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?:abstract
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Recently, cases of coronavirus disease 2019 (COVID-19) with unknown routes of transmission are being reported from various parts of Japan When close contacts of infected patients present with symptoms, the index of suspicion for COVID-19 is high, and consultations and examinations are implemented with sufficient infection control measures in place On the other hand, the possibility of COVID-19 is often difficult to consider initially in cases from the community presenting with upper respiratory tract symptoms, such as sore throat and cough, and/or fever The initial upper respiratory tract symptoms are similar to those of common cold It is only much later, usually about one week after the appearance of symptoms, that COVID-19 is suspected and the test for SARS-CovV-2 is performed Until then, the patients may have consulted their family doctor and been tested for influenza, and may have been prescribed a cold medicine or antitussive We encountered 10 cases of COVID-19 pneumonia that developed in the community and tested positive for SARS-CoV-2 by PCR The presenting symptoms were a fever of over 38°C in 9 cases, nasal discharge in 1 case, sore throat in 4 cases, cough in 8 cases, sputum in 5 cases, shortness of breath in 6 cases, malaise in 7 cases, and gastrointestinal symptoms in 3 cases Five cases also showed poor health and fever in the family All cases needed 1-3 consultations to be finally diagnosed, and the interval from the appearance of symptoms to diagnosis was 5-12 days Coarse crackles could be auscultated in only one case, and the SpO2 was more than 95% in 8 cases, and 80% in 2 cases No increase of the peripheral white blood cell count was observed in any of the cases, and the blood lymphocyte count was less than 1,000/μL in 6 cases The serum CRP showed only a slight increase to up to 5 mg/dL in 7 cases, and a slight increase in the d-dimer level was observed in 5 cases In some cases, while it was difficult to detect abnormalities on the chest X-ray, chest computed tomography showed multiple bilateral ground-glass opacities, predominantly in the peripheral/subpleural regions, in all cases Nine of the 10 patients also showed lesions in the lower right lobe We describe the clinical characteristics of COVID-19 pneumonia among cases of infectious diseases encountered in the community Based on the above, we suggest that in cases from the community presenting with fever and upper respiratory symptoms, one clue to suspecting COVID-19 is the presence of persons among family members who are also unwell
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