Demographic data and clinical symptoms
The demographic and clinical characteristics Of the 4 patients were summarized in Table 1. Case 1 was a 33 years old female without underlying comorbidities. The patient had no exposure to Huanan Seafood Market, which was linked to the first reported COVID-19 case. her first symptoms were cough and dizziness. the temperature was no more than 38℃ in her later disease course. She was diagnosed as moderate pneumonia and still in hospitalization at the end of our data collection. her illness courses exceeded 40 days.
Case 2 was a 50 years old female with hypertension. She had Covid-19 exposure because of her physician occupation. The first symptom were cough, sore throat and myalgia. Her body temperature is no more than 38℃ in all through her illness courses. She was diagnosed as moderate pneumonia, and her illness courses was 40 days. She was discharged from hospital at day 40.
Case 3 who was 36 years old without underlying comorbidities, male, had confirmed Covid-19 pneumonia patients exposure because of his physician occupation, his first symptom is cough, and fever, and later diarrhea. his highest body temperature is up to nearly 40℃ before admission to hospital. He was diagnosed as severe pneumonia, and his illness courses was more than 40 days. She was still in hospital.
Case 4 who was 46 years old with diabetes, male, had Huanan Seafood Market exposure, his first symptom is cough and chest tightness, and later short of breath. his highest body temperature is 37.7℃ before admission to hospital. He was diagnosed as severe pneumonia, and his illness courses was more than 50 days. He was still in hospital. The body temperature alteration of four cases was shown in figure 1.
Nucleic acid tests
All nucleic acid test results and the corresponding sampling sites of the 4 patients were shown in Figure 2. All cases had both double-negative and double-positive result at different time during the disease course. It is worth noting that sampling sites of case 2 were stool, sputum and throat swab specimens, while the other three cases were sampled from throat swab specimens. Case 3 and case 4 also were tested blood antibody. Case 2 had two consecutive double-negative results and was discharge from hospital, while other three cases were still in hospital.
Laboratory tests
Laboratory values are shown in Figure 3. Two moderate pneumonia cases (1 and 2) had no elevated D-Dimer level, while two severe cases (3 and 4) had elevated D-Dimer. This is confirmed former studies result of the severity of disease is related to D-Dimer level. Case 2, 3 and 4 had decreased lymphocyte count. Case 3 had the largest reduction of 0.15*109. This patient also had constantly higher temperatures, whether it suggests the body temperature is related to lymphocyte count needs further confirmation. All four cases had elevated eosinophils count. and the marker reached the highest level in the days 25-30, followed by a slow decrease, with more fluctuation in case 3 and 4, first reduced lower than normal, even zero the lowest in about days 10, and increase slowly, to the highest in the days 25-30, subsequently decrease slowly. Whether it suggests a reason of long courses needs more data to confirm. Increased neutrophil occurred in case3 and case4. The elevation of HCRP was also observed in case3 and case4. These two cases had secondary bacterial infection following virus infection. Maybe it suggests the secondary bacterial infection has an influence on severity of disease, but if secondary bacterial infection exists has no relation to the course of illness. From the data of hemoglobin, we observed the two severe cases had no anemia, while the decreased hemoglobin of two moderate cases was observed. It suggests the decreased hemoglobin has no relation to the course of illness. Elevated lactate dehydrogenase (LDH) was found in two severe cases, while decreased lactate dehydrogenase was found in case2. It maybe suggests the elevated LDH is related to severity of disease, but had no effect on the course of illness. Lymphocyte/ Neutrophil data shown the lower level in two-three weeks, and return to normal slowly after 3 weeks.
Imaging examinations
Intact CT imaging of all cases are available. Features of CT imaging, including location, proportion, numbers of associated lung lobes and manifestation, were shown in the supplementary table. Ground-glass opacity in both lungs were characteristically observed on CT in three cases without case1. Peripheral distribution was observed in case 1, and bilateral sides involvement were observed in other three patients. Pleural effusion and thickened pleura was not detected in any case(Figure 4).
Treatment
Antiviral drugs, Mechanical ventilation, Immunotherapy, oxygen therapy were administered to all patients. Intravenous antibiotics and Corticosteroids were given to two severe patients (Figure 5). Tranditional medicine was given to two moderate pneumonia. During the course of illness, case4 were given two antiviral drugs: Arbidol, Lopinavir and Ritonavir Tablets, two antibiotics: moxifloxacin, Levo +AG1:AI3 floxacin, 18 days of corticosteroids in all. Elevated ALT level was only observed in case4 . Case2 was given three antiviral drugs: Arbidol, Lopinavir and Ritonavir, oseltamivir, and Chinese tranditional medicine. And only case2 had drug caused leukopenia. Viral infection is a kind of self-limiting disease, although many things of the novel Covid-19 pneumonia is not clear, if it suggests the over-treatment of these patients needs consideration.
Complications and outcome
Until now, only case2 was discharged from hospital after two consecutive double-negative result. The other three cases were still in hospital. The two severe cases had hypoalbuminemia, case4 had respiratory failure. All four cases had no exacerbation.
