COVID-19 Victims Research Articles

Re: Management of dead bodies of COVID-19 victims

Letter to editor

End-of-life care and grief: study conducted with family members of COVID-19 victims.

This article aims to investigate the implications of grief among family members of COVID-19 victims; verify the prevalence of prolonged grief symptoms; and identify family members' expectations regarding end-of-life care for their loved ones affected by COVID-19. Descriptive, cross-sectional research, with a quantitative-qualitative approach. Data collection was performed using an online questionnaire, guided by the PG-13 instrument. Descriptive and inferential statistics were applied. The results were presented descriptively and with the aid of tables. The study sample included 142 family members, mostly female, who presented emotional, physical, social, and financial implications as a result of grief. A prevalence of prolonged grief symptoms was observed in 11.4% of the mourners with more than six months and 29.6% of those with less than six months. Three thematic categories were identified: transparency in communicating the health situation, access to moments of farewell, and promotion of comfort in care actions. The symptoms of Prolonged Grief Disorder have a significant association with the degree of kinship. In final care, family members' expectations were classified as: permission for a dignified farewell, effective communication, and promotion of comfort and care.

De-Exceptionalizing Pandemic Death in the United States: COVID-19’s Ambiguous and Layered Mourning

ABSTRACT: In the spring and early summer of 2020, mainstream media in the United States announced the “death of ritual” as public officials limited communities from gathering to care for their deceased—whether COVID-19 victims or people who happened to die during this first wave of pandemic restriction. From backlogged funeral homes and crematoria to bodies stacked in refrigerated trucks and families scrambling to find their deceased, headlines seemed to augur an unprecedented condition of interrupted or derailed mourning. But how singular was this moment? On the one hand, funeral directors were telling a different story, reminding us that they’d been here before when the stigma of HIV/AIDS robbed the deceased and their loved ones of expected ritual care. On the other, as scholars of post-conflict societies and missing migrants can attest, COVID-19 was by no means unique in disrupting the pace and order of mourning. This piece challenges the characterization of pandemic death in the United States, especially in the first waves of infection, as exceptional because of what it glosses over: the predictability of which bodies and whose lives routinely pay the highest tolls. Instead, we reflect on the temporality of incomplete and curtailed care by juxtaposing the pandemic’s seemingly singular chronotope—born from the politicized bodies of the living as much as the dead—with the exigencies of uncertain death that surround missing persons of conflicts and borders. Seemingly punctuated events like wars and pandemics that give rise to aberrant death throw timelines into disarray; they also expose what underlies and endures: longstanding inequities to conditions that secure life in the first place. Thus, challenging this notion of presumed exceptionalism, we argue that the US experience of pandemic death and mourning throws into relief—at least temporarily—its systems of domination and invites a closer look at the intertwining projects of memory and political transformation.

COVID-19 grassroots memorial practices in the UK

At the time of writing, confirmed UK deaths from COVID-19 number over 160,000. While the restrictions on burial rituals and closure of faith spaces during successive UK lockdowns have impacted the commemoration of COVID-19 victims, the emergence of grassroots memorial practices – from street art campaigns to yellow hearts in the windows of bereaved households – demonstrates the extent to which communities have adapted ceremonial processes in a period of national trauma. This visual essay examines a selection of grassroots activities, created both during and between UK lockdowns, charting the way in which apparently coherent aesthetic approaches to COVID-19 memorialisation provide cover for diverse political and personal agendas.

Healthcare Schemes to overcome financial toxicity of COVID-19: A Retrospective Single Center Study

BackgroundIndian healthcare system was nearly crashed during the pandemic and victims of COVID-19 experienced huge health related economic burden. Thus, we aimed to quantify the direct medical cost associated with COVID-19 management along with the healthcare schemes. MethodsA retrospective study was conducted for the duration of 8 months where the data of COVID-19 patients of one year (2020-2021) was collected from the medical record department. The data of COVID-19 patients of age 18 to 65 years with confirmed diagnosis based on RT-PCR test were included in the study whereas the data of special population such as pregnant, hemodialysis and patient undergoing surgery were excluded. ResultsOut of 1011 COVID-19 patients, 63.5% were males and 36.5% were female with the mean age of 43.8±14.5 years and with 9.47 days mean length of hospitalization. On direct medical cost analysis, USD 1060.92 was the total median expenses which includes COVID package plus outside COVID package expenses. Similarly, USD 728 and USD 51.1 were the median amount claimed through healthcare schemes and median co-payments respectively. The total median expenses with and without healthcare schemes were found to be USD 1061.37 and USD 1052.94 respectively whereas co-payments with and without schemes were USD 26.005 and USD 1046.64. ConclusionHealthcare schemes are the best strategy to overcome the direct medical cost associated with the management of the disease. Quantifying the medical cost could provide an insight to develop effective policy to counteract the financial toxicity among patients.

The mental health of the elderly in the context of the COVID-19 pandemic: cognitive, emotional, and social/behavioral aspects

Research on mental health during a pandemic is crucial as it affects behavior and disease transmission. It encompasses various aspects and is not limited to the presence of mental disorders but also relates to well-being, coping with stress, and contributing to society. The COVID-19 pandemic, with social distancing measures, has both advantages and disadvantages. It helps prevent the virus's spread but also leads to sedentary behavior, affecting vulnerable groups like the elderly. Pandemics typically generate anxiety, especially fear of infection and economic concerns, contributing to anxiety and depression. Fake news exacerbates anxiety. The constant fear of infection triggers stress-related bodily responses, affecting mental health. Women may be more vulnerable to mental health issues during a pandemic, but the relationship is not universally agreed upon. Family members of COVID-19 victims also face mental health challenges, given the restrictions on contact and burial. Pandemics disrupt the sense of reality and order, potentially leading to repressed trauma. The concept of mental health should focus on adaptability to change rather than rigid standards. Cognitive development is a lifelong process influenced by nature and culture, with synaptic plasticity allowing the brain to adapt to learning. Psychosocial development, as per Erikson, emphasizes the impact of society on personality formation, with a focus on ego integration. Emotions involve sensations, feelings, and conscious emotions, with biological, social, and individual aspects. The relationship between gender and psychosocial effects is debated, with various factors playing a role. Expanding research in this area is essential to understand the complex interplay of factors affecting mental health during a pandemic.

Vagus nerve SARS-CoV-2 infection and inflammatory reflex dysfunction: Is there a causal relationship?

Autonomic dysfunction is a clinical hallmark of infection caused by SARS-CoV-2, but the underlying mechanisms are unknown. The vagus nerve inflammatory reflex is an important, well-characterized mechanism for the reflexive suppression of cytokine storm, and its experimental or clinical impairment facilitates the onset and progression of hyperinflammation. Recent pathological evidence from COVID-19 victims reveals viral infection and inflammation in the vagus nerve and associated nuclei in the medulla oblongata. Although it has been suggested that vagus nerve inflammation in these patients mediates dysregulated respiration, whether it also contributes to dysfunction of the vagus nerve inflammatory reflex has not been addressed. Because lethality and tissue injury in acute COVID-19 are characterized by cytokine storm, it is plausible to consider evidence that impairment of the inflammatory reflex may contribute to overproduction of cytokines and resultant hyperinflammatory pathogenesis. Accordingly, here the authors discuss the inflammatory reflex, the consequences of its dysfunction in COVID-19, and whether there are opportunities for therapeutic intervention.

Blame others but hurt yourself: blaming or sympathetic attitudes toward victims of COVID-19 and how it alters one’s health status

Objective This study explored the relationship between blame/sympathy and blamer’s/sympathizer’s perceived health status. Design We recruited participants via an online survey platform. Study 1 was a cross-sectional study using data (N = 3304, M age = 28.22, SD age = 7.92, and 39.3% female) collected from 30 provinces, municipalities, and autonomous regions of China on February 3, 2020. Study 2 used the daily diary method collecting data from February 4 to 9, 2020. Sample (N = 2456, M age = 28.49, SD age = 7.49, and 39.4% were female) was obtained by inviting participants in Study 1 on the same platform. Main outcome measures Self-reported health status and life satisfaction. Results In Study 1, blame was negatively associated with perceived health status, while sympathy was positively associated with it. Negative emotions and risk perception are the underlying mechanisms, but neither of them has effects on the relationship between sympathy and perceived health status. Study 2 replicated these results using multilevel analysis. Conclusion The results highlight the importance of people’s attitudes on perceived health status. While sympathy is positively related to perceived health status, blaming has a negative association with perceived health status. Negative emotions and risk perceptions are the underlying mechanisms.

Are They Victims of COVID-19? The livelihood and quandaries of sex workers in the New Kuchingoro camp for internally displaced people in Abuja, Nigeria

In this paper, I examine the challenges faced by sex workers in the New Kuchingoro camp for internally displaced persons (IDPs) due to the COVID-19 pandemic. Previous studies on sex workers’ activities in the camp have underscored their hardships, distress, and deprivation, as well as their general inability to cope with COVID-19. Through my research, I reveal that the government and other agencies failed to support sex workers’ struggle to adequately provide for themselves and their families. I also explore the different strategies they employed in their efforts to survive during this period of hardship, which demonstrated their resilience.

Musha mukadzi: An African women’s religio-cultural resilience toolkit to endure pandemics

Life among most African families and communities revolves around women. In both African religion and culture, women’s lives oscillate between two opposite extremes of being at the centre and periphery at the same time. Women are both the healers and the often wounded by the system that respects them when there are problems and displaces them whenever there are opportunities. Their central role is expressed by a Shona proverb musha mukadzi (the home is a woman). This proverb expresses how women endure the pain of both religion and culture to create a decent society. Women also endure the pain of pandemics such as human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) and COVID-19 and at times succumb to the same while taking care of some family members who would have fallen victim to the epidemic. Countless married women have been made susceptible to HIV and AIDS as they try to live according to the African cultural dictates of mothering and/or motherhood. Other women and girls also contract the disease because of how religion and culture exert them to some unbearable circumstances. For example, women and girls nurse their ill relatives without protective equipment and clothing. At times they are abused by men because of some cultural beliefs that unprotected sex is a remedy for HIV and AIDS. In addition, most women and girls were also victims of COVID-19 while serving their family members. In doing all the good work to serve families, women are driven by the proverb musha mukadzi. Using desk research methodology, this paper argues that musha mukadzi is both a toolkit for women’s resilience to endure pandemics and at the same time a subtly oppressive statement often used to manipulate and abuse women to stand in places that are too difficult for their capabilities.Contribution: African women bear the brunt of pandemic burdens such as HIV, AIDS and COVID-19. Sometimes they become susceptible to the same while taking care of their family members affected by pandemics in the name of fulfilling the Shona proverb, musha mukadzi. The topic has contributed to the scope of the journal as it advocates to inculcate a peaceful society. The article also challenges African societies not to use musha mukadzi to ill-treat women as objects of African religio-cultural patriarchal ideology.

Knowledge, Concerns, and Psychological Distress Among Caregivers of Patients Seeking Emergency Medical Care for Non-COVID-19-Related Illness During the COVID-19 Pandemic: A Cross-Sectional Study.

Introduction During the active phase of the COVID-19 pandemic, the global healthcare system failed to meet the increased demand for healthcare resources,infrastructures, and facilities. The brunt of the healthcare crisis was faced not only by COVID-19 victims; a large majority of non-COVID patientswere deprived of routine and emergency care. Factors that possibly affected resource utilization, healthcare-seeking behavior, service delivery patterns, and national health systems' priority during the pandemic were the knowledge and attitudinal concerns related to the COVID-19 disease and its control measures. Here, we evaluated the knowledge, concern, and psychological distress among the caregiversof the patients attending the emergency department at a tertiary healthcare center inIndia.​ Methodology We conducted a survey-based study using a pre-validated questionnaire on the caregivers of the patients visiting the emergency department (ED) from June to September 2020 (during the first wave of the COVID-19 pandemic). The demographic details and responses of the participants were documented in the semi-structured proforma. A pre-validated COVID-19 Peritraumatic Distress Index (CPDI) questionnaire was used to assess psychological stress. Results Out of 1014 participantsinterviewed, the majority weremale attendants (72%), aged 18-45 (82%), and seeking medical attention for patients with chronic illnesses (76%). Acute onset emergencies like stroke, myocardial infarction, trauma, etc. were the ED presentation in only one-fifth of patients. COVID-19-related knowledge wasadequate for questions related to age groups at risk for the viral infection (97% agreed that all age groups were at risk), mode of transmission (75-90% were aware of the commonmodes of transmission), and >65% knew the common symptoms of COVID-19 infection. However, only 38.5% knew about frequent handwashingas a protective measure. More than half of the participants considered the COVID-19vaccine as the sole ray of hope and disregarded the effectiveness of alternative medicines such as Ayurvedic/homeopathic/allopathic medicines as preventive options. One-third were first-time visitors to the hospital, while two-thirds of all participants were afraid to visit any hospital during the COVID-19 pandemic. The majority (84%) faced difficulty in accessing the index tertiary care center due to transport, socioeconomic support, or lockdown-related restrictions. In comparison, 60% reported some form of discrimination at almost all levels of healthcare settings due to COVID-19-related priority changes. Nearly half (48%) of all enrolled caregivers reported experiencing mild-to-moderate distress (CPDI score=28-51), and 15.7% felt severe distress (CPDI score >51) while seeking treatment for the non-COVID-19 illness of their patient. Age and socioeconomic status were significantly associated with COVID-19-related psychological distress levels (p<0.001 in logistic regression), while gender, education, and residence showed no significant associations. Conclusion Most of the patient caregivers visiting the emergency department during the COVID-19 pandemic had an adequate understanding of risk factors and preventive measures. The major barriers to accessing healthcare facilities were transport, financial issues, and lockdown-related restrictions. Almost two-thirds of the caregivers revealed mild-to-moderate to severe psychological distress due to the pandemic and lockdown-related concerns.

Investigating the mediating influence of distress tolerance on the relationship between existential thinking, sense of coherence, and the severity of mourning among families who lost a loved one to COVID-19: A cross-sectional study.

The objective of the current study was to examine how distress tolerance functions as a mediator in the relationship between existential thinking, sense of coherence, and the severity of mourning experienced by families who have lost a loved one to COVID-19. The present study employed a descriptive correlational research design, targeting family members of those who passed away due to COVID-19 in the city of Mianeh in 2022. A sample of 160 individuals was selected for statistical analysis. The research instruments used in this study consisted of Flensberg's sense of coherence questionnaire (2006), Simmons and Gaher's emotional distress tolerance questionnaire (2005), Sugbart and Scott's grief experience questionnaire (1989), and Branton Scherer's existential thinking questionnaire (2006). The collected data were analyzed using path analysis, as well as SPSS and Amos software. The findings of the study revealed a significant correlation coefficient between existential thinking (r = 0.465), sense of coherence (r = 0.401), and distress tolerance (r = 0.521) with the severity of mourning experienced by families who lost a loved one to COVID-19. Moreover, the results indicated a positive and significant relationship (p > 0.01) between distress tolerance and sense of coherence (r = 0.126), as well as between distress tolerance and existential thinking (r = 0.059) among the bereaved families. However, the bootstrap test results suggested that distress tolerance did not mediate the relationship between sense of coherence and the severity of mourning in the families of COVID-19 victims. Consistent with prior research, the current study's findings indicated that both existential thinking and sense of coherence had a direct impact on the severity of mourning experienced by families who lost a loved one to COVID-19. Additionally, the results revealed that the influence of existential thinking on the severity of mourning was mediated indirectly by increasing distress tolerance.

Finding Balance with Music: Music Therapy as a Tool for Recovery and Increasing Welfare for Orphans of COVID-19 Victims.

Music therapy can effectively address children's psychological, emotional, cognitive, and social needs. Music therapy can provide a safe and supportive environment for children to process their emotions and deal with the grief of losing a parent.

Targeted Temperature Management After Cardiac Arrest in COVID-19 Patients.

There is a paucity of evidence regarding the utility of targeted temperature management (TTM) in COVID-19 patients who suffer cardiac arrest. This systematic review and meta-analysis aimed to use the available data of how temperature predicts outcomes in COVID-19 patients and the association between active cooling and outcomes in non-COVID-19 cardiac arrest patients to give recommendations for the utility of TTM in COVID-19 survivors of cardiac arrest. The PubMed, Embase, and Web of Science databases were queried in August 2022 for two separate searches: (1) temperature as a predictor of clinical outcomes in COVID-19 and (2) active cooling after return of spontaneous circulation (ROSC) in non-COVID-19. Forest plots were generated to summarize the results. Of the 4209 abstracts screened, none assessed the target population of TTM in COVID-19 victims of cardiac arrest. One retrospective cohort study evaluated hyperthermia in critically ill COVID-19 patients, two retrospective cohort studies evaluated hypothermia in septic COVID-19 patients, and 20 randomized controlled trials evaluated active cooling in non-COVID-19 patients after ROSC. Risk of death was higher in COVID-19 patients who presented with hyperthermia (risk ratio [RR] = 1.87) or hypothermia (RR = 1.77; p < 0.001). In non-COVID-19 victims of cardiac arrest, there was no significant difference in mortality (RR = 0.94; p = 0.098) or favorable neurological outcome (RR = 1.05; p = 0.41) with active cooling after ROSC. Further studies are needed to evaluate TTM in COVID-19 victims of cardiac arrest. However, given the available evidence that hyperthermia or hypothermia in COVID-19 patients is associated with increased mortality as well as our findings suggesting limited utility for active cooling in non-COVID-19 cardiac arrest patients, we posit that TTM to normothermia (core body temperature ∼37°C) would most likely be optimal for the best outcomes in COVID-19 survivors of cardiac arrest.

COVID-19 victimization experience and university students’ smartphone addiction: the mediating role of emotional intelligence

ObjectivesDuring the post-COVID-19 era, everyone has the risk of contracting the virus and becoming the victims of COVID-19. Examining the relationship between the COVID-19 victimization experience and its effects is more urgent. The aim of present study is to propose a mediation model to investigate the association between COVID-19 victimization experience and smartphone addiction, and the mediating role of emotional intelligence.MethodsA online questionnaire including the COVID-19 Victimization Experience Scale, the Smartphone Addiction Scale, and the Emotional Intelligence Scale among Chinese university students, were employed in this study. Finally, 1154 valid questionnaires were collected. The reliability and confirmatory factor analysis results showed that all three scales had good reliability and validity.ResultsStructural Equation Model (SEM) demonstrated that COVID-19 victimization experience significantly predicted smartphone addiction in university students, and emotional intelligence partially mediated the association between COVID-19 victimization experience and smartphone addiction. Bootstrap results furthermore tested the rigor of the mediating effect.ConclusionCOVID-19 victimization experience was a important variables in predicting university students’s martphone addiction, and emotional intelligence was a protective factor in decreasing the negative effect of COVID-19 victimization experience on addictive behaviors. It is suggested that instructors should integrate emotional intelligence training programs into mental health courses so as to improve students’ emotional intelligence ability.

The link between SARS-CoV-2 related microglial reactivity and astrocyte pathology in the inferior olivary nucleus.

The pathological involvement of the central nervous system in SARS-CoV2 (COVID-19) patients is established. The burden of pathology is most pronounced in the brain stem including the medulla oblongata. Hypoxic/ischemic damage is the most frequent neuropathologic abnormality. Other neuropathologic features include neuronophagia, microglial nodules, and hallmarks of neurodegenerative diseases: astrogliosis and microglial reactivity. It is still unknown if these pathologies are secondary to hypoxia versus a combination of inflammatory response combined with hypoxia. It is also unknown how astrocytes react to neuroinflammation in COVID-19, especially considering evidence supporting the neurotoxicity of certain astrocytic phenotypes. This study aims to define the link between astrocytic and microglial pathology in COVID-19 victims in the inferior olivary nucleus, which is one of the most severely affected brain regions in COVID-19, and establish whether COVID-19 pathology is driven by hypoxic damage. Here, we conducted neuropathologic assessments and multiplex-immunofluorescence studies on the medulla oblongata of 18 COVID-19, 10 pre-pandemic patients who died of acute respiratory distress syndrome (ARDS), and 7-8 control patients with no ARDS or COVID-19. The comparison of ARDS and COVID-19 allows us to identify whether the pathology in COVID-19 can be explained by hypoxia alone, which is common to both conditions. Our results showed increased olivary astrogliosis in ARDS and COVID-19. However, microglial density and microglial reactivity were increased only in COVID-19, in a region-specific manner. Also, olivary hilar astrocytes increased YKL-40 (CHI3L1) in COVID-19, but to a lesser extent than ARDS astrocytes. COVID-19 astrocytes also showed lower levels of Aquaporin-4 (AQP4), and Metallothionein-3 in subsets of COVID-19 brain regions. Cluster analysis on immunohistochemical attributes of astrocytes and microglia identified ARDS and COVID-19 clusters with correlations to clinical history and disease course. Our results indicate that olivary glial pathology and neuroinflammation in the COVID-19 cannot be explained solely by hypoxia and suggest that failure of astrocytes to upregulate the anti-inflammatory YKL-40 may contribute to the neuroinflammation. Notwithstanding the limitations of retrospective studies in establishing causality, our experimental design cannot adequately control for factors external to our design. Perturbative studies are needed to confirm the role of the above-described astrocytic phenotypes in neuroinflammation.

Chasing the Ordinary Way of Meaning: Amongst Language-Games and Everyday Practices

ABSTRACT In this article, we attempt to develop an essay on the concept of “ordinary meaning,” initially proposed by Michel Pêcheux. The concept, however, was not fully developed due to the French philosopher’s premature death in 1983. Thus, this essay aims to conjecture what this “ordinary way of meaning” might be. To do so, following Pêcheux’s suggestions, we will explore the “analysis of ordinary language,” as proposed by Ludwig Wittgenstein, and its culturalist reinterpretation by Michel de Certeau in everyday practices. At the end of the path, we arrive at two hypotheses: the first is that the “ordinary way of meaning” would not configure an “aspect” of meaning (or the inclusion of new objects, such as conversations, etc.), but a new paradigm to practice Discourse Analysis based on a “practical materialism”; the second is that thinking about meaning in its ordinary way causes Discourse Analysis to take into account discursive practices and their diagrams of action. Finally, as a simple homage to the more than 660,000 victims of COVID-19 in Brazil, the discussion around language-games and everyday practices will be guided by the reading of a Memorial Inumeráveis post in one of its social networks.

The Morbid Realities of Social Media: An Investigation into the Narratives Shared by the Deceased Victims of COVID-19

Social media platforms have had considerable impact on the real world especially during the Covid-19 pandemic. Problematic narratives related to Covid-19 might have caused significant impact on the population specifically due to its association with dangerous beliefs such as anti-vaccination and Covid denial. In this work, we study a unique dataset of Facebook posts by users who shared and believed in such narratives before succumbing to Covid-19 often resulting in death. We aim to characterize the dominant themes and sources present in the victim's posts along with identifying the role of the platform in handling deadly narratives. Our analysis reveals the overwhelming politicization of Covid-19 through the prevalence of anti-government themes propagated by right-wing political and media ecosystem. Furthermore, we highlight the efforts of Facebook's implementation of soft moderation actions intended to warn users of misinformation. Results from this study bring insights into the responsibility of political elites in shaping public discourse and the platform's role in dampening the reach of harmful narratives.

Remembering the victims of COVID-19: From personal to civic to reparative memory.

In March 2020, the Covid-19 pandemic had exploded in New York City, across the country, and around the world. At its height, thousands of people were dying every day in quarantined intensive care units and Covid wards, their families forbidden from attending their loved ones' last living moments, even to say good-bye. The victims were dying in isolation, consigned to make-shift morgues, and buried or cremated-without ceremony, without grieving loved ones present. To commemorate the victims of Covid communally in real time would also be to turn the mourners themselves into new Covid victims. Commemorative and collective grieving processes would have to be deferred until it was safe to gather together again. But memory deferred is also memory transformed with new and devastating meaning. In this short reflection on how the meanings engendered by memory of those lost to Covid-19 morph over time, I explore the differences between the memory of personal loss, civic memory, and reparative memory.

Qi-Dong-Huo-Xue-Yin balances the immune microenvironment to protect against LPS induced acute lung injury.

COVID-19 induces acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) and leads to severe immunological changes that threatens the lives of COVID-19 victims. Studies have shown that both the regulatory T cells and macrophages were deranged in COVID-19-induced ALI. Herbal drugs have long been utilized to adjust the immune microenvironment in ALI. However, the underlying mechanisms of herbal drug mediated ALI protection are largely unknown. This study aims to understand the cellular mechanism of a traditional Chinese medicine, Qi-Dong-Huo-Xue-Yin (QD), in protecting against LPS induced acute lung injury in mouse models. Our data showed that QD intrinsically promotes Foxp3 transcription via promoting acetylation of the Foxp3 promoter in CD4+ T cells and consequently facilitates CD4+CD25+Foxp3+ Tregs development. Extrinsically, QD stabilized β-catenin in macrophages to expedite CD4+CD25+Foxp3+ Tregs development and modulated peripheral blood cytokines. Taken together, our results illustrate that QD promotes CD4+CD25+Foxp3+ Tregs development via intrinsic and extrinsic pathways and balanced cytokines within the lungs to protect against LPS induced ALI. This study suggests a potential application of QD in ALI related diseases.