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.

中国海关第一例新型冠状病毒(2019-nCoV)肺炎病例报道

2020-01-23内蒙古二连浩特市确诊了中国海关第一例新型冠状病毒(2019 novel Coronavirus,2019-nCoV)感染的肺炎。该患者当时无咳嗽、气短等呼吸道症状,也无发热、乏力等全身症状,不符合"新型冠状病毒感染的肺炎诊疗方案"(试行第三版)[1]中疑似病例的诊断标准,考虑到同车有发热的湖北籍疑似患者,且该病毒感染尚处于研究阶段,其临床表现可能存在复杂性,不除外无症状患者的存在,故对患者进行了胸部CT及血常规的初筛,结果该患者胸部CT及血常规均异常,后经核酸检测阳性确诊为新型冠状病毒感染的肺炎,并获得了成功救治,有效避免了患者进一步向国内外传播的风险,为传染病的防控提供了有益的借鉴,为中国海关检验检疫工作做出了表率。现将患者的诊治过程汇报如下。

荧光免疫层析法检测全血2019-nCoV IgM和IgG抗体在新型冠状病毒肺炎诊断中的应用

目的探究荧光免疫层析法检测IgM和IgG抗体在诊断新型冠状病毒肺炎(COVID-19)患者中的应用价值。方法选取2020年1~2月在隔离病区收治观察的28例留观患者作为观察组,均是首次新型冠状病毒(2019-nCoV)咽拭子核酸检测阳性而第二次以后连续两次核酸检测为阴性的患者,将同期发热门诊排除COVID-19的30例发热患者作为对照组,采用荧光免疫层析法检测所有研究对象的2019-nCoV免疫球蛋白M(IgM)和免疫球蛋白G(IgG)抗体水平,采用秩和检验对组间差异进行统计学分析;比较两组患者2019-nCoV IgM和IgG的阳性检出率;计算荧光免疫层析法检测2019-nCoV IgM和IgG水平诊断新型冠状病毒肺炎的灵敏度和特异度。结果观察组2019-nCoV IgM和IgG水平差异有统计学意义(均Z=-6.412,P<0.05);观察组2019-nCoV IgM和IgG的阳性检出率分别为71.4%和75.0%,联合检测阳性检出率为96.4%。结论荧光免疫层析法检测IgM和IgG抗体在新型冠状病毒肺炎诊断中具有较高的灵敏度和特异度,可作为新型冠状病毒感染的有效筛查指标。

抗新型冠状病毒2019-nCoV新药的研发

2019年底,湖北武汉暴发了2019新型冠状病毒感染疾病(COVID-19),并快速在全国蔓延,且在多个国家发现病例。其感染病例和死亡病例在短时间内快速超过重症急性呼吸综合征(SARS),给中国带来了不可估量的损失。中国科研人员在短时间内,快速锁定病原体为2019-nCoV(或hCoV-19或SARS-CoV-2),并且在不同层面开展了相关抗病毒药物的研发工作。本文介绍了抗2019-nCoV新药研发的现状。同时,鉴于突发病原体的药物研发过程相对迟缓,我们建议对于潜在流行可能性的病原体,其药物研发要具有前瞻性,国家层面要推进广谱药物的研发和临床试验,以应对可能出现的疫情风险。

The Sunspot Cycle Leads to Origin and Epidemic Mechanism of Novel Coronavirus COVID-19

Listed examples of virus transmission epidemics that can be strongly transmitted through the air caused by sunspot change cycle, analyzed the mechanism that promotes the generation of new viruses. From the schematic diagram of the changes in the combined force of the hydrodynamic effect of the sun sweeping the earth and the sweeping force, we obtain the places that are prone to light vortices are 30 degrees north latitude and 30 degrees south latitude on the east coast of the mainland creatively. The curved continental lines are perfect, the range of the light vortex generated is more obviously, and the effect is stronger. And the curved continental lines are perfect, the range of the light vortex generated is more obviously, and the effect is stronger. It is inferred that the light vortex produces the special amplified energy so that can make the virus mutate to produce a new highly infectious novel coronavirus. The earliest known place and time of the novel coronavirus origin are consistent with the reasoning of the new theory. Because the radius and frequency of the light vortex are different, the resulting virus strains are also different. Moreover, the fatality rate in the light vortex area is much higher than that in the non-light vortex area, indicating that the virus’s toxicity and lethality are higher in the light vortex area, so it can explain why Russia, India, and countries in the African equatorial region mortality are much lower than the United States, Italy, Spain and Brazil. Finally, preventive and recommended measures are proposed.

The novel coronavirus outbreak in Wuhan,China

The novel coronavirus(2019-nCoV,or COVID-19)epidemic first broke out in Wuhan and has been spreading in whole China and the world.The numbers of new infections and deaths in Wuhan are still increasing,which have posed major public health and governance concerns.A series of mandatory actions have been taken by the municipal and provincial governments supported by the central government,such as measures to restrict travels across cities,case detection and contact tracing,quarantine,guidance and information to the public,detection kit development,etc.Challenges such as lacking effective drugs,insufficient hospital services and medical supplies,logistics,etc.have much alleviated with the solidarity of the whole society.The pandemic will definitely be ended with the continuous efforts of both national and international multi-sectoral bodies.

Current efforts and challenges facing responses to 2019-nCoV in Africa

The novel coronavirus is a pandemic that has started to creep into Africa thus making the virus a truly global,health security threat.The number of new 2019-nCoV cases has been rising in Africa,though currently lower than the cases reported outside the region.African countries have activated their Emergency Operations Centres to coordinate responses and preparedness activities to the pandemic.A series of measures such as restricting travel,case detection and contact tracing,mandatory quarantine,guidance and information to the public among other efforts are being implemented across Africa.However,the presence of porous borders,the double burden of communicable and noncommunicable diseases,poverty,poor health literacy,infodemic and family clustering,and most of all,weak health systems,may make containment challenging.It is important for African countries to continue to intensify efforts and address the challenges to effectively respond to the uncertainty the pandemic poses.

The novel coronavirus outbreak:what can be learned from China in public reporting?

The new coronavirus outbreak gets everyone’s attention.China’s national actions against the outbreak have contributed great contributions to the world.China has been learning from practice for better reporting and is fast to adapt itself.In this article we discuss China’s practice in public reporting and its implications to global health.Confirmed cases,dynamic suspected cases,recovered cases,and deaths have been reported both in accumulative numbers and their daily updates.Some ratio indictors reporting(fatality rate,recovery rate,etc.),trend reporting,and global surveillance have been applied as well.Some improvements can still be made.It is necessary to further explore the influential factors behind the indicators for interventions.Recommendations are made to the World Health Organization and other countries for better public reporting and surveillance.

2019冠状病毒病疫苗接种相关新发及复发肾小球病研究进展

作为控制疫情的重要手段,2019冠状病毒病(COVID-19)疫苗已经在全球范围内广泛接种,但疫苗接种引起的新发及复发肾小球病也引起了肾脏病领域研究者的高度关注。根据全球范围的报道,信使RNA疫苗与灭活疫苗都有可能引起新发及复发肾小球病;首剂及第2剂接种后都有可能发病;新发肾小球病以微小病变为主,大多对激素敏感;复发病例亦预后良好,部分可自行缓解。疫苗引起的体液、细胞免疫反应可能是导致新发及复发肾小球病的原因。本文总结了COVID-19疫苗接种相关的新发及复发肾小球病病例,并为肾脏病患者接种COVID-19疫苗提供了建议。

眼科医护人员2019新型冠状病毒感染的防护对策

医护人员与患者接触的频率比普通民众高,更容易受到2019新型冠状病毒(2019-nCoV)感染的威胁。本文根据2019-nCoV感染的临床及流行病学特征,从眼科患者就诊的不同阶段提出系统的防护建议,包括患者流行病学筛查,医护人员一般性防护、专科防护,眼科仪器消毒等,以便相关人员做好预防措施。

In silico screening of Chinese herbal medicines with the potential to directly inhibit 2019 novel coronavirus

Objective: In this study we execute a rational screen to identify Chinese medical herbs that are commonly used in treating viral respiratory infections and also contain compounds that might directly inhibit 2019 novel coronavirus(2019-nCoV), an ongoing novel coronavirus that causes pneumonia.Methods: There were two main steps in the screening process. In the first step we conducted a literature search for natural compounds that had been biologically confirmed as against sever acute respiratory syndrome coronavirus or Middle East respiratory syndrome coronavirus. Resulting compounds were cross-checked for listing in the Traditional Chinese Medicine Systems Pharmacology Database.Compounds meeting both requirements were subjected to absorption, distribution, metabolism and excretion(ADME) evaluation to verify that oral administration would be effective. Next, a docking analysis was used to test whether the compound had the potential for direct 2019-nCoV protein interaction.In the second step we searched Chinese herbal databases to identify plants containing the selected compounds. Plants containing 2 or more of the compounds identified in our screen were then checked against the catalogue for classic herbal usage. Finally, network pharmacology analysis was used to predict the general in vivo effects of each selected herb.Results: Of the natural compounds screened, 13 that exist in traditional Chinese medicines were also found to have potential anti-2019-nCoV activity. Further, 125 Chinese herbs were found to contain 2 or more of these 13 compounds. Of these 125 herbs, 26 are classically catalogued as treating viral respiratory infections. Network pharmacology analysis predicted that the general in vivo roles of these26 herbal plants were related to regulating viral infection, immune/inflammation reactions and hypoxia response.Conclusion: Chinese herbal treatments classically used for treating viral respiratory infection might contain direct anti-2019-nCoV compounds.

Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center's observational study

Background An outbreak of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was first detected in Wuhan,Hubei,China.People of all ages are susceptible to SARS-CoV-2 infection.No information on severe pediatric patients with COVID-19 has been reported.We aimed to describe the clinical features of severe pediatric patients with COVID-19.Methods We included eight severe or critically ill patients with COVID-19 who were treated at the Intensive Care Unit (ICU),Wuhan Children's Hospital from January 24 to February 24.We collected information including demographic data,symptoms,imaging data,laboratory findings,treatments and clinical outcomes of the patients with severe COVID-19.Results The onset age of the eight patients ranged from 2 months to 15 years;six were boys.The most common symptoms were polypnea (8/8),followed by fever (6/8) and cough (6/8).Chest imaging showed multiple patch-like shadows in seven patients and ground-glass opacity in six.Laboratory findings revealed normal or increased whole blood counts (7/8),increased C-reactive protein,procalcitonin and lactate dehydrogenase (6/8),and abnormal liver function (4/8).Other findings included decreased CD16 + CD56 (4/8) and Th/Ts*(1/8),increased CD3 (2/8),CD4 (4/8) and CD8 (1/8),IL-6 (2/8),IL-10 (5/8) and IFN-γ (2/8).Treatment modalities were focused on symptomatic and respiratory support.Two critically ill patients underwent invasive mechanical ventilation.Up to February 24,2020,three patients remained under treatment in ICU,the other five recovered and were discharged home.Conclusions In this series of severe pediatric patients in Wuhan,polypnea was the most common symptom,followed by fever and cough.Common imaging changes included multiple patch-like shadows and ground-glass opacity;and a cytokine storm was found in these patients,which appeared more serious in critically ill patients.

Clinical characteristics of coronavirus disease 2019 in patients aged 80 years and older

Objective: Coronavirus disease 2019(COVID-19) has raised concern around the world as an epidemic or pandemic. As data on COVID-19 has grown, it has become clear that older adults have a disproportionately high rate of death from COVID-19. This study describes the early clinical characteristics of COVID-19 in patients with more than 80 years of age.Methods: Epidemiological, clinical, laboratory, radiological, and treatment data from 17 patients diagnosed with COVID-19 between January 20 and February 20, 2020 were collected and analyzed retrospectively. Treatment outcomes among subgroups of patients with non-severe and severe symptoms of COVID-19 were compared.Results: Of the 17 hospitalized patients with COVID-19, the median age was 88.0 years(interquartile range, 86.6–90.0 years;range, 80.0–100.0 years) and 12(70.6%) were men. The age distribution of patients was not significantly different between non-severe group and severe group. All patients had chronic pre-existing conditions. Hypertension and cardiovascular diseases were the most common chronic conditions in both subgroups. The most common symptoms at the onset of COVID-19 were fever(n = 13;76.5%), fatigue(n = 11;64.7%), and cough(n = 5;29.4%). Lymphopenia was observed in all patients, and lymphopenia was significantly more severe in the severe group than that in non-severe group(0.4×10~9/L vs 1.2×10~9/L, P = 0.014). The level of serum creatinine was higher in the severe group than in the non-severe group(99.0 lmol/L vs 62.5 lmol/L, P = 0.038). The most common features of chest computed tomography images were nodular foci in 10(58.8%) patients and pleural thickening in 7(41.2%) patients. All patients received antiviral therapy, while some patients also received intravenous antibiotics therapy(76.5%), Chinese medicinal preparation therapy(Lianhuaqingwen capsule, 64.7%), corticosteroids(35.3%) or immunoglobin(29.4%). Eight patients(47.1%) were transferred to the intensive care unit because of complications. Ten patients(58.8%) received intranasal oxygen, while 3(17.6%)received non-invasive mechanical ventilation, and 4(23.5%) received high-flow oxygen. As of June 20,7(41.2%) patients had been discharged and 10(58.8% of this cohort, 77.8% of severe patients) had died.Conclusion: The mortality of patients aged 80 years and older with severe COVID-19 symptoms was high.Lymphopenia was a characteristic laboratory result in these patients, and the severity of lymphopenia was indicative of the severity of COVID-19. However, the majority of patients with COVID-19 in this age cohort had atypical symptoms, and early diagnosis depends on prompt use of a viral nucleic acid test.

A precision medicine approach to managing 2019 novel coronavirus pneumonia

In December 2019,several patients with pneumonia of an unknown cause were detected in Wuhan,China.On 7 January 2020,the causal organism was identified as a new coronavirus,later named as the 2019 novel coronavirus(2019-nCoV).Genome sequencing found the genetic sequence of 2019-nCoV homologous to that of severe acute respiratory syndrome-associated coronavirus.As of 29 January 2020,the virus had been diagnosed in more than 7000 patients in China and 77 patients in other countries.It is reported that both symptomatic and asymptomatic patients with 2019-nCoV can play a role in disease transmission via airborne and contact.This finding has caused a great concern about the prevention of illness spread.The clinical features of the infection are not specific and are often indistinguishable from those of other respiratory infections,making it difficult to diagnose.Given that the virus has a strong ability to spread between individuals,it is of top priority to identify potential or suspected patients as soon as possible—or the virus may cause a serious pandemic.Therefore,a precision medicine approach to managing this disease is urgently needed for detecting and controlling the spread of the virus.In this article,we present such an approach to managing 2019-nCoV-related pneumonia based on the unique traits of the virus recently revealed and on our experience with coronaviruses at West China Hospital in Chengdu,China.

2019 novel coronavirus outbreak:a quiz or final exam?

The 2019 novel coronavirus(2019-nCoV)is an emerging pathogen and is threatening the global health.Strikingly,more than 28000 cases and 550 deaths have been reported within two months from disease emergence.Armed with experience from previous epidemics in the last two decades,clinicians,scientists,officials,and citizens in China are all contributing to the prevention of further 2019-nCoV transmission.Efficient preliminary work has enabled us to understand the basic characteristics of 2019-nCoV,but there are still many unanswered questions.It is too early now to judge our performance in this outbreak.Continuous and strengthened efforts should be made not only during the epidemic,but also afterwards in order to prepare for any incoming challenges.

4例新型冠状病毒感染病例咽拭子与痰标本病毒核酸检测的比较

目的比较分析新型冠状病毒病例咽拭子与痰标本的病毒核酸检测效果。方法对4例新型冠状病毒确诊病例的咽拭子与痰标本分别进行人体细胞GAPDH管家基因、病毒ORF 1ab基因、N基因及S基因Real time RT-PCR核酸检测与比较。结果4例病例的咽拭子和痰标本中,人体细胞管家基因GAPDH均呈现明显典型的扩增信号曲线;病毒ORF 1ab基因、N基因及S基因核酸检测中,痰标本的扩增曲线信号均比咽拭子强,扩增曲线的CT值均低于咽拭子,在病例1和4表现更加明显,而病例4的咽拭子标本检测中,商品化试剂呈现阴性结果,而痰标本则呈现明显的阳性结果。结论在开展新型冠状病毒实验室核酸检测中,痰标本的病毒含量高于咽拭子标本,其检测效果优于咽拭子标本。

31例新型冠状病毒感染病例咽拭子与痰标本病毒核酸检测的比较

目的比较新型冠状病毒病例咽拭子标本与痰标本的病毒核酸检测结果。方法对31例新型冠状病毒确诊病例的咽拭子与痰标本分别进行病毒ORF1ab基因、N基因及人体上皮细胞(ribonucleoprotein,RNP)基因(试剂内标基因)RT-PCR核酸检测与比较。结果 31例病例的咽拭子和痰标本中,人体上皮细胞RNP基因均呈现明显典型的扩增信号曲线;病毒ORF1ab基因、N基因的检测结果:31例患者的咽拭子核酸结果中,28例患者均显示阴性,第9例和第16例患者的咽拭子为单基因阳性,第17例为双基因阳性;同时采集的痰标本结果显示,18例患者均为单基因阳性,13例患者为双基因阳性。痰标本的病毒ORF1ab基因和N基因核酸检测扩增曲线的Ct值小于咽拭子标本的Ct值。结论在开展新型冠状病毒实验室核酸检测中,痰标本的病毒含量高于咽拭子标本,其检测效果优于咽拭子标本,更能准确体现患者病情。

52例重症新型冠状病毒肺炎患者临床特征分析

目的:探讨52例重症新型冠状病毒肺炎(COVID-19)患者临床特征。方法:采用回顾性研究方法,收集2020年2月3日至3月1日,华中科技大学同济医院中法新城院区隔离病房,收治的核酸阳性的重症COVID-19患者52例一般资料,分析其临床表现、实验室检查和影像学检查特点。结果:52例患者中,男性30例,女性22例,平均年龄(60.5±13.3)岁;进展成重症平均时间(11.1±6.0)d。临床上均出现胸闷、呼吸困难、活动后加重,48例发热病例中有23例为高热。所有患者CT均发现双肺多发磨玻璃样斑片、条索状影,其中2例患者出现出现局限性气肿,1例患者在未使用呼吸机在静息状态下发生自发性气胸,超过1/4患者合并胸膜粘连、增厚、超过10%患者并发纵膈淋巴结肿大。经过治疗死亡5例(9.6%),其余患者均已好转。死亡患者平均年龄(74.8±24.6)岁,且均伴有基础疾病,如高血压、冠心病、脑梗死等;自发病至死亡(17.3±6.1)d,且死亡病例均伴有持续高热。结论:重症COVID-19患者肺部损害严重;持续高热是病情加重的危险信号,建议临床予以重视。

新型冠状病毒肺炎疫情期间ERCP在胆道外科中的临床实践

目的:探讨在新型冠状病毒肺炎(简称新冠肺炎;WHO定名COVID-19)疫情下,如何正确规范处理中重度胆道感染、梗阻性黄疸。方法:分析新冠肺炎疫情期间(2020年2月1日—2020年4月30日),湖北医药学院附属东风医院ERCP治疗的8例胆总管结石伴中重度胆道感染及2例中重度梗阻性黄疸患者的资料,评估疫情期间内镜逆行胰胆管造影术(ERCP)在胆道外科中的安全性和防护流程的有效性。在进行ERCP治疗时采集内镜镜身拭子进行新型冠状病毒核酸检测,对比术前咽拭子新型冠状病毒核酸检测。结果:10例ERCP治疗过程顺利,患者恢复良好,医护人员无感染病例发生。内镜镜身拭子检测新型冠状病毒核酸与常规咽拭子检测无显著差异。制定的防护操作流程达到预期效果。结论:在新型冠状病毒肺炎疫情期间,在严格遵循防护规范基础上ERCP在胆道外科中的治疗是安全的,医护人员感染风险可有效控制。在进行ERCP治疗时采集内镜镜身拭子的方法可行。

100例新型冠状病毒感染者临床病例分析

目的:分析2019新冠感染者的临床特征、影像学特点、病情演变,研究初始血清炎症因子与影像累及范围、预判病情进展的相关性。方法:回顾性分析100例2019新冠感染患者治疗初始的临床资料、血常规、CRP、IL-6、降钙素原及胸部CT影像资料,并进行回顾性总结分析。结果:(1)100例患者中,男性54例,女性46例;年龄段2~82岁,平均41岁;未成年人6例(6%),52%有武汉旅居史,合并基础病20例(20%),首诊发热89例(89%)。(2)白细胞正常范围83例(83%);淋巴细胞绝对值降低45例(45%);IL-6升高65例(65%);降钙素原升高0例。(3)双肺病变81例(81%);单侧肺病变11例(11%);伴少量胸腔积液3例(3%);胸部影像学正常8例(8%);早期多发磨玻璃样密度(GGO)或伴部分实变75例(75%)。(4)初始轻型/普通型99例,1例危重型,后期5例进展为重型;比较重/危重型患者(6例)与轻/普通型(94例)初始白细胞、CRP、IL-6无明显差异,而初始累及双肺患者具有更高的CRP、IL-6。结论:本地区新冠感染成年人多见,发热为主要临床表现,新型冠状病毒肺炎的CT影像有一定的特征性,初始感染炎症指标不能预判病情进展,CRP、IL-6表达水平与影像学累及范围具有相关性,重视无症状及影像学阴性感染者有利于早期阻断人群聚集的传播途径。