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      A cross-sectional comparison of epidemiological and clinical features of patients with coronavirus disease (COVID-19) in Wuhan and outside Wuhan, China

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      Author(s): a , b , 2 , a , b , 2 , a , b , 2 , a , b , a , b , a , b , a , b , a , b , a , b , a , b , a , b , a , b , a , b , a , b , a , b , 1 , c , 1 , ∗∗ , a , b , 1 , ∗
      Publication date (Electronic):
      Journal: Travel Medicine and Infectious Disease
      Publisher: Elsevier Ltd.
      Keywords: Coronavirus disease 2019, Severe acute respiratory syndrome-related coronavirus 2, Epidemiology, Clinical features, Virulence, Transmission, COVID-19, coronavirus disease 2019, SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, CDC, Centre for Disease Control and Prevention, RNA, ribonucleic acid, ICU, intensive care unit, ESR, erythrocyte sedimentation rate, CRP, C-reaction protein, PCT, Procalcitonin, CT, computerized tomography

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          Abstract

          Background

          Coronavirus disease 2019 (COVID-19) has spread outside the initial epicenter of Wuhan. We compared cases in Guangzhou and Wuhan to illustrate potential changes in pathogenicity and epidemiological characteristics as the epidemic has progressed.

          Methods

          We studied 20 patients admitted to the Third Affiliated Hospital of Sun Yat-Sen University in Guangzhou, China from January 22 to February 12, 2020. Data were extracted from medical records. These cases were compared with the 99 cases, previously published in Lancet, from Wuhan Jinyintan Hospital from January 1 to January 20, 2020.

          Results

          Guangzhou patients were younger and had better prognosis than Wuhan patients. The Wuhan patients were more likely to be admitted to the ICU (23% vs 5%) and had a higher mortality rate (11% vs 0%). Cases in Guangzhou tended to be more community clustered. Diarrhea and vomiting were more common among Guangzhou patients and SARS-CoV-2 RNA was found in feces. Fecal SARA-CoV-2 RNA remained positive when nasopharyngeal swabs turned negative in some patients.

          Conclusions

          This study indicates possible diminishing virulence of the virus in the process of transmission. Yet persistent positive RNA in feces after negative nasopharyngeal swabs suggests a possible prolonged transmission period that challenges current quarantine practices.

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Chaolin Huang, Yeming Wang, Xingwang Li … (2020)
          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            A Novel Coronavirus from Patients with Pneumonia in China, 2019

            Na Zhu, Dingyu Zhang, Wenling Wang … (2020)
            Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)
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              Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

              Dawei Wang, Bo Hu, Fangfang Zhu … (2020)
              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.
              Article 0 comments Cited 10771 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Jian-Rong He
                Bing-Liang Lin
                Journal
                Journal ID (nlm-ta): Travel Med Infect Dis
                Journal ID (iso-abbrev): Travel Med Infect Dis
                Title: Travel Medicine and Infectious Disease
                Publisher: Elsevier Ltd.
                ISSN (Print): 1477-8939
                ISSN (Electronic): 1873-0442
                Publication date PMC-release: 9 April 2020
                Publication date (Electronic): 9 April 2020
                Electronic Location Identifier: 101664
                Affiliations
                [a ]Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
                [b ]GuangDong Provincial Key Laboratory of Liver Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
                [c ]Nuffield Department of Women's and Reproductive Health, University of Oxford, UK
                Author notes
                [∗ ]Corresponding author. Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, China. linbingl@ 123456mail.sysu.edu.cn
                [1]

                Bing-Liang Lin, Jian-Rong He and Zhiliang Gao contributed equally to this work.

                [2]

                Ziying Lei, Huijuan Cao and Yusheng Jie contributed equally to this work.

                Article
                Publisher ID: S1477-8939(20)30132-0 Publisher ID: 101664
                DOI: 10.1016/j.tmaid.2020.101664
                PMC ID: 7194579
                PubMed ID: 32278758
                SO-VID: 8b425eb4-1f7c-40c1-b69e-db9c54981cb3
                Copyright © © 2020 Elsevier Ltd. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 7 March 2020
                Date revision received : 4 April 2020
                Date accepted : 5 April 2020
                Categories
                Subject: Article

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: coronavirus disease 2019,severe acute respiratory syndrome-related coronavirus 2,epidemiology,clinical features,virulence,transmission,covid-19, coronavirus disease 2019,sars-cov-2, severe acute respiratory syndrome coronavirus 2,cdc, centre for disease control and prevention,rna, ribonucleic acid,icu, intensive care unit,esr, erythrocyte sedimentation rate,crp, c-reaction protein,pct, procalcitonin,ct, computerized tomography
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: coronavirus disease 2019, severe acute respiratory syndrome-related coronavirus 2, epidemiology, clinical features, virulence, transmission, covid-19, coronavirus disease 2019, sars-cov-2, severe acute respiratory syndrome coronavirus 2, cdc, centre for disease control and prevention, rna, ribonucleic acid, icu, intensive care unit, esr, erythrocyte sedimentation rate, crp, c-reaction protein, pct, procalcitonin, ct, computerized tomography

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