Clinical features of covid-19

Vetter, Pauline; Vu, Diem; L’Huillier, Arnaud G.; Schibler, Manuel; Kaiser, Laurent; Jacquérioz, Frédérique

doi:10.1136/bmj.m1470

Cited by 255 publications

(250 citation statements)

References 30 publications

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“…Categorical variables are presented as number of patients (percentage). X 2 or Fisher exact test was used to compare categorical variables. A binary logistic regression analysis was carried out to isolate the contribution of early intubation and sex (independent variables) to mortality (categorical dependent variable).…”

Section: Discussionmentioning

confidence: 99%

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Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19 

Siempos

Xourgia

Ntaidou

et al. 2020

Preprint

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Background: Optimal timing of initiation of invasive mechanical ventilation in patients with acute hypoxemic respiratory failure due to COVID-19 is unknown. Thanks to early flattening of the epidemiological curve, ventilator demand in Greece was kept lower than supply throughout the pandemic, allowing for unbiased comparison of the outcomes of patients undergoing early intubation versus delayed or no intubation.Methods: We conducted an observational study including all adult patients with laboratory-confirmed COVID-19 consecutively admitted in Evangelismos Hospital, Athens, Greece between March 11, 2020 and April 15, 2020. Patients subsequently admitted in the intensive care unit (ICU) were categorized into the “early intubation” versus the “delayed or no intubation” group.Results: During the study period, a total of 101 patients (37% female, median age 65 years) were admitted in the hospital. Fifty-nine patients (58% of the entire cohort) were exclusively hospitalized in general wards with a mortality of 3% and median length of stay of 7 days. Forty-two patients (19% female, median age 65 years, 62% with at least one comorbidity, 14% never intubated) were admitted in the ICU; all with acute hypoxemic respiratory failure. Early intubation was not associated with higher ICU-mortality (21% versus 33%), fewer ventilator-free days (3 versus 2 days) or fewer ICU-free days than delayed or no intubation.Conclusions: A strategy of early intubation was not associated with worse clinical outcomes compared to delayed or no intubation. Given that early intubation may presumably reduce virus aerosolization, these results may justify further research with a randomized controlled trial.

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Section: Discussionmentioning

confidence: 99%

“…Management of acute hypoxemic respiratory failure associated with coronavirus disease 2019 (COVID-19) often includes mechanical ventilation [1,2]. Optimal timing of initiation of invasive mechanical ventilation remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19 

Siempos

Xourgia

Ntaidou

et al. 2020

Preprint

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“…Severe acute respiratory illness with fever and respiratory symptoms, such as cough and shortness of breath, are the primary case de nition, but recently patients without respiratory symptoms are becoming more recognized, with manifestations such as gastrointestinal, olfactory, cardiovascular, and neurological. Cases resulting in death are primarily middle-aged and elderly patients with obesity and/or pre-existing diseases (tumor surgery, cirrhosis, hypertension, coronary heart disease, diabetes, and Parkinson's disease) [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Emerging of a SARS-CoV-2 viral strain with a deletion in nsp1

Benedetti

Snyder²,

Giovanetti

et al. 2020

Preprint

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Background:The new Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), which was ﬁrst detected in Wuhan (China) in December of 2019 is responsible for the current global pandemic.Phylogenetic analysis revealed that it is similar to other betacoronaviruses, such as SARS-CoV and Middle-Eastern Respiratory Syndrome, MERS-CoV. Its genome is ∼30 kb in length and contains two large overlapping polyproteins, ORF1a and ORF1ab that encode for several structural and non-structural proteins. The non-structural protein 1 (nsp1) is arguably the most important pathogenic determinant, and previous studies on SARS-CoV indicate that it is both involved in viral replication and hampering the innate immune system response. Detailed experiments of site-specific mutagenesis and in vitro reconstitution studies determined that the mechanisms of action are mediated by i) the presence of specific amino acid residues of nsp1 and b) the interaction between the protein and the host’s small ribosomal unit. In fact, substitution of certain amino acids resulted in reduction of its negative effects.Methods: A total of 17928 genome sequences were obtained from the GISAID database (December 2019 to July 2020) from patients infected by SARS-CoV-2 from different areas around the world. Genomes alignment was performed using MAFFT (REFF) and the nsp1 genomic regions were identified using BioEdit and verified using BLAST. Nsp1 protein of SARS-CoV-2 with and without deletion have been subsequently modelled using I-TASSER.Results: We identified SARS-CoV-2 genome sequences, from several Countries, carrying a previously unknown deletion of 9 nucleotides in position 686-694, corresponding to the AA position 241-243 (KSF). This deletion was found in different geographical areas. Structural prediction modelling suggests an effect on the C-terminal tail structure.Conclusions: Modelling analysis of a newly identified deletion of 3 amino acids (KSF) of SARS-CoV-2 nsp1 suggests that this deletion could affect the structure of the C-terminal region of the protein, important for regulation of viral replication and negative effect on host’s gene expression. In addition, substitution of the two amino acids (KS) from nsp1 of SARS-CoV was previously reported to revert loss of interferon-alpha expression. The deletion that we describe indicates that SARS-CoV-2 is undergoing profound genomic changes. It is important to: i) confirm the spreading of this particular viral strain, and potentially of strains with other deletions in the nsp1 protein, both in the population of asymptomatic and pauci-symptomatic subjects, and ii) correlate these changes in nsp1 with potential decreased viral pathogenicity.

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“…Given the current coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome (SARS) coronavirus-2 (SARS-CoV-2), we revisited the Jeddah, Saudi Arabia 2013-2014 MERS-CoV outbreak for several reasons. Both coronaviruses currently coexist in the Middle East and around the globe in symptomatic and asymptomatic individuals [6][7][8][9] . Symptomatic patients may present with respiratory symptoms, such as cough, fever and dyspnea, and non-respiratory complaints 1,6,8 .…”

Section: Introductionmentioning

confidence: 99%

“…Both coronaviruses currently coexist in the Middle East and around the globe in symptomatic and asymptomatic individuals [6][7][8][9] . Symptomatic patients may present with respiratory symptoms, such as cough, fever and dyspnea, and non-respiratory complaints 1,6,8 . The overlap in clinical features and risk of death from either virus heightens the signi cance of such coexistence 1,8,9 .…”

Section: Introductionmentioning

confidence: 99%

Revisiting MERS-CoV Outbreak Chest Radiographic Initial Findings, Temporal Progression and Correlation to Outcomes: Insights for the COVID-19 Pandemic

Ajlan

Abourokbah

Alturkistany

et al. 2020

Preprint

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Objective:Accounts of initial and follow-up chest X-rays (CXRs) of the Middle East respiratory coronavirus (MERS-CoV) patients, and correlation with outcomes, are sparse. We retrospectively evaluated MERS-CoV CXRs initial findings, temporal progression and outcomes correlation. Such insights may be valuable during the current coronavirus disease 2019 (COVID-19) pandemic, given the clinical and imaging similarities described in both entities.Methods:Fifty-three real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR)-confirmed MERS-CoV patients with CXRs were retrospectively identified from November 2013 to October 2014. Initial and follow-up CXR imaging findings and distribution were evaluated over 75 days. Findings were correlated with outcomes.Results:Twenty-two of 53 (42%) initial CXRs were normal. In 31 (68%) abnormal initial CXRs, 15 (48%) showed bilateral non-diffuse involvement, 16 (52%) had ground-glass opacities (GGO), and 13 (42%) had peripheral distribution. On follow-up CXRs, mixed airspace opacities prevailed, seen in 16 (73%) of 22 patients 21-30 days after the initial CXRs. Bilateral non-diffuse involvement was the commonest finding throughout follow-up, affecting 16 (59%) of 27 patients 11-20 days after the initial CXRs. Bilateral diffuse involvement was seen in 5 (63%) of 8 patients 31-40 days after the initial CXRs. A bilateral diffuse CXR pattern had an odds ratio for mortality of 13 (95% CI=2-78) on worst and 18 (95% CI=3-119) on final CXRs (P-value <0.05).Conclusion: Initially, normal CXRs are common in MERS-CoV patients. Peripherally located ground-glass and mixed opacities are common on initial and follow-up imaging. The risk of mortality is higher when bilateral diffuse radiographic abnormalities are detected.

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Clinical features of covid-19

Abstract: The wide array of symptoms has implications for the testing strategy

Cited by 255 publications

References 30 publications

Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19

Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19

Emerging of a SARS-CoV-2 viral strain with a deletion in nsp1

Revisiting MERS-CoV Outbreak Chest Radiographic Initial Findings, Temporal Progression and Correlation to Outcomes: Insights for the COVID-19 Pandemic

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Clinical features of covid-19

Abstract: The wide array of symptoms has implications for the testing strategy

Cited by 255 publications

References 30 publications

Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19&nbsp;

Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19&nbsp;

Emerging of a SARS-CoV-2 viral strain with a deletion in nsp1

Revisiting MERS-CoV Outbreak Chest Radiographic Initial Findings, Temporal Progression and Correlation to Outcomes: Insights for the COVID-19 Pandemic

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Product

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Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19

Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19