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

      , Prof, MD a , * , , MD b , e , f , * , , Prof, MD g , * , , Prof, PhD h , * , , Prof, MD j , * , , MD k , * , , Prof, MD a , , MS b , c , e , , MDc l , , PhD b , c , e , , Prof, MD m , , MD a , , MD a , , MD a , , Prof, MD a , , Prof, MD a , , MD k , , MD b , e , f , , MD d , , MS h , , Prof, PhD i , , Prof, PhD h , , Prof, MD j , , Prof, MD n , , Prof, MD g , , Prof, MD o , , PhD h , , Prof, PhD h , , ** , , Prof, MD b , e , f , p , , *

      Lancet (London, England)

      Elsevier Ltd.

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          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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          Most cited references 4

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          Middle East Respiratory Syndrome Coronavirus (MERS-CoV): Announcement of the Coronavirus Study Group

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            Corticosteroids as adjunctive therapy in the treatment of influenza.

            Specific treatments for influenza are limited to neuraminidase inhibitors and adamantanes. Corticosteroids show evidence of benefit in sepsis and related conditions, most likely due to their anti-inflammatory and immunomodulatory properties. Although commonly prescribed for severe influenza, there is uncertainty over their potential benefits or harms. This is an update of a review first published in 2016.
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              Bats as animal reservoirs for the SARS coronavirus: Hypothesis proved after 10 years of virus hunting

              Recently, the team led by Dr. Zhengli Shi from Wuhan Institute of Virology, Chinese Academy of Sciences, and Dr. Peter Daszak from Ecohealth Alliance identified SL-CoVs in Chinese horseshoe bats that were 95% identical to human SARS-CoV and were able to use human angiotensin-converting enzyme 2 (ACE2) receptor for docking and entry. Remarkably, they isolated the first known live bat SL-CoV that replicates in human and related cells. Their findings provide clear evidence that some SL-CoVs circulating in bats are capable of infecting and replicating in human (Ge X Y, et al., 2013).
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                Author and article information

                Contributors
                Journal
                Lancet
                Lancet
                Lancet (London, England)
                Elsevier Ltd.
                0140-6736
                1474-547X
                24 January 2020
                15-21 February 2020
                24 January 2020
                : 395
                : 10223
                : 497-506
                Affiliations
                [a ]Jin Yin-tan Hospital, Wuhan, China
                [b ]Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
                [c ]Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
                [d ]Department of Radiology, China-Japan Friendship Hospital, Beijing, China
                [e ]Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
                [f ]Department of Respiratory Medicine, Capital Medical University, Beijing, China
                [g ]Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
                [h ]NHC Key Laboratory of Systems Biology of Pathogens and Christophe Merieux Laboratory, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
                [i ]Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
                [j ]Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
                [k ]Department of Pulmonary and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
                [l ]Tsinghua University School of Medicine, Beijing, China
                [m ]Department of Respiratory medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
                [n ]Department of Pulmonary and Critical Care Medicine, Peking University First Hospital, Beijing, China
                [o ]Department of Pulmonary and Critical Care Medicine, Peking University People's Hospital, Beijing, China
                [p ]Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China
                Author notes
                [* ]Correspondence to: Prof Bin Cao, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China caobin_ben@ 123456163.com
                [** ]Prof Jianwei Wang, NHC Key Laboratory of Systems Biology of Pathogens and Christophe Merieux Laboratory, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China wangjw28@ 123456163.com
                [*]

                Contributed equally

                [†]

                Joint corresponding authors

                Article
                S0140-6736(20)30183-5
                10.1016/S0140-6736(20)30183-5
                7159299
                31986264
                © 2020 Elsevier Ltd. All rights reserved.

                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.

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                Medicine

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