Caution: Clinical Characteristics of COVID-19 Patients Are Changing at Admission

Background: With the emergence of the 4th generation transmission, the prevention and treatment of the novel coronavirus disease 2019 (COVID-19) has entered a new period. During the admission, we found several changes in the clinical characteristics of patients with COVID-19. Methods: Patients suffered from COVID-19 were diagnosed and admitted to Renmin Hospital of Wuhan University. Clinical records, laboratory results were retrospectively reviewed and matched with the admission date to analyze characteristic changes of patients at the onset of illness. Findings: From Jan. 16 to Jan. 29, 2020, 89 patients had been identified as confirmed COVID-19. Patients were assigned into two groups according to the admission date. 31 [34·8%] of the infected patients were admitted from Jan. 16 to 22, and 58 [65·2%] were admitted from Jan. 23 to 29. Most of the infected patients were women (45 [77·6%] of 58) during Jan. 23 to 29, but less female (14 [45·2%] of 31) before Jan. 23. Patients admitted with more systemic symptoms such as fever (21 [67·7%] of 31), fatigue (13 [41·9%] of 31), and myalgia (7 [22·6%] of 31) before Jan. 23. Greater proportion of patients (10 [32·3%] of 31) admitted before Jan. 23 had a small amount of sputum production compared with a small proportion (4 [6·9%] of 58) admitted after Jan. 23. Other symptoms such as cough, nausea, diarrhea, and chest tightness were not significantly different between two groups. In addition, the group admitted before Jan. 23 had a larger proportion of patients with reduced lymphocyte (13 [54·2%] of 24), CD3 (11[52·4%] of 21), CD8 (9 [42·9%] of 21) cells and elevated SAA (18 [75·0%] of 24). Interpretation: The clinical characteristics of COVID-19 patients at the onset became partially different as the novel coronavirus spreads over time and generations, positive infection even appeared in patients after discharge. Findings from this study suggest that initial symptoms of recently infected patients seem more insidious. All provide clues that the new coronavirus may gradually evolve into an influenza-like virus, or it may be latent in some asymptomatic carrier for a long time. Funding Statement: No funding supported this study. Declaration of Interests: All the authors declare no competing interests. Ethics Approval Statement: The research protocol was reviewed and approved by the Ethics Committee in Renmin Hospital of Wuhan University (Wuhan, China). All research procedures adhered to the tenets of the Declaration of Helsinki.