The Relationship Between Insomnia and Anxiety Among COVID-19 Patients in China: the Chain Mediating Effect of Psychological Capital and Self-esteem (preprint)

Background：The outbreak of Corona Virus Disease (COVID-19) in 2019 has continued until now, posing a huge threat to the public’s physical and mental health, resulting in different degrees of mental health problems. As a vulnerable segment of the public, anxiety is one of the most common mental health problems among COVID-19 patients. Excessive anxiety aggravates the physical and psychological symptoms of COVID-19 patients, which is detrimental to their treatment and recovery, increases financial expenditure, affects family relations, and adds to the medical burden. Objective: This study aimed to explore the role of psychological capital and self-esteem in the relationship between insomnia and anxiety, thereby shedding light on the mechanism of the effect of insomnia on anxiety in COVID-19 patients. Methods: A cross-sectional study was conducted from April to May 2022 in Fangcang hospital in Shanghai, China. The self-administered questionnaires were distributed to 718 COVID-19 patients via cell phone using the Internet platform "Questionnaire Star", which included Athens Insomnia Scale, Psychological Capital Questionnaire, Self-esteem Scale, Self-Rating Anxiety Scale, gender, age, marital status, education. Data analysis was performed using descriptive analysis, independent-samples t-test, one-way analysis of variance, Pearson correlation analysis, ordinary least-squares regression, and bootstrap method. Results: Education background had significant impact on anxiety in COVID-19 patients (F =7.701, P < 0.001). Insomnia, psychological capital, self-esteem and anxiety were significantly correlated, respectively (P < 0.001). And Regression analysis showed that insomnia had a direct negative predictive effect on psychological capital (β = -0.699, P < 0.001) and self-esteem (β = -0.129, P < 0.001). Psychological capital had a direct positive predictive effect on self-esteem (β = 0.116, P < 0.001). Insomnia had a direct positive predictive effect on anxiety (β = 0.611, P < 0.001). Both psychological capital and self-esteem had significant negative predictive effects on anxiety (β = -0.060, P < 0.001; β = -0.722, P < 0.001). Conclusions: Insomnia had a significant positive predictive effect on anxiety. Insomnia was first associated with a decrease in psychological capital, followed by a sequential decrease in self-esteem, which in turn was associated with increased anxiety symptoms in COVID-19 patients.

Latent profile analysis of security among patients with COVID-19 infection in mobile cabin hospitals and its relationship with psychological capital

Aim COVID-19 patients' security is related to their mental health. However, the classification of this group's sense of security is still unclear. The aim of our research is to clarify the subtypes of security of patients infected with COVID-19, explore the factors affecting profile membership, and examine the relationship between security and psychological capital for the purpose of providing a reference for improving patients' sense of security and mental health. Methods A total of 650 COVID-19 patients in a mobile cabin hospital were selected for a cross-sectional survey from April to May 2022. They completed online self-report questionnaires that included a demographic questionnaire, security scale, and psychological capital scale. Data analysis included latent profile analysis, variance analysis, the Chi-square test, multiple comparisons, multivariate logistical regression, and hierarchical regression analysis. Results Three latent profiles were identified—low security (Class 1), moderate security (Class 2), and high security (Class 3)—accounting for 12.00, 49.51, and 38.49% of the total surveyed patients, respectively. In terms of the score of security and its two dimensions, Class 3 was higher than Class 2, and Class 2 was higher than Class 1 (all P < 0.001). Patients with difficulty falling asleep, sleep quality as usual, and lower tenacity were more likely to be grouped into Class 1 rather than Class 3;Patients from families with a per capita monthly household income <3,000 and lower self-efficacy and hope were more likely to be grouped into Classes 1 and 2 than into Class 3. Psychological capital was an important predictor of security, which could independently explain 18.70% of the variation in the patients' security. Conclusions Security has different classification features among patients with COVID-19 infection in mobile cabin hospitals. The security of over half of the patients surveyed is at the lower or middle level, and psychological capital is an important predictor of the patients' security. Medical staff should actively pay attention to patients with low security and help them to improve their security level and psychological capital.

Long-Term Follow-Up Study of COVID-19: Evaluation on Thin-Slice CT

Purpose To retrospectively analyse the CT imaging during the long-term follow-up of COVID-19 patients after discharge. Patients and Methods A total of 122 patients entered the study group. All patients underwent CT examinations. The CT images, which included distribution and imaging signs, were evaluated by two chest radiologists. Laboratory examinations included routine blood work, biochemical testing, and SARS-CoV-2 antibody screening. Statistical methods include chi-square, Fisher’s exact test, one-way analysis of variance, rank sum test and logistic regression by SPSS 17.0. Results There were 22 (18.0%) patients in the mild group, 74 (60.7%) patients in the moderate group, and 26 (21.3%) patients in the severe–critical group. The median follow-up interval was 405 days (378.0 days, 462.8 days). Only monocytes, prothrombin activity, and γ-glutamyltransferase showed significant differences among the three groups. We found that the more severe the patient’s condition, the more SARS-CoV-2 IgG antibodies existed. Only 11 patients (11.0%) showed residual lesions on CT. The CT manifestations included irregular linear opacities in nine cases (9.0%), reticular patterns in six cases (6.0%), and GGOs in five cases (5.0%). Conclusion The proportion of residual lesions on CT in COVID-19 patients was significantly reduced after long-term follow-up. The patients’ age and disease conditions were positively correlated with residual lesions.

Change in willingness to COVID-19 vaccination in China: Two online surveys during the pandemic.

OBJECTIVE: As the variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to emerge, periodic vaccine booster immunization may become a normal policy. This study investigated the changes and factors associated with vaccination intentions in various epidemic situations, which can provide suggestions for the construction and modification of routine vaccination program strategies. METHODS: Two cross-sectional online surveys were conducted in January and June of 2021. The willingness and confidence of the coronavirus disease 2019 (COVID-19) vaccination were measured following propensity score matching (PSM) treatment. The difference in the willingness for COVID-19 Vaccination in the two surveys was analyzed by single or multi-factor analyses. RESULTS: The willingness to accept the SARS-CoV-2 vaccine was higher in the second survey than that in the first survey (90.5% vs. 66.6%, p < 0.001). Concerns about the vaccine's safety declined (71.0% vs. 47.6%, p < 0.001), but concerns about the efficacy increased (22.4% vs. 30.9%, p < 0.001). Confidence in the SARS-CoV-2 vaccine had an important impact on the increased uptake willingness (odds ratio = 3.19, 95% confidence interval: 2.23-4.58, p < 0.001). CONCLUSIONS: There has been a significant increase in attitudes towards the SARS-CoV-2 vaccine which was associated with higher vaccine confidence. Vaccine effectiveness received more concerns from respondents rather than safety after nearly 6 months' utilization of the SARS-CoV-2 vaccine. It indicates that aggressive communication and timely disclosure of vaccine data can build vaccine confidence.

Reduced Neutralization of SARS-CoV-2 Omicron Variant in Sera from SARS-CoV-1 Survivors after 3-dose of Vaccination (preprint)

Recent studies found that Omicron variant escapes vaccine-elicited immunity. Interestingly, potent cross-clade pan-sarbecovirus neutralizing antibodies were found in survivors of the infection by SARS-CoV-1 after BNT162b2 mRNA vaccination (N Engl J Med. 2021 Oct 7;385(15):1401-1406). These pan-sarbecovirus neutralizing antibodies were observed to efficiently neutralize the infection driven by the S protein from both SARS-CoV and multiple SARS-CoV-2 variants of concern (VOC) including B.1.1.7 (Alpha), B.1.351 (Beta), and B.1.617.2 (Delta) (N Engl J Med. 2021 Oct 7;385(15):1401-1406). However, whether these cross-reactive antibodies could neutralize the Omicron variant is still unknown. Based on the data collected from a cohort of SARS-CoV-1 survivors received 3-dose of immunization, our studies reported herein showed that a high level of neutralizing antibodies against both SARS-CoV-1 and SARS-CoV-2 were elicited by a 3rd-dose of booster vaccination of protein subunit vaccine ZF2001. However, a dramatically reduced neutralization of SARS-CoV-2 Omicron Variant (B.1.1.529) is observed in sera from these SARS-CoV-1 survivors received 3-dose of Vaccination. Our results indicates that the rapid development of pan-variant adapted vaccines is warranted.

Changes in the Pathogenic Spectrum of Acute Respiratory Tract Infections During the COVID-19 Epidemic in Beijing, China (preprint)

Background: Public health measures against COVID-19 may influence other disease epidemics. Many countries have reported significant reductions in influenza activity in 2020–2021, but the prevalence of other respiratory pathogens during the COVID-19 pandemic has rarely been reported, especially in China.Methods: Data from the Respiratory Pathogen Surveillance System in Beijing were analyzed to compare pathogen infection rates before the COVID-19 (from 1 February 2015 to 31 January 2020) and during the COVID-19 (from 1 February 2020 to 31 January 2021).Findings: Among 41630 acute respiratory tract infections 13630 had at least one pathogen positive result, which decreased from 32·16% (95% CI 31·69%, 32·64%) before the COVID-19 to 10·97% (95% CI 10·03%, 11·96%) during the COVID-19, representing a 65·90% decrease (P<0·001). The positivity rate fluctuated with the strictness of public health measures. Before the COVID-19 epidemic, the top five of the pathogenic spectrums were IFV (26·27%), MP (19·30%), HPIV (11·80%), HRV (9·38%), and EV (8·38%), while during the COVID-19, the top five were seasonal HCoV (21·10%), HRV (18·99%), HPIV (14·98%), IFV (13·08%), and RSV (10.76%).Interpretation: The prevalence of respiratory pathogens decreased significantly during the COVID-19, closely relating to public health measures against COVID-19; these measures can serve as useful strategies for the prevention and control of other respiratory tract infections.Funding Statement: The National Major Science and Technology Project for Control and Prevention of Major Infectious Diseases in China (2017ZX10103004).Declaration of Interests: FH received funds from the National Major Science and Technology Project for Control and Prevention of Major Infectious Diseases in China (2017ZX10103004). All other authors declare no competing interests.Ethics Approval Statement: Ethics approval for the protocol of this study was obtained from the Ethics Committee of the BJCDC. Written informed consent was obtained.

Viral Sepsis, No Neglecting Complication Following Novel Corona Virus Disease (COVID-19) (preprint)

Background Until 24:00 of April 26th 2020, 2,918,268 laboratory-confirmed cases of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection have been reported worldwide, including 203,528 deaths. Bacterial infection is the main cause of sepsis, however, sepsis caused by virus is often ignored. Increased awareness, early recognition of viral sepsis, rapid administration of appropriate antiviral drugs, and urgent treatment can significantly reduce deaths of viral sepsis.Objectives Given the rapid global spread of novel Corona Virus Disease (COVID-19), coupled with the high rate of missed diagnosis of viral sepsis caused by SARS-CoV-2 infection, it is urgent to evaluate the multiple organ failure score and viral sepsis in COVID-19 patients, so as to determine the clinical characteristics of viral sepsis more accurately and reveal the risk factors related to mortality.Methods Here we provide a full description of three cases of viral sepsis and subsequent multiple organ dysfunction (MODS) caused by SARS-CoV-2 infection imported to Guiyang from Wuhan.Results Complete laboratory examination, imaging data and treatment methods for the patients are analyzed. Sepsis-related Organ Failure Assessment score (SOFA score) and Multiple organ dysfunction scores (MOD score) were daily assessed, aim to elucidate the clinical feature of viral sepsis and MODS and to attract enough attention by clinicians.Conclusions Therefore, we strongly suggest to daily evaluate SOFA score and MOD score in severe and critically-ill COVID-19 patients, so as to early diagnose and prevention of sepsis and MODS.