Long-term outcomes for epidemic viral pneumonia survivors after discharge from the intensive care unit: a systematic review

ABSTRACT Objective To review the long-term outcomes (functional status and psychological sequelae) of survivors of critical illnesses due to epidemic viral pneumonia before the COVID-19 pandemic and to establish a benchmark for comparison of the COVID-19 long-term outcomes. Methods This systematic review of clinical studies reported the long-term outcomes in adults admitted to intensive care units who were diagnosed with viral epidemic pneumonia. An electronic search was performed using databases: MEDLINE®, Web of Science™, LILACS/IBECS, and EMBASE. Additionally, complementary searches were conducted on the reference lists of eligible studies. The quality of the studies was assessed using the Newcastle-Ottawa Scale. The results were grouped into tables and textual descriptions. Results The final analysis included 15 studies from a total of 243 studies. This review included 771 patients with Influenza A, Middle East Respiratory Syndrome, and Severe Acute Respiratory Syndrome. It analyzed the quality of life, functionality, lung function, mortality, rate of return to work, rehospitalization, and psychiatric symptoms. The follow-up periods ranged from 1 to 144 months. We found that the quality of life, functional capacity, and pulmonary function were below expected standards. Conclusion This review revealed great heterogeneity between studies attributed to different scales, follow-up time points, and methodologies. However, this systematic review identified negative long-term effects on patient outcomes. Given the possibility of future pandemics, it is essential to identify the long-term effects of viral pneumonia outbreaks. This review was not funded. Prospero database registration: (www.crd.york.ac.uk/prospero) under registration ID CRD42021190296.

REVIEW ON STRUCTURE, PATHOGENECITY, TRANSMISSIBILITY AND EPIDEMIOLOGY OF HUMAN PATHOGENIC CORONAVIRUSES

Coronaviruses cause animal and human respiratory and bowel infections. They have not been deemed highly pathogenic to humans until the outbreak of severe acute respiratory syndrome (SARS) in 2002 and 2003 in Guangdong province, China. Coronaviruses (CoVs) are large, enveloped, positive-sense, single-stranded RNA viruses that can infect both animals and humans. Coronaviruses didn't just appear recently. They are large family of viruses that have been around for a long time. Formerly, coronaviruses (CoVs) were seen as relatively harmless respiratory pathogens to humans. However, two outbreaks of severe respiratory tract infection, caused by the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV) caused high pathogenicity and mortality rates among human populations as a result of zoonotic CoVs crossing the species barrier. Now the recent detection of the 2019 novel coronavirus (COVID-19), added a new member in corona virus family.The novel coronavirus (COVID 19) is one of the member of coronavirus family which infect human. Scientists have divided coronaviruses into four sub- groupings, called alpha, beta, gamma and delta. Seven of these viruses can infect people. The four common coronaviruses are-229E(alpha), NL63(alpha), OC43(beta), HKU1(beta). The three less-common coronaviruses are- MERS-CoV(beta), SARS-CoV(beta), SARS-CoV-2. Our main target is to describe the the structure, Pathogenecity, Transmissibility and Epidemiology of above mentioned subgroups of corona viruses in our review

Review and Prospects of Pathogen Detection Related to Autopsy of Coronavirus Infectious Diseases / 法医学杂志

In the past, coronavirus caused two serious human-to-human pandemics in the world, including severe acute respiratory syndrome （SARS） and Middle East respiratory syndrome （MERS）. In late 2019, coronavirus disease 2019 （COVID-19） caused another major global public health event. Due to the strong infectivity of novel coronavirus, it is difficult to carry out the autopsy of related death cases widely. This paper reviews the previous status of the pathogen detection related to the autopsy of coronavirus infection diseases, and introduces the ongoing detection methods of novel coronavirus in clinical practice, in order to provide reference for the pathogen detection and study related to autopsy of COVID-19.

Overview of the Management of COVID-19 Efficacy and Doubts

Coronavirus disease 2019 (COVID-19) is defined as an illness caused by a novel coronavirus now called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2. It was first identified during an outbreak of respiratory illness cases in Wuhan City, Hubei Province, China.Management of COVID-19 is still unspecific as there are no vaccine orspecific antiviral drugs areavailable for its treatment. This paper reviewsthemanagement efficacy and doubt of COVID-19.Methods: A comprehensive search from relevant literatures, World Health Organization (W.H.O), Centre for Disease Control and prevention (CDC) official websites and announcements was performed between 1 March2020 to 10:30 am 22 April 2020 (Nigerian time). A latest summary of 2019-nCoV and the current outbreak was drawn.Conclusion: The covid-19 pandemic is spreading rapidly and several researchers are making efforts to discover drugs for its treatment. Chloroquine phosphate, vaccines and other forms of management strategies have been employed. However, preventive measureslike social distancing, washing of handswith soap and water, wearing of face masks and psychosocial treatment should be adopted while waiting for pharmacological treatments.

COVID-19: The outbreak caused by a new coronavirus / COVID-19: la epidemia causada por un nuevo coronavirus

Abstract Before the severe acute respiratory syndrome outbreak in 2003, coronaviruses (CoVs) were not considered to be highly pathogenic to humans. However, it was this epidemic that highlighted this group of viruses and included them among the causative agents of emerging epidemic diseases. In addition, in 2012, another new CoV responsible for the Middle East respiratory syndrome was identified. Both infections were considered a threat to global health security. At present, the third epidemic caused by a CoV is being faced. This new CoV, called 2019-nCoV, was originated in the city of Wuhan, China, and has been linked to severe respiratory infections in humans. Thanks to the collaboration of experts worldwide, more information about this virus and its infection is reported each day, which allows modifying the recommendations for its prevention and treatment, without forgetting that the ultimate goal is to control this epidemic. In this review, the important aspects of this new coronavirus, 2019-nCoV, and its disease, COVID-19, have been summarized with the information available up to February 2020.

Resumen Previo al brote del síndrome respiratorio agudo grave de 2003, los coronavirus (CoV) no eran considerados como agentes altamente patogénicos para los humanos. Sin embargo, fue dicha epidemia la que destacó este grupo de virus y lo incluyó entre los agentes causantes de enfermedades epidémicas emergentes. Adicionalmente, en 2012 se identificó un nuevo CoV causante del síndrome respiratorio de Oriente Medio. Ambas infecciones fueron consideradas una amenaza para la seguridad sanitaria mundial. Hoy en día se presenta la tercera epidemia causada por un CoV. Este nuevo CoV, llamado 2019-nCoV, se originó en la ciudad de Wuhan, China, y ha sido relacionado con infecciones respiratorias graves en humanos. Gracias a la colaboración de expertos en todo el mundo, cada día se logra obtener más información sobre este virus y la infección que causa, lo cual permite modificar las recomendaciones para su prevención y tratamiento sin olvidar que el fin último es lograr el control de la epidemia. En esta revisión se resumen los aspectos más importantes acerca del nuevo 2019-nCoV y la enfermedad COVID-19, con la información disponible hasta febrero de 2020.

Review and Prospect of Pathological Features of Corona Virus Disease / 法医学杂志

Since 2003, coronavirus has caused multiple major public health events that resulted in global epidemics, such as severe acute respiratory syndrome （SARS）, Middle East respiratory syndrome （MERS） and corona virus disease 2019 （COVID-19）. Especially since COVID-19 outbroke in Wuhan, Hubei, in December 2019, coronavirus has had a significant impact on people's health and lives. But so far, the pathological diagnosis of COVID-19 has been relatively deficient： it is still confined to the pathological findings of punctured organs, and the majority of medical workers have poor awareness of its pathological characteristics. The COVID-19, as same as SARS and MERS, is caused by coronaviruses and can cause viral pneumonia. They have certain similarities. This article comprehensively reviews the pathological features observed in the autopsies of the aforementioned three diseases, in order to provide reference to the analysis of pathological changes of COVID-19.

Eficácia da máscara facial (TNT) na população para a prevenção de infecções por coronavírus: revisão sistemática / Effectiveness of the use of non-woven face mask to prevent coronavirus infections in the general population: a rapid systematic review

Resumo O objetivo deste artigo é avaliar a eficácia das máscaras faciais padrão tecido não tecido (TNT) para a prevenção de doenças respiratórias (MERS CoV, SARS-CoV e SARS-CoV-2) na população. Foi realizada busca nas bases de dados Medline, Embase, Cinahl, The Cochrane Library, Trip. Também busca complementar no Google Acadêmico, Rayyan e medRxiv. Não foram aplicados filtros relacionados a data, idioma ou status de publicação. Títulos e resumos foram rastreados e, posteriormente, textos completos foram avaliados. Foram incluídos três estudos: um ensaio clínico randomizado tipo cluster e duas revisões sistemáticas. O ensaio clínico indica benefício potencial de máscaras médicas para controle da fonte de infecção, para a doença respiratória clínica. Em uma das revisões sistemáticas, não foi possível estabelecer relação conclusiva entre uso da máscara e proteção contra infecção respiratória. Por fim, outra revisão sistemática demonstrou que máscaras são eficazes na prevenção da propagação de vírus respiratórios. As evidências apontam para benefício potencial das máscaras faciais padrão TNT. Para o cenário atual de pandemia por COVID 19, recomenda-se educação sobre uso adequado de máscaras, associado a medidas individuais de proteção.

Abstract Objectives: to evaluate the effectiveness of non-woven face masks for the prevention of respiratory infections (MERS CoV, SARS-CoV, and SARS-CoV-2) in the population. Methods: search in Medline, Embase, Cinahl, The Cochrane Library, Trip databases. Google Scholar, Rayyan and medRxiv were also consulted for complementary results. No filters related to date, language or publication status were applied. Titles and abstracts were screened, and later, full texts were evaluated. Results: three studies were included: a randomized cluster clinical trial and two systematic reviews. The clinical trial indicates a potential benefit of medical masks to control the source of clinical respiratory disease infection. In one of the systematic reviews, it was not possible to establish a conclusive relationship between the use of the mask and protection against respiratory infection. Finally, another systematic review indicated that masks are effective in preventing the spread of respiratory viruses. Conclusion: Evidence points to the potential benefit of standard non-woven face masks. For the current pandemic scenario of COVID-19, education on the appropriate use of masks associated with individual protection measures is recommended.

Bat-related coronavirus / 第二军医大学学报

The outbreak of coronavirus disease 2019 (COVID-19) in Dec. 2019 sounded another alarm for humanbeing, with the first being the outbreak of severe acute respiratory syndrome (SARS) in 2003. Researchers found that the natural host of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pathogen of COVID-19, may be the Rhinolophus sinicus. There have been four outbreaks of coronaviruses (severe acute respiratory syndrome coronavirus [SARS-CoV], Middle East respiratory syndrome coronavirus [MERS-CoV], swine acute diarrhea syndrome coronavirus [SADS-CoV] and SARS-CoV-2) worldwide since the beginning of 21st century, and they have caused huge threats and losses to human health, public health, economic development, and social stability. A large amount of evidence suggests that the natural host of all these four coronaviruses may be bats. This article reviews the species and global geographic distribution of bat-related coronaviruses, and the above-metioned four coronaviruses causing severe outbreaks.

Research progress on human coronavirus and antiviral drugs / 解放军医学杂志

Coronavirus mainly causes local infection in birds and mammals. In recent decades, there has been an evidence that it can infect humans. Highly pathogenic coronavirus, including severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), are fatal zoonotic viruses, which have posed a major threat to public health. Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2, COVID-19) has also seriously endangered the health and safety of the human beings. These coronaviruses transmit through close contact between people, resulting in the development of acute respiratory distress syndrome (ARDS) and multiple organ failure (MOF) and having a higher morbidity and mortality. This article reviews the structure, epidemiology, immunology and treatment of the coronavirus, hoping to provide reference for the prevention, control and treatment of the disease.

Diagnosis, treatment, control and prevention of SARS-CoV-2 and coronavirus disease 2019: back to the future / 生物工程学报

The ongoing outbreak of the coronavirus disease 2019 (COVID-19) as named by the World Health Organization has millions of confirmed cases around the world and has claimed hundreds of thousands of lives. The virus was named SARS-CoV-2 in February by International Committee on Taxonomy of Viruses. COVID-19 presents as fever, dry cough, dyspnea, headache and pneumonia. In a small subset of severe cases, the disease quickly progresses to respiratory failure and even death. Since the 21st century, there have been three major outbreaks caused by human coronaviruses, including the severe acute respiratory syndrome (SARS) that broke out in 2003, the Middle East respiratory syndrome (MERS) in 2012, and the recent pandemic of COVID-19. Since 2003, significant progress has been made in the study of SARS-CoV and MERS-CoV concerning their natural origins, pathogenesis, antiviral development and vaccine design. Since SARS-CoV-2 and SARS-CoV are closely related, previous findings on SARS-CoV are highly relevant to a better understanding as well as diagnosis, treatment, prevention and control of SARS-CoV-2. In this review, we highlight recent progresses in the field; compare the biological characteristics of SARS-CoV and SARS-CoV-2; summarize the urgently-needed diagnostic, treatment, prevention and control options; and provide future perspectives for the outcome of the outbreak and research questions to be answered, including some of the difficulties in vaccine development. Hopefully, our comments and suggestions would prove useful for the control of the SARS-CoV-2 epidemic in China and the world.

How Ophthalmologists Should Understand and Respond to the Current Epidemic of Novel Coronavirus Pneumonia (COVID-19) / 中华实验眼科杂志

The new coronavirus pneumonia that first appeared in Wuhan, China, in December 2019 has attracted great attention from both the Chinese government and the international community. The International Committee on Viral Classification named the virus "Severe Acute Respiratory Syndrome Coronavirus 2" (SARS-CoV-2), and the WHO named the pneumonia it causes "Coronavirus Disease 2019" (COVID-19). At present, the disease is centered in Wuhan City and is spreading rapidly to all parts of China, as well as twenty other countries. About 20% of the people infected during the SARS epidemic in 2003 were employees in hospital environments. COVID-19 has infected an even greater number of heath care workers. Therefore, ophthalmologists need to understand the disease and recognize the importance of taking preventive measures. Although ophthalmologists do not work on the front lines of the outbreak, due to their area of expertise, a variety of situations, such as infection consultations or ophthalmic emergency treatments, can lead to the exposure of ophthalmologists to high-risk environments. This risk will only increase as the number of infected patients continues to increase. When dealing with seemingly normal ophthalmic patients, the vigilance of ophthalmologists and associated staff tends to be significantly reduced. To better protect patients, families, and health care workers, it is strongly recommended that in addition to the standard precautions for the care of all patients, strict contact precautions and droplet precautions need to be taken by ophthalmologists. These measures include 1) wearing an efficient mask (an N95 mask); 2) always performing hand hygiene before and after examining a patient; (3) wearing sterile gloves when entering a patient’s room and touching a patient; (4) wearing a gown when contact is expected with items and environmental surfaces surrounding a patient or when the patient is incontinent or has diarrhea or a surgical or other invasive wound with oozing fluid; 5) cleaning and disinfecting ophthalmic equipment and correctly handling medical waste after examination to prevent transmission to patients who are subsequently examined; 6) wearing goggles and a disposable mask to cover the front and sides of the face before touching a patient, as the virus could spread through the ocular surface; 7) performing the relevant screening for novel coronavirus pneumonia for regular patients who have conjunctivitis and respiratory symptoms at the same time; 8) prohibiting the use of infected patients as potential donors for corneal transplants and temporarily adding donor SARS-CoV-2 screening to the medical standard of the eye bank during the outbreak; and 9) for the purposes of scientific research, diagnosis, and other special needs, packing, shipping, and transporting collected specimens according to the relevant dangerous biological goods regulations.

Use Stones from Another Mountain to Polish One’s Jade: Learn from MERS Studies toexplore potential mechanisms underlying the effect of diabetes mellitus on COVID-19 / 中华内分泌代谢杂志

Epidemiology studies suggest that comorbid diabetes may have negative impact on the progression and severity of the coronavirus disease 2019 (COVID-19), which first occurred in Wuhan. However, the exact mechanism remains unclear. A recent study on another type of coronavirus infection, Middle East Respiratory Syndrome (MERS), investigated its relationship with diabetes. This essay aims to give a brief introduction to this report and related studies, and to propose suggestions on what we can learn from these investigations to conduct further studies on the potential mechanisms underlying the effect of diabetes mellitus on COVID-19.

Absence of neutralizing activity in serum 1 year after successful treatment with antivirals and recovery from MERS in South Korea

We evaluated the neutralizing activity in serum from three patients >1 year after recovery from Middle East respiratory syndrome (MERS) associated with mild pneumonia treated with antivirals during the MERS outbreak in South Korea at 2015. The neutralizing activity in serum was measured by pseudovirus inhibition assays. Three-fold diluted serum of subjects showed only 9.7%, 10.3%, and 2.2% reductions in relative light units. So, significant neutralizing activity was not demonstrated in any sera of three patients with mild pneumonia >1 year after being successfully treated with antiviral agents and recovering from MERS coronavirus infection.

Establishment and evaluation of receptor binding domain (RBD)-based ELISA for Middle East respiratory syndrome coronavirus (MERS-CoV) antibody detection / 中华微生物学和免疫学杂志

Objective@#To establish an indirect enzyme-linked immunosorbent assay (ELISA)and to compare the efficiency of receptor binding domain (RBD) proteins in different forms for Middle East respiratory syndrome coronavirus (MERS-CoV) antibody detection.@*Methods@#The monomeric and trimeric forms of MERS-CoV RBD were expressed in Bac-insect cells, 293T cells and ExpiCHO-S™ expression system and then purified. The purified RBD proteins were identified with native gel electrophoresis and Western blot. Then, an equal amount of each RBD protein was used as coating antigen to establish an ELISA for detecting MERS-CoV IgG titer. For comparison, the newly developed ELISA and the commercial MERS-CoV IgG antibody detection kit (Euroimmune with S1 as the coating antigen) were used to measure the MERS-CoV antibody reference panel supplied by World Health Organization (WHO).@*Results@#The purified monomeric and trimeric MERS-CoV RBD were successfully prepared using 293T cells and ExpiCHO-S™ system. RBD antigens of different forms and from different systems could recognize MERS-CoV specific antibody without having any cross reaction with the sera from healthy adults. The in-house RBD-based ELISA had good detection consistency with the Euroimmune commercial kit. The positive samples showed higher and more concentrated values based on the RBD trimer than the monomer.@*Conclusions@#Novel indirect ELISA methods based on the monomeric and trimeric forms of RBD protein were established. The trimetric form-based ELISA achieved higher detection efficiency than the one using the monomer antigen, suggesting that it could be uses as a competent alternative to the commercial kit.

Establishment and evaluation of receptor binding domain (RBD)-based ELISA for Middle East re-spiratory syndrome coronavirus (MERS-CoV) antibody detection / 中华微生物学和免疫学杂志

Objective To establish an indirect enzyme-linked immunosorbent assay (ELISA)and to compare the efficiency of receptor binding domain (RBD) proteins in different forms for Middle East re-spiratory syndrome coronavirus (MERS-CoV) antibody detection. Methods The monomeric and trimeric forms of MERS-CoV RBD were expressed in Bac-insect cells, 293T cells and ExpiCHO-STM expression sys-tem and then purified. The purified RBD proteins were identified with native gel electrophoresis and Western blot. Then, an equal amount of each RBD protein was used as coating antigen to establish an ELISA for de-tecting MERS-CoV IgG titer. For comparison, the newly developed ELISA and the commercial MERS-CoV IgG antibody detection kit (Euroimmune with S1 as the coating antigen) were used to measure the MERS-CoV antibody reference panel supplied by World Health Organization (WHO). Results The purified mon-omeric and trimeric MERS-CoV RBD were successfully prepared using 293T cells and ExpiCHO-STM system. RBD antigens of different forms and from different systems could recognize MERS-CoV specific antibody without having any cross reaction with the sera from healthy adults. The in-house RBD-based ELISA had good detection consistency with the Euroimmune commercial kit. The positive samples showed higher and more concentrated values based on the RBD trimer than the monomer. Conclusions Novel indirect ELISA methods based on the monomeric and trimeric forms of RBD protein were established. The trimetric form-based ELISA achieved higher detection efficiency than the one using the monomer antigen, suggesting that it could be uses as a competent alternative to the commercial kit.

Psychiatric Morbidity of Survivors One Year after the Outbreak of Middle East Respiratory Syndrome in Korea, 2015 / 신경정신의학

OBJECTIVES: Patients with an infectious diseases during an outbreak can experience extreme fear and traumatic events in addition to suffering from their medical illness. This study examined the long-term impact of the outbreak of Middle East Respiratory Syndrome (MERS) in Korea, 2015 on the mental health of the survivors. METHODS: Sixty-three survivors from MERS were recruited from a prospective cohort study at six hospitals one year after the outbreak in 2015. The Korean-Symptom Check List 95 was administered to evaluate their psychiatric problems and analyzed according to the patient's characteristics and exposure to traumatic events during the outbreak. RESULTS: A total of 63.5% of survivors suffered from significant psychiatric problems: post-traumatic symptoms (36.5%), sleep problems (36.5%), anxiety (34.9%), and depression (30.2%). Survivors with a history of a ventilator treatment during the MERS epidemic, a family member who died from MERS, and a past psychiatric history showed higher post traumatic stress disorder, anxiety, depression, and suicidality than people who do not have those histories. CONCLUSION: The study suggests that MERS survivors could have a high chance of adverse psychiatric consequences, even after their recovery from MERS. Exposure to traumatic events during the outbreak and premorbid individual vulnerability would affect the long-term mental health problems.

Rapid establishment of a mouse model of MERS-CoV pseudovirus infection based on DPP4 transduction / 中华微生物学和免疫学杂志

Objective To rapidly establish a mouse model for optical imaging of the dynamical process of pseudotyped Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Methods In vitro expression in HeLa cells and functions of hDPP4 encoded by recombinant adenovirus Ad5 and pseudo-typed MERS-CoV were verified. The recombinant adenovirus expressing hDPP4 (Ad5-hDPP4) was injected into BALB/ c mice, which were then injected with pseudotyped MERS-CoV expressing firefly luciferase at a titer of 3×107 TCID50(50％ tissue culture infective dose) via intrathoracic (I. T. ) or intraperitoneal (I. P. ) injection. MERS-CoV infection and tissue distribution were observed using optical imaging techniques. Re-sults hDPP4 and firefly luciferase were efficiently expressed in HeLa cells. In BALB/ c mice injected with Ad5-hDPP4 via I. P. , firefly luciferase expression were detected in abdomen between 48-96 h after pseudo-typed MERS-CoV infection. The expression of firely luciferase was also detected in chests of BALB/ c mice injected with Ad5-hDPP4 via I. T. around 48 h after pseudotyped MERS-CoV infection. Conclusions This study reported a simple and rapid method for establishing a mouse model for conveniently and dynamically monitoring pseudotyped MERS-CoV infection, which might provide an effective means for in vivo evaluation of neutralizing antibodies or entry inhibitors by visualization with optical imaging techniques.

Middle East respiratory syndrome coronavirus in pediatrics: a report of seven cases from Saudi Arabia / 医学前沿

Infection with Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in 2012 as an important respiratory disease with high fatality rates of 40%-60%. Despite the increased number of cases over subsequent years, the number of pediatric cases remained low. A review of studies conducted from June 2012 to April 19, 2016 reported 31 pediatric MERS-CoV cases. In this paper, we present the clinical and laboratory features of seven patients with pediatric MERS. Five patients had no underlying medical illnesses, and three patients were asymptomatic. Of the seven cases, four (57%) patients sought medical advice within 1-7 days from the onset of symptoms. The three other patients (43%) were asymptomatic and were in contact with patients with confirmed diagnosis of MERS-CoV. The most common presenting symptoms were fever (57%), cough (14%), shortness of breath (14%), vomiting (28%), and diarrhea (28%). Two (28.6%) patients had platelet counts of < 150 × 10/L, and one patient had an underlying end-stage renal disease. The remaining patients presented with normal blood count, liver function, and urea and creatinine levels. The documented MERS-CoV Ct values were 32-38 for four of the seven cases. Two patients (28.6%) had abnormal chest radiographic findings of bilateral infiltration. One patient (14.3%) required ventilator support, and two patients (28.6%) required oxygen supplementation. All the seven patients were discharged without complications.

Impact of the 2015 Middle East Respiratory Syndrome Outbreak on Emergency Care Utilization and Mortality in South Korea

PURPOSE: In May 2015, South Korea experienced an epidemic of Middle East respiratory syndrome (MERS). This study investigated the impacts of MERS epidemic on emergency care utilization and mortality in South Korea. MATERIALS AND METHODS: A natural experimental study was conducted using healthcare utilization and mortality data of the entire Korean population. The number of monthly emergency room (ER) visits was investigated to identify changes in emergency care utilization during the MERS epidemic; these trends were also examined according to patients' demographic factors, disease severity, and region. Deaths within 7 days after visiting an ER were analyzed to evaluate the impact of the reduction in ER visits on mortality. RESULTS: The number of ER visits during the peak of the MERS epidemic (June 2015) decreased by 33.1% compared to the average figures from June 2014 and June 2016. The decrease was observed in all age, sex, and income groups, and was more pronounced for low-acuity diseases (acute otitis media: 53.0%; upper respiratory infections: 45.2%) than for high-acuity diseases (myocardial infarctions: 14.0%; ischemic stroke: 16.6%). No substantial changes were detected for the highest-acuity diseases, with increases of 3.5% for cardiac arrest and 2.4% for hemorrhagic stroke. The number of deaths within 7 days of an ER visit did not change significantly. CONCLUSION: During the MERS epidemic, the number of ER visits decreased in all age, sex, and socioeconomic groups, and decreased most sharply for low-acuity diseases. Nonetheless, there was no significant change in deaths after emergency care.

Depression as a Mediator of Chronic Fatigue and Post-Traumatic Stress Symptoms in Middle East Respiratory Syndrome Survivors

OBJECTIVE: The relationship among chronic fatigue, depressive symptoms, and post-traumatic stress symptoms (PTSSs) among Middle East respiratory syndrome (MERS) survivors is poorly understood. METHODS: Of 148 survivors who consented to be registered and underwent assessments at 12 months (T1) and 18 months (T2) after the MERS outbreak, 72 (48.65%) were evaluated for chronic fatigue, depressive symptoms, and PTSSs based on the Impact of Event ScaleRevised (IES-R), the Patient Health Questionnaire-9 (PHQ-9), and the Fatigue Severity Scale (FSS). Data from 52 subjects, who completed both assessments, were analyzed using a regression-based serial multiple mediation model (PROCESS Model 6). RESULTS: Bootstrap analyses indicated no direct effects of T1 FSS on T2 IES-R but significant positive indirect effects of T1 FSS on T2 IESR through T1 PHQ-9 and T2 PHQ-9 (B=2.1601, SE=1.3268, 95% confidence interval=0.4250–6.1307). In other words, both T1 PHQ-9 and T2 PHQ-9 fully mediated the relationship between T1 FSS and T2 IES. CONCLUSION: Chronic fatigue 12 months after MERS had indirect effects on prolonged PTSSs 18 months after MERS via persisting depression in MERS survivors. This finding supports the need to promote interventional programs for emerging infectious disease survivors with chronic fatigue to reduce depression and prevent prolonged PTSSs.