中医药对新型冠状病毒肺炎(COVID-19)恢复期患者肺功能影响的Meta分析

目的系统评价中医药对新型冠状病毒肺炎(COVID-19,简称:新冠肺炎)恢复期患者的肺功能影响,以期为临床决策及后续临床研究的开展提供参考。方法计算机检索中国知网(CNKI)、万方数据库(WanFang)、中国生物医学文献数据库(SinoMed)、维普期刊数据库(VIP)、PubMed、The Cochrane Library、EMbase数据库,检索时间为建库至2022年7月。由2名研究者按照纳入与排除标准独立筛选文献、提取数据且评估纳入研究的偏倚风险及方法学质量,采用Review Manager 5.4软件进行Meta分析。结果共纳入9项研究,其中5项随机对照试验、2项非随机对照试验、2项队列研究,纳入研究共包含1101例新冠肺炎恢复期患者。Meta分析结果显示:(1)针刺、中西医结合康复训练,可有效提升患者第一秒用力呼气容积(forced expiratory volume in one second,FEV1)水平(SMD=1.43,95%CI[1.10,1.75],P<0.00001)。(2)中西医结合康复训练可提升患者第一秒用力呼气容积占用力肺活量的百分比(forced expiratory volume in one second/forced vital capacity,FEV1/FVC)(MD=12.12,95%CI[9.46,14.79],P<0.00001)。(3)中药联合常规康复训练可有效降低患者改良医学研究学会呼吸困难量表(modified Medical Research Council,mMRC)评分(MD=-0.16,95%CI[-0.17,-0.15],P<0.00001)。(4)针刺、中药可提升肺部CT好转率(RR=1.14,95%CI[1.06,1.23],P=0.0003)。结论中医药可提升新冠肺炎恢复期患者FEV1及FEV1/FVC水平、降低mMRC评分及促进肺部CT好转率,促进新冠肺炎恢复期患者康复。受纳入研究数量限制,结论尚需更多高质量研究予以验证。

Treatment for COVID-19 patients in Vietnam: Analysis of time-to-recovery

Objective:To describe the recovery time and related factors among COVID-19 patients in Vietnam.Methods:We used the secondary data obtained from the official database of the Ministry of Health of Vietnam and other public data sources that were available by April 9 th,2020.Cox proportional hazards model was carried out to identify factors related to recovery time among COVID-19 patients.Results:By April 9 th,2020,the cumulative number of COVID-19 cases detected in Vietnam was 255,of which 129(50.6%)patients had fully recovered.The median recovery time of patients was 17(95%CI=16-19)days.Older patients had a lower likelihood of recovery(HR=0.98,95%CI=0.97-0.99,P<0.001),whereas patients with a history of international incoming travel had a higher likelihood of recovery(HR=1.57,95%CI=1.03-2.40,P=0.036).There was no statistically significant difference in the recovery time of patients treated in different hospital settings.Conclusions:More attention is needed for older patients and who did not have international travel history.Patients confirmed with COVID-19 could be treated at local health facilities to avoid unnecessary referrals and burdens to specialized hospitals at the central level.

The Effect of Dexamethasone versus Methylprednisolone in the Treatment of COVID-19 Patients in Jordan

Background: Previous studies focused on the treatment effect of steroids versus no steroids in treating severe COVID-19 patients, a few studies evaluated outcomes for treating those patients with either dexamethasone or methylprednisolone. Currently, we evaluate the difference in mortality associated with treating COVID-19 patients with dexamethasone versus methylprednisolone. Methods: With a retrospective multicenter study, records were reviewed for the admitted patients with severe COVID-19 during the peak of the severe COVID-19 pandemic. All admitted patients on dexamethasone or methylprednisolone were included. Patients were analyzed as all populations and propensity scores matched patients. Propensity scores were calculated for several confounders by the generalized linear model, and a “greedy” near-neighbor matching algorithm was used. Continuous variables with nonnormal distribution were analyzed by Wilcoxon signed rank test. Chi-squared and Fischer exact test analyzed categorical variables. P-values were adjusted by the Bonferroni method for both data cohorts. Body mass index was in categories. Radiological findings were divided into five categories. The outcomes: mortality, the need for home oxygen therapy, recovery, and residual symptoms on discharge were analyzed by an independent two-sample test for equality of proportions (with Yates correction), and logistic regression analysis. Results: Among the 1128 reviewed records, patients on dexamethasone or methylprednisolone were 1071, and the propensity score-matched patients were 784: dexamethasone 393 and methylprednisolone 391. There was no significant difference in the characteristics of patients between the two steroids (p-value and adjusted p-value > 0.05) for most variables. PSM adjusted a few discrepant variables before analysis. The outcome of the unmatched patients demonstrated dexamethasone benefit in the need for home oxygen therapy ( 0.05). However, matched patients demonstrated significantly lower mortality associated with dexamethasone treatment (difference -2.68%, 95%CI, -1.0, -0.004, p = 0.03, and OR 1.7, p = 0.017), and no difference for the other outcomes, including the need for home oxygen therapy (p-value > 0.05). Conclusion: Dexamethasone treatment caused significantly less mortality than methylprednisolone in treating our COVID-19 patients, but no significant difference in recovery, the need for home oxygen therapy, and residual symptoms on discharge.

COVID-19 patient with an incubation period of 27 d:A case report

BACKGROUND As a highly contagious disease,coronavirus disease 2019(COVID-19)is wreaking havoc around the world due to continuous spread among close contacts mainly via droplets,aerosols,contaminated hands or surfaces.Therefore,centralized isolation of close contacts and suspected patients is an important measure to prevent the transmission of COVID-19.At present,the quarantine duration in most countries is 14 d due to the fact that the incubation period of severe acute respiratory syndrome coronavirus type 2(SARS-CoV-2)is usually identified as 1-14 d with median estimate of 4-7.5 d.Since COVID-19 patients in the incubation period are also contagious,cases with an incubation period of more than 14 d need to be evaluated.CASE SUMMARY A 70-year-old male patient was admitted to the Department of Respiratory Medicine of The First Affiliated Hospital of Harbin Medical University on April 5 due to a cough with sputum and shortness of breath.On April 10,the patient was transferred to the Fever Clinic for further treatment due to close contact to one confirmed COVID-19 patient in the same room.During the period from April 10 to May 6,nucleic acid and antibodies to SARS-CoV-2 were tested 7 and 4 times,respectively,all of which were negative.On May 7,the patient developed fever with a maximum temperature of 39℃,and his respiratory difficulties had deteriorated.The results of nucleic acid and antibody detection of SARS-CoV-2 were positive.On May 8,the nucleic acid and antibody detection of SARS-CoV-2 by Heilongjiang Provincial Center for Disease Control were also positive,and the patient was diagnosed with COVID-19 and reported to the Chinese Center for Disease Control and Prevention.CONCLUSION This case highlights the importance of the SARS-CoV-2 incubation period.Further epidemiological investigations and clinical observations are urgently needed to identify the optimal incubation period of SARS-CoV-2 and formulate rational and evidence-based quarantine policies for COVID-19 accordingly.

A Study on the Global Scenario of COVID-19 Related Case Fatality Rate, Recovery Rate and Prevalence Rate and Its Implications for India—A Record Based Retrospective Cohort Study

Importance: Corona virus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pandemic claiming millions of lives since the first outbreak was reported in Wuhan, China during December 2019. It is thus important to make cross-country comparison of the relevant rates and understand the socio-demographic risk factors. Methods: This is a record based retrospective cohort study. Table 1 was extracted from https://www.worldometers.info/coronavirus/ and from the Corona virus resource center (Table 2, Figures 1-3), Johns Hopkins University. Data for Table 1 includes all countries which reported >1000 cases and Table 2 includes 20 countries reporting the largest number of deaths. The estimation of CFR, RR and PR of the infection, and disease pattern across geographical clusters in the world is presented. Results: From Table 1, we could infer that as on 4th May 2020, COVID-19 has rapidly spread world-wide with total infections of 3,566,423 and mortality of 248,291. The maximum morbidity is in USA with 1,188,122 cases and 68,598 deaths (CFR 5.77%, RR 15% and PR 16.51%), while Spain is at the second position with 247,122 cases and 25,264 deaths (CFR 13.71%, RR 38.75%, PR 9.78%). Table 2 depicts the scenario as on 8th October 2020, where-in the highest number of confirmed cases occurred in US followed by India and Brazil (cases per million population: 23,080, 5007 & 23,872 respectively). For deaths per million population: US recorded 647, while India and Brazil recorded 77 and 708 respectively. Conclusion: Studying the distribution of relevant rates across different geographical clusters plays a major role for measuring the disease burden, which in-turn enables implementation of appropriate public healthcare measures.

Investigation and Research on the Psychological Status of Children and Adolescents During the Epidemic Period of COVID-19

Objective:The paper was to analyze the investigation and study of the psychological status of children and adolescents during the epidemic period of COVID-19.Methods:From March 5th to 11th,2020,1766 students from 8 to 18 years old in Yan'an area were taken as the research objects,and the psychological characteristics of this group of people during the epidemic period of COVID-19 were analyzed by the online questionnaires.Results:In the questionnaire,all children and adolescents were in good psychological conditions,and they had not shown serious negative psychological emotions,and they attached great importance to COVID-19.Conclusion:The psychological changes of children and adolescents during the epidemic period of COVID-19 are diverse.Most children and adolescents have a good mental state,and a few have negative psychological emotions.It can strengthen the psychological management of children and adolescents during the epidemic,and promote the healthy growth of children and adolescents clinically.

Recovery rates and long-term olfactory dysfunction following COVID-19 infection

Objectives:Olfactory dysfunction is one of the most recognized symptoms of COVID-19,significantly impacting quality of life,particularly in cases where recovery is prolonged.This review aims to explore patterns of olfactory recovery post-COVID-19 infection,with particular focus on delayed recovery.Data Sources:Published literature in the English language,including senior author's own work,online and social media platforms,and patients'anecdotal reports.Method:A comprehensive review of the literature was undertaken by the authors with guidance from the senior author with expertise in the field of olfaction.Results:Based on self-report,an estimated 95%of patients recover their olfactory function within 6 months post-COVID-19 infection.However,psychophysical testing detects higher rates of persistent olfactory dysfunction.Recovery has been found to continue for at least 2 years postinfection;negative prognostic indicators include severe olfactory loss in the acute phase,female sex,and older age.Variability in quantitative and qualitative disturbance in prolonged cases likely reflects both peripheral and central pathophysiological mechanisms.Limitations of many of the reviewed studies reflect lack of psychophysical testing and baseline olfactory assessment.Conclusions:Post-COVID-19 olfactory dysfunction remains a significant health and psychosocial burden.Emerging evidence is improving awareness and knowledge among clinicians to better support patients through their olfactory rehabilitation,with hope of recovery after several months or years.Further research is needed to better understand the underlying pathogenesis of delayed recovery,identify at risk individuals earlier in the disease course,and develop therapeutic targets.

Positive reverse transcription-polymerase chain reaction assay results in patients recovered from COVID-19: Report of two cases

BACKGROUND Coronavirus disease 2019(COVID-19)has spread around the globe.On February 28,2020,the World Health Organization adjusted the risk of spread and impact of COVID-19 to“very high”at the global level.Studies have mainly focused on the etiology,epidemiology,and treatment of COVID-19 to limit further spread and the negative impact of the disease,while less attention has been devoted to the follow-up and reexamination of patients who recovered from COVID-19 or were released from quarantine.CASE SUMMARY This study reports two cases where patients who had negative reverse transcription-polymerase chain reaction(RT-PCR)test results and met the criteria for discharge subsequently had positive RT-PCR test results.The clinical manifestations and computed tomography(CT)findings of these patients were examined.The conversion of RT-PCR test results in these two patients may be related to false-negative and false-positive outcomes of the test.CT images helped track improvement of pulmonary lesions.CONCLUSION The timing of discharge of COVID-19 patients should be determined by comprehensive analysis of CT images and RT-PCR test results.

Efficacy and Safety of Viusid and Asbrip in Hospitalized Patients with Mild and Moderate COVID-19: A Randomized Controlled Trial

Background: The aim of this study was to test Viusid and Asbrip as adjuvants to the standard treatment of patients with COVID-19 disease which could favor the recovery of the patients and reduce the hospitalization days. Design: This is a randomized, open-label, controlled trial to determine the efficacy and safety of Viusid and Asbrip in hospitalized patients with mild to moderate symptoms of COVID-19. Material and Methods: A total of 60 patients with proven COVID-19 disease by PCR test were randomized in a 2:1 ratio. In the active group 40 patients received oral doses of Viusid (30 ml TID) and Asbrip (10 ml TID) plus standard treatment. The control group consisted of 20 patients receiving only standard treatment. The trial began with hospitalization, followed by home treatment for a total of 21 days. Four symptoms were followed: fever, dyspnea, cough and fatigue, assessed by score 0 - 3: 0 = well, 1 = mild, 2 = moderate, 3 = severe, with total sum, Composite Symptom Score (CSS) from 0 to 12. Results: The 21 days diagram of CSS shows statistically better results of Viusid-Asbrip group vs. Control group from day 4 to day 21. Time to semi-recovery in days, assessed by 50% of CSS, is better in Viusid-Asbrip group vs. Control group (6.07 ± 2.77 vs. 8.35 ± 2.94, p = 0.02). Time to recovery in days respectively is (14.05 ± 4.15 vs. 19.25 ± 2.12, p = 0.0001). And Hospitalization days are (9.05 ± 2.58 vs. 12.75 ± 4.44, p = 0.0003). Conclusion: This trial shows that adding of Viusid & Asbrip to the treatment of COVID-19 can contribute to faster recovery of the patients, decreasing of the hospital stay and milder course of the disease.

Transport in the Aftermath of COVID-19: Lessons Learned and Future Directions

This paper is a review of the impact on transport in the Asian region where enforced lockdowns and transport reductions have come with real human costs in the areas of economic development and access to jobs, society and services from various perspectives including urban planning and transport, economy, GHG and air pollutant emissions and gender as some of the areas of focus in the Sustainable Development Goals. Transportation systems with a high level of planning, flexible modes of transport and good communication with the public have proved more resilient than others. Furthermore, digital infrastructure has proven to be a key transport solution through this crisis. Data collection and real-time analysis have proven that their time has come to be effective in urban planning and transport management. Digital infrastructure is also driving online shopping and urban delivery services that allow people seeking to be socially distant to access daily necessities in a fast and relatively inexpensive manner. Making use of new global data sets and computing techniques can help cities and countries to plan better. Developing countries will need to improve their ability to gather relevant data from public and private sources and furthermore use the data to achieve more resilient, sustainable transportation. Achieving Sustainable Development Goals will require a reprioritization of funding and efforts to ensure that countries are building optimized infrastructure that provide transport and mobility services with minimal financial burdens including new leapfrog transit systems.

Increased number of symptoms during the acute phase of SARS-CoV-2 infection in athletes is associated with prolonged time to return to full sports performance—AWAREⅧ

Purpose The aim of the study was to identify factors associated with prolonged time to return to full performance(RTFP)in athletes with recent severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.Methods Prospective cohort study with cross sectional analysis.A total of 84 athletes with confirmed SARS-CoV-2 infection assessed at a coronavirus disease 2019 recovery clinic gave a history of age,sex,type/level of sport,co-morbidities,pre-infection training hours,and 26 acute SARS-CoV-2 symptoms from 3 categories(“nose and throat”,“chest and neck”,and“whole body”/systemic).Data on days to RTFP were obtained by structured interviews.Factors associated with RTFP were demographics,sport participation,history of co-morbidities,pre-infection training history,and acute symptoms(type,number).Outcomes were:(a)days to RTFP(median,interquartile range(IQR))in asymptomatic(n=7)and symptomatic athletes(n=77),and(b)hazard ratios(HRs;95%confidence interval)for symptomatic athletes with vs.without a factor(univariate,multiple models).HR<1 was predictive of higher percentage chance of prolonged RTFP.Significance was p<0.05.Results Days to RTFP were 30 days(IQR:23–40)for asymptomatic and 64 days(IQR:42–91)for symptomatic participants(p>0.05).Factors associated with prolonged RTFP(univariate models)were:females(HR=0.57;p=0.014),endurance athletes(HR=0.41;p<0.0001),co-morbidity number(HR=0.75;p=0.001),and respiratory disease history(HR=0.54;p=0.026).In symptomatic athletes,prolonged RTFP(multiple models)was significantly associated with increased“chest and neck”(HR=0.85;p=0.017)and“nose and throat”(HR=0.84;p=0.013)symptoms,but the association was more profound between prolonged RFTP and increased total number of“all symptoms”(HR=0.91;p=0.001)and“whole body”/systemic(HR=0.82;p=0.007)symptoms.Conclusion A larger number of total symptoms and specifically“whole body”/systemic symptoms during the acute phase of SARS-CoV-2 infection in athletes is associated with prolonged RTFP.

Cellular and Molecular Atlas of Peripheral Blood Mononuclear Cells from a Pregnant Woman After Recovery from COVID-19

Objective:This study aimed to investigate the immune response of a pregnant woman who recovered from the coronavirus disease 2019(COVID_(R)S)by using single-cell transcriptomic profiling of peripheral blood mononuclear cells(PBMCs)and to analyze the properties of different immune cell subsets.Methods:PBMCs were collected from the COVID_(R)S patient at 28 weeks of gestation,before a cesarean section.The PBMCs were then analyzed using single-cell RNA sequencing.The transcriptional profiles of myeloid,T,and natural killer(NK)cell subsets were systematically analyzed and compared with those of healthy pregnant controls from a published single-cell RNA sequencing data set.Results:We identified major cell types such as T cells,B cells,NK cells,and myeloid cells in the PBMCs of our COVID_(R)S patient.The increase of myeloid and B cells and decrease of T cells and NK cells in the PBMCs in this patient were quite distinct compared with that in the control subjects.After reclustering and Augur analysis,we found that CD16 monocytes and mucosal-associated invariant T(MAIT)cells were mostly affected within different myeloid,T,and NK cell subtypes in our COVID_(R)S patient.The proportion of CD16 monocytes in the total myeloid population was increased,and the frequency of MAIT cells in the total T and NK cells was significantly decreased in the COVID-RS patient.We also observed significant enrichment of gene sets related to antigen processing and presentation,T-cell activation,T-cell differentiation,and tumor necrosis factor superfamily cytokine production in CD16 monocytes,and enrichment of gene sets related to antigen processing and presentation,response to type II interferon,and response to virus in MAIT cells.Conclusion:Our study provides a single-cell resolution atlas of the immune gene expression patterns in PBMCs from a COVID_(R)S patient.Our findings suggest that CD16-positive monocytes and MAIT cells likely play crucial roles in the maternal immune response against severe acute respiratory syndrome coronavirus 2 infection.These results contribute to a better understanding of the maternal immune response to severe acute respiratory syndrome coronavirus 2 infection and may have implications for the development of effective treatments and preventive strategies for the coronavirus disease 2019 in pregnant women.

The importance of managing emotions and mental health in this lockdown period

With hundreds of millions of people grappling with isolation and heightened anxiety,the Novel Coronavirus pandemic is likely to have a serious universal impact on mental health worldwide,especially the elderly.Before the spread of coronavirus pneumonia all over the world,Chinese data have shown that the elderly is the most vulnerable faced with such diseases.We should pay more attention to those older people and help them manage their emotions to reduce the negative effects of social and emotional distance.

基于数据挖掘与网络药理学探讨新型冠状病毒肺炎恢复期中医药用药规律及机制

目的基于数据挖掘分析新型冠状病毒肺炎(Corona virus disease 2019,COVID-19)恢复期临床研究、名医经验及官方公布恢复期方药组方规律,应用网络药理学研究核心药物及其化合物在COVID-19恢复期的作用机制,为新冠肺炎恢复期的防治提供指导。方法通过检索中国知网等数据库以构建新冠肺炎恢复期中医处方数据库,采用数据挖掘和关联规则分析等方法,研究新冠肺炎恢复期方药组方规律,筛选核心药组;进一步采用网络药理学方法,通过GO分析和KEGG通路富集分析,研究核心药物的生物信号通路,阐明其作用机制。结果筛选官方公布的新冠肺炎恢复期处方86套,发现13味高频中药,进一步关联分析得到14个高频药组,结合复杂网络分析及聚类分析确定新冠肺炎恢复期核心药组。采用网络药理学方法,研究核心药组作用机制,筛选得到疾病核心作用靶点与主要化合物成分靶点交集34个,GO富集分析367条,KEGG分析108条。结论新冠肺炎恢复期用药规律以补脾益肺,益气养阴为主,祛湿利痰、解毒化瘀为辅,病机以正虚邪恋为特点,“茯苓-半夏-党参-陈皮”为新冠肺炎恢复期处方中的核心药组。网络药理学分析进一步分析发现核心药组的关键成分木犀草素、黄芩素、柚皮素等可调控LI6、TNF、AKT等关键靶点发挥作用,松弛素信号通路、糖尿病并发症AGE-RAG等信号通路可能为其关键通路。

徐伟辉“针、灸”治疗新型冠状病毒感染恢复期经验

随着新型冠状病毒感染大面积爆发,许多患者在感染新型冠状病毒感染后随着疾病的发生发展进入了新型冠状病毒感染恢复期。新型冠状病毒感染恢复期是指患者符合相关出院指征而未达到在临床上治愈的标准,患者出院后仍存在有咳嗽、乏力、焦虑等多功能障碍,影响社会各行各界复工复产,同时严重降低个人生活质量。针对新型冠状病毒感染恢复期,目前西医常规口服药物治疗都为对症治疗,大多无明显疗效。徐伟辉主任医师在临床工作多年,有充足完备的理论知识储备及专业操作技能,基于对新型冠状病毒感染恢复期的认识,再结合临床上大量收治新型冠状病毒感染恢复期患者的经验,基于扶正祛邪的治疗原则提出以腹针结合雷火灸治疗新型冠状病毒感染恢复期的具体运用方案,可以为临床上治疗新型冠状病毒感染恢复期患者提供更具有中医特色的可行建议,为临床中医治疗此类疾病提供新思路。

Year-round changes in tropospheric nitrogen dioxide caused by COVID-19 in China using satellite observation

The lockdown policy deals a severe blow to the economy and greatly reduces the nitrogen oxides(NOx)emission in China when the coronavirus 2019 spreads widely in early 2020.Here we use satellite observations from Tropospheric Monitoring Instrument to study the year-round variation of the nitrogen dioxide(NO_(2))tropospheric vertical column density(TVCD)in 2020.The NO_(2)TVCD reveals a sharp drop,followed by small fluctuations and then a strong rebound when compared to 2019.By the end of 2020,the annual average NO_(2)TVCD declines by only 3.4%in Chinamainland,much less than the reduction of 24.1%in the lockdown period.On the basis of quantitative analysis,we find the rebound of NO_(2)TVCD is mainly caused by the rapid recovery of economy especially in the fourth quarter,when contribution of industry and power plant on NO_(2)TVCD continues to rise.This revenge bounce of NO_(2)indicates the emission reduction of NOx in lockdown period is basically offset by the recovery of economy,revealing the fact that China’s economic development and NOx emissions are still not decoupled.More efforts are still required to stimulate low-pollution development.

Alterations in Phenotypes and Responses of T Cells Within 6 Months of Recovery from COVID-19: A Cohort Study

The COVID-19 pandemic,caused by the SARS-CoV-2 infection,is a global health crisis.While many patients have clinically recovered,little is known about long-term alterations in T cell responses of COVID-19 convalescents.In this study,T cell responses in peripheral blood mononuclear cells of a long-time COVID-19 clinically recovered(20–26 weeks)cohort(LCR)were measured via flow cytometry and ELISpot.The T cell responses of LCR were comparatively analyzed against an age and sex matched short-time clinically recovered(4–9 weeks)cohort(SCR)and a healthy donor cohort(HD).All volunteers were recruited from Wuhan Jinyintan Hospital,China.Phenotypic analysis showed that activation marker PD-1 expressing on CD4^(+)T cells of LCR was still significantly lower than that of HD.Functional analysis indicated that frequencies of Tc2,Th2 and Th17 in LCR were comparable to those of HD,but Tc17 was higher than that of HD.In LCR,compared to the HD,there were fewer IFN-c producing T cells but more IL-2 secreting T cells.In addition,the circulating Tfh cells in LCR were still slightly lower compared to HD,though the subsets composition had recovered.Remarkably,SARS-CoV-2 specific T cell responses in LCR were comparable to that of SCR.Collectively,T cell responses experienced long-term alterations in phenotype and functional potential of LCR cohort.However,after clinical recovery,SARS-CoV-2 specific T cell responses could be sustained at least for six months,which may be helpful in resisting re-infection。

The incubation period of COVID-19: a global meta-analysis of 53 studies and a Chinese observation study of 11 545 patients

Background:The incubation period is a crucial index of epidemiology in understanding the spread of the emerging Coronavirus disease 2019(COVID-19).In this study,we aimed to describe the incubation period of COVID-19 globally and in the mainland of China.Methods:The searched studies were published from December 1,2019 to May 26,2021 in CNKI,Wanfang,PubMed,and Embase databases.A random-efect model was used to pool the mean incubation period.Meta-regression was used to explore the sources of heterogeneity.Meanwhile,we collected 11545 patients in the mainland of China outside Hubei from January 19,2020 to September 21,2020.The incubation period ftted with the Log-normal model by the coarseDataTools package.Results:A total of 3235 articles were searched,53 of which were included in the meta-analysis.The pooled mean incubation period of COVID-19 was 6.0 days(95%confdence interval[CI]5.6–6.5)globally,6.5 days(95%CI 6.1–6.9)in the mainland of China,and 4.6 days(95%CI 4.1–5.1)outside the mainland of China(P=0.006).The incubation period varied with age(P=0.005).Meanwhile,in 11545 patients,the mean incubation period was 7.1 days(95%CI 7.0–7.2),which was similar to the fnding in our meta-analysis.Conclusions:For COVID-19,the mean incubation period was 6.0 days globally but near 7.0 days in the mainland of China,which will help identify the time of infection and make disease control decisions.Furthermore,attention should also be paid to the region-or age-specifc incubation period.

Demand for longer quarantine period among common and uncommon COVID-19 infections: a scoping review

Background:As one of the non-pharmacological interventions to control the transmission of COVID-19,determining the quarantine duration is mainly based on the accurate estimates of the incubation period.However,patients with coarse information of the exposure date,as well as infections other than the symptomatic,were not taken into account in previously published studies.Thus,by using the statistical method dealing with the interval-censored data,we assessed the quarantine duration for both common and uncommon infections.The latter type includes the presymptomatic,the asymptomatic and the recurrent test positive patients.Methods:As of 10 December 2020,information on cases have been collected from the English and Chinese databases,including Pubmed,Google scholar,CNKI(China National Knowledge Infrastructure)and Wanfang.Official websites and medias were also searched as data sources.All data were transformed into doubly interval-censored and the accelerated failure time model was applied.By estimating the incubation period and the time-to-event distribution of worldwide COVID-19 patients,we obtain the large percentiles for determining and suggesting the quarantine policies.For symptomatic and presymptomatic COVID-19 patients,the incubation time is the duration from exposure to symptom onset.For the asymptomatic,we substitute the date of first positive result of nucleic acid testing for that of symptom onset.Furthermore,the time from hospital discharge or getting negative test result to the positive recurrence has been calculated for recurrent positive patients.Results:A total of 1920 laboratory confirmed COVID-19 cases were included.Among all uncommon infections,34.1%(n=55)of them developed symptoms or were identified beyond fourteen days.Based on all collected cases,the 95th and 99th percentiles were estimated to be 16.2 days(95%Cl 15.5-17.0)and 22.9 days(21.7-24.3)respectively.Besides,we got similar estimates based on merely symptomatic and presymptomatic infections as 15.1 days(14.4-15.7)and 21.1 days(20.0-22.2).Conclusions:There are a certain number of infected people who require longer quarantine duration.Our findings well support the current practice of the extended active monitoring.To further prevent possible transmissions induced and facilitated by such infectious outliers after the 14-days quarantine,properly prolonging the quarantine duration could be prudent for high-risk scenarios and in regions with insufficient test resources.

中医治疗恢复期新型冠状病毒感染患者的研究进展

新型冠状病毒感染(coronavirus disease 2019,COVID-19)作为一种大规模爆发的流行病,它对人们生活以及生体健康造成了严重危害。自从2019年COVID-19爆发后,中医药就积极参加到病情救治当中去,在预防疾病向重症转化和后期的康复治疗中发挥着巨大作用。随着出院人数增加,后期新冠病毒肺炎患者的康复治疗日益受到重视,中医治疗在促进后期患者康复和防治复发等方面疗效突出。主要从病因病机、辨证分型以及治疗等方面对近几年中医治疗恢复期COVID-19患者的进展进行一个总结,以期为以后临床治疗提供参考。