2019-nCoV Infection Research Articles

Application of Bayesian phylogenetic inference modelling for evolutionary genetic analysis and dynamic changes in 2019-nCoV.

The novel coronavirus (2019-nCoV) has recently caused a large-scale outbreak of viral pneumonia both in China and worldwide. In this study, we obtained the entire genome sequence of 777 new coronavirus strains as of 29 February 2020 from a public gene bank. Bioinformatics analysis of these strains indicated that the mutation rate of these new coronaviruses is not high at present, similar to the mutation rate of the severe acute respiratory syndrome (SARS) virus. The similarities of 2019-nCoV and SARS virus suggested that the S and ORF6 proteins shared a low similarity, while the E protein shared the higher similarity. The 2019-nCoV sequence has similar potential phosphorylation sites and glycosylation sites on the surface protein and the ORF1ab polyprotein as the SARS virus; however, there are differences in potential modification sites between the Chinese strain and some American strains. At the same time, we proposed two possible recombination sites for 2019-nCoV. Based on the results of the skyline, we speculate that the activity of the gene population of 2019-nCoV may be before the end of 2019. As the scope of the 2019-nCoV infection further expands, it may produce different adaptive evolutions due to different environments. Finally, evolutionary genetic analysis can be a useful resource for studying the spread and virulence of 2019-nCoV, which are essential aspects of preventive and precise medicine.

Potential treatment methods targeting 2019-nCoV infection.

The novel coronavirus, 2019-nCoV, has quickly spread across the world and pose serious threat to public health because it can infect people very easily. The major clinical symptoms of 2019-nCoV infection include fever, dry cough, myalgia, fatigue, and diarrhea. The 2019-nCoV belongs to the betacoronavirus family, and gene sequencing results demonstrate that it is a single-stranded RNA virus, closely related to Severe Acute Respiratory Syndrome CoV (SARS-CoV) and Middle East Respiratory Syndrome CoV (MERS-CoV). It has been observed that the virus invades human body mainly through binding to angiotensin-converting enzyme 2 (ACE2) receptors similar to SARS-CoV and the main protease (Mpro) acts as a critical protease for digesting the polyprotein into functional polypeptides during the replication and transcription process of 2019-nCoV. In this review, we summarized the real-time information of 2019-nCoV treatment methods and mainly focused on the chemical drugs including lopinavir/ritonavir, chloroquine, hydroxychloroquine, arbidol, remdesivir, favipiravir and other potential innovative active molecules. Their potential targets, activity, clinical status and side effects are described. In addition, Traditional Chinese Medicine (TCM), Convalescent plasma therapy (CPT) and biological reagents available, as well as the promising vaccine candidates against 2019-nCoV are also discussed.

Zn2+ Ions-Immune Virucidal activities for children and adults with preventions against 2019-nCoV and COVID-19 infection

Zinc induced pediatric preventing respiratory 2019-nCoV is required that supplementation with zinc gluconate 20 mg in Zn deficient children resulted in a nearly twofold reduction of acute lower respiratory infections as well as the time to recovery. Zinc supplementation in children is associated with a reduction in the incidence and prevalence of pneumonia. Preventing 2019-nCoV pneumonia is required that zinc supplementation alone (10 to 20 mg) for more than 3 months significantly reduces in the rate of pneumonia. zinc pediatric intake may be required to be effective range 10～20 mg/d for 2019-CoV prevention, 10～30 mg/d for reduction of COVID-19 bronchitis, and 20～30 mg/d for recovery from COVID-19 pneumonia, in which Zn2+ could bind with viral surface proteins by Zn2+ions-centered tetrahedrally coordination pattern. On the other hand, for aults, the zinc-homeostatic immune concentration may provide a protective role against the COVID-19 pandemic, likely by improving the host’s resistance against viral infection. 50 mg of zinc per day might provide an additional shield against the COVID-19 pandemic, possibly by increasing the host resistance to viral infection to minimize the burden of the disease. In order to prevent that an outbreak of respiratory sickness caused by a novel coronavirus (COVID-19) has become a serious public threat and disrupted many lives,assessing the efficacy of FDA-approved Zn-ejector drugs such as disulfiram combined with interferon to treat COVID-19 infected patients has been proposed. The key strategies for preventing lung damages include avoiding direct lung infection, altering host-virus interactions, promoting immune responses, diluting virus concentrations in lung tissues by promoting viral migration to the rest of the body, maintaining waste removal balance, protecting heart function and renal function, avoiding other infections, reducing allergic reactions and anti-inflammatory. The interactions had been found on the binding specificity by Zn2+ ions-centered tetrahedral geometric coordination of the inhibitors against 3C and 3C-like proteases. In addition, transient zinc chelation TPEN and EPDTC have been noted as preventing virus replication. Zinc-induced ROS production in COVID-19 respiratory ailment and pneumonia occurs both in children and adults. In children. ROS production in zinc (Ⅱ)-immune pediatric patient with COVID-19 bronchitis and pneumonia cannot be elucidated yet. In adults, zinc induced ROS generation in pulmonary COVID-19 infected cells is that alterations of ROS-producing and scavenging pathways that are caused by respiratory viral infections are implicated in inflammation, lung epithelial disruption, and tissue damage, and, in some cases, even pulmonary fibrosis. The involvement of oxidative stress in cell deaths caused during RNA virus infection and ROS production is correlated with host cell death.

The First Case of COVID-19 in Semarang, Indonesia: A Case Report

In January 2020, the 2019 novel coronavirus (2019-nCoV) infection outbreak in China then spread progressively to other countries and WHO declared it a public health emergency that was of international concern. Among the countries in Asia affected outside China include Indonesia. The World Health Organization (WHO) on 11 February 2020, announced a new name for epidemic diseases caused by the 2019- novel coronavirus as coronavirus disease (COVID-19).Here, we report a case of the 2019 novel coronavirus (COVID-19) which was first confirmed in the city of Semarang, Indonesia. This case report reveals the natural journey of patients with COVID-19 who were treated in hospital and then recovered, which might be a good example of medical treatment.

Advance in human coronaviruses research of host interactions

2019-novel coronavirus (2019-nCoV) is a highly pathogenic human CoV that first emerged in Wuhan in 2019.2019-nCoV has a zoonotic origin and poses a major threat to public health.However, little is known about the viral factors contributing to the high virulence of 2019-nCoV.Many animal viruses, including CoVs, encode proteins that interfere with host gene expression, including those involved in antiviral immune responses, and these viral proteins are often major virulence factors.Human coronaviruses (HCoVs) are known respiratory pathogens associated with a range of respiratory infection.In the past 17 years, the onset of 2019-nCoV, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) have thrust HCoVs into spotlight of the research community due to their high pathogenicity in humans.The recent study of HCoVs-host interactions has contributed extensively to our understanding of infection pathogenesis of 2019-nCoV.This review discuss various host physiopathologic mechanism, such as apoptosis, innate immunity, endoplasmic reticulum (ER) stress response, mitogen-activated protein kinase (MAPK) pathway and nuclear factor kappa B (NF-κB) pathway that may be modulated by HCoVs and provides evidence for the intensive investigate of 2019-nCoV infection. Key words: Human coronavirus; Apoptosis; Innate immunity; Endoplasmic reticulum stress; Mitogen-activated protein; Nuclear factor kappa B

A Review Article on Corona Virus 2019-nCoV (COVID-19)

Coronaviruses are a group of viruses that cause diseases in mammals and birds. In humans, the viruses cause
 respiratory infections which are typically mild, including the common cold; however, rarer forms such as
 SARS, MERS and the novel coronavirus causing the current outbreak can be lethal. Coronaviruses were
 discovered in the 1960s. On 31 December 2019, the outbreak was traced to a novel strain of coronavirus,
 which was labelled as 2019-nCoV by the World Health Organization (WHO). Human to human transmission
 of coronaviruses is primarily thought to occur among close contacts via respiratory droplets generated
 by sneezing and coughing. Clinical laboratories performing routine haematology, urinalysis, and clinical
 chemistry studies, and microbiology laboratories performing diagnostic tests on serum, blood, or urine.
 There is currently no vaccine to prevent 2019-nCoV infection. The best way to prevent infection is to avoid
 being exposed to this virus.

Ibuprofen, a traditional drug that may impact the course of COVID-19 new effective formulation in nebulizable solution

The traditional formulation of ibuprofen is poorly soluble in water, so the administered dose must be 10 times higher than the dose required for a therapeutic effect. The development of a hydrosoluble form of ibuprofen can be a strategy to reach a high concentration in the lungs by using modern inhalation devices. Therefore, the development of an inhalable formulation with high bioavailability in the lungs was the leitmotiv of our investigation. The hypertonic ibuprofen solution to be nebulized (NIH) presents great relevant characteristics: bactericidal, virucidal, mucolytic and has a known anti-inflammatory property. Bactericidal and virucidal effects are related to the physico-chemical properties of Na-ibuprofenate as an amphipathic molecule. It has the capability to insert into the bilayer membranes destabilizing the structure, altering its biological properties and avoiding the duplication or infection. Our preliminary results indicate that the presence of this high ionic strength solution reduces 10 times the amount of ibuprofen necessary to kill bacteria, but also the time to kill 1x106 bacteria, from 4 h (in its absence) to only three minutes (in its presence). That was observed using Pseudomona aeruginosa, methicillin-resistant Staphylococcus aureus and Burkholderia cepacia. Also, “in vitro'' ibuprofen demonstrated virucidal activity against the so-called enveloped virus, a family that includes coronavirus strain (2019-nCoV). We observed too, the markedly reduced local inflammation in the airways after administering NIH lays on its ability to inhibit the enzyme cyclooxygenase and to markedly diminish reactive oxygen species (ROS). Other investigators also showed the importance of actin in the rapid spread of virus infection. Furthermore, reorganization of the actin filaments is a key step in lung inflammation induced by systemic inflammatory responses caused by SARS-CoV-2. These findings suggest that the interaction between actin proteins and S1 is involved in the 2019-nCoV infection and pathogenesis.Consequently, the possibility of interfering in this interaction could represent a valid hypothesis for the development of promising therapeutic and prevention strategies. In conclusion, we consider that treating people with COVID-19 with NIH may be beneficial and an opportunity to contribute for the current global health emergency.

Current Findings Regarding Natural Components With Potential Anti-2019-nCoV Activity.

COVID-19, a novel coronavirus pneumonia (named by the World Health Organization, WHO), has spread widely since the end of 2019. Research on synthetic drugs and vaccines has become a focus of attention in China and other countries, as such approaches are regarded as key tools for disease prevention and control; however, the development of these therapeutics will take months, or even years. Under such circumstances, development of coronavirus specific therapeutics is urgent. For this specific indication, the rapid performance of natural products, such as plant compounds, herbal extracts, and traditional Chinese medicine, could contribute as alternative measures. Recent investigations have provided evidence that these natural products are potential candidates for development as therapeutic agents against the virus that causes COVID-19, 2019-nCoV. Targeting the structural proteins or cellular receptors of 2019-nCoV, including coronavirus chymotrypsin-like (3CLpro or Mpro), helicase (nsP13), S protein, and human angiotensin converting enzyme 2 (ACE2), holds promise for preventing infection. In this review, we summarize some representative natural products and their active components that have potential anti-2019-nCoV effects. We focus on the basic structural elements of 2019-nCoV, its main mechanisms of action, and the feasibility and potential of products to inhibit the novel coronavirus. In addition, the relative advantages, additional functions, and precautions that should be used with typical natural products are also discussed. The aim is to make the case that natural products could be a valuable pool for the development of active compounds for treating 2019-nCoV infection, which may contribute to mitigation of the spread of the pandemic.

Clinical Analysis of 25 COVID-19 Infections in Children.

To describe the characteristics of clinical manifestations of children with 2019 novel coronavirus (2019-nCoV) infection in Chongqing. All 25 children with laboratory-confirmed 2019-nCoV infection by real-time reverse transcription-PCR (RNA-PCR) were admitted from the 4 designated treatment hospitals of 2019-nCoV in Chongqing from January 19 to March 12, 2020. Clinical data and epidemiologic history of these patients were retrospectively collected and analyzed. The diagnosis was confirmed through RNA-PCR testing. Among the 25 cases, 14 were males and 11 were females. The median age was 11.0 (6.3-14.5) years (range 0.6-17.0 years). All children were related to a family cluster outbreak, and 7 children (28%) with a travel or residence history in Hubei Province. These patients could be categorized into different clinical types, including 8 (32%) asymptomatic, 4 (16%) very mild cases and 13 (52%) common cases. No severe or critical cases were identified. The most common symptoms were cough (13 cases, 52%) and fever (6 cases, 24%). The duration time of clinical symptoms was 13.0 (8.0-25.0) days. In the 25 cases, on admission, 21 cases (84%) had normal white blood cell counts, while only 2 cases (8%) more than 10 × 10/L and 2 cases (8%) less than 4 × 10/L, respectively; 22 cases(88%) had normal CD4+ T lymphocyte counts, while in the remaining 3 cases(8%) this increased mildly; 23 cases had normal CD8+ T lymphocyte counts, while in the remaining 2 cases (8%) CD8+ T lymphocyte counts were mildly increased as well. All Lymphocyte counts were normal. There were no statistical differences of lab results between the groups of asymptomatic cases, mild cases and common cases. There were only 13 cases with abnormal CT imaging, most of which were located in the subpleural area of the bottom of the lung. All patients were treated with interferon, 6 cases combined with Ribavirin, and 12 cases combined with lopinavir or ritonavir. The days from onset to RNA turning negative was 15.20 ± 6.54 days. There was no significant difference of RNA turning negative between the groups of interferon, interferon plus ribavirin and interferon plus lopinavir or ritonavir treatment. All the cases recovered and were discharged from hospital. The morbidity of 2019-nCoV infection in children is lower than in adults and the clinical manifestations and inflammatory biomarkers in children are nonspecific and milder than that in adults. RNA-PCR test is still the most reliable diagnostic method, especially for asymptomatic patients.

Clinicopathologic Findings from Autopsy of the first autopsy done for Patient with COVID-19, Sylhet

The China Health Authority alerted the World Health Organization (WHO) on December 31 2019, to several cases of pneumonia of unknown aetiology in Wuhan City in Hubei Province in central China. Since December 8, 2019, these cases had been reported, worked at or lived around the local Huanan Seafood Market. Radiology finding may vary with patients age, disease progression, immunity status, comorbidity, and initial medical intervention. In a study describing 41 of the initial cases of 2019-nCoV infection, all 41 patients had pneumonia with abnormal findings on chest computed tomography (CT-scan). Abnormalities on chest CT-scan were also seen in another study of 6 cases, in which all of them showed multifocal patchy ground-glass opacities notably nearby the peripheral sections of the lungs. Complete autopsy studies were almost nonexistent in the initial phases of the outbreak; reasonably so, due to concerns related to infectivity, transmission rates, and biosafety. The few reports initially published were limited to postmortem biopsies in COVID-19–positive patients or from lobectomy specimens initially resected for lung adenocarcinoma, but patients were later found to be COVID-19–positive (7). Pathologic features of exudative and proliferative phases of diffuse alveolar damage (DAD) were noted in these initial reports and overlapping features with SARS were also noted. Later complete autopsies performed in United States further supported the presence of DAD. The predominant pattern of lung lesions in COVID-19 patients is DAD, as described for the other two coronavirus that infect humans, SARS-CoV and MERSCoV. Hyaline membrane formation and pneumocyte atypical hyperplasia are frequently found. The main relevant finding is the presence of platelet-fibrin thrombi in small arterial vessels; this important observation fits into the clinical context of coagulopathy which dominates in these patients and which is one of the main targets of therapy. The macroscopic features of COVID-19 are likely to be in the chest and may include pleurisy, pericarditis, lung consolidation and pulmonary oedema. Lung weight may be increased above normal. It should be noted a secondary infection may be superimposed on the viral infection that can lead to purulent inflammation more typical of bacterial infection. The pulmonary histologic characteristics of COVID-19 resembled those observed in diseases caused by other Betacoronavirus infections such as severe acute respiratory syndrome4 and Middle East respiratory syndrome. Histopathology of the lungs showed diffuse alveolar damage, consistent with early acute respiratory distress syndrome in 8 cases. Predominant findings were hyaline membranes, activated pneumocytes, microvascular thromboemboli, capillary congestion, and proteinenriched interstitial edema. As described by Wang and colleagues, a moderate degree of inflammatory infiltrates concurred with clinically described leukopenia in patients with COVID-19 and predominant infiltration of lymphocytes fit the picture of a viral pathogenesis.

Retrospective Analysis of 2019-nCov-Infected Cases in Dongyang, Southeastern China.

The 2019 novel coronavirus (2019-nCov) has caused increasing number of infected cases globally. This study was performed to analyze information regarding the transmission route and presence of viral nucleic acids on several clinical samples. Confirmed 2019-nCov-infected cases were identified in Dongyang and were treated according to guidelines for the diagnosis of 2019-nCov infection released by the National Health Commission. Information regarding the contacts that the infected people had was collected to determine whether it caused clustered cases. A series of successive nucleic acid examination of feces, oropharyngeal swabs, and sputum was also performed, and the results were analyzed. A total of 19 confirmed cases of 2019-nCov infection were identified in Dongyang, Zhejiang Province, China. Five cases showed severe symptoms, and the remaining ones showed mild manifestations. Ten cases infected from two asymptomatic individuals were clustered into two groups. Among 14 cases with consecutive nucleic acid test results, four patients showed positive results in feces after their negative conversion in oropharyngeal swabs. Asymptomatic individuals with the virus could cause 2019-nCov clustered cases, and the clustered cases may differ from sporadic cases on age and length of hospitalization. In addition, nucleic acids in feces last longer than those in oropharyngeal swabs.

Aromatic Herbs, Medicinal Plant-Derived Essential Oils, and Phytochemical Extracts as Potential Therapies for Coronaviruses: Future Perspectives.

After its recent discovery in patients with serious pneumonia in Wuhan (China), the 2019 novel coronavirus (2019-nCoV), named also Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has spread quickly. Unfortunately, no drug or vaccine for treating human this coronavirus infection is available yet. Numerous options for controlling or preventing emerging 2019-nCoV infections may be predicted, including vaccines, interferon therapies, and small-molecule drugs. However, new interventions are likely to require months to years to develop. In addition, most of the existing antiviral treatments frequently lead to the development of viral resistance combined with the problem of side effects, viral re-emergence, and viral dormancy. The pharmaceutical industry is progressively targeting phytochemical extracts, medicinal plants, and aromatic herbs with the aim of identifying lead compounds, focusing principally on appropriate alternative antiviral drugs. Spices, herbal medicines, essential oils (EOs), and distilled natural products provide a rich source of compounds for the discovery and production of novel antiviral drugs. The determination of the antiviral mechanisms of these natural products has revealed how they interfere with the viral life cycle, i.e., during viral entry, replication, assembly, or discharge, as well as virus-specific host targets. Presently, there are no appropriate or approved drugs against CoVs, but some potential natural treatments and cures have been proposed. Given the perseverance of the 2019-nCoV outbreak, this review paper will illustrate several of the potent antiviral chemical constituents extracted from medicinal and aromatic plants, natural products, and herbal medicines with recognized in vitro and in vivo effects, along with their structure–effect relationships. As this review shows, numerous potentially valuable aromatic herbs and phytochemicals are awaiting assessment and exploitation for therapeutic use against genetically and functionally different virus families, including coronaviruses.

Facts and Myths: Efficacies of Repurposing Chloroquine and Hydroxychloroquine for the Treatment of COVID-19.

The emergence of coronavirus disease 2019 (COVID-19) is caused by the 2019 novel coronavirus (2019-nCoV). The 2019-nCoV first broke out in Wuhan and subsequently spread worldwide owing to its extreme transmission efficiency. The fact that the COVID-19 cases and mortalities are reported globally and the WHO has declared this outbreak as the pandemic, the international health authorities have focused on rapid diagnosis and isolation of patients as well as search for therapies able to counter the disease severity. Due to the lack of known specific, effective and proven therapies as well as the situation of public-health emergency, drug repurposing appears to be the best armour to find a therapeutic solution against 2019-nCoV infection. Repurposing anti-malarial drugs and chloroquine (CQ)/ hydroxychloroquine (HCQ) have shown efficacy to inhibit most coronaviruses, including SARS-CoV-1 coronavirus. These CQ analogues have shown potential efficacy to inhibit 2019-nCoV in vitro that leads to focus several future clinical trials. This review discusses the possible effective roles and mechanisms of CQ analogues for interfering with the 2019-nCoV replication cycle and infection.

Progress in Treatment of Myocardial Injury in Patients with 2019-nCoV: A Chinese Experience.

Since December 2019, the 2019 novel coronavirus (2019-nCoV) infection began to appear in Hubei Province of China and gradually spread to other provinces and other countries. The virus has the characteristics of strong transmission capacity, diverse clinical manifestations, long incubation period, and latent infection, thus posing a serious threat to human life safety and health. With the increasing number of cases and the continuous enrichment of clinical data, 2019-nCoV-infected patients have received more and more attention regarding myocardial injury related to virus infection besides typical respiratory system manifestations. According to the published data, we summarize the myocardial injury manifestations, characteristics, effects on disease condition, and prognosis of 2019-nCoV-infected patients and discuss the possible injury mechanism, treatment methods, and future research directions.

Redeployment of dermatologists during COVID-19: Implementation of a large-scale, centralized results management infrastructure

On March 13, 2020, the White House declared a State of Emergency in response to the growing coronavirus disease 2019 (COVID-19) pandemic.1Proclamation No. 9994, 85 F.R. 15337 (March 18, 2020).Google Scholar As health systems across the country fortified themselves to treat and limit infection, they shared a common goal: to test large numbers of patients and swiftly disseminate test results. Discussions of COVID-19 results have added complexity, because they must address patient questions on symptom management, test interpretation, self-isolation, and our evolving understanding of the disease.2Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases [e-pub ahead of print]. Radiology. https://doi.org/10.1148/radiol.202020064, Accessed May 30, 2020.Google Scholar,3Yang Y, Yang M, Shen C, et al. Evaluating the accuracy of different respiratory specimens in the laboratory diagnosis and monitoring the viral shedding of 2019-nCoV infections [preprint]. medRxiv. https://doi.org/10.1101/2020.02.11.20021493.Google Scholar The scale, infectivity, and public health implications of COVID-19 have required health systems to rapidly develop new workflows and to redeploy physicians to support these operations. Dermatologists are well-suited to manage test results, because patient evaluation and counseling are integral to our practice, and we can redirect these skills to guide patients on COVID-19. At Penn Medicine, we have rapidly redeployed our dermatology department to create a COVID-19 Results Management team. An Applied Informatics Specialist/Physician Builder within our faculty spearheaded this effort in collaboration with Penn's Information Technology leadership. On March 25, our department began covering all ambulatory COVID-19 results, and in our first week of operation, we processed 2222 results. On March 30, we expanded our efforts to include all COVID-19, respiratory virus panel, and influenza results for all discharged patients seen in our 5 emergency departments and our urgent care center. In our first month, we managed a total of 14,296 results (Fig 1). Critical to our performance has been the rapid reconfiguration of our electronic health record, EpicCare, to identify all patients with new COVID-19 results from all ambulatory practices across the health system. This report of patients is run 3 times every day. Patients who are positive and negative populate electronic patient lists that are shared within our team of 85 providers, who volunteer for half-day shifts. An early, critical discovery was the need to manually confirm the laboratory result within each patient's medical record, because the EpicCare sorting strategy is not 100% accurate. Furthermore, we created department-level documentation tools (SmartPhrases) that allow for standardization of the language and resources provided to patients. The content of these SmartPhrases was developed in collaboration with our internal medicine and infectious disease colleagues and vetted for accuracy and consistency. This standardization allows us to collectively update our recommendations as new COVID-19 guidelines emerge while also enabling providers to give patient-specific advice for positive, negative, and indeterminate results (Fig 2). The SmartPhrases also contain background SmartData elements that allow us to track patient severity, outreach, and enrollment in internal COVID-19 monitoring initiatives. All providers use these documentation tools without exception, which ensures fidelity to our tracking system. We have rapidly redeployed our dermatology workforce to handle all COVID-19, influenza, and respiratory virus panel results from all emergency department and ambulatory test sites within our health care system. We have developed a sustainable, scalable strategy that can incorporate other departments as we resume normal dermatology clinical operations. Through this model, our department has continued to address urgent dermatologic needs while also supporting Penn Medicine's response to the COVID-19 pandemic.

Clinical analysis of 150 cases of 2019 novel coronavirus infection in Nanyang City, Henan Province

Objective: To analyze the epidemiological characteristics and clinical features of the patients with 2019-nCoV infection in Nanyang City, so as to provide evidence for clinical diagnosis and treatment. Methods: The epidemiology, clinical symptoms, atory and radiologic data of 150 patients with 2019-nCoV infection admitted to the designated hospitals in Nanyang City from January 24,2020 to February 16, 2020 were retrospectively analyzed. Results: The 150 patients with 2019 nCov infection consisted of 67 men and 83 women, and the median age was (45±16) years; 69 of them were the first generation case,60 of them were the second generation case, 6 of them were the third generation case,the median incubation period of the first generation case was (5.4±2.2) days, and the second generation case was (6.7±3.1) days, and the first-generation cases are the majority in severe patients (69%) . The most common basic disease was hypertension (13 cases, 9%), diabetes (9 cases, 6%), and the most common symptom is fever(142 cases, 95%, 63% showed moderate fever) , cough and sputum(108 cases,72%), fatigue(23 cases,15%), anorexia(20 cases, 13%), headache, diarrhea, muscle soreness, sore throat as the first symptoms. The average time from onset of symptoms to consultation was (4.2±2.2) days for all patients. The changes in peripheral blood cells were mainly lymphonpenia (83 cases, 55%) and eosinophilia (95 cases, 63%), The lymphocyte count of the severe and critically ill patients was more significantly reduced, and some patients had increased myocardial enzymes, mainly LDH (47 cases, 31%), and a few patients had liver function damage, mainly manifested in ALT and AST. High, very few patients have renal impairment. Among the inflammation-related indicators, the main manifestations are increased CRP (66 cases, 43%) and ESR (86 cases, 57%), elevated D-Dimer in 29% of patients. 144 cases have different degrees of infective lesions in chest CT examination, with 30 cases (21%) on one side and 144 cases (79%) on both sides. Morphologically, most of the lesions were patchy ground glass lesions, which could be accompanied by air bronchus signs and some consolidation and paving stone signs. Of the cases showing "white lung", 87% were sever ill or critically ill. After active treatment, 45% of patients were discharged according to discharge standards. 33% of sever and critically ill patients were discharged, 49% of them were degraded hospitalization.The average length of hospitalization was (12±4) days. Conclusion: A history of epidemiological exposure, fever, chest CT with signs of pneumonia, normal or decreased WBC, and lymphocytopenia, eosinophilia are the clinical basis for the diagnosis of this disease, and most of the sever patients were the first generation cases. The degree of lymphocytopenia is related to the severity of the disease.

A special on epidemic prevention and control: ophthalmologic research and prevention of 2019 novel coronavirus based on ocular manifestations of viral diseases

This article was published ahead of print on the official website of Chinese Journal of Ophthalmology on February 24, 2020. In China, the fight against the 2019 novel coronavirus (2019-nCoV) has been at a critical stage. It has been confirmed that the transmission of 2019-nCoV is mainly through respiratory droplets and contact. Some scholars also pointed out that the possibility of transmission through the digestive system and eyes should not be ignored. Whether infection with 2019-nCoV will develop eye symptoms and whether the virus will spread through eyes are confusing to the medical workers and the general public, and it is ophthalmologists' responsibility to carry out in-depth discussions. Based on the ocular manifestations of viral diseases, this article analyzes whether the eye secretions and tears carry the virus, and whether ophthalmologists and patients are at a high risk for 2019-nCoV infection, and then presents the current research methods and the necessary prevention and control measures in the field of ophthalmology, with an aim to contribute to the fight against 2019-nCoV. ( Chin J Ophthalmol, 2020, 56: 414-417).

Utilization of deceased donors during a pandemic: argument against using SARS-CoV-2-positive donors.

Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has rapidly become an unprecedented pandemic that has impacted society, disrupted hospital functions, strained health care resources, and impacted the lives of transplant professionals. Despite this, organ failure and the need for transplant continues throughout the United States. Considering the perpetual scarcity of deceased donor organs, Kates et al present a viewpoint that advocates for the utilization of coronavirus disease 2019 (COVID‐19)–positive donors in selected cases. We present a review of the current literature that details the potential negative consequences of COVID‐19–positive donors. The factors we consider include (1) the risk of blood transmission of SARS‐CoV‐2, (2) involvement of donor organs, (3) lack of effective therapies, (4) exposure of health care and recovery teams, (5) disease transmission and propagation, and (6) hospital resource utilization. While we acknowledge that transplant fulfills the mission of saving lives, it is imperative to consider the consequences not only to our recipients but also to the community and to health care workers, particularly in the absence of effective preventative or curative therapies. For these reasons, we believe the evidence and risks show that COVID‐19 infection should continue to remain a contraindication for donation, as has been the initial response of donation and transplant societies.

Pathological changes of fatal coronavirus disease 2019 (COVID-19) in the lungs: report of 10 cases by postmortem needle autopsy

Objectives: To observe the pulmonary changes with coronavirus disease 2019 (COVID-19) in postmortem needle specimens, to detect the presence of 2019 novel coronavirus(2019-nCoV) in the lung tissues, and to analyze the clinicopathological characteristics. Methods: For 10 decedents with 2019-nCoV infection in Wuhan, bilateral lungs underwent ultrasound-guided percutaneous multi-point puncture autopsy, and pulmonary pathological changes were described in routine hematoxylin-eosin staining (HE) slides. Electron microscopy was also performed. The reverse transcription polymerase chain reaction (RT-PCR) was employed to detect 2019-nCoV nucleic acid in lung tissue, and the pathological characteristics were demonstrated in combination with clinical data analysis. Results: Of the 10 deaths associated with COVID-19, 7 were male and 3 were female. The average age was 70 (39-87) years. Medical record showed that 7 patients had underlying diseases. The average course of disease was 30 (16-36) days. Nine cases showed fibrinous and suppurative exudation in the alveolar cavity accompanied by the formation of hyaline membrane, and fibroblastic proliferation of alveolar septum. Type Ⅱ alveolar epithelial cells showed reactive hyperplasia and desquamation. Many macrophages accumulated in the alveolar cavity. Capillary hyaline thrombus and intravascular mixed thrombus were noted. In some cases, acute bronchiolitis with mucous membrane exfoliation, accumulation of bronchiolar secretions, and bronchiolar epithelial metaplasia occurred. In the cohort, a large number of bacteria (cocci) were detected in 1 case and a large number of fungi (yeast type) were detected in 1 case. Nine cases were positive for the nucleic acids of 2019-nCoV while one case remained negative by RT-PCR. Coronavirus particles were detected in the cytoplasm of type Ⅱ alveolar epithelium. Conclusions: The pulmonary pathological changes of fatal COVID-19 are diffuse alveolar damage (DAD), mainly in the acute exudative stage and the organic proliferative stage. There are fibrinous exudate aggregation in alveolar cavity with hyaline membrane formation, fibroblastic proliferation in alveolar septum, and alveolar epithelial cell injuries with reactive hyperplasia and desquamation of type Ⅱ alveolar epithelial cells. A large amount of neutrophils and monocytes infiltration is present in most cases and bacteria and fungi are detected in some cases, suggesting a serious bacterial or fungal infection secondary to the DAD.

2019-nCoV: Measures Adopted at the Departments of Oral Surgery and Radiology during the Period of an Uncontrolled Transmission Increase.

A new mutation of 2019-nCoV emerged and has been spreading worldwide. Dental practices are an important person-to-person transmission route. In this regard, preventive measures are required to avoid the cross contamination among professionals and patients. This report brings recommended measures for dental assistance during the pandemic phase. The clinical protocol applied at the Department of Oral Maxillofacial and Surgery, such as at the Department of Radiology, Hospital University Münster, is described. A management protocol was applied to prevent the transmission route of 2019-nCoV. Patients infected with 2019-nCoV are treated only in emergency situations. The use of protective equipment and dental office isolation were the major points to avoid the contact between infected and non-infected patients. Preventive measures should be taken in order to reduce the spread of 2019-nCoV infection.