Case Series of 138 Hospitalized Patients in China
Meanwhile, in the largest case series published thus far, Dawei Wang, MD, Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China, and colleagues found that patients infected with 2019-nCoV may appear to be doing well for the first several days of illness before becoming critically ill.
Among the 138 hospitalized patients included in the report, which was published online February 7 in JAMA, the median time from first symptom to the development of dyspnea was 5.0 days, to hospital admission was 7.0 days, and to acute respiratory distress syndrome (ARDS) was 8.0 days.
“What that’s telling you is that this virus is really acting different [from other viral outbreaks]; this virus, when it gets in you, adapts itself so that you can wind up days later getting really serious disease…I think that’s a heads up: If somebody comes in and has moderate to minimal symptoms, stay heads up for some deterioration over the next few days,” Anthony Fauci, MD, Director, National Institute of Allergy and Infectious Diseases told JAMA editor Howard Bauchner, MD, in a February 6 interview.
The single-center case series, which included consecutive patients hospitalized with 2019-nCoV–infected pneumonia (NCIP) in Wuhan, China, between January 1 and January 28, 2020, revealed another noteworthy statistic: almost one third of patients (n = 40; 29%) were healthcare professionals presumed to be infected while in the hospital.
Most patients were treated with antiviral therapy (oseltamivir, 124 patients; 89.9%), and almost two thirds received antibacterial therapy (moxifloxacin, 89 [64.4%]; ceftriaxone, 34 [24.6%]; azithromycin, 25 [18.1%]; and glucocorticoid therapy, 62 [44.9%]).
“Bilateral distribution of patchy shadows and ground glass opacity was a typical hallmark of CT scan for NCIP,” Wang and colleagues write.
Thirty-six patients (26.1%) required intensive care unit (ICU) admission for treatment of organ dysfunction, including acute respiratory distress syndrome (22 [61.1%]), arrhythmia (16 [44.4%]), and shock (11 [30.6%]).
When the investigators compared those who required intensive care with those who did not, they found that the ICU patients were more likely to be older (median age 66 years vs 51 years), and to have underlying comorbidities, such as hypertension (21 [58.3%] vs 22 [21.6%]), diabetes (8 [22.2%] vs 6 [5.9%]), cardiovascular disease (9 [25.0%] vs 11 [10.8%]), and cerebrovascular disease (6 [16.7%] vs 1 [1.0%]).