Novel Coronavirus (2019-nCoV): Determining a suspected case

The novel coronavirus continues to spread - what should we know about it?

Pulmonary System Blog
By Dr. Hubertus Glaser und Dr. Jörg Zorn

The novel coronavirus continues to spread - what should we know about it?

Unfortunately, there is no good news regarding the new coronavirus. The number of confirmed cases approaches 3000, the number of suspected cases nears 6000 and the number of deaths approaches 100. Experts now assume that the virus can be transmitted from person to person. In Wuhan, where there was an outbreak of mysterious lung diseases at the end of December, at least 15 hospital employees have become infected with the coronavirus now known as "2019-nCoV". Infections or suspected cases have also been reported in other Chinese cities and across the globe.

The WHO has convened its Emergency Committee to discuss the declaration of a health emergency and potential actions to be taken. Given that medical staff has also been affected by the virus, we recommend colleagues to familiarize themselves with the latest information provided by the WHO and national health authorities, without the need to raise unnecessary alarms at this point in European territory.

What are the known risk areas so far?

Summarizing information distributed by the WHO, by January 27th, 2020 the situation was as follows:

Which patients with acute respiratory symptoms should be treated as suspect cases?

  1. Those people who have been in contact with a confirmed or probable 2019-nCoV case within the last 14 days before the onset symptoms, regardless of the severity of the acute respiratory symptomatology.
  2. Those cases with clinical, radiological or histopathological evidence of pneumonia AND that have stayed at a risk area within the previous 14 days before the onset of the disease.

What initial measures should be taken?

The patient should be isolated (in the case of 1. in a single room, in the case of 2. in an isolation room with an anteroom/lock), and appropriate measures should be taken to prevent the risk of infections due to breath/mucose droplets, i.e. protective gowns, gloves, protective goggles, mouth protection, nose protection or FFP2/FFP3 masks. The case must be reported to the respective public health department and appropriate laboratory diagnostics must be initiated.

How is the suspicion of a 2019-nCoV infection confirmed in the laboratory?

For Polymerase chain reaction (PCR) diagnostics, sample material should be taken from the upper respiratory tract [nasopharyngeal (NP) and/or oropharyngeal (OP) swabs or irrigation/aspirator] and lower respiratory tracts (sputum as instructed/induced, tracheal secretion, Bronchoalveolar lavage (BAL), also known as bronchoalveolar washing). The material must be then sent to national or any laboratories that can inform national and international health monitor agencies in real-time for any further decisions.

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