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First 12 patients with coronavirus disease 2019 (COVID-19) in the United States

By The COVID-19 Investigation Team, Stephanie A. Kujawski, Karen K Wong, Jennifer P. Collins, Lauren Epstein, Marie E. Killerby, Claire M. Midgley, Glen R. Abedi, N. Seema Ahmed, Olivia Almendares, Francisco N. Alvarez, Kayla N. Anderson, Sharon Balter, Vaughn Barry, Karri Bartlett, Karlyn Beer, Michael A. Ben-Aderet, Isaac Benowitz, Holly Biggs, Alison M. Binder, Stephanie R. Black, Brandon Bonin, Catherine M. Brown, Hollianne Bruce, Jonathan Bryant-Genevier, Alicia Budd, Diane Buell, Rachel Bystritsky, Jordan Cates, E. Matt Charles, Kevin Chatham-Stephens, Nora Chea, Howard Chiou, Demian Christiansen, Victoria Chu, Sara Cody, Max Cohen, Erin Conners, Aaron Curns, Vishal Dasari, Patrick Dawson, Traci DeSalvo, George Diaz, Matthew Donahue, Suzanne Donovan, Lindsey M. Duca, Keith Erickson, Mathew D. Esona, Suzanne Evans, Jeremy Falk, Leora R. Feldstein, Martin Fenstersheib, Marc Fischer, Rebecca Fisher, Chelsea Foo, Marielle J. Fricchione, Oren Friedman, Alicia M. Fry, Romeo R. Galang, Melissa M. Garcia, Susa I. Gerber, Graham Gerrard, Isaac Ghinai, Prabhu Gounder, Jonathan Grein, Cheri Grigg, Jeffrey D. Gunzenhauser, Gary I. Gutkin, Meredith Haddix, Aron J Hall, George Han, Jennifer Harcourt, Kathleen Harriman, Thomas Haupt, Amber Haynes, Michelle Holshue, Cora Hoover, Jennifer C. Hunter, Max W. Jacobs, Claire Jarashow, Michael A. Jhung, Kiran Joshi, Talar Kamali, Shifaq Kamili, Lindsay Kim, Moon Kim, Jan King, Hannah L. Kirking, Amanda Kita-Yarbro, Rachel Klos, Miwako Kobayashi, Anna Kocharian, Kenneth K. Komatsu, Ram Koppaka, Jennifer E. Layden, Yan Li, Scott Lindquist, Stephen Lindstrom, Ruth Link-Gelles, Joana Lively, Michelle Livingston, Kelly Lo, Jennifer Lo, Xiaoyan Lu, Brian Lynch, Larry Madoff, Lakshmi Malapati, Gregory Marks, Mariel Marlow, Glenn E. Mathisen, Nancy McClung, Olivia McGovern, Tristan D. McPherson, Mitali Mehta, Audrey Meier, Lynn Mello, Sung-sil Moon, Margie Morgan, Ruth N. Moro, Janna' Murray, Rekha Murthy, Shannon Novosad, Sara E. Oliver, Jennifer O'Shea, Massimo Pacilli, Clinton R Paden, Mark A. Pallansch, Manisha Patel, Sajan Patel, Isabel Pedraza, Satish K Pillai, Talia Pindyck, Ian Pray, Krista Queen, Nichole Quick, Heather Reese, Brian Rha, Heather Rhodes, Susan Robinson, Philip Robinson, Melissa Rolfes, Janell Routh, Rachel Rubin, Sarah L. Rudman, Senthilkumar K. Sakthivel, Sarah Scott, Christopher Shepherd, Varun Shetty, Ethan A. Smith, Shanon Smith, Bryan Stierman, William Stoecker, Rebecca Sunenshine, Regina Sy-Santos, Azaibi Tamin, Ying Tao, Dawn Terashita, Natalie J. Thornburg, Suxiang Tong, Elizabeth Traub, Ahmet Tural, Anna Uehara, Timothy M. Uyeki, Grace Vahey, Jennifer R. Verani, Elsa Villarino, Megan Wallace, Lijuan Wang, John T. Watson, Matthew Westercamp, Brett Whitaker, Sarah Wilkerson, Rebecca C. Woodruff, Jonathan M. Wortham, Tiffany Wu, Amy Xie, Anna Yousaf, Matthew Zahn, Jing Zhang

Posted 12 Mar 2020
medRxiv DOI: 10.1101/2020.03.09.20032896

IntroductionMore than 93,000 cases of coronavirus disease (COVID-19) have been reported worldwide. We describe the epidemiology, clinical course, and virologic characteristics of the first 12 U.S. patients with COVID-19. MethodsWe collected demographic, exposure, and clinical information from 12 patients confirmed by CDC during January 20-February 5, 2020 to have COVID-19. Respiratory, stool, serum, and urine specimens were submitted for SARS-CoV-2 rRT-PCR testing, virus culture, and whole genome sequencing. ResultsAmong the 12 patients, median age was 53 years (range: 21-68); 8 were male, 10 had traveled to China, and two were contacts of patients in this series. Commonly reported signs and symptoms at illness onset were fever (n=7) and cough (n=8). Seven patients were hospitalized with radiographic evidence of pneumonia and demonstrated clinical or laboratory signs of worsening during the second week of illness. Three were treated with the investigational antiviral remdesivir. All patients had SARS-CoV-2 RNA detected in respiratory specimens, typically for 2-3 weeks after illness onset, with lowest rRT-PCR Ct values often detected in the first week. SARS-CoV-2 RNA was detected after reported symptom resolution in seven patients. SARS-CoV-2 was cultured from respiratory specimens, and SARS-CoV-2 RNA was detected in stool from 7/10 patients. ConclusionsIn 12 patients with mild to moderately severe illness, SARS-CoV-2 RNA and viable virus were detected early, and prolonged RNA detection suggests the window for diagnosis is long. Hospitalized patients showed signs of worsening in the second week after illness onset.

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