Mental health impact of the Middle East respiratory syndrome,SARS,and COVID-19:A comparative systematic review and metaanalysis

BACKGROUND Over the last few decades,3 pathogenic pandemics have impacted the global population;severe acute respiratory syndrome coronavirus(SARS-CoV),Middle East respiratory syndrome coronavirus(MERS-CoV)and SARS-CoV-2.The global disease burden has attributed to millions of deaths and morbidities,with the majority being attributed to SARS-CoV-2.As such,the evaluation of the mental health(MH)impact across healthcare professionals(HCPs),patients and the general public would be an important facet to evaluate to better understand short,medium and long-term exposures.AIM To identify and report:(1)MH conditions commonly observed across all 3 pandemics;(2)Impact of MH outcomes across HCPs,patients and the general public associated with all 3 pandemics;and(3)The prevalence of the MH impact and clinical epidemiological significance.METHODS A systematic methodology was developed and published on PROSPERO(CRD42021228697).The databases PubMed,EMBASE,ScienceDirect and the Cochrane Central Register of Controlled Trials were used as part of the data extraction process,and publications from January 1,1990 to August 1,2021 were searched.MeSH terms and keywords used included Mood disorders,PTSD,Anxiety,Depression,Psychological stress,Psychosis,Bipolar,Mental Health,Unipolar,Self-harm,BAME,Psychiatry disorders and Psychological distress.The terms were expanded with a‘snowballing’method.Cox-regression and the Monte-Carlo simulation method was used in addition to I2 and Egger’s tests to determine heterogeneity and publication bias.RESULTS In comparison to MERS and SARS-CoV,it is evident SAR-CoV-2 has an ongoing MH impact,with emphasis on depression,anxiety and post-traumatic stress disorder.CONCLUSION It was evident MH studies during MERS and SARS-CoV was limited in comparison to SARS-CoV-2,with much emphasis on reporting symptoms of depression,anxiety,stress and sleep disturbances.The lack of comprehensive studies conducted during previous pandemics have introduced limitations to the“know-how”for clinicians and researchers to better support patients and deliver care with limited healthcare resources.

Serological Study of An Imported Case of Middle East Respiratory Syndrome and His Close Contacts in China, 2015

The first imported Middle East respiratory syndrome （MERS） case in China was identified in May 2015. We determined the kinetics of antibody （IgG and IgM） and neutralizing antibodies against MERS-coronavirus （MERS-CoV） in this case before discharge. Moreover, no seroconversion was found among 53 close contacts by anti-MERS IgG antibody enzyme-linked immunosorbent assay （ELISA） of paired serum samples. These findings suggest that neither community nor nosocomial transmission of MERS-CoV occurred in China.

Life after recovery from SARS,influenza,and Middle East respiratory syndrome: An insight into possible long-term consequences of COVID-19

Viral infectious diseases have become an increased public health issue in the past 20 years.The outbreaks of severe acute respiratory syndrome coronavirus(SARSCoV-1)in 2002,influenza H1N1 in 2009,Middle East respiratory syndrome-CoV in 2012,and the current new coronavirus SARS-CoV-2 have shown that viral infectious diseases are a major concern in the 21st century.As the world lives under the pandemic of a new coronavirus(COVID-19),knowing the clinical characteristics from those past diseases and their long-term outcomes is important to understand the current coronavirus pandemic and its complications and consequences better and plan for possible future outbreaks.Several long-term complications have been described with these respiratory viral diseases,such as decreased pulmonary function,pulmonary fibrosis,chronic fatigue syndrome,avascular necrosis of bone,polyneuropathy,encephalitis,posttraumatic stress disorder,depression,and anxiety.This article summarizes several studies describing chronic complications and long-term outcomes of patients recovered from these viral syndromes.

Sero-prevalence of Middle East Respiratory Syndrome Coronavirus among Camels at a Slaughterhouse in Kenya, 2015

Dromedary camels are implicated as reservoirs of MERS-CoV （Middle East Respiratory Syndrome coronavirus）. High prevalence of MERS-CoV antibodies in dromedaries in Africa and Arabian Peninsula was demonstrated from sera archived between 1992 and 2012 with matching of camel-derived and human-derived sequences from various regions suggesting zoonotic transmission. We assessed sero-prevalence of anti-MERS-CoV antibodies among dromedaries at Athi-River slaughterhouse, Kenya. Proportions were calculated and associations between anti-MERS-CoV antibody sero-positivity and age group, sex, and origin of camels were assessed using Chi-square tests. Out of 373 specimens, 53% were females, antibody sero-prevalence was 82%. Sero-prevalence did not differ by age group, sex, or origin. This study reports high sero-prevalence of MERS-CoV antibodies demonstrated among camels brought for slaughter from different regions of Kenya. This was consistent with other studies in Africa among adult camels and further proves that the virus likely remains present in Kenya. Since only mature camels were assessed, more studies on younger populations of camels could help determine the dynamics of virus transmission. Though the risk from mature animals is not known, at some point these camels become re-infected and human populations exposed to camels may still face some risks.

Epidemiology and evolution of Middle East respiratory syndrome coronavirus, 2012-2020

Background:The ongoing transmission of the Middle East respiratory syndrome coronavirus(MERS-CoV)in the Middle East and its expansion to other regions are raising concerns of a potential pandemic.An in-depth analysis about both population and molecular epidemiology of this pathogen is needed.Methods:MERS cases reported globally as of June 2020 were collected mainly from World Health Organization official reports,supplemented by other reliable sources.Determinants for case fatality and spatial diffusion of MERS were assessed with Logistic regressions and Cox proportional hazard models,respectively.Phylogenetic and phylogeographic analyses were performed to examine the evolution and migration history of MERS-CoV.Results:A total of 2562 confirmed MERS cases with 150 case clusters were reported with a case fatality rate of 32.7%(95%Cl:30.9-34.6%).Saudi Arabia accounted for 83.6%of the cases.Age of>65 years old,underlying conditions and>5 days delay in diagnosis were independent risk factors for death.However,a history of animal contact was associated with a higher risk(adjusted OR=297,95%Cl:1」0-7.98)among female cases<65 years but with a lower risk(adjusted OR=0.31,95%Cl:0.18-0.51)among male cases>65 years old.Diffusion of the disease was fastest from its origin in Saudi Arabia to the east,and was primarily driven by the transportation network.The most recent subclade C5.1(since 2013)was associated with non-synonymous mutations and a higher mortality rate.Phylogeographic analyses pointed to Riyadh of Saudi Arabia and Abu Dhabi of the United Arab Emirates as the hubs for both local and international spread of MERS-CoV.Conclusions:MERS-CoV remains primarily locally transmitted in the Middle East,with opportunistic exportation to other continents and a potential of causing transmission clusters of human cases.Animal contact is associated with a higher risk of death,but the association differs by age and sex.Transportation network is the leading driver for the spatial diffusion ofthe disease.These findings how this pathogen spread are helpful for targeting public health surveillance and interventions to control endemics and to prevent a potential pandemic.

Middle East respiratory syndrome coronavirus： current situation and travel-associated concerns

The emergence of Middle East respiratory syndrome coronavirus （MERS-CoV） in 2012 brought back memories of the occurrence of severe acute respiratory syndrome coronavirus （SARS-CoV） in 2002. More than 1500 MERS-CoV cases were recorded in 42 months with a case fatality rate （CFR） of 40%. Meanwhile, 8000 cases of SARS-CoV were confirmed in six months with a CFR of 10%. The clinical presentation of MERS-CoV ranges from mild and non-specific presentation to progressive and severe pneumonia. No predictive signs or symptoms exist to differentiate MERS-CoV from community-acquired pneumonia in hospitalized patients. An apparent heterogeneity was observed in transmission. Most MERS-CoV cases were secondary to large outbreaks in healthcare settings. These cases were secondary to community-acquired cases, which may also cause family outbreaks. Travel-associated MERS infection remains low. However, the virus exhibited a clear tendency to cause large outbreaks outside the Arabian Peninsula as exemplified by the outbreak in the Republic of Korea. In this review, we summarize the current knowledge about MERS-CoV and highlight travel-related issues.

Stochastic and spatio-temporal analysis of the Middle East Respiratory Syndrome outbreak in South Korea, 2015

South Korea was free of the Middle East Respiratory Syndrome(MERS)until 2015.The MERS outbreak in South Korea during 2015 was the largest outbreak of the Coronavirus outside the Middle East.The major characteristic of this outbreak is inter-or intra-hospital transmission.This recent MERS outbreak in South Korea is examined and assessed in this paper.The main objectives of the study is to characterize the pattern of the MERS outbreak in South Korea based on a basic reproductive ratio,the probability of ultimate extinction of the disease,and the spatio-temporal proximity of occurrence between patients.The survival function method and stochastic branching process model are adapted to calculate the basic reproductive ratio and the probability of ultimate extinction of the disease.We further investigate the occurrence pattern of the outbreak using a spatio-temporal autocorrelation function.

Middle East respiratory syndrome:what to be concerned more in preparedness?

The recent problem on Middle East respiratory syndrome is a very interesting new infection emerging from the Gulf area. For practitioners in intensive care medicine, knowledge update on this new emerging infection is needed. Preparation for diagnostic tool and antiviral drug to cope with possible outbreak is suggested. In addition, the consideration of ecological factors of this new disease is important. The consideration of not only ecological but also humanistic background can be useful to manage the new disease, Middle East respiratory syndrome as well. Finally, how to improve medical service for underserved population is a big issue. The local health department must play an important role.

Lucky China： Efficient Prevention from Middle East Respiratory Syndrome and its Beyond

Middle East respiratory syndrome （MERS） has recently drawn worldwide attention since its nosocomial or suspected community-acquired clusters in South Korea, which has been the largest and the most complex outbreak of the Middle East Region since 2012. It is such a large fortune for China to be able to prevent effectively from MERS, not only by actively monitoring the Korean imported case based on the notification of WHO Western Pacific Region Office （WPRO）, but also by properly quarantining a number of close contacts. Otherwise, China might undergo the same situation as in South Korea, or even worse, if the patient kept on traveling through Southern China or went to health care facilities without wearing any personal preventing equipment. To date, this laboratory-confirmed MERS patient has recovered and been discharged from hospital, and none of the close contacts （n = 75） has showed any associated symptoms, so lucky for him and China.

Diabetes Risk Factor and Its Relationship to Increasing Coronavirus (COVID-19) Mortality Rate in United States in 2019-2022: An Epidemiological Study

As an effort to understand the effect of diabetes on the increasing rate of COVID-19 infection, we embarked upon a detailed statistical analysis of various datasets that include COVID-19 infection and mortality rate, diabetes and diseases that may contribute to the severity and risk factor of diabetes in individuals and this impact on COVID-19 and the mortality rate. These diseases include respiratory diseases, cardiovascular diseases, and obesity. Equally significant is the statistical analysis on ethnicity, age, and sex on COVID-19 infection as well as mortality rate. Their possible contributions to increasing the severity and risk factor of diabetes as a risk to mortality to individuals who have COVID-19. Objectives: The ultimate objectives of this investigation are as follow: 1) Is there a risk factor of diabetes on COVID-19 infection and increasing mortality rate? 2) To what extent do other disease conditions that include, obesity, heart failure, and respiratory diseases influence the severity and risk factor of diabetes on increasing COVID-19 infection and mortality rate? 3) To what extent does age, race, and gender increase the mortality of COVID-19 and increase the severity and risk factor of diabetes on COVID-19 mortality rate? 4) How and why COVID-19 virus increases the risk of diabetes in children? 5) Diabetes and COVID-19: Who is most at Risk? Lastly, understanding the misconception of COVID-19 and diabetes.

Similarities and Differences of Early Pulmonary CT Features of Pneumonia Caused by SARS-CoV-2, SARS-CoV and MERS-CoV: Comparison Based on a Systemic Review

Objective To compare the similarities and differences of early CT manifestations of three types of viral pneumonia induced by SARS-CoV-2(COVID-19),SARS-CoV(SARS)and MERS-CoV(MERS)using a systemic review.Methods Electronic database were searched to identify all original articles and case reports presenting chest CT features for adult patients with COVID-19,SARS and MERS pneumonia respectively.Quality of literature and completeness of presented data were evaluated by consensus reached by three radiologists.Vote-counting method was employed to include cases of each group.Data of patients’manifestations in early chest CT including lesion patterns,distribution of lesions and specific imaging signs for the three groups were extracted and recorded.Data were compared and analyzed using SPSS 22.0.Results A total of 24 studies were included,composing of 10 studies of COVID-19,5 studies of MERS and 9 studies of SARS.The included CT exams were 147,40,and 122 respectively.For the early CT features of the 3 pneumonias,the basic lesion pattern with respect to"mixed ground glass opacity(GGO)and consolidation,GGO mainly,or consolidation mainly"was similar among the 3 groups(χ^2=7.966,P>0.05).There were no significant differences on the lesion distribution(χ^2=13.053,P>0.05)and predominate involvement of the subpleural area of bilateral lower lobes(χ^2=4.809,P>0.05)among the 3 groups.The lesions appeared more focal in COVID-19 pneumonia at early phase(χ^2=23.509,P<0.05).The proportions of crazy-paving pattern(χ^2=23.037,P<0.001),organizing pneumonia pattern(P<0.05)and pleural effusions(P<0.001)in COVID-19 pneumonia were significantly lower than the other two.Although rarely shown in the early CT findings of all three viral pneumonias,the fibrotic changes were more frequent in SARS than COVID-19 and MERS(χ^2=6.275,P<0.05).For other imaging signs,only the MERS pneumonia demonstrated tree-in-buds,cavitation,and its incidence rate of interlobular or intralobular septal thickening presented significantly increased as compared to the other two pneumonia(χ^2=22.412,P<0.05).No pneumothorax,pneumomediastinum and lymphadenopathy was present for each group.Conclusions Imaging findings on early stage of these three coronavirus pneumonias showed similar basic lesion patterns,including GGO and consolidation,bilateral distribution,and predominant involvement of the subpleural area and the lower lobes.Early signs of COVID-19 pneumonia showed less severity of inflammation.Early fibrotic changes appeared in SARS only.MERS had more severe inflammatory changes including cavitation and pleural effusion.The differences may indicate the specific pathophysiological processes for each coronavirus pneumonia.

Coronavirus: A “Mild” Virus Turned Deadly Infection

Coronaviruses are a family of viruses that can be transmitted from one person to another.Earlier strains have only been mild viruses,but the current form,known as coronavirus disease 2019(COVID-19),has become a deadly infection.The outbreak originated in Wuhan,China,and has since spread worldwide.The symptoms of COVID-19 include a dry cough,sore throat,fever,and nasal congestion.Antimicrobial drugs,pathogen–host interaction,and 2 weeks of isolation have been recommended for the treatment of the infection.Safe operating procedures,such as the use of face masks,hand sanitizer,handwashing with soap,and social distancing,are also suggested.Moreover,travel bans for cities,states,and countries have been put in place,along with lockdowns to control the outbreak.Travel restrictions,mask use,sanitizer or soap use,and avoidance of touching the face and nose have produced encouraging results,whereas the effectiveness of antibiotics has not been proved.The results of isolation for the recovery of infected people have also been promising.Travel bans and lockdowns have caused a slump in economies,and unemployment has risen sharply,resulting in an increase in mental health cases globally.To date,vaccines have been developed and are in use in certain countries,but following standard operating procedures remain critical.The countries following the guidelines can eradicate this virus.New Zealand was the rst country to eliminate the virus from their territory.

Theory and reality of antivirals against SARS-CoV-2

At present,over 180 million people have been infected with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)worldwide and there have been more than 3.8 million deaths due to the virus.However,specific effective antiviral treatment for this infectious disease is absent.At the beginning of the epidemic,relevant cellular and animal experiments of antiviral treatment for SARS-CoV-2 were conducted based on the prior studies of SARS-CoV and Middle East respiratory syndrome coronavirus.Some antivirals were preliminarily validated to be potentially effective in the clinical settings.But as the epidemic continued and more studies were carried out,the efficacy of these antiviral drugs became controversial.This paper reviews the pharmacology and application of interferon,lopinavir/ritonavir,ribavirin,chloroquine,arbidol,favipiravir,remdesivir,and thymosinα1 in coronavirus disease 2019.The actual effect of these drugs remains controversial.Meanwhile,the efficacy and safety of these drugs for patients with coronavirus disease 2019 still need to be explored.

Controversies’ clarification regarding ribavirin efficacy in measles and coronaviruses: Comprehensive therapeutic approach strictly tailored to COVID-19 disease stages

BACKGROUND Ribavirin is a broad-spectrum nucleoside antiviral drug with multimodal mechanisms of action,which supports its longevity and quality as a clinical resource.It has been widely administered for measles and coronavirus infections.Despite the large amount of data concerning the use of ribavirin alone or in combination for measles,severe acute respiratory syndrome,Middle East respiratory syndrome,and coronavirus disease 2019(COVID-19)outbreaks,the conclusions of these studies have been contradictory.Underlying reasons for these discrepancies include possible study design inaccuracies and failures and misinterpretations of data,and these potential confounds should be addressed.AIM To determine the confounding factors of ribavirin treatment studies and propose a therapeutic scheme for COVID-19.METHODS PubMed database was searched over a period of five decades utilizing the terms“ribavirin”alone or combined with other compounds in measles,severe acute respiratory syndrome,Middle East respiratory syndrome,and COVID-19 infections.The literature search was performed and described according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Articles were considered eligible when they reported on ribavirin dose regimens and/or specified outcomes concerning its efficacy and/or possible adverseeffects.In vitro and animal studies were also retrieved.A chapter on ribavirin’s pharmacology was included as well.RESULTS In addition to the difficulties and pressures of an emerging pandemic,there is the burden of designing and conducting well-organized,double-blind,randomized controlled trials.Many studies have succumbed to specific pitfalls,one of which was identified in naturally ribavirin-resistant Vero cell lines in in vitro studies.Other pitfalls include study design inconsistent with the well-established clinical course of disease;inappropriate pharmacology of applied treatments;and the misinterpretation of study results with misconceived generalizations.A comprehensive treatment for COVID-19 is proposed,documented by thorough,longterm investigation of ribavirin regimens in coronavirus infections.CONCLUSION A comprehensive treatment strictly tailored to distinct disease stages was proposed based upon studies on ribavirin and coronavirus infections.

Coronavirus disease 2019 (COVID-19), MERS and SARS: Similarity and difference

SARS-CoV-2 is the causative agent of COVID-19.Since its outbreak in December 2019,COVID-19 has swept the globe.By 17 July 2020,the World Health Organization(WHO)had confirmed 13?119?239 cases and 573?752 deaths,and the numbers are still rising.Current evidence shows that COVID-19 is lower than severe acute respiratory syndrome and Middle East respiratory syndrome in terms of severity and mortality risk,although the infections are particularly more severe in patients with underlying medical conditions.The bulk of COVID-19 patients had close contact with confirmed cases,but an exact origin and specific transmission for COVID-19 are still unknown.As there is no approved antiviral treatment for COVID-19 infection,proper prevention and control practices are essential to control the infection.To have an insight view of COVID-19,we summarized and compared the etiology,clinical manifestations,diagnosis,treatment,and prevention measures of COVID-19,severe acute respiratory syndrome,and Middle East respiratory syndrome.

Silent War to Emerging or Re-emerging Respiratory Infection Diseases Badly Kept in Mind

Recently,a man aged 44 years from South Korea who flew to Hong Kong on May 26,subsequently traveled to Huizhou,Guangdong Province,had drawn the worldwide attention.First laboratory-confirmed case of middle east respiratory syndrome （MERS） finally landed in China,3 years after the first identification of MERS coronavirus （MERS-CoV） in Saudi Arabia,2012.In reality actually, MERS did not attract much attention in China till now although we had alerted about the possibility of its importation, or even pandemic. A similar phenomenon has happened in South Korea, lacking of awareness among health care workers and the general public, contributing to suboptimal infection prevention and control measures in health facilities, and finally cause the outbreak of MERS in South Korea and the exported case to China. Fortunately, we have won out in the battle, and no additional cases have been identified among close contacts in China （n = 75）. Meanwhile, we still have lingering fears as there are sporadic infections and outbreaks all over the world.

Nosocomial infection control in healthcare settings: Protection against emerging infectious diseases

The Middle East respiratory syndrome(MERS)outbreak in Korea in 2015 may be attributable to poor nosocomial infection control procedures implemented.Strict infection control measures were taken in the hospital where an imported case with MERS was treated in southern China and 53 health care workers were confirmed to be MERS-CoV negative.Infection control in healthcare settings,in which patients with emerging infectious diseases such as MERS,Ebola virus disease,and the severe acute respiratory syndrome(SARS)are diagnosed and treated,are often imperfect.When it comes to emerging or unknown infectious diseases,before the imported case was finally identified or community transmission was reported,cases have often occurred in clusters in healthcare settings.Nosocomial infection control measures should be further strengthened among the workers and inpatients in designated healthcare settings that accommodate suspected cases suffering from emerging or unknown infectious diseases.

From SARS to MERS： evidence and speculation

The Middle East respiratory syndrome coronavirus （MERS-CoV） is a novel zoonotic pathogen. In 2012, the infectious outbreak caused by MERS-CoV in Saudi Arabia has spread to more than 1600 patients in 26 countries, resulting in over 600 deaths. Without a travel history, few clinical and radiological features can reliably differentiate MERS from SARS. But in real world, comparing with SARS, MERS presents more vaguely defined epidemiology, more severe symptoms, and higher case fatality rate. In this review, we summarize the recent findings in the field of MERS-CoV, especially its molecular virology, interspecies mechanisms, clinical features, antiviral therapies, and the further investigation into this disease. As a newly emerging virus, many questions are not fully answered, including the exact mode of transmission chain, geographical distribution, and animal origins. Furthermore, a new protocol needs to be launched to rapidly evaluate the effects of unproven antiviral drugs and vaccine to fasten the clinical application of new drugs.

Correlation between bioactive lipids and novel coronavirus:constructive role of biolipids in curbing infectivity by enveloped viruses,centralizing on EPA and DHA

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)belongs to the family coronaviridae.It is spherical and possesses proteins called spikes,which can clamp onto the human cells.Once in close interaction with the human cells,these viruses undergo structural change and can fuse with the cell membrane.The virus enters the host and starts the process of translation and transcription in the cells and uncoated genome,respectively.Due to the rapid transmittable nature of the virus,extant actions should be taken.The fatty acids administrated orally,or intravenously,could help us gear things up in providing resistance and preventing infection.Hence,the multiplication of the virus could be hindered by arachidonic acid,eicosapentaenoic acid(EPA),and docosahexaenoic acid(DHA).In that context,the current review highlights the role of these unsaturated fatty acids and their derivatives such as lipoxins and resolvins in the inactivation of the enveloped coro-navirus disease 2019(COVID-19).

Lessons from Coronavirus Disease 2019 Infections in Children

The novel coronavirus disease 2019(COVID-19)in human caused by novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is currently rampant across the world,causing an international concern for public health emergency.At the time of July,2020,about 8380000 confirmed cases and more than 450000 deaths have been reported worldwide.This is the third outbreak of severe coronavirus family after the Middle East respiratory syndrome(MERS)and severe acute respiratory syndrome(SARS).Young victims(<12 years)in clinical course and prognosis of pediatric COVID-19 appear symptomatically milder than do teenage and adult patients,and many children with asymptomatic infections or showing only mild symptoms may be transmitter as well.Thus,the children with COVID-19 infection deserve more attention.This review is cautiously designed to report the clinical characteristics and symptoms of three kinds of coronaviruses(SARS-CoV,MERS-CoV,and SARS-CoV-2)in children and to summarize some recommended tactics to reduce COVID-19 transmission and/or to attain improved prevention in children.