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Clinical characteristics of 80 hospitalized frontline medical workers infected with COVID-19 in Wuhan, China

Our take —

In this study of frontline medical workers in China, the authors highlight differences between SARS-Cov-2 confirmed cases and clinically-diagnosed cases, though some differences were likely overlooked due to small sample size and lack of statistical power. The discussion presents descriptive comparisons of characteristics between frontline medical workers and other studies in China, but additional (multi-site) prospective studies directly comparing medical workers and the general population are necessary to confirm their conjectures.

Study design

Case Series; Retrospective Cohort

Study population and setting

This study included 80 frontline medical workers (median age: 39 years, 61% female) who were hospitalized with confirmed SARS-CoV-2 infection (n=57) or clinically-diagnosed COVID-19 (n=23) at Tongji Hospital in Wuhan, China between January 10 and February 24, 2020. The authors compare clinical and laboratory characteristics between SARS-CoV-2 confirmed cases and clinically-diagnosed cases.

Summary of Main Findings

Among the 80 hospitalized frontline medical workers, 78 (98%) were discharged (including all clinically-diagnosed cases), one patient died, and one was still in ICU at the time of publication. Laboratory-confirmed cases were more likely to present with lymphopenia (53% vs. 35%) and myalgia (30% vs. 9%), but less likely to have cough (49% vs. 83%) and expectoration (18% vs. 39%) than clinically-diagnosed cases. 16 of 23 clinically- diagnosed patients received antibody tests, all of whom were IgG positive, and 5 (31%) were IgM positive for SARS-CoV-2, suggesting low sensitivity (high false negative rate) of SARS-CoV-2 by nucleic acid detection. The most frequently reported comorbidity among frontline medical workers was hypertension (12.5%); females accounted for the majority of cases (61%) and diarrhea was observed at a higher prevalence (19%). Median time from onset of clinical symptoms to hospitalization was 7 days.

Study Strengths

The study presents a detailed comparison of clinical and laboratory characteristics between nucleic acid-confirmed and clinically-diagnosed cases among frontline healthcare works. Supplemental material provides additional comparison between males and females.

Limitations

Relatively small sample size (n=80) from a single site. Conclusions about differences between laboratory-confirmed cases and clinically-diagnosed cases are based heavily on statistical significance (p<0.05). Given the descriptive nature of the study, no formal hypotheses were tested, nor were analyses adjusted for any potential confounders.

Value added

The authors report that this is the first account of hospitalized frontline medical workers with SARS-CoV-2 confirmed and clinically-diagnosed cases, noting several clinical differences between the groups.