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Novel Coronavirus: What the Clinician Needs to Know Interview

STEP 1: Listen to the podcast

STEP 2 (Members Only): Take the CME/MOC Quiz

Show Notes

·         Background:

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)

§  Both SARS and MERS are thought to have originated from bats, then spread through civets and camels, respectively, to humans

o    All coronaviruses isolated thus far are spread by droplets

o    The “corona” in coronavirus refers to the S spike on the virion

·         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

·         Diagnosis:

o    Compatible symptoms along with travel to China or other cases

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

·         Management:

o    Isolate suspected cases, use airborne and contact precautions along with goggles

§  If calling in from home, instruct to wear mask before coming in

§  Can potentially discharge/keep home with home isolation

§  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

§  In the works: monoclonal antibodies developed during the SARS epidemic, vaccine against the S protein (could be in phase 1 trials in as soon as 3 months)

o    Not recommended: steroids, interferon, ribavirin

o    the WHO activated a specific research and development blueprint for the virus

·         Impact:

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)

Disclosures

Contributors

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

Reviewers

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

CME Credit

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.

ABIM Maintenance of Certification (MOC) Points

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.5 medical knowledge MOC Point in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program.  Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

How to Claim CME Credit and MOC Points

After listening to the podcast, complete a brief multiple-choice question quiz. To claim CME credit and MOC points you must achieve a minimum passing score of 66%. You may take the quiz multiple times to achieve a passing score.

 

About Core IM

Welcome to Core IM, a virtual medical community! Core IM strives to empower its colleagues of all levels and backgrounds with clinically applicable information as well as inspire curiosity and critical thinking. Core IM promotes its mission through podcasts and other multimodal dialogues. ACP has teamed up with Core IM to offer continuing medical education, available exclusively to ACP members by completing the CME/MOC quiz.


Details

CME/MOC:

Up to 0.5 AMA PRA Category 1 Credits ™ and MOC Points
Expires February 4, 2023   active

Cost:

Free to Members

Format:

Podcasts and Audio Content

Product:

Core IM