America’s Patient Zero returned from Wuhan: He has not been named. (China is still trying to find its Patient Zero.)

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Boston Herald

First coronavirus case in U.S. traced back to Wuhan

The man came in with a ‘persistent dry cough and a 2-day history of nausea and vomiting’

By JOE DWINELL | joed@bostonherald.com | Boston HeraldPUBLISHED: March 23, 2020 at 7:18 p.m. | UPDATED: March 23, 2020 at 8:51 p.m.

A man just back from Wuhan walked into a clinic in Washington state Jan. 19 complaining of a four-day cough. One day later, he was patient zero.

The 35-year-old is America’s first case of the coronavirus, public health investigators report.

The man came in with a “persistent dry cough and a 2-day history of nausea and vomiting.” It got worse by day six, according to the report in the New England Journal of Medicine.

On the sixth day, the man had “atypical pneumonia,” often called walking pneumonia. He needed oxygen, he had “ongoing fevers,” and remdesivir (an antiviral drug studied to treat Ebola) was used to treat him. That, the Journal report states, seemed to help.

“On hospital day 8 — illness day 12 — the patient’s clinical condition improved. Supplemental oxygen was discontinued, and his oxygen saturation values improved to 94 to 96% while he was breathing ambient air,” the report states.

His appetite improved. His dry cough lingered, but he was getting better.

The report states the man’s case “highlights the importance of close coordination between clinicians and public health authorities at the local, state, and federal levels” and how to quickly share information. And, the researchers added, that man did not go to the Huanan Seafood Wholesale Market, once considered the coronavirus epicenter.

But since that man visited family in Wuhan, China, COVID-19 has spread across the globe like an invisible wildfire.

As of Monday night, 375,458 people had been infected worldwide with 16,371 deaths — the most in Italy that reported more than 6,000 dead.


https://www.bostonherald.com/2020/03/23/first-case-in-u-s-traced-back-to-wuhan/

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Excerpts from:

The New England Journal of Medicine

First Case of 2019 Novel Coronavirus in the United States

List of authors.

  • Michelle L. Holshue, M.P.H., 
  • Chas DeBolt, M.P.H., 
  • Scott Lindquist, M.D., 
  • Kathy H. Lofy, M.D., 
  • John Wiesman, Dr.P.H., 
  • Hollianne Bruce, M.P.H., 
  • Christopher Spitters, M.D., 
  • Keith Ericson, P.A.-C., 
  • Sara Wilkerson, M.N., 
  • Ahmet Tural, M.D., 
  • George Diaz, M.D., 
  • Amanda Cohn, M.D., 
  • et al.,
  •  for the Washington State 2019-nCoV Case Investigation Team*

Summary

An outbreak of novel coronavirus (2019-nCoV) that began in Wuhan, China, has spread rapidly, with cases now confirmed in multiple countries. We report the first case of 2019-nCoV infection confirmed in the United States and describe the identification, diagnosis, clinical course, and management of the case, including the patient’s initial mild symptoms at presentation with progression to pneumonia on day 9 of illness. This case highlights the importance of close coordination between clinicians and public health authorities at the local, state, and federal levels, as well as the need for rapid dissemination of clinical information related to the care of patients with this emerging infection.

On December 31, 2019, China reported a cluster of cases of pneumonia in people associated with the Huanan Seafood Wholesale Market in Wuhan, Hubei Province.1On January 7, 2020, Chinese health authorities confirmed that this cluster was associated with a novel coronavirus, 2019-nCoV.2 Although cases were originally reported to be associated with exposure to the seafood market in Wuhan, current epidemiologic data indicate that person-to-person transmission of 2019-nCoV is occurring.3-6 As of January 30, 2020, a total of 9976 cases had been reported in at least 21 countries,7 including the first confirmed case of 2019-nCoV infection in the United States, reported on January 20, 2020. Investigations are under way worldwide to better understand transmission dynamics and the spectrum of clinical illness. This report describes the epidemiologic and clinical features of the first case of 2019-nCoV infection confirmed in the United States.

Case Report

On January 19, 2020, a 35-year-old man presented to an urgent care clinic in Snohomish County, Washington, with a 4-day history of cough and subjective fever. On checking into the clinic, the patient put on a mask in the waiting room. After waiting approximately 20 minutes, he was taken into an examination room and underwent evaluation by a provider. He disclosed that he had returned to Washington State on January 15 after traveling to visit family in Wuhan, China. The patient stated that he had seen a health alert from the U.S. Centers for Disease Control and Prevention (CDC) about the novel coronavirus outbreak in China and, because of his symptoms and recent travel, decided to see a health care provider.

DISCUSSION

Our report of the first confirmed case of 2019-nCoV in the United States illustrates several aspects of this emerging outbreak that are not yet fully understood, including transmission dynamics and the full spectrum of clinical illness. Our case patient had traveled to Wuhan, China, but reported that he had not visited the wholesale seafood market or health care facilities or had any sick contacts during his stay in Wuhan. Although the source of his 2019-nCoV infection is unknown, evidence of person-to-person transmission has been published. Through January 30, 2020, no secondary cases of 2019-nCoV related to this case have been identified, but monitoring of close contacts continues.19

Detection of 2019-nCoV RNA in specimens from the upper respiratory tract with low Ct values on day 4 and day 7 of illness is suggestive of high viral loads and potential for transmissibility. It is notable that we also detected 2019-nCoV RNA in a stool specimen collected on day 7 of the patient’s illness. Although serum specimens from our case patient were repeatedly negative for 2019-nCoV, viral RNA has been detected in blood in severely ill patients in China.4 However, extrapulmonary detection of viral RNA does not necessarily mean that infectious virus is present, and the clinical significance of the detection of viral RNA outside the respiratory tract is unknown at this time.

Currently, our understanding of the clinical spectrum of 2019-nCoV infection is very limited. Complications such as severe pneumonia, respiratory failure, acute respiratory distress syndrome (ARDS), and cardiac injury, including fatal outcomes, have been reported in China.4,18,20 However, it is important to note that these cases were identified on the basis of their pneumonia diagnosis and thus may bias reporting toward more severe outcomes.

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. 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. In addition, the timing of our case patient’s progression to pneumonia on day 9 of illness is consistent with later onset of dyspnea (at a median of 8 days from onset) reported in a recent publication.4 Although a decision to administer remdesivir for compassionate use was based on the case patient’s worsening clinical status, randomized controlled trials are needed to determine the safety and efficacy of remdesivir and any other investigational agents for treatment of patients with 2019-nCoV infection.

We report the clinical features of the first reported patient with 2019-nCoV infection in the United States. Key aspects of this case included the decision made by the patient to seek medical attention after reading public health warnings about the outbreak; recognition of the patient’s recent travel history to Wuhan by local providers, with subsequent coordination among local, state, and federal public health officials; and identification of possible 2019-nCoV infection, which allowed for prompt isolation of the patient and subsequent laboratory confirmation of 2019-nCoV, as well as for admission of the patient for further evaluation and management. This case report highlights the importance of clinicians eliciting a recent history of travel or exposure to sick contacts in any patient presenting for medical care with acute illness symptoms, in order to ensure appropriate identification and prompt isolation of patients who may be at risk for 2019-nCoV infection and to help reduce further transmission. Finally, this report highlights the need to determine the full spectrum and natural history of clinical disease, pathogenesis, and duration of viral shedding associated with 2019-nCoV infection to inform clinical management and public health decision making.

https://www.nejm.org/doi/full/10.1056/NEJMoa2001191?query=featured_home

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Business Insider

The first COVID-19 case originated on November 17, according to Chinese officials searching for ‘Patient Zero’

Isaac Scher 
3/13/2020

  • The original case of the novel coronavirus emerged on November 17, according to data from the Chinese government reviewed by South China Morning Post.
  • The identity of the person has not been confirmed, but it appears to be a 55-year-old from the Hubei province.
  • It wasn’t until December that Chinese authorities realized they had a new type of virus on their hands.


https://www.msn.com/en-us/news/world/the-first-covid-19-case-originated-on-november-17-according-to-chinese-officials-searching-for-patient-zero/ar-BB119fWJ

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The Scientist

Chinese Officials Blame US Army for Coronavirus

There is no evidence backing the idea that SARS-CoV-2 originated from US service members visiting Wuhan.

Lisa Winter
Mar 13, 2020

AChinese official who has a history of attacking the United States online has lent a voice to a conspiracy theory that blames American soldiers for bringing COVID-19 to China, though the science does not support that narrative.

According to the unfounded accusation, which reports say has been widely shared on the popular Chinese social media platform Weibo, the novel coronavirus SARS-CoV-2 was introduced to China when 300 US military members arrived in the Wuhan region for the Military World Games in mid-October and infected the local population. None of the servicemembers who made the trip have tested positive for the virus.

An analysis of the virus’s genome indicates that the outbreak wasn’t caused by a strain from a lab and likely came from wild animals instead.

Despite the lack of evidence, the fact that a government official is making these claims seemingly unchecked could have larger consequences, says Victor Shih, an associate professor at the University of California, San Diego.

“If the [Chinese] leadership really believes in the culpability of the U.S. government,” Shih tells The New York Times, “it may behave in a way that dramatically worsens the bilateral relationship.”

The statements might simply be a distraction from criticisms about how China has handled the outbreak. Li Wenliang, a Chinese doctor who had tried to raise awareness about the virus in the early stages, was punished by the government and forced to say his concerns were an “illegal rumor.” Li contracted the virus himself while treating a patient in January and died on February 7. Critics claim that had these concerns been taken seriously at the time, it could have curbed the severity of the outbreak.

The unfounded claims could also be a response to US officials who have referred to SARS-CoV-2 as the “China virus” or “Wuhan virus,” according to the Times, terms that Lijian denounced as “highly irresponsible” at a March 4 press conference.

https://www.the-scientist.com/news-opinion/chinese-officials-blame-us-army-for-coronavirus-67267

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