It is difficult to identify suspected cases of atypical patients with coronavirus disease 2019 (COVID-19), and data on severe or critical patients are scanty. This retrospective study presents the clinical, laboratory, and radiological profiles, treatments, and outcomes of atypical COVID-19 patients without respiratory symptoms or fever at onset. The study examined ten atypical patients out of 909 severe or critical patients diagnosed with COVID-19 in Wuhan Union Hospital West Campus between 25 January 2020 and 10 February 2020. Data were obtained from the electronic medical records of severe or critical patients without respiratory symptoms or fever at onset. Outcomes were followed up to discharge or death. Among 943 COVID-19 patients, 909 (96.4%) were severe or critical type. Of the severe or critical patients, ten (1.1%) presented without respiratory symptoms or fever at admission. The median age of the ten participants was 63 years (interquartile range (IQR): 57–72), and seven participants were men. The median time from symptom onset to admission was 14 d (IQR: 7–20). Eight of the ten patients had chronic diseases. The patients had fatigue (n = 5), headache or dizziness (n = 4), diarrhea (n = 5), anorexia (n = 3), nausea or vomiting (n = 3), and eye discomfort (n = 1). Four patients were found to have lymphopenia. Imaging examination revealed that nine patients had bilateral pneumonia and one had unilateral pneumonia. Eventually, two patients died and eight were discharged. In the discharged patients, the median time from admission to discharge lasted 24 d (IQR: 13–43). In summary, some severe or critical COVID-19 patients were found to have no respiratory symptoms or fever at onset. All such atypical cases should be identified and quarantined as early as possible, since they tend to have a prolonged hospital stay or fatal outcomes. Chest computed tomography (CT) scan and nucleic acid detection should be performed immediately on close contacts of COVID-19 patients to screen out those with atypical infections, even if the contacts present without respiratory symptoms or fever at onset.

2019 冠状病毒病（COVID-19）非典型患者的疑似病例难以识别，重症或危重症患者的数据很少。这项回顾性研究介绍了非典型 COVID-19 患者的临床、实验室和放射学特征、治疗和结果，这些患者在发病时没有呼吸道症状或发烧。该研究于 2020 年 1 月 25 日至 2020 年 2 月 10 日期间在武汉协和医院西校区诊断为 COVID-19 的 909 名重症或危重症患者中检查了 10 名非典型患者。数据来自没有呼吸道症状的重症或危重症患者的电子病历或发病时发热。结果随访至出院或死亡。在 943 名 COVID-19 患者中，909 名（96.4%）为重症或危重症。在重症或危重症患者中，十 (1. 1%) 入院时没有呼吸道症状或发烧。10 名参与者的中位年龄为 63 岁（四分位距 (IQR)：57-72），7 名参与者是男性。从症状出现到入院的中位时间为 14 天（IQR：7-20）。十名患者中有八名患有慢性疾病。患者有疲劳（n  = 5)、头痛或头晕 ( n  = 4)、腹泻 ( n  = 5)、厌食 ( n  = 3)、 恶心或呕吐 ( n  = 3) 和眼睛不适 ( n = 1)。发现四名患者有淋巴细胞减少症。影像学检查显示，9 名患者患有双侧肺炎，1 名患者患有单侧肺炎。最终，两名患者死亡，八名患者出院。在出院患者中，从入院到出院的中位时间持续了 24 天（IQR：13-43）。总之，发现一些重症或危重症 COVID-19 患者在发病时没有呼吸道症状或发烧。所有此类非典型病例都应尽早识别和隔离，因为它们往往会导致住院时间延长或致命。应立即对 COVID-19 患者的密切接触者进行胸部计算机断层扫描 (CT) 扫描和核酸检测，以筛查非典型感染者，即使这些接触者在发病时没有呼吸道症状或发烧。