Industries' heterogeneous reactions during the COVID‐19 outbreak: Evidence from Chinese stock markets

This study examines the heterogeneous effects of the COVID-19 outbreak on stock prices in China. We confirm what is already known, that the pandemic has had a significant negative impact on stock market returns. Additionally, we find, this effect is heterogeneous across industries. Second, fear sentiment can directly cause stock prices to fall and panic exacerbates the negative impact of the pandemic on stock returns. Third, and most importantly, we demonstrate the underlying mechanisms of four firm characteristics and find that those with high asset intensity, low labor intensity, high inventory-to-revenue ratio, and small market value are more negatively affected than others. For labor-intensive state-owned firms, in particular, stock performance worsened because of higher idle labor costs. Finally, we created an index to measure the relative position of an industry in the supply chain, which shows that downstream companies were more vulnerable to the effects of the pandemic.

Severe COVID-19-associated sepsis is different from classical sepsis induced by pulmonary infection with carbapenem-resistant klebsiella pneumonia (CrKP).

PURPOSE: COVID-19 is also referred to as a typical viral septic pulmonary infection by 2019-nCoV. However, little is known regarding its characteristics in terms of systemic inflammation and organ injury, especially compared with classical bacterial sepsis. This article aims to investigate the clinical characteristics and prognosis between COVID-19-associated sepsis and classic bacterial-induced sepsis. METHODS: In this retrospective cohort study, septic patients with COVID-19 in the intensive care unit (ICU) of a government-designed therapy center in Shenzhen, China between January 14, 2020 and March 10, 2020, and septic patients induced by carbapenem-resistant klebsiella pneumonia (CrKP) admitted to the ICU of the Second People's Hospital of Shenzhen, China between January 1, 2014 and October 30, 2019 were enrolled. Demographic and clinical parameters including comorbidities, critical illness scores, treatment, and laboratory data, as well as prognosis were compared between the two groups. Risk factors for mortality and survival rate were analyzed using multivariable logistic regression and survival curve, respectively. RESULTS: A total of 107 patients with COVID-19 and 63 patients with CrKP were enrolled. A direct comparison between the two groups demonstrated more serious degrees of primary lung injury following 2019-nCoV infection (indicated by lower PaO2/FiO2), but milder systemic inflammatory response, lower sequential organ failure assessment score and better functions of the organs like heart, liver, kidney, coagulation, and circulation. However, the acquired immunosuppression presented in COVID-19 patients was more severe, which presented as lower lymphocyte counts (0.8×109/L vs. 0.9×109/L). Moreover, the proportion of COVID-19 patients treated with corticosteroid therapy and extracorporeal membrane oxygenation was larger compared with CrKP patients (78.5% vs. 38.1% and 6.5% vs. 0, respectively) who required less invasive mechanical ventilation (31.6% vs. 54.0%). The incidence of hospitalized mortality and length of ICU stay and total hospital stay were also lower or shorter in viral sepsis (12.1% vs. 39.7%, 6.5 days vs. 23.0 days and 21.0 days vs. 33.0 days, respectively) (all p < 0.001). Similar results were obtained after being adjusted by age, gender, comorbidity and PaO2/FiO2. Lymphocytopenia and high acute physiology and chronic health evaluation II scores were common risk factors for in-hospital death. While the death cases of COVID-19 sepsis mostly occurred at the later stages of patients' hospital stay. CONCLUSION: Critical COVID-19 shares clinical characteristics with classical bacterial sepsis, but the degree of systemic inflammatory response, secondary organ damage and mortality rate are less severe. However, following 2019-nCoV infection, the level of immunosuppression may be increased and thus induce in more death at the later stage of patients' hospitalstay.

Severe COVID-19-associated sepsis is different from classical sepsis induced by pulmonary infection with carbapenem-resistant klebsiella pneumonia (CrKP)

Purpose COVID-19 is also referred to as a typical viral septic pulmonary infection by 2019-nCoV. However, little is known regarding its characteristics in terms of systemic inflammation and organ injury, especially compared with classical bacterial sepsis. This article aims to learn the clinical characteristics and prognosis between COVID-19-associated sepsis and classic bacterial-induced sepsis. Methods In this retrospective cohort study, septic patients with COVID-19 in the intensive care unit (ICU) of a government-designed therapy center in Shenzhen, China between Jan 14, 2020 and Mar 10, 2020, and septic patients induced by carbapenem-resistant klebsiella pneumonia (CrKP) admitted at the ICU of the Second People’s Hospital of Shenzhen, China between Jan 1, 2014 and Oct 30, 2019, were enrolled. Demographic & clinical parameters including comorbidities, critical illness scores, treatment, and laboratory data, as well as prognosis were compared between the two groups. Risk factors for mortality and survival rate were analyzed using multivariable logistic regression and survival curve. Results A total of 107 patients with COVID-19 and 63 patients with CrKP were enrolled. A direct comparison between the two groups demonstrated more serious degrees of primary lung injury following 2019-nCoV infection (indicated by lower PaO2/FiO2) but milder systemic inflammatory response, lower sequential organ failure assessment (SOFA) score and better functions of the organs like heart, liver, kidney, coagulation, and circulation. However, the acquired immunosuppression presented in COVID-19 patients was more severe, which presented as lower lymphocyte counts. Moreover, the proportion of COVID-19 patients treated with corticosteroid therapy and extracorporeal membrane oxygenation was larger compared with CrKP patients who required less invasive mechanical ventilation. The incidence of hospitalized mortality and length of ICU stay and total hospital stay were also lower or shorter in viral sepsis. Similar results were obtained after being adjusted by age, gender, comorbidity and PaO2/FiO2. Lymphocytopenia and high acute physiology and chronic health evaluation II (APACH II) scores were common risk factors for in-hospital death. While the death cases of COVID-19 sepsis mostly occurred at the later stages of patients’ hospital stay. Conclusion Critical COVID-19 shares clinical characteristics with classical bacterial sepsis, but the degree of systemic inflammatory response, secondary organ damage and mortality rate are less severe. However, following 2019-nCoV infection, the level of immunosuppression may be increased and thus induce in more death at the later stage of patients’ hospital stay.

Risk factors for mortality in critically ill patients with COVID-19: a multicenter retrospective case-control study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has spread around the world, until now, the number of positive and death cases is still increasing. Therefore, it remains important to identify risk factors for death in critically patients. METHODS: We collected demographic and clinical data on all severe inpatients with COVID-19. We used univariable and multivariable Cox regression methods to determine the independent risk factors related to likelihood of 28-day and 60-day survival, performing survival curve analysis. RESULTS: Of 325 patients enrolled in the study, Multi-factor Cox analysis showed increasing odds of in-hospital death associated with basic illness (hazard ratio [HR] 6.455, 95% Confidence Interval [CI] 1.658-25.139, P = 0.007), lymphopenia (HR 0.373, 95% CI 0.148-0.944, P = 0.037), higher Sequential Organ Failure Assessment (SOFA) score on admission (HR 1.171, 95% CI 1.013-1.354, P = 0.033) and being critically ill (HR 0.191, 95% CI 0.053-0.687, P = 0.011). Increasing 28-day and 60-day mortality, declining survival time and more serious inflammation and organ failure were associated with lymphocyte count < 0.8 × 109/L, SOFA score > 3, Acute Physiology and Chronic Health Evaluation II (APACHE II) score > 7, PaO2/FiO2 < 200 mmHg, IL-6 > 120 pg/ml, and CRP > 52 mg/L. CONCLUSIONS: Being critically ill and lymphocyte count, SOFA score, APACHE II score, PaO2/FiO2, IL-6, and CRP on admission were associated with poor prognosis in COVID-19 patients.

Effects of hypertension on the outcomes of COVID-19: a multicentre retrospective cohort study.

Objectives: Hypertension is thought to be a contributor to mortality in coronavirus disease 2019 patients; however, limited clinical data on the outcomes of COVID-19 in patients with hypertension are available.Methods: This study was designed to confirm whether hypertension affects the outcomes of COVID-19. Results: A total of 983 patients with COVID-19 (female, 48%; male, 52%) were enrolled. Significantly higher odds of 60-day mortality (p = .017) were observed in the hypertensive group. In the hypertensive group, even after adjustment in multivariate analysis, the subgroup of patients 70 years old and older had higher 28-day mortality and total 60-day mortality rates than the other age subgroups (bothp < .05). A total of 297 (89%) COVID-19 patients with hypertension survived, and 35 (11%) died. In addition, compared with hypertensive patients who survived COVID-19, non-survivors had more pre-existing conditions, including cardiovascular diseases and stroke, higher blood pressure on admission, more severe inflammation, and more liver and kidney damage.Conclusion: Hypertension does not affect the outcome of COVID-19, which is different than the conclusions drawn in other studies. However, the 28-day mortality and total 60-day mortality rates of hypertensive patients (age ≥ 70) with COVID-19 were significantly elevated, and compared with the group of survivors, non-surviving COVID-19 patients with hypertension were older, had more basic diseases and had a more severe clinical condition.

Preventing crash in stock market: The role of economic policy uncertainty during COVID-19.

This paper investigates the impact of economic policy uncertainty (EPU) on the crash risk of US stock market during the COVID-19 pandemic. To this end, we use the GARCH-S (GARCH with skewness) model to estimate daily skewness as a proxy for the stock market crash risk. The empirical results show the significantly negative correlation between EPU and stock market crash risk, indicating the aggravation of EPU increase the crash risk. Moreover, the negative correlation gets stronger after the global COVID-19 outbreak, which shows the crash risk of the US stock market will be more affected by EPU during the epidemic.

The impact of COVID-19 on the stock market crash risk in China.

This study investigates the impact of the COVID-19 pandemic on the stock market crash risk in China. For this purpose, we first estimated the conditional skewness of the return distribution from a GARCH with skewness (GARCH-S) model as the proxy for the equity market crash risk of the Shanghai Stock Exchange. We then constructed a fear index for COVID-19 using data from the Baidu Index. Based on the findings, conditional skewness reacts negatively to daily growth in total confirmed cases, indicating that the pandemic increases stock market crash risk. Moreover, the fear sentiment exacerbates such risk, especially with regard to the impact of COVID-19. In other words, when the fear sentiment is high, the stock market crash risk is more strongly affected by the pandemic. Our evidence is robust for the number of daily deaths and global cases.

The role of chest CT quantitative pulmonary inflammatory index in the evaluation of the course and treatment outcome of COVID-19 pneumonia.

To explore the clinical application value of chest CT quantitative pulmonary inflammation index (PII) in the evaluation of the course and treatment outcome of COVID-19 pneumonia. One hundred and eighteen patients with COVID-19 pneumonia diagnosed by RT-PCR were analyzed retrospectively. The correlation between chest CT PII, clinical symptoms and laboratory examinations during the entire hospitalization period was compared. The average age of the patients was 46.0 ± 15 (range: 1-74) years. Of the 118 patients, 62 are male (52.5%) and 56 are female (47.5%). Among them, 116 patients recovered and were discharged, 2 patients died, and the median length of hospital stay was 22 (range: 9-41) days. On admission, 76.3% of the patients presented with fever, and the laboratory studies showed a decrease in lymphocyte (LYM) count and an increase in lactate dehydrogenase (LDH) levels, C-reactive protein (CRP) levels, and erythrocyte sedimentation rate (ESR). Within the studies' chest CTs, the median number of involved lung lobes was 4 (range: 0-5) and the median number of involved lung segments was 9 (range 0-20). The left lower lobe and the right lower lobe were the most likely areas to be involved (89.0% and 83.9%), and 84.7% of the patients had inflammatory changes in both lungs. The main manifestations on chest CT were ground glass opacities (31.4%), ground glass opacities and consolidation (20.3%), ground glass opacities and reticular patterns (32.2%), mixed type (13.6%), and white lungs (1.7%); common accompanying signs included linear opacities (55.9%), air bronchograms (46.6%), thick small vessel shadows (36.4%), and pleural hypertrophy (13.6%). The chest CT at discharge showed complete absorption of lesions in 19 cases (16.1%), but not in the remaining 99 cases. Lesions remained in a median of 3 lung lobes (range: 0-5). Residual lesions remained in a median of 5 lung segments (range: 0-20). The residual lesions mainly presented as ground glass opacities (61.0%), and the main accompanying sign was linear opacities (59.3%). Based on chest CT, the median maximum PII of lungs was 30.0% (range: 0-97.5%), and the median PII after discharge in the patients excluding the two deaths was 12.5% (range: 0-53.0%). PII was significantly negatively correlated with the LYM count and significantly positively correlated with body temperature, LDH, CRP, and ESR. There was no significant correlation between the PII and the white blood cell count, but the grade of PII correlated well with the clinical classification. PII can be used to monitor the severity and the treatment outcome of COVID-19 pneumonia, provide help for clinical classification, assist in treatment plan adjustments and aid assessments for discharge.

Thymosin α1 therapy in critically ill patients with COVID-19: A multicenter retrospective cohort study.

BACKGROUND: COVID-19 characterized by refractory hypoxemia increases patient mortality because of immunosuppression effects. This study aimed to evaluate the efficacy of immunomodulatory with thymosin α1 for critical COVID-19 patients. METHODS: This multicenter retrospective cohort study was performed in 8 government-designated treatment centers for COVID-19 patients in China from Dec. 2019 to Mar. 2020. Thymosin α1 was administrated with 1.6 mg qd or q12 h for >5 days. The primary outcomes were the 28-day and 60-day mortality, the secondary outcomes were hospital length of stay and the total duration of the disease. Subgroup analysis was carried out according to clinical classification. RESULTS: Of the 334 enrolled COVID-19 patients, 42 (12.6%) died within 28 days, and 55 (16.5%) died within 60 days of hospitalization. There was a significant difference in the 28-day mortality between the thymosin α1 and non-thymosin α1-treated groups in adjusted model (P = 0.016), without obvious differences in the 60-day mortality and survival time in the overall cohort (P > 0.05). In the subgroup analysis, it was found that thymosin α1 therapy significantly reduced 28-day mortality (Hazards Ratios HR, 0.11, 95% confidence interval CI 0.02-0.63, P=0.013) via improvement of Pa02/FiO2 (P = 0.036) and prolonged the hospital length of stay (P = 0.024) as well as the total duration of the disease (P=0.001) in the critical type patients, especially those aged over 64 years, with white blood cell >6.8×109/L, neutrophil >5.3×109/L, lymphocyte < 0.73 × 109/L, PaO2/FiO2 < 196, SOFA > 3, and acute physiology and chronic health evaluation (APACHE) II > 7. CONCLUSION: These results suggest that treatment with thymosin α1 can markedly decrease 28-day mortality and attenuate acute lung injury in critical type COVID-19 patients.

Clinical efficacy of intravenous immunoglobulin therapy in critical ill patients with COVID-19: a multicenter retrospective cohort study.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) outbreak is a major challenge all over the world, without acknowledged treatment. Intravenous immunoglobulin (IVIG) has been recommended to treat critical coronavirus disease 2019 (COVID-19) patients in a few reviews, but the clinical study evidence on its efficacy in COVID-19 patients was lacking. METHODS: 325 patients with laboratory-confirmed critical COVID-19 were enrolled from 4 government-designated COVID-19 treatment centres in southern China from December 2019 to March 2020. The primary outcomes were 28- and 60-day mortality, and the secondary outcomes were the total length of in-hospital and the total duration of the disease. Subgroup analysis was carried out according to clinical classification of COVID-19, IVIG dosage and timing. RESULTS: In the enrolled 325 patients, 174 cases used IVIG and 151 cases did not. The 28-day mortality was improved with IVIG after adjusting confounding in overall cohort (P = 0.0014), and the in-hospital and the total duration of disease were longer in the IVIG group (P < 0.001). Subgroup analysis showed that only in patients with critical type, IVIG could significantly reduce the 28-day mortality, decrease the inflammatory response and improve some organ functions (all P < 0.05); the application of IVIG in the early stage (admission ≤ 7 days) with a high dose (> 15 g per day) exhibited significant reduction in 60-day mortality in the critical-type patients. CONCLUSION: Early administration of IVIG with high dose improves the prognosis of critical-type patients with COVID-19. This study provides important information on clinical application of IVIG in the treatment of SARS-CoV-2 infection, including patient selection and administration dosage and timing.

Investigation of a family cluster outbreak of COVID-19 indicates the necessity of CT screening for asymptomatic family members in close contact with confirmed patients.

BACKGROUND: To investigate whether asymptomatic close-contact family members of patients diagnosed with coronavirus disease (COVID-19) should immediately undergo CT screening in addition to the viral nucleic acid test. METHODS: We retrospectively analyzed the data of a family cluster of 8 individuals, of whom 1 family member (Patient 3) had an epidemiologic history of having visited Guangzhou from Hubei Province on January 20, 2020. Her father (Patient 1) developed a fever and respiratory system symptoms and was confirmed COVID-19-positive on February 4-5, 2020 at Zengcheng People's Hospital, Guangzhou, China. Seven close-contact family members of the patients were then screened for COVID-19 on February 5-6 at the hospital. The CT imaging manifestation and laboratory tests of this family cluster were investigated and reported. RESULTS: Five (62.5%) of the 8 family members were confirmed COVID-19-positive. Except for Patient 1, who had fever, cough, fatigue, and dizziness, the remaining four (4/5, 80%) COVID-19-positive family members (Patients 2-5) had no clinical symptoms. Among the 5 patients, 2 had leukopenia (2/5, 40%), 1 had low absolute neutrophil counts (1/5, 20%), and 2 had increased high-sensitivity C-reactive protein (2/5, 40%). Ground-glass opacity (GGO) was found on chest CT imaging in all 5 patients (5/5, 100%), with interlobular septal thickening. Thickened blood vessel shadows were seen in 3 patients (3/5, 60%). The 3 COVID-19-negative family members (Family Members 1-3) did not have CT abnormalities, and they showed negative reverse transcription-polymerase chain reaction (RT-PCR) results twice. CONCLUSIONS: CT screening is necessary in close-contact family members of a confirmed COVID-19 pneumonia case, regardless of the presence of clinical symptoms.

An uncommon manifestation of COVID-19 pneumonia on CT scan with small cavities in the lungs: A case report.

RATIONALE: Chest computed tomography (CT) scans play a key role in diagnosing and managing of COVID-19 pneumonia. The typical manifestations of COVID-19 pneumonia on a chest CT scan are ground glass opacities, consolidation, nodules, and linear opacities. It can be accompanied by a "crazy-paving" pattern, air bronchograms, pleural hypertrophy, and pleural effusion. However, no literature has reported a case with cavities in the lungs. PATIENT CONCERNS: A 34-year-old male patient complained of fever, cough, fatigue, myalgia, diarrhea, headache, and dizziness for 2 weeks. This patient is living in Xiaogan, a city around Wuhan, and he had contact with a patient with COVID-19 pneumonia from Wuhan <14 days before he had fever. DIAGNOSIS: A nucleic acid test by rRT-PCR returned positive on a pharyngeal swab, confirming the diagnosis of COVID-19 pneumonia. INTERVENTIONS: Isolation antiviral treatment. OUTCOMES: After 19 days of isolation and antiviral treatment, his temperature returned to normal and the symptoms were relieved. The laboratory results also were returning to normal levels. The chest CT scan showed that the acute inflammation had subsided significantly. With 2 consecutive novel coronavirus nucleic acid tests had returned negative, the patient was discharged from the hospital and sent to a government designated hotel for quarantine observation. The unique chest CT manifestation in this case was the small cavities in both lungs during the absorption phase of this disease. These small cavities developed into consolidated nodules with clear edges and gradually shrank or disappeared. LESSONS: Although 2 consecutive nucleic acid tests returned negative in this patient, the small cavity changes in the lungs were observed, so the patient was quarantined for 14 days. However, follow-up CT after the first 14 days' quarantine showed new small cavity changes on the lungs, a further 14 days of quarantine was recommended. Therefore, in some COVID-19 cases, even if the nucleic acid tests turns negative, the disappearance of lung lesions may take a long time. The repeated chest CT scan plays an important role in the diagnosis and evaluation of the recovery of COVID-19.