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
Current epidemiology:
  • 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
Presentation of disease:
  • 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
Diagnosis:
  • 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
Management:
  • 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
Impact:
  • 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)