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The COVID-19 Pandemic and Mayo Clinic Proceedings

      The United States of America and the world remain gripped in the COVID-19 crisis, with the number of cases and deaths steadily increasing. This crisis has profoundly stressed health care systems and the nation’s capability in caring for patients afflicted by the disease; has imposed pervasive economic hardships with incalculable consequences; has altered our behavior by the need for social distancing and the wearing of face masks, by proscribing meetings and gatherings, and by eliciting shelter-in-place directives; has limited the freedom of travel and the ready supply of things we all took for granted; and has left us still dazed by its unanticipated appearance, its rapid dissemination, and the fearsomeness of its present and future impact. If ever there was a Black Swan phenomenon – an entirely unforeseen, rare phenomenon with profound and lasting consequences
      • Taleb N.
      The Black Swan: The Impact of the Highly Improbable.
      – COVID-19 is it.
      Because of the need to publish important and timely articles on the COVID-19 crisis as soon as possible, Mayo Clinic Proceedings has expedited the online publication of such articles ahead of print publication, and without copy editing or type setting. These articles are freely available at our website (http://www.mayoclinicproceedings.org) at our Coronavirus (COVID-19) Resource Center. Such articles address salient aspects of COVID-19 including Commentaries that discuss/provide the following: a guide to understanding the 2019 novel coronavirus and a broad outline of its biology and the disease it causes; the shortages in medicines and other medical supplies during the crisis, and strategies that may mitigate such deficiencies; diagnostic and treatment challenges in suspected or confirmed COVID-19 patients with potentially life-threatening diseases such as myocardial infarction, balancing, on the one hand, the need to diagnose and prevent fatality from such diseases, and, on the other, avoiding unnecessary procedures that may expose staff and personnel to COVID-19; and analyses of the Italian COVID-19 outbreak, including predisposing circumstances and persisting concerns, and strategies that promote cohesiveness and efficacy of medical care. There are Perspectives on assorted topics that include the following: the description of the spectrum and nuances of clinical symptoms and presentation as seen in a large urban ambulatory COVID-19 clinic; the delineation of the sobering significance of false-negative COVID-19 results that incurs the dual risks of either sustaining the contagion or causing a second wave phenomenon should a plateau of cases eventually occur; an in-depth discussion of the ethical considerations in the conduct of medical research during this crisis; and an outlining of challenges imposed by the COVID-19 crisis on medical education.
      In this online collection there are two Special Articles, one of which deals with possible arrhythmogenic risks associated with the repurposing of antimalarial drugs (hydroxychloroquine and chloroquine) as therapeutic agents for COVID-19. These drugs carry the risk of prolonging the QTc interval on the ECG and causing sudden cardiac death, especially when used in conjunction with other drugs such as lopinavir/ritonavir and macrolides. This article provides an algorithm regarding the assessment of such risks when these drugs are used and is based on the determination of QTc by standard ECG, telemetry strips, or a smart phone. Another Special Article addresses the concerns regarding the use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers in patients with COVID-19; this article concludes that the potential benefits of these agents outweigh the possible risks and that these drugs should not be stopped. An Original Article examines outcomes in 140 patients cared for at Union Hospital, Wuhan, China, and demonstrates that hypoxemia is a key risk factor for mortality in COVID-19. Other contributions in our collection include Letters to the Editor, discussing, for example, the need for more attention directed to the risk and occurrence of COVID-19 in pediatric populations, and the apparent efficacy of inhaled corticosteroids in COVID-19.
      This collection of papers on COVID-19 at our website is dynamic and will steadily expand as new content is added. For example, we anticipate the addition of articles on, among others, such topics as preventive strategies, diagnostic stewardship, delivery of care and patient management in diverse settings, and the expanding role of Telemedicine.
      COVID-19 has affected virtually all aspects of medical care - indeed our lives - forcing us to think about, experience, and address issues in ways we have never done before. Out of all this will come – as may occur during and in the aftermath of a Black Swan phenomenon - new paradigms and innovation that, with each and every hope, would benefit patient care and welfare; the fitness of health care systems, in general, and their preparedness and adaptability in times of emergency and other pandemics; the pursuit and conduct of medical education; and progress in and the contributions of biomedical research. In this COVID-19 crisis and on this ever-changing landscape, Mayo Clinic Proceedings endeavors to expeditiously contribute to the expanding literature and extends to everyone our best of wishes for their health and safety.

      Reference

        • Taleb N.
        The Black Swan: The Impact of the Highly Improbable.
        First Edition. Random House, New York2007: 366