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J. Korean Med. Sci., 2020 Apr 06;35(13):e142 | https://doi.org/10.3346/jkms.2020.35.e142 Clinical Course and Outcomes of Patients with Severe Acute Respiratory Syndrome Coronavirus 2 Infection: a Preliminary Report of the First 28 Patients from the Korean Cohort Study on COVID-19

Eu Suk Kim,^1,* Bum Sik Chin,^2,* Chang Kyung Kang,³ Nam Joong Kim,³ Yu Min Kang,⁴ Jae-Phil Choi,⁵ Dong Hyun Oh,⁵ Jeong-Han Kim,⁶ Boram Koh,⁷ Seong Eun Kim,⁸ Na Ra Yun,⁹ Jae-Hoon Lee,¹⁰ Jin Yong Kim,¹¹ Yeonjae Kim,² Ji Hwan Bang,¹² Kyoung-Ho Song,¹ Hong Bin Kim,¹ Ki-hyun Chung,¹³ Myoung-don Oh,³ and on behalf of the Korea National Committee for Clinical Management of COVID-19

¹Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. ²Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea.
³Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ⁴Department of Infectious Diseases, Myongji Hospital, Goyang, Korea. ⁵Department of Internal Medicine, Seoul Medical Center, Seoul, Korea. ⁶Division of Infectious Diseases, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea.
⁷Department of Internal Medicine, Gyeonggi Provincial Medical Center Ansung Hospital, Anseong, Korea. ⁸Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea. ⁹Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Korea. ¹⁰Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea. ¹¹Division of Infectious Diseases, Department of Internal Medicine, Incheon Medical Center, Incheon, Korea. ¹²Division of Infectious Diseases, Seoul Metropolitan Government- Seoul National University Boramae Medical Center, Seoul, Korea. ¹³Department of Pediatrics, National Medical Center, Seoul, Korea.

^*Eu Suk Kim and Bum Sik Chin contributed equally to this work.

Address for Correspondence: Myoung-don Oh, MD, PhD.

Abstract

Background
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected pneumonia emerged in Wuhan, China in December 2019. In this retrospective multicenter study, we investigated the clinical course and outcomes of novel coronavirus disease 2019 (COVID-19) from early cases in Republic of Korea.

Methods
All of the cases confirmed by real time polymerase chain reaction were enrolled from the 1st to the 28th patient nationwide. Clinical data were collected and analyzed for changes in clinical severity including laboratory, radiological, and virologic dynamics during the progression of illness.

Results
The median age was 40 years (range, 20–73 years) and 15 (53.6%) patients were male. The most common symptoms were cough (28.6%) and sore throat (28.6%), followed by fever (25.0%). Diarrhea was not common (10.7%). Two patients had no symptoms. Initial chest X-ray (CXR) showed infiltration in 46.4% of the patients, but computed tomography scan confirmed pneumonia in 88.9% (16/18) of the patients. Six patients (21.4%) required supplemental oxygen therapy, but no one needed mechanical ventilation. Lymphopenia was more common in severe cases. Higher level of C-reactive protein and worsening of chest radiographic score was observed during the 5–7 day period after symptom onset. Viral shedding was high from day 1 of illness, especially from the upper respiratory tract (URT).

Conclusion
The prodromal symptoms of COVID-19 were mild and most patients did not have limitations of daily activity. Viral shedding from URT was high from the prodromal phase. Radiological pneumonia was common from the early days of illness, but it was frequently not evident in simple CXR. These findings could be plausible explanations for the easy and rapid spread of SARS-CoV-2 in the community.

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