Optimal diagnostic fever thresholds using non-contact infrared thermometers under COVID-19.

Fever screening is an effective method to detect infectors associated with different variants of coronavirus disease 2019 (COVID-19) based on the fact that most infectors with COVID-19 have fever symptoms. Non-contact infrared thermometers (NCITs) are widely used in fever screening. Nevertheless, authoritative data is lacking in defining "fever" at different body surface sites when using NCITs. The purpose of this study was to determine the optimal diagnostic threshold for fever screening using NICTs at different body surface sites, to improve the accuracy of fever screening and provide theoretical reference for healthcare policy. Participants (n = 1860) who were outpatients or emergency patients at Chengdu Women's and Children's Central Hospital were recruited for this prospective investigation from March 1 to June 30, 2021. NCITs and mercury axillary thermometers were used to measure neck, temple, forehead and wrist temperatures of all participants. Receiver operating characteristic curves were used to reflect the accuracy of NCITs. Linear correlation analysis was used to show the effect of age on body temperature. Multilinear regression analysis was used to explore the association between non-febrile participant's covariates and neck temperature. The mean age of participants was 3.45 ± 2.85 years for children and 28.56 ± 7.25 years for adults. In addition 1,304 (70.1%) participants were children (≤12), and 683 (36.7%) were male. The neck temperature exhibited the highest accuracy among the four sites. Further the optimal fever diagnostic thresholds of NCITs at the four body surface measurement sites were neck (36.75 °C, sensitivity: 0.993, specificity: 0.858); temple (36.55 °C, sensitivity: 0.974, specificity: 0.874); forehead (36.45 °C, sensitivity: 0.961, specificity: 0.813); and wrist (36.15 °C, sensitivity: 0.951, specificity: 0.434). Based on the findings of our study, we recommend 36.15, 36.45, 36.55, and 36.75 °C as the diagnostic thresholds of fever at the wrist, forehead, temple and neck, respectively. Among the four surface sites, neck temperature exhibited the highest accuracy.

Moraxella occupied the largest proportion in the nasal microbiome in healthy children, which potential protect them from COVID-19.

BACKGROUND: In the prevalence of COVID-19, infection symptoms are different in children and adults. In this study to investigate the differences in the upper respiratory tract microbiome profile between healthy children and adults and to explore which microbiome protect them from COVID-19. METHODS: Thirty healthy children and 24 healthy adults were enrolled between October 2020 and January 2021. Nasal and throat swabs were obtained at enrollment, and DNA was extracted. We performed 16S rDNA sequencing to compare the alpha and beta diversity of the nasal and throat microbiomes between children and adults and assessed potential microbiome biomarkers. RESULTS: In the nasal microbiome, there were significant differences between healthy children and adults, and Moraxella occupied the largest proportion in healthy children. Notably, there was no significant difference between healthy children and adults in the throat microbiome, and it was predominated by Firmicutes. In the function analysis, compared with adults, there was increased enrichment in pathways related to amino acid metabolism and lipid metabolism, in children. CONCLUSIONS: In the upper respiratory tract microbiome profiles, Moraxella may be involved in protecting children from COVID-19 infections and may be involved the amino acid metabolism and lipid metabolism.

Reliability of Non-Contact Infrared Thermometers for Fever Screening Under COVID-19

Purpose Fever is one of the most typical clinical symptoms of coronavirus disease 2019 (COVID-19), and non-contact infrared thermometers (NCITs) are commonly used to screen for fever. However, there is a lack of authoritative data to define a “fever” when an NCIT is used and previous studies have shown that NCIT readings fluctuate widely depending on ambient temperatures and the body surface site screened. The aim of this study was to establish cut-off points for normal temperatures of different body sites (neck, forehead, temples, and wrist) and investigate the accuracy of NCITs at various ambient temperatures to improve the standardization and accuracy of fever screening. Patients and Methods A prospective investigation was conducted among 904 participants in the outpatient and emergency departments of Chengdu Women’s and Children’s Central Hospital. Body temperature was measured using NCITs and mercury axillary thermometers. A receiver operating characteristic curve was used to determine the accuracy of body temperature detection at the four body surface sites. Data on participant characteristics were also collected. Results Among the four surface sites, the neck temperature detection group had the highest accuracy. When the neck temperature was 37.35°C as the optimum fever diagnostic threshold, the sensitivity was 0.866. The optimum fever diagnostic thresholds for forehead, temporal, and wrist temperature were 36.65°C, 36.65°C, and 36.75°C, respectively. Moreover, triple neck temperature detection had the highest sensitivity, up to 0.998, whereas the sensitivity of triple wrist temperature detections was 0.949. Notably, the accuracy of NCITs significantly reduced when the temperature was lower than 18°C. Conclusion Neck temperature had the highest accuracy among the four NCIT temperature measurement sites, with an optimum fever diagnostic threshold of 37.35°C. Considering the findings reported in our study, we recommend triple neck temperature detection with NCITs as the fever screening standard for COVID-19.

Health QR Code Application in the Novel Containment Strategy and Healthcare Plan for Pregnant Women and Children Under Quarantine During the Summer Outbreak of SARS-CoV-2 Delta Variant in Chengdu, China: An Observational Study.

PURPOSE: To report the experience of health QR code application in Chengdu's anti-epidemic measures including circle-layer management, hospital triage system and healthcare plan for quarantined pregnant women and children during the summer outbreak of SARS-CoV-2 Delta strain in 2021 and to evaluate these measures. METHODS: We comprehensively summarized Chengdu's health code application in the circle-layer management (a set of stringent confinement measures of places confirmed cases and close contacts have recently been to and less strict quarantine measures of surrounding areas), hospital triage system, and healthcare plan for quarantined pregnant women and children. We also assessed the effectiveness or efficiency of these measures by analyzing the number of different cases with confirmed COVID-19 infections or epidemiological history, the attitude of quarantined pregnant women toward the summer outbreak and healthcare services, as well as the time needed for obtaining epidemiological history and accuracy of health-code-based hospital triage system. RESULTS: The circle-layer management lasted 15 days and ended with no community or nosocomial transmission happened. Approximately 70 pregnant women and 600 children below 6-year-old were quarantined. Four home visits and two patient transfers were performed. Online survey indicated that about 80% of quarantined women felt satisfactory about the healthcare service. The novel triage system identified 137/221 (61.99%) patients with epidemiological history from patients with yellow health code, and 71/4504 (1.57%) patients from patients with green health code in our hospital (p < 0.001). The health QR code markedly outperformed the traditional methods in the efficiency experiment of obtaining epidemiological history (3.52 ± 0.98 vs 78.91 ± 23.18 seconds, P < 0.001). CONCLUSION: The circle-layer management has successfully and precisely prevented the spread of the summer outbreak of COVID-19 in Chengdu. The health-code-based triage system showed great effectiveness and efficiency in triaging patients with epidemiological history. The healthcare services for quarantined pregnant women has basically met their needs.

The Prevention and Control Experience of Maternal Health Care from Chengu, China During the COVID-19 Epidemic.

Four months after the first case of COVID-19 was diagnosed in Wuhan, the national epidemic has been effectively controlled in China. In Chengdu, the capital city of Sichuan Province, several management measures, which have been proven to be effective, are taken to prevent pregnant women from being infected with COVID-19. Firstly, Chengdu formulated and issued the "Working Opinions on the Management of Maternal Women during the Epidemic Period of COVID-19 Infection" immediately after the outbreak. Secondly, some basic information of pregnant women returning from high-risk areas and countries is requested to be reported on a daily basis. Thirdly, a group of experts in Obstetrics, Pediatrics and Hospital Infection Management supervise the implementation of the COVID-19 health care services for pregnant women in primary care institutes. Fourthly, the list of health institutes providing services for confirmed and suspected cases was determined and announced to the public by the government promptly. Additionally, the prevention of mother to infant transmission of HIV is continually strictly practiced during the period of the COVID-19 epidemic. Lastly, all inpatients in the health facilities of Chengdu, including maternity hospitals, are required to have a COVID-19 RT-PCR test to further prevent nosocomial infection. Now, many people living in high-risk countries are coming to Chengdu, and it is therefore necessary to make the prevention and control measures a long-term process.

Obstetric Management of COVID-19 in Pregnant Women.

The 2019 novel coronavirus disease (COVID-19), which is caused by the novel beta coronavirus, SARS-CoV-2, is currently prevalent all over the world, causing thousands of deaths with relatively high virulence. Like two other notable beta coronaviruses, severe acute respiratory syndrome coronavirus-1 (SARS-CoV-1) and Middle East respiratory syndrome coronavirus (MERS-CoV), SARS-CoV-2 can lead to severe contagious respiratory disease. Due to impaired cellular immunity and physiological changes, pregnant women are susceptible to respiratory disease and are more likely to develop severe pneumonia. Given the prevalence of COVID-19, it is speculated that some pregnant women have already been infected. However, limited data are available for the clinical course and management of COVID-19 in pregnancy. Therefore, we conducted this review to identify strategies for the obstetric management of COVID-19. We compared the clinical course and outcomes of COVID-19, SARS, and MERS in pregnancy and discussed several drugs for the treatment of COVID-19 in pregnancy.