What do doctors do when they see Wuhan coronavirus?
January 24, 2020 1:52 PM Subscribe
I'm curious about the process for identifying/processing people who are suspected to have come down with Wuhan coronavirus.
-How do doctors identify it? Is it just symptoms + recent travel to Wuhan or thereabouts? Are there tests?
-How do doctors treat patients who have it? Is there a standard course that patients are expected to do?
More generally, how does data on epidemics come down from the CDC/WHO to local doctors on the ground? Also interested in differences between doctors in different areas, like with different income levels, single payer health systems vs more US style.
-How do doctors identify it? Is it just symptoms + recent travel to Wuhan or thereabouts? Are there tests?
-How do doctors treat patients who have it? Is there a standard course that patients are expected to do?
More generally, how does data on epidemics come down from the CDC/WHO to local doctors on the ground? Also interested in differences between doctors in different areas, like with different income levels, single payer health systems vs more US style.
Screening processes look for people who come from or who have travelled through afflicted areas, who have symptoms like respiratory issues and higher-than-average body temperature. The CDC has an outline here of what it is doing, as well as the WHO.
Chinese researchers sequenced the nCoV (Wuhan) coronavirus genome very quickly. Positive identification could be made from blood draws of possibly-infected patients who suffer nCoV-like symptoms — this was likely done for the Washington and Texas patients. Here is some information on how this is done for another coronavirus (MERS).
posted by They sucked his brains out! at 2:03 PM on January 24, 2020
Chinese researchers sequenced the nCoV (Wuhan) coronavirus genome very quickly. Positive identification could be made from blood draws of possibly-infected patients who suffer nCoV-like symptoms — this was likely done for the Washington and Texas patients. Here is some information on how this is done for another coronavirus (MERS).
posted by They sucked his brains out! at 2:03 PM on January 24, 2020
It's low on technical details, but here's the experience of a British man who was suspected of having it on return from China (he didn't in the end).
posted by EndsOfInvention at 2:16 PM on January 24, 2020 [6 favorites]
posted by EndsOfInvention at 2:16 PM on January 24, 2020 [6 favorites]
In terms of identification, yes, it is a combination of symptoms and recent travel to Wuhan or contact with people who have traveled there, followed by the confirmatory microbiology tests that Tshbo! describes. There's a protocol for novel epidemics like these that was developed during the big West African Ebola epidemic, where electronic medical record systems update their patient intake questionnaires that clinicians and registration staff use to include an initial question about travel to affected areas or contact with people who have traveled there, and then the system throws a critical alert if the patient has relevant symptoms and a travel/social history indicating possible exposure.
In terms of treatment, it's just the general supportive treatment that patients with viral pneumonia get, but with extremely strict isolation protocols, and without antiretroviral drugs because there are none known to work on coronavirus. Basic stuff like rest, acetaminophen, and humidifiers, possibly respiratory therapy interventions like bronchodilators or mucolytics, and if the patient's condition gets really bad, intubation or artificial respiration.
posted by strangely stunted trees at 2:18 PM on January 24, 2020 [1 favorite]
In terms of treatment, it's just the general supportive treatment that patients with viral pneumonia get, but with extremely strict isolation protocols, and without antiretroviral drugs because there are none known to work on coronavirus. Basic stuff like rest, acetaminophen, and humidifiers, possibly respiratory therapy interventions like bronchodilators or mucolytics, and if the patient's condition gets really bad, intubation or artificial respiration.
posted by strangely stunted trees at 2:18 PM on January 24, 2020 [1 favorite]
There's a great summary on WaPo of breakneck-paced scientific work done across the globe to sequence and analyse the nCoV genome, which shows a lot of biochemical similarity with the SARS virus, which should help with detection, identification and treatment strategies.
posted by They sucked his brains out! at 2:29 PM on January 24, 2020 [3 favorites]
posted by They sucked his brains out! at 2:29 PM on January 24, 2020 [3 favorites]
Chicago's health area network here is the general information given to Chicago from IDPH. This has more info than just that, but did have the information sent out to physicians working in emergency rooms about processes for notifying the public health department, sending out samples for testing, what types of precautions people should take ect.
direct link
posted by AlexiaSky at 7:35 PM on January 24, 2020
direct link
posted by AlexiaSky at 7:35 PM on January 24, 2020
how does data on epidemics come down from the CDC/WHO to local doctors on the ground?
focused CDC releases, for one.
Health Advisory Notices (HAN)
Morbitity & Mortality Weekly (but it lags)
posted by j_curiouser at 11:40 PM on January 24, 2020
focused CDC releases, for one.
Health Advisory Notices (HAN)
Morbitity & Mortality Weekly (but it lags)
posted by j_curiouser at 11:40 PM on January 24, 2020
This is what public health systems are for! I don't know details for other countries, but in the US the CDC has established a definition for a patient under investigation (PUI) that includes symptoms and recent travel to Wuhan. A doctor who identifies a PUI reports to local public health authorities, who help coordinate sample collection for shipping and testing at the CDC (the only lab currently doing testing in the US- side note, huge credit to China for data sharing and for lab scientists who came up with a new diagnostic test extremely quickly for a brand new pathogen). There is no specific treatment for this infection; treatment is supportive. If a PUI tests positive, public health staff will conduct contact tracing and monitoring to watch for spread of the virus.
As others mentioned, information on epidemics and other public health threats gets distributed to doctors and hospitals via established channels called health advisory networks. Notifications come from CDC, state, and local health departments. There are already existing systems for monitoring reportable diseases like measles. These systems and responses are publicly funded (and legally mandated, usually by state legislation) and exist in all areas of the US- it doesn't depend on income level or type of insurance. (Although care-seeking behavior certainly varies by socioeconomic status, and I'm sure not all health providers are equally diligent about reporting).
posted by emd3737 at 5:17 AM on January 25, 2020
As others mentioned, information on epidemics and other public health threats gets distributed to doctors and hospitals via established channels called health advisory networks. Notifications come from CDC, state, and local health departments. There are already existing systems for monitoring reportable diseases like measles. These systems and responses are publicly funded (and legally mandated, usually by state legislation) and exist in all areas of the US- it doesn't depend on income level or type of insurance. (Although care-seeking behavior certainly varies by socioeconomic status, and I'm sure not all health providers are equally diligent about reporting).
posted by emd3737 at 5:17 AM on January 25, 2020
Here is a phylogenetic tree, showing the degree to which the nCoV closely relates to the SARS coronavirus, which will be used to focus further research into control, treatment, and vaccine development.
posted by They sucked his brains out! at 12:24 PM on January 27, 2020
posted by They sucked his brains out! at 12:24 PM on January 27, 2020
NCBI is collecting nCoV sequence data on GenBank here, which includes sequencing results from the five known infected patients in the US.
posted by They sucked his brains out! at 1:31 PM on January 28, 2020
posted by They sucked his brains out! at 1:31 PM on January 28, 2020
As to why sequencing data matters:
With each new outbreak, scientists typically have to start from scratch. After the SARS outbreak in 2003, it took researchers about 20 months from the release of the viral genome to get a vaccine ready for human trials. By the time an epidemic caused by the Zika virus occurred in 2015, researchers had brought the timeline down to six months. Now, they hope the joint efforts will cut that time in half.
The morning after the Chinese scientists published their data earlier this month, Dr. Graham’s team got to work checking the sequence and comparing it with what they already had for SARS and MERS. They wanted to focus on the spike protein, which forms the crown of the coronavirus and recognizes receptors, or entry points, on a host cell.
“If you can block the spike protein from binding to a cell, then you’ve effectively prevented an infection,” said Kizzmekia Corbett, the scientific lead for Dr. Graham’s coronavirus team.
Dr. Corbett and others had studied the spike proteins on SARS and MERS viruses in detail, using them to develop experimental vaccines. The vaccines never made it to market because SARS was successfully contained with public health measures before the vaccine was ready and preliminary human trials for the MERS vaccine showed success last year.
But the scientists had a method for developing vaccines that could help them fast-track production for the new coronavirus. They used the template for the SARS vaccine and swapped in just enough genetic code that would make it work for the new virus. “I call it plug and play,” Dr. Corbett said.
posted by They sucked his brains out! at 11:50 AM on January 29, 2020
With each new outbreak, scientists typically have to start from scratch. After the SARS outbreak in 2003, it took researchers about 20 months from the release of the viral genome to get a vaccine ready for human trials. By the time an epidemic caused by the Zika virus occurred in 2015, researchers had brought the timeline down to six months. Now, they hope the joint efforts will cut that time in half.
The morning after the Chinese scientists published their data earlier this month, Dr. Graham’s team got to work checking the sequence and comparing it with what they already had for SARS and MERS. They wanted to focus on the spike protein, which forms the crown of the coronavirus and recognizes receptors, or entry points, on a host cell.
“If you can block the spike protein from binding to a cell, then you’ve effectively prevented an infection,” said Kizzmekia Corbett, the scientific lead for Dr. Graham’s coronavirus team.
Dr. Corbett and others had studied the spike proteins on SARS and MERS viruses in detail, using them to develop experimental vaccines. The vaccines never made it to market because SARS was successfully contained with public health measures before the vaccine was ready and preliminary human trials for the MERS vaccine showed success last year.
But the scientists had a method for developing vaccines that could help them fast-track production for the new coronavirus. They used the template for the SARS vaccine and swapped in just enough genetic code that would make it work for the new virus. “I call it plug and play,” Dr. Corbett said.
posted by They sucked his brains out! at 11:50 AM on January 29, 2020
So I don't know about solo practitioners, but I work for a large group practice (in an administrative capacity). We have a small, central infection control team. They do things like various infection control projects (working with service lines and strategic sourcing to buy cheaper cleaning agents; process improvement for cleaning endocavity probes, etc.). They do the normal public health surveillance stuff, serving as a resource for the practice when there are e.g. suspect measles cases or other public health-reportable cases. And then they monitor the daily WHO, CDC, and state and local public health email lists to track things like novel coronavirus. With our chief of infectious disease, they developed materials for all staff who work phones, guidance on what to do for suspect cases (fit tested n95 mask on clinicians and staff, HEPA filter in the room, ideally mask patients in the parking lot, etc.), standard work for the lab to send specimens to the CDC lab, and have done tons of communications. There is a new section on novel coronavirus on our shareplace page, they presented at our weekly all-management call, there was a special call for nursing and operations leaders, message of the day in our electronic health record. They work really hard to develop local practices following federal guidelines, really important work! Three cheers for public health, folks!
posted by teragram at 5:44 PM on January 30, 2020 [1 favorite]
posted by teragram at 5:44 PM on January 30, 2020 [1 favorite]
The CDC released a real-time RT-PCR assay to detect nCoV.
Briefly, the way this test works is by taking the RNA in the nCoV virus, turning it into DNA with an enzyme called reverse transcriptase ("RT"), then using the PCR technique to amplify, or copy, pieces of this specific DNA (and only this specific DNA).
A fluorescent label (e.g. SYBR Green) is used to make the DNA-of-interest light up, and the more DNA-of-interest there is, the brighter the light.
So if nCoV RNA is present, then its DNA equivalent gets copied, and over time the sample will light up more brightly than you'd expect with background light from the noisy copies of random DNA. As more PCR cycles are completed, more copies are made and the sample gets brighter: this is the "Delta R/n" value in the plot on the CDC page. If nCoV wasn't present (and the test was done properly), then the sample would not light up.
posted by They sucked his brains out! at 1:05 PM on February 4, 2020
Briefly, the way this test works is by taking the RNA in the nCoV virus, turning it into DNA with an enzyme called reverse transcriptase ("RT"), then using the PCR technique to amplify, or copy, pieces of this specific DNA (and only this specific DNA).
A fluorescent label (e.g. SYBR Green) is used to make the DNA-of-interest light up, and the more DNA-of-interest there is, the brighter the light.
So if nCoV RNA is present, then its DNA equivalent gets copied, and over time the sample will light up more brightly than you'd expect with background light from the noisy copies of random DNA. As more PCR cycles are completed, more copies are made and the sample gets brighter: this is the "Delta R/n" value in the plot on the CDC page. If nCoV wasn't present (and the test was done properly), then the sample would not light up.
posted by They sucked his brains out! at 1:05 PM on February 4, 2020
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posted by fingersandtoes at 2:01 PM on January 24, 2020 [2 favorites]