covid
212656559
Clinical course and risk factors for mortality of adult inpatients with COVID 19 in Wuhan, China: a retrospective cohort study
Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID 19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) Epidemiological and clinical characteristics of patients with COVID 19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients =18 years old) with laboratory confirmed COVID 19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48% patients had a comorbidity, with hypertension being the most common (58 [30% patients) followed by diabetes (36 [19% patients) and coronary heart disease (15 [8% patients) Multivariable regression showed increasing odds of in hospital death associated with older age (odds ratio 1*10, 95% CI 1*03 1*17, per year increase; p=0*0043) higher Sequential Organ Failure Assessment (SOFA) score (5*65, 2*61 12*23; p<0*0001) and d dimer greater than 1 mg/mL (18*42, 2*64 128*55; p=0*0033) on admission. Median duration of viral shedding was 20*0 days (IQR 17*0 24*0) in survivors, but SARS CoV 2 was detectable until death in non survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d dimer greater than 1 mg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
The Lancet
Fei Zhou Ting Yu Ronghui Du Guohui Fan Ying Liu Zhibo Liu Jie Xiang Ye-ming Wang Bin Song Xiaoying Gu Lulu Guan Yuan Wei Hui Li Xudong Wu Jiuyang Xu Shengjin Tu Yi Zhang Hua Chen Bin Cao
211262395
Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID 19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention.
Background: Hospitalised COVID 19 patients are frequently elderly subjects with co morbidities receiving polypharmacy, all of which are known risk factors for d
JAMA
Zunyou Wu Jennifer M McGoogan
211245138
Pathological findings of COVID 19 associated with acute respiratory distress syndrome
bPortuguese Abstract:O surto do novo coronavArus (COVID 19) em Wuhan, China, iniciado em dezembro de 2019, evoluiu para se tornar uma pandemia global A
The Lancet Respiratory Medicine
Zhe Xu Lei Shi Yijin Wang Jiyuan Zhang Lei Huang Chao Zhang Shuhong Liu Peng Zhao Hongxia Liu Li Zhu Yanhong Tai Changqing Bai Tingting Gao Jinwen Song Peng Xia Jinghui Dong Jingmin Zhao Fu-Sheng Wang
212721438
COVID 19: consider cytokine storm syndromes and immunosuppression
www.thelancet.com Published online March 13, 2020 https:/doi.org/10.1016/S0140 6736(20)30628 0 1 Submissions should be made via our electronic submission system at http:/ees.elsevier.com/ thelancet/ However, in hyperinflammation, immunosuppression is likely to be beneficial. Re analysis of data from a phase 3 randomised controlled trial of IL 1 blockade (anakinra) in sepsis, showed significant survival benefit in patients with hyperinflammation, without increased adverse events. A multicentre, randomised con trolled trial of tocilizumab (IL 6 receptor blockade, licensed for cytokine release syndrome) has been approved in patients with COVID 19: consider cytokine storm syndromes and immunosuppression
The Lancet
Puja Mehta Daniel Francis McAuley Michael Brown Emilie Sanchez Rachel Tattersall Jessica Manson
211253616
An interactive web based dashboard to track COVID 19 in real time
The outbreak of the 2019 novel coronavirus disease (COVID 19) has induced a considerable degree of fear, emotional stress and anxiety among individuals around t
The Lancet Infectious Diseases
Ensheng Dong Hongru Du Lauren Gardner
216075793
Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID 19 in the New York City Area.
Importance There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID 19) Objective To describe the clinical characteristics and outcomes of patients with COVID 19 hospitalized in a US health care system. Design, Setting, and Participants Case series of patients with COVID 19 admitted to 12 hospitals in New York City, Long Island, and Westchester County, New York, within the Northwell Health system. The study included all sequentially hospitalized patients between March 1, 2020, and April 4, 2020, inclusive of these dates. Exposures Confirmed severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample among patients requiring admission. Main Outcomes and Measures Clinical outcomes during hospitalization, such as invasive mechanical ventilation, kidney replacement therapy, and death. Demographics, baseline comorbidities, presenting vital signs, and test results were also collected. Results A total of 5700 patients were included (median age, 63 years [interquartile range {IQR} 52 75; range, 0 107 years] 39.7% female) The most common comorbidities were hypertension (3026; 56.6% obesity (1737; 41.7% and diabetes (1808; 33.8% At triage, 30.7% of patients were febrile, 17.3% had a respiratory rate greater than 24 breaths/minute, and 27.8% received supplemental oxygen. The rate of respiratory virus co infection was 2.1% Outcomes were assessed for 2634 patients who were discharged or had died at the study end point. During hospitalization, 373 patients (14.2% (median age, 68 years [IQR, 56 78] 33.5% female) were treated in the intensive care unit care, 320 (12.2% received invasive mechanical ventilation, 81 (3.2% were treated with kidney replacement therapy, and 553 (21% died. Mortality for those requiring mechanical ventilation was 88.1% The median postdischarge follow up time was 4.4 days (IQR, 2.2 9.3) A total of 45 patients (2.2% were readmitted during the study period. The median time to readmission was 3 days (IQR, 1.0 4.5) for readmitted patients. Among the 3066 patients who remained hospitalized at the final study follow up date (median age, 65 years [IQR, 54 75] the median follow up at time of censoring was 4.5 days (IQR, 2.4 8.1) Conclusions and Relevance This case series provides characteristics and early outcomes of sequentially hospitalized patients with confirmed COVID 19 in the New York City area.
JAMA
Safiya Richardson Jamie S Hirsch Mangala Narasimhan James M Crawford Thomas G McGinn Karina W Davidson Douglas P Barnaby Lance B Becker John Chelico Stuart Lance Cohen Jennifer Cookingham Kevin Coppa Michael A Diefenbach Andrew J Dominello Joan Duer-Hefele Louise Falzon Jordan S Gitlin Negin Hajizadeh Tiffany G Harvin David Hirschwerk Eun Ji Kim Zachary Kozel Lyndonna Marrast Jazmin N Mogavero Gabrielle A Osorio Michael Qiu Theodoros P Zanos
212665208
Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID 19) Epidemic among the General Population in China
Background: The 2019 coronavirus disease (COVID 19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID 19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID 19, knowledge and concerns about COVID 19, precautionary measures against COVID 19, and additional information required with respect to COVID 19. Psychological impact was assessed by the Impact of Event Scale Revised (IES R) and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS 21) Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20 24 h per day at home (84.7% were worried about their family members contracting COVID 19 (75.2% and were satisfied with the amount of health information available (75.1% Female gender, student status, specific physical symptoms (e.g. myalgia, dizziness, coryza) and poor self rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p 0.05) Specific up to date and accurate health information (e.g. treatment, local outbreak situation) and particular precautionary measures (e.g. hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p 0.05) Conclusions: During the initial phase of the COVID 19 outbreak in China, more than half of the respondents rated the psychological impact as moderate to severe, and about one third reported moderate to severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID 19 epidemic.
International journal of environmental research and public health
Cuiyan Wang Riyu Pan Xiaoyang Wan Yilin Tan Linkang Xu Cyrus Su Hui Ho Roger C M Ho
214771224
Virological assessment of hospitalized patients with COVID 2019
Coronavirus disease 2019 (COVID 19) is an acute infection of the respiratory tract that emerged in late 2019 1 2 Initial outbreaks in China involved 13.8% of cases with severe courses, and 6.1% of cases with critical courses 3 This severe presentation may result from the virus using a virus receptor that is expressed predominantly in the lung 2 4 the same receptor tropism is thought to have determined the pathogenicity but also aided in the control of severe acute respiratory syndrome (SARS) in 2003 5 However, there are reports of cases of COVID 19 in which the patient shows mild upper respiratory tract symptoms, which suggests the potential for pre or oligosymptomatic transmission 6 8 There is an urgent need for information on virus replication, immunity and infectivity in specific sites of the body. Here we report a detailed virological analysis of nine cases of COVID 19 that provides proof of active virus replication in tissues of the upper respiratory tract. Pharyngeal virus shedding was very high during the first week of symptoms, with a peak at 7.11 x 10 8 RNA copies per throat swab on day 4. Infectious virus was readily isolated from samples derived from the throat or lung, but not from stool samples in spite of high concentrations of virus RNA. Blood and urine samples never yielded virus. Active replication in the throat was confirmed by the presence of viral replicative RNA intermediates in the throat samples. We consistently detected sequence distinct virus populations in throat and lung samples from one patient, proving independent replication. The shedding of viral RNA from sputum outlasted the end of symptoms. Seroconversion occurred after 7 days in 50% of patients (and by day 14 in all patients) but was not followed by a rapid decline in viral load. COVID 19 can present as a mild illness of the upper respiratory tract. The confirmation of active virus replication in the upper respiratory tract has implications for the containment of COVID 19. Detailed virological analysis of nine cases of coronavirus disease 2019 (COVID 19) provides proof of active replication of the SARS CoV 2 virus in tissues of the upper respiratory tract.
Nature
Roman Wolfel Victor Max Corman Wolfgang Guggemos Michael Seilmaier Sabine Zange Marcel Alexander Muller Daniela Niemeyer Terry C Jones Patrick Vollmar Camilla Rothe Michael Hoelscher Tobias Bleicker Sebastian Brunink Julia Schneider Rosina Ehmann Katrin Zwirglmaier Christian Drosten Clemens M Wendtner
214627660
Hydroxychloroquine and azithromycin as a treatment of COVID 19: results of an open label non randomized clinical trial
Abstract Background Chloroquine and hydroxychloroquine have been found to be efficient on SARS CoV 2, and reported to be efficient in Chinese COV 19 patients. We evaluate the role of hydroxychloroquine on respiratory viral loads. Patients and methods French Confirmed COVID 19 patients were included in a single arm protocol from early March to March 16th, to receive 600mg of hydroxychloroquine daily and their viral load in nasopharyngeal swabs was tested daily in a hospital setting. Depending on their clinical presentation, azithromycin was added to the treatment. Untreated patients from another center and cases refusing the protocol were included as negative controls. Presence and absence of virus at Day6 post inclusion was considered the end point. Results Six patients were asymptomatic, 22 had upper respiratory tract infection symptoms and eight had lower respiratory tract infection symptoms. Twenty cases were treated in this study and showed a significant reduction of the viral carriage at D6 post inclusion compared to controls, and much lower average carrying duration than reported of untreated patients in the literature. Azithromycin added to hydroxychloroquine was significantly more efficient for virus elimination. Conclusion Despite its small sample size our survey shows that hydroxychloroquine treatment is significantly associated with viral load reduction/disappearance in COVID 19 patients and its effect is reinforced by azithromycin.
International Journal of Antimicrobial Agents
Philippe Gautret Jean-Christophe Lagier Philippe Parola Van Thuan Hoang Line Meddeb Morgane Mailhe Barbara Doudier Johan Courjon Valerie Giordanengo Vera Esteves Vieira Herve Tissot Dupont Stephane Honore Philippe Colson Eric Chabriere Bernard La Scola J M Rolain Philippe Brouqui Didier Raoult
212650690
The Incubation Period of Coronavirus Disease 2019 (COVID 19) From Publicly Reported Confirmed Cases: Estimation and Application
Background: A novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) was identified in China in December 2019. There is limited support for many of its key epidemiologic features, including the incubation period for clinical disease (coronavirus disease 2019 [COVID 19] which has important implications for surveillance and control activities. Objective: To estimate the length of the incubation period of COVID 19 and describe its public health implications. Design: Pooled analysis of confirmed COVID 19 cases reported between 4 January 2020 and 24 February 2020. Setting: News reports and press releases from 50 provinces, regions, and countries outside Wuhan, Hubei province, China. Participants: Persons with confirmed SARS CoV 2 infection outside Hubei province, China. Measurements: Patient demographic characteristics and dates and times of possible exposure, symptom onset, fever onset, and hospitalization. Results: There were 181 confirmed cases with identifiable exposure and symptom onset windows to estimate the incubation period of COVID 19. The median incubation period was estimated to be 5.1 days (95% CI, 4.5 to 5.8 days) and 97.5% of those who develop symptoms will do so within 11.5 days (CI, 8.2 to 15.6 days) of infection. These estimates imply that, under conservative assumptions, 101 out of every 10 000 cases (99th percentile, 482) will develop symptoms after 14 days of active monitoring or quarantine. Limitation: Publicly reported cases may overrepresent severe cases, the incubation period for which may differ from that of mild cases. Conclusion: This work provides additional evidence for a median incubation period for COVID 19 of approximately 5 days, similar to SARS. Our results support current proposals for the length of quarantine or active monitoring of persons potentially exposed to SARS CoV 2, although longer monitoring periods might be justified in extreme cases. Primary Funding Source: U.S. Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases, National Institute of General Medical Sciences, and Alexander von Humboldt Foundation.
Annals of Internal Medicine
Stephen A Lauer Kyra H Grantz Qifang Bi Forrest K Jones Qulu Zheng Hannah R Meredith Andrew S Azman Nicholas G Reich Justin Lessler