Broad cross-neutralizing antibodies against animal-associated sarbecoviruses generated by SARS-CoV-2 infection and vaccination in humans (preprint)

The outbreaks of severe acute respiratory syndrome coronavirus (SARS-CoV-1), Middle East respiratory syndrome coronavirus (MERS-CoV), and SARS-CoV-2 highlight the need for countermeasures to prevent future coronavirus pandemics. Given the unpredictable nature of spillover events, preparing antibodies with broad coronavirus-neutralizing activity is an ideal proactive strategy. Here, we investigated whether SARS-CoV-2 infection and vaccination could provide cross-neutralizing antibodies (nAbs) against zoonotic sarbecoviruses. We evaluated the cross-neutralizing profiles of plasma and monoclonal antibodies constructed from B cells from coronavirus disease 2019 (COVID-19) convalescents and vaccine recipients; against sarbecoviruses originating from bats, civets, and pangolins; and against SARS-CoV-1 and SARS-CoV-2. We found that both SARS-CoV-2 infection and vaccination elicited broad cross-nAbs against multiple sarbecoviruses, and vaccination boosters significantly augmented the magnitude and breadth of nAbs to sarbecoviruses. Of the nAbs, several exhibited neutralization activity against multiple sarbecoviruses by targeting the spike receptor-binding domain (RBD) and competing with angiotensin-converting enzyme 2 (ACE2) binding. SCM12-61 demonstrated exceptional potency, with half-maximal inhibitory concentration (IC50) values of 0.001–0.091 μg/mL, indicating its potential for combating new sarbecovirus outbreaks. Collectively, our findings suggest that both SARS-CoV-2 infection and current vaccination schemes elicit broad cross-neutralizing antibodies against diverse sarbecoviruses, enforcing prevention and therapeutic strategies for future sarbecovirus spillover events.

The completion rates of radiotherapy or chemoradiotherapy did not change after SARS-CoV-2 Omicron infection (preprint)

Background: The SARS-CoV-2 Omicron pandemic had a global impact on individuals with cancers. This study aimed to investigate the effect of Omicron infection on cancer patients in China. Methods: A retrospective study was conducted, including 347 patients with cancer who received radiotherapy or chemoradiotherapy between July 2022 and March 2023. The patients were divided into three groups: those without SARS-CoV-2 infection during treatment (Non-COVID-19 group), those who began treatment at least 10 days after first testing positive for SARS-CoV-2 (≥10-d COVID-19 group), and those who began treatment less than 10 days after first testing positive for SARS-CoV-2 (<10-d COVID-19 group). The serum levels of SAA, hsCRP, ALT, etc, were used to assess the severity of inflammation, liver damage, and cardiovascular injury. Results: The proportion of moderate and severe infected cases was higher in ≥10-d COVID-19 group compared with <10-d COVID-19 group (p=0.0446). Additionally, the serum levels of SAA, hsCRP, IL-6 and PCT, were significantly higher in ≥10-d COVID-19 group (p<0.05). Serum ALT, LDH and HBDH levels were also elevated in ≥10-d COVID-19 group (p<0.05). However, no significant differences were observed in frequency of neutropenia, thrombocytopenia and completion rates among three groups. Conclusion: Omicron infection leads to inflammation, liver damage and cardiovascular injury in cancer patients. Surprisingly, the duration of delay in radiotherapy or chemoradiotherapy after Omicron infection did not affect completion rates of current therapy, which was not consistent with the recommendations of NCCN guidelines. Moreover, the severity of Omicron infection was worse among cancer patients who received delayed treatment.

Influential Risk Spreaders and Systemic Risk in Chinese Financial Networks (preprint)

A novel approach of gravity strength centrality (GSC) model is proposed to identify the influential risk spreaders in Chinese financial networks. We also measure the systemic risk contribution of financial institutions via ∆CoVaR and detect the relationship between the risk spreading ability and the systemic risk contribution of financial institutions. Our findings show that (i) the novel GSC model has the best performance on identifying influential risk spreaders, (ii) financial institutions with larger risk spreading ability contribute more to the systemic risk, (iii) the COVID-19 pandemic has significantly enhanced the contribution of influential risk spreaders to the systemic risk.

Dajia Mazu Pilgrimage Show: Exploring the Sustainable Development of Taiwan's Religious Tourism from the Perspectives of Attraction, Happiness, and Revisit Intention

The Dajia Mazu pilgrimage is one of the most well-known events in the world. It not only satisfies tourists' spiritual desires for religious beliefs but also drives the development of destination tourism. In recent years, the tourism industry has been severely impacted by COVID-19. However, tourists participating in the Dajia Mazu pilgrimage continue to do so without fear of the pandemic. Therefore, understanding the relationship between tourists' attraction to religious tourism, perception of happiness, and willingness to revisit can contribute to the sustainable development of religious tourism, especially in the context of COVID-19. Accordingly, this study explored the sustainable development of Taiwan's religious tourism from the perspectives of tourism attraction, experiential value, happiness, and revisit intention. The study conducted quantitative research to address the research issue. Three hundred and fifty valid questionnaires were collected through on-site questionnaire distribution, and the data were analyzed by descriptive statistics and the structural equation partial least squares method. According to the results, the tourism attraction of the Dajia Mazu pilgrimage and the experiential value of tourists significantly impact happiness and revisit intention. Happiness is part of the intermediary variables of tourism attraction, experiential value, and revisit intention. Notably, the attraction of the Dajia Mazu pilgrimage and the experiential value pursued by tourists have not diminished despite the pandemic. Instead, the attraction has become an opportunity for tourists to seek spiritual comfort and support sustainable religious tourism development. Accordingly, spiritual comfort and maintaining their health and safety can be considered strategies to promote the sustainability of religious tourism in Taiwan.

Safety and immunogenicity of SCB-2019, an adjuvanted, recombinant SARS-CoV-2 trimeric S-protein subunit COVID-19 vaccine in healthy 12-17 year-old adolescents (preprint)

We previously demonstrated efficacy of the COVID-19 vaccine candidate, SCB-2019, in adults in the SPECTRA phase 2/3 efficacy study. We extended the study to include 1278 healthy 12-17-year-old adolescents in Belgium, Colombia and the Philippines who received either two doses of SCB-2019 or placebo 21 days apart, to assess immunogenicity as neutralizing antibodies against prototype SARS-CoV-2 and variants of concern, and safety and reactogenicity as solicited and unsolicited adverse events with a comparator group of young adults (18-25 years). In participants with no evidence of prior SARS-CoV-2 infection SCB-2019 immunogenicity in adolescents was non-inferior to that in young adults; respective geometric mean neutralizing titers (GMT) against prototype SARS-CoV-2 14 days after the second vaccination were 271 IU/mL (95% CI: 211-348) and 144 IU/mL (116-178). Most adolescents (1077, 84.3%) had serologic evidence of prior SAR-CoV-2 exposure at baseline; in these seropositive adolescents neutralizing GMTs increased from 173 IU/mL (135-122) to 982 IU/mL (881-1094) after the second dose. Neutralizing titers against Delta and Omicron BA SARS-CoV-2 variants were also increased, most notably in those with prior exposure. SCB-2019 vaccine was well tolerated with generally mild or moderate, transient solicited and unsolicited adverse events that were comparable in adolescent vaccine and placebo groups except for injection site pain - reported after 20% of SCB-2019 and 7.3% of placebo injections. SCB-2019 vaccine was highly immunogenic against SARS-CoV-2 prototype and variants in adolescents, especially in those with evidence of prior exposure, with comparable immunogenicity to young adults.

Comparative transcriptomic analyzes of human lung epithelial cells infected with wild-type SARS-CoV-2 and its variant with a 12-bp missing in the E gene

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that caused a global outbreak of coronavirus disease 2019 (COVID-19) pandemic. To elucidate the mechanism of SARS-CoV-2 replication and immunogenicity, we performed a comparative transcriptome profile of mRNA and long non-coding RNAs (lncRNAs) in human lung epithelial cells infected with the SARS-CoV-2 wild-type strain (8X) and the variant with a 12-bp deletion in the E gene (F8). In total, 3,966 differentially expressed genes (DEGs) and 110 differentially expressed lncRNA (DE-lncRNA) candidates were identified. Of these, 94 DEGs and 32 DE-lncRNAs were found between samples infected with F8 and 8X. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyzes revealed that pathways such as the TNF signaling pathway and viral protein interaction with cytokine and cytokine receptor were involved. Furthermore, we constructed a lncRNA-protein-coding gene co-expression interaction network. The KEGG analysis of the co-expressed genes showed that these differentially expressed lncRNAs were enriched in pathways related to the immune response, which might explain the different replication and immunogenicity properties of the 8X and F8 strains. These results provide a useful resource for studying the pathogenesis of SARS-CoV-2 variants.

Negative conversion, lymphocyte/monocyte ratio, and bilirubinemia in COVID-19 with mental disorders (preprint)

This retrospective study explored the changes in biomarkers indicators and prognosis in COVID-19 patients with mental disorders (n = 60) from the author’ Hospital between 2/13/2020 and 4/15/2020. Significant differences before and after negative conversion were observed in lymphocytes, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, aspartate aminotransferase, albumin, albumin/globulin ratio, direct bilirubin, alkaline phosphatase, uric acid, high-density lipoprotein cholesterol, and ApoA1 (all P < 0.05). Compared with the patients who had a negative conversion within 3 weeks, those who did not turn negative within 3 weeks had a higher frequency of cardiovascular diseases (27.3% vs. 4.2%, P = 0.040), a higher lymphocyte-to-monocyte ratio (median, 4.72 vs. 3.35, P = 0.003), and higher total bilirubin levels (median, 12.0 vs. 8.6 µmol/L, P = 0.031). The results present the changes in laboratory parameters in COVID-19 patients with a mental disorder. Cardiovascular diseases and higher lymphocyte-to-monocyte ratio, and total bilirubin levels could be associated with the amount of time required for negative conversion.

Comparison of clinical characteristics between SARS-CoV-2 Omicron variant and Delta variant infections in China

Background The continued ‘evolution’ of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to the emergence of the Omicron variant after the Delta variant, resulting in a significant increase in the number of people with COVID-19. This increase in the number of cases continues to have a significant impact on lives. Therefore, a more detailed understanding of the clinical characteristics of Omicron infection is essential. Methods Using medical charts, we extracted clinical information for 384 patients infected with the Omicron variant in Anyang City, Henan Province, China. Epidemiology and clinical characteristics were compared with a cohort of people infected with the Delta variant in Zhengzhou in 2021. Findings Common initial symptoms at onset of illness were cough [240 (63%)], expectoration [112 (29%)], fever [96 (25%)], nasal congestion [96 (25%)] and myalgia or fatigue [30 (6%)]. In patients with the Omicron variant, levels of total cholesterol, low-density lipoprotein and creatinine increased in 52 (14%), 36 (9%) and 58 (15%) patients, respectively, compared with patients with the Delta variant [one (1%), one (1%) and two (2%)]. Levels of triglyceride and high-density lipoprotein also increased. In patients with the Omicron variant, the levels of specific gravity and the erythrocyte sedimentation rate were increased in 115 (30%) and 81 (21%) patients, and serum levels of complement 3 decreased in 93 (41%). Results Compared with patients infected with Delta, no major differences in initial clinical symptoms were identified in patients infected with Omicron. However, dyslipidemia and kidney injury were much more severe in patients with the Omicron variant, and the erythrocyte sedimentation rate was increased. Due to decreased levels of complement 3, the immunity of patients with the Omicron variant was weak.

Heparin mimetics as potential intervention for COVID-19 and their bio-manufacturing

The COVID-19 pandemic has caused severe health problems worldwide and unprecedented decimation of the global economy. Moreover, after more than 2 years, many populations are still under pressure of infection. Thus, a broader perspective in developing antiviral strategies is still of great importance. Inspired by the observed multiple benefits of heparin in the treatment of thrombosis, the potential of low molecular weight heparin (LMWH) for the treatment of COVID-19 have been explored. Clinical applications found that LMWH decreased the level of inflammatory cytokines in COVID-19 patients, accordingly reducing lethality. Furthermore, several in vitro studies have demonstrated the important roles of heparan sulfate in SARS-CoV-2 infection and the inhibitory effects of heparin and heparin mimetics in viral infection. These clinical observations and designed studies argue for the potential to develop heparin mimetics as anti-SARS-CoV-2 drug candidates. In this review, we summarize the properties of heparin as an anticoagulant and the pharmaceutical possibilities for the treatment of virus infection, focusing on the perspectives of developing heparin mimetics via chemical synthesis, chemoenzymatic synthesis, and bioengineered production by microbial cell factories. The ultimate goal is to pave the eminent need for exploring novel compounds to treat coronavirus infection-caused diseases.

Dual Multi-scale Mean Teacher Network for Semi-supervised Infection Segmentation in Chest CT Volume for COVID-19 (preprint)

Automated detecting lung infections from computed tomography (CT) data plays an important role for combating COVID-19. However, there are still some challenges for developing AI system. 1) Most current COVID-19 infection segmentation methods mainly relied on 2D CT images, which lack 3D sequential constraint. 2) Existing 3D CT segmentation methods focus on single-scale representations, which do not achieve the multiple level receptive field sizes on 3D volume. 3) The emergent breaking out of COVID-19 makes it hard to annotate sufficient CT volumes for training deep model. To address these issues, we first build a multiple dimensional-attention convolutional neural network (MDA-CNN) to aggregate multi-scale information along different dimension of input feature maps and impose supervision on multiple predictions from different CNN layers. Second, we assign this MDA-CNN as a basic network into a novel dual multi-scale mean teacher network (DM${^2}$T-Net) for semi-supervised COVID-19 lung infection segmentation on CT volumes by leveraging unlabeled data and exploring the multi-scale information. Our DM${^2}$T-Net encourages multiple predictions at different CNN layers from the student and teacher networks to be consistent for computing a multi-scale consistency loss on unlabeled data, which is then added to the supervised loss on the labeled data from multiple predictions of MDA-CNN. Third, we collect two COVID-19 segmentation datasets to evaluate our method. The experimental results show that our network consistently outperforms the compared state-of-the-art methods.

Impact of vaccination with SCB-2019 COVID-19 vaccine on transmission of SARS-CoV-2 infection: a household contact study in the Philippines (preprint)

Background: An exploratory household transmission study was nested in SPECTRA, the phase 2/3 efficacy study of the adjuvanted recombinant protein-based COVID-19 vaccine SCB-2019. We compared occurrence of confirmed COVID-19 infections between households and household contacts of infected SPECTRA participants who were either placebo or SCB-2019 recipients. Methods: SPECTRA trial participants at eight study sites in the Philippines who developed rRT-PCR-confirmed COVID-19 were contacted by a study team blinded to assignment of index cases to vaccine or placebo groups to enroll in this household transmission study. Enrolled households and household contacts were monitored for three weeks using rRT-PCR and rapid antigen testing to detect new COVID-19 infections. Results: Observation of the households of 154 eligible COVID-19 index cases, 130 symptomatic and 24 asymptomatic at diagnosis, revealed household secondary attack rates for any COVID-19 infection of SCB-2019 index cases of 0.76% (90% CI: 0.15-3.90) compared with 5.88% (90% CI: 3.20-10.8) in placebo index case households, a relative risk reduction of 79% (90% CI: -28-97). The relative risk reduction of symptomatic COVID-19 was 84% (90% CI: 28-97) for household contacts of all COVID-19 infected index cases, and 80% (90% CI: 7-96) for household contacts of index cases with symptomatic COVID-19. Conclusions: In this prospective household contact study vaccination with SCB-2019 reduced SARS-CoV-2 transmission in households, so decreasing infections of household contacts, compared with placebo.

Spike-specific CXCR3+ TFH cells play a dominant functional role in supporting antibody responses in SARS-CoV-2 infection and vaccination (preprint)

CD4+ T follicular helper (TFH) cells are required for high-quality antibody generation and maintenance. However, the longevity and functional role of these cells are poorly defined in COVID-19 convalescents and vaccine recipients. Here, we longitudinally investigated the dynamics and functional roles of spike-specific circulating TFH cells and their subsets in convalescents at the 2nd, 5th, 8th, 12th and 24th months after COVID-19 symptom onset and in vaccinees after two and three doses of inactivated vaccine. SARS-CoV-2 infection elicited robust spike-specific TFH cell and antibody responses, of which spike-specific CXCR3+ TFH cells but not spike-specific CXCR3- TFH cells and neutralizing antibodies were persistent for at least two years in more than 80% of convalescents who experienced symptomatic COVID-19, which was well coordinated between spike-specific TFH cell and antibody responses at the 5th month after infection. Inactivated vaccine immunization also induced spike-specific TFH cell and antibody responses; however, these responses rapidly declined after six months with a two-dose standard administration, and a third dose significantly promoted antibody maturation and potency. Functionally, spike-specific CXCR3+ TFH cells exhibited better responsiveness than spike-specific CXCR3- TFH cells upon spike protein stimulation in vitro and showed superior capacity in supporting spike-specific antibody secreting cell (ASC) differentiation and antibody production than spike-specific CXCR3- TFH cells cocultured with autologous memory B cells. In conclusion, spike-specific CXCR3+ TFH cells played a dominant functional role in antibody elicitation and maintenance in SARS-CoV-2 infection and vaccination, suggesting that induction of CXCR3-biased spike-specific TFH cell differentiation will benefit SARS-CoV-2 vaccine development aiming to induce long-term protective immune memory.

Homologous and heterologous boosting of the ChAdOx1-S1-S COVID-19 vaccine with the SCB-2019 vaccine candidate: a randomized, observer-blinded, controlled, phase 2 study (preprint)

Background: Ongoing outbreaks of COVID-19 have been associated with waning immunity following primary immunizations and emergence of new SARS-CoV-2 variants. Heterologous boosters have been suggested to maintain population immunity. Methods: In this study of heterologous boosters we assessed immunogenicity and reactogenicity of booster doses of different formulations of alum-adjuvanted SCB-2019 vaccine (9 g SCB-2019 with or without CpG-1018 adjuvant, or 30 g SCB-2019 with CpG-1018) in Brazilian adults primed with ChAdOx1-S vector vaccine. S-protein and ACE2 binding antibodies were measured by ELISA on Days 1, 15 and 29. Participants self-reported solicited adverse events and reactions. Results: All SCB-2019 formulations increased ELISA antibodies against S-protein and ACE2 to a greater extent than ChAdOx1-S. After 30 g SCB-2019+CpG+alum titers against wild-type S-protein and ACE2 were significantly higher than after ChAdOx1-S on Days 15 and 29, as were GMTs for neutralizing antibodies against wild-type strain and Beta, Gamma, Delta, and Omicron variants. Boosting with SCB-2019 or ChAdOx1-S was well tolerated with no vaccine-related serious or severe adverse events. Conclusions: Heterologous boosting with SCB-2019 of ChAdOx1-S-primed adults was more efficient in increasing immunity against wild-type strain and SARS-CoV-2 variants than a homologous ChAdOx1-S booster, highest responses being with the 30 g SCB-2019+CpG+alum formulation.

Previous SARS-CoV-2 infection or a third dose of vaccine elicited cross-variant neutralizing antibodies in vaccinated solid organ transplant recipients (preprint)

The SARS-CoV-2 pandemic poses a great threat to global health, particularly in solid organ transplant recipients (SOTRs). Although a 3-dose mRNA vaccination protocol has been implemented for the majority of SOTRs, its effectiveness was still largely unknown. We analyzed 113 vaccinated SOTRs, and 30 healthy controls (HCs), some of whom had recovered from COVID, for their immune responses against the original vaccine strain and variants of concern (VOC), including the highly mutated-omicron variant. Here, we report that 3 doses of the mRNA vaccine had only a modest effect in eliciting anti-viral responses against all viral strains in the fully vaccinated SOTRs who did not contract the virus. Only 34.0% (16/47) of this group of patients demonstrated both detectable anti-RBD IgG and neutralization activities against alpha, beta, and delta variants, and only 8.5% (4/47) of them showed additional omicron-neutralizing capacities. In contrast, 79.5% (35/44) of the vaccinated recovered-SOTRs demonstrated both higher anti-RBD IgG levels and neutralizing activities against all VOC, including omicron. These findings illustrate a significant impact of previous infection on the development of anti-COVID immune responses in vaccinated SOTRs and highlight the need for alternative strategies to protect a subset of a lesser-vaccine responsive population.

Nebulized Exosomes Derived from Allogenic Adipose Tissue Mesenchymal Stromal Cells in Patients with Severe COVID-19: A Pilot Study (preprint)

BackgroundExisting clinical studies supported the potential efficacy of mesenchymal stromal cells as well as derived exosomes in the treatment of COVID-19. We aimed to explore the safety and efficiency of aerosol inhalation of the exosomes derived from human adipose-derived MSCs (haMSC-Exos) in patients with COVID-19.MethodsThe MEXCOVID trial is a phase 2a single-arm, open-labelled, interventional trial and patients were enrolled in Jinyintan Hospital, Wuhan, China. Eligible 7 patients were assigned to receive the daily dose of haMSCs-Exos (2.0×108 nano vesicles) for consecutively 5 days. The primary outcomes included the incidence of prespecified inhalation-associated events and serious adverse events. We also observed the demographic data, clinical characteristics, laboratory results including lymphocyte count, levels of D-dimer and IL-6 as well as chest imaging.ResultsSeven severe COVID-19 related pneumonia patients (4 males and 3 females) were enrolled and received nebulized haMSC-Exos. The median age was 57 year (IQR, 43 year to 70 year). The median time from onset of symptoms to hospital admission and administration of nebulized haMSC-Exos was 30 days (IQR, 15 days to 40 days) and 54 d (IQR, 34 d to 69 d), respectively. All COVID-19 patients tolerated the haMSC-Exos nebulization well, with no evidence of prespecified adverse events or clinical instability during the nebulization or during the immediate post-nebulization period. All patients presented a slight increase of serum lymphocyte counts (median as 1.61×109/L vs. 1.78×109/L). Different degrees of resolution of pulmonary lesions after aerosol inhalation of haMSC-Exos were observed among all patients, more obviously in 4 of 7 patients.ConclusionsOur trial shows that a consecutive 5 days inhalation dose of clinical grade haMSC-Exos up to a total amount of 2.0×109 nano vesicles was feasible and well tolerated in seven COVID-19 patients, with no evidence of prespecified adverse events, immediate clinical instability, or dose-relevant toxicity at any of the doses tested. This safety profile is seemingly followed by CT imaging improvement within 7 days. Further trials will have to confirm the long-term safety or efficacy in larger population.Trial RegistrationMEXCOVID, NCT04276987

China's experience in controlling COVID-19

Background: In less than a year, COVID-19 has swept the world and continued, too, seriously threatening the safety of all mankind, and caused great social panic and global economic and financial crisis. At the beginning, the epidemic was first diagnosed in China and the epidemic was severe. Under the strong command of the highest level of the Chinese government, the whole Chinese people united as one, and achieved initial results in the struggle against COVID-19 with scientific prevention and control.

Privacy Perils of Open Data and Data Sharing: A Case Study of Taiwan's Open Data Policy and Practices

Governments and private sector players have hopped on the open data train in the past few years. Both the governments and civil society in Taiwan are exploring the opportunities provided by the data stored in public and private sectors. While they have been enjoying the benefits of the sharing and flowing of data among various databases, the government and some players in the private sectors have also posed tremendous privacy challenges by inappropriately gathering and processing personal data. The amended Personal Data Protection Act was originally enacted as a regulatory mechanism to protect personal data and create economic benefits via enhancing the uses of public and private sector data. In reality, the Act has instead resulted in harm to Taiwan's data privacy situation in this big data era. This article begins with an overview of the Taiwan's open data policy history and its current practices. Next, the article analyzes cases in which the data sharing practices between different sectors have given rise to privacy controversies, with a particular focus on 2020, when Taiwan used data surveillance in response to the COVID-19 pandemic. Finally, this article flags problems related to an open data system, including the protection of sensitive data, de-identification, the right to consent and opt-out, and the ambiguity of "public interest," and concludes by proposing a feasible architecture for the implementation of a more sensible open data system with privacy-enhancing characteristics. [ABSTRACT FROM AUTHOR] Copyright of Washington International Law Journal is the property of Pacific Rim Law & Policy Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Prone positioning in non-intubated patients with coronavirus – A single-centre experience in Hong Kong

Introduction:Significant ventilator-associated pneumonia and mortality were found in COVID-19 patients who required mechanical ventilation which calls for non-invasive means in managing respiratory failure.Methods:We retrospectively reviewed patients admitted to the intensive care unit of Pamela Youde Nethersole Eastern Hospital in Hong Kong with severe acute respiratory syndrome coronavirus 2 infection from 28 November to 15 December 2020. Patients? laboratory, respiratory parameters and outcome data were recorded and analysed.Results:Eleven received prone ventilation. The median age was 67 (inter-quartile range: 59?72)?years, and median COVID-19 GRAM score was 151 (inter-quartile range: 133?181), representing a high-risk group. There were significant improvements 1?h after awake proning in SpO2 (95% vs 92%, p = 0.008), FiO2 (0.4 vs 0.5, p = 0.003), SpO2/FiO2 (240 vs 184, p = 0.005), respiratory rate (19 vs 26, p = 0.006) and respiratory rate ? oxygenation index (13.22 vs 7.67, p = 0.003;Table 1). Although not reaching statistical significance, the median PaO2, PaCO2 and PaO2/FiO2 improved after proning. The overall intubation rate was 22% and intensive care unit mortality was 22%, which is in contrast to 65.5% and 27.6%, respectively, in the first three waves. Although did not reach statistical significance, those received prone ventilation tend to have a lower ICU mortality (9.1% vs 42.9%, p = 0.245) and hospital mortality (18.2% vs 42.9%, p = 0.326).Conclusion:Awake proning potentially minimizes complications from invasive ventilation and provides a low-cost low-risk treatment option in COVID-19 patients with respiratory failure. This is particularly important when healthcare resources are strained at times of a pandemic.