Comparison of Epidemiological and Clinical Features of Patients with Coronavirus Disease (COVID-19) in Wuhan and Outside Wuhan, China

Background: Coronavirus disease 2019 (COVID-19) has spread outside the initial epicenter of Wuhan. We compared cases in Guangzhou and Wuhan to illustrate potential changes in pathogenicity and epidemiological characteristics as the epidemic has progressed. Methods: We studied all 20 patients admitted to the Third Affiliated Hospital of Sun Yat-Sen University in Guangzhou, China from January 22 to February 12, 2020. Data on demographic, epidemiological, clinical and laboratory characteristics were extracted from medical records. These cases were compared with the 99 cases, previously published in Lancet, from Wuhan Jinyintan Hospital from January 1 to January 20, 2020. Findings: Guangzhou patients were younger and had less severe symptoms and better prognoses than Wuhan patients. Cases in Guangzhou tended to be more clustered unlike in earlier Wuhan cases. The Wuhan patients were more likely to be admitted to the ICU (23% vs 5%), had a higher mortality rate (11% vs 0%) and their laboratory tests were generally less favorable. Chest CT scan indicated that multiple mottling and ground-glass opacity were more common in Guangzhou patients. Diarrhea and vomiting were more common among Guangzhou patients and SARS-CoV-2 RNA was found in feces. Fecal SARA-CoV-2 RNA remained positive when nasopharyngeal swabs turned negative in some patients. Interpretation: Cases exported outside Wuhan being less severe indicates possible diminishing virulence of the virus in the process of transmission. Yet persistent positive RNA in feces after negative throat swabs suggests a possible prolonged transmission period that challenges current quarantine practices. Funding Statement: This study was funded by the National Science and Technology Major Project (Bing-Liang Lin, 2018ZX10302204, Bing-Liang Lin, 2017ZX10203201003) , Emergency special program for 2019-nCoV of Guangdong province science and technology project (GDSTP-ESP) (Zhiliang Gao, 2020B111105001) and Tackling of key scientific and emergency special program of Sun Yat-sen University (SYSU-TKSESP, Liang Peng). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was approved by The Third Affiliated Hospital of Sun Yat-Sen University Ethics Committee, and oral consent was obtained from patients.