key: cord-0787695-t7uh4uba authors: Peng, Yuzhu; Xu, Biyun; Sun, Beicheng; Han, Guangshu; Zhou, Yi-Hua title: Importance of timely management of patients in reducing fatality rate of coronavirus disease 2019 date: 2020-05-11 journal: J Infect Public Health DOI: 10.1016/j.jiph.2020.04.015 sha: e3796e713753d24e2096383c951e2fd118163d83 doc_id: 787695 cord_uid: t7uh4uba Abstract The outbreak of coronavirus disease 2019 (COVID-19) characterized with pneumonia, firstly occurred in Wuhan city, China, in December 2019 has so far spread in over 200 countries and territories in the world. One of the important goals in facing outbreaks of COVID-19 is to reduce the case fatality rate. We reported here that the fatality rate of COVID-19 in other provinces of mainland China was 0.82% (121/14708), significantly lower than 6.62% (4512/68128) in Hubei province (p<0.0001). The main reason for the lower fatality rate was likely due to the timely management of the patients in other provinces, highlighting the importance of timely management of patients in reducing the fatality rate of COVID-19. The outbreak of coronavirus disease 2019 (COVID-19) characterized with pneumonia, caused by a novel coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2), firstly occurred in Wuhan city, the capital of Hubei Province, China, in December 2019 [1, 2] . Since then, COVID-19 has spread in whole China as well as other countries. Although World Health Organization (WHO) declared the outbreak of COVID-19 as Public Health Emergency of International Concern on January 30, 2020 [3] [4] [5] , COVID-19 has spread to more than 200 other countries and territories in the world, leading to nearly 2.88 million confirmed cases and an overall fatality rate 6.9% by April 27, 2020 [6] , whereas as of February 1, 2020, just 24 countries had 11953 confirmed patients (11821 in China) [7] . Since COVID-19 is still being spread, the most critical task now is to control the transmission. Another important goal in facing COVID-19 is to reduce the fatality rate. Here we report the significant difference of the fatality rate of COVID-19 in Hubei province and other provinces of mainland China, and emphasize the importance of timely management of patients in reducing the fatality of COVID-19. This study was approved by the institutional review board of Nanjing Drum Tower Hospital. Informed consent of patients was waived since this study was based on the publicly released data. China took the comprehensive strict measures, including city quarantine, home staying, social distance, mask use in general population as well as many others since January 22, 2020 in Wuhan city, and then in the whole Hubei province and extending these measures to whole mainland China since February 1, 2020. The daily newly diagnosed patients decreased from peak 4000-5000 cases to less than 100 cases after March 6, and further reduced to about 10 cases or fewer after April 20, 2020. As of April 27, 2020, totally 82836 patients with COVID-19 were confirmed in mainland China. Of them, 4633 were fatal, with an overall fatality rate 5.60% ( Table 1 ). The fatality rate of COVID-19 in other provinces of mainland China was 0.82% (121/14708), significantly lower than 6.62% (4512/68128) in Hubei province (p<0.0001). In Hubei province, the fatality rate in Wuhan city (7.69%, 3869/50333) was much higher than that in other regions (3.61%, 643/17795, p<0.0001). Since the daily release of COVID-19 information from January 21, 2020, the evolution of the fatality rate in Hubei province and other regions of mainland China is presented in Figure 1 , which shows that the fatality rate in other provinces of J o u r n a l P r e -p r o o f 5 mainland China was always significantly lower than that in Hubei province. In the present study, we found that the fatality rate of COVID-19 in other parts of mainland China was 0.82%, significantly lower than 6.62% in Hubei province, and in Hubei province, the fatality rate in other regions was lower than that in Wuhan city (3.61% vs 7.69%, p<0.0001) ( Table 1 ). The lower fatality rate is less likely due to the attenuation of virus by spreading in humans because almost all patients in Hubei collected from different parts of mainland China were 99.9% homology [9] . Thus, the lower fatality rate is not associated with virological factors. We consider that the main reason of lower fatality rate in other provinces of mainland China is associated with the timely treatment of the patients. In a report with 62 hospitalized patients in Zhejiang province, the median time from onset of the illness to hospitalization was 2 days, only one patient required to admit to an intensive care unit, and there was no fatal patient [10] . Since the official announcement of COVID-19 outbreaks in late January 2020, all provincial and local governments have taken comprehensive measures to control its spread. Suspected patients with fever J o u r n a l P r e -p r o o f 6 and/or cough received appropriate managements. Individuals with contacts with diagnosed COVID-2019 patients were strictly quarantined, and persons with contacts with anyone from Hubei province were requested to stay at home for two weeks. Most of patients indentified in other provinces of mainland China were among these monitored individuals. They had adequate rest during quarantine or home-stay, which is critical for self-limiting viral infections as there is no specific antiviral therapy against COVID-19. And they received necessary managements soon after the appearance of symptoms. Therefore, most patients actually received supportive treatment during the incubation period and very early phase of the disease. By contrast, as a surging number of patients developed in Hubei, particularly in Wuhan, many of them received delayed managements because of the poor preparedness for the COVID-19 outbreaks, leading to progress to severe disease form with increased fatality rate. A retrospective analysis of consecutive 138 patients with COVID-19 hospitalized from January 1 to January 28, 2020 in a hospital in Wuhan showed that it took median 7 days to be hospitalized [11] . The whole scenario throughout Wuhan city was even worse and by middle February 2020, it took median 9.8 days for severe COVID-19 patients being hospitalized after onset of the illness [12] . Additionally, the delayed hospitalization should have transmitted SARS-CoV-2 to more other individuals. The main limitation was that this study contained no detailed information about patients' demographic data and other underlying diseases, which may influence the fatality rate. Nevertheless, the data from as many as 68182 patients in Hubei and timely management of patients can reduce the fatality rate of COVID-19. In summary, timely management of COVID-19 patients is critical for reducing the fatality rate. This will be valuable to encourage febrile patients with cough to see doctors as soon as possible so that the fatality rate can be significantly reduced in patients with COVID-19. No funding sources. None declared. Conceived and designed the study: YP, BX, GH, and Y-HZ; Collected the data: YP, BX, and BS; Analyzed the data: YP, BX, and BS. Wrote the manuscript: YP and BX. Critically revised the manuscript: GH and Y-HZ. All authors approved the final manuscript. Table 1 . 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A sad fact released by the deputy director of the Medical Administration Bureau of the National Health Commission