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      SARS-CoV-2 Transmission in Patients With Cancer at a Tertiary Care Hospital in Wuhan, China

      research-article
      , MD 1 , 2 , 3 , , MD 1 , 2 , 3 , , MBBS, PhD 1 , 4 , 5 , , , MD 1 , 2 , 3 ,
      JAMA Oncology
      American Medical Association

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          Abstract

          This cross-sectional study reviews the medical records of 1524 patients with cancer treated at a single tertiary care hospital in Wuhan, China, to evaluate the characteristics associated with transmission of the SARS-CoV-2 virus.

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          Clinical Characteristics of Coronavirus Disease 2019 in China

          Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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            Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

            In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
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              Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

              Summary Background In December, 2019, a pneumonia associated with the 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China. We aimed to further clarify the epidemiological and clinical characteristics of 2019-nCoV pneumonia. Methods In this retrospective, single-centre study, we included all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020. Cases were confirmed by real-time RT-PCR and were analysed for epidemiological, demographic, clinical, and radiological features and laboratory data. Outcomes were followed up until Jan 25, 2020. Findings Of the 99 patients with 2019-nCoV pneumonia, 49 (49%) had a history of exposure to the Huanan seafood market. The average age of the patients was 55·5 years (SD 13·1), including 67 men and 32 women. 2019-nCoV was detected in all patients by real-time RT-PCR. 50 (51%) patients had chronic diseases. Patients had clinical manifestations of fever (82 [83%] patients), cough (81 [82%] patients), shortness of breath (31 [31%] patients), muscle ache (11 [11%] patients), confusion (nine [9%] patients), headache (eight [8%] patients), sore throat (five [5%] patients), rhinorrhoea (four [4%] patients), chest pain (two [2%] patients), diarrhoea (two [2%] patients), and nausea and vomiting (one [1%] patient). According to imaging examination, 74 (75%) patients showed bilateral pneumonia, 14 (14%) patients showed multiple mottling and ground-glass opacity, and one (1%) patient had pneumothorax. 17 (17%) patients developed acute respiratory distress syndrome and, among them, 11 (11%) patients worsened in a short period of time and died of multiple organ failure. Interpretation The 2019-nCoV infection was of clustering onset, is more likely to affect older males with comorbidities, and can result in severe and even fatal respiratory diseases such as acute respiratory distress syndrome. In general, characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia. Further investigation is needed to explore the applicability of the MuLBSTA score in predicting the risk of mortality in 2019-nCoV infection. Funding National Key R&D Program of China.
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                Author and article information

                Journal
                JAMA Oncol
                JAMA Oncol
                JAMA Oncol
                JAMA Oncology
                American Medical Association
                2374-2437
                2374-2445
                July 2020
                25 March 2020
                25 March 2020
                : 6
                : 7
                : 1108-1110
                Affiliations
                [1 ]Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
                [2 ]Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
                [3 ]Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
                [4 ]Division of Radiation Oncology, Division of Medical Sciences, National Cancer Centre Singapore, Singapore
                [5 ]Oncology Academic Programme, Duke-NUS Medical School, Singapore
                Author notes
                Article Information
                Corresponding Authors: Conghua Xie, MD, Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, People’s Republic of China ( chxie_65@ 123456whu.edu.cn ); Melvin L. K. Chua, MBBS, PhD, Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610 ( melvin.chua.l.k@ 123456singhealth.com.sg ).
                Accepted for Publication: March 11, 2020.
                Published Online: March 25, 2020. doi:10.1001/jamaoncol.2020.0980
                Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Yu J et al. JAMA Oncology.
                Author Contributions: Drs Xie and Chua had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Yu and Ouyang contributed equally as co–first authors. Drs Chua and Xie contributed equally as co–senior authors.
                Study concept and design: All authors.
                Acquisition, analysis, or interpretation of data: All authors.
                Drafting of the manuscript: Yu, Chua.
                Critical revision of the manuscript for important intellectual content: Yu, Ouyang, Xie.
                Statistical analysis: Yu, Chua.
                Administrative, technical, or material support: All authors.
                Study supervision: Yu, Chua, Xie.
                Funding/Support: Dr Chua is supported by the National Medical Research Council Clinician-Scientist Award (CSA/0027/2018).
                Role of the Funder/Sponsor: The National Medical Research Council had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
                Conflict of Interest Disclosures: No conflicts are reported.
                Additional Contributions: We thank all the patients who consented to this study, and the frontline healthcare professionals who are involved in patient care during this pandemic.
                Article
                cld200010
                10.1001/jamaoncol.2020.0980
                7097836
                32211820
                3c9df430-4dc7-4c35-8cec-5f4d07e68645
                Copyright 2020 Yu J et al. JAMA Oncology.

                This is an open access article distributed under the terms of the CC-BY License.

                History
                : 24 February 2020
                : 11 March 2020
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