Los Angeles Count Public Health Poster for 2019-nCoV
Los Angeles County Public Health Poster for 2019-nCoV

Background Context

The new respiratory illness originating from Wuhan City, China is caused by a virus, currently named “COVID-19” (AKA “ 2019-nCoV,”) short for “2019 novel coronavirus.” 2019-nCoV is a single pathogenic viral strain from an animal to human transmission – meaning that this animal virus developed a mutation that allowed it to infect humans. From the perspective of our human bodies, the novelty of the virus makes it difficult to combat. This allows it to grow, spread, damage, and infect much more aggressively than the common viruses living among us. 

Artist Rendition of Viruses
Artist Rendition of How Viruses Look Like

Did you know that it is unclear how effective the virus spreads from human-to-human?

Spreading of 2019-nCoV among humans is likely to occur through respiratory droplets, i.e. cough/sneeze from an infected person. However, different viruses spread with varying effectiveness. Measles and seasonal influenza is highly contagious. 2019-nCoV is thought to be less infectious than SARS (2002 outbreak). The virus continues to mutate as it infects humans, and another mutation that allows for more effective human-to-human spreading is possible. No cases of human-to-human transmission has been documented in the United States but it is expected to happen. The CDC still considers this outbreak as a very serious public health threat. However, the immediate health risk to the general American public is considered “low.” I just love conflicting messages from centralized governmental entities, don’t you? 

Ex. of Respiratory Droplets

What are the symptoms of a person infected with 2019-nCoV?

Typical symptoms include fever, cough, and shortness of breath. Illnesses can range from “little-to-no symptoms” all the way to “severely ill.” Keep in mind that these symptoms are consistent with every other common acute viral respiratory illness. On top of that, we are currently in an active flu season. So if you develop these generic symptoms of a viral infection, don’t assume its 2019-nCoV off the bat! (Unless you happened to travel to Wuhan China, then you should take it very seriously!) 

Respiratory Droplets from Coughing Spreads Most Respiratory Viruses, including 2019-nCoV

Current Situation as of January 27, 2020

The first cases of 2019-nCoV (1 in LA County and 1 in Orange County) have been confirmed in travelers from Wuhan city, China. These two patients appear to be unrelated and did not have contact with each other. Both individuals presented to their local hospitals after feeling unwell. One other patient was detected in the State of Washington earlier this month.

Wuhan City, China

How do doctors approach patients with 2019-nCoV?

Doctors are asked to identify patients who have clinical symptoms of a respiratory infection along with specific exposure to possible 2019-nCoV. So for example: 

  1. a patient must have a history of travel form Wuhan City, or 
  2. in close contact with a person who is under investigation for 2019-nCoV, or 
  3. in close contact with a laboratory-confirmed 2019-nCoV patient… 

…in addition to clinical symptoms of the infection. Doctors are expected to report such patients to a department called the “Acute Communicable Disease Control” immediately. Once reported, the doctor/hospital will have access to expedited testing capabilities that can confirm 2019-nCoV quickly.

To confirm the coronavirus infections, doctors need to collect and submit patient fluid samples for laboratory analysis. For upper respiratory tract specimens, a swab can be used to collect mucus from the nasopharyngeal (in the nose) space and oropharyngeal space (back of the mouth). Interestingly, the CDC requests specifically that only plastic shafted swabs be used and avoid the wooden shaft swabs. For lower respiratory tract specimens (i.e. fluid that comes from deeper inside the lung), doctors can collect sputum via coughing or do a bronchoalveolar lavage. A bronchoalveolar lavage is a more complicated procedure that involves a tiny fiber-optic camera inserted through their nose and into their lungs to withdraw specimen directly. 

Laboratory Analysis of Human Samples

How is 2019-nCoV treated in an infected person?

To my knowledge, there is no direct antiviral treatment for this pathogen at this time. This disease is treated like most other viral respiratory diseases with a medical strategy called “supportive care.” In supportive care, we let the viral infection run its course under medical supervision, ultimately allowing the immune system to cure the disease. Meanwhile, secondary symptoms are treated medically to minimize bodily damage. Keep in mind that supportive care is not the same as sitting at home and doing nothing! One other advantage to be treated by a hospital is to allow for proper quarantine of this novel infection. Once an effective antiviral is developed, it will likely be used first on severely ill cases.

How are 2019-nCoV patients separated from other hospital patients and staff?

The CDC recommends any patient under investigation for 2019-nCoV to be placed in a private room with a closed door. Ideally, “airborne isolation rooms” are used, which is simply a hospital room with negative air pressure. Air is sucked into the room when the door is opened; therefore, limiting the risk of an airborne leak outside the isolated room. This is an expensive type of setup, so the availability of such a room is limited. Realistically, any private room with a closed-door should do so long as infection precautions are used. The patient is asked to wear a surgical mask at all times to minimize respiratory droplet emission. The healthcare staff wears a disposable gown, gloves, face mask, and eye protection when caring for the patient. All American healthcare staff are trained in these protocols.

CDC says to Hospitals: “Close them doors!”

Concluding thoughts.

2019-nCoV is a new coronavirus that can hit a patient hard. In China, about 21% of cases have “severely ill” symptoms, and 3% of infected have died as a result. Patients who have died have underlying health conditions and tend to be older. The human-to-human transmission of this disease is thought to be significantly less than of SARS. We are in a flu season, where common respiratory viruses are already spreading in our population. The symptoms of these common viral infections are mostly exactly the same as 2019-nCoV. Individuals travelling from Wuhan, China, or those who are in close contact with these travelers, should be on high alert for this transmission of 2019-nCoV. Please alert healthcare professionals with the onset of general symptoms for their own protection, the protection of their immediate family, and as a duty to society. 

Remember your Duty to Society!

  • Cover your mouth when coughing or sneezing at ALL times, but especially in public. 
  • Not covering your mouth too hard of a habit to break? Here’s a hot tip, pretend that you are a protester in Hong Kong and just wear a face mask at all times. 
  • Stay at home if you are feeling ill
  • Report suspected 2019-nCoV cases to a medical professional. You can potentially save a stranger’s life by doing so.

This post was written from my experiences as a licensed medical doctor in California in addition to the following resources: 

LAC DPH Health Advisory – January 26, 2020

World Health Organization Interim Guidance -January 25, 2020

Center for disease Control and Prevention (updated January 26, 2020)

GreySheepMD’s promotional section:

  • Balaclavas– Unisex fashion accessories that act as a face mask to protect yourself from microscopic mucous droplets in a public space. We know 2019-nCoV spread by respiratory droplets. Asian citizens wear medical masks everywhere they go to protect themselves, but this is not the norm in ‘Merica! We can still protect ourselves, and at the same time not look like a total anxious nutcase in public, by wearing these breathable balaclavas. 
  • Kid’s face mask – these have cute designs on them that makes small children more agreeable to put them on. We bought this for our daughter because the in-laws would kill me if our child contract 2019-nCoV.

If you do support me by making a purchase through these links, I would like to make eye contact with you and say “thank you!”