Grief Response of Nursing Professionals Is Associated With Their Depression, Loneliness, Insomnia, and Work-Related Stress While Working in COVID-19 Inpatients Wards.

OBJECTIVE: We aimed to explore whether nursing professionals' psychological states affect their grief response for a patient's death in the coronavirus disease-2019 (COVID-19) inpatients' ward. METHODS: Survey was conducted among frontline nursing professionals working in COVID-19 inpatients wards at three tertiary-level affiliated hospitals of the University of Ulsan during April 7-26, 2022. Participants' information such as age, years of employment, or marital status were collected, and their responses to rating scales including Pandemic Grief Scale (PGS) for healthcare workers, Stress and Anxiety to Viral Epidemics-9 items (SAVE-9), Patient Health Questionnaire-9 (PHQ-9), Loneliness and Social Isolation Scale, and Insomnia Severity Scale (ISI) were collected. RESULTS: All 251 responses were analyzed. We observed that 34% reportedly suffered from depression. The linear regression analysis showed that a high PGS score was expected by high SAVE-9 (ß=0.12, p=0.040), high PHQ-9 (ß=0.25, p<0.001), high loneliness (ß=0.17, p=0.006), and high ISI score (ß=0.16, p=0.006, F=20.05, p<0.001). The mediation analysis showed that the depression of nursing professionals directly influenced their pandemic grief reaction, and their work-related stress and viral anxiety, insomnia severity, and loneliness partially mediated the association. CONCLUSION: We confirm that frontline nursing professionals' depression directly influenced their grief reaction, and their work-related stress and viral anxiety, insomnia severity, and loneliness partially mediated the association. We hope to establish a psychological and social support system for the mental health of nurses working in the COVID-19 wards.

Individual and Work-Related Characteristics Associated with COVID-19 Vaccination Status among Ohio Nurses.

Uptake of the COVID-19 vaccine by nurses lags behind that of other health care professionals with minimal empirical evidence to understand this phenomenon. In this secondary analysis, we examined nurses' individual and work-related characteristics and their association with COVID-19 vaccination status. Alumni of three Ohio nursing colleges and members of a professional organization were invited to complete questionnaires from June through August 2021. Logistic regression models were used to evaluate associations between nurse characteristics and vaccination status. Among 844 respondents, 754 (80.30%) had received at least one dose of the vaccine. Older age, having a bachelor's degree or higher, and working in critical care were associated with vaccination. Providing direct care for COVID-19 patients in the last 7 days and a higher perception of one's work being affected by COVID-19 were significantly associated with being vaccinated, whereas prior COVID-19 infection was inversely associated with vaccination status. Our findings suggest that COVID-19 vaccine uptake among nurses is influenced by a host of factors related to virus knowledge, beliefs, and risk perceptions. Awareness of these factors can aid the development of interventions to increase nurses' acceptance of vaccines.

Service Workers' Experience and Perceptions of Workplace Protective Measures During the Onset of COVID-19.

OBJECTIVES: The Coronavirus-2019 (COVID-19) pandemic presents a unique burden specifically for workers in service industries. However, limited research on service worker's experience during the onset of COVID-19 exists. We aimed to describe the experiences and concerns of service industry workers during the pandemic's onset. METHODS: This is a mixed-method study. Participants were recruited through social media and completed either a survey or a phone interview during May and June 2020. The survey and transcribed interview data were analyzed using the SPSS software and content analysis, respectively. RESULTS: Twenty-seven individuals completed audio-recorded phone interviews and 28 completed the survey. Participants were mostly women between 19 and 65 years old. Participants worked in food retail (n = 23), restaurant (n = 25), and hospitality (n = 7) industries. There was discordance in perceived threat level of COVID-19. Most participants reported that their workplace complied with their state's mandates for protection measures, while others reported lacking basic supplies such as soap, hand sanitizer, and masks. Job insecurity, change of job tasks, and work hours were the most common ways that COVID-19 affected the workers. Worker's assertiveness to self-protect while at work was influenced by their perceived severity of the pandemic. CONCLUSION/APPLICATION TO PRACTICE: This study highlights the vulnerability of service workers relating to job security and job tasks during the pandemic. Organizational processes are needed to promote safe work environments and facilitate access to resources for these workers. In addition, occupational health practitioners need to be aware of and address the emerging health risks and worker needs.

The effect of COVID-19 on workplace violence in California's hospitals: An interrupted time series analysis.

AIM: This study used California's unique Workplace Violent Incident Reporting System (WVIRS) to describe changes in workplace violence (WV) exposure for hospital-based healthcare workers during the pandemic. DESIGN: Interrupted time series analysis. METHODS: We compared the linear trends in weekly WV incidents reported during the period before the COVID-19 pandemic (7/1/2017-3/20/2020) to the period following California's shutdown (3/21/2020-6/30/2021). We created mixed effects models for incidents reported in emergency departments (EDs) and in other hospital units. We used hospital volume data from the California Department of Health Care Access and Information. RESULTS: A total of 418 hospitals reported 37,561 incidents during the study period. For EDs, the number of reported incidents remained essentially constant, despite a 26% drop in outpatient visits between the first and second quarters of 2020. For other hospital units, weekly incidents initially dropped-parallel to a 13% decrease in inpatient days between the first and second quarters of 2020-but then continued parallel to the trend seen in the pre-COVID period. CONCLUSION: WV persists steadily in California's hospitals. Despite major reductions in patient volume due to COVID-19, weekly reported ED incidents remained essentially unchanged. IMPACT: Surveys and media reported that WV increased during the pandemic, but it has been difficult to measure these changes using a large-scale database. The absolute number of WV incidents did not increase during the pandemic; however, the trend in reported incidents remained constant in the context of dramatic decreases in patient volume. New federal WV prevention legislation is being considered in the U.S. California's experience of implementation should be considered to improve WV reporting and prevention. PUBLIC CONTRIBUTION: There was no public contribution to this study. The goal of this analysis was to summarize findings from administrative data. The findings presented can inform future discussion of public policy and action.

Cross-cultural differences and similarities in nurses' experiences during the early stages of COVID-19 in Korea and the United States: A qualitative descriptive study.

Background: At the onset of the COVID-19 pandemic, governmental responses varied worldwide, which resulted in healthcare professionals and organizations having different experiences. As threats of global infectious disease and disasters increase, it is important to examine the collective experiences of nurses to leverage support across international settings and systems and to tailor specific policies to their local nursing workforce. Objective: To compare and contrast nurses' experiences working in hospitals at the onset of COVID-19 in South Korea and the United States. Method: This was a qualitative descriptive study. Nurses in South Korea and the United States were recruited through social media using snowball sampling between April and May 2020. Semi-structured telephone interviews were audio-recorded, transcribed, and translated as needed. The transcripts were analyzed thematically, and each theme was compared and synthesized using NVivo 12. Results: A total of 43 nurses from South Korea (n = 21) and the United States (n = 22) participated in the study. The majority of the participants were female and working as staff nurses in both countries. The work settings were similar between the participants from two countries. However, the participants in South Korea provided less direct care to patients with COVID-19 compared to the participants in the United States. Despite cultural and infrastructure differences, the nurses shared similar experiences. Conclusion: The overlapping similarities of nurses' experience highlight the need for national and global policies for a safe work environment and psychological well-being. The differences between the two countries also emphasize that specific policies and practice implications for the local contexts are needed in addition to global policies.

Psychometric properties of the Stress and Anxiety to Viral Epidemics-9 scale among frontline nursing professionals working in the COVID-19 inpatients ward.

This study examined the reliability and validity of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) scale among nursing professionals working in a COVID-19 inpatient ward. An anonymous, online survey was conducted among working frontline nursing professionals between April 7 and 18, 2022. We collected information about the participants' age, sex, years of employment, shift work, and marital status. In addition, the participants were asked whether they had dealt with infected patients recently, and whether they had been quarantined, infected, or vaccinated. SAVE-9, Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) were used to evaluate symptoms. We used the Confirmatory Factor Analysis (CFA) to determine the validity of the two-factor model of the SAVE-9 scale. We also tested reliability and convergent validity using the PHQ-9 and GAD-7 scales. A total of 136 responses was analyzed, and CFA for two-factors model of the SAVE-9 scale showed a good model fit among frontline nursing professionals (CFI = 1.000, TLI = 1.040, RMSEA = 0.000, RSMR = 0.060). Multi-group CFAs revealed that the SAVE-9 scale can measure work-related stress and viral anxiety in the same way across sex, having depression, or having generalized anxiety. The internal consistency was shown to be good, and the SAVE-9 scale was significantly correlated with the GAD-7 (r = 0.328, p < 0.001) and PHQ-9 score (r = 0.361, p < 0.001). The two-factor model of the SAVE-9 is a valid and reliable scale for frontline nursing professionals.

Moral Injury, Nurse Well-being, and Resilience Among Nurses Practicing During the COVID-19 Pandemic.

OBJECTIVE: The aim of this study was to determine relationships between moral injury (MI), well-being, and resilience among staff nurses and nurse leaders practicing during the COVID-19 (coronavirus disease 2019) pandemic. BACKGROUND: Attention to MI among health professionals, including nurses, increased in 2021, particularly related to the pandemic. Few studies examined MI, well-being, and resilience; even fewer provided implications for leadership/management. METHODS: The sample included 676 RNs practicing in Ohio. The electronic survey included assessments of MI, well-being, and resilience distributed via the Ohio Nurses Association and the schools of nursing alumni Listservs. RESULTS: There was a significant association between MI and negative well-being and negative association between MI and resilience. Differences were observed between staff nurses and leaders. CONCLUSIONS: This is the first study relating MI, resilience, and well-bring among nurses and nurse leaders during the pandemic. There is a need for additional research to further our understanding about nurses' health and well-being during the pandemic and beyond.

Evaluation of nurses' experiences with digital storytelling workshop: New way to engage, connect, and empower.

AIM: The aim of this work is to evaluate nurses' experiences, barriers, and facilitators in participating in digital storytelling workshops BACKGROUND: Nurses face ever-increasing demands and work time spent in isolation, leading to burnout. Storytelling-narrative skills of listening and creativity-may encourage meaningful connections with others, especially during the COVID-19 pandemic. However, evaluation of the user experiences of storytelling among nurses has been limited. METHOD: The methods used are semistructured individual interviews with 13 nurses from a public health nursing organization who participated in a 3-day digital storytelling workshop in 2019. The interviews were audio-recorded, transcribed verbatim, and thematically analysed using NVivo12. RESULTS: All participants were women and half were white. Healing, human connection, and nursing pedagogy were the three main themes. Participants highlighted the organizational support in providing a safe and dedicated "space" for nurses' well-being. They also expressed desire and willingness to participate in additional workshops outside of work hours. CONCLUSION: Further studies using a larger sample are needed to examine the scalability and efficacy of storytelling at work. IMPLICATIONS FOR NURSING MANAGEMENT: Nurses rated storytelling positively and suggested a brief version to be incorporated into nursing practice. Establishing the culture of organizational support and psychological safety was identified as the necessary antecedents.

Effects and safety of COVID-19 vaccination on assisted reproductive technology and pregnancy: A comprehensive review and joint statements of the KSRM, the KSRI, and the KOSAR.

Humanity is in the midst of the coronavirus disease 2019 (COVID-19) pandemic, and vaccines-including mRNA vaccines-have been developed at an unprecedented speed. It is necessary to develop guidelines for vaccination for people undergoing treatment with assisted reproductive technology (ART) and for pregnancy-related situations based on the extant laboratory and clinical data. COVID-19 vaccines do not appear to adversely affect gametes, embryos, or implantation; therefore, active vaccination is recommended for women or men who are preparing for ART. The use of intravenous immunoglobulin G (IVIG) for the treatment of immune-related infertility is unlikely to impact the effectiveness of the vaccines, so COVID-19 vaccines can be administered around ART cycles in which IVIG is scheduled. Pregnant women have been proven to be at risk of severe maternal and neonatal complications from COVID-19. It does not appear that COVID-19 vaccines harm pregnant women or fetuses; instead, they have been observed to deliver antibodies against severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) to the fetus. Accordingly, it is recommended that pregnant women receive COVID-19 vaccination. There is no rationale for adverse effects, or clinical cases of adverse reactions, in mothers or neonates after COVID-19 vaccination in lactating women. Instead, antibodies to SARS-CoV-2 can be delivered through breast milk. Therefore, breastfeeding mothers should consider vaccination. In summary, active administration of COVID-19 vaccines will help ensure the safe implementation of ART, pregnancy, and breastfeeding.

Factors Associated With Spontaneous Awakening Trial and Spontaneous Breathing Trial Performance in Adults With Critical Illness: Analysis of a Multicenter, Nationwide, Cohort Study.

BACKGROUND: Broad-scale adoption of spontaneous awakening trials (SATs) and spontaneous breathing trials (SBTs) into everyday practice has been slow, and uncertainty exists regarding what factors facilitate or impede their routine delivery. RESEARCH QUESTION: What patient, practice, and pharmacologic factors are associated with SAT and SBT performance and to what extent do they predict overall SAT/SBT performance? STUDY DESIGN AND METHODS: This secondary analysis used data collected from a national quality improvement collaborative composed of 68 diverse ICUs. Adults with critical illness adults who received mechanical ventilation and/or continuously infused sedative medications were included. We performed mixed-effects logistic regression modeling, created receiver operating characteristic curves, and calculated the area under the curve (AUC). RESULTS: Included in the SAT and SBT analysis were 4,847 and 4,938 patients, respectively. In multivariable models controlling for admitting patient characteristics, factors independently associated with higher odds of a next-day SAT and SBT included physical restraint use (adjusted odds ratio [AOR], 1.63; 95% CI, 1.42-1.87; AOR, 1.83; 95% CI, 1.60-2.09), documented target sedation level (AOR, 1.68; 95% CI, 1.41-2.01; AOR, 1.46; 95% CI, 1.24-1.72), more frequent level of arousal assessments (AOR, 1.22; 95% CI, 1.03-1.43; AOR, 1.32; 95% CI, 1.13-1.54), and dexmedetomidine administration (AOR, 1.23; 95% CI, 1.05-1.45; AOR, 1.52; 95% CI, 1.27-1.80). Factors independently associated with lower odds of a next-day SAT and SBT included deep sedation/coma (AOR, 0.69; 95% CI, 0.60-0.80; AOR, 0.33; 95% CI, 0.28-0.37) and benzodiazepine (AOR, 0.83; 95% CI, 0.72-0.95; AOR, 0.67; 95% CI, 0.59-0.77) or ketamine (AOR, 0.34; 95% CI, 0.16-0.71; AOR, 0.40; 95% CI, 0.18-0.88) administration. Models incorporating admitting, daily, and unit variations displayed moderate discriminant accuracy in predicting next-day SAT (AUC, 0.73) and SBT (AUC, 0.72) performance. INTERPRETATION: There are a number of modifiable factors associated with SAT/SBT performance that are amenable to the development and testing of implementation interventions.

The Perfect Storm: Organizational Dissonance and the Global Pandemic.

An incongruity between what is said and done can be harmful. Cultivating consonance is a place to bring organizations and nurses together.

Associations Among Nurses' Mental/Physical Health, Lifestyle Behaviors, Shift Length, and Workplace Wellness Support During COVID-19: Important Implications for Health Care Systems.

Work cultures supportive of wellness and shorter shift length have been associated with better mental/physical health outcomes in nurses, but how the coronavirus disease-19 (COVID-19) pandemic impacted such outcomes is not known. This study's aims were to (1) describe the mental/physical health, well-being, and healthy lifestyle behaviors of nurses during the pandemic; (2) explore the pandemic's impact on their health and healthy lifestyle behaviors; and (3) determine the associations of perceived workplace wellness support and shift length with nurses' health, well-being, and healthy lifestyle behaviors. A cross-sectional descriptive design was used with 264 nurses associated with Trusted Health. Nurses completed a survey containing valid and reliable scales measuring depression, anxiety, burnout and quality of life, perceived wellness culture, and healthy lifestyle behaviors. Results indicated that more than 50% of nurses had worsening mental/physical health relating to the pandemic. Compared with nurses whose workplaces provided little/no wellness support, nurses with workplaces that supported their wellness were 3 to 9 times as likely to have better mental/physical health, no/little stress, no burnout, and high quality of life. Nurses who worked longer shifts had poorer health outcomes. These findings indicate that workplace wellness support and shorter shifts positively impacted nurse mental/physical health and professional quality of life amidst the pandemic.

Influence of the First-wave COVID-19 Pandemic on Emergency Acute Coronary Syndrome: a Multicenter Retrospective Study From a Non-epicenter Region (preprint)

Background: The COVID-19 pandemic presented severe challenges to emergency practice of acute coronary syndrome (ACS). However, poor evidence was shown on ACS in a non-hot-spot region. We sought to clarify the influence of the first-wave COVID-19 pandemic on emergency ACS from a non-epicenter region. Methods: : This retrospective multicenter study was conducted in emergency ACS patients during the pandemic (from 2020-01-23 to 2020-03-29) and the ones during the same period in 2019. Clinical characteristics, timeline parameters and treatment strategies were compared between different groups. Association of the pandemic with non-invasive therapy was further assessed. Results: : Compared with 2019, ACS had a drop in admission (267 cases vs. 475 cases) and invasive therapy (140 cases vs. 318 cases). Also, process delays were detected including the period from symptom onset to first medical contact (S-to-FMC, 5h vs. 2.5h), the period from FMC to electrocardiogram (ECG) completed (8min vs. 4min) and the period from FMC to dual antiplatelet therapy (FMC-to-DAPT, 25min vs. 19min). Primary percutaneous coronary intervention (PPCI) decreased by 54.9% in STEMI and early invasive therapy decreased by 59.2% in NSTE-ACS. The proportion of invasive therapy in NSTE-ACS decreased more than in STEMI (16.9% vs. 10.1%) with longer process delay. The pandemic was associated with increased non-PPCI in STEMI (OR=1.707, 95%CI 1.082-2.692, P=0.021) and elevated medication in NSTE-ACS (OR=2.029, 95%CI 1.268-3.247, P=0.003), respectively. Conclusion: Even in a non-epicenter region, the first-wave COVID-19 pandemic caused a significant reduction of invasive therapy and evident process delays in emergency ACS.

I Am a Nurse, Not a Martyr: Qualitative Investigation of Nurses' Experiences During Onset of the Coronavirus Pandemic.

Nurses have always played an essential role during epidemics, risking their lives caring for sick and dying patients. However, the unprecedented nature of the novel coronavirus disease 2019 (COVID-19) has left organizations and healthcare professionals ill-prepared and under-equipped to manage the severity, manifestations, and acute and long-term implications. While COVID-19 has presented profound physical and mental health implications for nurses, we know little about nurses' professional experiences within their organizational context. Thus, this qualitative descriptive study fills that gap through in-depth exploration of nurses' shared professional experiences working in hospitals during the first surge of COVID-19 in the United States. Twenty-two nurses were interviewed via telephone during April and May 2020. Through thematic analysis four main themes emerged: (1) fear, (2) collective resilience through shared trauma, (3) uncharted territory, and (4) perceived disposability. Nurses felt ill-praepared for the rapid changes wrought by COVID-19; yet they also felt proud with a renewed sense of meaning in their work. While unit colleagues were a great source of strength, nurses still reported disappointment, even feeling abandoned by their organizations. Our study indicates that nurses relied on one another to cope and find meaning. These findings are invaluable for policy development and the establishment of preventive and early intervention strategies. Done right, such efforts could better support nurses by encouraging team building, protection, and rewards to maintain nurses' wellbeing during such outbreaks and in their aftermath. Organizations also ought to make nurses' health and wellbeing a priority by streamlining communication, transparency, and leadership visibility.

COVID-19 and Risk Factors of Anxiety and Depression in South Korea.

OBJECTIVE: The aims of this study were to explore the prevalence of and identify predictors of anxiety and depression related to coronavirus disease of 2019 (COVID-19) in South Korea. METHODS: The analysis is based on a quota survey design and a sampling frame that permitted recruitment of a national sample of 1,014 individuals between March 17-31, 2020. Several standardized measurements were used, including GAD-7, PHQ-9, COVID-19 related fear, restrictions in deaily life, as well as sociodemographic information and physical and psychosocial needs during the pandemic. Multiple logistic regression was conducted to analyze the influence of sociodemographic factors, fear, and physical/psychosocial needs on anxiety and depression. RESULTS: Significant numbers of the respondents were identifiable anxiety (19.0%) and depression group (17.5%), respectively. This indicates that the depression and anxiety prevalence rate after the COVID-19 is substantially high compared to the depression rate of 2.6% in 2020 and 2.8% in 2018 both reported in the Korea Community Health Survey and the anxiety rate of 5.7% reported in 2016 Survey of Mental Disorders in Korea. Multiple logistic regression results showed age, COVID-19 related fear, and the level of restrictions in daily as significant factors in understanding and predicting the anxiety group. Likfewise, the COVID-19 related fear, restrictions in daily life, and need for economic support were important predictors in predicting the depression group. CONCLUSION: Findings on predictors for greater vulnerability to anxiety and depression has important implications for public mental health in the context of the COVID-19 pandemic.

COVID-19 infection in patients with multiple myeloma: a German-Chinese experience from Wurzburg and Wuhan

In total, we identified five Caucasian patients from Wurzburg (Nos. 1-5) and three Asian patients from Wuhan (Nos. 6-8). The majority of the patients were male (n = 5, 63%), and the median age at COVID-19 diagnosis was 57 (range 39-83 years). The three patients from Wuhan were infected by COVID-19 in January or February 2020, while the Wurzburg patients were diagnosed in March or April 2020. Due to COVID-19 infection, anti-MM treatment was discontinued in all the patients. Notably, two patients (Nos. 3-4) in Wurzburg showed no COVID-19 symptoms, and the other three patients (Nos. 1, 2, and 5) exhibited only mild symptoms such as fever, cough, and nausea, which did not require an intensive care unit (ICU) admission. Interestingly, approximately 3 weeks after diagnosis, as the patient No. 6 was discharged and the swab was also negative for COVID-19, both COVID-19 IgM and IgG were tested negative in this patient. In four patients from Wurzburg, we also performed COVID-19 antibody test after recovery, and three of them (Nos. 1, 2, and 5) showed positive IgG, while one patient (No. 3) did not develop IgG or IgM against COVID-19. This finding suggested inadequate humoral immune response in MM patients, probably due to secondary immune deficiency caused by the treatments or the disease itself. This observation suggested that it might be a nosocomial infection in this patient. After recovery, two patients from Wurzburg received MM therapy, i.e., lenalidomide maintenance in one patient and DARA-VRCD (daratumumab, bortezomib, lenalidomide, cyclophosphamide, and dexamethasone) in another patient with NDMM.

Comparative Study of Hematological and Radiological Feature of Severe/Critically Ill Patients with COVID-19, Influenza A H7N9 and H1N1 Pneumonia (preprint)

Objectives This study aimed to explore useful clinical indexes for management of severe/critically ill patients with COVID-19, Influenza A H7N9 and H1N1 pneumonia by comparing hematological and radiological characteristics between them. Methods Severe/critically ill patients with confirmed diagnosis of COVID-19, Influenza A H7N9 and H1N1 pneumonia were retrospectively enrolled. The demographic data, clinical manifestations, hematological parameters, and radiological characteristics of three groups were compared. The influenza A was divided into two groups with/without patient death.Results In this study, 16 cases of COVID-19, 10 cases of influenza A (H7N9), and 13 cases of influenza A (H1N1) who met severe/critically ill criteria were included. Compared with COVID-19, the Influenza A (H7N9 and H1N1) groups had relatively more chronic diseases (80% and 92.3% vs 25%, P＜0.05), higher APACHE Ⅱ scores (16.00 ± 8.63 and 15.08 ± 6.24, vs 5.50 ± 2.58, P＜0.05) and higher mortality rates (40% and 46.2% vs 0%, P＜0.05). The hematological finding indicated that Influenza A H7N9 and H1N1 patients had more significant lymphocytopenia (0.59 ± 0.31 × 109/L and 0.56 ± 0.35 × 109/L vs 0.97 ± 0.33 × 109/L, P < 0.05), elevated neutrophil to lymphocyte ratio (NLR; 14.67 ± 6.10 and 14.64 ± 10.36 vs 6.29 ± 3.72, P < 0.05) compared to COVID-19. Especially in influenza A patients, NLR was significant different between the patients with or without death. Compared with the H7N9 group, ground glass opacity (GGO) on chest CT was more common in the COVID-19 group (P = 0.028), while pleural effusion was relatively rare (P = 0.001).ConclusionCompared to COVID-19, patients with Influenza A (H7N9 and H1N1) had more underlying chronic diseases and higher mortality rates. The NLR can be used as a clinical parameter for the predication of risk stratification and outcome in COVID-19 and Influenza A pneumonia. Manifestations of pleural effusion or GGO in chest CT may be helpful for the identification of different viral pneumonia.

Comparative study of hematological and radiological feature of severe/critically ill patients with COVID-19, Influenza A H7N9 and H1N1 pneumonia (preprint)

Objectives This study aimed to explore useful clinical indexes for management of severe/critically ill patients with COVID-19, Influenza A H7N9 and H1N1 pneumonia by comparing hematological and radiological characteristics between them.Methods Severe/critically ill patients with confirmed diagnosis of COVID-19, Influenza A H7N9 and H1N1 pneumonia were retrospectively enrolled. The demographic data, clinical manifestations, hematological parameters, and radiological characteristics of three groups were compared. The influenza A was divided into two groups with/without patient death.Results In this study, 16 cases of COVID-19, 10 cases of influenza A (H7N9), and 13 cases of influenza A (H1N1) who met severe/critically ill criteria were included. Compared with COVID-19, the Influenza A (H7N9 and H1N1) groups had relatively more chronic diseases (80% and 92.3% vs 25%, P༜0.05), higher APACHE Ⅱ scores (16.00 ± 8.63 and 15.08 ± 6.24, vs 5.50 ± 2.58, P༜0.05) and higher mortality rates (40% and 46.2% vs 0%, P༜0.05). The hematological finding indicated that Influenza A H7N9 and H1N1 patients had more significant lymphocytopenia (0.59 ± 0.31 × 109/L and 0.56 ± 0.35 × 109/L vs 0.97 ± 0.33 × 109/L, P < 0.05), elevated neutrophil to lymphocyte ratio (NLR; 14.67 ± 6.10 and 14.64 ± 10.36 vs 6.29 ± 3.72, P < 0.05) compared to COVID-19. Especially in influenza A patients, NLR was significant different between the patients with or without death. Compared with the H7N9 group, ground glass opacity (GGO) on chest CT was more common in the COVID-19 group (P = 0.028), while pleural effusion was relatively rare (P = 0.001).Conclusion Compared to COVID-19, patients with Influenza A (H7N9 and H1N1) had more underlying chronic diseases and higher mortality rates. The NLR can be used as a clinical parameter for the predication of risk stratification and outcome in COVID-19 and Influenza A pneumonia. Manifestations of pleural effusion or GGO in chest CT may be helpful for the identification of different viral pneumonia.