Journal article

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Clinical Characteristics of Coronavirus Disease 2019 in China

Author(s): Guan W, Ni Z, Hu Y et al

NEJM 2020; 10.1056/NEJMoa2002032

Respiratory critical care
Respiratory infections
Epidemiology
General respiratory patient care
Public health

Digest Author(s): Stylianos Loukides, e-Learning Director / 1 March, 2020

This is the first big study which describes the clinical characteristics of coronovirus disease in China. The authors retrieved data from medical records for both hospitalized and outpatients with laboratory-confirmed Covid-19. Data was retrieved between December 11, 2019, and January 29, 2020. The data recorded clinical symptoms or signs, laboratory findings (complete blood count, blood chemical analysis, coagulation testing, assessment of liver and renal function, and measures of electrolytes, C-reactive protein, procalcitonin, lactate dehydrogenase, and creatine kinase) and radiologic assessments included chest radiography or computed tomography (CT). Degree of severity of Covid-19 infection was assessed by the ATS criteria for CAP. The determination of incubation period was the following: The interval between the potential earliest date of contact of the transmission source and the potential earliest date of symptom onset.

7736 patients with Covid-19 had been hospitalized at 552 sites. Data was obtained for 1099 patients (14.2%). The median age was 47 years old, 41% females, 85% non-smokers, median incubation period 4 days, 88% with fever on admission, predominant symptom was cough accounting for 85%, 33% had sputum production and almost 20% had shortness of breath while 23% had a co-existing disease. 3,5% were health care workers while 44% were residents of Wuhan. Interestingly 26% were nonresidents of Wuhan and had neither visited the city nor had contact with Wuhan residents.

926 patients were characterized as non severe while 173 as severe ones. The predominant laboratory findings were lymphocytopenia accounting for 85% of cases and elevated CRP. Less common findings were mild liver dysfunction and elevated levels of LDH. 60% of the patients had radiologic abnormalities while 86% had findings on CT scans. The predominant finding was ground glass opacity. 91% of the patients were diagnosed with pneumonia.

6.5.0% were admitted to the ICU, 2.3% underwent mechanical ventilation either noninvasive or/and invasive and 1.4% died (all the abvoe variables were mainly observed in severe disease). Almost 60% of patients received antibiotic therapy, 35% received oseltamivir and 19% received systemic steroids. The median duration of hospitalization was 12.0 days. Severe patients experienced worse outcomes (noninvasive ventilation, 32.4% vs. 0%; invasive ventilation, 14.5% vs. 0%).

Comments - 4 major points:

  • Incubation period varies among patients.
  • Mortality was quite low accounting for 1.5%.
  • It is important to define the severity of the disease since severe patients experienced worse outcomes.
  • Treatment interventions remain uncertain.