Clinical and virological data of the first cases of COVID-19 in Europe: a case series

Abstract

Background: On Dec 31, 2019, China reported a cluster of cases of pneumonia in people at Wuhan, Hubei Province. The responsible pathogen is a novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report the relevant features of the first cases in Europe of confirmed infection, named coronavirus disease 2019 (COVID-19), with the first patient diagnosed with the disease on Jan 24, 2020.

Methods: In this case series, we followed five patients admitted to Bichat-Claude Bernard University Hospital (Paris, France) and Pellegrin University Hospital (Bordeaux, France) and diagnosed with COVID-19 by semi-quantitative RT-PCR on nasopharyngeal swabs. We assessed patterns of clinical disease and viral load from different samples (nasopharyngeal and blood, urine, and stool samples), which were obtained once daily for 3 days from hospital admission, and once every 2 or 3 days until patient discharge. All samples were refrigerated and shipped to laboratories in the National Reference Center for Respiratory Viruses (The Institut Pasteur, Paris, and Hospices Civils de Lyon, Lyon, France), where RNA extraction, real-time RT-PCR, and virus isolation and titration procedures were done.

Findings: The patients were three men (aged 31 years, 48 years, and 80 years) and two women (aged 30 years and 46 years), all of Chinese origin, who had travelled to France from China around mid-January, 2020. Three different clinical evolutions are described: (1) two paucisymptomatic women diagnosed within a day of exhibiting symptoms, with high nasopharyngeal titres of SARS-CoV-2 within the first 24 h of the illness onset (5·2 and 7·4 log₁₀ copies per 1000 cells, respectively) and viral RNA detection in stools; (2) a two-step disease progression in two young men, with a secondary worsening around 10 days after disease onset despite a decreasing viral load in nasopharyngeal samples; and (3) an 80-year-old man with a rapid evolution towards multiple organ failure and a persistent high viral load in lower and upper respiratory tract with systemic virus dissemination and virus detection in plasma. The 80-year-old patient died on day 14 of illness (Feb 14, 2020); all other patients had recovered and been discharged by Feb 19, 2020.

Interpretation: We illustrated three different clinical and biological types of evolution in five patients infected with SARS-CoV-2 with detailed and comprehensive viral sampling strategy. We believe that these findings will contribute to a better understanding of the natural history of the disease and will contribute to advances in the implementation of more efficient infection control strategies.

Funding: REACTing (Research & Action Emerging Infectious Diseases).

Figure 1

Schematic description of five cases of COVID-19 in France COVID-19=coronavirus disease 2019. ICU=intensive care unit.

Figure 2

Individual dynamics of the nasopharyngeal viral load and virus detection in other body fluids in the five COVID-19 cases in France (A–E) Blue lines represent the viral load in nasopharyngeal swab normalised using cell quantification. All positive samples below the quantification limit were represented on the quantification limit line. For readability, all negative results were represented on the x-axis, which correspond to our detection limit. / indicates not done, + indicates a positive result, and - indicates a negative result. NQ=not quantifiable. *Titre in log of copies per g of stools.

Figure 3

Overall dynamics of the nasopharyngeal viral load and virus detection in other body fluids in the five COVID-19 cases in France COVID-19=coronavirus disease 2019. / indicates not done, + indicates a positive result, and – indicates a negative result. *COVID-19 symptom onset.