Clinical and virological data of the first cases of COVID-19 in Europe: a case series - Lancet

Bron: 27-03-2020: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30200-0/fulltext

Aim
Overview on the relevant features of the first cases in Europe of confirmed covid-19 cases

Key points

• Three different clinical and biological types of covid infections described

Summary

• Methods:
  • case series part of an overall French clinical cohort assessing patients with COVID-19
  • All patients at French hospitals who were diagnosed with COVID-19 were enrolled from Jan 24 to Jan 29, 2020
  • Remdesivir used as treatment
  • Procedures sampling:
    1. nasopharyngeal, blood, urine and stool samples were obtained once daily for 3 days from hospital admissions, and once every 2 or 3 days until patient discharge
• Results:
  • patients were three men (age 31, 48 and 80 years old) and two women (age 30 and 46 years old), all Chinese origin, who travelled from China to France
  • Three different clinical evolutions are described:
    • two paucisymptomatic women diagnosed within a day of exhibiting symptoms, with high nasopharyngeal titres of COVID-19 within first 24 hours of the illness and viral detection in stools
    • a two-step disease progression in two young men, with a secondary worsening around 10 days after disease onset despite a decreasing viral load in nasopharyngeal samples
    • 80-year-old man with a rapid evolution towards multiple organ failure and a persistent high viral load in lower and upper respiratory tract with systemic virus dissemination and virus detection in plasma
  • 80-year-old man with a rapid evolution towards multiple organ failure and a persistent high viral load in lower and upper respiratory tract with systemic virus dissemination and virus detection in plasma. The 80-year-old patient died on day 14 of illness 
  • All other patients had recovered and been discharged by Feb 19, 2020. Interpretation
• High viral loads in upper respiratory tract samples are suggestive of potentially high risk of transmissibility during the very first days of symptoms
• This observation suggests that the virus shedding pattern of patients infected with SARS-CoV-2 is different from that seen with SARS-CoV, in which the virus load was very low at disease onset
  • The implication is that COVID-19 control measures should combine immediate isolation of patients with the disease together with a rapid screening and monitoring of the contacts of these patients to detect those with very mild symptoms
• In this case series, except for the patient with critical disease, the viral load decreased over time and became negative between illness day 9 and day 14