By the end of Jan 25, 31 (31%) patients had been discharged and 11 (11%) patients had died; all other
patients were still in hospital (table 1). The first two deaths were a 61-year-old man (patient 1) and a 69-year-old man (patient 2).
They had no previous chronic underlying disease but had a long history of smoking. Patient 1 was transferred to Jinyintan Hospital
and diagnosed with severe pneumonia and ARDS. He was immediately admitted to the intensive care unit (ICU) and given an intubated
ventilator-assisted breathing therapy. Later, the patient, having developed severe respiratory failure, heart failure, and sepsis,
experienced a sudden cardiac arrest on the 11th day of admission and was declared dead. Patient 2 had severe pneumonia and ARDS after
admission. The patient was transferred to the ICU and given ventilator-assisted breathing, and received anti-infection and ECMO treatment
after admission. The patient's hypoxaemia remained unresolved. On the ninth day of admission, the patient died of severe pneumonia,
septic shock, and respiratory failure. The intervals between the onset of symptoms and the use of ventilator-assisted breathing in the
two patients were 3 days and 10 days, respectively. The course of the disease and lung lesions progressed rapidly in both patients, with
both developing multiple organ failure in a short time. The deaths of these two patients were consistent with the MuLBSTA score, an early
warning model for predicting mortality in viral pneumonia.
Of the remaining nine patients who died, eight patients had lymphopenia, seven had bilateral pneumonia,
five were older than 60 years, three had hypertension, and one was a heavy smoker.
This is an extended descriptive study on the epidemiology
and clinical characteristics of the 2019-nCoV, including data on 99 patients who were transferred to Jinyintan Hospital from other
hospitals across Wuhan. It presents the latest status of the 2019-nCoV infection in China and adds details on combined bacterial and
Human coronavirus is one of the main pathogens of respiratory infection. The two highly pathogenic viruses,
SARS-CoV and MERS-CoV, cause severe respiratory syndrome in humans and four other human coronaviruses (HCoV-OC43, HCoV-229E, HCoV-NL63,
HCoV-HKU1) induce mild upper respiratory disease. The major SARS-CoV outbreak involving 8422 patients occurred during 2002–03 and spread
to 29 countries globally.9,10 MERS-CoV emerged in Middle Eastern countries in 2012 but was imported into China.11,12
The sequence of 2019-nCoV is
relatively different from the six other coronavirus subtypes but can be classified as betacoronavirus. SARS-CoV and MERS-CoV can be
transmitted directly to humans from civets and dromedary camels, respectively, and both viruses originate in bats, but the origin of
2019-nCoV needs further investigation.13,14,15 2019-nCoV also has enveloped virions that measure approximately 50–200 nm in
diameter with a
single positive-sense RNA genome.16 Club-shaped glycoprotein spikes in the envelope give the virus a crown-like or coronal appearance.
Transmission rates are unknown for 2019-nCoV; however, there is evidence of human-to-human transmission. None of the 99 patients we
examined were medical staff, but 15 medical workers have been reported with 2019-nCoV infection, 14 of whom are assumed to have been
infected by the same patient.17 The mortality of SARS-CoV has been reported as more than 10% and MERS-CoV at more than 35%.
5,18 At data cutoff for this study, mortality of the 99 included patients infected by 2019-nCoV was 11%, resembling that
in a previous study.3 However, additional deaths might occur in those still hospitalised.
We observed a greater number of men than women in the 99 cases of 2019-nCoV infection. MERS-CoV and
SARS-CoV have also been found to infect more males than females.19,20 The reduced susceptibility of females to viral infections
could be attributed to the protection from X chromosome and sex hormones, which play an important role in innate and adaptive immunity.21
Additionally, about half of patients infected by 2019-nCoV had chronic underlying diseases, mainly cardiovascular and cerebrovascular
diseases and diabetes; this is similar to MERS-CoV.19 Our results suggest that 2019-nCoV is more likely to infect older adult males
with chronic comorbidities as a result of the weaker immune functions of these patients.19,20,21,22
Some patients, especially severely ill ones, had co-infections of bacteria and fungi. Common bacterial
cultures of patients with secondary infections included A baumannii, K pneumoniae, A flavus, C glabrata, and C albicans.8 The high
drug resistance rate of A baumannii can cause difficulties with anti-infective treatment, leading to higher possibility of developing
septic shock.23 For severe mixed infections, in addition to the virulence factors of pathogens, the host’s immune status is also one
f the important factors. Old age, obesity, and presence of comorbidity might be associated with increased mortality.24 When populations
with low immune function, such as older people, diabetics, people with HIV infection, people with long-term use of immunosuppressive
agents, and pregnant women, are infected with 2019-nCoV, prompt administration of antibiotics to prevent infection and strengthening
of immune support treatment might reduce complications and mortality.
In terms of laboratory tests, the absolute value of lymphocytes in most patients was reduced. This result
suggests that 2019-nCoV might mainly act on lymphocytes, especially T lymphocytes, as does SARS-CoV. Virus particles spread through
the respiratory mucosa and infect other cells, induce a cytokine storm in the body, generate a series of immune responses, and cause
changes in peripheral white blood cells and immune cells such as lymphocytes. Some patients progressed rapidly with ARDS and septic
shock, which was eventually followed by multiple organ failure. Therefore, early identification and timely treatment of critical cases
is of crucial importance. Use of intravenous immunoglobulin is recommended to enhance the ability of anti-infection for severely ill
patients and steroids (methylprednisolone 1–2 mg/kg per day) are recommended for patients with ARDS, for as short a duration of
treatment as possible. Some studies suggest that a substantial decrease in the total number of lymphocytes indicates that coronavirus
consumes many immune cells and inhibits the body's cellular immune function. Damage to T lymphocytes might be an important factor
leading to exacerbations of patients. The low absolute value of lymphocytes could be used as a reference index in the diagnosis of
new coronavirus infections in the clinic.
In general, the characteristics of patients who died were in line with the early warning model for
predicting mortality in viral pneumonia in our previous study: the MuLBSTA score.8 The MuLBSTA score system contains six indexes,
which are multilobular infiltration, lymphopenia, bacterial co-infection, smoking history, hypertension, and age. Further
investigation is needed to explore the applicability of the MuLBSTA score in predicting the risk of mortality in 2019-nCoV infection.
This study has several limitations. First, only 99 patients with confirmed 2019-nCoV were included; suspected but undiagnosed cases
were ruled out in the analyses. It would be better to include as many patients as possible in Wuhan, in other cities in China, and
even in other countries to get a more comprehensive understanding of 2019-nCoV. Second, more detailed patient information,
particularly regarding clinical outcomes, was unavailable at the time of analysis; however, the data in this study permit an
early assessment of the epidemiological and clinical characteristics of 2019-nCoV pneumonia in Wuhan, China.
In conclusion, the infection of 2019-nCoV was of clustering onset, is more likely to infect older
men with comorbidities, and can result in severe and even fatal respiratory diseases such as ARDS.
NC, XD, FG, YH, YQ, JW, YL, YW, JX, TY, and LZ collected the epidemiological and clinical data and
processed statistical data. NC and MZ drafted the manuscript. JQ and XZ revised the final manuscript. XZ is responsible for
summarising all data related to the virus. LZ is responsible for summarising all epidemiological and clinical data.
Declaration of interests
We declare no competing interests.
This study was funded by the National Key R&D Program of China (number 2017YFC1309700 ).
We thank all patients involved in the study.
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