Novel Coronavirus Information Center

Elsevier’s free health and medical research on novel coronavirus (2019-nCoV)

Welcome to Elsevier's Novel Coronavirus Information Center.

A week in late January has shown us (again) how rapidly a new disease can take root and spread. Such events are accompanied by an explosion of clinical and epidemiological information and research. The goal of this website is to open whatever resources we can to help public health authorities, researchers and clinicians contain and manage this disease. We will provide continually updated resources from Elsevier's content and experts. Our resources span scientific and medical journals and textbooks, educational products, and a variety of other resources, like travel precautions from the CDC and media posts of interest to our community.

The site is curated by clinical experts from our Global Health business and updated frequently to keep pace with evolving knowledge.

If you're looking for information on our other free and low-cost access programs, including resources for patients and caregivers, you can find that here.

Margaret Trexler Hessen, MD
Director, Point of Care
Elsevier

Expert guidance and commentary

Key facts for clinicians

By Margaret Trexler Hessen, MD | January 27, 2020

Background: In December, China notified the World Health Organization of several cases of human respiratory illness, which appeared to be linked to an open seafood and livestock market in the city of Wuhan. The infecting agent has since been identified as a novel coronavirus, now called 2019-nCoV. Although the virus is presumed zoonotic in origin, person-to-person spread is evident. Cases have now been reported in many other areas of China and in other countries in Asia, Europe, the Asia Pacific and North America. Although travel within China has been restricted, and screening of travelers is being implemented in other countries, it is anticipated that more cases will be seen both inside China and internationally.

Novel coronaviruses have emerged as human pathogens in the past, notably associated with outbreaks of SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome). Current investigative methods and recommendations derive in some part from the experience of those epidemics.

Clinical presentation: The incubation period is thought to be 2 to 14 days. Symptoms include fever (which may be absent in persons at extremes of age or with immunocompromise), cough and dyspnea. Chest radiographs may show bilateral infiltrates. Clinical illness varies from mild to severe; about 25% of confirmed cases have been classified as severe, and there are increasing numbers of deaths. In early cases, mortality was associated with advanced age or comorbidities.

Diagnosis: Although respiratory infections (including influenza) are prevalent in the northern hemisphere during the winter, clinicians should inquire about travel history in persons presenting with respiratory illness. The possibility of 2019-nCoV infection should be suspected in persons who present with compatible clinical illness and exposure history. The US Centers for Disease Control (CDC) and World Health Organization (WHO) have slightly different criteria for whom to test, as noted below:

• Recent travel (within 14 days) from Wuhan, Hubei Province, China (WHO, CDC).
• Close contact with a person suspected or known to have infection due to 2019-nCoV (WHO, CDC). The CDC defines close contact as being within 6 feet (2 meters) or within a room or care area for a prolonged period without personal protective equipment OR having direct contact with secretions of a person with 2019-nCoV infection.
• Exposure to a healthcare facility in a country where hospital-associated nCoV infections have been reported (WHO).
• The disease occurs in a healthcare worker who has been working in an environment where patients with severe acute respiratory infections are being cared for, without regard to place of residence or history of travel (WHO).
• The person develops an unusual or unexpected clinical course, especially sudden deterioration despite appropriate treatment, without regard to place of residence or history of travel, even if another etiology has been identified that fully explains the clinical presentation (WHO).

In the United States, suspected cases should be reported immediately to local or state health departments, which will determine whether the patient meets clinical and epidemiologic criteria for disease and coordinate diagnostic testing of suspected patients through the CDC. Collection of specimens from the upper respiratory tract, lower respiratory tract and serum is recommended as a priority; other specimens, such as stool or urine, may be collected and stored to be tested at the discretion of the CDC. The CDC provides detailed information on collection and shipping of specimens for cases approved by local or state authorities. The CDC advised that testing for other respiratory pathogens by the provider should be done as part of the initial evaluation and should not delay specimen shipping to CDC.

If a patient with suspected 2019-nCoV infection tests positive for another respiratory pathogen, after clinical evaluation and consultation with public health authorities, they may no longer be considered a person under investigation.

Management: No specific antiviral agent is available for treatment of this infection, and there is no vaccine. Treatment is supportive and includes supplemental oxygen and conservative fluid management, as indicated by clinical condition. WHO provides detailed guidance on such supportive measures and cautions that severely ill patients should be treated empirically for other possible causes while diagnostic test results are pending.

Infection control measures are an integral part of management. Precautions should be instituted as soon as 2019-nCoV infection is suspected:

• Provide the patient with a face mask and place the patient in a closed room (preferably with structural safeguards against airborne transmission).
• Persons entering the room should follow standard, contact, and airborne precautions.
• Patients managed at home are encouraged to self-isolate to a single area of the house (preferably with a separate bathroom) and to wear a face mask during any contact with household members.
• The patient and all household members should follow diligent hand and cough hygiene.

Complications: Respiratory failure and septic shock occur in some patients. The case fatality rate is about 3 percent.

Margaret Trexler Hessen, MD, is an infectious disease specialist with 20 years of clinical practice experience and public health service, including outbreak management. She has been with Elsevier since 2010 and is currently Director, Point of Care.

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Clinicians need reliable and current information to combat novel coronavirus

By Jonathan Temte, MD, PhD | January 27, 2020

Coronaviruses are incredibly diverse, found in many animal species, and are commonly encountered in clinical practice during the cold and flu season, yet many primary care clinicians are not familiar with these respiratory pathogens. We rarely test for them, and when we do it’s usually when we’re looking for something else. Moreover, we have no specific treatments for these viruses.

The usual suspects have funny names: coronavirus HKU1, NL63, 229E and OC43. In our ongoing surveillance and epidemiological studies in school, clinics and longterm care settings, we find all four of these. There are two other coronaviruses that have been previously shown to infect humans: SARS (severe acute respiratory syndrome-associated coronavirus, or SARS-CoV), which emerged in 2003, and MERS (Middle East Respiratory Syndrome Coronavirus, or MERS-CoV), which emerged in 2012. SARS and MERS are associated with high case fatality rates.

Now a novel coronavirus, named 2019-nCoV, has emerged in China. There are hundreds of cases in China and multiple cases across the globe. The second case in the US was confirmed Friday in Illinois. We are extremely early in this rapidly expanding outbreak. With this evolving situation comes fear, misinformation and many unknowns. Accordingly, clinicians need to find reliable and current sources of credible information. A good place to start is the CDC resource page for healthcare professionals.

Jonathan Temte, MD, PhD, is Associate Dean for Public Health and Community Engagement and Professor of Family Medicine and Community Health at the University of Wisconsin School of Medicine and Public Health and former Chair of the Advisory Committee on Immunization Practices (ACIP). Jon currently serves as Chair of the Wisconsin Council on Immunization Practices and has been active on pandemic influenza and bioterrorism working groups for the state. He is a consultant for Elsevier's PracticeUpdate.

Elsevier Clinical Solutions

We've selected content from Clinical Solutions Nursing, Interprofessional Practice and Patient Education collections to share what we know to date about the novel coronavirus.

Patient engagement resources

Patient engagement resources use plain language to support shared decision-making between patients and healthcare providers. The goal is to deliver the right message in the right way at the time the patient is most ready to learn. The following resources provide an overview of the novel coronavirus to help patients and their families understand their risk, identify signs and symptoms, and prevent it from spreading:

• Patient Education document “Novel Corona Virus Infection”
• Video on hand hygiene
• Video on pneumonia

Clinical Skills for Nursing

Clinical Skills for Nursing provides the highest quality evidence for nursing practice procedures for nurses to care for patients. Our Isolation Precautions and Personal Protective Equipment checklists align with CDC and OSHA guidelines:

• Skills checklist “Isolation Precautions and Personal Protective Equipment”
• Extended text: “Isolation Precautions: Personal Protective Equipment”

Interprofessional Care Plans

These Interprofessional Care Plans provide an evidence-based and individualizable Interprofessional plan of care to manage fever and the possible development of pneumonia, which is consistent with the presentation of this virus. Using an interprofessional approach to patient care that aligns current evidence with the individual needs of the patient results in improved patient care outcomes.

• Care Plan Guide: Fever — Adult
• Care Plan Guide: Fever — Pediatric
• Care Plan Guide: Pneumonia — Adult
• Care Plan Guide: Pneumonia — Pediatric

中文资源 (Chinese-language resources)

Research

In this section, you can find the following resources:

• Journal articles, including The Lancet Coronavirus hub
• Book chapters
• Early-stage research (preprints on SSRN)

The Lancet Coronavirus hub

To assist health workers and researchers working under difficult and dangerous conditions to bring this outbreak to a close, The Lancet has created a Coronavirus hub page. This hub brings together new coronavirus content from The Lancet journals as it is published.

Articles in Elsevier journals

We will be updating this section continually.

• The Middle East Respiratory Syndrome (MERS), Infectious Disease Clinics of North America (Dec 2019)
• Severe Acute Respiratory Syndrome: Historical, Epidemiologic, and Clinical Features, Infectious Disease Clinics of North America (Dec 2019)
• Human Mobility and the Global Spread of Infectious Diseases: A Focus on Air Travel, Trends in Parisitology (Sept 2018)
• Biothreat Agents and Emerging Infectious Disease in the Emergency Department, Emergency Medicine Clinics of North America (May 2019)
• Emerging Respiratory Viruses in Children, Infectious Disease Clinics of North America (March 2018)
• Betacoronavirus Adaptation to Humans Involved Progressive Loss of Hemagglutinin-Esterase Lectin Activity, Cell Host & Microbe (March 2017)
• Epidemic and Emerging Coronaviruses (Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome), Clinics in Chest Medicine (March 2017)
• The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China, International Journal of Infectious Diseases (Feb 2020)
• Cross-sectional investigation and risk factor analysis of community-acquired and hospital-associated canine viral infectious respiratory disease complex, Heliyon (Nov 2019)
• Chiral zirconium quantum dots: A new class of nanocrystals for optical detection of coronavirus, Heliyon (Aug 2018)
• Middle East Respiratory Syndrome Coronavirus: What Do We Know?, The Journal for Nurse Practitioners (Jan 2015)

More published research

• Vincent J. Munster, PhD, et al: A Novel Coronavirus Emerging in China — Key Questions for Impact Assessment, The New England Journal of Medicine (Jan 24, 2020)
• Na Zhu, PhD, et al: A Novel Coronavirus from Patients with Pneumonia in China,  2019, The New England Journal of Medicine (Jan 24, 2020)
• Stanley Perlman, MD, PhD: Another Decade, Another Coronavirus, The New England Journal of Medicine (Jan 24, 2020)
• Catharine I. Paules, MD; Hilary D. Marston, MD, MPH; Anthony S. Fauci, MD: Coronavirus Infections — More Than Just the Common Cold – JAMA Viewpoint, JAMA Network (Jan 2020)

Book chapters

• Coronaviruses, Chapter 31, Fenner and White's Medical Virology (Fifth Edition (Elsevier's Academic Press, 2017)
• Coronaviruses, Including Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), Chapter 157, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Eighth Edition (Elsevier, 2015)

Early-stage research (preprints on SSRN platform)

Emerging and rapidly evolving healthcare emergencies necessitate the quick dissemination of research. The growing role of preprints, or early-stage research, was acknowledged in the Ebola and Zika virus outbreaks as a way of “accelerating the dissemination of scientific findings to support responses to infectious disease outbreaks.”

SSRN, Elsevier’s world-leading platform devoted to the rapid worldwide dissemination of early-stage research, is committed to making authors' coronavirus related research available immediately. Research on SSRN is free to download and upload. It is important to note that these papers have not benefited from the pivotal role of the peer-review process, which validates and improves the quality of final published journal articles.

• Cell Pyroptosis, a Potential Pathogenic Mechanism of 2019-nCoV Infection (Jan 29, 2020)
• Estimating the Transmission of Airborne Pathogens in Dental Clinics, Preprints with The Lancet (Jan 28, 2020)
• Sofosbuvir Can Inhibit the Newly Emerged Coronavirus (2019-nCoV) in Wuhan, China, Preprints with The Lancet (Jan 28, 2020)
• Estimation of the Transmission Risk of 2019-nCov and Its Implication for Public Health Interventions (Jan 27, 2020)
• Early transmissibility assessment of a novel coronavirus in Wuhan, China (Jan 27, 2020)
• Epidemiological and Clinical Characteristics of 99 Cases of 2019-Novel Coronavirus (2019-nCoV) Pneumonia in Wuhan, China, Preprints with The Lancet (Jan 27, 2020)

Related resources

Here, you will find official guidance from major health organizations such as the CDC and WHO and media posts of interest to our community.

• Travel precautions from the CDC
• CDC information and updates
• CDC guidance for healthcare professionals
• CDC: Information for Laboratories
• WHO: Novel coronavirus advice for the public
• WHO: Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected: Interim Guidance
• WHO: Statement on the meeting of the IHR (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV)
• National Genomic Data Center (China) 2019 nCoV Resource Center (新型冠状病毒信息库)

Official coronavirus guidance from various countries:

Australia | Canada | China | France | Singapore | Spain | UK | US

In the media

• Coronavirus Hits China Exchange Programs (Inside Higher Ed). Following CDC guidance, colleges are suspending travel to China, a popular destination for faculty and students and a country where many colleges have deep connections.