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      Características clínico-epidemiológicas y algunas reflexiones sobre la COVID-19 en Holguín, Cuba, 2020. Translated title: Clinical-epidemiological characteristics and some reflections about COVID-19 in Holguín, Cuba, 2020

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          Abstract

          RESUMEN Introducción: El SARS- CoV-2 es el agente causal de la COVID-19 la cual ya se ha convertido en una pandemia que azota al mundo con significativas tasas de mortalidad, cuyas características clínico epidemiológicas están rodeadas aún por diversos vacíos científicos. Objetivo: Caracterizar clínica y epidemiológicamente los casos de COVID-19 en Holguín. Método: Estudio observacional descriptivo de la pandemia COVID-19 en la provincia. Se caracterizaron los 92 casos que fueron confirmados por PCR, atendiendo a las variables epidemiológicas de edad, sexo, lugar de procedencia, presencia de síntomas al diagnóstico, oportunidad en el ingreso y principales síntomas; además se determinó la tasa de incidencia y de letalidad. Resultados: Predominó el sexo masculino; el grupo de edades más afectado fue el comprendido entre los 50 y 59 años; los municipios más incidentes fueron Holguín, Gibara y Banes; los principales síntomas al inicio de la enfermedad fueron tos, fiebre, secreción nasal y odinofagia, pero más de la mitad de los casos se encontraban asintomáticos en el momento del diagnóstico y no presentaron casos secundarios; menos de un tercio de los casos se ingresó en los primeros días de iniciados los síntomas, lo que influyó en su posterior evolución y convalecencia. Conclusiones: La COVID-19 es una enfermedad de transmisión respiratoria altamente contagiosa que debe ser atendida adecuadamente para disminuir su letalidad y donde el control epidemiológico de cada caso sospechoso, cobra gran importancia.

          Translated abstract

          ABSTRACT Introduction: SARS-CoV-2 is the causal agent of COVID-19, which has already become a pandemic that plagues the world with significant mortality rates, whose clinical-epidemiological characteristics are still surrounded by various scientific gaps. Objective: To characterize clinically and epidemiologically COVID-19 cases in Holguín. Method: Observational descriptive study of COVID-19 pandemic in the province. The 92 cases confirmed by PCR were characterized, taking into account the epidemiological variables of age, sex, place of origin, presence of symptoms at diagnosis, opportunity at admission and main symptoms; in addition, the incidence and fatality rates were determined. Results: Male sex predominated; the most affected age group was the one between 50 and 59 years; the most affected municipalities were Holguín, Gibara and Banes; the main symptoms at the beginning of the disease were cough, fever, runny nose and odynophagia, but more than half of the cases were asymptomatic at the time of diagnosis and they did not present secondary cases; less than a third of the cases were admitted in the first days after the symptoms started, which influenced their subsequent evolution and convalescence. Conclusions: COVID-19 is a highly contagious respiratory disease that must be adequately cared for in order to reduce its lethality and for which the epidemiological control of each suspected case takes on great importance.

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          Most cited references28

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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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            Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia

            Abstract Background The initial cases of novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) occurred in Wuhan, Hubei Province, China, in December 2019 and January 2020. We analyzed data on the first 425 confirmed cases in Wuhan to determine the epidemiologic characteristics of NCIP. Methods We collected information on demographic characteristics, exposure history, and illness timelines of laboratory-confirmed cases of NCIP that had been reported by January 22, 2020. We described characteristics of the cases and estimated the key epidemiologic time-delay distributions. In the early period of exponential growth, we estimated the epidemic doubling time and the basic reproductive number. Results Among the first 425 patients with confirmed NCIP, the median age was 59 years and 56% were male. The majority of cases (55%) with onset before January 1, 2020, were linked to the Huanan Seafood Wholesale Market, as compared with 8.6% of the subsequent cases. The mean incubation period was 5.2 days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of the distribution at 12.5 days. In its early stages, the epidemic doubled in size every 7.4 days. With a mean serial interval of 7.5 days (95% CI, 5.3 to 19), the basic reproductive number was estimated to be 2.2 (95% CI, 1.4 to 3.9). Conclusions On the basis of this information, there is evidence that human-to-human transmission has occurred among close contacts since the middle of December 2019. Considerable efforts to reduce transmission will be required to control outbreaks if similar dynamics apply elsewhere. Measures to prevent or reduce transmission should be implemented in populations at risk. (Funded by the Ministry of Science and Technology of China and others.)
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              Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study

              Summary Background An ongoing outbreak of pneumonia associated with the severe acute respiratory coronavirus 2 (SARS-CoV-2) started in December, 2019, in Wuhan, China. Information about critically ill patients with SARS-CoV-2 infection is scarce. We aimed to describe the clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia. Methods In this single-centered, retrospective, observational study, we enrolled 52 critically ill adult patients with SARS-CoV-2 pneumonia who were admitted to the intensive care unit (ICU) of Wuhan Jin Yin-tan hospital (Wuhan, China) between late December, 2019, and Jan 26, 2020. Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were all collected. Data were compared between survivors and non-survivors. The primary outcome was 28-day mortality, as of Feb 9, 2020. Secondary outcomes included incidence of SARS-CoV-2-related acute respiratory distress syndrome (ARDS) and the proportion of patients requiring mechanical ventilation. Findings Of 710 patients with SARS-CoV-2 pneumonia, 52 critically ill adult patients were included. The mean age of the 52 patients was 59·7 (SD 13·3) years, 35 (67%) were men, 21 (40%) had chronic illness, 51 (98%) had fever. 32 (61·5%) patients had died at 28 days, and the median duration from admission to the intensive care unit (ICU) to death was 7 (IQR 3–11) days for non-survivors. Compared with survivors, non-survivors were older (64·6 years [11·2] vs 51·9 years [12·9]), more likely to develop ARDS (26 [81%] patients vs 9 [45%] patients), and more likely to receive mechanical ventilation (30 [94%] patients vs 7 [35%] patients), either invasively or non-invasively. Most patients had organ function damage, including 35 (67%) with ARDS, 15 (29%) with acute kidney injury, 12 (23%) with cardiac injury, 15 (29%) with liver dysfunction, and one (2%) with pneumothorax. 37 (71%) patients required mechanical ventilation. Hospital-acquired infection occurred in seven (13·5%) patients. Interpretation The mortality of critically ill patients with SARS-CoV-2 pneumonia is considerable. The survival time of the non-survivors is likely to be within 1–2 weeks after ICU admission. Older patients (>65 years) with comorbidities and ARDS are at increased risk of death. The severity of SARS-CoV-2 pneumonia poses great strain on critical care resources in hospitals, especially if they are not adequately staffed or resourced. Funding None.

                Author and article information

                Journal
                ccm
                Correo Científico Médico
                ccm
                Universidad Ciencias Médicas de Holguín (Holguín, , Cuba )
                1560-4381
                September 2020
                : 24
                : 3
                : 821-843
                Affiliations
                [3] Holguín orgnameHospital Pediátrico Provincial Docente Octavio de la Concepción de la Pedraja Cuba
                [1] orgnameUniversidad de Ciencias Médicas de Holguín orgdiv1Facultad de Ciencias Médicas ¨Mariana Grajales Cuello¨ de Holguín Cuba
                [2] Holguín orgnameHospital Clínico Quirúrgico ¨Lucía Iñiguez Landín¨ Cuba
                Article
                S1560-43812020000300821 S1560-4381(20)02400300821
                6cb0c0b8-ce77-4a09-a74c-fff415b680c3

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 15 July 2020
                : 20 June 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 28, Pages: 23
                Product

                SciELO Cuba

                Categories
                ARTÍCULOS ORIGINALES

                coronavirus,COVID-19,SARS- CoV-2,pandemia,epidemia,pandemic,epidemic

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