Clinical course of first COVID-19 deaths in the US

April 01, 2020

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One of the first COVID-19 deaths in the US was at Evergreen Hospital in Kirkland, Washington. Over the following weeks, multiple further cases were identified in the surrounding community and treated at this hospital. Most were attributed to US transmission, and the majority were linked to exposures at a skilled nursing facility. The authors describe a case series of the incident cases of COVID-19 admitted to the intensive care unit (ICU) at Evergreen Hospital. They included all patients with confirmed SARS-CoV-2 infection by PCR admitted to the ICU. 21 cases were included (mean age 70 years, 52% male). Comorbidities were present in 86%, with chronic kidney disease and congestive heart failure being the most common. Initial symptoms included shortness of breath (76%), fever (52%) and cough (48%). The mean onset of symptoms prior to hospital admission was 3.5 days and 81% patients were admitted to the ICU <24 hours after admission. An abnormal chest radiograph was seen in 95% patients upon admission. The most common findings were bilateral reticular nodular opacities (52%) and ground-glass opacities (48%). By 72 hours, 86% of patients had bilateral reticular nodular opacities and 67% had evidence of ground-glass opacities. The mean white cell count was 9365 μL upon admission and 67% of patients had a white cell count in the normal range. 67% had an absolute lymphocyte count <1000 cells/μL and 38% had abnormal liver function tests. Mechanical ventilation was started in 71% of patients. Acute respiratory distress syndrome (ARDS) was seen in all the patients requiring mechanical ventilation, of which 53% had developed severe ARDS by 72 hours. While most patients did not present with shock, vasopressors were used for 67% patients during their illness. Cardiomyopathy developed in 33% patients. By the time of publication the mortality was 67%, and 24% of patients remained critically ill, with only 9.5% discharged from the ICU. Therefore there are poor short-term outcomes in patients requiring invasive ventilation.

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Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, et al. ISSN: JAMA; doi: 10.1001/jama.2020.4326.


Added: April 01, 2020