By Ranu S. Dhillon & Devabhaktuni Srikrishna
A new respiratory coronavirus, 2019-nCoV, is rapidly spreading throughout China, where authorities have imposed an unprecedented travel lockdown in 16 cities with a combined population of over 50 million.
With no vaccine or treatment, the most effective way to stop 2019-nCoV’s spread is to limit transmission by identifying infected individuals as quickly as possible, and isolating them for treatment before they can infect others. Because 2019-nCoV, like SARS, causes common symptoms, such as a fever and coughing, and can only be distinguished from more routine illnesses with laboratory testing, the same playbook used against SARS could be adapted to counter 2019-nCoV:
Contact tracing
People who have been around someone with a confirmed infection should be identified and monitored. If they develop any symptoms, they should be isolated and treated until laboratory testing can be done to determine if they have 2019-nCoV.
Screening with clinical case definition
Because there are likely many unreported cases, we need to use a clinical case definition, a checklist of symptoms and risk factors suggestive of infection, to screen people not known to be contacts of infected people but who have concerning symptoms. Those who screen positive should be isolated and treated until tested and, if positive, quarantined until they are no longer capable of transmitting infection.
These strategies are already being implemented. However, if it turns out that asymptomatic transmission—transmitting the disease by someone who displays no symptoms—is possible, all contacts and people who have been exposed to areas with known transmission would also need to be tested, regardless of whether they show any signs of illness. If people without symptoms are capable of transmitting the virus, it would be impossible to test entire city populations. These daunting challenges could be mitigated by using additional approaches not employed during the SARS crisis:
Home-based isolation
A system could immediately be established to take test samples from patients with concerning symptoms who are not severely ill and then send them home with protective respirator masks, instructions on hand-washing to prevent the further spread of the disease and orders to remain at home until the test results come back.
Rapid diagnostics
Another measure that could prove essential is the development of rapid, “point-of-care” diagnostic tests that do not require specialized equipment or technicians, and can provide results within minutes.
The 2019-nCoV epidemic is evolving by the hour. We need to move swiftly to respond to this threat.
Ranu S. Dhillon is an instructor at Harvard Medical School. Devabhaktuni Srikrishna is the founder of Patient Knowhow.
Image credits: Valeriy Kachaev | Dreamstime.com
