BACKGROUNDCommunity transmission of coronavirus 2019 was detected in the state of Washington in February 2020. METHODSWe identified patients from nine Seattle-area hospitals who were admitted to the intensive care unit (ICU) with confirmed infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Clinical data were obtained through review of medical records. The data reported here are those available through March 23, 2020. Each patient had at least 14 days of follow-up. RESULTSWe identified 24 patients with confirmed Covid-19. The mean (±SD) age of the patients was 64±18 years, 63% were men, and symptoms began 7±4 days before admission. The most common symptoms were cough and shortness of breath; 50% of patients had fever on admission, and 58% had diabetes mellitus. All the patients were admitted for hypoxemic respiratory failure; 75% (18 patients) needed mechanical ventilation. Most of the patients (17) also had hypotension and needed vasopressors. No patient tested positive for influenza A, influenza B, or other respiratory viruses. Half the patients (12) died between ICU day 1 and day 18, including 4 patients who had a do-not-resuscitate order on admission. Of the 12 surviving patients, 5 were discharged home, 4 were discharged from the ICU but remained in the hospital, and 3 continued to receive mechanical ventilation in the ICU. CONCLUSIONSDuring the first 3 weeks of the Covid-19 outbreak in the Seattle area, the most common reasons for admission to the ICU were hypoxemic respiratory failure leading to mechanical ventilation, hypotension requiring vasopressor treatment, or both. Mortality among these critically ill patients was high. (Funded by the National Institutes of Health.

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22Coronavirus disease-19 (COVID19), the novel respiratory illness caused by severe acute 23 respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with severe morbidity and 24 mortality. The rollout of diagnostic testing in the United States was slow, leading to numerous 25 cases that were not tested for SARS-CoV-2 in February and March 2020, necessitating the use 26 of serological testing to determine past infections. Here, we evaluated the Abbott SARS-CoV-2 27IgG test for detection of anti-SARS-CoV-2 IgG antibodies by testing 3 distinct patient 28 populations. We tested 1,020 serum specimens collected prior to SARS-CoV-2 circulation in the 29United States and found one false positive, indicating a specificity of 99.90%. We tested 125 30 patients who tested RT-PCR positive for SARS-CoV-2 for which 689 excess serum specimens 31 were available and found sensitivity reached 100% at day 17 after symptom onset and day 13 32 after PCR positivity. Alternative index value thresholds for positivity resulted in 100% sensitivity 33 and 100% specificity in this cohort. We tested 4,856 individuals from Boise, Idaho collected over 34 one week in April 2020 as part of the Crush the Curve initiative and detected 87 positives for a 35 positivity rate of 1.79%. These data demonstrate excellent analytical performance of the Abbott 36 SARS-CoV-2 IgG test as well as the limited circulation of the virus in the western United States. 37We expect the availability of high-quality serological testing will be a key tool in the fight 38 against SARS-CoV-2. 39 40 41 on June 9, 2020 by guest