Modified respiratory rate oxygenation index: an early warning index for the need of intubation in COVID-19 patients with high-flow nasal cannula therapy

Background High-flow nasal cannula oxygen therapy (HFNC) is recommended for COVID-19 patients. However, the increasing use of HFNC brings a risk of delayed intubation. The optimal timing of switching from HFNC to invasive mechanical ventilation (IMV) remains unclear. An effective predictor is needed to assist in deciding on the timing of intubation. Respiratory rate and oxygenation (ROX) index, defined as (SpO2/FiO2)/respiratory rate, already show good diagnostic accuracy. Modified ROX (mROX) index, defined as (PaO2/FiO2)/respiratory rate, might be better than the ROX index in predicting HFNC failure. Objective The aim was to evaluate the predictive value of mROX for HFNC failure in COVID-19 patients. Methods Severe or critical COVID-19 patients treated with HFNC were enrolled in two clinical centers. Laboratory indicators, respiratory parameters, and mROX index at 0 h and 2 h after initial HFNC were collected. Based on the need of IMV after HFNC initiation, the patients were divided into the HFNC failure group and the HFNC success group. The predictive value of mROX index for IMV was evaluated by the area under the receiver operating characteristic curve (AUROC) and logistic regression analysis. We performed Kaplan–Meier survival analysis using the log-rank test. Results Sixty COVID-19 patients (mean age, 62.8 ± 14.1 years;42 males) receiving HFNC were evaluated, including 18 critical and 42 severe cases. A total of 33 patients had hypertension;14 had diabetes;17 had chronic cardiac disease;11 had chronic lung disease;13 had chronic kidney disease;and 17 had a history of stroke. The AUROC of mROX index at 2 h was superior than that of other respiratory parameters to predict the need of IMV (0.959;P < 0.001). At the mROX index cutoff point of 4.45, predicting HFNC failure reached the optimal threshold, with specificity of 94% and sensitivity of 92%. Logistic regression analysis showed that 2-h mROX index below 4.45 was a protective factor for IMV (OR 0.18;95% CI, 0.05 to 0.64;P = 0.008). In the HFNC failure group, the median time from HFNC to IMV was 22.5 h. The 28-day mortality of the late intubation patients (≥22.5 h) was higher than that of the early intubation patients (<22.5 h) (53.8% vs 8.3%, P = 0.023). Conclusion mROX at 2 h is a good early warning index for the need of IMV in COVID-19 patients after HFNC initiation. Early intubation may lead to better survival in patients with 2-h mROX index below 4.45.

The social psychological impact of the COVID-19 pandemic on medical staff in China: A cross-sectional study.

BACKGROUND: The COVID-19 outbreak required the significantly increased working time and intensity for health professionals in China, which may cause stress signs. METHODS: From March 2-13 of 2020, 4,618 health professionals in China were included in an anonymous, self-rated online survey regarding their concerns on exposure to the COVID-19 outbreak. The questionnaires consisted of five parts: basic demographic information and epidemiological exposure; occupational and psychological impact; concerns during the episode; coping strategies; and the Huaxi Emotional-Distress Index (HEI). RESULTS: About 24.2% of respondents experienced high levels of anxiety or/and depressive symptoms since the COVID-19 outbreak. Respondents who worried about their physical health and those who had COVID-19 infected friends or close relatives were more likely to have high HEI levels, than those without these characteristics. Further, family relationship was found to have an independent protective effect against high HEI levels. Their main concerns were that their families would not be cared for and that they would not be able to work properly. Compared to respondents with clear emotional problems, those with somewhat hidden emotional issues adopted more positive coping measures. CONCLUSIONS: About a quarter of medical staff experienced psychological problems during the pandemic of COVID-19. The psychological impact of stressful events was related to worrying about their physical health, having close COVID-19 infected acquaintances and family relationship issues. Therefore, the psychological supprot for medical staff fighting in the COVID-19 pandemic may be needed.

Applications and prospects of cryo-EM in drug discovery.

Drug discovery is a crucial part of human healthcare and has dramatically benefited human lifespan and life quality in recent centuries, however, it is usually time- and effort-consuming. Structural biology has been demonstrated as a powerful tool to accelerate drug development. Among different techniques, cryo-electron microscopy (cryo-EM) is emerging as the mainstream of structure determination of biomacromolecules in the past decade and has received increasing attention from the pharmaceutical industry. Although cryo-EM still has limitations in resolution, speed and throughput, a growing number of innovative drugs are being developed with the help of cryo-EM. Here, we aim to provide an overview of how cryo-EM techniques are applied to facilitate drug discovery. The development and typical workflow of cryo-EM technique will be briefly introduced, followed by its specific applications in structure-based drug design, fragment-based drug discovery, proteolysis targeting chimeras, antibody drug development and drug repurposing. Besides cryo-EM, drug discovery innovation usually involves other state-of-the-art techniques such as artificial intelligence (AI), which is increasingly active in diverse areas. The combination of cryo-EM and AI provides an opportunity to minimize limitations of cryo-EM such as automation, throughput and interpretation of medium-resolution maps, and tends to be the new direction of future development of cryo-EM. The rapid development of cryo-EM will make it as an indispensable part of modern drug discovery.

Impact of the COVID-19 Pandemic on Air Quality in Metropolitan New Jersey.

Improved air quality has been the silver lining of the pandemic since early 2020. The air quality in northern New Jersey (NJ) was continuously measured during the COVID-19 pandemic and through the three stages of recovery, i.e., the Stay-at-home stage, Reopening stage 1, and Reopening stage 2. A significant change in air quality was observed during the Stay-at-home stage (March 16 to May 16, 2020) as most people stayed home and industrial activity decreased 60%. Compared to 2019, carbon dioxide (CO2) decreased 17%, carbon monoxide (CO) decreased 7%, and nitrogen oxides (NOx) decreased 51% during the Stay-at-home stage in 2020. However, the ground-level ozone (O3) increased in 2020 because of the reduced NOx emission and the possibly increased levels of volatile organic compounds (VOCs) due to warmer weather. With the step-by-step reopening process, the difference in local CO2 levels between 2019 and 2020 was reduced, and the NOx concentration returned to its 2019 level. The CO2 concentrations were positively correlated with CO, and the NOx concentrations were negatively correlated with O3. Under the COVID-19 pandemic in 2020, NJ consumed 14% less natural gas and 21% less gasoline; therefore, the CO2, CO, and NOx emissions and concentration levels were reduced besides the effects of meteorology parameters on air quality in metropolitan New Jersey. Our findings support that replacing fossil fuels with electric or renewable energy in the transportation systems and industry could be beneficial for the concentration reduction of certain greenhouse gases. Supplementary Information: The online version contains supplementary material available at 10.1007/s11270-022-05764-w.

Emerging Effects of IL-33 on COVID-19.

Since the start of COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), more than 6 million people have lost their lives worldwide directly or indirectly. Despite intensified efforts to clarify the immunopathology of COVID-19, the key factors and processes that trigger an inflammatory storm and lead to severe clinical outcomes in patients remain unclear. As an inflammatory storm factor, IL-33 is an alarmin cytokine, which plays an important role in cell damage or infection. Recent studies have shown that serum IL-33 is upregulated in COVID-19 patients and is strongly associated with poor outcomes. Increased IL-33 levels in severe infections may result from an inflammatory storm caused by strong interactions between activated immune cells. However, the effects of IL-33 in COVID-19 and the underlying mechanisms remain to be fully elucidated. In this review, we systematically discuss the biological properties of IL-33 under pathophysiological conditions and its regulation of immune cells, including neutrophils, innate lymphocytes (ILCs), dendritic cells, macrophages, CD4+ T cells, Th17/Treg cells, and CD8+ T cells, in COVID-19 phagocytosis. The aim of this review is to explore the potential value of the IL-33/immune cell pathway as a new target for early diagnosis, monitoring of severe cases, and clinical treatment of COVID-19.

Adaptive immune dysfunction in patients with COVID-19 and impaired kidney function during the omicron surge.

BACKGROUND: Little is known about the characteristics of lymphocyte subsets and the association with patient outcomes in COVID-19 with and without impaired kidney function. METHODS: Lymphocyte subsets were compared in COVID-19 patients with or without kidney dysfunction. The primary outcome was a composite of all-cause mortality or intensive care unit admission. Secondary outcomes included duration of viral shedding, length of hospital stay, and acute kidney injury. RESULTS: Lymphocyte subset cell counts demonstrated the lowest in patients with severe/critical COVID-19 and kidney dysfunction. Among all lymphocyte subset parameters, Th cell count was the most significant indicator for outcomes. ROC of the combined model of Th cell count and eGFR presented better predictive value than that of the other parameters. Th cell count <394.5 cells/µl and eGFR <87.5 ml/min/1·73m2 were independently associated with poor outcomes. The propensity score matching analysis revealed consistent results. CONCLUSIONS: Reduced Th cell count and eGFR may be applied as promising predictive indicators for identifying COVID-19 patients with high risk and poor outcomes.

VV116 versus Nirmatrelvir-Ritonavir for Oral Treatment of Covid-19.

BACKGROUND: Nirmatrelvir-ritonavir has been authorized for emergency use by many countries for the treatment of coronavirus disease 2019 (Covid-19). However, the supply falls short of the global demand, which creates a need for more options. VV116 is an oral antiviral agent with potent activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We conducted a phase 3, noninferiority, observer-blinded, randomized trial during the outbreak caused by the B.1.1.529 (omicron) variant of SARS-CoV-2. Symptomatic adults with mild-to-moderate Covid-19 with a high risk of progression were assigned to receive a 5-day course of either VV116 or nirmatrelvir-ritonavir. The primary end point was the time to sustained clinical recovery through day 28. Sustained clinical recovery was defined as the alleviation of all Covid-19-related target symptoms to a total score of 0 or 1 for the sum of each symptom (on a scale from 0 to 3, with higher scores indicating greater severity; total scores on the 11-item scale range from 0 to 33) for 2 consecutive days. A lower boundary of the two-sided 95% confidence interval for the hazard ratio of more than 0.8 was considered to indicate noninferiority (with a hazard ratio of >1 indicating a shorter time to sustained clinical recovery with VV116 than with nirmatrelvir-ritonavir). RESULTS: A total of 822 participants underwent randomization, and 771 received VV116 (384 participants) or nirmatrelvir-ritonavir (387 participants). The noninferiority of VV116 to nirmatrelvir-ritonavir with respect to the time to sustained clinical recovery was established in the primary analysis (hazard ratio, 1.17; 95% confidence interval [CI], 1.01 to 1.35) and was maintained in the final analysis (median, 4 days with VV116 and 5 days with nirmatrelvir-ritonavir; hazard ratio, 1.17; 95% CI, 1.02 to 1.36). In the final analysis, the time to sustained symptom resolution (score of 0 for each of the 11 Covid-19-related target symptoms for 2 consecutive days) and to a first negative SARS-CoV-2 test did not differ substantially between the two groups. No participants in either group had died or had had progression to severe Covid-19 by day 28. The incidence of adverse events was lower in the VV116 group than in the nirmatrelvir-ritonavir group (67.4% vs. 77.3%). CONCLUSIONS: Among adults with mild-to-moderate Covid-19 who were at risk for progression, VV116 was noninferior to nirmatrelvir-ritonavir with respect to the time to sustained clinical recovery, with fewer safety concerns. (Funded by Vigonvita Life Sciences and others; ClinicalTrials.gov number, NCT05341609; Chinese Clinical Trial Registry number, ChiCTR2200057856.).

Long-term impacts of non-occupational wildfire exposure on human health: A systematic review.

The intensity and frequency of wildfires is increasing globally. The systematic review of the current evidence on long-term impacts of non-occupational wildfire exposure on human health has not been performed yet. To provide a systematic review and identify potential knowledge gaps in the current evidence of long-term impacts of non-occupational exposure to wildfire smoke and/or wildfire impacts on human health. We conducted a systematic search of the literature via MEDLINE, Embase and Scopus from the database inception to July 05, 2022. References from the included studies and relevant reviews were also considered. The Newcastle-Ottawa Scale (NOS) and a validated quality assessment framework were used to evaluate the quality of observational studies. Study results were synthesized descriptively. A total of 36 studies were included in our systematic review. Most studies were from developed countries (11 in Australia, 9 in Canada, 7 in the United States). Studies predominantly focused on mental health (21 studies, 58.33%), while evidence on long-term impacts of wildfire exposure on health outcomes other than mental health is limited. Current evidence indicated that long-term impacts of non-occupational wildfire exposure were associated with mortality (COVID-19 mortality, cardiovascular disease mortality and acute myocardial disease mortality), morbidity (mainly respiratory diseases), mental health disorders (mainly posttraumatic stress disorder), shorter height of children, reduced lung function and poorer general health status. However, no significant associations were observed for long-term impacts of wildfire exposure on child mortality and respiratory hospitalizations. The population-based high-quality evidence with quantitative analysis on this topic is still limited. Future well-designed studies considering extensive wildfire smoke air pollutants (e.g., particulate matter, ozone, nitrogen oxides) and estimating risk coefficient values for extensive health outcomes (e.g., mortality, morbidity) are warranted to fill current knowledge gaps.

Prediction of high-flow nasal cannula outcomes at the early phase using the modified respiratory rate oxygenation index.

BACKGROUND: This study was designed to explore the early predictive value of the respiratory rate oxygenation (ROX) index modified by PaO2 (mROX) in high-flow nasal cannula (HFNC) therapy in patients with acute hypoxemia respiratory failure (AHRF). METHOD: Seventy-five patients with AHRF treated with HFNC were retrospectively reviewed. Respiratory parameters at baseline and 2 h after HFNC initiation were analyzed. The predictive value of the ROX (ratio of pulse oximetry/FIO2 to respiratory rate) and mROX (ratio of arterial oxygen /FIO2 to respiratory rate) indices with two variations by adding heart rate to each index (ROX-HR and mROX-HR) was evaluated. RESULTS: HFNC therapy failed in 24 patients, who had significantly higher intensive care unit (ICU) mortality and longer ICU stay. Both the ROX and mROX indices at 2 h after HFNC initiation can predict the risk of intubation after HFNC. Two hours after HFNC initiation, the mROX index had a higher area under the receiver operating characteristic curve (AUROC) for predicting HFNC success than the ROX index. Besides, baseline mROX index of greater than 7.1 showed a specificity of 100% for HFNC success. CONCLUSION: The mROX index may be a suitable predictor of HFNC therapy outcomes at the early phase in patients with AHRF.

Public health shocks, learning and diet improvement.

Many governments aim to mitigate health risks by attacking nutritional failures. In this article, we exploit a unique natural experiment, the COVID-19 pandemic as an exogenous public health shock, to estimate the learning effects of intensive health information campaigns on nutrient intake during the pandemic. Using data from nearly-one million food purchases in China, our empirical findings strongly support the learning effect in explaining improvements in nutrient intake in the post-COVID-19 period. We conclude that when public health shocks occur, policy makers can boost relevant learning mechanisms by promoting information and education to improve individuals' awareness of preventive health behaviors of a more permanent nature, which can lead to health improvements in a society.

[A case report of neonatal severe coronavirus disease 2019]. / æ–°ç”Ÿå„¿é‡åž‹æ–°åž‹å† çŠ¶ç— æ¯’è‚ºç‚Ž1例报告.

A 7-day-old male neonate was admitted due to testing positive for SARS-CoV-2. The neonate was born through cesarian section at 40 weeks and 2 days of gestation. His mother was diagnosed with coronavirus disease 2019 (COVID-19) caused by Omicron variant infection 1 day before delivery. The neonate was separated from his mother after birth and was taken care of by his father. Three days after the neonate was born, his father was also diagnosed with COVID-19. The neonate was diagnosed with COVID-19 on day 7 of life. The neonate presented with hyperpyrexia, dyspnea, hypoxia, and feeding difficulties, and the chest CT showed the coexistence of consolidation and ground glass-like changes mainly located below the posterior pleura. He was given symptomatic support treatment such as low flow oxygen therapy and posture management after admission. He was cured and discharged after 10 days of hospitalization. This is the first reported case of neonatal severe COVID-19 caused by Omicron variant infection in China. It is necessary to take appropriate protective measures for the neonate to prevent infection when the mother or caregiver of the neonate is a suspected or confirmed cases of COVID-19.

Regional industrial growth and biopharma patent networks: empirical insights from the UK.

The COVID-19 pandemic has once again brought the significance of biopharmaceutical and medical technology sectors to the spotlight. Seeing that some of the most critical medical breakthroughs such as the speedy mRNA vaccine development were results of cross-border patenting collaboration, we have proposed in a previous work a new method to identify the cross-border collaborative regional centres in the patent networks, using a clustering comparison approach based on adjusted mutual information (AMI). In this paper, we focus on the UK industrial landscape. We use the UK bioscience and health technology sector statistics from 2015 to 2020 and look into the regional growth of each postcode area. We compare the top growth regions with the cross-border collaborative centres identified using AMI comparison at the postcode area level, and find that both long-term and short-term AMI gains show an increase in the correlation with regional annual growth rates of firm numbers in the studied sectors from 2016 to 2020, and the increase is more consistent with the short-term AMI gain. We also found that areas more central in the long-term cross-regional R&D collaboration demonstrate a stronger association with more developed industrial settings indicated by more firms and, potentially more employment and turnover in the field. However, AMI gains are found to have negative correlations with the industrial growths as a sign of possible trade-offs of being central.

A comparative study of spike protein of SARS-CoV-2 and its variant Omicron (B.1.1.529) on some immune characteristics.

The emergence of Omicron variant raises great concerns because of its rapid transmissibility and its numerous mutations in spike protein (S-protein). S-protein can act as a pathogen-associated molecular pattern and complement activator as well as antigen. We compared some immune characteristics of trimer S-proteins for wild type (WT-S) and B.1.1.529 Omicron (Omicron-S) to investigate whether the mutations have affected its pathogenicity and antigenic shift. The results indicated that WT-S and Omicron-S directly activated nuclear factor-κB (NF-κB) and induced the release of pro-inflammatory cytokines in macrophages, but the actions of Omicron-S were weaker. These inflammatory reactions could be abrogated by a Toll-like receptor 4 antagonist TAK-242. Two S-proteins failed to induce the production of antiviral molecular interferon-ß. In contrast to pro-inflammatory effects, the ability of two S-proteins to activate complement was comparable. We also compared the binding ability of two S-proteins to a high-titer anti-WT-receptor-binding domain antibody. The data showed that WT-S strongly bound to this antibody, while Omicron-S was completely off-target. Collectively, the mutations of Omicron have a great impact on the pro-inflammatory ability and epitopes of S-protein, but little effect on its ability to activate complement. Addressing these issues can be helpful for more adequate understanding of the pathogenicity of Omicron and the vaccine breakthrough infection.

Innovating policies for university internationalisation in the changing post-pandemic global field

In the past several decades, internationalisation, which is featured by people and ideas’ unparalleled transnational mobility, has become a key discourse in higher education. Despite the spectacular outcomes that higher education internationalisation has achieved, scholars have detected weaknesses and vulnerabilities in its current policy and practice, which the COVID-19 pandemic have intensified. Informed by Marginson’s global higher education field framework, this study provides a critical reflection on the field’s evolution and the prospects for its future directions from experts’ perspectives. In unstructured interviews, 20 leading international scholars confirmed the global field’s dynamism and openness, and identified certain tendencies in its evolution, including a diversified and flattening structure. The experts highlighted the urgent demand for policy innovation on university internationalisation at the regional, national, and institutional levels in response to the changing global field in the post-pandemic era. The experts also stressed the significance of internationalisation’s cultural dimension, through which higher education internationalisation can escape the trap of the capitalist logic and address its shortcomings to achieve sustainable prosperity. [ FROM AUTHOR] Copyright of Policy Reviews in Higher Education is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Agency as power: An ecological exploration of an emerging language teacher leaders' emotional changes in an educational reform.

Teacher emotion, an important aspect of language teacher psychology (LTP), has recently drawn growing attention in language teacher development studies. Previous research has shown that language teachers, typically pressured by heavy workloads, may face emotional challenges from multiplied sources, especially in the context of educational changes such as curriculum reform and the COVID-19 emergency. Current literature on teachers' emotions largely centers around ordinary language teachers, with teacher leaders whose agentic actions often exert greater influence on the effectiveness of educational changes rarely examined. Situated in a top-tier research university that has been promoting an English for Academic Purposes reform to enhance its science students' multilingual competence in academic contexts, this longitudinal case study tracked the emotional trajectory of an English teacher, Lea, for 5 years. Adopting an ecological perspective, our study confirms that language teachers' emotions vary across the reform ecosystems and extends the current inquiry by conceptualizing the intricately interrelated teacher emotion, agency, power, and identity as dynamic constructs. This study also reveals how the reform-inflected emotional changes were associated with Lea's EAP teacher and teacher leader identity construction, with both identities reinforcing each other, which to some extent reconciled Lea's emotional tensions. Our study bears significant implications for language teachers involved in educational reform, teacher leaders, and school administrators.

Clinical characteristics in immune thrombocytopenia patients after COVID-19 vaccination.

It is well documented that COVID-19 vaccines greatly reduce the severity and complications of SARS-CoV-2 infection. However, it has been reported that COVID-19 related vaccines may induce or exacerbate autoimmune hematological disorders, for example, a decrease in platelet numbers characteristic of immune thrombocytopenia (ITP). To investigate this, we retrospectively reported, for the first time, the clinical characteristics of 42 ITP patients after COVID-19 vaccination in southwest China. Of the 42 patients, 28 patients were historically diagnosed ITP, and their platelet counts (PC) decrease mainly occurred after the first-dose vaccinations. The average PC after vaccination was 39.5 × 109/L and recovered to an average of 80.6 × 109/L after treatment. Efficacy of treatment was 90%, and only 10% maintained low PC at the third month of treatment. More interestingly, of the 42 patients, 14 were newly diagnosed ITP following vaccination. Of these 14 patients, 6 patients (43%) were found PC deterioration after the first vaccine dose, and 7 patients (50%) after the second dose. Fortunately, the peripheral PC of all 14 patients recovered significantly after treatment, and the average PC was 139.4 × 109/L, including 8 CRs (complete response) and 6 PRs (partial response). Notably, 9 of the 14 cases were found to have abnormal immune indices when thrombocytopenia diagnosed. No severe organ hemorrhage was found in either subgroup. These results are reassuring the vaccine safety for ITP patients, in that the risks of aggravating thrombocytopenia by COVID-19 vaccination do exist, but it was transient and can be effectively controlled through intensive clinical monitoring and management.

CHINA’S EXPERIENCE IN THE RULE OF LAW AND THE IMPROVEMENT OF PUBLIC EMOTION AND BEHAVIOR IN EPIDEMIC PREVENTION AND CONTROL

Background China implements a comprehensive strategy of rule of law. In December 2019, some unexplained cases of pneumonia were found in Wuhan, Hubei Province. Declared the fight against coronavirus disease in 2019. In this struggle, the rule of law should also be used in the prevention and control of coronavirus diseases. And constantly committed to improving public anxiety and behavior. Research Objects and Methods In order to understand how China applies the rule of law in epidemic prevention and control and its benefits, this paper uses the method of literature research to study how China applies the rule of law in epidemic prevention and control before the 2019 coronavirus disease outbreak. There are four epidemic prevention stages from the 2019 coronavirus disease outbreak (December 2019) to November 20211. Articles provided for the study include laws, regulations, government documents, news from national media and other official sources. In order to test the influence of emotional behavior, 60 subjects were used in this study. The stressful life events scale was the adolescent self rating life events check list (ASLEC) compiled by Liu Xianchen. The scale consists of 27 items, and the six dimensions are interpersonal relationship, academic stress, punishment, loss, health adaptation and others. It measures the life events that have brought stress to the subjects in the past six months. The scale adopts Likert 6-point scoring method, and 0 ~ 5 points represent “no occurrence, no influence” to “occurrence and extremely serious influence”. Add the scores of all items. The higher the score, the more stressful life events. Internal consistency of life event scale α The coefficient is 0.876. Pearson correlation, standard deviation and statistical significance were used to illustrate the correlation. Independent sample t-test was used to verify the difference between high anxiety group and low anxiety group. According to the statistical value of anxiety, participants were divided into three groups: low, medium and high anxiety groups. The questionnaire includes two kinds of anxiety, namely debilitating anxiety and promoting anxiety. The relationship between anxiety and self-efficacy of students of different majors and genders was investigated by t-test, univariate, multivariate analysis of variance and regression analysis. Results The research shows that before the outbreak of coronavirus disease in 2019, China's epidemic prevention legal system has laid a solid foundation for combating coronavirus disease in 2019. In the four different stages of epidemic prevention and control, the rule of law lies in the prevention, treatment and control of coronavirus diseases and the punishment of illegal and criminal acts. The political and legal departments also participated in the epidemic prevention and control work together with front-line staff. In addition, the rule of law plays an important role in recovery operations. Public legal services and typical cases guide relevant departments to restore service companies. The public convenience services of the judiciary help people quickly resolve disputes without violating the epidemic prevention and control. In view of the deficiency of epidemic prevention and control, it has improved China's public health legal system and blocked the loopholes in the criminal law of the People's Republic of China (hereinafter referred to as the criminal law). Due to the complexity of coronavirus disease, people were afraid from the beginning. However, the effective application of law and penalty enhances people's confidence in prevention and control. However, there is no public psychological service law in China. The rule of law has supported the decisive achievements of the fight against the novel coronavirus, stabilized social order, and enhanced people's confidence in this fight. Conclusion Before and after the outbreak of coronavirus disease in 2019, the rule of law is very important for epidemic prevention and control. The rule of law not only helps to eliminate the virus, but also pays attention to the recovery action after the epidemic and new problems in epidemic prevention and control. The main work of the rule of law will change with the development of the epidemic. The application of law or penalty can appease people afterwards, but it is more important to establish a legal system of public psychological services. But what will not change is that epidemic prevention and control should follow the road of the rule of law. In short, the government should be fully aware of the importance of people's emotional factors. Actively improve the surrounding environment, enhance their respective roles, pay special attention to their own standardized language and behavior, and shift from single display to multi-dimensional management, coordination and cooperation. In the process of prevention and control, actively present personalized psychological state to patients, flexibly organize epidemic prevention activities, strive to create a relaxed and harmonious rehabilitation atmosphere, create a friendly and mutual emotional treatment relationship, encourage and guide more, and truly achieve people-oriented, so as to reduce anxiety and adjust the public psychology to the best state.

[Expert statement on the construction criteria of critical care department in municipal and district designated hospitals under the pandemic prevention and control].

The global coronavirus disease 2019 epidemic is still in a pandemic state. Aging population with underlying diseases is prone to become severe, and have a higher mortality. The treatment capacity of the critical care department directly determines the treatment success rate of critical illness. At present, there is still a certain gap between domestic and foreign countries in intensive care unit (ICU), which is not only in the allocation of medical staff, but also in the beds and settings. The current medical model cannot fully meet the needs of development. The experience and lessons of many major public health emergencies suggested that "dual track of peace and war" approach in discipline construction of critical care is the best medical model. Following the concept of "combination of peace and war", strengthening the discipline construction of critical care department in municipal and district designated hospitals, allocating reasonable standard ICU, step-down ICU and combat readiness ICU, establishing rapid response team, and strengthening regular training and scientific management may be the key measures to deal with the epidemic.