Epidemiology of Acute Heart Failure in Critically Ill Patients With COVID-19: An Analysis From the Critical Care Cardiology Trials Network.

BACKGROUND: Acute heart failure (HF) is an important complication of coronavirus disease 2019 (COVID-19) and has been hypothesized to relate to inflammatory activation. METHODS: We evaluated consecutive intensive care unit (ICU) admissions for COVID-19 across 6 centers in the Critical Care Cardiology Trials Network, identifying patients with vs without acute HF. Acute HF was subclassified as de novo vs acute-on-chronic, based on the absence or presence of prior HF. Clinical features, biomarker profiles and outcomes were compared. RESULTS: Of 901 admissions to an ICU due to COVID-19, 80 (8.9%) had acute HF, including 18 (2.0%) with classic cardiogenic shock (CS) and 37 (4.1%) with vasodilatory CS. The majority (n = 45) were de novo HF presentations. Compared to patients without acute HF, those with acute HF had higher cardiac troponin and natriuretic peptide levels and similar inflammatory biomarkers; patients with de novo HF had the highest cardiac troponin levels. Notably, among patients critically ill with COVID-19, illness severity (median Sequential Organ Failure Assessment, 8 [IQR, 5-10] vs 6 [4-9]; P = 0.025) and mortality rates (43.8% vs 32.4%; P = 0.040) were modestly higher in patients with vs those without acute HF. CONCLUSIONS: Among patients critically ill with COVID-19, acute HF is distinguished more by biomarkers of myocardial injury and hemodynamic stress than by biomarkers of inflammation.

Multiscale and multisource data fusion for full-coverage PM2.5 concentration mapping: Can spatial pattern recognition come with modeling accuracy?

In spite of a variety of PM2.5 modeling schemes, general guidance for full-coverage PM2.5 concentration mapping from satellite observations is still lacking. The current technical gap is tied to how to integrate multiscale data from multiple sources to generate a spatially contiguous map that can better recognize PM2.5 distribution patterns without compromising modeling accuracy. In this study, ten different PM2.5 concentration data sets were generated using distinct mapping strategies and compared to one another, aiming to facilitate full-coverage PM2.5 concentration mapping with a generalized approach. The inter-comparison results indicated that different mapping strategies could yield comparable modeling accuracy albeit distinct PM2.5 distributions over space. Although the inclusion of PM2.5 autocorrelation terms as predictors can markedly improve the modeling accuracy, spatial patterns of PM2.5 estimations could be apparently distorted under different parameter configurations. In an attempt to balance the conflicting objectives, the optimal PM2.5 mapping scheme was proposed for broadened applications. A daily full-coverage PM2.5 concentration data set with 5-km resolution in China between 2015 and 2020 was generated for a demonstration to infer an apparent decreasing trend of PM2.5 across China over the past five years. Besides, the examination of COVID-19 pandemic impacts on regional air quality variations reveals a pattern of marked PM2.5 concentration decrease that cannot be easily realized by site-based air quality measurements. It is indicative that the proposed approach in this study can offer an optimal framework in support of various full-coverage PM2.5 mapping practices.

Impact of near-surface turbulence on PM2.5 concentration in Chengdu during the COVID-19 pandemic.

The role of meteorological conditions has long been recognized in modulating regional air quality. The impact of near-surface turbulence, nevertheless, remains poorly understood. To curb the spread of COVID-19, a variety of lockdown measures were implemented, providing us an unprecedented opportunity to examine the joint impact of emission control and meteorology on regional air quality. Here we examined the variations of planetary boundary layer (PBL) height, PM2.5 concentrations, turbulence kinetic energy (TKE), vertical wind shear, and their associations in Chengdu, Sichuan province in Southwest China between January 13 and February 24, 2020, by synergistically using micro pulse lidar, ground-level meteorological and PM2.5 measurements, as well as ultrasonic anemometer observations. During the study period, Sichuan basin was primarily regulated by the straight west wind, with an averaged wind speed of 2-3 m/s at 850 hPa, indicative of a relatively stable atmospheric dispersion condition. TKE was positively correlated with PBL height but negatively correlated with PM2.5. The PM2.5 concentration varied dramatically during pre- and post-lockdown periods but remained near constant at a relatively low level during the lockdown period. Meanwhile, the negative correlation between TKE and PM2.5 was much stronger during the lockdown and post-lockdown periods, when aerosol emissions were significantly reduced. Moreover, the correlation between TKE and PM2.5 exhibited large diurnal variability, with the strongest correlation observed during the daytime when solar radiation and turbulent mixing generally reached their peaks. Overall, the observational results in Chengdu underscore the non-negligible impact of turbulence on regional PM2.5 concentrations, which could help better understand the variation of regional air pollution events.

Systematic review and meta-analysis of clinical outcomes of COVID-19 patients undergoing gastrointestinal endoscopy.

BACKGROUND: The impact of gastrointestinal endoscopy on COVID-19 infection remains poorly investigated. We herein performed a systematic review and meta-analysis to evaluate the outcomes of COVID-19 in patients undergoing gastrointestinal endoscopy. METHOD: Ovid Medline, Ovid EMBASE, Ovid the Cochrane Library, and other electronic databases were searched until 30 November 2020 to identify publications with confirmed COVID-19 infection in patients undergoing gastrointestinal endoscopy. The primary outcomes were SARS-CoV-2 transmission, personal protective equipment use, rates of case fatality, complications, and procedural success. RESULTS: A total of 18 articles involving 329 patients were included in this systematic review and meta-analysis. The overall basic reproduction rate is 0.37, while the subgroup results from Asia, Europe, and North America are 0.13, 0.44, and 0.33, respectively. The differences in personal protective equipment use between the positive transmission and non-transmission group are mainly in isolation gowns, N95 or equivalent masks, and goggles or face-shields. The rate of case fatality, complication, and procedural success are 0.17 (95% confidence interval = 0.02-0.38), 0.00 (95% confidence interval = 0.00-0.02), and 0.89 (95% confidence interval = 0.50-1.00), respectively. The fatality rate in Europe was the highest (0.23, 95% confidence interval = 0.04-0.50), which is significantly different from other continents (p = 0.034). CONCLUSION: The risk of SARS-CoV-2 transmission within gastrointestinal endoscopy units is considerably low if proper use of personal protective equipment is applied. Similarly, a low fatality and complication rate, as well as a high procedural success rate, indicated that a full recovery of endoscopic units should be considered.

Abnormally Shallow Boundary Layer Associated With Severe Air Pollution During the COVID-19 Lockdown in China.

After the 2020 Lunar New Year, the Chinese government implemented a strict nationwide lockdown to inhibit the spread of the Coronavirus Disease 2019 (COVID-19). Despite the abrupt decreases in gaseous emissions caused by record-low anthropogenic activities, severe haze pollution occurred in northern China during the COVID lockdown. This paradox has attracted the attention of both the public and the scientific community. By analyzing comprehensive measurements of air pollutants, planetary boundary layer (PBL) height, and surface meteorology, we show that the severe air pollution episode over northern China coincided with the abnormally low PBL height, which had reduced by 45%, triggering strong aerosol-PBL interactions. After dynamical processes initiated the temperature inversion, the Beijing metropolitan area experienced a period with continuously shallow PBLs during the lockdown. This unprecedented event provided an experiment showcasing the role of meteorology, in particular aerosol-PBL interactions in affecting air quality.

Increased air pollution exposure among the Chinese population during the national quarantine in 2020.

The COVID-19 quarantine in China is thought to have reduced ambient air pollution. The overall exposure of the population also depends, however, on indoor air quality and human mobility and activities. Here, by integrating real-time mobility data and a questionnaire survey on time-activity patterns during the pandemic, we show that despite a decrease in ambient PM2.5 during the quarantine, the total population-weighted exposure to PM2.5 considering both indoor and outdoor environments increased by 5.7 µg m-3 (95% confidence interval, 1.2-11.0 µg m-3). The increase in population-weighted exposure was mainly driven by a nationwide urban-to-rural population migration before the Spring Festival coupled with the freezing of the migration backward due to the quarantine, which increased household energy consumption and the fraction of people exposed to rural household air pollution indoors. Our analysis reveals an increased inequality of air pollution exposure during the quarantine and highlights the importance of household air pollution for population health in China.

Meteorological conditions and nonpharmaceutical interventions jointly determined local transmissibility of COVID-19 in 41 Chinese cities: A retrospective observational study.

BACKGROUND: Before effective vaccines become widely available, sufficient understanding of the impacts of climate, human movement and non-pharmaceutical interventions on the transmissibility of COVID-19 is needed but still lacking. METHODS: We collected by crowdsourcing a database of 11 003 COVID-19 cases from 305 cities outside Hubei Province from December 31, 2019 to April 27, 2020. We estimated the daily effective reproduction numbers (Rt ) of COVID-19 in 41 cities where the crowdsourced case data are comparable to the official surveillance data. The impacts of meteorological variables, human movement indices and nonpharmaceutical emergency responses on Rt were evaluated with generalized estimation equation models. FINDINGS: The median Rt was 0•46 (IQR: 0•37-0•87) in the northern cities, higher than 0•20 (IQR: 0•09-0•52) in the southern cities (p=0•004). A higher local transmissibility of COVID-19 was associated with a low temperature, a relative humidity near 70-75%, and higher intracity and intercity human movement. An increase in temperature from 0℃ to 20℃ would reduce Rt by 30% (95 CI 10-46%). A further increase to 30℃ would result in another 17% (95% CI 5-27%) reduction. An increase in relative humidity from 40% to 75% would raise the transmissibility by 47% (95% CI 9-97%), but a further increase to 90% would reduce the transmissibility by 12% (95% CI 4-19%). The decrease in intracity human movement as a part of the highest-level emergency response in China reduced the transmissibility by 36% (95% CI 27-44%), compared to 5% (95% CI 1-9%) for restricting intercity transport. Other nonpharmaceutical interventions further reduced Rt by 39% (95% CI 31-47%). INTERPRETATION: Climate can affect the transmission of COVID-19 where effective interventions are implemented. Restrictions on intracity human movement may be needed in places where other nonpharmaceutical interventions are unable to mitigate local transmission. FUNDING: China Mega-Project on Infectious Disease Prevention; U.S. National Institutes of Health and National Science Foundation.