四川省新冠肺炎疫情风险分级策略应用

目的了解四川省新冠肺炎疫情风险分级情况,评估风险分级策略的应用,为应对疫情提供数据支持和思路。方法收集2020年1月21日0时—3月18日24时新冠肺炎疫情相关信息资料,使用ArcGIS作图,用SPSS22.0对数据进行整理和分析。结果四川省共有183个行政区,3月2日24时(四川省正式发布风险分级标准)为时间节点,全省共有128个低风险地区、54个中风险地区、1个高风险地区;聚集性病例、输入性病例在不同风险分级地区分布差异具有统计学意义(P=0.001,P <0.05),防治策略应以严防输入、阻断传播、精准救治为主;住院时长与地区风险分级具有相关性(r_s=0.088,P=0.041)。结论四川省中风险地区主要分布在经济较发达、人口流动频繁的成都及川东北地区,在风险分级差异化防控措施的实施下,本省疫情得到了有效控制。     

综合医院新冠肺炎医院感染防控策略

新冠肺炎传染性强、波及范围广,临床医院作为收治患者的前线,存在医务人员感染及院内传播的风险.本文结合综合医院新冠肺炎防控经验,从建立医院感染风险防控体系、制定动态防护和主动监测措施、加强防护物资管理等方面探讨新冠肺炎流行期间医院感染防控的实践与体会.     

新冠肺炎康复者血浆治疗非霍奇金淋巴瘤化疗后并发新冠肺炎3例效果

目的 评价新冠肺炎康复者血浆治疗非霍奇金淋巴瘤(NHL)利妥昔单抗化疗后并发新冠肺炎的有效性。方法 回顾性分析解放军总医院第一医学中心发热门诊于2023年2月1日-2月28日收治的3例接受新冠肺炎康复者血浆治疗的非霍奇金淋巴瘤利妥昔单抗化疗后并发新冠肺炎患者的临床资料,记录患者的性别、年龄、基础疾病、发病至输血时间、发病至新冠病毒核酸转阴时间、治疗时间、输血次数和输血量,白细胞计数(WBC)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)等实验室检查结果和肺部影像学结果。结果 3例患者中,男性2例,女性1例;年龄分别为53岁,55岁,60岁;入院新冠病毒核酸均阳性,新冠抗体阴性,肺部感染明确;均于入院后第3天,在标准治疗的基础上,分别予以输入康复者血浆14次(共计6 640 ml)、10次(共计4 340 ml)、2次(共计780 ml),输入血浆第14天、第4天、第2天后新冠核酸检测呈阴性;核酸转阴后患者体温逐渐恢复至正常范围,WBC、CRP、IL-6水平在输注血浆后逐渐升高,待新冠核酸转阴后水平逐渐下降至正常;复查肺部CT提示较前明显吸收;3例患者分别在院治疗30 d、15 d...     

新冠肺炎疫情常态化防控下北京市居民疫情风险感知现状及影响因素分析

目的 了解疫情防控常态化下北京市居民新型冠状病毒肺炎（COVID - 19,以下简称“新冠肺炎”）疫情风险感知现状,分析其影响因素,为今后防控工作提供参考。方法 2020年8月5—13日,借助“问卷星”网络问卷,依据城乡、年龄、性别、职业人口构成,通过将问卷链接或二维码定向转发的方式,对北京市居民开展调查。结果 北京市居民风险感知平均分为（49.48±16.61）分。居民疫情风险感知得分在不同性别、居住地、年龄、职业、是否有宗教信仰、家中是否有5岁以下儿童、65岁以上老年人以及妊娠期妇女以及是够购买意外、家庭财产、商业医疗保险人员中差异有统计学意义。性别（β = - 0.059,P = 0.014）、是否有宗教信仰（β = - 0.099,P＜0.001）、职业（β = 0.056,P＜0.001）、家中是否有妊娠期妇女（β = - 0.075,P = 0.001）以及是否购买家庭财产保险（β = 0.118,P＜0.001）是居民疫情风险感知的影响因素。结论 新冠肺炎疫情常态化防控下,北京市居民的疫情风险感知水平处于较低水平,男性、宗教信仰者、家中有妊娠期妇女的人、购买财产保险者风险感知程度较高,医务人员风险感知程度较低,在今后的防控工作中,要针对性的开展信息传播和风险沟通。     

深圳市龙华区新冠肺炎流行病学特征分析

目的 对深圳市龙华区新冠肺炎(COVID-19)流行病学特征进行描述,为有效控制疫情提供更多的参考依据.方法 对2020年1月15日-3月25日龙华区34例COVID-19病例资料进行整理和流行病学描述性分析.结果 34例COVID-19病例中,男性19例,女性15例,中位年龄45岁,中位潜伏期5d,发病高峰在1月25...     

兰州市某定点医院非新冠病房护理人员新冠肺炎知识掌握现状调查

目的:调查新型冠状病毒肺炎(COVID-19)防治期间兰州市某定点医院非新冠病房护理人员对新冠肺炎相关知识的掌握情况.方法:2020年3月16日至2020年3月25日采用线上问卷调查方式,对我院临床一线护理人员进行新冠肺炎相关知识调查.结果:非新冠病房护理人员在新冠肺炎基本知识、流行病学知识、防控、预防及隔离出院四个方...     

宁夏新冠肺炎流行病学特征分析

目的分析宁夏新型冠状病毒肺炎疫情流行特征,为疫情防控和策略制定提供依据。方法收集现场调查处置资料,采用描述流行病学的方法,分析2020年1月22日-3月31日宁夏新冠肺炎确诊病例的三间分布特征。结果宁夏新冠肺炎报告发病率为1.10/10万,无死亡病例。有2个发病高峰,单日最高报告病例数8例。疫情覆盖宁夏65.21%的县(市、区),主要集中在银川市和吴忠市;发病年龄以20～39岁最多,占46.05%,年龄中位数38岁,男女性别比为1.21∶1。职业分布以农民、商业服务、家务及待业为主,占73.68%。临床分型以普通型为主,占58.67%。潜伏期中位数为6.5 d。疫情早期感染来源以输入为主。聚集性疫情涉及病例占确诊病例总数的68.00%,其中存在家庭聚集的病例占86.27%,通过共同生活或聚餐而具有同屋和同餐传播的病例占86.27%。结论宁夏疫情以输入引起的本土感染和家庭聚集性病例为主,本地疫情已经基本阻断。需继续坚持外防输入、内防反弹的防控策略,持续关注境外陆路口岸入境输入风险,强化无症状感染者的排查管理工作。     

新冠肺炎疫情风险沟通现况调查与分析△

目的：对新冠肺炎疫情风险沟通现况开展调查,为提升应对突发公共卫生事件的能力提供依据。方法：2021年8月,在某市发生新冠肺炎暴发疫情期间,以问卷形式对该市居民开展新冠肺炎疫情风险认知及风险沟通现况调查。结果：积极的风险沟通可以提高居民新冠肺炎知识知晓率,受访者对国家官方媒体信任度最高,微信是居民获取风险信息的主要渠道,不同性别的调查对象关注点不同,42.12%通过拨打12345/12320主动与政府部门互动,学历越高者主动寻求风险信息的比例越高。结论：风险沟通对于新冠肺炎疫情防控工作具有积极作用,有助于维护良好的政府形象。     

温州地区新冠肺炎抗疫一线医护人员职业暴露危险因素分析

目的 探讨新冠肺炎抗疫一线医护人员职业暴露危险因素,构建职业暴露预测模型.方法 对2020年1-2月温州地区10家医疗机构共计326名新冠肺炎抗疫一线的医护人员进行问卷调查;采用单因素及多因素Logistic回归分析职业暴露的潜在危险因素,构建医护人员职业暴露事件的风险预测模型.结果 (1)通过单因素及多因素回归分析最...     

多院区综合医院应对新冠肺炎救治策略研究

大型多院区综合医院一般都具有较强的空间集中性、人口密集性和影响辐射性,在新发重大传染病暴发的情况下,大型多院区综合性医院必然成为新发重大传染病救治的前沿部门和关键环节,其救治策略直接对新发重大传染病的最后结果造成很大的影响。以泰州市某三甲多院区综合医院救治新冠肺炎为例,总结出多院区综合医院集中患者、集中专家、集中资源和集中救治的管理策略,供相关单位参考借鉴。     

COVID-19疫情下肺结核病人的COVID-19疫苗接种策略

COVID-19疫情流行形势依旧严峻,对于疫苗的普及接种刻不容缓。肺结核是中国高发的慢性传染病,由于病发肺部,肺结核患者合并感染COVID-19之后病情更重,治疗效果差。而目前对于肺结核患者接种COVID-19疫苗的保护效力、免疫原性及安全性仍知之甚少,也缺乏相应的循证医学证据。本文回顾了肺结核的发病机制与流行病学,探讨了肺结核患者体内的免疫状态,对目前国内外已有的对肺结核患者疫苗接种的提议进行了总结,同时结合其他特殊人群已有的疫苗接种的临床研究进行分析,探讨了COVID-19疫情下肺结核病人的疫苗接种策略和开展以肺结核患者为目标人群的COVID-19疫苗临床研究的必要性。     

Vitamin C in the Treatment of COVID-19

Vitamin C is an essential nutrient that serves as antioxidant and plays a major role as co-factor and modulator of various pathways of the immune system. Its therapeutic effect during infections has been a matter of debate, with conflicting results in studies of respiratory infections and in critically ill patients. This comprehensive review aimed to summarize the current evidence regarding the use of vitamin C in the prevention or treatment of patients with SARS-CoV2 infection, based on available publications between January 2020 and February 2021. Overall, 21 publications were included in this review, consisting of case-reports and case-series, observational studies, and some clinical trials. In many of the publications, data were incomplete, and in most clinical trials the results are still pending. No studies regarding prevention of COVID-19 with vitamin C supplementation were found. Although some clinical observations reported improved medical condition of patients with COVID-19 treated with vitamin C, available data from controlled studies are scarce and inconclusive. Based on the theoretical background presented in this article, and some preliminary encouraging studies, the role of vitamin C in the treatment of patients with SARS-CoV-2 infection should be further investigated.     

Three-Tiered COVID-19 Cohorting Strategy and Implications for Memory-Care

An outbreak of SARS-CoV-2 in a skilled nursing facility (SNF) can be devastating for residents and staff. Difficulty identifying asymptomatic and presymptomatic cases and lack of vaccination or treatment options make management challenging. We created, implemented, and now present a guide to rapidly deploy point-prevalence testing and 3-tiered cohorting in an SNF to mitigate an outbreak. We outline key challenges to SNF cohorting.     

COVID-19 Test Allocation Strategy to Mitigate SARS-CoV-2 Infections across School Districts

In response to COVID-19, schools across the United States closed in early 2020; many did not fully reopen until late 2021. Although regular testing of asymptomatic students, teachers, and staff can reduce transmission risks, few school systems consistently used proactive testing to safeguard return to classrooms. Socioeconomically diverse public school districts might vary testing levels across campuses to ensure fair, effective use of limited resources. We describe a test allocation approach to reduce overall infections and disparities across school districts. Using a model of SARS-CoV-2 transmission in schools fit to data from a large metropolitan school district in Texas, we reduced incidence between the highest and lowest risk schools from a 5.6-fold difference under proportional test allocation to 1.8-fold difference under our optimized test allocation. This approach provides a roadmap to help school districts deploy proactive testing and mitigate risks of future SARS-CoV-2 variants and other pathogen threats.     

High-Dose Convalescent Plasma for Treatment of Severe COVID-19

To assess whether high-dose coronavirus disease (COVID-19) convalescent plasma (CCP) transfusion may benefit patients with severe COVID-19, we conducted a multicenter randomized trial in Brazil. Patients with severe COVID-19 who were within 10 days of initial symptom onset were eligible. Patients in the CCP group received 3 daily doses of CCP (600 mL/d) in addition to standard treatment; control patients received standard treatment only. Primary outcomes were death rates at days 30 and 60 of study randomization. Secondary outcomes were ventilator-free days and hospital-free days. We enrolled 107 patients: 36 CCP and 71 control. At day 30, death rates were 22% for CCP and 25% for the control group; at day 60, rates were 31% for CCP and 35% for control. Needs for invasive mechanical ventilation and durations of hospital stay were similar between groups. We conclude that high-dose CCP transfused within 10 days of symptom onset provided no benefit for patients with severe COVID-19.     

新型冠状病毒肺炎疫情防控门诊管理应急策略

新型冠状病毒肺炎患者早期的甄别是控制患者在区域内蔓延,构筑院内防控第一线的重要手段。新型冠状病毒肺炎疫情严重,作为地市级定点收治医院的医疗质量管理部门,如何在高强度、高压力的医疗环境下严守院内防控的第一线,保证患者的有序收治、医务人员的医疗安全是医疗质量与安全管理部门亟待思考的重要问题。医院自疫情暴发以来,采取多重防控体系,不断摸索改进,取得了一定的经验,提高了患者的甄别能力,保障了医务人员及患者的安全。     

Calcifediol Treatment and Hospital Mortality Due to COVID-19: A Cohort Study

Context. Calcifediol has been proposed as a potential treatment for COVID-19 patients. Objective: To compare the administration or not of oral calcifediol on mortality risk of patients hospitalized because of COVID-19. Design: Retrospective, multicenter, open, non-randomized cohort study. Settings: Hospitalized care. Patients: Patients with laboratory-confirmed COVID-19 between 5 February and 5 May 2020 in five hospitals in the South of Spain. Intervention: Patients received calcifediol (25-hydroxyvitamin D₃) treatment (0.266 mg/capsule, 2 capsules on entry and then one capsule on day 3, 7, 14, 21, and 28) or not. Main Outcome Measure: In-hospital mortality during the first 30 days after admission. Results: A total of 537 patients were hospitalized with COVID-19 (317 males (59%), median age, 70 years), and 79 (14.7%) received calcifediol treatment. Overall, in-hospital mortality during the first 30 days was 17.5%. The OR of death for patients receiving calcifediol (mortality rate of 5%) was 0.22 (95% CI, 0.08 to 0.61) compared to patients not receiving such treatment (mortality rate of 20%; p < 0.01). Patients who received calcifediol after admission were more likely than those not receiving treatment to have comorbidity and a lower rate of CURB-65 score for pneumonia severity ≥ 3 (one point for each of confusion, urea > 7 mmol/L, respiratory rate ≥ 30/min, systolic blood pressure < 90 mm Hg or diastolic blood pressure ≤ 60 mm Hg, and age ≥ 65 years), acute respiratory distress syndrome (moderate or severe), c-reactive protein, chronic kidney disease, and blood urea nitrogen. In a multivariable logistic regression model, adjusting for confounders, there were significant differences in mortality for patients receiving calcifediol compared with patients not receiving it (OR = 0.16 (95% CI 0.03 to 0.80). Conclusion: Among patients hospitalized with COVID-19, treatment with calcifediol, compared with those not receiving calcifediol, was significantly associated with lower in-hospital mortality during the first 30 days. The observational design and sample size may limit the interpretation of these findings.     

Strategy to identify priority groups for COVID-19 vaccination: A population based cohort study

BackgroundEvidence from COVID-19 outbreak shows that individuals with specific chronic diseases are at higher risk of severe prognosis after infection. Public health authorities are developing vaccination programmes with priorities that minimize the risk of mortality and severe events in individuals and communities. We propose an evidence-based strategy that targets the frailest subjects whose timely vaccination is likely to minimize future deaths and preserve the resilience of the health service by preventing infections.MethodsThe cohort includes 146,087 cases with COVID-19 diagnosed in 2020 in Milan (3.49 million inhabitants). Individual level data on 42 chronic diseases and vital status updated as of January 21, 2021, were available in administrative data. Analyses were performed in three sub-cohorts of age (16–64, 65–79 and 80+ years) and comorbidities affecting mortality were selected by means of LASSO cross-validated conditional logistic regression. Simplified models based on previous results identified high-risk categories worth targeting with highest priority. Results adjusted by age and gender, were reported in terms of odds ratios and 95%CI.ResultsThe final models include as predictors of mortality (7,667 deaths, 5.2%) 10, 12, and 5 chronic diseases, respectively. The older age categories shared, as risk factors, chronic renal failure, chronic heart failure, cerebrovascular disease, Parkinson disease and psychiatric diseases. In the younger age category, predictors included neoplasm, organ transplantation and psychiatric conditions. Results were consistent with those obtained on mortality at 60 days from diagnosis (6,968 deaths).ConclusionThis approach defines a two-level stratification for priorities in the vaccination that can easily be applied by health authorities, eventually adapted to local results in terms of number and types of comorbidities, and rapidly updated with current data. After the early phase of vaccination, data on effectiveness and safety will give the opportunity to revise prioritization and discuss the future approach in the remaining population.