Epidemiological and Clinical Features Of 200 Hospitalized Patients with Corona Virus Disease 2019 in Yichang, China: A Descriptive Study

genome sequencing and phylogenetic analysis that the sequence of RNA genome of the virus is to bat coronaviruses, the bats the primary 200 We report the epidemiological and clinical futures of the 200 patients infected A total of 200 patients confirmed with COVID-19 in a were investigated retrospectively. The epidemiological data, demographic data, comorbidities and clinical laboratory tests, chest CT scans, treatment and clinical outcomes were collected. The data between patients admitted to the intensive unit (ICU) and those not in the compared. The Virus Disease infection was of clustering onset, and can cause severe respiratory disease and even death, especially for elderly patients with chronic disease. The mortality of ICU patients confirmed with COVID-19 was considerably high. The lymphocytes, especially T lymphocytes might be the main target of Corona Virus Disease (COVID-19) and related to the severity and mortality of disease, and the cytokine storm may be associated with the worsening of the disease


Introduction
The disease caused by the SARS-CoV-2 was officially named Corona Virus Disease 2019 (COVID-19) by WHO [8]. Previous studies showed that the clinical manifestations of patients with COVID-19 in Wuhan mainly included fever, chill, cough, difficulty in breathing, muscle soreness, fatigue, as well as complications such as acute respiratory distress syndrome (ARDS), acute kidney injury, and acute cardiac injury, etc [9]. Laboratory tests showed that the leukocytes were normal or decreased, and/or the lymphocytes decreased. And the chest imaging revealed typical features of viral pneumonia [10]. Wang et al reported that among the 138 investigated patients, 36 received ICU care, with the mortality of 4.3%. It was found that the COVID-19 was of clustering onset, and the older men with comorbidities were more likely to develop into critically ill patients [11]. Although the government adopted a series of measures to respond to this major public health emergency, such as prohibiting from leaving or coming into Wuhan and group activities, in the following dozens of days, a large cluster of the pneumonia rapidly spread throughout China and beyond. And the epidemic was especially severe in cities around Wuhan in Hubei Province. As of Feb 26, 2020, there were 78630 confirmed COVID-19 cases, 2358 suspected cases, 32531 cured cases, and 2747 deaths in China, of which 65596 were confirmed cases in Hubei Province and 929 were confirmed cases in Yichang City, which owns huge economic development potential in Hubei Province, second only to Wuhan [12,13].
So far, there have been several studies that have summarized and analyzed the epidemiological and clinical features of pneumonia caused by SARS-CoV-2 in Wuhan [14][15][16]. However, the information on the epidemiological and clinical features of COVID-19 in other areas is scarce. The main purpose of this study was to comprehensively analyze and compare the epidemiological, clinical, laboratory, radiological, treatment, and outcome data of confirmed patients with COVID-19 admitted in a designated hospital in Yichang, Hubei Province, China. We hope our findings can provide some references for understanding the epidemics and clinical characteristics of this novel coronavirus outside Wuhan.

Procedures
The epidemiological, clinical, laboratory, treatment, and outcome data of the patients were obtained from electronic medical records. All the data were reviewed by two physicians (LH Yang and R Zhang).The information included demographic data, family clustering (≥2 infected family member),exposure history (living   in or visiting Wuhan or contact with people from Wuhan ≤14 days   before infection), comorbidities, clinical manifestations (symptoms   and signs), laboratory tests, chest Computed Tomographic (CT) scans, treatment (ie, medical treatment, respiratory support, renal replacement therapy), and outcomes (complications, including death). Throat-swab samples from the upper respiratory tract were collected during hospitalization. SARS-COV-2 was detected by real-time polymerase chain reaction (RT-PCR) following the recommended protocol. Infection was confirmed when there were at least 2 positive results.

Outcomes
We described and summarized demographic data, family clustering, exposure history, potential comorbidities, clinical manifestations, laboratory tests, chest CT scans, treatment measures, and prognosis.

Statistical Analysis
All statistical analyses were performed using SPSS20.0 version software. Continuous variables were represented as mean, median,    In the non-ICU wards, high flow oxygen or noninvasive ventilation was required in 11 patients (9.9%), two of whom  Chest CT of a 51-year-old female taken on Feb 06, 2020 showed diffuse patchy shadows and ground glass opacity, with lobular and subsegmental consolidation.

B.
Chest CT images from an 83-year-old male who had COPD showed multiple mottling and ground-glass opacity on Feb 1, 2020.

C.
However, the lesions on both lungs were larger with patchy and nodular increased-density shadow on Feb 6, 2020.

Discussion
Here in, we reported a total of 200 patients with  [20,21]. However, the specific pathophysiology of COVID-19remains to be further explored.
At present, some effective treatment methods for COVID-19 have been summarized based on clinical practice [22][23][24]. The antiviral drugs for COVID-19 in clinic curently mainly includeαinterferon aerosol inhalation, Lopinavir / ritonavir, Ribavirin, Chloroquine phosphate and Abidol [25]. And the antibiotics should be used cautiously [26]. If the patient has dyspnea and chest imaging progress, glucocorticoids can be used within a short period of time (3 to 5 days) with the dose not exceeding 2 mg / kg / day of methylprednisolone [23]. Other treatments include respiratory support, traditional Chinese medicine treatment, the plasma treatment of rehabilitation patients, extracorporeal blood purification technologies such as plasma exchange, adsorption, perfusion, and hemofiltration. And a vaccine against SARS-CoV-2 is being under development.
There are still some limitations in this study. First of all, this study only included patients admitted to Yichang Central People's Hospital, which might not fully represent all the patients in the city.
Multi-center collaborative studies with larger sample size in the future are required. Secondly, throat swab specimens were used to diagnose COVID-19 by RT-PCR. However, specimens collected from the upper respiratory tract may lead to false negatives, thus leading to missed diagnosis and pseudo-cure cases. The viral load and viral antigen in blood can be detected to provide better assessment of the condition. Thirdly, many patients are still hospitalized at the time of manuscript submission, and the outcomes at present may not fully reflect the prognosis of all patients with COVID-19.

Conclusion
In conclusion, of the 200 patients infected with COVID-19in Yichang, China,14.5% of patients were admitted to the ICU, who were mainly older patients with comorbidities and ARDS. And the mortality of confirmed patients in the ICU was high.