[Source: International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC), full page: (LINK). Summary, edited.]
ISARIC (International Severe Acute Respiratory and Emerging Infections Consortium) – A global federation of clinical research networks, providing a proficient, coordinated, and agile research response to outbreak-prone infectious diseases
COVID-19 Report: 03 September 2020 – Containing data extracted 20 August 2020
Summary
The results in this report have been produced using data from the ISARIC COVID-19 database. For information, or to contribute to the collaboration, please contact ncov@isaric.org.
We thank all of the data contributors for collecting standardised data during these extraordinary times.
We plan to issue this report of aggregate data regularly for the duration of the SARS- CoV-2/COVID-19 pandemic.
Please note the following caveats. This is a dynamic report which captures new variables and information as our understanding of COVID-19 evolves. Please observe the N of each result to note newly added variables with fewer data points. Information is incomplete for the many patients who are still being treated.
Furthermore, it is likely that that we received more cases of severely ill individuals than those with relatively less severe illness; outcomes from these data, such as the proportion dying, must therefore not be used to infer outcomes for the entire population of people who might become infected. Some patients may be participants in clinical trials of experimental interventions. Many of the included cases are from the United Kingdom.
Additional caveats are provided in the in the ‘Caveats’ section below.
Up to the date of this report, data have been entered for 96074 individuals from 562 sites across 42 countries.
The analysis detailed in this report only includes individuals:
- for whom data collection commenced on or before 06 August 2020. (We have applied a 14-day rule to focus analysis on individuals who are more likely to have a recorded outcome. By excluding patients enrolled during the last 14 days, we aim to reduce the number of incomplete data records and thus improve the generalisability of the results and the accuracy of the outcomes. However, this limits our focus to a restricted cohort despite the much larger volumes of data held in the database.)
- who have laboratory-confirmed or clinically-diagnosed SARS-COV-2 infection. The cohort satisfying the above criteria has 81705 cases (95.82% are laboratory- confirmed for SARS-COV-2 infection).
The flow chart in Figure 1 gives an overview of the cohort and outcomes as of 20 August 2020.
Demographics and presenting features
Of these 81705 cases, 46516 are males and 35033 are females – sex is unreported for 156 cases. The minimum and maximum observed ages were 0 and 106 years respectively. The median age is 72 years. The observed mean number of days from (first) symptom onset to hospital admission was 7.8, with a standard deviation (SD) of 6.2 days and a median of 4 days. For all time-to-event variables, values greater than 120 days were treated as outliers and were excluded prior to any analysis.
The observed mean duration for the number of days from hospital admission to outcome (death or discharge) was 12.6, with SD 13 days and a median of 9 days. These estimates are based on all cases which have complete records on length of hospital stay (N = 77733).
The observed symptoms on admission partly represent case definitions and policies for hospital admission, which may change as time passes. The five most common symptoms at admission were history of fever, shortness of breath, cough, fatigue/malaise, and confusion. Frequencies of symptom prevalence vary with age.
25621/81862 (31.3%) patients presented with oxygen saturations <94%.
Outcomes
Outcomes have been recorded for 70225 patients, consisting of 47367 recoveries and 22858 deaths. Follow-up is ongoing for 2092 patients. Outcome records are unavailable for 9388 patients.
ICU/HDU:
A total of 13977 (17%) patients were admitted at some point of their illness into an intensive care unit (ICU) or high dependency unit (HDU). Of these, 4770 died, 586 are still in hospital and 6348 have recovered and been discharged.
The observed mean and median durations (in days) from hospital admission to ICU/HDU admission were 2.9 and 1 respectively (SD: 6.8) – estimated from records on cases with complete date records on hospital admission and ICU/HDU entry (N = 13275). The duration of stay in ICU/HDU had a mean of 13.2 days and a median of 8.5 (SD: 13.4 days) – estimated on only those cases with complete records for ICU/HDU duration or ICU/HDU start/end dates (N = 12088). Of these 13977 patients who were admitted into ICU/HDU, 4770 died, 586 are still in hospital and 6348 have recovered and been discharged. Outcome records are unavailable for 2273 cases.
Approximately 40% of patients with complete records on ICU admission dates were admitted to ICU within the first day of hospital admission. The distribution of the number of days from admission to ICU admission is shown in Figure 11.
Treatment
Antibiotics were received by 61796/74836 (82.6%) patients, and 7560/73902 (10.2%) received antivirals. These treatment categories are not mutually exclusive since some patients received multiple treatments. (The denominators differ due to data completeness.) 53920/80358 (67.1%) patients received some degree of oxygen supplementation: of these, 12300/53920 (22.8%) received NIV and 8803/53920 (16.3%) IMV. Of the patients admitted into ICU/HDU, 12091/13010 (92.9%) received antibiotics and 9398/18796 (50%) antivirals. 13028/13903 (93.7%) received some degree of oxygen supplementation, of which, 6980/13028 (53.6%) received NIV and 8272/13028 (63.5%) IMV. A total of 12300 patients received non-invasive mechanical ventilation (NIV). The mean and median durations from admission to receiving NIV were 4.2 days and 2 days respectively (SD: 8.7 days) – estimated from records on cases with complete records on dates of hospital admission and NIV onset (N = 9252). The mean and median durations for NIV were 2.4 days and 0 days respectively (SD: 5.4 days) – estimated based on only those cases which have complete NIV duration records (N = 5143). A total of 8803 patients received invasive mechanical ventilation (IMV). The mean and median durations from admission to receiving IMV were 3.7 days and 2 days respectively (SD: 7.9 days) – estimated from records on cases with complete records on dates of hospital admission and IMV onset (N = 7771). The mean, median and SD for the duration of IMV – estimated based on all 6624 cases with complete records on IMV stays – were 14.6 days, 11 days and 12.2 days respectively. Corticosteroids were administered to 12683 / 73354 (17.3%) patients. This includes 2851 / 7663 (37.2%) of those who received IMV, 7491 / 42387 (17.7%) of those who had oxygen therapy but not IMV, and 2332 / 23217 (10.0%) of those who had no oxygen therapy. On 16 June, results for dexamethasone were released for the RECOVERY randomized controlled trial (RECOVERY, 2020; RECOVERY Collaborative Group, 2020). This trial found that dexamethasone reduced deaths for patients receiving IMV and oxygen therapy, but not among patients not receiving respiratory support. Of patients admitted since 16 June, corticosteroids were received by 127 / 183 (69.4%) of those who received IMV, 464 / 1144 (40.6%) of those who had oxygen therapy but not IMV, and 155 / 1316 (11.8%) of those who had no oxygen therapy.
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Keywords: SARS-CoV-2; COVID-19.
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