The World Health Organization recognized SARS-CoV-2 as a public health concern and declared it as a pandemic on March 11, 2020. Over 12 million people have been affected across several countries since it was first recognized. SARS-CoV-2 is thought to commonly spread via respiratory droplets formed while talking, coughing, and sneezing of an infected patient. As several cases, with an absence of travel history to the majorly affected areas were identified, a strong possibility of community transmission could have been possible. Broadly, two modes of transmission of COVID-19 exist-direct and indirect. The direct mode includes (1) transmission via aerosols formed via surgical and dental procedures and/or in the form of respiratory droplet nuclei; (2) other body fluids and secretions, for example, feces, saliva, urine, semen, and tears; and (3) mother-to-child. Indirect transmission may occur via (1) fomites or surfaces (e.g., furniture and fixtures) present within the immediate environment of an infected patient and (2) objects used on the infected person (e.g., stethoscope or thermometer). As many of these modes may be underestimated, it is necessary to emphasize and illustrate them. The goal of this paper is to briefly review how SARS-CoV-2 is shown to transmit via various modes and propose measures to reduce the risk of spread within the population and operating personnel. Keywords Transmission. Modes of transmission. Aerosols. COVID-19 transmission Abbreviations COVID-19 Coronavirus disease-2019 C-section Cesarean section RNA Ribonucleic acid SARS-CoV-2 Severe acute respiratory distress syndrome-coronavirus-2 This article is part of the Topical Collection on Covid-19

An unidentified pneumonia outbreak was first observed in Wuhan, the capital of Hubei Province, China, in December 2019. WHO officially named the disease, Coronavirus Disease 2019 (COVID-19), and declared it as pandemic on Mar 11, 2020. Globally, there are more than 3 million confirmed cases with nearly 200,000 deaths. Hence, we aimed to perform a systematic review and pooled analysis of the current published literature on COVID-19 to provide an insight on the epidemiological and clinical characteristics of COVID-19 patients. A systematic search of published peer-reviewed articles that reported cases with demographical and clinical features of real-time reverse transcriptase polymerase chain reaction (rRT-PCR)-confirmed SARS-CoV-2 infection using MOOSE guidelines was conducted from December 1, 2019, to April 27, 2020, and 50 eligible articles were included for the final analysis. Review articles, opinion articles, and letters not presenting original data as well as studies with incomplete information were excluded. We included a total of 6635 patients from 50 articles, with 54.5 % being male. The predominant symptoms were fever (80.3%), cough (64.2%), and fatigue/myalgia (36.5%) and other symptoms including dyspnea, chest pain, and sore throat. We also found patients with GI symptoms like diarrhea (9.2%) and nausea/vomiting (5.2%). Comorbidities were found in 3,435 (51.7%) patients with the most common being hypertension (22.67%) followed by diabetes mellitus (12.78%). COVID-19 pandemic is not only leading a huge burden on health care facilities but significant disruption in the world society. Patients with coexisting comorbidities are at higher risk and need more utilization of health care resources. As this virus is spreading globally, all countries have to join hands and prepare at all levels of human resources, infrastructure, and facilities to combat the COVID-19 disease.Keywords COVID-19 . coronavirus disease . SARS-CoV-2 . 2019-nCoV . pandemic . outbreak . epidemiology This article is part of the Topical Collection on Covid-19

As of August 06, 2020, 18.9 million cases of SARS-CoV-2 and more than 711,000 deaths have been reported. As per available data, 80% of the patients experience mild disease, 20% need hospital admission, and about 5% require intensive care. To date, several modes of transmission such as droplet, contact, airborne, blood borne, and fomite have been described as plausible. Several studies have demonstrated shedding of the virus from patients after being free from symptoms, i.e. prolonged virus shedding. While few studies demonstrated virus shedding in convalescent patients, i.e. those testing negative for presence of virus on nasopharyngeal and/or oropharyngeal swabs, yet virus shedding was reported from other sources. Maximum duration of conversion time reported among the included studies was 60 days, while the least duration was 3 days. Viral shedding from sources other than nasopharynx and oropharynx, like stools, urine, saliva, semen, and tears, was reported. More number of studies described virus shedding from gastrointestinal tract (mainly in stools), while least a number of cases tested positive for the virus in tears. Prolonged viral shedding is important to consider while discontinuing isolation procedures and/or discharging SARS-CoV-2 patients. The risk of transmission varies in magnitude and depends on the infectivity of the shed virus in biological samples and the patient population involved. Clinical decision-making should be governed by clinical scenario, guidelines, detectable viral load, source of detectable virus, infectivity, and patient-related factors.

, Bangladesh saw a massive influx of Rohingya refugees following their violent persecution by the Myanmar authorities. Since then, the district of Cox's Bazar has been home to nearly 900,000 Rohingya refugees living in the densely populated and unhygienic camps. The refugees have been living in makeshift settlements which are cramped into one another, making it extremely difficult to maintain "social distance". The overcrowded conditions coupled with the low literacy level, lack of basic sanitation facilities, face masks and gloves and limited communication make these camps an ideal place for the virus to spread rapidly. As nations struggle to contain the SARS-CoV-2 virus, refugees are one such population who are extremely vulnerable to the effects of this outbreak. If issues are not addressed at an early stage, its effects can be catastrophic.

A bstract Objectives This systematic review aims to provide insight into the outcome of extracorporeal membrane oxygenation (ECMO) and invasive mechanical ventilation use in critically ill COVID-19 patients. Data sources Electronic databases PubMed Central and PubMed were searched from January 2020 to June 2020 for published studies about ECMO and/or invasive mechanical ventilation use in COVID-19 patients. Data Extraction and Study Selection: The search strategy retrieved 766 articles, of which 19 studies consisting of 204 patients fulfilled the inclusion criteria and were included in the analysis. Data synthesis Primary outcomes evaluated were discharge and/or clinical improvement and mortality rate. Secondary outcomes evaluated included reported complications and the mean number of days of hospitalization for survivors. Weighted averages of included studies were calculated, and data were pooled in forest plots. Nearly, 68.1% of the patients received invasive mechanical ventilation without ECMO support, and 31.9% were placed on ECMO. Also, 22.5% of the patients were discharged and/or clinically improved and 51.5% died. Twenty-six percent of the study population deteriorated but remained alive or experienced no improvement in clinical condition. And 75.2% of those who died belonged to the non-ECMO group and 24.8% to the ECMO group. The mortality rate in the non-ECMO group was 56.8% compared to 40% in the ECMO group. Conclusion The utility of ECMO during a pandemic is uncertain as it is a resource-intensive modality, especially when the mortality rate in severely ill patients infected with COVID-19 virus is already known to be high. How to cite this article Nagraj S, Karia R, Hassanain S, Ghosh P, Shah VR, Thomas A. Role of Invasive Mechanical Ventilation and ECMO in the Management of COVID-19: A Systematic Review. Indian J Crit Care Med 2021;25(6):691–698.