Clinical Course and Outcomes of Patients with Severe Acute Respiratory Syndrome Coronavirus 2 Infection: a Preliminary Report of the First 28 Patients from the Korean Cohort Study on COVID-19

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected pneumonia emerged in Wuhan, China in December 2019. In this retrospective multicenter study, we investigated the clinical course and outcomes of novel coronavirus disease 2019 (COVID-19) from early cases in Republic of Korea. Methods: All of the cases confirmed by real time polymerase chain reaction were enrolled from the 1st to the 28th patient nationwide. Clinical data were collected and analyzed for changes in clinical severity including laboratory, radiological, and virologic dynamics during the progression of illness. Results: The median age was 40 years (range, 20-73 years) and 15 (53.6%) patients were male. The most common symptoms were cough (28.6%) and sore throat (28.6%), followed by fever (25.0%). Diarrhea was not common (10.7%). Two patients had no symptoms. Initial chest X-ray (CXR) showed infiltration in 46.4% of the patients, but computed tomography scan confirmed pneumonia in 88.9% (16/18) of the patients. Six patients (21.4%) required J Korean Med Sci. 2020 Apr 6;35(13):e142 https://doi.

Smoking Is Associated With COVID-19 Progression: A Meta-analysis

“…A total of 907 studies were retrieved through the search, of which 19, 8-26 16 from China, 1 from Korea, and 2 from the United States, included data on smoking behavior and COVID-19 disease progression (Supplementary Table S1). Seventeen studies [9][10][11][12][14][15][16][17][18][19][20][21][22][23][24][25][26] were based on hospitalized patients and two 8,13 included both hospitalized patients and outpatients.…”

“…The exposure group for our analysis were those who had a history of smoking (current smokers or former smokers) and unexposed group was never smokers. Nine studies 10,12,14,18,20,21,23,25,26 assessed whether the patient was a "current smoker," five studies 8,9,13,16,24 assessed whether the patient was a current or former smoker (as separate categories), and five studies 11,15,17,19,22 assessed whether the patient had a "history of smoking" (current or former).…”

“…Outcomes were progression of COVID-19 to more severe or critical conditions or death. Six studies 11,16,20,21,23,24 categorized the outcome as severe or critical (respiratory distress with respiratory rate ≥30/min, or oxygen saturation ≤93% at rest, or oxygenation index ≤300 mm Hg, based on the diagnostic and treatment guideline for SARS-CoV-2 issued by Chinese National Health Committee or the American Thoracic Society guidelines for community acquired pneumonia 23,24 ) or nonsevere, three 10,17,18 categorized the outcome as progression or improvement, two 8,14 categorized the outcome as intensive care unit (ICU) admission or non-ICU admission, one 13 categorized the outcome as the primary composite endpoint (ICU admission, the use of mechanical ventilation, or death) or not, three 9,22,26 categorized the outcome as death or survivor, one 19 categorized the outcome as the occurrence of severe cases (without defining severe) or death or mild, one study 15 categorized the outcome as clinical deterioration during the hospitalization and needed supplemental oxygen therapy, one 12 categorized the outcome as a need of intensive mechanical ventilators, and one 25 categorized the outcome as abnormal chest imaging findings.…”

“…This analysis is based on unadjusted ORs that were either reported in the studies 17 or that we calculated based on counts in the studies. [8][9][10][11][12][13][14][15][16][18][19][20][21][22][23][24][25][26] Only one 17 of the studies reported unadjusted and adjusted ORs using multivariate analysis; after adjusting for confounding by age, maximum temperature at admission, respiratory failure, severe illness, albumin, creatinine, procalcitonin, and C-reactive protein level, the effect of smoking on disease severity increased (unadjusted: OR 12.19, 95% CI 1.76-84.31, p = .011; adjusted: OR 14.29, 95% CI 1.58-25.0, p = .018). Three peer-reviewed meta-analysis papers 6,34,35 on association between smoking and COVID-19 were also based on unadjusted ORs, but with fewer studies included.…”

Disruption of Adaptive Immunity Enhances Disease in SARS-CoV-2 Infected Syrian Hamsters

“…We reasoned that a similar approach might allow the development of a severe disease model for SARS-CoV-2. Moreover, clinical findings of lymphopenia associated with COVID-19 (5) and its prominence in severe cases (6,7) suggested 10 an immunosuppressed animal model of COVID-19 might more accurately model some aspects of human disease. Here, we used CyP-treated and RAG2 KO hamsters to investigate how transient disruption, or ablation, of the adaptive immune response affects SARS-CoV-2 infection.…”