COVID-19: highly variable initial presentation, EU/EEA/UK numbers climb

  • Guan. W et al.
  • NEJM
  • 29 Feb 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Chinese COVID-19 cohort data highlight rapid virus spread, highly variable clinical presentation.
  • ECDC reports that COVID-19 continues to spread through the EU/EEA and UK and risk is currently "moderate to high."

Why this matters

  • Compromised respiratory status on admission is the primary driver of disease severity.
  • Early diagnosis, isolation, symptomatic care provision essential.
  • Ensure familiarity with ECDC contact tracing and surveillance.

Key results

  • 1099 patients.
  • 43.9% Wuhan residents, 72.3% had contact with Wuhan residents; 1.9% had wildlife contact.
  • Median incubation: 4 (interquartile range [IQR], 2-7) days.
  • Median age: 47 (IQR, 35-58) years; 41.9% female.
  • Symptoms: fever (43.8%), cough (67.8%); nausea/vomiting (5.0%), diarrhea (3.8%). 
  • Comorbidity: 23.7%.
  • 86.2% (840/975) had abnormal CT; most commonly ground-glass opacity (56.4%), bilateral patchy shadowing (51.8%). 
  • 17.9% (157/877), 2.9% (5/173) patients with nonsevere, severe disease, respectively, had no CT abnormalities.
  • 6.1% met primary composite endpoint: 5.0% ICU admission, 2.3% mechanical ventilation, 1.4% died.
  • Cumulative endpoint risk: 3.6%, 20.6%, mild, severe cases, respectively.

Study design

  • Retrospective cohort analysis of Wuhan patients with confirmed COVID-19 requiring ICU admission, mechanical ventilation, or who had died through 20 January, 2020.
  • Funding: National Health Commission of China, others.

Limitations

  • Variable, incomplete documentation.
  • Recall, selection bias.
  • Censored clinical outcomes.