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The COVID-19 pandemic has underscored the need for effective ventilation control in public buildings. This study develops and evaluates a smart ventilation control algorithm (SIREN) that dynamically adjusts zone and system-level HVAC operation to maintain an acceptable COVID-19 infection risk and HVAC energy efficiency. SIREN uses real-time building operation data and Trim & Respond control logic to determine zone primary and system outdoor airflow rates. An EnergyPlus and CONTAM co-simulation framework was developed to assess its performance across various control scenarios and US climate zones. Results show that SIREN can flexibly control infection risk within a customized threshold (e.g. 3%) for every zone, while traditional controls cannot. At the building level, SIREN's HVAC energy consumption is comparable to a fixed 70% outdoor airflow fraction scenario, while its infection risk is lower than the 100% outdoor airflow scenario, illustrating its potential for safe and energy-efficient HVAC operation during pandemics.
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This study aims to present a smart ventilation control framework to reduce the infection risk of COVID-19 in indoor spaces of public buildings. To achieve this goal, an artificial neural network (ANN) was trained based on the results from a parametric computational fluid dynamics (CFD) simulation to predict the COVID-19 infection risk according to the zone carbon dioxide (CO2) concentration and other information (e.g., zone dimension). Four sample cases were analyzed to reveal how the CO2 concentration setpoint was varied for a given risk level under different scenarios. A framework of smart ventilation control was briefly discussed based on the ANN model. This framework could automatically adjust the system outdoor airflow rate and variable air volume (VAV) terminal box supply airflow rate to meet the needs of reducing infection risk and achieving a good energy performance. © International Building Performance Simulation Association, 2022
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Objective: To investigate the emergency surgical strategies for patients with acute abdomen during the Corona Virus Disease 2019 (COVID-19) outbreak. Method(s): The retrospective and descriptive study was conducted. The clinical data of 20 patients with acute abdomen who were admitted to the Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology between January 18, 2020 and February 10, 2020 were collected. There were 13 males and 7 females, aged from 25 to 82 years, with an average age of 57 years. All the patients with emergency surgeries received pulmonary computed tomography (CT) examination before surgery, and completed nucleic acid detection in throat swab if necessary. Patients excluded from COVID-19 underwent regular anesthesia, suspected and confirmed cases were selected a proper anesthesia based on their medical condition and surgical procedure. Patients excluded from COVID-19 underwent emergency surgeries following the regular procedure, suspected and confirmed cases underwent emergency surgeries following the three-grade protection. Observation indicators: (1) surgical situations;(2) postoperative situations. Measurement data with normal distribution were represented as average (range). Count data were described as absolute numbers. Result(s): (1) Surgical situations: of the 20 patients with acute abdomen, 16 patients were excluded from COVID-19, and 4 were not excluded. All the 20 patients underwent emergency abdominal surgeries successfully, of whom 2 received surgeries under epidural anesthesia (including 1 with open appendectomy, 1 with open repair of duodenal bulbar perforation), 18 received surgeries under general anesthesia (including 9 with laparoscopic repair of duodenal bulbar perforation, 3 with open partial enterectomy, 3 with laparoscopic appendectomy, 1 with laparoscopic left hemicolectomy, 1 with laparoscopic right hemicolectomy, 1 with cholecystostomy). The operation time of patients was 32-194 minutes, with an average time of 85 minutes. The volume of intraoperative blood loss was 50-400 mL, with an average volume of 68 mL. (2) Postoperative situations: 16 patients excluded from COVID-19 preopratively were treated in the private general ward postoperatively. One of the 16 patients had fever at the postoperative 5th day and was highly suspected of COVID-19 after an emergency follow-up of pulmonary CT showing multiple ground-glass changes in the lungs. The patient was promptly transferred to the isolation ward for treatment, and results of nucleic acid detection in throat swab showed double positive. Medical history described by the patient showed that the patient and family members were residents of Wuhan who were not isolated at home during the epidemic. There was no way to confirm whether they had a history of exposure to patients with COVID-19. Medical staffs involved in this case did not show COVID-19 related symptoms during 14 days of medical observation. The other 15 patients recovered well postoperatively. The 4 patients who were not excluded from COVID-19 preoperatively based on medical history and results of pulmonary CT examination were directly transferred to the isolation ward for treatment postoperatively. They were excluded from COVID-19 for two consecutive negative results of nucleic acid detection in the throat swab and recovered well. Two of the 20 patients with acute abdomen had postoperative complications. One had surgical incision infection and recovered after secondary closure following opening incision, sterilizing and dressing, the other one had intestinal leakage and was improved after conservative treatment by abdominal drainage. There was no death in the 20 patients with acute abdomen. Conclusion(s): Patients with acute abdomen need to be screened through emergency forward. Patients excluded from COVID-19 undergo emergency surgeries following the regular procedure, and patients not excluded from COVID-19 undergo emergency surgeries following the three-grade protection. The temperature, blood routine test and other l boratory examinations are performed to monitor patients after operation, and the pulmonary CT and throat nucleic acid tests should be conducted if necessary. Patients excluded from COVID-19 preopratively are treated in the private general ward postoperatively, and they should be promptly transferred to the isolation ward for treatment after being confirmed. Patients who are not excluded from COVID-19 preoperatively based on medical history should be directly transferred to the isolation ward for treatment postoperatively.Copyright © 2020 by the Chinese Medical Association.
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Objective: To investigate the emergency surgical strategies for patients with acute abdomen during the Corona Virus Disease 2019 (COVID-19) outbreak. Method(s): The retrospective and descriptive study was conducted. The clinical data of 20 patients with acute abdomen who were admitted to the Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology between January 18, 2020 and February 10, 2020 were collected. There were 13 males and 7 females, aged from 25 to 82 years, with an average age of 57 years. All the patients with emergency surgeries received pulmonary computed tomography (CT) examination before surgery, and completed nucleic acid detection in throat swab if necessary. Patients excluded from COVID-19 underwent regular anesthesia, suspected and confirmed cases were selected a proper anesthesia based on their medical condition and surgical procedure. Patients excluded from COVID-19 underwent emergency surgeries following the regular procedure, suspected and confirmed cases underwent emergency surgeries following the three-grade protection. Observation indicators: (1) surgical situations;(2) postoperative situations. Measurement data with normal distribution were represented as average (range). Count data were described as absolute numbers. Result(s): (1) Surgical situations: of the 20 patients with acute abdomen, 16 patients were excluded from COVID-19, and 4 were not excluded. All the 20 patients underwent emergency abdominal surgeries successfully, of whom 2 received surgeries under epidural anesthesia (including 1 with open appendectomy, 1 with open repair of duodenal bulbar perforation), 18 received surgeries under general anesthesia (including 9 with laparoscopic repair of duodenal bulbar perforation, 3 with open partial enterectomy, 3 with laparoscopic appendectomy, 1 with laparoscopic left hemicolectomy, 1 with laparoscopic right hemicolectomy, 1 with cholecystostomy). The operation time of patients was 32-194 minutes, with an average time of 85 minutes. The volume of intraoperative blood loss was 50-400 mL, with an average volume of 68 mL. (2) Postoperative situations: 16 patients excluded from COVID-19 preopratively were treated in the private general ward postoperatively. One of the 16 patients had fever at the postoperative 5th day and was highly suspected of COVID-19 after an emergency follow-up of pulmonary CT showing multiple ground-glass changes in the lungs. The patient was promptly transferred to the isolation ward for treatment, and results of nucleic acid detection in throat swab showed double positive. Medical history described by the patient showed that the patient and family members were residents of Wuhan who were not isolated at home during the epidemic. There was no way to confirm whether they had a history of exposure to patients with COVID-19. Medical staffs involved in this case did not show COVID-19 related symptoms during 14 days of medical observation. The other 15 patients recovered well postoperatively. The 4 patients who were not excluded from COVID-19 preoperatively based on medical history and results of pulmonary CT examination were directly transferred to the isolation ward for treatment postoperatively. They were excluded from COVID-19 for two consecutive negative results of nucleic acid detection in the throat swab and recovered well. Two of the 20 patients with acute abdomen had postoperative complications. One had surgical incision infection and recovered after secondary closure following opening incision, sterilizing and dressing, the other one had intestinal leakage and was improved after conservative treatment by abdominal drainage. There was no death in the 20 patients with acute abdomen. Conclusion(s): Patients with acute abdomen need to be screened through emergency forward. Patients excluded from COVID-19 undergo emergency surgeries following the regular procedure, and patients not excluded from COVID-19 undergo emergency surgeries following the three-grade protection. The temperature, blood routine test and other l boratory examinations are performed to monitor patients after operation, and the pulmonary CT and throat nucleic acid tests should be conducted if necessary. Patients excluded from COVID-19 preopratively are treated in the private general ward postoperatively, and they should be promptly transferred to the isolation ward for treatment after being confirmed. Patients who are not excluded from COVID-19 preoperatively based on medical history should be directly transferred to the isolation ward for treatment postoperatively.Copyright © 2020 by the Chinese Medical Association.
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As many schools remain closed during the COVID-19 pandemic, various courses have to be migrated online. Previous studies have showed that students' satisfaction of the courses could reflect the quality of online learning, which is determined by students' perception of online courses. Although the community of inquiry (CoI) framework provided an effective tool for measuring students' perception in online learning, the mechanisms between the CoI and satisfaction, especially the role of academic emotion and self-regulation, still need to be investigated in the online context. The present study aimed to (1) explore the relationships among three elements of the CoI framework;and (2) explore the relationships between the CoI and satisfaction, as well as the mediating role of academic emotion and self-regulation. The data was collected from 461 university students who were taking online courses in China. The results of Structural Equation Modeling showed that teaching presence significantly and positively predicted social presence and cognitive presence;both positive and negative academic emotions played the mediating roles between teaching presence, social presence and satisfaction;self-regulation played the mediating role between teaching presence, cognitive presence and satisfaction. The present study provided empirical evidence for the dynamics among the CoI framework as well as mechanisms between CoI and satisfaction in the online education environment. Copyright © 2023 Xue, Xu, Wu and Hu.
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This paper presents results of a student survey carried out among Civil and Construction Engineering undergraduate students within the School of Engineering, Design, and Built Environment at Western Sydney University. The survey investigated the learning experience of students and the effectiveness of new educational processes implemented during the COVID-19 pandemic. Both quantitative and qualitative approaches were employed to examine the perceptions of students on online teaching modes. The survey results indicated some positive features of online teaching such as flexibility, comfortable educational environments, and efficient time utilisation. However, students also found many challenges such as network instability, distractions, lack of engagement, and mental stress. The identified areas of improvement were closely related to these challenges. The survey results highlighted that most students were satisfied with the teaching strategies and assessment methods. Improved and effective teaching methodologies for students to achieve better learning outcomes are proposed and discussed. © 2022 IGI Global. All rights reserved.
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BACKGROUND: The prevalence of superficial fungal infections in India is believed to have increased substantially in the past decade. We evaluated the treatment outcomes and risk factors associated with clinical response to a treatment course of itraconazole for the management of dermatomycosis in India. METHODS: In this real-world, prospective pilot study (August 2019 to March 2020), adult participants (18-60 years), diagnosed with T. cruris or T. corporis, received itraconazole 200 mg/day (any formulation) orally for 7 days, and were followed for an additional 7 days. RESULTS: The study was terminated early due to the COVID-19 pandemic. Of 40 enrolled participants (mean [SD] age, 35.5 [12.73] years; {62.5%}] male; 37 received itraconazole and 20 (50%) completed the study. The median (range) Clinical Evaluation Tool Signs and Symptoms total score at baseline was 5.5 (2-10). Clinical response of "healed" or "markedly improved" based on the Investigator Global Evaluation Tool at day 7 (primary objective) was 42.9% (12/28; 95% CI: 24.53%, 61.19%). Itraconazole minimum inhibitory concentration for identified microorganisms, T. mentagrophytes species complex (91.7%) and T. rubrum (8.3%), was within the susceptibility range (0.015-0.25 mcg/mL). At day 14, 8/13 (61.5%) participants achieved a mycological response, 2/13 participants (15.4%) had a mycological failure and 90% showed a clinical response. CONCLUSION: COVID-19 pandemic affected patient recruitment and follow-up, so the findings call for a careful interpretation. Nevertheless, this real-world study reconfirmed the clinical efficacy and microbial susceptibility to itraconazole for the fungi causing dermatophytosis in India. TRIAL REGISTRATION: Trial registration number: Clinicaltrials.gov NCT03923010.
Subject(s)
COVID-19 , Dermatomycoses , Tinea , Adult , Male , Humans , Itraconazole/pharmacology , Antifungal Agents/pharmacology , Tinea/chemically induced , Tinea/drug therapy , Tinea/microbiology , Pilot Projects , Prospective Studies , PandemicsABSTRACT
COVID-19 is a severe global epidemic in human history. Even though there are particular medications and vaccines to curb the epidemic, tracing and isolating the infection source is the best option to slow the virus spread and reduce infection and death rates. There are three disadvantages to the existing contact tracing system: 1. User data is stored in a centralized database that could be stolen and tampered with, 2. User's confidential personal identity may be revealed to a third party or organization, 3. Existing contact tracing systems [1] [2] only focus on information sharing from one dimension, such as location-based tracing, which significantly limits the effectiveness of such systems. We propose a global COVID-19 information sharing and risk notification system that utilizes the Blockchain, Smart Contract, and Bluetooth. To protect user privacy, we design a novel Blockchain-based platform that can share consistent and non-tampered contact tracing information from multiple dimensions, such as location-based for indirect contact and Bluetooth-based for direct contact. Hierarchical smart contract architecture is also designed to achieve global agreements from users about how to process and utilize user data, thereby enhancing the data usage transparency. Furthermore, we propose a mechanism to protect user identity privacy from multiple aspects. More importantly, our system can notify the users about the exposure risk via smart contracts. We implement a prototype system to conduct extensive measurements to demonstrate the feasibility and effectiveness of our system.
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The rapid spread of the pandemic of coronavirus disease of 2019 (COVID-19) has created an unprecedented, global health disaster. During the outburst period, the paucity of knowledge and research aggravated devastating panic and fears that lead to social stigma and created serious obstacles to contain the disastrous epidemic. We propose a deep learning-based method to detect stigmatized contents on online social network (OSN) platforms in the early stage of COVID-19. Our method performs a semantic-based quantitative analysis to unveil essential spatial-temporal characteristics of COVID-19 stigmatization for timely alerts and risk mitigation. Empirical evaluations are carried out to examine our method's predictive utilities. The visualization results of the co-occurrence network using Gephi indicate two distinct groups of stigmatized words that pertain to people in Wuhan and their dietary behaviors, respectively. Netizens' participations and stigmatizations in the Hubei region, where the COVID-19 broke out, are twice (p < 0.05) and four (p <0.01) times more frequent and intense than those in other parts of China, respectively. Also, the number of COVID-19 patients is correlated with COVID-19-related stigma significantly (correlation coefficient = 0.838, p <0.01). The responses to individual users' posts have the power law distribution, while posts by official media appear to attract more responses (e.g., likes, replies, and forward). Our method can help platforms and government agencies manage public health disasters through effective identification and detailed analyses of social stigma on social media.
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With the outbreak of COVID-19 masks as the most important personal protective equipment, its necessity and importance becomes evident. Particle protective performance, as the key index of masks, the accuracy of its test result is very important. In this study, based on the high-precision photometer, the calibration method of particle protective performance testers for mask is studied. The protective performance is evaluated by the percentage of particle concentration reduction of before and after the mask. Photometric method is a relatively mature technology of particle concentration measurement, with advantages of portability and quick response. In our study, two photometers are used in the calibration. In order to ensure the accuracy, it is necessary to calibrate the two photometers first. Aerosol with concentrations about 1, 10, 20 and 30 mg/m3 is generated in the test chamber, respectively. The filter weight method is used to measure the concentration in the test chamber as the standard values. Within the weighing time, the concentration test results measured by the two photometers are recorded and calibrated with the concentration results measured by the weight method. For the two calibrated photometers, one is used to measure the particle concentration in the test chamber, the other is used to measure the particle concentration in the mask which is attached to the head mold. In this way, the particle protective performance value measured by the instrument can be calibrated. In our experiment, the extended uncertainty of the calibration results are lower than 3%. © 2021 SPIE.
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The recent COVID-19 pandemic has become a major threat to human safety and well-being. Non-pharmaceutical interventions such as contact tracing solutions are important to contain the spreads of COVID-19-like infectious diseases. However, current contact tracing solutions are fragmented with limited use of sensing technologies and centered on monitoring the interactions between individuals without an analytical framework for evaluating effectiveness. Therefore, we need to first explore generic architecture for contact tracing in the context of today's Internet of Things (IoT) technologies based on a broad range of applicable sensors. A new architecture for IoT based solutions to contact tracing is proposed and its overall effectiveness for disease containment is analyzed based on the traditional epidemiological models with the simulation results. The proposed work aims to provide a framework for assisting future designs and evaluation of IoT-based contact tracing solutions and to enable data-driven collective efforts on combating current and future infectious diseases.
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Vapor hydrogen peroxide is a strong oxidant. The final product is water and oxygen. It has the advantages of no residue, safety, rapid disinfection and wide material compatibility. Vapor hydrogen peroxide sterilization is widely used in pharmaceutical, medical, health, and biosafety fields to ensure the safety of drugs, medical devices and food, especially used for disinfection and prevention of respiratory infectious diseases such as COVID-19, MERS, SARS and H1N1. In order to ensure the sterilization effect, hydrogen peroxide detector is used to monitor the concentration of hydrogen peroxide. Based on the tunable laser absorption spectroscopy technology of 1 255 cm-1 quantum cascade laser, a vapor hydrogen peroxide concentration measuring device is developed. The concentration range is 0~1 800 ppm. The main parts of the detector are isolated from hydrogen peroxide by V-type optical path structure and optical window to avoid hydrogen peroxide corrosion. In view of the fact that the error of transmittance function approximated by the first-order Taylor series is large in the case of high concentration and high absorbance, the second-order Taylor series is used to approximate transmittance function, and the second-order function of the second harmonic signal with respect to the gas concentration is derived. The second harmonic signal is the voltage value, which is calibrated and traced by potassium permanganate titration. Finally, the measurement formula is obtained, which fits the high and low concentration hydrogen peroxide well, and the maximum fitting error is 3%. When the humidity changes, the second harmonic signal does not change, excluding the influence of moisture on the measurement of hydrogen peroxide, which is suitable for the measurement of high concentration VHP at atmospheric pressure during the sterilization process. © 2021, Peking University Press. All right reserved.
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The virus 2019-nCoV rapidly crossed the globe in the first quarter of 2020, and the global civil aviation industry contributed to the spread of the virus. The aircraft deplaning process is one of the critical stages of the spread of infectious diseases and merits careful research accordingly. However, little effort has been made to tailor the civil aircraft deplaning process to the existence of patients with severe acute airborne disease. In this study, we explore a mixed patient-health pedestrian deplaning flow from a Boeing 737-300’s with a full economy-class layout as per the virus spread dynamics during the process. We develop feasible deplaning management strategies that can reduce the inflection risk to the healthy passengers during the deplaning process. We then quantitatively compare the deplaning process before and after adopting the proposed strategies. The numerical results show that the proposed strategies effectively reduce the risk of infection during the deplaning process but sacrifice deplaning efficiency. We assert that health outweighs efficiency, and find that the proposed strategy may thus have practical value and potentially be of use to administrators. © 2021 Taylor & Francis Group, LLC and The University of Tennessee.
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Background: This study investigated the psychological status of patients and staff and implementabilty of prevention measures in hemodialysis centers in Guangdong Province of China during the Coronavirus disease 2019 (COVID-19) pandemic. Methods: An electronic questionnaire survey was performed in an anonymous manner between March 28 and April 3, 2020. Two questionnaires were designed to investigate the psychological status for hemodialysis patients and general staff (doctors, nurses, technicians, and other staff), respectively. And an additional questionnaire for administrators (directors or head nurses) of hemodialysis centers was designed to address the implementabilty of prevention measures, including strengthened patient triage management, restricting caregiver visits to patients during dialysis, strengthened prevention amongst staff, and improved patient education and protection. All the 516 hemodialysis centers registered in Guangdong Province were voluntarily invited to join the survey. Results: Total 1,782 patients, 3,400 staff, and 420 administrators responded for this survey. Patients living in rural areas reported a higher incidence of severe anxiety compared to those living in other areas. Medical staff reported better mental health than non-medical staff. With respect to implementabilty of prevention measures, hemodialysis centers in general hospitals outperformed independent blood purification centers, and tertiary hospitals outperformed other level hospitals. However, restricting acceptance of non-resident patients was lower in tertiary hospitals than that in other hospitals. Under this condition, only one patient imported from Hubei Province was diagnosed with COVID-19. Conclusions: The outbreak did not significantly affect the psychological status of most patients and medical staff. Due to the successful implementation of comprehensive prevention measures, the COVID-19 epidemic was controlled effectively. This provincial survey may provide experience for other countries and regions with similar epidemic.
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OBJECTIVES: Patients with severe or critical COVID-19 are at higher risk for developing acute kidney injury (AKI). However, whether AKI is diagnosed in all the patients and the correlation between the outcomes of COVID-19 are not well understood. PATIENTS AND METHODS: This cohort study was conducted from February 4, 2020 to April 16, 2020 in Wuhan, China. All consecutive inpatients with laboratory-confirmed COVID-19 were included in this study. AKI was defined according to the KDIGO 2012 criteria. The outcomes of patients with and without AKI and whether AKI was or was not recognized were compared. RESULTS: A total of 107 elderly patients were included in the final analysis. The median age was 70 (64-78) years, and 69 (64.5%) were men. Overall, 48 of 107 patients (44.9%) developed AKI during hospitalization. Meanwhile, 22 (45.8%) cases with AKI was not recognized (missed diagnosis) in this cohort. The Kaplan-Meier curves showed that survival was better in the non-AKI group than in the AKI group (log-rank, all P < 0.001); in the subgroups of the patients with AKI, the hospital survival rate decreased when AKI was not recognized. The survival of patients with recognized AKI was better than that of patients with unrecognized AKI (log-rank, all P < 0.001). According to the multivariate regression analysis, the independent risk factors for in-hospital mortality were AKI (recognized AKI vs non-AKI: HR = 2.413; 95% CI = 1.092-5.333; P = 0.030 and unrecognized AKI vs non-AKI: HR = 4.590; 95% CI = 2.070-10.175; P <0.001), C-reactive protein level (HR = 1.004; 95% CI = 1.000-1.008; P = 0.030), lactate level (HR = 1.236; 95% CI = 1.098-1.391; P < 0.001), and disease classification (critical vs severe: HR = 0.019; 95% CI = 1.347-26.396; P = 5.963). CONCLUSIONS: AKI is not an uncommon complication in elderly patients with COVID-19 who admitted to ICU. Extremely high rates of underdiagnosis and undertreatment of AKI have resulted in an elevated in-hospital mortality rate. Kidney protection is an important issue that cannot be ignored, and intensive care kidney specialists should take responsibility for leading the battle against AKI.
Subject(s)
Acute Kidney Injury/diagnosis , Acute Kidney Injury/mortality , COVID-19/pathology , Hospital Mortality , Missed Diagnosis , Acute Kidney Injury/etiology , Aged , China , Cohort Studies , Female , Hospitalization , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Factors , SARS-CoV-2 , Survival RateABSTRACT
COVID-19 is a newly identified disease, which is very contagious and has been rapidly spreading across different countries around the world, calling for rapid and accurate diagnosis tools. Chest CT imaging has been widely used in clinical practice for disease diagnosis, but image reading is still a time-consuming work. We aim to integrate an image preprocessing technology for anomaly detection with supervised deep learning for chest CT imaging-based COVID-19 diagnosis. In this study, a matrix profile technique was introduced to CT image anomaly detection in two levels. At one-dimensional level, CT images were simply flatted and transformed to a one-dimensional vector so that the matrix profile algorithm could be implemented for them directly. At two-dimensional level,a matrix profile was calculated in a sliding window way for every segment in the image. An anomaly severity score (CT-SS) was calculated, and the difference of the CT-SS between the COVID-19 CT images and Non-COVID-19 CT images was tested. A sparse anomaly mask was calculated and applied to penalize the pixel values of each image. The anomaly weighted images were then used to train standard DenseNet deep learning models to distinguish the COVID-19 CT from Non-COVID-19 CT images. A VGG19 model was used as a baseline model for comparison. Although extra finetuning needs to be done manually, the one-dimensional matrix profile method could identify the anomalies successfully. Using the two-dimensional matrix profiling method, CT-SS and anomaly weighted image can be successfully generated for each image. The CT-SS significantly differed among the COVID-19 CT images and Non-COVID-19 CT images (p - value <0.05). Furthermore, we identified a potential causal association between the number of underlying diseases of a COVID-19 patient and the severity of the disease through statistical mediation analysis. Compared to the raw images, the anomaly weighted images showed generally better performance in training the DenseNet models with different architectures for diagnosing COVID-19, which was validated using two publicly available COVID-19 lung CT image datasets. The metric Area Under the Curve(AUC) on one dataset were 0.7799(weighted)vs. 0.7391(unweighted), 0.7812(weighted) vs. 0.7410(unweighted), 0.7780(weighted) vs. 0.7399(unweighted), 0.7045(weighted) vs. 0.6910(unweighted) for DenseNet121, DenseNet169, DenseNet201, and the baseline model VGG19, respectively. The same trend was observed using another independent dataset. The significant results revealed the critical value of using this existing state-of-the-art algorithm for image anomaly detection. Furthermore, the end-to-end model structure has the potential to work as a rapid tool for clinical imaging-based diagnosis. CCBY