Reciprocity in Quarantine: Observations from Wuhan's COVID-19 Digital Landscapes

The 2003 SARS pandemic heralded the return of quarantine as a vital part of twenty-first century public health practice. Over the last two decades, MERS, Ebola, and other emerging infectious diseases each posed unique challenges for applying quarantine ethics lessons learned from the 2003 SARS-CoV-1 outbreak. In an increasingly interdependent and connected global world, the use of quarantine to contain the spread of SARS-CoV-2, or COVID-19, similarly poses new and unexpected ethical challenges. In this essay, we look beyond standard debates about the ethics of quarantine and state power to explore a key quarantine principle, Reciprocity, and how it is being negotiated by healthcare workers, volunteers, and citizens in the context of the Wuhan, China, quarantine. We analyze Reciprocity through the lens of two Wuhan case studies: (1) healthcare workers, particularly nurses, who are simultaneously essential workers and quarantined citizens, asked by their hospital administration to shave their heads because adequate PPE was not available, and (2) citizen-to-citizen mutual aid societies attempting to fill gaps in essential supplies left unfilled by the state. We analyze social media and video-blogs from Wuhan, on the platforms of Douyin and Sina Weibo, to understand how people define and respond to ethical and legal obligations in the wake of COVID-19. It is no surprise that quarantine principles from the 2003 SARS outbreak are inadequate for COVID-19 and that both infectious disease outbreak responses and ethics must adapt to the virtual age. We offer ideas to strengthen and clarify Reciprocal obligations for the state, hospital administrators, and citizens as the globe prepares for the next wave of COVID-19 circulating now.

Higher education and Sustainable Development Goals during COVID-19: coping strategies of a university in Wuhan, China

Background: It is widely perceived that COVID-19 has significant influence on higher education and also contribution to development including Sustainable Development Goals (SDGs). However there is insufficient evidence about investigations on such influences, especially at micro level.

Design and method: A university located in Wuhan, China, is selected for the case study to explore how COVID-19 affects higher education and how universities’ coping strategies of COVID-19 can contribute to SDGs. The method is an analysis of 32 institutional documents published by the university.

Results: The university in the case study has taken a number of coping strategies of COVID-19, largely in four aspects including medical services, online education, logistic support, and graduate employment promotion. These coping strategies contribute to achieving SDGs, especially SDGs 1, 3, 4, 5, 8, and 10.

Conclusions: The case study provides micro-level empirical evidence, which supports that appropriate university coping strategies of COVID-19 can contribute to SDGs, even it is widely perceived that the pandemic has brought strong negative impact on higher education and sustainable development. The selection of a university in Wuhan, China, can generate more practical implications, as Wuhan is the first city that experienced the unprecedented lockdown, and China is the first country that reopened university campuses after the lockdown.

Risk Factors for Mortality in 220 Patients With COVID-19 in Wuhan, China: A Single-Center, Retrospective Study

BACKGROUND

An outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 infection occurred in Wuhan, China, in December 2019. To date, the analysis of fatal cases and the risk factors for death have rarely been reported.

METHODS

In this study, 220 adult patients with confirmed and suspected COVID-19 were enrolled. Clinical characteristics, laboratory data, treatments, and complications were compared between 168 survivors and 52 nonsurvivors. Univariable analysis and multivariable logistic regression were used to investigate the risk factors for mortality.

RESULTS

A total of 220 patients (168 were discharged and 52 died in the hospital) were enrolled in the study. The median age of all patients was 59.5 (47.0-69.0) years, and the median age of patients who died was significantly older than that of patients who survived (70.5 vs 56.0 years, respectively; P < .001). According to multivariate logistic regression, older age (odds ratio: 1.09, 95% CI: 1.03-1.15; P = .001), initial Sequential Organ Failure Assessment (SOFA) score >2 (37.4, 9.4-148.0; P = .011), and respiratory rate >24 per minute (10.89, 1.47-80.67; P = .019) were independent risk factors for mortality.

CONCLUSION

Clinical and laboratory parameters predicting poor prognosis including older age, baseline SOFA score >2, and respiratory rate >24 per minute were identified.

An illumination of the ICN's core competencies in disaster nursing version 2.0: Advanced nursing response to COVID-19 outbreak in China

AIM

This study aims to report on the actions and incident management of the advanced practice nurses of a disaster operation team who were deployed in response to the COVID-19 outbreak, and to explore how it illustrated the Core Competencies in Disaster Nursing Version 2.0 delineated by the International Council of Nurses in 2019.

METHODS

This is a descriptive study. The participants (responders) communicated and reported their actions in the operation with headquarter on a popular social media platform in China (WeChat), established specifically for the three-rescue teams.

RESULTS

The response approach of advanced nurses to COVID-19 encompassed six of the eight domains of the competencies outlined in ICN CCDN V2.0, namely on preparation and planning, communication, incident management systems, safety and security, assessment and intervention.

CONCLUSIONS

The response teams of advanced practice nurses in this study clearly demonstrated their competencies in disaster rescue, which fulfilled most of the core competencies set forth by the ICN.

IMPLICATIONS FOR NURSING MANAGEMENT

The findings of this study contributed to understand the roles played by advanced practice nurses and nurse managers in disaster management and how these relate to the competencies set forth by the ICN.

Population migration, confirmed COVID-19 cases, pandemic prevention, and control: evidence and experiences from China

Aim

The virulence of the novel coronavirus disease (COVID-19) has facilitated its rapid transition towards becoming a pandemic. Hence, this study aims to investigate the association between population migration and the number of confirmed COVID-19 cases in China while investigating its measures for pandemic prevention and control.

Subject and methods

A susceptible–exposed–infected–recovered–dormancy (SEIRD) model for the spread of COVID-19 in China was created to theoretically simulate the relationship between the populations migrating from Wuhan and the number of confirmed cases. Data from Baidu’s real-time dynamic pandemic monitoring system were elicited to empirically examine the theoretical inferences.

Results

Populations migrating from Wuhan to other cities increased the initial number of latently infected cases in these cities, raising the number of confirmed cases. Hence, implementing social distancing between the susceptible and infected populations could effectively lower the number of infected cases. Using data from Baidu’s real-time dynamic pandemic monitoring system, the empirical results revealed that an increase of 1000 persons migrating from Wuhan raised the number of confirmed cases by 4.82 persons.

Conclusion

This study confirmed the positive association between population migration and the number of confirmed COVID-19 cases. Based on the theoretical and empirical analysis, China’s pandemic prevention and control measures are discussed.

Predictive Models of Mortality for Hospitalized Patients With COVID-19: Retrospective Cohort Study

BACKGROUND

The novel coronavirus SARS-CoV-2 and its associated disease, COVID-19, have caused worldwide disruption, leading countries to take drastic measures to address the progression of the disease. As SARS-CoV-2 continues to spread, hospitals are struggling to allocate resources to patients who are most at risk. In this context, it has become important to develop models that can accurately predict the severity of infection of hospitalized patients to help guide triage, planning, and resource allocation.

OBJECTIVE

The aim of this study was to develop accurate models to predict the mortality of hospitalized patients with COVID-19 using basic demographics and easily obtainable laboratory data.

METHODS

We performed a retrospective study of 375 hospitalized patients with COVID-19 in Wuhan, China. The patients were randomly split into derivation and validation cohorts. Regularized logistic regression and support vector machine classifiers were trained on the derivation cohort, and accuracy metrics (F1 scores) were computed on the validation cohort. Two types of models were developed: the first type used laboratory findings from the entire length of the patient's hospital stay, and the second type used laboratory findings that were obtained no later than 12 hours after admission. The models were further validated on a multicenter external cohort of 542 patients.

RESULTS

Of the 375 patients with COVID-19, 174 (46.4%) died of the infection. The study cohort was composed of 224/375 men (59.7%) and 151/375 women (40.3%), with a mean age of 58.83 years (SD 16.46). The models developed using data from throughout the patients' length of stay demonstrated accuracies as high as 97%, whereas the models with admission laboratory variables possessed accuracies of up to 93%. The latter models predicted patient outcomes an average of 11.5 days in advance. Key variables such as lactate dehydrogenase, high-sensitivity C-reactive protein, and percentage of lymphocytes in the blood were indicated by the models. In line with previous studies, age was also found to be an important variable in predicting mortality. In particular, the mean age of patients who survived COVID-19 infection (50.23 years, SD 15.02) was significantly lower than the mean age of patients who died of the infection (68.75 years, SD 11.83; P<.001).

CONCLUSIONS

Machine learning models can be successfully employed to accurately predict outcomes of patients with COVID-19. Our models achieved high accuracies and could predict outcomes more than one week in advance; this promising result suggests that these models can be highly useful for resource allocation in hospitals.

Online Health Information Seeking Using "#COVID-19 Patient Seeking Help" on Weibo in Wuhan, China: Descriptive Study

Background

First detected in Wuhan, China in December 2019, the COVID-19 pandemic stretched the medical system in Wuhan and posed a challenge to the state’s risk communication efforts. Timely access to quality health care information during outbreaks of infectious diseases can be effective to curtail the spread of disease and feelings of anxiety. Although existing studies have extended our knowledge about online health information–seeking behavior, processes, and motivations, rarely have the findings been applied to an outbreak. Moreover, there is relatively little recent research on how people in China are using the internet for seeking health information during a pandemic.

Objective

The aim of this study is to explore how people in China are using the internet for seeking health information during a pandemic. Drawing on previous research of online health information seeking, this study asks the following research questions: how was the “#COVID-19 Patient Seeking Help” hashtag being used by patients in Wuhan seeking health information on Weibo at the peak of the outbreak? and what kinds of health information were patients in Wuhan seeking on Weibo at the peak of the outbreak?

Methods

Using entity identification and textual analysis on 10,908 posts on Weibo, we identified 1496 patients with COVID-19 using “#COVID-19 Patient Seeking Help” and explored their online health information–seeking behavior.

Results

The curve of the hashtag posting provided a dynamic picture of public attention to the COVID-19 pandemic. Many patients faced difficulties accessing offline health care services. In general, our findings confirmed that the internet is used by the Chinese public as an important source of health information. The lockdown policy was found to cut off the patients’ social support network, preventing them from seeking help from family members. The ability to seek information and help online, especially for those with young children or older adult members during the pandemic. A high proportion of female users were seeking health information and help for their parents or for older adults at home. The most searched information included accessing medical treatment, managing self-quarantine, and offline to online support.

Conclusions

Overall, the findings contribute to our understanding of health information–seeking behaviors during an outbreak and highlight the importance of paying attention to the information needs of vulnerable groups and the role social media may play.

Protecting Healthcare Workers Amid the COVID-19 Crisis: A Safety Protocol in Wuhan

Coronavirus disease 2019 (COVID-19), which is caused by a distinct coronavirus, is an acute infectious disease that spreads mainly via the respiratory route. During the COVID-19 outbreak, many healthcare systems faced a severe burden when a large number of healthcare workers (HCWs) became infected due to the lack of adequate protection. Consequently, it was apparent that it is important to ensure the health and safety of HCWs in order to control the outbreak throughout society. In this article, we share our successful protocol for protecting the safety of HCWs in the course of their daily work in an orthopedics department with the aim of eventually reducing the risk of nosocomial infection. None of our HCWs or their families contracted the infection during the COVID-19 pandemic.

Temporal association between particulate matter pollution and case fatality rate of COVID-19 in Wuhan

The coronavirus (COVID-19) epidemic reported for the first time in Wuhan, China at the end of 2019, which has caused 4648 deaths in China as of July 10, 2020. This study explored the temporal correlation between the case fatality rate (CFR) of COVID-19 and particulate matter (PM) in Wuhan. We conducted a time series analysis to examine the temporal day-by-day associations. We observed a higher CFR of COVID-19 with increasing concentrations of inhalable particulate matter (PM) with an aerodynamic diameter of 10 μm or less (PM₁₀) and fine PM with an aerodynamic diameter of 2.5 μm or less (PM_2.5) in the temporal scale. This association may affect patients with mild to severe disease progression and affect their prognosis.

The application of Temporary Ark Hospitals in controlling COVID-19 spread: The experiences of one Temporary Ark Hospital, Wuhan, China

Coronavirus disease 2019 (COVID-19) had its evolution in Wuhan, Hubei Province, China, and now it has spread around the world, resulting in a large number of deaths. Temporary Ark hospitals (TAHs) have played an important role in controlling the spread of the epidemic in the city of Wuhan. Taking one TAH with 800 beds as an example, we summarized details of the layout, setting, working mode of medical staff, patient management, admission standards, discharge standards, and standards for transferring to another hospital, hospital operation, and so on. Over the period of operation, a total of 1124 patients were admitted for treatment. Of these, 833 patients were cured and discharged from the hospital and 291 patients were transferred to other designated hospitals, owing to aggravation of their condition. The achievement was to have zero infection for medical staff, zero in-hospital deaths among admitted patients, and zero readmission for discharged patients. The rapid deployment of TAH provided a suitable place for treating mild/moderate or no asymptomatic COVID-19 patients, which successfully helped to control the infection in Wuhan. The successful model of TAH would rapidly and effectively control the spread of COVID-19 in other cities.

Clinical Characteristics and Outcomes of Older Patients with Coronavirus Disease 2019 (COVID-19) in Wuhan, China: A Single-Centered, Retrospective Study

Background

In December 2019, the coronavirus disease 2019 (COVID-19) emerged in Wuhan city and spread rapidly throughout China and the world. In this study, we aimed to describe the clinical course and outcomes of older patients with COVID-19.

Methods

This is a retrospective investigation of hospitalized older patients with confirmed COVID-19 at Zhongnan Hospital of Wuhan University from January 1, 2020, to February 10, 2020.

Results

In total, 203 patients were diagnosed with COVID-19, with a median age of 54 years (interquartile range, 41-68; range, 20-91 years). Men accounted for 108 (53.2%) of the cases, and 55 patients (27.1%) were >65 years of age. Among patients who were 65 years and older, the mortality rate was 34.5% (19/55), which was significantly higher than that of younger patients at 4.7% (7/148). Common symptoms of older patients with COVID-19 included fever (94.5%; n=52), dry cough (69.1%; n=38), and chest distress (63.6%; n=35). Compared with young patients, older patients had more laboratory abnormalities and comorbidities. Through a multivariate analysis of the causes of death in older patients, we found that males, comorbidities, time from disease onset to hospitalization, abnormal kidney function, and elevated procalcitonin levels were all significantly associated with death.

Conclusions

In the recent outbreak of COVID-19, our local hospital in Wuhan found that patients aged 65 and older had greater initial comorbidities, more severe symptoms, and were more likely to experience multi-organ involvement and death, as compared with younger patients.

Review of X-ray and computed tomography scan findings with a promising role of point of care ultrasound in COVID-19 pandemic

As healthcare professionals continue to combat the coronavirus disease 2019 (COVID-19) infection worldwide, there is an increasing interest in the role of imaging and the relevance of various modalities. Since imaging not only helps assess the disease at the time of diagnosis but also aids evaluation of response to management, it is critical to examine the role of different modalities currently in use, such as baseline X-rays and computed tomography scans carefully. In this article, we will draw attention to the critical findings for the radiologist. Further, we will look at point of care ultrasound, an increasingly a popular tool in diagnostic medicine, as a component of COVID-19 management.

Associating COVID-19 Severity with Urban Factors: A Case Study of Wuhan

Wuhan encountered a serious attack in the first round of the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in a public health social impact, including public mental health. Based on the Weibo help data, we inferred the spatial distribution pattern of the epidemic situation and its impacts. Seven urban factors, i.e., urban growth, general hospital, commercial facilities, subway station, land-use mixture, aging ratio, and road density, were selected for validation with the ordinary linear model, in which the former six factors presented a globally significant association with epidemic severity. Then, the geographically weighted regression model (GWR) was adopted to identify their unevenly distributed effects in the urban space. Among the six factors, the distribution and density of major hospitals exerted significant effects on epidemic situation. Commercial facilities appear to be the most prevalently distributed significant factor on epidemic situation over the city. Urban growth, in particular the newly developed residential quarters with high-rise buildings around the waterfront area of Hanyang and Wuchang, face greater risk of the distribution. The influence of subway stations concentrates at the adjacency place where the three towns meet and some near-terminal locations. The aging ratio of the community dominantly affects the hinterland of Hankou to a broader extent than other areas in the city. Upon discovering the result, a series of managerial implications that coordinate various urban factors were proposed. This research may contribute toward developing specific planning and design responses for different areas in the city based on a better understanding of the occurrence, transmission, and diffusion of the COVID-19 epidemic in the metropolitan area.

Could threshold cycle value correctly reflect the severity of novel coronavirus disease 2019 (COVID-19)?

The novel coronavirus disease 2019 (COVID-19) is diagnosed by positive result of reverse transcription polymerase chain reaction (RT-PCR) for the novel coronavirus. We concluded that cycle threshold value (Ct-value) of real-time RT-PCR (rRT-PCR) assay could decrease as patients recover. Results of rRT-PCR assay could remain positive among asymptomatic patients for longer than 2 weeks. The discharge criteria of COVID-19 patients using a negative result of rRT-PCR should be reconsidered.

Retrospective analysis of clinical characteristics of 405 patients with COVID-19

Objective

This study was performed to investigate the clinical characteristics of patients with coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Methods

We analyzed the electronic medical records of 405 hospitalized patients with laboratory-confirmed COVID-19 in the Third Hospital of Wuhan.

Results

The patients’ median age was 56 years, 54.1% were female, 11.4% had a history of smoking, and 10.6% had a history of drinking. All cases of COVID-19 were community-acquired. Fever (76.8%) and cough (53.3%) were the most common clinical manifestations, and circulatory system diseases were the most common comorbidities. Gastrointestinal symptoms were present in 61.2% of the patients, and 2.9% of the patients were asymptomatic. Computed tomography showed ground-glass opacities in most patients (72.6%) and consolidation in 30.9%. Lymphopenia (72.3%) and hypoproteinemia (71.6%) were observed in most patients. About 20% of patients had abnormal liver function. Patients with severe disease had significantly more prominent laboratory abnormalities, including an abnormal lymphocyte count and abnormal C-reactive protein, procalcitonin, alanine aminotransferase, aspartate aminotransferase, D-dimer, and albumin levels.

Conclusion

SARS-CoV-2 causes a variety of severe respiratory illnesses similar to those caused by SARS-CoV-1. Older age, chronic comorbidities, and laboratory abnormalities are associated with disease severity.

Liver impairment in COVID-19 patients: A retrospective analysis of 115 cases from a single centre in Wuhan city, China

BACKGROUND

The SARS-CoV-2 pandemic is an ongoing global health emergency. The aim of our study was to investigate the changes of liver function and its clinical significance in COVID-19 patients.

METHOD

This retrospective, single-centre study was conducted on 115 confirmed cases of COVID-19 in Zhongnan hospital of Wuhan University from 18 January 2020 to 22 February 2020. Liver function and related indexes were analysed to evaluate its relationship with disease progression in COVID-19 patients.

RESULTS

Part of the COVID-19 patients presented with varying degrees of abnormality in liver function indexes. However, the levels of ALT, AST, TBIL, GGT and LDH in COVID-19 patients were not significantly different when compared with hospitalised community-acquired pneumonia patients, and the levels of albumin is even significantly higher. The levels of ALT, AST, TBIL, LDH and INR showed statistically significant elevation in severe COVID-19 cases compared with that in mild cases. However, the clinical significance of the elevation is unremarkable. Majority of severe COVID-19 patients showed significantly decreasing in albumin level and continuously decreasing in the progress of illness. Most of the liver function indexes in COVID-19 patients were correlated with CRP and NLR, the markers of inflammation. Logistic regression analysis further identified NLR as the independent risk factor for severe COVID-19, as well as age.

CONCLUSIONS

Although abnormalities of liver function indexes are common in COVID-19 patients, the impairment of liver function is not a prominent feature of COVID-19, and also may not have serious clinical consequences.

Current role of imaging in COVID-19 infection with recent recommendations of point of care ultrasound in the contagion: a narrative review

Radiological studies have an important role in the diagnosis and follow up of many infectious diseases. With current pandemic of Coronavirus disease 2019 (COVID-19) though the molecular analysis with reverse transcriptase polymerase chain reaction (RT-PCR) remains the cornerstone of diagnosis, the critical role of chest imaging including CT scan and baseline X-ray became apparent early in the course due to concern for less than optimal sensitivity of PCR testing. Delay in molecular diagnosis due to a shortage of testing kits and laboratory personnel also makes imaging an important modality in early diagnosis for appropriate triage and isolation decisions. CT scan technology is widely available in developed parts of the world but in developing countries, CT scanner is not widely available especially in rural settings. CT imaging usually requires patient movement to the radiology department and the scanner is not easy to disinfect. Point of care ultrasound (POCUS) has been used for many years in the assessment of critically ill patients in emergency departments and intensive care units. It is rapidly gaining popularity across many specialties and part of many general medicine training programs across the United States. It can be learned rapidly and with experienced hands, POCUS can help identify disease patterns in the lung parenchyma, and during the current pandemic has been gaining special attention. In this article, we review the most prominent imaging findings on chest X-ray and CT scan in patients with COVID-19. We also focus on the background and evolution of POCUS with studies showing the promising role of this diagnostic modality in COVID-19 infection. In addition, we describe step by step guidance on the use and disinfection of the portable ultrasound machine.

Using the COVID-19 to influenza ratio to estimate early pandemic spread in Wuhan, China and Seattle, US

BACKGROUND

Pandemic SARS-CoV-2 was first reported in Wuhan, China on December 31, 2019. Twenty-one days later, the US identified its first case--a man who had traveled from Wuhan to the state of Washington. Recent studies in the Wuhan and Seattle metropolitan areas retrospectively tested samples taken from patients with COVID-like symptoms. In the Wuhan study, there were 4 SARS-CoV-2 positives and 7 influenza positives out of 26 adults outpatients who sought care for influenza-like-illness at two central hospitals prior to January 12, 2020. The Seattle study reported 25 SARS-CoV-2 positives and 442 influenza positives out of 2353 children and adults who reported acute respiratory illness prior to March 9, 2020. Here, we use these findings to extrapolate the early prevalence of symptomatic COVID-19 in Wuhan and Seattle.

METHODS

For each city, we estimate the ratio of COVID-19 to influenza infections from the retrospective testing data and estimate the age-specific prevalence of influenza from surveillance reports during the same time period. Combining these, we approximate the total number of symptomatic COVID-19 infections.

FINDINGS

In Wuhan, there were an estimated 1386 [95% CrI: 420-3793] symptomatic cases over 30 of COVID-19 between December 30, 2019 and January 12, 2020. In Seattle, we estimate that 2268 [95% CrI: 498, 6069] children under 18 and 4367 [95% CrI: 2776, 6526] adults were symptomatically infected between February 24 and March 9, 2020. We also find that the initial pandemic wave in Wuhan likely originated with a single infected case who developed symptoms sometime between October 26 and December 13, 2019; in Seattle, the seeding likely occurred between December 25, 2019 and January 15, 2020.

INTERPRETATION

The spread of COVID-19 in Wuhan and Seattle was far more extensive than initially reported. The virus likely spread for months in Wuhan before the lockdown. Given that COVID-19 appears to be overwhelmingly mild in children, our high estimate for symptomatic pediatric cases in Seattle suggests that there may have been thousands more mild cases at the time.

Ischemic Necrosis of Lower Extremity in COVID-19: A Case Report

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an acute infectious disease that spreads mainly via the respiratory route. Elderly patients or those with underlying diseases are more seriously affected. We report a case of COVID-19 infection in a geriatric patient with arteriovenous thrombosis of the right lower limb. Despite persistent anticoagulant therapy, the patient's arterial thrombosis continued to progress and presented with ischemic necrosis of the lower extremity. After amputation in this case, the levels of D-dimer and inflammatory cytokine increased progressively, and he presented with acute myocardial infarction, which progressed rapidly to multisystem organ failure. However, whether coronavirus can directly cause the damage of the cardiovascular system and thrombosis needs further investigation.

Fangcang shelter hospitals are a One Health approach for responding to the COVID-19 outbreak in Wuhan, China

In February 2020, the exponential growth of COVID-19 cases in Wuhan city posed a huge economic burden to local medical systems. Consequently, Wuhan established Fangcang Shelter hospitals as a One Health approach for responding to and containing the COVID-19 outbreak by isolating and caring for mild-to-moderate cases. However, it is unclear to what degree the hospitals contained COVID-19. This study performed an interrupted time series analysis to compare the number of new confirmed cases of COVID-19 before and after the operation of Fangcang Shelter hospitals. The initial number of confirmed cases in Wuhan increased significantly by 68.54 cases per day prior to February 4, 2020. Compared with the number of cases noted 20 days before the use of Fangcang Shelter hospitals, a sustained reduction in the number of confirmed cases (trend change, -125.57; P < 0.0001) was noted 41 days after the use of the hospitals. Immediate-level changes were observed for confirmed cases (level change, 725.97; P = 0.025). These changes led to an estimated 5148 fewer confirmed cases (P < 0.0001). According to the mean confirmed cases of 395.71 per day before the intervention, we estimated that Wuhan had advanced the terminal phase of COVID-19 by 13 days. Furthermore, immediately after introduction of Fangcang Shelter Hospitals on February 5, the reproduction number dropped rapidly, from a pre-introduction rate of 4.0 to 2.0. The Fangcang Shelter hospitals most likely to reversed the epidemic trend of COVID-19 while a containment strategy was implemented in Wuhan. In a One Health perspective, Fangcang Shelter hospitals, with their functions of isolation and treatment of confirmed COVID-19 patients, engaging professionals from many disciplines, such as medicine, engineering, architecture, psychology, environmental health, and social sciences. The results of this study provide a valuable reference for health policy makers in other countries.

Clinical course and findings of 14 patients with COVID-19 compared with 5 patients with conventional human coronavirus pneumonia

OBJECTIVE

To clarify what future problems must be resolved and how clinical findings of SARS-CoV-2 infection differ from those of cHCoV infection.

METHODS

Patients and Methods Clinical characteristics of 14 patients with laboratory-confirmed Coronavirus disease 2019 (COVID-19) and 5 patients with cHCoV pneumonia admitted to our institution and treated up to March 8, 2020, were retrospectively analyzed.

RESULTS

On admission, 10 patients had pneumonia, 5 of whom had pulmonary shadows detectable only via computed tomography (CT). During hospitalization, another patient with no pulmonary shadows on admission developed pneumonia. In total, 11 (78.6%) of the 14 patients developed pneumonia, indicating its high prevalence in COVID-19. During hospitalization, the patients' symptoms spontaneously relapsed and resolved, and gastrointestinal symptoms were frequently found. C-reactive protein values showed correlation with the patients' clinical courses. Ritonavir/lopinavir were administered to 5 patients whose respiratory conditions worsened during admission, all of whom improved. However, the pneumonia in the 6 other patients improved without antivirals. None of the 14 patients died, whereas 5 other patients with cHCoV pneumonia were in respiratory failure on admission, and one patient (20%) died.

CONCLUSION

Both SARS-CoV-2 and cHCoV can cause severe pneumonia. Problems for future resolution include whether antiviral agents administered in cases of mild or moderate severity can reduce the number of severe cases, and whether antivirals administered in severe cases can reduce mortality.

Analysis of the Risk Factors for Mortality in Adult COVID-19 Patients in Wuhan: A Multicenter Study

Objectives: An outbreak of coronavirus disease (COVID-19) in 2019 in Wuhan, China, has spread quickly worldwide. However, the risk factors associated with COVID-19-related mortality remain controversial. Methods: A total of 245 adult patients with laboratory-confirmed COVID-19 from two centers were analyzed. Chi-square, Fisher's exact, and the Mann-Whitney U-tests were used to compare the clinical characteristics between the survivors and non-survivors. To explore the risk factors associated with in-hospital death, univariable and multivariable cox regression analyses were used. Results: Of the 245 patients included in this study, 23 (9.4%) died in the hospital. The multivariate regression analysis showed increased odds of in-hospital deaths associated with age, D-dimer levels >1,000 ng/L, platelet count <125, and higher serum creatinine levels. Conclusions: We identified risk factors that show significant association with mortality in adult COVID-19 patients, and our findings provide valuable references for clinicians to identify high-risk patients with COVID-19 at an early stage.

Clinical manifestations and radiological features by chest computed tomographic findings of a novel coronavirus disease-19 pneumonia among 92 patients in Japan

Introduction

The novel coronavirus disease (COVID-19) could cause a severe acute respiratory infectious disease, showing a high mortality rate of 12–45% among cases who required intensive care unit admission. COVID-19 pneumonia

Patients and methods

For the purpose of identifying clinical manifestations and radiological findings of COVID-19 pneumonia, we reviewed all cases of COVID-19 pneumonia which were published by the homepage of the Japanese Association for Infectious Diseases from Feb 5 2020 until April 30 2020, including our cases. All patients were diagnosed based on positive results of the novel coronavirus-real-time RT-PCR with chest computed tomography (CT) findings.

Results

A total of 92 patients were enrolled in this study. The median age was 66 years (range 16–92 years). For all, 50 (54%) were males. The most common underlying disease was hypertension in 32 (36%). Any comorbidity was seen in 60 (67%). The mortality rate was 4 (6%). In terms of clinical symptoms on an initial visit, fever and cough were confirmed in 66 (72%) and 37 (40%). Forty-three (47%) had no respiratory symptoms. As for radiological findings by chest CT scan, ground-glass opacities (GGO)s, peripheral distribution, bilateral lung involvements were seen in 88 (96%), 76 (83%) and 78 (85%), respectively.

Conclusion

It is difficult to diagnose as COVID-19 pneumonia due to poor respiratory symptoms. Chest CT findings typically show GGO, peripheral and bilateral shadows. Patients should have chest CT performed if suspected for early diagnosis and therapeutic intervention, resulting in a favorable outcome and prevention of secondary nosocomial transmitted infection.

The effect of travel restrictions on the geographical spread of COVID-19 between large cities in China: a modelling study

BACKGROUND

To contain the spread of COVID-19, a cordon sanitaire was put in place in Wuhan prior to the Lunar New Year, on 23 January 2020. We assess the efficacy of the cordon sanitaire to delay the introduction and onset of local transmission of COVID-19 in other major cities in mainland China.

METHODS

We estimated the number of infected travellers from Wuhan to other major cities in mainland China from November 2019 to February 2020 using previously estimated COVID-19 prevalence in Wuhan and publicly available mobility data. We focused on Beijing, Chongqing, Hangzhou, and Shenzhen as four representative major cities to identify the potential independent contribution of the cordon sanitaire and holiday travel. To do this, we simulated outbreaks generated by infected arrivals in these destination cities using stochastic branching processes. We also modelled the effect of the cordon sanitaire in combination with reduced transmissibility scenarios to simulate the effect of local non-pharmaceutical interventions.

RESULTS

We find that in the four cities, given the potentially high prevalence of COVID-19 in Wuhan between December 2019 and early January 2020, local transmission may have been seeded as early as 1-8 January 2020. By the time the cordon sanitaire was imposed, infections were likely in the thousands. The cordon sanitaire alone did not substantially affect the epidemic progression in these cities, although it may have had some effect in smaller cities. Reduced transmissibility resulted in a notable decrease in the incidence of infection in the four studied cities.

CONCLUSIONS

Our results indicate that sustained transmission was likely occurring several weeks prior to the implementation of the cordon sanitaire in four major cities of mainland China and that the observed decrease in incidence was likely attributable to other non-pharmaceutical, transmission-reducing interventions.

The nexus between COVID-19, temperature and exchange rate in Wuhan city: New findings from partial and multiple wavelet coherence

This study attempts to document the nexus between weather, COVID-19 outbreak in Wuhan and the Chinese economy. We used daily average temperature (hourly data), daily new confirmed cases of COVID-19 in Wuhan, and RMB (Chinese currency) exchange rate to represent the weather, COVID-19 outbreak and the Chinese economy, respectively. The methodology of Wavelet Transform Coherence (WTC), Partial Wavelet Coherence (PWC) and Multiple Wavelet Coherence (MWC) is employed to analyze the daily data collected from 21st January 2020 to 31st March 2020. The results have revealed a significant coherence between the series at different time-frequency combinations. The overall results suggest the insignificance of an increase in temperature to contain or slow down the new COVID-19 infections. The RMB exchange rate and the COVID-19 showed an out phase coherence at specific time-frequency spots suggesting a negative but limited impact of the COVID-19 outbreak in Wuhan on the Chinese export economy. Our results are contrary to many earlier studies which suggest a significant role of temperature in slowing down the COVID-19 spread. These results can have important policy implications for the containment of COVID-19 spread and macro-economic management with respect to changes in the weather.