Coronavirus Information for Independent Practitioners
It seems like each year we face a new life-threatening infectious disease that causes panic, uncertainty, and fear. Some may remember previous epidemic and pandemic outbreaks including: influenza in 2009, Polio and Ebola in 2014, and Zika virus in 2016.1 Other noted contaminants that have affected millions include: Cyclosporiasis, E.Coli, Necrotizing Fasciitis, Norovirus, Measles, Mumps, etc. Unfortunately, the newest to make the headlines has been identified as novel Coronavirus 2019-nCoV. According to the Centers for Disease Control and Prevention (CDC), the state of Washington is the first in the United States (U.S.) to confirm a positive case that originated in Wuhan City, Hubei Province, China. Additionally, Illinois (2), Arizona (1), and California (2) have also been identified with confirmed cases within the U.S.3
The CDC has reported more than 7000 confirmed human infections, 26 fatalities, throughout cases in 18 countries.1 The Department of Homeland Security and the Department of Transportation have changed passengers itineraries that are departing from Wuhan City to arrive at major U.S. international airports (JFK, LAX, ORD, ATL, SFO) that have implemented screenings of passengers.2,4 Latest evaluation of possible patients infected include: those with a history of travel from Wuhan City within the last two weeks along with fever and symptoms of lower respiratory illness (cough, shortness of breath), and anyone that has come in close contact with other infected patients.2
According to the World Heath Organization, an outbreak of pneumonia of unknown origin in Wuhan City seemed to be the point of origin. Chinese health officials later identified the patient’s symptoms as a novel virus of the coronaviridae (same family as SARS and MERS) that began within a large open seafood and live animal market. Camels, cats, and bats are known carriers, but which animal was the cause is unknown.1,4 To date, only one doctor from Wuhan has died after treating infected patients, so it seems to suggest a higher transmission of animal-to-person spread rather than person-to-person (through respiratory droplets).2,4,5 Fortunately, so far, there is no evidence of human-to-human transmission outside China.1 The CDC is unclear, at the present time, how 2019-nCoV is being transmitted between humans.4
Healthcare providers in the U.S. are required to obtain a travel history for all patients presenting with a febrile illness according to the CDC.4 One of Veradigm’s Electronic Health Records (EHRs) has issued a login notification that helps remind clinicians to capture this information. In addition, clinicians should notify both their institutional infection control personnel and the local health department if any patients meet the evaluation criteria above. A third clinician recommendation for detecting 2019-nCoV infection is to collect and test multiple clinical specimens from different sites, including all three specimen types (lower respiratory, upper respiratory, and serum specimens). These findings are imperative to help understand the magnitude of how easily or sustainably the virus is spread.4
As a pharmacist, my first thought is always to consider the patients well-being by asking how we eradicate this. Unfortunately, there are no guidelines available, or FDA approved treatment options including vaccines for the 2019-nCoV infection. Beijing’s government did announce they are experimenting treatment with an antiretroviral Lopinavir and Ritonavir.6 The CDC staff are working diligently with authorities in China and Thailand to characterize the spectrum and course of action with the limited information that is available through infected patients.2,4 Isolation, supportive care, and symptoms management is the standard of therapy for the time being. Working in direct patient care, I understand the vast implications of this rapid spreading infection and urge all healthcare associates to use extreme caution by using Personal Protective Equipment (PPE). For the most up-to-date recommendations and updates, I urge readers to visit the CDC website.4
References:
1 https://www.nytimes.com/2020/01/23/health/china-virus-who-emergency.html
2 https://www.pharmacytimes.com/news/cdc-announces-first-us-case-of-novel-coronavirus
4 https://www.empr.com/home/news/first-case-of-coronavirus-outbreak-in-the-united-states/