The New England Journal of Medicine has released a published “case report” of the first 2019 Novel Coronavirus (2019-nCoV AKA COVID-19 ) patients in the USA. We will summarize the patient’s timeline of symptoms in this article and try to extract helpful information about the current Wuhan Coronavirus scare.
|virus swarming a target cell under microscope (in vitro)|
A “case report” of the first 2019-nCoV case in the United States was published by the New England Journal of Medicine (NEJM). Case reports are just doctors describing their experience with a disease, and the NEJM is a very prestigious medical journal that, for the most part, can trust as scientifically legitimate. This article with digest this case report for you and give you a sense of the symptoms and timeline of the person. I’ll also give you my 2 cents for free.
The patient is 35-year old male, who’s only medical history is having high cholesterol. He’s a non-smoker as well, which is crucial because it tells us that his lungs are structurally healthy. So this patient has a 4-day history of a cough and feeling feverish.
|example of a 35-year old Asian male.|
GreySheepMD’s 1st cent:
Imagine if you had mild symptoms of fevers and a slight cough on day #1. Will you continue about your business (especially if you don’t have sick days)? What about day #2, when symptoms are slightly worse? Day #3? Day #4? I would think that most people would probably continue to work, buy food for the baby, go about their normal lives on the first few days. People can be in public with mild fever/cough and infect another strangers with 2019-nCoV. Even though the feverish person knows they are sick, no one else knows. This is what happens when you hear reports of “asymptomatic spread.” Another person has transmitted the virus from another sick, but unidentified source. You typically will not get the virus from a perfectly healthy person. My point is the opposite of trying to scare you but to argue against the fear-mongering social media message of asymptomatic infections. If you look closely at your co-worker, you can kind of tell if they are sick or not – even if they don’t declare it. If they are sick-ish, if they are low in energy, if they have a mild cough, if they are less funny, stay away from them! You have more control over your risk of infection than you know.
|public spaces are full of people|
So back to our patient. He did the responsible thing. He remembered the health advisory about 2019-nCoV and saw a doctor as soon as he was sure he was sick, even when his symptoms are like any other cold he has had. He shows up to the doctor who diagnosed him with 2019-nCoV with lab testings. He’s not that sick at this point – just a really bad cold. His doctors hospitalized him anyways to segregate (and I think to study) him.
|a peripheral IV is started on patients who are hospitalized as a standard of care|
So on the first five days of his hospitalization, he was determined to be mostly stable. He had occasional measurable fevers and tachycardia, all signs of bodily stress from a viral infection. He had non-productive cough and fatigue. Interestingly, he had symptoms of loose bowel movement (an “almost diarrhoea”, we all personally know what those are!) and abdominal pain. This is interesting because there have been reports of the virus showing up in the GI tract and our poop. Treatment during these five days follows a medical strategy called “supportive care.” In layman’s term, it means that the doctor does nothing about the disease – except for crossing his fingers, hoping his body will overcome the virus. Symptoms are treated with acetaminophen, ibuprofen and guaifenesin – yes you can take them all at the same time just like this patient but follow the instructions on the bottle. He also got IV hydration with normal saline (think IV hydration bar! but covered by medical insurance).
Laboratory tests (blood work) during these five days is unusual for a healthy person coming down with the cold. There is evidence (although mild) of kidney stress, liver stress/damage, overall bodily stress/damage. This tells me that the virus probably hurts all of your organs directly or indirectly. A chest x-ray also shows sign of developing pneumonia, which can sometimes happen with a terrible cold – but again, quite unusual for a healthy person with healthy lungs. This again tells me how damaging this virus can be to its primary target – our lungs.
|laboratory handling of biological specimens|
On the 6th day of hospitalization, despite proper medical management inside a hospital, his pneumonia gets even worse. They had to give him pure oxygen! The lung sounds (via stethoscope) are begging to sound gross. The doctors then administered an experimental antivirus drug called “remdesivir.” No side effects were noted on the patient, and his symptoms almost magically reverse on the 7th day of hospitalization after this experimental drug. Go USA! Woot!
GreySheepMD’s 2nd cent:
So what can we learn from one of our first American 2019-nCoV patients? We know that the virus sure has the potential to cause bodily damage in a healthy person. All organs are likely affected, but the lungs will be the hardest hit. As the virus infects a person, there will be a make-or-break point. That was day #6 for our case-study patient. By day #6, either the human wins and the illness goes away; or, the virus wins and symptoms deteriorate to life-threatening status. The virus won in this patient, but luckily, it’s 2020, and we have the technology to “undeath” infected people. It is just a matter of the economics of using this technology that will be the limiting step.
Link to the actual article published in the NEJM below:
This post was written from my experiences as a licensed medical doctor in California in addition to the following resources:
GreySheepMD’s promotional section:
Writing these blog articles take up way more time that I have expected! I decided to add this promotional section to monetize some my efforts… mainly to give my wife some justification as to why I’m spending so much of “personal free-time” working on this blogging project. I thought that it will be helpful to the reader to list a few relevant product suggestions that I have personal experience with. For those who are not familiar with how monetization works: I’ll be listing some products that I recommend, and if my reader clicks on the link and makes a purchase, I will be credit with a portion (a very small portion) of the sale.
- Balaclavas– Unisex fashion accessories that act as a face mask to protect yourself from microscopic mucous droplets in a public space. We know 2019-nCoV spread by respiratory droplets. Asian citizens wear medical masks everywhere they go to protect themselves, but this is not the norm in ‘Merica! Here in America, we refuse to look like total dweebs in public! A good compromise? Wear these breathable balaclavas.
If you do support me by making a purchase through these links, I would like to make eye contact with you and say “thank you!”