Coronavirus -- Update -- March 1, 2020

We are starting to see the research. This is absolutely fascinating. I'm impressed how fast some of this is being researched, vetted (peer-reviewed), published, and made available to the general public.

The New England Journal, "Clinical Characteristics of Coronavirus Disease 2019 in China," dated February 28, 2019, posted on the internet yesterday, February 29, 2019. Link here.

Background:

• total number of patients studied: 1,099; laboratory-confirmed Covid-19
• 522 hospitals in 30 provinces, autonomous regions, and municipalities in China through January 29, 2020
• originally published in Chinese and then translated; authors: four Chinese for the China Medical Treatment Expert Group for Covid-19;

Data points in the one-paragraph results section that caught my eye (numbers rounded)

• only 1.9% (and that's how they phrased it, "only") of the patients had a history of direct contact with wildlife;
• among non-residents of Wuhan, 70% had contact with residents of Wuhan, including 30% who had visited the city;
• most common symptoms: fever and cough; but fever was seen in less than half of those patients at time of admission (or just prior to admission);
• diarrhea: uncommon
• median incubation period: 4 days;
• chest x-rays: "pretty much" diagnostic if present
• a decrease in lymphocytes was present in 80% of patients on admission to hospital
• patients often presented without fever and many did not have abnormal radiologic findings

Comments:

• this is why this is called severe acute respiratory disease
• one does not generally get admitted to a hospital unless the condition is severe or contagious illness suspected;
• the chest x-ray findings/changes generally lag clinical presentation (true in almost any respiratory disease)
• so these patients were showing signs of fever and cough, but not necessarily severe respiratory distress; and x-rays were still clear;

Miscellaneous notes, other comments by the authors, in "dicussion:

• our study cannot preclude the presence of patients who have been termed "super-spreaders"
• despite the number of deaths associated with Covid-19, SARS-CoV-2 appears to have a lower case fatality rate than either SARS-CoV or Middle East respiratory-related coronavirus (MERS-CoV)
• fever and cough were the dominant symptoms [but] gastrointestinal symptoms were uncommon, which suggests a difference in viral tropism as compared with SARS-CoV [the "original SARS"], MERS-CoV, and seasonal influenza
• the absence of fever in Covid-19 is more frequent than in SARS-CoV (1%) and MERS-CoV infection (2%), so afebrile patients may be missed if the surveillance case definition focuses on fever detection;

Finally, death rate, comments by the authors:

• Our findings were more similar to the national official statistics, which showed a rate of death of 3.2% among 51,857 cases of Covid-19 as of February 16, 2020.
• Since patients who were mildly ill and who did not seek medical attention were not included in our study, the case fatality rate in a real-world scenario might be even lower.
• Early isolation, early diagnosis, and early management might have collectively contributed to the reduction in mortality in Guangdong.