Novel Coronavirus: What clinicians should know

Hospital Safety Insider, February 6, 2020

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By Christopher Cheney, HealthLeaders

An article published this week by the Journal of the American Medical Association provides clinical insights about the new coronavirus outbreak that started in China.

The Centers for Disease Control and Prevention (CDC) calls the new coronavirus 2019 novel coronavirus (2019-nCoV). Cases of 2019-nCoV mainly have been reported in China, where the epidemic began in the city of Wuhan in Hubei Province but cases have been reported in 26 countries, including 11 cases in the United States, the JAMA article says.

As of Feb. 4, more than 20,000 cases of infections had been reported, with 98.9% of the cases in China, and the virus had been tied to more than 400 deaths, the JAMA article says. A CDC webpage has updated information about the spread of 2019-nCoV and the response to the epidemic.

The JAMA article features several key points of information for clinicians:

  •     Five cities with high volumes of travel from China have had the most cases of 2019-nCoV outside of the epicenter in China: Bangkok, Hong Kong, Singapore, Taipei, and Tokyo.
  •     The first case of 2019-nCoV in Wuhan is believed to have spread from an animal to a human. There have been two other zoonotic coronavirus outbreaks in the past two decades: severe acute respiratory syndrome {SARS) and Middle East respiratory syndrome (MERS). Early data suggests that 2019-nCoV has greater infectivity and lower mortality than SARS and MERS.
  •     One study reported the incubation period for 2019-nCoV is 5.2 days, but it could be as long as 14 days. It is possible that the virus can be transmitted when an infected person is asymptomatic, but it is likely that most transmission occurs when an infected person is symptomatic.
  •     A study of 99 coronavirus patients in Wuhan found that most symptomatic people presented with fever and dry cough, with shortness of breath experienced by nearly a third of patients. Other symptoms included headache, sore throat and diarrhea. The study found the average age of patients was 55.5 years old.
  •     There have been few cases reported in children.
  •     Most cases appear to be mild. Patients who have required hospital admission have had pneumonia, and about a third of hospitalized patients have developed acute respiratory distress syndrome and have been admitted to an intensive care unit.
  •     Clinicians should obtain a travel history when patients have fever and respiratory symptoms, especially a dry cough. If these patients have a history of travel to Hubei Province in the prior 14 days, they should be considered a person under investigation (PUI).
  •     If a PUI presents, clinicians should report the case as soon as possible to their healthcare facility’s infection prevention staff and to local or state health departments. Currently, the CDC is conducting all diagnostic testing for 2019-nCoV. Clinicians should test PUIs for other respiratory pathogens, and they should consider prescribing oseltamivir until influenza testing is completed.
  •     If there is a high level of suspicion that a PUI has 2019-nCoV, the patient should don a face mask immediately and caregivers should wear N95 respirators.
  •     There is no vaccine for 2019-nCoV and no medications have been proven effective against the virus. Care has been mainly supportive. The antiviral remdesivir was prescribed for the first U.S. coronavirus patient.
  •     Public health measures that were effective in the SARS epidemic may be effective in the prevention of spreading 2019-nCoV: handwashing, respiratory etiquette such as covering the mouth when coughing, and staying home when sick.

Christopher Cheney is the senior clinical care? editor at HealthLeaders.

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