2019 Novel Coronavirus—Important Information for Clinicians

Coronavirus Resource Center

Only about 2% of those infected die of it.  My rubrics below -- JR

In early December 2019 a patient was diagnosed with an unusual pneumonia in the city of Wuhan, China. By December 31 the World Health Organization (WHO) regional office in Beijing had received notification of a cluster of patients with pneumonia of unknown cause from the same city.1 Wuhan, the capital city of Hubei Province in central China, is the nation’s seventh largest city, with a population of 11 million people. Over the next few days, researchers at the Wuhan Institute of Virology performed metagenomics analysis using next-generation sequencing from a sample collected from a bronchoalveolar lavage and identified a novel coronavirus as the potential etiology. They called it novel coronavirus 2019 (nCoV-2019).2 The US Centers for Disease Control and Prevention (CDC) refers to it as 2019 novel coronavirus (2019-nCoV).3

As of February 4, 2020, more than 20 000 cases of 2019-nCoV have been reported, 98.9% of them in China, and the outbreak is linked to more than 400 deaths. As the epidemic is evolving and the situation is rapidly changing, up-to-date reliable information on the number of cases and recommendations on management of cases and preventive interventions can be found at various sites, including the webpage developed by the CDC.3 Currently the number of infections outside of China remains small (approximately 180), but cases have been detected in 26 countries, including 11 cases in the United States.

While it is unclear how many people are truly infected, a modeling study suggests that as of January 25, 2020, 75 815 individuals have been infected in Wuhan alone.4 The authors calculated the basic reproductive number (the number of cases one infected individual generates), R0, of this outbreak to be 2.68 (95% CI, 2.47-2.86) and that the epidemic is doubling every 6.4 days. Because of extensive travel between China and cities like Bangkok, Hong Kong, Singapore, Tokyo, and Taipei, these locations have identified the majority of cases outside of mainland China. As testing becomes more frequent, the true number of cases and the full spectrum of disease will become more clear. However, for now, it appears that compared with the other 2 zoonotic coronaviruses that occurred in the last 20 years (severe acute respiratory syndrome [SARS] in 2002 and Middle East respiratory syndrome [MERS] in 2012), 2019-nCoV seems to have greater infectivity (eg, a higher R0) and a lower case fatality rate.1

From genetic sequencing data, it appears that there was a single introduction into humans followed by human-to-human spread. This novel virus shares 79.5% of genetic sequence with SARS-CoV and has 96.2% homology to a bat coronavirus.2 In addition, 2019-nCoV shares the same cell entry receptor, ACE2, with SARS-CoV. What is yet unclear is which animal is the intermediate species between bats and humans. For SARS it was civet cats, for MERS it is camels. While the source of 2019-CoV is yet unknown, early on the Huanan Seafood Wholesale Market was linked epidemiologically.1,5

The incubation period of this virus has been reported to be 5.2 days (95% CI, 4.1-7.0),6 although there is suggestion that it may be as long as 14 days. It is unclear when transmission begins and, although cases have been reported that suggest transmission during the asymptomatic phase, it is likely that the majority of secondary cases come from symptomatic individuals.

The clinical syndrome is nonspecific and characterized by fever and dry cough in the majority of patients, with about a third experiencing shortness of breath. Some patients have other symptoms such as myalgias, headache, sore throat, and diarrhea. The median age of patients is between 49 and 56 years.7,8 Cases in children have been rare. Although most cases appear to be mild, all patients admitted to the hospital have pneumonia with infiltrates on chest x-ray and ground glass opacities on chest computed tomography.8,9 About a third of patients subsequently developed acute respiratory distress syndrome and required care in the intensive care unit. This is particularly true for patients with comorbid conditions such as diabetes or hypertension.

When a patient presents with fever and respiratory symptoms (in particular a dry cough), clinicians should obtain a detailed travel history. If the patient has a history of travel to Hubei Province in the last 14 days, they should be considered a person under investigation (PUI)

There is little value to wearing a regular face mask absent a high probability of being exposed to coronavirus, but when there is a high degree of suspicion that a patient might have 2019-nCoV, they should have a face mask placed immediately and health care practitioners should wear N95 respirators.

To date, the management of infection has been largely supportive. Lopinavir/ritonavir is being investigated (Chinese clinical trial registry identifier: ChiCTR2000029308) based on previous studies suggesting possible clinical benefit in SARS and MERS. In addition, remdesivir, available through compassionate use, has also been tried and this latter antiviral was used in the first US patient identified.

In response to the outbreak, on January 23, 2020, Chinese authorities suspended travel in and out of Wuhan.10 Similar travel bans followed in other cities in Hubei Province, and in total close to 50 million people have been quarantined, an unprecedented effort to control any infectious disease. Similarly, other countries have responded by suspending travel to and from China and establishing screening at airports that have flights from China. The WHO on January 30 declared the outbreak a Public Health Emergency of International Concern (and the US State Department has increased the alert level to 4, recommending that citizens not travel to China).

On January 31 the Trump administration took the unprecedented action to suspend entry into the United States of all immigrants and nonimmigrants who have physically been in China, Hong Kong, or Macau in the previous 14 days. All US citizens and permanent residents who have been in Hubei Province in the last 14 days will also be subject to quarantine.

The effectiveness of these quarantines in curtailing the outbreak is doubtful because these measures have not worked in prior outbreaks, such as the 2009 influenza A(H1N1) or the 2014 Ebola pandemics, and quarantines are contrary to previously proven public health measures and the International Health Regulations.10

What interventions will ultimately control this outbreak is unclear because there is currently no vaccine, and the effectiveness of antivirals is unproven. However, basic public health measures such as staying home when ill, handwashing, and respiratory etiquette including covering the mouth and nose during sneezing and coughing were effective in controlling SARS. As a new outbreak confronts frontline clinicians and public health authorities, these groups must work together to educate the public by providing accurate and up-to-date information and by taking care of patients with respiratory illness in a timely and effective way.

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White House response to Trump acquittal

Today, the sham impeachment attempt concocted by Democrats ended in the full vindication and exoneration of President Donald J. Trump. As we have said all along, he is not guilty. The Senate voted to reject the baseless articles of impeachment, and only the President’s political opponents – all Democrats, and one failed Republican presidential candidate – voted for the manufactured impeachment articles.

In what has now become a consistent tradition for Democrats, this was yet another witch-hunt that deprived the President of his due process rights and was based on a series of lies.  Rep. Adam Schiff lied to Congress and the American people with a totally made up statement about the President’s phone call.  Will there be no retribution?  Speaker Nancy Pelosi also lied to the American people about the need to swiftly pass impeachment articles they dreamt up, only to sit on them for a month before sending over to the Senate. 

In the Senate, the Democrats continued to make their political motivations clear – Rep. Schiff proclaimed  the issues “cannot be decided at the ballot box” – proving once again they think they know better than the voters of this country.  This entire effort by the Democrats was aimed at overturning the results of the 2016 election and interfering with the 2020 election.

Throughout this wholly corrupt process, President Trump successfully advanced the interests of the United States and remained focused on the issues that matter to Americans.  He spent his time achieving real victories for the people of this country, and the Democrats – once again – have nothing to show for their fraudulent schemes. The President is pleased to put this latest chapter of shameful behavior by the Democrats in the past, and looks forward to continuing his work on behalf of the American people in 2020 and beyond.

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‘Ripped Our Hearts Out’: SOTU Guest Whose Brother Was Murdered Reacts to Pelosi Ripping Up Speech

Leftist animals have no feeling for other people at all

A guest at the State of the Union address whose brother was killed by an illegal alien said it was heartbreaking to watch House Speaker Nancy Pelosi rip up President Donald Trump’s speech.

Appearing on “Fox and Friends” Wednesday morning, Jody Jones, whose brother was shot and killed by an illegal alien at a California gas station in 2018, recounted how he felt when Pelosi chose to rip up Trump’s speech at the end of the address, calling it “probably the most disrespectful thing I have ever seen in my life.”

“Felt like she ripped our hearts out. All the guests. We couldn’t believe it,” Jones said.

“I don’t care how you feel about somebody. That was probably the most disrespectful thing I have ever seen in my life. Because, when she did that, it just tore us up. We couldn’t believe it,” he continued.

It wasn’t lost on the Fox News hosts or Jones that his brother’s name, Rocky Jones, was on that paper.

Trump invited Jody Jones to be one of his special guests at Tuesday night’s State of the Union address in Congress. Jones’ brother, Rocky, was shot and killed at a California gas station in 2018 by an illegal alien, and his presence Tuesday night was used to highlight the deadly consequences of sanctuary city policies.

The illegal alien who was held responsible for killing Rocky had been arrested for a DUI by local California authorities just days before the shooting. Immigration and Customs Enforcement had placed an immigration detainer on the individual, but because of sanctuary policy laws in the state, the detainer was ignored.

Jones asked that the legislation responsible for his brother’s death, SB 54, be abolished, and called on Pelosi to be more respectful.

“First of all, let’s do away with the SB 54. I don’t care how you feel about somebody. Think of other people and the others involved, please. Because what you did was very disrespectful, and it really ripped our hearts out,” Jones said.

During his address, Trump called on lawmakers to support legislation introduced by Republican North Carolina Sen. Thom Tillis, the Justice for Victims of Sanctuary Cities Act, that would allow people like Jones to sue sanctuary cities if a loved one is killed or hurt by such “deadly” policies.

As for Jones, he said this tragedy has affected his family tremendously, but it has not torn them apart.

“We are a pretty tight-knit family,” he said. “It’s really actually made us closer, and with the president inviting us, what an honor that was just to honor our brother and he sure did that.”

SOURCE 

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IN BRIEF

STRENGTH IN NUMBERS: Susan Collins will vote to acquit Trump, saying he's "learned" from impeachment (CBS News)

2020 VISION: Trump job approval at personal best 49% (Gallup)

PROBABLY A GOOD IDEA: Nevada Democrats vow not to use the same app that contributed to Iowa caucus failure (National Review)

WHO'D A THUNK IT? Sacramento proposes homeless shelter near school. It doesn't go well. (Hot Air)

GOOD GUYS WIN THE SKIRMISH: Virginia Senate blocks another Northam-backed gun bill (Fox News)

CORONAVIRUS: Hong Kong and Taiwan, territories that China sees as its own, restrict travel from the mainland (The Washington Post)

POLICY: Impeachment shows the ethical difficulties of foreign assistance (The Hill)

POLICY: Brexit's three key implications for U.S. policymakers (The Heritage Foundation)

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For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated), A Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

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