Observations about symptomatic and asymptomatic infections of 494 patients with COVID-19 in Shanghai, China - 26/08/20

Doi : 10.1016/j.ajic.2020.06.221

Xue Mei, MD ^a,^{^{1
These authors contributed equally.}}, Yuyi Zhang, MD ^a,^{^{1
These authors contributed equally.}}, Hui Zhu, MD ^a,^{^{1
These authors contributed equally.}}, Yun Ling, MD ^b, Ying Zou, MD ^a, Zhengguo Zhang, MD ^a, Hongying Guo, MD ^a, Yu Liu, MD ^a, Xingxia Cheng, MD ^a, Min Liu, MD ^c, Wei Huang, MD ^d, Jiefei Wang, MD ^a, Zhigang Yi, MD ^e,^⁎ , Zhiping Qian, MD ^a,^⁎ , Hongzhou Lu, MD ^e,^f,^⁎
^a Department of Severe Hepatology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
^b Department of Infection Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
^c Department of Gastroenterology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
^d Department of Respiratory, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
^e Research Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
^f Department of Infection and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China

^⁎Address correspondence to Zhigang Yi, Hongzhou Lu, Research Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.Research UnitShanghai Public Health Clinical Center, Fudan UniversityShanghaiChina^⁎⁎Address correspondence to Zhiping Qian, Department of Severe Hepatology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.Department of Severe HepatologyShanghai Public Health Clinical Center, Fudan UniversityShanghaiChina

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Highlights

•	COVID-19 symptoms are more severe in males and elderly patients whereas mild in young patients.
•	Imported cases in Shanghai mainly show upper respiratory tract symptoms.
•	Asymptomatic infections are common in young COVID-19 patients and the frequency is low.
•	1/3 COVID-19 patients continues to be viral RNA positive after symptoms disappear.
•	Time for COVID-19 symptoms disappear negatively correlates with lymphocyte count.

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Resumen

Background

Humans are generally susceptible to SARS-CoV-2, which has caused a global pandemic of COVID-19. The screening of infected people in the population still mainly depends on clinical symptoms. However, there is limited research on the characteristics of clinical symptoms in different populations, especially in imported cases.

Methods

To retrospectively analyze the clinical data of 494 confirmed COVID-19 patients admitted to a designated hospital in Shanghai from January 20, 2020, to March 31, 2020, we compared the clinical manifestations in different populations and their influencing factors in COVID-19 patients.

Results

(1) Of the 494 patients, 453 (91.7%) had different symptoms at admission, and 39 (7.89%) patients were asymptomatic. (2) We compared the symptoms of patients according to different stratifications and found the following results: (a) The proportion of dyspnea was significantly higher in male patients than in female patients (P < .05). (b) The proportions of a stuffy nose, sore throat, and olfactory and gustatory dysfunction were significantly higher in children than in adult patients (P < .05). (c) The proportions of fever, chest tightness, shortness of breath, and fatigue were significantly higher in local cases than in imported cases. In comparison, the proportions of nasal congestion, stuffy nose, sore throat, headache, and olfactory and gustatory dysfunction were significantly lower in imported cases than in imported cases (P < .05). (d) The proportions of chest tightness, shortness of breath, and dyspnea were significantly higher in severely ill patients than in those with mild symptoms (P < .05). (3) Thirty-one asymptomatic patients were significantly younger than symptomatic patients, and they had a higher proportion of imported cases, white blood cell and lymphocyte count levels, and fewer abnormal CT cases than the group of symptomatic patients (P < .05). (4) The number of days since the onset of the disease needed for the symptoms to disappear was associated with the epidemiological history (imported cases), the number of days until the pharyngeal swab nucleic acid test turned negative, the days of hospitalization, the days of onset, and the white blood cell and lymphocyte count levels (P < .05).

Conclusions

The majority of COVID-19 patients (91.7%) had early symptoms, whereas 7.89% of COVID-19 patients were asymptomatic. Younger patients had fewer symptoms, mainly the upper respiratory symptoms, and the illness condition was milder, which was more common in imported cases. Elderly male patients had severe symptoms when admitted. The number of days needed for the patient's symptoms to disappear was closely related to the number of days necessary for the pharyngeal swab nucleic acid test to turn negative.

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Key Words : SARS-CoV-2, Novel coronavirus pneumonia, Symptoms

Esquema

Demographic characteristics and baseline data

Distribution of symptoms in COVID-19 patients

Comparison of different stratification of symptomatic patients (n = 453)

Comparison of COVID-19 patients with symptomatic and asymptomatic infection

Comparison of nucleic acid positive and nucleic acid negative patients after symptoms disappeared

Factors associated with the number of days necessary for the symptoms to disappear in patients with COVID-19

Discussion

Conclusions

	Funding/support: This study was supported by Top University and First-Class Discipline Construction Project of Fudan University (Project No: IDF162005); Scientific research project for novel coronavirus “2019-nCoV” of ZQ (Project No: 2020YJKY01).
	Conflicts of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
	Author contributions: All of the authors participated in the research design. LH, QZ, and YZ had the idea for this study, designed it, and had full access to all of the data. MX, ZY, and ZH performed the data management and statistical analyses after discussion with all authors. All of the authors participated in data interpretation and in writing the manuscript. All of the authors took responsibility for the decision to submit for publication.