The patient was a 32-year-old female, mother of a 13-month-old boy who was breastfed since birth. On January 20, 2020, the patient and her son had a family meal with relatives who returned to Yiwu from Wuhan for the Spring Festival. After two weeks, the patient had nasal congestion, and her son had a fever with a peak temperature of 38.4℃, dry cough, and nasal congestion. Two days after the onset (February 2, 2020), tests for SARS-CoV–2 nucleic acid performed at the Fourth Affiliated Hospital, Zhejiang University School of Medicine, were positive in both the mother and the son, whereas the patient’s husband had a negative result. The results were confirmed by the Yiwu Center for Disease Control and Prevention. The patient suffered from postpartum depression, feeling deeply anxious, and insisting on staying with her child. At the same time, the husband asked for accompanying his wife and son due to concerns about the patient’s mental health. To respect the wish of the patient and her family, and after consultation with psychiatrists, the family was treated in the same negative-pressure isolation ward.
On admission, the mother had a symptom of nasal congestion, but without rhinorrhea, cough, sputum, fever, or fatigue. The physical examination revealed a body temperature of 36.4℃, respiratory rate of 18 breaths per minute, a pulse of 90 beats per minute, blood pressure of 102/74 mmHg, and oxygen saturation of 98% while breathing ambient air. Lung auscultation indicated no abnormalities. The results of a routine blood test, chest X-ray, C-reactive protein, and liver and kidney function were normal. Respiratory virus antigen quadruplet test (influenza A and B virus, respiratory syncytial virus, adenovirus) and the nucleic acid test for influenza A and B virus were negative. The patient received atomized inhalation of recombinant human interferon α–2b 5 million International Unit (IU) in 2 ml sterilized water twice a day as the antiviral treatment and traditional Chinese medicine as a supplemental therapy. She continued breastfeeding every day. The symptom of nasal congestion improved on day 1 after admission, and white blood cell count declined to 2.7×109/L, while the lymphocyte count was 0.9×109/L. The nasopharyngeal swab specimens were positive for SARS-CoV–2 nucleic acid, but the serum was negative. On day 2 after admission, the symptoms of nasal congestion disappeared, and afterward, the patient was free of symptoms such as nasal congestion.The body temperature and oxygen saturation without oxygen inhalation were monitored and remained within the normal range, and the patient was in stable condition. On day 3 after admission, the plain chest CT scan indicated the presence of density-increased patchy consolidation and ground-glass shadow in the lower lobe of the right lung, and viral pneumonia was considered (Figure 1A). Subsequently, on day 9 after admission, white blood cell and lymphocyte counts returned to a normal level, and liver and kidney function and myocardial enzyme spectrum continued to be normal. During the period of hospitalization, the serum, milk and feces specimens tested negative for SARS-CoV–2 nucleic acid, but the nasopharyngeal swabs were repeatedly positive. Chest CT scan showed that the inflammatory exudation in the lungs became gradually absorbed (Figure 1B, 1C). On days 8 and 24 after admission, the breastmilk tests yielded a positive result for SARS-CoV–2 IgG and negative for IgM. Similarly, the serum was positive for SARS-CoV–2 IgG and negative for IgM on days 15 and 19. After 27 days of treatment, the patient was discharged since three consecutive nasopharyngeal swabs were negative for SARS- CoV–2 nucleic acid. The major laboratory results of the patient are listed in Table 1.
The patient’s 13-month-old son continued to have a fever, occasional dry cough, and nasal congestion at admission to the hospital. The physical examination revealed a body temperature of 37.6℃, respiratory rate of 23 breaths per minute, a pulse of 105 beats per minute, blood pressure of 95/56 mmHg, oxygen saturation of 99% while breathing ambient air, and weight of 10 kg. There was no abnormality in lung auscultation. During the hospitalization, antiviral treatment with atomized inhalation of recombinant human interferon α–2b 1.5 million International Unit (IU) in 2 ml sterilized water was performed twice a day for 8 days. On the day of admission, lymphocyte count decreased to 2×109/L, and white blood cell count was 3.7×109/L. Serum tested negative for SARS-CoV–2 IgG and IgM. On day 1 after admission, the temperature returned to the normal value, and remained normal thereafter, but occasional dry cough and runny nose continued. On day 3 after admission, feces and nasopharyngeal swab specimens were positive for SARS-CoV–2 nucleic acid, and plain chest CT scan suggested ground-glass shadows in both lungs (figure 2D). On day 5 after admission, the cough of the child was essentially relieved, while occasional runny nose persisted. At that time, the counts of white blood cells and lymphocytes were 6.9×109/L and 5.1×109/L, respectively. The child became free of symptoms since on the 6th day after admission. On day 13, the serum was negative for SARS-CoV–2 nucleic acid, but positive for SARS-CoV–2 IgG and IgM. Nasopharyngeal swabs and feces specimens repeatedly tested positive for SARS-CoV–2 nucleic acid. On day 27 of the hospital stay, when the child tested negatively two consecutive times for SARS-CoV–2 nucleic acid in nasopharyngeal swabs and feces and chest CT indicated that the ground-glass shadows in the lungs were essentially absorbed (figure 2F), the child was discharged. The major laboratory results of the child are listed in table 2.