Spectrum and Clinical Characteristics of Symptomatic and Asymptomatic Coronavirus Disease 2019 (COVID-19) With and Without Pneumonia (preprint)

BackgroundCoronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic. Based on symptoms, COVID-19 cases can be classified as symptomatic or asymptomatic. However, there is limited information about the differences between COVID-19 patients with and without pneumonia. Our study aimed to further discuss the spectrum and clinical characteristics of symptomatic and asymptomatic COVID-19 patients with and without pneumonia. MethodsIn China, all COVID-19 cases are hospitalized in designated hospitals until two continuous negative oropharyngeal swabs obtained, which allows the professional monitoring of symptoms and clinical characteristics. We stratified all COVID-19 cases in our database, and evaluated clinical characteristics in different COVID-19 subgroups (symptomatic with pneumonia, symptomatic without pneumonia, asymptomatic with pneumonia and asymptomatic without pneumonia). ResultsAccording to symptoms and laboratory and radiologic findings, COVID-19 cases were defined as symptomatic with pneumonia, symptomatic without pneumonia, asymptomatic with pneumonia or asymptomatic without pneumonia. There were differences in the clinical characteristics and prognosis among the four groups. Both noninvasive (18, 4.2%) and invasive mechanical ventilation (11, 2.6%) were applied in only the symptomatic with pneumonia group. Likewise, extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) were applied in only the symptomatic with pneumonia group. There were no differences in the durations of viral shedding and hospitalization among the four groups.ConclusionWe have defined a comprehensive spectrum of COVID-19 with and without pneumonia. The symptomatic with pneumonia group consumed more medical resources than the other groups, and extra caution and monitoring should be applied in this group. The asymptomatic COVID-19 group had a similar viral shedding duration as the symptomatic COVID-19 group.Trial registrationNot available

Comparative Clinical Characteristics Among Different Age Group of Adult COVID-19 Patients (preprint)

Introduction: Coronavirus disease (COVID-19) is a global infectious disease with a large burden of illness and high healthcare costs.Objectives: This study aimed to compare clinical features among adult COVID-19 patients in different age groups.Methods: Laboratory-confirmed adult COVID-19 infection cases between Dec 31, 2019 to March 8, 2020obtained from Neighboring Cities. Patients weredivided into five age groups:age＜30, 30-40, 40-50, 50-65, ≥65 y (elderly). Age, sex, history of chronic disease and epidemiology, symptoms, laboratory tests, and outcomes were compared among different agegroups. Binary logistic regression analysis was conducted to evaluate associated factors for severe or critical type.Results:We studied 299 cases. Median (IQR) age was 44(34,54) and 158 (53%) were male. Percent of bilateral involvement on chest radiographs was increased significantly with older age (p=0.005). 53.3% of 30-40 years, 50% of 40-50 years, 36.6% of ＜30 years and 36.2% of 50-60 years were imported case, none of the elderly were imported case. Among all the observed symptoms, only symptom of dyspnea was significantly different between the elderly group and other groups (p < 0.001).Proportion of severe or critical type was 2.4%, 5.3%, 9.5%, 14.5%, and 35%in patients with age＜30, 30-40, 40-50, 50-65, ≥65 (p < 0.001), respectively. At this point, ICU admissionrate, ARDSand shock rate and on medical treatment rate was increased especially in patients ≥65 years. 285 patients (95.3%) were curedand discharged, 12 patients (4.0%) were still on medical treatment in hospital. There were 2 (0.67%) deaths; these occurred among persons ≥65 y (p < 0.001). Old age, high HR on admission,high respiratory rate on admission, and history of chronic heart diseasewere independently associated with severe or critical .Conclusions:Proportion of severe or critical type increased with old age groups. Adults with old ageand high HR, R rate in admission and history of chronic heart disease were associated withsevere or criticaltype in COVID-19.

Comparative Clinical Characteristics Among Different Age Group of Adult COVID-19 Patients (preprint)

Introduction: Coronavirus disease (COVID-19) is a global infectious disease with a large burden of illness and high healthcare costs.Objectives: This study aimed to compare clinical features among adult COVID-19 patients in different age groups.Methods: Laboratory-confirmed adult COVID-19 infection cases between Dec 31, 2019 to March 8, 2020 obtained from Neighboring Cities. Patients were divided into five age groups: age༜30, 30–40, 40–50, 50–65, ≥ 65 y (elderly). Age, sex, history of chronic disease and epidemiology, symptoms, laboratory tests, and outcomes were compared among different age groups. Binary logistic regression analysis was conducted to evaluate associated factors for severe or critical type.Results: We studied 299 cases. Median (IQR) age was 44 (34,54) and 158 (53%) were male. Percent of bilateral involvement on chest radiographs was increased significantly with older age (p = 0.005). 53.3% of 30–40 years, 50% of 40–50 years, 36.6% of ༜30 years and 36.2% of 50–60 years were imported case, none of the elderly were imported case. Among all the observed symptoms, only symptom of dyspnea was significantly different between the elderly group and other groups (p < 0.001). Proportion of severe or critical type was 2.4%, 5.3%, 9.5%, 14.5%, and 35% in patients with age༜30, 30–40, 40–50, 50–65, ≥ 65 (p < 0.001), respectively. At this point, ICU admission rate, ARDS and shock rate and on medical treatment rate was increased especially in patients ≥ 65 years. 285 patients (95.3%) were cured and discharged, 12 patients (4.0%) were still on medical treatment in hospital. There were 2 (0.67%) deaths; these occurred among persons ≥ 65 y (p < 0.001). Old age, high HR on admission, high respiratory rate on admission, and history of chronic heart disease were independently associated with severe or critical .Conclusions: Proportion of severe or critical type increased with old age groups. Adults with old age and high HR, R rate in admission and history of chronic heart disease were associated with severe or critical type in COVID-19.

Symptoms at disease onset predict prognosis in COVID-19 disease (preprint)

Background: The main clinical manifestations of coronavirus disease 2019 (COVID-19) onset are respiratory symptoms, including cough, sputum and dyspnea. However, a significant proportion of patients initially manifested extra-respiratory symptoms, such as fever, myalgia and diarrhea. Here we compared the different characteristics and outcomes between the patients with respiratory symptoms and extra-respiratory symptoms at illness onset.Methods: The patients admitted to the respiratory departments from eight hospitals out of Wuhan with nucleic acid-positive of severe acute respiratory syndrome coronavirus (SARS-CoV-2) were recruited. Epidemiological information, clinical manifestations, laboratory findings, and radiological characteristics, treatment regimens and outcomes data were recorded and analyzed.Results: The median age of the recruited 541 subjects was 43 years (IQR, 33-55). Of the 541 subjects, 404 (74.5%) subjects had initial symptom that were respiratory, while 137 (25.5%) subjects had extra-respiratory symptoms. Respiratory COVID-19 subjects had more secondary bacterial infections (p<0.001), needed the intensive care unit more (p=0.005), non-invasive ventilation more (p=0.004), developed ARDS more (p=0.001) and needed longer to recover (p=0.003) compared to predominately extra-respiratory COVID-19 subjects. The multivariate model showed that age (OR = 1.04, p = 0.01) dyspnea (OR = 4.91, p < 0.001) and secondary bacterial infection (OR = 19.8, p < 0.001) were independently associated with development of ARDS among COVID-19 patients.Conclusion: we identify COVID-19 subjects with dyspnea at disease onset have worse prognosis. We also demonstrate age and secondary bacterial infections to be independently associated with ARDS development in subjects with COVID-19.

Comparative clinical characteristics among different age group of adult COVID-19 Patients (preprint)

Introduction: Coronavirus disease (COVID-19) is a global infectious disease with a large burden of illness and high healthcare costs.Objectives: This study aimed to compare clinical features among adult COVID-19 patients in different age groups.Methods: Laboratory-confirmed adult COVID-19 infection cases between Dec 31, 2019 to March 8, 2020 obtained from Neighboring Cities. Patients were divided into five age groups: age＜30, 30-40, 40-50, 50-65, ≥65 y (elderly). Age, sex, history of chronic disease and epidemiology, symptoms, laboratory tests, and outcomes were compared among different age groups. Binary logistic regression analysis was conducted to evaluate associated factors for severe or critical type.Results: We studied 299 cases. Median (IQR) age was 44 (34,54) and 158 (53%) were male. Percent of bilateral involvement on chest radiographs was increased significantly with older age (p = 0.005). 53.3% of 30-40 years, 50% of 40-50 years, 36.6% of ＜30 years and 36.2% of 50-60 years were imported case, none of the elderly were imported case. Among all the observed symptoms, only symptom of dyspnea was significantly different between the elderly group and other groups (p < 0.001). Proportion of severe or critical type was 2.4%, 5.3%, 9.5%, 14.5%, and 35% in patients with age＜30, 30-40, 40-50, 50-65, ≥65 (p < 0.001), respectively.  At this point, ICU admission rate, ARDS and shock rate and on medical treatment rate was increased especially in patients ≥65 years. 285 patients (95.3%) were cured and discharged, 12 patients (4.0%) were still on medical treatment in hospital. There were 2 (0.67%) deaths; these occurred among persons ≥65 y (p < 0.001). Old age, high HR on admission, high respiratory rate on admission, and history of chronic heart disease were independently associated with severe or critical .Conclusions: Proportion of severe or critical type increased with old age groups. Adults with old age and high HR, R rate in admission and history of chronic heart disease were associated with severe or critical type in COVID-19.