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1.
Am J Kidney Dis ; 2020 Jul 03.
Article in English | MEDLINE | ID: covidwho-628057

ABSTRACT

RATIONALE & OBJECTIVE: Patients receiving maintenance hemodialysis (MHD) are highly vulnerable to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The current study was designed to evaluate the prevalence of SARS-CoV-2 infection based on both nucleic acid testing (NAT) and antibody testing in Chinese patients receiving MHD. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: From Dec 1, 2019 to Mar 31, 2020, 1027 MHD patients in five large hemodialysis centers in Wuhan, China were enrolled. Patients were screened for SARS-CoV-2 infection by symptoms and initial chest computed tomography (CT). If patients developed symptoms after initial screening was negative, a repeat CT was obtained. Patients suspected of being infected with SARS-CoV-2 were tested with two consecutive throat swabs for viral RNA. In mid-March 2020 antibody testing for SARS-CoV-2 was obtained for all MHD patients. EXPOSURE: NAT and antibody test results for SARS-CoV-2. OUTCOMES: Morbidity, clinical features, laboratory and radiologic findings. ANALYTICAL APPROACH: Differences between groups were examined by Student's t-test or Mann-Whitney U test, comparing those not infected to those infected and comparing those with infection detected by NAT to those with infection detected by positive serology test results. RESULTS: Among 1027 patients receiving MHD, 99 were identified as having SARS-CoV-2 infection, for a prevalence of 9.6%. Among these 99 cases, 52 (53%) were initially diagnosed with SARS-CoV-2 infection by positive NAT; 47 (47%) were identified later by positive IgG or IgM antibodies against SARS-CoV-2. There was a spectrum of antibody profiles in these 47 patients: IgM antibodies in 5 (11%), IgG antibodies in 35 (74%), and both IgM and IgG antibodies in 7 (15%). Of the 99 cases, 51% were asymptomatic during the epidemic; 61% had ground-glass or patchy opacities on chest CT compared to 11.6% among uninfected patients (P<0.001). Patients with hypertensive kidney disease were more often found to have SARS-CoV-2 infection and they were more likely to be symptomatic than patients with another primary cause of kidney failure. LIMITATIONS: Possible false-positive and false-negative results for both NAT and antibody testing; possible lack of generalizability to other dialysis populations. CONCLUSIONS: Half of the SARS-CoV-2 infections in patients receiving MHD were subclinical and were not identified by universal chest CT and selective NAT. Serologic testing may help to evaluate the overall prevalence and understand the diversity of clinical courses among patients receiving MHD who are infected with SARS-CoV-2.

2.
J Med Internet Res ; 22(4): e18948, 2020 04 22.
Article in English | MEDLINE | ID: covidwho-62910

ABSTRACT

BACKGROUND: Coronavirus disease (COVID-19) has been an unprecedented challenge to the global health care system. Tools that can improve the focus of surveillance efforts and clinical decision support are of paramount importance. OBJECTIVE: The aim of this study was to illustrate how new medical informatics technologies may enable effective control of the pandemic through the development and successful 72-hour deployment of the Honghu Hybrid System (HHS) for COVID-19 in the city of Honghu in Hubei, China. METHODS: The HHS was designed for the collection, integration, standardization, and analysis of COVID-19-related data from multiple sources, which includes a case reporting system, diagnostic labs, electronic medical records, and social media on mobile devices. RESULTS: HHS supports four main features: syndromic surveillance on mobile devices, policy-making decision support, clinical decision support and prioritization of resources, and follow-up of discharged patients. The syndromic surveillance component in HHS covered over 95% of the population of over 900,000 people and provided near real time evidence for the control of epidemic emergencies. The clinical decision support component in HHS was also provided to improve patient care and prioritize the limited medical resources. However, the statistical methods still require further evaluations to confirm clinical effectiveness and appropriateness of disposition assigned in this study, which warrants further investigation. CONCLUSIONS: The facilitating factors and challenges are discussed to provide useful insights to other cities to build suitable solutions based on cloud technologies. The HHS for COVID-19 was shown to be feasible and effective in this real-world field study, and has the potential to be migrated.


Subject(s)
Cloud Computing , Coronavirus Infections/epidemiology , Decision Support Systems, Clinical , Pneumonia, Viral/epidemiology , Sentinel Surveillance , Betacoronavirus , China/epidemiology , Coronavirus , Delivery of Health Care , Humans , Mobile Applications , Pandemics , Patient Discharge , Public Health
3.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 51(2): 131-138, 2020 Mar.
Article in Chinese | MEDLINE | ID: covidwho-18396

ABSTRACT

This review summarizes the ongoing researches regarding etiology, epidemiology, transmission dynamics, treatment, and prevention and control strategies of the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with comparison to severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV) and pandemic H1N1 virus. SARS-CoV-2 may be originated from bats, and the patients and asymptomatic carriers are the source of epidemic infection. The virus can be transmitted human-to-human through droplets and close contact, and people at all ages are susceptible to this virus. The main clinical symptoms of the patients are fever and cough, accompanied with leukocytopenia and lymphocytopenia. Effective drugs have been not yet available thus far. In terms of the prevention and control strategies, vaccine development as the primary prevention should be accelerated. Regarding the secondary prevention, ongoing efforts of the infected patients and close contacts quarantine, mask wearing promotion, regular disinfection in public places should be continued. Meanwhile, rapid detection kit for serological monitoring of the virus in general population is expected so as to achieve early detection, early diagnosis, early isolation and early treatment. In addition, public health education on this disease and prevention should be enhanced so as to mitigate panic and mobilize the public to jointly combat the epidemic.


Subject(s)
Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , Asymptomatic Diseases , Betacoronavirus/pathogenicity , Clinical Laboratory Techniques , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Cough/etiology , Early Diagnosis , Fever/etiology , Humans , Influenza A Virus, H1N1 Subtype , Leukopenia/etiology , Lymphopenia/etiology , Middle East Respiratory Syndrome Coronavirus , Pandemics/prevention & control , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , SARS Virus , Secondary Prevention , Viral Vaccines
4.
Nat Med ; 26(4): 502-505, 2020 04.
Article in English | MEDLINE | ID: covidwho-10221

ABSTRACT

We report epidemiological and clinical investigations on ten pediatric SARS-CoV-2 infection cases confirmed by real-time reverse transcription PCR assay of SARS-CoV-2 RNA. Symptoms in these cases were nonspecific and no children required respiratory support or intensive care. Chest X-rays lacked definite signs of pneumonia, a defining feature of the infection in adult cases. Notably, eight children persistently tested positive on rectal swabs even after nasopharyngeal testing was negative, raising the possibility of fecal-oral transmission.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/virology , Feces/virology , Pneumonia, Viral/virology , Virus Shedding , Betacoronavirus/genetics , Child , Child, Preschool , Clinical Laboratory Techniques , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Female , Humans , Infant , Male , Nasopharynx/virology , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Radiography, Thoracic , Real-Time Polymerase Chain Reaction , Rectum/virology
5.
Chin. J. Evid.-Based Med. ; 2(20): 125-133, 2020.
Article in Chinese | ELSEVIER | ID: covidwho-3359

ABSTRACT

China is facing the serious situation of 2019-novel coronavirus (2019-nCoV) infection. The health care institutions have actively participated in the prevention, diagnosis, and treatment of the disease. Proper regulation of in-hospital policy may help control virus spreading. We developed seven key clinical questions about the prevention and control of 2019-novel coronavirus infection in a hospital, and provided recommendations based on the best available evidence and expert experience. We interpret the recommendations for better feasibility in Chinese hospital. We hope to provide evidence and reference for the domestic medical institutions to reasonably adjust the hospital workflow during 2019-nCoV infection period.

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