Different effects of vaccine on VST in critical and non-critical COVID-19 patients: A retrospective study of 363 cases.

Aim: To explore the risk factors of prolonged viral shedding time (VST) in critical/non-critical COVID-19 patients during hospitalization. Methods: In this retrospective study, we enrolled 363 patients with SARS-CoV-2 infection admitted in a designated hospital during the COVID-19 outbreak in Nanjing Lukou International Airport. Patients were divided into critical (n = 54) and non-critical (n = 309) groups. We analyzed the relationship between the VST and demographics, clinical characteristics, medications, and vaccination histories, respectively. Results: The median duration of VST was 24 d (IQR, 20-29) of all patients. The VST of critical cases was longer than non-critical cases (27 d, IQR, 22.0-30.0 vs. 23 d, IQR 20-28, P < 0.05). Cox proportional hazards model showed that ALT (HR = 1.610, 95%CI 1.186-2.184, P = 0.002) and EO% (HR = 1.276, 95%CI 1.042-1.563, P = 0.018) were independent factors of prolonged VST in total cases; HGB (HR = 0.343, 95%CI 0.162-0.728, P = 0.005) and ALP (HR = 0.358, 95%CI 0.133-0.968, P = 0.043) were independent factors of prolonged VST in critical cases, while EO% (HR = 1.251, 95%CI 1.015-1.541, P = 0.036) was the independent factor of prolonged VST in non-critical cases. Vaccinated critical cases showed higher levels of SARS-CoV-2-IgG (1.725 S/CO, IQR 0.3975-28.7925 vs 0.07 S/CO, IQR 0.05-0.16, P < 0.001) and longer VSTs (32.5 d, IQR 20.0-35.25 vs 23 d, IQR 18.0-30.0, P = 0.011) compared with unvaccinated critical patients. Fully vaccinated non-critical cases, however, presented higher levels of SARS-CoV-2-IgG (8.09 S/CO, IQR 1.6975-55.7825 vs 0.13 S/CO IQR 0.06-0.41, P < 0.001) and shorter VSTs (21 d, IQR 19.0-28.0 vs 24 d, IQR 21.0-28.5, P = 0.013) compared with unvaccinated non-critical patients. Conclusions: Our results suggested that risk factors of prolonged VST were different between critical and non-critical COVID-19 patients. Increased level of SARS-CoV-2-IgG and vaccination did not shorten the VST and hospital stay in critical COVID-19 patients.

The relationship between oxygen therapy, drug therapy, and COVID-19 mortality.

Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19). We conducted a retrospective study of COVID-19 inpatients in Wuhan Pulmonary Hospital (Wuhan, China) from January 1 to February 29, 2020. The subjects were divided into four groups due to different treatment regimes. We used the Kaplan-Meier method to determine the cumulative rates of in-hospital death and the Cox proportional hazard model to calculate the risk factors and corresponding hazard ratios. A total of 185 patients were included in this study. The median age of the patients was 62 years, including 94 men and 91 women. Kaplan-Meier analysis demonstrated that mortality was higher in older patients, higher in men, and lower in the low-flow oxygen therapy group. Body mass index (BMI) had no influence on mortality, as well as high flow oxygen therapy, Lopinavir-ritonavir (LPV/r) therapy, and the interferon-alpha add LPV/r therapy. Cox proportional hazard regression confirmed that the low flow oxygen therapy was independent protective factor for in-hospital death after adjusting for age, gender, and BMI. In conclusion, the mortality was higher in older patients, higher in men, and lower in the low-flow oxygen therapy group. BMI had no influence on mortality, as well as high flow oxygen therapy, LPV/r therapy, and interferon-alpha add LPV/r therapy.

Environmental contamination with SARS-CoV-2 in COVID-19 hospitals in Wuhan, China, 2020.

Coronavirus disease 2019 (COVID-19) pandemic has caused high number of infections and deaths of healthcare workers globally. Distribution and possible transmission route of SARS-CoV-2 in hospital environment should be clarified. We herein collected 431 environmental (391 surface and 40 air) samples in the intensive care unit (ICU) and general wards (GWs) of three hospitals in Wuhan, China from February 21 to March 4, 2020, and detected SARS-CoV-2 RNA by real-time quantitative PCR. The viral positive rate in the contaminated areas was 17.8% (28/157), whereas there was no virus detected in the clean areas. Higher positive rate (22/59, 37.3%) was found in ICU than that in GWs (3/63, 4.8%). The surfaces of computer keyboards and mouse in the ICU were the most contaminated (8/10, 80.0%), followed by the ground (6/9, 66.7%) and outer glove (2/5, 40.0%). From 17 air samples in the contaminated areas, only one sample collected at a distance of around 30 cm from the patient was positive. Enhanced surface disinfection and hand hygiene effectively decontaminated the virus from the environment. This finding might help understand the transmission route and contamination risk of SARS-CoV-2 and evaluate the effectiveness of infection prevention and control measures in healthcare facilities.

Hypoxic preconditioned hUC-MSCs enhance its therapeutic efficacy in Lipopolysaccharide induced ALI via the TLR4/MyD88 and phosphorylation of PI3K/Akt mediated by TREM-1 (preprint)

Background: Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is caused by a variety of direct or indirect factors, such as infection including Corona Virus Disease 2019 (COVID19), trauma, inhalation of harmful gases, and shock. Progression of COVID19 severity can lead to ALI/ARDS. Owing to its unclear pathogenesis, there is currently no effective treatment established for this disease. As per a past report, human umbilical cord mesenchymal stem cells (hUC-MSCs) can decrease the extent of the injury of ALI in the mice. Hypoxic preconditioning umbilical cord MSCs (HP-hUC-MSCs) demonstrated significantly enhanced proliferation and differentiation capabilities. Furthermore, the expression of several growth factors was significantly upregulated, which remarkably increased the repair of damaged lung tissues. Methods The hUC-MSCs were cultured by cell adhesion. The properties of hUC-MSCs were identified by morphology, flow cytometry, osteogenesis, and adipogenic differentiation. We employed a transwell chamber to establish a co-culture system of hUC-MSCs and BEAS-2B. Accordingly, we evaluated the hUC-MSCs ability to treat ALI/ARDS in a lipopolysaccharide (LPS)-induced mouse model. The measurements of lung histopathological changes and neutrophil infiltration, wet/dry(W/D), pro-inflammatory, and anti-inflammatory cytokines in the bronchoalveolar lavage fluid (BALF) were performed. Results The cultured hUC-MSCs demonstrated excellent osteogenic and adipogenic differentiation abilities. When compared with normal hUC-MSCs, HP-hUC- MSCs can further reduce the inflammatory response of BEAS-2B and ALI model mice induced by LPS and enhance their anti-apoptotic ability. The level of soluble triggering receptor expressed on myeloid cells (sTREM-1) in patients with severe pneumonia increased, indicating a positive correlation with the disease severity. Conclusions Our positive preclinical results suggest that HP-hUC-MSCs can exert a stronger therapeutic effect on ALI by reducing the expression of TREM-1 and that the mechanism behind this phenomenon may be related to the TLR4/MyD88 and the phosphorylation of PI3K/Akt.

Comparison of reverse-transcription qPCR and droplet digital PCR for the detection of SARS-CoV-2 in clinical specimens of hospitalized patients.

Accurate detection of severe acute respiratory syndrome coronavirus 2 is not only necessary for viral load monitoring to optimize treatment in hospitalized coronavirus disease 2019 patients, but also critical for deciding whether the patient could be discharged without any risk of viral shedding. Digital droplet PCR (ddPCR) is more sensitive than reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) and is usually considered the superior choice. In the current study, we compared the clinical performance of RT-qPCR and ddPCR using oropharyngeal swab samples from patients hospitalized in the temporary Huoshenshan Hospital, Wuhan, Hubei, China. Results demonstrated that ddPCR was indeed more sensitive than RT-qPCR. Negative results might be caused by poor sampling technique or recovered patients, as the range of viral load in these patients varied significantly. In addition, both methods were highly correlated in terms of their ability to detect all three target genes as well as the ratio of copies of viral genes to that of the IC gene. Furthermore, our results evidenced that both methods detected the N gene more easily than the ORF gene. Taken together, these findings imply that the use of ddPCR, as an alternative to RT-qPCR, is necessary for the accurate diagnosis of hospitalized coronavirus disease 2019 patients.

Analysis of Continuous Mutation and Evolution on Circulating SARS-CoV-2

Monitoring the mutation and evolution of the virus is important for tracing its ongoing transmission and facilitating effective vaccine development. A total of 342 complete genomic sequences of SARS-CoV-2 were analyzed in this study. Compared to the reference genome reported in December 2019, 465 mutations were found, among which, 347 occurred in only 1 sequence, while 26 occurred in more than 5 sequences. For these 26 further identified as SNPs, 14 were closely linked and were grouped into 5 profiles. Phylogenetic analysis revealed the sequences formed 2 major groups. Most of the sequences in late period (March and April) constituted the Cluster II, while the sequences before March in this study and the reported S/L and A/B/C types in previous studies were all in Cluster I. The distributions of some mutations were specific geographically or temporally, the potential effect of which on the transmission and pathogenicity of SARS-CoV-2 deserves further evaluation and monitoring. Two mutations were found in the receptor-binding domain (RBD) but outside the receptor-binding motif (RBM), indicating that mutations may only have marginal biological effects but merit further attention. The observed novel sequence divergence is of great significance to the study of the transmission, pathogenicity, and development of an effective vaccine for SARS-CoV-2.

Impact of COVID-19 on Mental Health of Chinese Residents in Its Initial Stage.

This study aims to investigate the effect of coronavirus disease 2019 (COVID-19) on the Chinese public's mental health during its early stage. We collected the data through an online questionnaire survey. Specifically, we adopted the impact of event scale-revised (IES-R) and state-trait anxiety inventory (STAI) to assess symptomatic responses to exposure to traumatic life events and public anxiety, respectively, in the COVID-19 pandemic outbreak. Then, we evaluated the differences in the scores among various socio-demographic groups using Kruskal-Wakkis H tests and t-tests and analyzed the IES-R, state anxiety (SA) score, and trait anxiety (TA) score using the Pearson correlation analysis. Finally, we conducted a path analysis to determine the mediating role of post-traumatic stress disorder symptoms (measured by the IES-R) in the relationship between TA and SA. The results show that the average of the SA and TA scores were 48.0 ± 10.4 and 38.0 ± 8.2, respectively; the respondents who suffered from mild, moderate, and severe psychological impacts because of the health crisis accounted for 21.9, 5.2, and 13.1%, respectively; farmers have the highest IES-R score than others; people with the highest income have the lowest SA level; a significant positive correlation existed between the IES-R and STAI scores; and TA produces both direct and indirect (through the IES-R) effects on SA. Overall, the general Chinese public exhibited much higher anxiety levels than normal in the early days of the pandemic outbreak. Accordingly, we strongly recommend psychological counseling and intervention support to mitigate the adverse psychological impacts of such an event.

Traditional Uses, Pharmacological Effects, and Molecular Mechanisms of Licorice in Potential Therapy of COVID-19.

The current Coronavirus disease 2019 (COVID-19) pandemic has become a global challenge, and although vaccines have been developed, it is expected that mild to moderate patients will control their symptoms, especially in developing countries. Licorice, not only a food additive, but also a common traditional Chinese herbal medicine, which has several pharmacological effects, such as anti-inflammation, detoxification, antibacterial, antitussive, and immunomodulatory effects, especially in respiratory diseases. Since the outbreak of COVID-19, glycyrrhizin, glycyrrhizin diamine and glycyrrhizin extract have been widely studied and used in COVID-19 clinical trials. Therefore, it is a very interesting topic to explore the material basis, pharmacological characteristics and molecular mechanism of licorice in adjuvant treatment of COVID-19. In this paper, the material basis of licorice for the prevention and treatment of COVID-19 is deeply analyzed, and there are significant differences among different components in different pharmacological mechanisms. Glycyrrhizin and glycyrrhetinic acid inhibit the synthesis of inflammatory factors and inflammatory mediators by blocking the binding of ACE 2 to virus spike protein, and exert antiviral and antibacterial effects. Immune cells are stimulated by multiple targets and pathways to interfere with the pathogenesis of COVID-19. Liquiritin can prevent and cure COVID-19 by simulating type I interferon. It is suggested that licorice can exert its therapeutic advantage through multi-components and multi-targets. To sum up, licorice has the potential to adjuvant prevent and treat COVID-19. It not only plays a significant role in anti-inflammation and anti-ACE-2, but also significantly improves the clinical symptoms of fever, dry cough and shortness of breath, suggesting that licorice is expected to be a candidate drug for adjuvant treatment of patients with early / mild COVID-19.

Abnormal Glucose Metabolism Leads To Severe COVID-19 Due To Hyperinflammation: A Cross-Sectional Study (preprint)

Background: We aimed to describe the clinical features of novel coronavirus disease 2019 (COVID-19) patients with or without diabetes, focusing on the effect of abnormal HbA1c levels on inflammatory reactions and disease severity. Methods: : A total of 190 patients with COVID-19 were included in this cross-sectional study. Clinical and laboratory characteristics were collected and compared among moderate, severe, and critical cases, as well as among diabetes, prediabetes and nondiabetes cases. Receiver operating characteristic (ROC) curves were constructed to determine the diagnostic ability of HbA1c for disease severity. Logistic regression was used to explore the relationship between HbA1c levels and worse prognosis of COVID-19. Results: : HbA1c levels at admission were significantly different in patients with moderate, severe, and critical diseases (P<0.001). The area under the curve (AUC) of HbA1c levels to distinguish between moderate and severe-critical diseases was 0.938 (95% CI 0.906–0.970). After adjustment for confounders, the results showed that the increasing odds of in-hospital deaths were associated with HbA1c levels >6.0% (42 mmol/mol) (aOR 2.971 [95% CI 1.002, 8.804], P=0.049), and the increasing odds of severe or critical COVID-19 were associated with HbA1c levels ≥5.7% (39 mmol/mol) (aOR 29.588 [95% CI 8.285, 105.457], P<0.001). In addition, HbA1c levels strongly correlated with inflammatory markers and cytokines. Conclusions: : Abnormal glucose metabolism can cause a hyperinflammatory state of COVID-19, which manifests as severe disease.

Immune mechanism of SARS-CoV-2 and its vaccine development

In this review, the immune mechanism of SARS-CoV-2 virus was systematically reviewed. Through the deep understanding of the general immune mechanism, immune response, immunosuppression, immune escape, antibody antigen, long-term immunization and other aspects of the research progress, we put forward the strategy of vaccine development.

Reconciling Mortality Forecasts with EVT Errors: An Application to Solvency Capital Requirement (preprint)

In this paper, we propose a new framework to coherently produce probabilistic mortality forecasts by exploiting techniques in extreme value theory (EVT) and forecast reconciliation. We take advantage of U.S. monthly death counts data during the period of1968-2019 to explore the seasonality and the age-gender dependence structure of mortality. Our results indicate that incorporating EVT and forecast reconciliation greatly improves the overall mortality forecast accuracy, which has important implications for life insurers in terms of rate making, reserve setting, and capital adequacy compliance. Using the solvency capital requirement (SCR) under Solvency II as an example, we show that the SCR calculated by our approach is much higher than those calculated by alternative models, suggesting that failing to account for extreme mortality risk and mortality dependence can result in significant underfunded problems for life insurers.

Status of contamination with SARS-CoV-2 in isolation wards of Huoshenshan hospital

OBJECTIVE: To evaluate the status of contamination with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) in isolation wards of Huoshenshan Hospital so as to provide scientific basis for developing reasonable strategies of management of environmental health in isolation wards of COVID-19. METHODS: From Mar 9, 2020 to Mar 29, 2020, the samples were systematically collected from 2 common isolation wards that were randomly selected from Huoshenshan Hospital. The sampling objects included environmental samples, samples from personal protective equipment(PPE) of medical staff and samples from hands of medical staff. The samples were collected by cotton swab wiping method, SARS-CoV-2 nucleic acid testing was performed by real time fluorescence quantitative polymerase chain reaction, and the testing results were colleted and analyzed. RESULTS: A total of 244 samples were collected. SARS-CoV-2 nucleic acid testing showed that 1 sample that was collected from bedrail of a patient was tested positive among 171 environmental samples, with the positive rate 0.58%;all of the samples that were collected from PPE of 49 medical staff were tested negative;1 sample that was collected from the hands of a patient was tested positive among 24 samples that were collected from hands of patients and medical staff, with the positive rate 4.17%. CONCLUSION: It is an effective way to reasonably plan for layout of isolation ward and isolation procedure and rigidly implement the systems of environmental disinfection and hand hygiene so as to reduce the degree of contamination with SARS-CoV-2 in isolation wards, cut off the transmission routes of the virus and reduce the risk of exposure to nosocomial infection, meanwhile, it is necessary to strengthen the personal hygiene management during prevention and control of COVID-19.

Pricing Extreme Mortality Risk amid the COVID-19 Pandemic (preprint)

In pricing extreme mortality risk, it is commonly assumed that the interest rate and mortality rate are independent. However, the recent COVID-19 outbreak calls this assumption into question. We propose a bivariate affine jump-diffusion structure to jointly model the interest rate and excess mortality, allowing for both correlated diffusions and joint jumps. Utilizing the latest US mortality and interest rate data, we find a strong negative correlation between the jump sizes of interest rate and excess mortality, and a much higher jump intensity when the pandemic data is included. Moreover, we construct a risk-neutral pricing measure that accounts for both a diffusion risk premium and a jump risk premium. We then solve for the market prices of risk based on mortality bond prices. Our results show that the pandemic experience can drastically change investors’ risk perception and will likely reshape the post-pandemic mortality risk market.

Pharmacological and clinical application of heparin progress: An essential drug for modern medicine.

Heparin is the earliest and most widely used anticoagulant and antithrombotic drug that is still used in a variety of clinical indications. Since it was discovered in 1916, after more than a century of repeated exploration, heparin has not been replaced by other drugs, but a great progress has been made in its basic research and clinical application. Besides anticoagulant and antithrombotic effects, heparin also has antitumor, anti-inflammatory, antiviral, and other pharmacological activities. It is widely used clinically in cardiovascular and cerebrovascular diseases, lung diseases, kidney diseases, cancer, etc., as the first anticoagulant medicine in COVID-19 exerts anticoagulant, anti-inflammatory and antiviral effects. At the same time, however, it also leads to a lot of adverse reactions, such as bleeding, thrombocytopenia, elevated transaminase, allergic reactions, and others. This article comprehensively reviews the modern research progress of heparin compounds; discusses the structure, preparation, and adverse reactions of heparin; emphasizes the pharmacological activity and clinical application of heparin; reveals the possible mechanism of the therapeutic effect of heparin in related clinical applications; provides evidence support for the clinical application of heparin; and hints on the significance of exploring the wider application fields of heparin.

Fever and Antipyretic Supported by Traditional Chinese Medicine: A Multi-Pathway Regulation.

The coronavirus disease, 2019 (COVID-19), has spread rapidly around the world and become a major public health problem facing the world. Traditional Chinese medicine (TCM) has been fully committed to treat COVID-19 in China. It improved the clinical symptoms of patients and reduced the mortality rate. In light of the fever was identified as one of leading clinical features of COVID-19, this paper will first analyze the material basis of fever, including pyrogenic cytokines and a variety of the mediators of fever. Then the humoral and neural pathways of fever signal transmission will be described. The scattered evidences about fever recorded in recent years are connected in series. On this basis, the understanding of fever is further deepened from the aspects of pathology and physiology. Finally, combining with the chemical composition and pharmacological action of available TCM, we analyzed the mechanisms of TCMs to play the antipyretic effect through multiple ways. So as to further provide the basis for the research of antipyretic compound preparations of TCMs and explore the potential medicines for the prevention and treatment of COVID-19.

Comparative Efficacy of N95, Surgical, Medical, and Non-Medical Facemasks in Protection of Respiratory Virus Infection: A Living Systematic Review and Network Meta-Analysis (preprint)

Background: Current facemask guidelines for respiratory viruses vary, impeding policymakers and the general population in determining which facemasks are effective as personal protective equipment (PPE). We aimed to evaluate the comparative efficacy of N95, surgical/medical, and non-medical facemasks in preventing respiratory virus infection.Methods: This living systematic review and network meta-analysis (NMA) incorporated 31 published and unpublished randomised controlled trials (RCTs) and observational studies investigating specific mask efficacy against influenza virus, SARS-CoV-1, MERS-CoV, and SARS-CoV-2. We searched PubMed, Google Scholar, and medRxiv databases for studies published up to 22 October 2020 (PROSPERO registration: CRD42020214729). The primary outcome of interest was the rate of respiratory viral infection.Findings: N95 or equivalent masks were the most effective in conferring protection against coronavirus infections (RR, 0.37; 95% CI, 0.24–0.55; p < 0.001) consistently across subgroup analyses of causative viruses (SARS-CoV-1/MERS-CoV versus SARS-CoV-2) and clinical settings (community setting versus healthcare setting). There was a consistent trend towards reduced coronavirus and influenza infection rates with surgical or medical facemasks, albeit without reaching statistical significance; surgical or medical masks may show effect but lack in statistical power at this stage to detect a difference.Interpretation: Our study confirmed that the use of facemasks provides protection against respiratory viral infections in general; however, the efficacies may vary according to the type of facemask used. Our findings encourage the use of N95 respirators or their equivalents (e.g., FFP2 and KN95) in both community and healthcare settings.Funding: There was no funding source for this study.Declaration of Interests: We declare no competing interests.

Clinical features and antibody response of patients from a COVID-19 treatment hospital in Wuhan, China.

Coronavirus disease 2019 (COVID-19) has rapidly evolved into a global pandemic. A total of 1578 patients admitted into a newly built hospital specialized for COVID-19 treatment in Wuhan, China, were enrolled. Clinical features and the levels of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin (Ig)M and IgG were analyzed. In total, 1532 patients (97.2%) were identified as laboratory-confirmed cases. Seventy-seven patients were identified as asymptomatic carriers (n = 64) or SARS-CoV-2 RNA positive before symptom onset (n = 13). The positive rates of SARS-CoV-2 IgM and IgG were 80.4% and 96.8%, respectively. The median of IgM and IgG titers were 37.0A U/ml (interquartile range [IQR]: 13.4-81.1 AU/ml) and 156.9 AU/ml (IQR: 102.8-183.3 AU/ml), respectively. The IgM and IgG levels of asymptomatic patients (median titers, 8.3 AU/ml and 100.3 AU/ml) were much lower than those in symptomatic patients (median titers, 38.0 AU/ml and 158.2 AU/ml). A much lower IgG level was observed in critically ill patients 42-60 days after symptom onset. There were 153 patients with viral RNA shedding after IgG detection. These patients had a higher proportion of critical illness during hospitalization (p < .001) and a longer hospital stay (p < .001) compared to patients with viral clearance after IgG detection. Coronary heart disease (odds ratio [OR], 1.89 [95% confidence interval [CI], 1.11-3.24]; p = .020), and intensive care unit admission (OR, 2.47 [95% CI, 1.31-4.66]; p = .005) were independent risk factors associated with viral RNA shedding after IgG detection. Symptomatic patients produced more antibodies than asymptomatic patients. The patients who had SARS-CoV-2 RNA shedding after developing IgG were more likely to be sicker patients.

Analysis of Continuous Mutation and Evolution on Circulating SARS-CoV-2.

Monitoring the mutation and evolution of the virus is important for tracing its ongoing transmission and facilitating effective vaccine development. A total of 342 complete genomic sequences of SARS-CoV-2 were analyzed in this study. Compared to the reference genome reported in December 2019, 465 mutations were found, among which, 347 occurred in only 1 sequence, while 26 occurred in more than 5 sequences. For these 26 further identified as SNPs, 14 were closely linked and were grouped into 5 profiles. Phylogenetic analysis revealed the sequences formed 2 major groups. Most of the sequences in late period (March and April) constituted the Cluster II, while the sequences before March in this study and the reported S/L and A/B/C types in previous studies were all in Cluster I. The distributions of some mutations were specific geographically or temporally, the potential effect of which on the transmission and pathogenicity of SARS-CoV-2 deserves further evaluation and monitoring. Two mutations were found in the receptor-binding domain (RBD) but outside the receptor-binding motif (RBM), indicating that mutations may only have marginal biological effects but merit further attention. The observed novel sequence divergence is of great significance to the study of the transmission, pathogenicity, and development of an effective vaccine for SARS-CoV-2.

Research Progress on Main Symptoms of Novel Coronavirus Pneumonia Improved by Traditional Chinese Medicine.

Novel coronavirus (COVID-19) pneumonia has become a major threat to worldwide public health, having rapidly spread to more than 180 countries and infecting over 1.6 billion people. Fever, cough, and fatigue are the most common initial symptoms of COVID-19, while some patients experience diarrhea rather than fever in the early stage. Many herbal medicine and Chinese patent medicine can significantly improve these symptoms, cure the patients experiencing a mild 22form of the illness, reduce the rate of transition from mild to severe disease, and reduce mortality. Therefore, this paper summarizes the physiopathological mechanisms of fever, cough, fatigue and diarrhea, and introduces Chinese herbal medicines (Ephedrae Herba, Gypsum Fibrosum, Glycyrrhizae Radix et Rhizoma, Asteris Radix et Rhizoma, Ginseng Radix et Rhizoma, Codonopsis Radix, Atractylodis Rhizoma, etc.) and Chinese patent medicines (Shuang-huang-lian, Ma-xing-gan-shi-tang, etc.) with their corresponding therapeutic effects. Emphasis was placed on their material basis, mechanism of action, and clinical research. Most of these medicines possess the pharmacological activities of anti-inflammatory, antioxidant, antiviral, and immunity-enhancement, and may be promising medicines for the treatment or adjuvant treatment of COVID-19 patients.