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Abstract
Data on the detailed clinical progression of COVID-19 in conjunction with epidemiological
and virological characteristics are limited. In this case series, we describe the
first 12 US patients confirmed to have COVID-19 from 20 January to 5 February 2020,
including 4 patients described previously1-3. Respiratory, stool, serum and urine
specimens were submitted for SARS-CoV-2 real-time reverse-transcription polymerase
chain reaction (rRT-PCR) testing, viral culture and whole genome sequencing. Median
age was 53 years (range: 21-68); 8 patients were male. Common symptoms at illness
onset were cough (n = 8) and fever (n = 7). Patients had mild to moderately severe
illness; seven were hospitalized and demonstrated clinical or laboratory signs of
worsening during the second week of illness. No patients required mechanical ventilation
and all recovered. All had SARS-CoV-2 RNA detected in respiratory specimens, typically
for 2-3 weeks after illness onset. Lowest real-time PCR with reverse transcription
cycle threshold values in the upper respiratory tract were often detected in the first
week and SARS-CoV-2 was cultured from early respiratory specimens. These data provide
insight into the natural history of SARS-CoV-2. Although infectiousness is unclear,
highest viral RNA levels were identified in the first week of illness. Clinicians
should anticipate that some patients may worsen in the second week of illness.