Focus on COVID-19 in 1,000 people in China

Doctors in 552 medical centres across China pooled their data about people hospitalized with COVID-19. This allowed them to analyze features held in common by patients and could be used to form a picture of which patients are at heightened risk for further interventions (such as being placed in an intensive care unit), in need of mechanical ventilation or dying.

Of 1,099 people with virologically confirmed COVID-19, their distribution was as follows:

• admitted to the intensive care unit (ICU) – 5%
• underwent mechanical ventilation – 2.3%
• died – 1.4%

These figures are broadly in line with what has been reported in other studies of people with COVID-19.

Study details and results

Doctors analyzed medical records collected between December 11, 2019 and January 29, 2020.

The age distribution of patients was as follows:

• less than 14 years – 1%
• 15 to 49 years – 55%
• 50 to 64 years – 29%
• 65 years and older – 15%

The gender distribution of patients was 58% men, 42% women.

On admission to hospital, common symptoms were as follows:

• cough – 68%
• fever – 44%
• nausea or vomiting – 5%
• diarrhea – 4%

These symptoms were assessed as severe in 16% of people.

Among the 1,099 people, 24% had an underlying condition—most commonly higher-than-normal blood pressure or diabetes.

People with severe symptoms of COVID-19 were more likely to have an underlying condition (39%) than people who did not have severe symptoms (21%).

CT scans

On admission to the hospital, 975 people had CT scans of their chest. In 86% of scans, abnormalities of the lungs were found, suggestive of some degree of pneumonia.

Lab tests

Analysis of blood samples found many abnormalities, such as the following:

• less-than-normal levels of lymphocytes – 83%
• less-than-normal levels of platelets – 36%

Many patients had elevated levels of proteins suggestive of a high degree of inflammation:

• c-reactive-protein – 61%
• lactate dehydrogenase (LDH) – 41%

About one-fifth of patients had elevated levels of liver enzymes, suggestive of liver injury:

• AST (aspartate aminotransferase) – 22%
• ALT (alanine aminotransferase) – 21%

A large proportion of patients had elevated levels of a protein called d-dimer, suggesting elevated inflammation and also that there was a heightened risk of blood clots forming.

People with severe symptoms of COVID-19 were more likely to have highly abnormal lab test results.

Clinical outcomes

• admitted to the intensive care unit (ICU) – 5%
• underwent mechanical ventilation – 2.3%
• died – 1.4%

Among the 1,099 people in this study, the risk of having severe outcomes listed above was about 4%. However, among people who had severe symptoms of COVID-19, the risk was 21%.

On average, people were hospitalized for 13 days.

Treatment

People who are ill with COVID-19, like other people with severe respiratory infections, can also develop bacterial and in some cases fungal infections. Not surprisingly, 58% of the 1,099 people in the study received intravenous antibiotics. A total of 43% received oxygen delivered by nasal tube or mask. Mechanical ventilation was given to 2.3% of people.

Additional interventions included the use of steroids (methylprednisolone) in 19% of people. Nearly 36% received the anti-flu drug oseltamivir, as doctors hoped that it might help them fight the underlying infection (SARS-CoV-2). In the early days of the pandemic, doctors would use a wide range of antiviral drugs in the hope that they might provide benefit and save the lives of people with COVID-19.

Bear in mind

This report on 1,099 patients is a snapshot of the early part of the COVID-19 pandemic. It focuses on very ill patients. It is likely that people who had no symptoms or very mild symptoms would not have sought care and were not represented in this group of patients.

—Sean R. Hosein

REFERENCE:

Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. New England Journal of Medicine. 2020; in press.