Differences in the clinical characteristics and outcomes of COVID-19 patients in the epicenter and peripheral areas of the pandemic from China: a retrospective, large-sample, comparative analysis

Abstract

Background: There is limited information on difference of epidemiology, clinical characteristics and outcomes of the initial outbreak of the coronavirus disease (COVID-19) in Wuhan (the epicenter) and Sichuan (the peripheral area) in the early phase of the COVID-19 pandemic. This study was conducted to investigate the differences in the epidemiological and clinical characteristics of patients with COVID-19 between the epicenter and peripheral areas of pandemic and thereby generate information that would be potentially helpful in formulating clinical practice recommendations to tackle the COVID-19 pandemic.Methods: The Sichuan & Wuhan Collaboration Research Group for COVID-19 established two retrospective cohorts that separately reflect the epicenter and peripheral area during the early pandemic. The epidemiology, clinical characteristics and outcomes of patients in the two groups were compared. Multivariate regression analyses were used to estimate the adjusted odds ratios (aOR) with regard to the outcomes.Results: The Wuhan (epicenter) cohort included 710 randomly selected patients, and the peripheral (Sichuan) cohort included 474 consecutive patients. A higher proportion of patients from the periphery had upper airway symptoms, whereas a lower proportion of patients in the epicenter had lower airway symptoms and comorbidities. Patients in the epicenter had a higher risk of death (aOR=7.64), intensive care unit (ICU) admission (aOR=1.66), delayed time from illness onset to hospital and ICU admission (aOR=6.29 and aOR=8.03, respectively), and prolonged duration of viral shedding (aOR=1.64). Conclusions: The worse outcomes in the epicenter could be explained by the prolonged time from illness onset to hospital and ICU admission. This could potentially have been associated with elevated systemic inflammation secondary to organ dysfunction and prolonged duration of virus shedding independent of age and comorbidities. Thus, early supportive care could achieve better clinical outcomes.

Obesity is a strong risk factor for short-term mortality and adverse outcomes in Mexican patients with COVID-19: a national observational study

“…Despite being younger, patients in our cohort had a higher prevalence of obesity than both survivors (14.2%) and non-survivors (17.1%) included in a systematic review [13]. Variables for adjustment in our study included age, sex, time from symptom onset to medical care, smoking, and sociodemographic variables since these have been associated with the risk of developing severe disease and mortality in patients with COVID-19 [10,[20][21][22][23]. These covariates have been used in other studies, too [24,25].…”

The COVID-19 Pandemic and the Need for an Integrated and Equitable Approach: An International Expert Consensus Paper

“…Anticipation of medical treatment in patients with COVID-19 is essential for improved clinical outcome (Figure 3). 107 -Early diagnosis of COVID-19 with a simple and feasible methodology at the level of the primary health care structures are of major importance for prompt medical care. A regional procedure for prioritized hospitalization of patients at high risk or with early signs for disease worsening should be considered by health authorities since it is expected to improve the clinical outcomes.…”

COVID-19 patients with increasing age experience differential time to initial medical care and severity of symptoms

“…Delayed hospitalization is an independent risk factor for death, ICU admission, and invasive mechanical ventilation [3]. Older adults with COVID-19 who are hospitalized have been noted to have different viral kinetics than younger patients, with slower decline of viral load after its peak value, which has been identified as an independent risk factor for death [4].…”