A Novel Coronavirus Challenges China

Since news broke of a pneumonia outbreak with unknown origin in Wuhan, China, there has been increased concern and speculation in the media. Several individuals quickly drew comparisons to the SARS-CoV outbreak in 2003. As there have been several rapid developments, there is a lot to catch up on regarding this new outbreak.

Late last week, investigators identified the causative agent of the outbreak as a new coronavirus. Coronaviruses have also been responsible for the emergence of both SARS-CoV and MERS-CoV.

Recently, the Chinese public health authorities announced that the previously announced 59 cases have been scaled back to 41 cases. The first death has been labeled as a result of the novel Coronavirus (nCoV), for which a name has not been established yet. Health officials have also released more information, including the genetic data, on nCoV. The release of the genome can be found here, which was provided by the Shanghai Public Health Clinical Center & School of Public Health.

On Friday, the World Health Organization (WHO) released an update on the situation, which discussed the clinical signs and symptoms. The authors of the report described the symptoms of the infection as “fever, with a few patients having difficulty in breathing, and chest radiographs showing bilateral lung infiltrates.”

The situation report also noted that some patients were working in the Huanan Seafood Market but that based on the current information and investigations, there has been no significant human-to-human transmission. Furthermore, there have been no infections among health care workers. Based on the transmission of SARS-CoV in Toronto hospitals, this is welcome news.

The source of the virus is still unknown and the investigations and research into this novel strain are ongoing, which means response efforts will likely be evolving. Interestingly, supplies of N95 masks have been running low in Hong Kong, as panic around the outbreak sparked marked-up prices.

Preparedness

In response to the outbreak of nCoV, the WHO has released guidance for international travelers. Beyond practicing the usual precautions, the agency encourages travelers to or from the Wuhan City area to avoid close contact with people suffering from acute respiratory infections, engage in frequent hand hygiene procedures, and avoid close contact with live or dead farm or wild animals. The agency also recommends that travelers with symptoms of an acute respiratory infection should practice cough etiquette. At this time, no travel restrictions have been recommended. Further WHO information, such as their statements and guidance for testing and infection control can be found here.

The US Centers for Disease Control and Prevention (CDC) also released a situation report, including a risk assessment and what the CDC response entails (monitoring, establishing an Incident Management Structure, and more).

Realistically, this also means that clinicians in US health care facilities should ask patients of their recent international travel history. Should a patient have recent travel from the afflicted area and relevant symptoms, communication to the local public health department and implementation of airborne isolation precautions is critical.

This is an ideal time to re-educate frontline staff in emergency departments and urgent cares about the importance of the i³approach, which entails identify, isolate, and inform. Awareness of the situation, but also the understanding of how to proceed if patients should present in their health care environment, is important.

Since there has been a lack of significant transmission between people, reminding staff of triage travel-screening questions and isolation precautions is an important lesson that applies to diseases beyond this nCoV outbreak.

Remember, encourage staff to put a surgical mask on the patient and then place the individual in a negative pressure room while utilizing airborne isolation precautions. Communication with infection prevention and the local health department can help facilitate case review and risk assessments.

As more information comes from epidemiological investigations, guidance will likely evolve, but the lack of significant transmission between people is a good sign.