Epidemiological and etiological analysis of a case cluster caused by norovirus in a nursing home in Lanzhou

Objective To understand the epidemiology and etiology of a cluster of cases with gastroenteritis in a nursing home in Anning district of Lanzhou, and to provide a scientific evidence for the prevention and control of norovirus diarrhea in community nursing centers. Methods From January 28 to February 4 2021, an epidemiological investigation was conducted on all diarrhea cases, nursing staff and chefs in a nursing home in Anning district, Lanzhou city.Samples of patients′ anal swabs, feces, vomitus were collected for norovirus detection by real-time fluorescent PCR.ORF1/ORF2 junction region of norovirus in some selected positive samples（Ct value ≤ 25） was sequenced.MEGA-X software was used to construct a phylogenetic tree for genetic evolution analysis using the neighboring method. Results The first case was confirmed on January20,2021,and the number of cases peaked during January 25and 29.A total of 58clinically diagnosed cases were reported,57were older people,with an incidence of（57/360,15.83%）.Diarrhea（50/58,86.21%）,vomiting（35/58,60.34%）,nausea（13/58,22.41%）and abdominal pain（6/58,10.34%）were common symptoms,all cases were mild.Fifty-three asymptomatic cases were detected among chefs,housekeepers and nurses.A total of 163specimens were tested,the positive rate of norovirus GⅡwas 49.08%（80/163）.The positive rate of fecal samples collected from nurses,chefs and housekeepers was 48.62%（53/109）,and was11.11%（2/18）in environmental surface swabs.The possibility of other pathogenic infections such as SARS-CoV-2was ruled out by further tests.Thirteen positive samples were selected for sequencing,and 9were successfully sequenced,they were all recombinant GⅡ.4Sydney＿2012 [P16]genotypes,forming an independent cluster,while in a large evolutionary branch with the 2020GⅡ.10 [P16]and 2019GⅡ.2 [P16]virus strains in Lanzhou city,showing a relative close genetic connection. Conclusions GⅡ.4Sydney＿2012[P16]genotype of norovirus is found to be causative pathogen of this outbreak,and close contact is the main reason of the outbreak and persistence of the infection,so asymptomatic infections of norovirus play an important role in the disease spreading.Therefore,public health management in nursing homes and other centralized nursing facilities should be strengthened especially for asymptomatic workers in order to prevent virus transmission.

To what extent do college students cooperate with pandemic prevention and control policies? Compliance behaviours of young Chinese intellectual elites (preprint)

Background: During a crisis the COVID-19 pandemic, it is vital for young people, who always actively engage in more social activities, to comply with the government’s prevention and control measures.  Methods: An online questionnaire was administered to people aged 18 years and above from mainland Chinese from February to May 2022. We used student's t test and chi-square tests to analyse the college students’ compliance behaviours. Compliance motivation was divided into calculated, motivation and social motivations. We compared young people’s compliance motivations across different age and education groups.  Results: This study includes four key findings. First, the college students reported a high degree of compliance with COVID-19 pandemic prevention policies, especially those regarding obtaining vaccinations and providing codes or cards as a proof of health status, followed by wearing mask, taking nucleic acid tests, and maintaining a physical distance of at least 1 metre from every other person at public places. Second, older college students tended to comply with the pandemic prevention policies, while no significantly different variation was found among different education groups. Third, the primary motivations of the college students’ compliance were duties and obligations (77.5%), risk perception (63.7%), previous experience (56.7%), and trust in the government (52.1%); less important were bandwagon effect (5.4%), authoritative values (5%) and fear of being punished (2.8%). Fourth, compared with older college students, young college student were more likely to comply control policy because of government trust (52.1% vs 40.9%) and sense of responsibility (77.5% vs 72.7%), while older graduated students were more strongly motivated by risk perception (75.3% vs 63.7%) and past experience (61.8% vs 56.7%). Conclusion: Although college students’ compliance behaviour during the pandemic were motivated by a wide range of factors, our study identified that normative and calculated motivations were the most influential ones. Deterrence from calculated motivation and conformity from social motivation played only minor roles in impacting college students’ compliance.

NAGNN: Classification of COVID‐19 based on neighboring aware representation from deep graph neural network

COVID‐19 pneumonia started in December 2019 and caused large casualties and huge economic losses. In this study, we intended to develop a computer‐aided diagnosis system based on artificial intelligence to automatically identify the COVID‐19 in chest computed tomography images. We utilized transfer learning to obtain the image‐level representation (ILR) based on the backbone deep convolutional neural network. Then, a novel neighboring aware representation (NAR) was proposed to exploit the neighboring relationships between the ILR vectors. To obtain the neighboring information in the feature space of the ILRs, an ILR graph was generated based on the k‐nearest neighbors algorithm, in which the ILRs were linked with their k‐nearest neighboring ILRs. Afterward, the NARs were computed by the fusion of the ILRs and the graph. On the basis of this representation, a novel end‐to‐end COVID‐19 classification architecture called neighboring aware graph neural network (NAGNN) was proposed. The private and public data sets were used for evaluation in the experiments. Results revealed that our NAGNN outperformed all the 10 state‐of‐the‐art methods in terms of generalization ability. Therefore, the proposed NAGNN is effective in detecting COVID‐19, which can be used in clinical diagnosis.

Bullying, Present Romantic Relationship and Depression as Predictive Factors of Non-Suicidal Self-Injury in Adolescent Psychiatric Patients (preprint)

Background: Non-suicidal self-injury (NSSI), as a major public health issue of high complexity, multifactorial causes and great socioeconomic and family impact, affects China now especially after COVID-19. The aim of this study was to explore the clinical and psychological characteristic in adolescent psychiatric patients with or without NSSI. Methods: : Adolescent psychiatric patients were recruited from psychiatric outpatient and inpatient unit in Guangdong mental Health Center between October and December 2020. NSSI was evaluated by the modified version of Adolescents Self-Harm Scale. Childhood trauma was assessed by the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Peer bullying experience was evaluated by The Revised Olweus Bully/Victim Questionnaire（BVQ-R). Depression was assessed by the Montgomery–Asberg Depression Rating Scale (MADRS). Clinical data were collected from electronic medical record system. Results: : The sample included 157 adolescent psychiatric patients (72.6% female), aged 13-18 years (M=15.39, SD=0.145). NSSI group experienced more peer bullying (t=4.08, P ＜0.001), more likely to get into romantic relationship currently(χ2=5.38, P =0.02), more times of hospitalization (t=0.36, P <0.001), receiving more antipsychotic treatment (t=3.58, P <0.001), benzodiazepine treatment (t=3.46, P ＜0.001), and mood-stabilizer treatment (χ2 =8.53, P <0.001). The significant predictor of NSSI for the last one year included being in romantic relationship currently (OR =4.27, 95% CI=[1.53,11.93]), outpatient (OR=0.38, 95%CI=[0.16,0.88]), BVQ-R total (OR=1.10, 95% CI=[1.02,1.18])，MARDS total (OR= 1.05, 95% CI=[1.01,1.09]), and benzodiazepine PDD/DDD (OR=5.79, 95% CI=[0.99,33.72]). Conclusions: : Adolescent psychiatric patients with NSSI have significantly higher incidences of life event such as peer bulling, childhood trauma experience, and they were more likely to get into a romantic relationship. Meanwhile, patients with NSSI had significantly severe level of depression, being more on benzodiazepine and mood-stabilizer use. This provides a valuable basis for our clinical treatment of adolescent mental patients with NSSI.

Overview of SARS-CoV-2 viral load and its clinical value

During the unprecedented COVID-19 pandemic, detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral nucleic acids in diverse specimens from patients, people with suspected infection and their close contacts has been widely implemented in infection confirmation, patient management and transmission prevention. Viral nucleic acid detection results not only reflect the infection status in suspected cases, but also are used to quantify positive specimens in most assays. For most viral diseases, viral loads are theoretically associated with potent infectivity and prognostic outcomes in patients. In this review, the principles and characteristics of SARS-CoV-2 viral load detected by real time reverse transcription PCR (RT-PCR) and digital PCR are summarized. The distribution and dynamic changes in viral load in humans are discussed, and the correlations of viral load with disease severity, infectivity and prognostic indicators are analyzed. The comprehensive descriptions of COVID-19 characterization will help guide current practices in infection control, patient treatment and management, and combating the ongoing COVID-19 pandemic.

Emotional exhaustion in front-line healthcare workers during the COVID-19 pandemic -- the effects of time pressure, social sharing and cognitive reappraisal: A cross-sectional study (preprint)

Background: With the increasing spread of COVID-19, healthcare workers, especially front-line medical staff, have become more vulnerable to emotional exhaustion.Objectives: This study aimed to determine the influence of time pressure on the emotional exhaustion of front-line healthcare workers, and explore the effects of social sharing and cognitive reappraisal on this.Methods: This cross-sectional study was conducted in March 2020. A total of 232 questionnaires were completed by front-line healthcare workers in Wuhan city, Hubei province, China. Hierarchical linear regression and conditional process analysis were performed to explore the relationships among time pressure, social sharing, cognitive reappraisal, and emotional exhaustion.Results: Time pressure was positively associated with social sharing and emotional exhaustion. Social sharing presented a dark side in terms of the impact on emotional exhaustion. Cognitive reappraisal negatively moderated the relationship between time pressure and social sharing, and it further indirectly influenced the relationship between time pressure and emotional exhaustion through social sharing.Conclusions: Our findings shed light on how time pressure influences the emotional exhaustion of healthcare workers during the COVID-19 period. Although social sharing is commonly regarded as a positive behavior, we identified a dark side in terms of its impact. We also identified that improving cognitive reappraisal may present a positive strategy toward alleviating emotional exhaustion.

Impact of the COVID-19 pandemic on intention to use traditional Chinese medicine: A cross-sectional study based on the theory of planned behavior.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) has become an increasingly severe public health emergency. Although traditional Chinese medicine (TCM) has helped to combat COVID-19, public perception of TCM remains controversial. We used the theory of planned behavior (TPB) to identify factors that affect the intention to use TCM. METHODS: A cross-sectional web-based survey of 10,824 individuals from the general public was conducted between March 16 and April 2, 2020. The participants were recruited using a snowball sampling method. Data were collected using a self-administered questionnaire, based on the TPB. The questionnaire consisted of demographic characteristics and TPB structures. Structural equation modeling was used to identify predictors of intention. RESULTS: The results indicated the model explained 77.5% and 71.9% of intention and attitude variance. Intention to use TCM had the strongest relationship with attitude (P < 0.001), followed by past behavior (P < 0.001), subjective norms (P < 0.001) and perceived behavioral control (P < 0.001). Attitudes toward TCM were significantly affected by perceived behavioral control (P < 0.001), subjective norms (P < 0.001) and cognition of TCM (P < 0.001). CONCLUSION: Attitude is a key factor in determining the intention to use TCM, followed by past behaviors, subjective norms and perceived behavioral control. Our results offer important implications for health policy makers to promote the use of TCM.

Radiologic Risk Factors for Mortality of Patients with COVID-19 Pneumonia in Wuhan, China: A Retrospective Study (preprint)

Background: Computed tomography (CT) characteristics associated with critical outcomes of patients with coronavirus disease 2019 (COVID-19) have been reported. However, CT risk factors for mortality are poorly understood. We aimed to investigate the automatically quantified CT imaging predictors for COVID-19 mortality.Methods: In this retrospective study, laboratory-confirmed COVID-19 patients at Wuhan Central Hospital between December 9, 2019, and March 19, 2020, were included. A novel prognostic biomarker, V-HU score, depicting the volume of total pneumonia infection and the average Hounsfield unit (HU) value of consolidation areas was quantified from CT by an artificial intelligence (AI) system. Cox proportional hazards models were used to investigate risk factors for mortality.Findings: This study included 238 patients (126 survivors and 112 non-survivors). The V-HU marker was an independent predictor (hazard ratio [HR] 2·78, 95% CI 1·50-5·17; p=0·0012) after adjusting for several COVID-19 prognostic indicators significant in univariable analysis. The prognostic performance of the model containing clinical and outpatient laboratory factors was improved by integrating the V-HU marker (c-index: 0·695 versus 0·728; p<0·0001). Older patients (age>=65 years; HR 3·56, 95% CI 1·64-7·71; p=0·0006) and younger patients (age<65 years; HR 4·60, 95% CI 1·92-10·99; p<0·0001) could be risk-stratified by the V-HU marker.Interpretation: A combination of an increased volume of total pneumonia infection and high HU value of consolidation areas showed a strong correlation to COVID-19 mortality, as determined by AI quantified CT. The novel radiologic marker may be used for early risk assessment to prioritize critical care resources for patients at a high risk of mortality.Funding: None.Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: The study was approved by the Research Ethics Commission of Wuhan Central Hospital, and the requirement for writing informed consent was waived by the Ethics Commission for the emergence of infectious diseases.

Risk Factors for Critical-Ill Events of Patients With COVID-19 in Wuhan, China: A Retrospective Cohort Study (preprint)

Background To explore the risk factors for critical-ill events (intensive care, invasive ventilation, or death) in patients with COVID-19.Methods  Patients with laboratory-confirmed COVID-19 admitted to the Wuhan Leishenshan Hospital from February 13 to March 14 was retrospectively analyzed. Demographic data, symptoms, laboratory values at baseline, comorbidities, treatments and clinical outcomes were extracted from electronic medical records and compared between patients with and without critical-ill events. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression models were developed to explore the risk factors for critical-ill events. A risk nomogram was established to predict the probability for the critical-ill events. Survival analysis of patients with critical-ill events was performed by the Kaplan-Meier method.Results 463 COVID-19 patients were included in this study, of whom 397 were non-critically ill and 66 were critically ill (all from the intensive care unit). The LASSO regression identified four variables (hypersensitive cardiac troponin I, blood urea nitrogen , haemoglobin, and interleukin-6) contributing to the critical-ill events. Multivariable regression showed increasing odds of in-hospital critical-ill events associated with hypersensitive cTnI greater than 0.04 ng/mL (OR 20.98,95% CI 3.51-125.31), blood urea nitrogen greater than 7.6 mmol/L (OR 5.22, 95% CI 1.52-17.81, decreased haemoglobin (OR 1.06, 95% CI 1.04-1.10), and higher interleukin-6 (OR 1.05, 95% CI 1.02-1.08) on admission.   Conclusions  Hypersensitive cTnI greater than 0.04 ng/mL, blood urea nitrogen greater than 7.6 mmol/L, decreased haemoglobin, and high IL-6 were risk factors of critical-ill events in patients with COVID-19.

SARS-CoV-2 Spike Protein Interacts with Multiple Innate Immune Receptors (preprint)

The spike (S) glycoprotein in the envelope of SARS-CoV-2 is densely glycosylated but the functions of its glycosylation are unknown. Here we demonstrate that S is recognized in a glycan-dependent manner by multiple innate immune receptors including the mannose receptor MR/CD206, DC-SIGN/CD209, L-SIGN/CD209L, and MGL/CLEC10A/CD301. Single-cell RNA sequencing analyses indicate that such receptors are highly expressed in innate immune cells in tissues susceptible to SARS-CoV-2 infection. Binding of the above receptors to S is characterized by affinities in the picomolar range and consistent with S glycosylation analysis demonstrating a variety of N- and O-glycans as receptor ligands. These results indicate multiple routes for SARS-CoV-2 to interact with human cells and suggest alternative strategies for therapeutic intervention.

Epidemic Dynamics and Clinical Features of COVID-19 and Government Measures to Control Disease Transmission in Southern Hainan Island, China (preprint)

Objective: The objective of this study is to determine the epidemic dynamics and clinical features of COVID-19 in southern Hainan Island, China, and provide experience for other tropical areas of the world. Methods: This retrospective study included confirmed cases of COVID-19 in southern Hainan. All enrolled patients were treated in Sanya, and data on epidemiological and clinical features of the disease and infection prevention and control measures adopted by the local government during the epidemic were collected. Results: Of the 74 cases, 71 (95.95%) were imported from Wuhan, Hubei Province (47, 63.51%), other cities in Hubei Province (11, 14.86%), or provinces other than Hubei and Hainan (13, 17.57%). Three (4.06%) patients were infected in southern Hainan, including one autochthonous case in Sanya. Fifty-four cases (72.97%) were detected in Sanya, and 27 cases (27.03%) were diagnosed in other cities. The rate of severe or critical cases was 28.38% (21/74), and mortality was 2.7% (2/74). The serum lactate levels and base excess of severe-critical patients were higher than those of patients with mild-moderate disease. Multivariate logistic regression analysis showed that chronic conditions were risk factors for severe and critical COVID-19. Seventy-four patients were diagnosed with COVID-19 over a 22-day period in Sanya, and the epidemic period in the city was 48 days. The outbreak was controlled rapidly because the local government adopted strict infection prevention and control measures. Conclusions: The clinical characteristics of COVID-19 in Hainan Island were similar to those reported in other regions. In Sanya, the rate of severe and very severe cases was higher than in other regions; however, most cases were imported, and there was only one autochthonous case. The rapid control of the outbreak in Sanya may be related to the tropical climate, adoption of strict infection prevention and control measures, daily reporting of new cases, increased public awareness about the epidemic, and other emergency actions implemented by the local government.

Risk factors for critical-ill events of patients with COVID-19 in Wuhan, China: a retrospective cohort study (preprint)

Background Little is known about the risk factors for critical-ill events (intensive care, invasive ventilation, or death) in patients with COVID-19. Methods Patients with laboratory-confirmed COVID-19 admitted to the Wuhan Leishenshan Hospital from February 13 to March 14 was retrospectively analyzed. Demographic data, symptoms, laboratory values at baseline, comorbidities, treatments and clinical outcomes were extracted from electronic medical records and compared between patients with and without critical-ill events. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression models were developed to explore the risk factors for critical-ill events. A risk nomogram was established to predict the probability for the critical-ill events. Survival analysis of patients with critical-ill events was performed by the Kaplan-Meier method. Results 463 COVID-19 patients were included in this study, of whom 397 were non-critically ill and 66 were critically ill (all from the intensive care unit). The LASSO regression identified four variables (hypersensitive cardiac troponin I, blood urea nitrogen , haemoglobin, and interleukin-6) contributing to the critical-ill events. Multivariable regression showed increasing odds of in-hospital critical-ill events associated with hypersensitive cTnI greater than 0.04 ng/mL (OR 20.98,95% CI 3.51-125.31), blood urea nitrogen greater than 7.6 mmol/L (OR 5.22, 95% CI 1.52-17.81, decreased haemoglobin (OR 1.06, 95% CI 1.04-1.10), and higher interleukin-6 (OR 1.05, 95% CI 1.02-1.08) on admission. Conclusions Hypersensitive cTnI greater than 0.04 ng/mL, blood urea nitrogen greater than 7.6 mmol/L, decreased haemoglobin, and high IL-6 were risk factors of critical-ill events in patients with COVID-19.

Gut mycobiota alterations in patients with COVID-19 and H1N1 and associations with immune and gastrointestinal symptoms (preprint)

The relationship between gut microbes and COVID-19 or H1N1 flu is not fully understood. Here, we compared gut mycobiota of 67 COVID-19 patients, 35 H1N1 patients and 48 healthy controls (HCs) using internal transcribed spacer (ITS) 3-ITS4 sequencing. Fungal richness decreased in COVID-19 and H1N1 patients compared to HCs, but fungal diversity decreased in only H1N1 patients. Fungal mycobiota dysbiosis in both COVID-19 and H1N1 patients was mainly characterized by depletions of fungi such as Aspergillus, Penicillium, but several fungi, such as Candida parapsilosis, and Malassezia yamatoensis, were enriched in H1N1 patients. The altered fungal taxa were strongly associated with clinical features such as the incidence of diarrhoea, albumin. Gut mycobiota between COVID-19 patients with mild and severity symptoms are not different, as well as between COVID-19 patients in and out hospital. Therefore, gut mycobiota dysbiosis occur in covid-19 or H1N1 patients and do not improve until discharge.

Clinical Features of Hypertensive Patients With Covid-19 Compared With a Normotensive Group (preprint)

Background: The novel coronavirus (COVID-19), which began in Wuhan, China, in December 2019, has spread worldwide and poses a great threat to human health. Among COVID-19 patients, those with hypertension have been reported to have higher morbidity and mortality. This study was conducted to provide the international community with a deeper understanding of COVID-19 with hypertension.Methods: A total of 188 COVID-19 patients were studied from January to March 2020. The epidemiology, clinical features, and laboratory data of hypertensive patients with COVID-19 were collected, retrospectively analyzed, and compared with a normotensive group. The use of anti-hypertensive drugs, general treatment, and clinical outcomes of hypertensive patients were also analyzed.Results: The median ages in hypertensive patients with mild and severe COVID-19 were both significantly greater than the median age in the normotensive group. But there was no significant gender difference between the hypertensive and normotensive groups. All patients had lived in the Wuhan area. Common symptoms of all of the patients included fever, cough, and fatigue. Chest CT scans showed bilateral patchy shadows or ground glass opacity in the lungs of all of the patients. All (98 [100%]) of the hypertensive patients received antiviral therapy (Arbidol was used alone or in combination with Ribavirin), antibiotic therapy (85 [86.7%]), and corticosteroids (31 [31.6%]). It has been suggested that the combination of Arbidol and Ribavirin as initial therapy for hypertensive patients with COVID-19 is effective and safe. There were no significant differences in laboratory data between the mild cases in the hypertensive and the normotensive groups. In the severe cases, the hypertensive patients had higher plasma levels of D-dimer, C-reactive protein (CRP), and Interleukin-6 (IL-6) (P < 0.05). Furthermore, the hypertensive patients who were treated with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) had no statistically significant differences between the mild and severe groups (p > 0.05).Conclusion: In this study, we demonstrated that the hypertensive patients who were treated with ACEI/ARB did not have an increased risk of developing severe COVID-19. Arbidol and Ribavirin played an important role in the treatment of the viral pneumonia. Hypertensive patients with severe viral pneumonia had stronger inflammatory responses than non-hypertensive patients.

The respiratory sound features of COVID-19 patients fill gaps between clinical data and screening methods (preprint)

Background: The 2019 novel coronavirus (COVID-19) has continuous outbreaks around the world. Lung is the main organ that be involved. There is a lack of clinical data on the respiratory sounds of COVID-19 infected pneumonia, which includes invaluable information concerning physiology and pathology. The medical resources are insufficient, which are now mainly supplied for the severe patients. The development of a convenient and effective screening method for mild or asymptomatic suspicious patients is highly demanded. Methods: This is a retrospective case series study. 10 patients with positive results of nucleic acid were enrolled in this study. Lung auscultation was performed by the same physician on admission using a hand-held portable electronic stethoscope delivered in real time via Bluetooth. The recorded audio was exported, and was analyzed by six physicians. Each physician individually described the abnormal breathing sounds that he heard. The results were analyzed in combination with clinical data. Signal analysis was used to quantitatively describe the most common abnormal respiratory sounds. Results: All patients were found abnormal breath sounds at least by 3 physicians, and one patient by all physicians. Cackles, asymmetrical vocal resonance and indistinguishable murmurs are the most common abnormal breath sounds. One asymptomatic patient was found vocal resonance, and the result was correspondence with radiographic computed tomography. Signal analysis verified the credibility of the above abnormal breath sounds. Conclusions: This study describes respiratory sounds of patients with COVID-19, which fills up for the lack of clinical data and provides a simple screening method for suspected patients.

Clinical and Imaging features in COVID-19 Patients: Analysis of Data from Patients in Non-pandemic areas (preprint)

Purpose To describe the imaging characteristics in COVID-19 Patients from non-pandemic regions to improve understanding of the disease. Methods We reviewed chest CT scans of 30 COVID-19 patients from three hospitals in Sichuan province, China. Results Typical CT manifestations include the involvement of multiple lobes, mostly in the peripheral zone of the lungs, and subpleural distribution. GGO, crazy paving or mixed GGO and consolidation is the most common signs. Few patients can present small amount of pleural effusion. It is worth noting that none of the lung cavities, tree buds, and lymphadenopathy appeared. The follow-up imaging findings of some patients showed progress when the initial CT score reached 7. Conclusion The CT scan still play an important role in screening the COVID-19, most of the images present positive signs, mainly subpleural, multiple GGO. CT might can predict the severity or whether the patient will progress to severe illness. A small number of patients may be missed if they are based on CT findings alone, which should be closely combined with the patient's epidemiological history and nucleic acid test.

Recommendations for standardized management of CML patients in the core epidemic area of COVID-19(Multi-center survey results in Hubei Province, China) (preprint)

Background Since late December 2019, the outbreak of the novel coronavirus disease, COVID-19, that began in Wuhan, has become endemic in China and more than 100 countries and regions in the world. There is no report about the prevalence of COVID-19 in CML patients untill now. We aimed to describe the clinical course, outcomes of CML patients with COVID-19 and prevalence of COVID-19 in CML patients. Methods In this multi-center survey, cross-sectional survey, observational study, the clinical data of CML patients with COVID-19 in each center were collected. Simultaneously, an online survey was conducted for information about the CML patients under the management at each center by asking the CML patients to complete a questionnaire,from February 15, 2020 to February 21, 2020. The questionnaire includes demographic data, place of residence, smoking status, CML diagnosis and treatment, comorbidities, combined medications, epidemiological history, symptoms(fever, cough, shortness of breath, etc) during the epidemic. Additional clinical data was collected on respondents suspected or confirmed to have COVID-19. We described and analyzed the prevalence of COVID-19 in CML patients, and focus on the clinical characteristics and outcomes of COVID-19 patients. Data were compared between the CML patients with optimal response and those with non-optimal response. The primary outcome was prevalence of COVID-19 in CML patients, as of Feb 21, 2020. Secondary outcomes included the history of epidemiology of CML patients, the clinical characteristics and outcomes of CML patients with COVID-19 . Findings Of 392 respondents, 223( 56.9%) were males, and 240( 61.2%) were 50 years or younger. Only 10 patients took drugs irregularly due to the influence of the epidemic because of traffic control, pharmacies unable to operate normally, etc. In the history of epidemiology, there were 4 patients with definite contact with COVID-19, of which 3 were remote contact and 1 was close contact. 12 respondents had fever, cough or shortness of breath during the epidemic, 1 case (common type) was confirmed with COVID-19 and cured after treatment. 1 patient was clinically diagnosed and succumbed. 1 of 299 (0.3%) patients with an optimal response was diagnosed with COVID-19. Of the 50 patients who failed to respond to CML treatment or had a poor response, 1 patient (2%) had a clinical diagnosis of COVID-19. Interpretation While the 392 CML respondents required regular referrals to hospitals, they did not have much contact with COVID-19 patients during the outbreak. Patients who failed to achieved an optimal response to CML therapy appear more likely to have a symptomatic infection with SARS-CoV-2. Older patients with comorbidities are at increased risk of death.