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Early Discern COVID-19 from the Suspected Patients via Fever Clinics: A Multicenter Cohort Study from Shanghai

47 Pages Posted: 13 Mar 2020

See all articles by Bei Mao

Bei Mao

Tongji University - Department of Pulmonary and Critical Care Medicine

Yang Liu

Tongji University - Department of Pulmonary and Critical Care Medicine

Yan-hua Chai

Tongji University - Department of Pulmonary and Critical Care Medicine

Xiao-yan Jin

Shanghai Jiao Tong University (SJTU) - Department of Pulmonary and Critical Care Medicine

Hai Wen Luo

University of Science and Technology Beijing - School of Metallurgical and Ecological Engineering

Jia-wei Yang

Tongji University - Department of Pulmonary and Critical Care Medicine

Xi-wen Gao

Fudan University - Department of Respiratory and Critical Care Medicine

Xiao-lian Song

Tongji University - Department of Respiratory and Critical Medicine

Hong Bao

Fudan University - Department of Respiratory Medicine

An Wang

Zhoupu Hospital of Pudong New District - Department of Medical Management

Wen-chao Gu

Shanghai Pudong New Area People's Hospital - Department of Respiratory Medicine

Lei Zhao

Government of the People's Republic of China - Department of Pulmonary and Critical Care Medicine

Jie-ping Pan

Shanghai Nanhua Hospital of Pudong New District - Department of Infectious Disease

Fan Li

Shanghai Jiao Tong University (SJTU) - Department of Respiratory and Critical Care Medicine

Tie-feng Zhang

Shanghai Jiao Tong University (SJTU) - Department of Respiratory Medicine

Ye-chang Qian

Shanghai University of Traditional Chinese Medicine - Department of Respiratory Medicine

Chun-Ling Du

Fudan University - Department of Respiratory Medicine

Wei Ding

Shanghai Punan Hospital - Department of Respiratory Medicine

Chun-Lin Tu

Shanghai University of Medicine and Health Sciences - Department of Respiratory and Critical Care Medicine

De-Jie Chu

Shanghai Eighth People's Hospital - Department of Respiratory and Critical Care Medicine

Chun Li

Fudan University - Department of Respiratory and Critical Care Medicine

Yang Hu

Tongji University - Department of Pulmonary and Critical Care Medicine

Ling Ye

Fudan University - Department of Respiratory and Critical Care Medicine

Yong Luo

Shanghai Jiao Tong University (SJTU), School of Medicine, Xinhua Hospital, Department of Respiratory Medicine

Cui-xia Zheng

Tongji University - Department of Respiratory and Critical Care Medicine

Rong-huan Yu

Xuhui District Central Hospital - Department of Respiratory Medicine

Zhong-min Qiu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Respiratory and Critical Care Medicine

Hui-fang Cao

Jing'an District Centre Hospital of Shanghai - Department of Respiratory Medicine

Jia-wei Ren

Shanghai Fourth People's Hospital - Department of Respiratory Medicine

Jing-ya Zhao

Shanghai Jiao Tong University (SJTU) - Department of Respiratory and Critical Care Medicine

Chang-hui Wang

Tongji University - Department of Respiratory and Critical Medicine

Hong-Lu Zhou

Fudan University - Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS)

Jun Li

Tongji University - Clinical Translational Research Center

Shuo Liang

Tongji University - Department of Pulmonary and Critical Care Medicine

Zhi-jun Jie

Fudan University - Department of Respiratory and Critical Care Medicine

Jie-ming Qu

Shanghai Jiao Tong University (SJTU) - Department of Respiratory and Critical Care Medicine

Jin-Fu Xu

Tongji University - Department of Pulmonary and Critical Care Medicine

More...

Abstract

Background: The outbreak of novel coronavirus disease 2019 (COVID-19) has led to increasing international concern. Effective screening strategy and early recognition of the disease are crucial to limiting spread of this worldwide challenge.

Methods: Fever clinics of 25 hospitals evenly distributed in 16 Districts of Shanghai were selected. All patients visiting the fever clinics from the begin of the outbreak of Shanghai (17 January 2020) to 16 February were enrolled. A standardized procedure for COVID-19 screening was presented and all the suspected cases were monitored and analyzed till they were confirmed or excluded.

Findings: Among 53617 patients who visiting fever clinics, 1004 (1·87%) were considered as suspected cases, with 188 (0·35% of all patients, 18·73% of suspected cases) diagnosed as confirmed cases finally. Compared with the excluded cases, confirmed cases were older and the highest temperatures were relatively lower (p<0·01), and more symptoms like fatigue, headache, bad appetite and myalgia (p<0·05) were observed. Confirmed cases showed increased infected lung lobes (≥3) and ground glass opacity (GGO) in CT scans (p<0·001). Lower peripheral blood leucocytes and lymphocytes, procalcitonin, and higher lactate dehydrogenase and erythrocyte sedimentation rates were observed in confirmed cases (p<0·05). Exposure history (OR= 4·17), GGO (OR= 2·57), fatigue (OR= 1·61), and lymphocytes < 0·8×10^9/L (OR= 2·15,) were independent risk factors for confirmed COVID-19 cases.

Interpretation: The screening strategy is needed for excluding the diseases besides COVID-19 during the spread of this contagious disease. Relevant independent risk factors identified from this study may helpful for early recognition of the disease.

Funding Statement: This work was supported by the National Natural Science Fund for Distinguished Young Scholars to JFX (81925001), Shanghai Leading Talent Program (No. 2016036 to JFX) and the Project of the Shanghai Hospital Development Center (16CR3036A to JFX).

Declaration of Interests: All authors declare that they have no competing interests.

Ethics Approval Statement: The study was approved by the Research Ethics Committee of Shanghai Pulmonary Hospital and participating hospitals. Written informed consent was waived by the Ethics Commission of the designated hospitals for this emerging public health issue.

Keywords: COVID-19; suspected; screening; early detection; fever clinic

Suggested Citation

Mao, Bei and Liu, Yang and Chai, Yan-hua and Jin, Xiao-yan and Luo, Hai Wen and Yang, Jia-wei and Gao, Xi-wen and Song, Xiao-lian and Bao, Hong and Wang, An and Gu, Wen-chao and Zhao, Lei and Pan, Jie-ping and Li, Fan and Zhang, Tie-feng and Qian, Ye-chang and Du, Chun-Ling and Ding, Wei and Tu, Chun-Lin and Chu, De-Jie and Li, Chun and Hu, Yang and Ye, Ling and Luo, Yong and Zheng, Cui-xia and Yu, Rong-huan and Qiu, Zhong-min and Cao, Hui-fang and Ren, Jia-wei and Zhao, Jing-ya and Wang, Chang-hui and Zhou, Hong-Lu and Li, Jun and Liang, Shuo and Jie, Zhi-jun and Qu, Jie-ming and Xu, Jin-Fu, Early Discern COVID-19 from the Suspected Patients via Fever Clinics: A Multicenter Cohort Study from Shanghai (3/2/2020). Available at SSRN: https://ssrn.com/abstract=3550037 or http://dx.doi.org/10.2139/ssrn.3550037

Bei Mao (Contact Author)

Tongji University - Department of Pulmonary and Critical Care Medicine

Shanghai, 200433
China

Yang Liu

Tongji University - Department of Pulmonary and Critical Care Medicine

Shanghai, 200433
United States

Yan-hua Chai

Tongji University - Department of Pulmonary and Critical Care Medicine

Shanghai, 200433
United States

Xiao-yan Jin

Shanghai Jiao Tong University (SJTU) - Department of Pulmonary and Critical Care Medicine

Shanghai
China

Hai Wen Luo

University of Science and Technology Beijing - School of Metallurgical and Ecological Engineering ( email )

China

Jia-wei Yang

Tongji University - Department of Pulmonary and Critical Care Medicine

Shanghai, 200433
United States

Xi-wen Gao

Fudan University - Department of Respiratory and Critical Care Medicine

Shanghai, 266119
China

Xiao-lian Song

Tongji University - Department of Respiratory and Critical Medicine

Shanghai, 200003
China

Hong Bao

Fudan University - Department of Respiratory Medicine

Shanghai, 201399
China

An Wang

Zhoupu Hospital of Pudong New District - Department of Medical Management

Shanghai, 201318
China

Wen-chao Gu

Shanghai Pudong New Area People's Hospital - Department of Respiratory Medicine

Shanghai, 201200
China

Lei Zhao

Government of the People's Republic of China - Department of Pulmonary and Critical Care Medicine

Shanghai, 200135
China

Jie-ping Pan

Shanghai Nanhua Hospital of Pudong New District - Department of Infectious Disease

Shanghai, 200122
China

Fan Li

Shanghai Jiao Tong University (SJTU) - Department of Respiratory and Critical Care Medicine

Shanghai, 200090
China

Tie-feng Zhang

Shanghai Jiao Tong University (SJTU) - Department of Respiratory Medicine

Shanghai, 200000
China

Ye-chang Qian

Shanghai University of Traditional Chinese Medicine - Department of Respiratory Medicine

Shanghai, 201900
China

Chun-Ling Du

Fudan University - Department of Respiratory Medicine

Shanghai, 201700
China

Wei Ding

Shanghai Punan Hospital - Department of Respiratory Medicine

Shanghai, 200125
China

Chun-Lin Tu

Shanghai University of Medicine and Health Sciences - Department of Respiratory and Critical Care Medicine

Shanghai, 201800
China

De-Jie Chu

Shanghai Eighth People's Hospital - Department of Respiratory and Critical Care Medicine

Shanghai, 200235
China

Chun Li

Fudan University - Department of Respiratory and Critical Care Medicine

Shanghai, 200032
China

Yang Hu

Tongji University - Department of Pulmonary and Critical Care Medicine

Shanghai, 200433
United States

Ling Ye

Fudan University - Department of Respiratory and Critical Care Medicine

Shanghai, 200032
China

Yong Luo

Shanghai Jiao Tong University (SJTU), School of Medicine, Xinhua Hospital, Department of Respiratory Medicine

Shanghai
China

Cui-xia Zheng

Tongji University - Department of Respiratory and Critical Care Medicine

Shanghai, 200090
China

Rong-huan Yu

Xuhui District Central Hospital - Department of Respiratory Medicine

Shanghai, 200031
China

Zhong-min Qiu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Respiratory and Critical Care Medicine

China

Hui-fang Cao

Jing'an District Centre Hospital of Shanghai - Department of Respiratory Medicine

Shanghai, 200040
China

Jia-wei Ren

Shanghai Fourth People's Hospital - Department of Respiratory Medicine

Shanghai, 200081
China

Jing-ya Zhao

Shanghai Jiao Tong University (SJTU) - Department of Respiratory and Critical Care Medicine

China

Chang-hui Wang

Tongji University - Department of Respiratory and Critical Medicine

Shanghai, 200003
China

Hong-Lu Zhou

Fudan University - Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS)

138 Dong’an Rd
Shanghai, 200032
China

Jun Li

Tongji University - Clinical Translational Research Center

Shanghai
China

Shuo Liang

Tongji University - Department of Pulmonary and Critical Care Medicine

Shanghai, 200433
United States

Zhi-jun Jie

Fudan University - Department of Respiratory and Critical Care Medicine ( email )

Shanghai
China

Jie-ming Qu

Shanghai Jiao Tong University (SJTU) - Department of Respiratory and Critical Care Medicine ( email )

China

Jin-Fu Xu

Tongji University - Department of Pulmonary and Critical Care Medicine ( email )

Shanghai, 200433
United States

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