Coronavirus Disease 2019 (COVID-19)最新文献

英文中文

Drug repurposing and other strategies for rapid coronavirus antiviral development: lessons from the early stage of the COVID-19 pandemic 快速开发冠状病毒抗病毒药物的药物再利用和其他战略:来自COVID-19大流行早期的经验教训

Coronavirus Disease 2019 (COVID-19)

Pub Date : 2021-12-01 DOI: 10.1183/2312508x.10024020

Sophie O'Reilly, Matthew Angeliadis, Ross Murtagh, V. Gautier

The recent and recurrent spillover of three highly pathogenic coronaviruses, SARS-CoV-1, MERS-CoV and SARS-CoV-2, into human populations has stressed the importance of pandemic preparedness. Here, we describe how, in the absence of antiviral therapeutic options against coronaviruses, early clinical investigations have focused on the prompt repurposing of approved antiviral therapies. We discuss how, despite international collaborative efforts, their outcomes so far have been disappointing as none of the early drugs tested demonstrated effective clinical efficacy. We also outline innovative strategies and tools developed to fast-track development of novel classes of antivirals. These capitalise on a deeper understanding of viral molecular pathogenesis and how coronaviruses hijack the host cellular machinery to maximise their replication and counteract host defences. Collectively, these approaches are crucial to identify and validate novel targets for therapeutic interventions and expand the repertoire of broad-spectrum antiviral agents, so that these can be promptly deployed for current and future pandemics.Copyright © ERS 2021.

最近三种高致病性冠状病毒SARS-CoV-1、MERS-CoV和SARS-CoV-2在人群中反复蔓延，这突显了大流行防范的重要性。在这里，我们描述了在缺乏针对冠状病毒的抗病毒治疗选择的情况下，早期临床研究如何将重点放在迅速重新利用已批准的抗病毒治疗上。我们讨论了尽管国际合作努力，但迄今为止他们的结果令人失望，因为没有一种早期药物测试显示出有效的临床疗效。我们还概述了为快速开发新型抗病毒药物而开发的创新策略和工具。这些研究利用了对病毒分子发病机制以及冠状病毒如何劫持宿主细胞机制以最大化其复制并抵消宿主防御的更深入理解。总的来说，这些方法对于确定和验证治疗干预措施的新靶点以及扩大广谱抗病毒药物的储备至关重要，以便能够迅速部署这些药物以应对当前和未来的大流行。版权所有©ERS 2021。

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引用次数: 1

Post-COVID-19 rehabilitation Post-COVID-19康复

Coronavirus Disease 2019 (COVID-19)

Pub Date : 2021-12-01 DOI: 10.1183/2312508x.10024520

Sally J. Singh

The long-term problems for survivors of SARS-CoV-2 infection are not fully understood;data indicates a complex range of symptoms that initially appeared to focus on the respiratory system but now appear to be multisystem and wide ranging. The most frequently reported symptoms appear to be breathlessness, muscle weakness and fatigue. A proportion of individuals have persistent problems that would be amenable to a rehabilitation programme. The programme needs to have a much wider scope and remit than that of conventional pulmonary rehabilitation but this service model may form the foundation of a holistic programme to support the recovery of these individuals. Data from the SARS/MERS pandemic would support this initial approach. Rehabilitation teams need to collaborate to develop a wider interdisciplinary team to offer the best service to patients with post-COVID-19 symptoms.Copyright © ERS 2021.

SARS-CoV-2感染幸存者的长期问题尚不完全清楚;数据表明，一系列复杂的症状最初似乎集中在呼吸系统，但现在似乎是多系统和广泛的。最常见的症状是呼吸困难、肌肉无力和疲劳。一部分人有长期存在的问题，可以通过康复方案加以解决。该方案需要比传统的肺部康复有更广泛的范围和范围，但这种服务模式可以构成支持这些人康复的整体方案的基础。来自SARS/MERS大流行的数据将支持这一初步方法。康复团队需要合作建立一个更广泛的跨学科团队，为出现covid -19后症状的患者提供最佳服务。版权所有©ERS 2021。

引用次数: 0

COVID-19: management in the ICU COVID-19: ICU的管理

Coronavirus Disease 2019 (COVID-19)

Pub Date : 2021-12-01 DOI: 10.1183/2312508x.10025920

S. Ananth, A. Aujayeb, S. Brosnahan, L. Bos, R. D'Cruz, D. López-Padilla, A. Lubinsky, H. Kulkarni, T. Marín, E. Swingwood

Patients hospitalised due to infection with SARS-CoV-2 frequently require admission to the ICU for organ support. Most of these admissions are due to acute respiratory failure, often fulfilling the criteria for ARDS. This chapter will review current evidence-based management of this patient population. We discuss how oxygenation can be supported via noninvasive and invasive methods, and describe how invasive ventilation should be set to provide lung protection. We discuss how there is no place for routine antiviral, antibiotic and therapeutic anticoagulation in ICU patients with COVID-19-related ARDS, but there is a place for steroids and immunomodulation via anti-IL-6. Finally, we provide an overview of the complications and long-term consequences of critical illness caused by COVID-19.Copyright © ERS 2021.

因感染SARS-CoV-2而住院的患者经常需要入住ICU接受器官支持。这些入院的大多数是由于急性呼吸衰竭，通常符合ARDS的标准。本章将回顾当前对这一患者群体的循证管理。我们讨论了如何通过无创和有创方法来支持氧合，并描述了如何设置有创通气来提供肺部保护。我们讨论了为什么在重症监护病房的covid -19相关ARDS患者中没有常规抗病毒、抗生素和治疗性抗凝的位置，但类固醇和通过抗il -6进行免疫调节的位置。最后，我们概述了COVID-19引起的危重疾病的并发症和长期后果。版权所有©ERS 2021。

引用次数: 0

Economic, physical and social determinants of health during the COVID-19 lockdown: a call for renewed societal responses COVID-19封锁期间健康的经济、物质和社会决定因素:呼吁重新采取社会应对措施

Coronavirus Disease 2019 (COVID-19)

Pub Date : 2021-12-01 DOI: 10.1183/2312508x.10024720

L. Lui, Yena Lee, R. McIntyre

The COVID-19 pandemic is an unprecedented global public health crisis with respect to its effects on economic, physical and mental health. While early lockdown guidelines may have been effective for reducing viral transmission, prolonged quarantine and physical distancing measures may have augmented the disparities underlying the determinants of health. The aggregate effects of rapid and significant economic downturn, as well as physical and mental morbidity and mortality, are reported to increase the risk of suicide. Furthermore, students, females and individuals with pre-existing mental health illness(es) are at an increased risk for poor mental health outcomes as a result of decreased social support and gaps in healthcare access. Individuals with a mood disorder are at a greater risk for COVID-19 hospitalisation. Additionally, international collaboration addressing underlying social and economic inequities across high-, middle-and low-income countries is critical for managing infection rates. Taken together, public health policies should target upstream factors that affect the determinants of ill health.Copyright © ERS 2021.

COVID-19大流行对经济、身体和精神健康的影响是一场前所未有的全球公共卫生危机。虽然早期封锁指导方针可能有效地减少了病毒传播，但长期隔离和保持身体距离的措施可能会扩大健康决定因素背后的差距。据报道，迅速和严重的经济衰退以及身体和精神发病率和死亡率的总体影响增加了自杀的风险。此外，由于社会支持减少和在获得保健服务方面存在差距，学生、女性和先前患有精神健康疾病的个人面临精神健康状况不佳的风险增加。患有情绪障碍的人因COVID-19住院的风险更大。此外，开展国际合作，解决高、中、低收入国家之间潜在的社会和经济不平等问题，对于控制感染率至关重要。综上所述，公共卫生政策应针对影响健康不良决定因素的上游因素。版权所有©ERS 2021。

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引用次数: 0

Clinical features and acute management of COVID-19 in children 儿童COVID-19的临床特征和急性管理

Coronavirus Disease 2019 (COVID-19)

Pub Date : 2021-12-01 DOI: 10.1183/2312508x.10024320

K. Longbottom, E. Whittaker, Justin Penner

Children account for a minority of cases of SARS-CoV-2 infection. The majority with acute infection are asymptomatic or have mild disease. Severe disease and mortality are reported in children with associated comorbidities such as complex neurodisability. Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS;also referred to as multisystem inflammatory syndrome in children (MIS-C)) is observed ~3-6 weeks after acute infection in an estimated 0.05% of cases. This is characterised by multiorgan involvement, and >50% of cases have myocardial dysfunction and require critical care admission for supportive care. Neurological, cardiac, gastrointestinal, renal and dermatological symptoms are all reported in acute and post-acute SARS-CoV-2 infection. To date, there is no evidence of a benefit from remdesivir, steroids or other investigative treatment in children during acute infection, and their use is recommended only on a case-by-case compassionate basis. Management of PIMS-TS is based on evidence from Kawasaki disease with immunomodulation and cardiac protection, and urgent RCT data are required. The collateral effects of the pandemic are likely to have long-term effects on children's physical and mental health.Copyright © ERS 2021.

儿童占SARS-CoV-2感染病例的少数。大多数急性感染者无症状或病情轻微。严重的疾病和死亡率报告在儿童与相关的合并症，如复杂的神经残疾。与SARS-CoV-2暂时相关的儿科炎症性多系统综合征(PIMS-TS;也称为儿童多系统炎症综合征(MIS-C))在急性感染后约3-6周观察到，估计有0.05%的病例。其特点是多器官受累，超过50%的病例有心肌功能障碍，需要重症监护入院接受支持治疗。急性和急性后SARS-CoV-2感染均有神经系统、心脏、胃肠道、肾脏和皮肤症状的报告。迄今为止，尚无证据表明在急性感染期间使用瑞德西韦、类固醇或其他调查性治疗对儿童有益，并且仅建议在个案同情的基础上使用它们。PIMS-TS的管理是基于川崎病的免疫调节和心脏保护的证据，迫切需要RCT数据。这一大流行病的附带影响可能对儿童的身心健康产生长期影响。版权所有©ERS 2021。

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引用次数: 0

Epidemiology of COVID-19: global spread, risk factors for disease incidence, severity and mortality COVID-19流行病学:全球传播、疾病发病率、严重程度和死亡率的危险因素

Coronavirus Disease 2019 (COVID-19)

Pub Date : 2021-12-01 DOI: 10.1183/2312508x.10025420

J. Soriano, A. Infante

引用次数: 2

COVID-19: imaging COVID-19:成像

Coronavirus Disease 2019 (COVID-19)

Pub Date : 2021-12-01 DOI: 10.1183/2312508x.10012421

C. Laursen, H. Prosch, S. Harders, C. Falster, J. Davidsen, Á. Tárnoki

引用次数: 0

Lung pathology in COVID-19 COVID-19的肺部病理

Coronavirus Disease 2019 (COVID-19)

Pub Date : 2021-12-01 DOI: 10.1183/2312508x.10024220

M. Copin, J. Gibier, Véronique Hofman, Paul Hofman

The series of autopsies reported since the beginning of the pandemic have highlighted several patterns of lung damage, both isolated and combined. The factors influencing the occurrence of these different tissue responses to viral aggression by SARS-CoV-2 have not yet been determined. In asymptomatic patients or patients with respiratory symptoms who were not ventilated, lymphocyte pneumonia associated with type II pneumocyte atypical hyperplasia and a few hyaline membranes or focal lesions of acute fibrinous pneumonia have been observed. In critically ill patients, the most frequent pattern is diffuse alveolar damage with interstitial lymphoid infiltration, type II pneumocyte atypia and, very often, capillary or arteriolar microthromboses and/or endothelitis. The precise description of these lesions, which is becoming more and more consensual, makes it possible to understand the favourable effects of corticosteroid therapy in seriously ill patients and the evolution under ventilation towards fibrosis.Copyright © ERS 2021.

自大流行开始以来报告的一系列尸检突出了几种肺损伤模式，既有孤立的，也有合并的。影响这些组织对SARS-CoV-2病毒攻击的不同反应发生的因素尚未确定。在无症状患者或有呼吸道症状且不通气的患者中，观察到淋巴细胞肺炎伴ⅱ型肺细胞不典型增生和少数透明膜或急性纤维性肺炎局灶性病变。在危重患者中，最常见的模式是弥漫性肺泡损伤伴间质淋巴浸润，II型肺细胞异型性，并且非常常见的是毛细血管或小动脉微血栓形成和/或内皮炎。对这些病变的精确描述正变得越来越具有共识性，这使得人们有可能理解皮质类固醇治疗对重症患者的有利作用以及通气下向纤维化的演变。版权所有©ERS 2021。

引用次数: 0

Can the immune system be targeted to treat COVID-19? 免疫系统可以靶向治疗COVID-19吗?

Coronavirus Disease 2019 (COVID-19)

Pub Date : 2021-12-01 DOI: 10.1183/2312508x.10024120

Sarah Abdelhafeez, D. Doherty

In COVID-19, SARS-CoV-2 has been shown to activate both innate and adaptive immune responses. However, uncontrolled or impaired immunity can lead to the development of severe forms of the disease. Understanding the underlying immunology influencing disease expression as well as the natural history of the virus is imperative to develop preventative and therapeutic strategies to tackle the COVID-19 pandemic. This chapter aims to discuss the literature surrounding the immunology of COVID-19 in a clinical context, specifically applied to the development of therapeutics and vaccines to SARS-CoV-2.Copyright © ERS 2021.

引用次数: 0

Clinical features and acute management of COVID-19 in adults 成人COVID-19的临床特征和急性管理

Coronavirus Disease 2019 (COVID-19)

Pub Date : 2021-12-01 DOI: 10.1183/2312508x.10025520

Nuzhath Khan, L. Lamb, R. Moores

COVID-19 is a multisystem disease that requires holistic management. Most patients will experience mild symptoms including cough, fever and mild dyspnoea. A small proportion of patients will have severe manifestations including respiratory failure, ARDS and multiorgan failure. Extrapulmonary features are common and include gastrointestinal, thromboembolic, neurological, cardiac, renal, endocrine and dermatological manifestations. The care of COVID-19 patients requires close attention to these features. This includes respiratory support (such as supplemental oxygen, NIV and awake proning);fluid, electrolyte and nutrition management;prevention, detection and treatment of thrombotic events;management of diabetic complications;review of medications;appropriate use of antibiotics;and evidence-based use of therapeutic agents such as corticosteroids, antivirals such as remdesivir and other emerging therapies such as immunomodulating agents. Early planning for treatment escalation and decision making around the appropriateness of cardiopulmonary resuscitation are crucial as deterioration can be rapid. Prolonged symptoms occur in a minority of patients and longitudinal follow-up is required.Copyright © ERS 2021.

COVID-19是一种多系统疾病，需要全面管理。大多数患者会出现轻微症状，包括咳嗽、发烧和轻度呼吸困难。一小部分患者会出现呼吸衰竭、ARDS和多器官衰竭等严重症状。肺外特征是常见的，包括胃肠道，血栓栓塞，神经，心脏，肾脏，内分泌和皮肤病的表现。COVID-19患者的护理需要密切关注这些特征。这包括呼吸支持(如补充氧气、无创通气和清醒前推);液体、电解质和营养管理;血栓形成事件的预防、检测和治疗;糖尿病并发症的管理;药物审查;抗生素的适当使用;以及以证据为基础使用治疗药物，如皮质类固醇、瑞德西韦等抗病毒药物和其他新兴疗法，如免疫调节剂。早期计划治疗升级和决策围绕心肺复苏的适当性是至关重要的，因为恶化可以迅速。少数患者出现长期症状，需要进行纵向随访。版权所有©ERS 2021。

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引用次数: 0

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