Chinese Novel Coronavirus Outbreak 2020: Quick Facts for Practitioners

What You Should Know About the Chinese Coronavirus

Near the end of 2019, a new (novel) coronavirus was identified as the cause of a localized group of pneumonias in the Chinese city of Wuhan.  This new coronavirus has been designated 2019-nCoV, and it seems to be spreading globally with laboratory confirmed cases now being reported in other cities in Asia, as well as Australia, France, Germany, the US, and Canada. 

While coronaviruses are quite common, and are frequently associated with viral respiratory symptoms, this novel virus seems to be a bit more virulent in its presentation, especially in patients who are elderly or have other co-morbid conditions.  While 2019-nCoV has proven to cause significant illness and even death in some patients, it does not yet seem to possess the lethality of other similar betacoronavirus, such as those associated with SARS (Severe Acute Respiratory Syndrome) and MERS (Middle Eastern Respiratory Syndrome).

Spread and Symptoms of Coronavirus

Currently, it appears that the virus is spread by human to human contact, but may initially have had an animal host.  Based on the cases studied in China, it appears that there is an incubation period of up to 14 days from exposure before the onset of symptoms.  Most patients will experience mild, influenza-like symptoms such as fever, cough, malaise, dyspnea, and bilateral pulmonary infiltrates on chest x-ray.  However, up to 20% of the patients with confirmed infection have had severe illnesses that include respiratory failure, multi system organ failure, septic shock, and death.  30% of these patients developed ARDS, 10% required mechanical ventilation.  It should be noted that in the majority of the fatal cases, the patients were of generally older (median age of 49) and had other co-morbid conditions.

Coronavirus Treatment and Prevention

Currently, the CDC recommends considering 2019-nCoV as a causative agent in patients who present with fever, cough, and dyspnea who have traveled to China within the past 14 days, or have been in contact with a patient who either has a confirmed or suspected infection with 2019-nCoV.  Treatment is generally supported, and currently the only testing is by PCR performed by the CDC.  Patients with suspected infection should be isolated using standard, droplet, and contact precautions that include eye protection.  The general community is recommended to perform diligent hand hygiene and respiratory hygiene, and to avoid contact with sick individuals.  Also, any non-essential travel to China should be avoided.

Influenza vs. Coronavirus Symptoms

This virus will be challenging to distinguish from influenza while in peak flu season, and vigilance for lower respiratory symptoms with a travel history would broaden the range of identification. Overall, the death rate as of the time of this publication is 5% for those who have been confirmed to have had the virus, and most of these deaths are located in the Wuhan area of China.   There are currently 5 confirmed cases in the United States.  Overall, by comparison, the influenza outbreak has a higher mortality than this version of coronavirus, and as more exposures are identified, this number may change. 

For further information on the current WHO and CDC recommendations, see the links below.

• World Health Organization
• Center for Disease Control – guidance for healthcare practitioners
• Center for Disease Control – infection control and prevention