Characteristics of the first 12 patients with COVID-19 in the United States

Characteristics of the first 12 patients with COVID-19 in the United States. Heneghan C

https://www.cebm.net/study/characteristics-of-the-first-12-patients-with-covid-19-in-the-united-states/

Published on July 30, 2020

Reference COVID-19 Investigation Team. linical and virologic characteristics of the first 12 patients with coronavirus disease 2019 (COVID-19) in the United States. Nat Med. 2020;26(6):861-868. doi:10.1038/s41591-020-0877-5 Also published as Kujawski SA, Wong KK, Collins JP et al First 12 patients with coronavirus disease 2019 (COVID‐19) in the United States. medRxiv 2020. 10.1101/2020.03.09.20032896
Study type
Country USA
Setting Hospital and Community
Funding Details Non Reported
Transmission mode orofecal, Droplet
Exposures

Bottom Line

SARS-CoV-2 RNA was detected in at least one nasopharyngeal (NP) swab, 11/12 oropharyngeal (OP) swab and 7/10 in the stool. 

Evidence Summary

Twelve patients with confirmed COVID-19 were identified in six states. Five did not require hospitalization and were isolated at home and seven were hospitalized for clinical and public health reasons. Ten patients travelled to mainland China in the 2 weeks before illness onset. Patients reported cough (n = 12), subjective or measured fever (n = 9), diarrhoea (n = 3) and vomiting (n = 2).

SARS-CoV-2 RNA was detected in at least one nasopharyngeal (NP) swab, 11/12 oropharyngeal (OP) swab, 6/6 sputum, 1/11 in serum and 7/10 in stool 

Eleven patients tested positive in ≥2 respiratory specimen types collected between illness days 1–9.  The viral culture was attempted on initial respiratory specimens for nine patients and was successful in all nine. 

Viable SARS-CoV-2 was cultured at day 9 of illness (patient 10), but was not attempted on later specimens. 

SARS-CoV-2 rRT–PCR cycle threshold (Ct) values of the virus isolated from the 1st tissue culture passage were 12.3–35.7. Mean Ct values in positive specimens were 17.0–39.0 for NP, 22.3–39.7 for OP and 24.1–39.4 for stool. 

What did they do?

Case series describing the first 12 US patients confirmed to have COVID-19 from 20 January to 5 February 2020. Respiratory, stool, serum and urine specimens were submitted for SARS-CoV-2 real-time reverse-transcription polymerase chain reaction (rRT-PCR) testing, viral culture and whole-genome sequencing.  All  specimens were tested by rRT–PCR targeting three regions of the gene encoding the nucleocapsid protein

The rRT–PCR results were reported as positive (all targets positive), negative (all targets negative) or inconclusive (only one or two positive targets). If an initial result was inconclusive, the specimen was re-tested; if both tests were inconclusive, the final result was reported as inconclusive.

Patients were interviewed by public health officials about demographics, exposures, travel history and symptoms, including signs or symptoms before the presentation.

Study reliability

Clearly defined setting Demographic characteristics described Follow-up length was sufficient Transmission outcomes assessed Main biases are taken into consideration
Yes Yes Yes Yes No

What else should I consider?

About the authors

Carl Heneghan

Carl Heneghan

Carl is Professor of EBM & Director of CEBM at the University of Oxford. He is also a GP and tweets @carlheneghan. He has an active interest in discovering the truth behind health research findings