Lung ultrasound score as a predictor of failure to wean COVID-19 patients off mechanical ventilation: a prospective observational study (preprint)

Background The lung ultrasound score was developed for rapidly assessing the extent of lung ventilation, and it can predict failure to wean various types of patients off mechanical ventilation. Whether it is also effective for COVID-19 patients is unclear.Methods This single-center, prospective, observational study was conducted to assess the ability of the 12-region lung ultrasound score to predict failure to wean COVID-19 patients off ventilation. In parallel, we assessed whether right hemidiaphragmatic excursion or previously published predictors of weaning failure can apply to these patients. Predictive ability was assessed in terms of the area under the receiver operating characteristic curve (AUC).Results Among the 35 patients in the study, 12 patients (37%) could not be weaned off mechanical ventilation. The lung ultrasound score predicted these failures with an AUC of 0.885 (95% CI 0.770–0.999, p < 0.001), and a threshold score of 10 provided specificity of 72.7% and sensitivity of 92.3%. AUCs were lower for previously published predictors of weaning failure, and right hemidiaphragmatic excursion did not differ significantly between the two groups.Conclusions The lung ultrasound score can accurately predict failure to wean critically ill COVID-19 patients off mechanical ventilation, whereas assessment of right hemidiaphragmatic excursion does not appear helpful in this regard.Trial registration: https://clinicaltrials.gov/ct2/show/NCT05706441

Editorial: Platelets in Disease: From Biomarkers Discovery to Therapeutic Targets

With in-depth research on platelets, targeted platelet therapy is expected to become an important strategy for the treatment of related diseases. Immune responses to SARS-CoV-2 peptides in whole blood assays are associated with COVID-19.

Evaluation on potential detriments from lockdown-related isolation to mental health among school-aged youth in central China (preprint)

Background: Home isolation is a generally effective strategy for coronavirus disease control during lockdown periods. This study is to determine the potential adverse consequences of home isolation to mental health among school-aged youth after lifting of major lockdown measures in central China. Methods: This cohort study assessed the mental health of school-aged children and adolescents enrolled in Wuhan city and nearby areas in Hubei province, China, from July 1 to August 31, 2020. Post-lockdown responses to anxiety, depression, sleep disturbances and post-traumatic stress symptoms were assessed in online questionnaire-based surveys. Participants’ scores for the Zung self-rated anxiety scale, the Patient Health Questionnaire-9, the self-rating scale of sleep and the post-traumatic stress disorder self-rating scale (PTSS) were analyzed. Results: Questionnaire responses of 730 school children were collected. Among the participants, 6.25% of them had scores above thresholds for PTSS, 5.81% had anxiety, and 48.84% had depression. All subjects reported that they experienced sleep disturbances. Subjects who had anxiety might have a high risk for developing depression [OR: 16.07, p =0.008, 95%CI (2.08-123.94)] and PTSS [OR: 12.97, p <0.001, 95%CI (5.41-31.11)]. Both depression [OR: 17.35, p =0.006, 95%CI (2.28-131.87)] and PTSS [OR: 14.18, p <0.001, 95%CI (6.00-33.47)] were risk factors for developing anxiety among participants. Interestingly, higher educational levels of primary caregivers were a risk factor for developing depression [OR: 1.62, p =0.005, 95%CI (1.16-2.28)] in the participants, but a protective factor against PTSS [OR: 0.47, p =0.048, 95%CI (0.23-0.99)].Conclusions: The local youth had less than expected degree of increases in their self-reported PTSS and anxiety, after exiting lockdown-related isolation. As a result of a combination of compensatory mechanisms including internet-based home-schooling and increased intra-familial interactions, home isolation did not affect the mental health of local school-aged youth to an extent as great as expected.Trial registration: The Registration number of this trial is ChiCTR2000033054.

Signaling Potential Therapeutic Herbal Medicine Prescription for Treating COVID-19 by Collaborative Filtering

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has aggressed in more than 200 countries and territories since Dec 2019, and 30 million cases of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 have been reported, including 950,000 deaths. Supportive treatment remains the mainstay of therapy for COVID-19. There are no small-molecule–specific antiviral drugs available to prevent and treat COVID-19 until recently. Herbal medicine can facilitate syndrome differentiation and treatment according to the clinical manifestations of patients and has demonstrated effectiveness in epidemic prevention and control. The National Health Commission (NHC) of China has recommended “three TCM prescriptions and three medicines,” as a group of six effective herbal formulas against COVID-19 in the released official file “Diagnosis and Treatment Protocol for COVID-19 Patients: Herbal Medicine for the Priority Treatment of COVID-19.” This study aimed to develop a collaborative filtering approach to signaling drug combinations that are similar to the six herbal formulas as potential therapeutic treatments for treating COVID-19. The results have been evaluated by herbal medicine experts’ domain knowledge.

The effect of Health Literacy on COVID-19 Vaccine Hesitancy: The Moderating Role of Stress (preprint)

Abstract Background The COVID-19 vaccine is an essential means to establish group immunity and prevent the spread of the pandemic. However, the public's hesitation has created major difficulties to the promotion of the vaccine. By investigating the relationship between health literacy and COVID-19 vaccine hesitancy, as well as the potential moderating role of stress, the present study would provide critical insights for tailoring vaccine-promotion strategies. Objective The two-fold research purpose is: i) address the effect of health literacy on people's attitude toward COVID-19 vaccine, ii) clarify the role of stress in this effect. Method With structured questionnaires, an online survey was conducted to evaluate general public's COVID-19 vaccine hesitancy, health literacy, and perceived stress. In total, 560 responses were collected, and moderated regression analysis was conducted to test the effect of health literacy on vaccine hesitancy among people with different levels of stress. Results A total of 560 participants aged over 18 years were included in this study. About 39.8% of the respondents reported vaccine hesitancy, and this rate is higher among those aged 20-30 years old (83%) and female (71.3%). The results showed people with higher level of health literacy are less likely to have vaccine hesitancy . However, this effect was only among those with lower to moderate level of stress , among the people with high stress, no significant effect of health literacy was found . Conclusions By focusing on the effect of health literacy on COVID-19 vaccine hesitancy, the findings showed education program increasing individual's health literacy may also effectively reduce the public's vaccine hesitancy and promote accepting attitude. However, for people with high level of stress, other health programs need to be developed to enhance their positive attitude toward the COVID-19 vaccine. In conclusion, promotion strategies should be tailored for different populations, with considering individual factors such as health literacy and stress. Keywords vaccine hesitancy; health literacy; stress; moderation

The Impact of the COVID-19 Pandemic on Social Economy and Sustainability (preprint)

The Corona virus has been raging on across the world affecting hundreds of countries and billions of people. Naturally, it has had huge impacts on the world economy as a whole and the lives of people. This study aims to find out the effects that the COVID-19 has had on social economy and sustainability. The study takes up the primary aspects of social well-being like Poverty, Employment, The Condition of Women, Global Trade and Food Security and tries to find out the impact that the pandemic had on them. Analysing secondary data and reports from major international organisations like the United Nations and World Bank, this paper concludes that the effects of the pandemic have been huge. All the major aspects of the social economy have been affected by the pandemic and have resulted in huge losses in terms of economic well-being and social capital.

Factors Influencing Mental Health among Chinese Medical and Non-medical Students in the Early Stage of COVID-19 Pandemic (preprint)

Background: The 2019 coronavirus disease (COVID-19) pandemic is a public health emergency of international concern. This study aimed to assess the psychological outcomes and their influencing factors among medical and non-medical university students during the COVID-19 pandemic in China. Methods: A cross-sectional online survey using structured questionnaires was conducted from 20 February to 20 March 2020. Psychological outcomes were assessed according to the Depression, Anxiety, and Stress Scale (DASS-21). Influencing factors were assessed by COVID-19 knowledge, mindful coping scale, and sense of control scale.Results: Our sample comprises of 563 university students (male = 172, mean age = 21.52). Among them, 382 are medical students. Among the participants, 12.26%, 18.47%, and 8.53% of them have moderate to severe levels of depression, anxiety, and stress symptoms, respectively. Compared with the non-medical students, the medical students had a higher knowledge level of COVID-19, a higher sense of awareness, and fewer mental health symptoms. After controlling the covariance, perceived constrains of sense of control were negatively associated with depression, anxiety, and stress among both medical and non-medical students. Prevention of negative emotions by mindful coping was negatively associated with depression and anxiety among non-medical students. Knowledge of COVID-19 is not associated with mental distress among medical and non-medical students.Conclusions: During the COVID-19 pandemic in China, the mental health of university students was affected. Our findings suggested that a sense of control is a protective factor for both medical and non-medical students, while mindful coping is a protective factor for only non-medical students.

Serum Procalcitonin Levels on Admission Predict Death in Severe and Critical COVID-19 Patients in Wuhan, China

Background: We evaluated whether the serum procalcitonin (PCT) level could predict death in severe and critical coronavirus disease 2019 (COVID-19) patients. Methods: This study included 129 COVID-19 patients. PCT levels on admission, treatment, and death were collected. The outcomes were compared. Results: The optimum cutoff value of the PCT level determined by receiver operator characteristic curve analysis to predict all-cause death was 0.085 ng/mL, with sensitivity of 95.7% and specificity of 72.6%. Overall, 78 patients had a PCT level below 0.085 ng/mL and 51 patients had a PCT level of 0.085 ng/mL or greater. High-PCT-level patients had lower levels of lymphocytes (P= 0.001) and albumin (P = 0.002) and higher levels of creatinine (P = 0.024), D-dimer (P = 0.002), and white blood cells, neutrocytes (P < 0.001), high-sensitivity C-reactive protein (P < 0.001), interleukin-6 (P < 0.001), interleukin-8 (P = 0.001), interleukin-10 (P = 0.001), tumor necrosis factor (P < 0.001), erythrocyte sedimentation rate (P = 0.001), and ferritin (P = 0.001). During the 30-day observation period, 23 patients died. Mortality was significantly higher in high-PCT-level patients than in patients with low PCT levels (43.1% vs. 1.3%;P < 0.001). The risks of death (P < 0.0001) and ventilator use (P < 0.0001) were increased in patients with PCT levels of 0.085 ng/mL or greater. Conclusions: A PCT level of 0.085 ng/mL or greater on admission could effectively predict death and ventilator use in severe and critical COVID-19 patients.

Large-scale single-cell analysis reveals critical immune characteristics of COVID-19 patients (preprint)

Dysfunctional immune response in the COVID-19 patients is a recurrent theme impacting symptoms and mortality, yet the detailed understanding of pertinent immune cells is not complete. We applied single-cell RNA sequencing to 284 samples from 205 COVID-19 patients and controls to create a comprehensive immune landscape. Lymphopenia and active T and B cell responses were found to coexist and associated with age, sex and their interactions with COVID-19. Diverse epithelial and immune cell types were observed to be virus-positive and showed dramatic transcriptomic changes. Elevation of ANXA1 and S100A9 in virus-positive squamous epithelial cells may enable the initiation of neutrophil and macrophage responses via the ANXA1-FPR1 and S100A8/9-TLR4 axes. Systemic up-regulation of S100A8/A9, mainly by megakaryocytes and monocytes in the peripheral blood, may contribute to the cytokine storms frequently observed in severe patients. Our data provide a rich resource for understanding the pathogenesis and designing effective therapeutic strategies for COVID-19.

Dynamic changes of liver function parameters in patients with coronavirus disease 2019: A multicenter, retrospective study (preprint)

Background: Liver injuries in patients with coronavirus disease 2019 (COVID-19) have been reported, however, the clinical role played by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is obscure.  Methods: In this multicenter, retrospective study, the parameters of liver function tests in COVID-19 inpatients were compared between various timepoints referred to SARS-CoV-2 shedding, and 3 to 7 days before first detection of viral shedding was regarded as reference baseline.Results: Totally, 70 COVID-19 inpatients were enrolled. Twenty-two (31.4%) cases had self-medications history after illness. At baseline, 10 (14.3%), 7 (10%), 9 (12.9%), 2 (2.9%), 15 (21.4%), and 4 (5.7%) patients already had abnormal rates of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), albumin, and total bilirubin (TBIL), respectively. ALT and AST abnormal rates and levels did not show any significantly dynamic change during the full period of viral shedding (all P > 0.05). GGT abnormal rate (P = 0.008) and level (P = 0.033) significantly increased on day 10 of viral shedding. Meanwhile, no simultaneously significant increases of ALP abnormal rates and levels were observed. TBIL abnormal rates and levels significantly increased on day 1 and 5 of viral shedding (all P < 0.05). Albumin abnormal decrease rates increased and levels decreased consistently from baseline to SARS-CoV-2 clearance day (all P < 0.05). Thirteen (18.6%) patients had chronic liver diseases, two of them died. The ALT and AST abnormal rates and levels did not increase in patients with chronic liver diseases during SARS-CoV-2 shedding.Conclusions: The SARS-CoV-2 does not directly lead to elevations of ALT and AST, but may result in elevations of GGT and TBIL, the albumin decreased extraordinarily even SARS-CoV-2 shedding discontinued.

Self-efficacy and fatigue among health care workers during COVID-19 outbreak: A moderated mediation model of posttraumatic stress disorder symptoms and negative coping (preprint)

Background. Health care workers (HCWs) fighting Coronavirus Disease 2019 (COVID-19) are not immune to fatigue. Self-efficacy has been suggested as a protective factor for fatigue. Nonetheless, less is known regarding the underlying mechanisms behind the association. This research aimed to explore the prevalence of fatigue among HCWs during the pandemic, investigate the mediating effect of posttraumatic stress disorder (PTSD) symptoms and moderating effect of negative coping in the association between self-efficacy and fatigue.Methods. The cross-sectional study employed a sample of 527 HCWs from Anhui Province, China. Self-efficacy, PTSD symptoms, negative coping and fatigue were measured by General Self-Efficacy Scale (GSES), PTSD Checklist-Civilian Version (PCL-C), Simplified Coping Style Questionnaire (CSCQ) and 14-item Fatigue Scale (FS-14) respectively.Results. The prevalence of fatigue among HCWs was 56.7%. The effect of self-efficacy on fatigue was partially mediated by PTSD symptoms. Additionally, negative coping moderated both the direct effect of self-efficacy on fatigue and the mediating effect of PTSD symptoms. As revealed by Johnson-Neyman technique, when the standard score of negative coping enhanced to 1.49 and over, the direct association between self-efficacy and fatigue was not significant. Likewise, the effect of self-efficacy on PTSD symptoms had no statistical significance when the standard score of negative coping was − 1.40 and lower.Conclusions. More than half HCWs suffer from fatigue during the COVID-19. For HCWs during the COVID-19 epidemic, especially those with higher levels of negative coping, it might be crucial to design program combining the enhancement of self-efficacy and interventions for PTSD to reduce fatigue.

High risk of infection caused posttraumatic stress symptoms in individuals with poor sleep quality: A study on influence of coronavirus disease (COVID-19) in China (preprint)

The influence of the outbreak of coronavirus disease (COVID-19) on mental health was poorly understood. The present study aimed to exam sleep problems and posttraumatic stress symptoms (PTSS) in Chinese immediately after the massive outbreak of COVID-19. A total of 2027 Chinese participated in the present study. Wuhan-expose history, sleep quality and PTSS were measured with self-rating scales. Results showed that there were significant differences of PCL-5 and of sleep quality scores in different data-collection dates (ps<0.05). There were significant differences of PCL-5 scores (p<0.05) and latency onset of sleep (p<0.05) between participants with and without Wuhan-expose history. The interaction effect of Wuhan exposure history x sleep quality significantly influenced PCL-5 (ps<0.05). These results indicate that keeping good sleep quality in individuals with high infectious risk is a way to prevent PTSS.

Myocardial injury is associated with in-hospital mortality of confirmed or suspected COVID-19 in Wuhan, China: A single center retrospective cohort study (preprint)

[Background] Since December 2019, a cluster of coronavirus disease 2019 (COVID-19) occurred in Wuhan, Hubei Province, China and spread rapidly from China to other countries. In-hospital mortality are high in severe cases and cardiac injury characterized by elevated cardiac troponin are common among them. The mechanism of cardiac injury and the relationship between cardiac injury and in-hospital mortality remained unclear. Studies focused on cardiac injury in COVID-19 patients are scarce. [Objectives] To investigate the association between cardiac injury and in-hospital mortality of patients with confirmed or suspected COVID-19. [Methods] Demographic, clinical, treatment, and laboratory data of consecutive confirmed or suspected COVID-19 patients admitted in Wuhan No.1 Hospital from 25th December, 2019 to 15th February, 2020 were extracted from electronic medical records and were retrospectively reviewed and analyzed. Univariate and multivariate Cox regression analysis were used to explore the risk factors associated with in-hospital death. [Results] A total of 110 patients with confirmed (n=80) or suspected (n=30) COVID-19 were screened and 48 patients (female 31.3%, mean age 70.58{+/-}13.38 year old) among them with high-sensitivity cardiac troponin I (hs-cTnI) test within 48 hours after admission were included, of whom 17 (17/48, 35.4%) died in hospital while 31 (31/48, 64.6%) were discharged or transferred to other hospital. High-sensitivity cardiac troponin I was levated in 13 (13/48, 27.1%) patents. Multivariate Cox regression analysis showed pulse oximetry of oxygen saturation (SpO2) on admission (HR 0.704, 95% CI 0.546-0.909, per 1% decrease, p=0.007), elevated hs-cTnI (HR 10.902, 95% 1.279-92.927, p=0.029) and elevated d-dimer (HR 1.103, 95%CI 1.034-1.176, per 1mg/L increase, p=0.003) on admission were independently associated with in-hospital mortality. [Conclusions] Cardiac injury defined by hs-cTnI elevation and elevated d-dimer on admission were risk factors for in-hospital death, while higher SpO2 could be seen as a protective factor, which could help clinicians to identify patients with adverse outcome at the early stage of COVID-19.

Antibody responses to SARS-CoV-2 in COVID-19 patients: the perspective application of serological tests in clinical practice (preprint)

Background We aim to investigate the profile of acute antibody response in COVID-19 patients, and provide proposals for the usage of antibody test in clinical practice. Methods A multi-center cross-section study (285 patients) and a single-center follow-up study (63 patients) were performed to investigate the feature of acute antibody response to SARS-CoV-2. A cohort of 52 COVID-19 suspects and 64 close contacts were enrolled to evaluate the potentiality of the antibody test. Results The positive rate for IgG reached 100% around 20 days after symptoms onset. The median day of serocon-version for both lgG and IgM was 13 days after symptoms onset. Seroconversion of IgM occurred at the same time, or earlier, or later than that of IgG. IgG levels in 100% patients (19/19) entered a platform within 6 days after seroconversion. The criteria of IgG seroconversion and [≥] 4-fold increase in the IgG titers in sequential samples together diagnosed 82.9% (34/41) of the patients. Antibody test aided to confirm 4 patients with COVID-19 from 52 suspects who failed to be confirmed by RT-PCR and 7 patients from 148 close contacts with negative RT-PCR. Conclusion IgM and IgG should be detected simultaneously at the early phase of infection. The serological diagnosis criterion of seroconversion or [≥] 4-fold increase in the IgG titer is suitable for a majority of COVID-19 patients. Serologic test is helpful for the diagnosis of SARS-CoV-2 infection in suspects and close contacts.

Prevalence and Risk Factors of Acute Posttraumatic Stress Symptoms during the COVID-19 Outbreak in Wuhan, China (preprint)

BackgroundTo exam the prevalence of and risk factors for acute posttraumatic stress disorder (PTSD) in Chinese people shortly after the COVID-19 outbreak. MethodsAn online questionnaire survey was conducted between 30 January and 3 February, 2020. The survey included two self-administered questionnaires: one was designed to require participants personal information (gender, age, education background), current location, recent epidemic area contact history, the classification of population, and subjective sleep quality; the other was the PTSD Checklist for DSM-5 (PCL-5). ResultsA total of 2091 Chinese participated in this study. The prevalence of PTSD among the Chinese public one month after the COVID-19 outbreak was 4.6%. Multiple linear regression analysis revealed that gender (p < 0.001), epidemic area contact history (p = 0.047), classification of population (p < 0.001), and subjective sleep quality (p < 0.001) could be regarded as predictor factors for PTSD. LimitationsFirst, the majority of participants in this study were the general public, and confirmed or suspected patients being a small part. Second, the measurement of PTSD might be vulnerable to selection bias because of an online self-report study, such as participants recruitment. Third, the prevalence of PTSD in this study was estimated by an online questionnaire rather than a clinical interview. ConclusionsThe results revealed that some Chinese showed acute PTSD during the COVID-19 outbreak. Therefore, comprehensive psychological intervention needs further implementation. Furthermore, females, people who having recent epidemic area contact history, those at high risk of infection or with poor sleep quality deserve special attention.