Update on COVID-19: from epidemiology to clinical characteristics, & some recommendations

Report of the World Health Organization (WHO)-China Joint Mission on Coronavirus Disease 2019:
– major findings about virus, outbreak, transmission dynamics, disease progression/severity, the China response and knowledge gaps;
– recommendations in five major areas to inform the ongoing response in China and globally, for countries with imported cases and/or outbreaks of COVID-19, for uninfected countries, for the public, and for the international community;
– main signs and symptoms, clinical case management and infection prevention and control. There are no specific antiviral or immune modulating agents proven (or recommended) to improve outcomes. All patients are monitored by regular pulse oximetry. The guidelines include supportive care by clinical category (mild, moderate, severe & critical), as well as the role of investigational treatments such as chloroquine phosphate, lopinavir/ritonavir, alpha interferon, ribavirin, arbidol. The application of intubation/invasive mechanical ventilation and ECMO in critically ills can improve survival; clearly, though ECLS is very resource consumptive, any health system would need to carefully weigh the benefits.
Full text open access at http://bit.ly/2uF3L7o

Clinical characteristics of COVID-19 disease in China, data regarding 1099 patients with laboratory-confirmed COrona VIrus Disease 2019 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in China on The New England Journal of Medicine: most of patients received diagnosis of pneumonia 91.1%; ARDS diagnosed in 3.4%, and shock in 1.1%; 5.0% of cases were admitted to the ICU, 2.3% underwent invasive mechanical ventilation, ECMO performed in 5 patients (0.5%) with severe disease, 1.4% died. On admission, the degree of severity categorized as nonsevere in 926 patients and severe in 173;.in patients with severe disease presence of any coexisting illness more common, and older age vs nonsevere cases (median of 7 years).
Systemic glucocorticoids given to 18.6% (44.5% if severe disease, 13.7% nonsevere). . Median duration of hospitalization 12 days.
Open access full text on NEJM.

Characteristics of & main lessons from COVID-19 Coronavirus outbreak in China: summary of a report of 72314 cases (data from Chinese CDC), with comparison of COVID-19 with SARS and MERS, and response to the novel Coronavirus epidemic.
Here some of the key findings:
age: 87%: 30-79 years, 1% respectively 10-19 & <10 years
spectrum of disease (confirmed cases): 81% mild, 14% severe, 5% critical (respiratory failure, septic shock, and/or multiple organ dysfunction or failure)
case-fatality rate (confirmed cases): 2.3%, 14.8% in patients aged ≥80 years, 49.0% in critical cases.
Next steps? As global society is more interconnected than ever, and emerging pathogens do not respect geopolitical boundaries, proactive investment in public health infrastructure & capacity crucial to effectively respond to epidemics; persisting in improving international surveillance, cooperation, coordination, & communication, is critical to be better prepared to respond to future new public health threats. Full text open access on JAMA.
Also check the epidemiological characteristics of outbreak COVID-19 on China CDC Weekly.

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