Coronavirus Update: March 2, 2020

Coronavirus Disease 2019 (COVID-19) has spread across the world with over 90,000 confirmed infections to date and over 3,000 associated deaths. As of today, there are also >100 confirmed cases of COVID-19 in the United States, of which most are imported from countries including China, South Korea, and Italy (i.e. all countries which have reported >2,000 confirmed cases). As of recently, there is also evidence of community transmission, meaning that the virus has spread within the United States to people who did not travel nor had knowingly had contact with someone who had travelled outside the United States.

Symptoms may appear 2-14 days after exposure to the novel coronavirus, and may include fever, cough, and shortness of breath. The course of disease is mild in 4 out of 5 cases, while 14% have severe disease including pneumonia and requiring hospitalization, and 5% have life-threatening disease requiring admission to an Intensive Care Unit. The case fatality rate is 2.3%. Severe disease is more frequently observed in those who are older (particularly if >65 years of age), and in those with underlying diseases such as diabetes, chronic obstructive pulmonary disease (which is frequent in smokers), chronic heart failure, or cancer. To date, it remains unknown how much COVID-19 will affect people living with HIV, and if the course of disease will differ in people living with HIV from those who are HIV-negative.

Due to a national shortness of diagnostic tests, COVID-19 testing is currently limited to those with new onset acute respiratory illness who had close contact with a confirmed COVID-19 case, and those with fever, cough, and/or shortness of breath with a history of traveling to China, South Korea, Iran, Italy, or Japan, if they are also known to be either immunosuppressed (including living with HIV), have chronic lung disease, chronic heart failure, cancer, or are smokers. This means that people living with HIV who have traveled to China, South Korea, Iran, Italy, or Japan and present to the ED/Urgent Care with fever or respiratory symptoms will be tested for COVID-19. If people don’t fulfill these criteria, it is currently unlikely that they get tested, unless they had close contact with someone who was confirmed to have COVID-19.

This situation is changing constantly, and, given community transmission in the United States, relevant travel history may fall away as a requirement for getting tested for COVID-19.

Updated information on COVID-19 will be posted on this blog periodically, 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.