Introduction: The spread of the SARS-CoV-2 virus has caused severe problems for healthcare facilities and infrastructure worldwide. The development of rapid diagnostic tools, effective treatment protocols, and vaccines against the pathogen has accelerated. This work aims to elucidate the benefits of recombinant human monoclonal antibodies to slow the progression of SARS-CoV-2 variant B.1.617.2 infection (delta variant). Material and methods: This is a retrospective analysis with a 6-month follow-up involving all patients who received recombinant human monoclonal antibodies (MABs) casirivimab/ imdevimab at University Hospital Martin in November and December of 2021. Results: A total of 180 patients were enrolled in the cohort with a mean time to administration of symptoms were 6,01 +/-0,3 days in the group of vaccinated patients and 5,52+/-0,28 days in the group of non-vaccinated patients and a mean time to the resolution of symptoms were 4,37 +/-0,62 days in the group of vaccinated patients and 3,83 +/-0,3 days in the group with non-vaccinated patients. Of these patients, 13 developed bronchopneumonia (7,2%)—serious side effects after MAB administration were observed in 1 patient. Conclusion: Using recombinant human monoclonal antibodies casirivimab/ imdevimab to slow or to stop SARS-CoV-2 variant infection B.1.617.2 significantly affected the course of the disease. Quick diagnostics, identification of at-risk patients, and multidisciplinary collaboration are essential in COVID-19 management.

Background We estimated the secondary attack rate of SARS-CoV-2 among household contacts of PCR-confirmed cases of COVID-19 in rural Kenya and analysed risk factors for transmission. Methods We enrolled incident PCR-confirmed cases and their household members. At baseline, a questionnaire, a blood sample, and naso-oropharyngeal swabs were collected. Household members were followed 4, 7, 10, 14, 21 and 28 days after the date of the first PCR-positive in the household; naso-oropharyngeal swabs were collected at each visit and used to define secondary cases. Blood samples were collected every 1-2 weeks. Symptoms were collected in a daily symptom diary. We used binomial regression to estimate secondary attack rates and survival analysis to analyze risk factors for transmission. Results A total of 119 households with at least one positive household member were enrolled between October 2020 and September 2022, comprising 503 household members; 226 remained in follow up at day-14 (45%). A total of 43 secondary cases arose within 14 days of identification of the primary case, 81 household members remained negative. The 7-day secondary attack rate was 4% (95%CI 1-10%), the 14-day secondary attack rate was 28% (95%CI 17-40%). Of 38 secondary cases with data, 8 reported symptoms (21%, 95%CI 8-34%). Antibody to SARS-CoV-2 spike protein at enrolment was not associated with risk of becoming a secondary case. Conclusion Households in our setting experienced a lower 7-day attack rate than a recent meta-analysis indicated as the global average (23-43% depending on variant), and infection is mostly asymptomatic in our setting.

DEK locates in the nucleus of the cells or the cytoplasmic granules of neutrophils and plays different roles in cellular processes including NETosis, a suicide mechanism of neutrophils. Here we showed that the interaction of rDEK with CXCR2 leads to NETosis, which could be reduced by the CXCR1/CXCR2 inhibitor reparixin. We found that IL-8, IL-6, IL1-β, MPO, and CitH3 were increased whereas DEK was decreased in the serum of COVID-19 patients. Interestingly, reparixin or anti-DEK antibody reduced the NETosis induced by the patients’ serum, suggesting that initial cytokine stimulation may further induce the release of DEK. Our results support the use of reparixin as a potential therapeutic strategy in COVID-19 and suggest that DEK-CXCR2 interaction plays a role in NETosis.

COVID-19 pandemic has affected all countries and has threatened not only the health systems but overall governance structure of countries across the globe. Countries with weak public health systems remained at risk of substantial morbidity and mortality due to COVID-19. In Pakistan, due to diversity in provincial public health preparedness capacities SARS-CoV-2 data collection and response was fragmented during the early phase of the pandemic. To overcome this, the National CommandOperation Center (NCOC) was established in March 2020 and has been now merged with NIH. As of 7th February 2023, 1.6 million people have been infected with COVID-19, with over 30 thousand deaths reported across the country. NIH delivered awareness lectures on national media, point of entry, hospitals, and public institutes, and conducted vaccination companies, rapid response, surveillance, and diagnostics facilities at point of entry. NIH provided leadership for enhancing the COVID-19 testing capacities after acquiring SARS-CoV-2 detection capability in Feb 2020. NIH-mandated training on bio risk management, SARS-CoV-2 diagnostics, and laboratory assessment for a number of provincial public and private laboratories. Besides developing national guidelines for testing and strategies for molecular and antigen-based testing, the institute also leads genomic surveillance for SARS-CoV-2 covering all waves of SARS-CoV-2 pandemic which has subsequently revealed early detection of variants of concerns (VOCs). The NIH has submitted 3360 SARS-CoV-2 sequences to the GISAIDdatabase and organized an external quality assessment (EQA) of molecular detection of SARS-CoV-2 by distributing an EQA panel to public and private laboratories.

Background: Priming with ChAdOx1 followed by heterologous boosting have been considered in several countries. Nevertheless, analyses that provide a comparison of the immunogenicity of heterologous booster in comparison to homologous primary vaccination regimens and natural infection are lacking. In this study, we aimed to conduct a comparative assessment of the immunogenicity between heterologous prime-boost vaccination using BNT162b2 or mRNA-1273 and homologous primary vaccination regimens. Methods: We matched vaccinated naïve individuals (VN; n=673) who had received partial vaccination (n=64), primary vaccination (n=590), or primary series plus one mRNA vaccine heterologous booster (n=19) with individuals with a documented primary SARS-CoV-2 infection and no vaccination record (natural infection; NI cohort; n=206). We measured the levels of neutralizing total antibodies (NTAbs), total antibodies (TAbs), anti-S-RBD IgG, and anti-S1 IgA titers. Results: Homologous primary vaccination with ChAdOx1 not only showed less potent NTAb, TAb, anti-S-RBD IgG, and anti-S1 IgA immune responses compared to primary-BNT162b2 or mRNA-1273 vaccination regimens (P<0.05), but also showed ~3 fold less anti-S1 IgA response compared to infection-induced immunity (P<0.001). Nevertheless, heterologous booster dose resulted in a significant boost of at least ~12 folds in the immune response. Furthermore, correlation analyses revealed that both, anti-S-RBD IgG and anti-S1 IgA significantly contributed to virus neutralization among NI individuals, particularly in symptomatic and pauci-symptomatic individuals, whereas, among VN individuals, anti-S-RBD IgG was the main contributor to virus neutralization (r > 0.90, P < 0.001). Conclusion: The results emphasize the potential benefit of using heterologous mRNA boosters to increase antibody levels and neutralizing capacity.

Background: Changing morbidity and mortality from COVID-19 has been associated with the emergence of new SARS-CoV-2 variants. Whereby, acquisition of mutations in the Spike glycoprotein enhanced host receptor binding, cell entry and antibody escape. Understanding these can help predict the impact of these changes. We used genome sequence data to investigate mutation rates and entropy of SARS-CoV-2 during pandemic surges between 2020 and 2022. Methods: 1,637 SARS-CoV-2 genomes from Pakistan were analyzed using the Augur phylogenetic pipeline. Substitution rates and entropy of genomes were calculated year wise and, entropy in the Spike gene was compared for 2020, 2021 and 2022 (defined as periods A, B and C). Central Findings: In period A, G clades were predominant and SARS-CoV-2 genome substitution rate was 6.06 x 10 -4 per site per year. In period B, Delta variant were dominant and substitution rates increased to 9.74 x 10 -4. In period C, Omicron variants dominated with substitution rates at 5.02 x 10 -4. The rate of genome-wide entropy was the highest during B particularly, in the Spike gene such as, E484K and K417N. During C, genome-wide mutations were increased whilst entropy was reduced. Conclusions: The highest SARS-CoV-2 genome substitution rates in 2021 were associated with the Delta wave, which had the greatest morbidity and mortality. These stabilized during the Omicron wave in 2022, when COVID-19 numbers were high mortality was lower. Assessment of SARS-CoV-2 evolution should be monitored together with phylogeographical analysis can help predict future outbreaks and guide public health interventions.

BACKGROUND: Behavioral and emotional problems (BEPs) affected a significant proportion of preschool-aged children. The Covid-19 pandemic may increase the prevalence and treatment gap. Therefore, assessing determinant factors is needed to design appropriate prevention and early interventions. This study aims to assess the prevalence of BEPs in preschool-aged children in Indonesia and its determinant factors during the Covid-19 pandemic. METHODS: We conducted a community-based cross-sectional study in the Sleman District, Yogyakarta Special Province, Indonesia, from July to August 2022. We recruited children aged 2 to 5 and their parents using the Sleman Health and Demography Surveillance System framework. We used the Early Childhood Screening Assessment to detect BEPs in children and parents with a risk of depression. RESULTS: We recruited 214 children and their caregivers. The prevalence of BEPs in young children was 17.8%, and 16.8% of parents have a risk of depression. Based on the multivariate regression analysis, factors associated with BEPs are males adjusted OR 2.26 (95% CI:1.01-5.08) and parents with a risk for depression adjusted Odds Ratio 5.11 (95% CI 2.21-11.81). CONCLUSION: Early detection and intervention of BEPs in children and parents are essential to prevent mental illness and improve well-being, especially during the Covid-19 pandemic.

Despite recent advances in prophylactic vaccination, SARS-CoV-2 infections continue to cause significant morbidity. A better understanding of immune response differences between vaccinated individuals with and without later SARS-CoV-2 breakthrough infection is urgently needed. CoV-ADAPT is a prospective long-term study comparing humoral (anti-spike-RBD-IgG, neutralization capacity, avidity) and cellular (spike-induced T-cell interferon-γ release) immune responses in individuals vaccinated against SARS-CoV-2 at four different time points (three before and one after third vaccination). In this cohort study, 62 fully vaccinated individuals presented with SARS‑CoV-2 breakthrough infections vs 151 without infection 3-7 months following third vaccination. Breakthrough infections significantly increased anti-spike-RBD-IgG (p<0.01), but not spike-directed T-cell interferon-γ release (TC), antibody neutralization capacity or avidity. Anti-spike-RBD-IgG and antibody avidity decreased with age (p<0.01) and females showed higher anti-spike-RBD-IgG (p<0.01), and a tendency towards higher antibody avidity (p=0.051). The association between humoral and cellular immune responses previously reported at various time points was lost in subjects after breakthrough infections (p=0.807). Finally, a machine-learning approach based on our large immunological data set (a total of 49 variables) from different time points was unable to predict breakthrough infections (AUC: 0.55). In conclusion, distinct differences in humoral vs cellular immune responses in fully vaccinated individuals with or without breakthrough infection could be demonstrated. Breakthrough infections predominantly drive the humoral response without boosting the cellular component. Breakthrough infections could not be predicted based on immunological data, which indicates a superior role of environmental factors (e.g. virus exposure) in individualized risk assessment.

Background First Few “X” (FFX) studies provide evidence to guide public health decision making and resource allocation. The adapted WHO Unity FFX protocol for COVID-19 was implemented to gain an understanding of the clinical, epidemiological, virological, and household transmission dynamics of the first cases of COVID-19 infection detected in Juba, South Sudan. Methods Laboratory-confirmed COVID-19 cases were identified through the national surveillance system, and an initial visit was conducted with eligible cases to identify all close contacts. Consenting cases and close contacts were enrolled between June 2020 and December 2020. Demographic, clinical information and biological samples were taken at enrolment and 14–21 days post-enrolment for all participants. Results Twenty-nine primary cases and 82 contacts were included in analyses. Most primary cases (n=23/29, 79.3%) and contacts (n=61/82, 74.4%) were male. Many primary cases (n=18/29, 62.1%) and contacts (n=51/82, 62.2%) were seropositive for SARS-CoV-2 at baseline. The secondary attack rate among susceptible contacts was 12.9% (4/31; 95% CI: 4.9%–29.7%). All secondary cases and most (72%) primary cases were asymptomatic. Reported symptoms included coughing (n=6/29, 20.7%), fever or history of fever (n=4/29, 13.8%), headache (n=3/29, 10.3%) and shortness of breath (n=3/29, 10.3%). Of 38 cases, two were hospitalised (5.3%) and one died (2.6%). Conclusions These findings were used to develop the South Sudanese Ministry of Health surveillance and contract tracing protocols, informing local COVID-19 case definitions, follow-up protocols and data management systems. This investigation demonstrates that rapid FFX implementation is critical in understanding the emerging disease and informing response priorities.

A document by Marouène Belkahla. Click on the document to view its contents.

Objective: A qualitative study sought to understand the transition experiences of United States (U.S.) military Service members found “unfit for duty” following medical and physical evaluation boards (MEBs and PEBs). Methods: Confidential telephone interviews were conducted with 25 current and prior Service members. Participants were asked to share their experiences before, during, and after the MEB and PEB processes. To that end, interview questions were designed to gather the following types of transition experiences: (1) health conditions experienced during the medical disability evaluation process; (2) reactions to being recommended for separation, (3) transition-related stress and challenges, and (4) coping strategies. Salient themes were identified across chronological narratives. Results: Conditions that participants’ experienced included debilitating physical (e.g., injury) and/or mental health (e.g., post-traumatic stress disorder) conditions. In response to the “unfit for duty” notice, some participants reported emotional distress (e.g., anxiety, sadness, anger) connected to a sense of uncertainty about the future. Other participants reported relief connected to a sense of progression toward their medical disability claim status. Transition stress included the length of the MEB/PEB process, impact of the COVID-19 pandemic on the process, experiences of financial stress, impact on family life, and the compounded effect of these stressors on emotional distress, including depression and suicidal thoughts. Participants reported using adaptive (e.g., psychotherapy) and maladaptive (e.g., excessive drinking) strategies to cope with stress. Conclusions: The notable emotional distress and transition stress experienced by Service members found “unfit for duty” highlight the need for increased support and interventions to facilitate adaptive coping strategies during this vulnerable period.

Background: To evaluate the frequency and burden of disease of SARS-CoV-2 and other respiratory viruses in children under the age of 2 months. Methods: A retrospective, cross-sectional, single-center study was conducted between March 2021, and February 2022. All children under the age of 2 months and tested for SARS-CoV-2 were included. The frequency of SARS-CoV-2, of other respiratory viruses and the burden of disease caused by SARS-CoV-2 and other respiratory viruses were evaluated. Results: 727 children with an RT-PCR test for SARS-CoV-2 were included (mean age: 0.9 months (±0.6); boys: 57%); 514 (71%) in the emergency room and 213 (29%) in hospital. Among them, 62 (8.5%) had a positive RT-PCR test for SARS-CoV-2, more often in the Omicron period (23%) than in the Alpha period (4%). Of the 565 (78%) with a multiplex RT-PCR test for other viruses, 325 (58%) were positive. Children with a positive SARS-CoV-2 were less likely to have required respiratory support (p=.001), enteral nutrition (p=.03), or intensive care admission (p=.01) and had a shorter hospital stay than children with other respiratory viruses (5d vs. 7d, p=.007). Conclusion: In this young population of children, SARS-CoV-2 infection was less frequent and less severe than other viral respiratory infections.

Title: Complex regional pain syndrome of the knee after COVID-19 Vaccine in an adult patient

The end of the 2019/2020 influenza season was already registered in early summer 2020, and in the following season. There was an nearly complete absence of influenza. So far, the sometimes strict Covid-19 containment measures with contact restrictions and the obligation to wear a mask have been mentioned as reasons. This study looks for further reaseons and from several perspectives in order to develop strategies for a representative recording of influenza cases derive. In contrast to influenza A/B, the other viral respiratory pathogens (adenovirus, parainfluenza virus and RS virus) do not show any significant reduction. From 2020, the number of reports of respiratory infections to the RKI increased from an average of 300,000 annual reports by 2019 to 1,985,985 reports in 2020, over 5,453,017 reports in 2021 and to 29,681,158 in 2022. On the other hand cases of incapacity to work due to respiratory infections fell from 31.0% in 2019 to 15.3% in 2021. Influenza-specific diagnoses (ICD: J10.1-3) were encrypted 33,727 times in 2021, in 2020 there were still 109,846. The reduction in influenza A and B from 2020 as a result of the comprehensive Covid-19 control measures, including the obligation to wear masks, cannot be considered a major reason; rather, the aspect of underreporting of influenza cases plays a significant role. Therefore, the reporting quantity of the sentinal practices should be considered and the recording of incapacity diagnoses should be taken into account.

Background: As the ongoing public health crisis from Coronavirus Disease 2019 (COVID-19) pandemic puts strains on current models of cancer care, many health care centers had to adapt to minimize the risk of exposure and infection. The effects of the COVID-19 pandemic in a comprehensive cancer center were determined. Purpose: To measure the impact of the COVID-19 pandemic on care delivery at a comprehensive cancer center. Methods: The number of on-site and telehealth visits (TH) were obtained from scheduling software. Multiple factors including total visits, telehealth visits, screenings for cancer diagnosis, and cancer treatments were tracked from two years before the pandemic onset through 2022. The length of stay (LOS) and Case Mix Index (CMI) were calculated using hospital database. Results: In the third quarter of FY 2020, telehealth visits (TH) represented a fifth of total patient encounters. Cancer treatments, such as chemotherapy, radiation therapy, and surgery, decreased during the pandemic with number of surgeries being most affected (23% decrease in 2020 compared to the previous fiscal year). The average length of stay (LOS) was also longer with less discharges per given time during the pandemic. The increased LOS was related to increased severity of patient illnesses since CMI was higher. Screening mammograms decreased to a nadir of 58% in 2021 as compared to those screened in pre-pandemic fiscal years. Conclusions : The COVID-19 pandemic impacted many aspects of care, such as treatment and screenings. Many of these factors had to be postponed due to the fear of acquiring COVID-19 and access to care. The findings presented implicate that the delays and changes in cancer care during the pandemic resulted in less screening and treatment of more advanced disease.

The immune deregulation and disease-modifying anti-rheumatic drugs (DMARDs) make patients with autoimmune rheumatic diseases (ARD) more susceptible to infection. We aimed to investigate the prevalence and clinical outcome of COVID-19 in ARD patients with different treatments. PubMed, Embase, Medline, Cochrane Library, Web of Science were searched to identify the relevant evidence up to March 20, 2023. The overall prevalence of COVID-19 in ARD patients was 0.061. The ARD patients with glucocorticoids (GC) treatment had the highest prevalence[0.088(95%CI:0.065-0.110)] compared to biological (b) DMARDs[0.041(95%CI:0.031-0.051)], conventional synthetic (cs) DMARDs[0.055(95%CI:0.043-0.067)], and anti-TNF therapy[0.029(95%CI:0.003-0.056)]. In contrast, those receiving anti-TNF therapy had the lowest prevalence. The overall hospitalization rate, ICU admission rate, and mortality of ARD patients due to COVID-19 were 0.402(95%CI:0.330-0.476), 0.077(95%CI:0.051-0.107), and 0.073(95%CI:0.046-0.104). Using bDMARDs had lower hospitalization rates[0.216(95%CI:0.147-0.286)], ICU admission rates[0.010(95%CI:0.000-0.037)], and mortality[0.039(95%CI:0.007-0.087)]. Regression analysis showed a significant negative relationship between bDMARDs monotherapy and ICU admission rates(regression coefficient:-0.156, 95%CI:-0.260 - -0.051, P=0.006). Patients using csDMARDs had higher hospitalization rates[0.607(95%CI:0.450-0.755)], ICU admission rates[0.055(95%CI:0.037-0.075)], and mortality[0.074(95%CI:0.041-0.114)]. Patients using GC had a higher hospitalization rate[0.703(95%CI:0.449-0.910)], higher ICU admission rate[0.094(95%CI:0.046-0.152)], and lower mortality[0.070(95%CI:0.033-0.114)]. Regression analysis showed a significant positive correlation between GC monotherapy and hospitalization(regression coefficient:0.484, 95%CI:0.146-0.822, P=0.006). For ARD patients, csDMARDs were associated with disease severity in COVID-19, bDMARDs were associated with a reduced risk of severe disease, and GC was effective in patients with severe COVID-19-related respiratory failure.

Introduction: In this paper we examine the relationship between vaccination against COVID-19 and both the death rate from COVID-19 and the rate of COVID-19 spread. Our goal is determine if vaccination is associated with reduced death and/or spread of disease at the local level. Methods: This analysis was conducted at the county level in the state of Pennsylvania, United States of America, with data that were collected during the first half of 2022 from the state of Pennsylvania’s Covid Dashboard ([COVID-19 Data for Pennsylvania (pa.gov)](https://www.health.pa.gov/topics/disease/coronavirus/pages/cases.aspx) . Result s: Given that, during this time period, the vaccines being used were not geared specifically toward the common variants at that time, we found no statistically significant relationship between disease spread and vaccination rate at the county level. That said, we did find a highly statistically significant relationship between death rate and vaccination rate (p-value = 0.006). Specifically, a 1% increase in vaccination rate was found to correspond to a 0.751% decrease in death rate (95% confidence interval (0.236%, 1.266%)). Conclusions: These results support previous findings from across the world that Covid vaccination is highly efficacious in preventing death from the disease. Even during a time when vaccine design was not optimally matched with the prevailing strains, vaccination was found to reduce death rate. Hence, improving global vaccine availability is vitally important, in order to achieve necessary outcomes.

Background: Vaccination is a proven method of managing the COVID-19 pandemic and it is essential to prevent negative consequences in pregnant, lactating, and reproductive-age populations. The study aims to identify the rates of COVID-19 vaccine acceptance, the reasons for receiving and not receiving the vaccine, and the associated factors among pregnant, lactating, and non-pregnant women of reproductive age. Methods: This cross-sectional and analytical study was conducted online in Turkey, at the end of the fourth wave of the COVID-19 pandemic, between February-May 2022. A total of 658 participated in the study. The Question Form and the Fear of COVID-19 Scale were used to collect data. Results: Vaccine acceptance rates were 91.7% in non-pregnant women of reproductive age, 77% in lactating women, and 59% in pregnant women (p<0.05). The highest rate of vaccine hesitancy was observed in pregnant women (31.3%), and the vaccine rejection rate was the highest in lactating women (10.2%). For pregnant women (55.5%) and non-pregnant women of reproductive age (56.4%), the primary reason for the acceptance of the vaccine had no other choice but to be protected against the disease, while for lactating women (50.6%), the primary reason for receiving the vaccine was protecting the baby. Conclusion: Lack of knowledge about and confidence in the COVID-19 vaccine is still one of the barriers to vaccine acceptance today. Health care providers (HCPs) should provide effective counseling to pregnant, lactating, and non-pregnant reproductive-aged women based on current information and guidelines.

Objectives In a COVID-19 sero-surveillance cohort study with predominantly healthy and vaccinated individuals, the objectives were (i) to investigate longitudinally the factors associated with the quantitative dynamics of anti-spike IgG antibody levels, (ii) to evaluate whether the antibody levels were associated with protection from SARS-CoV-2 infection and (iii) to assess whether the association was different in the pre-Omicron compared with the Omicron period. Methods The QuantiVac Euroimmun ELISA test was used to quantify anti-S1 IgG levels. The entire study period (16 months), the 11-month pre-Omicron period and the cross-sectional analysis prior to the Omicron surge included 3219, 2310 and 895 reactive serum samples from 949, 919 and 895 study participants, respectively. Mixed-effect linear, mixed-effect time-to-event and logistic regression models were used to achieve the objectives. Results Age and time since infection or vaccination were the only factors associated with a decline of anti-S1 IgG levels. Antibody levels were significantly associated with protection from SARS-CoV-2 infection, and the association was higher for the Omicron than for the Alpha and Delta variants. In a prediction model, it was estimated that >8000 BAU/mL anti-S1 IgG was required to reduce the risk of infection with Omicron variants by 20% to 30% for 90 days. Conclusions Anti-S1 IgG antibody levels are associated with protection from infection. The levels in the pre-Omicron periods were less significant than during the Omicron surge, which in turn required very high levels for protection in a statistical model.

This study aimed to investigate the relationship between personality characteristics and psychological health of hospitals’ frontline medical staff and provide a basis and reference for targeted psychological health education for frontline medical staff and for the staff of related departments to formulate relevant policies. The self-evaluation scale of symptoms (SCL-90) was used to investigate the mental health status of 150 first-line medical staff in Zhejiang Province in response to the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia.The average scores of SCL-90 and somatization, obsessive-compulsive, depression, anxiety, hostility, terror, and psychotic factors were significantly higher than those of the normal sample in the first-aid medical staff of Aihu Hubei. The degree of influence on the mental health status of the frontline medical staff in service in Hubei is as follows, from high to low: the degree of suspicion that they may have been infected when new coronavirus pneumonia-related symptoms occur, the degree of fear of being infected and thus bring the infection to their families, and whether they have received a medical check-up recently, as well as a high level of education (both P<0.05).The psychological health level of the frontline medical staff is lower than the national norm. In the context of the increasing number of confirmed cases and the new type of coronavirus pneumonia in the absence of any specific curative treatments, the frontline medical staff is under great psychological pressure. It is necessary to institute targeted mental health promotion to relieve the psychological pressure endured by the frontline medical staff, promote their physical and mental health, and better respond to the pandemic in China.

Objectives: Circulating nucleocapsid (NCP) antigen of SARS-CoV-2 is increased in severely ill COVID-19 patients. However, clinical deterioration of COVID-19 often happens about one week after benign initial presentation. The role of NCP antigenemia as a biomarker in those cases remains unclear. We investigated NCP clearance kinetics in hospitalized patients as a risk assessment tool for predicting necessity of intensive care treatment of COVID-19 patients. Methods: Serum NCP was quantified using a commercial NCP-specific ELISA in hospitalized COVID-19 patients (n=63) during their hospital stay. Results were correlated to COVID-19 disease severity, inflammation parameters, antibody response and results of SARS-CoV-2 PCR from nasopharyngeal swabs.   Results: We demonstrate that NCP antigen levels in serum remained elevated in 45.6% of patients requiring treatment on intensive care units (ICU) after >8 days post positive SARS-CoV-2 PCR, compared to complete clearance in all non-ICU patients. This was in contrast to mucosal clearance of virus as measured by PCR. Antigen clearance was associated with higher IgG against S1 but not NCP.   Conclusions: Detection of NCP antigenemia after 8 days post COVID-19 diagnosis identifies patients who will require intensive care. Lack of NCP clearance after one week can thus help to assess the risk to develop severe COVID-19.

The “Severe Acute Respiratory Syndrome Coronavirus 2” (SARS-CoV-2) causes potentially fatal disease.The Covid-19 vaccine is the most effective weapon to reduce the virus spread. We describe a rare post-vaccine effect like Guillian Barré Syndrome. We reported a 66-years-old female patient with acute manifestations four weeks after vaccine administration.

The role of hydroxychloroquine (HCQ) in lowering the viral load of patients with COVID-19 is controversial. In our Institute, we treated more than 30,000 people with COVID-19 in 2020 and 2021, using the same diagnostic tools and the same treatment dosages. In this retrospective comparative study of data collected over this period, we aimed to compare the viral clearance in the nasopharynx as determined by qPCR in patients who were treated with HCQ and those who were not. As a new feature, we adjusted the data according to the most significant confounding factors (age, initial viral load, and timescale between the onset of symptoms and treatment). Of the 1 276 patients selected from our database, 776 were treated with HCQ and 500 were not. Viral clearance in the treatment group was reached significantly earlier than in the non-treatment group, at days 5, 10 and 30. These differences remain significant after adjustments for confounding factors. In conclusion, although age, initial viral load, and time to treatment do influence the viral load in patients with COVID-19, hydroxychloroquine associated with azithromycin still independently significantly lowered viral load more rapidly than other treatments, including azithromycin alone.

Background and Purpose: The Bazhen decoction is one of the most extensively used Traditional Chinese medicine (TCM) prescriptions for anti-aging. However, due to the complicity of the components, the pharmacological mechanism of Bazhen decoction is still limited. Experimental approach: We applied RNA sequencing and transcriptome analysis to get the full view of the signaling pathways regulated by Bazhen decoction in the wild type cell background. By using the progeroid cells derived from Werner syndrome mice, we applied Western blot, Immunofluorescence, flow cytometry and telomere FISH to verify the transcriptome data. Key Results: The transcriptome profile revealed that Bazhen decoction might systematically regulate multiple anti-aging pathways, including stem cell regulation, protein homeostasis, cardiovascular function, neuronal function, anti-inflammation, anti-DNA damage induced stress, DNA helicase activity and telomere lengthening. We found that multiple DNA helicases and telomere regulating proteins were up-regulated by Bazhen decoction, which promoted the resolving of G-quadruplex (G4) structure, and facilitated DNA replication and telomere elongation. These improvements also endowed the cellular resistance to DNA damages induced by replication stress. Together these data suggest that Bazhen decoction facilitate G4 resolving and telomere maintenance, which might contribute to the longevity sustaining properties revealed by transcriptome profile. Conclusions & Implications: Our data revealed a new strategy for recovering the pharmacological signature pathways for TCM, which could help the clinical precision medicine of TCM. By applying transcriptome in TCM-treated normal cell, we tried out a systematic analysis for dissecting the molecular mechanism of complicated TCM prescription in the normal genetic background.