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      Successful containment of Covid‐19 outbreak in a large maternity and perinatal center while continuing clinical service

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          Abstract

          With increasing number of SARS‐CoV‐2 infections and COVID‐19 patients to be taken care of by the health system, more and more health workers become affected by the disease. It has been reported that right from the beginning of the outbreak in Lombardy up to 20% of the doctors and nurses became infected. Under these circumstances, the regular operation of health institutions already suffering from a shortage of staff becomes difficult. This has led to complete or partial shutdowns of hospitals, either due to a lack of uninfected personnel or because of uncontrollable chains of infection endangering patients. In one of the largest university perinatal center in Bavaria with more than 3000 births per year, an outbreak of COVID‐19 occurred in March 2020, affecting 36 staff members, including doctors, nurses, and midwives. Here, we describe the outbreak and present the measures contributing to the successful containment of the outbreak within three weeks. At the same time, clinical services could be maintained, however, not without deployment of personnel exposed to employees infected with SARS‐CoV‐2. Apart from massive testing of personnel in pre‐defined phases and increased hygiene measures, including a general obligation to wear surgical face masks, we identified the need to monitor cases of illness across all groups of employees, to ensure social distancing within personnel and to evaluate contacts of clinical personnel outside of the hospital environment, in order to be able to interpret chains of infections and to disrupt them. Overall, only a bundle of measures is needed to contain such an outbreak.

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          Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention

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            Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR

            Background The ongoing outbreak of the recently emerged novel coronavirus (2019-nCoV) poses a challenge for public health laboratories as virus isolates are unavailable while there is growing evidence that the outbreak is more widespread than initially thought, and international spread through travellers does already occur. Aim We aimed to develop and deploy robust diagnostic methodology for use in public health laboratory settings without having virus material available. Methods Here we present a validated diagnostic workflow for 2019-nCoV, its design relying on close genetic relatedness of 2019-nCoV with SARS coronavirus, making use of synthetic nucleic acid technology. Results The workflow reliably detects 2019-nCoV, and further discriminates 2019-nCoV from SARS-CoV. Through coordination between academic and public laboratories, we confirmed assay exclusivity based on 297 original clinical specimens containing a full spectrum of human respiratory viruses. Control material is made available through European Virus Archive – Global (EVAg), a European Union infrastructure project. Conclusion The present study demonstrates the enormous response capacity achieved through coordination of academic and public laboratories in national and European research networks.
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              Virological assessment of hospitalized patients with COVID-2019

              Coronavirus disease 2019 (COVID-19) is an acute infection of the respiratory tract that emerged in late 20191,2. Initial outbreaks in China involved 13.8% of cases with severe courses, and 6.1% of cases with critical courses3. This severe presentation may result from the virus using a virus receptor that is expressed predominantly in the lung2,4; the same receptor tropism is thought to have determined the pathogenicity-but also aided in the control-of severe acute respiratory syndrome (SARS) in 20035. However, there are reports of cases of COVID-19 in which the patient shows mild upper respiratory tract symptoms, which suggests the potential for pre- or oligosymptomatic transmission6-8. There is an urgent need for information on virus replication, immunity and infectivity in specific sites of the body. Here we report a detailed virological analysis of nine cases of COVID-19 that provides proof of active virus replication in tissues of the upper respiratory tract. Pharyngeal virus shedding was very high during the first week of symptoms, with a peak at 7.11 × 108 RNA copies per throat swab on day 4. Infectious virus was readily isolated from samples derived from the throat or lung, but not from stool samples-in spite of high concentrations of virus RNA. Blood and urine samples never yielded virus. Active replication in the throat was confirmed by the presence of viral replicative RNA intermediates in the throat samples. We consistently detected sequence-distinct virus populations in throat and lung samples from one patient, proving independent replication. The shedding of viral RNA from sputum outlasted the end of symptoms. Seroconversion occurred after 7 days in 50% of patients (and by day 14 in all patients), but was not followed by a rapid decline in viral load. COVID-19 can present as a mild illness of the upper respiratory tract. The confirmation of active virus replication in the upper respiratory tract has implications for the containment of COVID-19.
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                Author and article information

                Contributors
                michael.kabesch@barmherzige-regensburg.de
                Journal
                Pediatr Allergy Immunol
                Pediatr Allergy Immunol
                10.1111/(ISSN)1399-3038
                PAI
                Pediatric Allergy and Immunology
                John Wiley and Sons Inc. (Hoboken )
                0905-6157
                1399-3038
                17 May 2020
                : 10.1111/pai.13265
                Affiliations
                [ 1 ] University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John University of Regensburg Regensburg Germany
                [ 2 ] University Department of Obstetrics and Gynecology at the Hospital St. Hedwig of the Order of St. John University of Regensburg Regensburg Germany
                [ 3 ] Institute of Clinical Microbiology and Hygiene Regensburg University Hospital Regensburg Germany
                [ 4 ] Department Infection Control and Infectious Disease University of Regensburg Regensburg Germany
                [ 5 ] Institute of Laboratory Medicine, Microbiology and Hygiene Hospital of the Order of St. John Regensburg Germany
                Author notes
                [*] [* ] Correspondence

                Michael Kabesch, University Children’s Hospital Regensburg (KUNO), St. Hedwig’s Hospital of the order of St. John, University of Regensburg, Steinmetzstr. 1‐3, D‐93049 Regensburg, Germany.

                Email: michael.kabesch@ 123456barmherzige-regensburg.de

                Author information
                https://orcid.org/0000-0003-0697-1871
                Article
                PAI13265
                10.1111/pai.13265
                7264500
                32319131
                66046f62-baf0-4f5d-8b5d-0662a1aec9c1
                © 2020 The Authors. Pediatric Allergy and Immunology published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 14 April 2020
                : 17 April 2020
                : 20 April 2020
                Page count
                Figures: 3, Tables: 1, Pages: 5, Words: 4368
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                corrected-proof
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.3 mode:remove_FC converted:02.06.2020

                Pediatrics
                containment,covid19,hygiene,outbreak,pediatric,sars-cov-2
                Pediatrics
                containment, covid19, hygiene, outbreak, pediatric, sars-cov-2

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