Report Documents Identification, Diagnosis and Management of First US Coronavirus Case

A presentation of mild symptoms from novel coronavirus (COVID-19) progressed to pneumonia after 9 days, according to a case report in The New England Journal of Medicine.

A multifaceted team of Washington-based investigators documented the identification, diagnosis, clinical course, and management of the first case of COVID-19 in the United States. They believed that doing so would help rapidly disseminate clinical information related to patient care as the virus spreads.

They described that a 35-year-old man decided to visit a health care provider after seeing alerts from the US Centers for Disease Control and Prevention (CDC) about recent travel to Wuhan, China. The man had recently returned to Snohomish County, Washington from China and after 4 days with a cough and fever, visited an urgent care center. He put on a mask in the waiting room and was taken to an examination room after 20 minutes, the case report stated, where he disclosed his recent travel.

The man disclosed he had not visited a seafood market thought to be the source of the outbreak, nor had any contact with known ill persons, the study authors wrote.

Health care workers notified local and state health departments, followed by the CDC’s Emergency Operations Center. The man was an otherwise healthy nonsmoker. He was tested for COVID-19 and discharged to home isolation with plans to undergo active monitoring by the local health department, the study authors said.

The following day, the CDC confirmed the patient had tested positive for novel coronavirus. Subsequently, he was admitted to an airborne-isolation unit at Providence Regional Medical Center for clinical observations. His examination was relatively unremarkable except for noting a persistent dry cough and a 2-day history of nausea and vomiting. The patient said he had not experienced shortness of breath or chest pain. His vital signs remained normal for days 2 through 5 of his hospitalization, characterized as days 6 through 9 of illness. He developed intermittent fevers, continued to have a dry cough, and appeared fatigued, the study authors said.

He was treated with saline over the first 6 days of hospitalization and the health care providers managed his symptoms with 650 mg of acetaminophen every 4 hours and 600 mg of ibuprofen every 6 hours.

A chest radiograph was taken on illness days 7, 9, and 10. On illness day 10, the radiograph showed signs consistent with atypical pneumonia, the investigators noted. He was treated with oxygen supplementation, as well as ongoing treatment for his fevers. By illness day 12, the patient’s clinical condition improved and supplemental oxygen was discontinued, the investigators wrote. His appetite improved as well, they said, though he still had intermittent dry cough and rhinorrhea.

As of January 30, 2020, the study authors said that the patient had remained hospitalized despite being afebrile and the resolution of all of his symptoms except his cough. However, they said the dry cough was decreasing in severity.

“Our case patient initially presented with mild cough and low-grade intermittent fevers, without evidence of pneumonia on chest radiography on day 4 of his illness, before having progression to pneumonia by illness day 9,” the study authors concluded. “These nonspecific signs and symptoms of mild illness early in the clinical course of 2019-nCoV infection may be indistinguishable clinically from many other common infectious diseases, particularly during the winter respiratory virus season.”

Since the hospitalization of this patient, there are a reported 12 coronavirus deaths in the US, with the majority happening in Washington state.

For the most recent case counts in the COVID-19 outbreak, check out the Contagion® Outbreak Monitor.