Clinical Characteristics of 1327 Patients with Coronavirus Disease 2019 in the Largest Fangcang Shelter Hospital in Wuhan
The rapid global spread of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), necessitated innovative approaches to manage the overwhelming number of cases. Fangcang shelter hospitals, a unique Chinese strategy, were established to isolate and treat patients with mild to moderate COVID-19, thereby reducing community transmission and alleviating pressure on traditional healthcare facilities. This study comprehensively analyzes the clinical characteristics of 1,327 patients admitted to Jianghan Fangcang shelter hospital, the largest such facility in Wuhan, China, during the initial phase of the pandemic.
Study Design and Methodology
Conducted between February 5 and March 9, 2020, this retrospective study included patients diagnosed with asymptomatic, mild, or moderate COVID-19. The diagnosis was confirmed using real-time reverse transcription polymerase chain reaction (RT-PCR) assays targeting the SARS-CoV-2 ORF1ab and nucleocapsid (N) genes. Throat swab samples were processed under standardized conditions: 50°C for 15 minutes, 95°C for 5 minutes, followed by 40 cycles of 94°C for 15 seconds and 55°C for 45 seconds. Ethical approval was obtained from the Union Hospital Ethics Committee, with waived informed consent due to the retrospective nature of the study.
Clinical data, including demographics, comorbidities, symptoms, laboratory results, and chest computed tomography (CT) findings, were systematically collected. Follow-up assessments occurred 2–4 weeks post-discharge. Statistical analyses utilized SPSS 23.0, with continuous variables expressed as medians (interquartile ranges, IQR) and categorical variables as percentages. Mann-Whitney U and χ²/Fisher’s exact tests compared groups, with significance set at P < 0.05.
Demographic and Comorbidity Profiles
The cohort’s median age was 50 years (IQR: 40–57), with a slight female predominance (55.7%, 739/1,327). Active smoking was rare (3.1%, 37/1,182). Hypertension (14.1%, 167/1,182), diabetes (5.2%, 62/1,182), and coronary heart disease (1.9%, 23/1,182) were the most prevalent comorbidities. These findings reflect the broader population’s risk factors, underscoring the role of pre-existing conditions in COVID-19 susceptibility.
Symptomatology and Clinical Presentation
Fever (59.6%, 703/1,180) was the most common initial symptom, followed by cough (29.9%, 353/1,180), fatigue (28.8%, 340/1,180), and myalgia/arthralgia (14.5%, 171/1,180). Gastrointestinal symptoms included diarrhea (8.7%, 103/1,180), anorexia (6.5%, 77/1,180), and nausea/vomiting (3.5%, 41/1,180). Notably, six patients presented with anosmia (loss of smell) without nasal congestion, four of whom also had fever. This distinct symptom combination may aid in differentiating COVID-19 from other respiratory infections.
During follow-up, chest tightness or pain (9.4%, 98/1,042) was the most persistent symptom, highlighting prolonged respiratory discomfort even after clinical recovery.
Laboratory and Radiological Findings
On admission, hematological abnormalities were infrequent: leukopenia (1.6%, 20/1,257), lymphocytopenia (3.8%, 48/1,257), and thrombocytopenia (1.4%, 17/1,257). Elevated C-reactive protein (CRP), a marker of inflammation, was observed in 9.2% (114/1,237) of patients.
Chest CT scans at disease onset predominantly revealed ground-glass opacities (71.0%, 686/966), with fewer cases of patchy shadows (22.0%, 212/966) and consolidation (1.0%, 10/966). By discharge, 95.5% (1,241/1,300) of patients showed significant radiographic improvement, while only one patient exhibited disease progression.
Symptomatic vs. Asymptomatic Patients
Comparative analysis of 1,119 symptomatic and 66 asymptomatic patients revealed distinct biological markers. Symptomatic individuals had higher CRP levels (0.90 [0.37, 2.16] mg/L vs. 0.65 [0.20, 1.26] mg/L; P = 0.011) and lower lymphocyte counts (1.85 [1.54, 2.25] × 10⁹/L vs. 2.01 [1.70, 2.28] × 10⁹/L; P = 0.031). Red blood cell indices also differed: asymptomatic patients exhibited higher mean corpuscular volume (MCV: 91.20 vs. 89.80 fL; P = 0.044) and mean corpuscular hemoglobin (MCH: 30.40 vs. 29.90 pg; P = 0.023), suggesting better oxygen-carrying capacity.
Despite these laboratory differences, CT abnormalities showed no significant variation between groups. Ground-glass opacities affected 70.8% of symptomatic versus 70.0% of asymptomatic patients (P = 0.882), while patchy shadows occurred in 22.3% vs. 25.6% (P = 0.612). Consolidation was absent in asymptomatic patients but present in 1.1% of symptomatic cases (P = 1.000). These results indicate that radiographic features alone may not reliably distinguish symptomatic from asymptomatic infections in non-severe cases.
Clinical Implications and Discussion
The prominence of fever and anosmia as early symptoms carries diagnostic significance. Anosmia without nasal congestion, particularly when accompanied by fever, appears more specific to COVID-19 than to influenza or common colds. This sensory deficit, likely due to viral invasion of olfactory neurons or sustentacular cells, warrants inclusion in screening protocols.
The association between elevated CRP, lymphocytopenia, and symptom severity aligns with previous studies linking these markers to poor prognosis. Lymphocyte depletion reflects SARS-CoV-2’s direct cytopathic effects or cytokine-mediated destruction, while CRP elevation indicates systemic inflammation. Conversely, preserved lymphocyte counts and lower CRP in asymptomatic patients suggest effective immune containment of the virus.
The dissociation between clinical symptoms and CT findings challenges the reliance on imaging alone for disease monitoring in mild-to-moderate cases. Ground-glass opacities, though common, did not correlate with symptom severity, implying that radiographic resolution (achieved in 95.5% of patients) may precede complete clinical recovery.
Limitations and Future Directions
This study’s retrospective design limited data completeness, particularly for longitudinal symptom tracking. The single-center focus on Jianghan Fangcang shelter hospital, while providing granular data from the pandemic epicenter, necessitates validation through multi-center studies. Furthermore, the absence of viral load quantification precluded analysis of virological-immunological correlations.
Conclusion
In the largest Fangcang shelter hospital cohort to date, fever and isolated anosmia emerged as key diagnostic clues for COVID-19. Laboratory markers like CRP and lymphocyte counts demonstrated prognostic value, whereas CT findings proved less discriminatory in non-critical cases. These insights refine clinical management strategies for mild-to-moderate COVID-19, emphasizing symptom monitoring over routine imaging in resource-constrained settings.
doi.org/10.1097/CM9.0000000000001194
Was this helpful?
0 / 0