Coronavirus Disease 2019 Cases In Wuhan Research Articles

The risk factors for mortality of diabetic patients with severe COVID-19: A retrospective study of 167 severe COVID-19 cases in Wuhan.

Diabetes is one of the most common comorbidities in adult patients with coronavirus disease 2019 (COVID-19). This study aimed to analyze the mortality risk factors of diabetic patients with COVID-19. A total of 167 patients with severe COVID-19, including 55 diabetic patients and 112 nondiabetic patients at Tongji Hospital, Wuhan, China from January 28, 2020, to March 10, 2020, were collected. The laboratory, radiological, management information, and medical history was retrospectively reviewed. Potential mortality risk factors in diabetic patients with COVID-19 were evaluated by the proportional hazard Cox model. The clinical information of 167 patients with severe COVID-19 was analyzed. The median age was 65.0 years. Approximately 32.9% of patients had diabetes. In total patients, older age, diabetes, and lymphocyte count were associated with increased risk of death. In diabetic patients, increased mortality was associated with decreased lymphocyte count (≤0.45×10⁹/L, HR 0.196, 95% CI 0.049-0.781, P = 0.021), lactate dehydrogenase >600 U/L (HR 8.010, 95% CI 1.540-41.670, P = 0.013), hsCRP >90 mg/L (HR 4.551, 95% CI 1.472-14.070, P = 0.009) and interleukin-10 >10 U/mL (HR 5.362, 95% CI 1.239-23.199, P = 0.025). COVID-19 patients with diabetes had a poor prognosis, especially when they had two or more of the following abnormalities (χ2 = 58.62, P<0.001): lymphocyte count was ≤0.45×10⁹/L, lactate dehydrogenase was >600 U/L, hsCRP was >90 mg/L and IL-10 was >10 U/mL. For diabetic patients with COVID-19, more attention should be paid to the dynamic monitoring of cytokine levels, and the control of hyperglycemia.

Effect of evacuation of Japanese residents from Wuhan, China, on preventing transmission of novel coronavirus infection: A modelling study

IntroductionIn late January 2020, the Japanese government carried out three evacuations by aircraft from Wuhan, China, to avoid further cases of coronavirus disease 2019 (COVID-19) among Wuhan's Japanese residents. Evacuation by aircraft may be an effective countermeasure against outbreaks of infectious diseases, but evidence of its effect is scarce. This study estimated how many COVID-19 cases were prevented among the Japanese residents of Wuhan by the evacuation countermeasure. MethodsWe constructed a SETAIR (susceptible-exposed-transitional-asymptomatic-infectious-recovered) model to capture the epidemic growth of COVID-19 cases in Wuhan to estimate the predicted number of COVID-19 cases among Wuhan's Japanese residents if evacuation had not occurred at the end of January. We used data on the number of COVID-19 cases confirmed in Hubei Province for the period Jan 20-Feb 16, 2020, and on the number of cases of Japanese residents who were evacuated by aircraft on Jan 29, 30, and 31. ResultsEleven imported COVID-19 cases were reported on Feb 1 from among the total 566 evacuees who returned to Japan. In the case of no evacuations being made, the cumulative number of COVID-19 cases among Wuhan's Japanese residents was estimated to reach 25 (95% CI [20,29]) on Feb 8 and 34 (95% CI [28,40]) on Feb 15. A 1-week delay in the evacuation might be led to 14 additional cases and a 2-week delay to 23 additional cases. ConclusionsEvacuation by aircraft can contribute substantially to reducing the number of infected cases in the initial stage of the outbreak.

Clinical features and the traditional Chinese medicine therapeutic characteristics of 293 COVID-19 inpatient cases.

Coronavirus disease 2019 (COVID-19) is now pandemic worldwide and has heavily overloaded hospitals in Wuhan City, China during the time between late January and February. We reported the clinical features and therapeutic characteristics of moderate COVID-19 cases in Wuhan that were treated via the integration of traditional Chinese medicine (TCM) and Western medicine. We collected electronic medical record (EMR) data, which included the full clinical profiles of patients, from a designated TCM hospital in Wuhan. The structured data of symptoms and drugs from admission notes were obtained through an information extraction process. Other key clinical entities were also confirmed and normalized to obtain information on the diagnosis, clinical treatments, laboratory tests, and outcomes of the patients. A total of 293 COVID-19 inpatient cases, including 207 moderate and 86 (29.3%) severe cases, were included in our research. Among these cases, 238 were discharged, 31 were transferred, and 24 (all severe cases) died in the hospital. Our COVID-19 cases involved elderly patients with advanced ages (57 years on average) and high comorbidity rates (61%). Our results reconfirmed several well-recognized risk factors, such as age, gender (male), and comorbidities, as well as provided novel laboratory indications (e.g., cholesterol) and TCM-specific phenotype markers (e.g., dull tongue) that were relevant to COVID-19 infections and prognosis. In addition to antiviral/antibiotics and standard supportive therapies, TCM herbal prescriptions incorporating 290 distinct herbs were used in 273 (93%) cases. The cases that received TCM treatment had lower death rates than those that did not receive TCM treatment (17/273 = 6.2% vs. 7/20= 35%, P = 0.0004 for all cases; 17/77= 22% vs. 7/9= 77.7%, P = 0.002 for severe cases). The TCM herbal prescriptions used for the treatment of COVID-19 infections mainly consisted of Pericarpium Citri Reticulatae, Radix Scutellariae, Rhizoma Pinellia, and their combinations, which reflected the practical TCM principles (e.g., clearing heat and dampening phlegm). Lastly, 59% of the patients received treatment, including antiviral, antibiotics, and Chinese patent medicine, before admission. This situation might have some effects on symptoms, such as fever and dry cough. By using EMR data, we described the clinical features and therapeutic characteristics of 293 COVID-19 cases treated via the integration of TCM herbal prescriptions and Western medicine. Clinical manifestations and treatments before admission and in the hospital were investigated. Our results preliminarily showed the potential effectiveness of TCM herbal prescriptions and their regularities in COVID-19 treatment.

Acute Pancreatitis as the Initial Manifestation in 2 Cases of COVID-19 in Wuhan, China.

Clinical data on coronavirus disease 2019 (COVID-19) with pancreatic injury are extremely limited. An acute manifestation of acute pancreatitis in COVID-19 has not been reported. We describe here 2 cases of COVID-19 with acute pancreatitis as the initial manifestation in Wuhan, China. Patient 1 died despite maximal mechanical ventilatory support and circulation support, while patient 2 was finally discharged after showing significant improvement. Low T cells in peripheral blood may indicate a poor outcome.

PC-FACS: COVID-19

PC-FACS (FastArticleCriticalSummaries forClinicians inPalliativeCare) provides hospice and palliative care clinicians with concise summaries of the most important findings from more than 100 medical and scientific journals. If you have colleagues who would benefit from receiving PCFACS, please encourage them to join the AAHPM at aahpm.org. Comments from readers are welcomed at pcfacs@aahpm.org.

Estimated Demand for US Hospital Inpatient and Intensive Care Unit Beds for Patients With COVID-19 Based on Comparisons With Wuhan and Guangzhou, China

Sustained spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has happened in major US cities. Capacity needs in cities in China could inform the planning of local health care resources. To describe and compare the intensive care unit (ICU) and inpatient bed needs for patients with coronavirus disease 2019 (COVID-19) in 2 cities in China to estimate the peak ICU bed needs in US cities if an outbreak equivalent to that in Wuhan occurs. This comparative effectiveness study analyzed the confirmed cases of COVID-19 in Wuhan and Guangzhou, China, from January 10 to February 29, 2020. Timing of disease control measures relative to timing of SARS-CoV-2 community spread. Number of critical and severe patient-days and peak number of patients with critical and severe illness during the study period. In Wuhan, strict disease control measures were implemented 6 weeks after sustained local transmission of SARS-CoV-2. Between January 10 and February 29, 2020, patients with COVID-19 accounted for a median (interquartile range) of 429 (25-1143) patients in the ICU and 1521 (111-7202) inpatients with serious illness each day. During the epidemic peak, 19 425 patients (24.5 per 10 000 adults) were hospitalized, 9689 (12.2 per 10 000 adults) were considered in serious condition, and 2087 (2.6 per 10 000 adults) needed critical care per day. In Guangzhou, strict disease control measures were implemented within 1 week of case importation. Between January 24 and February 29, COVID-19 accounted for a median (interquartile range) of 9 (7-12) patients in the ICU and 17 (15-26) inpatients with serious illness each day. During the epidemic peak, 15 patients were in critical condition and 38 were classified as having serious illness. The projected number of prevalent critically ill patients at the peak of a Wuhan-like outbreak in US cities was estimated to range from 2.2 to 4.4 per 10 000 adults, depending on differences in age distribution and comorbidity (ie, hypertension) prevalence. Even after the lockdown of Wuhan on January 23, the number of patients with serious COVID-19 illness continued to rise, exceeding local hospitalization and ICU capacities for at least a month. Plans are urgently needed to mitigate the consequences of COVID-19 outbreaks on the local health care systems in US cities.

Effects of Fang Cang Shelter Hospitals on the Reduction of COVID-19 New Cases in Wuhan: An Interrupted Time Series Analysis

Background: In December 2019, coronavirus disease 2019 (COVID-19) broke out in Wuhan, China and quickly spread to other areas and other countries worldwide. Since then, Wuhan implemented Fang Cang Shelter hospitals to stop the spread of SARS-CoV-2. This study aimed to evaluate the effects of Fang Cang Shelter hospitals on the trend of COVID-19 using an interrupted time series analysis to provide a reference for COVID-19 control in other countries. Methods: To evaluate whether Fang Cang Shelter hospitals change the epidemic trend of COVID-19 in Wuhan, China, an interrupted time series analysis was performed to compare the number of new confirmed cases of COVID-19 before (January 16, 2020–February 4, 2020) and after (February 5, 2020–March 16, 2020) the operation of Fang Cang Shelter hospitals. Our setting included Wuhan, China, where severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) was identified firstly as the cause of coronavirus disease-2019 (COVID-19). The information obtained included numbers of confirmed COVID-19 cases in Wuhan. Findings: The initial number of confirmed cases increased significantly per day prior to February 4, 2020 by 68.54 cases ( P < 0.0001; CI, 36.42–100.67) in Wuhan. Compared with the number of cases noted 20 days before the use of Fang Cang Shelter hospitals , a sustained reduction in the number of confirmed (trend change, −125.57; P < 0.0001 ; CI, −160.44 to − 90.69) cases of COVID-19 in Wuhan was noted 41 days after the use of Fang Cang Shelter hospitals. Immediate-level changes were observed for confirmed cases in Wuhan (level change, 725.97; P = 0.025; CI, 93.34–1358.59). These changes led to an estimated 5148 fewer confirmed cases ( P < 0.0001; CI, −6578.04 to −3718.29 ). Furthermore, according to the mean confirmed cases of 395.71 per day before the intervention, we estimated that Wuhan had advanced the terminal phase of COVID-19 by 13 days. Interpretation: Interrupted time series analysis revealed that Fang Cang Shelter hospitals were likely to reverse the epidemic trend of COVID-19 while containment strategy was implemented in Wuhan. The results provide a valuable reference for health policy makers in countries to which the COVID-19 outbreak has also spread, including Italy, Iran, and Spain. Funding Statement: This work was supported by The National Natural Science Foundation of China (81871681), The National First-class Discipline Programme of Food Science and Technology (JUFSTR20180101), The Fundamental Research Funds for the Central Universities funded by the Ministry of Education of China (JUSRP51710A), and Project of Wuxi Science and Technology Supporting Plan (N2020X004). Declaration of Interests: We declare no competing interests.

Phase- and Epidemic Regions- Adjusted Estimation of the Number of Coronavirus Disease 2019 Cases in China

Background: The outbreak of the Coronavirus Disease 2019 (COVID-19) was first reported in Wuhan in December 2019 and gradually spread to other areas in Hubei Province and regions outside Hubei Province in China. After implementation of prevention and control measures in China, the estimation of the epidemic trend is needed so as to predict the possible infection scale and epidemic characteristics of COVID-19, furtherly, to provide potential evaluation criteria for the effectiveness of current prevention and control measures and, to offer theoretical support for current decision-making on infectious disease prevention. Methods: A phase- and region-adjusted SEIR (Susceptible, Exposed, Infectious and Removed) model was applied for modeling and predicting the number of COVID-19 cases in Wuhan, Hubei Province and regions outside Hubei Province in China. Findings: The estimated number of infections would reach the peak in late February 2020 in Wuhan and Hubei Province, which is 55,303–84,520 and 83,944–129,312, respectively. The epidemic peaks in regions outside Hubei Province in China appeared on 13th Feb with the estimated 13,035–19,108 confirmed cases. Wuhan had an infection rate of more than 3,900 per million population as of 18th Feb 2020. In the areas adjacent to Wuhan, the average infection rate was around 550 per million population. In major financial regions (Beijing, Shanghai, and Guangdong) and provinces neighboring Hubei Province, the infection rate was over 10 per million population. Interpretation: It is reasonable to speculate that the outbreak would be braked soon with the very strong prevention measures taken all over China. Current estimation provided evidence for planned work resumption under stringent prevention and control in regions outside Hubei Province in China to further support the fight against the epidemic. Nevertheless, strict prevention and control measures should still be maintained, especially in the regions with high intensity of epidemic such as Hunan, Guangzhou, Zhejiang Province as well as densely-populated cities such as Shanghai and Beijing, considering the possibility of the second outbreak brought by the work resumption and population migration, especially from Hubei Province and high-intensity cities outside Hubei Province. Funding Statement: This work is funded by Medicine and Engineering Interdisciplinary Research Fund of Shanghai Jiao Tong University (YG2020YQ06), the National Key Research and Development Project (2018YFC1705100, 2018YFC1705103) and the National Natural Science Foundation of China (71673187). Declaration of Interests: All authors declare no competing interests.