Query: covid 19

title: Clinical course and risk factors for mortality of adult inpatients with COVID 19 in Wuhan, China: a retrospective cohort study
abstract: Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID 19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) Epidemiological and clinical characteristics of patients with COVID 19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described.  In this retrospective, multicentre cohort study, we included all adult inpatients =18 years old) with laboratory confirmed COVID 19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in hospital death.  patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48% patients had a comorbidity, with hypertension being the most common (58 [30% patients) followed by diabetes (36 [19% patients) and coronary heart disease (15 [8% patients) Multivariable regression showed increasing odds of in hospital death associated with older age (odds ratio 1*10, 95% CI 1*03 1*17, per year increase; p=0*0043) higher Sequential Organ Failure Assessment (SOFA) score (5*65, 2*61 12*23; p<0*0001) and d dimer greater than 1 mg/mL (18*42, 2*64 128*55; p=0*0033) on admission. Median duration of viral shedding was 20*0 days (IQR 17*0 24*0) in survivors, but SARS CoV 2 was detectable until death in non survivors. The longest observed duration of viral shedding in survivors was 37 days.  The potential risk factors of older age, high SOFA score, and d dimer greater than 1 mg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future.

title: Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID 19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention.
abstract: Hospitalised COVID 19 patients are frequently elderly subjects with co morbidities receiving polypharmacy, all of which are known risk factors for d

title: Pathological findings of COVID 19 associated with acute respiratory distress syndrome
abstract: bPortuguese Abstract:O surto do novo coronavArus (COVID 19) em Wuhan, China, iniciado em dezembro de 2019, evoluiu para se tornar uma pandemia global A

title: COVID 19: consider cytokine storm syndromes and immunosuppression
abstract: www.thelancet.com Published online March 13, 2020  0 1 Submissions should be made via our electronic submission system at http:/ees.elsevier.com/ thelancet/ However, in hyperinflammation, immunosuppression is likely to be beneficial. Re analysis of data from a phase 3 randomised controlled trial of IL 1 blockade (anakinra) in sepsis, showed significant survival benefit in patients with hyperinflammation, without increased adverse events. A multicentre, randomised con trolled trial of tocilizumab (IL 6 receptor blockade, licensed for cytokine release syndrome) has been approved in patients with COVID 19: consider cytokine storm syndromes and immunosuppression

title: An interactive web based dashboard to track COVID 19 in real time
abstract: The outbreak of the 2019 novel coronavirus disease (COVID 19) has induced a considerable degree of fear, emotional stress and anxiety among individuals around t

title: Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID 19 in the New York City Area.
abstract: Importance There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019  To describe the clinical characteristics and outcomes of patients with COVID 19 hospitalized in a US health care system.  The study included all sequentially hospitalized patients between March 1, 2020, and April 4, 2020, inclusive of these dates.  Confirmed severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample among patients requiring admission.  Clinical outcomes during hospitalization, such as invasive mechanical ventilation, kidney replacement therapy, and death. Demographics, baseline comorbidities, presenting vital signs, and test results were also collected.  A total of 5700 patients were included (median age, 63 years [interquartile range {IQR} 52 75; range, 0 107 years] 39.7% female) The most common comorbidities were hypertension (3026; 56.6% obesity (1737; 41.7% and diabetes (1808; 33.8% At triage, 30.7% of patients were febrile, 17.3% had a respiratory rate greater than 24 breaths/minute, and 27.8% received supplemental oxygen. The rate of respiratory virus co infection was 2.1% Outcomes were assessed for 2634 patients who were discharged or had died at the study end point. During hospitalization, 373 patients (14.2% (median age, 68 years [IQR, 56 78] 33.5% female) were treated in the intensive care unit care, 320 (12.2% received invasive mechanical ventilation, 81 (3.2% were treated with kidney replacement therapy, and 553 (21% died. Mortality for those requiring mechanical ventilation was 88.1% The median postdischarge follow up time was 4.4 days (IQR, 2.2 9.3) A total of 45 patients (2.2% were readmitted during the study period. The median time to readmission was 3 days (IQR, 1.0 4.5) for readmitted patients. Among the 3066 patients who remained hospitalized at the final study follow up date (median age, 65 years [IQR, 54 75] the median follow up at time of censoring was 4.5 days (IQR, 2.4 8.1)  This case series provides characteristics and early outcomes of sequentially hospitalized patients with confirmed COVID 19 in the New York City area.

title: Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID 19) Epidemic among the General Population in China
abstract: The 2019 coronavirus disease (COVID 19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID 19 outbreak. The data will be used for future reference.  From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID 19, knowledge and concerns about COVID 19, precautionary measures against COVID 19, and additional information required with respect to COVID 19. Psychological impact was assessed by the Impact of Event Scale Revised (IES R) and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS 21)  This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20 24 h per day at home (84.7% were worried about their family members contracting COVID 19 (75.2% and were satisfied with the amount of health information available (75.1% Female gender, student status, specific physical symptoms (e.g. myalgia, dizziness, coryza) and poor self rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p 0.05) Specific up to date and accurate health information (e.g. treatment, local outbreak situation) and particular precautionary measures (e.g. hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p 0.05)  During the initial phase of the COVID 19 outbreak in China, more than half of the respondents rated the psychological impact as moderate to severe, and about one third reported moderate to severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID 19 epidemic.

title: Hydroxychloroquine and azithromycin as a treatment of COVID 19: results of an open label non randomized clinical trial
abstract: Chloroquine and hydroxychloroquine have been found to be efficient on SARS CoV 2, and reported to be efficient in Chinese COV 19 patients. We evaluate the role of hydroxychloroquine on respiratory viral loads. Patients and methods French Confirmed COVID 19 patients were included in a single arm protocol from early March to March 16th, to receive 600mg of hydroxychloroquine daily and their viral load in nasopharyngeal swabs was tested daily in a hospital setting. Depending on their clinical presentation, azithromycin was added to the treatment. Untreated patients from another center and cases refusing the protocol were included as negative controls. Presence and absence of virus at Day6 post inclusion was considered the end point.  Six patients were asymptomatic, 22 had upper respiratory tract infection symptoms and eight had lower respiratory tract infection symptoms. Twenty cases were treated in this study and showed a significant reduction of the viral carriage at D6 post inclusion compared to controls, and much lower average carrying duration than reported of untreated patients in the literature. Azithromycin added to hydroxychloroquine was significantly more efficient for virus elimination.  Despite its small sample size our survey shows that hydroxychloroquine treatment is significantly associated with viral load reduction/disappearance in COVID 19 patients and its effect is reinforced by azithromycin.

title: The Incubation Period of Coronavirus Disease 2019 (COVID 19) From Publicly Reported Confirmed Cases: Estimation and Application
abstract: A novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) was identified in China in December 2019. There is limited support for many of its key epidemiologic features, including the incubation period for clinical disease (coronavirus disease 2019  which has important implications for surveillance and control activities.  To estimate the length of the incubation period of COVID 19 and describe its public health implications.  Pooled analysis of confirmed COVID 19 cases reported between 4 January 2020 and 24 February 2020.  News reports and press releases from 50 provinces, regions, and countries outside Wuhan, Hubei province, China.  Persons with confirmed SARS CoV 2 infection outside Hubei province, China.  Patient demographic characteristics and dates and times of possible exposure, symptom onset, fever onset, and hospitalization.  There were 181 confirmed cases with identifiable exposure and symptom onset windows to estimate the incubation period of COVID 19. The median incubation period was estimated to be 5.1 days (95% CI, 4.5 to 5.8 days) and 97.5% of those who develop symptoms will do so within 11.5 days (CI, 8.2 to 15.6 days) of infection. These estimates imply that, under conservative assumptions, 101 out of every 10 000 cases (99th percentile, 482) will develop symptoms after 14 days of active monitoring or quarantine.  Publicly reported cases may overrepresent severe cases, the incubation period for which may differ from that of mild cases.  This work provides additional evidence for a median incubation period for COVID 19 of approximately 5 days, similar to SARS. Our results support current proposals for the length of quarantine or active monitoring of persons potentially exposed to SARS CoV 2, although longer monitoring periods might be justified in extreme cases.  U.S. Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases, National Institute of General Medical Sciences, and Alexander von Humboldt Foundation.

title: Incidence of thrombotic complications in critically ill ICU patients with COVID 19
abstract: COVID 19 may predispose to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilisation and diffuse intravascular coagulation. Reports on the incidence of thrombotic complications are however not available.  We evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE) deep vein thrombosis, ischemic stroke, myocardial infarction or systemic arterial embolism in all COVID 19 patients admitted to the ICU of 2 Dutch university hospitals and 1 Dutch teaching hospital.  We studied 184 ICU patients with proven COVID 19 pneumonia of whom 23 died (13% 22 were discharged alive (12% and 139 (76% were still on the ICU on April 5th 2020. All patients received at least standard doses thromboprophylaxis. The cumulative incidence of the composite outcome was 31% (95%CI 20 41) of which CTPA and/or ultrasonography confirmed VTE in 27% (95%CI 17 37% and arterial thrombotic events in 3.7% (95%CI 0 8.2% PE was the most frequent thrombotic complication (n 25, 81% Age (adjusted hazard ratio (aHR) 1.05/per year, 95%CI 1.004 1.01) and coagulopathy, defined as spontaneous prolongation of the prothrombin time 3 s or activated partial thromboplastin time 5 s (aHR 4.1, 95%CI 1.9 9.1) were independent predictors of thrombotic complications.  The 31% incidence of thrombotic complications in ICU patients with COVID 19 infections is remarkably high. Our findings reinforce the recommendation to strictly apply pharmacological thrombosis prophylaxis in all COVID 19 patients admitted to the ICU, and are strongly suggestive of increasing the prophylaxis towards high prophylactic doses, even in the absence of randomized evidence.