PubMed Journals: JAMA

  Source:		PMID: 32125362

    		JAMA. 2020 Mar 3. doi:
     		10.1001/jama.2020.3204. [Epub ahead of

			Epidemiologic Features and Clinical Course of
			Patients Infected With SARS-CoV-2 in

			Young BE(1)(2)(3), Ong SWX(1)(2), Kalimuddin
			S(4)(5), Low JG(4)(6), Tan SY(7), Loh J(8), Ng
			OT(1)(2)(3), Marimuthu K(1)(2)(9), Ang LW(1),
			Mak TM(1), Lau SK(10), Anderson DE(6), Chan
			KS(4), Tan TY(6)(7), Ng TY(8), Cui L(1), Said
			Z(11), Kurupatham L(11), Chen MI(1)(12), Chan
			M(1)(2), Vasoo S(1)(2), Wang LF(6), Tan
			BH(3)(10), Lin RTP(1), Lee VJM(11)(12), Leo
			YS(1)(2)(3)(9)(12), Lye DC(1)(2)(3)(9); Singapore
			2019 Novel Coronavirus Outbreak Research

			Author Information
			(1) National Centre for Infectious Diseases,
			(2) Tan Tock Seng Hospital, Singapore.
			(3) Lee Kong Chian School of Medicine,
			(4) Singapore General Hospital, Singapore.
			(5) Duke-NUS Graduate Medical School,
			(6) Duke-NUS Medical School, Singapore.
			(7) Changi General Hospital, Singapore.
			(8) Sengkang General Hospital, Singapore.
			(9) Yong Loo Lin School of Medicine,
			(10) DSO National Laboratories, Singapore.
			(11) Ministry of Health, Singapore.
			(12) Saw Swee Hock School of Public Health,

			Importance: Severe acute respiratory syndrome
			coronavirus 2 (SARS-CoV-2) emerged in
			Wuhan, China, in December 2019 and has
			spread globally with sustained
			human-to-human transmission outside China.
			Objective: To report the initial experience in
			Singapore with the epidemiologic investigation
			of this outbreak, clinical features, and
			management. Design, Setting, and
			Participants: Descriptive case series of the
			first 18 patients diagnosed with polymerase
			chain reaction (PCR)-confirmed SARS-CoV-2
			infection at 4 hospitals in Singapore from
			January 23 to February 3, 2020; final follow-up
			date was February 25, 2020. Exposures:
			Confirmed SARS-CoV-2 infection. Main
			Outcomes and Measures: Clinical, laboratory,
			and radiologic data were collected, including
			PCR cycle threshold values from
			nasopharyngeal swabs and viral shedding in
			blood, urine, and stool. Clinical course was
			summarized, including requirement for
			supplemental oxygen and intensive care and
			use of empirical treatment with
			lopinavir-ritonavir. Results: Among the 18
			hospitalized patients with PCR-confirmed
			SARS-CoV-2 infection (median age, 47 years; 9
			[50%] women), clinical presentation was an
			upper respiratory tract infection in 12 (67%),
			and viral shedding from the nasopharynx was
			prolonged for 7 days or longer among 15
			(83%). Six individuals (33%) required
			supplemental oxygen; of these, 2 required
			intensive care. There were no deaths. Virus was
			detectable in the stool (4/8 [50%]) and blood
			(1/12 [8%]) by PCR but not in urine. Five
			individuals requiring supplemental oxygen were
			treated with lopinavir-ritonavir. For 3 of the 5
			patients, fever resolved and supplemental
			oxygen requirement was reduced within 3 days,
			whereas 2 deteriorated with progressive
			respiratory failure. Four of the 5 patients treated
			with lopinavir-ritonavir developed nausea,
			vomiting, and/or diarrhea, and 3 developed
			abnormal liver function test results. Conclusions
			and Relevance: Among the first 18 patients
			diagnosed with SARS-CoV-2 infection in
			Singapore, clinical presentation was frequently
			a mild respiratory tract infection. Some patients
			required supplemental oxygen and had variable
			clinical outcomes following treatment with an
			antiretroviral agent.

			DOI: 10.1001/jama.2020.3204
			PMID: 32125362

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