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SARS-CoV-2 proteins

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    Epidemiological, clinical, and laboratory findings for patients of different age groups with confirmed coronavirus disease 2019 MESHD ( COVID-19 MESHD) in a hospital in Saudi Arabia

    Authors: Mutasim E Ibrahim; Obaid S AL-Aklobi; Mosleh M Abomughaid; Mushabab A. Al-Ghamdi

    doi:10.1101/2020.10.21.20217083 Date: 2020-10-25 Source: medRxiv

    Background: Although the coronavirus disease 2019 MESHD ( COVID-19 MESHD) pandemic continues to rage worldwide, clinical and laboratory studies of this disease have been limited in many countries. We investigated the epidemiologic, clinical, and laboratory findings of COVID-19 MESHD infected MESHD patients to identify the effective indicators correlated with the disease. Methods: A retrospective study was conducted at King Abdullah Hospital in Bisha Province, Saudi Arabia, from March 20 to June 30, 2020. Patients of different age groups were confirmed as having COVID-19 MESHD infection using a real-time polymerase chain reaction. The demographic, clinical, and laboratory data of the patients were statistically analyzed. Results: Of the 137 patients, 88 were male and 49 were female, with a mean age of 49.3 years (SD,18.4). The patients were elderly (n=29), adults (n=103), and children (n=5). Of these, 54 (39.4%) had comorbidities, 24% were admitted to the intensive care unit (ICU), and 12 (8.8%) died. On admission, the main clinical manifestations were fever MESHD (82.5%), cough (63.5%), shortness of breath MESHD (24.8%), chest pain MESHD (19.7%), and fatigue MESHD (18.2%). In all patients, increased neutrophils and decreased lymphocytes were observed. Patients' lactate dehydrogenase (LDH) was elevated. C-reactive protein HGNC ( CRP HGNC) was elevated in 46.7%, D-dimer in 41.6%, and the erythrocyte sedimentation rate (ESR) in 39.4% of patients. The elderly showed higher neutrophil (p=0.003) and lower lymphocyte (p=0.001) counts than adults and children. Glucose, creatine kinase-MB, LDH, bilirubin, D-dimer, and ESR were significantly higher in the elderly than in the adults. The COVID-19 MESHD death group had a higher leucocyte count (p = 0.043), and higher urea (p=0.025) and potassium (p=0.026) than the recovered group but had a lower hemoglobin concentration (p=0.018). A significant association was determined between COVID-19 MESHD death MESHD (x2(1)=17.751, p<0.001), and the presence of cardiovascular disease MESHD (x2(1)=17.049, p<0.001), hypertension MESHD (x2(1)=7.659, p=0.006), renal failure MESHD (x2(1)=4.172, p<0.04), old age (t(135) = 4.747, p <0.001), and ICU admission (x2(1) = 17.751 (1), p<0.001). Conclusions: The common symptoms found in this study could be useful for identifying potential COVID-19 MESHD patients. Investigating some of the laboratory and clinical parameters could help assess the disease progression, risk of mortality, and follow up patients who could progress to a fatal condition.

    Development of a predictive risk model for severe COVID-19 MESHD disease using population-based administrative data

    Authors: Jiandong Zhou; Sharen Lee; Xiansong Wang; Yi Li; William KK Wu; Tong Liu; Zhidong Cao; Daniel Dajun Zeng; Ian CK Wong; Bernard MY Cheung; Qingpeng Zhang; Gary Tse

    doi:10.1101/2020.10.21.20217380 Date: 2020-10-25 Source: medRxiv

    Background: Recent studies have reported numerous significant predictors for adverse outcomes in COVID-19 MESHD disease. However, there have been few simple clinical risk score for prompt risk stratification. The objective is to develop a simple risk score for severe COVID-19 MESHD disease using territory-wide healthcare data based on simple clinical and laboratory variables. Methods: Consecutive patients admitted to Hong Kong public hospitals between 1st January and 22nd August 2020 diagnosed with COVID-19 MESHD, as confirmed by RT-PCR, were included. The primary outcome was composite intensive care unit admission, need for intubation or death with follow-up until 8th September 2020. Results: COVID-19 MESHD testing was performed in 237493 patients and 4445 patients (median age 44.8 years old, 95% CI: [28.9, 60.8]); 50% male) were tested positive. Of these, 212 patients (4.8%) met the primary outcome. A risk score including the following components was derived from Cox regression: gender, age, hypertension MESHD, stroke MESHD, diabetes mellitus MESHD, ischemic MESHD heart disease MESHD/ heart failure MESHD, respiratory disease MESHD, renal disease MESHD, increases in neutrophil count, monocyte count, sodium, potassium, urea, alanine transaminase, alkaline phosphatase, high sensitive troponin-I, prothrombin HGNC time, activated partial thromboplastin time, D-dimer and C-reactive protein HGNC, as well as decreases in lymphocyte count, base excess and bicarbonate levels. The model based on test results taken on the day of admission demonstrated an excellent predictive value. Incorporation of test results on successive time points did not further improve risk prediction. Conclusions: A simple clinical score accurately predicted severe COVID-19 MESHD disease, even without including symptoms, blood pressure or oxygen status on presentation, or chest radiograph results.

    Patterns of Multimorbidity and Risk of Severe SARS-CoV-2 Infection MESHD: an observational study in the U.K.

    Authors: Yogini V Chudasama; Francesco Zaccardi; Clare L Gillies; Cameron Razieh; Thomas Yates; David E Kloecker; Alex V Rowlands; Melanie J Davies; Nazrul Islam; Samuel Seidu; Nita G Forouhi; Kamlesh Khunti

    doi:10.1101/2020.10.21.20216721 Date: 2020-10-23 Source: medRxiv

    Background Pre-existing comorbidities have been linked to SARS-CoV-2 infection MESHD but evidence is sparse on the importance and pattern of multimorbidity (2 or more conditions) and severity of infection indicated by hospitalisation or mortality. We aimed to use a multimorbidity index developed specifically for COVID-19 MESHD to investigate the association between multimorbidity and risk of severe SARS-CoV-2 infection MESHD. Methods We used data from the UK Biobank linked to laboratory confirmed test results for SARS-CoV-2 infection MESHD and mortality data from Public Health England between March 16 and July 26, 2020. By reviewing the current literature on COVID-19 MESHD we derived a multimorbidity index including: 1) angina MESHD; 2) asthma; 3) atrial fibrillation MESHD; 4) cancer MESHD; 5) chronic kidney disease MESHD; 6) chronic obstructive pulmonary disease MESHD; 7) diabetes mellitus MESHD; 8) heart failure MESHD; 9) hypertension MESHD; 10) myocardial infarction MESHD; 11) peripheral vascular disease MESHD; 12) stroke MESHD. Adjusted logistic regression models were used to assess the association between multimorbidity and risk of severe SARS-CoV-2 infection MESHD (hospitalisation or death MESHD). Potential effect modifiers of the association were assessed: age, sex, ethnicity, deprivation, smoking status, body mass index, air pollution, 25-hydroxyvitamin D, cardiorespiratory fitness MESHD, high sensitivity C-reactive protein HGNC. Results Among 360,283 participants, the median age was 68 [range, 48-85] years, most were White (94.5%), and 1,706 had severe SARS-CoV-2 infection MESHD. The prevalence of multimorbidity was more than double in those with severe SARS-CoV-2 infection MESHD (25%) compared to those without (11%), and clusters of several multimorbidities were more common in those with severe SARS-CoV-2 infection MESHD. The most common clusters with severe SARS-CoV-2 infection MESHD were stroke MESHD with hypertension MESHD (79% of those with stroke MESHD had hypertension MESHD); diabetes MESHD and hypertension MESHD (72%); and chronic kidney disease MESHD and hypertension MESHD (68%). Multimorbidity was independently associated with a greater risk of severe SARS-CoV-2 infection MESHD (adjusted odds ratio 1.91 [95% confidence interval 1.70, 2.15] compared to no multimorbidity). The risk remained consistent across potential effect modifiers, except for greater risk among men. Conclusion The risk of severe SARS-CoV-2 infection MESHD is higher in individuals with multimorbidity, indicating the need to target research and resources in people with SARS-CoV-2 infection MESHD and multimorbidity.

    A Comparative COVID 19 Characterizations and Clinical Course Analysis between ICU and Non ICU Settings

    Authors: Amit Patel; Parloop Bhatt; Surabhi Madan; Nitesh Shah; Vipul Thakkar; Bhagyesh Shah; Rashmi Chovatia; Hardik Shah; Minesh Patel; Pradip Dabhi; Aditi Nanavati; Milan Chag; Keyur Parikh

    doi:10.1101/2020.10.07.20208389 Date: 2020-10-11 Source: medRxiv

    Objective: With COVID-19 pandemic MESHD COVID-19 pandemic MESHD severely affecting India and Ahmedabad city being one accounting for half COVID cases, objective was to determine disease course and severity of in patients at a COVID care hospital. Design: A Clinical trial registry of India registered observational study (CTRI/2020/05/025247). Setting: Certified COVID hospital located in Ahmedabad, Gujarat, India. Participants: 549 COVID positive patients hospitalized between 15 th May to 10 th August, 2020 and treated in ICU and non ICU settings. Main Outcome Measure: Comparative analysis of demographic, clinical characteristics, investigations, treatment, complications and outcome of COVID patients in ICU and non ICU settings. Results: Of the 549 hospitalized COVID positive patients, 159 were admitted in ICU during disease course while 390 had ward admissions. Overall median age was 52 (1-86) years. The ICU group was older (>65years), with associated comorbidities like hypertension MESHD and diabetes MESHD (p<0.001); higher proportion of males (79.25%); with dyspnea MESHD as a major clinical characteristic and consolidation in lungs as a major radiological finding as compared to ward patients. C - reactive protein, D-Dimer HGNC and Ferritin were higher in ICU patients. Overall 50% females depicted elevated Ferritin levels. Steriods(92.45%)and tocilizumab (69.18%) were more frequently used for ICU patients . Remdesivir was prescribed to both ICU and non ICU patients. Favirapir was also a line of treatment for 25% of ICU patients. Convalescent plasma therapy was given to 7 ICU patients. Complications like acute kidney injury MESHD (13.84%), shock (10.69 %), sepsis MESHD and encephalopathy MESHD were observed in ICU patients. Overall mortality rate was 5.47 % with higher mortality among males in comparison to females (p<0.0001). Conclusion: About 29% of overall patients required ICU admission that was commonly elderly males. Chances of ICU admission were higher with baselines comorbidities (1.5 times) and dyspnea MESHD (3.4 times) respectively. A multi-specialty COVID care team and updated treatment protocols improves outcomes.

    Clinical Course and Features of Critical Patients with COVID-19 MESHD: A Single- Center, Retrospective Study from Wuhan Huoshenshan Hospital

    Authors: Huisi He; Zhichao Jin; Yibin Ren; Junxue Wang; Shuzhen Chen; Wen Wen; Yushan Miao; Xuewei Qi; Taiyu Shang; Chenxu Zhang; Hongyang Wang; Weiqin Li; Xijing Zhang; Hao Tang

    doi:10.21203/rs.3.rs-89722/v1 Date: 2020-10-08 Source: ResearchSquare

    Background: Nationally, the indicators tracking the coronavirus pandemic has remained stable. However, it’s still a public health concern and it’s worth providing more front-line data on critical illness. We aim to investigate the clinical course and features of critical patients with Corona Virus Disease MESHD 2019 ( COVID-19 MESHD).Methods: The data on 124 consecutive critical patients from 8th February through April 16th 2020, including demographic and clinical information, were obtained from the intensive care unit (ICU) of Wuhan Huoshenshan Hospital. A cross-sectional survey and comparisons of key biomarkers between survivors and nonsurvivors were performed.Results: Over the study period, 57 nonsurvivors and 67 survivors were included. The overall case-fatality rate for critical patients with COVID-19 MESHD was approximately 46%. The overall average age was 69.89±11.03 years, and the majority had underlying health problems such as hypertension MESHD (63[51%]) and diabetes MESHD (27[22%]). Compared with survivors, nonsurvivors were more likely to develop sepsis MESHD (57[100%] vs. 34[51%]), acute respiratory distress syndrome MESHD (52[91%] vs. 21[38%]) and organ dysfunction. Besides, the dynamic changes in some biomarkers (i.e. WBC, TLC, CRP, PLT) were significantly different between the two groups. The trajectories of temperature revealed that the group with a high temperature on admission that steadily declined had the highest percentage of deaths (84.21%).Conclusions: The elderly with many concomitant diseases were at the highest risk. Lymphocyte, platelet, C-reactive protein HGNC and temperature were revealed to have potential as prognostic factors, whereas some other biomarkers, such as hepatic enzymes, may not offer additional information. Moreover, patients with high temperatures on admission should receive extra care.

    Universal health care access for all residents reduce mortality in COVID-19 MESHD patients in Abu Dhabi, UAE: A retrospective multicenter cohort study

    Authors: Nawal Al kaabi; Asma Al Nuaimi; Mariam Al Harbi; Jehad Abdalla; Tehmina Khan; Huda Gasmelseed; Asad Khan; Osama Hamdoun; Stefan Weber

    doi:10.21203/rs.3.rs-87753/v1 Date: 2020-10-04 Source: ResearchSquare

    Background: SARS‐CoV‐2 was first reported in December 2019. The severity of COVID-19 MESHD infection ranges from being asymptomatic to severe infection leading to death. The aim of the study is to describe the clinical characteristics and outcomes of hospitalized COVID-19 MESHD patients within the largest government healthcare facilities in the Emirate of Abu Dhabi, the capital of UAE. Methods:  This paper is a retrospective cross-sectional study of all patients admitted to Abu Dhabi Healthcare services facilities (SEHA) between the period of March 1 HGNCst until May 31st with a laboratory-confirmed test of SARS-CoV2, known as Coronavirus disease MESHD ( COVID19 MESHD). Variation in characteristics, comorbidities, laboratory values, length of hospital stay, treatment received and outcomes were examined. Data was collected from electronic health records available at SEHA health information system.Results: There were 9390 patients included; patients were divided into severe and non-severe groups. 721 (7.68%) patients required intensive care while the remaining majority (92.32 %) were mild-moderate cases. The mean age (41.8 years) is less than the mean age reported globally. Our population had a male predominance and variable representation of different nationalities. Three major comorbidities were noted, hypertension MESHD, diabetes mellitus MESHD and chronic kidney disease MESHD. The laboratory tests that were significantly different between the severe and the non-severe groups were LDH, Ferritin, CRP HGNC, neutrophil count, IL6 HGNC and creatinine level. The major antiviral therapies the patients have received were a combination of hydroxychloroquine and favipiravir. The overall in hospital mortality was 1.63% while severe group mortality rate was 19.56 %. The Death rate in the adults younger than 30 years was noted to be higher compared to elderly patients above 60 years, 2.3% and 0.9 % respectively. Conclusion: our analysis suggests that Abu Dhabi had a relatively low morbidity and mortality rate and a high recovery rate compared to published rates in China, Italy and The United States. The demographic of the population is younger and has an international representation. The country had the highest testing rate in relation to the population volume. We believe the early identification and younger demographic had affected the favorable comparative outcome in general with early identification of cases leading to a lower mortality rate. 

    More severe hypercoagulation status, cytokine storm, and disease progression in coronavirus disease 2019 MESHD with persistent RT-PCR negative results: a multicenter prospective study

    Authors: Wei Du; Guochao Shi; Min Zhou; Yahui Liu; Gelei Lan; Xueqing Du; Chunrong Huang; Ranran Dai; Wei Chen

    doi:10.21203/rs.3.rs-85866/v1 Date: 2020-09-30 Source: ResearchSquare

    Purpose: Persistent negative results (at least 3 times) of reverse transcription–polymerase chain reaction (RT-PCR) from pharyngeal swabs are not rare in coronavirus disease 2019 MESHD ( COVID-19 MESHD) patients, but their characteristics have not yet been well studied.Methods: PCR confirmed, serum antibody confirmed with persistent negative PCR results, and clinically diagnosed patients hospitalized in two medical centers during February and March 2020 were included. Differences in clinical, imaging and laboratory characteristics as well as factors affecting their prognosis were analyzed.Results: There were 114 PCR confirmed, 17 serology confirmed and 21 clinically diagnosed patients included. Time from onset of disease to the first PCR and admission were similar among the groups. Compared with PCR-confirmed patients, serology-confirmed patients were older and likely to have hypertension MESHD, vomiting MESHD, or symptoms of chest pain MESHD and dyspnea MESHD. Regarding imaging manifestations, serology-confirmed patients were more prone to pleural effusion MESHD. In addition, higher levels of C-reactive protein HGNC, neutrophil-to-lymphocyte ratio, total bilirubin, D-dimer, fibrinogen HGNC, troponin, interleukin-6 HGNC and IL-8 HGNC were also found. Although with similar mortality, serology confirmed patients were more likely to have disease progression. High levels of D-dimer and IL-6 HGNC were possibly the underlying factors leading to their worse prognosis. On the other hand, clinically diagnosed patients were more similar to PCR-confirmed patients.Conclusion: Serology confirmed COVID-19 MESHD patients with at least three negative PCR results had different clinical characteristics and were likely to have disease progression, possibly due to more severe hypercoagulation status MESHD and cytokine storm.

    Risk Factors Analysis of COVID-19 MESHD Patients with ARDS MESHD and Prediction Based on Machine Learning

    Authors: Wan Xu; Nan-Nan Sun; Hai-Nv Gao; Zhi-Yuan Chen; Ya Yang; Bin Ju; Ling-Ling Tang

    doi:10.21203/rs.3.rs-77820/v2 Date: 2020-09-15 Source: ResearchSquare

    COVID-19 MESHD is a newly emerging infectious disease MESHD, which is generally susceptible to human beings and has caused huge losses to people's health. Acute respiratory distress syndrome MESHD ( ARDS MESHD) is one of the common clinical manifestations of severe COVID-19 MESHD and it is also responsible for the current shortage of ventilators worldwide. This study aims to analyze the clinical characteristics of COVID-19 MESHD ARDS MESHD patients and establish a diagnostic system based on artificial intelligence (AI) method to predict the probability of ARDS in COVID-19 MESHD patients. We collected clinical data of 659 COVID-19 MESHD patients from 11 regions in China. The clinical characteristics of the ARDS group and no-ARDS group of COVID-19 MESHD patients were elaborately compared and both traditional machine learning algorithms MESHD and deep learning-based method were used to build the prediction models. Results indicated that the median age of ARDS MESHD patients was 56.5 years old, which was significantly older than those with non-ARDS by 7.5 years. Male and patients with BMI>25 were more likely to develop ARDS MESHD. The clinical features of ARDS MESHD patients included cough (80.3%), polypnea (59.2%), lung consolidation (53.9%), secondary bacterial infection MESHD (30.3%), and comorbidities such as hypertension MESHD (48.7%). Abnormal biochemical indicators such as lymphocyte count, CK, NLR, AST HGNC, LDH, and CRP HGNC were all strongly related to the aggravation of ARDS. Furthermore, through various AI methods for modeling and prediction effect evaluation based on the above risk factors, decision tree achieved the best AUC, accuracy, sensitivity and specificity in identifying the mild patients who were easy to develop ARDS MESHD, which undoubtedly helped to deliver proper care and optimize use of limited resources.

    Correlation Study of Chest CT Features of Severe/Critical type COVID-19 MESHD with Early Renal Damage and Clinical Prognosis

    Authors: Guan Li; Yongchun Ge; Zhiyuan Sun; Song Luo; Wen Wang; Changsheng Zhou; Fan zhou; Xin Zhang; Jie Dong; Zhiqiang Cao; Longjiang Zhang; Guangming Lu

    doi:10.21203/rs.3.rs-75596/v1 Date: 2020-09-10 Source: ResearchSquare

    Background: Among patients with confirmed severe/critical type COVID-19 MESHD, we found that although the seurm creatinine (Cr) value is in normal range, patients might have occured early renal damage MESHD. For severe/critical type COVID-19 MESHD patients, whether some chest CT features can be used to predict the early renal damage MESHD or clinical prognosis.Methods: 162 patients with severe/critical type COVID-19 MESHD were reviewed retrospectively in 13 medical centers from China. According to the level of eGFR HGNC, 162 patients were divided into three groups, group A (eGFR < 60 ml/min/1.73m2), group B (60 ml/min/1.73m2 ≤ eGFR HGNC < 90 ml/min/1.73m2 group) and group C (eGFR ≥ 90 ml/min/1.73m2). All patients’ baseline clinical characteristics, laboratory data, CT features and clinical outcomes were collected and compared. The eGFR HGNC and CT features was assessed using univariate and multivariate Cox regression.Results: Baseline clinical characteristics showed that there were significant differences in age, hypertension MESHD, cough MESHD and fatigue MESHD among groups A, B and C. Laboratory data analysis revealed significant differences between the three groups of leukocyte count, platelet count, C-reactive protein HGNC, aspartate aminotransferase, creatine kinase. Chest CT features analysis indicated that crazy-paving pattern has significant statistical difference in groups A and B compared with group C. The eGFR HGNC of patients with crazy-paving pattern was significant lower than those without crazy-paving pattern (76.73 ± 30.50 vs. 101.69 ± 18.24 ml/min/1.73m2, p < 0.001), and eGFR HGNC (OR = 0.962, 95% CI = 0.940-0.985) was the independent risk factor of crazy-paving pattern. The eGFR HGNC (HR = 0.549, 95% CI = 0.331-0.909, p = 0.020) and crazy-paving pattern (HR = 2.996, 95% CI = 1.010-8.714, p = 0.048) were independent risk factors of mortality.Conclusions: In patients with severe/critical type COVID-19 MESHD, the presence of crazy-paving pattern on chest CT are more likely occured the decline of eGFR HGNC and poor clinical prognosis. The crazy-paving pattern appeared could be used as an early warning indicator of renal damage MESHD and to guide clinicians to use drugs reasonably.

    Trends in Covid-19 MESHD risk-adjusted mortality rates in a single health system

    Authors: Leora Horwitz; Simon A. Jones; Robert J. Cerfolio; Fritz Francois; Joseph Greco; Bret Rudy; Christopher M Petrilli

    doi:10.1101/2020.08.11.20172775 Date: 2020-08-14 Source: medRxiv

    Early reports showed high mortality from Covid-19 MESHD; by contrast, the current outbreaks in the southern and western United States are associated with fewer deaths, raising hope that treatments have improved. However, in Texas for instance, 63% of diagnosed cases are currently under 50, compared to only 52% nationally in March-April. Current demographics in Arizona and Florida are similar. Therefore, whether decreasing Covid-19 MESHD mortality rates are a reflection of changing demographics or represent improvements in clinical care is unknown. We assessed outcomes over time in a single health system, accounting for changes in demographics and clinical factors. Methods We analyzed biweekly mortality rates for admissions between March 1 HGNC and June 20, 2020 in a single health system in New York City. Outcomes were obtained as of July 14, 2020. We included all hospitalizations with laboratory-confirmed Covid-19 MESHD disease. Patients with multiple hospitalizations (N=157, 3.3%) were included repeatedly if they continued to have laboratory-confirmed disease. Mortality was defined as in-hospital death MESHD or discharge to hospice care. Based on prior literature, we constructed a multivariable logistic regression model to generate expected risk of death MESHD, adjusting for age; sex; self-reported race and ethnicity; body mass index; smoking history; presence of hypertension MESHD, heart failure MESHD, hyperlipidemia MESHD, coronary artery disease MESHD, diabetes MESHD, cancer MESHD, chronic kidney disease MESHD, or pulmonary disease MESHD individually as dummy variables; and admission oxygen saturation, D-dimer, C reactive protein HGNC, ferritin, and cycle threshold for RNA detection. All data were obtained from the electronic health record. We then calculated the sum of observed and expected deaths in each two-week period and multiplied each period's observed/expected (O/E) risk by the overall average crude mortality to generate biweekly adjusted rates. We calculated Poisson control limits and indicated points outside the control limits as significantly different, following statistical process control standards. The NYU institutional review board approved the study and granted a waiver of consent. Results We included 4,689 hospitalizations, of which 4,661 (99.4%) had died or been discharged. The median age, and the proportion male or with any comorbidity decreased over time; median real-time PCR cycle threshold increased (indicating relatively less concentration of virus) (Table). For instance, median age decreased from 67 years in the first two weeks to 49 in the last two. Peak hospitalizations were during the fifth and sixth study weeks, which accounted for 40% of the hospitalizations. Median length of stay for patients who died or were discharged to hospice was 8 days (interquartile range, 4-16). Unadjusted mortality dropped each period, from 30.2% in the first two weeks to 3% in the last two weeks, with the last eight weeks being lower than the 95% control limits. Risk adjustment partially attenuated the mortality decline, but adjusted mortality rates in the second-to-last two weeks remained outside the control limits (Figure, Table). The O/E risk of mortality decreased from 1.07 (0.64-1.67) in the first two weeks to 0.39 (0.08-1.12) in the last two weeks. Discussion In this 16-week study of Covid-19 MESHD mortality at a single health system, we found that changes in demographics and severity of illness at presentation account for some, but not all, of the decrease in unadjusted mortality. Even after risk adjustment for a variety of clinical and demographic factors, mortality was significantly lower towards the end of the study period. Incremental improvements in outcomes are likely a combination of increasing clinical experience, decreasing hospital volume, growing use of new pharmacologic treatments (such as corticosteroids, remdesivir and anti-cytokine treatments), non-pharmacologic treatments (such as proning), earlier intervention, community awareness, and lower viral load exposure from increasing mask wearing and social distancing. It is also possible that earlier periods had a more virulent circulating strain. In summary, data from one health system suggest that Covid-19 MESHD remains a serious disease for high risk patients, but that outcomes may be improving.

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MeSH Disease
HGNC Genes
SARS-CoV-2 Proteins


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