Bai et al. Global Health Research and Policy (2020) 5:54 Global Health https://doi.org/10.1186/s41256-020-00183-y Research and Policy RESEARCH Open Access The epidemiological characteristics of deaths with COVID-19 in the early stage of epidemic in Wuhan, China Jianjun Bai1†, Fang Shi1†, Jinhong Cao1, Haoyu Wen1, Fang Wang1, Sumaira Mubarik1, Xiaoxue Liu1, Yong Yu2, Jianbo Ding3 and Chuanhua Yu1,4* Abstract Objectives: To analyze the epidemiological characteristics of COVID-19 related deaths in Wuhan, China and comprehend the changing trends of this epidemic along with analyzing the prevention and control measures in Wuhan. Methods: Through the China’s Infectious Disease Information System, we collected information about COVID-19 associated deaths from December 15, 2019 to February 24, 2020 in Wuhan. We analyzed the patient’s demographic characteristics, drew epidemiological curve and made geographic distribution maps of the death toll in each district over time, etc. ArcGIS was used to plot the numbers of daily deaths on maps. Statistical analyses were performed using SPSS and @Risk software. Results: As of February 24, 2020, a total of 1833 deaths were included. Among the deaths with COVID-19, mild type accounted for the most (37.2%), followed by severe type (30.1%). The median age was 70.0 (inter quartile range: 63.0–79.0) years. Most of the deaths were distributed in 50–89 age group, whereas no deaths occurred in 0– 9 age group. Additionally, the male to female ratio was 1.95:1. A total of 65.7% of the deaths in Wuhan combined with underlying diseases, and was more pronounced among males. Most of the underlying diseases included hypertension, diabetes and cardiovascular diseases. The peak of daily deaths appeared on February 14 and then declined. The median interval from symptom onset to diagnosis was 10.0 (6.0–14.0) days; the interval from onset to diagnosis gradually shortened. The median intervals from diagnosis to death and symptom onset to deaths were 6.0 (2.0–11.0), 17.0 (12.0–22.0) days, respectively. Most of the disease was centralized in central urban area with highest death rate in Jianghan District. Conclusion: COVID-19 poses a greater threat to the elderly people and men with more devastating effects, particularly in the presence of underlying diseases. The geographical distributions show that the epidemic in the central area of Wuhan is more serious than that in the surrounding areas. Analysis of deaths as of February 24 indicates that a tremendous improvement of COVID-19 epidemic in Wuhan has achieved by effective control measures taken by Wuhan Government. Keywords: COVID-19, Coronavirus disease 2019, Wuhan city, Epidemiological characteristic, Death * Correspondence: [email protected] †Jianjun Bai and Fang Shi contributed equally to this work. 1Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, 115#Donghu Road, Wuhan 430071, China 4Global Health Institute, Wuhan University, 185# Donghu Road, Wuhan 430072, China Full list of author information is available at the end of the article © The Author(s). 2020, corrected publication 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/ licenses/by/4.0/. Bai et al. Global Health Research and Policy (2020) 5:54 Page 2 of 10 Introduction to understand the changes of the COVID-19 epidemic The outbreak of new infectious diseases in recent years and the effects of prevention and control measures in has caused great losses to human health, quality of life Wuhan, China. and economy. Millions of infections were caused world- wide by Severe Acute Respiratory Syndrome Corona- Methods virus (SARS-CoV) in 2003, Middle East Respiratory Data sources Syndrome Coronavirus (MERS-CoV) in 2012, Ebola As a retrospective cross-sectional study, all data were ex- virus in 2014, Zika virus in 2015, and the plague in tracted from China’s Infectious Disease Information Sys- Madagascar in 2017 [1–3]. tem. Specific details of data collection were provided In December 2019, a new coronavirus began to spread elsewhere [5]. Through the Wuhan Statistics Bureau, the in Wuhan and even the whole country. On December permanent resident population of Wuhan in 2018 was 31, an alert was issued by the Wuhan Municipal Health 11.081 million. After eliminating the duplicate data, a Commission and a rapid response team was sent to Wu- total of 1833 deaths were included in the study. We re- han by the Chinese Center for Disease Control and Pre- moved duplicate data based on the name, ID number vention (China CDC). Epidemiological investigation and gender. If the name, ID number and gender of the implicated that this pneumonia epidemic was different case were the same, then the duplicate data were re- from the previous ones and Wuhan Huanan Seafood moved. A total of 59 duplicate entries were excluded be- Wholesale Market may be a possible source of infection. fore proceeding towards analyses. On January 1, the Huanan Seafood Wholesale Market was shut down. On January 20, China’s “National Infec- Variables tious Diseases Law” was amended to make 2019-novel Demographic data consisted of information on age, sex, coronavirus diseases (COVID-19) a Class B notifiable occupation, residential area, area of reporting units. disease and its “Frontier Health and Quarantine Law” Other available data included clinical outcomes, disease was amended to support the COVID-19 outbreak re- severity, report date, date of onset, date of diagnosis, sponse effort. On January 23, the Chinese Government date of death, the interval time from onset to diagnosis, began to limit movement of people in and out of Wuhan. the interval time from diagnosis to death and the inter- As of February 5, two newly established COVID-19 desig- val time from onset to death. The underlying disease nated hospitals and several mobile cabin hospitals have variable was determined using patient self-reported his- been opened. tory. The severity of symptoms were categorized as mild The WHO officially named this unexplained pneumonia type, common type, severe type or critical type, the de- as Coronavirus Disease 2019 (COVID-19) on February 11, tailed classification criteria were shown in Supplemen- 2020. Based on the genetic structure of the virus, the tary Table S1. The crude death rate was estimated as the International Committee on Taxonomy of Viruses offi- number of deaths divided by the number of permanent cially named the virus as Severe Acute Respiratory resident population of Wuhan. The date of onset was Syndrome Coronavirus 2 (SARS-CoV-2) [4], which is defined as the day when the symptom was observed. more contagious than both of the previous forms (SARS- CoV and MERS-CoV). Statistical analysis On March 11, the WHO officially declared the epi- We present continuous variables as medians (interquar- demic caused by COVID-19 as Pandemic. This is the tile ranges, IQR) and compared using Mann-Whitney U first time in this century that coronavirus infection test. If they are normally distributed, we present con- (SARS, MERS, COVID-19) has been evaluated as tinuous variables as mean (Standard Deviation, SD). Pandemic. Categorical variables were described as counts and per- As of February 24, 2020, 77,658 cases diagnosed with centages in each category. The probability distributions COVID-19 had been reported in Mainland China, of age and interval time were fitted and the distribution among which 64,786 (83.42%) cases were reported in with the lowest AIC value was selected as optimal distri- Hubei Province and 47,071 (60.61%) were in Wuhan bution. The map of epidemic situation in Wuhan was city. Among the 2663 deaths across Mainland China, drawn based on the number of daily deaths. We used 2563 (96.24%) deaths occurred in Hubei Province and ArcGIS to plot the numbers of daily deaths on maps. 2043 (76.72%) deaths in Wuhan city. The epidemio- Statistical analyses were performed using SPSS and logical features of COVID-19 cases are crucial for the @Risk software. development and implementation of effective control measures. In this study, we retrospectively collected and Ethics approval described detailed epidemiological and demographic Data collection, which determined by the National characteristics of deaths caused by COVID-19 in Wuhan Health Commission of the People’s Republic of China, Bai et al. Global Health Research and Policy (2020) 5:54 Page 3 of 10 was exempt from institutional review board approval be- symptoms for COVID-19 deaths occurred on January cause it was part of outbreak investigation. Study design 23, 2020. Since then, onset of illness has declined. The and data analysis have been reviewed and approved by number of diagnosis reached the peak of 122 on February the Medical Ethical Committees of Wuhan University 1, 2020, and the daily deaths reached the peak of 97 on (WHU2020-2020YF0031). February 14. As shown in Fig. 3. The median interval from symp- Results tom onset to diagnosis was 10.0 (IQR: 6.0–14.0) days Patients and obeyed the Log Logistic distribution.