What's Shanghai experience of COVID-19 management?

We have been able to sort out the early alarm indicators for severe COVID-19 pneumonia.

Clinical Indicators for deterioration of COVID-19 Pneumonia

Advanced age( age> 65y/o)

Complicated with other systemic diseases: diabetes mellitus, coronary heart disease, hypertension, obesity

Progressive worsening of lung parenchymal pathology > 50% for 2-3 days

CD4+ T lymphocytes number < 250/uL

Significant increase in serum IL-6 level

Lactate Dehydrogenase (LDH) level > 2x normal range upper limit

Serum Lactic Acid >/= 3 mmol/L, with metabolic alkalosis

Major systematic diseases/old age -- a very important indicator/rapid progression of clinical symptoms and signs are the major factors. In addition, Shanghai team was the earliest group that took notice that CD4+ T cells subgroups are also very important severe disease early indicators.

CD4+ cut off value is probably at 250/μL, it is less likely to see severe cases with CD4>400/μL, CT scan of the chest with CD4>2000/μL cases almost showed no pathological findings. Here is a patient with progressive dropping of CD4+ level, reflecting its's clinical severity.

CD4+ and COVID-19 infections have close relationship. We are not sure the exact cause-effect of the two. There is a possibility that the virus specifically attack CD4+, caused CD4 level to drop significantly, therefore severely destroyed the immune system. There is also a relationship with the CD4+ cell count and the timing of viral shedding. The lower the CD4 count, the longer the viral shedding period.