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First Mildly Ill, Nonhospitalized Case of Coronavirus Disease 2019 (COVID-19) Without Viral Transmission in the United States-Maricopa County, Arizona, 2020.
Clin Infect Dis. 2020 07 28; 71(15):807-812.CI

Abstract

BACKGROUND

Coronavirus disease 2019 (COVID-19) causes a range of illness severity. Mild illness has been reported, but whether illness severity correlates with infectivity is unknown. We describe the public health investigation of a mildly ill, nonhospitalized COVID-19 case who traveled to China.

METHODS

The case was a Maricopa County resident with multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive specimens collected on 22 January 2020. Contacts were persons exposed to the case on or after the day before case diagnostic specimen collection. Contacts were monitored for 14 days after last known exposure. High-risk contacts had close, prolonged case contact (≥ 10 minutes within 2 m). Medium-risk contacts wore all US Centers for Disease Control and Prevention-recommended personal protective equipment during interactions. Nasopharyngeal and oropharyngeal (NP/OP) specimens were collected from the case and high-risk contacts and tested for SARS-CoV-2.

RESULTS

Paired case NP/OP specimens were collected for SARS-CoV-2 testing at 11 time points. In 8 pairs (73%), ≥ 1 specimen tested positive or indeterminate, and in 3 pairs (27%) both tested negative. Specimens collected 18 days after diagnosis tested positive. Sixteen contacts were identified; 11 (69%) had high-risk exposure, including 1 intimate contact, and 5 (31%) had medium-risk exposure. In total, 35 high-risk contact NP/OP specimens were collected for SARS-CoV-2 testing; all 35 pairs (100%) tested negative.

CONCLUSIONS

This report demonstrates that SARS-CoV-2 infection can cause mild illness and result in positive tests for up to 18 days after diagnosis, without evidence of transmission to close contacts. These data might inform public health strategies to manage individuals with asymptomatic infection or mild illness.

Authors+Show Affiliations

Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. Maricopa County Department of Public Health, Phoenix, Arizona, USA. Arizona Department of Health Services, Phoenix, Arizona, USA.Maricopa County Department of Public Health, Phoenix, Arizona, USA.Maricopa County Department of Public Health, Phoenix, Arizona, USA.Maricopa County Department of Public Health, Phoenix, Arizona, USA.Maricopa County Department of Public Health, Phoenix, Arizona, USA.Maricopa County Department of Public Health, Phoenix, Arizona, USA.Maricopa County Department of Public Health, Phoenix, Arizona, USA.Maricopa County Department of Public Health, Phoenix, Arizona, USA.Maricopa County Department of Public Health, Phoenix, Arizona, USA.Maricopa County Department of Public Health, Phoenix, Arizona, USA.Maricopa County Department of Public Health, Phoenix, Arizona, USA.Maricopa County Department of Public Health, Phoenix, Arizona, USA.Maricopa County Department of Public Health, Phoenix, Arizona, USA.Arizona Department of Health Services, Phoenix, Arizona, USA.Arizona Department of Health Services, Phoenix, Arizona, USA.Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.Epidemiology Elective Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.Maricopa County Department of Public Health, Phoenix, Arizona, USA.Maricopa County Department of Public Health, Phoenix, Arizona, USA. Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.No affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

32240285

Citation

Scott, Sarah E., et al. "First Mildly Ill, Nonhospitalized Case of Coronavirus Disease 2019 (COVID-19) Without Viral Transmission in the United States-Maricopa County, Arizona, 2020." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 71, no. 15, 2020, pp. 807-812.
Scott SE, Zabel K, Collins J, et al. First Mildly Ill, Nonhospitalized Case of Coronavirus Disease 2019 (COVID-19) Without Viral Transmission in the United States-Maricopa County, Arizona, 2020. Clin Infect Dis. 2020;71(15):807-812.
Scott, S. E., Zabel, K., Collins, J., Hobbs, K. C., Kretschmer, M. J., Lach, M., Turnbow, K., Speck, L., White, J. R., Maldonado, K., Howard, B., Fowler, J., Singh, S., Robinson, S., Pompa, A. P., Chatham-Stephens, K., Xie, A., Cates, J., Lindstrom, S., ... Sunenshine, R. (2020). First Mildly Ill, Nonhospitalized Case of Coronavirus Disease 2019 (COVID-19) Without Viral Transmission in the United States-Maricopa County, Arizona, 2020. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 71(15), 807-812. https://doi.org/10.1093/cid/ciaa374
Scott SE, et al. First Mildly Ill, Nonhospitalized Case of Coronavirus Disease 2019 (COVID-19) Without Viral Transmission in the United States-Maricopa County, Arizona, 2020. Clin Infect Dis. 2020 07 28;71(15):807-812. PubMed PMID: 32240285.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - First Mildly Ill, Nonhospitalized Case of Coronavirus Disease 2019 (COVID-19) Without Viral Transmission in the United States-Maricopa County, Arizona, 2020. AU - Scott,Sarah E, AU - Zabel,Karen, AU - Collins,Jennifer, AU - Hobbs,Katherine C, AU - Kretschmer,Melissa J, AU - Lach,Mitchell, AU - Turnbow,Katie, AU - Speck,Lindsay, AU - White,Jessica R, AU - Maldonado,Keila, AU - Howard,Brandon, AU - Fowler,Jeanene, AU - Singh,Sonia, AU - Robinson,Susan, AU - Pompa,Alexandra Peterson, AU - Chatham-Stephens,Kevin, AU - Xie,Amy, AU - Cates,Jordan, AU - Lindstrom,Stephen, AU - Lu,Xiaoyan, AU - Rolfes,Melissa A, AU - Flanagan,Marcy, AU - Sunenshine,Rebecca, AU - ,, PY - 2020/03/07/received PY - 2020/04/01/accepted PY - 2020/4/3/pubmed PY - 2020/8/11/medline PY - 2020/4/3/entrez KW - COVID-19 KW - SARS-CoV-2 KW - illness severity KW - serial testing KW - viral transmission SP - 807 EP - 812 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 71 IS - 15 N2 - BACKGROUND: Coronavirus disease 2019 (COVID-19) causes a range of illness severity. Mild illness has been reported, but whether illness severity correlates with infectivity is unknown. We describe the public health investigation of a mildly ill, nonhospitalized COVID-19 case who traveled to China. METHODS: The case was a Maricopa County resident with multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive specimens collected on 22 January 2020. Contacts were persons exposed to the case on or after the day before case diagnostic specimen collection. Contacts were monitored for 14 days after last known exposure. High-risk contacts had close, prolonged case contact (≥ 10 minutes within 2 m). Medium-risk contacts wore all US Centers for Disease Control and Prevention-recommended personal protective equipment during interactions. Nasopharyngeal and oropharyngeal (NP/OP) specimens were collected from the case and high-risk contacts and tested for SARS-CoV-2. RESULTS: Paired case NP/OP specimens were collected for SARS-CoV-2 testing at 11 time points. In 8 pairs (73%), ≥ 1 specimen tested positive or indeterminate, and in 3 pairs (27%) both tested negative. Specimens collected 18 days after diagnosis tested positive. Sixteen contacts were identified; 11 (69%) had high-risk exposure, including 1 intimate contact, and 5 (31%) had medium-risk exposure. In total, 35 high-risk contact NP/OP specimens were collected for SARS-CoV-2 testing; all 35 pairs (100%) tested negative. CONCLUSIONS: This report demonstrates that SARS-CoV-2 infection can cause mild illness and result in positive tests for up to 18 days after diagnosis, without evidence of transmission to close contacts. These data might inform public health strategies to manage individuals with asymptomatic infection or mild illness. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/32240285/First_Mildly_Ill_Nonhospitalized_Case_of_Coronavirus_Disease_2019__COVID_19__Without_Viral_Transmission_in_the_United_States_Maricopa_County_Arizona_2020_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciaa374 DB - PRIME DP - Unbound Medicine ER -