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Coronavirus Infections: More Than Just the Common Cold
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- This article discusses pathophysiology and global health implications of human coronavirus infections, with recent highly pathogenic examples including the causative viruses for severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), as well as current outbreak in China. These viruses are large enveloped positive-strand RNA viruses that usually come from animal reservoirs, and due to basic virologic features and logistics of healthcare provision, it has been associated with peak transmission late in the disease course, and high human-to-human and nosocomial spread. Experience with prior pandemics have informed initial response strategies to the current novel coronavirus outbreak in China, and the clinical and global health implications of this disease remain to be seen.
- This article provides background information about pathophysiology and epidemiology of human coronaviruses, and lessons learned from prior pandemics that have informed a response to the novel coronavirus in China, whose ultimate global outcomes remain uncertain.
abstract
This abstract is available on the publisher's site.
Access this abstract nowHuman coronaviruses (HCoVs) have long been considered inconsequential pathogens, causing the “common cold” in otherwise healthy people. However, in the 21st century, 2 highly pathogenic HCoVs—severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)—emerged from animal reservoirs to cause global epidemics with alarming morbidity and mortality. In December 2019, yet another pathogenic HCoV, 2019 novel coronavirus (2019-nCoV), was recognized in Wuhan, China, and has caused serious illness and death. The ultimate scope and effect of this outbreak is unclear at present as the situation is rapidly evolving.
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Coronavirus Infections: More Than Just the Common Cold
JAMA 2020 Jan 23;[EPub Ahead of Print], CI Paules, HD Marston, AS FauciFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Coronavirus advances
I received an email today from a former family medicine resident and friend of mine. He wrote, “With the coronavirus activity, I was reminded of 2002-2003 when I was a new resident at Wingra in the staffing room with you, watching your computer with the SARS cases adding up in real time on a counter, and they just kept increasing and increasing. I suspect there will be much to follow with this pandemic, too!”
I still have my old Excel spreadsheet documenting that outbreak, and I still remember some of my old epidemiology math. In the past week, the global count of confirmed cases of novel coronavirus (2019-nCoV) infections has increased 13-fold. As I plotted out the exponential climb in the daily case counts today, I was able to calculate a doubling time of approximately 1.8 days. This is worrisome.
Accordingly, on January 29, a US coronavirus task force was created, which includes the Secretary of the Department of Health and Human Services, the Director of the CDC, the Director of the NIH National Institute of Allergy and Infectious Diseases, and the National Security Advisor. Closer to home, we hosted an expert panel on coronavirus at the University of Wisconsin School of Medicine and Public Health to a standing room-only audience. On January 30, the World Health Organization declared a public health emergency of international concern. Also, the first case of human-to-human transmission was confirmed in the US on that day.
We do not know where this is going. The case count has already surpassed that of SARS (severe acute respiratory syndrome), and this is taking off in January, which is 2 months earlier than the SARS outbreak began. Consequently, this 2019-nCoV outbreak is occurring in the midst of a significant seasonal influenza outbreak across the US and in the middle of the respiratory virus season, when conditions are favorable for transmission.
2019-nCoV is a rapidly evolving situation. We all hope that, like SARS, it disappears a few weeks after its emergence, but we need to prepare for widespread effects. Clinicians are called upon to keep abreast of factual and timely information. We will try to provide the best information as this outbreak develops.