Routine Coronavirus Infections (229E, NL63, OC43 and HKU1)
Coronavirus Disease 2019–2020 (COVID-19)
Severe Acute Respiratory Syndrome (SARS)
Comment: No specific treatment guidelines exist for non-SARS or non-COVID-19 coronavirus infections.
Comment: An early report includes electron microscopy photomicrographs as well as sequence analysis of what is now termed COVID-19 disease and SARS-2-CoV virus.
Comment: People evaluated as per this report in the US mostly were those with a history of travel/contacts from Wuhan City, China which is the apparent epicenter of this epidemic. Of 210 people, 148 (70%) had travel-related risk only, 42 (20%) had close contact with an ill laboratory-confirmed 2019-nCoV patient or PUI, and 18 (9%) had both travel- and contact-related risks. Eleven of these persons had a laboratory-confirmed 2019-nCoV infection. Given reports now around the globe, it is unclear if testing only those with potential links to China is prudent, but current availability of test kits from the CDC likely precludes wider testing until either FDA-approved or EUA approval is given to current commercially available respiratory panels to include COVID-19.
Comment: Strain analysis to date of COVID-19 suggests that they are very similar to bat SAR-like coronavirus.
Comment: One of the initial major reports of the Wuhan COVID-19 epidemic. In this series, the median age was 56 and slightly more men (54%) affected. Predominant symptoms include fever, fatigue and dry cough. Leukopenia was seen in ~70%. Thirty-six patients (26.1%) were transferred to the intensive care unit (ICU) because of complications, including acute respiratory distress syndrome (22 [61.1%]), arrhythmia (16 [44.4%]), and shock (11 [30.6%]).
Comment: Authors have sequenced what is now termed SARS-2-CoV. Its genome 79.5% sequence identify to SARS-CoV. Furthermore, it was found that 2019-nCoV is 96% identical at the whole-genome level to a bat coronavirus.
Comment: An early report that suggests the antimalarial chloroquine has shown efficacy against COVID-19 infection in Chinese trials. Of note, this drug has been tried for CHKV and others without good virological effect.
Comment: Summary of earlier in vitro studies suggesting drugs that may work against COVID-19. Remdesivir is currently under investigation in the Wuhan epidemic. This drug also has had activity for both prevention and treatment in a rhesus macaque module of MERS-CoV,
Comment: Chest CT shows early ground-glass infiltrates which may offer speedier "diagnosis" than PCR studies in an epidemic setting as a first finding if molecular assays not readily available.
Comment: The routine respiratory coronaviruses were seen mostly from December to May with a peak in January-February in this study of children as well as adults. In this respect, it runs about the same as influenza with a longer tail into the springtime. In this group, OC43 was most common with 229E the least. The highest infection frequency occurred in children under 5 years; children also sought medical attention (20%) than adults (9%). Older adults don’t appear especially prone to coronavirus infections compared to younger adults. This study backs that it mostly causes mild disease.
Comment: A Norwegian study found that human coronavirus infection was found in 10% of hospitalized patients, with high viral loads correlating with the presence of respiratory tract infection.
Comment: Much like MERS, in an outbreak of coronavirus infection on Reunion Island (in the Indian Ocean), severe illness resulting in ICU admission was usually occurring in patients with co-morbidities or older age.
Comment: In this young adult population, 30% of viral URTIs had HCoV while rhinovirus was second at 7.6%.
Comment: Study of 854,575 HCoV tests from 117 labs in the U.S. found peak incidence during December to March. Of these tests performed, 2.2% were positive for HCoV-OC43, 1.0% for HCoV-NL63, 0.8% for HCoV-229E, and 0.6% for HCoV-HKU1.
Comment: Unsurprisingly, HCoV was often shed > 21 days in the HSCT population.
Comment: A child with SCID, develop encephalitis with biopsy-proven etiology of OC43 in this letter to the NEJM.
Comment: Review of respiratory tract infections potentially affecting military recruits. Limited human coronavirus studies exist. Authors review one study involving U.S. military recruits in October 2011 through March 2013, investigators found that 35 (6%) of 615 recruits with FRI were infected with strains OC43 (67%), 229E (21%), and NL63 (12%). In the other involving Marine Corps recruits in Parris Island, SC, in the early 1970s, strain OC43 was identified in one winter, with 1% to 2% of such recruits sustaining infections and some of them being hospitalized for characteristic ARD. HCoV infections are an uncommon cause of ILI among patients seen at U.S. military MTFs (∼1%) (USAFSAM, unpublished data, 30 March 2015).
Comment: After RSV, human coronavirus infection was the leading cause of infection-causing hospitalization among this population in Kenya. Pneumonia caused by coronavirus was not as severe as RSV.
Comment: Canadian pneumonia study isolated coronavirus in 4 out of 193 total patients. The overall study found 15% of patients admitted with pneumonia had viral infections including influenza, hMPV and RSV.
Comment: An Australian study looked for the newly described human coronavirus NL63 among others in schoolchildren with acute respiratory illness. Both the coronavirus and hMPV infections were identified in 3.3% and 6.1% of specimens respectively. These viruses were also associated with children attending daycare.
Comment: Study refutes association with Kawasaki's disease suggested by Esper, et al.
Comment: Possible association with Kawasaki disease, although other studies have not confirmed this link [see Dominguez ref].
Comment: Findings indicate that non-pneumonic cases of SARS co-V infection do occur and were found in 0.48% of the population studied. Such infections may account for cases of SARS in patients with no obvious clinical exposure to symptomatic patients.
Comment: Nasopharyngeal swabs obtained from 50 children with asthma and were processed for PCR screening for viral infection. Adenovirus DNA was found in 78%, rhinovirus in 32% and coronavirus RNA in 2.7%. Similar viral genetic material was found in only 1 of the 20 healthy controls. The authors suggest that persistent viral infection may be associated with on-going asthma in these children.
Comment: Of 1198 patients admitted to a hospital in Houston, Texas with respiratory illness, evidence for infection with either rhinovirus or coronavirus was found in 61 (5.1%). The clinical expression of these infections included acute asthma, pneumonia, exacerbation of COPD and congestive heart failure. The vast majority of these patients had an underlying "cardiopulmonary" disease. All age groups were affected.
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