This post is for patients feeling ill and thinking about getting checked out by their local doctor during the current Wuhan Coronavirus scare. This is roughly how the initial patient-doctor interaction may look like. The Centers of Disease Control (CDC) has published a flowchart to help community doctors evaluate patients who may have the 2019 Novel Coronavirus (2019-nCoV, COVID-19). The flowchart is as follows:

flowchart from CDC guiding doctors during 2019-nCoV outbreak

Reason for published flowchart:

We (as in citizens of USA) are currently neck-deep in our influenza season. Many of us will come down with “common” viral respiratory infections even though Wuhan Coronavirus is in the forefront of our anxiety. The purpose of the flowchart is to identify patients who have a reasonable chance of being positive for 2019-nCoV, identify them, and isolate them from infecting others.

doctor checking patient for respiratory symptoms

Let’s go through each element of the chart with GreySheepMD:

Section A & B:

2019-nCoV must be contracted from a source, it will not spontaneously infect your body! Only patients who are exposed to the viral source should be considered a “Person Under Investigation for 2019-nCoV” or “PUI” for short. I just want to highlight that a patient must have symptoms of an infection (ie. fever, cough, breathing problems) in addition to 2019-nCoV exposure to be a PUI.

Viruses work by hijacking the host cells to do its bidding. In this case, the “host cells” are the human respiratory (epithelial) cells. The virus inserts its genetic contacts into the host cell (ie. rape) and forces the host cell to produce more viral copies at the expense of the host cell’s own life. These millions/billions of new viral copies then infect the cells next to it, thus spreading damage. It gets carried into your mucous. It makes you cough to aerosolized the  infected mucous, hoping that some of these copies will end up in the body of another human to repeat the infection process again in a new person.

Under a Microscope: virus pathogens surrounding and attacking host cells in vitro

As this viral infection process rages on, your body is also trying to fight against it. Your immune system “ramps up” and kills viruses by the thousands (but there are millions/billions of copies!). This ongoing combat triggers overt symptoms in the body, symptoms such as fevers, feeling ill, cough, and shortness of breath.

Now that we understand the pathophysiology of 2019-nCoV infection, we can understand that only symptomatic patients with exposure to 2019-nCoV are of concern. Asymptomatic individuals are typically not spreading viruses, therefore are of no threat to society. There are these rare cases of one virus or another demonstrating the ability to spread in an asymptomatic individual, but this is the exception and not the rule. Every zombie apocalypses movie I have seen shows viral spread throughout an asymptomatic population, followed by healthy people spontaneously morphing into zombies. Hollywood’s version of viral pathophysiology may be more familiar to us, but it is definitely not how the real world works.

scene of a zombie apocalypse

Section 1, 2 &, 3:

Once a PUI is identified, they are isolated to prevent spread. We know that 2019-nCoV spreads by “close contact.” Close contact, as defined by the CDC, is being within 6 feet of an infected person for over 10 minutes (and without protective equipment). Handling infected bodily fluids without protect equipment also counts as close contact. The isolation strategy is pretty much to avoid close contact whenever possible, and to use protection barriers when close contact is broken. You can use the close contact rule to your benefit in public during this Wuhan Coronavirus scare. Just stay 6-feet or greater away from people in public spaces. Better yet, wear face masks, don’t touch anything, or wash your hands compulsively.

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

CDC Update and Interim Guidance on Outbreak of 2019 Novel Coronavirus (2019-nCoV) – Feburary 1, 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!”