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2019 Novel Coronavirus (2019-nCoV)

Frank J. Domino, MD, Robert Baldor and Jeremy Golding, MD
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Subject: 2019 Novel Coronavirus (2019-nCoV)

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BASICS

  

DESCRIPTION

  • Recently emerged virus causing respiratory symptoms that may lead to death
  • A novel (new) coronavirus (named "2019-nCoV") that was first detected in Wuhan City, Hubei Province, China

EPIDEMIOLOGY

  

Incidence

  • As of January 27, 2020, 5 confirmed U.S. cases (4/5 along west coast) with 70+ under investigation
  • Internationally, most cases in China
  • Countries with confirmed cases include Southeast Asia (Thailand, Hong Kong, Taiwan, Cambodia, Japan, Singapore, Vietnam), Australia, Canada, France, and the USA
  • As of January 27, 2020:
    • 2,014 confirmed 2019-nCoV cases have been reported globally
    • Of the 2,014 cases reported, 1,985 cases were reported from China, including Hong Kong SAR (5 confirmed cases), Macau SAR (2 confirmed cases), and Taipei (3 confirmed cases)
    • 29 confirmed cases have been reported outside of China in 10 countries
    • Of these 29 exported cases, 26 had a travel history from Wuhan City, China
    • 56 deaths have been reported to date

ETIOLOGY AND PATHOPHYSIOLOGY

  • A novel (new) coronavirus (named "2019-nCoV") that was first detected in Wuhan City, Hubei Province, China
  • A virus related to bat coronaviruses and the Severe Acute Respiratory Syndrome (SARS) coronavirus
  • Believed to evolve in animals; coronaviruses, some causing illness in people and others that infect animals, including camels, cats, and bats
  • Initial spreading thought to be from animal to man via exposure to a large seafood and animal market, but recent epidemiologic surveillance suggests that the virus may have originated elsewhere and was brought into that marketplace.
  • Most new cases have not had animal market exposure, suggesting person-to-person spread is occurring.

RISK FACTORS

  • Exposure to people with a travel history to Wuhan, China
  • Spread via respiratory droplets produced when an infected person coughs or sneezes

GENERAL PREVENTION

  • Similar as for the influenza virus; hand washing, avoid others if ill
  • Obtaining the influenza vaccine; while not protective against the 2019-nCoV, will help the much great risk of severe illness or death from influenza

DIAGNOSIS

  

HISTORY

  • Initially: fever (temperature 37°C/98.6°F to 38°C/100.4°F), cough, chest discomfort
  • Over 4-5 days, fever reduces, but cough and chest discomfort worsen
ALERT

Please have the patient don a surgical mask immediately and place the patient in airborne isolation (negative air pressure with staff wearing an N-95 respirator), if the patient meets the following criteria:

  • Fever AND symptoms of lower respiratory illness (e.g. cough, shortness of breath, etc.) and in the last 14 days before symptom onset, has a
    • history of travel to or from Wuhan City, China, or
    • Close contact with a person who is under investigation for 2019-nCoV while that person was ill
    • or
  • Fever OR symptoms of lower respiratory illness (e.g. cough, shortness of breath, etc.) and in the last 14 days before symptom onset, has had close contact with an ill laboratory-confirmed 2019-nCoV patient.
 
  

PHYSICAL EXAM

Mild-to-severe respiratory illness with fever, cough, dyspnea, and chest discomfort 

DIFFERENTIAL DIAGNOSIS

Influenza, other virally-mediated respiratory illness 

DIAGNOSTIC TESTS & INTERPRETATION

  

Initial Tests (lab, imaging)

  • Obtain permission from the CDC prior to collecting specimens specific to 2019-nCoV, but do not wait to collect other diagnostic tests such as for influenza or RSV.
  • If permission is granted, the following specimens will need to be collected and refrigerated at 2-8°C
    • Nasopharyngeal swab AND oropharyngeal swab (use only synthetic fiber swabs with plastic shafts with a viral transport media)
    • Sputum
    • Serum (1 tube [5-10 mL]) of whole blood in a serum separator tube)
  • Chest X-ray, confirmatory CAT scan

Diagnostic Procedures / Other

  • Testing for 2019-nCoV can only be accomplished in the U.S. at the Centers for Disease Control and Prevention (CDC)
  • If a patient has had a potential exposure and is ill, immediately notify the CDC's Emergency Operations Center (EOC) at 770-488-7100 to determine whether testing for 2019-nCoV at CDC is indicated.

TREATMENT

  

GENERAL MEASURES

Hydration, oxygen 

MEDICATION

  

First Line

Treat as if bacterial pneumonia until proven otherwise. 

ISSUES FOR REFERRAL

If a patient has had a potential exposure and is ill, immediately notify the CDC's EOC at 770-488-7100 to determine whether testing for 2019-nCoV at CDC is indicated. 

ADMISSION, INPATIENT, AND NURSING CONSIDERATIONS

Any patient who has had a potential exposure and is ill should NOT enter a healthcare facility; remain at hom to allow quarantine. 

ONGOING CARE

  

PATIENT EDUCATION

  • Travel information can be found at the CDC: https://wwwnc.cdc.gov/travel/destinations/traveler/none/china#travel-notices
  • Frequently clean hands by using alcohol-based hand rub or soap and water.
  • When coughing and sneezing, cover mouth and nose with flexed elbow or tissue. Throw tissue away immediately and wash hands.
  • Avoid close contact with anyone who has fever and cough.
  • If you have fever, cough, and difficulty breathing, seek medical care early and share previous travel history with your healthcare provider.
  • When visiting live markets in areas currently experiencing cases of novel coronavirus, avoid direct unprotected contact with live animals and surfaces in contact with animals.
  • The consumption of raw or undercooked animal products should be avoided. Raw meat, milk, or animal organs should be handled with care, to avoid cross-contamination with uncooked foods, as per good food safety practices.

PROGNOSIS

Illness reports have ranged from patients with few symptoms to being severely ill and dying. 

ADDITIONAL READING

CLINICAL PEARLS

  • Recently emerged virus causing respiratory symptoms that may lead to death, a novel (new) coronavirus (named "2019-nCoV") first detected in Wuhan City, Hubei Province, China
  • If a patient has had a potential exposure and is ill, immediately notify the CDC's EOC at 770-488-7100 to determine whether testing for 2019-nCoV at CDC is indicated.
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