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2.
Clin Infect Dis ; 2020 May 30.
Article in English | MEDLINE | ID: covidwho-430202

ABSTRACT

BACKGROUND: The ongoing pandemic of novel coronavirus disease 2019 (COVID-19) is challenging global public health system. Sex-differences in infectious diseases are a common but neglected problem. METHODS: We used the national surveillance database of COVID-19 in mainland China to compared gender differences in attack rate (AR), proportion of severe and critical cases (PSCC) and case fatality rate (CFR) in relation to age, affected province, and onset-to-diagnosis interval. RESULTS: The overall AR was significantly higher in female population than in males (63.9 versus 60.5 per million persons; P ˂ .001). By contrast, PSCC and CFR were significantly lower among female patients (16.9% and 4.0%) than among males (19.5% and 7.2%), with ORs of 0.87 and 0.57, respectively (both P ˂ .001). The female-to-male differences were age-dependent, which were significant among people aged 50-69 years for AR, and in the patients of 30-years or older for both PSCC and CFR (all P ≤ .001). The AR, PSCC and CFR varied greatly from province to province. However, female-to-male differences in AR, PSCC and CFR were significant in the epicenter, Hubei province, where 82.2% confirmed cases and 97.4% deaths occurred. After adjusting for age, affected province and onset-to-diagnosis interval, the female-to-male difference in AR, PSCC and CFR remained significant in multivariate logistic regression analyses. CONCLUSIONS: We elucidate an age-dependent gender dimorphism for COVID-19, in which the females have higher susceptibility but lower severity and fatality. Further epidemiological and biological investigations are required to better understand the sex-specific differences for effective interventions.

3.
Chin. Trad. Herbal Drugs ; 6(51): 1435-1442, 20200328.
Article in Chinese | ELSEVIER | ID: covidwho-379970

ABSTRACT

For SARS-CoV-2-induced pneumonia, “Diagnosis and Treatment of Novel Coronavirus Pneumonia (trial version 3)” released by the National Health Commission of the People’s Republic of China and the National Administration of Traditional Chinese Medicine on January 22, 2020, first proposed the traditional Chinese medicine (TCM) treatment plan, which was gradually updated to the seventh edition. Patients diagnosed with severe COVID-19 often developed dyspnea and/or hypoxemia one week after onset, requiring respiratory support and circulation support. Through literature research, it was found that Chinese materia medica (CMM) with tonifying qi and activating blood effect could effectively improve hypoxemia of pneumonia-related diseases. This article summarizes the mechanism and clinical application of tonifying qi and activating blood CMM in the treatment of novel coronavirus pneumonia-associated hypoxemia, and provides a reference for clinical treatment of COVID-19.

4.
Chin. Trad. Herbal Drugs ; 6(51): 1463-1475, 20200328.
Article in Chinese | ELSEVIER | ID: covidwho-378454

ABSTRACT

The coronavirus disease 2019 (COVID-19) has been developing rapidly since the outbreak of Wuhan in December 2019. It has spread to many regions in the world in the short term, which has attracted wide attention at home and abroad. With the active intervention of traditional medicine, the epidemic situation has been effectively controlled, especially for the treatment of severe and critical patients, which shows its unique advantages. Since the outbreak of COVID-19, ethnic medical practitioners have made suggestions on the understanding and prevention measures of COVID-19 based on the theory of ethnic medicine. We should optimize the individual internal environment of patients with individualized traditional medicine prescription, combine the environmental factors such as the soil and space for the emergence and spread of the disease, and contribute our own strength to fighting against the epidemic as soon as possible and ensure the life and health of the minority people. It was suggested to set up a project to excavate, sort out, research and develop the preparations of medical institutions for the prevention and treatment of “pestilence” by national medicine, and make sufficient preparations for the prevention and treatment of “pestilence” caused by various viruses that may occur frequently, so as to protect human health.

5.
Emerg Microbes Infect ; 9(1): 1259-1268, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-342833

ABSTRACT

Quantitative real time PCR (RT-PCR) is widely used as the gold standard for clinical detection of SARS-CoV-2. However, due to the low viral load specimens and the limitations of RT-PCR, significant numbers of false negative reports are inevitable, which results in failure to timely diagnose, cut off transmission, and assess discharge criteria. To improve this situation, an optimized droplet digital PCR (ddPCR) was used for detection of SARS-CoV-2, which showed that the limit of detection of ddPCR is significantly lower than that of RT-PCR. We further explored the feasibility of ddPCR to detect SARS-CoV-2 RNA from 77 patients, and compared with RT-PCR in terms of the diagnostic accuracy based on the results of follow-up survey. 26 patients of COVID-19 with negative RT-PCR reports were reported as positive by ddPCR. The sensitivity, specificity, PPV, NPV, negative likelihood ratio (NLR) and accuracy were improved from 40% (95% CI: 27-55%), 100% (95% CI: 54-100%), 100%, 16% (95% CI: 13-19%), 0.6 (95% CI: 0.48-0.75) and 47% (95% CI: 33-60%) for RT-PCR to 94% (95% CI: 83-99%), 100% (95% CI: 48-100%), 100%, 63% (95% CI: 36-83%), 0.06 (95% CI: 0.02-0.18), and 95% (95% CI: 84-99%) for ddPCR, respectively. Moreover, 6/14 (42.9%) convalescents were detected as positive by ddPCR at 5-12 days post discharge. Overall, ddPCR shows superiority for clinical diagnosis of SARS-CoV-2 to reduce the false negative reports, which could be a powerful complement to the RT-PCR.


Subject(s)
Betacoronavirus/genetics , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Real-Time Polymerase Chain Reaction/methods , False Negative Reactions , Humans , Limit of Detection , Pandemics , RNA, Viral/genetics , Viral Load/methods
6.
J Neurovirol ; 26(3): 456-458, 2020 06.
Article in English | MEDLINE | ID: covidwho-291173

ABSTRACT

Three patients of coronavirus disease (COVID-19) showed the symptoms of olfactory dysfunction. Clinical characteristics and treatment were retrospective analyzed. Olfactory disorders are uncommon symptoms of COVID-19 in China. Early diagnosis and intervention are keys to the recovery of olfactory disorders. Particular attention should be devoted to olfactory dysfunction.


Subject(s)
Antiviral Agents/therapeutic use , Coronavirus Infections/physiopathology , Olfaction Disorders/physiopathology , Pneumonia, Viral/physiopathology , Taste Disorders/physiopathology , Vitamin B 12/analogs & derivatives , Adolescent , Adult , Betacoronavirus/drug effects , Betacoronavirus/pathogenicity , China , Cobicistat/therapeutic use , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Darunavir/therapeutic use , Female , Humans , Indoles/therapeutic use , Male , Methylprednisolone/therapeutic use , Olfaction Disorders/diagnosis , Olfaction Disorders/drug therapy , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/drug therapy , Taste Disorders/diagnosis , Taste Disorders/drug therapy , Treatment Outcome , Vitamin B 12/therapeutic use
7.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(3): 342-345, 2020 Mar 30.
Article in Chinese | MEDLINE | ID: covidwho-210236

ABSTRACT

OBJECTIVE: To investigate the effect of heat inactivation (56℃for 30 min) of SARS-CoV-2 on the results of therapeuticdrug monitoring (TDM) of voriconazole by liquid chromatography tandem mass spectrometry (LC-MS/MS). METHODS: We collected clinical blood samples from voriconazole-treated patients in heparinized tubes and sterilized the surface of the tubes with 75% ethanol. The whole blood samples were centrifuged to separate the plasma with or without prior heat inactivation, or only the separated plasma was heat inactivated. Heat inactivation of the samples was carried out at 56 ℃ for 30 min followed by protein precipitation with acetonitrile or ethanol. The plasma standard and quality control samples were inactivated in an identical manner and tested with LC-MS/MS along with the treated samples. RESULTS: The optimized method showed a high imprecision (with mean intra- and inter-day imprecisions of 3.59% and 2.81%, respectively) and a high accuracy (mean 97.37%) for detecting voriconazole in the inactivated samples at different concentration levels. Sample preparation with acetonitrile or ethanol resulted in a high mean recovery (100.56% or 95.90%) with minimal mean matrix effect (102.85% or 93.62%). The measured voriconazole concentrations in inactivated whole blood, inactivated plasma and the samples without inactivation all showed good linear correlations with correlation coefficients all greater than 0.99. CONCLUSIONS: Heat inactivation at 56 ℃ for 30 min combined with ethanol sample preparation only has limited effects to affect LC-MS-based voriconazole concentration measurement in whole blood samples collected in heparinized tubes, and can be used for therapeutic drug monitoring of voriconazole during the ongoing COVID-19 pandemic.


Subject(s)
Betacoronavirus , Coronavirus Infections , Drug Monitoring , Pandemics , Pneumonia, Viral , Tandem Mass Spectrometry , Voriconazole/therapeutic use , Chromatography, High Pressure Liquid , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Hot Temperature , Humans , Pneumonia, Viral/drug therapy , Pneumonia, Viral/epidemiology , Reproducibility of Results
8.
Nature ; 582(7813): 557-560, 2020 06.
Article in English | MEDLINE | ID: covidwho-137432

ABSTRACT

The ongoing outbreak of coronavirus disease 2019 (COVID-19) has spread rapidly on a global scale. Although it is clear that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted through human respiratory droplets and direct contact, the potential for aerosol transmission is poorly understood1-3. Here we investigated the aerodynamic nature of SARS-CoV-2 by measuring viral RNA in aerosols in different areas of two Wuhan hospitals during the outbreak of COVID-19 in February and March 2020. The concentration of SARS-CoV-2 RNA in aerosols that was detected in isolation wards and ventilated patient rooms was very low, but it was higher in the toilet areas used by the patients. Levels of airborne SARS-CoV-2 RNA in the most public areas was undetectable, except in two areas that were prone to crowding; this increase was possibly due to individuals infected with SARS-CoV-2 in the crowd. We found that some medical staff areas initially had high concentrations of viral RNA with aerosol size distributions that showed peaks in the submicrometre and/or supermicrometre regions; however, these levels were reduced to undetectable levels after implementation of rigorous sanitization procedures. Although we have not established the infectivity of the virus detected in these hospital areas, we propose that SARS-CoV-2 may have the potential to be transmitted through aerosols. Our results indicate that room ventilation, open space, sanitization of protective apparel, and proper use and disinfection of toilet areas can effectively limit the concentration of SARS-CoV-2 RNA in aerosols. Future work should explore the infectivity of aerosolized virus.


Subject(s)
Aerosols/analysis , Aerosols/chemistry , Bathroom Equipment , Betacoronavirus/isolation & purification , Coronavirus Infections/virology , Hospitals , Pneumonia, Viral/virology , Workplace , Betacoronavirus/genetics , China/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Crowding , Disinfection , Humans , Intensive Care Units , Masks , Medical Staff , Pandemics/prevention & control , Patients/statistics & numerical data , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , RNA, Viral/analysis , Social Isolation , Ventilation
9.
Gut ; 69(6): 997-1001, 2020 06.
Article in English | MEDLINE | ID: covidwho-30893

ABSTRACT

OBJECTIVE: To study the GI symptoms in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients. DESIGN: We analysed epidemiological, demographic, clinical and laboratory data of 95 cases with SARS-CoV-2 caused coronavirus disease 2019. Real-time reverse transcriptase PCR was used to detect the presence of SARS-CoV-2 in faeces and GI tissues. RESULTS: Among the 95 patients, 58 cases exhibited GI symptoms of which 11 (11.6%) occurred on admission and 47 (49.5%) developed during hospitalisation. Diarrhoea (24.2%), anorexia (17.9%) and nausea (17.9%) were the main symptoms with five (5.3%), five (5.3%) and three (3.2%) cases occurred on the illness onset, respectively. A substantial proportion of patients developed diarrhoea during hospitalisation, potentially aggravated by various drugs including antibiotics. Faecal samples of 65 hospitalised patients were tested for the presence of SARS-CoV-2, including 42 with and 23 without GI symptoms, of which 22 (52.4%) and 9 (39.1%) were positive, respectively. Six patients with GI symptoms were subjected to endoscopy, revealing oesophageal bleeding with erosions and ulcers in one severe patient. SARS-CoV-2 RNA was detected in oesophagus, stomach, duodenum and rectum specimens for both two severe patients. In contrast, only duodenum was positive in one of the four non-severe patients. CONCLUSIONS: GI tract may be a potential transmission route and target organ of SARS-CoV-2.


Subject(s)
Betacoronavirus , Coronavirus Infections , Gastrointestinal Tract , Pandemics , Pneumonia, Viral , Adult , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Female , Gastrointestinal Tract/physiopathology , Gastrointestinal Tract/virology , Humans , Male , Middle Aged , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology
10.
Emerg Microbes Infect ; 9(1): 761-770, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-29222

ABSTRACT

Circulating in China and 158 other countries and areas, the ongoing COVID-19 outbreak has caused devastating mortality and posed a great threat to public health. However, efforts to identify effectively supportive therapeutic drugs and treatments has been hampered by our limited understanding of host immune response for this fatal disease. To characterize the transcriptional signatures of host inflammatory response to SARS-CoV-2 (HCoV-19) infection, we carried out transcriptome sequencing of the RNAs isolated from the bronchoalveolar lavage fluid (BALF) and peripheral blood mononuclear cells (PBMC) specimens of COVID-19 patients. Our results reveal distinct host inflammatory cytokine profiles to SARS-CoV-2 infection in patients, and highlight the association between COVID-19 pathogenesis and excessive cytokine release such as CCL2/MCP-1, CXCL10/IP-10, CCL3/MIP-1A, and CCL4/MIP1B. Furthermore, SARS-CoV-2 induced activation of apoptosis and P53 signalling pathway in lymphocytes may be the cause of patients' lymphopenia. The transcriptome dataset of COVID-19 patients would be a valuable resource for clinical guidance on anti-inflammatory medication and understanding the molecular mechansims of host response.


Subject(s)
Bronchoalveolar Lavage Fluid , Chemokines/analysis , Coronavirus Infections/genetics , Cytokines/analysis , Leukocytes, Mononuclear , Pneumonia, Viral/genetics , Transcriptome , Apoptosis , Betacoronavirus , Coronavirus Infections/blood , Coronavirus Infections/immunology , Humans , Lymphopenia , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/immunology , RNA-Seq , Signal Transduction , Tumor Suppressor Protein p53
11.
N Engl J Med ; 382(13): 1199-1207, 2020 03 26.
Article in English | MEDLINE | ID: covidwho-57

ABSTRACT

BACKGROUND: The initial cases of novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, Hubei Province, China, in December 2019 and January 2020. We analyzed data on the first 425 confirmed cases in Wuhan to determine the epidemiologic characteristics of NCIP. METHODS: We collected information on demographic characteristics, exposure history, and illness timelines of laboratory-confirmed cases of NCIP that had been reported by January 22, 2020. We described characteristics of the cases and estimated the key epidemiologic time-delay distributions. In the early period of exponential growth, we estimated the epidemic doubling time and the basic reproductive number. RESULTS: Among the first 425 patients with confirmed NCIP, the median age was 59 years and 56% were male. The majority of cases (55%) with onset before January 1, 2020, were linked to the Huanan Seafood Wholesale Market, as compared with 8.6% of the subsequent cases. The mean incubation period was 5.2 days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of the distribution at 12.5 days. In its early stages, the epidemic doubled in size every 7.4 days. With a mean serial interval of 7.5 days (95% CI, 5.3 to 19), the basic reproductive number was estimated to be 2.2 (95% CI, 1.4 to 3.9). CONCLUSIONS: On the basis of this information, there is evidence that human-to-human transmission has occurred among close contacts since the middle of December 2019. Considerable efforts to reduce transmission will be required to control outbreaks if similar dynamics apply elsewhere. Measures to prevent or reduce transmission should be implemented in populations at risk. (Funded by the Ministry of Science and Technology of China and others.).


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Disease Transmission, Infectious/statistics & numerical data , Epidemics , Infectious Disease Incubation Period , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Adolescent , Adult , Aged , Betacoronavirus/genetics , China/epidemiology , Communicable Disease Control/methods , Coronavirus Infections/virology , Disease Transmission, Infectious/prevention & control , Epidemics/prevention & control , Female , Humans , Incidence , Male , Middle Aged , Pandemics , Pneumonia, Viral/virology , Polymerase Chain Reaction , Young Adult
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