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Management strategy of Corona Virus Disease-
2019 in quarantine zones outside hospitals:
Analysis of 1232 cases from a district in Wuhan
Xiaojian Zhu
Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology
Jue Wang
Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology
Department of Radiology
Hao Wang
The Dean of Hanzhengjie Community Healthy center of Qiaokou district
Yutong Tang
Wuhan union hospital
Shu Zhou
Wuhan union hospital
Yuxiao Zhang
Wuhan university of health science
Lianzhen Wang
Wuhan No.1 hospital
Shengxin Liu
The third people's hospital of Hubei Province
Yanmin Zhang
Wuhan No.1 hospital
Wen Liu
Wuhan union hospital
Wenlan Fu
The third people's hospital of hubei province
Yuanping Cai
Wuhan fourth hospital
Yu Tao
Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology
Fang Liu
The third people' s hospital of hubei province
Jun Zhou ( junzhouhbzsyy@163.com )
The third people' hospital of Hubei Province
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Abstract
The Corona Virus Disease 2019 (COVID-19) has evolved into a global pandemic in the early 2020.
Management strategy outside hospitals of the suspected cases, close contacts and discharged patients
might be as important as treatment in hospital. We analyzed information from 1232 cases at 14 hotels
(requisitioned as quarantine zones) in Qiaokou district, Wuhan during Feb 8th to Mar 4th 2020. Abide by
the unquarantine and hospitalization standard, 603 (48.94%) cases were released from quarantine zones;
540 (43.83%) cases were sent to hospital for further medical care. 89 (7.22%) cases remained on
quarantine up to the end of the analysis. The reasons for cases sent to the hospital for treatment were
either positive for COVID-19 nucleic acid test, progression in pulmonary CT scan, or aggravation of
symptoms. 11/59 patients switched from negative to positive for nucleic acid test during stayed in
quarantine zones after being discharged from the hospitals. In total, hospitalization and positive rate for
COVID-19 nucleic acid test both decreased over time. The quarantine measures were important and
played a pivotal role in identication of cardinal number, cutting off the transmission, reducing the scope
of prevention and rehabilitation therapy. This protocol adopted in Wuhan provided countries worldwide
with valuable experience.
Background
Corona Virus Disease 2019 (COVID-19) refers to pneumonia resulted from a novel coronavirus infection
in 2019
1
. According to the Chinese Center for Disease Control and Prevention of Viral Diseases, the virus
belongs to the β-coronavirus cluster, which comprised of a single-stranded ribonucleic acid (RNA)
structure, with the possibility for rapid mutation
2
. Since then, the COVID-19 has evolved into a global
pandemic in the early 2020; up to March 18
th
, there were more than 200,000 conrmed cases and the
estimated number of individuals call for prevention and control of infection has reached billions. Based
on epidemiological investigations, the incubation period of the virus is generally from 1 to 14 days in
which the disease can be contagious, and the majority of the population is susceptible to the virus
3
.
Unfortunately, there is no validated curative therapy such as vaccine or specic drug against COVID-19 so
far. As a result, screening, isolation, symptomatic and supportive care are the major treatment
procedures
1,2
. In order to screen as many people as possible and maximumly cut off the transmission,
Wuhan government began to designate hotels as quarantine zones from 1
th
Feb, and equip them with
basic medical care and testing abilities, in hope to properly screen suspected cases, close contacts with
conrmed cases and to monitor discharged patients. This work briey summarized the management
process and clinical outcomes at 14 quarantine zones in the Qiaokou District of Wuhan from Feb 8
th
to
Mar 4
th
2020.
Methods
Inclusion criteria and classication
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To clarify the effect and management process of quarantine zones on control of novel coronary
pneumonia, we gathered information of all cases came to 14 hotels in Qiaokou district, Wuhan P. R. China
from Feb 8
th
to Mar 4
th
, 2020. The research protocol was assessed and approved by the Ethical
Committee of the Tongji Hospital, Tongji medical college, Huazhong University of Science and
Technology. For data analysis, 416 cases with incomplete information were excluded.
According to the characteristics and reasons for which they came to the quarantine zones, we divided the
personnel into four groups: CT suspected, symptomatic suspected, close contacts and discharged
patients. CT suspected cases were those who came to the quarantine zone because of imaging features
of viral pneumonia, but with serum antibody (IgM or IgG) negative and nucleic acid test negative,
symptomatic or asymptomatic. People with fever or respiratory symptoms were termed as symptomatic
suspected cases (serum antibody (IgM or IgG) negative and nucleic acid test negative, without viral
pneumonia changes in CT scan when they came in). Close contacts: those who have history of close
contact with conrmed cases in the absence of effective protection. Discharged patients: patients
discharged from the designated hospital, whose CT scan showing signicant improvement after
treatment and nucleic acid test negative (2 consecutive times, more than one day apart from each other),
and with improvement of general condition.
Exclusion criteria
People with the following characteristics could not stay at the quarantine zones: (1)nucleic acid test of
COVID-19 positive at any time; (2)patients with serious complications/comorbidities such as metabolic
diseases, cardiovascular and cerebrovascular diseases; (3)people who are unable to take care of
themselves;(4) people who cannot guarantee completion of treatment plan and follow-up observations;
(5) patients taking part in clinical trials.
Management
Every quarantine zone was attended by doctors and nurses to monitor body temperature, blood oxygen
saturation, clinical symptoms at least once a day. During the isolation period, all cases could receive
basic oral medications if needed. Nasopharyngeal swab samples were collected in each zone and sent to
the CDC for COVID-19 nucleic acid tests. Most of the CT scan were performed and analyzed in the third
people's hospital of HuBei Province. Nasopharyngeal swab and CT scan were given to each case once
they came in, and at least one more time before they left the quarantine zones.
Unquarantine standard
All following four conditions must be met for de-isolation from quarantine zones: (1)cases should be in
good physical status, with ECOG score 0-2 points, and without respiratory symptoms; (2) the latest CT
scan suggested that the conditions of viral pneumonia signicantly improved; (3)two consecutive nucleic
acid tests were negative (more than one day apart from each other); (4) cases should have stayed for at
least 14 days.
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Hospitalization standard
Cases should be transferred to the mobile cabin or designated hospitals for treatment as soon as
possible if any one of following conditions were met: (1)COVID-19 nucleic acid positive at any time; (2)
respiratory symptoms were aggravated and required for further medication; (3) CT scan indicating a
unfavorable or worsening inammatory changes in pulmonary system;(4)cases with worsened health
condition during isolation, whether it’s related or unrelated to viral pneumonia.
Statistical Analysis
Data collection was performed in accordance with the RECORD standard. The rate of different time
points in the same group were evaluated by chi-square tests. All analyses were conducted with SPSS10.0
and P <0.05 was considered as statistical signicance.
Patient and Public Involvement
Patients were not involved in development of the research question and outcome measures, study design
or conduct of this study.
Results
Demographic and clinical characteristics
We enrolled 1648 cases at 14 quarantine zones in Qiaokou district from Feb 8
th
to Mar 4
th
2020. We
delineated 1,232 cases for further analysis and 416 cases with incomplete information were excluded.
Among them, the median age was 52.00 years (2-93y), and the average age was 50.95y (2y-93y); M:
F=577:655. Based on the source of the population and the reasons for which those cases entered the
quarantine zones, we articially divided all cases into 4 groups (Table 1). There were 607 CT suspected
cases (49.27%), which refers to people with viral pneumonia changes in CT scan, having symptoms or
not. Among them, M: F=271:336, and the median age was 53.00y (3-90y). Symptomatic suspected cases
were count to 200 (16.24%), who developed fever or respiratory symptoms but without classical CT
changes when they came to the zones. Among them, M: F=97:103, and the median age was 51.0 (2-82y).
In symptomatic group, fever is the most common symptom, followed by cough, dyspnea, chest
congestion and asthma, etc. Another 366 (29.71%) people who have histories of close contact with
conrmed COVID-19 cases in absence of effective protections were termed as close contact cases. The
M: F=180:186 and median age was 51.00y (5-93y). Finally, in 59 (4.79%) discharged patients, who had
been conrmed COVID-19 positive, accepted treatment in designated hospitals and were asked to stay at
the quarantine zones for at least 14 days before going back home, the M: F=29:30 and the median age
was 55.0 (9-89y).
Clinical outcomes of the cases
