Epidemiological Investigation and Analysis of Bovine Coronavirus in Beef Cattle in Jilin Province.

In order to comprehensively understand the epidemiological situation of bovine coronavirus (BCoV) in beef cattle herds in Jilin Province, blood, nasal swabs, fecal swabs and tissue organs of clinically diseased and dead cattle were collected in different seasons from 12 counties and cities in the east, central and western regions of Jilin Province, using serological and molecular diagnostic testing techniques to conduct an epidemiological investigation of BCoV in the The epidemiological situation of BCoV in some areas of Jilin Province. A total of 1 298 clinical serum samples, 462 clinical samples (including fecal samples, liver, lung, spleen, trachea and other tissue samples) were collected, and PCR detection of clinical samples was performed by applying commercial BCoV antibody detection kits to detect serum antibodies and a novel detection technique of nano-PCR, and sequencing and analysis of positive results detected by nucleic acid. The results showed that the serum positive rate of BCoV antibodies was 1.08%, and the positive rate of clinical samples such as feces and liver was 21.10%. The BCoV prevalent strain in the investigated area was more than 99% homologous to the prevalent strain in Sichuan, China, after sequencing analysis. This study provides a comprehensive survey of BCoV prevalence in central Jilin Province, which enriches the epidemiological survey data of bovine coronavirus and lays the foundation for guiding the prevention and control of bovine coronavirus.Copyright © 2023 Acta Veterinaria et Zootechnica Sinica. All rights reserved.

Practice of big data and artificial intelligence in epidemic surveillance and containment.

Faced with the current time-sensitive COVID-19 pandemic, the overburdened healthcare systems resulted in a strong demand to develop newer methods to control the spread of the pandemic. Big data and artificial intelligence (AI) have been leveraged amid the COVID-19 pandemic; however, little is known about its use for supporting public health efforts. In epidemic surveillance and containment, efforts are needed to treat critical patients, track and manage the health status of residents, isolate suspected cases, develop vaccines and antiviral drugs. The applications of emerging practices of artificial intelligence and big data have become powerful "weapons" to fight against the pandemic and provide strong support in pandemic prevention and control, such as early warning, analysis and judgment, interruption and intervention of epidemic, to achieve goals of early detection, early report, early diagnosis, early isolation and early treatment, and these are the decisive factors to control the spread of the epidemic and reduce the mortality. This paper systematically summarizes the application of big data and AI in epidemic, and describes practical cases and challenges with emphasis in epidemic prevention and control. The included studies showed that big data and AI have the potential strength to fight against COVID-19. However, many of the proposed methods are not yet widely accepted. Thus, the most rewarding research will be on methods promising value beyond COVID-19. More efforts are needed for developing standardized reporting protocols or guidelines for practice.

Pathogenic infection characteristics and risk factors for bovine respiratory disease complex based on the detection of lung pathogens in dead cattle in northeast China.

Bovine respiratory disease complex (BRDC) involves multiple pathogens, shows diverse lung lesions, and is a major concern in calves. Pathogens from 160 lung samples of dead cattle from 81 cattle farms in northeast China from 2016 to 2021 were collected to characterize the molecular epidemiology and risk factors of BRDC and to assess the major pathogens involved in bovine suppurative or caseous necrotizing pneumonia. The BRDC was diagnosed by autopsy, pathogen isolation, PCR, or reverse transcription-PCR detection, and gene sequencing. More than 18 species of pathogens, including 491 strains of respiratory pathogens, were detected. The positivity rate of bacteria in the 160 lung samples was 31.77%, including Trueperella pyogenes (9.37%), Pasteurella multocida (8.35%), Histophilus somni (4.48%), Mannheimia haemolytica (2.44%), and other bacteria (7.13%). The positivity rate of Mycoplasma spp. was 38.9%, including M. bovis (7.74%), M. dispar (11.61%), M. bovirhinis (7.94%), M. alkalescens (6.11%), M. arginini (0.81%), and undetermined species (4.68%). Six species of viruses were detected with a positivity rate of 29.33%, including bovine herpesvirus-1 (BoHV-1; 13.25%), bovine respiratory syncytial virus (BRSV; 5.50%), bovine viral diarrhea virus (BVDV; 4.89%), bovine parainfluenza virus type-3 (BPIV-3; 4.28%), bovine parainfluenza virus type-5 (1.22%), and bovine coronavirus (2.24%). Mixed infections among bacteria (73.75%), viruses (50%), and M. bovis (23.75%) were the major features of BRDC in these cattle herds. The risk analysis for multi-pathogen co-infection indicated that BoHV-1 and H. somni; BVDV and M. bovis, P. multocida, T. pyogenes, or Mann. haemolytica; BPIV-3 and M. bovis; BRSV and M. bovis, P. multocida, or T. pyogenes; P. multocida and T. pyogenes; and M. bovis and T. pyogenes or H. somni showed co-infection trends. A survey on molecular epidemiology indicated that the occurrence rate of currently prevalent pathogens in BRDC was 46.15% (6/13) for BoHV-1.2b and 53.85% (7/13) for BoHV-1.2c, 53.3% (8/15) for BVDV-1b and 46.7% (7/15) for BVDV-1d, 29.41% (5/17) for BPIV-3a and 70.59% (12/17) for BPIV-3c, 100% (2/2) for BRSV gene subgroup IX, 91.67% (33/36) for P. multocida serotype A, and 8.33% (3/36) for P. multocida serotype D. Our research discovered new subgenotypes for BoHV-1.2c, BRSV gene subgroup IX, and P. multocida serotype D in China's cattle herds. In the BRDC cases, bovine suppurative or caseous necrotizing pneumonia was highly related to BVDV [odds ratio (OR) = 4.18; 95% confidence interval (95% CI): 1.6-10.7], M. bovis (OR = 2.35; 95% CI: 1.1-4.9), H. somni (OR = 8.2; 95% CI: 2.6-25.5) and T. pyogenes (OR = 13.92; 95% CI: 5.8-33.3). The risk factor analysis found that dairy calves <3 mo and beef calves >3 mo (OR = 5.39; 95% CI: 2.7-10.7) were more susceptible to BRDC. Beef cattle were more susceptible to bovine suppurative or caseous necrotizing pneumonia than dairy cattle (OR = 2.32; 95% CI: 1.2-4.4). These epidemiological data and the new pathogen subgenotypes will be helpful in formulating strategies of control and prevention, developing new vaccines, improving clinical differential diagnosis by necropsy, predicting the most likely pathogen, and justifying antimicrobial use.

Epidemiological investigation of the first locally acquired case of COVID-19 identified by influenza surveillance-Taiwan, February 2020.

BACKGROUND: COVID-19 and influenza have similar clinical presentations that can range from mild to severe disease. The World Health Organization recommends that countries use existing influenza surveillance to monitor COVID-19 transmission in communities. We aim to describe the surveillance and investigation of COVID-19 at the early stage of the pandemic in Taiwan. METHODS: In February 2020, the Taiwan Centers for Disease Control enhanced COVID-19 surveillance through its existing influenza surveillance. We retrospectively tested patients for SARS-CoV-2 who had symptoms of severe complicated influenza but were negative in influenza testing. We conducted an epidemiological investigation and contact tracing for the index patient and secondary cases to prevent virus transmission. RESULTS: We identified the first COVID-19 patient on February 15 through enhanced COVID-19 surveillance. He had no history of traveling abroad and an unclear history of contact with COVID-19 cases. He presented with influenza-like illness on January 27 and was hospitalized from February 3 to 15. We identified 39 close contacts of the index patient, including 11 family members and 28 healthcare workers. In total, four close family contacts of the index patient tested positive for SARS-CoV-2. An additional 84 close contacts of the four secondary cases were identified and traced; none was diagnosed with COVID-19. CONCLUSIONS: We recommend enhancing COVID-19 surveillance by testing patients with influenza-like illness. To prevent the spread of COVID-19, we recommend using appropriate personal protective equipment when in close contact with patients who present with influenza-like illness or when caring for patients with pneumonia of unknown etiology.

How fast and how well the Omicron epidemic was curtailed. A Guangzhou experience to share.

Introduction: SARS-CoV-2 has ravaged the world and undergone multiple mutations during the course of the COVID-19 pandemic. On 7 April 2022, an epidemic caused by SARS-CoV-2 Omicron (BA.2) variant broke out in Guangzhou, China, one of the largest transportation and logistical hubs of the country. Methods: To fast curtained the Omicron epidemic, based on the routine surveillance on the risk population of SARS-CoV-2 infection, we identify key places of the epidemic and implement enhanced control measures against Omicron. Results: Transmission characteristics of the Omicron variant were analyzed for 273 confirmed cases, and key places involved in this epidemic were fully presented. The median incubation time and the generation time were 3 days, and the reproduction number Rt was sharply increased with a peak of 4.20 within 2 days. We tried an all-out effort to tackle the epidemic in key places, and the proportion of confirmed cases increased from 61.17% at Stage 2 to 88.89% at Stage 4. Through delimited risk area management, 99 cases were found, and the cases were isolated in advance for 2.61 ± 2.76 days in a lockdown zone, 0.44 ± 1.08 days in a controlled zone, and 0.27 ± 0.62 days in a precautionary zone. People assigned with yellow code accounted for 30.32% (84/277) of confirmed COVID-19 cases, and 83.33% of them were detected positive over 3 days since code assignment. For the districts outside the epicenter, the implementation duration of NPIs was much shorter compared with the Delta epidemic last year. Conclusion: By blocking out transmission risks and adjusting measures to local epidemic conditions through the all-out effort to tackle the epidemic in key places, by delimiting risk area management, and by conducting health code management of the at-risk population, the Omicron epidemic could be contained quickly.

COVID-19 and big data technologies: Experience in China

The experience of COVID-19 has shown that big data combined with advanced algorithms have a huge potential in supporting the fight against infectious diseases and pandemics. In China, big data on human mobility derived from smart sensors, integrated with detailed epidemiological data from patient interviews, have played an important role in the efficient and effective control of the pandemic via nonpharmaceutical interventions. Two official big data applications, namely “Health Code” and “Instrument for Measuring Close Contacts,” have been promoted to detect infected people with the potential to infect and conduct risk assessments in a timely manner during the pandemic. We explored the relationship between big data technologies and applications in virus transmission, risk assessment, and recovery decision making. In the future, the process of social recovery is likely to require the support of big data technology. The experience of using big data in China is expected to bring new insights into policymaking to control the COVID-19 pandemic in other countries and prevent future pandemics.

COVID-19 Case Tracking System in Quarantine Policy: Focus on the Privacy Shift Concept and Application in South Korea.

This study analyzed how Korea's quarantine policy manages personal information to prevent and control COVID-19. Korea effectively halted the spread of COVID-19 through epidemiological investigations and cell-broadcast systems. In this process, the route of infection is presented without identifying the patient, and the necessary participants are selected only through authentication. We found a correlation between the number of emergency text messages sent by the Ministry of Interior and Safety in 2020 and the number of confirmed cases (R2 = 0.465, p < 0.001). Based on Korea's case, we propose a new concept for solving the personal information problems that might arise during a pandemic response.

Dysregulation of Innate and Adaptive Immune Responses in Asymptomatic SARS-CoV-2 Infection with Delayed Viral Clearance.

Asymptomatic infection with SARS-CoV-2 is a major concern in the control of the COVID-19 pandemic. Many questions concerning asymptomatic infection remain to be answered, for example, what are the differences in infectivity and the immune response between asymptomatic and symptomatic infections? In this study, based on a cohort established by the Wuchang District Health Bureau of Wuhan in the early stage of the COVID-19 pandemic in Wuhan in 2019, we conducted a comprehensive analysis of the clinical, virological, immunological, and epidemiological data of asymptomatic infections. The major findings of this study included: 1) the asymptomatic cohort enrolled this study exhibited low-grade but recurrent activity of viral replication; 2) despite a lack of overt clinical symptoms, asymptomatic infections exhibited ongoing innate and adaptive immune responses; 3) however, the immune response from asymptomatic infections was not activated adequately, which may lead to delayed viral clearance. Given the fragile equilibrium between viral infection and host immunity, and the delayed viral clearance in asymptomatic individuals, close viral monitoring should be scheduled, and therapeutic intervention may be needed.

First reported nosocomial SARS-CoV-2 outbreak in a hospital-based laundry facility.

Nosocomial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks among health care workers have been scarcely reported so far. This report presents the results of an epidemiologic and molecular investigation of a SARS-CoV-2 outbreak among laundromat facility workers in a large tertiary centre in Israel. Following the first three reported cases of SARS-CoV-2 among laundromat workers, all 49 laundromat personnel were screened by qRT-PCR tests using naso- and oropharingeal swabs. Epidemiologic investigations included questionnaires, interviews and observations of the laundromat facility. Eleven viral RNA samples were then sequenced, and a phylogenetic analysis was performed using MEGAX.The integrated investigation defined three genetic clusters and helped identify the index cases and the assumed routes of transmission. It was then deduced that shared commute and public showers played a role in SARS-CoV-2 transmission in this outbreak, in addition to improper PPE use and social gatherings (such as social eating and drinking). In this study, we present an integrated epidemiologic and molecular investigation may help detect the routes of SARS-CoV-2 transmission, emphasising such routes that are less frequently discussed. Our work reinforces the notion that person-to-person transmission is more likely to cause infections than environmental contamination (e.g. from handling dirty laundry).

Uncertain future of privacy protection under the Korean public health emergency preparedness governance amid the COVID-19 pandemic

This article explores the implications of South Korea's assertions that it has successfully controlled the transmission of coronavirus disease (COVID-19). South Korea has consistently pursued two underlying policies since the COVID-19 outbreak, namely, securing maximum transparency and undertaking seemingly extreme preemptive measures. However, these measures have resulted in privacy concerns. Public health authorities are allowed to collect comprehensive personal details for contract tracings. Although the system of divulging infected persons' routes has been praised by the public, the contact tracing system carries blatant privacy risks. Politicians are easily tempted to reveal more information than is necessary or perhaps more than is legal to alleviate public anxiety. Until now, professional groups' autonomous authority has withstood the populist call for further intrusive measures against privacy rights. Nonetheless, it remains unclear how far the current public health emergency preparedness governance will go to strike a balance between privacy protection and efficient disease control, given the nebulous future of the current pandemic.

Propagation of a hospital-associated cluster of COVID-19 in Malaysia.

BACKGROUND: Hospitals are vulnerable to COVID-19 outbreaks. Intrahospital transmission of the disease is a threat to the healthcare systems as it increases morbidity and mortality among patients. It is imperative to deepen our understanding of transmission events in hospital-associated cases of COVID-19 for timely implementation of infection prevention and control measures in the hospital in avoiding future outbreaks. We examined the use of epidemiological case investigation combined with whole genome sequencing of cases to investigate and manage a hospital-associated cluster of COVID-19 cases. METHODS: An epidemiological investigation was conducted in a University Hospital in Malaysia from 23 March to 22 April 2020. Contact tracing, risk assessment, testing, symptom surveillance, and outbreak management were conducted following the diagnosis of a healthcare worker with SARS-CoV-2 by real-time PCR. These findings were complemented by whole genome sequencing analysis of a subset of positive cases. RESULTS: The index case was symptomatic but did not fulfill the initial epidemiological criteria for routine screening. Contact tracing suggested epidemiological linkages of 38 cases with COVID-19. Phylogenetic analysis excluded four of these cases. This cluster included 34 cases comprising ten healthcare worker-cases, nine patient-cases, and 15 community-cases. The epidemic curve demonstrated initial intrahospital transmission that propagated into the community. The estimated median incubation period was 4.7 days (95% CI: 3.5-6.4), and the serial interval was 5.3 days (95% CI: 4.3-6.5). CONCLUSION: The study demonstrated the contribution of integrating epidemiological investigation and whole genome sequencing in understanding disease transmission in the hospital setting. Contact tracing, risk assessment, testing, and symptom surveillance remain imperative in resource-limited settings to identify and isolate cases, thereby controlling COVID-19 outbreaks. The use of whole genome sequencing complements field investigation findings in clarifying transmission networks. The safety of a hospital population during this COVID-19 pandemic may be secured with a multidisciplinary approach, good infection control measures, effective preparedness and response plan, and individual-level compliance among the hospital population.

Teaching practice of field epidemiological investigation based on COVID-19 epidemic

The coronavirus disease 2019 (COVID-19) pandemic is accelerating in the world. Although the epidemic has been basically controlled across China at the present stage, the domestic epidemic prevention and control situation is still complex and grim. Field epidemiology played an important role in the prevention and control of infectious diseases during this epidemic and the past epidemics. In order to improve the teaching content of field epidemiology in undergraduate medical education, and to explore the practice of training in epidemiology with the present situation, this paper explored the teaching practice of field epidemiology investigation based on COVID-19. This study will help to enhance both the ability of students from theory to practice, and the adaption of high-level talents in field epidemic under the new situation. © 2021, Publication Centre of Anhui Medical University. All rights reserved.

Balancing Personal Privacy and Public Safety During COVID-19: The Case of South Korea.

There has been vigorous debate on how different countries responded to the COVID-19 pandemic. To secure public safety, South Korea actively used personal information at the risk of personal privacy whereas France encouraged voluntary cooperation at the risk of public safety. In this article, after a brief comparison of contextual differences with France, we focus on South Korea's approaches to epidemiological investigations. To evaluate the issues pertaining to personal privacy and public health, we examine the usage patterns of original data, de-identification data, and encrypted data. Our specific proposal discusses the COVID index, which considers collective infection, outbreak intensity, availability of medical infrastructure, and the death rate. Finally, we summarize the findings and lessons for future research and the policy implications.

High throughput diagnostics and dynamic risk assessment of SARS-CoV-2 variants of concern.

BACKGROUND: The rise of new SARS-CoV-2 variants worldwide requires global molecular surveillance strategies to support public health control. Early detection and evaluation of their associated risk of spreading within the population are pivotal. METHODS: Between April 2020 and February 2021, the UK Lighthouse Labs Network at Alderley Park tested more than eight million nose and throat swab samples for the presence of SARS-CoV-2, via PCR. The assay targeted three genomic regions of the virus: N, Orf1ab and S. Whole-genome next-generation sequencing was used to confirm positive PCR results. Positive results were mapped using the postal district origin of samples to allow real-time tracking of the spread of a new variant through the UK. FINDINGS: In mid-November 2020, the assay identified an increasing number of S gene negative, N and Orf1ab positive samples. Whole-genome sequencing demonstrated that the loss of S gene detection was due to the appearance of a SARS-CoV-2 lineage (B.1.1.7) designated as Variant of concern (VOC) 202012/01. By the beginning of January 2021, the new SARS-CoV-2 VOC comprised 70% of daily positive samples tested at Alderley Park and ∼98% by the end of February 2021. INTERPRETATION: The timeline view identified the rapid spread of the new SARS-CoV-2 variant across England during the first three weeks of December. Coupling high-throughput diagnostics and molecular surveillance was pivotal to the early detection of the spread of this variant. The availability of real-time tracking of an emerging variant is an important new tool to inform decision-making authorities for risk mitigation. In a respiratory pandemic, a tool for the timely response to the emergence and spread of a novel variant is vital, even more so when a variant is associated with the enhanced transmission, as has occurred with VOC 202012/01. FUNDING: None.

Development, Acceptance, and Concerns Surrounding App-Based Services to Overcome the COVID-19 Outbreak in South Korea: Web-Based Survey Study.

BACKGROUND: Since the COVID-19 outbreak, South Korea has been engaged in various efforts to overcome the pandemic. One of them is to provide app-based COVID-19-related services to the public. As the pandemic continues, a need for various apps has emerged, including COVID-19 apps that can support activities aimed at overcoming the COVID-19 pandemic. OBJECTIVE: We aimed to determine which apps were considered the most necessary according to users and evaluate the current status of the development of COVID-19-related apps in South Korea. We also aimed to determine users' acceptance and concerns related to using apps to support activities to combat COVID-19. METHODS: We collected data from 1148 users from a web-based survey conducted between November 11 and December 6, 2020. Basic statistical analysis, multiple response analysis, and the Wilcoxon rank sum test were performed using R software. We then manually classified the current status of the development of COVID-19-related apps. RESULTS: In total, 68.4% (785/1148) of the respondents showed high willingness to protect themselves from COVID-19 by using related apps. Users considered the epidemiological investigation app to be the most necessary app (709/1148, 61.8%) overall, followed by the self-management app for self-isolation (613/1148, 53.4%), self-route management app (605/1148, 52.7%), COVID-19 symptom management app (483/1148, 42.1%), COVID-19-related information provision app (339/1148, 29.5%), and mental health management app (270/1148, 23.5%). Despite the high intention to use these apps, users were also concerned about privacy issues and media exposure. Those who had an underlying disease and had experience using COVID-19-related apps showed significantly higher intentions to use those apps (P=.05 and P=.01, respectively). CONCLUSIONS: Targeting users is very important in order to design and develop the most necessary apps. Furthermore, to gain the public's trust and make the apps available to as many people as possible, it is vital to develop diverse apps in which privacy protection is maximized.

The precision of epidemiological investigation of COVID-19 transmission in Shanghai, China.

BACKGROUND: Shanghai had a local outbreak of COVID-19 from January 21 to 24. Timely and precise strategies were taken to prevent further spread of the disease. We discussed and shared the experience of COVID-19 containment in Shanghai. PROCESS: The first two patients worked at two hospitals but no staff from the two hospitals were infected. The suspected case and his two close contacts were confirmed to be infected within 12 h. The testing rate of individuals was low. The scope of screening was minimized to two related districts and the close contact tracing was completed within 12 h, which were precise and cost-effective. CONCLUSIONS: Active monitoring, precise epidemiological investigation and timely nucleic acid testing help discover new cases, minimize the scope of screening, and interrupt the transmission.

Risk of group aggregative behavior during COVID-19 outbreak: A case report.

BACKGROUND: At the end of 2019, a new epidemic of viral pneumonia emerged in China and was determined to be caused by a novel coronavirus, which was named coronavirus disease 2019 (COVID-19) by the World Health Organization. The epidemic quickly spread, causing a worldwide pandemic. Scientists and clinicians across the globe have shifted their research efforts towards understanding the virus itself and its epidemiology. CASE SUMMARY: In mid-January 2020, a Chinese family made a visit to a local city, and within the next 2 wk one after another fell ill with COVID-19. At the beginning of their first illness onset, the family had eaten in a restaurant, which led to the subsequent illness onset in another two families. All cases were diagnosed as COVID-19 by real-time fluorescent reverse transcription-polymerase chain reaction. Epidemiological investigation showed that the transmission chain was complete. CONCLUSION: This chain of social exposure highlights the danger of group aggregative behavior for spread of COVID-19.

Epidemiological Chronicle of the First Recovered Coronavirus Disease Patient From Panama: Evidence of Early Cluster Transmission in a High School of Panama City.

The first patient infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Panama was reported on March 9, 2020. Here, we describe the first case of recovery from coronavirus disease 2019 (COVID-19) in the country. The patient was a 49-year-old male high school teacher, who did not show any primary symptoms of COVID-19 described by health authorities as the signs for medical attention. Nonetheless, he became severely ill over the course of 2 weeks and almost lost the battle against COVID-19. The identification of the first cluster of SARS-CoV-2 community transmission in the secondary school where the patient of this case report taught, led to the closure of the school and, a day after, the shutdown of the national education system, which may have prevented the spread and slowed the transmission rate of COVID-19 during the early stages of invasion. This case report highlights the need to increase awareness among healthcare professionals in Latin America to consider symptoms such as anosmia and dysgeusia as the sentinel signs of COVID-19 infection in order to prevent deaths, especially in high-risk patients.

Ecological Study on Differences in COVID-19 Fatality among Wuhan, Rest of Hubei, and Rest of China.

BACKGROUND: China's vigorous anti-COVID-19 campaign has been going on for three months since January 20, which has contained the spread of the virus across China. OBJECTIVES: Epidemiological investigations found that COVID-19 fatality rates in Wuhan, rest parts of Hubei province except Wuhan (Rest of Hubei) and rest parts of Mainland China except Hubei province (Rest of China) were different. An ecological study was conducted to analyze the reasons and provide the world with China's anti-COVID-19 epidemic experiences. METHODS: Infected cases from Mainland China were divided into three populations: Wuhan, Rest of Hubei and Rest of China. Methods were based on The Novel Coronavirus Infected Pneumonia Diagnosis and Treatment Standards. Total confirmed cases, daily severe cases, total deaths from February 12 to April 20 were collected for statistical analysis. RESULTS: 50,333 total confirmed cases in Wuhan made up the most substantial part by comparison with 17,795 in Rest of Hubei and 14,630 in Rest of China, respectively. In the early stage of the COVID-19 epidemic, daily severe cases in Wuhan accounted for the majority, and as the epidemic controlled, severe cases in all three populations decreased. Total deaths in Wuhan constituted the most significant proportion, with the highest 3869 in contrast to 643 in Rest of Hubei and 120 in Rest of China. The fatality rates in Wuhan ranged from 2.82% to 7.69%, much higher than 1.80-3.61% in Rest of Hubei, and 0.49-0.88% in Rest of China. Pearson chi-square test for fatality rates in the three populations demonstrated significant differences (p < 0.01). CONCLUSION: The ecological comparison study among the three populations have proved that social distancing, quarantine, lockdown, cutting off sources of infection and transmission routes, early detection, early isolation, early treatment are all vital to control the epidemic by reducing COVID-19 confirmed cases, severe cases and the fatality rate.

Diagnosis and treatment of an elderly patient with 2019-nCoV pneumonia and acute exacerbation of chronic obstructive pulmonary disease in Gansu Province: A case report.

BACKGROUND: In December 2019, the first patient with 2019-novel coronavirus (2019-nCoV) was reported in Wuhan, China, and the disease spread rapidly across the country and surrounding countries within 2 mo. As of February 29, 2020, a total of 91 confirmed cases had been reported in Gansu Province. This case report of the diagnosis and treatment of an elderly patient with 2019-nCoV pneumonia complicated by acute exacerbation of chronic obstructive pulmonary disease in Gansu Province aims to provide a better reference for the treatment of patients in the future. CASE SUMMARY: The patient, a 94-year-old female, lived in Maiji District of Tianshui, Gansu Province, China. On January 30, 2020, she was admitted to the Fourth People's Hospital of Tianshui after 9 d of close contact with a patient with 2019-nCoV pneumonia. She was subsequently admitted to Gansu Provincial Hospital of Traditional Chinese Medicine for isolation and transferred to Tianshui Gansu Provincial Hospital of Infectious Diseases on February 3, 2020 for treatment. Upon initial examination, her body temperature was 36.7 °C , pulse was 80, breathing was 20, and blood pressure was 130/80 mmHg. She was conscious with normal development and normal nutrition. The pharynx was not red, and bilateral tonsils were not red and swollen. The lungs sounded slightly coarse with no dry or wet rales. The first symptoms were cough and fatigue on 2 February. The patient was hospitalized for 12 d. After active treatment, she was discharged on February 14 with a good prognosis. CONCLUSION: A history of exposure to the affected area or patient is a major cause of 2019-nCoV infection, and population clustering is a high risk factor for transmission. Patients may not necessarily have respiratory system symptoms as the only clinical manifestation but may also have concomitant or first onset digestive symptoms. Attention should be paid to the prevention and treatment of multiple organ dysfunction syndrome. Nucleic acid testing is extremely important and needs to be repeated several times. Laboratory and auxiliary examination indicators during the first week of admission are extremely important. It is feasible to carry out dynamic and continuous index monitoring, which can predict and guide the prevention and treatment of multiple organ dysfunction and the prognosis of the disease.