key: cord-0986420-e3dh0huv authors: Wang, Lei; Gao, Yong-hua; lou, Li-Li; Zhang, Guo-Jun title: The clinical dynamics of 18 cases of COVID-19 outside of Wuhan, China date: 2020-03-05 journal: Eur Respir J DOI: 10.1183/13993003.00398-2020 sha: c5aa7c0962a7247169ee2124f9f3be9fca8898fa doc_id: 986420 cord_uid: e3dh0huv The novel coronavirus can be transmitted from person to person with infection ranging from mild disease to severe pneumonia and radiological abnormalities on chest CT for most patients improved after RT-PCR conversion. Since an outbreak of 2019 novel coronavirus in Wuhan and related regions in Hubei province, an increasing number of exported cases have been confirmed in other provinces in China and in multiple countries around the world with substantial morbidity and mortality [1] [2] [3] [4] . The WHO has declared a public health emergency of international concern considering rapid increases in numbers of confirmed cases in China and additional countries. As of February 22, 2020, a total of 12938 patients had been confirmed outside of Wuhan and related regions in Hubei province of China [1] . However, there is limited information about COVID-19 outside of Wuhan [5] , and no study has reported the time to RT-PCR conversion and radiological changes after treatment. We recruited all patients who were diagnosed as having COVID-19 from Jan 21 to Feb 05, 2020, at the First Affiliated Hospital of Zhengzhou University in Zhengzhou, China. The final date of follow-up was February 7, 2020. Throat-swab specimens were collected and sent to the Henan center for disease control and prevention and SARS-CoV-2 detected by real-time RT-PCR. Chest computed tomography (CT) was performed on admission and at the time of RT-PCR conversion. Data were collected from electronic medical records, with epidemiological and symptom data confirmed by directly communicating with patients or their family members (interviews conducted by L.W. and L.L.L.). The date of symptom onset referred to the day when the symptom was noted. Time to real-time RT-PCR conversion was calculated from the date of symptom onset to the day when SARS-CoV-2 was undetectable from two consecutive throat-swab specimens. Patients could be discharged from hospital when they had RT-PCR conversion and no fever for at least three days according to the interim guidance from Chinese National Heath Commission on clinical management of COVID-19 [6] . The study was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University, with a waiver of written informed consent. 18 patients with COVID-19 were included, with one familial cluster of infection. Of these patients, 10 (55.6%) were male, with a median age of 39 years (interquartile range 29-55). For the familial cluster of infection (including 2 children aged 7 and 9 years), 5 of six family members had been tested positive for SARS-CoV-2 and the remaining one was highly suspected due to bilateral ground-glass opacities on his chest CT but RT-PCR was negative. 13 On admission, most patients presented as fever (94.4%) or cough (55.6%). Other symptoms included short of breath (22.2%), hemoptysis (5.6%), muscle ache (11.1%), headache (5.6%), sore throat (5.6%), diarrhea (16.7%), nausea and vomiting (5.6%). One patient had acute lung injury and was admitted to ICU. For laboratory results (data available for 16 patients) and chest CT, white blood cells were below the normal range in 3 (18.8%) and above the normal range in 1 (6.3%). 3 Our results firstly show that time to RT-PCR conversion was 19.5 days for COVID-19 and most patients had significantly radiological improvements after RT-PCR conversion. Consistent with previous studies, most patients manifested as fever, dry cough and short of breath [2] [3] [4] . The patterns of radiological appearance were bilateral ground-glass opacities with or without consolidations [7] . All these features resemble with SARS-CoV and MERS-CoV [8, 9] . However, patients with COVID-19 can present as mild disease or even no symptom, and no lung abnormalities or severe pneumonia on chest CT images. We reported a family cluster infection and some confirmed cases did not have comorbidities and the history of visiting to Wuhan, suggesting human-to-human transmission has been occurred outside of Wuhan regardless of age and underlying conditions [10] [11] [12] . Compared with patients in Wuhan, the manifestations of patients in Henan province are relatively mild [2] [3] [4] , which was consistent with 13 case series of COVID-19 in Beijing [5] . Notably, transmission in asymptomatic carrier has been reported [12] , which might pose more threat than symptomatic patients to epidemic prevention and control. The median time from symptom onset to RT-PCR conversion in patients with COVID-19 was 19.5 days, which seems to be shorter than patients infected with SARS or MERS-CoV [13, 14] . Previous studies in SARS-CoV or MERS-CoV showed that viral RNA could be detected in clinical specimens in patients >30 days after symptom onset [13, 14] . It was worth mentioning that we only used the throat-swab specimen to detect the viral RNA. Evidence have showed that SARS-CoV-2, SARS or MERS RNA could be detected in both upper and lower respiratory tract samples, even in blood, stool and urine specimens [2, 13, 14] . 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