Willingness to practice medicine and related influential factors among medical undergraduates during COVID-19: a cross-sectional study.

BACKGROUND: As the medical undergraduates constitute the future workforce in China, their career preferences hold a significant bearing on the quality of healthcare services, particularly in light of the ongoing COVID-19 pandemic. We aim to understand the current state of the willingness to practice medicine among medical undergraduates and to analyze the related influential factors. METHODS: During the COVID-19 epidemic, we conducted a cross-sectional survey via an online platform from February 15, 2022, to May 31, 2022, to collect participants' demographic information, psychology, and factors influencing their career choices. The general self-efficacy scale (GSES) was used to evaluate medical students' perceptions of their self-efficacy. Futhermore, we conducted multivariate logistic regression analyses to explore the influencing factors of medical undergraduates' willingness to pursure a caree in medicine. RESULTS: A total of 2348 valid questionnaires were included, and 1573 (66.99%) were willing to practice medicine for medical undergraduates after graduation. The mean GESE scores in the willingness group (2.87 ± 0.54) were significantly higher than those of the unwillingness group (2.73 ± 0.49). The multiple logistic regression showed that several factors were positively associated with willingness to practice medicine as a career, including students' GSES score (OR = 1.87), current major, household income, personal ideals (OR = 1.97), family support (OR = 1.44), high income (OR = 1.77), and social respect (OR = 2.19). Compared with those who were very afraid of COVID-19, students who did not express any fear towards the COVID-19 pandemic had a higher preference for choosing the medical profession as a career. Conversely, students thinking of high tension in the doctor-patient relationship, heavy workload, and long training were less likely to choose medical work after graduation. CONCLUSIONS: The study highlights a noteworthy prevalence of medical undergraduates who expressed their willingness to pursue medicine as a career post-graduation. Several factors, including but not limited to current major, household income, psychological factors, personal preferences, and career needs or preferences, were significantly associated with this willingness. Moreover, the impact of the COVID-19 pandemic on medical students' career choices cannot be overlooked.

Efficacy of the neutralizing antibodies after the booster dose on SARS-CoV-2 Omicron variant and a two-year longitudinal antibody study on Wild Type convalescents.

OBJECTIVES: Waning vaccine-induced immunity and emergence of new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants which may lead to immune escape, pose a major threat to the COVID-19 pandemic. Currently, enhanced efficacy of the neutralization antibodies (NAb) produced after the booster dose of vaccinations against the Omicron variant is the main focus of vaccine strategy research. In this study we have analyzed the potency of the NAbs and IgGs produced after the third vaccine dose in patients infected with Omicron variant and wild-type (WT) SARS-CoV-2. METHODS: We enrolled 75 patients with Omicron variant breakthrough infections, and 87 patients with WT infections. We recorded the clinical characteristics and vaccination information of all patients and measured the NAb and anti-S1 (spike protein) + N (nucleocapsid protein) IgG-binding antibodies against SARS-CoV-2 in serum samples of Omicron variant-infected patients at admission, and patients with WT COVID-19 infection from the time of admission and discharge, and one-year to two-years follow-ups. RESULTS: Our results demonstrated higher NAb levels, fewer clinical symptoms, and faster viral shedding in Omicron variant infected patients vaccinated with the booster dose. Hybrid immunity (natural infection plus vaccination) induces higher NAb levels than vaccine-only immunity. NAb and IgG levels decreased significantly at one-year follow-up in WT convalescents with natural infection. The NAb and IgG levels in booster-vaccinated COVID-19 patients were higher than those in two-dose-vaccinated patients. CONCLUSION: Our results suggest that booster vaccinations are required to improve the level of protective NAbs. Moreover, our data provide important evidence for vaccination strategies based on existing vaccines.

Proteomics Investigation of Diverse Serological Patterns in COVID-19.

Serum antibodies IgM and IgG are elevated during Coronavirus Disease 2019 (COVID-19) to defend against viral attacks. Atypical results such as negative and abnormally high antibody expression were frequently observed whereas the underlying molecular mechanisms are elusive. In our cohort of 144 COVID-19 patients, 3.5% were both IgM and IgG negative, whereas 29.2% remained only IgM negative. The remaining patients exhibited positive IgM and IgG expression, with 9.3% of them exhibiting over 20-fold higher titers of IgM than the others at their plateau. IgG titers in all of them were significantly boosted after vaccination in the second year. To investigate the underlying molecular mechanisms, we classed the patients into four groups with diverse serological patterns and analyzed their 2-year clinical indicators. Additionally, we collected 111 serum samples for TMTpro-based longitudinal proteomic profiling and characterized 1494 proteins in total. We found that the continuously negative IgM and IgG expression during COVID-19 were associated with mild inflammatory reactions and high T cell responses. Low levels of serum IgD, inferior complement 1 activation of complement cascades, and insufficient cellular immune responses might collectively lead to compensatory serological responses, causing overexpression of IgM. Serum CD163 was positively correlated with antibody titers during seroconversion. This study suggests that patients with negative serology still developed cellular immunity for viral defense and that high titers of IgM might not be favorable to COVID-19 recovery.

Parameters and Morphological Changes of Erythrocytes and Platelets of COVID-19 Subjects: A Longitudinal Cohort Study.

Purpose: Information about dynamic changes occurring in the parameters and morphology of erythrocytes and platelets during the coronavirus disease 2019 (COVID-19) infection and convalescence is scarce. To explore potential associations between dynamic erythrocyte and platelet parameters, morphological changes, and the course or severity of the disease is essential. Patients and Methods: From January 17th, 2020, to February 20th, 2022, we followed up on 35 patients with non-severe and 11 patients with severe COVID-19 following their discharge. We collected clinical features, dynamic complete blood count (CBC), and peripheral blood smears (PBS) and analyzed parameter and morphological changes of erythrocytes and platelets depending on the course or severity of the disease. The course of the disease included four periods, namely onset (T1), discharge (T2), 1-year follow-up (T3), and 2-year follow-up (T4). Results: Red blood cell (RBC) counts and hemoglobin were the lowest in T2, followed by T1, and lower in T1 and T2 than in T3 and T4. Inversely, the red blood cell distribution width (RDW) was the highest in T2, followed by T1, and higher than in T3 and T4. Compared to non-severe patients, the platelet of severe patients was lower in T1 and T2. In contrast, the mean platelet volume (MPV) and platelet distribution width (PDW) tended to be higher in severe patients. Similarly, anisocytosis was more common in peripheral blood smears at early stages and in severe patients. Finally, large platelets were more common in severe patients. Conclusion: Anisocytosis of erythrocytes and large platelets are found in patients with severe COVID-19, these changes may help primary hospitals to identify patients with a high risk of severe COVID-19 at an early stage.

A case study of HIV/AIDS services from community-based organizations during COVID-19 lockdown in China.

INTRODUCTION: People living with HIV (PLHIV) relied on community-based organizations (CBOs) in accessing HIV care and support during the COVID-19 pandemic in China. However, little is known about the impact of, and challenges faced by Chinese CBOs supporting PLHIV during lockdowns. METHODS: A survey and interview study was conducted among 29 CBOs serving PLHIV in China between November 10 and November 23, 2020. Participants were asked to complete a 20-minute online survey on their routine operations, organizational capacity building, service provided, and challenges during the pandemic. A focus group interview was conducted with CBOs after the survey to gather CBOs' policy recommendations. Survey data analysis was conducted using STATA 17.0 while qualitative data was examined using thematic analysis. RESULTS: HIV-focused CBOs in China serve diverse clients including PLHIV, HIV high-risk groups, and the public. The scope of services provided is broad, ranging from HIV testing to peer support. All CBOs surveyed maintained their services during the pandemic, many by switching to online or hybrid mode. Many CBOs reported adding new clients and services, such as mailing medications. The top challenges faced by CBOs included service reduction due to staff shortage, lack of PPE for staff, and lack of operational funding during COVID-19 lockdowns in 2020. CBOs considered the ability to better network with other CBOs and other sectors (e.g., clinics, governments), a standard emergency response guideline, and ready strategies to help PLHIV build resilience to be critical for future emergency preparation. CONCLUSION: Chinese CBOs serving vulnerable populations affected by HIV/AIDS are instrumental in building resilience in their communities during the COVID-19 pandemic, and they can play significant roles in providing uninterrupted services during emergencies by mobilizing resources, creating new services and operation methods, and utilizing existing networks. Chinese CBOs' experiences, challenges, and their policy recommendations can inform policy makers on how to support future CBO capacity building to bridge service gaps during crises and reduce health inequalities in China and globally.

Longitudinal observation of viral load in patients infected with Omicron variant and its relationship with clinical symptoms.

Objective: In 2022, a new coronavirus variant (Omicron) infection epidemic broke out in Shanghai, China. However, it is unclear whether the duration of this omicron variant is different from that of the prototype strain. Methods: We retrospectively analyzed 157 cases of Omicron variant infection in Taizhou Public Health Center from March 29, 2022, to April 18, 2022, and observed the dynamics of nucleic acid Ct values during the admission and discharge of patients. Clinical and laboratory indicators of these patients were also obtained. Results: Compared to the prototype strain, the Omicron variant showed a broad population susceptibility in infected individuals (regardless of age and presence of underlying disease) and had slight damage to the immune system and renal function; the viral loads peaked was 2-3 days from disease onset; the median duration of omicron variant was 15-18 days; the nucleic acid Ct value of nasopharyngeal swabs of infected patients is lower than that of throat swabs, and the Ct value of oropharyngeal swabs is unstable during the recovery period. Conclusion: Therefore, we found that the time to peak viral load of this Omicron variant was 2-3 days after the onset of the disease, and the duration was 15-18 days; symptomatic patients had higher viral load and longer hospitalization time. This finding will provide a basis for understanding omicron variants and formulating the national prevention and control strategy.

Physical condition, psychological status, and posttraumatic stress disorder among recovered COVID-19 subjects: A mediation analysis.

The physical condition of individuals who contracted COVID-19 had a profound influence on mitigating the physical and psychological impact of the disease and the symptoms of posttraumatic stress disorder (PTSD). Little attention has been focused on the influence of physical condition on PTSD among recovered COVID-19 subjects. This study explored the relationship between physical and psychological status and PTSD and the potential mechanisms. Questionnaires were completed by 73 (50.7%, 73/144) COVID-19 recovered subjects who were diagnosed in Taizhou, Zhejiang, China. We conducted a face-to-face survey from January 17 to March 10, 2020. The mediation analysis approach was applied in this research. Our data show that recovered COVID-19 subjects who were in better physical condition exhibited fewer psychological problems [B (95%CI), (-1.65 -3.04, -0.26)] and lower PTSD [B (95%CI), -6.13 (-9.43, -2.83)]. In addition, the worse the psychological status of recovered COVID-19 subjects was, the stronger the PTSD (B [95%CI], 0.58 [0.02, 1.14]). Moreover, psychological status could significantly mediate the impact of physical condition on PTSD (ß1θ2 = -0.87). Together, COVID-19 recovered subjects who have better physical condition could decrease their PTSD, and the worse the physical condition of COVID-19 recovered subjects would increase their psychological problems. Our finding about psychological status could significantly mediate the impact of the physical condition on PTSD might be useful for medical institutions and the government seeking to help with the follow-up rehabilitation training of recovered COVID-19 subjects.

Longitudinal observation of viral load in patients infected with Omicron variant and its relationship with clinical symptoms

Objective In 2022, a new coronavirus variant (Omicron) infection epidemic broke out in Shanghai, China. However, it is unclear whether the duration of this omicron variant is different from that of the prototype strain. Methods We retrospectively analyzed 157 cases of Omicron variant infection in Taizhou Public Health Center from March 29, 2022, to April 18, 2022, and observed the dynamics of nucleic acid Ct values during the admission and discharge of patients. Clinical and laboratory indicators of these patients were also obtained. Results Compared to the prototype strain, the Omicron variant showed a broad population susceptibility in infected individuals (regardless of age and presence of underlying disease) and had slight damage to the immune system and renal function;the viral loads peaked was 2-3 days from disease onset;the median duration of omicron variant was 15-18 days;the nucleic acid Ct value of nasopharyngeal swabs of infected patients is lower than that of throat swabs, and the Ct value of oropharyngeal swabs is unstable during the recovery period. Conclusion Therefore, we found that the time to peak viral load of this Omicron variant was 2-3 days after the onset of the disease, and the duration was 15-18 days;symptomatic patients had higher viral load and longer hospitalization time. This finding will provide a basis for understanding omicron variants and formulating the national prevention and control strategy.

Physical condition, psychological status, and posttraumatic stress disorder among recovered COVID-19 subjects: A mediation analysis

The physical condition of individuals who contracted COVID-19 had a profound influence on mitigating the physical and psychological impact of the disease and the symptoms of posttraumatic stress disorder (PTSD). Little attention has been focused on the influence of physical condition on PTSD among recovered COVID-19 subjects. This study explored the relationship between physical and psychological status and PTSD and the potential mechanisms. Questionnaires were completed by 73 (50.7%, 73/144) COVID-19 recovered subjects who were diagnosed in Taizhou, Zhejiang, China. We conducted a face-to-face survey from January 17 to March 10, 2020. The mediation analysis approach was applied in this research. Our data show that recovered COVID-19 subjects who were in better physical condition exhibited fewer psychological problems [B (95%CI), (−1.65 −3.04, −0.26)] and lower PTSD [B (95%CI), −6.13 (−9.43, −2.83)]. In addition, the worse the psychological status of recovered COVID-19 subjects was, the stronger the PTSD (B [95%CI], 0.58 [0.02, 1.14]). Moreover, psychological status could significantly mediate the impact of physical condition on PTSD (β1θ2 = −0.87). Together, COVID-19 recovered subjects who have better physical condition could decrease their PTSD, and the worse the physical condition of COVID-19 recovered subjects would increase their psychological problems. Our finding about psychological status could significantly mediate the impact of the physical condition on PTSD might be useful for medical institutions and the government seeking to help with the follow-up rehabilitation training of recovered COVID-19 subjects.

Differences Between Omicron Infections and Fever Outpatients: Comparison of Clinical Manifestations and Initial Routine Hematology Indicators.

Purpose: We evaluated the differences between patients with SARS-CoV-2 Omicron variant infections and Fever outpatients, so that prevention and control measures can be taken in time. Patients and Methods: This study retrospectively analyzed 65 patients with SARS-CoV-2 Omicron variant. Sixty-nine age- and sex-matched Fever outpatients were enrolled during the same period of time. We also reanalyzed data from 81 SARS-CoV-2 Wild-Type-infected patients. We compared the clinical characteristics and initial indexes of routine tests among the 3 groups. Results: A total of 93.8% of the patients with Omicron infections had clinical symptoms, and the major symptoms were cough, fever and pharyngalgia. Pharyngalgia was a specific manifestation in Omicron group compared to Wild-Type group. The white blood cell of the Omicron group was lower than that of the Fever group [5.0 (3.6-6.1) vs 10.1 (7.6-12.9) ×109/L, P < 0.001]. The neutrophil count in Omicron group was lower than that in Fever and Wild-Type group [2.6 (1.8-3.9) vs 8.1 (5.9-10.9), P < 0.001; 2.6 (1.8-3.9) vs 3.4 (2.5-4.7) ×109/L, P < 0.001]. The white blood cell and neutrophil counts were lower in Omicron group than in the Fever group. The top 5 major symptoms were fever, cough, pharyngalgia, headache and expectoration. Conclusion: There are differences between the patients with Omicron infections and Fever outpatients, both in clinical manifestations and initial routine hematology indicators. We hope to provide some clues for early identification combined with a history of living in the epidemic area.

Clinical practice of rapid antigen tests for SARS-CoV-2 Omicron variant: A single-center study in China.

Responding to the fast-spreading SARS-CoV-2 Omicron variant, to improve screening efficiency, rapid antigen tests (RATs) were first added as a supplementary detection method in China in mid-March, 2022. What and how big a role RATs should play need to be supported by clinical data. Here, RAT performance and relevant factors in comparison with nucleic acid amplification tests (NAATs) were assessed in Omicron-infected inpatients. From the NAAT results, nasopharyngeal swabs (NPs) performed better than oropharyngeal swabs (OPs). RATs tested on NAAT positive NPs performed better than those with OP-positive samples. The RAT positivity rate was strongly associated with high levels of N and OFR1ab genes, especially in NPs where patients also had significantly longer hospital stays and shorter days from symptom onset to RAT testing. Self-performed RATs had a detection accuracy that was comparable to professionally performed RATs when the subjects were well guided. The antigen negative rate of the studied patients was 100% at discharge. These findings suggest that, in addition to a supplementary detection role, RATs can be an important strategy for evaluating the disease progression of Omicron-infected inpatients. This study provides important clinical data to support better rules regarding RATs under China's COVID-19 prevention and control policy.

Parental Attitudes Towards Vaccination Against COVID-19 in China During Pandemic.

Purpose: The Chinese government has authorized the emergency use of an inactivated vaccine for COVID-19 in children and adolescents aged 3 to 17 years. This study aimed to investigate parents' attitudes towards vaccinating their children against COVID-19 and influencing factors. Patients and Methods: Through an online questionnaire survey, we collected self-reported children's demographic characteristics, physical conditions and parents' attitudes towards COVID-19 vaccination for children. The parents in the unwilling group received online consultation about the benefits and risks of COVID-19 vaccine and were asked to complete the questionnaire again. Results: A total of 868 participants were recruited from July 2021 to August 2021 in Nanjing, China. Overall, 76.0% of parents were willing to accept vaccination for children. Parents' willingness increased with children's age (P=0.018) and height (P=0.034), but decreased if the children fell sick within previous one month (P=0.030). Most of the unwilling parents gave a higher score to the risk of vaccination (53.76 VS 40.18). Unsafety (63.8%) and unfamiliarity (24.0%) were their major concerns. After consultation with a health worker, 24% of the unwilling parents turned willing. Conclusion: Children's age and recent physical condition are related to parents' attitudes towards vaccination for children against COVID-19. The major concerns of parents are unsafety and unfamiliarity. Parents view health workers as a reliable source of vaccine information. A successful consultation with health workers to understand the benefits and risks of vaccination can increase parents' willingness. This study provides insight into parents' attitudes towards vaccination for children against COVID-19 in China and related influencing factors. Our findings could be referenced in establishing policies for vaccinating children against COVID-19 in China.

Quality of Life and Mental Health Status in Recovered COVID-19 Subjects at Two Years after Infection in Taizhou, China: A Longitudinal Cohort Study.

According to previous studies, mental status in 1-year COVID-19 survivors might range from 6-43%. Longer-term psychological consequences in recovered COVID-19 subjects are unknown, so we analyzed longer-term quality of life and mental status in recovered COVID-19 subjects at 2 years after infection. Among 144 recovered COVID-19 subjects in the Taizhou region, 73 and 45 completed face-to-face follow-ups at the first year and second year after infection, respectively, with a 61.7% follow-up rate. The questionnaire, which was administered at both follow-ups, included questions about quality of life, psychological health, and post-traumatic stress disorder (PTSD). The Mann-Whitney U test was used to the differences of each scale between the first and second year. Among the 45 people who completed both follow-up visits, the incidence of psychological problems was 4.4% (2/45) in the first year, and no new psychological abnormalities were observed in the second year. Quality of life improved, while the General Health Questionnaire (GHQ-12) and Impact of Event Scale-Revised (IES-R) scores did not improve over time. The incidence of mental disorders was lower than those in previous studies. Multidisciplinary management for COVID-19 in this study hospital may have reduced the frequency to a certain extent. However, among those with mental health problems, such problems may exist for a long time, and long-term attention should be given to the psychological status of recovered COVID-19 subjects.

The evaluation of the immune status of COVID-19 recovered subjects with persistent abnormal lung CT after one year: A longitudinal cohort study.

OBJECTIVES: COVID-19 is an immune-related disease caused by novel Coronavirus SARS-COV-2. Lung lesions persist in some recovered patients, making long-term follow-up monitoring of their health necessary. The mechanism of these abnormalities is still unclear. In this study, the immune status was observed to explore the immune mechanism of persistent lung CT abnormalities in one-year COVID-19 recovered subjects. METHODS: One-year follow-up of 73 recovered patients from COVID-19 confirmed in Taizhou City, Zhejiang Province, was conducted to collect laboratory indicators such as blood immune cells, cytokines, complement series, immunoglobulin, and lung imaging; According to the results of lung CT, 60 patients were divided into normal CT group (n = 40) and abnormal CT group (n = 20). We compared the dynamic changes of immune indexes at three timepoints namely onset (T1), discharge (T2), and 1-year follow-up (T3), and studied the relationship between immune indexes and pulmonary sequelae. RESULTS: Compared with the healthy control, there was no significant difference in immune-related indexes, and immune levels had recovered. Patients with elder age, high BMI, severe patients, and those with underlying diseases (hypertension or diabetes) had a higher CT abnormal rate after recovery. Longitudinal observation showed that immunoglobulin increased first and then decreased, immune cell TBNK decreased in the onset period and increased in the recovery period, cytokine level increased significantly in the onset period and decreased to the normal level in the recovery period, and complement series C1q, C3 and C4 increased at the onset and decreased during the one-year follow-up. Complement C3 remained at a high level in the CT abnormal group (CT normal group vs CT abnormal group; P = 0.036). Correlation analysis showed that C3 negatively correlated restrictive ventilation index (TLC-He (ratio) (r = -0.302, P = 0.017). The above results suggest that complement C3 is a negative factor correlating abnormal pulmonary function 1 year after the recovery. CONCLUSION: After one year recovering from COVID-19, the subjects were with stable immune indicators. High levels of complement C3 were associated with persistent lung abnormalities in COVID-19 recovered subjects.

Methods for Continuous Blood Pressure Estimation Using Temporal Convolutional Neural Networks and Ensemble Empirical Mode Decomposition

Arterial blood pressure is not only an important index that must be measured in routine physical examination but also a key monitoring parameter of the cardiovascular system in cardiac surgery, drug testing, and intensive care. To improve the measurement accuracy of continuous blood pressure, this paper uses photoplethysmography (PPG) signals to estimate diastolic blood pressure and systolic blood pressure based on ensemble empirical mode decomposition (EEMD) and temporal convolutional network (TCN). In this method, the clean PPG signal is decomposed by EEMD to obtain n-order intrinsic mode functions (IMF), and then the IMF and the original PPG are input into the constructed TCN neural network model, and the results are output. The results show that TCN has better performance than CNN, CNN-LSTM, and CNN-GRU. Using the data added with IMF, the results of the above neural network model are better than those of the model with only PPG as input, in which the systolic blood pressure (SBP) and diastolic blood pressure (DBP) results of EEMD-TCN are −1.55 ± 9.92 mmHg and 0.41 ± 4.86 mmHg. According to the estimation results, DBP meets the requirements of the AAMI standard, BHS evaluates it as Grade A, SD of SBP is close to the standard AAMI, and BHS evaluates it as Grade B.

Potential Use of Serum Proteomics for Monitoring COVID-19 Progression to Complement RT-PCR Detection.

RT-PCR is the primary method to diagnose COVID-19 and is also used to monitor the disease course. This approach, however, suffers from false negatives due to RNA instability and poses a high risk to medical practitioners. Here, we investigated the potential of using serum proteomics to predict viral nucleic acid positivity during COVID-19. We analyzed the proteome of 275 inactivated serum samples from 54 out of 144 COVID-19 patients and shortlisted 42 regulated proteins in the severe group and 12 in the non-severe group. Using these regulated proteins and several key clinical indexes, including days after symptoms onset, platelet counts, and magnesium, we developed two machine learning models to predict nucleic acid positivity, with an AUC of 0.94 in severe cases and 0.89 in non-severe cases, respectively. Our data suggest the potential of using a serum protein-based machine learning model to monitor COVID-19 progression, thus complementing swab RT-PCR tests. More efforts are required to promote this approach into clinical practice since mass spectrometry-based protein measurement is not currently widely accessible in clinic.

Chinese Parent Intention to Vaccinate Children With Special Diseases Against COVID-19.

Background: Information on the intention of parents of children with special diseases to vaccinate their children against coronavirus disease 2019 (COVID-19) is scarce. Methods: In this survey, all participants (n = 914) were enrolled from a tertiary children's hospital between September 2020 and April 2021. A face-to-face questionnaire interview was conducted to collect information on the special diseases of children and parental attitudes about the COVID-19 vaccine. We compared the demographic and disease factors between the group of parents who were willing to vaccinate their children against COVID-19 and the group who were unwilling to vaccinate. Results: Among 941 children, 58.1% (n = 547) were boys. The Mean age was 1.4 (SD 1.9) years. If the COVID-19 vaccine becomes available for the child, 470 (49.9%) of parents were willing to provide vaccination for their children. The less the education levels of the father or mother, the more likely they were to vaccinate their children (P = 0.003, P = 0.007). However, more intentions to vaccinate were provided in parents of children with COVID-19 prevention and control education (P < 0.001). Conclusion: Our findings provided evidence that some parents are willing to vaccinate their children with special diseases against COVID-19. Professional knowledge about COVID-19 prevention and control may contribute to increased parental intention.

Breath-, air- and surface-borne SARS-CoV-2 in hospitals.

The COVID-19 pandemic has brought an unprecedented crisis to the global health sector. When discharging COVID-19 patients in accordance with throat or nasal swab protocols using RT-PCR, the potential risk of reintroducing the infection source to humans and the environment must be resolved. Here, 14 patients including 10 COVID-19 subjects were recruited; exhaled breath condensate (EBC), air samples and surface swabs were collected and analyzed for SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR) in four hospitals with applied natural ventilation and disinfection practices in Wuhan. Here we discovered that 22.2% of COVID-19 patients (n = 9), who were ready for hospital discharge based on current guidelines, had SARS-CoV-2 in their exhaled breath (~105 RNA copies/m3). Although fewer surface swabs (3.1%, n = 318) tested positive, medical equipment such as face shield frequently contacted/used by healthcare workers and the work shift floor were contaminated by SARS-CoV-2 (3-8 viruses/cm2). Three of the air samples (n = 44) including those collected using a robot-assisted sampler were detected positive by a digital PCR with a concentration level of 9-219 viruses/m3. RT-PCR diagnosis using throat swab specimens had a failure rate of more than 22% in safely discharging COVID-19 patients who were otherwise still exhaling the SARS-CoV-2 by a rate of estimated ~1400 RNA copies per minute into the air. Direct surface contact might not represent a major transmission route, and lower positive rate of air sample (6.8%) was likely due to natural ventilation (1.6-3.3 m/s) and regular disinfection practices. While there is a critical need for strengthening hospital discharge standards in preventing re-emergence of COVID-19 spread, use of breath sample as a supplement specimen could further guard the hospital discharge to ensure the safety of the public and minimize the pandemic re-emergence risk.

Eleven routine clinical features predict COVID-19 severity uncovered by machine learning of longitudinal measurements.

Severity prediction of COVID-19 remains one of the major clinical challenges for the ongoing pandemic. Here, we have recruited a 144 COVID-19 patient cohort, resulting in a data matrix containing 3,065 readings for 124 types of measurements over 52 days. A machine learning model was established to predict the disease progression based on the cohort consisting of training, validation, and internal test sets. A panel of eleven routine clinical factors constructed a classifier for COVID-19 severity prediction, achieving accuracy of over 98% in the discovery set. Validation of the model in an independent cohort containing 25 patients achieved accuracy of 80%. The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 0.70, 0.99, 0.93, and 0.93, respectively. Our model captured predictive dynamics of lactate dehydrogenase (LDH) and creatine kinase (CK) while their levels were in the normal range. This model is accessible at https://www.guomics.com/covidAI/ for research purpose.

Clinical evaluation of a rapid colloidal gold immunochromatography assay for SARS-Cov-2 IgM/IgG.

BACKGROUND: Since December 2019, there had been an outbreak of COVID-19 in Wuhan, China. At present, diagnosis COVID-19 were based on real-time RT-PCR, which have to be performed in biosafe laboratory and is unsatisfactory for suspect case screening. Therefore, there is an urgent need for rapid diagnostic test for COVID-19. OBJECTIVE: To evaluate the diagnostic performance and clinical utility of the colloidal gold immunochromatography assay for SARS-Cov-2 specific IgM/IgG anti-body detection in suspected COVID-19 cases. METHODS: In the prospective cohort, 150 patients with fever or respiratory symptoms were enrolled in Taizhou Public Health Medical Center, Taizhou Hospital, Zhejiang province, China, between January 20 to February 2, 2020. All patients were tested by the colloidal gold immunochromatography assay for COVID-19. At least two samples of each patient were collected for RT-PCR assay analysis, and the PCR results were performed as the reference standard of diagnosis. Meanwhile 26 heathy blood donor were recruited. The sensitivity and specificity of the immunochromatography assay test were evaluated. Subgroup analysis were performed with respect to age, sex, period from symptom onset and clinical severity. RESULTS: The immunochromatography assay test had 69 positive result in the 97 PCR-positive cases, achieving sensitivity 71.1% [95% CI 0.609-0.797], and had 2 positive result in the 53 PCR-negative cases, achieving specificity 96.2% [95% CI 0.859-0.993]. In 26 healthy donor blood samples, the immunochromatography assay had 0 positive result. In subgroup analysis, the sensitivity was significantly higher in patients with symptoms more than 14 days 95.2% [95% CI 0.741-0.998] and patients with severe clinical condition 86.0% [95% CI 0.640-0.970]. CONCLUSIONS: The colloidal gold immunochromatography assay for SARS-Cov-2 specific IgM/IgG anti-body had 71.1% sensitivity and 96.2% specificity in this population, showing the potential for a useful rapid diagnosis test for COVID-19. Further investigations should be done to evaluate this assay in variety of clinical settings and populations.