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May 30: Patients undergoing surgery after contracting the novel coronavirus are at an increased risk of postoperative death, according to a new study published in The Lancet journal which may lead to better treatment guidelines for COVID-19.

In the study, the scientists, including those from the University of Birmingham in the UK, examined data from 1,128 patients from 235 hospitals from a total of 24 countries.

Among COVID-19 patients who underwent surgery, they said the death rates approach those of the sickest patients admitted to intensive care after contracting the virus.

The scientists noted that SARS-CoV-2 infected patients who undergo surgery, experience substantially worse postoperative outcomes than would be expected for similar patients who do not have the infection.

According to the study, the 30-day mortality among these patients was nearly 24 per cent.

The researchers noted that mortality was disproportionately high across all subgroups, including those who underwent elective surgery (18.9 per cent), and emergency surgery (25.6 per cent).

Those who underwent minor surgery, such as appendicectomy or hernia repair (16.3 per cent), and major surgery such as hip surgery or for colon cancer also had higher mortality rates (26.9 per cent), the study said.

According to the study, the mortality rates were higher in men versus women, and in patients aged 70 years or over versus those aged under 70 years.

The scientists said in addition to age and sex, risk factors for postoperative death also included having severe pre-existing medical problems, undergoing cancer surgery, undergoing major procedures, and undergoing emergency surgery.

"We would normally expect mortality for patients having minor or elective surgery to be under 1 per cent, but our study suggests that in SARS-CoV-2 patients these mortality rates are much higher in both minor surgery (16.3%) and elective surgery (18.9%)," said study co-author Aneel Bhangu from the University of Birmingham.

Bhangu said these mortality rates are greater than those reported for even the highest-risk patients before the pandemic.

Citing an example from the 2019 UK National Emergency Laparotomy Audit report, he said the 30-day mortality was 16.9 per cent in the highest-risk patients.

Based on an earlier study across 58 countries, Bhangu said the 30-day mortality was 14.9 per cent in patients undergoing high-risk emergency surgery.

"We recommend that thresholds for surgery during the SARS-CoV-2 pandemic should be raised compared to normal practice," he said.

"For example, men aged 70 years and over undergoing emergency surgery are at particularly high risk of mortality, so these patients may benefit from their procedures being postponed," Bhangu added.

The study also noted that patients undergoing surgery are a vulnerable group at risk of SARS-CoV-2 exposure in hospital.

It noted that the patients may also be particularly susceptible to subsequent pulmonary complications, due to inflammatory and immunosuppressive responses to surgery and mechanical ventilation.

The scientists found that overall in the 30 days following surgery 51 per cent of patients developed a pneumonia, acute respiratory distress syndrome, or required unexpected ventilation.

Nearly 82 per cent of the patients who died had experienced pulmonary complications, the researchers said.

"Worldwide an estimated 28.4 million elective operations were cancelled due to disruption caused by COVID-19," said co-author Dmitri Nepogodiev from the University of Birmingham.

"Our data suggests that it was the right decision to postpone operations at a time when patients were at risk of being infected with SARS-CoV-2 in hospital," Nepogodiev said.

According to the researchers, there's now an urgent need for investment by governments and health providers in to measures which ensure that as surgery restarts patient safety is prioritised.

They said this includes the provision of adequate personal protective equipment (PPE), establishment of pathways for rapid preoperative SARS-CoV-2 testing, and consideration of the role of dedicated 'cold' surgical centres.

Beijing, Jun 18:  Besides washing hands and wearing masks, it is also important to close the toilet lid before flushing to contain the spread of COVID-19, as per a new study.

According to a new study cited by The Washington Post, scientists who simulated toilet water and airflows, have found that flushing a toilet can generate a plume of virus-containing aerosol particles that is widespread and can linger in the air long enough to be inhaled by others. The novel coronavirus has been found in the faeces of COVID-19 patients, but it remains unknown whether such clouds could contain enough virus to infect a person.

"Flushing will lift the virus up from the toilet bowl," co-author Ji-Xiang Wang, who researches fluids at Yangzhou University in Yangzhou, China, said in an email. Wang stressed that bathroom users "need to close the lid first and then trigger the flushing process" and wash hands properly if the closure is not possible. As one flushes the toilet with the lids open, bits of faecal matter swish around so violently that they can be propelled into the air, become aerosolised and then settle on the surroundings.

Experts call it the "toilet plume".Age-old studies have been made to understand the potential for airborne transmission of infectious disease via sewage, and the toilet plume's role. Scientists who have seeded toilet bowls with bacteria and viruses have found contamination of seats, flush handles, bathroom floors and nearby surfaces. This is one reason we are told to wash our hands after visiting the toilet. Public bathrooms are well known to contribute to the spread of viruses that transmit via ingestion, such as the noroviruses that haunt cruise ships. However, their role in the transmission of respiratory viruses has not been established, said Charles P Gerba, a microbiologist at the University of Arizona."The risk is not zero, but how great a risk it is, we do not know. The big unknown is how much virus is infectious in the toilet when you flush it ... and how much virus does it take to cause an infection," said Gerba, who has studied the intersection of toilets and infectious disease for 45 years.

A study published in March in the journal Gastroenterology found significant amounts of coronavirus in the stool of patients and determined that viral RNA lasted in faeces even after the virus cleared from the patients` respiratory tracts. While another study in the journal Lancet found coronavirus in faeces up to a month after the illness had passed.

Scientists around the world are now studying sewage to track the spread of the virus. According to the researchers, the presence of the virus in excrement and the gastrointestinal tract raises the prospect of transmission via toilets, because many COVID-19 patients experience diarrhoea or vomiting.

A study of air samples in two hospitals in Wuhan, China found that although coronavirus aerosols in isolation wards and ventilated patient rooms were very low, "it was higher in the toilet areas used by the patients".The Centers for Disease Control and Prevention (CDC) says it remains "unclear whether the virus found in faeces may be capable of causing COVID-19," and "there has not been any confirmed report of the virus spreading from faeces to a person".For now, the CDC characterises the risk as low based on observations from previous outbreaks of other coronaviruses such as severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS). Wang decided to use computer models to simulate toilet plumes while isolating at home, as per Chinese government orders and thinking about how a fluids researcher "could contribute to the global fight against the virus".

Published in the journal Physics of Fluids, the study found that flushing of both single-inlet toilets, which push water into the bowl from one port, and annular-inlet toilets, which pour water into the bowl from the rim's surrounding edge with even greater energy, results in "massive upward transport of virus".

Particles can reach heights of more than three feet and float in the air for more than a minute, it found. The paper recommends not just lid-closing and hand-washing, it urges manufacturers to produce toilets that close and self-clean automatically. It also suggests that toilet-users should wipe down the seat. Gerba, however, said seats should not be a major concern.

Research has found that public and household toilet seats are typically the cleanest surfaces in restrooms, he said, probably because so many people already wipe them off before using them. Also, he said of SARS-CoV-2, the virus that causes COVID-19, "I don't think it's butt-borne, so I don`t think you have to worry."Gerba, who has been studying coronavirus transmission for two decades to investigate the role of a toilet flushing in a SARS outbreak stresses "flush and run" when using a public toilet without a lid. Gerba also said that people should wash hands well post-flushing and use hand sanitiser after leaving the restroom. "Choose well-ventilated bathrooms if possible and do not hang around the restroom in any case," added Gerba.

Due to impacts of COVID-19, shipments of total mobile phones are forecast to decline 14.6% in 2020, while smartphone shipments will achieve a slightly slower decline of 13.7 % year over year to total 1.3 billion units this year, according to a Gartner forecast on Tuesday.

"While users have increased the use of their mobile phones to communicate with colleagues, work partners, friends and families during lockdowns, reduced disposable income will result in fewer consumers upgrading their phones," Ranjit Atwal, Senior Research Director at Gartner, said in a statement.

"As a result, phone lifetimes will extend from 2.5 years in 2018 to 2.7 years in 2020," said Atwal.

In 2020, affordable 5G phones were expected to be the catalyst to increase phone replacements, but now it is unlikely to be the case.

5G phones are now forecast to represent only 11% of total mobile phone shipments in 2020.

"The delayed delivery of some 5G flagship phones is an ongoing issue," said Annette Zimmermann, Research Vice President at Gartner.

"Moreover, the lack of 5G geographical coverage along with the increasing cost of the 5G phone contract will impact the choice of a 5G phone."

Overall, spending on 5G phones will be impacted in most regions apart from China, where continued investment in 5G infrastructure is expected, allowing providers in China to effectively market 5G phones.

The combined global shipments PCs, tablets and mobile phones are on pace to decline 13.6% in 2020, according to the forecast.

PC shipments are expected to decline 10.5% this year. Shipments of notebooks, tablets and Chromebooks are forecast to decline slower than the PC market overall in 2020.

"The forecasted decline in the PC market in particular could have been much worse," said Atwal.

"However, government lockdowns due to COVID-19 forced businesses and schools to enable millions of people to work from home and increase spending on new notebooks, Chromebooks and tablets for those workers. Education and government establishments also increased spending on those devices to facilitate e-learning."

Gartner said that 48 per cent of employees will likely work remotely at least part of the time after the COVID-19 pandemic, compared to 30 % pre-pandemic.

Overall, the work from home trend will make IT departments shift to more notebooks, tablets and Chrome devices for work.

"This trend combined with businesses required to create flexible business continuity plans will make business notebooks displace desk based PCs through 2021 and 2022," said Atwal.