Boston Globe Media: Stat; 2020
Boston Globe Media: Stat; 2020. professionals about the evolving way in which the diagnosis of Coronavirus Disease 2019 (COVID-19) is being made, with an emphasis on assessments to assist in making that diagnosis, some of Dibutyl phthalate which are available now, while others are in the process of becoming available. These assessments will also better define the risk Dibutyl phthalate of fatality due to COVID-19 by better identifying those who have been infected. This column will also provide some general information about the disease and its relative risks. For readers who want more information and the ability to stay current, links to credible websites that are being constantly updated are also included. COVID-19 and the media coverage concerning it have created great concern among both the general population and healthcare providers. This distress is likely to be further amplified in those who have significant psychiatric illnesses, including but not limited to stress disorders, major depressive disorder, bipolar disorder, and psychotic illnesses. Mental health care providers are therefore likely to encounter patients with questions and concerns about this illness. I hope that this column will help those professionals answer questions and concerns that their patients have. In the interest of brevity, this column will focus on the following questions: What is the definition of a case and how is that changing? What types of tests are available and what types of tests are coming? How will the availability of these tests impact probabilities of serious risk including fatalities? What is likely to happen after the first wave of COVID-19? SOME CAVEATS Readers should keep in mind a number of caveats as context for this column. First, it is being written as of March 26, 2020, the day on which the highest number of deaths from the virus in the United States occurred to date237, with total US deaths now exceeding 1000. Changes are occurring rapidly so that this column may be dated in a short time. Nevertheless, the information is timely for practitioners now. To help keep it current, the references include links to websites from credible sources that are being continuously updated, so that readers can go to those sources for additional current information even months after this column has been published. Second, I am a physician specializing in psychiatry and clinical pharmacology rather than infectious diseases, virology, or other related medical and laboratory specialties. However, I did 2 years of anatomical pathology during which I studied viral diseases. After that, I did my general medical internship followed by my psychiatry residency. Subsequently, I have spent 40 years as an academic physician with an emphasis on all phases of drug development research, and I have read the current literature on COVID-19. A BRIEF BACKGROUND Coronaviruses are a large family of viruses that are so named because of the crown-like spikes observed on their surface when viewed by electron microscopy. There are hundreds of coronaviruses, most of which circulate among animals, including pigs, camels, bats, and cats. Sometimes those viruses jump to humanscalled a spillover eventand can cause disease. Seven coronaviruses are known to cause human disease. Four of these human coronaviruses (HCoVs)HCoV-229E, HCoV-OC43, HCoV-NL63, and HCoV-HKU1usually cause a mild to moderate upper respiratory illness (eg, the common cold) in people. These 4 viruses continually circulate in the human population and cause respiratory infections in adults and children worldwide.1 However, 3 more recent coronaviruses can cause severe acute respiratory syndrome (SARS) with more serious outcomes in JAM3 people, including death. These 3 viruses and the diseases associated with them are: (a) SARS-CoV (now more commonly called SARS-CoV-1), which emerged in late Dibutyl phthalate 2002 and disappeared by 2004; (b) Middle East respiratory syndrome (MERS) virus, which emerged in 2012 and remains in circulation in camels; and (c) SARS-CoV-2 which emerged in December 2019 in China and causes the disease, COVID-19.2C4 WHAT IS THE DEFINITION OF A COVID-19 CASE AND HOW IS IT CHANGING? The first definition of COVID-19 was based solely on signs and symptoms of the infection (principally fever, cough, Dibutyl phthalate and shortness of breath) and ruling out other possible causes, particularly negative tests for influenza. This approach is still common but has been enhanced by a test to detect active shedding of the COVID-19 virus in respiratory specimens, mainly via upper nasal swabs. These tests use real time Reverse Transcriptase.