A team at Incheon Medical Center (IMC) has published a report on the epidemiological and clinical features of the first confirmed patient of the new coronavirus. The patient is reportedly all but free from her symptoms and healthy enough to conduct daily activities.

A chest radiography and HRCT scans of the patient's lung.

The report emphasized two things. First, chest radiography alone would have missed patients with pneumonia in the early phase of the new coronavirus. Second, taking travel history is of paramount importance for the early detection and isolation of the new coronavirus.

Professors Kim Jin-yong and Choe Pyoeng-gyun of IMC led the team. Professors Oh Yoon-ju, and Kim Jin-sil at the hospital and Oh Myoung-don of Seoul National University also participated in the study.

The patient, a 35-year-old Chinese woman, arrived at the Incheon International Airport from Wuhan on Jan. 19. During the quarantine inspection at the airport, the thermal scanner detected that her body temperature was 38.3 degrees Celsius. Due to her symptoms, the patient was immediately sent to a designated isolation hospital. The hospital confirmed that she had the new coronavirus, through a conventional pan-coronavirus polymerase chain reaction (PCR) assay.

The report noted that the patient denied any exposure to a febrile patient, wild animals, or visiting wet markets, including the Sea Food Market in Wuhan. However, she visited a local clinic in Wuhan after developing a fever, chill, and myalgia a day before her entry into Korea. The local clinic diagnosed her with the common cold as her chest radiography showed no infiltrates.

On the day of her admission to the Korean hospital, the physical examination revealed a body temperature of 38.4 degrees, a respiratory rate of 22 breaths per minute, a pulse of 118 per minute, and blood pressure of 139/92 mmHg.

The team also confirmed there were no signs of pharyngeal injections, skin rash, and adenopathy, and the chest radiography continued to show no infiltrations.

After four days of treatment, however, a high-resolution computed tomography (HRCT) showed multiple ground-glass opacities located in both subpleural spaces.

The laboratory tests showed mild changes, including leukopenia, thrombocytopenia, and liver enzyme elevation, while she developed nasal congestion, cough, sputum, pleuritic chest discomfort, and watery diarrhea during hospitalization.

The team also started treating her with 400mg of lopinavir and 100 mg of ritonavir. Still, fever persisted for 10 days with a maximum temperature of 38.9 degrees on the seventh day of illness, before it started to subside on Jan. 28.

Ultimately, the team confirmed that her dyspnea began to improve, reducing oxygen requirement, and lung lesions also began to diminish in chest radiography last Friday.

"The initial symptoms of the patient were fever, myalgia, and sore throat, which are common to any acute respiratory virus infection," the team said. "The only clue to the new coronavirus infection was her travel history."

This case highlights that taking travel history is of paramount importance for the early detection and isolation of patients infected with the new coronavirus, the team stressed.

The team also emphasized that as the patient was detected at the airport by the screening with a thermal scanner, entry screening might have helped slow the importation of an emerging virus.

"However, it is not a guarantee against the virus as it could miss many infected but asymptomatic or mild symptomatic passengers," the report noted. "Therefore, once the virus is spreading widely and an epidemic already starts, the entry screening will add little value to contain it."

The real benefit is its advertising effect; it may raise travelers' awareness and educate them about what they should do if they develop symptoms after arriving, the team added.

The team also stressed that it is essential to note that the patient had pneumonia as early as three days after the symptom onset, although her condition was stable.

"During the first three days, she did not develop any clinical features suggesting pneumonia, such as sputum, pleuritic chest discomfort, hemoptysis, crackles on lung auscultation, and infiltrates in chest radiography," the team said. "If we had not taken an HRCT scan of the lung, we would have missed the pneumonia diagnosis."

This case highlights that the possibility of the new coronavirus cannot be excluded based only on the clinical clues that the patient portrays during their initial period, the team added.

Therefore, the team suggested that hospitals should test for patients showing any signs of the new coronavirus.

"We do not know the infectious period of 2019-nCoV pneumonia yet, and if patients with mild symptoms are less infectious than patients with pneumonia," the team said. "What makes the problem more confusing is that we cannot predict who may progress from upper respiratory infection to pneumonia."

Considering all this, it is safer to do a new coronavirus screening test for all symptomatic patients with epidemiological risk than to wait until pneumonia develop and then test them, the team added.

The results of the research were published in the Journal of Korean Medical Science, under the title, "A First Case of 2019 Novel Coronavirus Pneumonia Imported into Korea from Wuhan, China: Implication for Infection Prevention and Control Measures."

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