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First Case of 2019 Novel Coronavirus in the United States.
N Engl J Med. 2020 03 05; 382(10):929-936.NEJM

Abstract

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.

Authors+Show Affiliations

From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.From the Epidemic Intelligence Service (M.L.H.), the National Center for Immunizations and Respiratory Diseases (A.C., L.F., A.P.), the Division of Viral Diseases (S.I.G., L.K., S.T., X.L., S. Lindstrom, M.A.P., W.C.W., H.M.B.), the Influenza Division (T.M.U.), and the Division of Preparedness and Emerging Infections (S.K.P.), Centers for Disease Control and Prevention, Atlanta; and the Washington State Department of Health, Shoreline (M.L.H., C.D., S. Lindquist, K.H.L., J.W.), Snohomish Health District (H.B., C.S.), Providence Medical Group (K.E.), and Providence Regional Medical Center (S.W., A.T., G.D.), Everett, and Department of Medicine, University of Washington School of Medicine, Seattle (C.S.) - all in Washington.No affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

32004427

Citation

Holshue, Michelle L., et al. "First Case of 2019 Novel Coronavirus in the United States." The New England Journal of Medicine, vol. 382, no. 10, 2020, pp. 929-936.
Holshue ML, DeBolt C, Lindquist S, et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med. 2020;382(10):929-936.
Holshue, M. L., DeBolt, C., Lindquist, S., Lofy, K. H., Wiesman, J., Bruce, H., Spitters, C., Ericson, K., Wilkerson, S., Tural, A., Diaz, G., Cohn, A., Fox, L., Patel, A., Gerber, S. I., Kim, L., Tong, S., Lu, X., Lindstrom, S., ... Pillai, S. K. (2020). First Case of 2019 Novel Coronavirus in the United States. The New England Journal of Medicine, 382(10), 929-936. https://doi.org/10.1056/NEJMoa2001191
Holshue ML, et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med. 2020 03 5;382(10):929-936. PubMed PMID: 32004427.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - First Case of 2019 Novel Coronavirus in the United States. AU - Holshue,Michelle L, AU - DeBolt,Chas, AU - Lindquist,Scott, AU - Lofy,Kathy H, AU - Wiesman,John, AU - Bruce,Hollianne, AU - Spitters,Christopher, AU - Ericson,Keith, AU - Wilkerson,Sara, AU - Tural,Ahmet, AU - Diaz,George, AU - Cohn,Amanda, AU - Fox,LeAnne, AU - Patel,Anita, AU - Gerber,Susan I, AU - Kim,Lindsay, AU - Tong,Suxiang, AU - Lu,Xiaoyan, AU - Lindstrom,Steve, AU - Pallansch,Mark A, AU - Weldon,William C, AU - Biggs,Holly M, AU - Uyeki,Timothy M, AU - Pillai,Satish K, AU - ,, Y1 - 2020/01/31/ PY - 2020/2/1/pubmed PY - 2020/3/17/medline PY - 2020/2/1/entrez SP - 929 EP - 936 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 382 IS - 10 N2 - 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. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/32004427/full_citation L2 - https://www.nejm.org/doi/10.1056/NEJMoa2001191?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -