2019-nCoV AKA COVID-19, AKA Wuhan Coronavirus

Context

We all know the symptoms of the new Wuhan Coronavirus respiratory infection: fever, cough, shortness of breath. We know that the virus can cause severe illness, including death – but this is typically only seen in older individuals with other serious medical problems. Most humans infected with the coronavirus will have mild-to-moderate symptoms. These symptoms will be identical to the other common respiratory viruses we are already used to, ie. Feeling ill, fatigue, cough, mucus, runny nose, fevers, low appetite, grouchiness. When a reasonably healthy patient with 2019-nCoV seeks medical care from a doctor, they will most likely get their medical treatment at home!

 
face-masks are a good way to protect yourself from 2019-nCoV

Patients investigated for 2019-nCoV are called PUI!

PUI = person under investigation, a term used by the CDC. For a patient to be a PUI, they must be sick AND have some exposure to Hubei Province or in proximity to someone who actually has 2019-nCoV. This is a concept that I find a lot of people do not understand, so please allow me to administer this POP QUIZ:

  • Quiz #1: If your co-worker returns from her vacation in Hubei Province, is she a PUI? Should you avoid her like how one avoids AIDs?
  • Quiz #2: If your co-work returns to work with a new cough, runny nose, and mucus production, is he a PUI? Should the whole office be closed down and quarantined?

(Answers to pop quiz at the end of the post)

 
workplaces are less fun with 2019-nCoV anxiety

What exactly is the treatment plan for a 2019-nCoV infected person?

There is no magic pill to cure a person of 2019-nCoV. Like most other human viral infections, the typical treatment plan is called “supportive care.” Supportive care is a strategy of patience. Over time, the virus and the patient’s body fight it out. Over a few days to weeks, our immune system typically win out. Symptoms can be treated with medications, ie, fevers, and cough with their respective over the counter drugs. People recover from other human viral infections without medical intervention all the time, so 2019-nCoV is no different in that regard. The main difference is that the Wuhan Virus is novel and that we as a society should strictly limit its spread; therefore, identifying the specific virus in a person and implementing an isolation plan is critical.

 
this is how an actual person recovering from 2019-nCoV looks like

                        Who get to sleepover at the hospital, and which have to sleep at home?

Doctors use criteria to determine who gets a higher level of care at the hospital to preserve the resource of limited hospital beds. PUI who are unstable, meaning that their blood pressure is severely abnormal, their fevers are not controlled, and/or their breathing is too difficult, will meet admission criteria and get admitted into the hospital. Sometimes a PUI who is not-that-sick gets a hospital bed anyways. Unfair, but why? Because that patient, for whatever reason, cannot be adequately cared for at their place of residence. Examples of this include lack of caregiver, lack of space to quarantine self, or has a potential high-risk patient at home, such as a newborn or older person.

 
cover thy mouth when coughing or sneezing!

Which 2019-nCoV PUI are typically sent home for supportive care?

Ideal patients for treatment at home have several qualities. Clinically, the patient must have mild enough symptoms and expected to recover successfully at home.  Such a patient should be strong enough to care for self; or, at least, have a reliable caregiver who can help with tasks of daily living. The home should have a separate bedroom to isolate the 2019-nCoV person. The household members should have access to protective equipment (ie, masks, gloves). Lastly, the household should not have members who are at high risk of dying from 2019-nCoV. As we have established, high-risk individuals are typically older, or very young, or pregnant, or have some kind of compromised immune system.

The CDC reports that as of 1/31/2020, there is only one case of human to human infection transmission of the virus in the USA. In that one case, the spread of the virus was between husband and wife. The spread was because of close contact, and the CDC defines “close contact” as being within 6 feet of a person with 2019-nCoV for 10 minutes or more. Fun thought, can you imagine a zombie apocalypse movie that has a the zombie virus spreading only through “close contact”? 

 
Woman from Wuhan with 2019-nCoV properly isolated in a room from other family members

How should I care for my family member who is being treated at home for 2019-nCoV?

My advice (and that of the CDC) is the keep the “close contact” in mind, and do all you can to avoid falling into that definition. Put the infected person in their own room, and close the door whenever possible. Use protective barriers like gloves and face mask. Do not share items with the infected. Wash hands frequently, clean counter-tops and furniture regularly. Don’t even speak or make eye contact to the infected. (I’m just kidding with that last one, the virus will not spread via conversation)

Answers to POP QUIZ: no and no, but I’m sure you already know that.

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

CDC “Clinician Outreach and Communication activity” (COCA) teleconference on January 31, 2020

CDC Implementing Home Care (updated January 31, 2020)

LAC DPH Telebriefing for Health Care Provider on January 30, 2020

GreySheepMD’s promotional section:

Writing these blog articles take up way more time that I have expected! I decided to add this promotional section to monetize some my efforts… mainly to give my wife some justification as to why I’m spending so much of “personal free-time” working on this blogging project.  I thought that it will be helpful to the reader to list a few relevant product suggestions that I have personal experience with. For those who are not familiar with how monetization works: I’ll be listing some products that I recommend, and if my reader clicks on the link and makes a purchase, I will be credit with a portion (a very small portion) of the sale. 

  • 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. 

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!”