Management of mild cases of COVID-19 in low-resource countries: An experience in Vietnam.

Dear Editor,

Since the first report of SARS-COV-2 in two Chinese people at Ho Chi Minh City on late January 2020, there have been more than 200 confirmed cases in Vietnam at the time of writing. At National Hospital for Tropical Diseases (NHTD) – a designed COVID-19 hospital in the Northern, we are currently providing care and treatment for nearly 100 patients, with approximately 90% of them are mild cases.

While not many studies have focused on mild cases of COVID-19, we read Chien-Yu Cheng and colleagues’ work with a great interest. The results showed that the duration of viral shedding could range from 2 to 3 weeks in mild patients. We have similar experiences in our practice during the first COVID-19 epidemic phase with the epicenter in China. Among five patients from the Wuhan cluster enrolled to NHTD in mid-January, all of them were mild with nonspecific symptoms, including fever, drug cough or sore throat (Table 1 ). No patients developed acute respiratory distress syndrome (ARDS) or related symptoms included shortness of breath or rapid breathing. Four patients had ground-glass opacification or bilateral cloudiness on radiographic imaging. The mildest case was a young male with no lung damage; however, this patient took the longest time to clear the virus (22 days versus 9–14 days among others).

Table 1

Clinical -profiles of SARS-CoV-2 patients in Vietnam.

	No. 01	No. 02	No. 03	No. 04	No. 05
Age	29	24	30	29	55
Gender	Male	Female	Male	Female	Female
Comorbidities	No	No	No	No	No
Assumed incubation perioda	4	9	9	9	8
Clinical symptoms
Fever	Yes	Yes	Yes	No	Yes
Cough	Yes	Yes	Yes	Yes	Yes
Sore throat	Yes	No	Yes	No	No
Myalgia	No	No	No	No	Yes
SpO2 (%)	95%	96%	96%	96%	97%
Radiographic imaging	Normal	Bilateral ground-glass opacification	Bilateral cloudiness over the upper lobes	Bilateral ground-glass opacification	Cloudiness in the right middle lobe of the lung
Duration of asymptomatica	15	4	12	12	4
Treatment
Oxygen support	No	No	No	No	No
Antiviral therapy	No	No	No	No	No
Antibiotics therapy	No	No	Yes	No	Yes
Total of RT-PCR tests	7	3	3	3	3
Duration of two consecutive negativesa	22	12	14	14	9

Duration was calculated from day of onsets and presented in days.

No patients had severe respiratory symptoms that required oxygen support therapy. No antiviral or glucocorticoid drugs were prescribed. Only supportive therapy, including nutrition enhancement, rehydration, and oral antitussives and expectorants was provided. The lopinavir/ritonavir has not been officially recommended by the Ministry of Health of Vietnam, and it may not be as effective in mild patients as shown in Chien-Yu Chengs’ findings.

In Vietnam, we require all patients to quarantine and stay at healthcare centers till they met the discharge criteria with two consecutive negatives RT-PCR in no less than 24 h. However, in the situation of rapidly increasing cases, inappropriate management of mild cases could increase the burden of healthcare system and medical costs in low-resource countries. Viral clearance is a major standard in the assessment of recovery and discharge from medical care, but the early results illustrated that the persistence of viral RNA is heterogeneous despite the rapidly remission of symptoms and can over three weeks even in very mild cases. In addition, long hospitalization stays may increase the risk for hospital-associated mental health problems, and unexpected hospital-acquired infections. We suggest the urgent need of more data from patients with mild symptoms. In addition, discharge standards should be considered for amendment based on the spread of epidemic and the response capacity of the local health system. Earlier discharge, when all symptoms are completely relieved, followed by self-isolation at home could be a potential strategy in the scenario of fast-growing number of cases, and when the health system is overloaded. Furthermore, the duration of isolation for suspected cases should be extended to 21 days or even four weeks to ensure they will not be able to transmit the virus without being identified.