Discussion
We illustrate three cases of atypical COVID-19. All patients were
admitted into single room facilities, where they were screened positive.
These patients could otherwise have been admitted to cohort cubicles
where the propensity for secondary spread, would have been higher.
The 2003 SARS-CoV-1 outbreak in Singapore saw sequential spread
involving three major acute care hospitals, the first arising following
the hospitalization of a returning traveller with atypical pneumonia.
Nosocomial transmission of SARS-CoV-1 resulted, taking a total of three
weeks to control in the first hospital cluster. [2] The index
patient central to another cluster of 60 patients at a second hospital
in March 2003, had presented with atypical features, masked by E.
coli bacteremia. [2-3] Our small case series illustrate the
vulnerability of our inpatient cohort where atypical COVID-19
presentation can potentially result in secondary nosocomial
transmission.
Contrary to the earlier SARS-CoV-1 outbreak, Singapore’s first local
case of SARS-CoV-2 was diagnosed promptly on January 23, 2020 in a
traveller from Wuhan, China. He presented with typical febrile
respiratory symptoms, and was diagnosed with pneumonia upon
hospitalization. [4] Asymptomatic transmission of SARS-CoV-2 adds to
the challenge of SARS-CoV-2 diagnosis and containment. Asymptomatic
ratio of COVID-19 has been estimated to be as high as 30.8% amongst
Japanese nationals evacuated from Wuhan, China. [5] This is
well-illustrated by our Case 3, where an ongoing outbreak in that
setting, raises the pre-test probability of infection and underscores
the immense challenge at curtailing transmission.
A high index of suspicion, strict infection control and prompt isolation
measures are crucial in protecting our healthcare system from nosocomial
SARS-CoV-2 outbreaks.