First 12 patients with coronavirus disease 2019 (COVID-19) in the United States
Authors:   The COVID-19 Investigation Team, Kujawski Stephanie A. , Wong Karen K , Collins Jennifer P. , Epstein Lauren , Killerby Marie E. , Midgley Claire M. , Abedi Glen R. , Ahmed N. Seema , Almendares Olivia , Alvarez Francisco N. , Anderson Kayla N. , Balter Sharon , Barry Vaughn , Bartlett Karri , Beer Karlyn , Ben-Aderet Michael A. , Benowitz Isaac , Biggs Holly , Binder Alison M. , Black Stephanie R. , Bonin Brandon , Brown Catherine M. , Bruce Hollianne , Bryant-Genevier Jonathan , Budd Alicia , Buell Diane , Bystritsky Rachel , Cates Jordan , Charles E. Matt , Chatham-Stephens Kevin , Chea Nora , Chiou Howard , Christiansen Demian , Chu Victoria , Cody Sara , Cohen Max , Conners Erin , Curns Aaron , Dasari Vishal , Dawson Patrick , DeSalvo Traci , Diaz George , Donahue Matthew , Donovan Suzanne , Duca Lindsey M. , Erickson Keith , Esona Mathew D. , Evans Suzanne , Falk Jeremy , Feldstein Leora R. , Fenstersheib Martin , Fischer Marc , Fisher Rebecca , Foo Chelsea , Fricchione Marielle J. , Friedman Oren , Fry Alicia M. , Galang Romeo R. , Garcia Melissa M. , Gerber Susa I. , Gerrard Graham , Ghinai Isaac , Gounder Prabhu , Grein Jonathan , Grigg Cheri , Gunzenhauser Jeffrey D. , Gutkin Gary I. , Haddix Meredith , Hall Aron J. , Han George , Harcourt Jennifer , Harriman Kathleen , Haupt Thomas , Haynes Amber , Holshue Michelle , Hoover Cora , Hunter Jennifer C. , Jacobs Max W. , Jarashow Claire , Jhung Michael A. , Joshi Kiran , Kamali Talar , Kamili Shifaq , Kim Lindsay , Kim Moon , King Jan , Kirking Hannah L. , Kita-Yarbro Amanda , Klos Rachel , Kobayashi Miwako , Kocharian Anna , Komatsu Kenneth K. , Koppaka Ram , Layden Jennifer E. , Li Yan , Lindquist Scott , Lindstrom Stephen , Link-Gelles Ruth , Lively Joana , Livingston Michelle , Lo Kelly , Lo Jennifer , Lu Xiaoyan , Lynch Brian , Madoff Larry , Malapati Lakshmi , Marks Gregory , Marlow Mariel , Mathisen Glenn E. , McClung Nancy , McGovern Olivia , McPherson Tristan D. , Mehta Mitali , Meier Audrey , Mello Lynn , Moon Sung-sil , Morgan Margie , Moro Ruth N. , Murray Janna' , Murthy Rekha , Novosad Shannon , Oliver Sara E. , O'Shea Jennifer , Pacilli Massimo , Paden Clinton R. , Pallansch Mark A. , Patel Manisha , Patel Sajan , Pedraza Isabel , Pillai Satish K. , Pindyck Talia , Pray Ian , Queen Krista , Quick Nichole , Reese Heather , Rha Brian , Rhodes Heather , Robinson Susan , Robinson Philip , Rolfes Melissa , Routh Janell , Rubin Rachel , Rudman Sarah L. , Sakthivel Senthilkumar K. , Scott Sarah , Shepherd Christopher , Shetty Varun , Smith Ethan A. , Smith Shanon , Stierman Bryan , Stoecker William , Sunenshine Rebecca , Sy-Santos Regina , Tamin Azaibi , Tao Ying , Terashita Dawn , Thornburg Natalie J. , Tong Suxiang , Traub Elizabeth , Tural Ahmet , Uehara Anna , Uyeki Timothy M. , Vahey Grace , Verani Jennifer R. , Villarino Elsa , Wallace Megan , Wang Lijuan , Watson John T. , Westercamp Matthew , Whitaker Brett , Wilkerson Sarah , Woodruff Rebecca C. , Wortham Jonathan M. , Wu Tiffany , Xie Amy , Yousaf Anna , Zahn Matthew , Zhang Jing 
Published: March 2020

Introduction

More than 93,000 cases of coronavirus disease (COVID-19) have been reported worldwide. We describe the epidemiology, clinical course, and virologic characteristics of the first 12 U.S. patients with COVID-19.

Methods

We collected demographic, exposure, and clinical information from 12 patients confirmed by CDC during January 20–February 5, 2020 to have COVID-19. Respiratory, stool, serum, and urine specimens were submitted for SARS-CoV-2 rRT-PCR testing, virus culture, and whole genome sequencing.

Results

Among the 12 patients, median age was 53 years (range: 21–68); 8 were male, 10 had traveled to China, and two were contacts of patients in this series. Commonly reported signs and symptoms at illness onset were fever (n=7) and cough (n=8). Seven patients were hospitalized with radiographic evidence of pneumonia and demonstrated clinical or laboratory signs of worsening during the second week of illness. Three were treated with the investigational antiviral remdesivir. All patients had SARS-CoV-2 RNA detected in respiratory specimens, typically for 2–3 weeks after illness onset, with lowest rRT-PCR Ct values often detected in the first week. SARS-CoV-2 RNA was detected after reported symptom resolution in seven patients. SARS-CoV-2 was cultured from respiratory specimens, and SARS-CoV-2 RNA was detected in stool from 7/10 patients.

Conclusions

In 12 patients with mild to moderately severe illness, SARS-CoV-2 RNA and viable virus were detected early, and prolonged RNA detection suggests the window for diagnosis is long. Hospitalized patients showed signs of worsening in the second week after illness onset.