A cross-sectional survey of epidemiology workforce performance and its influencing factors during the emergency response to the COVID-19 pandemic in Guangdong, China (preprint)

Background The epidemiology workforce contributes a lot to the response to COVID-19(Corona Virus Disease 2019) pandemic. Here this study focuses on the self-evaluation of the epidemiology workforce’s capacity and their impression of the cases they interviewed during the emergency response of the COVID-19 pandemic.Methods This study was a cross-sectional, anonymous survey conducted in Guangzhou, Shenzhen, Foshan, Dongguan and Zhuhai in Guangdong province. Data collection was performed between December 5, 2020 and December 22, 2020 through convenient sampling. A total of 596 epidemiology workforce participated in this study.Results Role in the team, professional title, gender, perceived social support, enough COVID-19 related training as well as experience were significantly associated with personal skills. 72.8% (429/589) and 86.3% (164/190) of participants reported they had interviewed uncooperative Chinese and foreign COVID-19 patients, respectively.Conclusions Epidemiology workforce needs enough training and experience to perform better in the investigation. Uncooperative patients were a big obstruction during the emergency response of the COVID-19 pandemic. Our results suggest Chinese experience and strategies focusing on the improvement of the public health emergency management system, including establishing Joint Prevention and Control Mechanism, enhancing training and the like.

Implications of Liver Injury in Risk-Stratification and Management of Patients with COVID-19 (preprint)

BackgroundInfection with SARS-CoV-2 has been associated with liver dysfunction, aggravation of liver burden, and liver injury. This study aimed to assess the effects of liver injuries on the clinical outcomes of patients with COVID-19.MethodsA total of 1,564 patients with severe or critical COVID-19 from Huoshenshan Hospital, Wuhan, were enrolled. Chronic liver disease (CLD) was confirmed by consensus diagnostic criteria. Laboratory test results were compared between different groups. scRNA-seq data and bulk gene expression profiles were used to identify cell types associated with liver injury.ResultsA total of 10.98% of patients with severe or critical COVID-19 developed liver injury after admission that was associated with significantly higher rates of mortality (21.74%, p<0.001) and intensive care unit admission (26.71%, p<0.001). A pre-existing CLD was not associated with a higher risk. However, fatty liver disease and cirrhosis were associated with higher risks, supported by evidences from single cell and bulk transcriptome analysis that showed more TMPRSS2+ cells in these tissues. By generating a model, we were able to predict the risk and severity of liver injury during hospitalization.ConclusionWe demonstrate that liver injury occurring during therapy in patients with COVID-19 is significantly associated with the severity of disease and mortality, but the presence of CLD is not associated. We provide a risk-score model that can predict whether patients with COVID-19 will develop liver injury or proceed to higher risk stages during subsequent hospitalizations. These findings may prove beneficial for the clinical management of patients infected with SARS-CoV-2.

ACE2 expression by colonic epithelial cells is associated with viral infection, immunity and energy metabolism (preprint)

Respiratory disease caused by the 2019 novel coronavirus (2019-nCoV) pneumonia first emerged in Wuhan, Hubei Province, China, in December 2019 and spread rapidly to other provinces and other countries. Angiotensin-converting enzyme 2 (ACE2) is the receptor for SARS-CoV and has been suggested to be also the receptor for 2019-nCoV. Paradoxically, ACE2 expression in the lung protects mice from SARS-CoV spike protein induced lung injury by attenuating the renin-angiotensin system. In the intestine, ACE2 also suppresses intestinal inflammation by maintaining amino acid homeostasis, antimicrobial peptide expression and ecology of the gut microbiome. Upon analysis of single cell-RNA sequencing data from control subjects and those with colitis or inflammatory bowel disease (IBD), we found that ACE2 expression in the colonocytes was positively associated with genes regulating viral infection, innate and cellular immunity, but was negatively associated with viral transcription, protein translation, humoral immunity, phagocytosis and complement activation. In summary, we suggest that ACE2 may play dual roles in mediating the susceptibility and immunity of 2019-nCoV infection.