A new report about 138 hospitalized patients infected with the virus in Wunan helps explain how the virus spreads and progresses. The report was published in “The Journal of the American Medical Association” (aka JAMA) on Friday, Feb. 7, 2020. This is the largest case series of hospitalized patients with the new coronavirus. If you don’t understand a medical term just press on the term and a definition will come up.
The hospital was Zhongnan Hospital of Wuhan University. The patients were in hospital from January 1 to January 28.
A ✅single patient in the hospital in Wunan ✅infected 10 healthcare workers and ✅four patients with the novel coronavirus. This patient had been in a surgery ward because of abdominal symptoms. The coronavirus had not been initially suspected in this patient because of the unusual presentation. Four other patients in this same abdominal surgery ward came down with the coronavirus. It’s presumed these other patients contracted the coronavirus from the first patient. This is reminiscent of the super-spreaders from the other coronavirus outbreaks of SARS and MERS. In these previous coronavirus outbreaks there were patients that infected many other patients. It’s not understood how this happens. Superspreaders had spread SARS and MERS to many other hospitalized patients.
The patients were ages 22 to 92 years old and the median age was 56 years old. 54.3% were men.
Human to human transmission was 41%. âś…41% of the patients are thought to have caught the virus while in the hospital. 17 (12.3%) of these patients had been admitted for other illnesses and there were 40 (29%) sickened healthcare workers.
Common symptoms included:
fever (136–98.6%)
fatigue (96-69.6%)
dry cough (82-59.4%)
lymphophenia (lymphocyte count, 0.8 x 10 9th power) (97 patients-70,3%)
prolonged prothrombin time (13.0 seconds) (80 patients-58%)
elevated lactase dehydrogenase (55 patients-39.9%)
CT Scan showing bilateral patchy shadows or ground glass opacity in the lungs (all patients-100%)
Patients receiving:
âś…Antiviral therapy with oseltamiver (124 89.9%) TAMIFLU
Antibacterial therapy moxifloxacin ( 89-64.4%)
cephtriaxone ( 34-24.6%)
azithromycin (25-18.1%)
Steroids (62-44.9%)
Kidney replacement therapy-2
Mechanical ventilation 17-(-47.2%)
oxygen
Complications requiring transfer to ICU:
36 patients-26.1%
acute respiratory distress syndrome (aka ARDS) (22- 61.1%)
arrhythmia (16-44.4%)
✅“Compared with non-ICU patients, patients who received ICU care had numerous laboratory abnormalities. ✅✅These abnormalities suggest that 2019-nCoV infection may be associated with cellular immune deficiency, coagulation activation, myocardia injury, hepatic injury, and kidney injury. These laboratory abnormalities are similar to those previously observed in patients with MERS-CoV and SARS-CoV infection.”
During hospitalization, most patients had marked lymphopenia, and nonsurvivors developed more severe lymphopenia over time. White blood cell counts and neutrophil counts were higher in nonsurvivors than those in survivors. The level of D-dimer was higher in nonsurvivors than in survivors. Similarly, as the disease progressed and clinical status deteriorated, the levels of blood urea and creatinine progressively increased before death.
shock (11-30.6%)
Patients with underlying comorbidities 26-72.6%
anorexia 24-66.7%, dypnea 23-63.9%,
Median time from initial symptoms to admission to ICU - 10 days
102 patients were not treated in ICU but were admitted to isolation wards
47 patients were discharged (34.1%)
âś…6 died, overall mortality 4,3%
âś…other patients were still in hospital at the conclusion of the study-85 (61.6%)
Median hospital stay 10 days, from 7-14 days.
“ Of the 138 patients, 64 (46.4%) had 1 or more coexisting medical conditions. Hypertension (43 [31.2%]), diabetes (14 [10.1%]), cardiovascular disease (20 [14.5%]), and malignancy (10 [7.2%]) were the most common coexisting conditions.”
“During hospitalization, most patients had marked lymphopenia (low number of white blood cells in the blood), and nonsurvivors developed more severe lymphopenia over time. White blood cell counts and neutrophil (the most abundant type of white blood cells) counts were higher in nonsurvivors than those in survivors. The level of D-dimer (checked to detect clots) was higher in nonsurvivors than in survivors. Similarly, as the disease progressed and clinical status deteriorated, the levels of blood urea and creatinine progressively increased before death.”
“Presumed hospital-related transmission was suspected if a cluster of medical profes- sionals or hospitalized patients in the same wards became infected in a certain time pe- riod and a possible source of infection could be tracked.”
The report notes that there was âś…rapid person to person spread in the hospitalized patients. It is thought that part of the reason for the spreading was that physicians failed to take measures to prevent the virus from spreading from the first patient with the atypical abdominal virus becaus the physicians did not know they were dealing with coronavirus with this patient. By the time it was realized the patient had coronavirus it was too late to contain within the hospital.
âś…Close to 10% of the patients did not initially present with the usual symptoms of the virus; cough and fever, instead presenting with nausea, diarrhea and other symptoms including headache, dizziness and abdominal pain. It took 1-2 days before fever and cough. The virus was detected in stool samples.
âś…Some patients who first seemed only mildly illâś… took a turn for the worse some days to a week afterwards. Median time for first time shortness of breath was five days. âś…It was eight days until severe breathing trouble. It is not safe to assume that patients doing well initially are going to continue to to do well.
Patents with diabetes, cancer, heart disease tended to become sicker than patients that were healthy and younger.
26% of the 138 needed intensive care. Their median age was 66 needing intensive care. The median age of patients that did not require intensive care was 51.
The death rate for the 138 patients was 4.3%. This figure is higher than for estimated reports from other areas of China.
“The dynamic profile of laboratory findings was tracked in 33 patients with NCIP (5 non- survivors and 28 survivors). ✅In the nonsurvivors, the neutrophil count, D-dimer, blood urea, and creatinine levels continued to increase, and the lymphocyte counts continued to decrease until death occurred.✅✅ Neutrophilia may be related to cytokine storm induced by virus invasion, coagulation activation could have been related to sustained inflammatory response, and acute kidney injury could have been related to direct effects of the virus, hypoxia, and shock. The 3 pathologic mechanisms may be associated with the death of patients with NCIP.”
“Until now, no specific treatment has been recommended for coronavirus infection except for meticulous supportive care. Currently, the approach to this disease is to control the source of infection; use of personal protection precaution to reduce the risk of transmission; and early diagnosis, isolation, and supportive treatments for affected patients. ✅✅Antibacterial agents are ineffective. In addition,✅✅ no antiviral agents have been found to provide benefit for treating SARS and MERS.✅✅ All of the patients in this study received antibacterial agents, ✅✅90% received antiviral therapy, and ✅✅45% received methylprednisolone. The dose of oseltamivir and methylprednisolone varied depending on disease severity. However,✅✅ no effective outcomes were observed.”
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https://jamanetwork.com/journals/jama/fullarticle/2761044
Zhiyong Peng, MD, Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China (Pengzy5@hot- mail.com).
Accepted for Publication: February 3, 2020.
Published Online: February 7, 2020. doi:10.1001/jama.2020.1585
February 7, 2020
Clinical Characteristics of 138 Hospital ized Patients With 2019 Novel Coronavirus Infected Pneumonia in Wuhan, China
Dawei Wang, MD1; Bo Hu, MD1; Chang Hu, MD1; et al
ôŹ°” Author Affiliations | Article Information
JAMA. Published online February 7, 2020. doi:10.1001/jama.2020.1585
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https://www.nytimes.com/2020/02/07/health/coronavirus-patients.html
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