Clinical characteristics and risk factors of severe COVID-19 in hospitalized neonates with Omicron variant infection: a retrospective study (preprint)

Background Previous study on coronavirus disease 2019 (COVID-19) in neonates was limited, especially in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) Omicron variant. This study aims to analyze the clinical characteristics and identify risk factors associated with severe COVID-19 in neonates infected with Omicron variant.Methods The study population was neonates with COVID-19 who were admitted to The Affiliated Children’s Hospital of Xi’an Jiaotong University in northwest China, from December 10, 2022 to January 20, 2023. Chinese Center for Disease Control and Prevention (CDC) announced that all local COVID-19 cases were infected with Omicron variant during the study period. Clinical and laboratory data was collected retrospectively. We used logistic regression analysis to investigate the risk factors for severe COVID-19, and derived odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) from it.Results A total of 108 neonates have a median age of 18.1 days (interquartile range 9.4–23.0) for diagnosis of COVID-19 including 84 in mild group and 24 in severe group. Of them, 6.5% were premature and 22.2% had severe infection. There were no deaths. The most common clinical manifestations were fever (88.9%) and cough (55.6%), with 5 cases (4.6%) complicated by pneumonia. 4 cases (3.7%) received respiratory support, including 2 cases of high-flow oxygen and 2 cases of non-invasive ventilation. Gestational age at birth (OR: 0.615; 95% CI: 0.393–0.961), neutrophil count (NEU) (OR:0.576; 95% CI : 0.344–0.962) and lymphocyte count (LYM) (OR: 0.159; 95% CI: 0.063–0.401) were independent risk factors for severe COVID-19. The combination of NEU and LYM had the largest receiver operating characteristic area under the curve [0.912 (95% CI:0.830–0.993)] for identifying severe COVID-19, with a sensitivity of 0.833 and a specificity of 0.917.Conclusions The general presentations and outcomes of neonatal COVID-19 caused by Omicron variant were not severe and very few patients required respiratory support. The simultaneous decrease in NEU and LYM can be used to identify severe infection.

Impact of a postpartum care rehabilitation program to prevent postpartum depression at a secondary municipal hospital in Qingdao China: a cross-sectional study.

BACKGROUND: The emerging postpartum rehabilitation (PPR) program in Chinese hospitals characterized by applying ongoing medical care through traditional cultural practices shows a protective effect in early puerperium in China. This study explores the benefit of PPR program practices to postpartum depression (PPD) and the influencing factors for PPD among Chinese women during the first postnatal six weeks. METHODS: The cross-sectional study included 403 participants and was conducted in a Secondary Municipal Hospital in Qingdao, China, from 01 to 2018 to 31 December 2021. Information on this PPR program was collected during the six-weeks postpartum consultation, including the Edinburgh postnatal depression scale (EPDS) scores, the measurement results for diastasis recti abdominis, and the international physical activity questionnaire (long form) (IPAQ-L) scores. Logistic regression models were used to examine the effect of the PPR program on PPD among the local population. The secondary aim of this study was to investigate possible influencing factors for PPD, such as coronavirus disease 2019 (COVID-19), physical exercises, etc. RESULTS: PPR program has shown a positive effect in preventing PPD (p < 0.001) and diastasis recti prevalence (p < 0.001) during the six-weeks postnatal control in Qingdao, China. Better post-pregnancy weight reduction (p = 0.04) and higher metabolic equivalent of task (MET) value (p < 0.001) were noticed in the non-PPR group. Furthermore, lower PPD risk was associated with factors such as longer relationship duration years (2-5 years) (p = 0.04) and exercising one to three times a week (p = 0.01). A higher PPD risk was related to factors such as urinary incontinence during the postpartum period (p = 0.04) and subjective insomnia (p < 0.001). No significant effect was shown between COVID-19 and the EPDS score in this study (p = 0.50). CONCLUSION: Our results suggested that the PPR program provided protection against PPD and diastasis recti during the first six weeks after delivery. Urinary incontinence and subjective insomnia were the main risk factors for PPD, while longer relationship duration years and exercising one to three times a week gave protective effects to PPD. This study emphasized that a comprehensive ongoing medical care program, such as the PPR program, effectively improves women's mental and physical health in the early postpartum in China.

Study characteristical and regional influences on postpartum depression before vs. during the COVID-19 pandemic: A systematic review and meta-analysis

Background While the public is under serious pressure from the coronavirus disease 2019 (COVID-19), the final impact and possible contributing factors to postpartum depression symptoms (PPDS) remain unknown. Therefore, a meta-analysis to investigate the association between PPDS and the COVID-19 pandemic was carried out by comparing the data between pre-pandemic and post-pandemic timeframes and exploring the influencing factors. Methods This systematic review was prospectively registered and recorded in a study protocol (Prospero CRD42022336820, http://www.crd.york.ac.uk/PROSPERO). A comprehensive search of PubMed, Embase, Web of Science, CINALH, Cochrane and Scopus was cmpleted on June 6, 2022. Studies that compared the prevalence of PPD before and during the COVID-19 pandemic period were included. Results Of 1766 citations identified, 22 studies were included with 15,098 participates before the COVID-19 pandemic and 11,836 participants during the COVID-19 pandemic. Overall, the analysis showed that the epidemic crisis was associated with an increased prevalence of PPDS (OR: 0.81 [0.68, 0.95], P = 0.009, I2 = 59%). Subgroup analysis was conducted according to the study characteristics and regions. Within the study characteristics classification, results showed an obvious increase in the prevalence of PPDS during the COVID-19 pandemic if PPDS cutoff was defined as Edinburgh postpartum depression score (EPDS) ≥13 points (OR: 0.72 [0.52, 0.98], P = 0.03, I2 = 67%) and an increased prevalence in follow-ups that happened after 2 weeks (≥ 2 weeks postpartum) (OR: 0.81 [0.68, 0.97], P = 0.02, I2 = 43%). Selected studies that were high-quality (OR: 0.79 [0.64, 0.97], P = 0.02, I2 = 56%) demonstrated an increased prevalence of PPDS during the COVID-19 pandemic period. Sorting by regional factors, studies conducted in Asia (OR: 0.81 [0.70, 0.93], P = 0.003, I2 = 0%) showed an increase of PPDS prevalence rates during the COVID-19 period, while studies conducted in Europe (OR: 0.82 [0.59, 1.13], P = 0.23, I2 = 71%) and North America (OR: 0.66 [0.42, 1.02], P = 0.06, I2 = 65%) showed no significant difference. All studies conducted in the developed (OR: 0.79 [0.64, 0.98], P = 0.03, I2 = 65%) and developing countries (OR: 0.81 [0.69, 0.94], P = 0.007, I2 = 0%) showed an increase of PPDS during the COVID-19 period. Conclusions The COVID-19 pandemic is associated with an increased prevalence of PPDS, especially after long-term follow-up and among the group with a high possibility of depression. The negative influence from the pandemic, causing more PPDS was significant in studies from Asia.

Study characteristical and regional influences on postpartum depression before vs. during the COVID-19 pandemic: A systematic review and meta-analysis.

Background: While the public is under serious pressure from the coronavirus disease 2019 (COVID-19), the final impact and possible contributing factors to postpartum depression symptoms (PPDS) remain unknown. Therefore, a meta-analysis to investigate the association between PPDS and the COVID-19 pandemic was carried out by comparing the data between pre-pandemic and post-pandemic timeframes and exploring the influencing factors. Methods: This systematic review was prospectively registered and recorded in a study protocol (Prospero CRD42022336820, http://www.crd.york.ac.uk/PROSPERO). A comprehensive search of PubMed, Embase, Web of Science, CINALH, Cochrane and Scopus was cmpleted on June 6, 2022. Studies that compared the prevalence of PPD before and during the COVID-19 pandemic period were included. Results: Of 1766 citations identified, 22 studies were included with 15,098 participates before the COVID-19 pandemic and 11,836 participants during the COVID-19 pandemic. Overall, the analysis showed that the epidemic crisis was associated with an increased prevalence of PPDS (OR: 0.81 [0.68, 0.95], P = 0.009, I 2 = 59%). Subgroup analysis was conducted according to the study characteristics and regions. Within the study characteristics classification, results showed an obvious increase in the prevalence of PPDS during the COVID-19 pandemic if PPDS cutoff was defined as Edinburgh postpartum depression score (EPDS) ≥13 points (OR: 0.72 [0.52, 0.98], P = 0.03, I 2 = 67%) and an increased prevalence in follow-ups that happened after 2 weeks (≥ 2 weeks postpartum) (OR: 0.81 [0.68, 0.97], P = 0.02, I 2 = 43%). Selected studies that were high-quality (OR: 0.79 [0.64, 0.97], P = 0.02, I 2 = 56%) demonstrated an increased prevalence of PPDS during the COVID-19 pandemic period. Sorting by regional factors, studies conducted in Asia (OR: 0.81 [0.70, 0.93], P = 0.003, I 2 = 0%) showed an increase of PPDS prevalence rates during the COVID-19 period, while studies conducted in Europe (OR: 0.82 [0.59, 1.13], P = 0.23, I 2 = 71%) and North America (OR: 0.66 [0.42, 1.02], P = 0.06, I 2 = 65%) showed no significant difference. All studies conducted in the developed (OR: 0.79 [0.64, 0.98], P = 0.03, I 2 = 65%) and developing countries (OR: 0.81 [0.69, 0.94], P = 0.007, I 2 = 0%) showed an increase of PPDS during the COVID-19 period. Conclusions: The COVID-19 pandemic is associated with an increased prevalence of PPDS, especially after long-term follow-up and among the group with a high possibility of depression. The negative influence from the pandemic, causing more PPDS was significant in studies from Asia.

Challenges of nursing care for elderly intensive care unit patients: A qualitative study based on the third wave of COVID-19 in China (preprint)

Background: With the aging population and the ongoing pandemic, elderly patients have accounted for a large proportion of ICU admissions. The aim of this study was to explore current challenges in the nursing of elderly patients with severe COVID-19 through the experience of frontline nurses. Methods: A qualitative descriptive design was used. In-depth and semi-structured interviews with 18 ICU nurses were conducted to explore the experience of providing care for elderly patients with severe COVID-19 in the Omicron wave. Traditional thematic analysis was applied. Results: Three themes emerged as follows: (1) No plan survives first contact with the enemy, (2) Expectations vs. Reality, (3) Difficult to cover all aspects. Conclusions: Challenges can be encountered in different stages of providing care for elderly patients with severe COVID-19, including the preparation and training of knowledge and skills in the early stage, the challenges posed by old age in the diagnostic and treatment stage, and the challenges of psychological care and rehabilitation care.

The Effect of Videoconferencing on Second-Language Learning: A Meta-Analysis.

To mitigate the unexpected closure of educational institutions during the COVID-19 pandemic, e-learning has become a practical alternative to conventional face-to-face instruction. Videoconferencing, a synchronous computer-mediated communication (SCMC) approach, has been adopted as a venue to continue student learning activities. However, in the field of second-language (L2) education, videoconferencing had already been integrated into learning tasks, enabling L2 learners to have more opportunities to access authentic linguistic input and participate in interactions with more proficient users or native speakers of the target languages. Research has reported the pedagogical benefits of learners' L2 achievement that are provided by videoconferencing, whereas some studies have reached a different conclusion. To further ascertain the effectiveness of videoconferencing in L2 learning, meta-analysis can be used to provide statistical evidence of the significance of study results, which serves as a useful reference for the application of videoconferencing to current e-learning practices. Thus, systematic meta-analysis was used in this study to synthesize the findings from experimental and quasi-experimental research into the effectiveness of videoconferencing for L2 learning. Videoconferencing approaches led to positive, medium overall effects in control/experimental group comparisons (g = 0.35, p < 0.5) on the L2 language development of listening and speaking abilities. However, this conclusion is based on five studies and, thus, needs to be treated cautiously. The implications of the findings and suggestions for future studies are discussed.

A test-based strategy does not help inform return to work for healthcare workers with COVID-19 (preprint)

Objective: To assess the utility of a test-based approach to shorten isolation of healthcare workers with COVID-19 in the setting of the highly transmissible omicron variant Methods: Between December 24th, 2021, to January 5th, 2022 HCWs who tested positive for SARS-CoV-2 were re-tested at least five days since onset of symptoms. Results: 46 sequential fully COVID-19 vaccinated HCWs who had tested positive for SARS-CoV-2 underwent follow up testing. All the isolates were confirmed as omicron variants and only 4 (8.7%) were negative 5 days or more since onset of symptoms., Conclusions: Implementation of a test-based strategy is logistically challenging, increases costs and did not lead to shorter isolation in our institution.

Choosing the right tool for the job: A comprehensive assessment of serological assays for SARS-CoV-2 as surrogates for authentic virus neutralization (preprint)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in late 2019 and has since caused a global pandemic resulting in millions of cases and deaths. Diagnostic tools and serological assays are critical for controlling the outbreak, especially assays designed to quantitate neutralizing antibody levels, considered the best correlate of protection. As vaccines become increasingly available, it is important to identify reliable methods for measuring neutralizing antibody responses that correlate with authentic virus neutralization but can be performed outside of biosafety level 3 (BSL3) laboratories. While many neutralizing assays using pseudotyped virus have been developed, there have been few studies comparing the different assays to each other as surrogates for authentic virus neutralization. Here we characterized three enzyme-linked immunosorbent assays (ELISAs) and three pseudotyped VSV virus neutralization assays and assessed their concordance with authentic virus neutralization. The most accurate assays for predicting authentic virus neutralization were luciferase and secreted embryonic alkaline phosphatase (SEAP) expressing pseudotyped virus neutralizations, followed by GFP expressing pseudotyped virus neutralization, and then the ELISAs.

The Effect of Staggered Shift Scheduling Mode on Nurses in the COVID-19 Isolation Ward- A Cross Sectional Study.

In order to explore the rational use of nursing resources in the epidemic situation of COVID-19, we optimized the shift arrangement in COVID-19 isolation area and constructed a reasonable nursing schedule under the condition of limited human resources. Seventy-eight nurses were arranged in COVID-19 isolation area to work for 1 week according to 3 different shifts: 4 + 4 h, 6 h and 6 h (overlapping by 1 h). Through the form of questionnaire, the comprehensive job satisfaction of 3 different models were compared, and the nursing quality and the consumption of protective equipment under 3 different modes were analyzed. The results showed that the comprehensive job satisfaction and nursing quality of nurses in 6 h (overlapping by 1 h) shift mode were better than those in other shift modes, and the consumption of protective equipment was lower.

Differences in the clinical characteristics and outcomes of COVID-19 patients in the epicenter and peripheral areas of the pandemic from China: a retrospective, large-sample, comparative analysis (preprint)

Background: There is limited information on the difference in epidemiology, clinical characteristics and outcomes of the initial outbreak of the coronavirus disease (COVID-19) in Wuhan (the epicenter) and Sichuan (the peripheral area) in the early phase of the COVID-19 pandemic. This study was conducted to investigate the differences in the epidemiological and clinical characteristics of patients with COVID-19 between the epicenter and peripheral areas of pandemic and thereby generate information that would be potentially helpful in formulating clinical practice recommendations to tackle the COVID-19 pandemic. Methods: The Sichuan & Wuhan Collaboration Research Group for COVID-19 established two retrospective cohorts that separately reflect the epicenter and peripheral area during the early pandemic. The epidemiology, clinical characteristics and outcomes of patients in the two groups were compared. Multivariate regression analyses were used to estimate the adjusted odds ratios (aOR) with regard to the outcomes. Results: The Wuhan (epicenter) cohort included 710 randomly selected patients, and the peripheral (Sichuan) cohort included 474 consecutive patients. A higher proportion of patients from the periphery had upper airway symptoms, whereas a lower proportion of patients in the epicenter had lower airway symptoms and comorbidities. Patients in the epicenter had a higher risk of death (aOR=7.64), intensive care unit (ICU) admission (aOR=1.66), delayed time from illness onset to hospital and ICU admission (aOR=6.29 and aOR=8.03, respectively), and prolonged duration of viral shedding (aOR=1.64). Conclusions: The worse outcomes in the epicenter could be explained by the prolonged time from illness onset to hospital and ICU admission. This could potentially have been associated with elevated systemic inflammation secondary to organ dysfunction and prolonged duration of virus shedding independent of age and comorbidities. Thus, early supportive care could achieve better clinical outcomes.

Seroprevalence of immunoglobulin M and G antibodies against SARS-CoV-2 in ophthalmic patients (preprint)

Using serological test to estimate the prevalence and infection potential of coronavirus disease 2019 in ocular diseases patients help understand the relationship between ocular diseases and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We conducted a cross-sectional study assaying the IgG and IgM antibodies in 1331 individuals with ocular diseases by using a magnetic chemiluminescence enzyme immunoassay kit, during the period from February 2020 to May 2020. In our study, the seroposivity in total ocular disease patients was 0.83% (11/1331). The patients with different ocular diseases including xerophthalmia, keratitis, conjunctival cyst, cataract, glaucoma, refractive error, strabismus and others had seroposivity of 2.94%, 12.5%, 25%, 4.41%, 2.63%, 1.6%, 2.22% and 0%, respectively. Among that, two ocular surface disease groups (keratitis and conjunctival cyst) had higher seroprevalence compared with others. All the participants were reverse transcription polymerase chain reaction negative for SARS-CoV-2 from throat swabs. Our study evaluated the seroprevalence in patients with different ocular diseases, which will help us understand the relationship between ocular disease and SARS-CoV-2 infection. Furthermore, the serological test for the presence of IgM and/or IgG antibodies against SARS-CoV-2 might provide accurate estimate of the prevalence of SARS-CoV-2 infection in patients with ocular diseases.

Analysis of 4 imaging features in patients with COVID-19 (preprint)

Background: The aim of this was to analyze 4 chest CT imaging features of patients with coronavirus disease 2019 (COVID-19) in Shenzhen, China so as to improve the diagnosis of COVID-19. Methods: Chest CT of 34 patients with COVID-19 confirmed by the nucleic acid test (NAT) were retrospectively analyzed. Analyses were performed to investigate the pathological basis of four imaging features(“feather sign”,“dandelion sign”,“pomegranate sign”, and “rime sign”) and to summarize the follow-up results. Results: There were 22 patients (65.2 %) with typical “feather sign”and 18 (52.9%) with “dandelion sign”, while few patients had “pomegranate sign” and “rime sign”. The “feather sign” and “dandelion sign” were composed of stripe or round ground-glass opacity(GGO), thickened blood vessels, and small-thickened interlobular septa. The “pomegranate sign” was characterized as follows: the increased range of GGO, the significant thickening of the interlobular septum, complicated with a small amount of punctate alveolar hemorrhage. The “rime sign” was characterized by numerous alveolar edemas. Microscopically, the wall thickening, small vascular proliferation, luminal stenosis, and occlusion, accompanied by interstitial infiltration of inflammatory cells, as well as numerous pulmonary interstitial fibrosis and partial hyaline degeneration were observed. Repeated chest CT revealed the mediastinal lymphadenectasis in one patient. Re-examination of the NAT showed another positive anal swab in two patients. Conclusion: “Feather sign” and “dandelion sign” were typical chest CT features in patients with COVID-19; “pomegranate sign” was an atypical feature, and “rime sign” was a severe feature. In clinical work, accurate identification of various chest CT signs can help to improve the diagnostic accuracy of COVID-19 and reduce the misdiagnosis or missed diagnosis rate.

The Role of Fever Clinic During the COVID-19 Pandemic: A Case Study of 1034 Febrile Patients (preprint)

Background Since winter of 2019, when coronavirus disease 2019 (Covid-19) emerged in China and rapidly spread throughout the entire world, many fever clinics were rearranged and enlarged to triage febrile patients in China.Methods This study included fever clinic visits of Sichuan Provincial Peoples’ Hospital to summarize the characteristics of these febrile patients retrospectively.Results From 24th January to 31th March, 1034 fever clinic visits with 530 male and 504 female, were triaged, treated and recorded. About 64.9% of them were checked with body temperature higher than 37.3℃. Cough (25.0%) and sore throat (19.2%) were the most common symptoms in addition to fever. Chest CT scan was ordered for 900 patients, and 172 cases (16.6%) were found ground grass opacity, 134 (13.0%) found local patchy shadowing, and 26 (2.5%) found bilateral patchy shadowing. At last 851 patients (82.3%) were excluded for COVID-19 or other severe diseases. Eighty patients (7.7%) were admitted to hospitalization for other conditions. One hundred and three (9.9%) patients were suspected or confirmed of COVID-19 at fever clinic, and then admitted to isolation ward.Conclusions The result of this study again verified the extraordinary role of fever clinics in pandemics. When confronted with a mass of unknown febrile patients, a well organized fever clinic may avoid the frustration of all medical staffs.

The Role of Fever Clinic During the COVID-19 Pandemic: A case study of 1034 febrile patients (preprint)

Background Since winter of 2019, when coronavirus disease 2019 (Covid-19) emerged in China and rapidly spread throughout the entire world, many fever clinics were rearranged and enlarged to triage febrile patients in China.Methods This study included fever clinic visits of Sichuan Provincial Peoples’ Hospital to summarize the characteristics of these febrile patients retrospectively.Results From 24th January to 31th March, 1034 fever clinic visits with 530 male and 504 female, were triaged, treated and recorded. About 64.9% of them were checked with body temperature higher than 37.3℃. Cough (25.0%) and sore throat (19.2%) were the most common symptoms in addition to fever. Chest CT scan was ordered for 900 patients, and 172 cases (16.6%) were found ground grass opacity, 134 (13.0%) found local patchy shadowing, and 26 (2.5%) found bilateral patchy shadowing. At last 851 patients (82.3%) were excluded for COVID-19 or other severe diseases. Eighty patients (7.7%) were admitted to hospitalization for other conditions. One hundred and three (9.9%) patients were suspected or confirmed of COVID-19 at fever clinic, and then admitted to isolation ward.Conclusions The result of this study again verified the extraordinary role of fever clinics in pandemics. When confronted with a mass of unknown febrile patients, a well organized fever clinic may avoid the frustration of all medical staffs.

Comorbidity and its impact on 1,590 patients with COVID-19 in China: A Nationwide Analysis (preprint)

Objective: To evaluate the spectrum of comorbidities and its impact on the clinical outcome in patients with coronavirus disease 2019 (COVID-19). Design: Retrospective case studies Setting: 575 hospitals in 31 province/autonomous regions/provincial municipalities across China Participants: 1,590 laboratory-confirmed hospitalized patients. Data were collected from November 21st, 2019 to January 31st, 2020. Main outcomes and measures: Epidemiological and clinical variables (in particular, comorbidities) were extracted from medical charts. The disease severity was categorized based on the American Thoracic Society guidelines for community-acquired pneumonia. The primary endpoint was the composite endpoints, which consisted of the admission to intensive care unit (ICU), or invasive ventilation, or death. The risk of reaching to the composite endpoints was compared among patients with COVID-19 according to the presence and number of comorbidities. Results: Of the 1,590 cases, the mean age was 48.9 years. 686 patients (42.7%) were females. 647 (40.7%) patients were managed inside Hubei province, and 1,334 (83.9%) patients had a contact history of Wuhan city. Severe cases accounted for 16.0% of the study population. 131 (8.2%) patients reached to the composite endpoints. 399 (25.1%) reported having at least one comorbidity. 269 (16.9%), 59 (3.7%), 30 (1.9%), 130 (8.2%), 28 (1.8%), 24 (1.5%), 21 (1.3%), 18 (1.1%) and 3 (0.2%) patients reported having hypertension, cardiovascular diseases, cerebrovascular diseases, diabetes, hepatitis B infections, chronic obstructive pulmonary disease, chronic kidney diseases, malignancy and immunodeficiency, respectively. 130 (8.2%) patients reported having two or more comorbidities. Patients with two or more comorbidities had significantly escalated risks of reaching to the composite endpoint compared with those who had a single comorbidity, and even more so as compared with those without (all P<0.05). After adjusting for age and smoking status, patients with COPD (HR 2.681, 95%CI 1.424-5.048), diabetes (HR 1.59, 95%CI 1.03-2.45), hypertension (HR 1.58, 95%CI 1.07-2.32) and malignancy (HR 3.50, 95%CI 1.60-7.64) were more likely to reach to the composite endpoints than those without. As compared with patients without comorbidity, the HR (95%CI) was 1.79 (95%CI 1.16-2.77) among patients with at least one comorbidity and 2.59 (95%CI 1.61-4.17) among patients with two or more comorbidities. Conclusion: Comorbidities are present in around one fourth of patients with COVID-19 in China, and predispose to poorer clinical outcomes.

Clinical characteristics of 2019 novel coronavirus infection in China (preprint)

Background: Since December 2019, acute respiratory disease (ARD) due to 2019 novel coronavirus (2019-nCoV) emerged in Wuhan city and rapidly spread throughout China. We sought to delineate the clinical characteristics of these cases. Methods: We extracted the data on 1,099 patients with laboratory-confirmed 2019-nCoV ARD from 552 hospitals in 31 provinces/provincial municipalities through January 29th, 2020. Results: The median age was 47.0 years, and 41.90% were females. Only 1.18% of patients had a direct contact with wildlife, whereas 31.30% had been to Wuhan and 71.80% had contacted with people from Wuhan. Fever (87.9%) and cough (67.7%) were the most common symptoms. Diarrhea is uncommon. The median incubation period was 3.0 days (range, 0 to 24.0 days). On admission, ground-glass opacity was the typical radiological finding on chest computed tomography (50.00%). Significantly more severe cases were diagnosed by symptoms plus reverse-transcriptase polymerase-chain-reaction without abnormal radiological findings than non-severe cases (23.87% vs. 5.20%, P<0.001). Lymphopenia was observed in 82.1% of patients. 55 patients (5.00%) were admitted to intensive care unit and 15 (1.36%) succumbed. Severe pneumonia was independently associated with either the admission to intensive care unit, mechanical ventilation, or death in multivariate competing-risk model (sub-distribution hazards ratio, 9.80; 95% confidence interval, 4.06 to 23.67). Conclusions: The 2019-nCoV epidemic spreads rapidly by human-to-human transmission. Normal radiologic findings are present among some patients with 2019-nCoV infection. The disease severity (including oxygen saturation, respiratory rate, blood leukocyte/lymphocyte count and chest X-ray/CT manifestations) predict poor clinical outcomes.