Coronavirus Disease 2019 Nucleic Acid Research Articles

Efficacy and safety of Nirmatrelvir/Ritonavir for treating the Omicron variant of COVID-19.

To evaluate the efficacy and safety of Nirmatrelvir/Ritonavir in the treatment of the Omicron variant of coronavirus disease 2019 (COVID-19). Data from 58 patients who were infected with the Omicron variant of COVID-19 were retrospectively collected. The patients were divided into two groups according to the treatment regimen they received. Patients in both groups were given Lianhua Qingwen capsules orally, three times/day, 6 g/time. The study group was given Nirmatrelvir 300 mg/Ritonavir 100 mg orally, q12h, for 5 days, and the control group was not given any antiviral drugs. The two groups were compared in terms of the change in computed tomography (CT) values of COVID-19 nucleic acid, the negative conversion time of COVID-19 RNA, hospitalization time, adverse drug reactions and COVID-19 nucleic acid re-positive tests. The time to increase the CT values in the study group was faster than that in the control group, and the CT values in the study group were significantly larger than in the control group on days four and seven (p < 0.05); The negative conversion time in the study group was shorter than the control group (Z = -2.424, p = 0.015), and the hospitalization time was also shorter (Z = -2.603, p = 0.009). There were no statistically significant adverse drug reactions during hospitalization in both groups (χ2 = 2.747, p = 0.097). None of the study group tested re-positive for SARS-CoV-2 nucleic acid after discharge. The efficacy of Nirmatrelvir/Ritonavir in the treatment of the Omicron variant of COVID-19 was positive and had good tolerance in patients.

Hematomyelia associated with coronavirus disease 2019: A rare case report.

Coronavirus disease 2019 (COVID-19) can damage the central nervous system. Although there have been reports of cerebral hemorrhage and infarction caused by COVID-19, hematomyelia due to COVID-19 has never been reported. A 40-year-old male was admitted to the hospital with positive nucleic acid detection for COVID-19 after experiencing fever for 2 weeks, urinary retention, fecal retention, and pain in both lower extremities for a week. The patient diagnosis was established using thoracic and lumbar magnetic resonance imaging (MRI). Contrast-enhanced thoracic and lumbar MRI revealed subdural (dorsal predominant) short T1 and slightly long T2 bands in the T12-S2 infundibular canal in the scan field, and the subdural hematoma was yet to be distinguished from other diseases. Spinal cord edema was observed in the left vertebral plate and facet joint of the T11 vertebral body, indicative of inflammation. The cerebrospinal fluid (CSF) was positive for COVID-19 nucleic acid. Antiinfection, immunomodulation, correction of acid-base balance and electrolyte disorders, improvement of circulation, nerve nutrition, and other symptomatic supportive treatments were administered to the patient. The patient symptoms significantly improved after 4 weeks of anti-infection and immunomodulatory therapy. Repeat thoracolumbar MRI revealed absorption of the spinal cord hematoma, and the patient was discharged from the hospital. To date, COVID-19-related hematomyelia has not been reported and anti-infective and immunomodulatory therapies may be effective. COVID-19 not only easily leads to brain injury but can also cause spinal cord injury and even spinal cord hemorrhage. When patients with COVID-19 experience symptoms and signs of spinal cord injury, spinal cord injury and bleeding caused by COVID-19 should be considered, and MRI and lumbar puncture should be performed as soon as possible to make a clear diagnosis.

Optimizing the nucleic acid screening strategy to mitigate regional outbreaks of SARS-CoV-2 Omicron variant in China: a modeling study

BackgroundThe Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads rapidly and insidiously. Coronavirus disease 2019 (COVID-19) screening is an important means of blocking community transmission in China, but the costs associated with testing are high. Quarantine capacity and medical resources are also threatened. Therefore, we aimed to evaluate different screening strategies to balance outbreak control and consumption of resources.MethodsA community network of 2000 people, considering the heterogeneities of household size and age structure, was generated to reflect real contact networks, and a stochastic individual-based dynamic model was used to simulate SARS-CoV-2 transmission and assess different whole-area nucleic acid screening strategies. We designed a total of 87 screening strategies with different sampling methods, frequencies of screening, and timings of screening. The performance of these strategies was comprehensively evaluated by comparing the cumulative infection rates, the number of tests, and the quarantine capacity and consumption of medical resource, which were expressed as medians (95% uncertainty intervals, 95% UIs).ResultsTo implement COVID-19 nucleic acid testing for all people (Full Screening), if the screening frequency was four times/week, the cumulative infection rate could be reduced to 13% (95% UI: 1%, 51%), the miss rate decreased to 2% (95% UI: 0%, 22%), and the quarantine and medical resource consumption was lower than higher-frequency Full Screening or sampling screening. When the frequency of Full Screening increased from five to seven times/week (which resulted in a 2581 increase in the number of tests per positive case), the cumulative infection rate was only reduced by 2%. Screening all people weekly by splitting them equally into seven batches could reduce infection rates by 73% compared to once per week, which was similar to Full Screening four times/week. Full Screening had the highest number of tests per positive case, while the miss rate, number of tests per positive case, and hotel quarantine resource consumption in Household-based Sampling Screening scenarios were lower than Random Sampling Screening. The cumulative infection rate of Household-based Sampling Screening or Random Sampling Screening seven times/week was similar to that of Full Screening four times/week.ConclusionsIf hotel quarantine, hospital and shelter hospital capacity are seriously insufficient, to stop the spread of the virus as early as possible, high-frequency Full Screening would be necessary, but intermediate testing frequency may be more cost-effective in non-extreme situations. Screening in batches is recommended if the testing capacity is low. Household-based Sampling Screening is potentially a promising strategy to implement.Graphical

Influence on emergency digit replantation and outcome assessment after COVID-19 virus nucleic acid testing normalization.

The study aims to compare the implementation and prognosis of emergency digit replantation surgery before and after normalized corona virus disease 2019 (COVID-19) nucleic acid testing for patients taking emergency operation and to explore the influence of normalized COVID-19 nucleic acid testing on replantation surgery. Normalized COVID-19 nucleic acid testing for patients taking emergency operation has been carried out since 1 August 2021 at our hospital, which means each patient who needs emergency surgical treatment has to obtain either positive or negative results of COVID-19 nucleic acid before entering the operating room. This research reviewed and compared the prognosis of the injured extremity that had emergency severed digit replantation between June and September 2021, at the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, and analyzed the impact of normalized COVID-19 nucleic acid testing on the outcome of the replanted fingers of different severity using disability of arm-shoulder-hand (DASH) and hand injury severity scoring (HISS) scoring systems. A total of 54 cases with 74 severed replanted phalanges were included replanted by the research group between 1 August and 30 September 2021, without any COVID-19 suspected/confirmed case detected. Compared with previous period (1 June to 31 July, 2021), although the interval between emergency visits and emergency replantation did increase significantly after normalized COVID-19 nucleic acid testing [(3.83 ± 0.94) to (1.77 ± 0.67) h, P < 0.05], we observed no significant difference in the improvement rate of the DASH scoring of the disabled upper extremity 3-month postoperatively (P = 0.538) nor in the complication rate (P = 0.344). Moreover, there was no significant difference in the improvement rate of the DASH scoring of the disabled upper extremity 3-month postoperatively in patients with different traumatic severities before and after normalized COVID-19 nucleic acid testing (moderate P = 0.269, severe P = 0.055, major P = 0.149). Despite the preoperative delay, the policy of COVID-19 nucleic acid testing normalization does not have explicit influence on the short-term outcomes of emergency digit replantation surgery. With this evidence, microsurgeons could pay attention to the patients' anxiety and spend more effort in comforting them during the prolonged preoperative wait. These insights may have implications for other emergency department resource management whenever a social crisis occurs.

An Effective Protocol for Management of International Arrivals at Risk in COVID-19 Pandemic: Experience From the Pre-Hospital Covid-19 Response Teams at Xi'an, China.

BackgroundThe coronavirus disease 2019 (COVID-19) outbreak within China has been well controlled and stabilized since early April 2020. Therefore, the current major focus in China is to prevent the introduction of COVID into China from international arrivals. To achieve this, pre-Hospital COVID-19 Response Teams (pHCRTs) have been established.ContextThe pHRCTs were established in Xi'an, China in early 2020. During the 12 months covered in this report, there were 356 international flight arrivals with over 5,000 COVID-19 Nucleic Acid Test (NAT) positive people, 500 of them with symptomatic COVID-19 and requiring admission to special hospitals. All other arrivals were managed in dedicated facilities by pHRCTs. The outcome measure of this report was the number of positive cases among the pHRCT members.DetailsFour hundred forty-two staff worked in the pHCRTs during the reporting period. Despite multiple throat swab PCR tests during their pHRCTs tour of duty, and the subsequent mandatory 14-day quarantine required before return to the general community, no staff became NAT positive.ConclusionThe prevention of community transmission from imported cases is a vital part of the strategy to maintain the low numbers of cases in countries which have achieved control, or suppression of local internal cases. The program of pHCRTs described in this article gives successful protocols for transportation of patients who are infectious based on the minimal transmission of virus and staff safety. The strategies employed may prove useful in future pandemics.

Preparation Work and On-Site Management of Large-Scale COVID-19 Nucleic Acid Testing: Report From the Field.

Routine coronavirus disease 2019 (COVID-19) screening found 1 asymptomatic COVID-19 patient. An emergency sampling team was organized consisting of 1200 health-care workers, and a total of 3.2228 million COVID-19 samples had been collected and detected. This study summarizes the on-site management experience in large-scale COVID-19 nucleic acid testing from various aspects: staff preparation, materials preparation, site layout, logistics support, and information system support. Suggestions are put forward for the deficiencies and parts needing improvement. Such deficiencies included some sampling sites were not properly chosen, different areas were unclearly marked off from each other, and some site moving lines were confounding; how to communicate with the street service workers who had little professional knowledge on the epidemic spread or the working principles of the workflow and site layout; and the way to resolve conflicts on site.

Use of proton pump inhibitors are associated with higher mortality in hospitalized patients with COVID-19.

BackgroundThe adverse effects of proton pump inhibitors (PPIs) on pneumonia have been well reported. However, the relationship between the use of PPIs and the adverse outcomes of coronavirus disease 2019 (COVID-19) is currently inconclusive. In this study, we aimed to explore the relationship between the use of PPIs and the in-hospital mortality among patients who were laboratory-confirmed SARS-CoV-2.MethodsData was derived from 2 hospitals which both were the first batch of SARS-CoV-2 specialist hospitals with four types of sensitivity analyses. This cohort included 4634 patients older than 18 years who were laboratory-confirmed SARS-CoV-2. Endpoints were death in hospital (primary) and the recovery of COVID-19 (secondary: the time of COVID-19 nucleic acid testing turning negative).ResultsIn the entire cohort, there were 3588 non-users, 399 ≤ 0.5 defined daily dose (DDD) PPIs users, 483 1 DDD users, and 164 ≥ 1.5 DDD users. The multivariate logistic regression analysis (odds ratio (OR) = 3.63, 95% confidence interval (CI) = 1.83-7.23, P = 0.0002) and four types of sensitivity analyses showed higher mortality in patients using PPIs during hospitalization, while the relationship between different PPIs dosages and the hospital mortality remained insignificant. Usage of the PPIs significantly prolongs the time of COVID-19 nucleic acid testing turning negative.ConclusionsThe use of PPIs may increase the risk of in-hospital death of patients who were laboratory-confirmed SARS-CoV-2, which means that physicians may need to re-evaluate the benefit-risk assessment of the use of PPIs during the COVID-19 pandemic.

Experimental Investigation on Thermal Comfort of COVID-19 Nucleic Acid Sampling Staff in Hot and Humid Environment: A Pilot Study of University Students

The current situation of Coronavirus Disease 2019 (COVID-19) prevention and control coupled with the need to work in high-temperature harsh environments makes it necessary to ensure the health and efficiency of medical staff. An experimental outdoor work tent was set up and university students were used to study the thermal comfort of personnel wearing protective clothing in hot and humid environments. The experiment was carried out simultaneously through subjective and objective field tests and physiological tests of personnel. The wet bulb globe temperature (WBGT) index was investigated to divide the outdoor thermal environment into four working conditions: 21–23 °C, 23–25 °C, 25–27 °C and 27–29 °C. Under the different thermal environment intensities, the variations of physiological parameters of test personnel were monitored. The results showed that when WBGT was increased to 27–29 °C, 100% of the participants expected the external temperature to become cooler and the humidity to decrease after one hour. When the temperature was close to 30 °C and the relative humidity was close to 60%, it was necessary to take cooling measures to reduce the thermal stress of the participants. Moreover, relationships between subjective feelings and physiological parameters of the nucleic acid sampling personnel were obtained. Results also found that the forehead, chest and back were the highest skin temperature parts, so it is most effective to give priority to improving the thermal comfort of these three locations. As an early attempt to conduct the real outdoor experimental study on the thermal comfort of COVID-19 nucleic acid sampling staff, this study provided a theoretical basis for follow-up research to develop cooling strategies for protective clothing in hot and humid outdoor environments.

The Experience of the Fight Against COVID-19 in Clinical Laboratory Departments from Chengdu, China.

ObjectiveIn order to fight against coronavirus disease 2019 (COVID-19) better and to share our experience as a reference for clinical laboratory departments.MethodsThis was a retrospective study conducted in the clinical laboratory department of Chengdu Women’s and Children’s Central Hospital in Chengdu, China, from April 2020 to January 2021. The number of nucleic acid and antibody testing specimens of suspected COVID-19 cases was analyzed. The key points of suspected-case sample processing and detection in the clinical laboratory department were summarized. The laboratory was directly involved in the sample processing and testing of suspected cases, the release of reports, and the transfer of specimens to the fever clinic.ResultsThe number of COVID-19 nucleic acid test specimens in our laboratory ranged from 102 to 2170 per day, and the number of antibody test specimens ranged from 24 to 391 per day. There were four main considerations in the treatment and detection of suspected-case specimens in the clinical laboratory: biosafety management in clinical laboratory departments, measures to ensure the health of the staff, the eight time points for processing suspected-case samples (turn-around time), and key points for the detection of suspected case specimens.ConclusionThe laboratory developed a protective process for COVID-19 antibody and nucleic acid detection during the pandemic. At present, the detection of COVID-19 antibodies and nucleic acids in the clinical laboratory department is orderly, and there have been no cases of laboratory infection.

Use of radiological tests in COVID-19 positive child cases: Is chest computed tomography necessary?

ObjectiveThis study aimed to correlate the radiographic findings of the coronavirus disease 2019 (COVID‐19) positive children with their clinical and laboratory findings and discuss the frequency and necessity of chest computed tomography (CT) used for the radiological imaging in paediatric patients with COVID‐19 infection.Materials and methodsSixty‐nine paediatric inpatient cases were retrospectively analysed using their clinical, laboratory and imaging features. The National Public Health Guide was used in the diagnosis and treatment of paediatric patients. COVID‐19 infections for all patients were confirmed by the COVID‐19 nucleic acid test using a pharyngeal swab.ResultsThe median age of the patients was 11 years [3‐15]. The most common clinical symptoms were fever (40.6%) and cough (33.3%). When the laboratory findings of patients were examined, the median white blood cell (WBC) count was 5.8/mm3 (4.8‐8.05/mm3), median lymphocyte count was 2.3/mm3 (1.7‐3.55/mm3) and median C‐reactive protein (CRP) level was 2.3/mm3 (1‐2.1/mm3). All patients had chest radiographs (CRXs), while only 44.9% of the patients underwent a chest CT. The 8.7% of CXRs and 12.8% of chest CT findings were found as pathological. Ground‐glass opacity was the most frequent finding. In the tomography group, the count of lymphocytes was lower, and creatine kinase (CK) and lactate dehydrogenase (LDH) levels were significantly higher. The patients with pathological tomography findings demonstrated no statistically significant difference in lymphocyte count and CK and LDH levels; however, their CRP value was significantly higher.ConclusionIn this study, it is emphasised that chest CT should be requested by considering the underlying diseases and severity of clinical findings in paediatric patients. In this way, unnecessary chest CT could be prevented in the paediatric population.

The epidemiological characteristics of clusters of novel coronavirus pneumonia in Chenzhou, China

Objective: This study was designed to analyze the characteristics of the novel coronavirus disease 2019 (COVID-19) epidemic in seven clusters in the city of Chenzhou, China, to act as a reference for the prevention and control of the COVID-19 epidemic. Methods: The data of confirmed COVID-19 cases reported between January 23 and February 24, 2020, were obtained from the Chenzhou infectious disease surveillance system. In line with the diagnostic criteria of the Novel Coronavirus Pneumonia Diagnosis and Treatment Plan (Sixth Edition, Trial Implementation), 33 patients in seven clusters were selected as the research subjects, and epidemiological data were collected for descriptive analysis. Results: Between January 23 and February 24, 2020, 46 patients with COVID-19 were diagnosed in the city of Chenzhou, comprising 24 male patients and 22 female patients. The age of these patients ranged from seven months to 72 years old. The average age was 35.88 ± 17.98 and included 13 individual patients and 33 patients in seven clusters. Six clusters were exposed to the virus in Wuhan (the Wuhan group), and the other cluster was exposed to it in Shenzhen (the Shenzhen group). In the Wuhan group, the disease was spread in clusters of one family. The incubation period was 1-9 days, and the average length of hospital stay was 13.25 ± 2.67 days. Only close contacts were infected. In the Shenzhen group, three different families were infected in the same cluster. The incubation period was 11-14 days, the time of positive-to-negative conversion in the nucleic acid test was longer, and the average hospitalization time was 17.33 ± 5.87 days. Contacts who were not in close contact were infected. Conclusion: Patients are infectious in the incubation period, and asymptomatic patients are also infectious. The infectivity of the Shenzhen group was stronger than that of the Wuhan group. In the Shenzhen group, the time of positive-to-negative conversion of COVID-19 nucleic acid was longer, and the length of hospital stay was longer.

Middle-aged and elderly patients with COVID-19 pneumonia arising from asymptomatic carriers: A report of six cases.

Middle-aged and elderly patients with COVID-19 pneumonia arising from asymptomatic carriers: A report of six cases.

Reuse process of positive pressure powered air-filter protective hoods

To establish reuse process of positive pressure powered air-filter protective hoods during coronavirus disease 2019 (COVID-19) epidemic. The procedure of pretreatment, storage, recovery, cleaning, disinfection and sterilization process of positive pressure powered air-filter protective hoods, which were used in the treatment of COVID-19 infection patients was established in Central Sterile Supply Department of the hospital. The cleaning and disinfection effects of the protective hoods after treatment were examined by magnifying glass method, residual protein detection method, real-time PCR, and agar pour plate method. Twenty five used protective hoods underwent totally 135 times of washing, disinfecting and sterilizing procedures. After washing, all the protein residue tests and COVID-19 nucleic acid tests showed negative results. After sterilizing, all the protective hoods met sterility requirement. All the tested protective hoods were undamaged after reprocessing. The established reuse procedures for used positive pressure powered air-filter protective hoods are safe.

Coronavirus Disease 2019 with Comorbid Pulmonary Tuberculosis: A Case Report

Introduction: Since December 2019, a new type of pneumonia named coronavirus disease 2019 (COVID-19) has been reported in Wuhan, Hubei province, China. At present, there are no relevant reports on cases of COVID-19 and comorbid pulmonary tuberculosis. We herein report a case of a patient with COVID-19 and comorbid pulmonary tuberculosis. Case Presentation: A 47-year-old female patient with COVID-19 positive pharyngeal swabs. She did not have fever, coughing or breathing difficulties. The patient diagnosed as COVID-19, and pulmonary tuberculosis based on the patient's epidemiological history, routine blood test, imaging findings, and COVID-19 nucleic acid test results. Contact and droplet precautions were implemented. Antiviral treatment, anti-tuberculosis treatment, and liver protection treatment were given. The patient has not complained of discomfort, and her condition is stable. Conclusions: COVID-19 and comorbid tuberculosis is suspected, epidemiological history, clinical presentation, laboratory tests, and imaging examinations must be combined to make a comprehensive diagnosis and prompt quarantine and treatment measures should be implemented.

Clinical features and outcomes of COVID-19 patients with benign prostatic hyperplasia in ageing male: A retrospective study of 18 cases.

AimA worldwide pandemic of coronavirus disease 2019 (COVID‐19) which emerged in China in December 2019 affects the world very seriously. We aimed to evaluate the benign prostatic hyperplasia (BPH) patients who were admitted and treated to our hospital due to COVID‐19.MethodsBetween March 18, 2020 and April 5, 2020, 18 patients admitted with COVID‐19 who has BPH and are using medication for this were included in the study and analysed retrospectively. Diagnosis was confirmed by COVID‐19 nucleic acid test by sampling sputum or nasopharyngeal swab. Standard COVID‐19 treatment protocol determined by our Ministry of Health was applied to all patients according to their risk groups. Epidemiological, clinical, radiological features, additional diseases, laboratory tests, complications and outcome data of all patients were recorded.ResultsMean age of patients was 59.6 (range: 56‐73). As the mode of transmission, 10 (55.5%) of patients were infected in hospital, 5 (27.7%) patients had a relative with COVID‐19 and three (16.6%) was unknown. During follow‐up, 2 (11.1%) patients were transferred to intensive care unit (ICU). One of these patients dramatically progressed and died. Patients who survived and were not transferred to ICU had lesser comorbidities and were relatively young. Mean duration of hospitalisation was 14.2 days (range 12‐19).ConclusionWe think that COVID‐19 patients with BPH had a low mortality rate and did not have a poor prognosis in this patient group. It is crucial to take comprehensive preventive measures to control COVID‐19 transmission via hospital route.

The role of triage in the prevention and control of COVID-19.

To prevent and control public health emergencies, we set up a prescreening and triage workflow and analyzed the effects on coronavirus disease 2019 (COVID-19). In accordance with the requirements of the level 1 emergency response of public health emergencies in Shaanxi Province, China, a triage process for COVID-19 was established to guide patients through a 4-level triage process during their hospital visits. The diagnosis of COVID-19 was based on positive COVID-19 nucleic acid testing according to the unified triage standards of the Guidelines for the Diagnosis and Treatment of Novel Coronavirus Pneumonia (Trial version 4),4 issued by the National Health Commission of the People's Republic of China. The screened rate of suspected COVID-19 was 1.63% (4 of 246) in the general fever outpatient clinic and 8.28% (13 of 157) in the COVID-19 outpatient clinic, and they showed a significant difference (P = .00). The triage procedure effectively screened the patients and identified the high-risk population.

A Dynamic Follow-Up of Pneumonia Caused by Coronavirus Disease 2019 (COVID-19) on CT Scan

: Coronavirus disease (COVID-19) broke out in Wuhan, China. It is a highly contagious respiratory disease, the basic reproductive number (RO value) for COVID-19 has been reported as 2.68 with an epidemic doubling time of 6.4 days. In this case report, a 50-year-old man presented with a history of fever and chills. Chest radiographs failed to find any abnormality, and computed tomography (CT) showed ground glass shadow of the upper lobe of the left lung. Real-time polymerase chain reaction (RT-PCR) of the patient’s pharyngeal swab was positive for COVID-19 nucleic acid. The course of the disease developed from mild to severe, then improved and recovered. The patient underwent antiviral drugs, low dose of glucocorticoids, symptomatic treatment, and immunoglobulin for human intravenous injection. We report this long time follow-up case of COVID-19.

Prevention program for the COVID-19 in a children's digestive endoscopy center.

The pneumonia caused by the coronavirus disease-2019 (COVID-19) outbreak in Wuhan, China constitutes a public health emergency of international concern. The gastrointestinal symptoms of vomiting, diarrhea and abdominal pain and the detection of COVID-19 nucleic acid from fecal specimens in a small number of patients suggest the possibility of transmission via the gastrointestinal tract. People of all ages are vulnerable to this virus, including children. Digestive endoscopy is an invasive procedure during which children cannot wear masks; therefore, they have higher risks of exposure to COVID-19, and the digestive endoscopy center is a relatively high-risk area for COVID-19 infection. Based on these factors and in combination with related policies and regulations, a prevention and control program for the COVID-19 pneumonia in a children's digestive endoscopy center was established to prevent the COVID-19 nosocomial infection.