We report eleven COVID-19 patients admitted to Meizhou people's hospital. Consistent with other reports[18–20], the most common symptoms are fever and cough, and diarrhea is rare. Cases 1, 2, 3 and 5 have been living in Wuhan for a long time and have all come to Meizhou since late January. Cases 7, 8 and 9 (the daughter of case 7 (mother) and case 8 (father)) have been living in Nanchang city, Jiangxi Province for a long time. Cases 7 and 8 arrived in Wuhan on January 15, 2020 and returned to Nanchang on January 17, 2020. Cases 7, 8 and 9 arrived in Meizhou from Nanchang on January 25, 2020. Three family clusters were identified. The sister and mother of case 1 were also COVID-19 patients (admitted to other designated hospitals). The mother of case 5 was also a COVID-19 patient (admitted to other designated hospitals). Cases 7, 8 and 9 are from a family.
Five of the 11 patients had no symptoms of fever upon admission. Patients without fever are easily overlooked, increasing the risk of transmission[13, 21]. It is important to determine the epidemiological history of a patient in clinical practice. The most common laboratory test results were decreased lymphocytopenia (LYM) and lymphocytic percentage (LYM%) or normal, decreased total protein (TP) and albumin (ALB), increased C reactive protein (CRP) and lactate dehydrogenase (LDH) or normal. Our results are consistent with those reported in previous studies[19, 22, 23]. In addition, we found that increased erythrocyte sedimentation rate (ESR), activated partial thromboplastin time (APTT), increased fibrinogen (FIB) and creatine kinase isoenzymes (CK-MB) were also laboratory abnormalities in some patients. Our results are consistent with some research reports[24, 25].
Our study found that NEU (r = 0.664, P = 0.026), CK-MB (r = 0.655, P = 0.029), BUN (r = 0.682, P = 0.021) and Ct value were significantly correlated. That is to say, NEU and CK-MB were negatively correlated with the SARS-CoV-2 viral load, and BUN was positively correlated with the SARS-CoV-2 viral load. Therefore, the combination of low NEU, CK-MB and high BUN concentration may indicate higher viral load and greater risk of transmission in patients with SARS-CoV-2 infection upon admission. A study has shown that CRP, ALB, LYM (%), LYM and NEU were highly correlated to the Ct value. We hope that the reports of these 11 cases in our hospital will provide useful information for the diagnosis and treatment of COVID-19.
We identified two different SNPs at positions 8781 and 28144, one is synonymous mutation (position 8781) in the ORF1ab locus, and the other as a missense mutation (position 28144) in ORF8. The mutation of position 28144 causes a Ser/Leu change, which is predicted to be affecting the structural disorder of the protein. In addition, it was a T base at position 8781, it must be a C base at position 28145. In contrast, if there is a C base at position 8781, there must be a T base at position 28145. According to the whole-genome molecular evolution analysis of SARS-CoV-2, it is found that there are two subtypes (L subtype and S subtype). The difference between the two subtypes lies in the position 28144 of the viral RNA genome, where L subtype is the T base (Leucine), and S subtype is the C base (Serine). It is speculated that there may be some differences in the transmission capacity and the severity of disease between L subtype and S subtype, among which L type is more common in the early stage of the outbreak in Wuhan. Among them, L subtype may be more infectious. To date, most COVID-19 patients have been infected with only one of these subtypes. In our study, cases 3, 4, 5, 10 and 11 have been infected with L subtype SARS-CoV-2, only cases 3 and 5 have lived or visited Wuhan. And the severity of these patients with L subtype was not significantly different from that of other patients.
The Novel Coronavirus Pneumonia (NCP) Protocol Trial Version 3 to Trial Version 7 released by the National Health Commission of the People’s Republic of China provide some reference drugs for the treatment of COVID-19. The Trial Version 3 proposes the atomized inhalation of alpha interferon and recommends the use of lopinavir/ritonavir for treatment. The Trial Version 4 suggested that severe patients can be treated with intestinal microecological modulators and convalescent plasma treatment. In the Trial Version 5, ribavirin (4 g/dose for first day in adults, 1.2 g/dose for the next day and once every 8 hours, or 8 mg/kg/dose, once every 8 hours) was recommended. The Trial Version 6 recommended chloroquine phosphate (500 mg/dose, 2 times/d for adults, not exceeding 10 d) and Arbidol (200 mg/dose, 3 times/d for adults, not exceeding 10 d).
In view of the characteristics of SARS-CoV-2, such as long incubation period, strong infectivity and general susceptibility of the population, there are currently no specific drug/drugs that can better treat the COVID-19 caused by SARS-CoV-2. Therefore, there is great significance to increase the recognition of clinical features, biochemical indexes of COVID-19 patients and the molecular biology level of SARS-CoV-2 and to search for potential drug/drugs with inhibitory effect on this virus.