coronavirus disease 2019 has emerged as a global public health emergency. Countries across the world are rapidly reporting new infections and case fatalities. 1 As the COVID-19 pandemic rapidly evolves, understanding symptoms and clinical characteristics of affected persons is essential. Patients with COVID-19 often present with fever, cough, and fatigue, although organ-specific symptoms have been reported. 2,3 The primary aim of this study was to systematically review published and preprint articles describing cutaneous symptoms associated with COVID-19 presentation.Literature for this review was identified by searching the PubMed/MEDLINE database for published articles and the medRxiv database for preprint ones. Search terms ''COVID-19,'' ''2019-nCoV,'' and Fig 1. PRISMA diagram for inclusion of records in systematic review.

The Varkud Satellite (VS) ribozyme catalyzes site-specific RNA cleavage and ligation, and serves as an important model system to understand RNA catalysis. Here we combine stereospecific phosphorothioate substitution, precision nucleobase mutation and linear free energy relationship measurements with molecular dynamics, molecular solvation theory, and ab initio quantum mechanical/molecular mechanical free energy simulations to gain insight into catalysis. Through this confluence of theory and experiment, we unify the existing body of structural and functional data to unveil the catalytic mechanism in unprecedented detail, including the degree of proton transfers in the transition state. Further, we provide evidence for a critical Mg 2+ ion in the active site that interacts with the scissile phosphate and anchors the general base guanine in position for nucleophile activation. This novel role for Mg 2+ adds to the diversity of known catalytic RNA strategies and unifies functional features observed in the VS, hairpin, and hammerhead ribozyme classes.

Objective: To assess public response to cancellations of elective surgeries following the American College of Surgeons' (ACS) recommendation on March 13. Methods: We queried text comments from Reddit, a social media platform and the fifth most popular website in the United States. Comments were manually reviewed to assess for relevance to elective surgery in the United States during the global coronavirus outbreak, whether the text was written by a healthcare worker (HCW), whether the user was based in the United States, and whether the text documented cancellations of surgery, expected cancellations of surgery, or surgery ongoing after the ACS announcement. Analysis of overall sentiment and negativity in comment text was performed using the Valence Aware Dictionary for sEntiment Reasoning (VADER), a validated natural language processing tool previously used in studies of health behaviors using social media. Non-parametric tests were used for subgroup comparisons based on posting date and characteristics identified during manual review. Results: Following manual review, 1272 comments were included for analysis. Overall sentiment among non-HCWs became significantly more negative following the ACS announcement (P ¼ 0.037). Overall sentiment did not significantly differ between HCWs and non-HCWs prior to the ACS announcement (P ¼ 0.98), but non-HCW sentiment became significantly more negative than HCW sentiment after the announcement (P ¼ 0.027). Negativity scores in posts describing cancellations were significantly higher among posts written by non-HCWs than HCWs (P ¼ 0.028). Conclusions: Cancellation of elective surgeries had an adverse emotional impact on non-HCWs. This finding highlights the importance of access to elective surgery to patients' emotional well-being.

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