Hospitalized Coronavirus Patients Develop Pneumonia, About 10% Die: Study

WEDNESDAY, Jan. 29, 2020 -- It's still the early days, but a report on the first 99 cases of the new coronavirus treated at a hospital in Wuhan, China, finds severe respiratory infection that proved fatal in about 10% of cases.

It should be noted that the report only involved patients sick enough to warrant hospitalization with 2019-nCoV -- the overall death rate from the infection remains much lower than that recorded in this study. As of Wednesday, Chinese authorities report that nearly 6,000 cases have been reported, including 132 deaths. That's a death rate of about 2% -- roughly similar to that seen with the flu.

All of the patients in China were admitted during the earliest stage of the outbreak, between Jan. 1 and Jan. 20, at Jinyintan Hospital in Wuhan, close to the seafood market where it's thought the 2019-nCoV pathogen emerged in late December.

All had pneumonia when they were admitted, and most (75%) had pneumonia in both lungs, said a team reporting in the Jan. 29 issue of The Lancet medical journal.

The typical patient was male (two-thirds of those treated), middle-aged or older (average age was 55.5 years) and almost half had underlying chronic diseases such as heart disease or diabetes, said a team led by Li Zhang, of the Tuberculosis and Respiratory Department at Wuhan Jinyintan Hospital.

Besides pneumonia, most patients had fever and coughing, and about a third had shortness of breath.

But the large majority -- 88 -- have survived their coronavirus infection, the group noted, and patients were treated with antiviral or antibiotic drugs and/or oxygen therapy.

However, 17 of the patients developed a critical condition known as acute respiratory distress syndrome (ARDS). According to the American Lung Association, "the main complication in ARDS is that fluid leaks into the lungs making breathing difficult or impossible." Eleven of the 17 people affected died after multiple organ failure, the Wuhan medical team said.

As for the rest, more than half (57) were still in the hospital as of Jan. 25, while about a third have been discharged.

According to the Wuhan team, the new data shows that "early identification and timely treatment of critical cases of 2019-nCoV are important."

"Effective life support and active treatment of complications should be provided to effectively reduce the severity of patients' conditions and prevent the spread of this new coronavirus in China and worldwide," the group concluded.

They stressed that many of the 11 patients who died were older and had underlying health issues: "five were older than 60 years, three had hypertension, and one was a heavy smoker," the team noted. The researchers said that pattern fits the typical profile of people who die from a viral pneumonia, as can happen with another viral disease, influenza.

Dr. Len Horovitz is a pulmonary specialist at Lenox Hill Hospital in New York City. Reading over the findings, he agreed that the clinical progress of 2019-nCoV appears to mimic that of flu.

"Complications and fatalities are associated with older adult men with comorbidities such as diabetes and pre-existing pulmonary conditions," Horovitz said. And he added that "this is not SARS." The death rate with SARS was roughly 10%, according to the The Lancet study.

An outbreak of SARS (severe acute respiratory syndrome) in China made headlines in 2003. SARS is from the same family of coronaviruses as 2019-nCoV, although it has key differences from the new germ.

One key difference is that it now appears people can transmit 2019-nCoV even when they are not showing symptoms -- a factor that could encourage the spread of the virus, experts say.

So far, only five cases of 2019-nCoV have been reported in the United States, all of them originating in people who were infected in China. No U.S. person-to-person transmission of the coronavirus has yet been reported, though a handful of other countries have seen such transmissions.

In related news, the U.S. Centers for Disease Control and Prevention said on Wednesday that a plane carrying U.S. citizens from Wuhan arrived at March Air Reserve Base in California on Wednesday morning and was met by CDC medical officers.

The 210 passengers were screened, monitored and evaluated by medical personnel at every stage of their journey, including before takeoff, during the flight, during a refueling in Anchorage, Alaska, and upon arrival in California, the CDC said.

Risk assessments -- including temperature checks and observing for respiratory symptoms -- have been conducted by CDC staff to check the health of each passenger, the agency said.

According to Horovitz, Americans should be vigilant about the new coronavirus, but should not panic. He said the comparisons to flu might be useful.

"It's clear that while there is cause for concern, mortality from coronavirus does not appear to be high," Horovitz said. "Up to 40,000 people die annually from influenza in this country in an average year -- and people still refuse the flu shot."

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Posted: January 2020