[Source: Open Forum Infectious Diseases, full page: (LINK). Abstract, edited.]
The course of mild and moderate Covid-19 infections – the unexpected long-lasting challenge
Lu Xia, Jun Chen, Thomas Friedemann, Zongguo Yang, Yun Ling, Xuhui Liu, Shuihua Lu, Tao Li, Zhigang Song, Wei Huang, Yunfei Lu, Sven Schröder, Hongzhou Lu
Open Forum Infectious Diseases, ofaa286, https://doi.org/10.1093/ofid/ofaa286
Published: 23 July 2020
Abstract
Background
The course of disease in mild and moderate COVID-19 has many implications for mobile patients, such as the risk of spread of the infection, the precautions taken and the investigations targeted at preventing transmission.
Methods
331 adults were hospitalized from 21 January to 22 February 2020 and classified as severe (10%) and critical (4.8%) cases; 1.5% died. 282 (85.2%) mild or moderate cases were admitted to regular wards. Epidemiological, demographic, clinical, chest CT scan, laboratory, treatment and outcome data from patient records were analyzed retrospectively.
Results
Patients were symptomatic for 9.82±5.75 (1–37) days. Pulmonary involvement was demonstrated on a chest CT scan in 97.9% of cases. It took 16.81±8.54 (3–49) days from the appearance of the first symptom until 274 patients tested virus-negative in NP swabs, blood, urine, and stool. And, 234 (83%) patients were already asymptomatic for 9.09±7.82 (1–44) days. Subsequently, 131 patients were discharged. 169 remained in hospital, these patients tested virus-free and were clinically asymptomatic, because of widespread persisting or increasing pulmonary infiltrates. Hospitalization took 16.24±7.57 (2–47) days – from the first symptom to discharge the time interval was 21.37±7.85 (3–52) days.
Conclusions
With an asymptomatic phase, disease courses are unexpectedly long until the stage of virus negativity. NP swabs are not reliable in later stages of COVID-19. Pneumonia outlasts virus-positive tests if sputum is not acquired. Imminent pulmonary fibrosis in high-risk groups demands follow-up examinations. Investigation of promising antiviral agents should heed the specific needs of mild and moderate COVID-19 patients.
Coronavirus disease 2019 (COVID-19), novel coronavirus (2019-nCoV), Human coronavirus (HCoV-19), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), lopinavir/ritonavir, Umifenovir, Shufeng Jiedu, Cohort study, virus transmission
Issue Section: Major Article
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© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
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Keywords: SARS-CoV-2; COVID-19.
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