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2.
National Science Review ; 2020.
Article | WHO COVID | ID: covidwho-741893

ABSTRACT

Targeted immunization of centralized nodes in large-scale networks has attracted significant attention However, in real-world scenarios, knowledge and observations of the network may be limited thereby precluding a full assessment of the optimal nodes to immunize (or quarantine) in order to avoid epidemic spreading such as that of the current COVID-19 epidemic Here, we study a novel immunization strategy where only n nodes are observed at a time and the most central among these n nodes is immunized This process can globally immunize a network We find that even for small n (≈10) there is significant improvement in the immunization (quarantine) which is very close to the levels of an immunization with full knowledge We develop an analytical framework for our method and determine the critical percolation threshold pc and the size of the giant component P∞ for networks with arbitrary degree distributions P(k) In the limit of n → ∞ we recover prior work on targeted immunization, whereas for n = 1 we recover the known case of random immunization Between these two extremes, we observe that as n increases, pc increases quickly towards its optimal value under targeted immunization with complete information In particular, we find a new general scaling relationship between ;pc(∞) − pc(n);and n as ;pc(∞) − pc(n);∼ n−1exp ( − αn) For Scale-free (SF) networks, where P(k) ∼ k−γ, 2 <γ <3, we find that pc has a transition from zero to non-zero when n increases from n = 1 to O(log N) (where N is the size of network) Thus, for SF networks, having knowledge of ≈log N nodes and immunizing them can dramatically reduce epidemic spreading We also demonstrate our limited knowledge immunization strategy on several real-world networks and confirm that in these real networks, pc increases significantly even for small n

3.
Medicine (Baltimore) ; 99(33): e21484, 2020 Aug 14.
Article in English | MEDLINE | ID: covidwho-740193

ABSTRACT

BACKGROUND: The objective of this study is to investigate the effects of humanistic care and psychological counseling (HCPC) on psychological disorders (PD) in medical students after coronavirus disease 2019 (COVID-19) outbreak. METHODS: We will search randomized controlled trials or case-controlled studies of HCPC on PD in medical students after COVID-19 outbreak in the following electronic databases: PUBMED/MEDLINE, EMBASE, Cochrane Library, CINAHL, AMED, WANGFANG, and CNKI. The time is restricted from the construction of each database to the present. All process of study selection, data collection, and study quality evaluation will be carried out by two independent authors. Any different opinions will be solved by a third author through discussion. We will employ RevMan 5.3 software to conduct statistical analysis. RESULTS: This study will provide a better understanding of HCPC on PD in medical students after COVID-19 outbreak. CONCLUSIONS: This study may offer strong evidence for clinical practice to treat PD in medical students after COVID-19 outbreak. STUDY REGISTRATION: CRD42020193199.


Subject(s)
Coronavirus Infections/psychology , Counseling/methods , Mental Disorders/therapy , Pneumonia, Viral/psychology , Psychotherapy/methods , Students, Medical/psychology , Adult , Betacoronavirus , Case-Control Studies , Female , Humanism , Humans , Male , Mental Disorders/psychology , Pandemics , Randomized Controlled Trials as Topic , Research Design , Systematic Reviews as Topic , Young Adult
4.
JAMA Intern Med ; 2020 Sep 01.
Article in English | MEDLINE | ID: covidwho-738931

ABSTRACT

Importance: Evidence of whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), can be transmitted as an aerosol (ie, airborne) has substantial public health implications. Objective: To investigate potential transmission routes of SARS-CoV-2 infection with epidemiologic evidence from a COVID-19 outbreak. Design, Setting, and Participants: This cohort study examined a community COVID-19 outbreak in Zhejiang province. On January 19, 2020, 128 individuals took 2 buses (60 [46.9%] from bus 1 and 68 [53.1%] from bus 2) on a 100-minute round trip to attend a 150-minute worship event. The source patient was a passenger on bus 2. We compared risks of SARS-CoV-2 infection among at-risk individuals taking bus 1 (n = 60) and bus 2 (n = 67 [source patient excluded]) and among all other individuals (n = 172) attending the worship event. We also divided seats on the exposed bus into high-risk and low-risk zones according to the distance from the source patient and compared COVID-19 risks in each zone. In both buses, central air conditioners were in indoor recirculation mode. Main Outcomes and Measures: SARS-CoV-2 infection was confirmed by reverse transcription polymerase chain reaction or by viral genome sequencing results. Attack rates for SARS-CoV-2 infection were calculated for different groups, and the spatial distribution of individuals who developed infection on bus 2 was obtained. Results: Of the 128 participants, 15 (11.7%) were men, 113 (88.3%) were women, and the mean age was 58.6 years. On bus 2, 24 of the 68 individuals (35.3% [including the index patient]) received a diagnosis of COVID-19 after the event. Meanwhile, none of the 60 individuals in bus 1 were infected. Among the other 172 individuals at the worship event, 7 (4.1%) subsequently received a COVID-19 diagnosis. Individuals in bus 2 had a 34.3% (95% CI, 24.1%-46.3%) higher risk of getting COVID-19 compared with those in bus 1 and were 11.4 (95% CI, 5.1-25.4) times more likely to have COVID-19 compared with all other individuals attending the worship event. Within bus 2, individuals in high-risk zones had moderately, but nonsignificantly, higher risk for COVID-19 compared with those in the low-risk zones. The absence of a significantly increased risk in the part of the bus closer to the index case suggested that airborne spread of the virus may at least partially explain the markedly high attack rate observed. Conclusions and Relevance: In this cohort study and case investigation of a community outbreak of COVID-19 in Zhejiang province, individuals who rode a bus to a worship event with a patient with COVID-19 had a higher risk of SARS-CoV-2 infection than individuals who rode another bus to the same event. Airborne spread of SARS-CoV-2 seems likely to have contributed to the high attack rate in the exposed bus. Future efforts at prevention and control must consider the potential for airborne spread of the virus.

5.
Aging Clin Exp Res ; 2020 Jul 30.
Article in English | MEDLINE | ID: covidwho-689020

ABSTRACT

BACKGROUND: At present, novel coronavirus disease 2019 (COVID-19) has become a serious global public health problem. The current meta-analysis aimed to find risk factors for the COVID-19-related death, helping to enhance the efficacy and reduce the mortality of COVID-19. METHODS: We searched PubMed, Embase, medRxiv, and Cochrane Library for articles published between January 1, 2020, and April 13, 2020. We statistically analyzed the risk factors of the COVID-19 deceased with meta-analysis. RESULTS: A total of 2401 patients in 15 articles were included in this study. Meta-analysis showed that 66.6% of COVID-19 deceased were male, with a median age of 69.9 years. Common symptoms of deceased included fever (70.6-100%), dyspnea (38.89-85.7%), cough (22.4-78%), and fatigue (22-61.9%). The incidence of hypertension, chronic cardiovascular disease, diabetes, and chronic cerebrovascular disease among the COVID-19 deceased were 38.56% (95% confidence interval (CI) 25.84 ~ 52.12%), 17.54% (95% CI 13.38 ~ 21.69%), 22.2% (95% CI 19.30 ~ 25.10%), and 15.58% (95% CI 10.05 ~ 21.12%), respectively. Compared with the surviving COVID-19 patients, the deceased had lower platelet levels (mean difference (MD) = - 39.35, 95% CI - 55.78 ~ - 22.93) and higher C-reactive protein (CRP) (MD = 80.85, 95% CI 62.53 ~ 99.18) and lactate dehydrogenase (LDH) (MD = 246.65, 95% CI 157.43 ~ 335.88) at admission. The most common complications of the deceased were acute respiratory distress syndrome (ARDS) (OR = 100.36, 95% CI 64.44 ~ 156.32) and shock (OR = 96.60, 95% CI 23.80 ~ 392.14). CONCLUSION: Most of the COVID-19 deceased were elderly males. Fever, dyspnea, dry cough, fatigue, hypertension, chronic cardiovascular and cerebrovascular disease, diabetes, and laboratory examinations showed low levels of platelet content, increased CRP and LDH were associated with the risk of dying. ARDS and shock were risk factors for death in COVID-19 patients.

6.
J Infect Dis ; 221(11): 1762-1769, 2020 05 11.
Article in English | MEDLINE | ID: covidwho-688308

ABSTRACT

BACKGROUND: In December 2019, novel coronavirus (SARS-CoV-2) pneumonia (COVID-19) was reported in Wuhan and has since rapidly spread throughout China. We aimed to clarify the characteristics and clinical significance of peripheral lymphocyte subset alteration in COVID-19. METHODS: The levels of peripheral lymphocyte subsets were measured by flow cytometry in 60 hospitalized COVID-19 patients before and after treatment, and their association with clinical characteristics and treatment efficacy was analyzed. RESULTS: Total lymphocytes, CD4+ T cells, CD8+ T cells, B cells, and natural killer (NK) cells decreased in COVID-19 patients, and severe cases had a lower level than mild cases. The subsets showed a significant association with inflammatory status in COVID-19, especially CD8+ T cells and CD4+/CD8+ ratio. After treatment, 37 patients (67%) showed clinical response, with an increase in CD8+ T cells and B cells. No significant change in any subset was detected in nonresponsive cases. In multivariate analysis, posttreatment decrease in CD8+ T cells and B cells and increase in CD4+/CD8+ ratio were indicated as independent predictors of poor efficacy. CONCLUSIONS: Peripheral lymphocyte subset alteration was associated with clinical characteristics and treatment efficacy of COVID-19. CD8+ T cells tended to be an independent predictor for COVID-19 severity and treatment efficacy.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/physiopathology , Lymphocyte Subsets , Pneumonia, Viral/complications , Pneumonia, Viral/physiopathology , Pneumonia/etiology , Pneumonia/physiopathology , Adult , Aged , Betacoronavirus/isolation & purification , China , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Female , Flow Cytometry , Humans , Lymphocyte Count , Lymphocyte Subsets/immunology , Male , Middle Aged , Pandemics , Pneumonia/diagnosis , Pneumonia/therapy , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Prognosis , Treatment Outcome
7.
Int J Infect Dis ; 98: 80-83, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-597827

ABSTRACT

BACKGROUND: Since the outbreak of Coronavirus Disease 2019 (COVID-19) in Wuhan, considerable attention has been paid to its epidemiology and clinical characteristics in children. However, it is also crucial for clinicians to differentiate COVID-19 from other respiratory infectious diseases, such as influenza viruses. METHODS: This was a retrospective study. Two groups of COVID-19 patients (n=57) and influenza A patients (n=59) were enrolled. We analyzed and compared their clinical manifestations, imaging characteristics and treatments. RESULTS: The proportions of cough (70.2%), fever (54.4%) and gastrointestinal symptoms (14.1%) in COVID-19 patients were lower than those of influenza A patients (98.3%, P<0.001; 84.7%, P<0.001; and 35.6%, P=0.007; respectively). In addition, COVID-19 patients showed significantly lower levels of leukocytes (7.87 vs. 9.89×109L-1, P=0.027), neutrophils (2.43 vs. 5.16×109L-1, P<0.001), C-reactive protein (CRP; 3.7 vs. 15.1mg/L, P=0.001) and procalcitonin (PCT; 0.09 vs. 0.68mm/h, P<0.001), while lymphocyte levels (4.58 vs. 3.56×109L-1; P=0.006) were significantly higher compared with influenza A patients. In terms of CT imaging, ground-glass opacification in chest CT was more common in COVID-19 patients than in influenza A patients (42.1% vs. 15%, P=0.032). In contrast, consolidation was more common in influenza A patients (25%) than in COVID-19 patients (5.2%, P=0.025). CONCLUSION: The clinical manifestations and laboratory tests of COVID-19 children are milder than those of influenza A children under 5 years. Additionally, imaging results more commonly presented as ground-glass opacities in COVID-19 patients.

8.
Int Immunopharmacol ; 85: 106683, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-548979

ABSTRACT

BACKGROUND: Since December 2019, novel coronavirus (SARS-CoV-2)-infected pneumonia (COVID-19) occurred in Wuhan, and rapidly spread throughout China. Our study aimed to evaluate the robustness of neutrophil to CD4+ lymphocyte ratio (NCD4LR) in predicting the negative conversion time (NCT) of SARS-CoV-2 in COVID-19 patients. METHODS: Univariate and multivariate analysis were conducted to evaluate the independency of NCD4LR in predicting NCT. Receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) were used to assess the diagnostic accuracy. RESULTS: Compared with low NCD4LR patients, patients with high NCD4LR had an older age; higher incidence of fever, fatigue, chest distress/breath shortness, severer disease assessment on admission; higher levels of inflammatory indicators; low levels of lymphocyte subsets, and a longer NCT. Multivariate analysis also identified NCD4LR as an independent risk factor for delayed NCT. ROC analysis showed that NCD4LR had a better performance than neutrophil to lymphocyte ratio in predicting the virus negative conversion within 2 weeks (AUC = 0.772), 3 weeks (AUC = 0.710), 4 weeks (AUC = 0.728), or 5 weeks (AUC = 0.815). CONCLUSION: This study suggests that NCD4LR is a potential and useful biomarker for predicting the virus negative conversion time in COVID-19 patients. Furthermore, due to the NCDLR value is easily calculated, it can be widely used as a clinical biomarker for disease progression and clinical outcomes in COVID-19 patients.


Subject(s)
Antibodies, Viral/blood , Betacoronavirus/isolation & purification , CD4-Positive T-Lymphocytes , Clinical Laboratory Techniques , Coronavirus Infections/immunology , Leukocyte Count , Neutrophils , Pneumonia, Viral/immunology , Viral Load , Viremia/immunology , Adult , Age Factors , Aged , Area Under Curve , Betacoronavirus/immunology , Biomarkers , Convalescence , Coronavirus Infections/blood , Coronavirus Infections/diagnosis , Coronavirus Infections/virology , Female , Humans , Inflammation , Inpatients , Lymphocyte Count , Male , Middle Aged , Multivariate Analysis , Nasopharynx/virology , Pandemics , Patient Discharge , Pneumonia, Viral/blood , Pneumonia, Viral/virology , ROC Curve , Retrospective Studies , Risk Factors , Symptom Assessment , Time Factors
9.
Clin Res Hepatol Gastroenterol ; 2020 May 12.
Article in English | MEDLINE | ID: covidwho-318469

ABSTRACT

BACKGROUNDS: Since December 2019, novel coronavirus (SARS-CoV-2)-infected pneumonia (COVID-19) occurred in Wuhan, and rapidly spread throughout China. Our study aimed to evaluate the association of liver injury and gastrointestinal symptoms (GIS) with the progression of COVID-19. METHODS: A comprehensive search was performed on the PubMed to identify eligible studies that summarized the liver injury and GIS in COVID-19. RESULTS: A total of 21 studies with 3024 patients were included. Up to 53% patients had liver dysfunctions and the degree of liver damage was associated the severity of the disease. The prevalence of diarrhoea, nausea/vomiting or abdominal pain in patients with COVID-19 were 9.1%, 5.2% and 3.5%, respectively. No significant was found in the prevalence of diarrhoea (OR, 1.24; 95%CI, 0.90 to 1.72; I2=0%, P=0.19) and nausea/vomiting (OR, 1.24; 95%CI, 0.57 to 2.69; I2=61%, P=0.58) between severe and non-severe patients. In addition, diarrhoea (OR, 1.22; 95%CI, 0.50 to 2.98; I2=0%, P=0.66) and nausea/vomiting (OR, 1.09; 95%CI, 0.46 to 2.62; I2=0%, P=0.84) were not associated with the prognosis of COVID-19 patients. CONCLUSIONS: The incidences of GIS in patients with COVID-19 is relatively low and are not associated with the COVID-19 progression. Gastroenterologists should pay more attention to the liver injury induced by SARS-CoV-2 during the course of infection.

12.
Open Forum Infect. Dis. ; 4(7)20200316.
Article in English | ELSEVIER | ID: covidwho-60353

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a rapidly emerging viral infection causing coronavirus disease 2019 (COVID-19). Hydroxychloroquine and chloroquine have garnered unprecedented attention as potential therapeutic agents against COVID-19 following several small clinical trials, uncontrolled case series, and public figure endorsements. While there is a growing body of scientific data, there is also concern for harm, particularly QTc prolongation and cardiac arrhythmias. Here, we perform a rapid narrative review and discuss the strengths and limitations of existing in vitro and clinical studies. We call for additional randomized controlled trial evidence prior to the widespread incorporation of hydroxychloroquine and chloroquine into national and international treatment guidelines.

13.
Pediatr Infect Dis J ; 39(6): e69-e70, 2020 06.
Article in English | MEDLINE | ID: covidwho-53033

ABSTRACT

Since December 2019, novel coronavirus-infected pneumonia (coronavirus disease 19) occurred in Wuhan and rapidly spread throughout China and beyond. During this period, increasing of reports found that several recovered patients from different hospitals showed positive results of nucleic acid test again soon after discharge. However, little attention has been paid to recovered children. Herein, we reported a case of 8-year-old recovered child, who was rehospitalized again because of unexplained fever.


Subject(s)
Coronavirus Infections/diagnosis , Patient Readmission , Pneumonia, Viral/diagnosis , Betacoronavirus , Child , China , Fever , Humans , Male , Pandemics , RNA, Viral/isolation & purification
15.
Clin Infect Dis ; 2020 Mar 16.
Article in English | MEDLINE | ID: covidwho-8710

ABSTRACT

BACKGROUND: Since December 2019, novel coronavirus (SARS-CoV-2)-infected pneumonia (COVID-19) occurred in Wuhan, and rapidly spread throughout China. This study aimed to clarify the characteristics of patients with refractory COVID-19. METHODS: In this retrospective single-center study, we included 155 consecutive patients with confirmed COVID-19 in Zhongnan Hospital of Wuhan University from January 1st to February 5th. The cases were divided into general and refractory COVID-19 groups according to the clinical efficacy after hospitalization, and the difference between groups were compared. RESULTS: Compared with general COVID-19 patients (45.2%), refractory patients had an older age, male sex, more underlying comorbidities, lower incidence of fever, higher levels of maximum temperature among fever cases, higher incidence of breath shortness and anorexia, severer disease assessment on admission, high levels of neutrophil, aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and C-reactive protein, lower levels of platelets and albumin, and higher incidence of bilateral pneumonia and pleural effusion (P<0.05). Refractory COVID-19 patients were more likely to receive oxygen, mechanical ventilation, expectorant, and adjunctive treatment including corticosteroid, antiviral drugs and immune enhancer (P<0.05). After adjustment, those with refractory COVID-19 were also more likely to have a male sex and manifestations of anorexia and fever on admission, and receive oxygen, expectorant and adjunctive agents (P<0.05) when considering the factors of disease severity on admission, mechanical ventilation, and ICU transfer. CONCLUSION: Nearly 50% COVID-19 patients could not reach obvious clinical and radiological remission within 10 days after hospitalization. The patients with male sex, anorexia and no fever on admission predicted poor efficacy.

16.
Euro Surveill ; 25(10)2020 03.
Article in English | MEDLINE | ID: covidwho-8160

ABSTRACT

Since December 2019, 62 medical staff of Zhongnan Hospital in Wuhan, China have been hospitalised with coronavirus disease 2019. During the post-discharge surveillance after clinical recovery, swabs were positive in two asymptomatic cases (3.23%). Case 1 had presented typical clinical and radiological manifestations on admission, while manifestation in Case 2 was very mild. In conclusion, a small proportion of recovered patients may test positive after discharge, and post-discharge surveillance and isolation need to be strengthened.


Subject(s)
Asymptomatic Infections , Betacoronavirus/isolation & purification , Coronavirus Infections/diagnosis , Infectious Disease Transmission, Patient-to-Professional , Patient Discharge , Pharynx/virology , Pneumonia, Viral/genetics , Adult , Betacoronavirus/genetics , Clinical Laboratory Techniques , Coronavirus Infections/genetics , Coronavirus Infections/transmission , Coronavirus Infections/virology , Female , Hospitalization , Humans , Male , Pneumonia, Viral/transmission , Predictive Value of Tests , Radiography , Real-Time Polymerase Chain Reaction , Tomography, X-Ray Computed
17.
Emerg Infect Dis ; 26(6): 1324-1326, 2020 06.
Article in English | MEDLINE | ID: covidwho-6800

ABSTRACT

We report co-infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza A virus in a patient with pneumonia in China. The case highlights possible co-detection of known respiratory viruses. We noted low sensitivity of upper respiratory specimens for SARS-CoV-2, which could further complicate recognition of the full extent of disease.


Subject(s)
Coronavirus Infections/diagnosis , Influenza, Human/diagnosis , Pneumonia, Viral/diagnosis , Aged , Betacoronavirus/isolation & purification , Bronchoalveolar Lavage Fluid/virology , China , Clinical Laboratory Techniques , Coinfection , Coronavirus Infections/virology , Humans , Influenza A virus , Influenza, Human/virology , Male , Nasopharynx/virology , Pandemics , Pneumonia, Viral/virology
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