The first 2019 novel coronavirus case in Nepal
Authors: Anup Bastola, Ranjit Sah, Alfonso J Rodriguez-Morales, Bibek Kumar Lal, Runa Jha, Hemant Chanda Ojha, Bikesh Shrestha, Daniel K W Chu, Leo L M Poon, Anthony Costello, Kouichi Morita, Basu Dev Pandey
Journal: The Lancet Infectious Diseases (2020)

In January, 2020, the outbreak of the 2019 novel coronavirus (2019-nCoV) in China spread progressively to other countries,1Huang C Wang Y Li X et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.Lancet. 2020; (published online Jan 24.)http://dx.doi.org/10.1016/S0140-6736(20)30183-5Summary Full Text Full Text PDF Scopus (32861) Google Scholar, 2Chan JF-W Yuan S Kok K-H et al.A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster.Lancet. 2020; (published online Jan 24.)http://dx.doi.org/10.1016/S0140-6736(20)30154-9Summary Full Text Full Text PDF Scopus (6197) Google Scholar with WHO declaring it a Public Health Emergency of International Concern.3WHOStatement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV).https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)Date: 2020Date accessed: January 2, 2020Google Scholar Among the affected countries beyond China (where 12 307 cases and 259 deaths were reported as of Feb 1, 2020) are others in Asia, including Nepal.4WHONovel coronavirus (2019-nCoV)—Situation report—10–30 January.https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200130-sitrep-10-ncov.pdf?sfvrsn=d0b2e480_2Date: 2020Date accessed: January 2, 2020Google Scholar On Jan 13, 2020, a 32-year-old man, a Nepalese student at Wuhan University of Technology, Wuhan, China, with no history of comorbidities, returned to Nepal. He presented at the outpatient department of Sukraraj Tropical and Infectious Disease Hospital, Kathmandu, with a cough. He had become ill on Jan 3, 6 days before he flew to Nepal. He indicated no exposure to the so-called wet market in Wuhan. Throat swabs obtained from the patient tested positive for 2019-nCoV on real-time RT-PCR assays at the WHO laboratory in Hong Kong. On admission to hospital in Kathmandu, his temperature was 37·2°C (99°F), with throat congestion, but with no other relevant signs or symptoms. He was isolated and treated with broad-spectrum antibiotics and supportive therapies. After 6 h, he complained of mild breathing difficulty and had decreased oxygen saturation (SpO2 87% on room air). Chest radiographs obtained on admission showed an infiltrate in the upper lobe of the left lung (figure). On Jan 14, his temperature rose to 38·9°C (102°F) and the next day he had breathing difficulties while in the supine position, with crepitations in the right lower lung field. His fever was no longer present on Jan 16, and his clinical condition improved. He was discharged the next day and instructed to self-quarantine at home. Laboratory tests showed no abnormalities. Real-time RT-PCR assays for influenza A and B viruses, and NS1 antigen rapid tests for dengue viruses, scrub typhus, and Brucella spp were negative. Follow-up assessments on Jan 29 and Jan 31 gave an RT-PCR negative throat swab for 2019-nCoV. Informed consent was obtained from the patient to be included in this Correspondence. Compared with other recently reported cases, which included rapid worsening and even progression to death,1Huang C Wang Y Li X et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.Lancet. 2020; (published online Jan 24.)http://dx.doi.org/10.1016/S0140-6736(20)30183-5Summary Full Text Full Text PDF Scopus (32861) Google Scholar, 2Chan JF-W Yuan S Kok K-H et al.A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster.Lancet. 2020; (published online Jan 24.)http://dx.doi.org/10.1016/S0140-6736(20)30154-9Summary Full Text Full Text PDF Scopus (6197) Google Scholar, 5Phan LT Nguyen TV Luong QC et al.Importation and human-to-human transmission of a novel coronavirus in Vietnam.N Engl J Med. 2020; (published online Jan 28.)DOI:10.1056/NEJMc2001272Crossref PubMed Scopus (810) Google Scholar, 6Zhu N Zhang D Wang W et al.A novel coronavirus from patients with pneumonia in China, 2019.N Engl J Med. 2020; (published online Jan 24.)DOI:10.1056/NEJMoa2001017Crossref PubMed Scopus (18588) Google Scholar our patient had only mild disease and survived and recovered after 13 days. A previous importation of 2019-nCoV in a family cluster in Vietnam included a father returning from Wuhan who transmitted the virus to his wife and son. They all recovered in less than 2 weeks.5Phan LT Nguyen TV Luong QC et al.Importation and human-to-human transmission of a novel coronavirus in Vietnam.N Engl J Med. 2020; (published online Jan 28.)DOI:10.1056/NEJMc2001272Crossref PubMed Scopus (810) Google Scholar In two cohorts in China (n=41, n=99), the case fatality rates were 15%1Huang C Wang Y Li X et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.Lancet. 2020; (published online Jan 24.)http://dx.doi.org/10.1016/S0140-6736(20)30183-5Summary Full Text Full Text PDF Scopus (32861) Google Scholar and 11%.7Chen N Zhou M Dong X et al.Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wçuhan, China: a descriptive study.Lancet. 2020; (published online Jan 30.)http://dx.doi.org/10.1016/S0140-6736(20)30211-7Summary Full Text Full Text PDF Scopus (14363) Google Scholar Some reports have indicated that few patients with 2019-nCoV infection have prominent upper respiratory tract signs and symptoms (eg, sore throat),1Huang C Wang Y Li X et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.Lancet. 2020; (published online Jan 24.)http://dx.doi.org/10.1016/S0140-6736(20)30183-5Summary Full Text Full Text PDF Scopus (32861) Google Scholar, 7Chen N Zhou M Dong X et al.Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wçuhan, China: a descriptive study.Lancet. 2020; (published online Jan 30.)http://dx.doi.org/10.1016/S0140-6736(20)30211-7Summary Full Text Full Text PDF Scopus (14363) Google Scholar as occurred with the Nepalese student. As expected, fever and cough are the main clinical findings in patients with confirmed 2019-nCoV infection, with up to a quarter requiring admission to the intensive care unit. Further studies in outpatient, primary care, and community settings are needed to get a full spectrum of clinical severity in imported, secondary, or autochthonous cases in all countries. These studies will be increasingly relevant as more cases of 2019-nCoV are diagnosed among people returning from Wuhan and other affected cities in China, but also among those who have acquired the infection from imported cases, even asymptomatic ones, as occurred in Germany.8Rothe C Schunk M Sothmann P et al.Transmission of 2019-ncov infection from an asymptomatic contact in Germany.N Engl J Med. 2020; (published Jan 30.)DOI:10.1056/NEJMc2001468Crossref PubMed Scopus (2812) Google Scholar We declare no competing interests. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, ChinaThe 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Full-Text PDF A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family clusterOur findings are consistent with person-to-person transmission of this novel coronavirus in hospital and family settings, and the reports of infected travellers in other geographical regions. Full-Text PDF Challenges of coronavirus disease 2019Yet again, the world is experiencing a global viral epidemic of zoonotic origin. As of Feb 12, 45 204 confirmed cases of coronavirus disease 2019 (COVID-19) and 1116 deaths had been reported in 25 countries. The majority of cases and, at the time of writing, all but one death have been in China, despite efforts in the country to halt transmission through shutting down transport, quarantining entire cities, and enforcing the use of face masks. International flights have been cancelled and affected cruise ships quarantined. Full-Text PDF