Coronavirus Cases Outside Wuhan Cause Alarm, but Few are "Deadly"

Screening for 2019 novel coronavirus continues around the world. A new research letter on the clinical characteristics of 13 patients sheds light on the nature of cases outside of Wuhan, China.

On February 7, 2020, 27 passengers on a cruise ship docked in Bayonne, New Jersey, were screened by the US Centers for Disease Control and Prevention (CDC) for 2019 novel coronavirus (2019-nCoV). The 27 passengers had recently traveled from mainland China.

CDC cleared 23 of the Bayonne passengers, while 4 were sent for further examination at an area hospital.

New Jersey still has no confirmed cases of 2019-nCoV, although an asymptomatic individual with travel history to China was placed in 14-day mandatory quarantine on February 5, according to the New Jersey Department of Health.

Another 2 ships, off the coasts of Japan and Hong Kong, have been quarantined.

According to the World Health Organization (WHO) February 7 situation report, there have been 31,481 confirmed cases of 2019-nCoV around the world in 24 countries, with a wide majority of cases concentrated in the Hubei province of China. Wuhan, the epicenter of the outbreak, is the capital of Hubei province.

A research letter published today in JAMA offers new insight into the epidemiologic and clinical characteristics of 2019-nCoV infections outside Wuhan.

The research letter reports the early clinical features of 13 patients with confirmed 2019-nCoV infections who were admitted to hospitals in Beijing, China.

Data described in the letter were obtained from 3 hospitals in Beijing. Patients were hospitalized between January 16 and January 29, 2020. There was a final follow-up report on February 4.

Cases of 2019-nCoV were confirmed in the patient cohort by throat swab samples subjected to a quantitative polymerase chain reaction assay at the Chinese Center for Disease Control and Prevention.

Patients had a median age of 34 years (25th-75th percentile: 34-48 years). Of the 13 patients, 2 were children between 2-15 years and 10 (77%) were men.

Nearly all patients, 12 of 13, had visited Wuhan or had contact with a Wuhan visitor. The patient who did not have known contact with Wuhan, however, suggests limited cases of local transmission in Beijing.

Before hospitalization, 12 patients reported fever. Other symptoms included upper airway congestion in 61.5% of patients, cough in 46.3% of patients, myalgia in 23.1% of patients, and headache in 23.1% of patients.

The youngest patient, who was 2 years old, had a week-long intermittent fever and a persistent cough in the 13 days leading up to 2019-nCoV confirmation.

Levels of C-reactive protein and lymphocytes were, on average, elevated in the patient cohort.

Computed tomography was performed for 9 patients and 4 had chest radiographs. In 6 patients, ground class opacity was seen in the right or in both lungs. In 1 chest radiograph, scattered opacities were observed in the left lower lung.

As of February 4, all patients had recovered, although 12 were still quarantined at hospitals.

Although the virus is serious, particularly where health resources may be significantly burdened by the outbreak such as Wuhan, it is notable that all of the Beijing patients studied recovered.

“Most of the infected patients were healthy adults; only 1 patient was older than 50 years and 1 younger than 5 years. This might be related to limited travel by younger and older patients rather than decreased susceptibility of these populations. Recovery of all patients suggests milder infections,” authors of the study wrote.

There have been 637 deaths, according to the WHO situation report. All but 2 of these deaths have been in China. Of the deaths in China, 618 were reported in Hubei, the province where Wuhan is located.