Demand for longer quarantine period among common and uncommon COVID-19 infections: a scoping review.

BACKGROUND: As one of the non-pharmacological interventions to control the transmission of COVID-19, determining the quarantine duration is mainly based on the accurate estimates of the incubation period. However, patients with coarse information of the exposure date, as well as infections other than the symptomatic, were not taken into account in previously published studies. Thus, by using the statistical method dealing with the interval-censored data, we assessed the quarantine duration for both common and uncommon infections. The latter type includes the presymptomatic, the asymptomatic and the recurrent test positive patients. METHODS: As of 10 December 2020, information on cases have been collected from the English and Chinese databases, including Pubmed, Google scholar, CNKI (China National Knowledge Infrastructure) and Wanfang. Official websites and medias were also searched as data sources. All data were transformed into doubly interval-censored and the accelerated failure time model was applied. By estimating the incubation period and the time-to-event distribution of worldwide COVID-19 patients, we obtain the large percentiles for determining and suggesting the quarantine policies. For symptomatic and presymptomatic COVID-19 patients, the incubation time is the duration from exposure to symptom onset. For the asymptomatic, we substitute the date of first positive result of nucleic acid testing for that of symptom onset. Furthermore, the time from hospital discharge or getting negative test result to the positive recurrence has been calculated for recurrent positive patients. RESULTS: A total of 1920 laboratory confirmed COVID-19 cases were included. Among all uncommon infections, 34.1% (n = 55) of them developed symptoms or were identified beyond fourteen days. Based on all collected cases, the 95th and 99th percentiles were estimated to be 16.2 days (95% CI 15.5-17.0) and 22.9 days (21.7‒24.3) respectively. Besides, we got similar estimates based on merely symptomatic and presymptomatic infections as 15.1 days (14.4‒15.7) and 21.1 days (20.0‒22.2). CONCLUSIONS: There are a certain number of infected people who require longer quarantine duration. Our findings well support the current practice of the extended active monitoring. To further prevent possible transmissions induced and facilitated by such infectious outliers after the 14-days quarantine, properly prolonging the quarantine duration could be prudent for high-risk scenarios and in regions with insufficient test resources.

Clinical Outcomes of COVID-19 Cases and Influencing Factors of Severe Cases in Qingdao City: A Retrospective Cohort Study (preprint)

BackgroundTo analyze the clinical outcomes of COVID-2019 cases and the influencing factors of severe cases in Qingdao City and provide theoretical reference basis for optimizing medical treatment and the strategies of epidemic prevention and control. MethodsThe demographical, epidemiological, clinical data of 81 confirmed COVID-2019 cases in Qingdao City were collected via epidemiological investigation and clinical process tracking. The status of cure, discharge, clinical outcome and influencing factors were analyzed in our study. ResultsAmong the 81 cases，12(14.81%) and 55(67.90%) were mild and ordinary, 9(11.11%) and 4(4.94%) were severe and critical, and 1 critical cases (1.23%) developed into fatal, with the fatality rate 1.23%. The median time from onset of symptoms to hospital admission were 3.67 days (IQR, 1.75 to 6.71). The median duration of illness were 21.00 days (IQR, 16.00 to 26.00) and the median length of hospitalization were 15.63 days (IQR, 11.60 to 20.50). The median time for progression to severe cases was 6.00 days after onset (IQR, 5.00-10.00). The median duration of severe cases was 8.00 days (IQR, 6.25-14.00). Age older than 40 years old (OR=5.797, 95%CI: 1.064~31.568) and first chest CT abnormal (OR=0.1140, 95%CI: 0.014~0.923) were the influencing factors of COVID-2019 severe cases. ConclusionsOlder age and first chest CT normal would be more prone to develop to severe cases of COVID-2019. During the epidemic period, it was necessary to classify and manage cases according to the needs of prevention and control in order to ensure the rational allocation of medical resources.

Nurses suffered with more psychological symptoms when fighting against novel coronavirus pneumonia (COVID-19): a longitudinal observational survey of medical staff (preprint)

Objective. Our objective is to investigate and analyze the psychological status of medical staff in a designated community hospital for COVID-19.Methods. We conducted a survey on medical staff in a designated community hospital for COVID-19 among the during-pandemic group (n = 120) and the after-pandemic group (n = 34). The symptom checklist 90 (SCL-90) questionnaire was used as a self-report instrument for the measurement of psychopathological complaints.Results. The during-pandemic group consisted of 120 individuals, including doctors (n = 36), nurses (n = 69) and technicians (n = 15). The SCL-90 sum scores showed no difference among doctors, nurses, and technicians (P > 0.05), but the somatization (SOM) item-scores of nurses were significantly higher than those of doctors and technicians (all P < 0.05). Meanwhile, the paranoid ideation (PAR) item-scores of nurses were significantly higher than those of doctors (P < 0.05). The after-pandemic group consisted only of nurses (n = 34). The score of each dimension of SCL-90 in nurses after the pandemic were relatively lower than that in nurses during the pandemic.Conclusions. Our study showed that nurses suffered with more psychological symptoms when fighting against COVID-19. The emergence of COVID-19 was the main factor leading to psychological problems of nurses.

Application of high-flow nasal cannula in hypoxemic patients with COVID-19: a retrospective cohort study (preprint)

Background: High-flow nasal cannula (HFNC) oxygen therapy provides effective respiratory support in patients with hypoxemic respiratory failure. However, the efficacy of HFNC for patients with COVID-19 has not been established. This study was performed to assess the efficacy of HFNC for patients with COVID-19 and describe early predictors of HFNC treatment success in order to develop a prediction tool that accurately identifies the need for invasive mechanical ventilation (IMV). Methods: We retrospectively reviewed the records of patients with COVID-19 who underwent HFNC in 2 hospitals in Wuhan between 1 January and 1 March 2020. Overall survival, the success rate of HFNC treatment and respiratory variables to predict the outcome of HFNC treatment were evaluated.Results: A total of 105 patients were analyzed. Of these, 65 patients (61.9%) showed improved oxygenation and were successfully withdrawn from HFNC. The oxygenation index (PaO2/FiO2), Oxygen saturation index (SpO2/FiO2) and respiratory rate-oxygenation index (ROX index: SpO2/FiO2*RR) at 6h, 12h and 24h of HFNC initiation were closely related to the prognosis. The best predictor was the ROX index at 24h after initiating HFNC (area under the receiver operating characteristic curve, 0.874). In the multivariate logistic regression analysis, young age, gender of female, and lower SOFA score all have predictive value, while a ROX index greater than 6.10 at 24 h after initiation was significantly associated with HFNC success (OR, 104.212; 95% CI, 11.399-952.757; p＜0.001).Conclusions: Our study indicated that HFNC was an effective way of respiratory support in the treatment of severe COVID-19. The ROX index greater than 6.10 at 24 h after initiating HFNC was a good predictor of successful HFNC treatment.