A Head-To-Head Comparative Study of Covid-19 Patients Between Epicenter and Peripheral Areas of Pandemic From China

Abstract Background: There has been little information on difference of epidemiology, clinical characteristics and outcomes between epicenter and peripheral areas of Covid-19 pandemic. Methods: Based on Sichuan & Wuhan collaboration research group for Covid-19, we established two retrospective cohorts reflecting the epicenter and peripheral area of pandemic. Epidemiology, clinical characteristics and outcomes of patients were compared. Multivariate regression analyses were used to estimate adjusted odds ratios (aOR) to identify clinical variables associated with outcomes.Results: Upon March 12, 2020, Wuhan cohort consisted of 710 patients using random sampling, and 474 consecutive cases constituted Sichuan cohort. Sichuan cohort had more upper airway symptoms, while Wuhan cohort is elder, has more lower airway symptoms and comorbidities. Wuhan cohort had higher risk of death (aOR=7.64), ICU admission (aOR=1.66), delayed time from illness onset to hospital and ICU admission (aOR=6.29 and aOR=8.03) and prolonged duration of viral shedding (aOR=1.64). Conclusions: Worse outcomes in the epicenter would be explained by delayed time from illness onset to hospital and ICU admission associated with elevated systemic inflammation reflecting organ dysfunction and prolonged duration of virus shedding except for age and comorbidities. It indicates potentially clinical implications of Covid-19 that early supportive care would achieve better clinical outcome.