Novel Coronavirus: Month Two

Nurse Beth, MSN

Month 2 of Coronavirus

The first case was detected in Wuhan City, Hubei Province, China, on December 12, 2019. Today is more than one month into the outbreak, with 56 deaths, 2,000 confirmed cases, and the world watching apprehensively.

The numbers are changing hourly in this rapidly evolving situation. More cases are likely to be identified in the coming days. Sources say another 1,000 cases are expected in Wuhan, the epicenter of the coronavirus outbreak.

Many of us recall the Ebola scare and fear, and before that, the 2003 severe acute respiratory syndrome (SARS). We're on edge because a pandemic could happen. Science fiction movies predicting the end of the world due to fast-spreading deadly diseases strike a chord because it's not outside the realm of possibility. This new virus, the 2019-Novel Coronavirus (2019-nCoV), is one of a large group of coronaviruses that infect animals and the humans who consume the infected animals.

From there, the virus evolves to person-to-person transmission. Some experts are calling for world-wide bans on wildlife trafficking and markets that feature wild and exotic animals for sale, such as anteaters and tortoises, considered delicacies in some regions.

The fact that the 2019-nCoV coronavirus originated in China is not reassuring to many. A memory mistrust of China's willingness to be transparent when the SARS epidemic struck still exists and causes unease along with the knowledge that, virus-wise, the planet is small and we are all easily connected. China kept news about SARS under the radar for the first few months of the outbreak. However, this time they are trying to handle things differently and overcome their lingering negative public image.

Worldwide

Cases have been confirmed in 10 countries including Australia, Canada (presumptive case), France, Japan and several other Asian countries.

The youngest so far is a nine-month-old baby in Bejing. The United States now has 5 confirmed infections- the most recent in California and Arizona. They are all reported as either hospitalized or having received medical attention, and in good condition.

How is it transmitted?

The virus is spread through close human contact (close meaning within 6 feet), though the CDC has not yet confirmed that it's spread through respiratory droplets (as is the flu). The CDC is saying that "transmission dynamics have yet to be determined". The risk assessment is changing daily, and the CDC is closely monitoring the evolving situation.

Similar viruses are transmitted by contact with high-touch objects such as doorknobs and elevator buttons. Touching a contaminated object and then touching one's face, eyes, nose or mouth can lead to infection.

The incubation period is believed to be 10-14 days, but again, information is being updated regularly. A recent announcement is that persons may be contagious before they develop symptoms, meaning the virus spreads far more quickly than previously expected. The "walking infected" make it more difficult to contain the virus and prevent transmission. Scientists say each infected person may infect 2-3 other people.

Prevention and Precautions

Wash your hands often. Use friction and rub all surfaces, including between the fingers.
Avoid crowded places and avoid unnecessary travel, especially to China. Cough etiquette and hand hygiene are the most effective preventative measures.
Healthcare personnel should use standard precautions, eye protection, airborne precautions and contact precautions. Airborne precautions include an N-95 respirator and a negative-pressure room if available.

What are the symptoms?

Symptoms include a fever, cough and shortness of breath, although a fever may not be present in all infected persons. It can lead to pneumonia and death. Some people experience mild symptoms, while others become seriously ill.

Diagnosis

At this time in the U.S., diagnostic testing is only being conducted by the CDC. Cultures are sent to the CDC while the person remains a person under investigation (PUI) until the disease is ruled out. Treatment is supportive.

Chinese Control Measures

Within China, some local governments have mandated the use of masks to be worn in public, but enough masks cannot be manufactured quickly enough to meet the need. A hospital is being constructed in Wuhan to house/quarantine patients.

Cars have been ordered off the streets in Wuhan. Roads are quiet and the town resembles a ghost town with citizens staying off the roads and inside. Reopening of schools and universities has been postponed indefinitely and events cancelled.

The city has imposed bans on citizens leaving the city. Several other cities in Hubei province are under full or partial lockdown. Citizens are worried that there may be shortages, and are trying to stock up on food and supplies. Long-distance buses are banned from Bejing and Shanghai.

Scientists are working around the clock to develop a vaccine. With earlier recognition than took place with SARS, some are predicting a better outcome with fewer deaths. SARS ultimately was responsible for 800 deaths.

Is your hospital or facility putting any plans in place yet? Do you think it's necessary, or is it better to take a wait and see approach?