By Mary O’Brien, M.D.
Chances are good you have a lot going on this week. And there’s a lot to keep up with in the news. Bearing that in mind, here is a synopsis of the facts concerning Coronavirus.
- Definition: Coronaviruses are enveloped RNA viruses which typically cause symptoms of the common cold. The name stems from the halo or corona-like appearance of the virus when viewed with an electron microscope.
- Medical terminology: The current coronavirus causing illness will be referred to as 2019 nCoV (novel coronavirus 2019) in the medical literature.
- Symptoms: Coronaviruses typically cause cold and flu-like symptoms such as runny nose, sore throat, headache, cough, fever, and malaise. Shortness of breath is often indicative of progression to a viral pneumonia.
- Countries with documented cases of 2019 nCoV: China, South Korea, Vietnam, Thailand, Nepal, Hong Kong, Singapore, Malaysia, Australia, Japan, France, U.S., Canada.
- Origins of current outbreak: Likely animal-to-human transmission with subsequent human-to-human transmission in Wuhan, China. Wuhan is the capital city of Hubei province and has a population of 11 million.
- Current problems related to epidemic in China: Multiple hospitals in China are overwhelmed, with shortages of supplies including masks, gloves, goggles, disposable gowns; reports of patients being turned away. Food shortages are reported in various areas as a result of transportation bans and lock downs.
- Containment measures in China: Travel bans now affect nearly 50 million people in China. Multiple tourist sites have been closed including some portions of the Great Wall, the Forbidden City, and Shanghai Disneyland. Movie theaters have been closed. Tour groups, cruises, and schools are closed. Many Chinese Lunar New Year Festivities have been cancelled. This week and next week comprise the busiest travel period in China and the resulting economic impact is expected to be significant.
- Current medical measures in progress: The Chinese government is flying hundreds of physicians and volunteers into affected areas and two temporary emergency hospitals are under construction to provide an additional 2,000 beds.
- Most vulnerable patients: Those at greatest risk include young children, the elderly, immuno-compromised patients, and those with diabetes, chronic heart or lung disease, and chronic renal disease.
- Usual cause of death: Viral pneumonia with respiratory failure is the most common fatal complication of coronaviruses.
- Appropriate work–up in acutely-ill patients with possible exposure: Patients who have travelled in China, within the past 2‒3 weeks, or who have had contact with such an individual, who have fever, cough, headache, or shortness of breath may warrant a CXR, CBC, liver enzymes (especially LDH and AST). Coronavirus testing involves real-time reverse transcriptase PCR (RT-PCR) of lower respiratory secretions.
- Historical perspective: Two other coronaviruses have caused serious respiratory illness in recent decades:
- MERS–CoV 2012 – Middle East Respiratory Syndrome
- SARS-CoV 2002-3 – Severe Acute Respiratory Syndrome
MERS resulted in 2,066 confirmed cases worldwide with 720 deaths.
SARS resulted in 8,000 confirmed cases worldwide with nearly 800 deaths (a mortality rate of 10%). Deaths were reported in 37 countries.
SARS was eradicated in 2004 by rapidly identifying and isolating “super-spreaders” (patients who infect unusually large numbers of people in the general population.)
- Prevention: Common sense and standard infectious disease principles are in order – frequent, thorough hand washing; avoid touching your face, nose, mouth, and eyes; do not travel, go to work, or socialize if you are ill; face masks can reduce transmission of virus-laden droplets from infected patients coughing or sneezing; avoid crowds; don’t share food, beverages, or utensils.
- Current status: As of Monday 1/27 – 2,700 confirmed cases with 81 deaths. Mortality rate at present is about 3%. These statistics will evolve rapidly.
- Check for updates from the CDC.
- Focus on facts, logic, and common sense.
- Employ time-tested ID principles and protocols.
- Realize similar outbreaks run their course (typically in winter) and eventually resolve with identification of the virus and isolation/containment of infection.
- Get a careful history from patients. The vast majority of people with cold or flu symptoms have a cold or flu – not coronavirus from China.