By Joanne Fruth, MD
Quick Facts — Novel Coronavirus (2019 – nCoV)
- 2019-nCoV is a virus first identified in Wuhan, China, late 2019.
- 5 cases have been confirmed so far in the US – ALL in individuals who had recent travel to Wuhan, China. States confirmed where the virus has been confirmed: WA, CA, IL, AZ. There is one human-to-human spread reported in the US. There have been NO cases reported in NC.
- 170 deaths so far reported in the 7,711 confirmed cases in China (as of January 29, 2020) – most deaths in patients over 50 and with some degree of immune compromise
- Symptoms are that of a mild to severe cold: fever, cough, and shortness of breath. Incubation is estimated from 2 to 14 days.
- Prevention is the same as for all viruses: good hand washing, avoid touching the eyes, cover mouth when sneezing or coughing, stay home when ill, avoid sick contacts.
- There is no vaccine for 2019-nCoV and treatment is supportive
- Transmission suspected to be from respiratory droplets (cough or sneeze) but the ease of transmission is not known. (e.g. – measles is HIGHLY contagious, MERS had low human to human transmission)
- Illness (1 in 10) or death (1 in 1000) from influenza is much more likely than illness or death from 2019-nCoV. It is NOT too late to receive a flu shot
- CDC currently has 165 samples of “Persons Under Investigation” (PUI) in the United States, of which 5 have been determined positive, 68 confirmed negative, and 92 pending.
Avance Recommendations Based on CDC Recommendation
Healthcare providers should obtain a detailed travel history for patients being evaluated with fever and acute respiratory illness.
Patients in the United States who meet the following criteria should be evaluated as a PUI in association with the outbreak of 2019-nCoV in Wuhan City, China.
Contact our Local Health Department at 919-212-7000 WHO WILL CONTACT THE CDC. CDC will assist local/state health departments to collect, store, and ship specimens appropriately to CDC, including during afterhours or on weekends/holidays. At this time, diagnostic testing for 2019-nCoV can be conducted only at CDC.
Clinical Features | & | Epidemiologic Risk |
| Fever1 and symptoms of lower respiratory illness (e.g., cough, difficulty breathing) | and | In the last 14 days before symptom onset, a history of travel from Wuhan City, China. – or – In the last 14 days before symptom onset, close contact2 with a person who is under investigation for 2019-nCoV while that person was ill. |
| Fever1 or symptoms of lower respiratory illness (e.g., cough, difficulty breathing) | and | In the last 14 days, close contact2 with an ill laboratory-confirmed 2019-nCoV patient. |
Additional Info
- There are 7 types of human coronaviruses, which cause a significant percent of all colds;
- “Corona” named for the crown or aura that appears on electron microscopy of the virus
- Coronavirus is now detected by PCR technology, which was not available 20 years ago, so testing via PCR to identify the virus was done quickly once the genetic sequence of this RNA virus was determined.
- “Novel” will be replaced once more is known about the virus;
- 2019-nCoV has been identified in China, Japan, Singapore, US, Canada, Australia, France
- The virus may have originated from animal source as persons first infected reported visiting a large seafood and animal market. Since then, individuals infected have NOT reported visiting the market, so human to human transmission is suspected.
- Other coronaviruses include “Severe Acute Respiratory Syndrome” or SARS in 2003 where 10% of 8000 people infected died and “Middle Eastern Respiratory Syndrome” or MERS in 2012 ultimately infecting 2468 persons with 35% mortality.
- For diagnosis – three samples will be needed and can ONLY be run at the CDC: 1. Upper respiratory tract sampling with synthetic fiber swab nasal and pharyngeal 2. Lower respiratory tract sputum or bronchial lavage and 3. serum. All specimens have special transport criteria which would be orchestrated by the State or Local Health Department to the CDC.
References:
- https://www.cdc.gov/coronavirus/2019-nCoV/clinical-criteria.html#foot1
- https://www.cdc.gov/coronavirus/2019-nCoV/clinical-criteria.html#foot2
Joanne M. Fruth, MD, FAAFP
Dr. Fruth is a family physician with a mission to promote the benefits of primary care and especially Family Medicine (#FMrevolution). As Medical Director at Avance Care, Dr. Fruth uses her years of experience and passion for teaching to inspire other clinicians to make each primary care visit one which builds the foundation good health
Dr. Fruth loves hiking, trips to Broadway and seeking adventure (or a quiet evening) with her emergency physician husband. She has three adult children on their own missions to make the world a better place.