In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a n...In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.展开更多
The genome sequence of the Severe Acute Respiratory Syndrome (SARS)-associated virus provides essential information for the identification of pathogen(s), exploration of etiology and evolution, interpretation of trans...The genome sequence of the Severe Acute Respiratory Syndrome (SARS)-associated virus provides essential information for the identification of pathogen(s), exploration of etiology and evolution, interpretation of transmission and pathogenesis, development of diagnostics, prevention by future vaccination, and treatment by developing new drugs. We report the complete genome sequence and comparative analysis of an isolate (BJ01) of the coronavirus that has been recognized as a pathogen for SARS. The genome is 29725 nt in size and has 11 ORFs (Open Reading Frames). It is composed of a stable region encoding an RNA-dependent RNA polymerase (composed of 2 ORFs) and a variable region representing 4 CDSs (coding sequences) for viral structural genes (the S, E, M, N proteins) and 5 PUPs (putative uncharacterized proteins). Its gene order is identical to that of other known coronaviruses. The sequence alignment with all known RNA viruses places this virus as a member in the family of Coronaviridae. Thirty putative substitutions have been identified by comparative analysis of the 5 SARS- associated virus genome sequences in GenBank. Fifteen of them lead to possible amino acid changes (non-synonymous mutations) in the proteins. Three amino acid changes, with predicted alteration of physical and chemical features, have been detected in the S protein that is postulated to beinvolved in the immunoreactions between the virus and its host. Two amino acid changes have been detected in the Mprotein, which could be related to viral envelope formation. Phylogenetic analysis suggests the possibility of non-human origin of the SARS-associated viruses but provides noevidence that they are man-made. Further efforts should focus on identifying the etiology of the SARS-associated virus and ruling out conclusively the existence of otherpossible SARS-related pathogen(s).展开更多
An acute respiratory disease,caused by a novel coronavirus(SARS-CoV-2,previously known as 2019-nCoV),the coronavirus disease 2019(COVID-19)has spread throughout China and received worldwide attention.On 30 January 202...An acute respiratory disease,caused by a novel coronavirus(SARS-CoV-2,previously known as 2019-nCoV),the coronavirus disease 2019(COVID-19)has spread throughout China and received worldwide attention.On 30 January 2020,World Health Organization(WHO)officially declared the COVID-19 epidemic as a public health emergency of international concern.The emergence of SARS-CoV-2,since the severe acute respiratory syndrome coronavirus(SARSCoV)in 2002 and Middle East respiratory syndrome coronavirus(MERS-CoV)in 2012,marked the third introduction of a highly pathogenic and large-scale epidemic coronavirus into the human population in the twenty-first century.As of 1 March 2020,a total of 87,137 confirmed cases globally,79,968 confirmed in China and 7169 outside of China,with 2977 deaths(3.4%)had been reported by WHO.Meanwhile,several independent research groups have identified that SARS-CoV-2 belongs toβ-coronavirus,with highly identical genome to bat coronavirus,pointing to bat as the natural host.The novel coronavirus uses the same receptor,angiotensin-converting enzyme 2(ACE2)as that for SARS-CoV,and mainly spreads through the respiratory tract.Importantly,increasingly evidence showed sustained human-tohuman transmission,along with many exported cases across the globe.The clinical symptoms of COVID-19 patients include fever,cough,fatigue and a small population of patients appeared gastrointestinal infection symptoms.The elderly and people with underlying diseases are susceptible to infection and prone to serious outcomes,which may be associated with acute respiratory distress syndrome(ARDS)and cytokine storm.Currently,there are few specific antiviral strategies,but several potent candidates of antivirals and repurposed drugs are under urgent investigation.In this review,we summarized the latest research progress of the epidemiology,pathogenesis,and clinical characteristics of COVID-19,and discussed the current treatment and scientific advancements to combat the epidemic novel coronavirus.展开更多
Background:The 2019 novel coronavirus(2019-nCoV)causing an outbreak of pneumonia in Wuhan,Hubei province of China was isolated in January 2020.This study aims to investigate its epidemiologic history,and analyze the c...Background:The 2019 novel coronavirus(2019-nCoV)causing an outbreak of pneumonia in Wuhan,Hubei province of China was isolated in January 2020.This study aims to investigate its epidemiologic history,and analyze the clinical characteristics,treatment regimens,and prognosis of patients infected with 2019-nCoV during this outbreak.Methods:Clinical data from 1372019-nCoV-infected patients admitted to the respiratory departments of nine tertiary hospitals in Hubei province from December 30,2019 to January 24,2020 were retrospectively collected,including general status,clinical manifestations,laboratory test results,imaging characteristics,and treatment regimens.Results:None of the 137 patients(61 males,76 females,aged 20-83 years,median age 57 years)had a definite history of exposure to Huanan Seafood Wholesale Market.Major initial symptoms included fever(112/137,81.8%),coughing(66/137,48.2%),and muscle pain or fatigue(44/137,32.1%),with other,less typical initial symptoms observed at low frequency,including heart palpitations,diarrhea,and headache.Nearly 80%of the patients had normal or decreased white blood cell counts,and 72.3%(99/137)had lymphocytopenia.Lung involvement was present in all cases,with most chest computed tomography scans showing lesions in multiple lung lobes,some of which were dense;ground-glass opacity co-existed with consolidation shadows or cord-like shadows.Given the lack of effective drugs,treatment focused on symptomatic and respiratory support.Immunoglobulin G was delivered to some critically ill patients according to their conditions.Systemic corticosteroid treatment did not show significant benefits.Notably,early respiratory support facilitated disease recovery and improved prognosis.The risk of death was primarily associated with age,underlying chronic diseases,and median interval from the appearance of initial symptoms to dyspnea.Conclusions:The majority of patients with 2019-nCoV pneumonia present with fever as the first symptom,and most of them still showed typical manifestations of v展开更多
Background:Human infections with zoonotic coronaviruses(CoVs),including severe acute respiratory syndrome(SARS)-CoV and Middle East respiratory syndrome(MERS)-CoV,have raised great public health concern globally.Here,...Background:Human infections with zoonotic coronaviruses(CoVs),including severe acute respiratory syndrome(SARS)-CoV and Middle East respiratory syndrome(MERS)-CoV,have raised great public health concern globally.Here,we report a novel batorigin CoV causing severe and fatal pneumonia in humans.Methods:We collected clinical data and bronchoalveolar lavage(BAL)specimens from five patients with severe pneumonia from Wuhan Jinyintan Hospital,Hubei province,China.Nucleic acids of the BAL were extracted and subjected to next-generation sequencing.Virus isolation was carried out,and maximum-likelihood phylogenetic trees were constructed.Results:Five patients hospitalized from December 18 to December 29,2019 presented with fever,cough,and dyspnea accompanied by complications of acute respiratory distress syndrome.Chest radiography revealed diffuse opacities and consolidation.One of these patients died.Sequence results revealed the presence of a previously unknownβ-CoV strain in all five patients,with 99.8%to 99.9%nucleotide identities among the isolates.These isolates showed 79.0%nucleotide identity with the sequence of SARS-CoV(GenBank NC_004718)and 51.8%identity with the sequence of MERS-CoV(GenBank NC_019843).The virus is phylogenetically closest to a bat SARS-like CoV(SL-ZC45,GenBank MG772933)with 87.6%to 87.7%nucleotide identity,but is in a separate clade.Moreover,these viruses have a single intact open reading frame gene 8,as a further indicator of bat-origin CoVs.However,the amino acid sequence of the tentative receptor-binding domain resembles that of SARS-CoV,indicating that these viruses might use the same receptor.Conclusion:A novel bat-borne CoV was identified that is associated with severe and fatal respiratory disease in humans.展开更多
The basic reproduction number of an infectious agent is the average number of infections one case can generate over the course of the infectious period,in a naïve,uninfected population.It is well-known that the e...The basic reproduction number of an infectious agent is the average number of infections one case can generate over the course of the infectious period,in a naïve,uninfected population.It is well-known that the estimation of this number may vary due to several methodological issues,including different assumptions and choice of parameters,utilized models,used datasets and estimation period.With the spreading of the novel coronavirus(2019-nCoV)infection,the reproduction number has been found to vary,reflecting the dynamics of transmission of the coronavirus outbreak as well as the case reporting rate.Due to significant variations in the control strategies,which have been changing over time,and thanks to the introduction of detection technologies that have been rapidly improved,enabling to shorten the time from infection/symptoms onset to diagnosis,leading to faster confirmation of the new coronavirus cases,our previous estimations on the transmission risk of the 2019-nCoV need to be revised.By using time-dependent contact and diagnose rates,we refit our previously proposed dynamics transmission model to the data available until January 29th,2020 and re-estimated the effective daily reproduction ratio that better quantifies the evolution of the interventions.We estimated when the effective daily reproduction ratio has fallen below 1 and when the epidemics will peak.Our updated findings suggest that the best measure is persistent and strict self-isolation.The epidemics will continue to grow,and can peak soon with the peak time depending highly on the public health interventions practically implemented.展开更多
基金supported(in part)by the Entrusted Project of National Center for Medical Service Administration,National Health and Family Planning Commission China(No.[2019]099)the First Level Funding of the Second Medical Leading Talent Project in Hubei Provincethe Special Project for Emergency of the Ministry of Science and Technology(2020YFC0841300)。
文摘In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.
文摘The genome sequence of the Severe Acute Respiratory Syndrome (SARS)-associated virus provides essential information for the identification of pathogen(s), exploration of etiology and evolution, interpretation of transmission and pathogenesis, development of diagnostics, prevention by future vaccination, and treatment by developing new drugs. We report the complete genome sequence and comparative analysis of an isolate (BJ01) of the coronavirus that has been recognized as a pathogen for SARS. The genome is 29725 nt in size and has 11 ORFs (Open Reading Frames). It is composed of a stable region encoding an RNA-dependent RNA polymerase (composed of 2 ORFs) and a variable region representing 4 CDSs (coding sequences) for viral structural genes (the S, E, M, N proteins) and 5 PUPs (putative uncharacterized proteins). Its gene order is identical to that of other known coronaviruses. The sequence alignment with all known RNA viruses places this virus as a member in the family of Coronaviridae. Thirty putative substitutions have been identified by comparative analysis of the 5 SARS- associated virus genome sequences in GenBank. Fifteen of them lead to possible amino acid changes (non-synonymous mutations) in the proteins. Three amino acid changes, with predicted alteration of physical and chemical features, have been detected in the S protein that is postulated to beinvolved in the immunoreactions between the virus and its host. Two amino acid changes have been detected in the Mprotein, which could be related to viral envelope formation. Phylogenetic analysis suggests the possibility of non-human origin of the SARS-associated viruses but provides noevidence that they are man-made. Further efforts should focus on identifying the etiology of the SARS-associated virus and ruling out conclusively the existence of otherpossible SARS-related pathogen(s).
基金by the National Natural Science Foundation of China(81870019)Guangdong Provincial Natural Science Foundation(2018A030313554)+2 种基金National Key R&D Program of China(2018YFC0910601)the National Medical Research Council,Singapore(NMRC/CIRG/1458/2016)a recipient of fellowship support from European Allergy and Clinical Immunology(EAACI)Research Fellowship 2019。
文摘An acute respiratory disease,caused by a novel coronavirus(SARS-CoV-2,previously known as 2019-nCoV),the coronavirus disease 2019(COVID-19)has spread throughout China and received worldwide attention.On 30 January 2020,World Health Organization(WHO)officially declared the COVID-19 epidemic as a public health emergency of international concern.The emergence of SARS-CoV-2,since the severe acute respiratory syndrome coronavirus(SARSCoV)in 2002 and Middle East respiratory syndrome coronavirus(MERS-CoV)in 2012,marked the third introduction of a highly pathogenic and large-scale epidemic coronavirus into the human population in the twenty-first century.As of 1 March 2020,a total of 87,137 confirmed cases globally,79,968 confirmed in China and 7169 outside of China,with 2977 deaths(3.4%)had been reported by WHO.Meanwhile,several independent research groups have identified that SARS-CoV-2 belongs toβ-coronavirus,with highly identical genome to bat coronavirus,pointing to bat as the natural host.The novel coronavirus uses the same receptor,angiotensin-converting enzyme 2(ACE2)as that for SARS-CoV,and mainly spreads through the respiratory tract.Importantly,increasingly evidence showed sustained human-tohuman transmission,along with many exported cases across the globe.The clinical symptoms of COVID-19 patients include fever,cough,fatigue and a small population of patients appeared gastrointestinal infection symptoms.The elderly and people with underlying diseases are susceptible to infection and prone to serious outcomes,which may be associated with acute respiratory distress syndrome(ARDS)and cytokine storm.Currently,there are few specific antiviral strategies,but several potent candidates of antivirals and repurposed drugs are under urgent investigation.In this review,we summarized the latest research progress of the epidemiology,pathogenesis,and clinical characteristics of COVID-19,and discussed the current treatment and scientific advancements to combat the epidemic novel coronavirus.
文摘Background:The 2019 novel coronavirus(2019-nCoV)causing an outbreak of pneumonia in Wuhan,Hubei province of China was isolated in January 2020.This study aims to investigate its epidemiologic history,and analyze the clinical characteristics,treatment regimens,and prognosis of patients infected with 2019-nCoV during this outbreak.Methods:Clinical data from 1372019-nCoV-infected patients admitted to the respiratory departments of nine tertiary hospitals in Hubei province from December 30,2019 to January 24,2020 were retrospectively collected,including general status,clinical manifestations,laboratory test results,imaging characteristics,and treatment regimens.Results:None of the 137 patients(61 males,76 females,aged 20-83 years,median age 57 years)had a definite history of exposure to Huanan Seafood Wholesale Market.Major initial symptoms included fever(112/137,81.8%),coughing(66/137,48.2%),and muscle pain or fatigue(44/137,32.1%),with other,less typical initial symptoms observed at low frequency,including heart palpitations,diarrhea,and headache.Nearly 80%of the patients had normal or decreased white blood cell counts,and 72.3%(99/137)had lymphocytopenia.Lung involvement was present in all cases,with most chest computed tomography scans showing lesions in multiple lung lobes,some of which were dense;ground-glass opacity co-existed with consolidation shadows or cord-like shadows.Given the lack of effective drugs,treatment focused on symptomatic and respiratory support.Immunoglobulin G was delivered to some critically ill patients according to their conditions.Systemic corticosteroid treatment did not show significant benefits.Notably,early respiratory support facilitated disease recovery and improved prognosis.The risk of death was primarily associated with age,underlying chronic diseases,and median interval from the appearance of initial symptoms to dyspnea.Conclusions:The majority of patients with 2019-nCoV pneumonia present with fever as the first symptom,and most of them still showed typical manifestations of v
基金This study was supported by grants from the Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences(No.2016-I2M-1-014)the National Major Science&Technology Project for Control and Prevention of Major Infectious Diseases in China(Nos.2017ZX10103004,2018ZX10305409,2017ZX10204401)the National Natural Science Foundation(No.81930063)
文摘Background:Human infections with zoonotic coronaviruses(CoVs),including severe acute respiratory syndrome(SARS)-CoV and Middle East respiratory syndrome(MERS)-CoV,have raised great public health concern globally.Here,we report a novel batorigin CoV causing severe and fatal pneumonia in humans.Methods:We collected clinical data and bronchoalveolar lavage(BAL)specimens from five patients with severe pneumonia from Wuhan Jinyintan Hospital,Hubei province,China.Nucleic acids of the BAL were extracted and subjected to next-generation sequencing.Virus isolation was carried out,and maximum-likelihood phylogenetic trees were constructed.Results:Five patients hospitalized from December 18 to December 29,2019 presented with fever,cough,and dyspnea accompanied by complications of acute respiratory distress syndrome.Chest radiography revealed diffuse opacities and consolidation.One of these patients died.Sequence results revealed the presence of a previously unknownβ-CoV strain in all five patients,with 99.8%to 99.9%nucleotide identities among the isolates.These isolates showed 79.0%nucleotide identity with the sequence of SARS-CoV(GenBank NC_004718)and 51.8%identity with the sequence of MERS-CoV(GenBank NC_019843).The virus is phylogenetically closest to a bat SARS-like CoV(SL-ZC45,GenBank MG772933)with 87.6%to 87.7%nucleotide identity,but is in a separate clade.Moreover,these viruses have a single intact open reading frame gene 8,as a further indicator of bat-origin CoVs.However,the amino acid sequence of the tentative receptor-binding domain resembles that of SARS-CoV,indicating that these viruses might use the same receptor.Conclusion:A novel bat-borne CoV was identified that is associated with severe and fatal respiratory disease in humans.
基金This research was funded by the National Natural Science Foundation of China(grant numbers:11631012(YX,ST),61772017(ST))by the Canada Research Chair Program(grant number:230720(JW)the Natural Sciences and Engineering Research Council of Canada(Grant number:105588-2011(JW).
文摘The basic reproduction number of an infectious agent is the average number of infections one case can generate over the course of the infectious period,in a naïve,uninfected population.It is well-known that the estimation of this number may vary due to several methodological issues,including different assumptions and choice of parameters,utilized models,used datasets and estimation period.With the spreading of the novel coronavirus(2019-nCoV)infection,the reproduction number has been found to vary,reflecting the dynamics of transmission of the coronavirus outbreak as well as the case reporting rate.Due to significant variations in the control strategies,which have been changing over time,and thanks to the introduction of detection technologies that have been rapidly improved,enabling to shorten the time from infection/symptoms onset to diagnosis,leading to faster confirmation of the new coronavirus cases,our previous estimations on the transmission risk of the 2019-nCoV need to be revised.By using time-dependent contact and diagnose rates,we refit our previously proposed dynamics transmission model to the data available until January 29th,2020 and re-estimated the effective daily reproduction ratio that better quantifies the evolution of the interventions.We estimated when the effective daily reproduction ratio has fallen below 1 and when the epidemics will peak.Our updated findings suggest that the best measure is persistent and strict self-isolation.The epidemics will continue to grow,and can peak soon with the peak time depending highly on the public health interventions practically implemented.
