Coronavirus…”2019-nCoV”

Coronaviruses (CoV) stem from a family of viruses that range in degree of illness starting from as mild as the common cold to more severe diseases such as Middle East Respiratory Syndrom (MERS-CoV) and Severe Acute Respiratory Syndrom (aks SARS). However, a novel coronavirus has emerged and is being closely monitored by the Center for Disease Control (CDC). This new coronavirus (2019-nCoV) first identified in Wuhan city, resulted in thousands of confirmed cases in China. There has been mixed reviews on the transmission of this virus. There were some initial link to a large seafood and animal market, suggesting animal-to-person spread, however, some who were infected had no such connection leading to a suspicion that it could be person-to-person transmission.

Person-to-person spread is common among other strains of coronavirus which is mainly transmitted via respiratory droplets from an infected person who coughs or sneezes and can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Some common sign and symptoms are mostly respiratory in nature and include, fever, cough, shortness of breath and breathing difficulties. Symptoms can be more severe, including pneumonia, severe acute respiratory syndrome, kidney failure and even death. 

The World Health Organization has issued new travel tips to help keep people protect themselves if they have to travel. There are standard recommendations that have been established to prevent infection spread focused on regular hand washing, covering mouth and nose when coughing and sneezing, thoroughly cooking meat and eggs. Even with these recommendations, the disease has spread to other countries including the first case of 2019-nCoV in the United States. Once he was identified because of the public health travel alerts from China where he visited, he was tested and hospitalized after he was confirmed as having the 2019-nCoV. He presented with persistent dry cough, nausea and vomiting and eventually progressed to pneumonia. He was treated antiviral (remdesivir), and with antibiotics (fear of hospital-acquired pneumonia) and oxygen supplementation. At the time this article was published he was still hospitalized although showing marked improvement.

This case represents the value and importance of up-to-date reporting between local and state health departments, together with treating clinicians and CDC Emergency Operations Center. Evidently, this patient’s prompt actions and heeding travel alerts lead to appropriate identification and immediate isolation to help reduce further transmission. Finally, this case highlights the need for researchers and clinicians to better understand clinical diseases because having knowledge of the full spectrum of new disease emergence, including pathology, viral transmission and infection can better optimize clinical management and public health decision making.

Week 2 Coronavirus (2019-nCoV) Continued…

The current epidemic is rapidly changing and new cases are continuing to emerge. Del Rio et al., provided a recent update on the newly discovered virus. “As of February 4, 2020, more than 20 000 cases of 2019-nCoV have been reported, 98.9% of them in China, and the outbreak is linked to more than 400 deaths.” The new coronavirus is considered a pandemic, although the number of infections outside of China remains small. There are approximately 180 cases that have been detected in 26 countries, including 11 cases in the United States. Cases have revealed that the incubation period of this virus has been reported to be 5.2 days and some cases show it to be as long as 14 days. The growing concern involves the revelation that the epidemic is doubling every 6.4 days. In the more severe cases, patients have been admitted to the hospital presenting with pneumonia, and about a third of patients subsequently developed acute respiratory distress syndrome and even required care in the intensive care unit. However, most cases appear to be mild.

One of the advances in microbiology includes genetic sequencing data to help identify useful features. Zhou et al., identified that the “novel virus shares 79.5% of genetic sequence with SARS-CoV and has 96.2% homology to a bat coronavirus.” It is still unclear what the source of 2019-CoV is yet, although there has been some link to an animal intermediate species between bats and humans; but most of the infections were Human-to-human transmission. The current coronavirus epidemic is the third relevant outbreak of coronavirus in the 21st century, and has already surpassed the number of individuals infected since SARS in 2003 and MERS in 2012. It could be that the rates are higher with 2019-CoV because of the late identification of the etiologic agent. Also, the ability of the individuals to shed the infection while asymptomatic has been of concern more so than the greater infectivity of the virus compared with SARS.

Finally, it is important to note that most of the infected patients were healthy adults. Therefore, the basic public health instructions are to avoid travel in areas of outbreak, staying home when ill, frequent handwashing with soap and water, and exhibiting respiratory etiquette including covering the mouth and nose during sneezing and coughing and not touching one’s face. Early detection seems to be related to less severe disease and recovery.