Abstract
BACKGROUND COVID-19 has been identified as the cause of the large outbreak of pneumonia in patients in Wuhan with shared history of exposure to the Huanan seafood market; however, there is more to learn about this disease. Some experts report that the virus may have reduced toxicity during transmission, but others say that toxicity does not change during transmission. CASE REPORT In this case series, we report clinical and imaging characteristics of 3 patients (A, B, and C) infected with COVID-19. In an exposure-tracking epidemiological investigation, we found that it is possible that Patient A transmitted the infection to her treating physician, Patient B. Patient B then likely transmitted the infection to her family member, Patient C. From the chest CT studies and clinical characteristics, we postulate that the virulence did not decrease during human-to-human transmission. In previous studies, patients with the virus infection had changes in chest CT; however, we found that during the early stages of this disease, some patients (Patient C) may have normal chest CT scans and laboratory studies. Most importantly, we found that IL-6 levels were highest and lymphocyte count was lowest in those with more severe infection. CONCLUSIONS In this case series, we report the exposure relationship of the 3 patients and found that chest CT scans may not have any changes at the beginning of this disease. Lymphopenia and elevated levels of IL-6 can be found after infection.