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At least 307 records · Page 17

Mechanical Ventilator Milano (MVM): A Novel Mechanical Ventilator Designed for Mass Scale Production in Response to the COVID-19 Pandemics

We present here the design of the Mechanical Ventilator Milano (MVM), a novel mechanical ventilator designed for mass scale production in response to the COVID-19 pandemics, to compensate for the dramatic shortage of such ventilators in many countries. This ventilator is an electro-mechanical equivalent of the old, reliable Manley Ventilator. Our design is optimized to permit large sale production in short time and at a limited cost, relying on off-the-shelf components, readily available worldwide from hardware suppliers. Operation of the MVM requires only a source of compressed oxygen (or compressed medical air) and electrical power. The MVM control and monitoring unit can be connected and networked via WiFi so that no additional electrical connections are necessary other than the connection to the electrical power. At this stage the MVM is not a certified medical device. Construction of the first prototypes is starting with a team of engineers, scientists and computing experts. The purpose of this paper is to disseminate the conceptual design of the MVM broadly and to solicit feedback from the scientific and medical community to speed the process of review, improvement and possible implementation.

Galbiati, C.↗

A ``Tail" of Two Cities: Fatality-based Modeling of COVID-19 Evolution in New York City and Cook County, IL

I describe $SIR$ modeling of the COVID-19 pandemic in two U.S. urban environments, New York City (NYC) and Cook County, IL, from onset through the month of June, 2020. Since testing was not widespread early in the pandemic in the U.S., I do not use data on confirmed cases and rely solely on public fatality data to estimate model parameters. Fits to the first 20 days of data determine a degenerate combination of the basic reproduction number, $R_0$, and the mean time to removal from the infectious population, $\gamma^{-1}$, with $\gamma (R_0-1) = 0.25 (0.21)$ inverse days for NYC (Cook County). Equivalently, the initial doubling time was $t_d = 2.8 (3.4)$ days for NYC (Cook). The early fatality data suggest that both locations had infections in early February. I model the mitigation measures implemented in mid-March in both locations (distancing, quarantine, isolation, etc) via a time-dependent reproduction number $R_t$ that declines monotonically from $R_0$ to a sma ller asymptotic value, with a parameterized functional form. The timing (mid-March) and duration (several days) of the transitions in $R_t$ appear well determined by the data. However, the fatality data determine only a degenerate combination of the parameters $R_0$, the percentage reduction in social contact due to mitigation measures, $X$, and the infection fatality rate (IFR), $f$. With flat priors, based on simulations the NYC model parameters have 95.45\% credible intervals of $R_0 = 3.0-5.4$, $X= 80-99.9\%$ and $f=2-6\%$, with $5-13\%$ of the population asymptotically infected. A strong external prior indicating a lower value of $f$ or of $\gamma^{-1}$ would imply lower values of $R_0$ and $X$ and higher percentage infection of the population. For Cook County, the evolution was qualitatively different: after mitigation measures were implemented, the daily fatality counts reached a plateau for about a month before tailing off. This is consistent with an $SIR$ model that exhibits ``critical slowing-down", in which $R_t$ plateaus ! at a value just above unity. For Cook County, the 95.45\% credible intervals for the model parameters are much broader and shifted downward, $R_0=1.4-4.7$, $X=26-54\%$, and $f=0.1-0.6\%$ with $15-88\%$ of the population asymptotically infected. Despite the apparently lower efficacy of its social contact reduction measures, Cook County has had significantly fewer fatalities per population than NYC, $D_\infty/N=100$ vs. 270 per 100,000. In the model, this is attributed to the lower inferred IFR for Cook; an external prior pointing to similar values of the IFR for the two locations would instead chalk up the difference in $D/N$ to differences in the relative growth rate of the disease. I derive a model-dependent threshold, $X^{crit}_e$, for `safe' re-opening, that is, for easing of contact reduction that would not trigger a second wave; for NYC, the models predict that increasing social contact by more than 20\% from post-mitigation levels will lead to renewed spread, while for Cook County the threshold value is very uncertain, given the parameter degeneracies. The timing of 2nd-wave growth will depend on the amplitude of contact increase relative to $X^{crit}_e$ and on the asymptotic growth rate, and the impact in terms of fatalities will depend on the parameter $f$.

Frieman, Joshua↗

COVID-19 Joint Pandemic Modeling and Analysis Platform

The non-pharmaceutical intervention to reduce the impact and spread of COVID-19 requires the development of policies and guidance through a collaborative effort among government, academia, medicine, and citizens. To operationalize this effort, we have developed an all-encompassing situational awareness platform that can process multi-modal and multi-source data allowing informed decision making. Besides, showing the current spread of infection, the platform also captures the impact of human dynamics on the infection spread, location, and availability of critical infrastructure, prediction, and high-performance computing driven simulation. The platform is extensible, allowing third-party integration and services to consume the curated data and analytics in near real-time. We believe the platform will augment critical decision making for reducing the impact and spread of the pandemic.

Thakur, Gautam↗

Multi-omics of NET formation and correlations with CNDP1, PSPB, and L-cystine levels in severe and mild COVID-19 infections

We report that we performed a multi-omics analysis of an immunologically naïve SARS-CoV-2 clinical cohort to characterize overall changes in plasma among control (uninfected), mild, and severe infections. A comparison of healthy controls and patient samples showed activation of neutrophil degranulation pathways. Consistent with this observation, we characterized neutrophil extracellular trap (NET) complexes that were partially initiated in a subset of the mild infections (showing partially formed NETs) and fully-formed NETs in a subset of severe infections (containing multiple NET proteins in individual patient samples). As a potential mechanism to suppress NET formation, multiple redox enzymes were elevated in the mild and severe population. Analysis of metabolites from the same cohort showed a 24 and 60-fold elevation in plasma L-cystine, the oxidized form of cysteine and substrate of the powerful antioxidant glutathione in mild and severe patients, respectively. Unique to patients with mild infections, the carnosine dipeptidase modifying enzyme (CNDP1) was up-regulated. The strong protein and metabolite oxidation signatures suggest multiple compensatory pathways working to suppress both free radical and NET formation in SARS-CoV-2 infections.

60 APPLIED LIFE SCIENCES↗

COVID-19 Infection Prevention through Natural Product Molecules

This project evaluates natural product molecules with the potential to prevent 2019- nCOV infection. The molecules theoretically work by blocking the ACE2 protein active site in human airways. Previous work focused on modeling candidate natural compounds, but this work examined baicalin, hesperetin, glycyrrhizin, and scutellarin in experimental in vitro studies, which included recombinant protein inhibition assays, cell culture virus inhibition assays, and cytotoxicity assays. The project delivered selectivity indices (ratio that measures the window between cytotoxicity and antiviral activity) of the four natural compounds that will help guide the direction of SARS-CoV-2 therapeutic development.

59 BASIC BIOLOGICAL SCIENCES↗

Diagnostic Testing for COVID-19 Bridging Study for QIAamp Viral RNA Extraction vs Beckman RNAdvance vs Thermofisher MagMAX

This report describes testing that was performed by LANL’s Biological Agent Testing Lab (BATL) to validate modifications to the CDC EUA 2019-Novel Coronavirus (2019- nCoV) Real-Time RT-PCR Diagnostic Panel (EUA-CDC-nCoV-IFU). BATL intends to implement the modifications to increase thoughput for daily testing . BATL validated the viral RNA extraction process, using the orignial component, QIAamp Viral RNA Mini Kit (Cat # 52906) and the new components, Beckman Coulter magnetic 96-well plate RNAdvance Viral kit (Cat # C63510), Thermofisher MagMAX Viral/Pathogen Nucleic Acid Isolation Kit (Cat # A48310). Equivalency was demonstrated between the original component and the Beckman Coulter magnetic 96-well plate RNAdvance Viral kit (Cat # C63510). Equivalency was also demonstrated between the original component and the Thermofisher MagMAX Viral/Pathogen Nucleic Acid Isolation Kit (Cat # A48310). Subsequently, substitution of the original component with either of these kits for viral RNA extraction increased BATL’s extraction capability from 100 samples per day to 279 samples per day.

59 BASIC BIOLOGICAL SCIENCES↗