SARS-CoV-2 and COVID-19 Executive Daily Digest
Coronavirus-19 (COVID-19), resulting from novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), began in December 2019 in Wuhan, China. The World Health Organization (WHO)1 declared a global health emergency on January 30, 20202 and a pandemic on March 11, 2020.3 COVID-19 was first reported in the United States (U.S.) on January 21, 2020 and in Kansas (KS) on March 7, 2020.
The total number of COVID-19 infections markedly exceeds previous coronavirus infection outbreaks including SARS in 2002 (8,098 infections, 774 deaths) and MERS in 2012 (2,458 infections, 848 deaths),4,5 implying a much higher case-fatality rate in SARS and MERS, however, the limited horizontal transmission of these viruses helped contain the outbreaks.
Analysis of 72,314 cases from China revealed that 81% of infections are mild, 14% are severe, and 5% are critical (respiratory failure, septic shock, and/or multiple organ dysfunction), with an overall fatality rate of 2.3%.6 In the US, analysis of 4,226 cases from the CDC as of March 16, 2020 reported estimated rates of hospitalization to be 20.7-31.4%, intensive care unit (ICU) admission to be 4.9-11.5%, and case fatality to be 1.8-3.4%.7 Based on population sampling in S. Korea and Germany, we estimate that 30% of infected people will be asymptomatic;8 however, more data is needed from US populations to better measure this. It is important because it impacts the speed at which the vulnerable population will become infected and thereafter immune.
The most common presenting symptoms for COVID-19 include fever (83-99%), cough (59-82%), fatigue (44-70%), anorexia (40-84%), and shortness of breath (31-40%). Other frequently observed symptoms include muscle soreness (11-35%), headache, as well as gastrointestinal symptoms. Extrapulmonary symptoms may occur early in the disease course including heart failure and kidney failure among others.9
COVID-19 testing during community spread
As outlined by the WHO, phases 5 and 6 of a pandemic refer to sustained community outbreaks at a global level with human-to-human transmission.10 Once community spread has been established in these pandemic phases and there is documentation of spread via asymptomatic individuals, pre-screening checklists have limited utility. Additionally, given the currently limited COVID-19 testing in the US including KS, individuals at-risk of spreading disease cannot be easily identified11. We recognize that this state may change if rapid testing is available, and patients can be tested, and results can be achieved quickly prior to hospitalization or ICU admission.
The target audience of this document includes hospital executives, physicians, advanced practice providers, nurses, and other health care professionals. Patients, the public, as well as policy makers may also benefit from this document. This document is not intended to impose a standard of care for individual institutions or healthcare systems. It provides the basis for rational and evidence based informed decisions in the setting of COVID-19 pandemic.
To provide this summary the committee evaluate data from
- CDC, NIH and WHO
- Local and reginal public Health departments
- Projections based on published models
- Actual data from KS and KUHS
- Data from other states and healthcare organizations
- Published and unpublished data from the literature
Information in this document may not be valid in the near future. We will conduct periodic reviews of the available evidence and continuously monitor the data to determine if information require modification. Based on the rapidly evolving nature of this pandemic, information will likely need to be updated daily. This document is not intended to establish clinical practice guidelines or the standard of care. Physicians should exercise their own clinical judgement in the care of individual patients.
- WHO. World Health Organization. World Health Organization. https://www.who.int. Published 2020. Accessed March 30, 2020, 2020.
- Chang D, Lin M, Wei L, et al. Epidemiologic and Clinical Characteristics of Novel Coronavirus Infections Involving 13 Patients Outside Wuhan, China. JAMA. 2020;323(11):1092-1093.
- Liu K, Fang YY, Deng Y, et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chin Med J (Engl). 2020.
- Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020.
- Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet.395(10223):497-506.
- Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet.395(10223):507-513.
- Chen L, Liu HG, Liu W, et al. [Analysis of clinical features of 29 patients with 2019 novel coronavirus pneumonia]. Chung-Hua Chieh Ho Ho Hu Hsi Tsa Chih Chinese Journal of Tuberculosis & Respiratory Diseases.43(3):203-208.
- Freund A. Up to 30% of coronavirus cases asymptomatic. 2020. https://www.dw.com/en/up-to-30-of-coronavirus-cases-asymptomatic/a-52900988. Accessed March 30, 2020.
- CDC. Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html: Centers for Disease Control and Prevention;2020.\
- WHO. Pandemic Influenza Preparedness and Response: A WHO Guidance Document. https://www.who.int/influenza/resources/documents/pandemic_guidance_04_2009/en/: World Health Organization;2009.
- Zhang W, Du RH, Li B, et al. Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerging Microbes & Infections.9(1):386-389.