January 29, 2020in Doctor Resource

The Novel Coronavirus: Update on the Outbreak in China

Last updated: January 29, 2020

The Centers for Disease Control (CDC) asks that people avoid non-essential travel to China. CDC is closely monitoring the novel-coronavirus outbreak that originated in Wuhan City, Hubei, China. On January 7, Chinese authorities confirmed they had identified a new virus, and by January 29, there were 5997 cases and 132 deaths in China attributed to this new coronavirus. Outside of China (includes Hong Kong, Macau, Taiwan), there are 70 confirmed cases with 5 of them in the United States in the states of CA, WA, AZ, and IL.

The World Health Organization (WHO) learned from previous coronavirus outbreaks (Middle-East Respiratory Syndrome and Severe Acute Respiratory Syndrome) that human-to-human transmission occurs through droplets, direct contact, and fomites, suggesting that the transmission method of 2019-nCoV can be similar.

The WHO recommends during this 2019-nCoV outbreak:

  • Avoiding close contact with people suffering from acute respiratory infections
  • Frequent hand-washing, especially after direct contact with ill people or their environment
  • Avoiding unprotected contact with farm or wild animals
  • People with symptoms of acute respiratory infection practicing cough etiquette (maintain distance, cover coughs and sneezes with disposable tissues or clothing, and wash hands).
  • Within healthcare facilities, enhancing standard infection prevention and control practices in hospitals, especially in emergency departments

CDC developed a PCR (polymerase chain reaction) test to diagnose 2019-nCoV, and currently is the only place that can test for the virus in the US. CDC plans to share testing ability in the coming days and weeks.

Patients who should be evaluated for the virus are those with:

  • Fever* AND lower respiratory symptoms (such as cough or difficulty breathing), AND in the 14 days before symptom onset
    • Traveled from Wuhan or anywhere in Hubei province, or
    • Had close contact with an ill person who is under investigation for 2019-nCoV
  • Fever* OR lower respiratory symptoms, AND in the last 14 days before symptom onset had close contact with an ill person who is lab-confirmed positive for 2019-nCoV

*Fever may not be present in some patients such as the very young, the elderly, the immunosuppressed, or those using fever-lowering medications.

To increase the likelihood of detecting 2019-nCoV, CDC recommends collecting three specimens from each patient under investigation (PUI): lower respiratory, upper respiratory, serum. Details on how to collect and ship samples to CDC are at: https://www.cdc.gov/coronavirus/2019-nCoV/guidelines-clinical-specimens.html

Testing for other respiratory pathogens should be done as part of the provider’s clinical evaluation. If a patient tests positive for another pathogen, and depending on the outcome of the provider’s consultation with Public Health, a patient may no longer be considered a PUI.

Home Care guidelines for PUI and for confirmed cases are at: https://www.cdc.gov/coronavirus/2019-ncov/guidance-prevent-spread.html

CDC states that patients confirmed to have 2019-nCoV but are well enough not to need hospitalization can be cared for at home. Likewise, patients under investigation (PUI) who do not need hospitalization can go home. Confirmed and suspected patients should not do activities outside the home, except for getting medical care. They should not go to work, school, or public areas, and should not use public transportation or taxi services.

Close contacts of such patients are to monitor themselves for 14 days after the last contact, and watch themselves for signs of:

  • Fever (check a temperature twice a day)
  • Cough
  • Shortness of breath
  • Other symptoms such as chills, body aches, sore throat, headache, diarrhea, nausea, vomiting, runny nose

A close contact who does not have any symptoms can continue with daily activities such as going to work, school, or other public areas during the 14-day monitoring period.

Robert Kwok

Robert Kwok

Robert Kwok, MD, Director of Health Informatics at HealthTap, is a board-certified physician who practiced medicine for 27 years. He earned his MD and pediatrics credentials at Baylor College of Medicine. Before HealthTap, he practiced clinical pediatrics in Northern California, most recently with Stanford Medicine.