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Objective:To analyze the relationship between blood electrolytes and the prognosis of patients with severe coronavirus disease 2019 (COVID-19) and to provide assistance for clinical decision-making.Methods:The clinical data of patients with severe COVID-19 admitted to intensive care unit (ICU) of the Wuhan Third Hospital by the Shanghai aid-Hubei medical team from January 21 to March 4, 2020 were collected. Excluding ineligible patients, 110 patients were finally enrolled. The patients' gender, age, temperature, heart rate, systolic and diastolic blood pressure, clinical symptoms at admission, time of symptom onset, duration of fever, and relevant indicators at admission to ICU (including blood potassium, chloride, sodium, calcium, phosphorus, and magnesium, etc.) and prognosis were analyzed. The patients were grouped by blood potassium or calcium levels or blood potassium/calcium ratio. The Kaplan-Meier survival curves were used to analyze the survival of patients in each group. The relationship between the potassium/calcium ratio and the prognosis was analyzed using restricted cubic spline plots. The relationship between each index in the different models and the prognosis was analyzed using Cox regression models.Results:Among 110 severe COVID-19 patients, 78 cases survived, and 32 cases died. Compared with the surviving group, patients in the death group had higher blood potassium levels [mmol/L: 4.25 (3.80, 4.65) vs. 3.90 (3.60, 4.20), P < 0.05] and lower blood calcium levels (mmol/L: 2.00±0.14 vs. 2.19±0.18, P < 0.05). The Kaplan-Meier survival curves showed that patients in the potassium > 4.2 mmol/L group had a worse prognosis than the potassium < 3.8 mmol/L group and the potassium 3.8-4.2 mmol/L group ( P = 0.011), patients in the calcium > 2.23 mmol/L group had a better prognosis than the calcium < 2.03 mmol/L group and the calcium 2.03-2.23 mmol/L group, and the lower calcium group had a worse prognosis ( P = 0.000 15). Cox regression analysis showed that the hazard ratio ( HR) of blood potassium and calcium were 2.08 and 0.01, respectively, in model 1 (single blood potassium or calcium) and in model 2 (model 1 plus age and gender), the HR of blood potassium and calcium were 1.98 and 0.01 respectively, which were significantly associated with patient prognosis (all P < 0.05). Patients in the group with the potassium/calcium ratio > 1.9 had higher blood potassium levels and a higher proportion of mechanical ventilation, lower calcium levels and lower proportion of survival, and longer time of ICU admission compared with the groups with the potassium/calcium ratio < 1.7 and 1.7-1.9. The Kaplan-Meier survival curves showed that the survival rate of the potassium/calcium ratio > 1.9 group was the lowest ( P < 0.000 1), and there was no statistically significant difference in survival between the potassium/calcium ratio < 1.7 group and the potassium/calcium ratio 1.7-1.9 group. A restricted cubic spline plot corrected for age and gender showed that patients in the potassium/calcium ratio > 1.8 group had HR values > 1. Cox regression analysis corrected for other indicators showed that the potassium/calcium ratio was still associated with patient prognosis ( HR = 4.85, P = 0.033). Conclusions:Blood potassium, calcium, and the potassium/calcium ratio at ICU admission are related to the prognosis of patients with severe COVID-19, and the potassium/calcium ratio is an independent risk factor for the death of patients. The higher the potassium/calcium ratio, the worse the prognosis of patients.
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Objective:To explore the diagnosis process and treatment experience of severe coronavirus disease 2019 (COVID-19) patients with heparin resistance (HR).Methods:The medical team of the First People's Hospital of Lianyungang admitted 2 severe COVID-19 patients with HR in intensive care unit (ICU) during their support to the designated hospital for the treatment of COVID-19 patients in Lianyungang City in November 2021. The clinical features, laboratory examinations, imaging features, treatment and prognosis of the two patients were analyzed.Results:Both severe COVID-19 patients received mechanical ventilation, 1 patient was treated with extracorporeal membrane oxygenation (ECMO) support. Both patients were complicated with lower extremity deep venous thrombosis and HR phenomenon under routine dose anticoagulant therapy. The maximum daily dose of unfractionated heparin exceeded 35 000 U (up to 43 200 U), the 2 patients failed to meet the standard of anticoagulation treatment, and the course of disease was prolonged. After that, argatroban was given 0.4 μg·kg -1·min -1 combined with anticoagulant therapy, the activated partial thromboplastin time (APTT) of patients undergoing ECMO could be maintained at 55-60 seconds and the activated coagulation time (ACT) of them could be maintained at 180-200 seconds. After ECMO support or later sequential mechanical ventilation, both patients recovered and were discharged, and deep venous thrombosis was also effectively controlled. Conclusion:HR phenomenon often occurs during the treatment of severe COVID-19 patients, the anticoagulation regimen should be adjusted in time, and the anticoagulation effect combined with argatroban is clear.
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Objective@# To conduct an epidemiological investigation on the first reported case of coronavirus disease 2019 （COVID-19） in Zhejiang Province, so as to provide reference for prevention and control of the disease.@*Methods @#According to the COVID-19 Diagnosis and Treatment Program （Trial） and the COVID-19 Prevention and Control Program （Trial） issued by National Health Commission of China, a field investigation was employed on a case of fever from Wuhan reported by Wenzhou in January 15, 2020; the real-time reverse transcription polymerase chain reaction （RT-PCR） assay was performed to detect the nucleic acid of severe acute respiratory syndrome coronavirus 2 （SARS-CoV-2） from the sputum specimens or throat swabs of the case; the close contacts of the case were tracked down; relevant prevention and control measures were implemented. @*Results @#The case had lived in Wuhan for long. On January 4 of 2020, he felt cold and uncomfortable without obvious inducement, and drove back to Wenzhou with his wife. He had fever （up to 39 ℃）, cough and expectoration on the next day. On January 9, the chest computed tomographic （CT） scan showed bilateral high-density patchy shadowing with blurred edges. On January 16, his throat swab and sputum samples were collected and sent to Zhejiang Provincial Center for Disease Control and Prevention （CDC） for detection of SARS-CoV-2. The result turned out to be positive on January 17, then was rechecked and confirmed by Chinese CDC on January 20. Two weeks before the onset of the disease, the patient was engaged in the door-to-door persuasion of installing elevators in an old residential area of Wuhan, and he denied any connection with other COVID-19 cases,markets,（sick or dead） poultry or poultry products. Totally 26 close contacts were identified and kept in quarantine. During this period,three of them developed fever or respiratory symptoms, but were excluded from COVID-19. On the afternoon of January 16,the health system of Zhejiang Province and Wenzhou City launched an emergency plan and implemented a series of prevention and control measures such as isolation and treatment of cases,screening and isolation of close contacts,and public health education. @*Conclusion @#According to the epidemiological history,clinical features and laboratory test Results,the patient was identified as the first reported case of COVID-19 in Zhejiang Province.
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Objective @#To study the epidemiological characteristics of coronavirus disease 2019 （COVID-19） in Zhoushan, so as to provide reference for improving the prevention and control capability of COVID-19.@*Methods @#All the confirmed cases of COVID-19 in Zhoushan, diagnosed according to China’s “COVID-19 diagnosis and treatment plan （fifth version） ” and reported from January 19 to February 17, 2020, were extracted from the infectious disease surveillance system. Data of general information, clinical characteristics, laboratory Results, transmission and detection routes were collected and analyzed. @*Results @#By February 17, Ten confirmed cases of COVID-19 in Zhoushan had been reported, including 7 males and 3 females. They were all adults, with an average age of （50.90±15.00） years. Five cases were discharged. The incubation period ranged from 2 to 12 days, with a median of 5 days. The first symptoms were fever （8 cases）, cough （7 cases） and muscle pain （2 cases）. Chest computed tomographic （CT） scans showed ground glass opacities in the lungs of all the cases. Six cases had Wuhan related exposure. SARS-CoV-2 was tested positive in the sputum specimens or throat swabs of all the cases and the faeces of 4 cases. The last suspicious exposure of 5 cases occurred before, and that of another 5 cases occurred after the onset of clinical symptoms in the confirmed maternal cases. Three cases were found in active consultation after clinical symptoms, and another 7 cases were found in the monitoring of close contacts.@*Conclusions @#The 10 confirmed cases of COVID-19 reported in Zhoushan are all adults, and most have Wuhan related exposure. SARS-CoV-2 can be detected in the fecal samples, but the existence of fecal-oral transmission needs more research. SARS-CoV-2 has strong infectivity, and may also have infectivity before the onset of symptoms （at the end of incubation period）. Isolation and early detection of close contacts are conducive for early case-finding.
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Objective @#To learn the epidemiological characteristics of coronavirus disease 2019 (COVID-19) cases reported from January 21 to February 20,2020 in Zhejiang Province,so as to provide basis for formulating and implementing effective control measures.@*Methods @#The COVID-19 cases reported by Zhejiang Province were extracted from the National Diseases Prevention and Control Information System. A descriptive analysis was adopted for the epidemiological characteristics of COVID-19 cases,including time,spatial and population distribution,severity of symptoms, and exposure history. @*Results @#Totally 1 284 cases were reported,of which 1 176 were confirmed cases (91.59%) and 108 were asymptomatic cases (8.41%). The first confirmed case was reported on January 21. The curve of the disease onset peaked from January 22 to 29, with 87 cases as the biggest number a day. The curve of the disease reported peaked from January 28 to 30, with 130 cases as the biggest number a day. Then the number of the cases showed a declining trend. By February 4, totally 79 counties (cities, districts) had confirmed cases, covering 87.78% of Zhejiang Province, and it has not increase since then. A male to female ratio of 1.02∶1 was reported among 1 284 cases,1 021 were 30-69 years old (79.52%) and 339 (26.40%) were business service providers. There were 11 health workers reported to be infected,but not by occupational exposure. Among the confirmed cases, 1 010 (85.88%) were clinically mild cases. One case died. Before January 23, the cases were mainly imported from Hubei Province, local cases were predominant by the end of January. @*Conclusions @#The COVID-19 epidemic has spread widely in Zhejiang Province and people are generally susceptible. Most cases were clinically mild, and were aged 30-69 years. No health workers infected were due to occupational exposure. The incidence of COVID-19 in Zhejiang Province has turned into a lower level,suggesting that the early prevention and control measures have achieved initial results. With people returning from holiday, precise prevention and control should be put into effect.
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@#Severe acute respiratory syndrome coronavirus（SARS-CoV-2）is highly infectious and people are generally susceptible to it. In this article,we reviewed current research into the epidemiological characteristics of coronavirus disease 2019（COVID-19）,introduced China's effective prevention and control experience,preliminarily summarized the phased Results of China's fight against the COVID-19,and reviewed the early measures taken by Singapore,Japan,Italy,Iran and South Korea. We recommended China’s prevention and control measures in response to COVID-19 to the world;appealed to pay attention to non-drug interventions,to strengthen the cooperation and sharing of COVID-19 epidemic data and research,to improve the global ability in respond to public health emergencies,and to reduce the impact of COVID-2019 on the sustainable development of economy and society.
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Objective@#To analyze the epidemiological characteristics of coronavirus disease 2019 （COVID-19） cases reported in Ningbo from January 22 to February 22, 2020, so as to provide guidance for the prevention and control of the COVID-19 epidemic.@*Methods@#The confirmed cases of COVID-19 reported by Ningbo were selected from National Diseases Prevention and Control Information System to analyze the epidemiological characteristics by descriptive epidemiological method, including time, spatial and population distribution, clinical symptoms and exposure history.@*Results@#A total of 157 confirmed cases of COVID-19 were reported and there was no death. The first confirmed case was reported on January 22. On the incidence curve, the peak was from January 22 to February 4, with a maximum of 15 cases in a single day. The incidence curve presented sustained human-to-human transmission. The number of the cases showed a declining trend from February 5. The confirmed cases were reported in all 10 counties（cities or districts）,among which 69（43.95%）cases were reported in Haishu District. The confirmed cases were mainly 30-69 years old,accounting for 78.34%;were mainly farmers,household workers and retired people,accounting for 59.87%;and were mainly clinically mild,accounting for 87.90%.There were 51 imported cases, accounting for 32.48%. The initial confirmed case was a local case. In the early stage of the epidemic, local cases and imported cases prevalent together,which was due to the outbreak caused by the large-scale buddhist activity on January 19.This event resulted in 67 confirmed cases and 15 asymptomatic cases. There totally reported 22 clusters with 138 （87.90%）confirmed cases. @*Conclusions@# In the early stage of the COVID-19 epidemic in Ningbo, the imported cases and local cases prevalent at the same time. Most of the cases were female, aged from 30 to 69 years, and their occupation were farmers, household workers and retired people. With comprehensive measures taken, the epidemic of COVID-19 in Ningbo have been under control.
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Objective@#To learn the epidemiological characteristics of coronavirus disease 2019（COVID-19）in Huzhou,so as to provide reference for prevention and control of COVID-19.@*Methods@#All the confirmed cases of COVID-19 in Huzhou,diagnosed according to the COVID-19 Diagnosis and Treatment Plan（Sixth Version Trial）and reported from January 25 to February 7,2020,were recruited. The process of diagnosis and treatment,clinical manifestation,exposure history and close contacts were collected to analyze the epidemiological characteristics. @*Results@#On January 25,the first confirmed cases of COVID-19 in Huzhou was reported. By February 7,totally 10 confirmed cases were reported and no asymptomatic infection was found. They were all imported,including three Wuhan residents,two with a trip to Wuhan,three with a trip to Suizhou,one with a trip to Hangzhou and one with a trip to Thailand（two Wuhan passengers on the same flight）. The ratio of male to female cases was 1∶1. The median age was 32 years old. Seven cases were found when they went to a doctor by themselves,and three cases were found during the quarantine. The main clinical manifestations were fever,dry cough and fatigue. The median time from onset to diagnosis was 3 days. By March 3,all the cases were discharged,with median course of 24 days. There were 312 close contacts,and all of them were released after 14 days of quarantine. @*Conclusions @#To prevent imported cases from outside and stop spread inside taken by Huzhou government was proved to be effective. All the COVID-19 cases in Huzhou were imported,mostly from Wuhan. No local cases were reported.
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Objective@#To analyze the epidemiological characteristics of coronavirus disease 2019 ( COVID-19 ) in Shaoxing from January 23 to March 31, 2020, so as to provide basis for the prevention and control of COVID-19.@*Methods@#The information of the COVID-19 cases in Shaoxing were collected from the National Diseases Prevention and Control Information System and the field investigation by CDCs. A descriptive analysis was used for the epidemiological characteristics, including time, spatial and population distribution, clinical features and exposure history. @*Results@# Totally 42 confirmed cases of COVID-19 were reported by March 31, without deaths. The first case was reported on January 23 and the last one was on February 13. The onset of cases peaked in mid-to-late January. All the counties ( cities or districts ) had confirmed cases, 14 cases were reported in Yuecheng District. Twenty-five ( 59.52% ) cases were 45 years old or over. Thirteen ( 30.95% ) cases were engaged in business and eight ( 19.05% ) cases were unemployed. No cases were found among medical staff. The main clinical symptoms were fever, dry cough, fatigue and imaging features of pneumonia, with nine ( 21.43% ) severe cases and three ( 7.14% ) critical cases. There were 34 ( 80.95% ) imported cases, who mainly came from Hubei Province. Totally 1 955 close contacts were tracked down, among whom 4 cases were confirmed, with the infection rate of 0.20%.@*Conclusions@#The COVID-19 cases reported in Shaoxing were mainly aged 45 years or over, severe and imported from Hubei Province. There was no continuous transmission in the community, and no infection in medical staff or deaths.
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Objective @#To compare the clinical characteristics of ordinary and severe coronavirus disease 2019 ( COVID-19 ) cases, so as to provide basis for the diagnosis, treatment and prognosis. @*Methods @#We recruited 77 COVID-19 cases in Wenzhou Central Hospital from January 15 to February 29, 2020, collected their general information, clinical symptoms, laboratory test and CT scan results, and compared the clinical features of ordinary and severe cases.@*Results@# There were 50 ordinary cases and 27 severe cases. The age, prevalence of hypertension and other baseline diseases of severe cases were higher than those of ordinary cases ( P<0.05 ) . The maximum body temperature during 1-3 days of hospitalization, proportion of body temperature rising, prevalence of cough, yellow phlegm, hemoptysis, chest tightness and shortness of breath of severe cases were higher than those of ordinary cases ( all P<0.05 ) . The proportion of pulmonary consolidation, glazing and patch shadow, the number of solid changes and the cumulative number of lesions of severe cases were higher than those of ordinary cases ( all P<0.05 ) . The values of LYM during 1-10 days of hospitalization, total T-lymphocyte percentage, CD4 count and percentage, CD8 count, Hb and oxygenation index of severe cases were lower than those of ordinary cases; while the values of LDH and NLR during 1-10 days of hospitalization, N8R, AST, ferritin, CRP during 1-7 days of hospitalization and D-dimer of severe cases were higher than those of ordinary cases ( all P<0.05 ). @*Conclusions@#Severe COVID-19 cases have older age, higher prevalence of baseline diseases, fever, shortness of breath symptoms, more lung consolidation and lesions, significantly decreased lymphocyte level ( especially CD4 ) , and increased LDH, NLR, ferritin and CRP.
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Objective@#To investigate the first family cluster of COVID-19 in Lanzhou, so as to provide basis for improving the COVID-19 outbreak prevention capacity. @*Methods @# On January 23, the First Hospital of Lanzhou University reported two suspected cases of COVID-19.According to the COVID-19 Epidemiological Investigation Plan ( second edition ) , general information, disease diagnosis and treatment, clinical symptoms, laboratory test results, household environment, exposure history and close contacts were collected to figure out the source of infection and routes of transmission. @*Results@#This family cluster lasted 29 days, from January 23 to February 21, reporting nine confirmed cases ( one death ) and one asymptomatic case. There were three imported cases from Wuhan, who were the source of the cluster; and seven secondary cases, who all had close contact with the imported cases during daily life or through having dinners. The secondary attack rate was 41.18% ( 7/17 ) . Among 9 confirmed cases, the incubation period ranged from four to ten days, with a median of nine days. Except for seven secondary cases, 24 close contacts were found and detected negative in the nucleic acid tests.@*Conclusions@#The first family cluster of COVID-19 in Lanzhou is caused by the imported cases from Wuhan. All the secondary cases have had dinners and/or had contact with the imported cases, thus they are infected through respiratory droplets and close contact.