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Id Subject Object Predicate Lexical cue
T1 0-94 Sentence denotes 2019 novel coronavirus of pneumonia in Wuhan, China: emerging attack and management strategies
T2 96-104 Sentence denotes Abstract
T3 105-220 Sentence denotes An ongoing outbreak of 2019-nCoV pneumonia was first identified in Wuhan, Hubei province, China at the end of 2019.
T4 221-377 Sentence denotes With the spread of the new coronavirus accelerating, person-to-person transmission in family homes or hospitals, and intercity spread of 2019-nCoV occurred.
T5 378-581 Sentence denotes At least 40,261 cases confirmed, 23,589 cases suspected, 909 cases death and 3444 cases cured in China and worldwide 24 countries confirmed 383 cases being diagnosed, 1 case death in February 10th, 2020.
T6 582-700 Sentence denotes At present, the mortality of 2019-nCoV in China is 2.3%, compared with 9.6% of SARS and 34.4% of MERS reported by WHO.
T7 701-763 Sentence denotes It seems the new virus is not as fatal as many people thought.
T8 764-966 Sentence denotes Chinese authorities improved surveillance network, made the laboratory be able to recognize the outbreak within a few weeks and announced the virus genome that provide efficient epidemiological control.
T9 967-1112 Sentence denotes More comprehensive information is required to understand 2019-nCoV feature, the epidemiology of origin and spreading, and the clinical phenomina.
T10 1113-1274 Sentence denotes According to the current status, blocking transmission, isolation, protection, and alternative medication are the urgent management strategies against 2019-nCoV.
T11 1276-1286 Sentence denotes Background
T12 1287-1439 Sentence denotes An outbreak of novel coronavirus pneumonia is ongoing, called 2019-nCoV, was first identified in Wuhan, Hubei province, China at the end of 2019 [1, 2].
T13 1440-1588 Sentence denotes As of February 10th, 2020, at least 40,261 cases confirmed, 23,589 cases suspected, 909 cases death and 3444 cases were cured in China (Fig. 1) [3].
T14 1589-1737 Sentence denotes 24 countries (Fig. 2) such as Japan, Singapore, Thailand, Korea, and the United States have 383 cases being diagnosed, with 1 case death so far [3].
T15 1738-2208 Sentence denotes Although Chinese authorities improved surveillance network, made the laboratory be able to recognize the outbreak within a few weeks and announced the virus genome that provide efficient epidemiological control, World Health Organization (WHO) assessed the risk as ‘very high’ in China and ‘high’ in global level in the coming weeks [4], and declared the public health emergency of international concern (PHEIC) over the global outbreak of 2019-nCoV in January 31, 2020.
T16 2209-2396 Sentence denotes Fig. 1 a The number cases of 2019-nCoV pneumonia confirmed in China by province Feb 10th, 2020; b The number cases of 2019-nCoV pneumonia confirmed in Hubei province, China Feb 10th, 2020
T17 2397-2472 Sentence denotes Fig. 2 The number of 2019-nCoV pneumonia confirmed in the world 10 Feb 2020
T18 2473-2714 Sentence denotes Based on the current epidemiological survey and data, more comprehensive information is required to understand 2019-nCoV feature, epidemiology of the outbreak including the source, transmission, extent of infection, and the clinical picture.
T19 2715-2792 Sentence denotes Further strategies are required to determine according to the current status.
T20 2794-2806 Sentence denotes Epidemiology
T21 2808-2826 Sentence denotes 2019-nCoV features
T22 2827-3040 Sentence denotes Coronaviruses are enveloped, positive-sense, single stranded RNA viruses that are distributed broadly among humans, other mammals, and birds, which cause respiratory, enteric, hepatic, and neurologic diseases [5].
T23 3041-3098 Sentence denotes Six coronavirus species are known to cause human disease.
T24 3099-3218 Sentence denotes Four viruses including hCoV-229E, OC43, NL63, and HKU1 are prevalent and typically cause mild respiratory diseases [6].
T25 3219-3426 Sentence denotes The two novel fatal coronaviruses emerge periodically in different areas, severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012.
T26 3427-3744 Sentence denotes Given the high prevalence and wide distribution of coronaviruses, the genetic diversity and frequent recombination of genomes, and increasing human and animal activities, novel coronaviruses are likely to emerge periodically in humans owing to frequent cross-species infections and occasional spillover events [7, 8].
T27 3745-4116 Sentence denotes As Zhu et al. reported that the identified 2019-nCoV genome has been sequenced are phylogenetically the closest to certain beta-coronaviruses detected in bats, belonging to the sarbecovirus subgenus of coronaviridae family [1], and these results in conjunction with other reports show that it is 75–80% identical to the SARS-CoV [9, 10] and 40% identical to the MERS-CoV.
T28 4117-4190 Sentence denotes It can be propagated in the same cells for growing SARS-CoV and MERS-CoV.
T29 4191-4331 Sentence denotes Notably, 2019-nCoV grows better in primary human airway epithelial cells than in standard tissue-culture cells, unlike SARS-CoV or MERS-CoV.
T30 4332-4539 Sentence denotes It appears that 2019-nCoV uses the same cellular receptor hACE2 (human angiotensin-converting enzyme 2) as SARS-CoV [11], it seems the transmission may develop after signs of lower respiratory tract disease.
T31 4541-4547 Sentence denotes Origin
T32 4548-4617 Sentence denotes The origin, spread and virulence of 2019-nCoV remain largely unknown.
T33 4618-4713 Sentence denotes Most of early infected patients were linked to Huanan seafood wholesale market in Wuhan, China.
T34 4714-4787 Sentence denotes However,there were 13 of the 41 cases had no link to the marketplace [2].
T35 4788-4925 Sentence denotes Most importantly, in the earliest case, the patient became ill on the 1st December 2019 and had no reported access to the seafood market.
T36 4926-5006 Sentence denotes And no epidemiological link was found between the first patient and later cases.
T37 5007-5076 Sentence denotes It seems that the seafood market is not the only origin of the virus.
T38 5077-5160 Sentence denotes The virus probably came into the market place first then it went out of there [12].
T39 5161-5307 Sentence denotes Analyses of blood samples in China from people and animals from other animal markets may reveal a clear picture of where the 2019-nCoV originated.
T40 5309-5318 Sentence denotes Spreading
T41 5319-5424 Sentence denotes An increasing number of cases evidenced the 2019-nCoV have the ability to transmit among humans [13, 14].
T42 5425-5651 Sentence denotes To date, no research found the special susceptible population of the new virus seems like SARS [15], 2019-nCoV is easily transmissible in human generally, but disease severity is not correlated to transmission efficiency [16].
T43 5652-5870 Sentence denotes According to the Chinese Center for Disease Control and Prevention (China CDC) reported that laboratory tests ruled out SARS-CoV, MERS-CoV, influenza, avian influenza, adenovirus and other common respiratory pathogens.
T44 5871-5949 Sentence denotes CDC considered the 2019-nCoV as a possible pathogen causing the outbreak [16].
T45 5950-6063 Sentence denotes The 2019-nCoV can cause severe illness in old patients with comorbidities and transmit readily among people [17].
T46 6064-6195 Sentence denotes At present, the mortality of 2019-nCoV in China is 2.3% [3], compared with 9.6% of SARS and 34.4% of MERS reported by WHO [16, 18].
T47 6196-6278 Sentence denotes Based on the current data, the new virus is not as fatally as many people thought.
T48 6279-6389 Sentence denotes The climate of temperature, relative humidity, and wind velocity should also be attention to the transmission.
T49 6390-6503 Sentence denotes 2019-nCoV pneumonia emerging attacks in the cold seasonal nature akin to viruses such as SARS and influenza [19].
T50 6505-6522 Sentence denotes Clinical features
T51 6523-6721 Sentence denotes Based on the current epidemiological survey, most individuals had a history of close contact to a patient who had 2019-nCoV infection or a history of travel from Wuhan City or Hubei province, China.
T52 6722-6788 Sentence denotes The incubation period is generally 3–7 days (within 14 days) [20].
T53 6790-6798 Sentence denotes Symptoms
T54 6799-6852 Sentence denotes The symptoms of 2019-nCoV infection were nonspecific.
T55 6853-6934 Sentence denotes The most common symptoms were onset of fever, generalized weakness and dry cough.
T56 6935-7043 Sentence denotes Some patients had headache and/or myalgia, but upper respiratory symptoms such as runny nose were rare [20].
T57 7044-7140 Sentence denotes Diarrhea was often identified, which had been reported 10.6% in SARS and up to 30% in MERS [21].
T58 7141-7264 Sentence denotes More than half of patients developed shortness of breath, the median duration from disease onset to dyspnea was 8 days [2].
T59 7265-7485 Sentence denotes Patients infected with 2019-nCoV might develop acute respiratory distress syndrome (ARDS), followed by septic shock, refractory metabolic acidosis and coagulation dysfunction, if the disease could not be controlled [20].
T60 7486-7588 Sentence denotes Notably, some patients were afebrile or confirmed biologically to have an asymptomatic infection [21].
T61 7589-7689 Sentence denotes These cryptic cases of walking pneumonia might serve as a possible source to propagate the outbreak.
T62 7690-7784 Sentence denotes Further studies on the epidemiological significance of these asymptomatic cases are warranted.
T63 7786-7805 Sentence denotes Laboratory findings
T64 7806-8023 Sentence denotes The blood cell counts of patients showed total white blood cells, lymphocyte, and platelet were lower than the average with extended activated thromboplastin time, increased C-reactive protein and muscle enzyme level.
T65 8024-8120 Sentence denotes D-dimer level were higher and lymphocyte decrease progressively, if the disease had aggravation.
T66 8121-8220 Sentence denotes The cytokine storm such as IL1B, IL1RA, IL7, IL8 could be associated with disease severity [2, 21].
T67 8221-8315 Sentence denotes The multifocal ground glass changes on chest CT scan were typical of viral pneumonia [Fig. 3].
T68 8316-8464 Sentence denotes If the disease continued to develop, the bilateral multiple lobular and subsegmental areas of consolidation would be found on chest CT scan [2, 21].
T69 8465-8574 Sentence denotes The lungs of aged patients showed more diffuse and extensive imaging than those of the younger patients [20].
T70 8575-8788 Sentence denotes Fig. 3 The multifocal ground glass changes on chest CT scan were typical of viral pneumonia in one infected 2019-nCoV patients. a shadow in right upper lobe; b shadow in bilateral lobe; c shadow in left lower lobe
T71 8790-8813 Sentence denotes Microbiological testing
T72 8814-8987 Sentence denotes Nasopharyngeal swab or sputum samples of patients were available for testing by specific RT-PCR assays for 2019-nCoV to detect the highly conserved RdRp and variable S gene.
T73 8988-9160 Sentence denotes The cycle threshold values of the sputum samples were 8–13 cycles earlier than those of throat swabs, indicating higher viral loads detected in the lower respiratory tract.
T74 9161-9329 Sentence denotes It is consistent with the observations in patients with MERS who had higher viral loads in lower respiratory tract samples than in upper respiratory tract samples [22].
T75 9330-9518 Sentence denotes Serum samples for 2019-nCoV which might indicate some virus spillover from the more severely infected lung into the systemic circulation, as previously reported in patients with SARS [23].
T76 9519-9720 Sentence denotes However, the first case of 2019-nCoV in the United States report the stool and respiratory specimens from the patients tested positive by RT-PCR for 2019-nCoV, whereas the serum remained negative [24].
T77 9721-9841 Sentence denotes Importantly, the ground glass changes on chest CT scan appeared earlier than the positive for RT-PCR test in some cases.
T78 9842-9976 Sentence denotes Repeat testing of nasopharyngeal swab or sputum samples are recommended in clinical suspected cases with an initially negative result.
T79 9978-9997 Sentence denotes Management strategy
T80 9999-10020 Sentence denotes Blocking transmission
T81 10021-10220 Sentence denotes Learning from the SARS outbreak, which started as animal-to-human transmission during the first phase of the epidemic, all game meat trades should be terminate to prevent this portal of transmission.
T82 10221-10376 Sentence denotes At the same time, we could not ignore the environmental assessments at the seafood market and investigations to identify the pathogen causing the outbreak.
T83 10377-10502 Sentence denotes Person-to-person transmission was efficient and super-spreading events had led to major outbreaks in public gathering places.
T84 10503-10605 Sentence denotes The severity of disease is an important indirect factor helps to identify those who had been infected.
T85 10606-10732 Sentence denotes If infection does not cause serious disease or asymptomatic infection, infected people probably end up in health care centers.
T86 10733-10839 Sentence denotes Instead, they would go to work and travel, thereby potentially spreading the virus to their contacts [16].
T87 10840-11015 Sentence denotes Recent epidemiological survey and studies showed the patients who did not travel to Wuhan became infected with the virus after several days of contact with the family members.
T88 11016-11129 Sentence denotes None of the family members had contacts with Wuhan markets or animals, neither had visited a Wuhan hospital [21].
T89 11130-11327 Sentence denotes Person-to-person transmission in family homes or hospital, and intercity spread of 2019-nCoV are occurring, and therefore vigilant control measures are warranted at the whole stage of the epidemic.
T90 11329-11338 Sentence denotes Isolation
T91 11339-11702 Sentence denotes Fortunately, with the spread of the new coronavirus accelerating, Chinese authorities responded not only treating the patients and isolating new cases as identified, tracing the contact, but also extended travel restrictions to 48 million people in hardest-hit Hubei province, banned inter-province buses to Beijing and canceled tour group travel abroad [25, 26].
T92 11703-11880 Sentence denotes However it is not completely under control, people with symptoms of pneumonia reported travel history to Wuhan have been identified at international airports over the past week.
T93 11881-12019 Sentence denotes It is crucial to isolate patients, trace and quarantine contacts as early as possible because asymptomatic infection began to appear [21].
T94 12020-12099 Sentence denotes Most importantly, the extent of interhuman transmission needs to be determined.
T95 12100-12208 Sentence denotes Transmission of SARS-CoV and MERS-CoV occurred to a large extent by means of superspreading events [27, 28].
T96 12209-12434 Sentence denotes Superspreading events have been implicated in 2019-nCoV transmission, so educate the public on both food and personal hygiene, and compliance to infection isolation to prevent super-spreading events deserves highly attention.
T97 12436-12446 Sentence denotes Protection
T98 12447-12528 Sentence denotes Transmission of 2019-nCoV probably occurs through spreading airborne and contact.
T99 12529-12585 Sentence denotes Aerosol and fecal–oral transmission remain unclear [24].
T100 12586-12810 Sentence denotes Public health measures, including quarantining in the community as well as timely diagnosis and strict adherence to universal precautions in health care settings [29], were critical in reducing the transmission of 2019-nCoV.
T101 12811-13054 Sentence denotes For healthcare personnel, to minimize the chance of exposures to 2019-nCoV needs to follow the standard of contact and airborne precautions, personal protection including gloves, gowns, respiratory protection, eye protection, and hand hygiene.
T102 13055-13270 Sentence denotes Some procedures performed on 2019-nCoV infected patients could generate infectious aerosols, e.g., nasopharyngeal specimen collection, sputum induction, and open suctioning of airways should be performed cautiously.
T103 13271-13440 Sentence denotes If performed, these procedures should take place in an airborne infection isolation room, and personnel should use respiratory and eye protection, and hand hygiene [30].
T104 13441-13585 Sentence denotes In addition, management of environmental infection control including laundry, food service utensils, and medical waste should also be performed.
T105 13586-13871 Sentence denotes Artificial Intelligence (AI), alternative selection to reducing infection for medical personnel, should be explored (Joint developed by Respiratory Research Institution of Zhongshan Hospital, Fudan University and RealMax Ltd Co), which will be benefit for remote guidance of practices.
T106 13873-13895 Sentence denotes Alternative medication
T107 13896-13977 Sentence denotes No antiviral treatment for coronavirus infection has been proven to be effective.
T108 13978-14116 Sentence denotes Previous studies showed the combination of lopinavir and ritonavir may be beneficial for SARS-CoV and MERS-CoV infected patients [31, 32].
T109 14117-14269 Sentence denotes Treatment with intravenous remdesivir (a novel nucleotide analogue prodrug in development) showed significant improvement for the first case in US [24].
T110 14270-14403 Sentence denotes A trial has been initiated quickly to assess the efficacy and safety of remdesivir in patients hospitalized with 2019-nCoV infection.
T111 14404-14537 Sentence denotes Recently, a potent binding of 2019-nCoV spike protein by a SARS-CoV specific human monoclonal antibody were under investigation [33].
T112 14538-14740 Sentence denotes As the cytokine storm was observed in severe 2019-nCoV infection patients, low dose corticosteroids has been used to treat the patients for possible benefit by reducing inflammatory-induced lung injury.
T113 14741-14864 Sentence denotes However, corticosteroids did not reduce the mortality for SARS-CoV and MERS-CoV infection by WHO interim guidance [34, 35].
T114 14865-15174 Sentence denotes Treatment regiments were classified into three categories depends on the severity of the disease: (1) For mild to moderate disease, the major treatment is supportive therapy [21]; (2) for severe disease, oxygen inhalation through mask, high nasal oxygen flow inhalation, or non-invasive ventilation is needed.
T115 15175-15600 Sentence denotes Careful and dynamic evaluation of patients oximeter and Chest imaging as well as laboratory examination is important; (3) for very severe disease, protective mechanical ventilation after tracheal intubation is required, and prone position ventilation followed if P/F ratio not improved, and eventually extracorporeal membrane oxygenation (ECMO) might be implemented if prone position plus mechanical ventilation did not work.
T116 15601-15674 Sentence denotes Notably, the anxiety and depression of patients need to be consideration.
T117 15675-15769 Sentence denotes We should not only pay attention to disease treatment, but also the mental issues of patients.
T118 15770-15989 Sentence denotes In addition, some traditional Chinese medicine (TCM), such as Snow Lotus (Saussuea involucrata), LianHuaQingWen [36], LiuShenWan [37] might be beneficial for coronavirus infection treatment through immunity enhancement.
T119 15990-16092 Sentence denotes Further evidence is needed to assess the effect of TCM treatment for patients infected with 2019-nCoV.
T120 16094-16105 Sentence denotes Conclusions
T121 16106-16196 Sentence denotes 2019-nCoV pneumonia are emerging attack at China and worldwide in the winter of 2019-2020.
T122 16197-16304 Sentence denotes The identified 2019-nCoV genome has been sequenced the closest to some beta-coronaviruses detected in bats.
T123 16305-16412 Sentence denotes Person-to-person transmission in family homes or hospital, and intercity spread of 2019-nCoV are occurring.
T124 16413-16531 Sentence denotes At present, the mortality of 2019-nCoV in China is 2.3%, compared with 9.6% of SARS and 34.4% of MERS reported by WHO.
T125 16532-16596 Sentence denotes It seems the new virus is not as fatally as many people thought.
T126 16597-16678 Sentence denotes The most common symptoms were onset of fever, generalized weakness and dry cough.
T127 16679-16776 Sentence denotes Notably, some patients were afebrile or confirmed biologically to have an asymptomatic infection.
T128 16777-16884 Sentence denotes And the ground glass changes on chest CT scan were earlier than the positive for RT-PCR test in some cases.
T129 16885-17019 Sentence denotes Repeat testing of nasopharyngeal swab or sputum samples are recommended in clinical suspected cases with an initially negative result.
T130 17020-17191 Sentence denotes According to the current status, blocking transmission, isolation, respiratory and eye protection, and hand hygiene are the urgent management strategies against 2019-nCoV.
T131 17193-17206 Sentence denotes Abbreviations
T132 17207-17236 Sentence denotes WHO World Health Organization
T133 17237-17291 Sentence denotes PHEIC Public health emergency of international concern
T134 17292-17330 Sentence denotes SARS Severe acute respiratory syndrome
T135 17331-17368 Sentence denotes MERS Middle East respiratory syndrome
T136 17369-17428 Sentence denotes China CDC Chinese Center for Disease Control and Prevention
T137 17429-17469 Sentence denotes ARDS Acute respiratory distress syndrome
T138 17470-17496 Sentence denotes AI Artificial Intelligence
T139 17497-17537 Sentence denotes ECMO Extracorporeal membrane oxygenation
T140 17538-17570 Sentence denotes TCM Traditional Chinese medicine
T141 17571-17587 Sentence denotes Publisher's Note
T142 17588-17706 Sentence denotes Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
T143 17708-17724 Sentence denotes Acknowledgements
T144 17725-17895 Sentence denotes We thanks the support of Shanghai Municipal Key Clinical Specialty (shslczdzd02201) and Shanghai Top-Priority Clinical Key Disciplines Construction Project (2017ZZ02013).
T145 17897-17919 Sentence denotes Authors’ contributions
T146 17920-18044 Sentence denotes Study concept and design (YS), data acquisition and interpretation (JS, JJ, LY and LH), drafting (JS), revision (YS and CB).
T147 18045-18096 Sentence denotes All authors read and approved the final manuscript.
T148 18098-18105 Sentence denotes Funding
T149 18106-18275 Sentence denotes This work was sponsored by Shanghai Municipal Key Clinical Specialty (shslczdzd02201); Shanghai Top-Priority Clinical Key Disciplines Construction Project (2017ZZ02013).
T150 18276-18332 Sentence denotes SJ was sponsored by Shanghai Pujiang Program (16PJD012).
T151 18334-18368 Sentence denotes Availability of data and materials
T152 18369-18384 Sentence denotes Not applicable.
T153 18386-18428 Sentence denotes Ethics approval and consent to participate
T154 18429-18444 Sentence denotes Not applicable.
T155 18446-18469 Sentence denotes Consent for publication
T156 18470-18485 Sentence denotes Not applicable.
T157 18487-18506 Sentence denotes Competing interests
T158 18507-18568 Sentence denotes All authors declare that they have no conflicts of interests.