Clinical characteristics of COVID-19 in 104 people with SARS-CoV-2 infection on the Diamond Princess cruise ship: a retrospective analysis

Abstract

Background The ongoing COVID-19 pandemic is a global threat. Identification of markers for symptom onset and disease progression is a pressing issue. We described the clinical features of people infected on board the Diamond Princess cruise ship who were diagnosed with asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or mild or severe COVID-19, on admission to the Self-Defense Forces Central Hospital (Tokyo, Japan) and at the end of observation.Methods This retrospective, single-centre study included participants with laboratory-detected SARS-CoV-2 infection who were admitted to the Self-Defense Forces Central Hospital from Feb 11 to Feb 25, 2020. Clinical records, laboratory data, and radiological findings were analysed. Clinical outcomes were followed up until discharge or Feb 26, 2020, whichever came first. We defined asymptomatic infection as SARS-CoV-2 infection with no history of clinical signs and symptoms, severe COVID-19 as clinical symptoms of pneumonia (dyspnoea, tachypnoea, peripheral capillary oxygen saturation <93%, and need for oxygen therapy), and mild COVID-19 as all other symptoms. Clinical features on admission were compared among patients with different disease severity, including asymptomatic infection, at the end of observation. We used univariable analysis to identify factors associated with symptomatic illness among asymptomatic people infected with SARS-CoV-2 and disease progression in patients with COVID-19. FindingsAmong the 104 participants included in the final analysis, the median age was 68 years (IQR 47-75) and 54 (52%) were male. On admission, 43 (41%) participants were classified as asymptomatic, 41 (39%) as having mild COVID-10, and 20 (19%) as having severe COVID-19. At the end of observation, 33 (32%) participants were confirmed as being asymptomatic, 43 (41%) as having mild COVID-19, and 28 (27%) as having severe COVID-19. Serum lactate hydrogenase concentrations were significantly higher in the ten participants who were asymptomatic on admission but developed symptomatic COVID-19 compared with the 33 participants who remained asymptomatic throughout the observation period (five [50%] vs four [12%] participants; odds ratio 7•25, 95% CI 1•43-36•70; p=0•020). Compared with patients with mild disease at the end of observation, patients with severe COVID-19 were older (median age 73 years [IQR 55-77] vs 60 years [40-71]; p=0•028) and had more frequent consolidation on chest CT (13 [46%] of 28 vs nine [21%] of 43; p=0•035) and lymphopenia (16 [57%] vs ten [23%]; p=0•0055) on admission. Interpretation Older age, consolidation on chest CT images, and lymphopenia might be risk factors for disease progression of COVID-19 and contribute to improved clinical management. Funding None.

Clinical and Epidemiological Characteristics and Outcome of Patients With Covid-19 in Sri Lanka; An Observational Study

“…These ndings contrast with the ndings of previously published studies of COVID-19. In most study series, fever was the most common symptom, followed by cough (5,13,19). Interestingly, most published studies reported sore throat as a less common symptom, reported only in 13.5% by Guan et al in China, 23.8% by Nitesh Gupta et al in India, whereas in our study sore throat is the most common symptom (5,21).…”

“…In our study the mean age is 37 years with nearly 50% being otherwise healthy and physically t navy personnel. These young and healthy individuals are more likely to develop asymptomatic infection with less prominent symptoms than older individuals (5,19). Intensive contact tracing and screening helped in recognising more patients with asymptomatic illnesses in our study.…”

“…Guan et al reported fever in 88.7% of patients in 1,099 hospitalised patients in China at the outset of outbreak of COVID-19 (5). Among 104 people with the SARS-CoV-2 infection on the Diamond Princess cruise ship, a majority (68%) had symptoms (19). Similarly, a study conducted in a tertiary care hospital in Pune, India had a higher proportion (75%) of symptomatic cases(20).…”

SARS-COV2 Renal Impairment in Critical Care: A Retrospective Study of 42 Cases - Kid COVID Study

“…Firstly, pre-hospital kidney function, de ned as renal functional reserve (25), might be critical in renal prognosis with higher creatinine level on hospital admission in patients who will develop AKI (94 mol.l ¹ in AKI group vs 74 mol.l ¹in non-AKI group). This creatinine value depends on patient's prior renal function but also on many other factors: hypovolemia induced by prolonged fever, infection-induced digestive disorders (26) and chronic hypertension, especially if treated by ACE inhibitors (27,28). However, hypovolemia may, at least partly, play a role as up to 50% of SARS-COV-2 patients had modi ed fractional excretion of urea during their ICU stay related to ARDS management, that requires avoidance of excess uid infusion (29).…”

Quantifying the clinical characteristics of coronavirus disease 2019 (COVID-19) of different age segments based on 60 patients

“…Analysis of the leukocyte count indicated that white blood cells have no obvious involvement in, or correlation with, the immune process of the disease; however, it is also possible that the patients in this group are all imported patients with relatively mild illness [12]. Earlier studies have shown that lymphopenia is a typical laboratory abnormality observed during highly pathogenic coronavirus infections [13,14], such as severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) infections [15,16]. We observed that the lymphocyte count in the > 65-year-old patients was less than that in the < 40-year-old and 40-65-years-old patients after 7 and 14 days of treatments.…”