Objective Evaluate the risk of pre-existing comorbidities on COVID-19 mortality, and provide clinical suggestions accordingly. Setting A nested case–control design using confirmed case reports released from the news or the national/provincial/municipal health commissions of China between 18 December 2019 and 8 March 2020. Participants Patients with confirmed SARS-CoV-2 infection, excluding asymptomatic patients, in mainland China outside of Hubei Province. Outcome measures Patient demographics, survival time and status, and history of comorbidities. Method A total of 94 publicly reported deaths in locations outside of Hubei Province, mainland China, were included as cases. Each case was matched with up to three controls, based on gender and age ±1 year old (94 cases and 181 controls). The inverse probability-weighted Cox proportional hazard model was performed, controlling for age, gender and the early period of the outbreak. Results Of the 94 cases, the median age was 72.5 years old (IQR=16), and 59.6% were men, while in the control group the median age was 67 years old (IQR=22), and 64.6% were men. Adjusting for age, gender and the early period of the outbreak, poor health conditions were associated with a higher risk of COVID-19 mortality (HR of comorbidity score, 1.31 [95% CI 1.11 to 1.54]; p=0.001). The estimated mortality risk in patients with pre-existing coronary heart disease (CHD) was three times that of those without CHD (p<0.001). The estimated 30-day survival probability for a profile patient with pre-existing CHD (65-year-old woman with no other comorbidities) was 0.53 (95% CI 0.34 to 0.82), while it was 0.85 (95% CI 0.79 to 0.91) for those without CHD. Older age was also associated with increased mortality risk: every 1-year increase in age was associated with a 4% increased risk of mortality (p<0.001). Conclusion Extra care and early medical interventions are needed for patients with pre-existing comorbidities, especially CHD.

Objectives Building individuals’ positive attitudes during a pandemic is essential for facilitating psychological resilience. However, little is known about how public health measures may improve people’s positive attitudes during a pandemic. We investigated the potential mechanism underlying the association between individuals’ perceived effectiveness of public health measures and positive attitudes towards the success of pandemic control during the COVID-19 pandemic, by examining the parallel mediating effects of three types of threat appraisals: concerns about contracting the virus, perceived impact of the pandemic on life and estimated duration of the pandemic. Design, setting and participants In February 2020 when the COVID-19 infection was spreading rapidly in China, a large cross-sectional survey was conducted among 132 054 adults from the 16 districts in Shanghai, China. Outcome measures Perceived effectiveness of the public health measures, positive attitudes towards the success of pandemic control and threat appraisals. Results Results of structural equation modelling supported the hypothesised mediation model: perceived effectiveness of public health measures was associated with lower levels of concerns about contracting the virus (β=−0.20), perceived impact of the pandemic (β=−0.13) and perceived duration of the pandemic (β=−0.20), which were then associated with higher levels of positive attitudes towards the success of pandemic control (βs=−0.12 to −0.25). Conclusions The findings suggest that threat appraisals may be important pathways through which individuals’ evaluations of prevention strategies may influence their attitudes towards the success of pandemic control. The health authorities should consider reducing people’s inappropriate threat appraisals when designing public health policies to facilitate people’s positive attitudes during a pandemic.

Background: China has experienced an outbreak of a novel human coronavirus (SARS-CoV-2) since December 2019, which quickly became a worldwide pandemic in early 2020. There is limited evidence on the mortality risk effect of pre-existing comorbidities for coronavirus disease 2019 (COVID-19), which has important implications for early treatment. Objective: Evaluate the risk of pre-existing comorbidities on COVID-19 mortality, and provide clinical suggestions accordingly. Method: This study used a nested case-control design. A total of 94 publicly reported deaths in locations outside of Hubei Province, China, between December 18 ^th , 2019 and March 8 ^th , 2020 were included as cases. Each case was matched with up to three controls, based on gender and age ± 1 year old (94 cases and 181 controls). The inverse probability weighted Cox proportional hazard model was performed. Results: History of comorbidities significantly increased the death risk of COVID-19: one additional pre-existing comorbidity led to an estimated 40% higher risk of death (p<0.001). The estimated mortality risk in patients with CHD was three times of those without CHD (p<0.001). The estimated 30-day survival probability for a profile patient with pre-existing CHD (65-year-old female with no other comorbidities) was 0.53 (95% CI [0.34-0.82]), while it was 0.85 (95% CI [0.79-0.91]) for those without CHD. Older age was also associated with increased death risk: every 5-year increase in age was associated with a 20% increased risk of mortality (p<0.001). Conclusion: Extra care and early medical intervention are needed for patients with pre-existing comorbidities, especially CHD.