Expert consensus on prevention and control of infection in makeshift hospitals

Makeshift hospitals have played an important role in responding to the spread of the epidemic caused by the Omicron coronavirus variant, one of the novel coronavirus(SARS-CoV-2) strains with significantly enhanced infectiousness. In order to prevent the patients, healthcare workers and other staff against from infection, Healthcare-associated Infection Management Committee of Chinese Hospital Association organized domestic experts to jointly formulate this consensus according to the comprehensive consideration of national guidelines as well as the actual characteristics and needs of makeshift hospitals. This consensus is mainly applicable for makeshift hospitals where a large number of asymptomatic and mild cases of novel coronavirus disease 2019(COVID-19) are treated. It provides guidance for the managers and staff to implement prevention and control work in line with local conditions in makeshift hospitals based on a perfect organizational structure and efficient working mechanism, the prevention and control work includes training and assessment of infection control knowledge and skills, flowing in and out of the makeshift hospitals for staff and materials, infection monitoring and feedback, implementation of infection prevention and control measures, requirements for infection management in key areas, occupational protection of staff and terminal disinfection, etc. Meanwhile, this consensus particularly emphasizes that the infection prevention and control in makeshift hospitals is a systematic project, which requires not only multi-system and multi-department collaboration, but also uniting in a concrete effort among leaders and staff. In accordance with the national guidelines and evidence-based experiences, it is very important to combine theory with practice for ensuring efficient operation and safety of makeshift hospitals.

Study of Silicon Nitride Waveguide Platform for On-Chip Virus Detection: Prospects for COVID-19 (preprint)

This work presents a rigorous sensitivity analysis of silicon nitride on silicon dioxide strip waveguide for virus detection, focusing on COVID-19. In general, by functionalizing the waveguide surface with specific antibodies layer, we make the optical sensor sensitive only to a particular virus. Unlike conventional virus detection methods such as polymerase chain reaction (PCR), integrated refractive index (RI) optical sensors offer cheap and mass-scale fabrication of compact devices for fast and straightforward detection with high sensitivity and selectivity. Our analysis includes a wide range of wavelengths from visible to mid-infrared. We determined the strip waveguide's single-mode dimensions and the optimum dimensions that maximize the sensitivity to the virus layer attached to its surface at each wavelength. We also compared the strip waveguide to the widely used slot waveguide. Our study shows that silicon nitride strip waveguide working at lower wavelengths is the optimum choice for virus detection as it maximizes both the waveguide sensitivity (S wg ) and the figure of merit (FOM) of the sensor. Furthermore, the optimized waveguide can work for a range of viruses. Balanced Mach-Zehnder interferometer (MZI) sensors were designed at different wavelengths showing high FOM at λ = 450nm ranging from 500 RIU -1 up to 1231 RIU -1 with L MZI =500 µm. Different MZI configurations were also studied and compared. Finally, edge coupling from the fiber to the sensor was designed, showing insertion loss (IL) at λ = 450nm of 4.1 dB for the design with FOM = 500 RIU -1 . The obtained coupling efficiencies are higher than recently proposed fiber couplers.

Possible SARS-coronavirus 2 inhibitor revealed by simulated molecular docking to viral main protease and host toll-like receptor

Aim: SARS-coronavirus 2 main protease (Mpro) and host toll-like receptors (TLRs) were targeted to screen potential inhibitors among traditional antiviral medicinal plants. Materials & methods: LeDock software was adopted to determine the binding energy between candidate molecules and selected protein pockets. Enrichment analyses were applied to illustrate potential pharmacology networks of active molecules. Results: The citrus flavonoid rutin was identified to fit snugly into the Mpro substrate-binding pocket and to present a strong interaction with TLRs TLR2, TLR6 and TLR7. One-carbon metabolic process and nitrogen metabolism ranked high as potential targets toward rutin. Conclusion: Rutin may influence viral functional protein assembly and host inflammatory suppression. Its affinity for Mpro and TLRs render rutin a potential novel therapeutic anti-coronavirus strategy.

Role of Professionalism in the Policy Response to COVID-19: Does a Public Health or Medical Background Help? (preprint)

Less than 5 percent of Chinese cities had top-ranked officials with public health or medical backgrounds (PHMBGs). Does professionalism improve their response to a public crisis like the COVID-19 pandemic? Collecting résumés of government and Party officials in almost all prefectural Chinese cities, and matching with other data sources, including weather conditions, city characteristics, COVID-19-related policies, and health outcomes, we demonstrate that cities 15 whose top officials had PHMBGs witnessed significantly lower infection rates, and often lower death rates, than cities whose top officials lacked such backgrounds. Mechanism testing suggests that the effects were at least partially explained by more rapid lockdown or community closure. Our findings offer insights into better preparation for future epidemics via improving leadership team composition, particularly recruiting major officials with PHMBGs.

Role of Professionalism in the Policy Response to COVID-19: Does a Public Health or Medical Background Help? (preprint)

Less than 5 percent of Chinese cities had top-ranked officials with public health or medical backgrounds (PHMBGs). Does professionalism improve their response to a public crisis like the COVID-19 pandemic? Collecting resumes of government and Party officials in almost all prefectural Chinese cities, and matching with other data sources, including weather conditions, city characteristics, COVID-19-related policies, and health outcomes, we demonstrate that cities 15 whose top officials had PHMBGs witnessed significantly lower infection rates, and often lower death rates, than cities whose top officials lacked such backgrounds. Mechanism testing suggests that the effects were at least partially explained by more rapid lockdown or community closure. Our findings offer insights into better preparation for future epidemics via improving leadership team composition, particularly recruiting major officials with PHMBGs.

Development and Clinical Evaluation of a Rapid Antibody Lateral Flow Assay for the Diagnosis of SARS-CoV-2 Infection (preprint)

Background: The novel coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has quickly spread worldwide since its outbreak in December 2019. One of the primary measures for controlling the spread of SARS-CoV-2 infection is an accurate assay for its diagnosis. SARS-CoV-2 real-time PCR kits suffer from some limitations, including false-negative results in the clinic. Therefore, there is an urgent need for the development of a rapid antibody test kit for COVID-19 diagnosis.Methods: The nuclear capsid protein (N) and spike protein 1 (S1) fragments of SARS-CoV-2 were expressed in Escherichia coli, and rapid antibody-based tests for the diagnosis of SARS-CoV-2 infection were developed and compared. To evaluate their clinical applications, the serum from COVID-19 patients, suspected COVID-19 patients, recovering COVID-19 patients, patients with general fever or pulmonary infection, doctors and nurses who worked at the fever clinic, and health professionals was analyzed by the rapid antibody test kits. The serum from patients infected with Mycoplasma pneumoniae and patients with respiratory tract infection was further analyzed to test its cross-reactivity with other respiratory pathogens.Results: A 47 kDa N protein and 67 kDa S1 fragment of SARS-CoV-2 were successfully expressed, purified, and renatured. The rapid antibody test with recombinant N protein showed higher sensitivity and specificity than the rapid IgM antibody test with recombinant S1 protein. Clinical evaluation showed that the rapid antibody test kit with recombinant N protein had 88.56% sensitivity and 97.42% specificity for COVID-19 patients, 53.48% positive rate for suspected COVID-19 patients, 57.14% positive rate for recovering COVID-19 patients, and 3.20%-3.27% cross-reactivity with other respiratory pathogens. The sensitivity of the kit did not significantly differ in COVID-19 patients with different disease courses (p < 0.01).Conclusion: The rapid antibody test kit with recombinant N protein has high specificity and sensitivity, and can be used for the diagnosis of SARS-CoV-2 infection combined with RT-PCR.

Clinical course and risk factors for mortality of COVID-19 patients with pre-existing cirrhosis: A multicenter cohort study (preprint)

Background: Patients with pre-existing cirrhosis are considered at increased risk of severe coronavirus disease 2019 (COVID-19) but the clinical course in these patients has not yet been reported. This study aimed to provide a detailed report of the clinical characteristics and outcomes among COVID-19 patients with pre-existing cirrhosis. Methods: In this retrospective, multicenter cohort study, we consecutively included all adult inpatients with laboratory-confirmed COVID-19 and pre-existing cirrhosis that had been discharged or had died by 24 March 2020 from 16 designated hospitals in China. Demographic, clinical, laboratory and radiographic findings on admission, treatment, complications during hospitalization and clinical outcomes were collected and compared between survivors and non-survivors. Findings: Twenty-one patients were included in this study, of whom 16 were cured and 5 died in hospital. Seventeen patients had compensated cirrhosis and hepatitis B virus infection was the most common etiology. Lymphocyte and platelet counts were lower, and direct bilirubin levels were higher in patients who died than those who survived (p= 0.040, 0.032, and 0.006, respectively). Acute respiratory distress syndrome and secondary infection were both the most frequently observed complications. Only one patient developed acute on chronic liver failure. Of the 5 non-survivors, all patients developed acute respiratory distress syndrome and 2 patients progressed to multiple organ dysfunction syndrome. Interpretation: Lower lymphocyte and platelet counts, and higher direct bilirubin level might represent poor prognostic indicators in SARS-CoV-2-infected patients with pre-existing cirrhosis.

Social distance and SARS memory: impact on the public awareness of 2019 novel coronavirus (COVID-19) outbreak (preprint)

This study examines publicly available online search data in China to investigate the spread of public awareness of the 2019 novel coronavirus (COVID-19) outbreak. We found that cities that suffered from SARS and have greater migration ties to the epicentre, Wuhan, had earlier, stronger and more durable public awareness of the outbreak. Our data indicate that forty-eight such cities developed awareness up to 19 days earlier than 255 comparable cities, giving them an opportunity to better prepare. This study suggests that it is important to consider memory of prior catastrophic events as they will influence the public response to emerging threats.

Clinical characteristics of 25 death cases infected with COVID-19 pneumonia: a retrospective review of medical records in a single medical center, Wuhan, China (preprint)

Summary Background The pneumonia caused by the 2019 novel coronavirus (SARS-CoV-2) is a highly infectious disease, which was occurred in Wuhan, Hubei Province, China in December 2019. As of February 13, 2020, a total of 59883 cases of COVID-19 in China have been confirmed and 1368 patients have died from the disease. However, the clinical characteristics of the dyed patients were still not clearly clarified. This study aims to summarize the clinical characteristics of death cases with COVID-19 and to identify critically ill patients of COVID-19 early and reduce their mortality. Methods The clinical records, laboratory findings and radiologic assessments included chest X-ray or computed tomography were extracted from electronic medical records of 25 died patients with COVID-19 in Renmin Hospital of Wuhan University from Jan 14 to Feb 13, 2020. Two experienced clinicians reviewed and abstracted the data. Findings The mean age of the dead was 71.48 years, the average course of the disease was 10.56 days, all patients eventually died of respiratory failure. All of those who died had underlying diseases, the most common of which was hypertension (16/25, 64%), followed by diabetes (10/25, 40%), heart diseases (8/25, 32%), kidney diseases (5/25, 20%), cerebral infarction (4/25, 16%), chronic obstructive pulmonary disease (COPD, 2/25, 8%), malignant tumors (2/25, 8%) and acute pancreatitis (1/25, 4%). The most common organ damage outside the lungs was the heart, followed by kidney and liver. In the patients' last examination before death, white blood cell and neutrophil counts were elevated in 17 patients (17/25, 68%) and 18 patients (18/25, 72%), lymphocyte counts were decreased in 22 patients (22/25, 88%). Most patients' PCT, CRP and SAA levels were elevated, the percentages were 90.5% (19/21), 85% (19/20) and 100% (21/21) respectively. The levels of the last test of neutrophils (15/16, 93.8%), PCT (11/11, 100%), CRP (11/13, 84.6%), cTnI (8/9, 88.9%), D-Dimer (11/12, 91.6%) and LDH (9/9, 100%) were increased as compared to the first test, while the levels of lymphocytes were decreased (14/16, 87.5%). Interpretation The age and underlying diseases (hypertension, diabetes, etc.) were the most important risk factors for death of COVID-19 pneumonia. Bacterial infections may play an important role in promoting the death of patients. Malnutrition was common to severe patients. Multiple organ dysfunction can be observed, the most common organ damage was lung, followed by heart, kidney and liver. The rising of neutrophils, SAA, PCT, CRP, cTnI, D-Dimer and LDH levels can be used as indicators of disease progression, as well as the decline of lymphocytes counts.

SARS-CoV-2 infection does not significantly cause acute renal injury: an analysis of 116 hospitalized patients with COVID-19 in a single hospital, Wuhan, China (preprint)

Summary Background Whether the patients with COVID-19 infected by SARS-CoV-2 would commonly develop acute renal function damage is a problem worthy of clinical attention. This study aimed to explore the effects of SARS-CoV-2 infection on renal function through analyzing the clinical data of 116 hospitalized COVID-19-confirmed patients. Methods 116 hospitalized COVID-19-confirmed patients enrolled in this study were hospitalized in the Department of Infectious Diseases, Renmin Hospital of Wuhan University from January 14 to February 13, 2020. The recorded information includes demographic data, medical history, contact history, potential comorbidities, symptoms, signs, laboratory test results, chest computer tomography (CT) scans, and treatment measures. SARS-CoV-2 RNA in 53 urine sediments of enrolled patients was examined by real-time RT-PCR. Findings 12 (10.8%) and 8 (7.2%) patients showed mild elevation of blood urea nitrogen or creatinine, and trace or 1+ albuminuria respectively in 111 COVID-19-confirmed patients without basic kidney disease. In addition, 5 patients with chronic renal failure (CRF) were undergone regular continuous renal replacement therapy (CRRT) were confirmed infection of SARS-CoV-2, and diagnosed as COVID-19. Beside the treatment of COVID-19, CRRT was also applied three times weekly. The course of treatment, the renal function indicators showed stable, without exacerbation of CRF, and pulmonary inflammation was gradually absorbed. All 5 patients with CRF were survived. Moreover, SARS-CoV-2 RNA in urine sediments was positive only in 3 patients from 48 cases without renal illness before, and one patient had a positive for SARS-CoV-2 ORF 1ab from 5 cases with CRF. Interpretation Acute renal impairment was uncommon in COVID-19. SARS-CoV-2 infection does not significantly cause obvious acute renal injury, or aggravate CRF in the COVID-19 patients.