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1.
Ann Transl Med ; 10(10): 545, 2022 May.
Article in English | MEDLINE | ID: covidwho-1887397

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) has forced accelerated optimization of Emergency Department (ED) process, and simulation tools offer an alternative approach to strategic assessment and selection. Methods: Field research and case analysis methods were used to obtain the treatment process and medical records information from the ED of a general hospital. Minitab was used for analysis of the measurement system, and Arena was applied for simulation modelling. We established a framework for the triage protocol of ordinary and quarantined patients, analysed bottlenecks in the treatment time of the hospital's ED, and proposed an optimised management strategy. Results: The computed tomography (CT) pre-scheduling strategy simulation results demonstrated that longer CT room preparation times for quarantined people before their arrival (Tp) resulted in reduced CT scan and waiting times for quarantined patients, but these times were longer for ordinary patients. The nucleic acid priority strategy simulation results demonstrated that when the average daily number of ordinary patients (λc) was relatively stable, the hospital could guide ordinary patients to perform nucleic acid testing first followed by CT testing. However, when λc fluctuated greatly, the hospital could appropriately reduce the proportion of preferential nucleic acid testing. Furthermore, when λc was overloaded, the nucleic acid priority strategy showed no advantages. The joint analysis results demonstrated that the optimal strategy selection was significantly affected by the severity of the epidemic. The nucleic acid detection sample size optimisation strategy demonstrated that optimizing the sample size of each batch according to the number of patients could effectively reduce the waiting times for nucleic acid testing (Tn). Conclusions: Simulation tools are an alternative method for strategic evaluation and selection that do not require external factors.

2.
Nat Commun ; 13(1): 1788, 2022 04 04.
Article in English | MEDLINE | ID: covidwho-1773979

ABSTRACT

The global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in the generation of variants that may diminish host immune responses to vaccine formulations. Here we show a registered observational clinical trial (NCT04795414), we assess the safety and immunogenicity of the inactivated SARS-CoV-2 vaccine BBIBP-CorV in a cohort of 1006 vaccine recipients. No serious adverse events are observed during the term of the study. Detectable virus-specific antibody is measured and determined to be neutralizing in 698/760 (91.84%) vaccine recipients on day 28 post second vaccine dose and in 220/581 (37.87%) vaccine recipients on day 180 post second vaccine dose, whereas vaccine-elicited sera show varying degrees of reduction in neutralization against a range of key SARS-CoV-2 variants, including variant Alpha, Beta, Gamma, Iota, and Delta. Our work show diminished neutralization potency against multiple variants in vaccine-elicited sera, which indicates the potential need for additional boost vaccinations.


Subject(s)
COVID-19 Vaccines , COVID-19 , Antibodies, Viral , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , SARS-CoV-2/genetics
3.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-325163

ABSTRACT

We assessed the safety and immunogenicity of an inactivated SARS-CoV-2 vaccine BBIBP-CorV, especially measured the resistance of four global variants of concern: Lineage B.1.1.7, Lineage B.1.351, Lineage P.1, and Lineage B.1.526 to neutralizing activity of vaccine-elicited sera. Among 1006 enrolled participants, no serious adverse event was reported within 28 days post-vaccination. Seroconversion of neutralizing antibodies was seen in 698 (91.84%) of 760 healthcare workers, and the geometric mean titres (GMTs) of neutralizing antibody titre was 62.68 (57.02–68.91) after the second immunization. We found that 57 (12.13%), 99 (20.97%), and 114 (24.26%) vaccine-elicited sera showed complete or partial loss of neutralizing activity against lineage B.1.1.7, lineage B.1.526, and lineage P.1, respectively, while 199 (42.34%) vaccine-elicited sera preserved neutralizing activity against lineage B.1.351, albeit at relatively low dilutions. These data indicated that humoral responses against SARS-CoV-2 could be effectively induced in vaccine recipients, although diminished neutralization potency against multiple variants was observed.

5.
BMJ ; 369: m1849, 2020 05 14.
Article in English | MEDLINE | ID: covidwho-1495142

ABSTRACT

OBJECTIVE: To assess the efficacy and safety of hydroxychloroquine plus standard of care compared with standard of care alone in adults with coronavirus disease 2019 (covid-19). DESIGN: Multicentre, open label, randomised controlled trial. SETTING: 16 government designated covid-19 treatment centres in China, 11 to 29 February 2020. PARTICIPANTS: 150 patients admitted to hospital with laboratory confirmed covid-19 were included in the intention to treat analysis (75 patients assigned to hydroxychloroquine plus standard of care, 75 to standard of care alone). INTERVENTIONS: Hydroxychloroquine administrated at a loading dose of 1200 mg daily for three days followed by a maintenance dose of 800 mg daily (total treatment duration: two or three weeks for patients with mild to moderate or severe disease, respectively). MAIN OUTCOME MEASURE: Negative conversion of severe acute respiratory syndrome coronavirus 2 by 28 days, analysed according to the intention to treat principle. Adverse events were analysed in the safety population in which hydroxychloroquine recipients were participants who received at least one dose of hydroxychloroquine and hydroxychloroquine non-recipients were those managed with standard of care alone. RESULTS: Of 150 patients, 148 had mild to moderate disease and two had severe disease. The mean duration from symptom onset to randomisation was 16.6 (SD 10.5; range 3-41) days. A total of 109 (73%) patients (56 standard of care; 53 standard of care plus hydroxychloroquine) had negative conversion well before 28 days, and the remaining 41 (27%) patients (19 standard of care; 22 standard of care plus hydroxychloroquine) were censored as they did not reach negative conversion of virus. The probability of negative conversion by 28 days in the standard of care plus hydroxychloroquine group was 85.4% (95% confidence interval 73.8% to 93.8%), similar to that in the standard of care group (81.3%, 71.2% to 89.6%). The difference between groups was 4.1% (95% confidence interval -10.3% to 18.5%). In the safety population, adverse events were recorded in 7/80 (9%) hydroxychloroquine non-recipients and in 21/70 (30%) hydroxychloroquine recipients. The most common adverse event in the hydroxychloroquine recipients was diarrhoea, reported in 7/70 (10%) patients. Two hydroxychloroquine recipients reported serious adverse events. CONCLUSIONS: Administration of hydroxychloroquine did not result in a significantly higher probability of negative conversion than standard of care alone in patients admitted to hospital with mainly persistent mild to moderate covid-19. Adverse events were higher in hydroxychloroquine recipients than in non-recipients. TRIAL REGISTRATION: ChiCTR2000029868.


Subject(s)
Antiviral Agents/therapeutic use , Coronavirus Infections/drug therapy , Hydroxychloroquine/therapeutic use , Pneumonia, Viral/drug therapy , Adult , COVID-19 , China , Female , Humans , Male , Middle Aged , Pandemics , Treatment Outcome
6.
Sci Bull (Beijing) ; 66(22): 2312-2319, 2021 Nov 30.
Article in English | MEDLINE | ID: covidwho-1331219

ABSTRACT

The presence of antiphospholipid antibodies was shown to be associated with thrombosis in coronavirus disease 2019 (COVID-19) patients. Recently, according to reports from several studies, the vaccine-induced immune thrombotic thrombocytopenia is mediated by anti-platelet factor 4 (PF4)-polyanion complex in adenovirus-vectored COVID-19 vaccine recipients. It is impendent to explore whether inactivated COVID-19 vaccine widely used in China influences prothrombotic autoantibody production and induces thrombosis. In this prospective study, we recruited 406 healthcare workers who received two doses, 21 days apart, of inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine (BBIBP-CorV, Sinopharm). Paired blood samples taken before vaccination and four weeks after the second vaccination were used in detecting prothrombotic autoantibodies, including anticardiolipin (aCL), anti-ß2 glycoprotein I (aß2GP1), anti-phosphatidylserine/prothrombin (aPS/PT), and anti-PF4-heparin. The seroconversion rate of SARS-CoV-2 specific antibodies was 95.81% (389/406) four weeks after vaccination. None of the subjects had spontaneous thrombosis or thrombocytopenia over a minimum follow-up period of eight weeks. There was no significant difference in the presence of all ten autoantibodies between samples collected before and after vaccination: for aCL, IgG (7 vs. 8, P = 0.76), IgM (41 vs. 44, P = 0.73), IgA (4 vs. 4, P = 1.00); anti-ß2GP1, IgG (7 vs. 6, P = 0.78), IgM (6 vs. 5, P = 0.76), IgA (3 vs. 5, P = 0.72); aPS/PT IgG (0 vs. 0, P = 1.00), IgM (6 vs. 5, P = 0.76); aPF4-heparin (2 vs. 7, P = 0.18), and antinuclear antibody (ANA) (18 vs. 21, P = 0.62). Notably, seven cases presented with anti-PF4-heparin antibodies (range: 1.18-1.79 U/mL) after vaccination, and none of them exhibited any sign of thrombotic disorder. In conclusion, inactivated SARS-CoV-2 vaccine does not influence the profile of antiphospholipid antibody and anti-PF4-heparin antibody nor increase the risk of thrombosis.

7.
Ann Palliat Med ; 10(4): 3937-3950, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1200419

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has resulted in an overwhelmed challenge to the healthcare system worldwide. METHODS: A case-control study of COVID-19 patients in Wuhan Third Hospital was conducted. 96 deceased COVID-19 patients and 230 discharged patients were included as the case group and control group, respectively. Demographic, epidemiological, clinical and laboratory variables on admission were collected from electronic medical records. Univariate and multivariate logistic regression were adopted to investigate the independent predictors of mortality. A nomogram was formed for predicting the mortality risk. RESULTS: The multivariate stepwise logistic model demonstrated that age of 60+ years (OR =4.426, 95% CI: 1.955-10.019), comorbidity of cerebrovascular disease (OR =7.084, 95% CI: 1.545-32.471), white blood cell (WBC) count >9.5×109/L (OR =7.308, 95% CI: 1.650-32.358), platelet count <125×109/L (OR =5.128, 95% CI: 2.157-12.191), aspartate aminotransferase (AST) >40 U/L (OR =2.554, 95% CI: 1.253-5.206), cystatin C >1.1 mg/L (OR =4.132, 95% CI: 2.118-8.059), C reactive protein (CRP) ≥100 mg/L (OR =2.830, 95% CI: 1.311-6.109), creatine kinase isoenzymes (CK-MB) >24 U/L (OR =6.015, 95% CI: 2.119-17.07) and D-dimer >5 µg/L (OR =4.917, 95% CI: 1.619-14.933) were independent predictors of mortality of COVID-19 patients. The nomogram demonstrated a well discriminatory accuracy for mortality prediction with a C-index of 0.903. CONCLUSIONS: The determinants identified may help to determine patients at high risk of death at an early stage and guide the optimal treatment.


Subject(s)
COVID-19 , Case-Control Studies , China/epidemiology , Humans , Middle Aged , Retrospective Studies , Risk Factors , SARS-CoV-2
8.
PeerJ ; 8: e9885, 2020.
Article in English | MEDLINE | ID: covidwho-761097

ABSTRACT

OBJECTIVES: Coronavirus Disease 2019 (COVID-19) has become a pandemic outbreak. Risk stratification at hospital admission is of vital importance for medical decision making and resource allocation. There is no sophisticated tool for this purpose. This study aimed to develop neural network models with predictors selected by genetic algorithms (GA). METHODS: This study was conducted in Wuhan Third Hospital from January 2020 to March 2020. Predictors were collected on day 1 of hospital admission. The primary outcome was the vital status at hospital discharge. Predictors were selected by using GA, and neural network models were built with the cross-validation method. The final neural network models were compared with conventional logistic regression models. RESULTS: A total of 246 patients with COVID-19 were included for analysis. The mortality rate was 17.1% (42/246). Non-survivors were significantly older (median (IQR): 69 (57, 77) vs. 55 (41, 63) years; p < 0.001), had higher high-sensitive troponin I (0.03 (0, 0.06) vs. 0 (0, 0.01) ng/L; p < 0.001), C-reactive protein (85.75 (57.39, 164.65) vs. 23.49 (10.1, 53.59) mg/L; p < 0.001), D-dimer (0.99 (0.44, 2.96) vs. 0.52 (0.26, 0.96) mg/L; p < 0.001), and α-hydroxybutyrate dehydrogenase (306.5 (268.75, 377.25) vs. 194.5 (160.75, 247.5); p < 0.001) and a lower level of lymphocyte count (0.74 (0.41, 0.96) vs. 0.98 (0.77, 1.26) × 109/L; p < 0.001) than survivors. The GA identified a 9-variable (NNet1) and a 32-variable model (NNet2). The NNet1 model was parsimonious with a cost on accuracy; the NNet2 model had the maximum accuracy. NNet1 (AUC: 0.806; 95% CI [0.693-0.919]) and NNet2 (AUC: 0.922; 95% CI [0.859-0.985]) outperformed the linear regression models. CONCLUSIONS: Our study included a cohort of COVID-19 patients. Several risk factors were identified considering both clinical and statistical significance. We further developed two neural network models, with the variables selected by using GA. The model performs much better than the conventional generalized linear models.

9.
Epidemiol Infect ; 148: e205, 2020 08 25.
Article in English | MEDLINE | ID: covidwho-729971

ABSTRACT

Sentinel surveillance system plays a key role in screening and monitoring emerging and acute infectious diseases in order to identify the suspected cases in time. During SARS period in 2003, fever clinics emerged in many cities in mainland China with the purpose to screen the suspected SARS patients and to transfer the confirmed cases to designated hospitals for professional management. Shanghai city has reserved the fever clinics and the designated hospitals since then. Hence, clinicians in the front line are able to respond quickly to the emerging COVID-19 outbreak with their accumulated knowledge and experiences from the past. One hundred seventeen fever clinics distributed in various district areas in Shanghai have played a vital 'sentinel' role to fight against the COVID-19 epidemic. Most of suspected patients were identified in fever clinics and thereafter among these suspected patients the COVID-19 cases were confirmed and were isolated quickly to avoid the spread. We would like to share the sentinel roadmap for screening and diagnosis of COVID-19 to medical healthcare workers around the world, especially countries who are facing great challenges to cope with COVID-19 and meanwhile with limited medical resources. These sentinel surveillance strategies will certainly provide insight into the early detection and timely isolation of suspected cases from the others.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , COVID-19 , Early Diagnosis , Humans , Pandemics , SARS-CoV-2
10.
Ann Transl Med ; 8(13): 816, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-692848

ABSTRACT

BACKGROUND: As a global pandemic, COVID-19 has aroused great concern in the last few months and a growing number of related researches have been published. Therefore, a bibliometric analysis of these publications may provide a direction of hot topics and future research trends. METHODS: The global literatures about COVID-19 published between 2019 and 2020 were scanned in the Web of Science collection database. "COVID-19" "Novel Coronavirus" "2019-nCoV" and "SARS-CoV-2" were used as the keywords to reach the relevant publications. VOSviewer was applied to perform the bibliometric analysis of these articles. RESULTS: Totally 3,626 publications on the topic of COVID-19 were identified and "COVID-19" with a total link strength of 2,649 appeared as the most frequent keyword, which had a strong link to "pneumonia" and "epidemiology". The mean citation count of the top 100 most cited articles was 96 (range, 26-883). Most of them were descriptive studies and concentrated on the clinical features. The highest-ranking journal was British medical journal with 211 publications and the most cited journal was Lancet with 2,485 citation counts. Eleven articles written by Christian Drosten from Berlin Institute of Virology have been cited for 389 times and 40 articles from Chinese Academy of Sciences have been cited for 1,597 times which are the most cited author and organization. The number of collaborators with China is 44 and the total link strength is 487. The main partners of China are USA, England and Germany. The published literatures have focused on three topics: disease management, clinical features and pathogenesis. CONCLUSIONS: The current growth trends predict a large increase in the number of global publications on COVID-19. China made the most outstanding contribution within this important field. Disease treatment, spike protein and vaccine may be hotspots in the future.

11.
J. Shanghai Jiaotong Univ. Med. Sci. ; 4(40): 417-421, 20200428.
Article in Chinese | WHO COVID, ELSEVIER | ID: covidwho-621324

ABSTRACT

Since December 2019, the coronavirus disease 2019 (COVID-19) has become one of the most significant infectious diseases in the world. The epidemic in China has been basically controlled through a series of prevention and control measures. But the number of confirmed cases and deaths in other countries and regions is still rapidly rising. In response to this major epidemic, the hospital's emergency management system is facing a great challenge, especially the department of emergency, which takes the responsibilities of the screening and diagnosis of fe-ver patients as well as the emergency treatment of ordinary patients. Through two months of practice and exploration, our hospital has summa-rized some experiences in improving the emergency management system, establishing a peace and war integration mechanism, reorganizing medical resources, guaranteeing the deployment of supplies and optimizing information system, and has achieved the "zero infection" of medical staff, "zero misdiagnosis" and "zero cross-infection" of patients with COVID-19.

12.
Chronic Dis Transl Med ; 6(2): 106-114, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-379972

ABSTRACT

Coronavirus disease (COVID-19) was first diagnosed in Wuhan in December 2019. The World Health Organization defined the subsequent outbreak of COVID-19 worldwide as a public health emergency of international concern. Epidemiological data indicate that at least 20% of COVID-19 patients have severe disease. In addition to impairment of the respiratory system, acute kidney injury (AKI) is a major complication. Immune damage mediated by cytokine storms and concomitant AKI is a key factor for poor prognosis. Based on previous experience of blood purification for patients with severe acute respiratory syndrome and Middle East respiratory syndrome combined with clinical front-line practice, we developed a blood purification protocol for patients with severe COVID-19. This protocol is divided into four major steps. The first step is to assess whether patients with severe COVID-19 require blood purification. The second step is to prescribe a blood purification treatment for patients with COVID-19. The third step is to monitor and adjust parameters of blood purification. The fourth step is to evaluate the timing of discontinuation of blood purification. It is expected that blood purification will play a key role in effectively reducing the mortality of patients with severe COVID-19 through the standardized implementation of the present protocol.

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