Wednesday, February 26, 2020

COVID-19: preparing for an epidemic

Testifying to the rapidly evolving nature of the epidemic, the following post on COVID-19, which I wrote for the AFP Community Blog just 3 weeks ago, is already somewhat out of date (at that point, for example, the novel coronavirus didn't have a formal name). Yesterday, an official at the Centers for Disease Control and Prevention (CDC) warned that an outbreak of COVID-19 in the U.S. is no longer a matter of "if," but "when," and that Americans need to be prepared for a "significant disruption" in their lives. Although only 14 U.S. cases (12 of them travel-related) had been confirmed as of Feb. 24, only a few hundred persons have actually been tested due to problems with the test kits. It's hard to have much confidence that an administration that has repeatedly sought to slash funding for the CDC is prepared to mobilize the nation's public health infrastructure to confront this significant health threat. As the president of the American Academy of Family Physicians, Dr. Gary LeRoy, predicted last month, family physicians will be on the front lines of identifying and preventing the spread of this new respiratory illness.


In a 2015 editorial on global health in American Family Physician, Drs. Ranit Mishori and Jessica Evert noted that "the world is not only smaller than ever, but it is also more intricately connected," with transportation networks facilitating the spread of exotic infectious diseases across oceans and borders. These words seem prescient today as China, the World Health Organization, and the international community work feverishly to contain the outbreak of the 2019 novel coronavirus (2019-nCoV), which was initially reported in patients with pneumonia in Wuhan, Hubei Province, China but has spread via travel and person-to-person transmission to 24 other countries, including 11 confirmed cases in the United States as of February 3. As scientists race to answer basic questions about this new respiratory infection, travel to China has been heavily restricted, U.S. citizens have been evacuated from the region, and travelers recently returned from Hubei Province are being quarantined by state governments.

To keep clinicians up-to-date on the evolving epidemic, the Centers for Disease Control and Prevention (CDC) has posted a comprehensive collection of resources for health care professionals who encounter patients with suspected 2019-nCoV, including an assessment flowchart and interim management guidance for patients with confirmed infection. Forward-thinking family physicians can also consult a previous Family Practice Management (now FPM) article for tips on on preparing your office for an infectious disease epidemic. Key points highlighted in this article include:

- Begin planning now.
- Master the detection, prevention and management of seasonal influenza and community-acquired pneumonia.
- Practice scrupulous infection control - "wash in and wash out."
- Communicate at all levels, and coordinate with public health agencies.
- Focus on staff management and business continuity.

Although the origin of the 2019-nCoV is not known, the linkage of the majority of early infections to a wholesale seafood market suggests the existence of an animal reservoir. A previous novel coronavirus outbreak that began in China, severe acute respiratory syndrome (SARS), was eventually traced to infected bats. However, the estimated 2% fatality rate of 2019-nCoV is substantially lower than the 10% fatality rate of SARS. In addition, it's important to remind worried patients that the CDC projects that the less lethal but far more prevalent (and preventable) seasonal influenza virus will cause 180,000-310,000 hospitalizations and 10,000-25,000 deaths during the current flu season.