Good morning all! Today on Grand Rounds here at Blogmocracy we are going to discuss a virus emanating from the Arab Peninsula, and no I don’t mean the one that turns men into misogynistic, cowardly, followers of a pedophile and turns women into black clad ghosts. No, today we are discussing Novel Coronavirus (this is the main link for the lecture).
What we are seeing emerge is a new virus that causes severe upper respiratory infections which can easily lead to pneumonia and then possibly death.
Coronaviruses are a large, diverse group of viruses that affect many animal species. A few of these viruses cause a wide range of respiratory illness in humans, typically with “common cold” symptoms. Genetic sequence data indicate that this new virus is a beta-coronavirus similar to bat coronaviruses, but not similar to any other coronavirus previously described in humans, including the coronavirus that caused severe acute respiratory syndrome (SARS) (1). Comparison of viral genetic sequences from the two patients indicated that the two viruses are closely related. Treatment is supportive because no specific therapy has been shown to be effective.
Since the discovery of a novel coronavirus (nCoV) by Dutch researchers in September 2012 in lung tissue from a national from Saudi Arabia who had died from pneumonia, 12 cases of nCoV have now been identified worldwide. The most recent two cases were part of a family cluster in the UK where the index patient had recently travelled to Saudi Arabia and Pakistan. Of the 12 confirmed cases to date, most required intensive care support and six have died.
There are a variety of coronaviruses and these can cause illnesses ranging from a common cold to pneumonia and acute respiratory distress syndrome. In light of the seriousness of the illness caused by this novel coronavirus, it is recommended that probable or confirmed cases should be managed in strict respiratory isolation and that all staff caring for these cases must wear full personal protective equipment (PPE) – FFP3 respirator (staff should be fit tested), goggles, gown and gloves. Anyone who was in close contact with a confirmed case of nCoV while the patient was ill should be followed up – this includes healthcare workers who provided direct clinical or personal care or examination of a case and were not wearing PPE while the patient was symptomatic.
The incubation period is currently considered to be up to ten days and therefore any respiratory illness occurring in the ten days following last contact with a confirmed case of nCoV is considered relevant and close contacts should self- isolate and alert their GP as soon as possible – where the close contacts are healthcare workers this should be there manager/ occupational health service. Symptoms would include fever, cough, or any other respiratory symptoms.
Updates on the current situation can be found on the “What’s new” page. Further information on case investigations and management; including case definitions is available on the Investigation and Management page of the HPA website. The latest changes to the management and investigation algorithms can also be found there. Information on infection control is available on the Guidance and Advice page.
Clinicians who think they may have a patient meeting the above criteria should discuss the case with their local microbiologist or infectious disease physician in the first instance.
Healthcare workers with health concerns or queries should contact their occupational health department.
A: Coronaviruses are common viruses that most people get some time in their life. Human coronaviruses usually cause mild to moderate upper-respiratory tract illnesses.
Coronaviruses are named for the crown-like spikes on their surface. There are three main sub-groupings of coronaviruses, known as alpha, beta and gamma, and a fourth provisionally-assigned new group called delta coronaviruses.
Human coronaviruses were first identified in the mid 1960s. The five coronaviruses that can infect people are: alpha coronaviruses 229E and NL63 and beta coronaviruses OC43, HKU1, and SARS-CoV, the coronavirus that causes severe acute respiratory syndrome.
Coronaviruses may also infect many different animals and cause them to have respiratory, gastrointestinal, liver, and neurologic diseases. Most of these coronaviruses usually infect only one animal species or, at most, a small number of closely related species. However, SARS-CoV can infect people and animals, including monkeys, Himalayan palm civets, raccoon dogs, cats, dogs, and rodents.
CDC continues to work closely with the World Health Organization (WHO) and other partners to better understand the public health risk presented by recently reported cases of infection with a novel coronavirus. As of March 6, 2013, 14 laboratory-confirmed cases have been reported to WHO – seven from Saudi Arabia, two from Qatar, two from Jordan, and three from the United Kingdom. The onset of illness was between April 2012 and February 2013 (1). Among the 14 cases, eight were fatal. Severe acute respiratory infections occurred in 13 of the 14 cases, while one case experienced a mild respiratory illness and fully recovered.
Clusters of cases in Saudi Arabia, Jordan and the United Kingdom are being investigated. The first cluster of two cases, both fatal, occurred near Amman, Jordan, in April 2012. Stored samples from these two cases tested positive retrospectively for the novel coronavirus. This cluster was temporally associated with cases of illness among workers in a hospital (2). A second cluster occurred in October 2012, in Saudi Arabia. Of the four individuals in the household, three were laboratory-confirmed cases, two of them died. In February 2013, a third cluster of three family members was identified in the United Kingdom. All three people tested positive for novel coronavirus. Among them, one family member is receiving treatment, one died, and one recovered after experiencing a mild respiratory illness. This cluster provides evidence of person-to-person transmission of novel coronavirus. It also provides the first example of mild illness being associated with novel coronavirus infection. The efficiency of person-to-person transmission of novel coronavirus is not well characterized but appears to be low, given the small number of confirmed cases since the discovery of the virus.
The reservoir and route of transmission of the novel coronavirus are still being investigated. Genetic sequencing to date has determined the virus is most closely related to coronaviruses detected in bats. CDC is continuing to collaborate with WHO and affected countries to better characterize the epidemiology of novel coronavirus infection in humans.