Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province

Abstract

Background: A novel coronavirus (2019-nCoV) causing an outbreak of pneumonia in Wuhan, Hubei province of China was isolated in January 2020. This study aims to investigate its epidemiologic history, and analyze the clinical characteristics, treatment regimens, and prognosis of patients infected with 2019-nCoV during this outbreak. Methods: Clinical data from 137 2019-nCoV-infected patients admitted to the respiratory departments of the respiratory departments of nine tertiary hospitals in Hubei province from December 30, 2019 to January 24, 2020 were retrospectively collected, including general status, clinical manifestations, laboratory test results, imaging characteristics, and treatment regimens. Results: None of the 137 patients (61 males, 76 females, aged 20-83 years, median age 57 years) had a definite history of exposure to Huanan Seafood Wholesale Market. Major initial symptoms included fever (112/137, 81.8%), coughing (66/137, 48.2%), and muscle pain or fatigue (44/137, 32.1%), with other, less typical initial symptoms observed at low frequency, including heart palpitations, diarrhea, and headache. Nearly 80% of the patients had normal or decreased white blood cell counts, and 72.3% (99/137) had lymphocytopenia. Lung involvement was present in all cases, with most chest computed tomography scans showing lesions in multiple lung lobes, some of which were dense; ground-glass opacity co-existed with consolidation shadows or cordlike shadows. Given the lack of effective drugs, treatment focused on symptomatic and respiratory support. Immunoglobulin G was delivered to some critically ill patients according to their conditions. Systemic corticosteroid treatment did not show significant benefits. Notably, early respiratory support facilitated disease recovery and improved prognosis. The risk of death was primarily associated with age, underlying chronic diseases, and median interval from the appearance of initial symptoms to dyspnea. Conclusions: The majority of patients with 2019-nCoV pneumonia present with fever as the first symptom, and most of them still showed typical manifestations of viral pneumonia on chest imaging. Middle-aged and elderly patients with underlying comorbidities are susceptible to respiratory failure and may have a poorer prognosis.

Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic

“…Increased case-fatality rates in the previously referenced analysis of 44,672 confirmed COVID-19 cases from Wuhan, China were noted in patients with CVD (10.5%), diabetes (7.3%), hypertension (6.0%), all notably higher than the overall case-fatality rate of 2.3% (15). Several smaller cohort studies have yielded similar results suggesting higher risk for adverse events in patients with CVD who contract COVID-19, although biases related to testing and standardized data apply here as well (1,19,(25)(26)(27)(28). Notably, while reports outside of China are limited, data from Italy suggest similar mortality rates and an elevated risk for death in patients with comorbidities (29).…”

“…Among 68 deaths in a case series of 150 patients with COVID-19, 7% were attributed to myocarditis with circulatory failure and in 33% of cases which myocarditis may have played a contributing role to the patient's demise (21). Other reports have described fulminant myocarditis in the setting of high viral load with autopsy findings of inflammatory mononuclear infiltrate in myocardial tissue (26,47,48). Pericardial involvement has not yet been reported but further study is needed.…”

“…Cardiac arrhythmias are another common CV manifestation described in patients with COVID-19 infection. While nonspecific, heart palpitations were part of the presenting symptomology in 7.3% of patients in a cohort of 137 patients admitted for COVID-19 disease(26). In hospitalized COVID-19 patients, cardiac arrhythmia was noted in 16.7% of 138 patients in a Chinese cohort and was more common in ICU patients compared to non-ICU patients (44.4% vs. 6.9%)(19).…”

2019 novel coronavirus (2019-nCoV) outbreak: A new challenge

“…Most of the patients were males (Table 1) with ranging ages eight to 92 years-old: interestingly, in the first period of this global epidemic there were few cases in young people under fifteen-yearsold [1,[4][5][6][7][8][9][10][11][12][13][14][15]. Nevertheless, among known infected subjects outside China prevalence of males and distribution of age, at the time of diagnosis, resemble those in Chinese epidemic [4,6,15].…”

Clinical and computed tomographic imaging features of novel coronavirus pneumonia caused by SARS-CoV-2

“…The outbreak of an epidemical pneumonia with initially unknown reasons in December 2019 in Wuhan, China was ultimately found to be caused by a new virus, the "2019 novel Coronavirus" (2019-nCoV) or SARS-CoV-2 formally named by the World Committee on Virus Classification, [1][2][3] and the disease caused by this virus was named as COVID-19 by the World Health Organization. 4 , 5 This virus has a characteristic crown representing the spike peplomers on the viral envelope, with strong infectivity and general suscepti-bility to people of all ages and across the globe.…”