Epidemic of the SARS-CoV-2 Omicron variant in Shanghai, China in 2022: Transient and persistent effects on Out-of-hospital cardiac arrests.

OBJECTIVE: To investigate transient and persistent effects of the Shanghai Omicron epidemic in 2022 on the incidence, characteristics, and outcomes of out-of-hospital cardiac arrest (OHCA). METHODS: This retrospective study examined electronic records of patients admitted to the Shanghai Emergency Medical Center during five periods: pre-epidemic, 1 January 2018 to 31 December 2019; low COVID-19 incidence, 1 January 2020 to 27 March 2022; Omicron epidemic, 28 March to 31 May 2022; early post-epidemic, 1 June to 31 July 2022; and late post-epidemic, 1 August to 30 September 2022. Clinicodemographic characteristics and outcomes of OHCA cases were compared between the pre-epidemic and other periods. RESULTS: A total of 55,104 OHCAs were included. The monthly number of OHCAs in the Omicron epidemic was 2.1 times the number in the pre-epidemic (1702 vs 793), while the number in the early post-epidemic was 1.9 times the number in the pre-epidemic (1515 vs 793). Compared to the pre-epidemic, OHCA during or after the epidemic was more likely to involve individuals with hypertension, coronary artery disease, heart failure or stroke. The probability that circulation would spontaneously resume after OHCA was significantly lower during the epidemic than before it (aOR 0.61, 95% CI 0.41-0.90; P = 0.012). However, this difference disappeared by the early post-epidemic. CONCLUSION: The monthly number of OHCAs doubled during the Omicron epidemic in Shanghai, and it remained elevated for another two months. OHCA affected individuals with cardiovascular and cerebrovascular diseases more during and after the epidemic than before it.

Persistent neurologic symptoms and cognitive dysfunction in non-hospitalized Covid-19 "long haulers".

OBJECTIVE: Most SARS-CoV-2-infected individuals never require hospitalization. However, some develop prolonged symptoms. We sought to characterize the spectrum of neurologic manifestations in non-hospitalized Covid-19 "long haulers". METHODS: This is a prospective study of the first 100 consecutive patients (50 SARS-CoV-2 laboratory-positive (SARS-CoV-2+ ) and 50 laboratory-negative (SARS-CoV-2- ) individuals) presenting to our Neuro-Covid-19 clinic between May and November 2020. Due to early pandemic testing limitations, patients were included if they met Infectious Diseases Society of America symptoms of Covid-19, were never hospitalized for pneumonia or hypoxemia, and had neurologic symptoms lasting over 6 weeks. We recorded the frequency of neurologic symptoms and analyzed patient-reported quality of life measures and standardized cognitive assessments. RESULTS: Mean age was 43.2 ± 11.3 years, 70% were female, and 48% were evaluated in televisits. The most frequent comorbidities were depression/anxiety (42%) and autoimmune disease (16%). The main neurologic manifestations were: "brain fog" (81%), headache (68%), numbness/tingling (60%), dysgeusia (59%), anosmia (55%), and myalgias (55%), with only anosmia being more frequent in SARS-CoV-2+ than SARS-CoV-2- patients (37/50 [74%] vs. 18/50 [36%]; p < 0.001). Moreover, 85% also experienced fatigue. There was no correlation between time from disease onset and subjective impression of recovery. Both groups exhibited impaired quality of life in cognitive and fatigue domains. SARS-CoV-2+ patients performed worse in attention and working memory cognitive tasks compared to a demographic-matched US population (T-score 41.5 [37, 48.25] and 43 [37.5, 48.75], respectively; both p < 0.01). INTERPRETATION: Non-hospitalized Covid-19 "long haulers" experience prominent and persistent "brain fog" and fatigue that affect their cognition and quality of life.

Safety of protease inhibitors and Arbidol for SARS-CoV-2 pneumonia in Zhejiang Province, China.

The aim of this study was to evaluate the safety of an antiviral regimen of protease inhibitors combined with Arbidol (umifenovir) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia patients. The genomic sequence of SARS-CoV-2 is highly homologous to that of SARS-CoV (Zhou et al., 2020). Previously published basic and clinical research on anti-SARS-CoV treatment found that lopinavir/ritonavir (LPV/r) could improve the prognosis of SARS patients (Chan et al., 2003; Chu et al., 2004). Darunavir (DRV) is another protease inhibitor that blocks the binding of SARS-CoV-2 to human angiotensin-converting enzyme 2 (Omotuyi et al., 2020). The broad-spectrum antiviral drug Arbidol (umifenovir) also shows in vitro anti-SARS-CoV activity (Khamitov et al., 2008).

Retrospective analysis of the clinical features of outpatients with novel coronavirus in areas outside Wuhan, China (preprint)

Objective: The novel coronavirus pneumonia (COVID-19) has spread rapidly across the globe with the movement of people. How to diagnose COVID-19 quickly and accurately is a concern for all. We retrospectively assessed the clinical characteristics of patients with COVID-19 detected by outpatient screening in areas outside Wuhan, China, to guide early screening outside the epidemic area, to isolate and treat COVID-19-positive patients, and to control the spread of this virus in the region.Results: Among the 213 patients treated in the fever clinic of our hospital, 41 tested positive for novel coronavirus (2019-nCoV) and 172 were negative. Among the positive patients, 13 (31.7%) of the patients had been to Wuhan, while 28 (68.3%) had not been to Wuhan. There were 4 cases of clustering occurrence. The main symptoms exhibited by COVID-19-positive patients were fever (87.8%), cough (68.3%), and expectoration (34.1%). The C-reactive protein (CRP) levels were increased in 35 (85.3%) positive patients; the hydroxybutyrate dehydrogenase in the myocardial zymogram was increased in 22 positive patients (53.6%) and 38 negative patients (22.1%); computed tomography (CT) findings revealed lung lesions in all 41 positive patients (100%).Conclusion: We classified the patient population and analyzed the data to understand the early clinical performance of COVID-19. Our research illustrate that screening for COVID-19 outside Wuhan should focus on early symptoms such as fever and cough, in combination with lung CT findings, epidemiological history, and sputum pathogen detection to determine whether patients need further isolation.