Correspondence (letters to the editor): Ambiguities

The authors report on a first case series of patients with COVID-19 and compare 24 cases with acute respiratory distress syndrome (ARDS) to 26 cases with non-ARDS (1). The data are important and have therefore been published extremely quickly, as there is currently little scientific knowledge about the clinical characteristics of the disease, especially in Germany. However, the article presents some ambiguities, which are however important for interpretation of the data.

First, the authors describe that in addition to bronchial secretions and sputum, “serum, urine, and stool were also tested for SARS-CoV-2”. Serum is then also listed in Table 2 under “virus detection”. It is not clear what this means. So far, it has been assumed in particular that SARS-CoV-2 is not transmitted through blood, and live viruses have not yet been detected in stool (2). Are the authors referring to antibody detection, or did they actually discover virus antigens in blood?

Furthermore, detailed information on patient selection is missing. It is stated that these patients were the first 50 to be treated at the hospital, yet 16 (14 with ARDS) had been transferred there. It can therefore be assumed that the non-ARDS group does not represent an appropriate comparison group in the scientific sense, as it was selected differently; therefore, certain characteristics of the ARDS group could be overestimated.

Finally, under the key messages, the authors state that “COVID-19 patients without ARDS also require longer hospitalization […]”. This general statement cannot be derived from the data, as only a small number of hospitalized COVID-19 cases were investigated. In fact, our experience (3) shows that most patients who first presented to the emergency room can be treated on an outpatient basis, although the proportion of patients who then require inpatient treatment at a later point in time is still the subject of ongoing investigations.