March 4, 2020

As the new respiratory virus known initially as the ‘coronavirus’ continues to dominate headlines, it seems like a good time to briefly review what we know (and don’t know) about this novel virus and take a look at the current state (as of this writing on 3/4/20).

A novel coronavirus, which likely originated in bats and subsequently gained the ability to spread from animals to humans, and then from human to human, was first detected in China and has now been identified in more than 70 countries around the world, including the US. It has been officially named ‘Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)’, and the respiratory disease that it causes is now being called COVID-19.

The virus has been shown to cause a broad spectrum of clinical illness, from mild symptoms to severe respiratory disease leading to death. Early estimates from patients who received medical attention in China suggest that approximately 80% of cases are mild, 15% severe, and 5% with critical illness. Initial symptoms are fever and cough, similar to influenza and other common respiratory infections. Also similar to influenza, the SARS-CoV-2 virus appears to cause more severe disease in the elderly, although at least from preliminary data out of China, it does not appear to cause severe disease in the very young, as flu is known to do. COVID-19 also appears to be more severe, at least in China, in men over 40, for reasons which remain unclear to date.

Given the rapid spread of this virus in China and then to other countries, over a month ago the WHO declared the outbreak a ‘public health emergency of international concern’ and the following day the US declared a ‘public health emergency’ here as well. There are legitimate fears that the virus will reach pandemic status.  To do so, it must meet a number of criteria—the virus must cause illness, including severe illness resulting in death, it must demonstrate sustained person-to-person spread, and it must demonstrate worldwide spread.  The SARS-CoV2 virus has already met the first two criteria, and appears to be approaching the third. The transmissibility and fatality rates appear similar to other pandemic viruses including the pandemic influenza virus of 1918, which is concerning when considering the global impact if the virus does reach pandemic status.

Health officials in the US and around the world are racing to better understand this new virus, develop vaccines, identify effective treatments, and track and limit its spread. To date, there have been over 94,000 COVID-19 cases around the world, with more than 120 of those now in the US across more than a dozen states.

Here in NH, DHHS officials have been monitoring this situation closely. As of this week, NH has its first confirmed case, in an adult health care worker in Grafton who had traveled in Italy. Given the evolving situation globally and nationally, it seems likely that we will be confronted with additional cases of COVID-19 here in the Granite State. Both the CDC (https://www.cdc.gov/coronavirus/2019-ncov/summary.html) and NH DHHS (https://www.dhhs.nh.gov/dphs/cdcs/2019-ncov.htm) have excellent, comprehensive, and up to date information on COVID-19, including information for providers on testing and treatment. The NHMS will continue to monitor the situation as well and provide updates as needed, as well as continuing to link to official WHO, CDC, and NH DHHS information in the Pulse to aid NH physicians in continuing to reference fact-based and current information on this rapidly evolving situation.

In health,

John Klunk, MD
NHMS President

Please send comments or questions to john.klunk@nhms.org.