In occult circles there may be a truth or maxim that kinda says if you cross your fingers behind your back then the lie you are telling doesnt count , As kids we did this all the time .."pax" i would shout" meaning you cant touch me
In the Jesuit faith there is a similar concept and probably used in other societies that is called "The revelation of the Method "
This idea of Tacit agreement runs though our society like that red pen you left in your shirt pocket and now has given all your whites a lovely pink hue ,,,
Survivors
is a British post-apocalyptic fiction drama television series created
by Terry Nation and produced by Terence Dudley at the BBC, that
broadcast from 1975 to 1977. It concerns the plight of a group of
people who have survived an apocalyptic plague pandemic, which was
accidentally released by a Chinese scientist and quickly spread
across the world via air travel. Referred to as "The Death",
the plague kills approximately 4,999 out of every 5,000 human beings
on the planet within a matter of weeks of being released. In episode 1 people are in the hospital lining up for a influenza jab! The doctor replies to his girlfriend , " oh it doesnt do any good , it just make them feel better "
https://youtu.be/zAyjkaFYnzE
https://youtu.be/3GSMQmbTGOg ( the Japanese press release )
https://youtu.be/3GSMQmbTGOg ( the Japanese press release )
mere coincidence ? most likely, but other movies have had similar fortune telling abilities..
The official narrative for the corona virus is as follow Snip; !
Nations around the
world are preparing for a possible major outbreak of a new deadly
virus. The coronavirus, which started in the Chinese city of Wuhan,
has already killed 17 people. It has spread to the USA, Japan, Korea
and Thailand. More than 540 people have caught the virus and are in
hospital.
The new corona virus
is suspected to have come from illegally traded animals in a Wuhan
market. The virus mutated and spread from an animal to a human. There
are fears it could mutate and spread further.
Scientists say the
virus is contagious and can be passed from person to person through
the air. Dr Linfa Wang, a virologist at the Duke-National University
of Singapore, said the new corona virus is in the same family as SARS,
but it's different from SARS. He said people needed to look for
pneumonia-like symptoms, such as fever, cough and difficulty
breathing. Fu Ning, a 36-year-old woman from Beijing, said: "I
feel fearful because there's no cure for the virus."
See the fear and predictive programming being set up , " contagious " and "no cure " hells bells whats a fella to do !
have faith in the powers that be ? like Bill and Melinda gates and the John Hopkins university ?
Event 201
The Johns Hopkins Center for Health Security in partnership with the World Economic Forum and the Bill and Melinda Gates Foundation hosted Event 201, a high-level pandemic exercise on October 18, 2019, in New York, NY. The exercise illustrated areas where public/private partnerships will be necessary during the response to a severe pandemic in order to diminish large-scale economic and societal consequences.no probably not , In my humble opinion any time you see the names "Bill and Melinda Gates " Satan is lurking somewhere in the shadows
But the Security at the Chinese Bio security plant(s) must be of a very high level, after all the deal in quite dangeous viruses on a daily basis:
"Wuhan Virus Laboratory is accredited to conduct
research on three types of viruses: Ebola, Congo-Crimea hemorrhagic
fever and Henipavirus"
OH SH#T.
Dont worry, while this might well be a "training exercise for a horseman; for "I looked, and beheld a pale horse: and his name that sat
on him was Death, and Hell followed with him. And power was
given unto them over the fourth part of the earth, to kill
with sword, and with hunger, and with death, and with the
beasts of the earth."
but can the virus spread. Yes it can and quickly. But there is a "but" ! In epidemiology, the basic reproduction number (sometimes called basic reproductive ratio, or incorrectly basic reproductive rate, and denoted R0, pronounced R nought or R zero) of an infection can be thought of as the expected number of cases directly generated by one case in a population where all individuals are susceptible to infection. The definition describes the state where no other individuals are infected or immunized (naturally or through vaccination).
, pronounced R-nought or R-zero) of the virus has been estimated to be between 1.4 and 3.9. This means that, when unchecked, the virus typically results in 1.4 to
3.9 new cases per established infection. It has been established that
the virus is
able to transmit along a chain of at least four people.
Human-to-human transmission of the virus has been confirmed. Corona viruses are primarily spread through close contact, in particular through respiratory droplets from coughs and sneezes within a range of about 6 feet (1.8 m). Viral RNA has also been found in stool samples from infected patients.
so, Say that an infectious individual makes β contacts per unit time producing new infections with a mean infectious period of 1/γ. Therefore, the basic reproduction number is
able to transmit along a chain of at least four people.
Human-to-human transmission of the virus has been confirmed. Corona viruses are primarily spread through close contact, in particular through respiratory droplets from coughs and sneezes within a range of about 6 feet (1.8 m). Viral RNA has also been found in stool samples from infected patients.
so, Say that an infectious individual makes β contacts per unit time producing new infections with a mean infectious period of 1/γ. Therefore, the basic reproduction number is
Accordingto the japanese Media , 13 people were diagnosed with the virus between the 13th and he 16th of January ,, this would give 13/3 or Ro of 4.33 which would seem about right,
The infection rate is as follows During an epidemic, typically the number of diagnosed infections over time is known. In the early stages of an epidemic, growth is exponential, with a logarithmic growth rate!
However, the most important uses of R0 are determining if an emerging infectious disease can spread in a population and determining what proportion of the population should be immunized through vaccination to eradicate a disease. In commonly used infection models, when R0 > 1 the infection will be able to start spreading in a population, but not if R0 < 1. Generally, the larger the value of R0, the harder it is to control the epidemic. For simple models and a 100% effective vaccine, the proportion of the population that needs to be vaccinated to prevent sustained spread of the infection is given by 1 − 1/R0. ( 1-1/4.339 = 0.77 )
So, While I am in no way an knowledgeable ion this subject. I does see to me that a contagious muva-faker of a common cold that has the ability to cause through respiratory pneumonia has been released. weather through design or accident. The conspiracy theorist in me say by design , Thanks Bill and Melinda ! However it will spread but doesn't have the ball to become an all out epidemic.
Once again I emplore you to take your TV outside and shoot it.
The infection rate is as follows During an epidemic, typically the number of diagnosed infections over time is known. In the early stages of an epidemic, growth is exponential, with a logarithmic growth rate!
During an epidemic, typically the number of diagnosed infections 
However, the most important uses of R0 are determining if an emerging infectious disease can spread in a population and determining what proportion of the population should be immunized through vaccination to eradicate a disease. In commonly used infection models, when R0 > 1 the infection will be able to start spreading in a population, but not if R0 < 1. Generally, the larger the value of R0, the harder it is to control the epidemic. For simple models and a 100% effective vaccine, the proportion of the population that needs to be vaccinated to prevent sustained spread of the infection is given by 1 − 1/R0. ( 1-1/4.339 = 0.77 )
So, While I am in no way an knowledgeable ion this subject. I does see to me that a contagious muva-faker of a common cold that has the ability to cause through respiratory pneumonia has been released. weather through design or accident. The conspiracy theorist in me say by design , Thanks Bill and Melinda ! However it will spread but doesn't have the ball to become an all out epidemic.
Once again I emplore you to take your TV outside and shoot it.
The latest I could find
Clinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
nejm.org
Clinical Characteristics of
Coronavirus Disease 2019 in China
Nan-shan Zhong
36-46 minutes
24 References
1 Citing Article
Abstract
Background
Since December 2019, when coronavirus disease 2019
(Covid-19) emerged in Wuhan city and rapidly spread
throughout China, data have been needed on the clinical
characteristics of the affected patients.
Methods
We extracted data regarding 1099 patients with laboratory-
confirmed Covid-19 from 552 hospitals in 30 provinces,
autonomous regions, and municipalities in China through
January 29, 2020. The primary composite end point was
admission to an intensive care unit (ICU), the use of
mechanical ventilation, or death.
1 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
Results
The median age of the patients was 47 years; 41.9% of the
patients were female. The primary composite end point
occurred in 67 patients (6.1%), including 5.0% who were
admitted to the ICU, 2.3% who underwent invasive
mechanical ventilation, and 1.4% who died. Only 1.9% of
the patients had a history of direct contact with wildlife.
Among nonresidents of Wuhan, 72.3% had contact with
residents of Wuhan, including 31.3% who had visited the
city. The most common symptoms were fever (43.8% on
admission and 88.7% during hospitalization) and cough
(67.8%). Diarrhea was uncommon (3.8%). The median
incubation period was 4 days (interquartile range, 2 to 7).
On admission, ground-glass opacity was the most common
radiologic finding on chest computed tomography (CT)
(56.4%). No radiographic or CT abnormality was found in
157 of 877 patients (17.9%) with nonsevere disease and in
5 of 173 patients (2.9%) with severe disease.
Lymphocytopenia was present in 83.2% of the patients on
admission.
Conclusions
During the first 2 months of the current outbreak, Covid-19
spread rapidly throughout China and caused varying
degrees of illness. Patients often presented without fever,
and many did not have abnormal radiologic findings.
(Funded by the National Health Commission of China and
others.)
2 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
Introduction
In early December 2019, the first pneumonia cases of
unknown origin were identified in Wuhan, the capital city of
Hubei province. 1 The pathogen has been identified as a
novel enveloped RNA betacoronavirus 2 that has currently
been named severe acute respiratory syndrome coronavirus
2 (SARS-CoV-2), which has a phylogenetic similarity to
SARS-CoV. 3 Patients with the infection have been
documented both in hospitals and in family settings. 4-8
The World Health Organization (WHO) has recently
declared coronavirus disease 2019 (Covid-19) a public
health emergency of international concern. 9 As of February
25, 2020, a total of 81,109 laboratory-confirmed cases had
been documented globally. 5,6,9-11 In recent studies, the
severity of some cases of Covid-19 mimicked that of SARS-
CoV. 1,12,13 Given the rapid spread of Covid-19, we
determined that an updated analysis of cases throughout
China might help identify the defining clinical characteristics
and severity of the disease. Here, we describe the results of
our analysis of the clinical characteristics of Covid-19 in a
selected cohort of patients throughout China.
3 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
Methods
Study Oversight
The study was supported by National Health Commission of
China and designed by the investigators. The study was
approved by the institutional review board of the National
Health Commission. Written informed consent was waived
in light of the urgent need to collect data. Data were
analyzed and interpreted by the authors. All the authors
reviewed the manuscript and vouch for the accuracy and
completeness of the data and for the adherence of the study
to the protocol, available with the full text of this article at
NEJM.org.
Data Sources
We obtained the medical records and compiled data for
hospitalized patients and outpatients with laboratory-
confirmed Covid-19, as reported to the National Health
Commission between December 11, 2019, and January 29,
2020; the data cutoff for the study was January 31, 2020.
Covid-19 was diagnosed on the basis of the WHO interim
guidance. 14 A confirmed case of Covid-19 was defined as a
positive result on high-throughput sequencing or real-time
reverse-transcriptase–polymerase-chain-reaction (RT-PCR)
4 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
assay of nasal and pharyngeal swab specimens. 1 Only
laboratory-confirmed cases were included in the analysis.
We obtained data regarding cases outside Hubei province
from the National Health Commission. Because of the high
workload of clinicians, three outside experts from
Guangzhou performed raw data extraction at Wuhan
Jinyintan Hospital, where many of the patients with Covid-19
in Wuhan were being treated.
We extracted the recent exposure history, clinical symptoms
or signs, and laboratory findings on admission from
electronic medical records. Radiologic assessments
included chest radiography or computed tomography (CT),
and all laboratory testing was performed according to the
clinical care needs of the patient. We determined the
presence of a radiologic abnormality on the basis of the
documentation or description in medical charts; if imaging
scans were available, they were reviewed by attending
physicians in respiratory medicine who extracted the data.
Major disagreement between two reviewers was resolved by
consultation with a third reviewer. Laboratory assessments
consisted of a complete blood count, blood chemical
analysis, coagulation testing, assessment of liver and renal
function, and measures of electrolytes, C-reactive protein,
procalcitonin, lactate dehydrogenase, and creatine kinase.
We defined the degree of severity of Covid-19 (severe vs.
nonsevere) at the time of admission using the American
Thoracic Society guidelines for community-acquired
pneumonia. 15
5 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
All medical records were copied and sent to the data-
processing center in Guangzhou, under the coordination of
the National Health Commission. A team of experienced
respiratory clinicians reviewed and abstracted the data.
Data were entered into a computerized database and cross-
checked. If the core data were missing, requests for
clarification were sent to the coordinators, who subsequently
contacted the attending clinicians.
Study Outcomes
The primary composite end point was admission to an
intensive care unit (ICU), the use of mechanical ventilation,
or death. These outcomes were used in a previous study to
assess the severity of other serious infectious diseases,
such as H7N9 infection. 16 Secondary end points were the
rate of death and the time from symptom onset until the
composite end point and until each component of the
composite end point.
Study Definitions
The incubation period was defined as the interval between
the potential earliest date of contact of the transmission
source (wildlife or person with suspected or confirmed case)
and the potential earliest date of symptom onset (i.e.,
cough, fever, fatigue, or myalgia). We excluded incubation
periods of less than 1 day because some patients had
continuous exposure to contamination sources; in these
cases, the latest date of exposure was recorded. The
6 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
summary statistics of incubation periods were calculated on
the basis of 291 patients who had clear information
regarding the specific date of exposure.
Fever was defined as an axillary temperature of 37.5°C or
higher. Lymphocytopenia was defined as a lymphocyte
count of less than 1500 cells per cubic millimeter.
Thrombocytopenia was defined as a platelet count of less
than 150,000 per cubic millimeter. Additional definitions —
including exposure to wildlife, acute respiratory distress
syndrome (ARDS), pneumonia, acute kidney failure, acute
heart failure, and rhabdomyolysis — are provided in the
Supplementary Appendix, available at NEJM.org.
Laboratory Confirmation
Laboratory confirmation of SARS-CoV-2 was performed at
the Chinese Center for Disease Prevention and Control
before January 23, 2020, and subsequently in certified
tertiary care hospitals. RT-PCR assays were performed in
accordance with the protocol established by the WHO. 17
Details regarding laboratory confirmation processes are
provided in the Supplementary Appendix.
Statistical Analysis
Continuous variables were expressed as medians and
interquartile ranges or simple ranges, as appropriate.
Categorical variables were summarized as counts and
percentages. No imputation was made for missing data.
Because the cohort of patients in our study was not derived
7 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
from random selection, all statistics are deemed to be
descriptive only. We used ArcGIS, version 10.2.2, to plot the
numbers of patients with reportedly confirmed cases on a
map. All the analyses were performed with the use of R
software, version 3.6.2 (R Foundation for Statistical
Computing).
Results
Demographic and Clinical Characteristics
Figure 1.
Figure 1. Distribution of
Patients with Covid-19 across China.
Shown are the official statistics of all documented,
8 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
laboratory-confirmed cases of coronavirus disease 2019
(Covid-19) throughout China, according to the National
Health Commission as of February 4, 2020. The numerator
denotes the number of patients who were included in the
study cohort and the denominator denotes the number of
laboratory-confirmed cases for each province, autonomous
region, or provincial municipality, as reported by the National
Health Commission.
Of the 7736 patients with Covid-19 who had been
hospitalized at 552 sites as of January 29, 2020, we
obtained data regarding clinical symptoms and outcomes for
1099 patients (14.2%). The largest number of patients (132)
had been admitted to Wuhan Jinyintan Hospital. The
hospitals that were included in this study accounted for
29.7% of the 1856 designated hospitals where patients with
Covid-19 could be admitted in 30 provinces, autonomous
regions, or municipalities across China (Figure 1).
9 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
Table 1.
Table 1. Clinical
Characteristics of the Study Patients, According to Disease
Severity and the Presence or Absence of the Primary
Composite End Point.
The demographic and clinical characteristics of the patients
are shown in Table 1. A total of 3.5% were health care
workers, and a history of contact with wildlife was
documented in 1.9%; 483 patients (43.9%) were residents
of Wuhan. Among the patients who lived outside Wuhan,
10 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
72.3% had contact with residents of Wuhan, including
31.3% who had visited the city; 25.9% of nonresidents had
neither visited the city nor had contact with Wuhan
residents.
The median incubation period was 4 days (interquartile
range, 2 to 7). The median age of the patients was 47 years
(interquartile range, 35 to 58); 0.9% of the patients were
younger than 15 years of age. A total of 41.9% were female.
Fever was present in 43.8% of the patients on admission
but developed in 88.7% during hospitalization. The second
most common symptom was cough (67.8%); nausea or
vomiting (5.0%) and diarrhea (3.8%) were uncommon.
Among the overall population, 23.7% had at least one
coexisting illness (e.g., hypertension and chronic obstructive
pulmonary disease).
On admission, the degree of severity of Covid-19 was
categorized as nonsevere in 926 patients and severe in 173
patients. Patients with severe disease were older than those
with nonsevere disease by a median of 7 years. Moreover,
the presence of any coexisting illness was more common
among patients with severe disease than among those with
nonsevere disease (38.7% vs. 21.0%). However, the
exposure history between the two groups of disease
severity was similar.
Radiologic and Laboratory Findings
11 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
Table 2.
Table 2. Radiographic and
Laboratory Findings.
Table 2 shows the radiologic and laboratory findings on
admission. Of 975 CT scans that were performed at the time
of admission, 86.2% revealed abnormal results. The most
common patterns on chest CT were ground-glass opacity
(56.4%) and bilateral patchy shadowing (51.8%).
Representative radiologic findings in two patients with
nonsevere Covid-19 and in another two patients with severe
Covid-19 are provided in Figure S1 in the Supplementary
Appendix. No radiographic or CT abnormality was found in
157 of 877 patients (17.9%) with nonsevere disease and in
5 of 173 patients (2.9%) with severe disease.
12 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
On admission, lymphocytopenia was present in 83.2% of
the patients, thrombocytopenia in 36.2%, and leukopenia in
33.7%. Most of the patients had elevated levels of
C-reactive protein; less common were elevated levels of
alanine aminotransferase, aspartate aminotransferase,
creatine kinase, and d-dimer. Patients with severe disease
had more prominent laboratory abnormalities (including
lymphocytopenia and leukopenia) than those with
nonsevere disease.
Clinical Outcomes
Table 3.
Table 3. Complications,
Treatments, and Clinical Outcomes.
None of the 1099 patients were lost to follow-up during the
study. A primary composite end-point event occurred in 67
patients (6.1%), including 5.0% who were admitted to the
ICU, 2.3% who underwent invasive mechanical ventilation,
13 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
and 1.4% who died (Table 3). Among the 173 patients with
severe disease, a primary composite end-point event
occurred in 43 patients (24.9%). Among all the patients, the
cumulative risk of the composite end point was 3.6%;
among those with severe disease, the cumulative risk was
20.6%.
Treatment and Complications
A majority of the patients (58.0%) received intravenous
antibiotic therapy, and 35.8% received oseltamivir therapy;
oxygen therapy was administered in 41.3% and mechanical
ventilation in 6.1%; higher percentages of patients with
severe disease received these therapies (Table 3).
Mechanical ventilation was initiated in more patients with
severe disease than in those with nonsevere disease
(noninvasive ventilation, 32.4% vs. 0%; invasive ventilation,
14.5% vs. 0%). Systemic glucocorticoids were given to 204
patients (18.6%), with a higher percentage among those
with severe disease than nonsevere disease (44.5% vs.
13.7%). Of these 204 patients, 33 (16.2%) were admitted to
the ICU, 17 (8.3%) underwent invasive ventilation, and 5
(2.5%) died. Extracorporeal membrane oxygenation was
performed in 5 patients (0.5%) with severe disease.
The median duration of hospitalization was 12.0 days
(mean, 12.8). During hospital admission, most of the
patients received a diagnosis of pneumonia from a
physician (91.1%), followed by ARDS (3.4%) and shock
(1.1%). Patients with severe disease had a higher incidence
of physician-diagnosed pneumonia than those with
14 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
nonsevere disease (99.4% vs. 89.5%).
Discussion
During the initial phase of the Covid-19 outbreak, the
diagnosis of the disease was complicated by the diversity in
symptoms and imaging findings and in the severity of
disease at the time of presentation. Fever was identified in
43.8% of the patients on presentation but developed in
88.7% after hospitalization. Severe illness occurred in
15.7% of the patients after admission to a hospital. No
radiologic abnormalities were noted on initial presentation in
2.9% of the patients with severe disease and in 17.9% of
those with nonsevere disease. Despite the number of
deaths associated with Covid-19, SARS-CoV-2 appears to
have a lower case fatality rate than either SARS-CoV or
Middle East respiratory syndrome–related coronavirus
(MERS-CoV). Compromised respiratory status on admission
(the primary driver of disease severity) was associated with
worse outcomes.
Approximately 2% of the patients had a history of direct
contact with wildlife, whereas more than three quarters were
either residents of Wuhan, had visited the city, or had
contact with city residents. These findings echo the latest
reports, including the outbreak of a family cluster, 4
15 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
transmission from an asymptomatic patient, 6 and the three-
phase outbreak patterns. 8 Our study cannot preclude the
presence of patients who have been termed “super-
spreaders.”
Conventional routes of transmission of SARS-CoV, MERS-
CoV, and highly pathogenic influenza consist of respiratory
droplets and direct contact, 18-20 mechanisms that probably
occur with SARS-CoV-2 as well. Because SARS-CoV-2 can
be detected in the gastrointestinal tract, saliva, and urine,
these routes of potential transmission need to be
investigated 21 (Tables S1 and S2).
The term Covid-19 has been applied to patients who have
laboratory-confirmed symptomatic cases without apparent
radiologic manifestations. A better understanding of the
spectrum of the disease is needed, since in 8.9% of the
patients, SARS-CoV-2 infection was detected before the
development of viral pneumonia or viral pneumonia did not
develop.
In concert with recent studies, 1,8,12 we found that the
clinical characteristics of Covid-19 mimic those of SARS-
CoV. Fever and cough were the dominant symptoms and
gastrointestinal symptoms were uncommon, which suggests
a difference in viral tropism as compared with SARS-CoV,
MERS-CoV, and seasonal influenza. 22,23 The absence of
fever in Covid-19 is more frequent than in SARS-CoV (1%)
and MERS-CoV infection (2%), 20 so afebrile patients may
be missed if the surveillance case definition focuses on
16 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
fever detection. 14 Lymphocytopenia was common and, in
some cases, severe, a finding that was consistent with the
results of two recent reports. 1,12 We found a lower case
fatality rate (1.4%) than the rate that was recently
reportedly, 1,12 probably because of the difference in sample
sizes and case inclusion criteria. Our findings were more
similar to the national official statistics, which showed a rate
of death of 3.2% among 51,857 cases of Covid-19 as of
February 16, 2020. 11,24 Since patients who were mildly ill
and who did not seek medical attention were not included in
our study, the case fatality rate in a real-world scenario
might be even lower. Early isolation, early diagnosis, and
early management might have collectively contributed to the
reduction in mortality in Guangdong.
Despite the phylogenetic homogeneity between SARS-
CoV-2 and SARS-CoV, there are some clinical
characteristics that differentiate Covid-19 from SARS-CoV,
MERS-CoV, and seasonal influenza infections. (For
example, seasonal influenza has been more common in
respiratory outpatient clinics and wards.) Some additional
characteristics that are unique to Covid-19 are detailed in
Table S3.
Our study has some notable limitations. First, some cases
had incomplete documentation of the exposure history and
laboratory testing, given the variation in the structure of
electronic databases among different participating sites and
the urgent timeline for data extraction. Some cases were
diagnosed in outpatient settings where medical information
17 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
was briefly documented and incomplete laboratory testing
was performed, along with a shortage of infrastructure and
training of medical staff in nonspecialty hospitals. Second,
we could estimate the incubation period in only 291 of the
study patients who had documented information. The
uncertainty of the exact dates (recall bias) might have
inevitably affected our assessment. Third, because many
patients remained in the hospital and the outcomes were
unknown at the time of data cutoff, we censored the data
regarding their clinical outcomes as of the time of our
analysis. Fourth, we no doubt missed patients who were
asymptomatic or had mild cases and who were treated at
home, so our study cohort may represent the more severe
end of Covid-19. Fifth, many patients did not undergo
sputum bacteriologic or fungal assessment on admission
because, in some hospitals, medical resources were
overwhelmed. Sixth, data generation was clinically driven
and not systematic.
Covid-19 has spread rapidly since it was first identified in
Wuhan and has been shown to have a wide spectrum of
severity. Some patients with Covid-19 do not have fever or
radiologic abnormalities on initial presentation, which has
complicated the diagnosis.
Funding and Disclosures
18 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
Supported by the National Health Commission of China, the
National Natural Science Foundation, and the Department
of Science and Technology of Guangdong Province.
Disclosure forms provided by the authors are available with
the full text of this article at NEJM.org.
Drs. Guan, Ni, Yu Hu, W. Liang, Ou, He, L. Liu, Shan, Lei,
Hui, Du, L. Li, Zeng, and Yuen contributed equally to this
article.
This article was published on February 28, 2020, at
NEJM.org.
We thank all the hospital staff members (see Supplementary
Appendix for a full list of the staff) for their efforts in
collecting the information that was used in this study; Zong-
jiu Zhang, Ya-hui Jiao, Xin-qiang Gao, and Tao Wei
(National Health Commission), Yu-fei Duan and Zhi-ling
Zhao (Health Commission of Guangdong Province), and Yi-
min Li, Nuo-fu Zhang, Qing-hui Huang, Wen-xi Huang, and
Ming Li (Guangzhou Institute of Respiratory Health) for
facilitating the collection of patients’ data; the statistical team
members Zheng Chen, Dong Han, Li Li, Zhi-ying Zhan, Jin-
jian Chen, Li-jun Xu, and Xiao-han Xu (State Key Laboratory
of Organ Failure Research, Department of Biostatistics,
19 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
Guangdong Provincial Key Laboratory of Tropical Disease
Research, School of Public Health, and Southern Medical
University, respectively); Li-qiang Wang, Wei-peng Cai, Zi-
sheng Chen (the Sixth Affiliated Hospital of Guangzhou
Medical University) and Chang-xing Ou, Xiao-min Peng, Si-
ni Cui, Yuan Wang, Mou Zeng, Xin Hao, Qi-hua He, Jing-pei
Li, Xu-kai Li, Wei Wang, Li-min Ou, Ya-lei Zhang, Jing-wei
Liu, Xin-guo Xiong, Wei-juna Shi, San-mei Yu, Run-dong
Qin, Si-yang Yao, Bo-meng Zhang, Xiao-hong Xie, Zhan-
hong Xie, Wan-di Wang, Xiao-xian Zhang, Hui-yin Xu, Zi-
qing Zhou, Ying Jiang, Ni Liu, Jing-jing Yuan, Zheng Zhu,
Jie-xia Zhang, Hong-hao Li, Wei-hua Huang, Lu-lin Wang,
Jie-ying Li, Li-fen Gao, Cai-chen Li, Xue-wei Chen, Jia-bo
Gao, Ming-shan Xue, Shou-xie Huang, Jia-man Tang, and
Wei-li Gu (Guangzhou Institute of Respiratory Health) for
their dedication to data entry and verification; Tencent
(Internet-services company) for providing the number of
hospitals certified to admit patients with Covid-19 throughout
China; and all the patients who consented to donate their
data for analysis and the medical staff members who are on
the front line of caring for patients.
Author Affiliations
From the State Key Laboratory of Respiratory Disease,
National Clinical Research Center for Respiratory Disease,
20 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
Guangzhou Institute of Respiratory Health, First Affiliated
Hospital of Guangzhou Medical University (W.G., W.L., J.H.,
R.C., C.T., T.W., S.L., Jin-lin Wang, N.Z., J.H., W.L.), the
Departments of Thoracic Oncology (W.L.), Thoracic Surgery
and Oncology (J.H.), and Emergency Medicine (Z.L.), First
Affiliated Hospital of Guangzhou Medical University, and
Guangzhou Eighth People’s Hospital, Guangzhou Medical
University (C.L.), and the State Key Laboratory of Organ
Failure Research, Department of Biostatistics, Guangdong
Provincial Key Laboratory of Tropical Disease Research,
School of Public Health, Southern Medical University (C.O.,
P.C.), Guangzhou, Wuhan Jinyintan Hospital (Z.N., J.X.),
Union Hospital, Tongji Medical College, Huazhong
University of Science and Technology (Yu Hu), the Central
Hospital of Wuhan (Y.P.), Wuhan No. 1 Hospital, Wuhan
Hospital of Traditional Chinese and Western Medicine
(L.W.), Wuhan Pulmonary Hospital (P.P.), Tianyou Hospital
Affiliated to Wuhan University of Science and Technology
(Jian-ming Wang), and the People’s Hospital of Huangpi
District (S.Z.), Wuhan, Shenzhen Third People’s Hospital
and the Second Affiliated Hospital of Southern University of
Science and Technology, National Clinical Research Center
for Infectious Diseases (L. Liu), and the Department of
Clinical Microbiology and Infection Control, University of
Hong Kong–Shenzhen Hospital (K.-Y.Y.), Shenzhen, the
Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai
(H.S.), the Department of Medicine and Therapeutics,
Chinese University of Hong Kong, Shatin (D.S.C.H.), and
the Department of Microbiology and the Carol Yu Center for
21 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
Infection, Li Ka Shing Faculty of Medicine, University of
Hong Kong, Pok Fu Lam (K.-Y.Y.), Hong Kong, Medical ICU,
Peking Union Medical College Hospital, Peking Union
Medical College and Chinese Academy of Medical Sciences
(B.D.), and the Chinese Center for Disease Control and
Prevention (G.Z.), Beijing, the State Key Laboratory for
Diagnosis and Treatment of Infectious Diseases, National
Clinical Research Center for Infectious Diseases, First
Affiliated Hospital, College of Medicine, Zhejiang University,
Hangzhou (L. Li), Chengdu Public Health Clinical Medical
Center, Chengdu (Y.L.), Huangshi Central Hospital of Edong
Healthcare Group, Affiliated Hospital of Hubei Polytechnic
University, Huangshi (Ya-hua Hu), the First Hospital of
Changsha, Changsha (J. Liu), the Third People’s Hospital of
Hainan Province, Sanya (Z.C.), Huanggang Central
Hospital, Huanggang (G.L.), Wenling First People’s
Hospital, Wenling (Z.Z.), the Third People’s Hospital of
Yichang, Yichang (S.Q.), Affiliated Taihe Hospital of Hubei
University of Medicine, Shiyan (J. Luo), and Xiantao First
People’s Hospital, Xiantao (C.Y.) — all in China.
Address reprint requests to Dr. Zhong at the State Key
Laboratory of Respiratory Disease, National Clinical
Research Center for Respiratory Disease, Guangzhou
Institute of Respiratory Health, First Affiliated Hospital of
Guangzhou Medical University, 151 Yanjiang Rd.,
Guangzhou, Guangdong, China, or at
nanshan@vip.163.com.
A list of investigators in the China Medical Treatment Expert
Group for Covid-19 study is provided in the Supplementary
22 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
Appendix, available at NEJM.org.
Supplementary Material
References (24)
1. 1. Huang C, Wang Y, Li X, et al. Clinical features of patients
infected with 2019 novel coronavirus in Wuhan, China.
Lancet 2020;395:497-506.
2. 2. Lu R, Zhao X, Li J, et al. Genomic characterisation and
epidemiology of 2019 novel coronavirus: implications for
virus origins and receptor binding. Lancet
2020;395:565-574.
3. 3. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from
patients with pneumonia in China, 2019. N Engl J Med
2020;382:727-733.
4. 4. Chan JF, Yuan S, Kok KH, et al. A familial cluster of
pneumonia associated with the 2019 novel coronavirus
indicating person-to-person transmission: a study of a family
cluster. Lancet 2020;395:514-523.
23 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
5. 5. Phan LT, Nguyen TV, Luong QC, et al. Importation and
human-to-human transmission of a novel coronavirus in
Vietnam. N Engl J Med. DOI: 10.1056/NEJMc2001272.
6. 6. Rothe C, Schunk M, Sothmann P, et al. Transmission of
2019-nCoV infection from an asymptomatic contact in
Germany. N Engl J Med. DOI: 10.1056/NEJMc2001468.
7. 7. Wu JT, Leung K, Leung GM. Nowcasting and forecasting
the potential domestic and international spread of the 2019-
nCoV outbreak originating in Wuhan, China: a modelling
study. Lancet 2020 January 31 (Epub ahead of print).
8. 8. Li Q, Guan X, Wu P, et al. Early transmission dynamics in
Wuhan, China, of novel coronavirus–infected pneumonia. N
Engl J Med. DOI: 10.1056/NEJMoa2001316.
9. 9. World Health Organization. Coronavirus disease
(COVID-19) outbreak (https://www.who.int).
10. 10. Holshue ML, DeBolt C, Lindquist S, et al. First case of
2019 novel coronavirus in the United States. N Engl J Med.
DOI: 10.1056/NEJMoa2001191.
11. 11. National Health Commission of the People’s Republic of
China home page (http://www.nhc.gov.cn).
12. 12. Chen N, Zhou M, Dong X, et al. Epidemiological and
clinical characteristics of 99 cases of 2019 novel
coronavirus pneumonia in Wuhan, China: a descriptive
study. Lancet 2020;395:507-513.
13. 13. Wang D, Hu B, Hu C, et al. Clinical characteristics of
138 hospitalized patients with 2019 novel coronavirus-
infected pneumonia in Wuhan, China. JAMA 2020 February
24 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
7 (Epub ahead of print).
14. 14. World Health Organization. Clinical management of
severe acute respiratory infection when novel coronavirus
(2019-nCoV) infection is suspected: interim guidance.
January 28, 2020 (https://www.who.int/docs/default-source
/coronaviruse/clinical-management-of-novel-cov.pdf).
15. 15. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and
treatment of adults with community-acquired pneumonia: an
official clinical practice guideline of the American Thoracic
Society and Infectious Disease Society of America. Am J
Respir Crit Care Med 2019;200(7):e45-e67.
16. 16. Gao H-N, Lu H-Z, Cao B, et al. Clinical findings in 111
cases of influenza A (H7N9) virus infection. N Engl J Med
2013;368:2277-2285.
17. 17. World Health Organization. Coronavirus disease
(COVID-19) technical guidance: laboratory testing for 2019-
nCoV in humans (https://www.who.int/emergencies
/diseases/novel-coronavirus-2019/technical-guidance
/laboratory-guidance).
18. 18. Lei H, Li Y, Xiao S, et al. Routes of transmission of
influenza A H1N1, SARS CoV, and norovirus in air cabin:
comparative analyses. Indoor Air 2018;28:394-403.
19. 19. Otter JA, Donskey C, Yezli S, Douthwaite S, Goldenberg
SD, Weber DJ. Transmission of SARS and MERS
coronaviruses and influenza virus in healthcare settings: the
possible role of dry surface contamination. J Hosp Infect
2016;92:235-250.
25 of 26
3/2/20, 9:18 PMClinical Characteristics of Coronavirus Disease...
about:reader?url=https://www.nejm.org/doi/full/...
20. 20. Zumla A, Hui DS, Perlman S. Middle East respiratory
syndrome. Lancet 2015;386:995-1007.
21. 21. Minodier L, Charrel RN, Ceccaldi PE, et al. Prevalence
of gastrointestinal symptoms in patients with influenza,
clinical significance, and pathophysiology of human
influenza viruses in faecal samples: what do we know? Virol
J 2015;12:215-215.
22. 22. Leung WK, To KF, Chan PK, et al. Enteric involvement
of severe acute respiratory syndrome-associated
coronavirus infection. Gastroenterology
2003;125:1011-1017.
23. 23. Assiri A, McGeer A, Perl TM, et al. Hospital outbreak of
Middle East respiratory syndrome coronavirus. N Engl J
Med 2013;369:407-416.
24. 24. World Health Organization. Coronavirus disease
(COVID-2019) situation reports (https://www.who.int
/emergencies/diseases/novel-coronavirus-2019/situation-
reports/).
Citing Article (1)
26 of 26
3/2/20, 9:18 PM
No comments:
Post a Comment
Note: only a member of this blog may post a comment.