The index case of SARS-CoV-2 in Scotland
Identifieur interne : 000A96 ( Pmc/Corpus ); précédent : 000A95; suivant : 000A97The index case of SARS-CoV-2 in Scotland
Auteurs : Katherine J. Hill ; Clark D. Russell ; Sarah Clifford ; Kate Templeton ; Claire L. Mackintosh ; Oliver Koch ; Rebecca K. SutherlandSource :
- The Journal of Infection [ 0163-4453 ] ; 2020.
Abstract
Since its identification in December 2019, SARS-CoV-2 has infected 125,048 persons globally with cases identified in 118 countries across all continents. We report on the Scottish index case of SARS-CoV-2 infection, the virus causing COVID-19.
Url:
DOI: 10.1016/j.jinf.2020.03.022
PubMed: 32205138
PubMed Central: 7118628
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PMC:7118628Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The index case of SARS-CoV-2 in Scotland</title><author><name sortKey="Hill, Katherine J" sort="Hill, Katherine J" uniqKey="Hill K" first="Katherine J." last="Hill">Katherine J. Hill</name><affiliation><nlm:aff id="aff0001">NHS Lothian, Regional Infectious Diseases Unit, Edinburgh, EH4 2XU</nlm:aff></affiliation></author><author><name sortKey="Russell, Clark D" sort="Russell, Clark D" uniqKey="Russell C" first="Clark D." last="Russell">Clark D. Russell</name><affiliation><nlm:aff id="aff0001">NHS Lothian, Regional Infectious Diseases Unit, Edinburgh, EH4 2XU</nlm:aff></affiliation><affiliation><nlm:aff id="aff0002">University of Edinburgh Centre for Inflammation Research, The Queen's Medical Research Institute, Edinburgh EH16 4TJ</nlm:aff></affiliation></author><author><name sortKey="Clifford, Sarah" sort="Clifford, Sarah" uniqKey="Clifford S" first="Sarah" last="Clifford">Sarah Clifford</name><affiliation><nlm:aff id="aff0001">NHS Lothian, Regional Infectious Diseases Unit, Edinburgh, EH4 2XU</nlm:aff></affiliation></author><author><name sortKey="Templeton, Kate" sort="Templeton, Kate" uniqKey="Templeton K" first="Kate" last="Templeton">Kate Templeton</name><affiliation><nlm:aff id="aff0003">NHS Lothian, Diagnostic Virology Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ</nlm:aff></affiliation></author><author><name sortKey="Mackintosh, Claire L" sort="Mackintosh, Claire L" uniqKey="Mackintosh C" first="Claire L." last="Mackintosh">Claire L. Mackintosh</name><affiliation><nlm:aff id="aff0001">NHS Lothian, Regional Infectious Diseases Unit, Edinburgh, EH4 2XU</nlm:aff></affiliation></author><author><name sortKey="Koch, Oliver" sort="Koch, Oliver" uniqKey="Koch O" first="Oliver" last="Koch">Oliver Koch</name><affiliation><nlm:aff id="aff0001">NHS Lothian, Regional Infectious Diseases Unit, Edinburgh, EH4 2XU</nlm:aff></affiliation></author><author><name sortKey="Sutherland, Rebecca K" sort="Sutherland, Rebecca K" uniqKey="Sutherland R" first="Rebecca K." last="Sutherland">Rebecca K. Sutherland</name><affiliation><nlm:aff id="aff0001">NHS Lothian, Regional Infectious Diseases Unit, Edinburgh, EH4 2XU</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32205138</idno><idno type="pmc">7118628</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118628</idno><idno type="RBID">PMC:7118628</idno><idno type="doi">10.1016/j.jinf.2020.03.022</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000A96</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000A96</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The index case of SARS-CoV-2 in Scotland</title><author><name sortKey="Hill, Katherine J" sort="Hill, Katherine J" uniqKey="Hill K" first="Katherine J." last="Hill">Katherine J. Hill</name><affiliation><nlm:aff id="aff0001">NHS Lothian, Regional Infectious Diseases Unit, Edinburgh, EH4 2XU</nlm:aff></affiliation></author><author><name sortKey="Russell, Clark D" sort="Russell, Clark D" uniqKey="Russell C" first="Clark D." last="Russell">Clark D. Russell</name><affiliation><nlm:aff id="aff0001">NHS Lothian, Regional Infectious Diseases Unit, Edinburgh, EH4 2XU</nlm:aff></affiliation><affiliation><nlm:aff id="aff0002">University of Edinburgh Centre for Inflammation Research, The Queen's Medical Research Institute, Edinburgh EH16 4TJ</nlm:aff></affiliation></author><author><name sortKey="Clifford, Sarah" sort="Clifford, Sarah" uniqKey="Clifford S" first="Sarah" last="Clifford">Sarah Clifford</name><affiliation><nlm:aff id="aff0001">NHS Lothian, Regional Infectious Diseases Unit, Edinburgh, EH4 2XU</nlm:aff></affiliation></author><author><name sortKey="Templeton, Kate" sort="Templeton, Kate" uniqKey="Templeton K" first="Kate" last="Templeton">Kate Templeton</name><affiliation><nlm:aff id="aff0003">NHS Lothian, Diagnostic Virology Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ</nlm:aff></affiliation></author><author><name sortKey="Mackintosh, Claire L" sort="Mackintosh, Claire L" uniqKey="Mackintosh C" first="Claire L." last="Mackintosh">Claire L. Mackintosh</name><affiliation><nlm:aff id="aff0001">NHS Lothian, Regional Infectious Diseases Unit, Edinburgh, EH4 2XU</nlm:aff></affiliation></author><author><name sortKey="Koch, Oliver" sort="Koch, Oliver" uniqKey="Koch O" first="Oliver" last="Koch">Oliver Koch</name><affiliation><nlm:aff id="aff0001">NHS Lothian, Regional Infectious Diseases Unit, Edinburgh, EH4 2XU</nlm:aff></affiliation></author><author><name sortKey="Sutherland, Rebecca K" sort="Sutherland, Rebecca K" uniqKey="Sutherland R" first="Rebecca K." last="Sutherland">Rebecca K. Sutherland</name><affiliation><nlm:aff id="aff0001">NHS Lothian, Regional Infectious Diseases Unit, Edinburgh, EH4 2XU</nlm:aff></affiliation></author></analytic><series><title level="j">The Journal of Infection</title><idno type="ISSN">0163-4453</idno><idno type="eISSN">1532-2742</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Summary</title><p>Since its identification in December 2019, SARS-CoV-2 has infected 125,048 persons globally with cases identified in 118 countries across all continents. We report on the Scottish index case of SARS-CoV-2 infection, the virus causing COVID-19.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Lillie, P J" uniqKey="Lillie P">P.J. Lillie</name></author><author><name sortKey="Samson, A" uniqKey="Samson A">A. 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Bouchama</name></author><author><name sortKey="Luke, T" uniqKey="Luke T">T. Luke</name></author><author><name sortKey="Baillie, J K" uniqKey="Baillie J">J.K. Baillie</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Young, B E" uniqKey="Young B">B.E. Young</name></author><author><name sortKey="Ong, S W X" uniqKey="Ong S">S.W.X. Ong</name></author><author><name sortKey="Kalimuddin, S" uniqKey="Kalimuddin S">S. Kalimuddin</name></author><author><name sortKey="Low, J G" uniqKey="Low J">J.G. Low</name></author><author><name sortKey="Tan, S Y" uniqKey="Tan S">S.Y. Tan</name></author><author><name sortKey="Loh, J" uniqKey="Loh J">J. Loh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zou, L" uniqKey="Zou L">L. Zou</name></author><author><name sortKey="Ruan, F" uniqKey="Ruan F">F. Ruan</name></author><author><name sortKey="Huang, M" uniqKey="Huang M">M. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Infect</journal-id><journal-id journal-id-type="iso-abbrev">J. Infect</journal-id><journal-title-group><journal-title>The Journal of Infection</journal-title></journal-title-group><issn pub-type="ppub">0163-4453</issn><issn pub-type="epub">1532-2742</issn><publisher><publisher-name>Published by Elsevier Ltd on behalf of The British Infection Association.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32205138</article-id><article-id pub-id-type="pmc">7118628</article-id><article-id pub-id-type="publisher-id">S0163-4453(20)30148-1</article-id><article-id pub-id-type="doi">10.1016/j.jinf.2020.03.022</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>The index case of SARS-CoV-2 in Scotland</article-title></title-group><contrib-group><contrib contrib-type="author" id="au0001"><name><surname>Hill</surname><given-names>Katherine J.</given-names></name><email>k.hill@doctors.org.uk</email><xref rid="aff0001" ref-type="aff">a</xref><xref rid="cor0001" ref-type="corresp">⁎</xref></contrib><contrib contrib-type="author" id="au0002"><name><surname>Russell</surname><given-names>Clark D.</given-names></name><xref rid="aff0001" ref-type="aff">a</xref><xref rid="aff0002" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="au0003"><name><surname>Clifford</surname><given-names>Sarah</given-names></name><xref rid="aff0001" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="au0004"><name><surname>Templeton</surname><given-names>Kate</given-names></name><xref rid="aff0003" ref-type="aff">c</xref></contrib><contrib contrib-type="author" id="au0005"><name><surname>Mackintosh</surname><given-names>Claire L.</given-names></name><xref rid="aff0001" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="au0006"><name><surname>Koch</surname><given-names>Oliver</given-names></name><xref rid="aff0001" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="au0007"><name><surname>Sutherland</surname><given-names>Rebecca K.</given-names></name><xref rid="aff0001" ref-type="aff">a</xref></contrib></contrib-group><aff id="aff0001"><label>a</label>NHS Lothian, Regional Infectious Diseases Unit, Edinburgh, EH4 2XU</aff><aff id="aff0002"><label>b</label>University of Edinburgh Centre for Inflammation Research, The Queen's Medical Research Institute, Edinburgh EH16 4TJ</aff><aff id="aff0003"><label>c</label>NHS Lothian, Diagnostic Virology Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, EH16 4TJ</aff><author-notes><corresp id="cor0001"><label>⁎</label>Corresponding author. <email>k.hill@doctors.org.uk</email></corresp></author-notes><pub-date pub-type="pmc-release"><day>21</day><month>3</month><year>2020</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub"><day>21</day><month>3</month><year>2020</year></pub-date><history><date date-type="accepted"><day>17</day><month>3</month><year>2020</year></date></history><permissions><copyright-statement>Crown Copyright © 2020 Published by Elsevier Ltd on behalf of The British Infection Association. All rights reserved.</copyright-statement><copyright-year>2020</copyright-year><copyright-holder></copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><abstract id="abs0001"><title>Summary</title><p>Since its identification in December 2019, SARS-CoV-2 has infected 125,048 persons globally with cases identified in 118 countries across all continents. We report on the Scottish index case of SARS-CoV-2 infection, the virus causing COVID-19.</p></abstract><kwd-group id="keys0001"><title>Keywords</title><kwd>Coronavirus</kwd><kwd>Communicable diseases, emerging</kwd><kwd>Respiratory tract infections</kwd></kwd-group></article-meta></front><body><p content-type="salutation">Letter</p><p id="para0002">We read with interest Lillie and colleagues’ letter on the first patients with COVID-19 in the UK.<xref rid="bib0001" ref-type="bibr"><sup>1</sup></xref> Since its identification in December 2019, SARS-CoV-2 has infected 125,048 persons globally with cases identified in 118 countries across all continents.<xref rid="bib0002" ref-type="bibr"><sup>2</sup></xref> We report on the Scottish index case of SARS-CoV-2 infection, the virus causing COVID-19.</p><p id="para0003">The patient, a 51-year-old male, contacted the Scottish telehealth service for advice on day +1 with a 24-hour history of fever and cough having returned to Scotland from northern Italy on day −2. His symptoms were in keeping with a “possible” case of COVID-19 according to the national case definition at the time. Community SARS-CoV-2 testing was arranged for day +2.</p><p id="para0004">The patient had travelled to Italy on day −9 to watch a rugby match in Rome. He travelled with his partner and two friends in a private rental vehicle through Lombardy, Veneto and Tuscany, staying in private rental accommodation, before flying back to Scotland from Milan on day −2. He was not aware of any contact with cases of COVID-19.</p><p id="para0005">On day 0 he developed fever, myalgia, malaise and sinusitis. This progressed to a cough productive of green sputum on day +1. His fever had subsided by day +2.</p><p id="para0006">The patient remained in self isolation in the community whilst awaiting the results of SARS-CoV-2 PCR which was performed in the West of Scotland Specialist Virology Centre on a combined nose/throat swab. This sample tested positive for SARS-CoV-2 on day +3 with a threshold cycle (Ct) value of 36. An urgent teleconference was held between virology, public health, Scottish ambulance service and the receiving regional High Consequence Infectious Diseases (HCID) unit. The patient was subsequently transferred by Special Operations Response Team (SORT) ambulance to the HCID unit. The patient was escorted from the ambulance to a laminar flow room (with antechamber) on the first floor of the unit by medical staff in appropriate personal protective equipment (PPE). The patient was wearing a surgical face masque throughout transit. The ambulance staff returned to their base for doffing of PPE.</p><p id="para0007">The patient was usually well and exercised regularly. He was a lifelong non-smoker. His medical history consisted only of hypertension. He had no known underlying lung disease. He took an ACE-inhibitor and self-medicated with paracetamol and non-steroidal anti-inflammatory drugs during his illness.</p><p id="para0008">On admission, the patient was afebrile with a mild non-productive cough. He had no limitation in exercise tolerance during this acute illness and continued to exercise in his home whilst self-isolating. On assessment, lung fields were clear on auscultation and bilateral scleral injection was noted. Admission vital signs were: heart rate 79 beats per minute, blood pressure 171/105 mmHg, respiratory rate 18, pulse oximetry 96% on air and temperature 36.5. The results of routine laboratory parameters are shown in <xref rid="tbl0001" ref-type="table">Table 1</xref>. By day three of admission the patient had lymphocytopenia, which was found in 80.4% of patients with laboratory-confirmed non-severe COVID-19 in mainland China.<xref rid="bib0003" ref-type="bibr"><sup>3</sup></xref> Chest radiography was not clinically indicated. PCR testing for other respiratory viruses, <italic>Mycoplasma pneumoniae</italic> and <italic>Chlamydia pneumoniae</italic> on the throat swab was negative. Nose and throat samples for SARS-CoV-2 PCR were obtained daily to monitor viral shedding (<xref rid="fig0001" ref-type="fig">Fig. 1</xref>). SARS-CoV-2 PCR on urine, faeces and EDTA blood was negative. The patient was clinically well throughout the admission; no supportive care was required. He was discharged after 8 days, following two sequential nose and throat swabs negative for SARS-CoV-2 by PCR. The initial viral sample was sequenced by the MRC-University of Glasgow Centre for Virus Research, mapped against the Wuhan-Hu-1 reference genome and aligned with a collection of global SARS-CoV-2 sequences, with the resulting analysis released open access. Phylogenetic analysis demonstrated that Scotland/CVR01/2020 belonged to a clade of isolates all acquired in northern Italy.<xref rid="bib0004" ref-type="bibr"><sup>4</sup></xref><table-wrap position="float" id="tbl0001"><label>Table 1</label><caption><p>Routine laboratory parameters.</p></caption><alt-text id="alt0002">Table 1</alt-text><table frame="hsides" rules="groups"><thead><tr><th valign="top">Parameter</th><th valign="top">Normal</th><th valign="top">Day 1</th><th valign="top">Day 2</th><th valign="top">Day 3</th></tr></thead><tbody><tr><td valign="top">Total white cell count (x10<sup>9</sup>/L)</td><td valign="top">4–11</td><td valign="top">4.9</td><td valign="top">4.5</td><td valign="top">4.6</td></tr><tr><td valign="top">Neutrophil count (x10<sup>9</sup>/L)</td><td valign="top">2–7.5</td><td valign="top">2.5</td><td valign="top">2.1</td><td valign="top">2.4</td></tr><tr><td valign="top">Lymphocyte count (x10<sup>9</sup>/L)</td><td valign="top">1.5–4</td><td valign="top">1.6</td><td valign="top">1.8</td><td valign="top">1.3</td></tr><tr><td valign="top">Monocyte count (x10<sup>9</sup>/L)</td><td valign="top">0.2–0.8</td><td valign="top">0.84</td><td valign="top">0.58</td><td valign="top">0.82</td></tr><tr><td valign="top">Platelet count (x10<sup>9</sup>/L)</td><td valign="top">150–400</td><td valign="top">239</td><td valign="top">242</td><td valign="top">240</td></tr><tr><td valign="top">C-reactive protein (mg/L)</td><td valign="top">0–5</td><td valign="top">4</td><td valign="top">2</td><td valign="top">3</td></tr></tbody></table><table-wrap-foot><fn><p>Renal and liver biochemistry values were normal.</p></fn></table-wrap-foot></table-wrap><fig id="fig0001"><label>Fig. 1</label><caption><p>SARS-CoV-2 PCR threshold cycle values during hospital admission</p><p>Note on day 2 a combined throat and nose swab was performed. Negative PCR is plotted as Ct value of 40 (dotted line).</p></caption><alt-text id="alt0001">Fig 1</alt-text><graphic xlink:href="gr1_lrg"></graphic></fig></p><p id="para0009">Public health undertook contact tracing and testing and no further cases were identified</p><p id="para0010">A large case series from China has reported that the majority of COVID-19 cases (81%) had mild disease only, with risk of severe disease and mortality higher in older patients with pre-existing medical conditions.<xref rid="bib0005" ref-type="bibr"><sup>5</sup></xref> The patient described here also had a mild and self-limiting illness. Although asymptomatic and mild manifestations of previous epidemic-associated coronaviruses (SARS and MERS) occur,<xref rid="bib0006" ref-type="bibr"><sup>6</sup></xref><sup>,</sup><xref rid="bib0007" ref-type="bibr"><sup>7</sup></xref> these appear to be substantially more common in COVID-19. This poses a challenge for the early identification and isolation of cases, to limit transmission. In the “contain” phase of the UK COVID-19 response, early case identification was reliant on epidemiologic (not severity) criteria. The public health guidance at the time of this case was that travellers to Veneto and Lombardy were considered at risk. The patient had travelled to these areas but in private transport, staying in the area briefly and having limited interactions with residents. Therefore, whilst fulfilling ‘at risk’ criteria, from a practical perspective the risk seemed low.</p><p id="para0011">The kinetics of SARS-CoV-2 viral load have not yet been well characterized in large numbers of patients. Prolonged nasopharyngeal viral shedding was reported in a series of 18 patients from Singapore, with a median of 12 days between first and last positive samples and an initial large decline in viral load followed by a slower decay of residual low-level virus.<xref rid="bib0008" ref-type="bibr"><sup>8</sup></xref> Similar kinetics were observed in 17 patients from China, where results were stratified by site tested (nose/throat) suggesting quantitatively greater and more prolonged shedding from the nose.<xref rid="bib0009" ref-type="bibr"><sup>9</sup></xref> The kinetics of shedding in this case match this pattern, with more prolonged nasal shedding (Figure).</p><p id="para0012">National public health guidance on PPE requirements for managing cases of COVID-19 in infectious disease units stipulates use of disposable gowns, two pairs of disposable gloves, visor and FFP3 respirator.<xref rid="bib0010" ref-type="bibr"><sup>10</sup></xref> These guidelines currently do not recommend use of specific footwear, so it is concerning that SARS-CoV-2 was detected by PCR from the shoe front of a healthcare worker caring for COVID-19 patients.<xref rid="bib0011" ref-type="bibr"><sup>11</sup></xref> For this case we used disposable boot covers over plastic clogs.</p><p id="para0013">As the SARS-CoV-2 outbreak continues, we are learning more about the clinical manifestations of the infection and the logistics of containing and managing cases. This case highlights the need to have a low index of suspicion for diagnosis of COVID-19 and for early isolation.</p><sec sec-type="COI-statement"><title>Declaration of Competing Interests</title><p id="para0015">The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.</p></sec></body><back><ref-list id="cebibl1"><title>References</title><ref id="bib0001"><label>1</label><element-citation publication-type="journal" id="sbref0001"><person-group person-group-type="author"><name><surname>Lillie</surname><given-names>P.J.</given-names></name><name><surname>Samson</surname><given-names>A.</given-names></name><name><surname>Li</surname><given-names>A.</given-names></name><name><surname>Adams</surname><given-names>K.</given-names></name><name><surname>Capstick</surname><given-names>R.</given-names></name><name><surname>Barlow</surname><given-names>G.D.</given-names></name></person-group><article-title>Novel coronavirus disease (Covid-19): the first two patients in the UK with person to person transmission</article-title><source>J Infect</source><year>2020</year><pub-id pub-id-type="doi">10.1016/j.jinf.2020.02.020</pub-id><comment>Published online ahead of print Feb 28</comment></element-citation></ref><ref id="bib0002"><label>2</label><mixed-citation publication-type="other" id="othref0001">WHO. 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KH and CDR collected the data. KT contributed to the section on virological testing. All authors contributed to the writing of the final version of the article.</p></sec><sec id="sec0002"><title>Acknowledgements</title><p id="para0016">We are grateful to the patient for providing informed consent to publish this report. Our thanks go to nursing staff, laboratory and medical colleagues in NHS Lothian who contributed directly or indirectly to patient care. We are grateful to colleagues in public health who contribute their expertise to management of these cases. This case report did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. There was no writing assistance.</p></sec></ack></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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