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1.
Emerg Microbes Infect ; : 1-42, 2020 Sep 22.
Article in English | MEDLINE | ID: covidwho-787003

ABSTRACT

Serology detection is recognized for its sensitivity in convalescent patients with COVID-19, in comparison with nucleic acid amplification tests(NAATs), which is considered as the gold standard for diagnosing acute infection. However, when and how serology detection performs the best remains unknown. This article aimed to evaluate the diagnostic accuracy of serologic methods for COVID-19 based on assay design and post-symptom-onset intervals. Two authors independently searched PubMed, Cochrane library, Ovid, EBSCO for case-control, longitudinal and cohort studies that determined the diagnostic accuracy of serology tests in comparison with NAATs for SARS-CoV-2 RNA in COVID-19 cases and used QUADAS-2 for quality assessment. Pooled accuracy was analyzed using INLA method. A total of 27 studies were included in this meta-analysis, with 4 cohort, 16 case-control and 7 longitudinal studies and 4,565 participants. The overall sensitivity of IgG, IgM, and total antibody(TAB) was 0.76(95%CI 0.65-0.86), 0.69(95%CI 0.59-0.78), 0.78(95%CI 0.70-0.85). The overall specificity was 0.98(95%CI 0.96-0.99), 0.95(95%CI 0.91-0.98), 0.97(95%CI 0.93-0.99). Serology tests had the lowest sensitivity at 0-7 days after symptom onset and the highest at >14 days. TAB had a better sensitivity than IgG or IgM only. Using combined nucleocapsid(N) and spike(S) protein had a better sensitivity compared to N or S protein only. Lateral flow immunoassay(LFIA) had a lower sensitivity than enzyme-linked immunoassay(ELISA) and chemiluminescent immunoassay(CLIA). Serology tests will play an important role in the clinical diagnosis for later stage COVID-19 patients. ELISA tests, detecting TAB or targeting combined N and S proteins had a higher diagnostic sensitivity compared to other methods.

2.
Emerg Microbes Infect ; 9(1): 1869-1877, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-730432

ABSTRACT

Critically ill patients with coronavirus diseases 2019 (COVID-19) are of grave concern. Those patients usually underwent a stage of excessive inflammation before developing acute respiratory distress syndrome. In this study, we test the hypothesis that short-term, low-to-moderate-dose corticosteroids would benefit patients when used in the early phase of excessive inflammation, namely, the therapeutic window. Among a Shanghai cohort and a validation cohort, we enrolled COVID-19 patients showing marked radiographic progression. Short-term, low-to-moderate-dose corticosteroids were considered for them. After identifying the possible markers for the therapeutic window, we then divided the patients, based on whether they were treated with corticosteroids within the therapeutic window, into the early-start group and control group. We identified that the therapeutic window for corticosteroids was characterized by a marked radiographic progression and lactase dehydrogenase (LDH) less than two times the upper limit of normal (ULN). The Shanghai cohort comprised of 68 patients, including 47 in the early-start group and 21 in the control group. The proportion of patients requiring invasive mechanical ventilation was significantly lower in the early-start group than in the control group (10.6% vs. 33.3%, difference, 22.7%, 95% confidence interval 2.6-44.8%). Among the validation cohort of 51 patients, similar difference of the primary outcome was observed (45.0% vs. 74.2%, P = 0.035). Among COVID-19 patients with marked radiologic progression, short-term, low-to-moderate-dose corticosteroids benefits patients with LDH levels of less than two times the ULN, who may be in the early phase of excessive inflammation.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Adrenal Cortex Hormones/administration & dosage , Biomarkers , Cohort Studies , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/pathology , Coronavirus Infections/therapy , Disease Progression , Humans , Inflammation/prevention & control , L-Lactate Dehydrogenase/blood , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/pathology , Pneumonia, Viral/therapy , Radiography , Reproducibility of Results , Respiration, Artificial , Respiratory Distress Syndrome, Adult/etiology , Treatment Outcome
3.
Emerg Microbes Infect ; 9(1): 1958-1964, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-725886

ABSTRACT

Objectives Severe or critical COVID-19 is associated with intensive care unit admission, increased secondary infection rate, and would lead to significant worsened prognosis. Risks and characteristics relating to secondary infections in severe COVID-19 have not been described. Methods Severe and critical COVID-19 patients from Shanghai were included. We collected lower respiratory, urine, catheters, and blood samples according to clinical necessity and culture and mNGS were performed. Clinical and laboratory data were archived. Results We found 57.89% (22/38) patients developed secondary infections. The patient receiving invasive mechanical ventilation or in critical state has a higher chance of secondary infections (P<0.0001). The most common infections were respiratory, blood-stream and urinary infections, and in respiratory infections, the most detected pathogens were gram-negative bacteria (26, 50.00%), following by gram-positive bacteria (14, 26.92%), virus (6, 11.54%), fungi (4, 7.69%), and others (2, 3.85%). Respiratory Infection rate post high flow, tracheal intubation, and tracheotomy were 12.90% (4/31), 30.43% (7/23), and 92.31% (12/13) respectively. Secondary infections would lead to lower discharge rate and higher mortality rate. Conclusion Our study originally illustrated secondary infection proportion in severe and critical COVID-19 patients. Culture accompanied with metagenomics sequencing increased pathogen diagnostic rate. Secondary infections risks increased after receiving invasive respiratory ventilations and intravascular devices, and would lead to a lower discharge rate and a higher mortality rate.


Subject(s)
Bacteremia/pathology , Bacterial Infections/pathology , Coronavirus Infections/pathology , Fungemia/pathology , Mycoses/pathology , Opportunistic Infections/pathology , Pneumonia, Viral/pathology , Respiratory Tract Infections/pathology , Urinary Tract Infections/pathology , Aged , Bacteremia/microbiology , Bacteremia/mortality , Bacteremia/virology , Bacterial Infections/microbiology , Bacterial Infections/mortality , Bacterial Infections/virology , Betacoronavirus/pathogenicity , Coronavirus Infections/microbiology , Coronavirus Infections/mortality , Coronavirus Infections/virology , Critical Illness , Female , Fungemia/microbiology , Fungemia/mortality , Fungemia/virology , Fungi/pathogenicity , Gram-Negative Bacteria/pathogenicity , Gram-Positive Bacteria/pathogenicity , Humans , Intensive Care Units , Lung/microbiology , Lung/pathology , Lung/virology , Male , Middle Aged , Mycoses/microbiology , Mycoses/mortality , Mycoses/virology , Opportunistic Infections/microbiology , Opportunistic Infections/mortality , Opportunistic Infections/virology , Pandemics , Pneumonia, Viral/microbiology , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Respiration, Artificial/adverse effects , Respiratory Tract Infections/microbiology , Respiratory Tract Infections/mortality , Respiratory Tract Infections/virology , Retrospective Studies , Risk , Severity of Illness Index , Survival Analysis , Urinary Tract Infections/microbiology , Urinary Tract Infections/mortality , Urinary Tract Infections/virology
4.
Emerg Microbes Infect ; 9(1): 1869-1877, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-713723

ABSTRACT

Critically ill patients with coronavirus diseases 2019 (COVID-19) are of grave concern. Those patients usually underwent a stage of excessive inflammation before developing acute respiratory distress syndrome. In this study, we test the hypothesis that short-term, low-to-moderate-dose corticosteroids would benefit patients when used in the early phase of excessive inflammation, namely, the therapeutic window. Among a Shanghai cohort and a validation cohort, we enrolled COVID-19 patients showing marked radiographic progression. Short-term, low-to-moderate-dose corticosteroids were considered for them. After identifying the possible markers for the therapeutic window, we then divided the patients, based on whether they were treated with corticosteroids within the therapeutic window, into the early-start group and control group. We identified that the therapeutic window for corticosteroids was characterized by a marked radiographic progression and lactase dehydrogenase (LDH) less than two times the upper limit of normal (ULN). The Shanghai cohort comprised of 68 patients, including 47 in the early-start group and 21 in the control group. The proportion of patients requiring invasive mechanical ventilation was significantly lower in the early-start group than in the control group (10.6% vs. 33.3%, difference, 22.7%, 95% confidence interval 2.6-44.8%). Among the validation cohort of 51 patients, similar difference of the primary outcome was observed (45.0% vs. 74.2%, P = 0.035). Among COVID-19 patients with marked radiologic progression, short-term, low-to-moderate-dose corticosteroids benefits patients with LDH levels of less than two times the ULN, who may be in the early phase of excessive inflammation.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Adrenal Cortex Hormones/administration & dosage , Biomarkers , Cohort Studies , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/pathology , Coronavirus Infections/therapy , Disease Progression , Humans , Inflammation/prevention & control , L-Lactate Dehydrogenase/blood , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/pathology , Pneumonia, Viral/therapy , Radiography , Reproducibility of Results , Respiration, Artificial , Respiratory Distress Syndrome, Adult/etiology , Treatment Outcome
5.
Asia Pac J Oper Res ; 3(37)20200601.
Article in English | ELSEVIER | ID: covidwho-609844

ABSTRACT

Since the onset of the COVID-19 outbreak in Wuhan, China, numerous forecasting models have been proposed to project the trajectory of coronavirus infection cases. Most of these forecasts are based on epidemiology models that utilize deterministic differential equations and have resulted in widely varying predictions. We propose a new discrete-Time Markov chain model that directly incorporates stochastic behavior and for which parameter estimation is straightforward from available data. Using such data from China's Hubei province (for which Wuhan is the provincial capital city and which accounted for approximately 82% of the total reported COVID-19 cases in the entire country), the model is shown to be flexible, robust, and accurate. As a result, it has been adopted by the first Shanghai assistance medical team in Wuhan's Jinyintan Hospital, which was the first designated hospital to take COVID-19 patients in the world. The forecast has been used for preparing medical staff, intensive care unit (ICU) beds, ventilators, and other critical care medical resources and for supporting real-Time medical management decisions.

6.
BMC Med ; 18(1): 168, 2020 06 03.
Article in English | MEDLINE | ID: covidwho-505886

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has infected more than 4 million people within 4 months. There is an urgent need to properly identify high-risk cases that are more likely to deteriorate even if they present mild diseases on admission. METHODS: A multicenter nested case-control study was conducted in four designated hospitals in China enrolling confirmed COVID-19 patients who were mild on admission. Baseline clinical characteristics were compared between patients with stable mild illness (stable mild group) and those who deteriorated from mild to severe illness (progression group). RESULTS: From Jan 17, 2020, to Feb 1, 2020, 85 confirmed COVID-19 patients were enrolled, including 16 in the progression group and 69 in the stable mild group. Compared to stable mild group (n = 69), patients in the progression group (n = 16) were more likely to be older, male, presented with dyspnea, with hypertension, and with higher levels of lactase dehydrogenase and c-reactive protein. In multivariate logistic regression analysis, advanced age (odds ratio [OR], 1.012; 95% confidence interval [CI], 1.020-1.166; P = 0.011) and the higher level of lactase dehydrogenase (OR, 1.012; 95% CI, 1.001-1.024; P = 0.038) were independently associated with exacerbation in mild COVID-19 patients. CONCLUSION: Advanced age and high LDH level are independent risk factors for exacerbation in mild COVID-19 patients. Among the mild patients, clinicians should pay more attention to the elderly patients or those with high LDH levels.


Subject(s)
Betacoronavirus , Coronavirus Infections/enzymology , L-Lactate Dehydrogenase/metabolism , Pneumonia, Viral/enzymology , Adolescent , Adult , Aged , Aged, 80 and over , C-Reactive Protein/metabolism , Case-Control Studies , China , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Disease Progression , Disease Susceptibility , Female , Humans , Hypertension/complications , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Risk Factors , Young Adult
7.
Clin Infect Dis ; 2020 May 28.
Article in English | MEDLINE | ID: covidwho-401831

ABSTRACT

BACKGROUND: The recent identification of a novel coronavirus, also known as SARS-CoV-2, has caused a global outbreak of respiratory illnesses. The rapidly developing pandemic has posed great challenges to diagnosis of this novel infection. However, little is known about the metatranscriptomic characteristics of patients with Coronavirus Disease 2019 (COVID-19). METHODS: We analyzed metatranscriptomics in 187 patients (62 cases with COVID-19 and 125 with non-COVID-19 pneumonia). Transcriptional aspects of three core elements - pathogens, the microbiome, and host responses - were interrogated. Based on the host transcriptional signature, we built a host gene classifier and examined its potential for diagnosing COVID-19 and indicating disease severity. RESULTS: The airway microbiome in COVID-19 patients had reduced alpha diversity, with 18 taxa of differential abundance. Potentially pathogenic microbes were also detected in 47% of the COVID-19 cases, 58% of which were respiratory viruses. Host gene analysis revealed a transcriptional signature of 36 differentially expressed genes significantly associated with immune pathways such as cytokine signaling. The host gene classifier built on such a signature exhibited potential for diagnosing COVID-19 (AUC of 0.75-0.89) and indicating disease severity. CONCLUSIONS: Compared to those with non-COVID-19 pneumonias, COVID-19 patients appeared to have a more disrupted airway microbiome with frequent potential concurrent infections, and a special trigger host immune response in certain pathways such as interferon gamma signaling. The immune-associated host transcriptional signatures of COVID-19 hold promise as a tool for improving COVID-19 diagnosis and indicating disease severity.

8.
Prevention and Control of COVID-19 ;
Article | WHO COVID | ID: covidwho-361173
11.
Clin. Transl. Med. ; 1(10): 13-16, 20200301.
Article in English | ELSEVIER | ID: covidwho-20608

ABSTRACT

A previously unknown beta coronavirus, SARS-CoV-2, was discovered from a cluster of patients with pneumonia of unknown cause in Wuhan since the end of 2019. Ever since the start of COVID-19, government administrations, academic institutions, and technology enterprises are under unprecedented cooperation in controlling this outbreak from pathogen identification, epidemic situation assessment, to outbreak containment. Timely identification, isolation, and whole-genome sequencing of SARS-CoV-2 have laid the foundation for effective control of this novel infection. With the increasing case numbers worldwide, more real-time information is emerging, changing our understandings to SARS-CoV-2 outbreak, and nonetheless refining the outbreak control responses. The efficient management of COVID-19 requires global collaboration and an efficient share of information.

12.
Emerg Microbes Infect ; 9(1): 687-690, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-18588

ABSTRACT

Three leading infectious disease experts in China were invited to share their bedside observations in the management of COVID-19 patients. Professor Taisheng Li was sent to Wuhan to provide frontline medical care. He depicts the clinical course of SARS-CoV-2 infection. Furthermore, he observes the significant abnormality of coagulation function and proposes that the early intravenous immunoglobulin and low molecular weight heparin anticoagulation therapy are very important. Professor Hongzhou Lu, a leader in China to try various anti-viral drugs, expresses concern on the quality of the ongoing clinical trials as most trials are small in scale and repetitive in nature, and emphasizes the importance of the quick publication of clinical trial results. Regarding the traditional Chinese medicine, Professor Lu suggests to develop a creative evaluation system because of the complicated chemical compositions. Professor Wenhong Zhang is responsible for Shanghai's overall clinical management of the COVID-19 cases. He introduces the team approach to manage COVID-19 patients. For severe or critically ill patients, in addition to the respiratory supportive treatment, timely multiorgan evaluation and treatment is very crucial. The medical decisions and interventions are carefully tailored to the unique characteristics of each patient.


Subject(s)
Betacoronavirus , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Antiviral Agents/therapeutic use , China , Clinical Trials as Topic , Coronavirus Infections/drug therapy , Coronavirus Infections/mortality , Critical Illness , Disease Progression , Female , Glucocorticoids/therapeutic use , Humans , Male , Medicine, Chinese Traditional , Pandemics , Patient Care Management , Patient Care Team , Pneumonia, Viral/drug therapy , Pneumonia, Viral/mortality , Thrombophilia/physiopathology , Thrombophilia/therapy
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