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Chinese emergency department (ED) staff encountered significant mental stress while fighting the coronavirus disease 2019 (COVID-19) pandemic. We sought to investigate the prevalence and associated factors for depressive symptoms among ED staff (including physicians, nurses, allied health, and auxiliary ED staff). A cross-sectional national survey of ED staff who were on duty and participated in combating the COVID-19 pandemic was conducted March 1–15, 2020. A total of 6,588 emergency medical personnel from 1,060 hospitals responded to this survey. A majority of respondents scored above 10 points on the PHQ-9 standardized test, which is associated with depressive symptoms. Those aged 31–45, those working in the COVID-19 isolation unit, and those with relatives ≤ 16 or ≥70 years old at home all had statistically significant associations with scoring >10 points. Depressive symptoms among Chinese emergency medical staff were likely quite common during the response to the COVID-19 pandemic and reinforce the importance of targeted ED staff support during future outbreaks.

Background: COVID-19 is a multi-systemic disease that is highly contagious and pathogenic. The long-term consequences of it are not yet clear, as is whether society and life can return to a healthy state. Long-term assessment of their health-related quality of life (HRQoL) is essential. This study aimed to investigate HRQoL and its risk factors in COVID-19 survivors at a follow-up of 6-month. Methods: A multicenter cross-sectional survey was conducted among 192 COVID-19 patients with confirmed age ≥ 18 years who were discharged from various hospitals in Wuhan from January to April 2020. The demographic characteristics, clinical characteristics, and laboratory results of the study subjects were obtained from the hospital's medical records. Survivors' HRQoL was assessed using the Short Form 36 (SF-36), cognition was assessed using the ascertain dementia eight-item informant questionnaire (AD8), and survivors' pulmonary function were examined. All participants in this study completed the survey and testing at Hubei Provincial Hospital of Chinese and Western Medicine. SF-36 scores were compared with the Chinese norm, and logistic regression and multivariate analysis were used to investigate the factors affecting HRQoL in COVID-19 survivors. Results: SF-36 showed significant differences in HRQoL between COVID-19 survivors and the general Chinese population ( P< 0.05).Multiple linear regression demonstrated that age was negatively correlated with physical functioning (PF), role-physical limitation (RP) and social functioning (SF) ( P

Background: Chinese emergency medical staff have great mental and work pressure in fighting the coronavirus disease 2019 (COVID-19) pandemic, and it is necessary to understand the prevalenece and influencing factors for depression. Methods: A cross-sectional national survey of general emergency medical staff who were on duty and participated in COVID-19 anti-pandemic from November 2019 to April 2020 was conducted and we used the scale of Patient Health Questionnaire-9 (PHQ-9) to assess depression symptom. Univariate analysis and multivariable logistic-regression models assessed for the associations of influencing PHQ-9 scores. Results: 6588 emergncy medical staff from 1060 hospitals responded to the survey. The average PHQ-9 score of all medical staff was 10.94±5.1. We use PHQ-9≥10 as the cut-off value to define major depression, the prevalence of major depression was 57.60%.The results of univariate analysis showed that demographic factors (gender, age, occupation, relationship status, living with childen ≤16 years-old or adults≥70 years- old), work factors (direct contact with confirmed COVID-19 patients or working in an isolation unit with COVID-19 patients), and forced isolation in the hospital all had an increased risk of major depression. In addition, multivariate logistic regression analysis indicated that main factors associated with major depression symptom were direct contact with confirmed COVID-19 patient (OR 1.153), working in a COVID-19 isolation ward (OR 1.366), age between 31-45 years old (OR 1.139), and living with children ≤16 years old (OR 1.126) or adults≥70 years old (OR 1.325). Working in Hubei province (the epicenter of the outbreak) during COVID-19 had no correlation with depression. Conclusion: Chinese emergency medical staff experienced depression burden during COVID-19 period, particularly, those aged 31-45,those working in isolation unit COVID-19, those living with children or older people These results reinforce the value of effective, targeted staff support during the COVID-19 or future outbreaks. Funding Statement: None. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study has been approved by the Ethics Committee of Peking Union Medical College Hospital, and all the participants provided informed consent.

Background: Chinese emergency medical staff have great mental and work pressure in fighting the coronavirus disease 2019 (COVID-19) pandemic, and it is necessary to understand the prevalenece and influencing factors for depression. Methods: A cross-sectional national survey of general emergency medical staff who were on duty and participated in COVID-19 anti-pandemic from November 2019 to April 2020 was conducted and we used the scale of Patient Health Questionnaire-9 (PHQ-9) to assess depression symptom. Univariate analysis and multivariable logistic-regression models assessed for the associations of influencing PHQ-9 scores. Results: 6588 emergncy medical staff from 1060 hospitals responded to the survey. The average PHQ-9 score of all medical staff was 10.94±5.1. We use PHQ-9≥10 as the cut-off value to define major depression, the prevalence of major depression was 57.60%.The results of univariate analysis showed that demographic factors(gender, age, occupation, relationship status, living with childen ≤16 years-old or adults≥70 years- old), work factors (direct contact with confirmed COVID-19 patients or working in an isolation unit with COVID-19 patients), and forced isolation in the hospital all had an increased risk of major depression. In addition, multivariate logistic regression analysis indicated that main factors associated with major depression symptom were direct contact with confirmed COVID-19 patient (OR 1.153), working in a COVID-19 isolation ward (OR 1.366), age between 31-45 years old (OR 1.139), and living with children ≤16 years old(OR 1.126) or adults≥70 years old (OR 1.325). Working in Hubei province (the epicenter of the outbreak) during COVID-19 had no correlation with depression. Conclusion: Chinese emergency medical staff experienced depression burden during COVID-19 period, particularly, those aged 31-45,those working in isolation unit COVID-19, those living with children or older people These results reinforce the value of effective, targeted staff support during the COVID-19 or future outbreaks. Funding Statement: The authors state that there is no funding for this article. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study has been approved by the Ethics Committee of Peking Union Medical College Hospital, and all the participants provided informed consent.

Objectives: To describe the clinical sequelae and immunological features of COVID-19 survivors who have been discharged from the hospital for 5-8 months. Methods: This study is a cross-sectional study of confirmed COVID-19 patients aged ≥18 years who were discharged from hospitals in Wuhan from January to April 2020. The demographics, clinical features, and laboratory findings of the participants were collected from medical records in the hospital. The participants from the study completed an investigation of clinical sequelae, blood tests, a pulmonary function examination and an unarmed rehabilitation evaluation at Hubei Provincial Hospital of Traditional Chinese & Western Medicine. A group of volunteers who were free of COVID-19 and lived in Wuhan during the outbreak were recruited as the comparison group. Results: The average age of the 574 COVID-19 survivors was 57.7±11.4 years, and 348 (60.6%) survivors were female. The average number of days from the onset of symptoms was 241.79±16.16. The average number of days from discharge was 194.3±14.4. Clinical sequelae were common, including general symptoms (n=321, 55.9%), respiratory symptoms (n=265, 46.2%), digestive symptoms (n=84, 14.6%), nervous symptoms (n=75,13.1%) and psychosocial symptoms (n=201, 35%). A total of 190 (33.7%) survivors reported reduced exercise capacity. Through the results of pulmonary function examination, anomalies were noted in carbon monoxide diffusion capacity (DLCO)% in 110 cases (32.4%), maximal mid-expiratory flow (MMEF)% in 105 cases (30.7%), forced expired flow at 50% of forced vital capacity (FEF 50 )% in 128 cases (37.4%), and forced expired flow at 75% of forced vital capacity (FEF 75 )% in 240 cases (70.2%). The counts of T lymphocyte, CD4+ T lymphocyte counts, CD8+ T lymphocyte counts, B lymphocyte and NK cell in the survival group was significantly lower than that in the comparison group(all P 0.05). The T lymphocyte counts, CD4+ T lymphocyte counts and CD8+ T lymphocyte counts of the patients before discharge were significantly higher than those in the early stage of admission (P < 0.025). There were 319 (55.6%) survivors with positive or weakly positive IgG antibodies and 17 (2.9%) survivors with positive or weakly positive IgM antibodies. Conclusion: Even after 5 to 8 months of discharge, many survivors still have clinical sequelae, and some of them have impaired immune function. Therefore, the long-term rehabilitation of COVID-19 survivors remains a concern. Funding Statement: This study was funded by the National Key R&D Plan of China (2020YFC0841600), Guangdong Provincial Key Laboratory of Research on Emergency in TCM (2017B030314176), R&D plan in key areas of Guangdong Province (2020B1111300005), and National Administration of Traditional Chinese Medicine (2020ZYLCYJ05-11). Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: This study was approved by the ethical committees of Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China (GPHCM; No. BF2020-205-01). All participants signed informed consent forms.

To investigate the prognostic value of procalcitonin (PCT) and C-reactive protein (CRP) combined with sequential organ failure assessment (SOFA) score in elderly patients with sepsis induced by pulmonary infection.A retrospective study was conducted. The elderly patients aged over 60 years old with sepsis induced by pulmonary infection admitted to Guangdong Provincial Hospital of Chinese Medicine from October 2015 to December 2018 were enrolled. The PCT, CRP and SOFA scores of patients within 24 hours after admission and 28-day prognosis were recorded. The patients were divided into groups according to the severity of the disease and 28-day prognosis. The differences in above parameters among all the groups were compared. Receiver operator characteristic (ROC) curve was drawn to analyze the prognostic value of the above indicators in elderly patients with sepsis induced by pulmonary infection alone or in combination.A total of 265 patients were enrolled in the study. According to the severity of the disease, the patients were divided into sepsis group (n = 194) and septic shock group (n = 71). According to the 28-day prognosis, the patients were divided into survival group (n = 186) and non-survival group (n = 79). Compared with the sepsis group, the PCT, CRP and SOFA scores of patients in the septic shock group were significantly increased [PCT (μg/L): 6.16 (1.94, 19.60) vs. 1.56 (0.34, 7.32), CRP (mg/L): 128.90 (54.93, 198.70) vs. 91.45 (30.15, 175.30), SOFA score: 9.0 (7.0, 12.0) vs. 4.0 (3.0, 5.0)] with significant differences (all P0.05). Compared with the survival group, the PCT, CRP and SOFA scores of sepsis patients in the non-survival group were significantly increased [PCT (μg/L): 4.80 (1.06, 19.60) vs. 1.82 (0.34, 7.24), CRP (mg/L): 135.20 (58.10, 225.50) vs. 91.45 (31.50, 172.53), SOFA score: 7.0 (4.0, 11.0) vs. 4.0 (3.0, 6.0)] with significant differences (all P0.01). ROC curve analysis showed that the area under the ROC curve (AUC) of PCT, CRP, SOFA score and CRP+PCT+SOFA score was 0.641, 0.607, 0.697, and 0.712, indicating that above parameters had certain predictive value for 28-day prognosis of elderly patients with sepsis induced by pulmonary infection, and the combined predictive value of them was the greatest with the sensitivity of 55.1% and the specificity of 80.1%.PCT, CRP and SOFA score are commonly used to evaluate the prognosis of the elderly patients with sepsis induced by pulmonary infection, and the combination of them has higher evaluation value.

Background Chinese herbal medicine (CHM) has been used for severe illness caused by coronavirus disease 2019 (COVID-19), but its treatment effects and safety are unclear. Purpose This study reviews the effect and safety of CHM granules in the treatment of patients with severe COVID-19. Methods We conducteda single-center, retrospective study on patients with severe COVID-19 in a designated hospital in Wuhan from January 15, 2020 to March 30, 2020. The propensity score matching (PSM) was used to assess the effect and safety of the treatment using CHM granules. The ratio of patients who received treatment with CHM granules combined with usual care and those who received usual care alone was 1:1. The primary outcome was the time to clinical improvement within 28 days, defined as the time taken for the patients’ health to show improvement by decline of two categories (from the baseline) on a modified six-category ordinal scale, or to be dischargedfrom the hospital before Day 28. Results Using PSM, 43 patients (45% male) aged 65.6 (57–70) yearsfrom each group were exactly matched. No significant difference was observed in clinical improvement of patients treated with CHM granules compared with those who received usual (p = 0.851). However, the use of CHM granules reduced the 28-day mortality (p = 0.049) and shortened the duration of fever (4 days vs. 7 days, p = 0.002). The differences in the duration of cough and dyspnea and the difference in lung lesion ratio on computerized tomography scans were not significant.Commonly,patients in the CHM group had an increased D -dimer level (p = 0.036). Conclusion Forpatients with severe COVID-19, CHM granules, combined with usual care, showed no improvement beyond usual care alone. However, the use of CHM granules reduced the 28-day mortality rate and the time to fever alleviation. Nevertheless, CHM granules may be associated with high risk of fibrinolysis.