2019冠状病毒病待排患者临床特征分析及鉴别诊断体会

目的　总结2019冠状病毒病（coronavirus disease 2019, COVID-19）待排患者的临床特征和鉴别诊断体会,提高COVID-19的诊断技能。方法　回顾性分析53例COVID-19待排患者的临床资料,包括流行病学史,以及白细胞计数、淋巴细胞计数、PLT、CRP、LDH、胸部高分辨CT（high resolution CT, HRCT）等检查结果。结果　本研究的53例COVID-19待排患者中,男32例,女21例;年龄15～79岁,平均年龄（53.5±8.4）岁。首诊时病程为1～12 d不等,病程中位数4 d。所有患者均否认COVID-19流行病学史。21例患者具有慢性基础病。首发症状主要为发热、乏力、咳嗽、咳痰、咽痛等。实验室检查外周血白细胞计数多为正常或减少;部分患者LDH、ALT、CK升高。胸部HRCT均呈现多发小斑片影、磨玻璃影及间质改变,以肺外带明显。53例患者均经间隔至少24 h的2次新冠病毒核酸检测为阴性,排除COVID-19,诊断为轻症社区获得性肺炎（community acquired pneumonia, CAP）,经治疗后患者无发热及呼吸道症状。结论　COVID-19待排患者的临床表现以及肺部影像学与COVID-19相似,与CAP鉴别亦缺乏特异性;结合流行病学史以及新型冠状病毒核酸检测可以提高COVID-19诊断准确率。     

药闻

新冠病毒"穷人的救星"羟基氯喹临床试验被证明有效?近日,法国一项新研究显示硫酸羟基氯喹对于治疗新冠肺炎(COVID-19)患者有显著疗效。在一项36个COVID-2019患者(6例无症状,22例有上呼吸道感染症状,8例有下呼吸道感染症状)参与的临床实验中.     

全球主要COVID-19数据来源间一致性及自身周期性研究进展

科学识别和解释不同COVID-19数据间一致性和周期性特征是准确了解COVID-19流行规律与制定防控措施的基础。本研究通过系统检索和梳理相关研究文献发现：(1)现有一致性研究集中于WHO、约翰霍普金斯大学等机构发布的全球COVID-19疫情数据,而且不同数据来源在数据收集、统计指标与数据共享、同一指标数值等方面不尽相同;(2)COVID-19疫情数据存在明显的周期性,现有的相关研究集中在发达国家,不同国家与地区间的疫情周期长短存在较大差异,有3.5 d、5.0 d、7.0 d和62.0 d等不同模式。关于周期性产生原因目前有样本检测和数据报告、生物学因素、社会因素、环境因素多种解释。综合来看,当前缺乏不同COVID-19数据来源间一致性的定量研究,暂未有研究评估数据一致性在不同时间和不同国家间的差异,也缺乏研究探讨全球不同国家的COVID-19疫情周期性差异。     

四川省463例COVID-19确诊病例临床症状特征分析

目的了解COVID-19病例临床症状,为早期识别病例和调整防控措施提供数据支持。方法从中国疾病预防控制信息系统的子模块"传染病管理信息系统"中获取数据,并结合现场流行病学调查情况对截至2020-02-27四川省报告的COVID-19确诊病例临床症状进行统计学描述和分析。结果四川省463例COVID-19确诊病例中,以发热(71.49%)、呼吸道和全身症状为主;有病例报告消化道症状,以恶心(8.42%)和腹泻(7.34%)较多。有发热症状的病例中仅62.32%体温高于38.0℃,其中56.49%伴咳嗽,16.38%伴咽痛;不发热但伴干咳和/或咳痰症状的病例构成比高于发热病例(P<0.001);四川省2月发病的病例,单一症状构成比较1月明显上升,且发热(χ^2=41.52,P<0.001)、乏力(χ^2=4.70,P=0.03)等症状构成比较1月有明显下降;咳嗽(χ^2=0.86,P=0.35)、咽痛(χ^2=0.51,P=0.48)和流涕(χ^2=0.03,P=0.87)症状构成比2月较1月有上升,但差异无统计学意义。结论采用体温筛查病例会有遗漏风险;不能通过流感样病例哨点监测有效发现COVID-19病例;应重视不发热但咳嗽和/或咳痰病例的发现与管理;随疾病传播,病例全身中毒症状逐步减轻,但数据有限,需持续观察。     

2021年12月西安市Delta新冠病毒变异株引发的COVID-19流行病学特征

目的 了解陕西省西安市新型冠状病毒肺炎(COVID-19)聚集性暴发期间确诊病例的流行病学特征,探索德尔塔(Delta)新冠病毒变异株引发疫情的防控策略。方法 回顾性查阅西安市COVID-19其中一所定点收治医院西安市人民医院确诊病例基本资料、诊断分型、首发症状等数据进行分析。结果 703例COVID-19确诊病例中,男女性别比为1.16∶1,年龄范围10个月～94岁,中位年龄33岁,主要以轻型(58.46%)和普通型(39.12%)为主,其中70.13%患者完成两针新冠疫苗接种,13.51%患者未接种过新冠疫苗;COVID-19首发症状以咳嗽、咽部症状、发热最为多见,分别占42.96%、29.87%、25.60%,另有129例患者疾病初期自觉无明显症状;患者年龄和疫苗接种情况对疾病分型影响均有统计学意义(P<0.05),≥60岁患者是重型(57.14%)或危重型(66.67%)病例高发人群,未接种疫苗患者导致重型(50.00%)或危重型(66.67%)发病率高。结论 陕西省西安市本次由Delta新冠病毒变异株引发的本土疫情聚集性暴发传播力强,传播速度快,根据人群分布特点,需重点...     

我国COVID-19疫情流行早期社区症状监测情况调查

目的 了解国内新型冠状病毒肺炎(COVID-19)疫情社区症状监测现况,为提升COVID-19疫情监测能力提供参考。 方法 对来自全国10个省市的疾病预防控制专业人员开展回顾性问卷调查,收集各省市在有无COVID-19疫情发生时城乡社区症状监测的情况,内容涉及有无统一的监测方案、监测内容、信息采集人员、信息上报部门、信息上报途径等内容。 结果 本次研究共收集到10个省市的相关信息,在有疫情和无疫情时,10个省市在城市社区和农村社区有无统一的症状监测方案的结果不一致;具有统一监测方案的省市,不同省市及其城乡社区的症状监测内容、信息采集人员、信息上报部门、信息上报方式等方面也存在较大的差异。 结论 COVID-19疫情流行早期,我国实施的COVID-19疫情社区症状监测体系存在覆盖面不全、缺乏统一标准化监测方案的问题。建议国家尽快制定重大传染病疫情的统一标准化社区症状监测方案及应用技术标准,为未来更好地应对此类疫情做好技术储备。     

新冠肺炎流行期间综合干预措施对医护人员疾病相关知识、自我防范及感染控制影响研究

目的：分析新冠肺炎（COVID-19）流行期间综合干预措施对医护人员疾病相关知识、自我防范及感染控制影响的效果。方法：对2019年12月-2020年3月COVID-19流行期间62名医护人员,均采用综合干预措施;比较干预前后医护人员手卫生情况。结果：研究显示,干预后医护人员COVID-19基本知识、鉴别诊断、消毒隔离等知识掌握情况明显优于干预前,（P＜0.05）;干预后医护人员个人防护正确率明显高于干预前（P＜0.05）,防疫期间我院未出现医护人员感染情况。结论：COVID-19流行期间对医院医护人员进行综合干预,可提高其个人防护正确率,实现了医护人员零感染。     

从COVID-19疫情带来的新认知中寻找传染病应对之道

当下全球新型冠状病毒肺炎(COVID-19)疫情出现反复,变异的德尔塔(Delta)毒株正在全球多地传播肆虐,给全球抗疫带来了严峻的挑战。人类的认知变化,其中不乏一些革命性的变化,均会对人类社会带来一定程度乃至巨大的影响,尤其当社会处于重大事件的关头。文中分析了COVID-19疫情带给人类的新认知,并在此基础上从强化治理能力与重大疫情防控救治体系构建全球抗疫共同体、创新应对输入性疫情、加快疫苗接种与适时策略调整、共同努力减少病毒变异、筛查手段的有效应用、防控策略的科学选择六个方面提出了应对之道。     

新型冠状病毒肺炎疫情对中国成人体重增加的影响及相关因素分析

目的 分析COVID-19疫情对中国成年人群体重增加的影响.方法 利用中国人民大学中国调查与数据中心开展的新冠肺炎疫情综合影响调查,通过随机数字拨号,于全国各个地级市抽取18岁及以上的成年居民样本,并用电话调查系统进行问卷调查,本研究纳入数据分析的样本共2051例.采用x2检验比较不同特征样本人群受疫情影响的体重增加差...     

COVID-19发病机制及诊断的研究进展

COVID-19的病原体SARS-CoV-2主要通过飞沫、气溶胶传播,病毒通过ACE2、CD147受体而进入人体细胞,引发炎症反应甚至炎症风暴造成组织器官损伤。COVID-19临床症状较为广泛,可以从轻症快速发展为严重呼吸道疾病直至死亡。诊断应注重流行病学调查和早期影像学检查的重要性,其"金标准"依靠病毒核酸检测和血清特异性抗体检测。预防病毒传播是控制SARS-CoV-2的重要措施。本文主要在病原体特征、发病机制、临床诊断等方面进行综述。     

COVID-19流行初期和常态化防控阶段大型劳动密集型企业员工疫情相关知信行调查

目的 了解COVID-19流行初期和常态化防控阶段大型劳动密集型企业员工疫情相关知信行(knowledge, attitudes and practices, KAP)状况,为企业复工复产和日常生产生活中园区疫情防控工作提供依据。方法 于2020年2月1日―4月30日和2022年1月2日―2月15日采用电子问卷对深圳市某大型劳动密集企业在职员工进行调查。结果 15 107名研究对象完成了两轮调查,平均年龄(32.42±6.02)岁。与流行初期相比,常态化防控阶段研究对象疫情相关知识(72.3%vs.84.9%)和态度(82.7%vs.89.1%)得分有所提升。知识方面,不同阶段病毒传播途径和物理防护措施各条目正确率较高,感染者主要临床症状和感染后果以及预防/治疗知识大多数条目正确率较低;态度方面,不同阶段研究对象能够意识到疫情的重要影响并积极寻求治疗,但对感染者能够被治愈的信心和能够判断自己是否具有相关症状的报告率较低。常态化防控阶段研究对象疫情防控行为总体执行程度有所下降(92.37%vs.88.21%),主要表现为大多数行为条目报告“完全做到”的比例降低。结论 应针对不同阶段劳动密...     

Long Term Follow-Up of Sarcopenia and Malnutrition after Hospitalization for COVID-19 in Conventional or Intensive Care Units

Background: The post-COVID-19 condition, defined as COVID-19-related signs and symptoms lasting at least 2 months and persisting more than 3 months after infection, appears now as a public health issue in terms of frequency and quality of life alterations. Nevertheless, few data are available concerning long term evolution of malnutrition and sarcopenia, which deserve further attention. Method: Sarcopenia was investigated prospectively, together with weight evolution, at admission and at 3 and 6 months after hospital discharge in 139 COVID-19 patients, using the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, associating both decreased muscle strength and muscle mass, assessed, respectively, with hand dynamometer and dual-energy X-ray absorptiometry. Results: Of the 139 patients, 22 presented with sarcopenia at 3 months; intensive care units (ICU) length of stay was the sole factor associated with sarcopenia after multivariate analysis. Although the entire group did not demonstrate significant weight change, weight decreased significantly in the sarcopenia group (Five and eight patients, showing, respectively, >5 or >10% weight decrease). Interestingly, at 6 months, 16 of the 22 patients recovered from sarcopenia and their weight returned toward baseline values. Conclusions: Sarcopenia and malnutrition are frequently observed in patients hospitalized for COVID-19, even 3 months after infection occurrence, but can largely be reversed at 6 months after discharge. Enhanced patient care is needed in sarcopenic patients, particularly during long stays in an ICU.     

The Role of Nutrients in Prevention,Treatment and Post-Coronavirus Disease-2019 (COVID-19)

SARS-CoV-2 virus, infecting human cells via its spike protein, causes Coronavirus disease 2019 (COVID-19). COVID-19 is characterized by shortness of breath, fever, and pneumonia and is sometimes fatal. Unfortunately, to date, there is still no definite therapy to treat COVID-19. Therefore, the World Health Organization (WHO) approved only supportive care. During the COVID-19 pandemic, the need to maintain a correct intake of nutrients to support very weakened patients in overcoming disease arose. The literature available on nutrient intake for COVID-19 is mainly focused on prevention. However, the safe intake of micro- and/or macro-nutrients can be useful either for preventing infection and supporting the immune response during COVID-19, as well as in the post-acute phase, i.e., “long COVID”, that is sometimes characterized by the onset of various long lasting and disabling symptoms. The aim of this review is to focus on the role of nutrient intake during all the different phases of the disease, including prevention, the acute phase, and finally long COVID.     

Emerging from COVID-19: A New,Rights-Based Relationship with the Nonhuman World?

This essay argues that the global response to COVID-19 should lead to new thinking and action, and specifically, a new relationship with the nonhuman world that is centered on mutuality and respect, not commodification and exploitation. Such a response would acknowledge and embed concepts like ecological justice and One Welfare in policy and practice, particularly regarding the consequences of intensive animal agriculture and production of monocultures of feedstock for the billions of farmed animals used in food production each year. Drawing on examples from the Global South and Global North, the essay suggests ways forward that provide opportunities for new thinking, research, and action, with the COVID-19 crisis contextualized by the urgency of the climate and biodiversity crises. With deep inequalities and infringement of rights embedded in each of these global challenges, successfully addressing them likely depends on useful disruptions in, and a bridging of, the divides that have separated human and nonhuman rights and have limited the intersections between public health, the environment, and animal welfare and rights.

Any way it’s said, it’s going to be an understatement: the wreckage caused by the COVID-19 pandemic has been enormous. Across the world, more than five million lives have been lost and millions more have been upended.¹ Children have missed months of vital schooling; rates of child marriage, domestic violence, and social isolation have increased; and many individuals have been unable to work, visit others, and grieve. The pandemic has also revealed the shortcomings and short-sightedness embedded in the relationships of most human societies with the nonhuman world, whether due to our failure to combat zoonoses, our reckless overuse of antibiotics, or the chronic vulnerability of our food systems. Yet, as governments apportion trillions of dollars to post-COVID-19 recovery, we await a true reckoning—including another pandemic. For COVID-19 is “not necessarily the big one,” according to Michael Ryan, head of emergencies at the World Health Organization.²This essay argues that our response to COVID-19 should lead to new thinking and action, and specifically, a new relationship with the nonhuman world that is centered on mutuality and respect, not commodification and exploitation. Such a response would acknowledge and embed concepts like ecological justice and One Welfare (which I discuss later) in policy and practice, particularly regarding intensive animal agriculture and monocultures of feedstock.     

Demographics of COVID-19 hospitalisations and related fatality risk patterns

The assessment of hospitalisations and intensive care is crucial for planning health care resources needed over the course of the coronavirus disease 2019 (COVID-19) pandemic. Nonetheless, comparative empirical assessments of COVID-19 hospitalisations and related fatality risk patterns on a large scale are lacking.This paper exploits anonymised, individual-level data on SARS-CoV-2 confirmed infections collected and harmonized by the European Centre for Disease Prevention and Control to profile the demographics of COVID-19 hospitalised patients across nine European countries during the first pandemic wave (February – June 2020). We estimate the role of demographic factors for the risk of in-hospital mortality, and present a case study exploring individuals’ comorbidities based on a subset of COVID-19 hospitalised patients available from the Dutch health system.We find that hospitalisation rates are highest among individuals with confirmed SARS-CoV-2 infection who are not only older than 70 years, but also 50-69 years. The latter group has a longer median time between COVID-19 symptoms’ onset and hospitalisation than those aged 70+ years. Men have higher hospitalisation rates than women at all ages, and particularly above age 50. Consistently, men aged 50-59 years have a probability of hospitalisation almost double than women do. Although the gender imbalance in hospitalisation remains above age 70, the gap between men and women narrows at older ages. Comorbidities play a key role in explaining selection effects of COVID-19 confirmed positive cases requiring hospitalisation.Our study contributes to the evaluation of the COVID-19 burden on the demand of health-care during emergency phases. Assessing intensity and timing dimensions of hospital admissions, our findings allow for a better understanding of COVID-19 severe outcomes. Results point to the need of suitable calibrations of epidemiological projections and (re)planning of health services, enhancing preparedness to deal with infectious disease outbreaks.     

新冠肺炎疫情期间医院员工健康监测与管理探讨

目的 探讨在新型冠状病毒肺炎疫情期间,通过监测相关高危临床症状实现员工健康监测精细化管理.方法 依托医院的健康上报流程,重点关注员工COVID-19相关的临床症状,对于出现症状的员工及时查找潜在原因,同时加强管理和干预,并进行核酸检测.结果 2020年2月14日至3月3日,共发现有症状人员79人次,其中发热18人次,呼...     

Covid-19 As Occupational Disease in Healthcare Workers: a Brief Review of Cases in The Clinical Hospital Centre Rijeka,Croatia

The coronavirus disease 19 (COVID-19) pandemic has had a tremendous impact on every facet of private life and work organisation in virtually all social and economic sectors worldwide. People who stand on the first line of defence are healthcare workers (HCWs) risking exposure to infected patients. However, even though they are often affected by COVID-19 and associated somatic and mental health problems, COVID-19 as a new illness was not immediately acknowledged as occupational disease. This is why several groups of HCWs contacted their occupational medicine physicians in 2020 with a request to register the infection with SARS-CoV-2 as occupational disease. In an attempt to support their appeals and show that hospital workers have a high occupational risk of COVID-19, this study presents COVID-19 incidence and symptoms in 100 employees working at 11 clinics of the Clinical Hospital Centre (CHC) Rijeka, Croatia from 1 June to end December 2020. All of them were infected with SARS-CoV-2 and took sick leave, which lasted 13.6±2.6 days in average. This study also looks into the role of occupational medicine physicians in prospective monitoring of acute and long-acting consequences of COVID-19 that might occur in HCWs.Key words: incidence, occupational medicine, SARS-CoV-2, symptoms     

Long Haul COVID-19 Videos on YouTube: Implications for Health Communication

The term COVID-19 “long haul” originated on social media and was later studied by the scientific community. This study describes content related to persistent COVID-19 symptoms on YouTube. The 100 most viewed English-language videos identified with the keywords “COVID-19 long haul” were assessed for video origin, engagement, and content related to COVID-19 long-haul. The findings indicate that the majority of videos were uploaded by television or internet news (56%), followed by consumers (members of the public, 32%), health professionals (only 9%), and lastly by entertainment TV (non-news programs, 3%). Videos originating from entertainment TV were significantly more likely to be “liked” than videos from other sources. The most commonly mentioned long-haul symptoms in the videos were physical (fatigue, 73%; difficulty breathing/shortness of breath, 56%; and joint or muscle pain, 49%) and cognitive (difficulty thinking or concentrating; 69%). The case of COVID-19 long haul demonstrates that social media are significant fora whereon the public identify health concerns. It is necessary for healthcare professionals to assume an active and responsible role in social media.

     

A Cost-Utility Analysis of Remote Pulse-Oximetry Monitoring of Patients With COVID-19

ObjectivesSince 2020, COVID-19 has infected tens of millions and caused hundreds of thousands of fatalities in the United States. Infection waves lead to increased emergency department utilization and critical care admission for patients with respiratory distress. Although many individuals develop symptoms necessitating a ventilator, some patients with COVID-19 can remain at home to mitigate hospital overcrowding. Remote pulse-oximetry (pulse-ox) monitoring of moderately ill patients with COVID-19 can be used to monitor symptom escalation and trigger hospital visits, as needed.MethodsWe analyzed the cost-utility of remote pulse-ox monitoring using a Markov model with a 3-week time horizon and daily cycles from a US health sector perspective. Costs (US dollar 2020) and outcomes were derived from the University Hospitals’ real-world evidence and published literature. Costs and quality-adjusted life-years (QALYs) were used to determine the incremental cost-effectiveness ratio at a cost-effectiveness threshold of $100 000 per QALY. We assessed model uncertainty using univariate and probabilistic sensitivity analyses.ResultsModel results demonstrated that remote monitoring dominates current standard care, by reducing costs ($11 472 saved) and improving outcomes (0.013 QALYs gained). There were 87% fewer hospitalizations and 77% fewer deaths among patients with access to remote pulse-ox monitoring. The incremental cost-effectiveness ratio was not sensitive to uncertainty ranges in the model.ConclusionsPatient with COVID-19 remote pulse-ox monitoring increases the specificity of those requiring follow-up care for escalating symptoms. We recommend remote monitoring adoption across health systems to economically manage COVID-19 volume surges, maintain patients’ comfort, reduce community infection spread, and carefully monitor needs of multiple individuals from one location by trained experts.     

The Effects of Severe Acute Respiratory Syndrome Coronavirus 2 on the Reported Mental Health Symptoms of Nonprofessional Carers: An Analysis Across Europe

ObjectivesThis study tries to analyze how the crisis generated by severe acute respiratory syndrome coronavirus 2 has affected the reported mental health symptoms of informal caregivers in different European countries.MethodsThe Survey of Health, Ageing and Retirement in Europe-COVID-19 was used, collecting information from the beginning of June 2020 to August 2020 about individuals’ state of health and the care they received. Several probit regression models were used to analyze the differences in the probability of (1) being sad or depressed, (2) being anxious or nervous, (3) having difficulty sleeping, and (4) feeling lonely, between individuals who provided informal care and individuals who did not. Several subanalyses by geographic area, mortality rates due to coronavirus disease 2019 (COVID-19), and long-term care expenditure were also performed.ResultsSince the outbreak of COVID-19, informal caregivers have had a higher probability of being sad or depressed of 8 percentage points (p.p.), a 7.1 p.p. higher probability of being anxious or nervous, and a 5.9 p.p. higher probability of having difficulty sleeping than non-caregivers. Informal caregivers in Southern Europe have had an 8 p.p. higher probability of being sad or depressed than non-caregivers. In Eastern Europe, this difference in probability reaches 9.7 p.p. Finally, in countries with higher mortality rates due to COVID-19, there have been greater differences in terms of being sad or depressed between caregivers and non-caregivers, regardless of expenditure on long-term care.ConclusionsSince the outbreak of COVID-19, informal caregivers in Europe have had a higher probability of reporting mental health symptoms than non-caregivers.