Asymptomatic COVID-19 in pregnant woman with typical chest CT manifestation: a case report

To the Editor: To date, coronavirus disease 2019 (COVID-19) has spread all over the world. As the exact sources of the virus, the time of virus shedding after infection and viral propagation are still undefined, there are still great challenges in controlling the virus spreading and the treatment of infection. Rapid diagnosis of infection cases and early isolation are extremely important for the overall prevention and control work.[1] Therefore, rapid diagnosis of infection cases and early isolation are extremely important for overall disease prevention and control.[2] In recent days, network media reported confirmed COVID-19 cases with more than two negative nucleic acid testing results at an early stage. However, detailed reports are still lacking. Therefore, we report here the history and clinical data of a confirmed case with negative 2019 novel coronavirus (2019-nCoV) nucleic acid test results within 8 days of onset and the final positive test result confirmed on the 11th day of onset in the Shenzhen University General Hospital. A 47-year-old woman who traveled to Wuhan on January 13, 2020 with her mother (who was later confirmed to be infected with the COVID-19) had an intermittent fever (highest body temperature: 37.9°C) on January 20, 2020 accompanied by coughing. Two days later, she was admitted to the Third People's Hospital of Shenzhen. Initially, her blood test revealed a normal white blood cell count (4.94 × 109/L) and decreased lymphocyte count (1.06 × 109/L), with an oxygen saturation level of 99%. After admission, the patient received atomized inhalation of interferon twice daily. 2019-nCoV nucleic acid testing by sampling from a throat swab on January 22 and 28 failed to show positive results. On June 29, 2020, the patient was transferred to the Shenzhen University General Hospital for further isolation and clinical observation. At admission (day 9 of onset), the patient had worsened headache and cough, but her body temperature (36.0–37.2°C) and oxygen saturation level (99%) remained relatively normal. Her blood test result showed a normal white blood cell count (5.81 × 109/L) and decreased lymphocyte count (0.91 × 109/L). Chest computed tomography revealed bilateral ground-glass opacity [Figure 1]. Besides atomized inhalation of interferon, oseltamivir (75 mg) was orally administered twice daily.Figure 1: Continuous chest computed tomography scans of the patient. (A) shows multiple ground-glass density shadows in the lower lobe of both lungs at the level of the aortic arch (B–D) are continuous faults extending downward.On January 31 (day 11 of onset), the blood gas analysis of the patient revealed dramatic deterioration (partial pressure of oxygen, 65.5 mmHg; partial pressure of carbon dioxide, 39.2 mmHg; and sulfur dioxide, 93.6%). 2019-nCOV nucleic acid testing was performed again by sampling from nasal swabs. The result showed positivity for COVID-19 infection, which was also verified by the Centers for Disease Control. According to the New Coronavirus Infection Pneumonia Protocol (version 6) published by the National Health Commission of the People's Republic of China, two consecutive negative respiratory 2019-nCoV nucleic acid test results (at least 1 day apart) are required for exclusion of COVID-19.[3] However, cases with highly suspected epidemiological history, typical clinical, laboratory, and radiological characteristics cannot be excluded. In the present case, the patient had a definite epidemiological history, characteristic pulmonary imaging findings, and typical clinical symptoms. However, no virus nucleic acid sequence was detected for 8 days and until the 11th day of onset, indicating the presence of a non-parallel relationship between 2019-nCoV nucleic acid testing and clinical symptoms. At present, nasal and throat swabs are often used for sampling of specimens for 2019-nCoV nucleic acid testing. The previous research conducted on influenza virus diagnostic tests showed that influenza viruses of different sub-types preferentially localized at different sites, resulting in a variation in the positive detection rates from different sampling sites.[3] To date, the exact biological characteristics of COVID-19 are still undefined, including its variant sub-types or preferred localizing sites.[4] Therefore, for this case, we suspect that changing the sampling site from the throat to the nasal region might have contributed to the positive result. At the time of write this case report, we had four patients with negative throat swabs who later tested positive using nasal swabs. The digestive system is another route for 2019-nCoV infection,[5] also suggesting that the localizing sites of the 2019-nCoV may differ based on route of infection. Accordingly, for patients with suspicion of COVID-19, multiple site sampling is conducive to earlier detection of 2019-nCoV. In addition, the status of the patients shortly before sampling should also be taken into consideration, as anti-viral nebulization treatment might influence the positive detection rate. Efforts need to be made to improve the efficiency of virus detection at an early stage for better prevention and control of the spread of the COVID-19. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. The patient has given her consent for the publication of her images and other clinical information in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed. Funding This study was supported by a grant from the Sanming Project of Medicine in Shenzhen (No. SZSM201911007). Conflicts of interest None.

We report a case of asymptomatic COVID-19 infection in a pregnant woman in the third trimester with good maternal and infant outcomes. The patient was admitted to the Second People's Hospital of Hefei on February 11, 2020, because of a novel coronavirus nucleic acid test result for one at 38 weeks of gestation. No abnormality was observed during her previous regular prenatal examinations. A throat swab sample was obtained from the patient four days before admission due to the diagnosis of COVID-19 infection in her husband and sister on the 14th and 7th day before her admission, and the new coronavirus nucleic acid test showed positive. The patient reported no discomfort before admission. Chest CT on the 3rd after admission showed a small amount of bilateral pleural effusion. Irregular contractions occurred three days after admission and labor was considered to be imminent. An emergency cesarean section was performed and the patient delivered a live baby girl. No tests were performed on amniotic fluid, cord blood or placenta for new coronavirus nuclei acid. The patient was isolated from the infant without breastfeeding after surgery. All medical staff involved in the cesarean section were isolated after surgery. Neonatal peripheral blood and nasopharyngeal swabs were collected for the new coronavirus nucleic acid tests on the day of birth and one day of age respectively, and nasopharyngeal swabs and anal suabs were taken at nine days after birth. All test results were negative. The patient recovered well after surgery with stable vital signs. Chest CT on the 8th after operation showed a small amount of bilateral pleural effusion, while the new coronavirus nucleic acid test results of the pharyngeal swabs were positive on the 11th and 12th day after operation. The throat swabs of all medical staff involved in the operation were negative 14 days after the operation. The mother and baby were discharged 14 days after the Cesarean section.

Serial CT features in discharged COVID-19 patients with positive RT-PCR re-test

We present a case report of a healthy neonate born by vaginal delivery to a woman who had recovered from COVID-19 after 37 days of discharge. The pregnant woman had fever, cough, and chills at 33+1 gestational weeks and was diagnosed with COVID-19 by coronavirus nucleic acid test one day later. She recovered and was discharged after a series of treatments, and the 2019 novel coronavirus nucleic acid test was negative and pulmonary CT was normal at the 2nd and 4th week after being discharged. The patient was admitted due to threatened labor at 38+4 gestational weeks and delivered a healthy newborn vaginally on that day. Both the mother and the baby were in good condition. All the maternal or neonatal specimens taken in the delivery room for 2019 novel coronavirus nucleic acid tests were negative, including the maternal pharynx, rectal and cervical secretions before delivery, amniotic fluid, and colostrum neonatal pharynx and rectal swabs after birth. The qualitative examination of 2019 novel coronavirus antibodies in the maternal venous blood test before delivery showed that both IgG and IgM were positive. While the same test for neonatal cord blood and femoral vein blood showed negative results. No inflammatory reaction was found in the placenta and immunohistochemistry detection of novel coronavirus N protein was negative. The mother and newborn were observed and treated postnatally in the same ward; neither of them had fever, cough, or fatigue, and were discharged three days after delivery. The qualitative examination of 2019 novel coronavirus antibodies (IgM and IgG) in the femoral vein blood of the neonate at 27 days old showed negative results. Key words: Coronavirus infections; Pregnancy complications, infectious; Parturition

To analyze the clinical and laboratory characteristics of coronavirus disease 2019 (COVID-19) patients with different prognosis, and to provide evidence for the diagnosis and treatment of COVID-19. The clinical and laboratory characteristics of 215 cases of confirmed COVID-19 patients admitted in the First People's Hospital of Tianmen City from January 18 to March 10, 2020 were retrospectively analyzed, including blood cell indexes, inflammatory indexes [C-reactive protein (CRP) and procalcitonin (PCT)], liver function, cardiac function, renal function, blood coagulation function, electrolyte, chest CT scan, and 2019 novel coronavirus (2019-nCoV) nucleic acid tests. The differences of above indexes in the two groups were compared and analyzed. In addition, 55 patients with other viral pneumonia were selected as the control group who admitted to the hospital from August 1 to November 30, 2019. The changes of laboratory indexes of COVID-19 group and control group were observed. In the 215 patients, 206 patients survived and 9 patients died. The average age of survival group was significantly lower than that in the death group, and the average length of hospital stay was significantly longer than the death group. (1) Clinical features: the proportion of underlying diseases in the death group was significantly higher than that in the survival group, such as dyspnea, sore throat, shiver, hypertension, diabetes, coronary heart disease, renal disease, and surgical history. There were no significant differences in other symptoms, signs and underlying diseases between the two group. (2) Laboratory test indexes of the two groups: in death group, white blood cell count [WBC (×109/L): 10.6 (4.0, 13.4) vs. 4.90 (3.92, 6.26)], neutrophils count [NEU (×109/L): 9.7 (3.4, 12.2) vs. 2.9 (2.1, 4.2)]; ratio of neutrophils to lymphocytes [NLR: 14.66 (5.19, 18.48) vs. 2.34 (1.47, 3.34)], CRP [mg/L: 130.21 (35.74, 210.86) vs. 17.90 (3.11, 50.23)], PCT [mg/L: 1.46 (0.45, 13.12) vs. 0.04 (0.02, 0.07)], lactate dehydrogenase [LDH (μmol×s-1×L-1): 4.80 (3.34, 7.37) vs. 3.77 (2.99, 5.12)], creatinine [Cr (μmol/L): 72.9 (69.6, 627.5) vs. 68.4 (55.5, 81.9)], D-dimer [mg/L: 0.86 (0.56, 3.32) vs. 0.39 (0.33, 0.58)], the area of ground glass opacity of chest CT scan [77.8% (7/9) vs. 35.0% (72/206)], the area of local patchy shadows [55.6% (5/9) vs. 17.5% (36/206)], the area of bilateral patchy shadows [100.0% (9/9) vs. 49.5% (102/206)] were significantly higher than those in survival group (all P < 0.01), lymphocyte count [LYM (×109/L): 0.6 (0.5, 0.8) vs. 1.3 (1.0, 1.6)], Na+ [mmol/L: 136.1 (131.0, 136.8) vs. 138.8 (136.5, 140.4)], Cl- [mmol/L: 97.7 (92.7, 100.9) vs. 102.7 (100.2, 104.3)], and carbon dioxide [CO2 (mmol/L): 23.0 (20.6, 28.5) vs. 29.2 (27.7, 30.9)] were significantly lower than those in survival group (all P < 0.05). (3) Laboratory test indicators in COVID-19 and control groups: in COVID-19 group, WBC, NEU, LYM, platelet count (PLT), coefficient of variation of red blood cell distribution width (RDW-CV), standard deviation of red blood cell distribution width (RDW-SD) and Cl- were significantly lower than those in control group, NLR, CRP, K+ and CO2 were significantly higher than those in control group. The major early symptoms of COVID-19 are fever, cough, chest tightness and fatigue. Age and underlying disease may be the risk factors which affect the prognosis of patients with COVID-19. The laboratory indexes such as WBC, NEU, LYM, CRP, PCT, LDH and Cr between death group and survival group were significantly abnormal in the early stages of COVID-19, which would have important implications for the prognosis of patients with COVID-19. Meanwhile, laboratory test indexes, including WBC, NEU, LYM, PLT, RDW-CV, RDW-SD, CRP, Cl-, K+ and CO2, also have important value in the differential diagnosis between COVID-19 and other viral pneumonia.

Objective In view of the difficulty of the shortage of new coronavirus nucleal acid test in the early COVID-19 outbreak, to explore the application value of chest CT in screening COVID-19 patients. Methods Retrospective analysis was performed on the data of patients with fever who received chest CT and new coronavirus nucleal acid test during January 25, 2020 to February 2, 2020 in Zhongnan Hospital of Wuhan University. A total of 587 patients were enrolled, including 290 males and 297 females, aged from 11.0 to 96.0 (51.3±17.1) years old. Take the nucleic acid test results as the gold standard, the sensitivity, specificity and rate of missed diagnosis of CT screening COVID-19 were calculated. Results Among the 587 patients, there were 433 positive cases (73.8%, 433/587) and 154 negative cases (26.2%, 154/587) of novel coronavirus nucleic acid test. Using CT screening, 494 cases (84.2%, 494/587) were positive and 93 cases (15.8%, 93/587) were negative. The sensitivity of CT screening COVID-19 was 97.7% (423/433), specificity was 53.9% (83/154) and rate of missed diagnosis was 2.3% (10/433). Conclusions In the early COVID-19 outbreak, CT screening has the advantages of high sensitivity and low rate of missed diagnosis of COVID-19, which can compensate for the shortage of new coronavirus nucleal acid test and can be used as the basis for rapid screening for early prevention and control of COVID-19 outbreak. Key words: COVID-19; Tomography, X-ray computed; Diagnostic test; Sensitivity

To investigate the curative efficacy and application value of convalescent plasma (CP) in severe and critical coronavirus disease 2019 (COVID-19) caused by Delta variant. The treatment process and results of CP therapy for a patient with critical COVID-19 caused by Delta variant were reported. The clinical application value of CP for COVID-19 caused by Delta variant was analyzed along with the literature review. Our case was a 50-year-old male, who was imported from abroad and had not been vaccinated against COVID-19. The novel coronavirus nucleic acid test was negative before entry. On the second day after entry, fever occurred, novel coronavirus nucleic acid test was positive. Chest CT images showed bilateral multiple mottling and ground-glass opacity with symptoms of nausea, headache, loss of appetite, diarrhea, but no running nose, nasal obstruction, dyspnea, abnormal smell and taste. The infection rapidly developed from medium to critical. On the basis of standard treatment, Delta variant CP was intravenous dripped on the 10th day of hospital admission (the 6th day after becoming severe). The patient's condition improved rapidly. The curative efficacy evaluation of this patient proved that CP therapy is of great value in the treatment of severe and critical COVID-19.

Background: Coronavirus disease-19 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and is generally susceptible to all people, including pregnant women. Case Report: A pregnant woman was admitted to the hospital with fever. She became covid positive after exposure to her husband who had returned from Wuhan. Her recurring clinical symptoms, chest CT showing sub-pleural patchy shadow resolved following antibiotics and antiviral therapy. Conclusion: Pregnant women are highly sensitive to virus, and her bilateral lung consolidation in the middle and lower field progressed rapidly. When the novel coronavirus nucleic acid or gene test of the patient is negative or turns negative, it is still necessary to combine chest CT examination, and to observe the clinical progress, so as to take relevant treatment measures in time.

This study aims to discuss the unique clinical features of patients with 2019-nCoV in Zhengzhou City to provide references for clinical diagnosis and treatment. Seventeen patients with 2019-nCoV in Zhengzhou People's Hospital from February to March 2020 were collected. Their epidemiology, clinical symptoms, laboratory examinations, and chest CT images were reviewed. All 17 patients were aged between 12-83 years, with an average age of 47 years, and consisted of 10 males (58.8%) and 7 females (41.2%). Two patients had histories of living or traveling in Wuhan, and 9 patients were attacked locally. The 6 remaining patients were unknown about incidence reasons. The average incubation period was 10 days, and the average time of the course of the disease was 9 days. Among the participants, 12 patients had fever as the first symptoms and 5 patients had normal body temperature. One patient was symptom-free carrier, and one patient had serious symptoms. One patient developed from mild symptoms to severe symptoms, and 14 patients had mild symptoms. Moreover, 7 patients had complications of cardiovascular and cerebrovascular diseases and hypertension, 1 patient was in the advanced stage of squamous cell lung carcinoma, and 1 patient had diabetes mellitus, renal failure, and late-stage uremia. According to novel coronavirus nucleic acid test, 8 patients were positive, accounting for 47.1%. All patients were negative in the novel coronavirus IgM antibody test and negative in other common respiratory pathogen detection. All 17 patients had ground glass-like high-density shadow or stripped high-density shadow on lung CT images, accompanied with many affected lesions on two lungs. The average stay in hospital was 10 days, and the average time of the course of the disease was 9 days. After hospitalization, 15 patients were discharged from the hospital upon recovery, 1 patient was transferred to superior hospital for continuous treatment, and 1 patient died. Patients with 2019-nCoV in Zhengzhou People's Hospital were mainly attacked in local areas, and most of them had mild symptoms. The positive rate of the nucleic acid test was 47.1%. The main clinical characteristics are increased neutrophil granulocytes, increased C-reactive proteins, decreased lymphocytes, ground glass-like or stripped lesions on lung CT image, common complications of cardiovascular and cerebrovascular diseases, and favorable prognosis.

Objective: This study has aimed to share the perioperative management practices and respective outcomes in patients; who underwent urgent thoracotomy due to traumatic hemothorax during the pandemic.Methods: In a single-center, 18 patients; who underwent urgent thoracotomy due to traumatic hemothorax in March 2020 to March 2021, were included in the study retrospectively. Patient data were retrieved from digital archive files. The initial evaluation was performed in the emergency room while wearing complete personal protective equipment. Patients were taken into the operating room under emergency conditions without waiting for the results of the nucleic acid tests performed on oropharyngeal and nasopharyngeal swabs. The operation was carried out by involving the minimum number of personnel. In the postoperative period, patients were followed up in a negative pressure intensive care room. Isolation measures were maintained until two novel coronavirus nucleic acid tests on oropharyngeal and nasopharyngeal swabs collected 48 hours apart were reported as negative.Results: During the one-year period in the COVID-19 pandemic, 18 patients were operated on with the indication of urgent thoracotomy. Of the patients, 14 were men (77.8%), and 4 were women (22.2%). Nucleic acid test results were negative in 17 patients (94.5%). The nucleic acid test result was reported positive in one patient (5.5%) for samples taken at the 48th hour. Nucleic acid tests were performed on the oropharyngeal and nasopharyngeal swabs obtained on the fifth and seventh days from the operation personnel. No novel coronavirus transmission occurred in the healthcare personnel. In the postoperative period, 15 patients (83.3%) were successfully treated and discharged from the hospital, but 3 patients (16.7%) died. No morbidity or mortality occurred due to COVID-19.Conclusion: Urgent thoracotomies can be successfully performed during the COVID-19 pandemic. Novel coronavirus transmissions can be avoided if relevant healthcare personel comply with isolation measures and use complete personnel protective equipment

Rationale:Chest computed tomography (CT) scans play a key role in diagnosing and managing of COVID-19 pneumonia. The typical manifestations of COVID-19 pneumonia on a chest CT scan are ground glass opacities, consolidation, nodules, and linear opacities. It can be accompanied by a “crazy-paving” pattern, air bronchograms, pleural hypertrophy, and pleural effusion. However, no literature has reported a case with cavities in the lungs.Patient concerns:A 34-year-old male patient complained of fever, cough, fatigue, myalgia, diarrhea, headache, and dizziness for 2 weeks. This patient is living in Xiaogan, a city around Wuhan, and he had contact with a patient with COVID-19 pneumonia from Wuhan <14 days before he had fever.Diagnosis:A nucleic acid test by rRT-PCR returned positive on a pharyngeal swab, confirming the diagnosis of COVID-19 pneumonia.Interventions:Isolation antiviral treatment.Outcomes:After 19 days of isolation and antiviral treatment, his temperature returned to normal and the symptoms were relieved. The laboratory results also were returning to normal levels. The chest CT scan showed that the acute inflammation had subsided significantly. With 2 consecutive novel coronavirus nucleic acid tests had returned negative, the patient was discharged from the hospital and sent to a government designated hotel for quarantine observation. The unique chest CT manifestation in this case was the small cavities in both lungs during the absorption phase of this disease. These small cavities developed into consolidated nodules with clear edges and gradually shrank or disappeared.Lessons:Although 2 consecutive nucleic acid tests returned negative in this patient, the small cavity changes in the lungs were observed, so the patient was quarantined for 14 days. However, follow-up CT after the first 14 days’ quarantine showed new small cavity changes on the lungs, a further 14 days of quarantine was recommended. Therefore, in some COVID-19 cases, even if the nucleic acid tests turns negative, the disappearance of lung lesions may take a long time. The repeated chest CT scan plays an important role in the diagnosis and evaluation of the recovery of COVID-19.

Discontinuation of antiviral drugs may be the reason for recovered COVID-19 patients testing positive again.

Objective To investigate the effect of virus inactivation on weak positive result of 2019 Novel Coronavirus (2019-nCoV) nucleic acid test. Method A retrospective study was conducted on the nasopharyngeal swabs of three patients with positive PCR nucleic acid test for Novel Coronavirus at different concentrations in the Second affiliated Hospital of Zhejiang University Medical College from January to February 2020.The virus in nasopharyngeal swab specimens were inactivated by water bath at 56 ℃ for 30 min, dry bath at 56 ℃ for 60 min and dry bath at 60 ℃ for 30 min respectively. After treatment, the sample RNA were extracted and then detected by three new commercial quantitative real-time polymerase chain reaction reagent kits for 2019-nCoV.Cycle threshold(Ct)value was used to evaluate the effect of virus inactivation on nucleic acid detection of 2019-nCoV. Results There was no significant difference between the groups before and after inactivation. Ct values of ORF1ab gene before inactivation were 23.28±0.28, 25.25±0.25, 28.93±0.44, 32.06±0.47, 35.20±0.38, 32.89±0.38, 36.24±0.23, 33.30±0.46, and those after inactivation were, group 1:23.60±0.20, 27.29±0.30, 31.83±0.51, 37.41±0.46, group 2:24.25±0.34, 27.18±0.42, 31.84±0.61, 34.99±1.01, 34.89±0.45,group 3:23.37±0.17, 26.89±0.52, 32.05±0.50.Ct value of N gene before inactivation were24.38±0.09, 26.64±0.11, 30.35±0.12, 33.29±0.33, 36.93±0.11, 34.50±0.12, 35.63±0.12, those after inactivation were, group 1:24.66 ±0.11, 28.52±0.14, 32.71±0.14, 37.00±0.13.group 2:25.41 ±0.10, 28.79±0.15, 33.29±0.28. group 3:23.37±0.11, 28.68±0.11, 33.54±0.13, 37.18±0.23(ORF1ab gene: t =-1.416; N gene: t=-1.379, P> 0.05). There was no significant difference amongthe three inactivation groups, the specific Ct values are shown above(ORF1ab gene: t =-0.460; N gene: t =-0.132, P>0.05). However, the Ct values of the inactivated groups (1,2,3) and the non-inactivated group at different dilution times were different (10 ×:Ct value of ORF1abwas 25.25±0.25 in the non-inactivated group, and 27.29±0.30, 27.18±0.42 and 26.89±0.52 in the inactivated group1,2 and 3.t (ORF1ab) = -7.327, P 0.05) and among the three reagents(reagent 1:7/11, 4/11, 3/11, 3/11, reagent 2:8/11, 4/11, 3/11, 3/11, reagent 3:5/11, 3/11, 3/11, 2/11)(χ2=1.199, P>0.05). Conclusion The virus inactivation can degrade the nucleic acid of the 2019nCoV, resulting in the decrease of the Ct value and the false negative results of the low-concentration specimens. Key words: Coronavirus; Virus inactivation; Nucleic acids; False negative reactions; Real-time polymerase chain reaction

Objective: To study the effect of COVID-19 on pregnancy outcomes and neonatal prognosis in Hubei Province. Method: s A retrospective comparison of the pregnancy outcomes was done between 16 women with COVID-19 and 45 women without COVID-19. Also, the results of laboratory tests, imaging examinations, and the 2019 novel coronavirus (2019-nCoV) nucleic acid test were performed in 10 cases of neonatal delivered from women with COVID-19. Result: s (1) Of the 16 pregnant women with COVID-19, 15 cases were ordinary type and 1 case was severe type. No one has progressed to critical pneumonia.The delivery method of the two groups was cesarean section, and the gestational age were (38.7±1.4) and (37.9±1.6) weeks,there was no significant difference between the two groups (P>0.05). Also, there wee no significant differences in the intraoperative blood loss and birth weight of the newborn between the two groups (all P>0.05). (2) Ten cases of neonates delivered from pregnant women with COVID-19 were collected. The 2019-nCoV nucleic acid test were all negative.There were no significant differences in fetal distress, meconium-stained amniotic fluid, preterm birth, and neonatal asphyxia between the two groups (all P>0.05).(3) In the treatment of uterine contraction fatigue, carbetocin or carboprost tromethamine was used more in cesarean section for pregnant women with COVID-19 (1.3±0.6), compared with Non-COVID-19 group (0.5±0.7),the difference was statistically significant (P=0.001). Conclusions: If there is an indication for obstetric surgery or critical illness of COVID-19 in pregnant women, timely termination of pregnancy will not increase the risk of premature birth and asphyxia of the newborn, but it is beneficial to the treatment and rehabilitation of maternal pneumonia. Preventive use of long-acting uterotonic agents could reduce the incidence of postpartum hemorrhage during surgery. 2019-nCoV infection has not been found in neonates delivered from pregnant women with COVID-19.

To observe the influence of Xuebijing injection on the inflammatory markers and prognosis of coronavirus disease 2019 (COVID-19) patients. Sixty severe COVID-19 patients admitted to Changsha Public Health Treatment Center (North Hospital of the First Hospital of Changsha City) from January to March in 2020 were randomly divided into routine treatment group, Xuebijing 50 mL group and Xuebijing 100 mL group, with 20 cases in each group. The routine treatment group was treated according to the National Health Commission's guide for COVID-19. On the basis of conventional treatment, Xuebijing injection was injected by 50 mL twice a day for 7 days in Xuebijing 50 mL group, while by 100 mL twice a day for 7 days in Xuebijing 100 mL group. The blood routine test, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), acute physiology and chronic health evaluation II (APACHE II) score, 2019 novel coronavirus (2019-nCoV) nucleic acid test and disease classification of three groups before and 8 days after treatment were observed. (1) After treatment, the white blood cell count (WBC) and lymphocyte count (LYM) of three groups increased, meanwhile CRP and ESR decreased. Compared with routine treatment group, the WBC count of Xuebijing 100 mL group after treatment significantly increased (×109/L: 7.12±0.55 vs. 5.67±0.51, P < 0.05), and the levels of CRP and ESR in Xuebijing 50 mL and 100 mL groups significantly decreased [CRP (mg/L): 32.3±4.6, 28.0±6.2 vs. 37.3±5.9; ESR (mm/1 h): 45.9±5.7, 40.5±7.4 vs. 55.3±6.6, all P < 0.05]. Compared with Xuebijing 50 mL group, the increase of WBC, and the decrease of CRP and ESR were more significant in Xuebijing 100 mL group [WBC (×109/L): 7.12±0.55 vs. 5.82±0.49, CRP (mg/L): 28.0±6.2 vs. 32.3±4.6, ESR (mm/1 h): 40.5±7.4 vs. 45.9±5.7, all P < 0.05]. (2) After treatment, the APACHE II score of three groups decreased. In Xuebijing 100 mL group, the APACHE II score after treatment was significantly lower than those in routine treatment and Xuebijing 50 mL groups (12.3±1.5 vs. 16.5±1.6, 15.9±1.4, both P < 0.05). After treatment, the 2019-nCoV nucleic acid test in three groups partly turned negative, with 9 cases in routine treatment group, 8 cases in Xuebijing 50 mL group and 9 cases in Xuebijing 100 mL group, without significant difference (P > 0.05). The conditions of patients in the three groups were improved after treatment, among them, 8 cases in the routine treatment group were transformed into common type, 1 case into critical type; 9 cases and 12 cases of Xuebijing 50 mL group and 100 mL group were transformed into common type respectively. Xuebijing 100 mL group was improved more obviously than Xuebijing 50 mL group and routine treatment group (both P < 0.05). The Xuebijing injection can effectively improve the inflammatory markers and prognosis of severe COVID-19 patients.