Early antiviral treatment contributes to alleviate the severity and improve the prognosis of patients with novel coronavirus disease (COVID-19)
Authors: L Cui
Z Chen
Y Meng
J Wu
D Wang
B Jiang
X Shi
J Yu
H Cao
L Li
J Liu
C Liu
W Li
Journal: Journal of internal medicine (2020)
Discipline: CLINICAL MEDICINE
Keywords: antiviral treatment; coronavirus disease-19 (COVID-19); disease progression; prognosis; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Affiliations: From the, State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China., Department of Laboratory Medicine, The First People's Hospital of Yancheng City, Yancheng, China., Department of Hepatology, The Second People's Hospital of Fuyang City, Fuyang, China., Department of Laboratory Medicine, The Central Blood Station of Yancheng City, Jiangsu, China., Department of Laboratory Medicine, The Fifth People's Hospital of Wuxi, Affiliated to Jiangnan University, Wuxi, China., Department of Infectious Disease, The Second People's Hospital of Yancheng City, Yancheng, China., Department of Infectious Disease, The First People's Hospital of Yancheng City, Yancheng, China., Department of Laboratory Medicine, Suzhou Vocational Health College, Suzhou, China., Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, Hangzhou, China.

Abstract:  Background: At present, the severity of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a focal point. Methods: To assess the factors associated with severity and prognosis of patients infected with SARS-CoV-2, we retrospectively investigated the clinical, imaging and laboratory characteristics of confirmed 280 cases of novel coronavirus disease (COVID-19) from 20 January to 20 February 2020. Results: The median age of patients in the mild group was 37.55 years, whilst that in the severe group was 63.04 years. The proportion of patients aged over 65 years in the severe group was significantly higher than that of the mild group (59.04% vs. 10.15%, P &lt; 0.05). 85.54% of severe patients had diabetes or cardiovascular diseases, which was significantly higher than that of the mild group (51.81% vs. 7.11%, P = 0.025; 33.73% vs. 3.05%, P = 0.042). Patients in the mild group experienced earlier initiation of antiviral treatment (1.19 ± 0.45 vs. 2.65 ± 1.06 days in the severe group, P &lt; 0.001). Our study showed that comorbidity, time from illness onset to antiviral treatment and age &gt;=65 were three major risk factors for COVID-19 progression, whilst comorbidity and time from illness onset to antiviral treatment were two major risk factors for COVID-19 recovery. Conclusions: The elderly and patients with underlying diseases are more likely to experience a severe progression of COVID-19. It is recommended that timely antiviral treatment should be initiated to slow the disease progression and improve the prognosis. 

Retracted: No

PubPeer comments:
 From the conclusion:  It is recommended that timely antiviral treatment should be initiated to slow the disease progression and improve the prognosis. How can the authors conclude as long as all patients were giving antiviral treatment?  In conclusion, there is a high mortality rate in the patients infected with SARS-CoV-2 in severe group. There are no deaths in your  severe group (61% remained in hospital). Maybe you mean in general, but that is not very clear. Why do you give traditional chinese medicine to the patients, which is based on pseudoscience? , 
 From the conclusion:  It is recommended that timely antiviral treatment should be initiated to slow the disease progression and improve the prognosis.  How can the authors conclude as long as all patients were giving antiviral treatment?  In the early stage of the epidemic, there is no clear conclusion whether the disease needs to be treated with antiviral therapy immediately. According to the National Health Commission of the People s Republic of China, ribavirin, lopinavir ritonavir antiviral therapy is advised to be used in COVID-19 patients. However, the anti-virus treatment scheme in different hospitals or regions in China, are also different. Our research analyzed the data of antiviral treatment schemes from four hospitals. It is found that patients who receive antiviral treatment in time can significantly reduce the incidence of severe disease and also have a better prognosis.  In conclusion, there is a high mortality rate in the patients infected with SARS-CoV-2 in severe group. There are no deaths in your  severe group (61% remained in hospital). Maybe you mean in general, but that is not very clear. There are no deaths in our study, which may be related to the timely and effective epidemic control policies in the study area to enable all confirmed patients to receive timely and effective treatment. The mortality rate here is the totality data at that time in China. I am sorry for that we didnu2019t describe it clearly.  Why do you give traditional Chinese medicine to the patients, which is based on pseudoscience?  In this study, some cases used traditional Chinese medicine, which is based on the National Health Commission of the People s Republic of China. Hongcui Cao, M.D. State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Rd., Hangzhou 310003, China; Tel: 86-571-87236451; Fax: 86-571-87236459; Email: hccao@zju.edu.cn ,