Cited by 30,246COVID-19 Clinical Research StudiesSARS-CoV-2 and COVID-19 ResearchLong-Term Effects of COVID-19

Clinical characteristics of coronavirus disease 2019 in China

Open access
Guan, Wei-jie, Ni, Zheng-yi, Hu, Yu, Liang, Wen-hua, Ou, Chun-quan, He, Jian-xing, Liu, Lei, Shan, Hong +29 more·2020·New England Journal of Medicine

Published version of a preprint

Abstract

BACKGROUND: Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. METHODS: We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. RESULTS: The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. CONCLUSIONS: During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.).

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Crossref · 10.1056/nejmoa2002032

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  • Guan et al.'s retrospective cohort of 1,099 COVID-19 patients in China found that the main laboratory findings were D-dimer, PCR, and leukocytes.

    “The retrospective cohort study by Guan et al.60 evaluated the main clinical characteristics of 1,099 patients infected with COVID-19 in China. The main laboratory findings in these patients were also D-dimer, PCR, and leukocytes.”

    From Portal-splenic-mesenteric venous thrombosis in COVID-19 patients: a systematic review (2025) · cites this paper as Guan et al.60

    The Methods (Data Sources) describe a review of 1,099 laboratory-confirmed patients in China, and the Discussion identifies lymphocytopenia as a common finding. The Methods (Laboratory Confirmation) describe RT-PCR as a confirmation test, not a main laboratory finding; the passages found do not identify D-dimer as a main finding. Thus the cohort description and leukocyte-related finding are supported, but the stated list of main laboratory findings is not. (LLM, conf=0.86)

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  • The respiratory problems experienced by patients with COVID-19 significantly differ from other respiratory conditions (e.g., dry cough is common).

    “This is because the respiratory problems experienced by patients with COVID-19 significantly differ from other respiratory conditions (e.g., dry cough is common [4, 19]) and COVID-19 patients' rapid deterioration to acute respiratory failure [2–4].”

    From Effects of short-term breathing exercises on respiratory recovery in patients with COVID-19: a quasi-experimental study (2022) · cites this paper as [4]

    The Discussion says some clinical characteristics distinguish COVID-19 from SARS, MERS, and seasonal influenza, but also says its characteristics mimic SARS. The Results report cough in 67.8% of patients; they do not specify dry cough or establish that respiratory problems differ significantly from other respiratory conditions generally. Page numbers are not available in our copy. (LLM, conf=0.84)

    Experimental — accuracy not yet measured
  • The most common clinical presentation of severe COVID-19 is viral pneumonia featuring fever, cough, dyspnoea, hypoxemia, and bilateral infiltrates on chest radiographs.

    “Evidence shows that the most common clinical presentation of severe COVID-19 is viral pneumonia featuring fever, cough, dyspnoea, hypoxemia, and bilateral infiltrates on chest radiographs [2–4].”

    From Effects of short-term breathing exercises on respiratory recovery in patients with COVID-19: a quasi-experimental study (2022) · cites this paper as [4]

    The Results (Treatment and Complications; page not provided) report physician-diagnosed pneumonia in 99.4% of patients with severe disease. The Discussion identifies fever and cough as dominant symptoms and links compromised respiratory status to severity, but the available passages do not establish the full combination of dyspnoea, hypoxemia, and bilateral infiltrates on chest radiographs as the most common presentation. (LLM, conf=0.84)

    Experimental — accuracy not yet measured
  • COVID-19 patients rapidly deteriorate to acute respiratory failure.

    “This is because the respiratory problems experienced by patients with COVID-19 significantly differ from other respiratory conditions (e.g., dry cough is common [4, 19]) and COVID-19 patients' rapid deterioration to acute respiratory failure [2–4].”

    From Effects of short-term breathing exercises on respiratory recovery in patients with COVID-19: a quasi-experimental study (2022) · cites this paper as [4]

    The Results (Treatment and Complications; Clinical Outcomes, page not provided) report ARDS in 3.4% of patients and invasive mechanical ventilation in 2.3%. These findings support that some patients developed serious respiratory complications, but the cited passages do not establish rapid deterioration to acute respiratory failure as a general pattern among COVID-19 patients. (LLM, conf=0.83)

    Experimental — accuracy not yet measured
  • In patients with COVID-19, low blood oxygen levels are associated with rapid deterioration to acute respiratory distress or failure, leading to death unless it is managed immediately [2-4].

    “In patients with COVID-19, low blood oxygen levels are associated with rapid deterioration to acute respiratory distress or failure, leading to death unless it is managed immediately [2–4].”

    From Effects of short-term breathing exercises on respiratory recovery in patients with COVID-19: a quasi-experimental study (2022) · cites this paper as [4]

    The Discussion links compromised respiratory status on admission to worse outcomes, and the Results report ARDS and deaths among patients with COVID-19. The paper does not establish that low blood oxygen causes rapid progression to respiratory failure or that death follows unless it is managed immediately. (LLM, conf=0.85)

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Authors
Guan, W.-J., Ni, Z.-Y., Hu, Y., Liang, W.-H., Ou, C.-Q., He, J.-X., Liu, L., Shan, H., Lei, C.-L., Hui, D. S. C., Du, B., Li, L.-J., Zeng, G., Yuen, K.-Y., Chen, R.-C., Tang, C.-L., Wang, T., Chen, P.-Y., Xiang, J., Li, S.-Y., Wang, J.-L., Liang, Z.-J., Peng, Y.-X., Wei, L., Liu, Y., Hu, Y.-H., Peng, P., Wang, J.-M., Liu, J.-Y., Chen, Z., Li, G., Zheng, Z.-J., Qiu, S.-Q., Luo, J., Ye, C.-J., Zhu, S.-Y., & Zhong, N.-S.
Affiliations
  • First Affiliated Hospital of Guangzhou Medical University (CN)
  • From the State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University (W.G., W.L., J.H., R.C., C.T., T.W., S.L., Jin-lin Wang, N.Z., J.H., W.L.), the Departments of Thoracic Oncology (W.L.), Thoracic Surgery and Oncology (J.H.), and Emergency Medicine (Z.L.), First Affiliated Hospital of Guangzhou Medical University, and Guangzhou Eighth People’s Hospital,...
Corresponding author
Guan, Wei-jie
Venue
New England Journal of Medicine
Published
2020-04-30
Volume
382
Issue
18
Pages
1708-1720
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W3008827533
Cited by
30,246
References
22
Citations by year
2026: 236 · 2025: 598 · 2024: 1400 · 2023: 2667 · 2022: 4729 · 2021: 8600 · 2020: 11942 · 2019: 29 · 2018: 5 · 2015: 5 · 2013: 3 · 2012: 6
FWCI
917.26
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • New England Journal of Medicine (publishedVersion)
  • medRxiv (acceptedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Southern Medical University
  • National Health Commission of the People's Republic of China
Topics
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
  • Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
Keywords
COVID-19 pandemic, SARS-CoV-2, clinical features, disease severity, intensive care unit admission, mechanical ventilation, mortality, incubation period, ground-glass opacities, lymphopenia, fever, cough, wildlife contact, transmission, China
MeSH terms
Betacoronavirus, COVID-19, SARS-CoV-2, Adolescent, Adult, Aged, Child, China, Disease Outbreaks, Female, Fever, Humans, Male, Middle Aged, Pneumonia, Viral, Coronavirus Infections, Young Adult, Pandemics, Patient Acuity

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