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February 5, 2020

2019 Novel Coronavirus—Important Information for Clinicians

Author Affiliations
  • 1Division of Infectious Diseases, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
  • 2Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor
  • 3Associate Editor, JAMA
JAMA. Published online February 5, 2020. doi:10.1001/jama.2020.1490

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

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    5 Comments for this article
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    "EPIDEMIOLOGIC RISK" SHOULD BE WIDENED FOR PATIENT INVESTIGATION
    Kilsoo Yie, M.D. | Jeju Soo Cardiovascular Center (JSCVC)
    As of Feb 5, 2020, South Korea has identified 19 patients with 2019-nCoV. Among them, 4 patients did not have a travel history to Wuhan city or even to China mainland. Korea CDC reported that one patient (12th patient) had been infected in Japan and had confirmed 2019-nCoV on returning to Korea. The patient has a contact history with 2019-nCoV patient during their time in Japan. The other three patients have a travel history including Singapore within the last 14 days. It is unclear where and who infected these three patients. However, recent increased number of patients in Asian country (26 patients in Singapore, 10 patients in Malaysia etc.) and the fact that patients occurrence without the history of China requires more widened risk indication for patient investigation.
    CONFLICT OF INTEREST: None Reported
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    Fatality Rate Comparison between SARS, MERS, and 2019-nCoV Adjustments.
    Jairo Campos, M.D. |
    SARS and MERS fatality rates used here are "end epidemic" rates against a 2019-nCoV fatality rate that is an "epidemic outbreak" rate. An adjustment formula is possible using the denominator(total number of deaths) in the fatality rate formula from a previous date found by the subtraction of the average of days between the date of case notification and the date of death notification. This is specially valuable as the curve hasn't reached its peak and has predictive "end epidemic" rate value.
    CONFLICT OF INTEREST: None Reported
    Hong Kong and Macao excluded
    Justin Choi, MB ChB (CUHK) | Hospital Authority
    According to Section 1 of Proclamation on Suspension of Entry as Immigrants and Nonimmigrants of Persons who Pose a Risk of Transmitting 2019 Novel Coronavirus (https://www.whitehouse.gov/presidential-actions/proclamation-suspension-entry-immigrants-nonimmigrants-persons-pose-risk-transmitting-2019-novel-coronavirus/), immigrants and nonimmigrants from Hong Kong and Macao are allowed to enter the US, subject to other immigration requirements.
    CONFLICT OF INTEREST: None Reported
    Pathology Studies Necessary to Determine Cause of Death
    Giuliano Ramadori, Professor of Medicine | University Clinic, Internal Medicine, Göttingen,Germany
    The new coronavirus pandemic originating from Wuhan, China has had a tremendous impact on the Chinese population and all nations around the world. The description of the cases in whom the coronavirus has been isolated and its genome has been sequenced has to be hugely appreciated.The coronavirus is supposed to be the cause of pneumonia in all patients and of the death of > 1100 Chinese patients. However it would be very important to obtain tissue pathology findings of the lung and of the other organs. In fact cofactors such as bacterial coinfection or even or even pollution particles in the patient´s bronchial macrophages may have played a role in inducing respiratory problems which may have led to the death of the patients, and should be investigated. We still do not know whether the new coronavirus is really more dangerous than the
    already known human coronavirus strains HKU1, NL63, 229E and 0C43, or the different influenza viruses.
    CONFLICT OF INTEREST: None Reported
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    Is "Hands Only" CPR Safe in COVID-19 Suspected Cases?
    Ornella Piazza, MD; Giuseppina Moccia; Francesco de Caro | Università di Salerno, Department of Medicine and Surgery
    In January 2020, an elderly man wearing a facemask collapsed and died on a street near a hospital in Wuhan.  He could have had a cardiac arrest but there were only a few passers-by, and they dared not go near him. Is it safe to perform cardiopulmonary resuscitation (CPR) on a cardiac arrest victim affected by COVID-19? A Singapore government website states that: “Members of the public can perform “hands-only CPR” without the need for mouth-to-mouth breathing...members of the public are also reminded to practice good personal hygiene after attending to an incident (1). “Hands-only CPR” has been found to be effective in increasing the chance of survival when performed early, but in our opinion, it is not risk free.

    Reference

    1. https://www.gov.sg/article/is-it-safe-to-perform-cpr-covid-19-situation, accessed 05 Feb 2020
    CONFLICT OF INTEREST: None Reported
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