背景2021年3月和7月云南省瑞丽市发生了2次境外输入病例导致的新型冠状病毒(SARS-CoV-2)感染的局部疫情,而且国内不断有输入病例导致的局部疫情出现。目的探讨SARS-CoV-2感染的成人与儿童本土病例流行病学及临床特征,为预防和治疗SARS-C...背景2021年3月和7月云南省瑞丽市发生了2次境外输入病例导致的新型冠状病毒(SARS-CoV-2)感染的局部疫情,而且国内不断有输入病例导致的局部疫情出现。目的探讨SARS-CoV-2感染的成人与儿童本土病例流行病学及临床特征,为预防和治疗SARS-CoV-2感染提供借鉴。设计病例系列报告。方法回顾性收集云南省瑞丽市SARS-CoV-2感染病例定点医院(中医傣医医院)2021年3月29日至4月30日(简称3月疫情,SARS-CoV-2)和2021年7月4~31日[简称7月疫情,新型冠状病毒德尔塔变异株(Delta-CoV)]收治的由输入病例感染的成人和儿童本土病例,采集人口学、流行病学史和临床特征资料。结果成人和儿童病例分别为192例(3月和7月疫情分别为112例和80例)和16例(3月和7月疫情分别为5例和11例);①儿童病例均未接种疫苗,成人仅7月疫情期间15例(18.8%)接种1剂型疫苗,19例接种了2剂型疫苗第1剂,14例(17.5%)接种了第2剂;②成人和儿童通过流行病学调查为密接者3月疫情分别为3.6%和40.0%,7月疫情分别为20.2%和54.5%,P<0.05。③2次疫情成人和儿童病例无危重型和死亡病例,成人以轻型和普通型为主,儿童以无症状感染、轻型和普通型为主。④成人有基础疾病3月和7月疫情分别为17.0%和13.8%,P<0.05;7月疫情儿童基础疾病1例为乙肝。⑤7月疫情成人发热病例(41.2%)较3月疫情(15.2%)占比高,P<0.05,7月疫情儿童发热病例45.4%。⑥成人7月疫情较3月疫情乏力和咽部不适占比更高,儿童以咳嗽和咽部不适为主。⑦成人淋巴细胞减少病例7月疫情较3月疫情占比更高,P<0.05,儿童仅在7月疫情出现1例;成人病例LDH、ALT、AST、CRP和D-二聚体升高者占比7月疫情均高于3月疫情,儿童仅在7月疫情LDH、AST、CRP和D-二聚体升高各2例(18.2%)。⑧儿童肺部CT以双肺多发磨玻璃影、浸润影为主,成人病例还表现为以肺外带多发小斑片影及间质改变。⑨2次疫情儿童无氧疗病例,成人氧疗时间7月疫情(150 h)较3月疫情(96 h)更长;2次疫情成人连续二次核酸转阴时间接近(19 d vs 22 d),儿童病例7月疫情(32 d)较3月疫情(15 d)更长,P<0.05。结论Delta-CoV较SARS-CoV-2感染的成人和儿童本土病例临床表现更重;儿童较成人病例临床表现轻,但核酸转阴时间较成人明显延长;Delta-CoV流行期间,成人病例36.3%完成了疫苗接种。展开更多
Wastewater surveillance has been applied in various parts of the world to monitor the introduction and transmissions of SARS-CoV-2 variants in a population. The knowledge of SARS-CoV-2 variants circulating in a popula...Wastewater surveillance has been applied in various parts of the world to monitor the introduction and transmissions of SARS-CoV-2 variants in a population. The knowledge of SARS-CoV-2 variants circulating in a population is critical to COVID-19 management and timing of the application of public health countermeasures. Contrary to the routine clinical surveillance of SARS-CoV-2 where cases from asymptomatic patients are often underreported, wastewater surveillance offers an unbiased tool for monitoring the extent of SARS-CoV-2 transmissions in a community. The present study aimed to characterize SARS-CoV-2 variants that circulated in Nairobi County, Kenya, between April 2021 and August 2021 utilizing wastewater samples. Viral RNA was extracted from wastewater samples, followed by SARS-CoV-2 screening by real-time RT-qPCR before targeted sequencing of the Spike gene. Forty samples were analyzed, of which 50% (n = 20) tested positive for SARS-CoV-2 by real-time RT-qPCR. Of these, 45% (n = 9) were successfully amplified by RT-PCR and sequenced. The majority (78%, 7/9) of the viruses belonged to the Delta (B.1.617.2) lineage of SARS-CoV-2, while a minority (22%) belonged to the Alpha (B.1.1.7) and Alpha-Delta lineages. Phylogenetic analysis of the SARS-COV-2 delta lineage strains revealed scattered clustering of the Kenyan viruses among the global strains included in the analysis, suggesting different introductory routes into the country. On the whole, our results confirm previous clinical findings that SARS-CoV-2 variants belonging to the Alpha (B.1.1.7) and Delta (B.1.617.2) lineages circulated in Nairobi County, Kenya during the study period, with the latter predominating. This is the first study to describe the diversity of SARS-CoV-2 variants circulating in Kenya, through wastewater analysis.展开更多
Background: SARS-CoV-2, the virus responsible for the current COVID-19 infection pandemic, has caused substantial damage and negative impacts in the world, including physical sickness, mental illness, death, society l...Background: SARS-CoV-2, the virus responsible for the current COVID-19 infection pandemic, has caused substantial damage and negative impacts in the world, including physical sickness, mental illness, death, society lock down, work interruption, and productivity reduction. From the onset in early 2020, the pandemic has not yet totally subsided as of July 2022. Although great efforts have been made to understand the nature of this pandemic by the medical and scientific communities, a comprehensive review of this pandemic has not been reported. Purpose: We aimed to perform a thorough review of the subject in order to come to a better understanding of the origin of the virus, its mutations and their corresponding health effects, its pathophysiology, and its responses to therapeutic intervention. A more comprehensive set of data on these subject matters, if available, would give healthcare providers a valuable tool in formulating the best methods to respond to the current disease and prevent the disease from spreading in the future. Method: An extensive literature search on the subjects of COVID-19 was conducted regarding the possible origin of the viral pathogen, its evolutionary changes and health impacts, the world’s responses to COVID-19 and outcomes of their responses, and healthcare professional’s actions to understand and manage the disease and the results of their actions. To gather these data, websites of PubMed and Google Scholar were utilized for the search with the following keywords: Pandemic, COVID-19, coronavirus, SARS, SARS-CoV, SARS-CoV-2, origin, pathogenesis, and treatment. Results: Our review revealed data that points to an interesting autoimmune phenomenon where most seriously sick patients affected by COVID-19 were documented by an IgA-dominant immune response to the pathogen, along with a neutrophil-directed infiltration to the vital organ in the lung aveola, resulting in critical lung injury, leading to respiratory failure, multi-organ failure, and death. Surprisingly, this IgA-mediated and neutrophil-directed disease pattern is nearly identical to a group of IgA-mediated autoimmune skin diseases, such as dermatitis herpetiformis, IgA bullous dermatosis, and IgA pemphigus, which respond well to treatment by dapsone, a sulfone class of antibiotic/anti-inflammatory drug. Moreover, the usefulness of dapsone was supported by a small clinical study. In addition, systemic corticosteroid, a trusted anti-inflammatory medication, has been used in this pandemic with variable degrees of success. Conclusion: The data collected from our review of the subject, together with our prior search knowledge, compel us to conclude that the underlying pathophysiology that causes serious respiratory distress and multi-organ failure is most likely to be autoimmune in nature and that strategies to counter these multifacet autoimmune disorders would be the most valuable in life-saving. Specifically, we identified clinical and laboratory evidence pointing to IgA autoimmune reaction as a key factor that causes significant mortality in many patients. Accordingly, we proposed the utilization of a combination of dapsone, corticosteroid, and anti-thrombotic drugs in severely ill patients at the earliest point of the disease process. The autoimmune multi-organ syndrome may explain the pathogenesis of COVID-19 as well as Post-COVID conditions and may guide healthcare professionals in a better direction to manage the disease. The possible origin of the viral pathogen may shed light on a better understanding of the pathogenesis of the disease.展开更多
The COVID crisis in India shows no sign of abating. The country of 1.4 billion has passed 30.5 million COVID-19 infections and over 402,000 deaths. Even government figures are likely underestimated due to problems wit...The COVID crisis in India shows no sign of abating. The country of 1.4 billion has passed 30.5 million COVID-19 infections and over 402,000 deaths. Even government figures are likely underestimated due to problems with testing and reporting in the country. Reasonable estimates due to under reporting and lack of testing put these figures at three times higher. The new cases and deaths are predicted to rise by September 2021. The situation is bad in the main cities, but also that it is worse in the poorer and rural areas where lack of healthcare resources has made those populations most vulnerable to the disease. There is an urgent need for rapid tests for quantification of infectiousness to triage patients. In traumatised India, saving lives has become the highest priority to be achieved by vaccinating 70 per cent of the adult population. Over 200 million population have been vaccinated. India’s monthly COVID vaccine manufacturing capacity is about 60 - 65 million doses against the final requirement of 1.45 billion doses to cover 70 per cent adults. Even though the second surge is on a decline in most of the states, mucormycosis continues to be a public health concern. There are 41,000 mucormycosis cases reported during the second wave. Daily increase in Delta plus variant cases should alert the Policy-makers. It has a very high transmissibility. Genomic testing & surveillance of mutations to limit fresh twist of pandemic is a necessity. Only a few drugs have emerged as approved COVID-19 treatments. Where are we with drug treatment? Over 30 billion USD have been spent on vaccine development because it has a market. Very little is spent on research on drug discovery. There has not been any significant antibiotic molecule for the last two decades. Politics has played and continues to play a big part in the spread of the virus but it is a situation that needs a global approach. Tiding over a pandemic requires detailed preparation at multiple levels on the part of the State. New ways to prevent, detect, track and treat SARS-CoV-2 infections are crucial keeping in view the rise of more-transmissible viral mutants like Delta plus.展开更多
文摘背景2021年3月和7月云南省瑞丽市发生了2次境外输入病例导致的新型冠状病毒(SARS-CoV-2)感染的局部疫情,而且国内不断有输入病例导致的局部疫情出现。目的探讨SARS-CoV-2感染的成人与儿童本土病例流行病学及临床特征,为预防和治疗SARS-CoV-2感染提供借鉴。设计病例系列报告。方法回顾性收集云南省瑞丽市SARS-CoV-2感染病例定点医院(中医傣医医院)2021年3月29日至4月30日(简称3月疫情,SARS-CoV-2)和2021年7月4~31日[简称7月疫情,新型冠状病毒德尔塔变异株(Delta-CoV)]收治的由输入病例感染的成人和儿童本土病例,采集人口学、流行病学史和临床特征资料。结果成人和儿童病例分别为192例(3月和7月疫情分别为112例和80例)和16例(3月和7月疫情分别为5例和11例);①儿童病例均未接种疫苗,成人仅7月疫情期间15例(18.8%)接种1剂型疫苗,19例接种了2剂型疫苗第1剂,14例(17.5%)接种了第2剂;②成人和儿童通过流行病学调查为密接者3月疫情分别为3.6%和40.0%,7月疫情分别为20.2%和54.5%,P<0.05。③2次疫情成人和儿童病例无危重型和死亡病例,成人以轻型和普通型为主,儿童以无症状感染、轻型和普通型为主。④成人有基础疾病3月和7月疫情分别为17.0%和13.8%,P<0.05;7月疫情儿童基础疾病1例为乙肝。⑤7月疫情成人发热病例(41.2%)较3月疫情(15.2%)占比高,P<0.05,7月疫情儿童发热病例45.4%。⑥成人7月疫情较3月疫情乏力和咽部不适占比更高,儿童以咳嗽和咽部不适为主。⑦成人淋巴细胞减少病例7月疫情较3月疫情占比更高,P<0.05,儿童仅在7月疫情出现1例;成人病例LDH、ALT、AST、CRP和D-二聚体升高者占比7月疫情均高于3月疫情,儿童仅在7月疫情LDH、AST、CRP和D-二聚体升高各2例(18.2%)。⑧儿童肺部CT以双肺多发磨玻璃影、浸润影为主,成人病例还表现为以肺外带多发小斑片影及间质改变。⑨2次疫情儿童无氧疗病例,成人氧疗时间7月疫情(150 h)较3月疫情(96 h)更长;2次疫情成人连续二次核酸转阴时间接近(19 d vs 22 d),儿童病例7月疫情(32 d)较3月疫情(15 d)更长,P<0.05。结论Delta-CoV较SARS-CoV-2感染的成人和儿童本土病例临床表现更重;儿童较成人病例临床表现轻,但核酸转阴时间较成人明显延长;Delta-CoV流行期间,成人病例36.3%完成了疫苗接种。
文摘Wastewater surveillance has been applied in various parts of the world to monitor the introduction and transmissions of SARS-CoV-2 variants in a population. The knowledge of SARS-CoV-2 variants circulating in a population is critical to COVID-19 management and timing of the application of public health countermeasures. Contrary to the routine clinical surveillance of SARS-CoV-2 where cases from asymptomatic patients are often underreported, wastewater surveillance offers an unbiased tool for monitoring the extent of SARS-CoV-2 transmissions in a community. The present study aimed to characterize SARS-CoV-2 variants that circulated in Nairobi County, Kenya, between April 2021 and August 2021 utilizing wastewater samples. Viral RNA was extracted from wastewater samples, followed by SARS-CoV-2 screening by real-time RT-qPCR before targeted sequencing of the Spike gene. Forty samples were analyzed, of which 50% (n = 20) tested positive for SARS-CoV-2 by real-time RT-qPCR. Of these, 45% (n = 9) were successfully amplified by RT-PCR and sequenced. The majority (78%, 7/9) of the viruses belonged to the Delta (B.1.617.2) lineage of SARS-CoV-2, while a minority (22%) belonged to the Alpha (B.1.1.7) and Alpha-Delta lineages. Phylogenetic analysis of the SARS-COV-2 delta lineage strains revealed scattered clustering of the Kenyan viruses among the global strains included in the analysis, suggesting different introductory routes into the country. On the whole, our results confirm previous clinical findings that SARS-CoV-2 variants belonging to the Alpha (B.1.1.7) and Delta (B.1.617.2) lineages circulated in Nairobi County, Kenya during the study period, with the latter predominating. This is the first study to describe the diversity of SARS-CoV-2 variants circulating in Kenya, through wastewater analysis.
文摘Background: SARS-CoV-2, the virus responsible for the current COVID-19 infection pandemic, has caused substantial damage and negative impacts in the world, including physical sickness, mental illness, death, society lock down, work interruption, and productivity reduction. From the onset in early 2020, the pandemic has not yet totally subsided as of July 2022. Although great efforts have been made to understand the nature of this pandemic by the medical and scientific communities, a comprehensive review of this pandemic has not been reported. Purpose: We aimed to perform a thorough review of the subject in order to come to a better understanding of the origin of the virus, its mutations and their corresponding health effects, its pathophysiology, and its responses to therapeutic intervention. A more comprehensive set of data on these subject matters, if available, would give healthcare providers a valuable tool in formulating the best methods to respond to the current disease and prevent the disease from spreading in the future. Method: An extensive literature search on the subjects of COVID-19 was conducted regarding the possible origin of the viral pathogen, its evolutionary changes and health impacts, the world’s responses to COVID-19 and outcomes of their responses, and healthcare professional’s actions to understand and manage the disease and the results of their actions. To gather these data, websites of PubMed and Google Scholar were utilized for the search with the following keywords: Pandemic, COVID-19, coronavirus, SARS, SARS-CoV, SARS-CoV-2, origin, pathogenesis, and treatment. Results: Our review revealed data that points to an interesting autoimmune phenomenon where most seriously sick patients affected by COVID-19 were documented by an IgA-dominant immune response to the pathogen, along with a neutrophil-directed infiltration to the vital organ in the lung aveola, resulting in critical lung injury, leading to respiratory failure, multi-organ failure, and death. Surprisingly, this IgA-mediated and neutrophil-directed disease pattern is nearly identical to a group of IgA-mediated autoimmune skin diseases, such as dermatitis herpetiformis, IgA bullous dermatosis, and IgA pemphigus, which respond well to treatment by dapsone, a sulfone class of antibiotic/anti-inflammatory drug. Moreover, the usefulness of dapsone was supported by a small clinical study. In addition, systemic corticosteroid, a trusted anti-inflammatory medication, has been used in this pandemic with variable degrees of success. Conclusion: The data collected from our review of the subject, together with our prior search knowledge, compel us to conclude that the underlying pathophysiology that causes serious respiratory distress and multi-organ failure is most likely to be autoimmune in nature and that strategies to counter these multifacet autoimmune disorders would be the most valuable in life-saving. Specifically, we identified clinical and laboratory evidence pointing to IgA autoimmune reaction as a key factor that causes significant mortality in many patients. Accordingly, we proposed the utilization of a combination of dapsone, corticosteroid, and anti-thrombotic drugs in severely ill patients at the earliest point of the disease process. The autoimmune multi-organ syndrome may explain the pathogenesis of COVID-19 as well as Post-COVID conditions and may guide healthcare professionals in a better direction to manage the disease. The possible origin of the viral pathogen may shed light on a better understanding of the pathogenesis of the disease.
文摘The COVID crisis in India shows no sign of abating. The country of 1.4 billion has passed 30.5 million COVID-19 infections and over 402,000 deaths. Even government figures are likely underestimated due to problems with testing and reporting in the country. Reasonable estimates due to under reporting and lack of testing put these figures at three times higher. The new cases and deaths are predicted to rise by September 2021. The situation is bad in the main cities, but also that it is worse in the poorer and rural areas where lack of healthcare resources has made those populations most vulnerable to the disease. There is an urgent need for rapid tests for quantification of infectiousness to triage patients. In traumatised India, saving lives has become the highest priority to be achieved by vaccinating 70 per cent of the adult population. Over 200 million population have been vaccinated. India’s monthly COVID vaccine manufacturing capacity is about 60 - 65 million doses against the final requirement of 1.45 billion doses to cover 70 per cent adults. Even though the second surge is on a decline in most of the states, mucormycosis continues to be a public health concern. There are 41,000 mucormycosis cases reported during the second wave. Daily increase in Delta plus variant cases should alert the Policy-makers. It has a very high transmissibility. Genomic testing & surveillance of mutations to limit fresh twist of pandemic is a necessity. Only a few drugs have emerged as approved COVID-19 treatments. Where are we with drug treatment? Over 30 billion USD have been spent on vaccine development because it has a market. Very little is spent on research on drug discovery. There has not been any significant antibiotic molecule for the last two decades. Politics has played and continues to play a big part in the spread of the virus but it is a situation that needs a global approach. Tiding over a pandemic requires detailed preparation at multiple levels on the part of the State. New ways to prevent, detect, track and treat SARS-CoV-2 infections are crucial keeping in view the rise of more-transmissible viral mutants like Delta plus.
