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[22]. 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[17]. 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)[26]. 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[26]. 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[27]. 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.