Increased circulating fibronectin, depletion of natural IgM and heightened EBV, HSV-1 reactivation in ME/CFS and long COVID (preprint)

Myalgic Encephalomyelitis/ Chronic Fatigue syndrome (ME/CFS) is a complex, debilitating, long-term illness without a diagnostic biomarker. ME/CFS patients share overlapping symptoms with long COVID patients, an observation which has strengthened the infectious origin hypothesis of ME/CFS. However, the exact sequence of events leading to disease development is largely unknown for both clinical conditions. Here we show antibody response to herpesvirus dUTPases, particularly to that of Epstein-Barr virus (EBV) and HSV-1, increased circulating fibronectin (FN1) levels in serum and depletion of natural IgM against fibronectin ((n)IgM-FN1) are common factors for both severe ME/CFS and long COVID. We provide evidence for herpesvirus dUTPases-mediated alterations in host cell cytoskeleton, mitochondrial dysfunction and OXPHOS. Our data show altered active immune complexes, immunoglobulin-mediated mitochondrial fragmentation as well as adaptive IgM production in ME/CFS patients. Our findings provide mechanistic insight into both ME/CFS and long COVID development. Finding of increased circulating FN1 and depletion of (n)IgM-FN1 as a biomarker for the severity of both ME/CFS and long COVID has an immediate implication in diagnostics and development of treatment modalities.

Guest Editorial Introduction to the Special Issue on Intelligent Transportation Systems in Epidemic Areas

The COVID-19 pandemic has posed significant challenges to transportation systems in various aspects, such as transferring patients and medical resources, enforcing physical distancing in public transportation, and controlling virus transmission through transportation networks. To address these challenges, a variety of artificial intelligence technologies, such as autonomous driving, big data analytics, intelligent vehicle routing and scheduling, and intelligent traffic control, have been employed in the design of intelligent transportation systems. This Special Issue provides a forum for researchers and practitioners to present the most recent advances in presenting and applying intelligent technologies to promote transportation systems in large-scale epidemics.

Toward masked face recognition: An effective facial feature extraction and refinement model in multiple scenes

With the impact of the COVID‐19 epidemic, the demand for masked face recognition technology has increased. In the process of masked face recognition, some problems such as less feature information and poor robustness to the environment are obvious. The current masked face recognition model is not quantified enough for feature extraction, there are large errors for faces with high similarity, and the categories cannot be clustered during the detection process, resulting in poor classification of masks, which cannot be well adapted to changes in multiple environments. To solve current problems, this paper designs a new masked face recognition model, taking improved Single Shot Multibox Detector (SSD) model as a face detector, and replaces the input layer VGG16 of SSD with Deep Residual Network (ResNet) to increase the receptive field. In order to better adapt to the network, we adjust the convolution kernel size of ResNet. In addition, we fine‐tune the Xception network by designing a new fully connected layer, and reduce the training cycle. The weights of the three input samples including anchor, positive and negative are shared and clustered together with triplet network to improve recognition accuracy. Meanwhile, this paper adjusts alpha parameter in triplet loss. A higher value of alpha can improve the accuracy of model recognition. We further adopt a small trick to classify and predict face feature vectors using multi‐layer perceptron (MLP), and a total of 60 neural nodes are set in the three neural layers of MLP to get higher classification accuracy. Moreover, three datasets of MFDD, RMFRD and SMFRD are fused to obtain high‐quality images in different scenes, and we also add data augmentation and face alignment methods for processing, effectively reducing the interference of the external environment in the process of model recognition. According to the experimental results, the accuracy of masked face recognition reaches 98.3%, it achieves better results compared with other mainstream models. In addition, the hyper‐parameters tuning experiment is carried out to improve the utilization of computing resources, which shows better results than the indicators of different networks. [ FROM AUTHOR]

The Influences of COVID-19 on Patients With Chronic Kidney Disease: A Multicenter Cross-Sectional Study

Background: The outbreak of coronavirus disease 2019 (COVID-19) has attracted global attention. During the lockdown period of COVID-19, follow-up of many patients with chronic disease had been interrupted, which brought severe challenges to better management of their disease. This study aimed at exploring the change of illness, daily life, and psychological responses during the COVID-19 pandemic among chronic kidney disease (CKD) patients. Methods: A total of 612 patients were enrolled in this study;282 patients were categorized into the CKD stage 1–2 group and 330 patients were categorized into the CKD stage 3–5 group. Among two groups, 168 (27.5%) and 177 (28.9%) patients were female with a median age of 42 and 45, respectively. The study was conducted by collecting the questionnaires in five nephrology centers. The questionnaire consisted of assessment of anxiety by using the Self-Rating Anxiety Scale and the influences of COVID-19, which included basic demographic data, the influences of COVID-19 on illness and daily life, as well as the patients' psychological responses during the epidemic. Results: A total of 612 patients were included and divided into two groups according to eGFR. Ninety-six patients (34%) in the CKD stage 1–2 group and 141 patients (42.7%) in the CKD stage 3–5 group had reduced their follow-up frequency (p = 0.031). More patients with CKD stages 1–2 consulted online (25.9%), p = 0.005. Besides, patients in the CKD stage 3–5 group tended to be more anxious about follow-up (p = 0.002), fearful of being infected with COVID-19 (p = 0.009), and more likely to feel symptoms getting worse (p = 0.006). The standard scores of SAS were 48.58 ± 7.082 and 51.19 ± 5.944 in the CKD stage 1–2 group and the CKD stage 3–5 group, respectively (p < 0.001). There were significant differences in the severity of anxiety (p = 0.004). Conclusion: COVID-19 had a greater impact on patients with CKD stages 3–5 than those with stages 1–2 in terms of illness, daily life, and psychological disorder. Patients with CKD stages 3–5 were more anxious during the COVID-19 pandemic.

Analysis and countermeasures on imported aquatic products of China in 2020

In recent years, the import of aquatic products in China has maintained a rapid development. The outbreak of the novel coronavirus pneumonia in the world in 2020 has brought a great impact on the import of aquatic products. This paper analyzed the global consumption and trade of aquatic products, studied China's imported products in 2020 from the aspects of import types, trading countries and trade modes, and analyzed that China's imported products had the characteristics of high quality and low price, large market potential, obvious decline in processing trade in the second half of the year affected by the new crown, and from the aspects of blocked transportation, decline in global output under the influence of public opinion, consumers' consumption had decreased, restrictive measures had been taken in some regions, corporate profits had been declining, the advantages of processing trade were no longer available, and the ability to cope with market changes was poor. Finally, we would conduct in-depth research on the reasons for the decline of China's imported aquatic products from the aspects of transmitting responsibility pressure to key national competent departments, strengthening the inspection and quarantine supervision of imported aquatic products strengthen self construction, provided technical support and guarantee, gave full play to the role of industry associations, expanded the import of high-quality aquatic products, promoted the increase of domestic aquaculture production, guided enterprises to explore the domestic market and make up for market vacancies, so as to provide some reference for meeting the people's good life needs and stabilizing market supply.

Intellectual property protection and high quality development of Radix Glycyrrhizae for treatment of COVID-19

Radix Glycyrrhizae is the dominant native medicinal material variety in the north and northwestern medicinal materials producing areas. It is a main Chinese medicine of effective TCM drugs and formulas for the treatment of new coronavirus disease(COVID-19). This paper introduces the medicinal value of Radix Glycyrrhizae, involving the labeling, cultural heritage, and creative intellectual property rights of the Chinese medicinal materials, analyzes the poverty-stricken areas that are ecologically suitable for Radix Glycyrrhizae cultivation, and the superior counties and production bases of the Chinese medicinal materials. Besides, mainly from the aspects of perfect intellectual property rights, the establishment of authentic medicinal material production bases, and the construction of quality control systems, etc., it discusses the rural revitalization strategy and the development strategy of traditional Chinese medicine(TCM), agricultural intellectual property protection and high-quality development strategy of Radix Glycyrrhizae.

Impact of the COVID-19 Pandemic on Willingness to Adopt Healthy Dietary Habits in China (preprint)

Background: To investigate impact of the 2019 novel coronavirus disease (COVID-19) pandemic on willingness to adopt healthy dietary habits in China.  Methods: A survey was carried out, and subjective perception of impact due to COVID-19 and willingness to change dietary habits were obtained. Results: A total of 22,459 subjects were derived from China, with an average age of 27.9±7.8 years old. Of them, the mean score of willingness to adopt healthy dietary habits was 2.2 (ranges from -9 to 9). Multivariate regression analysis showed that the impact of the COVID-19 pandemic (epidemic concern, impact of psychology, impact of work or study) are associated with a higher score of willingness to adopt healthy dietary habits among female, the older, on-medical worker, and individuals married or with higher education level, normal BMI. Conclusions: There was a positive improvement to a proper diet, so the changing features of diets should be considered in nutritional interventions for maintaining health, and prevention and control COVID-19 during the pandemic period.

Clinical efficacy of corticosteroids in the early stage of worsening of COVID-19 pneumonia (preprint)

Background: The World Health Organization (WHO) recommends using corticosteroids in patients with severe coronavirus disease 2019 (COVID-19) and acute respiratory distress syndrome (ARDS), and a large randomized controlled clinical trial in the UK found that dexamethasone was effective in reducing the number of deaths in patients with severe COVID-19.Case presentation: Herein, we described a case of COVID-19 with the clinical characteristics of the mild-symptomatic stage deteriorating to a critically ill state, who showed dramatic improvement with corticosteroids in the early stage of worsening of COVID-19 pneumonia.Discussion: This article further discusses the most suitable timing and dosage of corticosteroid to maximize its effect during the worsening of COVID-19 pneumonia.Learning points:• One of the main pathophysiological hypotheses for severe COVID-19 pneumonia is related to cytokine storm and viral load.• The clinical factors should be considered as the initial sign of a cytokine storm, and corticosteroid therapy may be useful in these patients. 

The Architecture of Inactivated SARS-CoV-2 with Postfusion Spikes Revealed by CryoEM and CryoET (preprint)

The outbreak of SARS-CoV-2 in December 2019, led to the ongoing global pandemic of coronavirus disease 2019 (COVID‑19), which has claimed more than a half million lives in a few months. Enormous efforts are being made in developing vaccines and therapeutic treatment to fight against COVID-19. Inactivated SARS-CoV-2 viruses are currently used as vaccine candidates; therefore, it is important to understand the architecture of SARS-CoV-2. We have propagated and purified a clinical strain of SARS-CoV-2 and genetically and structurally characterized β-propiolactone inactivated viruses. We observed that the virus particles are roughly spherical or moderately pleiomorphic. Although a small fraction of prefusion spikes are observed, the majority of viral spikes appear nail-shaped resembling a postfusion state, where S1 protein of the spike has disassociated. Cryo-electron tomography and subtomogram averaging of these spikes yielded a density map which closely matches the overall structure of SARS-CoV S2 spike and their corresponding glycosylation sites. Our findings have major implications in SARS-CoV-2 vaccine design owing to the critical importance of prefusion immunogens.Funding: This work was supported by the Science and Technology Innovation Committee of Shenzhen Municipality(202002073000002), the National Institutes of Health grant P50AI150481 (P.Z.), the UK Wellcome Trust Investigator Award 206422/Z/17/Z(P.Z.), and the UK Biotechnology and Biological Sciences Research Council grant BB/S003339/1 (P.Z.). Conflict of Interest: The authors declare no competing financial or non-financial interests. Ethical Approval: The research received approval from the Research Ethics Committee of Shenzhen Third People's Hospital, China (approval number: 2020-038). The Research Ethics Committee waived the requirement informed consent before the study started because of the urgent need to collect epidemiological and clinical data. We analyzed the data anonymously.

Investigation into Quality of Life and Psychological Status of Different Populations during COVID-19 : A study concerning Surrounding Areas of Wuhan (preprint)

Objective To investigate different populations' quality of life and psychological status in surrounding areas of Wuhan during COVID-19 pandemic. Methods The data of 248 residents living in Anhui from February 4 to 6 of 2020 were collected through network survey including age, gender, occupation, the World Health Organization Quality of Life measurement Scale short form (World Health Organization Quality of Life instrument - brief, WHOQOL BREF), Zung Self rating Anxiety Scale (Self- rating Anxiety Scale, SAS and Zung Self-Rating Depression Scale (SDS). Those surveyed, divided into two groups: medical staff (129 cases) and non-medical staff (119 cases), were made statistic analysis according to the factors mentioned above. Results The WHOQOL-BREF of medical staff in this region was lower than that of non-medical staff in the fields of physiology, psychology, social relations and environment, among whom female medical staff scored significantly lower than that of male medical staff in four fields. There was no significant statistical difference in SAS and SDS scores between the two groups, and gender had no significant influence on SAS and SDS scores of medical staff. Conclusion During the COVID-19 pandemic, medical staff enjoyed a lower quality of life of in surrounding areas of Wuhan than that of non-medical staff, and female medical staff even lower, which should arouse social concern.

Self-Reported Taste and Smell Disorders in Patients with COVID-19: Distinct Features in China (preprint)

Background: Last December 2019, a cluster of viral pneumonia cases identified as coronavirus disease 2019 (COVID-19), was reported in Wuhan, China. We aimed to explore the frequencies of nasal symptoms in patients with COVID-19, including loss of smell and taste, as well as their presentation as the first symptom of the disease and their association with the severity of COVID-19.Methods: In this retrospective study, 1,206 laboratory-confirmed COVID-19 patients were included and followed-up by telephone call one month after discharged from Tongji Hospital, Wuhan. Demographic data, laboratory values, comorbidities, symptoms, and numerical rating scale scores (0-10) of nasal symptoms were extracted from the hospital medical records, and confirmed or reevaluated by the telephone follow-up. Results: From COVID-19 patients (N = 1,172) completing follow-up, 199 (17%) subjects had severe COVID-19 and 342 (29.2%) reported nasal symptoms. The most common nasal symptom was loss of taste (20.6%, median score = 6), while 11.4% had loss of smell (median score = 5). The incidence of nasal symptom including loss of smell and loss of taste as the first onset symptom was <1% in COVID-19 patients. Loss of smell or taste scores showed no correlation with the scores of other nasal symptoms. Loss of taste scores, but not loss of smell scores, were significantly increased in severe vs. non-severe COVID-19 patients. Interleukin (IL)-6 and lactose dehydrogenase (LDH) serum levels positively correlated with loss of taste scores. About 80% of COVID-19 patients recovered from smell and taste dysfunction in 2 weeks.Conclusions: In the Wuhan COVID-19 cohort, only 1 out of 10 hospital admitted patients had loss of smell while 1 out 5 reported loss of taste which was associated to severity of COVID-19. Most patients recovered smell and taste dysfunctions in 2 weeks.

Development and External Evaluation of Predictions Models for Mortality of COVID-19 Patients using Machine Learning Method (preprint)

Background To develop and evaluate the prognostic machine-learning model for mortality in patients with coronavirus disease 2019 (COVID-19).Methods Clinical data of confirmed COVID-19 were retrospectively collected from Wuhan between 18th January and 29th March 2020. Gradient Boosting Decision Tree (GBDT), logistic regression (LR) model, and simplified LR with selected 5 features (LR-5) model were built to predict the mortality of COVID-19. 5-fold area under curve (AUC), accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated and compared between models.Results A total of 2,924 patients were included in the final analysis, 257(8.8%) of whom died during hospitalization and 2,667 (91.2%) survived. There were 21(0.7%) mild cases, 2,051(70.1%) moderate case, 779(26.6%) severe cases, and 73(2.5%) critically severe cases of COVID-19 on admission. The overall 5-fold AUC was observed highest in GBDT model (0.941), followed by LR (0.928) and LR-5 (0.913). The diagnostic accuracy were 0.889 in GBDT, 0.868 in LR and 0.887 in LR-5. GBDT model also showed the highest sensitivity (0.899) and speciality (0.889). The NPV of all three models exceeded 97%, while the PPV were relatively low in all models, 0.381 for LR, 0.402 for LR-5 and 0.432 for GBDT. In subgroups analysis with severe cases only, GBDT model also performed the best with a accuracy of 0.799 and 5-fold AUC (0.918).Conclusion The finding revealed that mortality prediction performance of the GBDT was superior to the LR models in confirmed cases of COVID-19, regardless of disease severity.

Self-reported taste and smell disorders in patients with COVID-19: distinct features in China (preprint)

ObjectivesWe aimed to explore the frequencies of nasal symptoms in patients with COVID-19, including loss of smell and taste, as well as their presentation as the first symptom of the disease and their association with the severity of COVID-19. MethodsIn this retrospective study, 1,206 laboratory-confirmed COVID-19 patients were included and followed-up by telephone call one month after discharged from Tongji Hospital, Wuhan. Demographic data, laboratory values, comorbidities, symptoms, and numerical rating scale scores (0-10) of nasal symptoms were extracted from the hospital medical records, and confirmed or reevaluated by the telephone follow-up. ResultsFrom COVID-19 patients (N = 1,172) completing follow-up, 199 (17%) subjects had severe COVID-19 and 342 (29.2%) reported nasal symptoms. The most common nasal symptom was loss of taste (20.6%, median score = 6), while 11.4% had loss of smell (median score = 5). The incidence of nasal symptom including loss of smell and loss of taste as the first onset symptom was <1% in COVID-19 patients. Loss of smell or taste scores showed no correlation with the scores of other nasal symptoms. Loss of taste scores, but not loss of smell scores, were significantly increased in severe vs. non-severe COVID-19 patients. Interleukin (IL)-6 and lactose dehydrogenase (LDH) serum levels positively correlated with loss of taste scores. About 80% of COVID-19 patients recovered from smell and taste dysfunction in 2 weeks. ConclusionIn the Wuhan COVID-19 cohort, only 1 out of 10 hospital admitted patients had loss of smell while 1 out 5 reported loss of taste which was associated to severity of COVID-19. Most patients recovered smell and taste dysfunctions in 2 weeks.

Impact of the COVID-19 pandemic on willingness to adopt healthy dietary habits in China (preprint)

Background: To investigate impact of the 2019 novel coronavirus disease (COVID-19) pandemic on willingness to adopt healthy dietary habits in China.Methods: A survey was carried out, and subjective perception of impact due to COVID-19 and willingness to change dietary habits were obtained.Results: A total of 22,459 subjects were derived from China, with an average age of 27.9±7.8 years old. Of them, the mean score of willingness to adopt healthy dietary habits was 2.2 (ranges from -9 to 9). Multivariate regression analysis showed that the impact of the COVID-19 pandemic (epidemic concern, impact of psychology, impact of work or study) are associated with a higher score of willingness to adopt healthy dietary habits among female, the older, on-medical worker, and individuals married or with higher education level, normal BMI.Conclusions: There was a positive improvement to a proper diet, so the changing features of diets should be considered in nutritional interventions for maintaining health, and prevention and control COVID-19 during the pandemic period.

COVID-19 in Wuhan: Sociodemographic Characteristics and Hospital Support Measures Associated with the Immediate Psychological Impact on Healthcare Workers (preprint)

Background: The outbreak of COVID-19 has laid unprecedented threats and challenges to health workers (HWs) in Wuhan, China. We aimed to assess the sociodemographic characteristics and hospital support measures associated with the immediate psychological impact on HWs at Tongji Hospital in Wuhan during COVID-19 outbreak. Methods: We conducted a single-center, cross-sectional survey of HWs via online questionnaires between February 8th and 10th, 2020. We evaluated stress, depression and anxiety by IES-R, PHQ-9, and GAD-7, respectively. We also designed a questionnaire to assess the perceptions of threat of COVID-19, and the effect of the hospital’s support measures. Multivariate logistic regression was used to identify predictors of acute stress, depression, and anxiety. Findings: We received 5062 completed questionnaires (response rate, 77.1%). 29.8%, 13.5% and 4.1% HWs reported stress, depression and anxiety symptoms. Women (odds ratio[OR], 1.31; 95%CI, 0.47-0.97; p=0.032), years of working >10 years (OR, 2.02; 95%CI, 1.47-2.79; p<0.001), concomitant chronic diseases (OR, 1.51; 95%CI, 1.27-1.80; p<0.001), history of mental disorders (OR, 3.27; 95%CI, 1.77-6.05; p<0.001), and family members or relatives confirmed or suspected (OR, 1.23; 95%CI, 1.02-1.48; p=0.03) were risk factors for stress, whereas hospital-based and department-based care (OR, 0.76; 95%CI, 0.60-0.97; p=0.024) and full coverage of all departments for avoiding nosocomial infection(OR, 0.69; 95%CI, 0.53-0.89; p=0.004) were protective factors. Interpretation: Women and those who have more than 10 years of working, concomitant chronic diseases, history of mental disorders, and family members or relatives confirmed or suspected are susceptible to stress, depression and anxiety among HWs during the epidemic. The hospital’s support measures could be helpful.Funding Statement: Supported by the grants 2017YFC1310000 from the National Key Research and Development Program of the Ministry of Science and Technology of China and 2018KFYXMPT015 from Research and Development Office of Huazhong University of Science and Technology. Declaration of Interests: The authors declare that they have no competing interests.Ethics Approval Statement: The study was approved by the institutional ethics board of Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology (ID: TJ-C20200129). The data analyses were done on unidentified datasets.

The corticosteroid treatment and response of patients with COVID-19 in Hubei, China: a retrospective, cohort study (preprint)

Background Since December 2019, COVID-19 has emerged in Wuhan, China and spread globally. As of now, there is still no explicit therapeutic regimen and the use of corticosteroid is also controversial. We aimed to explore the effectiveness of corticosteroid and provide evidence for the rational use of corticosteroid in different patients with COVID-19.Methods In this multi-centered, retrospective study, we extracted the clinical data of 649 cases with COVID-19 with definite outcome (discharged or dead) from 14 hospitals in Hubei province, and evaluated the clinical characteristics, treatment regimens, and their association with outcomes.Results Ninety-five of 649 patients had died. Older male patients with comorbidities had an increased risk of death and more obvious abnormalities in clinical indicators. Corticosteroid, γ-globulin treatment and invasive ventilation were more frequently used in non-survivors. Survivors with corticosteroid treatment had a prolonged hospitalization. The median time duration for temperature restore for non-survivors after corticosteroid treatment was longer than that of both survivors. The lymphocyte count on admission was lower in the patients treated with corticosteroids compared to those without corticosteroid treatment. Lymphocyte count recovered significantly after corticosteroid treatment in survivors, but not in non-survivors.Conclusions The responses to corticosteroid treatment were different in COVID-19 patients with different outcomes. The surviving patients with relatively lower lymphocyte count were more likely to be given corticosteroids. For non-survivors, the lymphocyte count was too low and the effect of corticosteroids was poor. Survivors under corticosteroid treatment had a prolonged hospitalization, but had a recovery of lymphocytes. The recovery of lymphocyte count and temperature after corticosteroid treatment may be used as predictors of prognosis of patients with COVID-19.

Clinical Characteristics of 20,662 Patients with COVID-19 in mainland China: A Systemic Review and Meta-analysis (preprint)

Coronavirus disease 2019 (COVID-19) is a global pandemic and has been widely reported; however, a comprehensive systemic review and meta-analysis has not been conducted. We systematically investigated the clinical characteristics of COVID-19 in mainland China to guide diagnosis and treatment. We searched the PubMed, Embase, Scopus, Web of Science, Cochrane Library, bioRxiv, medRxiv, and SSRN databases for studies related to COVID-19 published or preprinted in English or Chinese from January 1 to March 15, 2020. Clinical studies on COVID-19 performed in mainland China were included. We collected primary outcomes including signs and symptoms, chest CT imaging, laboratory tests, and treatments. Study selection, data extraction, and risk of bias assessment were performed by two independent reviewers. Qualitative and quantitative synthesis was conducted, and random-effects models were applied to pooled estimates. This study is registered with PROSPERO (number CRD42020171606). Of the 3624 records identified, 147 studies (20,662 patients) were analyzed. The mean age of patients with COVID-19 was 49.40 years, 53.45% were male, and 38.52% had at least one comorbidity. Fever and cough were the most common symptoms, followed by fatigue, expectoration, and shortness of breath. Most patients with COVID-19 had abnormal chest CT findings with ground glass opacity (70.70%) or consolidation (29.91%). Laboratory findings shown lymphopenia, increased lactate dehydrogenase, increased infection-related indicators, and fibrinolytic hyperactivity. Antiviral therapy, antibiotic therapy, and corticosteroids were administered to 89.75%, 79.13%, and 35.64% of patients, respectively. Most clinical characteristics of COVID-19 are non-specific. Patients with suspected should be evaluated by virological assays and clinically treated.

Suggestions for prevention of 2019 novel coronavirus infection in otolaryngology head and neck surgery medical staff / 中华耳鼻咽喉头颈外科杂志

@#The epidemic of the 2019 Novel Coronavirus (2019-nCoV) infection has presented as a grim and complex situation recently. More than 11,000 cases of 2019-nCoV infection has been confirmed in China until February 1st 2020, which are causing great impact to economy and society, and seriously interfering with ordinary medical practice of otolaryngology and head and neck surgery. This advice guideline discusses the medical protection measures required in the outpatient clinic as well as in operation ward in otolaryngology head and neck department, which aims to protect medical staff from 2019-nCoV infection.

Viral Architecture of SARS-CoV-2 with Post-Fusion Spike Revealed by Cryo-EM (preprint)

Since December 2019, the outbreak of Coronavirus Disease 2019 (COVID-19) spread from Wuhan, China to the world, it has caused more than 87,000 diagnosed cases and more than 3,000 deaths globally. To fight against COVID-19, we carried out research for the near native SARS-CoV-2 and report here our preliminary results obtained. The pathogen of the COVID-19, the native SARS-CoV-2, was isolated, amplified and purified in a BSL-3 laboratory. The whole viral architecture of SARS-CoV-2 was examined by transmission electron microscopy (both negative staining and cryo-EM). We observed that the virion particles are roughly spherical or moderately pleiomorphic. Spikes have nail-like shape towards outside with a long body embedded in the envelope. The morphology of virion observed in our result indicates that the S protein of SARS-CoV-2 is in post-fusion state, with S1 disassociated. This state revealed by cryo-EM first time could provide an important information for the identification and relevant clinical research of this new coronavirus.

COVID-19 in Wuhan: Immediate Psychological Impact on 5062 Health Workers (preprint)

BACKGROUND: The outbreak of COVID-19 has laid unprecedented psychological stress on health workers (HWs). We aimed to assess the immediate psychological impact on HWs at Tongji Hospital in Wuhan, China. METHODS: We conducted a single-center, cross-sectional survey of HWs via online questionnaires between February 8th and 10th, 2020. We evaluated stress, depression and anxiety by Impact of Event Scale-Revised (IES-R), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder 7-item (GAD-7), respectively. We also designed a questionnaire to assess the effect of psychological protective measures taken by Tongji Hospital. Multivariate logistic regression was used to identify predictors of acute stress, depression, and anxiety. RESULTS: We received 5062 completed questionnaires (response rate, 77.1 percent). 1509 (29.8 percent), 681 (13.5 percent) and 1218 (24.1 percent) HWs reported stress, depression and anxiety symptoms. Women (hazard ratio[HR], 1.31; P=0.032), years of working> 10 years (HR, 2.02; P<0.001), concomitant chronic diseases (HR, 1.51; P<0.001), history of mental disorders (HR, 3.27; P<0.001), and family members or relatives confirmed or suspected (HR, 1.23; P=0.030) were risk factors for stress, whereas care provided by hospital and department administrators(odds ratio [OR], 0.76; P=0.024) and full coverage of all departments with protective measures (OR, 0.69; P=0.004) were protective factors. CONCLUSIONS: Women and those who have more than 10 years of working, concomitant chronic diseases, history of mental disorders, and family members or relatives confirmed or suspected are susceptible to stress, depression and anxiety among HWs during the COVID-19 pandemic. Psychological protective measures implemented by the hospital could be helpful.