• Ziying Lei, Huijuan Cao, Yusheng Jie, Zhanlian Huang, Xiaoyan Guo, Junfeng Chen, Liang Peng, Hong Cao, Xiaoling Dai, Jing Liu, Xuejun Li, Jianyun Zhu, Wenxiong Xu, Dabiao Chen, Zhiliang Gao, Jian-Rong He, and Bing-Liang Lin.
• Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; GuangDong Provincial Key Laboratory of Liver Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
• Travel Med Infect Dis. 2020 May 1; 35: 101664.

BackgroundCoronavirus disease 2019 (COVID-19) has spread outside the initial epicenter of Wuhan. We compared cases in Guangzhou and Wuhan to illustrate potential changes in pathogenicity and epidemiological characteristics as the epidemic has progressed.MethodsWe studied 20 patients admitted to the Third Affiliated Hospital of Sun Yat-Sen University in Guangzhou, China from January 22 to February 12, 2020. Data were extracted from medical records. These cases were compared with the 99 cases, previously published in Lancet, from Wuhan Jinyintan Hospital from January 1 to January 20, 2020.ResultsGuangzhou patients were younger and had better prognosis than Wuhan patients. The Wuhan patients were more likely to be admitted to the ICU (23% vs 5%) and had a higher mortality rate (11% vs 0%). Cases in Guangzhou tended to be more community clustered. Diarrhea and vomiting were more common among Guangzhou patients and SARS-CoV-2 RNA was found in feces. Fecal SARA-CoV-2 RNA remained positive when nasopharyngeal swabs turned negative in some patients.ConclusionsThis study indicates possible diminishing virulence of the virus in the process of transmission. Yet persistent positive RNA in feces after negative nasopharyngeal swabs suggests a possible prolonged transmission period that challenges current quarantine practices.Copyright © 2020 Elsevier Ltd. All rights reserved.

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