#Clinical #Course and #Molecular #Viral #Shedding Among #Asymptomatic and Symptomatic Patients With #SARS-CoV-2 Infection in a #Community #Treatment Center in the Republic of #Korea (JAMA Intern Med., abstract)

[Source: JAMA Internal Medicine, full page: (LINK). Abstract, edited.]

Clinical Course and Molecular Viral Shedding Among Asymptomatic and Symptomatic Patients With SARS-CoV-2 Infection in a Community Treatment Center in the Republic of Korea

Seungjae Lee, MD1; Tark Kim, MD2; Eunjung Lee, MD1; Cheolgu Lee, MD3; Hojung Kim, MD4; Heejeong Rhee, MD5; Se Yoon Park, MD1; Hyo-Ju Son, MD1; Shinae Yu, MD6; Jung Wan Park, MD6; Eun Ju Choo, MD2; Suyeon Park, MS7; Mark Loeb, MD8; Tae Hyong Kim, MD1

Author Affiliations: 1 Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea; 2 Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea; 3 Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea; 4 Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea; 5 Department of Family Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea; 6 Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea; 7 Department of Biostatistics, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; 8 Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada

JAMA Intern Med. Published online August 6, 2020.  doi:10.1001/jamainternmed.2020.3862

 

Key Points

  • Question  – Are there viral load differences between asymptomatic and symptomatic patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection?
  • Findings  – In this cohort study that included 303 patients with SARS-CoV-2 infection isolated in a community treatment center in the Republic of Korea, 110 (36.3%) were asymptomatic at the time of isolation and 21 of these (19.1%) developed symptoms during isolation. The cycle threshold values of reverse transcription–polymerase chain reaction for SARS-CoV-2 in asymptomatic patients were similar to those in symptomatic patients.
  • Meaning  – Many individuals with SARS-CoV-2 infection remained asymptomatic for a prolonged period, and viral load was similar to that in symptomatic patients; therefore, isolation of infected persons should be performed regardless of symptoms.

 

Abstract

Importance  

There is limited information about the clinical course and viral load in asymptomatic patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Objective  

To quantitatively describe SARS-CoV-2 molecular viral shedding in asymptomatic and symptomatic patients.

Design, Setting, and Participants  

A retrospective evaluation was conducted for a cohort of 303 symptomatic and asymptomatic patients with SARS-CoV-2 infection between March 6 and March 26, 2020. Participants were isolated in a community treatment center in Cheonan, Republic of Korea.

Main Outcomes and Measures  

Epidemiologic, demographic, and laboratory data were collected and analyzed. Attending health care personnel carefully identified patients’ symptoms during isolation. The decision to release an individual from isolation was based on the results of reverse transcription–polymerase chain reaction (RT-PCR) assay from upper respiratory tract specimens (nasopharynx and oropharynx swab) and lower respiratory tract specimens (sputum) for SARS-CoV-2. This testing was performed on days 8, 9, 15, and 16 of isolation. On days 10, 17, 18, and 19, RT-PCR assays from the upper or lower respiratory tract were performed at physician discretion. Cycle threshold (Ct) values in RT-PCR for SARS-CoV-2 detection were determined in both asymptomatic and symptomatic patients.

Results  

Of the 303 patients with SARS-CoV-2 infection, the median (interquartile range) age was 25 (22-36) years, and 201 (66.3%) were women. Only 12 (3.9%) patients had comorbidities (10 had hypertension, 1 had cancer, and 1 had asthma). Among the 303 patients with SARS-CoV-2 infection, 193 (63.7%) were symptomatic at the time of isolation. Of the 110 (36.3%) asymptomatic patients, 21 (19.1%) developed symptoms during isolation. The median (interquartile range) interval of time from detection of SARS-CoV-2 to symptom onset in presymptomatic patients was 15 (13-20) days. The proportions of participants with a negative conversion at day 14 and day 21 from diagnosis were 33.7% and 75.2%, respectively, in asymptomatic patients and 29.6% and 69.9%, respectively, in symptomatic patients (including presymptomatic patients). The median (SE) time from diagnosis to the first negative conversion was 17 (1.07) days for asymptomatic patients and 19.5 (0.63) days for symptomatic (including presymptomatic) patients (P = .07). The Ct values for the envelope (env) gene from lower respiratory tract specimens showed that viral loads in asymptomatic patients from diagnosis to discharge tended to decrease more slowly in the time interaction trend than those in symptomatic (including presymptomatic) patients (β = −0.065 [SE, 0.023]; P = .005).

Conclusions and Relevance  

In this cohort study of symptomatic and asymptomatic patients with SARS-CoV-2 infection who were isolated in a community treatment center in Cheonan, Republic of Korea, the Ct values in asymptomatic patients were similar to those in symptomatic patients. Isolation of asymptomatic patients may be necessary to control the spread of SARS-CoV-2.

Keywords: SARS-CoV-2; COVID-19; Diagnostic tests; S. Korea.

——

Factors associated with #viral #load #kinetics of #MERS #coronavirus during the 2015 #outbreak in South #Korea (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Factors associated with viral load kinetics of Middle East respiratory syndrome coronavirus during the 2015 outbreak in South Korea

Jeong-Sun Yang, Min-Gyu Yoo, Hye-Ja Lee, Han Byul Jang, Hee-Dong Jung, Jeong-Gu Nam, Joo-Yeon Lee, Youngmee Jee, Sung Soon Kim

The Journal of Infectious Diseases, jiaa466, https://doi.org/10.1093/infdis/jiaa466

Published: 06 August 2020

 

Abstract

We conducted a retrospective study of Middle East respiratory syndrome coronavirus (MERS-CoV) viral load kinetics using data from patients hospitalised with MERS-CoV infection between 19 May and 20 August, 2015. Viral load trajectories were considered over the hospitalisation period using 1,714 viral load results measured in serial respiratory specimens of 185 patients. The viral load levels were significantly higher among non-survivors than among survivors (p=0.003). Healthcare workers (p = 0.001) and non-spreaders (p <0.001) had significantly lower viral loads. Viral RNA was present on the day of symptom onset and peaked 4–10 days after symptom onset.

Middle East respiratory syndrome coronavirus, viral load, virus shedding, healthcare-associated infections, infectious disease transmission

Issue Section: Brief Report

This content is only available as a PDF.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: MERS-CoV-2; South Korea.

——

Association between #NSAIDs use and adverse #clinical #outcomes among #adults hospitalized with #COVID19 in South #Korea: A nationwide study (Clin Infect Dis., abstract)

[Source: Clinical Infectious Diseases, full page: (LINK). Abstract, edited.]

Association between NSAIDs use and adverse clinical outcomes among adults hospitalized with COVID-19 in South Korea: A nationwide study

Han Eol Jeong, MPH, Hyesung Lee, MS, Hyun Joon Shin, MD, PhD, Young June Choe, MD, PhD, Kristian B Filion, PhD, Ju-Young Shin, PhD

Clinical Infectious Diseases, ciaa1056, https://doi.org/10.1093/cid/ciaa1056

Published: 27 July 2020

 

Abstract

BACKGROUND

Non-steroidal anti-inflammatory drugs (NSAIDs) may exacerbate COVID-19 and worsen associated outcomes by upregulating the enzyme that SARS-CoV-2 binds to enter cells. To our knowledge, no study has examined the association between NSAID use and the risk of COVID-19-related outcomes.

METHODS

We conducted a cohort study using South Korea’s nationwide healthcare database, which contains data of all subjects who received a test for COVID-19 (n=69,793) as of April 8, 2020. We identified adults hospitalized with COVID-19, where cohort entry was the date of hospitalization. NSAIDs users were those prescribed NSAIDs in the 7 days before and including cohort entry and non-users were those not prescribed NSAIDs during this period. Our primary outcome was a composite of in-hospital death, intensive care unit admission, mechanical ventilation use, and sepsis; our secondary outcomes were cardiovascular complications and acute renal failure. We conducted logistic regression analysis to estimate odds ratio (OR) with 95% confidence intervals (CI) using inverse probability of treatment weighting to minimize confounding.

RESULTS

Of 1,824 adults hospitalized with COVID-19 (mean age 49.0 years; female 59%), 354 were NSAIDs users and 1,470 were non-users. Compared with non-use, NSAIDs use was associated with increased risks of the primary composite outcome (OR 1.54 [95% CI 1.13-2.11]) but insignificantly associated with cardiovascular complications (1.54 [0.96-2.48]) or acute renal failure (1.45 [0.49-4.14]).

CONCLUSION

While awaiting the results of confirmatory studies, we suggest NSAIDs be used with caution among patients with COVID-19 as the harms associated with their use may outweigh their benefits in this population.

coronavirus disease 2019, nonsteroidal anti-inflammatory drugs, adverse outcomes, nationwide study, pharmacoepidemiologic study

Issue Section: Major Article

This content is only available as a PDF.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: SARS-CoV-2; COVID-19; NSAIDs; Drugs safety; S. Korea.

——

#Ambient #Air #Pollution, #Meteorology, and #COVID19 Infection in #Korea (J Med Virol., abstract)

[Source: Journal of Medical Virology, full page: (LINK). Abstract, edited.]

Ambient Air Pollution, Meteorology, and COVID‐19 Infection in Korea

Tung Hoang,  Tho Tran Thi Anh

First published: 21 July 2020 | DOI:  https://doi.org/10.1002/jmv.26325

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/jmv.26325

 

ABSTRACT

Background

The outbreak of novel pneumonia coronavirus disease has become a public health concern worldwide. Here, for the first time, the association between Korean meteorological factors and air pollutants and the COVID‐19 infection was investigated.

Materials and Methods

Data of air pollutants, meteorological factors, and daily COVID‐19 confirmed cases of 7 metropolitan cities and 9 provinces were obtained from February 03, 2020 to May 05, 2020 during the first wave of pandemic across Korea. We applied the generalized additive model to investigate the temporal relationship.

Results

There was a significantly non‐linear association between daily temperature and COVID‐19 confirmed cases. Each 1oC increase in temperature was associated with 9% (lag 0‐14, OR=1.09, 95% CI=1.03‐1.15) increase of COVID‐19 confirmed cases when the temperature was below 8oC. A 0.01 ppm increase in NO2 (lag 0‐7, lag 0.14, and lag 0‐21) was significantly associated with increases of COVID‐19 confirmed cases, with ORs (95% CIs) of 1.13 (1.02‐1.25), 1.19 (1.09‐1.30), and 1.30 (1.19‐1.41), respectively. A 0.1 ppm increase in CO (lag 0‐21) was associated with the increase in COVID‐19 confirmed cases (OR=1.10, 95% CI=1.04‐1.16). There was a positive association between per 0.001 ppm of SO2 concentration (lag 0, lag 0‐7, and lag 0‐14) and COVID‐19 confirmed cases, with ORs (95% CIs) of 1.13 (1.04‐1.22), 1.20 (1.11‐1.31), and 1.15 (1.07‐1.25), respectively.

Conclusion

There were significantly temporal associations between temperature, NO2, CO, and SO2 concentrations and daily COVID‐19 confirmed cases in Korea.

This article is protected by copyright. All rights reserved.

Keywords: SARS-CoV-2; COVID-19; Environmental pollution; S. Korea.

——

Prolonged (6 months) #Shedding of #MERS #Coronavirus #RNA in #Sputum of a #Lymphoma Patient (Open Forum Infect Dis., abstract)

[Source: Open Forum Infectious Diseases, full page: (LINK). Abstract, edited.]

Prolonged (6 months) Shedding of Middle East Respiratory Syndrome Coronavirus RNA in Sputum of a Lymphoma Patient

Pyoeng Gyun Choe, Wan Beom Park, Su-Jin Choi, Chang Kyung Kang, Yongil Koh, Nam Joong Kim, Myoung-don Oh

Open Forum Infectious Diseases, ofaa292, https://doi.org/10.1093/ofid/ofaa292

Published: 18 July 2020

 

Abstract

During the 2015 Korea Middle East Respiratory Syndrome coronavirus (MERS-CoV) outbreak, a lymphoma patient developed MERS pneumonia. His pneumonia improved by 45 days after illness onset, but the polymerase chain reaction tests remained (+) for 6 months. However, replication-competent virus were detected by 60 days after illness onset.

Coronavirus, MERS-CoV, lymphoma, real-time PCR, patient isolation

Issue Section: Brief Report

This content is only available as a PDF.

© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Keywords: MERS-CoV-2; Viral shedding; S. Korea.

——

#Contact #Tracing during #Coronavirus Disease Outbreak, South #Korea, 2020 (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 26, Number 10—October 2020 | Dispatch

Contact Tracing during Coronavirus Disease Outbreak, South Korea, 2020

Young Joon Park1, Young June Choe1, Ok Park, Shin Young Park, Young-Man Kim, Jieun Kim, Sanghui Kweon, Yeonhee Woo, Jin Gwack, Seong Sun Kim, Jin Lee, Junghee Hyun, Boyeong Ryu, Yoon Suk Jang, Hwami Kim, Seung Hwan Shin, Seonju Yi, Sangeun Lee, Hee Kyoung Kim, Hyeyoung Lee, Yeowon Jin, Eunmi Park, Seung Woo Choi, Miyoung Kim, Jeongsuk Song, Si Won Choi, Dongwook Kim, Byoung-Hak Jeon, Hyosoon Yoo, Eun Kyeong Jeong  , and on behalf of the COVID-19 National Emergency Response Center, Epidemiology and Case Management Team

Author affiliations: Korea Centers for Disease Control and Prevention, Cheongju, South Korea (Y.J. Park, O. Park, S.Y. Park, Y.-M. Kim, J. Kim, S. Kweon, Y. Woo, J. Gwack, S.S. Kim, J. Lee, J. Hyun, B. Ryu, Y.S. Jang, H. Kim, S.H. Shin, S. Yi, S. Lee, H.K. Kim, H. Lee, Y. Jin, E. Park, S.W. Choi, M. Kim, J. Song, S.W. Choi, D. Kim, B.-H. Jeon, H. Yoo, E.K. Jeong); Hallym University College of Medicine, Chuncheon, South Korea (Y.J. Choe)

 

Abstract

We analyzed reports for 59,073 contacts of 5,706 coronavirus disease (COVID-19) index patients reported in South Korea during January 20–March 27, 2020. Of 10,592 household contacts, 11.8% had COVID-19. Of 48,481 nonhousehold contacts, 1.9% had COVID-19. Use of personal protective measures and social distancing reduces the likelihood of transmission.

Keywords: SARS-CoV-2, COVID-19, S. Korea.

——

Effect of #COVID19 on #Tuberculosis Notification, South #Korea (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 26, Number 10—October 2020 | Research Letter

Effect of COVID-19 on Tuberculosis Notification, South Korea

Nakwon Kwak, Seung-Sik Hwang, and Jae-Joon Yim

Author affiliations: Seoul National University College of Medicine, Seoul, South Korea (N. Kwak, J.-J. Yim); Seoul National University Graduate School of Public Health, Seoul (S.-S. Hwang)

 

Abstract

After South Korea raised its infectious disease alert to the highest level in response to coronavirus disease emergence, tuberculosis notification during the first 18 weeks of 2020 decreased significantly from the same period for each year during 2015–2019. Adequate measures to diagnose, control, and prevent tuberculosis need to be maintained.

Keywords: SARS-CoV-2; COVID-19; Tuberculosis; S. Korea.

——

#Response #System for and #Epidemiological #Features of #COVID19 in Gyeongsangnam-do Province in South #Korea (Clin Infect Dis., abstract)

[Source: Clinical Infectious Diseases, full page: (LINK). Abstract, edited.]

Response System for and Epidemiological Features of COVID-19 in Gyeongsangnam-do Province in South Korea

Yu Mi Wi, Su Jin Lim, Si-Ho Kim, Seungjin Lim, Su Jin Lee, Byung-Han Ryu, Sun In Hong, Oh-Hyun Cho, Kyunglan Moon, Kyung-Wook Hong, Sunjoo Kim, In-Gyu Bae

Clinical Infectious Diseases, ciaa967, https://doi.org/10.1093/cid/ciaa967

Published: 16 July 2020

 

Abstract

Background

The South Korean government has been combating COVID-19 outbreak using public information and extensive viral screening. We described the application of the Korean response system in one province and outlined the epidemiological features of COVID-19 in the cohort.

Methods

A Rapid Response Team tracked the patients’ activities and identified close contacts. A Patient Management Team made decisions regarding the severity of illness, hospital allocation depending on severity, and time of discharge. A national medical center with 155 beds and 4 university-affiliated hospitals with 48 negative-pressure isolation rooms were dedicated for COVID-19 patients.

Results

As of April 15, 17 400 residents were tested, of whom 111 were confirmed positive cases. Of the 111 patients, 78 were cured and discharged, 2 recovered after mechanical ventilation, and none died. One healthcare worker at the national center tested positive for SARS-CoV-2. All 412 staff members at the center were tested, but there were no additional infections. Cough (30.0 %) was the most common initial symptom, whereas anosmia and ageusia were the first symptoms in 14.7% and 15.7% of the patients, respectively. Overall, 25 patients (22.5%) reported having no symptoms at admission and 7 (6.3%) remained asymptomatic at discharge.

Conclusions

A response system that enabled the early detection of COVID-19 cases, including asymptomatic and pre-symptomatic cases, and timely quarantine of these patients and their contacts, along with efficient allocation of medical resources, was the key to curbing the COVID-19 outbreak in Gyeongsangnam-do Province.

COVID-19, Response Team, Asymptomatic patients, Anosmia, Ageusia

Issue Section: Major Article

This content is only available as a PDF.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: SARS-CoV-2; COVID-19; South Korea.

—–

#Coronavirus Disease #Exposure and Spread from #Nightclubs, South #Korea (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 26, Number 10—October 2020 | Research Letter

Coronavirus Disease Exposure and Spread from Nightclubs, South Korea

Cho Ryok Kang, Jin Yong Lee  , Yoojin Park, In Sil Huh, Hyon Jeen Ham, Jin Kyeong Han, Jung Il Kim, Baeg Ju Na, and Seoul Metropolitan Government COVID-19Rapid Response Team (SCoRR Team)

Author affiliations: Seoul Metropolitan Government, Seoul, South Korea (C.R. Kang, H.J. Ham, J.K. Han, J.I. Kim, B.J. Na); Seoul National University Boramae Medical Centre, Seoul (J.Y. Lee); Seoul Centre for Infectious Disease Control and Prevention, Seoul (Y. Park, I.S. Huh)

 

Abstract

At least 246 cases of coronavirus disease (COVID-19) have been linked to nightclubs in Seoul, South Korea. During the April 30–May 5 holiday, young adults from across the country who visited nightclubs in Seoul contracted COVID-19 and spread it nationally. Nightclubs were temporarily closed to limit COVID-19 spread.

Keywords: SARS-CoV-2; COVID-19; S. Korea.

——

#Antibody #Responses to #SARS-CoV-2 at 8 Weeks Postinfection in #Asymptomatic Patients (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 26, Number 10—October 2020 | Research Letter

Antibody Responses to SARS-CoV-2 at 8 Weeks Postinfection in Asymptomatic Patients

Pyoeng Gyun Choe1, Chang Kyung Kang1, Hyeon Jeong Suh, Jongtak Jung, EunKyo Kang, Sun Young Lee, Kyoung-Ho Song, Hong Bin Kim, Nam Joong Kim, Wan Beom Park  , Eu Suk Kim  , and Myoung-don Oh

Author affiliations: Seoul National University Hospital, Seoul, South Korea (P.G. Choe, C.K. Kang, H.J. Suh, E.K. Kang, S.Y. Lee, N.J. Kim, W.B. Park, M.-D. Oh); Seoul National University Bundang Hospital, Seongnam, South Korea (J. Jung, K.-H. Song, H.B. Kim, E.S. Kim)

 

Abstract

We compared levels of severe acute respiratory syndrome coronavirus 2 neutralizing antibodies in recovery plasma from 7 completely asymptomatic coronavirus disease patients with those in symptomatic patients in South Korea. We found that serologic diagnostic testing was positive for 71% (5/7) of completely asymptomatic patients, but neutralizing antibody response occurred in all 7 patients.

Keywords: SARS-CoV-2; COVID-19; Serology; Diagnostic tests.

——