Highlights d Quantitative lipidomic and metabolomic profiling of COVID-19 plasma d Plasma metabolite panel distinguished COVID-19 from healthy controls (AUC = 0.975) d Differential correlation analyses uncovered metabolic dysregulation in COVID-19 d GM3-enriched exosomes are positively correlated with COVID-19 pathogenesis

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COVID-19 is associated with 5.1% mortality. Although the virological, epidemiological, clinical, and management outcome features of COVID-19 patients have been defined rapidly, the inflammatory and immune profiles require definition as they influence pathogenesis and clinical expression of COVID-19. Here we show lymphopenia, selective loss of CD4+ T cells, CD8+ T cells and NK cells, excessive T-cell activation and high expression of T-cell inhibitory molecules are more prominent in severe cases than in those with mild disease. CD8+ T cells in patients with severe disease express high levels of cytotoxic molecules. Histochemical studies of lung tissue from one fatality show sub-anatomical distributions of SARS-CoV-2 RNA and massive infiltration of T cells and macrophages. Thus, aberrant activation and dysregulation of CD8+ T cells occur in patients with severe COVID-19 disease, an effect that might be for pathogenesis of SARS-CoV-2 infection and indicate that immune-based targets for therapeutic interventions constitute a promising treatment for severe COVID-19 patients.

BackgroundChina had proposed the unification of equity and efficiency since the launch of the new round of health system reform in 2009. And the central government gave priority to the development of primary health care (PHC) whilst ensuring its availability and improving its efficiency. This study aimed to evaluate the changes of equity and efficiency in PHC resource allocation (PHCRA) and explored ways to improve the current situation.MethodsThe data of this study came from the China Health Statistical Yearbook (2013–2017) and China Statistical Yearbook (2017). Three and five indicators were used to measure equity and efficiency, respectively. The Lorenz curve, Gini coefficient (G), Theil index (T) and health resource density index (HRDI) were used to assess equity in demographic and geographical dimensions. Data envelopment analysis (DEA) and the Malmquist productivity index (MPI) were chosen to measure the efficiency and productivity of PHCRA.ResultsFrom 2012 to 2016, the total amount of PHCR had increased year by year. The Gs by population size were below 0.2 and that by geographical area were between 0.6 and 0.7. T had the same trend with G, and intra-regional contribution rates were higher than inter-regional contribution rates, which were all beyond 60%. From 2012 to 2016, the numbers of provinces that achieved an effective DEA were 4, 3, 4, 5 and 5, respectively. The mean of the total factor productivity index was 0.994.ConclusionThe equity of PHCRA in terms of population size is superior in the geographical area. Intra-regional differences are the main source of inequality. The eastern region has the highest density of PHCR, whereas the western region has the lowest. In addition, PHC institutions in more than 80% of the provinces are inefficient, and the productivity of the institutions decline by 0.6% from 2012 to 2016 because of technological retrogression.

In December 2019, a number of patients with a new type of pneumonia of unknown etiology were detected in Wuhan, China. (1) It was then soon determined that it was a new severe acute respiratory syndrome (SARS) that was caused by a new coronavirus, the SARS-CoV-2 virus. (2) The new pneumonia was later named the Novel 2019 Coronavirus or COVID-19. (3) In 2002-2003, another SARS-causing coronavirus, the SARS-CoV virus, caused one of the most deadly epidemics in recent history. The outbreak of SARS-CoV caused more than 8,000 reported cases and 774 deaths, with a case-fatality rate (CFR) of 7% in China. (4) Less than a decade later in 2012, another coronavirus, the Middle-East respiratory syndrome (MERS) virus, the MERS-CoV virus, emerged. (5) An outbreak of this virus in 2014 resulted in 662 reported cases and a CFR of 32.97%. (6) Together, these had informed us that coronaviruses represent a new kind of viral pathogens that are characterized by their ability to cause