Impacts of E-commerce on Shopping Trips for Non-grocery Experience Goods (preprint)

The rise in e-commerce adoption and decline in in-store shopping at the peak of the COVID-19 pandemic sparked optimism among researchers and transport planners on the potential of e-commerce in reducing shopping trips. However, fluctuations in consumers’ attitudes and shopping habits across the COVID-19 timeline add to the mix and necessitate an investigation into the travel effects of consumers’ evolving shopping behavior. In this regard, this study examines the interactions between the frequency of online shopping and shopping trips and the mediating effects of shoppers’ attitudes in early 2021. Over 2,000 Florida residents were surveyed to explore how various socio-economic, demographic and household characteristics, and attitudes influenced their shopping behavior for four types of non-grocery experience goods, namely clothing, shoes, watches, and jewelry (CSWJ); beauty and health products (BH); toys, kids, and baby supplies (TKB); home, garden, and tools (HGT). Structural equation models were developed to analyze their shopping patterns for each of the products, and results showed that the interactions between online and in-store purchase frequencies for CSWJ and TKB exhibited complementarity effects in both directions. For the other product types, online shopping had positive effects on in-store shopping frequency, but no effects were found in the reverse direction. Results also showed that personal attitudes played important roles in individuals’ shopping decisions, and there were significant mediating effects for a number of personal and household attributes. Tech savviness and the preferences toward alternative modes and online shopping benefits had direct positive influences on online shopping frequency, while the joy of shopping (i.e., shopping for leisure) and privacy and security concerns tended to increase in-store shopping frequency. Concerns regarding unattended delivery had negative impacts on online shopping frequency, while preferences toward the benefits of online shopping showed negative impacts on in-store shopping frequency. Based on these findings, the traffic implications of the expected higher delivery demand and passenger travel are discussed.

Qualitative research on factors affecting nurse-patient relationship under the background of COVID-19 (preprint)

Background Nursing-patient conflict is a worldwide medical dispute problem. Over the years, nursing-patient conflict has not been effectively alleviated. However, the contradiction between medical staffs and COVID-19 patients of China has almost completely disappeared.Objectives To explore factors alleviating contradiction between nurses and COVID-19 patients, which might provide an efficient way to improve medical staffs and patients relationship.Methods Semi-structured online interviews were conducted with 10 nurses who personally cared for patients in COVID-19 from the Chongqing medical rescue team to Hubei province. The whole interview was videotaped and transcribed to word, which return to the interviewee within 24 hours to confirm. Data were analyzed using NVivo11 coding by more than two researchers.Results Economy, expectation, emotion, communication, and media are the main factors that alleviating contradiction between nurses and COVID-19 patients.Conclusion Under the influence of certain factors, there is a high probability that the conflict between nurses and patients can be alleviated under daily circumstances. Free medical care, emphasis on online communication, uniform and publicly publicized disease guideline pairs, positive health care provider coverage, and increased nurse-patient trust may be important factors in improving the nurse-patient relationship in COVID-19.Further population-based intervention studies in the five areas are recommended.

SARS-CoV-2-Triggered Mast Cell Rapid Degranulation Induces Alveolar Epithelial Inflammation and Lung Injury (preprint)

SARS-CoV-2 infection-induced hyper-inflammation links to the acute lung injury and COVID-19 severity. Identifying the primary mediators that initiate the uncontrolled hypercytokinemia is essential for treatments. Mast cells (MCs) are strategically located at the mucosa and beneficially or detrimentally regulate immune inflammations. Here we showed that SARS-CoV-2-triggeed MC degranulation initiated alveolar epithelial inflammation and lung injury. SARS-CoV-2 challenge induced MC degranulation in ACE-2 humanized mice and rhesus macaques, and a rapid MC degranulation could be recapitulated with Spike-RBD binding to ACE2 in cells; MC degranulation alterred various signaling pathways in alveolar epithelial cells, particularly, led to the production of pro-inflammatory factors and consequential disruption of tight junctions. Importantly, the administration of clinical MC stabilizers for blocking degranulation dampened SARS-CoV-2-induced production of pro-inflammatory factors and prevented lung injury. These findings uncover a novel mechanism for SARS-CoV-2 initiating lung inflammation, and suggest an off-label use of MC stabilizer as immunomodulators for COVID-19 treatments.

Willingness to Receive COVID-19 Vaccination Among People Living With HIV and AIDS in China: A Nationwide Online Survey (preprint)

Background: People living with HIV and AIDS (PLWHA) could benefit from COVID-19 vaccination. There is a dearth of evidence on willingness to receive COVID-19 vaccination (WTR) among PLWHA.Methods: The study is a multicenter cross-sectional online survey conducted in eight conveniently selected Chinese metropolitan cities between January and February 2021. Participants were PLWHA aged 18-65 years and living in the study cities. Eight community-based organizations (CBO) providing services to PLWHA, one in each city, facilitated the recruitment through their networks. Eligible PLWHA completed an online survey developed using Golden Data, a widely used encrypted web-based survey platform in China. Logistic regression models and path analysis were used in data analysis.Findings: Out of 10,845 PLWHA approached by the CBO, 2740 completed the survey. This analysis was performed among 2570 participants who had never received COVID-19 vaccination. Over half of the participants reported WTR (57·2%, 1470/2570). After adjusting for potential confounders, all four constructs of the Theory of Planned Behavior (TPB) were significantly associated with WTR, including positive attitudes (adjusted odds ratio, aOR: 1·11, 95%CI: 1·09, 1·12), negative attitudes (aOR: 0·96, 95%CI: 0·94, 0.97), perceived support from significant others (perceived subjective norm) (aOR: 1·53, 95%CI: 1·46, 1·61), and perceived higher behavioral control (aOR: 1·13, 95%CI: 1·11, 1·14). At the interpersonal level, receiving advice supportive of COVID-19 vaccination from doctors (aOR: 1·99, 95%CI: 1·65, 2·40), CBO staff (aOR: 1·89, 95%CI: 1·51, 2·36), friends and/or family members (aOR: 3·22, 95%CI: 1·93, 5·35), and PLWHA peers (aOR: 2.38, 95%CI: 1·85, 3·08) were associated with higher WTR. Overall opinion supporting COVID-19 vaccination for PLWHA on Internet or social media was also positively associated with WTR (aOR: 1·59, 95%CI: 1·31, 1·94). Path analysis indicated that interpersonal-level variables was indirectly associated with WTR through TPB-related perceptions (β=0·43, 95% CI=0·37, 0·51).Interpretation: PLWHA in China reported a relatively low WTR. Interpersonal communication and Internet/social media may be the major sources to convey information and promote COVID-19 vaccination in the population.Funding Statement: This work was supported by the Academic technology leader project of Changzhi Medical College (Grant No. XSQ201902), he Beijing Excellent Talent Plan (2018000021223ZK04) and the National Institute of Mental Health of the National Institutes of Health under Award Numbers R34MH119963.Declaration of Interests: The authors have no conflicts of interest to disclose.Ethics Approval Statement: The Institutional Review Boards of Changzhi Medical College (RT2021003) approved this study.

Comparison of patients hospitalized with COVID-19, H7N9 and H1N1.

BACKGROUND: There is an urgent need to better understand the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), for that the coronavirus disease 2019 (COVID-19) continues to cause considerable morbidity and mortality worldwide. This paper was to differentiate COVID-19 from other respiratory infectious diseases such as avian-origin influenza A (H7N9) and influenza A (H1N1) virus infections. METHODS: We included patients who had been hospitalized with laboratory-confirmed infection by SARS-CoV-2 (n = 83), H7N9 (n = 36), H1N1 (n = 44) viruses. Clinical presentation, chest CT features, and progression of patients were compared. We used the Logistic regression model to explore the possible risk factors. RESULTS: Both COVID-19 and H7N9 patients had a longer duration of hospitalization than H1N1 patients (P < 0.01), a higher complication rate, and more severe cases than H1N1 patients. H7N9 patients had higher hospitalization-fatality ratio than COVID-19 patients (P = 0.01). H7N9 patients had similar patterns of lymphopenia, neutrophilia, elevated alanine aminotransferase, C-reactive protein, lactate dehydrogenase, and those seen in H1N1 patients, which were all significantly different from patients with COVID-19 (P < 0.01). Either H7N9 or H1N1 patients had more obvious symptoms, like fever, fatigue, yellow sputum, and myalgia than COVID-19 patients (P < 0.01). The mean duration of viral shedding was 9.5 days for SARS-CoV-2 vs 9.9 days for H7N9 (P = 0.78). For severe cases, the meantime from illness onset to severity was 8.0 days for COVID-19 vs 5.2 days for H7N9 (P < 0.01), the comorbidity of chronic heart disease was more common in the COVID-19 patients than H7N9 (P = 0.02). Multivariate analysis showed that chronic heart disease was a possible risk factor (OR > 1) for COVID-19, compared with H1N1 and H7N9. CONCLUSIONS: The proportion of severe cases were higher for H7N9 and SARS-CoV-2 infections, compared with H1N1. The meantime from illness onset to severity was shorter for H7N9. Chronic heart disease was a possible risk factor for COVID-19.The comparison may provide the rationale for strategies of isolation and treatment of infected patients in the future.

Comparison of clinical characteristics between fecal/perianal swab nucleic acid-positive and -negative patients with COVID-19.

INTRODUCTION: We analyzed the clinical characteristics of COVID-19 fecal/perianal swab nucleic acid-positive patients in our hospital and evaluated the effect of SARS-CoV-2 on the gastrointestinal tract. METHODOLOGY: Ninety-seven patients in the Fifth Affiliated Hospital of Sun Yat-sen University from January 17, 2020 to March 2, 2020 with fecal/perianal swab samples were selected as subjects and the results of real-time fluorescence reverse transcriptase-PCR SARS-CoV-2 nucleic acid detection of fecal/perianal swabs were used to divide subjects into positive and negative groups. RESULTS: Fecal/perianal swabs of 53.61% (52/97) patients were positive including 31 males (59.62%) and 21 females (40.38%). The negative group had more females than males (P = 0.001). The distribution of case classification based on the most severe condition observed after admission was different between groups: five (5.15%) critical type patients were all from the positive group (P = 0.029). There was no statistical difference in clinical manifestations between the groups. In the positive group, the mean nucleic acid-negative conversion time was 14.13 ± 8.61 days, which was significantly later than the negative group (6.98 ± 5.16 days; P < 0.001). In the positive group, 92% (48/52) had nucleic acid-negative conversion with a mean nucleic acid-negative conversion time of 22.58 ± 10.30 days. Among them, 41 (78.85%) cases were delayed compared with pharynx/nasal swab nucleic acid-negative conversion time. CONCLUSIONS: The positive rate of fecal/perianal swab nucleic acid in male patients was higher than that in female patients. Fecal/perianal swab nucleic acid positive may be an indicator of critical conditions in those with COVID-19.

Comparative Evaluation of 19 Reverse Transcription Loop-Mediated Isothermal Amplification Assays for Detection of SARS-CoV-2 (preprint)

Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has caused a global pandemics. To facilitate the detection of SARS-CoV-2 infection, various RT-LAMP assays using 19 sets of primers had been developed, but never been compared. We performed comparative evaluation of the 19 sets of primers using 4 RNA standards and 29 clinical samples from COVID-19 patients. Six of 15 sets of primers were firstly identified to have faster amplification when tested with four RNA standards, and were further subjected to parallel comparison with the remaining four primer sets using 29 clinical samples. Among these 10 primer sets, Set-4 had the highest positive detection rate of SARS-CoV-2 (82.8%), followed by Set-10, Set-11, Set-13 and Set-14 (75.9%), and Set-14 showed the fastest amplification speed (< 8.5 minutes), followed by Set-17 (< 12.5 minutes). Based on the overall detection performance, Set-4, Set-10, Set-11, Set-13, Set-14 and Set-17 that target Nsp3, S, S, E, N and N gene regions of SARS-CoV-2, respectively, are determined to be better than the other primer sets. Two RT-LAMP assays with the Set-14 primers in combination with any one of four other primer sets (Set-4, Set-10, Set-11, and Set-13) are recommended to be used in the COVID-19 surveillance.

Temporal dynamics of human respiratory and gut microbiomes during the course of COVID-19 in adults (preprint)

SARS-CoV-2 infects multiple organs including the respiratory tract and gut. Whether regional microbiomes are disturbed significantly to affect the disease progression of COVID-19 is largely unknown. To address this question, we performed cross-sectional and longitudinal analyses of throat and anal swabs from 35 COVID-19 adults and 15 controls by 16S rRNA gene sequencing. The results allowed a partitioning of patients into 3-4 categories (I-IV) with distinct microbial community types in both sites. Lower-diversity community types often appeared in the early phase of COVID-19, and synchronous fast restoration of both the respiratory and gut microbiomes from early dysbiosis towards late near-normal was observed in 6/8 mild COVID-19 adult patients despite they had a relatively slow clinical recovery. The synchronous shift of the community types was associated with significantly positive bacterial interactions between the respiratory tract and gut, possibly along the airway-gut axis. These findings reveal previously unknown interactions between respiratory and gut microbiomes, and suggest that modulations of regional microbiota might help to improve the recovery from COVID-19 in adult patients.

Progressive worsening of the respiratory and gut microbiome in children during the first two months of COVID-19 (preprint)

Children are less susceptible to COVID-19 and manifests lower morbidity and mortality after infection, for which a multitude of mechanisms may be proposed. Whether the normal development of gut-airway microbiome is affected by COVID-19 has not been evaluated. We demonstrate that COVID-19 alters the respiratory and gut microbiome of children. Alteration of the microbiome was divergent between the respiratory tract and gut, albeit the dysbiosis was dominated by genus Pseudomonas and sustained for up to 25-58 days in different individuals. The respiratory microbiome distortion persisted in 7/8 children for at least 19-24 days after discharge from the hospital. The gut microbiota showed early dysbiosis towards later restoration in some children, but not others. Disturbed development of both gut and respiratory microbiomes, and prolonged respiratory dysbiosis in children imply possible long-term complications after clinical recovery from COVID-19, such as predisposition to an increased health risk in the post-COVID-19 era.

Progressive worsening of the respiratory and gut microbiome in children during the first two months of COVID-19 (preprint)

Background Children are less susceptible to COVID-19 and manifests lower morbidity and mortality after infection, for which a multitude of mechanisms may be proposed. Whether the normal development of gut-airway microbiome is affected by COVID-19 has not been evaluated.Results We demonstrate that COVID-19 alters the respiratory and gut microbiome of children. Alteration of the microbiome was divergent between the respiratory tract and gut, albeit the dysbiosis was dominated by genus Pseudomonas and sustained for up to 25–58 days in different individuals. The respiratory microbiome distortion persisted in 7/8 children for at least 19–24 days after discharge from the hospital. The gut microbiota showed early dysbiosis towards later restoration in some children, but not others.Conclusions Disturbed development of both gut and respiratory microbiomes, and prolonged respiratory dysbiosis in children imply possible long-term complications after clinical recovery from COVID-19, such as predisposition to an increased health risk in the post-COVID-19 era.

High Acceptance of HIV Self-testing Among PrEP Recipients before COVID-19 Era: A Cross-sectional Analysis from PrEP Demonstration Project of MSM in China (preprint)

Background: Many Pre-exposure prophylaxis (PrEP) users have difficulty attending the quarterly facility-based HIV testing, which leads to the potential risk of drug resistance in the context of breakthrough infection with low drug compliance. We explored the acceptance of HIV self-testing (HIVST) service among PrEP recipients. Methods: MSM were recruited for the PrEP demonstration in four major cities in China from December 2018 to September 2019, provided with regimens of both daily and on-demand PrEP. Facility-based HIV testing was provided quarterly at clinic visits. Previous HIV testing history and acceptance of free HIVST kits to use between each quarterly clinic visit was collected. Correlates of levels of acceptance were analysed using multivariable ordinal logistic regression. Results: We recruited 1,222 MSM. among which 48.5% preferred daily PrEP and 51.5% preferred on-demand PrEP. There was 26.8% (321/1222) had never been to any facility-based HIV testing previously, and the self-reported major reason was that they had already routinely used HIVST. A quarter of the participants (74.5%, 910/1222) had used HIVST previously. There were 1184 MSM (96.9%) accepted to use HIVST between each quarterly clinic visits during PrEP usage, composing 947 ( 77.5%) very willing to, 237（19.4%）willing to, 29 (2.4%) unwilling to, and 9 (0.7%) very unwilling to. Participants preferred daily PrEP (vs. on-demand PrEP, aOR=1.8, 95% CI:1.3-2.4) and had less than 2 times of facility-based HIV testing in the past year (vs. ³2, aOR=1.4,95% CI:1.1-1.9) were more likely to have higher level of acceptance of HIVST.Conclusions: MSM had high acceptance of HIVST, especially among those preferred daily PrEP and with less facility-based HIV testing in the previous year. Offering HIVST services PrEP recipients is feasible and necessary. Above result is of great significance for promoting HIVST among PrEP users during COVID-19, improving awareness of their HIV infection status and ensuring compliance with medication. Future study should exam the impact of HIVST on HIV testing frequency among PrEP users.Trial registration: ChiCTR1800020374 on 27th Dec 2018. http://www.chictr.org.cn/searchproj.aspx

Psychological status and behavior changes of the public during the COVID-19 epidemic in China.

BACKGROUND: A cluster of pneumonia cases were reported by Wuhan Municipal Health Commission, China in December 2019. A novel coronavirus was eventually identified, and became the COVID-19 epidemic that affected public health and life. We investigated the psychological status and behavior changes of the general public in China from January 30 to February 3, 2020. METHODS: Respondents were recruited via social media (WeChat) and completed an online questionnaire. We used the State-Trait Anxiety Inventory, Self-rating Depression Scale, and Symptom Checklist-90 to evaluate psychological status. We also investigated respondents' behavior changes. Quantitative data were analyzed by t-tests or analysis of variance, and classified data were analyzed with chi-square tests. RESULTS: In total, 608 valid questionnaires were obtained. More respondents had state anxiety than trait anxiety (15.8% vs 4.0%). Depression was found among 27.1% of respondents and 7.7% had psychological abnormalities. About 10.1% of respondents suffered from phobia. Our analysis of the relationship between subgroup characteristics and psychological status showed that age, gender, knowledge about COVID-19, degree of worry about epidemiological infection, and confidence about overcoming the outbreak significantly influenced psychological status. Around 93.3% of respondents avoided going to public places and almost all respondents reduced Spring Festival-related activities. At least 70.9% of respondents chose to take three or more preventive measures to avoid infection. The three most commonly used prevention measures were making fewer trips outside and avoiding contact (98.0%), wearing a mask (83.7%), and hand hygiene (82.4%). CONCLUSIONS: We need to pay more attention to public psychological stress, especially among young people, as they are likely to experience anxiety, depression, and psychological abnormalities. Different psychological interventions could be formulated according to the psychological characteristics of different gender and age groups. The majority of respondents followed specific behaviors required by the authorities, but it will take time to observe the effects of these behaviors on the epidemic.

Recombinant SARS-CoV-2 spike S1-Fc fusion protein induced high levels of neutralizing responses in nonhuman primates (preprint)

The COVID-19 outbreak has become a global pandemic responsible for over 2,000,000 confirmed cases and over 126,000 deaths worldwide. In this study, we examined the immunogenicity of CHO-expressed recombinant SARS-CoV-2 S1-Fc fusion protein in mice, rabbits, and monkeys as a potential candidate for a COVID-19 vaccine. We demonstrate that the S1-Fc fusion protein is extremely immunogenic, as evidenced by strong antibody titers observed by day 7. Strong virus neutralizing activity was observed on day 14 in rabbits immunized with the S1-Fc fusion protein using a pseudovirus neutralization assay. Most importantly, in less than 20 days and three injections of the S1-Fc fusion protein, two monkeys developed higher virus neutralizing titers than a recovered COVID-19 patient in a live SARS-CoV-2 infection assay. Our data strongly suggests that the CHO-expressed SARS-CoV-2 S1-Fc recombinant protein could be a strong candidate for vaccine development against COVID-19. HighlightsO_LICHO-expressed S1-Fc protein is very immunogenic in various animals and can rapidly induce strong antibody production C_LIO_LIS1-Fc protein solicits strong neutralizing activities against live virus C_LIO_LIStable CHO cell line expressing 50 mg/L of S1-Fc and a 3,000 L Bioreactor can produce 3 million doses of human COVID-19 vaccine every 10 days, making it an accessible and affordable option for worldwide vaccination C_LI