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1.
Tidsskr Nor Laegeforen ; 141(2021-14)2021 10 12.
Article in Norwegian | MEDLINE | ID: covidwho-1528949

ABSTRACT

Multisystem inflammatory syndrome is a rare immune-mediated complication of infection with SARS-CoV-2 in children and adolescents. The patients can rapidly become seriously ill with high fever, gastrointestinal symptoms and cardiogenic shock. The goal of treatment is to ensure adequate circulation and prevent late complications by providing anti-inflammatory therapy.


Subject(s)
COVID-19 , SARS-CoV-2 , Adolescent , COVID-19/complications , Child , Humans , Syndrome , Systemic Inflammatory Response Syndrome
2.
Appl Intell (Dordr) ; : 1-16, 2021 Jul 05.
Article in English | MEDLINE | ID: covidwho-1514035

ABSTRACT

The coronavirus disease 2019 (COVID-19) is rapidly becoming one of the leading causes for mortality worldwide. Various models have been built in previous works to study the spread characteristics and trends of the COVID-19 pandemic. Nevertheless, due to the limited information and data source, the understanding of the spread and impact of the COVID-19 pandemic is still restricted. Therefore, within this paper not only daily historical time-series data of COVID-19 have been taken into account during the modeling, but also regional attributes, e.g., geographic and local factors, which may have played an important role on the confirmed COVID-19 cases in certain regions. In this regard, this study then conducts a comprehensive cross-sectional analysis and data-driven forecasting on this pandemic. The critical features, which has the significant influence on the infection rate of COVID-19, is determined by employing XGB (eXtreme Gradient Boosting) algorithm and SHAP (SHapley Additive exPlanation) and the comparison is carried out by utilizing the RF (Random Forest) and LGB (Light Gradient Boosting) models. To forecast the number of confirmed COVID-19 cases more accurately, a Dual-Stage Attention-Based Recurrent Neural Network (DA-RNN) is applied in this paper. This model has better performance than SVR (Support Vector Regression) and the encoder-decoder network on the experimental dataset. And the model performance is evaluated in the light of three statistic metrics, i.e. MAE, RMSE and R 2. Furthermore, this study is expected to serve as meaningful references for the control and prevention of the COVID-19 pandemic.

3.
Lancet Respir Med ; 9(7): 747-754, 2021 07.
Article in English | MEDLINE | ID: covidwho-1433967

ABSTRACT

BACKGROUND: The consequences of COVID-19 in those who recover from acute infection requiring hospitalisation have yet to be clearly defined. We aimed to describe the temporal trends in respiratory outcomes over 12 months in patients hospitalised for severe COVID-19 and to investigate the associated risk factors. METHODS: In this prospective, longitudinal, cohort study, patients admitted to hospital for severe COVID-19 who did not require mechanical ventilation were prospectively followed up at 3 months, 6 months, 9 months, and 12 months after discharge from Renmin Hospital of Wuhan University, Wuhan, China. Patients with a history of hypertension; diabetes; cardiovascular disease; cancer; and chronic lung disease, including asthma or chronic obstructive pulmonary disease; or a history of smoking documented at time of hospital admission were excluded at time of electronic case-note review. Patients who required intubation and mechanical ventilation were excluded given the potential for the consequences of mechanical ventilation itself to influence the factors under investigation. During the follow-up visits, patients were interviewed and underwent physical examination, routine blood test, pulmonary function tests (ie, diffusing capacity of the lungs for carbon monoxide [DLCO]; forced expiratory flow between 25% and 75% of forced vital capacity [FVC]; functional residual capacity; FVC; FEV1; residual volume; total lung capacity; and vital capacity), chest high-resolution CT (HRCT), and 6-min walk distance test, as well as assessment using a modified Medical Research Council dyspnoea scale (mMRC). FINDINGS: Between Feb 1, and March 31, 2020, of 135 eligible patients, 83 (61%) patients participated in this study. The median age of participants was 60 years (IQR 52-66). Temporal improvement in pulmonary physiology and exercise capacity was observed in most patients; however, persistent physiological and radiographic abnormalities remained in some patients with COVID-19 at 12 months after discharge. We found a significant reduction in DLCO over the study period, with a median of 77% of predicted (IQR 67-87) at 3 months, 76% of predicted (68-90) at 6 months, and 88% of predicted (78-101) at 12 months after discharge. At 12 months after discharge, radiological changes persisted in 20 (24%) patients. Multivariate logistic regression showed increasing odds of impaired DLCO associated with female sex (odds ratio 8·61 [95% CI 2·83-26·2; p=0·0002) and radiological abnormalities were associated with peak HRCT pneumonia scores during hospitalisation (1·36 [1·13-1·62]; p=0·0009). INTERPRETATION: In most patients who recovered from severe COVID-19, dyspnoea scores and exercise capacity improved over time; however, in a subgroup of patients at 12 months we found evidence of persistent physiological and radiographic change. A unified pathway for the respiratory follow-up of patients with COVID-19 is required. FUNDING: National Natural Science Foundation of China, UK Medical Research Council, and National Institute for Health Research Southampton Biomedical Research Centre. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.


Subject(s)
COVID-19/physiopathology , COVID-19/therapy , Hospitalization , Aged , Cohort Studies , Female , Humans , Longitudinal Studies , Male , Middle Aged , Prospective Studies , Respiratory Function Tests , Time Factors
4.
Mathematics ; 9(13):1555, 2021.
Article in English | MDPI | ID: covidwho-1295876

ABSTRACT

The global coronavirus disease 2019 (COVID-19) outbreak had a great impact on the tourism industry. Numerous hotels have ceased operations. Because of the increasing influence of blogs, various industries have adopted blogs as a publicity and marketing strategy. Companies utilize consumers’ trust and loyalty toward bloggers to effectively contact them. Hence, bloggers play a crucial role in the hotel industry. No past study has researched blogger selection by hotel managers. In this study, an innovative mixed multiple-criteria decision-making (MCDM) model including importance-performance analysis (IPA), analytic hierarchy process (AHP), and technique for order preference by similarity to ideal solution (TOPSIS) is established to assist hotel managers in selecting bloggers. We firstly collect the selection criteria via interviews with hotel managers and a review of literature on blogger selection. Messages with stick are understood, remembered, and have an enduring influence on opinions and behavior. Hence, we also introduce the concept of stick to the selection criteria. Based on IPA and the literature review, a hierarchical structure for blogger selection is constructed. Then, AHP and TOPSIS are integrated to assist the case company managers to select suitable bloggers.

5.
BMJ Open ; 11(5): e046157, 2021 05 24.
Article in English | MEDLINE | ID: covidwho-1242205

ABSTRACT

OBJECTIVE: We aim to explore and compare the effect of global travel restrictions and public health countermeasures in response to COVID-19 outbreak. DESIGN: A data-driven spatio-temporal modelling to simulate the spread of COVID-19 worldwide for 150 days since 1 January 2020 under different scenarios. SETTING: Worldwide. INTERVENTIONS: Travel restrictions and public health countermeasures. MAIN OUTCOME: The cumulative number of COVID-19 cases. RESULTS: The cumulative number of COVID-19 cases could reach more than 420 million around the world without any countermeasures taken. Under timely and intensive global interventions, 99.97% of infections could be avoided comparing with non-interventions. The scenario of carrying out domestic travel restriction and public health countermeasures in China only could contribute to a significant decrease of the cumulative number of infected cases worldwide. Without global travel restriction in the study setting, 98.62% of COVID-19 cases could be avoided by public health countermeasures in China only compared with non-interventions at all. CONCLUSIONS: Public health countermeasures were generally more effective than travel restrictions in many countries, suggesting multinational collaborations in the public health communities in response to this novel global health challenge.


Subject(s)
COVID-19 , Pandemics , China/epidemiology , Humans , Public Health , SARS-CoV-2 , Travel
6.
J Health Psychol ; : 13591053211003125, 2021 Apr 28.
Article in English | MEDLINE | ID: covidwho-1206119

ABSTRACT

The study explored how traditional and social media use produced various cognitive responses toward COVID-19, including perceived severity, susceptibility, and efficacy, and direct and indirect facilitation of COVID-19 preventive behaviors. We tested the hypotheses on data collected from 433 university students in Wuhan, China, using structural equation modeling. We found that traditional media enhanced engagement for preventive behaviors both directly and indirectly by enhancing perceived severity and efficacy, whereas social media showed no impact on preventive behaviors, either directly or indirectly. Furthermore, the direct effect of traditional media on preventive behaviors was markedly stronger than the indirect effect through perceptions.

8.
Lancet Reg Health West Pac ; 7: 100092, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1045136

ABSTRACT

Background: Recurring outbreaks of infectious diseases highlight the importance of population vaccination strategies. We aimed to assess the impact of national vaccination strategies on vaccine-preventable infectious diseases (VPDs) in Shanghai, China and to identify vulnerable groups that may benefit from future vaccination policies. Methods: Infectious disease data from 1953 to 2018 was obtained from Xuhui District Center for Disease Control and Prevention, Shanghai China. We used joinpoint regression to show incidence, mortality and fatality trends and to determine annual percent change in incidence of 12 VPDs among three eras of national immunization strategies: (1)1953-1977, (2)1978-2007, and(3)2008-2018. Findings: Incidence, mortality, and fatality from VPDs have decreased drastically over the three eras, despite the inclusion of more diseases over time. Strikingly, the overall yearly incidence of VPDs shows an increasing trend from 2000 to 2018 in Shanghai (annual percentage changes, APC:7.7, p = 0.025). In the third era (2008-2018), the three VPDs with the highest incidence were varicella (80.2 cases/100,000), hand, foot, and mouth disease (HFMD) (73.6 cases/100,000), and hepatitis (43.5 cases/100,000). A significant upward trend was also observed in hepatitis (APC:24.9, p<0.001), varicella (APC:5.9, p = 0.006), and HFMD (APC:11.8, p = 0.003) from 2008-2018. Hepatitis and tuberculosis are the only VPDs with fatality cases in this period. Interpretation: Focus is needed in controlling adult hepatitis and tuberculosis, either by introducing adult booster vaccines or by research into more effective vaccines. Varicella and HFMD are on the rise, but vaccines for these are not included in national programs. Strategies funded by government agencies or encouraged by research incentives are needed for varicella and HFMD, such as two-dose and novel multi-valent vaccines, respectively. Funding: Chinese Ministry of Education, Shanghai Municipal Government.

9.
J Med Virol ; 92(11): 2536-2542, 2020 11.
Article in English | MEDLINE | ID: covidwho-935115

ABSTRACT

Although emerging data demonstrated mortality of young COVID-19 patients, no data have reported the risk factors of mortality for these young patients, and whether obesity is a risk for young COVID-19 patients remains unknown. We conducted a retrospective study including 13 young patients who died of COVID-19 and 40 matched survivors. Logistic regression was employed to characterize the risk factors of mortality in young obese COVID-19 patients. Most of the young deceased COVID-19 patients were mild cases at the time of admission, but the disease progressed rapidly featured by a higher severity of patchy shadows (100.00% vs 48.70%; P = .006), pleural thickening (61.50% vs 12.80%; P = .012), and mild pericardial effusion (76.90% vs 0.00%; P < .001). Most importantly, the deceased patients manifested higher body mass index (odds ratio [OR] = 1.354; 95% confidence interval [CI] = 1.075-1.704; P = .010), inflammation-related index C-reactive protein (OR = 1.014; 95% CI = 1.003-1.025; P = .014), cardiac injury biomarker hs-cTnI (OR = 1.420; 95% CI = 1.112-1.814; P = .005), and increased coagulation activity biomarker D-dimer (OR = 418.7; P = .047), as compared with that of survivors. Our data support that obesity could be a risk factor associated with high mortality in young COVID-19 patients, whereas aggravated inflammatory response, enhanced cardiac injury, and increased coagulation activity are likely to be the mechanisms contributing to the high mortality.


Subject(s)
Body Mass Index , COVID-19/mortality , Disease Progression , Obesity/complications , Adolescent , Adult , Age Factors , COVID-19/diagnostic imaging , China , Disease Susceptibility , Female , Hospitalization/statistics & numerical data , Humans , Inflammation/virology , Male , Middle Aged , Odds Ratio , Prognosis , Retrospective Studies , Risk Factors , Tomography, X-Ray Computed , Young Adult
11.
Lancet ; 395(10236): 1569-1578, 2020 05 16.
Article in English | MEDLINE | ID: covidwho-824547

ABSTRACT

BACKGROUND: No specific antiviral drug has been proven effective for treatment of patients with severe coronavirus disease 2019 (COVID-19). Remdesivir (GS-5734), a nucleoside analogue prodrug, has inhibitory effects on pathogenic animal and human coronaviruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro, and inhibits Middle East respiratory syndrome coronavirus, SARS-CoV-1, and SARS-CoV-2 replication in animal models. METHODS: We did a randomised, double-blind, placebo-controlled, multicentre trial at ten hospitals in Hubei, China. Eligible patients were adults (aged ≥18 years) admitted to hospital with laboratory-confirmed SARS-CoV-2 infection, with an interval from symptom onset to enrolment of 12 days or less, oxygen saturation of 94% or less on room air or a ratio of arterial oxygen partial pressure to fractional inspired oxygen of 300 mm Hg or less, and radiologically confirmed pneumonia. Patients were randomly assigned in a 2:1 ratio to intravenous remdesivir (200 mg on day 1 followed by 100 mg on days 2-10 in single daily infusions) or the same volume of placebo infusions for 10 days. Patients were permitted concomitant use of lopinavir-ritonavir, interferons, and corticosteroids. The primary endpoint was time to clinical improvement up to day 28, defined as the time (in days) from randomisation to the point of a decline of two levels on a six-point ordinal scale of clinical status (from 1=discharged to 6=death) or discharged alive from hospital, whichever came first. Primary analysis was done in the intention-to-treat (ITT) population and safety analysis was done in all patients who started their assigned treatment. This trial is registered with ClinicalTrials.gov, NCT04257656. FINDINGS: Between Feb 6, 2020, and March 12, 2020, 237 patients were enrolled and randomly assigned to a treatment group (158 to remdesivir and 79 to placebo); one patient in the placebo group who withdrew after randomisation was not included in the ITT population. Remdesivir use was not associated with a difference in time to clinical improvement (hazard ratio 1·23 [95% CI 0·87-1·75]). Although not statistically significant, patients receiving remdesivir had a numerically faster time to clinical improvement than those receiving placebo among patients with symptom duration of 10 days or less (hazard ratio 1·52 [0·95-2·43]). Adverse events were reported in 102 (66%) of 155 remdesivir recipients versus 50 (64%) of 78 placebo recipients. Remdesivir was stopped early because of adverse events in 18 (12%) patients versus four (5%) patients who stopped placebo early. INTERPRETATION: In this study of adult patients admitted to hospital for severe COVID-19, remdesivir was not associated with statistically significant clinical benefits. However, the numerical reduction in time to clinical improvement in those treated earlier requires confirmation in larger studies. FUNDING: Chinese Academy of Medical Sciences Emergency Project of COVID-19, National Key Research and Development Program of China, the Beijing Science and Technology Project.


Subject(s)
Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Antiviral Agents/therapeutic use , Coronavirus Infections/drug therapy , Pneumonia, Viral/drug therapy , Adenosine Monophosphate/adverse effects , Adenosine Monophosphate/therapeutic use , Aged , Alanine/adverse effects , Alanine/therapeutic use , Antiviral Agents/adverse effects , Betacoronavirus , COVID-19 , China , Double-Blind Method , Female , Humans , Infusions, Intravenous , Male , Middle Aged , Negative Results , Pandemics , SARS-CoV-2
13.
Preprint | SSRN | ID: ppcovidwho-893

ABSTRACT

Background: Novel coronavirus disease COVID-19 has caused great damage to global public health. Wuhan is the first outbreak city in China, with the obviously

16.
Respiration ; 99(8): 649-657, 2020.
Article in English | MEDLINE | ID: covidwho-742293

ABSTRACT

BACKGROUND: A new virus broke out in Wuhan, Hubei, China, that was later named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical characteristics of severe pneumonia caused by SARS-CoV-2 are still not clear. OBJECTIVES: The aim of this study was to explore the clinical characteristics and risk factors of severe pneumonia caused by the SARS-CoV-2 in Wuhan, China. METHODS: The study included patients hospitalized at the Central Hospital of Wuhan who were diagnosed with COVID-19. Clinical features, chronic comorbidities, demographic data, laboratory examinations, and chest computed tomography (CT) scans were reviewed through electronic medical records. SPSS was used for data analysis to explore the clinical characteristics and risk factors of patients with severe pneumonia caused by SARS-CoV-2. RESULTS: A total of 110 patients diagnosed with COVID-19 were included in the study, including 38 with severe pneumonia and 72 with nonsevere pneumonia. Statistical analysis showed that advanced age, increased D-Dimer, and decreased lymphocytes were characteristics of the patients with severe pneumonia. Moreover, in the early stage of the disease, chest CT scans of patients with severe pneumonia showed that the illness can progress rapidly. CONCLUSIONS: Advanced age, decreased lymphocytes, and D-Dimer elevation are important characteristics of patients with severe COVID-19. Clinicians should focus on these characteristics to identify high-risk patients at an early stage.


Subject(s)
Coronavirus Infections/blood , Fibrin Fibrinogen Degradation Products/metabolism , Lung/diagnostic imaging , Lymphocyte Count , Pneumonia, Viral/blood , APACHE , Adult , Age Factors , Betacoronavirus , C-Reactive Protein/metabolism , COVID-19 , China/epidemiology , Comorbidity , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Cough/physiopathology , Disease Progression , Dyspnea/physiopathology , Fatigue/physiopathology , Female , Fever/physiopathology , Humans , Hypertension/epidemiology , Male , Middle Aged , Natriuretic Peptide, Brain/blood , Organ Dysfunction Scores , Pandemics , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Procalcitonin/blood , Pulmonary Disease, Chronic Obstructive/epidemiology , Respiratory Distress Syndrome/blood , Respiratory Distress Syndrome/diagnostic imaging , Respiratory Distress Syndrome/epidemiology , Risk Assessment , SARS-CoV-2 , Serum Albumin/metabolism , Severity of Illness Index , Sex Factors , Tomography, X-Ray Computed
17.
Crit Care Med ; 48(11): e1079-e1086, 2020 11.
Article in English | MEDLINE | ID: covidwho-725837

ABSTRACT

OBJECTIVES: An ongoing outbreak of coronavirus disease 2019 is spreading globally. Acute hypoxemic respiratory failure is the most common complication of coronavirus disease 2019. However, the clinical effectiveness of early high-flow nasal oxygen treatment in patients with coronavirus disease 2019 with acute hypoxemic respiratory failure has not been explored. This study aimed to analyze the effectiveness of high-flow nasal oxygen treatment and to identify the variables predicting high-flow nasal oxygen treatment failure in coronavirus disease 2019 patients with acute hypoxemic respiratory failure. DESIGN: A multicenter, retrospective cohort study. SETTING: Three tertiary hospitals in Wuhan, China. PATIENTS: Forty-three confirmed coronavirus disease 2019 adult patients with acute hypoxemic respiratory failure treated with high-flow nasal oxygen. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Mean age of the enrolled patients was 63.0 ± 9.7 years; female patients accounted for 41.9%. High-flow nasal oxygen failure (defined as upgrading respiratory support to positive pressure ventilation or death) was observed in 20 patients (46.5%), of which 13 (30.2%) required endotracheal intubation. Patients with high-flow nasal oxygen success had a higher median oxygen saturation (96.0% vs 93.0%; p < 0.001) at admission than those with high-flow nasal oxygen failure. High-flow nasal oxygen failure was more likely in patients who were older (p = 0.030) and male (p = 0.037), had a significant increase in respiratory rate and a significant decrease in the ratio of oxygen saturation/FIO2 to respiratory rate index within 3 days of high-flow nasal oxygen treatment. In a multivariate logistic regression analysis model, male and lower oxygen saturation at admission remained independent predictors of high-flow nasal oxygen failure. The hospital mortality rate of the cohort was 32.5%; however, the hospital mortality rate in patients with high-flow nasal oxygen failure was 65%. CONCLUSIONS: High-flow nasal oxygen may be effective for treating coronavirus disease 2019 patients with mild to moderate acute hypoxemic respiratory failure. However, high-flow nasal oxygen failure was associated with a poor prognosis. Male and lower oxygenation at admission were the two strong predictors of high-flow nasal oxygen failure.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Hypoxia/therapy , Intubation, Intratracheal/methods , Pneumonia, Viral/therapy , Adult , Aged , COVID-19 , Cohort Studies , Coronavirus Infections/complications , Female , Humans , Hypoxia/etiology , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Positive-Pressure Respiration , Respiratory Insufficiency/therapy , Retrospective Studies , SARS-CoV-2
18.
Symmetry-Basel ; 12(7), 2020.
Article | WHO COVID | ID: covidwho-724729

ABSTRACT

The infectious disease COVID-19 has swept across the world in 2020, and it continues to cause massive losses of life and severe economic problems in all countries. Providing emergency supplies such as protective medical equipment and materials required to secure people's livelihood is thus currently prioritized by governments. Establishing a reliable emergency logistics system is critical in this regard. This paper used the Delphi method to design a formal decision structure to assess emergency logistics system reliability (ELSR) by obtaining a consensus from a panel of experts. Assessing ELSR is a typical multiple-attribute decision making (MADM) problem, and the related MADM methods are usually on the basis of symmetry principles. A hybrid MADM model, called the Decision Making Trial and Evaluation Laboratory (DEMATEL)-based Analytical Network Process (D-ANP), was developed to identify the critical factors influencing ELSR. An analysis of empirical evidence showed that the emergency logistics command and coordination system and the emergency material supply system play important roles in ELSR, while the emergency logistics transportation and distribution system and the emergency information system are not so important. This conclusion is different from previous research about traditional disaster emergency logistics. Moreover, the cause-effect relationships among the key factors indicated that the system of command and coordination for emergency logistics and the supply system for emergency materials should be improved. Accordingly, effective suggestions for emergency logistics services for epidemic prevention are provided in this paper. The main contributions of this paper are (1) establishing a comprehensive and systematic evaluating index of ELSR for epidemic prevention;(2) employing a kind of structured, namely D-ANP, to identify the critical factors with non-commensurable and conflicting (competing) characteristics;and (3) comparing the differences of reliable criteria between the emergency logistics of epidemic prevention and the traditional disaster emergency logistics.

19.
Lancet ; 396(10249): 479-488, 2020 08 15.
Article in English | MEDLINE | ID: covidwho-666142

ABSTRACT

BACKGROUND: This is the first randomised controlled trial for assessment of the immunogenicity and safety of a candidate non-replicating adenovirus type-5 (Ad5)-vectored COVID-19 vaccine, aiming to determine an appropriate dose of the candidate vaccine for an efficacy study. METHODS: This randomised, double-blind, placebo-controlled, phase 2 trial of the Ad5-vectored COVID-19 vaccine was done in a single centre in Wuhan, China. Healthy adults aged 18 years or older, who were HIV-negative and previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection-free, were eligible to participate and were randomly assigned to receive the vaccine at a dose of 1 × 1011 viral particles per mL or 5 × 1010 viral particles per mL, or placebo. Investigators allocated participants at a ratio of 2:1:1 to receive a single injection intramuscularly in the arm. The randomisation list (block size 4) was generated by an independent statistician. Participants, investigators, and staff undertaking laboratory analyses were masked to group allocation. The primary endpoints for immunogenicity were the geometric mean titres (GMTs) of specific ELISA antibody responses to the receptor binding domain (RBD) and neutralising antibody responses at day 28. The primary endpoint for safety evaluation was the incidence of adverse reactions within 14 days. All recruited participants who received at least one dose were included in the primary and safety analyses. This study is registered with ClinicalTrials.gov, NCT04341389. FINDINGS: 603 volunteers were recruited and screened for eligibility between April 11 and 16, 2020. 508 eligible participants (50% male; mean age 39·7 years, SD 12·5) consented to participate in the trial and were randomly assigned to receive the vaccine (1 × 1011 viral particles n=253; 5 × 1010 viral particles n=129) or placebo (n=126). In the 1 × 1011 and 5 × 1010 viral particles dose groups, the RBD-specific ELISA antibodies peaked at 656·5 (95% CI 575·2-749·2) and 571·0 (467·6-697·3), with seroconversion rates at 96% (95% CI 93-98) and 97% (92-99), respectively, at day 28. Both doses of the vaccine induced significant neutralising antibody responses to live SARS-CoV-2, with GMTs of 19·5 (95% CI 16·8-22·7) and 18·3 (14·4-23·3) in participants receiving 1 × 1011 and 5 × 1010 viral particles, respectively. Specific interferon γ enzyme-linked immunospot assay responses post vaccination were observed in 227 (90%, 95% CI 85-93) of 253 and 113 (88%, 81-92) of 129 participants in the 1 × 1011 and 5 × 1010 viral particles dose groups, respectively. Solicited adverse reactions were reported by 183 (72%) of 253 and 96 (74%) of 129 participants in the 1 × 1011 and 5 × 1010 viral particles dose groups, respectively. Severe adverse reactions were reported by 24 (9%) participants in the 1 × 1011 viral particles dose group and one (1%) participant in the 5 × 1010 viral particles dose group. No serious adverse reactions were documented. INTERPRETATION: The Ad5-vectored COVID-19 vaccine at 5 × 1010 viral particles is safe, and induced significant immune responses in the majority of recipients after a single immunisation. FUNDING: National Key R&D Programme of China, National Science and Technology Major Project, and CanSino Biologics.


Subject(s)
Betacoronavirus/immunology , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Viral Vaccines/adverse effects , Viral Vaccines/immunology , Adenoviridae , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Antibodies, Neutralizing/blood , Antibodies, Viral/blood , COVID-19 , COVID-19 Vaccines , China , Coronavirus Infections/immunology , Double-Blind Method , Female , Genetic Vectors , Humans , Male , Middle Aged , SARS-CoV-2 , Spike Glycoprotein, Coronavirus/immunology , T-Lymphocytes/immunology , Viral Vaccines/administration & dosage , Young Adult
20.
Respir Res ; 21(1): 172, 2020 Jul 06.
Article in English | MEDLINE | ID: covidwho-656136

ABSTRACT

BACKGROUND: Previous studies have shown that Coronavirus Disease 2019 (COVID-19) patients with underlying comorbidities can have worse outcomes. However, the effect of hypertension on outcomes of COVID-19 patients remains unclear. RESEARCH QUESTION: The aim of this study was to explore the effect of hypertension on the outcomes of patients with COVID-19 by using propensity score-matching (PSM) analysis. STUDY DESIGN AND METHODS: Participants enrolled in this study were patients with COVID-19 who had been hospitalized at the Central Hospital of Wuhan, China. Chronic comorbidities and laboratory and radiological data were reviewed; patient outcomes and lengths of stay were obtained from discharge records. We used the Cox proportional-hazard model (CPHM) to analyze the effect of hypertension on these patients' outcomes and PSM analysis to further validate the abovementioned effect. RESULTS: A total of 226 patients with COVID-19 were enrolled in this study, of whom 176 survived and 50 died. The proportion of patients with hypertension among non-survivors was higher than that among survivors (26.70% vs. 74.00%; P < 0.001). Results obtained via CPHM showed that hypertension could increase risk of mortality in COVID-19 patients (hazard ratio 3.317; 95% CI [1.709-6.440]; P < 0.001). Increased D-dimer levels and higher ratio of neutrophils to lymphocytes (N/L) were also found to increase these patients' mortality risk. After matching on propensity score, we still came to similar conclusions. After we applied the same method in critically ill patients, we found that hypertension also increased risk of death in patients with severe COVID-19. CONCLUSION: Hypertension, increased D-dimer and the ratio of neutrophil to lymphocyte increased mortality in patients with COVID-19, with hypertension in particular.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Hospital Mortality , Hypertension/epidemiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Adult , Age Factors , Aged , COVID-19 , COVID-19 Testing , China/epidemiology , Clinical Laboratory Techniques/methods , Cohort Studies , Comorbidity , Female , Follow-Up Studies , Hospitalization/statistics & numerical data , Humans , Hypertension/diagnosis , Kaplan-Meier Estimate , Male , Middle Aged , Pandemics , Propensity Score , Proportional Hazards Models , Retrospective Studies , Risk Assessment , Severity of Illness Index , Sex Factors , Survival Analysis , Survivors , Tertiary Care Centers
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