A Machine Learning Approach Reveals Distinct Predictors of Vaping Dependence for Adolescent Daily and Non-Daily Vapers in the COVID-19 Era.

Since 2016, there has been a substantial rise in e-cigarette (vaping) dependence among young people. In this prospective cohort study, we aimed to identify the different predictors of vaping dependence over 3 months among adolescents who were baseline daily and non-daily vapers. We recruited ever-vaping Canadian residents aged 16-25 years on social media platforms and asked them to complete a baseline survey in November 2020. A validated vaping dependence score (0-23) summing up their responses to nine questions was calculated at the 3-month follow-up survey. Separate lasso regression models were developed to identify predictors of higher 3-month vaping dependence score among baseline daily and non-daily vapers. Of the 1172 participants, 643 (54.9%) were daily vapers with a mean age of 19.6 ± 2.6 years and 76.4% (n = 895) of them being female. The two models achieved adequate predictive performance. Place of last vape purchase, number of days a pod lasts, and the frequency of nicotine-containing vaping were the most important predictors for dependence among daily vapers, while race, sexual orientation and reporting treatment for heart disease were the most important predictors in non-daily vapers. These findings have implications for vaping control policies that target adolescents at different stages of vape use.

Association between the COVID-19 pandemic and first cancer treatment modality: a population-based cohort study.

BACKGROUND: Physicians were directed to prioritize using nonsurgical cancer treatment at the beginning of the COVID-19 pandemic. We sought to quantify the impact of this policy on the modality of first cancer treatment (surgery, chemotherapy, radiotherapy or no treatment). METHODS: In this population-based study using Ontario data from linked administrative databases, we identified adults diagnosed with cancer from January 2016 to November 2020 and their first cancer treatment received within 1 year postdiagnosis. Segmented Poisson regressions were applied to each modality to estimate the change in mean 1-year recipient volume per thousand patients (rate) at the start of the pandemic (the week of Mar. 15, 2020) and change in the weekly trend in rate during the pandemic (Mar. 15, 2020, to Nov. 7, 2020) relative to before the pandemic (Jan. 3, 2016, to Mar. 14, 2020). RESULTS: We included 321 535 people diagnosed with cancer. During the first week of the COVID-19 pandemic, the mean rate of receiving upfront surgery over the next year declined by 9% (rate ratio 0.91, 95% confidence interval [CI] 0.88-0.95), and chemotherapy and radiotherapy rates rose by 30% (rate ratio 1.30, 95% CI 1.23-1.36) and 13% (rate ratio 1.13, 95% CI 1.07-1.19), respectively. Subsequently, the 1-year rate of upfront surgery increased at 0.4% for each week (rate ratio 1.004, 95% CI 1.002-1.006), and chemotherapy and radiotherapy rates decreased by 0.9% (rate ratio 0.991, 95% CI 0.989-0.994) and 0.4% (rate ratio 0.996, 95% CI 0.994-0.998), respectively, per week. Rates of each modality resumed to prepandemic levels at 24-31 weeks into the pandemic. INTERPRETATION: An immediate and sustained increase in use of nonsurgical therapy as the first cancer treatment occurred during the first 8 months of the COVID-19 pandemic in Ontario. Further research is needed to understand the consequences.

Early survival for patients newly diagnosed with cancer during COVID-19 in Ontario, Canada: A population-based cohort study.

BACKGROUND: Little is known about the association between the COVID-19 pandemic and early survival among newly diagnosed cancer patients. METHODS: This retrospective population-based cohort study used linked administrative datasets from Ontario, Canada. Adults (≥18 years) who received a cancer diagnosis between March 15 and December 31, 2020, were included in a pandemic cohort, while those diagnosed during the same dates in 2018/2019 were included in a pre-pandemic cohort. All patients were followed for one full year after the date of diagnosis. Cox proportional hazards regression models were used to assess survival in relation to the pandemic, patient characteristics at diagnosis, and the modality of first cancer treatment as a time-varying covariate. Interaction terms were explored to measure the pandemic association with survival for each cancer type. RESULTS: Among 179,746 patients, 53,387 (29.7%) were in the pandemic cohort and 37,741 (21.0%) died over the first post-diagnosis year. No association between the pandemic and survival was found when adjusting for patient characteristics at diagnosis (HR 0.99 [95% CI 0.96-1.01]), while marginally better survival was found for the pandemic cohort when the modality of treatment was additionally considered (HR 0.97 [95% CI 0.95-0.99]). When examining each cancer type, only a new melanoma diagnosis was associated with a worse survival in the pandemic cohort (HR 1.25 [95% CI 1.05-1.49]). CONCLUSIONS: Among patients able to receive a cancer diagnosis during the pandemic, one-year overall survival was not different than those diagnosed in the previous 2 years. This study highlights the complex nature of the COVID-19 pandemic impact on cancer care.

Imaging and physician visits at cancer diagnosis: COVID -19 pandemic impact on cancer care.

BACKGROUND: Little is known about the COVID-19 pandemic impact on the provision of diagnostic imaging and physician visits at cancer diagnosis. METHODS: We used administrative databases from Ontario, Canada, to identify MRI/CT/ultrasound scans and in-person/virtual physician visits conducted with cancer patients within 91 days around the date of diagnosis in 2016-2020. In separate segmented regression procedures, we assessed the trends in weekly volume of these services per thousand cancer patients in prepandemic (June 26, 2016 to March 14, 2020), the change in mean volume at the start of the pandemic, and the additional change in weekly volume during the pandemic (March 15, 2020, to September 26, 2020). RESULTS: Totally, 403,561 cancer patients were included. On March 15, 2020 (COVID-19 arrived), mean scan volume decreased by 12.3% (95% CI: 6.4%-17.9%) where ultrasound decreased the most by 31.8% (95% CI: 23.9%-37.0%). Afterward, the volume of all scans increased further by 1.6% per week (95% CI: 1.3%-2.0%), where ultrasound increased the fastest by 2.4% (95% CI: 1.8%-2.9%). Mean in-person visits dropped by 47.4% when COVID-19 started (95% CI: 41.6%-52.6%) while virtual visits rose by 55.15-fold (95% CI: 4927%-6173%). In the pandemic (until September 26, 2020), in-person visits increased each week by 2.6% (95% CI: 2.0%-3.2%), but no change was observed for virtual visits (p -value = 0.10). CONCLUSIONS: Provision of diagnostic imaging and virtual visits at cancer diagnosis has been increasing since the start of COVID-19 and has exceeded prepandemic utilization levels. Future work should monitor the impact of these shifts on quality of delivered care.

Timeliness and Modality of Treatment for New Cancer Diagnoses During the COVID-19 Pandemic in Canada.

Importance: The impact of COVID-19 on the modality and timeliness of first-line cancer treatment is unclear yet critical to the planning of subsequent care. Objective: To explore the association of the COVID-19 pandemic with modalities of and wait times for first cancer treatment. Design, Setting, and Participants: This retrospective population-based cohort study using administrative data was conducted in Ontario, Canada, among adults newly diagnosed with cancer between January 3, 2016, and November 7, 2020. Participants were followed up from date of diagnosis for 1 year, until death, or until June 26, 2021, whichever occurred first, to ensure a minimum of 6-month follow-up time. Exposures: Receiving a cancer diagnosis in the pandemic vs prepandemic period, using March 15, 2020, the date when elective hospital procedures were halted. Main Outcomes and Measures: The main outcome was a time-to-event variable describing number of days from date of diagnosis to date of receiving first cancer treatment (surgery, chemotherapy, or radiation) or to being censored. For each treatment modality, a multivariable competing-risk regression model was used to assess the association between time to treatment and COVID-19 period. A secondary continuous outcome was defined for patients who were treated 6 months after diagnosis as the waiting time from date of diagnosis to date of treatment. Results: Among 313 499 patients, the mean (SD) age was 66.4 (14.1) years and 153 679 (49.0%) were male patients. Those who were diagnosed during the pandemic were less likely to receive surgery first (subdistribution hazard ratio [sHR], 0.97; 95% CI, 0.95-0.99) but were more likely to receive chemotherapy (sHR, 1.26; 95% CI, 1.23-1.30) or radiotherapy (sHR, 1.16; 95% CI, 1.13-1.20) first. Among patients who received treatment within 6 months from diagnosis (228 755 [73.0%]), their mean (SD) waiting time decreased from 35.1 (37.2) days to 29.5 (33.6) days for surgery, from 43.7 (34.1) days to 38.4 (30.6) days for chemotherapy, and from 55.8 (41.8) days to 49.0 (40.1) days for radiotherapy. Conclusions and Relevance: In this cohort study, the pandemic was significantly associated with greater use of nonsurgical therapy as initial cancer treatment. Wait times were shorter in the pandemic period for those treated within 6 months of diagnosis. Future work needs to examine how these changes may have affected patient outcomes to inform future pandemic guideline development.

Correlates of wanting to seek help for mental health and substance use concerns by sexual and gender minority young adults during the COVID-19 pandemic: A machine learning analysis.

The COVID-19 pandemic has worsened the mental health and substance use challenges among many people who are Two Spirit, lesbian, gay, bisexual, transgender, queer, questioning, and intersex (2SLGBTQI+). We aimed to identify the important correlates and their effects on the predicted likelihood of wanting to seek help among 2SLGBTQI+ young adults for mental health or substance use concerns during the pandemic. A cross-sectional survey was conducted in 2020-2021 among 2SLGBTQI+ young adults aged 16-29 living in two Canadian provinces (Ontario and Quebec). Among 1414 participants, 77% (n = 1089) wanted to seek help for their mental health or substance use concerns during the pandemic, out of these, 69.8% (n = 760) reported delay in accessing care. We built a random forest (RF) model to predict the status of wanting to seek help, which achieved moderately high performance with an area under the receiver operating characteristic curve (AUC) of 0.85. The top 10 correlates of wanting to seek help were worsening mental health, age, stigma and discrimination, and adverse childhood experiences. The interactions of adequate housing with certain sexual orientations, gender identities and mental health challenges were found to increase the likelihood of wanting to seek help. We built another RF model for predicting risk of delay in accessing care among participants who wanted to seek help (n = 1089). The model identified a similar set of top 10 correlates of delay in accessing care but lacked adequate performance (AUC 0.61). These findings can direct future research and targeted prevention measures to reduce health disparities for 2SLGBTQI+ young adults.

Are Older People Really More Susceptible to SARS-CoV-2?

Since the outbreak, COVID-19 has spread rapidly across the globe due to its high infectivity and lethality. Age appears to be one of the key factors influencing the status and progression of SARS-CoV-2 infection, as multiple reports indicated that the majority of COVID-19 infections and severe cases are elderly. Most people simply assume that the elderly are more susceptible to SARS-CoV-2 than the young, but the mechanism behind it is still open to question. The older and younger people are at similar risk of infection because their infection process is the same and they must be exposed to the virus first. However, whether they will get sick after exposure to the virus and how their disease progresses depend on their immune mechanisms. In older populations, inflammation and immune aging reduce their ability to resist SARS-CoV-2 infection. Meanwhile, under the influence of comorbidities, ACE2 receptor and various cytokines undergo corresponding changes, thus accelerating the entry, replication, and transmission of SARS-CoV-2 in the body, promoting disease progression, and leading to severe illness and even death. In addition, the relatively fragile mental state of the elderly can also affect their timely recovery from COVID-19. Therefore, once older people are infected with SARS-CoV-2, they are more prone to severe illness and death with a poor prognosis, and they should strengthen protection to avoid exposure to the virus.

Incident Cancer Detection During Multiple Waves of COVID-19: The Tsunami After the Earthquake.

No population-based study exists to demonstrate the full-spectrum impact of COVID-19 on hindering incident cancer detection in a large cancer system. Building upon our previous publication in JNCCN, we conducted an updated analysis using 12 months of new data accrued in the pandemic era (extending the study period from September 26, 2020, to October 2, 2021) to demonstrate how multiple COVID-19 waves affected the weekly cancer incidence volume in Ontario, Canada, and if we have fully cleared the backlog at the end of each wave.

Cancer Patients First Treated with Chemotherapy: Are They More Likely to Receive Surgery in the Pandemic?

Due to the ramping down of cancer surgery in early pandemic, many newly diagnosed patients received other treatments first. We aimed to quantify the pandemic-related shift in rate of surgery following chemotherapy. This is a retrospective population-based cohort study involving adults diagnosed with cancer between 3 January 2016 and 7 November 2020 in Ontario, Canada who received chemotherapy as first treatment within 6-months of diagnosis. Competing-risks regression models with interaction effects were used to quantify the association between COVID-19 period (receiving a cancer diagnosis before or on/after 15 March 2020) and receipt of surgical reSection 9-months after first chemotherapy. Among 51,653 patients, 8.5% (n = 19,558) of them ultimately underwent surgery 9-months after chemotherapy initiation. Receipt of surgery was higher during the pandemic than before (sHR 1.07, 95% CI 1.02-1.13). Material deprivation was independently associated with lower receipt of surgery (least vs. most deprived quintile: sHR 1.11, 95% CI 1.04-1.17), but did not change with the pandemic. The surgical rate increase was most pronounced for breast cancer (sHR 1.13, 95% CI 1.06-1.20). These pandemic-related shifts in cancer treatment requires further evaluations to understand the long-term consequences. Persistent material deprivation-related inequity in cancer surgical access needs to be addressed.

The Changing Face of Cancer Surgery During Multiple Waves of COVID-19.

COVID-19 has had a detrimental effect on the provision of cancer surgery, but its impact beyond the first 6 months of the pandemic remains unclear. We used data on 799 220 cancer surgeries performed in Ontario, Canada, during 2018-2021 and segmented regression to address this knowledge gap. With the arrival of the first COVID-19 wave (March 2020), mean cancer surgical volume decreased by 57%. Surgical volume then rose by 2.5% weekly and reached prepandemic levels in 8 months. The surgical backlog after the first wave was 47 639 cases. At the beginning of the second COVID-19 wave (January 2021), mean cancer surgical volume dropped by 22%. Afterward, surgical volume did not actively recover (2-sided P = .25), resulting in a cumulative backlog of 66 376 cases as of August 2021. These data urge the strengthening of the surgical system to quickly clear the backlog in anticipation of a tsunami of newly diagnosed cancer patients in need of surgery.

Correlates of past year suicidal thoughts among sexual and gender minority young adults: A machine learning analysis.

Sexual and gender minority populations are at elevated risk of experiencing suicidal thoughts and attempting suicide. The COVID-19 pandemic exacerbated mental health and substance use challenges among this population. We aimed to examine the relative importance and effects of intersectional factors and strong interactions associated with the risk of suicidal thoughts among Canadian lesbian, gay, bisexual, transgender, queer, questioning, intersex and Two Spirit (LGBTQI2S+) young adults. A cross-sectional online survey was conducted among LGBTQI2S + participants aged 16-29 years living in two Canadian provinces (Ontario, Quebec). Among 1414 participants (mean age 21.90 years), 61% (n = 857) participants reported suicidal thoughts in last 12 months. We built a random forest model to predict the risk of having past year suicidal thoughts, which achieved high performance with an area under the receiver operating characteristic curve (AUC) of 0.84. The top 10 correlates identified were: seeking help from health professionals for mental health or substance use issues since the start of the pandemic, current self-rated mental health status, insulted by parents or adults in childhood, ever heard that being identifying as LGBTQI2S+ is not normal, age in years, past week feeling depressed, lifetime diagnosis of mental illness, lifetime diagnosis of depressive disorder, past week feeling sad, ever pretended to be straight or cisgender to be accepted. The increase in the risk of suicidal thoughts for those having mental health challenges or facing minority stressors is more pronounced in those living in urban areas or being unemployed than those living in rural areas or being employed.

Structural Basis of the Main Proteases of Coronavirus Bound to Drug Candidate PF-07321332.

The high mutation rate of COVID-19 and the prevalence of multiple variants strongly support the need for pharmacological options to complement vaccine strategies. One region that appears highly conserved among different genera of coronaviruses is the substrate-binding site of the main protease (Mpro or 3CLpro), making it an attractive target for the development of broad-spectrum drugs for multiple coronaviruses. PF-07321332, developed by Pfizer, is the first orally administered inhibitor targeting the main protease of SARS-CoV-2, which also has shown potency against other coronaviruses. Here, we report three crystal structures of the main protease of SARS-CoV-2, SARS-CoV, and Middle East respiratory syndrome (MERS)-CoV bound to the inhibitor PF-07321332. The structures reveal a ligand-binding site that is conserved among SARS-CoV-2, SARS-CoV, and MERS-CoV, providing insights into the mechanism of inhibition of viral replication. The long and narrow cavity in the cleft between domains I and II of the main protease harbors multiple inhibitor-binding sites, where PF-07321332 occupies subsites S1, S2, and S4 and appears more restricted than other inhibitors. A detailed analysis of these structures illuminated key structural determinants essential for inhibition and elucidated the binding mode of action of the main proteases from different coronaviruses. Given the importance of the main protease for the treatment of SARS-CoV-2 infection, insights derived from this study should accelerate the design of safer and more effective antivirals. IMPORTANCE The current pandemic of multiple variants has created an urgent need for effective inhibitors of SARS-CoV-2 to complement vaccine strategies. PF-07321332, developed by Pfizer, is the first orally administered coronavirus-specific main protease inhibitor approved by the FDA. We solved the crystal structures of the main protease of SARS-CoV-2, SARS-CoV, and MERS-CoV that bound to the PF-07321332, suggesting PF-07321332 is a broad-spectrum inhibitor for coronaviruses. Structures of the main protease inhibitor complexes present an opportunity to discover safer and more effective inhibitors for COVID-19.

Virtual and in-person visits by Ontario physicians in the COVID-19 era.

INTRODUCTION: We examined the coronavirus disease 2019 (COVID-19) pandemic impact on weekly trends in the billing of virtual and in-person physician visits in Ontario, Canada. METHODS: In this retrospective cohort study, physician billing records from Ontario were aggregated on a weekly basis for in-person and virtual visits from 3 January 2016 to 27 March 2021. For each type of visit, a segmented negative binomial regression analysis was performed to estimate the weekly pre-pandemic trend in billing volume per thousand adults (3 January 2016 to 14 March 2020), the immediate change in mean volume at the start of the pandemic, and additional change in weekly volume in the pandemic era (15 March 2020 to 27 March 2021). RESULTS: Before the start of the pandemic, the weekly volume of virtual visits per thousand adults was low with a 0.5% increase per week (rate ratio [RR]: 1.0053, 95% confidence interval [CI]: 1.0050-1.0056). A dramatic 65% reduction in in-person visits (RR: 0.35, 95% CI: 0.32-0.39) occurred at the start of the pandemic while virtual visits grew by 21-fold (RR: 21.3, 95% CI: 19.6-23.0). In the pandemic era, in-person visits rose by 1.4% per week (RR: 1.014, 95% CI: 1.011-1.017) but no change was observed for virtual visits (p-value = 0.31). Overall, we noted a 57.6% increase in total weekly physician visits volume after the start of the pandemic. DISCUSSION: These results are meaningful for virtual care reimbursement models. Future study needs to assess the quality of care and whether the increase in virtual care volume is cost-effective to society.

Gene Knock-in by CRISPR/Cas9 and Cell Sorting in Macrophage and T Cell Lines.

Functional genomics studies of the immune system require genetic manipulations that involve both deletion of target genes and addition of elements to proteins of interest. Identification of gene functions in cell line models is important for gene discovery and exploration of cell-intrinsic mechanisms. However, genetic manipulations of immune cells such as T cells and macrophage cell lines using CRISPR/Cas9-mediated knock-in are difficult because of the low transfection efficiency of these cells, especially in a quiescent state. To modify genes in immune cells, drug-resistance selection and viral vectors are typically used to enrich for cells expressing the CRIPSR/Cas9 system, which inevitably results in undesirable intervention of the cells. In a previous study, we designed dual fluorescent reporters coupled to CRISPR/Cas9 that were transiently expressed after electroporation. This technical solution leads to rapid gene deletion in immune cells; however, gene knock-in in immune cells such as T cells and macrophages without the use of drug-resistance selection or viral vectors is even more challenging. In this article, we show that by using cell sorting to aid selection of cells transiently expressing CRISPR/Cas9 constructs targeting the Rosa26 locus in combination with a donor plasmid, gene knock-in can be achieved in both T cells and macrophages without drug-resistance enrichment. As an example, we show how to express human ACE2, a receptor of SARS-Cov-2, which is responsible for the current Covid-19 pandemic, in RAW264.7 macrophages by performing knock-in experiments. Such gene knock-in cells can be widely used for mechanistic studies.

The role of chest CT quantitative pulmonary inflammatory index in the evaluation of the course and treatment outcome of COVID-19 pneumonia.

To explore the clinical application value of chest CT quantitative pulmonary inflammation index (PII) in the evaluation of the course and treatment outcome of COVID-19 pneumonia. One hundred and eighteen patients with COVID-19 pneumonia diagnosed by RT-PCR were analyzed retrospectively. The correlation between chest CT PII, clinical symptoms and laboratory examinations during the entire hospitalization period was compared. The average age of the patients was 46.0 ± 15 (range: 1-74) years. Of the 118 patients, 62 are male (52.5%) and 56 are female (47.5%). Among them, 116 patients recovered and were discharged, 2 patients died, and the median length of hospital stay was 22 (range: 9-41) days. On admission, 76.3% of the patients presented with fever, and the laboratory studies showed a decrease in lymphocyte (LYM) count and an increase in lactate dehydrogenase (LDH) levels, C-reactive protein (CRP) levels, and erythrocyte sedimentation rate (ESR). Within the studies' chest CTs, the median number of involved lung lobes was 4 (range: 0-5) and the median number of involved lung segments was 9 (range 0-20). The left lower lobe and the right lower lobe were the most likely areas to be involved (89.0% and 83.9%), and 84.7% of the patients had inflammatory changes in both lungs. The main manifestations on chest CT were ground glass opacities (31.4%), ground glass opacities and consolidation (20.3%), ground glass opacities and reticular patterns (32.2%), mixed type (13.6%), and white lungs (1.7%); common accompanying signs included linear opacities (55.9%), air bronchograms (46.6%), thick small vessel shadows (36.4%), and pleural hypertrophy (13.6%). The chest CT at discharge showed complete absorption of lesions in 19 cases (16.1%), but not in the remaining 99 cases. Lesions remained in a median of 3 lung lobes (range: 0-5). Residual lesions remained in a median of 5 lung segments (range: 0-20). The residual lesions mainly presented as ground glass opacities (61.0%), and the main accompanying sign was linear opacities (59.3%). Based on chest CT, the median maximum PII of lungs was 30.0% (range: 0-97.5%), and the median PII after discharge in the patients excluding the two deaths was 12.5% (range: 0-53.0%). PII was significantly negatively correlated with the LYM count and significantly positively correlated with body temperature, LDH, CRP, and ESR. There was no significant correlation between the PII and the white blood cell count, but the grade of PII correlated well with the clinical classification. PII can be used to monitor the severity and the treatment outcome of COVID-19 pneumonia, provide help for clinical classification, assist in treatment plan adjustments and aid assessments for discharge.

Real-World Scenario of Patients With Lung Cancer Amid the Coronavirus Disease 2019 Pandemic in the People's Republic of China.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) outbreak throughout the world has affected millions of people in many ways, putting a huge burden on the health care system. The ongoing outbreak of this respiratory disease has posed critical challenges to public health, research, and medical communities around the world. This study aimed at evaluating the impact of COVID-19 pandemic on patients with lung cancer in the People's Republic of China. METHODS: We collected data on 397 inpatients from a single center during 4 weeks of the pandemic (2020 group) and that of 2504 inpatients during the same period (4 wk) in the past 5 years (2015-2019 group). A questionnaire was used to investigate the medical demands of 803 patients with lung cancer at 65 hospitals in 20 provinces in the People's Republic of China during the pandemic. We evaluated the incidence data of COVID-19 in Guangdong to analyze the tendency of the pandemic and compared it with inpatient data. RESULTS: The number of hospitalizations and lung cancer-related operations had steadily increased from 2015 to 2019 but reduced by an average of 26.72% (133.8) and 57.18% (45.4) in 2020. The hospital capacity decreased by 28.00% (35 inpatient beds) during the pandemic period of infection with severe acute respiratory syndrome coronavirus 2. The pandemic caused a greater impact on medical work related to lung cancer after the Chinese New Year holiday. Patients were most concerned about long waiting times for outpatient services, inpatient beds, physical examinations, or operations (406; 50.56%); the possibility of infection with the novel coronavirus (359; 44.71%); and the difficulties in getting to a hospital owing to transportation outages (279; 34.74%). Patients in stage I and II revealed having less fear about disease progression (14 [18.18%] and four [14.81%], respectively), had lower proportions of delayed medical arrangement (15 [19.48%] and six [22.22%], respectively), and complained less about complex treatment procedures (12 [15.58%] and five [18.52%], respectively). Patients in the high-infected area (345, 56.74%) complained more frequently about longer booking periods than those in the low-infected area (61, 31.28%). CONCLUSIONS: The treatment of patients with lung cancer has been affected by the pandemic to some extent. We provide suggestions on both clinical diagnosis and treatment strategies for lung cancer to optimize the process, given the urgency of the current circumstances. The demand for medical support among patients with lung cancer or other life-threatening diseases should be given sufficient attention, especially during the current COVID-19 outbreak.

Case report of a patient with suspected COVID-19 with depression and fever in an epidemic stress environment.

During the COVID-19 pandemic, the number of suspected cases, confirmed cases and those who passed away from the virus has been reported in major media and the internet, and has caused a high degree of tension. In addition, people's outdoor activities have been limited, making it more difficult to find outlets for releasing stress. Under this situation, some people began to experience emotions of anxiety and depression. This article reports a case of depression with fever caused by the stress tension of the pandemic. The patient was highly suspected to have contracted COVID-19. The reported patient, who had a history of depression and had been to Wuhan to attend an exam, showed obvious pre-exam anxiety under the epidemic situation, which gradually increased the patient's pressure and then caused some adverse symptoms, such as insomnia, anxiety, sweating and a reoccurrent fever. Local community authorities paid close attention to him and later sent him to a general hospital in Jingmen for quarantine and treatment, as he was suspected of having COVID-19. After being hospitalised for half a month, he was ruled out from having 'COVID-19' and was cured of depression and discharged from the hospital. From this case, we can realise that, under the situation of the epidemic, people are easily prone to insomnia, anxiety and even depression. As clinicians in general hospitals, especially when encountering large emergencies, we must carefully inquire about the patient's medical history while strengthening our understanding of psychiatric knowledge to improve the recognition rate for depression.

Aerosol and Surface Distribution of Severe Acute Respiratory Syndrome Coronavirus 2 in Hospital Wards, Wuhan, China, 2020.

To determine distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards in Wuhan, China, we tested air and surface samples. Contamination was greater in intensive care units than general wards. Virus was widely distributed on floors, computer mice, trash cans, and sickbed handrails and was detected in air ≈4 m from patients.