This study firstly reported the 90-day follow-up of patients with COVID-19, and all the cases survived during our follow-up. The median duration between disease onset and admission were 6 days in this study, which was shorter than those cases reported from Wuhan [2, 3]. In addition, all of the patients received an antivirus treatment in this study. Actually, to explore the efficacy of antivirus agents for SARS-CoV-2, multi-center clinical studies are ongoing in China.
Severe cases accounted for 12.1% in this study. Similarly, Guan et al. reported severe illness occurred in 15.7% of the 1009 patients with COVID-19 . Whereas, another two studies outside Wuhan demonstrated lower rates of severe cases in China [7, 8]. On the other hand, studies from Wuhan reported relative high rates of patients who had an ICU stay [1, 3]. No death happened in our study, while the mortality rate of COVID-19 ranged from 0 to 15% in previous studies [1, 2, 4–8]. These discrepancies may result from the various sample sizes, inclusion criteria, and different stages of the disease. Taken together, early detection and early intervention likely contributes to improve the prognosis of COVID-19.
Currently, the confirmed origin of SARS-CoV-2 is yet unknown. However, increasing evidence demonstrates it could spread effectively among human beings [8, 10, 11]. Most (86.9%) patients had a history of contacting with residents of Wuhan or the patients with COVID-19 in the present study, which is in agreement with previous studies [4, 5, 8]. Surprisingly, over 50% of the patients had a family cluster onset in this study. These results indicated that the importance of human-to-human transmission in SARS-CoV-2. The main transmission routes of SARS-CoV-2 are considered to be respiratory droplets and direct contact . Gastrointestinal tract and urine are potential transmission routes of SARS-CoV-2, which needs to be confirmed. To date, with the threat of COVID-19 worldwide, effective measures to block the transmission routes are urgent.
A few patients were without any symptoms after being infected by SARS-CoV-2. However, fever (mainly mild to moderate) and cough were the most common symptoms of our patients with COVID-19 in this study, which was in agreement with recent studies [2, 3, 5, 6]. Gastrointestinal symptoms were not common in COVID-19. The most common underlying disease was hypertension in this study. These were in accordance with previous studies [1, 2, 5, 6, 12].
Approximately a quarter of the patients had a lymphopenia in this study, which was lower than those reported in recent studies [2, 5–8]. Different disease stages might result in this. Increased levels of inflammatory factors CRP and ESR were frequently occurred in the present study, while upregulated levels of PCT were uncommonly observed in patients with COVID-19. The level of LDH was increased in a relative high rate of patients in this study. These results were similar with recent publications [2, 5, 7].
As showing in this study, chest CT scan of patients with COVID-19 could be normal, lung consolidation, ground-glass opacity, and bilateral patchy shadowing, and the latter two were most common. These findings were consistent with published studies [1, 5, 13–15]. Different stages of COVID-19 may result in various radiological manifestations .
This study has limitations. First, respiratory samples were used to confirm the presence of COVID-19 by RT-PCR. Due to newly emerging of SARS-CoV-2, the false negative may be inevitably existed, which would influence the findings of the study. Second, no pediatric patients included in the present study, because Hwa Mei Hospital is an adult hospital, and pediatric patients with COVID-19 were designated to a children hospital. Third, cases were all from one hospital in this study.