Friday, February 07, 2020

JAMA: Clinical Characteristics of 138 Hospitalized Coronavirus Patients

Credit WHO 


JAMA has published what appears to be the largest study of hospitalized novel coronavirus patients released to date, following 138 cases in Zhongnan Hospital of Wuhan University in Wuhan, China, from January 1 to January 28, 2020.
This is a lengthy, detailed, open-access report which you'll want to read in its entirety.  I've only excerpted some highlights from the abstract. 
It should be mentioned, however, that this is a snapshot in time of a cohort of cases, and while statistics such as mortality rates, and percentage of severe vs. mild cases are provided, at the time of submitting the manuscript most of the patients were still hospitalized and their final outcome was undetermined.

The 4.3% mortality rate (among this cohort of hospitalized cases at a single facility) is higher than we've seen reported previously, but may not be representative of the outbreak as a whole.  Some hospitals may be taking more severe cases than others, and we don't have a good feel for how many mild or moderate cases go unidentified.

More surprising is the statement that : Hospital-associated transmission was suspected as the presumed mechanism of infection for affected health professionals (40 [29%]) and hospitalized patients (17 [12.3%]).
Although we'd heard of 15 doctors infected in Wuhan early on, this suggests nosocomial transmission is more common than has been reported.  Not terribly surprising given the history with both SARS and MERS-CoV, but important to document.

Original Investigation
Caring for the Critically Ill Patient
February 7, 2020
Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

Dawei Wang, MD1; Bo Hu, MD1; Chang Hu, MD1; et alFangfang Zhu, MD1; Xing Liu, MD1; Jing Zhang, MD1; Binbin Wang, MD1; Hui Xiang, MD1; Zhenshun Cheng, MD2; Yong Xiong, MD3; Yan Zhao, MD4; Yirong Li, MD5; Xinghuan Wang, MD6; Zhiyong Peng, MD1
Author Affiliations Article InformationJAMA. Published online February 7, 2020.   doi:10.1001/jama.2020.1585

Key Points
  • Question What are the clinical characteristics of hospitalized patients with 2019 novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) in Wuhan, China?
  • Findings In this single-center case series involving 138 patients with NCIP, 26% of patients required admission to the intensive care unit and 4.3% died. Presumed human-to-human hospital-associated transmission of 2019-nCoV was suspected in 41% of patients.
  • Meaning In this case series in Wuhan, China, NCIP was frequently associated with presumed hospital-related transmission, 26% of patients required intensive care unit treatment, and mortality was 4.3%.

Importance In December 2019, novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
Objective To describe the epidemiological and clinical characteristics of NCIP.
Design, Setting, and Participants Retrospective, single-center case series of the 138 consecutive hospitalized patients with confirmed NCIP at Zhongnan Hospital of Wuhan University in Wuhan, China, from January 1 to January 28, 2020; final date of follow-up was February 3, 2020.
Exposures Documented NCIP.
Main Outcomes and Measures Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. Outcomes of critically ill patients and noncritically ill patients were compared. Presumed hospital-related transmission was suspected if a cluster of health professionals or hospitalized patients in the same wards became infected and a possible source of infection could be tracked.
Conclusions and Relevance In this single-center case series of 138 hospitalized patients with confirmed NCIP in Wuhan, China, presumed hospital-related transmission of 2019-nCoV was suspected in 41% of patients, 26% of patients received ICU care, and mortality was 4.3%.
          (Continue . . .)