Significance of "Qingfei" and "Paidu" of Qingfei Paidu Decoction in Treatment of COVID-19 / 中国实验方剂学杂志

Traditional Chinese medicine （TCM） has played an important role in the prevention and treatment of novel coronavirus disease 2019 （COVID-19）. Qingfei Paidu decoction，as a general prescription of Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia from the sixth to eighth versions，has been proved effective clinically and is suitable for mild，moderate，severe，and critical patients. It can significantly improve clinical symptoms such as fever， cough，asthma，fatigue， etc. On the basis of the findings of relevant research papers，this paper summarized the TCM understanding of COVID-19， including etiology，pathogenesis， disease location， and treatment，and concluded that the disease is caused by the pestilential Qi，localized in the lungs， and can affect the five organs. It is mainly characterized by coldness，dampness，heat，toxicity，stasis，and deficiency. In response to the etiology and pathogenesis of the disease，the therapeutic principles at all stages are dominated by the elimination of pathogens and removal of toxicity. According to the stages of disease development，the treatment should combine the severity of the disease and the course of the disease with the TCM syndromes. Furthermore，from the clinical application of Qingfei Paidu decoction，this paper discussed the therapeutic intention of "Qingfei （clearing of lungs）" and "Paidu （removal of toxicity）". Qingfei Paidu decoction can clear the pathogenic toxin in the lungs and eliminate external pestilential Qi，which is in line with the therapeutic principles for this pandemic by regulating the triple energizer and protecting healthy Qi using both coldness and warmth to treat both the symptoms and the root cause. Additionally，the experimental research progress on Qingfei Paidu decoction and its modified prescriptions were summarized. As studied， this prescription can inhibit cytokine storm，moderate the overactive immune response，potentiate the immune function and anti-viral ability of the body，and exert its effect on COVID-19 with multiple components，multiple targets，multiple pathways， and multiple biological functions. In conclusion，Qingfei Paidu decoction，as a core prescription for the treatment of COVID-19，can rapidly contain the development of COVID-19， which has been confirmed in terms of TCM theory，clinical efficacy， and experimental research.

Efficacy of COVID-19 outbreak management in a skilled nursing facility based on serial testing for early detection and control

ABSTRACT SARS-CoV-2 has a high risk of outbreak in long-term skilled nursing facilities (SNF). Coronavirus disease (COVID-19) has high mortality rates among the elderly with chronic health conditions. Following identification of COVID-19 index case in a SNF, serial point-prevalence was implemented with reverse transcription-polymerase chain reaction (RT-PCR) and immunochromatographic assays. Active surveillance and early isolation of infected patients were implemented. Out of 23 SNF residents and 26 healthcare workers (HCW), 18 (78%) and 12 (46%) tested positive for SARS-CoV-2, respectively. High proportion (38%) of positive patients were asymptomatic and RT-PCR was positive up to six days before symptoms. Five (21.74%) residents were hospitalized with COVID-19, and 2 (9%) died; only 1 (4%) HCW needed to be hospitalized and no staff members died. Active surveillance helped COVID-19 control and management in a SNF. Testing symptomatic individuals only may fail to identify and isolate all persons contributing to transmission. In high-risk elderly, only symptoms screening may not be enough for outbreak control.

Modelamiento predictivo para el cálculo de demanda de camas hospitalarias de cuidados intensivos a nivel nacional en el marco de la pandemia por COVID-19 / Predictive modeling to estimate the demand for intensive care hospital beds nationwide in the context of the COVID-19 pandemic

INTRODUCCIÓN: La pandemia por SARS CoV-2 está presionando fuertemente la capacidad de respuesta de los sistemas de salud en todo el mundo, siendo uno de los aspectos más importantes el aumento masivo de pacientes que requerirán utilizar camas hospitalarias de cuidados intensivos. OBJETIVO: Este estudio propone una metodología para estimar el momento de saturación de las camas de cuidados intensivos hospitalarios (camas críticas) y determinar el número de unidades requeridas para compensar dicha saturación. MÉTODO: Se analizaron 22 016 pacientes con confirmación diagnóstica para COVID-19 provocada por SARS-CoV-2, entre el 4 de marzo y el 5 de mayo de 2020 a nivel nacional. Sobre la base de información del Ministerio de Salud de Chile y a anuncios ministeriales en medios de prensa, se estimó una disponibilidad total actual de 1900 a 2200 camas críticas totales. Se utilizó la función de Gompertz para estimar el número esperado de pacientes COVID-19 y evaluar su exposición a la oferta disponible de camas de cuidados intensivos en varios escenarios posibles. Para ello se tomó en cuenta la oferta de camas críticas totales, el índice ocupacional promedio, y la demanda de pacientes COVID-19 que requerirán cama de cuidados intensivos. RESULTADOS: Considerando diferentes escenarios, entre el 11 y el 27 de mayo podría ser alcanzado el 100% de ocupación de camas críticas totales. Esta condición podría extenderse por unos 48 días dependiendo como se maneje la sobredemanda esperada. CONCLUSIÓN: Se puede establecer una ventana de operaciones relativamente estrecha, de 4 a 8 semanas, para mitigar la inminente saturación de camas críticas hospitalarias, producto de la demanda de pacientes COVID-19.

INTRODUCTION: SARS CoV-2 pandemic is pressing hard on the responsiveness of health systems worldwide, notably concerning the massive surge in demand for intensive care hospital beds. AIM: This study proposes a methodology to estimate the saturation moment of hospital intensive care beds (critical care beds) and determine the number of units required to compensate for this saturation. METHODS: A total of 22,016 patients with diagnostic confirmation for COVID-19 caused by SARS-CoV-2 were analyzed between March 4 and May 5, 2020, nationwide. Based on information from the Chilean Ministry of Health and ministerial announcements in the media, the overall availability of critical care beds was estimated at 1,900 to 2,000. The Gompertz function was used to estimate the expected number of COVID-19 patients and to assess their exposure to the available supply of intensive care beds in various possible scenarios, taking into account the supply of total critical care beds, the average occupational index, and the demand for COVID-19 patients who would require an intensive care bed. RESULTS: A 100% occupancy of critical care beds could be reached between May 11 and May 27. This condition could be extended for around 48 days, depending on how the expected over-demand is managed. CONCLUSION: A simple, easily interpretable, and applicable to all levels (nationwide, regionwide, municipalities, and hospitals) model is offered as a contribution to managing the expected demand for the coming weeks and helping reduce the adverse effects of the COVID-19 pandemic.

Knowledge, Practices and Attitude of Healthcare Providers about Using Face Mask to Limit the Spread of the Novel Coronavirus Disease

Aim: There is evidence that health care providers have insufficient knowledge and poor practices regarding the use of surgical mask. Therefore, this study aimed to explore the knowledge, practices and attitudeof healthcare providers about using face mask in order to limit the spreading of the novel coronavirus disease.Methodology:This was a cross sectional pilot study included a questionnaire about the knowledge of health care workers regarding the use of surgical face mask to prevent the new COVID-19 spreading and about their practices and the attitude of them regarding the use of surgical face mask to limit the new COVID-19 exposure Results: About 86.21% of health care workers said that the correct way ofusing surgical face maskisWhite side facing in and about 65.52% of them said that N-95 mask is the mask type that actually protect against COVID-19. All of the respondents reported that they wear a mask in public places to protect themselves against COVID-19 and that they wear a mask in hospital premises to protect themselves against COVID-19 (100.00%).Conclusion: The Knowledge, attitude, and practice of health care providers regarding the use of surgical face masks were found to be good but still more knowledge is required about several aspects such as the types of masks, the duration of using masks and the disposal of the masks

Síndrome inflamatorio multisistémico asociado a COVID-19 en niños: serie de casos en un hospital pediátrico de Perú / COVID-19-associated multisystem inflammatory syndrome in children: case series at a pediatric hospital in Peru

RESUMEN La pandemia de COVID-19 ha traído una nueva afección grave e inusual denominada Síndrome Inflamatorio Multisistémico en niños, de la cual aún hay mucho por conocer. Presentamos una serie de 8 casos atendidos en el Instituto Nacional de Salud del Niño, Lima Perú. La edad media fue 5,1 años. La presentación clínica incluyó fiebre, problemas gastrointestinales agudos, afectación ocular y mucocutánea. Cuatro cumplieron criterios para Enfermedad de Kawasaki clásica. Todos tuvieron serología positiva para SARS-CoV-2, hemograma patológico, marcadores inflamatorios elevados y pruebas de coagulación alteradas. Cinco casos presentaron hipertransaminasemia y tres retención nitrogenada. Cuatro casos cumplieron criterios para Síndrome de Activación Macrófagica. Todos recibieron inmunoglobulina intravenosa, corticoides y ácido acetil salicílico. Ninguno desarrolló aneurismas coronarios. Solo uno presentó miocarditis, shock y requirió ingreso a Unidad de Cuidados Intensivos. La mayoría evolucionaron favorablemente. En todo niño con fiebre, síntomas gastrointestinales y dermatológicos; asociado a exposición al SARS-CoV-2, debe investigarse compromiso multisistémico.

ABSTRACT During the COVID-19 pandemic, a new, severe and unusual condition called Multisystem Inflammatory Syndrome in children emerged, from which there is still much to learn. We report 8 children admitted to Instituto Nacional de Salud del Niño, in Lima, Perú. Their mean age was 5,1 years. Their clinical presentation included fever, acute gastrointestinal symptoms, ocular and mucocutaneous involvement. Four patients met criteria for classic Kawasaki Disease. All the patients had positive serology for SARS-CoV-2, abnormal complete blood counts and coagulation tests, and elevated inflammatory markers. Five had elevated liver enzymes and three had kidney involvement. Four patients met criteria for Macrophage Activation Syndrome. All of them received intravenous immune globulin, corticosteroids and aspirin. No coronary aneurysms were identified. Only one developed miocarditis, shock and was admitted to the Pediatric Intensive Care Unit. Most patients recovered successfully. Every child with fever, gastrointestinal and dermatological symptoms, associated with prior exposure to SARS-CoV-2, should be investigated for multi-systemic compromise.

Infección por el nuevo coronavirus 2019 en niños

RESUMEN La enfermedad del coronavirus 2019 (COVID-19) es poco frecuente en niños y su salud se ve poco comprometida en la mayoría de casos. La presentación clínica más común es tos, fiebre y eritema faríngeo, los casos graves suelen presentarse con taquipnea. El curso de la enfermedad es de una a dos semanas. Los hallazgos de laboratorio son inespecíficos, entre ellos, linfopenia, elevación de la proteína C reactiva y la procalcitonina. En fases iniciales, la radiografía torácica es usualmente normal, y los hallazgos tomográficos más comunes son consolidaciones con signo del halo, vidrio esmerilado y nódulos pequeños, que afectan principalmente las zonas subpleurales. El manejo es sintomático y, en los casos graves, debe estar enfocado a brindar soporte respiratorio. Se recomienda que la manipulación de las secreciones respiratorias sea limitada y que se tengan las mismas precauciones para evitar contaminación que en pacientes adultos.

ABSTRACT COVID-19 is rarely reported in children and they are mildly affected in most cases. The most common clinical presentation of COVID-19 is cough, fever and sore throat; severe cases show tachypnea. The course of the disease is from one to two weeks. Laboratory findings are nonspecific; lymphopenia, elevation of C-reactive protein and procalcitonin have been described. Early chest X-ray is usually normal, and the most common tomographic findings are consolidations with halo, ground-glass opacities and tiny nodules which mainly affects subpleural areas. Management of the disease is supportive; in severe cases, it should be focused on respiratory support. It is recommended to limit the handling of respiratory secretions and to follow the same preventive measures provided to adults.

Clinical efficacy of Lianhua Qingwen integrated with Western medicine on COVID-19 by Meta-analysis / 中草药

Objective: To systematically evaluate the efficacy of Lianhua Qingwen (LQC) on COVID-19, and provide evidence for the formulation and optimization of clinical therapy on COVID-19. Methods: Six databases (PubMed, Cochrane Library, Wanfang, Weipu, CBM and CNKI) were searched up to May 27, 2020. The Cochrane collaborative bias risk tool was used for risk evaluation and quality assessment; Meta-analysis was carried out by Stata 15 software. Begg's test was used for publication bias. Results: Seven clinical trials were included with 665 COVID-19 patients. Compared with Western medicine alone, integrated Lianhua Qingwen significantly improved the effective rate of clinical symptoms [RR = 1.24, 95% CI (1.12, 1.38), P < 0.05] of COVID-19, increased CT improvement [RR = 1.14, 95% CI (1.02, 1.28), P < 0.05] and reduced the proportion of progressing into sever clinical level [RR = 0.48, 95% CI (0.31, 0.72), P < 0.05]; In addition, integrated Lianhua Qingwen could effectively shorten the duration of fever [SMD = -0.87, 95% CI (-1.22,-0.52), P < 0.05], time of clinical symptoms disappearance [SMD = -1.19, 95% CI (-1.56, -0.82), P < 0.05] and hospital stay [SMD = -0.61, 95% CI (-0.91, -0.30), P < 0.05]. Conclusion: Lianhua Qingwen could be used as adaptive and complementary medicine to improve clinical symptoms and CT for COVID-19.

Clinical Characteristics and Coping Strategies of Neoplasms with 2019 Novel Coronavirus Infection / 中国肺癌杂志

Since mid-December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has outbroken in Wuhan, Hubei Province, China, and spread rapidly to other provinces in China and dozens of countries and regions around the world, becoming the Public Health Emergency of International Concern (Public Health Emergency of International Concern). SARS-CoV-2 can mainly transmit by droplets or close contact, and is generally susceptible in the crowd. Tumor patients are at high risk of this pathogen because of their impaired immune function. Identifying tumor patients with 2019 novel coronavirus disease (COVID-19) early, and understanding its distribution characteristics can help to improve the cure rate of patients, and better control the epidemic and development of SARS-CoV-2 much better. With comprehensive analysis of relevant literature, this paper reviews the clinical characteristics of neoplastic patients with COVID-19, and puts forward some suggestions on how to deal with this epidemic.

Novel coronavirus disease with conjunctivitis and conjunctivitis as first symptom: Two cases report / 中华实验眼科杂志

As the frontline health care workers at the center of the novel coronavirus disease (COVIN-19) outbreak, we have found many asymptomatic COVIN-19 patients or patients with mild symptoms since December 2019. A number of COVIN-19 cases with conjunctivitis or conjunctivitis as the first symptom have been observed in our clinical work. This paper reports the diagnosis and treatment of one COVIN-19 patient with conjunctivitis as the first symptom and one COVIN-19 patient with conjunctivitis. Case one occurred conjunctivitis at the third day after closely contacted with determined COVID-19 patient and visited to eye doctor, and the symptom of conjunctivitis following the topical administration of anti-virual eyedrops for 1 week, followed by COVID-19. Her 2019-nCoV RNA detection of nasopharynx swab was positive but that of conjunctival sac swab was a negative result. Case two had a positive epidemiological history and simultaneous onset of COVID-19 and conjunctivitis.She presented positive results of 2019-nCoV RNA detection in both nasopharynx and conjunctival sac swabs, and other lab results supported the diagnosis of COVID-19 but she had a normal CT findings of the chest. The ocular symptoms were disappeared after topical administration of anti-virual eyedrops for 1 week.

Analysis of the path from discovery of novel coronavirus disease 2019 cases to its diagnosis in Shaanxi Province / 西安交通大学学报(医学版)

Objective: To explore the problems and experience in the prevention and control of novel coronavirus disease 2019 (COVID-19) by analyzing the path from its discovery to its diagnosis in Shaanxi Province. Methods: We collected the important data of COVID-19 epidemic situation in Shaanxi Province as of March 26, 2020, the trajectory of the diagnosed cases, contact history, close contacts and other important information for a descriptive epidemiological analysis. Results: Totally 72.65% (178/245) of the confirmed COVID-19 cases in Shaanxi Province were not in isolation or management at the time of onset, which resulted in an infection rate of 1.37% in close-knit populations. The duration between the onset of local COVID-19 cases in Shaanxi and the delay in confirmed diagnosis was relatively long (6.30 days), and the mean incubation period was 7.27 days. The delay time (7.29 days) between onset and diagnosis of preepidemic cases was longer than that (6.19 days) of later epidemic cases. Conclusion: According to the epidemic situation, we should gradually sort out the loopholes in previous work and at the same time make timely evaluation of the new problems arising under the new situation and constantly adjust the prevention and control strategies.

Health management of breast cancer patients outside the hospital during the outbreak of 2019 novel coronavirus disease / 中华肿瘤杂志

The outbreak of 2019 novel coronavirus disease (COVID-19) is spreading rapidly. In order to prevent cluster outbreaks, the government strengthened the management and control of personnel mobility, which had a great impact on the examination and treatment of breast cancer patients. This paper discusses how to realize scientific health management of breast cancer patients outside the hospital based on the existing epidemic situation, characteristics of breast cancer patients and public health safety factors. The breast cancer patients should synthetically consider the epidemic prevention situation of inhabitance, the disease stage and previous therapeutic schedule to decide the next therapeutic schedule. If necessary, after professional discussion and communication between doctors and patients online or offline, the hospital visiting time should be delayed through seeking alternative treatment schemes, and psychological counseling for patients should be paid attention to at the same time.

Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease / 中华医学杂志(英文版)

Background@#Since early December 2019, the 2019 novel coronavirus disease (COVID-19) has caused pneumonia epidemic in Wuhan, Hubei province of China. This study aims to investigate the factors affecting the progression of pneumonia in COVID-19 patients. Associated results will be used to evaluate the prognosis and to find the optimal treatment regimens for COVID-19 pneumonia.@*Methods@#Patients tested positive for the COVID-19 based on nucleic acid detection were included in this study. Patients were admitted to three tertiary hospitals in Wuhan between December 30, 2019, and January 15, 2020. Individual data, laboratory indices, imaging characteristics, and clinical data were collected, and statistical analysis was performed. Based on clinical typing results, the patients were divided into a progression group or an improvement/stabilization group. Continuous variables were analyzed using independent samples t-test or Mann-Whitney U test. Categorical variables were analyzed using chi-squared test or Fisher’s exact test. Logistic regression analysis was performed to explore the risk factors for disease progression.@*Results@#Seventy-eight patients with COVID-19-induced pneumonia met the inclusion criteria and were included in this study. Efficacy evaluation at 2 weeks after hospitalization indicated that 11 patients (14.1%) had deteriorated, and 67 patients (85.9%) had improved/stabilized. The patients in the progression group were significantly older than those in the disease improvement/stabilization group (66 [51, 70] years vs. 37 [32, 41] years, U =4.932, P =0.001). The progression group had a significantly higher proportion of patients with a history of smoking than the improvement/stabilization group (27.3% vs. 3.0%, χ2=9.291, P =0.018). For all the 78 patients, fever was the most common initial symptom, and the maximum body temperature at admission was significantly higher in the progression group than in the improvement/stabilization group (38.2 [37.8, 38.6]℃ vs. 37.5 [37.0, 38.4]℃, U=2.057, P =0.027). Moreover, the proportion of patients with respiratory failure (54.5% vs. 20.9%, χ2=5.611, P=0.028) and respiratory rate (34 [18, 48] breaths/min vs. 24 [16, 60] breaths/min, U=4.030, P=0.004) were significantly higher in the progression group than in the improvement/stabilization group. C-reactive protein was significantly elevated in the progression group compared to the improvement/stabilization group (38.9 [14.3, 64.8] mg/L vs. 10.6 [1.9, 33.1] mg/L, U=1.315, P=0.024). Albumin was significantly lower in the progression group than in the improvement/stabilization group (36.62±6.60 g/L vs. 41.27±4.55 g/L, U =2.843, P =0.006). Patients in the progression group were more likely to receive high-level respiratory support than in the improvement/stabilization group (χ2=16.01, P=0.001). Multivariate logistic analysis indicated that age (OR, 8.546; 95% CI: 1.628-44.864; P = 0.011), history of smoking (OR, 14.285; 95% CI: 1.577-25.000; P = 0.018), maximum body temperature at admission (OR, 8.999; 95% CI: 1.036-78.147, P = 0.046), respiratory failure (OR, 8.772, 95% CI: 1.942-40.000; P = 0.016), albumin (OR, 7.353, 95% CI: 1.098-50.000; P = 0.003) and C-reactive protein (OR, 10.530; 95% CI: 1.224-34.701, P = 0.028) were risk factors for disease progression.@*Conclusions@#Several factors that led to the progression of COVID-19 pneumonia were identified, including age, history of smoking, maximum body temperature on admission, respiratory failure, albumin, C-reactive protein. These results can be used to further enhance the ability of management of COVID-19 pneumonia.