COVID-19 research briefs: mortality 21% for hospitalized patients in New York City, and transmission in a restaurant in China

Daily POEMs

Published: 2020-05-23 © 2020 John Wiley & Sons, Inc.

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Clinical question
What was the outcome for patients hospitalized with COVID-19 in New York City in March/April 2020? Can a cluster of COVID-19 cases be linked to a small restaurant in China, despite table distancing?

Bottom line
COVID-19 infection had a high mortality rate in patients who were hospitalized in New York City during March/April 2020, especially in those who required mechanical ventilation. Investigators uncover possible transmission of COVID-19 in a restaurant in China despite a distance of 1 meter (3 feet) among tables. (LOE = 4)

Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. Published online April 22, 2020. doi:10.1001/jama.2020.6775. Lu J, Gu J, Li K, et al. COVID-19 outbreak associated with air conditioning in restaurant, Guangzhou, China, 2020. Emerg Infect Dis 2020;26(7). [Early release]

Study design: Other

Setting: Other

Research Brief #22: This is a case series of 5700 individuals infected with COVID-19 who were hospitalized at one of 12 hospitals in the New York City area between March 1, 2020, and April 4, 2020. Their median age was 63 and 60% were men. A total of 57% of patients had hypertension, 34% had diabetes, and 42% were obese. Only 31% of patients were febrile and 28% were receiving supplemental oxygen at triage. Among the 2634 patients who were discharged or died by the end of the study period, 373 (14%) were treated in the intensive care unit, 320 (12%) received mechanical ventilation, and 553 (21%) died. Of those who were mechanically ventilated, 3% were discharged alive, 25% died, and 72% were still hospitalized at the end of the study period. Research Brief #23: These investigators report a cluster of 10 COVID-19 cases that were most likely spread from a single infected person at a restaurant in Guangzhou, China. The index case and 3 family members traveled from Wuhan on January 23, 2020, and had lunch at a small restaurant. The index case reportedly did not feel ill at lunch, but developed cough and fever later that day. Within 2 weeks, 9 other people who were in the restaurant became ill, including 4 family members of the index case, 3 members of a family sitting at a neighboring table, and 2 family members sitting at the table on the other side. The distance between tables was 3 feet. The exposure time of the index case to the other 2 families was approximately 1 hour. The investigators could find no other exposures to COVID-19 for the other 2 infected families. The investigators hypothesize that the infection was spread by the direction of airflow from the air-conditioning unit. If so, this finding has significant implications as other countries open up restaurants and other businesses that require close physical proximity and ventilation. Social distancing and the use of well-constructed face masks seem essential for reducing the spread of COVID in close public spaces.

John Hickner, MD, MS
Professor Emeritus
Dept of Family Medicine
Michigan State University
East Lansing, MI

Copyright © 2020 John Wiley & Sons, Inc.