Mayo Medical Laboratories is excited to introduce a new regular video series, "Outside the Berry Box." This series will provide you a brief update on a specific subject related to the laboratory medicine and pathology industry. The first video provides a quick update about a novel coronavirus in the Arabian Peninsula.
In mid-March, the Centers for Disease Control and Prevention and the World Health Organization announced the presence of a novel coronavirus in the Arabian Peninsula and the United Kingdom. In this video, Matthew Binnicker, Ph.D., laboratory director of the Mayo Clinic Virology Laboratory, outlines key things health care providers should know about this coronavirus and proper testing protocol.
In mid March, the Centers for Disease Control and Prevention and the World Health Organization announced the presence of a novel coronavirus in the Arabian Peninsula and the United Kingdom. To learn more about this novel coronavirus and what health care providers need to know about it, we sat down with Dr. Matthew Binnicker, the laboratory director of the Mayo Clinic Virology Laboratory. We started off by asking him to provide us a little more background on this novel coronavirus.
Dr. Binnicker, can you please give us a little background on the novel coronavirus that has been identified in the Middle East?
There are many serotypes of Coronavirus, and when we become infected with the common types of this virus, symptoms are generally mild and we experience a cold-like syndrome that typically lasts about 1 week. But sometimes these viruses mutate, and acquire traits that make them more virulent. And that’s the case with a recent, novel Coronavirus that’s been detected in 15 patients over the past 12 months. Most of these patients have experienced severe acute respiratory illness, and nine of the 15 individuals, or 60%, have died from the infection. So there’s obviously something unique about this strain of virus. It’s important to point out that the majority of the patients that have been infected with this virus are from the Middle East, and no cases have been reported yet in the United States.
The World Health Organization and the Centers for Disease Control and Prevention recently established a case definition for possible novel CoV infection. What are some of the key aspects of the case definition that providers should know?
During the very early stages of the illness, it may be challenging for healthcare providers to distinguish the novel Coronavirus infection from other common respiratory diseases, like Influenza. This is because patients with the novel Coronavirus have developed, primarily, a respiratory illness, which has been accompanied by a fever and cough in most of the cases. So these aren’t very specific symptoms. And because of this, it’s important for providers to gather some more information. First, is their a high suspicion that the patient has pneumonia or severe respiratory distress? This is usually determined based on clinical features, as well as obtaining a chest X-ray. Second, and probably most important at this time, is has the patient traveled to the Middle East within the past 10 days, or, have they been in close contact with a sick person who has recently visited this area? And finally, have other more common infections, like influenza, been ruled-out? Each of these factors should be taken into consideration when evaluating an individual with possible novel Coronavirus infection.
If a provider suspects a novel Coronavirus infection, what should they do?
If a patient meets each of the case-definition criteria, which again are 1) the appropriate clinical symptoms, 2) evidence of pneumonia or severe respiratory distress, 3) recent travel history to the Middle East, and 4) no other diagnosis…the first thing a healthcare provider should do is place the patient in the appropriate isolation precautions, and then contact their state health laboratory or the CDC. These public health laboratories will be able to evaluate the patient’s clinical and travel history, and arrange for laboratory testing, if they determine that it’s necessary.
Samples for viral culture from suspected cases of the novel coronavirus should not be sent to Mayo Clinic. Can you clarify what testing should continue to be sent to reference laboratory partners?
If there is a high degree of suspicion for a case of novel Coronavirus infection, we’re asking that providers don’t submit samples to a clinical laboratory for viral culture. This is because, once we grow the virus in culture, it may pose a serious health risk to our laboratory staff. You need to take a certain, high level of precaution when working with this virus, and that is best suited for a lab like the one at CDC. However, clinical labs can perform “rule-out” testing for other, more common respiratory infections, like influenza or RSV, using molecular tests, like PCR. This is because when these tests are ordered, the lab won’t be growing the virus, but instead, they’ll be inactivating the virus, isolating its RNA…or it’s genome, and then using certain tests to detect whether those viruses are present or not.
Dr. Binnicker, do you have any additional thoughts on what providers should know about novel coronavirus testing?
I think the most important thing at this point is for doctors and lab staff to be aware that a novel Coronavirus has been detected, it has a high mortality rate, but right now cases seem to be limited primarily to the Middle East, and several cases have occurred in the United Kingdom. Another important point that I should make, is that although this new virus comes from the same family as SARS, which we saw back in 2003, the CDC has determined that it’s not the same virus. And finally, I’d just reiterate that if a provider sees a patient with a severe respiratory disease, who has recently traveled to the Middle East, the best thing that they can do is to contact their state health lab or the CDC, and those agencies will be able to help determine whether specific testing for the novel Coronavirus is needed.