B cell acute lymphoblastic leukemia following mild COVID-19 in an 11-year-old boy (preprint)

Coronavirus disease-2019 (COVID-19) has infected millions of people with high lethality in the world, but little is known whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has impacts on triggering pediatric acute lymphoblastic leukemia (ALL). We present a case of a child with atypical clinical manifestation who developed B-cell acute lymphoblastic leukemia following a mild symptomatic COVID-19 infection. This case underlines the risks of potential oncogenic effects with the history of this viral infection and a state of immunosuppression.

The Insights, 'Comfort', Effect and Bottleneck Breakthrough of 'E-Commerce Temperature', during the COVID-19 Pandemic

The impact of the COVID-19 pandemic on fresh food e-commerce has led to a loss of consumers, and 'e-commerce temperature';is seen as an important means of alleviating consumer dissatisfaction and retaining consumers. To explore the connotation and effect of it, and to break through possible 'comfort';bottlenecks, we used online reviews of the Jingdong fresh food platform as research data, mined the characteristics of 'e-commerce temperature';with the help of the LDA topic model, and evaluated the mechanism of 'e-commerce temperature';on consumer satisfaction during the pandemic by using quasi-natural experiments and Word2vec-based sentiment analysis. The results show that 'e-commerce temperature';has five connotations of logistics commitment, humanized delivery, health pledge, pandemic perseverance, and consumer care, which can effectively mitigate the loss of consumer satisfaction. Interestingly, we found that the 'e-commerce temperature';has a limited 'comfort';effect. Additionally, further social network analysis shows that the bottleneck is mainly due to the consumers' psychological gaps when comparing the usual e-commerce services, and cretailers can repair them through financial compensation and spiritual solace. The study explores e-commerce service quality at different pandemic stages with the help of text mining techniques, enriches the theory of e-commerce research, and alleviates the Hawthorne bias in traditional empirical studies. This study also provides a reference for e-retailers to improve service quality and respond to emergencies in a changing post-pandemic era.

SARS-CoV-2 and Plasmodium falciparum Co-Infection in a Returning Traveler

Since December 2019, the Coronavirus Disease 2019 (COVID-19) pandemic has become a non-neglectable context for the whole healthcare system. Under the background of COVID-19, the detection and diagnosis of malaria cases are under challenge. Here, we reported a COVID-19 and malaria co-infection traveler who has a long living history in Cameroon. The case was administered with dihydroartemisinin and piperaquine tablets for malaria, Lopinavir and Ritonavir tablets, Arbidol, recombinant human interferon α-2b and Compound Maxing Yifei mixture for COVID-19, and Zolpidem Tartrate tablets, Diazepam, Paroxetine Hydrochloride tablets, Thymosin α1, and Lianhua Qinwen Jiaonang during the second hospitalization of the patient since the patient has a certain level of anxiety and insomnia with no evidence of inflammatory reactions. After being tested negative two times for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 48 h, the patient met China's COVID-19 discharge standards and was discharged with stable vital signs and mental state. Since most countries in the sub-Saharan region have a fragile health system, co-infection for both Plasmodium and SARS-CoV-2 may not be uncommon, and raise a challenge in diagnosis, treatment, and prevention for both diseases. We add to the literature on co-infection of P. falciparum malaria and COVID-19 and offer operational advice on diagnosis, prevention, and treatment for the co-infection.

Electrochemical oxygen generator with 99.9% oxygen purity and high energy efficiency (preprint)

Under the growing crisis of coronavirus disease 2019 pandemic, the global medical system is facing the predicament of an acute shortage of medical-grade oxygen (O2, ≥ 99.5% purity). Herein, we manufactured an oxygen generation device relying on electrochemical technology. The performance of electrochemical oxygen generator (EOG) was remarkably improved to a practically applicable level, achieving long-term (>200 h), stable, and quick production (>1.5L/min) of high purity O2 (99.9%) under high energy efficiency (496 L/kW·h), viasimultaneous optimizations for intrinsic electrochemical reaction mechanism, electrocatalysts, and external cell structure. The EOG also presents powerful competitiveness in user experience, which finds expression in high portability (4.7 kg), nearly instant O2 production (<1 s), and a quiet working condition (<39 dB). The EOG shows great potential to substitute commercial pressure swing adsorption O2 generation devices, which may significantly impact the traditional oxygen production industry.  

The Implementation of a Primary Care-Based Integrated Mobile Health Intervention for Stroke Management in Rural China: Mixed-Methods Process Evaluation

Background: There is a lack of evidence concerning the effective implementation of strategies for stroke prevention and management, particularly in resource-limited settings. A primary-care-based integrated mobile health intervention (SINEMA intervention) has been implemented and evaluated via a 1-year-long cluster-randomized controlled trial. This study reports the findings from the trial implementation and process evaluation that investigate the implementation of the intervention and inform factors that may influence the wider implementation of the intervention in the future. Methods: We developed an evaluation framework by employing both the RE-AIM framework and the MRC process evaluation framework to describe the implementation indicators, related enablers and barriers, and illustrate some potential impact pathways that may influence the effectiveness of the intervention in the trial. Quantitative data were collected from surveys and extracted from digital health monitoring systems. In addition, we conducted quarterly in-depth interviews with stakeholders in order to understand barriers and enablers of program implementation and effectiveness. Quantitative data analysis and thematic qualitative data analysis were applied, and the findings were synthesized based on the evaluation framework. Results: The SINEMA intervention was successfully implemented in 25 rural villages, reached 637 patients with stroke in rural Northern China during the 12 months of the trial. Almost 90% of the participants received all follow-up visits per protocol, and about half of the participants received daily voice messages. The majority of the intervention components were adopted by village doctors with some adaptation made. The interaction between human-delivered and technology-enabled components reinforced the program implementation and effectiveness. However, characteristics of the participants, doctor-patient relationships, and the healthcare system context attributed to the variation of program implementation and effectiveness. Conclusion: A comprehensive evaluation of program implementation demonstrates that the SINEMA program was well implemented in rural China. Findings from this research provide additional information for program adaptation, which shed light on the future program scale-up. The study also demonstrates the feasibility of combining RE-AIM and MRC process evaluation frameworks in process and implementation evaluation in trials. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03185858.

Maternal Mental Health Status and Approaches for Accessing Antenatal Care Information During the COVID-19 Epidemic in China: Cross-Sectional Study.

BACKGROUND: China was the first country in the world to experience a large-scale COVID-19 outbreak. The rapid spread of the disease and enforcement of public health measures has caused distress among vulnerable populations such as pregnant women. With a limited understanding of the novel, emerging infectious disease, pregnant women have sought ways to access timely and trusted health care information. The mental health status of pregnant women during this public health emergency, as well as how they responded to the situation and where and how they obtained antenatal care information, remain to be understood. OBJECTIVE: This study aimed to evaluate the mental health status of pregnant women during the COVID-19 epidemic in China by measuring their perceived stress, anxiety, and depression levels; explore the approaches used by them to access antenatal health care information; and determine their associations with maternal mental health status. METHODS: We conducted a web-based, cross-sectional survey to assess the mental health status of Chinese pregnant women by using the validated, Chinese version of Perceived Stress Scale, Self-Rating Anxiety Scale, and Edinburgh Depression Scale. We also collected information on the various approaches these women used to access antenatal care information during the early stage of the COVID-19 epidemic, from February 5 to 28, 2020. RESULTS: A total of 1873 pregnant women from 22 provinces or regions of China participated in the survey. The prevalence of perceived stress, anxiety, and depression among these participants was 89.1% (1668/1873; 95% CI 87.6%, 90.4%), 18.1% (339/1873; 95% CI 16.4%, 19.9%), and 45.9% (859/1873; 95% CI 43.6%, 48.1%), respectively. Hospitals' official accounts on the Chinese social media platforms WeChat and Weibo were the most popular channels among these pregnant women to obtain antenatal care information during the COVID-19 outbreak. Access to antenatal care information via the hospitals' official social media accounts was found to be associated with a significantly lower risk of perceived stress (adjusted odds ratio [aOR] 0.46, 95% CI 0.30-0.72; P=.001), anxiety (aOR 0.53, 95% CI 0.41-0.68; P<.001), and depression (aOR 0.73, 95% CI 0.59-0.91; P=.005). Access to health care information via hospital hotlines or SMS was found to be significantly associated with a lower risk of anxiety only (OR 0.77, 95% CI 0.60-0.98; P=.04). CONCLUSIONS: During the COVID-19 outbreak in China, pregnant women experienced high levels of perceived stress, anxiety, and depression. During such public health emergencies, mental health care services should be strengthened to reassure and support pregnant women. Specific information targeted at pregnant women, including information on how to cope in an emergency or major disease outbreak, developed and disseminated by health care institutions via social media platforms could be an effective way to mitigate mental health challenges and ensure epidemic preparedness and response in the future.

The Volatile and Heterogenous Gut Microbiota Shifts of COVID-19 Patients Over The Course of A Probiotics-Assisted Therapy (preprint)

Background Coronavirus disease 2019 (COVID-19) has rapidly become a global pandemic, and little is known regarding the gut microbiota dynamics of the disease that often features a drastic and swift progression. Here we employed analyses of 16S rRNA gene sequencing and metatranscriptome to investigate the gut microbiome characteristics of a group of COVID-19 patients over the course of a probiotics-assisted therapy. Results The COVID-19 patients exhibited apparent microbiota alterations characterized by prominent compositional and functional shifts, which included taxonomic changes (e.g., increased relative abundance of Enterococcus and Rhodococcus, and decreased relative abundance of Faecalibacterium and Clostridium XlVa) and transcriptional changes (e.g., increased transcriptional activities of Escherichia coli and Klebsiella pneumoniae, virulence factors, and antibiotic resistance genes, and decreased activities of Faecalibacterium prausnitzii). Importantly, there were great interpersonal heterogeneity and intertimepoint fluctuations, as the most abundant or transcriptionally active taxa often greatly differed among individual patients and timepoints. Coincided with the resolution of respiratory symptoms, after the therapy some patients showed signs of recovery in the gut microbiome abnormalities. Associations were identified between gut and airway taxa and serum factors. Conclusion Our findings suggested that there is a lack of gut microbiota stability in COVID-19 patients and that measures are needed to ameliorate the gut microbiome perturbations in the patients to improve the prognosis. In addition, inclusion of probiotics is safe for treating COVID-19 patients and may improve their prognosis. Trial registration ISRCTN, ChiCTR2000029999. Registered 19 February 2020, http://www.chictr.org.cn/showprojen.aspx?proj=49717

Study on the COVID-19 infection status, prevention and control strategies among entry people in Shenzhen (preprint)

Background The overseas COVID-19 confirmed cases continue to rise for months, while people overseas prefer to return China at present. It is risky to have a large number of imported cases which may cause a relapse of COVID-19 outbreak. In order to prevent imported infection, Shenzhen government has implemented the closed-loop management strategy by taking nucleic acid testing (NAT) for severe acute respiratory syndromes coronavirus 2 (SARS-CoV-2) and requiring14-days medical observation for individuals with overseas tour history (Hong Kong, Macao, Taiwan province and other countries) within 14 days. Our study aim to describe the status of COVID-19 infection among entry people in Shenzhen, and evaluate the effect of closed-loop management strategy.Methods We made a descriptive study and risk analyze by the entry time, reported time, local confirmed cases in origin countries. The NAT were completed in Shenzhen center for disease control and prevention (CDC), ten district-level CDCs, as well as fever clinics.Results A total of 86,844 people overseas entered Shenzhen from January 1 to April 18, 2020, there were 39 imported cases and 293 closed contacts. The infection rate of entry people was 4.49‰ (95% CI: 3.26‰ − 6.05‰). 14 imported cases (35.9%) came from the UK, 9 (23.08%) came from the US. Entry people from the US since Mar 9 or from the UK since Mar 13 are the high-risk population. As of July 17, there have been no new confirmed cases in Shenzhen for 153 days, and the number of confirmed case, close contact, and asymptomatic case are 0. So the closed-loop management is effective to prevent imported infection and control domestic relapse. The distribution of entry time and report time for imported cases overseas was similar. So it is important to take closed-loop management at the port.Conclusions The risk of imported infection from the US and UK were higher that other countries and regions in Shenzhen. The closed-loop management is effective to prevent imported infection and control domestic relapse. Every country is closely connected under the background of globalization. In order to control COVID-19 outbreak, we need the collaboration and cooperation at the global, national, and subnational levels to prevent, detect, and respond effectively.

Study on the COVID-19 infection status, prevention and control strategies among entry people in Shenzhen (preprint)

Background The COVID-19 confirmed cases overseas continue to rise for months, while people overseas prefer to return at present. It is risky to have a large number of infected imported cases which may cause COVID-19 spread to China and even lead to outbreak again. In order to prevent imported infection, Shenzhen implemented the losed-loop management strategy by taking nucleic acid testing (NAT) for severe acute respiratory syndromes coronavirus 2 (SARS-CoV-2) and medical observation for 14 days among individuals who have epidemic history (Hong Kong, Macao, Taiwan province and other countries) within 14 days. Our study described the status of COVID-19 infection among entry people in Shenzhen, and also evaluated the effect of closed-loop management strategy.Methods A total of 86,844 people overseas entered Shenzhen from January 1 to April 18, 2020, and there were 39 imported cases. We made a descriptive study by analyzing the entry time, reported time, local confirmed cases in origin countries, and the number of entry people from abroad. The NAT were completed in Shenzhen center for disease control and prevention (CDC), ten district-level CDCs, as well as fever clinics.Results The infection rate of entry people was 4.49‰ (95% CI: 3.26‰ − 6.05‰). Most of the entry people or imported cases have Chinese nationality. The number of entry people and imported cases in Nanshan and Futian districts were larger than others. 15.73% of the entry people came from the US, and 12.67% came from the UK. 14 imported cases (35.9%) came from the UK, 9 (23.08%) came from the US. The imported risks from the US and UK in Shenzhen were higher than other countries or regions. According to the 14-days’ incubation period and the number of entry people, individuals from the US since Mar 9 were the high-risk population. Accordingly, entry people from the UK since Mar 13 were the high-risk population. It is important to evaluate the imported risk by analyzing local confirmed cases status in origin countries or regions and the number of entry people from these countries or regions to Shenzhen. The distribution of entry time and report time for imported cases in Shenzhen were similar. So it is important to prevent and control COVID-19 imported infection by taking NAT and medical observation at port.Conclusions It is effective to implement closed-loop management strategy for individuals who have epidemic history (Hong Kong, Macao, Taiwan province and other countries) within 14 days. In order to control COVID-19 outbreak, we need the collaboration and cooperation at the global, national, and subnational levels to prevent, detect, and respond effectively.

Quality of life during the epidemic of COVID-19 and its associated factors among enterprise workers in East China (preprint)

Background: The COVID-19 related lockdown and home confinement might have an important impact on the quality of life in enterprise workers. We investigated the quality of life during the epidemic in enterprise workers who just returned to work, and assessed its potential influencing factors to have a better understanding of the impact of COVID-19 epidemic lockdown and home confinement. Methods: This was a cross-sectional study of enterprise workers conducted in Deqing and Taizhou, Zhejiang Province, China. The Chinese version of EQ5D was used to assess life quality, and information about general characteristics and COVID-19 related factors was collected by a structured questionnaire, which was distributed through the social application “WeChat”. Results: A total of 2,435 participants were enrolled, 59.5% of which worked in Deqing. About 50% of the participants reported worries about the COVID-2019 epidemic and 40.1% had a centralized or home quarantine during the epidemic. The mean EQ-5D score and VAS were 0.990 and 93.5. Multiple logistic regression showed that the quality of life measures was related to physical activities (ORad=0.46) and keeping home ventilation (ORad=0.04) in Deqing, and were related to wearing a mask when going out (ORad=0.35), keeping home ventilation (ORad=0.16), unmarried status (ORad=2.38) and having a centralized or home quarantine (ORad=1.64) in Taizhou,Conclusions: The quality of life for returning enterprise workers in areas with different risks of COVID-19 was affected by different factors. Associated factors identified from this study would help develop proper intervention measures for enterprise workers to reduce the impact of large-scale public health events like the COVID-19 on their quality of life.

Effects of home quarantine for COVID-19 community control in Shenzhen, China, 2020 (preprint)

Background: Shenzhen implement classification management to prevent and control coronavirus disease 2019 (COVID-19) outbreak. Individuals with epidemic histories (came from Hubei and any other affected regions), but without symptoms were instructed to take home quarantine for 14 days and nucleic acid testing (NAT) for SARS-CoV-2. We described the infection status of the home-quarantined individuals, and effects of community control strategies in the three incubations after Wuhan closure in Shenzhen.Methods: This was a descriptive research, the sample size was 2,004 individuals based on multistage sampling during the pre-investigation. And the formal investigation expanded the sample size to 57,012 individuals based on pre-investigation. A single throat swab was collected from each individual for nucleic acid testing (NAT) by reverse transcription-polymerase chain reaction (RT-PCR). NAT was performed by a third-party institution. We collected information related to demographics, disease history, travel history, and personal protective measures before home quarantine, and monitored close-contact histories using the We Chat questionnaire.Results: The total infection rate of home-quarantined individuals was 0.12‰ (95% CI: 0.05‰–0.24‰) out of the total sample size of 59,016. The detection period for seven confirmed cases was primarily concentrated between February 8 and 18, 2020, which was during the second incubation period after Wuhan's closure. The home quarantined individuals with epidemic histories (came from Hubei and any other affected regions) were considered the high risk population during the first two incubations after Wuhan’s closure. No positive cases were detected from February 25 to March 5(the third incubation after Wuhan’s closure). The number of newly-confirmed cases per day was 0 for eight consecutive days from February 22 to 29 in Shenzhen.Conclusions: The community control strategies for home-quarantined individuals with epidemic histories (came from Hubei and any other affected regions), but without symptoms to take the NAT in the first two incubations is effective to control COVID-19. But it is not advocating for home-quarantined person to take the NAT since the third incubation.

Research on COVID-19 prevention and control strategies, and the effect of home quarantine in Shenzhen, China, 2020 (preprint)

AbstractBackground: To study the prevention and control strategies of coronavirus disease 2019 (COVID-19), and to analyze the infection of the home-quarantined individuals with epidemic histories (came from Hubei and any other affected regions), but without symptoms in the three incubations after Wuhan closure in Shenzhen.Methods: The sample size was 2,004 individuals based on multistage sampling during the pre-investigation. Based on the results of the pre-investigation, the formal investigation expanded the sample size to 57,012 individuals. A single throat swab was collected from each individual for nucleic acid testing (NAT) by reverse transcription-polymerase chain reaction (RT-PCR). NAT was performed by a third-party institution, BGI. We collected information related to demographics, disease history, travel history, and personal protective measures before home quarantine, and monitored close-contact histories using the We Chat questionnaire.Results: The total infection rate of home-quarantined individuals was 0.11% (95% CI: 0.05%–0.24%) out of the total sample size of 59,016. The detection period for seven confirmed cases was primarily concentrated between February 8 and 18, 2020, which was during the second incubation period after Wuhan's closure. The home quarantined individuals with epidemic histories (came from Hubei and any other affected regions) were considered the high risk population during the first two incubations after Wuhan’s closure. No positive cases were detected from February 25 to present (the third incubation after Wuhan’s closure). The number of newly-confirmed cases per day was 0 for 8 days from February 22 to 29 in Shenzhen. Thus, the strategies of prevention and control were effective.Conclusions: The strategies and policies were effective for the prevention and control of COVID-19. Additionally, the strategy of implementing NAT during the first two incubations for home-quarantined individuals with epidemic histories (came from Hubei and any other affected regions), but without symptoms, facilitated early detection, early reporting, early diagnosis, early quarantining, and early treatment. However, our findings do not support NAT for home quarantined persons during the third incubation after Wuhan’s closure to present.

Radiological changes of serial CT examinations in patients recovering from coronavirus disease 2019 (COVID-19) (preprint)

Purpose: To find the pulmonary CT imaging characteristics in patients recovering from coronavirus disease 2019 (COVID-19).Method: Twenty patients with confirmed COVID-19 were enrolled. We analyzed the changes of four pulmonary CT imaging manifestations (ground glass opacity, consolidation, crazy paving sign and cord/band sign) in patients during hospitalization. The disease course was divided into four stages: early stage (0-4 days), progressive stage (5-8 days), peak stage (9-13 days) and absorption stage (≥14 days).Results: There were 12 male and 8 female with an average age of 45±16 years. In the first three stages, GGO was the most common sign on CT imaging. Then, the proportion of GGO decreased in the absorption stage compared with the first three stages (P<0.05). The proportion of crazy paving sign peaked in the progressive stage and then declined, with statistical difference between the progressive stage and the absorption stage (P<0.05). Cord/band sign was increasing from the early stage to the absorption stage, and statistical differences were found between the early stage and the peak stage (P<0.05), as well as the absorption stage and the first three stages (P<0.05). No statistical differences of consolidation proportion were found among the four stages.Conclusions: CT imaging showed different characteristics during the four stages. The proportion of cord/band sign significantly increased in the third stage, which might be an indicator of COVID-19 improvement.

Fighting against the common enemy of COVID-19: a practice of building a community with a shared future for mankind.

The outbreak of coronavirus disease 2019 (COVID-19) has caused more than 80 813 confirmed cases in all provinces of China, and 21 110 cases reported in 93 countries of six continents as of 7 March 2020 since middle December 2019. Due to biological nature of the novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with faster spreading and unknown transmission pattern, it makes us in a difficulty position to contain the disease transmission globally. To date, we have found it is one of the greatest challenges to human beings in fighting against COVID-19 in the history, because SARS-CoV-2 is different from SARS-CoV and MERS-CoV in terms of biological features and transmissibility, and also found the containment strategies including the non-pharmaceutical public health measures implemented in China are effective and successful. In order to prevent a potential pandemic-level outbreak of COVID-19, we, as a community of shared future for mankind, recommend for all international leaders to support preparedness in low and middle income countries especially, take strong global interventions by using old approaches or new tools, mobilize global resources to equip hospital facilities and supplies to protect noisome infections and to provide personal protective tools such as facemask to general population, and quickly initiate research projects on drug and vaccine development. We also recommend for the international community to develop better coordination, cooperation, and strong solidarity in the joint efforts of fighting against COVID-19 spreading recommended by the joint mission report of the WHO-China experts, against violating the International Health Regulation (WHO, 2005), and against stigmatization, in order to eventually win the battle against our common enemy - COVID-19.