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Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsWho was the original patient in Washington?
Dr. Angela Rasmussen on MSNBC just said that they think that the rash of coronavirus cases in Washington State started with the original patient who was sent there several weeks ago.
What is she talking about?
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Who was the original patient in Washington? (Original Post)
Baitball Blogger
Mar 2020
OP
dalton99a
(81,451 posts)1. His case was published in the New England Journal of Medicine:
First Case of 2019 Novel Coronavirus in the United States
Michelle L. Holshue, M.P.H., Chas DeBolt, M.P.H., Scott Lindquist, M.D., Kathy H. Lofy, M.D., John Wiesman, Dr.P.H., Hollianne Bruce, M.P.H., Christopher Spitters, M.D., Keith Ericson, P.A.-C., Sara Wilkerson, M.N., Ahmet Tural, M.D., George Diaz, M.D., Amanda Cohn, M.D., LeAnne Fox, M.D., Anita Patel, Pharm.D., Susan I. Gerber, M.D., Lindsay Kim, M.D., Suxiang Tong, Ph.D., Xiaoyan Lu, M.S., Steve Lindstrom, Ph.D., Mark A. Pallansch, Ph.D., William C. Weldon, Ph.D., Holly M. Biggs, M.D., Timothy M. Uyeki, M.D., and Satish K. Pillai, M.D. for the Washington State 2019-nCoV Case Investigation Team*
Michelle L. Holshue, M.P.H., Chas DeBolt, M.P.H., Scott Lindquist, M.D., Kathy H. Lofy, M.D., John Wiesman, Dr.P.H., Hollianne Bruce, M.P.H., Christopher Spitters, M.D., Keith Ericson, P.A.-C., Sara Wilkerson, M.N., Ahmet Tural, M.D., George Diaz, M.D., Amanda Cohn, M.D., LeAnne Fox, M.D., Anita Patel, Pharm.D., Susan I. Gerber, M.D., Lindsay Kim, M.D., Suxiang Tong, Ph.D., Xiaoyan Lu, M.S., Steve Lindstrom, Ph.D., Mark A. Pallansch, Ph.D., William C. Weldon, Ph.D., Holly M. Biggs, M.D., Timothy M. Uyeki, M.D., and Satish K. Pillai, M.D. for the Washington State 2019-nCoV Case Investigation Team*
On January 19, 2020, a 35-year-old man presented to an urgent care clinic in Snohomish County, Washington, with a 4-day history of cough and subjective fever. On checking into the clinic, the patient put on a mask in the waiting room. After waiting approximately 20 minutes, he was taken into an examination room and underwent evaluation by a provider. He disclosed that he had returned to Washington State on January 15 after traveling to visit family in Wuhan, China. The patient stated that he had seen a health alert from the U.S. Centers for Disease Control and Prevention (CDC) about the novel coronavirus outbreak in China and, because of his symptoms and recent travel, decided to see a health care provider.
Apart from a history of hypertriglyceridemia, the patient was an otherwise healthy nonsmoker. The physical examination revealed a body temperature of 37.2°C, blood pressure of 134/87 mm Hg, pulse of 110 beats per minute, respiratory rate of 16 breaths per minute, and oxygen saturation of 96% while the patient was breathing ambient air. Lung auscultation revealed rhonchi, and chest radiography was performed, which was reported as showing no abnormalities (Figure 1). A rapid nucleic acid amplification test (NAAT) for influenza A and B was negative. A nasopharyngeal swab specimen was obtained and sent for detection of viral respiratory pathogens by NAAT; this was reported back within 48 hours as negative for all pathogens tested, including influenza A and B, parainfluenza, respiratory syncytial virus, rhinovirus, adenovirus, and four common coronavirus strains known to cause illness in humans (HKU1, NL63, 229E, and OC43).
Given the patients travel history, the local and state health departments were immediately notified. Together with the urgent care clinician, the Washington Department of Health notified the CDC Emergency Operations Center. Although the patient reported that he had not spent time at the Huanan seafood market and reported no known contact with ill persons during his travel to China, CDC staff concurred with the need to test the patient for 2019-nCoV on the basis of current CDC persons under investigation case definitions.8 Specimens were collected in accordance with CDC guidance and included serum and nasopharyngeal and oropharyngeal swab specimens. After specimen collection, the patient was discharged to home isolation with active monitoring by the local health department.
On January 20, 2020, the CDC confirmed that the patients nasopharyngeal and oropharyngeal swabs tested positive for 2019-nCoV by real-time reverse-transcriptasepolymerase-chain-reaction (rRT-PCR) assay. In coordination with CDC subject-matter experts, state and local health officials, emergency medical services, and hospital leadership and staff, the patient was admitted to an airborne-isolation unit at Providence Regional Medical Center for clinical observation, with health care workers following CDC recommendations for contact, droplet, and airborne precautions with eye protection.9
...
Apart from a history of hypertriglyceridemia, the patient was an otherwise healthy nonsmoker. The physical examination revealed a body temperature of 37.2°C, blood pressure of 134/87 mm Hg, pulse of 110 beats per minute, respiratory rate of 16 breaths per minute, and oxygen saturation of 96% while the patient was breathing ambient air. Lung auscultation revealed rhonchi, and chest radiography was performed, which was reported as showing no abnormalities (Figure 1). A rapid nucleic acid amplification test (NAAT) for influenza A and B was negative. A nasopharyngeal swab specimen was obtained and sent for detection of viral respiratory pathogens by NAAT; this was reported back within 48 hours as negative for all pathogens tested, including influenza A and B, parainfluenza, respiratory syncytial virus, rhinovirus, adenovirus, and four common coronavirus strains known to cause illness in humans (HKU1, NL63, 229E, and OC43).
Given the patients travel history, the local and state health departments were immediately notified. Together with the urgent care clinician, the Washington Department of Health notified the CDC Emergency Operations Center. Although the patient reported that he had not spent time at the Huanan seafood market and reported no known contact with ill persons during his travel to China, CDC staff concurred with the need to test the patient for 2019-nCoV on the basis of current CDC persons under investigation case definitions.8 Specimens were collected in accordance with CDC guidance and included serum and nasopharyngeal and oropharyngeal swab specimens. After specimen collection, the patient was discharged to home isolation with active monitoring by the local health department.
On January 20, 2020, the CDC confirmed that the patients nasopharyngeal and oropharyngeal swabs tested positive for 2019-nCoV by real-time reverse-transcriptasepolymerase-chain-reaction (rRT-PCR) assay. In coordination with CDC subject-matter experts, state and local health officials, emergency medical services, and hospital leadership and staff, the patient was admitted to an airborne-isolation unit at Providence Regional Medical Center for clinical observation, with health care workers following CDC recommendations for contact, droplet, and airborne precautions with eye protection.9
...
Baitball Blogger
(46,700 posts)2. Great information!
I'm going by my original hunch that a health care worker got it and passed it along to other health care workers and patients. Some of them are mobile between medical locations.
Ms. Toad
(34,062 posts)4. Here's the link to the article
https://www.nejm.org/doi/full/10.1056/NEJMoa2001191
It's an interesting read, especially in light of two individuals yesterday talking about stockpiling antibiiotics - one of whom insisted that antibiotics were appropriate for secondary illnesses. The hospital was concerned about the pneumonia being a secondary (hospital-acquired) pneumonia but discontinued antibiotic treatment when he persistently tested negative for bacteria. From what I've been reading, the pneumonia is part of the primary illness (i.e. viral in origin), and often appears after the patient appears to be improving.
Creating drug-resistent bacteria is a real risk - especially with this illness, when pneumonia is part of the primary illness, don't just start swallowing whatever is in your medicine cabinet without consulting with your doctor.
It's an interesting read, especially in light of two individuals yesterday talking about stockpiling antibiiotics - one of whom insisted that antibiotics were appropriate for secondary illnesses. The hospital was concerned about the pneumonia being a secondary (hospital-acquired) pneumonia but discontinued antibiotic treatment when he persistently tested negative for bacteria. From what I've been reading, the pneumonia is part of the primary illness (i.e. viral in origin), and often appears after the patient appears to be improving.
Creating drug-resistent bacteria is a real risk - especially with this illness, when pneumonia is part of the primary illness, don't just start swallowing whatever is in your medicine cabinet without consulting with your doctor.
dalton99a
(81,451 posts)5. UPDATE: He recovered after experimental treatment
https://www.scmp.com/news/world/united-states-canada/article/3050949/us-coronavirus-patient-who-was-worlds-first-treated
US coronavirus patient who was worlds first treated with experimental Gilead drug remdesivir and recovered
Man who visited Wuhan fell ill after returning home to the United States on January 15
Doctors administered experimental antiviral Gilead drug after patient showed signs of developing pneumonia
Tribune News Service
Published: 2:53pm, 17 Feb, 2020
The man, 35, had been visiting family in Wuhan. He flew into Seattle-Tacoma International Airport on January 15, two days before flights from China's Hubei province began being funnelled through three US airports that could screen passengers for signs of illness. That has now been expanded to 11 airports, of which Seattle is one.
When he got home, he developed a dry cough and low fever and, having read news of the new coronavirus, promptly visited an urgent care clinic. The Snohomish Health District sent samples to the Centres for Disease Control & Prevention (CDC) in Atlanta for testing. ...
After discussions with doctors at the CDC and the patient, Diaz got approval from the Federal Drug Administration to administer an experimental antiviral drug called remdesivir.
Once the patient was doing better, it was a matter of working with the CDC and the health district to determine when he could be discharged and how he would be monitored after that. He lives alone, which made the prospect of quarantining him easier.
Sometime between January 31 and February 3, the patient was stealthily taken home. The isolation unit has been taken down, the area sterilised. At the hospital on the northern edge of downtown Everett, life goes on.
US coronavirus patient who was worlds first treated with experimental Gilead drug remdesivir and recovered
Man who visited Wuhan fell ill after returning home to the United States on January 15
Doctors administered experimental antiviral Gilead drug after patient showed signs of developing pneumonia
Tribune News Service
Published: 2:53pm, 17 Feb, 2020
The man, 35, had been visiting family in Wuhan. He flew into Seattle-Tacoma International Airport on January 15, two days before flights from China's Hubei province began being funnelled through three US airports that could screen passengers for signs of illness. That has now been expanded to 11 airports, of which Seattle is one.
When he got home, he developed a dry cough and low fever and, having read news of the new coronavirus, promptly visited an urgent care clinic. The Snohomish Health District sent samples to the Centres for Disease Control & Prevention (CDC) in Atlanta for testing. ...
After discussions with doctors at the CDC and the patient, Diaz got approval from the Federal Drug Administration to administer an experimental antiviral drug called remdesivir.
Once the patient was doing better, it was a matter of working with the CDC and the health district to determine when he could be discharged and how he would be monitored after that. He lives alone, which made the prospect of quarantining him easier.
Sometime between January 31 and February 3, the patient was stealthily taken home. The isolation unit has been taken down, the area sterilised. At the hospital on the northern edge of downtown Everett, life goes on.
Yo_Mama_Been_Loggin
(107,922 posts)3. His identity was kept confidential
But he had traveled to the Wuhan province