Epidemiology and clinical re-positivity evaluation of SARS-CoV-2 cases in Wuxi

Persistence of anti-SARS-CoV-2 IgM in convalescent COVID-19 patients

To predict COVID-19 severity by building a prediction model based on the clinical manifestations and radiomic features of the thymus in COVID-19 patients. We retrospectively analyzed the clinical and radiological data from 217 confirmed cases of COVID-19 admitted to Xiangyang NO.1 People's Hospital and Jiangsu Hospital of Chinese Medicine from December 2019 to April 2022 (including 118 mild cases and 99 severe cases). The data were split into the training and test sets at a 7:3 ratio. The cases in the training set were compared in terms of clinical data and radiomic parameters of the lasso regression model. Several models for severity prediction were established based on the clinical and radiomic features of the COVID-19 patients. The DeLong test and decision curve analysis (DCA) were used to compare the performances of several models. Finally, the prediction results were verified on the test set. For the training set, the univariate analysis showed that BMI, diarrhea, thymic steatosis, anorexia, headache, findings on the chest CT scan, platelets, LDH, AST and radiomic features of the thymus were significantly different between the two groups of patients (P < 0.05). The combination model based on the clinical and radiomic features of COVID-19 patients had the highest predictive value for COVID-19 severity [AUC: 0.967 (OR 0.0115, 95%CI: 0.925-0.989)] vs. the clinical feature-based model [AUC: 0.772 (OR 0.0387, 95%CI: 0.697-0.836), P < 0.05], laboratory-based model [AUC: 0.687 (OR 0.0423, 95%CI: 0.608-0.760), P < 0.05] and model based on CT radiomics [AUC: 0.895 (OR 0.0261, 95%CI: 0.835-0.938), P < 0.05]. DCA also confirmed the high clinical net benefits of the combination model. The nomogram drawn based on the combination model could help differentiate between the mild and severe cases of COVID-19 at an early stage. The predictions from different models were verified on the test set. Severe cases of COVID-19 had a higher level of thymic involution. The thymic differentiation in radiomic features was related to disease progression. The combination model based on the radiomic features of the thymus could better promote early clinical intervention of COVID-19 and increase the cure rate.

Knowledge regarding the treatment cost of coronavirus disease 2019 (COVID-19) in the real world is vital for disease burden forecasts and health resources planning. However, it is greatly hindered by obtaining reliable cost data from actual patients. To address this knowledge gap, this study aims to estimate the treatment cost and specific cost components for COVID-19 inpatients in Shenzhen city, China in 2020-2021. It is a 2 years' cross-sectional study. The de-identified discharge claims were collected from the hospital information system (HIS) of COVID-19 designated hospital in Shenzhen, China. One thousand three hundred ninety-eight inpatients with a discharge diagnosis for COVID-19 from January 10, 2020 (the first COVID-19 case admitted in the hospital in Shenzhen) to December 31, 2021. A comparison was made of treatment cost and cost components of COVID-19 inpatients among seven COVID-19 clinical classifications (asymptomatic, mild, moderate, severe, critical, convalescent and re-positive cases) and three admission stages (divided by the implementation of different treatment guidelines). The multi-variable linear regression models were used to conduct the analysis. The treatment cost for included COVID-19 inpatients was USD 3,328.8. The number of convalescent cases accounted for the largest proportion of all COVID-19 inpatients (42.7%). The severe and critical cases incurred more than 40% of treatment cost on western medicine, while the other five COVID-19 clinical classifications spent the largest proportion (32%-51%) on lab testing. Compared with asymptomatic cases, significant increases of treatment cost were observed in mild cases (by 30.0%), moderate cases (by 49.2%), severe cases (by 228.7%) and critical cases (by 680.7%), while reductions were shown in re-positive cases (by 43.1%) and convalescent cases (by 38.6%). The decreasing trend of treatment cost was observed during the latter two stages by 7.6 and 17.9%, respectively. Our findings identified the difference of inpatient treatment cost across seven COVID-19 clinical classifications and the changes at three admission stages. It is highly suggestive to inform the financial burden experienced by the health insurance fund and the Government, to emphasize the rational use of lab tests and western medicine in the COVID-19 treatment guideline, and to design suitable treatment and control policy for convalescent cases.

Interpretation of the diagnosis and treatment protocol for COVID‐19 (Trial Version 9)

To analyse the prevalence of severe and critical COVID-19 cases and its determinants, a systematic review and meta-analysis were conducted using Review Manager. Four English and two Chinese databases were used to identify and explore the relationships between the severity of COVID-19 and its determinants, with no restrictions on publication date. The odds ratio and 95% CI were combined to assess the influencing level of all factors. Twenty-three articles containing a total of 15,828 cases of COVID-19 were included in this systematic review. The prevalence of severe and critical COVID-19 cases was 17.84% and 4.9%, respectively. A total of 148 factors were identified, which included behavioural, symptom, comorbidity, laboratory, radiographic, exposure, and other factors. Among them, 35 factors could be included in the meta-analysis. Specifically, for example, the male (OR 1.55, 95% CI 1.42–1.69) and elderly (OR 1.06, 95% CI 1.03–1.10) populations tended to experience severe and critical illness. Patients with cough, dyspnea, fatigue, fever, and gastrointestinal symptoms could have severe and critical diseases. Regarding laboratory results, albumin, aspartate aminotransferase, creatinine, D-dimer, fibrinogen, neutrophils, procalcitonin, platelets, and respiratory rate were potential factors that could be used to predict the severity of COVID.

Prediction on the number of confirmed Covid-19 with the FUDAN-CCDC mathematical model and its epidemiology, clinical manifestations, and prevention and treatment effects

COVID-19 in Venezuela: Costs and challenges of management severe cases at home in a crisis setting

ObjectiveTreatment for COVID-19 is still urgent need for the critically ill and severe cases. UC-MSC administration has a therapeutic benefit for severe COVID-19 patients even in the recovery period. In this paper, we aimed to present our clinical experience with UC-MSC treatment in severe and critical severe COVID-19 patients.MethodsIn this study we evaluated the clinical outcome of severe/critically severe 210 COVID-19 patients treated with UC-MSCs, 1–2 × 106 per kilogram to 210 patients from 15/10/2020 until 25/04/2021.ResultsOut of 99 critically severe intubated patients we have observed good clinical progress/discharged from ICU in 52 (52.5%) patients. Where as 86 (77.5%) of 111 severe unintubated patients discharged from ICU. Intubated 47 (47.5%) patients and unintubated 25 (22.5%) patients pass away. Significantly higher survival was observed in patients who underwent UC-MSCs before intubation (OR = 1.475, 95% CI = 1.193–1.824 p < 0.001). It was observed that the SaO2 parameter tended to improve after UC-MSC therapy compared to all groups. But SaO2 parameter between intubated and unintubated groups was not statistically significant (p > 0.05), while in discharged cases SaO2 parameter was statistically significant (p = 0.01). Besides, there was a statistically significant relation with intubation status, age (OR = 3.868, 95% CI = 0.574–7.152 p = 0.02) and weigh (OR = 6.768, 95% CI = 3.423–10.112 p < 0.001) thus presented an elevated risk for COVID-19. The linear regression analysis confirmed that the high weight was associated with the risk of intubation in COVID-19 (p = 0.001).ConclusionsAccording to our results and from recent studies, UC-MSC treatment is safe with high potential to be used as an added therapeutic treatment for severe COVID-19 patients. Our experience showed that UC-MSC therapy may restore oxygenation and downregulate cytokine storm in patients hospitalized with severe COVID-19. We advice wider randomised studies to discover the detailed therapeutic pathophysiology of the MSCs on COVID-19 patients.Graphical abstractMSCs transplantation improves the damaging effects of the cytokine storm through immunomodulation and improving tissue and organ repair. Severe patients who were unintubated were in the Phase I, while critical patients who were intubated were in the Phase II. The figure is created via biorender application, (BioRender.com).

Background: COVID-19 has emerged in Dhaka city of Bangladesh since March 8, 2020 and rapidly spread throughout the country. Though non-severe cases can be managed in home, severe cases are more likely to be hospitalized and need intensive care unit (ICU) admission. Understanding the common demographic, clinical and laboratory features of severe versus non-severe patients could be quite useful for clinicians and might help to predict disease progression. This study aimed to compare demographic, clinical and laboratory findings among severe and non-severe COVID-19 cases.&#x0D; Methods: This retrospective study was conducted on confirmed COVID-19 patients who were admitted in a private set-up of Bangladesh, from 1st April 2020 to 31st March 2021. All confirmed COVID-19 cases were categorized into severe (severe/critical) and non-severe (asymptomatic/mild/moderate) group. The demographic, clinical and laboratory parameters were recorded. Patients’outcome was categorized by discharged (recovered), transferred to higher center (referred) and death.&#x0D; Results: Among 219 COVID-19 patients, 139 (78 males and 61 females) were in non-severe and 80 patients (56 males and 24 females) were in severe group. There was older age and male predominance among severe than nonsevere infection (pÂ0.05). The co-morbidities and smoking history showed non-significant differences between the groups. Among the presenting symptoms, cough and dyspnoea were present 91.3% and 61.3% respectively in severe vs 75.5% and 27.3% respectively in non-severe group. There was significantly lower percentages of lymphocyte (19.8 ± 12.6 %); higher values of ferritin (ng/mL) and D-dimer (mg/l) [1384.50 (103 - 2898) and 0.74 (0.03 - 883) respectively] among patients with severe COVID-19, pÂ0.05. On chest x-ray, pneumonitis was present in 69 (95.8%) patient in severe group, whereas 90 (78.3%) in non-severe group and the difference was statistically significant (pÂ0.05). High-resolution computed tomography (HRCT) scan of chest was done, in severe group 28 (80.0%) showed ground-glass opacity (GGO) and in non-severe group it was 41 (65.1%). The average duration of hospital stay was significantly higher in severe group (11.2 ± 8.1 days) than non-severe group (7.0 ± 5.9 days). Death was observed significantly higher in severe versus non-severe group (16.3% vs 1.4%) (p value &lt;.05).&#x0D; Conclusion: There was older age and male predominance in severe COVID -19 cases. Feritin, D-dimer were significantly higher in severe group and lower percentages of lymphocyte was also noticed in this group. The mortality and longer hospital stay were observed more in severe group than non-severe.&#x0D; BIRDEM Med J 2022; 12(2): 129-135

In December 2019, a novel coronavirus was identified in Wuhan City, Hubei Province, China and later the disease was named coronavirus disease 2019 (COVID-19). On March 11, 2020, the World Health Organization (WHO) officially announced that COVID-19 had reached global pandemic status. This article summarized the understanding of the etiology, pathogenesis, epidemiology, clinical characteristics, diagnosis, treatment, rehabilitation, and prevention and control measures of COVID-19 based on the available data and anti-epidemic experience in China.

Objective: To describe the characteristics of clinical manifestations and epidemiology of children with 2019 novel coronavirus (2019-nCoV) infection. Methods: All 34 children with laboratory-confirmed 2019-nCoV infection by quantitative real-time reverse transcription-PCR through nasopharyngeal swab specimens were admitted to the Third People's Hospital of Shenzhen from January 19 to Febuary 7, 2020. Clinical data and epidemiological history of these patients were retrospectively collected and analyzed. Results: Among the 34 cases, 14 were males, and 20 were females. The median age was 8 years and 11 months. No patients had underlying diseases. There were 28 children (82%) related with a family cluster outbreak. There were 26 children (76%) with a travel or residence history in Hubei Province. These patients could be categorized into different clinical types, including 22 (65%) common cases, 9 (26%) mild cases and 3 (8.8%) asymptomatic cases. No severe or critical cases were identified. The most common symptoms were fever (17 cases, 50%) and cough (13 cases, 38% ). In the 34 cases, the white blood cell counts of 28 cases (82%) were normal. Five cases had white blood cell counts more than 10×10(9)/L. One case had white blood cell counts less than 4×10(9)/L. Neutropenia and lymphopenia was found in one case, respectively. C-reactive protein levels and erythrocyte sedimentation rates were elevated in 1 and 5 case, respectively. Elevated procalcitonin was found in 1 case and D-Dimer in 3 cases. The levels of lactic dehydrogenase (LDH) were more than 400 U/L in 10 cases. The CT images of these patients showed bilateral multiple patchy or nodular ground-glass opacities and/or infiltrating shadows in middle and outer zone of the lung or under the pleura. Twenty patients were treated with lopinavir and ritonavir. Glucocorticoids and immunoglobulin were not used in any cases. All the cases improved and were discharged from hospital. Further following up was need. Conclusions: The clinical manifestations in children with 2019-nCoV infection are non-specific and are milder than that in adults. Chest CT scanning is heplful for early diagnosis. Children's infection is mainly caused by family cluster outbreak and imported cases. Family daily prevention is the main way to prevent 2019-nCoV infection.

Incidence of post-COVID-19 syndrome and its association with COVID-19 severity in a tertiary private hospital: Prospective cohort study

Decision letter: SARS-CoV-2 shedding dynamics across the respiratory tract, sex, and disease severity for adult and pediatric COVID-19

The Philippines has recorded over 470,000 COVID-19 cases in children, with over 1,500 deaths during the same period. Although a Philippine online pediatric COVID-19 registry exists, this only relies on passive surveillance. This study determined the clinical and laboratory profile, risk factors for severe COVID-19, and mortality, management, and outcome of pediatric SARS-CoV-2 patients admitted at the Philippine General Hospital (PGH) from April 2020 to June 2022 to fill in knowledge gaps on the epidemiology of COVID-19 infection in children. This was a retrospective cohort study of pediatric COVID-19 cases admitted at the PGH, a designated COVID referral center during the study period. Demographic and clinical profile, risk factors, comorbidities, laboratory and radiologic findings, management, and outcomes across different disease severity states were gathered by chart review and the data were analyzed using STATA 17. There were 448 pediatric patients admitted and diagnosed with COVID-19 during the study period. Most patients belonged to the 1-5-year age group (25.9%), had no known exposure to a COVID-19 case (65.4%), were mild cases (37.3%%), and did not receive any dose of the COVID-19 vaccine (96.7%). The most common presenting symptoms across all disease categories were fever (44.4%), cough (28.6%), and shortness of breath (26.6%). Multisystem inflammatory syndrome in children (MIS-C) presented with fever (100%) and rash (53.9%). The risk factors for severe disease were the presence of a congenital anomaly lung disease, and elevated procalcitonin. Most patients with MIS-C were previously well with no comorbidities. Laboratory findings which were markedly elevated among severe and critical cases were ESR, CRP, D-dimer, LDH, and IL-6. Ferritin, procalcitonin (PCT) and IL-6 were elevated only in severe to critical COVID-19 cases and remained within normal for the other disease categories. As to treatment, asymptomatic, mild, and moderate cases were given supportive medications (zinc, vitamin D, and vitamin C), while investigational drugs particularly corticosteroids, IVIG, and remdesivir, were used in severe cases.Antibiotics were given to 71.7% of patients at the outset. As to the outcomes, 89% recovered, while 8.9% died. The case fatality rate from COVID-19 infection was at 2.2%. Admitted pediatric COVID-19 cases are generally mild but admission is due to underlying illness or comorbidities. Those with severe to critical cases have underlying comorbidities and had either progression or complications due to COVID disease. D-dimer, LDH, IL-6, ferritin and procalcitonin were elevated among severe and critical cases which can be utilized as inflammatory markers.

Background: Nutritional status has impact on body immune function that is important for controlling disease process and prognosis of the newly emerging Coronavirus Disease 2019 (COVID-19). As no vaccine or specific antiviral treatment is not available for COVID-19, therefore, improvement of nutritional status is important. Adequate and appropriate diet is required for maintaining good nutritional status. There is very few research carried out to evaluate the influence of nutritional status and dietary habit of patients with COVID-19. Objective: To study the nutritional status and dietary habit of COVID-19 patients admitted in a tertiary hospital of Dhaka, Bangladesh and its impact on the severity of the disease COVID-19. Methodology: A cross-sectional study was performed on 384 patients in the Corona unit of Holy Family Red Crescent Hospital during 17th May to 31st December’ 2020. Patients were selected conveniently according to inclusion criteria. COVID-19 patients were categorized as Mild, Moderate and Severe cases according to National Institute of health and latest Public Health Information from Centers for Disease Control (CDC). Direct interviewing of the selected patients with pretested structured questionnaire, data were collected on socio demographic characteristics, nutritional status following Body Mass Index (BMI) grading, daily consumption of different food items in the last 3 months and dietary habits in the last 3 months of these three categories of patients. Written consent of the patient and ethical clearance was obtained prior to data collection. All statistical analyses were performed by using the SPSS software version 21. Result: A total of 384 patients interviewed. Age distribution was Mean ±SD, 42.85±13.82. Male/Female ratio 1.33. Most of them were graduates, 33.1% and 42.9% were Govt. service holders. Monthly family income was Tk 35000 (taka thirty-five thousand) and above in 39.6% cases. Regarding source of infection in these patients, 40.3% and 35.2% from traveling abroad and shopping respectively. Urban dwellers were75% and 25% from rural area. Nutritional status of COVID-19 patients was calculated according to BMI grading. Among all Underweight COVID-19 patients- 90% were Moderate cases. Among all Normal nutritional status COVID- 19 patients we found 37.5%, 41.7% and 20.8% were in mild cases, moderate cases, and severe cases respectively. Regarding Overweight COVID-19 patients we found 46.7% and 32.7% in moderate and in severe cases. Obese 1 were 48.1% in moderate cases and 32.1% in severe cases of COVID-19 patients. On the other hand, all (100%) obese 2 patients were moderate cases. BMI found statistically significant p – 0.002. Regarding food items protein showed statistically significant (p- 0.04). In severe cases having good sun exposure was found in only 19.5% cases. Regarding dietary habit of COVID-19 patients, most of the variables were found statistically significant i,e skipping of their meal (p-0.016), number of meal ( p-0.040), quality of food( p-0.014), taking food according to daily requirement ( p - 0.021) and eating extra salt with food(p-0.029). Conclusion: Considering the result, it can be concluded that COVID-19 patients were mostly middle aged from urban areas with average economic status. Source of infection was from traveling abroad and shopping. Nutritional status of most of Moderate and Severe COVID-19 cases were under weight, obese 1 and obese 2. Concerning diet and dietary habit, protein, skipping of meal, number of meals, variety of food, eating food according to daily requirement and eating extra salt with food significantly associated with the severity of COVID-19. This was a single centered study with a small sample size. A multicenter, larger sample size study recommended for confirming our data and to get an actual view of the nutritional status and dietary habit of COVID19 patients. Northern International Medical College Journal Vol. 13 No. 1-2 July 2021-January 2022, Page 574-580