Clinical characteristics and outcomes of unvaccinated kidney transplant patients infected with SARS-CoV-2 omicron subvariant BA.5.2 (preprint)

Background  Kidney transplant (KT) recipients, who are chronically immunocompromised, face increased risks due to COVID-19 and lower vaccination rates. Limited knowledge exists regarding the clinical characteristics of unvaccinated KT patients with COVID-19. This study aimed to examine the clinical features and outcomes of unvaccinated KT patients infected with SARS-CoV-2 omicron subvariant BA.5.2.  Methods  The study enrolled 36 unvaccinated KT patients with COVID-19 and compared them to 20 infected control cases without underlying medical conditions. Clinical characteristics, laboratory tests, treatment regimens, and outcomes were analyzed. RT-PCR confirmed SARS-CoV-2 Omicron BA.5.2 subvariant infection.  Results  The KT patients experienced severe disease, with 66.7% classified as severe/critical illness. Dyspnea on admission, lower blood leukocyte and lymphocyte counts, hemoglobin levels, and serum albumin levels were more prevalent in the KT group compared to the control group. Severe/critical illness was associated with factors such as age, diabetes mellitus, lung infection CT score, and elevated levels of D-dimer, IL-6, CRP, Procalcitonin, and ferritin. Blood lymphocyte counts and serum albumin levels were significantly lower in the severe/critical illness group in KT patients. Treatment included discontinuation of anti-metabolic drugs, reduction, or discontinuation of calcineurin inhibitor drugs, antiviral therapy, and early patient-tailored nutritional support. Acute kidney injury was observed in 19.4% of cases, and four patients died during the observation period.  Conclusions  Early diagnosis, personalized treatment regimens, and diligent monitoring are crucial for unvaccinated KT patients with COVID-19. These findings contribute to understanding the clinical characteristics and management of COVID-19 in the KT population.

Clinical Characteristics of 427 Unvaccinated Chinese Adult Patients with Maintenance Hemodialysis infected with SARS-CoV-2 Omicron subvariant BA.5.2 (preprint)

To analyze the clinical characteristics and outcomes of unvaccinated adult patients on maintenance hemodialysis infected with SARS-CoV-2 Omicron subvariant BA.5.2.The clinical data of 427 maintenance hemodialysis patients infected with SARS-CoV-2 Omicron subvariant BA.5.2 in our hospital were retrospectively collected. The patients were grouped according to the severity of the disease and compared. The clinical outcome and two-month follow-up were analyzed.These results suggest that CRP level, procalcitonin level, and bicarbonate concentration are related to the severity of disease caused by SARS-CoV-2 omicron BA.5.2 infection in unimmunized MHD patients. In addition, the co-bacterial infection may be an important cause of severe illness. Therefore, strengthen the treatment of critically ill patients, and actively and effectively control infection and secondary infection; Effective vaccination is the key to improving clinical outcomes to prevent the conversion of ordinary patients to severe and critical cases. Fever, age, ORF1ab gene value, and arterial oxygen partial pressure may be independent risk factors for disease severity in COVID-19 patients.

Awareness towards COVID-19 prevention and factors related to the willingness to receive COVID-19 vaccine among people living with HIV/AIDS

Objective To understand the awareness level towards coronavirus disease 2019（COVID-19） prevention and the willingness to receive COVID-19 vaccine among people living with HIV/AIDS, and to discuss the related factors. Methods A questionnaire survey was conducted among people living with HIV/AIDS who visited the HIV clinic in the PLA General Hospital from June to December 2021.A general descriptive analysis, univariate and binary logistic regression analysis were performed to analyze data. Results A total of 169 questionnaires were analyzed.Among them, 93.5%（158/169） would like to know more about COVID-19 related knowledge, 88.2%（149/169） were reminded to inject vaccine, 98.8%（167/169） would be far away from medium and high risk areas, 97.0%（164/169） would persuade others to follow the disease preventive requirements, 14.2%（24/169） thought that the propaganda was exaggerated, 30.8%（52/169） were worried about the safety of the vaccine, 80.5%（136/169） thought that they would feel relieved after the vaccination, and 98.2%（166/169） agreed that vaccination was the most effective way to fight against COVID-19. However, only 60.4%（102/169） were willing to receive COVID-19 vaccine.The major factors affecting vaccination intention were age and feeling safe after vaccination. Conclusions People living with HIV/AIDS are more cautious about COVID-19 vaccination, therefore the coverage rate is relatively low.It is necessary for health providers to understand the specific situation of people living with HIV, and to enhance the heath education on the safety of COVID-19 vaccine especially among people with HIV/AIDS in order to improve the willingness to receive COVID-19 vaccine.

Droplets Transmission Mechanism in a Commercial Wide-Body Aircraft Cabin

COVID-19 is a respiratory infectious disease that spreads readily between people, and an urgent issue of passengers' exposure risk assessment in commercial aircraft has been raised because an aircraft cabin as a confined space may carry and transmit the disease worldwide. In this study, the droplets transmission process under different ventilation systems in a twin-aisle wide-body aircraft was studied using CFD simulations and the infection risk of passengers was assessed by the improved Wells–Riley model. Numerical results found that the transmission mechanism of droplets in the aircraft cabin was different depending on the type of ventilation systems and the location of the infectious source. Annular airflow could effectively enhance the ability of droplets transmission, while direct airflow, represented by displacement ventilation, could significantly inhibit droplets transmission. Accordingly, a new type of ventilation system was proposed based on the concept that the overall space is organized by annular airflow and the local area is direct airflow. Compared with sidewall mixing ventilation system, the infection risk of the new ventilation system presented in this study is reduced by 27%.

Psychological Characteristics of Lung Cancer Patients During the 2019 Novel Coronavirus Outbreak: A Cross-Sectional and Longitudinal Study Based on a Propensity Score-Matched Population (preprint)

Objective: This study sought to reveale the psychological characteristics of lung cancer patients at different time points of the COVID-19 epidemic. Methods: : This cross-sectional study used data from two different regional medical centers. 128 pairs of lung cancer (LC) patients and non-lung cancer subjects (NLC) were selected through propensity score matching (PSM) analysis. For the longitudinal study, the anxiety and distress state before and during the COVID-19 pandemic were surveyed through a dedicated questionnaire. Results: : A total of 135 LC patients and 165 healthy individuals were included in this cross-sectional study. After PSM analysis, 128 pairs of LC patients and NLC were matched and compared in this analysis. During the uptrend period of COVID-19 epidemic, there were significant differences in anxiety between LC patients and NLC ( P =0.005). For LC patients, the proportions of severe distress differed significantly between the uptrend and the decline period (22.05% vs 11.90%, P =0.032). In two-way repeated ANOVA analysis, no significant main effect for group or group × condition interaction effect has been founded. The distress of LC patients is mainly manifested as worry. Logistic regression showed that gender (OR=41.48, 95% CI: 9.74-17.97), age (OR=0.20, 95% CI: 0.08-0.50), and education level (OR=4.82, 95% CI: 1.98-11.69) were correlated with “worry” and contributed significantly to the model. Conclusions: : This study revealed that lung cancer patients had significant anxiety and distress during the uptrend period of the COVID-19 epidemic. The distress states of LC patients mainly manifested as worry, which was associated with age, gender, and education level.

Declined eGFR Associated With Poor Prognosis in COVID-19 Patients in Wuhan, China: A Retrospective Cohort Study (preprint)

Background: Increasing evidence revealed that kidney was one of the targets of SARS-CoV-2. However, the incidences of kidney abnormalities were significantly different, from 0·5 to 75·4% in coronavirus disease 2019 (COVID-19) patients. The association of kidney injury with prognosis remain controversial.Methods: In this retrospective cohort study, laboratory confirmed COVID-19 in patients with severe type were enrolled. Demographic, clinical, and laboratory data were collected. Association of estimated glomerular filtration rate (eGFR) with 28-days mortality was analyzed.Findings: The total 28-days mortality of hospitalization was 22·3% (79/354). Non-survivors had a significantly declined eGFR levels than survivors (75·95 [IQR: 47·22,92·84] ml/min/1·73m2 vs. 96·43 [IQR: 84·11,108·47] ml/min/1·73m2, P <0·0001). The 28-days mortality in declined eGFR group (<90 ml/min/1·73m2) was significantly higher than that in normal eGFR group (38·5% vs. 10·7%, P <0·0001). Multivariate logistic regression revealed that the independent risk factors of 28-days outcome included lower eGFR (OR: 3·97, 95%CI: 1·42-11·11), elevated WBC (OR: 7·08, 95%CI: 3·15-15·90), lymphopenia (OR: 2·58, 95%CI: 1·21-5·49), and IL-6 (OR: 7·90, 95%CI: 2·19-28·49). Kaplan-Meier analysis indicated the survival disadvantage in patients with declined eGFR. ROC curve showed the eGFR cut-off value for predicting 28-days death was 82·2 μmol/L, with the sensitivity of 76·7%, and specialty of 66·3%.Interpretation: Declined eGFR was associated with poor prognosis, and could be used an independent risk factor of 28-days mortality in COVID-19 patients. Early detection, and surveillance for eGFR may benefit to identify patients with high-risk of progression.Funding Information: Program of Key Talents of Medical Science in Jiangsu Province, Suzhou science and technology development plan.Declaration of Interests: The authors have declared that no conflict of interest exists.Ethics Approval Statement: This study was approved by the institutional review boards at the First Affiliated Hospital of Soochow University and Wuhan Tongji Hospital. As COVID-19 is an emerging infectious disease, the written informed consent was exempted.

Declined eGFR Associated with Poor Prognosis in COVID-19 Patients in Wuhan, China: A Retrospective Cohort Study (preprint)

Background: Increasing evidence revealed that kidney was one of the targets of SARS-CoV-2. However, the incidences of kidney abnormalities were significantly different, from 0.5 to 75.4% in coronavirus disease 2019 (COVID-19) patients. The association of kidney injury with prognosis remain controversial. Methods: : In this retrospective cohort study, laboratory confirmedCOVID-19inpatients with severe type were enrolled. Demographic, clinicaland laboratory data were collected. Association of estimated glomerular fifiltration rate (eGFR)with 28-days mortality was analyzed. Results: : The total 28-days mortality of hospitalizationwas 22.3% (79/354). Non-survivors had a significantly declined eGFR levels than survivors (75.95 [IQR: 47.22,92.84] ml/min/1.73m 2 vs. 96.43 [IQR: 84.11,108.47] ml/min/1.73m 2 , P <0.001). The 28-days mortality in declined eGFR group (<90 ml/min/1.73m 2 ) was significantly higher than that in normal eGFR group (38.5% vs. 10.7%, P <0.001). Multivariate logistic regression revealed that the independent risk factors of 28-days outcome included lower eGFR (OR: 3.97, 95%CI: 1.42-11.11), elevated WBC (OR: 7.08, 95%CI: 3.15-15.90), lymphopenia (OR: 2.58, 95%CI: 1.21-5.49)andIL-6 (OR: 7.90, 95%CI: 2.19-28.49). Kaplan-Meier analysis indicated the survival disadvantage in patients with declined eGFR. ROC curve showed the eGFR cut-off value for predicting 28-days death was 82.2 μmol/L, with the sensitivity of 76.7% and speciality of 66.3%. Conclusion: Declined eGFR was associated with poor prognosis and could be used an independent risk factor of 28-days mortality in COVID-19 patients. Early detection and surveillance for eGFR may benefit to identify patients with high-risk ofprogression.

Clinical Characteristics, Risk Factors and Cardiac Manifestations of Cancer Patients with COVID-19 (preprint)

Background: Coronavirus disease 2019 (COVID-19) has been associated with cardiovascular features, which may be deteriorated in cancer patients.Methods: We retrospectively assessed 1,244 COVID-19 patients from February 1st to August 31st (140 cancer and 1104 non-cancer patients). Clinical data and laboratory findings were obtained and compared between cancer and non-cancer groups. Risk factors for in-hospital mortality were identified by multivariable COX regression models.Findings: The median age of cancer group was older than that in non-cancer patients [61 (57-67) vs. 56 (40-68), p < 0.001]. For cancer group, 56% were in severe and critical status, while the proportion was 10% for non-cancer group. Cancer patients had increased levels of leukocyte, neutrophil count and BUN (all p < 0.01), while lymphocyte count was significantly lower (p < 0.001). The most common solid tumor types were gastrointestinal cancer (26%), lung cancer (21%), breast and reproductive cancer (both 19%). There is a rising for cardiac biomarkers, including Pro-BNP, cTnI, MYO, CK-MB, and D-Dimer in COVID-19 cancer population, especially in deceased cancer subjects. The 30-day in hospital mortality in cancer group was dramatically raised than that in non-cancer group (12.9% vs. 4.0%, p<0.01). In multivariable COX regression models, fever, disease severity status, underlying diseases were risk factors for mortality. The Pro-BNP and D-Dimer levels were significantly increased in cancer subjects with cardiovascular disease.Interpretation: COVID-19 cancer patients relate to deteriorating conditions, increased risk of admission to intensive care units and in-hospital mortality. They display severely impaired myocardium, damaged heart function and imbalanced homeostasis of coagulation, which warrants more aggressive treatment. Funding: The current work was supported by the National Natural Science Foundation Project of China (Grant No. 81670304) and the Fundamental Research Funds for the Central Universities of China (NO.2042019kf0058).Declaration of Interests: All authors report no relationship or conflict of interest to disclose.Ethics Approval Statement: This study was approved by the National Health Commission of China and the institutional review board at Renmin Hospital of Wuhan University (Wuhan, China).

Pre-existing Health Conditions and Epicardial Adipose Tissue Volume: Potential Risk Factors for Myocardial Injury in COVID-19 Patients.

Background: Myocardial injury is a life-threatening complication of coronavirus disease 2019 (COVID-19). Pre-existing health conditions and early morphological alterations may precipitate cardiac injury and dysfunction after contracting the virus. The current study aimed at assessing potential risk factors for COVID-19 cardiac complications in patients with pre-existing conditions and imaging predictors. Methods and Results: The multi-center, retrospective cohort study consecutively enrolled 400 patients with lab-confirmed COVID-19 in six Chinese hospitals remote to the Wuhan epicenter. Patients were diagnosed with or without the complication of myocardial injury by history and cardiac biomarker Troponin I/T (TnI/T) elevation above the 99th percentile upper reference limit. The majority of COVID-19 patients with myocardial injury exhibited pre-existing health conditions, such as hypertension, diabetes, hypercholesterolemia, and coronary disease. They had increased levels of the inflammatory cytokine interleukin-6 and more in-hospital adverse events (admission to an intensive care unit, invasive mechanical ventilation, or death). Chest CT scan on admission demonstrated that COVID-19 patients with myocardial injury had higher epicardial adipose tissue volume ([EATV] 139.1 (83.8-195.9) vs. 92.6 (76.2-134.4) cm2; P = 0.036). The optimal EATV cut-off value (137.1 cm2) served as a useful factor for assessing myocardial injury, which yielded sensitivity and specificity of 55.0% (95%CI, 32.0-76.2%) and 77.4% (95%CI, 71.6-82.3%) in adverse cardiac events, respectively. Multivariate logistic regression analysis showed that EATV over 137.1 cm2 was a strong independent predictor for myocardial injury in patients with COVID-19 [OR 3.058, (95%CI, 1.032-9.063); P = 0.044]. Conclusions: Augmented EATV on admission chest CT scan, together with the pre-existing health conditions (hypertension, diabetes, and hyperlipidemia) and inflammatory cytokine production, is associated with increased myocardial injury and mortality in COVID-19 patients. Assessment of pre-existing conditions and chest CT scan EATV on admission may provide a threshold point potentially useful for predicting cardiovascular complications of COVID-19.

The influence of pre-existing hypertension on coronavirus disease 2019 patients.

Hypertension represents one of the most common pre-existing conditions and comorbidities in Coronavirus disease 2019 (COVID-19) patients. To explore whether hypertension serves as a risk factor for disease severity, a multi-centre, retrospective study was conducted in COVID-19 patients. A total of 498 consecutively hospitalised patients with lab-confirmed COVID-19 in China were enrolled in this cohort. Using logistic regression, we assessed the association between hypertension and the likelihood of severe illness with adjustment for confounders. We observed that more than 16% of the enrolled patients exhibited pre-existing hypertension on admission. More severe COVID-19 cases occurred in individuals with hypertension than those without hypertension (21% vs. 10%, P = 0.007). Hypertension associated with the increased risk of severe illness, which was not modified by other demographic factors, such as age, sex, hospital geological location and blood pressure levels on admission. More attention and treatment should be offered to patients with underlying hypertension, who usually are older, have more comorbidities and more susceptible to cardiac complications.

Clinical characteristics of 44 patients with coronavirus disease 2019 in Yongzhou

Objective: To analyze the general situation and clinical characteristics of coronavirus disease 2019 (COVID-2019)in Yongzhou city and provide reference for COVID-2019 control. Methods: 44 patients with COVID-2019 admitted in Yongzhou central hospital were included in the study. According to the clinical classification, the patients were divided into two groups: mild and moderate group (MM group, 32 cases), severe and critical group (SC group, 12 cases). The general situation, epidemiology, clinical symptoms, medical history and complications, laboratory examination, imaging characteristics and treatment plan of the two groups were compared and analyzed, and the clinical characteristics, treatment process and prognosis were summarized. Results: There was no significant difference between mild and moderate group and severe and critical group in age, gender, definite incubation period or definite infection transmission generations (P=0.072, 0.543, 0.108, 0.067). Compared with MM group, SC group needs longer hospitalization time(16.5±6.0 vs 12.4±4.5, P=0.019). There was no significant difference between the two groups in clinical symptoms of fever, cough, fatigue, pharyngeal pain, nasal obstruction, runny nose, diarrhea, history of hypertension or diabetes (each P> 0.05), Compared with MM group, SC group had higher proportion of hypokalemia and AST increase (58.3％ vs 15.6％, P=0.014;41.7％ vs 9.4％, P=0.042). There was no significant difference in hypoproteinemia, elevated ALT, respiratory failure or heart failure (each P > 0.05). Compared with MM group, SC group had higher WBC count, higher neutrophil count, lower lymphocyte count and more multileaf lesions in the laboratory and CT results (91.7％ vs 37.5％, P=0.010;91.7％ vs 46.9％, P=0.019;91.7％ vs 18.8％, P=0.000;100.00％ vs 59.4％, P=0.024). There was no significant difference between the two groups in decrease of leukocyte count, neutrophil count, eosinophil count, increase of C-reactive protein, ESR, LDH, ground glass or subpleural or extrapulmonary zone were the main pathological changes of CT (each P > 0.05). Compared with MM group, SC group were different in the use rate of antibiotics, glucocorticoids, immunoglobulin and noninvasive ventilator in the treatment plan (91.7％ vs 53.1％, P=0.044;100.00％ vs 59.4％, P=0.024;83.3％ vs 28.1％, P=0.001;41.7％ vs 0, P=0.001). 44 cases (100％) were cured without death. Conclusion: Compared with MM group, SC group is more likely to have increased leukocyte count, increased neutrophil count, decreased lymphocyte count and CT lesions with multileaf focus, more likely to have hypokalemia and increased AST, more likely to use antibiotics, glucocorticoids, immunoglobulins and non-invasive ventilator.

Cardiac involvement in COVID-19 patients: mid-term follow up by cardiac magnetic resonance imaging (preprint)

Background: Coronavirus disease 2019 (COVID-19) induces myocardial injury, either direct myocarditis or indirect injury due to systemic inflammatory response. Myocardial involvement has been proved to be one of the primary manifestations of COVID-19 infection, according to laboratory test, autopsy, and cardiac magnetic resonance imaging (CMRI). However, the middle-term outcome of cardiac involvement after the patients were discharged from the hospital is yet unknown. The present study aimed to evaluate mid-term cardiac sequelae in recovered COVID-19 patients by CMRIMethods: A total of 47 recovered COVID-19 patients were prospectively recruited and underwent CMRI examination in this study. The CMRI protocol consisted of black blood fat-suppressed T2 weighted imaging (BB-T2WI), T2 star mapping, left ventricle cine imaging, pre- and post-contrast T1 mapping, and late gadolinium enhancement (LGE). Myocardium edema and LGE were assessed in recovered COVID-19 patients. The left ventricle (LV) and right ventricle (RV) function and LV mass were assessed and compared with normal controls.Results: Finally, 44 recovered COVID-19 patients and 31 normal controls were included in this study. No edema was observed in any patient. LGE was found in 13 patients. All LGE lesions were located in the middle myocardium and/or sub-epicardium with a scattered distribution. Further analysis showed that LGE-positive patients had significantly decreased left ventricle peak global circumferential strain (LVpGCS), right ventricle peak global circumferential strain (RVpGCS), right ventricle peak global longitudinal strain (RVpGLS) as compared to non-LGE patients (p＜0.05), while no difference was detected between the non-LGE patients and normal controls.Conclusion: Myocardium injury existed in about 30% of COVID-19 patients. These patients had peak right ventricle strain that decreased at the 3-month follow-up. Cardiac MRI can monitor the COVID-19-induced myocarditis progression, and CMR strain analysis is a sensitive tool to evaluate the recovery of left ventricle circumferential contraction dysfunction and right ventricular dysfunction.

Mental health of spinocerebellar ataxia patients during COVID-19 pandemic: a cross-sectional study (preprint)

COVID-19 is a global concern nowadays, and the psychological impact of the pandemic cannot be overlooked. People are under insurmountable pressure, which may lead to psychological problems such as anxiety and depression. The purpose of this study was to evaluate the mental health of spinocerebellar ataxia (SCA) patients during COVID-19 pandemic and to analyze its influencing factors. We conducted an online questionnaire survey among 307 SCA patients from China. The contents of the questionnaire included general information, the self-rating anxiety scale (SAS), the self-rating depression scale (SDS). The relevant influencing factors included COVID-19 risk factors, age, gender, BMI (body mass index), educational background, disease course, and score of the scale for the assessment and rating of ataxia (SARA). Results indicate the 307 SCA patients had an anxiety rate of 34.9%, along with a depression rate of 56.7%. Their SAS and SDS scores were significantly higher than those of the Chinese norm group (SAS: 45.8±10.1 vs. 37.2±12.6, P < 0.01; SDS: 55.1±12.2 vs. 41.9±10.6, P < 0.01). Risks of exposure to COVID-19, educational level, and disease course may be factors affecting mental health status. The existence of a positive correlation among the scores of SARA, SAS and SDS scale was demonstrated, the higher the SARA score, the higher the risk of anxiety and depression. Anxiety and depression were more prevalent in SCA patients compared with the normal population, and depression was more common than anxiety during this pandemic. More psychological attention should be paid to SCA patients during COVID-19 pandemic.

Prognostic Value of Serum Creatinine in Severe Covid-19 Patients in Wuhan, China: A Retrospective Cohort Study (preprint)

Objectives: Although the respiratory and immune systems are the major targets of SARS-CoV-2, increasing evidence revealed that kidney injury was not rare in coronavirus disease 2019 (COVID-19). However, the incidences of kidney abnormalities were significantly different, from 0.5 to 75.4% in several reports. The association of kidney injury with prognosis remain controversial.Methods:In this retrospective single center cohort study, laboratory confirmedCOVID-19inpatients with severe type were enrolled. Demographic, clinicaland laboratory data were collected. Association ofserum creatinine (SCr)with 28-days mortality in severe COVID-19 patients was analyzed.Results:18.79% (48/304) patients died during the first 28-days of hospitalization.Non-survivors had a significantly higher SCr levels than survivors (109.27μmol/L vs. 69.99μmol/L, P <0.001). The 28-days mortality in high SCr group (>76μmol/L) was significantly higher than that in low SCr group (31.7% vs. 7.5%, P <0.001). Multivariate logistic regression revealed that the independent risk factors of 28-days outcome included age(OR: 2.95, 95%CI: 1.08-8.05), WBC (OR: 6.09, 95%CI: 2.27-6.39), lymphopenia (OR: 3.49, 95%CI: 1.55-7.92), IL-6 (OR: 4.44, 95%CI: 1.64-11.99) and SCr (OR: 2.69, 95%CI: 1.18-6.11). Kaplan-Meier analysis demonstrated the survival disadvantage in patients with high SCr levels (>76μmol/L). ROC curve showed the SCr cut-off value for predicting 28-days death was 77.5 μmol/L, with the sensitivity of 68.8% and speciality of 74.1%.Conclusion: SCr was associated with poor prognosis and might be an independent risk factor for in-hospital death. The cut-off value of SCr for prognosis prediction was 77.5 μmol/L, with the sensitivity of 68.8% and speciality of 74.1%.

Clinical Features and Lymphocyte Subsets in Recovered Covid-19 Patients With Prolonged Viral Rna Shedding Duration (preprint)

Background:The 2019 novel coronavirus disease (COVID-19) spread in many countries.Data about viral shedding duration, particularly the prolonged ones of the pathogen SARS-Coronavirus-2 (SARS-CoV-2) is scarce. The longest viral RNA sheddingduration reported previously was 37 days. Herein, we report the clinical and immunologic features ofrecovered COVID-19cases with a medium viral RNA shedding duration of 44 days. Cases presentation: Nine laboratory-confirmed COVID-19 cases from Wuhan with viral RNA shedding duration more than 30 days were included in our study,5 of them were moderate.Althoughinflammatory markers were significantlyhigher, the medium duration in severepatients was similar to that in moderate patients (44.5days vs. 43.6days). Severepatients showed higher NK cells levels, although the T cells and B cells were lower as compared with moderate patients. Contrary to previous reports in influenza, prolonged viralshedding time did not cause poor prognosis in this study.Conclusions: There could be characteristic immunological dysfunction in COVID-19 patients with prolonged viral shedding durationand interestingly, prolonged viral shedding duration seemed not to be related with poor prognosis.

Clinical observation of glucocorticoids application in patients with severe coronavirus disease 2019 (COVID-19): a descriptive study (preprint)

Background The coronavirus disease 2019 (COVID-19) caused an ongoing pandemic and bring heavy burden globally. We retrospectively investigated the effect of glucocorticoids on clinical symptoms, course of disease, and negative change of nucleic acid detection in patients with severe COVID-19.Methods Individual demographics data, CT images, clinical outcomes, laboratory investigations, treatment of patients with severe COVID-19 were collected from electronic medical records of the Central Hospital of Wuhan, from January 28 to February 28, 2020.Results Eighteen severe cases of COVID-19 received low-dose of glucocorticoid treatments. They were initially treated with 40 mg methylprednisolone with gradually reduced doses and changed into oral prednisolone. The courses of glucocorticoid treatments ranged from 4 to 30 days. The pulmonary infections were absorbed to different degrees in 16 cases, one case deteriorated in CT imaging and one had no significant change. All cases had fever regression. Fifteen cases could respire without oxygen supply. Two were still inhaled oxygen through nasal catheters and one with high flow oxygen gradually transferred to face mask for oxygen supply. Five cases discharged. Twelve cases who were in stable conditions for treatment remained in hospital. One case was still in critical condition. The results of three re-examinations of SARS-Cov-2 nucleic acids by RT-PCR were negative.Conclusions The early use of low-dose glucocorticoid therapy in severe COVID-19 infection may have a positive effect on the prevention and treatment of disease deterioration.

Early chest computed tomography to diagnose COVID-19 from suspected patients: A multicenter retrospective study.

Objective: The purpose of this study was to distinguish the imaging features of COVID-19 from those of other infectious pulmonary diseases and evaluate the diagnostic value of chest CT for suspected COVID-19 patients. Methods: Adult patients suspected of COVID-19 aged >18 years who underwent chest CT scans and reverse-transcription polymerase chain reaction (RT-PCR) tests within 14 days of symptom onset were enrolled. The enrolled patients were confirmed and grouped according to the results of the RT-PCR tests. The basic demographics, single chest CT features, and combined chest CT features were analyzed for the confirmed and nonconfirmed groups. Results: A total of 130 patients were enrolled, with 54 testing positive and 76 testing negative. The typical CT imaging features of the positive group were ground glass opacities (GGOs), the crazy-paving pattern and air bronchogram. The lesions were mostly distributed bilaterally and close to the lower lungs or the pleura. When features were combined, GGOs with bilateral pulmonary distribution and GGOs with pleural distribution were more common among the positive patients, found in 31 (57.4%) and 30 patients (55.6%), respectively. The combinations were almost all statistically significant (P < .05), except for the combination of GGOs with consolidation. Most combinations presented relatively low sensitivity but extremely high specificity. The average specificity of these combinations was approximately 90%. Conclusions: The combinations with GGOs could be useful in the identification and differential diagnosis of COVID-19, alerting clinicians to isolate patients for prompt treatment and repeat RT-PCR tests until the end of incubation.