Global Health & Medicine 2020;2(3):174-177.
COVID-19 can suddenly become severe: a case series from Tokyo, Japan
Nakamura K, Ide S, Saito S, Kinoshita N, Kutsuna S, Moriyama Y, Suzuki T, Ota M, Nomoto H, Mizoue T, Hojo M, Takasaki J, Asai Y, Terada M, Akiyama Y, Miyazato Y, Nakamoto T, Wakimoto Y, Ujiie M, Yamamoto K, Ishikane M, Morioka S, Hayakawa K, Sugiyama H, Ohmagari N
Since the initial report of coronavirus disease (COVID-19) from the City of Wuhan, China in December 2019, there have been multiple cases globally. Reported here are 11 cases of COVID-19 at this hospital; all of the patients in question presented with relative bradycardia. The severity of the disease was classified into four grades. Of the patients studied, 3 with mild COVID-19 and 3 with moderate COVID-19 improved spontaneously. Lopinavir/ ritonavir was administered to 3 patients with severe COVID-19 and 2 with critical COVID-19. Both patients with critical COVID-19 required mechanical ventilation and extracorporeal membrane oxygenation. Both patients with critical COVID-19 had a higher fever that persisted for longer than patients with milder COVID-19. The respiratory status of patients with critical COVID-19 worsened rapidly 7 days after the onset of symptoms. Relative bradycardia may be useful in distinguishing between COVID-19 and bacterial community-acquired pneumonia. In patients who have had a fever for > 7 days, the condition might worsen suddenly.