Coronavirus Infected Pneumonia Research Articles

A Review on COVID-19: A Global Pandemic

Human community has encountered viral diseases multiple times, COVID-19 (corona virus disease 2019) is another infectious viral disease that has fetched the attention of the entire world. It is majorly a respiratory tract disease, with SARS-CoV 2 being the etiologic agent. As SARS-cov2 represents genetic similarity to a bat coronavirus, there are chances that it has originated from bats. Initially WHO names the illness-“novel coronavirus infected pneumonia (NCIP)’’. On 11 February 2020 WHO officially renamed the condition as corona virus disease-2019 (COVID-19) and the virus was renamed as severe acute respiratory syndrome corona virus (SARS-CoV2) by the international committee on taxonomy of viruses. The symptoms of COVID 19 varies from asymptomatic or mild to severe illness and finally mortality. Out of the reported symptom the most common ones are fever, cough, myalgia, fatigue, pneumonia and complicated dyspnea.

Clinical Characteristics of Four Medical Doctors used Chloroquine as prophylaxis with 2019 Novel Coronavirus-Infected Pneumonia

Aim: The aim of this study to report the initial experience in a General Surgery clinique with the epidemiologic investigation of the COVID-19 outbreak, clinical features, and usage of prophylaxis. Material and Methods: Descriptive cases of 4 general surgery assistants diagnosed with Reverse Transcriptase- Polymerase Chain Reaction (RT-PCR) confirmed SARS-CoV-2 infection in Turkey from March 20 to March 30, 2020; the final follow-up date was March 31, 2020. Clinical, laboratory, and radiologic data were collected. The clinical course was summarized, including usage of Chloroquine as prophylaxis. Result: Among the 4 medical doctor patients with PCR-confirmed SARS-CoV-2 infection with the mean age of 29, all of them were male (100%), the clinical presentation was an upper respiratory tract infection in all of the patients. All patients use Chloroquine prophylactically before symptoms onset. Conclusions: Among the 4 medical doctors diagnosed with SARS-CoV-2 infection in the General Surgery Clinique in Turkey, the clinical presentation was frequently a mild respiratory tract infection with the use of Chloroquine.

High-Flow Nasal Cannula, a Boon or a Bane for COVID-19 Patients? An Evidence-Based Review.

Purpose of ReviewThis review instantiates the efficacy and safety of HFNC in the context of COVID-19 pandemic.Recent FindingsGlobally, the healthcare system is facing an unprecedented crisis of resources due to the 2019 novel coronavirus disease (COVID-19) pandemic. Fever, cough, dyspnea, myalgia, fatigue, and pneumonia are the most common symptoms associated with it. The incidence of invasive mechanical ventilation in ICU patients ranges from 29.1 to 89.9%. Supplemental oxygen therapy is the main stay treatment for managing hypoxemic respiratory failure. The high-flow nasal cannula (HFNC) is a novel non-invasive strategy for better oxygenation and ventilation in critically ill patients. In this grim scenario, a reduction in mechanical ventilation by means of HFNC is of prime interestSummaryHFNC is considered an aerosol-generating intervention with the risk of viral aerosolization with a concern of potential nosocomial transmission of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). However, there is no consensus regarding the use of HFNC in novel coronavirus-infected pneumonia (NCIP). HFNC seems to be an effective and safe treatment modality in acute respiratory failure with optimal settings and selection of ideal patients.

COVID-19 infection in patients with mast cell disorders including mastocytosis does not impact mast cell activation symptoms

COVID-19 infection in patients with mast cell disorders including mastocytosis does not impact mast cell activation symptoms

Modular composite building in urgent emergency engineering projects: A case study of accelerated design and construction of Wuhan Thunder God Mountain/Leishenshan hospital to COVID-19 pandemic

Wuhan Leishenshan/Leishenshan (“Leishenshan” for short) hospital is a makeshift emergency hospital for treating patients diagnosed with the novel coronavirus-infected pneumonia (NCIP). Engineering construction uses modular composite building finished products to the greatest extent, which reduces the workload of field operations and saves a lot of time. The building information model (BIM) technology assists in design and construction work to meet rapid construction requirements. Besides, based on the unmanned aerial vehicles (UAVs) data analysis and application platform, digitization and intelligence in engineering construction are improved. Simultaneously, on-site construction and overall hoisting were carried out to achieve maximum efficiency. This article aims to take the construction of Leishenshan Hospital as an example to illustrate how to adopt BIM technology and other high-tech technology such as big data, artificial intelligence, drones, and 5G for the fast construction of the fabricated steel structure systems in emergency engineering projects.

2019 novel coronavirus disease with secondary ischemic stroke: two case reports

BackgroundThe COVID-19 pandemic, which broke out in Wuhan in 2019, has become the global health crisis of our time. Elderly patients with certain fundamental diseases are more likely to develop severe cases. The secondary lesion following viral infection have only rarely been reported.Case presentationWe here report two cases of coronavirus-infected pneumonia with acute ischemic stroke in middle-aged patients. In both COVID-19 cases, neurological physical examinations showed normal results before infection. Lymphocytopenia, accompanied by elevated cytokines and D-dimers, were found from serum clinical laboratory examination at admission. Dysarthria and limb muscle weakness are initial manifestations, occurring one week after infect-causative pathogen, SARS-CoV-2. The head CT and head/neck arterial CTA showed small-vessel occlusion. The patients were diagnosed with coronavirus diseases with secondary acute ischemic stroke. They were treated with tirofiban and followed up with daily aspirin and atorvastatin.ConclusionsThese cases suggested that secondary ischemic stroke, mainly manifested as small-vessel occlusion, should be considered for COVID-19 patients and diagnosed and treated promptly.

Analysis of Clinical Features in Novel Coronavirus Pneumonia Convalescents

Background: To analyze the clinical features of convalescent individuals with novel coronavirus-infected pneumonia (novel coronavirus pneumonia) at rehabilitation station in Wuhan. Methods: 712 patients in the convalescence period of novel coronavirus pneumonia isolated and observed at the rehabilitation station were investigated by collecting their basic data, clinical syndrome features, and tongue manifestations. The clinical syndrome features were analyzed based on guidelines of Diagnosis and Treatment Plan for Novel Coronavirus-infected Pneumonia (National Health Commission of the People's Republic of China, 7th Trial Edition). Results: Cough (24.86%), chest tightness and shortness of breath (23.17%), and fatigue (16.57%) were the main symptoms of patients in the convalescence period of novel coronavirus pneumonia. Their tongue appearance was mostly characterized by redness (88.65%), thick coating (67.25%), greasy coating (49.78%) and white coating (76.86%). Conclusion: Compared with the ordinary / mild patients, cough and anorexia symptoms were more common in the severe / critical patients. In convalescent patients, red and fat tongue with thick greasy fur were common.

COVID-19 PNEUMONIA ASSOCIATED WITH RHABDOMYOLYSIS IN PATIENT WITH PREVIOUS CHRONIC THERAPY WITH STATIN: COINCIDENCE OR REALTED CONDITIONS?

  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus which causes coronavirus disease 2019 (COVID-19). It was first identified amid an outbrake of respiratory illness cases in Wuhan City, Hubei Province, China. COVID-19 was reported to the world Health Organisation (WHO) on 31 December 2019 and declare as a global pandemic on 11 March 2020 . Presentation of COVID-19 range from asymptomatic or mild symptoms to severe illness or death. The most serious complication of COVID-19 is a type of pneumonia that’s been called 2019 novel coronavirus-infected pneumonia (NCIP). COVID-19 pneumonia presents as an atypical pneumonia, with diffuse bilateral lung involvement. Severe cases present with acute lung injury, and acute respiratory distress syndrome (ARDS). Rhabdomyolisis can be initial presentation of COVID-19, and also is a life-threatening disorder. Rhabdomyolysis is the breakdown of skeletal muscle by releasing it cellular content into the systemic circulation.  A 73-year-old man was admitted to our hospital with bilateral pneumonia, muscle pain, and worsening symptoms. On hospital day 5 his oxygen saturation get low, so we started treatment with oxygen inhalation by high flow mask. On the 14th hospital day the muscle enzymes started increasing. After propriety treatment the patient was discharged on hospital day 28.Patient with COVID-19 pneumonia can developed rhabdomyolysis because of SARS CoV-2 infection also there is a risk of developing rhabdomyolysis after using drug for treatment of COVID-19. Our patient was on previous chronic therapy with statins but with normal liver and muscle enzymes. During his hospitalization and deteriorated of his clinical condition the enzymes increased with presentation of rhabdomyolysis. Our findings indicate that rapid clinical recognition and positive hydration treatment of COVID-19–asociated rhabdomyolysis can reduce the risk for serious complications. Keywords: SARS-CoV-2, COVID-19, COVID-19 pneumonia, rhabdomyolysis, chronic statin therapy

Retrospective analysis of the efficacy of traditional Chinese medicine Lianhua Qingwen Capsule for the treatment of novel coronavirus-infected pneumonia

Retrospective analysis of the efficacy of traditional Chinese medicine Lianhua Qingwen Capsule for the treatment of novel coronavirus-infected pneumonia

Differential diagnosis of high altitude pulmonary edema and COVID-19 with computed tomography feature

To investigate the computed tomography (CT) characteristics and differential diagnosis of high altitude pulmonary edema (HAPE) and COVID-19, CT findings of 52 cases of HAPE confirmed in Medical Station of Sanshili Barracks, PLA 950 Hospital from May 1, 2020 to May 30, 2020 were collected retrospectively. The size, number, location, distribution, density and morphology of the pulmonary lesions of these CT data were analyzed and compared with some already existed COVID-19 CT images which come from two files, "Radiological diagnosis of COVID-19: expert recommendation from the Chinese Society of Radiology (First edition)" and "A rapid advice guideline for the diagnosis and treatment of 2019 novel corona-virus (2019-nCoV) infected pneumonia (standard version)". The simple or multiple ground-glass opacity (GGO) lesions are located both in the HAPE and COVID-19 at the early stage, but only the thickening of interlobular septa, called "crazy paving pattern" belongs to COVID-19. At the next period, some increased cloudy shadows are located in HAPE, while lesions of COVID-19 are more likely to develop parallel to the direction of the pleura, and some of the lesions show the bronchial inflation. At the most serious stage, both the shadows in HAPE and COVID-19 become white, but the lesions of HAPE in the right lung are more serious than that of left lung. In summary, some cloudy shadows are the feature of HAPE CT image, and "crazy paving pattern" and "pleural parallel sign" belong to the COVID-19 CT, which can be used for differential diagnosis.

Clinical application of the COVID-19 Reporting and Data System (CO-RADS) in patients with suspected SARS-CoV-2 infection: observational study in an emergency department

• CO-RADS improves the risk classification by 65.8% in patients affected by COVID-19. • CO-RADS combined with RT-PCR presents an AUC of 0.98 for patients with COVID-19. • CO-RADS improves the risk classification by 82.1% in patients not affected by COVID-19.

Coronavirus (COVID-19): the potential contamination among dentistry professionals in Brazil

The coronavirus (COVID-19) is considered a global pandemic with several respiratory syndrome caused by coronavirus 2 (SARS-CoV-2). The main symptoms of COVID-19 are fever, cough, and fatigue, while other symptoms include sputum production, diarrhea and alterations on the gastrointestinal system. The COVID-19 was recently identified in the saliva of infected patients and the transmission through of droplets and aerosols generated during clinical dental care is possible among dentists, oral health assistants and/or oral health technicians and others around the social cycle of the friendship of these health professionals, such as families and colleagues. Thus, there is very necessary to improve the several types of prevention to healthcare professionals that realize the liberation of aerosol during oral assistance. It’s important to mention that these precautions are important to prevent human-to-human transmission and protect the global system of health. In addition, this care is essential to decrease the spread of COVID-19 in this moment. Descriptors: Coronavirus Infections; Dentistry; Occupational Diseases.ReferencesLi LY, Wu W, Chen S, Gu JW, Li XL, Song HJ et al. Digestive system involvement of novel coronavirus infection: Prevention and control infection from a gastroenterology perspective. J Dig Dis. 2020;21(4):199-204. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33.Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J et al. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. Am J Gastroenterol. 2020;115(5):766-73.Gabutti G, d'Anchera E, Sandri F, Savio M, Stefanati A. Coronavirus: update related to the current outbreak of COVID-19. Infect Dis Ther. 2020;9(2):1-13.Liu L, Wei Q, Alvarez X, Wang H, Du Y, Zhu H et al. Epithelial cells lining salivary gland ducts are early target cells of severe acute respiratory syndrome coronavirus infection in the upper respiratory tracts of rhesus macaques. J Virol. 2011;85(8):4025-30.To KK, Tsang OT, Yip CC, Chan KH, Wu TC, Chan JMC et al. Consistent Detection of 2019 Novel Coronavirus in Saliva. Clin Infect Dis. 2020;71(15):841-43.Sabino-Silva R, Jardim ACG, Siqueira WL. Coronavirus COVID-19 impacts to dentistry and potential salivary diagnosis. Clin Oral Investig. 2020;24(4):1619-21.Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-69.Brazilian Ministry of Health. https://saude.gov.br/Brazilian Institute of Geography and Statistic. https://www.ibge.gov.br/Lauc G, Sinclair D. Biomarkers of biological age as predictors of COVID-19 disease severity. Aging (Albany NY). 2020;12(8):6490-91.Federal Council of Dentistry from Brazil. http://website.cfo.org.br/dados-estatisticos-de-profissionais-e-entidades-ativas-por-ano/Regional Dentistry Council of the State of São Paulo. http://www.crosp.org.br/intranet/estatisticas/estMunicipios.phpThompson RN. Novel Coronavirus Outbreak in Wuhan, China, 2020: Intense Surveillance Is Vital for Preventing Sustained Transmission in New Locations. J Clin Med. 2020;9(2):498.

Reply by Authors.

You have accessJournal of UrologyLetters to the Editor/Errata1 Oct 2020Reply by Authorsis a reply to letterRe: COVID-19 Coagulopathy: Considerations for Urologists J. S. Jue and M. Alameddine J. S. JueJ. S. Jue More articles by this author and M. AlameddineM. Alameddine More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001229AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail The COVID-19 pandemic has drawn attention toward respiratory symptoms and treatment of multiple organ dysfunction syndrome, while urological complaints and pathologies are sometimes overlooked. Cai et al describe a series of 18 patients with SARS-CoV-2 infection and superimposed urosepsis during the pandemic. In their series 5 of 18 patients (28%) were diagnosed with PE immediately after the onset of urosepsis. The authors note that 40% of the patients with PE died, while 60% were successfully treated. These initial results highlight the increased prevalence of thromboembolism in patients with COVID-19 with active urological problems. Cai et al do not mention if the PEs in their series were detected incidentally or as a result of a sudden change in clinical status. They also do not mention the specific venous thromboembolism (VTE) prophylaxis used prior to PE diagnosis. It is essential that patients with COVID-19 be treated with pharmacological VTE prophylaxis while inpatients, and escalated to therapeutic anticoagulation if a new VTE is confirmed.1 Initiation of therapeutic anticoagulation for suspected PE has been commonly practiced during the COVID-19 pandemic due to difficulty transporting mechanically ventilated patients for cross-sectional imaging and initiatives to limit staff exposure to COVID-19.1 Currently reasons to suspect PE include sudden respiratory decompensation, evidence of right heart strain and confirmation of deep vein thrombosis. There is likely low value in performing computerized tomographic pulmonary angiography purely in the setting of urosepsis without clinical suspicion of PE. It is important to remember that many patients with urosepsis or SARS-CoV-2 infection have a concomitant acute kidney injury (AKI). Patients with both infections are likely to have an AKI that is multifactorial in nature. AKI in COVID-19 has been attributed to cardiovascular comorbidities, endothelial damage, immune response dysregulation and microthromboemboli.2 AKI in the setting of COVID-19 progresses to the point of requiring renal replacement therapy in 2% to 9% of patients.3,4 This rate increases to 6% to 23% when severe infection is present.5,6 Therefore, we only recommend diagnostic testing for PE if clinically suspected, in order to avoid the unnecessary risks associated with therapeutic anticoagulation and intravenous contrast material. Reference 1. : COVID-19 and its implications for thrombosis and anticoagulation. Blood 2020; 135: 2033. Google Scholar 2. : Management of acute kidney injury in patients with COVID-19. Lancet Respir Med 2020; doi: 10.1016/S2213-2600(20)30229-0. Crossref, Google Scholar 3. : Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507. Google Scholar 4. : Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323: 1061. Google Scholar 5. : Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; 8: 475. Google Scholar 6. : Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708. Google Scholar © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology1 Jul 2020Re: COVID-19 Coagulopathy: Considerations for Urologists Volume 204Issue 4October 2020Page: 849-850 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information J. S. Jue More articles by this author M. Alameddine More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Improving the performance of CNN to predict the likelihood of COVID-19 using chest X-ray images with preprocessing algorithms

ObjectiveThis study aims to develop and test a new computer-aided diagnosis (CAD) scheme of chest X-ray images to detect coronavirus (COVID-19) infected pneumonia. MethodCAD scheme first applies two image preprocessing steps to remove the majority of diaphragm regions, process the original image using a histogram equalization algorithm, and a bilateral low-pass filter. Then, the original image and two filtered images are used to form a pseudo color image. This image is fed into three input channels of a transfer learning-based convolutional neural network (CNN) model to classify chest X-ray images into 3 classes of COVID-19 infected pneumonia, other community-acquired no-COVID-19 infected pneumonia, and normal (non-pneumonia) cases. To build and test the CNN model, a publicly available dataset involving 8474 chest X-ray images is used, which includes 415, 5179 and 2,880 cases in three classes, respectively. Dataset is randomly divided into 3 subsets namely, training, validation, and testing with respect to the same frequency of cases in each class to train and test the CNN model. ResultsThe CNN-based CAD scheme yields an overall accuracy of 94.5 % (2404/2544) with a 95 % confidence interval of [0.93,0.96] in classifying 3 classes. CAD also yields 98.4 % sensitivity (124/126) and 98.0 % specificity (2371/2418) in classifying cases with and without COVID-19 infection. However, without using two preprocessing steps, CAD yields a lower classification accuracy of 88.0 % (2239/2544). ConclusionThis study demonstrates that adding two image preprocessing steps and generating a pseudo color image plays an important role in developing a deep learning CAD scheme of chest X-ray images to improve accuracy in detecting COVID-19 infected pneumonia.

Abstract IA13: Treatment of COVID-19 pulmonary failure by targeting BTK

Abstract Pulmonary failure is the main cause of mortality related to COVID-19 infection. Up to 80% of patients hospitalized for COVID-19 infection require supplemental oxygenation, of whom 30-40% may require mechanical ventilation. SARS-CoV-2 binds via the ACE2-receptor that is highly expressed on alveolar type II (ATII) cells in the lung. ATII cells constitute 5-15% of the lung epithelium. While alveolar type I cells are highly adapted for gas exchange, alveolar type II cells have a specialized role in innate immune response. ATII cells express Toll receptors (TLRs) and can trigger inflammatory cytokines and chemoattractants in response to pathogens that recruit and activate other immune cells, including macrophages and neutrophils. We and others previously showed that BTK, and its upstream activator HCK, were involved in TLR-mediated signaling. Both BTK and HCK are triggered by MYD88, a TLR-adaptor protein that signals for all Toll receptors except TLR3 in response to viral and bacterial pathogens, including coronaviruses. ATII cells express TLRs, as do alveolar macrophages that coordinate inflammatory responses with ATII cells. As components of TLR/MYD88 signaling, BTK and HCK can drive inflammatory cytokine production through ERK1/2. The potential for BTK inhibitors to abrogate lung injury and death was demonstrated in an experimental model wherein mice challenged with a lethal intranasal inoculum of a mouse-adapted strain of H1N1 influenza virus were protected against lung injury. Control mice developed respiratory failure, along with histologic and CT findings consistent with lung injury in sharp contrast to the mice that received ibrutinib. Control mice also lost weight and died, whereas those treated with ibrutinib recovered their weight after a brief loss and all survived. Mice treated with ibrutinib also showed decreased inflammatory cell infiltration as well as proinflammatory cytokines in lung tissues that included proinflammatory and chemoattractant cytokines such as IL-1β, IL-6, KC/CXCL1, TNFα, and MCP-1 observed in SARS-Cov-1 and SARS-CoV-2 patients. In a series of Waldenstrom’s macroglobulinemia (WM) patients who were on full-dose ibrutinib (420 mg/day) and contracted COVID-19, none experienced dyspnea. In this series, one WM patient who contracted COVID-19 on reduced-dose ibrutinib (140 mg/day) experienced dyspnea and became hypoxic when ibrutinib was stopped and required mechanical ventilation. He was started on full-dose ibrutinib and showed rapid improvement, was extubated the next day, and did not require any oxygen supplementation two days later. Consistent with his rapid course of improvement on ibrutinib, his C-reactive protein level showed a marked decrease. In a subsequent and larger experience, Roschewski and colleagues administered acalabrutinib to 19 COVID-19 patients, 11 on supplemental oxygenation and 8 on mechanical ventilation. Eight of 11 (73%) and 2/8 (25%) on supplemental oxygenation and mechanical ventilation were discharged on room air, respectively. Ex vivo analysis of peripheral blood samples showed attenuation of activated monocyte BTK expression and IL-6 production following acalabrutinib. Serially collected blood samples from patients with chronic lymphocytic leukemia (CLL), WM, and chronic graft-versus-host disease (cGVHD) on ibrutinib monotherapy also showed marked reductions in proinflammatory and chemoattractant cytokines that greatly overlapped with those reported elevated in the plasma of SARS-Cov-1 and SARS-COV-2 patients, and in ACE2+ cells from lung tissue of SARS-CoV-1 patients. In the iLLUMINATE randomized study, CLL subjects treated with ibrutinib immediately prior to infusion with obinutuzumab also showed significantly decreased levels of inflammatory cytokines associated with infusion related reactions (a cytokine release syndrome). These findings are consistent with a shift from an M1 to M2 polarized macrophage response following ibrutinib and are supported by preclinical and clinical studies showing dependence of macrophage lineage commitment on BTK function. BTK-inhibitors may therefore provide protection against lung injury and even improve pulmonary function in hypoxic patients with COVID-19. Randomized clinical trials to examine the benefit of BTK-inhibitors in COVID-19 patients in pulmonary distress and/or accompanying corollary studies to identify response biomarkers have been initiated: NCT04439006, NCT04382586, NCT04346199, NCT04380688. Selected

Hypercoagulability in ICU Patients With Coronavirus Disease 2019 With Respiratory Failure Results in Increased Prevalence of Venous Thromboembolic Disease

Hypercoagulability in ICU Patients With Coronavirus Disease 2019 With Respiratory Failure Results in Increased Prevalence of Venous Thromboembolic Disease

Ecological Study on Differences in COVID-19 Fatality among Wuhan, Rest of Hubei, and Rest of China

BackgroundChina’s vigorous anti-COVID-19 campaign has been going on for three months since January 20, which has contained the spread of the virus across China.ObjectivesEpidemiological investigations found that COVID-19 fatality rates in Wuhan, rest parts of Hubei province except Wuhan (Rest of Hubei) and rest parts of Mainland China except Hubei province (Rest of China) were different. An ecological study was conducted to analyze the reasons and provide the world with China’s anti-COVID-19 epidemic experiences.MethodsInfected cases from Mainland China were divided into three populations: Wuhan, Rest of Hubei and Rest of China. Methods were based on The Novel Coronavirus Infected Pneumonia Diagnosis and Treatment Standards. Total confirmed cases, daily severe cases, total deaths from February 12 to April 20 were collected for statistical analysis.Results50,333 total confirmed cases in Wuhan made up the most substantial part by comparison with 17,795 in Rest of Hubei and 14,630 in Rest of China, respectively. In the early stage of the COVID-19 epidemic, daily severe cases in Wuhan accounted for the majority, and as the epidemic controlled, severe cases in all three populations decreased. Total deaths in Wuhan constituted the most significant proportion, with the highest 3869 in contrast to 643 in Rest of Hubei and 120 in Rest of China. The fatality rates in Wuhan ranged from 2.82% to 7.69%, much higher than 1.80–3.61% in Rest of Hubei, and 0.49–0.88% in Rest of China. Pearson chi-square test for fatality rates in the three populations demonstrated significant differences (p < 0.01).ConclusionThe ecological comparison study among the three populations have proved that social distancing, quarantine, lockdown, cutting off sources of infection and transmission routes, early detection, early isolation, early treatment are all vital to control the epidemic by reducing COVID-19 confirmed cases, severe cases and the fatality rate.

Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline (updated version)

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, coronavirus disease 2019 (COVID-19), affecting more than seventeen million people around the world. Diagnosis and treatment guidelines for clinicians caring for patients are needed. In the early stage, we have issued “A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)”; now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline. We formed a working group of clinical experts and methodologists. The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas: chemoprophylaxis, diagnosis, treatments, and discharge management. We searched the literature for direct evidence on the management of COVID-19, and assessed its certainty generated recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Recommendations were either strong or weak, or in the form of ungraded consensus-based statement. Finally, we issued 34 statements. Among them, 6 were strong recommendations for, 14 were weak recommendations for, 3 were weak recommendations against and 11 were ungraded consensus-based statement. They covered topics of chemoprophylaxis (including agents and Traditional Chinese Medicine (TCM) agents), diagnosis (including clinical manifestations, reverse transcription-polymerase chain reaction (RT-PCR), respiratory tract specimens, IgM and IgG antibody tests, chest computed tomography, chest x-ray, and CT features of asymptomatic infections), treatments (including lopinavir-ritonavir, umifenovir, favipiravir, interferon, remdesivir, combination of antiviral drugs, hydroxychloroquine/chloroquine, interleukin-6 inhibitors, interleukin-1 inhibitors, glucocorticoid, qingfei paidu decoction, lianhua qingwen granules/capsules, convalescent plasma, lung transplantation, invasive or noninvasive ventilation, and extracorporeal membrane oxygenation (ECMO)), and discharge management (including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge). We also created two figures of these recommendations for the implementation purpose. We hope these recommendations can help support healthcare workers caring for COVID-19 patients.

COVID-19 and Gastrointestinal Tract Symptoms: Recognition, Containment, and Learning From the Past

COVID-19 and Gastrointestinal Tract Symptoms: Recognition, Containment, and Learning From the Past

Investigation of the Psychological disorders in the healthcare nurses during a coronavirus disease 2019 outbreak in China.

The first case of atypical pneumonia caused by coronavirus disease 2019 (COVID-19) was reported in Wuhan, China in December 2019. Since then, cases of novel coronavirus-infected pneumonia (NCIP) have been reported throughout China as well as in 25 other countries. With the rapid growth of this global outbreak, psychological disorders or impact among the healthcare nurses caused by the COVID-19 pandemic is of great importance and worth to be evaluated. Here, we aimed to determine the levels of stress and psychological disorders of nurses who provided nursing care during the COVID-19 outbreak. A total of 159 nurses who provided healthcare work for COVID-19 patients were enrolled in our study. The psychological disorders and stress level were assessed via a questionnaire implemented by the mobile app. The results showed that the nurses who worked in the non-critical care ward (general ward in which the invasive medical procedure such as mechanical ventilation is absent) scored significantly higher on the traumatization condition (P < .05) and stress level (P < .01) as well as the impact of event scale -revised level (P < .01) compared with those worked in the critical care ward. In contrast to the previous report, our findings revealed that the future intervention for preventing the mental crisis among the healthcare nurses needs to be focusing on the individuals in the non-critical care ward instead of those in the critical care ward under the spreading of COVID-19.