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Study shows how picornaviruses infect the host cell - News-Medical.Net

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Study shows how picornaviruses infect the host cell - News-Medical.Net Study shows how picornaviruses infect the host cell - News-Medical.Net Posted: 13 Aug 2020 12:00 AM PDT Picornaviruses is a family of viruses that can cause a number of different diseases, including polio, meningitis, and in rare cases myocarditis, encephalitis, and paralysis. In a new dissertation in biomedical science from Linnaeus University, Helena Vandesande has studied, among other things, how picornaviruses infect the host cell and take over its machinery to replicate more virus particles. Although the family of picornaviruses has been named after their smallness, they include a large and varied selection of viruses. The perhaps most notorious of the viruses being the polio virus, which can be traced all the way back to ancient Egypt's lists of epidemics. Unfortunately, the picornaviruses are just as topical today and cause a number of more or less serious

“How a healthy-looking baby might spread the coronavirus - Los Angeles Times” plus 2 more

“How a healthy-looking baby might spread the coronavirus - Los Angeles Times” plus 2 more


How a healthy-looking baby might spread the coronavirus - Los Angeles Times

Posted: 06 Mar 2020 01:17 AM PST

First, the mother and nanny were hospitalized with pneumonia, suspected of being infected with the novel coronavirus. The next day, the father fell ill with a fever and sore throat and was hospitalized too.

With no one to care for him, the baby was brought to the hospital to be cared for in an isolation unit. The child — a 6-month-old boy — came to the hospital with no symptoms of COVID-19. He seemed perfectly healthy, was breathing fine and had no fever on his arrival at the hospital, medical professionals observed.

But a closer examination produced a surprise: Huge amounts of the novel coronavirus were detected in the baby. The virus was found in his throat, blood and stool. Pathogens continued to be detected in the boy for the first 16 days he was at the hospital. But he never showed symptoms of the illness, apart from a single temperature reading of 101.3 degrees that fell back to normal within an hour.

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In this case from Singapore — reported in a study published in the journal Clinical Infectious Diseases — the mother had not traveled, but her job put her in close contact with tourists from China, the epicenter of the outbreak.

The findings are critical for public health officials to understand, researchers say.

"While most adults with COVID-19 infection have fever, respiratory symptoms and/or chest X-ray changes, current data suggest that the majority of the infected children have mild or no symptoms," wrote the authors, experts with the KK Women's and Children's Hospital and the National Centre for Infectious Disease in Singapore.

Dr. Otto Yang, an infectious diseases expert at UCLA who wasn't a part of the study, said the findings have "important implications." The results show how children can "have minimal symptoms or no symptoms, but are infectious," he said.

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"In general, the younger you are, the less severe your symptoms are. But that's not because you don't get infected. It's because the infection doesn't cause you to get sick," Yang said. Nonetheless, "you probably still remain very infectious."

Other studies back up the idea that babies, toddlers and young children are either not falling ill, or not getting very sick, from the virus, which has sickened more than 97,000 globally and killed more than 3,000.

A sweeping review of 44,672 lab-confirmed COVID-19 patients in China by Chinese authorities found that no deaths occurred among anyone younger than 10.

Another study by experts in Wuhan, China, published in the Journal of the American Medical Assn., sought to review all hospitalized infants diagnosed with COVID-19 infection between Dec. 8 and Feb. 6 in China.

By Feb. 6, there had been 31,211 confirmed cases of COVID-19 and 637 fatalities. But the authors could find only nine infected babies who were hospitalized nationwide.

"None of the nine infants required intensive care or mechanical ventilation or had any severe complications," the study said.

Four had fever, two had mild upper respiratory tract symptoms and one had no symptoms but tested positive for the virus because of the baby's exposure to infected family. There were no symptoms available for the other two patients.

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And a report published in the World Journal of Pediatrics, summarizing experts' consensus on the coronavirus in children, also warned that people who have a "silent infection" are among the main sources of transmission for the illness.

"We also should attach importance to asymptomatic cases, which may play a critical role in the transmission process," the report said. "Respiratory droplets and contact are the main transmission routes. Close contact with symptomatic cases and asymptomatic cases with silent infection are the main transmission routes of [novel coronavirus] infection in children."

However, the director-general of the World Health Organization has pushed back on the idea that the coronavirus can infect people as easily as the flu. Tedros Adhanom Ghebreyesus said Tuesday that although a person with influenza can be contagious when an infected person does not have symptoms, the same does not appear to be true for the coronavirus.

Most infected children have no fever or symptoms of pneumonia, and few progress to infections of the lung, the report said. Infected children may either show no signs of illness, or have fever, dry cough and fatigue; few have upper-respiratory symptoms such as a runny nose or nasal congestion, and some report a stomach ache, nausea, vomiting and diarrhea.

One possible reason why babies, toddlers and young children have not been critically threatened by the new coronavirus is their immature immune system. An undeveloped immune system might prevent the body from triggering inflammation severe enough to result in pneumonia, septic shock or organ failure, said Yang, the infectious diseases specialist at UCLA.

While the new coronavirus can cause mild or no illness in the very young, the risk is much higher in those over the age of 70. Underlying medical conditions are also a risk factor for complications, such as diabetes, obesity, disease of the heart, lung or kidney and those with weakened immune systems, according to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Most people who become infected with COVID-19 show only mild symptoms; the review of 44,672 lab-confirmed patients showed 81% with mild symptoms. Researchers found 14% had severe illnesses and 5% were critical, half of whom died.

Times staff writer Deborah Netburn contributed to this report.

Coronavirus is forcing pregnant women to rethink birth plans - Business Insider - Business Insider

Posted: 06 Mar 2020 01:41 PM PST

  • Pregnant women who are due to give birth in the next couple months are considering how their plans may need to shift in light of novel coronavirus outbreaks
  • One told Insider she's worried she'll endure the labor and delivery alone if her mom isn't able to travel and her husband needs to stay home with their son. 
  • Other women who'd already planned midwife-assisted birth center births are especially glad they'll be able to avoid the hospital. 
  • Experts say pregnant women should be especially careful to avoid catching the virus, but there's no indication moms can pass it to their babies. 
  • Visit Business Insider's homepage for more stories.

When pregnant women and their families make birth plans, they're typically imagining the best-case scenario — detailing who they do (and don't) want in the room, what medication options they want, and whether they'd like to be able to sit on a ball or push in a tub, for instance. 

But Jen Judson, who's 33 weeks pregnant, is more preoccupied with her worst-case scenario plan: delivering her baby in the hospital alone.  

The Arlington, Virginia, journalist had planned to have her husband by her side. But that arrangement could be foiled if the novel coronavirus outbreaks prevents her mom, who has diabetes, from flying into town to look after their toddler while Judson is in labor. 

"If daycare is closed due to quarantine and the hospital has restrictions, I'll probably go in alone and have my husband stay with my son at home," she said. "Not ideal." 

Jen Judson baby
Jen Judson with her husband and son.
Sarah Culver Photography

As coronavirus outbreaks emerge throughout the US, with no clear sign of slowing down, let alone stopping, women like Judson and their families are rethinking what it will mean to deliver a baby in what could be "the height of a global health crisis," as Judson said. 

While no pregnant women told Insider they're making drastic changes, like switching from a hospital birth to a birth center, many said they're worried. Others said they're not changing anything, and some are especially relieved they'd already planned on giving birth outside of the hospital. 

For all kinds of scenarios, though, women's health experts say pregnant women should trust that their healthcare facilities are monitoring evolving guidelines on how to protect them and their future children. And, in the meantime, be extra diligent about hand-washing and other coronavirus prevention-practices.

A top concern is the need to visit hospitals, and picking up coronavirus while there

Lauren McCauley, a paralegal living in Wilmington, Delaware, had already been juggling the stresses of being a working single mother to a 16-month-old and carrying a high-risk pregnancy conceived with the help of fertility treatments when the coronavirus news broke. 

"The worry for me, or my unborn baby, or my child contracting coronavirus, is unbelievably nerve-wracking," she said.

"I'm all they have." 

McCauley, who's planning to have a C-section in early fall since her last child was born via an emergency C-section, said she's also been "freaking out" about needing to be in and out of the hospital for weekly appointments, and the idea of giving birth there only compounds those anxieties.  

"Am I doomed to be in the same hospital as other patients who are there fighting for their lives with such a virus?" she asked. "Am I going to catch it there? Will my baby?" 

Lauren big pic
Lauren McCauley with her daughter.
Janna Bannan

Out-of-hospital births are in the spotlight 

For women like McCauley and Judson, who's also having a C-section due to a few factors that make her pregnancy higher risk, a hospital birth is the safest option. 

But some women with low-risk pregnancies who are planning to deliver at birth centers, or freestanding facility typically staffed by midwives, told Insider coronavirus outbreaks have made them especially grateful they can avoid the hospital during their prenatal care, labor, and delivery. 

Kristin Saylor, an episcopal priest in San Francisco who's due in July, for one, originally opted for a midwife-assisted birth center mostly because she felt it would give her the best chance of building a relationship with providers who would be with her during birth. 

The lower rate of unwanted interventions at birth centers appealed to her, too. And, since the overall costs checked out to be about the same as a hospital birth, "it was kind of a no-brainer," she said. 

But now, in light of coronavirus, Saylor said, she's "more relieved than ever" that she's going the out-of-hospital route. "Even my mother, who has disapproved of my birth plan from the start, is suddenly thrilled I'll be out of the hospital," she said. 

Tiffany Caplan, and integrative health practitioner in Ventura, California, who's 33 weeks pregnant and planning to deliver at a birth center, shared a similar sentiment. "I'm definitely happy with my decision," she said. 

Dr. Sarita Bennett, an osteopathic physician and certified nurse midwife who serves as the vice president of the Midwives Alliance of North America, wrote on her organization's website that, in a pandemic, "it only makes sense for out-of-hospital birth to become the safer choice for the majority of people." 

But for women to transfer far into their pregnancies is complicated, plus, there simply aren't enough midwives to go around. Most prohibitively, Bennett thinks, mainstream images of childbirth lag behind reality: for healthy women with uncomplicated pregnancies, delivering at an accredited birth center is a safe option endorsed by the American College of Obstetricians and Gynecologists. 

"I believe the fear of the virus, real or imagined, would have to overcome the fear of birth — learned and enhanced — for the majority of families to choose out-of-hospital birth," Bennett told Insider. 

Some women aren't changing much, if anything  

Andrea Bertola Shaw, a website designer in New York City who's due in early June, finds that being pregnant has, in some ways, made her family especially prepared to fend off a coronavirus outbreak.

Her home was already well-stocked with cleaning supplies like now-cherished hand-sanitizers and Clorox wipes, and she already got her groceries delivered because it's easier for her physically. Now, she said, "it has the added bonus of avoiding super crowded places." 

Still, she has some concerns: Should take her two-year-old out of daycare, at least during April when the virus may be peaking, to prevent him from bringing home germs? Or does it not matter, since her family has already endured coxsackie, the flu and a stomach bug this winter? 

"I can't say its not terrifying to bring a newborn into the world with a global pandemic," she added.  

Meanwhile, Min Seo, an executive assistant in New York City whose baby is due April 24, told Insider she's proceeding as planned.

"I've felt my immune system has been weaker during my pregnancy so I'm being extra cautious, but I trust that my doctor and hospital will make the right decisions for me when the time comes," she said. "I prefer not to join in on the panic surrounding the virus until we as a public know more." 

FILE - In this Feb. 16, 2017, file photo newborns rest in the nursery of Aishes Chayil, a postpartum recovery center, in Kiryas Joel, N.Y. Some parents are discovering that the Social Security number assigned to their newborn is being used by criminals to commit fraud. Identity theft experts recommend that parents freeze their children's credit now to help prevent problems in the future. (AP Photo/Seth Wenig, File)
A few infants in China tested positive for coronavirus shortly after birth, but it's unclear how they were infected.
Associated Press

The virus hasn't been around long enough to know if or how it may affect pregnant women and newborns 

Experts recommend pregnant women follow Seo's lead: Be extra cautious, and patient as health providers and researchers learn more about exactly if or how this virus affects women and their future babies. 

Meantime, be extra diligent about taking coronavirus-related precautions like frequent hand-washing and avoiding people who are sick, since pregnancy makes the immune systems are weaker and contracting a virus of any kind is linked with a higher risk of pregnancy complications, Dr. Jessica Madden, a pediatrician and neonatologist who serves as the medical director of Aeroflow Breastpumps, told Insider.

Keep in mind that maternity hospitals have guidelines for suspected COVID-19 cases in place to keep other patients, including pregnant women, safe, she added. 

And, take comfort in understanding that it doesn't seem like pregnant women with COVID-19 are at any higher risk of complications, nor does the virus seem to cross the placenta and affect the fetus. 

"It's understandable that pregnant women would be concerned about exposure to the virus and any negative effect it could have on their health and the health of their fetus," Dr. Christopher Zahn, vice president of practice activities at the American College of Obstetricians and Gynecologists, wrote in a statement to Insider.  

"However, it is critical to note that at this time, for the general public in the United States, the immediate health risk from COVID-19 is considered low." 

COVID-19: What Parents Need to Know - Stanford Children's Health Blog - Stanford Children's Health

Posted: 06 Mar 2020 11:54 AM PST

Q&A with Anita Juvvadi, MD, Stanford Children's Health pediatrician with Juvvadi Pediatrics
Q&A with Anita Juvvadi, MD, Stanford Children's Health pediatrician with Juvvadi Pediatrics

News about the current outbreak of novel coronavirus (COVID-19), has parents wondering what they should do to keep their families protected. We sat down with Stanford Children's Health pediatrician Anita Juvvadi, MD, with Juvvadi Pediatrics, to address the most common questions she is receiving from patients and their families.

Q: As a pediatrician, what are some of the most common questions you are hearing from patients and their families right now?

Dr. Juvvadi: The most common thing we are hearing from parents is that their child has a fever and a cough, and they are wondering how worried they should be. Others are asking if they should keep their kids home from school, swimming lessons, and other activities. Also, some day cares are asking parents to provide a doctor's note to reassure them that a child does not have COVID-19 when they so much as have a runny nose, which is excessive and unnecessary. And as we approach spring break, we are also getting questions about whether families should cancel their travel plans.

Q: We will dig into those questions further, but first, how susceptible are children to COVID-19?

Dr. Juvvadi: I want to reassure all families with young children that with data from almost 100,000 patients now affected by the COVID-19 virus, the age range with the least susceptibility appears to be young children. So there is a very good chance that your child will not be severely affected even if exposed.

That said, with the general exposure to COVID-19 through mucus membranes, any human being could be susceptible to the disease. Because we know that the virus seems to cause a pneumonia, for children with severe asthma or a congenital heart problem, we are recommending parents take extra precautions right now. This could mean keeping them home from swimming lessons and indoor play places or activities like gymnastics.

Q: If a child exhibits flu-like symptoms, how do parents know whether the child has COVID-19 versus flu or a seasonal cold?

Dr. Juvvadi: If your child has a runny nose, chances are it is not the COVID-19 virus that they are fighting. More specifically, if they have a fever, cough, congestion, goopy eyes, stomach pain, nausea and vomiting, it could be the regular flu or a mild viral illness, and we are asking those patients to come into the office so we can test them for influenza. If it is a fever with a cough, difficulty breathing, and fatigue, but without a runny nose or nausea, we are recommending that parents take their child to the ER to be tested for COVID-19, to be safe. But for the most part, these cases are turning out to be an upper respiratory infection or flu, which is far more common than COVID-19.

Q: What should parents be doing at home to protect against the virus and be prepared for the possibility of being quarantined?

Dr. Juvvadi: In general, practice good handwashing techniques, cover your cough within your elbow, and only wear a mask if you have a flu virus or a runny nose. It is not an exaggeration that most viruses are avoidable with good handwashing. How do you think doctors and nurses stay healthy?!

While there is no need to stock up on everything, if you have young children at home, it is a good idea to have at least two weeks' worth of infant formula, diapers, wipes, and baby food if your baby is eating solids. For toddlers, have on hand some simple activities that you can do at home on the off chance that you become homebound for two weeks. A quick trip to the craft store could be a good idea!

If you have older children who are attending day care or school, follow the standard handwashing protocols. In general, during flu season it is a good idea to give your child a shower or bath when they come home, and remind them to avoid touching their nose, eyes, and mouth.

Q: What are you recommending for parents who ask if they should be keeping kids home from day care, school, parks and playdates?

Dr. Juvvadi: I encourage parents to continue sending their kids to school and their other typical activities, especially if they are without a preexisting health condition such as a lung or heart condition, which could put them at greater risk for the virus. Schools and teachers are being vigilant about cleaning, and the amount of community exposure will be the same regardless of whether a child goes to school or not.

For other young kids, it's not a bad idea to keep them out of indoor play places right now, but please continue to spend time outdoors. The fresh air is good for kids, and for you as parents. Letting kids be active is the best thing we can do for them right now.

If you have a newborn, our standard recommendation is to stay away from busy places like malls and grocery stores during flu season until baby is at least a month old and has built some immunity.

Q: Should parents of newborn babies keep visitors away? What about older siblings who are in day care and/or school?

Dr. Juvvadi: If you have a newborn at home, continue to follow your usual hand hygiene practices, breastfeed your baby if possible, and make sure baby gets plenty of sunlight and fresh air. It is a good idea to use antibacterial wipes to wipe down countertops and diaper-changing stations once a day. Visitors are perfectly OK, especially if they are healthy adults and family. If you would like to be extra cautious, you can avoid closed, indoor spaces and meet them outdoors such as in your backyard or at a local park. As always, all visitors must wash hands before picking up baby. For young visitors, I usually recommend that they may kiss baby's feet, but not baby's hands or face.

Q: If a woman who is pregnant or breastfeeding becomes sick, should she be concerned that her baby could contract COVID-19?

Dr. Juvvadi: According to the CDC, "in limited case series reported to date, no evidence of virus has been found in the breast milk of women with COVID-19. No information is available on the transmission of the virus that causes COVID-19 through breast milk (i.e., whether infectious virus is present in the breast milk of an infected woman)."

In most cases where mom is exposed to a virus or has any symptoms, we recommend that the best thing she can do is continue to breastfeed baby if possible, because through breastmilk, the baby receives the antibodies that mom's body is producing. Historically, we have seen that with cases of influenza and other viruses, a baby who is breastfed tends to have the mildest version of the illness among anyone else in the family.

We don't have enough information right now about adverse pregnancy outcomes in pregnant women with COVID-19. If you are pregnant, you should practice the usual preventive actions to avoid infection, like frequent handwashing, and avoid spending time with people who are sick.

Q: Should families consider canceling upcoming vacation plans? What travel precautions do you recommend?

Dr. Juvvadi: Local travel by car is perfectly safe. If you plan to fly, it's a good idea to exercise caution and use antibacterial wipes to clean airplane surfaces such as tray tables, armrests, and bathroom surfaces that you may touch. And as always, wash hands with soap and water or use hand sanitizer frequently, avoid touching your face, and cough into your elbow if needed. To be safe, for the time being, avoid crowded places that are difficult to clean, such as amusement parks, arcades and indoor play places.

For the latest information about COVID-19, please visit: http://coronavirus.stanfordchildrens.org

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