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Clinical Features of COVID-19 Patients in One Designated Medical Institutions in Chengdu, China

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Clinical Features of COVID-19 Patients in One Designated Medical Institutions in Chengdu, China Clinical features of COVID-19 patients in one designated medical institutions in Chengdu, China Gui Zhou Department of Infection managementChengdu Fifth People’s Hospital of Chengdu University of tcm, Chengdu, Sichuan Province, 611130, China Yun-Hui Tan Department of Critical Care Medicine, Chengdu Fifth People’s Hospital of Chengdu University of tcm, Chengdu, Sichuan Province, 611130, China Jiang-Cuo Luo Department of internal medicine, Anhong Township Health Hospital, Aba, Sichuan Province, 623300 China Yi-Xiao Lu Department of the Public Health of Advanced Preventive Medicine, Graduate School of Biomedical Science, Nagasaki University, Japan Jing Feng Department of Infectious Disease, Pidu District People’s Hospital of Chengdu University Chengdu, Sichuan Province, 611730, China Juan Li Department of Infectious Disease, Pidu District People’s Hospital of Chengdu University Chengdu, Sichuan Province, 611730, China Yun-Mei Yang Respiratory medicine of Infection management ,Chengdu Fifth People’s Hospital of Chengdu University of tcm, Chengdu, Sichuan Province, 611130, China Long Chen 8 Nursing department of Infection management,Chengdu Fifth People’s Hospital of Chengdu University of tcm, Chengdu, Sichuan Province, 611130, China Jian-Ping Zhang ( [email protected] ) Department of the Child-adolescent and Maternal Care of faculty of Public Health, Kunming Medical University, Kunming, Yunnan Province, 650000, China Research Article Keywords: COVID-19, Clinical features, SARS-Cov-2 Posted Date: May 19th, 2020 Page 1/12 DOI: https://doi.org/10.21203/rs.3.rs-30405/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 2/12 Abstract OBJECTIVE: To study the clinical characteristics of patients infected with the 2019 severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) responsible for coronavirus disease (COVID-2019). METHODS: Data were collected from 20 patients admitted to the Pidu District People’s Hospital in Chengdu from January 26, 2020 to March 1, 2020 with laboratory-conrmed SARS-Cov-2 infection. Clinical data were collected using the World Health Organization (WHO) nCoV CASE RECORDFORM Version 1.2 28JAN2020, which includes parameters such as: temperature, epidemiological characteristics, social network, history of exposure, and incubation period. If information was unclear, the team reviewed the original data and contacted patients directly if necessary. RESULTS: The median age of the 20 COVID-19 infected patients studied was 42.5 years. In this cohort, four patients became severely ill and one deteriorated rapidly during treatment. This patient was transferred to another medical center with an intensive care unit (ICU) for treatment. This patient died after admission to the ICU. Two of the twenty patients remained positive SARS-Cov-2 more than three weeks, and they were quarantined in a medical facility without medication. According to our analysis, all of the studied cases were infected by human-to-human transmission due to the lack of protective measures; transmission through contact within families requires conrmation. The most common symptoms at onset of illness were fever in 13 (65%) patients, cough in 9 (45%), headache in 3 (15%), fatigue in 6 (30%), diarrhea in 3 (15%), and abdominal pain in 2 (10%). Six patients (30%) developed shortness of breath upon admission. The median time from exposure to onset of illness was 6.5 days (interquartile range 3.25–9 days), and from the onset of symptoms to rst hospital admission was 3.5 (1.25–7) days. CONCLUSION: Compared with patients infected with SARS-Cov-2 in Wuhan (up to the end of February 2020), the symptoms of patients in one hospital in Chengdu, Sichuan Province, were relatively mild and patients were discharged from the hospital after only a short stay. However, the fasting blood glucose of the infected individuals was found to be slightly elevated because of the state of emergency. The dynamic changes in lymphocyte levels can predict disease status of COVID-19. They are also suggestive of changes in mean platelet volume during disease progression. This suggests that the patients had mild cases of COVID-19. However, because there is no effective drug treatment for COVID-19, it is important to detect and identify severe cases from mild cases early. Introduction Over the past few decades, there has been a series of respiratory infections caused by emerging viruses, which originated in animals. These viruses—severe respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and pandemic inuenza A (H1N1)—have reached epidemic levels by crossing species barriers. The result has been thousands of human infections and hundreds of deaths1. Currently, a mysterious outbreak of atypical pneumonia in late 2019 was traced to a Page 3/12 seafood wholesale market in Wuhan, China. Within a few weeks, a novel coronavirus, SARS-CoV–2, was announced by the World Health Organization (WHO)2. SARS-CoV–2 is responsible for the outbreak of Coronavirus Disease 2019 (COVID–19). At the early stages of the outbreak, samples from ve patients were submitted for full-length genome sequencing. Patient results that were almost identical to each other were identied as SARS-CoV–2, which is 96% identical at the whole-genome level to a bat coronavirus3. There is a worldwide concern about SARS-CoV–2 as a global public health threat4. On January 30, 2020, the WHO declared COVID–19 as the sixth public health emergency of international concern. SARS-CoV–2 is spread by human-to- human transmission via droplets or direct contact.5 As of March 1, 2020, there are 79,972 conrmed COVID–19 cases (including 7,365 severe cases) and 2,873 deaths in China. In other countries, there are 7,651 conrmed COVID–19 cases and 118 deaths. Economists estimate that, without urgent global actions to curtail the Wuhan SARS-CoV–2 within the shortest possible time, China is expected to lose up to $62 billion in the rst quarter of the year, while the world is likely to lose over $280 billion within the same period7. To control COVID–19, effective prevention and control measurements must include early detection, diagnosis, treatment, and quarantine in order to block human-to-human transmission as well as reduce secondary infections among close contacts and health care workers8. The local government restricted the import of patients from other provinces and the diffusion of patients internally. In Chengdu, China, 187 medical institutions were designated for the treatment of SARS-CoV–2. This study was carried out in Pidu District People's Hospital, and it describes the clinical characteristics and laboratory ndings of patients in Sichuan Province infected with SARS-Cov–2 to provide insight into the prevention and treatment of COVID–19. In the early stages of the outbreak, the clinical and epidemiological characteristics of COVID–19 were mainly introduced in severe patients in Wuhan9, but many mild cases can become severe or critical. SARS-Cov–2 will lead to severe infection and death if patients are not identied early enough in the mild stages of the disease. Methods Data sources The working group conducted a retrospective study focusing on the clinical characteristics of conrmed cases of COVID–19 at the Pidu District People's Hospital in Chengdu from January 26, 2020 to March 1, 2020. Since the outbreak of COVID–19 in Wuhan, China, strict precautionary measures have been implemented in Sichuan Province, including the creation of fever clinics that exclusively receive patients with suspected SARS-Cov–2 infection, dened as presenting with a fever, or any respiratory symptoms, including dry cough, especially those with a history of travel to Wuhan or exposure to infected people within two weeks before symptom onset. Case denitions of conrmed human infection with SARS-Cov– Page 4/12 2 are in accordance with the interim guidance from the WHO. An Ingenuity CT scanner (Philips (China) Co. Ltd.) was used and set at 210 mA and 120 kV, with the minimum slice thickness of 1 mm. Only the patients with a laboratory-conrmed infection were enrolled in this study. The working group collected data on 20 patients admitted to the hospital with laboratory-conrmed SARS-Cov–2 infection. Some patients came directly from Pidu District People's Hospital, while other patients were transferred to other medical institutions for treatment by the working group of COVID–19 prevention and control in Chengdu. All of the patients were conrmed as COVID–19-positive. Information was collected on dates of illness onset, visits to clinical facilities, and hospital admissions. Epidemiological data were collected through brief interviews with each patient. Several doctors interviewed each patient to collect exposure histories during the two weeks before illness onset or after the outbreak of COVID–19 in Wuhan, including the dates and times of close contact (gathering, living, or working together) with individuals from Wuhan with conrmed or suspected SARS-Cov–2 infection. Physicians also investigated the social network of the patient, including family social network, friend social network, and colleague social network. The working group extracted the medical records of patients using WHO nCov CASE RECORD FORM and self-made scale. A team of doctors who had been treating patients with COVID–19 collected and reviewed the data. The design of the study process was based on the Chinese national diagnosis and treatment plan without any intervention measures, concern about privacy of patients, informed patients of specic rules, and conducted with the informed consent of patients. All of the information on the content of the study shall be kept by a special person for inspection, if necessary. Due to the urgent need to collect data on this emerging pathogen. Using a standardized case report form to collect clinical data according to design requirements, the working group contacted the doctor responsible for the treatment of the patient for clarication if the information was unclear.
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