2019-nCoV was discovered because of a viral pneumonia case in Wuhan, China in 2019. At present, the 2019-nCoV has shown a very strong ability of human-to-human transmission and now confirmed in multiple countries. As of February 10, 2020, the number of confirmed cases in China has exceeded 40,000. At present, there is still a lack of effective antiviral drugs for pathogens, and the treatment of the disease is mainly isolation treatment and symptomatic support treatment. In order to better understand the transmission dynamics and clinical characteristics of the disease, investigations are being carried out around the world.
Researchers from the Washington State 2019-nCoV Case Investigation Team reported the first confirmed case of 2019-nCoV infection in the United States and described the identification, diagnosis, clinical course, and management of the case. The report highlights “the importance of clinicians eliciting a recent history of travel or exposure to sick contacts in any patient presenting for medical care with acute illness symptoms, in order to ensure appropriate identification and prompt isolation of patients who may be at risk for 2019-nCoV infection and to help reduce further transmission.” Finally, this report highlights “the need to determine the full spectrum and natural history of clinical disease, pathogenesis, and duration of viral shedding associated with 2019-nCoV infection to inform clinical management and public health decision making.”
The patient went to an emergency clinic in Washington State on January 19, 2020, and had a four-day history of cough and subjective fever. The patient disclosed that he had returned to Washington State on January 15 after visiting his family in Wuhan, China. Based on his travel history, the hospital immediately notified local and state health departments. The Washington Department of Health, along with urgent care clinician, notified the Control and Prevention (CDC) Emergency Operations Center. According to the CDC guidance, CDC staff collected eight samples from patients, including serum, nasopharyngeal and oropharyngeal swabs, as clinical samples for 2019-nCoV diagnostic tests. After collecting samples, the patient “was discharged to home isolation with active monitoring by the local health department.”
“On January 20, 2020, the CDC confirmed that the patient’s nasopharyngeal and oropharyngeal swabs tested positive for 2019-nCoV by real-time reverse-transcriptase–polymerase-chain-reaction (rRT-PCR) assay.” During days 2-5 of hospitalization (days 6-9 of illness), “Treatment during this time was largely supportive. For symptom management, the patient received, as needed, antipyretic therapy consisting of 650 mg of acetaminophen every 4 hours and 600 mg of ibuprofen every 6 hours. He also received 600 mg of guaifenesin for his continued cough and approximately 6 liters of normal saline over the first 6 days of hospitalization.”
According to the report, “A chest radiograph was taken on hospital day 3 (illness day 7) was reported as showing no evidence of infiltrates or abnormalities. However, a second chest radiograph from the night of hospital day 5 (illness day 9) showed evidence of pneumonia in the lower lobe of the left lung.” “On hospital day 6 (illness day 10), a fourth chest radiograph showed basilar streaky opacities in both lungs, a finding consistent with atypical pneumonia, and rales were noted in both lungs on auscultation.” Then, “clinicians pursued the compassionate use of investigational antiviral therapy. Treatment with intravenous remdesivir (a novel nucleotide analog prodrug in development) was initiated on the evening of day 7, and no adverse events were observed in association with the infusion. Vancomycin was discontinued on the evening of day 7, and cefepime was discontinued on the following day, after serial negative procalcitonin levels and negative nasal PCR testing for methicillin-resistant Staphylococcus aureus.” “On hospital day 8 (illness day 12), the patient’s clinical condition improved.” The report showed that “As of January 30, 2020, the patient remains hospitalized. He is afebrile, and all symptoms have resolved with the exception of his cough, which is decreasing in severity.”
In this report, although the clinical condition of patients improved after the use of remdesivir, clinical controlled trials are needed to determine the safety and efficacy of remdesivir and any other experimental drugs in the treatment of patients with 2019-nCoV infection.
Holshue, M. L., DeBolt, C., Lindquist, S., Lofy, K. H., Wiesman, J., Bruce, H., … & Diaz, G. (2020). First case of 2019 novel coronavirus in the United States.New England Journal of Medicine.