Investigation and analysis of entry personnel’s mental health status under COVID-2019 quarantine in Shanghai, China (preprint)

Background To investigate the mental health status and stress coping of quarantined personnel entering Shanghai from abroad, identify the key influencing factors, and provide suggestions for improving the mental health of COVID-19 quarantined personnel.Methods We surveyed quarantined individuals to collect general demographic data and COVID-19-related information of 327 entry personnel at the quarantine medical observation point. PHQ-9, GAD-7, and Cope scale (simplified version) were used to assess depression, anxiety, and individual stress coping. We analyzed the independent individual variables for their relationship with mental health outcomes.Results Among the entry quarantined personnel, we found that 27.8% scored positively for depression and 20.5% for anxiety. Depressive symptoms were more likely in individuals with pre-existing health conditions (p = 0.003), lack of medical insurance (p = 0.012), worry about the impact of the epidemic on their studies / work (p = 0.020), worry about the lack of daily necessities during quarantine (p = 0.005), and worry about being rejected or discriminated against by the outside world after quarantine (p = 0.002). Anxiety symptoms were more likely in those without medical insurance (p = 0.008) and those worried about being rejected or discriminated against by the outside world after quarantine (p = 0.010). In terms of stress coping, those with higher scores in "denial (disapproval of events) (p = 0.025, P = 0.041), guilt and self-blame (p = 0.001, p = 0.009)" were more likely to score higher for depression and anxiety.Conclusion Attention should be paid to the negative psychological reactions of the entry quarantined personnel, especially those with pre-existing health conditions, those without medical insurance, and students studying abroad who are at high risk of negative emotions. Timely mental health support should be provided. Accurate and effective epidemic dynamic information and preventive and control measures can be provided to the public through media publicity to prevent fear and stigma against quarantined personnel.

To Adopt CCU Technology or Not? An Evolutionary Game between Local Governments and Coal-Fired Power Plants

Carbon dioxide capture and utilization (CCU) technology is a significant means by which China can achieve its ambitious carbon neutrality goal. It is necessary to explore the behavioral strategies of relevant companies in adopting CCU technology. In this paper, an evolutionary game model is established in order to analyze the interaction process and evolution direction of local governments and coal-fired power plants. We develop a replicator dynamic system and analyze the stability of the system under different conditions. Based on numerical simulation, we analyze the impact of key parameters on the strategies of stakeholders. The simulation results show that the unit prices of hydrogen and carbon dioxide derivatives have the most significant impact: when the unit price of hydrogen decreases to 15.9 RMB/kg or the unit price of carbon dioxide derivatives increases to 3.4 RMB/kg, the evolutionary stabilization strategy of the system changes and power plants shift to adopt CCU technology. The results of this paper suggest that local governments should provide relevant support policies and incentives for CCU technology deployment, as well as focusing on the synergistic development of CCU technology and renewable energy hydrogen production technology.

Unvaccinated Children Are an Important Link in the Transmission of SARS-CoV-2 Delta Variant (B1.617.2): Comparative Clinical Evidence From a Recent Community Surge

Objective To evaluate the necessity of Covid-19 vaccination in children aged < 12 y by comparing the clinical characteristics between unvaccinated children aged < 12 y and vaccinated patients aged ≥ 12y during the Delta surge (B.1.617.2) in Putian, Fujian, China. Methods A total of 226 patients with SARS-Cov-2 Delta variant (B.1.167.2;confirmed by Real-time PCR positivity and sequencing) were enrolled from Sep 10th to Oct 20th, 2021, including 77 unvaccinated children (aged < 12y) and 149 people aged ≥ 12y, mostly vaccinated. The transmission route was explored and the clinical data of two groups were compared;The effect factors for the time of the nucleic acid negativization (NAN) were examined by R statistical analysis. Results The Delta surge in Putian spread from children in schools to factories, mostly through family contact. Compared with those aged ≥ 12y, patients aged < 12y accounted for 34.07% of the total and showed milder fever, less cough and fatigue;they reported higher peripheral blood lymphocyte counts [1.84 (1.32, 2.71)×10

Co-Infecting Pathogens Can Contribute to Inflammatory Responses and Severe Symptoms in COVID-19 (preprint)

Background: The current pandemic of COVID-19 is posing a major challenge to public health on a global scale. While it is generally believed severe COVID-19 results from over-expression of inflammatory mediators (i.e. a “cytokine storm”), it is still unclear whether and how co-infecting pathogens contribute to disease pathogenesis. To address this, we followed the entire course of disease in severe COVID-19 cases to reveal the presence and abundance of all potential pathogens present - the total “infectome” - and how they interact with the host immune system in the context of severe COVID-19 disease.Methods: We considered one severe and three critical cases of COVID-19, as well as a set of healthy controls, with longitudinal samples (throat swab, whole blood and serum) taken in each case. Total RNA sequencing (meta-transcriptomics) was performed to simultaneously reveal pathogen diversity and abundance, as well as host immune responses, within each sample. A Bio-Plex method was used to measure serum cytokine and chemokine levels.Findings: Eight pathogens were identified in these COVID-19 patients - Aspergillus fumigatus, Mycoplasma orale, Myroides odorantus, Acinetobacter baumannii, Candida tropicalis, herpes simplex virus and human cytomegalovirus - that appeared at different stages of disease course. Notably, the dynamics of inflammatory mediators in the serum as well as respiratory tract were better associated with the dynamics of the infectome as a whole rather than SARS-CoV-2 alone. Correlation analysis revealed that pulmonary injury was directly associated with cytokine levels, which in turn was associated with the proliferation of SARS-CoV-2 and the co-infecting pathogens.Interpretation: The cytokine storm that resulted in aggravated acute lung injury and death involved the highly complex and dynamic entire infectome of each patient, of which SARS-CoV-2 was a component. These results call for a precision-medicine approach to investigating both the infection and the host response on a daily basis as a standard means of infectious disease characterization.Funding: Guangzhou Institute of Respiratory Health Open Project (Funds provided by China Evergrande Group) - Project No. (2020GIRHHMS01), Guangdong Province “Pearl River Talent Plan” Innovation and Entrepreneurship Team Project (2019ZT08Y464), Macao Science and Technology Development Fund (0042/2020/A), Science research project of the Guangdong Province (2019B030316028), Special Project for Scientific and Technological Development and Emergency Response in COVID-19 Prevention and Control of Guangdong Province (2020A111129028), Special Project for Research and Promotion of Prevention and Control Techniques of COVID-19 and Emergency Response in Dongguan City (202071715001114), Jack Ma Foundation (2020-CMKYGG-02), Guangzhou Medical University High-level University Clinical Research and Cultivation Program ([2017] 159 and 160) and ARC Australian Laureate Fellowship (FL170100022).Declaration of Interests: We declare no competing interests.Ethics Approval Statement: The ethics committee of the FAHGMU (Ethics No. 2020-85) and Dongguan’s People’s Hospital (KYKT2020-005-A1) approved the sampling procedure and the use of patient samples for this study. Informed consent was obtained from each patient.

Survey of the Status Quo and Work Situation of Chinese Hospital Infection Control Professionals During the Epidemic of COVID-19 (preprint)

Background:The coronavirus disease 2019 (COVID-19) is spreading rapidly worldwide, bringing great challenges to infection control professionals (ICPs). The study aims to understand the status quo and the situation of work and physical and mental health of Chinese infection control professionals (ICPs) during the epidemic of coronavirus disease 2019 (COVID-19), in order to complete hospital infection control work and respond to public health emergencies better.[1]Methods:The questionnaire was designed to conduct anonymous investigations onChinese ICPs relying on the questionnaire star applet during the epidemic of COVID-19.Results:A total of 1652 ICPs from 1265 hospitals were surveyed. 84.32% ICPs’ professional background was nursing; 33.9% could not be promoted in professional title; 62.65% ICPs’ daily income was lower than similar staff at the same level in the hospital; 98% thought that the hospital infection control discipline should be set up.During the epidemic, the ICPs did a lot of work, and most heads of the infectioncontrol department believed that the infection control department had a great role in this epidemic. During this epidemic, 90.47% ICPs worked more than 9 hours a day; the highest psychological stress score was 10 points(out of 10), accounting for 32.14%; 79.3% had worse sleep than usual. Most ICPs felt tired, frustrated and powerless frequently, but only 20.40% complained frequently or consistently. Conclusions:Chinese ICPs are facing difficulties in promotion of professional title, poor salary, high work intensity and high psychological pressure currently.They has undertaken a lot of work and played an important role in the prevention and control of COVID-19.

Association of immunological features with COVID-19 severity: a systematic review and meta-analysis (preprint)

Background: We aim to explore the association of immunological features with COVID-19 severity.Methods: We conducted a meta-analysis to estimate mean difference (MD) of immune cells and cytokines levels with COVID-19 severity in PubMed, Web of Science, Scopus, the Cochrane Library and the grey literature.Results: A total of 21 studies with 2033 COVID-19 patients were included. Compared with mild cases, severe cases showed significantly lower levels of some immune cells, CD3+ T cell (×106, MD, -413.87; 95%CI, -611.39 to -216.34), CD4+ T cell (×106, MD, -203.56; 95%CI, -277.94 to -129.18), CD8+ T cell (×106, MD, -128.88; 95%CI, -163.97 to -93.79), B cell (×106/L; MD, -23.87; 95%CI, -43.97 to -3.78) and NK cell (×106/L; MD, -57.12; 95%CI, -81.18 to -33.06), and significantly higher levels of some cytokines, TNF-α (pg/ml; MD, 0.34; 95%CI, 0.09 to 0.59), IL-5 (pg/ml; MD, 14.2; 95%CI, 3.99 to 24.4), IL-6 (pg/ml; MD, 13.07; 95%CI, 9.80 to 16.35), and IL-10 (pg/ml; MD, 2.04; 95%CI, 1.32 to 2.75), and significantly higher levels of some chemokines, MCP-1 (SMD, 3.41; 95%CI, 2.42 to 4.40), IP-10 (SMD, 2.82; 95%CI, 1.20 to 4.45) and eotaxin (SMD, 1.55; 95%CI, 0.05 to 3.05). However, no significant differences were found in other indicators, Treg cell (×106, MD, -0.13; 95%CI, -1.40 to 1.14), CD4+/CD8+ ratio (MD, 0.26; 95%CI, -0.02 to 0.55), IFN-γ (pg/ml; MD, 0.26; 95%CI, -0.05 to 0.56), IL-2 (pg/ml; MD, 0.05; 95%CI, -0.49 to 0.60), IL-4 (pg/ml; MD, -0.03; 95%CI, -0.68 to 0.62), GM-CSF (SMD, 0.44; 95%CI, -0.46 to 1.35), and RANTES (SMD, 0.94; 95%CI, -2.88 to 4.75).Conclusion: Our meta-analysis revealed significant lower levels of immune cells (CD3+ T, CD4+ T, CD8+ T, B and NK cells), significant higher levels of cytokines (TNF-α, IL-5, IL-6 and IL-10) and significant higher levels of chemokines (MCP-1, IP-10 and eotaxin) in severe cases compared with mild cases of COVID-19. Measurement of immunological features could help to assess disease severity for effective triage of COVID-19 patients.

Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Patients Living with Human Immunodeficiency Virus: Case Reports and Review of the Literature (preprint)

Background: Novel coronavirus pneumonia (COVID-19) outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread over the globe. The knowledge about SARS-CoV-2 infection in immunocompromised patients was limited. Case presentation: We presented here two human immunodeficiency virus (HIV)-infected cases with laboratory confirmed COVID-19 and clinically confirmed COVID-19, respectively. The patients both presented with fever at illness onset and patchy shadows in radiological images of lungs. Laboratory findings revealed leukopenia, lymphopenia and positive anti-HIV antibody. The younger case had a moderate course and was discharged after a 28-day hospitalization. However, the elder case with multiple comorbidities developed dyspnea and died on the fourth day after admission. Conclusions: Combining our data with two case reports, we summarize that disease course varies in HIV-infected patients with COVID-19. More attention should be paid to the management of these patients. Whether there is any difference about clinical characteristics and prognosis of COVID-19 between HIV-infected and non-HIV infected patients, remains to be further investigated.

Clinical Features of COVID-19 Related Liver Damage (preprint)

BACKGROUND: A recent outbreak of SARS-CoV-2 infection occurs mainly in China, with rapidly increasing the number of cases (namely COVID-19). Abnormal liver functions are frequently present in these patients, here we aimed to clarify the clinical features of COVID-19-related liver damage to provide some references for the clinical treatment. METHODS: In this retrospective, single-center study, we included all confirmed COVID-19 cases in Shanghai Public Health Clinical Center from January 20 to January 31, 2020. The outcomes were followed up until February 19, 2020. A total of 148 cases were analyzed for clinical features, laboratory parameters (including liver function tests), medications and the length of stay. FINDINGS: Of 148 confirmed SARS-CoV-2-infected patients, 49.3% were females and 50.7% were males. The median age was 50.5 years (interquartile range, 36-64). Patients had clinical manifestations of fever (70.1%), cough (45.3%), expectoration (26.7%) at admission. 75 patients (50.7%) showed abnormal liver functions at admission. Patients (n = 75) who had elevated liver function index were more likely to have a moderate-high degree fever (44% vs 27.4%; p = 0.035) and significantly present in male patients (62.67% vs 38.36%; p = 0.005). The numbers of CD4+ and CD8+ T cells were significantly lower in abnormal liver function group than those in normal liver function group. There was no statistical difference in prehospital medications between normal and abnormal liver function groups, while the utilization rate of lopinavir/ritonavir after admission was significantly higher in patients with emerging liver injury than that in patients with normal liver functions. Importantly, the emerging abnormal liver functions after admission caused a prolonged length of stay. INTERPRETATION: SARS-CoV-2 may cause the liver function damage and the Lopinavir/ritonavir should be applied carefully for the treatment of COVID-19.