ABSTRACT
Background: Global outbreak of novel coronavirus 2019 (COVID-19) continues to constitute a public health emergency of international concern. However, few studies have directly compared the differences of clinical features and outcomes between imported and non-imported COVID-19 patients. Methods: In this retrospective, multi-centre, descriptive study, we enrolled 275 patients (53 imported cases and 222 non-imported cases) with laboratory-confirmed COVID-19 from four designated hospitals in Chongqing, China. Epidemiological, demographic, clinical, laboratory, treatment, and outcome data were collected and analyzed. Outcomes were followed up until Mar 1, 2020. Findings: The proportion of asymptomatic patients in the non-imported group was significantly higher than that in the imported group (18.9% vs. 3.8%, p=0.016), and the proportions of symptoms of fever, sore throat and diarrhea in the non-imported group were all lower than those in the imported group (p≤0.048). The imported group had a lower lymphocyte count (1.1×109/L vs. 1.5×10 9 /L, p=0.018), higher neutrophil-to-lymphocyte ratio (NLR) value (2.6 vs. 2.3, p=0.0237), higher proportion of CD4+ T cells reduction (70% vs. 44.6%, p=0.043), longer duration of viral shedding (20 days vs. 18 days, p = 0.0416) than the non-imported group. As to asymptomatic patients in non-imported group, 33.3% had no abnormal chest CT images. They had higher proportion of ground-glass opacity (21.4% vs. 5.6%, p=0.004), lower proportions of bilateral patchy shadowing (7.1% vs. 21%, p=0.027) and multiple manifestations (21.4% vs. 31.3%, p=0.014), higher lymphocyte count (1.6×109/L vs. 1.3×109/L, p=0.003) including both CD4+ (567 vs. 414, p=0.029) and CD8+ (370 vs. 279, p=0.003) T cells than the symptomatic patients in non-imported group. Furthermore, when compared with imported group, asymptomatic group showed higher lymphocyte count (1.6×109/L vs. 1.1×109 /L, p< 0.001) and CD4+ T cells(567 vs.375, p=0.029), while the symptomatic group showed no difference in lymphocyte count, CD4+ or CD8+ T cells (p ≥ 0.0894). Interpretation: In our retrospective study, we found the non-imported group displayed higher lymphocyte count, lower proportion of CD4+ T cells reduction, lower NLR value, shorter duration of viral shedding, but more atypical symptoms and a much higher asymptomatic proportion when compared with imported cases. Our further subgroup analysis suggested that the counts of lymphocyte and CD4+ T cell from non-imported asymptomatic group were higher than those in the imported patients, but there were no difference between non-imported symptomatic and imported patients. Our results indicated that when compared with imported patients, damage to the immune system by SARS-Cov-2 in non-imported patients was milder, and this might be mainly due to its higher asymptomatic proportion. Funding: National Natural Science Foundation of China (No. 81500015). Natural Science Foundation of Chongqing Science and technology bureau (No. cstc2018jcyjAX0115). National Natural Science Foundation of Chongqing (No. cstc2019jcyj‑msxmX0849). The Joint Fund of Science and Health Medicine of Chongqing, China (No. 2019QNXM004).Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: This study is approved by Ethics Committees of the four hospitals mentioned above and written informed consent was obtained from each enrolled patient.
Subject(s)
Fever , COVID-19 , DiarrheaABSTRACT
BackgroundEffects of early rehabilitation therapy in severe and critical COVID-19 patients remains to be elucidated. MethodsWe recruited 80 severely and critically ill COVID-19 patients in Chongqing from January 21 to March 15, 2020, who had received rehabilitation therapies or standard treatments within 72 h of intensive care unit (ICU) admission. We analyzed mortality rates, length of stay in the ICU and hospital, ventilator-free days, and adverse events during hospitalization. Respiratory function, independent functional status, muscle strength, exercise capacity and life quality were measured at hospital discharge and during a three-month follow-up. ResultsWe found no significant differences between the intervention and control groups in terms of ICU, hospital, and 28-day mortality rates, and lengths of stay in the ICU and hospital. Additionally, early rehabilitation enhanced the duration of ventilator-free days, with no increased adverse events and complications. Total lung capacity and carbon monoxide diffusion capacity, Barthel index, and functional independence measure for patients in the intervention group were all higher than those in the control group at hospital discharge and one month after discharge. Compared to the control group, patients in the intervention group had significantly higher Medical Research Council scores and greater walking distance capacities within 6 min at hospital discharge, as well as one month and three months after discharge. The St. George's Respiratory Questionnaire score was lower in the intervention group than in the control group at one month and three months after hospital discharge.ConclusionsEarly physical and pulmonary rehabilitation is safe and effective for severely and critically ill COVID-19 patients to promote their functional, physical, and psychological recovery.
Subject(s)
COVID-19ABSTRACT
Background: Global outbreak of novel coronavirus 2019 (COVID-19) continues to constitute a public health emergency of international concern. However, few studies have directly compared the differences of clinical features and outcomes between imported and non-imported COVID-19 patients. We aimed to directly compare the differences of clinical features and outcomes between imported and non-imported COVID-19 patients.Methods: we enrolled 275 patients (53 imported and 222 non-imported cases) with laboratory-confirmed COVID-19 from four designated hospitals in Chongqing, China. Epidemiological, demographic, clinical, laboratory, treatment, and outcome data were collected and analyzed. Independent samples t- test, Mann- Whitney U test, Wilcoxon test,χ2 test, or Fisher’s exact test were adopted to compare the difference between imported and non-imported groups where appropriateResults: The imported group had a higher proportion of asymptomatic patients (18.9% vs. 3.8%, p=0.016), lower lymphocyte count (1.1×109/L vs. 1.5×109 /L, p=0.018), higher neutrophil-to-lymphocyte ratio (NLR) (2.6 vs. 2.3, p=0.0237), higher proportion of CD4+ T cells reduction (70% vs. 44.6%, p=0.043), longer duration of viral shedding (20 days vs. 18 days, p = 0.0416) than the non-imported group. The symptomatic non-imported group had a lower lymphocyte count (1.3×109/L vs. 1.6×109 /L, p=0.003), lower CD4+ and CD8+ T cells, longer viral shedding (20 days vs.13 days, p< 0.001) and hospital stay (17 days vs.14 days, p=0.015) than the asymptomatic non-imported group. Furthermore, when compared with imported group, asymptomatic non-imported group showed higher lymphocyte count (1.6×109/L vs. 1.1×109 /L, p< 0.001) and CD4+ T cells(567 vs.375, p=0.029), while the symptomatic non-imported group showed no difference in lymphocyte count, CD4+ or CD8+ T cells (p ≥ 0.0894).Conclusion: Our results indicated that when compared with imported patients, damage to the immune system by SARS-Cov-2 in non-imported patients was milder, and this might be mainly due to its higher asymptomatic proportion.Clinical trial registration: ChiCTR2000033980. Registered 19 June 2020 - Retrospectively registered, http:// www.chictr.org.cn.
Subject(s)
COVID-19ABSTRACT
Background SARS-CoV-2 has been a global pandemic, but the emergence of asymptomatic patients has caused difficulties in the prevention of the epidemic. Therefore, it is significant to understand the epidemiological characteristics of asymptomatic patients with SARS-CoV-2 infection. Methods In this single-center, retrospective and observational study, we collected data from 167 patients with SARS-CoV-2 infection treated in Chongqing Public Health Medical Center (Chongqing, China) from January to March 2020. The epidemiological characteristics and variable of these patients were collected and analyzed. Findings 82.04% of the SARS-CoV-2 infected patients had a travel history in Wuhan or a history of contact with returnees from Wuhan, showing typical characteristics of imported cases, and the proportion of severe Covid-19 patients was 13.2%, of which 59% were imported from Wuhan. For the patients who was returnees from Wuhan, 18.1% was asymptomatic patients. In different infection periods, compared with the proportion after 1/31/2020, the proportion of asymptomatic patient among SARS-CoV-2 infected patient was higher(19% VS 1.5%). In different age groups, the proportion of asymptomatic patient was the highest(28.6%) in children group under 14, next in elder group over 70 (27.3%). Compared with mild and common Covid-19 patients, the mean latency of asymptomatic was longer (11.25 days VS 8.86 days), but the hospital length of stay was shorter (14.3 days VS 16.96 days). Conclusion The SARS-CoV-2 prevention needs to focus on the screening of asymptomatic patients in the community with a history of contact with the imported population, especially for children and the elderly population.
Subject(s)
COVID-19 , Severe Acute Respiratory SyndromeABSTRACT
Background: SARS-CoV-2 has been a global pandemic, but the emergence of asymptomatic patients has caused difficulties in the prevention of the epidemic. Therefore, it is significant to understand the epidemiological characteristics of asymptomatic patients with SARS-CoV-2 infection. Methods: In this single-center, retrospective and observational study, we collected data from 167 patients with SARS-CoV-2 infection treated in Chongqing Public Health Medical Center (Chongqing, China) from January to March 2020. The epidemiological characteristics and variable of these patients were collected and analyzed. Findings: 82.04% of the SARS-CoV-2 infected patients had a travel history in Wuhan or a history of contact with returnees from Wuhan, showing typical characteristics of imported cases, and the proportion of severe Covid-19 patients was 13.2%, of which 59% were imported from Wuhan. For the patients who was returnees from Wuhan, 18.1% was asymptomatic patients. In different infection periods, compared with the proportion after 1/31/2020, the proportion of asymptomatic patient among SARS-CoV-2 infected patient was higher(19% VS 1.5%). In different age groups, the proportion of asymptomatic patient was the highest(28.6%) in children group under 14, next in elder group over 70 (27.3%). Compared with mild and common Covid-19 patients, the mean latency of asymptomatic was longer (11.25 days VS 8.86 days), but the hospital length of stay was shorter (14.3 days VS 16.96 days) . Conclusion: The SARS-CoV-2 prevention needs to focus on the screening of asymptomatic patients in the community with a history of contact with the imported population, especially for children and the elderly population.
Subject(s)
COVID-19 , Severe Acute Respiratory SyndromeABSTRACT
BackgroundIn January 19, 2020, first case of 2019 novel coronavirus (2019-nCoV) pneumonia (COVID-19) was confirmed in Chongqing municipality, China. MethodsIn this retrospective, descriptive, multiple-center study, total of 267 patients with COVID-19 confirmed by real-time RT-PCR in Chongqing from Jan 19 to Feb 16, 2020 were recruited. Epidemiological, demographic, clinical, radiological characteristics, laboratory examinations, and treatment regimens were collected on admission. Clinical outcomes were followed up until Feb 16, 2020. Results267 laboratory-confirmed COVID-19 patients admitted to 3 designated-hospitals in Chongqing provincial municipality from January 19 to February 16, 2020 were enrolled and categorized on admission. 217 (81.27%) and 50 (18.73%) patients were categorized into non-severe and severe subgroups, respectively. The median age of patients was 48.0 years (IQR, 35.0-65.0), with 129 (48.3%) of the patients were more than 50 years of age. 149 (55.8%) patients were men. Severe patients were significantly older (median age, 71.5 years [IQR, 65.8-77.0] vs 43.0 years [IQR, 32.5-57.0]) and more likely to be male (110 [50.7%] vs 39 [78.0%]) and have coexisting disorders (15 [30.0%] vs 26 [12.0%]). 41 (15.4%) patients had a recent travel to Hubei province, and 139 (52.1%) patients had a history of contact with patients from Hubei. On admission, the most common symptoms of COVID-19 were fever 225(84.3%), fatigue (208 [77.9%]), dry cough (189 [70.8%]), myalgia or arthralgia (136 [50.9%]). Severe patients were more likely to present dyspnea (17 [34.0%] vs 26 [12.0%]) and confusion (10 [20.0%] vs 15 [6.9%]). Rales (32 [12.0%]) and wheezes (20 [7.5%]) are not common noted for COVID-19 patients, especially for the non-severe (11 [5.1%], 10 [4.6%]). 118 (44.2%). Most severe patients demonstrated more laboratory abnormalities. 231 (86.5%), 61 (22.8%) patients had lymphopenia, leukopenia and thrombocytopenia, respectively. CD4+T cell counts decrease was observed in 77.1 % of cases, especially in the severe patients (45, 100%). 53.1% patients had decreased CD+3 T cell counts, count of CD8+T cells was lower than the normal range in part of patients (34.4%). More severe patients had lower level of CD4+ T cells and CD+3 T cells (45 [100.0%] vs 29[56.9%], 31 [68.9%] vs 20 [39.2%]). Most patients had normal level of IL-2, IL-4, TNF- and INF-{gamma}, while high level of IL-6 and IL-17A was common in COVID-19 patients (47 [70.1%], 35 [52.2%]). Level of IL-6, IL-17A and TNF- was remarkably elevated in severe patients (32 [84.2%] vs 15 [51.7%], 25 [65.8%] vs 10 [34.5%], 17 [44.7%] vs 5 [17.2%]). All patients received antiviral therapy (267, 100%). A portion of severe patients (38, 76.0%) received systemic corticosteroid therapy. Invasive mechanical ventilation in prone position, non-invasive mechanical ventilation, high-flow nasal cannula oxygen therapy was adopted only in severe patients with respiratory failure (5[10.0%], 35[70.0%], 12[24.0%]). Traditional Chinese medicine was adopted to most of severe patients (43,86.0%). Conclusion:Our study firstly demonstrated the regional disparity of COVID-19 in Chongqing municipality and further thoroughly compared the differences between severe and non-severe patients. The 28-day mortality of COVID-19 patients from 3 designed hospitals of Chongqing is 1.5%, lower than that of Hubei province and mainland China including Hubei province. However, the 28-mortality of severe patients was relatively high, with much higher when complications occurred. Notably, the 28-mortality of critically severe patients complicated with severe ARDS is considerably as high as 44.4%. Therefore, early diagnosis and intensive care of critically severe COVID-19 cases, especially those combined with ARDS, will be considerably essential to reduce mortality.