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2.
Kexue Tongbao/Chin. Sc. Bull. ; 11(65): 1009-1015, 20200415.
Article in Chinese | ELSEVIER | ID: covidwho-679721

ABSTRACT

The spread of an epidemic should be a phenomenon governed by the natural growth law: More infected beget more infections. This basic rule would be useful especially when an outbreak is caused by a novel virus with its basic characteristics full of unknowns so much that there would be too many uncertainties that would be impossible for anyone to run the traditional epidemiological model meaningfully. The natural growth law does not depend on the detailed characteristics of the virus. When it is employed, a transmission rate can be defined and determined directly from clinical field data, which can change following the course of the epidemic development. Such a data driven natural growth model has been developed to track the development for any epidemic. It can yield useful information on the propagation pattern of the epidemic dynamically. The transmission rate so determined is sensitive enough not only to track the course of the epidemic but also to reveal the effects of control measures quantitatively. Importantly, it offers the potential to make predictions for epidemic management. In December 2019, a severe epidemic, the novel coronavirus epidemic, now designated as the COVID-19, broke out in Wuhan, China. It spread quickly in and around Wuhan. To complicate the situation, the outbreak initial period also coincided with the travel peak related with the Spring Festival. To prevent its spreading, Chinese government has instituted strict quarantine by lockdown the City and the surrounding Hubei Province. This drastic quarantine measure seemed to have slowed down the spread of the COVID-19 markedly. However, to evaluate the control effects quantitatively remains a challenge. In this paper, we propose to quantify the effectiveness of the quarantine using the natural growth model. Based on the model, we first estimated the transmission rates of the COVID-19 for different typical periods as follows: In December 2019, the transmission rate is about 0.26; in the late January 2020, it is between 0.40 and 0.46. Therefore, if the strict quarantine measures had not been instituted for the epidemic at all, 16.98 million to 76.11 million people would have been infected under the transmission rate between 0.40 and 0.46, as of February 18, 2020, according to the model. Even for a very low transmission rate as 0.26, there would have been 513 thousand infected as of February 18, 2020, far greater than the actual data of some 58 thousand reported by the Chinese National Health Commission. The model can also be used to estimate the consequence of putting off the control measures. We conducted a hypothetical study as follows. We divided the development of the epidemic into three stages: Before January 24, 2020, the infection grew as the actual situation does; from January 25, 2020 to the day before the supposed date of the start of the control measures, the infection grew with a transmission rate of 0.45; from the supposed date of the start of the control measure onwards, the infection took the actual transmission rate starting from January 25 on. Our model results indicate that the more days delayed for the quarantine measures, the faster increase of the infections. If the strict control measures were pushed back by one day (or 7 days), there would be 27 (or 785) thousand more infected cases than the reported as of February 18, 2020 in the whole China, in which 12 (or 493) thousand are in the Hubei Province. The above estimation is quite conservative. Less infected is easier to control; therefore, putting the measure control off we will have even more infected than estimated that would made the epidemic even harder to contain.

3.
Global Health ; 16(1): 69, 2020 07 28.
Article in English | MEDLINE | ID: covidwho-680059

ABSTRACT

BACKGROUND: The outbreak of 2019 coronavirus disease (COVID-19) could increase the risk of depression. However, epidemiological data on outbreak-associated depressive morbidity of female adolescents are not available. This study determines the incidence and correlates of depression among female adolescents aged 11-18 years during the COVID-19 outbreak in mainland China. METHODS: A large cross-sectional sample, nationwide online survey was conducted during the COVID-19 outbreak. Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), and the correlative factors of depression were analyzed. RESULTS: In this study, 4805 female adolescents were enrolled with a median (range) age of 15 (11-18) years. Of them, 1899 (39.5%) suffered from depression with a CES-D score of > 15. The onset of depression was significantly related to age, grade, distant learning, attitude toward COVID-19, sleep duration, and physical exercise duration. Furthermore, participants aged 15-18 years (OR = 1.755, 95% CI: 1.550-1.987, p < 0.001), participating in distant learning (OR = 0.710, 95% CI: 0.564-0.894, p = 0.004), concerned about COVID-19 (OR = 0.414, 95% CI: 0.212-0.811, p = 0.010), with sleep duration/day of < 6 h (OR = 2.603, 95% CI: 1.946-3.483, p < 0.001),and with physical exercise duration/day < 30 min (OR = 1.641, 95% CI: 1.455-1.850, p < 0.001) represented to be independent factors for suffering from depression. CONCLUSION: During the COVID-19 outbreak, depression was common among female adolescents. Older age, distant learning, concern about COVID-19, short sleep duration, and physical exercise duration represented the independent factors for suffering from depression.


Subject(s)
Coronavirus Infections/epidemiology , Depression/epidemiology , Disease Outbreaks , Pneumonia, Viral/epidemiology , Adolescent , Child , China/epidemiology , Cross-Sectional Studies , Female , Humans , Pandemics , Prevalence , Risk Factors , Surveys and Questionnaires
4.
Integrative Medicine Research ; 2020.
Article | WHO COVID | ID: covidwho-671946

ABSTRACT

Background The aim of this study was to evaluate the clinical efficacy of Xuanfei Baidu Decoction (XBD) combined with conventional drug therapy compared with conventional medicine alone in patients with coronavirus disease 2019 (COVID-19) Methods Forty-two patients with COVID-19 were randomly assigned to XBD plus conventional medicine (n=22) and conventional medicine alone (n=20) Both groups were treated for 1 week The primary endpoint was the disappearance rate of main symptoms (fever, cough, and fatigue) Results Compared with the conventional medicine, the disappearance rate of clinical symptoms such as fever, cough, fatigue and loss of appetite in the experimental group were significantly reduced (P<0 05) The number of white blood cells and lymphocytes in the experimental group increased significantly (P<0 05), which all returned to normal parameters Meanwhile, the C-reactive protein and erythrocyte sedimentation rate in the experimental group were significantly reduced (P<0 05) Conclusion XBD combined with conventional medicine may significantly improve patient's clinical symptoms, increase the number of white blood cells and lymphocytes to improve immunity, and also significantly reduce C-reactive protein and erythrocyte sedimentation rate to play an anti-inflammatory effect However, it needs to be confirmed by a large sample study Clinical trial registration China Clinical Trial Registry (ChiCTR2000034795)

5.
Epilepsia ; 61(6): e49-e53, 2020 06.
Article in English | MEDLINE | ID: covidwho-637375

ABSTRACT

Our aim was to clarify the incidence and risk of acute symptomatic seizures in people with coronavirus disease 2019 (COVID-19). This multicenter retrospective study enrolled people with COVID-19 from January 18 to February 18, 2020 at 42 government-designated hospitals in Hubei province, the epicenter of the epidemic in China; Sichuan province; and Chongqing municipality. Data were collected from medical records by 11 neurologists using a standard case report form. A total of 304 people were enrolled, of whom 108 had a severe condition. None in this cohort had a known history of epilepsy. Neither acute symptomatic seizures nor status epilepticus was observed. Two people had seizurelike symptoms during hospitalization due to acute stress reaction and hypocalcemia, and 84 (27%) had brain insults or metabolic imbalances during the disease course known to increase the risk of seizures. There was no evidence suggesting an additional risk of acute symptomatic seizures in people with COVID-19. Neither the virus nor potential risk factors for seizures seem to be significant risks for the occurrence of acute symptomatic seizures in COVID-19.


Subject(s)
Coronavirus Infections/epidemiology , Hypoxia/epidemiology , Pneumonia, Viral/epidemiology , Seizures/epidemiology , Water-Electrolyte Imbalance/epidemiology , Adolescent , Adult , Aged , Betacoronavirus , Child , Child, Preschool , China/epidemiology , Female , Humans , Incidence , Infant , Infant, Newborn , Male , Middle Aged , Pandemics , Retrospective Studies , Risk Factors , Sepsis/epidemiology , Severity of Illness Index , Young Adult
7.
Neurology ; 2020 Jun 17.
Article in English | MEDLINE | ID: covidwho-606935

ABSTRACT

OBJECTIVE: To investigate new-onset neurologic impairments associated with coronavirus disease 2019 (COVID-19). METHODS: A retrospective multicenter cohort study conducted between 18 January and 20 March 2020 including people with confirmed COVID-19 from 56 hospitals officially designated in three Chinese regions; data were extracted from medical records. New-onset neurologic events as assessed by neurology consultants based on manifestations, clinical examination and investigations, in which critical events included disorders of consciousness, stroke, CNS infection, seizures and status epilepticus. RESULTS: We enrolled 917 people with average age 48.7 years and 55% were male. The frequency of new onset critical neurologic events was 3.5% (32/917) overall and 9.4% (30/319) among those with severe or critical COVID-19. These were impaired consciousness (n=25) or/and stroke (n=10). The risk of critical neurologic events was highly associated with age above 60 years and previous history of neurological conditions. Non-critical events were seen in less than 1% (7/917), including muscle cramp, unexplained headache, occipital neuralgia, tic and tremor. Brain CT in 28 people led to new findings in nine. Findings from lumbar puncture in three with suspected CNS infection, unexplained headache or severe occipital neuralgia were unremarkable. CONCLUSIONS: People with COVID-19 aged over 60 and neurologic comorbidities were at higher risk of developing critical neurologic impairment, mainly impaired consciousness and cerebrovascular accidents. Brain CT should be considered when new-onset brain injury is suspected, especially in people under sedation or showing an unexplained decline in consciousness. Evidence of direct acute insult of SARS-COV-2 to the CNS is still lacking.

9.
Clin Infect Dis ; 2020 May 22.
Article in English | MEDLINE | ID: covidwho-351568

ABSTRACT

BACKGROUND: We previously reported that lymphocytopenia and T cell exhaustion is notable in acute COVID19 patients, especially in aged and severe cases. Thymosin alpha 1 (Tα1) had been used in the treatment of viral infections as an immune response modifier for many years. However, clinical benefits and mechanism of Tα1 supplement to COVID-19 are still unclear. METHODS: We retrospectively reviewed the clinical outcomes of 76 severe cases with COVID-19 admitted into two hospitals in Wuhan from December 2019 to March 2020. The thymus output in peripheral blood mononuclear cells (PBMCs) from COVID-19 patients was measured by T cell receptor excision circles (TREC). The levels of T cell exhaustion markers PD-1 and Tim-3 on CD8+ T cells were detected by flow cytometry. RESULTS: Compared with untreated group, Tα1 treatment significantly reduces mortality of severe COVID-19 patients (11.11% vs. 30.00%, p=0.044). Tα1 timely enhances blood T cell numbers in COVID-19 patients with severe lymphocytopenia (the counts of CD8+ T cells or CD4+ T cells in circulation lower than 400/µL or 650/µL, respectively). Under such conditions, Tα1 also successfully restores CD8+ and CD4+ T cell numbers in aged patients. Meanwhile, Tα1 reduces PD-1 and Tim-3 expression on CD8+ T cells from severe COVID-19 patients in comparison with untreated cases. It is of note that restoration of lymphocytopenia and acute exhaustion of T cells are roughly parallel to the rise of TRECs. CONCLUSIONS: Tα1 supplement significantly reduce mortality of severe COVID-19 patients. COVID-19 patients with the counts of CD8+ T cells or CD4+ T cells in circulation lower than 400/µL or 650/µL, respectively, gain more benefits from Tα1. Tα1 reverses T cell exhaustion and recovers immune reconstitution through promoting thymus output during SARS-CoV-2 infection.

10.
Clin Infect Dis ; 2020 May 22.
Article in English | MEDLINE | ID: covidwho-343498

ABSTRACT

BACKGROUND: We previously reported that lymphocytopenia and T cell exhaustion is notable in acute COVID19 patients, especially in aged and severe cases. Thymosin alpha 1 (Tα1) had been used in the treatment of viral infections as an immune response modifier for many years. However, clinical benefits and mechanism of Tα1 supplement to COVID-19 are still unclear. METHODS: We retrospectively reviewed the clinical outcomes of 76 severe cases with COVID-19 admitted into two hospitals in Wuhan from December 2019 to March 2020. The thymus output in peripheral blood mononuclear cells (PBMCs) from COVID-19 patients was measured by T cell receptor excision circles (TREC). The levels of T cell exhaustion markers PD-1 and Tim-3 on CD8+ T cells were detected by flow cytometry. RESULTS: Compared with untreated group, Tα1 treatment significantly reduces mortality of severe COVID-19 patients (11.11% vs. 30.00%, p=0.044). Tα1 timely enhances blood T cell numbers in COVID-19 patients with severe lymphocytopenia (the counts of CD8+ T cells or CD4+ T cells in circulation lower than 400/µL or 650/µL, respectively). Under such conditions, Tα1 also successfully restores CD8+ and CD4+ T cell numbers in aged patients. Meanwhile, Tα1 reduces PD-1 and Tim-3 expression on CD8+ T cells from severe COVID-19 patients in comparison with untreated cases. It is of note that restoration of lymphocytopenia and acute exhaustion of T cells are roughly parallel to the rise of TRECs. CONCLUSIONS: Tα1 supplement significantly reduce mortality of severe COVID-19 patients. COVID-19 patients with the counts of CD8+ T cells or CD4+ T cells in circulation lower than 400/µL or 650/µL, respectively, gain more benefits from Tα1. Tα1 reverses T cell exhaustion and recovers immune reconstitution through promoting thymus output during SARS-CoV-2 infection.

11.
Front Immunol ; 11: 827, 2020.
Article in English | MEDLINE | ID: covidwho-332452

ABSTRACT

Background: The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has posed great threat to human health. T cells play a critical role in antiviral immunity but their numbers and functional state in COVID-19 patients remain largely unclear. Methods: We retrospectively reviewed the counts of T cells and serum cytokine concentration from data of 522 patients with laboratory-confirmed COVID-19 and 40 healthy controls. In addition, the expression of T cell exhaustion markers were measured in 14 COVID-19 cases. Results: The number of total T cells, CD4+ and CD8+ T cells were dramatically reduced in COVID-19 patients, especially in patients requiring Intensive Care Unit (ICU) care. Counts of total T cells, CD8+ T cells or CD4+ T cells lower than 800, 300, or 400/µL, respectively, were negatively correlated with patient survival. T cell numbers were negatively correlated to serum IL-6, IL-10, and TNF-α concentration, with patients in the disease resolution period showing reduced IL-6, IL-10, and TNF-α concentrations and restored T cell counts. T cells from COVID-19 patients had significantly higher levels of the exhausted marker PD-1. Increasing PD-1 and Tim-3 expression on T cells was seen as patients progressed from prodromal to overtly symptomatic stages. Conclusions: T cell counts are reduced significantly in COVID-19 patients, and the surviving T cells appear functionally exhausted. Non-ICU patients with total T cells counts lower than 800/µL may still require urgent intervention, even in the immediate absence of more severe symptoms due to a high risk for further deterioration in condition.


Subject(s)
Betacoronavirus/physiology , Coronavirus Infections/immunology , Pneumonia, Viral/immunology , Coronavirus Infections/blood , Coronavirus Infections/pathology , Cytokines/blood , Humans , Lymphocyte Count , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/pathology , T-Lymphocytes/immunology
13.
J Affect Disord ; 274: 1-7, 2020 09 01.
Article in English | MEDLINE | ID: covidwho-245043

ABSTRACT

BACKGROUND: When COVID-19 emerged in China in late 2019, most citizens were home-quarantined to prevent the spread of the virus. This study explored the prevalence of post-traumatic stress disorder (PTSD) and depression in a sample of home-quarantined college students to identify the psychological distress risk factors. METHOD: The PTSD and depressive symptoms in the 2485 participants from 6 universities were investigated using online survey versions of the PTSD Checklist Civilian Version and the 9-question Patient Health Questionnaires (PHQ-9), and data on sleep durations, exposure, home-quarantine time and socio-demographic variables were also collected. RESULTS: The PTSD and depression prevalence were found to be 2.7% and 9.0%. Subjectively, feeling extreme fear was the most significant risk factor for psychological distress, followed by short sleep durations, being in their graduating year (4th year) and living in severely afflicted areas. Sleep durations was a mediator between exposures and mental health problems. CONCLUSIONS: The results suggested that the psychological consequences of the COVID-19 could be serious. Psychological interventions that reduce fear and improve sleep durations need to be made available to the home-quarantined university students, and graduating students and those in the worst-hit areas should be given priority focus.


Subject(s)
Betacoronavirus , Coronavirus Infections/psychology , Depressive Disorder/epidemiology , Pneumonia, Viral/psychology , Quarantine/psychology , Stress Disorders, Post-Traumatic/epidemiology , Students/psychology , Adolescent , Adult , Attitude to Health , Causality , China/epidemiology , Comorbidity , Depressive Disorder/psychology , Disease Outbreaks , Female , Humans , Male , Pandemics , Prevalence , Stress Disorders, Post-Traumatic/psychology , Students/statistics & numerical data , Surveys and Questionnaires , Universities , Young Adult
14.
J Zhejiang Univ Sci B ; 21(5): 343-360, 2020 May.
Article in English | MEDLINE | ID: covidwho-209913

ABSTRACT

Pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection emerged in Wuhan City, Hubei Province, China in December 2019. By Feb. 11, 2020, the World Health Organization (WHO) officially named the disease resulting from infection with SARS-CoV-2 as coronavirus disease 2019 (COVID-19). COVID-19 represents a spectrum of clinical manifestations that typically include fever, dry cough, and fatigue, often with pulmonary involvement. SARS-CoV-2 is highly contagious and most individuals within the population at large are susceptible to infection. Wild animal hosts and infected patients are currently the main sources of disease which is transmitted via respiratory droplets and direct contact. Since the outbreak, the Chinese government and scientific community have acted rapidly to identify the causative agent and promptly shared the viral gene sequence, and have carried out measures to contain the epidemic. Meanwhile, recent research has revealed critical aspects of SARS-CoV-2 biology and disease pathogenesis; other studies have focused on epidemiology, clinical features, diagnosis, management, as well as drug and vaccine development. This review aims to summarize the latest research findings and to provide expert consensus. We will also share ongoing efforts and experience in China, which may provide insight on how to contain the epidemic and improve our understanding of this emerging infectious disease, together with updated guidance for prevention, control, and critical management of this pandemic.


Subject(s)
Betacoronavirus/genetics , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Amino Acid Motifs , Animals , Antiviral Agents , China/epidemiology , Communicable Disease Control/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/prevention & control , Coronavirus Infections/therapy , Humans , Immunization, Passive , Medicine, Chinese Traditional , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Protein Domains , Spike Glycoprotein, Coronavirus/chemistry , Viral Vaccines
15.
Biosci Trends ; 14(3): 222-226, 2020 Jul 17.
Article in English | MEDLINE | ID: covidwho-100190

ABSTRACT

The new coronavirus (COVID-19) has been characterized as a world pandemic by WHO since March 11, 2020. Although it is likely that COVID-19 transmission is primarily via droplets and close contact, airborne transmission and fecal-oral route remains a possibility. The medical staff working in the operating room, such as anesthesiologists, surgeons and nurses, are at high risk of exposure to virus due to closely contacting patients. The perioperative management is under great challenge while performing surgeries for patients suffering COVID-19, including emergency cesarean section, which is one of the most common surgeries under such circumstances. How to prevent medical staff from cross-infection is an issue of great concern. In this article, we give a practice of anesthesia scenario design for emergency cesarean section in a supposed standard patient suffering COVID-19, aimed to optimize the work flow and implement the protective details through simulation of a real operation scenario, which may be useful for training and clinical practice of anesthesia management for patients suffering COVID-19 or other fulminating infectious diseases.


Subject(s)
Anesthesia , Cesarean Section , Coronavirus Infections , Infection Control/methods , Pandemics , Pneumonia, Viral , Pregnancy Complications, Infectious , Betacoronavirus , Emergency Treatment , Female , Humans , Pregnancy
17.
J Dig Dis ; 21(4): 199-204, 2020 Apr.
Article in English | MEDLINE | ID: covidwho-42091

ABSTRACT

An epidemic of an acute respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, now known as coronavirus disease 2019 (COVID-19), beginning in December 2019, has attracted an intense amount of attention worldwide. As the natural history and variety of clinical presentations of this disease unfolds, extrapulmonary symptoms of COVID-19 have emerged, especially in the digestive system. While the respiratory mode of transmission is well known and is probably the principal mode of transmission of this disease, a possibility of the fecal-oral route of transmission has also emerged in various case series and clinical scenarios. In this review article, we summarize four different aspects in published studies to date: (a) gastrointestinal manifestations of COVID-19; (b) microbiological and virological investigations; (c) the role of fecal-oral transmission; and (d) prevention and control of SARS-CoV-2 infection in the digestive endoscopy room. A timely understanding of the relationship between the disease and the digestive system and implementing effective preventive measures are of great importance for a favorable outcome of the disease and can help climnicians to mitigate further transmission by taking appropriate measures.


Subject(s)
Coronavirus Infections/transmission , Cross Infection/prevention & control , Digestive System Diseases , Endoscopy, Digestive System/standards , Gastroenterology/standards , Infection Control/standards , Pneumonia, Viral/transmission , Betacoronavirus/isolation & purification , Coronavirus Infections/complications , Coronavirus Infections/virology , Cross Infection/etiology , Cross Infection/virology , Digestive System Diseases/diagnosis , Digestive System Diseases/etiology , Digestive System Diseases/microbiology , Digestive System Diseases/virology , Hospital Units/standards , Humans , Pandemics , Personal Protective Equipment/standards , Pneumonia, Viral/complications , Pneumonia, Viral/virology
19.
International Journal of Dermatology and Venereology ; Latest Articles, 2020.
Article | WHO COVID | ID: covidwho-10190

ABSTRACT

The 2019 novel coronavirus infection has brought a great challenge in prevention and control of the national epidemic of COVID-19 in China During the fight against the epidemic of COVID-19, properly carrying out pre-examination and triage for patients with skin lesions and fever has been a practical problem encountered in hospitals for skin diseases as well as clinics of dermatology in general hospitals Considering that certain skin diseases may have symptom of fever, and some of the carriers of 2019 novel coronavirus and patients with COVID-19 at their early stage may do not present any symptoms of COVID-19, to properly deal with the visitors to clinics of dermatology, the Chinese Society of Dermatology organized experts to formulate the principles and procedures for pre-examination and triage of visitors to clinics of dermatology during the epidemic of COVID-19 Corresponding authors: Dr Qian-Jin Lu, Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China E-mail: qianlu5860@csu edu cn;Dr Zhi-Rong Yao, Department of Dermatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China E-mail: dermatology yao@sohu com Received 2 March, 2020 Conflicts of interest: The authors reported no conflicts of interest #The Chinese version of this has been published on Chinese Journal of Dermatology, 2020,53(3):165-167 doi: 10 35541/cjd 20200119 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4 0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited The work cannot be changed in any way or used commercially without permission from the journal http://creativecommons org/licenses/by-nc-nd/4 0 © 2020 by Lippincott Williams & Wilkins, Inc

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