According to the World Health Organization (WHO), viral diseases continue to emerge and represent a serious issue to public health In the last twenty years, several viral epidemics such as the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 to 2003, and H1N1 influenza in 2009, have been recorded Most recently, the Middle East respiratory syndrome coronavirus (MERS-CoV) was first identified in Saudi Arabia in 2012 In a timeline that reaches the present day, an epidemic of cases with unexplained low respiratory infections detected in Wuhan, the largest metropolitan area in China's Hubei province, was first reported to the WHO Country Office in China, on December 31, 2019 Published literature can trace the beginning of symptomatic individuals back to the beginning of December 2019 As they were unable to identify the causative agent, these first cases were classified as "pneumonia of unknown etiology " The Chinese Center for Disease Control and Prevention (CDC) and local CDCs organized an intensive outbreak investigation program The etiology of this illness is now attributed to a novel virus belonging to the coronavirus (CoV) family, COVID-19 On February 11, 2020, the WHO Director-General, Dr Tedros Adhanom Ghebreyesus, announced that the disease caused by this new CoV was a "COVID-19," which is the acronym of "coronavirus disease 2019" In the past twenty years, two additional coronavirus epidemics have occurred  SARS-CoV provoked a large-scale epidemic beginning in China and involving two dozen countries with approximately 8000 cases and 800 deaths, and the MERS-CoV that began in Saudi Arabia and has approximately 2,500 cases and 800 deaths and still causes as sporadic cases This new virus seems to be very contagious and has quickly spread globally In a meeting on January 30, 2020, per the International Health Regulations (IHR, 2005), the outbreak was declared by the WHO a Public Health Emergency of International Concern (PHEIC) as it had spread to 18 countries with four countries reporting human-to-human transmission An additional landmark occurred on February 26, 2020, as the first case of the disease, not imported from China, was recorded in the United States Initially, the new virus was called 2019-nCoV Subsequently, the task of experts of the International Committee on Taxonomy of Viruses (ICTV) termed it the SARS-CoV-2 virus as it is very similar to the one that caused the SARS outbreak (SARS-CoVs) The CoVs have become the major pathogens of emerging respiratory disease outbreaks They are a large family of single-stranded RNA viruses (+ssRNA) that can be isolated in different animal species  For reasons yet to be explained, these viruses can cross species barriers and can cause, in humans, illness ranging from the common cold to more severe diseases such as MERS and SARS  Interestingly, these latter viruses have probably originated from bats and then moving into other mammalian hosts — the Himalayan palm civet for SARS-CoV, and the dromedary camel for MERS-CoV — before jumping to humans The dynamics of SARS-Cov-2 are currently unknown, but there is speculation that it also has an animal origin The potential for these viruses to grow to become a pandemic worldwide seems to be a serious public health risk Concerning COVID-19, the WHO raised the threat to the CoV epidemic to the "very high" level, on February 28, 2020 Probably, the effects of the epidemic caused by the new CoV has yet to emerge as the situation is quickly evolving World governments are at work to establish countermeasures to stem possible devastating effects Health organizations coordinate information flows and issues directives and guidelines to best mitigate the impact of the threat At the same time, scientists around the world work tirelessly, and information about the transmission mechanisms, the clinical spectrum of disease, new diagnostics, and prevention and therapeutic strategies are rapidly developing Many uncertainties remain with regard to both the virus-host interac ion and the evolution of the epidemic, with specific reference to the times when the epidemic will reach its peak At the moment, the therapeutic strategies to deal with the infection are only supportive, and prevention aimed at reducing transmission in the community is our best weapon Aggressive isolation measures in China have led to a progressive reduction of cases in the last few days In Italy, in geographic regions of the north of the peninsula, political and health authorities are making incredible efforts to contain a shock wave that is severely testing the health system In the midst of the crisis, the authors have chosen to use the "Statpearls" platform because, within the PubMed scenario, it represents a unique tool that may allow them to make updates in real-time  The aim, therefore, is to collect information and scientific evidence and to provide an overview of the topic that will be continuously updated

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Features, Evaluation and Treatment Coronavirus (COVID-19)

Objective: The recent outbreak of Novel Coronavirus Disease (COVID-19) is reminiscent of the SARS outbreak in 2003. We aim to compare the severity and mortality between male and female patients with COVID-19 or SARS. Study Design and Setting: We extracted the data from: (1) a case series of 43 hospitalized patients we treated, (2) a public data set of the first 37 cases of patients who died of COVID-19 and 1,019 patients who survived in China, and (3) data of 524 patients with SARS, including 139 deaths, from Beijing in early 2003. Results: Older age and a high number of comorbidities were associated with higher severity and mortality in patients with both COVID-19 and SARS. Age was comparable between men and women in all data sets. In the case series, however, men's cases tended to be more serious than women's (P = 0.035). In the public data set, the number of men who died from COVID-19 is 2.4 times that of women (70.3 vs. 29.7%, P = 0.016). In SARS patients, the gender role in mortality was also observed. The percentage of males were higher in the deceased group than in the survived group (P = 0.015). Conclusion: While men and women have the same prevalence, men with COVID-19 are more at risk for worse outcomes and death, independent of age.

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Gender Differences in Patients With COVID-19: Focus on Severity and Mortality

COVID-19 pathophysiology: A review.

The World Health Organization has declared the rapid spread of COVID-19 around the world a global public health emergency. It is well-known that the spread of the disease is influenced by people’s ...

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Risk perceptions of COVID-19 around the world

Anecdotal evidence suggests that Coronavirus disease 2019 (COVID-19), caused by the coronavirus SARS-CoV-2, exhibits differences in morbidity and mortality between sexes. Here, we present a meta-analysis of 3,111,714 reported global cases to demonstrate that, whilst there is no difference in the proportion of males and females with confirmed COVID-19, male patients have almost three times the odds of requiring intensive treatment unit (ITU) admission (OR = 2.84; 95% CI = 2.06, 3.92) and higher odds of death (OR = 1.39; 95% CI = 1.31, 1.47) compared to females. With few exceptions, the sex bias observed in COVID-19 is a worldwide phenomenon. An appreciation of how sex is influencing COVID-19 outcomes will have important implications for clinical management and mitigation strategies for this disease. Anecdotal reports suggest potential severity and outcome differences between sexes following infection by SARS-CoV-2. Here, the authors perform meta-analyses of more than 3 million cases collected from global public data to demonstrate that male patients with COVID-19 are 3 times more likely to require intensive care, and have ~40% higher death rate.

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Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission.

Importance The recent outbreak of Novel Coronavirus (SARS-CoV-2) Disease (COVID-19) has put the world on alert, that is reminiscent of the SARS outbreak seventeen years ago. Objective We aim to compare the severity and mortality between male and female patients with both COVID-19 and SARS, to explore the most useful prognostic factors for individualized assessment. Design, Setting, and Participants We extracted the data from a case series of 43 hospitalized patients we treated, a public data set of the first 37 cases died of COVID-19 in Wuhan city and 1019 survived patients from six cities in China. We also analyzed the data of 524 patients with SARS, including 139 deaths, from Beijing city in early 2003. Main Outcomes and Measures Severity and mortality. Results Older age and high number of comorbidities were associated with higher severity and mortality in patients with both COVID-19 and SARS. The percentages of older age (≥65 years) were much higher in the deceased group than in the survived group in patients with both COVID-19 (83.8 vs. 13.2, P Conclusions and Relevance Older age and male gender are risk factors for worse outcome in patients with COVID. While men and women have the same susceptibility to both SARS-CoV-2 and SARS-CoV, men may be more prone to have higher severity and mortality independent of age and susceptibility. Key Points Question Are men more susceptible to getting and dying from COVID-19? Findings In the case series, men tend to be more serious than women. In the public data set, the percentage of men were higher in the deceased group than in the survived group, although age was comparable between men and women. Meaning Male gender is a risk factor for worse outcome in patients with COVID independent of age and susceptibility.

/pdf/gender-differences-in-patients-with-covid-19-focus-on-5qkuv553m7.pdf

Gender differences in patients with COVID-19: Focus on severity and mortality

The pandemic of 2019 coronavirus (SARS-CoV-2) disease (COVID-19) has imposed a severe public health burden worldwide. Most patients with COVID-19 were mild. Severe patients progressed rapidly to critical condition including acute respiratory distress syndrome (ARDS), multi-organ failure and even death. This study aims to find early multi-organ injury indicators and blood glucose for predicting mortality of COVID-19.Fasting blood glucose (FBG) ≥7.0 mmol/L for two times during hospitalization and without a history of diabetes were defined as new-onset COVID-19-related diabetes (CRD). Indicators of injuries for multiple organs, including the lung, heart, kidney and liver, and glucose homeostasis were specifically analyzed for predicting death.A total of 120 patients with a severity equal to or greater than Moderate were hospitalized. After excluding patients with history of diabetes, chronic heart, kidney, and liver disease, 69 patients were included in the final analysis. Of the 69 patients, 23 were Moderate, 20 were Severe, and 26 were Critical (including 16 deceased patients). Univariable analysis indicated that CRD, lactate dehydrogenase (LDH), hydroxybutyrate dehydrogenase (HBDH), creatine kinase (CK) and creatinine (Cr) were associated with death. Multivariable analysis indicated that CRD was an independent predictor for death (HR = 3.75, 95% CI 1.26-11.15). Abnormal glucose homeostasis or CRD occurred earlier than other indicators for predicting poor outcomes. Indicators of multiple organ injury were in parallel with the expression patterns of ACE2 (the SARS-CoV-2 receptor) in different organs including pancreatic islet.New-onset COVID-19-related diabetes is an early indicator of multi-organ injury and predictor for poor outcomes and death in COVID-19 patients. As it is easy to perform for clinical practices and self-monitoring, glucose testing will be helpful for predicting poor outcomes to facilitate appropriate intensive care. 

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New-onset COVID-19–related diabetes: an early indicator of multi-organ injury and mortally of SARS-CoV-2 infection

Objective
To analyzethe clinical features of severe or critical 2019 novel coronavirus pneumonia (COVID-19) patients.


Methods
Clinical data of 58 patients with severe or critical COVID-19 in Wuhan Union Hospital, Tongji medical college of Huazhong University of Science and Technology from January 29 to February 26 in 2020 were collected. The general information, clinical symptoms, resultsofblood testand chest computed tomography (CT) imaging, treatments and outcomes of patients were analyzed retrospectively.


Results
36 severe cases (62.1%) and 22 critical cases (37.9%) , 28 males (48.3%) and 30 females (51.7%) , with average age of (62.12±12.95) years were enrolled. 48.2% of the patients had underlying disease including Hypertension (21 cases, 36.2%), Diabetes mellitus (11 cases, 19.0%), Coronary heart disease (6 cases,10.3%), Chronic renal failure (2 cases, 3.4%) and Malignant tumor (1 case, 1.7%).

The symptoms included fever (54 cases, 93.1%), dyspnea (48 cases, 82.8%),cough (46 cases, 79.3%), muscle soreness (32 cases, 55.2%), sore throat (15 cases, 25.9%) and diarrhea (6 cases, 10.3%). Decreased or increased white blood cell count was found in 12.1% and 10.3% of the patients.Decreased percent of lymphocyte, increased percent of neutrophil, and decreased hemoglobin level were found in 60.3%, 46.6%, and 41.4% of the patientsrespectively. Elevated CRP, PCT and D-dimmer level were demonstrated in 65.5%, 62.1%, and 77.5% of the cases. Increased level of ALT, AST, LDH and decreased serum albumin were found in 55.2%, 43.1%, 67.2% and 74.1% of all the patients respectively.The main features of CT were patchy shadows and ground glass shadows, bilateral and peripheral distribution, consolidation and interlobular septal thickening were found in most of the patient’s lungs. 29 cases (50.0%) were treated with antibiotics, and 14 cases (24.1%) with systemic glucocorticoid. In addition to supportive and antivirustreatment,oxygen therapy methods including nasal catheter (9 cases, 15.5%), oxygen mask (33 cases, 56.9%), high-flow nasal catheter (8 cases, 13.3%) and invasive mechanical ventilation were adopted in 15.5%, 56.9%, 13.3% and 13.3% of the patients. 21 patients (36.2%) had been discharged from the hospital, 27 patients (46.6%) in remission were still in the isolation wards, 3 patients (5.2%) had been to the ICU as the disease got worse, and 7 patients were dead.


Conclusions
Abouthalfofthe patients with severe/critical COVID-19 had underlying disease. severe/criticalCOVID-19 patients often showed extrapulmonary abnormity as well as lung dysfunction. Comprehensive treatment as early as possibly may be important for prognosis improvement of these patients.


Key words: 
2019 novel coronavirus pneumonia; Clinical features; Disease severity

Analysis of clinical features of 58 patients with severe or critical 2019 novel coronavirus pneumonia

Background: Most patients with Coronavirus Disease 2019 (COVID-19) were mild. Severe patients progressed rapidly to critical condition including multi-organ failure and even death. Identification of early predictive factors is urgently necessary to facilitate appropriate intensive care.

Methods: We included all patient admitted to Wuhan Union Hospital and treated by the supportive medical team of Beijing Tongren Hospital as of March 20, 2020. Indicators of injuries for multiple organs, including the heart, kidney and liver, and glucose homeostasis were specifically analyzed for predicting primary outcomes (an intensive care unit (ICU) or death).

Findings: The data of 120 patients with a severity equal to or greater than Moderate, discharged from the hospital or died were extracted. After excluding patients with chronic heart, kidney, liver disease and diabetes, 69 patients were included in the final analysis. There were 26 cases with primary outcomes including 16 deaths. Univariable analysis indicated that elevations of fasting blood glucose (FBG), lactate dehydrogenase (LDH), hydroxybutyrate dehydrogenase (HBDH), creatine kinase (CK) and creatinine (Cr) were associated with higher odds of primary outcomes and more hazards of death. Cox regression results indicated that FBG≥7mmol/L was the only independent predictor for death (HR = 3.75, 95% CI 1.26-11.15). Cluster analysis found more proximities of FBG (at the time of admission) with LDH, HDDH or Creatinine (at the time after 2-4 days of hospitalization) (r=0.43, 0.43 and 0.50, respectively, P<0.01 for all), indicating that FBG Among patients with primary outcomes, although FBG and LDH levels were much higher on admission, they dramatically decreased subsequently, while in deceased patients they increased continuously.

Conclusions: FBG is a representative of the clustered indicators of multi-organ injury and the earliest predictor for poor outcomes and death in COVID patients. As it is easy to perform for clinical practices and self-monitoring, FBG testing will be much helpful for predicting critical condition to facilitate appropriate intensive care.

Funding Statement: This study was funded by the National Key RD The Beijing Science and Technology Project.

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: The Research Ethics Commission of Beijing Tongren Hospital, Capital Medical University (TRECKY2020-013) approved the study and the Ethics Commission waived the requirement for informed consent.

Peng Bai

Papers

Gender Differences in Patients With COVID-19: Focus on Severity and Mortality

Gender differences in patients with COVID-19: Focus on severity and mortality

New-onset COVID-19–related diabetes: an early indicator of multi-organ injury and mortally of SARS-CoV-2 infection

Analysis of clinical features of 58 patients with severe or critical 2019 novel coronavirus pneumonia

Blood Glucose Is a Representative of the Clustered Indicators of Multi-Organ Injury for Predicting Mortality of COVID-19 in Wuhan, China