- Factors Associated with Hospital Admission and Critical Illness among 5279 People with Coronavirus Disease 2019 in New York City: Prospective Cohort Study (NYU)
5,279 patients were included. 2,741 of these 5,279 (51.9%) were admitted, of whom 1,904 (69.5%) were discharged alive without hospice care and 665 (24.3%) [CFR of 12.6%] were discharged to hospice care or died. Of 647 (23.6%) patients requiring mechanical ventilation, 391 (60.4%) died and 170 (26.2%) were extubated or discharged. The strongest risk for hospital admission was associated with age, with an odds ratio of >2 for all age groups older than 44 years and 37.9 (95% confidence interval 26.1 to 56.0) for ages 75 years and older. Other risks were heart failure, male sex, chronic kidney disease, and any increase in body mass index (BMI). The strongest risks for critical illness besides age were associated with heart failure, BMI >40, and male sex. Admission oxygen saturation of <88%, troponin level >1, C reactive protein level >200, and D-dimer level >2500 were, however, more strongly associated with critical illness than age or comorbidities. Risk of critical illness decreased significantly over the study period. Similar associations were found for mortality alone.
- Epidemiology, Clinical Course, and Outcomes of Critically Ill Adults with COVID-19 in New York City: A Prospective Cohort Study (Columbia University Medical Center)
Between March 2 and April 1, 2020, 1,150 adults were admitted to both hospitals [Milstein and the Allen] with laboratory-confirmed COVID-19, of which 257 (22%) were critically ill. The median age of patients was 62 years (IQR 51–72), 67% were men. 212 (82%) patients had at least one chronic illness, the most common of which were hypertension (63%) and diabetes (36%). 119 (46%) patients had obesity. As of April 28, 2020, 101 (39%) patients had died and 94 (37%) remained hospitalised [CFR of 8.8%]. 203 (79%) patients received invasive mechanical ventilation for a median of 18 days (IQR 9–28), 170 (66%) of 257 patients received vasopressors and 79 (31%) received renal replacement therapy. The median time to in-hospital deterioration was 3 days (IQR 1–6). In the multivariable Cox model, older age, chronic cardiac disease, chronic pulmonary disease, higher concentrations of interleukin-6, and higher concentrations of D-dimer were independently associated with in-hospital mortality.
- Characterization and Clinical Course of 1,000 Patients with Coronavirus Disease 2019 in New York: Retrospective Case Series (Columbia University Medical Center)
Of the first 1,000 patients, 150 presented to the emergency department, 614 were admitted to hospital (not intensive care units), and 236 were admitted or transferred to intensive care units. The most common presenting symptoms were cough (732/1,000), fever (728/1,000), and dyspnea (631/1,000). Patients in hospital, particularly those treated in intensive care units, often had baseline comorbidities including hypertension, diabetes, and obesity. Patients admitted to intensive care units were older, predominantly male (158/236, 66.9%), and had long lengths of stay (median 23 days, interquartile range 12-32 days); 78.0% (184/236) developed acute kidney injury and 35.2% (83/236) needed dialysis. Only 4.4% (6/136) of patients who required mechanical ventilation were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at three to four days, and at nine days. As of 30 April, 90 patients remained in hospital and 211 had died in hospital.
- Presenting Characteristics, Comorbidities, and Outcomes Among 5,700 Patients Hospitalized With COVID-19 in the New York City Area (Northwell Health)
A total of 5,700 patients were included (median age, 63 years; 39.7% female). The most common comorbidities were hypertension (56.6%), obesity (41.7%), and diabetes (33.8%). At triage, 30.7% of patients were febrile, 17.3% had a respiratory rate greater than 24 breaths/minute, and 27.8% received supplemental oxygen. The rate of respiratory virus co-infection was 2.1%. Outcomes were assessed for 2,634 patients who were discharged or had died at the study end point. During hospitalization, 373 patients (14.2%) were treated in the intensive care unit care, 320 (12.2%) received invasive mechanical ventilation, 81 (3.2%) were treated with kidney replacement therapy, and 553 (21%) died. Mortality for those requiring mechanical ventilation was 88.1%. A total of 45 patients (2.2%) were readmitted during the study period. The median time to readmission was 3 days. 3,066 patients remained hospitalized at the final study follow-up date.
- Clinical Characteristics of COVID-19 in New York City (Weill Cornell Medicine)
Among the 393 patients, median age was 62.2 years, 60.6% were male, and 35.8% had obesity. The most common presenting symptoms were cough (79.4%), fever (77.1%), dyspnea (56.5%), myalgias (23.8%), diarrhea (23.7%), and nausea and vomiting (19.1%). Most of the patients (90.0%) had lymphopenia, 27% had thrombocytopenia, and many had elevated liver-function values and inflammatory markers. Between March 5 and April 10, respiratory failure leading to invasive mechanical ventilation developed in 130 patients (33.1%); to date, only 43 of these patients (33.1%) have been extubated. In total, 40 of the patients (10.2%) have died, and 260 (66.2%) have been discharged from the hospital; outcome data are incomplete for the remaining 93 patients (23.7%).
- COVID-19 in Critically Ill Patients in the Seattle Region — Case Series
“The case fatality rate of 50% in this series (to date) is similar to that reported among critically ill patients in Chinese hospitals but lower than that in a single-center experience reported from our area. Although the case fatality rate was higher in persons 65 years of age or older, it was still substantial (37%) in persons younger than 65 years of age. Our case fatality rate may be an underestimate, given that 3 patients remained intubated at the time data were censored.”
- CDC: Severe Outcomes Among Patients with COVID-19
This first preliminary description of outcomes among patients with COVID-19 in the United States indicates that fatality was highest in persons aged ≥85, ranging from 10% to 27%, followed by 3% to 11% among persons aged 65–84 years, 1% to 3% among persons aged 55-64 years.
- Baseline Characteristics and Outcomes of 1,591 Patients with SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy
This is the first large retrospective observational report on the characteristics of patients with COVID-19 in Italy, describing the course of more than 1500 critically ill adults over a 4-week period in February and March. All patients with a positive laboratory test for SARS-CoV-2 (17,713 as of March 28, 2020) who were admitted to one of the 72 ICUs in the Lombardy ICU network were enrolled (totaling 1591 patients, or 9% of all positive SARS-CoV-2 tests). The patients in the ICU were largely male (82%) with a median age of 63, and they tended to have cardiovascular comorbidities, including hypertension. Overall, 88% patients required invasive mechanical ventilation. Detailed respiratory treatment data were available for 875 patients, who tended to have high requirements for ventilatory support including a median PEEP of 14 cm H2O, a median PaO2/FiO2 ratio of 160, and, in 27% of patients, treatment with prone ventilation. The in-ICU mortality rate was 26%, and an additional 58% remained in intensive care at the time of publication.
- The Early Phase of the COVID-19 Outbreak in Lombardy, Italy (Not Peer Reviewed)
“We analyzed the first 5,830 laboratory-confirmed cases to provide the first epidemiological characterization of a COVID-19 outbreak in a Western Country. The median age of cases is 69 years (range, 1 month to 101 years). 47% of positive subjects were hospitalized. Among these, 18% required intensive care. The mean serial interval is estimated to be 6.6 days (95% CI, 0.7 to 19). We estimate the basic reproduction number at 3.1 (95% CI, 2.9 to 3.2). We did not observe significantly different viral loads in nasal swabs between symptomatic and asymptomatic.
- Incidence, Clinical Characteristics and Prognostic Factor[s] of Patients with COVID-19: A Systematic Review and Meta-analysis (Not Peer Reviewed)
“A total of 30 studies including 53,000 patients with COVID-19 were included in this study, the mean age was 49.8 years and 55.5% were male. The pooled incidence of severity and mortality were 20.2% and 3.1%, respectively. The predictor for disease severity included old age (≥ 50 yrs), male, smoking and any comorbidity, especially chronic kidney disease, chronic obstructive pulmonary disease and cerebrovascular disease. In terms of laboratory results, increased lactate dehydrogenase, C-reactive protein, and D-dimer and decreased blood platelet and lymphocytes count were highly associated with severe COVID-19 (all P < 0.001). Meanwhile, old age (≥ 60 yrs), followed by cardiovascular disease, hypertension, and diabetes were found to be independent prognostic factors for COVID-19 related death."
- Characteristics and Outcomes of Children With COVID-19 Infection Admitted to US and Canadian Pediatric ICUs
This study was designed to examine 46 PICUs in North America—despite the number of beds that represents, that was still only 48 children who were afflicted with COVID-19. The median age was 13 years, split about evenly between male and female patients. Overall, 83% had significant preexisting conditions and 73% had a presentation that was primarily respiratory. Even though they were requiring intensive care, only 38% required ventilation, and only 1 patient required ECMO. Notably, only 2 died at the completion of the study period.
- Epidemiological Characteristics of 2,143 Pediatric COVID-19 Patients in China
Chinese case series of 2,143 pediatric patients with COVID-19. There were 731 (34.1%) laboratory-confirmed cases and 1,412 (65.9%) suspected cases. The median age of all patients was 7 years (interquartile range: 2-13), and 1213 cases (56.6%) were boys. Over 90% of all patients were asymptomatic, mild, or moderate cases. The median time from illness onset to diagnoses was 2 days (range: 0 to 42 days). There was a rapid increase of disease at the early stage of the epidemic and then there was a gradual and steady decrease. Disease rapidly spread from Hubei Province to surrounding provinces over time. Children at all ages appeared susceptible to COVID-19, and there was no significant gender difference. Although clinical manifestations of children’s COVID-19 cases were generally less severe than those of adults, young children, particularly infants, were vulnerable to infection.
- COVID-19 in Pregnancy: Early Lessons
Five of the seven patients presented with symptoms of COVID-19, including cough, myalgias, fevers, chest pain, and headache. Four patients were admitted to the hospital, including two who required supportive care with intravenous hydration. Most notably, the other two admitted patients were asymptomatic on admission to the hospital, presenting instead for obstetrically-indicated labor inductions; both of these patients became symptomatic post-partum, each requiring intensive care unit admission.
- Cutaneous Manifestations in COVID-19: A First Perspective
Of 88 patients, 18 (20%) had cutaneous manifestations, 8 of them at the onset and 10 after hospitalization. Fourteen had an erythematous rash, 3 had widespread urticaria, and 1 had chickenpox-like vesicles. The authors speculate that the cutaneous manifestations are similar to those of other common viral infections.
- Case Report: COVID-19–associated Acute Hemorrhagic Necrotizing Encephalopathy
The authors report the first presumptive case of acute necrotizing hemorrhagic encephalopathy associated with COVID-19. Acute necrotizing encephalopathy (ANE) is rare but has been associated with influenza and other viral infections and has been related to intracranial cytokine storms that result in breakdown of the blood–brain barrier, but without direct viral invasion or parainfectious demyelination. In this case, the patient, a female airline worker in her late 50s, demonstrated hemorrhagic rim-enhancing lesions within the bilateral thalami, medial temporal lobes, and subinsular regions on brain MRI. Noncontrast CT images showed symmetric hypoattenuation within the bilateral medial thalami with a normal CT angiogram and CT venogram. While predominantly described in the pediatric population, ANE is known to occur in adults as well.