Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China.
南京地区密切接触者中筛查的 24 例新型冠状病毒肺炎无症状感染的临床特征。
- 作者列表："Hu Z","Song C","Xu C","Jin G","Chen Y","Xu X","Ma H","Chen W","Lin Y","Zheng Y","Wang J","Hu Z","Yi Y","Shen H
:Previous studies have showed clinical characteristics of patients with the 2019 novel coronavirus disease (COVID-19) and the evidence of person-to-person transmission. Limited data are available for asymptomatic infections. This study aims to present the clinical characteristics of 24 cases with asymptomatic infection screened from close contacts and to show the transmission potential of asymptomatic COVID-19 virus carriers. Epidemiological investigations were conducted among all close contacts of COVID-19 patients (or suspected patients) in Nanjing, Jiangsu Province, China, from Jan 28 to Feb 9, 2020, both in clinic and in community. Asymptomatic carriers were laboratory-confirmed positive for the COVID-19 virus by testing the nucleic acid of the pharyngeal swab samples. Their clinical records, laboratory assessments, and chest CT scans were reviewed. As a result, none of the 24 asymptomatic cases presented any obvious symptoms while nucleic acid screening. Five cases (20.8%) developed symptoms (fever, cough, fatigue, etc.) during hospitalization. Twelve (50.0%) cases showed typical CT images of ground-glass chest and 5 (20.8%) presented stripe shadowing in the lungs. The remaining 7 (29.2%) cases showed normal CT image and had no symptoms during hospitalization. These 7 cases were younger (median age: 14.0 years; P=0.012) than the rest. None of the 24 cases developed severe COVID-19 pneumonia or died. The median communicable period, defined as the interval from the first day of positive nucleic acid tests to the first day of continuous negative tests, was 9.5 days (up to 21 days among the 24 asymptomatic cases). Through epidemiological investigation, we observed a typical asymptomatic transmission to the cohabiting family members, which even caused severe COVID-19 pneumonia. Overall, the asymptomatic carriers identified from close contacts were prone to be mildly ill during hospitalization. However, the communicable period could be up to three weeks and the communicated patients could develop severe illness. These results highlighted the importance of close contact tracing and longitudinally surveillance via virus nucleic acid tests. Further isolation recommendation and continuous nucleic acid tests may also be recommended to the patients discharged.
: 以前的研究已经显示了 2019 新型冠状病毒 (新型冠状病毒肺炎) 患者的临床特征和人传人的证据。无症状感染的可用数据有限。本研究旨在介绍从密切接触者中筛选出的 24 例无症状感染病例的临床特征，并展示无症状新型冠状病毒肺炎病毒携带者的传播潜力。对江苏省南京市 1 月 28 日至 20 20 0 年 2 月 9 日门诊和社区所有新型冠状病毒肺炎患者 (或疑似患者) 密切接触者进行流行病学调查。无症状携带者通过检测咽拭子样本的核酸，实验室证实新型冠状病毒肺炎病毒呈阳性。回顾了他们的临床记录、实验室检查和胸部ct扫描。结果，在核酸筛查时，24 例无症状病例均未出现任何明显症状。5 例 (20.8%) 住院期间出现症状 (发热、咳嗽、乏力等)。12 例 (50.0%) 表现为典型的磨玻璃胸部CT图像，5 例 (20.8%) 表现为肺部条纹阴影。其余 7 例 (29.2%) CT表现正常，住院期间无症状。这 7 例比其余病例更年轻 (中位年龄: 14.0 岁; P = 0.012)。24 例患者均未发生严重新型冠状病毒肺炎肺炎或死亡。中位数传染期，定义为从核酸检测阳性的第一天到连续阴性检测的第一天的间隔，为 9.5 天 (24 例无症状病例达 21 天)。通过流行病学调查，我们观察到典型的无症状传播到同居家庭成员，甚至引起严重的新型冠状病毒肺炎肺炎。总体而言，从密切接触者中发现的无症状携带者在住院期间容易发生轻度疾病。然而，传染期可能长达三周，沟通的患者可能发展为严重的疾病。这些结果强调了通过病毒核酸检测密切接触者追踪和纵向监测的重要性。进一步的隔离建议和持续的核酸检测也可能被推荐给出院的患者。
METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.
METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.