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       #Post#: 80--------------------------------------------------
       Clinical Characteristics of 138 Hospitalized Patients With 2019 
       Novel Coronavirus–Infected Pneumonia
       By: mixin Date: February 9, 2020, 10:05 am
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       February 7, 2020
       Conclusions and Relevance:
       In this single-center case series of 138 hospitalized patients
       with confirmed NCIP in Wuhan, China, presumed hospital-related
       transmission of 2019-nCoV was suspected in 41% of patients, 26%
       of patients received ICU care, and mortality was 4.3%.
       (2019 novel coronavirus (2019-nCoV)–infected pneumonia = (NCIP)
       Results:
       * Of 138 hospitalized patients with NCIP, the median age was 56
       years (interquartile range, 42-68; range, 22-92 years) and 75
       (54.3%) were men.
       ** Hospital-associated transmission was suspected as the
       presumed mechanism of infection for affected health
       professionals (40 [29%]) and hospitalized patients (17 [12.3%]).
       ** Common symptoms included fever (136 [98.6%]), fatigue (96
       [69.6%]), and dry cough (82 [59.4%]). Lymphopenia (lymphocyte
       count, 0.8 × 109/L [interquartile range {IQR},
       0.6-1.1]) occurred in 97 patients (70.3%), prolonged prothrombin
       time (13.0 seconds [IQR, 12.3-13.7]) in 80 patients (58%), and
       elevated lactate dehydrogenase (261 U/L [IQR, 182-403]) in 55
       patients (39.9%).
       ** Chest computed tomographic scans showed bilateral patchy
       shadows or ground glass opacity in the lungs of all patients.
       ** Most patients received antiviral therapy (oseltamivir, 124
       [89.9%]), and many received antibacterial therapy (moxifloxacin,
       89 [64.4%]; ceftriaxone, 34 [24.6%]; azithromycin, 25 [18.1%])
       and glucocorticoid therapy (62 [44.9%]).
       ** Thirty-six patients (26.1%) were transferred to the intensive
       care unit (ICU) because of complications, including acute
       respiratory distress syndrome (22 [61.1%]), arrhythmia (16
       [44.4%]), and shock (11 [30.6%]).
       ** The median time from first symptom to dyspnea was 5.0 days,
       to hospital admission was 7.0 days, and to ARDS was 8.0 days.
       ** Patients treated in the ICU (n = 36), compared
       with patients not treated in the ICU (n = 102), were
       older (median age, 66 years vs 51 years), were more likely to
       have underlying comorbidities (26 [72.2%] vs 38 [37.3%]), and
       were more likely to have dyspnea (23 [63.9%] vs 20 [19.6%]), and
       anorexia (24 [66.7%] vs 31 [30.4%]).
       ** Of the 36 cases in the ICU, 4 (11.1%) received high-flow
       oxygen therapy, 15 (41.7%) received noninvasive ventilation, and
       17 (47.2%) received invasive ventilation (4 were switched to
       extracorporeal membrane oxygenation).
       ** As of February 3, 47 patients (34.1%) were discharged and 6
       died (overall mortality, 4.3%), but the remaining patients are
       still hospitalized. Among those discharged alive
       (n = 47), the median hospital stay was 10 days (IQR,
       7.0-14.0).
  HTML https://jamanetwork.com/journals/jama/fullarticle/2761044
       #Post#: 82--------------------------------------------------
       Re: Clinical Characteristics of 138 Hospitalized Patients With 2
       019 Novel Coronavirus–Infected Pneum
       By: epsilon Date: February 9, 2020, 1:10 pm
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       First large scale clinical study (n>1000 patients from all over
       China)
  HTML https://www.medrxiv.org/content/10.1101/2020.02.06.20020974v1
       Key points:
       Fatality rate "only" 1.5%, definitely below SARS / MERS
       BUT:
       "Of 840 patients who underwent chest computed tomography on
       admission, 76.4% manifested as
       pneumonia" -> not good
       [quote]Oxygen therapy, mechanical ventilation were initiated in
       38.0%, 6.1% of patients, respectively [/quote]
       Definitely not good. Means gigantic hospital/ICU capacity
       necessary to deal with community outbreak.
       [quote] Notably, fever occurred in only 43.8% of patients ...
       such patients may be missed if the surveillance case definition
       focused heavily on fever detection [/quote]
       Not good.
       [quote]The median incubation period was 3.0 days (range, 0 to
       24.0) i.e. shorter than a recent report (3.0 days vs. 5.2 days)
       [8][/quote]
       Most worrying finding because it means the virus spreads
       exponentially twice as fast as presumed.
       -> Case doubling period may be even LESS THAN 3 DAYS (depending
       on R0>3)
       [quote]
       we might have missed asymptomatic or mild
       cases managed at home, and hence our cohort might represent the
       more severe end of 2019-nCoV
       [/quote]
       This is reassuring. Hopefully mild clinical spectrum will turn
       out to be large majority rather than the pneumonia cases.
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