Many of my patients have expressed concern about news of the outbreak of a novel Coronavirus (2019-nCoV) in Wuhan, China, and the recent confirmation of an infected patient in our neighboring state of Illinois. I am watching these developments closely and am receiving updates and guidance daily from the Indiana State Health Commissioner. To help everyone understand our current knowledge of this infection, I have put together a review of the available literature and resources, from the CDC, Johns Hopkins Department of Infectious Disease, and the Indiana State Department of Health. I will cover what we know of coronaviruses in general, as well as the evolving knowledge base about this novel strain. We will cover how it compares to the flu (influenza), and what we can do to help protect ourselves.
What is a coronavirus? Coronaviruses are a class of virus that includes many you have heard of before: the common cold, various versions of viral bronchitis, as well as two other recent varieties that caused outbreaks in China and Saudi Arabia in recent years, SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome). As in the case of the new 2019-nCOV strain, coronaviruses may be zoonotic (animal) diseases that mutate to be able to infect humans. This strain seems to have originated in a livestock market in Wohan City, China, and initially seemed to have been transmitted from animals to humans. At the beginning of the outbreak, there were questions about whether 2019-nCOV could be transmitted from human to human, but at this time it is clear that human to human transmission is occurring.
How big a risk is the novel coronavirus to people in the US at this time? Though there have been several thousand cases identified at this time in China, as of the date of this article (Jan 29, 2020), there have been only 5 confirmed cases in the United States. The CDC (Centers for Disease Control) has put screening procedures in place at airports for all travelers returning to the US from China. China is also implementing quarantine measures to help reduce the spread of the disease. The greatest number of cases seem to be among household contacts of infected people and health care workers who are exposed in the care of infected patients. Based on this pattern, there is a theory that the virus may require more intensive exposure for transmission than casual contact, however this has not been confirmed at this time. The CDC has developed and made available to state health departments, a viable diagnostic test for the 2019-nCOV virus. It is not currently available in neighborhood primary care offices and clinics, but can be arranged when necessary through the State Health Departments. Because of the low risk of infection in the US at this time, physicians are being advised to arrange for testing only for symptomatic patients who have traveled to China within the incubation period, and symptomatic patients who were in close personal contact with known 2019-nCOV carriers. The mechanism of human to human spread of the novel coronavirus appears to be via respiratory droplets (coughing, sneezing) and its spread can be limited by using appropriate respiratory droplet barriers (masks, gloves, hand washing) when in contact with an infected patient. In the US currently, patients presenting with fever, cough and respiratory symptoms are much more likely to be ill with influenza or the common forms of coronavirus (common cold and bronchitis) that we are accustomed to seeing this time of year. Physicians are being advised to confirm recent travel history with all patients with fever and respiratory symptoms to be pro-active.
How does this outbreak compare with my risk from influenza? At the time of this article posting, China has confirmed approximately 5,974 cases of the 2019-nCOV virus. To put this into perspective, let’s compare this outbreak to our annual influenza (flu) rates. According to CDC data, between October 1, 2019 and Dec 7th 2019, there were 3.7 million cases of the flu, up to 41,000 hospitalizations for influenza and 1,300-3,300 flu related deaths. Have you received your flu vaccine? In the US, we are exponentially more at risk from influenza at this time, than this novel coronavirus outbreak.
How can we protect ourselves?
- Support your overall health with excellent nutrition, adequate rest, good hydration, and manage your stress. These measures help ensure a strong immune system ready to battle any potential infectious exposures.
- Get your flu vaccine! Again, in the US, we are much more likely to see severe illness, hospitalization and death from influenza, than this new coronavirus at this time. Those who receive the flu vaccine give their immune systems a head start against exposures to influenza, which is a much higher risk than the novel coronavirus at this time.
- Wash your hands before eating and after touching public surfaces. Viruses are largely eliminated by thorough 20 second hand washing and if soap and water is not available, the use of alcohol based hand sanitizer solutions.
- If you are sick, stay home!!! Do not expose schoolmates or workmates.
- Avoid eating and drinking after others and sharing water bottles.
- If there is a household contact who is ill, consider the use of respiratory droplet contact protection strategies (keep the used kleenex contained, wipe down surfaces frequently with Clorox wipes or other antiviral cleaner, try to keep the ill person primarily in a private room if possible, consider the use of face mask if you are in close contact for caregiving, wash your hands frequently).
How can I keep up to date as this outbreak evolves? You can check the CDC website page devoted to the 2019-nCOV virus by clicking here. This site is updated daily with the latest, most accurate information available.
Written by: Ann C. Collins, MD
Centers for Disease Control and Prevention Website and Clinician updates
Indiana State Health Department Physician communications
Communication from Paul G. Auwaerter, MD via Medscape Jan, 29,2020. Dr. Auwaerter is Professor of Medicine at the Johns Hopkins University School of Medicine, Clinical Director of the division of Infectious Disease.