Background Three clusters of coronavirus disease 2019 (COVID-19) linked to a tour group from China, a company conference, and a church were identified in Singapore in February, 2020.Methods We gathered epidemiological and clinical data from individuals with confirmed COVID-19, via interviews and inpatient medical records, and we did field investigations to assess interactions and possible modes of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Open source reports were obtained for overseas cases. We reported the median (IQR) incubation period of SARS-CoV-2.
Findings As of Feb 15, 2020, 36 cases of COVID-19 were linked epidemiologically to the first three clusters of circumscribed local transmission in Singapore. 425 close contacts were quarantined. Direct or prolonged close contact was reported among affected individuals, although indirect transmission (eg, via fomites and shared food) could not be excluded. The median incubation period of SARS-CoV-2 was 4 days (IQR 3-6). The serial interval between transmission pairs ranged between 3 days and 8 days.Interpretation SARS-CoV-2 is transmissible in community settings, and local clusters of COVID-19 are expected in countries with high travel volume from China before the lockdown of Wuhan and institution of travel restrictions. Enhanced surveillance and contact tracing is essential to minimise the risk of widespread transmission in the community.Funding None.
Articles 2www.thelancet.com Published online March 16, 2020 https://doi.
Diagnosis of SDRIFE is dependent upon recognition of the clinical morphology and distribution of the rash, and its temporal relationship to the use of the suspected drug. Outcomes of in-vivo and in-vitro tests have been inconsistent, and thus may not be useful in the identification of the putative drug.
We describe a COVID-19 patient with acute hyperhidrosis and symptomatic orthostatic tachycardia. We encountered 3 other patients with ophthalmic dysautonomia. We posit COVID-19 as a cause of acute, limited, possibly dysimmune, autonomic dysfunction.A 39-year-old man, a construction worker with no medical history, was diagnosed with COVID-19 from nasopharyngeal swab reverse transcription polymerase chain reaction (rt-PCR) when he presented with 8 days of acute respiratory symptoms, diarrhea, abdominal discomfort and pneumonia. Within 2 days‚ he required supplemental oxygen and prone-positioning, and was placed on a remdesivir trial. He recovered without ventilatory support. His blood pressure at admission was 165/92 mmHg. In hospital‚ it ranged from 130 to 170/80-110 mmHg. He was started on amlodipine 2.5 mg. His blood glucose ranged from 9 to 13 mmol/L and HbA1c was 8.8%. He was diagnosed with diabetes mellitus (DM) and given insulin and metformin.At day 13 of illness, as he was recuperating in the general ward with stable blood pressure and parameters, he developed right leg ischemia. Computed tomography (CT) aortogram showed a mural thrombus at the suprarenal aorta.
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