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EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-312652


Human beings are constantly struggling with various epidemics. Although we gained a lot of experience and success, in the face of the new epidemic, we still inevitably face pressure from public health, politics, and the economy. Case fatality ratio (CFR) received widespread attention as one of the indicators describing the severity of the epidemic and evaluating treatment options. However, due to the ongoing epidemic situation and the constant changes in the death and diagnosis data, no scientific method for this situation to calculate the CFR exists. This study proposes a method for estimating CFR in the continuation of the epidemic. CFR is estimated by "ratio of the cumulative number of deaths before j days from a given day to the sum of the number of patients discharged from a given day and the cumulative number of deaths before j days from a given day ". Take the ongoing outbreak of COVID COVID-19 in December 2019 as an example. The results show that, regardless of the size of the estimated value or its changing trend, the estimated CFR given by the new method shows better stability and better reflects the true situation of the case fatality rate;additionally, the improvement of medical conditions can also be clearly reflected in the change in valuation. When j = 10, according to the data of March 10, the CFR of COVIDCOVID-19 in Wuhan, China and China (excluding Hubei)is 6.23%,4.46%, and 0.87%, respectively. This method of estimating CFR can be used in time to evaluate the therapeutic effect of different medical schemes and different regions, which is of great value and significance for the decision decision-making in the epidemicprevention and control.Authors Wanling Hu, Xiaoyun Liu, and Tao Wang contributed equally to this work

Signal Transduct Target Ther ; 5(1): 219, 2020 10 06.
Article in English | MEDLINE | ID: covidwho-834865


Convalescent plasma (CP) transfusion has been indicated as a promising therapy in the treatment for other emerging viral infections. However, the quality control of CP and individual variation in patients in different studies make it rather difficult to evaluate the efficacy and risk of CP therapy for coronavirus disease 2019 (COVID-19). We aimed to explore the potential efficacy of CP therapy, and to assess the possible factors associated with its efficacy. We enrolled eight critical or severe COVID-19 patients from four centers. Each patient was transfused with 200-400 mL of CP from seven recovered donors. The primary indicators for clinical efficacy assessment were the changes of clinical symptoms, laboratory parameters, and radiological image after CP transfusion. CP donors had a wide range of antibody levels measured by serology tests which were to some degree correlated with the neutralizing antibody (NAb) level. No adverse events were observed during and after CP transfusion. Following CP transfusion, six out of eight patients showed improved oxygen support status; chest CT indicated varying degrees of absorption of pulmonary lesions in six patients within 8 days; the viral load was decreased to a negative level in five patients who had the previous viremia; other laboratory parameters also tended to improve, including increased lymphocyte counts, decreased C-reactive protein, procalcitonin, and indicators for liver function. The clinical efficacy might be associated with CP transfusion time, transfused dose, and the NAb levels of CP. This study indicated that CP might be a potential therapy for severe patients with COVID-19.

Antibodies, Neutralizing/administration & dosage , Antibodies, Viral/administration & dosage , Betacoronavirus/pathogenicity , Coronavirus Infections/therapy , Pneumonia, Viral/therapy , Adult , Aged , Antiviral Agents/therapeutic use , Betacoronavirus/immunology , Biomarkers/blood , C-Reactive Protein/metabolism , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/immunology , Coronavirus Infections/pathology , Disease Progression , Female , Humans , Immunization, Passive/methods , Liver Function Tests , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/immunology , Pneumonia, Viral/pathology , Procalcitonin/blood , SARS-CoV-2 , Severity of Illness Index , Tomography, X-Ray Computed , Viral Load
Chinese Science Bulletin ; 65(22):2342-2350, 2020.
Article | WHO COVID | ID: covidwho-740395


The COVID-19 outbreak has been associated with over 250000 confirmed infections and over 11000 confirmed deaths worldwide. The epidemic poses a huge challenge to global public health security. Cure rate (CR)/case fatality rate (CFR) is an important data to assess the severity of an epidemic disease and an important consideration to evaluate the therapeutic effect. The current calculation of CR or CFR for COVID-19 epidemic is based on formula: number of cure or deaths/number of diagnosed. This calculation method was called crude CR/CFR. However, there is no more scientific method to calculate the CR and CFR of the epidemic due to the changing data of the epidemic, especially the large increase of the number of diagnosed and hospitalized. The estimated CFR calculated by the basic formula is called crude CFR. Considering a large number of hospitalized patients, we revised the calculation method for CR, which is the ratio of cumulative discharges on a given day to the sum of cumulative discharges on a given day and cumulative deaths before j days is used to estimate the CR. In addition, the CFR can be estimated accordingly. According to statistical theory, if the COVID-19 epidemic event satisfies the statistical random event hypothesis, the estimated daily CR and CFR rate should be basically stable without considering the discovery of future special drugs and special medical methods. Therefore, the j value is selected with the minimum variance or coefficient of variation of the daily estimate of CR as the selection index, and the best value of j is determined by reference to clinical observation statistics. According to the results, the coefficient of variation of the estimated CR of Wuhan, Hubei, China, Hubei excluding Wuhan and China excluding Hubei reached the minimum value at j=8,10,10,10 and 12, respectively, indicating that this is the least difference in the estimated value of each day. When j=9, the CR of COVID-19 was estimated to be about 95.8% in China, while the CFR was estimated to be about 4.2%, which is lower than that of the SARS epidemic in mainland China in 2003;the CR in Wuhan was estimated to be about 94.5%, while the CFR in Wuhan was estimated to be about 5.5%. Because of the large number of cases and low cure rate in Wuhan, the cure rate in Hubei Province is lower than the national average. The CR of Hubei excluding Wuhan was similar to the national average. The CR of China excluding Hubei Province is the highest, which may be related to the factors of more imported cases, different age structure of imported cases, relatively few patients and better treatment conditions in the other provinces. This method of estimating the CR optimized the calculation method of crude CR, considering the influence of the population still in hospital on the valuation. So the comparatively accurate CR/CFR predictions for the ongoing epidemics are conducive to decision making regarding epidemic prevention and control as well as evaluating the curative effects of availed treatments.