COVID-19: Case Series Identifies Initial Signs
An in-depth study of the first 12 patients diagnosed with COVID-19 (coronavirus) in the U.S. found the most common initial symptoms were coughs and fever and that patients had the highest virus levels in their upper respiratory tracts during the first week of illness. Investigators advised physicians to anticipate that conditions of some COVID-19 patients may worsen in the second week of illness.
The case series, published in the journal Nature Medicine and led by the Centers for Disease Control and Prevention (CDC), included 13 co-authors from Cedars-Sinai among more than 150 authors from multiple institutions. The 12 patients in the study were confirmed to have COVID-19 from Jan. 20 to Feb. 5, and all of them recovered from their illness.
"Although duration of infectiousness is unclear, these early data show viable virus can be cultured readily from upper respiratory tract specimens soon after illness onset," the investigators stated. "Further studies on infectious period and risk factors for transmission are needed."
Other information about the 12 patients included the following:
- Median age: 53.
- Severity of disease: All patients had mild to moderately severe illness. Seven were hospitalized and demonstrated clinical or laboratory signs of worsening during the second week of illness. No patient required mechanical ventilation and all recovered.
- Other symptoms: Diarrhea, vomiting, headache and nausea.
- Underlying medical conditions: Included heart and blood vessel disease, diabetes and liver problems.
- Hospitalization history: Five did not require hospitalization and were isolated at home. Seven were hospitalized for clinical and public health reasons. Four of five patients with underlying medical conditions were hospitalized.
- History of travel to China: Ten patients had traveled to mainland China in the two weeks before illness onset, including nine to Wuhan City.
"This early, vital information about this novel virus will help us better understand the development of the disease and how it spreads," said Jonathan Grein, MD, director of Hospital Epidemiology at Cedars-Sinai and a co-author of the case series.
Another Cedars-Sinai co-author, Rekha Murthy, MD, vice president of Medical Affairs and associate chief medical officer, added that the study is significant because it is one of the first to analyze early observations about potential transmission and susceptibility to complications from COVID-19.
The other co-authors from Cedars-Sinai included Michael Ben-Aderet, MD; Jeremy Falk, MD; Oren Friedman, MD; Gary Gutkin, MD; Kelly Lo, MD; Gregory Marks, PharmD; Mitali Mehta, MD; Margie Morgan, PhD; Isabel Pedraza, MD; Ethan Smith; and Tiffany Wu, MD.
Claire Midgley, PhD, was corresponding author, and Sara Oliver, MD, was first author of the study; both are from the CDC.