Coronavirus Updates for Clinicians

Although there is still no vaccine or effective antiviral treatment for the novel coronavirus (2019-nCoV) that continues to spread worldwide, clinicians are increasingly aware of the symptoms.

Since its discovery in December 2019 in Wuhan, China, the capital city of Hubei Province,¹2019-nCoV has spread to over 28,000 people in China, and 225 in 24 other countries. It has resulted in 564 deaths within China, and 1 in the Philippines.²Of the total number of cases, 98.9% have been in China.²

The 2019-nCoV is closely related to earlier SARS [severe acute respiratory syndrome], and MERS [Middle East respiratory syndrome] outbreaks that occurred in the last 20 years. Compared to these 2 viruses, 2019-nCoV seems to have greater infectivity, and a lower case fatality rate.¹

Symptoms are characterized by fever and dry cough in most patients, with about a third of these patients experiencing shortness of breath.¹

Thus far, the median age of patients has been between 49 and 56 years, and cases in children have been rare. Although most cases have been relatively mild, all patients admitted to hospitals have presented with pneumonia with infiltrates on chest x-ray and ground glass opacities on chest computed tomography.¹About a third of these patients subsequently developed acute respiratory distress syndrome and required care in the intensive care unit.¹

Based on genetic sequencing data, researchers believe there was a single introduction of 2019-nCoV to humans followed by human-to-human spread. 2019-nCoV shares 79.5% of its genetic sequence with SARS, and has 96.2% homology to a bat coronavirus. It is still unclear which animal is the intermediate species between bats and humans in the novel virus.¹

The incubation period for 2019-nCoV has been reported to be 5.2 days, though there are suggestions that it may be as long as 14 days. Some cases that have been reported suggest transmission during the asymptomatic phase, but investigators believe the majority of secondary cases come from symptomatic individuals.¹

If a patient presents with the symptoms, clinicians should obtain a detailed travel history. If the patient has traveled to Hubei Province within the last 14 days, they should be considered under investigation. Next steps should include notifying the health care facility’s infection prevention team, and the local or state health department. State health departments then notify the CDC’s Emergency Operations Center.¹

On Tuesday, the FDA issued anemergency use authorizationfor the first 2019-nCoV diagnostic, allowing the use of the test at any CDC-qualified lab in the country.³

Because it is influenza season and many of the symptoms are similar, clinicians should consider prescribing oseltamivir pending the results of influenza testing, according to an opinion published in theJournal of the American Medical Association.¹

Although no treatment has been found effective against 2019-nCoV, remdesivir is available through compassionate use and was used in the first patient identified in the US.¹Remdesivir has demonstrated in vitro and in vivo activity in animal models against SARS and MERS, leading to hope that it may also be effective against 2019-nCoV.³

The World Health Organization has also announced a global research and innovation forum to accelerate developments of treatments, and a vaccine. The forum will be held February 11-12, 2020 in Geneva, Switzerland and will bring together key scientists, public health agencies, ministries of health, and research funders. The experts will build on existing SARS and MERS research.⁴

“Understanding the disease, its reservoirs, transmission, and clinical severity and then developing effective counter-measures is critical for the control of the outbreak, to reduce deaths and minimize the economic impact,” said Soumya Swaminathan, MD, WHO Chief Scientist, in a statement.⁴

REFERENCES

1. del Rio C, Malani P. 2019 Novel Coronavirus—Important Information for Clinicians.JAMA; Feb 5, 2020.https://jamanetwork.com/journals/jama/fullarticle/2760782. Accessed Feb 6, 2020.
2. World Health Organization press briefing; Feb 6, 2020.http://bit.ly/39aZ044. Accessed Feb 6, 2020.
3. Antrim A. WHO Requests $675 Million from Global Community to Fight Coronavirus.Pharmacy Times; Feb 5, 2020.https://www.pharmacytimes.com/news/who-requests-675-million-from-global-community-to-fight-coronavirus. Accessed Feb 6, 2020.
4. WHO to accelerate research and innovation for new coronavirus. World Health Organization website; Feb 6, 2020.https://www.who.int/news-room/detail/06-02-2020-who-to-accelerate-research-and-innovation-for-new-coronavirus. Accessed Feb 6, 2020.