The 2019 Novel Coronavirus is now a public health emergency. In this episode of Core IM, the team will discuss the virus, how to diagnose it, as well as management steps. Join us for this episode of Novel Coronavirus: What the Clinician Needs to Know.
Please note that the information presented in this podcast was based on best available information at the time of release. Please refer to your local healthcare agency for the latest information.
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o Coronaviruses cause 10-30% of upper respiratory tract infections
o Coronaviruses have on occasion been transmitted from animal to humans (SARS, MERS, and now likely 2019-nCoV), and then acquired the ability to also be transmitted from humans to other humans
§ Animal-to-human transmission without human-to-human transmission would result in isolated cases without further spread (e.g. avian flu)
o All coronaviruses isolated thus far are spread by droplets
· Current epidemiology:
o Has been reported in all provinces of China
o R0 (measure of how many secondary cases result from a primary case) = ~2
§ Secondary cases: cases acquired from primary cases and not from the animal market where the outbreak started
§ In comparison, measles has an R0 of 12-18 (!)
§ SARS had a similar R0 as the 2019-nCoV
· Presentation of disease:
o Presents with influenza-like illness (ILI), including fever, cough, myalgia and on some occasions, diarrhea
o Bilateral infiltrates are commonly seen on chest imaging
o Lymphopenia as a prominent lab abnormality
o Severe cases may result in ARDS or death
o CDC has a PCR test with 24-48 hr turnaround time
§ The whole genome of the virus is already known and public
§ Specimens to run: nasopharyngeal swab, deep respiratory (sputum, BAL, or tracheal aspirate), serum
§ Of note, the coronavirus on some respiratory viral panels is NOT the 2019-nCoV
o Isolate suspected cases, use airborne and contact precautions along with goggles
§ If calling in from home, instruct to wear mask before coming in
§ Some downsides of widespread large-scale quarantine: panic, inability to get in supplies
o Call the CDC to coordinate collection of samples
o Two drugs on compassionate-use basis: Kalitra (lopinavir/ritonavir), remdesavir
o Not recommended: steroids, interferon, ribavirin
o the WHO activated a specific research and development blueprint for the virus
o WHO had not declared it a public health emergency; factors considered include worldwide impact, including effect on economics, commerce, etc.
§ potentially could affect aid, research funding, etc.
o In comparison, influenza is more of a threat to the US at this point, with 15 million illnesses worldwide, 140000 hospitalizations, 8000 deaths (54 in children)
Shreya Trivedi, MD - Host
Marty Fried, MD - Host
Steve R. Liu, MD - Host
Clem Lee, MD - Host, CME questions, show notes
Christina Fiske, MD -Guest
Davoren Chick, MD, FACP
Tabassum Salam, MD, FACP
Those named above unless otherwise indicated have no relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients.
Release Date: February 4, 2020
Expiration Date: February 4, 2023
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American College of Physicians and the Core IM. The American College of Physicians is accredited by the ACCME to provide continuing medical education for physicians.
The American College of Physicians designates each enduring material (podcast) for 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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