Keywords
COVID-19 pandemic
Symptoms and Comorbidities
Systematic Review
Correlation Analysis
Symptoms and Comorbidities
Systematic Review
Correlation Analysis
Abstract
Objectives: We aimed to estimate the reported symptoms and comorbidities and assess the correlation between a series of symptoms and comorbidities and age of the patients’ positive in COVID-19.
Methods: We performed a systematic review and meta-analysis [PROSPERO registration: CRD42020182677]. Databases [PubMed, SCOPUS, EMBASE, WHO, Semantic Scholar, and COVID-19 Primer] were searched for clinical studies published from January to April 2020. The pooled prevalence of symptoms and comorbidities were identified using the random effect model, and the multivariable factor analysis was performed to show the correlation between a group of symptoms and comorbidities and age of the COVID-19 patients.
Results: Twenty-nine articles, with 4,884 COVID-19 patients were included in this study. Altogether, we found 33 symptoms and 44 comorbidities where the most frequent 19 symptoms and 11 comorbidities were included in the meta-analysis. The fever [84%], cough/dry cough [61%], and fatigue/weakness [42%] were found more prevalent. On the other hand, acute respiratory distress syndrome, hypertension and diabetes were the most prevalent comorbid condition. The multivariable factor analysis showed positive association between a group of symptoms and comorbidities, and with the patients' age. The symptoms comprising fever, dyspnea/shortness of breath, nausea, vomiting, abdominal pain, dizziness, anorexia and pharyngalgia; and the comorbidities including diabetes, hypertension, coronary heart disease, COPD/lung disease and ARDS were positively correlated with the COVID-19 patient’s age.
Conclusion: As a unique effort, this study found a group of symptoms and comorbidities, correlated with age of the COVID-19 patients that may help to implement patient-centred interventions.
References
1. WHO. WHO Coronavirus Disease (COVID-19) Dashboard. Geneva: World Health Organization, 2020.
2. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497–506.
3. Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis 2020;94:91–95.
4. Emami A, Javanmardi F, Pirbonyeh N, Akbari A. Prevalence of Underlying Diseases in Hospitalized Patients with COVID-19: a Systematic Review and Meta-Analysis. Arch Acad Emerg Med 2020; 8:e35.
5. Zhang G, Hu C, Luo L, Fang F, Chen Y, Li J, et al. Clinical Features and Treatment of 221 Patients with COVID-19 in Wuhan, China. SSRN Electron J 2020; Feb 2.doi: http://dx.doi.org/10.2139/ssrn.3546095
6. Qian K, Deng Y, Tai Y, Peng J, Peng H, Jiang L. Clinical Characteristics of 2019 Novel Infected Coronavirus Pneumonia：A Systemic Review and Meta-analysis. medRxiv 2020; Feb 17.doi: https://doi.org/10.1101/2020.02.14.20021535.
7. Jain V, Yuan J-M. Systematic review and meta-analysis of predictive symptoms and comorbidities for severe COVID-19 infection. medRxiv 2020; Mar 16. doi: https://doi.org/10.1101/2020.03.15.20035360.
8. Baradaran A, Ebrahimzadeh MH, Baradaran A, Kachooei AR. Prevalence of Comorbidities in COVID-19 Patients : A Systematic Review and Meta-Analysis. Arch Bone Jt Surg 2020;247:247–55.
9. Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. J Infect 2020;80:656–65.
10. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 2009; 6:e1000097.
11. Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Healthc 2015;13:147—53.
12. Riley RD, Higgins JPT, Deeks JJ. Interpretation of random effects meta-analyses. BMJ 2011;342:964–7.
13. Chowdhury MZI, Rahman M, Akter T, Akhter T, Ahmed A, Shovon MA, et al. Hypertension prevalence and its trend in Bangladesh: evidence from a systematic review and meta-analysis. Clin Hypertens 2020; 26: 1-19.
14. De Tayrac M, Lê S, Aubry M, Mosser J, Husson F. Simultaneous analysis of distinct Omics data sets with integration of biological knowledge: Multiple Factor Analysis approach. BMC Genomics 2009; 10: 1-17.
15. Rahman MM, Farhana Z, Tani TA, Ullah MO. IntegratingOverweight-obesity and Reproductive Factors of Married Women in Bangladesh. J Gov Innov 2017; 3:55–72.
16. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA - J Am Med Assoc 2020;323:1061–9.
17. Liu Y, Huang F, Xu J, Yang P, Qin Y, Cao M, et al. Anti-hypertensive Angiotensin II receptor blockers associated to mitigation of disease severity in elderly COVID-19 patients. medRxiv 2020; Mar 3. doi: https://doi.org/10.1101/2020.03.20.20039586.
18. Jaillon S, Berthenet K, Garlanda C. Sexual Dimorphism in Innate Immunity. Clin Rev Allergy Immunol 2019;56:308–21.
19. Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. J Infect 2020;80: 656-65.
20. Xu XW, Wu XX, Jiang XG, Xu KJ, Ying LJ, Ma CL, et al. 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.
21. Liu K, Fang Y-Y, Deng Y, Liu W, Wang M-F, Ma J-P, et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chin Med J (Engl). 2020;0:1.
22. Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. Bmj. 2020;2:m1091.
23. Yuan M, Yin W, Tao Z, Tan W, Hu Y. Association of radiologic findings with mortality of patients infected with 2019 novel coronavirus in Wuhan, China. PLoS One 2020;15:e0230548.
24. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507–13.
25. Barrasa H, Rello J, Tejada S, Martín A, Balziskueta G, Vinuesa C, et al. SARS-Cov-2 in Spanish Intensive Care: Early Experience with 15-day Survival In Vitoria. Anaesth Crit Care Pain Med 2020; Apr 9. doi: https://doi.org/10.1016/j.accpm.2020.04.001.
26. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. 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; 8:475–81.
27. Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis 2020;34: 101623.
28. Cao Y, Liu X, Xiong L, Cai K. Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2: A systematic review and meta-analysis. J Med Virol 2020; 1-11.
29. Fuentes E, Fuentes M, Alarcón M, Palomo I. Immune system dysfunction in the elderly. An Acad Bras Cienc 2017;89:285–99.
30. Weyand CM, Goronzy JJ. Aging of the immune system: Mechanisms and therapeutic targets. Annals of the American Thoracic Society 2016; 15: S422–8.
31. Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients. J Infect 2020;80: e14-8.
32. CDC.Coronavirus Disease 2019 (COVID-19), 2020, https://www.cdc.gov/coronavirus/ 2019-ncov/symptoms-testing/symptoms.html(accessed May 25, 2020).
33. CNN. Seniors with Covid-19 show unusual symptoms, doctors say, 2020, https://edition.cnn.com/2020/04/23/health/seniors-elderly-coronavirus-symptoms-wellness-partner/index.html(accessed May 25, 2020).
34. WHO. Coronavirus disease (COVID-19) outbreak statement – Older people are at highest risk from COVID-19, but all must act to prevent community spread.Europe: World Health Organization, 2020.
35. Financial Express. Coronavirus pandemic: Elderly more vulnerable to the disease; Here’s what doctors have to say, 2020.https://www.financialexpress.com/lifestyle/health/coronavirus-pandemic-elderly-more-vulnerable-to-the-disease-heres-what-doctors-have-to-say/1938699/(accessed May 24, 2020].
36. Wan S, Xiang Y, Fang W, Zheng Y, Li B, Hu Y, et al. Clinical Features and Treatment of COVID-19 Patients in Northeast Chongqing. J Med Virol 2020;92:797-806.
37. Jin Zhang J, Dong X, yuan Cao Y, dong Yuan Y, bin Yang Y, qin Yan Y, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy Eur J Allergy Clin Immunol 2020; 2:1–12.
38. Zhu W, Xie K, Lu H, Xu L, Zhou S, Fang S. Initial clinical features of suspected coronavirus disease 2019 in two emergency departments outside of Hubei, China. J Med Virol 2020; Mar 13: 0–3.
39. Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, et al. Clinical and immunologic features in severe and moderate Coronavirus Disease 2019. J Clin Invest 2020;130: 2620-9.
40. Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan J, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci. 2020;63:364–74.
41. Mo P, Xing Y, Xiao Y, Deng L, Zhao Q, Wang H, et al. Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China. Clin Infect Dis. 2020; Mar 16: ciaa270.
42. Jin X, Lian JS, Hu JH, Gao J, Zheng L, Zhang YM, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut 2020;69:1002-9.
43. Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020;382:1708-20.
44. Zhou Z, Zhao N, Shu Y, Han S, Chen B, Shu X. Effect of gastrointestinal symptoms on patients infected with COVID-19. Gastroenterology 2020; 158: 2294-7.
45. Du Y, Tu L, Zhu P, Mu M, Wang R, Yang P, et al. Clinical Features of 85 Fatal Cases of COVID-19 from Wuhan: A Retrospective Observational Study. Am J Respir Crit Care Med 2020;201:1372-9.
46. Xu X, Yu C, Qu J, Zhang L, Jiang S, Huang D, et al. Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2. Eur J Nucl Med Mol Imaging. 2020;47:1275-80.
47. Goyal P, Choi JJ, Pinheiro LC, Schenck EJ, Chen R, Jabri A, et al. Clinical Characteristics of Covid-19 in New York City. N Engl J Med. 2020;382: 2372-74.
48. Yan CH, Faraji F, Prajapati DP, Boone CE, DeConde AS. Association of chemosensory dysfunction and Covid-19 in patients presenting with influenza-like symptoms. Int Forum Allergy Rhinol 2020;Apr 12: 1-8.
49. Gupta N, Agrawal S, Ish P, Mishra S, Gaind R, Usha G, et al. Clinical and epidemiologic profile of the initial COVID-19 patients at a tertiary care centre in India. Monaldi Arch chest Dis. 2020 Apr 10;90:193–6.
50. Yang W, Cao Q, Qin L, Wang X, Cheng Z, Pan A, et al. 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; 80:388–93.
51. Han C, Duan C, Zhang S, Spiegel B, Shi H, Wang W, et al. Digestive Symptoms in COVID-19 Patients With Mild Disease Severity: Clinical Presentation, Stool Viral RNA Testing, and Outcomes. Am J Gastroenterol 2020; 115:916–23.
52. Kim ES, Chin BS, Kang CK, Kim NJ, Kang YM, Choi JP, et al. Clinical course and outcomes of patients with severe acute respiratory syndrome coronavirus 2 infection: A preliminary report of the first 28 patients from the korean cohort study on COVID-19. J Korean Med Sci 2020;35:e142.
53. Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: Characteristics and prognostic factors based on 4-week follow-up. J Infect 2020;80: 639-45.
54. Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 2020; 20:425–34.
2. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497–506.
3. Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis 2020;94:91–95.
4. Emami A, Javanmardi F, Pirbonyeh N, Akbari A. Prevalence of Underlying Diseases in Hospitalized Patients with COVID-19: a Systematic Review and Meta-Analysis. Arch Acad Emerg Med 2020; 8:e35.
5. Zhang G, Hu C, Luo L, Fang F, Chen Y, Li J, et al. Clinical Features and Treatment of 221 Patients with COVID-19 in Wuhan, China. SSRN Electron J 2020; Feb 2.doi: http://dx.doi.org/10.2139/ssrn.3546095
6. Qian K, Deng Y, Tai Y, Peng J, Peng H, Jiang L. Clinical Characteristics of 2019 Novel Infected Coronavirus Pneumonia：A Systemic Review and Meta-analysis. medRxiv 2020; Feb 17.doi: https://doi.org/10.1101/2020.02.14.20021535.
7. Jain V, Yuan J-M. Systematic review and meta-analysis of predictive symptoms and comorbidities for severe COVID-19 infection. medRxiv 2020; Mar 16. doi: https://doi.org/10.1101/2020.03.15.20035360.
8. Baradaran A, Ebrahimzadeh MH, Baradaran A, Kachooei AR. Prevalence of Comorbidities in COVID-19 Patients : A Systematic Review and Meta-Analysis. Arch Bone Jt Surg 2020;247:247–55.
9. Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. J Infect 2020;80:656–65.
10. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 2009; 6:e1000097.
11. Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Healthc 2015;13:147—53.
12. Riley RD, Higgins JPT, Deeks JJ. Interpretation of random effects meta-analyses. BMJ 2011;342:964–7.
13. Chowdhury MZI, Rahman M, Akter T, Akhter T, Ahmed A, Shovon MA, et al. Hypertension prevalence and its trend in Bangladesh: evidence from a systematic review and meta-analysis. Clin Hypertens 2020; 26: 1-19.
14. De Tayrac M, Lê S, Aubry M, Mosser J, Husson F. Simultaneous analysis of distinct Omics data sets with integration of biological knowledge: Multiple Factor Analysis approach. BMC Genomics 2009; 10: 1-17.
15. Rahman MM, Farhana Z, Tani TA, Ullah MO. IntegratingOverweight-obesity and Reproductive Factors of Married Women in Bangladesh. J Gov Innov 2017; 3:55–72.
16. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA - J Am Med Assoc 2020;323:1061–9.
17. Liu Y, Huang F, Xu J, Yang P, Qin Y, Cao M, et al. Anti-hypertensive Angiotensin II receptor blockers associated to mitigation of disease severity in elderly COVID-19 patients. medRxiv 2020; Mar 3. doi: https://doi.org/10.1101/2020.03.20.20039586.
18. Jaillon S, Berthenet K, Garlanda C. Sexual Dimorphism in Innate Immunity. Clin Rev Allergy Immunol 2019;56:308–21.
19. Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. J Infect 2020;80: 656-65.
20. Xu XW, Wu XX, Jiang XG, Xu KJ, Ying LJ, Ma CL, et al. 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.
21. Liu K, Fang Y-Y, Deng Y, Liu W, Wang M-F, Ma J-P, et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chin Med J (Engl). 2020;0:1.
22. Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. Bmj. 2020;2:m1091.
23. Yuan M, Yin W, Tao Z, Tan W, Hu Y. Association of radiologic findings with mortality of patients infected with 2019 novel coronavirus in Wuhan, China. PLoS One 2020;15:e0230548.
24. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507–13.
25. Barrasa H, Rello J, Tejada S, Martín A, Balziskueta G, Vinuesa C, et al. SARS-Cov-2 in Spanish Intensive Care: Early Experience with 15-day Survival In Vitoria. Anaesth Crit Care Pain Med 2020; Apr 9. doi: https://doi.org/10.1016/j.accpm.2020.04.001.
26. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. 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; 8:475–81.
27. Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis 2020;34: 101623.
28. Cao Y, Liu X, Xiong L, Cai K. Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2: A systematic review and meta-analysis. J Med Virol 2020; 1-11.
29. Fuentes E, Fuentes M, Alarcón M, Palomo I. Immune system dysfunction in the elderly. An Acad Bras Cienc 2017;89:285–99.
30. Weyand CM, Goronzy JJ. Aging of the immune system: Mechanisms and therapeutic targets. Annals of the American Thoracic Society 2016; 15: S422–8.
31. Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients. J Infect 2020;80: e14-8.
32. CDC.Coronavirus Disease 2019 (COVID-19), 2020, https://www.cdc.gov/coronavirus/ 2019-ncov/symptoms-testing/symptoms.html(accessed May 25, 2020).
33. CNN. Seniors with Covid-19 show unusual symptoms, doctors say, 2020, https://edition.cnn.com/2020/04/23/health/seniors-elderly-coronavirus-symptoms-wellness-partner/index.html(accessed May 25, 2020).
34. WHO. Coronavirus disease (COVID-19) outbreak statement – Older people are at highest risk from COVID-19, but all must act to prevent community spread.Europe: World Health Organization, 2020.
35. Financial Express. Coronavirus pandemic: Elderly more vulnerable to the disease; Here’s what doctors have to say, 2020.https://www.financialexpress.com/lifestyle/health/coronavirus-pandemic-elderly-more-vulnerable-to-the-disease-heres-what-doctors-have-to-say/1938699/(accessed May 24, 2020].
36. Wan S, Xiang Y, Fang W, Zheng Y, Li B, Hu Y, et al. Clinical Features and Treatment of COVID-19 Patients in Northeast Chongqing. J Med Virol 2020;92:797-806.
37. Jin Zhang J, Dong X, yuan Cao Y, dong Yuan Y, bin Yang Y, qin Yan Y, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy Eur J Allergy Clin Immunol 2020; 2:1–12.
38. Zhu W, Xie K, Lu H, Xu L, Zhou S, Fang S. Initial clinical features of suspected coronavirus disease 2019 in two emergency departments outside of Hubei, China. J Med Virol 2020; Mar 13: 0–3.
39. Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, et al. Clinical and immunologic features in severe and moderate Coronavirus Disease 2019. J Clin Invest 2020;130: 2620-9.
40. Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan J, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci. 2020;63:364–74.
41. Mo P, Xing Y, Xiao Y, Deng L, Zhao Q, Wang H, et al. Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China. Clin Infect Dis. 2020; Mar 16: ciaa270.
42. Jin X, Lian JS, Hu JH, Gao J, Zheng L, Zhang YM, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut 2020;69:1002-9.
43. Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020;382:1708-20.
44. Zhou Z, Zhao N, Shu Y, Han S, Chen B, Shu X. Effect of gastrointestinal symptoms on patients infected with COVID-19. Gastroenterology 2020; 158: 2294-7.
45. Du Y, Tu L, Zhu P, Mu M, Wang R, Yang P, et al. Clinical Features of 85 Fatal Cases of COVID-19 from Wuhan: A Retrospective Observational Study. Am J Respir Crit Care Med 2020;201:1372-9.
46. Xu X, Yu C, Qu J, Zhang L, Jiang S, Huang D, et al. Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2. Eur J Nucl Med Mol Imaging. 2020;47:1275-80.
47. Goyal P, Choi JJ, Pinheiro LC, Schenck EJ, Chen R, Jabri A, et al. Clinical Characteristics of Covid-19 in New York City. N Engl J Med. 2020;382: 2372-74.
48. Yan CH, Faraji F, Prajapati DP, Boone CE, DeConde AS. Association of chemosensory dysfunction and Covid-19 in patients presenting with influenza-like symptoms. Int Forum Allergy Rhinol 2020;Apr 12: 1-8.
49. Gupta N, Agrawal S, Ish P, Mishra S, Gaind R, Usha G, et al. Clinical and epidemiologic profile of the initial COVID-19 patients at a tertiary care centre in India. Monaldi Arch chest Dis. 2020 Apr 10;90:193–6.
50. Yang W, Cao Q, Qin L, Wang X, Cheng Z, Pan A, et al. 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; 80:388–93.
51. Han C, Duan C, Zhang S, Spiegel B, Shi H, Wang W, et al. Digestive Symptoms in COVID-19 Patients With Mild Disease Severity: Clinical Presentation, Stool Viral RNA Testing, and Outcomes. Am J Gastroenterol 2020; 115:916–23.
52. Kim ES, Chin BS, Kang CK, Kim NJ, Kang YM, Choi JP, et al. Clinical course and outcomes of patients with severe acute respiratory syndrome coronavirus 2 infection: A preliminary report of the first 28 patients from the korean cohort study on COVID-19. J Korean Med Sci 2020;35:e142.
53. Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: Characteristics and prognostic factors based on 4-week follow-up. J Infect 2020;80: 639-45.
54. Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 2020; 20:425–34.