COVID-19 is challenging healthcare preparedness, world economies, and livelihoods. The infection and death rates associated with this pandemic are strikingly variable in different countries. To elucidate this discrepancy, we analyzed 2431 early spread SARS-CoV-2 sequences from GISAID. We estimated continental-wise admixture proportions, assessed haplotype block estimation, and tested for the presence or absence of strains’ recombination. Herein, we identified 1010 unique missense mutations and seven different SARS-CoV-2 clusters. In samples from Asia, a small haplotype block was identified, whereas samples from Europe and North America harbored large and different haplotype blocks with nonsynonymous variants. Variant frequency and linkage disequilibrium varied among continents, especially in North America. Recombination between different strains was only observed in North American and European sequences. In addition, we structurally modelled the two most common mutations, Spike_D614G and Nsp12_P314L, which suggested that these linked mutations may enhance viral entry and replication, respectively. Overall, we propose that genomic recombination between different strains may contribute to SARS-CoV-2 virulence and COVID-19 severity and may present additional challenges for current treatment regimens and countermeasures. Furthermore, our study provides a possible explanation for the substantial second wave of COVID-19 presented with higher infection and death rates in many countries.

This is a retrospective single-center study of 417 consecutive patients with coronavirus disease 2019 (COVID-19) admitted to Jaber Al-Ahmad Hospital in Kuwait between February 24, 2020 and May 24, 2020. In total, 39.3% of patients were asymptomatic, 41% were symptomatic with mild/moderate symptoms, 19.7% were admitted to the intensive care unit (ICU). Most common symptoms in cohort patients were fever (34.3%) and dry cough (32.6%) while shortness in breath was reported in (75.6%) of ICU admissions. Reported complications requiring ICU admission included Sepsis (68.3%), acute respiratory distress syndrome (95.1%) and heart failure (63.4%). ICU patients were more likely to have comorbidities, in comparison to non-ICU patients, including diabetes (35.4% vs 20.3%) and hypertension (40.2% vs 26.9%). Mortality rate of cohort was 14.4% and mean age of death was 54.20 years (± 11.09) and 90% of death cases were males. Chest high-resolution computed tomography for ICU cases reveled multifocal large patchy areas of ground glass opacification mixed with dense consolidation. Cases admitted to ICU showed abnormal levels of markers associated with infection, inflammation, abnormal blood clotting, heart problems and kidney problems. Mean hospital stay for asymptomatic cases was 20.69 days ±8.57 and for mild/moderate cases was 21.4 days ±8.28. Mean stay in ICU to outcome for survivors was 11.95 days ±8.96 and for death cases 13.15 days ±10.02. In this single-center case series of 417 hospitalized COVID-19 patients in Kuwait 39.3% were asymptomatic cases, 41% showed mild/moderate symptoms and 18.7% were admitted to ICU with a mortality rate of 14.4%.

Objectives To translate and validate French versions of two health‐related quality of life questionnaires for patients with peripheral facial palsy: Facial Disability Index (FDI) and Facial Clinimetric Evaluation (FaCE) scale. Design Prospective cohort study. Setting University tertiary referral centre. Participants A pilot test was performed on 10 subjects (5 patients with facial palsy of more than 1‐month duration and 5 normal subjects), and then 67 adult patients with facial palsy were enrolled in the validation study. Main outcome measures Translation of the original questionnaires has followed international guidelines using a forward‐backward translation method. A pilot test and a validation study based on the translated questionnaires were performed. Internal consistency, test‐retest reliability, validity and responsiveness were assessed. Validity was assessed by comparing to SF‐36 and Sunnybrook/House‐Brackmann grading systems. Subjects answered scales twice within a one‐week interval. Results Sixty‐seven patients were enrolled, among which 63 completed scales one week later (retest). For physical and social functions of FDI and FaCE scores, Cronbach's α representing internal consistency was 0.88, 0.70 and 0.89, and test‐retest reliability by intra‐class correlation coefficients was 0.81, 0.86 and 0.89, respectively. The correlation of facial movement score of FaCE scale was good with Sunnybrook/House‐Brackmann grading systems (0.73 and −0.75, P < 0.01). The correlation of social function of FaCE scale was excellent with social function of SF‐36 (0.8, P < 0.01). Conclusions French versions of FDI and FaCE scale are psychometrically valid. Both questionnaires can be used for clinical studies to assess the quality of life of patients with peripheral facial palsy.