Public Health

2019 novel coronavirus: 6 questions that doctors are asking

The World Health Organization (WHO) recently declared the 2019-nCoV outbreak a public health emergency of international concern. Physicians and other health professionals are working on the front lines of this outbreak, along with public health agencies, to diagnose individuals early to help contain the spread of the virus.

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While the situation has been changing rapidly, public health experts at the Centers for Disease Control and Prevention (CDC) took the time in a recent webinar to address questions from physicians and other health professionals.

At this article’s deadline, the 2019-nCoV has surpassed 17,300 confirmed cases in 24 countries and has killed at least 360 people, according to the WHO. In the U.S., the number of confirmed 2019-nCoV cases was 11, which includes two cases of human-to-human transmission of the virus in this country. Both cases of human-to-human transmission in the U.S. were among close household contacts of travel-associated cases.

JN Learning™ is offering updates on 2019-nCoV diagnosis and treatment, eligible for CME credit.

The 195 Americans who returned from Wuhan by plane and agreed to a 72-hour stay at an air base for monitoring and testing have now been placed under a mandatory 14-day federal quarantine. It is the first time in 50 years that the government has issued such a quarantine. On Friday, the Trump administration also declared 2019-nCoV a public health emergency, saying it would bar foreign nationals who have visited China in the last two weeks from entering the U.S. Other measures will also be imposed on Americans returning from China.

Because little is known so far about 2019-nCoV, there’s no vaccine or specific treatment available and the care is primarily supportive rather than curative. In the meantime, though, the CDC offers interim guidelines for physicians and other health professionals caring for patients with confirmed 2019 novel coronavirus infection.

“Physicians have a critical role to play in not only diagnosing and treating patients during times like this, but also as sources for timely, accurate and evidence-based information as the global medical community responds to this outbreak,” said Jesse M. Ehrenfeld, MD, MPH, chair of the AMA Board of Trustees, in a video released Friday, Jan. 31. “While the CDC anticipates more cases of the novel coronavirus to be discovered in the U.S. in the days ahead, it considers the overall risk to be low.”

Here are six questions that physicians are asking about the novel coronavirus, or 2019-nCoV.

What should I look for?

Patients in the U.S. who meet certain criteria should be evaluated as a patient under investigation (PUI) for 2019-nCoV. This includes those who have a fever or signs of a lower respiratory illness and within 14 days of symptom onset have had close contact with a confirmed 2019-nCoV patient; those who have a fever and signs of a lower respiratory illness and a history of travel from Hubei province within 14 days of symptom onset; and those who have a fever and signs of a lower respiratory illness requiring hospitalization and history of travel from mainland China within 14 days of symptom onset.

It is important to note that not everyone will present with a fever or cough. Patients should be evaluated and cases should be discussed with public health departments on an individual basis. Learn more from the CDC on how to identify and assess the 2019 novel coronavirus.

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How do I protect myself?

It is important to take conservative measures to protect yourself and your patients. While a face mask is standard precaution, patients should also be evaluated in a private room—ideally an airborne infection isolation room—with the door closed.

It is important to use standard, contact and airborne precautions, as well as wearing eye protection, gloves and disposable scrubs before entering the room when caring for a PUI. Learn more about the CDC’s interim infection prevention and control recommendations.

How do I get the state or local health department involved?

In the event of a PUI for 2019-nCoV, notify both infection control personnel at your health care facility and your local or state health department. When a PUI is identified, state or local health departments should immediately contact CDC’s Emergency Operations Center at (770) 488-7100 and complete this form.

The National Association of County and City Health Officials has a directory of local health departments by state or ZIP code.

For now, testing can only be done at the CDC, which has developed a real-time reverse transcription-polymerase chain reaction test that can diagnose 2019-nCoV. However, multiple clinical specimens and all three specimen types—lower respiratory, upper respiratory and serum specimens—should be collected at clinical or public health labs. Learn more about the CDC’s clinical specimen guidelines.

Who has worse outcomes?

Risk factors are not yet clear, says the CDC. However, it appears that older patients and those with underlying medical conditions may be at higher risk for severe complications from 2019-nCoV. Such conditions include type 2 diabetes, hypertension or cardiovascular disease. Learn more from the CDC about the management of patients with confirmed 2019-nCoV.

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Tracking the Wuhan coronavirus: 5 things doctors must know

Can 2019-nCoV be asymptomatically transmitted?

The CDC does not have direct evidence that 2019-nCoV can be transmitted asymptomatically. Physicians in Germany have reported, in a letter to The New England Journal of Medicine, that people showing no symptoms might appear to spread the novel coronavirus. If confirmed, this finding will make it harder to contain 2019-nCoV.

How do I know when to discharge?

This should be a case-by-case discussion, says the CDC. For PUIs or confirmed cases, the CDC continues to recommend isolation, noting that this is not a discharge decision, but a medical one. As more information becomes available, guidance will continue to change. Physicians and other health professionals are encouraged to follow updates on 2019-nCoV from the CDC.

Every doctor should “get informed and understand the risks coronavirus poses to their patients and their unique communities,” the AMA’s Dr. Ehrenfeld said. “The AMA is continuing to monitor this situation, and in partnership with the CDC, will help lead the charge in confronting today’s public health crises.”