The Desynchrony between Clinical Course and RT-PCR Test Results in Patients with COVID-19 Infected Pneumonia During the Treatment in Wuhan, China
19 Pages Posted: 23 Mar 2020More...
Background: A cluster of cases infected with the novel coronavirus (COVID-19) pneumonia outbroke in Wuhan, China. Recovered patients may remain virus carriers. Data therefore have been collected to formulate integrated guidelines for hospital discharge or discontinuation of quarantine.
Methods: From January 2020 to March 2020, we investigated 30 patients with unstable conditions which indicates shifting results of virus RNA detections in Wuhan Jin Yin-tan Hospital (Wuhan, China). Evidences like clinical records, nursing records, laboratory and Radiology examinations for all confirmed positive patients by viral nucleic acid detections were collected beforehand. Dataset were then analyzed to identify the relationship between the RNA detection and symptoms.
Findings: The median age of parents was 60.5-year-old, with 14 patients (46.7%) aged between 15 and 49, and 10 (33.3%) older than 65 years (as shown in table 1). 14 patients (46.7%) were male, slightly less than female (16, 53.3%). 17 patients (56.7%) had chronic diseases which include diabetes, hypertension, bronchial asthma, tumor post-operation, bullae of lung post- operation, hepatitis B cirrhosis, cerebrovascular diseases, gout, postpartum, pituitary adenoma. The most common symptoms were fever (93.3%), cough (90%), and dyspnoea (63·3%). The median duration from the onset of symptoms to admission into the hospital was 13 (IQR 5–31) days. A majority of the patients received intravenous antibiotics (90.0%) and broad-spectrum antivirus therapy (86.7%) while 26 patients (86.7%) received nutrition support therapy. Systemic glucocorticoids were administrated to 8 patients (26.7%). Oxygen therapy by nasal cannula was adopted in all cases while invasive ventilation not engaged in any treatment. All of the 30 patients were being followed up during the study. Nobody was transferred to ICU or treated with the use of invasive mechanical ventilation. All of them are still alive.
Interpretation: The disease course of confirmed patients, which can be evaluated by clinical manifestation and radiological examination results, may not reciprocate mono-directional reversion of positive RT-PCR test results into negative ones. Patients infected with COVID-19 may become asymptomatic in the process of treatment and recovery, combined with promising chest CT findings, however, unpredictable changes in RT-PCR test results between positives and negatives have been identified. Due to the unavailability of quantitative studies and the lack of specific medicine for COVID-19 infected pneumonia, longer periods of hospitalization and quarantine, integrated specimens for RT-PCR test are therefore suggested.
Funding Statement: This study is funded by The National Natural Science Foundation of China (No: 81802137).
Declaration of Interests: The authors declare no competing interests.
Ethics Approval Statement: The study was approved by the Ethics Commission of Wuhan Jin-Yintan Hospital. Due to the severity of this highly contagious disease, the patients’ verbal agreements to participate in the research were obtained and the written informed consent was waived.
Keywords: COVID-19; SARS-CoV-2; Coronavirus; RT-PCR test
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