Strategies for screening, occupational prevention, and management of COVID-19 in outpatient clinics in Shandong

Objective We hope to analyze the information of outpatients in a tertiary care hospital during the epidemic of COVID-19, so as to formulate effective regulations for the prevention and control of COVID-19. Methods We collected information from outpatients from January 28, 2020 to March 2, 2020 and performed the statistical analysis. Results During the study period, there were more than 60,000 outpatients. Among them, 404 patients with a body temperature above 37.3°C who had not been to Wuhan and had no contact with people from Wuhan. There were 8 people who had contact with people from Wuhan, such as 4 people with fever, 3 people with normal body temperature but cough symptoms, and 1 person with normal body temperature and no other discomfort. There were 2 patients with high body temperature from the epidemic area in Wuhan, and one novel Coronavirus patient was confirmed as the final result. Conclusion During the COVID-19 pandemic, outpatient medical staff should enhance their awareness of protection, hospitals should standardize the outpatient COVID-19 prevention and control system, improve the prevention and emergency system, and reduce occupational exposure hazards and the occurrence of post-exposure infections.

Efficacy and Safety of Leflunomide for Refractory COVID-19: A Pilot Study.

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may persist in patients with coronavirus disease 2019 (COVID-19) despite receiving standard care. Methods: In this pilot study of hospitalized adult patients (≥18 years of age), with radiologically confirmed pneumonia who were SARS-CoV-2 positive for more than 28 days despite standard care, were assigned to receive standard of care (SOC, grp I) or leflunomide + SOC (grp 2). After 2 weeks, grp 1 and grp 2 patients who continued to be SARS-CoV-2-positive received leflunomide for 14 days while continuing SOC. The primary outcomes were the rate of and time to SARS-CoV-2 clearance and the 14-day and 30-day hospital discharge rate. Results: 12 patients were enrolled in grp 1 and 15 patients were in grp 2. The 14 days SARS-CoV-2 viral clearance rate was 80.0% (12/15) for grp 2 patients receiving leflunomide vs. 16.7% for grp 1 patients (2/12) (p = 0.002). By day 14, the median time to SARS-CoV-2 clearance was 6.0 days (range 1-12, IQR 1-12) for grp 2 patients. In grp 1, two patients converted to viral negative on days 1 and 6 (p = 0.002). The 14-day discharge rate was 73.3% (11/15) for the grp 2 vs. 8.3% (1/12) for grp 1 (p = 0.001). The 30 days discharge rate was 100% (15/15) for the grp 2 vs. 66.7% (8/12) for grp 1. No severe adverse events or deaths were reported. Conclusion: Leflunomide may improve the SARS-CoV-2 clearance rate and discharge rate in patients with refractory COVID-19. The tolerability of the 14-28 days course of treatment with leflunomide is acceptable. These preliminary observations need to be verified by a large sample size and randomized controlled trial.

Expert consensus on prevention and cardiopulmonary resuscitation for cardiac arrest in COVID-19

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: (1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. (2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. (3) Healthcare workers should wear personal protective equipment (PPE). (4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. (5) Hands-only chest compression and mechanical chest compression are recommended. (6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. (7) CPR should be provided for 20-30 min. (8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: (1) Healthcare workers should wear PPE. (2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. (3) Both the benefits to patients and the risk of infection should be considered. (4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

The Current Situation and Influencing Factors of Job Stress Among Frontline Nurses Assisting in Wuhan in Fighting COVID-19.

Background: The coronavirus disease 2019 (COVID-19) pandemic continues to pose an unprecedented threat and challenge to public health around the world. Lacking sufficient human resources, nurses are required to undertake an increased workload at the clinical frontline of this epidemic. Additionally, nurses are at a high risk due to their working within close proximity to COVID-19 patients. As a result, they experience increased job stress. Objective: To explore the current situation and influencing factors of job stress among clinical first-line nurses fighting COVID-19. Methods: A convenience sampling method was used to conduct a questionnaire survey with 110 nurses who were on the clinical frontline of the COVID-19 epidemic in a hospital in Wuhan. Results: The job stress scores of clinical nurses on the frontline of the COVID-19 epidemic were collected (91.42 ± 26.09); the dimensions of work environment and resources as well as workload and time pressure were ranked first and second, respectively. The results of a multiple stepwise regression analysis showed that working hours per day, service years, number of night shifts per week, and level of academic qualification were the main factors affecting the job stress levels of nursing staff. Conclusions: The job stress of nurses on the clinical frontline of the COVID-19 epidemic was found to be at a medium level. Nursing leaders and hospital managers should pay attention to the impact of job stress on frontline nurses, while taking positive and effective measures aimed at eliminating the source of nursing work pressures to stabilize their nursing teams and promote their work in the fight against this epidemic.

Differences in the Clinical and Hematological Characteristics of COVID-19 Patients with and without Type 2 Diabetes.

OBJECTIVE: To examine whether comorbidity with type 2 diabetes (T2D) affects the clinical and hematological parameters of coronavirus disease 2019 (COVID-19) patients. METHODS: We retrospectively investigated the clinical, imaging, and laboratory characteristics of patients with confirmed COVID-19 who were hospitalized from January 30, 2020 to March 17, 2020, at the Renmin Hospital of Wuhan University. A detailed clinical record was kept for each subject, including the medical history of COVID-19 and physical and laboratory examinations. A total of 164 subjects were eligible for the study, among which 40 patients were comorbid with T2D. Further analysis was conducted in two subcohorts of sex- and age-matched patients with and without T2D to identify hematological and biochemical differences. The laboratory tests, including routine blood tests, serum biochemistry, and coagulation function, were performed upon admission. RESULTS: The two groups showed no significant differences in baseline parameters, including age, sex, chest X-ray, or computed tomography (CT) findings, upon admission. However, patients with T2D showed an increased incidence of diarrhea. T2D patients required more recovery time from pneumonia, as shown by follow-up CT findings, which might contribute to the prolonged hospitalization. Comorbidity with T2D also increased risk of secondary bacterial infection during COVID-19. The T2D group had significantly higher white blood cell and neutrophil counts compared with the nondiabetic group, but T2D patients suffered from more severe lymphocytopenia and inflammation (P < 0.05). Most biochemical parameters showed no significant differences between the two groups (P > 0.05). However, patients with T2D seemed to have a significantly higher risk of developing hyperlactatemia, hyponatremia, and hypocalcemia. CONCLUSIONS: COVID-19 patients comorbid with T2D demonstrated distinguishing clinical features and hematological parameters during the infection. It is necessary to develop a different clinical severity scoring system for COVID-19 patients with T2D. This study may provide helpful clues for the assessment and management of COVID-19 in T2D patients.