Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jul 23;7(9):ofaa286.
doi: 10.1093/ofid/ofaa286. eCollection 2020 Sep.

The Course of Mild and Moderate COVID-19 Infections-The Unexpected Long-Lasting Challenge

Lu Xia  1 , Jun Chen  1 , Thomas Friedemann  2 , Zongguo Yang  1 , Yun Ling  1 , Xuhui Liu  1 , Shuihua Lu  1 , Tao Li  1 , Zhigang Song  1 , Wei Huang  1 , Yunfei Lu  1 , Sven Schröder  2 , Hongzhou Lu  1
Affiliations

The Course of Mild and Moderate COVID-19 Infections-The Unexpected Long-Lasting Challenge

Lu Xia et al. Open Forum Infect Dis. .

Abstract

Background: The course of disease in mild and moderate COVID-19 has many implications for mobile patients, such as the risk of spread of the infection, precautions taken, and investigations targeted at preventing transmission.

Methods: Three hundred thirty-one adults were hospitalized from January 21 to February 22, 2020, and classified as severe (10%) or critical (4.8%) cases; 1.5% died. Two hundred eighty-two (85.2%) mild or moderate cases were admitted to regular wards. Epidemiological, demographic, clinical, chest computed tomography (CT) scan, laboratory, treatment, and outcome data from patient records were analyzed retrospectively.

Results: Patients were symptomatic for 9.82±5.75 (1-37) days. Pulmonary involvement was demonstrated on a chest CT scan in 97.9% of cases. It took 16.81±8.54 (3-49) days from the appearance of the first symptom until 274 patients tested virus-negative in naso- and oropharyngeal (NP) swabs, blood, urine, and stool, and 234 (83%) patients were asymptomatic for 9.09±7.82 (1-44) days. Subsequently, 131 patients were discharged. One hundred sixty-nine remained in the hospital; these patients tested virus-free and were clinically asymptomatic because of widespread persisting or increasing pulmonary infiltrates. Hospitalization took 16.24±7.57 (2-47) days; the time interval from the first symptom to discharge was 21.37±7.85 (3-52) days.

Conclusions: With an asymptomatic phase, disease courses are unexpectedly long until the stage of virus negativity. NP swabs are not reliable in the later stages of COVID-19. Pneumonia outlasts virus-positive tests if sputum is not acquired. Imminent pulmonary fibrosis in high-risk groups demands follow-up examinations. Investigation of promising antiviral agents should heed the specific needs of mild and moderate COVID-19 patients.

Keywords: Cohort study; Shufeng Jiedu; coronavirus disease 2019 (COVID-19); lopinavir/ritonavir; umifenovir.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Timeline of the course of mild and moderate COVID-19 cases. Abbreviations: CT, computed tomography; NP, naso- and oropharyngeal swab.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Li Q, Guan X, Wu P, et al. . Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020; 382:1199–207. - PMC - PubMed
    1. Lu H, Stratton CW, Tang Y. Outbreak of pneumonia of unknown etiology in Wuhan, China: the mystery and the miracle. J Med Virol 2020; 92:401–2. - PMC - PubMed
    1. Tian S, Hu N, Lou J, et al. . Characteristics of COVID-19 infection in Beijing. J Infect 2020; 80:P401–6. - PMC - PubMed
    1. World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19—11 March 2020.2020 Available at: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-re.... Accessed 15 March 2020.
    1. Gorbalenya AE, Baker SC, Baric RS, et al. . The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol 2020; 5:536–44. - PMC - PubMed