Coronavirus -Update

22nd January 2020

9th February 2020 12.00hr GMT

The outbreak of the novel Coronavirus, named 2019-nCOV by The World Health Organisation, also known as Wuhan Coronavirus, Wuhan flu, Wuhan seafood market pneumonia virus and Wuhan pneumonia has now been confirmed to be transmitted from human to human. The information from China appears to be significantly controlled and managed. The virus outbreak now meets the definition of a Pandemic as defined by the WHO.
Many governments are now putting in restrictions to travellers from China as this is where the majority of cases are currently present.

What are Coronaviruses?
Coronaviruses were first detected in the 1960’s in patients with symptoms of the common cold. There are 3-4 sub-families of the coronaviruses including SARS (severe acute respiratory syndrome). SARS is about 90% similar to the current coronavirus at the DNA level. The virus is likely to have originated in bats.
This outbreak appears to have arisen in a market where animals were illegally traded. This incudes bats.

Incubation is between 1-14 days from contact to the development of symptoms. Clearly this will create a problem with spread of the virus into new territories as infected individuals can appear well once they are infected.

Symptoms are very similar to the common cold with fever, sore throat and swollen lymph glands. They can also cause pneumonia either direct viral pneumonia or secondary bacterial pneumonia.

Treatment is supportive. There are no specific treatments for the coronaviruses but treatment options using current anti-viral medications are being explored.

Clinical characteristics
Chen et al published data (www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30211-7/fulltext) on 99 patients with a confirmed diagnosis of Coronavirus infection treated in Wuhan Jinyintan Hospital from 1st January to 20th January 2020. This cohort of data gives us significant insight into how we might expect the virus to behave as cases increase in The United Kingdom.

The study showed that the patients manifested with the following clinical features

The predominant features are therefore Fever, Cough and Shortness of Breath

Clinical investigations included diagnosis using real time RT-PCR of sputum or endotracheal aspirates. X-ray investigations revealed the following:
On admission, blood tests showed neutrophils above the normal range in 38% and raised leucocytes in 24% of patient’s. Albumin was decreased in 98% of patients.LDH was moderately increased in 76% (mean = 336.0). CRP and ESR were increased in 86% and 85% respectively. The absolute value of lymphocytes were reduced in most patients.

The mortality rate in this cohort of patients was 11%.

There were more men than women affected in this study and half of the pateints had underlying diseases mainly cardiovascular, cerebrovascular and diabetes. Some patients progressed rapidly with ARDS, septic shock and multi-organ failure.
These workers recommend the use of Intravenous immunoglobulin in Severly ill patients and steroids in those with ARDS.
This study suggests that Coronavirus is more likely to infect older men with comorbidities but note that there are cases in the paediatric population including a 10 day old baby being infected.

In order to reduce the impact of this virus and lessen the chance of spread we need people who develop respiratory symptoms (ie Flu like symptoms) to take measures that will reduce the chance of spreading the virus to others. The NHS 111 service will help to direct you to make the right decision for patients who might be infected.
This pandemic is likely to significantly stretch NHS services.

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