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What Doctors Need To Know About The Coronavirus

JAMA Viewpoint says, Human coronaviruses (HCoVs) have long been considered inconsequential pathogens, causing the “common cold” in otherwise healthy people. However, in the 21st century, 2 highly pathogenic HCoVs—severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)—emerged from animal reservoirs to cause global epidemics with alarming morbidity and mortality. In December 2019, yet another pathogenic HCoV, 2019 novel coronavirus (2019-nCoV), was recognized in Wuhan, China.

According to the American Medical Association, a man hospitalized in Everett, Washington, has been diagnosed with the 2019 novel coronavirus after returning to the U.S. from travels to Wuhan, China. The infectious respiratory disease has already killed 18 people and spread to 9 countries.

Since there is little information about the 2019-nCoV, there’s no vaccine or specific treatment available and the care is primarily supportive rather than curative.

The CDC released criteria to guide evaluation of patients under investigation and recommendations for reporting, testing, and specimen collection.

The CDC clinical criteria for a 2019-nCoV patient under investigation (PUI) have been developed based on what is known about MERS-CoV and SARS-CoV and are subject to change as additional information becomes available.

Health care providers should obtain a detailed travel history for patients being evaluated with fever and acute respiratory illness.

Patients in the United States who meet the following criteria should be evaluated as a PUI in association with the outbreak of 2019-nCoV in Wuhan City, China.

Clinical features and epidemiologic risk
Clinical Features&Epidemiologic Risk
Fever and symptoms of lower respiratory illness (e.g., cough, difficulty breathing)andIn the last 14 days before symptom onset, a history of travel from Wuhan City, China.

– or –

In the last 14 days before symptom onset, close contact with a person who is under investigation for 2019-nCoV while that person was ill.

Fever or symptoms of lower respiratory illness (e.g., cough, difficulty breathing)andIn the last 14 days, close contact with an ill laboratory-confirmed 2019-nCoV patient.

Healthcare providers should immediately notify both infection control personnel at their healthcare facility and their local or state health department in the event of a PUI for 2019-nCoV. State health departments that have identified a PUI should immediately contact CDC’s Emergency Operations Center (EOC) at 770-488-7100 and complete a 2019-nCoV PUI case investigation form available below.

CDC’s EOC will assist local/state health departments to collect, store, and ship specimens appropriately to CDC, including during afterhours or on weekends/holidays. At this time, diagnostic testing for 2019-nCoV can be conducted only at CDC.

Testing for other respiratory pathogens should not delay specimen shipping to CDC. If a PUI tests positive for another respiratory pathogen, after clinical evaluation and consultation with public health authorities, they may no longer be considered a PUI. This may evolve as more information becomes available on possible 2019-nCoV co-infections.

For biosafety reasons, it is not recommended to perform virus isolation in cell culture or initial characterization of viral agents recovered in cultures of specimens from a PUI for 2019-nCoV.

To increase the likelihood of detecting 2019-nCoV infection, CDC recommends collecting and testing multiple clinical specimens from different sites, including all three specimen types—lower respiratory, upper respiratory, and serum specimens. Additional specimen types (e.g., stool, urine) may be collected and stored. Specimens should be collected as soon as possible once a PUI is identified regardless of time of symptom onset.

 

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