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. 2021 May 28;6(1):18.
doi: 10.1186/s41256-021-00200-8.

The comparison of epidemiological characteristics between confirmed and clinically diagnosed cases with COVID-19 during the early epidemic in Wuhan, China

Fang Shi #  1 , Haoyu Wen #  1 , Rui Liu  2 , Jianjun Bai  1 , Fang Wang  1 , Sumaira Mubarik  1 , Xiaoxue Liu  1 , Yong Yu  3 , Qiumian Hong  4 , Jinhong Cao  1 , Chuanhua Yu  5   6
Affiliations

The comparison of epidemiological characteristics between confirmed and clinically diagnosed cases with COVID-19 during the early epidemic in Wuhan, China

Fang Shi et al. Glob Health Res Policy. .

Abstract

Background: To put COVID-19 patients into hospital timely, the clinical diagnosis had been implemented in Wuhan in the early epidemic. Here we compared the epidemiological characteristics of laboratory-confirmed and clinically diagnosed cases with COVID-19 in Wuhan.

Methods: Demographics, case severity and outcomes of 29,886 confirmed cases and 21,960 clinically diagnosed cases reported between December 2019 and February 24, 2020, were compared. The risk factors were estimated, and the effective reproduction number (Rt) of SARS-CoV-2 was also calculated.

Results: The age and occupation distribution of confirmed cases and clinically diagnosed cases were consistent, and their sex ratio were 1.0 and 0.9, respectively. The epidemic curve of clinical diagnosis cases was similar to that of confirmed cases, and the city centers had more cumulative cases and higher incidence density than suburbs in both of two groups. The proportion of severe and critical cases (21.5 % vs. 14.0 %, P < 0.0001) and case fatality rates (5.2 % vs. 1.2 %, P < 0.0001) of confirmed cases were all higher than those of clinically diagnosed cases. Risk factors for death we observed in both of two groups were older age, male, severe or critical cases. Rt showed the same trend in two groups, it dropped below 1.0 on February 6 among confirmed cases, and February 8 among clinically diagnosed cases.

Conclusions: The demographic characteristics and spatiotemporal distributions of confirmed and clinically diagnosed cases are roughly similar, but the disease severity and clinical outcome of clinically diagnosed cases are better than those of confirmed cases. In cases when detection kits are insufficient during the early epidemic, the implementation of clinical diagnosis is necessary and effective.

Keywords: COVID-19; Clinical diagnosis; Effective reproduction number; Epidemiology; Risk factor; Wuhan city.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The epidemiological curves of confirmed cases and clinically diagnosed cases with COVID-19 in Wuhan from January 1 to February 24, 2020
Fig. 2
Fig. 2
The cumulative numbers and incidence density of confirmed cases and clinically diagnosed cases with COVID-19 in 13 districts of Wuhan. (a) rose diagram of cumulative confirmed cases, (b) rose diagram of cumulative clinically diagnosed cases. The 7 districts with blue series belong to the city centers, and the 6 districts with orange series belong to the suburbs in Wuhan. (c) map of incidence density of confirmed cases, (d) map of incidence density of clinically diagnosed cases
Fig. 3
Fig. 3
Risk factors for death in COVID-19 patients from multivariable logistic-regression analysis
Fig. 4
Fig. 4
Estimated Rt of confirmed cases and clinically diagnosed cases with COVID-19 in Wuhan, China. The 95 % confidence intervals are presented as red or blue shading. The gray horizontal line indicates Rt = 1, below which suggests that the outbreak is gradually controlled
See this image and copyright information in PMC

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