Prevalence and severity of corona virus disease 2019 (COVID-19): A systematic review and meta-analysis

Yong Hu, Jiazhong Sun, Zhe Dai, Haohua Deng, Xin Li, Qi Huang, Yuwen Wu, Li Sun, Yancheng Xu, Yong Hu, Jiazhong Sun, Zhe Dai, Haohua Deng, Xin Li, Qi Huang, Yuwen Wu, Li Sun, Yancheng Xu

Abstract

Background: Since being first reported in Wuhan, China, in December 8, 2019, the outbreak of the novel coronavirus, now known as COVID-19, has spread globally. Some case studies regarding the characteristics and outcome of patients with COVID-19 have been published recently. We conducted a meta-analysis to evaluate the risk factors of COVID-19.

Methods: Medline, SinoMed, EMBASE, and Cochrane Library were searched for clinical and epidemiological studies on confirmed cases of COVID-19.

Results: The incidence of fever, cough, fatigue, and dyspnea symptoms were 85.6 % (95CI 81.3-89.9 %), 65.7 % (95CI 60.1-71.4 %), 42.4 % (95CI 32.2-52.6 %) and 21.4 % (95CI 15.3-27.5 %). The prevalence of diabetes was 7.7 % (95CI 6.1-9.3 %), hypertension was 15.6 % (95CI 12.6-18.6 %), cardiovascular disease was 4.7 % (95CI 3.1-6.2 %), and malignancy was 1.2 % (95CI 0.5-1.8 %). The complications, including ARDS risk, ranged from 5.6-13.2 %, with the pooled estimate of ARDS risk at 9.4 %, ACI at 5.8 % (95CI 0.7-10.8 %), AKI at 2.1 % (95CI 0.6-3.7 %), and shock at 4.7 % (95CI 0.9-8.6 %). The risks of severity and mortality ranged from 12.6 to 23.5% and from 2.0 to 4.4 %, with pooled estimates at 18.0 and 3.2 %, respectively. The percentage of critical cases in diabetes and hypertension was 44.5 % (95CI 27.0-61.9 %) and 41.7 % (95CI 26.4-56.9 %), respectively.

Conclusion: Fever is the most common symptom in patients with COVID-19. The most prevalent comorbidities are hypertension and diabetes which are associated with the severity of COVID-19. ARDS and ACI may be the main obstacles for patients to treatment recovery. The case severe rate and mortality is lower than that of SARS and MERS.

Keywords: COVID-19; Comorbidities; Mortality; Severity; Symptom.

Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Copyright © 2020 Elsevier B.V. All rights reserved.

Figures

Fig. 1
Fig. 1
Flow diagram for selection of studies for inclusion in this meta-analysis.
Fig. 2
Fig. 2
Forest plot of the prevalence of symptoms in patients with COVID-19. Weights were calculated from binary random-effects model analysis. (a. fever. b. cough. c. fatigue. d. dyspnea). CI = confidence interval, COVID-19=Corona Virus Disease 2019.
Fig. 3
Fig. 3
Meta-analysis of the proportion of comorbidities in COVID-19 cases. Weights were calculated from binary random-effects model analysis. Values represent proportions of diabetes (a), hypertension (b), CAD (c), and malignancy (d). CAD = coronary artery disease, COVID-19=Corona Virus Disease 2019.
Fig. 4
Fig. 4
Forest plot of the incidence of complications in patients with COVID-19. (a. ARDS. b. ACI. c. AKI. d. shock), CI = confidence interval. ARDS = acute respiratory distress syndrome, ACI = acute cardiac injury, AKI = acute kidney injury, COVID-19=Corona Virus Disease 2019.
Fig. 5
Fig. 5
Forest plot of the incidence of severity and mortality in patients with COVID-19. (a. severe rate. b. mortality), meta-analysis of the severe rate of COVID-19 patients with diabetes (c), or hypertension (d). CI = confidence interval, COVID-19=Corona Virus Disease 2019.

References

    1. Rothan H.A., Byrareddy S.N. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J. Autoimmun. 2020 doi: 10.1016/j.jaut.2020.102433. Feb 26.
    1. Sohrabi C., Alsafi Z., O’Neill N. World Health Organization declares global emergency: a review of the 2019 Novel Coronavirus (COVID-19) Int. J. Surg. (Lond. Engl.) 2020 doi: 10.1016/j.ijsu.2020.02.034. Feb 26.
    1. Shanmugaraj B., Malla A., Phoolcharoen W. Emergence of novel coronavirus 2019-nCoV: need for rapid vaccine and biologics development. Pathogens. 2020;9(2) doi: 10.3390/pathogens9020148. Feb 22.
    1. Wu J.T., Leung K., Leung G.M. Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study. Lancet (Lond. Engl.) 2020;395(10225):689–697. doi: 10.1016/s0140-6736(20)30260-9. Feb 29.
    1. Wu Y.C., Chen C.S., Chan Y.J. The outbreak of COVID-19: an overview. J. Chin. Med. Assoc. 2020;83(3):217–220. doi: 10.1097/jcma.0000000000000270. Mar.
    1. Huang C., Wang Y., Li X. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (Lond. Engl.) 2020;395(10223):497–506. doi: 10.1016/s0140-6736(20)30183-5. Feb 15.
    1. Zhu N., Zhang D., Wang W. A novel coronavirus from patients with pneumonia in China, 2019. N. Engl. J. Med. 2020;382(8):727–733. doi: 10.1056/NEJMoa2001017. Feb 20.
    1. Coronaviridae Study Group of the International Committee on Taxonomy of Viruses The species severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat. Microbiol. 2020 doi: 10.1038/s41564-020-0695-z. Mar 2.
    1. Zhou P., Yang X.L., Wang X.G. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020 doi: 10.1038/s41586-020-2012-7. Feb 3.
    1. Benvenuto D., Giovanetti M., Ciccozzi A., Spoto S., Angeletti S. The 2019-new coronavirus epidemic: evidence for virus evolution. J. Med. Virol. 2020;92(4):455–459. doi: 10.1002/jmv.25688. Apr.
    1. Wu F., Zhao S., Yu B. A new coronavirus associated with human respiratory disease in China. Nature. 2020 doi: 10.1038/s41586-020-2008-3. Feb 3.
    1. Letko M., Marzi A., Munster V. Functional assessment of cell entry and receptor usage for SARS-CoV-2 and other lineage B betacoronaviruses. Nat. Microbiol. 2020 doi: 10.1038/s41564-020-0688-y.
    1. Wu A., Peng Y., Huang B. Genome composition and divergence of the novel coronavirus (2019-nCoV) originating in China. Cell Host Microbe. 2020 doi: 10.1016/j.chom.2020.02.001. Feb 7.
    1. Lu R., Zhao X., Li J. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet (Lond. Engl.) 2020;395(10224):565–574. doi: 10.1016/s0140-6736(20)30251-8. Feb 22.
    1. Yan R., Zhang Y., Li Y., Xia L., Guo Y., Zhou Q. Structural basis for the recognition of the SARS-CoV-2 by full-length human ACE2. Science (New York, N.Y.) 2020 doi: 10.1126/science.abb2762. Mar 4.
    1. Wrapp D., Wang N. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science. 2020 doi: 10.1126/science.abb2507. Feb 19.
    1. Guan W.J., Ni Z.Y., Hu Y. Clinical characteristics of coronavirus disease 2019 in China. N. Engl. J. Med. 2020 doi: 10.1056/NEJMoa2002032. Feb 28.
    1. Hellewell J., Abbott S., Gimma A. Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts. Lancet Glob. Health. 2020 doi: 10.1016/s2214-109x(20)30074-7. Feb 28.
    1. Bai Y., Yao L., Wei T. Presumed asymptomatic carrier transmission of COVID-19. JAMA. 2020 doi: 10.1001/jama.2020.2565. Feb 21.
    1. Pan Y., Zhang D., Yang P., Poon L.L.M., Wang Q. Viral load of SARS-CoV-2 in clinical samples. Lancet Infect. Dis. 2020 doi: 10.1016/s1473-3099(20)30113-4. Feb 24.
    1. Chen Huijun, Guo Juanjuan, Wang Chen. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020 doi: 10.1016/s0140-6736(20)30360-3. February 12.
    1. Holshue M.L., DeBolt C., Lindquist S. First case of 2019 novel coronavirus in the United States. N. Engl. J. Med. 2020;382(10):929–936. doi: 10.1056/NEJMoa2001191. Mar 5.
    1. Zhang W., Du R.H., Li B. Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerg. Microbes Infect. 2020;9(1):386–389. doi: 10.1080/22221751.2020.1729071. Dec.
    1. Zhang J.J., Dong X., Cao Y.Y. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020 doi: 10.1111/all.14238. Feb 19.
    1. Wang D., Hu B., Hu C. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020 doi: 10.1001/jama.2020.1585. Feb 7.
    1. Chen N., Zhou M., Dong X. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet (Lond. Engl.) 2020;395(10223):507–513. doi: 10.1016/s0140-6736(20)30211-7. Feb 15.
    1. Liu K., Fang Y.Y., Deng Y. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chin. Med. J. 2020 doi: 10.1097/cm9.0000000000000744. Feb 7.
    1. Yang W., Cao Q., Qin L. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19): a multi-center study in Wenzhou city, Zhejiang, China. J. Infect. 2020 doi: 10.1016/j.jinf.2020.02.016. Feb 26.
    1. Liu Y., Yang Y., Zhang C. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci. China Life Sci. 2020;63(3):364–374. doi: 10.1007/s11427-020-1643-8. Mar.
    1. Yang X., Yu Y., Xu J. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir. Med. 2020 doi: 10.1016/s2213-2600(20)30079-5. Feb 24.
    1. Wu J., Liu J., Zhao X. Clinical characteristics of imported cases of COVID-19 in Jiangsu Province: a multicenter descriptive study. Clin. Infect. Dis. 2020 doi: 10.1093/cid/ciaa199. Feb 29.
    1. Xu X., Yu C., Qu J. Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2. Eur. J. Nucl. Med. Mol. Imaging. 2020 doi: 10.1007/s00259-020-04735-9. Feb 28.
    1. Xu X.W., Wu X.X., Jiang X.G. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ. 2020;368:m606. doi: 10.1136/bmj.m606. Feb 19.
    1. Ke Wen, Li Wengang, Dawei Zhang. Epidemiological and clinical characteristics of 46 newly-admitted coronavirus disease 2019 cases in Beijing. Zhonghua Liuxingbing za zhi. 2020;38 doi: 10.3760/cma.j.cn311365-20200219-00086. 2020-02-26.
    1. Tian S., Hu N., Lou J. Characteristics of COVID-19 infection in Beijing. J. Infect. 2020 doi: 10.1016/j.jinf.2020.02.018. Feb 27.
    1. Chen L., Liu H.G., Liu W. Analysis of clinical features of 29 patients with 2019 novel coronavirus pneumonia. Chin. J. Tuberculosis Respir. Dis. 2020;43(0):E005. doi: 10.3760/cma.j.issn.1001-0939.2020.0005. Feb 6.
    1. Liu P., Tan X.Z. 2020. 2019 Novel Coronavirus (2019-nCoV) Pneumonia. Feb 4: 200257.
    1. Young B.E., Ong S.W.X., Kalimuddin S. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. JAMA. 2020 doi: 10.1001/jama.2020.3204. Mar 3.
    1. Xu Y.H., Dong J.H., An W.M. Clinical and computed tomographic imaging features of novel coronavirus pneumonia caused by SARS-CoV-2. J. Infect. 2020 doi: 10.1016/j.jinf.2020.02.017. Feb 25.
    1. Li K., Wu J., Wu F. The clinical and chest CT features associated with severe and critical COVID-19 pneumonia. Invest. Radiol. 2020 doi: 10.1097/rli.0000000000000672. Feb 29.
    1. Huang Y., Tu M., Wang S. Clinical characteristics of laboratory confirmed positive cases of SARS-CoV-2 infection in Wuhan, China: a retrospective single center analysis. Travel Med. Infect. Dis. 2020 doi: 10.1016/j.tmaid.2020.101606. Feb 27.
    1. Novel Coronavirus Pneumonia Emergency Response Epidemiology Team The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua liu xing bing xue za zhi. 2020;41(2):145–151. doi: 10.3760/cma.j.issn.0254-6450.2020.02.003. Feb 17.
    1. Liu J., Zheng X., Tong Q. Overlapping and discrete aspects of the pathology and pathogenesis of the emerging human pathogenic coronaviruses SARS-CoV, MERS-CoV, and 2019-nCoV. J. Med. Virol. 2020 doi: 10.1002/jmv.25709. Feb 13.
    1. Prompetchara E., Ketloy C., Palaga T. Immune responses in COVID-19 and potential vaccines: lessons learned from SARS and MERS epidemic. Asian Pac. J. Allergy Immunol. 2020 doi: 10.12932/ap-200220-0772. Feb 27.
    1. Sun Z., Thilakavathy K. Potential factors influencing repeated SARS outbreaks in China. Int. J. Environ. Res. Public Health. 2020;17(5) doi: 10.3390/ijerph17051633. Mar 3.

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