Learning from the SARS outbreak, which started as animal-to-human transmission during the first phase of the epidemic, all game meat trades should be terminate to prevent this portal of transmission. At the same time, we could not ignore the environmental assessments at the seafood market and investigations to identify the pathogen causing the outbreak.
Person-to-person transmission was efficient and super-spreading events had led to major outbreaks in public gathering places. The severity of disease is an important indirect factor helps to identify those who had been infected. If infection does not cause serious disease or asymptomatic infection, infected people probably end up in health care centers. Instead, they would go to work and travel, thereby potentially spreading the virus to their contacts . Recent epidemiological survey and studies showed the patients who did not travel to Wuhan became infected with the virus after several days of contact with the family members. None of the family members had contacts with Wuhan markets or animals, neither had visited a Wuhan hospital . Person-to-person transmission in family homes or hospital, and intercity spread of 2019-nCoV are occurring, and therefore vigilant control measures are warranted at the whole stage of the epidemic.
Fortunately, with the spread of the new coronavirus accelerating, Chinese authorities responded not only treating the patients and isolating new cases as identified, tracing the contact, but also extended travel restrictions to 48 million people in hardest-hit Hubei province, banned inter-province buses to Beijing and canceled tour group travel abroad [25, 26]. However it is not completely under control, people with symptoms of pneumonia reported travel history to Wuhan have been identified at international airports over the past week.
It is crucial to isolate patients, trace and quarantine contacts as early as possible because asymptomatic infection began to appear . Most importantly, the extent of interhuman transmission needs to be determined. Transmission of SARS-CoV and MERS-CoV occurred to a large extent by means of superspreading events [27, 28]. Superspreading events have been implicated in 2019-nCoV transmission, so educate the public on both food and personal hygiene, and compliance to infection isolation to prevent super-spreading events deserves highly attention.
Transmission of 2019-nCoV probably occurs through spreading airborne and contact. Aerosol and fecal–oral transmission remain unclear . Public health measures, including quarantining in the community as well as timely diagnosis and strict adherence to universal precautions in health care settings , were critical in reducing the transmission of 2019-nCoV.
For healthcare personnel, to minimize the chance of exposures to 2019-nCoV needs to follow the standard of contact and airborne precautions, personal protection including gloves, gowns, respiratory protection, eye protection, and hand hygiene. Some procedures performed on 2019-nCoV infected patients could generate infectious aerosols, e.g., nasopharyngeal specimen collection, sputum induction, and open suctioning of airways should be performed cautiously. If performed, these procedures should take place in an airborne infection isolation room, and personnel should use respiratory and eye protection, and hand hygiene . In addition, management of environmental infection control including laundry, food service utensils, and medical waste should also be performed. Artificial Intelligence (AI), alternative selection to reducing infection for medical personnel, should be explored (Joint developed by Respiratory Research Institution of Zhongshan Hospital, Fudan University and RealMax Ltd Co), which will be benefit for remote guidance of practices.
No antiviral treatment for coronavirus infection has been proven to be effective. Previous studies showed the combination of lopinavir and ritonavir may be beneficial for SARS-CoV and MERS-CoV infected patients [31, 32]. Treatment with intravenous remdesivir (a novel nucleotide analogue prodrug in development) showed significant improvement for the first case in US . A trial has been initiated quickly to assess the efficacy and safety of remdesivir in patients hospitalized with 2019-nCoV infection. Recently, a potent binding of 2019-nCoV spike protein by a SARS-CoV specific human monoclonal antibody were under investigation .
As the cytokine storm was observed in severe 2019-nCoV infection patients, low dose corticosteroids has been used to treat the patients for possible benefit by reducing inflammatory-induced lung injury. However, corticosteroids did not reduce the mortality for SARS-CoV and MERS-CoV infection by WHO interim guidance [34, 35].
Treatment regiments were classified into three categories depends on the severity of the disease: (1) For mild to moderate disease, the major treatment is supportive therapy ; (2) for severe disease, oxygen inhalation through mask, high nasal oxygen flow inhalation, or non-invasive ventilation is needed. Careful and dynamic evaluation of patients oximeter and Chest imaging as well as laboratory examination is important; (3) for very severe disease, protective mechanical ventilation after tracheal intubation is required, and prone position ventilation followed if P/F ratio not improved, and eventually extracorporeal membrane oxygenation (ECMO) might be implemented if prone position plus mechanical ventilation did not work. Notably, the anxiety and depression of patients need to be consideration. We should not only pay attention to disease treatment, but also the mental issues of patients.
In addition, some traditional Chinese medicine (TCM), such as Snow Lotus (Saussuea involucrata), LianHuaQingWen , LiuShenWan  might be beneficial for coronavirus infection treatment through immunity enhancement. Further evidence is needed to assess the effect of TCM treatment for patients infected with 2019-nCoV.