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Posted By: Susanne J. Phillips, DNP, APRN, FNP-BC
February 04, 2020
On Thursday, January 23, 2020, Chinese authorities closed Wuhan's airports, train stations, bus stations, and ports. By now, several other cities in China have followed suit as the government attempts to control the outbreak of a novel coronavirus (2019-nCoV). If you work in emergency care, infectious disease, urgent care, or student health, you have likely brushed up on Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus (SARS-CoV), as standing policies frequently require initial screening for all patients presenting with respiratory complaints. China is currently struggling to contain 2019-nCoV; as of this writing, it has been reported that more than 20,000 people in China have been infected, and more than 400 have died. To date, cases have now been reported in more than 22 other countries, including Thailand, Japan, the Republic of Korea, and the United States. The first US-confirmed case was identified in Everett, Washington. Unfortunately, there have now been multiple confirmed cases in the US. This post will provide primary care providers with a "coronavirus refresher," with a discussion of the CDC's recommendations for management and reporting to follow in the next post.
Human coronavirus can cause a community-acquired upper respiratory tract infection in both adults and children; certain coronaviruses may also cause diarrhea in infants and children—a topic for another blog. Transmission of respiratory coronaviruses is similar to that of rhinoviruses—via direct contact with infected secretions or large aerosol droplets. The novel coronavirus identified in Wuhan at the end of 2019 initially caused a cluster of pneumonia cases, with several cases reported in other areas in China, including Beijing.
Clinicians should consider coronavirus in patients with fever and/or lower respiratory tract symptoms who have recently traveled to the Wuhan area or have had close contact with a confirmed or suspected case of 2019-nCoV. Symptoms typically present similarly to those of rhinoviruses, with upper respiratory symptoms such as nasal congestion and rhinorrhea. At this time, reverse-transcriptase polymerase chain reaction (RT-PCR) and immunofluorescence antigen detection assays can detect coronaviruses from nasopharyngeal samples.
The World Health Organization has published guidance documents for all countries, including recommendations on surveillance and monitoring, laboratory testing, clinical management, infection control, and communication. Additional information, including on coronavirus epidemiology, can be found on the World Health Organization website.
In this week's next post: CDC coronavirus recommendations and further guidance for healthcare professionals.
- Gaunt ER, Hardie A, Claas EC, et al. Epidemiology and clinical presentations of the four human coronaviruses 229E, HKU1, NL63, and OC43 detected over 3 years using a novel multiplex real-time PCE method. J Clin Microbiol. 2010;48:2940-2947.
- World Health Organization. Coronavirus. www.who.int/health-topics/coronavirus. Accessed January 24, 2020.