COVID-19 can suddenly become severe: a case series from Tokyo, Japan

Keiji Nakamura; Satoshi Ide; Sho Saito; Noriko Kinoshita; Satoshi Kutsuna; Yuki Moriyama; Tetsuya Suzuki; Masayuki Ota; Hidetoshi Nomoto; Tetsuya Mizoue; Masayuki Hojo; Jin Takasaki; Yusuke Asai; Mari Terada; Yutaro Akiyama; Yusuke Miyazato; Takato Nakamoto; Yuji Wakimoto; Mugen Ujiie; Kei Yamamoto; Masahiro Ishikane; Shinichiro Morioka; Kayoko Hayakawa; Haruhito Sugiyama; Norio Ohmagari

doi:10.35772/ghm.2020.01054

Brief Report

COVID-19 can suddenly become severe: a case series from Tokyo, Japan

Keiji Nakamura, Satoshi Ide, Sho Saito, Noriko Kinoshita, Satoshi Kutsuna, Yuki Moriyama, Tetsuya Suzuki, Masayuki Ota, Hidetoshi Nomoto, Tetsuya Mizoue, Masayuki Hojo, Jin Takasaki, Yusuke Asai, Mari Terada, Yutaro Akiyama, Yusuke Miyazato, Takato Nakamoto, Yuji Wakimoto, Mugen Ujiie, Kei Yamamoto, Masahiro Ishikane, Shinichiro Morioka, Kayoko Hayakawa, Haruhito Sugiyama, Norio Ohmagari

Author information

Keiji Nakamura
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Satoshi Ide
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Sho Saito
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Noriko Kinoshita
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Satoshi Kutsuna
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Yuki Moriyama
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Tetsuya Suzuki
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Masayuki Ota
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Hidetoshi Nomoto
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Tetsuya Mizoue
Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
Masayuki Hojo
Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
Jin Takasaki
Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
Yusuke Asai
AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan.
Mari Terada
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Yutaro Akiyama
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Yusuke Miyazato
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Takato Nakamoto
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Yuji Wakimoto
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Mugen Ujiie
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Kei Yamamoto
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Masahiro Ishikane
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Shinichiro Morioka
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Kayoko Hayakawa
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Haruhito Sugiyama
National Center for Global Health and Medicine, Tokyo, Japan.
Norio Ohmagari
Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.

Keywords: COVID-19, SARS-CoV-2, pneumonia

JOURNAL FREE ACCESS

2020 Volume 2 Issue 3 Pages 174-177

DOI https://doi.org/10.35772/ghm.2020.01054

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Abstract

Since the initial report of coronavirus disease (COVID-19) from the City of Wuhan, China in December 2019, there have been multiple cases globally. Reported here are 11 cases of COVID-19 at this hospital; all of the patients in question presented with relative bradycardia. The severity of the disease was classified into four grades. Of the patients studied, 3 with mild COVID-19 and 3 with moderate COVID-19 improved spontaneously. Lopinavir/ritonavir was administered to 3 patients with severe COVID-19 and 2 with critical COVID-19. Both patients with critical COVID-19 required mechanical ventilation and extracorporeal membrane oxygenation. Both patients with critical COVID-19 had a higher fever that persisted for longer than patients with milder COVID-19. The respiratory status of patients with critical COVID-19 worsened rapidly 7 days after the onset of symptoms. Relative bradycardia may be useful in distinguishing between COVID-19 and bacterial community-acquired pneumonia. In patients who have had a fever for > 7 days, the condition might worsen suddenly.

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