Thinking about hot issues in the diagnosis and treatment of novel coronavirus pneumonia_West China Medical Journal

Authors：

BAI Lang , WANG Ming , TANG Xiaoqiong , SHANG Jin , JIANG Wei , LÜ Duoduo , WANG Yonghong , HAN Ning , HUANG Wei , DU Lingyao ,  TANG Hong

Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

TANG Hong, Email: htang6198@hotmail.com

Keywords：

2019 novel coronavirus; Novel coronavirus pneumonia; Hotspot issues; Views

DOI：

10.7507/1002-0179.202002044

Video：

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At the end of December 2019, some hospitals in Wuhan, Hubei, China found unexplained pneumonia cases one after another. On January 12, 2020, World Health Organization officially named the new coronavirus that caused the outbreak as “2019 new coronavirus”. The National Health Committee of China has organized experts to compile a “pneumonia diagnosis and treatment program for new coronavirus infection” to guide the prevention, control, diagnosis and treatment of the disease. However, due to the limited knowledge of the disease, there are still many problems to be solved in the diagnosis and treatment of the disease. We reviewed the researches on coronavirus infections related to severe acute respiratory syndrome and Middle East respiratory syndrome, combined with our own experience in diagnosis and treatment, and proposed some thoughts on several unclear hot issues such as the mode of disease transmission, the incubation period, the practical application of diagnostic standards, and the choice of treatment drugs in the diagnosis and treatment plan.

Citation： BAI Lang, WANG Ming, TANG Xiaoqiong, SHANG Jin, JIANG Wei, LÜ Duoduo, WANG Yonghong, HAN Ning, HUANG Wei, DU Lingyao, TANG Hong. Thinking about hot issues in the diagnosis and treatment of novel coronavirus pneumonia. West China Medical Journal, 2020, 35(2): 125-131. doi: 10.7507/1002-0179.202002044 Copy

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2.	Holshue ML, DeBolt C, Lindquist S, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med, 2020.
3.	Schaefer E, Harms C, Viner M, et al. Investigation of an experimental infection model of equine coronavirus in adult horses. J Vet Intern Med, 2018, 32(6): 2099-2104.
4.	Li Y, Wu Q, Huang L, et al. An alternative pathway of enteric PEDV dissemination from nasal cavity to intestinal mucosa in swine. Nat Commun, 2018, 9(1): 3811.
5.	Jones RM, Brosseau LM. Aerosol transmission of infectious disease. J Occup Environ Med, 2015, 57(5): 501-508.
6.	Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet, 2020: S0140-6736(20)30154-9.
7.	Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med, 2020.
8.	Zhao Z, Zhang F, Xu M, et al. Description and clinical treatment of an early outbreak of severe acute respiratory syndrome (SARS) in Guangzhou, PR China. J Med Microbiol, 2003, 52(Pt 8): 715-720.
9.	Cai QC, Xu QF, Xu JM, et al. Refined estimate of the incubation period of severe acute respiratory syndrome and related influencing factors. Am J Epidemiol, 2006, 163(3): 211-216.
10.	Hui DS, Memish ZA, Zumla A. Severe acute respiratory syndrome vs. the Middle East respiratory syndrome. Curr Opin Pulm Med, 2014, 20(3): 233-241.
11.	Cheng VC, Lau SK, Woo PC, et al. Severe acute respiratory syndrome coronavirus as an agent of emerging and reemerging infection. Clin Microbiol Rev, 2007, 20(4): 660-694.
12.	Peiris JS, Lai ST, Poon LL, et al. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet, 2003, 361(9366): 1319-1325.
13.	Azhar EI, Hui DSC, Memish ZA, et al. The middle east respiratory syndrome (MERS). Infect Dis Clin North Am, 2019, 33(4): 891-905.
14.	World Health Organization. Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases. (2020-01-17)[2020-02-06]. https://www.who.int/publications-detail/laboratory-testing-for-2019-novel-coronavirus-in-suspected-human-cases-20200117.
15.	Branche AR, Walsh EE, Formica MA, et al. Detection of respiratory viruses in sputum from adults by use of automated multiplex PCR. J Clin Microbiol, 2014, 52(10): 3590-3596.
16.	Chan KH, Poon LL, Cheng VC, et al. Detection of SARS coronavirus in patients with suspected SARS. Emerg Infect Dis, 2004, 10(2): 294-299.
17.	Jeong JH, Kim KH, Jeong SH, et al. Comparison of sputum and nasopharyngeal swabs for detection of respiratory viruses. J Med Virol, 2014, 86(12): 2122-2127.
18.	Lei J, Li J, Li X, et al. CT imaging of the 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology, 2020, 31: 200236.
19.	Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020: S0140-6736(20)30183-5.
20.	Sui X, Huang Y, Song W, et al. Clinical features of pulmonary cryptococcosis in thin-section CT in immunocompetent and non-AIDS immunocompromised patients. Radiol Med, 2020, 125(1): 31-38.
21.	Josset L, Menachery VD, Gralinski LE, et al. Cell host response to infection with novel human coronavirus EMC predicts potential antivirals and important differences with SARS coronavirus. mBio, 2013, 4(3): e00113-e00165.
22.	Lau SK, Lau CC, Chan KH, et al. Delayed induction of proinflammatory cytokines and suppression of innate antiviral response by the novel Middle East respiratory syndrome coronavirus: implications for pathogenesis and treatment. J Gen Virol, 2013, 94(Pt 12): 2679-2690.
23.	Cinatl J, Morgenstern B, Bauer G, et al. Treatment of SARS with human interferons. Lancet, 2003, 362(9380): 293-294.
24.	Ströher U, DiCaro A, Li Y, et al. Severe acute respiratory syndrome-related coronavirus is inhibited by interferon-alpha. J Infect Dis, 2004, 189(7): 1164-1167.
25.	Hensley LE, Fritz LE, Jahrling PB, et al. Interferon-beta 1a and SARS coronavirus replication. Emerg Infect Dis, 2004, 10(2): 317-319.
26.	de Wilde AH, Raj VS, Oudshoorn D, et al. MERS-coronavirus replication induces severe in vitro cytopathology and is strongly inhibited by cyclosporin A or interferon-α treatment. J Gen Virol, 2013, 94(Pt 8): 1749-1760.
27.	Haagmans BL, Osterhaus AD. Coronaviruses and their therapy. Antiviral Res, 2006, 71(2/3): 397-403.
28.	Loutfy MR, Blatt LM, Siminovitch KA, et al. Interferon alfacon-1 plus corticosteroids in severe acute respiratory syndrome:a preliminary study. JAMA, 2003, 290(24): 3222-3228.
29.	刘鉴峰, 刘金剑, 褚丽萍, 等. 雾化吸入干扰素 α1b 在兔体内的分布及代谢途径. 医药导报, 2013, 32(1): 1-5.
30.	Momattin H, Mohammed K, Zumla A, et al. Therapeutic options for Middle East respiratory syndrome coronavirus (MERS-CoV)--possible lessons from a systematic review of SARS-CoV therapy. Int J Infect Dis, 2013, 17(10): e792-e798.
31.	中华医学会呼吸病学分会呼吸治疗学组. 雾化治疗专家共识 (草案). 中华结核和呼吸杂志, 2014, 37(11): 805-808.
32.	Koren G, King S, Knowles S, et al. Ribavirin in the treatment of SARS: a new trick for an old drug?. CMAJ, 2003, 168(10): 1289-1292.
33.	Levy MM, Baylor MS, Bernard GR, et al. Clinical issues and research in respiratory failure from severe acute respiratory syndrome. Am J Respir Crit Care Med, 2005, 171(5): 518-526.
34.	Tai DY. Pharmacologic treatment of SARS: current knowledge and recommendations. Ann Acad Med Singapore, 2007, 36(6): 438-443.
35.	Lee N, Hui D, Wu A, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med, 2003, 348(20): 1986-1994.
36.	Barnard DL, Day CW, Bailey K, et al. Enhancement of the infectivity of SARS-CoV in BALB/c mice by IMP dehydrogenase inhibitors, including ribavirin. Antiviral Res, 2006, 71(1): 53-63.
37.	Falzarano D, de Wit E, Martellaro C, et al. Inhibition of novelβ coronavirus replication by a combination of interferon-α2b and ribavirin. Sci Rep, 2013, 3: 1686.
38.	Wong RS, Wu A, To KF, et al. Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis. BMJ, 2003, 326(7403): 1358-1362.
39.	Al-Tawfiq JA, Momattin H, Dib J, et al. Ribavirin and interferon therapy in patients infected with the Middle East respiratory syndrome coronavirus: an observational study. Int J Infect Dis, 2014, 20: 42-46.
40.	Tsang KW, Ho PL, Ooi GC, et al. A cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med, 2003, 348(20): 1977-1985.
41.	丁可, 徐作军, 黄慧, 等. 409 例传染性非典型肺炎糖皮质激素应用的回顾性分析. 实用全科医学, 2005, 3(3): 193-194.
42.	林江涛. 传染性非典型肺炎治疗中糖皮质激素应用的几个问题. 中华结核和呼吸杂志, 2003, 26(6): 326-327.
43.	Stockman LJ, Bellamy R, Garner P. SARS: systematic review of treatment effects. PLoS Med, 2006, 3(9): e343.
44.	World Health Organization. Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (‎MERS-CoV)‎ infection is suspected. (2019-01)[2020-02-06]. https://apps.who.int/iris/bitstream/handle/10665/178529/WHO_MERS_Clinical_15.1_eng.pdf;jsessionid=BD4B6FD240B454EF60E4A7FBFCC91F9C?sequence=1.

1. Lu R, Zhao X1, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet, 2020: S0140-6736(20)30251-8.
2. Holshue ML, DeBolt C, Lindquist S, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med, 2020.
3. Schaefer E, Harms C, Viner M, et al. Investigation of an experimental infection model of equine coronavirus in adult horses. J Vet Intern Med, 2018, 32(6): 2099-2104.
4. Li Y, Wu Q, Huang L, et al. An alternative pathway of enteric PEDV dissemination from nasal cavity to intestinal mucosa in swine. Nat Commun, 2018, 9(1): 3811.
5. Jones RM, Brosseau LM. Aerosol transmission of infectious disease. J Occup Environ Med, 2015, 57(5): 501-508.
6. Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet, 2020: S0140-6736(20)30154-9.
7. Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med, 2020.
8. Zhao Z, Zhang F, Xu M, et al. Description and clinical treatment of an early outbreak of severe acute respiratory syndrome (SARS) in Guangzhou, PR China. J Med Microbiol, 2003, 52(Pt 8): 715-720.
9. Cai QC, Xu QF, Xu JM, et al. Refined estimate of the incubation period of severe acute respiratory syndrome and related influencing factors. Am J Epidemiol, 2006, 163(3): 211-216.
10. Hui DS, Memish ZA, Zumla A. Severe acute respiratory syndrome vs. the Middle East respiratory syndrome. Curr Opin Pulm Med, 2014, 20(3): 233-241.
11. Cheng VC, Lau SK, Woo PC, et al. Severe acute respiratory syndrome coronavirus as an agent of emerging and reemerging infection. Clin Microbiol Rev, 2007, 20(4): 660-694.
12. Peiris JS, Lai ST, Poon LL, et al. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet, 2003, 361(9366): 1319-1325.
13. Azhar EI, Hui DSC, Memish ZA, et al. The middle east respiratory syndrome (MERS). Infect Dis Clin North Am, 2019, 33(4): 891-905.
14. World Health Organization. Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases. (2020-01-17)[2020-02-06]. https://www.who.int/publications-detail/laboratory-testing-for-2019-novel-coronavirus-in-suspected-human-cases-20200117.
15. Branche AR, Walsh EE, Formica MA, et al. Detection of respiratory viruses in sputum from adults by use of automated multiplex PCR. J Clin Microbiol, 2014, 52(10): 3590-3596.
16. Chan KH, Poon LL, Cheng VC, et al. Detection of SARS coronavirus in patients with suspected SARS. Emerg Infect Dis, 2004, 10(2): 294-299.
17. Jeong JH, Kim KH, Jeong SH, et al. Comparison of sputum and nasopharyngeal swabs for detection of respiratory viruses. J Med Virol, 2014, 86(12): 2122-2127.
18. Lei J, Li J, Li X, et al. CT imaging of the 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology, 2020, 31: 200236.
19. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020: S0140-6736(20)30183-5.
20. Sui X, Huang Y, Song W, et al. Clinical features of pulmonary cryptococcosis in thin-section CT in immunocompetent and non-AIDS immunocompromised patients. Radiol Med, 2020, 125(1): 31-38.
21. Josset L, Menachery VD, Gralinski LE, et al. Cell host response to infection with novel human coronavirus EMC predicts potential antivirals and important differences with SARS coronavirus. mBio, 2013, 4(3): e00113-e00165.
22. Lau SK, Lau CC, Chan KH, et al. Delayed induction of proinflammatory cytokines and suppression of innate antiviral response by the novel Middle East respiratory syndrome coronavirus: implications for pathogenesis and treatment. J Gen Virol, 2013, 94(Pt 12): 2679-2690.
23. Cinatl J, Morgenstern B, Bauer G, et al. Treatment of SARS with human interferons. Lancet, 2003, 362(9380): 293-294.
24. Ströher U, DiCaro A, Li Y, et al. Severe acute respiratory syndrome-related coronavirus is inhibited by interferon-alpha. J Infect Dis, 2004, 189(7): 1164-1167.
25. Hensley LE, Fritz LE, Jahrling PB, et al. Interferon-beta 1a and SARS coronavirus replication. Emerg Infect Dis, 2004, 10(2): 317-319.
26. de Wilde AH, Raj VS, Oudshoorn D, et al. MERS-coronavirus replication induces severe in vitro cytopathology and is strongly inhibited by cyclosporin A or interferon-α treatment. J Gen Virol, 2013, 94(Pt 8): 1749-1760.
27. Haagmans BL, Osterhaus AD. Coronaviruses and their therapy. Antiviral Res, 2006, 71(2/3): 397-403.
28. Loutfy MR, Blatt LM, Siminovitch KA, et al. Interferon alfacon-1 plus corticosteroids in severe acute respiratory syndrome:a preliminary study. JAMA, 2003, 290(24): 3222-3228.
29. 刘鉴峰, 刘金剑, 褚丽萍, 等. 雾化吸入干扰素 α1b 在兔体内的分布及代谢途径. 医药导报, 2013, 32(1): 1-5.
30. Momattin H, Mohammed K, Zumla A, et al. Therapeutic options for Middle East respiratory syndrome coronavirus (MERS-CoV)--possible lessons from a systematic review of SARS-CoV therapy. Int J Infect Dis, 2013, 17(10): e792-e798.
31. 中华医学会呼吸病学分会呼吸治疗学组. 雾化治疗专家共识 (草案). 中华结核和呼吸杂志, 2014, 37(11): 805-808.
32. Koren G, King S, Knowles S, et al. Ribavirin in the treatment of SARS: a new trick for an old drug?. CMAJ, 2003, 168(10): 1289-1292.
33. Levy MM, Baylor MS, Bernard GR, et al. Clinical issues and research in respiratory failure from severe acute respiratory syndrome. Am J Respir Crit Care Med, 2005, 171(5): 518-526.
34. Tai DY. Pharmacologic treatment of SARS: current knowledge and recommendations. Ann Acad Med Singapore, 2007, 36(6): 438-443.
35. Lee N, Hui D, Wu A, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med, 2003, 348(20): 1986-1994.
36. Barnard DL, Day CW, Bailey K, et al. Enhancement of the infectivity of SARS-CoV in BALB/c mice by IMP dehydrogenase inhibitors, including ribavirin. Antiviral Res, 2006, 71(1): 53-63.
37. Falzarano D, de Wit E, Martellaro C, et al. Inhibition of novelβ coronavirus replication by a combination of interferon-α2b and ribavirin. Sci Rep, 2013, 3: 1686.
38. Wong RS, Wu A, To KF, et al. Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis. BMJ, 2003, 326(7403): 1358-1362.
39. Al-Tawfiq JA, Momattin H, Dib J, et al. Ribavirin and interferon therapy in patients infected with the Middle East respiratory syndrome coronavirus: an observational study. Int J Infect Dis, 2014, 20: 42-46.
40. Tsang KW, Ho PL, Ooi GC, et al. A cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med, 2003, 348(20): 1977-1985.
41. 丁可, 徐作军, 黄慧, 等. 409 例传染性非典型肺炎糖皮质激素应用的回顾性分析. 实用全科医学, 2005, 3(3): 193-194.
42. 林江涛. 传染性非典型肺炎治疗中糖皮质激素应用的几个问题. 中华结核和呼吸杂志, 2003, 26(6): 326-327.
43. Stockman LJ, Bellamy R, Garner P. SARS: systematic review of treatment effects. PLoS Med, 2006, 3(9): e343.
44. World Health Organization. Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (‎MERS-CoV)‎ infection is suspected. (2019-01)[2020-02-06]. https://apps.who.int/iris/bitstream/handle/10665/178529/WHO_MERS_Clinical_15.1_eng.pdf;jsessionid=BD4B6FD240B454EF60E4A7FBFCC91F9C?sequence=1.

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