Full spectrum of COVID-19 severity still being depicted
Authors: Zhou Xu, Shu Li, Shen Tian, Hao Li, Ling-quan Kong
Journal: The Lancet (2020)

Chaolin Huang and colleagues1Huang C Wang Y Li X et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.Lancet. 2020; (published online Jan 24.)https://doi.org/10.1016/S0140-6736(20)30183-5Summary Full Text Full Text PDF Scopus (32891) Google Scholar first reported the clinical features of patients infected with severe acute respiratory syndrome corona virus 2 (SARS-CoV-2; previously known as 2019-nCoV), which emerged in Wuhan, China. Their study will contribute to the diagnosis and treatment of 2019 novel coronavirus disease (COVID-19). Meanwhile, the conclusions have caused a certain degree of social panic. Huang and colleagues1Huang C Wang Y Li X et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.Lancet. 2020; (published online Jan 24.)https://doi.org/10.1016/S0140-6736(20)30183-5Summary Full Text Full Text PDF Scopus (32891) Google Scholar only included 59 suspected cases with fever and dry cough, and 41 patients were confirmed to be infected with SARS-CoV-2. They concluded that SARS-CoV-2 infection was associated with a high rate of admission to intensive care units (13 [32%] of 41 patients) and mortality (six [15%] of 41 patients); however, we believe these conclusions were inaccurate and misleading. Case fatality ratio should not be confused with mortality rate. Case fatality rate is defined as the proportion of people who die of a certain disease; however, mortality rate usually reflects the death rate in an entire population.2Centers for Disease Control and PreventionPrinciples of epidemiology in public health practice: lesson 3.https://www.cdc.gov/csels/dsepd/ss1978/lesson3/section3.htmlDate: May 18, 2012Date accessed: February 4, 2020Google Scholar The case fatality rate is therefore approximately 15% in the study population,1Huang C Wang Y Li X et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.Lancet. 2020; (published online Jan 24.)https://doi.org/10.1016/S0140-6736(20)30183-5Summary Full Text Full Text PDF Scopus (32891) Google Scholar but this estimate is also inaccurate since case detection is highly biased towards the more severe cases in the early stages.3Wang C Horby PW Hayden FG Gao GF A novel coronavirus outbreak of global health concern.Lancet. 2020; (published online Jan 24.)https://doi.org/10.1016/S0140-6736(20)30185-9Summary Full Text Full Text PDF Scopus (5024) Google Scholar In fact, a large number of mild and asymptomatic patients might not receive timely diagnosis or health care, which can conceal the real incidence and allow disease progression. Patients with SARS-CoV-2 infection are presenting with a wide range of symptoms. Most patients seem to have mild disease, and about 20% appear to progress to severe disease, including pneumonia, respiratory failure, and, in some cases, even death.4WHONovel coronavirus (2019-nCoV) situation reports. Situation report - 23.https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200212-sitrep-23-ncov.pdf?sfvrsn=41e9fb78_2Date: Feb 12, 2020Date accessed: February 12, 2020Google Scholar As of Feb 12, 2020, WHO4WHONovel coronavirus (2019-nCoV) situation reports. Situation report - 23.https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200212-sitrep-23-ncov.pdf?sfvrsn=41e9fb78_2Date: Feb 12, 2020Date accessed: February 12, 2020Google Scholar reports that 45 171 people have been diagnosed with SARS-CoV-2 worldwide, and 44 730 of these cases are in China.4WHONovel coronavirus (2019-nCoV) situation reports. Situation report - 23.https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200212-sitrep-23-ncov.pdf?sfvrsn=41e9fb78_2Date: Feb 12, 2020Date accessed: February 12, 2020Google Scholar Of the confirmed cases in China, 8204 (18%) cases were recorded as severe infections, and 1114 (2%) patients died, which is a lower case fatality rate than previously reported.4WHONovel coronavirus (2019-nCoV) situation reports. Situation report - 23.https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200212-sitrep-23-ncov.pdf?sfvrsn=41e9fb78_2Date: Feb 12, 2020Date accessed: February 12, 2020Google Scholar, 5National Health Commission of the People's Republic of ChinaLatest on the novel coronavirus outbreak.http://www.nhc.gov.cn/xcs/yqtb/202002/395f075a5f3a411f80335766c65b0487.shtmlDate: Feb 12, 2020Date accessed: February 13, 2020Google Scholar The case fatality rate for COVID-19 reported by Huang and colleagues1Huang C Wang Y Li X et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.Lancet. 2020; (published online Jan 24.)https://doi.org/10.1016/S0140-6736(20)30183-5Summary Full Text Full Text PDF Scopus (32891) Google Scholar could be misunderstood, and detection bias should not be neglected. We declare no competing interests. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, ChinaThe 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Full-Text PDF Full spectrum of COVID-19 severity still being depicted – Authors' replyZhou Xu and colleagues point out that mortality, which should be referred correctly and more clearly as case fatality ratio, among the first 41 cases with laboratory-confirmed 2019 novel coronavirus disease (COVID-19; previously known as 2019-nCoV) was misleading in our Article.1 Full-Text PDF