Clinical Course of Five COVID-19 Patients and Treatment Updates

Coronaviruses (CoVs) are enveloped, positive-sense RNA viruses. A novel coronavirus (nCoV) was discovered to be a cause of pneumonia outbreak in Wuhan, China in late 2019. The World Health Organization (WHO) named the disease as Coronavirus Disease 2019 (COVID-19) and declared it as a pandemic in March 2020. Since the detection of the first case of COVID-19 in the United States on January 20th, 2020 in Washington State, the pandemic is still expanding. As of July 8th, the United States (U.S.) has the maximum number (3.1 million) of confirmed COVID-19 patients. In this case series, we are presenting the clinical course of the first five confirmed COVID-19 cases admitted to a community hospital in the U.S. in the beginning of March 2020. We analyzed their clinical characteristics, pre-existing comorbidities, laboratory and radiological findings. The clinical management and outcomes are discussed alongside the literature review about current management options. In conclusion, primary management is supportive care to improve oxygenation by various methods. Safety and efficacy of treatment options including ramdesevir, IL-6 inhibitors and convalescent plasma have not yet been established and none of these is FDA approved so far. Increased age (>80 years), hypoxia at the time of presentation and pre-existing co-morbidities are likely related with poor outcomes.