March 1, 2020

COVID-19: The Novel Coronavirus 2019

The Novel Coronavirus 2019, was first reported on in Wuhan, China in late December 2019.  The outbreak was declared a public health emergency of international concern in January 2020 and on March 11th, 2020, the outbreak was declared a global pandemic.  The spread of this virus is now global with lots of media attention.  The virus has been named SARS-CoV-2 and the disease it causes has become known as coronavirus disease 2019 (COVID-19).  This new outbreak has been producing lots of hysteria and false truths being spread, however the data surrounding the biology, epidemiology, and clinical characteristics are growing daily, making this a moving target.  This post will serve as a summary of what is currently known, how to screen, when to test, and how to prevent spread of COVID-19.

This post has was getting to big to be useful, so we have broken each section up into its own post for easier use…

COVID-19 Facts

• Betacoronavirus
• Currently there are 7 known coronaviruses known to infect humans
• COVID-19 is in the same family as SARS-CoV and MERS-CoV
• Animal reservoir likely from bats

• Evaluation of 103 SARS-CoV-2 genomes have shown there are two major types of the virus (i.e. COVID-19 is potentially mutating) [Link is HERE]:
  • L Type (70%): More prevalent; More aggressive & spreads more quickly; Often seen in patients in Wuhan China
  • S Type (30%): Less aggressive; Strain spreading in countries outside of China
  • There is a request to retract the paper on subtypes which can be found HERE
• Overall case fatality rate is estimated to be between 0.2%  –  6.6%
• Case fatality rate is estimated to be ≈8% in patients 70 – 79 years of age [1]
• Case fatality rate is estimated to be ≈15% in patients ≥80 years of age [1]
• 80% of mortality cases in patients ≥60 years of age [2]
• Study out of Italy also showed similar numbers with mortality increasing with age[3]:

• Binds with high affinity to the angiotensin-converting enzyme 2 (ACE2) receptor in humans. The ACE2 enzyme is expressed in type II alveolar cells in the lungs
• Severe disease and poor outcomes (i.e. ICU level of care and mortality) currently appear to occur in patients with chronic pulmonary disease, smoking, chronic medical conditions (i.e. hypertension, diabetes, or cardiovascular disease), or advanced age while kids and healthy younger adults seem to have milder courses
  • The reasons for children having milder forms of illness are not clear at this time
  • Preliminary evidence suggests children are just as likely as adults to become infected but are less likely to be symptomatic or develop severe symptoms
  • Our focus should be on patient populations at high risk (i.e. Nursing homes & hospitals)
• Two fact sheets from the CDC Website for the lay public:
  • COVID-19 in general (COVID-19 Fact Sheet)
  • Suspected COVID-19 infection (Suspected COVID-19 Fact Sheet)

COVID-19 Update – March 2020 with Dr. Anthony Fauci, MD from March 6th, 2020 (34:44min)

The Basics (Click on Image to go)

Screening, Testing, PUI, and Returning to Work (Click on Image to go)

Potential Workflows and Telemedicine (Click on Image to go)

Laboratory and Imaging Abnormalities (Click on Image to go)

Thrombosis & Hemoglobin (Click on Image to go)

Neurologic Manifestations (Click on Image to go)

Pediatrics and Pregnancy (Click on Image to go)

Prevention (Click on Image to go)

The Society of Critical Care Medicine/Surviving Sepsis Campaign Guidelines on the Management of Critically Ill Adults with COVID-19 (Click on Image to go)

Cardiovascular Considerations (Click on Image to go)

Airway Management (Click on Image to go)

Clinical-Therapeutic Staging Proposal and Treatment (Click on Image to go)

Critical Care Utilization for COVID-19 Outbreak in Lombardy, Italy (Click on Image to go)

Protecting Our Families and Patient Disposition (Click on Image to go)

Coronavirus Q&A with Anthony Fauci, MD April 8th, 2020 (Video Time 35:30min)

References:

1. Wu Z et al. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72,314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020. PMID: 32091533
2. Yee J et al. Novel coronavirus 2019 (COVID-19): Emergence and Implications for Emergency Care. Infectious Disease 2020. [Link is HERE]
3. Sorbello M et al. The Italian Coronavirus Disease 2019 Outbreak: Recommendations from Clinical Practice. Anaesthesia 2020. [Epub Ahead of Print]

For More Thoughts on This Topic Checkout:

• PulmCrit: COVID-19
• Propofology: #COVID19 Resource Page
• HIPPO EM: COVID-19
• EMRAP: COVID-19 Resources
• EMRAP: CorePendium – Novel Coronavirus 2019 (COVID-19)
• Critical Care Northhampton: COVID-19 – Your One-Stop Resource! 
• Joe Rogan Experience #1439: Michael Osterholm
• Journal Feed: COVID-19 – Coronavirus Deep Dive
• EPMonthly: Debunking Coronavirus Myths vs. Truths
• St. Emlyn’s: 2019 Novel Coronavirus (Wuhan)
• First10EM: COVID-19 Resources
• WHO: Clinical Management of Severe Acute Respiratory Infection When Novel Coronavirus (nCoV) Infection is Suspected
• EMCases: COVID-19 Your Colleagues’ Experiences and Practical Tips
• St. Emlyn’s: COVID19 – Why We Need Evidence Based Medicine (EBM) More Than Ever During a Pandemic
• EMUpdates: A Mass Casualty in Slow Motion – Emergency Medicine During the COVID-19 Surge in New York City

Post Peer Reviewed By: Anand Swaminathan, MD (Twitter: @EMSwami) and Mizuho Morrison, DO (Twitter: mizuhomorrison)

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Salim Rezaie

Emergency Physician at Greater San Antonio Emergency Physicians (GSEP)

Creator & Founder of REBEL EM

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