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COVID-19 Clinical Course

January 23, 2021
Sam Ashoo

Clinical Course

The CDC reports a summary of “multiple early studies from Wuhan, China who had severe COVID-19 illness”1 showing these median timeframes:

  • 5-8 days – onset of illness to dyspnea
  • 8-12 days – onset of illness to acute respiratory distress syndrome (ARDS)
  • 9.5-12 days – onset of illness to ICU admission
  • 10-13 days – length of hospitalization among survivors

The CDC also notes “Clinicians should be aware of the potential for some patients with COVID-19 to rapidly deteriorate about one week after illness onset.”1

Case Distribution

The largest published data set comes from a Chinese study of 72 314 cases, published in JAMA in February 2020.2 Summary of the data provides the following:

72 314 Cases (as of February 11, 2020)2

  • Confirmed cases: 44 672 (62%)
  • Suspected cases: 16 186 (22%)
  • Diagnosed cases: 10 567 (15%)
  • Asymptomatic cases: 889 (1%)

Spectrum of disease (N = 44 415)2

  • Mild: 81% (36 160 cases)
  • Severe: 14% (6168 cases)
  • Critical: 5% (2087 cases)

Age distribution (N = 44 672)2

  • ≥80 years: 3% (1408 cases)
  • 30-79 years: 87% (38 680 cases)
  • 20-29 years: 8% (3619 cases)
  • 10-19 years: 1% (549 cases)
  • <10 years: 1% (416 cases)

Case-fatality rate2

  • 2.3% (1023 of 44 672 confirmed cases)
  • 14.8% in patients aged ≥80 years (208 of 1408)
  • 8.0% in patients aged 70-79 years (312 of 3918)
  • 49.0% in critical cases (1023 of 2087)

Health care personnel infected2

  • 3.8% (1716 of 44 672)
  • 63% in Wuhan (1080 of 1716)
  • 14.8% cases classified as severe or critical (247 of 1668)
  • 5 deaths

Pediatric distribution3

  •  728 (34.1%) laboratory-confirmed cases and 1407 (65.9%) suspected cases
  • 94% asymptomatic, mild, or moderate disease
  • 5% severe disease
  • <1% critical disease

The CDC reports “Among U.S. COVID-19 cases reported January 22–May 30, 2020, overall the proportion of people who were hospitalized was 14%, including 2% admitted to the intensive care unit (ICU).  Overall 5% of patients died.”1

Sources

  1. CDC https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
  2. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020 Feb 24;323(13):1239–42. doi:10.1001/jama.2020.2648external icon.
  3. Dong Y, Mo X, Hu Y, et al. Epidemiology of COVID-19 Among Children in China. Pediatrics. 2020 Jun;145(6): e20200702. doi:10.1542/peds.2020-0702external icon.

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