A 35-year-old male resident of Washington, presented to an urgent care clinic on 19th January 2020, with a four-day history of fever, persistent dry cough, nausea and vomiting for two days and positive travel history. He had travelled to Wuhan, China, from where he returned back four days back i.e. oh 15th January. Apart from the presenting symptoms and the history of hypertriglyceridemia, he was a healthy individual with insignificant past medical and surgical history.
Upon physical examination, the following was revealed:
– Temperature: 37.2°C
– Blood pressure: 134/87 mm Hg
– Pulse: 110 beats per minute
– Respiratory rate: 16 breaths per minute
– SaO2: 96% on room air.
Mucous membranes were dry.
Ronchi was noticed on lung auscultation whereas and chest radiography was normal. All tests including rapid nucleic acid amplification test (NAAT) for influenza and nasopharyngeal swab for coronavirus, viral respiratory infections, including respiratory syncytial virus, adenovirus, parainfluenza, etc. were reported to be normal.
With the positive travel history and the pandemic situation, Health departments were notified and the CDC swab-tested the patient for 2019-nCoV, which came out to be positive. Thereafter, the patient was admitted to the isolation unit where the patient received supportive treatment like fluids (2L of 0.9% normal saline) and anti-emetics to help with nausea. Over the course of the next 2-3 days, the patient’s vitals remained relatively stable accompanied by intermittent bouts of fever and fatigue, but the patient developed loose motions with abdominal discomfort on day two of hospitalization.
RRT-PCR testing was conducted on the stool and respiratory samples which returned back positive, whereas the serum test remained negative for Covid-19. Complete blood picture reflected reduced WBCs (leukopenia), mild decrease in platelets (thrombocytopenia), and high creatine kinase. A second CXR was done on hospital day 5, suggesting pneumonia in the lower lobe of the left lung and SaO2 dropped to 90% on room air, therefore the next day, the patient was given supplemental oxygen by nasal cannula and antibiotics, vancomycin and cefepime were initiated. With the gradually progressive and positive test for coronavirus, physicians were compelled to initiate intravenous antiviral, remdesivir, on the seventh day of hospitalization, after which the patient improved with gradual improvement in the saturation of oxygen, auscultatory findings of lungs and his appetite.
The last known report till the 30th of January revealed that the patient has become asymptomatic except for mild intermittent cough and rhinorrhea, but was kept under observation in the hospital
Treatment of coronavirus is largely supportive and symptomatic with fluids and antipyretics like acetaminophen and ibuprofen. Although the best treatment is still prevention!
First Case of 2019 Novel Coronavirus in the United States. (2020, January 31). Retrieved from New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMoa2001191
World Health Organisation: https://www.who.int/health-topics/coronavirus