How the Novel Coronavirus (2019-nCoV) Was First Recognized
Doctors in China’s Hubei Province (Wuhan City) witnessed numerous pneumonia cases on the 31 December 2019 (World Health Organization, 2020). These cases proved to be highly complicated and troublesome since the clinicians and scientists could not match the virus configuration with any of the previously known virus structures. The pathophysiology, etiology, and mode of transmission of the coronaviruses were not initially known to the medical community.
The Chinese healthcare sector tracked a new virus on 7 January 2020 that matched with several virus families related to MERS, SARS, and the common cold. Scientists named this newly diagnosed coronavirus as 2019-nCoV. The Chinese medical community, in coordination with WHO (World Health Organization), initiated the search to understand the specificities of 2019-nCoV in the context of challenging its transmission across the globe.
What Does Coronavirus Do to the Body?
Coronavirus primarily attacks the respiratory system, leading to complications based on disease conditions including SARS-CoV (Severe Acute Respiratory Syndrome) and MERS-CoV (Middle East Respiratory Syndrome).
The commonly reported symptoms of coronavirus include:
- Dyspnea/breathing difficulty
- Flu-like symptoms, including headache, sore throat, and coughing
Physicians are also required to carefully watch for other pneumonia-related symptoms and signs in patients suspected of having a coronavirus infection (American Lung Association, 2020). These symptoms include:
- Weakness or reduced energy
- Chest pain
- Shallow or rapid breathing
- Shaking chills
- Expectoration of blood and/or yellow mucus
- Greenish colored cough
These symptoms could lead to the occurrence of serious debility and/or death if left untreated in clinical settings.
Can Coronavirus Be Treated?
The following are the current treatment standards recommended by the World Health Organization (WHO) for coronavirus infections.
The administration of empiric antibiotics is highly recommended for infected patients based on their reported clinical manifestations (World Health Organization, 2020). Patients suspected of having an infection must receive empiric antibiotics within one hour following the confirmation of sepsis.
The empiric diagnosis must include sepsis or healthcare-associated/community-acquired pneumonia. The animal influenza virus transmission and travel history affirmation of the suspected patients warrant the administration of neuraminidase inhibitors in the health care setting. The de-escalation of empiric therapy is highly recommended based on clinical judgment in the context of animal influenza virus exposure.
Patients affected with shock require supplemental oxygen therapy at the rate of 5 liters per minute following the reporting of shock, hypoxemia, and respiratory distress in the context of severe acute respiratory infection (SARI). The ultimate goal of oxygen therapy is based on acquiring an oxygen saturation level of 90% in the suspected patients (World Health Organization, 2020). However, the administration of oxygen therapy to pregnant women is based on the oxygen saturation level target of 92%-95%.
Fluid resuscitation is the preferred therapeutic option for SARI patients (World Health Organization, 2020). However, since fluid therapy for an extended duration adversely impacts oxygen saturation level, physicians must mechanically ventilate the infected patients following the reporting of respiratory complications.
Systemic Corticosteroids (Only When Necessary and on a Short-Term Basis)
The physicians must not administer systemic corticosteroids to the patients suspected for 2019-nCoV on a routine basis (World Health Organization, 2020). This is because long-term administration of systemic corticosteroids potentially increases the risk for delayed viral clearance, diabetes, psychosis, and avascular necrosis. The utilization of steroids for respiratory management of 2019-nCoV patients should only reciprocate following the affirmation of co-morbid conditions and their clinical complications.
Communication Between Patients, Caretakers, and Other Health Care Professionals
The physicians must actively coordinate with 2019-nCoV patients and their caretakers to acquire information regarding prognosis and co-morbidities in the context of developing holistic person-centered therapies and life-saving treatments (World Health Organization, 2020).
Active Monitoring of the Patient's Condition
The physicians must actively monitor the clinical condition of 2019-nCoV patients in the context of configuring safe supportive therapies based on the reporting of sepsis and progressive respiratory failure (World Health Organization, 2020).
How Can You Protect Yourself?
Preventive Measures for Novel Coronavirus Infection
High compliance with the following safety tips is of paramount importance for reducing the transmission of coronaviruses infections from animals to humans or from diseased patients to healthy individuals (WHO, 2020).
The general preventive measures to challenge coronavirus transmission frequency include the adoption of appropriate hand washing techniques and other hygiene measures. The utilization of protective facial masks is also recommended to reduce the risk of infection transmission after sneezing and coughing.
The appropriate cooking of eggs and meat is also recommended to control the transfer of coronaviruses from animals to healthy people. Most importantly, healthy people must avoid closely contacting with suspected patients or individuals affected by respiratory symptoms of the cold (including sneezing and coughing).
- The avoidance of uncooked or under-cooked animal food is necessary to improve food safety practices. For example, people must refrain from using raw meats or consuming unpasteurized milk. Most importantly, the cooks and food processing professionals must practice caution while managing animal organs to effectively reduce the frequency of cross-contamination. Thorough cooking and appropriate handling of meat products is necessary.
- People should refrain from traveling to coronaviruses outbreak locations.
- Patients infected with fever and cough should not travel to new locations. They should wear gloves and face masks while making direct contact with live animals and/or their products. They should also undertake screening measures to rule out their exposure to the deadly virus.
- The experience of difficulty breathing, cough, and fever by any individual requires prompt reporting to the health care facility. The infected patients must share their travel history with the concerned physician. The occurrence of respiratory symptoms and/or fever during travel also requires prompt reporting to the crew for receiving immediate medical attention.
- Frequent utilization of water, soap, and alcohol-based hand sanitizers are highly recommended for washing hands to reduce the risk of transmission.
- People must wash their hands after sneezing, coughing, and administering care to diseased individuals.
- Washing of hands is also recommended before, during, and after food preparation.
- People should adopt healthy eating habits and must wash their hands before eating and after utilizing urinals or toilets.
- Visible dirt on hands must not be ignored and require cleaning through elevated compliance with hand-washing habits.
- Careful handling of animal waste products is necessary to challenge the frequency of cross-infection.
- Utilization of tissue papers during sneezing and coughing is highly recommended. People must use closed bins for disposal of used tissues.
- People must not spit in public places and utilize toilets and private locations for expectorating their respiratory wastes.
- Professionals at meat shops must utilize different knives and chopping boards for processing cooked food items or raw meat. They must frequently wash their hands while contacting cooked and/or raw food materials.
- People must avoid contacting or eating dead or sick animals.
- People should limit their visits to wet markets and must adopt safe hand hygiene practices while contacting or touching animals or their products.
- People must refrain from contacting the mouth, nose, and eyes of animals in the wet markets. They must not touch spoiled or dead animals and stay away from fluids, waste products, and stray animals.
- Professionals in wet markets must practice caution and use protective equipment and clothing while handling animal products and/or animals. They should also wash their protective coverings at isolated locations each day and must not carry them to their homes. They should avoid exposing family members to work shoes and clothing.
- Professionals at wet markets must regularly disinfect their equipment several times per day.
Other Supportive Measures for the Management of Infection
What Other Steps Should You Consider to Challenge 2019-nCoV (Novel Coronavirus) Transmission?
The health care professionals, home care providers, patients, and family members or caretakers must effectively comply with the following measures for the systematic management of novel coronavirus (2019-nCoV) infection (World Health Organization, 2020).
- The health care professionals and/or caretakers must proactively inform the hospital setting regarding the arrival of the patient infected with respiratory symptoms.
- The diseased patient must wear a protective covering over his/her face while traveling to the health care facility.
- The patient must avoid using public transport while moving to the health care setting for medical attention. The suspected patient should preferably use a private vehicle or ambulance (with opened windows) while traveling to the medical facility.
- The diseased person must practice hand hygiene measures and maintain a distance of at least one meter from other healthy people during travel. Similarly, the caregivers and family members of the patient must also comply with the appropriate hand hygiene measures.
- The surfaces of the vehicle used during transportation of the infected patient require disinfection through a standard bleach solution.
- The infected patient should receive the appropriate ventilation during his/her stay in the hospital setting.
- The caretakers must not frequently visit the patient and only one healthy person should perform the duty of accomplishing the personalized health care requirements.
- The utilization of tightly fitted (disposable) medical masks by the family member or caretaker and health care professionals is highly warranted to reduce the risk of cross-contamination.
- The attending persons must not reuse the facial mask in any condition. They should also comply with hand hygiene measures while handling their masks during patient management.
- The visitors must perform hand hygiene intervention before and after visiting the hospital setting.
- The personal protective equipment, masks, tissues, and gloves require placement in a separately lined container for their disposal or decontamination (as applicable).
- The caretakers must not share bed linen, clothes, towels, drinks, dishes, eating utensils, cigarettes, toothbrushes, and eatables with infected patients. The cleaning of utensils should be performed through water and detergent for their re-use. The selection of a strong detergent is highly recommended for cleaning bed linens, clothes, and towels of the infected patients.
General Information About Coronavirus (2019-nCoV)
An Overview of the Wuhan Coronavirus Outbreak
China’s Wuhan city witnessed pneumonia in many individuals and scientists could not identify its immediate cause and predisposing factors (Hui et al., 2020). However, they epidemiologically correlated the transmission of 2019-nCoV with living animals in the Human Seafood Wholesale Market.
Eventually, the Chinese medical community configured surveillance interventions after recognizing the serious public health threat posed by 2019-nCoV. The novel infection detection strategy for 2019-nCoV is based on the provision of PCR (polymerase chain reaction) tests. WHO has recognized the genome sequence of 2019-nCoV in the context of its high similarity with SARS-CoV. The GenBank sequences of 2019-nCoV are publicly available at NCBI (2020).
How Was It Transferred From Animals to Humans?
The zoonotic nature of coronaviruses facilitates their transmission from animals to healthy individuals. The clinical evaluations have affirmed the transmission of coronaviruses from dromedary camels and civet cats to healthy individuals.
What Are Potential Sources for Viral Transmission?
Individuals exposed to wildlife or farm animals including bats, snakes in the Huanan seafood wholesale market experience an elevated risk of contacting coronaviruses. 2019-nCoV is a recombinant type virus having the configuration of a coronavirus of unknown origin and the bat coronavirus.
The recombinant character of 2019-nCoV is driven by the interaction between cell surface receptor and viral spike glycoprotein. Furthermore, the RSCU bias of the snake makes it an active source of 2019-nCoV. Research findings reveal spike glycoprotein’s homologous recombination pattern as the preliminary cause of coronavirus cross-infection from animals to the human populations (Ji, Wang, Zhao, Zai, & Li, 2020).
What Is the Epidemiology of 2019-nCoV?
The latest WHO report describes 2-14 days incubation period (WHO, 2020). However, the scientific community has not yet determined the duration (after infection) of coronavirus transmission to healthy individuals.
As of 17 February 2020, 71,429 cases of 2019-nCoV have been confirmed so far on a global scale. China has witnessed 70,635 2019-nCoV infected patients with a reported 1,772 deaths from infection.
Additionally, 794 patients have also been diagnosed with 2019-nCoV outside of China in 25 nations, including Japan, the Republic of Korea, Vietnam, Singapore, Australia, Malaysia, Thailand, Nepal, USA, Canada, and France. People traveling from these countries to China has become the sole reason for their contact with the epidemiological link of coronaviruses.
How Is Coronavirus Diagnosed?
The diagnostic interventions for 2019-nCoV detection include the following measures (World Health Organization, 2020).
- Analysis of Respiratory Material: The respiratory assessment reciprocates with the laboratory analysis of endotracheal aspirate or sputum. The specimen analysis from the upper respiratory tract is considered as a weak measure to evaluate the establishment and progression of 2019-nCoV. The development of progressive disease; however, reciprocates with a positive specimen from the lower respiratory tract.
- Serological Testing: Blood serum analysis also helps in affirming the presence of 2019-nCoV in the suspected human host. However, a serum negative finding does not necessarily rule out the occurrence of novel coronavirus infection. The positive finding elevates the risk of co-infection along with the progression of the novel coronavirus. Clinicians recommend repeated testing and sampling for confirming 2019-nCoV infection in suspected cases.
The following specimens are usually collected to investigate respiratory infection in patients with suspected exposure to novel coronavirus.
- Urine sample
- Whole blood sample (for antigen evaluation)
- Convalescent and acute serum samples
- Lung tissue sample through autopsy or biopsy
- Sputum from the lower respiratory tract
- Nasal wash/nasopharyngeal aspirate
- Endotracheal aspirate
- Bronchoalveolar lavage
- Oropharyngeal and nasopharyngeal swabs for viral load assessment
To confirm the diagnosis of coronavirus infection, the recommendation is to perform a PCR assay after acquiring positive findings from the above-mentioned tests. The case definition of 2019-nCoV does not rely on the reported occurrence of comorbid respiratory infection from a conventional respiratory pathogen. The endemic nature of coronaviruses warrants the development of a pan-coronavirus assay for the systematic amplification of virus sequences.
The final confirmation and characterization of coronaviruses require the assessment of non-conserved regions through amplicon sequencing. Some of the other serious variants of coronaviruses recognized through these diagnostic interventions include beta-coronaviruses HCoV-OC43, HCoV-HKU1, HCoV-NL63, and HCoV-229E.
The biosafety measures warrant the utilization of powered air-purifying respirator, eye protectors (face shields/goggles), gloves, full-sleeved gowns, waterproof aprons, and fluid resistant dresses by the laboratory teams to minimize their risk for 2019-nCoV exposure. Furthermore, systematic utilization of decontamination procedures and safe specimen handling interventions is highly needed during sample(s) transport to restrict the transmission of deadly coronaviruses to the healthy population.
Note: Please read my subsequent article to know about Current (Evidence-Based) Opportunities for the Clinical Management of COVID-19.
American Lung Association. (2020). Pneumonia Symptoms and Diagnosis.
Hui, D. S., Azhar, E. I., Madani, T. A., Ntoumi, F., Kock, R., Dar, O., . . . Petersena, E. (2020). The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China. International Journal of Infectious Diseases, 91, 264-266.
Ji, W., Wang, W., Zhao, X., Zai, J., & Li, X. (2020). Homologous recombination within the spike glycoprotein of the newly identified coronavirus may boost cross-species transmission from snake to human. Journal of Medical Virology.
NCBI GenBank. (2020). 2019-nCoV Sequences (Wuhan coronavirus).
World Health Organization. (2020). Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: Interim guidance . Geneva: WHO.
World Health Organization. (2020). Coronavirus disease 2019 (COVID-19): Situation Report—28.
World Health Organization. (2020). Home care for patients with suspected novel coronavirus (nCoV) infection presenting with mild symptoms and management of contacts: Interim guidance. Geneva: WHO .
World Health Organization. (2020). Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases: Interim guidance. Geneva: WHO.
World Health Organization. (2020). Novel Coronavirus.
World Health Organization. (2020). Novel Coronavirus (2019-nCoV). Geneva: World Health Organization.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2020 Dr Khalid Rahman
Dr Khalid Rahman (author) from India on March 07, 2020:
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Monica on March 06, 2020:
what is the process for disposing a body of a person who has passed from coronavirus?
sarahkhalid on February 18, 2020:
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Dr Khalid Rahman (author) from India on February 01, 2020:
Lorna Lamon on January 31, 2020:
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Dr Khalid Rahman (author) from India on January 31, 2020:
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Dr Khalid Rahman (author) from India on January 31, 2020:
Dear Lorna Lamon: You're most welcome.
Lorna Lamon on January 30, 2020:
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