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      Detectable serum SARS-CoV-2 viral load (RNAaemia) is closely correlated with drastically elevated interleukin 6 (IL-6) level in critically ill COVID-19 patients

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          Abstract

          Background

          Although the detection of SARS-CoV-2 viral load in respiratory specimens has been widely used to diagnose coronavirus disease-19 (COVID-19), it is undeniable that serum SARS-CoV-2 nucleic acid (RNAaemia) could be detected in a fraction of COVID-19 patients. However, it is not clear whether testing for RNAaemia is correlated with the occurrence of cytokine storms or with the specific class of patients.

          Methods

          This study enrolled 48 patients with COVID-19 admitted to the General Hospital of Central Theater Command, PLA, a designated hospital in Wuhan, China. The patients were divided into three groups according to the “Diagnosis and Treatment of New Coronavirus Pneumonia (6 th edition)” issued by the National Health Commission of China. The clinical and laboratory data were collected. The serum viral load and IL-6 levels were determined. .

          Results

          Clinical characteristics analysis of 48 cases of COVID-19 showed that RNAaemia was diagnosed only in the critically ill group and seemed to reflect the severity of the disease. Furthermore, the level of inflammatory cytokine IL-6 in critically ill patients increased significantly, almost 10 times that in other patients. More importantly, the extremely high IL-6 level was closely correlated with the detection of RNAaemia (R = 0.902).

          Conclusions

          Detectable serum SARS-Cov-2 RNA(RNAaemia) in COVID-19 patients was associated with elevated IL-6 concentration and poor prognosis. Because the elevated IL-6 may be part of a larger cytokine storm which could worsen outcome, IL-6 could be a potential therapeutic target for critically ill patients with an excessive inflammatory response.

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          Is Open Access

          Novel Coronavirus Outbreak in Wuhan, China, 2020: Intense Surveillance Is Vital for Preventing Sustained Transmission in New Locations

          The outbreak of pneumonia originating in Wuhan, China, has generated 24,500 confirmed cases, including 492 deaths, as of 5 February 2020. The virus (2019-nCoV) has spread elsewhere in China and to 24 countries, including South Korea, Thailand, Japan and USA. Fortunately, there has only been limited human-to-human transmission outside of China. Here, we assess the risk of sustained transmission whenever the coronavirus arrives in other countries. Data describing the times from symptom onset to hospitalisation for 47 patients infected early in the current outbreak are used to generate an estimate for the probability that an imported case is followed by sustained human-to-human transmission. Under the assumptions that the imported case is representative of the patients in China, and that the 2019-nCoV is similarly transmissible to the SARS coronavirus, the probability that an imported case is followed by sustained human-to-human transmission is 0.41 (credible interval [0.27, 0.55]). However, if the mean time from symptom onset to hospitalisation can be halved by intense surveillance, then the probability that an imported case leads to sustained transmission is only 0.012 (credible interval [0, 0.099]). This emphasises the importance of current surveillance efforts in countries around the world, to ensure that the ongoing outbreak will not become a global pandemic.
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            Author and article information

            Journal
            Clin Infect Dis
            Clin. Infect. Dis
            cid
            Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
            Oxford University Press (US )
            1058-4838
            1537-6591
            17 April 2020
            17 April 2020
            Affiliations
            [1 ] Department of Clinical Laboratory, General Hospital of Central Theater Command , PLA, Wuhan, China
            [2 ] State Key Laboratory of Virology, School of Basic Medical Sciences, Wuhan University , Wuhan, China
            [3 ] Department of Gynecology and Obstetrics, Zhongnan Hospital of Wuhan University , Wuhan, China
            [4 ] State Key Laboratory of Aquaculture Microbiology , College of Fisheries, Huazhong Agricultural University , Wuhan, China
            [5 ] Hubei Provincial Key Laboratory of Allergy and Immunology , Wuhan, China
            [6 ] Department of Immunology, School of Basic Medical Sciences, Wuhan University , Wuhan, China
            [7 ] Department of Medical Microbiology, School of Basic Medical Sciences, Wuhan University , Wuhan, China
            [8 ] State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences , Wuhan, China
            [9 ] Department of Radiology, General Hospital of Central Theater Command , PLA, Wuhan, China
            Author notes
            Corresponding author: Feng Li E-mail: fli222@ 123456whu.edu.cn , Tel:+86 27 68759222 State Key Laboratory of Virology, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China.

            These authors contributed equally to this work.

            Article
            ciaa449
            10.1093/cid/ciaa449
            7184354
            32301997
            © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

            This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

            This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

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