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

doi:10.35772/ghm.2020.01054

. 2020 Jun 30;2(3):174-177.

doi: 10.35772/ghm.2020.01054.

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

Keiji Nakamura¹, Satoshi Ide¹, Sho Saito¹, Noriko Kinoshita¹, Satoshi Kutsuna¹, Yuki Moriyama¹, Tetsuya Suzuki¹, Masayuki Ota¹, Hidetoshi Nomoto¹, Tetsuya Mizoue², Masayuki Hojo³, Jin Takasaki³, Yusuke Asai⁴, Mari Terada¹, Yutaro Akiyama¹, Yusuke Miyazato¹, Takato Nakamoto¹, Yuji Wakimoto¹, Mugen Ujiie¹, Kei Yamamoto¹, Masahiro Ishikane¹, Shinichiro Morioka¹, Kayoko Hayakawa¹, Haruhito Sugiyama⁵, Norio Ohmagari¹

Affiliations

¹ Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
² Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
³ Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
⁴ AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan.
⁵ National Center for Global Health and Medicine, Tokyo, Japan.

PMID: 33330803
PMCID: PMC7731267
DOI: 10.35772/ghm.2020.01054

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

Keiji Nakamura et al. Glob Health Med. 2020.

. 2020 Jun 30;2(3):174-177.

doi: 10.35772/ghm.2020.01054.

Authors

Affiliations

¹ Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
² Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
³ Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
⁴ AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan.
⁵ National Center for Global Health and Medicine, Tokyo, Japan.

PMID: 33330803
PMCID: PMC7731267
DOI: 10.35772/ghm.2020.01054

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.

Keywords: COVID-19; SARS-CoV-2; pneumonia.

2020, National Center for Global Health and Medicine.

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Figures

**Figure 1.**
**Scatter plot of heart rate and body temperature for all patients.** All of the patients with COVID-19 displayed relative bradycardia. Patients with critical COVID-19 tended to have a higher fever than those with less severe COVID-19.

**Figure 2.**
**Progress charts for patients with critical COVID-19.** Shown here are progress charts for 2 patients with critical COVID-19. They had a high fever for over 7 days and their respiratory status rapidly deteriorated.

See this image and copyright information in PMC

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References

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[1] Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi. 2020; 41:145-151. (in Chinese). - PubMed

[2] Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi. 2020; 41:145-151. (in Chinese). - PubMed

[3] Cunha BA. The diagnostic significance of relative bradycardia in infectious disease. Clin Microbiol Infect. 2000; 6:633-634. - PubMed

[4] Cunha BA. The diagnostic significance of relative bradycardia in infectious disease. Clin Microbiol Infect. 2000; 6:633-634. - PubMed

[5] Singh V, Sharma A, Khandelwal R, Kothari K. Variation of axillary temperature and its correlation with oral temperature. J Assoc Physicians India. 2000; 48:898-900. - PubMed

[6] Singh V, Sharma A, Khandelwal R, Kothari K. Variation of axillary temperature and its correlation with oral temperature. J Assoc Physicians India. 2000; 48:898-900. - PubMed

[7] Hu Z, Song C, Xu C, Jin G, Chen Y, Xu X, Ma H, Chen W, Lin Y, Zheng Y, Wang J, Hu Z, Yi Y, Shen H. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Sci China Life Sci. 2020; 63:706-711. - PMC - PubMed

[8] Hu Z, Song C, Xu C, Jin G, Chen Y, Xu X, Ma H, Chen W, Lin Y, Zheng Y, Wang J, Hu Z, Yi Y, Shen H. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Sci China Life Sci. 2020; 63:706-711. - PMC - PubMed

[9] Guo G, Ye L, Pan K, Chen Y, Xing D, Yan K, Chen Z, Ding N, Li W, Huang H, Zhang L, Li X, Xue X. New insights of emerging SARS-CoV-2: epidemiology, etiology, clinical features, clinical treatment, and prevention. Front Cell Dev Biol. 2020; 8:1-22. - PMC - PubMed

[10] Guo G, Ye L, Pan K, Chen Y, Xing D, Yan K, Chen Z, Ding N, Li W, Huang H, Zhang L, Li X, Xue X. New insights of emerging SARS-CoV-2: epidemiology, etiology, clinical features, clinical treatment, and prevention. Front Cell Dev Biol. 2020; 8:1-22. - PMC - PubMed

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

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

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