow and payment strategies whilst significant changes in facilities and infrastructure are also not needed, they argue.

In a recent editorial, the Editor-in-Chief, Dr. James J James statess that there are currently two potential public health crises in the US. The first, COVID-19, we are all too aware of and are currently in the throes of attempting to control it through containment and mitigation. We are currently focusing on extreme containment measures, which cannot work as the transmission has already occurred nationwide. Data from South Korea and Italy indicate such measures may not even be necessary or very effective.

The side effect of these extreme measures is severe socio-economic damage realized through negative impacts on income, employment, and education, the recognized critical social determinants of health necessary for physical, mental, spiritual, and social wellbeing. This will unleash a second public crisis which , history shows, will have far greater negative impacts on overall morbidity and mortality than that which we are currently seeing from COVID-19.

To contain and mitigate both crises, we need national and state level strategies based on what we know of the epidemiological and clinical aspects of this disease. These strategies need to be targeted across individual and community risk determined by known risk factors such as age, population density, and transmission characteristics. This will enable us to begin recovery and transition back to a healthy economy while taking the necessary measures to address COVID-19.

Of the seven coronaviruses known to infect people, four cause common respiratory infections that are sharply seasonal and appear to transmit similarly to influenza, according to a new study by University of Michigan School of Public Health researchers.

The study authors say it is not possible to determine whether SARS-CoV-2 coronavirus, which causes COVID-19 disease, will behave likewise. But they hope their findings will help investigators better prepare for what's to come during the COVID-19 pandemic. Their study appears in the Journal of Infectious Diseases.

"Even though the seasonal coronaviruses found in Michigan are related to SARS-CoV-2, we do not know whether that virus will behave like the seasonal coronaviruses," said Arnold Monto, the Thomas Francis Collegiate Professor of Epidemiology at the U-M School of Public Health. "Only time will tell if SARS-CoV-2 will become a continuing presence in the respiratory infection landscape, continue with limited circulation as with MERS, or like SARS, disappear from humans altogether."

The researchers note that while coronaviruses have long been recognized as human respiratory pathogens, human coronaviruses have historically been detected in mild respiratory illnesses; when animal coronaviruses spill over to humans, however, they can cause severe disease. Severe acute respiratory syndrome (SARS) in 2002 and Middle East respiratory syndrome (MERS) in 2012 both emerged when a coronavirus jumped from an animal to people. The COVID-19 pandemic is believed to have started in the same way.

Monto and colleagues used data from the Household Influenza Vaccine Evaluation study, an ongoing longitudinal investigation of respiratory illnesses in households with children in the Ann Arbor area. For the last 10 years, between 890 to 1,441 individuals from several hundred households participated in the study. The continuing study is now tracking the occurrence of SARS-CoV-2 and its potential presence in Michigan households.

In 2010, the study began tracking the occurrence of four typically mild human coronaviruses (OC43, 229E, HKU1 and NL63). The researchers looked at frequency, seasonality and household transmission characteristics of the 993 infections caused by those coronaviruses. They found:

Overall, 9% of adult cases and 20% of cases in children were associated with doctor visits. On average, 30% of influenza cases require a doctor visit.

When year-round surveillance occurred, most coronavirus cases were detected between December and April/May, and peaked in January/February. Only 2.5% of the cases occurred between June and September.

The highest infection frequency was in children under age 5.

Of the 993 infections, 260 were acquired from an infected household contact.

The serial interval between index and household-acquired cases ranged from 3.2 to 3.6 days; secondary infection risk ranged from 7.2% to 12.6% by type.

Cases in children under age 5 and adults over age 50 were more likely to be classified as severe.

Monts and colleagues say that the coronaviruses studied are sharply seasonal in Michigan and appear, based on serial interval and secondary infection risk, to have similar transmission potential to that of the influenza A (H3N2) virus in the study population. They say the results are not indicative of how SARS-CoV-2 will behave.

In a separate ongoing study, the researchers are using samples collected before the COVID-19 pandemic to explore community introduction of SARS-CoV-2. Preliminary results show no evidence that SARS-CoV-2 was present in the community before March.

Below please find a summary and links of new coronavirus-related content published today in Annals of Internal Medicine. The summary below is not intended to substitute for the full article as a source of information. A collection of coronavirus-related content is free to the public at http://go.annals.org/coronavirus.

1. Locally informed simulation model predicts hospital capacity needs during COVID-19 pandemic

Free content: http://annals.org/aim/article/doi/10.7326/M20-1260

A locally informed simulation model may help hospital administrators better prepare for capacity strain during the COVID-19 pandemic. The COVID-19 Hospital Impact Model for Epidemics, or CHIME, includes a user-friendly interface so that hospital leaders can, at any time, independently estimate the time until their hospitals' capacities would likely be exceeded. The model also predicts the intensity of the surge, including need for ward and intensive care unit (ICU) beds and ventilators, and the duration of time that each hospital would experience a demand in excess of capacity, enabling users to plan for upcoming equipment and clinical staffing demands. A brief research report is published in Annals of Internal Medicine.

Recognizing a need in their own hospital, researchers at the University of Pennsylvania Health System found that an SIR epidemiologic model could be used to make short-term projections about hospital capacity strain early in the course of an epidemic. The team explored a range of scenarios based on published data from other regions of the world and quickly developed a flexible interface that provides most likely estimates, as well as best- and worst-case estimates in real time. Their model informed many key health system decisions, such as reducing elective surgeries and declining outside transfers, well before the system was actually strained, and also provided multiple other insights that helped health system leaders prepare, react, and respond effectively.

The CHIME tool, with development led by the Penn Predictive Healthcare Team, is available for free to the public at http://penn-chime.phl.io.

Media contacts: The lead author, Gary Weissman, MD, MSHP, and his coauthors, can be reached through Lauren Ingeno at Lauren.Ingeno@Pennmedicine.upenn.edu.

Also new in Annals:

Intersecting U.S. Epidemics: COVID-19 and Lack of Health Insurance
Steffie Woolhandler, MD, MPH; David U. Himmelstein, MD
Ideas & Opinions
Free content: http://annals.org/aim/article/doi/10.7326/M20-1491
Media contact: The lead author, Steffie Woolhandler, MD, MPH, can be reached through Clare Fauke at clare@pnhp.org.

Fighting COVID-19: Enabling Graduating Students to Start Internship Early at Their Own Medical School
Dawn E. DeWitt, MD
Ideas & Opinions
Free content: http://annals.org/aim/article/doi/10.7326/M20-1262
Media contact: The author, Dawn E. DeWitt, MD, can be reached directly at awn.dewitt@wsu.edu.

The Role of Medical Students during the COVID-19 Pandemic
David Gibbes Miller, MSc; Leah Pierson, BA; Samuel Doernberg, BA
Ideas & Opinions
Free content: http://annals.org/aim/article/doi/10.7326/M20-1281
Media contact: The lead author, David Gibbes Miller, MSc, and his coauthors, can be reached directly through Leah Pierson directly at Leah_Pierson@hms.harvard.edu.