ABSTRACT
BACKGROUND: Little is known about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant of concern (VOC)-contaminated environmental surfaces and air in hospital wards admitting COVID-19 cases. Our study was designed to identify high-risk areas of Delta VOC contamination in the hospital and provide suggestions to in-hospital infection control. We analyzed the SARS-CoV-2 Delta VOC contamination in the air and environmental surface samples collected from a hospital in Nanjing, China. METHODS: We collected data on clinical features, laboratory tests, swab tests, and hospital wards, identified the factors associated with environmental contamination, and analyzed patients' hygiene behaviors during hospitalization. RESULTS: A total of 283 environmental surface and air samples were collected from a hospital admitting 36 COVID-19 patients. Twelve swab samples from ten patients were positive. Toilet seats had the highest contamination rate (11.8%), followed by bedside tables (8.2%), garbage bins (5.9%), and bedrails (1.6%). The median time of symptom onset to surface sampling was shorter in the positive environment group than in the negative environment group (11 vs. 18 days; P=0.001). The results indicated that environmental surface contamination was associated with positive anal swabs [odds ratio (OR) 27.183; 95% CI: 2.359-226.063; P=0.003] and the time from symptom onset to surface sampling (OR 0.801; 95% CI: 0.501-0.990; P=0.046). The survey revealed that 33.3% of the patients never cleaned or disinfected their bedside tables or toilets, and 8.3% of them only cleaned their bedside tables or toilets. More than half of the patients often (25%) or always (30.6%) put the used masks on their bedside tables. Only 16.7% of the patients threw the masks into the specific garbage bin for used masks. CONCLUSIONS: The SARS-CoV-2 Delta VOC was detected on environmental surfaces, especially toilet seats and bedside tables, within a median time of 11 days after symptom onset. Our study provided potential predictors for environmental surface contamination, including positive anal swabs and the time from symptom onset to sampling. Disinfecting high-risk environmental surfaces should be emphasized in hospital wards, especially for patients in the early stage of COVID-19.
ABSTRACT
This study aimed to detect, analyze, and correlate the clinical characteristics, blood coagulation functions, blood calcium levels, and inflammatory factors in patients with mild and severe COVID-19 infections. The enrolled COVID-19 infected patients were from Wuhan Jin Yin-tan Hospital (17 cases, Wuhan, China), Suzhou Infectious Disease Hospital (87 cases, Suzhou, China), and Xuzhou Infectious Disease Hospital (14 cases, Xuzhou, China). After admission, basic information was collected; X-ray and chest CT images were obtained; and data from routine blood tests, liver and kidney function, myocardial enzymes, electrolytes, blood coagulation function, (erythrocyte sedimentation rate) ESR, C-reactive protein (CRP), IL-6, procalcitonin (PCT), calcitonin, and other laboratory tests were obtained. The patients were grouped according to the clinical classification method based on the pneumonia diagnosis and treatment plan for new coronavirus infection (trial version 7) in China. The measurements from mild (56 cases) and severe cases (51 cases) were compared and analyzed. Most COVID-19 patients presented with fever. Chest X-ray and CT images showed multiple patchy and ground glass opacities in the lungs of COVID 19 infected patients, especially in patients with severe cases. Compared with patients with mild infection, patients with severe infection were older (p = 0.023) and had a significant increase in AST and BUN. The levels of CK, LDH, CK-MB, proBNP, and Myo in patients with severe COVID-19 infection were also increased significantly compared to those in patients with mild cases. Patients with severe COVID-19 infections presented coagulation dysfunction and increased D-dimer and fibrin degradation product (FDP) levels. Severe COVID-19 patients had low serum calcium ion (Ca2+) concentrations and high calcitonin and PCT levels and exhibited serious systemic inflammation. Ca2+ in COVID-19 patients was significantly negatively correlated with PCT, calcitonin, D-dimer, PFDP, ESR, CRP and IL-6. D-dimer in COVID-19 patients was a significantly positively correlated with CRP and IL-6. In conclusion, patients with severe COVID-19 infection presented significant metabolic dysfunction and abnormal blood coagulation, a sharp increase in inflammatory factors and calcitonin and procalcitonin levels, and a significant decrease in Ca2+. Decreased Ca2+ and coagulation dysfunction in COVID-19 patients were significantly correlated with each other and with inflammatory factors.
ABSTRACT
Background and Objectives: Corona Virus Disease 2019 (COVID-19) has become a serious pandemic disease worldwide. Identification of biomarkers to predict severity and prognosis is urgently needed for early medical intervention due to high mortality of critical cases with COVID-19. This retrospective study aimed to indicate the values of carcinoembryonic antigen (CEA) in evaluating the severity and prognosis of COVID-19. Methods: We included 46 death cases from intensive care unit and 68 discharged cases from ordinary units with confirmed COVID-19 of Wuhan Jin Yin-tan Hospital from January 1 to March 22, 2020. Laboratory and radiologic data were analyzed retrospectively. All patients were followed up until April 10, 2020. Results: COVID-19 patients in the death group had significantly higher CEA levels (ng/ml) than discharged group (14.80 ± 14.20 vs. 3.80 ± 2.43, P < 0.001). The risk of COVID-19 death increased 1.317 times for each additional 1 ng/ml CEA level (OR = 1.317, 95% CI: 1.099-1.579). The standardized and weighted receiver operating characteristic curve (ROC) analysis adjusted to age, sex, and ferritin levels suggested that the area under the curve (AUC) of the serum CEA levels was 0.808 in discrimination between death cases and discharged cases with COVID-19 (P < 0.001). We found mortality of COVID-19 is associated with elevated CEA levels increased (HR = 1.023, 95% CI: 1.005-1.042), as well as age (HR = 1.050, 95% CI: 1.016-1.086) and ferritin levels (HR = 1.001, 95% CI: 1.001-1.002) by survival analysis of Cox regression model. Among discharged patients, CEA levels were significant lower in moderate cases compared to the severe and critical cases (P = 0.005; OR = 0.488, 95% CI: 0.294-0.808) from binary logistic regression analysis. The AUC of CEA levels was 0.79 in distinguishing moderate cases from discharged COVID-19 patients by standardized and weighted ROC analysis (P < 0.001). A positive correlation between CEA levels and CT scores existed in discharged patients (Correlation Coefficient: 0.687; P < 0.001). Conclusions: Elevated CEA levels increased the risk of death from COVID-19 and CEA levels were related to CT scores of the discharged patients positively.