|A decade removed from the last pandemic –Novel H1N1 Influenza in 2008-9, which resurfaced again in 2013 — the world is confronting the next global viral outbreak, the Coronavirus Disease of 2019 (COVID-19) novel coronavirus (named the SARS-CoV-2 virus), which has emerged prominently in the global arena. The novel 2019-nCoV Coronavirus was first identified and isolated in patients with respiratory illnesses in Wuhan City, China, in December 2019, and in a few months has already infected almost 100,000 individuals in over 50 countries including the U.S.
Read on for more valuable information about the Coronavirus and opportunities for telemedicine to play a critical role in US domestic and worldwide efforts to combat the spread of disease.
What factors contribute to a global pandemic?
In short, it amounts to two major considerations: Disease Spread and Disease Severity. A disease that can be easily transmitted and is particularly virulent can cause worldwide disaster. Conversely, a disease which cannot be easily communicated to others, or one which, even if easily transmitted, has a relatively benign clinical course (like the common cold, the most common Coronavirus) is not of great concern to the global medical community.
What are coronaviruses?
Coronaviruses are a family of viruses which are well known and have been studied since the 1930’s. While most are benign, such as the common cold, particular mutations can cause an uptake in the virulence of the microorganism, leading to outbreaks of severe disease states. This includes Severe Acute Respiratory Syndrome (SARS), which was responsible for over 700 deaths, predominantly in Asia in 2003; and Middle Eastern Respiratory Syndrome (MERS). COVID-19 is this type of virus.
What do we know about this most recent virus strain?
First isolated from a patient with respiratory illness in in Wuhan City, China, it has since been identified in tens of thousands of patients in China, with other major areas of infection including Italy (Milan) and Iran. There have been over 3,000 confirmed deaths, thought the true number is likely much higher due to underreporting and under-diagnosis.
Although there were initially very few cases in the United States, this past month has brought the virus to our shores. There have been over 100 confirmed cases in the U.S. with nine deaths, all of whom in patients with long standing chronic medical conditions. Small outbreaks were noted in Washington state (Seattle) and California. Although currently episodes of the virus have been sporadic within the U.S., the Center for Disease Control (CDC) warned that it is likely that there will be widespread transmission over the coming months.
With the virulence associated to this particular virus strand in the context of the global interconnected world in which we live, experts are justifiably concerned for wide and rapid spread of the infection. The World Health Organization places the mortality rate from COVID19 infection at 3-4%, which is significantly higher than Influenza infection this year. Hence, there is genuine and legitimate concern that a global infectious spread could prove catastrophic.
Combatting the Spread of this Virus
Thankfully, infectious disease specialists, public health experts, physicians and public policy leaders have stepped in to take meaningful, aggressive measures to combat the spread of the virus. Chinese leaders have quarantined city inhabitants, closed local shops (reportedly Starbucks has shut down many of its local branches) and instituted regulations on mask wearing, hand hygiene and close monitoring for anyone at risk of contracting the illness.
Many countries have either limited flights or travel to China or stopped it entirely. The United States has similarly quarantined a large number of at-risk targets, ceased flights to China and issued a strict travel advisory. I just returned from a trip to California and can attest to the near ubiquitous presence of masks and hand sanitizers and wipes in airports and on airlines.
The Critical Role of Telemedicine
Telemedicine is poised to play a crucial role in the management of this potential global health hazard.
From an epidemiological standpoint, there are certain differences between this year’s seasonal influenza viral infection and that of COVID 19. The time from infection to the development of symptoms (latency period) is longer, hence individuals can exist in a carrier state for up to two weeks. Additionally, it transmits more easily than seasonal influenza, through means such as via coughing, sneezing and touching surfaces that infected individuals have contacted. Unlike the flu which typically has high fevers, body aches and fatigue, in addition to upper respiratory symptoms such as runny nose or cough, the symptoms of COVID19 are more mild. Both, however, can cause severe pneumonias and other respiratory complications, particularly in elder individuals and those with chronic medical conditions.
Overall, however, the initial signs and symptoms of the infection cannot be easily distinguished from other more benign coronavirus, or other viral, such as influenza infections, and the syndrome cannot be diagnosed without specific diagnostics. Additionally, as of yet, there are no approved medications or vaccines for the infection, so care for patients is limited to supportive and preventive care.
There are a number of important roles that telemedicine physicians can play.
First and foremost, physicians must counsel patients who may need to travel to the region on the risks that such an endeavor would entail. Patients must be made aware as to the scientific realities on the ground. Additionally, those who were in the regions in question, or who were potentially exposed, must be instructed on the proper means – barrier, anti-septic, quarantine, etc. – to prevent exposing others. Specifically:
1. Washing one’s hands regularly with soap and water for at least 20 seconds
2. Avoiding unnecessary social contact such as hand shaking and hugging
3. Avoiding touching one’s nose, mouth or face; and washing one’s hands (or disinfecting) after such contact occurs
4. Staying home if one feels ill, particularly with a fever, cough or runny nose
5. Seeking medical attention if one is short of breath, has difficulty breathing, has high spiking fevers or symptoms that continue without improvement.
Moreover, patients with possible exposure who are experiencing symptoms must be coached to seek medical attention immediately, alert those who they may have inadvertently spread the illness to and direct their medical teams to rule out the novel virus via specific diagnostic evaluation.
Lastly, telemedicine may prove to be a useful area of health information regarding the spread of the infection, identifying new areas of infection and serving as a helpful means of containment. What better clinical service to coordinate and quarantine a disease then a national centralized physician network whose expertise is remote communications and cloud-based software reporting?
Patients and providers who have ANY QUESTIONS at all are recommended to contact their local health department for further information and guidance.
It is our sincere hope that current measures help stem the tide of infection spread and prevent worldwide viral dissemination. Telemedicine stands to play a crucial role both in the continued management and isolation of the virus, as well as in coordinating care should it emerge in small pockets in other international domains.