A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV) infected pneumonia(standard version)

In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.

Increased alcohol consumption during the COVID-19 pandemic:A cross-sectional study

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has significantly impacted health,mental well-being,and societal functioning,particularly for individuals with psychiatric conditions and substance use disorders.Recent evidence highlights a concerning increase in alcohol consumption during the pandemic,with a study spanning 2015-2020 indicating heightened usage,especially among young and middle-aged adults,for relaxation and tension relief.Additionally,addressing challenges exacerbated by the pandemic,another study underscored persistent barriers to healthcare access,resulting in increased alcohol and tobacco use rates and limited healthcare options.These findings shed light on the unique vulnerabilities exposed by the pandemic,emphasizing the need to investigate further its impact on alcohol consumption in diverse non-urban American communities.AIM To investigate the impact of the COVID-19 pandemic on alcohol abuse using socioeconomic and medical parameters in diverse non-urban community in America.METHODS Based on a cross-sectional analysis of 416 participants the United States in 2021,the study utilized The Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition criteria to categorize alcohol consumption levels.Participants aged 21 years and above were surveyed through an online platform due to COVID-19 challenges.The survey was conducted from January 14 to January 31,2022,recruiting participants via social media and ensuring anonymity.Informed consent was secured,emphasizing the voluntary nature of participation,and participants could only take the survey once.RESULTS Out of 416 survey respondents,396 met eligibility criteria,with 62.9%reporting increased alcohol consumption during COVID-19.Males(68.8%)and ages 21-29 years(34.6%)predominated.Low alcohol consumption decreased by 2.8%(P=0.237),moderate by 21.4%(P<0.001),and heavy increased by 14.9%(P<0.001).Alcohol abuse rose by 6.5%(P=0.0439),with a 7%increase in self-identified alcohol abusers/alcoholics.Seeking treatment during COVID-19 rose by 6.9%.Easier alcohol access(76.0%)was reported,while 80.7%found it harder to access medical care for alcohol-related issues.These findings highlight the pandemic's impact on alcohol consumption and healthcare access,emphasizing the need for targeted interventions during public health crises.CONCLUSION The COVID-19 pandemic exacerbated alcoholism and abuse,with increased heavy consumption(P<0.001)and abuse(P=0.0439).Access to medical programs for addressing alcohol abuse declined,highlighting the need for targeted intervention.

Analysis of status quo and research progress in nursing care for different typed coronavirus disease 2019: A literature review

At present,patients with coronavirus disease 2019(COVID‑19)are showing a surge in the world,to explore the clinical characteristics,treatment,and care of different types of COVID‑19.The authors reviewed the existing literature,selected,and analyzed the diagnosis and treatment records of 11 patients with COVID‑19 who were initially cured,including patient information,clinical manifestations,auxiliary examination results,treatment principles,nursing evaluation,nursing goals,nursing diagnosis,and nursing measures,and found clinical similarities and differences in the care of different types of patients.Among them,nine patients recovered and discharged after receiving treatment,and two died.As there is no specific medicine,only symptomatic treatment and supportive treatment can be given.Eleven common nursing measures and special nursing measures of different levels were carried out for patients diagnosed with mild,common,severe,and critical illnesses,and different treatment methods were given according to the severity of signs and symptoms.By summarizing the similarities and differences of clinical nursing interventions,we hope to help improve the quality of care for patients diagnosed with COVID‑19.

Home‑based treatment and nursing plan of a patient diagnosed with mild‑to‑common coronavirus disease 2019

To date,there are no known specific antiviral medicines recommended for coronavirus disease 2019(COVID‑19).The treatment mainly focuses on the improvement of the immunity of the individual and the application of palliative treatment.A case of a patient diagnosed with mild COVID‑19 and then later developed common COVID‑19 which was treated and closely monitored at home will be presented.The patient was advised for self‑quarantine with several prescribed medications.Nursing home and self‑care advice were given to the patient,including a change of lifestyle for the duration of the isolation,medication advice,symptomatic care,change of diet,how to monitor the progress of the disease,psychological care,and follow‑up instructions.During the course of the nursing plan,the patient showed significant improvements,and normal life functions were restored.On February 05,2020,novel coronavirus nucleic acid test showed negative after re‑examination;the patient was cured.Therefore,providing adequate nursing plan for home‑based self‑care treatment can effectively cure mild and common cases of COVID‑19.

Characterization of the receptor-binding domain(RBD)of 2019 novel coronavirus:implication for development of RBD protein as a viral attachment inhibitor and vaccine

The outbreak of Coronavirus Disease 2019(COVID-19)has posed a serious threat to global public health,calling for the development of safe and effective prophylactics and therapeutics against infection of its causative agent,severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),also known as 2019 novel coronavirus(2019-nCoV).The CoV spike(S)protein plays the most important roles in viral attachment,fusion and entry,and serves as a target for development of antibodies,entry inhibitors and vaccines.Here,we identified the receptor-binding domain(RBD)in SARS-CoV-2 S protein and found that the RBD protein bound strongly to human and bat angiotensin-converting enzyme 2(ACE2)receptors.SARS-CoV-2 RBD exhibited significantly higher binding affinity to ACE2 receptor than SARS-CoV RBD and could block the binding and,hence,attachment of SARS-CoV-2 RBD and SARS-CoV RBD to ACE2-expressing cells,thus inhibiting their infection to host cells.SARS-CoV RBD-specific antibodies could crossreact with SARS-CoV-2 RBD protein,and SARS-CoV RBD-induced antisera could cross-neutralize SARS-CoV-2,suggesting the potential to develop SARS-CoV RBD-based vaccines for prevention of SARS-CoV-2 and SARS-CoV infection.

Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease

Background Since early December 2019,the 2019 novel coronavirus disease(COVID-19)has caused pneumonia epidemic in Wuhan,Hubei province of China.This study aimed to investigate the factors affecting the progression of pneumonia in COVID-19 patients.Associated results will be used to evaluate the prognosis and to find the optimal treatment regimens for COVID-19 pneumonia.Methods Patients tested positive for the COVID-19 based on nucleic acid detection were included in this study.Patients were admitted to 3 tertiary hospitals in Wuhan between December 30,2019,and January 15,2020.Individual data,laboratory indices,imaging characteristics,and clinical data were collected,and statistical analysis was performed.Based on clinical typing results,the patients were divided into a progression group or an improvement/stabilization group.Continuous variables were analyzed using independent samples t-test or Mann-Whitney U test.Categorical variables were analyzed using Chi-squared test or Fisher’s exact test.Logistic regression analysis was performed to explore the risk factors for disease progression.Results Seventy-eight patients with COVID-19-induced pneumonia met the inclusion criteria and were included in this study.Efficacy evaluation at 2 weeks after hospitalization indicated that 11 patients(14.1%)had deteriorated,and 67 patients(85.9%)had improved/stabilized.The patients in the progression group were significantly older than those in the disease improvement/stabilization group(66[51,70]vs.37[32,41]years,U=4.932,P=0.001).The progression group had a significantly higher proportion of patients with a history of smoking than the improvement/stabilization group(27.3%vs.3.0%,χ^2=9.291,P=0.018).For all the 78 patients,fever was the most common initial symptom,and the maximum body temperature at admission was significantly higher in the progression group than in the improvement/stabilization group(38.2[37.8,38.6]vs.37.5[37.0,38.4]°C,U=2.057,P=0.027).Moreover,the proportion of patients with respiratory failure(54.5%vs.20.9%,χ^2=5.611,P=0.028)and respiratory rate(34[18,48]vs.24[16,60]breaths/min,U=4.030,P=0.004)were significantly higher in the progression group than in the improvement/stabilization group.C-reactive protein was significantly elevated in the progression group compared to the improvement/stabilization group(38.9[14.3,64.8]vs.10.6[1.9,33.1]mg/L,U=1.315,P=0.024).Albumin was significantly lower in the progression group than in the improvement/stabilization group(36.62±6.60 vs.41.27±4.55 g/L,U=2.843,P=0.006).Patients in the progression group were more likely to receive high-level respiratory support than in the improvement/stabilization group(χ^2=16.01,P=0.001).Multivariate logistic analysis indicated that age(odds ratio[OR],8.546;95%confidence interval[CI]:1.628-44.864;P=0.011),history of smoking(OR,14.285;95%CI:1.577-25.000;P=0.018),maximum body temperature at admission(OR,8.999;95%CI:1.036-78.147,P=0.046),respiratory failure(OR,8.772,95%CI:1.942-40.000;P=0.016),albumin(OR,7.353,95%CI:1.098-50.000;P=0.003),and C-reactive protein(OR,10.530;95%CI:1.224-34.701,P=0.028)were risk factors for disease progression.Conclusions Several factors that led to the progression of COVID-19 pneumonia were identified,including age,history of smoking,maximum body temperature at admission,respiratory failure,albumin,and C-reactive protein.These results can be used to further enhance the ability of management of COVID-19 pneumonia.

A bibliometric analysis of nursing research in COVID‑19 in China

Objective:The objective of this study is to analyze the current status of nursing research in COVID‑19 through literature metrology and provide ideas and references for further research.Methods:The search terms such as“novel coronavirus/COVID‑19”and“nursing”were used to search the nursing‑related papers published in China National Knowledge Infrastructure,Wanfang Data,VIP Data,SinoMed,Web of Science,and PubMed from October 1,2019,to March 30,2020.The bibliometric methods and related software were used for analysis.Results:A total of 234 articles were included from 48 journals,and core journals accounted for 61.1%.There were five nursing literature topics and 14 document types.There is a cooperative relationship between six institutions.Keywords include nursing staff,nursing management,and protection.Conclusions:The opening of journal green channels and the establishment of database columns will help the spread of anti‑epidemic academic results.The topics of nursing literature include clinical nursing,nursing management,prevention and control,nursing education,and social surveys.Nursing literature types focus on cross‑sectional research and experience summary;the cooperation between researchers and research institutions has begun to take shape,and it is recommended to strengthen the research on iatrogenic injuries and nurse training in future nursing research.

Clinical features and outcomes of 2019 novel coronavirus-infected patients with high plasma brain natriuretic peptide levels

Background As shown in previous studies,high brain natriuretic peptide(BNP)is one of common abnormal laboratory test results in some critical patients infected with 2019 novel coronavirus(2019-nCoV),while the role of BNP in the prognosis of coronavirus disease 2019(COVID-19)is still unknown.This study aims to investigate the effects of the increased BNP value on the outcomes of 2019-nCoV infected patients.Methods Our study initially included patients diagnosed with COVID-19 in Guangzhou Eighth People’s Hospital from January 20 th,2020 to February 24 th.After screening out the participants based on the exclusion criteria,a total of 34 participants were finally enrolled in our research for retrospective analysis.The primary outcome was severe pneumonia defined according to the international guidelines for community-acquired pneumonia.Clinical characteristics and laboratory data were collected from their medical records.Results The best cut-off value of BNP for predicting severe pneumonia was 97.5 pg/mL with the sensitivity for 80%and the specificity for 91.7%.The median age for high BNP level group(>97.5 pg/mL)was 60.5 years(interquartile range:40-80 years).The ratio of males in those patients was 60.0%.Compared with the normal BNP level group,higher temperature(P=0.09),higher values of aspartate aminotransferase(P=0.02),troponin I(P<0.001),C-reactive protein(P<0.001)and myoglobin(P=0.001)as well as lower levels of hemoglobin(P=0.04)and platelet count(P=0.001)were observed in the high BNP group.Multivariable logistic regression demonstrated that 2019-nCoV infected patients with high BNP were more likely to develop severe pneumonia(OR:17.368,P=0.025)and be admitted to the intensive care unit(OR:27.093,P=0.048).Conclusions The increased level of BNP is associated with the undesirable condition and disease aggravation of patients with COVID-19.BNP is expected to be an independent prognostic predictor of clinical outcomes for patients with COVID-19.

Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province

Background:The 2019 novel coronavirus(2019-nCoV)causing an outbreak of pneumonia in Wuhan,Hubei province of China was isolated in January 2020.This study aims to investigate its epidemiologic history,and analyze the clinical characteristics,treatment regimens,and prognosis of patients infected with 2019-nCoV during this outbreak.Methods:Clinical data from 1372019-nCoV-infected patients admitted to the respiratory departments of nine tertiary hospitals in Hubei province from December 30,2019 to January 24,2020 were retrospectively collected,including general status,clinical manifestations,laboratory test results,imaging characteristics,and treatment regimens.Results:None of the 137 patients(61 males,76 females,aged 20-83 years,median age 57 years)had a definite history of exposure to Huanan Seafood Wholesale Market.Major initial symptoms included fever(112/137,81.8%),coughing(66/137,48.2%),and muscle pain or fatigue(44/137,32.1%),with other,less typical initial symptoms observed at low frequency,including heart palpitations,diarrhea,and headache.Nearly 80%of the patients had normal or decreased white blood cell counts,and 72.3%(99/137)had lymphocytopenia.Lung involvement was present in all cases,with most chest computed tomography scans showing lesions in multiple lung lobes,some of which were dense;ground-glass opacity co-existed with consolidation shadows or cord-like shadows.Given the lack of effective drugs,treatment focused on symptomatic and respiratory support.Immunoglobulin G was delivered to some critically ill patients according to their conditions.Systemic corticosteroid treatment did not show significant benefits.Notably,early respiratory support facilitated disease recovery and improved prognosis.The risk of death was primarily associated with age,underlying chronic diseases,and median interval from the appearance of initial symptoms to dyspnea.Conclusions:The majority of patients with 2019-nCoV pneumonia present with fever as the first symptom,and most of them still showed typical manifestations of viral pneumonia on chest imaging.Middle-aged and elderly patients with underlying comorbidities are susceptible to respiratory failure and may have a poorer prognosis.

Effectiveness of glucocorticoid therapy in patients with severe coronavirus disease 2019:protocol of a randomized controlled trial

Background:At the end of 2019,a novel coronavirus outbreak causative organism has been subsequently designated the 2019 novel coronavirus(2019-nCoV).The effectiveness of adjunctive glucocorticoid therapy in the management of 2019-nCoV-infected patients with severe lower respiratory tract infections is not clear,and warrants further investigation.Methods:The present study will be conducted as an open-labeled,randomized,controlled trial.We will enrol 48 subjects from Chongqing Public Health Medical Center.Each eligible subject will be assigned to an intervention group(methylprednisolone via intravenous injection at a dose of 1-2 mg/kg/day for 3 days)or a control group(no glucocorticoid use)randomly,at a 1:1 ratio.Subjects in both groups will be invited for 28 days of follow-up which will be scheduled at four consecutive visit points.We will use the clinical improvement rate as our primary endpoint.Secondary endpoints include the timing of clinical improvement after intervention,duration of mechanical ventilation,duration of hospitalization,overall incidence of adverse events,as well as rate of adverse events at each visit,and mortality at 2 and 4 weeks.Discussion:The present coronavirus outbreak is the third serious global coronavirus outbreak in the past two decades.Oral and parenteral glucocorticoids have been used in the management of severe respiratory symptoms in coronavirus-infected patients in the past.However,there remains no definitive evidence in the literature for or against the utilization of systemic glucocorticoids in seriously ill patients with coronavirus-related severe respiratory disease,or indeed in other types of severe respiratory disease.In this study,we hope to discover evidence either supporting or opposing the systemic therapeutic administration of glucocorticoids in patients with severe coronavirus disease 2019.

Combination of western medicine and Chinese traditional patent medicine in treating a family case of COVID-19

In December 2019,an outbreak of novel coronavirus(2019-nCoV)occurred in Wuhan,Hubei Province,China.By February 14,2020,it has led to 66492 confirmed patients in China and high mortality up to^2.96%(1123/37914)in Wuhan.Here we report the first family case of coronavirus disease 2019(COVID-19)confirmed in Wuhan and treated using the combination of western medicine and Chinese traditional patent medicine Shuanghuanglian oral liquid(SHL).This report describes the identification,diagnosis,clinical course,and management of three cases from a family,suggests the expected therapeutic effects of SHL on COVID-19,and warrants further clinical trials.

Analysis of an improved workflow of endoscope reprocessing for bedside endoscopic diagnosis and treatment on COVID-19 patients

Severe cases infected with the coronavirus disease 2019(COVID-19),named by the World Health Organization(WHO)on Feb.11,2020,tend to present a hypercatabolic state because of severe systemic consumption,and are susceptible to stress ulcers and even life-threatening gastrointestinal bleeding.Endoscopic diagnosis and treatment constitute an irreplaceable part in the handling of severe COVID-19 cases.Endoscopes,as reusable precision instruments with complicated structures,require more techniques than other medical devices in cleaning,disinfection,sterilization,and other reprocessing procedures.From 2016 to 2019,health care-acquired infection caused by improper endoscope reprocessing has always been among the top 5 on the list of top 10 health technology hazards issued by the Emergency Care Research Institute.Considering the highly infective nature of COVID-19 and the potential aerosol contamination therefrom,it is of pivotal significance to ensure that endoscopes are strictly reprocessed between uses.In accordance with the national standard"Regulation for Cleaning and Disinfection Technique of Flexible Endoscope(WS507-2016),"we improved the workflow of endoscope reprocessing including the selection of chemicals in an effort to ensure quality control throughout the clinical management towards COVID-19 patients.Based on the experience we attained from the 12 severe COVID-19 cases in our hospital who underwent endoscopy 23 times in total,the article provides an improved version of endoscopic reprocessing guidelines for bedside endoscopic diagnosis and treatment on COVID-19 patients for reference.

Building stock market resilience through digital transformation:Using Google trends to analyze the impact of COVID-19 pandemic

As the 2019 novel coronavirus disease(COVID-19)pandemic rages globally,its impact has been felt in the stock markets around the world.Amidst the gloomy economic outlook,certain sectors seem to have survived better than others.This paper aims to investigate the sectors that have performed better even as market sentiment is affected by the pandemic.The daily closing stock prices of a total usable sample of 1,567 firms from 37 sectors are first an a lyzed using a combination of hierarchical clustering and shape-based distance(SBD)measures.Market sentiment is modeled from Google trends on the COVID-19 pandemic.This is then analyzed against the time series of daily closing stock prices using augmented vector autoregression(VAR).The empirical results indicate that market sentiment towards the pandemic has significant effects on the stock prices of the sectors.Particularly,the stock price performance across sectors is differentiated by the level of the digital transformation of sectors,with those that are most digitally transformed,showing resili ence towards negative market sentime nt on the pandemic.This study contributes to the existing literature by incorporating search trends to an a lyze market sentiment,and by showing that digital transformation moderated the stock market resilience of firms against concern over the COVID-19 outbreak.

Single-Cell RNA Expression Profiling of ACE2 and AXL in the Human Maternal-Fetal Interface

2019 novel coronavirus disease has resulted in thousands of critically ill patients in China,which is a serious threat to people’s life and health.Severe acute respiratory syndrome-coronavirus 2(SARS-CoV-2)was reported to share the same receptor,angiotensin-converting enzyme 2(ACE2),with SARS-CoV.Here,based on the public single-cell RNA-sequencing database,we analyzed the mRNA expression profile of putative receptor ACE2 and AXL receptor tyrosine kinase(AXL)in the early maternal-fetal interface.The result indicates that the ACE2 has very low expression in the different cell types of early maternal-fetal interface,except slightly high in decidual perivascular cells cluster 1(PV1).Interestingly,we found that the Zika virus(ZIKV)receptor AXL expression is concentrated in perivascular cells and stromal cells,indicating that there are relatively more AXL-expressing cells in the early maternal-fetal interface.This study provides a possible infection route and mechanism for the SARS-CoV-2-or ZIKV-infected mother-to-fetus transmission disease,which could be informative for future therapeutic strategy development.

The digitalization and public crisis responses of small and medium enterprises:Implications from a COVID-19 survey

The 2019 novel coronavirus disease(COVID-19)outbreak is a global crisis that has placed small and medium enterprises(SMEs)under huge pressure to survive,requiring them to respond effectively to the crisis.SMEs have adopted various digital tech no logies to cope with this crisis.Using a data set from a survey with 518 Chin ese SMEs,the study examines the relati on ship between SMEs'digitalizatio n and their public crisis responses.The empirical results show that digitalization has enabled SMEs to respond effectively to the public crisis by making use of their dynamic capabilities.In addition,digitalization can help improve SMEs'performance.We propose a theoretical framework ofdigitalization and crisis respohses for SMEs and present three avenues for future research.

Microstructures and dynamic processes within the five-phase system:Regarding COVID-19 as a complex system

The research uses the development of 2019 novel coronavirus disease(COVID-19)in the human body as an example to explore the microstructures and dynamic processes of a concise complex system from the lens of the five-phase system.Based on the structural balance theory and system dynamics,the research finds that Iransitive triads and cyclic triads in the fivephase system are both imbalanced.The integration of these differentiated triads comprises of a balaneed intermediate form in the shape of quadrangular cycles.These cycles serve as microstructures of the five-phase system,due to the inherent balancing feedback mechanism,and support the generation of resultants.The alter nation of quadra ngular cycles drives the spirali ng development of the whole system.By orderly and regular in terweaving of sig ned directed links,the research provides a holistic,process-oriented demonstrati on for the developme nt processes of COVID-19.It clarifies that the esse nee of the five-phase system is phase-tra nsition processes with the quadrangular cycle as carrier and supporter,rather than the static aggregati on of five elements.The research deep ens the understanding of system non linearity by visualizi ng the circular causality and promotes the academic dialogue between the Western process theory and the Chinese inherited notion of the fivephase system.

How different types of financial service providers support small- and mediumenterprises under the impact of COVID-19 pandemic: From the perspective of expectancy theory

The 2019 novel coronavirus disease(COVID-19)pandemic has significantly impacted several aspects of the society and the economy.A problem that needs prompt attention in this situation is the increasing difficulties faced by small-and mediumsized enterprises(SMEs)in raising capital,which has aroused great concern from multiple stakeholders such as public administrations and regulators.As the major supply of capital,financial service providers(FSPs)play a critical role in financing SMEs.However,how FSPs deal with SME financing during shocks has not yet been fully researched.Accordingly,in this study,a theoretical framework based on expectancy theory is proposed to explore the expected strategic adjustments of FSPs in financing SMEs.Specifically,this study investigates 272 FSPs in China on their expectancy and attitude on financing to SMEs during the COVID-19 pandemic.Furthermore,this study has divided FSPs into three categories:commercial banks,non-bank financial institutions,and credit-enhanced FSPs.Differences among these categories are compared and analyzed.

Progresses in clinical studies on antiviral therapies for COVID-19—Experience and lessons in design of clinical trials

Antiviral therapy with antiviral agents is a very important component of treatment for the 2019 novel coronavirus disease(COVID-19)caused by the severe acute respiratory syndrome coronavirus-2(SARS-CoV-2).It is important to clarify how to evaluate efficacy and safety of antiviral agents in treatment of COVID-19 during the pandemic of this disease.We need to answer the following questions:do we still need to use rigorously designed randomized controlled clinical trials(RCTs)?Or,will it be enough if we use loosened criteria,observational studies or even retrospective case series and case reports?The answer is"No,we still need to use the strictly designed preferably blinded multicenter RCTs to evaluate the antiviral agents."In this article,we reviewed almost all the RCT reports on monotherapies and combined therapies with antiviral agents for COVID-19,and found that among the reports on monotherapies,only remdesivir,and among combined antiviral agents,only the combined regimen with interferon-β1b,lopinavir-ritonavir and ribavirin were effective and safe based on evidences from RCTs.The results of five RCTs for chloroquine or hydroxychloroquine consistently showed that they were ineffective and unsafe in the treatment of COVID-19,especially at larger doses.Many aspects in the design of the clinical trials may be related to success or failure of a trial and the relevant factors need to be analyzed,discussed and emphasized from the specific requirements and considerations of antiviral therapies.We hope such discussions be of certain use in designing clinical trials for pediatric antiviral therapies.

Multidisciplinary,three-dimensional and individualized comprehensive treatment for severe/critical COVID-19

Severe/critical cases account for 18e20% of all novel coronavirus disease 2019(COVID-19)patients,but their mortality rate can be up to 61.5%.Furthermore,all deceased patients were severe/critical cases.The main reasons for the high mortality of severe/critical patients are advanced age(>60 years old)and combined underlying diseases.Elderly patients with comorbidities show decreased organ function and low compensation for damage such as hypoxia and inflammation,which accelerates disease progression.The lung is the main target organ attacked by severe acute respiratory syndrome coronavirus 2(SARSCoV-2)while immune organs,liver,blood vessels and other organs are damaged to varying degrees.Liver volume is increased,and mild active inflammation and focal necrosis are observed in the portal area.Virus particles have also been detected in liver cells.Therefore,multidisciplinary teams(MDTs)and individualized treatment plans,accurate prediction of disease progression and timely interventions are vital to effectively reduce mortality.Specifically,a“multidisciplinary three-dimensional management,individualized comprehensive plan”should be implemented.The treatment plan complies with three principles,namely,multidisciplinary management of patients,individualized diagnosis and treatment plans,and timely monitoring and intervention of disease.MDT members are mainly physicians from critical medicine,infection and respiratory disciplines,but also include cardiovascular,kidney,endocrine,digestion,nerve,nutrition,rehabilitation,psychology and specialty care.According to a patient's specific disease condition,an individualized diagnosis and treatment plan is formulated(one plan for one patient).While selecting individualized antiviral,anti-inflammatory and immunomodulatory treatment,we also strengthen nutritional support,psychological intervention,comprehensive rehabilitation and timely and full-course intervention to develop overall and special nursing plans.In response to the rapid progression of severe/critical patients,MDT members need to establish a three-dimensional management model with close observation and timely evaluation.The MDT should make rounds of the quarantine wards both morning and night,and of critical patient wards nightly,to implement“round-theclock rounds management”,to accurately predict disease progression,perform the quick intervention and prevent rapid deterioration of the patient.Our MDT has cumulatively treated 77 severe/critical COVID-19 cases,including 62(80.5%)severe cases and 15(19.5%)critical cases,with an average age of 63.8 years.Fifty-three(68.8%)cases presented with more than one underlying disease and 65(84.4%)severe cases recovered from COVID-19.The average hospital stay of severe/critical cases was 22 days,and the mortality rate was 2.6%,both of which were significantly lower than the 30e40 days and 49.0e61.5%,respectively,reported in the literature.Therefore,a multidisciplinary,three-dimensional and individualized comprehensive treatment plan can effectively reduce the mortality rate of severe/critical COVID-19 and improve the cure rate.

Crisis challenges of small firms in Macao during the COVID-19 pandemic

This research develops a framework that combines crisis stages,stakeholder engagement and crisis challenges.The framework is applied to small firms in Macao during the 2019 novel coronavirus disease(COVID-19)pandemic crisis.We conduct a qualitative study based on semi-structured interviews with the leaders of six small firms in Macao.The findings suggest that the COVID-19 pandemic has turned into a"normal"context,which blurs the traditional crisis termination stage.We also find that participating firms engage more with internal stakeholders than external ones.The strategies adopted by small firms include flexible human resource(HR)practices,cost reduction,enhancing customer relations,and using government support schemes.These strategies are effective in the short term;firms need to pay attention to diversity and learning for the long term.