An index of open-access content relevant to COVID-19
Evaluation of Prognosis of Novel Coronavirus Pneumonia Combined with Acute Respiratory Distress Syndrome Patients with the Oxygenation Index and Dispersion Index of Mechanical Ventilation
WANG Jun，JIANG Shuqing*
Department of Critical Care Medicine，Tongde Hospital of Zhejiang Province，Hangzhou 330009，China
Abstract: Backgroud In the treatment of severe and severe cases，New Coronavirus pneumonia diagnosis and treatment plan （Trial Seventh Edition） suggested that if the patients did not improve or deteriorate within a short time （1-2 h） after the use of high flow nasal catheter oxygen therapy or non-invasive ventilation，tracheal intubation and invasive mechanical ventilation should be carried out in time. No objective reference indexes have been proposed in the opinions，and the commonly used oxygenation index is insufficient in the clinical application of such patients，so it is particularly important to explore more valuable reference indexes. Objective To compare the difference of dispersion index and oxygenation index in the prognosis assessment of patients diagnosed with Novel Coronavirus Pneumonia （COVID-19） who have acute respiratory distress syndrome （ARDS） when they are treated with mechanical ventilation. Methods A retrospective single center study was conducted in 39 patients with ARDS of Novel Coronavirus Pneumonia admitted to ICU with mechanical ventilation of Wuhan Tianyou Hospital from January 25，2020 to March 14，2020. Two of them were lost due to death within 24 hours，patients were divided into survival group （n=11） and death group （n=26） according to their 28-day status. Ventilator parameters and corresponding blood gas values were recorded to study the correlation between dispersion index and oxygenation index and 28 days' prognosis of patients. Results The worst oxygenation index，the dispersion index，and the worst dispersion index when entering ICU in the survival group were higher than those in the death group （P<0.05）. The sensitivity of the oxygenation index to predict death when entering the ICU was 100.0%，the specificity of the oxygenation index was 46.2%，the area under the ROC curve （AUC） was 0.654，and the difference between AUC and the reference value was not statistically significant （P=0.144）；The sensitivity of the oxygenation index to predict death was 3.8%，the specificity was 100.0%，and the AUC was 0.862 when the oxygenation index was the lowest，comparing with the reference value，the difference was statistically significant （P<0.05）；The sensitivity of the dispersion index to predict death was 7.7%，the specificity was 100.0%，and the AUC was 0.734 when entering the ICU，comparing with the reference value，the difference was statistically significant （P<0.05）；The sensitivity of the dispersion index to predict death was 100.0%，the specificity was 80.8%，and the AUC was 0.902 when the dispersion index was the lowest，comparing with the reference value，the difference was statistically significant （P<0.05）. Conclusion Dispersion index is a more sensitive and reliable prognostic indicator for ARDS in Novel Coronavirus Pneumonia patients than oxygenation index. The dispersion index is a more sensitive and reliable prognostic evaluation index than the oxygenation index in Novel Coronavirus Pneumonia patients with ARDS.
Cross-sectional Study of Target Admission General Practitioners' Participation in Combating COVID-19 Pandemic
CHENG Haozhe1，2，WANG Ziyue1，2，ZHANG Baisong1，2，WANG Huijuan1，2，WEI Tiantian1，2，CHENG Xiaoran1，2，LI Mingyue1，2，HU Dan2，LIU Xiaoyun2*
1.School of Public Health，Peking University，Beijing 100191，China
2.China Center for Health Development Studies，Peking University，Beijing 100191，China
*Corresponding author：LIU Xiaoyun，Professor，Doctoral supervisor；E-mail：xiaoyunliu@pku.edu.cn
Abstract: Background Primary healthcare workers have played an important role in combating the COVID-19 pandemic. Beginning in 2010，China initiated a national policy of implementing the rural-oriented tuition-free medical education（RTME） program，aiming to train general practitioners（GPs） with a medical undergraduate degree to work in rural areas to address the shortage of rural physicians. Since 2015，many graduates with RTME returned to the contracted rural hospital to fulfill a 3-year obliged health services，and their performance in combating COVID-19 epidemic is worth to be concerned about. Objective To compare the participation and role of target admission GPs and other graduates trained with a five-year undergraduate degree program for clinical medical students in combating COVID-19 pandemic，and to analyze the duties and challenges for target admission GPs during the anti-pandemic period，then based on this，to put forward policy recommendations for incentivizing target admission GPs. Methods The data were sourced from the Target Admission Medical Students Cohort Study Program. We conducted a follow-up survey among 1 631 target admission GPs and 1 009 other clinical medical graduates graduating from 4 medical colleges in central and western China using an online questionnaire in September 2020. Basic demographics，job information and work status during the COVID-19 pandemic were collected. Results Among those who were employed in the study period，target admission GPs had a higher rate of participating in combating COVID-19 pandemic than other clinical medical graduates〔70.18%（1 113/1 586）vs 51.58%（293/568），P<0.05〕. Among target admission GPs，men had a higher rate of being involved in combating COVID-19 pandemic than women（P<0.05）；those admitted in 2015 and 2016 had a higher rate of being involved in combating COVID-19 pandemic than those admitted during 2017 to 2019（P<0.05）；and those who were married had a higher rate of being involved in combating COVID-19 pandemic than those who were unmarried/divorced/other marital status（P<0.05）. The top 3 types of work which most target admission GPs participated were "health promotion and education"〔88.59%（986/1 113）〕，"community epidemic prevention and management"〔85.62%（953/1 113）〕，and "SARS-CoV-2 nucleic acid testing and screening"〔67.30%（749/1 113）〕. The top three challenges most target admission GPs faced in combating COVID-19 pandemic were "lack of personal protective equipment"〔77.72%（865/1 113）〕，"too much workload and/or pressure"〔41.87%（466/1 113）〕，and "worrying about themselves and their family being infected"〔37.56%（418/1 113）〕. The prevalence of target admission GPs who reported that there was an increase in daily clinical work was 57.50%（640/1 113）. And that of target admission GPs who reported that there was an increase in daily public health services was 62.26%（693/1 113）. Conclusion Target admission GPs have implemented multiple key services regarding COVID-19 containment，indicating that they have played a role in the national COVID-19 containment that cannot be ignored. However，they faced difficulties such as insufficient personal protective equipment and excessive work pressure. Measures need to be taken to improve the infrastructures in rural areas，and to provide more protection and support for primary healthcare workers.
A Follow-up Survey on Mental Health Status of COVID-19 Survivors
WANG Xixin1，2，CAO Jie3，YANG Yanguo4，XU Fei3，XIA Lei1，2，HU Xiaowen3，LIU Huanzhong1，2*
1.Department of Psychiatry，Chaohu Hospital of Anhui Medical University，Hefei 238000，China
2.School of Mental Health and Psychological Sciences，Anhui Medical University，Hefei 238000，China
3.Department of Pulmonary and Critical Care Medicine，the First Affiliated Hospital of University of Science and Technology/Anhui Provincial Hospital，Hefei 238000，China
4.Department of Respiratory Medicine，Anqing Hospital affiliated to Anhui Medical University，Anqing 246000，China
*Corresponding author：LIU Huanzhong，Chief physician，Doctoral supervisor；E-mail：huanzhongliu@ahmu.edu.cn.
Abstract: Background The "Work Plan for Psychological Counseling of Patients Under Normalization of Prevention and Control of New Coronary Pneumonia" in September 2020 pointed out that it is important to strengthen the follow-up of the psychological status of COVID-19 patients after recovery. At present，cross-sectional studies have found that patients have frequent mental health problems after recovery，but there is still a lack of dynamic follow-up studies. Objective A dynamic follow-up survey was conducted to investigate the mental health status and its influencing factors of COVID-19 patientstwo weeks and three months after recovery and discharge. Methods COVID-19 patients diagnosed in two designated hospitals in Anhui Province from February to April 2020 were selected as the research objects，the thegeneral demographic data were collected，and the Streaming Depression Self-Rating Scale （CES-D），Insomnia Severity Index Scale （ISI），Somatization Symptom Self-rating Scale（SSS） and Post-Traumatic Stress Disorder Checklist（PCL） were used for mental health status evaluation. Results One hundred and twenty five questionnaires were distributed.The results showed that the incidences of depression，insomnia，PTSD and somatization symptoms in COVID-19 patients at 2 weeks after discharge were 9.92% （12/121），26.45%（32/121），1.65%（2/121） and 4.96%（6/121），respectively. The incidences of depression，insomnia，PTSD and somatization symptoms at 3 months were 36.47%（31/85），83.53%（71/85），8.24%（7/85） and 18.82%（16/85），respectively. There was no significant difference in gender，age，health status，family support，need for psychological assistance and acceptance of psychological assistance between 2 weeks and 3 months after discharge （P>0.05）. There were significant differences in the economic status，physical and mental impairment and care about the views of the people around them at 2 weeks and 3 months after discharge（P<0.05）. The total scores of CES-D，ISI，SSS and PCL at 3 months after discharge were higher than those at 2 weeks after discharge（P<0.05）. In the Multivariate Logistic regression analysis with depression as the dependent variable，age and the need for psychological assistance were the risk factors of depression at 2 weeks after discharge（P<0.05）. Physical and mental impairment was the risk factor of depression at 2 weeks and 3 months after discharge（P<0.05）. The risk factor of depression at 3 months after discharge was caring about the views of the people around them. Patients who cared about the views of others were 3.997 times more likely to suffer from depressive symptoms than those who didn't〔OR （95%CI）=3.997（1.708，9.351），P=0.001〕. In the Multivariate Logistic regression with insomnia as the dependent variable，age，physical and mental impairment and the need for psychological assistance were the risk factors of insomnia at 2 weeks after discharge（P<0.05）. The risk factor of insomnia at 3 months after discharge was caring about the views of the people around them or not. Patients who cared about the views of others were 10.255 times more likely to suffer from insomnia than those who didn't〔OR （95%CI）= 10.255 （2.796，37.611），P<0.001〕.Conclusion After recovery and discharge，COVID-19 patients have obvious mental health problems such as depression，insomnia，post-traumatic stress disorder and somatization symptoms，and the longer the follow-up period，the higher the incidence of symptoms. Psychiatric professionals need to carry out psychological crisis intervention as soon as possible.
Prognostic Indicators for Severity in COVID-19 Patients：a Meta-analysis
WANG Jiting1，2，LI Jun3，TIAN Yuan1，2，LI Yaling 1*
1.Department of Pharmacy，the Affiliated Hospital of Southwest Medical University，Luzhou 646000，China
2.School of Pharmacy，Southwest Medical University，Luzhou 646000，China
3.Department of Traditional Chinese Medicine，the Affiliated Hospital of Southwest Medical University，Luzhou 646000，China
*Corresponding author：LI Yaling，Chief pharmacist，Master supervisor；E-mail：lylapothecary@swmu.edu.cn
Abstract: Background The COVID-19 has become a global pandemic declared by the WHO，and the severity of which affects the prognosis of patients.Objective To explore the prognostic indicators for severity and their predictive values in COVID-19 patients，providing a reference for clinical prediction of patients'outcome and prognosis.Methods Eight databases （the Cochrane Library，Embase，PubMed，Web of Science，SinoMed，CNKI，Wanfang Data Knowledge Service Platform，VIP）were searched from inception to 2020-09-03 for randomized controlled trials（RCTs）about severe versus non-severe COVID-19 patients or deceased versus survived COVID-19 patients with prognostic indicators［including procalcitonin （PCT），C-reactive protein （CRP），lymphocyte count （LYM），interleukin-6 （IL-6），D-dimer）studied.The modified Jaded Scale was used to assess the methodological quality.Stata 12.0 was used for meta-analysis.Results Fifteen RCTs were included，involving 1 476 cases，all were assessed with high methodological quality（modified Jadad Scale score ranging from 4 to 5 points）.Meta-analysis found that severe COVID-19 patients had higher mean values of PCT〔SMD=-2.28，95%CI （-3.60，
-0.98），P<0.001〕，CRP〔SMD=-2.23，95%CI （-3.38，-1.07），P<0.001〕，IL-6〔SMD=-2.97，95%CI （-4.94，-1.00），P<0.001〕，and D-dimer〔SMD=-1.22，95%CI （-2.66，0.21），P=0.008〕than non-severe COVID-19 patients.Severe COVID-19 patients had lower mean LYM〔SMD=1.41，95%CI （0.34，2.48），P<0.001〕.The deceased COVID-19 patients had higher mean values of PCT〔SMD=-4.11，95%CI （-9.98，1.76），P=0.007〕，CRP〔SMD=-2.73，95%CI （-4.21，-1.25），P<0.001〕，IL-6〔SMD=-3.79，95%CI （-4.90，-2.67），P<0.001〕，and D-dimer〔SMD=-0.68，95%CI （-1.46，0.09），P=0.009〕 than the survived.The deceased COVID-19 patients had lower mean LYM 〔SMD=2.08，95%CI （0.93，3.22），P<0.001〕.Conclusion Increased PCT，CRP，IL-6 and D-dimer and decreased LYM were found in severe or deceased COVID-19 patients，indicating that the former three may be positively correlated with severity，while the latter may be negatively correlated with severity.These five indicators may be used as prognostic indicators for severity，too high PCT，CRP，IL-6 and D-dimer，and too low LYM may suggest a poor prognosis.
Recent Developments in the Pathogenesis of COVID-19-associated Myocarditis
LUO Fei1，LI Shuren2*，HAO Xiao2，BAI Yuhao1，YUAN Kexin2，XIE Yuetao2
1.Graduate School，North China University of Science and Technology，Tangshan 063210，China
2.No.1 Cardiovascular Department，Hebei General Hospital，Shijiazhuang 050051，China
*Corresponding author：LI Shuren，Master supervisor；E-mail：lsr64@126.com
Abstract: Severe acute respiratory syndrome coronavirus-2（SARS-CoV-2）was initially thought to mainly affect the respiratory system.A growing body of research has found that SARS-CoV-2 infection can affect multiple human organ systems，and heart is a major target organ secondary to lung.COVID-19-associated cardiac injury is often seen clinically，about 1%-7% of which is myocarditis.COVID-19-associated myocarditis often has a poor outcome.However，the possible pathogenesis mechanisms of COVID-19-associated cardiac injury，and its progression to COVID-19-associated myocarditis，as well as related pathophysiological changes are still unknown.Available data analysis has revealed that the recognized mechanism of cardiac injury in COVID-19 is ACE2-mediated cardiac injury，and cytokine storm-mediated or immune-mediated cardiac injury is only suggestive currently.Due to limited use of cardiac MRI and endocardial biopsy as well as insufficient autopsy findings and other basic research data in patients with COVID-19-associated myocarditis，the diagnosis and treatment of COVID-19-associated myocarditis are challenges that still exist for clinicians.We reviewed the possible pathophysiological mechanisms of COVID-19-associated myocarditis，which will contribute to improving medical workers' understanding of this disease so that its related mortality may be reduced.
Development of the COVID-19 Cluster Containment Evaluation System Using the Emergency Management Theory
LIU Jue1，LIANG Wannian2*，LIU Min1*，YANG Weizhong3，LIU Xia4，WU Jing5，WANG Yadong6，SHAN Guangliang7，HAN Hui8，ZHOU Lei9
1.School of Public Health，Peking University，Beijing 100191，China
2.Vanke School of Public Health，Tsinghua University，Beijing 100084，China
3.School of Population Medicine and Public Health，Peking Union Medical College，Beijing 100730，China
4.Chinese Preventive Medical Association，Beijing 100009，China
5.China Health Education Center，Beijing 100011，China
6.School of Public Health，Capital Medical University，Beijing 100069，China
7.Institute of Basic Medicine，Chinese Academy of Medical Sciences，Peking Union Medical College，Beijing 100730，China
8.Chinese Academy of Inspection and Quarantine，Beijing 100176，China
9.Health Emergency Center，Chinese Center for Disease Control and Prevention，Beijing 102206，China
*Corresponding authors：LIANG Wannian，Professor；E-mail：liangwn@tsinghua.edu.cn
LIU Min，Professor；E-mail：liumin@bjmu.edu.cn
Abstract: Background During the normal prevention and control phase of COVID-19，a number of clusters occurred in China，and all of them have been brought under control．Scientific assessment of the effectiveness of cluster containment helps to timely summarize the experience and shortcomings，contributing to better responding to the epidemic．However，there is still a lack of tools to evaluate the effectiveness of COVID-19 cluster containment．Objective To develop a COVID-19 cluster containment evaluation system as a tool for assessing the effectiveness of COVID-19 cluster containment．Methods During November 2020 to February 2021，by use of the emergency management theory，we formulated a theoretical framework，and used it to develop the COVID-19 Cluster Containment Evaluation System involving COVID-19 cluster prevention，responses and containment assessment using literature review and two rounds of Delphi consultation．Results The system consists of 5 domains（COVID-19 cluster detection and reporting，COVID-19 cluster precise containment，public protection against COVID-19 cluster，medical treatment for COVID-19 cluster，and effectiveness of COVID-19 cluster containment），with 27 items and 107 sub-items．The Kendall's coefficient of concordance ranged from 0.710 to 0.912．The full score for the system is 100 points，and higher score indicates a better effectiveness of containment．Conclusion This system may be used as an auxiliary tool for assessing the effectiveness of COVID-19 cluster containment in normal prevention and control phase of COVID-19．
Clinical Characteristics，Severity of Illness and Its Influencing Factors in COVID-19 Patients with Diarrhea as the Initial Symptom
ZU Ming1，SHI Yanyan2，NING Jing1，LU Haoping1，ZHAO Zhiling3，CHENG Qin4，SHEN Ning4，GE Qinggang3*，DING Shigang1*
1.Department of Gastroenterology，Peking University Third Hospital，Beijing 100191，China
2.Research Center of Clinical Epidemiology，Peking University Third Hospital，Beijing 100191，China
3.Intensive Care Unit，Peking University Third Hospital，Beijing 100191，China
4.Department of Respiratory and Critical Care Medicine，Peking University Third Hospital，Beijing 100191，China
*Corresponding author：GE Qinggang，Professor；E-mail：qingganggelin@126.com
DING Shigang，Professor；E-mail：dingshigang222@163.com
ZU Ming and SHI Yanyan are co-first authors
Abstract: Background There are gastrointestinal symptoms in some patients with COVID-19，but there are few reports about the clinical characteristics and prognosis in COVID-19 patients with diarrhea as the initial symptom.Objective To analyze the clinical characteristics，severity of illness and its influencing factors in COVID-19 patients with diarrhea as the initial symptom.Methods A total of 207 COVID-19 patients with positive RNA test results of nasopharyngeal swabs were taken over by Peking University Medical Team for Hubei from 2020-01-28 to 2020-02-28，who were hospitalized in isolated wards in Tongji Hospital Zhongfa New Town Branch Affiliated to Tongji Medical College，Huazhong University of Science and Technology，17 cases with diarrhea as the initial symptom charged by Medical Team of Peking University Third Hospital were selected as observation group，34 cases without diarrhea as the initial symptom were selected as control group.General information，clinical symptoms，blood routine test results，liver function index，blood lipid indices，creatinine，coagulation function indicators，inflammatory indicators，PCT，myocardial injury indicators，chest CT findings，clinical classification，maximum body temperature，therapeutic protocols，incidence of complications，survival status，duration from onset to treatment and hospital stays were compared between the two groups；univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of severity of illness in patients with COVID-19.Results Incidence of expectoration，D-dimer，abnormal rate of PCT and proportion of patients with severe and critical clinical classification types in observation group were significantly lower than control group，incidence of debilitation and albumin in observation group were significantly higher than control group，prothrombin time and hospital stays in observation group were significantly shorter than control group（P<0.05）.Multivariate Logistic regression analysis results showed that，albumin〔OR=0.739，95%CI（0.569，0.960）〕was the protective factor of severity of illness in patients with COVID-19，but PCT〔OR=7.349，95%CI（1.213，44.513）〕was the risk factor（P<0.05）.Conclusion In COVID-19 patients with diarrhea as the initial symptom，the respiratory symptom and severity of illness are relatively mild，incidence of debilitation is relatively high，clinical classification is mainly common type，and hospital stays is relatively short；albumin is the protective factor of severity of illness in patients with COVID-19，but PCT is the risk factor.
Comparative Analysis of the New Coronavirus Pneumonia Treatment Guidelines Issued by the US NIH in 2021 and the New Coronavirus Pneumonia Treatment Plans Issued by China
LI Shuren1*，ZHAO Wenjing1，2，LI Jianchao1，3，MENG Yang1，2，HAO Xiao1，ZHANG Qianhui1
1.Department 1 of Cardiology，Hebei Renmin Hospital，Shijiazhuang 050051，China
2.Graduate School of Hebei Medical University，Shijiazhuang 050051，China
3.Graduate School of Hebei North University，Zhangjiakou 075000，China
*Corresponding author：LI Shuren，Chief physician，Professor；E-mail：lsr6412@163.com
Abstract: At present，the new coronavirus pneumonia （COVID-19） has swept most countries in the world. At present，there is no specific medicine and targeted treatment methods for it. The medication treatment mainly aimed to suppress the excessive activation of the immune system and support organ after anti-virus treatment. This article compared the treatment methods according to National Institute of Health（NIH） and Chinese recommendations for diagnosis and treatment of novel coronavirus （SARS-CoV-2） infection（Trial 8th version），in order to provide a theoretical basis for clinicians in the treatment of COVID-19.
Counting the Cost of Pandemics：Spanish Flu vs COVID-19
Leon Piterman1，Marika Vicziany1，LIN Chuling（translator）2，HUANG Wenjing（translator）3，YANG Hui（translator）1
1.Monash University，Melbourne 3168，Australia
2.Xinxing Community Health Service Center，Luohu Hospital Group，Shenzhen 518003，China
3.Huangbeiling Community Health Service Center，Luohu Hospital Group，Shenzhen 518003，China
Abstract: There have been at least 20 plagues or pandemics clearly recorded in human history. The historical lessons are always worth learning. During the last century，human society has made great progress，while repeated the mistakes they had made. This article is a collaboration between medical expert and historian to compare the current COVID-19 pandemic with the "Spanish Flu" pandemic 100 years ago，with Australia as the base of comparison. The purpose is to enlighten and emphasize the needs to review our policies and actions. Researchers believe that the contexts of the two pandemics have been dramatically changed，the most obvious of which is the overall progress of the social economy and science and technology marked by the Information Age. However，when faced the attack of viral pathogens，the epidemic prevention strategies adopted as well as mistakes made are somewhat similar. The mental health effects of a pandemic are often neglected while health professionals deal with acute life-threatening risks. There are significant impacts which manifested as anxiety，depression and substance use disorders，especially PTSD，and its impact on family，health professionals，and on unemployed，youth and other socially disadvantaged groups. The researchers analyzed the characteristics of the mental health effects of the three stages of the COVID-19 pandemic，and suggested more needs to be learned about its psycho-social impact on communities across the globe and the effect of the imminent economic recession on the physical and mental well-being of this，and subsequent，generations.
Construction and Operation of COVID-19 Isolation Sites in Primary Healthcare Institutions：a Case Study of Wuhan
ZHENG Yanling1，YIN Delu2*，ZHOU Hejun3*，CHEN Tianmu4
1.Shouyilu Community Health Center of Wuchang District，Wuhan 430060，China
2.Capital Institute of Pediatrics，Beijing 100020，China
3.National Institute of Parasitic Diseases，Chinese Center for Disease Control and Prevention，Shanghai 200025，China
4.School of Public Health，Xiamen University，Xiamen 361102，China
*Corresponding authors：YIN Delu，Associate professor；E-mail：deluyin@126.com
ZHOU Hejun，Assistant professor；E-mail：zhouhejun2@163.com
Abstract: In Wuhan，various types of COVID-19 isolation sites played an important role in the implementation of different types of actions using a tiered approach to effectively contain the pandemic，during the period in which there was a social panic caused by the COVID-19 outbreak，and a run on and overdrawing of medical resources，and the first batch of mobile cabin hospitals and designated hospitals for COVID-19 patients were under construction. These isolation sites delivered essential healthcare services，especially Chinese medicine therapies，to patients suffering from COVID-19（and underlying diseases） as first-contact health services，greatly alleviating the patients' fear of failing to access to treatment，effectively stopping the spread of household and community COVID-19 transmissions，and alleviating the level of COVID-19 panic in the community. Wuhan's experience suggests that under limited conditions，efforts should be taken to divide the isolation site into three relatively separate zones: clean，buffer and contaminated. And classified management is recommended for isolated patients suffering from tuberculosis，AIDS and other infectious diseases.
Clinical Features and Prognostic Risk Factors of COVID-19 in Adults: a Retrospective Analysis of 93 Cases
CAI Miaotian，LI Tongzeng，ZHANG Longyu，XU Hui，MOU Danlei，LIANG Lianchun
Integrated Department of Infectious Diseases，Beijing Youan Hospital， Capital Medical University，Beijing 100069，China
*Corresponding author：LIANG Lianchun，Chief physician；E-mail：llc671215@sohu.com
Abstract: Background Since April 2020， the number of newly diagnosed cases and death cases of COVID-19 have decreased significantly in China but increased rapidly abroad.Early diagnosis and treatment are of great concern to improving the prognosis of COVID-19 patients.Objective To investigate the clinical features and prognostic risk factors of adult patients with COVID-19，offering a reference for clinical diagnosis and treatment of this disease.Methods A retrospective design was used.Participants were 93 adult cases of COVID-19 who were treated in Beijing Youan Hospital between January and February 2020.They were categorized into common，severe and critical types by the most serious conditions during hospitalization，in accordance with the Diagnosis and Treatment Protocol for COVID-19（Trial Version 7）issued by the National Health Commission of the People's Republic of China.Indications such as general information，major clinical manifestations，baseline laboratory parameters，APACHE II and SOFA scores within 24 hours of admission，imaging findings，comorbidities and complications，treatments and outcomes were collected.Results There were 57 cases of common type（61.3%），22 of severe type（23.7%）and 14 of critical type（15.0%）.The male ratio was slighter higher in critical group，and female ratio was slighter higher in other groups，but sex composition showed no significant differences across the groups（P>0.05）.The median age for common，severe and critical groups was 45.0，62.0 and 81.0 years，respectively，showing significant differences（P<0.05）.And the proportion of patients older than 60 years differed across common，severe and critical groups（15.8% vs 54.5% vs 92.9%）（P<0.05）.Compared with common and severe groups，the rate of positive-to negative inversion of SARS-CoV-2 viral load detected by nucleic acid test was decreased，the duration of viral shedding was prolonged，and the interval from onset to dyspnea was shortened，markedly in critical group（P<0.05）.Fever and cough were the most common clinical manifestations whose overall incidences were 88.2% and 87.1%，respectively，showing no significant difference among the groups（P>0.05）.Dyspnea occurred in all severe or critical cases，showing a higher incidence than common cases（100.0% vs 31.6%）（P<0.05）.The incidence of lymphocytopenia in critical group was 100%，which was significantly higher than that in common group（49.1%）or severe group（59.1%）（P<0.05）.Acute liver injury was the most common complication（58.1%）in all cases，but its incidence was obviously increased in severe group （77.3%） or critical group（92.9%），than that of common group（42.1%）（P<0.05）.Chinese medicine therapy was used in 75.3% of all cases，but the severe cases had a higher rate of treating with Chinese medicine than critical cases（90.9% vs 50.0%，P<0.05）.The rate of corticosteroid use in severe cases（63.6%）or critical cases（64.3%）was significantly increased than that of common cases（5.3%）（P<0.05）.Six patients（6.5%）were treated with invasive ventilation， but only 1 of them（16.7%）was successfully extubated ultimately.Nine patients（9.7%）died in hospital due to all causes.Logistic regression analysis revealed that age ≥74 years〔OR（95%CI）=33.714（3.021，376.211），P=0.004〕and baseline SOFA≥2.5〔OR（95%CI）=15.447（1.331，179.260），P=0.029〕were independent risk factors for in-hospital death. Conclusion COVID-19 mainly manifests as respiratory infections. Severe patients are apt to appear tissue injury and dysfunction of organs like liver， kidney and heart， etc. The majority of patients have a favorable outcome. Age and baseline SOFA score would help to label the prognosis of patients at an early stage.
Roles of Primary Care Doctors in COVID-19 Pandemic：Level of Consistency Across Perceptions of Doctors and Experts and Impact Factors
YANG Chenbin1，LI Yanmei1，LI Zhangping1*，YANG Hui2，NI Yunchao1，LIN Jin3，WANG Dongsheng1，XU Huaqing1，SONG Wenxing1
1.Department of Emergency，the First Affiliated Hospital of Wenzhou Medical University，Wenzhou 325000，China
2.Monash University，Melbourne 3168，Australia
3.Students' Affairs Division，Wenzhou Medical University Renji College，Wenzhou 325000，China
*Corresponding author：LI Zhangping，Chief physician，Master supervisor；E-mail：wzlizhangping@126.com
Abstract: Background Primary doctors have participated in containing the COVID-19 pandemic outbroken in December 2019 at the primary level. Investigating their perception of their own roles in the pandemic containment and influencing factors is necessary，since their perceived roles have impact on their recognition of obligations. Objective To investigate the consistency of primary doctors and experts' perceptions of roles of primary doctors in COVID-19 containment，providing evidence for the development of targeted trainings for primary doctors and the determination of the roles of them in major public health events. Methods A questionnaire survey was conducted among 1 758 primary care doctors from Zhejiang Province from February 21 to 27，2020 for investigating their perceptions of roles of primary care doctors in COVID-19 containment，including whether health education of infectious diseases should be conducted，the classification of COVID-19 and classification，reporting and referral of suspected cases，treatment of suspected or confirmed cases，follow-up of patients after treatment. The role positioning of primary care doctors was compared the consensus rate with expert recommendations，and the consistency rate was high when it was more than 90%. Multivariate Logistic regression was used to analyze the factors that the self-role orientation of primary care doctors was inconsistent with the expert's suggestion. Results Among 1 758 participants，1 513（86.1%） participated in the frontline containment of COVID-19 pandemic. Respondents and experts had highly identical perceptions on primary care doctors' roles in carrying out health education on infectious diseases〔99.6%（1 751/1 758）〕，reporting or referring suspected cases〔96.8%（1 702/1 758）〕 and following-up of the treaded patients〔91.3%（1 605/1 758）〕，while they were at variance over diagnosing and classifying COVID-19〔49.5%（871/1 758）〕 as well as treating suspected cases〔61.4%（1 080/1 758）〕. Logistic regression analysis indicated that working at a clinic or health station，and intermediate or senior professional title were facilitators for respondents having similar perceptions on primary care doctors' roles in diagnosing and classifying COVID-19（P<0.05）；working at a clinic or health station，intermediate or senior professional title，and participating in COVID-19 containment were facilitators for respondents having similar perceptions on treating suspected cases to those of experts（P<0.05）. Conclusion Most primary care doctors have participated in frontline COVID-19 containment. Their perceptions of their roles over diagnosing and classifying COVID-19，and treating suspected cases are low consistent with those of experts. In view of this，functional support for diagnosing and treating COVID-19 and guidance on how to appropriately understand primary doctors' roles in COVID-19 containment should be given to primary doctors with junior professional title，less years of working as a doctor，working at the community（township） health center，or without an experience of containing COVID-19 at the frontline.