What is Coronavirus?
January 27, 2020
AUBURN, Alabama – With the appearance of the coronavirus in the United States, there are a number of questions regarding what the disease is, how it is transmitted, who is vulnerable and how it is treated. Dr. Marilyn Bulloch, associate clinical professor in the Harrison School of Pharmacy’s Department of Pharmacy Practice, provides comments on what is known about coronavirus.
Dr. Bulloch received her Pharm.D. from Rutgers in 2007 and completed residencies at UAB and the Charleston (S.C.) Area Medical Center. Her research interests include acute care pharmacotherapy, infectious diseases, internal medicine, and medication use in older adults. She has spoken at the national, regional, and local level on a variety of medicine related topics, including influenza and other concerning viral infections. She has been published in numerous medical and pharmacy journals including Pharmacotherapy, Annals of Pharmacotherapy, the Journal of Pharmacy Practice, and the Journal of the American Pharmacists Association.
What is coronavirus?
Coronaviruses are a group of viruses that infects the respiratory system and causes a variety of symptoms including cough, a runny nose, sore throat, and occasionally a fever. Most coronaviruses infect only animals, but there now seven strains known to cause human infection. Many adults have been infected by a coronavirus at least once in their life.
The Novel Coronavirus 2019, also known as (2019,nCoV) is a new strain of the virus. The WHO says that this name is temporary, and it is possible that in the coming weeks to months, it may be called something different. It was first reported in late December 2019 (New Years Eve) in Wuhan China, and therefore humans have not had previous exposure and the ability to develop immunity to it. The novelty of the virus is what makes it particularly impactful should someone become infected with it.
It appears this started as animal-to-human and is now human-to-human. How does a disease make that transition?
There are many viruses that are transmitted among animals that are not transmitted to humans. Human-to-animal transmission commonly begins in areas of the world where humans live in close contact with animals. This is often much more extensive than what people in the United States may consider as “close contact”. According to the CDC and WHO, it seems that a large market where seafood and animals were sold facilitated the animal-person transmission of the novel coronavirus 2019.
All viruses evolve or mutate over time. Though rare, some coronaviruses can evolve to a point where human-to-human transmission is possible. This was seen in the past with the SARS and MERS viruses, both of which prompted outbreaks and public health concerns. Human cases of the novel coronavirus 2019 have been reported in many people who have not had any exposure to the suspected animal and seafood market, which suggests to experts that the virus has evolved to the point where human-to-human transmission is now possible. This all occurred within a matter of weeks from the first reported illness from the virus.
What is the process for clinicians when it comes to finding a way to treat a new disease?
The novel coronavirus is in the same family as SARS and MERS. Families of viruses share certain microbiologic characteristics, but also maintain their own unique properties. It is very similar to what in seen with influenza and varicella viruses. In addition to this being a new strain of virus, viruses in themselves can evolve or change over time. An analogy would be to think of a family who has a new child. The new child is his or her own person. The clothes on that child can change. It is still the same child, but it looks slightly different. It is the same process with viruses and that makes them very difficult to treat. There are very few effective antivirals available, and even when one is available, resistance can develop very quickly.
Currently there are no antivirals available specifically to treat coronaviruses. Patients are managed with a combination of isolation and treatment of symptoms and complications. Use of antivirals not specific to coronavirus and steroids have been used in some patients. Research on potential vaccines and treatments for SARS and MERS has been ongoing since those viruses emerged, but there is still no cure. Given how new this novel coronavirus is, a definitive treatment may take years, or even decades, to discover and develop. It is possible, due to the virus’ ability to mutate and evolve, that such a cure may never be a possibility.
What are precautions people can take against a disease like this?
Good infection control practices are the most important method of preventing the spread of this virus. Some of these practices are very simple and are encouraged in general to prevent the spread of other viruses, bacteria, and pathogens. Simple activities such as covering your mouth or nose when sneezing or coughing, frequent handwashing with soap and water or alcohol-based disinfectants, and avoiding close contact with anyone with a fever or a cough all help prevent human-to-human transmission of pathogens. Consuming raw, undercooked, or under processed animal products (including meat, milk, and organs) should be avoided. Though less of a concern in the United States, the WHO has advised that people visiting markets that sell live animals should avoid direct and unprotected contact with animals and any surfaces that are in contact with the animals.
For those who may be around patients with coronavirus-like symptoms, they may wish to use a facemask and gloves. They should avoid sharing common household items such as dishes and towels. It is also advised that, if possible, people avoid using the same bathroom as someone who has symptoms. Any and all surfaces that have come in contact with the patient should be cleaned and disinfected using a diluted bleach solution or EPA-approved household disinfected every day. This includes, but is not limited to tables, doorknobs, countertops, toilets, computers, and sinks. The CDC is also recommending that close contacts monitor their own health for 14 days from the first day of contact with the infected patient. This should include taking their own temperature twice a day. At the first sign of fever or respiratory symptoms, a healthcare provider should be contacted.
The CDC has taken an active role in trying to prevent the spread of the virus. In the past week, they have started to screen airline passengers arriving on directly or through connections from Wuhan China. One case has been identified in the United States in a person returning from Wuhan on January 21, 2020. The CDC sent a response team to where the patient is located and the patient. Placing that patient in isolation has hopefully prevented additional spread of the virus in the United States, but it is possible for the virus to arrive with other people traveling to North America from countries where more cases of the virus have been identified.
What are some of the symptoms and what are areas people should express caution?
Symptoms may appear as soon as two days or up to 14 days after initial exposure to the virus. General symptoms include a fever, cough, and difficulty breathing. It is possible that some patients may not experience a fever. This includes young children, older adults, those with diseases or who are on medications that suppress the immune system, and those taking medications which lower fever. Some patients may develop more severe complications. Those with severe symptoms can experience pneumonia, acute respiratory distress syndrome, or sepsis.
The CDC has established an infection control plan that includes mandatory isolation for any person who is determined to be infected with this novel coronaviruses. Those who are determined to be well enough to be cared for at home will be isolated at home and monitored by the health department. Patients who experience more severe disease and require hospitalization will be appropriately isolated to prevent spread to other patients, as well as hospital employees and staff.
About the Harrison School of Pharmacy
Auburn University’s Harrison School of Pharmacy is ranked among the top 20 percent of all pharmacy schools in the United States, according to U.S. News & World Report. Fully accredited by the Accreditation Council for Pharmacy Education (ACPE), the School offers doctoral degrees in pharmacy (Pharm.D.) and pharmaceutical sciences (Ph.D.) while also offering a master’s in pharmaceutical sciences. The School’s commitment to world-class scholarship and interdisciplinary research speaks to Auburn’s overarching Carnegie R1 designation that places Auburn among the top 100 doctoral research universities in the nation. For more information about the School, please call 334.844.8348 or visit http://pharmacy.auburn.edu.
Last Updated: January 27, 2020