A thirty-five year old female accountant flew into South Korea from Wuhan, China and was intercepted by a quarantine official when she presented with a high fever, 38.3 C., and when questioned stated that she had symptoms of a cold before her trip. Her case was published February 10th, 2020 in the Journal of Korean Medical Science, and authored by Jin Yong Kim et al. (See the link below.)
The patient arrived at the South Korean airport on January 19th, and after screening with a high fever, she was taken to the hospital and isolated. She presented as having fever, sore throat, chills, nasal congestion with sputum, and watery diarrhea. Her chest xray was normal, but her computer tomography images were consistent with pneumonia. She did not display symptoms consistent with pneumonia and would have been overlooked for that diagnosis if the CT had not been performed. Lab work showed leukopenia and thrombocytopenia. She was placed on 400 mgs of lopinivir, and 100 mg of ritonavir: both are antiviral medications. Her oxygen saturation level fell to 91% and she was placed on supplemental oxygen, 3L(1/21/20, then 6L(1/24/20). About January 31st her dyspnea began to decrease and her lung lesions were seen to diminish. Her pneumonia decreased gradually toward January 31st. She was treated in isolation after she tested positive for Covid19 on day one of her treatment and other than supplemental O2, and treatment with antivirals, ritonavir and lopinavir, she received no other treatments.
The authors suggest that her case points toward how easy it is to miss the pneumonia because she presented with no symptoms of pneumonia. They also highlight how important it is to test every high fever patient for Covid19 on admission. Once the patient tests positive, one can go beyond a normal xray and give the patient a computer tomography scan. The patient’s drop in oxygen saturation to 91% seemed like a red flag to make the search for pneumonia more urgent. The patient’s lab values are given in a large table and offer clinicians a chance to look for patterns in the lab values related to the overall course of her illness. Finally, it would be interesting to hear how the authors chose the antivirals and what they think about their effectiveness.