*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?Β
- 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 βcoronaβ 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
- Isolate suspected cases, use airborne and contact precautions along with goggles
- 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)
- WHO has declared it a public health emergency; factors considered include worldwide impact, including effect on economics, commerce, etc.
References
- Paules, C. I., Marston, H. D., & Fauci, A. S. (2020). Coronavirus InfectionsβMore 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)
Tags: 2019-nCOV, CME
12 comments on “Novel Coronavirus: What the Clinician Needs to Know Interview”
Excellent presentation! Thank you
Great presentation.
Thank you
Thank you both!
Thank you it was very comprehensive and well presented . I shared it with other patient care providers and staff since there has been an increase in questions and inquiry related to how and why this infection was different than other flu .
Thank you for your kind words and sharing with your colleagues!
Clear and concise presentacion.
Thank you Jose!
A very Informative, concise presentation. Will definitely be sharing with my office staff.
Excellent discussion… informative and on point… hopefully more to come soon!
Excellent! Thank you!!!
Great concise summarization of the information known at the time. Juxtaposed to our current unbelievable situation, it might be good to update the presentation. Thank you.
Good presentation. Maybe some of the information is now (as of July 20, 2020) is outdated