The authors reply: Weng et al. question the clinical benefit of remdesivir treatment. In our article, we noted that the decision to administer remdesivir for compassionate use was based on the patient’s worsening clinical status. No inferences are possible from the uncontrolled treatment of one patient, and we stated, “randomized, controlled trials are needed to determine the safety and efficacy of remdesivir and any other investigational agents for treatment of patients with 2019-nCoV infection.” | | Tsung notes that an increase in lymphocyte counts and subsequent clinical improvement are consistent with activation of the adaptive immune response and resolution of SARS-CoV-2 infection. IgM and IgA antibodies may be detectable early in the clinical course, and IgG antibodies can be detected a median of 14 days after the onset of illness.1 We agree that the adaptive immune response contributes to clinical recovery and clearance of SARS-CoV-2, although one study showed that seroconversion was not correlated with a rapid decline in the SARS-CoV-2 load.2 In another study that showed a good correlation between IgG and neutralizing antibody titers, an increase in IgG antibody levels was correlated with a decrease in the viral load between 1 and 3 weeks after the onset of illness, but SARS-CoV-2 RNA was still detectable for prolonged periods.3 | | Zhang inquires about detection of SARS-CoV-2 in stool and urine specimens after remdesivir treatment. In our patient, although a stool specimen collected on day 7 of illness was positive with high cycle threshold values (36 to 38) that were consistent with detection of viral RNA and probably not infectious virus, a stool specimen obtained from the patient on day 14 of illness was negative. SARS-CoV-2 RNA was not detected in urine specimens; these findings are consistent with those in a larger study.4 | | Wen et al. and Link and Hold raise the issue of fecal–oral transmission of SARS-CoV-2. Diarrhea has been reported to occur in patients with Covid-19, and it can precede the development of respiratory symptoms and progression to pneumonia. SARS-CoV-2 RNA has been detected in stool specimens, and recovery of live infectious virus from stool has been reported.4 Further studies are needed to understand the implications of SARS-CoV-2 detected in stool for transmission of the virus. | | Ren et al. argue that high-resolution low-dose chest CT should be performed instead of chest radiography in persons with fever and suspected Covid-19. The Centers for Disease Control and Prevention recommends collection of nasopharyngeal swab specimens and lower respiratory specimens, if available, for SARS-CoV-2 testing and prioritizes testing of hospitalized patients and symptomatic health care workers. Furthermore, the American College of Radiology has noted concerns regarding prevention and control of SARS-CoV-2 transmission in health care facilities, including transmission that may occur with the use of CT scanners, and has recommended that CT should not be used to screen for or diagnose Covid-19.5

Laboratory diagnostics play an essential role in pandemic preparedness. In January 2020, the first US case of COVID-19 was confirmed in Washington State. At the same time, the Washington State Public Health Laboratory (WA PHL) was in the process of building upon and initiating innovative preparedness activities to strengthen laboratory testing capabilities, operations, and logistics. The response efforts of WA PHL, in conjunction with the Centers for Disease Control and Prevention, to the COVID-19 outbreak in Washington are described herein-from the initial detection of severe acute respiratory syndrome coronavirus 2 through the subsequent 2 months.Factors that contributed to an effective laboratory response are described, including preparing early to establish testing capacity, instituting dynamic workforce solutions, advancing information management systems, refining laboratory operations, and leveraging laboratory partnerships. We also report on the challenges faced, successful steps taken, and lessons learned by WA PHL to respond to COVID-19.The actions taken by WA PHL to mount an effective public health response may be useful for US laboratories as they continue to respond to the COVID-19 pandemic and may help inform current and future laboratory pandemic preparedness activities. (Am J Public Health. Published online ahead of print March 18, 2021: e1-e9. https://doi.org/10.2105/AJPH.2021.306212).

We describe the contact investigation for an early confirmed case of coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in the United States. Contacts of the case-patient were identified, actively monitored for symptoms, interviewed for a detailed exposure history, and tested for SARS-CoV-2 infection by real-time reverse transcription PCR (rRT-PCR) and ELISA. Fifty contacts were identified and 38 (76%) were interviewed, of whom 11 (29%) reported unprotected face-to-face interaction with the case-patient. Thirty-seven (74%) had respiratory specimens tested by rRT-PCR, and all tested negative. Twenty-three (46%) had ELISA performed on serum samples collected approximately 6 weeks after exposure, and none had detectable antibodies to SARS-CoV-2. Among contacts who were tested, no secondary transmission was identified in this investigation, despite unprotected close interactions with the infectious case-patient.

An outbreak of novel coronavirus (2019-nCoV) that began in Wuhan, China, has spread rapidly, with cases now confirmed in multiple countries. We report the first case of 2019-nCoV infection confirmed in the United States and describe the identification, diagnosis, clinical course, and management of the case, including the patient's initial mild symptoms at presentation with progression to pneumonia on day 9 of illness. This case highlights the importance of close coordination between clinicians and public health authorities at the local, state, and federal levels, as well as the need for rapid dissemination of clinical information related to the care of patients with this emerging infection.