under the microscope
By Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM, FACSc
ovel outbreaks from any microbe are always of public
health concern. The risk from these outbreaks depends
on characteristics of the virus, including whether and how well
it spreads between people, the severity of resulting illness,
and the medical or other measures available to control the
impact of the virus (e.g., vaccine or antivirals).
The novel coronavirus (2019-nCoV) is a serious public
health threat. The fact that it has caused severe illness and
sustained person-to-person spread in China is concerning,
but it is unclear how the situation in other parts of the world
As of Feb. 13, 2020, the Centers for Disease Control and
Prevention (CDC) has reported 15 cases of 2019-nCoV, 318
negative, and 68 pending cases in the U.S., with no deaths.
The outbreak first started in Wuhan, China, but cases have
been identified in a growing number of other international
locations. Johns Hopkins Center for Systems Science and
Engineering (CSSE) has reported more than 40,000 cases
with 910 deaths in 29 countries.
With the growing concern over 2019-nCoV, exactly what
questions should healthcare professionals and others (EVS,
medical laboratory, etc.) be asking.
How does 2019-nCoV spread? While there is much to
learn regarding the transmission of this novel virus, spread
is thought to occur from person-to-person via respiratory
droplets among close contacts. Close contact can occur while
caring for a patient, including:
• Being within 6 feet (2 meters) of a patient with
2019-n-CoV for prolonged time periods.
• Direct contact with infectious secretions from a patient
with 2019-nCoV. Infectious secretions may include sputum,
serum, blood, and respiratory droplets.
If close contact occurs while not wearing all recommended
PPE, there may be risk of infection.
How long (duration) can 2019-nCoV survive outside
of a host? All viruses require a host to reproduce and
survive. It is currently unclear if a person can get 2019-nCoV
by touching a surface or object with virus on it and then
touching his or her own mouth, nose, or their eyes. Some
reports show coronavirus strains (229E) have survived more
than three hours after drying onto porous and non-porous
materials, including aluminum and sterile sponges; strain
OC43 remained infectious up to one hour. Thus, it is prudent
to remain vigilant in both the use of PPE and disinfection of
surfaces in the control of 2019-nCoV.
How can healthcare personnel (and other related
professionals) protect themselves? According to the CDC,
healthcare personnel caring for patients with confirmed or
possible 2019-nCoV should adhere to CDC recommendations
for infection prevention and control (IPC):
• Assess and triage patients with acute respiratory
symptoms and risk factors to minimize chances of exposure,
including use of facemasks on the patient and isolating them
in an Airborne Infection Isolation Room (AIIR), if available.
• Use Standard Precautions, Contact Precautions, and
Airborne Precautions and eye protection when caring
• Perform hand hygiene with alcohol-based handrub
before and after all patient contact, contact with potentially
infectious material, and before putting on and upon removal
of personal protective equipment (PPE), including gloves.
• Practice proper use PPE in a manner to prevent
• Perform aerosol-generating procedures, including
collection of diagnostic respiratory specimens, in an AIIR,
while following IPC practices, including use of appropriate PPE.
What about environmental cleaning and disinfection?
CDC states routine cleaning and disinfection procedures
are appropriate for 2019-nCoV in healthcare settings. Products
with EPA-approved emerging viral pathogens claims are
recommended. Management of laundry, food service utensils,
and medical waste should be performed in accordance with
What do we currently know about the human-to-human
transmission of this novel coronavirus? More specifically,
once one person is infected, does the coronavirus appear to
be significantly contagious in a human-to-human context?
The modes of human-to-human transmission of the virus
are still being determined, but given current evidence, it is
most likely spread by the following, according to the CDC.
• Through the air by coughing and sneezing
• Close personal contact, such as touching or shaking hands
• Touching an object or surface with the virus on it, then
touching your mouth, nose or eyes before washing your hands
• In rare cases, fecal contamination
With current data available and my professional experience,
I do not believe this novel virus is any more contagious than
the influenza virus. At this time, both appear to have similar
transmission rates (1.4 – 4) and case fatality rates (currently
holding steady at about 2 percent). Of course, this could
change, and it is why we must monitor the outbreak closely
and rely on “confirmed and accurate” laboratory test results.
Everyone should pay attention to reputable sources and
heed the advice of the government and public health experts.
The U.S. Department of State has issued a level 4 “do not
travel” advisory for China. Proper perspective is critical. There
is no need to panic. We should all do our part in not becoming
part of the problem as a “super-spreader” of inaccurate or
unchecked information surrounding this virus outbreak.
3 Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM,
FACSc, serves as chair and professor of the Clinical Laboratory
Science Program at Texas State; associate director for the
Translational Health Research Initiative; as well as associate
dean for research in the College of Health Professions. Follow
him on Twitter @RodneyRohde / @TXST_CLS, or on his website:
10 march 2020 • www.healthcarehygienemagazine.com