Researchers are working quickly to understand the newly-identified 2019 coronavirus – a new study defines clinical features and what we know about coronavirus so far.
Beginning in December 2019, cases resembling viral pneumonia began to emerge in the city of Wuhan, China – all of an unknown origin. Samples analyzed from the lower respiratory tract of these patients revealed a new coronavirus, aptly named 2019 novel coronavirus (2019-nCoV). Since then, the spread of the virus has continued. Not only are there more than 4000 confirmed cases in China, but there are confirmed cases reported in other countries including Japan, South Korea, the United States, Canada, Australia, France, and Germany, among others.
Most coronavirus strains, like the common cold, are mild, however, some can cause severe illness and higher death rates, such as severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). The outbreak of this new strain of coronavirus leaves many questions scientists are scrambling to answer. In a study published in The Lancet, researchers in China studied the first laboratory-confirmed cases of 2019-nCoV in Wuhan to better understand its clinical features.
Fifty-nine suspected patient cases from Wuhan (as of December 31, 2019), diagnosed with pneumonia with an unknown cause were included in the study. The suspected patients were placed in isolation at designated hospitals with airborne precautions. Respiratory, blood, and fecal samples were obtained and sent to local disease control centres for diagnostic testing.. On January 2, 2020, 41 out of the 59 suspected patients were confirmed to be infected with the 2019 novel coronavirus. Twenty-seven of these patients had direct exposure to the seafood market in Wuhan that is suspected to be the source of the 2019 novel coronavirus (i.e., where animal to human transmission first occurred).
Twenty of the confirmed cases were patients between the ages of 25 and 49 and fourteen were between the ages of 50 and 64. There were no children or adolescent patients among the forty-one confirmed cases in the study. Most of the patients were male and less than half (13 out of 41) had underlying medical conditions such as diabetes, high blood pressure, and cardiovascular disease.
The most common symptoms at the onset of infection included: fever, dry cough, and fatigue. Less common symptoms were sputum production, headaches, coughing up blood (two patients) and diarrhea (one patient). Notably, more than half of infected patients developed shortness of breath or difficulty breathing after a median of eight days from when they first experienced any symptoms.
At hospital admission, all patients had low white blood cell and lymphocyte counts and abnormal chest x-ray results. Complications of the infection included acute respiratory distress syndrome (caused by rapid widespread lung inflammation), heart injuries, and secondary infections. As of January 22, 2020, twenty-eight patients had been cleared for discharge (i.e., no fever for at least 10 days, improvement of chest x-rays, and no virus in respiratory tract samples) and six patients died.
Based on the findings from this cohort of forty-one confirmed cases of the 2019 novel coronavirus, the clinical features of this viral infection are similar to those of SARS-CoV. Patients with 2019-nCoV presented with serious pneumonia that proved fatal for some patients. High death rates are seen with more severe illness from 2019-nCoV, such as the development of acute respiratory distress syndrome that required ICU admission and oxygen support.
Current evidence suggests that the 2019-nCoV is transmissible from human to human. Airborne precautions, especially for front-line healthcare workers with fit-tested N95 respirator marks and personal protective equipment are strongly recommended.
The current study was limited by the small sample size of forty-one patients, therefore making it difficult to assess risk factors for severity of disease and death. There is a growing urgency to understand the virus and its evolutionary potential as the number of deaths and confirmed cases around the globe continues to rise. Further studies and research would help inform governments, health officials, and medical professionals worldwide, should the need to handle a global pandemic arise.
Written by Maggie Leung, PharmD.
References:
Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., … Cao, B. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. doi: 10.1016/s0140-6736(20)30183-5
Mansoor, S. (2020, January 28). Coronavirus Latest: Live Updates and What to Know. Retrieved from https://time.com/5772481/china-coronavirus-latest/
Image by Silas Camargo Silão from Pixabay
