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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.

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    Holshue ML
    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.
    DeBolt C
    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.
    Lindquist S
    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.
    Lofy KH
    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.
    Wiesman J
    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.
    Bruce H
    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.
    Spitters C
    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.
    Ericson K
    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.
    Wilkerson S
    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.
    Tural A
    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.
    Diaz G
    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.
    Cohn A
    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.
    Fox L
    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.
    Patel A
    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.
    Gerber SI
    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.
    Kim L
    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.
    Tong S
    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.
    Lu X
    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.
    Lindstrom S
    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.
    Pallansch MA
    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.
    Weldon WC
    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.
    Biggs HM
    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.
    Uyeki TM
    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.
    Pillai SK
    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.
    Washington State 2019-nCoV Case Investigation Team
    No affiliation info available

    MeSH

    AdultBetacoronavirusBlood Chemical AnalysisChinaCoronavirus InfectionsDisease ProgressionGenome, ViralHumansLungMalePneumonia, ViralRadiography, ThoracicSequence Analysis, DNATravelUnited States

    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 - http://www.nejm.org/doi/full/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 -