Coronavirus: what providers should know

What is coronavirus?

Coronaviruses is one of a large family of viruses worldwide. Many coronaviruses cause mild upper respiratory infections, but coronaviruses that infect animals can evolve and become a new human coronavirus strain. These can cause more severe illness. The current outbreak, which began in Wuhan, Hubei Province, China, is known as 2019-nCoV and has spread to several other countries, including the U.S.

What can I tell patients who are concerned about coronavirus?

If a patient and their family have not recently traveled internationally, the risk of acquiring 2019-nCoV right now is low, says Dr. Jasjit Singh, a pediatric infectious disease specialist at CHOC Children’s.

“Please remind your patients that at this point in our community, influenza is a more immediate concern,” says Dr. Singh. “We are in the midst of influenza season, and thus far in the U.S., the CDC has reported 15 million cases of influenza, including 8,200 fatalities – 54 of which have been children. Therefore, a good way to avoid a severe respiratory illness is to get the influenza vaccine.”

How can patients and families prevent coronavirus infection?

There is no vaccine for 2019-nCoV. The best way to prevent infection is to avoid exposure in the first place. As of Jan. 27, 2020, The CDC has recommended that people avoid all nonessential travel to China.

What was the source of the 2019-nCoV outbreak?

Public health officials are still working to identify the source of the 2019-nCoV outbreak. Many of the earliest patients infected had links to a large seafood and animal market, suggesting animal-to-person spread. However, recent patients have not had exposure to animal markets, suggesting person-to-person spread is occurring. This can happen via respiratory droplets spread when someone with coronavirus coughs or sneezes.

What are symptoms of coronavirus?

Reported illnesses have ranged from people showing little to no symptoms to severe illness and death. Symptoms of coronavirus can include fever, cough and shortness of breath. Symptoms can appear in as few as two days after exposure to as many as 14 days after exposure.

Currently, diagnostic testing for 2019-nCoV can only be done at the CDC. The respiratory pcr panel at CHOC Children’s (RP-pcr) tests for 4 routine strains of coronavirus and does not pick up this strain.

What should I do if I suspect a patient has contracted coronavirus?

Patients in the U.S. who meet the following criteria should be evaluated as a patient under investigation (PUI) in association with the outbreak of 2019-nCoV in Wuhan City, China:

  1. Fever AND symptoms of lower respiratory illness (e.g., cough, shortness of breath), and in the last 14 days before symptom onset:
    • a history of travel from Wuhan City, China
    • close contact with a person who is under investigation for 2019-nCOV while that person was ill
  2. Fever OR symptoms of lower respiratory illness (e.g., cough, shortness of breath), and in the last 14 days before symptom onset:
    • Close contact with an ill laboratory-confirmed 2019-nCoV patient

If a case of nCoV is suspected, providers should notify infection prevention staff at their facility immediately, as well as local or state health officials.

What precautions should providers take when seeing patients?

Providers who care for patients with respiratory illness should take the following precautions:

  • If caring for patients with respiratory symptoms and fever, obtain a detailed travel history.
  • Continue to evaluate for other common respiratory illnesses currently circulating, such as influenza and RSV.
  • In addition to standard precautions, use Airborne and Contact with an N95 mask, eye protection, gown and gloves.
  • If a provider suspects a patient has contracted nCoV, they should notify both infection prevention at their facility and local or state public health authorities immediately.