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2020

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02

Scientific Research News | Research Progress of novel coronavirus Pneumonia (COVID-19) (XIX)


1. 2019-nCoV Epidemic Alert

■ At 2 o'clock on February 17, the joint prevention and control mechanism of the State Council held a press conference in Beijing to introduce the progress of medical treatment. Sun Yanrong, deputy director of the Biology Center of the Ministry of Science and Technology, said at the meeting, "More than ten hospitals in Beijing, Guangdong and Hunan provinces jointly carried out the safety and efficacy evaluation of chloroquine phosphate for the treatment of new coronary pneumonia. Clinically, we have seen the efficacy with great certainty, whether it is from a series of indicators such as severe disease rate, antipyretic phenomenon, lung imaging improvement time, viral nucleic acid negative time and negative conversion rate, and shortening the course of the disease, etc., for systematic comprehensive research and judgment, the medication group is better than the control group. Moreover, after careful and careful discussion, the efficacy expert group finally reached a consensus that chloroquine phosphate "is an old drug that has been on the market for many years, and the safety of treatment for a wide range of people is controllable." Based on the clinical studies carried out by previous clinical institutions, it can be determined that chloroquine phosphate has efficacy in the treatment of new coronary pneumonia. Based on the urgent needs of current clinical treatment, experts unanimously recommend that "chloroquine phosphate should be included in the new version of the diagnosis and treatment guidelines as soon as possible to expand the scope of clinical application." ”

In terms of traditional Chinese medicine, Li Yu, director of the Department of Science and Technology of the State Administration of Traditional Chinese Medicine, said that the State Administration of Traditional Chinese Medicine launched the "Clinical Screening Research on Effective Prescriptions for the Prevention and Treatment of New Coronary Pneumonia in Traditional Chinese Medicine" on January 1, guided by clinical "urgent, practical and effective". With the availability of 27 clinically valid data, on February 214, the National Health Commission and the State Administration of Traditional Chinese Medicine jointly issued a document recommending the use of lung cleansing and detoxification soup to the whole country.
In addition, Guo Yanhong, Inspector of the Medical Administration of the National Health Commission, said that the situation in Wuhan has also changed greatly at this stage. Especially in the recent past, through early diagnosis and early treatment, through continuous observation of mild patients after admission, it can be seen that the proportion of severe disease has decreased from 2% at the beginning to 6% at present. Therefore, it should be said that "four mornings and four concentrations" is a very effective measure to improve the cure rate and admission rate, and reduce the infection rate and case fatality rate.

■ On February 2020~2, 12, WHO and the Global Collaborative on Infectious Disease Prevention and Control Research jointly organized the Global Research and Innovation Forum on the Novel Coronavirus. The forum identified nine priority research areas related to the pandemic:

First, to better understand the natural history, transmission patterns, and diagnostic methods of the virus, researchers will focus on pathological model development, including animal models of infection, disease, and transmission, and develop tools for monitoring and studying viral phenotypic changes and potential adaptations, and support the application of diagnostic tools and related products to improve clinical processes.
Second, researchers will further identify the animal host, find evidence that it (or they) continue to spread the virus to humans, and understand the socioeconomic and behavioral risk factors that this entails.
Third, epidemiological studies will focus on understanding the process of virus transmission, determining the severity of the disease, understanding population susceptibility, and determining which public health measures are effective in controlling the outbreak.
Fourth, clinical features and management will attempt to define the natural history of disease, develop a set of core clinical outcomes to maximize the use of data generated by a series of trials, and identify complementary and supportive interventions to improve clinical outcomes.
Fifth, strengthen epidemic prevention and control by optimizing the use of personal protective equipment and minimizing the role of environmental factors in the spread of the virus, especially for health workers.
Sixth, the development of candidate therapies will focus on developing animal models and standardizing challenging studies, conducting preventive clinical studies and prioritizing use in healthcare professionals.
Seventh, the development of vaccine candidates will focus on optimizing clinical trial design for vaccine candidates for Phase 3 trials and priority testing, and developing assays for assessing vaccine immune responses and vaccine development.
Eighth, ethical considerations in research should include articulating and translating existing ethical principles and standards related to the salient issues of COVID, and conducting ethical assessments in all nine research areas.
Ninth, at the social science level related to the pandemic, the underlying drivers of spreading misinformation and rumours and triggering and spreading fear, anxiety and stigmatization through social media, including through social media, should be identified.

2. Advances in biological research of 2019-nCoV

■ On February 2, Dmitry Korkin's research group at Worcester Tech University published the article Structural genomics and interactomics of 14 Wuhan novel coronavirus, 2019-nCoV, indicate evolutionary conserved functional on the biology preprint platform bioRxiv regions of viral proteins, by studying the structural genomes and interaction groups of novel coronaviruses, the functional conserved regions of viral protein evolution were revealed. In this study, a comprehensive homologous modeling analysis of the 2019D structure of viral proteins was carried out, protein interaction complexes were predicted by model comparison, and the virus macromolecular interaction network was constructed, which provided a protein structure reference for drug design against the novel coronavirus [3].
■ On February 1, Jianxing He's team from Guangzhou Medical University published a review entitled "Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China" online in the international top cancer journal The Lancet Oncology, which analyzed the risk of severe COVID-14 in cancer patients for the first time. The study found that patients with cancer may have a higher risk of COVID-2 than those without cancer. In addition, the review found that cancer patients have a poor prognosis for COVID-19 and promptly reminded doctors that cancer patients should pay more attention in the case of rapid deterioration. Therefore, the researchers propose three main strategies for cancer patients in this COVID-19 crisis and for future severe infectious disease attacks. First, deferral of adjuvant chemotherapy or elective surgery should be considered in endemic areas; Second, stricter personal protection rules should be established for cancer patients; Third, when cancer patients are infected with 19-nCoV, enhanced monitoring or treatment should be considered, especially in elderly patients or those with other comorbidities[19].

3. 2019-nCoV epidemiological study

■ On February 2, the Epidemiological Group of the Novel Coronavirus Pneumonia Emergency Response Mechanism of the Chinese Center for Disease Control and Prevention released the largest analysis of the epidemiological characteristics of novel coronavirus pneumonia in the Chinese Journal of Epidemiology. As of 17 February 2020, a total of 2,11 confirmed and suspected cases have been reported. Among the 72314,72314 cases reported, 44672,61 were confirmed cases, accounting for 8.16186%, and 22,4 were suspected cases, accounting for 10567.14%; There were 6,889 clinically diagnosed cases, accounting for 1.2%. Among them, there were 77 cases of asymptomatic infection that everyone was more concerned about, accounting for 8.30%. Among the confirmed cases, 69.51% of the patients were aged 4~74 years old, 7.80% were male, 9.1023% in Hubei Province, and 2.3% were mild/moderate. Of the confirmed cases, there were 2 deaths, representing a crude case fatality rate of 8.1%, compared with 7.80% in men and 14.8% in women. In the ≥ 0 age group, the highest crude case fatality rate is 015.10%. The case fatality density was 10.0 per 015 person-days, i.e. the average risk of death per patient observed for 5 days was 1.2.
By occupation, retirees have the highest crude case fatality rate of 9.0 per cent. Hubei province's crude case fatality rate (4.7%) is 3.0 times higher than that of other provinces (9.10%). The crude case fatality rate is about 5.7% in patients with no reported comorbidities, and much higher in patients with comorbidities, including 3.6% in patients with cardiovascular disease, 3.6% in diabetes, 0.5% in chronic respiratory disease, 6.13% in hypertension and 8.4% in cancer. Severe cases accounted for 7.49% and critical cases accounted for 0.325%. The crude case fatality rate for critically ill cases is 10%, and the case fatality density is 0.325, i.e. the average risk of death per critically ill case observed for <> days is <>.<>.

The patients were concentrated in 30~79 years old, and this age group accounted for 89.8% of the total number of confirmed cases, 88.6% in Wuhan City, 86.6% in Hubei Province (including Wuhan), and 60.44% in the whole country (including Hubei). The proportion of cases in the elderly group over 1 years old was 35.1% in Wuhan, 31.2% in Hubei (including Wuhan), and 0.99% in the whole country (including Hubei). The ratio of confirmed cases to men is 1.1:04 in Wuhan, 1.1:06 in Hubei, and 1.<>:<> nationwide.

Among the confirmed cases, 0.2% of the cases were onset before 2019 December 12, and the cases were all in Hubei; 31.1% of the cases were onset before 7 January and were distributed in 1 counties in 10 provinces, of which Hubei accounted for 20.113%. 88.5% of the cases were dated before January 13 and were distributed in 8 counties and districts in 1 provinces, of which Hubei accounted for 20.30%; 627.77% of the cases were dated before January 6 and were distributed in 73,1 counties and districts in 1 provinces, of which Hubei accounted for 31.31%. 1310.74% of the cases reported living in or travelling to Wuhan within 7 days prior to onset of illness, or having had close contact with patients in Wuhan. Of the 68 medical institutions that provide services for patients with the new coronavirus, a total of 6,14 medical staff were infected with the new coronavirus (422,3019 confirmed cases), of which 1716 died. Analysis of 5 symptomatic confirmed cases, Wuhan had 1688 cases, accounting for 1080.64% of the total number of cases among medical personnel in the country, 0 cases (394.23%) in other regions except Wuhan in Hubei, and 3 cases (30.214%) in 12 provinces (autonomous regions/municipalities) except Hubei. The proportion of severe cases was 7.17% in Wuhan, 7.10% in Hubei, and 4.7% nationwide except Hubei. According to different time periods, the proportion of severe cases among medical staff in Wuhan gradually decreased from a peak of 0.38% to 9.2% in early February.

Based on the above data, the researchers believe that although the new coronavirus is highly contagious, most patients have mild manifestations and the overall crude case fatality rate is low. Most of the fatalities were patients aged 60 years and older with underlying medical conditions such as hypertension, cardiovascular disease and diabetes.

The timing of this outbreak is consistent with previous findings that wildlife may have been traded at the Wuhan Huanan Seafood Market, enabling the novel coronavirus to spread from a still-unknown wild animal to humans and then from person to person. As of now, there is no evidence of a super-spreader incident in any of the healthcare facilities that serve patients with novel coronavirus pneumonia.

In addition, the article pointed out that although the epidemic situation tends to decline as of February 2, the epidemic has not yet ended, especially after the resumption of work, a large number of people movement and contact, increasing the risk of the spread of new crown pneumonia, it is necessary to continue to implement the detection and disposal of the first case in the community and workplace, etc., to prevent the epidemic from rebounding [11].

Bibliography:

[1] Cui H, Gao Z, Liu M, et al. Structural genomics and interactomics of 2019 Wuhan novel coronavirus, 2019-nCoV, indicate evolutionary conserved functional regions of viral proteins. bioRxiv 2020:2020.02.10.942136.
[2] Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. The Lancet Oncology.
[3] Epidemiological Group of Novel Coronavirus Pneumonia Emergency Response Mechanism, Chinese Center for Disease Control and Prevention. Chinese Journal of Epidemiology, 2020, 41(2): 145-151.)

 

 

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