Novel Coronavirus: What the Clinician Needs to Know Interview
Background:
- Coronaviruses cause 10-30% of upper respiratory tract infections
- Coronaviruses have on occasion been transmitted from animal to humans (SARS, MERS, and now likely 2019-nCoV), and then acquired the ability to also be transmitted from humans to other humans
- Animal-to-human transmission without human-to-human transmission would result in isolated cases without further spread
- Both SARS and MERS are thought to have originated from bats, then spread through civets and camels, respectively, to humans
- All coronaviruses isolated thus far are spread by droplets
- The "corona" in coronoavirus refers to the S spike on the virion
- Has been reported in all provinces of China
- R0 (measure of how many secondary cases result from a primary case) = ~2
- Secondary cases: cases acquired from primary cases and not from the animal market where the outbreak started
- In comparison, measles has an R0 of 12-18(!)
- SARS had a similar R0 as the 2019-nCoV
- Presents with influenza-like illness (ILI), including fever, cough, myalgia and on some occasions, diarrhea
- Bilateral infiltrates are commonly seen on chest imaging
- Lymphopenia as a prominent lab abnormality
- Severe cases may result in ARDS or death
- Compatible symptoms along with travel to China or exposure to other cases
- CDC has a PCR test with 24-48 hr turnaround time
- The whole genome of the virus is already known and public
- Specimens to run: nasopharyngeal swab, deep respiratory (sputum, BAL, or tracheal aspirate), serum
- Of note, the coronavirus on some respiratory viral panels is NOT the 2019-nCoV
- The whole genome of the virus is already known and public
- Isolate suspected cases, use airborne and contact precautions along with goggles
- If calling in from home, instruct to wear mask before coming in
- Can potentially discharge/keep home with home isolation
- Some downsides of widespread large-scale quarantine: panic, inability to get in supplies
- Call the CDC to coordinate collection of samples
- Two drugs on compassionate-use basis: Kalitra (lopinavir/ritonavir), remdesavir
- In the works: monoclonal antibodies developed against coronaviruses during the SARS epidemic, vaccine against the S protein (could be in phase 1 trials in as soon as 3 months)
- Not recommended: steriods, interferon, ribavirin
- The WHO activated a specific research and development blueprint for the virus
- WHO has declared it a public health emergency; factors considered include worldwide impact, including effect on economics, commerce, etc.
- Potentially could affect aid, research funding, etc.
- In comparison, influenza is more of a threat to the US at this point, with 15 million illnesses worldwide, 140000 hospitalizations, 8000 deaths (54 in children)