key: cord-0878998-6xg1sjxb
authors: Peng, Fen
title: COVID-19: The experience from Beijing, China
date: 2020-12-15
journal: Clin Dermatol
DOI: 10.1016/j.clindermatol.2020.12.007
sha: 93465a9a1114c6c56247bf60acae377c0223dcc4
doc_id: 878998
cord_uid: 6xg1sjxb

The epidemiology of coronavirus disease 2019 (COVID-19) in Beijing, China, is summarized. This presentation highlights its main clinical manifestations, including the skin findings in Beijing and sums up the cutaneous damage to the medical staff in their epidemic preventative work. Although there had been few COVID-19 patients who reported skin lesions in Beijing and even in China, dermatologists still needed to pay attention to self-protection in their daily work. Skin damage caused by protective equipment is very common in the majority of the medical staff in Beijing.

Almost every year, there is a small epidemic of respiratory tract infection. A previous study found that, from 2015 to 2016, the influenza-associated severe acute respiratory infection hospitalization rate in Beijing, China, was between 39 and 37 per 100,000 persons. 1 The major epidemics were coronavirus and H7 N9 infection. 2 COVID-19 has typical features of the coronavirus family and has been classified in the betacoronavirus 2 b lineage. COVID-19 has a close similarity to bat coronaviruses; it has been postulated that bats are the primary source; however, the origin of the COVID-19 is still being investigated. 3 By April 16, 2020, a total of 83,798 COVID-19 cases were confirmed in China. In Beijing, 593 cases were confirmed, and 8 patients died. At present, the Chinese epidemic has been basically controlled with the main crisis coming from imported cases. The situation in Beijing has even been better controlled with quarantine of travelers wishing to enter China.

Patients from Wuhan showed common findings, including fever, fatigue, and a dry cough. Lymphopenia (lymphocyte count, 0.8 × 10 9 /L) occurred in 70.3% of patients with prolonged prothrombin time in 58% of patients, and elevated lactate dehydrogenase (261 U/L) in 39.9% of them. Chest Comp (CT) computed tomographic scans (CT) showed bilateral patchy shadows or ground glass opacity in the lungs of all patients. 3 Based on a study enrolling 161 cases from Changsha, Hunan Province, China, fever (71%) and cough (61.1%) were the most common clinical manifestations; fatigue (39.8%) was frequently reported. Muscle soreness, diarrhea, nausea, and headache were rare. 4 During the outbreak, a few patients who had been diagnosed with COVID-19 developed urticaria as their first sign, for which they consulted the dermatology department 2 ; however, there is an unclear potential relationship between urticaria and COVID-19. Urticaria is known to be caused by SARS-CoV. 5 In addition, two infected Chinese doctors developed skin hyperpigmentation after treatment ( Figure 1 ). It was initially thought to be a drug reaction due to polymyxin B, as previous studies had shown that intravenous polymyxin B treatment may cause acquired skin hyperpigmentation. 6 , 7 There are a few reports of such lesions in COVID-19 patients in Beijing, although there are now some reports from elsewhere of COVID-19-infected patients who had developed skin eruptions. 8 These skin findings may be due to a viral variation or even racial differences. A coronavirus infection can invade multiple body organs. Previous studies have even found the existence of coronavirus in the sweat of SARS patients. 9 The differential diagnoses of fever with such eruptions are listed in Table 1 .

The National Health and Health Commission of China has classified COVID-19 as a class B infectious disease, but it has now adopted class A infectious disease prevention and control measures. Medical staff personnel are required to wear level one to three protective equipment according to exposure risk (low, medium, or high), and level three protective equipment must be worn when diagnosing or treating nursing confirmed or suspected cases, including medical protective masks, goggles or protective masks, isolation clothes, protective clothes, latex gloves, and shoe covers. These measures need to be renewed every 4 hours, according to the exposure risk. Wearing protective masks for a long period often causes 80% of the medical staff to suffer from skin injury and facial abrasions. A small cross-sectional study in China reported the main skin damage caused by protective equipment in health care staff and pointed toward pressure injury (26.58%), moistureassociated skin damage (8.83%), and skin tears (3.12%). 10 We classified skin damage accordingly:

1. Pressure ulcers caused by wearing protective tools such as masks and goggles for an extended period 2. Skin immersion caused by long-term dampness 3. Skin allergy caused by protective equipment 4. Hand dermatitis caused by frequent cleaning

Some medical staff members were still being infected with this new coronavirus, even though they were wearing masks and isolation clothing. Experts hypothesized that the virus could be spread by the hands or by touching the eyes. The World Health Organization (WHO) then suggested that hand washing should be done more frequently:

1. Before patient contact 2. Before cleaning instruments 3. After contact with body fluids 4. After any contact with patients 5. Any contact with the patients' surrounding environment It has become important to clean the hands before touching the mucous membrane of the nose and eyes to avoid the virus infecting the mucous membranes of the nose and eyes through droplets or aerosols. Dermatologists should necessarily be cautious, even with patients with nonrespiratory infectious diseases. The survival period of viruses on inanimate surface and hands are shown in Table 2 .

The main manifestation of COVID-19 in China includes fever, fatigue, and a dry cough. A few patients developed urticaria as their first sign. In addition, two infected Chinese doctors developed skin hyperpigmentation after treatment. The main skin damage caused by protective equipment in Chinese health care staff has pointed toward pressure injury, moisture-associated skin damage, and skin tears. Chinese experts have hypothesized that the virus could be spread by the hands or by touching the eyes, and so hand washing should be performed frequently.

Hospitalizations for influenza-associated severe acute respiratory infection

The importance of infection control in clinical practice of dermatology from the ongoing Wuhan outbreak of the novel coronavirus pneumonia

Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan

Clinical characteristics of 161 cases of corona virus disease 2019 (COVID-19) in Changsha

Urticaria and infection

Acquired skin hyperpigmentation following intravenous polymyxin B treatment: A cohort study

Polymyxin B-induced skin hyperpigmentation: A rare case report and literature review

Generalized pustular figurate erythema: A newly delineated severe cutaneous drug reaction linked with hydroxychloroquine

Pathology and pathogenesis of severe acute respiratory syndrome

The Incidence and epidemic characteristics of medical staff's skin injuries caused by personal protective equipment for fighting against 2019-nCoV infection