Thr NEW ENGLAND JOURNAL f MEDICINE NEARLY DECEMBER 201 throughput sequencingor real-time reve RT-PCR fied in Wuhan.the capital city of Hubei al swab specimens province The pathogen has been identified as aonly laboratory-confirmed cases were included novel enveloped RNA betacoronavirus'that has in the analysis. currently been named severe acute respiratory We obtained data regarding cases outside syndrom (SARS-C Hubei province from the Nationa has a p sin bec the hig d of cli ented The World Health Organization (WHO)has re tan Hospital where many of the patients with cently declared coronavirus disease 2019 (Covid-19) covid-19 in wuhan were being treated a public health emergency of international con We extracted the recent exposure history e且total f81,109 clinical syn cas ission from el cked se lud me cal re FSARS ments in Co Given the rapid (CT) ead of Covid-19.we the clinical care needs of the patient.We deter throughout mainland China might help identify mined the presence of a radiologic abnormality the defining clinical characteristics and s on the basis of the documentation or description the disea Her we escribe the results of our medical charts;if im aging scans were he clin thr ugh disa nt h ultation with a third revie METHODS Laboratory ass essments consisted of a complete STUDY OVERSIGHT blood count,blood chemical analysis,coagula The study was supported by Natio onal Health tion test ing,assessment of liver and renal func sion of Ch na and esign the tion,and me ap genas H med 1.10 waived in light of the urgent need to collect time of admission using the american Thoraci data.Data were analyzed and interpreted by the Society guidelinesfor communityacquired pneu authors.All the authors reviewed the manuscript monia and vouch for the accuracy and completeness of All medical records were copied and sent t the data and for ble estu this e data-proce an He. cians reviewed and abstracted the data.Data DATA SOURCES were entered into a computerized database and We obtained the medical records and compiled cross-checked.If the core data were missing data for hospitalized patient requests for clarification were sent to the coo ratory-con odcoaoupata -19,as reporte iganchesubscqueaiyoataciadthetmd 11 2920 0. 1302 STUDY OUTCOMES Covid-19 was dias nosed on the basis of the The primary composite end point was admission WHO interim guidance.4A confirmed case of to an intensive care unit (ICU),the use of me- Covid-19 was defined as a positive result on high- chanical ventilation,or death.These outcomes N ENGLI MED NEIM ORO Downloaded from nejm.org at SOUTHERN MEDICAL UNIVERSITY nal us Copyngnt 2020 M2 n engl j med nejm.org The new england journal o f medicine I n early December 2019, the first pneu￾monia cases of unknown origin were identi￾fied in Wuhan, the capital city of Hubei province.1 The pathogen has been identified as a novel enveloped RNA betacoronavirus2 that has currently been named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has a phylogenetic similarity to SARS-CoV.3 Pa￾tients with the infection have been documented both in hospitals and in family settings.4-8 The World Health Organization (WHO) has re￾cently declared coronavirus disease 2019 (Covid-19) a public health emergency of international con￾cern.9 As of February 25, 2020, a total of 81,109 laboratory-confirmed cases had been document￾ed 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 mainland 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. Methods Study Oversight The study was supported by National Health Commission of China and designed by the in￾vestigators. The study was approved by the insti￾tutional 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-tran￾scriptase–polymerase-chain-reaction (RT-PCR) 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 Com￾mission. Because of the high workload of clini￾cians, three outside experts from Guangzhou performed raw data extraction at Wuhan Jinyin￾tan 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 find￾ings on admission from electronic medical rec￾ords. Radiologic assessments included chest radi￾ography or computed tomography (CT), and all laboratory testing was performed according to the clinical care needs of the patient. We deter￾mined the presence of a radiologic abnormality on the basis of the documentation or description in medical charts; if imaging scans were avail￾able, 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, coagula￾tion testing, assessment of liver and renal func￾tion, 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 pneu￾monia.15 All medical records were copied and sent to the data-processing center in Guangzhou, under the coordination of the National Health Com￾mission. A team of experienced respiratory clini￾cians 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 coor￾dinators, who subsequently contacted the attend￾ing clinicians. Study Outcomes The primary composite end point was admission to an intensive care unit (ICU), the use of me￾chanical ventilation, or death. These outcomes The New England Journal of Medicine Downloaded from nejm.org at SOUTHERN MEDICAL UNIVERSITY on March 6, 2020. For personal use only. No other uses without permission. Copyright © 2020 Massachusetts Medical Society. All rights reserved