Clinical Features,Treatment And Prevention Of Coronavirus Disease-19

Part Ⅰ Clinical features and treatment of co-infection with SARS-CoV-2 and other respiratory pathogensPurpose:To differentiate between respiratory infections caused by SARS-CoV-2 and other respiratory pathogens during the COVID-19 outbreak in Wuhan,this study retrospectively collected the detection of pathogens in COVID-19 patients,and planned to determine the incidence of respiratory co-infection and the clinical characteristics of patients co-infected with SARS-CoV-2 and other respiratory pathogens.Patients and methods:We screened 1,523 nasopharyngeal swabs and sputum samples from 836 people,and finally included 250 patients diagnosed with COVID-19.RT-PCR was used to detect influenza A,influenza B and respiratory syncytial viruses.Chemiluminescence immunoassays were used to detect Ig M antibodies for adenovirus,Chlamydia pneumoniae and Mycoplasma pneumoniae in the serum of patients.Based on these results,we divided the patients into two groups,the simple SARS-CoV-2 infected group and the coinfected other respiratory pathogens group.Coinfected patients were then further categorized as having a coinfection of viral pathogen（CoIV）or coinfection of atypical bacterial pathogen（CoIaB）.Results:No statistically significant differences were found in age,gender,symptom,oxygen support demand rate,the time taken to return negative SARS-CoV-2 nucleic acid test results,length of hospital stays,and mortality between the simple SARS-CoV-2infection group and the coinfection group.Of the 250 hospitalized COVID-19 patients,39（15.6%）tested positive for at least one respiratory pathogen in addition to SARS-CoV-2.A third of these pathogens were detected as early as the 1^stweek after symptom onset and another third were identified after more than three weeks.The most detected CAP pathogen was C.pneumoniae（5.2%）,followed by the respiratory syncytial virus（4.8%）,M.pneumoniae（4.4%）and adenovirus（2.8%）.Patients coinfected with viral pathogens（CoIV）（n=18）had lower levels of IL-2,IL-4,and TNF-αin their peripheral blood at admission（2.4 vs 2.8 pg/ml,2.0 vs 2.5 pg/ml,2.0 vs 2.6 pg/ml）and longer hospital stays（24vs 15 days）when compared to patients coinfected with atypical bacterial pathogens（CoIaB）（n=21）.Except for four fatality,the remaining 246 patients all recovered with favourable outcomes.Conclusion:In COVID-19 patients,co-infection with other pathogens is common.Co-infection can occur at any stage of the COVID-19 course.The progression of co-infection may be related to cytokine storm.Co-infection is still an important consideration in targeted therapy strategies for COVID-19 patients.However,co-infection with other pathogens has no significant impact on the prognosis of COVID-19 patients.Part Ⅱ The preventive effect of Arbidol on COVID-19: a preliminary studyPurpose: There is currently no preventive medication against SARS-CoV-2 infection.This study intends to explore the preventive effect of taking Arbidol after exposure to confirmed cases of COVID-19.Patients and methods: We conducted a retrospective cohort study on family members and health care workers who were exposed to patients confirmed to have SARS-CoV-2infection（primary case）by real-time RT-PCR and chest CT from January 1 to January 16,2020.The last follow-up date was March 6,2020.The emergence of fever and/or respiratory symptoms after exposure to the primary case were collected.The relation between post-exposure prophylaxis and infection in household contacts and healthcare workers were respectively analyzed.Results: 66 members in 27 families and 124 health care workers had evidence of close exposure to patients with confirmed COVID-19.Cox regression based on the data of the family members and health care workers with Arbidol or not showed that Arbidol PEP was a protective factor against the development of COVID-19（HR 0.025,95% CI 0.003-0.209,P=0.0006 for family members and HR 0.056,95% CI 0.005-0.662,P= 0.0221 for health care workers）.Conclusion: The results of this preliminary exploratory study indicate that after exposure to COVID-19,taking Arbidol can reduce the risk of SARS-CoV-2 infection.Arbidol’s post-exposure prevention potential for COVID-19 still needs further evaluation.