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Xiong Wang, Wei Liu, Jinzhu Zhao, Yanjun Lu, Xu Wang, Caizheng Yu, Shuhua Hu,
Na Shen, Weiyong Liu, Ziyong Sun, Wengang Li
PII: S0195-6701(20)30194-8
DOI: https://doi.org/10.1016/j.jhin.2020.04.019
Reference: YJHIN 5984
Please cite this article as: Wang X, Liu W, Zhao J, Lu Y, Wang X, Yu C, Hu S, Shen N, Liu W, Sun Z,
Li W, Clinical characteristics of 80 hospitalized frontline medical workers infected with COVID-19 in
Wuhan, China, Journal of Hospital Infection, https://doi.org/10.1016/j.jhin.2020.04.019.
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Xiong Wang1*, Wei Liu2*, Jinzhu Zhao3*, Yanjun Lu1, Xu Wang1, Caizheng Yu2, Shuhua Hu2, Na
Shen1, Weiyong Liu1, Ziyong Sun1#, Wengang Li2#
#Correspondence to: Ziyong Sun, Email: zysun@tjh.tjmu.edu.cn, Tel: +86 027 83663639.
Wengang Li, Email: 228907211@qq.com, Tel: +86 027 83663764.
A number of studies have reported the clinical characteristics of infected patients in both Wuhan
and other cities in China1,3,5-7. The frontline medical workers were in high risk of infection, and
1,716 medical workers were infected up to February 11, 20208, and 11 of them died up to
February 24, 2020. However, the clinical investigation of this special group of population was
insufficient3.
Methods
Data collection
COVID-19 was diagnosed based on positive SARS-CoV-2 nucleic acid test from Respiratory tract
specimen or based on clinical diagnosis with fever and bilateral involvement on chest radiographs
according to the fifth version of COVID-19 diagnosis and control plan published by the
government. Epidemiological, clinical, laboratory, radiological, treatment and outcome data of the
infected frontline medical workers at Tongji Hospital, Tongji Medical College, Huazhong
University of Science and Technology were obtained from electronic medical records. Information
recorded included occupation, exposure history, medical history, symptom, durations from onset
to hospital admission, laboratory test, chest computed tomographic (CT) scan, treatment measure,
and outcome. Laboratory findings and chest CT scan were collected on admission to hospital.
Acute respiratory distress syndrome (ARDS) was defined according to the Berlin definition9. The
study was approved by Tongji Hospital Ethics Committee (No.TJ-C2030).
Statistical Analysis
SARS-CoV-2 nucleic acid confirmed patients were grouped as NAC and clinically diagnosed
patients were classified as CD group. The inclusion criteria of CD were listed in Table S1.
Continuous variables were presented as medians with interquartile (IQR) ranges or means and
standard deviations. Student t test was used for data were normally distributed; otherwise, the
Wilcoxon Rank-Sum test was used. Categorical variables were analyzed using the χ2 or Fisher’s
exact test. All analyses were done with SPSS 16. P value less than 0.05 was considered
statistically significant.
In NAC group, 17 (29.82%) patients presented myalgia, while only 2 (8.70%) patients had
myalgia in CD group (p=0.044). 28 (49.12%) NAC patients had cough, and 19 (82.61%) CD
patients had cough (p=0.006). Expectoration occurred differently between the two groups (17.54%
vs 39.13% for NAC and CD groups, p=0.040).
The clinical characteristics were stratified by sex (Table S2). Composition was quite different
between males and females. Doctors accounted for 61.29% of males affected, whilst they
accounted 8.16% of females affacted. Moreover, 22.58% of males had hypertension, and only 6.12%
of females suffered with hypertension. Other aspects of clinical characteristics were similar
between males and females.
Laboratory tests were performed on hospital admission, 19 of the 80 (23.75%) patients showed
leucopenia and 38 (47.5%) showed lymphopenia. The platelet and D-dimer levels were within
normal range. 12 (15%) patients showed prolonged prothrombin time (PT), and 13 (26.53%)
showed shortened activated partial thromboplastin time (APTT). 19 (23.75%) patients showed
increased serum creatinine level, and 30 (37.5%) had decreased creatine kinase (CK). Levels of
lactate dehydrogenase (LDH), alanine aminotransferase (ALT), and aspartate aminotransferase
(AST) were increased in 37 (46.25%), 14 (17.5%), and 21 (26.25%) patients respectively.
Bilateral involvement on chest radiographs were observed in all patients except for one (Table 2).
NAC and CD groups showed similar laboratory findings except for lymphocyte count, which was
lower in NAC group. 30 (52.63%) of NAC patients showed lymphopenia, while only 8 (34.78%)
showed lymphopenia in CD group.
Laboratory findings showed significant difference between males and females (Table S3). Females
had higher platelet count than males. 19.35% of males had decreased platelet count, while it was
only 4.08% for females. APTT was slightly different between males and females. Males had
higher levels of creatinine than females. 54.84% of males had increased creatinine, whilst only
4.08% of female showed increased creatinine. Moreover, males had higher level of CK, ALT, and
AST than females.
Four of the 80 patients were transferred to intensive care unit (ICU) for acute respiratory distress
syndrome (ARDS). 78 (97.5%) patients received antiviral treatment including Arbidol, Kaletra,
and interferon-α, 75 (93.75%) were given antibiotic treatment, and 46 (57.5%) were given
corticosteroid treatment. 68 (85%) patients received noninvasive ventilation, and 2 (2.5%)
received invasive ventilation who further received extracorporeal membrane (ECMO). At this
point, 78 (97.5%) patients had been discharged, one patient had died, and one was still in ICU
(Table 1). The median time for hospitalization was 20.5 days. No significant difference was found
between NAC and CD groups in treatment and outcome. No significant difference was found
between males and females in treatment and outcome.
This is the first report of hospitalized frontline medical workers with COVID-19 including 57
SARS-CoV-2 confirmed and 23 clinically diagnosed cases. None of these workers visited Huanan
seafood market in Wuhan. The median age was 39 years (IQR: 32-48.5 years), similar with a
report from Zhejiang province, China, which showed a median age of 41 years (IQR: 32-52 years)
7
, but different from local study from Wuhan including 138 patients with a median age of 56 years
(IQR: 42-68 years). Female patients accounted for the majority (61.25%) of all cases in our study,
quite different from other studies1,3,7. It suggests that the infected frontline medical workers were
younger than other patients, and female workers were infected more than male, consistent with the
large number of nurses serving in hospital. Hypertension was the most common comorbidity,
consistent with other studies from Wuhan3, while liver disease was the most common comorbidity
in Zhejiang province7. Wuhan is an inland city and Zhejiang included several coastal cities,
whether the difference of comorbidity is caused by the geographic difference is unknown. The
most common symptoms were similar with other studies, however, a higher ratio of diarrhea was
observed in the frontline medical workers (18.75%) than other patients in Wuhan (10.1%)3 and
Zhejiang province (8%)7. The median time from onset to hospital admission was 2 days in
Zhejiang province, shorter than that in our study (7 days), which may be caused by urgent alarm
of the government from January 23 2020. The NAC group had higher ratio of myalgia but lower
ratio of cough and expectoration than the CD group. The clinical features varied between male and
female patients. These data indicate that the frontline medical workers showed some unique
characteristics.
Laboratory findings were consistent with previous studies, including leucopenia, lymphopenia,
increased LDH, ALT, and AST. Yet, some results were different from other studies. D-dimer were
all in normal range, and several studies showed increased D-dimer6. In a recent study by Tang et al,
they found that Non-survivors showed significantly higher level of D-dimer than survivors in
patients with COVID-1910. Some medical workers had already taken actions before hospital
admission, and most patients were mild to moderate in our study. 12 (15%) patients showed
prolonged PT and 3 (3.75%) showed decreased PT, while these numbered 5% and 30%
respectively in a previous study including 99 patients in Wuhan6. Slightly prolonged PT was also
observed in another study in our center10. Coagulation test may be influenced by several factors of
patients. The laboratory findings also varied between male and female patients. Moreover, NAC
group had lower level of lymphocyte than CD group.
The treatments were different in this hospital than other regions. Antibiotics were given for 93.75%
of all cases, and this number was 45% in Zhejiang province7. Moreover, corticosteroid treatment
was carried out in 57.5% of all patients, which was only 26% in Zhejiang7 and 44.9% in another
hospital in Wuhan6. The mortality was 1.25% in our study, low than 4.3% in other patients in
Wuhan6. Both NAC and CD groups received similar treatments and showed similar outcome.
16 of the 23 CD patients received antibodies test against SARS-CoV-2 including IgM and IgG. All
the 16 patients showed positive IgG, and 5 of 16 patients had positive IgG and IgM. Therefore, the
negative nuclear acid result of SARS-CoV-2 in CD patients might be caused by the low sensitivity
of its method.
Author contributions
ZS and WL (Wengang Li) designed this study. XW (Xiong Wang), WL (Wei Liu), JZ, YL, XW
(Xu Wang), CY, SH, and WL (Weiyong Liu) collected the epidemiological and clinical data. JZ
and NS processed statistical data. XW (Xiong Wang) drafted the manuscript.
Declaration of interests
We declare no competing interests.
Acknowledgments
We thank all patients involved in the study.
References
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8 http://www.nhc.gov.cn/xcs/fkdt/202002/5329d7ab7af24690a1d5b66982333af3.shtml.
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10 Tang, N., Li, D., Wang, X. & Sun, Z. Abnormal Coagulation parameters are associated