Analysis on traditional Chinese medicine syndrome characteristics of patients infected with severe acute respiratory syndrome coronavirus 2 omicron variant in a shelter hospital in Shanghai

Objective: To analyze the characteristics of traditional Chinese medicine (TCM) syndromes of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron variant in a shelter hospital in Shanghai. Methods: A total of 621 patients infected with SARS-CoV-2 omicron variant from Apr. 4 to May 24, 2022 in a shelter hospital in Shanghai were enrolled. The data of the patients, including the general information and common clinical syndromes (such as fever, headache, stuffy nose, runny nose, cough, and sputum), were collected on admission by TCM syndrome electronic scale, and core syndrome characteristics were analyzed base on the proportion of each symptom. The syndromes were divided according to the symptom score of patients, and the differences of disease course among the syndromes were compared. Results: The proportion of patients aged 30 to 49 years old was the highest among 621 patients infected with omicron variant (49.76%, 309/621). The most prominent symptoms were cough and expectoration, accounting for 62.32% (387/621) and 68.12% (423/621), respectively. The more common symptoms included sore throat, stuffy nose, runny nose, fatigue, muscle pain, and headache. White sputum was mostly seen in the expectoration and clear mucus was mostly seen in runny nose. According to the clinical symptoms, the core syndrome characteristic of patients infected with omicron variant was cold epidemic constraint in the lung featuring dampness and toxins. The main syndrome was plague invading the defensive exterior, accounting for 40.10% (249/621). The second and third ones were heat toxin attacking the lung syndrome (29.95%, 186/621) and dampness obstructing (17.55%, 109/621), while the least common syndrome was deficiency of qi and yin (7.73%, 48/621). The course of qi and yin deficiency was longer than the other 3 syndromes (P < 0.05). Conclusion: The core TCM syndrome characteristic of patients infected with SARS-CoV-2 omicron variant is cold epidemic constraint in the lung featuring dampness and toxins. The main syndrome is plague invading the defensive exterior. The pattern tends to convert into qi and yin deficiency along the long course.

A Predictive Nomogram for Predicting Improved Clinical Outcome Probability in Patients with COVID-19 in Zhejiang Province, China.

The aim of this research was to develop a quantitative method for clinicians to predict the probability of improved prognosis in patients with coronavirus disease 2019 (COVID-19). Data on 104 patients admitted to hospital with laboratory-confirmed COVID-19 infection from 10 January 2020 to 26 February 2020 were collected. Clinical information and laboratory findings were collected and compared between the outcomes of improved patients and non-improved patients. The least absolute shrinkage and selection operator (LASSO) logistics regression model and two-way stepwise strategy in the multivariate logistics regression model were used to select prognostic factors for predicting clinical outcomes in COVID-19 patients. The concordance index (C-index) was used to assess the discrimination of the model, and internal validation was performed through bootstrap resampling. A novel predictive nomogram was constructed by incorporating these features. Of the 104 patients included in the study (median age 55 years), 75 (72.1%) had improved short-term outcomes, while 29 (27.9%) showed no signs of improvement. There were numerous differences in clinical characteristics and laboratory findings between patients with improved outcomes and patients without improved outcomes. After a multi-step screening process, prognostic factors were selected and incorporated into the nomogram construction, including immunoglobulin A (IgA), C-reactive protein (CRP), creatine kinase (CK), acute physiology and chronic health evaluation II (APACHE II), and interaction between CK and APACHE II. The C-index of our model was 0.962 (95% confidence interval (CI), 0.931-0.993) and still reached a high value of 0.948 through bootstrapping validation. A predictive nomogram we further established showed close performance compared with the ideal model on the calibration plot and was clinically practical according to the decision curve and clinical impact curve. The nomogram we constructed is useful for clinicians to predict improved clinical outcome probability for each COVID-19 patient, which may facilitate personalized counselling and treatment.

Studying the effects of booster shots and antibody responses to the SARS-CoV-2 vaccination over time in health personnel.

Background: With the emergence of mutant versions that lead to continual spreading and recurrent infections of SARS-CoV-2, the COVID-19 vaccines can assist protection for high risk groups, particularly health workers. Even while booster shots have been widely used, longitude studies on immune responses in healthy subjects are uncommon. Methods: Eighty-five healthcare workers who received the BBIBP-CorV vaccine were prospectively enrolled and monitored for up to ten months. Automated Pylon immunoassays were used to quantify total anti-SARS-CoV2 antibody levels (TAb), surrogate neutralization antibody levels (NAb), and antibody avidities over the course of the follow-up. Additionally, hematology analyses were performed. Results: Pylon antibody testing revealed that every participant tested negative at the beginning, and 88.2% of them tested positive about 14 days after receiving their second dosage. The TAb levels and NAb levels peaked in 76.5% and 88.2% of the subjects, respectively, at the same time. Age was connected with the peak antibody levels, but not with gender, BMI, or baseline hematological factors. The positive rates and the antibody levels had already started to decline three months following the second injection. The antibody levels and avidities quickly increased following the booster doses to levels that were considerably greater than the peak antibody responses before to the booster shots. Hematology testing revealed no safety concerns with immunizations. Conclusion: In healthy workers, the two doses of BBIBP-CorV were able to induce humoral immunity; however, 3 months following vaccination, the antibody levels started to decline. The BBIBP-CorV booster injections increase both the quantity and quality of antibodies, which gave support for utilizing booster doses to prolong the duration of the vaccine's protective effects.

Clinical characteristics and clinical outcome of community clusters with SARS-CoV-2 infection.

Background: Community clustering is one of the main features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, few studies have been conducted on the clinical characteristics and clinical outcome of clustered cases and sporadic cases with COVID-19. Methods: We recruited 41 community clusters confirmed with SARS-CoV-2 infection compared with 49 sporadic cases in Zhejiang Province from 19 January 2020 to 9 June 2020. Clinical data were collected to evaluate the clinical outcome and characteristics of community clusters. Results: Compared to sporadic cases, clustered cases had significantly lower Acute Physiology and Chronic Health Evaluation II (APACHE II) score {5.0 [interquartile range (IQR), 2.0-7.5] vs. 7.0 [IQR, 4.0-12.5]; P = 0.005}, less members in intensive care unit (ICU) (6 [14.6%] vs. 18 [36.7%]; P = 0.018), and shorter time of viral shedding in fecal samples (18.5 [IQR, 17.0-28.3] vs. 32.0 [IQR, 24.3-35.5]; P = 0.002). Univariable logistic regression revealed that older age (odds ratios 1.078, 95% confidence intervals 1.007-1.154, per year increase; p = 0.032), high APACHE II score (3.171, 1.147-8.76; P = 0.026), elevated interleukin-2 levels (3.078, 1.145-8.279; P = 0.026) were associated with ICU admission of clustered cases. Conclusions: Compared to sporadic cases, clustered cases exhibited milder disease severity and a better clinical outcome, which may be closely related to the management of early detection, early diagnosis, early treatment and early isolation of COVID-19.

Clinical characteristics and clinical outcome of community clusters with SARS-CoV-2 infection

Background Community clustering is one of the main features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, few studies have been conducted on the clinical characteristics and clinical outcome of clustered cases and sporadic cases with COVID-19. Methods We recruited 41 community clusters confirmed with SARS-CoV-2 infection compared with 49 sporadic cases in Zhejiang Province from 19 January 2020 to 9 June 2020. Clinical data were collected to evaluate the clinical outcome and characteristics of community clusters. Results Compared to sporadic cases, clustered cases had significantly lower Acute Physiology and Chronic Health Evaluation II (APACHE II) score {5.0 [interquartile range (IQR), 2.0–7.5] vs. 7.0 [IQR, 4.0–12.5];P = 0.005}, less members in intensive care unit (ICU) (6 [14.6%] vs. 18 [36.7%];P = 0.018), and shorter time of viral shedding in fecal samples (18.5 [IQR, 17.0–28.3] vs. 32.0 [IQR, 24.3–35.5];P = 0.002). Univariable logistic regression revealed that older age (odds ratios 1.078, 95% confidence intervals 1.007–1.154, per year increase;p = 0.032), high APACHE II score (3.171, 1.147–8.76;P = 0.026), elevated interleukin-2 levels (3.078, 1.145–8.279;P = 0.026) were associated with ICU admission of clustered cases. Conclusions Compared to sporadic cases, clustered cases exhibited milder disease severity and a better clinical outcome, which may be closely related to the management of early detection, early diagnosis, early treatment and early isolation of COVID-19.

Characteristics of COVID-19 Patients With SARS-CoV-2 Positivity in Feces.

Background: SARS-CoV-2 is highly contagious and poses a great threat to epidemic control and prevention. The possibility of fecal-oral transmission has attracted increasing concern. However, viral shedding in feces has not been completely investigated. Methods: This study retrospectively reviewed 97 confirmed coronavirus disease 2019 (COVID-19) patients hospitalized at the First Affiliated Hospital, School of Medicine, Zhejiang University, from January 19 to February 17, 2020. SARS-CoV-2 RNA in samples of sputum, nasopharyngeal or throat swabs, bronchoalveolar lavage and feces was detected by real-time reverse transcription polymerase chain reaction (RT-PCR). Clinical characteristics and parameters were compared between groups to determine whether fecal RNA was positive. Results: Thirty-four (35.1%) of the patients showed detectable SARS-CoV-2 RNA in feces, and 63 (64.9%) had negative detection results. The median time of viral shedding in feces was approximately 25 days, with the maximum time reaching 33 days. Prolonged fecal-shedding patients showed longer hospital stays. Those patients for whom fecal viral positivity persisted longer than 3 weeks also had lower plasma B-cell counts than those patients in the non-prolonged group [70.5 (47.3-121.5) per µL vs. 186.5 (129.3-376.0) per µL, P = 0.023]. Correlation analysis found that the duration of fecal shedding was positively related to the duration of respiratory viral shedding (R = 0.70, P < 0.001) and negatively related to peripheral B-cell counts (R = -0.44, P < 0.05). Conclusions: COVID-19 patients who shed SARS-CoV-2 RNA in feces presented similar clinical characteristics and outcomes as those who did not shed SARS-CoV-2 RNA in feces. The prolonged presence of SARS-CoV-2 nucleic acids in feces was highly correlated with the prolonged shedding of SARS-CoV-2 RNA in the respiratory tract and with lower plasma B-cell counts.

Investigation and analysis of a cluster of COVID-19 associated with exposure to a shopping mall in Jinan City

Objective: To analyze a cluster outbreak of COVID-19 associated with exposure to a shopping mall in Jinan City, investigate the possible transmission chain, and provide reference for further prevention and control.

Nucleic acid detection of fecal samples from confirmed cases of COVID-19

To investigate the status of viral infection in the feces of confirmed COVID-19, cases fecal samples or anal swabs from 36 confirmed cases were collected, 2019-nCoV was detected by real-time fluorescence RT-PCR, and the infection rates of the cases were compared by statistical analysis software SPSS 19.0. Among the 36 samples, 20 (55.56%) were positive for 2019-nCoV. The positive rate of critical cases (2/3) and severe cases(6/9) were both 66.67%, the positive rate of common pneumonia was 62.50% (10/16), and the positive rate of mild pneumonia was 25.00% (2/8). The 36 confirmed COVID-19 cases included 22 males and 14 females, with a detection rate of 54.55% and 57.14%, respectively. The age distribution range of the cases was ranging between 17 and 86 years old, with an average age of 48.75 years. Among the 36 samples, 2 positive specimens in 5 anal swab specimens and 18 positive specimens in 31 fecal specimens were detected. There were no statistically significant differences in the positive detection rates among clinical types, genders, ages and specimen types, respectively. From these results, we deduced that fecal samples of confirmed COVID-19 cases contained 2019-nCoV, which can cause infection through potential fecal-oral transmission and be significant for clinical treatment and epidemiological study.

Sandwich/competitive immuno-sensors on micro-interface for SARS-CoV-2 neutralizing antibodies.

A simple, rapid and robust method to quantify SARS-CoV-2 neutralizing antibodies (nAbs) is urgently needed for determining COVID-19 serodiagnosis, vaccine development and evaluation of vaccine efficacy. In this study, we report sandwich/competitive immuno-sensors based on lateral chromatography micro-interface for accurate quantification of SARS-CoV-2 nAbs. Fluorescent microspheres (FMS) labeled receptor binding domain (RBD) antigen was prepared for detection of nAbs with high sensitivity. Sandwich and competitive immunoassay were conducted on the microfluidic-based sensor within 10 min and the fluorescent signal of immunoassay was analyzed by a portable microfluidic immunoassay instrument. The nAbs detection range of sandwich immuno-sensor and competitive immuno-sensor was 4.0 ng/mL to 400 ng/mL and 2.13 ng/mL to 213 ng/mL, respectively. Furthermore, the sandwich immuno-sensor was demonstrated to be comparable with existing methods and used to detect 182 clinical serum samples from vaccinated individuals. Sandwich immuno-sensor based on lateral chromatography micro-interface allowed reliable, fast, and low-cost detection of nAbs, which holds considerable potential for nAbs testing.

Sandwich/Competitive Immuno-sensors on Micro-interface for SARS-CoV-2 Neutralizing Antibodies

A simple, rapid and robust method to quantify SARS-CoV-2 neutralizing antibodies (nAbs) is urgently needed for determining COVID-19 serodiagnosis, vaccine development and evaluation of vaccine efficacy. In this study, we report sandwich/competitive immuno-sensors based on lateral chromatography micro-interface for accurate quantification of SARS-CoV-2 nAbs. Fluorescent microspheres (FMS) labeled receptor binding domain (RBD) antigen was prepared for detection of nAbs with high sensitivity. Sandwich and competitive immunoassay were conducted on the microfluidic-based sensor within 10 minutes and the fluorescent signal of immunoassay was analyzed by a portable microfluidic immunoassay instrument. The nAbs detection range of sandwich immuno-sensor and competitive immuno-sensor was 4.0 ng/mL to 400 ng/mL and 2.13 ng/mL to 213 ng/mL, respectively. Furthermore, the sandwich immuno-sensor was demonstrated to be comparable with existing methods and used to detect 182 clinical serum samples from vaccinated individuals. Sandwich immuno-sensor based on lateral chromatography micro-interface allowed reliable, fast, and low-cost detection of nAbs, which holds considerable potential for nAbs testing. Graphical abstract Image 1

Isolation and genome sequence analyses of 2019-nCoV from COVID-19 patients in Fujian Province, China

To explore genomic characteriation of 2019-nCoV, throat swab specimens from COVID-19 patients were inoculated on Vero-E6 cells. Six days post-inoculation, supernatants of cell cultures were collected, tested, and sequenced on the Ion Torrent S5 Next-Generation Sequencing system. Two strains viruses were isolated from 12 specimens (eight of them were positive in ORF1ab gene and N gene, one of them was positive in N gene and three of them were negative in ORF1ab gene and N gene), as confirmed by online BLAST search at NCBI website. Genetic similarity of more than 99.9% were observed, from genomic level to structure genes including E, M, N and S genes, between the 2 isolates and the 2019-nCoV reference strain Wuhan-Hu-1 that isolated from Wuhan, Hubei province. Therefore, these results indicated that 2019-nCoV isolates in Fujian province have not mutated significantly yet so far.

Clinical Characteristics and Factors Associated With Long-Term Viral Excretion in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection: a Single-Center 28-Day Study.

BACKGROUND: Despite the ongoing spread of coronavirus disease 2019 (COVID-19), knowledge about factors affecting prolonged viral excretion is limited. METHODS: In this study, we retrospectively collected data from 99 hospitalized patients with coronavirus disease 2019 (COVID-19) between 19 January and 17 February 2020 in Zhejiang Province, China. We classified them into 2 groups based on whether the virus test results eventually became negative. Cox proportional hazards regression was used to evaluate factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding. RESULTS: Among 99 patients, 61 patients had SARS-CoV-2 clearance (virus-negative group), but 38 patients had sustained positive results (virus-positive group). The median duration of SARS-CoV-2 excretion was 15 (interquartile range, 12-19) days among the virus-negative patients. The shedding time was significantly increased if the fecal SARS-CoV-2 RNA test result was positive. Male sex (hazard ratio [HR], 0.58 [95% confidence interval {CI}, .35-.98]), immunoglobulin use (HR, 0.42 [95% CI, .24-.76]), APACHE II score (HR, 0.89 [95% CI, .84-.96]), and lymphocyte count (HR, 1.81 [95% CI, 1.05-3.1]) were independent factors associated with a prolonged duration of SARS-CoV-2 shedding. Antiviral therapy and corticosteroid treatment were not independent factors. CONCLUSIONS: SARS-CoV-2 RNA clearance time was associated with sex, disease severity, and lymphocyte function. The current antiviral protocol and low-to-moderate dosage of corticosteroid had little effect on the duration of viral excretion.