ABSTRACT
Background Tianmen had the highest case-fatality rate (CFR) among all the cities in China early in the transmission of SARS-CoV-2, but little is known about the details of the epidemic in Tianmen. Our study aims to reveal the causes of the high CFR from the aspects of clinical features, medical resources, and epidemic situation.Methods In this study, we report the admission and outcomes of 341 patients with confirmed COVID-19 who were admitted and hospitalized in the hospital (The First People's Hospital of Tianmen) from January 14 to February 25, 2020. Epidemic information and medical resources across different regions were collected and compared. Results All deaths from COVID-19 in Tianmen occurred in the hospital, and the proportion of patients with critical (8.5%) symptoms in the hospital is higher than the average in China. In addition, the number of affected patients in Tianmen is quite low, but the hospital and the whole city had the highest CFR in the early stage of the epidemic. Completely different from the stable CFR in Hubei Province, the CFR of COVID-19 in the hospital and city dropped dramatically, from the largest value in China to a more average level, within a few days. Analysis of government public documents showed that the per capita medical resources in Tianmen are worse than those of Wuhan and Hubei. Conclusions Our findings suggest that the inadequate capacity to respond to public health emergencies caused by relatively scarce health-care resources is a crucial factor contributing to the higher CFR of infectious diseases in regions with lower economic levels. Such countries and territories should implement strategies earlier to minimize the danger of COVID-19.