The Wuhan coronavirus (2019-nCoV) outbreak has unfolded so rapidly
that many clinicians are scrambling to stay on top of it. Here are the
answers to some frequently asked questions about how to prepare your
clinic to respond to this outbreak.
Keep in mind that the outbreak is moving rapidly. Though scientific
and epidemiologic knowledge has increased at unprecedented speed, there
is much we don’t know, and some of what we think we know will change.
Follow the links for the most up-to-date information.
What should our clinic do first?
Plan ahead with the following:
- Develop a plan for office staff to take travel histories from anyone
with a respiratory illness, and provide training for those who need it.
Travel history at present should include asking about travel to China
in the past 14 days, specifically Wuhan city or Hubei province.
- Review up-to-date infection control practices with all office staff and provide training for those who need it.
- Take an inventory of supplies of personal protective equipment
(PPE), such as gowns, gloves, masks, eye protection, and N95 respirators
or powered air-purifying respirators (PAPRs), and order items that are
missing or low in stock.
- Fit-test users of N95 masks for maximal effectiveness.
- Plan where a potential patient would be isolated while obtaining expert advice.
- Know whom to contact at the state or local health department if you have a patient with the appropriate travel history.
The Centers for Disease Control and Prevention (CDC) has prepared a
toolkit to help frontline healthcare professionals prepare for this virus. Providers need to stay up-to-date on the
latest recommendations, as the situation is changing rapidly.
When should I suspect 2019-nCoV illness, and what should I do?
Take the following steps to assess the concern and respond:
- If a patient with respiratory illness has traveled to China in the
past 14 days, immediately put a mask on the patient and move the
individual to a private room. Use a negative-pressure room if available.
- Put on appropriate PPE (including gloves, gown, eye protection, and
mask) for contact, droplet, and airborne precautions. CDC recommends an
N95 respirator mask if available, although we don’t know yet if there is
true airborne spread.
- Obtain an accurate travel history, including dates and cities. (Tip:
Get the correct spelling, as the English spelling of cities in China
can cause confusion.)
- If the patient meets the current CDC definition of “person under investigation” (PUI),
or if you need guidance on how to proceed, notify infection control (if
you are in a facility that has it) and call your state or local health
department immediately.
- Contact public health authorities who can help decide whether the
patient should be admitted to airborne isolation or monitored at home
with appropriate precautions.
What is the definition of a PUI?
The current definition of a
PUI is a person who has fever and symptoms of a respiratory infection (cough, shortness of breath)
AND who has
EITHER been in Wuhan city or Hubei province in the past 14 days
OR
had close contact with a person either under investigation for
2019-nCoV infection or with confirmed infection. The definition of a PUI
will change over time, so check
this link.
How can I test for 2019-nCoV?
As of January 30, 2020, testing is by PCR and only available in the
United States through CDC in Atlanta. Testing should soon be available
in state health department laboratories. If public health authorities
decide that your patient should be tested, they will instruct you on
which
samples to obtain.
The full sequence of 2019-nCoV has been shared, so some reference
laboratories may develop and validate tests, ideally with assistance
from CDC. If testing becomes available, make certain that it is a
reputable lab that has carefully validated the test.
Should I test for other viruses?
Because the symptoms of 2019-nCoV infection overlap with those of
influenza and other respiratory viruses, PCR testing for other viruses should be considered
if
it will change management (ie, change the decision to provide influenza
antivirals). Use appropriate PPE while collecting specimens, including
eye protection. If 2019-nCoV is a consideration, you may want to send
the specimen to a hospital lab for testing, where the sample will be
processed under a biosafety hood, rather than doing point-of-care
testing in the office.
How dangerous is 2019-nCoV?
The current estimated mortality rate is 2%-3%. That is probably an
overestimate, as those with severe disease and those who die are more
likely to be tested and reported early in an epidemic.
Our current knowledge is based on preliminary reports from
hospitalized patients and will probably change. From the speed of spread
and a single family cluster, it seems likely that there are milder
cases and perhaps asymptomatic infection.
What else do I need to know about coronaviruses?
Coronaviruses are a large and diverse group of viruses, many of which
are animal viruses. Before the discovery of the 2019-nCoV, six
coronaviruses were known to infect humans. Four of these (HKU1, NL63,
OC43, and 229E) predominantly cause mild to moderate upper respiratory
illness, and they are thought to be responsible for
10%-30% of colds. They occasionally cause
viral pneumonia and can be detected by some commercial multiplex panels.
Two other coronaviruses have caused outbreaks of severe respiratory
illness in people: SARS, which emerged in Southern China in 2002, and
MERS in the Middle East, in 2012. Unlike SARS, sporadic cases of MERS
continue to occur.
The current outbreak is caused by
2019-nCoV,
a previously unknown beta coronavirus. It is most closely related
(~96%) to a bat virus and shares about 80% sequence homology with SARS
CoV.
Andrew T. Pavia, MD, is the George and Esther Gross Presidential
Professor and chief of the division of pediatric infectious diseases at
the University of Utah School of Medicine. His research interests
include the epidemiology of influenza and other emerging infections,
pneumonia, and vaccine-preventable diseases. He has published more than
250 articles, textbook chapters, reviews, and scientific abstracts.
https://www.medscape.com/viewarticle/924555#vp_1
