The pathological mechanism of the COVID-19 convalescence and its treatment with traditional Chinese medicine

The severe acute respiratory syndrome coronavirus - 2 (SARS - CoV - 2) was reported to cause the Wuhan outbreak of the corona virus disease 2019(COVID-19). To date, the COVID-19 has infected more than 600 million people gloabally. As a growing number of patients recover from acute infections and are discharged from hospitals, the proportion of patients in the recovery period is gradually increasing. Many of these individuals have been reported to experience multiple symptoms during the convalescence, such as fatigue, dyspnea and pain which are designated as "long-COVID”, "post-COVID syndrome” or "recovery sequelae. We searched for recent articles published in PubMed on COVID-19 convalescence and found that the pathogenesis of COVID-19 convalescence is not yet well recognized. It may be associated with incomplete recovery of immune system, parenchymal organ damage (liver or lung), coagulation abnormalities, "second hit” caused by viral infection, and Phenomenon of Cell Senescence-Associated Secretory Phenotype (SASP). Some drugs and psychological factors of patients also play a non-negligible role in it. We also found that the effect of traditional Chinese medicine (TCM) is effective in the treatment of the COVID-19 recovery phase, which can not only relieve the corresponding symptoms, but also improve the indicators and pulmonary fibrosis. Bufei Huoxue Capsule, as the only drug explicitly mentioned for COVID-19 recovery period, can exert strong rehabilitative effects on physiological activity in patients recovering from COVID-19. In addition, in previous studies, traditional Chinese medicine has been confirmed to have the ability to resist cytokine storms, as well as improve coagulation and myocardial damage, which makes it have potential therapeutic advantages in targeting the hyperimmune response, coagulation abnormalities and myocardial damage existing in the recovery period. In conclusion, the clinical symptoms of patients convalescing from COVID-19 are complex, and its pathogenesis has not been elucidated. traditional Chinese medicine, as a traditional treatment, its specific action and mechanism need to be confirmed by more studies, so that it can play a better role.

Increased COVID-19 Infection Susceptibility and Adverse Outcomes Due to Obesity: A Systematic Review and Meta-analysis (preprint)

Objectives: Study bidirectional relationships between weight gain, obesity and COVID-19 infection risk during the pandemic.Methods: MEDLINE, Embase, MedRxiv, and WHO COVID-19 Database were searched till June 2, 2020. Newspaper and internet article sources were identified using a media database. Meta-analysis was conducted using random- and fixed effect models.Results: Ten studies published from 5 countries met inclusion criteria; five studies (provided 17 analyses/types of results) were included in meta-analysis. The studies suggested bidirectional relationships and some dose-response relationships. Meta-analysis showed obesity was associated with increased COVID-19 infection risk (Odds ratio, OR=1.69, 95% CI: 1.41, 2.02). COVID-19 risk increased with obesity (OR=1.43 (1.18, 1.73)) and severe obesity (OR=1.96 (1.49, 2.59)). Obesity was positively associated with COVID-19 mortality (OR=1.64, 95% CI: 1.20, 2.25) and its severity: admission to intensive care unit (ICU) (OR=2.01 (1.25, 3.23)), and invasive mechanical ventilation (IMV) use (OR=8.20 (2.10, 31.91)). We also observed a stronger association in younger age groups (β=-0.29 (-0.47 to -0.10)).Conclusions: Obesity was positively associated with higher COVID-19 infection risk, severity, and mortality. Appropriate treatment of COVID-19 patients with obesity and weight management are warranted.