Multi-platform deep sequencing of SARS-CoV-2 JN.1 lineages variation reveal immune escape and transmission (preprint)

Objectives Dominant strains had been replaced by SARS-CoV-2 JN.1 lineages, and spread widely in a short period of time. However, accurate detection method and reason for rapid spread have not been clarified.Methods Ion Torrent, Illumina and Nanopore sequencing platforms were used to detect whole genome sequences of SARS-CoV-2 positive cases in Dalian CDC from December 2023 to January 2024.Results Ion Torrent and Illumina platform had missing sites, but optimized Ion Torrent and Nanopore platform covered all detected sites. Ion Torrent platform had higher sensitivity than others and was more suitable for short-read length sequencing. However, primers need to be optimized in time. Illumina platform was also suitable for short-read length and prone to site drop out. Nanopore platform was more suitable for long read-length sequencing and had high compatibility for more variation site. Furthermore, compared JN.1 lineages with BA.2.86, multiple specific variation sites were detected for the first time in non-S protein region.Conclusion Timely optimized primers and supplement variation sites will provide a more effective mean for monitoring and controlling the prevalence of JN.1 lineages in advance, and the discovery of specific variation sites may reveal the reasons for immune escape and rapid transmission.

Pandemic preparedness through genomic surveillance: Overview of mutations in SARS-CoV-2 over the course of COVID-19 outbreak (preprint)

Genomic surveillance is a vital strategy for preparedness against the spread of infectious diseases and to aid in development of new treatments. In an unprecedented effort, millions of samples from COVID-19 patients have been sequenced worldwide for SARS-CoV-2. Using more than 8 million sequences that are currently available in GenBank SARS-CoV-2 database, we report a comprehensive overview of mutations in all 26 proteins and open reading frames (ORFs) from the virus. The results indicate that the spike protein, NSP6, nucleocapsid protein, envelope protein and ORF7b have shown the highest mutational propensities so far (in that order). In particular, the spike protein has shown rapid acceleration in mutations in the post-vaccination period. Monitoring the rate of non-synonymous mutations (Ka) provides a fairly reliable signal for genomic surveillance, successfully predicting surges in 2022. Further, the external proteins (spike, membrane, envelope, and nucleocapsid proteins) show a significant number of mutations compared to the NSPs. Interestingly, these four proteins showed significant changes in Ka typically 2 to 4 weeks before the increase in number of human infections (surges). Therefore, our analysis provides real time surveillance of mutations of SARS-CoV-2, accessible through the project website http://pandemics.okstate.edu/covid19/. Based on ongoing mutation trends of the virus, predictions of what proteins are likely to mutate next are also made possible by our approach. The proposed framework is general and is thus applicable to other pathogens. The approach is fully automated and provides the needed genomic surveillance to address a fast-moving pandemic such as COVID-19.

The impacts of patient mistreatment on healthcare workers’ role behaviors: a study in Chinese Fangcang shelter hospitals (preprint)

Background: Fangcang shelter hospitals have played an important role in the battle against the COVID-19 epidemic in China. Verbal and physical attacks on patients are prone to occur in such hospitals. This study explored the impacts of patient mistreatment on healthcare workers’ role behaviors (service performance and patient-oriented organizational citizenship behavior). Methods: We examined the influence of patient mistreatment on service performance and patient-oriented organizational citizenship behavior, as well as the mediating effect of emotional exhaustion and the moderating effect of displaced aggression by patients, using hierarchical linear regression and conditional process analysis. Results: Patient mistreatment was positively associated with emotional exhaustion among healthcare workers, while emotional exhaustion was negatively associated with service performance and patient-oriented organizational citizenship behavior. Mediation analysis revealed that emotional exhaustion mediated the association between patient mistreatment and both types of role behaviors. Moderated mediation analysis found that the mediation effect was weaker when the displaced aggression by patients was high. Conclusions: The findings clarified the relationship between patient mistreatment, emotional exhaustion, service performance, and patient-oriented organizational citizenship behavior. Additional assistance should be provided to healthcare workers dealing with patient mistreatment. Displaced aggression by patients attenuates the positive effects of patient mistreatment on the emotional exhaustion of healthcare workers. Our findings reveal the mechanism and boundary conditions of patient mistreatment affecting healthcare workers' service performance and patient-oriented organizational citizenship behavior.

Exercise from home improves physical performance：A study conducted specifically for COVID-19 (preprint)

Purpose COVID-19 has rampaged the world. Nowaday, a lot of people in Taiwan still experiencing working from home, as well as exercising from home (EFH) to maintain their physical health. This study aimed to investigate the difference in training efficacy by joining online workout courses and coach supervision.Methods Twenty participants were recruited in this study. The subjects were randomly divided into coach supervision and online training groups. A pre-test was first conducted, followed by a post-test after 8 weeks of training intervention. The tests were to measure the participant’s muscle hypertrophy and sports performance, with the former including InBody body composition analysis, and the latter including the assessment of jumping ability, 20-metre sprint, bench press, and squat performances. The two-way mixed design measures ANOVA was applied for statistical measurement. If the correlation between the two factors was significant, the Bonferroni post hoc test will be applied to determine the main effects. (α = 0.05).Results There was no significant difference between the two training groups. However, substantial differences were observed between the jumping ability, bench press performance, and squat performance of the pre- and post-tests in both groups, with the participants generally performing better in the latter case. In terms of body composition and muscle circumference, no significant changes were found between both tests.Conclusion Participating online training courses at home is recommended when exercising outdoor is forbidden. Moreover, online training not only reduces the transmission of coronavirus, but also helps improve the immunity in a safe environment.

Respiratory immune status and microbiome in recovered COVID-19 patients revealed by metatranscriptomic analyses

Coronavirus disease 2019 (COVID-19) is currently a severe threat to global public health, and the immune response to COVID-19 infection has been widely investigated. However, the immune status and microecological changes in the respiratory systems of patients with COVID-19 after recovery have rarely been considered. We selected 72 patients with severe COVID-19 infection, 57 recovered from COVID-19 infection, and 65 with non-COVID-19 pneumonia, for metatranscriptomic sequencing and bioinformatics analysis. Accordingly, the differentially expressed genes between the infected and other groups were enriched in the chemokine signaling pathway, NOD-like receptor signaling pathway, phagosome, TNF signaling pathway, NF-kappa B signaling pathway, Toll-like receptor signaling pathway, and C-type lectin receptor signaling pathway. We speculate that IL17RD, CD74, and TNFSF15 may serve as disease biomarkers in COVID-19. Additionally, principal coordinate analysis revealed significant differences between groups. In particular, frequent co-infections with the genera Streptococcus, Veillonella, Gemella, and Neisseria, among others, were found in COVID-19 patients. Moreover, the random forest prediction model with differential genes showed a mean area under the curve (AUC) of 0.77, and KCNK12, IL17RD, LOC100507412, PTPRT, MYO15A, MPDZ, FLRT2, SPEG, SERPINB3, and KNDC1 were identified as the most important genes distinguishing the infected group from the recovered group. Agrobacterium tumefaciens, Klebsiella michiganensis, Acinetobacter pittii, Bacillus sp. FJAT.14266, Brevundimonas naejangsanensis, Pseudopropionibacterium propionicum, Priestia megaterium, Dialister pneumosintes, Veillonella rodentium, and Pseudomonas protegens were selected as candidate microbial markers for monitoring the recovery of COVID patients. These results will facilitate the diagnosis, treatment, and prognosis of COVID patients recovering from severe illness.

Emerging variants of SARS-CoV-2 NSP10 highlight strong functional conservation of its binding to two non-structural proteins, NSP14 and NSP16 (preprint)

The coronavirus SARS-CoV-2 protects its RNA from being recognized by host immune responses by methylation of its 5' end, also known as capping. This process is carried out by two enzymes, non-structural protein 16 (NSP16) containing 2'-O-methyltransferase and NSP14 through its N7 methyltransferase activity, which are essential for the replication of the viral genome as well as evading the host's innate immunity. NSP10 acts as a crucial cofactor and stimulator of NSP14 and NSP16. To further understand the role of NSP10, we carried out a comprehensive analysis of >13 million globally collected whole-genome sequences (WGS) of SARS-CoV-2 obtained from the Global Initiative Sharing All Influenza Data (GISAID) and compared it with the reference genome Wuhan/WIV04/2019 to identify all currently known variants in NSP10. T12I, T102I, and A104V in NSP10 have been identified as the three most frequent variants and characterized using X-ray crystallography, biophysical assays, and enhanced sampling simulations. In contrast to other proteins such as spike and NSP6, NSP10 is significantly less prone to mutation due to its crucial role in replication. The functional effects of the variants were examined for their impact on the binding affinity and stability of both NSP14-NSP10 and NSP16-NSP10 complexes. These results highlight the limited changes induced by variant evolution in NSP10 and reflect on the critical roles NSP10 plays during the SARS-CoV-2 life cycle. These results also indicate that there is limited capacity for the virus to overcome inhibitors targeting NSP10 via the generation of variants in inhibitor binding pockets.

Constructing of a scientific fitness literacy evaluation model for adults (preprint)

COVID-19-associated lockdown has been implemented worldwide, potentially causing unfavorable changes in lifestyle and psychological health. Physical literacy, healthy diets, and lifestyles play important roles in mitigating the adverse effects. Therefore, this study aimed to enable individuals to understand their fitness literacy and establish a personalized exercise plan. In this study, 903 adults aged 19－59 were surveyed based on the concept of scientific fitness literacy and the influencing factors in the context of the effective containment of COVID-19 before (2019) and during (2020) the pandemic. This study screened four factors from four dimensions–cognition, attitude, ability and skills, and behavior and habits–that can influence adults' scientific fitness literacy. Confirmatory factor analysis (CFA) and AMOS software were used to construct an evaluation index system of scientific fitness literacy for adults. The model consisting 10 items with 4 factors to evaluation index system has good overall fitness, reliability, convergent validity, differential validity, and model stability and was able to analyze the factors that affect the scientific fitness literacy of individuals from different perspectives. This allowed individuals at different stages to have a deeper understanding of scientific fitness literacy.

How does growth mindset affect mental health of high school students during the COVID-19 epidemic? The role of grit and coping strategies

Background The outbreak of COVID-19 epidemic continues to unfold globally, which harms the public’s mental health. Adolescents’ mental health is affected by social isolation and lockdown during the COVID-19 epidemic. The implicit theory of thoughts-emotion-behavior states that individuals with a growth mindset believe that thoughts, emotions, and behaviors can be changed through effort and tend to persist in pursuing higher goals and maintain enthusiasm as well as cope with stress resiliently, thus having higher gritty and levels of mental health. This study aimed to explore the role of grit and coping strategies in the influence of the growth mindset on adolescents’ mental health during the COVID-19 epidemic period. Methods A total of 1564 participants (Mage = 17.02, 760 boys, 804 girls) from three high schools in China were recruited to complete The Self-report Questionnaire-20, The Growth Mindset Scale, The Short Grit Scale, and The Coping Style Scale to evaluate mental health, growth mindset, grit, and positive coping strategies, respectively. Results The results showed that growth mindset has no significant indirect effect on mental health through grit but has a significant indirect effect on mental health through coping strategies. The results of chain mediation analysis showed that grit and coping strategies play chain mediating roles between growth mindset and adolescents’ mental health. Conclusion The findings suggest that cultivating a growth mindset, developing grit, and teaching adolescents to adopt positive coping strategies can improve adolescents’ mental health.

Future COVID-19 surges prediction based on SARS-CoV-2 mutations surveillance (preprint)

COVID-19 has aptly revealed that airborne viruses such as SARS-CoV-2 with the ability to rapidly mutate, combined with high rates of transmission and fatality can cause a deadly world-wide pandemic in a matter of weeks. Apart from vaccines and post-infection treatment options, strategies for preparedness will be vital in responding to the current and future pandemics. Therefore, there is wide interest in approaches that allow predictions of increase in infections (surges) before they occur. We describe here real time genomic surveillance particularly based on mutation analysis, of viral proteins as a methodology for a priori determination of surge in number of infection cases. The full results are available for SARS-CoV-2 at http://pandemics.okstate.edu/covid19/, and are updated daily as new virus sequences become available. This approach is generic and will also be applicable to other pathogens.

Community Services and Social Involvement in COVID-19 Governance in Urban China (preprint)

Background: This study explores how the services provided by different types of Chinese communities varied in their impact on the social involvement of their residents during the COVID-19 pandemic. Previous research has shown that services in traditional Chinese communities have supported pandemic governance because of their human resource advantages. However, we argue that the services provided by intelligent communities not only adhered to COVID-19 pandemic governance but also promoted the social involvement of the residents.Methods: Using a case study approach of the intelligent community Fang Xing and the traditional community Qili Tang, both located in Hefei city in Anhui, China, this article compares traditional and intelligent Chinese community services. We conducted 42 in-person interviews (21 residents, 10 volunteers, 11 staff members), 30 telephone interviews (10 residents, 10 volunteers, 10 staff members), and 50 online video interviews (30 residents, 10 volunteers, 10 staff members) from June to August 2020.Results: The findings suggest that while the traditional community decreased its residents’ social involvement by restricting certain services during the pandemic, the intelligent community was able to apply COVID-19 governance measures without restricting its residents’ social involvement. In the traditional community, family members were obliged to take responsibility for daily living services and family care tasks. This community often responded slowly when providing required services compared to intelligent communities. The intelligent community contributed greatly to its residents’ social involvement in the process of pandemic governance. It offered an attractive option for residents to act as community service managers and prepared its residents for local-level pandemic governance.Conclusions: This study provides a better understanding of the relationship between community services and residents’ social involvement in terms of the different dimensions of community services. The intelligent community model can act as a reference for international community development during health emergencies.

The positive rate of IgM and IgG antibodies against SARS-CoV-2 is similar in severe and non-severe COVID-19 patients

Background: Coronavirus disease 2019 (COVID-19) has spread rapidly in China and globally. In order to control the spread of the epidemic, it is important to find an efficient diagnostic method. Objectives: The aim of this study was to assess the responses of antibodies during SARS-CoV-2 infection in relation to disease severity and to evaluate the association between the positive rate of antibody detection and nucleic acid test.

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.

Prevalence and correlates of fatigue and its association with quality of life among clinically stable older psychiatric patients during the COVID-19 outbreak: A cross-sectional study (preprint)

Background: The pattern of fatigue in older psychiatric patients during the COVID-19 outbreak was unknown. This study examined the prevalence of fatigue and its association with overall quality of life (overall QOL) in clinically stable older patients with psychiatric disorders during the COVID-19 outbreak. Methods: : This was a multicenter, cross-sectional study. Fatigue, depressive symptoms, pain, insomnia symptoms, and overall QOL were assessed with standardized instruments. Results: : A total of 1,063 patients were recruited. The prevalence of fatigue was 47.1% (95%CI: 44.1% - 50.1%). An analysis of covariance revealed that overall QOL was significantly lower in patients with fatigue compared to those without (P=0.011). A multiple logistic regression analysis revealed that more severe depressive symptoms (OR=1.15, P<0.001), insomnia symptoms (OR=1.08, P<0.001) and pain (OR=1.43, P<0.001) were significantly associated with fatigue. Conclusions: : Fatigue is common among clinically stable older patients with psychiatric disorders during the COVID-19 outbreak. Considering its negative impact on overall QOL, regular assessment of fatigue and appropriate treatment warrant attention in this subpopulation.

The Prevalence of Insomnia Symptoms and Its Association With Quality of Life Among Clinically Stable Older Patients With Psychiatric Disorders in China During the COVID-19 Outbreak (preprint)

Aims: The negative impact of the COVID-19 outbreak on sleep quality of clinically stable psychiatric patients is unknown. This study examined the prevalence of insomnia symptoms and its association with quality of life (QOL) in clinically stable older psychiatric patients during the COVID-19 outbreak. Methods: This multicenter, cross-sectional study involved older patients attending maintenance-treatment at the outpatient departments of four major psychiatric hospitals in China. Patients’ basic socio-demographic and clinical characteristics were collected. Insomnia symptoms, depressive symptoms, and QOL were assessed with the Insomnia Severity Index (ISI), Patient Health Questionnaire (PHQ-9), and two items of the World Health Organization Quality of Life-brief version (WHOQOL-BREF), respectively. Binary logistic regression analysis was conducted to examine the independent associations of socio-demographic and clinical variables with insomnia symptoms, while the association between insomnia symptoms and QOL was examined with analysis of covariance.Results: A total of 941 patients were recruited. The prevalence of insomnia symptoms was 57.1% (95% CI: 53.9-60.2%). Analysis of covariance revealed that QOL was significantly lower in patients with insomnia symptoms compared to those without them (P<0.01). Multivariate logistic regression analysis showed that insomnia symptoms were positively and independently associated with more severe depressive symptoms (P<0.01, OR=1.31, 95%CI: 1.26-1.37). Compared to patients with major depressive disorder, those with other psychiatric diagnoses had significantly higher prevalence of insomnia symptoms (P=0.03, OR=1.47, 95%CI: 1.02-2.12).Conclusions: Insomnia symptoms were common among clinically stable older psychiatric patients during the COVID-19 outbreak. Considering their negative impact on QOL, regular assessment and treatment of insomnia symptoms need to be addressed in this population. 

SARS-CoV-2 infection induces sustained humoral immune responses in convalescent patients following symptomatic COVID-19 (preprint)

Long-term antibody responses and neutralizing activities following SARS-CoV-2 infections have not yet been elucidated. We quantified immunoglobulin M (IgM) and G (IgG) antibodies recognizing the SARS-CoV-2 receptor-binding domain (RBD) of the spike (S) or the nucleocapsid (N) protein, and neutralizing antibodies during a period of six months following COVID-19 disease onset in 349 symptomatic COVID-19 patients, which were among the first world-wide being infected. The positivity rate and magnitude of IgM-S and IgG-N responses increased rapidly. High levels of IgM-S/N and IgG-S/N at 2-3 weeks after disease onset were associated with virus control and IgG-S titers correlated closely with the capacity to neutralize SARS-CoV-2. While specific IgM-S/N became undetectable 12 weeks after disease onset in most patients, IgG-S/N titers showed an intermediate contraction phase, but stabilized at relatively high levels over the six months observation period. At late time points the positivity rates for binding and neutralizing SARS-CoV-2-specific antibodies was still over 70%. Taken together, our data indicate sustained humoral immunity in recovered patients who suffer from symptomatic COVID-19, suggesting prolonged immunity.

Early prediction for severe COVID-19 with hypertension and intervention (preprint)

Background To identify the early predictors of severe coronavirus disease 2019 (COVID-19) with hypertension,explore antihypertensive drugs with potential therapeutic effects, and provide a basis for clinical prediction and treatment decisions.Method: A retrospective study was performed on all included cases.Results A total of 68 COVID-19 patients with hypertension were included,27 (39.7%) was severe and 41 (60.3%) was non-severe. Between the non-severe group (n = 41) and the severe group (n = 27),number of elevated B-type natriuretic peptide (BNP) and abnormal renal function,and albumin,lactate dehydrogenase,ultrasensitive troponin I,PH Value,arterial carbon dioxide partial pressure,sodium,osmotic pressure (OP),blood sugar (BS) and oxygenation index (OI) are significantly different.While age, male gender,comorbidities with diabetes or atherosclerotic cardiovascular disease,smoking history,number of abnormal liver function,heart rate,respiratory rate, blood pressure,white blood cell count,hematocrit,potassium and lactic acid are statistically insignificant.Four independent predictors of BNP (P = .026),OP (P = .004),BS (P = .017) and OI (P = .001) are obtained through multivariate binary logistic regression model.The area under curve (AUC) of receiver operating characteristic (ROC) of model is 0.904 ([95%CI] [0.832–0.976];P = .000),with excellent performance.Compared with blank control group (n = 27) and other antihypertensive drugs group (n = 20),OP ([287.3 ± 5.7] vs [283.5 ± 6.1];P = .045) ([287.3 ± 5.7] vs [281.9 ± 5.4];P = .007) in renin-angiotensin-aldosterone system (RAS) inhibitors group (n = 21) have increased significantly.Compared with controlled blood pressure group (n = 30),OP ([285.7 ± 6.2] vs [282.2 ± 5.2];P = .012) of uncontrolled group (n = 38) increased significantly.Conclusion Decreased OP and OI, increased BNP and BS are early predictors for severe COVID-19 patients with hypertension.For poorly controlled blood pressure,targeting RAS and OP,early use of RAS inhibitors or combination with loop diuretics may be an effective treatment.

Consensus on standardized diagnosis and treatment for osteoporotic vertebral compression fracture patients during epidemic of corona virus disease 2019 / 中华创伤杂志

Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of OVCF patients with suspected or confirmed COVID-19, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of patients with OVCF diagnosed with COVID-19, the authors jointly develop this expert consensus. The consensus systematically recommends the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures based on the different types and epidemic prevention and control requirements.

Clinical Characteristics of SARS-CoV-2 Pneumonia Compared to Controls in Chinese Han Population (preprint)

Background In December 2019, novel coronavirus (SARS-CoV-2) infected pneumonia occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of SARS-CoV-2 pneumonia without comorbidities compared to normal controls in Chinese Han population is limited. Our objective is to describe the epidemiological and clinical characteristics of SARS-CoV-2 pneumonia without comorbidities compared to normal controls in the Chinese Han population. Methods Retrospective, multi-center case series of the 69 consecutive hospitalized patients with confirmed SARS-CoV-2 pneumonia, from February 7 to February 28, 2020; final date of follow-up was February 29, 2020. Results The study population included 69 hospitalized patients with confirmed SARS-CoV-2 pneumonia without comorbidities and 14,117 normal controls. 50.7% patients were male and 49.3% were female; 1.5% patients were asymptomatic cases, 63.8% patients were mild cases, and 36.2% patients were severe or critical cases. Compared with mild patients (n = 44), severe or critical patients (n = 25) were significantly older (median age, 67 years [IQR, 58-79] vs. 49 years [IQR, 36-60]; P < 0.01). Fever was present in 98.6% of the patients. The second most common symptom was cough (62.3%), fatigue (58.0%), sputum (39.1%), and headache (33.3%). The median incubation period was 4 days (IQR, 2 to 7). Leukocyte count was 74.1% of normal controls and lymphocyte count was 45.9% of normal controls. The phenomenon of lymphocyte depletion (PLD) observed in severe or critical cases in 100%. Levels of lactate dehydrogenase, D-dimer, procalcitonin, and interleukin-6 were showed significant differences between mild and severe or critical cases. Chest computed tomographic scans showed bilateral patchy patterns (49.3%), local patchy shadowing (29.0%), and ground glass opacity (21.7%). 7.3% patients were diagnosed ARDS, 7.3% patients were diagnosed acute cardiac injury (troponin I >28 pg/mL) and 4.4% patients were diagnosed fungal infections or shock. 4.3% patients have been discharged; 1.5% patient had died; 1.5% patient had recovery. Conclusions In this multicenter case series of 69 patients without comorbidities, the full spectrum of asymptomatic, mild, severe, and critical cases is described. 50.7% patients were male and 49.3% were female; 1.5% patients were asymptomatic cases, 63.8% patients were mild cases, and 36.2% patients were severe or critical cases. 4.3% patients have been discharged; 1.5% patient had died; 1.5% patient had recovery. Among the 25 patients with severe or critical disease, 12.0% patients were underwent non-invasive mechanical ventilation, 8.0% patients underwent invasive mechanical ventilation, and 4.0% patients died.