In view of her travel history from Wuhan, the district rapid response team decided to admit her in an isolation room which was designated for the corona epidemic. Lung auscultation revealed normal breath sounds with no adventitious sounds. In the Emergency department in General Hospital, she was afebrile with a pulse rate of 82/min, blood pressure 130/80 mmHg, temperature 98.5☏ and oxygen saturation 96 per cent while the patient was breathing ambient air. She received the instructions from the Kerala State authorities to visit a healthcare facility if she develops any symptoms because of the travel history to China. She did not visit the Huanan Seafood Wholesale Market, however, she gave a history of travel from Wuhan to Kunming by train where she noticed people with respiratory symptoms in railway station and train. She did not give a history of contact with a person suspected or confirmed with COVID-19 infection. On the 27 th morning, she felt a mild sore throat and dry cough. She was asymptomatic between January 23 and 26. She disclosed that she had returned to Kerala from Wuhan city, China, on Januowing to COVID-19 outbreak situation there. There was no history of fever, rhinitis or shortness of breath. On January 27, 2020, a 20 yr old female presented to the Emergency Department in General Hospital, Thrissur, Kerala, with a one-day history of dry cough and sore throat. We present here the first case of COVID-19 infection reported in Kerala, India. Outside China, 794 cases were reported with three deaths 6.

As on February 17, 2020, except China, 25 other countries have been affected by COVID-19 outbreak with 70,635 confirmed cases and 1,772 deaths in China. The second meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (2005) regarding the outbreak of novel coronavirus 2019 in the People's Republic of China on January 30, 2020, declared COVID-19 outbreak as Public Health Emergency of International Concern (PHEIC) 5. The most common clinical features of the early clinical cases from Wuhan, China, were fever (98.6%), fatigue (69.6%) and dry cough (59.4%) 4. The cases initially identified had a history of exposure to the Huanan Seafood Wholesale Market 3. During this period, the causal agent was not identified. From Decemto January 3, 2020, a total of 44 patients with pneumonia of unknown aetiology were reported to the WHO by the national authorities in China 2. On December 31, 2019, China informed the World Health Organization (WHO) about cases of pneumonia of unknown aetiology detected in Wuhan city, Hubei province of China. Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East respiratory syndrome (MERS)-CoV and severe acute respiratory syndrome (SARS)-CoV 1.

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