Coughing Intensity and Wind Direction Effects on the Transmission of Respiratory Droplets: A Computation with Euler-Lagrange Method

Studies on droplet transmission are needed to understand the infection mechanism of SARS-CoV-2. This research investigated the effects of coughing intensity and wind direction on respiratory droplets transportation using the Euler-Lagrange method. The results revealed that both coughing intensity and wind conditions considerably influence the transmission of small and medium droplets but had little effect on large droplets. A stronger coughing intensity resulted in small and medium droplets traveling farther in a calm wind and spreading widely and rapidly in a windy environment. The droplets do not travel far in the absence of ambient wind, even with stronger coughing. Medium droplets spread in clusters, and small droplets drifted out of the domain in the band area in different wind conditions except for 60 degrees and 90 degrees wind directions, in which cases, the droplets were blown directly downstream. In 0 degrees wind direction, many droplets were deposited on the human body. The fast and upward movement of particles in 60 degrees and 90 degrees directions could cause infection risk with short exposure. In 180 degrees wind direction, droplets spread widely and traveled slowly because of the reverse flow downstream, prolonged exposure can result in a high risk of infection.

Epidemiological study on myopia among primary school students in Xindu District of Chengdu in 2018-2020

AIM: To observe the epidemiological characteristics of myopia among primary school students in Xindu District of Chengdu before and after COVID-19 home isolation period (from Jan.-May 2020). METHODS: Cross-sectional study. A total of 10 153 primary school students from grade 1-6 (age 6-13, three classes per grade) were selected from four primary schools in Xindu District of Chengdu for three consecutive years (2018-2020), by using a random stratified cluster sampling method. All students' visual acuity and spherical equivalent refraction (SE) were measured, a further cycloplegia optometry was conducted for those whose visual acuity was less than 5.0. The SE was recorded and the prevalence of myopia was calculated. Chi-square test was used to compare the difference of prevalence of myopia between different years. One-way Anova was used to compare the difference of SE among different years. RESULTS: There was statistical difference in prevalence of myopia between the three years (2018: 35.98%, 2019: 36.29%, 2020: 42.52%;χ2=39.374, P<0.001). The prevalence of myopia among 6-9 years old students increased significantly in 2020 (P<0.01). They were 2.20 times (6 years old), 2.08 times (7 years old), 1.36 times (8 years old) and 1.24 times (9 years old) of the previous year. Students aged 6-9 years showed an obvious myopic shift in SE in 2020 (P<0.05). The increases were -0.34±0.76D (6 years old), -0.28±0.84D (7 years old), -0.29±1.41D (8 years old) and -0.18±1.35D (9 years old) than the previous year. The prevalence of myopia and SE remained stable among 10-13 years old students in 2018-2020 (P>0.05). CONCLUSION: After the COVID-19 home isolation period, there was a significant myopic shift among students aged 6-9 years old. We should pay more attention to the window period for myopia prevention and control of 6-9 years old.

[Epidemiological characteristics of novel coronavirus pneumonia in Shijiazhuang, China].

Objective: To analyze the epidemiological characteristics of an outbreak of novel coronavirus pneumonia (COVID-19) in Shijiazhuang, Hebei Province in 2021 and to provide scientific basis for developing improved strategies to prevent and control the outbreak of COVID-19. Methods: Descriptive analysis of the outbreak of COVID-19 in Shijiazhuang, Hebei Province was performed with SPSS 21.0 and Excel software. The statistical analysis of the incubation period was performed using the rstan package in R4.0.4. Results: As of February 14th 2021, a total of 942 local confirmed cases were reported in Hebei Province, 869 cases in Shijiazhuang, of which 847 cases were available for case information. This outbreak was mainly in rural areas, with the largest number of confirmed cases in Xiaoguozhuang village, 249 (29.4%); followed by Nanqiaozhai village, 128 (15.1%); and Liujiazuo village, 85 (10.0%). The outbreak lasted from January 2nd, 2021 to February 14th, 2021, and was mainly transmitted among the farmers as well as the students through dining parties, public gatherings and family contacts, showing an obvious time and occupation concentration trend. An analysis of 116 local confirmed cases in this outbreak with specific exposure time and onset time indicated that the median incubation period was 6 [interquartile range(IQR): 3.3, 10.0] days; whereas another report including 264 local confirmed cases with specific exposure time window showed that a median incubation period was 8.5 [95% confidence interval (CI): 1.8-18.8] days. Conclusions: This outbreak was mainly related to rural areas, and was associated with parties, public gatherings and family gatherings. Self-protection and isolation of key areas and populations at risk should be effectively implemented to avoid close contact and other measures to reduce the occurrence of COVID-19 aggregation. Based on the results of the incubation period of this outbreak, the isolation period could be recommended to be extended to three weeks.

Improving post-operative care during COVID-19 pandemic: Wearable sensors identify clinical deterioration in patients monitored at home following radical cystectomy

Introduction: Radical cystectomy (RC) has 30-day and 90-day re-admission rates of 15% and 20% respectively. Majority of complications such as infective and bowel-related are frequently associated with changes in vital signs. The primary aim was to compliance and feasibility of using remote monitoring in patients discharged following RC. Secondary endpoints included monitoring for adverse events. Materials & Methods: Patients consented to a 30-day monitoring period commencing on discharge (Day 1). A wearable sensor was worn continuously, intermittent monitoring and a PROM (quality-of-recovery-15 questionnaire (QoR15) was also completed using a bespoke app. Data was collected in real-time to a secure server (Ethera.health) was assessed in the DREAMPath study (ISRCTN62293620). Readmission and complications (CD grades I-V) were recorded. Results: Compliance with the wearable device and interaction with the app and PROM was high. In 16% of cases a significant adverse event necessitating readmission was recorded. On average 5,687 data points were collected for each case over 30 days. A measure of physiological performance status derived from the wearable device alone was applied across the study cohort and identified clinical deterioration in 75% of cases at least 48 hrs before readmission. A combination of performance measurement and the QoR15 identified clinical deterioration in all cases prior to admission. Conclusions: Remote monitoring is feasible, and patients can engage with it with minimal effort. In the COVID era, this is invaluable as this data can be used to triage patients remotely and treat complications early.

[Preliminary study of the relationship between novel coronavirus pneumonia and liver function damage: a multicenter study].

Objective: To analyze the clinical characteristics of cases of novel coronavirus pneumonia and a preliminary study to explore the relationship between different clinical classification and liver damage. Methods: Consecutively confirmed novel coronavirus infection cases admitted to seven designated hospitals during January 23, 2020 to February 8, 2020 were included. Clinical classification (mild, moderate, severe, and critical) was carried out according to the diagnosis and treatment program of novel coronavirus pneumonia (Trial Fifth Edition) issued by the National Health Commission. The research data were analyzed using SPSS19.0 statistical software. Quantitative data were expressed as median (interquartile range), and qualitative data were expressed as frequency and rate. Results: 32 confirmed cases that met the inclusion criteria were included. 28 cases were of mild or moderate type (87.50%), and four cases (12.50%) of severe or critical type. Four cases (12.5%) were combined with one underlying disease (bronchial asthma, coronary heart disease, malignant tumor, chronic kidney disease), and one case (3.13%) was simultaneously combined with high blood pressure and malignant tumor. The results of laboratory examination showed that the alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), and total bilirubin (TBil) for entire cohort were 26.98 (16.88 ~ 46.09) U/L and 24.75 (18.71 ~ 31.79) U/L, 39.00 (36.20 ~ 44.20) g/L and 16.40 (11.34 ~ 21.15) µmol/L, respectively. ALT, AST, ALB and TBil of the mild or moderate subgroups were 22.75 (16.31 ~ 37.25) U/L, 23.63 (18.71 ~ 26.50) U/L, 39.70 (36.50 ~ 46.10) g/L, and 15.95 (11.34 ~ 20.83) µmol/L, respectively. ALT, AST, ALB and TBil of the severe or critical subgroups were 60.25 (40.88 ~ 68.90) U/L, 37.00 (20.88 ~ 64.45) U/L, 35.75 (28.68 ~ 42.00) g/L, and 20.50 (11.28 ~ 25.00) µmol/L, respectively. Conclusion: The results of this multicenter retrospective study suggests that novel coronavirus pneumonia combined with liver damage is more likely to be caused by adverse drug reactions and systemic inflammation in severe patients receiving medical treatment. Therefore, liver function monitoring and evaluation should be strengthened during the treatment of such patients.

[Clinical characteristics and death risk factors of severe COVID-19].

Objective: To analyze the clinical features and death-related risk factors of COVID-19. Methods: We enrolled 891 COVID-19 patients admitted to the Affiliated Hospital of Jianghan University from December 2019 to February 2020, including 427 men and 464 women. Of the 891 cases, 582 were severe or critical, including 423(73%)severe and 159 (27%) critical cases. We compared the demographics, laboratory findings, clinical characteristics, treatments and prognosis data of the 582 severe patients. Univariate and multivariate logistic regression analysis was conducted to explore the risk factors associated with death in COVID-19 patients. Results: The 582 severe patients included 293 males and 289 females, with a median age of 64(range 24 to 106). Sixty-three patients died, including 45 males and 18 females, with a median age of 71(range 37 to 90). The average onset time of the 582 patients was 8 days, of whom 461 (79%) had fever, 358 (62%) dry cough, 274 (47%) fatigue. There were 206 cases with shortness of breath (35%), 155 cases with expectoration (27%), 83 cases with muscle pain or joint pain (14%), 71 cases with diarrhea (12%), and 29 cases with headache (4%). Underlying diseases were present in 267 (46%) patients, most commonly hypertension (194, 33%), followed by diabetes (69, 12%), coronary atherosclerotic heart disease (37, 6%), tumor (18, 3%), and chronic obstructive pulmonary disease (5, 1%). Chest CT showed bilateral lung involvement in 505 patients (87%). Upon admission, the median lymphocyte count of the 582 patients was 0.8(IQR, 0.6-1.1)×10(9)/L, the median D-dimer was 0.5 (IQR, 0.4- 0.8) mg/L, the median N-terminal brain natriuretic peptide precursor (NT-proBNP) was 433 (IQR, 141- 806) pg/L, and the median creatinine was 70.3 (IQR, 56.9-87.9) µmol/L. The death group had a median lymphocyte count of 0.5 (0.4-0.8)×10(9)/L, D-dimer 1.1 (0.7-10.0)mg/L, N-terminal brain natriuretic peptide precursor 1479(893-5 087) pg/ml, and creatinine 89.9(67.1-125.3) µmol/L. Multivariate logistic analysis showed that increased D-dimer (OR: 1.095, 95% CI: 1.045-1.148, P<0.001), increased NT-proBNP (OR: 4.759, 95% CI: 2.437-9.291, P<0.001), and decreased lymphocyte count (OR: 0.180, 95% CI: 0.059-0.550, P=0.003) were the risk factors of death in COVID-19 patients. Conclusions: The average onset time of severe COVID-19 was 8 days, and the most common symptoms were fever, dry cough and fatigue. Comorbidities such as hypertension were common and mostly accompanied by impaired organ functions on admission. Higher D-dimer, higher NT-proBNP, and lower lymphocyte count were the independent risk factors of death in COVID-19 patients.

[Clinical characteristics of 30 medical workers infected with new coronavirus pneumonia].

Objective: To investigate the clinical characteristics of medical staff with novel coronavirus pneumonia(NCP). Methods: 30 patients infected with novel coronavirus referred to jianghan university hospital between January 11, 2020 and January 3, 2020 were studied. The data reviewed included those of clinical manifestations, laboratory investigation and Radiographic features. Results: The patients consisted of 10 men and 20 women, including 22 doctors and 8 nurses,aged 21~59 years(mean 35±8 years).They were divided to 26 common type and 4 severe cases, all of whom had close(within 1m) contact with patients infected of novel coronavirus pneumonia. The average contact times were 12 (7,16) and the average cumulative contact time was 2 (1.5,2.7) h.Clinical symptoms of these patients were fever in 23 patients (76.67%) , headache in 16 petients (53.33%) , fatigue or myalgia in 21patients (70%) , nausea, vomiting or diarrhea in 9 petients (30%) , cough in 25 petients (83.33%) , and dyspnea in 14 petients (46.67%) .Routine blood test revealed WBC <4.0×10(9)/L in 8 petients (26.67%) , (4-10) ×10(9)/L in 22 petients (73.33%) , and WBC>4.0×10(9)/L in 4 petients (13.33%) during the disease.Lymphocyte count <1.0×10(9)/L occurred in 12 petients (40%),abnormal liver function in 7 petients (23.33%) ,myocardial damage in 5 petients(16.67%), elevated D-dimer (>0.5mg/l) in 5 patients (16.67%). Compared with normal patients, the average exposure times, cumulative exposure time, BMI, Fever time, white blood cell count, liver enzyme, LDH, myoenzyme and D-dimer were significantly increased in severe patients, while the lymphocyte count and albumin levels in peripheral blood were significantly decreased.Chest CT mainly showed patchy shadows and interstitial changes.According to imaging examination, 11 patients (36.67%) showed Unilateral pneumonia and 19 patients (63.33%) showed bilateral pneumonia,4 patients (13.33%) showed bilateral multiple mottling and ground-glass opacity.Compared with the patients infected in the protected period, the proportion of severe infection and bilateral pneumonia were both increased in the patients infected in unprotected period. Conclusion: Medical staffs are at higher risk of infection.Infection rates are associated with contact time, the amount of suction virus. Severe patients had BMI increased, heating time prolonged , white blood cell count, lymphocyte count, D-dimer and albumin level significantly changed and were prone to be complicated with liver damage and myocardial damage.Strict protection measures is important to prevent infection for medical workers.