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Open accessJournal ArticleDOI: 10.1001/JAMA.2020.2648

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

07 Apr 2020-JAMA (American Medical Association)-Vol. 323, Iss: 13, pp 1239-1242
Abstract: Background: Hospitalised COVID-19 patients are frequently elderly subjects with co-morbidities receiving polypharmacy, all of which are known risk factors for d

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Topics: Outbreak (56%)
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Open accessJournal ArticleDOI: 10.1016/J.IJANTIMICAG.2020.105949
Abstract: Background Chloroquine and hydroxychloroquine have been found to be efficient on SARS-CoV-2, and reported to be efficient in Chinese COV-19 patients. We evaluate the role of hydroxychloroquine on respiratory viral loads. Patients and methods French Confirmed COVID-19 patients were included in a single arm protocol from early March to March 16th, to receive 600mg of hydroxychloroquine daily and their viral load in nasopharyngeal swabs was tested daily in a hospital setting. Depending on their clinical presentation, azithromycin was added to the treatment. Untreated patients from another center and cases refusing the protocol were included as negative controls. Presence and absence of virus at Day6-post inclusion was considered the end point. Results Six patients were asymptomatic, 22 had upper respiratory tract infection symptoms and eight had lower respiratory tract infection symptoms. Twenty cases were treated in this study and showed a significant reduction of the viral carriage at D6-post inclusion compared to controls, and much lower average carrying duration than reported of untreated patients in the literature. Azithromycin added to hydroxychloroquine was significantly more efficient for virus elimination. Conclusion Despite its small sample size our survey shows that hydroxychloroquine treatment is significantly associated with viral load reduction/disappearance in COVID-19 patients and its effect is reinforced by azithromycin.

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Topics: Hydroxychloroquine (62%), Viral load (54%), Lower respiratory tract infection (51%) ...read more

3,596 Citations


Open accessJournal ArticleDOI: 10.1136/BMJ.M1091
Tao Chen1, Di Wu1, Huilong Chen1, Weiming Yan1  +17 moreInstitutions (1)
26 Mar 2020-BMJ
Abstract: Objective To delineate the clinical characteristics of patients with coronavirus disease 2019 (covid-19) who died. Design Retrospective case series. Setting Tongji Hospital in Wuhan, China. Participants Among a cohort of 799 patients, 113 who died and 161 who recovered with a diagnosis of covid-19 were analysed. Data were collected until 28 February 2020. Main outcome measures Clinical characteristics and laboratory findings were obtained from electronic medical records with data collection forms. Results The median age of deceased patients (68 years) was significantly older than recovered patients (51 years). Male sex was more predominant in deceased patients (83; 73%) than in recovered patients (88; 55%). Chronic hypertension and other cardiovascular comorbidities were more frequent among deceased patients (54 (48%) and 16 (14%)) than recovered patients (39 (24%) and 7 (4%)). Dyspnoea, chest tightness, and disorder of consciousness were more common in deceased patients (70 (62%), 55 (49%), and 25 (22%)) than in recovered patients (50 (31%), 48 (30%), and 1 (1%)). The median time from disease onset to death in deceased patients was 16 (interquartile range 12.0-20.0) days. Leukocytosis was present in 56 (50%) patients who died and 6 (4%) who recovered, and lymphopenia was present in 103 (91%) and 76 (47%) respectively. Concentrations of alanine aminotransferase, aspartate aminotransferase, creatinine, creatine kinase, lactate dehydrogenase, cardiac troponin I, N-terminal pro-brain natriuretic peptide, and D-dimer were markedly higher in deceased patients than in recovered patients. Common complications observed more frequently in deceased patients included acute respiratory distress syndrome (113; 100%), type I respiratory failure (18/35; 51%), sepsis (113; 100%), acute cardiac injury (72/94; 77%), heart failure (41/83; 49%), alkalosis (14/35; 40%), hyperkalaemia (42; 37%), acute kidney injury (28; 25%), and hypoxic encephalopathy (23; 20%). Patients with cardiovascular comorbidity were more likely to develop cardiac complications. Regardless of history of cardiovascular disease, acute cardiac injury and heart failure were more common in deceased patients. Conclusion Severe acute respiratory syndrome coronavirus 2 infection can cause both pulmonary and systemic inflammation, leading to multi-organ dysfunction in patients at high risk. Acute respiratory distress syndrome and respiratory failure, sepsis, acute cardiac injury, and heart failure were the most common critical complications during exacerbation of covid-19.

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Topics: Exacerbation (52%), Respiratory failure (52%), Heart failure (52%) ...read more

2,470 Citations


Open accessJournal ArticleDOI: 10.1001/JAMACARDIO.2020.1017
Tao Guo1, Yongzhen Fan1, Ming Chen1, Xiaoyan Wu1  +6 moreInstitutions (1)
01 Jul 2020-JAMA Cardiology
Abstract: Importance Increasing numbers of confirmed cases and mortality rates of coronavirus disease 2019 (COVID-19) are occurring in several countries and continents. Information regarding the impact of cardiovascular complication on fatal outcome is scarce. Objective To evaluate the association of underlying cardiovascular disease (CVD) and myocardial injury with fatal outcomes in patients with COVID-19. Design, Setting, and Participants This retrospective single-center case series analyzed patients with COVID-19 at the Seventh Hospital of Wuhan City, China, from January 23, 2020, to February 23, 2020. Analysis began February 25, 2020. Main Outcomes and Measures Demographic data, laboratory findings, comorbidities, and treatments were collected and analyzed in patients with and without elevation of troponin T (TnT) levels. Result Among 187 patients with confirmed COVID-19, 144 patients (77%) were discharged and 43 patients (23%) died. The mean (SD) age was 58.50 (14.66) years. Overall, 66 (35.3%) had underlying CVD including hypertension, coronary heart disease, and cardiomyopathy, and 52 (27.8%) exhibited myocardial injury as indicated by elevated TnT levels. The mortality during hospitalization was 7.62% (8 of 105) for patients without underlying CVD and normal TnT levels, 13.33% (4 of 30) for those with underlying CVD and normal TnT levels, 37.50% (6 of 16) for those without underlying CVD but elevated TnT levels, and 69.44% (25 of 36) for those with underlying CVD and elevated TnTs. Patients with underlying CVD were more likely to exhibit elevation of TnT levels compared with the patients without CVD (36 [54.5%] vs 16 [13.2%]). Plasma TnT levels demonstrated a high and significantly positive linear correlation with plasma high-sensitivity C-reactive protein levels (β = 0.530,P Conclusions and Relevance Myocardial injury is significantly associated with fatal outcome of COVID-19, while the prognosis of patients with underlying CVD but without myocardial injury is relatively favorable. Myocardial injury is associated with cardiac dysfunction and arrhythmias. Inflammation may be a potential mechanism for myocardial injury. Aggressive treatment may be considered for patients at high risk of myocardial injury.

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2,236 Citations


Open accessJournal ArticleDOI: 10.1016/S0140-6736(20)31022-9
Yeming Wang1, Yeming Wang2, Dingyu Zhang, Guanhua Du3  +45 moreInstitutions (11)
16 May 2020-The Lancet
Abstract: Summary Background No specific antiviral drug has been proven effective for treatment of patients with severe coronavirus disease 2019 (COVID-19). Remdesivir (GS-5734), a nucleoside analogue prodrug, has inhibitory effects on pathogenic animal and human coronaviruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vitro, and inhibits Middle East respiratory syndrome coronavirus, SARS-CoV-1, and SARS-CoV-2 replication in animal models. Methods We did a randomised, double-blind, placebo-controlled, multicentre trial at ten hospitals in Hubei, China. Eligible patients were adults (aged ≥18 years) admitted to hospital with laboratory-confirmed SARS-CoV-2 infection, with an interval from symptom onset to enrolment of 12 days or less, oxygen saturation of 94% or less on room air or a ratio of arterial oxygen partial pressure to fractional inspired oxygen of 300 mm Hg or less, and radiologically confirmed pneumonia. Patients were randomly assigned in a 2:1 ratio to intravenous remdesivir (200 mg on day 1 followed by 100 mg on days 2–10 in single daily infusions) or the same volume of placebo infusions for 10 days. Patients were permitted concomitant use of lopinavir–ritonavir, interferons, and corticosteroids. The primary endpoint was time to clinical improvement up to day 28, defined as the time (in days) from randomisation to the point of a decline of two levels on a six-point ordinal scale of clinical status (from 1=discharged to 6=death) or discharged alive from hospital, whichever came first. Primary analysis was done in the intention-to-treat (ITT) population and safety analysis was done in all patients who started their assigned treatment. This trial is registered with ClinicalTrials.gov, NCT04257656. Findings Between Feb 6, 2020, and March 12, 2020, 237 patients were enrolled and randomly assigned to a treatment group (158 to remdesivir and 79 to placebo); one patient in the placebo group who withdrew after randomisation was not included in the ITT population. Remdesivir use was not associated with a difference in time to clinical improvement (hazard ratio 1·23 [95% CI 0·87–1·75]). Although not statistically significant, patients receiving remdesivir had a numerically faster time to clinical improvement than those receiving placebo among patients with symptom duration of 10 days or less (hazard ratio 1·52 [0·95–2·43]). Adverse events were reported in 102 (66%) of 155 remdesivir recipients versus 50 (64%) of 78 placebo recipients. Remdesivir was stopped early because of adverse events in 18 (12%) patients versus four (5%) patients who stopped placebo early. Interpretation In this study of adult patients admitted to hospital for severe COVID-19, remdesivir was not associated with statistically significant clinical benefits. However, the numerical reduction in time to clinical improvement in those treated earlier requires confirmation in larger studies. Funding Chinese Academy of Medical Sciences Emergency Project of COVID-19, National Key Research and Development Program of China, the Beijing Science and Technology Project.

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Topics: Placebo (55%), Clinical endpoint (53%), Hazard ratio (53%) ...read more

2,131 Citations


Open accessJournal ArticleDOI: 10.1016/J.CELL.2020.05.015
25 Jun 2020-Cell
Abstract: Understanding adaptive immunity to SARS-CoV-2 is important for vaccine development, interpreting coronavirus disease 2019 (COVID-19) pathogenesis, and calibration of pandemic control measures. Using HLA class I and II predicted peptide "megapools," circulating SARS-CoV-2-specific CD8+ and CD4+ T cells were identified in ∼70% and 100% of COVID-19 convalescent patients, respectively. CD4+ T cell responses to spike, the main target of most vaccine efforts, were robust and correlated with the magnitude of the anti-SARS-CoV-2 IgG and IgA titers. The M, spike, and N proteins each accounted for 11%-27% of the total CD4+ response, with additional responses commonly targeting nsp3, nsp4, ORF3a, and ORF8, among others. For CD8+ T cells, spike and M were recognized, with at least eight SARS-CoV-2 ORFs targeted. Importantly, we detected SARS-CoV-2-reactive CD4+ T cells in ∼40%-60% of unexposed individuals, suggesting cross-reactive T cell recognition between circulating "common cold" coronaviruses and SARS-CoV-2.

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Topics: Coronavirus (54%)

1,935 Citations


References
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Open accessJournal ArticleDOI: 10.1093/JTM/TAAA020
Abstract: Public health measures were decisive in controlling the SARS epidemic in 2003. Isolation is the separation of ill persons from non-infected persons. Quarantine is movement restriction, often with fever surveillance, of contacts when it is not evident whether they have been infected but are not yet symptomatic or have not been infected. Community containment includes measures that range from increasing social distancing to community-wide quarantine. Whether these measures will be sufficient to control 2019-nCoV depends on addressing some unanswered questions.

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Topics: Quarantine (52%), Isolation (health care) (50%), Public health (50%)

1,296 Citations


Open accessJournal ArticleDOI: 10.46234/CCDCW2020.032
01 Jan 2020-
Abstract: 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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Topics: Outbreak (53%)

1,238 Citations


Open accessJournal ArticleDOI: 10.3201/EID2605.200146
Zhanwei Du1, Lin Wang2, Simon Cauchemez3, Xiaoke Xu4  +4 moreInstitutions (7)
Abstract: On January 23, 2020, China quarantined Wuhan to contain coronavirus disease (COVID-19). We estimated the probability of transportation of COVID-19 from Wuhan to 369 other cities in China before the quarantine. Expected COVID-19 risk is >50% in 130 (95% CI 89-190) cities and >99% in the 4 largest metropolitan areas.

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244 Citations


Open accessJournal ArticleDOI: 10.4414/SMW.2020.20203
Abstract: It is tempting to estimate the case fatality rate by dividing the number of known deaths by the number of confirmed cases. The resulting number, however, does not represent the true case fatality rate and might be off by orders of magnitude.

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Topics: Case fatality rate (71%)

139 Citations


Open accessJournal ArticleDOI: 10.1017/S0950268820000254
Brian McCloskey1, David L Heymann2Institutions (2)
Abstract: The response to the novel coronavirus outbreak in China suggests that many of the lessons from the 2003 SARS epidemic have been implemented and the response improved as a consequence. Nevertheless some questions remain and not all lessons have been successful. The national and international response demonstrates the complex link between public health, science and politics when an outbreak threatens to impact on global economies and reputations. The unprecedented measures implemented in China are a bold attempt to control the outbreak - we need to understand their effectiveness to balance costs and benefits for similar events in the future.

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135 Citations


Performance
Metrics
No. of citations received by the Paper in previous years
YearCitations
202238
20214,602
20205,818
20196