SARS-CoV-2 LIVE VIRUS NEUTRALIZATION AFTER FOUR COVID-19 VACCINE DOSES IN PWH ON ART

Background: Limited data exist regarding the immune benefits of fourth COVID-19 vaccine doses in people with HIV (PWH) receiving antiretroviral therapy (ART), particularly given that most have now experienced SARS-CoV-2 infection. We measured the effect of fourth doses on SARS-CoV-2 neutralization in 63 PWH, including 19 SARS-CoV-2-naive and 44 SARS-CoV-2-experienced participants. Method(s): Wild-type (WT)-, Omicron-BA.5 and Omicron-BQ.1-specific neutralization activities were longitudinally quantified using live virus assays up to one month post-fourth vaccine dose. Multiple linear regression was used to investigate the relationship between sociodemographic, health and vaccinerelated variables and SARS-CoV-2 neutralization. Result(s): Participants (54 male;9 female) received monovalent (44%) or bivalent (56%) mRNA fourth doses. In COVID-19-naive PWH, a fourth dose enhanced WT- and BA.5-specific neutralization modestly above three-dose levels (p=0.1). In COVID-19-experienced PWH, a fourth dose enhanced WT neutralization modestly (p=0.1) and BA.5 neutralization significantly (p=0.002). Consistent with the humoral benefits of 'hybrid' immunity, the highest neutralization was observed in COVID-19-experienced PWH after a fourth dose. Of note, PWH with Omicron-era infections exhibited higher WT-specific (p=0.04), but comparable BA.5- or BQ.1-specific neutralization, compared to PWH with pre-Omicron-era infections. Overall, BA.5 neutralization was significantly lower than WT in all participants regardless of COVID-19 experience, and BQ.1 neutralization was significantly lower than BA.5 (all p< 0.0001). In multivariable analyses, fourth dose valency did not significantly affect neutralization magnitude, nor did sex, age nor CD4+ T-cell count (neither recent nor nadir). Rather, an mRNA-1273 fourth dose (versus a BNT162b2 one) was the strongest correlate of WT-specific neutralization, while prior COVID-19, regardless of infection era, was the strongest correlate of BA.5 and BQ.1-specific neutralization post-fourth dose. Conclusion(s): Fourth COVID-19 vaccine doses, irrespective of valency, benefit PWH regardless of prior SARS-CoV-2 infection, but the highest neutralization of Omicron-BA.5 and BQ.1 variants post-fourth dose occurred in PWH with hybrid immunity. These results support existing recommendations that all adults receive a fourth immunization within 6 months of their third vaccine dose (or their most recent SARS-CoV-2 infection). (Figure Presented).

Massive-scale genomic analysis reveals SARS-CoV-2 mutation characteristics and evolutionary trends

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic resulted in significant societal costs. Hence, an in-depth understanding of SARS-CoV-2 virus mutation and its evolution will help determine the direction of the COVID-19 pandemic. In this study, we identified 296,728 de novo mutations in more than 2,800,000 high-quality SARS-CoV-2 genomes. All possible factors affecting the mutation frequency of SARS-CoV-2 in human hosts were analyzed, including zinc finger antiviral proteins, sequence context, amino acid change, and translation efficiency. As a result, we proposed that when adenine (A) and tyrosine (T) bases are in the context of AM (M stands for adenine or cytosine) or TA motif, A or T base has lower mutation frequency. Furthermore, we hypothesized that translation efficiency can affect the mutation frequency of the third position of the codon by the selection, which explains why SARS-CoV-2 prefers AT3 codons usage. In addition, we found a host-specific asymmetric dinucleotide mutation frequency in the SARS-CoV-2 genome, which provides a new basis for determining the origin of the SARS-CoV-2. Finally, we summarize all possible factors affecting mutation frequency and provide insights into the mutation characteristics and evolutionary trends of SARS-CoV-2. © 2022 The Authors. mLife published by John Wiley & Sons Australia, Ltd. on behalf of Institute of Microbiology, Chinese Academy of Sciences.

Prolonged Viral Shedding in Three Young Adult Cases of COVID-19

Severe acute respiratory syndrome coronavirus-2 infection is usually self-limited, with a short duration for viral shedding within several weeks. However, prolonged viral shedding has been observed in severe or immune-compromised coronavirus disease 2019 (COVID-19) cases. Here, we reported that three young adult cases of COVID-19 patients, who were either immunosuppressed nor severe, showed prolonged viral RNA shedding from the upper respiratory tract for 58, 81, and 137 days since initial diagnosis. To our knowledge, this is the longest duration of viral shedding reported to date in young adult patients. Further studies on factors relevant to prolonged viral positivity, as well as the correlation between viral positivity and transmission risk are needed for the optimal management of COVID-19 patients with prolonged nucleic acid positive. © Copyright 2022 The Chinese Medical Association, published by Wolters Kluwer Health, Inc.

Research progress of coronavirus disease 2019 in digestive system

The coronavirus disease 2019 (COVID‑19) is caused by the SARS‑CoV‑2 infection, and has become a public health event in the world. In addition to pneumonia, some COVID‑19 patients also show various gastrointestinal symptoms, and even take the gastrointestinal symptoms as the first symptom. Doctors should be alert to the spread of fecal oral transmission. Nutritional support and intestinal microecological balance play an important role in the treatment of COVID‑19. This paper summarizes the research progress of COVID‑19 in the digestive system by consulting relevant literatures, in order to provide a reference for the clinical diagnosis and treatment of the disease. © 2022, Editorial Board of Medical Journal of Wuhan University. All right reserved.

Location-specific health impacts of climate change require location-specific responses

Left unmitigated, climate change poses a catastrophic risk to human health, demanding an urgent and concerted response from every country. The 2015 Lancet Commission on Health and Climate Change and The Lancet Countdown: Tracking Progress on Health and Climate Change have been initiated to map out the impacts of climate change and the necessary policy responses. To meet these challenges, Tsinghua University, partnering with the University College London and 17 Chinese and international institutions, has prepared the Chinese Lancet Countdown report, which has a national focus and builds on the work of the global Lancet Countdown: Tracking Progress on Health and Climate Change. Drawing on international methodologies and frameworks, this report aims to deepen the understanding of the links between public health and climate change at the national level and track them with 23 indicators. This work is part of the Lancet's Countdown broader efforts to develop regional expertise on this topic, and coincides with the launch of the Lancet Countdown Regional Centre in Asia, based at Tsinghua University. The data and results of this report are presented at the provincial level, where possible, to facilitate targeted response strategies for local decision-makers. Based on the data and findings of the 2020 Chinese Lancet Countdown report, five recommendations are proposed to key stakeholders in health and climate change in China: (1) Enhance inter-departmental cooperation. Climate change is a challenge that demands an integrated response from all sectors, urgently requiring substantial inter-departmental cooperation among health, environment, energy, economic, financial, and education authorities. (2) Strengthen health emergency preparedness. Knowledge and findings on current and future climate-related health threats still lack the required attention and should be fully integrated into the emergency preparedness and response system. (3) Support research and raise awareness. Additional financial support should be allocated to health and climate change research in China to enhance health system adaptation, mitigation measures, and their health benefits. At the same time, media and academia should be fully motivated to raise the public and politicians' awareness of this topic. (4) Increase climate change mitigation. Speeding up the phasing out of coal is necessary to be consistent with China's pledge to be carbon neutral by 2060 and to continue to reduce air pollution. Fossil fuel subsidies must also be phased out. (5) Ensure the recovery from COVID-19 to protect health now and in the future. China's efforts to recover from COVID-19 will shape public health for years to come. Climate change should be a priority in these interventions. © 2021, Science Press. All right reserved.

Clinical characteristics of COVID‑19 complicated with pleural and pericardial effusion in 10 patients

Objective: To retrospectively analyze the clinical characteristics of corona virus disease 2019 (COVID‑19) patients with pleural and pericardial effusion. Methods: We retrospectively reviewed and compared data of 60 COVID‑19 inpatients including 10 patients with pleural effusion (PLE) and pericardial effusion (PCE) and 50 cases without PLE/PCE, from January 20, 2020 to March 23, 2020 in Renmin Hospital of Wuhan University. The patients' medical history, clinical features, physical findings, laboratory test results, and chest tomographic imaging were recorded and analyzed. Statistical significance was determined using the chi‑square test, Fisher's exact test, and the Mann‑Whitney U‑test. Results: COVID‑19 patients with PLE and PCE had a higher temperature (P<0.001), a higher incidence of breath shortness (P=0.024) and faster respiratory frequency (P=0.004) than those without PLE and PCE. Laboratory findings showed that patients with PLE and PCE had higher levels of C‑reactive protein (CRP,P=0.039) and D‑dimer (P=0.038), and lower levels of lymphocytes (P=0.024), hemoglobin (P=0.003), CD4+T cell counts (P=0.016), and oxygen saturation (P=0.037). Meanwhile, patients with PLE and PCE had higher incidence of severe or critical illness and mortality rates as compared with those without PLE and PCE (all P<0.05). Conclusion: PLE and PCE were indicators for severe inflammation and poor clinical outcomes, and might be independent risk factors for critical type in COVID‑19 patients. It suggests that the treatment for the COVID‑19 patients with PLE and PCE should be more active and timely. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.

Advance on clinical characteristics and injury mechanism of diabetic patients with coronavirus pneumonia

Currently, there are seven types of coronaviruses that can infect humans. Among them, severe acute respiratory syndrome coronavirus (SARS‑CoV), middle east respiratory syndrome coronavirus (MERS‑CoV) and severe acute respiratory syndrome coronavirus‑2 (SARS‑CoV‑2) are three types of coronavirus which have the greatest impact on human health in the past 20 years. Diabetic patients with hypoimmunity may have adverse outcomes and different injury mechanisms when infected with coronaviruses. This review is about the advance on clinical characteristics and injury mechanism of diabetic patients with SARS‑CoV, MERS‑CoV, or SARS‑CoV‑2. The purpose of writting this review is to arouse the attention of clinicians to diabetic patients with coronavirus infection and provide help for clinicians in the treatment of coronavirus disease 2019. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.

Estimation of the Unreported Infections of COVID-19 based on an Extended Stochastic Susceptible-Exposed-Infective-Recovered Model

In this paper, an innovative SEIR(Susceptible-Exposed-Infective-Recovered) model is proposed to estimate the true infectivity and lethality of the COVID-19 epidemic in Wuhan, China. Segmented parameters are used in the model to prove the effectiveness of improved public health interventions such as city lockdown and extreme social distancing.And the generally polynomial chaos method is used to increase the reliability of the model results in the case of parameter estimation. The accuracy and validity of the proposed SEIR model are proved according to the official reported data.Also, according to the epidemic trend reflected by the model, the effectiveness and timeliness of the epidemic prevention policies formulated by the government can be reflected. © 2021 IEEE.

Risk perception characteristics and influencing factors of frontline medical staff during the coronavirus disease 2019 epidemic

Objective To explore the risk perception characteristics and influencing factors of frontline medical staff during the coronavirus disease 2019 (COVID-19) epidemic, so as to provide effective reference for correctly perceiving the risk, improving stress-coping skills and maintaining mental health during the high-risk and high-intensity combat against the COVID-19 epidemic. Methods A risk perception questionnaire based on the context of COVID-19 epidemic was used to investigate the risk perception level of 181 frontline medical staff fighting against COVID-19 epidemic. Nonparametric test was used to compare the demographic factors and risk perception dimensions. Logistic regression analysis was used to predict the effect of demographic factors on the risk perception level of frontline medical staff. Results During the COVID-19 epidemic, the overall risk perception score of the frontline medical staff was 36.39±8.59, and the scoring rate was 60.65%. The top three dimensions with the highest scoring rate were physical function risk, organization risk and personal safety risk. The score of frontline medical staff in Hubei province was higher than that outside Hubei province (Z=-2.180, P<0.05) and the score of medical technicians (doctors and technicians) was higher than that of nurses (Z=-3.039, P<0.01). The location of frontline medical staff could significantly predict the overall risk perception (P<0.05). Conclusion During the COVID-19 epidemic, the risk perception of frontline medical staff has been found at the medium level, with the risk perception degree of frontline medical staff in Hubei province being higher than that outside Hubei province and the risk perception degree of medical technicians being higher than that of nurses. The location of frontline medical staff can predict their risk perception.

[Pay attention to the exposure risk of patients with chronic wounds on the way to hospital during coronavirus disease 2019 epidemic prevention and control].

Statistics show that 76.74% (4 688) of 6 109 patients with chronic wounds are over 50 years of age; the proportion of patients with underlying diseases in all age groups above 50 years ranges from 78.25% to 100.00%. Among the underlying diseases of chronic wound patients, the top four diseases are diabetes mellitus, cardiovascular and cerebrovascular diseases, hypertension, and respiratory diseases. The above underlying diseases and ages of patients are the susceptibility factors of coronavirus disease 2019 released by National Health Commission of China. It is an unavoidable fact that the patients with chronic wounds have to go to the hospital for treatment prescribed by the physician. At the same time, we found that quite a few patients preferred going far afield in choosing hospital for treatment due to various reasons. During the prevention and control of coronavirus epidemic, this " go far afield" style of seeking medical treatment may increase the exposure risk during travelling. Accordingly, we convened 36 wound care clinics in different regions in Shanghai to implement the " Five Measures" encouraging the patients with chronic wounds to seek medical treatment nearby. The principle of this operation is that when seeking medical treatment, patients with chronic wounds should try their best to reduce the travel distance as much as possible to minimize the exposure risk during the epidemic period, which will in turn support the campaign of epidemic prevention and control.

Prevention and control strategies of coronavirus disease 2019 in oral and maxillofacial surgery wards

Coronavirus disease 2019 (COVID-19) has been confirmed to transmit by contact and respiratory droplets, and possibly by aerosols. Medical staff of oral and maxillofacial surgery departments need close contact with head and face of patients during the diagnosis and treatment, and aerosols may be generated during the operation. The risk of infection exposure is high, and the ward management is facing severe challenges. During the COVID-19 epidemic, the diagnosis and treatment in oral and maxillofacial surgery wards should be carried out reasonably after comprehensive assessment of patient condition. We put forward relevant prevention and control measures during the epidemic from the aspects of patient treatment, ward infection prevention and control, supply management, emergency plan, and training of medical staff, so as to provide references for prevention and control of the epidemic in oral and maxillofacial surgery wards.

Current practice and potential strategy in diagnosing COVID-19.

OBJECTIVE: To summarize the current practice and potential strategy in diagnosing coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: PubMed, Web of Science were systematically searched using terms including "COVID-19", "SARS-CoV-2" and "2019-nCoV". After removing duplicates, we then identified articles, letters and commentaries regarding diagnosing COVID-19. RESULTS: Here we summarized relatively mature diagnostic methods like nuclear acid test and computed tomography. Besides, new aspects regarding these detection methods like suitable specimens for nuclear acid test, possible use of 18F-FDG PET/CT were also reported. Especially, we also presented several novel techniques for diagnosing COVID-19 like lung ultrasound. CONCLUSIONS: Chinese Clinical Guidance for COVID-19 Pneumonia Diagnosis and Treatment (7th edition) by National Health Commission is recommended to follow as it provides detailed diagnostic procedures using currently available tools. We suggest clinicians further explore the saliva's utility as a specimen for nuclear acid test and the use of lung ultrasound.

Risk factors for disease severity, unimprovement, and mortality in COVID-19 patients in Wuhan, China.

OBJECTIVE: In December 2019, coronavirus disease (COVID-19) emerged in Wuhan. However, the characteristics and risk factors associated with disease severity, unimprovement and mortality are unclear and our objective is to throw some light on these. METHODS: All consecutive patients diagnosed with COVID-19 admitted to the Renmin Hospital of Wuhan University from January 11 to February 6, 2020, were enrolled in this retrospective cohort study. RESULTS: A total of 663 COVID-19 patients were included in this study. Among these, 247 (37.3%) had at least one kind of chronic disease; 0.5% of the patients (n = 3) were diagnosed with mild COVID-19, while 37.8% (251/663), 47.5% (315/663), and 14.2% (94/663) were in moderate, severe, and critical conditions, respectively. In our hospital, during follow-up 251 of 663 patients (37.9%) improved and 25 patients died, a mortality rate of 3.77%. Older patients (>60 years old) and those with chronic diseases were prone to have a severe to critical COVID-19 condition, to show unimprovement, and to die (p <0.001, <0.001). Multivariate logistic regression analysis identified being male (OR = 0.486, 95%CI 0.311-0.758; p 0.001), having a severe COVID-19 condition (OR = 0.129, 95%CI 0.082-0.201; p <0.001), expectoration (OR = 1.796, 95%CI 1.062-3.036; p 0.029), muscle ache (OR = 0.309, 95%CI 0.153-0.626; p 0.001), and decreased albumin (OR = 1.929, 95%CI 1.199-3.104; p 0.007) as being associated with unimprovement in COVID-19 patients. CONCLUSION: Male sex, a severe COVID-19 condition, expectoration, muscle ache, and decreased albumin were independent risk factors which influence the improvement of COVID-19 patients.