Updated March 10, 2020
Novel Coronavirus (COVID-19) Testing
Clinical laboratories LabCorp and Quest Diagnostics announced COVID-19 testing availability. According to a LabCorp press release, the test is available for ordering by physicians or other authorized healthcare providers anywhere in the U.S. The test detects the presence of the underlying virus that causes COVID-19 and is for use with patients who meet current guidance for evaluation of infection with COVID-19. Learn more.
Quest will be in a position to receive specimens for testing and begin to provide testing on Monday, March 9, 2020. Learn more.
U.S. health officials have advised that Americans should be prepared for significant disruption due to the coronavirus (COVID-19) outbreak.
I. Pathogenic Characteristics
The Novel Coronavirus belonging to the genus of betacoronavirus. The enveloped viral particles may appear spherical or oblong, with a diameter of 60-140nm. Its genetic characteristics are significantly different from SARS-CoV and MERS-CoV. Current research shows that it has more than 85% homology with bat SARS-like coronavirus (bat-SL-CoVZC45).
When isolated and cultured in vitro, the new coronavirus can be found in human respiratory epithelial cells in about 96 hours, while it takes about 6 days to isolate and culture in Vero E6 and Huh-7 cell lines.
Most of the understanding of the physicochemical properties of coronavirus comes from the research of SARS-CoV and MERS-CoV. The virus is sensitive to ultraviolet rays and heat. Under 56 °C for 30 minutes, ether solvents, 75% ethanol, chlorine-containing disinfectants, peracetic acid, and chloroform can effectively inactivate the virus. Chlorhexidine cannot effectively inactivate the virus.
II. Epidemiological Characteristics
(1) Source of infection.
At present, the source of infection is mainly patients infected by the novel coronavirus. Those who are asymptomatic but infected may also become a source of infection.
(2) Route of transmission.
The main route of transmission is respiratory droplets and close contact. There is the possibility of aerosol transmission when exposed to high concentration aerosol for a long time in a relatively closed environment. As new coronaviruses can be isolated in feces and urine, attention should be paid to aerosol or contact transmission of fecal and urine to environmental pollution.
(3) Susceptible populations.
The population is generally susceptible.
III. Clinical Characteristics
Based on the current epidemiological investigation, the incubation period is 1-14 days, and most often between 3-7 days.
The primary presentations are fever, dry cough, and fatigue. A minority of patients have symptoms such as nasal congestion, nasal discharge, sore throat, muscle pain, and diarrhea. Severe patients often suffer from dyspnea and/or hypoxemia one week after symptom onset, and severe patients can rapidly progress to acute respiratory distress syndrome, septic shock, difficult to correct metabolic acidosis, coagulation dysfunction and multiple organ failure. It is worth noting that severe and critical patients may have moderate to low fever or even no obvious fever during the course of the disease.
Some children and infants may present with atypical symptoms such as vomiting and diarrhea, or only with malaise and rapid breathing.
Patients with the mild form of the disease present only as low fever, slight fatigue, and so forth, with no lung inflammation.
Judging from the current cases, most patients have a good prognosis and a minority are in critical condition. The prognosis of the elderly and those with chronic underlying diseases is more poor. The clinical course of COVID-19 in pregnant patients is similar to that for patients of the same age. The symptoms of children are relatively mild.
新型冠状病毒属于B属的冠状病毒,有包膜,颗粒呈圆形或椭圆形,常为多形性,直径60-140nm。 其基因特征与SARS-CoV和 MERS-CoV 有明显区别。 目前研究显示与蝙蝠 SARS 样冠状病毒(bat-SL-CoVZC45)同源性达85%以上。体外分离培养时,新型冠状病毒 96 个小时左右即可在人呼吸道上皮细胞内发现,而在 Vero E6 和 Huh-7细胞系中分离培养需约6天。
对冠状病毒理化特性的认识多来自对SARS-CoV 和 MERS-CoV的研究。 病毒对紫外线和热敏感,56°C 30 分钟、乙醚、75%乙醇、含氯消毒剂、过氧乙酸和氯仿等脂溶剂均可有效灭活病毒, 氯己定不能有效灭活病毒。
经呼吸道飞沫和密切接触传播是主要的传播途径。 在相对封闭的环境中长时间暴露于高浓度气溶胶情况下存在经气溶胶传播的可能。 由于在粪便及尿中可分离到新型冠状病毒,应注意粪便及尿对环境污染造成气溶胶或接触传播。
以发热、干咳、乏力为主要表现。 少数患者伴有鼻塞、流涕、咽痛、肌痛和腹泻等症状。 重症患者多在发病一周后出现呼吸困难和/或低氧血症,严重者可快速进展为急性呼吸窘迫综合征、脓毒症休克、难以纠正代谢性酸中毒和出凝血功能障碍及多器官功能衰竭等。 值得注意的是重型、危重型患者病程中可为中低热,甚至无明显发热。
从目前收治的病例情况看,多数患者预后良好,少数患者病情危重。 老年人和有慢性基础疾病者预后较差。 患有新型冠状病毒肺炎的孕产妇临床过程与同龄患者相近。 儿童病例症状对较轻。
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