Avoid common mistakes on your manuscript.
To the Editor,
The title of a recent Images article in the Journal by Chen et al.1 describes chest computed tomography (CT) findings in a pregnant woman with coronavirus disease (COVID-19) as “early coronavirus disease.” We argue that these findings are inconsistent with “early” COVID-19. Cases of COVID-19 were identified in Thailand shortly after its first appearance in China2; as of 14 March 2020, there have been 82 confirmed diagnoses of COVID-19 reported in Thailand. All Thai cases are confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) in two reference labs, and all patients receive chest CT scans. Thirty-eight of the 82 cases were diagnosed during active screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in persons who had been in close contact to patients known to have COVID-19. Most of those screened were asymptomatic or reported only mild symptoms; none showed abnormal findings on chest CT scans. One asymptomatic Thai patient underwent general anesthesia for orthopedic surgery before being diagnosed with COVID-19 in the postoperative period. This case also had normal CT findings at the time of diagnosis.
Hu et al. reported that 29.2% of asymptomatic patients from China who were infected with SARS-CoV-2 and who presented with no or mild symptoms at the time of diagnosis by RT-PCR test had a normal chest CT scan.3 Asymptomatic SARS-CoV-2 infection is possible and has been previously reported in Thailand and Croatia.4 COVID-19 may be asymptomatic in its early stages even though viral RNA can be detected by RT-PCR screening.4 We therefore discourage the consideration of CT findings when ruling out cases of COVID-19.
References
Chen R, Chen J, Meng Q. Chest computed tomography images of early coronavirus disease (COVID-19). Can J Anesth 2020. DOI: https://doi.org/10.1007/s12630-020-01625-4.
Yasri S, Wiwanitkit V. Wuhan coronavirus outbreak and imported case. Adv Trop Med Pub Health Int 2020; 10: 1-2.
Hu Z, Song C, Xu C, et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Sci China Life Sci 2020. DOI: https://doi.org/10.1007/s11427-020-1661-4.
Joob S, Ronald M. Asymptomatic COVID-19: an important clinical consideration. Adv Lab Med Int 2020; 10: 4-5.
Conflicts of interest
None.
Funding statement
None.
Editorial responsibility
This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This letter is accompanied by a reply. Please see Can J Anesth 2020; 67: this issue.
Rights and permissions
About this article
Cite this article
Mungmunpuntipantip, R., Wiwanitkit, V. Uncertainty in using chest computed tomography in early coronavirus disease (COVID-19). Can J Anesth/J Can Anesth 67, 897 (2020). https://doi.org/10.1007/s12630-020-01639-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12630-020-01639-y