A 69-year old man, from Lombardy, Italy, was admitted to our unit because of acute respiratory distress syndrome that required mechanical ventilation; he was in Nice, France, on holiday. He had previously been fit and well; he had a history of hypertension controlled with bisoprolol 2· 5 mg/day. He initially reported vomiting and diarrhoea, and 7 days afterwards, he came to our emergency department with a cough, fever of 39 C, and dyspnoea. He was immediately transferred to our intensive care unit (ICU) because of the respiratory distress syndrome and severe hypoxia. Investigations found a haemoglobin concentration of 15· 4 g/dL, a platelet count of 187× 10⁹ per L, and a leucocyte count of 14· 9× 10⁹ per L (neutrophils 89%, lymphocytes 7%, monocytes 4%, and no eosinophils or basophils). His blood pH was 7· 27, partial pressure of carbon dioxide was 45· 3 mm Hg, partial pressure of oxygen was 146 mm Hg, and peripheral oxygen saturation was 98· 2%.

A CT of his chest showed bilateral ground-glass opacities and condensations (figure; video). PCR of swabs taken from his upper respiratory tract showed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) confirming a diagnosis of coronavirus disease 2019 (COVID-19). Multiplex PCR was negative for other viruses using BioFire FilmArray Respiratory Panel 2 plus