Background: Hospitalised COVID-19 patients are frequently elderly subjects with co-morbidities receiving polypharmacy, all of which are known risk factors for d

https://jamanetwork.com/journals/jama/articlepdf/2762130/jama_wu_2020_vp_200028.pdf

Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention

Using news reports and press releases from provinces, regions, and countries outside Wuhan, Hubei province, China, this analysis estimates the length of the incubation period of COVID-19 and its pu...

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The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application.

Only 3 cases of coronavirus disease 2019 (COVID-19) were identified in Italy in the first half of February 2020 and all involved people who had recently traveled to China. On February 20, 2020, a severe case of pneumonia due to SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) was diagnosed in northern Italy’s Lombardy region in a man in his 30s who had no history of possible exposure abroad. Within 14 days, many other cases of COVID-19 in the surrounding area were diagnosed, including a substantial number of critically ill patients.1 On the basis of the number of cases and of the advanced stage of the disease it was hypothesized that the virus had been circulating within the population since January. Another cluster of patients with COVID-19 was simultaneously identified in Veneto, which borders Lombardy. Since then, the number of cases identified in Italy has rapidly increased, mainly in northern Italy, but all regions of the country have reported having patients with COVID-19. After China, Italy now has the second largest number of COVID-19 cases2 and also has a very high case-fatality rate.3 This Viewpoint reviews the Italian experience with COVID-19 with an emphasis on fatalities.

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Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy.

Importance The coronavirus disease 2019 (COVID-19) pandemic, due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a worldwide sudden and substantial increase in hospitalizations for pneumonia with multiorgan disease. This review discusses current evidence regarding the pathophysiology, transmission, diagnosis, and management of COVID-19. Observations SARS-CoV-2 is spread primarily via respiratory droplets during close face-to-face contact. Infection can be spread by asymptomatic, presymptomatic, and symptomatic carriers. The average time from exposure to symptom onset is 5 days, and 97.5% of people who develop symptoms do so within 11.5 days. The most common symptoms are fever, dry cough, and shortness of breath. Radiographic and laboratory abnormalities, such as lymphopenia and elevated lactate dehydrogenase, are common, but nonspecific. Diagnosis is made by detection of SARS-CoV-2 via reverse transcription polymerase chain reaction testing, although false-negative test results may occur in up to 20% to 67% of patients; however, this is dependent on the quality and timing of testing. Manifestations of COVID-19 include asymptomatic carriers and fulminant disease characterized by sepsis and acute respiratory failure. Approximately 5% of patients with COVID-19, and 20% of those hospitalized, experience severe symptoms necessitating intensive care. More than 75% of patients hospitalized with COVID-19 require supplemental oxygen. Treatment for individuals with COVID-19 includes best practices for supportive management of acute hypoxic respiratory failure. Emerging data indicate that dexamethasone therapy reduces 28-day mortality in patients requiring supplemental oxygen compared with usual care (21.6% vs 24.6%; age-adjusted rate ratio, 0.83 [95% CI, 0.74-0.92]) and that remdesivir improves time to recovery (hospital discharge or no supplemental oxygen requirement) from 15 to 11 days. In a randomized trial of 103 patients with COVID-19, convalescent plasma did not shorten time to recovery. Ongoing trials are testing antiviral therapies, immune modulators, and anticoagulants. The case-fatality rate for COVID-19 varies markedly by age, ranging from 0.3 deaths per 1000 cases among patients aged 5 to 17 years to 304.9 deaths per 1000 cases among patients aged 85 years or older in the US. Among patients hospitalized in the intensive care unit, the case fatality is up to 40%. At least 120 SARS-CoV-2 vaccines are under development. Until an effective vaccine is available, the primary methods to reduce spread are face masks, social distancing, and contact tracing. Monoclonal antibodies and hyperimmune globulin may provide additional preventive strategies. Conclusions and Relevance As of July 1, 2020, more than 10 million people worldwide had been infected with SARS-CoV-2. Many aspects of transmission, infection, and treatment remain unclear. Advances in prevention and effective management of COVID-19 will require basic and clinical investigation and public health and clinical interventions.

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Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review.

OBJECTIVE: To identify the epidemiological characteristics and transmission patterns of pediatric patients with the 2019 novel coronavirus disease (COVID-19) in China. METHODS: Nationwide case series of 2135 pediatric patients with COVID-19 reported to the Chinese Center for Disease Control and Prevention from January 16, 2020, to February 8, 2020, were included. The epidemic curves were constructed by key dates of disease onset and case diagnosis. Onset-to-diagnosis curves were constructed by fitting a log-normal distribution to data on both onset and diagnosis dates. RESULTS: There were 728 (34.1%) laboratory-confirmed cases and 1407 (65.9%) suspected cases. The median age of all patients was 7 years (interquartile range: 2–13 years), and 1208 case patients (56.6%) were boys. More than 90% of all patients had asymptomatic, mild, or moderate cases. The median time from illness onset to diagnoses was 2 days (range: 0–42 days). There was a rapid increase of disease at the early stage of the epidemic, and then there was a gradual and steady decrease. The disease rapidly spread from Hubei province to surrounding provinces over time. More children were infected in Hubei province than any other province. CONCLUSIONS: Children of all ages appeared susceptible to COVID-19, and there was no significant sex difference. Although clinical manifestations of children’s COVID-19 cases were generally less severe than those of adult patients, young children, particularly infants, were vulnerable to infection. The distribution of children’s COVID-19 cases varied with time and space, and most of the cases were concentrated in Hubei province and surrounding areas. Furthermore, this study provides strong evidence of human-to-human transmission.

https://pediatrics.aappublications.org/content/pediatrics/early/2020/03/16/peds.2020-0702.1.full.pdf

Epidemiology of COVID-19 Among Children in China.

Introduction Method Results Discussion Acknowledgements References FIGURE1 FIGURE2 FIGURE3 FIGURE4 TABLE1 TABLE2 Article Metrics Get Citation PDF All Search  PDF " Cite  Share 4/15/20, 07*33 The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020 Page 7 of 11 http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-f...etter&utm_medium=email&utm_campaign=newsletter_axiosam&stream=top (/fileCCDCW/journal/article/ccdcw/2020/8/PIC/COVID-19-1.jpg) FIGURE 1. Age distribution and sex ratio of all confirmed COVID-19 cases in China through February 11, 2020. (A) patients diagnosed in the city of Wuhan only; (B) patients diagnosed in Hubei Province, which includes Wuhan as its capital city; and (C) patients diagnosed in China overall, including Hubei Province and all 30 other provincial-level administrative divisions (PLADs). Dashed red line highlights the proportion of patients in the 30–79 years age range. Sex ratio (i.e. male-to-female [M:F] ratio) is shown below each graph. Download: Full-Size Img PowerPoint (/fileCCDCW/journal/article/ccdcw/2020/8/PIC/COVID-19-2.jpg) FIGURE 2. Geo-temporal spread of COVID-19 in China through February 11, 2020. (A) a total of 14 county-level administrative areas (hereafter counties) in Hubei Province only (inset) had reported cases as of December 31, 2019; (B) by January 10, 2020, 113 counties in 20 PLADs had reported cases with the highest prevalence still in Hubei Province; (C) nine days later, on January 20, 627 counties in 30 PLADs had reported cases and PLADs neighboring Hubei Province observed increasing prevalence; (D) by the end of January 31, 1,310 counties across all 31 PLADs were affected and prevalence in the central, south, and south-central regions had risen dramatically; (E) by the end of February 11, 1,386 counties nationwide were affected and prevalence in the south-central PLADs had risen to the level of Hubei. Download: Full-Size Img PowerPoint Article Views(866606) PDF Downloads(31719)

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The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020

/pdf/protocol-for-prevention-and-control-of-covid-19-edition-6-1m1zbwm43p.pdf

Protocol for Prevention and Control of COVID-19 (Edition 6)

/pdf/reported-cases-and-deaths-of-national-notifiable-infectious-zl072hmusk.pdf

Reported Cases and Deaths of National Notifiable Infectious Diseases — China, January, 2021

/pdf/establishment-of-the-niac-technical-working-group-on-covid-3slwrdnikp.pdf

Establishment of the NIAC Technical Working Group on COVID-19 Vaccines

/pdf/world-suicide-prevention-day-september-10-2020-wy028c2xb9.pdf

China Cdc Weekly

Papers

The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020

Protocol for Prevention and Control of COVID-19 (Edition 6)

Reported Cases and Deaths of National Notifiable Infectious Diseases — China, January, 2021

Establishment of the NIAC Technical Working Group on COVID-19 Vaccines

World Suicide Prevention Day — September 10, 2020