Clinical progression of patients with COVID-19 in Shanghai, China

J Infect. 2020 May;80(5):e1-e6. doi: 10.1016/j.jinf.2020.03.004. Epub 2020 Mar 19.


Background: Studies on the 2019 novel coronavirus disease (COVID-19) have generally been limited to the description of the epidemiology and initial clinical characteristics. We investigated the temporal progression in patients with COVID-19.

Methods: In this retrospective, single-center study, we included confirmed cases of COVID-19 from Jan 20 to Feb 6, 2020 in Shanghai. Final date of follow-up was February 25, 2020.

Results: Of the 249 patients enrolled, the median age was 51 years old, and 126 (50.6%) were male. The duration from onset of symptoms to hospitalization was 4(2-7) days in symptomatic patients. Fever was occurred in 235(94.3%) patients. A total of 215 (86.3%) patients had been discharged after 16(12-20) days hospitalization. The estimated median duration of fever in all the patients with fever was 10 days (95 confidential intervals [CIs]: 8-11 days) after onset of symptoms. Patients who were transferred to intensive care units (ICU) had significantly longer duration of fever as compared to those not in ICU (31 days v.s. 9 days after onset of symptoms, respectively, P <0.0001). Radiological aggravation of initial image was observed in 163 (65.7%) patients on day 7 after onset of symptoms. 154(94.5%) of these patients showed radiological improvement on day 14. The median duration to negative reverse-transcriptase PCR tests of upper respiratory tract samples was 11 days (95 CIs: 10-12 days). Viral clearance was more likely to be delayed in patients in ICU than those not in ICU (P <0.0001). In multivariate logistical analysis, age (Odds ratio [OR] = 1.06) and CD4 T cell count (OR = 0.55 per 100 cells/ul increase) were independently associated with ICU admission.

Conclusions: The majority of COVID-19 cases are mild. The clinical progression pattern suggests that early control of viral replication and application of host-directed therapy in later stage is essential to improve the prognosis of CVOID-19.

Keywords: COVID-19; Clinical characteristics; Clinical progression; SARS-CoV-2; Viral clearance.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Betacoronavirus
  • COVID-19
  • China
  • Coronavirus Infections / blood
  • Coronavirus Infections / complications
  • Coronavirus Infections / diagnostic imaging
  • Coronavirus Infections / pathology*
  • Disease Progression*
  • Female
  • Fever / etiology
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / blood
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / diagnostic imaging
  • Pneumonia, Viral / pathology*
  • Prognosis
  • Retrospective Studies
  • SARS-CoV-2
  • Time Factors
  • Tomography, X-Ray Computed