Measuring short- and long-run impacts of COVID19 on the sharing economy and business models

Research has highlighted the impact of COVID-19 on firms without elaborating on how the epidemic effect sharing economy and business models from both the short and long-run perspectives. Drawing on the literature-based view and the vector error-correction model, this study attempts to examine the effects of COVID-19 related factors on companies that provide or share access to goods and services that are facilitated by a community-based online platform. We argue that the government response, and the testing policy and contact tracing will promote managers to adjust their business model. In the long term, economic support, such as income support and debt relief, will reduce stuffs' motivation to work, leading to less achievements. On the other hand, due to the strictness of policies, people will increase online activities and stimulate the sharing economy. Using Indxx data and the Oxford COVID-19 Government Response Tracker database, the analysis of time series data from 75 U.S.-listed companies provides supports for both the short-run effects of the lockdown restrictions and closures with measures, and the government response, and the long-run effects of economic support, and the strictness of lockdown-style policies. This study contributes to business management literature by elaborating upon the causality relationships of how COVID 19 related factors effect sharing economy and business models in the short and long terms. The findings benefit scholars, managers, and policymakers of modernized firms.

Alpha-Soluble NSF Attachment Protein Prevents the Cleavage of the SARS-CoV-2 Spike Protein by Functioning as an Interferon-Upregulated Furin Inhibitor.

Loss of the furin cleavage motif in the SARS-CoV-2 spike protein reduces the virulence and transmission of SARS-CoV-2, suggesting that furin is an attractive antiviral drug target. However, lack of understanding of the regulation of furin activity has largely limited the development of furin-based therapeutic strategies. Here, we find that alpha-soluble NSF attachment protein (α-SNAP), an indispensable component of vesicle trafficking machinery, inhibits the cleavage of SARS-CoV-2 spike protein and other furin-dependent virus glycoproteins. SARS-CoV-2 infection increases the expression of α-SNAP, and overexpression of α-SNAP reduces SARS-CoV-2 infection in cells. We further reveal that α-SNAP is an interferon-upregulated furin inhibitor that inhibits furin function by interacting with its P domain. Our study demonstrates that α-SNAP, in addition to its role in vesicle trafficking, plays an important role in the host defense against furin-dependent virus infection and therefore could be a target for the development of therapeutic options for COVID-19. IMPORTANCE Some key mutations of SARS-CoV-2 spike protein, such as D614G and P681R mutations, increase the transmission or pathogenicity by enhancing the cleavage efficacy of spike protein by furin. Loss of the furin cleavage motif of SARS-CoV-2 spike protein reduces the virulence and transmission, suggesting that furin is an attractive antiviral drug target. However, lack of understanding of the regulation of furin activity has largely limited the development of furin-based therapeutic strategies. Here, we found that in addition to its canonical role in vesicle trafficking, alpha-soluble NSF attachment protein (α-SNAP) plays an important role in the host defense against furin-dependent virus infection. we identified that α-SNAP is a novel interferon-upregulated furin inhibitor and inhibits the cleavage of SARS-CoV-2 spike protein and other furin-dependent virus glycoproteins by interacting with P domain of furin. Our study demonstrates that α-SNAP could be a target for the development of therapeutic options for COVID-19.

Transferrin Receptor Protein 1 Cooperates with mGluR2 To Mediate the Internalization of Rabies Virus and SARS-CoV-2.

Identification of bona fide functional receptors and elucidation of the mechanism of receptor-mediated virus entry are important to reveal targets for developing therapeutics against rabies virus (RABV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Our previous studies suggest that metabotropic glutamate receptor subtype 2 (mGluR2) functions as an entry receptor for RABV in vitro, and is an important internalization factor for SARS-CoV-2 in vitro and in vivo. Here, we demonstrate that mGluR2 facilitates RABV internalization in vitro and infection in vivo. We found that transferrin receptor 1 (TfR1) interacts with mGluR2 and internalizes with mGluR2 and RABV in the same clathrin-coated pit. Knockdown of TfR1 blocks agonist-triggered internalization of mGluR2. Importantly, TfR1 also interacts with the SARS-CoV-2 spike protein and is important for SARS-CoV-2 internalization. Our findings identify a novel axis (mGluR2-TfR1 axis) used by RABV and SARS-CoV-2 for entry, and reveal TfR1 as a potential target for therapeutics against RABV and SARS-CoV-2. IMPORTANCE We previously found that metabotropic glutamate receptor subtype 2 (mGluR2) is an entry receptor for RABV in vitro, and an important internalization factor for SARS-CoV-2 in vitro and in vivo. However, whether mGluR2 is required for RABV infection in vivo was unknown. In addition, how mGluR2 mediates the internalization of RABV and SARS-CoV-2 needed to be resolved. Here, we found that mGluR2 gene knockout mice survived a lethal challenge with RABV. To our knowledge, mGluR2 is the first host factor to be definitively shown to play an important role in RABV street virus infection in vivo. We further found that transferrin receptor protein 1 (TfR1) directly interacts and cooperates with mGluR2 to regulate the endocytosis of RABV and SARS-CoV-2. Our study identifies a novel axis (mGluR2-TfR1 axis) used by RABV and SARS-CoV-2 for entry and opens a new door for the development of therapeutics against RABV and SARS-CoV-2.

Research on the relationship between architectural features in northeast China and vertical aerosol transmission of COVID-19.

During the COVID-19 pandemic, many buildings in northeast China have had clusters of infected cases in the vertical layout. There is speculation that vertical aerosol transmission occurs. The houses in northeast China are airtight, and range hoods may be used for a long period of time when cooking. The pathway and factors influencing vertical aerosol transmission are worth studying. To elucidate a viral aerosol transmission pathway, we selected a multistory apartment and a high-rise building in Changchun city, Jilin province, China, to conduct an in-depth investigation and on-site simulation experiments. According to epidemiological investigation information on infected cases, building structures, drainage, ventilation, etc., we used fluorescent microspheres to simulate the behaviors of infected people, such as breathing and flushing the toilet after defecation, to discharge simulated viruses and track and monitor them. The field simulation experiment confirmed the transmission of fluorescent microsphere aerosols to other rooms in two types of buildings using a vertical aerosol transmission pathway of toilet flush-sewage pipe-floor drain without a water seal. Our study showed that, in the absence of a U-shaped trap or floor drain water seal whether in a multistory apartment or high-rise residential building, there is a transmission pathway of "excretion of virus through feces-toilet flushing-sewage pipe-floor drain without water seal," which will cause the vertical transmission of viral aerosol across floors during the COVID-19 pandemic. Moreover, the negative pressure generated by turning on the range hood when closing doors and windows increase aerosol transmission. Based on this negative pressure, prevention and control measures for residential buildings in northeast China during the COVID-19 pandemic were proposed.

Effectiveness and safety research of Qingfei Paidu (QFPD) in treatment of COVID-19: an up-to-date systematic review and meta-analysis.

BACKGROUND: Since the outbreak of COVID-19 in 2019, the global economy, culture, politics, and people's lives and health have been severely damaged and threatened. Although western modern medical treatment has made great efforts, the treatment of COVID-19 has not achieved ideal clinical efficacy with severe sequelae. Qingfei Paidu (QFPD), an important herbal prescription for COVID-19 treatment, has shown remarkable therapeutic effects in China's fight against the epidemic. MATERIALS AND METHODS: We searched seven databases up to 7 September 2022, including PubMed, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, World Scientific and SpringerLink. We used the Cochrane Risk of Bias tool to assess the quality of randomized controlled trials. All analysis results were conducted by RevMan 5.4.1 to carry out a meta-analysis. RESULTS: Fifteen studies with 10390 patients were included. QFPD could not only significantly improve the cure rate and lung CT of COVID-19, reduce the number of patients turning to critical condition and death, shorten the time for nucleic acid conversion and the length of hospital stay, but change laboratory indexes and relieve body symptoms quickly without adverse effects. CONCLUSIONS: Compared with patients only treated by conventional western treatment (CWM), QFPD combined with CWM could be more effective for patients. It is worth spreading to other countries in the global battle against COVID-19.

Ambient air pollutants concentration prediction during the COVID-19: A method based on transfer learning.

Research on the correlation analysis between COVID-19 and air pollution has attracted increasing attention since the COVID-19 pandemic. While many relevant issues have been widely studied, research into ambient air pollutant concentration prediction (APCP) during COVID-19 is still in its infancy. Most of the existing study on APCP is based on machine learning methods, which are not suitable for APCP during COVID-19 due to the different distribution of historical observations before and after the pandemic. Therefore, to fulfill the predictive task based on the historical observations with a different distribution, this paper proposes an improved transfer learning model combined with machine learning for APCP during COVID-19. Specifically, this paper employs the Gaussian mixture method and an optimization algorithm to obtain a new source domain similar to the target domain for further transfer learning. Then, several commonly used machine learning models are trained in the new source domain, and these well-trained models are transferred to the target domain to obtain APCP results. Based on the real-world dataset, the experimental results suggest that, by using the improved machine learning methods based on transfer learning, our method can achieve the prediction with significantly high accuracy. In terms of managerial insights, the effects of influential factors are analyzed according to the relationship between these influential factors and prediction results, while their importance is ranked through their average marginal contribution and partial dependence plots.

Diltiazem inhibits SARS-CoV-2 cell attachment and internalization and decreases the viral infection in mouse lung

Since the outbreak of the new crown pneumonia, the new coronavirus (SARSCoV-2) has been mutating continuously, and it has now become prevalent in more than 200 countries. The cumulative number of confirmed cases in the world has exceeded 460 million, and the number of deaths has exceeded 6 million. The rapid mutation of SARS-CoV-2 highlights the importance of preventive and therapeutic drugs, however, effective therapeutic drugs for new coronary pneumonia are still very scarce. It is still the common goal of scientists from all over the world to develop a safe and effective drug for the treatment of new coronary pneumonia that can inhibit the infection of multiple SARS-CoV-2 mutant strains.

Study on flexible surface dielectric barrier discharge plasma film for in situ inactivation of bacteria and viruses

COVID-19 is still pandemic in the world although it has lasted for more than two years, in situ real-time disinfection of curved surfaces in public places is extremely urgent. A flexible plasma film based on surface dielectric barrier discharge is proposed in this study. In situ disinfection effect and the influence of curvature on the performance are studied. The results showed that the film could in situ inactivate a variety of pathogens. Specifically, 10 min plasma treatment results in a log reduction of 3.10, 3.42, and 3.03 for Escherichia coli, Staphylococcus aureus, and vesicular stomatitis virus, respectively. The discharge power and disinfection effect of the film are independent of the curvature, which proves that it can be used for in situ disinfection of curved surfaces. It is speculated that the combined effects of a strong electric field and radical etching physical damage as well as the chemical damage of reactive oxygen and nitrogen species to the protein are the main reasons for the inactivation of pathogens. The inhibition of the film to Omicron type SARS-CoV-2 pseudovirus is 99.3%, and the killing rate to natural bacteria is 94.3%. The film can run for at least 10 h without significant reduction in disinfection effect. In addition, large-scale and digitalization increase the practical potential of a disinfection film. In conclusion, this film is expected to realize in situ real-time disinfection of curved surfaces such as the buttons of the elevator or instrument and door handles, which is of great significance in blocking the spread of COVID-19. [ FROM AUTHOR] Copyright of Applied Physics Letters is the property of American Institute of Physics and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

In-duct grating-like dielectric barrier discharge system for air disinfection.

In the context of spreading Coronavirus disease 2019 (COVID-19), the combination of heating, ventilation, and air-conditioning (HVAC) system with air disinfection device is an effective way to reduce transmissible infections. Atmospheric-pressure non-equilibrium plasma is an emerging technique for fast pathogen aerosol abatement. In this work, in-duct disinfectors based on grating-like dielectric barrier discharge (DBD) plasmas with varied electrode arrangements were established and evaluated. The highest airborne bacterial inactivation efficiency was achieved by 'vertical' structure, namely when aerosol was in direct contact with the discharge region, at a given discharge power. For all reactors, the efficiency was linearly correlated to the discharge power (R2 =0.929-0.994). The effects of environmental factors were examined. Decreased airflow rates boosted the efficiency, which reached 99.8% at the velocity of 0.5 m/s with an aerosol residence time of ~3.6 ms. Increasing humidity (relative humidity (RH)=20-60%) contributed to inactivation efficacy, while high humidity (RH=70%-90%) led to a saturated efficiency, possibly due to the disruption of discharge uniformity. As suggested by the plasma effluent treatment and scavenger experiments, gaseous short-lived chemical species or charged particles were concluded as the major agents accounting for bacterial inactivation. This research provides new hints for air disinfection by DBD plasmas.

A look at the focus shift in innovation literature due to Covid-19 pandemic.

This study explores the problems related to the development of innovation research in the field of business and economics and the change in their characteristics following the coronavirus disease 2019 (COVID-19) pandemic. We compile a comprehensive bibliometric analysis of 17,277 pre-epidemic publications and 4,240 post-epidemic publications from the Web of Science. Using bibliometric methods and visualization tools, we present the changes in these publications following the COVID-19 pandemic, and identify the influential countries and regions, sources, and references, and obtain features of keywords over time. The results show that innovation research is rich in content, and involves a wide range; it has been focusing on emerging topics, such as those concerning low-carbon, innovation forms, and epidemic environments, following the COVID-19 pandemic. This study contributes to the body of knowledge on innovation, and helps to understand the features and structures of innovation research in business and economics.

Diltiazem inhibits SARS-CoV-2 cell attachment and internalization and decreases the viral infection in mouse lung.

The continuous emergence of severe acute respiratory coronavirus 2 (SARS-CoV-2) variants and the increasing number of breakthrough infection cases among vaccinated people support the urgent need for research and development of antiviral drugs. Viral entry is an intriguing target for antiviral drug development. We found that diltiazem, a blocker of the L-type calcium channel Cav1.2 pore-forming subunit (Cav1.2 α1c) and an FDA-approved drug, inhibits the binding and internalization of SARS-CoV-2, and decreases SARS-CoV-2 infection in cells and mouse lung. Cav1.2 α1c interacts with SARS-CoV-2 spike protein and ACE2, and affects the attachment and internalization of SARS-CoV-2. Our finding suggests that diltiazem has potential as a drug against SARS-CoV-2 infection and that Cav1.2 α1c is a promising target for antiviral drug development for COVID-19.

SARS-CoV-2 uses metabotropic glutamate receptor subtype 2 as an internalization factor to infect cells.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses angiotensin-converting enzyme 2 (ACE2) as a binding receptor to enter cells via clathrin-mediated endocytosis (CME). However, receptors involved in other steps of SARS-CoV-2 infection remain largely unknown. Here, we found that metabotropic glutamate receptor subtype 2 (mGluR2) is an internalization factor for SARS-CoV-2. Our results show that mGluR2 directly interacts with the SARS-CoV-2 spike protein and that knockdown of mGluR2 decreases internalization of SARS-CoV-2 but not cell binding. Further, mGluR2 is uncovered to cooperate with ACE2 to facilitate SARS-CoV-2 internalization through CME and mGluR2 knockout in mice abolished SARS-CoV-2 infection in the nasal turbinates and significantly reduced viral infection in the lungs. Notably, mGluR2 is also important for SARS-CoV spike protein- and Middle East respiratory syndrome coronavirus spike protein-mediated internalization. Thus, our study identifies a novel internalization factor used by SARS-CoV-2 and opens a new door for antiviral development against coronavirus infection.

Disinfection of Escherichia coli in ice by surface dielectric barrier discharge plasma.

A variety of pathogens can cause people to suffer from serious diseases, and the transmission of COVID-19 through the cold chain has once again attracted people's attention to cold chain disinfection. Unfortunately, there is no mature cold chain disinfection technique yet. In this study, a low-temperature plasma disinfection technique for a cold chain is proposed. The disinfection effect of plasma generated by surface dielectric barrier discharge on Escherichia coli in ice at cryogenic temperature is studied, and the possible disinfection mechanism is discussed. It is found that the O3 mode and the NOx mode also exist in the surface dielectric barrier discharge at cryogenic temperature, just as at room temperature. The disinfection effect of both modes is weak in 5 min plasma treatment, but in 60 min post-treatment, the NOx mode shows a stronger disinfection effect, with 4.45 log reduction. It is speculated that gaseous H2O2 and NOx can be adsorbed on the ice surface in the NOx mode and then converted into peroxynitrite, which is a powerful bactericidal species. In conclusion, a low-temperature plasma is a promising technique for cold chain disinfection, which is of great significance for ensuring people's health.

Risk Factors for COVID-19 in Patients with Hypertension.

BACKGROUND: Hypertension, as the most common comorbidity for patients with coronavirus disease 19 (COVID-19), has resulted in cases with more severe symptoms and higher mortality. The risk factors associated with COVID-19 in patients with hypertension are unknown. METHODS: All the available and confirmed patients with COVID-19 from February 3 to March 10, 2020, were enrolled from Huoshenshan Hospital, Wuhan, China. The demographic characteristics, clinical manifestations, laboratory data, radiological assessments, and treatments on admission were extracted and compared. Univariate and multivariate logistic regression methods were used to explore risk factors associated with COVID-19 in patients with hypertension and the severity of the cohort. RESULTS: A total of 430 available patients with COVID-19 were enrolled in the study, including 151 eligible patients with COVID-19 and hypertension. After PSM analysis, 141 patients without hypertension and 141 cases with hypertension were well matched. Compared with cases without hypertension, patients with hypertension were more severe (28.4% vs. 12.1%, p=0.001). In multivariate analysis, we found that neutrophil count (OR: 1.471; p=0.001), coronary heart disease (OR: 5.281; p=0.011), and the level of K+ (OR: 0.273; p < 0.001) were associated with patients with hypertension. In addition, the percentage of pulmonary infection volume was larger in cases with hypertension (4.55 vs. 5.8, p=0.017) and was a high risk factor for severe COVID-19 in patients with hypertension (OR: 1.084; p < 0.001). CONCLUSION: On admission, coronary heart disease, neutrophil count, and the level of K+ were associated with COVID-19 patients with hypertension. The percentage of the pulmonary infection volume was significantly larger in COVID-19 patients with hypertension and was a risk factor for COVID-19 severity of the cohort.

Fast Screening and Primary Diagnosis of COVID-19 by ATR-FT-IR.

The outbreak of coronavirus disease 2019 (COVID-19) has led to substantial infections and mortality around the world. Fast screening and diagnosis are thus crucial for quick isolation and clinical intervention. In this work, we showed that attenuated total reflection-Fourier transform infrared spectroscopy (ATR-FT-IR) can be a primary diagnostic tool for COVID-19 as a supplement to in-use techniques. It requires only a small volume (∼3 µL) of the serum sample and a shorter detection time (several minutes). The distinct spectral differences and the separability between normal control and COVID-19 were investigated using multivariate and statistical analysis. Results showed that ATR-FT-IR coupled with partial least squares discriminant analysis was effective to differentiate COVID-19 from normal controls and some common respiratory viral infections or inflammation, with the area under the receiver operating characteristic curve (AUROC) of 0.9561 (95% CI: 0.9071-0.9774). Several serum constituents including, but not just, antibodies and serum phospholipids could be reflected on the infrared spectra, serving as "chemical fingerprints" and accounting for good model performances.

Emergency surgical workflow and experience of suspected cases of COVID-19: A case report.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 has been confirmed to be a newly discovered zoonotic pathogen that causes highly contagious viral pneumonia, which the World Health Organization has named novel coronavirus pneumonia. Since its outbreak, it has become a global pandemic. During the outbreak of coronavirus disease 2019 (COVID-19), however, there is no mature experience or guidance on how to carry out emergency surgery for suspected cases requiring emergency surgical intervention and perioperative safety protection against virus. CASE SUMMARY: A 41-year-old man was admitted to the hospital for emergency treatment due to "3-d abdominal pain aggravated with cessation of exhaust and defecation". After improving inspections and laboratory tests, the patient was assessed and diagnosed by the multiple discipline team as "strangulation obstruction, pulmonary infection". His body temperature was 38.8 °C, and the chest computed tomography showed pulmonary infection. Given fever and pneumonia, we could not rule out COVID-19 after consultation by fever clinicians and respiratory experts. Hence, we performed emergency surgery under three-level protection for the suspected case. After surgery, his nucleic acid test for COVID-19 was negative, meaning COVID-19 was excluded, and routine postoperative treatment and nursing was followed. The patient was treated with symptomatic support after the operation. The stomach tube and urinary tube were removed on the 1st d after the operation. The clearing diet was started on the 3rd d after the operation, and the body temperature returned to normal. Flatus and bowel movements were noted on 5th postoperative day. He was discharged after 8 d of hospitalization. The patient was followed up for 4 mo after discharge, no serious complications occurred. A 71-year-old woman was admitted to our emergency room due to "abdominal distention, fatigue for 6 d and fever for 13 h". After the multiple discipline team evaluation, the patient was diagnosed as "intestinal obstruction, abdominal mass, peritonitis and pulmonary infection". At that time, the patient's body temperature was 39.6 °C, and chest computed tomography indicated pulmonary infection. COVID-19 could not be completely excluded after consultation in the fever outpatient department and respiratory department. Therefore, the patient was treated as a suspected case, and an urgent operation was performed under three-level medical protection. Postoperative nucleic acid test was negative, COVID-19 was excluded, and routine postoperative treatment and nursing were followed. After the operation, the patient received symptomatic and supportive treatment. The gastric tube was removed on the 1st d after the operation, and the urinary tube was removed on the 3rd d after the operation. Enteral nutrition began on the 3rd d after the operation. To date, no serious complications have been found during follow-up after discharge. CONCLUSION: Based on the previous treatment experience, we reviewed the procedures of two cases of suspected COVID-19 emergency surgery and extracted the perioperative protection experience. By referring to the literature and following the regulations on prevention and management of infectious diseases, we have developed a relatively mature and complete emergency surgical workflow for suspected COVID-19 cases and shared perioperative protection and management experience and measures.

The impact of COVID-19 on intestinal flora: A protocol for systematic review and meta analysis.

BACKGROUND: Coronavirus disease (COVID-19) sparked global concern for its outbreak and pandemic. It caused severe respiratory tract infections and a significant proportion of patients with gastrointestinal symptoms. Several studies have investigated the intestinal flora of COVID-19. However, so far there has been no evidence demonstrating the evidence on the association of COVID-19 with intestinal flora through meta-analysis. A systematic and comprehensive understanding of their relationship is essential to provide public health prevention or treatment strategy. METHODS AND ANALYSIS: This systematic review and meta-analysis will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Observational studies (cohort studies, case-control, and cross-sectional studies) and clinical trials will be eligible. Studies eligible for inclusion must contain participants with COVID-19. Systematic searches will be conducted in PubMed, EMBASE, Cochrane Library, Ovid, EBSCO, World Health Organization COVID-19 database, China National Knowledge Internet, WanFang Data, Chinese Scientific and Technological Journal Database, and Chinese Biomedical Databases. A pre-designed search strategy of medical subject headings and free text terms for COVID-19 and intestinal flora will be used. Two reviewers will independently screen the titles and abstracts, followed by full-text screening. Discrepancies will be resolved by consensus with a third reviewer. The reviewers will then extract data from each eligible article based on PECOS (Population, Exposure, Comparator, Outcomes, and Study design). The risk of bias and quality of included studies will be assessed using an appropriate tool. A random-effects meta-analysis will be considered where there are sufficiently homogeneous studies; otherwise, a narrative synthesis will be conducted. Heterogeneity among studies will be assessed using I statistics. If substantial heterogeneity detected, subgroup analyses and meta-regression will be conducted to look for the potential causes. ETHICS AND DISSEMINATION: Ethical approval is not required as we will use data from published articles. Findings will be published in a peer-reviewed journal.PROSPERO registration number: CRD42020191640.

Pulmonary vascular endothelial injury and acute pulmonary hypertension caused by COVID-19: the fundamental cause of refractory hypoxemia?

Coronavirus disease (COVID-19) is a severe infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that binds to the cells; angiotensin converting enzyme 2 (ACE2) receptor. In the first severe case of COVID-19 in Shenzhen city, we found that in addition to the typical clinical manifestations, our patient presented hemoptysis, refractory hypoxemia and pulmonary fibrosis-like changes on computed tomography (CT) involving alveoli and pulmonary interstitium in the early stage and acute pulmonary hypertension and right heart failure in the later stage, which were not completely justified by myocarditis, acute respiratory distress syndrome (ARDS), pulmonary fibrosis and high PEEP level. The lung compliance deterioration of this patient was not as serious as we expected, indicating classic ARDS was not existed. Simultaneously, the first autopsy report of COVID-19 in China showed normal-structured alveoli and massive thick excretion in the airway. Then, we speculated that the virus not only attacked alveolar epithelial cells, but also affected pulmonary vascular endothelial cells. Imbalance in the ACE2-RAAS- bradykinin axis and the cytokine storm could be an important mechanism leading to pathophysiological changes in pulmonary vascular and secondary refractory hypoxemia. Pulmonary vasculitis or capillaritis associated to immune damage and an inflammatory storm could exist in COVID-19 because of ground-glass opacities in the subpleural area, which are similar to connective tissue disease associated interstitial lung disease (CTD-ILD). Thus, this case elucidates new treatment measures for COVID-19.

Histopathological features of multiorgan percutaneous tissue core biopsy in patients with COVID-19.

AIMS: The global outbreak of COVID-19 has resulted in an increased mortality. However, whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect multiple organs is still unclear. In this study, postmortem percutaneous biopsies of multiple organs from deceased patients were performed to understand the histopathological changes caused by COVID-19. METHODS: Biopsy specimens of pulmonary, cardiac, hepatic and lymphoid tissues were obtained from three patients, who died due to COVID-19 pneumonia. H&E stain, Masson trichrome stain, immunohistochemistry stain and in-situ hybridisation were used. RESULTS: Pulmonary damages caused by SARS-CoV-2 infection was diffuse alveolar damage (DAD). In the early phase, the histological findings were mainly those of exudative features of DAD. The later phase was characterised by organisation of DAD combined with bacterial pneumonia. No serious damage was found in the bronchiolar epithelium and submucosal glands. The hepatic tissue revealed features of ischaemic necrosis, but findings suggestive of mild lobular hepatitis were also observed. The lymphoid tissue revealed features of non-specific acute lymphadenitis. The cardiac tissue revealed changes of underlying disease. SARS-CoV-2 RNAs were not detected in hepatocytes, cholangiocytes and lymphocytes of lymph nodes. CONCLUSIONS: COVID-19 predominantly involves the pulmonary tissue, causes DAD and aggravates the cardiovascular disease. However, other extrapulmonary tissues did not reveal any virus-specific findings, but were affected by multiple factors. The findings in this report caution the pathologists that they should not mistakenly attribute all the histological features to CoV infection. Moreover, the clinicians should pay attention to the potentially injurious and correctable causes.