Thanks to Dr. Krutika Kappali for tweeting the link to this report in The Lancet: First imported case of 2019 novel coronavirus in Canada, presenting as mild pneumonia.
A 56-year-old man presented to our Emergency Department in Toronto, ON, Canada, with fever and non-productive cough, 1 day after returning from a 3-month visit to Wuhan, China. Given this travel history, the transferring ambulance and receiving hospital personnel used appropriate personal protective equipment. He had a medical history of well controlled hypertension.
On examination, his maximum temperature was 38·6°C, oxygen saturation was 97% on room air, and respiratory rate was 22 breaths per min—without any signs of respiratory distress. Laboratory investigations showed mild thrombocytopenia (113 × 109 per L, normal 150–400), haemoglobin concentration 146 g/L (normal 130–180), white blood cell count 7·4 × 109 per L (normal 4–11), creatinine concentration 81 μmol/L, alanine aminotransferase 29 IU/L (normal <40), and lactate concentration 1·1 mmol/L (normal 0·5–2·0). A chest x-ray showed patchy bilateral, peribronchovascular, ill-defined opacities in all lung zones.
Considering the clinical presentation of viral pneumonia in a patient with the appropriate epidemiological risk, the patient was admitted as a probable case of 2019 novel coronavirus (2019-nCoV) infection. The public health authority was notified of the case on admission and it traced the contacts.
Mid-turbinate swabs were negative for influenza virus A and influenza virus B, parainfluenza virus, respiratory syncytial virus, adenovirus, and human metapneumovirus. Coronavirus was detected in both mid-turbinate and throat swabs by PCR and confirmed as 2019-nCoV by sequencing. 1 day after admission to hospital, the patient developed mild haemoptysis and significant rhinorrhoea, but he remained otherwise well. His intermittent fever lasted 5 days before fully resolving, and his platelet count normalised; he was discharged home and followed up by public health workers.
We believe this is the first confirmed case of 2019-nCoV in Canada. The presentation with fever, cough, and bilateral pneumonia is typical of most cases described so far. However, only a minority of previously reported cases had thrombocytopenia—and this was a worrying feature in our patient. Yet despite significant radiographic abnormalities, our patient remained well and did not require intubation or supplemental oxygen—unlike many cases with similar x-ray findings reported so far.
This case highlights the milder spectrum of pneumonia caused by 2019-nCoV. Further, it suggests that the identification of individuals—like our patient—who could be managed by being quarantined at home, rather than in hospital, might be an important strategy for containing this outbreak.
