As of March 10, there are >115,000 confirmed cases of Coronavirus Disease 2019 (COVID-19) across the world including >1,000 confirmed cases in the United States and >116 in California. Symptoms may appear 2-14 days after exposure to the novel coronavirus, and may include fever, non-productive cough, and shortness of breath. The course of disease is mild in 4 out of 5 cases and most people will recover spontaneously. Mortality from COVID-19 is age-dependent, with highest mortalities observed in the elderly, and varies widely between nations, from 0.2% in Germany to over 0.7% in South Korea and 3.2% in the United States to 5% in Italy. The comparatively higher mortality rates in Italy can be explained at least in part by the fact that in Italy, testing is focused on individuals above 50 years of age, who represent 77% of diagnosed cases but only 44% of Italy’s population.
Slowly, testing for the novel coronavirus is becoming more widely available, but there is still a significant shortage of tests. Starting on March 10, UC San Diego began offering daily testing in-house, which means a much shorter turnaround time as results don’t have to be sent out to the CDC. Because of a limited supply of reagents, prior approval of Infectious Diseases specialists is required to permit ordering, and testing will be restricted to those with symptoms of fever, cough, or shortness of breath and with a history of travel within the past 14 days to communities with widespread or sustained community transmission of the coronavirus.
As a result of the continuous spread, more and more measures are coming into effect that impact daily life. For example, at UC San Diego, starting in the Spring Quarter, all lecture and discussion courses will be delivered remotely. The goal of these measures is to slow down the pandemic and to allow hospitals to prepare for the situation. At the virtual Conference on Retroviruses and Opportunistic Infections (CROI) on March 10, Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, emphasized that several vaccines for the novel coronavirus are currently being developed in the U.S. and abroad, and that the first vaccines are expected to be evaluated in clinical studies within as soon as two months. There are also 261 clinical trials underway that evaluate treatment options for COVID-19. In addition, the National Institutes of Health (NIH) trial evaluating one of the most promising drugs – Remdesivir - has started in the U.S.
At the virtual CROI meeting on March 10, it was also emphasized that for those living with HIV, low CD4 cell count and detectable viral load are likely risk factors for severe disease and mortality. Age is another important risk factor, given that >50% people with HIV in the U.S. are >50 years old. However, because this is a new virus and data is limited, it is important that all people living with HIV take precautions, which include:
- Keeping vaccinations up to date (particularly influenza and pneumococcal vaccination)
- Ensuring ample HIV medication supply (30-day supply at all times)
- Establishing a plan for clinical care if isolated/quarantined (e.g. telemedicine options or physician online portals)
- Maintaining a social network but remotely. Social distancing, meaning remaining out of congregate settings, avoiding mass gatherings, and maintaining distance (approximately 6 feet) from others when possible is recommended by the CDC
- Avoiding close contact with people who are sick, when possible
- Avoiding touching your eyes, nose, and mouth
- Washing hands often with soap and water for at least 20 seconds
We will be back with more updates, and the newest information can always be found on the CDC webpage: https://www.cdc.gov/coronavirus/2019-ncov/index.html
This update was prepared by Dr. Martin Hoenigl and Dr. Susan Little of the UC San Diego Antiviral Research Center.