Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore

Original: JAMA. Published online March 03, 2020. doi:10.1001/jama.2020.3204

Author(s): Young BE, Xiang Ong SW, Kalimuddin S et al

Reviewer: Stylianos Loukides, e-Learning Director

Published: 08 Mar, 2020

The authors wanted to report the Singapore experience in regard to SARS CoV-2 infection in Singapore. Epidemiological and clinical data is provided. Time period of assessment was from January 23 to February 3, 2020 with final follow-up date the 25th of February 2020.

18 patients diagnosed with polymerase chain reaction (PCR)–confirmed SARS-CoV-2 infection at 4 hospitals were described. All patients traveled to Wuhan in China at least 14 days before the onset of the symptoms. Mean age was 47 years (range 31-73), 50% males, 28% with a co-morbidity.

Cough was the predominant symptom accounting for 85% of cases, following by fever (72%) and sore throat (61%). No patients presented with a severe acute respiratory distress syndrome, and only 1 required immediate supplemental oxygen. Lymphopenia was the predominant laboratory finding.

6 patients (33%) experienced low saturation and required supplemental oxygen. 12 patients (67%) had a normal Chest x ray on admission. 9 of them remained with clear X ray while 3 of them showed some abnormal radiological findings which are mainly bilateral opacities. 2 patients admitted to ICU and one required MV.

There were no deaths as of February 25, 2020. Of the 6 patients who required supplemental oxygen, 5 received lopinavir-ritonavir (Lopinavir and ritonavir is a combination antiviral medicine used to treat human immunodeficiency virus (HIV). For 3 of 5 patients initiation of lopinavir-ritonavir was followed by a reduction in supplemental oxygen requirements within 3 days, and viral shedding in nasopharyngeal swabs cleared within 2 days of treatment for 2 of 5. Two patients deteriorated with Virus continued to be detected in secretions, while 4 patients experienced adverse events with only one to complete the 14 day treatment course.

We have a variable clinical course of the disease. Treatment interventions are still not adequate to support effectiveness. Here is the first study outside China which actually faced the problem in a different setting since some previous reports – even unpublished – were helpful for the disease management.

Respiratory digests
Respiratory infections