To the Editor,
We thank Andrea Lovato et al for their letter, which was written in response to our recent meta‐analysis published in the journal. 1 From the news, we learned that the heroic Italian people are fighting the Corona Virus Disease 2019 (COVID‐19) tenaciously. We wish you a great victory in this battle.
In our paper, we concluded by meta‐analysis that the incidence of fever was 0.891 (95% confidence interval [CI]: 0.818, 0.945), the incidence of cough was 0.722 (95% CI: 0.657, 0.782), and the incidence of muscle soreness or fatigue was 0.425 (95% CI: 0.213, 0.652). The incidence of acute respiratory distress syndrome (ARDS) was 0.148 (95% CI: 0.046, 0.296), the incidence of abnormal chest computer tomography (CT) was 0.966 (95% CI: 0.921, 0.993), the percentage of severe cases in all infected cases was 0.181 (95% CI: 0.127, 0.243), and the case fatality rate of patients with SARS‐CoV‐2 infection was 0.043 (95% CI: 0.027, 0.061). By reading the relevant literature, we learned that diarrhea, hemoptysis, headache, sore throat, shock, and other symptoms are rare.
In our study, we included 10 relevant literatures and extracted data of common clinical symptoms from these studies for meta‐analysis. From the study of the Chinese Center for Disease Control and Prevention(China CDC), 2 we only extracted the relevant data of the patient in critical condition and case fatality. As you said, there are no data of other specific clinical symptoms in the study of the China CDC that can be used for meta‐analysis. In the study of Yang et al, 3 we also only extracted the relevant data of the patient in critical condition and case fatality. We have listed the specific clinical features extracted from each of the included literature in detail in Table 1.
Table 1.
The characteristics of the literature
| First author | Year | Country | Follow‐up (days) | No. Patients | Sex | Average age | Research type | Literature quality | Clinical symptom |
|---|---|---|---|---|---|---|---|---|---|
| Chaolin Huang | 2020 | China | 18 | 41 | Male: 30 | 49 | Retrospective study | 7 | Fever |
| ARDS | |||||||||
| Muscle soreness or fatigue | |||||||||
| Female: 11 | |||||||||
| Cough | |||||||||
| Abnormal chest CT | |||||||||
| Patient in critical condition | |||||||||
| Death of patient | |||||||||
| Dawei Wang | 2020 | China | 34 | 138 | Male: 75 | 56 | Retrospective study | 7 | Fever |
| ARDS | |||||||||
| Female: 63 | Muscle soreness or fatigue | ||||||||
| Cough | |||||||||
| Abnormal chest CT | |||||||||
| Patient in critical condition | |||||||||
| Death of patient | |||||||||
| Nanshan Chen | 2020 | China | 25 | 99 | Male: 67 | 55.5 | Retrospective study | 6 | Fever |
| ARDS | |||||||||
| Muscle soreness or fatigue | |||||||||
| Female: 32 | |||||||||
| Cough | |||||||||
| Abnormal chest CT | |||||||||
| Death of patient | |||||||||
| Weijie Guan | 2020 | China | 28 | 1099 | Male: 640 | 47 | Retrospective study | 8 | Fever |
| ARDS | |||||||||
| Female: 459 | Muscle soreness or fatigue | ||||||||
| Cough | |||||||||
| Abnormal chest CT | |||||||||
| Patient in critical condition | |||||||||
| Death of patient | |||||||||
| Lei Chen | 2020 | China | 15 | 29 | Male: 21 | 56 | Retrospective study | 6 | Fever |
| Muscle soreness or fatigue | |||||||||
| Female: 8 | |||||||||
| Cough | |||||||||
| Patient in Critical condition | |||||||||
| Death of patient | |||||||||
| Kaiyuan Sun | 2020 | America | 42 | 288 | Male: 182 | 44 | Retrospective study | 5 | Death of patient |
| Female: 106 | |||||||||
| Yang Yang | 2020 | China | 51 | 4021 | Male: 2211 | 49 | Retrospective study | 5 | Patient in critical condition |
| Female: 1810 | |||||||||
| Death of patient | |||||||||
| Jie Li | 2020 | China | 21 | 17 | Male: 9 | 45 | Retrospective study | 6 | Fever |
| Muscle soreness or fatigue | |||||||||
| Female: 8 | |||||||||
| Cough | |||||||||
| Abnormal chest CT | |||||||||
| China CDC | 2020 | China | 43 | 44672 | Male: 22 981 | ‐‐ | Retrospective study | 6 | Patient in Critical condition |
| Female: 21 691 | |||||||||
| Death of patient | |||||||||
| Xiaowei Xu | 2020 | China | 16 | 62 | Male: 36 | 41 | Retrospective study | 6 | Fever |
| Muscle soreness or fatigue | |||||||||
| Female: 26 | |||||||||
| Cough | |||||||||
| Abnormal chest CT | |||||||||
| Patient in Critical condition | |||||||||
| Death of patient |
Abbreviations: China CDC, Chinese Center for Disease Control and Prevention; CT, computer tomography.
We believe that the symptoms of sore throat are not specific to COVID‐19. Because some patients also have symptoms of a sore throat after a violent cough. The study by Huang et al 4 also did not consider sore throat as a specific symptom of COVID‐19. According to a recent study by Rodriguez‐Morales et al, 5 the incidence of sore throat in COVID‐19 patients was 11%. Compared with cough, fever, and muscle soreness or fatigue, sore throat is really rare in COVID‐19 patients.
In the treatment of COVID‐19 in China, few patients were treated for symptoms of sore throat. Most COVID‐19 patients were asked by doctors for real‐time reverse transcriptase polymerase chain reaction (RT‐PCR) assays due to cough and fever. Chinese physicians found that the combination of RT‐PCR and chest CT could improve the diagnostic accuracy of COVID‐19.
Of course, we agree with you that no clinical symptom should be ignored. Although the incidence of sore throat in COVID‐19 patients is not high, it should be paid more attention to by medical workers. COVID‐19 is the common enemy of all mankind. According to the study of Rodriguez‐Morales et al, 5 the case fatality rate of COVID‐19 patients worldwide has reached 13.9%. Early diagnosis and treatment can effectively reduce the case fatality rate of COVID‐19 patients before the development of specific drugs and vaccines to treat COVID‐19.
Clinical practice has proved that the methods of prevention of COVID‐19 that you mentioned in your article are scientific and effective. 6 We also hope that you will share with us your experience and lessons learned in the treatment of COVID‐19. We believe that with the concerted efforts of all mankind, we will surely overcome this plague.
CONFLICT OF INTERESTS
The authors declare that there are no conflict of interests.
REFERENCES
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