Real-world Effectiveness of BNT162b2 in Children and Adolescents in Preventing Infection and Severe Diseases with SARS-CoV-2 During the Delta and Omicron Periods: Findings from Trial Emulation Using an EHR-based Cohort (preprint)

BACKGROUND The current understanding of the long-term effectiveness of the BNT162b2 vaccine for a range of outcomes across diverse U.S. pediatric populations is limited. In this study, we assessed the effectiveness of BNT162b2 against various strains of the SARS-CoV-2 virus using data from a national collaboration of pediatric health systems (PEDSnet). METHODS We emulated three target trials to assess the real-world effectiveness of BNT162b2: adolescents aged 12 to 20 years during the Delta variant period (Target trial 1), children aged 5 to 11 years (Target trial 2) and adolescents aged 12 to 20 years during the Omicron variant period (Target trial 3). The outcomes included documented infection, COVID-19 illness severity, admission to an intensive care unit (ICU), and two cardiac-related outcomes, myocarditis and pericarditis. In the U.S., immunization records are often captured and stored across multiple disconnected sources, resulting in incomplete vaccination records in patients' electronic health records (EHR). We implemented a novel trial emulation pipeline accounting for possible misclassification bias in vaccine documentation in EHRs. The effectiveness of the BNT162b2 vaccine was estimated from the Poisson regression model with confounders balanced via propensity score stratification. RESULTS During the Delta period, the BNT162b2 vaccine demonstrated an overall effectiveness 98.4% (95% CI, 98.1 to 98.7) against documented infection among adolescents, with no significant waning after receipt of the first dose. During the Omicron period, the overall effectiveness was estimated to be 74.3% (95% CI, 72.2 to 76.2) in preventing documented infection among children, which was higher against moderate or severe COVID-19 (75.5%; 95% CI, 69.0 to 81.0) and ICU admission with COVID-19 (84.9%; 95% CI, 64.8 to 93.5). In the adolescent population, the overall effectiveness against documented Omicron infection was 85.5% (95% CI, 83.8 to 87.1), with effectiveness of 84.8% (95% CI, 77.3 to 89.9) against moderate or severe COVID-19, and 91.5% (95% CI, 69.5 to 97.6) against ICU admission with COVID-19. The effectiveness of the BNT162b2 vaccine against the Omicron variant declined after 4 months following the first dose and then stabilized with higher levels of uncertainty. Across all three cohorts, the risk of cardiac outcomes was approximately 65% to 85% lower in the vaccinated group than that of the unvaccinated group accounting for possible misclassification bias. CONCLUSIONS This study suggests BNT162b2 was effective among children and adolescents in Delta and Omicron periods for a range of COVID-19-related outcomes and is associated with a lower risk for cardiac complications. Waning effectiveness over time suggests that revaccination may be needed in the future.

Clinical efficacy and safety of interleukin-1 blockade in the treatment of patients with COVID-19: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: This study evaluated the clinical efficacy and safety of interleukin-1 (IL-1) blockade for patients with COVID-19. METHODS: The PubMed, Web of Science, Ovid Medline, Embase and Cochrane Library databases were searched for relevant articles from their inception to 25 September 2022. Only randomized clinical trials (RCTs) that assessed the clinical efficacy and safety of IL-1 blockade in the treatment of patients with COVID-19 were included. RESULTS: This meta-analysis included seven RCTs. No significant difference in the all-cause mortality rate of patients with COVID-19 was observed between the IL-1 blockade and control groups (7.7 vs. 10.5%, odds ratio [OR] = 0.83, 95% confidence interval [CI] 0.57-1.22; I2 = 18%). However, the study group was at significantly lower risk of requiring mechanical ventilation (MV) compared with the control group (OR = 0.53, 95% CI 0.32-0.86; I2 = 24%). Finally, the risk of adverse events was similar between the two groups. CONCLUSIONS: IL-1 blockade does not provide increased survival benefits in hospitalized patients with COVID-19, but it may reduce the need for MV. Furthermore, it is a safe agent for use in the treatment of COVID-19.>.

This systematic review and meta-analysis of randomized clinical trials (RCTs) evaluated the clinical efficacy and safety of interleukin-1 (IL-1) blockade for patients with COVID-19.Based on the analysis of six RCTs, no significant difference in the all-cause mortality rate of patients with COVID-19 was observed between the IL-1 blockade and control groups.The study group using IL1 was associated with a significantly lower risk of requiring mechanical ventilation compared with the control group.The risk of adverse events was similar between the study and the control groups.

A review of epidemic investigation on cold‐chain food‐mediated SARS‐CoV‐2 transmission and food safety consideration during COVID‐19 pandemic

COVID‐19 has brought speculations on potential transmission routes of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), the causal agent of the pandemic. It is reported that the main route of virus transmission to be person‐to‐person by respiratory droplets;however, people have raised concerns on the possible transmission of SARS‐CoV‐2 to humans via food and packaging and its potential effects on food safety. This review discusses food safety issues in the COVID‐19 pandemic and reveals its possible transmission in cold‐chain food. The first outbreak of COVID‐19 in late 2019 was associated with a seafood market in Wuhan, China, while the second outbreak of COVID‐19 in June 2020 was also related to a seafood market in Beijing, China. As of 2020, several frozen seafood products linked with SARS‐CoV‐2 have been reported in China. According to the current survey and scientific studies, the risk of infection by SARS‐CoV‐2 from cold‐chain food, food products, and food packaging is thought to be very low. However, studies on food cold chain contamination have shown that SARS‐CoV‐2 remained highly stable under refrigerated (4°C) and even in freezing conditions (−10 to −80°C). Since one mode of SARS‐CoV‐2 transmission appears to be touching contaminated surfaces, it is important to clean and sanitize food contact surfaces properly. Understanding food safety hazard risks is essential to avoid potential negative health effects and SARS‐CoV‐2 transmission in the food supply chain during the COVID‐19 pandemic.

Psychological Capital and Alienation among patients with COVID-19 infection: The mediating role of Social Support (preprint)

Background COVID-19 infection continues all over the world, causing serious physical and psychological impacts to patients. Patients with COVID-19 infection suffer from various negative emotional experiences such as anxiety, depression, mania, and alienation, which seriously affect their normal life and is detrimental to the prognosis. Our study is aimed to investigate the effect of psychological capital on alienation among patients with COVID-19 and the mediating role of social support in this relationship.Methods The data were collected in China by the convenient sampling method. A sample of 259 COVID-19 patients completed the psychological capital, social support and social alienation scale and the structural equation model was adopted to verify the research hypotheses.Results Psychological capital was significantly and negatively related to the COVID-19 patients’ social alienation (p < .01). And social support partially mediated the association between psychological capital and patients’ social alienation (p < .01).Conclusion Psychological capital is critical to predicting COVID-19 patients’ social alienation. Social support plays an intermediary role and explains how psychological capital alleviates the sense of social alienation among patients with COVID-19 infection.

Predicting social media rumours in the context of public health emergencies

The spread of rumours on social media in the context of public health emergencies often distorts perceptions of public events and obstructs crisis management. Microblog entries about 28 rumour cases are collected on Sina Weibo during the COVID-19 outbreak. The Modality–Agency–Interactivity–Navigability model is used to identify the key factors of rumour prediction. To investigate the relationship among information modality, information content, information source and rumour identification, the binary logistic regression model is established based on the features of users and microblog entries. In addition, we propose a multi-feature rumour prediction model based on the Bidirectional Encoder Representations from Transformers (BERT) and Extreme Gradient Boosting (XGBoost) models. The proposed rumour prediction model has the best performance compared with other models. The feature importance is then calculated by the SHapley Additive exPlanations (SHAP), which can also explain the XGBoost results. It is shown that the likelihood that microblog entries are rumours decreases as the values of variables such as user influence and the positive sentiment of comments rise. Microblog entries posted on Thursdays or at noon are more probably to be rumours than those posted at other time. The proposed model can assist emergency management departments in establishing a feasible rumour prediction mechanism to guide public opinion against rumours. [ FROM AUTHOR]

Demoralization: Where it stands-and where we can take it: A bibliometric analysis

Objectives The purpose is to analyze existing studies related to the field of demoralization through bibliometrics. Methodology Relevant literature on demoralization was searched from PubMed, Web of Science, the Cochrane Library, and CINAHL Complete. Bibliometric analysis was performed using GraphPad Prisma 8.2.1, VOSviewer 1.6.18 and R software. Research publication trends, author-country collaboration, research hotspots and future trends were explored by generating network relationship maps. Results A total of 1,035 publications related to the field of demoralization were identified. The earliest relevant studies have been published since 1974, and the studies have grown faster since 2000. Psyche-oncology and Psychother Psychosom had the highest number of publications (n = 25). The United States, Italy and Australia have made outstanding contributions to the field and there was an active collaboration among leading scholars. Major research hotspots include the multiple ways of assessing demoralization, the specificity of various demographics and psychological disorders in different disease contexts, and the association and distinction of diverse clinical psychological abnormalities. The impact of COVID-19 on demoralization and subsequent interventions and psychological care may become a future research direction. Conclusion There has been a significant increase in research in the field of demoralization after 2000. The United States provided the most publications. There is overall active collaboration between authors, countries, and institutions. In future research, more attention will be paid to the effects of COVID-19 on demoralization and intervention care for this psychology.

Beta variant COVID-19 protein booster vaccines elicit durable cross-neutralization against SARS-CoV-2 variants of concern in non-human primates (preprint)

Rapid spread of the SARS-CoV-2 Omicron subvariants despite the implementation of booster vaccination has raised questions about the durability of protection conferred by current vaccines. Vaccines that can induce broader and more durable immune responses against SARS-CoV-2 post-booster are urgently needed. We recently reported that our Beta-containing protein-based SARS-CoV-2 spike booster vaccine candidates with AS03 adjuvant (CoV2 preS dTM-AS03) elicited robust cross-neutralizing antibody responses up to 3 months in macaques primed with mRNA or protein-based subunit vaccine candidates. Here we demonstrate that the AS03-adjuvanted Beta-containing vaccine formulations induce durable cross-neutralizing antibody responses against Omicron (BA.1) and SARS-CoV-1, and are detectable in all macaques 6 months post-booster. We also describe the induction of consistent and robust memory B cell responses, independent of the levels measured post-primary immunization. These data suggest that a booster dose with a Beta-containing CoV2 preS dTM-AS03 vaccine can induce robust and durable cross-neutralizing responses against a broad spectrum of variants.

Nitrogen-rich based conjugated microporous polymers for highly efficient adsorption and removal of COVID-19 antiviral drug chloroquine phosphate from environmental waters

Chloroquine phosphate (CQP) has been suggested as an important and effective clinical reliever medication for the 2019 coronavirus (COVID-19). Nevertheless, its excessive use will inevitably cause irreparable damage to the entire ecosystem, thereby posing a considerable environmental safety concern. Hence, the development of highly-efficient methods of removing CQP from water pollution sources, e.g., effluents from hospitals and pharmaceutical factories is significant. This study reported the fabrication of novel CN bond linked conjugated microporous polymers (CMPs) (BPT–DMB–CMP) with multiple nitrogen-rich anchoring sites for the quick and efficient removal of CQP from aqueous solutions. The irreversible covalent CN bond linked in the internal framework of BPT–DMB–CMP endowed it with good chemical stability and excellent adsorbent regeneration. With its predesigned functional groups (i.e., rich NH bonds, triazine rings, and benzene rings) and large area surface (1,019.89 m2·g−1), BPT–DMB–CMP demonstrated rapid adsorption kinetics (25 min) and an extraordinary adsorption capacity (334.70 mg·g−1) for CQP, which is relatively higher than that of other adsorbents. The adsorption behavior of CQP on BPT–DMB–CMP corresponded with Liu model and mixed-order model. Based on the density functional theory (DFT) calculations, X-ray photoelectron spectroscopy (XPS), and adsorption comparisons test, the halogen bonding, and hydrogen bonding cooperates with π − π, C  H···π interactions and size-matching effect in the CQP adsorption system on BPT–DMB–CMP. The excellent practicability for the removal of CQP from real wastewater samples verified the prospect of practical application of BPT–DMB–CMP. BPT–DMB–CMP exhibited the application potentials for the adsorption of other antiviral drugs. This work opens up an efficient, simple, and high adsorption capacity way for removal CQP.

Effect of fluvoxamine on outcomes of nonhospitalized patients with COVID-19: A systematic review and meta-analysis.

OBJECTIVES: This meta-analysis investigated the use of fluvoxamine for the treatment of nonhospitalized patients with COVID-19. METHODS: PubMed, Web of Science, Ovid medline, Embase, Scopus, Cochrane Library databases, and ClinicalTrials.gov were searched for studies published before June 25, 2022. Only clinical studies that compared the efficacy and safety of fluvoxamine with other alternatives or placebos in the treatment of nonhospitalized patients with COVID-19 were included. RESULTS: Four studies with 1814 patients, of whom 912 received fluvoxamine, were included in this study. Compared with the control group receiving placebo or no therapy, the study group receiving fluvoxamine demonstrated a lower risk of hospitalization and emergency department (ED) visits (odds ratio [OR], 0.59; 95 % CI, 0.44-0.79; I2 = 26 %). In addition, the rate of hospitalization remained significantly lower in patients who received fluvoxamine than in the control group (OR, 0.69; 95 % CI, 0.51-0.94; I2 = 36 %). Although the study group demonstrated a lower risk of requirement of mechanical ventilation and intensive care unit admission, and mortality than the control group, these differences were nonsignificant. Finally, fluvoxamine use was associated with a similar risk of adverse events as that observed in the control group. CONCLUSION: Fluvoxamine can be safely used in nonhospitalized patients with COVID-19 and can reduce the hospitalization rate or ED visits in these patients.

Virtual Reality in Treatment for Psychological Problems in First-Line Health Care Professionals Fighting COVID-19 Pandemic: A Case Series.

ABSTRACT: Virtual reality therapy (VRT) is a new psychotherapeutic approach integrating virtual reality technology and psychotherapy. This case series aimed to study effectiveness of VRT in treating psychological problems. We described four cases of first-line health care professionals with emerging clinically significant early psychological problems during the COVID-19 outbreak, and specifically received the VRT treatment. We compared the Patient Health Questionnaire 9 items (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), PHQ-15, and Athens Insomnia Scale to evaluate psychological symptoms and sleep quality before and after sessions. All four cases showed a reduction in scale comparison. General scores of the PHQ-9 reduced 65%, GAD-7 reduced 52.17%, PHQ-15 decreased 38.17%, and scores of the Athens Insomnia Scale reduced 67.44%. Meanwhile, a reduction in depression, anxiety, psychosomatic, and sleeping symptoms was also found, which decreased 76.92% in general. These results are highly significant statistically. This case series demonstrated the effectiveness of VRT on psychological problems as a promising approach to apply on various psychological distress and disorders.

Effect of colchicine on the outcomes of patients with COVID-19: a systematic review and meta-analysis of randomised controlled trials.

AIM: This meta-analysis aimed to assess the usefulness of colchicine in patients with COVID-19. METHODS: PubMed, Web of Science, Ovid MEDLINE, the Cochrane Library, Embase, and Clinicaltrials.gov were searched for relevant randomised controlled trials (RCTs) published between database inception and November 12, 2021. Only RCTs that compared the clinical efficacy and safety of colchicine with other alternative treatments or placebos in patients with COVID-19 were included. RESULTS: Overall, 7 RCTs involving 16,024 patients were included; 7,794 patients were in the study group receiving colchicine and 8,230 were in the control group receiving placebo or standard treatment. The study and control groups had similar risk of mortality (odds ratio [OR], 1.00; 95% CI, 0.91-1.09; I2 = 0%). No significant difference was observed between the study and control groups in terms of the need for non-invasive ventilation (OR, 0.92; 95% CI, 0.83-1.03; I2 = 0%), the need for mechanical ventilation (OR, 0.64; 95% CI, 0.32-1.32; I2 = 58%), and length of hospital stay (mean difference, -0.42 days; 95% CI, -1.95 to 1.11; I2 = 62%). In addition, colchicine was associated with significantly higher risks of gastrointestinal adverse events (OR, 1.81; 95% CI, 1.56-2.11; I2 = 0%) and diarrhoea (OR, 2.12; 95% CI, 1.75-2.56; I2 = 9%). CONCLUSIONS: Colchicine does not improve clinical outcomes in patients with COVID-19, so it did not support the additional use of colchicine in the treatment of patients with COVID-19.Key messageColchicine could not reduce the mortality of patients with COVID-19.No significant difference was observed between the colchicine and comparators in terms of the need for non-invasive ventilation, need for mechanical ventilation, and length of hospital stay.Colchicine was associated with a higher risk of gastrointestinal adverse events.

Do oil price shocks drive unemployment? Evidence from Russia and Canada

This paper investigates the dynamic relationships between the crude oil price (COP) and the unemployment rate (UR) in Russia and Canada with a bootstrap subsample rolling-window causality test. This approach relaxes linear assumptions, fully considers structural breaks, and captures time-varying causalities between variables;thus, it performs better than traditional long-run causality tests. The empirical results indicate that there are dynamic causal links between the COP and the UR in certain subsample intervals, which does not fully support Carruth's model. Furthermore, the causality between the COP and the UR in Russia can be described based on Western sanctions, China-Russia energy cooperation and the COVID-19 pandemic. In contrast, a decrease in major oil companies' production and the development of U.S. shale oil are employed to explain the fluctuating relationship between the COP and the UR in Canada. Our study identifies potential heterogeneous reasons for the dynamic causalities of major exporting countries, and it reveals novel influencing mechanisms between these two variables. Thus, some policies are suggested to alleviate shocks from oil prices, including oil risk management and oil cooperation for Russia and oil export structural adjustments and monitoring mechanism establishment for Canada.

Mental and physical health among the French population before and during the first and second COVID-19 lockdowns: Latent class trajectory analyses using longitudinal data.

BACKGROUND: The French government issued national COVID-19-related confinement and stay-at-home orders depending on different epidemic levels in a bid to stem the coronavirus pandemic and its resurgence. The long-term impact of lockdown measures on the general population may vary. We aimed to identify and characterize self-reported mental and physical health trajectories in the French population from pre-lockdown to the first and second COVID-19 lockdowns and to identify factors associated with health status variation patterns. METHODS: We did a secondary analysis of the MAVIE cohort in France. Volunteers of this national cohort were recruited between November 2014 and December 2019, and information was collected at recruitment (pre-lockdown), April-May 2020 (the first lockdown), and October-December 2020 (the second lockdown). Latent class mixed models were built to identify distinct anxiety (as measured by GAD-7) and depressive (as measured by PHQ-9) symptoms, and self-perceived mental and physical health trajectories. Factors associated with status variation were identified by logistic or multinomial regression. RESULTS: A total of 613 participants with data in all three data collection waves were included. Respondents spent almost half as much time on traditional media, websites and social media during the second lockdown as during the first. Mean anxiety scores were 1.96, 2.37 and 2.82 at pre-lockdown, and the first and second lockdowns, respectively. Mean depressive scores were 3.12, 3.36 and 3.95, respectively. Latent class mixed models fitted two and three distinct trajectory classes respectively for anxiety symptoms ('no pre-pandemic anxiety, slightly increase', 58.9%; 'consistently fair', 41.1%) and depressive symptoms ('consistently very low', 34.6%; 'consistently low', 56.1%; 'increasing and clinically significant at the second lockdown', 9.3%), and four classes for self-perceived mental and physical health. Females were more likely to belong to trajectories of the most vulnerable one as regard to the symptoms of anxiety and depression, and self-perceived mental and physical health. The younger participants were also more vulnerable to anxiety symptoms and those with a clinical diagnosis or a positive COVID-19 test for the participant or relatives were more likely to belong to vulnerable trajectories for depressive symptoms and self-perceived mental health. CONCLUSION: A continuing increase in the mean scores of anxiety and depression symptoms was observed throughout the two lockdown periods in France. Further analyses revealed distinct patterns with a small fraction of volunteers experiencing worsening mental and physical health symptoms. This vulnerable small part of the population requires targeted support.

Efficacy of melatonin in the treatment of patients with COVID-19: A systematic review and meta-analysis of randomized controlled trials.

This study investigated the effect of melatonin on clinical outcomes in patients with coronavirus disease 2019 (COVID-19). We searched PubMed, the Web of Science, the Cochrane Library, Ovid MEDLINE, and Clinicaltrials.gov for randomized controlled trials (RCTs) published before September 11, 2021. Only RCTs that compared the clinical efficacy of melatonin with a placebo in the treatment of patients with COVID-19 were included. The primary outcome measure was the clinical recovery rate. We included three RCTs in this meta-analysis. Melatonin 3 mg three times daily was administered in one RCT, and 3 or 6 mg daily before bedtime in the other two trials. Treatment duration was 14 days in two RCTs and 7 days in one trial. The clinical recovery rates were 94.2% (81/86) and 82.4% (70/85) in the melatonin and control groups, respectively. Overall, patients receiving melatonin had a higher clinical recovery rate than did the controls (odds ratio [OR]: 3.67; 95% CI: 1.21-11.12; I2 = 0%, p = 0.02). The risk of intensive care unit admission was numerically lower in the melatonin group than in the control group (8.3% [6/72] vs. 17.6% [12/68], OR: 0.45; 95% CI: 0.16-1.25; I2 = 0%, p = 0.13), and the risk of mortality was numerically lower in the melatonin group than in the control group (1.4% [1/72] vs. 4.4% [3/68], OR: 0.32; 95% CI: 0.03-3.18; I2 = 0%, p = 0.33). In conclusion, melatonin may help improve the clinical outcomes of patients with COVID-19.

Acute COVID-19 severity and mental health morbidity trajectories in patient populations of six nations: an observational study.

BACKGROUND: Long-term mental and physical health consequences of COVID-19 (long COVID) are a persistent public health concern. Little is still known about the long-term mental health of non-hospitalised patients with COVID-19 with varying illness severities. Our aim was to assess the prevalence of adverse mental health symptoms among individuals diagnosed with COVID-19 in the general population by acute infection severity up to 16 months after diagnosis. METHODS: This observational follow-up study included seven prospectively planned cohorts across six countries (Denmark, Estonia, Iceland, Norway, Sweden, and the UK). Participants were recruited from March 27, 2020, to Aug 13, 2021. Individuals aged 18 years or older were eligible to participate. In a cross-sectional analysis, we contrasted symptom prevalence of depression, anxiety, COVID-19-related distress, and poor sleep quality (screened with validated mental health instruments) among individuals with and without a diagnosis of COVID-19 at entry, 0-16 months from diagnosis. In a cohort analysis, we further used repeated measures to estimate the change in mental health symptoms before and after COVID-19 diagnosis. FINDINGS: The analytical cohort consisted of 247 249 individuals, 9979 (4·0%) of whom were diagnosed with COVID-19 during the study period. Mean follow-up was 5·65 months (SD 4·26). Participants diagnosed with COVID-19 presented overall with a higher prevalence of symptoms of depression (prevalence ratio [PR] 1·18 [95% CI 1·03-1·36]) and poorer sleep quality (1·13 [1·03-1·24]) but not symptoms of anxiety (0·97 [0·91-1·03]) or COVID-19-related distress (1·05 [0·93-1·20]) compared with individuals without a COVID-19 diagnosis. Although the prevalence of depression and COVID-19-related distress attenuated with time, individuals diagnosed with COVID-19 but never bedridden due to their illness were consistently at lower risk of depression (PR 0·83 [95% CI 0·75-0·91]) and anxiety (0·77 [0·63-0·94]) than those not diagnosed with COVID-19, whereas patients who were bedridden for more than 7 days were persistently at higher risk of symptoms of depression (PR 1·61 [95% CI 1·27-2·05]) and anxiety (1·43 [1·26-1·63]) than those not diagnosed throughout the study period. INTERPRETATION: Severe acute COVID-19 illness-indicated by extended time bedridden-is associated with long-term mental morbidity among recovering individuals in the general population. These findings call for increased vigilance of adverse mental health development among patients with a severe acute disease phase of COVID-19. FUNDING: Nordforsk, Horizon2020, Wellcome Trust, and Estonian Research Council.

Self-Service System for the Family Members of ICU Patients: A Pilot Study.

Family members of intensive care unit patients are often experience high anxiety and require more information about the patients. However, most Taiwanese healthcare institutions currently face manpower shortages due to the COVID-19 pandemic. Therefore, the task of providing additional services to meet family members' needs and relieve their stress was deferred by some healthcare institutions. The self-service system, known to be effective and efficient in other industries, was recommended for use in the healthcare industry. This study aims to explore an intensive care unit self-service system (ICU-SSS) designed for the family members of ICU patients. This study investigates the feasibility of the system by following a mixed method approach, including qualitative interviews and a quantitative survey. Firstly, interviews with five family members and five ICU staff members of a case hospital were conducted to identify the need to develop an ICU-SSS for the family member. Secondly, a survey was completed by 30 family members to evaluate the system. The interview results reveal nine categories of family members' needs and the survey results show that the ICU family members assigned acceptable scores to all the ICU-SSS functions, except the importance of "Logistical information". Based on these findings, the scientific and practical implications are discussed.

Three doses of an inactivation-based COVID-19 vaccine induces cross-neutralizing immunity against the SARS CoV-2 Omicron variant.

The immunity potency upon natural infection or vaccination is the main concern for the vaccine strategy of severe acute respiratory syndrome coronavirus 2 (SARS COV-2 variant), especially the recently reported Omicron variant (B.1.1.529). In this study, 200 recipients immunized with three doses of a COVID-19-inactivated vaccine were enrolled, whose serum samples were collected within 2 months after the third immunization. The neutralizing activity of sera against the pseudotyped Omicron variant, prototype, and Delta variant was determined. Our results demonstrated that the positive neutralization activity was 95.5% for the Omicron variant, 99.5% for the prototype, and 98.5% for the Delta variant. The geometric mean titers (GMT) for the Omicron variant was 49 and maintained sustained immune levels for 2 months, which decreased by 4.9-fold and 3.0-fold compared with the prototype (GMT, 239) and Delta variant (GMT, 148), respectively. In summary, our study demonstrated that three doses of a COVID-19-inactivated vaccine effectively yielded potent cross-neutralizing activity against the Omicron variant at 2 months after the third vaccination.

Treatment of Coronavirus Disease 2019 Patients With Prolonged Postsymptomatic Viral Shedding With Leflunomide: A Single-center Randomized Controlled Clinical Trial.

BACKGROUND: We aimed to evaluate the efficacy and safety of leflunomide, an approved dihydroorotate dehydrogenase inhibitor, to treat coronavirus disease 2019 (COVID-19) patients with prolonged postsymptomatic viral shedding. METHODS: We conducted a prospective, randomized controlled, open-label trial involving hospitalized adult COVID-19 patients with prolonged polymerase chain reaction (PCR) positivity. Patients were randomly assigned to receive either leflunomide (50 mg every 12 hours, 3 consecutive times, orally; then 20 mg once daily for 8 days), in addition to nebulized interferon alpha 2a (IFN-α-2a, 3 million IU each time, twice daily for 10 days), or nebulized IFN-α-2a alone for 10 days. The primary endpoint was the duration of viral shedding. RESULTS: A total of 50 COVID-19 patients with prolonged PCR positivity were randomized into 2 groups: 26 were assigned to the leflunomide plus IFN-α-2a group, and 24 were assigned to the interferon-alone group. Treatment with leflunomide was not associated with a difference from the interferon-alone group in the duration of viral shedding (hazard ratio for negative reverse-transcription PCR, 0.70 [95% confidence interval, .391-1.256]; P = .186). In addition, the patients given leflunomide did not have a substantially shorter length of hospital stay than patients treated with interferon alone, with median durations of 29.0 (interquartile range [IQR], 19.3-47.3) days and 33.0 (IQR, 29.3-42.8) days, respectively (P = .170). Two leflunomide recipients were unable to complete the full 10-day course of administration due to adverse events. CONCLUSIONS: In COVID-19 patients with prolonged PCR positivity, no benefit in terms of the duration of viral shedding was observed with the combined treatment of leflunomide and IFN-α-2a beyond IFN-α-2a alone.

Nitrate and secondary organic aerosol dominated particle light extinction in Beijing due to clean air action

Air quality in China has been continuously improved since clean air action in 2013, yet the visibility was not improved simultaneously. Here we employed a new method by integrating highly-time resolved aerosol compositions with particle light extinction (bext) into positive matrix factorization to quantify the different contributors to visibility degradation during four seasons in Beijing. Our results show that ammonium nitrate-related factor contributed dominantly to bext during all seasons (31–48%) and played more significant roles during low-visibility periods. Secondary organic aerosol (SOA) was an important contributor of bext (27–35%) in autumn and spring while primary OA related sources were more important in winter (37%). An increase in aerosol mass extinction efficiency and similarly important roles of ammonium nitrate and SOA in visibility degradation were also observed during COVID-19 lockdown. Our results point towards a future challenge in improving visibility in China due to the increased contributions of nitrate and SOA in PM2.5. Future emission controls with a priority to decrease nitrate would benefit both air quality and visibility.