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Case Reports
. 2020 Jul 28;71(15):807-812.
doi: 10.1093/cid/ciaa374.

First Mildly Ill, Nonhospitalized Case of Coronavirus Disease 2019 (COVID-19) Without Viral Transmission in the United States-Maricopa County, Arizona, 2020

Sarah E Scott  1   2   3 , Karen Zabel  2 , Jennifer Collins  2 , Katherine C Hobbs  2 , Melissa J Kretschmer  2 , Mitchell Lach  2 , Katie Turnbow  2 , Lindsay Speck  2 , Jessica R White  2 , Keila Maldonado  2 , Brandon Howard  2 , Jeanene Fowler  2 , Sonia Singh  2 , Susan Robinson  3 , Alexandra Peterson Pompa  3 , Kevin Chatham-Stephens  4 , Amy Xie  5 , Jordan Cates  1   6 , Stephen Lindstrom  6 , Xiaoyan Lu  6 , Melissa A Rolfes  7 , Marcy Flanagan  2 , Rebecca Sunenshine  2   8 ; Maricopa County COVID-19 Case Investigation Team
Affiliations
Case Reports

First Mildly Ill, Nonhospitalized Case of Coronavirus Disease 2019 (COVID-19) Without Viral Transmission in the United States-Maricopa County, Arizona, 2020

Sarah E Scott et al. Clin Infect Dis. .

Abstract

Background: Coronavirus disease 2019 (COVID-19) causes a range of illness severity. Mild illness has been reported, but whether illness severity correlates with infectivity is unknown. We describe the public health investigation of a mildly ill, nonhospitalized COVID-19 case who traveled to China.

Methods: The case was a Maricopa County resident with multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive specimens collected on 22 January 2020. Contacts were persons exposed to the case on or after the day before case diagnostic specimen collection. Contacts were monitored for 14 days after last known exposure. High-risk contacts had close, prolonged case contact (≥ 10 minutes within 2 m). Medium-risk contacts wore all US Centers for Disease Control and Prevention-recommended personal protective equipment during interactions. Nasopharyngeal and oropharyngeal (NP/OP) specimens were collected from the case and high-risk contacts and tested for SARS-CoV-2.

Results: Paired case NP/OP specimens were collected for SARS-CoV-2 testing at 11 time points. In 8 pairs (73%), ≥ 1 specimen tested positive or indeterminate, and in 3 pairs (27%) both tested negative. Specimens collected 18 days after diagnosis tested positive. Sixteen contacts were identified; 11 (69%) had high-risk exposure, including 1 intimate contact, and 5 (31%) had medium-risk exposure. In total, 35 high-risk contact NP/OP specimens were collected for SARS-CoV-2 testing; all 35 pairs (100%) tested negative.

Conclusions: This report demonstrates that SARS-CoV-2 infection can cause mild illness and result in positive tests for up to 18 days after diagnosis, without evidence of transmission to close contacts. These data might inform public health strategies to manage individuals with asymptomatic infection or mild illness.

Keywords: COVID-19; SARS-CoV-2; illness severity; serial testing; viral transmission.

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