J Korean Med Sci. 2020 Aug 3;35(30):e280 https://doi.org/10.3346/jkms.2020.35.e280 eISSN 1598-6357·pISSN 1011-8934 Original Article Clinical Course and Outcomes of 3,060 Infectious Diseases, Microbiology & Parasitology Patients with Coronavirus Disease 2019 in Korea, January–May 2020 Ho Kyung Sung ,1 Jin Yong Kim ,2 Jeonghun Heo ,3 Haesook Seo ,4 Young soo Jang ,5 Hyewon Kim ,6 Bo Ram Koh ,7 Neungsun Jo ,8 Hong Sang Oh ,9 Young Mi Baek ,10 Kyung-Hwa Park ,11 Jeung A Shon ,12 Min-Chul Kim ,13 Joon Ho Kim ,14 Hyun-Ha Chang ,15 Yukyung Park ,16 Yu Min Kang ,17 Dong Hyun Lee ,18 Dong Hyun Oh ,19 Hyun Jung Park ,20 Kyoung-Ho Song ,21 Eun Kyoung Lee ,22 Hyeongseok Jeong ,23 Ji Yeon Lee ,24 Ja-Young Ko ,25 Jihee Choi ,26 Eun Hwa Ryu ,27 Ki-hyun Chung ,28 Myoung-don Oh ,29 and The Korea National Committee for Clinical Management Received: Jul 2, 2020 Accepted: Jul 19, 2020 of COVID-19 Address for Correspondence: 1National Emergency Medical Center, National Medical Center, Seoul, Korea Myoung-don Oh, MD 2Division of Infectious Diseases, Department of Internal Medicine, Incheon Medical Center, Incheon, Korea 3 Department of Internal Medicine, Seoul Department of Pulmonology, Busan Medical Center, Busan, Korea 4 National University College of Medicine, 101 Department of Tuberculosis, Seoul Metropolitan Seobuk Hospital, Seoul, Korea 5Department of Orthopedic Surgery, Seoul Metropolitan Seonam Hospital, Seoul, Korea Daehak-ro, Jongno-gu, Seoul 03080, Korea. 6Department of Laboratory Medicine, Chungju Medical Center, Chungju, Korea E-mail: [email protected] 7Department of Internal Medicine, Gyeonggi Provincial Medical Center Ansung Hospital, Anseong, Korea 8Department of Infection Control, Chungcheongnam-do Gongju Medical Center, Gongju, Korea © 2020 The Korean Academy of Medical 9Division of Infectious Disease, Department of Internal Medicine, Armed Forces Capital Hospital, Sciences. Seongnam, Korea This is an Open Access article distributed 10Department of Infection Control, Chungcheongnam-do Seosan Medical Center, Seosan, Korea under the terms of the Creative Commons 11Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea Attribution Non-Commercial License (https:// 12Department of Nursing, Yeongju Red Cross Hospital, Yeongju, Korea creativecommons.org/licenses/by-nc/4.0/) 13Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, which permits unrestricted non-commercial Korea use, distribution, and reproduction in any 14Department of Surgery, Gyeonggi Provincial Medical Center Uijeongbu Hospital, Uijeongbu, Korea medium, provided the original work is properly 15Division of Infectious Disease, Department of Internal Medicine, Kyungpook National University Hospital, cited. Daegu, Korea 16Department of Internal Medicine, Korea Workers’ Compensation & Welfare Services Daegu Hospital, ORCID iDs Daegu, Korea Ho Kyung Sung 17Division of Infectious Diseases, Department of Internal Medicine, Myongji Hospital, Goyang, Korea https://orcid.org/0000-0002-1207-0298 18Department of Internal Medicine, Chungcheongnam-do Cheonan Medical Center, Cheonan, Korea 19 Jin Yong Kim Division of Infectious Diseases, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea 20 https://orcid.org/0000-0002-4306-1597 Department of Internal Medicine, Jeonllanam-do Suncheon Medical Center, Suncheon, Korea 21Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Jeonghun Heo Hospital, Seongnam, Korea https://orcid.org/0000-0002-9534-2921 22Infection Control Team, Cheongju Medical Center, Cheongju, Korea Haesook Seo 23Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of https://orcid.org/0000-0002-3554-6172 Medicine, Daejeon, Korea Young soo Jang 24Division of Infectious Diseases, Department of Internal Medicine, Keimyung University Dongsan Hospital, https://orcid.org/0000-0003-3586-9446 Daegu, Korea Hyewon Kim 25Intensive Care Team, Gyeonggi Provincial Medical Center Paju Hospital, Paju, Korea https://orcid.org/0000-0003-3491-1059 26Infection Control Team, Gyeonggi Provincial Medical Center Icheon Hospital, Icheon, Korea Bo Ram Koh 27Infection Control Team, Korea Worker's Compensation & Welfare Service Changwon Hospital, Changwon, https://orcid.org/0000-0002-8810-1417 Korea 28 Neungsun Jo National Medical Center, Seoul, Korea 29 https://orcid.org/0000-0003-4622-9655 Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Hong Sang Oh Medicine, Seoul, Korea https://orcid.org/0000-0002-4535-6305 https://jkms.org 1/11 Clinical Outcomes of COVID-19, Korea Young Mi Baek ABSTRACT https://orcid.org/0000-0002-8314-6317 Kyung-Hwa Park Background: The fatality rate of patients with coronavirus disease 2019 (COVID-19) varies https://orcid.org/0000-0003-2836-6963 among countries owing to demographics, patient comorbidities, surge capacity of healthcare Jeung A Shon https://orcid.org/0000-0001-9515-7665 systems, and the quality of medical care. We assessed the clinical outcomes of patients with Min-Chul Kim COVID-19 during the first wave of the epidemic in Korea. https://orcid.org/0000-0003-4410-5608 Methods: Using a modified World Health Organization clinical record form, we obtained Joon Ho Kim clinical data for 3,060 patients with COVID-19 treated at 55 hospitals in Korea. Disease severity https://orcid.org/0000-0003-4127-2312 scores were defined as: 1) no limitation of daily activities; 2) limitation of daily activities but Hyun-Ha Chang https://orcid.org/0000-0002-9405-2121 no need for supplemental oxygen; 3) supplemental oxygen via nasal cannula; 4) supplemental Yukyung Park oxygen via facial mask; 5) non-invasive mechanical ventilation; 6) invasive mechanical https://orcid.org/0000-0002-0660-9867 ventilation; 7) multi-organ failure or extracorporeal membrane oxygenation therapy; and 8) Yu Min Kang death. Recovery was defined as a severity score of 1 or 2, or discharge and release from isolation. https://orcid.org/0000-0002-4368-9878 Results: The median age of the patients was 43 years of age; 43.6% were male. The median Dong Hyun Lee time from illness onset to admission was 5 days. Of the patients with a disease severity score https://orcid.org/0000-0003-1179-1664 Dong Hyun Oh of 3–4 on admission, 65 (71.5%) of the 91 patients recovered, and 7 (7.7%) died due to illness https://orcid.org/0000-0002-9990-6042 by day 28. Of the patients with disease severity scores of 5–7, 7 (19.5%) of the 36 patients Hyun Jung Park recovered, and 8 (22.2%) died due to illness by day 28. None of the 1,324 patients who were https://orcid.org/0000-0003-4104-9583 < 50 years of age died; in contrast, the fatality rate due to illness by day 28 was 0.5% (2/375), Kyoung-Ho Song 0.9% (2/215), 5.8% (6/104), and 14.0% (7/50) for the patients aged 50–59, 60–69, 70–79, and https://orcid.org/0000-0002-4517-3840 Eun Kyoung Lee ≥ 80 years of age, respectively. https://orcid.org/0000-0003-1104-268X Conclusion: In Korea, almost all patients of < 50 years of age with COVID-19 recovered Hyeongseok Jeong without supplemental oxygen. In patients of ≥ 50 years of age, the fatality rate increased with https://orcid.org/0000-0002-4539-079X age, reaching 14% in patients of ≥ 80 years of age. Ji Yeon Lee https://orcid.org/0000-0002-2788-1392 Keywords: COVID-19; SARS-CoV-2; Prognosis; Cohort Study; Korea Ja-Young Ko https://orcid.org/0000-0002-1044-644X Jihee Choi https://orcid.org/0000-0002-5255-1352 INTRODUCTION Eun Hwa Ryu https://orcid.org/0000-0001-5814-7636 Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome virus 2 Ki-hyun Chung https://orcid.org/0000-0002-7100-2519 (SARS-CoV-2), was first reported in China on December 31, 2019. Since then, it has spread Myoung-don Oh throughout the world; consequently, the World Health Organization declared the COVID-19 https://orcid.org/0000-0002-2344-7695 outbreak as a pandemic on March 12. As of June 13, the pandemic disease had spread to 215 countries, resulting in approximately 7.5 million cases and over 423,000 deaths.1 In Korea, Funding the first case of COVID-19 was confirmed on January 20.2 As of June 15, there were 12,121 This work was supported by the Korea Centers 3 for Disease Control and Prevention (grant No. confirmed cases of COVID-19, with 277 deaths. 4838-330-320-01). The clinical spectrum of COVID-19 encompasses asymptomatic infection, mild upper Disclosure respiratory tract illness, pneumonia that may result in respiratory failure, multi-organ failure, The authors have no potential conflicts of interest to disclose. and death. Most infections are non-severe: of 44,500 laboratory-confirmed cases, 81% were mild (no or mild pneumonia) disease.4 However, the clinical outcomes of patients with Author Contributions severe pneumonia vary widely. For example, in China, the case-fatality ratio (CFR) among Conceptualization: Sung HK, Kim JY, Oh M. critical cases was 49.0% (1,023/2,087).4 In the Lombardi region of Italy, 26% (405/1,581) Methodology: Sung HK, Kim JY, Oh M. Formal 5 analysis: Sung HK, Oh M. Data curation: Sung patients admitted to the intensive care unit died. In New York City, 24.3% (665/2,741) HK. Writing - original draft: Oh M, Sung HK, patients were discharged to hospice care or died.6 In contrast, the overall CFR in Korea is Kim JY. Writing - review & editing: Sung HK, 2.3%. The observed differences in clinical outcomes and CFRs in patients with COVID-19 in Kim JY, Heo J, Seo H, Jang YS, Kim H, Koh BR, various countries may be related to patient demographics, surge capacity of the healthcare system, and medical care quality, as well as the case definition of COVID-19. https://jkms.org https://doi.org/10.3346/jkms.2020.35.e280 2/11 Clinical Outcomes of COVID-19, Korea Jo N, Oh HS, Baek YM, Park KH, Shon JA, Kim Towards a better response to the next wave of the pandemic, the clinical course and outcomes MC, Kim JH, Chang HH, Park YK, Kang YM, Lee of COVID-19 patients need to be defined.