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.

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.

COVID-19 vaccination program in the mainland of China: a subnational descriptive analysis on target population size and current progress

Background:China is facing substantial risks of imported coronavirus disease 2019(COVID-19)cases and a domestic resurgence in the long run,and COVID-19 vaccination is expected to be the long-lasting solution to end the pandemic.We aim to estimate the size of the target population for COVID-19 vaccination at the provincial level in the mainland of China,and summarize the current progress of vaccination programs,which could support local governments in the timely determination and adjustment of vaccination policies and promotional measures.Methods:We conducted a descriptive study of the entire population in the mainland of China,between December 2020 and August 2021.By extracting provincial-stratifed data from publicly available sources,we estimated the size of priority target groups for vaccination programs,and further characterized the ongoing vaccination program at the provincial level,including the total doses administered,the coverage rate,and the vaccination capacity needed to achieve the target coverage of 80%by the end of 2021.We used R(version 4.1.0)to complete the descriptive statistics.Results:The size of the target population shows large diferences among provinces,ranging from 3.4 million to 108.4 million.As of 31 August,2021,the speed of vaccine roll-out difers considerably as well,with the highest coverage occurring in Beijing and Shanghai,where 88.5%and 79.1%of the population has been fully vaccinated,respectively.In 22 of 31 provincial-level administrative divisions(PLADs),more than 70%of the population was administered at least one dose by August.With the current vaccination capacity,the target of 80%coverage could be achieved by 2021 in 28 PLADs.Conclusions:Disparities exist in the target population size and vaccination progress across provinces in the mainland of China.China has made great strides in the vaccination speed since roll-out,and could basically achieve the targeted vaccine coverage.

Asymptomatic and Pre-Symptomatic COVID-19 in China

As the novel coronavirus disease 2019(COVID-19)pandemic spreads rapidly across the globe many unanswered questions about the basic biology and epidemiology of the disease hamper our response strategies and limit our ability to achieve control and prevent a rebound or so-called“second wave”.One such crucial question is:To what degree do asymptomatic cases contribute to transmission?Early,small studies on this subject have found wide ranging estimates of the prevalence of asymptomatic carriers,and just a handful of studies so far have documented viral shedding by asymptomatic cases[1].We recently re-examined China’s COVID-19 case report data to investigate this question[2].This Editorial aims to describe how asymptomatic cases contribute to transmission and what the implications are for control strategies.

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.

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.

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.

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.

The influence of the corporate social responsibility disclosures on consumer brand attitudes under the impact of CO VID-19

This study focuses on the use of we-media by small-and medium-sized enterprises(SMEs)to disclose internal corporate social responsibility(ICSR)under the impact of the 2019 novel coronavirus disease(COVID-19).Study 1 interprets the catalyst effect of COVID-19 on the externalization of SMEs'ICSR.The fuzzy grading evaluation method is initially verified.Under the impact of COVID-19,SMEs fulfilling their ICSR can enhance consumer brand attitudes.Study 2 uses a structural equation model and empirical analysis of 946 effective samples and finds that consumers perceive the self-sacrifice of corporations during the coronavirus disease period.SMEs can fulfill their ICSR to enhance the internal explanation mechanism of consumer brand attitudes and the moderating role of enterprise losses.