Compare the epidemiological and clinical features of imported and local COVID-19 cases in Hainan, China
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Compare the epidemiological and clinical features of imported and local COVID-19 cases in Hainan, China Biao Wu1,2†, Zi-Ying Lei3,4†, Kun-Liang Wu5†, Jian-Rong He6†, Hui-Juan Cao3,4†, Juan Fu1†, Feng Chen7, Yuan Chen2, Bao Chen2, Xiao-Li Zhou2, Tao Huang8, Tao Wu1, Yong-Guo Du5, Suo-Xian Chen1, Fu-Rong Xiao1, Zhi-Liang Gao3,4, Jing He5*†, Feng Lin1*† and Bing-Liang Lin3,4,9*† Abstract Background: Effective management of imported cases is an important part of epidemic prevention and control. Hainan Province, China reported 168 coronavirus disease 2019 (COVID-19), including 112 imported cases on February 19, 2020, but successfully contained the epidemic within 1 month. We described the epidemiological and clinical characteristics of COVID-19 in Hainan and compared these features between imported and local cases to provide information for other international epidemic areas. Methods: We included 91 patients (56 imported and 35 local cases) from two designated hospitals for COVID-19 in Haikou, China, from January 20 to February 19, 2020. Data on the demographic, epidemiological, clinical and laboratory characteristics were extracted from medical records. Patients were followed until April 21, 2020, and the levels of antibodies at the follow-ups were also analysed by the Wilcoxon matched-pairs signed ranks test. Results: Of the 91 patients, 78 (85.7%) patients were diagnosed within the first three weeks after the first case was identified (Day 1: Jan 22, 2020), while the number of local cases started to increase during the third week. No new cases occurred after Day 29. Fever and cough were two main clinical manifestations. In total, 15 (16.5%) patients were severe, 14 (15.4%) had complicated infections, nine (9.9%) were admitted to the intensive care unit, and three died. The median duration of viral shedding in feces was longer than that in nasopharyngeal swabs (19 days vs 16 days, P = 0.007). Compared with local cases, imported cases were older and had a higher incidence of fever and concurrent infections. There was no difference in outcomes between the two groups. IgG was positive in 92.8% patients (77/83) in the follow-up at week 2 after discharge, while 88.4% patients (38/43) had a reduction in IgG levels in the follow-up at week 4 after discharge, and the median level was lower than that in the follow-up at week 2 (10.95 S/Cut Off (S/CO) vs 15.02 S/CO, P < 0.001). (Continued on next page)
* Correspondence: [email protected]; [email protected]; [email protected] † Biao Wu, Zi-Ying Lei, Kun-Liang Wu, Jian-Rong He, Hui-Juan Cao, Juan Fu and Bing-Liang Lin contributed equally to this work. † Jing He and Feng Lin contributed equally with the corresponding author, but not the first authors of this work. 5 Department of Infectious Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, China 1 Department of Infectious Diseases, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China 3 Department of Infectious Diseases, t
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