Genomic evidence for divergent co-infections of co-circulating SARS-CoV-2 lineages.

Co-infection of RNA viruses may contribute to their recombination and cause severe clinical symptoms. However, the tracking and identification of SARS-CoV-2 co-infection persist as challenges. Due to the lack of methods for detecting co-infected samples in a large amount of deep sequencing data, the lineage composition, spatial-temporal distribution, and frequency of SARS-CoV-2 co-infection events in the population remains unclear. Here, we propose a hypergeometric distribution-based method named Cov2Coinfect with the ability to decode the lineage composition from 50,809 deep sequencing data. By resolving the mutational patterns in each sample, Cov2Coinfect can precisely determine the co-infected SARS-CoV-2 variants from deep sequencing data. Results from two independent and parallel projects in the United States achieved a similar co-infection rate of 0.3-0.5 % in SARS-CoV-2 positive samples. Notably, all co-infected variants were highly consistent with the co-circulating SARS-CoV-2 lineages in the regional epidemiology, demonstrating that the co-circulation of different variants is an essential prerequisite for co-infection. Overall, our study not only provides a robust method to identify the co-infected SARS-CoV-2 variants from sequencing samples, but also highlights the urgent need to pay more attention to co-infected patients for better disease prevention and control.

Dynamic correlation and risk resonance among industries of Chinese stock market: New evidence from time–frequency domain and complex network perspectives

To sustain market stability, it is crucial to research the impact of risk resonance across industries. In this paper, we demonstrate the dynamic risk resonance between various sectors in the Chinese market. To do so, by using a recently developed method that divides spillover measures based on variance decompositions into their components at different frequency ranges, a set of frequency spillover matrices is obtained to show the overall risk resonance within sectors. Second, we use a complex network to investigate the risk contagion path among different industries. The research results show that: (1) the risk resonance effect varies significantly over time;(2) during our sample period, the transportation and utilities industries are net transmitters;(3) the risk resonance mechanism is frequency dependent. Spillovers generated at low-frequency, extreme occurrences have a long-lasting effect on the industry's risk resonance;and (4) extreme events such as the financial crisis and the COVID-19 will enhance the risk resonance effect. The results of our research can provide a reference for market participants to formulate corresponding regulatory and investment strategies.

Assessing the Impacts of Stay-in-Place Policy of COVID-19 Pandemic during the Chinese Spring Festival: A Stated Preference Approach

This paper aims to investigate Chinese people's willingness to stay in the city where they work when the Spring Festival meets the COVID-19 pandemic. Specifically, a stated choice experiment about intercity travel including three homecoming trips (i.e., trips carried by conventional railway, high-speed railways, and private car) and the option "stay in place" was designed. Respondents were requested to choose the most preferred alternative in the context of the current situation of the COVID-19 pandemic and relevant policies. Based on the data collected from 800 respondents, a latent class mixed logit model was developed and estimated to capture the potential correlations within alternatives and respondents and the preference heterogeneity between respondents. Two latent classes were identified, one of which paid more attention to epidemic prevention policies while the other cared more about the characteristics of homecoming trips. Results show that people's willingness to stay in the city of work is largely dependent on epidemic prevention policies in their hometowns and decisions of social network members. [ FROM AUTHOR]

Comparison of Resilience Among Healthcare Workers During the COVID-19 Pandemics: A Multinational Cross-Sectional Survey in Southeast Asian Jurisdictions

Objectives: To examine the level of resilience among the frontline healthcare workers (HCWs) in four different Southeast Asian jurisdictions and identify the potential factors that may enhance healthcare workers resilience. Methods: An online cross-sectional survey was carried out among 3,048 eligible healthcare workers in Hong Kong, Nepal, Vietnam, and Taiwan from May 2021 to July 2022, and information on individual resilience, socio-demographic characteristics, organizational supports, and personal exposures were collected. A binary logistic regression model was used to identify the factors that were associated with a high resilience level. Results: The resilience score was the highest among healthcare workers of Vietnam, followed by Taiwan and Hong Kong, with Nepal scoring the lowest. Participants with old age, part-time work, higher education level, more satisfaction with workplace policy, better organizational supports, and fewer COVID-specific worries were associated with higher resilience. Healthcare workers who were satisfied with the overall organizational policy support had an OR of 1.48 (95% CI: 1.25–1.76) for a high resilience level. Conclusion: Implementing satisfying organizational policies and establishing supportive work environments for frontline healthcare workers can increase individual resilience and organizational stability.

All That Glitters is Not Green: Impact of Biophilic Designs on Customer Experiential Values

Since COVID-19, people appreciate fully immersing themselves in nature. Bringing elements of nature into service spaces has been an important concern for marketers. Yet, there have been only a few studies addressing the impact of natural and biophilic aspects within servicescapes. This study investigated the effect of biophilic design on experiential values such as esthetics, escapism, economic value, and attitude toward hotels and the role of the hotel segment and its environmental beliefs regarding green behavior on the relationships. The results indicated that in a luxury hotel setting, the biophilic design engendered better esthetic perceptions, escapism, economic value, and attitude toward the hotel. At a midscale hotel, a non-biophilic design induced higher experiential values. In addition, customers' environmental beliefs had significant effects on experiential values. Results provided practical suggestions for hotel managers, marketers, and interior designers on how biophilic servicescapes can enhance a hotel's marketing effectiveness.

Human mobility variations in response to restriction policies during the COVID-19 pandemic: An analysis from the Virus Watch community cohort in England, UK

Objective Since the outbreak of COVID-19, public health and social measures to contain its transmission (e.g., social distancing and lockdowns) have dramatically changed people's lives in rural and urban areas globally. To facilitate future management of the pandemic, it is important to understand how different socio-demographic groups adhere to such demands. This study aims to evaluate the influences of restriction policies on human mobility variations associated with socio-demographic groups in England, UK. Methods Using mobile phone global positioning system (GPS) trajectory data, we measured variations in human mobility across socio-demographic groups during different restriction periods from Oct 14, 2020 to Sep 15, 2021. The six restriction periods which varied in degree of mobility restriction policies, denoted as “Three-tier Restriction,” “Second National Lockdown,” “Four-tier Restriction,” “Third National Lockdown,” “Steps out of Lockdown,” and “Post-restriction,” respectively. Individual human mobility was measured with respect to the time period people stayed at home, visited places outside the home, and traveled long distances. We compared these indicators across the six restriction periods and across socio-demographic groups. Results All human mobility indicators significantly differed across the six restriction periods, and the influences of restriction policies on individual mobility behaviors are correlated with socio-demographic groups. In particular, influences relating to mobility behaviors are stronger in younger and low-income groups in the second and third national lockdowns. Conclusions This study enhances our understanding of the influences of COVID-19 pandemic restriction policies on human mobility behaviors within different social groups in England. The findings can be usefully extended to support policy-making by investigating human mobility and differences in policy effects across not only age and income groups, but also across geographical regions.

Factor structure and measurement invariance of the Chinese version of the COVID-19 Phobia Scale in depressive symptoms sample during COVID-19 closure: An exploratory structural equation modeling approach

The COVID-19 Phobia Scale is an instrument for measuring the phobia of coronavirus. It has a stable four-factor structure and good reliability and validity in other countries and regions. In order to expand related research, this study aims to test the reliability and validity of the COVID-19 Phobia Scale in Chinese adolescents with depressive symptoms. The C19P-SC was translated into Chinese by the method of forward and back translation and tested in 1933 Chinese adolescents with depressive symptoms. Confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were used to test and compare the four-factor model of the C19P-SC. Then we tested the measurement invariance of the C19P-SC across gender and time. Finally, the reliability was measured with the McDonald's omega coefficients. Consistent with previous studies, the C19P-SC showed a stable four-factor structure. The results showed that ESEM was better than CFA and more reasonable. In addition, the results of multi-group ESEM showed that the C19P-SC met the strict invariance at male and female and partial longitudinal strict invariance. The Mcdonald's omega coefficients of the C19P-SC total scale and each subscale reached the expected acceptable level. In short, the reliability and validity index of C19P-SC has reached an acceptable level, and the measurement invariance of different genders and different time points was established, but the cross-factor phenomenon of individual items was abnormal, and a further revision and testing are still needed.

SARS-CoV-2 vaccination in androgen sensitive phenotypes – A study on associated factors for SARS-CoV-2 vaccination and its adverse effects among androgenetic alopecia and benign prostate hyperplasia patients

Background Androgen sensitivity, which was established as the leading etiology of androgenetic alopecia (AGA) and benign prostatic hyperplasia (BPH), plays an important role in SARS-CoV-2 infection. Vaccination is essential for AGA and BPH patients in view of the high risk from SARS-CoV-2 infection. Purpose We aimed to investigate the associated factors for SARS-CoV-2 vaccination and its side effects in populations with AGA and BPH. Method We collected the data on SARS-CoV-2 vaccination and adverse reactions of male AGA and BPH patients visited the outpatient of Xiangya hospital by telephone and web-based questionnaires. Vaccination rate and adverse reactions were compared by different vaccine types and use of anti-androgen therapy. Result A total of 457 AGA patients and 397 BPH patients were recruited in this study. Among which, 92.8% AGA patients and 61.0% BPH patients had at least the first dose of SARS-CoV-2 vaccination (p < 0.001). Having comorbidities and use of anti-androgen therapy increased the risk of un-vaccination among AGA by 2.875 and 3.729 times, respectively (p < 0.001). Around 31.1% AGA patients and 9.5% BPH patients presented adverse reactions, which were mostly mild. Anti-androgen therapy increased the inclination of injection site pain after vaccination (18.7% vs 11.9%;OR: 1.708, 95% CI: 1.088-2.683, p = 0.019). Conclusion Co-existence of other systemic diseases and anti-androgen therapy were the limiting factors for SARS-CoV-2 unvaccination, especially in AGA patients. The importance of SARS-CoV-2 vaccines should be strengthened and popularized in androgen sensitive phenotypes.

The spatial-temporal distribution and aetiological characteristics of hand, foot, and mouth disease before and after the EV‑A71 vaccination and COVID-19 pandemic in Kunming, China, 2017–2020 (preprint)

Background: After the vaccination enterovirus 71 (EV-A71) vaccine and Corona Virus Disease 2019 (COVID-19) outbreak, the prevalence of Hand, foot, and mouth disease (HFMD) remained high and the spatial-temporal distribution of enteroviruses changed. Therefore, it is essential to define the temporal features, spatial distributions, epidemiological and aetiological characteristics of HFMD of Kunming. Methods Between 2017 and 2020, a total of 36540 HFMD children cases diagnosed with HFMD in Kunming, including 32754 enteroviruses positive clinical samples. Demographic, geographical, epidemiological and aetiological data of the cases were acquired and analyzed. Results Other enteroviruses replaced EV-A71 and the incidence of EV-A71 has decreased dramatically, while, coxsackievirus A6 (Cox A6) and coxsackievirus A16 (Cox A16) with significant outbreaks in 2018 and 2019, respectively. The major and junior peaks all extended for 2-4 months than before that vaccination EV-A71 vaccine. After the COVID-19 outbreak, Cox A6 as the predominant serotype pathogens, and only single peaks appeared in 2019 and 2020. Although the high incidence of HFMD areas were Guandu, Chenggong and Xishan, the annual incidence of different enterovirus serotype appeard in different regions. In 2017, other enteroviruses prevailed in Shilin; In 2018, Cox A16 and Cox A6 prevailed in Luquan and Shilin, respectively; In 2019, Cox A16 prevailed in Jinning; In 2020, Cox A6 and coxsackievirus A10 (Cox A10) prevailed in Luquan and Shilin, respectively. Meanwhile, the epidemic cycle of Cox A6 and Cox A16 was only 1 year, and Cox A10 and other enteroviruses were potential risk pathogens. Conclusions The spatial and temporal distribution of HFMD varies at different scales, and the incidence of different pathogens associated HFMD has obvious regional differences and seasonal trends. Therefore, the research of multivalent combined vaccines are urgently needed, while, proper preventive and protective measures could effectively control the incidence of HFMD-like diseases.

The Effect of Azithromycin Plus Zinc Sulfate on ACE2 Expression through IκBα of Human Respiratory Cells in SARS-CoV-2: In Vitro Study

Large-scale efforts have been persistently undertaken for medical prophylaxis and treatment of COVID-19 disasters worldwide. A variety of novel viral spike protein-targeted vaccines have been extensively distributed for global inoculation based on accelerated approval. With concerns of emerging spike protein mutations, we revisited the early but inconclusive clinical interest in the repurposed combination of azithromycin (AZT) and zinc supplements with safety advantages. The aim of this study is to provide in vitro proof of concept for IκBα associated rapid and synergistic suppression of angiotensin-converting enzymes 2 (ACE2) following combination treatments with AZT plus zinc sulfate in two human airway cells with ACE2 expression, Calu-3 and H322M, representative cells of the human upper and lower airway origin respectively. Clinical timing of AZT combined with zinc is indicated based on suppression of the key cellular entry molecule, ACE2, of SARS-CoV-2.

Expert consensus on prevention and cardiopulmonary resuscitation for cardiac arrest in COVID-19

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: (1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. (2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. (3) Healthcare workers should wear personal protective equipment (PPE). (4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. (5) Hands-only chest compression and mechanical chest compression are recommended. (6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. (7) CPR should be provided for 20-30 min. (8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: (1) Healthcare workers should wear PPE. (2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. (3) Both the benefits to patients and the risk of infection should be considered. (4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

The point-of-care-testing of nucleic acids by chip, cartridge and paper sensors

ABSTRACT Point-of-care nucleic acid testing (POCNAT) has played an important role in the outbreak of infectious diseases (e.g., COVID-19) over recent years. POCNAT aims to realize the rapid, simple and automatic detection of nucleic acid. Thanks to the development of manufacturing technology, electronic information technology, artificial intelligence technology, and biological information technology in recent years, the development of the POCNAT device has led to significant advancement. Instead of the normal nucleic acid detection methods used in the laboratory, some novel experimental carriers have been applied, such as chips, cartridges and papers. The application of these experimental carriers has realized the automation and integration of nucleic acid detection. The entire process of nucleic acid detection is normally divided into three steps (nucleic acid extraction, target amplification and signal detection). All of the reagents required by the process can be pre-stored on these experimental carriers, without unnecessary manual operation. Furthermore, all of the processes are carried out in this experimental carrier, with the assistance of a specific control device. Although they are complicated to manufacture and precise in design, their application provides a significant step forwards in nucleic acid detection and realizes the integration of nucleic acid detection. This technology has great potential in the field of point-of-care molecular diagnostics in the future. This paper focuses on the relevant content of these experimental carriers.

Epidemiological characteristics of 147 patients infected with SARS-CoV-2 in Chengdu

Objective: Analysis of the epidemiological characteristics and trend of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were conducted in Chengdu.

M3Lung-Sys: A Deep Learning System for Multi-Class Lung Pneumonia Screening from CT Imaging (preprint)

To counter the outbreak of COVID-19, the accurate diagnosis of suspected cases plays a crucial role in timely quarantine, medical treatment, and preventing the spread of the pandemic. Considering the limited training cases and resources (e.g, time and budget), we propose a Multi-task Multi-slice Deep Learning System (M3Lung-Sys) for multi-class lung pneumonia screening from CT imaging, which only consists of two 2D CNN networks, i.e., slice- and patient-level classification networks. The former aims to seek the feature representations from abundant CT slices instead of limited CT volumes, and for the overall pneumonia screening, the latter one could recover the temporal information by feature refinement and aggregation between different slices. In addition to distinguish COVID-19 from Healthy, H1N1, and CAP cases, our M 3 Lung-Sys also be able to locate the areas of relevant lesions, without any pixel-level annotation. To further demonstrate the effectiveness of our model, we conduct extensive experiments on a chest CT imaging dataset with a total of 734 patients (251 healthy people, 245 COVID-19 patients, 105 H1N1 patients, and 133 CAP patients). The quantitative results with plenty of metrics indicate the superiority of our proposed model on both slice- and patient-level classification tasks. More importantly, the generated lesion location maps make our system interpretable and more valuable to clinicians.

A proof of concept for neutralizing antibody-guided vaccine design against SARS-CoV-2 (preprint)

Mutations and transient conformational movements of receptor binding domain (RBD) that make neutralizing epitopes momentarily unavailable, present immune escape routes to SARS-CoV-2. To mitigate viral escape, we developed a cocktail of neutralizing antibodies (NAbs) targeting epitopes located on different domains of spike (S) protein. Screening of a library of monoclonal antibodies generated from peripheral blood mononuclear cells of COVID-19 convalescent patients yielded potent NAbs, targeting N-terminal domain (NTD) and RBD domain of S, effective at nM concentrations. Remarkably, combination of RBD-targeting NAbs and NTD-binding NAb, FC05, dramatically enhanced the neutralization potency in cell-based assays and animal model. Results of competitive SPR assays and cryo-EM structures of Fabs bound to S unveil determinants of immunogenicity. Combinations of immunogens, identified in NTD and RBD of S, when immunized in rabbits elicited potent protective immune responses against SARS-CoV-2. These results provide a proof-of-concept for neutralization-based immunogen design targeting SARS-CoV-2 NTD and RBD.

Loss expansion of SARS-CoV-2 specific immunity is a key risk factor in fatal patients with COVID-19 (preprint)

The dynamic immunological characteristics of COVID-19 patients are essential for clinicians to understand the disease progression. Our data showed that the immune system and function have gradually remodeled and declined with age from 16-91 years old in 25,239 healthy controls. Analyzing the relationship between the number of lymphocytes and age showed that lymphocytes and subsets tended to decline with age significantly, whereas, the number of natural killer cells tended to increase with age significantly. SARS-CoV-2 specific immunity has declined with age in fatal cases. Furthermore, SARS-CoV-2 specific immunity is associated with survival time in fatal cases. The loss expansion of SARS-CoV-2 specific immunity could be expanded in vitro. A concurrent decline in SARS-CoV-2 specific cellular and humoral immunity and prolonged SARS-CoV-2 exposure predicted fatal outcomes. Our findings have provided a basis for further analysis of SARS-CoV-2 specific immunity and understanding the pathogenesis of fatal COVID-19 patients.

Do not forget interaction: Predicting fatality of COVID-19 patients using logistic regression (preprint)

Amid the ongoing COVID-19 pandemic, whether COVID-19 patients with high risks can be recovered or not depends, to a large extent, on how early they will be treated appropriately before irreversible consequences are caused to the patients by the virus. In this research, we reported an explainable, intuitive, and accurate machine learning model based on logistic regression to predict the fatality rate of COVID-19 patients using only three important blood biomarkers, including lactic dehydrogenase, lymphocyte (%) and high-sensitivity C-reactive protein, and their interactions. We found that when the fatality probability produced by the logistic regression model was over 0.8, the model had the optimal performance in that it was able to predict patient fatalities more than 11.30 days on average with maximally 34.91 days in advance, an accumulative f1-score of 93.76% and and an accumulative accuracy score of 93.92%. Such a model can be used to identify COVID-19 patients with high risks with three blood biomarkers and help the medical systems around the world plan critical medical resources amid this pandemic.

The psychological impact of COVID-19 outbreak on medical staff and the general public (preprint)

Purpose: To assess the psychological effects of the novel coronavirus disease (COVID-19) on medical staff and the general public.Methods: During the outbreak of COVID-19, an internet-based questionnaire included The Self-rating Depression Scale (SDS), Perceived Stress Scale (PSS-10), and Impact of Event Scale-Revised (IES-R) was used to assess the impact of the epidemic situation on the mental health of medical staff and general population in Wuhan and its surrounding areas.Results: The results suggest that the outbreak of COVID-19 has affected individuals significantly, the degree of which is related to age, sex, occupation and mental illness. There was a significant difference in PSS-10 and IES-R scores between the medical staff and the general population. The medical staff showed higher PSS-10 scores (16.813 ± 4.87) and IES-R scores (22.40 ± 12.12) compared to members of the general population PSS-10 (14.80 ± 5.60) and IES-R scores (17.89 ± 13.08). However, there was no statistically significant difference between the SDS scores of medical staff (44.52 ± 12.36) and the general public (43.08 ± 11.42). In terms of the need for psychological assistance, 50.97% of interviewees responded that they needed psychological counseling, of which medical staff accounted for 65.87% and non-medical staff accounted for 45.10%.Conclusion: During the ongoing COVID-19 outbreak, great attention should be paid to the mental health of the population, especially medical staff, and measures such as psychological intervention should be actively carried out for reducing the psychosocial effects.

Clinical analysis of 2019 coronavirus disease (COVID-19) on one case with living-related kidney transplantation / 中华器官移植杂志

Objective@#To analyze the clinical characteristics of one living-related kidney transplant recipient infected with 2019 coronavirus disease (COVID-19) .@*Method@#The clinical diagnosis and treatment of one relative renal transplant recipient after the occurrence of COVID-19 were analyzed retrospectively, including the course of onset, clinical manifestations, blood routine test, renal function, lung CT scan, nucleic acid detection, outpatient and inpatient therapies and outcomes.@*Result@#The case was diagnosed as COVID-19 (severe type) with influenza A virus infection. The clinical symptoms were gradually relieved and the lung lesions were absorbed through the treatment of reduce and stop taking immunosuppressant, antiviral therapy of abidol/oseltamivir, prevention of bacterial infection, hormone anti-inflammatory, oxygen inhalation, nutritional support and adequate rest.@*Conclusion@#This case present typical characteristics of COVID-19 in epidemiological investigation, clinical manifestation, examination, pulmonary imaging and etiology. After comprehensive treatment including reduce and stop immunosuppressive therapy, clinical cure was achieved. The long-term effect of COVID-19 on this immunosuppressive patient remains follow-up.