Predictive factors for enhanced community mental health vulnerability in this COVID-19 pandemic era.

OBJECTIVE: Explore the mental health status and its influencing factors of local community residents under the post-epidemic era of COVID-19 in China. METHODS: The basic information scale, self-rating depression scale (SDS) and self-rating anxiety scale (SAS) were used to carry out an online questionnaire survey among community residents in Jiangsu Province, China, and the influencing factors of depression and anxiety were analyzed by multivariate logistic regression. RESULTS: A total of 993 residents completed the mental health survey. It was found that the incidence of depressive and anxiety symptoms was 37.06% and 22.86%. Multivariate logistic regression analysis showed that women [OR (95% CI) = 26.239 (14.743-46.698)], college degree and above [OR (95% CI) = 1.843 (1.085-3.130)] and ordinary residents [OR (95% CI) = 2.222 (1.441-3.425)] were risk factors for depressive symptoms, urban residents had lower risk [OR (95% CI) = 0.655 (0.394-0.829)]. Women [OR (95% CI) = 33.595 (15.812-71.381)], ordinary residents [OR (95% CI) = 3.017 (1.602-5.680)] were risk factors for anxiety symptoms, while the incidence was reduced in professional and technical personnel [OR (95% CI) = 0.271 (0.123-0.597)], workers [OR (95% CI) = 0.383 (0.168-0.876)], soldiers or policemen [OR (95% CI) = 0.200 (0.042-0.961)], married residents [OR (95% CI) = 0.463 (0.230-0.931)], and urban residents [OR (95% CI) = 0.531 (0.251-0.824)]. CONCLUSION: The incidence of symptoms of depression and anxiety among residents was relatively high under the post-epidemic era of COVID-19, which could be affected by various factors.

Mechanisms and strategies for operation of fever clinics in a general hospital during prevention and control of COVID-19

OBJECTIVE: To explore the mechanisms and strategies for operation of fever clinics of a general hospital during prevention and control of COVID-19. METHODS: The working characteristics and management modes of the fever clinic of the First Medical Center of Chinese PLA General Hospital were analyzed and summarized during the period of normalized prevention and control without cases and the period with local outbreak. RESULTS: During the period of normalized prevention and control, strict pre-job admission was carried out, the new recruits must pass the qualification test for special positions, the daily training was intensified, the treatment procedures were optimized, the step of identification of infectious diseases was moved forward to the triage;the closed-loop management of information was improved, the links such as identification of infectious diseases, treatment warning, prewarning and reporting have been achieved, and the standard prevention measures were taken. During the period of local outbreak, the application for demand of personnel and prevention supplies was put forward, fever clinic was designed and expanded, supporting personnel was trained, shifts were reasonably arranged, supervisors were added, and 24-hour logistic shifts wee also added. Zero infection of health care workers and zero case of nosocomial infection were achieved during the prevention and control of epidemic. CONCLUSION: The fever clinic is an outpost of prevention and control of infectious diseases. Combined with the characteristics, it is recommended that the construction of departments, personnel management and hardware configuration should be solidified and promoted.

Effects of Reactive Capacity on Product Quality and Firm Profitability in an Uncertain Market

In many supply chains, the brand-owning retailer designs product quality and decides the retail price but often outsources its production to suppliers. For products with a short selling season, low reactive capacity in the supply chain requires the supplier to carry out production before the selling season;but the uncertain market demand creates risks of stockout or excess inventory. Suppliers' reactive capacity and demand uncertainty can influence brand owners' product pricing and quality decisions. For example, during the COVID-19 pandemic, automakers faced supply shortages for automotive chips because of the upstream suppliers' limited parts inventory and production capacities, which have prompted the automakers to increase the quality (e.g., producing higher trims with more optional upgrade features) and price of their products to target fewer (high-valuation) consumers. This paper studies the impacts of the supplier's reactive capacity and demand uncertainty on product quality and firm profitability under pull contracts in the supply chain. We find that an increase in the supplier's reactive capacity can lead to higher or lower equilibrium product quality, benefiting the retailer but potentially reducing the supplier's profit. Interestingly, both the retailer and the supplier can be worse off with a higher probability for the high market state (with more high-valuation consumers). Further, a higher probability for the high market state can lead to lower product quality.

Research Progress on the Role of Microglia Membrane Proteins or Receptors in Neuroinflammation and Degeneration.

Microglia are intrinsic immune cells of the central nervous system and play a dual role (pro-inflammatory and anti-inflammatory) in the homeostasis of the nervous system. Neuroinflammation mediated by microglia serves as an important stage of ischemic hypoxic brain injury, cerebral hemorrhage disease, neurodegeneration and neurotumor of the nervous system and is present through the whole course of these diseases. Microglial membrane protein or receptor is the basis of mediating microglia to play the inflammatory role and they have been found to be upregulated by recognizing associated ligands or sensing changes in the nervous system microenvironment. They can then allosterically activate the downstream signal transduction and produce a series of complex cascade reactions that can activate microglia, promote microglia chemotactic migration and stimulate the release of proinflammatory factor such as TNF-α, IL-ß to effectively damage the nervous system and cause apoptosis of neurons. In this paper, several representative membrane proteins or receptors present on the surface of microglia are systematically reviewed and information about their structures, functions and specific roles in one or more neurological diseases. And on this basis, some prospects for the treatment of novel coronavirus neurological complications are presented.

An improved numerical model for epidemic transmission and infection risks assessment in indoor environment.

Social distance will remain the key measure to contain COVID-19 before the global widespread vaccination coverage expected in 2024. Containing the virus outbreak in the office is prioritised to relieve socio-economic burdens caused by COVID-19 and potential pandemics in the future. However, "what is the transmissible distance of SARS-CoV-2" and "what are the appropriate ventilation rates in the office" have been under debate. Without quantitative evaluation of the infection risk, some studies challenged the current social distance policies of 1-2 m adopted by most countries and suggested that longer social distance rule is required as the maximum transmission distance of cough ejected droplets could reach 3-10 m. With the emergence of virus variants such as the Delta variant, the applicability of previous social distance rules are also in doubt. To address the above problem, this study conducted transient Computational Fluid Dynamics (CFD) simulations to evaluate the infection risks under calm and wind scenarios. The calculated Social Distance Index (SDI) indicates that lower humidity leads to a higher infection risk due to weaker evaporation. The infection risk in office was found more sensitive to social distance than ventilation rate. In standard ventilation conditions, social distance of 1.7 m-1.8 m is sufficient distances to reach low probability of infection (PI) target in a calm scenario when coughing is the dominant transmission route. However in the wind scenario (0.25 m/s indoor wind), distance of 2.8 m is required to contain the wild virus type and 3 m is insufficient to contain the spread of the Delta variant. The numerical methods developed in this study provide a framework to evaluate the COVID-19 infection risk in indoor environment. The predicted PI will be beneficial for governments and regulators to make appropriate social-distance and ventilation rules in the office.

A predictive score for progression of COVID-19 in hospitalized persons: a cohort study.

Accurate prediction of the risk of progression of coronavirus disease (COVID-19) is needed at the time of hospitalization. Logistic regression analyses are used to interrogate clinical and laboratory co-variates from every hospital admission from an area of 2 million people with sporadic cases. From a total of 98 subjects, 3 were severe COVID-19 on admission. From the remaining subjects, 24 developed severe/critical symptoms. The predictive model includes four co-variates: age (>60 years; odds ratio [OR] = 12 [2.3, 62]); blood oxygen saturation (<97%; OR = 10.4 [2.04, 53]); C-reactive protein (>5.75 mg/L; OR = 9.3 [1.5, 58]); and prothrombin time (>12.3 s; OR = 6.7 [1.1, 41]). Cutoff value is two factors, and the sensitivity and specificity are 96% and 78% respectively. The area under the receiver-operator characteristic curve is 0.937. This model is suitable in predicting which unselected newly hospitalized persons are at-risk to develop severe/critical COVID-19.

A Multi-National Test of the Effect of Age and Sex on Compliance with COVID-19 Public Health Measures (preprint)

Background: The COVID-19 global pandemic has brought far-reaching consequences on individual and societal levels. Social distancing and physical hygiene constitute effective public health measures to limit the spread of the virus. The current study investigates individual age and sex demographics, in interaction with countries’ human development index (HDI), as crucial factors influencing compliance with public health measures in a large multi-national adult lifespan sample.Methods: This report leverages data from a large-scale international collaboration (Van Bavel et al., 2020; https://psyarxiv.com/ydt95/ ) comprising 45,576 individuals from 66 countries/territories collected in Spring 2020. Participants provided self-reports of their compliance with three public health measures (i.e., spatial distancing, physical hygiene, policy support).Findings: Older age, female sex, and lower HDI were independently associated with greater compliance with public health measures. In addition, a significant three-way interaction between participant age, participant sex, and a country’s HDI revealed that compliance was lowest in young males from well-developed countries, while compliance was highest among females across all ages from less-developed countries.Interpretation: Compliance with public health measures is crucial in effectively reducing virus spread. Our findings suggest that age and sex as individual-level demographics, in tandem with HDI as a country-level predictor, affect individuals’ willingness to comply with public health measures. These results highlight the potential of data-driven tailored (i.e., towards specific demographics, countries) health campaigns and public policies in the fight against a global pandemic.Funding Statement: John Templeton Foundation; National Institute on Aging, National Institutes on Health; and Social Science and Humanities Research Council of Canada.Declaration of Interests: All authors declare no competing interests.Ethics Approval Statement: The protocol was approved by the ethics board at the University of Kent.

A novel artificial intelligence-assisted triage tool to aid in the diagnosis of suspected COVID-19 pneumonia cases in fever clinics.

BACKGROUND: Currently, the need to prevent and control the spread of the 2019 novel coronavirus disease (COVID-19) outside of Hubei province in China and internationally has become increasingly critical. We developed and validated a diagnostic model that does not rely on computed tomography (CT) images to aid in the early identification of suspected COVID-19 pneumonia (S-COVID-19-P) patients admitted to adult fever clinics and made the validated model available via an online triage calculator. METHODS: Patients admitted from January 14 to February 26, 2020 with an epidemiological history of exposure to COVID-19 were included in the study [model development group (n=132) and validation group (n=32)]. Candidate features included clinical symptoms, routine laboratory tests, and other clinical information on admission. The features selection and model development were based on the least absolute shrinkage and selection operator (LASSO) regression. The primary outcome was the development and validation of a diagnostic aid model for the early identification of S-COVID-19-P on admission. RESULTS: The development cohort contained 26 cases of S-COVID-19-P and seven cases of confirmed COVID-19 pneumonia (C-COVID-19-P). The final selected features included one demographic variable, four vital signs, five routine blood values, seven clinical signs and symptoms, and one infection-related biomarker. The model's performance in the testing set and the validation group resulted in area under the receiver operating characteristic (ROC) curves (AUCs) of 0.841 and 0.938, F1 scores of 0.571 and 0.667, recall of 1.000 and 1.000, specificity of 0.727 and 0.778, and precision of 0.400 and 0.500, respectively. The top five most important features were age, interleukin-6 (IL-6), systolic blood pressure (SYS_BP), monocyte ratio (MONO%), and fever classification (FC). Based on this model, an optimized strategy for the early identification of S-COVID-19-P in fever clinics has also been designed. CONCLUSIONS: A machine-learning model based solely on clinical information and not on CT images was able to perform the early identification of S-COVID-19-P on admission in fever clinics with a 100% recall score. This high-performing and validated model has been deployed as an online triage tool, which is available at https://intensivecare.shinyapps.io/COVID19/.

The treatment and rehabilitation of a critical COVID-19 case in China.

The lung lesions of this COVID-19 patient were slowly absorbed, and the clinical symptoms with shortness of breath were improved slowly in the recovery period.

Theory-based Behavioral Predictors of Self-reported Use of Face Coverings in Public Settings during the COVID-19 Pandemic in the United States.

BACKGROUND: Investigating antecedents of behaviors, such as wearing face coverings, is critical for developing strategies to prevent SARS-CoV-2 transmission. PURPOSE: The purpose of this study was to determine associations between theory-based behavioral predictors of intention to wear a face covering and actual wearing of a face covering in public. METHODS: Data from a cross-sectional panel survey of U.S. adults conducted in May and June 2020 (N = 1,004) were used to test a theory-based behavioral path model. We (a) examined predictors of intention to wear a face covering, (b) reported use of cloth face coverings, and (c) reported use of other face masks (e.g., a surgical mask or N95 respirator) in public. RESULTS: We found that being female, perceived importance of others wanting the respondent to wear a face covering, confidence to wear a face covering, and perceived importance of personal face covering use was positively associated with intention to wear a face covering in public. Intention to wear a face covering was positively associated with self-reported wearing of a cloth face covering if other people were observed wearing cloth face coverings in public at least "rarely" (aOR = 1.43), with stronger associations if they reported "sometimes" (aOR = 1.83), "often" (aOR = 2.32), or "always" (aOR = 2.96). For other types of face masks, a positive association between intention and behavior was only present when observing others wearing face masks "often" (aOR = 1.25) or "always" (aOR = 1.48). CONCLUSIONS: Intention to wear face coverings and observing other people wearing them are important behavioral predictors of adherence to the CDC recommendation to wear face coverings in public.

Aging in an “infodemic”: The role of cognition, affect, and experience on news veracity detection during the COVID-19 pandemic (preprint)

Increasing misinformation spread, including news about COVID-19, poses a threat to older adults but there is little empirical research on this population within the fake news literature. Embedded in the Changes in Integration for Social Decisions in Aging (CISDA) model, this study examined the role of (i) analytical reasoning; (ii) affect; and (iii) news consumption frequency, and their interplay with (iv) news content, in determining news veracity detection in aging during the COVID-19 pandemic. Participants were randomly assigned to view COVID or non-COVID news articles, followed by measures of analytical reasoning, affect, and news consumption frequency. Comparable across young and older adults, detection accuracy was higher for fake than real news unrelated to COVID, and non-COVID fake news detection was predicted by individual differences in analytic reasoning. Examination of chronological age effects further revealed that news veracity detection among more elderly older adults depended on interactions between individual CISDA components and news content. Collectively, these findings suggest that age-related vulnerabilities to deceptive news may only be apparent in very old age. Our findings advance understanding of psychological mechanisms in real and fake news evaluation and empirically support CISDA in its application to news veracity detection in aging.

Epidemiological and clinical characteristics of a familial cluster of COVID-19.

We report a family cluster of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection involving five patients in a family cluster in Dazhou, China, including the epidemiological, clinical, laboratory and radiological findings. Three-generation transmission was observed. Through epidemiological investigation, we observed asymptomatic transmission to a cohabiting family member, as well as person-to-person transmission of SARS-CoV-2 outside Wuhan city. The asymptomatic transmission demonstrated here provides evidence that there could be a greater risk of Coronavirus Disease 2019 (COVID-19) spread. This cluster also demonstrated that COVID-19 is transmissible during the incubation period of an asymptomatic person. Early isolation and treatment, stressing prevention of cluster outbreaks, could help prevent further spread of the epidemic.

Preliminary evidence from a multicenter prospective observational study of the safety and efficacy of chloroquine for the treatment of COVID-19.

Effective therapies are urgently needed for the SARS-CoV-2 pandemic. Chloroquine has been proved to have antiviral effect against coronavirus in vitro. In this study, we aimed to assess the efficacy and safety of chloroquine with different doses in COVID-19. In this multicenter prospective observational study, we enrolled patients older than 18 years old with confirmed SARS-CoV-2 infection excluding critical cases from 12 hospitals in Guangdong and Hubei Provinces. Eligible patients received chloroquine phosphate 500 mg, orally, once (half dose) or twice (full dose) daily. Patients treated with non-chloroquine therapy were included as historical controls. The primary endpoint is the time to undetectable viral RNA. Secondary outcomes include the proportion of patients with undetectable viral RNA by day 10 and 14, hospitalization time, duration of fever, and adverse events. A total of 197 patients completed chloroquine treatment, and 176 patients were included as historical controls. The median time to achieve an undetectable viral RNA was shorter in chloroquine than in non-chloroquine (absolute difference in medians -6.0 days; 95% CI -6.0 to -4.0). The duration of fever is shorter in chloroquine (geometric mean ratio 0.6; 95% CI 0.5 to 0.8). No serious adverse events were observed in the chloroquine group. Patients treated with half dose experienced lower rate of adverse events than with full dose. Although randomized trials are needed for further evaluation, this study provides evidence for safety and efficacy of chloroquine in COVID-19 and suggests that chloroquine can be a cost-effective therapy for combating the COVID-19 pandemic.

Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus.

Since December 2019, an epidemic caused by novel coronavirus (2019-nCoV) infection has occurred unexpectedly in China. As of 8 pm, 31 January 2020, more than 20 pediatric cases have been reported in China. Of these cases, ten patients were identified in Zhejiang Province, with an age of onset ranging from 112 days to 17 years. Following the latest National recommendations for diagnosis and treatment of pneumonia caused by 2019-nCoV (the 4th edition) and current status of clinical practice in Zhejiang Province, recommendations for the diagnosis and treatment of respiratory infection caused by 2019-nCoV for children were drafted by the National Clinical Research Center for Child Health, the National Children's Regional Medical Center, Children's Hospital, Zhejiang University School of Medicine to further standardize the protocol for diagnosis and treatment of respiratory infection in children caused by 2019-nCoV.