WHO Says Coronavirus Infections May Be Slowing, but Clinicians Should Still Be Cautious

Patients concerned about the novel coronavirus (COVID-19) need to remain calm and should not go to emergency departments if they are not symptomatic, said Laura Celmins, PharmD, BCPS, BCCCP, a clinical pharmacy specialist in emergency medicine at UChicago Medicine, in an email.¹

Fears surrounding the COVID-19 outbreak have had major effects even in unaffected areas, including face mask shortages, a falling stock market,² and many unsubstantiated rumors. Federal agencies and drug manufacturers have leapt into action, however, sending diagnostic tests around the country, and working to developing potential vaccines and treatments.

The Global Situation

There are currently more than 75,204 confirmed cases worldwide, and more than 2000 deaths,³ associated with the virus. On Saturday, France reported the first coronavirus-related death outside of Asia, a Chinese tourist.⁴ In the United States, the CDC has confirmed 15 cases, and has 52 additional cases pending test results⁵.

In a media briefing on Monday, World Health Organization Director-General Tedros Adhanom, PhD, said experts are beginning to get a clearer picture of the outbreak, and its development.⁶ Adhanom cited a report from Chinese authorities that detailed more than 44,000 confirmed cases.⁶

“These data give us a better understanding about the age range of people affected, the severity of the disease, and the mortality rate,” Ahdanom said in the press briefing. “As such, they are very important in enabling WHO to provide good evidence-based advice to countries.”⁶

According to Adhanom, the report suggests a decline in new cases, though he cautioned the global health community to take this data cautiously. He added that these trends could easily change as the virus spreads to new populations.⁶

The report also suggests that COVID-19 has a lower death rate than the earlier severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) outbreaks, which are related viruses.⁷ According to the report, the national mortality rate for COVID-19 is 2.38% in China, and 0.25% outside of China. Globally, the SARS fatality rate was 9.6%, and the MERS fatality rate was 34%.⁷

Adhanom noted in the briefing that more than 80% of patients with COVID-19 have a mild case and will recover, and about 14% of cases have been classified as severe. Just about 5% of patients have critical disease including respiratory failure, septic shock, and multi-organ failure.⁶

The risk of death increases with the age of the patient. Ahdanom added that there are relatively few cases among children, but more research is needed to understand why.⁶

In the United States

Although there have only been a few confirmed cases in the US, Celmins said she has seen a rise in concerned patients requesting screening.¹

“We’ve had patients who happened to be in the airport at the same time as eventually positive patients come to the [emergency department] because they were worried about exposure,” Celmins said.¹

She added that clinicians are still recommending basic hygiene, including hand washing, and habits such as sneezing or coughing into your elbow. Additionally, healthy patients do not need to wear face masks.¹

“We should save them for people who are actively symptomatic,” Celmins said.¹

UChicago Medicine is not currently performing screening testing on asymptomatic patients, Celmins said, so patients should not come in expecting immediate testing if they are not showing symptoms.¹

“The [emergency department] is for sick patients, [so] coming in ‘to get checked out’ or request a test we won’t perform only contributes to overcrowding, increases treatment delays, and potentially exposes the healthy person to sick patients,” Celmins said.¹

Agencies including the FDA and CDC are focusing on efforts to diagnose, treat, and prevent the virus. The FDA has issued an emergency use authorization (EUA) to enable immediate use of a diagnostic test in CDC-qualified labs, and have developed an EUA review template for tests to detect the virus.⁸ In a release on February 14, the FDA said that template has been distributed to more than 50 developers who have expressed interest in developing diagnostics.⁸

REFERENCES

• Interview with Pharmacy Times via email. February 19, 2020.
• CBS News. U.S. stocks drop after Apple warns of financial hit from coronavirus. CBS website. https://www.cbsnews.com/news/stock-market-down-apple-coronavirus-financial-performance/. Updated February 18, 2020. Accessed February 19, 2020.
• Coronavirus disease 2019 (COVID-19) Situation Report — 29. WHO website; February 19, 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200219-sitrep-30-covid-19.pdf?sfvrsn=6e50645_2. Accessed February 19, 2020.
• Ganley E. France Has Reported the First COVID-19 Death Outside Asia. Time. https://time.com/5785366/coronavirus-death-outside-asia-france/. Published February 17, 2020. Accessed February 19, 2020.
• Coronavirus Disease 2019 (COVID019) in the U.S. CDC website, https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html. Updated February 19, 2020. Accessed February 19, 2020.
• WHO Director-General’s remarks at the media briefing on COVID-2019 outbreak on 17 February 2020 [news release]. Geneva, Switzerland; February 17, 2020: WHO website. https://www.who.int/dg/speeches/detail/who-director-general-s-remarks-at-the-media-briefing-on-covid-2019-outbreak-on-17-february-2020. Accessed February 19, 2020.
• Expert Group for the Prevention and Control of New Coronavirus Pneumonia of Chinese Preventive Medicine Association. The Latest Understanding of Epidemiological Features of New Coronavirus Pneumonia [J]. Chinese Journal of Epidemiology, 2020, 41 (02): 139-144. DOI: 10.3760/cma.j/issn.0254-6450.2020.02.002. http://rs.yiigle.com/yufabiao/1181136.htm. Accessed February 19, 2020.
• FDA’s Actions in Response to 2019 Novel Coronavirus at Home and Abroad [news release]. Silver Spring, MD; FDA website: February 14, 2020. https://www.fda.gov/news-events/press-announcements/fdas-actions-response-2019-novel-coronavirus-home-and-abroad. Accessed February 19, 2020.