COVID-19 coronavirus disease 2019 caused by SARS-CoV-2
by dr Z Halat
Medical Epidemiology Consultant

SARS-CoV-2 formerly known as Novel Coronavirus (2019-nCoV)  novel-coronavirus-2019-nCoV.com, Wuhan coronavirus 武汉冠状病毒  武漢冠狀病毒) causing 2019-nCoV acute respiratory disease (ICD-10: U07.1). Codes U00-U49 are to be used by WHO for the provisional assignment of new diseases of uncertain etiology. In emergency situations codes are not always accessible in electronic systems.
A physician must contribute to the development of the profession by sharing his knowledge and experience 
ὄμνυμι Ἀπόλλωνα ἰητρὸν καὶ Ἀσκληπιὸν καὶ Ὑγείαν καὶ Πανάκειαν καὶ θεοὺς πάντας τε καὶ πάσας, ἵστορας ποιεύμενος, ἐπιτελέα ποιήσειν κατὰ δύναμιν καὶ κρίσιν ἐμὴν ὅρκον τόνδε καὶ συγγραφὴν τήνδε:

ἡγήσεσθαι μὲν τὸν διδάξαντά με τὴν τέχνην ταύτην ἴσα γενέτῃσιν ἐμοῖς, καὶ βίου κοινώσεσθαι, καὶ χρεῶν χρηΐζοντι μετάδοσιν ποιήσεσθαι, καὶ γένος τὸ ἐξ αὐτοῦ ἀδελφοῖς ἴσον ἐπικρινεῖν ἄρρεσι, καὶ διδάξειν τὴν τέχνην ταύτην, ἢν χρηΐζωσι μανθάνειν, ἄνευ μισθοῦ καὶ συγγραφῆς, παραγγελίης τε καὶ ἀκροήσιος καὶ τῆς λοίπης ἁπάσης μαθήσιος μετάδοσιν ποιήσεσθαι υἱοῖς τε ἐμοῖς καὶ τοῖς τοῦ ἐμὲ διδάξαντος, καὶ μαθητῇσι συγγεγραμμένοις τε καὶ ὡρκισμένοις νόμῳ ἰητρικῷ, ἄλλῳ δὲ οὐδενί.

διαιτήμασί τε χρήσομαι ἐπ᾽ ὠφελείῃ καμνόντων κατὰ δύναμιν καὶ κρίσιν ἐμήν, ἐπὶ δηλήσει δὲ καὶ ἀδικίῃ εἴρξειν.

οὐ δώσω δὲ οὐδὲ φάρμακον οὐδενὶ αἰτηθεὶς θανάσιμον, οὐδὲ ὑφηγήσομαι συμβουλίην τοιήνδε: ὁμοίως δὲ οὐδὲ γυναικὶ πεσσὸν φθόριον δώσω.

ἁγνῶς δὲ καὶ ὁσίως διατηρήσω βίον τὸν ἐμὸν καὶ τέχνην τὴν ἐμήν.

οὐ τεμέω δὲ οὐδὲ μὴν λιθιῶντας, ἐκχωρήσω δὲ ἐργάτῃσιν ἀνδράσι πρήξιος τῆσδε.

I swear by Apollo Physician, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.

To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician’s oath, but to nobody else.

I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein.

When the oath was rewritten in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, the prayer was omitted, and that version has been widely accepted and is still in use today by many US medical schools:[30]

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

Dr. Vladimir (Zev) Zelenko

Board Certified Family Practitioner

501 Rt 208, Monroe, NY 10950

845-238-0000


March 23, 2020

 

To all medical professionals around the world:

 

My name is Dr. Zev Zelenko and I practice medicine in Monroe, NY. For the last 16 years, I have cared for approximately 75% of the adult population of Kiryas Joel, which is a very close knit community of approximately 35,000 people in which the infection spread rapidly and unchecked prior to the imposition of social distancing.

 

As of today my team has tested approximately 200 people from this community for Covid-19, and 65% of the results have been positive. If extrapolated to the entire community, that means more than 20,000 people are infected at the present time. Of this group, I estimate that there are 1500 patients who are in the high-risk category (i.e. >60, immunocompromised, comorbidities, etc).

 

Given the urgency of the situation, I developed the following treatment protocol in the pre-hospital setting and have seen only positive results:

 

1.  Any patient with shortness of breath regardless of age is treated.

2.  Any patient in the high-risk category even with just mild symptoms is treated.

3.  Young, healthy and low risk patients even with symptoms are not treated (unless their circumstances change and they fall into category 1 or 2).

 

My out-patient treatment regimen is as follows:

 

1.  Hydroxychloroquine 200mg twice a day for 5 days

2.  Azithromycin 500mg once a day for 5 days

3.  Zinc sulfate 220mg once a day for 5 days

 

The rationale for my treatment plan is as follows. I combined the data available from China and South Korea with the recent study published from France (sites available on request). We know that hydroxychloroquine helps Zinc enter the cell. We know that Zinc slows viral replication within the cell. Regarding the use of azithromycin, I postulate it prevents secondary bacterial infections. These three drugs are well known and usually well tolerated, hence the risk to the patient is low.

 

Since last Thursday, my team has treated approximately 350 patients in Kiryas Joel and another 150 patients in other areas of New York with the above regimen.

 

Of this group and the information provided to me by affiliated medical teams, we have had ZERO deaths, ZERO hospitalizations, and ZERO intubations. In addition, I have not heard of any negative side effects other than approximately 10% of patients with temporary nausea and diarrhea.

In sum, my urgent recommendation is to initiate treatment in the outpatient setting as soon as possible in accordance with the above. Based on my direct experience, it prevents acute respiratory distress syndrome (ARDS), prevents the need for hospitalization and saves lives.
With much respect,
Dr. Zev Zelenko
cc: President Donald J. Trump; Mr. Mark Meadows, Chief of Staff

Novel coronavirus (SARS-CoV-2) Discharge criteria for confirmed COVID-19 cases – When is it safe to discharge COVID-19 cases from the hospital or end home isolation? here

This document has been produced upon request of an EU/EEA Member State. It suggests criteria to be considered when deciding whether a confirmed COVID-19 case can be safely (i.e. without being infectious) discharged from hospital or released from home isolation. To address this request, the following working questions were developed:  What is the duration of SARS-CoV-2 virus shedding in bodily fluids of symptomatic patients after remission of symptoms?  What is the duration of SARS-CoV-2 virus shedding in bodily fluids of asymptomatic patients?  Which tests are available to document the lack of infectivity in a previously diagnosed infection?  What is the longest documented transmission from an asymptomatic person? Below ECDC provides a desk review of existing guidance documents and protocols from national and international organisations and a convenient search of peer-reviewed publications. What is the duration of SARS-CoV-2 virus shedding in bodily fluids of symptomatic patients after remission of symptoms? SARS-CoV-2 virus can initially be detected 1–2 days prior to symptom onset in upper respiratory tract samples; the virus can persist for 7–12 days in moderate cases and up to 2 weeks in severe cases (WHO mission to China Report) [1]. In faeces, viral RNA has been detected in up to 30% of patients from day 5 after onset and up to 4 to 5 weeks in moderate cases. The significance of faecal viral shedding for transmission still has to be clarified [1]. Prolonged viral shedding from nasopharyngeal aspirates – up to at least 24 days after symptom onset – was reported among COVID-19 patients in Singapore [2]. Researchers from Germany also reported prolonged viral shedding with high sputum viral load after recovery in a convalescent patient [3]. They acknowledge, however, that viability of SARS-CoV-2 detected by qRT-PCR in this patient has not been proven by viral culture. Prolonged virus shedding has been observed among convalescent children after mild infections, in respiratory tract samples (22 days) and faeces (between two weeks and more than one month) [4]. A shift from positive oral swab samples during early infection to positive rectal swab samples during late infection was observed on Chinese patients; the authors raised concerns about the fact that COVID-19 patients were discharged from hospital on the basis of negative oral swabs [5]. Discharge criteria for confirmed COVID-19 cases ECDC TECHNICAL REPORT 2 Researchers from China report that in upper respiratory specimens, the pattern of viral nucleic acid shedding in SARS-CoV-2-infected patients resembles that of patients with influenza; it also appears to be different from the pattern seen in patients infected with SARS-CoV-1 [6]. ECDC comment: Although the oral-faecal route does not appear to be a driver of transmission, its significance remains to be determined. Discharged patients should be advised to strictly follow personal hygiene precautions in order to protect household contacts. This applies to all convalescing patients, but particularly to convalescent children. What is the duration of SARS-CoV-2 virus shedding in bodily fluids of asymptomatic patients? The virus has been detected in asymptomatic persons. Pan et al. report on a family cluster where a mother and a child were both asymptomatic but had positive RT-PCR results [7] . Hoehl et al. (2020) also report that two out of 114 Germans who were evacuated from Hubei province on 1 Feb 2020 tested positive in two throat swab specimens by RT-PCR and presented no symptoms [8]. The two persons were isolated in a hospital in Frankfurt where a faint rash and minimal pharyngitis was observed in one of them. Both patients were still well and afebrile 7 days after admission. Potential infectivity was confirmed by virus culture. Zou et al. 2020 report that the viral load of asymptomatic patients was similar to symptomatic patients, indicating a transmission potential of asymptomatic or pre-symptomatic patients [6]. The study reports that patients with few or no symptoms had modest levels of detectable viral RNA in the oropharynx for at least 5 days [6]. Potential transmission from asymptomatic persons has been reported. Bai et al. 2020 report a familial cluster of five COVID-19 patients hospitalised with fever and respiratory symptoms that had contact before onset of symptoms with an asymptomatic family member, a young 20-year-old woman, after her return from Wuhan. She remained asymptomatic for the entire duration of laboratory and clinical monitoring (19 days) [9]. ECDC comment: Provided that there are sufficient resources, there is a clear benefit in testing asymptomatic patients before they are released from isolation. However, in the context of limited resources for healthcare and laboratories during the COVID-19 epidemic, the testing of symptomatic persons should have priority over the testing of asymptomatic patients before release from isolation. Which tests are available to document the lack of infectivity in a previously diagnosed infection? On its website, ECDC provides the following advice. The specific tests currently recommended by WHO for the diagnosis and confirmation of SARS-CoV-2 are described on a dedicated WHO webpage. A single positive test should be confirmed by a second RT-PCR assay targeting a different SARS-CoV-2 gene. A single negative SARSCoV-2 test (especially if from an upper respiratory tract specimen) or a positive test result for another respiratory pathogen result does not exclude SARS-CoV-2 infection. A high RT-PCR cycle threshold value (e.g. > 35) obtained as a result in E-gene RT-PCR could be due to E-gene positive control contamination of reagents. In countries where the epidemic is not yet widespread, all positive results should therefore be confirmed by a second gene target. In countries with a widespread epidemic, one gene target is considered enough (see WHO’s updated laboratory guidance). However, confirmation of positive test results that have high CT values should still be considered in all regions and countries. What is the longest documented transmission from an asymptomatic person? There is insufficient evidence to provide a qualified answer to this question. Significance of persistence of viral RNA vs. infectious virus? Viral RNA can persist over long periods of time in bodily fluids. This does not necessarily mean that the person is still infectious. Isolation of viruses in virus culture is needed to show the infectivity of the virus. Hoehl et al. 2020 reported infectious virus from two asymptomatic cases [8]. An overview of recommendations for the de-isolation of COVID-19 patients from national bodies in countries that have experienced local transmissions of SARS-CoV-2 is presented in the Table below.  Despite of some differences in practice, a consensus exists to combine a) the evidence for viral RNA clearance from the upper respiratory tract with b) the clinical resolution of symptoms. Discharge criteria for confirmed COVID-19 cases ECDC TECHNICAL REPORT 3  At least two upper respiratory tract samples negative for SARS-CoV-2, collected at ≥ 24-hour intervals are recommended to document SARS-CoV-2 clearance.  For symptomatic patients after the resolution of symptoms, samples should be collected at least seven days after the onset or after > 3 days without fever.  For asymptomatic SARS-CoV-2-infected persons, the tests to document virus clearance should be taken at a minimum of 14 days after the initial positive test.  Italy indicates that serology tests to document IgG antibody specific to SARS-CoV-2 will be of value. Table: Comparison of current guidelines on de-isolation of COVID-19 cases Symptomatic cases, hospitalised Asymptomatic infections, persons isolated at home Ministero della salute, Consiglio Superiore di Sanità, Italy (28 February 2020) A COVID-19 patient can be considered cured after the resolution of symptoms and 2 negative tests for SARSCoV-2 at 24-hour intervals. For patients who clinically recover earlier than 7 days after onset, an interval of 7 days between the first and the final test is advised. Note: Virus clearance is defined as viral RNA disappearance from bodily fluids of symptomatic and asymptomatic persons, accompanied by appearance of specific IgG. Negative SARS-CoV-2 RNA test at 14 days after the first test (end of the quarantine period). China CDC Diagnosis and treatment protocol for COVID-19 patients (trial version 7, revised) Patients meeting the following criteria can be discharged:  Afebrile for >3 days,  Improved respiratory symptoms,  pulmonary imaging shows obvious absorption of inflammation, and  nucleic acid tests negative for respiratory tract pathogen twice consecutively (sampling interval ≥ 24 hours). After discharge, patients are recommended to continue 14 days of isolation management and health monitoring, wear a mask, live in a single room with good ventilation, reduce close contact with family members, eat separately, keep hands clean and avoid outdoor activities. It is recommended that discharged patients should have follow-up visits after 2 and 4 weeks. National Centre for Infectious Diseases (NCID) Singapore De-isolation of COVID-19 suspect cases: link Discharge patient with advisory and clinic follow-up if indicated and with daily wellness calls until day 14 after last possible exposure, under the following conditions:  Afebrile ≥ 24 hours,  2 respiratory samples tested negative for SARSCoV-2 by PCR in ≥ 24 hours,  Day of illness from onset ≥ 6 days  OR  Alternative aetiology found (e.g. influenza, bacteraemia)  OR  Not a close contact of a COVID-19 case  Does not require in-patient care for other reasons. CDC USA Interim guidance for discontinuation of transmissionbased precautions and disposition of hospitalized patients with COVID-19: link Negative rRT-PCR results from at least 2 consecutive sets of nasopharyngeal and throat swabs collected ≥ 24 hours apart from a patient with COVID-19 (a total of four negative specimens) AND resolution of fever, without use of antipyretic medication, improvement in illness signs and symptoms. Note: decision to be taken on a case-by-case basis in consultation with clinicians and public health officials Discharge criteria for confirmed COVID-19 cases ECDC TECHNICAL REPORT 4 Symptomatic cases, hospitalised Asymptomatic infections, persons isolated at home CDC USA Interim guidance for discontinuation of in-home isolation for patients with COVID-19: link At least 2 consecutive sets of nasopharyngeal and throat swabs collected ≥ 24 hours apart from a patient with COVID-19 (a total of four negative specimens) AND resolution of fever, without use of antipyretic medication, improvement in illness signs and symptoms. Note: decision to be taken on a case-by-case basis in consultation with clinicians and public health officials Conclusions When deciding on criteria for hospital discharge of COVID-19 patients, health authorities should take into account several factors such as the existing capacity of the healthcare system, laboratory diagnostic resources, and the current epidemiological situation. In the early stages of SARS-CoV-2 spread (limited number of cases and no apparent sustained transmission: scenarios 1 and 2 in ECDC’s Rapid Risk Assessment – fifth update) and with no pressure on healthcare facilities and optimal laboratory testing capacity, COVID-19 patients may be discharged from hospital and moved to home care (or other types of non-hospital care and isolation) based on:  clinical criteria (e.g. no fever for > 3 days, improved respiratory symptoms, pulmonary imaging showing obvious absorption of inflammation, no hospital care needed for other pathology, clinician assessment)  laboratory evidence of SARS-CoV-2 clearance in respiratory samples; 2 to 4 negative RT-PCR tests for respiratory tract samples (nasopharynx and throat swabs with sampling interval ≥ 24 hours). Testing at a minimum of 7 days after the first positive RT-PCR test is recommended for patients that clinically improve earlier.  Serology: appearance of specific IgG when an appropriate serological test is available. In the context of sustained widespread transmission (scenario 3 and 4 in ECDC’s Rapid Risk Assessment – fifth update) with increasing pressure on healthcare systems or when healthcare facilities are already overwhelmed and laboratory capacity is restrained, alternative algorithms for hospital discharge of COVID-19 patients are warranted. The discharge from hospital of mild cases – if clinically appropriate – may be considered, provided that they are placed into home care or another type of community care. After discharge, 14 days of further isolation with regular health monitoring (e.g. follow-up visits, phone calls) can be considered, provided the patient’s home is equipped for patient isolation and the patients takes all necessary precautions (e.g. single room with good ventilation, face-mask wear, reduced close contact with family members, separate meals, good hand sanitation, no outdoor activities) in order to protect family members and the community from infection and further spread of SARS-CoV-2. Due to increasing evidence of virus shedding through faeces by convalescent patients, particularly children, recommendations for careful personal hygiene precautions after de-isolation are warranted. Discharge criteria for confirmed COVID-19 cases ECDC TECHNICAL REPORT 5 References 1. World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID19). Geneva: WHO; 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/whochina-joint-mission-on-covid-19-final-report.pdf. 2. Young BE, Ong SWX, Kalimuddin S, Low JG, Tan SY, Loh J, et al. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. JAMA. 2020. 3. Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, et al. Transmission of 2019-nCoV Infection from an asymptomatic contact in Germany. New England Journal of Medicine. 2020;382(10):970-1. 4. Cai J, Xu J, Lin D, Yang z, Xu L, Qu Z, et al. A case series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clinical Infectious Diseases. 2020. 5. Zhang W, Du R-H, Li B, Zheng X-S, Yang X-L, Hu B, et al. Molecular and serological investigation of 2019- nCoV infected patients: implication of multiple shedding routes. Emerging Microbes & Infections. 2020 2020/01/01;9(1):386-9. 6. Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 Viral load in upper respiratory specimens of infected patients. New England Journal of Medicine. 2020. 7. Pan X, Chen D, Xia Y, Wu X, Li T, Ou X, et al. Asymptomatic cases in a family cluster with SARS-CoV-2 infection. The Lancet Infectious Diseases. 2020 2020/02/19/. 8. Hoehl S, Rabenau H, Berger A, Kortenbusch M, Cinatl J, Bojkova D, et al. Evidence of SARS-CoV-2 infection in returning travelers from Wuhan, China. New England Journal of Medicine. 2020. 9. Bai Y, Yao L, Wei T, Tian F, Jin D-Y, Chen L, et al. Presumed Asymptomatic carrier transmission of COVID-19. JAMA. 2020.



How to use ICD-10-CM, new lab testing codes for COVID-19

from the AAP Division of Health Care Finance
March 12, 2020
Coding Corner
How to use ICD-10-CM, new lab testing codes for COVID-19

from the AAP Division of Health Care Finance

The introduction of 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) in the United States has produced an influx of patients into the health care system. While knowing how to diagnose and treat these patients is vital, being able to appropriately capture this information for data tracking and payment also is important. The National Center for Healthcare Statistics has developed a resource for International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding that already is in effect.

COVID-19 attacks the respiratory system; therefore, suspicion of the disease typically will accompany respiratory conditions. A confirmation of COVID-19 will therefore be linked to a specific respiratory condition.

Coding guidance: ICD-10-CM

Pneumonia: For a pneumonia case confirmed as due to the 2019 novel coronavirus (COVID-19), assign codes J12.89, Other viral pneumonia, and B97.29, Other coronavirus as the cause of diseases classified elsewhere.
Acute bronchitis: For a patient with acute bronchitis confirmed as due to COVID-19, assign codes J20.8, Acute bronchitis due to other specified organisms, and B97.29. If the bronchitis is not specified as acute, due to COVID-19, report code J40, Bronchitis, not specified as acute or chronic, along with code B97.29.
Lower respiratory infection: If the COVID-19 is documented as being associated with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS, report with code J22, Unspecified acute lower respiratory infection, with code B97.29. If the COVID-19 is documented as being associated with a respiratory infection, NOS, it would be appropriate to assign code J98.8, Other specified respiratory disorders, with code B97.29.
Acute respiratory distress syndrome (ARDS): ARDS may develop in conjunction with COVID-19. Cases with ARDS due to COVID-19 should be assigned the codes J80, Acute respiratory distress syndrome, and B97.29.
Exposure to COVID-19: For cases where there is possible exposure to COVID-19, but the disease is ruled out, report code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out. For cases where there is an actual exposure to someone who is confirmed to have COVID-19, report code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. This code is not necessary if the exposed patient is confirmed to have COVID-19.
Signs and symptoms: For patients presenting with any signs/symptoms and where a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as: Cough (R05); Shortness of breath (R06.02) or Fever unspecified (R50.9).
Do not report “suspected” cases of COVID-19 with B97.29. In addition, diagnosis code B34.2, Coronavirus infection, unspecified, typically is not appropriate.

Coding guidance: procedural

There are no unique codes for evaluating and managing this condition; however, be sure to clearly document any additional time spent with the family or time spent coordinating any care that is not face-to-face with the patient and/or family.

Testing

There is no code for swabbing the patient for COVID-19, much like there is no code for swabbing for influenza. However, if the specimen will be prepared by your office and sent to an outside lab, report the specimen collection code 99000.

The Centers for Medicare & Medicaid Services (CMS) developed two new lab testing codes:

U0001 will be reported for coronavirus testing using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel.
U0002 will be reported for validated non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19).
If your office is not running the test for COVID-19 or incurring the cost, you will not report these codes.

The American Medical Association Current Procedural Terminology (CPT) Editorial Panel has developed a CPT code which streamlines novel coronavirus testing offered by hospitals, health systems, and laboratories in the United States. The code was effective March 13, 2020, for use as the industry standard for reporting of novel coronavirus tests across the nation’s health care system.

87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique

Telehealth

As concerns arise over the easy spread of COVID-19, increasing the use of telehealth has been proposed. In this instance, telehealth is referring only to the synchronous live videoconferencing. Knowing your state laws and payer rules is important in this instance. (See resources for AAP fact sheet on coding for telehealth services and help in navigating your state laws on telehealth services.)

Advocacy and payment

The AAP is monitoring health plan carrier uptake of the new Healthcare Common Procedure Coding System (HCPCS) Level II codes: U0001 and U0002. Per CMS, the Medicare claims processing system will be able to accept this code for payment as of April 1 for dates of service on or after Feb. 4, 2020.

The Academy sent inquiries to the largest national carriers (Aetna, Anthem, Cigna, Humana and UnitedHealthcare) to ascertain their coverage policies. The carriers will offer the test with no patient out-of-pocket expense, and as of press time, Humana replied that it will follow CMS with retroactive coverage to Feb. 4, 2020. Carriers are waiting for CMS to value COVID-19 testing before establishing their fee schedules for the test. In the interim, providers should check their carrier contract regarding payments for services not included in the fee schedule (e.g., payment as a percentage of billed charges).

Additionally, several carriers are waiving co-payments for all diagnostic testing related to COVID-19 and for video visits (in lieu of office visits) for synchronous virtual care (live videoconferencing only).



HCoV-19 (SARS-2) virus could be detected in aerosols up to 3 hours post aerosolization, up to 4 hours on copper, up to 24 hours on cardboard and up to 2-3 days on plastic and stainless steel. HCoV-19 and SARS-CoV-1 exhibited similar half-lives in aerosols, with median estimates around 2.7 hours. Both viruses show relatively long viability on stainless steel and polypropylene compared to copper or cardboard: the median half-life estimate for HCoV-19 is around 13 hours on steel and around 16 hours on polypropylene. Our results indicate that aerosol and fomite transmission of HCoV-19 is plausible, as the virus can remain viable in aerosols for multiple hours and on surfaces up to days.

The Coronavirus May Linger On Plastic And Stainless Steel For Days, A Preliminary Study Found
A preliminary study sheds more light on the virus’s ability to linger in the environment.
Stephanie M. Lee
BuzzFeed News Reporter
Posted on March 11, 2020, at 6:33 p.m. ET

“This is not surprising — it’s excellent science,” said David Weber, an epidemiologist and infectious disease expert at the University of North Carolina at Chapel Hill, who was not involved with the new paper. “It adds to what we know about COVID[-19],” the name of the disease caused by the new coronavirus.

Previous studies have detected the MERS virus, also a type of coronavirus, on steel and plastic surfaces for up to two days, and the SARS virus on plastic for up to five days.

Weber said that the paper is important because it sheds further light on how SARS-CoV-2 behaves. But he noted that it doesn’t explain how much surface or air contact might actually contribute to someone’s likelihood of getting sick.

Suppose that an infected person rubs their nose and touches a plastic door handle, which is in turn touched by someone else who rubs their own nose. “Does that account for 0.01% of transmissions or 15% of transmissions?” Weber said. “We don't know how frequent it is.”

The scientists ran a battery of tests with a strain of SARS-CoV-2. They sprayed it into a rotating drum and measured how long it stayed in the air: three hours. They also deposited small amounts on plastic and stainless steel (up to two to three days), copper (up to four hours), and on cardboard (24 hours). The authors of the paper did not immediately return a request for comment.

Weber said that although the results of the aerosol study seemed legitimate, they weren’t clearly applicable to real-world conditions. “The question is, do you have enough virus in the air so that someone 15 feet away could get infected like they could with measles?” he said. “This doesn't really prove this to me one way or another.”

He also noted that in the open air, viruses tend to dry out from humidity or be killed off by ultraviolet light.

If proven true, the findings would further reinforce the need to adhere to the CDC’s existing coronavirus guidelines, Weber said.

The agency advises staying at least six feet away from people who are coughing and sneezing, and cleaning and disinfecting frequently touched surfaces in household common areas, from sinks to light switches to tables.

Peplomer aka spike protein
SARs-CoV-2 attacks human host cells through the ACE-2 receptors, then furin targets, GRP78 receptors, and
receptor CD147
Angiotensin-converting enzyme 2 (ACE2), a homologue of ACE, is one of the important receptors on the cell membrane of the host cells. The interaction of SP and ACE2 contributes to the SARS-CoV invasion for human host cells.
 SARS-CoV-2 invaded host cells via a novel route of CD147-spike protein (SP). SP bound to CD147, a receptor on the host cells, thereby mediating the viral invasion.SARS-CoV-2 invades host cells via a novel route: CD147-spike protein
Glikoproteina kolca nowego koronawirusa 2019-nCoV zawiera miejsce cięcia podobne do furiny, nieobecne w CoV tego samego kladu
The spike glycoprotein of the new coronavirus 2019-nCoV contains a furin-like cleavage site absent in CoV of the same clade




World Health Organization declared that the outbreak of 2019-nCoV constitutes a Public Health Emergency of International Concern (PHEIC)
see how they dealt with ebola crisis before and now
ebola-virus-disease.com


The epidemic of 1679 commemoration: The Plague Column formally Holy Trinity and the nine choirs of angels, 1694, Pestsäule, Heilige Dreifaltigkeit und zu den 9 Chören der Engel, Graben, Vienna, Austria. Fine Art Photography by Zbigniew Halat i.e. HalatFineArt
Upamiętnienie epidemii z 1679 r .: Kolumna Morowa formalnie Święta Trójca i dziewięć chórów aniołów, 1694, Pestsäule, Heilige Dreifaltigkeit und zu den 9 Chören der Engel, Graben, Wiedeń, Austria.The epidemic of 1679 commemoration: The Plague Column formally Holy Trinity and the nine choirs of angels, 1694, Pestsäule, Heilige Dreifaltigkeit und zu den 9 Chören der Engel, Graben, Vienna, Austria. Fine Art Photography by Zbigniew Halat

Discovery of a novel coronavirus associated with the recent pneumonia outbreak in humans and its potential bat origin
Peng Zhou, Xing-Lou Yang, Xian-Guang Wang, Ben Hu, Lei Zhang, Wei Zhang, Hao-Rui Si, Yan Zhu, Bei Li, Chao-Lin Huang, Hui-Dong Chen, Jing Chen, Yun Luo, Hua Guo, Ren-Di Jiang, Mei-Qin Liu, Ying Chen, Xu-Rui Shen, Xi Wang, Xiao-Shuang Zheng, Kai Zhao, Quan-Jiao Chen, Fei Deng, Lin-Lin Liu, Bing Yan, Fa-Xian Zhan, Yan-Yi Wang, Gengfu Xiao, Zheng-Li Shi
doi: https://doi.org/10.1101/2020.01.22.914952
This article is a preprint and has not been certified by peer review [what does this mean?].
AbstractInfo/HistoryMetrics Preview PDF
Abstract
Since the SARS outbreak 18 years ago, a large number of severe acute respiratory syndrome related coronaviruses (SARSr-CoV) have been discovered in their natural reservoir host, bats. Previous studies indicated that some of those bat SARSr-CoVs have the potential to infect humans. Here we report the identification and characterization of a novel coronavirus (nCoV-2019) which caused an epidemic of acute respiratory syndrome in humans, in Wuhan, China. The epidemic, started from December 12th, 2019, has caused 198 laboratory confirmed infections with three fatal cases by January 20th, 2020. Full-length genome sequences were obtained from five patients at the early stage of the outbreak. They are almost identical to each other and share 79.5% sequence identify to SARS-CoV. Furthermore, it was found that nCoV-2019 is 96% identical at the whole genome level to a bat coronavirus. The pairwise protein sequence analysis of seven conserved non-structural proteins show that this virus belongs to the species of SARSr-CoV. The nCoV-2019 virus was then isolated from the bronchoalveolar lavage fluid of a critically ill patient, which can be neutralized by sera from several patients. Importantly, we have confirmed that this novel CoV uses the same cell entry receptor, ACE2, as SARS-CoV.



The 1567 plague epidemic killed a third of the inhabitants of Wroclaw. Are we globally helpless again?
The 1567 plague epidemic killed a third of the inhabitants of Wroclaw. Are we globally helpless again? Epitaph paintings by Tobias Fendt, 1567: Christ pronounces the Final Judgement and Family of the deceased on the background panorama of Wroclaw. Fine Art Photography by Zbigniew Halat
Epitaph paintings by Tobias Fendt, 1567: Christ pronounces the Final Judgement and Family of the deceased on the background panorama of  Wroclaw, National Museum in Wroclaw, Poland. Fine Art Photography by Zbigniew Halat


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