PMC:7126544 / 29030-33578 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7126544","sourcedb":"PMC","sourceid":"7126544","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7126544","text":"6.1 Clinical manifestations\nAccording to the guidelines published by the NHC and based on current epidemiological studies, the incubation period is typically 3–7 days, with a maximum of 14 days [82]. Common symptoms of COVID-19 include fever, fatigue, and dry cough. A few patients have symptoms such as nasal congestion, runny nose, sore throat, and diarrhea. Some patients only have a low fever, mild fatigue, and no pneumonia. In severe cases, the infection can cause pneumonia, shortness of breath and breathing difficulties occurring more than one week after infection. Critical patients may progress rapidly to acute respiratory distress syndrome (ARDS), septic shock, metabolic acidosis, coagulation dysfunction, and even death. It is worth noting that during the course of severe and critical patients, there can be moderate to low-grade fever or even no obvious fever.\nHuang et al. provided first-hand data regarding COVID-19 [26]. Their study reported the clinical features of the first 41 patients admitted to the designated hospital in Wuhan who were laboratory-confirmed COVID-19 by January 2, 2020. Twenty-seven (66%) of the 41 patients had been exposed to the Huanan seafood market. Common symptoms at the onset of illness were fever (98%), cough (76%), and myalgia or fatigue (44%). Less common symptoms were sputum production, headache, hemoptysis, and diarrhea. Dyspnea developed in 22 (55%) of 40 patients and 26 (63%) of 41 patients had lymphopenia. The median time from onset of symptoms to first hospital admission was 7.0 days, to shortness of breath was 8.0 days, and to ARDS was 9.0 days. Almost a third of patients developed ARDS requiring intensive care, 5 patients had acute cardiac injury, and 4 patients required assisted ventilation. Eventually 28 patients were discharged, 13 patients were admitted to the intensive care unit (ICU) and 6 patients died.\nChen et al. reported 99 patients with SARS-CoV-2 pneumonia admitted to the Jinyintan Hospital in Wuhan [37]. Forty-nine (49%) patients had a history of exposure to the local Huanan seafood market and 50 patients (51%) had chronic underlying diseases. Patients had clinical manifestations of fever (83%), cough (82%), shortness of breath (31%), muscle aches (11%), confusion (9%), headache (8%), sore throat (5%), rhinorrhea (4%), chest pain (2%), and diarrhea (2%). Eighty-nine (90%) patients had more than one symptom. According to their study, many cases presented with organ function damage, including 17 cases with ARDS, 8 cases with acute respiratory injury, 3 cases with acute renal injury, 4 cases with septic shock, and 1 case with ventilator-associated pneumonia. Eventually 31 patients were discharged, 11 patients died, and the remaining 57 patients were still in hospital.\nAt Zhongnan Hospital of Wuhan University in Wuhan, Wang et al. [83] enrolled 138 hospitalized patients with SARS-CoV-2 pneumonia. Common symptoms included fever (98.6%), fatigue (69.6%), dry cough (59.4%), myalgia (34.8%), and dyspnea (31.2%). The median time from first symptom to dyspnea was 5.0 days, to hospital admission was 7.0 days, and to ARDS was 8.0 days. Major complications during hospitalization included ARDS, arrhythmia, and shock. Of the 138 hospitalized patients, 47 recovered and have been discharged, 36 patients were admitted to the ICU and 6 patients have died.\nChang et al. [84] reported 13 confirmed patients outside of Wuhan, including 2 children (aged 2 years and 15 years). Twelve patients (92%) had fever before hospitalization. Other symptoms included upper airway congestion (62%), cough (46%), myalgia (23%), and headache (23%). All the patients recovered.\nGuan et al. [85] reported 1099 confirmed patients from 552 hospitals in the whole of China as of January 29, 2020. The most common symptoms including fever (87.9%) and cough (67.7%), whereas diarrhea (3.7%) and vomiting (5.0%) were rare. They also pointed out that only 43.8% of the patients had fever on presentation but 87.9% developed fever after being hospitalized. Moreover, compared with non-severe cases, any underlying diseases were significantly more common in severe cases. The most common complication was pneumonia (79.1%), ARDS (3.4%) and shock (1.0%). Of the 1099 patients, 55 patients were admitted to the ICU, and 15 patients died.\nThere were therefore a total of 41, 99 and 138 (total 278) cases of SARS-CoV pneumonia admitted in the 3 regional hospitals closest to the Huanan Seafood Market that resulted in 6, 11 and 6 deaths (23 deaths) or a case fatality rate of 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