key: cord-0934990-ws8poqlh
authors: Lu, Chong; Wang, Han-Yu; Chen, Xiao; Wu, Zi-Ling; Meng, Shan; He, Wei; Xu, Kai-Song; Fu, Xin-Qiao; Hu, Yu; Yang, Chao; Sun, Hui
title: Clinical characteristics of 1327 patients with coronavirus disease 2019 (COVID-19) in the largest Fangcang shelter hospital in Wuhan
date: 2021-01-20
journal: Chin Med J (Engl)
DOI: 10.1097/cm9.0000000000001194
sha: 370aa709b3c95eda8fac33f0fdc8e5d8e836db1f
doc_id: 934990
cord_uid: ws8poqlh

nan

To the Editor: Coronavirus disease 2019 (COVID-19), a result of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is highly infectious. [1] As COVID-19 spreads rapidly, and the majority of the patients develop mild to moderate form of the disease, we aimed to study the clinical characteristics of these patients admitted to Jianghan Fangcang shelter hospital, the largest Fangcang shelter hospital in Wuhan, China. This retrospective study included 1327 patients with asymptomatic or mild to moderate COVID-19 who were hospitalized in Jianghan Fangcang shelter hospital between 5 February and 9 March 2020. The study was approved by the Medical Ethics Committee of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (No.

[2020]0038) and was exempted from the need for informed consent from patients. In all the patients, the throat swab specimens were tested by real-time reverse transcription polymerase chain reaction (RT-PCR) assay by amplifying open reading frame 1ab (ORF1ab) gene and nucleocapsid protein (N) gene of SARS-CoV-2. The RT-PCR was performed following the manufacturer's protocol (Shanghai Bio-germ Medical Technology Company, Shanghai, China). The reaction conditions for RT-PCR assay were 50°C for 15 min, 95°C for 5 min followed by 40 cycles at 94°C for 15 s, and 55°C for 45 s, respectively. All the patients were followed up within 2 to 4 weeks after being discharged from the Fangcang shelter hospital.

Statistical analysis of the data was performed by SPSS 23.0 software (SPSS Inc., Chicago, IL, USA). Categorical variables were described as numbers and percentages, and continuous variables as median with interquartile range (IQR). Mann-Whitney U test was used for analysis of continuous variables and Fisher exact test or x 2 test was used for comparison of categorical variables. P < 0.05 was considered as statistically significant.

In this study, the median age of the patients was 50 (40À57) years, and 55.7% (739/1327) of patients were females. Only 3.1% (37/1182) of the patients were active smokers. The most commonly observed comorbidities were hypertension (14.1%, 167/1182), diabetes (5.2%, 62/1182), and coronary heart disease (1.9%, 23/1182).

The most commonly reported initial symptoms were fever (59.6%, 703/1180), followed by cough (29.9%, 353/ 1180), fatigue (28.8%, 340/1180), and myalgia/arthralgia (14.5%, 171/1180). The common symptoms related to the gastrointestinal tract were diarrhea (8.7%, 103/1180), anorexia (6.5%, 77/1180), and nausea/vomiting (3.5%, 41/1180). It is worth highlighting that six patients had anosmia without nasal congestion as the initial symptom. As to the day of follow-up, chest distress/chest pain (9.4%, 98/1042) was the most difficult symptom to be relieved.

On admission, leukopenia, lymphocytopenia, and thrombocytopenia were present in 1.6% (20/1257), 3.8% (48/ 1257), and 1.4% (17/1257) of the patients, respectively. Moreover, 9.2% (114/1237) of the patients had elevated levels of C-reactive protein (CRP). On chest computed tomography (CT), the most common pattern at disease onset was ground-glass opacity (71.0%, 686/966). At the time of discharge from the Fangcang shelter hospital, the findings on chest CT were alleviated in 95.5% (1241/1300) of the patients. However, only one patient had chest CT findings suggestive of disease progression.

As shown in Table 1 Interestingly, in our study, six patients reported absence of olfactory sensation without nasal congestion as the initial symptom, and four out of the six patients had fever, which might suggest that, compared with cold and influenza, anosmia is a specific symptom of COVID-19. Thus, COVID-19 should be suspected when a febrile patient presents with the deficiency of olfactory sensation without nasal congestion. Symptomatic patients have higher CRP level and lower lymphocytes counts than asymptomatic patients, which might suggest that higher CRP level and lower lymphocytes counts were related to the severity of symptoms. Lymphocytopenia was recognized as an indicator of poor prognosis of COVID-19, [2] and higher CRP level was associated with critical illness, [3] while higher lymphocyte counts and lower CRP might suggest the better prognosis of asymptomatic patients. The level of erythrocyte, hemoglobin, HCT, MCV, and MCH were higher in asymptomatic patients, which might be related to the oxygen-delivering capacity of the red blood cells and hemoglobin. However, CT characteristics were not statistically different between symptomatic and asymptomatic patients, which might indicate that CT characteristics were not associated with the severity of symptoms in non-critical patients.

There were some limitations in our study. Firstly, this was a retrospective study, therefore, complete information was not available for all the patients. Secondly, though our study was based on the data of the biggest Fangcang shelter hospital in China, a large-scale study involving other Fangcang shelter hospitals is required.

In conclusion, patients with fever and anosmia but without nasal congestion are more likely to be suffering from COVID-19. Higher CRP level and lower lymphocytes counts might relate to the severity of symptoms, while CT abnormalities were not associated with the severity of symptoms in non-critical patients.

This study was supported by the grant from Hubei Natural Science Foundation (No. 2019CFB499). 

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Clinical characteristics of 1327 patients with coronavirus disease 2019 in the largest Fangcang shelter hospital in Wuhan

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