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Novel Coronavirus Infection in Patients Outside Wuhan, China
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- Among three hospitals in Beijing, China, the median age of 13 patients admitted with 2019-nCoV infection was 34 years. Of these patients 12 had exposure in Wuhan or to people from Wuhan; only 1 patient did not have any such contact. Fever before hospitalization was reported in 12 patients, and 46.3% had cough, 61.5% had upper airway congestion, 23.1% had myalgia, and 23.1% had headache. On chest x-ray, 1 patient demonstrated scattered opacities, and 6 patients had ground-glass opacities.
- The 2019-nCoV outbreak is the third coronavirus epidemic in the 21st century. The higher infection rate of the disease may be due to the late identification of the disease etiology and the infectivity of the asymptomatic host, rather than increased viral infectivity. More details of patient outcomes after transfer to specialty hospitals is needed to establish a complete picture of infection.
abstract
This abstract is available on the publisher's site.
Access this abstract nowIn December 2019, cases of pneumonia appeared in Wuhan, China. The etiology of these infections was a novel coronavirus (2019-nCoV), possibly connected to zoonotic or environmental exposure from the seafood market in Wuhan. Human-to-human transmission has accounted for most of the infections, including among health care workers. The virus has spread to different parts of China and at least 26 other countries. A high number of men have been infected, and the reported mortality rate has been approximately 2%, which is lower than that reported from other coronavirus epidemics including severe acute respiratory syndrome (SARS; mortality rate, >40% in patients aged >60 years) and Middle East respiratory syndrome (MERS; mortality rate, 30%). However, little is known about the clinical manifestations of 2019-nCoV in healthy populations or cases outside Wuhan. We report early clinical features of 13 patients with confirmed 2019-nCoV infection admitted to hospitals in Beijing.
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Epidemiologic and Clinical Characteristics of Novel Coronavirus Infections Involving 13 Patients Outside Wuhan, China
JAMA 2020 Feb 07;[EPub Ahead of Print], D Chang, M Lin, L Wei, L Xie, G Zhu, CS Dela Cruz, L SharmaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The outbreak of Coronavirus Disease 2019 (COVID-19) is a rapidly evolving situation, making it hard to keep abreast of ever-changing information. As of my clast check, there were 76,214 reported cases and 2,247 deaths.[1] Two recent reports take us inside Chinese hospitals; one within the hot zone of Wuhan and the other in Beijing. Information from these locations can provide some guidance in regards to presentation and complications experienced by more severe cases.
The epicenter of COVID-19 is Wuhan (Hubei Provence, People’s Republic of China). A cases series of 138 consecutive novel coronavirus-infected pneumonia (NCIP) patients details the presentations and outcomes.[2] The mean age was 56 years, with slightly more males (46%) than females (54%). Symptoms at onset included fever (99%), fatigue (70%), dry cough (59%), myalgia (35%) and dyspnea (31%). These individuals had depressed total lymphocyte counts, prolong prothrombin times, and elevated LDH. About one of four patients required ICU care; they tended to be older, and with more comorbid conditions. Typical progression from onset included the development of dyspnea at 5 days, hospitalization at 7 days, and ICU admission at 10 days. Patients requiring intensive care had higher WBC and neutrophil counts, and higher levels of D-Dimer, creatine kinase, and creatinine. Common complications included shock (9%), ARDS (20%), arrhythmia (17%), and acute myocardial injury (7%). All patients, regardless of ICU admission, demonstrated bilateral lung involvement on chest CT. Of note: over 40% of the cases were likely hospital-acquired (12% patients and 29% health care workers).
The 13 patients from Beijing were younger, including two children, and demonstrated fever (92%), nasal congestion (62%), myalgia (23%) and headache (23%). C-reactive protein and lymphocyte counts were elevated. Only half of these patients had abnormalities on chest CT or chest radiographs. All of these patients recovered.
There are a couple of message that I take away from these two studies. First, COVID-19 has a myriad of presentations, but fever is common is patients requiring hospitalization. This contrasts with our surveillance series of 344 ambulatory primary care patients with seasonal coronaviruses in which 49% report fever. Second, this is a highly contagious virus which spreads easily within healthcare settings to other patients and to health care workers. As COVID-19 appears outside of China, principles of source control, use of personal protective equipment, and early detection become our most potent elements of prevention and control.
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