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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Coronavirus 101</title><author><name sortKey="Holstein, Barbara" sort="Holstein, Barbara" uniqKey="Holstein B" first="Barbara" last="Holstein">Barbara Holstein</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmc">7146654</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146654</idno><idno type="RBID">PMC:7146654</idno><idno type="doi">10.1016/j.nurpra.2020.03.021</idno><idno type="pmid">NONE</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000E76</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000E76</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Coronavirus 101</title><author><name sortKey="Holstein, Barbara" sort="Holstein, Barbara" uniqKey="Holstein B" first="Barbara" last="Holstein">Barbara Holstein</name></author></analytic><series><title level="j">The Journal for Nurse Practitioners</title><idno type="ISSN">1555-4155</idno><idno type="eISSN">1878-058X</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>COVID-2019 emerged from China in late December. It follows two other coronavirus outbreaks, the SARS-CoV and the MERS-CoV. Coronaviruses usually circulate among animals but sometimes can jump to humans. These three strains have caused severe disease in humans and global transmission concerns. Symptoms of COVID-2019 include cough, fever, and shortness of breath. Related illnesses can range from mild to severe to fatal. Primary care providers must be alert to respiratory symptoms they encounter that are associated with pertinent travel history, be prepared to safely screen, examine and possibly test and/or report suspicions to the health department for further evaluation.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="O Neil, J" uniqKey="O Neil J">J. O'Neil</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Coleman, C" uniqKey="Coleman C">C. Coleman</name></author><author><name sortKey="Frieman, M" uniqKey="Frieman M">M. Frieman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Paules, C" uniqKey="Paules C">C. Paules</name></author><author><name sortKey="Marston, H" uniqKey="Marston H">H. Marston</name></author><author><name sortKey="Fauci, A" uniqKey="Fauci A">A. Fauci</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="De Wit, E" uniqKey="De Wit E">E. de Wit</name></author><author><name sortKey="Van Doremalen, N" uniqKey="Van Doremalen N">N. van Doremalen</name></author><author><name sortKey="Falzarano, D" uniqKey="Falzarano D">D. Falzarano</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chen, N" uniqKey="Chen N">N. Chen</name></author><author><name sortKey="Min, Z" uniqKey="Min Z">Z. Min</name></author><author><name sortKey="Dong, X" uniqKey="Dong X">X. Dong</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shi, C" uniqKey="Shi C">C. Shi</name></author><author><name sortKey="Nabar, N" uniqKey="Nabar N">N. Nabar</name></author><author><name sortKey="Huang, N" uniqKey="Huang N">N. Huang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fehr, A" uniqKey="Fehr A">A. Fehr</name></author><author><name sortKey="Rudragouda, C" uniqKey="Rudragouda C">C. Rudragouda</name></author><author><name sortKey="Perlman, S" uniqKey="Perlman S">S. Perlman</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Wu, F" uniqKey="Wu F">F. Wu</name></author><author><name sortKey="Su, Z" uniqKey="Su Z">Z. Su</name></author><author><name sortKey="Bin, Y" uniqKey="Bin Y">Y. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Nurse Pract</journal-id><journal-id journal-id-type="iso-abbrev">J Nurse Pract</journal-id><journal-title-group><journal-title>The Journal for Nurse Practitioners</journal-title></journal-title-group><issn pub-type="ppub">1555-4155</issn><issn pub-type="epub">1878-058X</issn><publisher><publisher-name>Elsevier</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmc">7146654</article-id><article-id pub-id-type="publisher-id">S1555-4155(20)30181-1</article-id><article-id pub-id-type="doi">10.1016/j.nurpra.2020.03.021</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Coronavirus 101</article-title></title-group><contrib-group><contrib contrib-type="author" id="au1"><name><surname>Holstein</surname><given-names>Barbara</given-names></name><degrees>MSN, FNP (retired)</degrees><email>barbholstein9@gmail.com</email><xref rid="cor1" ref-type="corresp">∗</xref></contrib></contrib-group><author-notes><corresp id="cor1"><label>∗</label>Corresponding author, Volunteer provider at Hope Clinic, Midvale, Utah, 1377 Emerson Avenue SLC, Utah 84105 1-801-485-5025 <email>barbholstein9@gmail.com</email></corresp></author-notes><pub-date pub-type="pmc-release"><day>10</day><month>4</month><year>2020</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub"><day>10</day><month>4</month><year>2020</year></pub-date><history><date date-type="received"><day>10</day><month>3</month><year>2020</year></date><date date-type="rev-recd"><day>23</day><month>3</month><year>2020</year></date><date date-type="accepted"><day>24</day><month>3</month><year>2020</year></date></history><permissions><copyright-statement>Published by Elsevier Inc.</copyright-statement><copyright-year>2020</copyright-year><copyright-holder></copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><abstract id="abs0010"><p>COVID-2019 emerged from China in late December. It follows two other coronavirus outbreaks, the SARS-CoV and the MERS-CoV. Coronaviruses usually circulate among animals but sometimes can jump to humans. These three strains have caused severe disease in humans and global transmission concerns. Symptoms of COVID-2019 include cough, fever, and shortness of breath. Related illnesses can range from mild to severe to fatal. Primary care providers must be alert to respiratory symptoms they encounter that are associated with pertinent travel history, be prepared to safely screen, examine and possibly test and/or report suspicions to the health department for further evaluation.</p></abstract><abstract abstract-type="author-highlights" id="abs0015"><title>Highlights</title><p><list list-type="simple" id="ulist0010"><list-item id="u0010"><p id="p0010">A newly emerged zoonotic coronavirus, COVid-19, threatens global health security</p></list-item><list-item id="u0015"><p id="p0015">WHO has declared COVID-19 virus a "public health emergency of international concern"</p></list-item><list-item id="u0020"><p id="p0020">Cases of COVID-19 are spreading in communities worldwide from person to person</p></list-item><list-item id="u0025"><p id="p0025">CDC recently warned that community spread of COVID is expected to increase in the U.S.</p></list-item><list-item id="u0030"><p id="p0030">WHO stresses virus containment, surveillance, prevention at all levels of healthcare</p></list-item></list></p></abstract></article-meta></front><body><sec id="sec1"><title>Epidemiology/Pathophysiology</title><p id="p0035">For the most part, little is known about emerging pathogens before they emerge so, frequently, viruses from zoonotic sources that are unrecognized present a unique challenge to science and medicine. A zoonosis is an infection caused by bacteria, viruses, parasites, or fungi transferred from a non-human animal to humans.<xref rid="bib1" ref-type="bibr"><sup>1</sup></xref> Zoonotic transmission may be due to a spillover event from an animal to a human, which is caused by a sustained or new close human contact or by climate changes that affect the distribution of disease vectors, e.g.; insects that have been previously restricted geographically through the effects of climate changes. Evolution of a pathogen that has been previously animal-restricted can cause a virus to emerge-one that is capable of utilizing a human receptor or the cellular machinery needed to cause infection.<xref rid="bib2" ref-type="bibr"><sup>2</sup></xref> Coronaviruses (CoVs) are large enveloped, positive strand RNA viruses. These viruses fall into four genera: alpha, beta, delta, and gamma. The two CoV subtypes known to affect humans (HCoVs) are alpha and beta. Four HCoVs including HCoV229E, NL63, OC43, and HKU1 account for 10%-30% of adult respiratory infections and are endemic globally. The ecologically diverse coronavirus occurs most prevalently in bats which serve as a host reservoir.<xref rid="bib3" ref-type="bibr"><sup>3</sup></xref> The mild types of CoVs in humans, which cause the common cold, gained little attention until 2002 when the virus emerged from Guangdong Province, China causing cases of severe atypical pneumonia. This disease, which became known as SARS, or severe acute respiratory syndrome, caused world-wide concern when it spread to 37 countries.<xref rid="bib4" ref-type="bibr"><sup>4</sup></xref> The causative agent was SARS-CoV and bats were determined to be the zoonotic reservoir. Subsequent transmission to humans transpired from civets (an Asian animal related to the mongoose and weasel) which had become infected by a bat.<xref rid="bib4" ref-type="bibr"><sup>4</sup></xref><sup>,</sup><xref rid="bib5" ref-type="bibr"><sup>5</sup></xref> Globally, this virus affected more than 8,000 people and had a 10% fatality rate.<xref rid="bib6" ref-type="bibr"><sup>6</sup></xref> Following SARS, MERS-CoV emerged in 2012 from the Middle Eastern Arabian Peninsula. Like SARS, the origin host for MERS-CoV is the bat but the transmitting animal is typically the dromedary camel. The virus has infected 1728 people, since its emergence, and has had a 35.6% mortality rate since August of 2016.<xref rid="bib7" ref-type="bibr"><sup>7</sup></xref></p><p id="p0040">Recently, in December of last year, coronavirus re-emerged, once again from China, with the initial outbreak in Wuhan, a city located in the country's Hubei Province. It has since been designated as SARS-CoV-2 and the resulting disease is called COVID-2019 <xref rid="bib8" ref-type="bibr"><sup>8</sup></xref>. Close to 300,000 cases, globally, have been reported, since its outbreak. The point of origin is considered to be a seafood/animal market in Wuhan which houses and sells, not only fish, but exotic animals including hedgehogs, badgers, snakes, and birds (turtledoves).<xref rid="bib8" ref-type="bibr"><sup>8</sup></xref><sup>,</sup><xref rid="bib9" ref-type="bibr"><sup>9</sup></xref> This new virus, like the SARS and MERS coronaviruses, is also a beta subtype and its exact animal host/reservoir has yet to be determined. However, the World Health Organization (WHO) has reported that environmental samples taken from the marketplace came back positive for COVID-2019. Its similarity to SARS is found in the predominant human receptor for the SARS S glycoprotein, human angiotensin-converting enzyme 2 (ACE2), which is found primarily in the lower respiratory tract, rather than in the upper airway.<xref rid="bib3" ref-type="bibr"><sup>3</sup></xref> This may be a partial explanation for the severe respiratory symptoms and consequences of both diseases including acute respiratory distress syndrome (ARDS). When cases were being confirmed in people who had not visited the Wuhan seafood market or been in its proximity, suspicions arose that the virus was being transmitted from person to person.<xref rid="bib10" ref-type="bibr"><sup>10</sup></xref> A study published by the New England Journal of Medicine of the first 435 patients that were infected with the new virus, in Wuhan, found that the median age was 59 years old (range of 15-89 yrs.), 56% were male, and that no children < 15yrs had contracted the disease.<xref rid="bib11" ref-type="bibr"><sup>11</sup></xref> Since this study, however, a retrospective study at Wuhan University that was published in JAMA has reported that 9 infants had contracted COVID-2019 ranging in age from 1-11mos. of which seven were female.<xref rid="bib12" ref-type="bibr"><sup>12</sup></xref> The first confirmed U.S. case of COVID-2019 was diagnosed in the state of Washington, on January 30, 2020, resulting from person to person contact, and was it determined to be caused through international travel to Wuhan, China.<xref rid="bib13" ref-type="bibr"><sup>13</sup></xref> This, also, is the date the rapidly spreading virus was declared a public health emergency of international concern (PHEIC) by the International Health Regulations (IHR) emergency committee of the WHO. PHEIC is defined by the WHO as "an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease; and to potentially require a coordinated international response.” This definition implies a situation that: "is serious, unusual, or unexpected; carries implications for public health beyond the affected State’s national border; and may require immediate international action." Declaring a PHEIC expands the WHO’s authority to coordinate a response in various ways, including through the issuance of recommendations on whether countries should impose trade and travel restrictions.<xref rid="bib10" ref-type="bibr"><sup>10</sup></xref> Five other diseases which have met the WHO criteria for this particular designation include Ebola (2019) in the Democratic Republic of Congo, Zika (2016), Ebola (2014) in West Africa, Polio (2014), and H1N1 (2009).<xref rid="bib14" ref-type="bibr"><sup>14</sup></xref> Since January 30, and as of March 23, the Center for Disease Control (CDC) has reported a total of 33,044 confirmed cases of COVID-2019 in the U.S. in all 50 states including the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands. Among this number, there have been 400 deaths.<xref rid="bib8" ref-type="bibr"><sup>8</sup></xref> The hardest hit state thus far has been New York. A global pandemic stemming from the virus was officially declared by the WHO on March 11. The total number of people infected globally, as of March 23, according to the WHO, is 332,930 and the virus has spread to most regions of the world with 14,510 resultant deaths. China, the virus' epicenter has confirmed 81,601 cases with 3276 fatalities to date.<xref rid="bib8" ref-type="bibr"><sup>8</sup></xref><sup>,</sup><xref rid="bib10" ref-type="bibr"><sup>10</sup></xref> Global mortality rate so far is at 4.4%, a much lower rate than the SARS and MERS viruses at this point in time. Daily updated statistics can be found at the CDC and WHO websites. Some cities, states and complete countries have been forced to <italic>shelter in place</italic> in an effort to prevent further spread. COVID-2019 has not, as of yet, peaked according to public health authorities with the ultimate scope and effects of the outbreak remaining to be seen. The number of confirmed cases has far surpassed those of both SARS and MERS combined-placing an astounding strain on health care systems. The CDC recommendations for international travel from the U.S. can be found on its website. Ultimately, international travel is not recommended, if it is not essential, and postponement of any nonessential international travel should, especially, be considered by older adults and those with chronic medical conditions (CDC Warning Level 3).<xref rid="bib8" ref-type="bibr"><sup>8</sup></xref></p></sec><sec id="sec2"><title>Transmission</title><p id="p0045">Although the origin of the COVID-2019 is zoonotic, current epidemiologic data demonstrate that human transmission is occurring.<xref rid="bib8" ref-type="bibr"><sup>8</sup></xref><sup>,</sup><xref rid="bib10" ref-type="bibr"><sup>10</sup></xref><sup>,</sup><xref rid="bib18" ref-type="bibr"><sup>18</sup></xref> It is thought to spread through respiratory droplets resulting from a cough or sneeze of an infected person that reaches people who are in close contact i.e.; people who are 6 feet or less apart. Transmission may occur through a person who has contact with infected surfaces or objects who then touch their eyes, nose or mouth but this, as yet, has not been considered a frequent route of transmission for this particular coronavirus. The COVID-2019 virus appears to spread most from a person who is at the peak of their symptoms. It has been suspected that it is spread as well from persons infected with the virus who are not yet exhibiting symptoms.<xref rid="bib8" ref-type="bibr"><sup>8</sup></xref> The incubation period has been determined to be 2-14 days. Transmission of the disease remains easy and sustainable in Hubei Province and in other parts of China and now has a similar spread in many other countries. CDC issued a statement on February 25, 2020 that spread was expected to occur in the U.S. and, this has since proven to be the case.</p><p id="p0050">Clinical stigmatization is a phenomenon which may occur with an infectious disease. In the case of COVID people may associate it, in general, with the Chinese population. Stigmatization would occur for example when a Chinese American, living in the U.S., is associated with the virus.<xref rid="bib8" ref-type="bibr"><sup>8</sup></xref></p><sec id="sec2.1"><title>Clinical Symptoms</title><p id="p0055">Predominant clinical symptoms are fever, dry cough, and shortness of breath.<xref rid="bib5" ref-type="bibr"><sup>5</sup></xref><sup>,</sup><xref rid="bib8" ref-type="bibr"><sup>8</sup></xref><sup>,</sup><xref rid="bib10" ref-type="bibr"><sup>10</sup></xref><sup>,</sup><xref rid="bib15" ref-type="bibr"><sup>15</sup></xref><sup>,</sup><xref rid="bib16" ref-type="bibr"><sup>16</sup></xref><sup>,</sup><xref rid="bib17" ref-type="bibr"><sup>17</sup></xref><sup>,</sup><xref rid="bib18" ref-type="bibr"><sup>18</sup></xref> Ten percent of patients have presented with nausea and diarrhea 1-2 days prior to development of fever and dyspnea in a retrospective study in a Wuhan, China hospital. Upon imaging examination, 74 (75%) patients in this same cohort showed bilateral pneumonia.<xref rid="bib5" ref-type="bibr"><sup>5</sup></xref> As with SARS and MERS, a large number of patients have exhibited symptoms of viral pneumonia including fever, difficulty breathing, and in the most severe cases bilateral infiltrates.<xref rid="bib16" ref-type="bibr"><sup>16</sup></xref> Patients admitted to ICU were older adults and those who had comorbid conditions-suggesting a poor outcome.<xref rid="bib5" ref-type="bibr"><sup>5</sup></xref> Complications, in addition to pneumonia, included respiratory failure, ARDS, cardiac injury, shock, kidney injury, and fatal outcomes.<xref rid="bib5" ref-type="bibr"><sup>5</sup></xref><sup>,</sup><xref rid="bib17" ref-type="bibr"><sup>17</sup></xref></p><p id="p0060">Pregnant women, because they are in an immunosuppressive state that causes adaptive changes such as diaphragm elevation, increased oxygen consumption, and edema of respiratory mucosa, are particularly susceptible to respiratory pathogens. Severe pneumonia can render these women intolerant to hypoxia<xref rid="bib19" ref-type="bibr"><sup>19</sup></xref>-this could characterize this population as high risk for COVID-2019. A retrospective study of nine Chinese pregnant women from Wuhan who were in late pregnancy and who had contracted the virus (all of whom delivered during the course of their illness) demonstrated that there was non-vertical transmission of the disease.<xref rid="bib19" ref-type="bibr"><sup>19</sup></xref> Typical symptoms of the virus were exhibited in these women and none developed pneumonia or died. Zhu et al confirmed non-vertical transmission in a study of 8 neonates born to Chinese women who had COVID-2019.<xref rid="bib20" ref-type="bibr"><sup>20</sup></xref> A larger cohort of 38 pregnant women studied by Schwartz included the nine women from Wuhan and others from areas surrounding the epicenter of the viral outbreak. Again, it was demonstrated that there were no cases of viral related maternal pneumonia or death and no vertical transmission to the neonates.<xref rid="bib21" ref-type="bibr"><sup>21</sup></xref></p><p id="p0065">In children, so far, mostly the very young appear to become infected. For example, in nine infants studied by Wei et al, who tested positive for COVID-2019, some had fever, others exhibited mild respiratory symptoms, and others had no symptoms at all. The latter group had been exposed to family members so they had been tested. No infants developed complications.<xref rid="bib12" ref-type="bibr"><sup>12</sup></xref> A second study of children with COVID-2019 published at a later date and conducted by Dong et al had a much larger cohort of 2143 children from China, demonstrating spread of the disease. Most of the cases in this study were mild and, in comparison to infected adults who had severe or critical disease in the same time frame (18.5 %),<xref rid="bib22" ref-type="bibr"><sup>22</sup></xref> only 5.9% of children had a similar progression of the disease. Only one child in this study died. The reduced clinical severity of COVID-2019 in children is not understood but is thought to be related to both exposure and host factors. There is also speculation that children are less sensitive because the binding ability, in other words, the maturity and function of ACE2 (discussed earlier) may be lower in children in comparison to adults. Children under the age of one year were the most affected, in this study-10.6 %, followed by those 1-5 years old, 7.3%, suggesting that young children particularly infants are the most vulnerable to COVID-2019.<xref rid="bib23" ref-type="bibr"><sup>23</sup></xref></p></sec><sec id="sec2.2"><title>Diagnosis/Evaluation</title><p id="p0070">Infection control measures should be implemented, when COVID-2019 is suspected, with immediate isolation. A focus should be made on early recognition. Persons presenting with fever and/or lower respiratory tract symptoms who have had recent travel to a heavily affected region within14 days or those who have had close contact with a person either suspected of having the infection or having been confirmed as infected, should be considered as potentially infected and be tested. According to the CDC, if an individual is severely ill and no etiology has been determined, even if there has been no known exposure COVID-2019, testing should be done.<xref rid="bib8" ref-type="bibr"><sup>8</sup></xref> Collection of specimens to test for COVID-2019 virus from the upper respiratory tract (nasopharyngeal and oropharyngeal swab) should be obtained. Sputum, tracheal aspirate, or bronchioalveolar lavage specimens are recommended as well, if possible, from the lower tract. Additional specimens (e.g., stool, urine) may also be collected.<xref rid="bib8" ref-type="bibr"><sup>8</sup></xref><sup>,</sup><xref rid="bib10" ref-type="bibr"><sup>10</sup></xref> COVID-2019 virus is detected by polymerase chain reaction; in the United States, testing is performed by the CDC or a CDC-qualified lab.<xref rid="bib8" ref-type="bibr"><sup>8</sup></xref><sup>,</sup><xref rid="bib15" ref-type="bibr"><sup>15</sup></xref> Specimen collection should be done by personnel wearing appropriate PPE including gown, gloves, eye protection, and a mask that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator mask.<xref rid="bib8" ref-type="bibr"><sup>8</sup></xref><sup>,</sup> Critical shortages of PPE are being acknowledged by hospitals worldwide at this time.</p></sec><sec id="sec2.3"><title>Treatment/Prevention</title><p id="p0075">Treatment is primarily supportive to help relieve symptoms such as analgesics for fever and oxygen for hypoxia as well as infection control measures. If the disease is severe, measures should be taken to support vital organ function. The WHO recommends that corticosteroids should be avoided unless indicated for other reasons (for example, chronic obstructive pulmonary disease) due to the potential for prolonging viral replication as observed in MERS-CoV patients<xref rid="bib10" ref-type="bibr"><sup>10</sup></xref><sup>,</sup><xref rid="bib24" ref-type="bibr"><sup>24</sup></xref> The following two retrospective studies of patients hospitalized in Wuhan, China with the COVID- 2019 virus outline implemented treatment regimens. In a study by Chen et al, in addition to supportive measures, at the Jinyintan Hospital some patients were given antibiotics, thirteen patients received non-invasive mechanical ventilator treatment, and four required invasive ventilation treatment.<xref rid="bib5" ref-type="bibr"><sup>5</sup></xref> At Zhongnan Hospital of Wuhan University, patients, according to the study by Huang et al, in addition to supportive care, patients received antiviral therapy (Oseltamivir, 124 [89.9%]) and many received antibiotics. ICU patients received high-flow oxygen, or noninvasive ventilation. Invasive mechanical ventilation was required in 17 patients.<xref rid="bib17" ref-type="bibr"><sup>17</sup></xref> For patients with mild infection, who can be adequately isolated in an outpatient setting, home management may be appropriate, if they have no underlying chronic conditions e.g.; heart or lung disease, renal failure or immunocompromising conditions. Management of such patients should focus on prevention of transmission to others, and monitoring for clinical deterioration, which should be reported immediately to public health officials and would prompt hospitalization <xref rid="bib8" ref-type="bibr"><sup>8</sup></xref><sup>,</sup><xref rid="bib10" ref-type="bibr"><sup>10</sup></xref> Remdesivir and Chloroquine, both broad spectrum antivirals, were tested recently in vitro by Wang et al for efficacy against COVID-2019. Both drugs showed an ability to control the virus.<xref rid="bib25" ref-type="bibr"><sup>25</sup></xref> Remdesivir was compassionately used in the first U.S. patient confirmed with COVID-2019 in the state of Washington due to this person's worsening clinical condition.<xref rid="bib13" ref-type="bibr"><sup>13</sup></xref> Compassionate use of an unapproved drug is when a patient's condition is serious and no other treatment options are available. Wang et al have recommended use of both Chloroquine and Remdesivir in persons who have this virus. However, randomized controlled trials are needed to determine the safety and efficacy of these drugs in patients with this infection, in keeping with the WHO's recommendation for of avoidance of their use.</p><p id="p0080">Management of patients who test positive during pregnancy and have no symptoms is similar to the general population in that self-monitoring at home is recommended for 14 days. These patients, as well as those self-monitoring for mild illness from the disease, due to the potential risk of intrauterine growth restriction, should have fetal growth ultrasounds and doppler assessments bimonthly. Pregnant women with COVID-2019 related pneumonia should be cared for in a tertiary care center by a multi-disciplinary team.<xref rid="bib26" ref-type="bibr"><sup>26</sup></xref> Women who test positive for COVID-2019 at delivery may safely breastfeed their newborns.<xref rid="bib8" ref-type="bibr"><sup>8</sup></xref></p><p id="p0085">The best way to prevent illness from COVID-2019, since there is no current vaccine, is to avoid being exposed to this virus. The CDC recommends everyday preventive actions to help prevent the spread of respiratory disease, including avoiding close contact with people who are sick, covering your cough or sneeze, avoidance of touching eyes, nose, and mouth, washing hands often with soap or alcohol-based hand sanitizers, and not wearing a face mask if you are well. Masks are not recommended for healthy persons for protection from the disease unless there is known exposure. <xref rid="bib8" ref-type="bibr"><sup>8</sup></xref></p></sec><sec id="sec2.4"><title>The Role of Primary Care Providers</title><p id="p0090">Indispensable tools for the detection and monitoring of outbreaks and public health emergencies include strong epidemiology and surveillance systems, however, strong primary care systems can form the foundation of any emergency response. Member states of WHO have shown a consistent commitment to training community-based health professionals who then become capable of providing care across the spectrum of prevention, preparedness, response, and recovery, which further develops primary care. Often considered the ‘front door’ of the healthcare system primary care should be involved in planning and action for health emergency risk management <xref rid="bib27" ref-type="bibr"><sup>27</sup></xref>. It is important that there is close coordination between clinicians and public health authorities at the local, state, and federal level. From a clinical perspective, when a patient presents with fever and respiratory symptoms (in particular a dry cough), clinicians should obtain a detailed travel history. CDC guidelines for health care professionals for evaluating patients' epidemiological risks, in conjunction with the characteristic symptoms of COVID-2019 can be found on its website. When symptoms, travel history, and relevant illness exposure raises suspicion for COVID-2019, the state or local health department should be immediately notified. This person becomes a person under investigation (PUI) and should be placed in isolation and infection control personnel, if applicable, for the facility should be notified immediately. Healthcare staff who are in contact with the patient should utilize PPE precautions. If, and when testing is done, testing personnel should wear an N95 respirator mask as discussed in the diagnosis/evaluation section. In the severely ill individual, testing can be considered, as previously mentioned, when another etiology has not been identified and exposure history is equivocal (e.g., uncertain travel or exposure, or no known exposure). Slowing U.S. transmission of COVID-2019 is critical and the fact that primary care providers play an important role has already become evident, since the December emergence of this virus. This has been demonstrated by the detection of eight of the first eleven U.S. cases by clinicians who then collaborated with public health officials to test persons at risk.<xref rid="bib28" ref-type="bibr"><sup>28</sup></xref> Both early recognition and an increased understanding of the virus by health care providers can reduce transmission.<xref rid="bib27" ref-type="bibr"><sup>27</sup></xref></p></sec></sec><sec id="sec3"><title>Conclusion</title><p id="p0095">The Wuhan emergence of the third coronavirus this century is a stark reminder of the continuing threat of zoonotic diseases to global health security. There is increasing international concern regarding its continued spread. The rapid identification and containment of this virus by China's public health authorities reflects the increasing global capacity to detect, identify, and define new outbreaks.<xref rid="bib29" ref-type="bibr"><sup>29</sup></xref> The disease has met all three criteria for a pandemic: 1). Caused by an illness and fatalities are related to this illness; 2). has had sustained person to person spread, and recently; 3) worldwide spread. .<xref rid="bib8" ref-type="bibr"><sup>8</sup></xref> A concerted and collaborative global effort, based on sharing experiences from all geographical regions and all disciplines, should continue to be led and coordinated by the WHO with an emphasis placed on containment, surveillance, and prevention in addition to rapid dissemination of clinical information related to the care of patients with this infection. This effort can start with early detection of the virus by primary health care providers through an awareness of COVID 2019 characteristics and recognition of possible cases, which is then followed by, if needed, coordination with public health systems. 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