*Please note that the information presented in this podcast was based on best available information at the time of release* Please refer to your local healthcare agency for the latest information

Time Stamps

• 01:29 Novel parts of coronavirus
• 02:58 What symptoms do patients present with for the novel coronavirus?
• 04:07 What distinguishes coronavirus from other influenza-like illness?
• 05:21 When coronavirus is suspected, what should you do?
• 07:02 What does testing for coronavirus entail?
• 08:54 What kind of isolation is required?
• 10:04 Do patients need to be isolated in biocontainment units?
• 10:34 What is treatment for the novel coronavirus?
• 12:19 Potential for vaccines
• 15:17 What is R0? How contagious is the novel coronavirus? 
• 17:03 Animal reservoirs with 2019-nCoV, SARS, and MERS
• 19:14 What should we tell patients for prevention?

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Show Notes

• 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 (e.g. avian flu)
    • 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 coronavirus 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: steroids, 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)

References

• Paules, C. I., Marston, H. D., & Fauci, A. S. (2020). Coronavirus Infections—More Than Just the Common Cold. JAMA.
• Hu, B., Ge, X., Wang, L. F., & Shi, Z. (2015). Bat origin of human coronaviruses. Virology journal, 12(1), 221.
• Tu, C., Crameri, G., Kong, X., Chen, J., Sun, Y., Yu, M., … & Yu, Y. (2004). Antibodies to SARS coronavirus in civets. Emerging infectious diseases, 10(12), 2244.
• Azhar, E. I., El-Kafrawy, S. A., Farraj, S. A., Hassan, A. M., Al-Saeed, M. S., Hashem, A. M., & Madani, T. A. (2014). Evidence for camel-to-human transmission of MERS coronavirus. New England Journal of Medicine, 370(26), 2499-2505.
• https://www.health.harvard.edu/blog/the-new-coronavirus-what-we-do-and-dont-know-2020012518747
• https://www.npr.org/sections/goatsandsoda/2020/01/24/798661901/wuhan-coronavirus-101-what-we-do-and-dont-know-about-a-newly-identified-disease
• Majumder, M., & Mandl, K. D. (2020). Early transmissibility assessment of a novel coronavirus in Wuhan, China. China (January 23, 2020).
• https://www.bbc.com/news/world-asia-china-51305526
• Guerra, F. M., Bolotin, S., Lim, G., Heffernan, J., Deeks, S. L., Li, Y., & Crowcroft, N. S. (2017). The basic reproduction number (R0) of measles: a systematic review. The Lancet Infectious Diseases, 17(12), e420-e428.
• Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., … & Cheng, Z. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet.
• https://www.cdc.gov/flu/avianflu/avian-in-humans.htm
• https://www.cdc.gov/flu/weekly
• https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fclinical-criteria.html
• https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
• https://www.cdc.gov/coronavirus/mers/infection-prevention-control.html
• https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
• https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fguidelines-clinical-specimens.html
• https://ncbiinsights.ncbi.nlm.nih.gov/2020/01/13/novel-coronavirus/
• https://www.youtube.com/watch?v=3qlagdc_luM
• https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200127-sitrep-7-2019–ncov.pdf
• https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)