key: cord-0937907-hrobt83q
authors: Qian, Guo-Qing; Ma, Ada Hoi Yan; Yang, Nai-Bin; Ruan, Lie-Min
title: Response letter to COIVD-19 Disease: Tackling a pandemic in 21(st) Century
date: 2020-04-08
journal: QJM
DOI: 10.1093/qjmed/hcaa118
sha: 802dd00c2082c8fe7f3b03f270ada85759773e4f
doc_id: 937907
cord_uid: hrobt83q

nan

At the time of paper submission, nearly two-thirds of the COVID-19 patients were not discharged, but now all 91 patients are fully discharged without death, including a 96-yearold woman. 2 Moreover, as at 24:00 on March 29 th in Zhejiang province, there were 1,255 laboratory-confirmed cases, 1,225 cases were discharged, 29 remain hospitalized and 1 case died. A total of 46,521 close contacts were tracked, and 2,827 people are still under medical observation. 3 The mortality rate between Wuhan and Zhejiang is quite different, where reported mortality rates range from 4.3 to 15% in Wuhan. 4-6 The longer median time for illness onset to hospital admission (9.84 days, however, the median time from visiting doctor to be confirmed was 1 days in Zhejiang), and shortage of health care workers and resources in the early stage, might have contributed to higher mortality in Wuhan. 7 The bilateral pneumonia in chest computed tomography (CT) scan was an important manifestation of COVID-19. In our study, 67.03% of patients had bilateral pneumonia in CT scan and none of the patients used extracorporeal membrane oxygenation (ECMO). 2 Other studies have presented similar statistics. In Shanghai, which is geographically adjacent to Zhejiang, it was reported that 81.53% of COVID-19 patients had bilateral infiltrations in Shanghai. 8 In an earlier study of Zhejiang patients, Lian et al examined the medical records of 788 patients, at the time of their submission in early February most patients had yet to be discharged, none had died and they concluded that the symptoms of COVID-19 in Zhejiang province were relatively mild given the evidence they had at the time. 7, 9 This result might be due to well-resourced treatments administered in Zhejiang and Shanghai. The serious cases reported in Chen et al and Huang et al had high incidences of acute respiratory distress syndrome (ARDS) could be due to that these were cases drawn from Wuhan, and some of the sample were taken from designated hospitals for severe pneumonia. Collectively, the research indicates that there are important differences in COVID-19 case fatality rate in different regions.

In our study, the odds of developing severe COVID-19 is larger amongst those over 60. 2 There were 9 patients (9.89%) that had severe COVID-19. There were 19 (20.88%) patients who were 60 years or older, 5 of them (26.32%) developed severe COVID-19 (Figure) .

Amongst the 9 severe patients, 8 had hypertension, 4 had Type 2 diabetes mellitus, and one had a history of cancer. Moreover, several studies have reported that hypertension, diabetes, cardiovascular disease, and COPD were associated with severity and admission to intensive care units. 7, 10, 11 The clinical features of COVID-19 are of great concern to many. SARS-CoV-2 spreads rapidly through human-to-human contacts. Presymptomatic or asymptomatic patients are infectious. 12 The reproduction number (R0) is lower in SARS-CoV-2 (1.4 to 2.5) compared to SARS-CoV (2 to 5), and also the case fatality rate is lower than SARS-CoV (9.5%) and

MERS-CoV (37%). 13 Fever, cough and fatigue are the most common symptoms reported in our study, which is similar to other cohorts. Interestingly, diarrhoea was presented in 23.8% patients of our study 2 compared to 3% or 2% of other studies. 4,6 In comparison, the proportion of patients of MERS and SARS who had diarrhoea ranged from12.3% to one-thirds. 1,14,15 Moreover, the gastrointestinal symptoms of confirmed subjects were 37% from a Singapore study. 16 On the other hand, diarrhoea was more common in the ICU group. 10 twice a day for 14 days did not benefit those with severe COVID-19 (assessed on whether it accelerate clinical improvement, reduce mortality, and diminish throat viral RNA detectability) . 18 However, the median days of ICU length of stay of the treatment group was controversial by some references. 19, 20 Current research suggested that remdesivir (GS-5734) and chloroquine (Sigma-C6628) can effectively inhibit SARS-CoV-2 at cellular level. 21 The current consensus of experts in China is that, Chloroquine 500mg twice a day for 10 days should be administered to COVID-19 patients. 22 Chloroquine might be an effective drug for treating COVID-19.

COIVD 19 Disease: Tackling a pandemic in 21st Century

Epidemiologic and Clinical Characteristics of 91 Hospitalized Patients with COVID-19 in Zhejiang, China: A retrospective, multi-centre case series

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China

Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

Analysis of Epidemiological and Clinical features in older patients with Corona Virus Disease 2019 (COVID-19) out of Wuhan

Clinical progression of patients with COVID-19 in Shanghai

Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series

Systematic review and meta-analysis of predictive symptoms and comorbidities for severe COVID-19 infection

Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis

A COVID-19 Transmission within a family cluster by presymptomatic infectors in China

A novel coronavirus outbreak of global health concern

Middle East respiratory syndrome

Clinical management and infection control of SARS: lessons learned

Epidemiological and Clinical Predictors of COVID-19

Caution: The clinical characteristics of COVID-19 patients at admission are changing. medRxiv 2020

A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19

Negida A, Bahbah EI. Comments on the Hydroxychloroquine/Azithromycin Study and Lessons for Future Clinical Trials of COVID-19 Treatments

Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro

Collaboration Group of Guangdong Provincial Department of Science and Technology and Health and Health Committee

Age distribution of the 91 COVID-19 patients reported in Qian

Age distribution of the 91 COVID-19 patients reported in Qian et al