The New York Times reports that a highly contagious patient, virus transmission inside a hospital and unexpected turns for the worse have emerged as part of the epidemic in China. One patient, admitted to a hospital in Wuhan, China, infected at least 10 health care workers and four other patients with the coronavirus that has sickened more than 34,000 people, killed 700 and reached two dozen other countries.
The case was just one disturbing detail in a new report on 138 patients in Wuhan that helps explain how the illness progresses and how it spreads. The report, one of two published on Friday by JAMA, is among the most comprehensive articles to date about people infected with the newly identified virus.
The patients ranged in age from 22 to 92, with a median of 56 years, and were admitted to Zhongnan Hospital of Wuhan University from Jan. 1 to Jan 28. Many of them — 41 percent — were presumed to have caught the virus in the hospital, including 17 people who had been admitted for other illnesses, and 40 health care workers.
The patient who infected so many health workers had been placed in a surgical ward because of abdominal symptoms, and the coronavirus was not initially suspected. Four other patients in that ward also contracted the disease, presumably from the first patient.
The incident was a chilling reminder of the “super-spreaders” in outbreaks of other coronavirus diseases, SARS and MERS — patients who infected huge numbers of other people, sometimes dozens. The phenomenon is poorly understood and unpredictable, an epidemiologist’s nightmare. Super-spreaders led to considerable transmission of MERS and SARS inside hospitals.
Reporting on Friday in JAMA, the authors said their data suggested that rapid person-to-person spread of the virus had occurred among their cases. That was in part because of patients like the one admitted to the surgical department, whose symptoms misled doctors into suspecting other illnesses and failing to take precautions to prevent spread of the virus until it was too late. About 10 percent of the patients did not initially have the usual symptoms, cough and fever, but instead had diarrhea and nausea first. Other uncommon symptoms included headache, dizziness and abdominal pain.
Another cause for concern was that some patients who at first appeared mildly or moderately ill then took a turn for the worse several days or even a week into their illness. The median time from their first symptoms to when they became short of breath was five days; to hospitalization, seven days; and to severe breathing trouble, eight days. Experts say that pattern means patients must be carefully monitored, and it is not safe to assume that someone who seems to be doing well early on is out of the woods.
The finding is a “heads up” to doctors to keep an eye on these patients, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in a recorded interview posted by JAMA.
Like previous reports on coronavirus patients, this one found that older people and those with underlying health problems like diabetes, heart disease or cancer tended to become more severely ill than younger, healthier patients. Over all, about 26 percent of the 138 patients needed intensive care; their median age was 66, compared with a median of 51 years for those who did not require intensive care. For this series of patients, the death rate was 4.3 percent, which is higher than the estimates coming from other parts of China.
The reason is not known, and the figures may change as more information is gathered.
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