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3.
Can Respir J ; 2020: 2045341, 2020.
Article in English | MEDLINE | ID: mdl-33005276

ABSTRACT

Objective: Coronavirus disease 2019 (COVID-19), caused by the novel coronavirus SARS-CoV-2, was first identified in December 2019 in Wuhan, China, and has since spread globally, resulting in an ongoing pandemic. However, the study of asymptomatic patients is still rare, and the understanding of its potential transmission risk is still insufficient. In this study, epidemiological investigations were conducted in the Zhejiang province to understand the epidemiology and clinical characteristics of asymptomatic patients with COVID-19. Methods: This retrospective study was carried out on 22 asymptomatic patients and 234 symptomatic patients with COVID-19 who were hospitalized in Zhejiang Duodi Hospital from January 21 to March 16, 2020. The characteristics of epidemiology, demography, clinical manifestations, and laboratory data of mild patients were compared and analyzed. Results: The median age was 28 years in asymptomatic patients and 48 years in symptomatic patients. The proportion who were female was 77.3% in asymptomatic patients and 36.3% in symptomatic patients (p < 0.001). The proportion of patients with coexisting diseases was 4.5% in asymptomatic patients and 38.0% in symptomatic patients (p=0.002). The proportion of patients with increased CRP was 13.6% in the asymptomatic group and 61.1% in the symptomatic group (p < 0.001). The proportion of patients received antiviral therapy was 45.5% in the asymptomatic group and 97.9% in the symptomatic group (p < 0.001). The proportion of patients received oxygen therapy was 22.7% in the asymptomatic group and 99.1% in symptomatic patients (p < 0.001). By March 16, 2020, all patients were discharged from the hospital, and no symptoms had appeared in the asymptomatic patients during hospitalization. The median course of infection to discharge was 21.5 days in asymptomatic patients and 22 days in symptomatic patients. Conclusions: Asymptomatic patients are also infectious; relying only on clinical symptoms, blood cell tests, and radiology examination will lead to misdiagnosis of most patients, leading to the spread of the virus. Investigation of medical history is the best strategy for screening asymptomatic patients, especially young people, women, and people without coexisting disease, who are more likely to be asymptomatic when infected. Although the prognosis is good, isolation is critical for asymptomatic patients, and it is important not to end isolation early before a nucleic acid test turns negative.


Subject(s)
Asymptomatic Diseases , Coronavirus Infections , Disease Transmission, Infectious/prevention & control , Pandemics , Pneumonia, Viral , Risk Assessment/methods , Adult , Age Factors , Asymptomatic Diseases/epidemiology , Asymptomatic Diseases/therapy , Betacoronavirus/isolation & purification , COVID-19 , China/epidemiology , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Diagnostic Errors/prevention & control , Female , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Oxygen Inhalation Therapy/statistics & numerical data , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Prognosis , SARS-CoV-2 , Sex Factors , COVID-19 Drug Treatment
4.
EClinicalMedicine ; 26: 100492, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32864590

ABSTRACT

BACKGROUND: It has been reported that a fraction of recovered coronavirus disease 2019(COVID-19) patients have retested positive for SARS-CoV-2. Clinical characteristics and risk factors for retesting positive have not been studied extensively. METHODS: In this retrospective, single-center cohort study, we included adult patients (≥ 18 years old) diagnosed as COVID-19 in Affiliated Yueqing Hospital, Wenzhou Medical University, Zhejiang, China. All the patients were discharged before March 31, 2020, and were re-tested for SARS-CoV-2 RNA by real-time reverse-transcriptase polymerase-chain-reaction (RT-PCR) after meeting the discharge criteria. We retrospectively analyzed this cohort of 117 discharged patients and analyzed the differences between retest positive and negative patients in terms of demographics, clinical characteristics, laboratory findings, chest computed tomography (CT) features and treatment procedures. FINDINGS: Compared with the negative group, the positive group had a higher proportion of patients with comorbidities (Odds Ratio(OR) =2·12, 95% Confidence Interval(CI) 0·48-9·46; p = 0·029), longer hospital stay (OR=1·21, 95% CI 1·07-1·36; p = 0·008), a higher proportion of patients with lymphocytopenia (p = 0·036), a higher proportion of antibiotics treatment (p = 0·008) and glucocorticoids treatment (p = 0·003). Multivariable regression showed increasing odds of positive SARS-CoV-2 retest after discharge associated with longer hospital stay (OR=1·22, 95% CI 1·08-1·38; p = 0·001), and lymphocytopenia (OR=7·74, 95% CI 1·70-35·21; p = 0·008) on admission. INTERPRETATION: Patients with COVID-19 who met discharge criteria could still test positive for SARS-CoV-2 RNA. Longer hospital stay and lymphopenia could be potential risk factors for positive SARS-CoV-2 retest in COVID-19 patients after hospital discharge. FUNDING: Natural Science Foundation of Zhejiang Province, Medical Scientific Research Fund of Zhejiang Province, Wenzhou science and technology project.

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