Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis.

Key Clinical Points Mild or Moderate Covid-19 Covid-19 (the illness caused by SARS-CoV-2) has a range of clinical manifestations, including cough, fever, malaise, myalgias, gastrointestinal symptom...

https://www.nejm.org/doi/pdf/10.1056/NEJMcp2009249

Mild or Moderate Covid-19.

Currently, the number of patients with coronavirus disease 2019 (COVID-19) has increased rapidly, but relationship between comorbidity and patients with COVID-19 still not clear. The aim was to explore whether the presence of common comorbidities increases COVID-19 patients' risk. A literature search was performed using the electronic platforms (PubMed, Cochrane Library, Embase, and other databases) to obtain relevant research studies published up to March 1, 2020. Relevant data of research endpoints in each study were extracted and merged. All data analysis was performed using Stata12.0 software. A total of 1558 patients with COVID-19 in 6 studies were enrolled in our meta-analysis eventually. Hypertension (OR: 2.29, P<0.001), diabetes (OR: 2.47, P<0.001), chronic obstructive pulmonary disease (COPD) (OR: 5.97, P<0.001), cardiovascular disease (OR: 2.93, P<0.001), and cerebrovascular disease (OR:3.89, P=0.002)were independent risk factors associated with COVID-19 patients. The meta-analysis revealed no correlation between increased risk of COVID-19 and liver disease, malignancy, or renal disease. Hypertension, diabetes, COPD, cardiovascular disease, and cerebrovascular disease are major risk factors for patients with COVID-19. Knowledge of these risk factors can be a resource for clinicians in the early appropriate medical management of patients with COVID-19.

Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis.

Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis

Importance The current rapid worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection justifies the global effort to identify effective preventive strategies and optimal medical management. While data are available for adult patients with coronavirus disease 2019 (COVID-19), limited reports have analyzed pediatric patients infected with SARS-CoV-2. Objective To evaluate currently reported pediatric cases of SARS-CoV-2 infection. Evidence Review An extensive search strategy was designed to retrieve all articles published from December 1, 2019, to March 3, 2020, by combining the termscoronavirusandcoronavirus infectionin several electronic databases (PubMed, Cochrane Library, and CINAHL), and following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Retrospective cross-sectional and case-control studies, case series and case reports, bulletins, and national reports about the pediatric SARS-CoV-2 infection were included. The risk of bias for eligible observational studies was assessed according to the Strengthening the Reporting of Observational Studies in Epidemiology reporting guideline. Findings A total of 815 articles were identified. Eighteen studies with 1065 participants (444 patients were younger than 10 years, and 553 were aged 10 to 19 years) with confirmed SARS-CoV-2 infection were included in the final analysis. All articles reflected research performed in China, except for 1 clinical case in Singapore. Children at any age were mostly reported to have mild respiratory symptoms, namely fever, dry cough, and fatigue, or were asymptomatic. Bronchial thickening and ground-glass opacities were the main radiologic features, and these findings were also reported in asymptomatic patients. Among the included articles, there was only 1 case of severe COVID-19 infection, which occurred in a 13-month-old infant. No deaths were reported in children aged 0 to 9 years. Available data about therapies were limited. Conclusions and Relevance To our knowledge, this is the first systematic review that assesses and summarizes clinical features and management of children with SARS-CoV-2 infection. The rapid spread of COVID-19 across the globe and the lack of European and US data on pediatric patients require further epidemiologic and clinical studies to identify possible preventive and therapeutic strategies.

https://jamanetwork.com/journals/jamapediatrics/articlepdf/2765169/jamapediatrics_castagnoli_2020_rv_200005_1598544887.48635.pdf

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review.

Characteristics of COVID-19 infection in Beijing.

Clinical characteristics of older patients infected with COVID-19: A descriptive study.

Since December 2019, the first case of a novel coronavirus (COVID-19) infection pneumonia was detected in Wuhan, and the outbreak has been spreading rapidly in the world. As of February 18, 2020, a total of 73,332 cases of confirmed COVID-19 infection have been detected in the world as reported by the WHO [1, 2]. Given that the asymptomatic persons are potential sources of COVID-19 infection [3], we report a familial cluster case of five patients infected with COVID-19 from an asymptomatic confirmed case in Beijing. We obtained the data of patients, which included demographic, epidemiological, and clinical features; chest radiography; laboratory test; and outcomes. Laboratory confirmation of COVID-19 was detected in the first hospital admission and verified by the Beijing Center for Disease Control and Prevention (CDC). An asymptomatic case was defined as a laboratory-confirmed COVID19 infection case who was afebrile and well. We enrolled the family that had five patients in total with COVID-19 infection who were transferred by the Beijing Emergency Medical Service (EMS) from January 24 to 27, 2020, to the designated hospitals for special treatment. Clinical outcomes were followed up to February 29, 2020. The familial cluster of five patients (index patient to patient 4) was infected with COVID-19, and just the index patient had been to Wuhan, who had no symptoms before his family members started to get sick one after another. On January 19, the index patient, a 48-year-old male, came back to Beijing from Wuhan. He invited his nephew (patient 3) for dinner. On January 22, patient 3, a 32-year-old man, became ill with continuous high fever and fatigue; the highest body temperature was 40.2 °C; he first visited a hospital on January 24. Two nasopharyngeal swabs sample were obtained and were found to be positive for COVID-19 on the real-time reverse transcription-polymerase chain reaction (RT-PCR) assay. Before he went to the hospital, his uncle (index patient) was informed that his relative in Wuhan had been infected with COVID-19. On January 23, the index patient’s wife, patient 1, a 45-year-old female, had a fever of 37.8 °C too. For the reason that his relative in Wuhan and nephew had been detected to be infected with COVID-19, his family visited a hospital together and tested the RT-PCR for COVID-19, the results of which were all positive (Fig. 1). The chest radiograph of patient 2 was normal, and it is noteworthy that she was an asymptomatic too. The index patient’s and his wife’s (patient 1) chest radiograph demonstrated ground glass opacities (Fig. 2). Then, the family were transferred by EMS to the designated hospitals for special treatment and isolated on January 27. On the same day, the nephew’s mother (patient 4) got a fever of 38.4 with joint pain; after being confirmed with COVID-19 infection, she was transferred to the designated hospital too. On February 18, 2020, index patient to patient 2 were discharged, the index patient had no fever along with dry cough, and patient 2 had no clinical symptoms during hospitalization, while patients 3 and 4 were still in hospital. Finally, the familial cluster infected with COVID-19 has been reported in homes or hospital, especially without obvious symptoms [4]. According to our recent study, 5% of COVID-19 infection were asymptomatic cases [5]. If the asymptomatic cases cannot be found or isolated appropriately for medical observation, they will spread the virus to other close contacts quickly. Therefore, to identify and control the asymptomatic cases, as well as early quarantine for their close contacts, especially in families are important measures to prevent transmission of the COVID-19 infection.

/pdf/familial-cluster-of-covid-19-infection-from-an-asymptomatic-2y97ak9mt0.pdf

Familial cluster of COVID-19 infection from an asymptomatic.

Background: Since the first case of a novel coronavirus (COVID-19) infection pneumonia was detected in Wuhan, China, a series of confirmed cases of the COVID-19 were found in Beijing. We analyzed the data of 262 confirmed cases to determine the clinical and epidemiological characteristics of COVID-19 in Beijing. 

Methods: We collected patients who were transferred by Beijing Emergency Medical Sevice to the designated hospitals. The information on demographic, epidemiological, clinical, laboratory test for the COVID-19 virus, diagnostic classification, cluster case and outcome were obtained. Furthermore we compared the characteristics between severe and common confirmed cases which including mild cases, no-pneumonia cases and asymptomatic cases, and we also compared the features between COVID-19 and 2003 SARS. 

Findings: By Feb 10, 2020, 262 patients were transferred from the hospitals across Beijing to the designated hospitals for special treatment of the COVID-19 infected by Beijing emergency medical service. Among of 262 patients, 46 (17.6%) were severe cases, 216 (82.4%) were common cases, which including 192 (73.3%) mild cases, 11(4.2%) non-pneumonia cases and 13 (5.0%) asymptomatic cases respectively. The median age of patients was 47.5 years old and 48.5% were male. 192 (73.3%) patients were residents of Beijing, 50 (26.0%) of which had been to Wuhan, 116 (60.4%) had close contact with confirmed cases, 21 (10.9%) had no contact history. The most common symptoms at the onset of illness were fever (82.1% ), cough (45.8%), fatigue (26.3%), dyspnea (6.9%) and headache (6.5%). The median incubation period was 6.7 days, the interval time from between illness onset and seeing a doctor was 4.5 days. As of Feb 10, 17.2% patients have discharged and 81.7% patients remain in hospital in our study, the fatality of COVID-19 infection in Beijing was 0.9%. 

Interpretation: On the basis of this study, we provided the ratio of the COVID-19 infection on the severe cases to the mild, asymptomatic and non-pneumonia cases in Beijing. Population was generally susceptible, and with a relatively low fatality rate. The measures to prevent transmission was very successful at early stage, the next steps on the COVID-19 infection should be focused on early isolation of patients and quarantine for close contacts in families and communities in Beijing. 

Funding Statement: This study was supported by the Beijing Municipal Science and Technology Project (Z191100004419003) and the National Science and Technology Fundamental Resources Investigation Project (2018FY100600). 

Declaration of Interests: All authors declare no competing interests.

Ethics Approval Statement: The study was approved by Ethics Committee of Beijing Emergency Medical Center (No.2020- 01) and the written informed consent was waived because of the retrospective nature of the study and belongs to emergency medical service.

Characteristics of COVID-19 Infection In Beijing

To explore the potential of SARS-CoV-2 spread during air travel and the risk of in-flight transmission.We enrolled all passengers and crew suspected of being infected with SARS-CoV-2, who bounded f...

Jing Lou

Papers

Characteristics of COVID-19 infection in Beijing.

Clinical characteristics of older patients infected with COVID-19: A descriptive study.

Familial cluster of COVID-19 infection from an asymptomatic.

Characteristics of COVID-19 Infection In Beijing

Transmission of SARS-CoV-2 during air travel: a descriptive and modelling study.