Health Care Updates on Coronavirus

Although there is still no vaccine or effective antiviral treatment for the novel coronavirus (2019-nCoV) that continues to spread worldwide, health care providers should be aware of the symptoms.

By February 7, there were 12 confirmed cases in the United States and 100 pending cases, including specimens received by the CDC and awaiting testing, and specimens in route to CDC testing facilities.¹ According to the World Health Organization (WHO), there were 37,558 confirmed cases globally as of Saturday.²

Since its discovery in December 2019 in Wuhan, China, the capital city of Hubei Province,¹ 2019-nCoV has resulted in 812 deaths within China and 1 in the Philippines.² Of the total cases, 98.9% have been in China.³ Last week also saw the first death of a US citizen, a man aged 60 years, who died in China on Thursday, according to the Wall Street Journal.⁴

The 2019-nCoV is closely related to earlier SARS [severe acute respiratory syndrome] and MERS [Middle East respiratory syndrome] outbreaks in the last 20 years. Compared to these 2 viruses, 2019-nCoV seems to have greater infectivity and a lower case fatality rate.⁵

Symptoms of 2019-nCoV are characterized by fever and dry cough in most patients, with about a third experiencing shortness of breath. ⁵

Thus far, the median age of patients is between 49 years and 56 years, and cases in children have been rare. Although most cases have been relatively mild, all patients admitted to hospitals have presented with pneumonia with infiltrates on chest x-rays and ground glass opacities on chest computed tomography.⁴ About a third of these patients subsequently developed acute respiratory distress syndrome and required care in the intensive care unit. ⁵

Based on genetic sequencing data, researchers believe there was a single introduction of 2019-nCoV to humans followed by human-to-human spread. 2019-nCoV shares 79.5% of its genetic sequence with SARS and has 96.2% homology to a bat coronavirus. It is still unclear which animal is the intermediate species between bats and humans in the novel virus. ⁵

The incubation period for the 2019-nCoV has been reported to be 5.2 days, though there are suggestions that it may be as long as 14 days. Some cases have been reported which suggest transmission during the asymptomatic phase, but investigators believe the majority of secondary cases come from symptomatic individuals.⁵

If a patient presents with the symptoms, clinicians should obtain a detailed travel history. If the patient has traveled to Hubei Province within the last 14 days, they should be considered under investigation. The next steps should include notifying the health care facility’s infection prevention team, as well as the local or state health department. State health departments would then notify the CDC’s Emergency Operations Center. ⁵

On Tuesday, the FDA issued an emergency use authorization for the first 2019-nCoV diagnostic, allowing the use of the test at any CDC-qualified lab in the country.⁶

Because it is influenza season and many of the symptoms are similar, clinicians should consider prescribing oseltamivir pending the results of influenza testing, according to an opinion published in the Journal of the American Medical Association.⁵

Although no treatment has been found effective against 2019-nCoV, remdesivir is available through compassionate use and was used in the first patient identified in the US.⁴ Remdesivir has demonstrated in vitro and in vivo activity in animal models against SARS and MERS, leading to hope that it may also be effective against 2019-nCoV.⁶

The World Health Organization has also announced a global research and innovation forum to accelerate developments of treatments and a vaccine. The forum will be held February 11-12 in Geneva, and will bring together key scientists, public health agencies, ministries of health, and research funders. The experts will build on existing SARS and MERS research.⁷

“Understanding the disease, its reservoirs, transmission, and clinical severity and then developing effective counter-measures is critical for the control of the outbreak, to reduce deaths and minimize the economic impact,” said Soumya Swaminathan, MD, WHO Chief Scientist, in a statement.⁷

REFERENCES

• Confirmed 2019-nCoV Cases in the US. Centers for Disease Control and Prevention website; Updated February 7, 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html. Accessed February 10, 2020.
• Novel Coronavirus (2019-nCoV) Situation Report 20. World Health Organization; February 9, 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200209-sitrep-20-ncov.pdf?sfvrsn=6f80d1b9_4. Accessed February 10, 2020.
• World Health Organization press briefing; Feb 6, 2020. http://bit.ly/39aZ044. Accessed Feb 6, 2020.
• Woo S. American Citizen Diagnosed With Coronavirus Dies in China. The Wall Street Journal; Updated February 8, 2020. https://www.wsj.com/articles/an-american-citizen-diagnosed-with-coronavirus-has-died-in-china-11581141185. Accessed February 10, 2020.
• Del Rio C, Malani P. 2019 Novel Coronavirus—Important Information for Clinicians. JAMA; Feb 5, 2020. https://jamanetwork.com/journals/jama/fullarticle/2760782. Accessed Feb 6, 2020.
• Antrim A. WHO Requests $675 Million from Global Community to Fight Coronavirus. Pharmacy Times; Feb 5, 2020. https://www.pharmacytimes.com/news/who-requests-675-million-from-global-community-to-fight-coronavirus. Accessed Feb 6, 2020.
• WHO to accelerate research and innovation for new coronavirus. World Health Organization website; Feb 6, 2020. https://www.who.int/news-room/detail/06-02-2020-who-to-accelerate-research-and-innovation-for-new-coronavirus. Accessed Feb 6, 2020.