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

Abstract

Importance: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, in December 2019 and has spread globally with sustained human-to-human transmission outside China.

Objective: To report the initial experience in Singapore with the epidemiologic investigation of this outbreak, clinical features, and management.

Design, setting, and participants: Descriptive case series of the first 18 patients diagnosed with polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection at 4 hospitals in Singapore from January 23 to February 3, 2020; final follow-up date was February 25, 2020.

Exposures: Confirmed SARS-CoV-2 infection.

Main outcomes and measures: Clinical, laboratory, and radiologic data were collected, including PCR cycle threshold values from nasopharyngeal swabs and viral shedding in blood, urine, and stool. Clinical course was summarized, including requirement for supplemental oxygen and intensive care and use of empirical treatment with lopinavir-ritonavir.

Results: Among the 18 hospitalized patients with PCR-confirmed SARS-CoV-2 infection (median age, 47 years; 9 [50%] women), clinical presentation was an upper respiratory tract infection in 12 (67%), and viral shedding from the nasopharynx was prolonged for 7 days or longer among 15 (83%). Six individuals (33%) required supplemental oxygen; of these, 2 required intensive care. There were no deaths. Virus was detectable in the stool (4/8 [50%]) and blood (1/12 [8%]) by PCR but not in urine. Five individuals requiring supplemental oxygen were treated with lopinavir-ritonavir. For 3 of the 5 patients, fever resolved and supplemental oxygen requirement was reduced within 3 days, whereas 2 deteriorated with progressive respiratory failure. Four of the 5 patients treated with lopinavir-ritonavir developed nausea, vomiting, and/or diarrhea, and 3 developed abnormal liver function test results.

Conclusions and relevance: Among the first 18 patients diagnosed with SARS-CoV-2 infection in Singapore, clinical presentation was frequently a mild respiratory tract infection. Some patients required supplemental oxygen and had variable clinical outcomes following treatment with an antiretroviral agent.

Figure 1.. Time Course of Symptoms, Supplemental Oxygen Requirements, Hospital Admission, and Discharge of Patients Infected With SARS-CoV-2

ICU indicates intensive care unit; PCR, polymerase chain reaction.

Figure 2.. Clinical Progress in Patients Treated With Lopinavir-Ritonavir

Cycle threshold (Ct) value corresponds to the number of copies of the virus in a biological sample, in an inversely proportional and exponential manner. ICU indicates intensive care unit; GI, gastrointestinal; ND, not detected; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; Y, yes; Vt, mechanical ventilation.