Special Issue: COVID-19
Surge hospitals play an important role in combating a major infectious disease outbreak. Compared with other situations, the management and operation of surge hospitals amid the outbreak of major infectious diseases are specific, and serious consequences will be caused if there is a loophole in the hospital management model. However, there is no research that reviews and summarizes relevant studies.
To perform a scoping review of the research on surge hospital management during a major infectious disease outbreak, so as to understand the elements of hospital management and research status, providing guidance for future research in this field.
This review used a methodological framework developed based on Arksey & O'Malley's framework and principles as well as recommendations from related scholars and colleagues' guiding principles. Studies on the management of surge hospitals amid the outbreak of major infectious diseases were searched in electronic databases of PubMed, Embase, Cochrane Library and SinoMed from inception to June 17, 2022. Then the included studies were summarized and analyzed.
Twenty-five studies were included. All studies were about the management of mobile cabin hospitals and designated hospitals for treating COVID-19 in China during the COVID-19 pandemic. The elements of surge hospital management included emergency preparedness, personnel management, operation management and service management.
The number of studies on surge hospital management has increased, with an extensive scope of research, but the quality of them is unsatisfactory, and there is a lack of unified evaluation indicators and feedback tools. In the future, efforts should be made to improve the quality of relevant studies, formulate a standardized surge hospital management process, increase the construction and implementation of evaluation indicators, so as to provide more guidance for clinical nursing practice.
The COVID-19 pandemic has devastated human health and global economy. Diminished immune function of health-related vulnerable populations leads to insufficient protective effect of the vaccine with a higher risk of severe illness and death following infection, and there is a lack of adequate targeted drugs for the prevention and treatment of COVID-19. In the context that COVID-19 treated as a Category B disease in China, vulnerable populations have become the priority populations for epidemic prevention and control. Therefore, the strategies of individual immunization and prevention should be further optimized for vulnerable populations. In addition to vaccines, other prevention strategies should be supplemented, such as long-acting neutralizing antibodies. Based on this, this paper reviews the identification, immune function characteristics and prevention strategies of COVID-19 in vulnerable populations, to provide a reference for the prevention and control strategies for health-related vulnerable populations in China, expecting that more suitable preventive drugs for vulnerable populations can be developed in the future to reduce the risk of COVID-19 in vulnerable populations.
Inhaled recombinant COVID-19 vaccine (type 5 adenoviral vector) (hereinafter referred to as the inhaled COVID-19 vaccine) is the first approved inhaled COVID-19 vaccine in China, with the advantages of good immunity, painlessness, and higher accessibility, which has been included in the WHO Emergency Use Listing and China's list of second-dose booster immunization vaccines. The real-world application of this vaccine deserves more attention due to the poor understanding of it by the public.
To understand the real experience in depth of first-line medical staff in epidemic prevention aged≥18 years in Guiyang city who received inhaled COVID-19 vaccine, so as to provide a reference for the promotion of this type of vaccine.
The recipients who completed the emergency vaccination with inhaled COVID-19 vaccine at a vaccination site of Guiyang city in October 2022 were selected as research subjects based on the the principle of booster immunization by using purposive sampling method. The sample size was determined by interviewing until no new case emerged which was data saturation. A total of 17 recipients were interviewed in this study. Semi-structured interviews were conducted with the research subjects, face-to-face interviews were conducted to understand the vaccination experience at that time firstly, and telephone interviews were conducted 5-7 days after vaccination. The Colaizzi seven-step analysis method was used for the data collection and analysis.
A total of five themes were summarized including the convenience of vaccination, good vaccination experience, light psychological burden, low vaccine hesitancy and uncertain protective effect. The convenience of vaccination includes simple and time-saving vaccination process, fast vaccination speed, low cost, and no interruption of nucleic acid testing; the good vaccination experience includes comfortable feeling of vaccination, harmonious observation atmosphere, fewer adverse reactions, and no interference with daily life; light psychological burden includes reduction of tension and anxiety of vaccination, better mental health maintenance, non-invasive vaccination and elimination of vaccination fears; low vaccine hesitancy includes high vaccination accessibility, increase of vaccine acceptance, increase of public perception of epidemic outbreak risk; uncertain protective effect includes uncertain which vaccination method provides better protection between injection and inhalation, whether inhaled COVID-19 vaccine has a good protective effect against variant strains.
Inhaled COVID-19 vaccine is convenient to administer with fewer adverse reactions, which is highly accepted by first-line medical staff in epidemic prevention aged≥18 years in Guiyang city with good experience.
Chronic kidney disease (CKD) is characterized by abnormal urine test or progressive kidney function decline. Patients with CKD are at a higher risk of COVID-19 infection with higher conversion and mortality rates after infection for their reduced kidney function, long-term use of immunosuppressive agents or combination of underlying diseases. Therefore, rational drug use is particularly important for CKD patients combined with COVID-19 infection. This article summarizes special considerations for the use of relevant medications in patients with CKD by integrating the current evidence of medications for the treatment of COVID-19 infection, including antiviral drugs, anti-inflammatory drugs, antithrombotic drugs, convalescent plasma and neutralizing monoclonal antibodies, as well as commonly used symptomatic drugs of respiratory system (such as antfebrile, antisputum and cough medicine and anti-allergic drugs), high lighting the modified medication regiments according to kidney function levels, in order to provide a reference for clinical professionals, assist in clinical decision-making and rational drug use, and ensure clinical efficacy and safety.
The elderly are a priority population for COVID-19 vaccination. COVID-19 vaccination can effectively reduce the risk of developing severe and critically ill patients or even death in COVID-19 patients. However, the current vaccination rate of the elderly in China is relatively low, and the COVID-19 vaccination behavior among the elderly has been rarely reported in current studies.
To investigate COVID-19 vaccination behavior and its influencing factors among the elderly in China, and to provide a reference for improving the COVID-19 vaccination rate of the elderly.
A total of 1 323 older adults aged 60 years and above in Wujin District of Changzhou City, Zhongmu County of Zhengzhou City, Chengzhong District of Xining City and Linkou County of Mudanjiang City were selected as research subjects from August 3 to August 14 in 2022 by using a stratified random sampling method and investigated by self-designed questionnaires. Binary Logistic regression analysis was used to explore the influencing factors of the first dose of COVID-19 vaccination, full course of COVID-19 vaccination, and booster dose of COVID-19 vaccination.
96.60% (1 278/1 323) of the elderly received the first dose of COVID-19 vaccine, 91.76% (1 214/1 323) completed the full course of COVID-19 vaccination, and 79.67% (1 054/1 323) received the booster dose of COVID-19 vaccine. The results of binary Logistic regression analysis showed that compared with the older adults aged 60-64 years, the older adults aged 75 years and above were less likely to receive the first dose of the COVID-19 vaccine〔OR (95%CI) =0.27 (0.11, 0.62), P<0.05〕; compared with the older adults with chronic disease, the older adults without chronic disease were more likely to receive the first dose of COVID-19 vaccine〔OR (95%CI) =2.07 (1.12, 3.84), P<0.05〕; the older adults with higher levels of perceived benefit were more likely to receive the first dose of COVID-19 vaccine〔OR (95%CI) =1.39 (1.07, 1.79), P<0.05〕. Compared with the older adults aged 60-64 years, who maintained regular physical exercise, those aged 75 years and above〔OR (95%CI) =0.34 (0.19, 0.59), P<0.05〕, who did not maintain regular physical exercise〔OR (95%CI) =0.64 (0.42, 0.96), P<0.05〕were less likely to complete the full course of vaccination; compared with the older adults with chronic diseases, the older adults without chronic diseases were more likely to complete the full course of the COVID-19 vaccination〔OR (95%CI) =1.59 (1.05, 2.40), P<0.05〕. Compared with older adults aged 60-64 years and from the central region, the older adults aged 75 years and above〔OR (95%CI) =0.55 (0.36, 0.86), P<0.05〕and from the eastern region〔OR (95%CI) =0.47 (0.34, 0.64), P<0.05〕were less likely to receive the booster dose of COVID-19 vaccine; compared with the older adults with chronic diseases, the older adults without chronic diseases were more likely to receive the booster dose of COVID-19 vaccine〔OR (95%CI) =1.54 (1.15, 2.06), P<0.05〕; older adults with higher levels of perceived severity were more likely to receive the booster dose of COVID-19 vaccine〔OR (95%CI) =1.06 (1.00, 1.11), P<0.05〕. Subgroup analysis showed that compared with the older adults with chronic diseases aged 60-64 years, from the central region, older adults with chronic diseases aged 75 years and above〔OR (95%CI) =0.35 (0.19, 0.65), P<0.05〕, from the eastern region〔OR (95%CI) =0.49 (0.29, 0.83), P<0.05〕were less likely to receive the booster dose of COVID-19 vaccine; older adults with chronic diseases who had higher levels of perceived severity were more likely to receive the booster dose of COVID-19 vaccine〔OR (95%CI) =1.09 (1.01, 1.18), P<0.05〕. Compared with the older adults from the central region without chronic diseases, the older adults from the eastern region without chronic diseases were less likely to receive the booster dose of COVID-19 vaccine〔OR (95%CI) =0.44 (0.29, 0.68), P<0.05〕.
More attention should be paid to the elderly who are senior and with chronic diseases in the process of COVID-19 vaccination. The vaccination rate of the elderly should be further increased by strengthening the publicity of COVID-19 vaccine knowledge.
Azovudine is a widely used antiviral drug for COVID-19 in China, but published trials on its effect on hepaticand renal function are extremely scarce.
To explore the changes of in hepatic and renal function in patients with COVID-19 infection after using Azovudine, so as to provide a reference for thesafe use of Azovudine in patients with renal insufficiency.
Inpatients ina tertiary general hospitalwho used Azovudine for COVID-19 from December 26, 2022 to December 31, 2022 were consecutively included in the retrospective study and divided into the normal group, mild injury group, moderate injury group, severe injury group, and end-stage groupaccording to estimated glomerularrate (eGFR) levels. The changes of biochemical parametersof liver and kidney including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), albumin (ALB), total bilirubin (TB), serum creatinine (Scr), eGFR were observed in each group; the formula D_FR=D_NL×[1-F_k (1-K_f) ] was used to correct the maintenance dose of Azivudine in patients with eGFR<60 mL·min-1· (1.73 m2) -1. The patients were divided into the corrected group and uncorrected group according to whether they were administered according to this formula, the biochemical parameters of liver and kidney were compared between the two groups.
Among 322 patients who used Azovudine, 190 patients met the inclusion and exclusion criteria. After grouping by the level of eGFR, there were statistically significant differences in the distribution of age, COVID-19 severity, peak procalcitonin (PCT) values, antihypertensive drugs, loop diuretics and Azovudine maintenance dose in each group (P<0.05) ; there were 73 cases (38.4%) with elevated ALT level after Azovudine treatment, and 68 cases (93.2%) with elevated ALT level within one time of the upper normal limit; eGFR decreased in 58 cases (30.5%), of which 7 cases (12.1%) dropped to the next renal function grade; regardless of the grade of renal injury, there were no deterioration in eGFR, ALT, AST, TB, ALP and albumin after the use of conventional dose or corrected dose of Azivudine (P>0.05) ; because the patients with moderate and severe renal injury were dose-corrected with Azivudine, the safety of this population was not compared if the dose was not corrected.
The use of Azivudine is prone to cause the elevation of ALT level and the decrease of eGFR, but the injury with clinical significance is 2.6% and 3.7%, respectively; there was no aggravation of liver and kidney injury in patients with moderate and severe kidney injury after using the corrected dose of Azivudine, however, this conclusion needs to be confirmed in a multicenter randomized controlled study with a large sample.
Primary healthcare is the first line of defense for the containment of COVID-19 pandemic. Primary healthcare has been studied extensively by academic circles in various countries during the pandemic, but the focuses vary across these studies due to differences in primary healthcare systems in different countries.
To understand the advances, hotspots, trends and differences of primary care-related research at home and abroad during the COVID-19 epidemic, and to provide a reference for further research in this field.
Primary healthcare-related studies published during the COVID-19 pandemic (between January 1, 2020 and June 30, 2022) were searched in databases of CNKI and Web of Science Core Collection on July 5, 2022, and 282 from the former database and 1 755 from the latter were included. CiteSpace was used for visualization analysis to provide a graphic visualization of co-occurrence networks of authors, keywords and keywords clusters, to perform a timeline analysis, and to detect keywords with bursts.
The number of publications in China grew fast at the beginning of the pandemic, then the growth gradually decreased, and tended to level off at the late stage. In contrast, relevant research started later in foreign countries, but the number of relevant publications maintained high-speed growth as of the study time. The major author cooperation forms were inter-small teams cooperation and inter-individual cooperation, and no large-scale inter-team cooperation was found. The hotspots of domestic research focus on the systems, the exploration of mechanisms and management practices related to pandemic prevention and control, while international research focuses on changes in healthcare-seeking patterns and the satisfaction of patients' medical needs under the influence of the pandemic. Psychological problems related to the pandemic were concerned by both domestic and international research.
Domestic and foreign studies have similarities and different focuses. To continuous refine and diversify domestic research, it is suggested to learn international experience, pay attention to the construction of relevant research forces, improve the knowledge system in this field, and actively use information technology to improve the primary care system amid the pandemic.
Evidence shows that coronavirus disease 2019 (COVID-19) can impact multiple bodily systems, with the cardiovascular system being commonly affected. In order to guide healthcare providers in diagnosing and managing cardiovascular issues related to COVID-19, the consensus group recommends: (1) Routine cardiac troponin testing is necessary for patients who are hospitalized or exhibit symptoms related to heart conditions after COVID-19 infection to evaluate potential myocardial injury and help detect any cardiac complications. Patients with myocardial injury not related to heart issues tend to have a poorer outcome. (2) Relatively few cases of acute myocarditis linked to COVID-19 have been reported, and individuals suspected of having myocarditis should be evaluated and managed based on risk stratification. (３) COVID-19 infection should be considered a risk factor for increasing the incidence of cardiovascular disease. All individuals who have been infected should adhere to a healthy lifestyle more strictly and implement appropriate primary or secondary preventive measures for cardiovascular disease. (4) For individuals who experience the persistence or emergence of new symptoms 3 months after the initial COVID-19 infection and have been experiencing these symptoms for at least 2 months, with no clear diagnosis of a cardiovascular disease through standard diagnostic tests, it is advisable to consider the possibility of "post COVID-19 condition". Rehabilitation should be given top priority for these patients.
COVID-19 may impair the central nervous system, but the prevalence and related factors of very early cognitive impairment in discharged COVID-19 convalescents are still unclear.
To assess the prevalence of very early cognitive impairment in discharged COVID-19 convalescents, and to identify its influencing factors.
This study included 574 COVID-19 convalescents from August 28 to September 30, 2020, including individuals who were discharged from designated hospitals for treating COVID-19 in Wuhan from December 2019 to April 2020 randomly selected from the hospital information system, and those with informed consent recruited through news media. According to the Eight-item Informant Interview to Differentiate Aging and Dementia (AD8) score, the subjects were divided into a very early cognitive impairment group (AD8≥2) and a non-very early cognitive impairment group (AD8<2). A questionnaire survey was conducted with the subjects by four investigators at Hubei Provincial Hospital of Traditional Chinese& Western Medicine, using the General Information Questionnaire to collect demographic information and past disease history of the patients (including gender, age, underlying disease, classification of COVID-19 on admission, interval between discharge and the current survey, and various symptoms present at the time of follow-up), using the Generalized Anxiety Disorder-7 (GAD-7), the PTSD Check List–Civilian Version (PCL-C), and the Short Form 36 Health Survey Questionnaire (SF-36) to assess patients' anxiety, post-traumatic stress disorder, and quality of life, respectively. Three hundred and eleven cases finally completed the cognitive function screening. Multiple Logistic regression was used to evaluate the effects of gender, age, underlying disease and admission classification of COVID-19 on very early cognitive impairment. A restricted cubic spline model was used to assess the quantitative relationship between anxiety level and very early cognitive impairment.
311 (54.18%) who effectively responded to the survey was finally enrolled, including 170 (54.7%) with very early cognitive impairment and 141 (45.3%) without. 230 (23.9%) had residual symptoms after discharge. Comparisons of gender, age, insomnia, fatigue, chest tightness, shortness of breath, loss of appetite, generalized anxiety disorder, PTSD positive, and the score of each SF-36 entry among COVID-19 convalescents with and without very early cognitive impairment were statistically significant (P<0.05). Multivariate Logistic regression analysis suggested that females〔OR (95%CI) =2.658 (1.528, 4.625) 〕, advanced age〔OR (95%CI) =3.736 (1.083, 12.890) 〕, and having generalised anxiety disorder〔OR (95%CI) =5.081 (1.229, 21.008) 〕were influential factors in increasing very early cognitive impairment (P<0.05). Restricted cubic spline models indicated a linear quantitative relationship between anxiety level and very early cognitive impairment, with higher levels of anxiety associated with a greater likelihood of very early cognitive impairment (P for non-linear test =0.132) .
The incidence of very early cognitive impairment is high in COVID-19 convalescents, and it may be higher in those who are older, female, or have generalized anxiety symptoms. Timely interventions for psychiatric problems and alleviation of anxiety symptoms in COVID-19 convalescents, especially in older women, may help to improve their cognitive function and Alzheimer's disease.
During the prevention and control of the COVID-19, the decrease in routine medical care has spread across countries in various degrees, also affecting the management of chronic disease accordingly. The policies and schemes of prevention and control of the COVID-19 in China have been adjusted since December 2022, health care system has been facing serious challenges, bringing increased pressure on primary care. Based on the experiences of other countries, this paper suggests that primary care in China should pay attention to the promoting of self-management for patients with chronic diseases, providing proactive service for patients with complex situations and high demand, strengthening the application and research of telemedicine, intensifying the community connection of primary care services, focusing on the improvement of the compensation mechanism of health services.
The outbreak of COVID-19 in Xi'an between 2021 and 2022 was a large-scale local epidemic in a large city with a huge number of cases. It is necessary to analyze and summarize the contents of this outbreak.
To analyze the disease characteristics of patients with COVID-19, and to explore the risk factors as well as predictors of serious cases.
General data and laboratory parameters were retrospectively collected from patients diagnosed with a new coronavirus pneumonia who were admitted to the Fourth People's Hospital of Xi'an between December 2021 and January 2022. Based on the the ratios of total IgG to lymphocyte percentage (IgG∶L%) , total IgM to lymphocyte percentage (IgM∶L%) , total IgG to lymphocyte count ratio (IgG∶L#) , and total IgM to lymphocyte count ratio (IgM∶L#) , patients were divided into three groups: mild and common, severe and critical. Multivariate Logistic regression analysis was used to explore the risk factors of developing severe and critically new coronavirus; then the ROC curve was drawn to analyze the predictive indexes and predictive value of severe and critical COVID-19, the area under the ROC curve (AUC) was calculated, and the AUC of each index was compared using the Delong test.
A total of 699 patients with identified COVID-19 were finally included, and divided into two groups: the mild and common (n=678) and the severe and critical (n=21) forms, with the mild and common forms having younger age, and less underlying disease, D-dimer, IgM∶L%, IgM∶L#, and higher lymphocyte percentage and lymphocyte count than the severe and critical forms (P<0.05) . Multivariate Logistic regression analysis showed that age〔OR=1.068, 95%CI (1.031, 1.105) , P<0.001〕, D-dimer 〔OR=1.612, 95%CI (1.026, 2.533) , P=0.038〕as well as IgM∶ L#〔OR=1.034, 95%CI (1.006, 1.063) , P=0.018〕 were risk factors for the development of severe and dangerous new coronavirus, and lymphocyte percentage 〔OR=0.918, 95%CI (0.844, 0.997) , P=0.043〕was a protective factor for the development of severe and critical new coronavirus. To establish a joint prediction model for severe and critical novel coronavirus infection, P=-5.031+0.065×age-0.086× lymphocyte percentage +0.738× lymphocyte count +0.477× D-dimer +0.034×IgM∶L#, and the cutoff value for combined detection to predict severe and critical COVID-19 was 0.04, with a sensitivity of 90.00%, a specificity of 83.18%, and its AUC of 0.912〔95%CI (0.858, 0.965) 〕, which was greater than that for age (Z=5.314, P<0.001) , lymphocyte percentage (Z=-1.987, P=0.047) , D-dimer (Z=2.273, P=0.023) , and IgM∶L# (Z=0.161, P<0.001) , with statistically significant differences.
In the acute phase of COVID-19, there is an imbalance between inflammatory response and cellular immune function, and this imbalance, along with age and D-dimer, are all risk factors for severe COVID-19. Combined indicators including age, D-dimer, lymphocyte percentage and IgM∶L# can effectively predict severe and critical COVID-19 .
The COVID-19 pandemic seriously affects human health and life. COVID-19 has been reportedly associated with a high risk of thrombotic events, which are closely associated with stroke.
To assess the effect and possible mechanism of COVID-19 on stroke morbidity, providing a reliable theoretical basis for scientific prevention and treatment of COVID-19 in stroke.
We searched databases of Web of Science, PubMed, EmBase, Cochrane Library, CNKI and Wanfang Data for cohort studies and case-control studies related to COVID-19 and stroke published from December 2019 to January 2022. Two researchers conducted literature screening and data extraction separately. The Newcastle-Ottawa Scale was used to assess the quality of included studies. Meta-analysis was used to evaluate the impact of COVID-19 on stroke mortality. Funnel plot was used to evaluate the potential publication bias.
A total of 18 studies were included, 12 of them were of good quality, and other 6 were of fair quality. Meta-analysis showed that stroke patients with COVID-19 had higher mortality〔RR=4.16, 95%CI (2.82, 6.13) , P<0.000 01〕, prolonged prothrombin time (PT) 〔MD=0.78, 95%CI (0.35, 1.20) , P=0.000 3〕, higher D-dimer level〔MD=1.34, 95%CI (0.83, 1.84) , P<0.000 01〕 and higher NIHSS score〔MD=6.66, 95%CI (4.54, 8.79) , P<0.000 01〕, as well as younger age〔MD=-2.04, 95%CI (-3.48, -0.61) , P=0.005〕than those without COVID-19. There was no statistically significant difference in activated partial thromboplastin time between stroke patients with and without COVID-19〔MD=2.51, 95%CI (-2.69, 7.71) , P=0.34〕. Funnel plot assessing potential publication bias in the impact of COVID-19 on stroke mortality was basically symmetrical.
COVID-19 could increase the risk of stroke mortality, which may be related to alterations in the coagulation system manifested by abnormal PT and D-dimer level and so on. And the outcomes of stroke patients with COVID-19 were associated with age and NIHSS score at admission.
The worldwide COVID-19 pandemic has turned into a global catastrophic public health crisis, and the conclusion about the risk factors of hospital death in COVID-19 patients is not uniform.
To explore risk factors of in-hospital death in patients with COVID-19 by a meta-analysis.
Case-control studies about risk factors of in-hospital death in COVID-19 patients were searched from databases of the Cochrane Library, ScienceDirect, PubMed, Medline, Wanfang Data, CNKI and CQVIP from inception to October 1, 2021. Literature screening, data extraction and methodological quality assessment were conducted. Meta-analysis was performed using Stata 15.1. Meta-regression was used to explore the potential sources of heterogeneity.
Eighty studies were included which involving 405 157 cases〔349 923 were survivors (86.37%) , and 55 234 deaths (13.63%) 〕, that were rated as being of high quality by the Newcastle-Ottawa Scale. Meta-analysis showed that being male〔OR=1.49, 95%CI (1.41, 1.57) , P<0.001) , older age〔WMD=10.44, 95%CI (9.79, 11.09) , P<0.001〕, dyspnoea〔OR=2.09, 95%CI (1.80, 2.43) , P<0.001〕, fatigue〔OR=1.49, 95%CI (1.31, 1.69) , P<0.001〕, obesity〔OR=1.46, 95%CI (1.43, 1.50) , P<0.001〕, smoking〔OR=1.18, 95%CI (1.14, 1.23) , P<0.001〕, stroke〔OR=2.26, 95%CI (1.41, 3.62) , P<0.001〕, kidney disease〔OR=3.62, 95%CI (3.26, 4.03) , P<0.001〕, cardiovascular disease〔OR=2.34, 95%CI (2.21, 2.47) , P<0.001〕, hypertension〔OR=2.23, 95%CI (2.10, 2.37) , P<0.001〕, diabetes〔OR=1.84, 95%CI (1.74, 1.94) , P<0.001〕, cancer〔OR=1.86, 95%CI (1.69, 2.05) , P<0.001〕, pulmonary disease〔OR=2.38, 95%CI (2.19, 2.58) , P<0.001〕, liver disease〔OR=1.65, 95%CI (1.36, 2.01) , P<0.001〕, elevated levels of white blood cell count〔WMD=2.03, 95%CI (1.74, 2.32) , P<0.001〕, neutrophil count〔WMD=1.77, 95%CI (1.49, 2.05) , P<0.001〕, total bilirubin〔WMD=3.19, 95%CI (1.96, 4.42) , P<0.001〕, aspartate transaminase〔WMD=13.02, 95%CI (11.70, 14.34) , P<0.001〕, alanine transaminase〔WMD=2.76, 95%CI (1.68, 3.85) , P<0.001〕, lactate dehydrogenase〔WMD=166.91, 95%CI (150.17, 183.64) , P<0.001〕, blood urea nitrogen〔WMD=3.11, 95%CI (2.61, 3.60) , P<0.001〕, serum creatinine〔WMD=22.06, 95%CI (19.41, 24.72) , P<0.001〕, C-reactive protein〔WMD=76.45, 95%CI (71.33, 81.56) , P<0.001〕, interleukin-6〔WMD=28.21, 95%CI (14.98, 41.44) , P<0.001〕, and erythrocyte sedimentation rate〔WMD=8.48, 95%CI (5.79, 11.17) , P<0.001〕 were associated with increased risk of in-hospital death for patients with COVID-19, while myalgia〔OR=0.73, 95%CI (0.62, 0.85) , P<0.001〕, cough〔OR=0.87, 95%CI (0.78, 0.97) , P=0.013〕, vomiting〔OR=0.73, 95%CI (0.54, 0.98) , P=0.030〕, diarrhoea〔OR=0.79, 95%CI (0.69, 0.92) , P=0.001〕, headache〔OR=0.55, 95%CI (0.45, 0.68) , P<0.001〕, asthma〔OR=0.73, 95%CI (0.69, 0.78) , P<0.001〕, low body mass index〔WMD=-0.58, 95%CI (-1.10, -0.06) , P=0.029〕, decreased lymphocyte count〔WMD=-0.36, 95%CI (-0.39, -0.32) , P<0.001〕, decreased platelet count〔WMD=-38.26, 95%CI (-44.37, -32.15) , P<0.001〕, increased D-dimer〔WMD=0.79, 95%CI (0.63, 0.95) , P<0.001〕, longer prothrombin time〔WMD=0.78, 95%CI (0.61, 0.94) , P<0.001〕, lower albumin〔WMD=-1.88, 95%CI (-2.35, -1.40) , P<0.001〕, increased procalcitonin〔WMD=0.27, 95%CI (0.24, 0.31) , P<0.001〕, and increased cardiac troponin〔WMD=0.04, 95%CI (0.03, 0.04) , P<0.001〕were associated with decreased risk of in-hospital death due to COVID-19. According to the meta-regression result, the heterogeneity in gender, renal disease, cardiovascular diseases, asthma, white blood cell count, neutrophil count, platelet count, hemoglobin, and urea nitrogen differed siangificnatly by country (P<0.05) .
The risk of in-hospital death due to COVID-19 may be increased by 25 factors (including being male, older age, dyspnoea, fatigue, obesity, smoking, stroke, kidney disease, cardiovascular disease, hypertension, diabetes, cancer, pulmonary disease, liver disease, elevated levels of white blood cells, neutrophil count, total bilirubin, aspartate transaminase, alanine transaminase, lactate dehydrogenase, blood urea nitrogen, serum creatinine, C-reactive protein, interleukin-6, and erythrocyte sedimentation rate) , and may be decreased by 13 factors (including myalgia, cough, vomiting, diarrhoea, headache, asthma, low body mass index, decreased lymphocyte count and platelet count, increased D-dimer, longer prothrombin time, lower albumin, increased procalcitonin and cardiac troponin) . The conclusion drawn from this study needs to be further confirmed by high-quality, multicenter, large-sample, real-world studies.
Respiratory virus infection is an important trigger of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) . China has adopted a series of containment measures assisting to curb COVID-19 transmission since the outbreak of the pandemic. Several studies showed a decrease in hospitalizations for AECOPD during the COVID-19 pandemic. However, there has been a relative lack of studies investigating the effects of preventive measures on the frequency and severity of exacerbations.
To explore the impact of the COVID-19 pandemic on the frequency of AECOPD with or without medical attention.
The subjects were from a prospective COPD cohort study conducted in the First Affiliated Hospital of Guangzhou Medical University, which began recruiting patients in early 2016, with visits every 3 months to collect demographic and clinical data, including those who were followed up during June to August 2017 (group 1) , June to August 2018 (group 2) , June to August 2019 (group 3) , and June to August 2020 (group 4) . Basic clinical data (including the frequency of AECOPD, sex, age, symptom score and so on) were collected from group 1 from October 2016 to May 2017, group 2 from October 2017 to May 2018, group 3 from October 2018 to May 2019, and group 4 from October 2019 to May 2020 (during which the periods from October 2019 to January 2020, and from February to May 2020 were defined as pre-COVID-19 period, and post-COVID-19 period, respectively) . The frequency of AECOPD during October to May next year in group 4 was compared with that of the other three groups. The changes in the frequency of AECOPD between pre- and post-COVID-19 periods were analyzed.
There were 162 patients in group 1, 157 in group 2, 167 in group 3, and 159 in group 4. Group 1 had a higher frequency of AECOPD in February to May than in October to January next year (P=0.013) , so did group 2 (P=0.016) . In contrast, group 4 had a higher frequency of AECOPD in October to January next year than in February to May (P=0.001) . The frequency of AECOPD during October to December in group 4 was similar to that of the other three groups (P>0.05) . But the frequency of AECOPD from February to April in group 4 was lower than that in groups 1-3 (P<0.05) . There was no significant difference in the monthly frequency of AECOPD without medical attention in group 4 compared with that of groups 1-3 (P>0.05) . The frequency of AECOPD with medical attention from October to December in group 4 was similar to that of groups 1-3 (P>0.05) . but it from February to April in group 4 was lower than that in groups 1-3 (P<0.05) .
Prevention and control measures targeting COVID-19 may be contributive to reducing the frequency of AECOPD. It is suggested that COPD patients should reduce gathering activities, maintain social distance, wear masks when going out, and wash hands frequently even after the COVID-19.
The transmission speed and concealment of the Omicron variant of SARS-CoV-2 have been enhanced. The awareness level and skills of correctly donning and doffing personal protective equipment (PPE) in SARS-CoV-2 containment workers from the mobile cabin hospital are associated with their own health status, and the overall quality of COVID-19 pandemic control.
To understand the awareness and skills of correctly donning and doffing PPE in SARS-CoV-2 containment workers from a mobile cabin hospital.
By use of cluster sampling, 460 SARS-CoV-2 containment workers were selected from the Fourth Branch of Shanghai Mobile Cabin Hospital located in the National Exhibition and Convention Center (Shanghai) , from April 10 to May 10, 2022. Their awareness and skills of correctly donning and doffing PPE were assessed using an online survey with a self-developed questionnaire named Awareness of Correctly Donning and Doffing Personal Protective Equipment, and using an onsite performance assessment with a self-developed questionnaire named Skills of Correctly Donning and Doffing Personal Protective Equipment, respectively.
The survey obtained a response rate of 83.5% (384/460) . According to the survey, both doctors and nurses had significantly higher average scores with regards to the operations at the first donning area, second donning area, front doffing area and first doffing area, second doffing area, and hand hygiene disinfection than public security officers and fire fighters (P<0.05) . All of the 460 cases completed the onsite performance assessment. Both doctors and nurses obtained lower average scores in terms of completing the operations at the first donning area, and donning steps in clean area into contaminated area than public security officers and fire fighters (P<0.05) . Doctors had much lower average score for completing the operations at the first donning area than nurses (P<0.05) .
There were significant differences in the levels of awareness and skills of correctly donning and doffing PPE in SARS-CoV-2 containment workers by occupation. Targeted and focused trainings and supervisions should be carried out to improve the mismatching between the levels of awareness and skills.
The spreading epidemic of novel coronavirus (corona virus disease 2019, COVID-19) pneumonia poses a serious challenge to global life health and disease control, with significantly higher mortality rates among individuals infected with COVID-19 comorbid underlying disease. Inhibitors of the rennin-angiotensin-aldosterone system (RAASi) , an important class of anti-hypertensive drugs, have been found to increase the morbidity and mortality of COVID-19. This study aimed to clarify the efficacy and safety of RAASi treatment in COVID-19 patients with hypertension.
To systematically evaluate the efficacy and safety of RAASi therapy in COVID-19 patients with hypertension.
PubMed, Embase, Cochrane Library and China National Knowledge Infrastructure (CNKI) were searched from inception to January 2022. A publicly available case-control studies of COVID-19 patients with hypertension treated with RAASi versus non RAASi therapy were included, and outcome measures were overall mortality, incidence of critical illness, incidence of acute respiratory distress syndrome (ARDS) , incidence of myocardial injury, and incidence of renal injury, with meta-analysis performed using Revman 5.3.
Seventeen studies with a total of 5 689 patients were included, of whom 2 168 received RAASi therapy and 3 521 did not. Meta analysis showed that overall mortality was lower in COVID-19 comorbid hypertensive patients treated with RAASi compared with non RAASi treated patients 〔OR=0.54, 95%CI (0.41, 0.72) , P<0.000 1〕; Between RAASi treated and non RAASi treated COVID-19 patients associated with hypertension, the incidence of critical illness 〔OR=0. 92, 95%CI (0.79, 1.08) , P=0.30〕, the incidence of ARDS 〔OR=0.81, 95%CI (0.57, 1.13, P=0.22〕, the incidence of myocardial injury 〔OR=1.03, 95%CI (0.83, 1.27) , P=0.82〕, and the incidence of kidney injury 〔OR=1.13, 95%CI (0.78, 1.66) , P=0.52〕, differences were not statistically significant.
Treatment with RAASi in COVID-19 patients with hypertension reduced the overall mortality rate, and did not increase the incidence of critical illness, ARDS, myocardial injury, and renal injury in COVID-19 patients with hypertension. RAASi therapy is effective and safe in treating patients with COVID-19 combined with hypertension.
The global COVID-19 is still in a pandemic state, and Omicron is still the dominant variant in the world, accounting for about 99% of the global gene sequence. Many regions around the world are experiencing the seventh wave of the epidemic. This round of epidemics is mainly caused by Omicron subvariants BA.4 and BA.5, but the epidemiological characteristics of Omicron subvariants BA.4 and BA.5 are still unclear, bringing great challenges to the prevention and control of the epidemic in countries and regions. In this study, discovery and epidemic status, the incubation period, transmissibility, clinical symptoms, case fatality rate, and the protective effect of vaccines of Omicron subvariants BA.4 and BA.5 were reviewed, in order to provide reference for scientific prevention and control of Omicron subvariants BA.4 and BA.5.
Based on the current prevalence of Coronavirus Disease 2019 (COVID-19) , early diagnosis, isolation, and treatment are important methods to prevent and control infectious diseases. The establishment of convenient and efficient immunochromatographic detection techniques is essential for the prevention and control of COVID-19 epidemic.
To establish a method for the detection of SARS-CoV-2 anti-N protein IgG antibody by immun of luorescence chromatography method based on quantum dots labeling technology in August, 2020. In order to determine whether the detected persons had been infected with COVID-19 or been injected with SARS-CoV-2 inactivated vaccine.
The prepared rat anti-human secondary antibody and anti-N protein antibody were immobilized on a Nitrocellulose (NC) membrane as detection line (T) and quality control line (C) , respectively. Then the SARS-CoV-2 N protein labeled by quantum dots was evenly sprayed on glass fiber, which was assembled, cut and packaged into test strips after drying. The test strips were used to detect the clinical serum of 35 COVID-19 patients and 50 healthy individuals, the results of the initial screening of the ELISA kit were used as a control to calculate the detection specificity and sensitivity of quantum dots fluorescence immunochromatography. The sensitivity of the test strip was detected by using the N protein antibody standard.
The specificity and sensitivity of the strip were 100.00%, 94.29%, and the susceptibility was 8.53-17.06 ng/ml antibody concentration.
The detection of anti-N protein IgG antibody in serum by quantum dots labeling is simple, fast, with strong sensitivity and specificity.
Policies Implemented in Beijing for Guaranteeing Healthcare for Community-dwelling Patients with Noncommunicable Diseases during the COVID-19 Pandemic
The COVID-19 pandemic brings about influence and challenge for ensuring healthcare services for non-communicable diseases. To guarantee the healthcare services for community-living patients with non-communicable diseases and to meet their healthcare needs, the Beijing municipal government issued a series of policies and relevant supporting measures, including five parts: promoting the implementation of the extended prescription policy, providing Internet-based medical services, further implementing the hierarchical medical system, giving full play to the role of family doctors, and carrying out the service of doorstep delivery of medicines. We reviewed and summarized policies and corresponding measures implemented in Beijing for guaranteeing healthcare for community-dwelling non-communicable disease patients during COVID-19 early response period and ongoing containment period. By evaluating the implementation effect of the policies and comparing with those at home and abroad, it is found that the community chronic disease management under the continuous epidemic situation can be further optimized in the future from the aspects of strengthening the training of grass-roots medical personnel, paying attention to the monitoring of chronic diseases and their risk factors, accurate health management, continuing to implement the hierarchical diagnosis and treatment system, and exploring the whole cycle health management of chronic diseases.
Analysis and Research on the Characteristics of COVID-19 Epidemic in Urban Village and Its Prevention and Control Strategies in Primary Care Institutions
For a period of time, the outbreak of the COVID-19 outbreak in many urban villages in our country had caused concern. The dense and complex population structure of urban villages, with their inter-regional mobility, posed a challenge to the prevention and control of the epidemic.
Urban village areasare more prone to regional outbreaks of infectious diseases because of their spatial environment, demographic characteristics, cross-regional mobility and the characteristics of residents' medical treatment behavior. The purpose of this study was tounderstand the characteristics of the COVID-19 epidemic situation in urban villages and the current situation and difficulties of primary care institutions in carrying out COVID-19 epidemic prevention and control measures, in order to provide references for primary care institutions to deal with normalized prevention and control, social dynamic clearing work and future infectious disease prevention and control.
By using public opinion analysis, literature retrieval, online interviews with epidemic prevention and control personnel and experts in urban village, the epidemic situation, prevention and control status of urban village were summarized, and the existing weak links and important loopholes were analyzed.
Based on the relevant information, a total of six points of concern were extracted: (1) The number of mapping and screening objects was large, which was the focus and difficulty of epidemic prevention and control work in urban villages. (2) There was not strict closed-loop management lead to virus carriers who were not timely controlled, which caused a risk of spreading the epidemic. (3) The prevention and control of nosocomial infection in primary care institutions was not in place. (4) There were loopholes in the inspection of close contacts in the principle of territorial management; close contacts who did not live and work in the same administrative area but only screened in their living places, which may lead to the spread of the epidemic in workplaces where secondary close contacts may be at risk of infection were not screened in a timely manner. (5) Overload had become the norm, highlighting the large gap in primary health care manpower. (6) During the normalization of epidemic prevention and control, residents were paralyzed and careless, and the phenomenon of not wearing masks in public places and crowd gathering was common. Health education still needs to be strengthened and emphasized that residents were the first responsible for their own health.
Primary care providers played an important role in the prevention and control of COVID-19 in urban village by undertaking community management, outpatient treatment, public health services, health education, vaccination, quarantine hotel stationing, joint prevention and control, etc. It was recommended that additional fever sentinel clinics be set up for early detection and isolation to avoid further spread of the epidemic, rental houses be requisitioned to meet the demand for isolated medical observation, primary care institutions be strengthened for hospitalization and prevention, green relief channels be opened to protect special groups from medical treatment, volunteers be organized to reinforce primary care institutions, and health education emphasized that residents were the first to be responsible for maintaining their own health and raised personal awareness of the risk of COVID-19 prevention and control.
Expert Advice on Community-based Grid Containment of COVID-19 Pandemic by the General Practice Network & Regional Medical Consortium
The COVID-19 containment has become a top global public health concern. China has obtained a phased achievement in containing COVID-19 pandemic, during the process, primary medical institutions and general practitioner teams in regional medical consortiums have played a key role. To better guide and standardize the development of regional medical consortiums, give full play to the bridge role and grid management of general medicine in COVID-19 pandemic containment, and consolidate the achievements of COVID-19 pandemic containment further, we invited a group of related experts to develop the Expert Advice on Community-based Grid Containment of COVID-19 Pandemic by the General Practice Network & Regional Medical Consortium (the First Version for Trial Implementation) (hereinafter referred to as the Expert Advice) following in-depth analysis and thorough consideration of literature review results, suggestions extensively collected and practical evidence, which mainly includes the following aspects: the essential characters of the general practice network & regional medical consortium, organizational structure, contents and separation of responsibilities and duties, operation mechanism, content of the work, workflow, training and assessment. We hope the Expert Advice will contribute to the construction and operation of the general practice network & regional medical consortium in various regions for COVID-19 containment.
Roles of Primary Care in Response to the COVID-19 Pandemic Defined in Policy Documents
The major promise for promoting primary care intuitions to take the initiative to play an active role in containing the COVID-19 pandemic is defining the duties and roles that they should undertake.
To review the policy documents related to COVID-19 issued by China's health administrative departments to make a systematic summary of the responsibilities and duties that should be undertaken by primary care institutions, offering guidance for COVID-19 containment in various regions of China.
In August 2021, we searched the official websites of the National Health Commission of the People's Republic of China (PRC) and its subordinate institutions for policy documents related to COVID-19 using "primary careinstitutions" "prevention and control at the community level" "COVID-19" and "COVID-19 prevention and control" as the main search terms. The policy documents containing "COVID-19 prevention and control" and "primary careinstitutions" were sorted out in chronological order of publication, and their contents were intensively reviewed, organized, summarized and analyzed.
Thirty-four policy documents extracted from the official websites of the National Health Commission of the PRC and its three subordinate institutions (Department of Primary Health, the former Bureau of Medical Administration and the former Bureau of Disease Prevention and Control) were finally enrolled. They were mainly formulated by the Joint Prevention and Control Mechanism of the State Council in Response to the COVID-19, General Office and Department of Primary Health of the National Health Commission of the PRC. According to these policy documents, the major responsibilities of primary care institutions in containing COVID-19 include: early detection and reporting the suspected COVID-19 cases; receiving trainings regarding knowledge related to COVID-19 containment and emergency preparedness drills for coping with the pandemic; strengthening nosocomial COVID-19 infection containment and personal protection against the pandemic; cooperating with the community in fighting the COVID-19 pandemic; implementing health education about COVID-19 containmentusing a scientific approach; health management of priority populations; collecting and submitting nucleic acid samples; COVID vaccination.
Primary care institutions play a vital role in containing COVID-19 in China. The local governments should follow policy guidelines, and take measures according to the local conditions to facilitate the primary care in stitutions to better their performance in response to COVID-19 as frontline responders.
The Incubation Period of COVID-19 Caused by Different SARS-CoV-2 Variants
Since the beginning of the COVID-19 epidemic, the pathogen of COVID-19, SARS-CoV-2, has evolved and mutated continuously, producing variants with different enhanced transmission and virulence, such as Alpha (B.1.1.7) , Beta (B.1.351) , Gamma (P.1) , Delta (B.1.617.2) and Omicron (B.1.1.529) . An intensive study of the incubation period of COVID-19 caused by different SARS-CoV-2 variants will contribute to tracing the origin of COVID-19, determining the detention, quarantine and isolation time of close contacts, and timely improving measures for containing COVID-19. We reviewed the major studies on the incubation period of COVID-19 caused by wild-type strains and different variants of SARS-CoV-2, which estimated that the incubation period of COVID-19 caused by wild-type SARS-CoV-2 strains was 4-8 (median 5.5) days. And that for COVID-19 caused by Beta or Gamma variant was generally similar to that by wild-type strains, about 5 days. The incubation period of COVID-19 caused by Alpha, Delta and Omicron variants was shorter than that of other strains, which was 4, 4 and 3 days, respectively.
The Core Competencies in Emergency Management and Areas in Demand for Improvement in Community Public Health Emergency Responders amid COVID-19 Pandemic
Under the conditions of regular containment of COVID-19 epidemic, the levels of core competencies in emergency management of community public health emergency responders are directly associated with the effectiveness of management of public health emergencies. However, there are few studies on core competencies in emergency management of public health emergencies and areas in demand for improvement in community public health emergency responders.
To examine the core competencies in emergency management of COVID-19 pandemic, and associated factors as well as areas in demand for improvement within community public health emergency responders from Zhejiang Province.
Using the Core Response Competence Index System for Infectious Disease Emergencies among Medical Staff as a reference, we developed a questionnaire consisting of three parts: demographic and COVID-19 containment status, Core Competencies for Emergency Management of Public Health Emergencies (CCEMPHE) , and areas in demand for improvement, and used it to conduct an online survey with 749 community public health emergency responders selected from six counties (districts) of Zhejiang using stratified cluster sampling in September 2020.
The survey achieved a response rate of 93.3% (699/749) . The average score of CCEMPHE for the respondents was (118.38±27.60) , with a scoring rate of 62.3%. The scoring rates of three dimensions of the CCEMPHE from high to low were prevention ability (66.4%) , preparedness ability (63.7%) and rescue ability (62.0%) . Multiple linear regression analysis showed that education background (b=4.55) , physical quality for emergency work (b=9.26) , experiences of participating in developing emergency plan/technical proposal (b=6.43) , attending emergency training (b=6.35) , field epidemiology training (b=4.62) , on-site emergency disposal experience (b=5.32) , the number of theoretical trainings related to COVID-19 (b=4.29) , and the number of COVID-19 containment projects involved in (b=1.16) , were associated with the core competencies in emergency management of COVID-19 pandemic in community public health emergency responders (P<0.05) . In terms of areas in demand for improvement, the knowledge related to health emergency response and management (4.09±0.86) was in highest demand, on-site guidance (4.17±0.84) was the most popular training form and short-term training (3.93±0.92) was the most suitable training method.
The community public health emergency responders in Zhejiang Province had lower intermediate CCEMPHE, and a high demand for improvement. To improve the core competencies in emergency management of infectious disease emergencies of community public health emergency responders, it is suggested to health administrators to strengthen practice trainings for these responders based on their needs, especially on-site practice trainings, with a focus on practical skill training.
Epidemiologic Features and Containment of SARS-CoV-2 Omicron Variant
Since the first case of the Omicron (B.1.1.529) variant discovered in South Africa was reported to the WHO on November 24, 2021, a total of 57 countries (regions) had reported Omicron cases as of December 8, 2021. Omicron has become the dominant strain in some African countries and is spreading rapidly. Although Omicron causes mild symptoms, with most cases being asymptomatic and mild, the rapid increase in the number of cases could put a heavy strain on global health systems. In addition, its source, transmission characteristics and vaccine resistance remain unclear, which brings great challenges to pandemic prevention and control in all countries (regions) . We reviewed the latest developments in etiological characteristics, mutation sources, transmission characteristics and possible mechanisms, pandemic status, vaccine protection effect and containment measures regarding Omicron, providing a reference for scientific containment of Omicron mutant.
在过去的10 d 里，博伊尔夫人，一位59 岁的遗孀，已经是第三次来诊所看病了。她长期患有广泛性焦虑症，伴有频繁发作的躯体化症状，目前服用150 mg 的文拉法辛才能控制住。 自从新型冠状病毒肺炎（以下简称新冠肺炎）大流行以来，她笃信自己会被这种病毒消灭掉。她丈夫3 年前死于运动神经元疾病，她曾看到过丈夫挣扎着喘不上气的样子，后来也在电视上看到过几次患者使用呼吸机的镜头，这让她坚信这就是等待着她的命运结局。
