Pre-COVID resting-state brain activity in the fusiform gyrus prospectively predicts social anxiety alterations during the pandemic (preprint)

Persistent social anxiety (SA) has been reported to be associated with the coronavirus disease 2019 (COVID-19) pandemic, but the neurobiopsychological mechanisms underlying this relationship remain unclear. This study aimed to elucidate the neurofunctional markers for the development of SA during the pandemic and the potential roles of COVID-related posttraumatic stress symptoms (PTSS) in the brain-SA alterations link. Before the COVID-19 pandemic (T1), 100 general college students underwent baseline brain resting-state magnetic resonance imaging and behavioral tests for SA. During the period of community-level outbreaks (T2), these students were recontacted to undergo follow-up assessments of SA and COVID-related PTSS. Whole-brain correlation analyses and prediction analyses found that pre-pandemic spontaneous neural activity (measured by fractional amplitude of low-frequency fluctuations) in the right fusiform gyrus (FG) was positively linked with SA alterations (T2 – T1) during the pandemic. Moreover, mediation analyses revealed a mediating role of COVID-specific PTSS in the association of right FG activity with SA alterations. Importantly, our results persisted even after adjusting for the effects of pre-pandemic family socioeconomic status, other stressful life events, and general anxiety. Overall, our study provides fresh evidence for neurofunctional markers of COVID-induced aggravation of SA and may help individuals vulnerable to SA exacerbation benefit from targeted clinical interventions.

Disrupted rhythms of life, work and entertainment and their associations with psychological impacts under the stress of the COVID-19 pandemic: A survey in 5854 Chinese people with different sociodemographic backgrounds

Background & aim: The coronavirus disease 2019 (COVID-19) pandemic has affected the life and work of people worldwide. The present study aimed to evaluate the rhythm disruptions of life, work, and entertainment, and their associations with the psychological impacts during the initial phase of the COVID-19 pandemic. Method: A cross-sectional study was conducted from the 10th to 17th March 2020 in China. A structured e-questionnaire containing general information, the Chinese version of Brief Social Rhythm Scale, and Zung's self-rating scales of depression and anxiety (SDS and SAS) was posted and collected online through a public media (i.e. EQxiu online questionnaire platform). Scores in sleeping, getting up, and socializing (SGS) rhythm and eating, physical practice, and entertainment (EPE) rhythm were compared among and between participants with different sociodemographic backgrounds including gender, age, education, current occupation, annual income, health status, and chronic disease status. Correlations of SDS and SAS with SGS-scale and EPE-scale were also analyzed. Results: Overall, 5854 participants were included. There were significant differences in the scores of SGS-scale and EPE-scale among people with different sociodemographic backgrounds. The scores were significantly higher in the groups with female gender, low education level, lower or higher than average income, poor health status, ages of 26-30 years or older than 61 years, nurses and subjects with divorce or widow status. There were also significant differences in SAS and SDS scores among people with different sociodemographic backgrounds (all P< 0.05). The overall prevalence of depression and anxiety was 24.3% and 12.6%, respectively, with nurses having the highest rates of depression (32.94%) and anxiety (18.98%) among the different occupational groups. SGS-scale was moderately correlated with SDS and SAS, and disruption of SGS rhythm was an independent risk factor for depression and anxiety. Conclusion: Social rhythm disruption was independently associated with depression and anxiety. Interventions should be applied to people vulnerable to the rhythm disruption during the COVID-19 pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Nursing experience of COVID-19 prevention and control in a regional central hospital in a non-Wuhan area in China

The objective of the article was to outline the practical nursing management strategies successfully followed in a general tertiary hospital involved in the of pre-screening 195458 patients, treatment of 316 suspected cases, and 4 confirmed COVID-19 cases from December 2019 to Mar 29, 2020, with no infection of medical staff. During the outbreak, the orderly management and distribution of personal protective equipment (PPE) were essential for COVID-19 prevention and control. A two-level warehouse management system for PPE was established. The hospital-level warehouse of the isolation hospital stored medical supplies. Input/output forms were used to record the usage of PPE. The wardlevel warehouse was equipped with daily requirements of protective supplies. Medical staff followed the policies and procedures of isolation precautions to use PPE. The nurse in charge reported the quantity of PPE used so that replenishment could be provided in time. Reasonable distribution and usage of PPE could be obtained through the two-level warehouse management system.

Dynamic Zero-Covid strategy curtails mutagenesis and emergence of new variants of the SARS-CoV-2 (preprint)

Within the local outbreak period of SARS-CoV-2 Delta variant in Nanjing and Yangzhou, China, we analyzed the mutation process of the Delta variants in 520 cases, as well as the production, spread and elimination of new mutant strains under the non-pharmaceutical interventions (NPI) strategy. The investigation on distribution of COVID-19 cases and phylogenetic analysis of SARS-CoV-2 genome sequences attributed to tracking the transmission chains, transmission chains were terminated by the isolation of the COVID-19 patients and quarantine of close-contracts, suggesting the importance of NPI in prompting some mutations to disappear and stopping the transmission of new variants. Dynamic zero-Covid strategy has been implemented successfully to against the second-largest local epidemic caused by an imported COVID-19 case in China.

Alterations in the Composition of Intestinal DNA Virome in Patients With COVID-19

Patients with Coronavirus Disease 2019 (COVID-19), due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection mainly present with respiratory issues and related symptoms, in addition to significantly affected digestive system, especially the intestinal tract. While several studies have shown changes in the intestinal flora of patients with COVID-19, not much information is available on the gut virome of such patients. In this study, we used the viromescan software on the latest gut virome database to analyze the intestinal DNA virome composition of 15 patients with COVID-19 and investigated the characteristic alternations, particularly of the intestinal DNA virome to further explore the influence of COVID-19 on the human gut. The DNA viruses in the gut of patients with COVID-19 were mainly crAss-like phages (35.48%), Myoviridae (20.91%), and Siphoviridae (20.43%) family of viruses. Compared with healthy controls, the gut virome composition of patients with COVID-19 changed significantly, especially the crAss-like phages family, from the first time of hospital admission. A potential correlation is also indicated between the change in virome and bacteriome (like Tectiviridae and Bacteroidaceae). The abundance of the viral and bacterial population was also analyzed through continuous sample collection from the gut of patients hospitalized due to COVID-19. The gut virome is indeed affected by the SARS-CoV-2 infection, and along with gut bacteriome, it may play an important role in the disease progression of COVID-19. These conclusions would be helpful in understanding the gut-related response and contribute to the treatment and prevention strategies of COVID-19.

Severe Adaptive Immune Suppression May be Why Patients with Severe COVID-19 Cannot be Discharged From the ICU Even After Negative Viral Tests (preprint)

Background: During the COVID-19 pandemic, a phenomenon emerged in which some patients with severe disease were critically ill and could not be discharged from the ICU even though they exhibited negative viral tests. In general, continuous negative viral tests are thought to indicate that the virus has been cleared from the body and that the patients can be considered "recovered". However, because these patients were still critically ill, they obviously had not truly recovered from the disease. We sought to investigate why these patients were still critically ill even though they exhibited negative viral tests by analyzing the gene expression profiles of their peripheral immune cells using transcriptome sequencing. Methods: Fourteen severe COVID-19 patients with at least 3 negative virus tests but were still in critical ill and could not be discharged from the ICU were enrolled. Blood samples from 14 patients and 5 healthy donors were collected. Total RNA was extracted from nucleated cells for RNA-Sequencing. FeatureCounts v1.5.0-p3 was used to count the reads numbers mapped to each gene. Results: All enrolled patients, regardless of changes in genes related to different symptoms and inflammatory responses, showed universally and severely decreased expression of adaptive immunity-related genes, especially those related to T/B cell arms and HLA molecules, and that these patients exhibited long-term secondary infections. This adaptive immune suppression is unlikely due to classic immune checkpoint molecules such as PD-1 or long-term use of glucocorticoids but may be caused by an unknown mechanism that has not yet been discovered. Conclusions: Our findings strongly suggest that an initial recovery of these severe COVID-19 patients, as indicated by negative viral tests, may not indicate actual recovery. They still suffer from secondary infections for a long period of time because of severe adaptive immunosuppression and need to receive a variety of antibiotics, antifungal drugs, or combination therapies. Appropriate methods should be used to detect their adaptive immune function, and appropriate immunotherapy that can activate the adaptive immune response should be developed. Trial registration: Not applicable (this study does not involve intervention on human participants).

Effectiveness of Adjunctive Corticosteroid Therapy in Patients with Severe COVID-19: A Retrospective Cohort Study (preprint)

Objective: To investigate the effectiveness of adjunctive corticosteroid therapy in patients with severe COVID-19.Methods: We conducted a retrospective analysis of the difference in several outcomes between patients with severe COVID-19 who received corticosteroid therapy (the corticosteroid group) and patients with severe COVID-19 who did not receive corticosteroid therapy (the non-corticosteroid group).Results: Seventy-five patients were included in this study. Of these, 47 patients were in the corticosteroid group and 28 patients were in the non-corticosteroid group. There were no differences between the two groups in the total length of hospital stay (LOS), the length of ICU stay, high-flow oxygen days, non-invasive ventilator days, invasive ventilation days, and mortality rate. Total lesion volume ratio, consolidation volume ratio and GGO volume ratio in the corticosteroid group decreased significantly on day 14, while those in the non-corticosteroid group did not show a significant decrease.Conclusions: Our results show that adjunctive corticosteroid use did not significantly improve clinical outcomes in severe COVID-19 patients, but might promote the absorption of pulmonary lesions. Larger multicenter randomized controlled studies may be needed to confirm this.

CONUT score is associated with mortality in patients with COVID-19: a retrospective study in Wuhan (preprint)

Background The coronavirus disease 2019 (COVID-19) pneumonia, outbreak in Wuhan, China, has led to a global pandemic. The high mortality of COVID-19 patients makes it significant to evaluate possible disease progression. This study was designed to explore the prognostic value of Controlling Nutritional Status (CONUT) score in patients with COVID-19.Methods Patients diagnosed with COVID-19 of a single center in Wuhan, China from January 2020 to February 2020 were enrolled in this study. Logistic regression analysis was performed to find independent risk factor of mortality. Receiver operating characteristics (ROC) curve was drawn to evaluate the prognostic value of CONUT score.Results Among 442 included patients, there were 79 non-survivors with mortality of 17.9%. Compared with survivors, the median age (p < 0.001) and male ratio (p = 0.042) were higher in non-survivors. Non-survivors had higher incidence of comorbidities including hypertension (p < 0.001), chronic lung disease (p = 0.001) and cardiovascular disease (p = 0.005). Complications such as respiratory failure(p < 0.001), acute kidney injury (AKI) (p < 0.001) occurred more frequently in non-survivors. Multivariate logistic regression analysis showed that CONUT (p = 0.002), lactate dehydrogenase (LDH) (p < 0.001), C-reactive protein (CRP) (p = 0.020) were risk factor of mortality in COVID-19 patients. Area under the ROC curve (AUC) of CONUT and Nutrition risk screening 2002 (NRS2002) score were 0.813 and 0.795, respectively. Comprised of CONUT, LDH, CRP, the constructed prognostic model had higher AUC of 0.923 (Z = 3.5210, p < 0.001).Conclusion CONUT is an independent risk factor of mortality in COVID-19 patients. Evaluating CONUT is beneficial for clinicians to predict the progression of COVID-19 patients and strengthen monitoring and management to improve prognosis.