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Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore.
JAMA. 2020 Mar 03 [Online ahead of print]JAMA

Abstract

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.

Authors+Show Affiliations

National Centre for Infectious Diseases, Singapore. Tan Tock Seng Hospital, Singapore. Lee Kong Chian School of Medicine, Singapore.National Centre for Infectious Diseases, Singapore. Tan Tock Seng Hospital, Singapore.Singapore General Hospital, Singapore. Duke-NUS Graduate Medical School, Singapore.Singapore General Hospital, Singapore. Duke-NUS Medical School, Singapore.Changi General Hospital, Singapore.Sengkang General Hospital, Singapore.National Centre for Infectious Diseases, Singapore. Tan Tock Seng Hospital, Singapore. Lee Kong Chian School of Medicine, Singapore.National Centre for Infectious Diseases, Singapore. Tan Tock Seng Hospital, Singapore. Yong Loo Lin School of Medicine, Singapore.National Centre for Infectious Diseases, Singapore.National Centre for Infectious Diseases, Singapore.DSO National Laboratories, Singapore.Duke-NUS Medical School, Singapore.Singapore General Hospital, Singapore.Duke-NUS Medical School, Singapore. Changi General Hospital, Singapore.Sengkang General Hospital, Singapore.National Centre for Infectious Diseases, Singapore.Ministry of Health, Singapore.Ministry of Health, Singapore.National Centre for Infectious Diseases, Singapore. Saw Swee Hock School of Public Health, Singapore.National Centre for Infectious Diseases, Singapore. Tan Tock Seng Hospital, Singapore.National Centre for Infectious Diseases, Singapore. Tan Tock Seng Hospital, Singapore.Duke-NUS Medical School, Singapore.Lee Kong Chian School of Medicine, Singapore. DSO National Laboratories, Singapore.National Centre for Infectious Diseases, Singapore.Ministry of Health, Singapore. Saw Swee Hock School of Public Health, Singapore.National Centre for Infectious Diseases, Singapore. Tan Tock Seng Hospital, Singapore. Lee Kong Chian School of Medicine, Singapore. Yong Loo Lin School of Medicine, Singapore. Saw Swee Hock School of Public Health, Singapore.National Centre for Infectious Diseases, Singapore. Tan Tock Seng Hospital, Singapore. Lee Kong Chian School of Medicine, Singapore. Yong Loo Lin School of Medicine, Singapore.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32125362

Citation

Young, Barnaby Edward, et al. "Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore." JAMA, 2020.
Young BE, Ong SWX, Kalimuddin S, et al. Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore. JAMA. 2020.
Young, B. E., Ong, S. W. X., Kalimuddin, S., Low, J. G., Tan, S. Y., Loh, J., Ng, O. T., Marimuthu, K., Ang, L. W., Mak, T. M., Lau, S. K., Anderson, D. E., Chan, K. S., Tan, T. Y., Ng, T. Y., Cui, L., Said, Z., Kurupatham, L., Chen, M. I., ... Lye, D. C. (2020). Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore. JAMA. https://doi.org/10.1001/jama.2020.3204
Young BE, et al. Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore. JAMA. 2020 Mar 3; PubMed PMID: 32125362.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore. AU - Young,Barnaby Edward, AU - Ong,Sean Wei Xiang, AU - Kalimuddin,Shirin, AU - Low,Jenny G, AU - Tan,Seow Yen, AU - Loh,Jiashen, AU - Ng,Oon-Tek, AU - Marimuthu,Kalisvar, AU - Ang,Li Wei, AU - Mak,Tze Minn, AU - Lau,Sok Kiang, AU - Anderson,Danielle E, AU - Chan,Kian Sing, AU - Tan,Thean Yen, AU - Ng,Tong Yong, AU - Cui,Lin, AU - Said,Zubaidah, AU - Kurupatham,Lalitha, AU - Chen,Mark I-Cheng, AU - Chan,Monica, AU - Vasoo,Shawn, AU - Wang,Lin-Fa, AU - Tan,Boon Huan, AU - Lin,Raymond Tzer Pin, AU - Lee,Vernon Jian Ming, AU - Leo,Yee-Sin, AU - Lye,David Chien, AU - ,, Y1 - 2020/03/03/ PY - 2020/3/4/entrez PY - 2020/3/4/pubmed PY - 2020/3/4/medline JF - JAMA JO - JAMA N2 - 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. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/32125362/full_citation L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2020.3204 DB - PRIME DP - Unbound Medicine ER -
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