Research on the Equity and Influencing Factors of Medical and Health Resources Allocation in the Context of COVID-19: A Case of Taiyuan, China.

COVID-19 has killed millions of people worldwide. As a result, medical and health resources continue to be strained, posing a great threat to people's safety and economic and social development. This paper built the index system of influencing factors of medical and health resources containing the economy, population and society, and then classified Taiyuan into three types of regions by cluster analysis. The Gini coefficient, Theil index and agglomeration degree were then used to analyze the spatial distribution of medical and health resources allocation, and its influencing factors were studied by grey relational analysis. It was found that the population allocation of medical and health resources in Taiyuan was better than area allocation. Population has the greatest influence on the allocation of medical and health resources, followed by society and the economy. The more developed the regional economy, the more diversified the main influencing factors, and the more adjustment and control choices of medical and health resources allocation. Suggestions for optimal allocation were put forward in order to fully utilize the limited medical and health resources, effectively respond to the epidemic needs, promote the sustainable development of resources, protect the health of residents, and improve social benefits.

Molnupiravir and Its Active Form, EIDD-1931, Show Potent Antiviral Activity against Enterovirus Infections In Vitro and In Vivo.

Enterovirus infections can cause hand, foot, and mouth disease (HFDM), aseptic meningitis, encephalitis, myocarditis, and acute flaccid myelitis, leading to death of infants and young children. However, no specific antiviral drug is currently available for the treatment of this type of infection. The Unites States and United Kingdom health authorities recently approved a new antiviral drug, molnupiravir, for the treatment of COVID-19. In this study, we reported that molnupiravir (EIDD-2801) and its active form, EIDD-1931, have broad-spectrum anti-enterovirus potential. Our data showed that EIDD-1931 could significantly reduce the production of EV-A71 progeny virus and the expression of EV-A71 viral protein at non-cytotoxic concentrations. The results of the time-of-addition assay suggest that EIDD-1931 acts at the post-entry step, which is in accordance with its antiviral mechanism. The intraperitoneal administration of EIDD-1931 and EIDD-2801 protected 1-day-old ICR suckling mice from lethal EV-A71 challenge by reducing the viral load in various tissues of the infected mice. The pharmacokinetics analysis indicated that the plasma drug concentration overwhelmed the EC50 for enteroviruses, suggesting the clinical potential of molnupiravir against enteroviruses. Thus, molnupiravir along with its active form, EIDD-1931, may be a promising drug candidate against enterovirus infections.

Equilibrium of Tiered Healthcare Resources during the COVID-19 Pandemic in China: A Case Study of Taiyuan, Shanxi Province.

COVID-19 has caused more than 500 million infections and 6 million deaths. Due to a continuous shortage of medical resources, COVID-19 has raised alarm about medical and health resource allocation in China. A balanced spatial distribution of medical and health resources is a key livelihood issue in promoting the equalization of health services. This paper explores the spatial allocation equilibrium of two-tier medical and health resources and its influencing factors in Taiyuan. Using extracted POIs of medical and health resources of AMAP, we evaluated the spatial quantitative characteristics through the Health Resources Density Index, researched the spatial distribution pattern by kernel density analysis, hot spot analysis, and service area analysis, and identified the influencing factors of the spatial distribution equilibrium by the Geodetector model. The findings are as follows. The overall allocation level of medical and health resources in Taiyuan is low. There are tiered and regional differences; the response degree of primary care facilities to external factors is greater than that of hospitals; and the comprehensive influence of economic and topographic systems is crucial compared with other factors. Therefore, in order to promote the rational spatial distribution of medical and health resources in Taiyuan and to improve the construction of basic medical services within a 15 min radius, it is important to continuously improve the tiered healthcare system, uniformly deploy municipal medical and health resources, and increase the resource allocation to surrounding counties and remote mountainous areas. Future research should focus on collecting complete data, refining the research scale, analyzing qualitative differences, and proposing more accurate resource allocation strategies.

Association of renalase with clinical outcomes in hospitalized patients with COVID-19.

Renalase is a secreted flavoprotein with anti-inflammatory and pro-cell survival properties. COVID-19 is associated with disordered inflammation and apoptosis. We hypothesized that blood renalase levels would correspond to severe COVID-19 and survival. In this retrospective cohort study, clinicopathologic data and blood samples were collected from hospitalized COVID-19 subjects (March-June 2020) at a single institution tertiary hospital. Plasma renalase and cytokine levels were measured and clinical data abstracted from health records. Of 3,450 COVID-19 patients, 458 patients were enrolled. Patients were excluded if <18 years, or opted out of research. The primary composite outcome was intubation or death within 180 days. Secondary outcomes included mortality alone, intensive care unit admission, use of vasopressors, and CPR. Enrolled patients had mean age 64 years (SD±17), were 53% males, and 48% non-whites. Mean renalase levels was 14,108·4 ng/ml (SD±8,137 ng/ml). Compared to patients with high renalase, those with low renalase (< 8,922 ng/ml) were more likely to present with hypoxia, increased ICU admission (54% vs. 33%, p < 0.001), and cardiopulmonary resuscitation (10% vs. 4%, p = 0·023). In Cox proportional hazard model, every 1000 ng/ml increase in renalase decreased the risk of death or intubation by 5% (HR 0·95; 95% CI 0·91-0·98) and increased survival alone by 6% (HR 0·95; CI 0·90-0·98), after adjusting for socio-demographics, initial disease severity, comorbidities and inflammation. Patients with high renalase-low IL-6 levels had the best survival compared to other groups (p = 0·04). Renalase was independently associated with reduced intubation and mortality in hospitalized COVID-19 patients. Future studies should assess the pathophysiological relevance of renalase in COVID-19 disease.

Has the Sudden Health Emergency Impacted Public Awareness? Survey-Based Evidence from China.

Public environmental cognition is an important basis for optimizing environmental management and reducing tensions between humans and land. Although the level of environmental cognition is a gradual process under normal conditions, it often changes qualitatively because of major public emergencies. During the 2019 new coronavirus epidemic (COVID-19), the most significant public health event in recent years, 24,188 national samples were obtained based on a network survey. The comprehensive evaluation method was used to assess the impact of major public events on public environmental cognition and the characteristics of spatial and temporal distribution. The findings are as follows. (1) During the epidemic period, sudden public health emergencies effectively promoted the national residents' environmental awareness, whether urban residents or rural; most respondents generally agreed with the concept of "respect nature and cherish life". (2) The environmental cognition of national residents was higher in the northwest and lower in the northeast of China, which is suitable for economic and social development and humanistic tradition. (3) There was a clear positive correlation between environmental awareness and education level. (4) During the epidemic, nervousness of respondents had a negative effect on environmental cognition. This study provides scientific support and a basis for decision making for the government to carry out environmental management optimization and improve the ecological and environmental cognition of the public, as well as devise effective intervention mechanisms with different time and space dimensions for similar future public health emergencies.

Spatio-temporal characteristics of the novel coronavirus attention network and its influencing factors in China.

The outbreak of a novel coronavirus pneumonia (COVID-19), wherein more than 200 million people have been infected and millions have died, poses a great threat to achieving the United Nations 2030 sustainable development goal (SDGs). Based on the Baidu index of 'novel coronavirus', this paper analyses the spatial and temporal characteristics of and factors that influenced the attention network for COVID-19 from January 9, 2020, to April 15, 2020. The study found that (1) Temporally, the attention in the new coronavirus network showed an upward trend from January 9 to January 29, with the largest increase from January 23 to January 29 and a peak on January 29, and then a slow downward trend. The level of attention in the new coronavirus network was basically flat when comparing January 22 and March 4. (2) Spatially, first, from the perspective of regional differences, the network attention in the eastern and central regions decreased in turn. The network users in the eastern region exhibited the highest attention to the new coronavirus, especially in Guangdong, Shandong, Jiangsu and other provinces and cities. The network attention in Tibet, Xinjiang, Qinghai and Ningxia in the western region was the lowest in terms of the national network attention. Second, from the perspective of interprovincial differences, the attention in the new coronavirus network was highly consistent with the Hu Huanyong line of China's population boundary. The east of the Hu Huanyong line is densely populated, and the network showed high concern, mostly ranking at the third to fifth levels. (3) The number of Internet users in the information technology field, the population, and the culture and age characteristics of individuals are important factors that influence the novel coronavirus attention network.

Influence of Major Public Health Emergencies on Family Relationship and Humanistic Geographical Characteristics of China.

Harmonious and stable family relations are undoubtedly an important component of victory in terms of epidemic prevention. Take the COVID-2019 (2019 new crown pneumonia epidemic) as the major public events background; 24,188 national samples were obtained based on a network survey. We selected gender, education level, occupation type, family scale, neighborhood relationship and psychological state as independent variables, and adopted multiple logistic models to assess the impact of major public events on family relationships and the characteristics of humanistic-regional attributes. The findings are as follows: (1) During the epidemic period, major public health emergencies effectively promoted the national residents' family relationships. (2) The family relationships of national residents presented a high level in central China and a low level in the border areas of China, which is consistent with the spread of COVID-2019 in January and February. (3) Family relationship level averages between 2.201~2.507 among different groups when divided by occupation, age and education. The family relationship has improved, but the change is not drastic and the gap between various groups is not significant, so there is essentially no difference. (4) The impact of major public health emergencies on all families is nearly sudden and instant, so that family relationship changes are often also abrupt. (5) Educational level, family size and gender have a positive effect on the change in family relations, but this effect is weakened as family education level increases; while the anxiety of the interviewees and the neighborhood had a negative effect on the change in family relationship, this indicates that the better the neighborhood relations are, the more harmonious a family relationship is. The above research can provide an important scientific support and decision-making basis for the government to carry out community prevention work, respond to major public health emergencies and construct a family support social policy system in the future.

Comparative Antiviral Efficacy of Viral Protease Inhibitors against the Novel SARS-CoV-2 In Vitro.

The recent outbreak of novel coronavirus pneumonia (COVID-19) caused by a new coronavirus has posed a great threat to public health. Identifying safe and effective antivirals is of urgent demand to cure the huge number of patients. Virus-encoded proteases are considered potential drug targets. The human immunodeficiency virus protease inhibitors (lopinavir/ritonavir) has been recommended in the global Solidarity Trial in March launched by World Health Organization. However, there is currently no experimental evidence to support or against its clinical use. We evaluated the antiviral efficacy of lopinavir/ritonavir along with other two viral protease inhibitors in vitro, and discussed the possible inhibitory mechanism in silico. The in vitro to in vivo extrapolation was carried out to assess whether lopinavir/ritonavir could be effective in clinical. Among the four tested compounds, lopinavir showed the best inhibitory effect against the novel coronavirus infection. However, further in vitro to in vivo extrapolation of pharmacokinetics suggested that lopinavir/ritonavir could not reach effective concentration under standard dosing regimen [marketed as Kaletra®, contained lopinavir/ritonavir (200 mg/50 mg) tablets, recommended dosage is 400 mg/10 mg (2 tablets) twice daily]. This research concluded that lopinavir/ritonavir should be stopped for clinical use due to the huge gap between in vitro IC50 and free plasma concentration. Nevertheless, the structure-activity relationship analysis of the four inhibitors provided further information for de novel design of future viral protease inhibitors of SARS-CoV-2.

Anti-SARS-CoV-2 Potential of Artemisinins In Vitro.

The discovery of novel drug candidates with anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) potential is critical for the control of the global COVID-19 pandemic. Artemisinin, an old antimalarial drug derived from Chinese herbs, has saved millions of lives. Artemisinins are a cluster of artemisinin-related drugs developed for the treatment of malaria and have been reported to have multiple pharmacological activities, including anticancer, antiviral, and immune modulation. Considering the reported broad-spectrum antiviral potential of artemisinins, researchers are interested in whether they could be used to combat COVID-19. We systematically evaluated the anti-SARS-CoV-2 activities of nine artemisinin-related compounds in vitro and carried out a time-of-drug-addition assay to explore their antiviral mode of action. Finally, a pharmacokinetic prediction model was established to predict the therapeutic potential of selected compounds against COVID-19. Arteannuin B showed the highest anti-SARS-CoV-2 potential with an EC50 of 10.28 ± 1.12 µM. Artesunate and dihydroartemisinin showed similar EC50 values of 12.98 ± 5.30 µM and 13.31 ± 1.24 µM, respectively, which could be clinically achieved in plasma after intravenous administration. Interestingly, although an EC50 of 23.17 ± 3.22 µM was not prominent among the tested compounds, lumefantrine showed therapeutic promise due to high plasma and lung drug concentrations after multiple dosing. Further mode of action analysis revealed that arteannuin B and lumefantrine acted at the post-entry step of SARS-CoV-2 infection. This research highlights the anti-SARS-CoV-2 potential of artemisinins and provides leading candidates for anti-SARS-CoV-2 drug research and development.