Uncoating the novel #nCoV #coronavirus - an update

Wow, how quickly things change in the rapidly evolving world of global #publichealth regarding infectious agents and outbreaks. About 10 days ago, I made several quick posts in various social media channels regarding the uptick of pneumonia cases in Wuhan, China. Whew, look at where we are today (1/24/2020)!

A second travel-associated case of the novel coronavirus first seen in Wuhan, China, has been confirmed in the U.S., officials said on Friday. Identified as a Chicago woman in her 60s, she was asymptomatic when she returned home from China on Jan. 13, 2020, after being in China since late December 2019, Illinois health officials said on a phone call with reporters. She started to "feel unwell" a few days after returning home and contacted her health provider, who quickly recognized the potential and sent her to an appropriately equipped hospital. The CDC confirmed that the woman tested positive for novel coronavirus. There are 63 cases being monitored in the U.S. that stretch across 22 states, including the first patient in Washington state and the new case in Illinois, said Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases.

The first confirmed case was the state of Washington. The patient recently returned from Wuhan, China, where an outbreak of pneumonia caused by this novel coronavirus has been ongoing since December 2019. While originally thought to be spreading from animal-to-person, there are growing indications that limited person-to-person spread is happening. It’s unclear how easily this virus is spreading between people.The patient from Washington with confirmed 2019-nCoV infection returned to the United States from Wuhan on January 15, 2020. The patient sought care at a medical facility in the state of Washington, where the patient was treated for the illness. Based on the patient’s travel history and symptoms, healthcare professionals suspected this new coronavirus. A clinical specimen was collected and sent to CDC overnight, where laboratory testing confirmed the diagnosis via CDC’s Real time Reverse Transcription-Polymerase Chain Reaction (rRT-PCR) test.

Welcome to your TGIF morning update on the rapidly evolving #nCov #coronavirus global outbreak. The global community must take proper precautions, based on real-time date & analysis surrounding this #nCoV. At the moment, there's no need to panic - Period. Yes, pay attention & use normal #handhygiene & other Healthcare / PPE precautions. The fatality rate (at this time) appears to be in the range of 2-3% or so...that's around the fatality rate of #flu. Stayed tuned to reputable sources - CDC World Health Organization (WHO) or similar.

WE WILL see continued global expansion of cases. It's expected. We do NOT want to overcrowd Emergency Rooms and other healthcare areas with panic. The "key" concern now would be the following: 1) Patient travel history (did they travel to Wuhan or nearby areas; 2) do they have a fever; 3) do they have lower respiratory illness; 4) proper testing (if needed) to discern from other respiratory illnesses (e.g. flu, RSV, other cold viruses, etc.) 5) If testing confirms virus, then proper care and possible isolation from other immunocompromised populations.

Image courtesy: Jim Wilson, MD FAAP, Health Security Intelligence Expert

The latest WHO situation report (1/23/2020) confirms the following:

• 581 confirmed cases, and 17 deaths (overall mortality rate = 3%). This is a fatality rate which is in the range of influenza (~1.5 - 2.5% depending on sources).
• 571 cases confirmed in China (mainly from Wuhan City, although many other provinces in China now have a small number of cases (see the image below).
• Cases have also been reported from Thailand, Japan, Hong Kong, Taipei Municipality, USA, and the Republic of Korea; these cases all had recent travel history to Wuhan.
• There is now clear evidence of human-to-human transmission, including family clusters without obvious links to Wuhan.
• There have been “few” reports of hospital outbreaks or infections in healthcare workers (this number is variable and changing depending on sources, but it's not a "0")
• The meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) regarding the outbreak of novel coronavirus 2019 in the People’s Republic of China, with exportations currently reported in the Republic of Korea, Japan, Thailand and Singapore, took place January 22-23, 2020.
• Members of the Emergency Committee expressed divergent views on whether this event constitutes a Public Health Emergency of International Concern (PHEIC) or not. At that time, the advice was that the event did not constitute a PHEIC, but the Committee members agreed on the urgency of the situation and suggested that the Committee should be reconvened in a matter of days to examine the situation further.

More updated information can be found via CDC , WHO and PHE.

For most of us in public health, medical laboratory and healthcare, we urge proper precaution WITH perspective. It's important to remember the following:

• A case fatality rate is a dynamically changing number based on the rapidly changing data coming in to calculate it. We now have amazing advanced diagnostics (a GOOD thing) which means we can now diagnose MORE cases. But, this means we are going to have reactive surveillance and investigation because this is a new pathogen. In other words, if you LOOK with a better (more sensitive / specific diagnostic test) tool, you will FIND more cases. Fatality usually lags in cases, so we must be careful with any "solid" facts or statements about fatality rates. With more time and accurate (confirmed positive cases) the data will be more reliable.
• We WILL SEE more cases. More cases are likely to be identified in the coming days, including more cases in the United States. Given what has occurred previously with MERS and SARS, it’s likely that some person-to-person spread will continue to occur. Again, we should Not panic. Coronaviruses are responsible for about 30% of common colds. We should use #handhygiene and common sense healthcare precautions (PPE, possible isolation, increased awareness of travel history, increased healthcare worker protection where appropriate, etc.).
• It's important to remember that any type of "panic" could cause major issues with ER / EDs and other healthcare facilities regarding surge capacity. We do not won't to overwhelm our healthcare facilities and professionals without planning.
• It is expected that further international exportation of cases may appear in any country. Thus, all countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoV infection, and to share full data with WHO.

Lastly, keep in mind how rapidly information (as well as the virus) is being spread. Please, also remember the hundreds (if not thousands) of dedicated public health, medical laboratory, and other healthcare professionals who are doing their very best, often in trying and difficult (sometimes panic mode) situations to take care of you and provide accurate information in an extremely "social media" world. Thank them, and let's remember to support them at all times. Especially, when times are quiet with funding and policy support.

Learn more about my microbial musings and thoughts in my invited Healthcare Hygiene Magazine monthly column "Under the Microscope" as well as my other #MedicalLaboratory and #PublicHealth research interests. #WeSaveLivesEveryday

Dr. Rodney E. Rohde (Twitter: @RodneyRohde & @TXST_CLS) is Professor and Chair of the Clinical Laboratory Science Program (CLS) Program #TXST_CLS, as well as Research Dean in the College of Health Professions at Texas State University. Dr. Rohde serves as Associate Director of the Translational Health Research Initiative at Texas State #TXST_THR and has been named an Honorary Professor of International Studies, a Global Fellow, and a Fellow of the Association of Clinical Scientists.