Volume 26, Number 10—October 2020
Synopsis
Clinical Course of Asymptomatic and Mildly Symptomatic Patients with Coronavirus Disease Admitted to Community Treatment Centers, South Korea
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Abstract
We evaluated the clinical course of asymptomatic and mildly symptomatic patients with laboratory-confirmed coronavirus disease (COVID-19) admitted to community treatment centers (CTCs) for isolation in South Korea. Of 632 patients, 75 (11.9%) had symptoms at admission, 186 (29.4%) were asymptomatic at admission but developed symptoms during their stay, and 371 (58.7%) remained asymptomatic during their entire clinical course. Nineteen (3.0%) patients were transferred to hospitals, but 94.3% (573/613) of the remaining patients were discharged from CTCs upon virologic remission. The mean virologic remission period was 20.1 days (SD + 7.7 days). Nearly 20% of patients remained in the CTCs for 4 weeks after diagnosis. The virologic remission period was longer in symptomatic patients than in asymptomatic patients. In mildly symptomatic patients, the mean duration from symptom onset to virologic remission was 11.7 days (SD + 8.2 days). These data could help in planning for isolation centers and formulating self-isolation guidelines.
Coronavirus disease (COVID-19) is an infectious disease caused by a novel coronavirus, now called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has been spreading rapidly in many countries worldwide since the pandemic began in Wuhan, the capital of Hubei Province in China, in December 2019 (1,2). In South Korea, a confirmed case of COVID-19 was reported on January 20, 2020, and the number of confirmed cases has increased markedly since late February, especially in the Daegu and Gyeongsangbuk-do regions (3). Mass infection at a religious institution in Daegu City was the main cause of the surge in COVID-19 cases, which affected almost two thirds of the patients diagnosed in Daegu. To prevent further spread in the community, all members of this group were screened for SARS-CoV-2, regardless of whether they had symptoms. Real-time reverse transcription PCR (rRT-PCR) analysis of the nasopharyngeal swab samples from 10,459 persons showed 4,259 (40.7%) were positive for SARS-CoV-2 (4).
The exponential increase in COVID-19 cases in this area was so severe that local and government medical institutions were not able to handle the surge. Thus, many symptomatic patients, including some with advanced respiratory insufficiency, had to wait at home for hospitalization because no beds were available (3,5). In addition, hospital overload because of crowding with patients diagnosed with COVID-19 prevented adequate allocation of medical resources for patients with higher mortality risk because of age and presence of underlying conditions. To promote efficient allocation of advanced medical resources to severe COVID-19 patients, on March 2, 2020, South Korea implemented community treatment centers (CTCs), novel institutions to accommodate and monitor asymptomatic to mildly symptomatic case-patients who do not require hospital admission (6).
The clinical spectrum of COVID-19 could range from asymptomatic to severe pneumonia with respiratory failure and even death (7–9). Several studies have been published on the clinical characteristics or outcomes of COVID-19, but most analyzed data from hospitalized patients (10–12). To date, details of the natural course of COVID-19 in patients with no or mild symptoms in out-of-hospital settings has not been well documented. We describe the demographic and clinical characteristics of patients at 2 CTCs in Daegu, South Korea, and factors associated with treatment outcomes in such patients.
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