Clinical Characteristics and Risk factors for developed COVID-19 patients transferring to designated hospital from Jianghan Fangcang shelter Hospital: a retrospective, observational study

  1. Yunfei Liao
  2. Yong Feng
  3. Bo Wang
  4. Hanyu Wang
  5. Jinsha Huang
  6. Yaxin Wu
  7. Ziling Wu
  8. Xiao Chen
  9. Chao Yang
  10. Xinqiao Fu
  11. Hui Sun

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Abstract

Background

The outbreak of coronavirus disease 2019 (COVID-19) has become a world-wide emergency. Fangcang shelter hospitals have been applied in COVID-19 to ease ongoing shortage of medical resources in Wuhan since February 2020.

Method

This study enrolled all cases (no=1848) with mild or moderate type of COVID-19 in Fangcang shelter hospital of Jianghan in Wuhan from Feb 5th to Mar 9th, 2020. Diagnosis of COVID-19 was based on the National health commission of China. Epidemiological history, comorbidity, vital signs, symptoms and signs were recorded in detail. Laboratory tests included biochemical indicators and nucleic acid tests by throat swabs have been performed as well.

Finding

A total of 1327 patients reached the criteria of isolation release. Meanwhile, 521 patients have been transferred to the designated hospitals for further treatment, including severe type, fever more than 3 days, and severe comorbidity. The case-severity rate (rate of mild or moderate type transforming to severe type) was 3.0% in the shelter hospital. The patients from mild or moderate type to severe type showed the following clinical characteristics: the median incubation (onset to shelter) period was 10 days; they were all symptomatic at admission; fever, cough, and fatigue were the most common symptoms; hypertension, diabetes and coronary heart diseases were common co-morbidities; most of the patients had elevated levels of CRP at ill onset with 33.3% over 10 mg per L; bilateral distribution and ground-glass opacity were the most common manifestations in chest CT.

Interpretation

The potential risk factors of fever, fatigue, high level of C-reactive protein were the risk factors to identify the progression of COVID-19 patients with mild or moderate type. Fangcang shelter hospitals have substantially reduced the time from the onset of severe symptoms transfer to a designated hospital. Early application of the Fangcang shelter hospital may contribute to decrease the ratio of mild transforming to severe patients.

Funding

No specific grant from any funding was applied to this research.

Research in context

Evidence before this study

We searched PubMed from Nov 1, 2019, to Apr 8, 2020, for studies published in any language using the terms “COVID-19”, “coronavirus disease 2019”, “novel coronavirus”, “cabin hospital”, “shelter hospital”. Five studies have been found about coronavirus disease 2019 (COVID-19) in shelter hospital or cabin hospital. Fangcang shelter hospital of Jianghan received the largest number of patients among Fangcang shelter hospitals in Wuhan. These studies were related to development of Fangcang shelter hospitals, explaining three key characteristics (rapid construction, massive scale, and low cost) and five essential functions (isolation, triage, basic medical care, frequent monitoring and rapid referral, and essential living and social engagement). To our knowledge, there are no studies to comprehensively investigate a cohort of mild COVID-19 patients transfer to designated hospital from shelter hospital and their distinctive clinical features. Since Fangcang shelter hospital is a novel public health strategy, we aimed to investigate the clinical characteristics and risk factors for developed COVID-19 patients transfer to the designated hospital in Jianghan Fangcang shelter Hospital.

Added value of this study

From Feb 5th to Mar 9th, a total of 1848 cases of mild or moderate type of COVID-19 were enrolled in Fangcang shelter hospital of Jianghan (Wuhan, China). Of these cases, 521 patients were transferred to designated hospitals. Rate of mild or moderate type transforming to severe type was 3.0 % (56/1848) in the Fangcang shelter hospital. The median incubation (onset to shelter) period was 10 days (IQR 8.0-16.0). Patients with fever on cabin admission, high level C-reactive protein were also associated with mild-to-severe. Early application of the shelter hospital may contribute to alleviate the shortage of medical resources and decrease the ratio of severe patients. Furthermore, Fangcang shelter hospitals are likely to have substantially reduced the time from the onset of severe symptoms to admission to a designated hospital. The clinical characteristics of patients transferred to the designated hospital were important for the revision of admission criteria of COVID patients in Fangcang shelter hospitals. Dynamic observation the risk factors of mild to severe patients is contribute to great value for early prognosis and treatment.

Implications of all the available evidence

Keep vigilance of those mild patients whose had a fever over 38.0°C, cough and fatigue when they isolated at home. Fangcang shelter hospital could provide the rational strategy for isolation and triage of infected patients and decrease the family or community transmission cases.

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  1. ScreenIT

    SciScore for 10.1101/2020.04.21.20074724: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was approved by the Research Ethics Commission of Wuhan Union Hospital ([2020]0038) and informed consent was waived by the Ethics Commission of Wuhan Union Hospital for emerging infectious diseases.
    Consent: This study was approved by the Research Ethics Commission of Wuhan Union Hospital ([2020]0038) and informed consent was waived by the Ethics Commission of Wuhan Union Hospital for emerging infectious diseases.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Analyses were performed using SPSS 20.0 statistical package.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There were some limitations in this study. Firstly, due to limited medical resources in Fangcang shelter hospital, not all laboratory tests have been performed, such as lactate dehydrogenase, IL-6, and serum ferritin. Secondly, the study was limited to the patients with mild or moderate infection in a single center study. However, we focused on the therapeutic and preventive value of mobile cabin hospital in the COVID-19 patients with mild or moderate type. The study population is representative of cases mild developed to severe in Wuhan. To the best of our knowledge, this is the largest retrospective cohort study to disclose the clinical characteristics and risk factors for developed COVID-19 patients transferring to the designated hospital in Fangcang shelter hospital. Overall, Fangcang shelter hospitals have substantially reduced the time from the onset of severe symptoms to admission to a designated hospital. Early application of the Fangcang shelter hospital may contribute to alleviate the shortage of medical resources and decrease the ratio of severe patients. We believe that the information in the article will provide valuable data for other countries facing the COVID-19 pandemic, when they are establishing the national public health emergency management for COVID-19.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.04.21.20074724v1 on medRxiv