Case1
A 46-year-old female with fever, dry cough, shortness of breath after activity for 2 days, and no underlying disease in the past.On February 15 (the third day after onset, dpoi 3), the patient was diagnosed as COVID-19 due to RT-PCR test of throat swab. The patient's condition continued to worsen after treatment symptomatically with Arbidol and Lopinavir and Ritonavir and other supportive care. The blood gas analysis (no oxygen inhalation) suggested that the patient's partial pressure of oxygen (PO2) was 49 mmHg and the chest CT indicates ground-glass shadows in both lower lungs.Therefore,the patient was diagnosed with respiratory failure and initiated to receive non-invasive mechanical ventilation. She was transferred to the Chongqing Public Health Medical Center on February 16 (dpoi 4), and the antiviral drugs were changed to darunavir and Arbidol. After 3 days of treatment, the patient self-reported that there was no obvious relief of shortness of breath and poor sleep. We infused 200 ml ABO-compatible CP from convalescent patients with SARS-CoV-2 infection at 00:15 on February 19 (dpoi 7), and the second 200 ml ABO-compatible CP was given at 8: 00 a.m on February 20 (dpoi 8). No adverse reaction was observed. The symptoms were relieved and the ventilator was removed on February 22nd (dpoi 10). Twice repeated RT-PCR tests were performed on throat swabs (interval at least 24 hours) on February 23rd (dpoi 11) and February 25th (dpoi 13), and the results were all negative. The patient was rehabilitated and discharged on 28 February (dpoi 16). And she was advised to reexamine PCR and antibodies after 14 days of self-isolation after discharging.
Case 2
A 64-year-old female who was hospitalized in Jiangbei District people's Hospital of Chongqing because of dry cough and wheezing after activity for 2 days.Meanwhile, the patient was denied any previous comorbidity.The throat swabs for SARS-CoV-2 by RT-PCR were positive on Feb. 8 (dpoi 2). The chest CT revealed large ground glass shadow in both lungs and blood gas analysis (oxygen inhalation 2L/min) suggested PO2 was 61 mmHg. The patients were given symptomatic treatment with Lopinavir and Ritonavir, interferon and other supportive care. The patient was transferred to Chongqing Public Health Medical Center on February 9 (dpoi 3) for further centralized treatment, and was given symptomatic treatments, including darunavir, Arbidol, high-flow nasal catheter oxygen inhalation. The patient's symptoms of wheezing did not improve, and subsequent chest CT on February 14(dpoi 8) demonstrated that the lesions of both lungs continued to progress. In total, we infused 400 ml of ABO-compatible convalescent plasma into the patient.The first dose (200 ml) was given at 00:10 on February 18 (dpoi 12), and the second administration (200 ml) was at 12:50 on February 19 (dpoi 13). On February 21th (dpoi 15), she self-reported that the symptoms of wheezing were significantly improved, and the high-flow nasal catheter was changed to low-flow nasal catheter for oxygen inhalation. And the chest CT obtained on the same day (dpoi 15) suggested obvious absorption of bilateral lung lesions (Fig. 1).Two repeated RT-PCR tests results were negative on February 20 (dpoi 14) and February 22 (dpoi 16) (at least 24 hours apart).She was cured and discharged from the hospital on February 25 (dpoi 19). And, like other patients, we asked her to reexamine PCR and antibodies after 14 days of staying in isolation at home after discharge.
Case 3
A 70-year-old woman with cough and sputum for 4 days, shortness of breath for 1 day, and a past medical history of diabetes.She was diagnosed as COVID-19 in Zhongshan Hospital of Chongqing on January 25th (dpoi 4). Her chest CT showed multiple patchy high-density shadows and flocculent blurred shadows in both lungs and the blood gas analysis showed that the oxygenation index (OI) was 157 mmHg. Later, she was transferred to Chongqing Public Health Medical Center for centralized isolation treatment on January 26 (dpoi 5). Then,Lopinavir and Ritonavir, interferon and other supportive care were given at the beginning of the treatment. Later, it was changed to darunavir, Arbidol, methylprednisolone, and other supportive symptomatic treatment because of the condition did not improve. The chest CT on Feb.11 (dpoi 21) showed that there was no obvious absorption of bilateral lung lesions. The patient complained of obvious shortness of breath and the PO2 fluctuated from 45 to 80 mmHg. Multiple nucleic acid tests showed positive. Non-invasive ventilator was given oxygen therapy on February 16 (dpoi 26). We gave the patient a total of 400 ml ABO-compatible CP. The first dose was given at 8: 00 a.m (200 ml) on February 21 (dpoi 31), and the second administration time was at 08:30 a.m. (200 ml) on February 23rd (dpoi 33). After that, the patient's shortness of breath symptoms was relieved. She was withdrawn from the ventilator on Feb. 24 (dpoi 34), and the throat swab RT-PCR repeated test was negative on Feb. 25 (dpoi 35) and 26 (dpoi 36) (at least 24 hours interval). The chest CT showed partial absorption of both lung lesions on Feb. 27 (dpoi 37). The patient has met the discharge criteria and was discharged from hospital on Feb. 28 (dpoi 38). And she was advised to reexamine PCR and antibodies after 14 days of self-isolation after discharging.
Case 4
An 84-year-old male who was admitted to Yongchuan Hospital of Chongqing Medical University on February 3 (dpoi 4) with fever, cough, sputum and shortness of breath for 4 days. He has a previous medical history of chronic obstructive pulmonary diseases(COPD). On the same day, the nucleic acid amplification of material from a throat swab demonstrated the new coronavirus SARS-CoV-2. The chest CT showed diffuse parenchymal abnormalities in the periphery of the whole lungs and the PO2 was 60 mmHg (4L/ min of oxygen inhalation). Then, Arbidol, darunavir and non-invasive ventilation oxygen therapy were given. The patient complained of poor sleep quality and obvious shortness of breath after treatment. Considering that the patient was previously complicated with COPD, we treated the patient with methylprednisolone. The chest CT on February 15 (dpoi 16) showed that there was no significant change in both lung lesions. We gave the patient 3 times of total 800 ml ABO-compatible convalescent plasma from February20 (dpoi 21) to 23 (dpoi 24), and there was no obvious adverse reaction. The symptoms of wheezing were relieved on Feb. 24 (dpoi 25), and methylprednisolone was discontinued. The repeated RT-PCR tests of pharyngeal swabs were negative on February 25th and 26th (interval at least 24 hours). The chest CT on February 26th (dpoi 27) showed that the lesions of both lungs were partial absorbed. Now the patient was cured and discharged from hospital on February 28th. And he was advised to reexamine PCR and antibodies after 14 days of self-isolation after discharge from the hospital.
Case 5
A 63-year-old male with fever, dry cough and shortness of breath after activity for 2 days. He had a medical history of hypertension. He was diagnosed with COVID-19 after performing real-time RT-PCR for COVID-19 by throat swab on February 3 (dpoi 2) and was admitted to Yongchuan Hospital affiliated to Chongqing Medical University. The chest CT suggested ground glass changes in both lungs and the PO2 was 70 mmHg. After treatment symptomatically with Arbidol, darunavir and high-flow nasal catheter oxygen inhalation, the symptoms of fever were significantly relieved, but the symptoms of shortness of breath were aggravated. The blood gas analysis (O2 4L/min) indicated that the PO2 was 60 mmHg on Feb.6 (dpoi 5), indicating that the patient had respiratory failure. Non-invasive mechanical ventilation was given. The patient had slight relief of shortness of breath and poor appetite after a few days of treatment. A total of 400 ml CP was given to the patient.The first time(200 ml) was at 8: 00 a.m. on February 13 (dpoi 12), and the second time(200 ml) was at 8: 00 p.m. on February 13 (dpoi 12). On February 15th (dpoi 14), the symptoms of the patients were significantly relieved and his spirits were improved. Chest CT obtained on the same day showed partial absorption of both lungs.The results of two continual RT-PC-reactive proteinCR tests of throat swabs were negative on February 16 ( 15) and 18 (dpoi 17) (at least 24 hours interval). The patient was rehabilitated and discharged on February 19 (dpoi 18). As usual, he was advised to reexamine PCR and antibodies after 14 days of self-isolation.