re: Coronavirus Disease 2019 (COVID-19) ***W.H.O. DECLARES A GLOBAL PANDEMIC***

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muh

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Italian blood seems lazy and weak

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Case 1 occurred in a 35-year-old woman from South Asia who worked as a restaurant server on the ship. On day 1 of her illness, February 7, she experienced throat dryness and a slight cough (Figure, panel A). She and her roommate shared a bathroom with 2 others who had similar symptoms earlier. Case-patient 1 reported her symptoms but continued to work because she was afebrile. On day 3, she had throat soreness, stayed in her room, and was tested for SARS-CoV-2 by reverse transcription PCR (RT-PCR). On days 4–5, her symptoms diminished. On day 6, she was told she tested positive and was transferred to Asahi General Hospital (Chiba, Japan).

At admission, she had a slight sore throat and cough. Her temperature was 36.5°C; blood pressure, 113/85 mm Hg; pulse, 92 bpm; respiration, 16 breaths/min; and oxygen saturation, 95% on ambient air. She had no underlying medical conditions and was taking no routine medication. On examination, her throat was bright red without exudates, lung auscultation was clear, and chest radiographs and blood tests were not clinically significant (Appendix Figure 1, panel A, Table 1). We did not suspect pneumonia and did not perform computed tomography. On day 8, she reported slight rhinorrhea. On day 9, RT-PCR again was positive for SARS-CoV-2. Her symptoms continued to diminish, and by day 10 she had discontinued all medications. RT-PCR results were positive on days 13 and 15, negative on day 19, positive again on day 20, and negative again on days 22 and 23, meeting the criteria for discharge, 2 consecutive negative assays.

She never had fever, shortness of breath, or sputum, and daily lung auscultation was clear, suggesting absence of pneumonia.

Case 2 occurred in a 27-year-old man from South Asia who worked as a kitchen cleaner on the ship. On day 1 of his illness, February 8, he had a fever (38.6°C), sore throat, and cough. His roommate had similar symptoms that started 2 days before. Case-patient 2 reported his symptoms but continued to work. On day 2, he was tested for SARS-CoV-2 but continued to work. On day 3, his fever persisted, so he stayed in his room. By day 4, his symptoms resolved. On day 5, he was told he tested positive for SARS-CoV-2 and was transferred to Asahi General Hospital.

At admission, he had no respiratory or other symptoms. He had no underlying medical conditions and was taking no routine medication. His temperature was 36.0°C; blood pressure, 132/85 mm Hg; pulse, 87 bpm; respirations, 16 breaths/min; and oxygen saturation, 95% on ambient air. On examination, his throat was bright red without exudates (Appendix Figure 2), lung auscultation was clear, and chest radiographs and blood tests were not clinically significant (Appendix Figure 1, panel B, Table 2). He remained asymptomatic, but on day 8, RT-PCR results were positive; results remained positive on days 12, 14, 18, and 21.

His throat redness did not improve, but he did not report throat soreness or discomfort. He never experienced shortness of breath or sputum, and daily lung auscultations were clear.

We describe 2 mild cases of COVID-19 without discernable pneumonia, which could represent the clinical course in young, healthy persons. Worldwide, cases are appearing without apparent epidemiologic links (8). As the virus spreads, more mild COVID-19 cases are likely, and clinicians should be aware of clinical manifestations in the absence of severe symptoms. Case-patient 2’s symptoms rapidly decreased, but detectable viral RNA persisted for >2 weeks.

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