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Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m606 (Published 19 February 2020) Cite this as: BMJ 2020;368:m606

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Covid-19: a puzzle with many missing pieces

  1. Xiao-Wei Xu, physician1,
  2. Xiao-Xin Wu, physician1,
  3. Xian-Gao Jiang, physician2,
  4. Kai-Jin Xu, physician1,
  5. Ling-Jun Ying, physician3,
  6. Chun-Lian Ma, physician4,
  7. Shi-Bo Li, physician5,
  8. Hua-Ying Wang, physician6,
  9. Sheng Zhang, physician7,
  10. Hai-Nv Gao, professor8,
  11. Ji-Fang Sheng, professor1,
  12. Hong-Liu Cai, physician1,
  13. Yun-Qing Qiu, professor1,
  14. Lan-Juan Li, professor1
  1. 1State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Centre for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310003, China
  2. 2Department of Infectious Disease, Wenzhou Central Hospital, Wenzhou, Zhejiang Province, China
  3. 3Department of Infectious Disease, Taizhou Enze Medical Centre (Group), Enze Hospital, Taizhou, Zhejiang Province, China
  4. 4Department of Infectious Disease, First People’s Hospital of Wenling, Wenling, Zhejiang Province, China
  5. 5Department of Infectious Disease, Affiliated Zhoushan Hospital, Wenzhou Medical University, Zhoushan, Zhejiang Province, China
  6. 6Department of Respiratory and Critical Care Medicine, Yinzhou People’s Hospital, Affiliated Yinzhou Hospital, College of Medicine, Ningbo University, Ningbo City, Zhejiang Province, China
  7. 7Department of Infectious Disease, Taizhou Hospital, Taizhou, Zhejiang Province, China
  8. 8Department of Infectious Disease, ShuLan (Hangzhou) Hospital affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, Zhejiang Province, China
  1. Correspondence to: L-J Li ljli{at}zju.edu.cn
  • Accepted 13 February 2020

Abstract

Objective To study the clinical characteristics of patients in Zhejiang province, China, infected with the 2019 severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) responsible for coronavirus disease 2019 (covid-2019).

Design Retrospective case series.

Setting Seven hospitals in Zhejiang province, China.

Participants 62 patients admitted to hospital with laboratory confirmed SARS-Cov-2 infection. Data were collected from 10 January 2020 to 26 January 2020.

Main outcome measures Clinical data, collected using a standardised case report form, such as temperature, history of exposure, incubation period. If information was not clear, the working group in Hangzhou contacted the doctor responsible for treating the patient for clarification.

Results Of the 62 patients studied (median age 41 years), only one was admitted to an intensive care unit, and no patients died during the study. According to research, none of the infected patients in Zhejiang province were ever exposed to the Huanan seafood market, the original source of the virus; all studied cases were infected by human to human transmission. The most common symptoms at onset of illness were fever in 48 (77%) patients, cough in 50 (81%), expectoration in 35 (56%), headache in 21 (34%), myalgia or fatigue in 32 (52%), diarrhoea in 3 (8%), and haemoptysis in 2 (3%). Only two patients (3%) developed shortness of breath on admission. The median time from exposure to onset of illness was 4 days (interquartile range 3-5 days), and from onset of symptoms to first hospital admission was 2 (1-4) days.

Conclusion As of early February 2020, compared with patients initially infected with SARS-Cov-2 in Wuhan, the symptoms of patients in Zhejiang province are relatively mild.

Footnotes

  • Contributors: X-WX and X-XW contributed equally to this article. XWX and LJL conceptualised the paper. XXW analysed the data, with input from JFS, KJX, XGJ, LJY, CLM, SBL, HYW, SZ, HNG, HLC, and YQQ. XWX and XXW wrote the initial draft with all authors providing critical feedback and edits to subsequent revisions. All authors approved the final draft of the manuscript. L-LJ is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding: No funding.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was approved by the Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine (2020IIT A0001).

  • Patient consent: Obtained.

  • Data sharing: No additional data available.

  • Transparency: The lead authors and manuscript’s guarantor affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

  • Dissemination to participants and related patient and public communities: No study participants were involved in the preparation of this article. The results of the article will be summarised in media press releases from the Zhejiang University and presented at relevant conferences.

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