Grasselli, Giacomo, et al. “Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response.” JAMA, 13 Mar. 2020, doi:10.1001/jama.2020.4031.
The median time from onset of symptoms to first hospital admission was 7·0 days (4·0–8·0), to shortness of breath was 8·0 days (5·0–13·0), to ARDS was 9·0 days (8·0–14·0), to mechanical venti lation was 10·5 days (7·0–14·0), and to ICU admission was 10·5 days (8·0–17·0).
As of 20 February 2020 and based on 55924 laboratory confirmed cases, typical signs and symptoms include: fever (87.9%), dry cough (67.7%), fatigue (38.1%), sputum production (33.4%), shortness of breath (18.6%), sore throat (13.9%), headache (13.6%), myalgiaor arthralgia (14.8%), chills(11.4%), nausea or vomiting (5.0%), nasal congestion (4.8%), diarrhea (3.7%), and hemoptysis (0.9%), and conjunctival congestion (0.8%).
A total of 72,314 patient records—44,672 (61.8%) confirmed cases, 16,186 (22.4%) suspected cases, 10,567 (14.6%) clinically diagnosed cases (Hubei Province only), and 889 asymptomatic cases (1.2%)—contributed data for the analysis. Among confirmed cases, most were aged 30–79 years (86.6%), diagnosed in Hubei (74.7%), and considered mild (80.9%). A total of 1,023 deaths occurred among confirmed cases for an overall case fatality rate of 2.3%. The COVID-19 spread outward from Hubei Province sometime after December 2019, and by February 11, 2020, 1,386 counties across all 31 provinces were affected. The epidemic curve of onset of symptoms peaked around January 23–26, then began to decline leading up to February 11. A total of 1,716 health workers have become infected and 5 have died (0.3%).
Otherwise, about 14 percent were considered severe, which was defined as cases with difficult or labored breathing, an increased rate of breathing, and decreased blood oxygen levels. None of the severe cases were fatal; all recovered.
Nearly 5 percent of cases were considered critical. These cases included respiratory failure, septic shock, and/or multiple organ dysfunction or failure. About half of these patients died.
Additionally, the researchers had information about other health conditions for 20,812 of the 44,672 patients. Of those with additional medical information available, 15,536 said they had no underlying health conditions. The fatality rate among that group was 0.9 percent.
The fatality rates were much higher among the remaining 5,279 patients who reported some underlying health conditions.
Those who reported cardiovascular disease had a fatality rate of 10.5 percent. For patients with diabetes, the fatality rate was 7.3 percent. Patients with chronic respiratory disease had a rate of 6.3 percent. Patients with high blood pressure had a fatality rate of 6.0 percent and cancer patients had a rate of 5.6 percent.