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COVID - 19

Coronavirus Disease (COVID-19) is a severe acute respiratory syndrome which was first detected in Wuhan City, Hubei Province, China.

DESCRIPTION
  • Coronavirus Disease 2019 (COVID-19) is a severe acute respiratory syndrome which was first detected in Wuhan City, Hubei Province, China.

  • The disease results from a novel virus, newly named coronavirus 2 (SARS-CoV-2).

  • The syndrome may lead to respiratory failure and death, particularly in elderly and immune-compromised individuals.

EPIDEMIOLOGY
Incidence
  • On January 31, 2020, the United States Secretary of Health and Human Services declared the SARS-CoV-2 virus a U.S. public health emergency.

  • Mortality statistics are reported daily by the World Health Organization (WHO) at https://www.who.int/emergencies/diseases/novel-coronavirus-2019, and more information on the world pandemic can be tracked at https://www.who.int/.

  • Johns Hopkins University Global COVID-19 cases by country: https://coronavirus.jhu.edu/map.html

  • U.S. cases: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-US.html

  • Worldwide crude mortality rate is approximately 4.7%.

  • Pediatric cases of COVID-19 have had milder disease course than adults. This population accounts for 1.7% of all confirmed U.S. cases, with 3 pediatric deaths. Pediatric symptoms include: 73% fever, cough, or shortness of breath. In adults, 93% will have this symptom complex. Hospitalizations in pediatric populations are ~5% vs. ~10% in adults (1).

  • Racial disparities are appearing in the U.S. population based upon data from Chicago and Louisiana, where African Americans account for 70% of the deaths, but only comprise 30% of the population. In Michigan, African Americans comprise 14% of the population but account for ~40% of the deaths, with many of the cases occurring in Detroit where 80% of the population is black.


ETIOLOGY AND PATHOPHYSIOLOGY
  • A novel (new) coronavirus (originally named "2019-nCoV," now officially coronavirus 2 [SARS-CoV-2]) caused the coronavirus disease COVID-19.

  • Related to bat coronaviruses and to other Severe Acute Respiratory Syndrome (SARS) coronaviruses

  • Believed to evolve in animals; some strains of coronaviruses cause illness in people and others primarily infect animals, including camels, cats, and bats

  • Virology: SARS-CoV-2 is a positive-sense single stranded RNA virus (+ssRNA), a betacoronavirus belonging to the same subgenus as the virus responsible for the severe acute respiratory syndrome (SARS) and the virus causing the Middle East respiratory syndrome (MERS). The SARS-CoV-2 virus uses the angiotensin-converting enzyme 2 (ACE-2) receptor for cellular entry.

  • Initial spreading for this novel coronavirus may have been from animal to man via exposure to a large seafood and animal market.

  • For over 95% of infected persons, symptoms appear within 11.5 days. Median incubation time to is about was 5.5 days (2).

  • Retrospective cohort study from Wuhan found the median duration of viral shedding to be 20 days, with the longest shedding at 37 days.

RISK FACTORS
  • Travel from countries of the world or specific regions that are experiencing outbreaks

  • The U.S. State Department issues travel bans and/or advisories as conditions change around the world, and advice can be found at https://travel.state.gov.

  • Can be spread through community contact

  • Spread via respiratory droplets produced when an infected person coughs or sneezes

  • Risk factors for adverse outcomes include age over 70 years, tobacco abuse, cardiovascular disease, cerebrovascular disease, hypertension, diabetes, and chronic pulmonary disease.

GENERAL PREVENTION
  • Hand washing, avoid others if ill, avoid touching face

  • Social distancing: a public health intervention that keeps people and communities at a distance from others so those infected with an illness cannot pass it on to others. Includes keeping six feet apart from others, closing of schools, workplaces, meetings, social and religious gatherings, and sporting events.

  • Wearing surgical masks in public may reduce risk of transmission to others. Experimental data has found surgical and cotton masks allow the SARS-CoV-2 virus to pass through after cough, with the virus concentrated on the outer surface, but there is conflicting data on if masks lower or prevent others from contagion (3,4). N95 respirators were not tested.

  • Use of gloves is not recommended for the general population as it may decrease patient hand hygiene and increase carelessness.

  • A Cochrane recent review found:

    • Hand washing for 20 seconds with soap lowers viral carriage and lowers risk of transmission.

    • Self-quarantine for all with symptoms of fever or new cough until symptoms resolve

    • Quarantine if exposed to confirmed COVID-19 infections reduces infections and deaths compared to no quarantine.

    • Quarantine of returning international travelers from high risk countries to prevent transmission and death has small benefit.

    • Combination of quarantine and prevention methods (sheltering, school and business closures, social distancing) had a greater effect on disease transmission, use of critical care and deaths compared to quarantine alone.



  • Vaccine is not available.

  • In lab evaluation, comparing SARS Corona Virus to COVID-19 found: COVID-19 virus was detectable 72 hours after application to plastic and after 48 hours on stainless steel: on cardboard was less than 24 hours (5).

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