Clinical Characterization of 162 COVID-19 patients in Israel: Preliminary Report from a Large Tertiary Center

I n February 2020, the World Health Organization designated the name Coronavirus disease-2019 (COVID-19) to a clinical condition caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) [1]. The virus was initially identified in December of 2019 as a cause for a cluster of pneumonia cases in several provinces in China. Its clinical features range from asymptomatic carriage, flu-like symptoms including cough, fever, general weakness, myalgia, and respiratory failure requiring mechanical ventilation. There are several reports of the virus having non-respiratory clinical manifestations such as diarrhea, myocarditis and even hemorrhagic necrotizing encephalopathy [2][3][4]. The disease is highly infectious with a reproductive number (R0) ranging from 2.2-3.5 [5], which explains its rapid spread throughout the world. As of April 2020, the worldwide patient population was 1,617,576 with 96,939 deaths. These numbers continued to dramatically increase. Accumulating evidence suggests that in contrast to the initial, mild disease caused by viral replication, more severe manifestations of disease are immunemediated with a cytokine storm characteristic of its advanced, lethal stages [6]. Israel's first experience with the virus was atypical, comprising a mission to bring home the 11 Israeli citizens onboard the Diamond Princess cruise ship and who had not yet tested positive for the virus. On the night of 11 February 2020, those patients were flown to Israel via a private jet and immediately transferred to the quarantine facility at Sheba Medical Center, Tel Hashomer. Of that group, two patients later tested positive for the virus. The quarantine center, later converted into Department of Internal Medicine: Corona Care Unit, was the first internal ward department in Israel, designated to treat COVID-19 patients. The first COVID-19 case diagnosed in Israel, a 40-year-old male who returned from Italy, was diagnosed on 20 February 2020, and was hospitalized as an inaugural patient. From that moment on and up to the present time, the department continues to admit patients and treats the