• Feng Ye, Shicai Xu, Zhihua Rong, Ronghua Xu, Xiaowei Liu, Pingfu Deng, Hai Liu, and Xuejun Xu.
• Department of Neurosurgery, The Second People's Hospital of Chengdu, Chengdu, China. Electronic address: yefeng19930@126.com.
• Int. J. Infect. Dis. 2020 May 1; 94: 133-138.

ObjectivesWith the ongoing outbreak of COVID-19 around the world, it has become a worldwide health concern. One previous study reported a family cluster with an asymptomatic transmission of COVID-19. Here, we report another series of cases and further demonstrate the repeatability of the transmission of COVID-19 by pre-symptomatic carriers.MethodsA familial cluster of five patients associated with COVID-19 was enrolled in the hospital. We collected epidemiological and clinical characteristics, laboratory outcomes from electronic medical records, and also verified them with the patients and their families.ResultsAmong them, three family members (Case 3/4/5) had returned from Wuhan. Additionally, two family members, those who had not traveled to Wuhan, also contracted COVID-19 after contacting with the other three family members. Case 1 developed severe pneumonia and was admitted to the ICU. Case 3 and Case 5 presented fever and cough on days two through three of hospitalization and had ground-glass opacity changes in their lungs. Case 4 presented with diarrhea and pharyngalgia after admission without radiographic abnormalities. Case 2 presented no clinical nor radiographic abnormalities. All five cases had an increasing level of C-reactive protein.ConclusionsOur findings indicate that COVID-19 can be transmitted by asymptomatic carriers during the incubation period.Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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