With the increasing number of 2019 novel coronavirus (2019 nCoV) cases both in China and across the world, it’s time to consider the impact and management of this disease from an EMS perspective. There are currently 11 known cases of 2019 nCoV identified in the U.S., so it is not time for hysteria. It is, however, time for education and preparation. This is also a great time to review and update your department’s procedures to address all types of highly infectious and contagious diseases. The numbers are constantly changing, so some of this information may become outdated quickly.
What is a coronavirus?
The 2019 nCoV is a specific coronavirus that causes respiratory illness similar to influenza. In fact, around 20% of cases of the normal common cold are caused by various coronaviruses. Past respiratory illness outbreaks such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) have also been a result of coronavirus infections.
How is the 2019 nCoV spread?
The 2019 nCoV is thought to be spread by respiratory droplet transmission and/or contact with infected patients, so PPE consists of gloves, eye protection, and an N95 mask for the EMS provider. It is also advised to place a surgical mask on any prospective infected patient if they tolerate this clinically.
Where did this 2019 nCoV start, and how bad is it?
The 2019 nCoV started in late December in Wuhan, a city of more than 11 million people in central China. It has since spread to Southeast Asia, Europe, Canada, and the U.S. The current mortality is believed to be approximately 3%, with older adults being affected most frequently. There have been more than 360 deaths and 17,000 cases in China, and another 170 confirmed cases in more than 20 additional countries.
What are we doing to protect the public in the U.S. currently?
Identification, quarantine, and contact tracing are the key steps in the initial management of any outbreak. We are currently screening passengers returning from Wuhan in multiple U.S. airports. In the U.S. all infected individuals are currently quarantined, with the first secondary transmission recently confirmed. Additionally, all travel from Wuhan has been shut down by the Chinese government in attempt to decrease spread.
What specific actions should a medic take if they are concerned a patient may be at risk for 2019 nCoV?
First of all, these cases will likely present like any other upper respiratory viral illness, ranging from mild cough and aches to sepsis and respiratory failure. Therefore, don’t forget the ABCs and basic management of respiratory pathology.
Three additional steps are necessary if you are concerned about 2019 nCoV. First, ask if the patient has been to Wuhan or in contact with anyone who has. If the answer is no, then as of now the risk is quite low. However, if the patient answers “yes” or you are still concerned, apply an N95 to yourself (along with eye protection and gloves) and a surgical mask to the patient (if tolerated). Finally alert your receiving emergency department as soon as possible to facilitate isolation placement upon arrival.
Please see www.CDC.gov for additional information and check out the associated MCHD Paramedic Podcast.
Dr. Casey Patrick is the assistant medical director for Montgomery County Hospital District EMS and is a practicing emergency physician in multiple community emergency departments in the greater Houston area. His EMS educational focus is on innovative paramedic teaching via the MCHD Paramedic Podcast.