Background: On 29th December 2019, a cluster of cases displaying the symptoms of a "pneumonia of unknown cause" was identified in Wuhan, Hubei province of China. This systematic review and meta-analysis aims to review the epidemiological and clinical characteristics of COVID-19 cases in the early phase of the COVID-19 pandemic. Methods: The search strategy involved peer-reviewed studies published between 1st January and 11th February 2020 in Pubmed, Google scholar and China Knowledge Resource Integrated database. Publications identified were screened for their title and abstracts according to the eligibility criteria, and further shortlisted by full-text screening. Three independent reviewers extracted data from these studies, and studies were assessed for potential risk of bias. Studies comprising non-overlapping patient populations, were included for qualitative and quantitative synthesis of results. Pooled prevalence with 95% confidence intervals were calculated for patient characteristics. Results: A total of 29 publications were selected after full-text review. This comprised of 18 case reports, three case series and eight cross-sectional studies on patients admitted from mid-December of 2019 to early February of 2020. A total of 533 adult patients with pooled median age of 56 (95% CI: 49-57) and a pooled prevalence of male of 60% (95% CI: 52-68%) were admitted to hospital at a pooled median of 7 days (95% CI: 7-7) post-onset of symptoms. The most common symptoms at admission were fever, cough and fatigue, with a pooled prevalence of 90% (95% CI: 81-97%), 58% (95% CI: 47-68%), and 50% (95% CI: 29-71%), respectively. Myalgia, shortness of breath, headache, diarrhea and sore throat were less common with pooled prevalence of 27% (95% CI: 20-36%), 25% (95% CI: 15-35%), 10% (95% CI: 7-13%), 8% (95% CI: 5-13%), and 7% (95% CI: 1-15%), respectively. ICU patients had a higher proportion of shortness of breath at Koh et al. Epidemiological and Clinical Features of COVID-19 Cases presentation, as well as pre-existing hypertension, cardiovascular disease and COPD, compared to non-ICU patients in 2 studies (n = 179). Conclusion: This study highlights the key epidemiological and clinical features of COVID-19 cases during the early phase of the COVID-19 pandemic.

This systematic and meta-review aimed to compare clinical presentation, outcomes, and care management among patients with COVID-19 during the early phase of the pandemic. A total of 77 peer-reviewed publications were identified between January 1, 2020 and April 9, 2020 from PubMed, Google Scholar, and Chinese Medical Journal databases. Subsequently, meta-analysis of 40 non-overlapping studies, comprising of 4844 patients from seven countries, was conducted to see differences in clinical characteristics and laboratory outcomes across patients from different geographical regions (Wuhan, other parts of China and outside China), severity (non-severe, severe and fatal) and age groups (adults and children). Patients from Wuhan had a higher mean age (54.3 years) and rates of dyspnea (39.5%) compared with patients from other parts of China and outside China. Myalgia, fatigue, acute respiratory distress syndrome (ARDS) and fatalities were also significantly more prevalent among Wuhan patients. A significant dose–response increase in prevalence of diabetes, D-dimer, white blood cells, neutrophil levels and ARDS was seen from non-severe to severe and fatal outcomes. A significant increase in mean duration of symptom onset to admission was seen between non-severe cases (4.2 days) and severe and fatal cases (6.3 days and 8.8 days, respectively). Proportion of asymptomatic cases was higher in children (20%) compared with adults (2.4%). In conclusion, patients with COVID-19 from Wuhan displayed more severe clinical disease during the early phase of the pandemic, while disease severity was significantly lesser among pediatric cases. This review suggests that biomarkers at admission may be useful for prognosis among patients with COVID-19.

IntroductionRegardless of having effective vaccines against COVID-19, containment measures such as enhanced physical distancing and good practice of personal hygiene remain the mainstay of controlling the COVID-19 pandemic. Countries across Asia have imposed these containment measures to varying extents. However, residents in different countries would have a differing degree of compliance to these containment measures potentially due to differences in the level of awareness and motivation in the early phase of pandemic.ObjectivesIn our study, we aimed to describe and correlate the level of knowledge and attitude with the level of compliance with personal hygiene and physical distancing practices among Asian countries in the early phase of pandemic.MethodsA multinational cross-sectional study was carried out using electronic surveys between May and June 2020 across 14 geographical areas. Subjects aged 21 years and above were invited to participate through social media, word of mouth and electronic mail.ResultsAmong the 2574 responses obtained, 762 (29.6%) participants were from East Asia and 1812 (70.4%) were from Southeast Asia (SEA). A greater proportion of participants from SEA will practise physical distancing as long as it takes (72.8% vs 60.6%). Having safe distancing practices such as standing more than 1 or 2 m apart (AdjOR 5.09 95% CI (1.08 to 24.01)) or more than 3 or 4 m apart (AdjOR 7.05 95% CI (1.32 to 37.67)), wearing a mask when they had influenza-like symptoms before the COVID-19 pandemic, preferring online news channels such as online news websites/applications (AdjOR 1.73 95% CI (1.21 to 2.49)) and social media (AdjOR 1.68 95% CI (1.13 to 2.50) as sources of obtaining information about COVID-19 and high psychological well-being (AdjOR 1.39 95% CI (1.04 to 1.87)) were independent factors associated with high compliance.ConclusionsWe found factors associated with high compliance behaviour against COVID-19 in the early phase of pandemic and it will be useful to consider them in risk assessment, communication and pandemic preparedness.

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This study assessed the impact of weather factors, including novel predictors—pollutant standards index (PSI) and wind speed—on dengue incidence in Singapore between 2012 and 2019. Autoregressive integrated moving average (ARIMA) model was fitted to explore the autocorrelation in time series and quasi-Poisson model with a distributed lag non-linear term (DLNM) was set up to assess any non-linear association between climatic factors and dengue incidence. In DLNM, a PSI level of up to 111 was positively associated with dengue incidence; incidence reduced as PSI level increased to 160. A slight rainfall increase of up to 7 mm per week gave rise to higher dengue risk. On the contrary, heavier rainfall was protective against dengue. An increase in mean temperature under around 28.0 °C corresponded with increased dengue cases whereas the association became negative beyond 28.0 °C; the minimum temperature was significantly positively associated with dengue incidence at around 23–25 °C, and the relationship reversed when temperature exceed 27 °C. An overall positive association, albeit insignificant, was observed between maximum temperature and dengue incidence. Wind speed was associated with decreasing relative risk (RR). Beyond prevailing conclusions on temperature, this study observed that extremely poor air quality, high wind speed, minimum temperature ≥27 °C, and rainfall volume beyond 12 mm per week reduced the risk of dengue transmission in an urbanized tropical environment.

Relationship between local weather, air pollution and hospital attendances for urticaria in children: Time stratified analysis of 12,002 cases.

IntroductionThe association of weather factors on dengue transmission in an urbanized tropical environment remains inconclusive. This study aims to assess the impact of weather factors on dengue incidence in Singapore between 2012 and 2019.MethodsData on weather variables (daily temperature, air quality, rainfall & wind speed) and weekly dengue incidence rates were collected from 1 January 2012 to 25 August 2019. Statistically significant correlated variables identified from cross-correlation analysis using Pearson’s correlation were examined in univariate ARIMA model. Quasi-Poisson model with a distributed lag non-linear model (DLNM) was established to assess any non-linear association between climatic factors and dengue incidence. FindingsPoor air quality (PSI: 150) and high wind speeds (12 km/h) were associated with reduced risk of dengue transmission in an urbanized tropical environment. Only a limited temperature range (27-32 °C and 23-25 °C) promotes dengue transmission whereas extreme heat inhibited dengue incidence (27°C, Ref. 25.14 °C; RR: 0.74, 95% CI: 0.58, 0.93). Rainfall exerts positive and negative influence alternately on weekly dengue cases across lags but the influence was not robust in sensitivity analysis. Based on split-sample model validation, mean temperature was the best predictor of dengue in prediction part (MAE: 43.15, RMSE: 51.39).

Diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during border screening among returning residents and prioritized travelers during the early phase of a pandemic can reduce the risk of importation and transmission in the community. This study aimed to compare the accuracy of various SARS-CoV-2 diagnostics and assess their potential utility as border screening for infection and immunity. Systematic literature searches were conducted in six electronic databases for studies reporting SARS-CoV-2 diagnostics (up to April 30, 2020). Meta-analysis and methodological assessment were conducted for all included studies. The performance of the diagnostic tests was evaluated with pooled sensitivity, specificity, and their respective 95% confidence intervals. A total of 5,416 unique studies were identified and 95 studies (at least 29,785 patients/samples) were included. Nucleic acid amplification tests (NAAT) consistently outperformed all other diagnostic methods regardless of the selected viral genes with a pooled sensitivity of 98% and a pooled specificity of 99%. Point-of-care (POC) serology tests had moderately high pooled sensitivity (69%), albeit lower than laboratory-based serology tests (89%), but both had high pooled specificity (96–98%). Serology tests were more sensitive for sampling collected at ≥ 7 days than ≤ 7 days from the disease symptoms onset. POC NAAT and POC serology tests are suitable for detecting infection and immunity against the virus, respectively as border screening. Independent validation in each country is highly encouraged with the preferred choice of diagnostic tool/s.