ABSTRACT
A series of lockdown measures in response to the Corona Virus Disease 2019 (COVID-19) outbreak resulted in a drop in anthropogenic emissions and changes in concentrations of PM2.5 and O-3. Backward trajectories analysis, cluster analysis, potential source contribution function (PSCF) and concentration weighted trajectory (CWT) technologies were conducted to reveal the characteristics and potential source areas of pollutants in Beijing before the COVID-19 outbreak (BCO period), during the outbreak (COB period) and after the outbreak (ACO period), as well as the contemporaneous period in 2019 (CCO period), which is critical for exploring the efficient control measures and making policy. The results indicated that despite the significant reduction in anthropogenic emissions during the epidemic, the PM2.5 concentrations increased by 1.0% caused by unfavorable meteorological conditions. O-3 concentrations increased by 174.8% compared to that during the BCO period due to the increased temperature and inappropriate precursor reduction ratios. A considerable decrease of NO3- in PM2.5 was observed under the influence of significant reductions in vehicle emissions during the lockdown. The cluster analysis revealed that short-range transport played a significant role in the accumulation of local PM2.5 pollution, while long-range northwest airflows contributed more to O-3 accumulation, and weakened as the season changed. The PSCF and CWT analysis demonstrated that potential source areas of PM2.5 were mostly located in the central and southern Hebei, the southwestern Shandong in the CCO period, and expanded to central Inner Mongolia and northern Shanxi in the COB period. These areas were highly compatible with the high emission areas of the emission inventory statistics. After the outbreak, the source areas of O-3 were centered in the Beijing-Tianjin-Hebei region and Shandong province, with a radial dispersion in all directions, while they were distributed in the central Mongolia and Inner Mongolia during the other periods.
ABSTRACT
Objective: To describe the epidemiological characteristics and clinical features of patients with fatal coronavirus disease (COVID-19), in order to provide evidence for clinical diagnosis and treatment. Methods: In this retrospective study, we analyzed data on 141 fatal cases of confirmed COVID-19 that occurred among patients in Jinyintan Hospital in Wuhan, China, from January 20 to March 6, 2020. We analyzed their epidemiological characteristics, clinical and radiological features, laboratory results, and treatment. Results: Of the 141 patients (49 females, 92 males), the median age was 77 years (range: 24-92 years). The most likely source of exposure included the Huanan seafood market (n=3, 2%), family members (n=6, 4%), and hospital-acquired infection (n=8, 6%). The remaining 116 patients (72%) had no known source of exposure. Of the patients, 101 (72%) had chronic diseases. The most common comorbidities were hypertension, diabetes and coronary heart disease. The most common clinical manifestations were fever (n=121, 85%), dry cough (n=77, 54%), shortness of breath (n=23, 16%), and chest pain (n=15, 10%). Less common clinical manifestations included fatigue (n=7, 4%), headache (n=3, 2%), disorders of consciousness (n=2, 1%), diarrhea (n=2, 1%) and lumbago (n=1, 0.7%). In terms of laboratory tests, the absolute value of lymphocytes in most patients was reduced (n=132, 94%), but C-reactive protein (n=141, 100%), procalcitonin(n=121, 89%), serum amyloid (n=140, 99%) were significantly increased. The most common findings on imaging of the lungs were bilateral multiple mottling and ground-glass opacity (n=101, 72%), mainly in the lower lobes (n=15, 10%), with lesions being more common on the right. Other imaging findings included diffuse consolidation (n=4, 3%), ground-glass opacity and consolidation (n=20, 14%), and pneumothorax (n=1, 0.7%). All patients were treated with antibiotics and antiviral drugs. Other treatments included immunoglobulin (n=49, 35%), corticosteroids (n=45, 32%), continuous renal replacement therapy (n=24, 17%), and extracorporeal membrane oxygenation (n=12, 9%). All patients were treated with oxygen therapy. The mode of administration included invasive mechanical ventilation (n=61, 43%), noninvasive mechanical ventilation (n=65, 46%), and nasal catheter oxygen inhalation (n=15, 11%). The direct causes of death were acute respiratory distress syndrome (n=90, 64%), multiple organ failure (n=24, 17%), sudden cardiac arrest (n=11, 8%), viral myocarditis (n=8, 5%), acute myocardial infarction (n=4, 3%), cerebrovascular accident (n=3, 2%), and acute gastrointestinal bleeding (n=1, 0.7%). Conclusions: Risk factors for death due to COVID-19 included older age, male sex, and the presence of comorbidities. The most common direct causes of death were acute respiratory distress syndrome, multiple organ failure, sudden cardiac arrest, and viral myocarditis.