Coronavirus: covid-19 has killed more people than SARS and MERS combined, despite lower case fatality rate

Dear Editor, The rapid emergence of COVID-19 in Wuhan city, Hubei Province, China, has resulted in thousands of deaths [1]. Many infected patients, however, presented mild flu-like symptoms and quickly recover [2]. To effectively prioritize resources for patients with the highest risk, we identified clinical predictors of mild and severe patient outcomes.Using the database of Jin Yin-tan Hospital and Tongji Hospital, we conducted a retrospective multicenter study of 68 death cases (68/150, 45%) and 82 discharged cases (82/150, 55%) with laboratory-confirmed infection of SARS-CoV-2. Patients met the discharge criteria if they had no fever for at least 3 days, significantly improved respiratory function, and had negative SARS-CoV-2 laboratory test results twice in succession. Case data included demographics, clinical characteristics, laboratory results, treatment options and outcomes. For statistical analysis, we represented continuous measurements as means (SDs) or as medians (IQRs) which compared with Student's t test or the Mann-Whitney-Wilcoxon test. Categorical variables were expressed as numbers (%) and compared by the χ 2 test or Fisher's exact test.The distribution of the enrolled patients' age is shown in Fig. 1a. There was a significant difference in age between the death group and the discharge group (p < 0.001) but no difference in the sex ratio (p = 0.43). A total of 63% (43/68) of patients in the death group and 41% (34/82) in the discharge group had underlying diseases (p = 0.0069). It should be noted that patients with cardiovascular diseases have a significantly increased risk of death when they are infected with SARS-CoV-2 (p < 0.001). A total of 16% (11/68) of the patients in the death group had secondary infections, and 1% (1/82) of the patients in the discharge group had secondary infections (p = 0.0018). Laboratory results showed that there were significant differences in white blood cell counts, absolute values of lymphocytes, platelets, albumin, total bilirubin, blood urea nitrogen, blood creatinine, myoglobin, cardiac troponin, C-reactive protein (CRP) and interleukin-6 (IL-6) between the two groups ( Fig. 1b and Supplementary Table 1).The survival times of the enrolled patients in the death group were analyzed. The distribution of survival time from disease onset to death showed two peaks, with the first one at approximately 14 days (22 cases) and the second one at approximately 22 days (17 cases) (Fig. 1c). An analysis of the cause of death was performed. Among the 68 fatal cases, 36 patients (53%) died of respiratory failure, five patients (7%) with myocardial damage died of circulatory failure, 22 patients (33%) died of both, and five remaining died of an unknown cause (Fig. 1d). Based on the analysis of the clinical data, we confirmed that some patients died of fulminant myocarditis. In this study, we first reported that the infection of SARS-CoV-2 may cause fulminant myocarditis. Given that fulminant myocarditis is characterized by a rapid progress and a severe state of illness [3], o...

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confidence: 99%

Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China

et al. 2020

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“…including the 2002-2003 severe acute respiratory syndrome (SARS) epidemic and the Middle East respiratory syndrome (MERS-CoV), had higher associated case fatality rates of 9.6% and 34.4%, respectively (15), COVID-19 has resulted in many more deaths than both of these prior outbreaks combined, an issue that is in part related to the greater infectivity and higher attack rate of this virus, leading to a larger number of infected patients (15,16). Uncertain and inconsistent disease ascertainment have resulted in variability in reported case fatality rates for several reasons, including: 1) the disease may be asymptomatic or mildly symptomatic in a large proportion of patients (15), 2) inadequate testing capabilities in most geographies, leading to frequent underdiagnosis, especially in patients with less serious illness, and 3) complications and death often ensue much later than contagion (typically between 2 and 3 weeks after infection).…”

Section: Pathophysiology Epidemiology and Clinical Features Of Covimentioning

confidence: 99%

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

Driggin

Madhavan

Bikdeli

et al. 2020

Journal of the American College of Cardiology

1,883

1,931

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“…At the time of writing this commentary (February 2020), the death toll from the COVID-19 epidemic caused by coronavirus SARS-CoV-2, which emerged in late December 2019 in Wuhan, China (World Health Organization, 2019), has surpassed the combined death toll of the SARS (Severe Acute Respiratory Syndrome) epidemic of [2002][2003] and the MERS (Middle East Respiratory Syndrome) epidemic of 2013 combined (Mahase, 2020). This epidemic seems to be spreading at an exponential rate, with a doubling period of 1.8 days, and there are fears that it might progress to pandemic scales (Cheng & Shan, 2020).…”

Section: Sars-cov-2mentioning

confidence: 99%

Angiotensin receptor blockers as tentative SARS‐CoV‐2 therapeutics

Genevieve

2020

Drug Development Research

724

709

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At the time of writing this commentary (February 2020), the coronavirus COVID-19 epidemic has already resulted in more fatalities compared with the SARS and MERS coronavirus epidemics combined. Therapeutics that may assist to contain its rapid spread and reduce its high mortality rates are urgently needed. Developing vaccines against the SARS-CoV-2 virus may take many months. Moreover, vaccines based on viral-encoded peptides may not be effective against future coronavirus epidemics, as virus mutations could make them futile. Indeed, new Influenza virus strains emerge every year, requiring new immunizations. A tentative suggestion based on existing therapeutics, which would likely be resistant to new coronavirus mutations, is to use available angiotensin receptor 1 (AT1R) blockers, such as losartan, as therapeutics for reducing the aggressiveness and mortality from SARS-CoV-2 virus infections. This idea is based on observations that the angiotensin-converting enzyme 2 (ACE2) very likely serves as the binding site for SARS-CoV-2, the strain implicated in the current COVID-19 epidemic, similarly to strain SARS-CoV implicated in the 2002-2003 SARS epidemic. This commentary elaborates on the idea of considering AT1Rblockers as tentative treatment for SARS-CoV-2 infections, and proposes a research direction based on datamining of clinical patient records for assessing its feasibility.

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Coronavirus: covid-19 has killed more people than SARS and MERS combined, despite lower case fatality rate

Abstract: The novel coronavirus that has so far spread from China to 26 countries around the world does not seem to be as "deadly as other coronaviruses including SARS and MERS," the World Health Organization has said.

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Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China

Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China

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

Angiotensin receptor blockers as tentative SARS‐CoV‐2 therapeutics

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