Monthly News Bite From The Pathologist: Feb 2020 Coronavirus Update (2019-nCoV)

The epidemiological reports on the novel coronavirus (2019-nCov) suggest that the reach of the virus is indeed expanding. While it does not fulfill the academic criteria for a pandemic, the spread of cases is certainly concerning. For clinicians in southern Africa, it must be noted that there are no currently confirmed cases at the time of writing. A press release issued by the Ministry of Health Republic of Botswana (File MH3/30/1 XVIII (62)) reported a suspected case on 31 January 2020, but this remains unconfirmed. While vigilance is necessary, sensationalism can impact public health efforts negatively.The guidelines for case definitions are provided below.

Currently the only authorized laboratory to confirm 2019-nCoV is the National Institute of Communicable Diseases (NICD Hotline number 082 883 9920 and see website for updates http://www.nicd.ac.za/covid-19-update-5/). Private laboratories may help to facilitate communications and transfers, but there is only one national authority on the subject, and that is the NICD.

 

Guidelines for case definition

If the patient satisfies epidemiological AND clinical criteria, they are classified as a suspect case.

Epidemiological criteria

Travel to agreed areas of human-to-human transmission OR Close contact (see Contact definition below) with a confirmed case of 2019-nCoV within the last 14 days.

Clinical criteria

Fever or history of fever and acute respiratory infection (sudden onset of respiratory infection with at least one of: shortness of breath, cough or sore throat)

OR

Severe acute respiratory infection requiring admission to hospital with clinical or radiological evidence of pneumonia or acute respiratory distress syndrome (i.e. even if no evidence of fever).

Confirmed case

A person who tests positive to a specific 2019-nCoV PCR test at a reference laboratory.

Reference for further reading: Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al.  Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Jan 24. doi: 10.1016/S0140-6736(20)30183-5. PMID: 31986264.

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