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1.
Front Pharmacol ; 13: 964037, 2022.
Article in English | MEDLINE | ID: covidwho-2022839

ABSTRACT

Background: The coronavirus disease of 2019 (COVID-19) is a severe public health issue that has infected millions of people. The effective prevention and control of COVID-19 has resulted in a considerable increase in the number of cured cases. However, little research has been done on a complete metabonomic examination of metabolic alterations in COVID-19 patients following treatment. The current project pursues rigorously to characterize the variation of serum metabolites between healthy controls and COVID-19 patients with nucleic acid turning negative via untargeted metabolomics. Methods: The metabolic difference between 20 COVID-19 patients (CT ≥ 35) and 20 healthy controls were investigated utilizing untargeted metabolomics analysis employing High-resolution UHPLC-MS/MS. COVID-19 patients' fundamental clinical indicators, as well as health controls, were also collected. Results: Out of the 714 metabolites identified, 203 still significantly differed between COVID-19 patients and healthy controls, including multiple amino acids, fatty acids, and glycerophospholipids. The clinical indexes including monocytes, lymphocytes, albumin concentration, total bilirubin and direct bilirubin have also differed between our two groups of participators. Conclusion: Our results clearly showed that in COVID-19 patients with nucleic acid turning negative, their metabolism was still dysregulated in amino acid metabolism and lipid metabolism, which could be the mechanism of long-COVID and calls for specific post-treatment care to help COVID-19 patients recover.

2.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-312697

ABSTRACT

Background: The severe acute respiratory syndrome coronavirus-2 outbreak was identified in China in December 2019 and spread worldwide, reaching the pandemic levels. However, a specific, effective and proven therapy for the patients with coronavirus disease 2019 (COVID-19) remains elusive. We aim to compare the efficacy and the safety of three antiviral monotherapies (chloroquine phosphate, arbidol (Umifenovir) or lopinavir/ritonavir) in non-severe, hospitalised COVID-19 patients. Methods: : We retrospectively analysed the hospitalised, laboratory-confirmed COVID-19 patients, treated with antiviral monotherapies at Huizhou Municipal Central Hospital between Jan 19 and Mar 16, 2020. Demographic and clinical data were extracted from electronic medical records. The primary outcome of the study was the viral shedding interval. Results: : Twenty-seven patients with COVID-19 were included in the study with 10 receiving chloroquine phosphate, 11 receiving arbidol and 6 receiving lopinavir/ritonavir. Baseline demographics and clinical data were similar between groups. The median viral shedding interval in the lopinavir/ritonavir group was 13.0 days (95% CI: 12.2-23.8), while significantly shorter in the chloroquine group at 5.0 days (95% CI: 0.4-9.6) (p=0.003). A reduced median interval was also observed in the arbidol group, with 8.0 days (95%CI: 4.9-11.1) (p=0.008). Moreover, the hospitalisation duration was shorter in the chloroquine (9.3 ± 1.8 days, p<0.001) and arbidol groups (11.7 ± 3.7 days, p<0.001), and the hospitalisation costs were significantly reduced in the chloroquine (USD 1327 ± 566, p=0.001) and arbidol groups (USD 1167 ± 434, p<0.001), when compared with the lopinavir/ritonavir group (hospitalisation length and costs: 19.7 ± 4.4 days and USD 3806 ± 2262, respectively). Conclusions: : Chloroquine and arbidol could not only shorten the viral shedding interval but also decreased the hospitalisation duration and hospitalisation expenses. Trial registration: The ethics committee of the Huizhou Municipal Central Hospital approved this study, and the trial was registered with www.chictr.org.cn (ChiCTR2000030931).

3.
Front Public Health ; 9: 749294, 2021.
Article in English | MEDLINE | ID: covidwho-1566664

ABSTRACT

Objectives: To investigate the epidemiological characteristics and infection routes of new cases in order to provide information for preventing COVID-19 resurgence in areas initially under control. Methods: The information of new symptomatic and asymptomatic patients in Chinese mainland was collected. The location distribution, epidemic course, infection routes and patients' characteristics of outbreaks were described and analyzed. Results: There were 43 new outbreaks with 3,795 symptomatic patients in Chinese mainland from March 21, 2020 to June 13, 2021. These outbreaks mainly occurred in central, border and coastal port cities. The main infection route of first generation indigenous patients was contact with imported cases and contaminated goods or environments. The infection routes of secondary generation patients mainly included family transmission, indoor social gathering infection, nosocomial infection and other infection routes. Family transmission was the most common infection route, and indoor social gathering was the most important reason for the large-scale outbreaks. Conclusions: Strengthen the management of imported patients and staff in high-risk posts was the key point to avoid the first generation indigenous patients. Adequate family isolation, prompt management policies for indoor public place and monitor of population at risk of infection were key strategies for preventing COVID-19 resurgence in areas initially under control.


Subject(s)
COVID-19 , Cross Infection , Epidemics , Cross Infection/epidemiology , Disease Outbreaks , Humans , SARS-CoV-2
5.
Front Med (Lausanne) ; 8: 638201, 2021.
Article in English | MEDLINE | ID: covidwho-1264342

ABSTRACT

Introduction: Noninvasive ventilation (NIV) has been used to alleviate hypoxemia and dyspnea, but there is no consensus on the application of NIV in patients with coronavirus disease 2019 (COVID-19). Some staff use NIV as the rescue therapy which might lead to the adverse outcomes. This study was to identify early factors associated with intubation to help the medical staff select appropriate patients for receiving NIV treatment. Methods: Patients with laboratory-confirmed COVID-19 who were treated with NIV in emergency department or ICU of the Third People's Hospital (the only designated hospital for treating COVID-19 in Shenzhen) between January 1 and August 31, 2020, were retrospectively analyzed. Results: Thirty-nine patients with COVID-19 treated with NIV were included; of them, 16 (41%) received endotracheal intubation and 3 (8%) died. Significant differences were observed between intubated and non-intubated patients in PaO2/FiO2 before NIV initiation, hospitalization duration, NIV as the rescue therapy, and PaO2/FiO2 of ≤200 mmHg after 1-2 h of NIV initiation. Notably, 1-2 h after NIV initiation, a PaO2/FiO2 of ≤200 mmHg (odds ratio [OR], 9.35; 95% confidence interval [CI], 1.84-47.62; P = 0.007) and NIV as the rescue therapy (OR, 5.43; 95% CI, 1.09-27.12; P = 0.039) were the risk factors for intubation. Conclusions: In patients with COVID-19-related acute hypoxemic respiratory failure receiving NIV, close attention should be paid to PaO2/FiO2 after 1-2 h of NIV initiation. Also, using NIV as rescue therapy should draw our awareness that it might delay escalation of respiratory support and lead to adverse outcomes.

6.
Wien Klin Wochenschr ; 132(13-14): 396-399, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-996393

ABSTRACT

The novel coronavirus disease 2019 (COVID-19) occurred in China (mainly in Wuhan, Hubei Province) at the end of December 2019. Henan province is located in the center of China, borders on Hubei province by land in the south with the nearest distance of 200 kilometers to Wuhan. As the inland provinces in mainland China, frequent communication in transportation and population flow make it difficult to confine the pandemic, which is similar to that in the landlocked countries in Europe. The expected cases in Henan were mainly imported. A bundle of intervention strategies were adopted from 26 January 2020 to cut off the spread between the infected patients and the native residents. The pandemic was controlled 2 month later after the bundle of strategies was adopted although the number of cases continued to increase explosively during the first 10 days. A total of 1273 cases were confirmed, 1251 patients were cured, 22 patients died, and 1 patient was still in hospital until 29 March 2020. The peak of daily increased cases was 109 cases. Our data show that COVID-19 is highly infectious and easy to cause an outbreak, but it can be controlled by early effective interventions. A bundle of strategies according to the specific situation of each country is suggested to be implemented as early as possible.


Subject(s)
Coronavirus Infections , Coronavirus , Infection Control , Pandemics , Pneumonia, Viral , Betacoronavirus , COVID-19 , China/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Europe , Humans , Infection Control/methods , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2
7.
J Clin Invest ; 130(10): 5235-5244, 2020 10 01.
Article in English | MEDLINE | ID: covidwho-969923

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent for coronavirus 2019 (COVID-19) pneumonia. Little is known about the kinetics, tissue distribution, cross-reactivity, and neutralization antibody response in patients with COVID-19. Two groups of patients with RT-PCR-confirmed COVID-19 were enrolled in this study: 12 severely ill patients in intensive care units who needed mechanical ventilation and 11 mildly ill patients in isolation wards. Serial clinical samples were collected for laboratory detection. Results showed that most of the severely ill patients had viral shedding in a variety of tissues for 20-40 days after onset of disease (8/12, 66.7%), while the majority of mildly ill patients had viral shedding restricted to the respiratory tract and had no detectable virus RNA 10 days after onset (9/11, 81.8%). Mildly ill patients showed significantly lower IgM response compared with that of the severe group. IgG responses were detected in most patients in both the severe and mild groups at 9 days after onset, and remained at a high level throughout the study. Antibodies cross-reactive to SARS-CoV and SARS-CoV-2 were detected in patients with COVID-19 but not in patients with MERS. High levels of neutralizing antibodies were induced after about 10 days after onset in both severely and mildly ill patients which were higher in the severe group. SARS-CoV-2 pseudotype neutralization test and focus reduction neutralization test with authentic virus showed consistent results. Sera from patients with COVID-19 inhibited SARS-CoV-2 entry. Sera from convalescent patients with SARS or Middle East respiratory syndrome (MERS) did not. Anti-SARS-CoV-2 S and N IgG levels exhibited a moderate correlation with neutralization titers in patients' plasma. This study improves our understanding of immune response in humans after SARS-CoV-2 infection.


Subject(s)
Antibodies, Viral/blood , Betacoronavirus/metabolism , Coronavirus Infections/blood , Pneumonia, Viral/blood , Viral Load , Virus Shedding , Adult , Aged , Antibody Specificity , COVID-19 , Cross Reactions , Female , Humans , Kinetics , Male , Middle Aged , Pandemics , SARS-CoV-2 , Severity of Illness Index
8.
Clin Respir J ; 15(3): 280-286, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-901006

ABSTRACT

Fangcang shelter (Cabin) hospitals were set up in order to cope with the rapid growth of confirmed cases of coronavirus disease 2019 (COVID-19) in Wuhan, China at a time when there were insufficient beds in designated hospitals. This paper describes the layout and functioning of a typical Fangcang shelter hospital, Wuhan Dongxihu Fangcang shelter Hospital, where the author has worked, the working mechanism, experience and effectiveness. A set of patient management protocols was employed for daily practice, which included preset criteria and procedure for admission, examination, medication treatment, referral and discharge. WeChat platform with different groups was used for communication, ward round, test appointments and patient data communication. All these procedures and mechanisms of working enabled the effective management of a larger number of patients with relatively few doctors. As a result, 442 mild or moderate COVID-19 patients in Hall C were successfully managed by a team of 40 doctors, with 246 (56%) patients were cured and discharged from the Fangcang shelter hospital while the remaining 196 (44%) patients were referred on to designated hospitals for further treatment. The reasons for referral included poor resolution in computerized tomography (CT) scan (59%), persistently positive severe acute respiratory syndrome coronavirus 2 by PCR after 9 days of admission (16%), deterioration in CT image (4%), development of dyspnoea (1%) and other (4%) or unclear reasons (16%) due to no record of reasons for referral on the document. There were no deaths and no complaints from the patients in Hall C. In summary, the Fangcang shelter hospital could be run successfully with a set of patient management protocols under conditions of limited facilities and medical staff. It was effective and safe in isolating patients, providing basic medical care and early identification of potential severe cases. This experience may provide a successful example of a working mechanism for the prevention and control of the COVID-19 pandemic worldwide.


Subject(s)
COVID-19/epidemiology , Disease Management , Hospitals, Special/organization & administration , Mobile Health Units/organization & administration , Pandemics , COVID-19/therapy , China/epidemiology , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , SARS-CoV-2
9.
COVID-19 ; : 89-97, 2021.
Article in English | ScienceDirect | ID: covidwho-893385

ABSTRACT

We have been continuously deepening our understanding of 2019 coronavirus disease (COVID-19)—an emerging disease. Further knowledge on varying clinical manifestations, phenotypes, clinical course, acute and chronic conditions, susceptibility, as well as research to improve our ability in identification of susceptible populations and tracking the direction of evolution of the virus, are urgently needed.

10.
COVID-19 ; : 75-88, 2021.
Article in English | ScienceDirect | ID: covidwho-893384

ABSTRACT

The control of infectious disease is more dependent on prevention than on treatment. The first task is to isolate the source of infection. Suspected patients, mildly affected patients, and close contacts of confirmed cases should be placed under medical observation. No matter whether there is an etiological diagnosis or not, suspected patients should be kept in strict isolation. It is difficult to identify the source of infection completely unless compulsory measures are taken, such as door-to-door screening. Therefore, the focus of prevention is how to cut off the transmission routes. Given that droplet transmission and contact transmission appear to be the main routes of transmission of COVID-19, the general public need to refrain from going outdoors as much as possible, wear masks in public, and keep good hygiene including frequent handwashing, and wiping and disinfecting door handles and elevator buttons. It is recommended to stop using central air-conditioning because COVID-19 may also spread through aerosol transmission.

11.
COVID-19 ; : 55-74, 2021.
Article in English | ScienceDirect | ID: covidwho-893383

ABSTRACT

Suspected and confirmed cases should be treated in a designated hospital with effective isolation and protective conditions. The isolation condition of suspected cases should be the highest, and treatment should be carried out in a single room instead of mixed accommodation. Only confirmed cases should be admitted to the same ward, and critically ill patients should be admitted to ICU as soon as possible. At this stage, asymptomatic infected persons should also be isolated for observation. If a severe epidemic occurs in the area and medical resources are limited, mild cases and asymptomatic infected persons can be treated and observed at home, but registration and management should be carried out by the local disease prevention and control institutions and community health service centers, so as to guide, observe, and treat the quarantine at home. Moreover, the referral and transfer of severe patients should be safe, evaluated well, and no problems should be caused on the way.

12.
COVID-19 ; : 41-54, 2021.
Article in English | ScienceDirect | ID: covidwho-893382

ABSTRACT

The diagnosis of COVID-19 is based on epidemiological history, clinical manifestations, and pathogenic confirmation.

13.
COVID-19 ; : 13-39, 2021.
Article in English | ScienceDirect | ID: covidwho-893381

ABSTRACT

The incubation period from exposure to symptoms is generally 7–14 days;the shortest is 1 day, the longest is up to 20 days. Fever, fatigue, and dry cough appear to be the most common symptoms at illness onset, but these symptoms, which also present in influenza and other respiratory infections, are nonspecific. Upper respiratory tract symptoms like nasal obstruction and rhinorrhea are relatively rare. In general, the majority of patients have a satisfactory prognosis with a few patients being critically ill. Fatal cases are commonly seen in the elderly and those with chronic underlying diseases, such as diabetes and heart disease.

14.
COVID-19 ; : 7-11, 2021.
Article in English | ScienceDirect | ID: covidwho-893380

ABSTRACT

Combined with clinical manifestations and chest imaging features, such as dry cough and abnormal coagulation function, chest imaging mainly showed multiple small patches and interstitial changes at the early stage, with obvious extravasation and less exudative lesions, which developed into multiple ground-glass opacity and infiltrating shadows in the lungs. In critically ill patients receiving tracheal intubation, infiltration fluid is rare in the trachea, which is different from influenza and avian influenza. We assume that pathogenesis of COVID-19 lung injury could mainly be impairment of the lung interstitium and vascular endothelium. Although ARDS can be found in some patients, exudative lesions are relatively less.

15.
COVID-19 ; : 1-6, 2021.
Article in English | ScienceDirect | ID: covidwho-893379

ABSTRACT

Viral infectious diseases remain a major challenge for human health. Following the emergence of a new coronavirus pneumonia, more than 10,000 species of wild viruses have been mentioned by mass media, but only a few are well recognized. In recent decades, human beings have constantly faced the challenge of bacterial and viral infections. The most common pathogens of new infectious diseases are viruses, the latest being COVID-19. Therefore, we should pay close attention to the severity of respiratory virus infection. There are many common viruses that can cause respiratory infections, including influenza-related viruses, human metapneumovirus, measles virus, rhinovirus, enterovirus, coronavirus, respiratory tract syncytial virus, adenovirus, cytomegalovirus, herpes simplex virus, etc. In particular, there are more than 100 species of coronaviruses.

16.
Eur Respir Rev ; 29(157)2020 Sep 30.
Article in English | MEDLINE | ID: covidwho-835811

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome-coronavirus-2. Consensus suggestions can standardise care, thereby improving outcomes and facilitating future research. METHODS: An International Task Force was composed and agreement regarding courses of action was measured using the Convergence of Opinion on Recommendations and Evidence (CORE) process. 70% agreement was necessary to make a consensus suggestion. RESULTS: The Task Force made consensus suggestions to treat patients with acute COVID-19 pneumonia with remdesivir and dexamethasone but suggested against hydroxychloroquine except in the context of a clinical trial; these are revisions of prior suggestions resulting from the interim publication of several randomised trials. It also suggested that COVID-19 patients with a venous thromboembolic event be treated with therapeutic anticoagulant therapy for 3 months. The Task Force was unable to reach sufficient agreement to yield consensus suggestions for the post-hospital care of COVID-19 survivors. The Task Force fell one vote shy of suggesting routine screening for depression, anxiety and post-traumatic stress disorder. CONCLUSIONS: The Task Force addressed questions related to pharmacotherapy in patients with COVID-19 and the post-hospital care of survivors, yielding several consensus suggestions. Management options for which there is insufficient agreement to formulate a suggestion represent research priorities.


Subject(s)
Advisory Committees/organization & administration , Betacoronavirus , Consensus , Coronavirus Infections/epidemiology , International Cooperation , Pneumonia, Viral/epidemiology , Pulmonary Medicine/standards , Societies, Medical , COVID-19 , Europe , Humans , Pandemics , SARS-CoV-2 , United States
17.
Clinical eHealth ; 3:7-15, 2020.
Article in English | PMC | ID: covidwho-822402

ABSTRACT

The aim is to diagnose COVID-19 earlier and to improve its treatment by applying medical technology, the “COVID-19 Intelligent Diagnosis and Treatment Assistant Program (nCapp)” based on the Internet of Things. Terminal eight functions can be implemented in real-time online communication with the “cloud” through the page selection key. According to existing data, questionnaires, and check results, the diagnosis is automatically generated as confirmed, suspected, or suspicious of 2019 novel coronavirus (2019-nCoV) infection. It classifies patients into mild, moderate, severe or critical pneumonia. nCapp can also establish an online COVID-19 real-time update database, and it updates the model of diagnosis in real time based on the latest real-world case data to improve diagnostic accuracy. Additionally, nCapp can guide treatment. Front-line physicians, experts, and managers are linked to perform consultation and prevention. nCapp also contributes to the long-term follow-up of patients with COVID-19. The ultimate goal is to enable different levels of COVID-19 diagnosis and treatment among different doctors from different hospitals to upgrade to the national and international through the intelligent assistance of the nCapp system. In this way, we can block disease transmission, avoid physician infection, and epidemic prevention and control as soon as possible.

18.
Crit Care ; 24(1): 571, 2020 09 23.
Article in English | MEDLINE | ID: covidwho-788736

ABSTRACT

Coronavirus disease (COVID-19) is an emerging viral infection that is rapidly spreading across the globe. SARS-CoV-2 belongs to the same coronavirus class that caused respiratory illnesses such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). During the SARS and MERS outbreaks, many frontline healthcare workers were infected when performing high-risk aerosol-generating medical procedures as well as when providing basic patient care. Similarly, COVID-19 disease has been reported to infect healthcare workers at a rate of ~ 3% of cases treated in the USA. In this review, we conducted an extensive literature search to develop practical strategies that can be implemented when providing respiratory treatments to COVID-19 patients, with the aim to help prevent nosocomial transmission to the frontline workers.


Subject(s)
Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Respiratory Distress Syndrome/therapy , Aerosols/adverse effects , COVID-19 , Coronavirus Infections/transmission , Humans , Meta-Analysis as Topic , Observational Studies as Topic , Pneumonia, Viral/transmission , Randomized Controlled Trials as Topic , Respiratory Distress Syndrome/virology , Systematic Reviews as Topic
19.
J Virol ; 94(15)2020 07 16.
Article in English | MEDLINE | ID: covidwho-762192

ABSTRACT

Middle East respiratory syndrome coronavirus (MERS-CoV) causes severe acute respiratory disease in humans. MERS-CoV strains from early epidemic clade A and contemporary epidemic clade B have not been phenotypically characterized to compare their abilities to infect cells and mice. We isolated the clade B MERS-CoV ChinaGD01 strain from a patient infected during the South Korean MERS outbreak in 2015 and compared the phylogenetics and pathogenicity of MERS-CoV EMC/2012 (clade A) and ChinaGD01 (clade B) in vitro and in vivo Genome alignment analysis showed that most clade-specific mutations occurred in the orf1ab gene, including mutations that were predicted to be potential glycosylation sites. Minor differences in viral growth but no significant differences in plaque size or sensitivity to beta interferon (IFN-ß) were detected between these two viruses in vitro ChinaGD01 virus infection induced more weight loss and inflammatory cytokine production in human DPP4-transduced mice. Viral titers were higher in the lungs of ChinaGD01-infected mice than with EMC/2012 infection. Decreased virus-specific CD4+ and CD8+ T cell numbers were detected in the lungs of ChinaGD01-infected mice. In conclusion, MERS-CoV evolution induced changes to reshape its pathogenicity and virulence in vitro and in vivo and to evade adaptive immune response to hinder viral clearance.IMPORTANCE MERS-CoV is an important emerging pathogen and causes severe respiratory infection in humans. MERS-CoV strains from early epidemic clade A and contemporary epidemic clade B have not been phenotypically characterized to compare their abilities to infect cells and mice. In this study, we showed that a clade B virus ChinaGD01 strain caused more severe disease in mice, with delayed viral clearance, increased inflammatory cytokines, and decreased antiviral T cell responses, than the early clade A virus EMC/2012. Given the differences in pathogenicity of different clades of MERS-CoV, periodic assessment of currently circulating MERS-CoV is needed to monitor potential severity of zoonotic disease.


Subject(s)
Coronavirus Infections/virology , Genotype , Host-Pathogen Interactions , Middle East Respiratory Syndrome Coronavirus/physiology , Adult , Animals , Disease Models, Animal , Genome, Viral , Host-Pathogen Interactions/immunology , Humans , Interferon Type I/pharmacology , Male , Mice , Middle East Respiratory Syndrome Coronavirus/classification , Middle East Respiratory Syndrome Coronavirus/isolation & purification , Middle East Respiratory Syndrome Coronavirus/pathogenicity , Phylogeny , RNA, Viral , T-Lymphocytes/immunology , T-Lymphocytes/metabolism , Virulence , Virus Replication/drug effects , Virus Replication/genetics , Whole Genome Sequencing
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