Clinical features and outcomes in kidney transplant recipients with COVID-19 pneumonia: a single center retrospective cohort study (preprint)

Objective This retrospective cohort study aimed to assess the clinical characteristics, treatment outcomes, and short-term prognosis of kidney transplant recipients (KTRs) with concurrent coronavirus disease 2019 (COVID-19) pneumonia.Methods KTRs with COVID-19 pneumonia who were admitted to our hospital from December 28, 2022, to March 28, 2023 were included in the study, and their clinical symptoms, response to antiviral medications, and short-term prognosis were analyzed.Results A total of 64 KTRs with initial diagnosis of COVID-19 pneumonia were included in this study. The primary symptoms were fever, cough, and myalgia, with an incidence of 79.7%, 89.1%, and 46.9%, respectively. The administration of antiviral drugs (paxlovid or molnupiravir) within 1–5 days and for over 5 days demonstrated a statistically significant reduction in viral shedding time compared to the group without antiviral medication (P = 0.002). Both the paxlovid and molnupiravir treatment groups exhibited a significantly shorter duration of viral shedding time in comparison to the group without antiviral drugs (P = 0.002). After 6 months of recovery, there was no significantly negative impact on transplant kidney function (P = 0.294).Conclusion Fever, cough, and myalgia remain common initial symptoms of concurrent COVID-19 pneumonia in KTRs. The earlier use of antiviral drugs (the paxlovid or molnupiravir) is associated with better therapeutic outcomes. severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had limited impact on short-term renal function of the KTRs with concurrent moderate or severe COVID-19 pneumonia.

Assessment and Management on the Risk of Glucocorticoid-Induced Osteonecrosis After COVID-19 (preprint)

Background: Coronavirus disease 2019 (COVID-19) is an emerging global medical challenge and glucocorticoids remain the most promising therapy. Osteonecrosis (ON) is a disease caused by reduced blood flow to bones in the joints, which will rapidly induce joint destroy. ON had been frequently identified among convalescent patients after Severe Acute Respiratory Syndrome (SARS). Considering the similarity of SARS and COVID-19 on their pathogen, clinical characteristics and therapeutic strategies, it is particularly worrying whether ON will be a common sequela among convalescent COVID-19 patient.Methods: This multi-strategy study integrating different research methods, such as meta-analysis, systematic review and cross-sectional investigation. At first, two meta-analyses were performed on the incidence of osteonecrosis among SARS patients and the clinical data of glucocorticoid exposure among COVID-19 patients. Then, a systematic review of low-dosage glucocorticoid associated osteonecrosis and a real-world cross-sectional investigation of glucocorticoid exposure of COVID-19 patients in China Wuhan were also provided. Moreover, the pathogenesis, diagnosis, prevention, and treatment options for osteonecrosis after COVID-19 infection were further described.Findings: Our meta-analysis showed that 32% of SARS patients had developed ON after receiving glucocorticoid treatment with high dose, and our system review also supported that low level glucocorticoid exposure may lead to the occurrence of ON. Similarly, 40% of COVID-19 patients had undergone glucocorticoid treatment according to our meta-analysis. The cross-sectional investigation in China Wuhan found that the average of cumulative glucocorticoid exposure level was 504 mg calculated by the dosage of methylprednisolone. Notably, a confirmed osteonecrosis case after COVID-19 was identified during our investigation. Preventive management of ON shall better start with regular clinical followup observation.Interpretation: Growing evidence of the glucocorticoid therapy for COVID-19 patients prompts us to put forward the risk-classification-based early screening and early prevention protocol of ON, which may be of clinical significance in favorable prognosis of this disease.Registration Details: PROSPERO, registration number CRD42020203536.Funding Information: This study was supported by the Special Project For COVID-19 Prevention and Management of Ministry of Education of China (2020-JYB-YJ-023), the National Key Research and Development Program of China (2019ZX09731-002) and the State Key Program of National Natural Science Foundation of China (82030122).Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: The protocol for the investigation study has been registered in the Chinese Clinical Trial Registry (ChiCTR), (URL: http://www.chictr.org.cn/showproj.aspx?proj=61769, No. ChiCTR2000038333). This study was approved by the Ethics Institutional Review Board of the Third Affiliated Hospital of Beijing University of Chinese Medicine (No. BZYSY-2020KYKTPJ-06), and informed consent was obtained from every participant patient.

Better Strategies for Containing COVID-19 Epidemics --- A Study of 25 Countries via an Extended Varying Coefficient SEIR Model (preprint)

We evaluate the effectiveness of COVID-19 control strategies of 25 countries which have endured more than four weeks of community infections. With an extended SEIR model that allows infections in both the exposed and infected states, the key epidemic parameters are estimated from each country's data, which facilitate the evaluation and cross-country comparison. It is found quicker control measures significantly reduce the average reproduction numbers and shorten the time length to infection peaks. If the swift control measures of Korea and China were implemented, average reductions of 88% in the confirmed cases and 80% in deaths would had been attained for the other 23 countries from start to April 10. Effects of earlier or delayed interventions in the US and the UK are experimented which show at least 75% (29%) less infections and deaths can be attained for the US (the UK) under a Five-Day Earlier experiment. The impacts of two removal regimes (Korea and Italy) on the total infection and death tolls on the other countries are compared with the naturally forecast ones, which suggest there are still ample opportunity for countries to reduce the final death numbers by improving the removal process.

Epidemic prevention and control measures in China significantly curbed the epidemic of COVID-19 and influenza (preprint)

At the end of 2019, an outbreak of unknown pathogen pneumonia occurred in China, then it was named corona virus disease 2019 (COVID-19). With the rapid spread of COVID-19, a series of strict prevention and control measures were implemented to cut the spread of the epidemic. Influenza as a respiratory tract infection disease as COVID-19 might also be controlled. To assess the effects, we used the total passenger numbers sent in mainland China from 2018 to 2020 and the daily number of railway passenger (DNRP) flow in 2020 during Spring Festival travel rush to reflect the population movement and further to analyze newly and cumulative confirmed COVID-19 and influenza. We found that with implementing the series measures on COVID-19, not only COVID-19, but also influenza mitigated in China. The prevention and control measures for COVID-19 might be used in controlling respiratory tract diseases, and reducing the national health economic burden. When other countries issue measures on COVID-19 and influenza, they should consider adopting more aggressive epidemic prevention and control strategies.

Clinical Characteristics of Coronavirus Disease 2019 in Hainan, China (preprint)

Background: Since January 2020, coronavirus disease 2019 (Covid-19) has spread rapidly and developing the pandemic model around the world. Data have been needed on the clinical characteristics of the affected patients in an imported cases as model in island outside Wuhan. Methods: We conducted a retrospective study included all 168 confirmed cases of Covid-19 in Hainan province from 22 January 2020 to 13 March 2020. Cases were confirmed by real-time RT-PCR and were analysed for demographic, clinical, radiological and laboratory data. Results: Of 168 patients, 160 have been discharged, 6 have died and 2 remain hospitalized. The median age was 51.0 years and 51.8% were females. 129 (76.8%) patients were imported cases, and 118 (70.2%), 51 (30.4%) and 52 (31%) of patients lived in Wuhan or traveled to Wuhan, had contact with Covid-19 patients, or had contact with Wuhan residents, respectively. The most common symptoms at onset of illness were fever (65.5%), dry cough (48.8%) and expectoration (32.1%). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (60.2%). The elderly people with diabetes, hypertension and CVD are more likely to develop severe cases. Follow-up of 160 discharged patients found that 20 patients (12.5%) had a positive RT-PCR test results of pharyngeal swabs or anal swabs or fecal. Conclusions: In light of the rapid spread of Covid-19 around the world, early diagnosis and quarantine is important to curb the spread of Covid-19 and intensive treatments in early stage is to prevent patients away from critical condition.

Favipiravir versus Arbidol for COVID-19: A Randomized Clinical Trial (preprint)

Background No clinically proven effective antiviral strategy exists for the epidemic Coronavirus Disease 2019 (COVID-19). Methods We conducted a prospective, randomized, controlled, open-label multicenter trial involving adult patients with COVID-19. Patients were randomly assigned in a 1:1 ratio to receive conventional therapy plus Umifenovir (Arbidol) (200mg*3/day) or Favipiravir (1600mg*2/first day followed by 600mg*2/day) for 10 days. The primary outcome was clinical recovery rate of Day 7. Latency to relief for pyrexia and cough, the rate of auxiliary oxygen therapy (AOT) or noninvasive mechanical ventilation (NMV) were the secondary outcomes. Safety data were collected for 17 days. Results 240 enrolled COVID-19 patients underwent randomization; 120 patients were assigned to receive Favipiravir (116 assessed), and 120 to receive Arbidol (120 assessed). Clinical recovery rate of Day 7 does not significantly differ between Favipiravir group (71/116) and Arbidol group (62/120) (P=0.1396, difference of recovery rate: 0.0954; 95% CI: -0.0305 to 0.2213). Favipiravir led to shorter latencies to relief for both pyrexia (difference: 1.70 days, P<0.0001) and cough (difference: 1.75 days, P<0.0001). No difference was observed of AOT or NMV rate (both P>0.05). The most frequently observed Favipiravir-associated adverse event was raised serum uric acid (16/116, OR: 5.52, P=0.0014). Conclusions Among patients with COVID-19, Favipiravir, compared to Arbidol, did not significantly improve the clinically recovery rate at Day 7. Favipiravir significantly improved the latency to relief for pyrexia and cough. Adverse effects caused Favipiravir are mild and manageable. This trial is registered with Chictr.org.cn (ChiCTR2000030254).