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A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19

Cao et al., New England Journal of Medicine, doi:10.1056/NEJMoa2001282, LOTUS China, NCT02845843
May 2020  
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Mortality 23% Improvement Relative Risk Improvement, day 28 29% Improvement, day 14 22% Improvement, day 7 4% Viral clearance, day 28 4% Viral clearance, day 21 -0% Viral clearance, day 14 -5% Viral clearance, day 10 2% Viral clearance, day 5 2% Lopinavir/ritonavir  LOTUS China  LATE TREATMENT  RCT Is late treatment with lopinavir/ritonavir beneficial for COVID-19? RCT 199 patients in China (January - February 2020) Lower mortality (p=0.39) and greater improvement (p=0.19), not sig. c19early.org Cao et al., New England J. Medicine, May 2020 Favorslopinavir/ritonavir Favorscontrol 0 0.5 1 1.5 2+
RCT 199 hospitalized COVID-19 patients showing no significant difference with lopinavir-ritonavir treatment. 28-day mortality was lower in the treatment group, without statistical significance. 3 treatment patients died within 24 hours after randomization and did not receive lopinavir–ritonavir. No significant difference was found in viral RNA load over time between the groups.
Viral load measured by PCR may not accurately reflect infectious virus measured by viral culture. Porter et al. show that viral load early in infection was correlated with infectious virus, but viral load late in infection could be high even with low or undetectable infectious virus. Assessing viral load later in infection may underestimate reductions in infectious virus with treatment.
Standard of Care (SOC): SOC for COVID-19 in the study country, China, is average with moderate average efficacy for approved treatments2. This may explain in part the very high mortality seen in this study.
risk of death, 23.2% lower, RR 0.77, p = 0.39, treatment 19 of 99 (19.2%), control 25 of 100 (25.0%), NNT 17.
risk of no improvement, 29.3% lower, RR 0.71, p = 0.19, treatment 21 of 99 (21.2%), control 30 of 100 (30.0%), NNT 11, day 28.
risk of no improvement, 22.1% lower, RR 0.78, p = 0.03, treatment 54 of 99 (54.5%), control 70 of 100 (70.0%), NNT 6.5, day 14.
risk of no improvement, 4.1% lower, RR 0.96, p = 0.17, treatment 93 of 99 (93.9%), control 98 of 100 (98.0%), NNT 25, day 7.
risk of no viral clearance, 3.7% lower, RR 0.96, p = 1.00, treatment 24 of 59 (40.7%), control 30 of 71 (42.3%), NNT 63, day 28.
risk of no viral clearance, 0.3% higher, RR 1.00, p = 1.00, treatment 25 of 59 (42.4%), control 30 of 71 (42.3%), day 21.
risk of no viral clearance, 4.8% higher, RR 1.05, p = 0.86, treatment 27 of 59 (45.8%), control 31 of 71 (43.7%), day 14.
risk of no viral clearance, 2.4% lower, RR 0.98, p = 1.00, treatment 30 of 59 (50.8%), control 37 of 71 (52.1%), NNT 79, day 10.
risk of no viral clearance, 2.2% lower, RR 0.98, p = 1.00, treatment 39 of 59 (66.1%), control 48 of 71 (67.6%), NNT 66, day 5.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Cao et al., 7 May 2020, Randomized Controlled Trial, China, peer-reviewed, median age 58.0, 65 authors, study period 18 January, 2020 - 3 February, 2020, trial NCT02845843 (history) (LOTUS China). Contact: caobin_ben@163.com, yh-birm@263.net, 1813886398@qq.com.
This PaperMiscellaneousAll
A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19
Bin Cao, Yeming Wang, Danning Wen, Wen Liu, Jingli Wang, Guohui Fan, Lianguo Ruan, Bin Song, Yanping Cai, Ming Wei, Xingwang Li, Jiaan Xia, Nanshan Chen, Jie Xiang, Ting Yu, Tao Bai, Xuelei Xie, Li Zhang, Caihong Li, Ye Yuan, Hua Chen, Huadong Li, Hanping Huang, Shengjing Tu, Fengyun Gong, Ying Liu, Yuan Wei, Chongya Dong, Fei Zhou, Xiaoying Gu, Jiuyang Xu, Zhibo Liu, Yi Zhang, Hui Li, Lianhan Shang, Ke Wang, Kunxia Li, Xia Zhou, Xuan Dong, Zhaohui Qu, Sixia Lu, Xujuan Hu, Shunan Ruan, Shanshan Luo, Jing Wu, Lu Peng, Fang Cheng, Lihong Pan, Jun Zou, Chunmin Jia, Juan Wang, Xia Liu, Shuzhen Wang, Xudong Wu, Qin Ge, Jing He, Haiyan Zhan, Fang Qiu, Li Guo, Chaolin Huang, Thomas Jaki, Frederick G Hayden, Peter W Horby, Dingyu Zhang, Chen Wang
New England Journal of Medicine, doi:10.1056/nejmoa2001282
2.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org. A data sharing statement provided by the authors is available with the full text of this article at NEJM.org. We thank all patients who participated in this trial and their families. We also thank Bandar Al Knawy and Yaseen Arabi for shar-ing the MIRACLE trial documentation and meeting reports from WHO Novel Coronavirus R&D. Teddy Clinical Research Laboratory (Shanghai) served as the central laboratory, and Roche Diag nostics (Shanghai) provided instruments and SARS-CoV-2 assay detection. We dedicate this work to the memory of health care workers who have given their lives in the care of patients with Covid-19. L., Yuan Wei, K.W., K.L., X.Z., X.D., Z.Q., Sixia Lu, X.H., S.R., Shanshan Luo, Jing Wu, Lu Peng, F.C., Lihong Pan, J.Z., C.J., Juan Wang, Xia Liu, S.W., X.W., Q.G., J.H., H.Z., F.Q., C.H., D.Z.) -all in China; Lancaster University, Lancaster (T.J.), and the University of Oxford, Oxford (P.W.H.) -both in the United Kingdom; and the University of Virginia School of Medicine, Charlottesville (F.G.H.). Appendix
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DOI record: { "DOI": "10.1056/nejmoa2001282", "ISSN": [ "0028-4793", "1533-4406" ], "URL": "http://dx.doi.org/10.1056/NEJMoa2001282", "alternative-id": [ "10.1056/NEJMoa2001282" ], "author": [ { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Cao", "given": "Bin", "sequence": "first" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, 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"sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Liu", "given": "Wen", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute 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Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Ruan", "given": "Lianguo", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Song", "given": "Bin", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Cai", "given": "Yanping", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Wei", "given": "Ming", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Li", "given": "Xingwang", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Xia", "given": "Jiaan", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Chen", "given": "Nanshan", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Xiang", "given": "Jie", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Yu", "given": "Ting", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Bai", "given": "Tao", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Xie", "given": "Xuelei", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Zhang", "given": "Li", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Li", "given": "Caihong", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Yuan", "given": "Ye", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Chen", "given": "Hua", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Li", "given": "Huadong", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Huang", "given": "Hanping", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Tu", "given": "Shengjing", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Gong", "given": "Fengyun", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Liu", "given": "Ying", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Wei", "given": "Yuan", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Dong", "given": "Chongya", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Zhou", "given": "Fei", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Gu", "given": "Xiaoying", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Xu", "given": "Jiuyang", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Liu", "given": "Zhibo", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Zhang", "given": "Yi", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Li", "given": "Hui", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Shang", "given": "Lianhan", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), 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Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Zhou", "given": "Xia", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Dong", "given": "Xuan", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Qu", "given": "Zhaohui", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), 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"From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Ruan", "given": "Shunan", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Luo", "given": "Shanshan", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., Yeming Wang, G.F., F.Z., X.G., Z.L., Y.Z., Hui Li, L.S., C.W.), and the Institute of Clinical Medical Sciences (G.F., X.G.), China–Japan Friendship Hospital, the Institute of Respiratory Medicine, Chinese Academy of Medical Sciences (B.C., Yeming Wang, F.Z., Z.L., Y.Z., Hui Li, C.W.), the Clinical and Research Center of Infectious Diseases, Beijing..." } ], "family": "Wu", "given": "Jing", "sequence": "additional" }, { "affiliation": [ { "name": "From the Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases (B.C., 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Late treatment
is less effective
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