Collateral Damage or Benefit? The Impacts of COVID-19 Induced Lockdown and Mandatory Screening Policy on Lung Surgery: Evidence from Wuhan (preprint)

Background: The COVID-19 pandemic, accompanied by governments' regulatory restrictions to contain it, interfered with surgical services provision. We aimed to evaluate the impact of a 76-day city-wide lockdown in Wuhan, China, on the provision of four types of surgery and investigate the association between COVID-19 screening measures and the post-lockdown surge in lung surgery. Methods: We collected data of four types of surgery: lung, esophagus, liver, and stomach, conducted between October 1, 2019, to July 31, 2020, from three major hospitals in Wuhan. We compared the demographic information of patients before and after the COVID-19 induced lockdown by surgery types. We then used difference-in-differences analysis to compare the volumes of lung surgery with three other types of surgery. We estimated the abnormal post-lockdown surge in lung surgery, accounting for scheduling delay. Next, we probed into the association between such abnormal increase in lung surgery and the mandatory chest CT scans required by the government as a COVID-19 screening measure using linear regression. Finally, we analyzed the proportion of lung cancer surgery and its demographic characteristics before and after the lockdown.Findings: After the lockdown started, all four types of surgery quickly dropped to a very low level and stayed at that minimum level throughout the lockdown period. Within 12 weeks after the lockdown was lifted, all three surgery types returned to and stayed at the pre-lockdown period except lung surgery, which surged to 150% of the pre-lockdown level. Specifically, the weekly volume of lung surgery in the post-lockdown period was 60% higher than that of esophagus surgery (95% CI, 0·31-0·90), 39% higher than that of liver surgery (95% CI, 0·17-0·63), and 24% higher than that of stomach surgery (95% CI, 0·01-0·47). Moreover, for every 1,000 chest CT scans conducted in week t-1, on average 3·5 (95% CI, 0·56-6·49) lung surgery were expected to occur in the week that followed. Besides, more young female patients received lung surgery after the lockdown [82 (58%) vs. 57 (45%)]. Finally, the fractions of post-lockdown lung cancer surgery were significantly greater than those in the pre-lockdown period (73% vs. 66%).Interpretation: The lockdown severely affected surgical services in Wuhan. Amid the recovery, the surge in lung surgery was associated with the large-scale chest CT screening policy implemented during and after the lockdown. Such a large-scale chest CT screening could be a blessing as it advanced the diagnosis window of lung diseases for young females.Funding: No funding is declared for this study.Declaration of Interests: None reported.Ethics Approval Statement: The authors have used data with the approval from the healthcare information system of three Triple-A accredited hospitals.

COVID-19 is a risk factor for severe liver damage for patients with intrahepatic cholestasis of pregnancy: a case report (preprint)

Background: Patients with intrahepatic cholestasis of pregnancy (ICP) may present with slight liver damage. In the global outbreak, the number of pregnant women infected with coronavirus disease 2019 (COVID-19) is increasing. For the pregnant patients with ICP, COVID-19 may cause severe liver damage.Case presentation: A 31-year-old pregnant woman was admitted with fever and respiratory symptoms to Tongji Hospital in Wuhan amid the outbreak of COVID-19. Her chest CT scan showed an infection with viral pneumonia as multiple ground glass opacities in both lungs were spotted. Laboratory tests revealed increased white blood cell (WBC) count and decreased lymphocyte count. The levels of serum total bile acid (TBA) were highly elvated. So were the indices of liver function, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), direct bilirubin (DBIL), alkaline phosphatase (AKP), 𝛄-glutamyltranspeptidase (𝛄-GT), and lactate dehydrogenase (LDH). The patient was later diagnosed of COVID-19 with comorbid ICP, presenting severe liver damage. Through timely termination of pregnancy and effective treatments, the prognoses of the patient and the fetus were well improved.Conclusions: This case highlights that COVID-19 may be a risk factor of severe liver damage for patients with ICP.Timely termination of pregnancy and effective symptomatic treatments are helpful to improve the progonosis.

Evaluation of the clinical characteristics of suspected or confirmed cases of COVID-19 during home care with isolation: A new retrospective analysis based on O2O (preprint)

Summary Background The recent outbreak of the novel coronavirus in December 2019 (COVID-19) has activated top-level response nationwide. We developed a new treatment model based on the online-to-offline (O2O) model for the home isolated patients, because in the early stages the medical staff were insufficient to cope with so many patients. Methods In this single-centered, retrospective study, we enrolled 48 confirmed/suspected COVID-19 patients who underwent home isolation in Wuhan between January 6 and January 31, 2020. By WeChat and online document editing all patients were treated with medical observation scale. The clinical indications such as Fever, Muscle soreness, Dyspnea and Lack of strength were collected with this system led by medical staff in management, medicine, nursing, rehabilitation and psychology. Findings The mean(SD) age of 48 patients was 39.08(13.88) years, 35(72.9%) were women. Compared with non-hospitalized patients, inpatients were older([≥]8805;70years, 2.4% vs 33.3%, P<0.04). All inpatients had fever, 50% inpatients had coughs and showed infiltration in both lungs at the time of diagnosis. 33.3% inpatients exhibited negative changes in their CT results at initial diagnosis. The body temperature of non-hospitalized patients with mild symptoms returned to normal by day 4-5. While dyspnea peaked on day 6 for non-hospitalized patients with mild symptoms, it persisted in hospitalized patients and exacerbated over time. The lack of strength and muscle soreness were both back to normal by day 4 for non-hospitalized patients. Interpretation Monitoring the trends of symptoms is more important for identifying severe cases. Excessive laboratory data and physical examination are not necessary for the evaluation of patients with mild symptoms. The system we developed is the first to convert the subjective symptoms of patients into objective scores. This type of O2O, subjective-to-objective strategy may be used in regions with similar highly infectious diseases to minimize the possibility of infection among medical staff.